%0 Journal Article %J Journal of the American Geriatrics Society %D Forthcoming %T Association between experiencing low healthcare quality and developing dementia. %A Aravena, José M %A Chen, Xi %A Levy, Becca R %K Dementia %K healthcare quality indicators %K Patient Satisfaction %K Perceived Discrimination %K Social determinants of health %X

BACKGROUND: Low healthcare quality has been found to predict the development of a number of illnesses in older adults. However, it has not been investigated as a determinant of dementia. Thus, the goal of this study was to assess whether experiencing low healthcare quality is associated with developing dementia in people aged 60 and older.

METHODS: Participants in the Health and Retirement Study, without dementia and aged 60 and older at baseline, were followed from 2006 to 2019. Experiencing low healthcare quality was assessed at baseline through questions about healthcare discrimination and dissatisfaction with healthcare services. The outcome, development of new cases of dementia, was determined through physician diagnosis or a cognition score compatible with dementia (assessed by the Telephone Interview for Cognitive Status). Cox regression was used to estimate the hazard ratio (HR) of dementia, adjusting for participants' demographic, health, and socioeconomic factors.

RESULTS: Among the 3795 participants included in the cohort, 700 developed dementia. Experiencing low healthcare quality was associated with increased dementia risk over 12 years (unadjusted HR: 1.68, 95% CI: 1.27-2.21, p-value <0.001; fully adjusted HR: 1.50, 95% CI: 1.12-2.01, p-value: 0.006). Healthcare discrimination and dissatisfaction with the healthcare quality received were independently associated with increased dementia risk.

CONCLUSIONS: As predicted, experiencing low healthcare quality was associated with greater dementia risk. To date, most measures to reduce dementia have focused on individual-level behaviors. Our findings suggest that implementing structural changes to improve healthcare quality delivery for older persons could reduce dementia prevalence.

%B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.18842 %0 Journal Article %J Innovation in Aging %D Forthcoming %T Can Retrospective Reports Provide Accurate Job History Information? A Comparison with Concurrent Reports in a National Prospective Study of Older Adults %A Sonnega, Amanda %A Al-Hinai, Maymona %A Chen, Qize %A Helppie-McFall, Brooke %A Smith, Jacqui %K employment history %K Life History Mail Survey %K recall accuracy %X Growing interest in the impact of lifetime occupational exposures on later life health underscores the need to expand and evaluate the quality of data resources. The present study took advantage of a retrospective life history survey fielded within context of the Health and Retirement Study (HRS) to assess the accuracy of retrospectively obtained information on job history. We evaluated hypotheses related to job history and respondent characteristics to understand more about factors associated with recall accuracy.We used data from the Life History Mail Survey (LHMS), a self-administered survey conducted in 2015 and 2017. We compared the match rate of work status collected in the LHMS questionnaire with data collected concurrently during HRS core face-to-face or phone interviews from 1992 through 2016 with respect to jobs held at the time of interview. We also conducted a limit set of comparisons of occupation and industry match.The sample was 61.79\% female, 82.12\% white, and 8.57 percent Hispanic with a mean age of 74.70 years. The overall work status match rate was 83 percent. Jobs held longer ago were recalled with less accuracy. Jobs held for longer durations and that were full-time rather than part-time were recalled with greater accuracy. More complex job histories that involved a larger number of jobs were also associated with a lower match rate. Higher levels of conscientiousness and cognitive functioning were both associated with a higher match between the two sources of work status information. The occupation match rate was 69 percent, and the industry match rate was 77 percent.A self-administered, paper-and-pencil questionnaire attempting to measure decades-long histories of autobiographically important dimensions of life can provide reasonably accurate historical employment information. Several factors are likely to influence the relative accuracy of recalled information. %B Innovation in Aging %G eng %R 10.1093/geroni/igae021 %0 Journal Article %J Journal of Aging and Health %D Forthcoming %T Employment Dynamics Among Adult Children at the Onset of Parental Dementia: Variation by Sociodemographic Characteristics. %A Stokes, Jeffrey E %A Kindratt, Tiffany B %A Antonucci, Toni C %A Cox, Chelsea G %A Choi, Hwajung %K Caregiving %K Dementia %K Employment %K Families %K financial %X

OBJECTIVES: To examine the influence of sociodemographic factors on employment changes among adult children following onset of parental Alzheimer's disease and related dementia (ADRD).

METHODS: We used Health and Retirement Study (2010-2018; = 20,110) data to examine adult child (ages 50-70) changes in employment and work hours at onset of parental ADRD and potential variation by gender, age, race, ethnicity, and education.

RESULTS: Parental ADRD onset was not associated with changes in adult child employment overall, although associations differed substantially across subpopulations defined by education level. Sons with the lowest education were likely to cease employment, while daughters with the lowest education were likely to reduce work hours. Sons at older ages were increasingly likely to reduce work hours or end employment following parental ADRD onset.

DISCUSSION: The potential impact of parental ADRD on adult child employment is complex and should be considered in the context of sociodemographic factors.

%B Journal of Aging and Health %P 8982643231201547 %8 2023 Sep 14 %G eng %R 10.1177/08982643231201547 %0 Journal Article %J Research Square %D Forthcoming %T The Hidden Role of Racial Wealth Disparities in Older Adults’ Vulnerability to COVID-19 %A Ruth Winecoff %A Padmaja Ayyagari %A Melissa McInerney %A Kosali I. Simon %A M Kate Bundorf %K COVID-19 %K Racial wealth disparities %X Background: To examine racial and ethnic differences in wealth and other economic, exposure and baseline health-related risks of COVID-19 among older adults in the U.S. Methods: Using rich data on wealth and long-term care use among older Americans unique to the 2016 Health and Retirement Study, we quantify differences in COVID-19 vulnerability among non-Hispanic white, non-Hispanic Black and Hispanic respondents aged 50+. We measure wealth, other economic (insurance, income); exposure (long-term care, employment, telework, household size); and health (chronic conditions, smoking) risk stratified by age (50-64, 65+). Results: Blacks and Hispanics face dramatically greater financial risk that potentially increases exposure to COVID-19, relative to whites; Blacks and Hispanics are four to five times more likely to have no financial wealth. Blacks are also more likely than whites to use long-term care. Blacks and Hispanics also are less likely to have health insurance and face greater risk of exposure to COVID-19 because they are less likely to telework, and Hispanic older adults reside in larger households. Black and Hispanic older adults are also more likely to have a chronic condition associated with worse COVID-19 outcomes. Conclusions: Our results suggest that wealth differences may play a substantial role in contributing to the very large racial and ethnic disparities in the health burden of COVID-19. Racial disparities in long-term care, where COVID-19 risks are higher, contribute to make older Black Americans even more vulnerable to COVID-19. %B Research Square %@ 2693-5015 %G eng %R 10.21203/rs.3.rs-271452/v1 %0 Journal Article %J Journal of Aging and Health %D Forthcoming %T The Impact of Sustained Ownership of a Pet on Cognitive Health: A Population-Based Study. %A Applebaum, Jennifer W %A Shieu, Monica M %A McDonald, Shelby E %A Dunietz, Galit Levi %A Braley, Tiffany J %K cognitive function %K Cognitive health %K companion animals %K pet ownership %K Pets %X

To examine associations between sustained ownership of a pet and cognitive outcomes among a national sample of U.S. adults. Weighted linear mixed models were estimated using the Health and Retirement Study (2010-2016, = 1369) to compare repeated measures of cognitive function between respondents who endorsed owning a pet in a sustained manner (>5 years), versus those who owned a pet ≤5 years, and non-pet owners. Respondents aged 65+ who owned a pet >5 years demonstrated higher composite cognitive scores, compared to non-pet owners (β = .76, = .03). Sustained pet ownership was associated with higher immediate (β = .3, = .02) and delayed (β = .4, = .007) word recall scores. There were no significant differences in cognitive scores between pet owners and non-owners aged < 65. Sustained ownership of a pet could mitigate cognitive disparities in older adults. Further studies are needed to examine potential causal pathways, including physical activity and stress buffering, versus selection effects.

%B Journal of Aging and Health %G eng %R 10.1177/08982643221122641 %0 Manuscript %D Forthcoming %T Lifetime Adversity Prospectively Predicts Depression, Anxiety, and Cognitive Impairment in a Nationally Representative Sample of Older Adults in the United States %A SangNam Ahn %A Seonghoon Kim %A Hongmei Zhang %A Aram Dobalian %A George Slavich %K Anxiety %K depression %K LIFE STRESS %X Although life stress and adversity have emerged as risk factors for mental health problems and cognitive impairment among older adults, prior studies on this topic have been cross-sectional and based on relatively homogeneous samples. To address these issues, we examined prospective associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in a nationally representative, longitudinal sample of older adults in the U.S. Method: We analyzed data from the Health and Retirement Study (1992-2016). The sample included 3,496 individuals (59.9% female), aged ≥64 years old (M age=76.0 ±7.6 years). We used the individual-level panel data and ordinary least squares regressions to estimate associations between childhood and adulthood adversities and later-life depression, anxiety, and cognitive impairment. Results: Many participants experienced a significant early life (38%) or adulthood (79%) stressor. Second, experiencing a childhood adversity was associated with a 17.4% increased risk of experiencing an adulthood adversity. Finally, childhood and adulthood adversities both prospectively predicted more symptoms of late-life depression, anxiety, and cognitive impairment. Discussion: These findings are among the first to demonstrate prospective associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in older adults. Screening for lifetime stressors may thus help health care professionals and policymakers identify individuals who could benefit from interventions designed to reduce stress and enhance resilience. %G eng %R 10.22541/au.167407887.71569947/v1 %0 Journal Article %J American Journal of Obstetrics and Gynecology %D Forthcoming %T Longitudinal study of cognitive decline among women with and without urinary incontinence. %A High, Rachel A %A Alvarez, Miriam %A Champion, Brachel %A Anger, Jennifer %A Handa, Victoria L %K Aging %K Cognitive decline %K Dementia %K Memory %K Urinary incontinence %X

BACKGROUND: Cross-sectional and short-term cohort studies have demonstrated an association between urinary incontinence and dementia as well as lower performance on cognitive testing. The Health and Retirement Study, a longitudinal study of community-dwelling older adults, offers an opportunity to assess the temporal association between these conditions, as this study included an assessment of incontinence symptoms as well as biennial assessments of cognitive function.

OBJECTIVES: This study aimed to evaluate if urinary incontinence before age 70 had an effect on changes in cognitive function among women participating in the Health and Retirement Study.

STUDY DESIGN: This secondary analysis included data from female respondents in the Health and Retirement Study ages 58 to 67 years with ≥2 cognitive assessments. Urinary incontinence was defined as any involuntary loss of any urine in the preceding 12 months. A control group without incontinence was reweighted for better comparability using coarsened exact matching for age and comorbidities. Validated methods, including neuropsychological test data, estimated a Memory score and DP for each participant biennially. Coprimary outcomes were the changes in Memory score and dementia probability. Linear regression models were used to estimate the association of urinary incontinence with change in Memory score and dementia probability, adjusting for baseline demographics and comorbidities. A subgroup analysis was performed to assess the effects of urinary incontinence frequency on these outcomes. The infrequent subgroup reported less than fifteen days of leakage per month and the frequent subgroup reported fifteen or more days of leakage per month.

RESULTS: Among eligible female respondents, 40.6% reported urinary incontinence between ages 58 to 69 years. Baseline Memory scores and dementia probability were similar between those with urinary incontinence (n=1706) and controls (n=2507). Memory score declined significantly in both cohorts, indicating poorer memory over time -0.222 among those with incontinence (95% confidence interval (CI) -0.245, -0.199) versus -0.207 in controls (95% CI: -0.227, -0.188). The decline of Memory score was not statistically different between cases and controls (mean difference -0.015, 95% CI: -0.045, 0.015). Dementia probability increased significantly in both groups, indicating a greater probability of dementia: 0.018 among those with incontinence (95% CI: 0.015, 0.020) and by 0.020 among controls (95% CI: 0.017, 0.022). The change in DEMENTIA PROBABILITY was not significantly different between groups (mean difference -0.002, 95% CI: -0.006, 0.002). Frequent urinary incontinence was reported in 105/1706 (6%) with urinary incontinence. Memory score declined and dementia probability increased with time (p<0.001) in frequent and infrequent UI subgroups. There was no dose-response relationship.

CONCLUSIONS: Measures of cognitive performance declined with approximately 10 years of observation; the changes in performance were not associated with the presence of urinary incontinence in their younger years.

%B American Journal of Obstetrics and Gynecology %G eng %R 10.1016/j.ajog.2024.02.305 %0 Journal Article %J Molecular Psychiatry %D Forthcoming %T A naturally occurring variant of SHLP2 is a protective factor in Parkinson's disease. %A Kim, Su-Jeong %A Miller, Brendan %A Hartel, Nicolas G %A Ramirez, Ricardo %A Braniff, Regina Gonzalez %A Leelaprachakul, Naphada %A Huang, Amy %A Wang, Yuzhu %A Arpawong, Thalida Em %A Crimmins, Eileen M %A Wang, Penglong %A Sun, Xianbang %A Liu, Chunyu %A Levy, Daniel %A Yen, Kelvin %A Petzinger, Giselle M %A Graham, Nicholas A %A Jakowec, Michael W %A Cohen, Pinchas %K DNA %K Parkinson Disease %X

Mitochondrial DNA single nucleotide polymorphisms (mtSNPs) have been associated with a reduced risk of developing Parkinson's disease (PD), yet the underlying mechanisms remain elusive. In this study, we investigate the functional role of a PD-associated mtSNP that impacts the mitochondrial-derived peptide (MDP) Small Humanin-like Peptide 2 (SHLP2). We identify m.2158 T > C, a mtSNP associated with reduced PD risk, within the small open reading frame encoding SHLP2. This mtSNP results in an alternative form of SHLP2 (lysine 4 replaced with arginine; K4R). Using targeted mass spectrometry, we detect specific tryptic fragments of SHLP2 in neuronal cells and demonstrate its binding to mitochondrial complex 1. Notably, we observe that the K4R variant, associated with reduced PD risk, exhibits increased stability compared to WT SHLP2. Additionally, both WT and K4R SHLP2 show enhanced protection against mitochondrial dysfunction in in vitro experiments and confer protection against a PD-inducing toxin, a mitochondrial complex 1 inhibitor, in a mouse model. This study sheds light on the functional consequences of the m.2158 T > C mtSNP on SHLP2 and provides insights into the potential mechanisms by which this mtSNP may reduce the risk of PD.

%B Molecular Psychiatry %G eng %R 10.1038/s41380-023-02344-0 %0 Journal Article %J Alzheimers & dementia: the journal of the Alzheimer's Association %D Forthcoming %T An outcome-wide analysis of the effects of diagnostic labeling of Alzheimer's disease and related dementias on social relationships. %A Amano, Takashi %A Halvorsen, Cal J %A Kim, Seoyoun %A Reynolds, Addam %A Scher, Clara %A Jia, Yuane %K diagnostic label of dementia %K Health and Retirement Study (HRS) %K outcome-wide analysis %K Propensity score analysis %K social engagement %K social network %K Social Support %X

INTRODUCTION: This study examines how receiving a dementia diagnosis influences social relationships by race and ethnicity.

METHODS: Using data from the Health and Retirement Study (10 waves; 7,159 observations) of adults 70 years and older predicted to have dementia using Gianattasio-Power scores (91% accuracy), this study assessed changes in social support, engagement, and networks after a dementia diagnosis. We utilized quasi-experimental methods to estimate treatment effects and subgroup analyses by race/ethnicity.

RESULTS: A diagnostic label significantly increased the likelihood of gaining social support but reduced social engagement and one measure of social networks. With some exceptions, the results were similar by race and ethnicity.

DISCUSSION: Results suggest that among older adults with assumed dementia, being diagnosed by a doctor may influence social relationships in both support-seeking and socially withdrawn ways. This suggests that discussing services and supports at the time of diagnosis is important for healthcare professionals.

%B Alzheimers & dementia: the journal of the Alzheimer's Association %G eng %R 10.1002/alz.13574 %0 Journal Article %J Aging & Mental Health %D Forthcoming %T Physical, cognitive, and social activities as mediators between personality and cognition: evidence from four prospective samples. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K activities %K Aging %K Cognition %K lifestyle %K longitudinal %K Personality %X

OBJECTIVES: The present study examined how activity engagement mediates the association between personality and cognition.

METHODS: Participants were middle-aged and older adults (Age range: 24-93 years;  > 16,000) from the Midlife in the United States Study, the Health and Retirement Study, the English Longitudinal Study of Ageing, and the Wisconsin Longitudinal Study of Aging. In each sample, personality traits and demographic factors were assessed at baseline, engagement in cognitive, physical, and social activities was assessed in a second wave, and cognition was measured in a third wave, 8 to 20 years later.

RESULTS: Random-effect meta-analyses indicated that lower neuroticism and higher extraversion, openness, and conscientiousness were prospectively associated with better cognition. Most of these associations were partly mediated by greater engagement in physical and cognitive activities but not social activities. Physical activity accounted for 7% (neuroticism) to 50% (extraversion) and cognitive activity accounted for 14% (neuroticism) to 45% (extraversion) of the association with cognition.

CONCLUSION: The present study provides replicable evidence that physical and cognitive activities partly mediate the prospective association between personality traits and cognitive functioning.

%B Aging & Mental Health %P 1-10 %G eng %R 10.1080/13607863.2024.2320135 %0 Journal Article %J Journal of the American Geriatrics Society %D Forthcoming %T Prevalence of cognitive impairment in home health physical therapy. %A Miller, Matthew J %A Cenzer, Irena %A Barnes, Deborah E %A Ankuda, Claire K %A Covinsky, Kenneth E %K cognitive impairment %K Dementia %K home health %K physical therapy %K Rehabilitation %X

BACKGROUND: The prevalence of cognitive impairment in home health physical therapy (HHPT) is unknown. We sought to identify the prevalence of cognitive impairment, including cognitive impairment no dementia (CIND) and dementia, among older adults who used HHPT, and if cognitive impairment prevalence was higher among those with HHPT-relevant characteristics.

METHODS: For our cross-sectional analysis, we identified 963 fee-for-service Medicare beneficiaries with HHPT claims (>85 years old: 28.8%, women: 63.7%, non-Hispanic White: 82.1%) in the 2014 and 2016 waves of the Health and Retirement Study (HRS) and used a validated algorithm to categorize cognitive status as normal, CIND, or dementia. We estimated the population prevalence and calculated age, gender, race/ethnicity adjusted odds ratio (aOR) of CIND and dementia for characteristics relevant to HHPT service delivery including depression, walking difficulty, fall history, incontinence, moderate-vigorous physical activity (MVPA) ≤1x/week, and community-initiated HHPT using multinomial logistic regression.

RESULTS: The population prevalence of cognitive impairment was 46.4% (CIND: 27.3%, dementia: 19.1%). The prevalence of cognitive impairment was greater among those with depression (46.7% vs. 39.5%), difficulty walking across the room (58.9% vs. 41.8%), fall history (49.1% vs. 42.9%), MVPA ≤1x/week (50.0% vs. 38.0%), and community-initiated HHPT (55.2% vs. 40.2%). Compared to normal cognitive status, the odds of cognitive impairment were greater for those with MVPA≤1x/week (CIND: aOR = 1.57 [95% CI: 1.05-2.33], dementia: aOR = 2.55 [95% CI: 1.54-4.22]), depression (dementia: aOR = 1.99 [95% CI: 1.19-3.30]), difficulty walking across the room (dementia: aOR = 2.54 [95% CI: 1.40-4.60]), fall history (dementia: aOR = 1.85 [95% CI: 1.20-2.83]), and community-initiated HHPT (dementia: aOR = 1.72 (95% CI: 1.13-2.61]).

CONCLUSION: There is a high prevalence of CIND and dementia in HHPT, and no characteristics had a low prevalence of cognitive impairment. Physical therapists should be ready to identify cognitive impairment and adapt home health service delivery for this vulnerable population of older adults.

%B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.18715 %0 Journal Article %D Forthcoming %T Racial, ethnic, and urban/rural differences in transitions into diabetes: Evidence from the Health and Retirement Survey biomarker and self-reported data %A Hyeran, Chung %A Arends-Kuenning, Mary Paula %K biomarker data %K Diabetes %K ethnicity %K race %K rural %K self reported %K urban %X We examine the differences in transitions between stages of type 2 diabetes across racial, ethnic, and urban/rural statuses. The individual-level data from the 2006 to 2012 waves of the Health and Retirement Survey (HRS) and county-level data from the 1990-2000 US Censuses, the Dartmouth Atlas of Health Care, and the Inter-university Consortium for Political and Social Research are used to analyze the transition from the stage of prediabetic to diabetic, and the transition from having no diabetes to being prediabetic and diabetic. The HRS includes both biomarker data and self-reported doctors' diagnoses of diabetes, which allow us to identify people who are prediabetic and undiagnosed diabetics. Employing logistic models, we find that the likelihood of reporting the transition from prediabetes to diabetes increases with the degree of rurality. We also find that county-level proxies for structural disadvantage and individual-level correlates attenuate race/ethnicity and rurality disparities in the development of diabetes. In addition, racial/ethnic differences in transitions into diabetes are partially explained by differences in individual-level factors and further explained by differences in disadvantaged conditions associated with rural counties. %G eng %U https://www.researchgate.net/publication/354982473_Racial_ethnic_and_urbanrural_differences_in_transitions_into_diabetes_Evidence_from_the_Health_and_Retirement_Survey_biomarker_and_self-reported_data %0 Journal Article %J Journal of the American Geriatrics Society %D Forthcoming %T Racial inequality in functional trajectories between Black and White U.S. veterans. %A Jacobs, Josephine C %A Bowling, Christopher Barrett %A Brown, Tyson %A Smith, Valerie A %A Decosimo, Kasey %A Wilson, Sarah M %A Hastings, Susan Nicole %A Shepherd-Banigan, Megan %A Allen, Kelli %A Van Houtven, Courtney %K Functional limitations %K psychosocial stressors %K racial inequity %K Veterans %X

BACKGROUND: Racial inequality in functional trajectories has been well documented in the U.S. civilian population but has not been explored among Veterans. Our objectives were to: (1) assess how functional trajectories differed for Black and White Veterans aged ≥50 and (2) explore how socioeconomic, psychosocial, and health-related factors altered the relationship between race and function.

METHODS: We conducted a prospective, longitudinal analysis using the 2006-2016 Health and Retirement Study. The study cohort included 3700 Veterans who self-identified as Black or White, responded to baseline psychosocial questionnaires, and were community-dwelling on first observation. We used stepwise and stratified linear mixed effects models of biannually assessed functional limitations. The outcome measure was as a count of functional limitations. Race was measured as respondent self-identification as Black or White. Demographic measures included gender and age. Socioeconomic resources included partnership status, education, income, and wealth. Psychosocial stressors included exposure to day-to-day and major discrimination, traumatic life events, stressful life events, and financial strain. Health measures included chronic and mental health diagnoses, smoking, rurality, and use of Veterans Affairs services.

RESULTS: Black Veterans developed functional limitations at earlier ages and experienced faster functional decline than White Veterans between the ages of 50 and 70, with convergence occurring at age 85. Once we accounted for economic resources and psychosocial stressors in multivariable analyses, the association between race and the number of functional limitations was no longer statistically significant. Lower wealth, greater financial strain, and traumatic life events were significantly associated with functional decline.

CONCLUSIONS: Health systems should consider how to track Veterans' function earlier in the life course to ensure that Black Veterans are able to get timely access to services that may slow premature functional decline. Providers may benefit from training about the role of economic resources and psychosocial stressors in physical health outcomes.

%B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.18169 %0 Journal Article %J Journal of Neurotrauma %D Forthcoming %T Systematic Review, Meta-Analysis, and Population Attributable Risk of Dementia Associated with Traumatic Brain Injury in Civilians and Veterans. %A Gardner, Raquel C %A Bahorik, Amber %A Kornblith, Erica S %A Allen, Isabel Elaine %A Plassman, Brenda L %A Yaffe, Kristine %K Dementia %K systematic review %K Traumatic Brain Injury %K veteran %X

Traumatic brain injury (TBI) is an established risk factor for dementia. However, the magnitude of risk is highly variable across studies. Identification of sub-populations at highest risk, with careful consideration of potential sources of bias, is urgently needed to guide public health policy and research into mechanisms and treatments. We conducted a systematic review and meta-analysis of risk of all-cause dementia after all-severity TBI. We assessed for effect of participant age and sex, veteran status, research methods, and region. The search window covered January 1990 to January 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Thirty-two studies met inclusion criteria. Data were pooled using random effects models. Population attributable risk (PAR) of dementia due to TBI in the U.S. was calculated by sex and veteran status. Pooled risk ratio (RR) for dementia after TBI was 1.66 (95% confidence interval 1.42-1.93). Younger age, male sex, and studies from Asia were associated with significantly higher risk; veteran status was not. Risk of dementia associated with "head injury/trauma" was not significantly different from that associated with "TBI" diagnosis specifically. PAR of dementia due to TBI among U.S. veterans was twice that of the general U.S. population, largely due to the high prevalence of TBI exposure in the majority male veteran population. This meta-analysis found that TBI is associated with nearly 70% increased risk of dementia. Risk may be highest among younger adults, men, and cohorts in Asia. Efforts to prevent TBI and also to prevent post-TBI dementia are of high importance. Additionally, improved methods for diagnosing and tracking TBI on a public health level, such as national registries, may improve the quality and generalizability of future epidemiological studies investigating the association between TBI and dementia.

%B Journal of Neurotrauma %G eng %R 10.1089/neu.2022.0041 %0 Journal Article %J The Gerontologist %D Forthcoming %T Unrelenting Growth and Diversification: Using the Health and Retirement Study to Illuminate Cannabis Use among Aging Americans. %A Kaskie, Brian %A Bhagianadh, Divya %A Bobitt, Julie %A Martinos, Fadi %A Milavetz, Gary %A Arora, Kanika %K health retirement survey %K Marijuana %K Older Adults %K Opioids %K pain %X

BACKGROUND AND OBJECTIVES: Cannabis use among aging Americans continues to increase. We examine correlates of cannabis use including attitudes, state of residence, health status and service use.

RESEARCH DESIGN AND METHODS: Using the 2018 Health and Retirement Study Cannabis module completed by 1,372 respondents aged 50 and older, we distinguished current cannabis users from those who have never used or have some prior use. We linked 2018 and 2016 core HRS data and used multinomial regressions to identify associations among current use, attitudes, place of residence, as well as current (2018) and past (2016) medical conditions, pain and sleep issues. We also examined associations among cannabis use, hospital stays and outpatient medical visits.

RESULTS: Past year cannabis use reached 10.3% among aging Americans. Attitudes toward cannabis have changed over time with 4 of 5 survey respondents currently holding a favorable attitude. Attitude and state of residence were associated with current use. Cannabis users reported higher levels of pain, were more likely to use prescription opioids, and report activity limitations in both 2016 and 2018. Associations between cannabis use and sleep issues or concurrent healthcare use were not observed.

DISCUSSION AND IMPLICATIONS: Changing attitudes and state legalization appear important for late middle age and older persons, and as many as 1 of every 5 persons over 50 may be using cannabis by 2030. Cannabis use among aging Americans warrants increased attention from care providers, program administrators and policy makers, especially as a prevention or harm reduction strategy relative to prescription opioids.

%B The Gerontologist %G eng %R 10.1093/geront/gnae016 %0 Journal Article %J Journal of Aging and Health %D Forthcoming %T The Worst of Times: Depressive Symptoms Among Racialized Groups Living With Dementia and Cognitive Impairment During the COVID-19 Pandemic. %A Brown, Monique J %A Adkins-Jackson, Paris B %A Sayed, Linda %A Wang, Fei %A Leggett, Amanda %A Ryan, Lindsay H %K Cognition %K COVID %K Dementia %K depression %K Older Adults %X

To explore differences in depressive symptoms for older adults (Black, Latinx, and White) by cognitive status during the 2020 COVID-19 pandemic. Data from the Health and Retirement Study identified older adults as cognitively normal, cognitively impaired without dementia (CIND), and persons living with dementia (PLWD). Multiple linear regression analyses examined associations between cognitive status and depressive symptoms among these racialized groups. Compared to the cognitively normal older adults racialized as Black, those with CIND reported higher depressive symptoms during the pandemic (overall and somatic) and PLWD had higher somatic symptoms ( < .01). Older adults racialized as White with CIND reported higher somatic ( < .01) symptoms compared to cognitively normal older adults racialized as White. The COVID-19 pandemic was a challenging event among older adults racialized as Black with CIND and PLWD. Future studies should examine if these depressive symptoms persist over time.

%B Journal of Aging and Health %P 8982643231223555 %G eng %R 10.1177/08982643231223555 %0 Journal Article %J Social Science & Medicine %D 2024 %T The association between incarceration and housing insecurity and advanced immune age during late life %A Lauren MacConnachie %A Yuan S. Zhang %A Mateo Farina %A Carmen Gutierrez %A Andrew Hoover %A Yuelin He %A Allison E. Aiello %A Grace A. Noppert %K Aging %K Homelessness %K Housing insecurity %K HRS %K immune aging %K Immunosenescence %K incarceration %K Inequity %K psychosocial stressors %X Emerging evidence suggests that psychosocial stress ages the immune system. Accordingly, immune aging may be an important potential mechanism linking psychosocial stress to aging-related decline and disease. Incarceration and housing insecurity represent severe and complex experiences of a multitude of psychosocial stressors, including discrimination, violence, and poverty. In this study, we investigated the association between incarceration and/or housing insecurity and advanced immune age in adults aged 55 and older. Our sample was derived from the Health and Retirement Survey (HRS), with n = 7003 individuals with valid housing insecurity data and n = 7523 with valid incarceration data. From 2016 Venous Blood Study data, we assessed immune aging using a comprehensive set of immune markers including inflammatory markers (IL-6, CRP, s-TNFR1), markers of viral control (CMV IgG antibodies), and ratios of T cell phenotypes (CD8+:CD4+, CD + Memory: Naïve, CD4+ Memory: Naïve, CD8+ Memory: Naïve ratios). We found that both incarceration and housing insecurity were strongly associated with more advanced immune aging as indicated by increased inflammation, reduced viral control, and reduction in naïve T cells relative to memory T cells. Given that those who experienced incarceration, housing insecurity, and/or are racialized minorities were less likely to be included in this study, our results likely underestimated these associations. Despite these limitations, our study provided strong evidence that experiencing incarceration and/or housing insecurity may accelerate the aging of the immune system. %B Social Science & Medicine %P 116698 %G eng %R https://doi.org/10.1016/j.socscimed.2024.116698 %0 Journal Article %J Journal of Personality %D 2024 %T The effects of socioeconomic status on personality development in adulthood and aging. %A Luo, Jing %A Zhang, Bo %A Antonoplis, Stephen %A Mroczek, Daniel K %K adulthood development %K Aging %K Personality %K socioeconomic status %X

INTRO: The current study examined the effects of adulthood socioeconomic status (SES) on levels of and changes in the Big Five personality traits domains and nuances in adulthood and during aging. We also tested whether the relations between adulthood SES and personality traits differed by childhood SES and age.

METHODS: Data were drawn from three longitudinal studies: the Swedish Adoption/Twin Study of Aging (SATSA, N = 2000), the Midlife in the United States (MIDUS, N = 6428), and the Health and Retirement Study (HRS, N = 23,238).

RESULTS: Using the latent growth models, across samples, we found associations between high SES and low levels of neuroticism and high levels of extraversion, openness, and conscientiousness. The effects of SES on changes in personality traits were mainly observed in the aging sample of HRS. In general, a similar pattern was observed at the nuance level. Analyses of the moderating effects of age suggested some evidence for the increasingly important role of SES in levels of and changes in personality traits in older ages.

CONCLUSION: The findings support SES as a source that partially accounts for individual differences in personality traits level. Some evidence was found for the relations between SES and changes in personality traits in old age.

%B Journal of Personality %V 92 %P 243-260 %G eng %N 1 %R 10.1111/jopy.12801 %0 Journal Article %J The Journals of Gerontology, Series B %D 2024 %T Personality and Cognition: The Mediating Role of Inflammatory Markers. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K Cognition %K Inflammation %K longitudinal %K Personality %X

OBJECTIVES: Five-Factor Model personality traits are associated consistently with cognition. Inflammation has been hypothesized as a biological pathway in this association, but this assumption has yet to be tested. The present study tested inflammatory markers as mediators between personality traits and cognition.

METHODS: Participants were from the Health and Retirement Study (HRS; N= 4,364; 60% women; Mean age= 64.48 years, SD= 8.79). Personality traits and demographic factors were assessed in 2010/2012. Data on inflammatory markers [High Sensitivity C-reactive protein (hsCRP), Interleukin-6 (IL-6), soluble tumor necrosis factor 1 (sTNFR1), Interleukin-10 (IL-10), Interleukin-1 receptor antagonist (IL-1Ra), and transforming growth factor (TGF)-β1] were obtained in 2016 from the HRS Venuous Blood Study. Cognition was assessed in 2020 using the modified Telephone Interview for Cognitive Status (TICSm).

RESULTS: Higher neuroticism was related to lower cognition at follow-up, whereas higher extraversion, openness, agreeableness, and conscientiousness were associated with better cognition. Higher extraversion and higher conscientiousness were related to lower hsCRP, IL-6, IL-10, IL-1Ra, and sTNFR1, and higher openness was associated with lower IL-10, IL-1Ra, and sTNFR1 and to higher sTGF-β1. Lower sTNFR1 partially mediated the associations between conscientiousness, extraversion, and openness and cognition at follow-up, explaining an estimated 4 to 12% of these associations. The mediating role of sTNFR1 persisted when physical activity and depressive symptoms were included as additional mediators.

CONCLUSION: The present study provides new evidence on personality and inflammatory markers. Consistent with the inflammation hypothesis, the sTNFR1 finding supports a potential biological pathway between personality and cognition.

%B The Journals of Gerontology, Series B %V 79 %P gbad152 %G eng %N 1 %R 10.1093/geronb/gbad152 %0 Journal Article %J Developmental Psychology %D 2024 %T Purposeful and purposeless aging: Structural issues for sense of purpose and their implications for predicting life outcomes. %A Pfund, Gabrielle N %A Olaru, Gabriel %A Allemand, Mathias %A Hill, Patrick L %K Aged %K Aging %K Humans %K Longevity %K Retirement %K United States %X

Despite the value of sense of purpose during older adulthood, this construct often declines with age. With some older adults reconsidering the relevance of purpose later in life, the measurement of purpose may suffer from variance issues with age. The current study investigated whether sense of purpose functions similarly across ages and evaluated if the predictive power of purpose on mental, physical, cognitive, and financial outcomes changes when accounting for a less age-affected measurement structure. Utilizing data from two nationwide panel studies (Health and Retirement Study: = 14,481; Midlife in the United States: = 4,030), the current study conducted local structural equation modeling and found two factors for the positively and negatively valenced purpose items in the Purpose in Life subscale (Ryff, 1989), deemed the purposeful and purposeless factor. These factors become less associated with each other at higher ages. When reproducing past findings with this two-factor structure, the current study found that the purposeful and purposeless factors predicted these outcomes in the same direction as would be suggested by past research, but the magnitude of these effects differed for some outcomes. The discussion focuses on the implications of what this means for our understanding of sense of purpose across the lifespan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

%B Developmental Psychology %V 60 %P 75-93 %G eng %N 1 %R 10.1037/dev0001633 %0 Journal Article %J Environmental Research %D 2024 %T Residential greenspace and major depression among older adults living in urban and suburban areas with different climates across the United States. %A Fossa, Alan J %A D'Souza, Jennifer %A Bergmans, Rachel %A Zivin, Kara %A Adar, Sara D %K Aged %K depression %K Depressive Disorder, Major %K Environmental Exposure %K Female %K Humans %K Male %K Mental Health %K Middle Aged %K Parks, Recreational %K United States %X

BACKGROUND AND AIM: Residential greenspace could alleviate depression - a leading cause of disability. Fewer studies of depression and greenspace have considered major depression, and, to our knowledge, none have considered how climate, which determines vegetation abundance and type, may change the impacts of greenspace. Our aim was to investigate whether residential greenspace is associated with major depression among older adults and explore effect modification by climate.

METHODS: We used biennial interviews between 2008 and 2016 from the Health and Retirement Study. We calculated greenness within walking distance of home addresses as the maximum NDVI for the year of each participant interview averaged within a 1 km buffer. Reflecting clinical criteria, a score of ≥5 on the CIDI-SF indicated major depression in the preceding 12-months. We characterized climate using Köppen-Geiger classifications. To estimate prevalence ratios, we used Poisson regression. Our models adjusted for sociodemographic characteristics, geography, annual sunshine, and bluespace.

RESULTS: The 21,611 eligible participants were 65 ± 10 years old on average, 55% female, 81% White, 12% Black, 10% Hispanic/Latino, and 31% had at least a 4-year college degree. The 12-month prevalence of a major depression was 8%. In adjusted models, more residential greenspace was associated with a lower prevalence of major depression (prevalence ratio per IQR, 0.91; 95% CI, 0.84 to 0.98). There was evidence of effect modification by climate (P forinteraction, 0.062). We observed stronger associations in tropical (prevalence ratio per IQR 0.69; 95% CI, 0.47 to 1.01) and cold (prevalence ratio per IQR, 0.83; 95% CI, 0.74 to 0.93) climates compared to arid (prevalence ratio per IQR 0.99; 95% CI, 0.90 to 1.09) and temperate (prevalence ratio per IQR 0.98; 95% CI, 0.86 to 1.11) climates.

CONCLUSIONS: Residential greenspace may help reduce major depression. However, climate may influence how people benefit from greenspace.

%B Environmental Research %V 243 %P 117844 %G eng %R 10.1016/j.envres.2023.117844 %0 Journal Article %J Journal of Personality %D 2024 %T Rural-urban differences in personality traits and well-being in adulthood. %A Atherton, Olivia E %A Willroth, Emily C %A Graham, Eileen K %A Luo, Jing %A Mroczek, Daniel K %A Lewis-Thames, Marquita W %K Big Five %K Life Satisfaction %K MIDUS %K psychological well-being %K rurality %X

OBJECTIVE: One large focus of personality psychology is to understand the biopsychosocial factors responsible for adult personality development and well-being change. However, little is known about how macro-level contextual factors, such as rurality-urbanicity, are related to personality development and well-being change.

METHOD: The present study uses data from two large longitudinal studies of U.S. Americans (MIDUS, HRS) to examine whether there are rural-urban differences in levels and changes in the Big Five personality traits and well-being (i.e., psychological well-being, and life satisfaction) in adulthood.

RESULTS: Multilevel models showed that Americans who lived in more rural areas tended to have lower levels of openness, conscientiousness, and psychological well-being, and higher levels of neuroticism. With the exception of psychological well-being (which replicated across MIDUS and HRS), rural-urban differences in personality traits were only evident in the HRS sample. The effect of neuroticism was fully robust to the inclusion of socio-demographic and social network covariates, but other effects were partially robust (i.e., conscientiousness and openness) or were not robust at all (i.e., psychological well-being). In both samples, there were no rural-urban differences in Big Five or well-being change.

CONCLUSIONS: We discuss the implications of these findings for personality and rural health research.

%B Journal of Personality %V 92 %P 73-87 %G eng %N 1 %R 10.1111/jopy.12818 %0 Journal Article %J Am J Hum Genet %D 2023 %T 15 years of GWAS discovery: Realizing the promise. %A Abdellaoui, Abdel %A Yengo, Loic %A Verweij, Karin J H %A Visscher, Peter M %K Gene Frequency %K Genetics, Population %K Genome-Wide Association Study %K Humans %K Multifactorial Inheritance %K Polymorphism, Single Nucleotide %X

It has been 15 years since the advent of the genome-wide association study (GWAS) era. Here, we review how this experimental design has realized its promise by facilitating an impressive range of discoveries with remarkable impact on multiple fields, including population genetics, complex trait genetics, epidemiology, social science, and medicine. We predict that the emergence of large-scale biobanks will continue to expand to more diverse populations and capture more of the allele frequency spectrum through whole-genome sequencing, which will further improve our ability to investigate the causes and consequences of human genetic variation for complex traits and diseases.

%B Am J Hum Genet %V 110 %P 179-194 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/36634672?dopt=Abstract %R 10.1016/j.ajhg.2022.12.011 %0 Web Page %D 2023 %T Addressing the Nation's Retirement Crisis: The 80% %A National Council on Aging %K Retirement %K Social Security Benefits %I National Council on Aging %G eng %U https://ncoa.org/article/addressing-the-nations-retirement-crisis-the-80-percent-financially-struggling %0 Journal Article %J Clin Epigenetics %D 2023 %T ADHD genetic burden associates with older epigenetic age: mediating roles of education, behavioral and sociodemographic factors among older adults. %A Arpawong, Thalida E %A Klopack, Eric T %A Jung K Kim %A Crimmins, Eileen M %K Aged %K Aging %K Attention Deficit Disorder with Hyperactivity %K Biomarkers %K DNA Methylation %K Educational Status %K Epigenesis, Genetic %K Humans %K Middle Aged %K sociodemographic factors %X

BACKGROUND: Shortened lifespans are associated with having Attention Deficit Hyperactivity Disorder (ADHD), which is likely mediated by related behavioral and sociodemographic factors that are also associated with accelerated physiological aging. Such factors include exhibiting more depressive symptoms, more cigarette smoking, higher body mass index, lower educational attainment, lower income in adulthood, and more challenges with cognitive processes compared to the general population. A higher polygenic score for ADHD (ADHD-PGS) is associated with having more characteristic features of ADHD. The degree to which (1) the ADHD-PGS associates with an epigenetic biomarker developed to predict accelerated aging and earlier mortality is unknown, as are whether (2) an association would be mediated by behavioral and sociodemographic correlates of ADHD, or (3) an association would be mediated first by educational attainment, then by behavioral and sociodemographic correlates. We evaluated these relationships in a population-based sample from the US Health and Retirement Study, among N = 2311 adults age 50 and older, of European-ancestry, with blood-based epigenetic and genetic data. The ADHD-PGS was calculated from a prior genomewide meta-analysis. Epigenome-wide DNA methylation levels that index biological aging and earlier age of mortality were quantified by a blood-based biomarker called GrimAge. We used a structural equation modeling approach to test associations with single and multi-mediation effects of behavioral and contextual indicators on GrimAge, adjusted for covariates.

RESULTS: The ADHD-PGS was significantly and directly associated with GrimAge when adjusting for covariates. In single mediation models, the effect of the ADHD-PGS on GrimAge was partially mediated via smoking, depressive symptoms, and education. In multi-mediation models, the effect of the ADHD-PGS on GrimAge was mediated first through education, then smoking, depressive symptoms, BMI, and income.

CONCLUSIONS: Findings have implications for geroscience research in elucidating lifecourse pathways through which ADHD genetic burden and symptoms can alter risks for accelerated aging and shortened lifespans, when indexed by an epigenetic biomarker. More education appears to play a central role in attenuating negative effects on epigenetic aging from behavioral and sociodemographic risk factors related to ADHD. We discuss implications for the potential behavioral and sociodemographic mediators that may attenuate negative biological system effects.

%B Clin Epigenetics %V 15 %P 67 %G eng %N 1 %R 10.1186/s13148-023-01484-y %0 Report %D 2023 %T Adult Children’s Four-year College Completion by Parent’s Race, Ethnicity, and Educational Attainment %A Kellyanne Bunkley %A Jaycob Applegate %A Jenjira Yahirun %K College %K ethnicity %K Parent's Race %K Racial Disparities %K University %B ScholarWorks@BGSU %I National Center for Family & Marriage Research %C Bowling Green, Ohio %G eng %R https://doi.org/10.25035/ncfmr/fp-23-12 %0 Journal Article %J The American Journal of Hospice and Palliative Care %D 2023 %T Advance Care Planning Among Older Adults with Cognitive Impairment. %A Rahemi, Zahra %A Malatyali, Ayse %A Adams, Swann A %A Jarrín, Olga F %A Demiris, George %A Parker, Veronica %A Ghaiumy Anaraky, Reza %A Dye, Cheryl J %K Advance care planning %K Alzheimer %K Dementia %K End-of-life care %X

In this study, we used data from the Health and Retirement Study (HRS) to investigate factors associated with older adults' engagement with advance care planning (ACP) across varying levels of cognitive functioning status. Our analysis used a sample of 17,698 participants in the HRS 2014 survey. Survey descriptive procedures (Proc SurveyMeans, Proc SurveyFreq) and logistic regression procedures (Proc SurveyLogistic) were used. Race, ethnicity, level of cognition, education, age, and number of chronic diseases consistently predicted ACP. Participants with lower levels of cognition were less likely to have a living will and durable power of attorney for healthcare (DPOAH). African American and Hispanic participants, younger participants, and those with lower cognition and education levels were less likely to engage in ACP. Marital status and loneliness predicted ACP engagement. Some results varied across the cognition cohorts. Our results indicated that sociodemographic status, together with health and cognitive status, has a significant role in predicting ACP. The results can provide valuable insights on ACP for older adults with or at risk of Alzheimer's disease and related dementia and other cognitive impairments, caregivers, families, and healthcare providers.

%B The American Journal of Hospice and Palliative Care %V 40 %P 1182-1189 %G eng %N 11 %R 10.1177/10499091221146255 %0 Journal Article %J Aging and Health Research %D 2023 %T Advance care planning and outpatient visits among older adults across cognitive levels %A Rahemi, Zahra %A Bacsu, Juanita-Dawne R. %A Sefcik, Justine S. %A Sadafipoor, Maryam S. %A Demiris, George %A Adams, Swann Arp %K Advance care planning %K cognitive impairment %K Health and Retirement Study %K Healthcare use %K Outpatient visits %X Advance care planning (ACP) can help reduce end-of-life care challenges for persons with Alzheimer's disease and related dementia and their care partners. Building on our previous work, we examined the impact of ACP on outpatient/doctor visits in older adults with dementia/impaired cognition and normal cognition. Using datasets from the 2014 Health and Retirement Study (HRS), we conducted a cross-sectional study of 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. Our findings indicated that having at least one ACP measure was significantly associated with a higher mean number of outpatient visits in both cognition groups. Based on our findings, we recommend considering healthcare access and use as an intervening variable in future ACP research. %B Aging and Health Research %V 3 %G eng %R 10.1016/j.ahr.2023.100166 %0 Journal Article %J Journal of the American College of Cardiology %D 2023 %T AGE DISPARITIES IN THE ASSOCIATION BETWEEN INSOMNIA SYMPTOMS AND INCIDENCE OF STROKE: A PROSPECTIVE COHORT STUDY %A Wendemi Sawadogo %A Tilahun Adera %B Journal of the American College of Cardiology %V 81 %P 1681-1681 %G eng %U https://www.jacc.org/doi/abs/10.1016/S0735-1097%2823%2902125-3 %R 10.1016/S0735-1097(23)02125-3 %0 Journal Article %J J Intell %D 2023 %T Age-Related Trajectories of General Fluid Cognition and Functional Decline in the Health and Retirement Study: A Bivariate Latent Growth Analysis. %A Handing, Elizabeth P %A Jiao, Yuqin %A Aichele, Stephen %X

There have been few studies on associations between age-related declines in fluid cognition and functional ability in population-representative samples of middle-aged and older adults. We used a two-stage process (longitudinal factor analysis followed by structural growth modeling) to estimate bivariate trajectories of age-related changes in general fluid cognition (numeracy, category fluency, executive functioning, and recall memory) and functional limitation (difficulties in daily activities, instrumental activities, and mobility). Data came from the Health and Retirement Study (Waves 2010-2016; N = 14,489; ages 50-85 years). Cognitive ability declined on average by -0.05 SD between ages 50-70 years, then -0.28 SD from 70-85 years. Functional limitation increased on average by +0.22 SD between ages 50-70 years, then +0.68 SD from 70-85 years. Significant individual variation in cognitive and functional changes was observed across age windows. Importantly, cognitive decline in middle age (pre-age 70 years) was strongly correlated with increasing functional limitation ( = -.49, < .001). After middle age, cognition declined independently of change in functional limitation. To our knowledge, this is the first study to estimate age-related changes in fluid cognitive measures introduced in the HRS between 2010-2016.

%B J Intell %V 11 %G eng %N 4 %R 10.3390/jintelligence11040065 %0 Journal Article %J The Journals of Gerontology, Series B %D 2023 %T Aging on the job? The association between occupational characteristics and accelerated biological aging. %A Andrasfay, Theresa %A Jung K Kim %A Jennifer A Ailshire %A Crimmins, Eileen %K Biomarkers %K Functional age %K Psychosocial stress %K work-related issues %X

OBJECTIVES: There is a common belief that demanding jobs can make workers age faster, but there is little empirical evidence linking occupational characteristics to accelerated biological aging. We examine how occupational categorizations and self-reported working conditions are associated with expanded biological age, which incorporates 22 biomarkers and captures physiologic dysregulation throughout several bodily systems.

METHODS: Data are from 1,133 participants in the Health and Retirement Study (HRS) who were aged 51-60 and working for pay in the 2010 or 2012 wave and who participated in the 2016 Venous Blood Study (VBS). We estimate associations between occupational category (professional/managerial, sales/clerical, service, and manual) and self-reported working conditions (psychosocial demands, job control, heavy lifting, and working 55 or more hours per week) and expanded biological age.

RESULTS: Compared to same-age individuals working in professional or managerial positions, those working in service jobs appear 1.65 years older biologically even after adjusting for social and economic characteristics, self-reported working conditions, health insurance, and lifestyle-related risk factors. Low job control is associated with 1.40 years, heavy lifting with 2.08 years, and long working hours with 1.87 years of accelerated biological aging.

DISCUSSION: Adverse occupational characteristics held at midlife, particularly service work, low job control, heavy lifting, and long work hours, are associated with accelerated biological aging. These findings suggest that work may be important for the overall aging process beyond its associations with specific diseases or risk factors.

%B The Journals of Gerontology, Series B %V 78 %P 1236-1245 %G eng %N 7 %R 10.1093/geronb/gbad055 %0 Journal Article %J Alzheimers Dement %D 2023 %T Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations. %A Llibre-Guerra, Jorge J %A Li, Jing %A Qian, Yuting %A Llibre-Rodriguez, Juan de Jesús %A Jiménez-Velázquez, Ivonne Z %A Acosta, Daisy %A Salas, Aquiles %A Llibre-Guerra, Juan Carlos %A Valvuerdi, Adolfo %A Harrati, Amal %A Weiss, Jordan %A Liu, Mao-Mei %A Dow, William H %K Aged %K Alleles %K Alzheimer disease %K Apolipoprotein E4 %K Apolipoproteins E %K Caribbean Region %K Female %K Genotype %K Hispanic or Latino %K Humans %K Male %X

INTRODUCTION: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations.

METHODS: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non-Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample.

RESULTS: Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8%-25.4%), but was substantially higher in AAs (33.6%; P < 0.001). APOE ε4 carriers had higher dementia prevalence across all groups.

DISCUSSION: APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.

%B Alzheimers Dement %V 19 %P 602-610 %G eng %N 2 %R 10.1002/alz.12699 %0 Journal Article %D 2023 %T The Association between Physical Activity Levels and Neurodegenerative Disease among Elderly in the United States %A Nadia Abasrashid %K Alzheimer's %K Dementia %K Elderly %K Neurodegenerative Disease %K Physical activity %X Objective: The aim of this study was investigating the relationship between participating in Vigorous, Moderate, and Mild Physical Activity and the risk of dementia and Alzheimer's among older adults. Methods: The survey data from the years 2020 of Health and Retirement Study Consumption and Activities Mail Survey (HRS CAMS) was used. The HRS CAMS includes some information of demographic characteristics, frequency and intensity of physical activity, and medical background including dementia and Alzheimer's diseases. A regression model was used to test whether vigorous, moderate, and mild physical activity was associated with dementia and Alzheimer’s. Results: The sample (n = 8806) was predominantly female (54.7%) and white (60.8%) with a mean age (SD) of 70.4 years old. When controlled for covariates, the findings show Vigorous PA were more likely to have 18 percent higher Alzheimer’s. Similarly, those who did not participate in Vigorous PA was associated with 15 percent higher chance of dementia. Conclusions: We observed a significant association between vigorous, moderate, and mild physical activity and dementia and Alzheimer among older adults. Moreover, we figured out that those people who are not active physically are more likely to get Alzheimer's and dementia. Based on the results of this study, promotion of PA might reduce the risk of dementia and Alzheimer's in older adults. %G eng %R https://doi.org/10.51224/SRXIV.256 %0 Journal Article %J Journal of Pain and Symptom Management %D 2023 %T The Association of Private Prayer with Neuropsychiatric Symptoms, Cognition, and Sleep Disturbances in Persons with Dementia (Sci255) %A Katherine C. Britt %A Kathy C. Richards %A Shelli Kesler %A Gayle Acton %A Jill Hamilton %A Kavita Radhakrishnan %X Outcomes 1. Verbalize the association of private prayer with symptoms of dementia progression with cultural consideration of populations who may find religion and spirituality important to inform person-centered care. 2. Demonstrate the need for additional studies to be conducted examining association of private prayer over time with symptoms of dementia progression to evaluate potential for improving quality of life. Protective factors that slow progression and improve quality of life in persons with dementia (PWD) are needed. Neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances are common, increase caregiver stress, and indicate dementia progression. Accruing research suggests religious practice is associated with improved mental and physical health, yet few studies have been conducted in dementia. We analyzed data from the Health and Retirement study in 2000, 2006, and 2008 and sub study, Aging, Demographics, and Memory Study in 2001–2003, 2006–2007, and 2008–2009 to examine the association of private prayer with NPS, cognitive function, and sleep disturbances among PWD age 70 years and older in the United States (N=40). A cross-sectional analysis using bootstrapped Spearman's Rho correlation was utilized. Mean age was 84.67 years (sd 5.16), 73.9% were non-Hispanic White, and 74.9% were female. Ninety-one percent reported praying at least once per week with higher rates identified among non-Hispanic Black (100%) and Hispanic participants (100%). Cognitive function was 1.169 (sd .516), indicating mild cognitive impairment, mean score of NPS 5.22 (sd 7.41) was identified as clinically significant, and mean sleep disturbances .79 (sd 1.078) were mild on 0–9 score. Private prayer was significantly associated with neuropsychiatric symptoms (rs (97) = - .358, 95% CI [-.363, -.353], p<.01), cognitive function (rs (97) = - .383, 95% CI [-.388, -.378], p<.01), and sleep disturbances (rs (97) = -,147 95% CI [-.153, -.141], p<.01). Increased frequency of private prayer was associated with lower NPS, better cognitive function, and lower sleep disturbances. This could be due to the use of cognitive processes used in prayer to seek guidance for making decisions, request aid when distressed, and reduce loneliness through communication with the divine. Longitudinal studies are needed, including minority populations and examining age moderation especially as minorities and older adults find religion and spirituality important. %B Journal of Pain and Symptom Management %V 65 %P e670 %G eng %U https://www.sciencedirect.com/science/article/pii/S0885392423003846 %R https://doi.org/10.1016/j.jpainsymman.2023.02.305 %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2023 %T Association of Religious Service Attendance and Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances in All-Cause Dementia. %A Britt, Katherine Carroll %A Richards, Kathy C %A Acton, Gayle %A Hamilton, Jill %A Radhakrishnan, Kavita %K Cognition %K Dementia %K Religion %K Sleep %K Sleep Wake Disorders %K Spirituality %X

Commonly reported in dementia, neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances indicate dementia progression. With the growing dementia burden, identifying protective factors that may slow dementia progression is increasingly essential. Religion and spirituality are associated with better mental and physical health, yet few studies have been reported in older adults with dementia. This study examines associations between religious service attendance and symptoms of dementia progression. Using data from the Health and Retirement Study in 2000, 2006, and 2008 and the sub-study, Aging, Demographics, and Memory Study in 2001-2003, 2006-2007, and 2008-2009, we examined the association of religious attendance with neuropsychiatric symptoms, cognitive function, and sleep disturbances among U.S. older adults aged 70 years and older with all-cause dementia ( = 72) using Spearman's partial Rho correlation controlling for social interaction. Significant associations were identified for religious attendance and NPS (r (97) = -0.124, 95% CI [-0.129, -0.119], < 0.0005); cognitive function, r (97) = -0.018, 95% CI [-0.023, -0.013], < 0.001); and sleep disturbances, r (97) = -0.275, 95% CI [-0.280, -0.271], < 0.0005). Beyond adjusting for social interaction, increased religious attendance was associated with lower NPS, better cognitive function, and fewer sleep disturbances. Clinical trials and longitudinal studies with a larger sample size examining religion and spirituality factors with dementia progression are warranted.

%B International Journal of Environmental Research and Public Health %V 20 %P 4300 %G eng %N 5 %R 10.3390/ijerph20054300 %0 Journal Article %J JAMA Psychiatry %D 2023 %T Association of the Mediterranean Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) Diet With the Risk of Dementia. %A Chen, Hui %A Dhana, Klodian %A Huang, Yuhui %A Huang, Liyan %A Tao, Yang %A Liu, Xiaoran %A Melo van Lent, Debora %A Zheng, Yan %A Ascherio, Alberto %A Willett, Walter %A Yuan, Changzheng %K Dementia %K Hypertension %K Mediterranean diet %X

IMPORTANCE: Dementia threatens the well-being of older adults, making efforts toward prevention of great importance.

OBJECTIVE: To evaluate the association of the Mediterranean-Dietary Approaches to Stop Hypertension (DASH) Intervention for Neurodegenerative Delay (MIND) diet with the risk of dementia in 3 prospective studies and a meta-analysis.

DESIGN, SETTING, AND PARTICIPANTS: Cohort analyses included the Whitehall II study (WII), the Health and Retirement Study (HRS), and the Framingham Heart Study Offspring cohort (FOS), and the meta-analysis included 11 cohort studies. Participants were middle-aged and older women and men from WII in 2002 to 2004, HRS in 2013, and FOS in 1998 to 2001 without dementia at the study baseline. Data were analyzed from May 25 to September 1, 2022.

EXPOSURES: MIND diet score was measured using food frequency questionnaires, and scores ranged from 0 to 15, with a higher score indicating higher adherence to the MIND diet.

MAIN OUTCOME AND MEASURES: Incident all-cause dementia, with cohort-specific definitions.

RESULTS: Included in this study were 8358 participants (mean [SD] age, 62.2 [6.0] years; 5777 male [69.1%]) from WII, 6758 participants (mean [SD] age, 66.5 [10.4] years; 3965 female [58.7%]) from HRS, and 3020 participants (mean [SD] age, 64.2 [9.1] years; 1648 female [54.6%]) from FOS. The mean (SD) baseline MIND diet score was 8.3 (1.4) in WII, 7.1 (1.9) in HRS, and 8.1 (1.6) in FOS. Over 166 516 person-years, a total of 775 participants (220 in WII, 338 in HRS, and 217 in FOS) developed incident dementia. In the multivariable-adjusted Cox proportional hazard model, higher MIND diet score was associated with lower risk of dementia (pooled hazard ratio [HR] for every 3-point increment, 0.83; 95% CI, 0.72-0.95; P for trend = .01; I2 = 0%). The associations were consistently observed in subgroups defined by sex, age, smoking status, and body mass index. In the meta-analysis of 11 cohort studies with 224 049 participants (5279 incident dementia cases), the highest tertile of MIND diet score was associated with lower risk of dementia compared with the lowest tertile (pooled HR, 0.83; 95% CI, 0.76-0.90; I2 = 35%).

CONCLUSIONS AND RELEVANCE: Results suggest that adherence to the MIND diet was associated with lower risk of incident dementia in middle-aged and older adults. Further studies are warranted to develop and refine the specific MIND diet for different populations.

%B JAMA Psychiatry %G eng %R 10.1001/jamapsychiatry.2023.0800 %0 Journal Article %J The Journal of Gerontology, Series A %D 2023 %T Associations between Change in Kidney Functioning, Age, Race/ethnicity and Health Indicators in the Health and Retirement Study. %A Zhao, Erfei %A Jennifer A Ailshire %A Jung K Kim %A Wu, Qiao %A Crimmins, Eileen M %K Cystatin C %K Kidney function %K Metabolism %X

BACKGROUND: The aging process is accompanied by decline in kidney functioning. It remains unknown to what extent age-related decline in kidney functioning can be attributed to health indicators, and whether rate of decline differs across sociodemographic groups.

METHODS: Using data from the Health and Retirement Study from 2006/2008 through 2014/2016, we estimated kidney functioning trajectories, determined by cystatin C, among adults aged over 51 over 8-year. We evaluated the role of age, health conditions/behaviors, and genetics in the decline and also examined sociodemographic differentials.

RESULTS: Kidney function declined with age and accelerated at older ages, even after adjusting for health conditions/behaviors and genetic differences (e.g., 0.019 mg/L annual increase in cystatin C among 70-79 compared to 0.007 mg/L among 52-59 at baseline). Decline occurred faster among those with uncontrolled diabetes (0.008, p=0.009), heart conditions (0.007, p<0.000), and obesity (0.005, p=0.033). Hispanic participants (0.007, p=0.039) declined faster than non-Hispanic White persons due to diabetes, heart conditions, and obesity; non-Hispanic Black participants had worse baseline kidney functioning (0.099, p<0.000), but only one-fourth of this Black-White difference was explained by investigated risk factors. People with higher education experienced slower decline (-0.009, p=0.004).

CONCLUSIONS: Age was a significant predictor of decline in kidney functioning, and its association was not fully explained by health conditions/behaviors, or genetics. Better management of diabetes, heart conditions, and obesity is effective in slowing this decline. Baseline differences in kidney functioning (e.g., between non-Hispanic White and Black persons; those with and without hypertension) suggest disparities occur early in the life course and require early interventions.

%B The Journal of Gerontology, Series A %V 78 %P 2094-2104 %G eng %N 11 %R 10.1093/gerona/glad204 %0 Journal Article %J The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences %D 2023 %T Associations Between Longitudinal Loneliness, DNA Methylation Age Acceleration, and Cognitive Functioning. %A Lynch, Morgan %A Em Arpawong, Thalida %A Beam, Christopher R %K Aged %K Aging %K Biomarkers %K Cognition %K DNA Methylation %K Humans %K Loneliness %K Longitudinal Studies %X

OBJECTIVES: Loneliness may influence aging biomarkers related to cognitive functioning, for example, through accelerated DNA methylation (DNAm) aging.

METHODS: In the present study, we tested whether six common DNAm age acceleration measures mediated the effects of baseline loneliness and five different longitudinal loneliness trajectories on general cognitive ability, immediate memory recall, delayed memory recall, and processing speed in 1,814 older adults in the Health and Retirement Study.

RESULTS: We found that baseline loneliness and individuals who belong to the highest loneliness trajectories had poorer general cognitive ability and memory scores. Only DNAm age acceleration measures that index physiological comorbidities, unhealthy lifestyle factors (e.g., smoking), and mortality risk-mediated effects of baseline loneliness on general cognitive ability and memory functioning but not processing speed. These same DNAm measures mediated effects of the moderate-but-declining loneliness trajectory on cognitive functioning. Additionally, immediate and delayed memory scores were mediated by GrimAge Accel in the lowest and two highest loneliness trajectory groups. Total and mediated effects of loneliness on cognitive functioning outcomes were mainly accounted for by demographic, social, psychological, and physiological covariates, most notably self-rated health, depressive symptomatology, objective social isolation, and body mass index.

DISCUSSION: Current findings suggest that DNAm biomarkers of aging, particularly GrimAge Accel, have promise for explaining the prospective association between loneliness and cognitive functioning outcomes.

%B The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences %V 78 %P 2045-2059 %G eng %N 12 %R 10.1093/geronb/gbad128 %0 Report %D 2023 %T At Home versus in a Nursing Home: Long-term Care Settings and Marginal Utility %A Bertrand Achou %A Philippe De Donder %A Franca Glenzer %A Minjoon Lee %A Marie-Louise Leroux %X Marginal utility of financial resources when needing long-term care, and the related incentives for precautionary savings and insurance, may vary significantly by whether one receives care at home or in a nursing home. In this paper, we develop strategic survey questions to estimate those differences. All else equal, we find that the marginal utility is significantly higher when receiving care at home rather than in a nursing home. We then use these estimates within a quantitative life cycle model to evaluate the impact of the expected choice of care setting (home versus nursing home) on precautionary savings and insurance valuation. The estimated marginal utility differences imply a significant increase in the incentives to save when expecting to receive care at home. Larger incentives to self-insure also translate to a higher valuation of additional subsidies for home care than for nursing homes, shedding light on an efficient way to expand public long-term care subsidies. We also examine how the magnitude of our results quantitatively vary with the existing public long-term care subsidies. %I Université du Québec à Montréal %G eng %U https://economie.esg.uqam.ca/wp-content/uploads/sites/54/2023/05/2023_02_docdt_eco.pdf %0 Journal Article %J Aging Ment Health %D 2023 %T The bidirectional relationship between depressive symptoms and functional limitations among centenarian survivors in their 80s: Testing bivariate latent change score models. %A Lee, Gina %A Arieli, Rotem %A Ryou, Yeon Ji %A Martin, Peter %K bidirectional friendships %X

OBJECTIVES: The purpose of the study was to examine a bivariate latent change score model of depressive symptoms and functional limitations (activities of daily living) among centenarian or near-centenarian survivors over four waves using the Health and Retirement Study.

METHOD: Four hundred and sixty participants who eventually survived to age 98 or older were included by calculating their death age. Data from the time when the participants were in their 80s were analyzed. The mean age at baseline (1994) was 85.5 years. The observation interval was 2 years, from 1994 to 2000. Including age, gender, and education as a covariate, eight different models were conducted to examine the bivariate effects among depressive symptoms and functional limitations.

RESULTS: Of the eight models, the bivariate model of depressive symptoms predicting change in functional limitations fitted the data best. The parameter estimates of the final model indicated significant predictive pathways from depressive symptoms to subsequent changes in depressive symptoms and functional limitations.

CONCLUSION: This study tested the bidirectional relationship between depressive symptoms and functional limitations among centenarian survivors in their 80s, which uncovered that depressive symptoms is a dominant variable among the two constructs. Our findings add to a lacking number of longitudinal studies with oldest old adults.

%B Aging Ment Health %P 1-9 %8 2023 Feb 14 %G eng %R 10.1080/13607863.2023.2177830 %0 Journal Article %J Ann Neurol %D 2023 %T Biological Age Acceleration and Motoric Cognitive Risk Syndrome. %A Sathyan, Sanish %A Ayers, Emmeline %A Adhikari, Dristi %A Gao, Tina %A Milman, Sofiya %A Barzilai, Nir %A Verghese, Joe %K Motoric Cognitive Risk Syndrome %X

OBJECTIVE: Motoric cognitive risk (MCR) syndrome, a predementia syndrome characterized by slow gait and subjective cognitive concerns, is associated with multiple age-related risk factors. We hypothesized that MCR is associated with biological age acceleration. We examined the associations of biological age acceleration with MCR, and mortality risk in MCR cases.

METHODS: Biological age was determined using proteomic and epigenetic clocks in participants aged 65 years and older in the LonGenity study (N = 700, females = 57.9%) and Health and Retirement Study (HRS; N = 1,043, females = 57.1%) cohorts. Age acceleration (AgeAccel) was operationally defined as the residual from regressing predicted biological age (from both clocks separately) on chronological age. Association of AgeAccel with incident MCR in the overall sample as well as with mortality risk in MCR cases was examined using Cox models and reported as hazard ratios (HRs).

RESULTS: AgeAccel scores derived from a proteomic clock were associated with prevalent MCR (odds ratio adjusted for age, gender, education years, and chronic illnesses [aOR] = 1.36, 95% confidence interval [CI] = 1.09-1.71) as well as predicted incident MCR (HR = 1.19, 95% CI = 1.00-1.41) in the LonGenity cohort. In HRS, the association of AgeAccel using an epigenetic clock with prevalent MCR was confirmed (aOR = 1.47, 95% CI = 1.16-1.85). Participants with MCR and accelerated aging (positive AgeAccel score) were at the highest risk for mortality in both LonGenity (HR = 3.38, 95% CI = 2.01-5.69) and HRS (HR = 2.47, 95% CI = 1.20-5.10).

INTERPRETATION: Accelerated aging predicts risk for MCR, and is associated with higher mortality in MCR patients. ANN NEUROL 2023.

%B Ann Neurol %G eng %R 10.1002/ana.26624 %0 Journal Article %J PLoS One %D 2023 %T Biological expressions of early life trauma in the immune system of older adults. %A Noppert, Grace A %A Duchowny, Kate A %A Stebbins, Rebecca %A Aiello, Allison E %A Dowd, Jennifer B %A Clarke, Philippa %K Adolescent %K Aged %K Cytomegalovirus Infections %K Humans %K Immune System %K Immunoglobulin G %K Interleukin-6 %K United States %K White %X

BACKGROUND: Poor immune function is associated with increased risk for a number of age-related diseases, however, little is known about the impact of early life trauma on immune function in late-life.

METHODS: Using nationally representative data from the Health and Retirement Study (n = 5,823), we examined the association between experiencing parental/caregiver death or separation before age 16 and four indicators of immune function in late-life: C-reactive Protein (CRP), Interleukin-6 (IL-6), soluble Tumor Necrosis Factor (sTNFR), and Immunoglobulin G (IgG) response to cytomegalovirus (CMV). We also examined racial/ethnic differences.

FINDINGS: Individuals that identified as racial/ethnic minorities were more likely to experience parental/caregiver loss and parental separation in early life compared to Non-Hispanic Whites, and had poorer immune function in late-life. We found consistent associations between experiencing parental/caregiver loss and separation and poor immune function measured by CMV IgG levels and IL-6 across all racial/ethnic subgroups. For example, among Non-Hispanic Blacks, those that experienced parental/caregiver death before age 16 had a 26% increase in CMV IgG antibodies in late-life (β = 1.26; 95% CI: 1.17, 1.34) compared to a 3% increase in CMV antibodies among Non-Hispanic Whites (β = 1.03; 95% CI: 0.99, 1.07) controlling for age, gender, and parental education.

INTERPRETATION: Our results suggest a durable association between experiencing early life trauma and immune health in late-life, and that structural forces may shape the ways in which these relationships unfold over the life course.

%B PLoS One %V 18 %P e0286141 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/37343002?dopt=Abstract %R 10.1371/journal.pone.0286141 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T The burden of pre-admission pain, depression, and caregiving on palliative care needs for seriously ill trauma patients. %A Abbas, Muhammad %A Reich, Amanda Jane %A Wang, Yihan %A Hu, Frances Y %A Bollens-Lund, Evan %A Kelley, Amy S %A Cooper, Zara %X

INTRODUCTION: Increasing numbers of individuals admitted to hospitals for trauma are older adults, many of whom also have underlying serious illnesses. Older adults with serious illness benefit from palliative care, but the palliative care needs of seriously ill older adults with trauma have not been elucidated. We hypothesize that older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours before trauma admission.

METHODS: Using Health and Retirement Study data (2008-2018) linked to Medicare claims, we identified patients 66 years or older who met an established definition of serious illness in surgery and were admitted with trauma. Descriptive analyses were performed for baseline patient characteristics, pre-admission pain (dichotomized as none/mild vs. moderate/severe), depression (dichotomized as no, Center for Epidemiologic Studies Depression scale [CES-D] < 3 vs. yes, CES-D ≥ 3), and unpaid caregiving hours (dichotomized as low (<30 h/month), high (≥30 h/month)).

RESULTS: We identified 1741 patients, 67.4% were female and 86.8% White. Mean age was 83 (SD 7.5), and 60.3% had ≥4 comorbidities. The majority (62.9%) were admitted due to falls, 33.5% had isolated hip fracture. The prevalence of baseline moderate/severe pain and depression were 38.1% and 42.6%, respectively. Among the cohort, 42.2% had unpaid caregiving, of those 27.7% had ≥30 h/week of unpaid caregiving hours.

CONCLUSIONS: Prior to trauma admission, older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours. These findings may inform targeted palliative care interventions to reduce symptom burden and post-discharge healthcare utilization.

%B J Am Geriatr Soc %8 2023 Feb 21 %G eng %R 10.1111/jgs.18289 %0 Journal Article %J medRxiv %D 2023 %T Cardiovascular disease and type 2 diabetes in older adults: a combined protocol for an individual participant data analysis for risk prediction and a network meta-analysis of novel anti-diabetic drugs. %A Aponte Ribero, Valerie %A Alwan, Heba %A Efthimiou, Orestis %A Abolhassani, Nazanin %A Bauer, Douglas C %A Henrard, Séverine %A Christiaens, Antoine %A Waeber, Gérard %A Rodondi, Nicolas %A Gencer, Baris %A Del Giovane, Cinzia %K anti-diabetic drugs %K Cardiovascular disease %K Diabetes %K risk prediction %X

INTRODUCTION: Older and multimorbid adults with type 2 diabetes (T2D) are at high risk of cardiovascular disease (CVD) and chronic kidney disease (CKD). Estimating risk and preventing CVD is a challenge in this population notably because it is underrepresented in clinical trials. Our study aims to (1) assess if T2D and haemoglobin A1c (HbA1c) are associated with the risk of CVD events and mortality in older adults, (2) develop a risk score for CVD events and mortality for older adults with T2D, (3) evaluate the comparative efficacy and safety of novel antidiabetics.

METHODS AND ANALYSIS: For Aim 1, we will analyse individual participant data on individuals aged ≥65 years from five cohort studies: the Optimising Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older People study; the Cohorte Lausannoise study; the Health, Aging and Body Composition study; the Health and Retirement Study; and the Survey of Health, Ageing and Retirement in Europe. We will fit flexible parametric survival models (FPSM) to assess the association of T2D and HbA1c with CVD events and mortality. For Aim 2, we will use data on individuals aged ≥65 years with T2D from the same cohorts to develop risk prediction models for CVD events and mortality using FPSM. We will assess model performance, perform internal-external cross validation, and derive a point-based risk score. For Aim 3, we will systematically search randomized controlled trials of novel antidiabetics. Network meta-analysis will be used to determine comparative efficacy in terms of CVD, CKD, and retinopathy outcomes, and safety of these drugs. Confidence in results will be judged using the CINeMA tool.

ETHICS AND DISSEMINATION: Aims 1 and 2 were approved by the local ethics committee (Kantonale Ethikkommission Bern); no approval is required for Aim 3. Results will be published in peer-reviewed journals and presented in scientific conferences.

STRENGTHS AND LIMITATIONS: We will analyse individual participant data from multiple cohort studies of older adults who are often not well represented in large clinical trials.By using flexible survival parametric models, we will be able to capture the potentially complex shapes of the baseline hazard functions of cardiovascular disease (CVD) and mortality.Our network meta-analysis will include recently published randomised controlled trials on novel anti-diabetic drugs that have not been included in previous network meta-analysis and results will be stratified by age and baseline HbA1cAlthough we plan to use several international cohorts, the external validity of our findings and particularly of our prediction model will need to be assessed in independent studiesOur study will help guide CVD risk estimation and prevention among older adults with type 2 diabetes.

%B medRxiv %G eng %R 10.1101/2023.03.13.23287105 %0 Journal Article %J J Frailty Aging %D 2023 %T Centrally Acting ACE Inhibitor Use and Physical Performance in Older Adults. %A George, C J %A Hall, C B %A Weiss, E F %A Verghese, J %A Neptune, E %A Abadir, P %K Aged %K Angiotensin-Converting Enzyme Inhibitors %K Cross-Sectional Studies %K Hand Strength %K Humans %K Muscle Strength %K Physical Functional Performance %X

BACKGROUND: There is conflicting evidence regarding the role of angiotensin-converting enzyme inhibitors and physical function. While some studies show improvements in muscle strength and physical function, others show no significant difference or decreased performance. This ambiguity could be due to differential effects of angiotensin-converting enzyme inhibitor subtypes which can be categorized as centrally or peripherally-acting based upon their ability to cross the blood-brain barrier.

OBJECTIVE: The objective of this study is to compare physical performance measures among angiotensin-converting enzyme inhibitor subtype users.

METHODS: Design: Cross-sectional Setting: Ambulatory Participants: Performed in 364 participants in the Health and Retirement Study cohort who were ≥ 65 years (median age (IQR) 74.00 (69-80) years.

MEASUREMENTS: Average difference in hand grip (kg), gait speed(m/s) and peak expiratory flow (L/min).

RESULTS: Compared to participants on a peripherally-acting angiotensin-converting enzyme inhibitor (113 (31%)), those on a centrally-acting agent (251(69%)) had stronger grip strength 28.9 ±1.0 vs 26.3±1.0, p=.011 and higher peak expiratory flow rates 316.8±130.4 vs. 280.0±118.5, p= .011 in unadjusted analysis. After multiple adjustments the difference in PEF remained statistically significant (Estimate(CI) 26.5, 95% CI 2.24, 50.5, p = 0.032).

CONCLUSION: Our results suggest that in older adults the use of centrally-acting angiotensin-converting enzyme inhibitors compared to a peripherally acting angiotensin-converting enzyme inhibitors was associated with better lung function in older individuals.

%B J Frailty Aging %V 12 %P 103-108 %8 2023 %G eng %N 2 %R 10.14283/jfa.2023.10 %0 Journal Article %J International Psychogeriatrics %D 2023 %T Changes in social lives and loneliness during COVID-19 among older adults: a closer look at the sociodemographic differences. %A Choi, Eun Young %A Farina, Mateo P %A Zhao, Erfei %A Jennifer A Ailshire %K COVID-19 %K Diversity %K Pandemic %K Psychosocial %K social isolation %X

OBJECTIVES: The COVID-19 pandemic greatly impacted the social lives of older adults across several areas, leading to concern about an increase in loneliness. This study examines the associations of structural, functional, and quality aspects of social connection with increased loneliness during COVID-19 and how these associations vary by sociodemographic factors.

DESIGN: Secondary data analyses on a nationally representative survey of older US adults.

SETTING: The 2020 Health and Retirement Study (HRS) COVID-19 module.

PARTICIPANTS: The study sample includes 3,804 adults aged 54 or older.

MEASUREMENTS: Increased loneliness was based on respondents' self-report on whether they felt lonelier than before the COVID-19 outbreak.

RESULTS: While 29% felt lonelier after COVID-19, middle-aged adults, women, non-Hispanic Whites, and the most educated were more likely to report increased loneliness. Not having enough in-person contact with people outside the household was associated with increased loneliness (OR = 10.07, < .001). Receiving emotional support less frequently (OR = 2.28, < .05) or more frequently (OR = 2.00, < .001) than before was associated with increased loneliness. Worse quality of family relationships (OR = 1.85, < .05) and worse friend/neighbor relationships (OR = 1.77, < .01) were related to feeling lonelier. Significant interactions indicated stronger effects on loneliness of poor-quality family relationships for women and insufficient in-person contact with non-household people for the middle-aged group and non-Hispanic Whites.

CONCLUSIONS: Our findings show an increase in loneliness during COVID-19 that was partly due to social mitigation efforts, and also uncover how sociodemographic groups were impacted differently, providing implications for recovery and support.

%B International Psychogeriatrics %V 35 %P 305-317 %G eng %N 6 %R 10.1017/S1041610222001107 %0 Journal Article %J JAMA Netw Open %D 2023 %T CogDrisk, ANU-ADRI, CAIDE, and LIBRA Risk Scores for Estimating Dementia Risk. %A Huque, Md Hamidul %A Kootar, Scherazad %A Eramudugolla, Ranmalee %A Han, S Duke %A Carlson, Michelle C %A Lopez, Oscar L %A Bennett, David A %A Peters, Ruth %A Anstey, Kaarin J %K Aged %K Aged, 80 and over %K Alzheimer disease %K Australia %K Cohort Studies %K Female %K Heart Disease Risk Factors %K Humans %K Male %K Risk Factors %X

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

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

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

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

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

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

%B JAMA Netw Open %V 6 %P e2331460 %8 2023 Aug 01 %G eng %N 8 %R 10.1001/jamanetworkopen.2023.31460 %0 Journal Article %J Journal of Applied Gerontology %D 2023 %T Comparison of Cognitive and Physical Decline as Predictors of Depression Among Older Adults. %A Scher, Clara %A Nepomnyaschy, Lenna %A Amano, Takashi %K Activities of Daily Living %K Cognitive Dysfunction %K depression %K Retirement %K Risk Factors %X

Activities of daily living (ADL) limitations and cognitive impairment have been identified as key risk factors for depression among older adults. However, little has been done to compare the strength of these relationships. The current study describes the prevalence and compares the independent and joint associations of ADL and cognitive limitations with depression among older adults in the US. Analyses are based on a sample of 30,923 observations on 13,545 unique respondents from three waves (2012, 2014, and 2016) of the Health and Retirement Study. Linear and logistic multivariate regression models with random and individual fixed effects were estimated. Findings indicate that both cognitive and ADL limitations are associated with depression; however, across all models, ADL limitations have a much stronger association. Further, in our most rigorous models, having both limitations is not significantly different from having just ADL, and not cognitive, limitations.

%B Journal of Applied Gerontology %V 42 %P 387-398 %G eng %N 3 %R 10.1177/07334648221139255 %0 Journal Article %J Neurobiology & Aging %D 2023 %T A comparison of cognitive performances based on differing rates of DNA methylation GrimAge acceleration among older men and women. %A O'Shea, Deirdre M %A Alaimo, Hannah %A Davis, Jennifer D %A Galvin, James E %A Tremont, Geoffrey %K Aging %K Cognition %K DNA Methylation %K Executive function %K GrimAge %K Memory %K sex/gender differences %X

Cognitive heterogeneity increases with age rendering sex differences difficult to identify. Given established sex differences in biological aging, we examined whether comparisons of men and women on neuropsychological test performances differed as a function of age rate. Data were obtained from 1921 adults enrolled in the 2016 wave of the Health and Retirement Study. The residual from regressing the DNA methylation GrimAge clock on chronological age was used as the measure of aging rate. Slow and fast age rates were predefined as 1 standard deviation below or above the sex-specific mean rates, respectively. ANCOVAs were used to test group differences in test performances. Pairwise comparisons revealed that slow aging men outperformed fast aging women (and vice versa) on measures of executive function/speed, visual memory and semantic fluency; however, when groups were matched by aging rates, no significant differences remained. In contrast, women, regardless of their aging rates, education or depressive symptoms maintained their advantage on verbal learning and memory. Implications for research on sex differences in cognitive aging are discussed.

%B Neurobiology & Aging %V 123 %P 83-91 %G eng %R 10.1016/j.neurobiolaging.2022.12.011 %0 Journal Article %J JAMA Intern Med %D 2023 %T Comparison of Particulate Air Pollution From Different Emission Sources and Incident Dementia in the US. %A Zhang, Boya %A Weuve, Jennifer %A Kenneth M. Langa %A D'Souza, Jennifer %A Szpiro, Adam %A Jessica Faul %A Mendes de Leon, Carlos %A Gao, Jiaqi %A Kaufman, Joel D %A Sheppard, Lianne %A Lee, Jinkook %A Lindsay C Kobayashi %A Hirth, Richard %A Adar, Sara D %X

IMPORTANCE: Emerging evidence indicates that exposure to fine particulate matter (PM2.5) air pollution may increase dementia risk in older adults. Although this evidence suggests opportunities for intervention, little is known about the relative importance of PM2.5 from different emission sources.

OBJECTIVE: To examine associations of long-term exposure of total and source-specific PM2.5 with incident dementia in older adults.

DESIGN, SETTING, AND PARTICIPANTS: The Environmental Predictors of Cognitive Health and Aging study used biennial survey data from January 1, 1998, to December 31, 2016, for participants in the Health and Retirement Study, which is a nationally representative, population-based cohort study in the US. The present cohort study included all participants older than 50 years who were without dementia at baseline and had available exposure, outcome, and demographic data between 1998 and 2016 (N = 27 857). Analyses were performed from January 31 to May 1, 2022.

EXPOSURES: The 10-year mean total PM2.5 and PM2.5 from 9 emission sources at participant residences for each month during follow-up using spatiotemporal and chemical transport models.

MAIN OUTCOMES AND MEASURES: The main outcome was incident dementia as classified by a validated algorithm incorporating respondent-based cognitive testing and proxy respondent reports. Adjusted hazard ratios (HRs) were estimated for incident dementia per IQR of residential PM2.5 concentrations using time-varying, weighted Cox proportional hazards regression models with adjustment for the individual- and area-level risk factors.

RESULTS: Among 27 857 participants (mean [SD] age, 61 [10] years; 15 747 [56.5%] female), 4105 (15%) developed dementia during a mean (SD) follow-up of 10.2 [5.6] years. Higher concentrations of total PM2.5 were associated with greater rates of incident dementia (HR, 1.08 per IQR; 95% CI, 1.01-1.17). In single pollutant models, PM2.5 from all sources, except dust, were associated with increased rates of dementia, with the strongest associations for agriculture, traffic, coal combustion, and wildfires. After control for PM2.5 from all other sources and copollutants, only PM2.5 from agriculture (HR, 1.13; 95% CI, 1.01-1.27) and wildfires (HR, 1.05; 95% CI, 1.02-1.08) were robustly associated with greater rates of dementia.

CONCLUSION AND RELEVANCE: In this cohort study, higher residential PM2.5 levels, especially from agriculture and wildfires, were associated with higher rates of incident dementia, providing further evidence supporting PM2.5 reduction as a population-based approach to promote healthy cognitive aging. These findings also indicate that intervening on key emission sources might have value, although more research is needed to confirm these findings.

%B JAMA Intern Med %G eng %R 10.1001/jamainternmed.2023.3300 %0 Journal Article %J Journal of Alzheimer's Disease : JAD %D 2023 %T The Construction of a Multidomain Risk Model of Alzheimer's Disease and Related Dementias. %A Akushevich, Igor %A Yashkin, Arseniy %A Ukraintseva, Svetlana %A Yashin, Anatoliy I %A Kravchenko, Julia %K Alzheimer disease %K Comorbidity %K Dementia %K Humans %K Hypertension %K Medicare %K United States %X

BACKGROUND: Alzheimer's disease (AD) and related dementia (ADRD) risk is affected by multiple dependent risk factors; however, there is no consensus about their relative impact in the development of these disorders.

OBJECTIVE: To rank the effects of potentially dependent risk factors and identify an optimal parsimonious set of measures for predicting AD/ADRD risk from a larger pool of potentially correlated predictors.

METHODS: We used diagnosis record, survey, and genetic data from the Health and Retirement Study to assess the relative predictive strength of AD/ADRD risk factors spanning several domains: comorbidities, demographics/socioeconomics, health-related behavior, genetics, and environmental exposure. A modified stepwise-AIC-best-subset blanket algorithm was then used to select an optimal set of predictors.

RESULTS: The final predictive model was reduced to 10 features for AD and 19 for ADRD; concordance statistics were about 0.85 for one-year and 0.70 for ten-year follow-up. Depression, arterial hypertension, traumatic brain injury, cerebrovascular diseases, and the APOE4 proxy SNP rs769449 had the strongest individual associations with AD/ADRD risk. AD/ADRD risk-related co-morbidities provide predictive power on par with key genetic vulnerabilities.

CONCLUSION: Results confirm the consensus that circulatory diseases are the main comorbidities associated with AD/ADRD risk and show that clinical diagnosis records outperform comparable self-reported measures in predicting AD/ADRD risk. Model construction algorithms combined with modern data allows researchers to conserve power (especially in the study of disparities where disadvantaged groups are often grossly underrepresented) while accounting for a high proportion of AD/ADRD-risk-related population heterogeneity stemming from multiple domains.

%B Journal of Alzheimer's Disease : JAD %V 96 %P 535-550 %G eng %N 2 %R 10.3233/JAD-221292 %0 Web Page %D 2023 %T Coronary heart disease before age 45 may increase risk of dementia later in life %A American Heart Association %K Dementia %K Heart disease %I American Heart Association %G eng %U https://newsroom.heart.org/news/coronary-heart-disease-before-age-45-may-increase-risk-of-dementia-later-in-life %0 Journal Article %J The Journal of Gerontology, Series B %D 2023 %T Cross-National and Cross-Generational Evidence That Educational Attainment May Slow the Pace of Aging in European-Descent Individuals. %A Sugden, Karen %A Moffitt, Terrie E %A Arpawong, Thalida Em %A Arseneault, Louise %A Belsky, Daniel W %A Corcoran, David L %A Crimmins, Eileen M %A Hannon, Eilis %A Houts, Renate %A Mill, Jonathan S %A Poulton, Richie %A Ramrakha, Sandhya %A Wertz, Jasmin %A Williams, Benjamin S %A Caspi, Avshalom %K Academic Success %K Educational Status %K Genome-Wide Association Study %X

OBJECTIVES: Individuals with more education are at lower risk of developing multiple, different age-related diseases than their less-educated peers. A reason for this might be that individuals with more education age slower. There are 2 complications in testing this hypothesis. First, there exists no definitive measure of biological aging. Second, shared genetic factors contribute toward both lower educational attainment and the development of age-related diseases. Here, we tested whether the protective effect of educational attainment was associated with the pace of aging after accounting for genetic factors.

METHODS: We examined data from 5 studies together totaling almost 17,000 individuals with European ancestry born in different countries during different historical periods, ranging in age from 16 to 98 years old. To assess the pace of aging, we used DunedinPACE, a DNA methylation algorithm that reflects an individual's rate of aging and predicts age-related decline and Alzheimer's disease and related disorders. To assess genetic factors related to education, we created a polygenic score based on the results of a genome-wide association study of educational attainment.

RESULTS: Across the 5 studies, and across the life span, higher educational attainment was associated with a slower pace of aging even after accounting for genetic factors (meta-analysis effect size = -0.20; 95% confidence interval [CI]: -0.30 to -0.10; p = .006). Further, this effect persisted after taking into account tobacco smoking (meta-analysis effect size = -0.13; 95% CI: -0.21 to -0.05; p = .01).

DISCUSSION: These results indicate that higher levels of education have positive effects on the pace of aging, and that the benefits can be realized irrespective of individuals' genetics.

%B The Journal of Gerontology, Series B %V 78 %P 1375-1385 %G eng %N 8 %R 10.1093/geronb/gbad056 %0 Journal Article %J Journal of Alzheimers Disease: JAD %D 2023 %T Dementia Attributable Healthcare Utilizations in the Caribbean versus United States. %A Li, Jing %A Weiss, Jordan %A Rajadhyaksha, Ashish %A Acosta, Daisy %K Aged %K Alzheimer disease %K Delivery of Health Care %K ethnicity %K Humans %K Patient Acceptance of Health Care %K Puerto Rico %K United States %X

BACKGROUND: Despite the high burden of Alzheimer's disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer's disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

%B Journal of Alzheimers Disease: JAD %V 96 %P 801-811 %G eng %N 2 %R 10.3233/JAD-230505 %0 Journal Article %J Journal of Alzheimers Disease: JAD %D 2023 %T Dementia Attributable Healthcare Utilizations in the Caribbean versus United States. %A Li, Jing %A Weiss, Jordan %A Rajadhyaksha, Ashish %A Acosta, Daisy %A Harrati, Amal %A Jiménez Velázquez, Ivonne Z %A Liu, Mao-Mei %A Guerra, Jorge J Llibre %A Rodriguez, Juan de Jesús Llibre %A Dow, William H %K Aged %K Alzheimer disease %K Delivery of Health Care %K ethnicity %K Humans %K Patient Acceptance of Health Care %K Puerto Rico %K United States %X

BACKGROUND: Despite the high burden of Alzheimer's disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer's disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

%B Journal of Alzheimers Disease: JAD %V 96 %P 801-811 %G eng %N 2 %R 10.3233/JAD-230505 %0 Journal Article %J JAMDA %D 2023 %T Depressive Multimorbidity and Trajectories of Functional Status among Older Americans: Differences by Racial/Ethnic Group. %A Botoseneanu, Anda %A Elman, Miriam R %A Allore, Heather G %A Dorr, David A %A Newsom, Jason T %A Nagel, Corey L %A Quiñones, Ana R %K Depressive symptoms %K Functional limitations %K Health Disparities %K multimorbidity %K Race/ethnicity %X

OBJECTIVE: This study aims to evaluate the impact of depressive multimorbidity (ie, including depressive symptoms) on the long-term development of activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations according to racial/ethnic group in a representative sample of US older adults.

DESIGN: Prospective, observational, population-based 16-year follow-up study of nationally representative sample.

SETTING AND PARTICIPANTS: Sample of older non-Hispanic Black, Hispanic, and nonHispanic White Americans from the Health and Retirement Study (2000‒2016, N = 16,364, community-dwelling adults ≥65 years of age).

METHODS: Data from 9 biennial assessments were used to evaluate the accumulation of ADL-IADL limitations (range 0‒11) among participants with depressive (8-item Center for Epidemiologic Studies Depression score≥4) vs somatic (ie, physical conditions only) multimorbidity vs those without multimorbidity (no or 1 condition). Generalized estimating equations included race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White), baseline age, sex, body mass index, education, partnered, and net worth.

RESULTS: Depressive and somatic multimorbidity were associated with 5.18 and 2.95 times greater accumulation of functional limitations, respectively, relative to no disease [incidence rate ratio (IRR) = 5.18, 95% confidence interval, CI (4.38,6.13), IRR = 2.95, 95% CI (2.51,3.48)]. Hispanic and Black respondents experienced greater accumulation of ADL-IADL limitations than White respondents [IRR = 1.27, 95% CI (1.14, 1.41), IRR = 1.31, 95% CI (1.20, 1.43), respectively].

CONCLUSIONS AND IMPLICATIONS: Combinations of somatic diseases and high depressive symptoms are associated with greatest accumulation of functional limitations over time in adults ages 65 and older. There is a more rapid growth in functional limitations among individuals from racial/ethnic minority groups. Given the high prevalence of multimorbidity and depressive symptomatology among older adults and the availability of treatment options for depression, these results highlight the importance of screening/treatment for depression, particularly among older adults with socioeconomic vulnerabilities, to slow the progression of functional decline in later life.

%B JAMDA %V 24 %P 250-257 %G eng %N 2 %R 10.1016/j.jamda.2022.11.015 %0 Journal Article %J J of the American Geriatric Society %D 2023 %T The devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies. %A Ankuda, Claire K %A Covinsky, Kenneth %A Freedman, Vicki A %A Kenneth M. Langa %A Aldridge, Melissa D %A Yee, Cynthia %A Kelley, Amy S %K Activities of Daily Living %K Cohort Studies %K Disabled Persons %K Medicare %K Self Care %X

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

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

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

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

%B J of the American Geriatric Society %V 71 %P 858-868 %G eng %N 3 %R 10.1111/jgs.18158 %0 Journal Article %J J Head Trauma Rehabil %D 2023 %T Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations. %A Yashkin, Arseniy P %A Gorbunova, Galina A %A Tupler, Larry %A Yashin, Anatoliy I %A Doraiswamy, Murali %A Akushevich, Igor %K Alzheimer disease %K Traumatic Brain Injury %K veteran %X

OBJECTIVE: To directly compare the effect of incident age 68+ traumatic brain injury (TBI) on the risk of diagnosis of clinical Alzheimer's disease (AD) in the general population of older adults, and between male veterans and nonveterans; to assess how this effect changes with time since TBI.

SETTING AND PARTICIPANTS: Community-dwelling traditional Medicare beneficiaries 68 years or older from the Health and Retirement Study (HRS).

DESIGN: Fine-Gray models combined with inverse-probability weighting were used to identify associations between incident TBI, post-TBI duration, and TBI treatment intensity, with a diagnosis of clinical AD dementia. The study included 16 829 older adults followed over the 1991-2015 period. For analyses of veteran-specific risks, 4281 veteran males and 3093 nonveteran males were identified. Analysis of veteran females was unfeasible due to the age structure of the population. Information on occurrence(s) of TBI, and onset of AD and risk-related comorbidities was constructed from individual-level HRS-linked Medicare claim records while demographic and socioeconomic risk factors were based on the survey data.

RESULTS: Later-life TBI was strongly associated with increased clinical AD risk in the full sample (pseudo-hazard ratio [HR]: 3.22; 95% confidence interval [CI]: 2.57-4.05) and in veteran/nonveteran males (HR: 5.31; CI: 3.42-7.94), especially those requiring high-intensity/duration care (HR: 1.58; CI: 1.29-1.91). Effect magnitude decreased with time following TBI (HR: 0.72: CI: 0.68-0.80).

CONCLUSION: Later-life TBI was strongly associated with increased AD risk, especially in those requiring high-intensity/duration care. Effect magnitude decreased with time following TBI. Univariate analysis showed no differences in AD risk between veterans and nonveterans, while the protective effect associated with veteran status in Fine-Gray models was largely due to differences in demographics, socioeconomics, and morbidity. Future longitudinal studies incorporating diagnostic procedures and documentation quantifying lifetime TBI events are necessary to uncover pathophysiological mediating and/or moderating mechanisms between TBI and AD.

%B J Head Trauma Rehabil %G eng %R 10.1097/HTR.0000000000000865 %0 Report %D 2023 %T Disparities in LTSS Needs and Supportive Resources at Age 55, and Outcome Disparities During the Next Decade %A ATI Advisory %K Disparities %K Long-term services and supports %X Our research highlights disparities and differences in the prevalence of long-term services and supports (LTSS) needs and related resources among U.S. adults aged 55 and living in the community. We examine private finances, insurance coverage, and social supports, as well as long-term health, LTSS and financial outcomes over the next decade. Disparities and differences occurred along racial and ethnic, gender, and geographic lines. This report analyzes data from the University of Michigan Health and Retirement Study (HRS). %I ATI Advisory %G eng %U https://atiadvisory.com/resources/disparities-in-ltss-needs-and-supportive-resources-at-age-55-and-outcome-disparities-during-the-next-decade/ %0 Journal Article %J Alzheimers Dement %D 2023 %T Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India. %A Westrick, Ashly C %A Avila-Rieger, Justina %A Gross, Alden L %A Hohman, Timothy %A Vonk, Jet M J %A Zahodne, Laura B %A Lindsay C Kobayashi %K Education %K gender disparities %K India %K memory function %K United States %X

INTRODUCTION: We compared gender disparities in later-life memory, overall and by education, in India and the United States (US).

METHODS: Data (N = 7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of India-Diagnostic Assessment of Dementia (LASI-DAD; N = 4096; 2017-19) and US Health and Retirement Study HCAP (HRS-HCAP; N = 3347; 2016-17). We derived harmonized memory factors from each study using confirmatory factor analysis. We used multivariable-adjusted linear regression to compare gender disparities in memory function between countries, overall and by education.

RESULTS: In the United States, older women had better memory than older men (0.28 SD-unit difference; 95% CI: 0.22, 0.35). In India, older women had worse memory than older men (-0.15 SD-unit difference; 95% CI: -0.20, -0.10), which attenuated with increasing education and literacy.

CONCLUSION: We observed gender disparities in memory in India that were not present in the United States, and which dissipated with education and literacy.

%B Alzheimers Dement %G eng %R 10.1002/alz.13404 %0 Journal Article %J J Aging Health %D 2023 %T An Early and Unequal Decline: Life Course Trajectories of Cognitive Aging in the United States. %A Yang, Yang C %A Walsh, Christine E %A Shartle, Kaitlin %A Stebbins, Rebecca C %A Aiello, Allison E %A Belsky, Daniel W %A Harris, Kathleen Mullan %A Chanti-Ketterl, Marianne %A Plassman, Brenda L %K Alzheimer's disease %K cognitive aging %K Dementia %K social disparities %X

OBJECTIVES: Cognitive aging is a lifelong process with implications for Alzheimer's disease and dementia. This study aims to fill major gaps in research on the natural history of and social disparities in aging-related cognitive decline over the life span.

METHODS: We conducted integrative data analysis of four large U.S. population-based longitudinal studies of individuals aged 12 to 105 followed over two decades and modeled age trajectories of cognitive function in multiple domains.

RESULTS: We found evidence for the onset of cognitive decline in the 4 decade of life, varying gender differences with age, and persistent disadvantage among non-Hispanic Blacks, Hispanics, and those without college education. We further found improvement in cognitive function across 20 century birth cohorts but widening social inequalities in more recent cohorts.

DISCUSSION: These findings advance an understanding of early life origins of dementia risk and invite future research on strategies for promoting cognitive health for all Americans.

%B J Aging Health %P 8982643231184593 %G eng %R 10.1177/08982643231184593 %0 Journal Article %J J Geriatr Oncol %D 2023 %T Education, incident cancer, and rate of memory decline in a national sample of US adults in mid-to-later-life. %A Ospina-Romero, Monica %A Brenowitz, Willa D %A Glymour, M Maria %A Westrick, Ashly %A Graff, Rebecca E %A Hayes-Larson, Eleanor %A Mayeda, Elizabeth Rose %A Ackley, Sarah F %A Lindsay C Kobayashi %K Aged %K Aging %K Cancer Survivors %K Educational Status %K Humans %K Longitudinal Studies %K Memory Disorders %K Middle Aged %K Neoplasms %X

INTRODUCTION: Middle-aged and older adults who develop cancer experience memory loss following diagnosis, but memory decline in the years before and after cancer diagnosis is slower compared to their cancer-free counterparts. Educational attainment strongly predicts memory function during aging, but it is unclear whether education protects against memory loss related to cancer incidence or modifies long-term memory trajectories in middle-aged and older cancer survivors.

MATERIALS AND METHODS: Data were from 14,449 adults (3,248 with incident cancer, excluding non-melanoma skin cancer) aged 50+ in the population-based US Health and Retirement Study from 1998 to 2016. Memory was assessed every two years as a composite of immediate and delayed word recall tests and proxy assessments for impaired individuals. Memory scores all time points were standardized at to the baseline distribution. Using multivariate-adjusted linear mixed-effects models, we estimated rates of memory decline in the years before cancer diagnosis, shortly after diagnosis, and in the years after diagnosis. We compared rates of memory decline between incident cancer cases and age-matched cancer-free adults, overall and according to level of education (<12 years, "low"; 12 to <16 years, "intermediate"; ≥16 years, "high").

RESULTS: Incident cancer diagnoses were followed by short-term declines in memory averaging 0.06 standard deviation (SD) units (95% confidence interval [CI]: -0.084, -0.036). Those with low education experienced the strongest magnitude of short-term decline in memory after diagnosis (-0.10 SD units, 95% CI: -0.15, -0.05), but this estimate was not statistically significantly different from the short-term decline in memory experienced by those with high education (-0.04 SD units, 95% CI: -0.08, 0.01; p-value for education as an effect modifier = 0.15). In the years prior to and following an incident cancer diagnosis, higher educational attainment was associated with better memory, but it did not modify the difference in rate of long-term memory decline between cancer survivors and those who remained cancer-free.

DISCUSSION: Education was associated with better memory function over time among both cancer survivors and cancer-free adults aged 50 and over. Low education may be associated with a stronger short-term decline in memory after a cancer diagnosis.

%B J Geriatr Oncol %V 14 %P 101530 %G eng %N 5 %R 10.1016/j.jgo.2023.101530 %0 Journal Article %J J Aging Soc Policy %D 2023 %T Effects of California's Paid Family Leave Law on Caregiving by Older Adults. %A Abramowitz, Joelle %A Dillender, Marcus %K California %K Caregiving %K Older Adults %X

In 2004, California became the first state to require that employers provide paid family leave (PFL) to their employees. This paper examines the effect of California's PFL law on time spent caregiving to parents and to grandchildren by older adults aged 50-79. To identify the effect of the law, the paper uses the 1998-2016 waves of the Health and Retirement Study and a difference-in-differences approach comparing outcomes in California to other states before and after the implementation of the law. Results suggest that the law induced a switch in caregiving behavior with older adults spending less time caring for grandchildren and more time helping parents. Focusing on women, results further suggest that PFL affected older adults both through their own leave-taking and through reallocations of their caregiving time in response to leave-taking by new parents. The findings motivate thinking more broadly when calculating the costs and benefits of PFL policies; to the extent that California's PFL law enabled older adults to provide more care for their parents they otherwise would not have received, such an outcome represents an indirect benefit of the policy.

%B J Aging Soc Policy %P 1-18 %G eng %R 10.1080/08959420.2023.2226283 %0 Journal Article %J Physiol Behav %D 2023 %T Effects of weight stigma on BMI and inflammatory markers among people living with obesity. %A Nicolau, Joana %A Tofé, Santiago %A Bonet, Aina %A Sanchís, Pilar %A Pujol, Antelm %A Ayala, Luisa %A Gil, Apolonia %A Masmiquel, Lluís %K Adult %K Body Mass Index %K C-reactive protein %K Ferritins %K Humans %K Hydrocortisone %K Obesity %K Weight Loss %K Weight Prejudice %X

OBJECTIVE: Weight stigma (WS) and prejudice are one of the most prevalent ways of discrimination among adults, comparable with rates of racial discrimination. Exposure to WS among patients with obesity (PWO) may make the adoption of healthy dietary patterns and regular physical activity even more challenging and, therefore, the achievement of weight loss. Additionally, WS could also induce physiological responses such as increased levels of inflammatory markers, due to stress exposure.

METHOD: Subjects attending two obesity clinics were evaluated at baseline and after a minimum follow-up of six months. The weight Bias Internalization Scale (WBIS) and the Stigmatizing Situations Inventory (SSI) were administered to evaluate WS. Also, anthropometric and inflammatory markers, including cortisol, ferritin and C-reactive protein (CRP), were recorded at baseline.

RESULTS: 79 PWO (87.3%♀, 45.5 ± 1.3 years, 35.9 ± 6.3 kg/m) were included. At baseline, 72.2% started liraglutide as anti-obesity drug. Baseline body mass index (BMI) correlated positively with both WBIS (r = 0.23; p = 0.03) and SSI (r = 0.25; p = 0.02) scores. Mean percentual weight loss after a mean follow-up of six months was -7.28%. However, there was a negative, but not statistically significant, correlation between weight loss and both WBIS (r=-0.14; p = 0.2) and SSI (r=-0.19; p = 0.08). Regarding inflammatory markers, plasma cortisol levels at baseline correlated positively with WBIS (p = 0.005) and SSI (p = 0.02). CRP at baseline also presented a positive correlation with SSI (p = 0.03). No significant correlations were found for stigma tests and ferritin levels.

DISCUSSION: As weight increases among PWO, so does stigma. Despite we did not find a significant negative association between the presence of WS and weight loss outcomes, there was an increase in inflammatory markers among PWO who experienced higher levels of WS.

%B Physiol Behav %V 262 %P 114088 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/36657653?dopt=Abstract %R 10.1016/j.physbeh.2023.114088 %0 Journal Article %J JAMA Internal Medicine %D 2023 %T Estimated Annual Spending on Lecanemab and Its Ancillary Costs in the US Medicare Program. %A Arbanas, Julia Cave %A Damberg, Cheryl L %A Leng, Mei %A Harawa, Nina %A Sarkisian, Catherine A %A Landon, Bruce E %A Mafi, John N %K Health Care Costs %K lecanemab %K Medicare spending %X Lecanemab, an antidementia medication with modest clinical benefit, received accelerated US Food and Drug Administration (FDA) approval. Traditional FDA approval of lecanemab could occur in 2023, prompting Medicare to reconsider coverage restrictions and potentially enabling widespread use. Lecanemab’s $26 500 proposed annual acquisition cost and ancillary spending (eg, imaging) could increase Medicare spending, possibly leading to beneficiary premium increases. To estimate annual Medicare spending on lecanemab, we performed a cost analysis using nationally representative survey data from the 2018 Health and Retirement Study (HRS). %B JAMA Internal Medicine %V 183 %P 885-889 %G eng %N 8 %R 10.1001/jamainternmed.2023.1749 %0 Journal Article %J SSM - Mental Health %D 2023 %T Estimating the heterogeneous effect of life satisfaction on cognitive functioning among older adults: Evidence of US and UK national surveys %A Komura, Toshiaki %A Cowden, Richard G. %A Chen, Ruijia %A Andrews, Ryan M. %A Shiba, Koichiro %K Cognition %K Heterogeneity %K Life Satisfaction %K Psychological well being %K Social psychology of aging %X Backgrounds: The emerging field of positive psychology suggests higher life satisfaction, a form of psychological well-being, may improve cognitive functioning. Although evidence exists for population-average associations between psychological well-being and better cognitive function, little is known about how the relationship varies across individuals. Methods: We analyzed a national sample of US and UK adults aged ≥50 from the Health and Retirement Study (HRS) (n = 10,650) and the English Longitudinal Survey of Aging (ELSA) (n = 5514). We assessed life satisfaction at baseline using the Satisfaction with Life Scale. Cognitive functioning was assessed using a modified version of the Telephone Interview for Cognitive Status score after 4-year follow-up. We estimated the population-average association between life satisfaction and cognitive functioning in each sample via doubly-robust targeted maximum likelihood estimation with SuperLearning. To assess effect heterogeneity, we estimated conditional average effects via a causal forest algorithm. Results: We did not find reliable evidence of a population-average association between life satisfaction and higher cognitive functioning in HRS (HRS: β = -0.12; 95%CI: -0.30, 0.06) and ELSA (ELSA: β = 0.39; 95%CI: -0.00, 0.79). Our machine-learning-based approach for estimating effect heterogeneity discovered the effect of life satisfaction on cognitive function can substantially vary across individuals. Life satisfaction appeared less beneficial, or even detrimental, among individuals with lower socioeconomic status, poor health status, and more negative psychological conditions, both in the US and UK samples. Conclusions: Further research is needed to uncover mechanisms underlying the heterogeneous effects of life satisfaction on cognitive function, as it may have unintended adverse consequences among some subgroups. %B SSM - Mental Health %V 4 %G eng %R 10.1016/j.ssmmh.2023.100260 %0 Web Page %D 2023 %T Facing Financial Ruin as Costs Soar for Elder Care %A Reed Abelson %A Jordan Rau %K Finances %K health costs %K Long-term Care %B Dying Broke %I The New York Times %C New York, NY %G eng %U https://www.nytimes.com/2023/11/14/health/long-term-care-facilities-costs.html %0 Journal Article %J Research Square %D 2023 %T Food security status and breast cancer screening among women in the United States: Evidence from Health and Retirement Study and Health Care and Nutrition Study %A Mahmood, Asos %A Kedia, Satish %A Dillon, Patrick %A kim, Hyunmin %A Arshad, Hassan %A Ray, Meredith %K breast cancer screening %K Food security %X Purpose: To assesses the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast x-ray) among older women in the United States (US). <h4>Methods: </h4> Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 to 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and fitted a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening. <h4>Results: </h4>: Food insecurity was significantly associated with failure to obtain a mammogram or breast x-ray within the past two years. Food-insecure women had 54% lower odds of reporting breast cancer screening in the past two years (OR=0.46; 95% CI: 0.30-0.70, P-value <.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms. <h4>Conclusion: </h4> Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower-income and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the financial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity. %B Research Square %G eng %R 10.21203/rs.3.rs-176608/v1 %0 Journal Article %J Nat Hum Behav %D 2023 %T Genetic associations with parental investment from conception to wealth inheritance in six cohorts. %A Wertz, Jasmin %A Moffitt, Terrie E %A Arseneault, Louise %A Barnes, J C %A Boivin, Michel %A Corcoran, David L %A Danese, Andrea %A Hancox, Robert J %A Harrington, HonaLee %A Houts, Renate M %A Langevin, Stephanie %A Liu, Hexuan %A Poulton, Richie %A Sugden, Karen %A Tanksley, Peter T %A Williams, Benjamin S %A Caspi, Avshalom %K genetic associations %K parental investment %K wealth inheritance %X

Genetic inheritance is not the only way parents' genes may affect children. It is also possible that parents' genes are associated with investments into children's development. We examined evidence for links between parental genetics and parental investments, from the prenatal period through to adulthood, using data from six population-based cohorts in the UK, US and New Zealand, together totalling 36,566 parents. Our findings revealed associations between parental genetics-summarized in a genome-wide polygenic score-and parental behaviour across development, from smoking in pregnancy, breastfeeding in infancy, parenting in childhood and adolescence, to leaving a wealth inheritance to adult children. Effect sizes tended to be small at any given time point, ranging from RR = 1.12 (95% confidence interval (95%CI) 1.09, 1.15) to RR = 0.76 (95%CI 0.72, 0.80) during the prenatal period and infancy; β = 0.07 (95%CI 0.04, 0.11) to β = 0.29 (95%CI 0.27, 0.32) in childhood and adolescence, and RR = 1.04 (95%CI 1.01, 1.06) to RR = 1.11 (95%CI 1.07, 1.15) in adulthood. There was evidence for accumulating effects across development, ranging from β = 0.15 (95%CI 0.11, 0.18) to β = 0.23 (95%CI 0.16, 0.29) depending on cohort. Our findings are consistent with the interpretation that parents pass on advantages to offspring not only via direct genetic transmission or purely environmental paths, but also via genetic associations with parental investment from conception to wealth inheritance.

%B Nat Hum Behav %G eng %R 10.1038/s41562-023-01618-5 %0 Journal Article %J The Lancet %D 2023 %T Genetically and environmentally predicted obesity in relation to cardiovascular disease: a nationwide cohort study %A Ojalehto, Elsa %A Zhan, Yiquiang %A Jylhava, Juulia %A Reynolds, Chandra %A Anna K. Dahl Aslan %A Karlsson, Ida %K BMI %K Cardiovascular disease %K Obesity %K polygenic score %K Twins %X Background Evidence indicates that the adverse health effects of obesity differ between genetically and environmentally influenced obesity. We examined differences in the association between obesity and cardiovascular disease (CVD) between individuals with a genetically predicted low, medium, or high body mass index (BMI). Methods We used cohort data from Swedish twins born before 1959 who had BMI measured between the ages of 40–64 years (midlife) or at the age of 65 years or later (late-life), or both, and prospective CVD information from nationwide register linkage through 2016. A polygenic score for BMI (PGSBMI) was used to define genetically predicted BMI. Individuals missing BMI or covariate data, or diagnosed with CVD at first BMI measure, were excluded, leaving an analysis sample of 17,988 individuals. We applied Cox proportional hazard models to examine the association between BMI category and incident CVD, stratified by the PGSBMI. Co-twin control models were applied to adjust for genetic influences not captured by the PGSBMI. Findings Between 1984 and 2010, the 17,988 participants were enrolled in sub-studies of the Swedish Twin Registry. Midlife obesity was associated with a higher risk of CVD across all PGSBMI categories, but the association was stronger with genetically predicted lower BMI (hazard ratio from 1.55 to 2.08 for those with high and low PGSBMI, respectively). Within monozygotic twin pairs, the association did not differ by genetically predicted BMI, indicating genetic confounding not captured by the PGSBMI. Results were similar when obesity was measured in late-life, but suffered from low power. Interpretation Obesity was associated with CVD regardless of PGSBMI category, but obesity influenced by genetic predisposition (genetically predicted high BMI) was less harmful than obesity influenced by environmental factors (obesity despite genetically predicted low BMI). However, additional genetic factors, not captured by the PGSBMI, still influence the associations. %B The Lancet %G eng %R 10.1016/j.eclinm.2023.101943 %0 Journal Article %J Geroscience %D 2023 %T A genome-wide association study of frailty identifies significant genetic correlation with neuropsychiatric, cardiovascular, and inflammation pathways. %A Ye, Yixuan %A Noche, Rommell B %A Szejko, Natalia %A Both, Cameron P %A Acosta, Julian N %A Leasure, Audrey C %A Brown, Stacy C %A Sheth, Kevin N %A Gill, Thomas M %A Zhao, Hongyu %A Falcone, Guido J %K genome-wide. cardiovascular %K Inflammation %K neuropsychiatric %X

Frailty is an aging-related clinical phenotype defined as a state in which there is an increase in a person's vulnerability for dependency and/or mortality when exposed to a stressor. While underlying mechanisms leading to the occurrence of frailty are complex, the importance of genetic factors has not been fully investigated. We conducted a large-scale genome-wide association study (GWAS) of frailty, as defined by the five criteria (weight loss, exhaustion, physical activity, walking speed, and grip strength) captured in the Fried Frailty Score (FFS), in 386,565 European descent participants enrolled in the UK Biobank (mean age 57 [SD 8] years, 208,481 [54%] females). We identified 37 independent, novel loci associated with the FFS (p < 5 × 10), including seven loci without prior described associations with other traits. The variants associated with FFS were significantly enriched in brain tissues as well as aging-related pathways. Our post-GWAS bioinformatic analyses revealed significant genetic correlations between FFS and cardiovascular-, neurological-, and inflammation-related diseases/traits, and subsequent Mendelian Randomization analyses identified causal associations with chronic pain, obesity, diabetes, education-related traits, joint disorders, and depressive/neurological, metabolic, and respiratory diseases. The GWAS signals were replicated in the Health and Retirement Study (HRS, n = 9,720, mean age 73 [SD 7], 5,582 [57%] females), where the polygenic risk score built from UKB GWAS was significantly associated with the FFS in HRS individuals (OR per SD of the score 1.27, 95% CI 1.22-1.31, p = 1.3 × 10). These results provide new insight into the biology of frailty by comprehensively evaluating its genetic architecture.

%B Geroscience %G eng %R 10.1007/s11357-023-00771-z %0 Journal Article %J J Pers Soc Psychol %D 2023 %T Getting under the skin? Influences of work-family experiences on personality trait adaptation and reciprocal relationships. %A Li, Wen-Dong %A Wang, Jiexin %A Allen, Tammy %A Zhang, Xin %A Yu, Kaili %A Zhang, Hong %A Huang, Jason L %A Liu, Mengqiao %A Li, Andrew %X

The literature on personality trait development has mainly focused on influences of life experiences in one single life domain (e.g., work or family) separate from one another and has primarily examined personality development in early life stages. Thus, less attention has been devoted to influences from interplays across different life domains and personality development in middle and late adulthood. Synthesizing the literature on personality science and organizational research, we built a theoretical model and investigated what, how, and why the interplay between two central life domains-work and family-may be related to personality trait development of people at their middle and late life stages, and more important, change-related reciprocal relationships between personality traits and work-family experiences. Generally, convergent findings with data from two longitudinal studies (National Survey of Midlife in the United States, maximum = 3,192, three waves; and Health and Retirement Study, maximum = 1,133, three waves except anxiety) revealed that work-to-family conflict, family-to-work conflict, work-to-family facilitation, and family-to-work facilitation mostly had lagged effects on changes of Conscientiousness, Extraversion, and Neuroticism, and the influences were generally channeled through changes of anxiety. Personality traits also had lagged influences on changes of work-family experiences, with some influences deteriorating over time. Change-related reciprocal relationships were recorded mainly between Neuroticism and Extraversion with work-family experiences. Some selection effects were larger than socialization effects. Our research contributes to the personality and the work-family literature and represents a useful example of cross-fertilization of research in different areas of psychology to advance personality research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

%B J Pers Soc Psychol %G eng %R 10.1037/pspp0000476 %0 Journal Article %J J Appl Gerontol %D 2023 %T Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels. %A Rahemi, Zahra %A Malatyali, Ayse %A Bacsu, Juanita-Dawne R %A Sefcik, Justine S %A Petrovsky, Darina V %A Baker, Zachary G %A Ma, Kris Pui Kwan %A Smith, Matthew L %A Adams, Swann A %K Advance care planning %K cognitive levels %K Healthcare %K Older Adults %X

This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8% had normal cognition, and 22% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP measure was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.

%B J Appl Gerontol %P 7334648231191667 %G eng %R 10.1177/07334648231191667 %0 Web Page %D 2023 %T Hobbies Are The Secret To Happiness? Pleasurable Activities Help Older Adults Avoid Depression %A Anderer, John %K activities %K depression %K Happiness %K hobbies %I StudyFinds %G eng %U https://studyfinds.org/hobbies-happiness-depression/ %0 Journal Article %J American Economic Journal: Economic Policy %D 2023 %T Housing in Medicaid: Should It Really Change? %A Achou, Bertrand %K homestead exemption %K lower-income %K Medicaid %K Retirement %X Housing is mostly exempted from Medicaid and Supplemental Social Insurance means tests. Reforms of this special treatment have been debated, but little is known about its costs, benefits, and redistributive implications. I estimate a life cycle model of single retirees accounting for this exemption. It shows that the homestead exemption explains important patterns of Medicaid recipiency and that it is highly valued. It also shows that estate recovery could cover most of its costs with possibly limited negative welfare consequences. Finally, the model predicts that removing the homestead exemption or enforcing estate recovery programs would reduce redistribution toward lower-income retirees. %B American Economic Journal: Economic Policy %V 15 %P 1-36 %G eng %N 1 %R 10.1257/pol.20200178 %0 Journal Article %J JAMA Network Open %D 2023 %T Hypertension and Stroke as Mediators of Air Pollution Exposure and Incident Dementia. %A Zhang, Boya %A Kenneth M. Langa %A Weuve, Jennifer %A D'Souza, Jennifer %A Szpiro, Adam %A Jessica Faul %A Mendes de Leon, Carlos %A Kaufman, Joel D %A Lisabeth, Lynda %A Hirth, Richard A %A Adar, Sara D %K Air Pollution %K Dementia %K Hypertension %K Particulate Matter %K Stroke %X

IMPORTANCE: Fine particulate matter air pollution (PM2.5) has been consistently associated with cardiovascular disease, which, in turn, is associated with an increased risk of dementia. As such, vascular dysfunction might be a mechanism by which PM2.5 mediates dementia risk, yet few prior epidemiological studies have examined this potential mechanism.

OBJECTIVE: To investigate whether hypertension and stroke serve as mediators and modifiers of the association of PM2.5 with incident dementia.

DESIGN, SETTING, AND PARTICIPANTS: As part of the Environmental Predictors of Cognitive Health and Aging (EPOCH) Project, this cohort study used biennial survey data collected between 1998 and 2016 from respondents of the Health and Retirement Study (HRS), a nationally representative, population-based, cohort in the US. Eligible participants were those over 50 years of age who were free of dementia at baseline and had complete exposure, mediator, outcome, and demographic data from the HRS. Data analysis was conducted from August to November 2022.

EXPOSURES: Exposure to PM2.5, calculated for the 10 years preceding each person's baseline examination according to residential histories and spatiotemporal models.

MAIN OUTCOMES AND MEASURES: Incident dementia was identified using a validated algorithm based on cognitive testing and informant reports. The 4-way decomposition causal mediation analysis method was used to quantify the degree to which hypertension and stroke mediated or modified the association of PM2.5 with incident dementia after adjustment for individual-level and area-level covariates.

RESULTS: Among 27 857 participants (mean [SD] age at baseline, 61 [10] years; 15 747 female participants [56.5%]; 19 249 non-Hispanic White participants [69.1%]), 4105 (14.7%) developed dementia during the follow-up period (mean [SD], 10.2 [5.6] years). Among participants with dementia, 2204 (53.7%) had a history of hypertension at baseline and 386 (9.4%) received a diagnosis of hypertension during the follow up. A total of 378 participants (9.2%) had a history of stroke at baseline and 673 (16.4%) developed stroke over the follow-up period. The IQR of baseline PM2.5 concentrations was 10.9 to 14.9 μg/m3. In fully adjusted models, higher levels of PM2.5 (per IQR) were not associated with increased risk of incident dementia (HR, 1.04; 95% CI, 0.98 to 1.11). Although there were positive associations of prevalent stroke (HR, 1.67; 95% CI, 1.48 to 1.88) and hypertension (HR, 1.15; 95% CI, 1.08 to 1.23) with incident dementia compared with those free of stroke and hypertension during follow-up, there was no statistically significant association of PM2.5 with stroke (odds ratio per IQR increment in PM2.5, 1.08; 95%CI, 0.91 to 1.29) and no evidence of an association of PM2.5 with hypertension (odds ratio per IQR increment in PM2.5, 0.99; 95%CI, 0.92 to 1.07). Concordantly, there was no evidence that hypertension or stroke acted as mediators or modifiers of the association of PM2.5 with incident dementia. Although the nonmediated interaction between PM2.5 and hypertension accounted for 39.2% of the total excess association (95% CI, -138.5% to 216.9%), the findings were not statistically significant.

CONCLUSIONS AND RELEVANCE: These findings suggest that although hypertension may enhance the susceptibility of individuals to air pollution, hypertension and stroke do not significantly mediate or modify the association of PM2.5 with dementia, indicating the need to investigate other pathways and potential mediators of risk.

%B JAMA Network Open %V 6 %P e2333470 %G eng %N 9 %R 10.1001/jamanetworkopen.2023.33470 %0 Journal Article %J PLoS One %D 2023 %T Inequality in housing transitions during cognitive decline. %A Mawhorter, Sarah L %A Wilkie, Rachel Z %A Jennifer A Ailshire %K Caregivers %K Cognitive Dysfunction %K Dementia %K Housing %K Humans %K Nursing homes %K Quality of Life %K United States %X

Independent living can become challenging for people experiencing cognitive decline. With reduced functioning and greater care needs, many people with dementia (PWD) may need to move to another home with better safety features, move to live closer to or with relatives who can provide care, or enter a nursing home. Housing plays a key role in supporting quality of life for both PWD and their caregivers, so the ability to move when needed is crucial for their well-being. Yet the substantial costs of moving, housing, and care mean that PWD with limited financial resources may be unable to afford moving, exacerbating inequalities between more and less advantaged PWD. Emerging qualitative research considers the housing choices of PWD and their caregivers, yet little is known on a broader scale about the housing transitions PWD actually make over the course of cognitive decline. Prior quantitative research focuses specifically on nursing home admissions; questions remain about how often PWD move to another home or move in with relatives. This study investigates socioeconomic and racial/ethnic disparities in the timing and type of housing transitions among PWD in the United States, using Health and Retirement study data from 2002 through 2016. We find that over half of PWD move in the years around dementia onset (28% move once, and 28% move twice or more) while 44% remain in place. Examining various types of moves, 35% move to another home, 32% move into nursing homes, and 11% move in with relatives. We find disparities by educational attainment and race/ethnicity: more advantaged PWD are more likely to move to another home and more likely to enter a nursing home than less advantaged groups. This highlights the importance of providing support for PWD and their families to transition into different living arrangements as their housing needs change.

%B PLoS One %V 18 %P e0282329 %G eng %N 4 %R 10.1371/journal.pone.0282329 %0 Journal Article %J Alzheimer's Dementia %D 2023 %T Influence of physical activity and the MIND diet on cognition %A Sangwoo Ahn %X Background Physical activity or the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet as a neuroprotective diet is known to be beneficial for cognitive health among older adults, but little is known about the influence on cognition when both behaviors are combined. Therefore, this study was conducted to investigate whether engaging in both behaviors is associated with better cognitive health compared with either behavior alone or neither behavior. Method Data were from the Health and Retirement Study for this cross-sectional, observational study. A total of 3,463 non-demented participants with the mean age of 68.0 ± 10.0 years were included. Associations of physical activity (PA) and the MIND diet (MIND) with global cognition and odds of cognitive decline were explored using multivariate linear regression and binary logistic regression models with interaction terms between PA and MIND. Result Compared with neither behavior (PA−/MIND−), PA only (PA+/MIND−) was not associated with cognitive outcomes. Compared with PA−/MIND−, MIND only (PA−/MIND+) predicted higher global cognition (mean difference, d = 0.81; p < 0.001) and lower odds of cognitive decline (odds ratio, OR = 0.68; p < 0.01). Compared with PA−/MIND−, both behaviors (PA+/MIND+) predicted higher global cognition (d = 0.98; p < 0.001) and lower odds of cognitive decline (OR = 0.69; p < 0.01). Compared with PA+/MIND−, PA+/MIND+ predicted higher global cognition (d = 0.60; p < 0.001), but did not predict a risk of cognitive decline. Compared with PA−/MIND+, PA+/MIND+ did not predict cognitive outcomes. Conclusion Adherence to both physical activity and the MIND diet was associated with better cognitive outcomes than non-adherence to both or adherence to physical activity only. Encouraging both behaviors would be important for the cognitive health of older adults. %B Alzheimer's Dementia %V 19 %G eng %N S8 %R https://doi.org/10.1002/alz.062948 %0 Journal Article %J Neurology %D 2023 %T Insomnia Symptoms Trajectories and increased risk of Stroke: A Prospective Cohort Study (P1-5.021) %A Wendemi Sawadogo %A Tilahun Adera %X Objective: To investigate the trajectory of insomnia symptoms over time and their association with stroke events.Background: Insomnia is a frequent disorder affecting over one-third of the U.S population. However, the association between insomnia symptoms and stroke is less studied and it is unclear whether insomnia symptoms remain constant or change over time.Design/Methods: We used the Health and Retirement Study from 2002 to 2020. The independent variable was insomnia symptoms classified on a scale ranging from 0 to 8 and including difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Repeated measures latent class analysis was used to identify subgroups among the study participants with different insomnia trajectories over time. Cox proportional hazards regression models were employed to investigate the association between the subgroup of insomnia symptoms and stroke events.Results: A total of 31,126 participants were included with a mean follow-up of 9 years. Three subgroups of insomnia symptoms were identified based on 3 consecutive measurements of insomnia symptoms at 2-year intervals. The subgroups were named: “constantly no symptoms”, “constantly low symptoms”, and “constantly high insomnia symptoms”. Compared to participants classified as “constantly no symptoms”, participants classified as “constantly low symptoms” had an increased risk of stroke (hazard ratio (HR) = 1.15, 95% confidence interval (CI): 1.00, 1.32). Similarly, compared to participants classified as “constantly no symptoms”, participants classified as “constantly high symptoms” had an increased risk of stroke (HR= 1.42, 95% CI: 1.22, 1.64).Conclusions: Our findings indicate that insomnia symptoms remain constantly reported over time in this population. There is a need for better awareness and management of insomnia symptoms to prevent stroke occurrence.Disclosure: Dr. Sawadogo has nothing to disclose. Prof. Adera has nothing to disclose. %B Neurology %V 100 %G eng %R 10.1212/WNL.0000000000201917 %0 Journal Article %J The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences %D 2023 %T Less is (Often) More: Number of Children and Health Among Older Adults in 24 Countries. %A Antczak, R %A Quashie, N T %A Mair, C A %A Arpino, B %K Cross-National %K Family %K Fertility %K global aging %K Well-being %X

OBJECTIVES: Previous evidence about the impact of parenthood on health for older adults is mixed, perhaps due to variation in number of children and context. Higher numbers of children could lead to support or strain, depending on individual and country contexts. Yet, no studies currently exist that examine associations between number of children and several health indicators among older adults across multiple global regions.

METHODS: We analyze cross-sectional data (1992-2017) of 166,739 adults aged 50+ across 24 countries from the Health and Retirement Study family of surveys to document associations between number of children, treated as a categorical variable, and five health outcomes (self-rated health, ADL limitations, IADL limitations, chronic conditions, depression). We perform multivariable analyses by estimating logistic regression models for each country and each outcome.

RESULTS: Multiple comparisons between categories of number of children revealed at least one significant difference in each country, and a majority of significant differences indicated those with more children had poorer health. The risk of poorer health for parents of multiple children was observed in 15 countries, but in some countries fewer children predict poorer health. The greatest number of differences were identified for depression and chronic conditions, and very few for functional limitations.

DISCUSSION: We observe a greater probability that more children is associated with poorer health in later life, especially for chronic conditions and depression. However, a universal global or regional pattern could not be identified. These findings raise new questions about how country contexts shape fertility and health.

%B The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences %V 78 %P 1892-1902 %G eng %N 11 %R 10.1093/geronb/gbad123 %0 Journal Article %J SSM Population Health %D 2023 %T Longitudinal associations between allostatic load, pet ownership, and socioeconomic position among U.S. adults aged 50. %A Applebaum, Jennifer W %A McDonald, Shelby E %A Zsembik, Barbara A %K Allostatic load %K pet ownership %K Pets %K social inequalities %K Social position %X

It is hypothesized that pets provide benefits to human health by buffering the deleterious effects of stress, but varying exposure to chronic stress via social position is rarely considered in these conceptual and empirical models. Allostatic load is an index of biological and physical measures that represents cumulative wear and tear on the body via chronic stress exposure. In this study, we use the 2006-2016 waves of the Health and Retirement Study, a nationally representative, longitudinal panel survey of adults aged 50+ in the United States, to test whether and to what extent pet ownership has an impact on allostatic load, and whether pet ownership moderates the effects of socioeconomic position on allostatic load. Linear mixed effects regression models revealed that pet owners had significantly lower allostatic load scores than those who do not own pets; however, after adjusting for socioeconomic position (i.e., wealth, education, race, ethnicity, gender, marital status), the effect of pet ownership was no longer significant. We estimated a series of models stratified by sociodemographic groups to test moderation effects. Among those who had a high school education, pet owners had lower allostatic load scores, whereas among those who had attended some college, pet owners had higher scores. Among those who were aged 80+, pet owners had higher scores than those who did not own pets. These findings suggest that the magnitude of the effect of pet ownership on allostatic load may not be sufficient to counteract experiences of high chronic stress as experienced by lower-status groups. Supporting the human-animal bond may contribute to improving older adult population health if paired with efforts to address the underlying causes of population health disparities.

%B SSM Population Health %V 21 %P 101344 %G eng %R 10.1016/j.ssmph.2023.101344 %0 Journal Article %J Clinical Gerontologist %D 2023 %T Longitudinal Examination of an Ethnic Paradox of Stress and Mental Health in Older Black and Latinx Adults. %A Thalida E. Arpawong %A Sakuma, Kari-Lyn K %A Espinoza, Lilia %A Huh, Jimi %K Depressive symptoms %K Health Disparities %K physical functioning %K psychological resilience %K Race/ethnicity %K Stressful Life Events %X

OBJECTIVES: To explain the ethnic paradox of mental health in aging, we evaluated whether Black and Latinx older adults experience (1) fewer depressive symptoms (DepSx), but more physical problems, and (2) greater psychological resilience as a result of life stressors than White older adults.

METHODS: DepSx, physical health, and recent stress were obtained biennially from 25,893 older adults (77% White, 15% Black, 9% Latinx) in the U.S. Health and Retirement Study, across 16 years. Psychological resilience, lifetime stress, and discrimination experiences were available for 13,655 individuals. We conducted mixed-effects and linear regression analyses.

RESULTS: For Blacks and Latinxs, experiencing more-than-usual stress events was associated with less increase in DepSx compared to Whites, although on average Blacks and Latinxs experience more DepSx. Black adults showed worse physical health than White adults and weaker effects of stress on psychological resilience despite experiencing more stress of all types. Findings were mixed for Latinxs.

CONCLUSIONS: Studying effects of time-varying stress on changes in health and multiple stressors on psychological resilience by race/ethnicity elucidates mechanisms for later-age health disparities.

CLINICAL IMPLICATIONS: Cross-sectional evaluations of stress and psychological health in a clinical setting may provide incomplete appraisals of health risks for Black and Latinx older Americans.

%B Clinical Gerontologist %V 46 %P 27-46 %G eng %N 1 %R 10.1080/07317115.2022.2056102 %0 Journal Article %J Int J Nurs Sci %D 2023 %T Longitudinal impact of volunteering on the cognitive functioning of older adults: A secondary analysis from the US Health and Retirement Study. %A Villalonga-Olives, Ester %A Majercak, Kayleigh R %A Almansa, Josue %A Khambaty, Tasneem %K cognitive functioning %K Older Adults %K Volunteering %X

OBJECTIVES: To examine the relationship of volunteering with cognitive activity, social activity, and physical activity among older adults and, ultimately, with later cognitive functioning across different time periods.

METHODS: We used individual responding to three waves of the US Health and Retirement Study panel data from 2008, 2012, and 2016 ( = 2,862). Self-reported questionnaires were used to assess annual volunteering frequency (non volunteering, volunteering <100 h and ≥100 h), and an adapted version of the Telephone Interview for Cognitive Status (TICS) was used to assess memory, mental processing, knowledge, language, and orientation. A structural equation model was estimated to assess effects on cognitive functioning throughout waves.

RESULTS: Those participants that were part of volunteering activities in 2012 showed an increase between 2008 and 2012 in moderate physical activity ( = 0.19,  < 0.001 for those volunteering less than 100 h and 0.21,  < 0.001 for those volunteering at least 100 h), increase in social activity ( 0.10, 0.052 for those volunteering less than 100 h and 0.12, 0.018 for those volunteering at least 100 h) and increase in higher cognitive activity ( 0.13,  < 0.001 for those volunteering at least 100 h), compared to participants who did not volunteer. Higher levels of cognitive activity in 2008 and 2012 were associated with higher cognitive functioning on the following waves ( 0.66 and 0.60,  < 0.001, respectively).

DISCUSSION: Volunteering is a modifiable activity that can be increased to bolster cognitive functioning in older adulthood, primarily mediated by increased cognitive activity.

%B Int J Nurs Sci %V 10 %P 373-382 %G eng %N 3 %R 10.1016/j.ijnss.2023.06.018 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2023 %T Measures of physical performance as mediators between personality and cognition in two prospective studies. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Cabibel, Vincent %A Terracciano, Antonio %K Cognition %K Personality %K Physical Functional Performance %X

Few studies have examined the pathways linking personality to cognition. This study aimed to examine whether measures of physical performance (gait speed, peak expiratory flow (PEF), and grip strength) mediated the association between five-factor model personality traits and cognition (memory performance, subjective memory, and informant-rated cognition). Participants were aged 57 to 95 years from the Health and Retirement Study (HRS, N = 4,109) and the English Longitudinal Study of ageing (ELSA, N = 3,584). In HRS, personality and demographic factors were assessed in 2008/2010, physical performance in 2012/2014, and memory performance and subjective memory in 2016/2018. Informant-rated cognition was obtained in 2016 for an HRS subsample. In ELSA, personality and demographic factors were assessed in 2010/2011, physical performance in 2012/2013, and objective and subjective memory in 2014/2015. Informant-rated cognition was obtained in 2018 for an ELSA subsample. With a few exceptions, replicable patterns of mediation were found across HRS and ELSA. Slower gait speed partially mediated the association between higher neuroticism, lower conscientiousness and worse scores on all three cognitive measures (memory performance, subjective memory, and informant-rated cognition). Slower gait also partially mediated the association between openness and both objective and subjective memory. There was less replicable evidence for a mediating role of PEF and grip strength. The present study advances knowledge on the pathways linking personality to cognition in older adults and supports the hypothesis that personality associations with better physical function can help support healthy cognitive aging.

%B Archives of Gerontology and Geriatrics %V 107 %P 104902 %G eng %R 10.1016/j.archger.2022.104902 %0 Journal Article %J The Journals of Gerontology, Series B %D 2023 %T The Mediating Role of Biomarkers in the Association between Subjective Aging and Episodic Memory. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K biological factors %K longitudinal %K mechanisms %K Memory %K self-perceptions of aging %K Subjective age %X

OBJECTIVES: Subjective aging, indexed by subjective age and self-perceptions of aging (SPA), is consistently related to cognition in adulthood. The present study examined whether blood biomarkers mediate the longitudinal associations between subjective aging indices and memory.

METHODS: Data of 5,369 individuals aged 50 to 94 years (Mean= 66.89 years, SD= 9.22; 60% women) were drawn from the Health and Retirement Study (HRS). Subjective age, SPA, and demographic factors were assessed in 2012/2014. Interleukin-6, C-reactive protein, albumin, cystatin C, N-terminal pro B-type natriuretic peptide (NT-proBNP), fasting glucose, Vitamin D, hemoglobin, red cells distribution width, and epigenetic aging were assessed as part of the HRS Venuous Blood Study in 2016. Memory was measured in 2018. The mediators (except for epigenetic aging, which was assessed in a subsample) were tested simultaneously in models that accounted for demographic covariates.

RESULTS: An older subjective age was related to worse memory partially through higher fasting glucose, higher cystatin C, higher NT-proBNP, and accelerated epigenetic aging. Negative SPA were related to worse memory through lower Vitamin D3, higher fasting glucose, higher cystatin C, higher NT-proBNP, and accelerated epigenetic aging. The biomarkers explained between 2% and 10% of subjective age and between 1% and 8% of SPA associations with memory. Additional analysis revealed that biomarkers continued to be significant mediators when physical inactivity and depressive symptoms were included as additional mediators.

CONCLUSION: The present study adds to existing research on the association between subjective aging and memory by providing new evidence on the biological mediators of this association.

%B The Journals of Gerontology, Series B %V 78 %P 242-252 %G eng %N 2 %R 10.1093/geronb/gbac155 %0 Journal Article %J Biol Psychol %D 2023 %T The mediating role of Vitamin D in the association between personality and memory: Evidence from two samples. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K Adult %K Aging %K Humans %K Longitudinal Studies %K Neuroticism %K Personality %K Vitamin D %X

Five-Factor Model (FFM) personality traits are consistently related to cognition in old age. However, little is known about the biological mediators of this association. The present study examined whether levels of Vitamin D mediated the association between personality and memory. Participants were adults aged 50-96 years from the Health and Retirement Study (HRS, N = 5229) and the English Longitudinal Study of Ageing (ELSA, N = 4249). In HRS, personality and demographic factors were assessed in 2012/2014, Vitamin D was assessed in 2016, and memory was assessed in 2018. In ELSA, personality and demographic factors were obtained in 2010/2011, Vitamin D was measured in 2012/2013, and memory was assessed in 2014/2015. In both samples, higher extraversion and conscientiousness were related to higher levels of Vitamin D, whereas higher neuroticism was related to lower Vitamin D. In both samples, higher Vitamin D partly mediated the association between both higher extraversion and conscientiousness and better memory. The association between higher neuroticism and worse memory at follow-up was partially mediated by lower Vitamin D in the HRS and ELSA. Vitamin D did not mediate the association between higher openness and better memory. The present study extends the personality-cognition literature by providing new replicable evidence that Vitamin D is a biological mediator.

%B Biol Psychol %V 178 %P 108525 %8 2023 Mar %G eng %R 10.1016/j.biopsycho.2023.108525 %0 Journal Article %J Journal of Pension Economics and Finance %D 2023 %T Migration, work, and retirement: the case of Mexican-origin populations %A Emma Aguila %A Lee, Zeewan %A Rebeca Wong %K Hispanics %K Immigrants %K Retirement %K Social Security %X Mexico and the United States both face rapid population aging as well as older populations with high poverty rates. Among the most vulnerable populations of retirement age in either nation are Mexican immigrants to the United States. This work uses data from the U.S. Health and Retirement Study and the Mexican Health and Aging Study to assess retirement decisions among persons born in Mexico and working in either nation as well as such decisions by non-Hispanic Whites in the United States. Social security system incentives matter for the retirement of Mexican immigrants in the U.S. but not for return-migrants in Mexico. %B Journal of Pension Economics and Finance %G eng %R 10.1017/S1474747221000342 %0 Journal Article %J Innov Aging %D 2023 %T Neighborhood Social Environment and Self-Perceptions of Aging. %A Choi, Eun Young %A Zelinski, Elizabeth M %A Jennifer A Ailshire %X

BACKGROUND AND OBJECTIVES: Self-perceptions of aging (SPA) are associated with health and well-being later in life. Although prior studies have identified individual-level predictors of SPA, the role of neighborhood social context in SPA remains largely unexplored. A neighborhood social environment may act as a critical avenue for older adults to remain healthy and socially active, contributing to their evaluations of how they grow old. The present study aims to fill the previous research gap by examining the relationship between neighborhood social environment and SPA, and how age may moderate this relationship. This study is guided by Bronfenbrenner's Ecology of Human Development theory and Lawton's Ecological Model of Aging, positing that an individual's aging experience is deeply rooted in their residential environment.

RESEARCH DESIGN AND METHODS: Our sample includes 11,145 adults aged 50+ from the 2014 and 2016 waves of the Health and Retirement Study. We included 4 social and economic aspects of neighborhoods: (1) neighborhood poverty; (2) percentage of older adults; (3) perceived social cohesion; and (4) perceived disorder.

RESULTS: Multilevel linear regression models showed that respondents in neighborhoods with higher percentages of the older population and with perceptions of high neighborhood disorder reported more negative SPA. Those who perceived their neighborhoods as more socially cohesive reported more positive SPA. Controlling for individual socioeconomic and health status, only neighborhood social cohesion remained significant. We also found significant interaction effects between neighborhood social cohesion and age: The effects of neighborhood cohesion on SPA were stronger in middle age than in old age.

DISCUSSION AND IMPLICATIONS: Our findings provide insights into how neighborhood social context is associated with SPA, suggesting that a socially cohesive neighborhood may be important to promote more favorable perceptions of aging, particularly for middle-aged residents.

%B Innov Aging %V 7 %P igad038 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/37213322?dopt=Abstract %R 10.1093/geroni/igad038 %0 Journal Article %J Epigenetics %D 2023 %T Occupational characteristics and epigenetic aging among older adults in the United States. %A Andrasfay, Theresa %A Crimmins, Eileen %K Aged %K Aging %K DNA Methylation %K Epigenesis, Genetic %K ethnicity %K Humans %K United States %X

Occupational characteristics have been studied as risk factors for several age-related diseases and are thought to impact the ageing process, although there has been limited empirical work demonstrating an association between adverse occupational characteristics and accelerated ageing and this prior work has yielded mixed results. We used the 2010 and 2016 waves of the Health and Retirement Study ( = 1,251) to examine the association between occupation categories and self-reported working conditions of American adults at midlife and their subsequent epigenetic ageing as measured through five epigenetic clocks: PCHorvath, PCHannum, PCPhenoAge, PCGrimAge, and DunedinPACE. We found that individuals working in sales/clerical, service, and manual work show evidence of epigenetic age acceleration compared to those working in managerial/professional jobs and that the associations were stronger with second- and third-generation clocks. Individuals reporting high stress and high physical effort at work showed evidence of epigenetic age acceleration only on PCGrimAge and DunedinPACE. Most of these associations were attenuated after adjustment for race/ethnicity, educational attainment, and lifestyle-related risk factors. Sales/clerical work remained significantly associated with PCHorvath and PCHannum, while service work remained significantly associated with PCGrimAge. The results suggest that manual work and occupational physical activity may appear to be risk factors for epigenetic age acceleration through their associations with socioeconomic status, while stress at work may be a risk factor for epigenetic age acceleration through its associations with health behaviours outside of work. Additional work is needed to understand when in the life course and the specific mechanisms through which these associations occur.

%B Epigenetics %V 18 %P 2218763 %G eng %N 1 %R 10.1080/15592294.2023.2218763 %0 Web Page %D 2023 %T Older ‘sandwich generation’ Californians spent more time with parents and less with grandkids after paid family leave law took effect %A Abramowitz, Joelle %K Caregiving %K grandchildren %K paid family leave %K Parents %I The Conversation %G eng %U https://theconversation.com/older-sandwich-generation-californians-spent-more-time-with-parents-and-less-with-grandkids-after-paid-family-leave-law-took-effect-210154 %0 Journal Article %J Innovation and Aging %D 2023 %T Pain, Physical Demands at Work, and Future Work Expectations Among Older Adults in the United States. %A Andrasfay, Theresa %A Fennell, Gillian %A Crimmins, Eileen %K Disability %K Retirement %K Working Longer %X

BACKGROUND AND OBJECTIVES: In the United States, pain is becoming increasingly prevalent among older adults at the same time as policies are incentivizing work longer. Given that pain and physically demanding jobs are both linked to early retirement and they often go hand-in-hand, it is important to assess how the unique effects of pain and physical work demands may interact in predicting future work expectations.

RESEARCH DESIGN AND METHODS: Using Health and Retirement Study data (1998, 2004, 2010, and 2016 waves), we assess how pain and physical job demands influence future work expectations of 10,358 adults at midlife (ages 51-56), after accounting for sociodemographic, job, health, and financial characteristics.

RESULTS: Compared to men with no pain, activity-interfering pain was associated with low expectations of full-time work past 62 regardless of job demands, while noninterfering pain was associated with 62% higher odds (odds ratio [OR] = 1.62, 95% confidence interval [CI]: 1.35-1.93) of expecting not to work full-time past age 62 only among those with physically demanding jobs. Having both interfering pain and a physically demanding job was associated with increased odds of expecting not to work full-time past age 65 for men (OR = 1.25, 95% CI: 1.06-1.47) and past age 62 for women (OR = 1.18, 95% CI: 1.00-1.39).

DISCUSSION AND IMPLICATIONS: The co-occurrence of physically demanding work with pain-particularly activity-interfering pain-is associated with low expectations of full-time work past ages 62 and 65 for adults at midlife. Working longer may be feasible for older adults whose pain does not interfere with work, but unrealistic for individuals facing both pain and physically demanding work.

%B Innovation and Aging %V 7 %P igad089 %G eng %N 10 %R 10.1093/geroni/igad089 %0 Journal Article %J Journal of Population Ageing %D 2023 %T Parental Divorce in Childhood and the Accelerated Epigenetic Aging for Earlier and Later Cohorts: Role of Mediators of Chronic Depressive Symptoms, Education, Smoking, Obesity, and Own Marital Disruption %A Jung K Kim %A Arpawong, Thalida Em %A Klopack, Eric T. %A Crimmins, Eileen M. %K childhood adversities %K Cohort Difference %K DunedinPACE %K Epigenetic aging %X We examine effects of parental divorce on epigenetic aging in later adulthood for two birth cohorts: one born in the early 20th century and the other born in the later 20th century. Using data from the Health and Retirement Study (n = 1,545), we examine the relationship between parental divorce in childhood and accelerated epigenetic aging in older adulthood as indicated by the Dunedin methylation Pace of Aging score. We assess how this relationship is mediated by chronic depressive symptoms, education, lifetime smoking, body mass index (BMI), and an older adult’s own divorce. The mean age of the earlier cohort is 85.8 (SD = 3.9) and that of the later cohort is 60.2 (SD = 2.8). We find that parental divorce was related to faster aging in the later-born cohort, and that 56% of this relationship (b = 0.060) was mediated by chronic depressive symptoms (b = 0.013), lower education levels (b = 0.005), and smoking (b = 0.019). For the earlier cohort, there was no effect of parental divorce on epigenetic aging. Parental divorce in childhood may have lasting effects on later-life health, as reflected in the rate of epigenetic aging. However, the effects and mechanisms of this relationship differ across cohorts living in different social environments. © 2023, The Author(s). %B Journal of Population Ageing %G eng %R 10.1007/s12062-023-09434-5 %0 Journal Article %J Demography %D 2023 %T Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis. %A Boen, Courtney E %A Yang, Y Claire %A Aiello, Allison E %A Dennis, Alexis C %A Harris, Kathleen Mullan %A Kwon, Dayoon %A Belsky, Daniel W %K Aging %K Black or African American %K Health Status Disparities %K Humans %K Life Change Events %K Morbidity %K Mortality %K White %X

Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27% to 55% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7% to 11%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.

%B Demography %V 60 %P 1815-1841 %G eng %N 6 %R 10.1215/00703370-11057546 %0 Journal Article %J Demography %D 2023 %T Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis. %A Boen, Courtney E %A Yang, Y Claire %A Aiello, Allison E %A Dennis, Alexis C %K Aging %K Black or African American %K Health Status Disparities %K Humans %K Life Change Events %K Morbidity %K Mortality %K White %X

Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27% to 55% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7% to 11%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.

%B Demography %V 60 %P 1815-1841 %G eng %N 6 %R 10.1215/00703370-11057546 %0 Journal Article %J Demography %D 2023 %T Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis. %A Boen, Courtney E %A Yang, Y Claire %A Aiello, Allison E %A Dennis, Alexis C %K Aging %K Black or African American %K Health Status Disparities %K Humans %K Life Change Events %K Morbidity %K Mortality %K White %X

Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27% to 55% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7% to 11%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.

%B Demography %V 60 %P 1815-1841 %G eng %N 6 %R 10.1215/00703370-11057546 %0 Journal Article %J Journal of Environmental Psychology %D 2023 %T Perceived neighborhood characteristics and wellbeing: Exploring mediational pathways %A Liat Ayalon %K Mental Health %K neighborhood cohesion %K neighborhood disorder %K Objective %K Subjective %K Wellbeing %X The present study evaluated possible mediators of the association between perceived neighborhood characteristics and wellbeing. Both objective: social participation, community engagement, and number of chronic conditions and subjective: loneliness, perceived discrimination, and subjective health indicators were examined as possible mediators. The health and retirement study is a longitudinal panel survey consisting of a representative sample of US citizens over the age of 50. Analysis was based on data collected in 2010, 2014, and 2018. A total of 5590–5851 participants were included in the analyses. Path models were conducted to examine mediation, using 5000 bootstraps. Even after controlling for sociodemographic variables, there was a significant association between perceived neighborhood characteristics measured in 2010 and wellbeing measured in 2018. This association was partially mediated by loneliness, perceived discrimination, and subjective health measured in 2014, but not by community engagement, social participation, and number of chronic conditions. In a sensitivity analysis, some of the objective indicators partially accounted for the relationship between perceived neighborhood characteristics and the subjective indicators. The findings point to the importance of subjective mediators, rather than objective ones in explaining the association between perceived neighborhood characteristics and wellbeing. Hence, they call for further attention to the subjective characteristics of the neighborhood as important to older persons’ wellbeing. %B Journal of Environmental Psychology %V 88 %P 102020 %G eng %R https://doi.org/10.1016/j.jenvp.2023.102020 %0 Journal Article %J Aging Ment Health %D 2023 %T Perceived neighborhood disorder, social cohesion, and depressive symptoms in spousal caregivers. %A Choi, Yeon Jin %A Jennifer A Ailshire %X

OBJECTIVES: Prior research into the factors linked to mental health of caregivers of older adults have largely focused on individual- or household-level characteristics, but neighborhood supports and stressors may also matter for caregiver mental health. The current study fills this knowledge gap by examining the association of neighborhood social cohesion and disorder and depressive symptoms among spousal caregivers.

METHOD: We used data from the 2006 to 2016 waves of the Health and Retirement Study, which include 2,322 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood social cohesion and disorder with depressive symptoms.

RESULTS: A higher level of perceived neighborhood social cohesion was associated with fewer depressive symptoms ( = -0.06, 95% CI: -0.10, -0.02). On the other hand, greater perceived neighborhood disorder was associated with more symptoms ( = 0.04, 95% CI: 0.01, 0.08). The association of perceived social cohesion with depressive symptoms remained even after controlling for perceived disorder, but neighborhood disorder was no longer associated with depressive symptoms after accounting for reported neighborhood social cohesion.

CONCLUSIONS: This study suggests neighborhood supports and stressors matter for caregiver well-being. Neighborhood-based social support may be particularly important for caregivers as they navigate the challenges caregiving for an aging spouse can bring. Future studies should determine if enhancing positive characteristics of the neighborhood promotes well-being of spousal caregivers.

%B Aging Ment Health %P 1-8 %G eng %R 10.1080/13607863.2023.2212250 %0 Journal Article %J Journal of Consumer Affairs %D 2023 %T Perception versus the reality of financial situation: The role of personality traits in the United States %A Olajide, Olamide %A Asebedo, Sarah %A Lacombe, Donald %A Little, Todd %K financial health; financial satisfaction; personality traits; well-being %X An individual might have a net worth of $10,000 and believe they are in great shape financially, while another individual might have $100,000 and feel otherwise. Could personality explain this disparity between perception and reality of their financial situation? This study answers this research question using data from the 2018 Health and Retirement Study (HRS). Findings from this study show that conscientious and extraverted consumers believe they are doing better than they are. Conversely, consumers who exhibit traits relating to neuroticism, openness to experience, and agreeableness think their financial situation is worse than it is. These findings have implications for consumers, professional advisors, and policymakers. © 2023 American Council on Consumer Interests. %B Journal of Consumer Affairs %G eng %R 10.1111/joca.12556 %0 Journal Article %J Psychoneuroendocrinology %D 2023 %T Personality and aging-related immune phenotype. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K Female %K Humans %K Immunoglobulin G %K Male %K Neuroticism %K Personality %K Personality Disorders %X

An aging-related immune phenotype (ARIP) has been defined as a decrease in naïve T cells (T) relative to the accumulation of memory T cells (T). Recent research implicates ARIP measures, such as CD4 +T/T and CD8 +T/T ratios, in multimorbidity and mortality. This study examined whether psychological dispositions that assess how people think, feel, and behave are related to CD4 +T/T and CD8 +T/T. Participants were adults aged 50-104 years (N = 4798; 58% women, Mean Age= 67.95, SD= 9.56) from the Health and Retirement Study. Data on CD4 +T/T and CD8 +T/T were obtained in 2016. Data on personality, demographic factors, and potential clinical (body mass index, disease burden), behavioral (smoking, alcohol, physical activity), psychological (depressive symptoms, stress), and biological (cytomegalovirus IgG antibodies) mediating factors were obtained in 2014/2016. Controlling for demographic factors, higher conscientiousness was related to higher CD4 +T/T and CD8 +T/T. To a lesser extent, higher neuroticism and lower extraversion were associated with lower CD4 +T/T Physical activity, and to a lesser extent BMI and disease burden, were the most robust mediators between personality and ARIP measures. Cytomegalovirus IgG level mediated the association between conscientiousness and both CD4 +T/T and CD8 +T/T. This study provides novel evidence that personality is related to ARIP. Higher conscientiousness and, to a lesser extent, higher extraversion may be protective against age-related immunophenotype change, whereas neuroticism may be a risk factor.

%B Psychoneuroendocrinology %V 153 %P 106113 %G eng %R 10.1016/j.psyneuen.2023.106113 %0 Journal Article %J Stroke %D 2023 %T Personality and Risk of Incident Stroke in 6 Prospective Studies. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Humans %K Longitudinal Studies %K Middle Aged %K Neuroticism %K Personality %K Prospective Studies %K Stroke %K United States %K Young Adult %X

BACKGROUND: A large literature has examined a broad range of factors associated with increased risk of stroke. Few studies, however, have examined the association between personality and stroke. The present study adopted a systematic approach using a multi-cohort design to examine the associations between 5-Factor Model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and incident stroke using data from 6 large longitudinal samples of adults.

METHODS: Participants (age range: 16-104 years old, N=58 105) were from the MIDUS (Midlife in the United States) Study, the HRS (Health and Retirement Study), The US (Understanding Society) study, the WLS (Wisconsin Longitudinal Study), the NHATS (National Health and Aging Trends Study), and the LISS (Longitudinal Internet Studies for the Social Sciences). Personality traits, demographic factors, clinical and behavioral risk factors were assessed at baseline; stroke incidence was tracked over 7 to 20 years follow-up.

RESULTS: Meta-analyses indicated that higher neuroticism was related to a higher risk of incident stroke (hazard ratio, 1.15 [95% CI, 1.10-1.20]; <0.001), whereas higher conscientiousness was protective (HR, 0.89 [95% CI, 0.85-0.93]; <0.001). Additional meta-analyses indicated that BMI, diabetes, blood pressure, physical inactivity, and smoking as additional covariates partially accounted for these associations. Extraversion, openness, and agreeableness were unrelated to stroke incidence.

CONCLUSIONS: Similar to other cardiovascular and neurological conditions, higher neuroticism is a risk factor for stroke incidence, whereas higher conscientiousness is a protective factor.

%B Stroke %V 54 %P 2069-2076 %G eng %N 8 %R 10.1161/STROKEAHA.123.042617 %0 Journal Article %J Respiratory Medicine %D 2023 %T Personality associations with lung function and dyspnea: Evidence from six studies %A Yannick Stephan %A Angelina R. Sutin %A Martina Luchetti %A Damaris Aschwanden %A Pauline Caille %A Antonio Terracciano %K Dyspnea %K lung function %K Peak expiratory flow %K Personality %X Objective The present study examined the association between Five Factor Model personality traits and lung function and dyspnea. Methods Participants were middle aged and older adults aged 34–103 years old (N > 25,000) from the Midlife in the United States Study (MIDUS), the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the National Health and Aging Trends Survey (NHATS), and the Wisconsin Longitudinal Study graduate (WLSG) and sibling (WLSS) samples. Data on peak expiratory flow (PEF), dyspnea, personality traits, smoking, physical activity, body mass index (BMI), emotional/psychiatric problems, and demographic factors were obtained in each sample. Results A meta-analysis indicated that higher neuroticism was related to lower PEF, higher risk of PEF less than 80% of predicted value, and higher risk of dyspnea. In contrast, higher extraversion and conscientiousness were associated with higher PEF, lower likelihood of PEF lower than 80% of the predicted value, and lower risk of dyspnea. Higher openness was related to higher PEF and lower risk of PEF less than 80%, whereas agreeableness was related to higher PEF and lower risk of dyspnea. Smoking, physical activity, BMI and emotional/psychiatric problems partially accounted for these associations. There was little evidence that lung disease moderated the association between personality and PEF and dyspnea. Conclusions Across cohorts, this study found replicable evidence that personality is associated with lung function and associated symptomatology. %B Respiratory Medicine %V 208 %P 107127 %G eng %R https://doi.org/10.1016/j.rmed.2023.107127 %0 Journal Article %J Journal of Financial Counseling and Planning %D 2023 %T Personality Traits, Consumer Home Value, and Mortgage Debt %A Pearson, Blain M. %A Quadria, Taufiq Hasan %A Asebedo, Sarah %X Research on residential preferences has consistently orbited around their been correlation with economic and social factors. This study builds on the existing literature by investigating the personality characteristics that shape residential behavior. The specific objective is to examine the Big Five personality traits (OCEAN) —openness, conscientiousness, extraversion, agreeableness, and neuroticism—and their relationship with the value of individuals’ primary residences and mortgage debt using data collected from the Health and Retirement Study. Regression models are estimated to examine the associations between the OCEAN personality traits and home value and mortgage debt. The findings reveal the following associations: openness and conscientiousness are associated positively, and agreeableness is associated negatively, with larger home values; whereas openness and agreeableness are associated positively, and conscientiousness and neuroticism are associated negatively, with larger mortgage debts. © 2023 Association for Financial Counseling and Planning Education®. %B Journal of Financial Counseling and Planning %V 34 %P 127 – 136 %G eng %U https://www.scopus.com/inward/record.uri?eid=2-s2.0-85159658891&doi=10.1891%2fJFCP-2021-0006&partnerID=40&md5=6aa37bc0f19ec5c85286c8313ab03c30 %9 Article %R 10.1891/JFCP-2021-0006 %0 Journal Article %J United European Gastroenterol Journal %D 2023 %T A pilot genome-wide association study meta-analysis of gastroparesis. %A Tavares, Leticia Camargo %A Zheng, Tenghao %A Kwicklis, Madeline %A Mitchell, Emily %A Pandit, Anita %A Pullapantula, Suraj %A Bernard, Cheryl %A Teder-Laving, Maris %A Marques, Francine Z %A Esko, Tonu %A Kuo, Braden %A Shulman, Robert J %A Chumpitazi, Bruno P %A Koch, Kenneth L %A Sarosiek, Irene %A Abell, Thomas L %A McCallum, Richard W %A Parkman, Henry P %A Pasricha, Pankaj J %A Hamilton, Frank A %A Tonascia, James %A Zawistowski, Matthew %A Farrugia, Gianrico %A Grover, Madhusudan %A D'Amato, Mauro %K abdominal pain %K delayed gastric emptying %K Diabetes %K enteric nervous system %K gastroparesis %K Genetics %K immune dysregulation %K Inflammation %K motor function. %K PXDNL %X

BACKGROUND: Gastroparesis (GP) is characterized by delayed gastric emptying in the absence of mechanical obstruction.

OBJECTIVE: Genetic predisposition may play a role; however, investigation at the genome-wide level has not been performed.

METHODS: We carried out a genome-wide association study (GWAS) meta-analysis on (i) 478 GP patients from the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium (GpCRC) compared to 9931 population-based controls from the University of Michigan Health and Retirement Study; and (ii) 402 GP cases compared to 48,340 non-gastroparesis controls from the Michigan Genomics Initiative. Associations for 5,811,784 high-quality SNPs were tested on a total of 880 GP patients and 58,271 controls, using logistic mixed models adjusted for age, sex, and principal components. Gene mapping was obtained based on genomic position and expression quantitative trait loci, and a gene-set network enrichment analysis was performed. Genetic associations with clinical data were tested in GpCRC patients. Protein expression of selected candidate genes was determined in full thickness gastric biopsies from GpCRC patients and controls.

RESULTS: While no SNP associations were detected at strict significance (p ≤ 5 × 10 ), nine independent genomic loci were associated at suggestive significance (p ≤ 1 × 10 ), with the strongest signal (rs9273363, odds ratio = 1.4, p = 1 × 10 ) mapped to the human leukocyte antigen region. Computational annotation of suggestive risk loci identified 14 protein-coding candidate genes. Gene-set network enrichment analysis revealed pathways potentially involved in immune and motor dysregulation (p ≤ 0.05). The GP risk allele rs6984536A (Peroxidasin-Like; PXDNL) was associated with increased abdominal pain severity scores (Beta = 0.13, p = 0.03). Gastric muscularis expression of PXDNL also positively correlated with abdominal pain in GP patients (r = 0.8, p = 0.02). Dickkopf WNT Signaling Pathway Inhibitor 1 showed decreased expression in diabetic GP patients (p = 0.005 vs. controls).

CONCLUSION: We report preliminary GWAS findings for GP, which highlight candidate genes and pathways related to immune and sensory-motor dysregulation. Larger studies are needed to validate and expand these findings in independent datasets.

%B United European Gastroenterol Journal %V 11 %P 784-796 %G eng %N 8 %R 10.1002/ueg2.12453 %0 Report %D 2023 %T Predicting individual-level longevity with statistical and machine learning methods %A Luca Badolato %A Ari Decter-Frain %A Nicholas J. Irons %A Maria Miranda %A Erin Walk %A Elnura Zhalieva %A Monica Alexander %A Ugofilippo Basellini %A Emilio Zagheni %K forecasts %K Inequality %K Longevity %K USA %X Individual-level mortality prediction is a fundamental challenge with implications for people and societies. Accurate longevity predictions improve life planning, targeting of high-risk individuals, and organization of social interventions, policies, and public spending. Demographers and actuaries have been primarily concerned with mortality modeling and prediction at a macro level, leveraging strong regularities in mortality rates over age, sex, space, and time. Besides clinical settings, individual-level mortality predictions have been largely overlooked and have remained a challenging task. We model and predict individual-level lifespan using data from the US Health and Retirement Study, a nationally representative longitudinal survey of people over 50 years of age. We estimate 12 statistical and machine learning survival analysis models using over 150 predictors measuring behavioral, biological, demographic, health, and social indicators. Extending previous research on inequalities in mortality and morbidity, we investigate inequalities in individual mortality prediction by gender, race and ethnicity, and education. Machine learning and traditional models report comparable accuracy and relatively high discriminative performance, particularly when including time-varying information (best mean Area Under the Curve = 0.87). However, the models and predictors used fail to account for a majority of lifespan heterogeneity at the individual level. We observe consistent inequalities in mortality predictability and risk discrimination, with lower prediction accuracy for men, non-Hispanic Blacks, and low-educated individuals. In addition, people in these groups show lower accuracy in their subjective predictions of their own lifespan. Finally, we see minimal variation in the top features across groups, with variables related to habits, health history, and finances being relevant predictors. Our results assess how well mortality can be predicted from representative surveys, providing baselines and guidance for future research across countries. %I Max Planck Institute %G eng %R 10.4054/MPIDR-WP-2023-008 %0 Journal Article %J Geriatrics (Basel, Switzerland) %D 2023 %T Prevalence and Trends of Slow Gait Speed in the United States. %A Stover, Emily %A Andrew, Sarah %A Batesole, Joshua %A Berntson, Maren %A Carling, Chloe %A FitzSimmons, Samantha %A Hoang, Tyler %A Nauer, Joseph %A McGrath, Ryan %K Geriatrics %K Physical Functional Performance %K Population Surveillance %K Walking %X

Gait speed is a simple, effective indicator of age-related disease and disability. We sought to examine the prevalence and trends of slow gait speed in older Americans. Our unweighted analytic sample included 12,427 adults aged ≥ 65 years from the 2006-2016 waves of the Health and Retirement Study. Gait speed was measured in participant residences. Persons with gait speed < 0.8 or <0.6 m/s were slow. Sample weights were used to generate nationally representative estimates. The overall estimated prevalence of slow gait speed with the <0.8 m/s cut-point was 48.6% (95% confidence interval (CI): 47.4-49.8) in the 2006-2008 waves yet was 45.7% (CI: 44.3-47.1) in the 2014-2016 waves, but this downward trend was not statistically significant ( = 0.06). The estimated prevalence of slowness with the <0.6 m/s cut-point was 21.3% (CI: 20.4-22.3) for the 2006-2008 waves, 18.5% (CI: 17.5-19.4) for the 2010-2012 waves, and 19.2% (CI: 18.2-20.2) for the 2014-2016 waves, but there were again no significant trends ( = 0.61). Our findings showed that the estimated prevalence of slow gait speed in older Americans is pronounced, and different cut-points largely inform how slowness is categorized. Continued surveillance of slowness over time will help guide screening for disablement and identify sub-populations at greatest risk for targeted interventions.

%B Geriatrics (Basel, Switzerland) %V 8 %G eng %N 5 %R 10.3390/geriatrics8050095 %0 Journal Article %J Journal of strength and conditioning research %D 2023 %T Prevalence and Trends of Weakness Among Middle-Aged and Older Adults in the United States. %A McGrath, Ryan %A FitzSimmons, Samantha %A Andrew, Sarah %A Black, Kennedy %A Bradley, Adam %A Christensen, Bryan K %A Collins, Kyle %A Klawitter, Lukus %A Kieser, Jacob %A Langford, Matthew %A Orr, Megan %A Hackney, Kyle J %K Aged %K Body Mass Index %K Female %K Hand Strength %K Humans %K Male %K Middle Aged %K Muscle Weakness %K Prevalence %K Retirement %K United States %X

McGrath, R, FitzSimmons, S, Andrew, S, Black, K, Bradley, A, Christensen, BK, Collins, K, Klawitter, L, Kieser, J, Langford, M, Orr, M, and Hackney, KJ. Prevalence and trends of weakness among middle-aged and older adults in the United States. J Strength Cond Res 37(12): 2484-2490, 2023-Muscle weakness, which is often determined with low handgrip strength (HGS), is associated with several adverse health conditions; however, the prevalence and trends of weakness in the United States is not well-understood. We sought to estimate the prevalence and trends of weakness in Americans aged at least 50 years. The total unweighted analytic sample included 22,895 Americans from the 2006-2016 waves of the Health and Retirement Study. Handgrip strength was measured with a handgrip dynamometer. Men with weakness were below at least one of the absolute or normalized (body mass, body mass index) cut points: <35.5 kg, <0.45 kg/kg, <1.05 kg/kg/m 2 . The presence of any weakness in women was also identified as being below one of the absolute or normalized HGS cut points: <20.0 kg, <0.34 kg/kg, or <0.79 kg/kg/m 2 . There was an increasing trend in the prevalence of any weakness over time ( p < 0.001). The prevalence of weakness was 45.1% (95% confidence interval [CI]: 44.0-46.0) in the 2006-2008 waves and 52.6% (CI: 51.5-53.7) in the 2014-2016 waves. Weakness prevalence was higher for older (≥65 years) Americans (64.2%; CI: 62.8-65.5) compared with middle-aged (50-64 years) Americans (42.2%; CI: 40.6-43.8) in the 2014-2016 waves. Moreover, the prevalence of weakness in the 2014-2016 waves was generally higher in women (54.5%; CI: 53.1-55.9) than in men (50.4%; CI: 48.7-52.0). Differences existed in weakness prevalence across races and ethnicities. The findings from our investigation suggest that the prevalence of weakness is overall pronounced and increasing in Americans. Efforts for mitigating and better operationalizing weakness will elevate in importance as our older American population grows.

%B Journal of strength and conditioning research %V 37 %P 2484-2490 %G eng %N 12 %R 10.1519/JSC.0000000000004560 %0 Journal Article %J Journal of strength and conditioning research %D 2023 %T Prevalence and Trends of Weakness Among Middle-Aged and Older Adults in the United States. %A McGrath, Ryan %A FitzSimmons, Samantha %A Andrew, Sarah %A Black, Kennedy %K Aged %K Body Mass Index %K Female %K Hand Strength %K Humans %K Male %K Middle Aged %K Muscle Weakness %K Prevalence %K Retirement %K United States %X

McGrath, R, FitzSimmons, S, Andrew, S, Black, K, Bradley, A, Christensen, BK, Collins, K, Klawitter, L, Kieser, J, Langford, M, Orr, M, and Hackney, KJ. Prevalence and trends of weakness among middle-aged and older adults in the United States. J Strength Cond Res 37(12): 2484-2490, 2023-Muscle weakness, which is often determined with low handgrip strength (HGS), is associated with several adverse health conditions; however, the prevalence and trends of weakness in the United States is not well-understood. We sought to estimate the prevalence and trends of weakness in Americans aged at least 50 years. The total unweighted analytic sample included 22,895 Americans from the 2006-2016 waves of the Health and Retirement Study. Handgrip strength was measured with a handgrip dynamometer. Men with weakness were below at least one of the absolute or normalized (body mass, body mass index) cut points: <35.5 kg, <0.45 kg/kg, <1.05 kg/kg/m 2 . The presence of any weakness in women was also identified as being below one of the absolute or normalized HGS cut points: <20.0 kg, <0.34 kg/kg, or <0.79 kg/kg/m 2 . There was an increasing trend in the prevalence of any weakness over time ( p < 0.001). The prevalence of weakness was 45.1% (95% confidence interval [CI]: 44.0-46.0) in the 2006-2008 waves and 52.6% (CI: 51.5-53.7) in the 2014-2016 waves. Weakness prevalence was higher for older (≥65 years) Americans (64.2%; CI: 62.8-65.5) compared with middle-aged (50-64 years) Americans (42.2%; CI: 40.6-43.8) in the 2014-2016 waves. Moreover, the prevalence of weakness in the 2014-2016 waves was generally higher in women (54.5%; CI: 53.1-55.9) than in men (50.4%; CI: 48.7-52.0). Differences existed in weakness prevalence across races and ethnicities. The findings from our investigation suggest that the prevalence of weakness is overall pronounced and increasing in Americans. Efforts for mitigating and better operationalizing weakness will elevate in importance as our older American population grows.

%B Journal of strength and conditioning research %V 37 %P 2484-2490 %G eng %N 12 %R 10.1519/JSC.0000000000004560 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Prevalence of unpaid caregiving, pain, and depression in older seriously ill patients undergoing elective surgery. %A Hu, Frances Y %A Wang, Yihan %A Abbas, Muhammad %A Bollens-Lund, Evan %A Reich, Amanda J %A Lipsitz, Stuart R %A Gray, Tamryn F %A Kim, Dae %A Ritchie, Christine %A Kelley, Amy S %A Cooper, Zara %K depression %K Surgery %K unpaid caregiving %X

INTRODUCTION: Serious illness is a life-limiting condition negatively impacting daily function, quality of life, or excessively straining caregivers. Over 1 million older seriously ill adults undergo major surgery annually, and national guidelines recommend that palliative care be available to all seriously ill patients. However, the palliative care needs of elective surgical patients are incompletely described. Understanding baseline caregiving needs and symptom burden among seriously ill older surgical patients could inform interventions to improve outcomes.

METHODS: Using Health and Retirement Study data (2008-2018) linked to Medicare claims, we identified patients ≥66 years who met an established serious illness definition from administrative data and underwent major elective surgery using Agency for Healthcare Research and Quality (AHRQ) criteria. Descriptive analyses were performed for preoperative patient characteristics, including: unpaid caregiving (no or yes); pain (none/mild or moderate/severe); and depression (no, CES-D < 3, or yes, CES-D ≥ 3). Multivariable regression was performed to examine the association between unpaid caregiving, pain, depression, and in-hospital outcomes, including hospital days (days admitted between discharge date and one-year post-discharge), in-hospital complications (no or yes), and discharge destination (home or non-home).

RESULTS: Of the 1343 patients, 55.0% were female and 81.6% were non-Hispanic White. Mean age was 78.0 (SD 6.8); 86.9% had ≥2 comorbidities. Before admission, 27.3% of patients received unpaid caregiving. Pre-admission pain and depression were 42.6% and 32.8%, respectively. Baseline depression was significantly associated with non-home discharge (OR 1.6, 95% CI 1.2-2.1, p = 0.003), while baseline pain and unpaid caregiving needs were not associated with in-hospital or post-acute outcomes in multivariable analysis.

CONCLUSIONS: Prior to elective surgery, older adults with serious illnesses have high unpaid caregiving needs and a prevalence of pain and depression. Baseline depression alone was associated with discharge destinations. These findings highlight opportunities for targeted palliative care interventions throughout the surgical encounter.

%B J Am Geriatr Soc %8 2023 Mar 13 %G eng %R 10.1111/jgs.18316 %0 Journal Article %J Mathematical and Computational Applications %D 2023 %T Pseudo-Poisson Distributions with Concomitant Variables %A Arnold, Barry C. %A Manjunath, Bangalore G. %K correlation; likelihood ratio test; maximum likelihood estimators; pseudo-Poisson; regression %X It has been argued in Arnold and Manjunath (2021) that the bivariate pseudo-Poisson distribution will be the model of choice for bivariate data with one equidispersed marginal and the other marginal over-dispersed. This is due to its simple structure, straightforward parameter estimation and fast computation. In the current note, we introduce the effects of concomitant variables on the bivariate pseudo-Poisson parameters and explore the distributional and inferential aspects of the augmented models. We also include a small simulation study and an example of application to real-life data. %B Mathematical and Computational Applications %V 28 %P 11 %G eng %R 10.3390/mca28010011 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Quantifying the contribution of work characteristics to educational disparities in health-induced work limitations. %A Abrams, Leah R %A Berkman, Lisa F %X

OBJECTIVES: To quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in mid-life and old age.

METHODS: We used the Health and Retirement Study (2006-2016) to examine educational disparities in reporting "any impairment or health problem that limits the kind or amount of paid work" in ages 51-80.

RESULTS: We found disparities to be profound and persistent over time. Blinder-Oaxaca three-fold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a measure of health, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates.

DISCUSSION: Therefore, work environments appear to play an important role in educational disparities in mid-to-late-life disability.

%B J Gerontol B Psychol Sci Soc Sci %8 2023 Aug 17 %G eng %R 10.1093/geronb/gbad112 %0 Journal Article %J J Racial Ethn Health Disparities %D 2023 %T Race, Educational Attainment, and Sustained High Body Mass Index over 24 Years of Follow-up in Middle-Aged and Older Adults. %A Assari, Shervin %A Cobb, Sharon %A Najand, Babak %A Zare, Hossein %A Sonnega, Amanda %X

BACKGROUND: Educational attainment has been linked to reduced risk of health problems such as obesity, but research suggests that this effect may be weaker for non-Hispanic Black individuals compared to non-Hispanic White individuals, a pattern known as minorities' diminished returns (MDRs).

OBJECTIVES: This study is aimed at examining the differential association between educational attainment and sustained high body mass index (BMI) among non-Hispanic Black and non-Hispanic White middle-aged and older adults in the USA.

METHODS: Using data from the Health and Retirement Study (HRS) spanning 1992-2016, we analyzed a national sample of 35,110 individuals, including 7766 non-Hispanic Black and 27,344 non-Hispanic White individuals. We used logistic regression models to examine the relationship between educational attainment, race, and sustained high BMI, while controlling for age, sex, and marital status at baseline.

RESULTS: Approximately 30.6% of the sample (n = 10,727) had sustained high BMI, while 69.4% (n = 24,383) had sustained low BMI over the period of follow-up. Higher levels of educational attainment were associated with a lower risk of sustained high BMI. We also found, however, that the protective effects of education against sustained high BMI were weaker for non-Hispanic Blacks compared to non-Hispanic Whites.

CONCLUSION: Our findings suggest that the protective effects of educational attainment against sustained high BMI may be more robust for non-Hispanic Whites than for non-Hispanic Blacks. Further research should explore whether these results are found in other racial and ethnic minorities and whether potential life history experiences may contribute to these disparities.

%B J Racial Ethn Health Disparities %G eng %R 10.1007/s40615-023-01589-3 %0 Journal Article %J Population Research and Policy Review %D 2023 %T Race, gender, and cohort differences in the educational experiences of Black and White Americans %A Walsemann, Katrina M. %A Fisk, Calley E. %A Farina, Mateo P. %A Abbruzzi, Emily %A Jennifer A Ailshire %K Educational experiences %K life course %K life history %K Schools %X Federal legislation and judicial intervention led to significant transformation in the U.S. education system during the early to mid-twentieth century. These changes may differentiate older adults in their experiences of aging, particularly at the intersection of race, gender, and cohort, but are not well documented among current cohorts of older adults. Our study addresses this gap by providing rich, descriptive information on the educational experiences of U.S. adults who attended primary or secondary school between 1915 and 1977. We used data from the Health and Retirement Study (HRS), a nationally representative, prospective study of U.S. adults over age 50 years. The HRS collected information on respondents’ schooling history and experiences through a Life History Mail Survey (LHMS). We restricted our sample to age-eligible HRS-LHMS respondents who self-identified as non-Hispanic White or non-Hispanic Black and completed at least 75% of their primary or secondary schooling in the U.S. (n = 10,632). Educational experiences, defined as pre-k to post-secondary education, varied across cohort, regardless of race or gender. Greater course offerings, improvements in learning support, and increasing exposure to integrated schools occurred across successive cohorts. We found the highest rates of enrollment in college preparatory curriculum and foreign-language courses as well as diagnosed learning differences in cohorts born after 1948. Among White adults, many of the gender differences in educational experiences documented in the oldest cohort were still found among the most recent cohort. Few gender differences, however, were found for Black adults regardless of cohort. Conversely, most race inequities in educational experiences persisted. Such inequities may be an important source of continued differences in experiences of aging observed across demographic groups. © 2023, The Author(s), under exclusive licence to Springer Nature B.V. %B Population Research and Policy Review %V 42 %G eng %R 10.1007/s11113-023-09831-w %0 Journal Article %J JAMA Intern Med %D 2023 %T Racial and Ethnic Disparities in Health Care Use and Access Associated With Loss of Medicaid Supplemental Insurance Eligibility Above the Federal Poverty Level. %A Roberts, Eric T %A Kwon, Youngmin %A Hames, Alexandra G %A McWilliams, J Michael %A Ayanian, John Z %A Tipirneni, Renuka %K Aged %K Cross-Sectional Studies %K Female %K Healthcare Disparities %K Humans %K Male %K Medicaid %K Medicare %K Middle Aged %K Poverty %K United States %X

IMPORTANCE: Medicaid supplemental insurance covers most cost sharing in Medicare. Among low-income Medicare beneficiaries, the loss of Medicaid eligibility above this program's income eligibility threshold (100% of federal poverty level [FPL]) may exacerbate racial and ethnic disparities in Medicare beneficiaries' ability to afford care.

OBJECTIVE: To examine whether exceeding the income threshold for Medicaid, which results in an abrupt loss of Medicaid eligibility, is associated with greater racial and ethnic disparities in access to and use of care.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a regression discontinuity design to assess differences in access to and use of care associated with exceeding the income threshold for Medicaid eligibility. We analyzed Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities associated with the loss of Medicaid eligibility, we compared discontinuities in outcomes among Black and Hispanic beneficiaries (n = 2885) and White beneficiaries (n = 5259). Analyses were conducted between January 1, 2022, and October 1, 2022.

MAIN OUTCOME MEASURES: Patient-reported difficulty accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data.

RESULTS: This cross-sectional study included 8144 participants (38 805 person-years), who when weighted represented 151 282 957 person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% FPL. In the weighted sample, the mean (SD) age was 75.4 (9.4) years, 66.1% of beneficiaries were women, 14.8% were non-Hispanic Black, 13.6% were Hispanic, and 71.6% were White. Findings suggest that exceeding the Medicaid eligibility threshold was associated with a 43.8 percentage point (pp) (95% CI, 37.8-49.8) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp (95% CI, 25.4-36.6) lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care (discontinuity: 5.7 pp; 95% CI, 2.0-9.4), lower outpatient use (-6.3 services per person-year; 95% CI, -10.4 to -2.2), and fewer medication fills (-6.9 fills per person-year; 95% CI, -11.4 to -2.5), but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use (disparity: -6.2 services per person-year; 95% CI, -11.7 to -0.6; P = .03) and medication fills (disparity: -7.2 fills per person-year; 95% CI, -13.4 to -1.0; P = .02) among Black and Hispanic vs White beneficiaries.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that loss of eligibility for Medicaid supplemental insurance above the federal poverty level, which increases cost sharing in Medicare, was associated with increased racial and ethnic health care disparities among low-income Medicare beneficiaries. Expanding eligibility for Medicaid supplemental insurance may narrow these disparities.

%B JAMA Intern Med %V 183 %P 534-543 %G eng %N 6 %R 10.1001/jamainternmed.2023.0512 %0 Journal Article %J SSM Popul Health %D 2023 %T Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans. %A O'Neill, AnnaMarie S %A Newsom, Jason T %A Trubits, Em F %A Elman, Miriam R %A Botoseneanu, Anda %A Allore, Heather G %A Nagel, Corey L %A Dorr, David A %A Quiñones, Ana R %K Disparities %K ethnic %K Older Americans %K racial %K socioeconomic %X

INTRODUCTION: Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories.

METHODS: Data from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count.

RESULTS: Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth).

CONCLUSION: These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.

%B SSM Popul Health %V 22 %P 101375 %G eng %R 10.1016/j.ssmph.2023.101375 %0 Journal Article %J Demography %D 2023 %T Racialized Health Inequities: Quantifying Socioeconomic and Stress Pathways Using Moderated Mediation. %A Brown, Tyson H %A Hargrove, Taylor W %A Homan, Patricia %A Adkins, Daniel E %X

Racism drives population health inequities by shaping the unequal distribution of key social determinants of health, such as socioeconomic resources and exposure to stressors. Research on interrelationships among race, socioeconomic resources, stressors, and health has proceeded along two lines that have largely remained separate: one examining differential effects of socioeconomic resources and stressors on health across racialized groups (moderation processes), and the other examining the role of socioeconomic resources and stressors in contributing to racial inequities in health (mediation processes). We conceptually and analytically integrate these areas using race theory and a novel moderated mediation approach to path analysis to formally quantify the extent to which an array of socioeconomic resources and stressors-collectively and individually-mediate racialized health inequities among a sample of older adults from the Health and Retirement Study. Our results yield theoretical contributions by showing how the socioeconomic status-health gradient and stress processes are racialized (24% of associations examined varied by race), substantive contributions by quantifying the extent of moderated mediation of racial inequities (approximately 70%) and the relative importance of various social factors, and methodological contributions by showing how commonly used simple mediation approaches that ignore racialized moderation processes overestimate-by between 5% and 30%-the collective roles of socioeconomic status and stressors in accounting for racial inequities in health.

%B Demography %G eng %R 10.1215/00703370-10740718 %0 Journal Article %J Alzheimers Dement (Amst) %D 2023 %T Representativeness of samples enrolled in Alzheimer's disease research centers. %A Arce Rentería, Miguel %A Mobley, Taylor M %A Evangelista, Nicole D %A Medina, Luis D %A Deters, Kacie D %A Fox-Fuller, Joshua T %A Minto, Lex R %A Avila-Rieger, Justina %A Bettcher, Brianne M %X

UNLABELLED: To generalize findings on the mechanisms and prognosis in Alzheimer's disease and related dementias (ADRD), it is critical for ADRD research to be representative of the population. Sociodemographic and health characteristics across ethnoracial groups included in the National Alzheimer's Coordinating Center sample (NACC) were compared to the nationally representative Health and Retirement Study (HRS). Baseline NACC data ( = 36,639) and the weighted 2010 HRS wave ( = 52,071,840) were included. We assessed covariate balance by calculating standardized mean differences across harmonized covariates (i.e., sociodemographic, health). NACC participants were older, more educated, with worse subjective memory and hearing, but endorsed fewer depressive symptoms compared to HRS participants. While all racial and ethnic groups in NACC differed from HRS participants in the same way overall, these differences were further amplified between racial and ethnic groups. NACC participants do not represent the U.S. population in key demographic and health factors, which differed by race and ethnicity.

HIGHLIGHTS: We examined selection factors included in NACC studies compared to a nationally representative sample.Selection factors included demographic and health factors and self-reported memory concerns.Results suggest that NACC participants are not representative of the U.S. population.Importantly, selection factors differed across racial and ethnic groups.Findings are suggestive of selection bias within NACC studies.

%B Alzheimers Dement (Amst) %V 15 %P e12450 %G eng %N 2 %R 10.1002/dad2.12450 %0 Report %D 2023 %T Retirement Trajectories and Social Security’s Retirement Earnings Test %A Bob Joondeph %A Nancy J. Altman %A Jagadeesh Gokhale %A Amy Shuart %K benefits %K FRA %K RET %K Social Security %B Research Portfolio on Retirement %I Social Security Advisory Board %C Washington, DC %G eng %U https://www.ssab.gov/research/retirement-trajectories-and-social-security-retirement-earnings-test/?mc_cid=8bc0768a81&mc_eid=4b82b179ac %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Self-perception of aging and perceived medical discrimination. %A Sun, Na %A Xu, Ziyao %A Hua, Cassandra L %A Qiu, Xiao %A Pittman, Amelia %A Abdou, Basel %A Brown, J Scott %K ageism; intersection; medical environment; perspective of age. %X

BACKGROUND: Individuals who perceive medical discrimination often face adverse consequences. How individuals perceive their own aging experiences may influence perceived medical discrimination due to age by generating expectations that they will receive poor treatment from clinicians, which may be amplified for individuals who also perceive discrimination because of race. This study explored the relationship between self-perceptions of aging (SPA) and perceived medical discrimination due to age, race, and other reasons.

METHODS: We used three waves (2008, 2012, 2016) from the nationally representative Health and Retirement Study (HRS) data. Our sample included 10,188 community-residing individuals aged 51 and over. SPA were measured by two domains: positive SPA and negative SPA. Multinomial logistic regression that adjusted for demographic, health characteristics, and year-fixed effects was conducted to estimate the relationship between SPA and categories of perceived medical discrimination (age, race, age and race, and other).

RESULTS: Approximately 11% of the population perceived discrimination because of age or race in the medical setting from 2008 to 2016. Older adults who had a positive SPA were 15% [Adjusted relative risk ratio (ARR): 0.85, 95% CI: 0.79-0.91], 13% [ARRR: 0.87, 95% CI: 0.76-1.00], and 20% [ARRR: 0.80, 95% CI: 0.74-0.88] less likely to experience perceived medical discrimination due to age, race, and the intersection of age and race, respectively, than those who did not, holding other factors constant. Those who held a negative SPA were 38% [ARRR: 1.38, 95% CI: 1.28-1.48] more likely to report perceived medical discrimination due to age and 12% [ARRR: 1.12, 95% CI: 1.03-1.21] more likely to report perceived medical discrimination due to other reasons.

CONCLUSIONS: Holding a positive perception of aging may help reduce perceived medical discrimination because of age and race, which may in turn improve communication and lead to timely and appropriate treatment.

%B J Am Geriatr Soc %G eng %R 10.1111/jgs.18517 %0 Journal Article %J Arch Clin Neuropsychol %D 2023 %T Sense of Purpose in Life and Beliefs and Knowledge of Alzheimer's Disease. %A Sutin, Angelina R %A Stephan, Yannick %A Luchetti, Martina %A Aschwanden, Damaris %A Sesker, Amanda A %A Zhu, Xianghe %A Terracciano, Antonio %K Alzheimer's disease %K beliefs %K Knowledge %X

OBJECTIVE: A sense of purpose in life is associated with healthier cognitive outcomes, including lower risk of Alzheimer's Disease (ad). The present research examines whether purpose is also associated with beliefs and knowledge of ad.

METHOD: A random subsample (N = 1,187) of community-dwelling participants from the Health and Retirement Study completed a module on self-reported beliefs and knowledge of ad.

RESULTS: Purpose in life was associated with lower perceived threat of ad and greater belief that modifiable factors (e.g., physical activity) decrease risk. Associations were not moderated by experience with ad or depressive symptoms. Purpose was unrelated to beliefs that genetics or stress increase risk or knowledge of ad.

CONCLUSIONS: Individuals with a sense of purpose are less concerned about risk of developing ad and believe modifiable factors reduce risk. These beliefs may support engagement in behaviors that reduce risk and be one psychological pathway through which purpose protects against ad.

%B Arch Clin Neuropsychol %8 2023 Feb 04 %G eng %R 10.1093/arclin/acad014 %0 Journal Article %J Work, Aging and Retirement %D 2023 %T Sensory Loss and its Association with Different Types of Departures from the Labor Force Among Older Adults in the US %A Garcia Morales, Emmanuel E %A Powel, Danielle S %A Gray, Andrew %A Assi, Lama %A Reed, Nicholas S %X To investigate the association between sensory loss and the timing and type of self-reported departures from the labor force, via retirement or disability, we used data from the Health and Retirement Study, cycles 2004–2018. Based on self-reported sensory loss, we classified individuals into four groups: no sensory loss, hearing loss only, vision loss only, and dual sensory loss (vision and hearing loss). We assumed that older adults could leave the labor force either by retirement or due to disability. Because once one type of exit is observed the other type cannot be observed, we implemented a competing risk approach to estimate the instantaneous rate of departure (sub-distribution hazard rate) for leaving the labor force due to disability, treating retirement as a competing risk, and for departures via retirement, with disability as the competing risk. We found that compared to older adults with no sensory loss, adults with vision loss are at a higher risk for leaving the labor force via disability (when treating retirement as a competing risk). Compared to no sensory loss, hearing loss was associated with a higher risk for retirement in models treating disability as a competing risk. Given the differences between disability and retirement benefits (before and after retirement age), policies intended to keep people with sensory loss from early labor force departures, such as accommodations in the workplace and/or hearing and vision care coverage, might contribute to better retiring conditions and healthy aging among older adults with sensory loss. %B Work, Aging and Retirement %G eng %R 10.1093/workar/waad010 %0 Journal Article %J AJPM Focus %D 2023 %T Shingles Vaccine Uptake Among Older Adults: Identifying Early, Later, and Nonadopters %A Kang, Alice H. %A Jung K Kim %A Jennifer A Ailshire %A Crimmins, Eileen M. %K adoption timing %K Health and Retirement Study %K Shingles vaccination %X Introduction: There is growing interest in accelerating adoptions of vaccines. This study examined factors that differentiate the acceptance and timing of uptake of the first shingles vaccine, Zostavax, among older adults in the U.S. Methods: Data from Health and Retirement Study respondents who were aged ≥62 years in 2008 were analyzed to determine whether they received a shingles vaccination from 2006 to 2016. Multinomial logistic regression was used to examine the characteristics associated with vaccine uptake and timing. Results: Of those eligible, 15.2% were vaccinated early (between 2006 and 2010), 20.2% were vaccinated later, and 64.6% remained unvaccinated 10 years after the shingles vaccine was introduced. Respondents more likely to be vaccinated were those who had higher education and income, experience with influenza vaccination, more frequent social interaction with friends, or were residing in an area with higher shingles vaccination rates. Conclusions: Shingles vaccination rates vary by social and geographic characteristics. Efforts to improve and expedite vaccination and other new preventive measures should target specific populations and geographic areas. %B AJPM Focus %V 2 %G eng %R 10.1016/j.focus.2023.100143 %0 Journal Article %J J Alzheimers Dis %D 2023 %T A Simple Single Item Rated by an Interviewer Predicts Incident Dementia Over 15 Years. %A Sutin, Angelina R %A Aschwanden, Damaris %A Luchetti, Martina %A Stephan, Yannick %A Terracciano, Antonio %X

Subjective memory is useful to detect cognitive deficits not apparent on objective tests. This research evaluates whether memory rated by an interviewer predicts incident dementia. Health and Retirement Study participants without cognitive impairment at baseline whose memory was rated by the interviewer were analyzed (N = 12,749). Worse interviewer-rated memory was associated with higher risk of incident dementia over 15 years (HR = 1.40, 95% CI = 1.27-1.54). The association was evident even among participants in the top quartile of objective memory performance (HR = 1.71, 95% CI = 1.26-2.32). Interviewer-rated memory may be a low-cost supplement to neuropsychological evaluation to predict dementia risk beyond self-reports and objective cognitive testing.

%B J Alzheimers Dis %G eng %R 10.3233/JAD-230417 %0 Journal Article %J Brain, Behavior, and Immunity %D 2023 %T Socioeconomic and race/ethnic differences in immunosenescence: Evidence from the Health and Retirement Study. %A Noppert, Grace A %A Stebbins, Rebecca C %A Dowd, Jennifer Beam %A Aiello, Allison E %K Academic Success %K COVID-19 %K Health Status %K Pandemics %K SARS-CoV-2 %X

BACKGROUND: The COVID-19 pandemic has highlighted the urgent need to understand variation in immunosenescence at the population-level. Thus far, population patterns of immunosenescence have not well described.

METHODS: We characterized measures of immunosenescence from the 2016 Venous Blood Study from the nationally representative U.S Health and Retirement Study (HRS) of individuals ages 50 years and older.

RESULTS: Median values of the CD8+:CD4+, EMRA:Naïve CD4+ and EMRA:Naïve CD8+ ratios were higher among older participants and were lower in those with additional educational attainment. Generally, minoritized race and ethnic groups had immune markers suggestive of a more aged immune profile: Hispanics had a CD8+:CD4+ median value of 0.37 (95 % CI: 0.35, 0.39) compared to 0.30 in non-Hispanic Whites (95 % CI: 0.29, 0.31). Non-Hispanic Blacks had the highest median value of the EMRA:Naïve CD4+ ratio (0.08; 95 % CI: 0.07, 0.09) compared to non-Hispanic Whites (0.03; 95 % CI: 0.028, 0.033). In regression analyses, race/ethnicity and education were associated with large differences in the immune ratio measures after adjustment for age and sex.

CONCLUSIONS: Lower educational attainment and minoritized racial ethnic status were associated with higher levels of immunosenescence. This population variation may have important implications for both risk of age-related disease and vulnerability to emerging pathogens (e.g., SARS-CoV-2).

%B Brain, Behavior, and Immunity %V 107 %P 361-368 %G eng %R 10.1016/j.bbi.2022.10.019 %0 Journal Article %J Journal of the American Heart Association %D 2023 %T Spousal Concordance of Hypertension Among Middle-Aged and Older Heterosexual Couples Around the World: Evidence From Studies of Aging in the United States, England, China, and India. %A Varghese, Jithin Sam %A Lu, Peiyi %A Choi, Daesung %A Lindsay C Kobayashi %A Ali, Mohammed K %A Patel, Shivani A %A LI, CHIHUA %K CHARLS %K cross‐national study %K ELSA %K Hypertension %K LASI %K spousal concordance %X

BACKGROUND: Health concordance within couples presents a promising opportunity to design interventions for disease management, including hypertension. We compared the concordance of prevalent hypertension within middle-aged and older heterosexual couples in the United States, England, China, and India.

METHODS AND RESULTS: Cross-sectional dyadic data on heterosexual couples were used from contemporaneous waves of the HRS (US Health and Retirement Study, 2016/17, n=3989 couples), ELSA (English Longitudinal Study on Aging, 2016/17, n=1086), CHARLS (China Health and Retirement Longitudinal Study, 2015/16, n=6514), and LASI (Longitudinal Aging Study in India, 2017/19, n=22 389). Concordant hypertension was defined as both husband and wife in a couple having hypertension. The prevalence of concordant hypertension within couples was 37.9% (95% CI, 35.8-40.0) in the United States, 47.1% (95% CI, 43.2-50.9) in England, 20.8% (95% CI, 19.6-21.9) in China, and 19.8% (95% CI, 19.0-20.5) in India. Compared with wives married to husbands without hypertension, wives married to husbands with hypertension were more likely to have hypertension in the United States (prevalence ratio, 1.09 [95% CI, 1.01- 1.17), England (prevalence ratio, 1.09, 95% CI, 0.98-1.21), China (prevalence ratio, 1.26 [95% CI, 1.17-1.35), and India (prevalence ratio, 1.19 [95% CI, 1.15-1.24]). Within each country, similar associations were observed for husbands. Across countries, associations in the United States and England were similar, whereas they were slightly larger in China and India.

CONCLUSIONS: Concordance of hypertension within heterosexual couples was consistently observed across these 4 socially and economically diverse countries. Couple-centered interventions may be an efficient strategy to prevent and manage hypertension in these countries.

%B Journal of the American Heart Association %G eng %R 10.1161/JAHA.123.030765 %0 Web Page %D 2023 %T Stroke, High BP Don't Mediate Pollution's Link to Dementia %A Anderson, Pauline %K Dementia %K Hypertension %K Particulate Matter %K Stroke %I Medscape %G eng %U https://www.medscape.com/viewarticle/996924 %0 Journal Article %J J Patient Rep Outcomes %D 2023 %T Structural equation model of coping and life satisfaction of community-dwelling older people during the COVID-19 pandemic. %A Lalani, Nasreen %A Dongjuan, Xu %A Cai, Yun %A Arling, Greg W %K Activities of Daily Living %K Adaptation, Psychological %K Aged %K Child %K COVID-19 %K Female %K Frailty %K Humans %K Independent Living %K Male %K Pandemics %K Personal Satisfaction %X

BACKGROUND: COVID-19 put older individuals at high risk for morbidity and mortality, isolation, reduced coping, and lower satisfaction with life. Many older adults experienced social isolation, fear, and anxiety. We hypothesized that successful coping with these stressors would maintain or improve satisfaction with life, a crucial psychological outcome during the pandemic. Our study investigated relationships between older people's coping and life satisfaction during the pandemic and their optimism, sense of mastery, closeness with spouse, family, and friends, and vulnerabilities from frailty, comorbid diseases, memory problems, and dependencies in instrumental activities of daily living (IADL).

METHODS: The study was based on a special COVID-19 sample of 1351 community-dwelling older adults who participated in the 2020 Health and Retirement Survey. A comprehensive structural equation modeling was used to test direct and indirect effects, with life satisfaction as the main outcome and coping as a mediator between the other variables and coping.

RESULTS: Most survey respondents were female and between the ages of 65-74 years. They averaged 1.7 chronic conditions, one in seven was frail, about one-third rated their memory as fair or poor, and about one in seven reported one or more difficulties in IADL. As hypothesized-older people with increased sense of mastery and optimism were better able to cope and had greater life satisfaction. In addition, close relationships with friends and with other family members besides the spouse/partner or children contributed to more successful coping, while the interpersonal closeness of all types contributed directly to greater life satisfaction. Finally, older people with more IADL limitations reported greater difficulty coping and lower life satisfaction, and those older people who were frail or had multiple comorbid diseases reported lower life satisfaction.

CONCLUSIONS: Optimism, sense of mastery and closeness with family/friends promotes coping and life satisfaction, whereas frailty and comorbidities make coping more challenging and lead to lower life satisfaction particularly during a pandemic. Our study improves on prior research because of its nationally representative sample and formal specification and testing of a comprehensive theoretical framework.

%B J Patient Rep Outcomes %V 7 %P 46 %G eng %N 1 %R 10.1186/s41687-023-00583-x %0 Web Page %D 2023 %T This Expense is 5x More Likely to Drive Spending Volatility in Retirement than Health Care %A Anderson, Brian %K expenses %K Health Care %K Retirement %I 401KSpecialist %G eng %U https://401kspecialistmag.com/this-expense-is-5x-more-likely-to-drive-spending-volatility-in-retirement-than-health-care/ %0 Journal Article %J Mech Ageing Dev %D 2023 %T Understanding Alzheimer's disease in the context of aging: Findings from applications of stochastic process models to the Health and Retirement Study. %A Arbeev, Konstantin G %A Bagley, Olivia %A Yashkin, Arseniy P %A Duan, Hongzhe %A Akushevich, Igor %A Ukraintseva, Svetlana V %A Yashin, Anatoliy I %K Aged %K Aging %K Alzheimer disease %K Apolipoproteins E %K Humans %K Medicare %K Retirement %K United States %X

There is growing literature on applications of biodemographic models, including stochastic process models (SPM), to studying regularities of age dynamics of biological variables in relation to aging and disease development. Alzheimer's disease (AD) is especially good candidate for SPM applications because age is a major risk factor for this heterogeneous complex trait. However, such applications are largely lacking. This paper starts filling this gap and applies SPM to data on onset of AD and longitudinal trajectories of body mass index (BMI) constructed from the Health and Retirement Study surveys and Medicare-linked data. We found that APOE e4 carriers are less robust to deviations of trajectories of BMI from the optimal levels compared to non-carriers. We also observed age-related decline in adaptive response (resilience) related to deviations of BMI from optimal levels as well as APOE- and age-dependence in other components related to variability of BMI around the mean allostatic values and accumulation of allostatic load. SPM applications thus allow revealing novel connections between age, genetic factors and longitudinal trajectories of risk factors in the context of AD and aging creating new opportunities for understanding AD development, forecasting trends in AD incidence and prevalence in populations, and studying disparities in those.

%B Mech Ageing Dev %V 211 %P 111791 %8 2023 Apr %G eng %R 10.1016/j.mad.2023.111791 %0 Journal Article %J Gerontologist %D 2023 %T The value of Medicare coverage on depressive symptoms among older immigrants. %A Jun, Hankyung %A Mattke, Soeren %A Chen, Alice %A Aguila, Emma %K depression %K Disparities %K Health Insurance %X

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.

%B Gerontologist %G eng %R 10.1093/geront/gnad070 %0 Report %D 2023 %T What Matters for Annuity Demand: Objective Life Expectancy or Subjective Survival Pessimism? %A Arapakis, Karolos %A Gal Wettstein %K Annuity %K Life Expectancy %K Survival expectation %X Objective life expectancy and subjective survival pessimism (defined as the difference between objective and subjective life expectancy) may both affect the demand for annuities. The question this project answers is: how do these two explanations contribute to annuitization decisions in practice? To explore this question, the analysis estimates regression models that include objective life expectancy, subjective survival pessimism, and other characteristics that are linked to annuitization decisions. The results show that, as one would expect, individuals with higher objective life expectancy are more likely to buy an annuity. Similarly, less pessimistic individuals are also more likely to buy an annuity. A one-year rise in objective life expectancy increases the probability of buying an annuity product by 0.20 percentage points, which is nearly nine times larger than a one-year decline in pessimism. %B Working Papers %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/what-matters-for-annuity-demand-objective-life-expectancy-or-subjective-survival-pessimism/ %0 Report %D 2023 %T Wills, Wealth, and Race %A Aubry, Jean-Pierre %A Alicia H. Munnell %A Gal Wettstein %K inheritances %K Racial Disparities %K Retirement %X The brief’s key findings are: The analysis explores how receiving an inheritance, having a will, and planning and realizing a bequest are interrelated and vary by race. Black and Hispanic individuals are less likely to get an inheritance, have a will, and plan to leave a bequest. Among those who do plan to leave a bequest, Black and Hispanic individuals are less likely to realize their bequest target. However, having a will increases the chances of achieving one’s bequest target, offering a potential way to improve the situation. %B Issue in Brief %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/wills-wealth-and-race/ %0 Journal Article %J Mathematics %D 2023 %T Zero-Dependent Bivariate Poisson Distribution with Applications %A Qarmalah, Najla %A Alzaid, Abdulhamid A. %K Poisson; Bernoulli; count data; maximum likelihood; moment method; regression; bivariate models %X The bivariate Poisson model is the most widely used model for bivariate counts, and in recent years, several bivariate Poisson regression models have been developed in order to analyse two response variables that are possibly correlated. In this paper, a particular class of bivariate Poisson model, developed from the bivariate Bernoulli model, will be presented and investigated. The proposed bivariate Poisson models use dependence parameters that can model positively and negatively correlated data, whereas more well-known models, such as Holgate’s bivariate Poisson model, can only be used for positively correlated data. As a result, the proposed model contributes to improving the properties of the more common bivariate Poisson regression models. Furthermore, some of the properties of the new bivariate Poisson model are outlined. The method of maximum likelihood and moment method were used to estimate the parameters of the proposed model. Additionally, real data from the healthcare utilization sector were used. As in the case of healthcare utilization, dependence between the two variables may be positive or negative in order to assess the performance of the proposed model, in comparison to traditional bivariate count models. All computations and graphs shown in this paper were produced using R programming language. %B Mathematics %V 11 %P 1194 %G eng %R 10.3390/math11051194 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Age Profiles of Cognitive Decline and Dementia in Late Life in the Aging, Demographics and Memory Study (ADAMS). %A Walsh, Christine E %A Yang, Yang C %A Oi, Katsuya %A Allison E Aiello %A Daniel W. Belsky %A Mullan Harris, Kathleen %A Brenda L Plassman %K ADAMS %K Cognition %K joint models %K latent class %K longitudinal trajectories %K Mortality %X

OBJECTIVES: To better understand the temporal dynamics of progression from cognitive decline to onset of dementia in the dementia-free older population in the U.S.

METHODS: We used longitudinal data from a diverse national population-based sample of older adults (N=531) in the Aging, Demographics and Memory Study (ADAMS) from the Health and Retirement Study (HRS) with repeated measures of cognitive function and dementia diagnosis during 12 years of follow-up from 1996 to 2009. We employed joint latent class mixed models to estimate the association between cognitive change and competing risks of dementia and non-dementia death and identify heterogeneity in the age profiles of such association adjusting for baseline characteristics.

RESULTS: Our analyses found three latent classes with distinct age profiles of cognitive decline and associated risk of dementia and mortality: "Rapid Cognitive Decline" (19.6%), "Moderate Progression" (44.6%), and "Optimal Cognitive Aging" (35.8%). When simultaneously accounting for cognitive trajectories and time-to-dementia/death, we also found associations of baseline covariates with slope of cognitive decline (e.g., steeper decline among non-Hispanic Blacks and more educated) and risk of dementia (e.g., greater risk for females and apolipoprotein E [APOE-4] carriers, but no difference by education level) that differ substantially from those in separate longitudinal mixed models or survival models.

DISCUSSION: The differential age patterns of cognitive decline predicting dementia incidences identified in this study suggest variation in the course of cognitive aging in older adults that may inform future etiological and intervention studies.

%B The Journals of Gerontology, Series B %V 77 %P 1880-1891 %G eng %N 10 %R 10.1093/geronb/gbac038 %0 Thesis %D 2022 %T Approximate Methods for Analyzing Semi-Parametric Longitudinal Models with Non-Ignorable Missing Responses %A Aloraini, Najla M. %K Monte Carlo Method %K semiparametric method %I Carleton University %C Ottawa, Ontario %V Ph.D. %G eng %U https://curve.carleton.ca/system/files/etd/24e8d2ff-a110-49c1-975e-c152ee811742/etd_pdf/bc78132120938372ed253a76ea91c339/aloraini-approximatemethodsforanalyzingsemiparametric.pdf %0 Web Page %D 2022 %T Are We Worrying About the ‘Right’ Retirement Risks? %A Adams, Nevin E %K health %K Longevity %K market %K retirement risks %I American Society of Pension Professionals & Actuaries %G eng %U https://www.asppa-net.org/news/are-we-worrying-about-%E2%80%98right%E2%80%99-retirement-risks %0 Journal Article %J Journal of Personality %D 2022 %T The Association Between Facets of Conscientiousness and Performance-based and Informant-Rated Cognition, Affect, and Activities in Older Adults. %A Angelina R Sutin %A Damaris Aschwanden %A Yannick Stephan %A Antonio Terracciano %K attention %K cognitive function %K Conscientiousness %K Facets %K Five factor model %K Memory %X

OBJECTIVE: To identify facets of Conscientiousness associated with objective cognitive performance, informant-rated cognitive decline, and informant-rated affect and activities implicated in cognitive health.

METHOD: Health and Retirement Study participants (N=2,516) reported on their personality, completed a comprehensive cognitive assessment, and had knowledgeable informants report on their cognition, affect, and activities.

RESULTS: Industriousness and responsibility were associated with better cognitive performance; order was associated with less informant-rated cognitive decline. The facets were also associated with more positive affect, less negative affect, greater engagement in cognitive activities and activities outside the house, and less engagement in passive activities, as rated by a knowledgeable informant. Informant-rated engagement in cognitive activities mediated the association between self-reported responsibility and objective cognitive performance.

CONCLUSIONS: Tendencies toward achievement and accountability were associated with healthier cognitive performance and daily profiles that support cognitive health, whereas organization was associated with cognition as reported by a knowledgeable informant. The differential pattern of correlates is informative for the theoretical processes that link distinct facets of Conscientiousness to healthier cognitive aging.

%B Journal of Personality %V 90 %P 121-132 %G eng %N 2 %R 10.1111/jopy.12657 %0 Journal Article %J Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition %D 2022 %T The Association Between Five Factor Model Personality Traits and Verbal and Numeric Reasoning. %A Angelina R Sutin %A Yannick Stephan %A Martina Luchetti %A Jason E Strickhouser %A Damaris Aschwanden %A Antonio Terracciano %K meta-analysis %K numeric reasoning %K Personality Traits %K Reasoning %K verbal abilities %X

Five-factor model (FFM) personality traits are related to basic cognitive functions and risk of cognitive impairment in late life. The present study addresses whether FFM traits are also associated with a more complex cognitive function, reasoning, across adulthood. We used seven samples to examine the relation between personality and verbal (total = 39,177) and numeric (total = 76,388) reasoning. A meta-analysis indicated higher Neuroticism was associated modestly with worse performance on verbal and numeric reasoning tasks. Openness was associated with better verbal reasoning and was unrelated to numeric reasoning. Surprisingly, Extraversion was associated modestly with worse performance in both domains, and Conscientiousness was essentially unrelated to reasoning. Agreeableness was unrelated to reasoning. There was significant heterogeneity across the samples but only limited evidence for moderation by age or sex. Consistent with other cognitive domains, the results suggested that Neuroticism is related to worse performance globally, whereas Openness tends to be associated with better verbal abilities. Among the unexpected findings was the better reasoning of introverts. The pattern also suggests that the common positive association between Conscientiousness and cognition does not extend to reasoning and suggests that Conscientiousness may support healthier cognitive aging through basic cognitive functions rather than through complex functions like reasoning.

%B Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition %V 29 %P 297-317 %G eng %N 2 %R 10.1080/13825585.2021.1872481 %0 Journal Article %J Alzheimer Disease & Associated Disorders %D 2022 %T The Association Between Patterns of Social Engagement and Conversion From Mild Cognitive Impairment to Dementia: Evidence From the Health and Retirement Study. %A Amano, Takashi %A Sojung Park %A Morrow-Howell, Nancy %A Carpenter, Brian %K cognitive impairment %K environmental enrichment model %K Latent Class Analysis %X

OBJECTIVES: This study examined the association between patterns of social engagement and conversion from cognitive impairment, no dementia (CIND) to dementia. It also tested whether social engagement is associated with conversion independently from physical and cognitive engagements.

METHOD: Data from 2 waves (2010 and 2014) of the Health and Retirement Study (HRS) were used. The sample consisted of 1227 people who had CIND in 2010. To identify the heterogeneity of social engagement, latent class analysis was utilized. Multinomial logistic regression analysis was utilized to investigate the association between patterns of social engagement and probability of conversion to dementia and death or dropout.

RESULTS: The result showed that patterns of social engagement that represent higher level and more variety of social engagement were associated with lower probabilities of conversion to dementia in 4 years but not with probabilities of death or dropout. The relationship held after controlling for physical and cognitive engagements.

DISCUSSION: Findings implied that promoting social engagement may be protective against developing dementia even for the high-risk group of people with CIND. Future studies should investigate the mechanism behind the relationship between patterns of social engagement and lower probabilities of conversion to dementia.

%B Alzheimer Disease & Associated Disorders %V 36 %P 7-14 %G eng %N 1 %R 10.1097/WAD.0000000000000486 %0 Journal Article %J International Journal of Nursing Studies %D 2022 %T Association of Adherence to high-intensity physical activity and the Mediterranean-dietary approaches to stop hypertension intervention for neurodegenerative delay diet with cognition: A cross-sectional study %A Sangwoo Ahn %A Carrie N. Lingerfelt %A Chung Eun Lee %A Jung-Ah Lee %A Hollie A. Raynor %A Joel G. Anderson %K Cognition %K Dementia %K Health Promotion %K MIND diet %K Physical activity %X Background Prevention is a priority in the absence of a cure for dementia. Physical activity and a neuroprotective diet such as the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet are healthy lifestyle behaviors that may slow the onset of dementia. However, research on the relationship between the combination of physical activity and the MIND diet and cognition is rare. Objectives The purpose of this study was to investigate whether the combination of high-intensity physical activity and the MIND diet is associated with better cognition compared with either behavior alone or neither behavior. Design A population-based, cross-sectional study was conducted using data from the Health and Retirement Study. Methods Using information from a total of 3463 participants (age 68.0 ± 10.0 years), multivariate linear regression models and binary logistic regression models with interaction terms between high-intensity physical activity (PA) and the MIND diet (MIND) were used to assess associations of PA and MIND with global cognition and odds of cognitive decline. Group comparisons were conducted among four groups: PA−/MIND−, PA+/MIND−, PA−/MIND+, and PA+/MIND+. Results PA+/MIND− did not predict cognitive outcomes (versus PA−/MIND−). PA−/MIND+ was associated with better global cognition (mean difference [d] = 0.81; 95% confidence interval [CI] = 0.50–1.11; p < 0.001) and lower odds of cognitive decline (odds ratio [OR] = 0.68; 95% CI = 0.54–0.86; p = 0.001) (versus PA−/MIND−). PA+/MIND+ predicted better global cognition (d = 0.98; 95% CI = 0.59–1.36; p < 0.001) and lower odds of cognitive decline (OR = 0.69; 95% CI = 0.50–0.94; p = 0.004) (versus PA−/MIND−). PA+/MIND+ was associated with better global cognition (d = 0.60; 95% CI = 0.08–1.12; p < 0.001), but did not predict lower odds of cognitive decline (versus PA+/MIND−). PA+/MIND+ did not predict cognitive outcomes (versus PA−/MIND+). Conclusions Combining high-intensity physical activity and the MIND diet was associated with better cognitive health than high-intensity physical activity alone or non-adherence to both behaviors. To potentially exert additive effects, it will be important to encourage these two healthy habits. More research on the role of combined physical activity and dietary change is necessary to further inform policy and clinical guidance. What is already known •Because there is no cure for dementia, prevention is a major issue.•A healthy lifestyle is a non-pharmacological way to potentially prevent dementia.•Physical activity or the Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet may improve cognitive function. What this paper adds •The influence of the combination of high-intensity physical activity and the MIND diet on cognitive health was investigated among a nationally representative sample of community-dwelling individuals without dementia.•The combination of high-intensity physical activity and the MIND diet was associated with better global cognition and a lower risk of cognitive decline compared with neither behavior.•Adding the MIND diet to high-intensity physical activity was associated with higher global cognition when compared with high-intensity physical activity only, which may imply an additive effect. %B International Journal of Nursing Studies %V 131 %P 104243 %G eng %R https://doi.org/10.1016/j.ijnurstu.2022.104243 %0 Journal Article %J JAMA Network Open %D 2022 %T Association of Playing College American Football With Long-term Health Outcomes and Mortality. %A Phelps, Alyssa %A Alosco, Michael L %A Baucom, Zachary %A Hartlage, Kaitlin %A Palmisano, Joseph N %A Weuve, Jennifer %A Mez, Jesse %A Tripodis, Yorghos %A Stern, Robert A %K Aged %K Brain Concussion %K Cohort Studies %K Female %K Football %K Health Care %K Humans %K Male %K Neurodegenerative Diseases %K Outcome Assessment %X

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

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

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

Exposure: Participation in football at ND.

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

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

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

%B JAMA Network Open %V 5 %P e228775 %G eng %N 4 %R 10.1001/jamanetworkopen.2022.8775 %0 Journal Article %J Innovation in Aging %D 2022 %T ASSOCIATION OF RELIGIOUS ATTENDANCE WITH NEUROPSYCHIATRIC SYMPTOMS, COGNITION, AND SLEEP IN COGNITIVE IMPAIRMENT %A Britt, Katherine %A Richards, Kathy %A Kesler, Shelli %A Acton, Gayle %A Hamilton, Jill %A Radhakrishnan, Kavita %K Cognition %K cognitive impairment %K Religious attendance %X Neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances are common among older adults with cognitive impairment. Religious practices may protect mental and physical health, yet few studies have been reported in older adults with cognitive impairment. Utilizing the Health and Retirement Study in 2006 and 2008 and sub study, Aging, Demographics, and Memory study in 2006–2007 and 2008–2009, we examined the association of religious attendance with NPS, cognition, and sleep disturbances controlling for social interaction in older adults with cognitive impairment (N = 63). Bootstrapped Spearman’s partial Rho correlation was conducted separately for time points one (T1) and two (T2); Wilcoxon signed-rank tests were used to examine significant change over time. Mean age was 81.89(5.26) years, 65.9\% were non-Hispanic White, 50.1\% were female, and mean cognition (Clinical Dementia Rating) was .94(.228). Significant changes over 1.5 years were found for sleep disturbances but not for NPS and cognition. Significant associations were found for religious attendance and NPS (T1: rs (97)= - .103, 95\% CI [-.108, -.098], p \< .0005 and T2: -.243, 95\% CI [-.246,-.239], p \< .0005), cognition, (T1: rs (97) = - .119, 95\% CI [-.122, -.115], p \< .0005, and T2: rs (97) = -.104, 95\% CI [-.107,-.102], p \< .0005), and sleep disturbances, (T1: rs (97) = .028, 95\% CI [.023, .033], p \< .001, and T2: rs (97) = -.051, 95\% CI [-.056,-.047], p \< .001). Increased religious attendance was associated with lower NPS and cognition at both time points and greater sleep disturbances at T1 but lower at T2. Longitudinal studies are needed to examine associations further. %B Innovation in Aging %V 6 %P 819-819 %8 12 %G eng %R 10.1093/geroni/igac059.2946 %0 Journal Article %J SSM - Population Health %D 2022 %T The associations between relative and absolute body mass index with mortality rate based on predictions from stigma theory %A Gregory Pavela %A Nengjun Yi %A Luis Mestre %A Stella Lartey %A Pengcheng Xun %A David B. Allison %K BMI %K Deviance %K Epidemiology %K Lifespan %K Longevity %K Mortality rate %K Obesity %K Relative weight %K Stigma %X Background The social consequences of obesity may influence health and mortality rate (MR), given obesity's status as a highly stigmatized condition. Hence, a high absolute body mass index (BMI) in conjunction with the stigmatization of a high BMI may each independently increase the rate of MR. Objectives We tested whether relative BMI, defined as ordinal rank within a social reference group jointly defined by age, sex, and race/ethnicity, is associated with MR independent of absolute BMI. Methods Data were from three nationally representative datasets: the Health and Retirement Study (n = 31,115), the National Health Interview Survey (NHIS, n = 529,362), and the National Health and Nutrition Examination Survey (n = 31,115). Relative BMI kg/m2 deciles were calculated within twenty-four subgroups jointly defined by age (6 levels), sex (2 levels), and race/ethnicity (4 levels). The association between ordinal rank BMI and MR was assessed using Cox survival generalized additive models in each dataset with adjustments for age, race, sex, smoking, educational attainment, and absolute BMI. Results Absolute BMI had a significant non-monotonic association with MR, such that BMI was positively associated with mortality at BMI levels above approximately 25 kg/m2. Contrary to expectations, results from NHIS indicated that individuals in the first decile of relative BMI had the highest MR whereas relative BMI was not associated with MR in the NHANES and HRS. Conclusion We hypothesized that the stigmatization of obesity might lead to an increased MR after controlling for absolute BMI. Contrary to expectations, a higher relative BMI was not associated with an increased MR independent of absolute BMI. %B SSM - Population Health %V 19 %P 101200 %G eng %R https://doi.org/10.1016/j.ssmph.2022.101200 %0 Journal Article %J Health & Social Care in the Community %D 2022 %T Associations between volunteering and cognitive impairment: The moderating role of race/ethnicity. %A Wang, Yi %A Wong, Roger %A Amano, Takashi %A Shen, Huei-Wern %K formal volunteering %K informal volunteering %K minority ageing %K objective cognition %K subjective cognition %X

Although volunteering has been shown to benefit cognitive health, there is a paucity of evidence on informal volunteering and subjective measures of cognitive impairment. Also, little is known about whether such relationships vary by race/ethnicity. This study aimed to examine the associations of both formal and informal volunteering with older adults' objective and subjective cognition and explore the moderating role of race/ethnicity in such associations. Using data from the Health and Retirement Study in the United States (2010-2016), 9941 older adults (51+) who were cognitively unimpaired in 2010 and alive through 2016 were included. Ordered logistic regression models were performed to assess the relationships among volunteering, cognitive impairment and race/ethnicity. Findings showed that more years of formal and informal volunteering significantly reduced the odds of objective cognitive impairment; neither volunteering type was significant for subjective cognitive impairment. The relationship between informal volunteering and objective cognition varied by race/ethnicity. Compared to non-Hispanic Whites, non-Hispanic Black older adults who engaged in more years of informal volunteering had a significantly higher odds of cognitive impairment over time. The current study is one of the first to look at the associations between informal volunteering and cognition. The inclusion of subjective cognitive impairment, paired with objective measures of cognition, also adds value to the knowledge body. Our findings indicate any type of volunteering is a viable approach to prevent cognitive impairment for older populations. However, more research is needed to better understand why racial/ethnic minority, particularly non-Hispanic Black older adults, do not benefit from informal volunteering.

%B Health & Social Care in the Community %V 30 %P e4433-e4441 %G eng %N 6 %R 10.1111/hsc.13847 %0 Journal Article %J Work Aging and Retirement %D 2022 %T Beyond Hours Worked and Dollars Earned: Multidimensional EQ, Retirement Trajectories and Health in Later Life %A Sarah B. Andrea %A Eisenberg-Guyot, Jerzy %A Vanessa M Oddo %A Peckham, Trevor %A Jacoby, Daniel %A Hajat, Anjum %K employment quality %K health %K Retirement %X The working lives of Americans have become less stable over the past several decades and older adults may be particularly vulnerable to these changes in employment quality (EQ). We aimed to develop a multidimensional indicator of EQ among older adults and identify EQ and retirement trajectories in the United States. Using longitudinal data on employment stability, material rewards, workers’ rights, working-time arrangements, unionization, and interpersonal power relations from the Health and Retirement Study (HRS), we used principal component analysis to construct an EQ score. Then, we used sequence analysis to identify late-career EQ trajectories (age 50–70 years; N = 11,958 respondents), overall and by sociodemographics (race, gender, educational attainment, marital status). We subsequently examined the sociodemographic, employment, and health profiles of these trajectories. We identified 10 EQ trajectories; the most prevalent trajectories were Minimally Attached and Wealthy (13.9%) and Good EQ to Well-off Retirement (13.7%), however, 42% of respondents were classified into suboptimal trajectories. Those in suboptimal trajectories were disproportionately women, people of color, and less-educated. Individuals in the Poor EQ to Delayed and Poor Retirement and Unattached and Poor clusters self-reported the greatest prevalence of poor health and depression, while individuals in the Wealthy Business Owners and Great EQ to Well-off Retirement clusters self-reported the lowest prevalence of poor health and depression at baseline. Trajectories were substantially constrained for women of color. Although our study demonstrates EQ is inequitably distributed in later life, labor organizing and policy change may afford opportunities to improve EQ and retirement among marginalized populations. %B Work Aging and Retirement %V 8 %P 51-73 %@ 2054-4650 %G eng %N 1 %R 10.1093/workar/waab012 %0 Journal Article %J SSM - Population Health %D 2022 %T Black-White variation in the relationship between early educational experiences and trajectories of cognitive function among US-born older adults %A Katrina M. Walsemann %A Eleanor M. Kerr %A Jennifer A Ailshire %A Pamela Herd %K cognitive impairment %K Dementia %K Early Life %K Memory %K school segregation %X Black adults face a substantially higher risk for dementia in later life compared to their White peers. Given the critical role of educational attainment and cognitive function in later life dementia risk, this paper aims to determine if early educational experiences and educational attainment are differentially related to trajectories of cognitive status across race and if this further varies by education cohort. We use data from the Life History Mail Survey (LHMS) and prospective data on cognition from the Health and Retirement Study (HRS). We restrict our sample to Black and White US-born adults who provided at least one measure of cognitive status from 1995/6–2016. We find evidence of Black-White differences in the association between educational experiences and level of cognitive function, episodic memory, and working memory, but little evidence of Black-White differences in these associations with decline. Having a learning problem was associated with lower levels of cognitive function, episodic memory, and working memory for White and Black older adults, but was more strongly related to these outcomes among Black older adults. Further, the Black-White difference in this association was generally found in older cohorts that completed schooling after enactment of federal policies that improved educational resources for children with learning disabilities. Attending racially discordant schools was positively associated with level of these cognitive outcomes for Black older adults but not for White older adults. We also find that the educational gradient in level of cognitive function was larger for Black compared to White older adults in older cohorts not benefiting from the Brown v Board of Education decision but was similar for Black and White older adults attending school in the post-Brown era. %B SSM - Population Health %V 19 %P 101184 %G eng %R 10.1016/j.ssmph.2022.101184 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Changing relationships between social contact, social support and depressive symptoms during the COVID-19 pandemic. %A Ang, Shannon %K COVID-19 %K Depressive symptoms %K informal social participation %X

OBJECTIVES: Given the longstanding consensus that social contact can promote older adult well-being, many have focused on how social contact changed during the pandemic. Less is known, however, about whether the link between social contact and health changed during the pandemic. This study sought to understand how associations between social contact, social support, and depressive symptoms changed during the COVID-19 pandemic.

METHODS: Data from two waves of the Health and Retirement Study were used. Respondents reported both virtual and in-person social contact, as well as perceived positive and negative social support. I use path models to estimate relationships between social contact, social support, and depressive symptoms. Bootstrapping was used to estimate the change in associations between 2016 and 2020.

RESULTS: Estimates show that associations between positive social support and depressive symptoms, as well as between in-person social contact and depressive symptoms, attenuated during the pandemic. Virtual social contact played a relatively minor role in determining outcomes such as social support and depressive symptoms, compared to in-person social contact.

DISCUSSION: Findings suggest that researchers and policymakers should not only focus on the changing quantity of social interactions when events such as the COVID-19 pandemic happen, but also the changing content and efficacy of the social interactions that remain.

%B The Journals of Gerontology, Series B %V 77 %P 1732-1739 %G eng %N 9 %R 10.1093/geronb/gbac063 %0 Report %D 2022 %T Cognitive Decline, Limited Awareness, Imperfect Agency, and Financial Well-being %A Ameriks, John %A Caplin, Andrew %A Lee, Minjoon %A Matthew D. Shapiro %A Tonetti, Christopher %K Cognitive decline %K Financial well-being %X Cognitive decline may lead older Americans to make poor financial decisions. Preventing poor decisions may require timely transfer of financial control to a reliable agent. Cognitive decline, however, can develop unnoticed, creating the possibility of suboptimal timing of the transfer of control. This paper presents survey-based evidence that wealthholders regard suboptimal timing of the transfer of control, in particular delay due to unnoticed cognitive decline, as a substantial risk to financial well-being. This paper provides a theoretical framework to model such a lack of awareness and the resulting welfare loss. %B Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w29634 %0 Journal Article %J Journal of Aging and Health %D 2022 %T Cognitive Impairment and the Trajectory of Loneliness in Older Adulthood: Evidence from the Health and Retirement Study. %A Lee, Ji Hyun %A Martina Luchetti %A Damaris Aschwanden %A Sesker, Amanda A %A Jason E Strickhouser %A Antonio Terracciano %A Angelina R Sutin %K cognitive impairment %K cognitive impairment no dementia %K Dementia %K Loneliness %X

To examine whether the trajectory of facets of loneliness-emotional and social-varied by cognitive impairment status in older adulthood. Data came from the Health and Retirement Study 2008-2018 waves ( = 15,352). Cognitive impairment was assessed using standard cutoffs for cognitive impairment no dementia (CIND) and dementia. The 11-item UCLA loneliness scale was used to measure emotional and social loneliness. Using multilevel modeling, we found that CIND and dementia status were associated with higher overall, emotional, and social loneliness, controlling for physical health, social contact, and depressive symptoms. The trajectory of loneliness did not vary by cognitive status. There were modest variations by sociodemographic factors. Persons with CIND and dementia experience heightened emotional and social loneliness, but cognitive impairment does not contribute to the worsening of loneliness. Older adults' social integration may be maintained early in cognitive impairment.

%B Journal of Aging and Health %V 34 %P 3-13 %G eng %N 1 %R 10.1177/08982643211019500 %0 Journal Article %J The Journals of Gerontology: Series A %D 2022 %T Cognitive Performance Trajectories Before and After Sleep Treatment Initiation in Middle-Aged and Older Adults: Results from the Health and Retirement Study. %A Christopher N Kaufmann %A Bondi, Mark W %A Thompson, Wesley K %A Adam P Spira %A Ancoli-Israel, Sonia %A Anil K. Malhotra %K Cognitive decline %K Sleep %K sleep treatment %X

BACKGROUND: Sleep disturbances are associated with risk of cognitive decline but it is not clear if treating disturbed sleep mitigates decline. We examined differences in cognitive trajectories before and after sleep treatment initiation.

METHODS: Data came from the 2006-2014 Health and Retirement Study. At each of five waves, participants were administered cognitive assessments and scores were summed. Participants also reported if, in prior two weeks, they had taken medications or used other treatments to improve sleep. Our sample (N=3,957) included individuals who at HRS 2006 were >50 years, had no cognitive impairment, reported no sleep treatment, and indicated experiencing sleep disturbance. We identified differences between those receiving vs. not receiving treatment in subsequent waves, and among those treated (N=1,247), compared cognitive trajectories before and after treatment.

RESULTS: At baseline, those reporting sleep treatment at subsequent waves were more likely to be younger, female, Caucasian, to have more health conditions, to have higher BMI, and more depressive symptoms (all p's≤0.015). Decline in cognitive performance was mitigated in periods after sleep treatment vs. periods before (B=-0.20, 95% CI=-0.25, -0.15, p<0.001; vs., B=-0.26, 95% CI=-0.32, -0.20, p<0.001), and this same trend was seen for self-initiated and doctor-recommended treatments. Trends were driven by those with higher baseline cognitive performance-those with lower performance saw cognitive declines following sleep treatment.

CONCLUSIONS: In middle-aged and older adults with sleep disturbance, starting sleep treatment may slow cognitive decline. Future research should assess types, combinations, and timing of treatments most effective in improving cognitive health in later life.

%B The Journals of Gerontology: Series A %V 77 %P 570-578 %G eng %N 3 %R 10.1093/gerona/glab164 %0 Thesis %D 2022 %T A Comprehensive Evaluation of Life Purpose, Psychosocial Wellbeing, and Mortality %A Alimujiang, Aliya %K life purpose %K Mortality %K Psychosocial %K Wellbeing %I University of Michigan %C Ann Arbor, MI %V Ph.D. %G eng %U https://scholar.google.com/scholar_url?url=https://deepblue.lib.umich.edu/bitstream/handle/2027.42/174471/aaliya_1.pdf%3Fsequence%3D1&hl=en&sa=X&d=12234348909635596177&ei=nPsfY7jSGciTywTTs62IBg&scisig=AAGBfm26tvkoxvQKSLY63j8zIxyPMXUsug&oi=scholaralrt&hist %0 Report %D 2022 %T Constructing a Work History Dataset of Jobs Held During Early and Middle Adulthood Using the Health and Retirement Study %A Park, Sung S. %A Pratt, Boriana %A Pebley, Anne R. %A Goldman, Noreen %A Sheftel, Mara Getz %A Andrasfay, Theresa %A Lee, Keunbok %K Employment %K Functional limitations %K life course %K Occupation %X The Health and Retirement Survey (HRS) (https://hrs.isr.umich.edu/about) collects extensive data on current employment and occupation at each wave but data on occupations prior to the start of the survey are limited to an abbreviated job history in each respondent's first interview focused on recently held jobs. Therefore, using HRS data to link employment earlier in respondents' lives to socioeconomic, health, and other outcomes at older ages has been infeasible. The RAND Corporation created a dataset from the HRS Core and Exit Interviews called the RAND HRS Cross-Year Longitudinal file which is used by many researchers working with HRS. This dataset contains a variable called the "longest job held" for each respondent. However, this variable is the longest job held among the limited subset of jobs reported in HRS (most of which are recent) and not necessarily the longest job that the respondent has held to date. In 2017, HRS conducted a Life History Mail Survey (LHMS) of HRS respondents who had participated in the 2016 Core interview. The LHMS was conducted in three parts which, combined, include all of the 2016 Core interview respondents. The LHMS questionnaire was a pencil-paper survey completed and returned by respondents and included a grid asking %I UCLA: California Center for Population Research %C Los Angeles, CA %G eng %U https://escholarship.org/uc/item/3bz58411 %0 Journal Article %J Innovation in Aging %D 2022 %T COPING AND LIFE SATISFACTION OF OLDER PEOPLE DURING THE COVID-19 PANDEMIC %A Xu, Dongjuan %A Lalani, Nasreen %A Arling, Gregory %K COVID-19 pandemic %K Life Satisfaction %K Older people %X Covid-19 put older individuals at high risk for increased morbidity and mortality, isolation, reduced coping and life satisfaction. Optimism, sense of mastery and closeness with family and friends can enhance coping and life satisfaction among older adults. No such studies were found during the pandemic. Our study examined the associations between optimism, sense of mastery, closeness with spouse, family, and friends, physical and psychological functioning and its effects on coping and life satisfaction. A national representative sample of 1,890 community dwelling older adults was obtained from the 2020 Health and Retirement Study COVID-19 data during March 2020-June 2021. A structural equation modeling approach used to test the associations and their direct and indirect effects on life satisfaction. Coping was seen as a mediator affecting these relationships and their effects on life satisfaction. Optimism (β = .318, p \< .001), mastery (β = .195, p \< .001) closeness with spouse/partner (β = .199, p \< .001), closeness with children ((β = .075, p \< .010), friends (β = .086, p \< .001), had significant positive direct and indirect effects on life satisfaction. Frailty (β = -.137, p \< .001), comorbidities (β = -.057, p \< .050), and IADL limitations (β = -.118, p \< .001) had negative direct effects on life satisfaction. Optimism, sense of mastery and closeness with family/friends promotes coping and life satisfaction whereas frailty and comorbidities negatively influence coping and life satisfaction of the older adults. Community interventions should target coping strategies that enhances optimism, mastery, and interpersonal closeness among older adults during pandemic. %B Innovation in Aging %V 6 %P 878-878 %8 12 %G eng %R 10.1093/geroni/igac059.3134 %0 Web Page %D 2022 %T Cost of Chronic Disease in Retirement Is Highest for Women and People of Color %A National Council on Aging %K Chronic disease %K Racial Disparities %K Retirement %B PR Newswire %G eng %U https://www.prnewswire.com/news-releases/cost-of-chronic-disease-in-retirement-is-highest-for-women-and-people-of-color-301529730.html %0 Journal Article %J The Journal of Gerontology, Series A %D 2022 %T COVID-19 pandemic impact on trajectories in cardiometabolic health, physical activity and functioning among adults from the 2006-2020 Health and Retirement Study. %A Beydoun, Hind A %A Beydoun, May A %A Gautam, Rana S %A Alemu, Brook T %A Weiss, Jordan %A Hossain, Sharmin %A Zonderman, Alan B %K Activities of Daily Living %K COVID-19 %K lifestyle %K Obesity %K Statistical models %X

BACKGROUND: The aim of this study was to evaluate the impact of the COVID-19 pandemic on trajectories in cardiometabolic health, physical activity and functioning among U.S. older adults, overall and according to selected baseline socio-demographic characteristics.

METHODS: We performed secondary analyses using longitudinal data on 1,372 participants from the 2006-2020 Health and Retirement Study. Pre-post COVID-19 pandemic onset was examined in relation to body mass index (BMI), number of cardiometabolic risk factors and/or chronic conditions, physical activity, Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) using mixed-effects regression models and group-based trajectory models.

RESULTS: The COVID-19 pandemic was associated with significantly increased BMI (β=1.39, 95% CI: 0.74, 2.03). Furthermore, the odds of having at least one cardiometabolic risk factor and/or chronic disease increased pre-post COVID-19 onset (OR 1.16, 95% CI: 1.00, 1.36), whereas physical functioning worsened pre-post COVID-19 onset (ADL: β=1.11, 95% CI: 0.94, 1.28; IADL: β=0.59, 95% CI: 0.46, 0.73). The pre-post COVID-19 period (2018-2020) showed a stable group of trajectories, with low, medium and high levels of the selected health indicators. Health disparities according to sex, race/ethnicity, educational level, work status and total wealth are highlighted.

CONCLUSIONS: The COVID-19 pandemic onset appears to worsen cardiometabolic health and physical functioning among U.S. older adults, with clusters of individuals defined by selected socio-demographic characteristics experiencing distinct trajectories pre-post COVID-19 pandemic onset.

%B The Journal of Gerontology, Series A %V 77 %P 1371-1379 %G eng %N 7 %R 10.1093/gerona/glac028 %0 Journal Article %J PLoS One %D 2022 %T Cross-national harmonization of cognitive measures across HRS HCAP (USA) and LASI-DAD (India). %A Vonk, Jet M J %A Gross, Alden L %A Zammit, Andrea R %A Bertola, Laiss %A Avila, Justina F %A Jutten, Roos J %A Gaynor, Leslie S %A Suemoto, Claudia K %A Lindsay C Kobayashi %A O'Connell, Megan E %A Elugbadebo, Olufisayo %A Amofa, Priscilla A %A Staffaroni, Adam M %A Arce Rentería, Miguel %A Turney, Indira C %A Richard N Jones %A Jennifer J Manly %A Lee, Jinkook %A Zahodne, Laura B %K Cognition %K cognitive aging %K Episodic %K HCAP %K India %K Language %K LASI-DAD %K Memory %K Neuropsychological tests %X

BACKGROUND: As global populations age, cross-national comparisons of cognitive health and dementia risk are increasingly valuable. It remains unclear, however, whether country-level differences in cognitive function are attributable to population differences or bias due to incommensurate measurement. To demonstrate an effective method for cross-national comparison studies, we aimed to statistically harmonize measures of episodic memory and language function across two population-based cohorts of older adults in the United States (HRS HCAP) and India (LASI-DAD).

METHODS: Data for 3,496 HRS HCAP (≥65 years) and 3,152 LASI-DAD (≥60 years) participants were statistically harmonized for episodic memory and language performance using confirmatory factor analysis (CFA) methods. Episodic memory and language factor variables were investigated for differential item functioning (DIF) and precision.

RESULTS: CFA models estimating episodic memory and language domains based on a priori adjudication of comparable items fit the data well. DIF analyses revealed that four out of ten episodic memory items and five out of twelve language items measured the underlying construct comparably across samples. DIF-modified episodic memory and language factor scores showed comparable patterns of precision across the range of the latent trait for each sample.

CONCLUSIONS: Harmonization of cognitive measures will facilitate future investigation of cross-national differences in cognitive performance and differential effects of risk factors, policies, and treatments, reducing study-level measurement and administrative influences. As international aging studies become more widely available, advanced statistical methods such as those described in this study will become increasingly central to making universal generalizations and drawing valid conclusions about cognitive aging of the global population.

%B PLoS One %V 17 %P e0264166 %G eng %N 2 %R 10.1371/journal.pone.0264166 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Demographic and Health Characteristics of Older Latino Birth Cohorts in the Health and Retirement Study. %A García, Catherine %A Garcia, Marc A %A Jennifer A Ailshire %K Demographics %K health %K Latinos/Hispanics %K Well-being %X

BACKGROUND AND OBJECTIVES: Latinos are the fastest aging racial/ethnic minority group in the United States One limitation to understanding the diverse experiences of older Latinos is the lack of nationally representative data necessary to examine factors contributing to changes in population-level health over time. This is needed to provide a more comprehensive picture of the demographic characteristics that influence the health and well-being of older Latinos.

METHODS: We utilized the steady-state design of the Health and Retirement Study (HRS) from 1992 to 2016 to examine the demographic and health characteristics of the five entry birth cohorts of older Latinos aged 51-56 (n=2,882). Adjusted Wald tests were used to assess statistically significant differences in demographic and health characteristics across the five HRS birth cohorts.

RESULTS: Cross-cohort comparisons of demographic and health characteristics of older Latinos indicate significant change over time, with later-born HRS birth cohorts less likely to identify as Mexican-origin, more likely to identify as a racial "other," and more likely to be foreign-born. In addition, we find that later-born cohorts are more educated and exhibit a higher prevalence of hypertension, diabetes, and obesity.

DISCUSSION: Increasing growth and diversity among the older U.S. Latino population make it imperative that researchers document changes in the demographic composition and health characteristics of this population as it will have implications for researchers, policymakers, health care professionals, and others seeking to anticipate the needs of this rapidly aging population.

%B The Journals of Gerontology, Series B %V 77 %P 2060-2071 %G eng %N 11 %R 10.1093/geronb/gbac017 %0 Journal Article %J IJERPH %D 2022 %T Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006–2020 Health and Retirement Study %A Beydoun, Hind A. %A Beydoun, May A. %A Alemu, Brook T. %A Weiss, Jordan %A Hossain, Sharmin %A Gautam, Rana S. %A Zonderman, Alan B. %K cardiometabolic %K COVID-19 %K healthcare services %K lifestyle %K Machine learning %K socio-demographic %X Background: The coronavirus disease 19 (COVID-19) was declared a global pandemic on 11 March 2020. To date, a limited number of studies have examined the impact of this pandemic on healthcare-seeking behaviors of older populations. This longitudinal study examined personal characteristics linked to COVID-19 outcomes as predictors of self-reported delayed healthcare services attributed to this pandemic, among U.S. adults, ≥50 years of age. Methods: Secondary analyses were performed using cross-sectional data (1413 participants) and longitudinal data (2881 participants) from Health and Retirement Study (HRS) (2006–2018) linked to the 2020 HRS COVID-19 Project (57% female, mean age: 68 years). Demographic, socioeconomic, lifestyle and health characteristics were evaluated in relation to delayed overall, surgical and non-surgical healthcare services (“Since March 2020, was there any time when you needed medical or dental care, but delayed getting it, or did not get it at all?” and “What type of care did you delay”) using logistic regression and Ensemble machine learning for cross-sectional data as well as mixed-effects logistic modeling for longitudinal data. Results: Nearly 32.7% delayed healthcare services, 5.8% delayed surgical services and 31.4% delayed non-surgical services. Being female, having a college degree or higher and 1-unit increase in depression score were key predictors of delayed healthcare services. In fully adjusted logistic models, a history of 1 or 2 cardiovascular and/or metabolic conditions (vs. none) was associated with 60–70% greater odds of delays in non-surgical services, with distinct findings for histories of hypertension, cardiovascular disease, diabetes and stroke. Ensemble machine learning predicted surgical better than overall and non-surgical healthcare delays. Conclusion: Among older adults, sex, education and depressive symptoms are key predictors of delayed healthcare services attributed to the COVID-19 pandemic. Delays in surgical and non-surgical healthcare services may have distinct predictors, with non-surgical delays more frequently observed among individuals with a history of 1 or 2 cardiovascular and/or metabolic conditions. %B IJERPH %V 19 %P 1-24 %G eng %U https://EconPapers.repec.org/RePEc:gam:jijerp:v:19:y:2022:i:19:p:12059-:d:923426 %0 Journal Article %J Journal of Research in Social Science and Humanities %D 2022 %T DETERMINANTS OF INSURANCE ENROLLMENT %A Gudeta Kebede Asfaw %K Age %K household income %K Insurance policy %K Marital Status %K retirement status %X Ownership of health insurance policy is a mechanism for protecting an individual family’s financial security. It is also a means for a risk-aversion strategy for the cost of medical care, loss of productivity time during the illness, and in a more serious case death. This study examines the factors that influence the ownership of insurance policies at an individual level using a binary logistic regression model. The data used in this study was taken from the Health and Retirement Study (HRS), the fifth wave in 2002 with 3206 respondents of the survey, whereby thirty-nine percent of the respondents happened to have an insurance policy scheme. The outcome of this model indicated that retirement status, household income, years of schooling, and marital status variables were all found to have a statistically (at 95% confidence level) associated with ownership of insurance policy. Contrastingly, the other covariates, namely: age at the time of the survey, race, and gender of the respondents had insignificantly relationship with the ownership of insurance policy. %B Journal of Research in Social Science and Humanities %V 2 %G eng %N 1 %R 10.47679/jrssh.v2i1.25 %0 Journal Article %J Innovation in Aging %D 2022 %T DEVELOPMENT OF A FRAILTY INDEX FOR PEOPLE WITH DEMENTIA IN THE HEALTH AND RETIREMENT STUDY %A Wilkie, Rachel %A Jennifer A Ailshire %K Dementia %K frailty index %X Frailty indices (FI) have been found to predict adverse outcomes, such as, mortality, hospitalization, and institutionalization in older adults. However, traditional FIs often exclude people with dementia (PWD), who may not be able to consent to or complete all of the standard frailty items. While frailty is a known risk factor for onset of dementia and PWD have higher rates of frailty, little is known regarding how frailty predicts outcomes among PWD. Our study aims to develop an FI for PWD and to examine how this index relates to mortality, hospitalization, and nursing home stays. We used data from the Health and Retirement Study to create a 52-item FI for community-dwelling adults aged 50 years and over classified as having dementia (n = 1,107) in 2014. The index includes deficits in four domains: chronic health conditions, functional status, sensory problems, and overall health and wellbeing. A standardized FI score between 0 and 1 was calculated for each respondent. We used logistic regression to examine associations with FI and 2-year mortality, hospitalization, and nursing home stay, adjusting for age and gender. We found that a 0.1 unit increase in FI was significantly associated with higher odds of 2-year mortality (OR 1.39, p< 0.001), hospitalization (OR 1.45, p< 0.001), and nursing home stay (OR 1.38, p< 0.001) for people with dementia. This study developed an FI which is predictive for adverse outcomes among PWD. Future work should explore how socioeconomic and neighborhood factors contribute to the relationship between frailty and adverse outcomes among PWD. %B Innovation in Aging %V 6 %P 429 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1685 %0 Journal Article %J Nutrients %D 2022 %T Diet Quality and Health in Older Americans. %A Zhao, Hang %A Andreyeva, Tatiana %K Activities of Daily Living %K Aged %K diet %K Eating %K Healthy %K Nutritional Status %X

Adequate nutrition is an essential component of healthy ageing. This study documents the quality of diets among older Americans and implications of healthy eating for their physical and mental health. Using a nationally representative longitudinal sample of adults aged ≥50 years, from the Health and Retirement Study (HRS) 2010-2016 and food intake data from the 2013 Health Care and Nutrition Study (HCNS), the study evaluates the onset of health problems along the spectrum of diet quality measured by the Healthy Eating Index (HEI)-2015. Older adults adhering to healthier diets, in the high HEI group, have a significantly lower risk of developing limitations in activities of daily living (15.2% vs. 19.6%, < 0.01) and depression (11.8% vs. 14.9%, < 0.01), as compared to participants with low HEI scores. Consuming healthier diets also predicts more favorable health outcomes, as measured by blood-based biomarkers, including C-reactive protein (3.3 vs. 3.8, < 0.05), cystatin C (1.1 vs. 1.2, < 0.1), total cholesterol (192.1 vs. 196.4, < 0.1), and high-density lipoprotein (57.2 vs. 53.8, < 0.01). Most older Americans can benefit from improving diet to reduce their risk of disability, chronic disease, and depression.

%B Nutrients %V 14 %P 1198 %G eng %N 6 %R 10.3390/nu14061198 %0 Journal Article %J Journal of Alzheimer's Disease %D 2022 %T Difficulties with Activities of Daily Living and Receipt of Care Among Older Adults with Cognitive Impairment: Differences Between Those Living Alone and Those Living with Others. %A Yang, Yulin %A Swinnerton, Kaitlin %A Portacolone, Elena %A Allen, Isabel Elaine %A Torres, Jacqueline M %A Duchowny, Kate %K Activities of Daily Living %K Cognitive Dysfunction %K home environment %K Independent Living %K Prevalence %X

We compared the prevalence of reporting difficulty with basic and instrumental activities of daily living without help received for persons with cognitive impairment living alone versus those living with others. We used data on 13,782 community-dwelling participants aged 55+ with cognitive impairment in the Health and Retirement Study (2000-2016). Models were stratified by gender and race/ethnicity. Among cognitively impaired older adults, those living alone were more likely to report difficulty without help received than those living with others. Results were similar by gender and race/ethnicity. Providers and policymakers might focus their efforts on ensuring the adequate provision of home and community-based services for older adults living alone with cognitive impairment.

%B Journal of Alzheimer's Disease %V 89 %P 31-37 %G eng %N 1 %R 10.3233/JAD-220172 %0 Journal Article %J Alzheimer Disease & Associated Disorders %D 2022 %T Does a Cancer Diagnosis in Mid-to-Later Life Modify Racial Disparities in Memory Aging? %A Eastman, Marisa R %A Ospina-Romero, Monica %A Westrick, Ashly C %A Jasdeep S Kler %A M. Maria Glymour %A Abdiwahab, Ekland %A Lindsay C Kobayashi %K cancer diagnosis %K Memory %K Racial Disparities %X

BACKGROUND: It is unknown whether an incident cancer diagnosis differentially impacts acute and long-term memory aging between older White and Black Americans.

METHODS: Incident cancer diagnoses and memory (immediate and delayed recall, combined with proxy-reported memory) were assessed at biennial study interviews in the US Health and Retirement Study (N=14,235, 1998-2016). We used multivariable segmented linear mixed-effects models to evaluate the rate of change in standardized memory score (SD/decade) in the years before, acutely at the time of, and in the years following an incident cancer diagnosis, compared to cancer-free adults, by race.

RESULTS: Black participants experienced faster memory decline than White participants (cancer-free group: -1.211 vs. -1.077; P<0.0001). An incident cancer diagnosis was associated with an acute memory drop in White, but not Black participants (-0.065 vs. 0.024; P<0.0001). However, White cancer survivors experienced slower memory decline than cancer-free White adults before and after diagnosis, but this memory advantage was not observed among Black cancer survivors.

CONCLUSIONS: Racial disparities in memory aging are not modified by an incident cancer diagnosis. The acute cancer-related memory decline and long-term memory advantage experienced by White, but not Black, cancer survivors relative to cancer-free older adults, requires further investigation.

%B Alzheimer Disease & Associated Disorders %V 36 %P 140-147 %G eng %N 2 %R 10.1097/WAD.0000000000000493 %0 Journal Article %J Gerontology & Geriatric Medicine %D 2022 %T Does the Chronic Stress of Everyday Discrimination or Race Itself Better Predict AD Onset Risk? %A Gary, Katharine M %A Hoque, Masudul %A Yashkin, Arseniy P %A Yashin, Anatoliy I %A Akushevich, Igor %K AD/ADRD %K Discrimination %K medical sociology %K Racial Disparities %K the stress process %X

Using evidence from the Health and Retirement Study, we explore racial disparities in Alzheimer's Disease (AD) onset risk. From a stress process perspective, there is substantial evidence in the literature that everyday discrimination is a chronic strain for Black individuals that acts as a social determinant of illness. However, few studies have examined specific relationships between this social stressor, race, and AD onset risk. Using Cox Proportional Hazard Models, we examined racial differences in exposure and vulnerability to everyday discrimination. Findings suggest that everyday discrimination predicts AD onset risk, and Black individuals experience more frequent exposure to everyday discrimination as a chronic strain. However, contrary to the stress process model, Black respondents were not more vulnerable to the effect of everyday discrimination on AD onset risk. Racial bias from medical professionals during the diagnostic process and mortality selection bias may explain this effect. Overall, the results of this study provide further evidence that discrimination is a key factor in predicting AD while also considering that many racial minorities with high rates of this type of social stress may not receive an unbiased diagnosis and/or survive to late life to develop AD.

%B Gerontology & Geriatric Medicine %V 8 %P 23337214221142944 %G eng %R 10.1177/23337214221142944 %0 Journal Article %J SSM Population Health %D 2022 %T Education in the Jim Crow South and Black-White inequities in allostatic load among older adults. %A Walsemann, Katrina M %A Pearson, Jay %A Abbruzzi, Emily %K Education %K Measurement %K race disparity %X

In the U.S., Black adults consistently have higher allostatic load - an indicator of physiological dysregulation - than White adults. Education is considered a likely mechanism given racial differences in attainment, but evidence is mixed. This may be due, in part, to data limitations that have made it difficult for scholars to account for the structurally rooted systemic racism that shaped the U.S. education system and led to large racial inequities in school term length and school attendance among older adults who grew up in the Jim Crow South. Our study addresses this limitation by linking historical data on Black and White segregated school systems in the U.S. South from 1919 to 1954 to the Health and Retirement Study (HRS) to determine if a new measure of educational attainment that accounts for structural racism that led to differences in the number of school days attended by Black and White students across years and states better explains Black-White inequities in allostatic load among older adults who attended school during Jim Crow. We restrict our sample to HRS respondents racialized as White or Black, who resided in the South when they were school-aged, completed primary/secondary school between 1919 and 1954, and provided a measure of allostatic load (n = 1932). We find that our new measure of schooling - duration in school - reduced the Black-White inequity in allostatic load more so than self-reported years of schooling whether we measured allostatic load continuously (34% vs 16%) or categorically (45% vs 20%). Our findings highlight the importance of identifying and using historically informed measures of schooling that account for structurally rooted systemic racism when trying to understand how education shapes the health of individuals racialized as Black in the United States.

%B SSM Population Health %V 19 %P 101224 %G eng %R 10.1016/j.ssmph.2022.101224 %0 Thesis %B Economics %D 2022 %T Essays in the Economics of Aging %A Arapakis, Karolos %K Medicaid %K Medicare administrative data %K Out-of-pocket medical expenses %X This thesis is made up of three main essays that aim to develop a deeper understanding of issues involving the public insurance programs for the elderly, and the risks they insure against. In the first essay (Chapter 2), using data from the Health and Retirement Study linked to administrative Medicare and Medicaid records, along with the Medical Expenditure Panel Survey, we estimate the stochastic process for total and out-of-pocket medical spending. By focussing on dynamics, we consider not only the risk of catastrophic expenses in a single year, but also the risk of moderate but persistent expenses that accumulate into a catastrophic lifetime cost. We also assess the reduction in out-of-pocket medical spending provided by public insurance schemes such as Medicare or Medicaid. We find that although Medicare and Medicaid pay the majority of medical expenses, households at age 65 will on average incur $59,000 in out-of-pocket costs with 10 percent of households incurring more than $121,000 in out-of-pocket expenses over their remaining lives. In the second essay (Chapter 3), we compare dementia prevalence and how it varies by socioeconomic status (SES) in the United States and England. We compare between country differences in age-gender standardized dementia prevalence, across the SES gradient. Dementia prevalence was estimated in each country using an algorithm based on an identical battery of demographic, cognitive, and functional measures. Dementia prevalence is higher among the disadvantaged in both countries, with the United States being more unequal according to four measures of SES. Once past health factors and education were controlled for, most of the within country inequalities disappeared; however, the cross-country difference in prevalence for those in the lowest income decile remained disproportionately high. This provides evidence that disadvantage in the United States is a disproportionately high risk factor for dementia. In the final essay (Chapter 4), we assess the optimal structure the U.S. Social Security system, taking into account the current system’s unfunded liabilities, transition dynamics and political feasibility constraints. We base the assessment on an estimated overlapping generations general equilibrium model that features both aggregate and idiosyncratic uncertainty. The quantitative analysis establishes that although transition costs greatly restrict the U.S. government’s ability to move away from the current Social Security system, ignoring the political feasibility constraints allows the government to increase welfare by transitioning to a more progressive and less costly to operate system. However, taking into account the political feasibility constraints overturns this result, as no reform is simultaneously welfare increasing and politically feasible. %B Economics %I University College London %C London %V Ph.D. %G eng %U https://discovery.ucl.ac.uk/id/eprint/10152204/1/Thesis.pdf %0 Thesis %D 2022 %T Essays on Long-Term Care Insurance: Risk Misperceptions, Suboptimal Timing, and Racial Disparities %A Ahmadi, Angie %K Long-term care insurance %K Racial Disparities %K Risk misperceptions %X This dissertation focuses on long-term care (LTC) in old age and the low ownership of private long-term care insurance (LTCI). Older adults in the US face significant risk of needing long-term care services. Despite the risk, most Americans never attempt to insure against it, and those who do tend to apply late in life when they are likely to be rejected. The first essay in this dissertation builds a quantitative equilibrium model to study consumers’ decision about when to buy LTCI in the presence of uninsurability risk. The model evaluates how much of the delay in purchase can be explained by risk misperceptions. I formulate the problem as a three-period model where consumers may buy insurance in a competitive market based on their observable risk characteristics during the first two periods in order to insure against nursing home risk in the third period. I estimate the model using the Health and Retirement Study (HRS). The model successfully reproduces the low ownership rates and timing of purchase across all income quintiles. I find that risk misperceptions lead to 42% lower than optimal purchase rate, and cause 29% of early buyers to delay their purchase. The sub-optimal behavior is particularly pronounced among the middle-income consumers. The second essay studies the patterns of LTC risk and LTCI purchase across race and ethnicity in the US. By 2050, the share of Blacks and Hispanics in the over-85 population is expected to increase to 40%. A better understanding of risk and insurance across different segments of the aging population is particularly important, given this increasing racial heterogeneity in older adults. Using the HRS, this chapter studies racial disparities in late-in-life health outcomes and estimates the risk of having a nursing home stay over lifetime across race and ethnicity. It finds that Blacks and Hispanics have a lower risk of entering a nursing home than Whites. The paper also examines differences in the likelihood of LTCI purchase across different racial and ethnic groups. The findings suggest that once demographic, socioeconomic, and family characteristics are accounted for, non-Whites are not less likely to buy insurance. %I American University %C Washington, D.C. %V Ph.D. %G eng %U https://www.proquest.com/docview/2695929386/abstract/152E12F6A2414D3CPQ/1?accountid=14667 %0 Journal Article %J JAMA Health Forum %D 2022 %T Estimated Annual Spending on Aducanumab in the US Medicare Program %A Mafi, John N. %A Leng, Mei %A Arbanas, Julia Cave %A Tseng, Chi-Hong %A Damberg, Cheryl L. %A Catherine A Sarkisian %A Landon, Bruce E. %K aducanumab %K annual spending %K Medicare %X The US Food and Drug Administration’s June 2021 decision to approve aducanumab for treatment for Alzheimer dementia raised concerns that a drug with uncertain benefit and high cost could, in aggregate, threaten Medicare's solvency. In response to these concerns, Biogen recently announced a 50% annual drug price reduction from $56 000 to $28 200 per patient. Preliminary US spending estimates either used extrapolated Alzheimer dementia prevalence data from 2012 or did not explicitly quantify ancillary costs, such as additional diagnostic imaging to monitor the amyloid-associated imaging abnormalities (ARIAs) that occur in 41% of treated patients, and did not incorporate the recently announced price reduction.1-3 We estimated upper bound and lower bound annualized Medicare costs for administering aducanumab to beneficiaries with the approved indications of mild cognitive impairment (MCI) or mild dementia, focusing on the degree to which associated ancillary health services affect spending.1 %B JAMA Health Forum %V 3 %P e214495 - e214495 %@ 2689-0186 %G eng %N 1 %R https://doi.org/10.1001/jamahealthforum.2021.4495 %0 Journal Article %J Journal of the American Geriatrics Society %D 2022 %T Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: A cross-sectional analysis. %A Oronce, Carlos Irwin A %A Arbanas, Julia Cave %A Leng, Mei %A Landon, Bruce E %A Damberg, Cheryl L %A Sarkisian, Catherine %A Mafi, John N %K Alzheimer disease %K drugs %K Medicare %K Spending %X Aducanumab, a weight-dosed Alzheimer's drug with uncertain benefits and high cost, could strain Medicare's budget if approved for widespread use.1 In April 2022, Medicare issued a final determination restricting aducanumab's use to clinical trials. However, Medicare's coverage decision may still be overturned by legal challenges, potentially leading to much higher uptake.2 Moreover, several other Alzheimer's infusion drugs similar to aducanumab are currently in the development pipeline.3 Because aducanumab is available in two fixed-dose vial sizes, its use may result in large amounts of discarded drug and wasteful spending.4, 5 To quantify the amount of discarded drug and potential savings that could be generated from more efficient aducanumab vial sizes, we analyzed patient weight distributions from a nationally representative sample of Medicare beneficiaries with mild cognitive impairment (MCI) or mild dementia. %B Journal of the American Geriatrics Society %V 70 %P 2714-2718 %G eng %N 9 %R 10.1111/jgs.17891 %0 Journal Article %J Innovation in Aging %D 2022 %T EXAMINING PHYSICAL HEALTH AMONG COHORTS OF CENTENARIAN SURVIVORS IN THE HEALTH AND RETIREMENT STUDY %A Rotem Arieli %K health %X This research highlights cohort differences in physical health among centenarians/near-centenarians in the Health and Retirement Study. Across 14 waves, participants aged 98 or older (n=494) were compared by three cohorts (i.e., 1890-1900, 1901-1910, and 1911-1920). Cohorts were examined at respective waves where participants were 96, 98, and 100 years of age. One-way ANOVA results presented significant differences in functional health at age 96 (F[2,324]=5.01, p<.01), subjective health at age 98 (F[2,212]=7.94, p<.001), and health conditions at ages 98 (F[2,213]=12.52, p<.001) and 100 (F[2,115]=3.45, p<.05). The oldest cohort had significantly better functional health than the youngest cohort (age 96), better subjective health than the two younger cohorts (age 98), and fewer health conditions than the youngest cohort (ages 98 and 100). Consistently, the oldest cohort performed better on subjective and objective health markers, providing implications for health care, disease prevention, and policy related to the shrinking “healthspan” among exceptional agers. %B Innovation in Aging %V 6 %8 12/2022 %G eng %N Supplement_1 %9 Journal Article %& 304 %R https://doi.org/10.1093/geroni/igac059.1205 %0 Journal Article %J Home Health Care Services Quarterly %D 2022 %T Examining variation in state spending on medicaid long-term services and supports for older adults. %A Mellgard, George %A Claire K. Ankuda %A Rahman, Omari-Khalid %A Amy Kelley %K long-term services and support %K Medicaid %X

State Medicaid programs are the largest source of funding for long-term services and supports (LTSS). We characterized states across quartiles of mean LTSS spending for individuals ≥65 and used the Health and Retirement Study to examine the demographic, functional, and caregiving characteristics across these quartiles. Individuals in states with lower Medicaid spending on LTSS reported more family and friend caregiving hours and were more likely to be from racial and ethnic minority groups. Continued work is needed to improve Medicaid LTSS policy to better support vulnerable populations, particularly in lower quartile states.

%B Home Health Care Services Quarterly %V 41 %P 54-64 %G eng %N 1 %R 10.1080/01621424.2021.2004286 %0 Journal Article %J Journal of Psychiatric Research %D 2022 %T Facets of conscientiousness and motoric cognitive risk syndrome %A Yannick Stephan %A Angelina R. Sutin %A Martina Luchetti %A Damaris Aschwanden %A Antonio Terracciano %K cognitive complaint %K Conscientiousness %K motoric cognitive risk %K walking speed %X Conscientiousness is related to a lower risk of motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by slow gait speed and cognitive complaints. The present study examines which facets of conscientiousness are related to concurrent and incident MCR. Participants were dementia-free older adults aged 65–99 years (N = 6001) from the Health and Retirement Study (HRS). Baseline data on conscientiousness facets and MCR (cognitive complaints and gait speed) were collected in 2008/2010, along with the covariates: demographic factors, cognition, physical activity, disease burden, depressive symptoms, and body mass index (BMI). MCR was assessed again in 2012/2014 and 2016/2018. Controlling for demographic factors, higher industriousness was related to a nearly 30% lower likelihood of concurrent MCR (Odds Ratio [OR] = 0.75, 95%CI: 0.67–0.85, p < .001) and to about 60% reduced risk of incident MCR (Hazard ratio [HR] = 0.63, 95%CI: 0.56–0.71, p < .001). Self-control, order, and responsibility were also associated with a lower likelihood of concurrent (OR range: 0.82–0.88) and incident (HR range: 0.72–0.82) MCR. Traditionalism (HR = 0.84, 95%CI: 0.75–0.93, p < .01) and virtue (HR = 0.84, 95%CI: 0.75–0.93, p < .01) were related to a lower risk of incident MCR. Cognition, physical activity, disease burden, depressive symptoms, and BMI partially accounted for these associations. Industriousness is the facet of conscientiousness with the strongest association with risk of MCR. This facet could be targeted in interventions to reduce MCR and, ultimately, dementia. %B Journal of Psychiatric Research %V 151 %P 73-77 %G eng %R 10.1016/j.jpsychires.2022.03.050 %0 Journal Article %J eClinicalMedicine %D 2022 %T Financial social protection and individual out-of-pocket costs of long-term care in the USA and Europe: An observational study %A Marco Angrisani %A José Carlos Ortega Regalado %A Tiago Cravo Oliveira Hashiguchi %K Cross-country analysis %K Long term care expenditure %K SHARE %K Social protection systems %X Background Empirical evidence informing policies aiming at ensuring affordability of long-term care (LTC) costs is limited. Combining system-level with individual-level data, we quantify the burden of out-of-pocket costs of LTC services on households in 13 European countries and the USA and explore how social protection systems impact affordability of care. Methods In this observational study, we use harmonised data from the Health and Retirement Study (HRS), collected between 2012 and 2016, and from the Survey of Health, Ageing and Retirement in Europe, collected between 2013 and 2017. We assess the severity of LTC needs of older adults (65+) on the basis of self-reported limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). We classify countries' social protection systems in terms of affordability and progressivity using information obtained from country officials. We examine variation in individual-level out-of-pocket LTC costs by social protection systems' affordability and progressivity. Findings Out-of-pocket LTC costs are heterogeneous across countries and increase with individuals' needs. In countries where LTC is more affordable and social protection systems less progressive, older adults incur significantly lower levels of LTC costs. Within Europe, not only are costs lower where systems are characterized by higher affordability and lower progressivity, but they also represent a lower share of households' disposable income. Interpretation Our findings indicate that the social protection systems significantly affect the level of out-of-pocket costs faced and reported by older adults with LTC needs as well as the share of their income that is devoted to pay for care. Funding We received funding from the National Institute on Aging (grant number R01 AG030153). The OECD programme of work on ageing and long-term care is partly funded by the European Union. %B eClinicalMedicine %V 50 %P 101503 %G eng %R 10.1016/j.eclinm.2022.101503 %0 Journal Article %J EClinicalMedicine %D 2022 %T Financial social protection and individual out-of-pocket costs of long-term care in the USA and Europe: An observational study. %A Angrisani, Marco %A Regalado, José Carlos Ortega %A Hashiguchi, Tiago Cravo Oliveira %K Cross-country analysis %K Long term care expenditure %K SHARE %K Social protection systems %X

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

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

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

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

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

%B EClinicalMedicine %V 50 %P 101503 %G eng %R 10.1016/j.eclinm.2022.101503 %0 Journal Article %J Preventive Medicine Reports %D 2022 %T Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans. %A Choi, Yeon Jin %A Eileen M. Crimmins %A Jennifer A Ailshire %K diet quality %K Food access %K Healthy Eating Index %K Obesity risk %K Social and environmental factors %X

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

%B Preventive Medicine Reports %V 29 %P 101912 %G eng %R 10.1016/j.pmedr.2022.101912 %0 Journal Article %J Annals of Surgery %D 2022 %T Functional and Cognitive Decline Among Older Adults After High-risk Surgery. %A Suwanabol, Pasithorn A %A Li, Yun %A Abrahamse, Paul %A De Roo, Ana C %A Vu, Joceline V %A Maria J Silveira %A Mody, Lona %A Dimick, Justin B %K Cognitive decline %K functional decline %K Surgery %X

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

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

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

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

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

%B Annals of Surgery %V 275 %P e132-e139 %G eng %N 1 %R 10.1097/SLA.0000000000003950 %0 Journal Article %J Lupus Science & Medicine %D 2022 %T GENETIC EVALUATION OF MOLECULAR TRAITS IN SYSTEMIC LUPUS ERYTHEMATOSUS %A Castellini-Perez, O. %A Iakovliev, A. %A Martinez-Bueno, M. %A Barturen, G. %A Alarcon-Riquelme, M. E. %A Carnero-Montoro, E. %A Spiliopoulou, A. %K Autoimmune Diseases %K lupus %K molecular traits %X Purpose Systemic Lupus Erythemathosus (SLE) is a prototypic systemic autoimmune disease characterized by a complex aetiology. Epigenetic alterations are known to be mediators of the environmental and genetic factors and to impact transcriptional programs. Here we aim to investigate genetic correlations between SLE and different molecular traits such as DNA methylation, gene expression and protein level by computing genotypic risk scores for the intermediate traits. Methods We use genotypes for 13,482 European ancestry individuals obtained from pre-existing projects studying SLE genetics, i) 4,174 SLE patients from a collection of SLE cohorts and 4,048 healthy controls from the University of Michigan Health and Retirement Study, ii) 696 SLE patients and 304 healthy controls from the International Consortium for Systemic Lupus Erythematosus Genetics and iii) 397 SLE patients and 561 healthy controls from the PRECISESADS Consortium. We computed genotypic risk scores for biomarkers using the GENOSCORES platform and tested the association between scores and the SLE phenotype using a logistic regression model for each score separately and adjusting for sex and 20 genetic principal components. Results We computed 1,716 locus-specific genotypic scores for loci affecting human plasma proteins (pQTLs). We detected 7 protein scores significantly associated with the SLE phenotype at Bonferroni correction. One of the 7 proteins, FCGR2B, is already known in SLE pathogenesis. Additionally, 4 protein scores were located within the HLA region in chromosome 6 (AMBN, ATF6, EDA, FIBCD1) and the remaining 2 (AXIN2, TREML4) scores were located in chromosome 14. Furthermore, we computed scores for the gene expression of these 7 proteins in different tissues and showed that scores for the gene expression of the AXIN2 gene were significantly associated with the SLE phenotype. Conclusions and Ongoing Analyses This study expands the list of candidate proteins associated with SLE and regions that might contain novel genes implicated in the SLE phenotype. Our findings demonstrate how genotypic scores for molecular traits can be used to identify and characterize genetic associations with complex disease traits. We aim to further explore the detected associations by considering DNA methylation traits and their association with SLE. %B Lupus Science & Medicine %V 9 %P A13-A14 %G eng %N Suppl 2 %R 10.1136/lupus-2022-elm2022.19 %0 Journal Article %J Innovation in Aging %D 2022 %T GENETIC RISK FOR ADHD ON LATER LIFE EMOTIONAL AND COGNITIVE HEALTH: TESTING MECHANISMS OF EFFECT %A Arpawong, Thalida Em %A Huh, Jimi %K ADHA %K Cognitive health %K Emotional Health %K genetic risk %X Attention Deficit Hyperactivity Disorder (ADHD) is associated with emotional regulation and cognitive processing challenges throughout life. Not well-understood is how ADHD genetic risk (ADHD-GR) affects depressive symptoms (DepSx) and cognitive functioning in older age. Furthermore, less is known about the mechanisms through which some individuals show better outcomes despite higher ADHD-GR. We evaluated potential mechanisms using the Health and Retirement Study with data from 7,871 European Americans (EAs) and 1,226 African Americans (AAs), ages 50-93, and ADHD-GR calculated from a mixed ancestry genomewide scan. Mediators included closeness of parental relationships during childhood, sense of purpose in life in adulthood, and educational attainment. Outcomes included validated scales for DepSx and cognitive functioning. Structural equation models were stratified by race/ethnicity due to potential differences in genetic effects, adjusted for age, gender, ancestry, and health conditions with DepSx and genetic risk for dementia with cognitive functioning. Among EAs, ADHD-GR significantly predicted lower sense of purpose (p<.05) and worse parental relationships (p<.001), with higher levels of both, in turn, predicting less DepSx (p's< 0.01). ADHD-GR also showed significant direct effects on DepSx (p<.01), controlling for mediators. Additionally, ADHD-GR predicted less education (p<.001), but more education predicted better cognitive functioning (p< 0.001). No relationships with ADHD-GR were significant among AAs. Findings imply that among EAs, mediators could be targets to mitigate negative effects on psychological and cognitive health, two hallmark challenges for individuals with ADHD. More work is needed to characterize ADHD-GR on outcomes among older AAs. %B Innovation in Aging %V 6 %P 431 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1691 %0 Journal Article %J Elife %D 2022 %T Genetic variation in ALDH4A1 is associated with muscle health over the lifespan and across species. %A Villa, Osvaldo %A Stuhr, Nicole L %A Yen, Chia-An %A Eileen M. Crimmins %A Arpawong, Thalida Em %A Curran, Sean P %K C. elegans %K evolutionary biology %K Genetics %K Genomics %X

The influence of genetic variation on the aging process, including the incidence and severity of age-related diseases, is complex. Here we define the evolutionarily conserved mitochondrial enzyme ALH-6/ALDH4A1 as a predictive biomarker for age-related changes in muscle health by combining genetics and a gene-wide association scanning (GeneWAS) from older human participants of the US Health and Retirement Study (HRS). In a screen for mutations that activate oxidative stress responses, specifically in the muscle of , we identified 96 independent genetic mutants harboring loss-of-function alleles of , exclusively. Each of these genetic mutations mapped to the ALH-6 polypeptide and led to the age-dependent loss of muscle health. Intriguingly, genetic variants in show associations with age-related muscle-related function in humans. Taken together, our work uncovers mitochondrial as a critical component to impact normal muscle aging across species and a predictive biomarker for muscle health over the lifespan.

%B Elife %V 11 %P e74308 %G eng %R 10.7554/eLife.74308 %0 Journal Article %J Elife %D 2022 %T Genetic variation in ALDH4A1 predicts muscle health over the lifespan and across species %A Villa, Osvaldo %A Stuhr, Nicole L. %A Yen, Chia-An %A Eileen M. Crimmins %A Thalida E. Arpawong %A Curran, Sean P. %K Genetic Variation %K muscle health %X Environmental stress can negatively impact organismal aging, however, the long-term impact of endogenously derived reactive oxygen species from normal cellular metabolism remains less clear. Here we define the evolutionarily conserved mitochondrial enzyme ALH-6/ALDH4A1 as a biomarker for age-related changes in muscle health by combining C. elegans genetics and a gene-wide association study (GeneWAS) from aged human participants of the US Health and Retirement Study (HRS)1–4. In a screen for mutations that activate SKN-1-dependent oxidative stress responses in the muscle of C. elegans5–7, we identified 96 independent genetic mutants harboring loss-of-function alleles of alh-6, exclusively. These genetic mutations map across the ALH-6 polypeptide, which lead to age-dependent loss of muscle health. Intriguingly, genetic variants in ALDH4A1 differentially impact age-related muscle function in humans. Taken together, our work uncovers mitochondrial alh-6/ALDH4A1 as a critical component of normal muscle aging across species and a predictive biomarker for muscle health over the lifespan.Competing Interest StatementThe authors have declared no competing interest. %B Elife %V 11 %G eng %N e74308 %R 10.7554/eLife.74308 %0 Journal Article %J Molecular Psychiatry %D 2022 %T Genome-wide meta-analyses reveal novel loci for verbal short-term memory and learning. %A Lahti, Jari %A Tuominen, Samuli %A Yang, Qiong %A Pergola, Giulio %A Ahmad, Shahzad %A Amin, Najaf %A Armstrong, Nicola J %A Beiser, Alexa %A Bey, Katharina %A Bis, Joshua C %A Boerwinkle, Eric %A Bressler, Jan %A Campbell, Archie %A Campbell, Harry %A Chen, Qiang %A Corley, Janie %A Cox, Simon R %A Davies, Gail %A De Jager, Philip L %A Derks, Eske M %A Jessica Faul %A Fitzpatrick, Annette L %A Fohner, Alison E %A Ford, Ian %A Fornage, Myriam %A Gerring, Zachary %A Grabe, Hans J %A Grodstein, Francine %A Gudnason, Vilmundur %A Simonsick, Eleanor %A Holliday, Elizabeth G %A Joshi, Peter K %A Kajantie, Eero %A Kaprio, Jaakko %A Karell, Pauliina %A Kleineidam, Luca %A Knol, Maria J %A Kochan, Nicole A %A Kwok, John B %A Leber, Markus %A Lam, Max %A Lee, Teresa %A Li, Shuo %A Loukola, Anu %A Luck, Tobias %A Marioni, Riccardo E %A Mather, Karen A %A Medland, Sarah %A Mirza, Saira S %A Nalls, Mike A %A Nho, Kwangsik %A O'Donnell, Adrienne %A Oldmeadow, Christopher %A Painter, Jodie %A Pattie, Alison %A Reppermund, Simone %A Risacher, Shannon L %A Rose, Richard J %A Sadashivaiah, Vijay %A Scholz, Markus %A Satizabal, Claudia L %A Schofield, Peter W %A Schraut, Katharina E %A Scott, Rodney J %A Simino, Jeannette %A Smith, Albert V %A Smith, Jennifer A %A Stott, David J %A Surakka, Ida %A Teumer, Alexander %A Thalamuthu, Anbupalam %A Trompet, Stella %A Turner, Stephen T %A van der Lee, Sven J %A Villringer, Arno %A Völker, Uwe %A Wilson, Robert S %A Wittfeld, Katharina %A Vuoksimaa, Eero %A Xia, Rui %A Yaffe, Kristine %A Yu, Lei %A Zare, Habil %A Zhao, Wei %A Ames, David %A Attia, John %A Bennett, David A %A Brodaty, Henry %A Chasman, Daniel I %A Goldman, Aaron L %A Hayward, Caroline %A Ikram, M Arfan %A Jukema, J Wouter %A Sharon L R Kardia %A Lencz, Todd %A Loeffler, Markus %A Mattay, Venkata S %A Palotie, Aarno %A Psaty, Bruce M %A Ramirez, Alfredo %A Ridker, Paul M %A Riedel-Heller, Steffi G %A Sachdev, Perminder S %A Saykin, Andrew J %A Scherer, Martin %A Schofield, Peter R %A Sidney, Stephen %A Starr, John M %A Trollor, Julian %A Ulrich, William %A Wagner, Michael %A David R Weir %A Wilson, James F %A Wright, Margaret J %A Weinberger, Daniel R %A Debette, Stéphanie %A Eriksson, Johan G %A Mosley, Thomas H %A Launer, Lenore J %A van Duijn, Cornelia M %A Deary, Ian J %A Seshadri, Sudha %A Räikkönen, Katri %K Genome %K health outcomes %K Memory %K neurocognitive outcomes %K polygenic score %K Verbal Learning %X

Understanding the genomic basis of memory processes may help in combating neurodegenerative disorders. Hence, we examined the associations of common genetic variants with verbal short-term memory and verbal learning in adults without dementia or stroke (N = 53,637). We identified novel loci in the intronic region of CDH18, and at 13q21 and 3p21.1, as well as an expected signal in the APOE/APOC1/TOMM40 region. These results replicated in an independent sample. Functional and bioinformatic analyses supported many of these loci and further implicated POC1. We showed that polygenic score for verbal learning associated with brain activation in right parieto-occipital region during working memory task. Finally, we showed genetic correlations of these memory traits with several neurocognitive and health outcomes. Our findings suggest a role of several genomic loci in verbal memory processes.

%B Molecular Psychiatry %G eng %R 10.1038/s41380-022-01710-8 %0 Journal Article %J Journal of Addiction Medicine %D 2022 %T Geriatric Conditions Among Middle-aged and Older Adults on Methadone Maintenance Treatment: A Pilot Study. %A Benjamin H Han %A Cotton, Brandi Parker %A Polydorou, Soteri %A Sherman, Scott E %A Rosie Ferris %A Arcila-Mesa, Mauricio %A Qian, Yingzhi %A McNeely, Jennifer %K Aged %K Analgesics, Opioid %K Female %K Humans %K Methadone %K Middle Aged %K Opiate Substitution Treatment %K Opioid-Related Disorders %K Pilot Projects %X

OBJECTIVES: The number of older adults on methadone maintenance treatment (MMT) for opioid use disorder is increasing, but little is known about the characteristics and healthcare needs of this aging treatment population. This population may experience accelerated aging due to comorbidities and health behaviors. The aim of this study was to compare the prevalence of geriatric conditions among adults age ≥50 on MMT to a nationally representative sample of community-dwelling older adults.

METHODS: We performed a geriatric assessment on 47 adults age ≥50 currently on MMT enrolled in 2 opioid treatment programs, in New York City and in East Providence, Rhode Island. We collected data on self-reported geriatric conditions, healthcare utilization, chronic medical conditions, physical function, and substance use. The results were compared to 470 age, sex, and race/ethnicity-matched adults in the national Health and Retirement Study.

RESULTS: The mean age of the study sample was 58.8 years and 23.4% were female. The most common chronic diseases were hypertension (59.6%) and arthritis (55.3%) with 66% reporting ≥2 diseases. For geriatric conditions, adults on MMT had a significantly higher prevalence of mobility, hearing, and visual impairments as well as falls, urinary incontinence, chronic pain, and insomnia than the Health and Retirement Study sample.

CONCLUSIONS: Older adults on MMT in 2 large opioid treatment programs have a high prevalence of geriatric conditions. An interdisciplinary, geriatric-based approach to care that focuses on function and addresses geriatric conditions is needed to improve the health of this growing population.

%B Journal of Addiction Medicine %V 16 %P 110-113 %G eng %N 1 %R 10.1097/ADM.0000000000000808 %0 Journal Article %J Research on Aging %D 2022 %T Grandparenting, Social Relations, and Mortality in Old Age. %A Heejung Jang %A Tang, Fengyan %A Fusco, Rachel A %A Engel, Rafael J %A Steven M. Albert %K Grandparenting %K Mortality %K Social networks %K Social Support %X

Guided by a convoy model of social relations, this study investigates the relationships between grandparenting status, social relations, and mortality among community-dwelling grandparents age 65 and older who are caring for their grandchildren. The data were drawn from the 2008 and 2016 waves of the Health and Retirement Study ( = 564). Latent class analysis was used to identify the social network structure based on six indicators of interpersonal relationships and activities. A series of hierarchical Weibull hazard models estimated the associations between grandparent caregiving, social relations, and mortality risk. Results of survival analyses indicate that co-parenting and custodial grandparents had higher all-cause mortality risk than grandparents who babysat occasionally; however, for custodial grandparents, the association was not significant once social relation variables were added to the model. This study suggests that community-based support may be beneficial to older grandparents and improved relationship quality is integral to the well-being of older adults.

%B Research on Aging %V 44 %P 265-275 %G eng %N 3-4 %R 10.1177/01640275211015433 %0 Journal Article %J OBM Geriatrics %D 2022 %T Happy and Satisfied in Very Late Life? Findings from the Health and Retirement Study %A Rotem Arieli %A Gina Lee %A Yeon Ji Ryou %A Peter Martin %K centenarian %K exceptional longevity %K Happiness %K Leave Behind Questionnaire %K Life Satisfaction %K Optimism %K Purpose in life %K Self-rated health %K Subjective well-being %X This research aims to examine cross-sectional and longitudinal associations of positive subjective well-being among centenarians and near-centenarians in the Health and Retirement Study. Participants who eventually survived to age 98 or older (N = 516) were included. Study variables included demographic characteristics, health and activities of daily living (ADL) functioning, cognitive functioning, and positive well-being. Additionally, a smaller subsample (n = 192) of participants with supplemental leave-behind questionnaire (LBQ) data, some of whom (n = 30) were assessed across three comparative time points, were included to examine psychological well-being variables over time. In the full sample, approximately 86% and 81% of participants over or near the age of 100 reported enjoying their lives and being happy, respectively. Also in the full sample, better self-rated health (SRH) was associated with greater happiness/enjoyment. Results with the LBQ subsample (n = 192) identified that a) greater life satisfaction related to better SRH, b) better cognitive functioning related to greater optimism and purpose in life, and c) more educated and non-White participants tended to have greater purpose in life. Finally, for the longitudinal subsample, life satisfaction increased significantly while purpose in life decreased significantly as participants neared age 100. Implications for this study include a greater focus on developing interventions geared toward improving psychological well-being; specifically, increasing purpose in life and optimism, as well as focusing on improving happiness and life enjoyment. %B OBM Geriatrics %V 6 %P 29 %G eng %N 4 %R 10.21926/obm.geriatr.2204211 %0 Web Page %D 2022 %T Has COVID Created a Retirement Confidence Conundrum? %A Nevin E. Adams %K COVID-19 %K Retirement %I National Association of Plan Advisors %G eng %U https://www.napa-net.org/news-info/daily-news/has-covid-created-retirement-confidence-conundrum %0 Report %D 2022 %T HOW MUCH DO RETIREES SPEND ON UNCERTAIN HEALTH COSTS? %A Arapakis, Karolos %K health cost %K Medicaid %K Medicare %K out-of-pocket costs %K Retirees %X The brief’s key findings are: One risk that retirees face is uncertain out-of-pocket health costs, over and above predictable insurance premiums. The analysis shows that total spending on retirees’ health care – including long-term care and excluding premiums – is high. But insurers like Medicare and Medicaid cover about 80 percent of the costs. As a result, 65-year-old households, on average, are estimated to pay $67,000 out-of-pocket over their remaining lifetime. %B Briefs %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/briefs/how-much-do-retirees-spend-on-uncertain-health-costs/ %0 Report %D 2022 %T How Redistributive Are Public Health Care Schemes? Evidence from Medicare and Medicaid in Old Age %A Arapakis, Karolos %A Eric French %A John Bailey Jones %A McCauley, Jeremy %K Medicaid %K Medicare %K public health care %K Social Security earnings records %X Most health care for the U.S. population 65 and older is publicly provided through Medicare and Medicaid. Despite the massive expenditures of these systems, little is known about how redistributive they are. Using data from the Health and Retirement Study matched to administrative Medicare, Medicaid, and Social Security earnings records, we estimate the distribution of lifetime Medicare and Medicaid benefits received and the distribution of lifetime taxes paid to finance these benefits. For the cohort who turned 65 between 1999 and 2004, we find that benefits are greater among those with high income, in large part because they live longer. Nonetheless, high-income people pay more in the way of taxes. Middle-income households gain the most from these programs as these people live long yet pay modest taxes. All income groups gain from these programs: This cohort’s lifetime tax contribution did not cover the medical benefits it received. This deficit is paid by younger cohorts. %B MRDRC Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/how-redistributive-are-public-health-care-schemes-evidence-from-medicare-and-medicaid-in-old-age/ %0 Journal Article %J Aging & Mental Health %D 2022 %T How widowhood status relates to engagement in advance care planning among older adults: does race/ethnicity matter? %A Shinae L Choi %A Su Hyun Shin %A Rebecca S Allen %K Advance care planning %K Advance directives %K Race/ethnicity %K Widowhood %X

OBJECTIVES: This study investigated whether and to what extent widowhood status is related to engagement in advance care planning (ACP), and further whether race/ethnicity moderated the relation.

METHODS: We analyzed a total of 11,257 older Americans from the Health and Retirement Study using random-effect regression models after controlling for covariates and year-fixed effects.

RESULTS: We found that both being a widow/widower ever and having been widowed for a longer period of time were associated with a higher probability of engagement in ACP. Specifically, we found that a one-year increase in the number of years since spousal death was associated with 1.02 ( < 0.05, 95% CI = 1.00, 1.03) changes in the odds ratios of informal ACP; however, inclusion of a quadratic term indicated that this association reversed after the peak. Moreover, our findings suggested a moderating effect of race/ethnicity on the relations of the length of time since spousal loss with engagement in ACP. Specifically, the odds of widowed non-Hispanic Blacks discussing with someone the care or medical treatment (informal ACP) and having a living will (formal ACP) were 0.96 ( < 0.05, 95% CI = 0.93, 1.00) and 0.88 ( < 0.05, 95% CI = 0.79, 0.97) times that of non-widowed non-Hispanic Whites. Compared with their non-Hispanic White counterparts, widowed non-Hispanic Blacks were less likely to engage in ACP, and the negative relations were exacerbated when they became widows/widowers.

CONCLUSION: We elaborated on these findings and discussed their implications for understanding the moderating effect of race/ethnicity on the relation between late-life widowhood and engagement in ACP. In order to develop programs that enhance engagement in ACP and reduce racial/ethnic disparities, research must incorporate intersectionality theory with attention to motivations and decision-making style among diverse widows/widowers. The findings from this study could help inform policy makers when developing public health programs and health care reimbursement programs that enhance engagement in ACP among widows/widowers.

%B Aging & Mental Health %V 26 %P 604-613 %G eng %N 3 %R 10.1080/13607863.2020.1867823 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Identifying Racial and Rural Disparities of Cognitive Functioning among Older Adults: The Role of Social Isolation and Social Technology Use. %A Byrne, Kaileigh A %A Ghaiumy Anaraky, Reza %K Cognition %K rurality %K Social Interaction %K Social networks %K Technology %X

OBJECTIVES: Social isolation is associated with poorer cognitive outcomes among older adults. The use of online social technology platforms may provide a means to reduce social isolation. However, research examining whether social technology can mitigate the negative effects of social isolation on cognitive functioning is limited. This study investigates the interaction between social isolation and social technology use on cognitive functioning among older adults and seeks to identify racial and rural-urban differences in this relationship.

METHOD: Data was obtained from the Health and Retirement Study 2014 to 2018 waves (N=5,358). Participants (aged 50-102) completed self-report measures of social isolation, loneliness, and frequency of online social communication and completed the modified Telephone Interview for Cognitive Status (TICS-m), which assesses cognitive functioning. Examinations of race focused on differences between Black/African American and White/Caucasian groups; rurality was operationalized using Beale Rural-Urban Continuum Codes. Data was analyzed using structural equation models.

RESULTS: Social technology use moderated the negative relationship between social isolation and cognitive functioning, controlling for age, education, gender, wealth, and general computer usage. Greater social technology use was associated with better cognitive functioning among socially isolated older adults. Results showed evidence of racial, but not rural-urban, differences in the relationship between social technology use and cognitive functioning. Regardless of degree of social isolation, frequent social technology use was associated with improved cognitive functioning in Black/African American older adults but not White/Caucasians older adults.

DISCUSSION: Social technology may represent a way to mitigate cognitive decline, particularly among Black/African American older adults.

%B The Journals of Gerontology, Series B %V 77 %P 1779-1790 %G eng %N 10 %R 10.1093/geronb/gbac055 %0 Journal Article %J Journal of Palliative Medicine %D 2022 %T Impact of Comorbid Dementia on Patterns of Hospice Use. %A Aldridge, Melissa D %A Hunt, Lauren %A Husain, Mohammed %A Li, Lihua %A Amy Kelley %K Comorbidity %K Dementia %K end of life %K Health Services Research %K Hospice %X

The evidence base for understanding hospice use among persons with dementia is almost exclusively based on individuals with a primary terminal diagnosis of dementia. Little is known about whether comorbid dementia influences hospice use patterns. To estimate the prevalence of comorbid dementia among hospice enrollees and its association with hospice use patterns. Pooled cross-sectional analysis of the nationally representative Health and Retirement Study (HRS) linked to Medicare claims. Fee-for-service Medicare beneficiaries in the United States who enrolled with hospice and died between 2004 and 2016. Dementia was assessed using a validated survey-based algorithm. Hospice use patterns were enrollment less than or equal to three days, enrollment greater than six months, hospice disenrollment, and hospice disenrollment after six months. Of 3123 decedents, 465 (14.9%) had a primary hospice diagnosis of dementia and 943 (30.2%) had comorbid dementia and died of another illness. In fully adjusted models, comorbid dementia was associated with increased odds of hospice enrollment greater than six months (adjusted odds ratio [AOR] = 1.52, 95% confidence interval [CI]: 1.11-2.09) and hospice disenrollment following six months of hospice (AOR = 2.55, 95% CI: 1.43-4.553). Having a primary diagnosis of dementia was associated with increased odds of hospice enrollment greater than six months (AOR = 2.62, 95% CI: 1.86-3.68), hospice disenrollment (AOR = 1.82, 95% CI: 1.32-2.51), and hospice disenrollment following six months of hospice (AOR = 4.31, 95% CI: 2.37-7.82). Approximately 45% of the hospice population has primary or comorbid dementia and are at increased risk for long hospice enrollment periods and hospice disenrollment. Consideration of the high prevalence of comorbid dementia should be inherent in hospice staff training, quality metrics, and Medicare Hospice Benefit policies.

%B Journal of Palliative Medicine %V 25 %P 396-404 %G eng %N 3 %R 10.1089/jpm.2021.0055 %0 Journal Article %J BMC Health Services Research %D 2022 %T The importance of chronic conditions for potentially avoidable hospitalizations among non-Hispanic Black and non-Hispanic White older adults in the US: a cross-sectional observational study. %A Jørgensen, Terese Sara Høj %A Allore, Heather %A Elman, Miriam R %A Nagel, Corey %A Quiñones, Ana R %K Aged %K Asthma %K chronic %K Chronic Obstructive %K Heart Failure %K Hospitalization %K Humans %K Medicare %K Pulmonary Disease %K Renal Insufficiency %X

BACKGROUND: Non-Hispanic (NH) Black older adults experience substantially higher rates of potentially avoidable hospitalization compared to NH White older adults. This study explores the top three chronic conditions preceding hospitalization and potentially avoidable hospitalization among NH White and NH Black Medicare beneficiaries in the United States.

METHODS: Data on 4993 individuals (4,420 NH White and 573 NH Black individuals) aged ≥ 65 years from 2014 Medicare claims were linked with sociodemographic data from previous rounds of the Health and Retirement Study. Conditional inference random forests were used to rank the importance of chronic conditions in predicting hospitalization and potentially avoidable hospitalization separately for NH White and NH Black beneficiaries. Multivariable logistic regression with the top three chronic diseases for each outcome adjusted for sociodemographic characteristics were conducted to quantify the associations.

RESULTS: In total, 22.1% of NH White and 24.9% of NH Black beneficiaries had at least one hospitalization during 2014. Among those with hospitalization, 21.3% of NH White and 29.6% of NH Black beneficiaries experienced at least one potentially avoidable hospitalization. For hospitalizations, chronic kidney disease, heart failure, and atrial fibrillation were the top three contributors among NH White beneficiaries and acute myocardial infarction, chronic obstructive pulmonary disease (COPD), and chronic kidney disease were the top three contributors among NH Black beneficiaries. These chronic conditions were associated with increased odds of hospitalization for both groups. For potentially avoidable hospitalizations, asthma, COPD, and heart failure were the top three contributors among NH White beneficiaries and fibromyalgia/chronic pain/fatigue, COPD, and asthma were the top three contributors among NH Black beneficiaries. COPD and heart failure were associated with increased odds of potentially avoidable hospitalization among NH White beneficiaries, whereas only COPD was associated with increased odds of potentially avoidable hospitalizations among NH Black beneficiaries.

CONCLUSION: Having at least one hospitalization and at least one potentially avoidable hospitalization was more prevalent among NH Black than NH White Medicare beneficiaries. This suggests greater opportunity for increasing prevention efforts among NH Black beneficiaries. The importance of COPD for potentially avoidable hospitalizations further highlights the need to focus on prevention of exacerbations for patients with COPD, possibly through greater access to primary care and continuity of care.

%B BMC Health Services Research %V 22 %P 468 %G eng %N 1 %R 10.1186/s12913-022-07849-y %0 Journal Article %J Personality and Individual Differences %D 2022 %T Individual differences in personality and positive emotion for wealth creation %A Sarah D. Asebedo %A Taufiq Hasan Quadria %A Ying Chen %A Esteban Montenegro-Montenegro %K Big Five personality traits %K Broaden-and-build theory of positive emotions %K net wealth %K random intercept cross-lagged panel model %X This study identified evidence of a bidirectional causal relationship between positive emotions and net wealth using a random intercept cross-lagged panel model with three time points (2008, 2012, and 2016) within a sample of 10,898 Americans over age 50 from the Health and Retirement Study. The Great Recession might have contributed to net wealth's effect on positive emotions during this study. The results also suggest that positive emotions shape net wealth, providing evidence favoring the broaden-and-build theory of positive emotions and the potential effectiveness of positive psychological interventions for personal finance behaviors. Furthermore, a cross-level interaction of all Big-five personality traits with positive emotion and net wealth showed large cross-lag effects when positive emotion is a predictor of net wealth. Likewise, the interaction of positive emotion by the Big Five traits was a predictor of net wealth, indicating the need for further examination of the moderated effect of positive emotion in the context of personality traits and net wealth. %B Personality and Individual Differences %V 199 %P 111854 %G eng %R https://doi.org/10.1016/j.paid.2022.111854 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T The inequitable burden of the COVID-19 pandemic among marginalized older workers in the United States: an intersectional approach. %A Andrea, Sarah B %A Eisenberg-Guyot, Jerzy %A Blaikie, Kieran J %A Owens, Shanise %A Oddo, Vanessa M %A Peckham, Trevor %A Minh, Anita %A Hajat, Anjum %K COVID-19 %K Employment %K Inequities %K Intersectionality %X

OBJECTIVES: The COVID-19 pandemic has profoundly affected the lives of people globally, widening longstanding inequities. We examined the COVID-19 pandemic's impact on employment conditions by race/ethnicity, gender, and educational attainment and the association between such conditions and well-being in older adults in the United States.

METHODS: Using data from the Health and Retirement Study respondents interviewed between May 2020 and May 2021 when they were ≥55 years of age, we examined intersectional patterns in COVID-19-related changes in employment conditions among 4,107 participants working for pay at the start of the pandemic. We also examined the compounding nature of changes in employment conditions and their association with financial hardship, food insecurity, and poor self-rated health.

RESULTS: Relative to non-Hispanic White men with greater than high school education (>HS), Black and Latinx men and women were more likely to experience job loss irrespective of education; among those who did not experience job loss, men with ≤HS reporting Black, Latinx, or "other" race were >90% less likely to transition to remote work. Participants who experienced job loss with decreased income or continued in-person employment with decreased income/shift changes had greater prevalence of financial hardship, food insecurity, and poor/fair self-rated health than others.

DISCUSSION: The impact of COVID-19 on employment conditions is inequitably patterned and is associated with financial hardship, food insecurity, and adverse health in older adults. Policies to improve employment quality and expand social insurance programs among this group are needed to reduce growing inequities in well-being later in life.

%B The Journals of Gerontology, Series B %V 77 %P 1928-1937 %G eng %N 10 %R 10.1093/geronb/gbac095 %0 Journal Article %J Clinical Nursing Research %D 2022 %T The Influence of the Val66Met Variant on the Association Between Physical Activity/Grip Strength and Depressive Symptoms in Persons With Diabetes. %A Zeng, Bin %A Yue, Yan %A Liu, Tingting %A Ahn, Hyochol %A Li, Changwei %K Brain-Derived Neurotrophic Factor %K Depressive symptoms %K Diabetes %K Grip strength %K Physical activity %X

The rs6265 in the (BDNF) is associated with depression in people with diabetes. Both physical activity (PA) and grip strength are negatively associated with depression. We conducted cross-sectional analyses of the wave 10 survey data for a nationally representative sample of 1,051 diabetes participants of the Health and Retirement Study. Both greater PA (β = -.15) and stronger grip strength (β = -.02) were independently associated with depression. Although the interaction between rs6265 and PA on depressive symptoms was not significant, the negative PA-depression association was stronger among female non-Met carriers (β = -.19) and male Met carriers (β = -.14). Meanwhile, grip strength was associated with depression only in Met carriers (β = -.04), and similar association was observed in both males and females. In conclusion, female non-Met carriers and male Met carriers may benefit from PA, and Met carriers may benefit from grip strength to relieve depression.

%B Clinical Nursing Research %G eng %R 10.1177/10547738221119343 %0 Journal Article %J Advances in Life Course Research %D 2022 %T Internet use and cohort change in social connectedness among older adults %A Shannon Ang %K Cohort change %K Internet use %K Social connectedness %X Social connections are an integral part of living in society, and trends in social connectedness are thus closely scrutinized. The phenomenon of networked individualism argues that densely knit communities organized around formal social groups such as households and workplaces are becoming less common. Due to advances in technology, individuals are able to develop personalized communities that are more diverse and less geographically-bound. The objective of this study was to determine how both average levels and the variability of social connectedness have changed across cohorts, and how much of this is due to increased internet use. Data from 2006, 2008, 2016, and 2018 waves of the Health and Retirement Study were used to investigate cohort changes in various indicators of social connectedness. The analytical sample consisted of older adults aged 58–69 from the Silent Generation (born 1920–1947) and Baby Boomers (born 1948–1965). Heteroscedastic regression models and decomposition methods were used to investigate the role of increased internet use in driving some of these changes. Findings suggest that increases in internet use was associated with increases in the variance of social participation (i.e., contact with friends and family) in the United States. However, evidence around more subjective measures of social connectedness (i.e., social support, loneliness) was less clear. Future research should seek to understand how cohort change in technological use may affect objective and subjective aspects of social connectedness in different ways. %B Advances in Life Course Research %V 54 %P 100514 %G eng %R https://doi.org/10.1016/j.alcr.2022.100514 %0 Journal Article %J Genes %D 2022 %T The Interplay of Epigenetic, Genetic, and Traditional Risk Factors on Blood Pressure: Findings from the Health and Retirement Study. %A Zhang, Xinman %A Ammous, Farah %A Lin, Lisha %A Ratliff, Scott M %A Ware, Erin B %A Jessica Faul %A Zhao, Wei %A Sharon L R Kardia %A Smith, Jennifer A %K Blood pressure %K DNA Methylation %K genetic risk score %K Genetics %K interaction %K methylation risk score. %X

The epigenome likely interacts with traditional and genetic risk factors to influence blood pressure. We evaluated whether 13 previously reported DNA methylation sites (CpGs) are associated with systolic (SBP) or diastolic (DBP) blood pressure, both individually and aggregated into methylation risk scores (MRS), in 3070 participants (including 437 African ancestry (AA) and 2021 European ancestry (EA), mean age = 70.5 years) from the Health and Retirement Study. Nine CpGs were at least nominally associated with SBP and/or DBP after adjusting for traditional hypertension risk factors ( < 0.05). MRS was positively associated with SBP in the full sample (β = 1.7 mmHg per 1 standard deviation in MRS; = 2.7 × 10) and in EA (β = 1.6; = 0.001), and MRS with DBP in the full sample (β = 1.1; = 1.8 × 10), EA (β = 1.1; = 7.2 × 10), and AA (β = 1.4; = 0.03). The MRS and BP-genetic risk scores were independently associated with blood pressure in EA. The effects of both MRSs were weaker with increased age ( < 0.01), and the effect of MRS was higher among individuals with at least some college education ( = 0.02). In AA, increasing MRS was associated with higher SBP in females only ( = 0.01). Our work shows that MRS is a potential biomarker of blood pressure that may be modified by traditional hypertension risk factors.

%B Genes %V 13 %P 1959 %G eng %N 11 %R 10.3390/genes13111959 %0 Journal Article %J Innovation in Aging %D 2022 %T INTRODUCING THE CENTENARIANS IN THE HEALTH AND RETIREMENT STUDY %A Martin, Peter %A Lee, Gina %A Arieli, Rotem %A Ryou, Yeon Ji %X The Health and Retirement Study (HRS) is a nationally representative sample of older adults, and data are available for 15 waves. This presentation presents an overview of the oldest cohort of the HRS (the AHEAD sample) as they become centenarians. Basic characteristics of these centenarians and near centenarians (98 years and older, N = 516) indicate that they are primarily female (77 percent), White (82 percent) with on average 10.6 years of education. The average age was 84.2 years at baseline and 98.3 years at wave 14. We analyze data by comparing centenarian survivors to nonsurvivors, by following them longitudinally, and by comparing different cohorts of centenarians over historical time. Results indicate that centenarians continue to enjoy life, and they have special survivorship characteristics. Newer cohorts, however, show a more compromised quality of life. The results are relevant to family members of oldest-old adults and to community service providers. %B Innovation in Aging %V 6 %P 304-304 %G eng %R 10.1093/geroni/igac059.1203 %0 Conference Paper %B APHA 2022 Annual Meeting and Expo %D 2022 %T Joint association of physical activity and BMI with functional limitations among older adults in US %A Alqurashi, Sultain %A Alotaibi, Abrar %A Alasiri, Ghadi %A Alaboundi, Shatha %A Amal Al Qays %A Alahmadi, Raghad %A Alenazi, Walaa %A Patippe, Cindy %A Alanazi, Hissah %A Alfahmi, Mona %A Shi, Qiuhu %A Kim, Hae-Young %K ADL %K BMI %K Physical activity %X Introduction and Objectives: Loss of the ability to perform basic functional tasks such as activities of daily living (ADLs) increases with age. This study aimed to examine the joint association of physical activity and body mass index (BMI) with functional limitations among US older adults. Methods: This study used the longitudinal data from the Health and Retirement Study (2004–2018 waves), a nationally representative sample of US adults. The analysis included adults aged 60 years or older, with at least 2 follow-up assessments. The main outcome measures were physical functioning summary score and the combined activities of daily living - instrumental activities of daily living (ADL-IADL) index. The associations of the physical activity and BMI with the functional limitations were estimated using generalized estimating equations (GEE) models with negative binomial distribution. Results: Thirteen thousand nine hundred fifty-one participants contributed 77,016 observations, with mean (SD) follow-up of 9.0 (4.2) years. Participants had a mean (SD) age of 70.9 (8.0) years at baseline, 56.6% were women, 74.3% were non-Hispanic white, and 15.1% were non-Hispanic black. In covariate-adjusted model, compared to normal weight with physically inactive, the expected number of physical functioning limitations were lower among normal weight with active (IRR=0.73, 95% CI: 0.72-0.75), overweight with active (IRR=0.79, 95% CI: 0.78-0.81), and obese with active (IRR=0.95, 95% CI: 0.93-0.98). In covariate-adjusted model, compared to normal weight with physically inactive, the expected number of limitations on ADL-IADL were lower among normal weight with active (IRR=0.39, 95% CI: 0.37-0.41), overweight with active (IRR=0.39, 95% CI: 0.36-0.41), and obese with active (IRR=0.54, 95% CI: 0.50-0.58). Discussion: Engagement in moderate/vigorous activities at least once per week is associated with lower numbers of functional limitations, regardless of weight. Physical activity is likely to be beneficial for functional activities among older adults. %B APHA 2022 Annual Meeting and Expo %I APHA %G eng %U https://apha.confex.com/apha/2022/meetingapi.cgi/Session/66401?filename=2022_Session66401.pdf&template=Word %0 Journal Article %J American Journal of Preventive Medicine %D 2022 %T Lifecourse Traumatic Events and Cognitive Aging in the Health and Retirement Study. %A Stebbins, Rebecca C %A Maselko, Joanna %A Yang, Y Claire %A Plassman, Brenda L %A Edwards, Jessie K %A Aiello, Allison E %K Cognition %K lifecourse %K traumatic events %X

INTRODUCTION: Much of the heterogeneity in the rate of cognitive decline and the age of dementia onset remains unexplained, and there is compelling data supporting psychosocial stressors as important risk factors. However, the literature has yet to come to a consensus on whether there is a causal relationship and, if there is, its direction and strength. This study estimates the relationship between lifecourse traumatic events and cognitive trajectories and predicted dementia incidence.

METHODS: Using data on 7,785 participants aged ≥65 years from the Health and Retirement Study, this study estimated the association between lifecourse experience of 10 traumatic events (e.g., losing a child) and trajectories of Telephone Interview for Cognitive Status from 2006 to 2016 using linear mixed-effects models and predicted incident dementia from 2006 to 2014 using cumulative incidence functions (data analysis was in 2020-2022). Inverse probability weights accounted for loss to follow-up and confounding by sex, education, race/ethnicity, and age.

RESULTS: Experiencing 1 or more traumatic events over the lifecourse was associated with accelerated decline compared with experiencing no events (e.g., β= -0.05 [95% CI= -0.07, -0.02] Health and Retirement Study-Telephone Interview for Cognitive Status units/year; 1 vs 0 events). In contrast, experiencing traumatic events was associated with better cognitive function cross-sectionally. Furthermore, the impact of trauma on cognitive decline was of greater magnitude when it occurred after the age of 64 years. However, the magnitude and direction of association varied by the specific traumatic event. There were no associations with predicted incident dementia.

CONCLUSIONS: These results suggest that researchers and clinicians should not aggregate traumatic events for understanding the risk of accelerated cognitive decline.

%B American Journal of Preventive Medicine %V 63 %P 818-826 %G eng %N 5 %R 10.1016/j.amepre.2022.05.007 %0 Report %D 2022 %T Limited Cognitive Ability May Reduce SNAP Participation among Older Adults %A Heflin, Colleen %A Zuo, Dongmei %A Alphonso, Gabriella %K cognitive function %K SNAP program %B Research Brief %I Center for Aging and Policy Studies, Syracuse University %C Syracuse, NY %G eng %U https://surface.syr.edu/cgi/viewcontent.cgi?article=1196&context=lerner %0 Journal Article %J Sleep %D 2022 %T Longitudinal associations between insomnia symptoms and all-cause mortality among middle-aged and older adults: A population-based cohort study. %A Mahmood, Asos %A Ray, Meredith %A Kenneth D. Ward %A Dobalian, Aram %A Ahn, Sang Nam %K all-cause mortality %K insomnia symptoms %K Marginal Structural Modeling %K middle-aged %K risk factor %K Sleep disturbance %X

To date, there is no scientific consensus on whether insomnia symptoms increase mortality risk. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and non-restorative sleep) and all-cause mortality among middle-aged and older adults during 14 years of follow-up. Data were obtained from 2004 through 2018 survey waves of the Health and Retirement Study in the United States for a population-representative sample of 15,511 respondents who were ≥50 years old in 2004. Respondents were interviewed biennially and followed through the end of the 2018 survey wave for the outcome. Marginal structural discrete-time survival analyses were employed to account for time-varying confounding and selection bias. Of the 15,511 cohort respondents (mean [±SD] age at baseline, 63.7 [±10.2] years; 56.0% females), 5,878 (31.9%) died during follow-up. At baseline (2004), 41.6% reported experiencing at least one insomnia symptom. Respondents who experienced one (HR=1.11; 95% CI: 1.03-1.20), two (HR=1.12; 95% CI: 1.01-1.23), three (HR=1.15; 95% CI: 1.05-1.27), or four (HR=1.32; 95% CI: 1.12-1.56) insomnia symptoms had on average a higher hazard of all-cause mortality, compared to those who were symptom-free. For each insomnia symptom, respondents who experienced difficulty initiating sleep (HR=1.12; 95% CI: 1.02-1.22), early-morning awakening (HR=1.09; 95% CI: 1.01-1.18), and nonrestorative sleep (HR=1.17; 95% CI: 1.09-1.26), had a higher hazard of all-cause mortality compared to those not experiencing the symptom. The findings demonstrate significant associations between insomnia symptoms and all-cause mortality, both on a cumulative scale and independently, except for difficulty maintaining sleep. Further research should investigate the underlying mechanisms linking insomnia symptoms and mortality.

%B Sleep %V 45 %P zsac019 %G eng %N 6 %R 10.1093/sleep/zsac019 %0 Journal Article %J Health Services Research %D 2022 %T Longitudinal associations between time-varying insomnia symptoms and all-cause health care services utilization among middle-aged and older adults in the United States. %A Mahmood, Asos %A Kedia, Satish %A Dobalian, Aram %A Chang, Cyril F %A Ahn, SangNam %K health care services utilization %K home health care services %K Hospitalization %K insomnia symptoms %K nursing home stay %X

OBJECTIVE: To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults.

DATA SOURCES: The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States.

STUDY DESIGN: This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals.

DATA COLLECTION/EXTRACTION METHODS: We extracted longitudinal data from 2002 through 2018 waves of the HRS.

PRINCIPAL FINDINGS: Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms.

CONCLUSIONS: The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.

%B Health Services Research %G eng %R 10.1111/1475-6773.13971 %0 Journal Article %J Aging & Mental Health %D 2022 %T A longitudinal study shows stress proliferation effects from early childhood adversity and recent stress on risk for depressive symptoms among older adults. %A Thalida E. Arpawong %A Mekli, Krisztina %A Lee, Jinkook %A Drystan F. Phillips %A Margaret Gatz %A Carol A Prescott %K adverse child events %K depression %K Mental Health %K stress generation %K Trauma %X

We evaluated whether the effects of recent stressful life events (SLEs) and early childhood adversities (ECAs) on depressive symptoms are consistent between men and women and across older age, and whether there was evidence for the following: stress sensitization, whereby the psychological impact of SLEs is greater for individuals with ECAs compared with those without; or stress proliferation effect, whereby those with ECAs are more likely to report more SLEs than those without ECAs to effect depressive symptoms. ECAs, SLEs in the past two years, and current depressive symptoms through a modified CES-D were obtained from 11,873 individuals participating in a population representative study of older adults, yielding 82,764 observations. Mixed-effects regression models on depressive symptoms were constructed to control for multiple observations per participant and evaluate within-person effects over time, thereby reducing bias from reverse causation. Results suggest a stress proliferation effect and do not support stress sensitization. ECAs contribute to vulnerability for depressive symptoms, with a dosage effect for each additional ECA. Recent SLEs result in greater depressive symptom risk, with stable effects over age and dosage effects for each additional SLE that were smaller than the effects of ECAs among men, but not women. Belonging to an ethnic minority group, having less education, and less household income at baseline were associated with greater depressive symptom risk. Findings suggest the importance of addressing early childhood adversity and sociodemographic factors, among at-risk older adults to mitigate life-course stress proliferative processes and thereby reduce disparate risk for depression in older age.

%B Aging & Mental Health %V 26 %P 870-880 %G eng %N 4 %R 10.1080/13607863.2021.1904379 %0 Journal Article %J Journal of Pain and Symptom Management %D 2022 %T Medicare Coverage at the End of Life: Separate and Unequal? %A Claire Ankuda %K end of life %K Medicare %K out-of-pocket costs %X Outcomes 1. Contrast the pros and cons of different Medicare insurance types, from a patient perspective 2. Understand and describe out-of-pocket costs across Medicare Original Research Background Medicare coverage varies across beneficiaries, with some opting into Medicare Advantage (MA) versus traditional Medicare (TM); some are enrolled in supplementary insurance, and some are dually enrolled in Medicaid. It is unknown how variation affects those at the end of life and their families, Research Objectives We aim to characterize types of Medicare coverage at the end of life and assess how coverage type affects out-of-pocket spending in the last year of life. Methods We used the Health and Retirement Study, a nationally representative cohort study, to identify decedents between 1998 and 2016 with linked Medicare claims. Medicare insurance types were defined as TM alone, TM with supplementary insurance, MA, and dual eligible. We examined the sociodemographic and health characteristics of decedents across insurance groups and the reported out-of-pocket expenditures for hospitalizations in the last year of life. Results We identified 7,910 decedents, 8.5% who were enrolled in TM alone, 43.9% in TM with supplementary insurance, 27.2% in MA, and 20.5% duals. Although rates of MA grew over time, rates of TM with supplementary insurance fell. Compared to those with supplementary insurance or in MA, those in TM alone were younger, more likely to be male, in the lowest quartile of wealth, without a high school education, non-Hispanic Black, or Hispanic/Latino. Preliminary investigation of out-of-pocket costs showed that among those hospitalized in the last year of life, 31.4% of those with TM alone spent more than $2,000 out of pocket, compared to 14.9% in MA and 11.5% with supplementary insurance. Conclusion Across those enrolled in Medicare at the end of life but without Medicaid, those in TM alone are more likely to be from racial and ethnic minority groups and with lower education and wealth and yet face higher out-of-pocket spending. Implications for Research, Policy, or Practice Differences within Medicare create differential cost burdens at the end of life that may increase disparities for patients and their families. %B Journal of Pain and Symptom Management %V 63 %P 866 %G eng %N 5 %R https://doi.org/10.1016/j.jpainsymman.2022.02.055 %0 Journal Article %J Journal of Multimorbidity and Comorbidity %D 2022 %T Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults. %A Quiñones, Ana R %A Nagel, Corey L %A Botoseneanu, Anda %A Newsom, Jason T %A Dorr, David A %A Kaye, Jeffrey %A Thielke, Stephen M %A Allore, Heather G %K Cognition %K depression %K joint trajectories %K multimorbidity %X

BACKGROUND: Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology.

METHODS: We analyzed 16 years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (≥65 years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains.

RESULTS: We identified four distinct multidimensional trajectory groups: (1) (32.7% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) (32.9%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) (19.9%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) (14.1%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two classes.

CONCLUSIONS: There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.

%B Journal of Multimorbidity and Comorbidity %V 12 %P 26335565221143012 %G eng %R 10.1177/26335565221143012 %0 Journal Article %J The Journals of Gerontology: Series B %D 2022 %T Multifaceted Demands of Work and Their Associations with Cognitive Functioning: Findings From the Health and Retirement Study. %A Lee, Yeonjung Jane %A Gonzales, Ernest %A Andel, Ross %K Cognition %K Employment %K Older workers %X

OBJECTIVES: The present study examines the associations among mental, social, and physical demands of work with cognitive functioning among older adults in the United States.

METHODS: Data from 3,176 respondents in the Health and Retirement Study were analyzed using growth curve modeling (2004-2014). The study investigated differences by gender, race, ethnicity, and education.

RESULTS: Higher mental and social demands of work were associated with higher levels of initial cognitive functioning, but not significantly associated with slower cognitive decline over time. Physical demands of work were negatively associated with initial cognitive functioning and also marginally associated with a slower rate of decline in cognitive functioning going into older adulthood. In stratified analyses, results varied by sociodemographic characteristics.

DISCUSSION: The results partially support the environmental complexity hypothesis and the productive aging framework in that higher mental and social demands and lower physical demands relate to better cognitive functioning at baseline, with the differences appearing stable throughout older adulthood. The stratified results shed light on addressing disparities in cognitive aging and work environments.

%B The Journals of Gerontology: Series B %V 77 %P 351-361 %G eng %N 2 %R 10.1093/geronb/gbab087 %0 Journal Article %J The Journals of Gerontology: Series A %D 2022 %T Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race/Ethnicity and Body Mass Index. %A Anda Botoseneanu %A Markwardt, Sheila %A Corey L Nagel %A Allore, Heather G %A Jason T Newsom %A David A Dorr %A Ana R Quiñones %K Body Mass Index %K Disease accumulation %K multimorbidity %K Race/ethnicity %X

BACKGROUND: Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups.

METHOD: We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (≥2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases.

RESULTS: Overweight and obesity were more prevalent in non-Hispanic Black (82.3%) and Hispanic (78.9%) than non-Hispanic White (70.9 %) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants.

CONCLUSIONS: Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight.

%B The Journals of Gerontology: Series A %V 77 %P e89-e97 %G eng %N 2 %R 10.1093/gerona/glab116 %0 Journal Article %J BMC Geriatrics %D 2022 %T Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study. %A Aubert, Carole E %A Kabeto, Mohammed %A Kumar, Navasuja %A Wei, Melissa Y %K Activities of Daily Living %K Hand Strength %K multimorbidity %K Retirement %K walking speed %X

BACKGROUND: Multimorbidity is highly prevalent and associated with several adverse health outcomes, including functional limitations. While maintaining physical functioning is relevant for all adults, identifying those with multimorbidity at risk for faster rates of physical functioning decline may help to target interventions to delay the onset and progression of disability. We quantified the association of multimorbidity with rates of long-term disability and objective physical functioning decline.

METHODS: In the Health and Retirement Study, we computed the Multimorbidity-Weighted Index (MWI) by assigning previously validated weights (based on physical functioning) to each chronic condition. We used an adjusted negative binomial regression to assess the association of MWI with disability (measured by basic and instrumental activities of daily living [ADLs, IADLs]) over 16 years, and linear mixed effects models to assess the association of MWI with gait speed and grip strength over 8 years.

RESULTS: Among 16,616 participants (mean age 67.3, SD 9.7 years; 57.8% women), each additional MWI point was associated with a 10% increase in incidence rate of disability (IRR: 1.10; 95%CI: 1.09, 1.10). In 2,748 participants with data on gait speed and grip strength, each additional MWI point was associated with a decline in gait speed of 0.004 m/s (95%CI: -0.006, -0.001). The association with grip strength was not statistically significant (-0.01 kg, 95%CI: -0.73, 0.04). The rate of decline increased with time for all outcomes, with a significant interaction between time and MWI for disability progression only.

CONCLUSION: Multimorbidity, as weighted on physical functioning, was associated with long-term disability, including faster rates of disability progression, and decline in gait speed. Given the importance of maintaining physical functioning and preserving functional independence, MWI is a readily available tool that can help identify adults to target early on for interventions.

%B BMC Geriatrics %V 22 %P 910 %G eng %N 1 %R 10.1186/s12877-022-03548-9 %0 Journal Article %J Innovation in Aging %D 2022 %T Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014) %A Quiñones, Ana R %A Markwardt, Sheila %A Allore, Heather %A Newsom, Jason %A Nagel, Corey %A Dorr, David %A Botoseneanu, Anda %K Medicare Beneficiaries %K multimorbidity progression %X Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1% in youngest age category [67-69] vs. 50.3% for incident and 66.7% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6% CIND/dementia vs. 15.4% for incident and 16.8% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4%) than in the incident (11.8%) and no multimorbidity groups (13.4%). Non-Hispanic White beneficiaries were more represented in the incident (83.5%) than the prevalent (77.2%) and the no multimorbidity (77.7%). Hispanic beneficiaries were more represented in the no (8.9%) than the prevalent (7.4%) and incident multimorbidity groups (4.7%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status. %B Innovation in Aging %V 5 %P 614 %G eng %N Suppl 1 %R 10.1093/geroni/igab046.2347 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T A New Path to Address Multimorbidity? Longitudinal Analyses of Retirement Sequences and Chronic Diseases in Old Age. %A Calvo, Esteban %A Azar, Ariel %A Shura, Robin %A Ursula M. Staudinger %K career %K labor force %K noncommunicable disease %K trajectory %K Work %X

Chronic disease and multimorbidity are growing health challenges for aging populations, often coinciding with retirement. We examine late-life predictors of multimorbidity, focusing on the association between retirement sequences and number of chronic diseases. We modeled the number of chronic diseases as a function of six types of previously identified 10-year retirement sequences using Health and Retirement Study (HRS) data for 7,880 Americans observed between ages 60 to 61 and 70 to 71. Our results show that at baseline, the adjusted prevalence of multimorbidity was lowest in sequences characterized by late retirement from full-time work and highest in sequences characterized by early labor-force disengagement. Age increases in multimorbidity varied across retirement sequences, though overall differences in prevalence persisted at age 70 to 71. Earlier life disadvantages did not moderate these associations. Findings suggest further investigation of policies that target health limitations affecting work, promote continued beneficial employment opportunities, and ultimately leverage retirement sequences as a novel path to influence multimorbidity in old age.

%B Journal of Applied Gerontology %V 41 %P 952-961 %G eng %N 4 %R 10.1177/07334648211031038 %0 Journal Article %J Religions %D 2022 %T Older Adults with Dementia: Association of Prayer with Neuropsychiatric Symptoms, Cognitive Function, and Sleep Disturbances %A Britt, Katherine Carroll %A Richards, Kathy C. %A Acton, Gayle %A Hamilton, Jill %A Radhakrishnan, Kavita %K Alzheimer’s %K coping %K illness %K Religion %K Spirituality %K supplication %X Protective factors that slow dementia progression and improve quality of life are needed. Neuropsychiatric symptoms (NPS), cognitive decline, and sleep disturbances are commonly found in dementia, indicate progression, and increase caregiver distress. The purpose of this study was to examine the association of private prayer with NPS, cognitive function, and sleep disturbances in older adults with dementia. We analyzed data from the Health and Retirement Study in 2000, 2006, and 2008 and Aging, Demographics, and Memory Sub study in 2001–2003, 2006–2007, and 2008–2009 among 40 older adults (age 70–100 years, mean age = 84.67, 29 females and 11 males, 73.9% non-Hispanic White, and 19.2% Non-Hispanic Black, and 3% Hispanic, cognitive function = 1.169 indicating mild cognitive impairment) using correlational analysis. The results indicated that increased frequency of private prayer was significantly associated with lower NPS, better cognitive function, and lower sleep disturbances. In total, 100% of Non-Hispanic Black and Hispanic participants reported praying at least once per week. Findings could be due to use of cognitive processes used in prayer during supplication, requesting aid, and through communication with the divine, reducing loneliness. Longitudinal studies including historically underrepresented populations are needed to examine these associations over time. %B Religions %V 13 %P 973 %G eng %R 10.3390/rel13100973 %0 Journal Article %J Ageing International %D 2022 %T Older Workers with Physically Demanding Jobs and their Cognitive Functioning. %A Choi, Eunhee %A Kim, Sung-Geun %A Laura B Zahodne %A Steven M. Albert %K cognitive function %K Employment %K Older workers %K Physically demanding jobs %K productive aging %X

Although employment can provide older people with both financial and nonfinancial rewards, it is questionable whether those benefits extend to all older workers, particularly those with physically demanding jobs. This study aimed to examine whether the perceived level of physical demands placed on older workers 55 or older is significantly associated with their cognitive function. Using the Health and Retirement Study (HRS) 2010 wave, we analyzed two domains of cognition: verbal episodic memory and reasoning. After controlling for demographics and risk factors for age-related cognitive deterioration, the perceived level of physical demands placed on older workers was still significantly and negatively linked with both memory and reasoning domains of cognition. Older workers with more physically demanding jobs tended to have poorer cognitive function. Further longitudinal studies are needed to confirm this relationship.

Supplementary Information: The online version contains supplementary material available at 10.1007/s12126-020-09404-8.

%B Ageing International %V 47 %P 55-71 %G eng %N 1 %R 10.1007/s12126-020-09404-8 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Pathways from early life SES to dementia risk in old age: The role of personality. %A Sesker, Amanda A %A O'Súilleabháin, Páraic S %A Lee, Ji Hyun %A Damaris Aschwanden %A Martina Luchetti %A Yannick Stephan %A Antonio Terracciano %A Angelina R Sutin %K CIND %K Conscientiousness %K cSES %K Dementia %K Neuroticism %X

OBJECTIVE: This study investigates the association between childhood socioeconomic status (cSES) and risk of cognitive impairment in older adulthood, and whether Five Factor Model personality traits mediated this association.

METHODS: A sample of 9,995 participants (mean age = 67.01 years) from the Health and Retirement Study were followed every two years from 2006 to 2018. cSES was tested as a predictor of risk of dementia and risk of cognitive impairment not dementia (CIND). Personality was tested as a mediator of these associations. Models were adjusted for age, gender, ethnicity, race, education, and baseline year.

RESULTS: Although effect sizes were modest, results indicated that lower cSES was associated with higher risk of dementia (HR=0.88, [0.775, 0.985]). Higher cSES was also associated with higher Conscientiousness and lower Neuroticism. Conscientiousness and Neuroticism each accounted for 7.9% of the total effect of cSES on dementia. Results were similar for CIND.

CONCLUSIONS: Early childhood socioeconomic factors may contribute to cognitive impairment in older adulthood, an association mediated, in part, through adult personality traits.

%B The Journals of Gerontology, Series B %V 77 %P 850-859 %G eng %N 5 %R 10.1093/geronb/gbab159 %0 Journal Article %J Frontiers in Public Health %D 2022 %T Perceived discrimination in middle-aged and older adults: Comparison between England and the United States. %A Amirova, Aliya %A Rimes, Katharine A %A Hackett, Ruth A %K Aging %K Disabled Persons %K ELSA %K Perceived Discrimination %K Socioeconomic factors %X

OBJECTIVES: This study examined differences in perceived discrimination across multiple characteristics in England and the United States (US), in middle- and older-aged adults.

METHODS: Using data from the English Longitudinal Study of Aging ( = 8,671) and the US-based Health and Retirement Study ( = 7,927), we assessed cross-national differences in perceived discrimination attributed to disability, financial status, sex, race, sexual orientation, and weight. We also compared how perceived discrimination varied with socioeconomic position (SEP) based on wealth.

RESULTS: Perceived discrimination due to financial status was more common in England (6.65%) than in the US (2.14%) adjusting for age, sex, and wealth [Odds Ratio (OR) = 1.09, 95% CI (1.07; 1.10)]. This affected people of low but not high SEP. Sexual orientation discrimination was more common in England [0.72 vs. 0.15%, OR = 4.61, 95% CI (2.48; 8.57)]. Sex-based perceived discrimination was more prevalent in the US (12.42%) than England (9.07%) adjusting for age and wealth [OR = 0.87, 95% CI (0.86; 0.89)]. Cross-national differences in sex discrimination did not vary with SEP. Racism was the most common type of perceived discrimination reported in both samples (England: 17.84%, US: 19.80%), with no significant cross-national differences after adjustment for sex.

DISCUSSION: Perceived discrimination attributed to financial status and sexual orientation were more prevalent in England, while more women perceived sex discrimination in the US. This study suggests that country-specific and socioeconomic factors affect the prevalence of perceived discrimination. This may be relevant when targeting interventions aimed at reducing perceived discrimination.

%B Frontiers in Public Health %V 10 %P 975776 %G eng %R 10.3389/fpubh.2022.975776 %0 Journal Article %J SSM - Population Health %D 2022 %T Perceived healthcare discrimination and well-being among older adults in the United States and Brazil %A Angela R. Dixon %A Leslie B. Adams %A Tszshan Ma %K Comparative analysis %K depression %K Discrimination %K ELSI %K Health Disparities %K Race/ethnicity %K Social determinants of health %X Despite well-documented evidence illustrating the relationship between discrimination and health, less is known about the influence of unfair treatment when receiving medical care. Moreover, our current knowledge of cross-national and racial variations in healthcare discrimination is limited in aging populations. This article addresses these gaps using two harmonized data sets of aging populations to clarify the relationship between healthcare discrimination and health in the United States and Brazil. We use nationally representative, harmonized data from the Health and Retirement Study in the United States and the Brazilian Longitudinal Study of Aging to examine and compare perceived discrimination in the healthcare setting and its relationship to self-rated health, depression diagnosis, and depressive symptoms across national contexts. Using Poisson regression models and population attributable risk percent estimates, we found that aging adults reporting healthcare discrimination were at higher risk of poor self-rated health, diagnosed depression, and depressive symptoms. Our results also suggest that reducing perceived healthcare discrimination may contribute to improved self-rated health and mental well-being in later life across racialized societies. In two comparative settings, we highlight the differential impact of healthcare discrimination on self-rated health and depression. We describe the implications of our study's findings for national public health strategies focused on eliminating discrimination in the healthcare setting, particularly among aging countries. %B SSM - Population Health %V 18 %P 101113 %G eng %R https://doi.org/10.1016/j.ssmph.2022.101113 %0 Journal Article %J Personality and Individual Differences %D 2022 %T Personality and change in perceived control during the acute stage of the coronavirus pandemic. %A Sesker, Amanda A %A Lee, Ji Hyun %A Luchetti, Martina %A Damaris Aschwanden %A Stephan, Yannick %A Terracciano, Antonio %A Sutin, Angelina R %K COVID-19 %K perceived control %K Personality Traits %X

Lower perceived control (PC) is related to maladaptive psychological responses to stressful events, yet it is unclear whether longer-term situations are associated with PC change over time. This study examined PC change during the beginning of the coronavirus pandemic and whether trajectories varied by age and personality. Personality was assessed in 2455 U.S. adults (18-100 years) from an online study conducted January-February 2020. PC was assessed across three follow-ups (March-July 2020). Latent growth curves modeled PC change. In controlled models, PC decreased (β = -0.107,  = .005). Older adults had higher PC than younger adults (β = 0.012,  = .001), and experienced less PC decline (β = 0.012,  < .001). All personality traits but Openness were related to PC at baseline (βs ranged from -0.912 to 0.543, ps < .001). Conscientiousness (β = 0.155,  = .002), Extraversion (β = 0.128,  = .008), and Agreeableness (β = 0.099,  = .044) were associated with less PC decline. Employment (β = 0.160,  = .022), health (β = 0.133,  = .002), and disease burden (β = -0.056,  = .014) were also associated with PC change. These results were largely driven by the financial dimension of PC. This study provides evidence for PC change during the COVID-19 pandemic and identifies sociodemographic, personality, and health moderators of PC trajectory.

%B Personality and Individual Differences %V 192 %P 111607 %G eng %R 10.1016/j.paid.2022.111607 %0 Journal Article %J Personality and Individual Differences %D 2022 %T Personality traits and long-term care financial risks among older Americans %A Preston D. Cherry %A Sarah Asebedo %K Big 5 %K Financial risks %K Five factor model %K Long-term Care %K Long-term care services %K OCEAN traits %K Personality Traits %K Uncertainty risks %X Individuals are susceptible to financial uncertainty across the financial life cycle. The last of three financial life cycle stages is the distribution of accumulated wealth to fund retirement. Individuals maximize utility by smoothing consumption over the life cycle while managing uncertainty events. Life cycle events include the potential need and financial cost for long-term care support and services. Pre-cautionary savings are used to exchange insurance premiums for the coverage of high uncertainty events. Despite the theoretical need for uncertainty protection, consumer demand for insurance that mitigates or eliminates risk exposure to uncertainty events is historically low. This conundrum is commonly referred to as uncertainty “puzzles.” The empirical and descriptive literature examines many potential factors for these protection gaps that range from financial, health, social insurance, substitute and complimentary assets, socio-demographic factors, individual preferences, behavioral, and psychosocial factors, which this current paper controls for a majority. Research is growing yet limited when considering individuals personality traits as potential explanations for personal finance behaviors. This study investigates and provides results that suggest that personality traits could partially explain the low demand for financial uncertainty insurance. Of the five personality traits, an individual who more strongly identifies with conscientiousness, holding all else equal, was found to associate positively with long-term care insurance ownership. %B Personality and Individual Differences %V 192 %P 111560 %G eng %R 10.1016/j.paid.2022.111560 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Physical Activity as a Mediator between Race/Ethnicity and Changes in Multimorbidity. %A Jason T Newsom %A Denning, Emily C %A Elman, Miriam R %A Anda Botoseneanu %A Heather G. Allore %A Corey L Nagel %A David A Dorr %A Ana R Quiñones %K Chronic illness %K Disparities %K Exercise %X

OBJECTIVES: Studies report racial/ethnic disparities in multimorbidity (≥2 chronic conditions) and their rate of accumulation over time as well as differences in physical activity. Our study aimed to investigate whether racial/ethnic differences in the accumulation of multimorbidity were mediated by physical activity among middle-aged and older adults.

METHODS: We assessed racial/ethnic differences in the accumulation of multimorbidity (of nine conditions) over twelve years (2004-2016) in the Health and Retirement Study (HRS; N = 18,264, mean age = 64.4 years). Structural equation modeling was used to estimate latent growth curve models of changes in multimorbidity and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White participants) to changes in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, household wealth, insurance coverage, smoking, alcohol, and body-weight.

RESULTS: There was a significant increase in multimorbidity over time. Initial levels and changes in multimorbidity over time varied significantly across individuals. Indirect effects of the relationship between race/ethnicity and changes in multimorbidity as mediated by physical activity were significant, consistent with the mediational hypothesis. Black respondents engaged in significantly lower levels of physical activity than White respondents after controlling for covariates, but there were no differences between Hispanic and White respondents once education was included. These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in mid-to-late life, suggesting greater need to intervene to reduce sedentary behavior and increase physical activity.

%B The Journals of Gerontology, Series B %V 77 %P 1529-1538 %G eng %N 8 %R 10.1093/geronb/gbab148 %0 Journal Article %J Scientific Reports %D 2022 %T Predictors of Covid-19 level of concern among older adults from the health and retirement study. %A Beydoun, Hind A %A Beydoun, May A %A Weiss, Jordan %A Gautam, Rana S %A Hossain, Sharmin %A Alemu, Brook T %A Zonderman, Alan B %K COVID-19 %K Female %K Life Style %K Retirement %K Risk Factors %X

The purpose of this longitudinal study is to construct a prediction model for Covid-19 level of concern using established Covid-19 socio-demographic, lifestyle and health risk characteristics and to examine specific contributions of obesity-related cardiometabolic health characteristics as predictors of Covid-19 level of concern among a representative sample of U.S. older adults. We performed secondary analyses of existing data on 2872 2006-2020 Health and Retirement Study participants and examined 19 characteristics in relation to the outcome of interest using logistic regression and machine learning algorithms. In mixed-effects ordinal logistic regression models, a history of diabetes, stroke as well as 1-2 cardiometabolic risk factors and/or chronic conditions were associated with greater Covid-19 level of concern, after controlling for confounders. Female sex, birth cohort, minority race, Hispanic ethnicity and total wealth as well as depressive symptoms were associated with higher level of Covid-19 concern, and education was associated with lower level of Covid-19 concern in fully adjusted mixed-effects ordinal logistic regression models. The selected socio-demographic, lifestyle and health characteristics accounted for < 70% of the variability in Covid-19 level of concern based on machine learning algorithms. Independent risk factors for Covid-19 level of concern among U.S. older adults include socio-demographic characteristics and depressive symptoms. Advanced research is needed to identify relevant predictors and elucidate underlying mechanisms of observed relationships.

%B Scientific Reports %V 12 %P 4396 %G eng %N 1 %R 10.1038/s41598-022-08332-8 %0 Journal Article %J Front Public Health %D 2022 %T Projecting the chronic disease burden among the adult population in the United States using a multi-state population model. %A Ansah, John P %A Chiu, Chi-Tsun %K Adult %K Aged %K Chronic disease %K Cross-Sectional Studies %K ethnicity %K Hispanic or Latino %K Humans %K Middle Aged %K United States %K White People %X

INTRODUCTION: As the United States population ages, the adult population with chronic diseases is expected to increase. Exploring credible, evidence-based projections of the future burden of chronic diseases is fundamental to understanding the likely impact of established and emerging interventions on the incidence and prevalence of chronic disease. Projections of chronic disease often involve cross-sectional data that fails to account for the transition of individuals across different health states. Thus, this research aims to address this gap by projecting the number of adult Americans with chronic disease based on empirically estimated age, gender, and race-specific transition rates across predetermined health states.

METHODS: We developed a multi-state population model that disaggregates the adult population in the United States into three health states, i.e., (a) healthy, (b) one chronic condition, and (c) multimorbidity. Data from the 1998 to 2018 Health and Retirement Study was used to estimate age, gender, and race-specific transition rates across the three health states, as input to the multi-state population model to project future chronic disease burden.

RESULTS: The number of people in the United States aged 50 years and older will increase by 61.11% from 137.25 million in 2020 to 221.13 million in 2050. Of the population 50 years and older, the number with at least one chronic disease is estimated to increase by 99.5% from 71.522 million in 2020 to 142.66 million by 2050. At the same time, those with multimorbidity are projected to increase 91.16% from 7.8304 million in 2020 to 14.968 million in 2050. By race by 2050, 64.6% of non-Hispanic whites will likely have one or more chronic conditions, while for non-Hispanic black, 61.47%, and Hispanic and other races 64.5%.

CONCLUSION: The evidence-based projections provide the foundation for policymakers to explore the impact of interventions on targeted population groups and plan for the health workforce required to provide adequate care for current and future individuals with chronic diseases.

%B Front Public Health %V 10 %P 1082183 %8 2022 %G eng %R 10.3389/fpubh.2022.1082183 %0 Journal Article %J Gerontology and Geriatric Medicine %D 2022 %T Psychological Resilience and Cognitive Function Among Older Military Veterans. %A McDaniel, Justin T %A Hascup, Erin R %A Hascup, Kevin N %A Trivedi, Mehul %A Henson, Harvey %A Rados, Robert %A York, Mary %A Albright, David L %A Weatherly, Taryn %A Frick, Kaitlyn %K neurocognitive disorders %K psychological resilience %K Veterans Health %X

The purpose of this study was to explore the association between psychological resilience and cognitive function in military veterans. We obtained public-use data from the Health and Retirement Study (HRS) for this cross-sectional study of military veterans aged 52 to 101 years ( = 150). We estimated a multivariable linear regression model in which cognitive function served as the dependent variable and psychological resilience served as the independent variable. After controlling for demographics, health conditions, and health behaviors, veterans who had higher psychological resilience scores had better cognitive function (b = 0.22, = 0.03). Our findings suggest that psychological resilience may be associated with cognitive function among veterans. These findings highlight the importance of assessing psychological resilience in gerontological social work practice.

%B Gerontology and Geriatric Medicine %V 8 %P 23337214221081363 %G eng %R 10.1177/23337214221081363 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Race inequity in school attendance across the Jim Crow South and its implications for Black-White disparities in trajectories of cognitive function among older adults. %A Katrina M Walsemann %A Urena, Stephanie %A Mateo P Farina %A Jennifer A Ailshire %K cognitive function %K Education %K historical data %K life course %K Racial Disparities %K school segregation %X

OBJECTIVES: Although education is a key determinant of cognitive function, its role in determining Black-White disparities in cognitive function is unclear. This may be due, in part, to data limitations that have made it difficult to account for systemic educational inequities in the Jim Crow South experienced by older cohorts, including differences in the number of days Black students attended school compared to their White counterparts or Black peers in better funded southern states. We determine if accounting for differential rates of school attendance across race, years, and states in the Jim Crow South better illuminates Black-White disparities in trajectories of cognitive function.

METHODS: We linked historical state-level data on school attendance from the 1919/20 to 1953/54 Biennial Surveys of Education to the Health and Retirement Study, a nationally representative, longitudinal study of U.S. adults over age 50. We restricted our sample to Black and White older adults who attended school in the Jim Crow South and began primary school in/after 1919/20 and completed primary/secondary school by 1953/1954 (n=4,343). We used linear mixed models to estimate trajectories of total cognitive function, episodic memory, and working memory.

RESULTS: Self-reported years of schooling explained 28-33% of the Black-White disparity in level of cognitive function, episodic memory, and working memory. Duration of school, a measure that accounted for differential rates of school attendance, explained 41-55% of the Black-White disparity in these outcomes.

DISCUSSION: Our study highlights the importance of using a more refined measure of schooling for understanding the education--cognitive health relationship.

%B The Journals of Gerontology, Series B %V 77 %P 1467-1477 %G eng %N 8 %R 10.1093/geronb/gbac026 %0 Journal Article %J Alzheimer's & Dementia %D 2022 %T Racial/Ethnic Disparities in Risk and Protective Factors of Dementia in the United States %A Nasim B. Ferdows %A Maria P. Aranda %K Dementia %K racial/ethnic disparities %X Background Recent population-based studies show decline in dementia incidence and prevalence in high-income countries, suggesting that improved population cardiovascular health and rising levels of education in the past 25 years were associated with reduction of dementia risks. However, in the US, there is a variation in changes over time of educational attainment, prevalence and management of chronic diseases, and behaviors associated with poor cardiovascular health among racial/ethnic groups. This study examines the risk and protective factors associated with dementia and decomposes racial/ethnic disparities in factors associated with cognitive functioning. Method We performed a retrospective analysis of 3,495 older individuals (65+) in 2016 who participated in Harmonized Cognitive Assessment Protocol, linked to Health and Retirement Study to trace the individuals back to 2000. Using Mini-Mental State Examination (MMSE), individuals were classified as demented vs normal. Risk factors included were cardiovascular factors, hearing loss, and history of being uninsured in midlife, and current smoking, depression, and physical inactivity. Protective factors included were educational attainment. Using Oaxaca-Blinder decomposition, the relative contribution of different variables in explaining racial/ethnic disparities in cognitive functioning was evaluated. Result Accounting for sociodemographic, mid-, and later-life characteristics, Blacks have higher odds of having dementia, following Hispanics and Whites. Higher levels of education and wealth were associated with lower odds of dementia. History of stroke and hearing loss during mid-life, and depression and physical inactivity in late-life were associated with higher odds of dementia. The decomposition shows that about 32% of Blacks and Whites difference in MMSE score was explained by demographics and later-life characteristics, while nearly 68% of the difference remains unexplained. Comparing Whites and Hispanics, 70% of the difference in MMSE score was explained by demographics and later-life characteristics, while nearly 30% of the difference remains unexplained. Conclusion Blacks and Hispanics are found to have a higher risk of dementia compared to whites. Accounting for demographics, mid- and later-life risk and protective factors explain only one-third of the difference in cognitive functioning between Blacks and Whites and nearly two-thirds of the differences between Hispanics and Whites. %B Alzheimer's & Dementia %V 18 %P e066713 %G eng %N S8 %R 0.1002/alz.066713 %0 Journal Article %J Innovation in Aging %D 2022 %T REACHING THE LIMIT: CENTENARIANS IN THE HEALTH AND RETIREMENT STUDY %A Martin, Peter %A Jennifer A Ailshire %K centenarian survivors %K Life Expectancy %X Although life expectancy has increased significantly over the last century, it is still unlikely that individuals reach the century mark of their lives. As a result, it is difficult to study a large enough sample of centenarian survivors; it is even more difficult to follow developmental trajectories of those who survive into very late life. The AHEAD sample of the Health and Retirement Study (HRS) contains longitudinal data of older adults who first participated in 1993. More than 500 HRS participants survived to at least 98 years of age. In this symposium, we present three uses of the data: first, we compare centenarians to older adults who did not survive into their nineties. Second, we compare different cohorts of centenarians with regard to health and psychosocial behavior. Third, we follow participants from their eighties to 100 years of age. The first presentation provides an overview of the HRS subsample. The second presentation highlights the personality profiles of centenarians. The third presentation traces health and psychological well-being among centenarians in the HRS. Finally, we discuss trajectories of cognition and functional limitations for three cohorts of centenarians. The results provide important information for policies and practical implications for families and service providers to older adults, highlighting available resources and health and well-being changes in very late life. %B Innovation in Aging %V 6 %P 304 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1202 %0 Journal Article %J Pain Medicine %D 2022 %T Reciprocal effects between depressive symptoms and pain in veterans over 50 years of age or older %A Sarah C. Griffin %A Young, Jonathan R %A Naylor, Jennifer C %A Allen, Kelli D %A Beckham, Jean C %A Patrick S Calhoun %K depression %K pain %K Veterans %X

OBJECTIVE: Depression and chronic pain are major problems in American veterans, yet there is limited long-term research examining how they relate to one another in this population. This study examined the relationship between depressive symptoms and pain in U.S. veterans aged 50+.

METHODS: This study used data on veterans from the 2002-2016 waves of the Health and Retirement Study (n = 4,302), a large-scale observational study of Americans aged 50+. Measures included a short form of the Center for Epidemiologic Studies Depression scale and two items assessing the presence and degree of pain. Analyses included random intercept cross-lagged panel models (RI-CLPM).

RESULTS: In the RI-CLPM, there were roughly equivalent cross-lagged effects between depressive symptoms and pain. There was also evidence that depressive symptoms and pain have a trait-like component and that these trait-like characteristics are associated.

CONCLUSIONS: These findings indicate that depressive symptoms and pain in veterans are stable characteristics in American veterans over 50. There appear to be reciprocal effects between the two, whereby deviations in one's typical depressive symptoms predict subsequent deviations in one's pain level and vice-versa; however, the size of these effects is very small. These findings suggest that clinicians should treat both depressive symptoms and pain, rather than assume that treatment benefits in one domain will lead to major benefits in another.

%B Pain Medicine %V 23 %P 295-304 %G eng %N 2 %R 10.1093/pm/pnab294 %0 Journal Article %J SSM - Population Health %D 2022 %T Regional variation in U.S dementia trends from 2000-2012 %A Jennifer A Ailshire %A Katrina M. Walsemann %A Calley E. Fisk %K Dementia %K health trends %K Regional variation %X Although recent studies report a decline in dementia prevalence among U.S. older adults, national trends may mask subnational variation, particularly given large health and social inequalities linked to geography. To address this gap, we determined if there was subnational variation in reported national dementia trends and if region-specific trends were explained by sociodemographic and health characteristics. Data come from the 2000 (n = 10,447) and 2012 (10,426) waves of the Health and Retirement Study. We used validated methods for dementia classification using proxy and self-respondents. Logistic regression models, adjusted for within-person clustering over time, estimated trends in dementia prevalence by region and census division. We found subnational variation in dementia prevalence in both 2000 and 2012, as well as in change in dementia prevalence during this period. In 2000, dementia prevalence was lowest in the West (8.6%), higher in the Midwest (10.0%) and Northeast (11.1%), and highest in the South (14.6%). Dementia prevalence declined over time across all regions of the U.S. from 2000 to 2012 but remained highest in the South (10.7%) compared to the other regions (7.0–7.8%). Despite downward trends in dementia across the U.S., the prevalence of dementia in the South in 2012 approximated levels found in other regions in 2000. There was relatively less change over time in the West compared to other regions, but dementia prevalence was already quite low in the West in 2000. Within region, trends in dementia prevalence between 2000 and 2012 also varied slightly across census divisions. Subnational variation in changes in dementia prevalence were largely explained by education and health status. Variation in baseline prevalence, as well as differential rates of change, highlight the importance of examining subnational variation in dementia trends. %B SSM - Population Health %V 19 %P 101164 %G eng %R https://doi.org/10.1016/j.ssmph.2022.101164 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Religious Involvement and Cognitive Functioning at the Intersection of Race/Ethnicity and Gender in Mid-Life and Older Adults. %A Henderson, Andrea K %A Katrina M Walsemann %A Jennifer A Ailshire %K cognitive functioning %K gender %K race %K Religion %X

OBJECTIVES: To investigate the association between religious involvement and cognitive functioning at the intersections of race-ethnicity and gender among mid-life and older adults, and to determine if psychosocial factors help explain this relationship.

METHODS: The sample included 14,037 adults aged 50+ from the Health and Retirement Study (HRS). We utilized measures from the HRS 2010 and 2012 Core interviews and Leave Behind questionnaires and estimated our models using linear regression.

RESULTS: Compared to individuals who frequently attended religious services, infrequent religious service attendance was related to poorer cognitive functioning. Religiosity was inversely associated with cognitive functioning at baseline, but the relationship varied by race/gender subgroup. Greater religiosity was associated with better cognitive functioning among Black women, but lower cognitive functioning among White men and women. Psychosocial factors did little to explain the inverse association between religiosity and cognitive functioning.

DISCUSSION: Results suggest the association between religious involvement and cognitive functioning is varied and complex, and largely dependent on important social identities. The findings have important implications for investigating health-protective factors, like religious involvement, using an intersectional perspective.

%B The Journals of Gerontology, Series B %V 77 %P 237-248 %G eng %N 1 %R 10.1093/geronb/gbab034 %0 Journal Article %J European Journal of Nutrition %D 2022 %T Reported organic food consumption and metabolic syndrome in older adults: Cross-sectional and longitudinal analyses %A Aljahdali, Abeer A %A Baylin, Ana %A Ludwig-Borycz, Elizabeth %A Heidi M Guyer %K Cardiometabolic risk factors %K Metabolic syndrome %K Organic food %X Purpose: Examine cross-sectional and longitudinal relationships between organic food consumption, metabolic syndrome (MetS), and its components among older adults. Methods: Respondents of the 2012 Health and Retirement Study (HRS), and Health Care and Nutrition Study (HCNS) were included in this study. Organic food consumption was measured with a crude binary question asking about past-year consumption (yes/no). Cross-sectional analyses were conducted with 6,633 participants (mean (SE) age, 65.5 (0.3) years). Longitudinal analyses were conducted with a subset of 1,637 respondents who participated in the HRS Venous Blood Study (mean (SE) age, 63.8 (0.4) years). Hemoglobin A1C and high-density lipoprotein cholesterol were assessed using dried blood spots at baseline. Glucose, high-density lipoprotein cholesterol, and triglycerides were assessed using fasting blood samples collected 4 years after baseline. Waist circumference and blood pressure were measured at baseline and follow-up. Logistic and linear regressions were used to assess the associations between organic food consumption, MetS, and its components. Results: Any organic food consumption over the previous year was reported among 47.4% of cross-sectional and 51.3% of longitudinal participants. Unadjusted models showed inverse cross-sectional associations between organic food consumption and waist circumference, blood pressure, and hemoglobin A1C, and positive longitudinal association with high-density lipoprotein cholesterol. No significant associations were detected in the fully adjusted models. Conclusions: No association was observed between organic food consumption and MetS among older adults after adjusting for confounders. Future studies with a precise definition, quantitative assessment of the consumption, and duration of organic food consumption, together with pesticides biomarkers, are warranted. %B European Journal of Nutrition %V 61 %P 1255-1271 %G eng %N 3 %R 10.1007/s00394-021-02717-7 %0 Thesis %D 2022 %T Retirees' psychological and financial well-being: Investigating partnership effects and financial knowledge on retirement outcomes %A Abualshamat, Ghirass Ghazi %K Couples %K Financial well-being %K psychological well-being %K Retirement %X An obvious trend over the past years showed an increased number of retirees in the United States. The increase in retirees has brought increased concern about how individuals adjust to the retirement life phase. This dissertation investigates retirees' psychological and financial well-being by looking at partnership effects and financial knowledge on retirement outcomes. The first paper looked into the relationship between couples' joint retirement and retirement satisfaction. The analysis uses cross-sectional data from the 2016 Health and Retirement Study (HRS). This paper shows a positive relationship between the likelihood of being very satisfied during retirement and the partner's retirement status, household income, net worth, health, education, and age. The second paper investigated the relationship between couples' joint retirement and post-retirement depression. The analysis uses cross-sectional data from the HRS for 2016. This paper indicates that retirees are less likely to be depressed when their partner is fully retired than retirees with a not retired partner. The third paper examined whether financial knowledge is associated with older investors' investment holdings by looking at the type and the number of investment instruments in a portfolio. The analysis uses cross-sectional data from the 2015 National Financial Capability Study-Investor Survey by FINRA. The results show a positive relationship between financial knowledge and having an investment instruments score of zero and one. The results also show a negative relationship between financial knowledge and having a portfolio with investment instruments score above one. %I Texas Tech University %C Lubbock, TX %G eng %U https://hdl.handle.net/2346/89461 %0 Journal Article %J Alzheimer's & Dementia %D 2022 %T Selection Factors Influencing Participation in National Alzheimer’s Coordinating Center (NACC) Studies Compared to the Nationally Representative Health and Retirement Study (HRS) %A Nicole D. Evangelista %A Miguel Arce Renteria %A Taylor M Mobley %A Joshua T. Fox-Fuller %A Lex Minto %A Justina F Avila %A Kacie D Deters %A Luis D Medina %A Bri M Bettcher %K Alzheimer's %K Dementia %K racial/ethnic disparities %X Background Racial/ethnic disparities in ADRD are well documented such that prevalence of ADRD and known risk factors (e.g., cardiovascular disease, educational attainment) disproportionately impact Black and Latinx populations compared to their White counterparts. To generalize findings on the mechanisms and disease course and mitigate racial/ethnic disparities in ADRD, it is critical that diverse populations are well represented in studies of ADRD. We examined selection factors across racial/ethnic groups included in National Alzheimer’s Coordinating Center data (NACC) compared to the general U.S. population using data from the Health and Retirement Study (HRS). Method Analyses included baseline NACC data from 33,998 participants (Mage = 74.1yrs±8.0; Medu = 15.5±6.9; 56.7% women) and the 2010 wave of HRS weighted up to the 2010 US population aged 60+ years (weighted n = 48,726,070; Mage = 71.3yrs; Medu = 12.9yrs; 54.3% women). We assessed covariate balance between NACC and the 2010 US population aged 60+ by calculating standardized mean differences across harmonized sociodemographic factors, self-reported health characteristics, depressive symptoms, and subjective memory concerns stratified by race/ethnicity. Standardized mean differences greater than +/- 0.25 were considered strong selection factors into NACC. Result Across all racial/ethnic groups, NACC participants were more likely to be older, have higher educational attainment, and report subjective memory concerns and hearing difficulties compared to the 2010 US population aged 60+ years (Figure). Standardized mean differences for age, educational attainment, and memory concerns were larger among non-Latinx Whites compared to differences among non-Latinx Black and Latinx participants. There was greater representation of non-Latinx Black women in NACC, and non-Latinx Black and Latinx NACC participants were less likely to endorse depressive symptoms. Additionally, results suggested non-Latinx White participants were less likely to report diabetes and hypertension compared to their 2010 aged 60+ US population counterparts. Conclusion Results suggest that NACC participants are not representative of the U.S. population in key demographic and health factors and self-reported memory concerns. These selection factors differed across racial/ethnic groups and are suggestive of selection bias. Future studies should leverage statistical tools that aimed at generalizing findings to general populations. Studies should also consider mitigating these sources of bias through inclusive recruitment efforts across Alzheimer’s Disease Centers to improve generalizability. %B Alzheimer's & Dementia %V 18 %P e065949 %G eng %N S7 %R 10.1002/alz.065949 %0 Journal Article %J Aging & Mental Health %D 2022 %T Self-perceptions of aging and depressive symptoms: the mediating role of loneliness. %A Dikla Segel-Karpas %A Cohn-Schwartz, Ella %A Liat Ayalon %K Depressive symptoms %K Loneliness %K self-perceptions of aging %X

Depression is a major health concern for both individuals and societies. Hence, understanding the risk factors for depression is of importance. As individuals grow older, the way in which they perceive the aging process may have a significant influence on their physical and mental health. More negative perceptions of aging could put individuals at risk for social withdrawal, causing loneliness and resulting in higher levels of depressive symptoms. We use the Health and Retirement Survey, a large and longitudinal dataset spanning over a period of 8 years, to examine a model in which loneliness mediates the relationship between self-perceptions of aging and depressive symptoms. Our findings suggest that loneliness indeed mediates the relationship between self-perceptions of aging and depressive symptoms. The results highlight to the importance of the way people view the aging process in shaping their social and mental well-being. Practitioners may want to address self-perceptions of aging when helping older adults cope with loneliness and depressive symptoms.

%B Aging & Mental Health %V 26 %P 1495-1501 %G eng %N 7 %R 10.1080/13607863.2021.1991275 %0 Journal Article %J Gerontology %D 2022 %T Sense of Purpose in Life and Markers of Hearing Function: Replicated Associations across Two Longitudinal Cohorts. %A Angelina R Sutin %A Martina Luchetti %A Damaris Aschwanden %A Yannick Stephan %A Antonio Terracciano %K Episodic Memory %K hearing acuity %K Hearing loss %K Replication %K Sense of purpose %X

INTRODUCTION: A sense of purpose in life is a psychological resource that is associated with healthier outcomes. The present research examines whether a greater sense of purpose in life is associated with subjective and objective markers of hearing health and whether hearing acuity contributes to the association between purpose and episodic memory. We sought to evaluate whether these associations were replicable across 2 independent samples.

METHODS: Participants in the Health and Retirement Study (N = 14,291) and the English Longitudinal Study of Ageing (N = 8,844) reported on their purpose in life and perceived hearing quality at baseline. Hearing acuity was measured using an audiometer 2-4 years later, and episodic memory was measured at baseline and 6-8 years later.

RESULTS: In both samples, higher purpose in life was associated with better hearing quality measured concurrently, lower risk of either subjective or objective hearing impairment, and hearing acuity accounted for some of the longitudinal relation between sense of purpose and better episodic memory.

DISCUSSION: Across samples, measures, and analytical approaches, the present research indicates replicable associations between sense of purpose in life and hearing health. It further indicates that hearing may be one factor that associates purpose with better episodic memory.

%B Gerontology %V 68 %P 943-950 %G eng %N 8 %R 10.1159/000521257 %0 Journal Article %J Journal of Aging and Health %D 2022 %T Social Relationships, Wealth, and Cardiometabolic Risk: Evidence from a National Longitudinal Study of U.S. Older Adults. %A Shartle, Kaitlin %A Yang, Yang Claire %A Richman, Laura S %A Belsky, Daniel W %A Aiello, Allison E %A Harris, Kathleen Mullan %K cardiometabolic risk %K Social Relationships %K Trajectories %K Wealth %X

To investigate multiple dimensions of social relationships related to biomarkers of cardiometabolic health and how their associations vary by wealth in older adults. Growth curve models were used to investigate the longitudinal associations between measures of both positive and negative social relationships and cardiometabolic risk (CMR) over a 10-year period from 2006 to 2016 and the moderation of this association by wealth in the Health and Retirement Study (HRS). Older adults with better social relationships had lower CMR on average. The protective effects of positive social relationships, however, waned at older ages, particularly for low-wealth individuals. Our results suggest that good social relationships promote healthy aging by buffering against harmful cardiometabolic consequences of psychosocial stress, particularly among relatively wealthy individuals. Efforts to improve old age health would be more effective when focusing simultaneously on fostering social connections and boosting financial resources.

%B Journal of Aging and Health %V 34 %P 1048-1061 %G eng %N 6-8 %R 10.1177/08982643221087807 %0 Report %D 2022 %T Societal Impact of Research Funding for Women's Health in Rheumatoid Arthritis %A Baird, Matthew D. %A Melanie A. Zaber %A Annie Chen %A Andrew W. Dick %A Chloe E. Bird %A Molly Waymouth %A Grace Gahlon %A Denise D. Quigley %A Hamad Al-Ibrahim %A Lori Frank %X Women's health has suffered from insufficient research addressing women. The research community has not widely embraced the value of this research, and the impact of limited knowledge about women's health relative to men's is far-reaching. Without information on the potential return on investment for women's health research, research funders, policymakers, and business leaders lack a basis for altering research investments to improve knowledge of women's health. As part of an initiative of the Women's Health Access Matters (WHAM) nonprofit foundation, RAND Corporation researchers examined the impact of increasing funding for women's health research on rheumatoid arthritis (RA). RA was chosen partly because of its higher prevalence in women than men, with some symptom profiles differing by sex. In this report, the authors present the results of microsimulation models used to explore the potential for enhanced investment in women's health research, in terms of the economic well-being of women and for the U.S. population. %B Research Reports %I RAND Corporation %C Santa Monica, CA %G eng %U https://www.rand.org/content/dam/rand/pubs/research_reports/RRA700/RRA708-3/RAND_RRA708-7.appendixes.pdf %0 Journal Article %J BMC Public Health %D 2022 %T Sociodemographic and health status differences in delaying medical care during the COVID-19 pandemic among older adults: findings from the Health and Retirement Study. %A Farina, Mateo P %A Jennifer A Ailshire %K COVID-19 %K Health Status %K Health Status Disparities %K Pandemics %K Retirement %X

BACKGROUND: During the COVID-19 Pandemic, adults in the United States reported delaying medical care, which may be tied risk of infection and local policies limiting appointment. Some populations may have been more likely to delay care than others, leading to other forms of health inequality during this period. To-date there is little research on delayed care among U.S. older adult. We determine the prevalence of delayed medical care among older adults and investigate sociodemographic and health status inequalities in delaying health care.

METHOD: We used data from the first public release of the nationally representative Health and Retirement Study COVID-19 Subsample (N = 3006). Using logistic regression, we assessed whether differences in delaying health care varied by age, sex, race/ethnicity, education, self-rated health (SRH), and having any Activity of Daily Living (ADL) limitation. We also conducted additional analysis that evaluated differences in delaying care by two care subtypes: doctor and dental care visits.

RESULTS: About 30% of U.S. older adults reported delaying care with the most common types of delayed care being dental or doctor visits. Adults ages 75 and older were less likely to delay care, while women, college educated, and those with poor SRH, and any ADL limitations were more likely to delay care.

CONCLUSIONS: Nearly one-third of older adults delayed care during the COVID-19 pandemic. The increased likelihood of delayed care among people with worse health suggests that there may be longer-term impacts on the health care system and population health from the COVID-19 pandemic, and may contribute to health inequalities in the near future.

%B BMC Public Health %V 22 %P 1720 %G eng %N 1 %R 10.1186/s12889-022-14118-4 %0 Journal Article %J Innovation in Aging %D 2022 %T SOCIODEMOGRAPHIC DIFFERENCES IN IMMUNOSENESCENCE IN OLDER AGE: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY %A Noppert, Grace %A Stebbins, Rebecca %A Dowd, Jennifer %A Aiello, Allison E %K Immunosenescence %K sociodemographic differences %X Population patterns of immunosenescence are not well described. We characterized markers of immunosenescence and assessed sociodemographic differences in a population of individuals ages 56 years and older using newly released venous blood data from the nationally representative U.S. Health and Retirement Study (HRS) (n=8,400). Median values of the CD8+:CD4+, effector memory (em)RA:naïve CD4+ and emRA:naïve CD8+ T cell ratios were higher among older participants (more aged immune profile) and were lower among those with additional educational attainment (less aged immune profile). Racialized minority populations had immune markers suggestive of a more aged immune profile: Hispanics had a CD8+:CD4+ median value of 0.37 (95% CI: 0.35, 0.39) compared to Whites (0.30, 95% CI: 0.29, 0.31). Blacks had the highest median value of the emRA:naive CD4+ ratio (0.08; 95% CI: 0.07, 0.09) compared to Whites (0.03; 95% CI: 0.028, 0.033). Our regression analyses showed that race/ethnicity and education were associated with large differences in T-cell markers of aging, which were orders of magnitude greater than age. By standardizing regression coefficients to estimate years of immunological aging, we found that each additional level of education was associated with roughly an additional decade of immunological age, and racialized minorities had on average an immunological age two to four decades higher than Whites. As one of the first large-scale population-based investigations of immunosenescence, our study advances understanding of the immune mechanisms underlying age-related disease, with implications for risks such as vulnerability to novel pathogens (e.g., SARS-CoV-2). %B Innovation in Aging %V 6 %P 447-448 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1749 %0 Journal Article %J American Journal of Infection Control %D 2022 %T Socio-demographic, lifestyle and health characteristics as predictors of self-reported Covid-19 history among older adults: 2006-2020 Health and Retirement Study. %A Beydoun, Hind A %A Beydoun, May A %A Hossain, Sharmin %A Alemu, Brook T %A Gautam, Rana S %A Weiss, Jordan %A Zonderman, Alan B %K Cardiovascular Diseases %K Chronic disease %K COVID-19 %K ethnicity %K Female %K Life Style %K Retirement %K Self Report %X

BACKGROUND: To identify key socio-demographic, lifestyle, and health predictors of self-reported coronavirus disease 2019 (Covid-19) history, examine cardiometabolic health characteristics as predictors of self-reported Covid-19 history and compare groups with and without a history of Covid-19 on trajectories in cardiometabolic health and blood pressure measurements over time, among United States (U.S.) older adults.

METHODS: Nationally representative longitudinal data on U.S. older adults from the 2006-2020 Health and Retirement Study were analyzed using logistic and mixed-effects logistic regression models.

RESULTS: Based on logistic regression, number of household members (OR=1.26, 95% CI: 1.05, 1.52), depressive symptoms score (OR = 1.21, 95% CI: 1.04, 1.42) and number of cardiometabolic risk factors or chronic conditions ("1-2" vs "0") (OR = 0.27, 95% CI: 0.11, 0.67) were significant predictors of self-reported Covid-19 history. Based on mixed-effects logistic regression, several statistically significant predictors of Covid-19 history were identified, including female sex (OR = 3.06, 95% CI: 1.57, 5.96), other race (OR = 5.85, 95% CI: 2.37, 14.43), Hispanic ethnicity (OR = 2.66, 95% CI: 1.15, 6.17), number of household members (OR = 1.25, 95% CI: 1.10, 1.42), moderate-to-vigorous physical activity (1-4 times per month vs never) (OR = 0.38, 95% CI: 0.18, 0.78) and number of cardiometabolic risk factors or chronic conditions ("1-2" vs "0") (OR = 0.34, 95% CI: 0.19, 0.60).

CONCLUSIONS: Number of household members, depressive symptoms and number of cardiometabolic risk factors or chronic conditions may be key predictors for self-reported Covid-19 history among U.S. older adults. In-depth analyses are needed to confirm preliminary findings.

%B American Journal of Infection Control %V 50 %P 482-490 %G eng %N 5 %R 10.1016/j.ajic.2022.02.021 %0 Journal Article %J Addictive Behaviors %D 2022 %T Socioeconomic Status across the Life Course and Smoking Cessation among Older Adult Smokers in the U.S %A Jaqueline C. Avila %A Sangah Lee %A Ezinwa Osuoha %A Dale Dagar Maglalang %A Alexander Sokolovsky %A Jasjit S. Ahluwalia %K Smoking cessation %K socioeconomic status %K Tobacco %X Socioeconomic status (SES) at different stages of the life course impacts late-life health. However, whether SES across the life course impacts smoking cessation in late-life is not known. Purpose: Assess how life course SES impacts smoking cessation among older smokers. Methods We identified 5,124 smokers, 50 years and older, from the 1998 to 2018 waves of the Health and Retirement Study. The outcome was self-reported smoking cessation. The main exposure was life course SES, defined as: low child and low adult SES (persistent low); low child, high adult SES (upward mobility); high child, low adult SES (downward mobility); and high child, high adult SES (persistent high). A multilevel mixed-effect logistic model was used to examine how life course SES predicts smoking cessation at age 65 and over time, adjusted for covariates. Results Compared to those with persistent high SES, those with persistent low SES, upward and downward SES were more likely to be Hispanic or non-Hispanic Black. The adjusted results showed that at age 65, compared to those with persistent high SES, those with persistent low SES (OR=0.69, 95% CI= [0.51-0.92]), upward SES (OR=0.49, [0.32-0.75]), and downward SES (OR=0.55, [0.40-0.76]) were less likely to quit. However, as age increased, only those with downward or persistent low SES were significantly less likely to quit compared to those with persistent high SES. Conclusion: Social mobility of SES from childhood to adulthood significantly impacts smoking cessation. Both stages of the life course should be considered to understand smoking behaviors. %B Addictive Behaviors %V 135 %P 107454 %G eng %R 10.1016/j.addbeh.2022.107454 %0 Journal Article %J Neurology %D 2022 %T Socioeconomic Status, Biological Aging, and Memory in a Diverse National Sample of Older US Men and Women. %A Avila-Rieger, Justina %A Turney, Indira C %A Vonk, Jet M J %A Esie, Precious %A Seblova, Dominika %A Weir, Vanessa R %A Belsky, Daniel W %A Jennifer J Manly %K biological aging %K Cognition %K DNA Methylation %K Race/ethnicity %K sex/gender %K socio-economic status %X

BACKGROUND AND OBJECTIVES: Exposure to socioeconomic disadvantage is associated with early-onset cognitive aging. Biological aging, the progressive loss of system integrity that occurs as we age is proposed as a modifiable process mediating this health inequality. We examined whether socioeconomic disparities in cognitive aging in mid-to late-life adults is explained by accelerated biological aging similarly across race, ethnicity and sex/gender.

METHODS: Data was from a prospective cohort study of the U.S. Health and Retirement Study DNA-methylation sub-study. Socioeconomic status (SES) was measured from years of education and household wealth at baseline. The extent and pace of biological aging were quantified using three DNA-methylation measures: PhenoAge, GrimAge, and DunedinPoAm. Cognitive aging was measured from repeated longitudinal assessments of immediate and delayed word recall. Latent growth curve modeling estimated participants' level of memory performance and rate of decline over 2-11 follow-up assessments spanning 2-20 years. Multiple-group models were estimated to assess whether the relationship between SES and memory trajectories was mediated by biological aging across racial-ethnic by sex/gender subgroups.

RESULTS: Data from a total of 3,997 adults aged 50-100 were analyzed. Participants with lower SES had lower memory performance, faster decline and exhibited accelerated biological aging (SES effect size associations (β) ranged from .08 to .41). Accelerated biological aging was associated with decreased memory performance and faster memory decline (effect-size range .03 to .23). SES-biological aging associations were strongest for White men and women and weakest for Latinx women. The relationship between biological aging measures and memory was weaker for Black participants compared with White and Latinx people. In mediation analysis, biological aging accounted for 4-27% of the SES-memory gradient in White participants. There was little evidence of mediation in Black or Latinx participants.

DISCUSSION: Among a national sample of mid-to late-life adults, DNA-methylation measures of biological aging were variably associated with memory trajectories and SES across White, Black, and Latinx mid-to late-life adults. These results challenge the assumption that DNA-methylation biomarkers of aging that were developed in primarily White people can equivalently quantify aging processes affecting cognition in Black and Latinx mid-to late-life adults.

%B Neurology %V 99 %P e2114-e2124 %G eng %N 19 %R 10.1212/WNL.0000000000201032 %0 Journal Article %J Journal of Alzheimer's Disease %D 2022 %T Subjective Cognitive Decline: Is a Resilient Personality Protective Against Progression to Objective Cognitive Impairment? Findings from Two Community-Based Cohort Studies. %A Aschwanden, Damaris %A Sutin, Angelina R %A Ledermann, Thomas %A Luchetti, Martina %A Stephan, Yannick %A Sesker, Amanda A %A Zhu, Xianghe %A Terracciano, Antonio %K Apolipoprotein E4 %K Cognitive Dysfunction %K Personality %K Personality Disorders %X

BACKGROUND: Subjective cognitive decline (SCD) is related to personality functioning and risk of subsequent objective cognitive impairment.

OBJECTIVE: The aim of this study was to examine whether lower neuroticism and higher conscientiousness-resilient personality traits-protect against conversion from SCD to objective cognitive impairment in two longitudinal community-based cohorts.

METHODS: Data from the Health and Retirement Study (N = 1,741, Mean age = 68.64 years, Follow-up mean = 7.34 years) and the National Health and Aging Trends Survey (N = 258, Mean age = 79.34 years, Follow-up mean = 4.31 years) were analyzed using Cox regression analysis, controlling for sociodemographic covariates, symptoms of anxiety and depression, and apolipoprotein ɛ4.

RESULTS: The pooled results showed that lower neuroticism and higher conscientiousness were associated with decreased risk of conversion from SCD to objective cognitive impairment.

CONCLUSION: Among individuals with SCD, those with a resilient personality may have more cognitive and psychological reserve to maintain cognitive functioning and delay conversion to objective cognitive impairment. The findings further contribute to a better understanding of personality along the cognitive continuum: The observed effect sizes were smaller than those reported in cognitively normal individuals but larger than in individuals with mild cognitive impairment. Personality could provide useful information to identify individuals with SCD who may develop objective cognitive impairment-namely those who hold a vulnerable personality (higher neuroticism, lower conscientiousness).

%B Journal of Alzheimer's Disease %V 89 %P 87-105 %G eng %N 1 %R 10.3233/JAD-220319 %0 Journal Article %J Innovation In Aging %D 2022 %T Trajectories of Frailty With Aging: Coordinated Analysis of Five Longitudinal Studies. %A Jenkins, Natalie D %A Hoogendijk, Emiel O %A Armstrong, Joshua J %A Lewis, Nathan A %A Ranson, Janice M %A Rijnhart, Judith J M %A Ahmed, Tamer %A Ghachem, Ahmed %A Mullin, Donncha S %A Ntanasi, Eva %A Welstead, Miles %A Auais, Mohammad %A Bennett, David A %A Bandinelli, Stefania %A Cesari, Matteo %A Ferrucci, Luigi %A French, Simon D %A Huisman, Martijn %A Llewellyn, David J %A Scarmeas, Nikolaos %A Piccinin, Andrea M %A Hofer, Scott M %A Muniz-Terrera, Graciela %K Age-related changes %K Frailty %K Latent growth curve %X

Background and Objectives: There is an urgent need to better understand frailty and its predisposing factors. Although numerous cross-sectional studies have identified various risk and protective factors of frailty, there is a limited understanding of longitudinal frailty progression. Furthermore, discrepancies in the methodologies of these studies hamper comparability of results. Here, we use a coordinated analytical approach in 5 independent cohorts to evaluate longitudinal trajectories of frailty and the effect of 3 previously identified critical risk factors: sex, age, and education.

Research Design and Methods: We derived a frailty index (FI) for 5 cohorts based on the accumulation of deficits approach. Four linear and quadratic growth curve models were fit in each cohort independently. Models were adjusted for sex/gender, age, years of education, and a sex/gender-by-age interaction term.

Results: Models describing linear progression of frailty best fit the data. Annual increases in FI ranged from 0.002 in the Invecchiare in Chianti cohort to 0.009 in the Longitudinal Aging Study Amsterdam (LASA). Women had consistently higher levels of frailty than men in all cohorts, ranging from an increase in the mean FI in women from 0.014 in the Health and Retirement Study cohort to 0.046 in the LASA cohort. However, the associations between sex/gender and rate of frailty progression were mixed. There was significant heterogeneity in within-person trajectories of frailty about the mean curves.

Discussion and Implications: Our findings of linear longitudinal increases in frailty highlight important avenues for future research. Specifically, we encourage further research to identify potential effect modifiers or groups that would benefit from targeted or personalized interventions.

%B Innovation In Aging %V 6 %P igab059 %G eng %N 2 %R 10.1093/geroni/igab059 %0 Thesis %B Economics %D 2022 %T Two Essays in Applied Microeconomics: Retirement, Income Inequalities, and Other Economic Indicators of Health and Life Satisfaction %A Akbari, Zahra %K casual effects %K Happiness %K Health Disparities %K job withdrawal %K Self-reported health %K socioeconomic status %X The following proposal includes two essays in applied microeconomics. The first essay studied the relationship between income differences among siblings and the health outcomes of the individuals. Health inequalities and the factors associated with them have been a significant interest of health economists. Among those factors that can lead to health differences in adulthood, many studies have studied financial status. There are still many questions about these factors which should be answered in this area, especially about the adulthood income relative to a reference group and how it can be related to differences in adulthood health. The main goal of this paper was to estimate the relationship between health outcomes and income differences among siblings. We considered the siblings as one of the reference groups that could have a meaningful impact on people’s health. This paper also examined whether the income of siblings can have a causal relationship with the good health of the individuals. The causal association between income differences and health indicators, self-reported general health, was examined using the Wisconsin Longitudinal Study data. The results showed a significant positive relationship between the income of a randomly selected sibling and the health outcome but controlling for the endogeneity of the differences in income made the coefficient of the income differences less significant. The results of the fixed effect model showed that the relationship disappeared when we controlled for individual fixed effects. We also discussed the issues of estimating the relationship with controlling for individual fixed effects and suggested a way to solve the issue. The second essay was on the causal effect of retirement on life satisfaction. The Health and Retirement Study data was used to estimate the impact of retirement on life satisfaction. Additionally, a two-stage process was used to find the potential mechanism through which retirement impacts life satisfaction. Regression discontinuity design was applied to deal with the reverse causality between retirement and life satisfaction. The eligibility age for pension was used as a rule for treatment assignment. The initial result showed that retiring leads to an increased probability of being satisfied with life. Physical activity, sleep quality, and social contacts are how retirement changes life satisfaction. %B Economics %I University of Southern Florida %V Ph.D. %G eng %U https://www.proquest.com/docview/2707997397/abstract/523088815575485FPQ/1?accountid=14667 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Unmet Expectations About Work at Age 62 and Depressive Symptoms. %A Leah R. Abrams %A Philippa J Clarke %A Neil K Mehta %K depression %K Expectations %K Mental Health %K Retirement %X

OBJECTIVES: Exiting the labor force earlier or later than planned is common, with predictable economic consequences. However, the mental health ramifications of such off-time events are not known but are important to promoting well-being in retirement.

METHODS: Using the Health and Retirement Study (1992-2016), we created six groups based on the alignment of expectations about full-time work at age 62 (reported at ages 51-61) with realized labor force status after reaching age 62 (N=10,421). Negative binomial models estimated the adjusted association between unmet expectations about work and depressive symptoms.

RESULTS: Unexpectedly not working was associated with higher depressive symptoms than working as expected after adjusting for sociodemographic, economic, and health factors at the time of expectations (IRR=1.35, 95% CI:1.17, 1.56). Additionally adjusting for health declines and marriage dissolution between expectations and age 62 partially attenuated the association, but unexpectedly not working remained significantly associated with a 1.16 increase in the incidence rate of depressive symptoms. Unexpectedly working at 62 was not associated with depressive symptoms. Race/ethnicity interacted with expectation alignment (F(15,42)=2.44, p=0.0118) in that Hispanic respondents experienced an increase in depressive symptoms when working after unmet and unsure expectations compared to met expectations, whereas white respondents did not.

DISCUSSION: Unlike working longer than expected, unexpectedly not working at 62 was associated with depressive symptoms, even after accounting for health declines. Public and employer policies should assist workers in remaining in the labor force as long as planned and offer mental health supports for unexpected work exits.

%B The Journals of Gerontology, Series B %V 77 %P 615-625 %G eng %N 3 %R 10.1093/geronb/gbab113 %0 Web Page %D 2022 %T When will we care as much about Alzheimer’s as we did about COVID-19? %A Arends, Brett %K Alzheimer %K Dementia %I MarketWatch %G eng %U https://www.marketwatch.com/story/when-will-we-care-as-much-about-alzheimers-as-we-did-about-covid-19-11666801372?mod=mw_latestnews %0 Report %D 2022 %T Work and Retirement of Older Black and Hispanic Adults %A Emma Aguila %A Zeewan Lee %K adults %K black %K Hispanic %K Older %K Retirement %K Work %X Growing U.S. income inequality and the aging of Black and Hispanic populations point to greater risks of financial insecurity for older populations in coming years. Research on retirement determinants for Blacks and Hispanics is limited. Using data from the Health and Retirement Study, we analyze retirement determinants for Blacks and Hispanics. We link this data to the Working Trajectories file and restricted SSA individual-level files to determine Social Security wealth by race and ethnic origin. Using sociodemographic, health, and economic covariates, we construct a conditional probit model that identifies the probability a given individual will retire from the workforce over time. We find that Hispanics, Blacks, and non-Hispanic whites respond similarly to Social Security, private pension incentives, and other institutional (e.g., health insurance) influences on retirement. In their retirement decisions, non-Hispanic Blacks are not responsive to some sociodemographic characteristics (male, couple, and number of household members), but they are responsive to physical and mental health problems. Hispanics are less responsive than non-Hispanic whites to most sociodemographic characteristics (male, education, and couple) and mental health problems in their retirement decisions. Our findings for non-Hispanic whites are consistent with previous literature. Our research can inform programs and policies to improve the quality of life for older adults, especially those isolated by cultural, economic, educational, or other barriers. %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, Michigan %G eng %U https://mrdrc.isr.umich.edu/publications/papers/pdf/wp452.pdf %0 Journal Article %J Ageing and Society %D 2022 %T Work at age 62: expectations and realisations among recent cohorts of Americans %A Leah R. Abrams %A Philippa J Clarke %A Neil K Mehta %K birth cohorts %K Education %K race %K retirement timing %K unmet expectations %K Work %X Much remains unknown about how the 2008 Great Recession, coupled with the ageing baby-boomer cohort, have shaped retirement expectations and realised retirement timing across diverse groups of older Americans. Using the Health and Retirement Study (1992–2016), we compared expectations about full-time work at age 62 (reported at ages 51–61) with realised labour force status at age 62. Of the 12,049 respondents, 34 per cent reported no chance of working full time at 62 (zero probability) and 21 per cent reported it was very likely (90–100 probability). Among those reporting no chance of working, there was a 0.111 probability of unmet expectations; among those with high expectations of working, there was a 0.430 probability of unmet expectations. Black and Hispanic Americans were more likely than white Americans to have unmet expectations of both types. Educational attainment was associated with higher probability of unexpectedly working and lower probability of unexpectedly not working. Baby-boomers experienced fewer unmet expectations than prior cohorts but more uncertainty about work status at 62. Our findings highlight the unpredictability of retirement timing for significant segments of the US population and the role of the Great Recession in contributing to uncertainty. Given the individual and societal benefits of long work lives, special attention should be paid to the high rates of unexpectedly not working at age 62. %B Ageing and Society %V 42 %P 1213-1233 %G eng %N 5 %R 10.1017/S0144686X20001531 %0 Journal Article %J Sleep %D 2021 %T 160 Underlying Factors Contributing to Sleep Health Among Middle-aged and Older Adults %A Lorenz, Rebecca %A Chandola, Varun %A Auerbach, Samantha %A Orom, Heather %A Li, Chin-Shang %A Chang, Yu-Ping %K Sleep %K Sleep disturbance %K sleep quality %X Although poor sleep is not inherent with aging, an estimated 50-70 million adults in the US have insufficient sleep. Sleep duration is increasingly recognized as incomplete and insufficient. Instead, sleep health (SH), a multidimensional concept describing sleep/wake patterns that promote well-being has been shown to better reflect how sleep impacts the individual. Therefore, focusing on the underlying factors contributing to sleep health may provide the opportunity to develop interventions to improve sleep health in middle-age and older adults.Data from the 2014 wave of the Health and Retirement Study (HRS) were used. Sample size was restricted to those who completed an additional questionnaire containing sleep variables. A derivation of the SH composite was constructed using eight selected sleep variables from the HRS data based on the five dimensions of sleep: Satisfaction, Alertness, Timing, Efficiency, and Duration. Total score ranged from 0-100, with higher scores indicating better SH. Weighting variables were based on complex sampling procedures and provided by HRS. Machine learning-based framework was used to identify determinants for predicting SH using twenty-six variables representing individual health and socio-demographics. Penalized linear regression with elastic net penalty was used to study the impact of individual predictors on SH.Our sample included 5,163 adults with a mean age of 67.8 years (SD=9.9; range 50-98 years). The majority were female (59%), white (78%), and married (61%). SH score ranged from 27-61 (mean=50; SD=6.7). Loneliness (coefficient=-1.92), depressive symptoms (coefficient=-1.28), and physical activity (coefficient=1.31) were identified as the strongest predictors of SH. Self-reported health status (coefficient=-1.11), daily pain (coefficient=-0.65), being middle-aged (coefficient=-0.26), and discrimination (coefficient=-0.23) were also significant predictors in this model.Our study identified key predictors of SH among middle-aged and older adults using a novel approach of Machine Learning. Improving SH is a concrete target for health promotion through clinical interventions tailored towards increasing physical activity and reducing loneliness and depressive symptoms among middle-aged adults.This study was supported by National Heart, Lung, and Blood Institute (NHLBI) UB Clinical Scholar Program in Implementation Science to Achieve Triple Aims-NIH K12 Faculty Scholar Program in Implementation Science %B Sleep %V 44 %P A65 - A65 %8 2021 %@ 0161-8105 %G eng %U https://doi.org/10.1093/sleep/zsab072.159 %N Supplement_2 %! Sleep %0 Journal Article %J Lancet %D 2021 %T The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. %A Watts, Nick %A Amann, Markus %A Arnell, Nigel %A Ayeb-Karlsson, Sonja %A Beagley, Jessica %A Belesova, Kristine %A Boykoff, Maxwell %A Byass, Peter %A Cai, Wenjia %A Campbell-Lendrum, Diarmid %A Capstick, Stuart %A Chambers, Jonathan %A Coleman, Samantha %A Dalin, Carole %A Daly, Meaghan %A Dasandi, Niheer %A Dasgupta, Shouro %A Davies, Michael %A Di Napoli, Claudia %A Dominguez-Salas, Paula %A Drummond, Paul %A Dubrow, Robert %A Ebi, Kristie L %A Eckelman, Matthew %A Ekins, Paul %A Escobar, Luis E %A Georgeson, Lucien %A Golder, Su %A Grace, Delia %A Graham, Hilary %A Haggar, Paul %A Hamilton, Ian %A Hartinger, Stella %A Hess, Jeremy %A Hsu, Shih-Che %A Hughes, Nick %A Jankin Mikhaylov, Slava %A Marcia P Jimenez %A Kelman, Ilan %A Kennard, Harry %A Kiesewetter, Gregor %A Kinney, Patrick L %A Kjellstrom, Tord %A Kniveton, Dominic %A Lampard, Pete %A Lemke, Bruno %A Liu, Yang %A Liu, Zhao %A Lott, Melissa %A Lowe, Rachel %A Martinez-Urtaza, Jaime %A Maslin, Mark %A McAllister, Lucy %A McGushin, Alice %A McMichael, Celia %A Milner, James %A Moradi-Lakeh, Maziar %A Morrissey, Karyn %A Munzert, Simon %A Murray, Kris A %A Neville, Tara %A Nilsson, Maria %A Sewe, Maquins Odhiambo %A Oreszczyn, Tadj %A Otto, Matthias %A Owfi, Fereidoon %A Pearman, Olivia %A Pencheon, David %A Quinn, Ruth %A Rabbaniha, Mahnaz %A Robinson, Elizabeth %A Rocklöv, Joacim %A Romanello, Marina %A Semenza, Jan C %A Sherman, Jodi %A Shi, Liuhua %A Springmann, Marco %A Tabatabaei, Meisam %A Taylor, Jonathon %A Triñanes, Joaquin %A Shumake-Guillemot, Joy %A Vu, Bryan %A Wilkinson, Paul %A Winning, Matthew %A Gong, Peng %A Montgomery, Hugh %A Costello, Anthony %K Climate Change %K Conservation of Natural Resources %K COVID-19 %K Extreme Weather %K Global Health %K health policy %K Humans %K International Cooperation %K Pandemics %K SARS-CoV-2 %B Lancet %V 397 %P 129-170 %G eng %N 10269 %R 10.1016/S0140-6736(20)32290-X %0 Journal Article %J Annals of Epidemiology %D 2021 %T Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement Study %A Stolz, Erwin %A Mayerl, Hannes %A Emiel O Hoogendijk %A Armstrong, Joshua J. %A Roller-Wirnsberger, Regina %A Wolfgang Freidl %K Aged %K aged 80 and over %K Death %K Frailty %K Geriatrics %K repeated rounds of survey %X BackgroundLittle is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life.Material and methods23,393 observations from up to the last 21 years of life of 5,713 deceased participants of the AHEAD cohort in the Health and Retirement Study were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual, self- and proxy-reported assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points.ResultsThe average normal (pre-terminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI-value of 0.29 in the total sample, 0.27 for men, and 0.30 for women.ConclusionWe found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30. %B Annals of Epidemiology %V 58 %P 156-161 %@ 1047-2797 %G eng %R 10.1016/j.annepidem.2021.03.008 %0 Journal Article %J The Annals of Applied Statistics %D 2021 %T Assessing selection bias in regression coefficients estimated from nonprobability samples with applications to genetics and demographic surveys %A Brady T. West %A Roderick J.A. Little %A Rebecca R. Andridge %A Philip S. Boonstra %A Erin B Ware %A Anita Pandit %A Fernanda Alvarado-Leiton %K Linear regression %K nonprobability samples %K polygenic scores %K probit regression %K Selection Bias %X Selection bias is a serious potential problem for inference about relationships of scientific interest based on samples without well-defined probability sampling mechanisms. Motivated by the potential for selection bias in: (a) estimated relationships of polygenic scores (PGSs) with phenotypes in genetic studies of volunteers and (b) estimated differences in subgroup means in surveys of smartphone users, we derive novel measures of selection bias for estimates of the coefficients in linear and probit regression models fitted to nonprobability samples, when aggregate-level auxiliary data are available for the selected sample and the target population. The measures arise from normal pattern-mixture models that allow analysts to examine the sensitivity of their inferences to assumptions about nonignorable selection in these samples. We examine the effectiveness of the proposed measures in a simulation study and then use them to quantify the selection bias in: (a) estimated PGS-phenotype relationships in a large study of volunteers recruited via Facebook and (b) estimated subgroup differences in mean past-year employment duration in a nonprobability sample of low-educated smartphone users. We evaluate the performance of the measures in these applications using benchmark estimates from large probability samples. %B The Annals of Applied Statistics %V 15 %P 1556-1581 %G eng %N 3 %R https://doi.org/10.1214/21-AOAS1453 %0 Journal Article %J Alzheimer Disease & Associated Disorders %D 2021 %T The Association Between Cancer and Spousal Rate of Memory Decline: A Negative Control Study to Evaluate (Unmeasured) Social Confounding of the Cancer-memory Relationship. %A Ospina-Romero, Monica %A Willa D Brenowitz %A M. Maria Glymour %A Elizabeth R Mayeda %A Graff, Rebecca E %A Witte, John S %A Ackley, Sarah F %A Lu, Kun Ping %A Lindsay C Kobayashi %K Cancer %K Cognition %K Spouses %X

Cancer diagnoses are associated with better long-term memory in older adults, possibly reflecting a range of social confounders that increase cancer risk but improve memory. We used spouse's memory as a negative control outcome to evaluate this possible confounding, since spouses share social characteristics and environments, and individuals' cancers are unlikely to cause better memory among their spouses. We estimated the association of an individual's incident cancer diagnosis (exposure) with their own (primary outcome) and their spouse's (negative control outcome) memory decline in 3601 couples from 1998 to 2014 in the Health and Retirement Study, using linear mixed-effects models. Incident cancer predicted better long-term memory for the diagnosed individual. We observed no association between an individual's cancer diagnosis and rate of spousal memory decline. This negative control study suggests that the inverse association between incident cancer and rate of memory decline is unlikely to be attributable to social/behavioral factors shared between spouses.

%B Alzheimer Disease & Associated Disorders %V 35 %P 271-274 %G eng %N 3 %R 10.1097/WAD.0000000000000398 %0 Journal Article %J American Journal of Epidemiology %D 2021 %T Association Between Immune Response to Cytomegalovirus and Cognition in the Health and Retirement Study. %A Rebecca C Stebbins %A Grace A Noppert %A Yang Claire Yang %A Jennifer B Dowd %A Simanek, Amanda %A Allison E Aiello %K Alzheimer's disease %K Cognitive decline %K Cytomegalovirus %K Dementia %K Educational attainment %K immune function %X

Chronic infections and the subsequent immune response have recently been shown to be risk factors for cognitive decline and Alzheimer disease and related dementias (ADRD). While some studies have shown an association between cytomegalovirus (CMV), a chronic and highly prevalent infection, and cognition and/or ADRD, these studies have been limited by nonrepresentative and small samples. Using 2016 data on 5,617 adults aged 65 years or more from the Health and Retirement Study, we investigated the cross-sectional associations of both CMV serostatus and immunoglobulin G (IgG) antibody response with cognitive function using linear regression models adjusting for age, sex, race/ethnicity, and educational attainment. We further investigated potential effect-measure modification by educational attainment. Overall, both CMV seropositivity and higher IgG antibody response were associated with lower cognitive function, though the relationship was not statistically significant in adjusted models. Among participants with less than a high school diploma, CMV seropositivity and being in the first tertile of IgG response, relative to seronegative persons, were associated with lower scores on the Telephone Interview for Cognitive Status (-0.56 points (95% confidence interval: -1.63, 0.52) and -0.89 points (95% confidence interval: -2.07, 0.29), respectively), and the relationship was attenuated among those with higher education. Our results suggest that CMV may be a risk factor for cognitive impairment, particularly among persons with fewer educational resources.

%B American Journal of Epidemiology %V 190 %P 786-797 %G eng %N 5 %R 10.1093/aje/kwaa238 %0 Conference Proceedings %B APHA 2021 Annual Meeting and Expo %D 2021 %T Association between insomnia symptoms and incident heart failure among middle-aged and older adults: A population-based cohort study %A Mahmood, Asos %A Ray, Meredith %A Dobalian, Aram %A Kenneth D. Ward %A Ahn, SangNam %K Heart Failure %K insomnia symptoms %X Background. Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue. Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF. Methods. Data were obtained from the Health and Retirement Study in the US for a sample of 12,761 adults (age ≥50 years; mean [SD] age, 66.7 [9.4] years; 57.7% females) who were free from HF at baseline in 2002. Respondents were followed for 16 years for incident HF. We employed marginal structural discretetime survival analyses to adjust for potential time-varying biological, psycho-cognitive, and behavioral factors and to account for bias due to differential loss to follow-up. Results. At baseline, 38.4% of the respondents reported at least one insomnia symptom. During follow-up, 1,730 respondents had incident HF. Respondents experiencing one (hazard ratio [HR]=1.22; 95% CI: 1.08– 1.38), two (HR=1.45; 95% CI: 1.21–1.72), three (HR=1.66; 95% CI: 1.37–2.02), or four (HR=1.80; 95% CI: 1.25–2.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents. Respondents experiencing trouble initiating sleep (HR=1.17; 95%CI: 1.01–1.36), maintaining sleep (HR=1.14; 95% CI: 1.01–1.28), early-morning awakening (HR=1.20; 95% CI: 1.02–1.43), or non-restorative sleep (HR=1.25; 95% CI: 1.06–1.46) had a higher hazard of incident HF than asymptomatic respondents. Conclusions. Insomnia symptoms, both cumulatively and individually, are associated with incident HF. Public health awareness and screening for insomnia symptoms in at-risk populations should be encouraged to reduce HF incidence. %B APHA 2021 Annual Meeting and Expo %G eng %U https://apha.confex.com/apha/2021/meetingapi.cgi/Session/63001?filename=2021_Session63001.pdf&template=Word %0 Journal Article %J Journal of Neurotrauma %D 2021 %T Association Between Lifetime History of Traumatic Brain Injury, Prescription Opioid Use and Persistent Pain: A Nationally Representative Study. %A Raj G. Kumar %A Katherine A Ornstein %A Corrigan, John %A Adams, Rachel Sayko %A Dams-O'Connor, Kristen %K Brain Injuries %K Epidemiology %X

Pain is common among adults with traumatic brain injury (TBI), yet little data exists regarding prevalence of opioid use in this population. The objective of this retrospective cohort study was to evaluate the association between lifetime TBI exposure, opioid use, and pain in a nationally-representative sample of 1,022 adults aged 50+ who participated in the Health and Retirement Study (HRS). Our primary exposure was lifetime TBI history measured via the Ohio State University TBI Identification Method. We evaluated three alternate TBI exposures (years since most recent TBI, age at first TBI, and number of lifetime TBIs) in sensitivity analyses. We evaluated two outcomes: recent opioid medication use, and moderate-to-severe pain measured over two HRS waves. We classified three pain groups (persistent, intermittent, and no pain). Prevalence of opioid use among individuals with and without TBI were 19.7% and 13.6%, respectively. After adjustment for age, sex, and race, individuals with TBI had a 52% increased risk for opioid use compared to individuals without TBI (RR=1.52, 95% CI: 1.11, 2.04). Individuals with recent TBI (1-10 years ago), first TBI after age 40+, and 2+ lifetime TBIs had greatest risk for opioid use. Compared to individuals without TBI, individuals with TBI had 4.9-times increased odds for persistent versus no pain, and 1.9-times increased odds of intermittent versus no pain. Persistent pain among adults with lifetime TBI is elevated compared to the general population, which may contribute to increased opioid use among persons with TBI, particularly those with recent injuries or multiple lifetime TBIs.

%B Journal of Neurotrauma %V 38 %P 2284-2290 %G eng %N 16 %R 10.1089/neu.2020.7496 %0 Journal Article %J JAMA %D 2021 %T Association of Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention With Memory Decline in Older Adults Undergoing Coronary Revascularization %A Elizabeth L Whitlock %A L Grisell Diaz-Ramirez %A Alexander K Smith %A W John Boscardin %A Kenneth E Covinsky %A Michael S. Avidan %A M. Maria Glymour %K cardiology %K cardiothoracic surgery %K ischemic heart disease %X It is uncertain whether coronary artery bypass grafting (CABG) is associated with cognitive decline in older adults compared with a nonsurgical method of coronary revascularization (percutaneous coronary intervention [PCI]).To compare the change in the rate of memory decline after CABG vs PCI.Retrospective cohort study of community-dwelling participants in the Health and Retirement Study, who underwent CABG or PCI between 1998 and 2015 at age 65 years or older. Data were modeled for up to 5 years preceding and 10 years following revascularization or until death, drop out, or the 2016-2017 interview wave. The date of final follow-up was November 2017.CABG (including on and off pump) or PCI, ascertained from Medicare fee-for-service billing records.The primary outcome was a summary measure of cognitive test scores and proxy cognition reports that were performed biennially in the Health and Retirement Study, referred to as memory score, normalized as a z score (ie, mean of 0, SD of 1 in a reference population of adults aged ≥72 years). Memory score was analyzed using multivariable linear mixed-effects models, with a prespecified subgroup analysis of on-pump and off-pump CABG. The minimum clinically important difference was a change of 1 SD of the population-level rate of memory decline (0.048 memory units/y).Of 1680 participants (mean age at procedure, 75 years; 41% female), 665 underwent CABG (168 off pump) and 1015 underwent PCI. In the PCI group, the mean rate of memory decline was 0.064 memory units/y (95% CI, 0.052 to 0.078) before the procedure and 0.060 memory units/y (95% CI, 0.048 to 0.071) after the procedure (within-group change, 0.004 memory units/y [95% CI, −0.010 to 0.018]). In the CABG group, the mean rate of memory decline was 0.049 memory units/y (95% CI, 0.033 to 0.065) before the procedure and 0.059 memory units/y (95% CI, 0.047 to 0.072) after the procedure (within-group change, −0.011 memory units/y [95% CI, −0.029 to 0.008]). The between-group difference-in-differences estimate for memory decline for PCI vs CABG was 0.015 memory units/y (95% CI, −0.008 to 0.038; P = .21). There was statistically significant increase in the rate of memory decline after off-pump CABG compared with after PCI (difference-in-differences: mean increase in the rate of decline of 0.046 memory units/y [95% CI, 0.008 to 0.084] after off-pump CABG), but not after on-pump CABG compared with PCI (difference-in-differences: mean slowing of decline of 0.003 memory units/y [95% CI, −0.024 to 0.031] after on-pump CABG).Among older adults undergoing coronary revascularization with CABG or PCI, the type of revascularization procedure was not significantly associated with differences in the change of rate of memory decline. %B JAMA %V 325 %P 1955-1964 %@ 0098-7484 %G eng %N 19 %R 10.1001/jama.2021.5150 %0 Journal Article %J Seminars in Hearing %D 2021 %T The Association of Vision, Hearing, and Dual-Sensory Loss with Walking Speed and Incident Slow Walking: Longitudinal and Time to Event Analyses in the Health and Retirement Study %A Ahmed F Shakarchi %A Lama Assi %A Gami,Abhishek %A Kohn,Christina %A Joshua R Ehrlich %A Bonnielin K Swenor %A Nicholas S. Reed %K dual-sensory loss %K Hearing loss %K vision loss %K walking speed %X With the aging of the population, vision (VL), hearing (HL), and dual-sensory (DSL, concurrent VL and HL) loss will likely constitute important public health challenges. Walking speed is an indicator of functional status and is associated with mortality. Using the Health and Retirement Study, a nationally representative U.S. cohort, we analyzed the longitudinal relationship between sensory loss and walking speed. In multivariable mixed effects linear models, baseline walking speed was slower by 0.05 m/s (95% confidence interval [CI] = 0.04–0.07) for VL, 0.02 (95% CI = 0.003–0.03) for HL, and 0.07 (95% CI = 0.05–0.08) for DSL compared with those without sensory loss. Similar annual declines in walking speeds occurred in all groups. In time-to-event analyses, the risk of incident slow walking speed (walking speed < 0.6 m/s) was 43% (95% CI = 25–65%), 29% (95% CI = 13–48%), and 35% (95% CI = 13–61%) higher among those with VL, HL, and DSL respectively, relative to those without sensory loss. The risk of incident very slow walking speed (walking speed < 0.4 m/s) was significantly higher among those with HL and DSL relative to those without sensory loss, and significantly higher among those with DSL relative to those with VL or HL alone. Addressing sensory loss and teaching compensatory strategies may help mitigate the effect of sensory loss on walking speed. %B Seminars in Hearing %V 42 %P 75-84 %@ 0734-0451 %G eng %N 1 %R 10.1055/s-0041-1726017 %0 Journal Article %J Alzheimer's & Dementia %D 2021 %T Associations between education and dementia in the Caribbean and the United States: An international comparison. %A Li, Jing %A Llibre-Guerra, Jorge J %A Harrati, Amal %A Weiss, Jordan %A Jiménez-Velázquez, Ivonne Z %A Acosta, Daisy %A Llibre-Rodriguez, Juan de Jesús %A Liu, Mao-Mei %A William H Dow %K Caribbean %K Dementia %K Education %K Hispanics %K Sister studies %X

Introduction: Despite high dementia prevalence in Hispanic populations globally, especially Caribbean Hispanics, no study has comparatively examined the association between education and dementia among Hispanics living in the Caribbean Islands and older adults in the United States.

Methods: We used data on 6107 respondents aged 65 and older in the baseline wave of the population-based and harmonized 10/66 survey from Cuba, the Dominican Republic, and Puerto Rico, collected between 2003 and 2008, and 11,032 respondents aged 65 and older from the U.S.-based Health and Retirement Study data in 2014, a total of 17,139 individuals. We estimated multivariable logistic regression models examining the association between education and dementia, adjusted for age, income, assets, and occupation. The models were estimated separately for the Caribbean population (pooled and by setting) and the U.S. population by race/ethnicity (Hispanic, Black, and White), followed by pooled models across all populations.

Results: In the Caribbean population, the relative risk of dementia among low versus high educated adults was 1.45 for women (95% confidence interval [CI] 1.17, 1.74) and 1.92 (95% CI 1.35, 2.49) for men, smaller compared to those in the United States, especially among non-Hispanic Whites (women: 2.78, 95% CI 1.94, 3.61; men: 5.98, 95% CI 4.02, 7.95).

Discussion: The differential associations between education and dementia across the Caribbean and US settings may be explained by greater disparities in social conditions in the United States compared to the Caribbean, such as access to health care, healthy behaviors, and social stressors, which serve as potentially important mediators.

%B Alzheimer's & Dementia %V 7 %P e12204 %G eng %N 1 %R 10.1002/trc2.12204 %0 Conference Paper %B ISEE Conference Abstracts %D 2021 %T Associations of Long-term Air Pollution Exposure and Incident Late-Life Disability in Older U.S. Adults: The Health Retirement Study %A Gao, Jiaqi %A Carlos F. Mendes de Leon %A D'Souza, Jennifer %A Zhang, Boya %A Szpiro, Adam %A Young, Michael %A Weuve, Jennifer %A Kenneth M. Langa %A Jessica Faul %A Kaufman, Joel %A Richard A Hirth %A Sara Dubowsky Adar %K Activities of Daily Living %K Air Pollution %K Long-Term Exposure %X Late-life disability is of critical concern to older adults and can reflect the cumulative burden of chronic disease over the lifespan. Although air pollution has been associated with many common chronic conditions, associations with disability are understudied. We aimed to quantify associations between long-term exposures to air pollution and late-life disability. METHODS: We used biennial data between 2000 and 2016 on self-reported Activities of Daily Living (ADL) from participants 65 years from the nationally representative Health and Retirement Study. Using a spatiotemporal prediction model, we estimated 10-year PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences. We then estimated the risk of incident ADL disability as a function of time-varying air pollution, adjusting for individual and area-level confounders and sampling weights in a Cox model. We fitted single- and two-pollutant models. RESULTS:Our study population of 16,927 adults (70+6.4 years) was predominantly non-Hispanic White (76%), Non-Hispanic Black (14%), and Hispanic White (8%) and 32% reported a new disability during follow-up. Overall, we found some evidence that air pollution was associated with an increased risk of ADL disability. After adjustment for place and PM2.5, we found that interquartile increases in PM10-2.5 and NO2 were associated with 8% (HR: 1.08 per 5 µg/m3, 95% CI: 1.01, 1.17) and 9% (HR: 1.09 per 6 ppb, 95% CI: 1.00, 1.19) greater hazards of ADL, respectively, with similar findings in the single pollutant models. PM2.5 and O3 were not associated with higher hazards of ADL in single or multipollutant models after detailed adjustment for place. CONCLUSIONS:This prospective study in a nationally representative sample of older adults found some evidence that higher levels of some but not all long-term air pollutants assessed are associated with increased risk of late-life disability. %B ISEE Conference Abstracts %V 2021 %G eng %U https://ehp.niehs.nih.gov/action/doSearch?AllField=Associations+of+Long-term+Air+Pollution+Exposure+and+Incident+Late-Life+Disability+in+Older+U.S.+Adults%3A+The+Health+Retirement+Study %N 1 %0 Report %D 2021 %T A behavioural gap in survival beliefs %A Apicella, Giovanna %A De Giorgi, Enrico G. %K longevity risk %K mortality risk %K sentiment %K subjective beliefs %X Life span uncertainty (longevity risk) impacts several economic decisions. Individuals can form and revise their survival beliefs making use of behavioural heuristics. We propose a model of sentiment, in which individuals are assumed to switch between optimistic and pessimistic expectations on their health. When optimism is persistent in the face of health shocks, or when individuals are more likely to change their sentiment from pessimistic to optimistic than otherwise, our model predicts survival under-estimation at young ages and over-estimation at old ages. An empirical analysis based on the longitudinal data from the Health and Retirement Study (HRS) validates our model. %G eng %R 10.2139/ssrn.3821595 %0 Journal Article %J The Journals of Gerontology, Series A %D 2021 %T Cardiometabolic Risk Trajectory among Older Americans: Findings from the Health and Retirement Study. %A Wu, Qiao %A Jennifer A Ailshire %A Jung K Kim %A Eileen M. Crimmins %K cardiovascular %K Change with age %K Medication %K Metabolism %X

BACKGROUND: Cardiometabolic risk (CMR) is a key indicator of physiological decline with age; but age-related declines in a nationally representative older U.S. population have not been previously examined.

METHODS: We examined the trajectory of cardiometabolic risk (CMR) over 8 years of aging, from 2006/2008 to 2014/2016, among 3,528 people over age 50 in the Health and Retirement Study. We used growth curve models to examine change in total CMR as well as in individual cardiometabolic biomarkers to understand how baseline differences and rates of change vary across sociodemographic characteristics, by smoking status, and medication use.

RESULTS: Total CMR did not change among respondents who survived over 8 years. Despite significant differences in CMR across demographic and education groups at baseline, the pace of change with age did not differ by these characteristics. Among individual biomarkers, risk levels of diastolic blood pressure, resting heart rate, and total cholesterol decreased over 8 years while glycosylated hemoglobin, waist circumference, and pulse pressure increased over that time. Both the statistical significance levels and the magnitudes of the reduction over time with age in diastolic blood pressure, resting heart rate, and total cholesterol in models adjusted for age, race/ethnicity, gender, smoking, and education were reduced after controlling for blood pressure and cholesterol medication.

CONCLUSIONS: The relatively constant total CMR level over 8 years occurred because some indicators improved with age while some deteriorated in this period. Medication use contributed to the improvement in blood pressure, resting heart rate, and total cholesterol.

%B The Journals of Gerontology, Series A %V 76 %P 2265-2274 %G eng %N 12 %R 10.1093/gerona/glab205 %0 Report %D 2021 %T The Causes and Consequences of Opioid Use among Older Americans: A Panel Survey Approach %A Philip Armour %A Smart, Rosanna %A Brennan, Elliott %K causes %K consequences %K Opioids %X The research reported herein was performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium through the University of Michigan Retirement and Disability Research Center Award RDR18000002-02. The opinions and conclusions expressed are solely those of the author(s) and do not represent the opinions or policy of SSA or any agency of the federal government. Neither the United States government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States government or any agency thereof. %B MRDRC Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/publications/papers/pdf/wp419.pdf %0 Journal Article %J The Journal of Gerontology: Series B %D 2021 %T Changes in Health Care Access and Utilization for Low-SES Adults Age 51-64 after Medicaid Expansion. %A Tipirneni, Renuka %A Helen G Levy %A Kenneth M. Langa %A Ryan J McCammon %A Zivin, Kara %A Jamie E Luster %A Karmakar, Monita %A John Z. Ayanian %K Affordable Care Act %K Hospitalization %K Medicaid %K Retirement %X

OBJECTIVES: Whether the Affordable Care Act (ACA) insurance expansions improved access to care and health for adults age 51-64 has not been closely examined. This study examined longitudinal changes in access, utilization, and health for low-socioeconomic status adults age 51-64 before and after the ACA Medicaid expansion.

METHODS: Longitudinal difference-in-differences (DID) study before (2010-2014) and after (2016) Medicaid expansion, including N=2,088 noninstitutionalized low-education adults age 51-64 (N=633 in Medicaid expansion states, N=1,455 in non-expansion states) from the nationally representative biennial Health and Retirement Study. Outcomes included coverage (any, Medicaid, private), access (usual source of care, difficulty finding doctor, foregone care, cost-related medication nonadherence, out-of-pocket costs), utilization (outpatient visit, hospitalization), and health status.

RESULTS: Low-education adults age 51-64 had increased rates of Medicaid coverage (+10.6 percentage points [pp] in expansion states, +3.2 pp in non-expansion states, DID +7.4 pp, p=0.001) and increased likelihood of hospitalizations (+9.2 pp in expansion states, -1.1 pp in non-expansion states, DID +10.4 pp, p=0.003) in Medicaid expansion compared with non-expansion states after 2014. Those in expansion states also had a smaller increase in limitations in paid work/housework over time, compared to those in non-expansion states (+3.6 pp in expansion states, +11.0 pp in non-expansion states, DID -7.5 pp, p=0.006). There were no other significant differences in access, utilization or health trends between expansion and non-expansion states.

DISCUSSION: After Medicaid expansion, low-education status adults age 51-64 were more likely to be hospitalized, suggesting poor baseline access to chronic disease management and pent-up demand for hospital services.

%B The Journal of Gerontology: Series B %V 76 %P 1218-1230 %G eng %N 6 %R 10.1093/geronb/gbaa123 %0 Report %D 2021 %T The Changing Picture of Who Claims Social Security Early %A Philip Armour %A Knapp, David %K claims %K Retirement %K Social Security %X The authors identify the demographic, employment, and economic characteristics associated with those who claim at the EEA and relate these characteristics to people who claim after it. %B Research Report %I AARP Public Policy Institute %C Washington, D.C. %G eng %R 10.26419/ppi.00133.001 %0 Report %D 2021 %T The Changing Relationship between Bodyweight and Longevity in High- and Low-Income Countries %A Joanna Aleksandra Kopinska %A Atella, Vincenzo %A Bhattacharya, Jay %A Grant Miller %K BMI %K Income %K MHAS %K Technology %X Standard measures of bodyweight (overweight and obese, for example) fail to reflect technological progress over time - and in particular, recent progress disproportionately promoting longevity at higher bodyweights (and differences in access to it). This paper builds on the pioneering work of Hans Waaler (Waaler, 1984) and Robert Fogel (Fogel, 1994) to empirically estimate how technological progress, and differential access to it, have fundamentally transformed the relationship between body mass index (BMI) and longevity in high-, middle-, and low-income countries. Importantly, we show that the combined effect of technological progress and access to it across countries is so profound that the share of national populations above mortality-minimizing bodyweight is not clearly greater in countries with higher overweight and obesity rates (as traditionally defined) - and in fact, relative to current standards, a larger share of low-income countries’ populations can be unhealthily heavy. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w28813 %0 Journal Article %J Age and Ageing %D 2021 %T Cognitive health expectancies of cardiovascular risk factors for cognitive decline and dementia. %A Zheng, Lidan %A Fiona E Matthews %A Kaarin J. Anstey %K Cardiovascular disease %K cognitive health expectancy %K cognitive impairment %X

BACKGROUND: Cognitive health expectancy estimates the proportion of the lifespan that is lived in good cognitive health at the population level. A number of cardiovascular diseases have been identified to be risk factors for cognitive decline and dementia including diabetes, stroke, heart diseases and hypertension. The aim of this study was to examine how these cardiovascular conditions relate to cognitive health expectancy.

METHODS: Longitudinal data were obtained from the US Health and Retirement Study. Multistate modelling was used to estimate total life expectancy (LE), cognitive impairment free life expectancy (CIFLE) and years spent with cognitive impairment (CILE) across self-reported diabetes, hypertension, heart problems and stroke. Individual and cumulative effects of multiple cardiovascular conditions were examined.

RESULTS: The presence of cardiovascular disease was associated with a 5- to 9-year decrease in LE and 4- to 8-year decrease in CIFLE at age 55. The outcomes varied in a hierarchical fashion by cardiovascular condition. Relative to other conditions, individuals with stroke had the shortest LE and CIFLE. Analysis of multiple cardiovascular risk factors revealed that each additional cardiovascular condition was associated with an exponential decrease in LE and CIFLE.

CONCLUSIONS: Having a cardiovascular condition is associated with a lower CIFLE and higher proportion of life lived with cognitive impairment. However, the outcomes vary depending on the type of cardiovascular condition. Reducing incidence of stroke and minimising exposure to multiple cardiovascular risk factors may be beneficial in helping to improve population estimates of cognitive health expectancy.

%B Age and Ageing %V 50 %P 169-175 %G eng %N 1 %R 10.1093/ageing/afaa111 %0 Web Page %D 2021 %T The Consequences of Claiming Social Security Benefits at Age 62 %A Philip Armour %A Knapp, David %K consequences %K Social Security %X As individuals approach their 60s, they face the important decision about when to start claiming Social Security retirement benefits. “The Consequences of Claiming Social Security Benefits at Age 62” by Philip Armour and David Knapp of the RAND Corporation asks what financial consequences the decision to collect early might have for the individual over time. A companion report, “The Changing Picture of Who Claims Social Security Early,” examines the characteristics of those who decide to start collecting at the early eligibility age (EEA) of 62 compared with those who wait. Importantly, that study suggests that employment losses resulting from the COVID-19 recession may lead to earlier claiming—in particular among those with less education and those living in more rural areas. As the current study shows, this could have significant implications for the financial security of a whole cohort of retirees in the coming decades given the penalties associated with early claiming. %I AARP Public Policy Institute %C Washington, D.C. %G eng %U https://www.aarp.org/ppi/info-2021/-the-consequences-of-claiming-social-security-benefits-at-age-62.html %0 Report %D 2021 %T The Consequences of Claiming Social Security Benefits at Age 62 %A Philip Armour %A Knapp, David %K consequences %K Social Security %X As individuals approach their 60s, they face the important decision about when to start claiming Social Security retirement benefits. “The Consequences of Claiming Social Security Benefits at Age 62” by Philip Armour and David Knapp of the RAND Corporation asks what financial consequences the decision to collect early might have for the individual over time. A companion report, “The Changing Picture of Who Claims Social Security Early,” examines the characteristics of those who decide to start collecting at the early eligibility age (EEA) of 62 compared with those who wait. Importantly, that study suggests that employment losses resulting from the COVID-19 recession may lead to earlier claiming—in particular among those with less education and those living in more rural areas. As the current study shows, this could have significant implications for the financial security of a whole cohort of retirees in the coming decades given the penalties associated with early claiming. %I AARP Public Policy Institute %C Washington, D.C. %G eng %R 10.26419/ppi.00134.001 %0 Report %D 2021 %T The Cost of Worrying About an Epidemic: Ebola Concern and Cognitive Function in the US %A Apenbrink, Christian %K cognitive function %K Ebola %K Emotions %K Epidemics %K Fear %K Worry %X Do emotional responses to the spread of an infectious disease affect the quality of economic decision-making? In the context of an episode of heightened public concern about Ebola in the US in October 2014, I document that worrying about the possibility of an epidemic can impair cognitive function. My analysis relies on data from cognitive tests administered as part of a wave of survey interviews by a large US panel study, which I combine with measures of local concern about Ebola based on internet search volume. For identification, I exploit temporal and spatial variation in Ebola concern caused by the emergence of four cases of Ebola that were diagnosed in the US. Using proximity to the US cases as an instrumental variable, I show that the local level of Ebola concern individuals are exposed to at the time and place of the interview reduces their scores on the cognitive test. In additional analyses, I find no indication of fear-induced selection effects that could plausibly explain these results. Moreover, proximity to subsequent Ebola locations is unrelated to test scores for interviews conducted before the emergence of the first US case. My findings indicate that emotional responses to epidemics can entail a temporary cognitive cost even for individuals for whom the actual health risk never materializes. %B ECONtribute Discussion Paper %I ECONtribute %G eng %U https://www.econtribute.de/RePEc/ajk/ajkdps/ECONtribute_120_2021.pdf %0 Journal Article %J Addiction %D 2021 %T Cross-country differences in age trends in alcohol consumption among older adults: a cross-sectional study of individuals aged 50 years and older in 22 countries. %A Calvo, Esteban %A Allel, Kasim %A Ursula M. Staudinger %A Castillo-Carniglia, Alvaro %A Medina, José T %A Katherine M Keyes %K alcohol %K cross-cultural %K development %K drink %K global %K Mixed model %K multi-level %X

BACKGROUND AND AIMS: Age-related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross-national variation in the quantity and patterns of drinking throughout older age, and to investigate country-level variables explaining cross-national variation in consumption for individuals aged 50 years and older.

DESIGN: Cross-sectional observational study using previously harmonized survey data.

SETTING: Twenty-two countries surveyed in 2010 or the closest available year.

PARTICIPANTS: A total of 106 180 adults aged 50 years and over.

MEASUREMENTS: Cross-national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country-level variables moderating age-related declines in drinking.

FINDINGS: Alcohol consumption was negatively associated with age (risk ratio = 0.98; 95% confidence interval = 0.97, 0.99; P-value < 0.001), but there was substantial cross-country variation in the age-related differences in alcohol consumption [likelihood ratio (LR) test P-value < 0.001], even after adjusting for the composition of populations. Countries' development level and alcohol prices explained 31% of cross-country variability in SDUs (LR test P-value < 0.001) but did not explain cross-country variability in the prevalence of heavy drinkers.

CONCLUSIONS: Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country-specific composition of populations and country-level contextual factors such as development level and alcohol prices.

%B Addiction %V 116 %P 1399-1412 %G eng %N 6 %R 10.1111/add.15292 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Dementia and Cognitive Decline in Older Adulthood: Are Agricultural Workers at Greater Risk? %A Arora, Kanika %A Xu, Lili %A Bhagianadh, Divya %K agriculture %K cognitive functioning %K Dementia %K growth curve models %X

OBJECTIVES: To examine whether long-term exposure to agricultural work is associated with dementia prevalence and the rate of cognitive change in older adulthood.

METHODS: We employed data from the Health and Retirement Study (1998-2014). Multiple logistic regression was used to determine whether a longest-held job in the agricultural sector was associated with differences in dementia prevalence. We examined if hearing impairment, depression and physical health indicators mediated the relationship between agricultural work and cognitive functioning. Sub-group analyses were done by age, retirement status, job tenure, and cognitive domain. We employed growth curve models to investigate implications of agricultural work on age trajectories of cognitive functioning.

RESULTS: Longest-held job in agriculture, fishing, and forestry (AFF) was associated with 46% greater odds of having dementia. The relationship between AFF exposure and cognitive functioning was not mediated by hearing impairment, depression, or physical health indicators. Results were stronger among younger and retired older adults as well as those with extensive job tenure. AFF exposure was associated with lower scores in working memory and attention and processing speed. Growth curve models indicated that while agricultural work exposure was associated with lower initial levels of cognitive functioning, over time the pattern reversed with individuals in non-AFF jobs showing more accelerated cognitive decline.

DISCUSSION: Consistent with European studies, results from the U.S. also demonstrate a higher prevalence of dementia among agricultural workers. The cognitive reserve framework may explain the seemingly paradoxical result on age patterning of cognitive performance across older adults with different work histories.

%B The Journals of Gerontology: Series B %V 76 %P 1629-1643 %G eng %N 8 %R 10.1093/geronb/gbab005 %0 Journal Article %J BMJ Open %D 2021 %T Dementia and disadvantage in the USA and England: population-based comparative study. %A Arapakis, Karolos %A Brunner, Eric %A Eric French %A McCauley, Jeremy %K Dementia %K Health Economics %K Public Health %X

OBJECTIVES: To compare dementia prevalence and how it varies by socioeconomic status (SES) across the USA and England.

DESIGN: Population-based comparative study.

SETTING: Non-Hispanic whites aged over 70 population in the USA and England.

PARTICIPANTS: Data from the Health and Retirement Study and the English Longitudinal Study of Ageing, which are harmonised, nationally representative panel studies. The sample includes 5330 and 3147 individuals in the USA and England, respectively.

MAIN OUTCOME MEASURES: Between country differences in age-gender standardised dementia prevalence, across the SES gradient. Dementia prevalence was estimated in each country using an algorithm based on an identical battery of demographic, cognitive and functional measures.

RESULTS: Dementia prevalence is higher among the disadvantaged in both countries, with the USA being more unequal according to four measures of SES. Overall prevalence was lower in England at 9.7% (95% CI 8.9% to 10.6%) than the USA at 11.2% (95% CI 10.6% to 11.8%), a difference of 1.4 percentage points (pp) (p=0.0055). Most of the between country difference is driven by the bottom of the SES distribution. In the lowest income decile individuals in the USA had 7.3 pp (p<0.0001) higher prevalence than in England. Once past health factors and education were controlled for, most of the within country inequalities disappeared; however, the cross-country difference in prevalence for those in lowest income decile remained disproportionately high.

CONCLUSIONS: There is inequality in dementia prevalence according to income, wealth and education in both the USA and England. England has lower dementia prevalence and a less steep SES gradient. Most of the cross-country difference is concentrated in the lowest SES group, which provides evidence that disadvantage in the USA is a disproportionately high risk factor for dementia.

%B BMJ Open %V 11 %P e045186 %G eng %N 10 %R 10.1136/bmjopen-2020-045186 %0 Journal Article %J BMC Medical Research Methodology %D 2021 %T Development and validation of prediction model to estimate 10-year risk of all-cause mortality using modern statistical learning methods: a large population-based cohort study and external validation. %A Ajnakina, Olesya %A Agbedjro, Deborah %A Ryan J McCammon %A Jessica Faul %A Murray, Robin M %A Stahl, Daniel %A Andrew Steptoe %K Absolute risk %K Mortality %K Population-based longitudinal study %K Prognostic factors %K Statistical learning %K Survival %X

BACKGROUND: In increasingly ageing populations, there is an emergent need to develop a robust prediction model for estimating an individual absolute risk for all-cause mortality, so that relevant assessments and interventions can be targeted appropriately. The objective of the study was to derive, evaluate and validate (internally and externally) a risk prediction model allowing rapid estimations of an absolute risk of all-cause mortality in the following 10 years.

METHODS: For the model development, data came from English Longitudinal Study of Ageing study, which comprised 9154 population-representative individuals aged 50-75 years, 1240 (13.5%) of whom died during the 10-year follow-up. Internal validation was carried out using Harrell's optimism-correction procedure; external validation was carried out using Health and Retirement Study (HRS), which is a nationally representative longitudinal survey of adults aged ≥50 years residing in the United States. Cox proportional hazards model with regularisation by the least absolute shrinkage and selection operator, where optimisation parameters were chosen based on repeated cross-validation, was employed for variable selection and model fitting. Measures of calibration, discrimination, sensitivity and specificity were determined in the development and validation cohorts.

RESULTS: The model selected 13 prognostic factors of all-cause mortality encompassing information on demographic characteristics, health comorbidity, lifestyle and cognitive functioning. The internally validated model had good discriminatory ability (c-index=0.74), specificity (72.5%) and sensitivity (73.0%). Following external validation, the model's prediction accuracy remained within a clinically acceptable range (c-index=0.69, calibration slope β=0.80, specificity=71.5% and sensitivity=70.6%). The main limitation of our model is twofold: 1) it may not be applicable to nursing home and other institutional populations, and 2) it was developed and validated in the cohorts with predominately white ethnicity.

CONCLUSIONS: A new prediction model that quantifies absolute risk of all-cause mortality in the following 10-years in the general population has been developed and externally validated. It has good prediction accuracy and is based on variables that are available in a variety of care and research settings. This model can facilitate identification of high risk for all-cause mortality older adults for further assessment or interventions.

%B BMC Medical Research Methodology %V 21 %P 8 %G eng %N 1 %R 10.1186/s12874-020-01204-7 %0 Journal Article %J International Journal of Epidemiology %D 2021 %T Development of a common scale for measuring healthy ageing across the world: results from the ATHLOS consortium. %A Sanchez-Niubo, Albert %A Forero, Carlos G %A Wu, Yu-Tzu %A Giné-Vázquez, Iago %A Prina, Matthew %A de la Fuente, Javier %A Daskalopoulou, Christina %A Critselis, Elena %A De La Torre-Luque, Alejandro %A Panagiotakos, Demosthenes %A Arndt, Holger %A Ayuso-Mateos, José Luis %A Bayes-Marin, Ivet %A Bickenbach, Jerome %A Bobak, Martin %A Caballero, Francisco Félix %A Chatterji, Somnath %A Egea-Cortés, Laia %A García-Esquinas, Esther %A Leonardi, Matilde %A Koskinen, Seppo %A Koupil, Ilona %A Mellor-Marsá, Blanca %A Olaya, Beatriz %A Pająk, Andrzej %A Prince, Martin %A Raggi, Alberto %A Rodríguez-Artalejo, Fernando %A Sanderson, Warren %A Scherbov, Sergei %A Tamosiunas, Abdonas %A Tobias-Adamczyk, Beata %A Tyrovolas, Stefanos %A Haro, Josep Maria %K Aging %K Cohort Studies %K Health Status %K healthy aging %K Humans %K Reproducibility of Results %X

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

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

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

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

%B International Journal of Epidemiology %V 50 %P 880-892 %G eng %N 3 %R 10.1093/ije/dyaa236 %0 Book Section %B Administrative Records for Survey Methodology %D 2021 %T Disclosure Limitation and Confidentiality Protection in Linked Data %A Abowd, John M. %A Schmutte, Ian M. %A Vilhuber, Lars %E Asaph Young Chun %E Larsen, Michael D. %E Durrant, Gabriele %E Reiter, Jerome P. %K confidentiality protection %K disclosure limitation %K legal protections %K physical protections %K Restricted data %K Social Security Administration %X This chapter provides an overview of the methods that have been developed and implemented to safeguard privacy, while providing researchers the means to draw valid conclusions from protected data. It focuses on the protections that pertain to the linked nature of the data. The protection mechanisms are both physical and statistical, but exist because of the need to balance the privacy of the respondents, including the confidentiality protection their data receive, with society's need and desire for ever more detailed, timely, and accurate statistics. To illustrate the application of new disclosure avoidance techniques, the chapter describes three examples of linked data and the means by which confidentiality protection is applied to each. Health and Retirement Study–Social Security Administration (SSA) data, Survey of Income and Program Participation–SSA–Internal Revenue Service, inked Establishment and Employee Records Several methods are currently used by national statistical offices and other data collecting agencies to provide access to confidential data. %B Administrative Records for Survey Methodology %I John Wiley & Sons, Ltd %P 25-59 %@ 9781119272076 %G eng %& 2 %R https://doi.org/10.1002/9781119272076.ch2 %0 Journal Article %J The American Journal of Human Genetics %D 2021 %T Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry. %A Graff, Mariaelisa %A Justice, Anne E %A Young, Kristin L %A Marouli, Eirini %A Zhang, Xinruo %A Fine, Rebecca S %A Lim, Elise %A Buchanan, Victoria %A Rand, Kristin %A Feitosa, Mary F %A Wojczynski, Mary K %A Yanek, Lisa R %A Shao, Yaming %A Rohde, Rebecca %A Adeyemo, Adebowale A %A Aldrich, Melinda C %A Matthew A. Allison %A Ambrosone, Christine B %A Ambs, Stefan %A Amos, Christopher %A Donna K Arnett %A Atwood, Larry %A Bandera, Elisa V %A Traci M Bartz %A Becker, Diane M %A Berndt, Sonja I %A Bernstein, Leslie %A Bielak, Lawrence F %A Blot, William J %A Erwin P Bottinger %A Bowden, Donald W %A Bradfield, Jonathan P %A Brody, Jennifer A %A Broeckel, Ulrich %A Burke, Gregory %A Brian E Cade %A Cai, Qiuyin %A Caporaso, Neil %A Carlson, Chris %A John Carpten %A Casey, Graham %A Chanock, Stephen J %A Chen, Guanjie %A Chen, Minhui %A Chen, Yii-Der I %A Chen, Wei-Min %A Chesi, Alessandra %A Chiang, Charleston W K %A Chu, Lisa %A Coetzee, Gerry A %A Conti, David V %A Cooper, Richard S %A Cushman, Mary %A Ellen W Demerath %A Deming, Sandra L %A Dimitrov, Latchezar %A Ding, Jingzhong %A Diver, W Ryan %A Duan, Qing %A Michele K Evans %A Falusi, Adeyinka G %A Jessica Faul %A Myriam Fornage %A Caroline S Fox %A Freedman, Barry I %A Garcia, Melissa %A Gillanders, Elizabeth M %A Phyllis J Goodman %A Gottesman, Omri %A Grant, Struan F A %A Guo, Xiuqing %A Hakonarson, Hakon %A Haritunians, Talin %A Tamara B Harris %A Harris, Curtis C %A Henderson, Brian E %A Hennis, Anselm %A Dena G Hernandez %A Hirschhorn, Joel N %A McNeill, Lorna Haughton %A Howard, Timothy D %A Howard, Barbara %A Hsing, Ann W %A Hsu, Yu-Han H %A Hu, Jennifer J %A Huff, Chad D %A Huo, Dezheng %A Ingles, Sue A %A Irvin, Marguerite R %A John, Esther M %A Johnson, Karen C %A Jordan, Joanne M %A Kabagambe, Edmond K %A Kang, Sun J %A Sharon L R Kardia %A Keating, Brendan J %A Rick A Kittles %A Eric A Klein %A Kolb, Suzanne %A Kolonel, Laurence N %A Charles Kooperberg %A Kuller, Lewis %A Kutlar, Abdullah %A Leslie A Lange %A Langefeld, Carl D %A Loic Le Marchand %A Leonard, Hampton %A Lettre, Guillaume %A Levin, Albert M %A Li, Yun %A Li, Jin %A Liu, Yongmei %A Liu, Youfang %A Liu, Simin %A Kurt Lohman %A Lotay, Vaneet %A Lu, Yingchang %A Maixner, William %A JoAnn E Manson %A McKnight, Barbara %A Meng, Yan %A Monda, Keri L %A Monroe, Kris %A Moore, Jason H %A Thomas H Mosley %A Mudgal, Poorva %A Murphy, Adam B %A Nadukuru, Rajiv %A Michael A Nalls %A Nathanson, Katherine L %A Nayak, Uma %A N'Diaye, Amidou %A Nemesure, Barbara %A Neslund-Dudas, Christine %A Neuhouser, Marian L %A Nyante, Sarah %A Ochs-Balcom, Heather %A Ogundiran, Temidayo O %A Ogunniyi, Adesola %A Ojengbede, Oladosu %A Okut, Hayrettin %A Olopade, Olufunmilayo I %A Olshan, Andrew %A Padhukasahasram, Badri %A Palmer, Julie %A Palmer, Cameron D %A Palmer, Nicholette D %A George J Papanicolaou %A Patel, Sanjay R %A Pettaway, Curtis A %A Peyser, Patricia A %A Press, Michael F %A Rao, D C %A Rasmussen-Torvik, Laura J %A Redline, Susan %A Reiner, Alex P %A Rhie, Suhn K %A Rodriguez-Gil, Jorge L %A Charles N Rotimi %A Rotter, Jerome I %A Ruiz-Narvaez, Edward A %A Rybicki, Benjamin A %A Babatunde Salako %A Sale, Michele M %A Sanderson, Maureen %A Eric E Schadt %A Schreiner, Pamela J %A Schurmann, Claudia %A Schwartz, Ann G %A Daniel Shriner %A Signorello, Lisa B %A Andrew B Singleton %A David S Siscovick %A Smith, Jennifer A %A Smith, Shad %A Elizabeth K Speliotes %A Spitz, Margaret %A Stanford, Janet L %A Stevens, Victoria L %A Stram, Alex %A Strom, Sara S %A Sucheston, Lara %A Yan V Sun %A Tajuddin, Salman M %A Taylor, Herman %A Taylor, Kira %A Bamidele O Tayo %A Michael J Thun %A Tucker, Margaret A %A Vaidya, Dhananjay %A Van Den Berg, David J %A Vedantam, Sailaja %A Vitolins, Mara %A Wang, Zhaoming %A Erin B Ware %A Wassertheil-Smoller, Sylvia %A David R Weir %A Wiencke, John K %A Williams, Scott M %A L Keoki Williams %A Wilson, James G %A Witte, John S %A Wrensch, Margaret %A Wu, Xifeng %A Yao, Jie %A Zakai, Neil %A Zanetti, Krista %A Zemel, Babette S %A Zhao, Wei %A Jing Hua Zhao %A Zheng, Wei %A Zhi, Degui %A Zhou, Jie %A Zhu, Xiaofeng %A Ziegler, Regina G %A Zmuda, Joe %A Alan B Zonderman %A Psaty, Bruce M %A Ingrid B Borecki %A Cupples, L Adrienne %A Liu, Ching-Ti %A Christopher A Haiman %A Ruth J F Loos %A Ng, Maggie C Y %A Kari E North %K Africa %K African Americans %K Blacks %K Body Height %K Europe %K Female %K Genome-Wide Association Study %K Humans %K Male %K Polymorphism, Single Nucleotide %X

Although many loci have been associated with height in European ancestry populations, very few have been identified in African ancestry individuals. Furthermore, many of the known loci have yet to be generalized to and fine-mapped within a large-scale African ancestry sample. We performed sex-combined and sex-stratified meta-analyses in up to 52,764 individuals with height and genome-wide genotyping data from the African Ancestry Anthropometry Genetics Consortium (AAAGC). We additionally combined our African ancestry meta-analysis results with published European genome-wide association study (GWAS) data. In the African ancestry analyses, we identified three novel loci (SLC4A3, NCOA2, ECD/FAM149B1) in sex-combined results and two loci (CRB1, KLF6) in women only. In the African plus European sex-combined GWAS, we identified an additional three novel loci (RCCD1, G6PC3, CEP95) which were equally driven by AAAGC and European results. Among 39 genome-wide significant signals at known loci, conditioning index SNPs from European studies identified 20 secondary signals. Two of the 20 new secondary signals and none of the 8 novel loci had minor allele frequencies (MAF) < 5%. Of 802 known European height signals, 643 displayed directionally consistent associations with height, of which 205 were nominally significant (p < 0.05) in the African ancestry sex-combined sample. Furthermore, 148 of 241 loci contained ≤20 variants in the credible sets that jointly account for 99% of the posterior probability of driving the associations. In summary, trans-ethnic meta-analyses revealed novel signals and further improved fine-mapping of putative causal variants in loci shared between African and European ancestry populations.

%B The American Journal of Human Genetics %V 108 %P 564-582 %G eng %N 4 %R 10.1016/j.ajhg.2021.02.011 %0 Conference Paper %B Retirement and Disability Research Consortium 23rd Annual Meeting %D 2021 %T On the Distribution and Dynamics of Medical Expenditure among the Elderly %A Arapakis, Karolos %A Eric French %A John Bailey Jones %A McCauley, Jeremy %K dynamics %K Medicaid %K Medical spending %K Medicare %X Using data from the Health and Retirement Study (HRS), we estimate the stochastic process for total medical spending and its components. By focussing on dynamics, we consider not only the risk of catastrophic expenses in a single year, but also the risk of moderate but persistent expenses that accumulate into a catastrophic lifetime cost. We also assess the reduction in out-of-pocket medical spending risk provided by public insurance schemes such as Medicare or Medicaid. %B Retirement and Disability Research Consortium 23rd Annual Meeting %I Center for Financial Security, University of Wisconsin-Madison %C Virtual Event %8 08/2021 %G eng %U https://cfsrdrc.wisc.edu/files/2021-RDRC-Meeting-Booklet.pdf#page=7 %0 Journal Article %J Scientific Reports %D 2021 %T The dynamic association between body mass index and cognition from midlife through late-life, and the effect of sex and genetic influences %A Ida Karlsson %A Margaret Gatz %A Thalida E. Arpawong %A Anna K. Dahl Aslan %A Chandra A Reynolds %K Cognition %K Epidemiology %K Genetics %K longitudinal %K Obesity %X Body mass index (BMI) is associated with cognitive abilities, but the nature of the relationship remains largely unexplored. We aimed to investigate the bidirectional relationship from midlife through late-life, while considering sex differences and genetic predisposition to higher BMI. We used data from 23,892 individuals of European ancestry from the Health and Retirement Study, with longitudinal data on BMI and three established cognitive indices: mental status, episodic memory, and their sum, called total cognition. To investigate the dynamic relationship between BMI and cognitive abilities, we applied dual change score models of change from age 50 through 89, with a breakpoint at age 65 or 70. Models were further stratified by sex and genetic predisposition to higher BMI using tertiles of a polygenic score for BMI (PGSBMI). We demonstrated bidirectional effects between BMI and all three cognitive indices, with higher BMI contributing to steeper decline in cognitive abilities in both midlife and late-life, and higher cognitive abilities contributing to less decline in BMI in late-life.&nbsp;The effects of BMI on change in cognitive abilities were more evident in men compared to women, and among those in the lowest tertile of the PGSBMI compared to those in the highest tertile, while the effects of cognition on BMI were similar across groups. In conclusion, these findings highlight a reciprocal relationship between BMI and cognitive abilities, indicating that the negative effects of a higher BMI persist from midlife through late-life, and that weight-loss in late-life may be driven by cognitive decline. %B Scientific Reports %V 11 %P 7206 %@ 2693-5015 %G eng %N 1 %R 10.21203/rs.3.rs-186197/v1 %0 Journal Article %J Journal of Alzheimer's Disease %D 2021 %T Education Differences in the Adverse Impact of PM2.5 on Incident Cognitive Impairment Among U.S. Older Adults. %A Jennifer A Ailshire %A Katrina M Walsemann %K Aging %K Air Pollution %K Cognition %K Dementia %K Education %K Modifiable risk factors %X

BACKGROUND: Air pollution is linked to worse cognitive function in older adults, but whether differences in this relationship exist by education, a key risk factor for cognitive decline, remains unknown.

OBJECTIVE: To determine if the association between fine particulate matter air pollution (PM2.5) and incident cognitive impairment varies by level of education in two cohorts assessed a decade apart.

METHODS: We used data on adults ages 60 and older from the nationally representative Health and Retirement Study (HRS) linked with tract-level annual average PM2.5. We used mixed-effects logistic regression models to examine education differences in the association between PM2.5 and incident cognitive impairment in two cohorts: 2004 (n = 9,970) and 2014 (n = 9,185). Cognitive impairment was determined with tests of memory and processing speed for self-respondents and proxy and interviewer assessments of cognitive functioning in non-self-respondents.

RESULTS: PM2.5 was unrelated to incident cognitive impairment among those with 13 or more years of education, but the probability of impairment increased with greater concentrations of PM2.5 among those with 8 or fewer years of education. The interaction between education and PM2.5 was only found in 2004, possibly because PM2.5 concentrations were much lower in 2014.

CONCLUSION: Education is a key determinant of cognitive decline and impairment, and in higher pollution contexts may serve as a protective factor against the harms of air pollution on the aging brain. Additionally, because air pollution is ubiquitous, and particularly harmful to vulnerable populations, even small improvements in air quality may have large impacts on population health.

%B Journal of Alzheimer's Disease %V 79 %P 615-625 %G eng %N 2 %R 10.3233/JAD-200765 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T The effect of diabetes on the cognitive trajectory of older adults in Mexico and the U.S %A Jaqueline C Avila %A Mejia Arango, Silvia %A Jupiter, Daniel %A Brian Downer %A Rebeca Wong %K cognitive aging %K Cross-cultural study %K Longitudinal methods %K MHAS %X To study the impact of diabetes on the long-term cognitive trajectories of older adults in two countries with different socioeconomic and health settings, and to determine if this relationship differs by cognitive domains. This study uses Mexico and the United States to confirm if patterns hold in both populations, as these countries have similar diabetes prevalence but different socioeconomic conditions and diabetes-related mortality.Two nationally representative cohorts of adults aged 50 years or older are used: the Mexican Health and Aging Study for Mexico, and the Health and Retirement Study for the U.S., with sample sizes of 18, 810 and 26, 244 individuals, respectively, followed over 14 years. The outcome is cognition measured as a total composite score, and by domain (memory and non-memory). Mixed-effect linear models are used to test the effect of diabetes on cognition at 65 years old and over time in each country.Diabetes is associated with lower cognition and non-memory scores at baseline and over time in both countries. In Mexico, diabetes only predicts lower memory scores over time, while in the U.S. it only predicts lower memory scores at baseline. Women have higher total cognition and memory scores than men in both studies. The magnitude of the effect of diabetes on cognition is similar in both countries.Despite the overall lower cognition in Mexico and different socioeconomic characteristics, the impact of diabetes on cognitive decline and the main risk and protective factors for poor cognition are similar in both countries. %B The Journals of Gerontology: Series B %V 76 %P e153-e164 %@ 1079-5014 %G eng %N 4 %R 10.1093/geronb/gbaa094 %0 Journal Article %J Dementia and Geriatric Cognitive Disorders %D 2021 %T The Effect of Receiving a Diagnosis of Alzheimer's Disease and Related Dementias on Social Relationships of Older Adults. %A Amano, Takashi %A Reynolds, Addam %A Scher, Clara %A Jia, Yuane %K Diagnosis of dementia %K Propensity score analysis %K Social Relationships %X

INTRODUCTION: Although early diagnosis has been recognized as a key strategy to improve outcomes of Alzheimer's disease and related dementias (ADRD), the effect of receiving a diagnosis on patients' well-being is not well understood. This study addresses this gap by examining if receiving a dementia diagnosis influences social relationships.

METHODS: Data from the 3 waves (2012, 2014, and 2016) of the Health and Retirement Study were utilized as part of this study. This study examined whether receiving a new diagnosis of ADRD changed subsequent social relationships (social networks, social engagement, and social support). Regression analyses with inverse probability weighting were performed to estimate the impact of receiving a dementia diagnosis on changes in social relationships.

RESULTS: Receiving a new diagnosis of ADRD reduced both informal and formal social engagement. We found no statistically significant impacts of receiving a diagnosis of ADRD on social networks and social support.

CONCLUSIONS: Results suggest that receiving a new diagnosis of ADRD may have unintended impacts on social relationships. Practitioners and policymakers should be aware of these consequences and should identify strategies to alleviate the negative impact of receiving a diagnosis of ADRD and methods to mobilize support networks after receiving a diagnosis.

%B Dementia and Geriatric Cognitive Disorders %V 50 %P 401-406 %G eng %N 4 %R https://doi.org/10.1159/000519581 %0 Journal Article %J Current Alzheimer Research %D 2021 %T Effects of the Co-occurrence of Diabetes Mellitus and Tooth Loss on Cognitive Function. %A Luo, Huabin %A Tan, Chenxin %A Adhikari, Samrachana %A Brenda L Plassman %A Kamer, Angela R %A Frank A Sloan %A Schwartz, Mark D %A Qi, Xiang %A Bei Wu %K cognitive function %K Dementia %K Diabetes %K effects of co-occurrence %K Population %K Tooth Loss %X

OBJECTIVE: Both diabetes mellitus (DM) and poor oral health are common chronic conditions and risk factors of Alzheimer's disease and related dementia among older adults. This study assessed the effects of DM and complete tooth loss (TL) on cognitive function, accounting for their interactions.

METHODS: Longitudinal data were obtained from the 2006, 2012, and 2018 waves of the Health and Retirement Study. This cohort study included 7,805 respondents aged 65 years or older with 18,331 person-year observations. DM and complete TL were self-reported. Cognitive function was measured by the Telephone Interview for Cognitive Status. Random-effect regressions were used to test the associations, overall and stratified by sex.

RESULTS: Compared with older adults without neither DM nor complete TL, those with both conditions (b = -1.35, 95% confidence interval [CI]: -1.68, -1.02), with complete TL alone (b = -0.67, 95% CI: -0.88, -0.45), or with DM alone (b = -0.40, 95% CI: -0.59, -0.22), had lower cognitive scores. The impact of having both conditions was significantly greater than that of having DM alone (p < .001) or complete TL alone (p = 0.001). Sex-stratified analyses showed the effects were similar in males and females, except having DM alone was not significant in males.

CONCLUSION: The co-occurrence of DM and complete TL poses an additive risk for cognition. Healthcare and family-care providers should pay attention to the cognitive health of patients with both DM and complete TL. Continued efforts are needed to improve older adults' access to dental care, especially for individuals with DM.

%B Current Alzheimer Research %V 18 %P 1023-1031 %G eng %N 13 %R 10.2174/1567205019666211223093057 %0 Thesis %D 2021 %T Essays in Labor Economics %A Ahmed, Shahid %K dual earner households %K Joint Retirement %X This paper studies the increase in joint retirement among dual earner households since 1975 and the factors that account for this increase. I use the 1982-2014 panel of Health and Retirement Study to document at 24 percentage point increase in the joint retirement rate among dual earner households from 1975 to 2014. This increase in the joint retirement rate coincides with various economic and demographic changes in the United States. I focus on the increase in the share of college educated women, the increase in marital sorting by education and the decline in age differences between spouses as potential drivers of the increase in joint retirement. %I The University of Minnesota %C Minneapolis, MN %V Ph.D. %G eng %0 Journal Article %J Frontiers in Public Health %D 2021 %T Examining Rural and Racial Disparities in the Relationship Between Loneliness and Social Technology Use Among Older Adults %A Byrne, Kaileigh A. %A Anaraky, Reza Ghaiumy %A Dye, Cheryl %A Ross, Lesley A. %A Chalil Madathil, Kapil %A Knijnenburg, Bart %A Levkoff, Sue %K Disparities %K Loneliness %K rurality %K Technology %X Loneliness, the subjective negative experience derived from a lack of meaningful companionship, is associated with heightened vulnerability to adverse health outcomes among older adults. Social technology affords an opportunity to cultivate social connectedness and mitigate loneliness. However, research examining potential inequalities in loneliness is limited. This study investigates racial and rural-urban differences in the relationship between social technology use and loneliness in adults aged 50 and older using data from the 2016 wave of the Health and Retirement Study (N = 4,315). Social technology use was operationalized as the self-reported frequency of communication through Skype, Facebook, or other social media with family and friends. Loneliness was assessed using the UCLA Loneliness scale, and rural-urban differences were based on Beale rural-urban continuum codes. Examinations of race focused on differences between Black/African-American and White/Caucasian groups. A path model analysis was performed to assess whether race and rurality moderated the relationship between social technology use and loneliness, adjusting for living arrangements, age, general computer usage. Social engagement and frequency of social contact with family and friends were included as mediators. The primary study results demonstrated that the association between social technology use and loneliness differed by rurality, but not race. Rural older adults who use social technology less frequently experience greater loneliness than urban older adults. This relationship between social technology and loneliness was mediated by social engagement and frequency of social contact. Furthermore, racial and rural-urban differences in social technology use demonstrated that social technology use is less prevalent among rural older adults than urban and suburban-dwelling older adults; no such racial differences were observed. However, Black older adults report greater levels of perceived social negativity in their relationships compared to White older adults. Interventions seeking to address loneliness using social technology should consider rural and racial disparities. %B Frontiers in Public Health %V 9 %P 1280 %G eng %R 10.3389/fpubh.2021.723925 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Family caregiving and place of death: Insights from cross-national analysis of the Harmonized End of Life Data. %A Jennifer A Ailshire %A Osuna, Margarita %A Wilkens, Jenny %A Jinkook Lee %K Activities of Daily Living %K Aging %K Disability %K family caregivers %K Nursing homes %K SHARE %K spouse %K Terminally Ill %X

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

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

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

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

%B The Journals of Gerontology: Series B %V 76 %P S76-S85 %G eng %N Supplement_1 %R 10.1093/geronb/gbaa225 %0 Report %D 2021 %T Finding Needles in Haystacks: Multiple-Imputation Record Linkage Using Machine Learning %A Abowd, John M. %A Abramowitz, Joelle %A Levenstein, Margaret C. %A McCue, Kristin %A Patiki, Dhiren %A Trivellore E. Raghunathan %A Rodgers, Ann %A Matthew D. Shapiro %A Wasi, Nada %A Zinsser, Dawn %K Machine learning %K record linkage %X This paper considers the problem of record linkage between a household-level survey and an establishment-level frame in the absence of unique identifiers. Linkage between frames in this setting is challenging because the distribution of employment across establishments is highly skewed. To address these difficulties, this paper develops a probabilistic record linkage methodology that combines machine learning (ML) with multiple imputation (MI). This ML-MI methodology is applied to link survey respondents in the Health and Retirement Study to their workplaces in the Census Business Register. The linked data reveal new evidence that non sampling errors in household survey data are correlated with respondents’ workplace characteristics. %B Working Paper %I United State Census Bureau %G eng %U https://www.census.gov/library/working-papers/2021/adrm/CES-WP-21-35.html %0 Journal Article %J Public Health Nutrition %D 2021 %T Food and Nutrient Intake and Diet Quality among Older Americans %A Choi, Yeon Jin %A Eileen M. Crimmins %A Jung K Kim %A Jennifer A Ailshire %K diet quality %K food %K Nutrients %X A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality. For this study, data from a nationally representative sample of 5,614 community-dwelling older adults over age 54 in the Health and Retirement Study – Health Care and Nutrition Survey were used. Descriptive analyses were conducted to assess average intake of 17 food groups and nutrients and the percentage of respondents who consumed an optimal amount of food and nutrients. Differences in diet quality by sociodemographic, psychosocial, environmental, and geographic factors were assessed using chi-square and OLS regression was used to identify risk and protective factors for good quality diet. Overall, only 10.7% of respondents had a good quality diet (HEI score 81 and above); the majority had diets considered poor or needing improvement. Less than 50% of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socioeconomic status, fewer psychosocial resources, and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality. Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality. %B Public Health Nutrition %V 24 %P 1638-1647 %G eng %N 7 %R 10.1017/S1368980021000586 %0 Journal Article %J Mol Psychiatry %D 2021 %T Gene-educational attainment interactions in a multi-ancestry genome-wide meta-analysis identify novel blood pressure loci. %A de Las Fuentes, Lisa %A Yun Ju Sung %A Noordam, Raymond %A Thomas W Winkler %A Feitosa, Mary F %A Schwander, Karen %A Bentley, Amy R %A Brown, Michael R %A Guo, Xiuqing %A Alisa Manning %A Daniel I Chasman %A Aschard, Hugues %A Traci M Bartz %A Bielak, Lawrence F %A Campbell, Archie %A Cheng, Ching-Yu %A Dorajoo, Rajkumar %A Hartwig, Fernando P %A Horimoto, A R V R %A Li, Changwei %A Li-Gao, Ruifang %A Liu, Yongmei %A Marten, Jonathan %A Musani, Solomon K %A Ntalla, Ioanna %A Rankinen, Tuomo %A Melissa Richard %A Sim, Xueling %A Smith, Albert V %A Tajuddin, Salman M %A Bamidele O Tayo %A Vojinovic, Dina %A Warren, Helen R %A Xuan, Deng %A Alver, Maris %A Boissel, Mathilde %A Jin-Fang Chai %A Chen, Xu %A Christensen, Kaare %A Divers, Jasmin %A Evangelou, Evangelos %A Gao, Chuan %A Giorgia G Girotto %A Sarah E Harris %A He, Meian %A Hsu, Fang-Chi %A Kühnel, Brigitte %A Laguzzi, Federica %A Li, Xiaoyin %A Lyytikäinen, Leo-Pekka %A Ilja M Nolte %A Poveda, Alaitz %A Rauramaa, Rainer %A Riaz, Muhammad %A Rueedi, Rico %A Shu, Xiao-Ou %A Snieder, Harold %A Sofer, Tamar %A Takeuchi, Fumihiko %A Verweij, Niek %A Erin B Ware %A Weiss, Stefan %A Yanek, Lisa R %A Amin, Najaf %A Dan E Arking %A Donna K Arnett %A Bergmann, Sven %A Boerwinkle, Eric %A Brody, Jennifer A %A Broeckel, Ulrich %A Brumat, Marco %A Burke, Gregory %A Cabrera, Claudia P %A Canouil, Mickaël %A Chee, Miao Li %A Chen, Yii-Der Ida %A Cocca, Massimiliano %A Connell, John %A de Silva, H Janaka %A de Vries, Paul S %A Eiriksdottir, Gudny %A Jessica Faul %A Fisher, Virginia %A Forrester, Terrence %A Fox, Ervin F %A Friedlander, Yechiel %A Gao, He %A Gigante, Bruna %A Giulianini, Franco %A Gu, Chi Charles %A Gu, Dongfeng %A Tamara B Harris %A He, Jiang %A Heikkinen, Sami %A Heng, Chew-Kiat %A Hunt, Steven %A Ikram, M Arfan %A Irvin, Marguerite R %A Kähönen, Mika %A Kavousi, Maryam %A Khor, Chiea Chuen %A Kilpeläinen, Tuomas O %A Koh, Woon-Puay %A Komulainen, Pirjo %A Kraja, Aldi T %A Krieger, J E %A Langefeld, Carl D %A Li, Yize %A Liang, Jingjing %A David C Liewald %A Liu, Ching-Ti %A Liu, Jianjun %A Kurt Lohman %A Mägi, Reedik %A McKenzie, Colin A %A Meitinger, Thomas %A Andres Metspalu %A Milaneschi, Yuri %A Lili Milani %A Dennis O Mook-Kanamori %A Michael A Nalls %A Nelson, Christopher P %A Norris, Jill M %A Jeff O'Connell %A Ogunniyi, Adesola %A Padmanabhan, Sandosh %A Palmer, Nicholette D %A Nancy L Pedersen %A Thomas T Perls %A Peters, Annette %A Petersmann, Astrid %A Peyser, Patricia A %A Polasek, Ozren %A David J Porteous %A Raffel, Leslie J %A Rice, Treva K %A Rotter, Jerome I %A Rudan, Igor %A Rueda-Ochoa, Oscar-Leonel %A Sabanayagam, Charumathi %A Babatunde Salako %A Schreiner, Pamela J %A Shikany, James M %A Stephen Sidney %A Sims, Mario %A Sitlani, Colleen M %A Smith, Jennifer A %A John M Starr %A Strauch, Konstantin %A Swertz, Morris A %A Teumer, Alexander %A Tham, Yih Chung %A André G Uitterlinden %A Vaidya, Dhananjay %A van der Ende, M Yldau %A Waldenberger, Melanie %A Wang, Lihua %A Wang, Ya-Xing %A Wei, Wen-Bin %A David R Weir %A Wen, Wanqing %A Yao, Jie %A Yu, Bing %A Yu, Caizheng %A Yuan, Jian-Min %A Zhao, Wei %A Alan B Zonderman %A Becker, Diane M %A Bowden, Donald W %A Ian J Deary %A Dörr, Marcus %A Tõnu Esko %A Freedman, Barry I %A Froguel, Philippe %A Paolo P. Gasparini %A Gieger, Christian %A Jost Bruno Jonas %A Kammerer, Candace M %A Kato, Norihiro %A Lakka, Timo A %A Leander, Karin %A Lehtimäki, Terho %A Patrik K E Magnusson %A Marques-Vidal, Pedro %A Brenda W J H Penninx %A Nilesh J Samani %A van der Harst, Pim %A Wagenknecht, Lynne E %A Wu, Tangchun %A Zheng, Wei %A Zhu, Xiaofeng %A Bouchard, Claude %A Cooper, Richard S %A Correa, Adolfo %A Michele K Evans %A Gudnason, Vilmundur %A Caroline Hayward %A Horta, Bernardo L %A Tanika N Kelly %A Stephen B Kritchevsky %A Levy, Daniel %A Walter R Palmas %A Pereira, A C %A Province, Michael M %A Psaty, Bruce M %A Ridker, Paul M %A Charles N Rotimi %A Tai, E Shyong %A van Dam, Rob M %A Cornelia M van Duijn %A Wong, Tien Yin %A Kenneth Rice %A Gauderman, W James %A Alanna C Morrison %A Kari E North %A Sharon L R Kardia %A Caulfield, Mark J %A Elliott, Paul %A Munroe, Patricia B %A Franks, Paul W %A Rao, Dabeeru C %A Myriam Fornage %K Blood pressure %K Epistasis, Genetic %K Genetic Loci %K Genome-Wide Association Study %K Humans %K Hypertension %K Polymorphism, Single Nucleotide %X

Educational attainment is widely used as a surrogate for socioeconomic status (SES). Low SES is a risk factor for hypertension and high blood pressure (BP). To identify novel BP loci, we performed multi-ancestry meta-analyses accounting for gene-educational attainment interactions using two variables, "Some College" (yes/no) and "Graduated College" (yes/no). Interactions were evaluated using both a 1 degree of freedom (DF) interaction term and a 2DF joint test of genetic and interaction effects. Analyses were performed for systolic BP, diastolic BP, mean arterial pressure, and pulse pressure. We pursued genome-wide interrogation in Stage 1 studies (N = 117 438) and follow-up on promising variants in Stage 2 studies (N = 293 787) in five ancestry groups. Through combined meta-analyses of Stages 1 and 2, we identified 84 known and 18 novel BP loci at genome-wide significance level (P < 5 × 10). Two novel loci were identified based on the 1DF test of interaction with educational attainment, while the remaining 16 loci were identified through the 2DF joint test of genetic and interaction effects. Ten novel loci were identified in individuals of African ancestry. Several novel loci show strong biological plausibility since they involve physiologic systems implicated in BP regulation. They include genes involved in the central nervous system-adrenal signaling axis (ZDHHC17, CADPS, PIK3C2G), vascular structure and function (GNB3, CDON), and renal function (HAS2 and HAS2-AS1, SLIT3). Collectively, these findings suggest a role of educational attainment or SES in further dissection of the genetic architecture of BP.

%B Mol Psychiatry %V 26 %P 2111-2125 %G eng %N 6 %R 10.1038/s41380-020-0719-3 %0 Report %D 2021 %T Heterogeneity in Self-Employment and the Transition to Retirement among Older Adults in the United States %A Abramowitz, Joelle %K Retirement %K Self-employment %X The fraction of workers who are self-employed increases with age, but the types of self-employment that older workers do and the effects of this work on their well-being is not well understood. This project examines such heterogeneity by considering how differing investment and managerial responsibilities in self-employment contribute to disparities in characteristics and measures of economic, physical, and mental well-being. The paper first uses internal narrative descriptions of industry and occupation in the 1994 to 2018 Health and Retirement Study and machine learning methods to classify self-employment reports into a useful framework of self-employment roles. The project then uses these roles to examine self-employment heterogeneity and finds substantial differences in demographic characteristics, work characteristics, income, benefits, quality of life, and retirement expectations across self-employment roles. Further work finds distinctive patterns in role changes with the transition to retirement such that large shares of workers in all roles transition into independent self-employment at the time of retirement. Work linking to administrative records suggests substantial discrepancies, which vary across roles, between survey responses and administrative records and finds the most prominent discrepancies for post-retirement independent self-employment. The paper’s findings motivate future research exploring the work trajectories leading to these roles and their consequences on financial, physical, and mental well-being into retirement. %B MRDRC Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/heterogeneity-in-self-employment-and-the-transition-to-retirement-among-older-adults-in-the-united-states/ %0 Report %D 2021 %T Heterogenous Trajectories in Physical, Mental and Cognitive Health among Older Americans: Roles of Genetics and Earlier SES %A Hoang, Cung Truong %A Amin, Vikesh %A Behrman, Jere R. %A Hans-Peter Kohler %A Iliana V. Kohler %K Aging trajectories %K childhood socioeconomic status %K polygenic scores %K schooling %X We investigate the roles of genetic predispositions, childhood SES and adult schooling attainment in shaping trajectories for three important components of the overall health and wellbeing of older adults -- BMI, depressive symptoms and cognition. We use the Health & Retirement Study (HRS) and group-based trajectory modelling (GBTM) to identify subgroups of people who share the same underlying trajectories over ages 50-94 years. After identifying common underlying trajectories, we use fractional multinomial logit models to estimate associations of (1) polygenic scores for BMI, depression, ever-smoked, education, cognition and subjective wellbeing, (2) childhood SES and (3) schooling attainment on the probabilities of trajectory group membership. While genetic predispositions do play a part in predicting trajectory group membership, our results highlight the long arm of socioeconomic factors. Schooling attainment is the most robust predictor—it predicts increased probabilities of belonging to trajectories with BMI in the normal rage, low depressive symptoms and high initial cognition. Childhood circumstances are manifested in trajectories to a lesser extent, with childhood SES only predicting the likelihood of being on the low depressive symptoms trajectory. We also find suggestive evidence that associations of schooling attainment on the probabilities of being on trajectories with BMI in the normal rage, low depressive symptoms and high initial cognition vary with genetic predispositions. %B University of Pennsylvania Population Center Working Paper (PSC/PARC) %I University of Pennsylvania %C Philadelphia, PA %G eng %U https://repository.upenn.edu/psc_publications/76/ %0 Journal Article %J Housing Studies %D 2021 %T Housing and cardiometabolic risk among older renters and homeowners %A Mawhorter, Sarah %A Eileen M. Crimmins %A Jennifer A Ailshire %K cardiometabolic risk %K health %K Homeownership %K housing affordability %K housing conditions %X Scholars consistently find that renters have poorer health outcomes when compared with homeowners. Health disparities between renters and homeowners likely widen over the life course, yet few studies have examined this link among older adults, and the connection is not fully understood. Homeowners’ relative socio-economic advantage may explain their better health; renters also more commonly experience adverse housing conditions and financial challenges, both of which can harm health. In this paper, we analyse the extent to which socio-economic advantage, housing conditions, and financial strain explain the relationship between homeownership and health among adults over age 50, using Health and Retirement Study 2010/2012 data to assess cardiometabolic risk (CMR) levels using biomarkers for inflammation, cardiovascular health, and metabolic function. We find that people living with poor housing conditions and financial strain have higher CMR levels, even taking socio-economic advantage into account. This analysis sheds light on the housing-related health challenges of older adults, especially older renters. %B Housing Studies %@ 0267-3037 %G eng %R 10.1080/02673037.2021.1941792 %0 Journal Article %J Journal of Public Economics %D 2021 %T Housing liquidity and long-term care insurance demand: A quantitative evaluation %A Achou, Bertrand %K Housing %K Insurance %K Life-cycle %K Liquidity %K Long-term Care %K Retirement %X In theory, illiquid housing may substitute for long-term care insurance (LTCI) as retirees decumulate housing wealth mainly when moving to long-term care facilities. In this paper, I build and estimate a rich life-cycle model of single retirees in order to evaluate whether the impact of housing liquidity on LTCI demand is large. Overall, I find that the prospects of increasing LTCI demand by making housing more liquid are quite limited, as even large increases in housing liquidity generate modest increases in LTCI demand. I also find a limited impact of housing liquidity on the demand for life annuities. Finally, I show that the types of bequest motives used to rationalize the low take-up of reverse mortgages are generally inconsistent with the low demand for LTCI, suggesting that other factors may play a role in this low take-up of reverse mortgages. %B Journal of Public Economics %V 194 %P 104353 %@ 0047-2727 %G eng %R https://doi.org/10.1016/j.jpubeco.2020.104353 %0 Journal Article %J Sleep Medicine %D 2021 %T Insomnia as a predictor of diagnosed memory problems: 2006-2016 Health and Retirement Study %A Beydoun, Hind A. %A Beydoun, May A. %A Weiss, Jordan %A Hossain, Sharmin %A Huang, Shuyan %A Alemu, Brook T. %A Alan B Zonderman %K Aging %K Alzheimer’s disease %K Dementia %K insomnia %K Neurodegenerative %K Sleep %X ObjectiveTo evaluate the longitudinal relationship in insomnia symptoms over time with incident memory problems and dementia diagnoses among U.S. adults aged 65 years and older.MethodsSecondary analyses were performed on 9,518 elderly participants (≥65 years) who completed the 2006 wave of the Health and Retirement Study (HRS) and were followed-up to determine if insomnia symptom scores (2006-2014) were associated with time-to-onset of [1] physician-diagnosed “memory-related disease”, “Alzheimer’s disease” and/or “dementia, senility or any other serious memory impairment” and [2] diagnosis of dementia based on HRS-specific criteria. Cox proportional hazards models were constructed adjusting for socio-demographic, lifestyle, and health characteristics.ResultsIn fully adjusted models, severe insomnia symptoms were associated with increased risk of physician-diagnosed memory problems. Individuals reporting any change (increase or decrease) in insomnia symptoms during the 2006-2010 period were more likely to be diagnosed with dementia based on HRS criteria. Finally, those who experienced an increase in the severity of insomnia symptoms over time exhibited 41-72% increased risks of physician-diagnosed memory problems and 45-58% increased risks of dementia diagnosis based on HRS criteria.ConclusionsWhen severe insomnia symptoms increased over time, physician-diagnosed memory problems and dementia diagnoses also increased among U.S. elderly people over a 10-year follow-up period. More studies are required to confirm these findings using large prospective cohort designs and validated tools. %B Sleep Medicine %V 80 %P 158-166 %@ 1389-9457 %G eng %R 10.1016/j.sleep.2021.01.038 %0 Journal Article %J European Heart Journal %D 2021 %T Insomnia symptoms and incident heart failure: a population-based cohort study. %A Mahmood, Asos %A Ray, Meredith %A Dobalian, Aram %A Kenneth D. Ward %A Ahn, SangNam %K Heart Failure %K insomnia symptoms %K Marginal structural models %K risk factor %K Sleep disturbance %X

AIMS: Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue. Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We investigated the longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF.

METHODS AND RESULTS: Data were obtained from the Health and Retirement Study in the US for a population-representative sample of 12,761 middle-aged and older adults (age ≥ 50 years; mean [SD] age, 66.7 [9.4] years; 57.7% females) who were free from HF at baseline in 2002. Respondents were followed for 16 years for incident HF. We employed marginal structural discrete-time survival analyses to adjust for potential time-varying biological, psycho-cognitive, and behavioral factors and to account for bias due to differential loss to follow-up. At baseline, 38.4% of the respondents reported experiencing at least one insomnia symptom. During the 16-year follow-up, 1,730 respondents developed incident HF. Respondents experiencing one (hazard ratio [HR]=1.22; 95% CI: 1.08-1.38), two (HR=1.45; 95% CI: 1.21-1.72), three (HR=1.66; 95% CI: 1.37-2.02), or four (HR=1.80; 95% CI: 1.25-2.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents. Respondents that had trouble initiating sleep (HR=1.17; 95%CI: 1.01-1.36), maintaining sleep (HR=1.14; 95% CI: 1.01-1.28), early-morning awakening (HR=1.20; 95% CI: 1.02-1.43), or non-restorative sleep (HR=1.25; 95% CI: 1.06-1.46) had a higher hazard of incident HF than asymptomatic respondents.

CONCLUSION: Insomnia symptoms, both cumulatively and individually, are associated with incident HF. Public health awareness and screening for insomnia symptoms in at-risk populations should be encouraged to reduce HF incidence.

%B European Heart Journal %V 42 %P 4169-4176 %G eng %N 40 %R 10.1093/eurheartj/ehab500 %0 Journal Article %J Mechanisms of Ageing and Development %D 2021 %T Interplay between stress-related genes may influence Alzheimer's disease development: The results of genetic interaction analyses of human data. %A Anatoliy Yashin %A Wu, Deqing %A Konstantin G Arbeev %A Bagley, Olivia %A Akushevich, Igor %A Duan, Matt %A Arseniy P Yashkin %A Svetlana Ukraintseva %K Alzheimer’s disease %K Genetic interactions %K Integrated stress response %K Polygenic risk score %X

Emerging evidence from experimental and clinical research suggests that stress-related genes may play key roles in AD development. The fact that genome-wide association studies were not able to detect a contribution of such genes to AD indicates the possibility that these genes may influence AD non-linearly, through interactions of their products. In this paper, we selected two stress-related genes (GCN2/EIF2AK4 and APP) based on recent findings from experimental studies which suggest that the interplay between these genes might influence AD in humans. To test this hypothesis, we evaluated the effects of interactions between SNPs in these two genes on AD occurrence, using the Health and Retirement Study data on white indidividuals. We found several interacting SNP-pairs whose associations with AD remained statistically significant after correction for multiple testing. These findings emphasize the importance of nonlinear mechanisms of polygenic AD regulation that cannot be detected in traditional association studies. To estimate collective effects of multiple interacting SNP-pairs on AD, we constructed a new composite index, called Interaction Polygenic Risk Score, and showed that its association with AD is highly statistically significant. These results open a new avenue in the analyses of mechanisms of complex multigenic AD regulation.

%B Mechanisms of Ageing and Development %V 196 %P 111477 %G eng %R 10.1016/j.mad.2021.111477 %0 Journal Article %J SSM - Population Health %D 2021 %T Intersectional trends in employment quality in older adults in the United States %A Sarah B. Andrea %A Eisenberg-Guyot, Jerzy %A Peckham, Trevor %A Vanessa M Oddo %A Hajat, Anjum %K employment quality %K Inequities %K Intersectionality %K Precarious employment %X Americans' working lives have become more precarious over the past several decades. Worsening employment quality has been linked to poorer physical and mental health and may disproportionately impact marginalized working populations. We examined differences in the quality and character of worker-employer relationships among older workers in the United States (US) across intersecting gender-racial/ethnic-educational subgroups. Using longitudinal data on employment stability, material rewards, workers’ rights, working-time arrangements, unionization, and interpersonal power relations from the Health and Retirement Study (1992–2016), we used principal components analysis to construct an employment quality (EQ) score. We estimated intersectional differences in EQ, overall and over time, using generalized estimating equations. Overall, EQ was greatest for white men with college degrees and poorest for Latinx women with < high school degrees. Over time, EQ tended to remain unchanged or slightly worsen across intersectional strata; the greatest EQ reduction was for Latinx women with college degrees, while the greatest improvement was for white women with high school degrees. There are enduring and growing inequities in EQ for older marginalized adults in the US, which may contribute to growing health inequities. %B SSM - Population Health %V 15 %P 100868 %@ 2352-8273 %G eng %R 10.1016/j.ssmph.2021.100868 %0 Journal Article %J Journal of Pension Economics and Finance %D 2021 %T Introduction to the Special Issue on New Longitudinal Data for Retirement Analysis and Policy %A Marco Angrisani %A Samek, Anya %A Arie Kapteyn %K Longitudinal data %K Methodology %X The number of data sources available for academic research on retirement economics and policy has increased rapidly in the past two decades. Data quality and comparability across studies have also improved considerably, with survey questionnaires progressively converging towards common ways of eliciting the same measurable concepts. Probability-based Internet panels have become a more accepted and recognized tool to obtain research data, allowing for fast, flexible, and cost-effective data collection compared to more traditional modes such as in-person and phone interviews. In an era of big data, academic research has also increasingly been able to access administrative records (e.g., Kostøl and Mogstad, 2014; Cesarini et al., 2016), private-sector financial records (e.g., Gelman et al., 2014), and administrative data married with surveys (Ameriks et al., 2020), to answer questions that could not be successfully tackled otherwise. %B Journal of Pension Economics and Finance %P 1–5 %G eng %R 10.1017/S1474747221000044 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Life Course Socioeconomic Disadvantage and the Aging Immune System: Findings from the Health and Retirement Study %A Grace A Noppert %A Rebecca C Stebbins %A Jennifer B Dowd %A Robert A Hummer %A Allison E Aiello %K immune aging %K life course studies %K persistent infections %K socioeconomic disadvantage %X Previous research has documented a consistent association between current socioeconomic status (SES) and cytomegalovirus (CMV). Early life is likely a critical period for CMV exposure and immune development, but less is known about early life socioeconomic factors and CMV, particularly in older age populations. Using data from the Health and Retirement Study, we investigated the association between life course socioeconomic disadvantage and immune response to CMV among older adults.Using ordered logit models, we estimated associations between several measures of socioeconomic disadvantage and the odds of being in a higher CMV Immunoglobulin G (IgG) response category in a sample of 8,168 respondents aged 50+ years.We found a significant association between educational attainment and CMV IgG response. Those with less than a high school education had 2.00 (95% CI: 1.67, 2.40) times the odds of being in a higher CMV category compared to those with a college degree or greater. In addition, we also observed a significant association with parental education and CMV response. Individuals with parents having 8 years or less of schooling had 2.32 (95% CI: 2.00, 2.70) times the odds of higher CMV response compared to those whose parents had greater than a high school education.CMV IgG levels in older adults are associated with both early life and adult SES. Life course socioeconomic disadvantage may contribute to disparities in immunological aging. %B The Journals of Gerontology: Series B %V 76 %P 1195-1205 %@ 1079-5014 %G eng %N 6 %R https://doi.org/10.1093/geronb/gbaa144 %0 Journal Article %J Journal of Gerontology: Series B %D 2021 %T Longitudinal analysis of psychosocial stressors and body mass index in middle-aged and older adults in the United States. %A Cuevas, Adolfo G %A Greatorex-Voith, Siobhan %A Shervin Assari %A Slopen, Natalie %A Economos, Christina D %K BMI %K middle-aged %K Older Adults %K Psychosocial stress %X

OBJECTIVE: Psychosocial stress may be a risk factor for obesity and overweight in middle-aged and older adults. However, research on psychosocial stress and excess body weight has typically been cross-sectional and focused on single stressors.

METHODS: Using three waves of data from the Health and Retirement Study, we conducted longitudinal analyses to assess associations between five psychosocial stressors-individually and in combination-and body mass index (BMI), adjusting for sociodemographic factors, alcohol use, and smoking history. We tested interaction effects between race and gender with stressors on BMI.

RESULTS: A total of 3,956 participants were included in the main analyses. Most participants were White (88.04%) and more than half were female (60.39%). Perceived discrimination, financial stress, and relationship stress were positively associated with BMI. A greater cumulative stress burden was associated with higher BMI. In stratified analyses, greater financial stress was associated with higher BMI among White participants, whereas greater neighborhood stress was associated with lower BMI among Black participants. Greater relationship stress, financial stress, cumulative high-stress, and overall cumulative stress burden were associated with higher BMI for women, but not men.

DISCUSSIONS: Different sources of stress may be risk factors to weight gain and impact BMI in adults. White and female adults may be more susceptible to the obesogenic effects of stressors. Reducing exposure to stress may help reduce the burden of high BMI among middle-aged and older adults.

%B Journal of Gerontology: Series B %V 76 %P 1580-1589 %G eng %N 8 %R 10.1093/geronb/gbaa142 %0 Journal Article %J Journal of the American Medical Directors Association %D 2021 %T Longitudinal Assessment of the Relationships Between Geriatric Conditions and Loneliness. %A Yu, Kexin %A Wu, Shinyi %A Yuri Jang %A Chou, Chih-Ping %A Kathleen H. Wilber %A Aranda, María P %A Iris Chi %K fall %K geriatric syndrome %K Longitudinal analysis %K random intercept cross-lagged panel model %K Reciprocal relationships %X

OBJECTIVES: In response to the lack of longitudinal evidence, this study aims to disentangle time sequence and directionality between the severity of geriatric conditions (GCs) and loneliness.

DESIGN: Longitudinal panel study.

SETTING AND PARTICIPANTS: The working sample had 4680 participants of 2006, 2010, and 2014 waves of the Health and Retirement Study (HRS). All participants were at least 65 years old at baseline. Proxy responded cases and individuals who suffered from moderate to severe cognitive impairment were excluded from the analysis.

METHODS: Loneliness was measured with the 3-item UCLA loneliness scale. Five GCs were included: falls, incontinence, vision impairment, hearing impairment, and pain. Severity indicators were the number of times fallen in the past 2 years, number of days experiencing loss of bladder control in the past month, self-rated eyesight, self-rated hearing, and participants' perceived level of pain.

RESULTS: Random-intercept cross-lagged panel models were run to analyze the relationship between the severity of each individual GC and loneliness. All models were controlled for baseline demographics, social isolation, self-rated health, physical function, comorbidities, and hospitalization. The longitudinal association between loneliness and fall was bidirectional: a higher loneliness score predicted an increased number of falls and vice versa. Incontinence, vision impairment, hearing impairment, and pain were not significantly associated with loneliness longitudinally. The association between the random intercept of loneliness and some GCs (vision and pain) were significant, indicating the severity of these GCs were related to loneliness at the between-person level at baseline.

CONCLUSION AND IMPLICATIONS: Findings of the longitudinal analysis suggest a reciprocal relationship between fall and loneliness. Fall prevention programs could be integrated with social service for addressing loneliness, and alleviating loneliness might be beneficial for preventing falls. Results of this study highlight the importance of integrating clinical management of falls with social services addressing loneliness in long term care.

%B Journal of the American Medical Directors Association %V 22 %P 1107-1113.e1 %G eng %N 5 %R 10.1016/j.jamda.2020.09.002 %0 Journal Article %J The Journal of Gerontology: Series B %D 2021 %T Longitudinal dyadic effects of aging self-perceptions on health %A Cohn-Schwartz, Ella %A Dikla Segel-Karpas %A Liat Ayalon %K depression %K longitudinal change %K Marriage %K Self-rated health %X Adults' perceptions of aging are known to affect their mental and physical health. However, not much is known about how perceptions of aging within the couple-unit affect each member of the unit. Therefore, the current study explores the effects of husbands' and wives' self-perceptions of aging (SPA) on each other's physical and mental health, both directly and indirectly, through impacting each other's SPA.The study used data from the Health and Retirement Study, focusing on couples aged 50 and above. Self-rated health and CES-D depression scale were used as indicators of physical and mental health. SPA was measured using the "Attitudes toward aging" subscale of the "Philadelphia Geriatric Center Morale Scale". An actor–partner interdependence mediation model was used to examine the effects of the 2008 SPA of couples on each other's 2012 SPA and 2016 health.The SPA of both husbands and wives was associated with their own future mental and physical health in 2016, but not with that of their partner. However, their SPA was associated with their partner's health indirectly, by influencing the SPA of the partner. That is, the SPA of both husbands and wives in 2008 impacted their partner's SPA in 2012, which was subsequently related to that partner's mental and physical health in 2016.Older couples can influence each other's health indirectly, by affecting each other's SPA. This indicates that adults' SPA are interconnected and thus, the entire couple-unit should be targeted to enhance positive SPA. %B The Journal of Gerontology: Series B %V 76 %P 900-909 %@ 1079-5014 %G eng %N 5 %R 10.1093/geronb/gbaa082 %0 Conference Paper %B ISEE Conference Abstracts %D 2021 %T Long-Term Air Pollution Exposures and Major Depression in Older U.S. Adults: The Health and Retirement Study %A Rachel S. Bergmans %A D' Souza, Jennifer %A Fossa, Alan %A Szpiro, Adam %A Young, Michael T %A Carlos F. Mendes de Leon %A Kaufman, Joel %A Richard A Hirth %A Sara Dubowsky Adar %K Health Disparities %K Major depression %K Psychiatric epidemiology %K Traffic-Related Air Pollution %X Major depression is a leading cause of morbidity worldwide, especially during later life. Since heritability is modest (40-50%), there is interest in understanding risk from environmental factors like air pollution. However, research examining this issue is scarce, and often does not use clinical diagnostic criteria. Here, we aimed to quantify associations of air pollution with prevalent major depression in a cohort that deploys diagnostic assessments. METHODS: We conducted a repeated measure analysis of 2008-2016 interviews from the Health and Retirement Study, a nationally representative cohort of older adults in the United States. Major depression status was determined biennially using the Composite International Diagnostic Interview Short Form, with a cutoff of 5. We estimated 1-year average PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences using fine-scale spatiotemporal models. To estimate prevalence ratios, we fit generalized linear models that accounted for sample weights and clustering by participant. All models included demographic characteristics, individual and neighborhood socioeconomic status, calendar time, and geographic area. RESULTS:Among 25,305 participants with complete data, there was a mean age of 63 years, 53% were female, and most were Non-Hispanic White (73%), with some Black (11%) and Hispanic participants. Eight percent reported major depression. In fully adjusted models, we observed that higher PM2.5 and NO2 concentrations were associated with a greater prevalence of major depression (PR: 1.13 per 3 µg/m³ PM2.5, 95% CI: 1.03, 1.23; PR: 1.23 per 5 ppb NO2, 95% CI: 1.06, 1.20). Only the association with NO2 was robust to adjustment for other pollutants, however, and no associations were observed with PM10-2.5 or O3. CONCLUSIONS:Overall, we observed a robust association of major depression prevalence with long-term exposure to NO2 but not with other air pollutants. This suggests that traffic may be a modifiable risk factor that could be targeted to reduce socioeconomic disparities in mental health. %B ISEE Conference Abstracts %V 2021 %G eng %U https://ehp.niehs.nih.gov/doi/abs/10.1289/isee.2021.O-LT-071 %N 1 %0 Journal Article %J Human Genetics and Genomics Advances %D 2021 %T Multi-Ancestry Genome-wide Association Study Accounting for Gene-Psychosocial Factor Interactions Identifies Novel Loci for Blood Pressure Traits. %A Sun, Daokun %A Melissa Richard %A Musani, Solomon K %A Yun Ju Sung %A Thomas W Winkler %A Schwander, Karen %A Jin-Fang Chai %A Guo, Xiuqing %A Kilpeläinen, Tuomas O %A Vojinovic, Dina %A Aschard, Hugues %A Traci M Bartz %A Bielak, Lawrence F %A Brown, Michael R %A Chitrala, Kumaraswamy %A Hartwig, Fernando P %A Horimoto, Andrea R V R %A Liu, Yongmei %A Alisa Manning %A Noordam, Raymond %A Smith, Albert V %A Sarah E Harris %A Kühnel, Brigitte %A Lyytikäinen, Leo-Pekka %A Ilja M Nolte %A Rauramaa, Rainer %A van der Most, Peter J %A Wang, Rujia %A Erin B Ware %A Weiss, Stefan %A Wen, Wanqing %A Yanek, Lisa R %A Dan E Arking %A Donna K Arnett %A Barac, Ana %A Boerwinkle, Eric %A Broeckel, Ulrich %A Chakravarti, Aravinda %A Chen, Yii-Der Ida %A Cupples, L Adrienne %A Davigulus, Martha L %A de Las Fuentes, Lisa %A de Mutsert, Renée %A de Vries, Paul S %A Delaney, Joseph A C %A Ana V Diez Roux %A Dörr, Marcus %A Jessica Faul %A Fretts, Amanda M %A Gallo, Linda C %A Hans-Jörgen Grabe %A Gu, C Charles %A Tamara B Harris %A Hartman, Catharina C A %A Heikkinen, Sami %A Ikram, M Arfan %A Isasi, Carmen %A Johnson, W Craig %A Jost Bruno Jonas %A Kaplan, Robert C %A Komulainen, Pirjo %A Krieger, Jose E %A Levy, Daniel %A Liu, Jianjun %A Kurt Lohman %A Luik, Annemarie I %A Martin, Lisa W %A Meitinger, Thomas %A Milaneschi, Yuri %A Jeff O'Connell %A Walter R Palmas %A Peters, Annette %A Peyser, Patricia A %A Pulkki-Raback, Laura %A Raffel, Leslie J %A Reiner, Alex P %A Kenneth Rice %A Robinson, Jennifer G %A Rosendaal, Frits R %A Schmidt, Carsten Oliver %A Schreiner, Pamela J %A Schwettmann, Lars %A Shikany, James M %A Shu, Xiao-Ou %A Stephen Sidney %A Sims, Mario %A Smith, Jennifer A %A Sotoodehnia, Nona %A Strauch, Konstantin %A Tai, E Shyong %A Taylor, Kent %A André G Uitterlinden %A Cornelia M van Duijn %A Waldenberger, Melanie %A Wee, Hwee-Lin %A Wei, Wen-Bin %A Wilson, Gregory %A Xuan, Deng %A Yao, Jie %A Zeng, Donglin %A Zhao, Wei %A Zhu, Xiaofeng %A Alan B Zonderman %A Becker, Diane M %A Ian J Deary %A Gieger, Christian %A Lakka, Timo A %A Lehtimäki, Terho %A Kari E North %A Oldehinkel, Albertine J %A Brenda W J H Penninx %A Snieder, Harold %A Wang, Ya-Xing %A David R Weir %A Zheng, Wei %A Michele K Evans %A Gauderman, W James %A Gudnason, Vilmundur %A Horta, Bernardo L %A Liu, Ching-Ti %A Dennis O Mook-Kanamori %A Alanna C Morrison %A Pereira, Alexandre C %A Psaty, Bruce M %A Amin, Najaf %A Fox, Ervin R %A Charles Kooperberg %A Sim, Xueling %A Laura Bierut %A Rotter, Jerome I %A Sharon L R Kardia %A Franceschini, Nora %A Rao, Dabeeru C %A Myriam Fornage %K blood pressure traits %X

Psychological and social factors are known to influence blood pressure (BP) and risk of hypertension and associated cardiovascular diseases. To identify novel BP loci, we carried out genome-wide association meta-analyses of systolic, diastolic, pulse, and mean arterial BP taking into account the interaction effects of genetic variants with three psychosocial factors: depressive symptoms, anxiety symptoms, and social support. Analyses were performed using a two-stage design in a sample of up to 128,894 adults from 5 ancestry groups. In the combined meta-analyses of Stages 1 and 2, we identified 59 loci (p value <5e-8), including nine novel BP loci. The novel associations were observed mostly with pulse pressure, with fewer observed with mean arterial pressure. Five novel loci were identified in African ancestry, and all but one showed patterns of interaction with at least one psychosocial factor. Functional annotation of the novel loci supports a major role for genes implicated in the immune response (), synaptic function and neurotransmission (), as well as genes previously implicated in neuropsychiatric or stress-related disorders (). These findings underscore the importance of considering psychological and social factors in gene discovery for BP, especially in non-European populations.

%B Human Genetics and Genomics Advances %V 2 %P 100013 %G eng %N 1 %R 10.1016/j.xhgg.2020.100013 %0 Journal Article %J Innovation in Aging %D 2021 %T Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014) %A Quiñones, Ana %A Markwardt, Sheila %A Allore, Heather %A Newsom, Jason %A Nagel, Corey %A Dorr, David %A Botoseneanu, Anda %X Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1% in youngest age category [67-69] vs. 50.3% for incident and 66.7% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6% CIND/dementia vs. 15.4% for incident and 16.8% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4%) than in the incident (11.8%) and no multimorbidity groups (13.4%). Non-Hispanic White beneficiaries were more represented in the incident (83.5%) than the prevalent (77.2%) and the no multimorbidity (77.7%). Hispanic beneficiaries were more represented in the no (8.9%) than the prevalent (7.4%) and incident multimorbidity groups (4.7%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status. %B Innovation in Aging %V 5 %P 614 %G eng %N Suppl 1 %R 10.1093/geroni/igab046.2347 %0 Journal Article %J Innovation in Aging %D 2021 %T MULTIMORBIDITY TRAJECTORY CLASSES AS PREDICTED BY RACE, ETHNICITY, AND SOCIAL RELATIONSHIP QUALITY %A Newson, Jason %A O'Neill, AnneMarie %A Denning, Emily C %A Anda Botoseneanu %A Allore, Heather G %A Corey L Nagel %A David A Dorr %A Ana R Quiñones %K multimorbidity %K Race/ethnicity %K social relationship %X Growth mixture modeling was used to classify multimorbidity (≥2 chronic conditions) trajectories over a 10-year period (2006-2016) in the Health and Retirement Study (N = 7,151, mean age = 68.6 years). Race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White) and social relationship quality (positive social support and negative social exchanges, such as criticisms) were then used to predict trajectory class membership, controlling for age, sex, education, and wealth. We identified three trajectory classes: initial low levels and rapid accumulation of multimorbidity (increasing: 12.6%), initial high levels and gradual accumulation of multimorbidity (high: 19.5%), and initial low levels and gradual accumulation of multimorbidity (low: 67.9%). Blacks were more than twice as likely to be in the increasing (OR = 2.04, CI[1.29,3.21]) and high (OR = 2.28 CI[1.58,3.206]) multimorbidity groups compared with Whites, but there were no significant differences between Hispanics and Whites for either trajectory class (OR = .84 CI[.47,1.51]and OR = .74 CI[.41,1.34], respectively). Increments in perceived support were associated with significantly lower risk of membership in the increasing (OR = .59, CI[.46,.78]) and high classes (OR = .54 CI[.42,.69]), and increments in negative exchanges were associated with significantly higher risk of membership in the increasing (OR = 1.64 CI[1.19,2.25]) and high classes (OR = 2.22 CI[1.64,3.00]). These results provide important new information for understanding health disparities and the role of social relationships associated with multimorbidity in middle and later life that may aid in identifying those most at risk and suggesting possible interventions for mitigating that risk. %B Innovation in Aging %V 5 %P 873 %G eng %U https://watermark.silverchair.com/igab046.3157.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAw4wggMKBgkqhkiG9w0BBwagggL7MIIC9wIBADCCAvAGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMvYWi7nxZ2T3DhQ7tAgEQgIICwQjhrrWTdWJufk1mgdVsBv4wjBsKIMO8ZZuAA3KbKU %N Suppl _1 %0 Journal Article %J Journal of the American Geriatric Society %D 2021 %T A national profile of kinlessness at the end of life among older adults: Findings from the Health and Retirement Study. %A Natalie Plick %A Claire K. Ankuda %A Christine A Mair %A Husain, Mohammed %A Katherine A Ornstein %K Caregiving %K end of life %K Families %K kinlessness %K location of death %X

BACKGROUND/OBJECTIVES: The majority of end-of-life (EOL) caregiving is provided by unpaid family members. An increasing number of older adults are kinless (without close family/partnerships) and may have insufficient caregiver support to remain at home at the EOL. We therefore determined what proportion of older adults are kinless at the EOL and assessed the association of kinlessness with EOL care.

DESIGN: Retrospective analysis of Health and Retirement Study decedents, 2002-2015.

SETTING: US population-based sample.

PARTICIPANTS: Decedents age 51+ who died within 1 year of interview (n = 3844) and subset who are community-dwelling at last interview.

MEASUREMENTS: Kinlessness was defined as lacking a spouse/partner and children. Primary outcome measure was location of death. Secondary outcome measures included contextual EOL measures such as symptom burden and caregiver support.

RESULTS: A total of 7.4% of decedents were kinless at the EOL. Kinless decedents were more likely to be female, nonwhite, enrolled in Medicaid, living alone, or living in a nursing home prior to death. Although community-dwelling kinless decedents received fewer hours of caregiving per week at the EOL (34.7 vs. 56.2, p < 0.05) and were more likely to die in nursing homes (18.1% vs. 10.3%, p < 0.05) than those with kin, they did not have higher EOL symptom burden or treatment intensity (e.g., intensive care unit use). In multinomial logistic analysis controlling for demographic and illness characteristics, kinless decedents living in the community before death had a twofold increased risk of dying in the nursing home (odds ratio [OR] = 2.02 [95% confidence interval (CI) = 1.09-3.72]) and a trend toward increased risk of hospital death (OR = 1.60 [95% CI = 0.96-2.69]) versus home setting.

CONCLUSIONS: Kinless individuals are more likely to die in nursing homes, even if they are living in the community in their last year of life. Expanded long-term care services and policies are needed to enable all older adults regardless of their family support systems to receive high-quality EOL care.

%B Journal of the American Geriatric Society %V 69 %P 2143-2151 %G eng %N 8 %R 10.1111/jgs.17171 %0 Journal Article %J Innovation in Aging %D 2021 %T Neighborhood Characteristics and Accelerated Aging: Evidence From the Health and Retirement Study %A Lee, Haena %A Jennifer A Ailshire %A Eileen M. Crimmins %K accelerated aging %K Neighborhood characteristics %K Venous Blood Study %X An individual’s rate of aging directly impacts one’s functioning, morbidity and mortality. Identifying factors related to accelerated or delayed aging may provide important information for potential areas of intervention. While race/ethnicity, socioeconomic status and behavior characteristics have been linked to biological aging, it is unclear whether neighborhood characteristics are associated with one’s rate of aging. We use a novel aging measure, Expanded Biological Age, from the 2016 Health and Retirement Study Venous Blood Study (HRS-VBS) to investigate whether individuals living with unfavorable neighborhood conditions are experiencing accelerated aging compared to those living in more favorable conditions. We constructed a summary measure of expanded biological age using 22 novel biomarkers in the HRS-VBS; we then regressed the summary measure on age and used the residuals as indicators of accelerated or delayed aging. We measured neighborhood physical disorder, presence of green space, and perceived social cohesion using the 2016 HRS Interviewer Observation data and Self-Administered Questionnaire. We find that individuals living with higher levels of neighborhood physical disorder appeared 1.05 years older biologically than the average for those of the same chronological age. Individuals living near green space including parks were 1.5 years younger biologically than expected based on their chronological age though this association was marginally significant. We did not find an association between neighborhood social cohesion and accelerated aging. This implies that living with severe neighborhood disorder, characterized by presence of disrepair, trash/litter, and abandoned structures, and living near green space, play an important role in who lives longer. %B Innovation in Aging %V 5 %P 244 %G eng %N Suppl 1 %R 10.1093/geroni/igab046.944 %0 Report %D 2021 %T The Non-Cognitive Roots of Civic Honesty: Evidence from the US %A Bucciol Alessandro %A Luca Zarri %K Civic Honesty %K Personality Traits %K socioeconomic status %X Even though a large experimental literature explored the links between personality traits and honesty, available evidence is inconclusive. In this study, we provide large-scale evidence on the influence of the “Big Five” personality traits on civic honesty, by considering the role played by individuals’ socioeconomic status. To this aim, we rely on survey data from the Health and Retirement Study (HRS), which is representative of the US population aged 50 or more. We show that most “Big Five” traits significantly affect civic honesty, with Agreeableness being the strongest predictor. We view our findings as complementing and extending to civic-minded behavior the results of prior work on cheating based on small samples and non-representative subject pools. %B Department of Economics Working Paper Series %I University of Verona %C Verona, Italy %G eng %U http://dse.univr.it/home/workingpapers/wp2021n2.pdf %0 Web Page %D 2021 %T Opinion: Retirees with annuities have more fun %A Arends, Brett %K annuities %K Retirement %K Wealth %X The reassurance that they won’t outlive their savings lets them open up their wallets and have a good time while they can, argue researchers David Blanchett and Michael Finke. Blanchett is the head of retirement research at QMA/Prudential Financial, an insurance company, and Finke is a professor and chair of economic security research at the American College of Financial Services. %B Retirement Weekly %I MarketWatch %G eng %U https://www.marketwatch.com/story/retirees-with-annuities-have-more-fun-11628192718 %0 Journal Article %J Public Health Nutrition %D 2021 %T Organic food consumption is associated with inflammatory biomarkers among older adults. %A Ludwig-Borycz, Elizabeth %A Heidi M Guyer %A Aljahdali, Abeer A %A Baylin, Ana %K C-reactive protein %K Chronic disease %K Conventional food consumption %K Cystatin C %K Organic food consumption %K Pesticides %X

OBJECTIVE: The association between organic food consumption and biomarkers of inflammation, C-reactive protein (CRP) and cystatin C (CysC) was explored in this cross-sectional analysis of older adults.

DESIGN: Dietary data and organic food consumption was collected in 2013 from a FFQ. Alternative Mediterranean diet score (A-MedDiet) was calculated as a measure of healthy eating. Biomarkers CRP and CysC were collected in serum or plasma in 2016. We used linear regression models to assess the associations between organic food consumption and CRP and CysC.

SETTING: This cross-sectional analysis uses data from the nationally representative, longitudinal panel study of Americans over 50, the Health and Retirement Study.

PARTICIPANTS: The mean age of the analytic sample (n 3815) was 64·3 (se 0·3) years with 54·4 % being female.

RESULTS: Log CRP and log CysC were inversely associated with consuming organic food after adjusting for potential confounders (CRP: β = -0·096, 95 % CI 0·159, -0·033; CysC: β = -0·033, 95 % CI -0·051, -0·015). Log CRP maintained statistical significance (β = -0·080; 95 % CI -0·144, -0·016) after additional adjustments for the A-MedDiet, while log CysC lost statistical significance (β = -0·019; 95 % CI -0·039, 0·000). The association between organic food consumption and log CRP was driven primarily by milk, fruit, vegetables and cereals, while log CysC was primarily driven by milk, eggs and meat after adjustments for A-MedDiet.

CONCLUSIONS: These findings support the hypothesis that organic food consumption is inversely associated with biomarkers of inflammation CRP and CysC, although residual confounding by healthy eating and socioeconomic status cannot be ruled out.

%B Public Health Nutrition %V 24 %P 4603-4613 %G eng %N 14 %R 10.1017/S1368980020005236 %0 Journal Article %J Journal of General Internal Medicine %D 2021 %T Patterns of Material Hardship and Food Insecurity Among Older Adults During the COVID-19 Pandemic. %A Claire K. Ankuda %A Fogel, Joyce %A Amy Kelley %A Byhoff, Elena %K COVID-19 %K Food insecurity %K material hardship %K race %X The coronavirus (COVID-19) pandemic has major economic consequences across the USA.1 Along with heightened risk for severe COVID-19,2 older adults have less digital access which may be a barrier to mobilizing supports including grocery delivery.3,4 While people with lower incomes and from racial and ethnic minoritized groups have faced high levels of material hardship due to COVID-19,1 little is known about the experience of older adults. We aim to assess the prevalence and risk factors for material hardship and food insecurity among older adults in the USA. %B Journal of General Internal Medicine %V 36 %P 3639-3641 %G eng %N 11 %R 10.1007/s11606-021-06905-3 %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2021 %T Perceived Neighborhood Characteristics and Cognitive Functioning among Diverse Older Adults: An Intersectional Approach %A Amy D Thierry %A Kyler J. Sherman-Wilkins %A Armendariz, Marina %A Allison R Sullivan %A Heather R. Farmer %K cognitive functioning %K Health Disparities %K Intersectionality %K Neighborhoods %K Older Adults %X Unfavorable neighborhood conditions are linked to health disparities. Yet, a dearth of literature examines how neighborhood characteristics contribute to cognitive health in diverse samples of older adults. The present study uses an intersectional approach to examine how race/ethnicity, gender, and education moderate the association between neighborhood perceptions and cognitive functioning in later life. We used data from adults ≥65 years old (n = 8023) in the 2010–2016 waves of the nationally representative Health and Retirement Study (HRS). We conducted race/ethnicity-stratified linear regression models where cognitive functioning, measured using the 35-point Telephone Interview Cognitive Screen (TICS), was regressed on three neighborhood characteristics—cleanliness, safety, and social cohesion. We examine whether there is heterogeneity within race/ethnicity by testing if and how the relationship between neighborhood characteristics and cognitive functioning differs by gender and education. Among White adults, worse neighborhood characteristics were associated with lower cognitive functioning among those with less education. However, for Black adults, poor perceived quality of one’s neighborhood was associated with worse cognitive functioning among those with more years of education compared to those with fewer years of education. Among Mexicans, perceived neighborhood uncleanliness was associated with lower cognitive functioning among those with less education, but higher cognitive functioning for those with higher levels of education. Thus, this study contributes to the literature on racial/ethnic disparities in cognitive aging disparities by examining neighborhood contextual factors as determinants of cognitive functioning. In particular, we find that higher education in the context of less favorable neighborhood environments does not confer the same benefits to cognitive functioning among all older adults. %B International Journal of Environmental Research and Public Health %V 18 %P 1-14 %G eng %N 5 %R 10.3390/ijerph18052661 %0 Journal Article %J PLoS One %D 2021 %T Peripheral edema: A common and persistent health problem for older Americans. %A Besharat, Soroush %A Grol-Prokopczyk, Hanna %A Gao, Shan %A Feng, Changyong %A Akwaa, Frank %A Gewandter, Jennifer S %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Edema %K ethnicity %K Female %K Follow-Up Studies %K Humans %K Longitudinal Studies %K Lower Extremity %K Male %K Middle Aged %K Mobility Limitation %K Prognosis %K Surveys and Questionnaires %K United States %X

Peripheral edema (i.e., lower limb swelling) can cause pain, weakness, and limited range of motion. However, few studies have examined its prevalence in the U.S. or its association with demographics, comorbidities, activity, or mobility. This study used data from the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults (age 51+/ N = 19,988 for 2016), to evaluate time trends and correlates of peripheral edema using weighted descriptive statistics and logistic regressions, respectively. Peripheral edema was assessed with the question "Have you had… // Persistent swelling in your feet or ankles?" The weighted prevalence of edema among older U.S. adults was 19% to 20% between 2000 and 2016. Peripheral edema was associated with older age, female sex, non-white race, low wealth, obesity, diabetes, hypertension, pain, low activity levels, and mobility limitations (odds ratios ranging from 1.2-5.6; p-values ≤0.001). This study provides the first estimates of national prevalence and correlates of peripheral edema among older Americans. Peripheral edema is common and strongly associated with comorbidities, pain, low activity levels, and mobility limitations, and disproportionately affects poorer and minority groups. Peripheral edema should be a focus of future research in order to develop novel and cost-effective interventions.

%B PLoS One %V 16 %P e0260742 %G eng %N 12 %R 10.1371/journal.pone.0260742 %0 Journal Article %J Journal of Applied Gerontology %D 2021 %T Physical Activity and Falls Among a National Cohort of Older Veterans %A Dan Marciniak %A Neil B. Alexander %A Geoffrey J Hoffman %K Aging %K Disability %K Falls %K Physical activity %K Veterans %X The more than 20 million U.S. veterans have a history of physical activity engagement but face increasing disability as they age. Falls are common among older adults, but there is little evidence on veterans’ fall risk. We conducted a retrospective cohort study using 48,643 observations from 14,831 older (≥65 years) Americans from the 2006–2014 waves of the Health and Retirement Study. Veterans reported more noninjurious falls (26.6% vs. 24.0%, p < .002), but fewer fall-related injuries (8.9% vs. 12.3%, p < .001) than nonveterans. In adjusted analyses, for each 5-year increase in age, the odds of a noninjurious fall were greater for veterans (odds ratio [OR] = 1.05, 95% confidence interval [CI] = [1.01, 1.10]) and, among those with regular physical activity, the odds were lower for veterans compared with nonveterans (OR = 0.89; 95% CI = [0.81, 0.99]). For veterans, physical activity engagement may prove a particularly effective mechanism for reducing the aging-related risks associated with falls and fall injuries. %B Journal of Applied Gerontology %V 40 %P 310-319 %G eng %N 3 %R 10.1177/0733464820915807 %0 Journal Article %J Work, Aging and Retirement %D 2021 %T Physical Work Exposures of Older Workers: Does Measurement Make a Difference? %A Andrasfay, Theresa %A Pebley, Anne R %A Goldman, Noreen %K Health Inequality %K long-term health consequences %K O*NET %K Older workers %K physical work %X Physically demanding work at later ages, which is especially prevalent among disadvantaged groups, is associated with long-term health outcomes and may contribute to health inequality over the life course. Past studies of these issues have relied on occupational characteristics from the Occupational Information Network (O*NET), but few have assessed how O*NET compares to survey reports when measuring occupational exposures in analyses of socioeconomic status, work conditions, and health. We compare Health and Retirement Study (HRS, N = 16,683 working respondents) and O*NET measurements of general physical activity, frequency of lifting/handling objects, and frequency of stooping-related postures required at work. Pearson correlations between the HRS items and corresponding O*NET items vary from weak to moderate for lifting/handling and stooping-related postures to relatively large for general physical activity. Though they are measured on different scales, both the HRS and O*NET measures of physical demands reveal similar sex, racial/ethnic, and educational differentials in exposure to physically strenuous work. We fit random effects Poisson models to assess how these measures predict accumulation of functional limitations, a potential long-term consequence of strenuous working conditions. Comparable HRS and O*NET measures have similar associations with functional limitations. We also consider an average of physical demand items available in O*NET, finding that this measure has similar associations with functional limitations as the O*NET measure of general physical activity. These results suggest that O*NET characteristics and HRS respondent reports produce comparable disparities in physical work exposures (PWEs) and associations between physically demanding work and declines in physical functioning. %B Work, Aging and Retirement %P waab014 %@ 2054-4650 %G eng %R 10.1093/workar/waab014 %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2021 %T Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity %A Jun, Hankyung %A Emma Aguila %K Cognitive health %K Health Insurance %K Mental Health %K Multiple Chronic Conditions %K race disparity %X Older adults with multiple chronic conditions have a higher risk than those without multiple conditions of developing a mental health condition. Individuals with both physical and mental conditions face many substantial burdens. Many such individuals also belong to racial and ethnic minority groups. Private insurance coverage can reduce the risks of developing mental illnesses by increasing healthcare utilization and reducing psychological stress related to financial hardship. This study examines the association between private insurance and mental health (i.e., depressive symptoms and cognitive impairment) among older adults in the United States with multiple chronic conditions by race and ethnicity. We apply a multivariate logistic model with individual fixed-effects to 12 waves of the Health and Retirement Study. Among adults with multiple chronic conditions in late middle age nearing entry to Medicare and of all racial and ethnic groups, those without private insurance have a stronger probability of having depressive symptoms. Private insurance and Medicare can mediate the risk of cognitive impairment among non-Hispanic Whites with multiple chronic conditions and among Blacks regardless of the number of chronic conditions. Our study has implications for policies aiming to reduce disparities among individuals coping with multiple chronic conditions. %B International Journal of Environmental Research and Public Health %V 18 %P 1-15 %G eng %N 5 %R 10.3390/ijerph18052615 %0 Journal Article %J Epidemiology %D 2021 %T Proof of concept example for use of simulation to allow data pooling despite privacy restrictions. %A Teresa Filshtein %A Li, Xiang %A Zimmerman, Scott C %A Ackley, Sarah F %A M. Maria Glymour %A Melinda C Power %K data pooling %K Methodology %K privacy restrictions %X

BACKGROUND: Integrating results from multiple samples is often desirable, but privacy restrictions may preclude full data pooling, and most datasets do not include fully harmonized variable sets. We propose a simulation-based method leveraging partial information across datasets to guide creation of synthetic data, based on explicit assumptions about the underlying causal structure, that permits pooled analyses that adjust for all desired confounders in the context of privacy restrictions.

METHODS: This proof-of-concept project uses data from the Health and Retirement Study (HRS) and Atherosclerosis Risk in Communities (ARIC) study. We specified an estimand of interest and a directed acyclic graph (DAG) summarizing the presumed causal structure for the effect of glycated hemoglobin (HbA1c) on cognitive change. We derived publicly reportable statistics to describe the joint distribution of each variable in our DAG. These summary estimates were used as data-generating rules to create synthetic datasets. After pooling, we imputed missing covariates in the synthetic datasets and used the synthetic data to estimate the pooled effect of HbA1c on cognitive change, adjusting for all desired covariates.

RESULTS: Distributions of covariates, as well as model coefficients and associated standard errors for our model estimating the effect of HbA1c on cognitive change were similar across cohort-specific original and pre-imputation synthetic data. The estimate from the pooled synthetic incorporates control for confounders measured in either original dataset.

DISCUSSION: Our approach has advantages over meta-analysis or individual-level pooling/data harmonization when privacy concerns preclude data sharing and key confounders are not uniformly measured across datasets.

%B Epidemiology %V 32 %P 638-647 %G eng %N 5 %R 10.1097/EDE.0000000000001373 %0 Journal Article %J Medical Care %D 2021 %T Racial and Ethnic Differences in Multimorbidity Changes Over Time. %A Ana R Quiñones %A Jason T Newsom %A Elman, Miriam R %A Markwardt, Sheila %A Corey L Nagel %A David A Dorr %A Heather G. Allore %A Anda Botoseneanu %K multimorbidity %K race and ethnicity %X

BACKGROUND: Our understanding of how multimorbidity progresses and changes is nascent.

OBJECTIVES: Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297).

MEASURES: Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms.

RESULTS: Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014.

CONCLUSIONS AND RELEVANCE: Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.

%B Medical Care %V 59 %P 402-409 %G eng %N 5 %R 10.1097/MLR.0000000000001527 %0 Journal Article %J Nutrients %D 2021 %T The Relationship between Political, Economic, Social, and Cultural Vulnerability and Food Insecurity among Adults Aged 50 Years and Olde %A Patrick Brady %A Askelson, Natoshia M %A Ashida, Sato %A Nothwehr, F. %A Janssen, Brandi %A Frisvold, David %K Food insecurity %K social exclusion %X Individuals experience food insecurity when they worry about or have limited access to nutritious foods. Food insecurity negatively impacts older adults’ health. Social exclusion is a theoretical framework describing how unequal access to rights, resources, and capabilities results in political, economic, social, and cultural vulnerability, which leads to health disparities. We used the Health and Retirement Study to cross-sectionally examine associations between vulnerability and experiencing food insecurity in adults 50 years and older using the social exclusion framework. We tested the association between experiencing food insecurity and indicators of political, economic, social, and cultural vulnerability using logistic regression controlling for demographic and health-related factors. Analyses were performed with all respondents and sub-group of respondents with incomes less than 400% of the federal poverty level (FPL). Assets (OR = 0.97 in both samples), income (OR = 0.85, 0.80 in 400% FPL sub-sample), perceived positive social support from other family (OR = 0.86, 0.84 in 400% FPL sub-sample), and perceived everyday discrimination (OR = 1.68, 1.82 in 400% FPL sub-sample) were significantly associated with food insecurity. Perceived positive social support from spouses, children, or friends and U.S. citizenship status were not significantly associated with food insecurity. Further research is needed to define and measure each dimension of vulnerability in the social exclusion framework. Interventions and policies designed to prevent food insecurity should address these vulnerabilities %B Nutrients %V 13 %P 3896 %G eng %N 11 %R https://doi.org/10.3390/nu13113896 %0 Web Page %D 2021 %T Retirees who pay the most in taxes make only $36,000 a year on average, study finds %A Asymkos, Stephanie %K Retirement %K Taxes %X Retirees who have the most money pay the most in taxes, according to a recent working paper, but they’re not necessarily rich. “Most of the tax burden is carried by the top quintile of households,” Anqi Chen, co-author and assistant director of savings research at the Center for Retirement Research at Boston College, told Yahoo Money. But “it's important to keep in mind that when we think about the top quintile of households — the top 20% — they're not the super wealthy.” %B Yahoo! Finance %I Yahoo! %G eng %U https://finance.yahoo.com/news/retirees-pay-the-most-in-taxes-175434021.html %0 Thesis %D 2021 %T The Role of Social Support and Health Promotion Behaviors For U.S. Aging Adults %A Akers, Erika %K Health behaviors. gender %K Social Support %X Background and Objectives: Perceived social support may influence health outcomes among older adults by influencing the practice of health-related behaviors, including preventive and lifestyle behaviors. This study examines how social support influences health behaviors in the aging United States (U.S.) population. Methods: I analyzed data from 4,891 respondents aged 50 and older in the 2014-2016 Health and Retirement Study, a nationally representative longitudinal survey of midlife and older adults. Multivariate logistic regression was used to examine the relationship between positive social support and health behaviors by gender. Results: Results show that the role of children’s positive social support is important for the engagement of moderate and vigorous physical activity for both men and women. Discussion: These findings contribute to current research and bode the importance of social support related interventions within public health efforts to address population health disparities through the social determinants of health (SDOH) frameworks. %I University of Nebraska, Lincoln %C Lincoln, NE %G eng %U https://digitalcommons.unl.edu/honorsembargoed/191/ %0 Journal Article %D 2021 %T Roles of interacting stress-related genes in lifespan regulation: Insights for translating experimental findings to humans %A Anatoliy Yashin %A Wu, Deqing %A Konstantin G Arbeev %A Arseniy P Yashkin %A Akushevich, Igor %A Bagley, Olivia %A Duan, Matt %A Svetlana Ukraintseva %K amino acids starvation %K GCN2/EIF2AK4 and CHOP/DDI3T genes %K GxG interactions %K Integrated stress response %K Lifespan %X Aim: Experimental studies provided numerous evidence that caloric/dietary restriction may improve health and increase the lifespan of laboratory animals, and that the interplay among molecules that sense cellular stress signals and those regulating cell survival can play a crucial role in cell response to nutritional stressors. However, it is unclear whether the interplay among corresponding genes also plays a role in human health and lifespan. Methods: Literature about roles of cellular stressors have been reviewed, such as amino acid deprivation, and the integrated stress response (ISR) pathway in health and aging. Single nucleotide polymorphisms (SNPs) in two candidate genes (GCN2/EIF2AK4 and CHOP/DDI3T) that are closely involved in the cellular stress response to amino acid starvation, have been selected using information from experimental studies. Associations of these SNPs and their interactions with human survival in the Health and Retirement Study data have been estimated. The impact of collective associations of multiple interacting SNP pairs on survival has been evaluated, using a recently developed composite index: the SNP-specific Interaction Polygenic Risk Score (SIPRS). Results: Significant interactions have been found between SNPs from GCN2/EIF2AK4 and CHOP/DDI3T genes that were associated with survival 85+ compared to survival between ages 75 and 85 in the total sample (males and females combined) and in females only. This may reflect sex differences in genetic regulation of the human lifespan. Highly statistically significant associations of SIPRS [constructed for the rs16970024 (GCN2/EIF2AK4) and rs697221 (CHOP/DDIT3)] with survival in both sexes also been found in this study. Conclusion: Identifying associations of the genetic interactions with human survival is an important step in translating the knowledge from experimental to human aging research. Significant associations of multiple SNPxSNP interactions in ISR genes with survival to the oldest old age that have been found in this study, can help uncover mechanisms of multifactorial regulation of human lifespan and its heterogeneity. %V 5 %P 357-379 %G eng %R 10.20517/jtgg.2021.26 %0 Journal Article %J Occupational and Environmental Medicine %D 2021 %T S-207 Multidimensional employment quality, retirement trajectories and cardiometabolic health in later life in the US %A Sarah B. Andrea %A Eisenberg-Guyot, Jerzy %A Peckham, Trevor %A Vanessa M Oddo %A Hajat, Anjum %K cardiometabolic health %K employment quality %K Retirement %X Introduction The working lives of Americans have become less stable over the past several decades and older adults may be particularly vulnerable to these changes in employment quality (EQ).Objective We examined later-life multidimensional EQ and retirement trajectories of older Americans and the potential consequences worsening EQ may have for cardiometabolic health and health inequities in this population.Methods Using longitudinal data on employment stability, material rewards, workers’ rights, working-time arrangements, unionization, and interpersonal power relations from the Health and Retirement Study, we used principal component analysis to construct an EQ score. Then, we used sequence analysis to identify late-career EQ trajectories (age 50–70 years; N=11,958 respondents), overall and by race, gender, educational attainment, marital status. Finally, we estimated the association between trajectory-membership and post-sequence-analysis-period prevalence of poor cardiometabolic health.Results We identified ten EQ trajectories; the most prevalent trajectories were Minimally Attached and Wealthy (13.9%) and Good EQ to Good Retirement (13.7%), however, 42% of respondents were classified into suboptimal trajectories. Those in suboptimal trajectories were disproportionately women, Hispanic and/or Black, Indigenous and People of Color, and those with lower educational attainment. Moreover, those in suboptimal trajectories tended to report the worse cardiometabolic health. For example, the prevalence of hypertension was lowest for those in the Wealthy Business Owners trajectory and highest for Workers with Premature Mortality, followed by workers with Fair EQ and Good but Diminishing Wealth in Retirement.Conclusion EQ is inequitably distributed and may play a role in cardiometabolic health inequities in later life. %B Occupational and Environmental Medicine %V 78 %P A153–A154 %G eng %N Suppl 1 %R 10.1136/OEM-2021-EPI.420 %0 Journal Article %J Journal of Psychiatric Research %D 2021 %T Self-Rated Health and Incident Dementia over Two Decades: Replication Across Two Cohorts %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Damaris Aschwanden %A Antonio Terracciano %K Dementia %K longitudinal %K Risk Factors %K Self-rated health %X This prospective study examined the association between self-rated health and incident dementia in two large cohorts of middle-aged and older adults. Participants were drawn from the Health and Retirement Study (HRS, N= 13,839, Mean Age= 64.32, SD= 9.04) and the English Longitudinal Study of Ageing (ELSA, N=4649, Mean Age = 64.44, SD= 9.97). Self-rated health and covariates were assessed at baseline in 1998 and 2002, and cognitive status was tracked for up to 21 years in HRS and 17 years in ELSA, respectively. Controlling for demographic factors, poorer self-rated health was associated with higher risk of incident dementia in HRS (HR: 1.18, 95%CI: 1.12-1.24, p<.001) and ELSA (HR: 1.38, 95%CI: 1.23-1.55, p<.001). These associations remained significant when diabetes, hypertension, smoking, physical inactivity, depressive symptoms, personality, and polygenic risk for Alzheimer’s Disease were included as additional covariates or when cases occurring within the first ten years of follow-up were excluded from the analyses. There was no replicable evidence that age, sex, education, race or ethnicity moderated the association. Self-rated health is a long-term, replicable predictor of incident dementia that is independent of genetic, clinical, and behavioral risk factors. %B Journal of Psychiatric Research %V 143 %P 462-466 %@ 0022-3956 %G eng %R 10.1016/j.jpsychires.2021.06.036 %0 Newspaper Article %B The New York Times %D 2021 %T She Bought a Truck on eBay, Then Forgot It. A Dementia Diagnosis Came Later. %A Andrews, Michelle %K Alzheimer's disease %K Cognition %K Dementia %X Impulsive purchases, out-of-control spending: These behaviors can be early signs of Alzheimer’s disease or other cognitive decline. %B The New York Times %I New York Times %C New York, New York %G eng %U https://www.nytimes.com/2021/04/29/business/alzheimers-dementia-personal-finance.html %0 Journal Article %J Journal of Survey Statistics and Methodology %D 2021 %T A Simple Question Goes a Long Way: A Wording Experiment on Bank Account Ownership %A Marco Angrisani %A Mick P. Couper %K Cognitive Ability %K Financial literacy %X Ownership of a bank account is an objective measure and should be relatively easy to elicit via survey questions. Yet, depending on the interview mode, the wording of the question and its placement within the survey may influence respondents’ answers. The Health and Retirement Study (HRS) asset module, as administered online to members of the Understanding America Study (UAS), yielded substantially lower rates of reported bank account ownership than either a single question on ownership in the Current Population Survey (CPS) or the full asset module administered to HRS panelists (both interviewer-administered surveys). We designed and implemented an experiment in the UAS comparing the original HRS question eliciting bank account ownership with two alternative versions that were progressively simplified. We document strong evidence that the original question leads to systematic underestimation of bank account ownership. In contrast, the proportion of bank account owners obtained from the simplest alternative version of the question is very similar to the population benchmark estimate. We investigate treatment effect heterogeneity by cognitive ability and financial literacy. We find that questionnaire simplification affects responses of individuals with higher cognitive ability substantially less than those with lower cognitive ability. Our results suggest that high-quality data from surveys start from asking the right questions, which should be as simple and precise as possible and carefully adapted to the mode of interview. %B Journal of Survey Statistics and Methodology %G eng %R https://doi.org/10.1093/jssam/smab045 %0 Journal Article %J Journal of Aging and Health %D 2021 %T Skilled Nursing Facilities Modify the Relationship Between Depressive Symptoms and Hospital Readmissions but Not Health Outcomes Among Older Adults. %A Leah R. Abrams %A Geoffrey J Hoffman %K depression %K Medicare %K post-acute care %K Readmissions %K Rehabilitation %X

Despite detrimental effects of depressive symptoms on self-care and health, hospital discharge practices and the benefits of different discharge settings are poorly understood in the context of depression. This retrospective cohort study comprised 23,485 hospitalizations from Medicare claims linked to the Health and Retirement Study (2000-2014). Respondents with depressive symptoms were no more likely to be referred to home health, whereas the probability of discharge to skilled nursing facilities (SNFs) went up a half percentage point with each increasing symptom, even after adjusting for family support and health. Rehabilitation in SNFs, compared to routine discharges home, reduced the positive association between depressive symptoms and 30-day hospital readmissions (OR = 0.95, = 0.029) but did not prevent 30-day falls, 1-year falls, or 1-year mortality associated with depressive symptoms. Depressive symptoms were associated with discharges to SNFs, but SNFs do not appear to address depressive symptoms to enhance functioning and survival.

%B Journal of Aging and Health %V 33 %P 817-827 %G eng %N 10 %R 10.1177/08982643211013127 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Smoking and Alcohol Consumption Following a New Dementia Diagnosis. %A Arora, Kanika %A Bhagianadh, Divya %K alcohol %K Dementia %K dementia diagnosis %K Smoking %X

OBJECTIVES: Despite extensive research on lifestyle factors that influence the risk of developing dementia, limited evidence exists on whether older adults adopt healthier habits post-diagnosis in the hope of preserving their quality of life.

METHOD: Using panel data (1998-2014) from the Health and Retirement Study, this study investigated whether individuals who received a new dementia diagnosis were more likely to modify smoking and drinking behaviors than those without such a diagnosis. Propensity score weighting was used to adjust for observable differences between groups.

RESULTS: Older adults with a new dementia diagnosis were 2.8 times more likely to reduce alcohol consumption than those without such a diagnosis. This result was mainly attributable to "light" drinkers at baseline and appeared to fade over time. We found no statistically significant effect of a dementia diagnosis on smoking cessation or on reduction in the number of cigarettes smoked. These results were robust to multiple sensitivity tests, including the use of cognition scores to indicate dementia onset instead of self-reported physician diagnosis.

DISCUSSION: A new dementia diagnosis can serve as a window of opportunity that prompts some older adults to change habits related to alcohol consumption. This has important implications for clinical practice surrounding dementia diagnosis disclosure, the rates of which are currently much lower than other medical conditions.

%B The Journals of Gerontology: Series B %V 76 %P 745-755 %G eng %N 4 %R 10.1093/geronb/gbz127 %0 Journal Article %J Journal of Biosciences and Medicines %D 2021 %T Social Determinants of Change in Smoking Status over a 26-Year Follow up Period among Middle-Aged and Older Americans %A Shervin Assari %K race %K Smoking %K socioeconomic status %K Tobacco Use %X Educational attainment and income are among major socioeconomic status (SES) indicators that are inversely associated with cigarette smoking. Marginalization-related Diminished Returns (MDRs), however, are weaker protective effects of SES indicators for racial and ethnic minority groups compared to non-Hispanic White people. The aim is to test whether racial and ethnic differences exist in the effects of educational attainment and income on cigarette smoking of middle-aged and older American adults. This is a 26-year longitudinal study using data from the Health and Retirement Study (HRS), a nationally representative study of middle-aged and older adults in the US. A total number of 11,316 middle-aged and older adults (age ≥ 50) were followed for up to 26 years. The independent variables were educational attainment and income. The dependent variables were always smoking and being quitters over the follow-up time. Age, gender, self-rated health, and chronic medical conditions were the covariates. Race/ethnicity was the moderator. Logistic regressions were used to analyze the data. Most participants were never smokers (n = 7950), followed by quitters (n = 1765), always smokers (n = 1272), and initiators (n = 329). Overall, high educational attainment (OR = 0.92, 95% CI = 0.90 - 0.95) and income (OR = 0.99, 95% CI = 0.99 - 0.99) reduced the odds of being always smoker. High educational attainment (OR = 1.05, 95% CI = 1.02 - 1.08) was associated with higher odds of being a quitter. Ethnicity, however, showed significant interactions with education on both outcomes suggesting that the effects of educational attainment on reducing the odds of always being a smoker (OR = 1.24, 95% CI = 1.14 - 1.35) and increasing the odds of quitting (OR = 0.84, 95% CI = 0.75 - 0.93) were smaller for Hispanics than non-Hispanics. In the United States, middle-aged and older Hispanic adults remain at high risk of smoking cigarettes despite high educational attainment. That is, high educational attainment may better help non-Hispanic than Hispanic middle-aged and older adults to avoid cigarette smoking. As a result, we may observe a more than expected burden of tobacco use in middle class Hispanic middle-aged and older adults. Policymakers should not reduce racial and ethnic tobacco inequalities to SES gap, as ethnic tobacco disparities may persist in high SES levels as well. %B Journal of Biosciences and Medicines %V 9 %P 29-41 %G eng %R 10.4236/jbm.2021.94003 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Social Engagement and Cognitive Function of Older Adults in Mexico and the United States: How Universal Is the Interdependence in Couples? %A Bret Howrey %A Jaqueline C Avila %A Brian Downer %A Rebeca Wong %K Cohort Analysis %K Cross-country study %K Marriage %K MHAS %X

OBJECTIVES: Increased social engagement in older adults has been linked to positive cognitive outcomes; however, it is unclear if the social engagement of husbands and wives influences their own cognition as well as each other's cognition. Moreover, it is unknown if any such patterns persist in different country contexts.

METHODS: Data from the 2001 Mexican Health and Aging Study (MHAS) and the 2000 Health and Retirement Study (HRS) were combined, and comparable samples of married couples without cognitive impairment at baseline were drawn. Follow-up cognition data was obtained from the 2012 MHAS and the 2012 HRS. Structural equation models (SEM) were used to test the actor-partner interdependence model with moderating effect of country on the association of social engagement with cognition.

RESULTS: Significant actor effects were observed for wives in both countries. Actor effects for husbands were observed in the United States only. In Mexico, a significant partner effect was observed where wives' social engagement benefited their own cognition as well as their husbands', but not vice versa. Partner effects were not observed in the United States. No moderation effects of country were observed.

DISCUSSION: Our results suggest asymmetric patterns of actor-partner interdependence in Mexico, which may be reflective of the more traditional social role of women, and codependence within the couple. On the other hand, our results for the United States, where each spouse had significant actor effects but no partner effects, may suggest more independence within the couple.

%B The Journals of Gerontology: Series B %V 76 %P S41-S50 %G eng %N Supplement_1 %R 10.1093/geronb/gbaa025 %0 Journal Article %J SSM - Population Health %D 2021 %T Social vulnerability and aging of elderly people in the United States %A Ana Lucia Abeliansky %A Devin Erel %A Holger Strulik %K frailty index %K health %K Social capital %K Social vulnerability %X We use 7 waves of the Health and Retirement Study and construct a social vulnerability index (SVI) for elderly U.S. Americans (born 1913–1966). We show that the SVI is mildly larger for men than for women and increases in age from above age 60 onwards for both genders. Social vulnerability of men (but not of women) is lower in the West and Midwest than in other regions and higher income mildly reduces the SVI for men (but not for women). In cohort analysis we find an increase of the SVI for individuals born in the late 1940s or later, which is, however, statistically significant only for women. In order to investigate the nexus between social vulnerability and aging, we construct a frailty index from the same data. We find that socially vulnerable persons display more health deficits at any age. Using the initial SVI (at first interview) we find that social vulnerability exerts a significant impact on subsequent accumulation of health deficits, which is of about the same size for men and women. A one standard deviation increase in the initial SVI leads to a 20 percent increase of the frailty index at any age. %B SSM - Population Health %V 16 %P 100924 %G eng %R 10.1016/j.ssmph.2021.100924 %0 Journal Article %J Journal of Psychosomatic Research %D 2021 %T Subjective age and multiple cognitive domains in two longitudinal samples %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Damaris Aschwanden %A Antonio Terracciano %K Adulthood %K Cognition %K Executive function %K Memory %K numeric reasoning %K Subjective age %K verbal fluency %K Visuospatial ability %X Objective Subjective age is consistently related to memory performance and global cognitive function among older adults. The present study examines whether subjective age is prospectively related to specific domains of cognitive function. Method Participants were drawn from the Health and Retirement Study (HRS, N = 2549, Mean Age = 69.66, SD = 7.36) and the Midlife in the United States Survey (MIDUS, N = 2499, Mean Age = 46.24, SD = 11.25). In both samples, subjective age, depressive symptoms, chronic conditions, and demographic factors were assessed at baseline. Four domains of cognition were assessed 8 years later in the HRS and almost 20 years later in the MIDUS: episodic memory, speed-attention-executive, verbal fluency, and numeric reasoning. HRS also assessed visuospatial ability. Results Regression analysis revealed that an older subjective age was related to worse performance in the domains of episodic memory and speed-attention-executive in both samples. The effect size for the difference between a younger and an older subjective age was d = 0.14 (MIDUS) and d = 0.24 (HRS) for episodic memory and d = 0.25 (MIDUS) and d = 0.33 (HRS) for speed-attention-executive. Feeling older was related to lower verbal fluency in HRS (d = 0.30) but not in MIDUS, whereas no association was found with numeric reasoning in either sample. An older subjective age was related to lower visuospatial ability in HRS (d = 0.25). Conclusion Subjective age is prospectively related to performance in different cognitive domains. The associations between subjective age and both episodic memory and speed-attention-executive functions were replicable and robust over up to 20 years of follow-up. %B Journal of Psychosomatic Research %V 150 %P 110616 %G eng %R 10.1016/j.jpsychores.2021.110616 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2021 %T Subjective Age and Verbal Fluency among Middle Aged and Older Adults: A Meta-Analysis of Five Cohorts %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Damaris Aschwanden %A Antonio Terracciano %K Adulthood %K ELSA %K Sister studies %K Subjective age %K verbal fluency %X Objectives This study aimed to examine the relation between subjective age and verbal fluency in five large samples of older adults to advance knowledge on the role of subjective age in a complex cognitive function that is an intermediate marker of cognitive impairment and dementia risk. Methods Participants (N > 27,000), aged 32 to 99 years old, predominantly white, were from the Wisconsin Longitudinal Study Graduate (WLSG) and Siblings (WLSS) samples, the Health and Retirement Study (HRS), the Midlife in the United States Study (MIDUS), and the English Longitudinal Study of Ageing (ELSA). They provided complete data on subjective age, demographic factors and verbal fluency. Estimates from each sample were combined in a meta-analysis. Results Across each of the five samples and in the meta-analysis, an older subjective age was related to lower performance on the verbal fluency task. This association was independent of chronological age and was not moderated by age, sex, nor education. The difference in fluency between individuals with an older and younger subjective age ranged from d= .09 to d= .37 across the five samples. Conclusions This study found replicable evidence for an association between an older subjective age and lower verbal fluency, extending knowledge about an intermediate marker of cognitive function. %B Archives of Gerontology and Geriatrics %V 97 %P 104527 %G eng %R 10.1016/j.archger.2021.104527 %0 Report %D 2021 %T TEMPORAL INSTABILITY OF RISK PREFERENCE AMONG THE POOR: EVIDENCE FROM PAYDAY CYCLES %A Akesaka, Mika %A Eibich, Peter %A Hanaoka, Chie %A Shigeoka, Hitoshi %K Income %K instability %K payday cycles %K Risk preference %X The poor live paycheck to paycheck and are repeatedly exposed to strong cyclical income fluctuations. We investigate whether such income fluctuations affect risk preference among the poor. If risk preference temporarily changes around payday, optimal decisions made before payday may no longer be optimal afterward, which could reinforce poverty. By exploiting Social Security payday cycles in the US, we find that risk preference among the poor relying heavily on Social Security changes around payday. Rather than cognitive decline before payday, the deterioration of mental health and relative deprivation may play a role. We find similar evidence among the Japanese elderly. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w28784 %0 Thesis %B Economics %D 2021 %T THREE ESSAYS ON THE ECONOMICS OF THE ELDERLY %A Adelman, Alan %K Cognition %K Retirement %X The following three essays cover topics on the economics of aging. In the first paper, I estimate the effect of pre-retirement cognitive ability on retirement behavior using the Health and Retirement Study. I find that cognitive ability delays retirement by extending labor force participation past the age of 65. I also find evidence that cognitive ability increases the propensity to delay Social Security benefits. These findings suggest that cognitive ability has a protective effect on labor force attachment and delays transition into retirement. The second paper uses a novel data set from China to study how instituting a pension program can influence individual cognition. Collaborating with Plamen Nikolov, we find that introducing pension benefits has a negative effect on the cognitive functioning among the elderly. The largest effect size was on the delayed recall test, which is a significant predictor of the onset of dementia. We also find suggestive evidence that the program has a larger impact among women. This chapter shows that retirement plays a significant role in explaining cognitive decline at older ages. The third paper is a collaboration with Hwan-sik Choi. In this chapter we study the role of noncognitive ability, focusing on Conscientiousness, in wealth accumulation and its indirect effect through the health status channel. Conscientiousness is associated with an increase in total net wealth. The indirect effect through health status is positive and a substantial portion of the total effect of Conscientiousness. We explore novel instruments for health status using polygenic scores and obtain similar results to the OLS results: Conscientiousness plays an important role in wealth accumulation and a fundamental factor behind the health effect on wealth accumulation. %B Economics %I The State University of New York at Binghamton %V Ph.D. %G eng %U https://www.proquest.com/openview/a43ca4958ca58c90c118cd2334119879/1?pq-origsite=gscholar&cbl=18750&diss=y %0 Journal Article %J Journal of Family and Economic Issues %D 2021 %T Timing of Immigration Effects Asset Change Among Hispanic Caregivers of Older Family Members %A Tamara J. Cadet %A Shanna Lynn Burke %A Frances R. Nedjat-Haiem %A Bakk, Louanne %A Naseh, Mitra %A Grudzien, Adrienne %A O’Driscoll, Janice %A Alcide, Amary %K Cross-cultural studies %K Economics %K Hispanic %K Immigration %K Informal care-giving %K Latino/a %K mexican american %K Relocation and transition %X Given the cultural value of family in Hispanic culture, older Hispanic immigrants are likely to have family caregivers. This study examined the economic implications of caring for older Hispanic adults regarding non-housing financial wealth over time. Using the 2008, 2010, and 2012 waves of the Health and Retirement Study (HRS) and RAND HRS data files, this study compares changes in the non-housing financial wealth between 2008 and 2012 by caregiving and immigration status among Hispanics. This study examined differences in assets between Hispanic caregivers and non-caregivers and more specifically examined the subpopulation of Hispanic caregivers who immigrated prior to and after 1968 as compared to U.S.-born caregivers to better understand the effect of the Immigration and Nationality Amendment Act of 1965 on asset change. Results indicate that caregiving itself did not have a statistically significant association with wealth, but the timing of immigration to the US had a statistically significant correlation (p < .05) with changes in the financial wealth. The findings of this study have implications for policy and program development targeting older adults and caregiving for this population. %B Journal of Family and Economic Issues %V 42 %P 561-572 %@ 1573-3475 %G eng %N 3 %R https://doi.org/10.1007/s10834-020-09719-3 %0 Journal Article %J PLoS One %D 2021 %T Trajectories of physical functioning among older adults in the US by race, ethnicity and nativity: Examining the role of working conditions. %A Pebley, Anne R %A Goldman, Noreen %A Andrasfay, Theresa %A Pratt, Boriana %K ethnicity %K nativity %K physical functioning %K race %X

Latinos in the US live significantly longer than non-Latino whites, but spend more years disabled. Differentials in socioeconomic status account for part, but not all, of the difference in older age disability between Latinos and whites. We hypothesize that a factor often ignored in the literature-the fact that Latinos, on average, have more physically strenuous jobs than non-Latino whites-contributes to the higher Latino risk of functional limitations at older ages. We use longitudinal data from the 1998-2014 Health and Retirement Study (HRS) comprising 17,297 respondents. Compared to US-born whites, Latinos, especially Latino immigrants, report substantially higher levels of physical effort at work. Latino-black differences are much smaller than Latino-white differences. As hypothesized, physical work effort is strongly related to functional limitations. However, differentials in physical work effort for Latinos and whites in their fifties and early sixties are weakly related to Latino-white differentials in FL at later ages.

%B PLoS One %V 16 %P e0247804 %G eng %N 3 %R 10.1371/journal.pone.0247804 %0 Journal Article %J Gerontology and Geriatric Medicine %D 2021 %T Unwelcome Companions: Loneliness Associates with the Cluster of Pain, Fatigue, and Depression in Older Adults %A Powell, Victoria D. %A Nauzley C Abedini %A Andrzej T Galecki %A Mohammed U Kabeto %A Kumar, Navasuja %A Maria J Silveira %K depression %K Fatigue %K Loneliness %K pain %K psychosocial stressors %K symptom clusters %X Objective: Pain, fatigue, and depression commonly co-occur as a symptom cluster in pathological inflammatory states. Psychosocial stressors such as loneliness may lead to similar states through shared mechanisms. We investigated the association of loneliness with pain, fatigue, and depression in older adults. Methods: Using Health and Retirement Study data (N?=?11,766), we measured cross-sectional prevalence of frequent, moderate to severe pain; severe fatigue; depressive symptoms; and co-occurrence of symptoms surpassing threshold levels (i.e., symptom cluster). Logistic regression models evaluated associations with loneliness. Results: Pain, fatigue, and depression were reported in 19.2%, 20.0%, and 15.3% of the total sample, respectively. The symptom cluster was seen in 4.9% overall; prevalence in lonely individuals was significantly increased (11.6% vs. 2.3%, p?RATIONALE: Social participation is an important predictor of individual health outcomes, but few studies have examined it in the context of marriage relationships, even though the social lives of spouses are inextricably linked.

OBJECTIVE: To examine whether individuals' mental health is associated with their spouse's contact with friends and family.

METHODS: Using dyadic data from adults aged 50 and above in the Health and Retirement Study (N = 5030 couples), I examine whether individuals' mental health is associated with their spouse's contact with friends and family (i.e., partner effects) through a longitudinal actor-partner interdependence model. In addition, I test for the presence of gender differences in these effects. Both depressive symptoms and binge drinking are used as measures of mental health to account for the different ways in which men and women may express psychological distress.

RESULTS: Results show partial evidence that spousal contact with friends and family are associated with one's own mental health outcomes, and that within-dyad discrepancies in informal social participation may be detrimental to mental well-being.

CONCLUSIONS: These findings highlight the importance of understanding the dynamics between social participation and health through the lens of "linked lives", especially for married couples.

%B Social Science & Medicine %V 276 %G eng %R 10.1016/j.socscimed.2021.113848 %0 Report %D 2020 %T The 80%: Four Ways to Help Retirees Make Their Money Last %A National Council on Aging %A Leading Age LTSS Center @UMass Boston %A Nationwide %K Retirement %K Social Security Benefits %B White Paper %I National Council on Aging %G eng %U chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://assets-us-01.kc-usercontent.com/ffacfe7d-10b6-0083-2632-604077fd4eca/cb3ef5d5-2183-4720-bdb5-d0b5c4d848c2/2021-FWP-DG03_The%2080_White%20Paper_FINAL.pdf %0 Journal Article %J Inquiry : a journal of medical care organization, provision and financing %D 2020 %T ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study %A Melissa McInerney %A Ruth Winecoff %A Padmaja Ayyagari %A Kosali I. Simon %A M Kate Bundorf %K crowd-out %K difference-in-differences %K Health Status %K Insurance Coverage %K Medicaid %K near-elderly adults %K Patient Protection and Affordable Care Act %X The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12% reduction in metabolic syndrome; a 32% reduction in complications from metabolic syndrome; an 18% reduction in the likelihood of gross motor skills difficulties; and a 34% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults. %B Inquiry : a journal of medical care organization, provision and financing %V 57 %@ 1945-72430046-9580 %G eng %R 10.1177/0046958020935229 %0 Journal Article %J Journal of Alzheimer's Disease %D 2020 %T Age of Migration and Cognitive Function Among Older Latinos in the United States %A Marc Garcia %A Ortiz, Kasim %A Arévalo, Sandra P. %A Diminich, Erica D. %A Emily Briceño %A Vega, Irving E. %A Wassim Tarraf %K Alzheimer’s disease and related dementias %K cognitive function %K Immigration %K Latino %K nativity %K Sex differences %X Background: Age of migration has been shown to have a robust association with Latino immigrant health outcomes; however, the relationship between timing of migration and cognition is less understood. Objective: To examine associations between race/ethnicity, nativity, age of migration, and cognitive aging among US-born (USB) non-Latino Whites (NLW) and USB and foreign-born Latinos 50 years and older. Methods: We used longitudinal biennial data from the Health and Retirement Study (HRS; 2006-2014) to fit generalized linear and linear latent growth curve models for: 1) global cognition (Modified Telephone Interview for Cognitive Status; TICS-M); 2) memory and attention subdomains of TICS-M; and 3) cognitive dysfunction. We also tested for sex modifications. Results: In age and sex adjusted models, all Latino subgroups, independent of nativity and age of migration, had lower global and domain-specific cognitive scores and higher propensity of cognitive impairment classification compared to USB-NLWs. Differences between USB Latinos, but not other Latino subgroups, and USB-NLWs remained after full covariate adjustment. Latinas, independent of nativity or age of migration, had poorer cognitive scores relative to NLW females. Differences between all Latinos and USB-NLWs were principally expressed at baseline. Racial/ethnic, nativity, and age of migration grouping was not associated with slope (nor explained variance) of cognitive decline. Conclusion: Older US-born Latinos, regardless of sex exhibit poorer cognitive function than older USB-NLWs and foreign-born Latinos. Social determinants that differentially affect cognitive function, particularly those that compensate for education and sex differences among US-born Latinos and foreign-born Latinos, require further exploration. %B Journal of Alzheimer's Disease %V 76 %P 1493-1511 %@ 1875-8908 %G eng %N 4 %R 10.3233/JAD-191296 %0 Journal Article %J BMC medicine %D 2020 %T Age-dependent effects of body mass index across the adult life span on the risk of dementia: a cohort study with a genetic approach %A Ida Karlsson %A Lehto, Kelli %A Margaret Gatz %A Chandra A Reynolds %A Anna K. Dahl Aslan %K Body Mass Index %K Dementia %K Index Medicus %K Life span %K longitudinal %K Obesity paradox %K polygenic score %K Twin design %X BACKGROUNDWhile a high body mass index (BMI) in midlife is associated with higher risk of dementia, high BMI in late-life may be associated with lower risk. This study combined genetic designs with longitudinal data to achieve a better understanding of this paradox.METHODSWe used longitudinal data from 22,156 individuals in the Swedish Twin Registry (STR) and 25,698 from the Health and Retirement Study (HRS). The STR sample had information about BMI from early adulthood through late-life, and the HRS sample from age 50 through late-life. Survival analysis was applied to investigate age-specific associations between BMI and dementia risk. To examine if the associations are influenced by genetic susceptibility to higher BMI, an interaction between BMI and a polygenic score for BMI (PGSBMI) was included in the models and results stratified into those with genetic predisposition to low, medium, and higher BMI. In the STR, co-twin control models were applied to adjust for familial factors beyond those captured by the PGSBMI.RESULTSAt age 35-49, 5 units higher BMI was associated with 15% (95% CI 7-24%) higher risk of dementia in the STR. There was a significant interaction (p = 0.04) between BMI and the PGSBMI, and the association present only among those with genetic predisposition to low BMI (HR 1.38, 95% CI 1.08-1.78). Co-twin control analyses indicated genetic influences. After age 80, 5 units higher BMI was associated with 10-11% lower risk of dementia in both samples. There was a significant interaction between late-life BMI and the PGSBMI in the STR (p = 0.01), but not the HRS, with the inverse association present only among those with a high PGSBMI (HR 0.70, 95% CI 0.52-0.94). No genetic influences were evident from co-twin control models of late-life BMI.CONCLUSIONSNot only does the association between BMI and dementia differ depending on age at BMI measurement, but also the effect of genetic influences. In STR, the associations were only present among those with a BMI in opposite direction of their genetic predisposition, indicating that the association between BMI and dementia across the life course might be driven by environmental factors and hence likely modifiable. %B BMC medicine %V 18 %G eng %N 1 %M 32513281 %R 10.1186/s12916-020-01600-2 %0 Journal Article %J Scientific Reports %D 2020 %T Aging in the USA: similarities and disparities across time and space. %A Ana Lucia Abeliansky %A Devin Erel %A Holger Strulik %K frailty index %K health deficits %K non-linear regression %X

We study biological aging of elderly U.S. Americans born 1904-1966. We use thirteen waves of the Health and Retirement Study and construct a frailty index as the number of health deficits present in a person measured relative to the number of potential deficits. We find that, on average, Americans develop 5% more health deficits per year, that men age slightly faster than women, and that, at any age above 50, Caucasians display significantly fewer health deficits than African Americans. We also document a steady time trend of health improvements. For each year of later birth, health deficits decline on average by about 1%. This health trend is about the same across regions and for men and women, but significantly lower for African Americans compared to Caucasians. In non-linear regressions, we find that regional differences in aging follow a particular regularity, akin to the compensation effect of mortality. Health deficits converge for men and women and across American regions and suggest a life span of the American population of about 97 years.

%B Scientific Reports %V 10 %G eng %N 1 %R 10.1038/s41598-020-71269-3 %0 Journal Article %J Journal of Primary Care & Community Health %D 2020 %T Annual Wellness Visits and Influenza Vaccinations among Older Adults in the US. %A Jørgensen, Terese Sara Høj %A Heather G. Allore %A Elman, Miriam R %A Corey L Nagel %A Zhang, Mengran %A Markwardt, Sheila %A Ana R Quiñones %K annual wellness visits %K influenza vaccinations %K machine learning methods %K preventive healthcare utilization %X

OBJECTIVES: Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations.

METHODS: Data on 4999 individuals aged ≥65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations.

RESULTS: Two-year uptake was 22.8% for AWVs and 65.9% for influenza vaccinations. For AWVs, geographical region and wealth emerged as the most important predictors. For influenza vaccinations, number of somatic conditions, race/ethnicity, education, and wealth were the most important predictors.

CONCLUSIONS: The importance of geographic region for AWV utilization suggests that this service was unequally adopted. Non-Hispanic black participants and/or those with functional limitations were less likely to receive influenza vaccination.

%B Journal of Primary Care & Community Health %V 11 %G eng %R 10.1177/2150132720962870 %0 Journal Article %J Neurobiol Aging %D 2020 %T APOE region molecular signatures of Alzheimer's disease across races/ethnicities. %A Alexander M Kulminski %A Shu, Leonardo %A Loika, Yury %A Nazarian, Alireza %A Konstantin G Arbeev %A Svetlana Ukraintseva %A Anatoliy Yashin %A Culminskaya, Irina %K Alleles %K Alzheimer disease %K Apolipoproteins E %K Continental Population Groups %K Haplotypes %K Heterozygote %K Homozygote %K Humans %K Linkage Disequilibrium %K Polymorphism, Single Nucleotide %K Risk Factors %X

The role of even the strongest genetic risk factor for Alzheimer's disease (AD), the apolipoprotein E (APOE) ε4 allele, in its etiology remains poorly understood. We examined molecular signatures of AD defined as differences in linkage disequilibrium patterns between AD-affected and -unaffected whites (2673/16,246), Hispanics (392/867), and African Americans (285/1789), separately. We focused on 29 polymorphisms from 5 genes in the APOE region emphasizing beneficial and adverse effects of the APOE ε2- and ε4-coding single-nucleotide polymorphisms, respectively, and the differences in the linkage disequilibrium structures involving these alleles between AD-affected and -unaffected subjects. Susceptibility to AD is likely the result of complex interactions of the ε2 and ε4 alleles with other polymorphisms in the APOE region, and these interactions differ across races/ethnicities corroborating differences in the adverse and beneficial effects of the ε4 and ε2 alleles. Our findings support complex race/ethnicity-specific haplotypes promoting and protecting against AD in this region. They contribute to better understanding of polygenic and resilient mechanisms, which can explain why even homozygous ε4 carriers may not develop AD.

%B Neurobiol Aging %V 87 %P 141.e1-141.e8 %8 2020 03 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31813627?dopt=Abstract %R 10.1016/j.neurobiolaging.2019.11.007 %0 Journal Article %J Innovation in Aging %D 2020 %T The Association Between Depressive Symptoms and Accumulation of Stress Among Black Men in the Health and Retirement Study. %A Roland J. Thorpe Jr. %A Ryon J. Cobb %A King, Keyonna %A Bruce, Marino A %A Archibald, Paul %A Jones, Harlan P %A Norris, Keith C %A Keith E Whitfield %A Hudson, Darrell %K Allostatic load %K Black men %K Depressive symptoms %K health %K Inequities %K Men %K Stress %X

Background and Objectives: Among the multiple factors posited to drive the health inequities that black men experience, the fundamental role of stress in the production of poor health is a key component. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. Few studies have investigated how AL contributes to depressive symptoms among black men. The purpose of the cross-sectional study was to examine the association between AL and depressive symptoms among middle- to old age black men.

Research Design and Methods: This project used the 2010 and 2012 wave of the Health and Retirement Study enhanced face-to-face interview that included a biomarker assessment and psychosocial questionnaire. Depressive symptoms, assessed by the endorsement of 3 or more symptoms on the Center for Epidemiological Studies-Depression 8-item scale, was the outcome variable. The main independent variable, AL, score was calculated by summing the number values that were in the high range for that particular biomarker value scores ranging from 0 to 7. black men whose AL score was 3 or greater were considered to be in the high AL group. Modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs).

Results: There was a larger proportion of black men in the high AL group who reported depressive symptoms (30.0% vs. 20.0%) compared with black men in the low AL group. After adjusting for age, education, income, drinking, and smoking status, the prevalence of reporting 3 or more depressive symptoms was statistically significant among black men in the high AL group (PR = 1.61 [95% CI: 1.20-2.17]) than black men in the low AL group.

Discussion and Implications: Exposure to chronic stress is related to reporting 3 or more depressive symptoms among black men after controlling for potential confounders. Improving the social and economic conditions for which black men work, play, and pray is key to reducing stress, thereby potentially leading to the reporting of fewer depressive symptoms.

%B Innovation in Aging %V 4 %P igaa047 %G eng %N 5 %R 10.1093/geroni/igaa047 %0 Journal Article %J Innovation in Aging %D 2020 %T The Association Between Diabetes and Cognition Among Older Hispanics in the United States and Mexicans in Mexico %A Jaqueline C Avila %A Rebeca Wong %A Ternent, Rafael Samper %K Cognition %K Diabetes %K Latinos/Hispanics %K MHAS %X The objective is to assess if the effect of diabetes on cognition differs by race/ethnicity in the U.S. and how this association differs between older Hispanics in the U.S. and older Mexicans in Mexico. Data comes from a sample of older adults 50 and older with direct interviews from the 2012 waves of the Health and Retirement Study (N=17,810) and the Mexican Health and Aging Study (N=13,270). Cognition was measured as a total cognition score. OLS regressions were used to test the association between diabetes and cognition by race/ethnicity in the U.S. and among older Mexicans in Mexico. Results showed that Non-Hispanic Whites (NHW) had the highest cognition scores in the U.S., followed by Hispanics and non-Hispanic blacks (NHB). Mean cognition score of older Mexicans was higher than for NHB and Hispanics in the U.S. but lower than NHWs. The prevalence of diabetes was highest among Hispanics (32.3%), followed by NHB (30.6%) and NHW (19.9%). The prevalence of diabetes in Mexico was like those NHW in the U.S. (19.9%). In the U.S., the effect of being NHB and Hispanic (compared to white) on cognition was equivalent to having 5.3 and 2.4 fewer years of education, respectively. However, the effect of diabetes on cognition did not differ by race/ethnicity. The final analysis will include a direct comparison between Hispanics in the U.S. and a matched sample of older adults in Mexico with similar sex and age to test differences in the effect of diabetes on cognition between these two samples. %B Innovation in Aging %V 4 %P 159 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.517 %0 Journal Article %J American Journal of Industrial Medicine %D 2020 %T Association between longest-held occupation and Social Security Disability Insurance benefits receipt %A Abay Asfaw %A Pana-Cryan, Regina %A Brian Quay %K Cox proportional hazard model %K longest-held occupation %K multiple imputation %K Social Security Disability Insurance %X Introduction The cost of the Social Security Disability Insurance (DI) program has increased over time though recent reports showed that disability incidence and prevalence rates have started declining. We explored whether occupation was one of the risk factors for the rising number of disabled workers who received DI benefits during 1992-2016. Methods We used a cohort of 16 196 Health and Retirement Survey respondents between the age of 51 and 64 years who were followed from their date of entry until they received DI benefits, died, reached full retirement age, or reached the end of the follow-up period (2016). We used the extended stratified Cox proportional hazard model. Because one-third of the respondents in our cohort did not report their longest-held occupation, we used a multiple-imputation method. Results The hazard of receiving DI benefits was 51%, 78%, 81%, and 85% higher among workers with longest-held occupations in sales, mechanics and repair, protective services, and personal services, respectively than among workers with longest-held occupations in the reference managerial occupation. The hazard of receiving DI benefits was more than double among workers with longest-held occupations in the construction trade and extractors, transportation operation, machine operators, handlers, and food preparation than among workers with the longest-held occupation in the reference managerial occupation. Conclusion Improving the overall working conditions in these occupations would help reduce worker suffering and the number of applicants for DI benefits, thereby reducing the burden of workplace injury and illness on the DI program. %B American Journal of Industrial Medicine %G eng %R 10.1002/ajim.23121 %0 Journal Article %J American Journal of Industrial Medicine %D 2020 %T Association between longest‐held occupation and Social Security Disability Insurance benefits receipt %A Abay Asfaw %A Regina Pana‐Cryan %A Brian Quay %K Cox proportional hazard model %K longest‐held occupation %K multiple imputation %K Occupational Health And Safety %K Social Security Disability Insurance %X Introduction The cost of the Social Security Disability Insurance (DI) program has increased over time though recent reports showed that disability incidence and prevalence rates have started declining. We explored whether occupation was one of the risk factors for the rising number of disabled workers who received DI benefits during 1992‐2016. Methods We used a cohort of 16 196 Health and Retirement Survey respondents between the age of 51 and 64 years who were followed from their date of entry until they received DI benefits, died, reached full retirement age, or reached the end of the follow‐up period (2016). We used the extended stratified Cox proportional hazard model. Because one‐third of the respondents in our cohort did not report their longest‐held occupation, we used a multiple‐imputation method. Results The hazard of receiving DI benefits was 51%, 78%, 81%, and 85% higher among workers with longest‐held occupations in sales, mechanics and repair, protective services, and personal services, respectively than among workers with longest‐held occupations in the reference managerial occupation. The hazard of receiving DI benefits was more than double among workers with longest‐held occupations in the construction trade and extractors, transportation operation, machine operators, handlers, and food preparation than among workers with the longest‐held occupation in the reference managerial occupation. Conclusion Improving the overall working conditions in these occupations would help reduce worker suffering and the number of applicants for DI benefits, thereby reducing the burden of workplace injury and illness on the DI program. %B American Journal of Industrial Medicine %V 63 %P 676-684 %8 08 %@ 02713586 %G eng %N 8 %R 10.1002/ajim.23121 %0 Journal Article %J Innovation in Aging %D 2020 %T Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States %A Emily J Nicklett %A Chen, Jieling %A Xiang, Xiaoling %A Leah R. Abrams %A Amanda Sonnega %A Kimson E Johnson %A Cheng, Jianjia %A Shervin Assari %K Age at diagnosis %K Chronic disease self-management %K Event-oriented model %K Life-course perspective %K Piecewise regression %K Race/ethnicity %X BACKGROUND AND OBJECTIVES: Physical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes. RESEARCH DESIGN AND METHODS: We examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004-2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis. RESULTS: Across participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (β: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D. DISCUSSION AND IMPLICATIONS: Modest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed. %B Innovation in Aging %V 4 %P igz048 %@ 2399-5300 %G eng %N 1 %4 igz048[PII] %R 10.1093/geroni/igz048 %0 Journal Article %J Innovation in Aging %D 2020 %T Binge Drinking, Depressive Symptoms, and Sleep Health in Middle-Aged and Older Adults %A Lorenz, Rebecca %A Auerbach, Samantha %A Chang, Yu-Ping %K depression %K Depressive symptoms %K Drinking %K Drinking problems %K Sleep %K Sleep disturbance %X Unhealthy alcohol consumption such as binge drinking and depression are common problems among adults. The combined effect of binge drinking and depression might contribute to negative health outcomes, such as accidents, addiction, or sleep problems. Previous evidence has indicated that alcohol consumption differs by age. However, little is known about the association between binge drinking, depression, and sleep health, and how age might play a role in this association. This study aimed to examine the association between binge drinking, depressive symptoms, and sleep health in middle-aged and older adults and characterize any age differences. A total of 5191 middle-aged and older adults from the 2014 Core Survey of the Health and Retirement Survey (HRS) data aged 50 to 80 were included for this study. Binge drinking was defined as the consumption of 5 or more drinks (men) and 4 or more drinks (women) per drinking day. Depressive symptoms were measured using a validated 8-item Center for Epidemiologic Studies Depression Scale. Sleep health was assessed using a composite measure. Age was grouped into middle-aged (50-64.9 years) and older (65-79.9 years) adults. Multiple linear regression analysis was used to examine the associations between variables of interest. Our findings indicated that binge drinking and depressive symptoms negatively influenced sleep health among middle-aged adults, however this relationship was not found in older adults. Clinicians should simultaneously assess problematic alcohol consumption, depressive symptoms, and sleep health. Future research can develop and test age-specific interventions to reduce unhealthy drinking behaviors in middle-aged adults. %B Innovation in Aging %V 4 %P 425-425 %8 12 %G eng %R 10.1093/geroni/igaa057.1373 %0 Journal Article %J Innovation in Aging %D 2020 %T Cardiometabolic Risk and Biomarker Trajectories Among Older Adults: Findings From the Health and Retirement Study %A Wu, Qiao %A Eileen M. Crimmins %A Jennifer A Ailshire %A Jung K Kim %A Zhao, Erfei %K biomarker trajectories %K cardiometabolic risk %X The deterioration of the cardiovascular system is a process associated with aging. Most of the prior works have examined changes in cardiometabolic risk (CMR) while aging at the population level using cross-sectional data, but we study within-person changes for total CMR and separate risk factors, including pulse pressure, resting heart rate, C-reactive protein, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, total cholesterol, waist circumference, and obesity. We examine 8-year changes (from 2006 to 2014) among respondents from the Health and Retirement Study biomarker sample (n=19,776). We use growth curve models to identify differences at baseline and the changes while aging, by age, gender, race/ethnicity, and education. Blacks, the old-old, the less educated, and current smokers have higher baseline CMR. The total CMR increases while people age over 8 years. HbA1c, waist circumference, and pulse pressure increase significantly with age. A reduction in total cholesterol can be observed and is likely due to medication. The CMR increase is no longer significant after accounting for socioeconomic status. The next step of this study is to focus on the disparity of risk distribution, in order to identify the individuals that are most in need of specific care and support. %B Innovation in Aging %V 4 %P 429 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.1386 %0 Journal Article %J Journal of Applied Gerontology %D 2020 %T Caregiving, recovery, and death after incident ADL/IADL disability among older adults in the United States %A Claire K. Ankuda %A Deborah A Levine %A Kenneth M. Langa %A Katherine A Ornstein %A Amy Kelley %K Activities of Daily Living %K Caregiving %K Disabilities %X This study assesses patterns of caregiving, death, and recovery after incident disability in older adults. We used the Health and Retirement Study to follow of a cohort of adults age ≥65 years in the United States with incident disability in activities of daily living (ADLs) or instrumental activities of daily living (IADLs; n = 8,713). Rates of care and function state were assessed biennially: deceased, nursing home dwelling, at home with paid help, at home with both paid and unpaid help, at home with unpaid help, at home with no assistance and recovered. In the 2 years after incident disability, 22.1% recovered and 46.8% died. Transitions between care and function states occurred frequently, with more than 20% of the cohort living at home with no assistance despite disability at least once. This study demonstrates the high levels of care and function state fluctuation and unmet needs after functional disability. %B Journal of Applied Gerontology %V 39 %G eng %U https://journals.sagepub.com/doi/10.1177/0733464819826842 %N 4 %9 Journal %! J Appl Gerontol %R 10.1177/0733464819826842 %0 Conference Paper %B Retirement and Disability Research Consortium 22nd Annual Meeting %D 2020 %T Cognitive Ability, Cognitive Aging, and Debt Accumulation %A Marco Angrisani %A Burke, Jeremy %A Arie Kapteyn %K Cognition %K Debt %K Mortgages %X While a large literature has examined savings behavior and accumulation among older adults, relatively little research has explored older adults’ debt behaviors and outcomes. Recent work by Lusardi, Mitchell, and Oggero (2020) shows that older adults from recent generations tend to hold more debt than their predecessors, particularly mortgage debt, and correspondingly face greater financial insecurity near retirement age. While documenting such trends is an important first step, developing policy interventions to counteract them requires identifying the underlying drivers of the observed surge in debt burdens among recent older adults. One potential candidate is the increasing complexity of financial products targeted to consumers in the past few decades (Célérier and Vallee, 2017), particularly among mortgage products (Amromin et al., 2018). Figure 1 documents that originations of complex mortgages with zero or negative amortization surged in the early 2000s and subsequently reduced sharply after the financial crisis. Consumers from later cohorts may have difficulty appropriately selecting among and using these increasingly complicated instruments (Brown et al., 2017; Hastings and Mitchell, 2018). This may be particularly true for individuals with low cognitive ability and older individuals experiencing cognitive decline. As the financial landscape has become progressively more complex, the rise in debt burdens may be concentrated on those who are less cognitively able, raising concerns about the economic security of individuals who may not be adequately equipped to navigate the system. %B Retirement and Disability Research Consortium 22nd Annual Meeting %I Retirement and Disability Research Consortium %C Virtual %G eng %U https://crr.bc.edu/wp-content/uploads/2020/01/2020-RDRC-Meeting-Booklet.pdf#page=96 %0 Journal Article %J Brain Sciences %D 2020 %T Combined Effects of Ethnicity and Education on Burden of Depressive Symptoms over 24 Years in Middle-Aged and Older Adults in the United States %A Shervin Assari %K Educational attainment %K Ethnic Groups %K Hispanic %K Latino %K race %K socioeconomic position %K socioeconomic status %X Ethnicity and educational attainment are among the major social determinants of depression in the general population. While high education credentials protect individuals against depressive symptoms, this protection may be weaker for ethnic minority groups such as Hispanic Whites compared to the majority group (non-Hispanic Whites). Built on marginalization-related diminished returns (MDRs), the current study used 24-year follow-up data from a nationally representative sample of middle-aged and older adults to explore ethnic variation in the protective effect of education levels against the burden of depressive symptoms over time. Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992–ongoing), a nationally representative longitudinal study. HRS followed 8314 middle-aged and older adults (50+ years old) for up to 24 years. From this number, 763 (9.2%) were Hispanic White, and 7551 (90.8%) were non-Hispanic White Americans. Education level was the independent variable. We had two outcomes. Firstly, using cluster analysis, individuals were categorized to low- and high-risk groups (regarding the burden of depressive symptoms over 24 years); secondly, average depressive symptoms were observed over the 24 years of follow up. Age and gender were the covariates. Ethnicity was the moderator. Linear and logistic regression were used for analysis. Logistic regression showed that, overall, high educational credentials reduced the odds of chronic depressive symptoms over the 24 years of follow-up. Linear regression also showed that higher years of education were associated with lower average depressive symptoms over time. Both models showed statistically significant interactions between ethnicity and graduation, indicating a smaller protective effect of high education against depressive symptoms over the 24 years of follow-up time among Hispanic with respect to non-Hispanic White people. In line with the MDRs, highly educated Hispanic White Americans remain at high risk for depressive symptoms, a risk that is unexpected given their education. The burden of depressive symptoms, however, is lowest for highly educated non-Hispanic White Americans. Policies that exclusively focus on equalizing educational gaps across ethnic groups may fail to eliminate the ethnic gap in the burden of chronic depressive symptoms, given the diminished marginal health return of education for ethnic minorities. Public policies must equalize not only education but also educational quality across ethnic groups. This aim would require addressing structural and environmental barriers that are disproportionately more common in the lives of ethnic minorities across education levels. Future research should test how contextual factors, residential segregation, school segregation, labor market practices, childhood poverty, and education quality in urban schools reduce the health return of educational attainment for highly educated ethnic minorities such as Hispanics. %B Brain Sciences %V 10 %P 209 %G eng %N 4 %R 10.3390/brainsci10040209 %0 Journal Article %J Hospital Practices and Research %D 2020 %T Combined Effects of Race and Educational Attainment on Physician Visits Over 24 Years in a National Sample of Middle-Aged and Older Americans %A Shervin Assari %K Educational attainment %K Ethnic Groups %K Health Services Accessibility %K Minority Group %K Minority health %K Socioeconomic Factor %K socioeconomic status %X Background: The literature on Minorities’ Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities. Objectives: The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US. Methods: This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis. Results: Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. A similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults. Conclusion: Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people’s prohealth behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES. %B Hospital Practices and Research %V 5 %P 17-23 %G eng %U http://www.jhpr.ir/article_106233_b81d29258c11ca165abdfa2e1243f9f3.pdf %N 1 %9 Journal %R 10.34172/hpr.2020.04 %0 Journal Article %J Journal of Affective Disorders %D 2020 %T Connectivity of depression symptoms before and after diagnosis of a chronic disease: A network analysis in the U.S. Health and Retirement Study %A Jaakko Airaksinen %A Kia Gluschkoff %A Mika Kivimäki %A Markus Jokela %K Chronic disease %K depression %K Network analysis %X Background Many chronic diseases increase the risk of depressive symptoms, but few studies have examined whether these diseases also affect the composition of symptoms a person is likely to experience. As the risk and progression of depression may vary between chronic diseases, we used network analysis to examine how depression symptoms are connected before and after the diagnosis of diabetes, heart disease, stroke, and cancer. Methods Participants (N = 7779) were from the longitudinal survey of the Health and Retirement Study. Participants were eligible if they had information on depression symptoms two and/or four years before and after the diagnosis of either diabetes, heart disease, cancer or stroke. We formed a control group with no chronic disease that was matched on age, sex and ethnic background to those with a disease. We constructed depression symptom networks and compared the overall connectivity of those networks, and depression symptom sum scores, for before and after the diagnosis of each disease. Results Depression symptom sum scores increased with the diagnosis of each disease. The connectivity of depression symptoms remained unchanged for all the diseases, except for stroke, for which the connectivity decreased with the diagnosis. Limitations Comorbidity with other chronic diseases was not controlled for as we focused on the onset of specific diseases. Conclusions Our results suggest that although the mean level of depression symptoms increases after the diagnosis of chronic disease, with most chronic diseases, these changes are not reflected in the network structure of depression symptoms. %B Journal of Affective Disorders %V 266 %P 230 - 234 %G eng %U http://www.sciencedirect.com/science/article/pii/S0165032719313539 %R https://doi.org/10.1016/j.jad.2020.01.170 %0 Journal Article %J Annals of palliative medicine %D 2020 %T Considering self-reported baseline function and cognition in predicting post-operative complications among older adults %A Shnayder, Michelle M %A Montgomery, John R %A Abrahamse, Paul %A Suwanabol, Pasithorn A %K cognitive impairment %K Memory %K Postoperative Complications %X BACKGROUND:Older adults experience high rates of postoperative complications and poorer outcomes. Current perioperative risk assessments lack specific measures and are too time-consuming for busy surgeons. METHODS:Using data from the Health and Retirement Study Survey linked with Medicare data, we performed a cross-sectional study, evaluating all adults ≥65 years old who underwent high-risk elective surgery between 1992-2012. Primary exposure variables included self-reported preoperative functional and cognitive abilities using activities of daily living (ADLs), instrumental activities of daily living (IADLs), and a 27-point self-administered test of memory and mental processing. Primary outcome was the development of a serious postoperative complication within 30-days following index operation. RESULTS:Overall, 42% (n=501) developed at least one serious postoperative complication. Patients with moderate (aOR 1.52, 95% CI: 1.14-2.04) and severe (aOR 1.55, 95% CI: 1.00-2.46) baseline functional limitations were at higher risk of serious postoperative complications compared to those with no functional limitation. Cognitive impairment was not associated with serious postoperative complications. CONCLUSIONS:Self-reported functional measures may help to quickly identify patients at high-risk for surgical complications and better inform pre-operative discussions including earlier initiation of palliative care services. %B Annals of palliative medicine %G eng %R 10.21037/apm-20-816 %0 Journal Article %J Healthcare (Amsterdam) %D 2020 %T A decade of experience for high-needs beneficiaries under Medicare Advantage. %A Levinson, Zachary %A Adler-Milstein, Julia %K Access %K health outcomes %K High-needs beneficiaries %K Medicare advantage %K Quality of care %X

OBJECTIVE: To describe the association between longitudinal enrollment in Medicare Advantage (MA) and utilization, access, quality of care, and health outcomes for beneficiaries with complex health needs.

DATA SOURCES/STUDY SETTING: Beneficiary characteristics, enrollment, and outcomes data from the 2004-2016 waves of the Health and Retirement Study (HRS).

STUDY DESIGN: Using the HRS panel structure, we identified beneficiaries consistently reporting high needs as well as enrollment in MA versus traditional Medicare (TM). We first evaluated a robust set of beneficiary characteristics to identify those that distinguish beneficiaries who consistently enrolled in MA versus TM. We then described adjusted differences in outcomes between high-needs beneficiaries who consistently enrolled in MA versus TM.

PRINCIPAL FINDINGS: Among high-needs beneficiaries, there was a modest amount of favorable selection into MA based on health. Controlling for several characteristics, MA enrollees used less care (with a 6.6 percentage point (pp) lower probability of hospitalization, 4.7 fewer physician visits, and a 5.1 pp lower probability of using home health care), had a 4.1 pp greater probability of being unable to afford their care, and had a 5.7 pp lower probability of reporting that they were very satisfied with their care. Compared to associations between MA and outcomes for high-needs beneficiaries, for non-high-needs beneficiaries MA enrollment was associated with smaller decreases in utilization and no statistically significant difference in the inability to afford care.

CONCLUSIONS: Our descriptive findings raise the possibility that high-needs beneficiaries may experience unique challenges in MA compared to their non-high-needs counterparts.

%B Healthcare (Amsterdam) %V 8 %G eng %N 4 %R 10.1016/j.hjdsi.2020.100490 %0 Thesis %B Health Services Organization and Policy %D 2020 %T Depressive Symptoms in Late Life: The Role of Sociodemographic Factors, Retirement Timing, and Post-Acute Care %A Leah R. Abrams %K Depressive symptoms %K sociodemographics %X The mental well-being of older Americans is a pressing public health concern given the aging population and recent increases in midlife suicide and substance use. Depressive symptoms specifically are a common cause of poor quality of life in old age, and one of the leading causes of disability. This dissertation uses nationally-representative longitudinal data from the Health and Retirement Study to improve understandings of depressive symptoms in mid- and late life, their social patterning, and their intersection with post-hospital recoveries. In Chapter 2, I used mixed-effect models to characterize population trends in how depressive symptoms change over ages 51-90 by gender, race/ethnicity, educational attainment, and birth cohort. This research highlighted large disparities in depressive symptoms in midlife by educational attainment, pointing to the importance of early life exposures for late life health. Results also reaffirmed mental health concerns about recent birth cohorts. Looking at a key life event for this age group, I next focused on retirement timing. This research examined how expectations about full time work at age 62, reported between ages 51- 61, align with realized labor force status to determine whether unmet expectations about retirement timing relate to depressive symptoms across sociodemographic groups. The results revealed that unmet retirement expectations are more common among Hispanic and Black Americans compared to White Americans. In addition, those of low educational attainment were at high risk of unexpectedly not working at age 62. Interestingly, unexpectedly working was not associated with depressive symptoms, pointing to the benefits of work for mental health at older ages and the resilience of those adapting to staying in the labor force. Unexpectedly not working was associated with a small increase in depressive symptoms at age 62, which was explained by health declines between expectations and reaching age 62. Future research attention should be directed at mitigating health-related early labor force departures, which differentially occur among disadvantaged groups in America. Finally, I linked survey data from the Health and Retirement Study to Medicare claims data to consider the role of depressive symptoms in recovering from acute hospitalizations. I tested whether different post-acute care settings might mitigate the association between depressive symptoms and poor health outcomes – hospital readmissions, falls, and mortality. Risk for 30-day hospital readmissions increased with increasing depressive symptoms for those recovering at home with or without home health, but not for patients in inpatient rehabilitation settings such as Skilled Nursing Facilities. Post-acute care settings did not modify the relationships between depressive symptoms and each of falls or mortality; therefore, referring depressed patients to inpatient rehabilitation settings could help hospitals avoid financial penalties for readmissions, but will not improve patients’ risks for falls or mortality. Together, this research provides a rich interdisciplinary look at social factors related to depressive symptoms in the aging population and gives insights into one aspect of health services that may address the harmful repercussions of depressive symptoms on other health outcomes. %B Health Services Organization and Policy %I University of Michigan %C Ann Arbor, MI %V Doctor of Philosophy %G eng %U https://deepblue.lib.umich.edu/bitstream/handle/2027.42/163101/lrabrams_1.pdf?sequence=1 %0 Journal Article %J Innovation in Aging %D 2020 %T Diet Quality and Biological Risk in a National Sample of Older Americans %A Choi, Yeon Jin %A Jennifer A Ailshire %A Jung K Kim %A Eileen M. Crimmins %K biological risk %K diet quality %X Biomarkers are sensitive to current health status and capture aspects of health that may precede the development of disease and other health problems. Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. For the analysis, we used nutrition and biomarker data from 3,641 older adults (over age 50) in the Health and Retirement Study. Eleven out of 13 individual dietary components were associated with lower biological risk. After controlling for SES, health behaviors, and access to health care, a high intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids and a low intake of sodium and saturated fat were still associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. After controlling for SES, health behaviors, and access to health care, respondents with poor/suboptimal quality diet continued to exhibit higher biological risk than those with good quality diet, though the differences in biological risk were reduced. Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids, while limiting consumption of sodium and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity. %B Innovation in Aging %V 4 %P 920 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.3378 %0 Journal Article %J Journal of General Internal Medicine %D 2020 %T Difficulty with Taking Medications Is Associated with Future Diagnosis of Alzheimer's Disease and Related Dementias. %A Douglas Barthold %A Marcum, Zachary A %A Chen, Shuxian %A White, Lindsay %A Ailabouni, Nagham %A Basu, Anirban %A Norma B Coe %A Gray, Shelly L %K Alzheimer’s disease and related dementias %K cognitive screening %K medication management %X

BACKGROUND: Medication management requires complex cognitive functioning, and therefore, difficulty taking medications might be an early sign of cognitive impairment and could be a risk factor for Alzheimer's disease and related dementias (ADRD). Accordingly, people with difficulty taking medications may benefit from more detailed cognitive screening, potentially aiding in the diagnosis of ADRD, which is underdiagnosed. We are unaware of evidence on medication management difficulties that precede a real-world ADRD diagnosis in the USA.

OBJECTIVE: Examine the association between difficulty taking medications and subsequent real-world ADRD diagnoses.

DESIGN: Case-control study, using Health and Retirement Study (HRS) survey data linked to Medicare claims.

PARTICIPANTS: A total of 1461 HRS respondents with an ADRD diagnosis observed from 1993 to 2012 (cases), matched by year of birth, wave of HRS entry, and sex to 3771 controls with no ADRD diagnosis.

MAIN MEASURES: We examined the association between diagnosis of ADRD and self-reported difficulty taking medications in the preceding years (1-2 and 3-4 years prior to case definition). Control individuals were assigned the index date from their matched case. Conditional logistic regressions adjusted for age, sex, race, education, and comorbidities.

KEY RESULTS: Compared with matched controls, cases had higher prevalence of difficulty taking medications 1-2 years prior to diagnosis (11.0% versus 2.3%), and 3-4 years prior to diagnosis (5.8% versus 2.3%). Adjusted analyses showed that compared with individuals without ADRD, those with an ADRD diagnosis had more than four times higher odds of difficulty taking medications 1-2 years prior (OR = 4.56 (CI 3.30-6.31)), and more than two times higher odds of difficulty taking medications 3-4 years prior (OR = 2.41 (CI 1.61-3.59)).

CONCLUSIONS: Odds of medication difficulty 1-2 years prior were more than four times greater for individuals with ADRD diagnoses compared with those without ADRD. Medication management difficulties may prompt further cognitive screening, potentially aiding in earlier recognition of ADRD.

%B Journal of General Internal Medicine %G eng %R 10.1007/s11606-020-06279-y %0 Journal Article %J Journals of Gerontology Series B: Psychological Sciences & Social Sciences %D 2020 %T Disentangling the Stress Process: Race/Ethnic Differences in the Exposure and Appraisal of Chronic Stressors among Older Adults. %A Lauren L Brown %A Uchechi A Mitchell %A Jennifer A Ailshire %K Chronic stress %K Depressive symptoms %K Racial/ethnic differences %K Socioeconomic factors %X

Objectives: Exposure to stressors is differentially distributed by race/ethnicity with minority groups reporting a higher stress burden than their white counterparts. However, to really understand the extent to which some groups bear a disproportionate stress burden we need to consider race/ethnic differences in stress appraisal, specifically how upsetting stressors may be, in addition to stress exposure. We examine racial/ethnic differences in both the number of reported chronic stressors across 5 domains (health, financial, residential, relationship and caregiving) and their appraised stressfulness among a diverse sample of older adults.

Method: Data come from 6,567 adults ages 52+ from the 2006 Health and Retirement Study.

Results: Results show older blacks, US and foreign-born Hispanics report more chronic stress exposure than whites and are two to three times as likely to experience financial strain and housing-related stress. Socioeconomic factors fully explain the Hispanic-white difference in stress exposure, but black-white differences remain. Despite experiencing a greater number of stressors, blacks and US-born Hispanics are less likely to be upset by exposure to stressors than whites. US-born Hispanics are less upset by relationship-based stressors specifically, while blacks are less upset across all stress domains in fully adjusted models. Foreign-born Hispanics are only less upset by caregiving strain.

Discussion: The distinction between exposure and appraisal based measures of stress may shed light on important pathways that differentially contribute to race/ethnic physical and mental health disparities.

%B Journals of Gerontology Series B: Psychological Sciences & Social Sciences %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29878196?dopt=Abstract %R 10.1093/geronb/gby072 %0 Journal Article %J Gerontologist %D 2020 %T Does Sexual Orientation Relate to Health and Well-Being? Analysis of Adults 50+ Years of Age %A Nelson, Christi L %A Andel, Ross %K depression %K LGB %K Minority Stress Theory %X Based on the Minority Stress Theory, this article examines the associations between sexual orientation and self-reported measures of physical, mental, and cognitive health, as well as health risk behaviors.The analytical sample included members of the 2016 wave of the Health and Retirement Study aged 50+ years. Binary and ordered logistic regressions were conducted to assess whether being a sexual minority was associated with poorer self-rated physical, mental, and cognitive health, as well as being more likely to engage in health risk behaviors.In analyses using overall and propensity-matched samples, lesbian, gay, and bisexual (LGB) participants were about twice as likely to report ever having depression as their heterosexual counterparts but were also more likely to report better self-rated health. The LGB group was more likely to report ever having smoked but were not significantly different in any of the other health risk behaviors.LGB individuals appear to be at greater risk of ever experiencing depression than heterosexual individuals but, at the same time, report better physical health. This may suggest a tendency for resilience. Differences in health risk behavior may also exist. Mental health and other medical professionals should receive special training to better understand the unique problems of LGB individuals. %B Gerontologist %V 60 %P 1282-1290 %G eng %N 7 %R 10.1093/geront/gnz187 %0 Journal Article %J American Journal of Human Biology %D 2020 %T Dried blood spots: Effects of less than optimal collection, shipping time, heat, and humidity %A Eileen M. Crimmins %A Yuan S Zhang %A Jung K Kim %A Frochen, Stephen %A Kang, Hyewon %A Shim, Hyunju %A Jennifer A Ailshire %A Potter, Alan %A Cofferen, Jake %A Jessica Faul %K Dried Blood Spot Testing %X Abstract Objectives This study investigates how factors related to collection, storage, transport time, and environmental conditions affect the quality and accuracy of analyses of dried blood spot (DBS) samples. Methods Data come from the 2016 Health and Retirement Study (HRS) DBS laboratory reports and the HRS merged with the National Climatic Data Center (NCDC) Global Historical Climate Network Daily (NCDC GHCN-Daily) and the NCDC Local Climatological Data, by zip code. We ran regression models to examine the associations between assay values based on DBS for five analytes (total cholesterol, high-density lipoprotein (HDL) cholesterol, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and cystatin C) and the characteristics of DBS cards and drops, shipping time, and temperature, and humidity at the time of collection. Results We found cholesterol measures to be sensitive to many factors including small spots, shipping time, high temperature and humidity. Small spots in DBS cards are related to lower values across all analytes. Longer DBS transit time before freezing is associated with lower values of total and HDL cholesterol and cystatin C. Results were similar whether or not venous blood sample values were included in equations. Conclusions Small spots, long shipping time, and exposure to high temperature and humidity need to be avoided if possible. Quality of spots and cards and information on shipping time and conditions should be coded with the data to make adjustments in values when necessary. The different results across analytes indicate that results cannot be generalized to all DBS assays. %B American Journal of Human Biology %V 32 %P e23390 %G eng %N 5 %R 10.1002/ajhb.23390 %0 Journal Article %J JAMA Ophthalmology %D 2020 %T Dual Sensory Impairment and Perceived Everyday Discrimination in the United States %A Ahmed F Shakarchi %A Lama Assi %A Joshua R Ehrlich %A Deal, Jennifer A %A Nicholas S. Reed %A Bonnielin K Swenor %K Discrimination %K hearing %K impairments %K vision %X Perceived everyday discrimination is a psychosocial stressor that has been linked to adverse health outcomes including increased mortality. We assessed the association of vision, hearing and dual sensory impairments (VI, HI, and DSI, respectively) with the perception of everyday discrimination using a cross-sectional analysis of the Health and Retirement Study 2006 and 2008 visits. Perceived everyday discrimination was measured on the validated Williams scale (range 0 to 5). Participants rated their vision and hearing, using eyeglasses or hearing aids if applicable, on an ordinal scale (poor, fair, good, very good, excellent). Sensory impairment was defined as poor or fair self-rated ability in the relevant sensory modality, and sensory impairment was categorized as neither sensory impairment (NSI), VI alone, HI alone, and DSI. Linear regression models were used to estimate differences in perceived discrimination associated with sensory impairment, after adjusting for age, sex, race, ethnicity, foreign birth, body mass index, relationship status, net household wealth, and number of chronic diseases (among diabetes, hypertension, heart disease, stroke, lung disease, non-skin cancer, and arthritis). Analyses were adjusted for the complex survey design and differential nonresponse. Nursing home residents were excluded. We included 13,092 individuals. After applying survey weights, 11.7% had VI alone, 13.1% had HI alone, and 7.9% had DSI. In the fully adjusted model, participants with VI alone (β = 0.07; CI = 0.02 – 0.13) and HI alone (β = 0.07; CI = 0.02 – 0.11) perceived greater everyday discrimination compared with participants with NSI. The DSI group perceived greater discrimination (β = 0.23; CI = 0.16 – 0.29) compared with NSI, VI alone (β = 0.16; CI = 0.08 – 0.23), and HI alone (β = 0.16; CI = 0.09 – 0.23) groups. Older adults with hearing or vision loss in the United States perceive greater discrimination in their day-to-day lives than non-sensory impaired older adults. Older adults with both hearing and vision loss perceive even more discrimination than those with either hearing or vision loss alone. %B JAMA Ophthalmology %V 138 %P 1-7 %@ 1552-5783 %G eng %N 12 %R 10.1001/jamaophthalmol.2020.3982 %0 Journal Article %J American Journal of Epidemiology %D 2020 %T Early Educational Experiences and Trajectories of Cognitive Functioning Among Mid-Life and Older U.S. Adults %A Katrina M Walsemann %A Jennifer A Ailshire %X Educational attainment is often considered the most important protective factor against cognitive impairment and dementia, yet significant variation in early educational experiences exists among mid-life and older U.S. adults. We use prospective data from the Health and Retirement Study (HRS) along with information on respondents’ early educational experiences collected in the 2015 and 2017 HRS Life History Mail Survey (HRS-LHMS) to examine if school context, educational content, and academic ability are associated with trajectories of cognitive functioning and whether educational attainment explains this relationship. We restrict our sample to age-eligible HRS-LHMS respondents who provided data on cognitive functioning at least once from 1998 to 2014, and attended primary school or higher (n=9,565 respondents providing 62,037 person-period observations). Estimates from linear mixed models revealed that school context, educational content, and academic ability were significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Educational attainment explained from 9\% to 55\% of the association between these early educational experiences and level of cognitive functioning; however, all relationships remained statistically significant. Our results suggest that educational experiences that span childhood and adolescence are independently related to level of cognitive functioning decades later. %B American Journal of Epidemiology %8 01 %G eng %U https://doi.org/10.1093/aje/kwz276 %R 10.1093/aje/kwz276 %0 Journal Article %J Biodemography and Social Biology %D 2020 %T Educational mobility and telomere length in middle-aged and older adults: testing three alternative hypotheses. %A Cuevas, Adolfo G %A Greatorex-Voith, Siobhan %A Abuelezam, Nadia %A Eckert, Natalie %A Shervin Assari %K Education %K social mobility %K Telomere length %X

Critical period, social mobility, and social accumulation are three hypotheses that may explain how educational mobility impacts health. Thus far, there is little evidence on how these processes are associated with biological aging as measured by telomere length. Using cross-sectional data from the 2008 Health and Retirement Study, we examined the association between educational mobility (parental education and contemporaneous education) and telomere length. The final model is adjusted for sociodemographic factors and socioeconomic status, childhood adversity, and health behaviors/risk factors, as well as depressive symptoms. A total of 1,894 participants were included in the main analyses. High parental education was associated with longer telomere length in a fully adjusted model (B = 0.03, CI [0.002,0.07]). Downwardly mobile individuals (high parental education and low contemporaneous education) had longer telomere length compared to stably low individuals in a fully adjusted model (B = 0.05, CI [0.004,0.09]). There was support for the critical period hypothesis and partial support for the change hypothesis. There was no evidence to support the social accumulation hypothesis. Prospective studies are needed to understand the mechanism that can help further explain the association between educational mobility and telomere length.

%B Biodemography and Social Biology %V 66 %P 220-235 %G eng %N 3-4 %R 10.1080/19485565.2021.1983760 %0 Journal Article %J Journal of Dental Research %D 2020 %T Education-Related Inequalities in Dental Services Use among Older Adults in 23 Countries %A Andrade, F. Bof de %A Antunes, J.L.F. %A Andrade, F.C.D. %A Lima-Costa, M.F.F. %A Macinko, J. %K Dental Care %K Epidemiology %K health care disparities %K Health Services for the Aged %K Oral Health %K Socioeconomic factors %X This study aimed to measure the magnitude of education-related inequalities in the use of dental services among older adults (aged 50?y or older) from a sizable multicountry sample of 23 upper-middle- and high-income countries. This study used cross-sectional data from nationally representative surveys of people aged 50 y and over. Countries included in the Health and Retirement Study surveys were the following: Brazil, China, South Korea, Mexico, United States, Austria, Belgium, Croatia, Czech Republic, Denmark, Estonia, France, Germany, Greece, Italy, Israel, Luxembourg, Poland, Portugal, Slovenia, Spain, Sweden, and Switzerland. The dependent variable was the use of dental services, based on the self-report of having had a dental visit within the previous year, except for the United States and South Korea, which used 2-y recall periods. Educational level was used as the measure of socioeconomic position and was standardized across countries. Multivariate logistic regression modeling was used to evaluate the factors associated with the use of dental services, and the magnitude of education inequalities in the use of dental services was assessed using the slope index of inequality (SII) to measure absolute inequalities and the relative index of inequality for relative inequalities. The pooled prevalence of the use of dental services was 31.7% and ranged from 18.7% in China to 81.2% in Sweden. In the overall sample, the absolute difference in the prevalence of use between the lowest and highest educational groups was 20?percentage points. SII was significant for all countries except Portugal. Relative educational inequalities were significant for all countries and ranged from 3.2 in Poland to 1.2 in Sweden. There were significant education-related inequalities in the use of dental care by older adults in all countries. Monitoring these inequalities is critical to the planning and delivery of dental services. %B Journal of Dental Research %@ 0022-0345 %G eng %R 10.1177/0022034520935854 %0 Journal Article %J Nova Economia %D 2020 %T Ex-ante moral hazard: empirical evidence for private health insurance in Brazil %A Maia,Ana C. %A Andrade,Mô %A Chein,Flávia %K Business and Economics %K Health Insurance %K moral hazard %X This paper explores the existence of ex-ante moral hazard in private health insurance in Brazil. Before the advent of illness, insured individuals have no incentives to seek preventive care if it is not previously contractible. The data set comprises longitudinal administrative records of health care utilization from a Brazilian employer-sponsored health insurance plan. The empirical strategy is based on an exogenous and anticipated shock in health insurance coverage not associated with health conditions. The results show an increase of up to 17% on medical visits and 22% on diagnostic tests due to the loss of health insurance. Medical visits start to increase five months before the individual leaves the health insurance pool, reaching its peak at two months prior to exit. For diagnostic tests, the increase was observed only in the last two months before the loss of health insurance coverage. Epub Mar 06, 2020. ISSN 0103-6351. https://doi.org/10.1590/0103-6351/4886. Este artigo explora a existência de risco moral ex-ante no setor de saúde suplementar no Brasil. Antes do evento da doença, indivíduos com plano/seguro saúde não têm incentivos para procurar cuidado preventivo se esse não for contratado previamente. O conjunto de dados utilizado inclui registros administrativos longitudinais da utilização de cuidados de saúde de um plano de saúde brasileiro patrocinado pelo empregador. A estratégia empírica é baseada em uma mudança exógena e antecipada na cobertura de seguro de saúde não associada à condição de saúde. Os resultados mostram um aumento de até 17% nas consultas médicas e 22% nos exames diagnósticos. As consultas médicas começam a aumentar a partir do quinto mês antes do indivíduo deixar a carteira com um pico em dois meses. Para testes diagnósticos, o maior aumento foi observado em um e dois meses antes da perda da cobertura do plano de saúde. %B Nova Economia %V 29 %P 987-1008 %@ 0103-6351 %G eng %U https://search.proquest.com/docview/2375479034/6609E5AC3637428BPQ?accountid=14667 %N 3 %9 Journal %R https://doi.org/10.1590/0103-6351/4886 %0 Report %D 2020 %T EXTENDING THE EARNED INCOME TAX CREDIT: HOW THE ECONOMIC SECURITY PROJECT’S COST-OF-LIVING REFUND WOULD AFFECT FAMILY CAREGIVERS %A Maag, Elaine %A Melissa Favreault %A Airi, Nikhita %K budget %K Families %K Income %K Taxes %K Wealth %X In recognition of the important work family caregivers do, the Economic Security Project (ESP) has proposed that they be eligible for the cost-of-living refund, an expansion of the earned income tax credit (EITC). Among other changes to the EITC, the cost-of-living refund would extend benefits to family caregivers who have little or no earnings from paid employment, essentially expanding the kinds of work eligible for tax benefits. We estimate the caregiver provisions of the proposal would increase tax benefits for 2.6 million families in 2020. The proposal would provide $2,830 billion in tax benefits over fiscal years 2019–28; 1 extending full benefits to low-income family caregivers would account for about $180 billion2 of those costs. Benefits from the caregiver provision would be highly concentrated among very low-income families. %B Tax Policy Center Brief %I Urban Institute and Brookings Institution %C Washington, D.C. %G eng %U https://www.urban.org/research/publication/extending-earned-income-tax-credit-how-economic-security-projects-cost-living-refund-would-affect-family-caregivers %0 Journal Article %J PloS one %D 2020 %T Female vulnerability to the effects of smoking on health outcomes in older people %A Haghani, Amin %A Thalida E. Arpawong %A Jung K Kim %A Lewinger, Juan Pablo %A Caleb E Finch %A Eileen M. Crimmins %K Cardiovascular disease %K Smoking %K Women's Health %X Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity. %B PloS one %V 15 %@ 1932-6203 %G eng %U https://pubmed.ncbi.nlm.nih.gov/32497122 %N 6 %1 32497122[pmid] %4 PONE-D-20-03538[PII] %! PLoS One %R 10.1371/journal.pone.0234015 %0 Journal Article %J The Journal of the Economics of Ageing %D 2020 %T Gender Differences in Cognitive Function among Older Mexican Immigrants %A Maria Casanova %A Emma Aguila %K Cognition %K Gender Differences %K MHAS %K Older Adults %X This paper uses data from the Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) to study the cognitive function of Mexican-born older adults residing in the United States (Mexican immigrants). We find that, once differences in socioeconomic factors are accounted for, the cognitive function of male Mexican immigrants is statistically indistinguishable from that of male non-Hispanic (NH) whites, but the cognitive scores of female Mexican immigrants remain significantly below those of their NH white counterparts. We explore four potential hypotheses that may explain the cognition gap for female Mexican immigrants. Namely, we investigate whether the relative incidence of risk factors for dementia, when compared to NH whites, is higher for female than for male Mexican immigrants (the “risk factor hypothesis”); whether the mortality rate of male Mexican immigrants with low cognition is higher, relative to their white counterparts, than that of female Mexican immigrants (the “survival bias hypothesis”); whether female Mexican immigrants are less positively selected than their male counterparts in terms of predisposition to cognitive decline when compared with either the non-migrant Mexican population or the population of return migrants (the “differential selection hypothesis”); and whether male immigrants are better acculturated to life in the United States than female immigrants (the “acculturation hypothesis). We find no support for the risk-factor, survival, or acculturation hypotheses but we find evidence suggesting that the differential selection hypothesis may explain part of the female cognitive gap. Our results imply that older Mexican females currently residing in the U.S. may be at elevated risk for dementia and should be targeted by campaigns aimed at preventing or diagnosing the condition. %B The Journal of the Economics of Ageing %V 16 %G eng %R https://doi.org/10.1016/j.jeoa.2019.100226 %0 Journal Article %J Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %D 2020 %T Genetic and regulatory architecture of Alzheimer's disease in the APOE region %A Alexander M Kulminski %A Shu, Leonardo %A Loika, Yury %A He, Liang %A Nazarian, Alireza %A Konstantin G Arbeev %A Svetlana Ukraintseva %A Anatoliy Yashin %A Culminskaya, Irina %K Alzheimer's disease %K Apolipoprotein E %K Linkage Disequilibrium %X Abstract Introduction Apolipoprotein E (APOE) ε2 and ε4 alleles encoded by rs7412 and rs429358 polymorphisms, respectively, are landmark contra and pro “risk” factors for Alzheimer's disease (AD). Methods We examined differences in linkage disequilibrium (LD) structures between (1) AD-affected and unaffected subjects and (2) older AD-unaffected and younger subjects in the 19q13.3 region harboring rs7412 and rs429358. Results AD is associated with sex-nonspecific heterogeneous patterns of decreased and increased LD of rs7412 and rs429358, respectively, with other polymorphisms from five genes in this region in AD-affected subjects. The LD patterns in older AD-unaffected subjects resembled those in younger individuals. Polarization of the ε4- and ε2 allele–related heterogeneous LD clusters differentiated cell types and implicated specific tissues in AD pathogenesis. Discussion Protection and predisposition to AD is characterized by an interplay of rs7412 and rs429358, with multiple polymorphisms in the 19q13.3 region in a tissue-specific manner, which is not driven by common evolutionary forces. %B Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %V 12 %P e12008 %G eng %U https://alz-journals.onlinelibrary.wiley.com/doi/abs/10.1002/dad2.12008 %R https://doi.org/10.1002/dad2.12008 %0 Journal Article %J Research in Human Development %D 2020 %T Glycosylated Hemoglobin Level, Race/Ethnicity, and Cognition in Midlife and Early Old Age %A Ortiz, Kasim %A Marc Garcia %A Emily Briceño %A Diminich, Erica D. %A Arévalo, Sandra P. %A Vega, Irving E. %A Wassim Tarraf %K biomarker data %K cognitive function %K Racial/ethnic differences %X Empirical evidence linking racial/ethnic differences in glycosylated hemoglobin levels (HbA1c) to cognitive function in midlife and early old age is limited. We use biomarker data from the Health and Retirement Study (HRS, 2006?2014), on adults 50?64 years at baseline (57?73 years by 2014), and fit multinomial logistic regression models to assess the association between baseline HbA1c, cognitive function (using Langa?Weir classifications) and mortality across 8 years. Additionally, we test for modification effects by race/ethnicity. In age- and sex-adjusted models high HbA1c level was associated with lower baseline cognition and higher relative risk ratios (RRR; vs. normal cognition) for cognitive impairment no dementia (CIND; RRR = 2.3; 95%CI = [1.38;3.84]; p < .01), and dementia (RRR = 4.00; 95%CI = [1.76;9.10]; p < .01). Adjusting for sociodemographic, behavioral risk factors, and other health conditions explained the higher RRR for CIND and attenuated the RRR for dementia by approximately 30%. HbA1c levels were not linked to the slope of cognitive decline, and we found no evidence of modification effects for HbA1c by race/ethnicity. Targeting interventions for glycemic control in the critical midlife period can protect baseline cognition and buffer against downstream development of cognitive impairment. This can yield important public health benefits and reductions in burdens associated with cognitive impairment, particularly among race/ethnic minorities who are at higher risk for metabolic diseases. %B Research in Human Development %V 17 %P 20 - 40 %@ 1542-7609 %G eng %N 1 %R 10.1080/15427609.2020.1743810 %0 Journal Article %J Collabra: Psychology %D 2020 %T Is Healthy Neuroticism Associated with Health Behaviors? A Coordinated Integrative Data Analysis %A Graham, Eileen %A Sara J Weston %A Nicholas A. Turiano %A Damaris Aschwanden %A Booth, Tom %A Harrison, Fleur %A James, Byran %A Nathan A Lewis %A Makkar, Steven %A Mueller, Swantje %A Wisniewski, Kristi %A Yoneda, Tomiko %A Zhaoyang, Ruixue %A Avron Spiro III %A Willis, Sherry %A K. Warner Schaie %A Sliwinski, Martin %A Lipton, Richard %A Katz, Mindy %A Ian J Deary %A Elizabeth Zelinski %A David A Bennett %A Sachdev, P S %A Brodaty, H %A Troller, Julian %A Ames, David %A Margaret J Wright %A Denis Gerstorf %A Allemand, Mathias %A Drewelies, Johanna %A Wagner, Gert G %A Muniz-Terrera, Graciela %A Andrea M Piccinin %A Scott M Hofer %A Daniel K. Mroczek %K Coordinated IDA %K Health behaviors %K Healthy Neuroticism %X Current literature suggests that neuroticism is positively associated with maladaptive life choices, likelihood of disease, and mortality. However, recent research has identified circumstances under which neuroticism is associated with positive outcomes. The current project examined whether “healthy neuroticism”, defined as the interaction of neuroticism and conscientiousness, was associated with the following health behaviors: smoking, alcohol consumption, and physical activity. Using a pre-registered multi-study coordinated integrative data analysis (IDA) approach, we investigated whether “healthy neuroticism” predicted the odds of engaging in each of the aforementioned activities. Each study estimated identical models, using the same covariates and data transformations, enabling optimal comparability of results. These results were then meta-analyzed in order to estimate an average (N-weighted) effect and to ascertain the extent of heterogeneity in the effects. Overall, these results suggest that neuroticism alone was not related to health behaviors, while individuals higher in conscientiousness were less likely to be smokers or drinkers, and more likely to engage in physical activity. In terms of the healthy neuroticism interaction of neuroticism and conscientiousness, significant interactions for smoking and physical activity suggest that the association between neuroticism and health behaviors was smaller among those high in conscientiousness. These findings lend credence to the idea that healthy neuroticism may be linked to certain health behaviors and that these effects are generalizable across several heterogeneous samples. %B Collabra: Psychology %V 6 %G eng %N 1 %R http://doi.org/10.1525/collabra.266 %0 Journal Article %J Journal of Business & Economic StatisticsJournal of Business & Economic Statistics %D 2020 %T Heterogeneity in Expectations, Risk Tolerance, and Household Stock Shares: The Attenuation Puzzle %A Ameriks, John %A Kezdi, Gabor %A Lee, Minjoon %A Matthew D. Shapiro %K household portfolio choice %K Risk preference %K Subjective stock returns distribution %K Survey measurement %X AbstractThis article jointly estimates the relationship between stock share and expectations and risk preferences. The survey allows individual-level, quantitative estimates of risk tolerance and of the perceived mean, and variance of stock returns. These estimates have economically and statistically significant association for the distribution of stock shares with relative magnitudes in proportion with the predictions of theories. Incorporating survey measurement error in the estimation model increases the estimated associations 2-fold, but they are still substantially attenuated being only about 5% of what benchmark finance theories predict. Because of the careful attention in the estimation to measurement error, the attenuation likely arises from economic behavior rather than errors in variables. %B Journal of Business & Economic StatisticsJournal of Business & Economic Statistics %V 38 %P 633 - 646 %@ 0735-0015 %G eng %N 3 %R 10.1080/07350015.2018.1549560 %0 Journal Article %J Innovation in Aging %D 2020 %T Hopelessness among Middle-aged and Older Blacks: The Negative Impact of Discrimination and Protecting Power of Social and Religious Resources %A Uchechi A Mitchell %A Gutierrez-Kapheim, Melissa %A Ann W Nguyen %A Al-Amin, Nadia %K African American %K Mental Health %K Minority Issues %K race %K Religion and spirituality %K Social networks %K Social Support %K Stress & Coping %X Hopelessness—a state of despair characterized by a negative outlook towards the future and a belief in insurmountable challenges—is a risk factor for major depression, cardiovascular disease, and all-cause mortality among older adults. It is also an understudied consequence of discrimination. Older Blacks disproportionately report experiencing discrimination and, as a result, may be at greater risk of feeling hopeless. However, social and religious resources may protect against the adverse effects of discrimination. The current study examines whether social support, social engagement, religious attendance, and religiosity buffer the effects of self-reported everyday discrimination on hopelessness among a nationally representative sample of Blacks.Using data from the 2010/2012 psychosocial assessment of the Health and Retirement Study, we regressed hopelessness on everyday discrimination, stratifying by two age groups, ages 51-64, representing middle-age (n=1,302) and age 65 and older, representing old age (n=887). Interaction terms tested whether each resource moderated the discrimination-hopelessness relationship controlling for depressive symptoms, socioeconomic status, and demographic characteristics.Greater reports of everyday discrimination were associated with higher levels of hopelessness for middle-aged and older Blacks. For middle-aged Blacks, the resources did not moderate the discrimination-hopelessness relationship; rather higher levels of support (b=-.294, p<0.01), religiosity (b=-.297, p<0.001), religious attendance (b=-.218, p<0.05) were independently and inversely associated with hopelessness. For older Blacks, higher levels of religiosity moderated the discrimination-hopelessness relationship (b=-.208, p<0.05) and higher levels of support (b=-.304, p<0.05) and social engagement (b=-.236, p<0.05) were independently and inversely associated with hopelessness.Findings suggest that self-reported everyday discrimination increases hopelessness among middle-aged and older Blacks but social and religious resources may counterbalance its effects, in age-specific ways, to protect against hopelessness. Religiosity may be especially important for older Blacks as a buffer against the negative consequences of discrimination on hopelessness. %B Innovation in Aging %V 4 %P igaa044 %@ 2399-5300 %G eng %N 5 %R 10.1093/geroni/igaa044 %0 Government Document %D 2020 %T How Did the Reintroduction of the Social Security Statement Change Workers' Expectations and Plans? %A Philip Armour %K Social Security Benefits %X This article examines how the reintroduction of Social Security Statement mailings from September 2014 through December 2016 affected recipients' expectations about Social Security benefits and their benefit claiming decisions. During the reintroduction period, Statements were mailed to workers reaching multiple-of-5 ages, enabling a comparison of results for 2016 recipients, 2014/2015 recipients, and reintroduction-period nonrecipients. I fielded a specialized American Life Panel (ALP) survey to elicit recall of and reactions to receiving the Statement and used earlier ALP modules to control for respondents' prior Social Security knowledge. I find that recipients remember and value the information provided in the Statement, although the effects quickly diminish after receipt. Recipients were likelier than nonrecipients to expect future benefits but were also more likely to expect Congress to enact future benefit cuts. Married female recipients were more likely to expect spousal benefits, and recipients overall were more likely to change their planned claiming age. %I Office of Retirement and Disability Policy, Social Security Administration %V 80 %G eng %U https://www.ssa.gov/policy/docs/ssb/v80n4/v80n4p23.html %N 4 %0 Journal Article %J American Journal of Industrial Medicine %D 2020 %T Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study. %A Silver, Sharon R %A Alarcon, Walter A %A Li, Jia %K COPD %K exposure %K longitudinal %K Occupation %X

BACKGROUND: Chronic health effects from accumulated occupational exposures manifest as the workforce ages. The Health and Retirement Study (HRS), a panel survey of U.S. adults nearing/in retirement, allows assessment of associations among industry and occupation (I/O), workplace exposures, and incident chronic obstructive pulmonary disease (COPD).

METHODS: The study population comprised respondents from the 1992 HRS cohort employed in 1972 or later and not diagnosed with COPD as of initial interview. We examined associations with incident COPD through 2016 and: (1) broad and selected detailed I/O, (2) workplace exposures, and (3) exposures within I/O. Given the cohort's baseline age (50-62), we calculated subhazard ratios (SHRs) for COPD accounting for competing risk of death.

RESULTS: SHRs for COPD were significantly elevated for several industries: mining; blast furnaces, steelworks, rolling and finishing mills; groceries and related products; and automotive repair shops. Occupations with significantly elevated SHRs were maids and housemen; farmworkers; vehicle/mobile equipment mechanics and repair workers; material moving equipment operators; and nonconstruction laborers. Significantly elevated COPD SHRs were observed for specific I/O-exposure pairs: blast furnace/steelworks/rolling/finishing mills and asbestos; automotive repair shops and aerosol paints; farmworkers and pesticide exposures; and both material moving equipment operators and nonconstruction laborers exposed to dust and ash.

CONCLUSIONS: Certain jobs and occupational exposures are associated with increased risk for developing COPD in late preretirement and during retirement. Given the disability and economic costs of COPD, these findings support focusing exposure prevention and medical monitoring resources on groups of workers at increased risk.

%B American Journal of Industrial Medicine %G eng %R 10.1002/ajim.23196 %0 Journal Article %J Innovation in Aging %D 2020 %T Kinlessness at the End of Life in the United States: Implications for Place of Death, and Quality of Life Among Older Adults %A Katherine A Ornstein %A Natalie Plick %A Claire K. Ankuda %K end of life %K kinless %X We used the Health and Retirement Study, a large nationally representative study of U.S. older adults from 2002-2015, to identify decedents and assess quality of EOL care by availability of kin. 7.9% of participants were kinless at EOL (no adult children or spouses), reflecting national estimates of 1,027,600 older adults. Those who were kinless at EOL were more likely to be female (61.2% vs 51.5%), from the lowest wealth quartile (53.6% vs 35.6%), and less likely to be white and non-Hispanic (75.6% vs 81.8%). Among the community-dwelling population, individuals with kin received 2.4 times as much hours of help from informal caregivers per month, compared to those without kin. We did not observe differences in rates of hospital death by kin status in adjusted models. More work is needed to assess any unmet needs in the EOL period for kinless older adults, especially as healthcare moves towards increased in-home supports. %B Innovation in Aging %V 4 %P 604 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.2037 %0 Thesis %B Healthcare Administration %D 2020 %T Leadership and End-of-Life Planning Among Elderly Patients With End-Stage Renal Disease %A Armstrong-Fears, Elizabeth %K End-of-life decision making %K ethnicity %K renal disease %X More than 8-million people in the United States possess no kidney function. The purpose of this quantitative casual-comparative research study is to examine the relationship between ethnicity status of African American and European American patients suffering from end-stage renal disease, and advanced care planning and end-of-life decisionmaking among patients who are 55 years of age and older. The health belief model is the selected explanatory framework used to examine (a) whether ethnicity status is a significant predictor of whether decedents had written end-of-life care instructions, (b) whether ethnicity status is a significant predictor of whether treatment decisions were made, and (c) whether ethnicity status is a predictor of whether patients 55 years of age and older were able to participate in these decisions during the final days of life. The quantitative causal-comparative research design utilized a secondary data set with 4,172 European Americans, of whom 1,010 (24.2%) died from kidney disease, and 1,013 African American in the sample with 289 (28.6%) who died from kidney disease. The logistic regression resulted in the rejection of the null hypothesis for each of the three research questions. The study results may be used by executive leaders to understand factors of patient safety, value-based care, medical technology, health care resources for family, and caregivers that ultimately increase the quality of life of the patient and care needs at the end of life. %B Healthcare Administration %I Walden University %C Minneapolis, MN %V Doctor of Philosophy %G eng %U https://search.proquest.com/openview/d916559b126a3e7548658855ff0d8784/1?pq-origsite=gscholar&cbl=18750&diss=y %0 Journal Article %J Demographic Research %D 2020 %T Life After Death: Widowhood and Volunteering Gendered Pathways Among Older Adults %A Bolano, Danilo %A Bruno Arpino %K Gender Differences %K Older Adults %K trajectories of social activities %K Volunteering %K Widowhood %X Background: Spousal loss is one of the most traumatic events an individual can experience. Studies on behavioral changes before and after this event are scarce. Objective: This study investigates gender differences in pathways of volunteering before and after transition to widowhood among older adults in the United States. Methods: We use longitudinal data from the Health and Retirement Study and estimate fixed-effect models with lags and leads to identify pathways of volunteering on a sample of 1,982 adults aged 50 and over. Results: The results show a U-shape pattern with a decline in volunteering activities before the death of the partner and then a slight process of adaptation and recovery. The process is strongly gendered with women considerably more resilient than men. Whether death was expected or not influences the effect of partner death on volunteering likely due to the pre-death burden of caregiving. Looking at the role of pre-death partner’s volunteering we found, for both genders, but especially for women, that the odds of volunteering increase (decrease) if the partner was (was not) volunteering (complementarity hypothesis). Contribution: Given the positive effects of volunteering both for the volunteer and the society as a whole, our findings contribute to the literature highlighting that critical family events may affect participation in society of older people and demonstrating the heterogeneity of the effects especially in terms of gender differences. %B Demographic Research %V 43 %P 581-616 %G eng %R 10.4054/DemRes.2020.43.21 %0 Journal Article %J Ageing and Society %D 2020 %T Life transitions and leisure activity engagement among older Americans: findings from a national longitudinal study %A Yura Lee %A Iris Chi %A Jennifer A Ailshire %K CAMS %K Leisure activities %K Life transitions %K Widowhood %X One of the major aspects of successful ageing is active engagement in later life. Retirement and widowhood are two significant life transitions that may largely influence leisure engagement patterns among older adults. Limited findings exist regarding the impact of life transitions on leisure activity engagement due to the scarcity of longitudinal data with repeated measurement of older individuals' leisure engagement. This study longitudinally examined changes in leisure activity engagement as influenced by retirement and widowhood using five waves of national panel data from the Health and Retirement Study and its supplementary Consumption and Activities Mail Survey. Multi-level modelling was conducted with retirement and widowhood status as time-varying variables. Socio-economic status, depressive symptoms, cognitive function, self-rated health and functional limitations were also included as time-varying and time-invariant covariates. Findings show that engagement in mental, physical, social and household activities significantly decreased during an eight-year period. Moreover, transition from working to retired status was associated with increased engagement in mental, social and household activities but decreased engagement in physical activities among men only. Transition from married to widowhood status was associated with decreased engagement in household activities among women only. Encouraging active leisure engagement among individuals who experience either or both life transitions may help maintain their health after transition. %B Ageing and Society %V 40 %P 537-564 %G eng %U https://www.cambridge.org/core/journals/ageing-and-society/article/life-transitions-and-leisure-activity-engagement-among-older-americans-findings-from-a-national-longitudinal-study/4660EFBC38391378EE45D4BDD860943E %N 3 %9 Journal %! Ageing and Society %R 10.1017/S0144686X18001101 %0 Journal Article %J European Journal of Public Health %D 2020 %T Life-course risk factors are associated with activity of daily living disability in older adults. %A Macinko, James %A Vaz de Melo Mambrini, Juliana %A Bof de Andrade, Fabíola %A Drumond Andrade, Flavia Cristina %A Lazalde, Gabriela E %A Lima-Costa, Maria Fernanda %K Activities of Daily Living %K Aging %K Child %K Disability %K Educational Status %K human development index %K multimorbidity %K Older adult %K Socioeconomic factors %X

BACKGROUND: Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI).

METHODS: Data include 100 062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability.

RESULTS: In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country's HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7% in the lowest HDI country to 21.8% in the highest HDI country.

CONCLUSIONS: Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.

%B European Journal of Public Health %G eng %R 10.1093/eurpub/ckaa156 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2020 %T Lifetime History of Traumatic Brain Injury is Associated with Increased Loneliness in Adults: A U.S. Nationally Representative Study %A Raj G. Kumar %A Katherine A Ornstein %A Bollens-Lund, Evan %A Watson, Eric M. %A Claire K. Ankuda %A Amy Kelley %A Dams-O'Connor, Kristen %K Loneliness %K Older Adults %K Traumatic Brain Injury %X Background/Objectives: An estimated 55 million individuals worldwide live with chronic disability associated with Traumatic Brain Injury (TBI) which may include cognitive, behavioral and social impairments. Reduced participation in social activities is common after TBI, however few studies have evaluated loneliness among survivors of TBI. The current study aimed to evaluate the association between history of TBI and loneliness, and to identify mediators of this association. Methods/Design: Retrospective cohort study. Nationally representative sample of N=724 adults over age 50 (Health and Retirement Study). Loneliness was evaluated using the 11-item Revised UCLA (R-UCLA) Loneliness Scale (range 11-33). Lifetime history of TBI evaluated retrospectively using the Ohio State University TBI Identification Method. We included the following covariates: age, sex, race, education; and mediators: depressive symptoms, number of comorbidities, chronic pain, difficulty with activities of daily living, and social network index. Results: History of TBI was associated with a 1.28 point (95% CI: 0.46, 2.11, p<0.05; Cohen's D=0.284) increase in R-UCLA loneliness scale scores, after covariate adjustment. Individuals with more recent injuries (within 10 years) and multiple lifetime TBIs reported the highest loneliness scores. In the structural equation model, depressive symptoms and comorbidity burden partially mediated the relationship between TBI and loneliness. All models were adjusted for United States (U.S.) population sampling weights. Conclusions: History of TBI was associated with greater loneliness compared to individuals without TBI in a representative sample of U.S. adults. Managing depressive symptoms and medical consequences of TBI may be a target to ameliorate reporting of loneliness in this population. This article is protected by copyright. All rights reserved. %B International Journal of Geriatric Psychiatry %V 35 %P 553-563 %G eng %N 5 %R 10.1002/gps.5271 %0 Journal Article %J Sage Journals %D 2020 %T Living Alone in the United States and Europe: The Impact of Public Support on the Independence of Older Adults %A Mudrazija, Stipica %A Jacqueline L. Angel %A Cipin, Ivan %A Smolic, Sime %K Income and wealth %K Living Alone %K Public Policy %X While we know that living alone is often associated with greater risk of financial hardship, we have limited knowledge on the possible link between the availability of public support and independent living. We use data from the 2014 Health and Retirement Study and the 2011–2015 Survey of Health, Ageing and Retirement in Europe to compare income and wealth profiles of the population aged 60 and above who are living alone in the United States and 19 European countries. We find that the likelihood of living alone is higher in generous welfare states, with social support and spending both positively associated with living alone. The relationship between personal resources and living alone has a smaller positive gradient in countries with robust welfare systems. The lack of adequate public support in less generous welfare states may constrain the ability of many low-income older adults without a partner to continue living independently. %B Sage Journals %V 42 %P 150-162 %G eng %U https://journals.sagepub.com/doi/full/10.1177/0164027520907332?journalCode=roaa %N 5-6 %R https://doi.org/10.1177/0164027520907332 %0 Journal Article %J Public Health Nutrition %D 2020 %T Living alone, social networks in neighbourhoods, and daily fruit and vegetable consumption among middle-aged and older adults in the USA %A Choi, Yeon Jin %A Jennifer A Ailshire %A Eileen M. Crimmins %K Dietary intake %K Fruit and vegetable consumption %K Healthy diet %K Living arrangements %K Social networks %X Objective: A social network is a valuable resource in later life. Therefore, the current study aims to investigate whether social networks within homes and neighbourhoods are associated with older adults’ daily fruit and vegetable consumption. Design: Cross-sectional secondary data analysis. Setting: USA. Participants: A nationally representative sample of 6865 community-dwelling older adults over age 53 in the Health and Retirement Study – Health Care and Nutrition Survey. Results: Older adults who lived alone with no children or friends nearby had the lowest fruit and vegetable consumption. However, the daily fruit and vegetable consumption of respondents who lived alone and had children or friends nearby or those who lived with someone and had no children or friends nearby was not statistically different from those who lived with someone and had children or friends nearby. This suggests that having a social network either at home or in the neighbourhood complements the absence of living with someone or having children or friends nearby and attenuates the negative association between limited social networks and daily fruit and vegetable consumption. A greater decrease in the number of fruits and vegetables consumed was observed among men when they lived alone with no children or friends nearby. Conclusions: Special attention should be given to older adults with limited social networks, especially older adults living alone with no children or friends nearby. Provision of help with grocery shopping and meal preparation as well as social support networks and more opportunities that can improve social engagement appear to be necessary. %B Public Health Nutrition %V 23 %P 3315-3323 %G eng %N 18 %R 10.1017/S1368980020002475 %0 Journal Article %J Psychology and Aging %D 2020 %T Loneliness and hostility in older adults: A cross-lagged model. %A Dikla Segel-Karpas %A Liat Ayalon %K Hostility %K Loneliness %X Loneliness takes a meaningful toll on individuals' physical and mental well-being. One of its possible consequences is the perception that others are not to be trusted and are a source of wrongdoing, defined as cynical hostility. At the same time, cynical hostility could also deter individuals from seeking the comfort of close social relationships. We use the Health and Retirement Study to test a cross-lagged model of hostility and loneliness in a sample of 7500 older adults. The results suggest that there are bidirectional associations between hostility and loneliness. The findings are discussed in light of existing theories on human development, and practical implications are suggested. (PsycINFO Database Record (c) 2020 APA, all rights reserved). %B Psychology and Aging %V 35 %P 169–176 %G eng %U https://psycnet.apa.org/record/2019-66844-001 %N 2 %9 Journal %R 10.1037/pag0000417 %0 Journal Article %J International Journal of Obesity %D 2020 %T Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies %A Virtanen, Marianna %A Markus Jokela %A Lallukka, Tea %A Magnusson Hanson, Linda %A Pentti, Jaana %A Solja T. Nyberg %A Alfredsson, Lars %A G David Batty %A Casini, Annalisa %A Clays, Els %A DeBacquer, Dirk %A Ervasti, Jenni %A Fransson, Eleonor %A Halonen, Jaana I. %A Head, Jenny %A Kittel, France %A Knutsson, Anders %A Leineweber, Constanze %A Nordin, Maria %A Oksanen, Tuula %A Pietiläinen, Olli %A Rahkonen, Ossi %A Salo, Paula %A Archana Singh-Manoux %A Stenholm, Sari %A Suominen, Sakari B. %A Theorell, Töres %A Vahtera, Jussi %A Westerholm, Peter %A Westerlund, Hugo %A Mika Kivimäki %K Preventive medicine %K Risk Factors %X Objective To examine the relation between long working hours and change in body mass index (BMI). Methods We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35–40 h, reference), 41–48 h, 49–54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25–29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline. Results Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90–1.00) for part-time work, 1.07 (1.02–1.12) for 41–48 weekly working hours, 1.09 (1.03–1.16) for 49–54 h and 1.17 (1.08–1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity. Conclusions This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours. %B International Journal of Obesity %V 44 %P 1368 - 1375 %@ 1476-5497 %G eng %! International Journal of Obesity %R 10.1038/s41366-019-0480-3 %0 Journal Article %J Diseases of the colon and rectum %D 2020 %T Long-term Functional Decline After High-Risk Elective Colorectal Surgery in Older Adults %A De Roo, A.C. %A Yun Li %A Abrahamse, P.H. %A Regenbogen, S.E. %A Suwanabol, P.A. %K Colon %K Postoperative Complications %K Surgery %X BACKGROUND: Although most surgical outcomes research focuses on clinical end points and complications, older adult patients may value functional outcomes more. However, little is known about the risk of long-term functional disability after colorectal procedures. OBJECTIVE: The purpose of this research was to understand the incidence and likelihood of functional decline after high-risk (ie, ≥1% inpatient mortality) colorectal operations both without and with complications. DESIGN: This was a retrospective matched cohort study. SETTINGS: The Health and Retirement Study, a nationally representative, longitudinal survey of adults >50 years of age, collects data on functional status, cognition, and demographics, among other topics. The survey was linked with Medicare claims and National Death Index data from 1992 to 2012. PATIENTS: Patients ≥65 years of age who underwent elective high-risk colorectal surgery with functional status measured before and after surgery were included. These patients were matched 1:3 to survey respondents who did not undergo major surgery, based on propensity scores. MAIN OUTCOME MEASURES: Functional decline, the primary outcome, was defined as an increase in the number of activities of daily living and instrumental activities of daily living requiring assistance before and after surgery. Using logistic regression, we examined whether surgery without or with complications was associated with functional decline. RESULTS: We identified 289 patients who underwent high-risk colorectal surgery and 867 matched control subjects. Of the surgery patients, 90 (31%) experienced a complication. Compared with the control subjects, surgery patients experienced greater likelihood of functional decline (without complications: OR = 1.82 (95% CI, 1.22-2.71), and with complications: OR = 2.96 (95% CI, 1.70-5.14)). Increasing age also predicted greater odds of functional decline (OR = 2.09, per decade (95% CI, 1.57-2.80)). LIMITATIONS: The functional measures were self-reported by survey participants. CONCLUSIONS: High-risk colorectal surgery, without or with complications, is associated with increased likelihood of functional decline in older adults. Patient-centered decision-making should include discussion of expected functional outcomes and long-term disability. %B Diseases of the colon and rectum %V 63 %P 75 - 83 %8 2020 %@ 15300358 (ISSN) %G eng %N 1 %R 10.1097/DCR.0000000000001541 %0 Journal Article %J Innovation in Aging %D 2020 %T Measuring More Than Exposure: Does Stress Appraisal Matter for Black-White Differences in Anxiety and Depressive Symptoms among Older Adults? %A Lauren L Brown %A Leah R. Abrams %A Uchechi A Mitchell %A Jennifer A Ailshire %K Aging %K Chronic stress %K Health Disparities %K Mental Health %X Prior research and theory suggest that exposure to objectively stressful events contributes to mental health disparities. Yet, Blacks report higher cumulative stress exposure than whites but lower levels of common psychiatric disorders. In order to understand why Blacks bear disproportionate stress exposure but similar or better mental health relative to whites, we need to consider race differences in not only stress exposure, but also stress appraisal—how upsetting stress exposures are perceived to beWe examine whether race differences in the number of reported chronic stressors across five domains (health, financial, residential, relationship, caregiving) and their appraised stressfulness explain Black-white differences in anxiety and depressive symptoms. Data come from 6,019 adults ages 52+ from the 2006 Health and Retirement StudyOlder Blacks in this sample experience greater exposure to chronic stressors but appraise stressors as less upsetting relative to whites. In fully adjusted models stress exposure is related to higher levels of anxiety and depressive symptoms and perceiving stress as upsetting is associated with higher symptomology for whites and Blacks. We also find that Blacks report greater anxiety symptoms but fewer depressive symptoms with more stress exposure relative to whites. Stress appraisal partially explains race differences in the association between stress exposure and anxiety symptoms and fully explains race differences in the association between exposure and depressive symptomsThe relationship between race, chronic stress exposure, and mental health is mediated by stress appraisal. Stress appraisal provides insight on important pathways contributing to Black-white mental health disparities in older adulthood %B Innovation in Aging %V 4 %P igaa040 %@ 2399-5300 %G eng %N 5 %R https://doi.org/10.1093/geroni/igaa040 %0 Journal Article %J Molecular Psychiatry %D 2020 %T Meta-analysis of up to 622,409 individuals identifies 40 novel smoking behaviour associated genetic loci. %A Erzurumluoglu, A Mesut %A Liu, Mengzhen %A Jackson, Victoria E %A Barnes, Daniel R %A Datta, Gargi %A Melbourne, Carl A %A Young, Robin %A Batini, Chiara %A Surendran, Praveen %A Jiang, Tao %A Adnan, Sheikh Daud %A Afaq, Saima %A Agrawal, Arpana %A Altmaier, Elisabeth %A Antoniou, Antonis C %A Asselbergs, Folkert W %A Baumbach, Clemens %A Laura Bierut %A Bertelsen, Sarah %A Boehnke, Michael %A Bots, Michiel L %A Brazel, David M %A Chambers, John C %A Chang-Claude, Jenny %A Chen, Chu %A Corley, Janie %A Chou, Yi-Ling %A David, Sean P %A de Boer, Rudolf A %A Christiaan de Leeuw %A Joe G Dennis %A Dominiczak, Anna F %A Dunning, Alison M %A Easton, Douglas F %A Charles B Eaton %A Elliott, Paul %A Evangelou, Evangelos %A Jessica Faul %A Tatiana Foroud %A Goate, Alison %A Gong, Jian %A Hans-Jörgen Grabe %A Jeffrey Haessler %A Christopher A Haiman %A Hallmans, Göran %A Anke R Hammerschlag %A Sarah E Harris %A Andrew T Hattersley %A Andrew C Heath %A Hsu, Chris %A Iacono, William G %A Kanoni, Stavroula %A Kapoor, Manav %A Kaprio, Jaakko %A Sharon L R Kardia %A Karpe, Fredrik %A Kontto, Jukka %A Kooner, Jaspal S %A Charles Kooperberg %A Kuulasmaa, Kari %A Laakso, Markku %A Lai, Dongbing %A Langenberg, Claudia %A Le, Nhung %A Lettre, Guillaume %A Loukola, Anu %A Luan, Jian'an %A Pamela A F Madden %A Mangino, Massimo %A Riccardo E Marioni %A Marouli, Eirini %A Marten, Jonathan %A Nicholas G Martin %A McGue, Matt %A Michailidou, Kyriaki %A Mihailov, Evelin %A Moayyeri, Alireza %A Moitry, Marie %A Müller-Nurasyid, Martina %A Naheed, Aliya %A Nauck, Matthias %A Neville, Matthew J %A Sune Fallgaard Nielsen %A Kari E North %A Markus Perola %A Pharoah, Paul D P %A Pistis, Giorgio %A Tinca J Polderman %A Posthuma, Danielle %A Neil Poulter %A Qaiser, Beenish %A Rasheed, Asif %A Reiner, Alex %A Renstrom, Frida %A Rice, John %A Rohde, Rebecca %A Rolandsson, Olov %A Nilesh J Samani %A Samuel, Maria %A Schlessinger, David %A H Steven Scholte %A Scott, Robert A %A Peter Sever %A Shao, Yaming %A Shrine, Nick %A Smith, Jennifer A %A John M Starr %A Kathleen E Stirrups %A Stram, Danielle %A Heather M Stringham %A Tachmazidou, Ioanna %A Tardif, Jean-Claude %A Thompson, Deborah J %A Hilary A Tindle %A Tragante, Vinicius %A Trompet, Stella %A Turcot, Valérie %A Tyrrell, Jessica %A Vaartjes, Ilonca %A Van Der Leij, Andries R %A van der Meer, Peter %A Varga, Tibor V %A Verweij, Niek %A Völzke, Henry %A Wareham, Nicholas J %A Warren, Helen R %A David R Weir %A Weiss, Stefan %A Wetherill, Leah %A Yaghootkar, Hanieh %A Yavas, Ersin %A Jiang, Yu %A Chen, Fang %A Zhan, Xiaowei %A Zhang, Weihua %A Zhao, Wei %A Zhao, Wei %A Zhou, Kaixin %A Amouyel, Philippe %A Blankenberg, Stefan %A Caulfield, Mark J %A Chowdhury, Rajiv %A Francesco Cucca %A Ian J Deary %A Deloukas, Panos %A Di Angelantonio, Emanuele %A Marco M Ferrario %A Ferrières, Jean %A Franks, Paul W %A Timothy M Frayling %A Frossard, Philippe %A Hall, Ian P %A Caroline Hayward %A Jansson, Jan-Håkan %A Jukema, J Wouter %A Kee, Frank %A Männistö, Satu %A Andres Metspalu %A Munroe, Patricia B %A Børge G Nordestgaard %A Palmer, Colin N A %A Veikko Salomaa %A Sattar, Naveed %A Timothy Spector %A David P Strachan %A van der Harst, Pim %A Zeggini, Eleftheria %A Saleheen, Danish %A Adam S Butterworth %A Wain, Louise V %A Gonçalo R Abecasis %A Danesh, John %A Tobin, Martin D %A Scott Vrieze %A Liu, Dajiang J %A Howson, Joanna M M %K Biological Specimen Banks %K Databases, Factual %K Europe %K Exome %K Female %K Genetic Loci %K Humans %K Male %K Polymorphism, Single Nucleotide %K Smoking %K United Kingdom %X

Smoking is a major heritable and modifiable risk factor for many diseases, including cancer, common respiratory disorders and cardiovascular diseases. Fourteen genetic loci have previously been associated with smoking behaviour-related traits. We tested up to 235,116 single nucleotide variants (SNVs) on the exome-array for association with smoking initiation, cigarettes per day, pack-years, and smoking cessation in a fixed effects meta-analysis of up to 61 studies (up to 346,813 participants). In a subset of 112,811 participants, a further one million SNVs were also genotyped and tested for association with the four smoking behaviour traits. SNV-trait associations with P < 5 × 10 in either analysis were taken forward for replication in up to 275,596 independent participants from UK Biobank. Lastly, a meta-analysis of the discovery and replication studies was performed. Sixteen SNVs were associated with at least one of the smoking behaviour traits (P < 5 × 10) in the discovery samples. Ten novel SNVs, including rs12616219 near TMEM182, were followed-up and five of them (rs462779 in REV3L, rs12780116 in CNNM2, rs1190736 in GPR101, rs11539157 in PJA1, and rs12616219 near TMEM182) replicated at a Bonferroni significance threshold (P < 4.5 × 10) with consistent direction of effect. A further 35 SNVs were associated with smoking behaviour traits in the discovery plus replication meta-analysis (up to 622,409 participants) including a rare SNV, rs150493199, in CCDC141 and two low-frequency SNVs in CEP350 and HDGFRP2. Functional follow-up implied that decreased expression of REV3L may lower the probability of smoking initiation. The novel loci will facilitate understanding the genetic aetiology of smoking behaviour and may lead to the identification of potential drug targets for smoking prevention and/or cessation.

%B Molecular Psychiatry %V 25 %P 2392-2409 %G eng %N 10 %R 10.1038/s41380-018-0313-0 %0 Journal Article %J The Journals of Gerontology: Series B %D 2020 %T Multimorbidity and the Transition Out of Full-Time Paid Employment: A Longitudinal Analysis of the Health and Retirement Study %A Sander K. R. van Zon %A Reijneveld, S.A. %A Galaurchi, A. %A Carlos F. Mendes de Leon %A Josue Almansa %A Bültmann, U. %K chronic health %K condition labor market participation %K socioeconomic position %K Transition %X OBJECTIVES: This study aims to examine whether older workers aged 50-64 years with multimorbidity are at increased risk to transition from full-time paid employment to part-time employment, partial retirement, unemployment, disability, economic inactivity, full retirement or die than workers without a chronic health condition and workers with one chronic health condition, and whether socioeconomic position (SEP) modifies these transitions. METHOD: Using data from the Health and Retirement Study (1992-2014; n = 10,719), sub-distribution hazard ratios with 95% confidence intervals were calculated with a time-varying Fine and Gray competing-risks survival regression model to examine exit from full-time paid employment. We investigated the modifying effect of SEP by examining its interaction with multimorbidity. RESULTS: Workers with multimorbidity had a higher risk of transitioning to partial retirement (1.45; 1.22, 1.72), disability (1.84; 1.21, 2.78) and full retirement (1.63; 1.47, 1.81), and they had a higher mortality risk (2.58; 1.71, 3.88) than workers without chronic disorders. Compared to workers with one chronic health condition, workers with multimorbidity had an increased risk for partial (1.19; 1.02, 1.40) and full retirement (1.29; 1.17, 1.42), and mortality (1.49; 1.09, 2.04). Only SEP measured as educational level modified the relationship between multimorbidity and mortality. DISCUSSION: Workers with multimorbidity seem more prone to leave full-time paid employment than workers without or with one a chronic health condition. Personalized work accommodations may be necessary to help workers with multimorbidity prolong their working life. © The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. %B The Journals of Gerontology: Series B %V 75 %P 705-715 %G eng %N 3 %R 10.1093/geronb/gbz061 %0 Report %D 2020 %T New Insights on Self-Employment of Older Adults in the United States %A Abramowitz, Joelle %K Restricted data %K Self-employment %X Many people engage in self-employment, yet there exists a dearth of data on these arrangements. This paper addresses this gap by creating a novel dataset of self-employment roles to examine heterogeneity in self-employment arrangements. The approach uses non-public 2016 Health and Retirement Study (HRS) data on employer names and locations and narrative descriptions of industry and occupation for older workers reporting self-employment to classify self-employment of older adults in the United States into entrepreneurial roles (own/run; manage; independent). Using this classification system along with the breadth of information collected in the HRS, this work finds substantial differences in demographic characteristics, work characteristics, income, and benefits, as well as substantial variation in quality of life and retirement expectations. The paper also links the classification to administrative records on self-employment and wage employment to identify discrepancies by role across data sources. The paper found that: Of the self-employed in the HRS, business management and ownership are associated with being male and having higher education; greater labor income and wealth; and expectations of working longer.Independent roles are associated with being more likely to identify as retired, while business management roles are associated with better mental health.Self-employment in general is associated with being less likely to say they would like to leave work but stay employed for money or health insurance and with having a more favorable view of work, though disparities by self-employment exist across role as well.Further work linking to administrative records suggests substantial discrepancies between survey responses and administrative records. The policy implications of the findings are: Meaningful differences in the nature of work and characteristics of the self-employed exist.One-size-fits-all policies will not address the needs of this diverse group.Combining survey and administrative records is critical for identifying the prevalence and characteristics of heterogeneity among the self-employed and formulating appropriate policy. DOWNLOAD FULL PAPER Learn more about the Steven H. Sandell Grant Program %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/working-papers/new-insights-on-self-employment-of-older-adults-in-the-united-states/ %0 Report %D 2020 %T Nursing Home Use Expectations and Wealth Accumulation Among Older Adults %A Padmaja Ayyagari %A Wang, Yang %K Disparities %K Nursing home use %K Subjective Expectations %K wealth accumulation %X Long-term care represents a significant cost to older adults in the US, and nursing home use is an important part of long-term care. It is therefore important to understand how older adults make nursing home-related decisions. This study analyzes the determinants of older adults’ nursing home use expectations, their relationship with actual nursing home use in the future, and the association between nursing home use expectations and older adults’ decisions regarding wealth accumulation. The findings indicate that older adults update their nursing home use expectations rationally and their nursing home use expectations have strong predictive power for actual nursing home use in the future, but these expectations are not statistically significantly associated with wealth accumulation. %B Retirement & Disability Research Center working paper %I Center for Financial Security, University of Wisconsin-Madison %C Madison, WI %G eng %U https://cfsrdrc.wisc.edu/publications/working-paper/wi20-01 %0 Journal Article %J British Journal of Health Psychology %D 2020 %T Optimism, pessimism, and health biomarkers in older couples. %A Arbel, Reout %A Dikla Segel-Karpas %A William J. Chopik %K Biomarkers %K Couples %K health %K Older Adults %K Optimism %K pessimism %X

OBJECTIVE: Studies have demonstrated the importance of optimism in predicting perceived general health. However, the handful of studies focusing on cardiovascular biomarkers show inconsistent effects. Additionally, no study examined whether spousal levels of optimism and pessimism affect an individual's biological markers of cardiovascular health. Thus, our objectives were to examine whether partners' optimism and pessimism affect individual biological markers, differentiating between between-dyad associations and within-dyad predictive processes.

METHODS: Three waves of the Health and Retirement Study collected in 2006, 2010, and 2014 were used to test actor and partner effects of optimism and pessimism on C-reactive protein (CRP) and high-density lipoprotein. Multilevel longitudinal actor-partner models were used to examine the contribution of a partner's optimism and pessimism to each biomarker, adjusting for respondent's age, sex, depression, body mass index, daily activity levels, and a summary score of respondent's doctor-diagnosed chronic conditions.

RESULTS: Partners' pessimism and optimism levels were moderately associated. Results for within-person effects were all non-significant, both within and across waves. Associations at the between-person level were also non-significant, with the exception of a positive association between husbands' pessimism and their own CRP, and husbands' optimism and their wives' CRP.

CONCLUSIONS: Results suggest that optimism and pessimism may not play a pertinent role in within variability of biomarkers of cardiovascular diseases and have a minor role in predicting to between-person variability of biomarkers of cardiovascular diseases.

%B British Journal of Health Psychology %8 2020 Sep 10 %G eng %R 10.1111/bjhp.12466 %0 Journal Article %J The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %D 2020 %T Patterns of social engagement among older adults with mild cognitive impairment. %A Amano, Takashi %A Morrow-Howell, Nancy %A So Jung Park %K CIND %K Cognition & Reasoning %K Health Conditions and Status %K Social Support %X

OBJECTIVES: Promoting engagement in social activities may be an intervention that prevents or delays cognitive impairment. Nevertheless, little is known about social engagement among people with mild cognitive impairment. We aim to examine patterns of social engagement among people with mild cognitive impairment and to assess whether factors under four domains of the WHO's ICF model (personal factors, environmental factors, body functions and structure, and health condition) associate with different patterns of social engagement.

METHOD: Data were drawn from the 2010 Health and Retirement Study. The final sample comprised 1,227 people with Cognitive Impairment No Dementia (CIND). Latent class analysis and multinomial logistic regression were utilized.

RESULTS: Three patterns of social engagement were identified: informal social engagement only, formal and informal social engagement, and low social engagement. Factors in each of the four ICF model domains were associated with the probability of class membership.

DISCUSSION: Our findings suggest that social engagement is heterogeneous among people with CIND and that some groups of people with CIND have possibilities of engaging in more social activities, especially in formal social activities. Results also indicate that providing informal social resources may be essential for social programs designed specifically for people with CIND to promote their formal social engagement. Future study is needed to examine possible differences in outcomes across groups with similar patterns of social engagement.

%B The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %V 75 %P 1361-1371 %G eng %N 7 %R 10.1093/geronb/gbz051 %0 Journal Article %J Drug and Alcohol Dependence %D 2020 %T Perceived social capital and binge drinking in older adults: the Health and Retirement Study, US data from 2006-2014 %A E. Villalonga-Olives %A Josue Almansa %A F. Shaya %A Ichiro Kawachi %K Binge drinking %K Older Adults %K Social capital %K social epidemiology %X Objective Social capital has been described as having both positive influences as well as negative influences (“the dark side”) on health behaviors. We sought to test the association of perceived social capital on the risk of binge drinking among older adults, using a longitudinal design. Methods We used HRS (Health and Retirement Study) data, a nationally representative sample of US adults aged ≥50 years evaluated every two years (from 2006 to 2014). We investigated the relationship between perceived social capital (neighborhood social cohesion and neighborhood physical disorder, positive social support and negative social support) and binge drinking over time, with a multilevel structural equation modelling (MSEM) approach, modelling number of binge-drinking days as hurdle negative binomial. We used MSEM estimating the associations at person level (overall) and within waves. Results The sample included 19140 individuals (at baseline mean age 66.8 (SD 10.3). Over time, the number of binge drinking days decreased. Negative social support increased the average number of binge drinking days among those who drink, where one unit increase was associated with an increase of 37% in the expected number of days binge drinking in the same wave. The association of positive social support on the number of binge drinking days was stronger for females (-0.59 (SE = 0.12)), while neighborhood social cohesion was significantly associated with binge drinking in females -0.05 (SE = 0.01), but not in males. Conclusions Negative social support favored binge drinking. Positive social support and neighborhood social cohesion are protective factors for binge drinking, especially for women. %B Drug and Alcohol Dependence %P 108099 %G eng %R 10.1016/j.drugalcdep.2020.108099 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Personal Mastery and the Medical, Financial, and Physical Cancer Burden: Gender and Race Differences Among Older Adults %A Tetyana Pudrovska %A Andriy Anishkin %K Cancer %K Health Disparities %K Intersectionality %K Masculinity %K Mastery %X Objectives: We explore how a new cancer diagnosis affects trajectories of personal mastery among non-Hispanic Black and White older adults. We estimate whether and how cancer therapy (chemotherapy, surgery, radiation), the amount and type of health care contacts, the financial burden, and the physical symptoms of cancer explain within- and between-gender differences in mastery. Method: Using the 2006–2014 data from the Health and Retirement Study, we apply matching and multiple regression models testing mediating and moderating effects. Results: White men experience a substantially more pronounced decline in mastery after a cancer diagnosis than all women and Black men. Cancer treatment disproportionately decreases White men’s mastery via exposure to health care settings. Discussion: Cultural norms of masculinity and femininity imbue cancer and its treatment with gender-specific meanings. Deference to medical authority and losses of independence, decision-making, and self-reliance are incompatible with masculinity and might affect mastery more adversely in older White men. %B Journal of Aging and Health %G eng %9 Journal %R 10.1177/0898264320912611 %0 Journal Article %J Journal of Aging and Physical Activity %D 2020 %T Physical Activity and Insomnia Symptoms Over 10 Years in a U.S. National Sample of Late-Middle-Age and Older Adults: Age Matters %A Amanda Sonnega %A Amanda N Leggett %A Renee Pepin %A Shervin Assari %K insomnia %X Research suggests that physical activity may influence sleep, yet more research is needed before it can be considered a frontline treatment for insomnia. Less is known about how this relationship is moderated by age. Using multilevel modeling, we examined self-reported physical activity and insomnia symptoms in 18,078 respondents from the U.S. nationally representative Health and Retirement Study (2004–2014). The mean baseline age was 64.7 years, with 53.9% female. Individuals who reported more physical activity (B = −0.005, p < .001) had fewer insomnia symptoms. Over 10 years, the respondents reported fewer insomnia symptoms at times when they reported more physical activity than was average for them (B = −0.003, p < .001). Age moderated this relationship (B = 0.0002, p < .01). Although modest, these findings concur with the literature, suggesting moderate benefits of physical activity for sleep in older adults. Future research should aim to further elucidate this relationship among adults at advanced ages. %B Journal of Aging and Physical Activity %G eng %R https://doi.org/10.1123/japa.2018-0337 %0 Journal Article %J Social Science & Medicine %D 2020 %T Physical functioning and survival: Is the link weaker among Latino and black older adults? %A Andrasfay, Theresa %A Goldman, Noreen %K Functional limitations %K Mortality %K physical functioning %K Race/ethnicity %X Measures of physical functioning are among the strongest predictors of mortality, but no previous study has assessed whether the predictive value of such measures varies by race/ethnicity, as has been done for the simple self-rated health question. The current study tests whether the relationship between two measures of physical functioning (the number of self-reported functional limitations and measured walking speed) and mortality is weaker (has a lower hazard ratio) for Latinos and blacks than for whites. Data were drawn from the 1998–2014 waves of the Health and Retirement Study, with mortality follow-up through 2016. We used Cox hazard models with household random effects to test for interactions between race/ethnicity and these measures of physical functioning and verified earlier findings for self-rated health. The number of self-reported functional limitations is significantly related to mortality for all racial/ethnic groups, but has a substantially lower hazard ratio for blacks and Latinos than for whites, as hypothesized. This hazard ratio remains lower for blacks and Latinos after adjustment for sociodemographic characteristics and health conditions. These findings suggest that the higher rates of functional limitations observed among Latinos and blacks compared with whites may reflect a history of strenuous physical work, inadequately controlled pain, lower leisure-time physical activity, or untreated/under-treated mobility problems that can lead to reduced physical performance without necessarily having a substantial effect on mortality risk. On the other hand, we do not detect significant racial/ethnic differences in the association between measured walking speed and subsequent mortality. This may be the result of the smaller sample size for the walking speed tests, the more nuanced nature of the continuous walking speed measure, or the fact that the walking speed test captures only a subset of the limitations included in the self-reports. %B Social Science & Medicine %V 255 %P 112983 %G eng %R 10.1016/j.socscimed.2020.112983 %0 Journal Article %J Journal of Alzheimer's disease : JAD %D 2020 %T Predicting Cognitive Impairment and Dementia: A Machine Learning Approach %A Damaris Aschwanden %A Aichele, S. %A Ghisletta, P. %A Antonio Terracciano %A Kliegel, M. %A Angelina R Sutin %A Justin Brown %A Allemand, M. %K Aging %K cognitive impairment %K Cox proportional hazard survival analysis %K Dementia %K Machine learning %K Protective factors %K random forest survival analysis %K Risk Factors %X BACKGROUND: Efforts to identify important risk factors for cognitive impairment and dementia have to date mostly relied on meta-analytic strategies. A comprehensive empirical evaluation of these risk factors within a single study is currently lacking. OBJECTIVE: We used a combined methodology of machine learning and semi-parametric survival analysis to estimate the relative importance of 52 predictors in forecasting cognitive impairment and dementia in a large, population-representative sample of older adults. METHODS: Participants from the Health and Retirement Study (N = 9,979; aged 50-98 years) were followed for up to 10 years (M = 6.85 for cognitive impairment; M = 7.67 for dementia). Using a split-sample methodology, we first estimated the relative importance of predictors using machine learning (random forest survival analysis), and we then used semi-parametric survival analysis (Cox proportional hazards) to estimate effect sizes for the most important variables. RESULTS: African Americans and individuals who scored high on emotional distress were at relatively highest risk for developing cognitive impairment and dementia. Sociodemographic (lower education, Hispanic ethnicity) and health variables (worse subjective health, increasing BMI) were comparatively strong predictors for cognitive impairment. Cardiovascular factors (e.g., smoking, physical inactivity) and polygenic scores (with and without APOEɛ4) appeared less important than expected. Post-hoc sensitivity analyses underscored the robustness of these results. CONCLUSIONS: Higher-order factors (e.g., emotional distress, subjective health), which reflect complex interactions between various aspects of an individual, were more important than narrowly defined factors (e.g., clinical and behavioral indicators) when evaluated concurrently to predict cognitive impairment and dementia. %B Journal of Alzheimer's disease : JAD %V 75 %P 717-728 %G eng %N 3 %R 10.3233/JAD-190967 %0 Journal Article %J JAMA Network Open %D 2020 %T Prehospital and Posthospital Fall Injuries in Older US Adults %A Geoffrey J Hoffman %A Mary Tinetti %A Ha, Jinkyung %A Neil B. Alexander %A Lillian C. Min %K Fall injury %K Hospitalization %K Medicare %X To date, measurement and treatment of older adult fall injury has been siloed within specific care settings, such as a hospital or within a nursing home or community. Little is known about changes in fall risk across care settings. Understanding the occurrence of falls across settings has implications for measuring and incentivizing high-value care across care settings.To estimate the risk of older adult fall injury within and across discrete periods during a 12-month care episode anchored by an acute hospitalization.This cohort study is a longitudinal analysis of 12-month periods that include an anchor hospital stay using national data from 2006 to 2014. Participants included older (aged ≥65 years) Medicare fee-for-service beneficiaries from the Health and Retirement Study. Weekly fall injury rates were computed for 4 periods compared with the anchor hospitalization: at baseline (1-6 months before hospitalization), just before (<1 month before hospitalization), just after (<1 month after hospitalization), and at follow-up (1-6 months after hospitalization). Piecewise logistic regression models estimated weekly marginal risk of fall injury within each period, adjusting for sociodemographic and health characteristics. Fall injury risks for high-risk beneficiaries with a fall injury during the anchor hospitalization were also estimated. Data analysis was performed from November 2019 to April 2020.Fall injuries.In total, 10 106 anchor hospitalizations for 4101 beneficiaries (mean [SD] age, 77.1 [7.6] years; 5912 hospitalizations among women [58.5%]) were identified. The overall fall injury risk was 0.77%. In adjusted models, marginal increases in weekly fall injury risk just before hospitalization (0.27 percentage points [95% CI, 0.22 to 0.33 percentage points], or 30.0%; P < .001) were 4 times greater than decreases just after hospitalization (−0.18 percentage points [95% CI, −0.23 to −0.13 percentage points], or −9.2%; P < .001)]. A greater risk differential before and after hospitalization was observed for patients with an inpatient fall injury (1.89 percentage points [95% CI, 1.37 to 2.40], or 309.8%; P < .001; vs −0.39 percentage points [95% CI, −0.73 to −0.04], or −11.6%; P = .03).An episode-based assessment of fall injury illustrates substantial variability in period-specific risks over an extended period including an anchor hospitalization. Risk transitions between periods include sizable increases just before hospitalization that do not fully subside after hospital discharge. Financial incentives to coordinate hospital and posthospital care for patients at risk for fall injury are needed. These could include bundled payments for fall injury episodes that incentivize coordination across settings. %B JAMA Network Open %V 3 %@ 2574-3805 %G eng %N 8 %R https://doi.org/10.1001/jamanetworkopen.2020.13243 %0 Journal Article %J European Review of Aging and Physical Activity %D 2020 %T Psycho-social correlates of leisure-time physical activity (LTPA) among older adults: a multivariate analysis %A Lee, Sunwoo %A Lee, Chungsup %A An, Jaesung %X Still, a considerable number of older adults hardly meet the daily physical activity recommendation. The current study examined how the elderly’s attitudinal and perceptional aspects were associated with their Leisure-Time Physical Activity (LTPA) participation in order to provide insight into the physical activity promotion. %B European Review of Aging and Physical Activity %V 17 %@ 1861-6909 %G eng %U https://eurapa.biomedcentral.com/articles/10.1186/s11556-020-00238-6#citeas %N 1 %9 Journal %! European Review of Aging and Physical Activity %R https://doi.org/10.1186/s11556-020-00238-6 %0 Journal Article %J Journals of Gerontology Series B: Psychological Sciences & Social Sciences %D 2020 %T Purpose in Life Among Centenarian Offspring. %A Marone, Sarah %A Bloore, Katherine %A Sebastiani, Paola %A Flynn, Christopher %A Leonard, Brittany %A Whitaker, Kelsey %A Mostowy, Marilyn %A Thomas T Perls %A Andersen, Stacy L %K Adult children %K Logistic Regression %K Mortality %K Multigenerational %K Parents %K Purpose in life %X

Objectives: Purpose in life (PIL), a feeling of meaning and direction in life, is associated with favorable health outcomes including lower mortality and reduced risk of disease, disability, and cognitive impairment. Since centenarian offspring have been shown to have long health spans we sought to examine whether they have higher PIL than individuals without familial longevity.

Method: We compared PIL scores from the Ryff Scales of Psychological Well-Being in centenarian offspring from the New England Centenarian Study (N=361, mean age=82.0 years) with three referent groups: spouses, birth cohort-matched referents, and Health and Retirement Study (HRS) participants.

Results: Logistic regression analyses adjusted for age, sex, education, and marital status indicated greater odds of high PIL among centenarian offspring compared with spouse (adjusted odds ratio [aOR] 1.92, 95% CI 1.002-3.68, p=.049) and birth cohort referents (aOR 2.64, 95% CI 1.36-5.14, p=.004). Offspring had an almost three times greater odds of having high PIL than HRS participants (OR 2.93, 95% CI 2.17-3.96, p<0.0001).

Discussion: Higher PIL is associated with being an offspring of a long-lived parent and may play a role in the ability to delay age-associated illnesses and functional decline. Increasing purposefulness may be a target for interventions to promote healthy aging.

%B Journals of Gerontology Series B: Psychological Sciences & Social Sciences %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29522128?dopt=Abstract %R 10.1093/geronb/gby023 %0 Journal Article %J Research in Human Development %D 2020 %T Race/Ethnic Differences in Social Resources as Cognitive Risk and Protective Factors %A Katz, Benjamin %A Turney, Indira %A Ji Hyun Lee %A Amini, Reza %A Kristine J. Ajrouch %A Toni C Antonucci %K Cognition %K HCAP %K Race/ethnicity %K social network %X Overall social network size, often the sum of common lifetime relationships, including children, family, and friends, has been linked to cognitive impairment and Alzheimer?s Disease. However, little research has examined the association between network size composition and cognitive function in middle-aged and older adults in the context of race/ethnicity. We investigated the associations between the number of close children, family, and friends independently with executive function (EF) and memory across a subsample of non-Hispanic Black, Hispanic, and non-Hispanic White participants who completed the Health and Retirement Study Harmonized Cognitive Assessment Protocol (N = 2,395). We found that network size composition was more closely linked to EF than memory and that these associations varied by race/ethnicity. Specifically, the strongest associations existed between EF and quadratic estimates of the number of close children of non-Hispanic Black participants, and number of close family members for Hispanic participants. Among Black participants, a curvilinear relationship indicated that two close children were associated with greater EF, while a smaller or larger number of close children were associated with lower EF. On the other hand, among Hispanic participants, higher EF was associated with fewer (0?1) and greater (4-5+) numbers of family member contacts. Overall, these results indicate that examining children, family, and friends independently may be more useful than the common practice of aggregation of overall network size, especially in the context of race/ethnicity. %B Research in Human Development %V 17 %P 57-77 %@ 1542-7609 %G eng %N 1 %R 10.1080/15427609.2020.1743809 %0 Journal Article %J Ethnicity & Disease %D 2020 %T Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study %A Buie, Joy %A Zhao, Yujing %A Burns, Suzanne %A Magwood, Gayenell %A Adams, Robert %A Sims, Catrina %A Lackland, Daniel %K Activities of Daily Living %K Blacks %K Epidemiology %K Motor Skills %K Risk Factors %X Background and Purpose: Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.Methods: We examined Health and Retire­ment Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000- 2014. Analysis of 1,002 first-time, non- Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily liv­ing (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.Results: Black stroke survivors were young­er compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comor­bidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of hav­ing increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.Conclusion: Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy. %B Ethnicity & Disease %V 30 %P 339-348 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/32346280 %N 2 %9 Journal %R 10.18865/ed.30.2.339 %0 Journal Article %J Journal of the American Geriatrics SocietyJournal of the American Geriatrics SocietyJ Am Geriatr Soc %D 2020 %T The Relationship of Loneliness to End-of-Life Experience in Older Americans: A Cohort Study %A Nauzley C Abedini %A Choi, Hwajung %A Melissa Y Wei %A Kenneth M. Langa %A Vineet Chopra %K Advance care planning %K aggressive care %K end of life %K Loneliness %K symptoms %X OBJECTIVES Little is known about the relationship between loneliness and end-of-life (EOL) experience including symptom burden, intensity of care, and advance care planning among older adults. DESIGN Secondary analysis of the Health and Retirement Study (HRS). SETTING Population based. PARTICIPANTS Decedents older than 50?years who died between 2004 and 2014 (n = 8700). Exclusions included those who were ineligible for surveys assessing loneliness (n = 2932) or had missing or incomplete loneliness or symptom data (n = 2872). MEASUREMENTS Individuals were characterized as lonely based on responses to the three-item Revised University of California, Los Angeles Loneliness Scale in the most recent HRS survey before death. Outcomes were proxy reports of total EOL symptom burden, intensity of EOL care (eg, late hospice enrollment, place of death, hospitalizations, use of life support), and advance care planning. Results were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS One-third of 2896 decedents (n = 942) were lonely. After adjusting for demographics, socioeconomic status, multimorbidity, depressive symptoms, family and friends, and social support, loneliness was independently associated with increased total symptom burden at EOL (ß = .13; P =?.004). Compared with nonlonely individuals, lonely decedents were more likely to use life support in the last 2?years of life (35.5% vs 29.4%; aOR = 1.36; 95% CI = 1.08-1.71) and more likely to die in a nursing home (18.4% vs 14.2%; aOR = 1.78; 95% CI = 1.30-2.42). No significant differences in other measures of intense care (late hospice enrollment, number of hospitalizations, or dialysis use) or likelihood of advance care planning were observed. CONCLUSION Lonely older people may be burdened by more symptoms and may be exposed to more intense EOL care compared with nonlonely people. Interventions aiming to screen for, prevent, and mitigate loneliness during the vulnerable EOL period are necessary. %B Journal of the American Geriatrics SocietyJournal of the American Geriatrics SocietyJ Am Geriatr Soc %@ 0002-8614 %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16354 %9 Journal %! Journal of the American Geriatrics Society %R 10.1111/jgs.16354 %0 Journal Article %J Journal of the American Geriatrics Society %D 2020 %T The Relationship of Loneliness to End-of-Life Experience in Older Americans: A Cohort Study %A Nauzley C Abedini %A Choi, Hwajung %A Melissa Y Wei %A Kenneth M. Langa %A Vineet Chopra %K Advance care planning %K aggressive care %K end of life %K Loneliness %K symptoms %X OBJECTIVES Little is known about the relationship between loneliness and end-of-life (EOL) experience including symptom burden, intensity of care, and advance care planning among older adults. DESIGN Secondary analysis of the Health and Retirement Study (HRS). SETTING Population based. PARTICIPANTS Decedents older than 50 years who died between 2004 and 2014 (n = 8700). Exclusions included those who were ineligible for surveys assessing loneliness (n = 2932) or had missing or incomplete loneliness or symptom data (n = 2872). MEASUREMENTS Individuals were characterized as lonely based on responses to the three-item Revised University of California, Los Angeles Loneliness Scale in the most recent HRS survey before death. Outcomes were proxy reports of total EOL symptom burden, intensity of EOL care (eg, late hospice enrollment, place of death, hospitalizations, use of life support), and advance care planning. Results were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS One-third of 2896 decedents (n = 942) were lonely. After adjusting for demographics, socioeconomic status, multimorbidity, depressive symptoms, family and friends, and social support, loneliness was independently associated with increased total symptom burden at EOL (ß = .13; P = .004). Compared with nonlonely individuals, lonely decedents were more likely to use life support in the last 2 years of life (35.5% vs 29.4%; aOR = 1.36; 95% CI = 1.08-1.71) and more likely to die in a nursing home (18.4% vs 14.2%; aOR = 1.78; 95% CI = 1.30-2.42). No significant differences in other measures of intense care (late hospice enrollment, number of hospitalizations, or dialysis use) or likelihood of advance care planning were observed. CONCLUSION Lonely older people may be burdened by more symptoms and may be exposed to more intense EOL care compared with nonlonely people. Interventions aiming to screen for, prevent, and mitigate loneliness during the vulnerable EOL period are necessary. J Am Geriatr Soc 68:1064–1071, 2020 %B Journal of the American Geriatrics Society %V 68 %P 1064-1071 %G eng %U https://pubmed.ncbi.nlm.nih.gov/32128789/ %N 5 %R 10.1111/jgs.16354 %0 Journal Article %J Innovation in Aging %D 2020 %T Resilience Factors That Modify Genetic Risk for ADHD Matter for Later Life Emotional and Cognitive Health Outcomes %A Thalida E. Arpawong %A Milam, Joel %K ADHD %K Cognitive health %K Emotional Health %X Having features of Attention Deficit Hyperactivity Disorder (ADHD) is associated with challenges with emotional regulation and cognitive function. Heritability for ADHD in adults is estimated to be 30%. The degree to which genetic risk for ADHD can be modified by protective factors, such as strong personal relationships and pursuing more education, to result in better emotional and cognitive outcomes at later ages is not well understood. We evaluated these relationships in a population-representative sample of older adults in the U.S. Health and Retirement Study, with 9,003 European Americans (EA; 57% women, age M=68.6, SD=10.4), and 1,622 African Americans (AA; 63% women, age M=64.4, SD=9.5). Outcomes included validated scales for psychological resilience, life satisfaction, depressive symptoms (DepSx), cognitive functioning, and impairment, assessed between 2008-2012. A genetic risk score for ADHD (GRS-ADHD) was calculated from a genomewide-scan, using a mixed ancestry sample. We used multivariable linear and logistic regression models, adjusted for age, gender, and genetic ancestry. We found a protective effect such that stronger personal relationships in adulthood reduced the inverse relationship between the GRS-ADHD and resilience and life satisfaction in later age (interaction p’s<.004 in EAs), but not with DepSx. In contrast, strong parental relationships in childhood attenuated the association between the GRS-ADHD and later life DepSx (interaction p’s<.007 in EAs and AAs) only. Education did not modify, but mediated the main effect of the GRS-ADHD on cognitive abilities and impairment in EAs and AAs. Findings have implications for later age health for those at greater genetic risk for ADHD. %B Innovation in Aging %V 4 %P 458 - 459 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1484 %0 Journal Article %J CLINICAL SOCIAL WORK JOURNAL %D 2020 %T Resource and Network Predictors of Multiple Volunteering Cessations: Implications for Social Policy and Practice %A Shen, Huei-Wern %A Wang, Yi %A Wong, Roger %A Amano, Takashi %K civic engagement %K productive aging %K Volunteer activity %K Volunteer cessation %X The benefits of volunteering are well-documented, however, studies specifically investigating the cessation of volunteering in old age are relatively limited, especially on multiple stops of volunteering. The present study explores the number of times older people stop volunteering over 14 years, and examines its association with financial resources, health, family demands, social networks, neighborhood environment as well as the sociodemographic characteristics. Using eight-wave data from the Health and Retirement Study, the sample included 3914 volunteers who were 50 + in 1998 and were alive throughout 2012. Among the sample, 32.75% never stopped volunteering, 41.47% stopped once, 20.77% stopped twice, and 5.01% stopped three times. Findings from Poisson regression models indicated that respondents who were older, less educated, less religious, had lower income at baseline, later developed cognitive problems, became caregivers, and had no friends living nearby were more likely to stop volunteering multiple times. Findings from the present study suggest retaining volunteers by adjusting volunteering responsibilities for older volunteers who are more vulnerable to volunteering cessation and encouraging continued commitment by maximizing their friendship and religious networks. %B CLINICAL SOCIAL WORK JOURNAL %G eng %U https://link.springer.com/article/10.1007%2Fs10615-020-00748-x %9 Article; Early Access %R 10.1007/s10615-020-00748-x %0 Report %D 2020 %T The Shared Non-cognitive Roots of Health and Socioeconomic Status: Evidence from the US %A Bucciol Alessandro %A Coriele, Chiara %A Zarri Luca %K Bivariate Model %K Non-Cognitive Factors %K Self-reported Health Status %K Subjective Socioeconomic Status %X A voluminous literature established a strong relationship between subjective health and socioeconomic status measures. We test the idea that self-reported health and subjective socioeconomic status have “shared non-cognitive roots”, i.e., that the same personality traits significantly affect both status variables, even after controlling for the complex relationships involving objective and subjective measures across the two domains. To this aim, we estimate a bivariate model based on longitudinal large-scale data (30,675 observations) from six waves (2006-2016) of the US Health and Retirement Study. Our findings strongly support our conjecture, as all the “Big Five” traits are significantly related to self-reported health and subjective socioeconomic status with the same sign, even after controlling for both objective measures and once the other subjective measure is considered. These results point to a novel, direct channel through which non-cognitive factors similarly influence self-evaluations across distinct, though strongly intertwined, domains. %B Department of Economics Working Paper Series %I University of Verona %C Verona, Italy %G eng %U http://dse.univr.it/home/workingpapers/wp2020n14.pdf %0 Journal Article %J International Journal of Public Health %D 2020 %T Social capital and health status: Longitudinal race and ethnicity differences in older adults from 2006 to 2014. %A Villalonga-Olives, Ester %A Josue Almansa %A Knott, Cheryl L. %A Ransome, Yusuf %K Health Status %K longitudinal %K Multilevel %K No terms assigned %K Older Adults %K Racial differences %K Social capital %X AbstractObjectivesWe examined the longitudinal associations of social capital on self-rated health and differences by race/ethnicity in older adults.MethodsWe used Health and Retirement Study, a nationally representative sample of US adults aged ≥ 50 years evaluated every 2 years (2006–2014) (N = 18,859). We investigated the relationship between social capital indicators (neighborhood social cohesion/physical disorder, positive/negative social support) with self-rated health accounting for age, gender, education and stratified by race/ethnicity. We used structural equation multilevel modeling estimating the associations: within-wave and between-persons.ResultsWe observed between-persons-level associations among social capital indicators and self-rated health. Individuals with overall levels of positive social support and neighborhood social cohesion tended to have overall better self-rated health [correlations 0.21 (p < 0.01) and 0.29 (p < 0.01), respectively]. For Hispanics, the corr %B International Journal of Public Health %V 65 %P 291-302 %G eng %N 3 %R 10.1007/s00038-020-01341-2 %0 Journal Article %J Innovation in Aging %D 2020 %T Social Engagement and Cognitive Function of Older Adults in Mexico and the United States %A Bret Howrey %A Jaqueline C Avila %A Brian Downer %A Rebeca Wong %K Cognition %K Mexico %K MHAS %K social engagement %X Social engagement is linked to better cognition, but it is unclear if the social engagement of husbands and wives influences their own cognition as well as each other’s cognition in two very different country contexts. Data on married couples come from the 2001 Mexican Health and Aging Study (MHAS) and the 2000 Health and Retirement Study (HRS), with follow-up cognition measured in 2012. Structural equation models (SEM) were used to test the actor-partner interdependence model on the association of social engagement with cognition. In Mexico wives’ social engagement benefited their own cognition as well as their husbands’, but husband’s social engagement was unrelated to cognition. In the U.S. both wives’ and husbands’ social engagement benefited their own cognition, but not each other’s. Results suggest asymmetric patterns of actor-partner interdependence in Mexico, possibly reflecting more traditional social roles of women and co-dependence within couples, but more independence within U.S. couples. %B Innovation in Aging %V 4 %P 560 - 561 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.1846 %0 Thesis %B Sociology %D 2020 %T Three Papers on Social Participation over the Life Course %A Ang, Shannon %K health %K life course perspective %K Social participation %X Social participation encapsulates the involvement and participation of individuals in social activities (e.g., informal social gatherings, affiliations to community organizations), and has long been a subject of interest for sociologists. Recent scholarship has since established a strong positive association between social participation and health, suggesting that social participation can buffer the negative health effects of stress and promote healthy behavior through social influence, among other pathways. There are however three key limitations of prior research. First, perhaps driven by anxieties around rising health costs of an aging population, studies on social participation and health overwhelmingly focus on older populations. Second, many are interested in examining societal change in social connectedness over time, but given the use of repeated cross-section data, are at risk of conflating age and cohort effects. Third, research often treats social participation solely as a characteristic of the individual, even though the social participation of proximate others may also affect one’s own outcomes – e.g., spouses may be influenced by their friends’ health behavior, and in turn influence their partners. We know very little about how social participation operates in the context of interdependent individuals such as spousal dyads. This dissertation addresses existing gaps in the literature by applying the life course perspective to the study of social participation and health. I do this through a series of papers that (1) examine how social participation varies over age and cohort; (2) establish how the association between social participation and health changes with age; and (3) investigate how social participation and health is associated in the context of marital dyads. The first paper uses data from the Americans’ Changing Lives (ACL) study, a longitudinal dataset collected from the same individuals over 25 years (1986-2011). I employ a Multivariate Bayesian generalized additive mixed model to estimate age-cohort trajectories of formal and informal social participation. I find that changes in social participation by age and cohort are less drastic than commonly assumed; older adults seem to compensate for age-graded declines in informal social participation by increasing their formal social participation. Any anxiety around societal declines in social connectedness precipitated by past studies is overblown – later-born cohorts seem to have similar (or greater) levels of social participation compared to older cohorts. In the second paper, I use data from ACL once again, employing growth curve models to estimate how the association between social participation and health changes with age. I find that formal social participation (e.g., attendance and engagement in community groups and organizations) becomes more important for males as they age – the negative association between formal social participation and depressive symptoms becomes stronger in old age. Using data from the Health and Retirement Study, the final paper utilizes actor-partner interdependence models to examine social participation and mental health among married couples. I find evidence supporting the hypothesis that spousal social participation is positively associated with one’s own mental health (i.e., partner effects), even after accounting for interdependencies in mental health between spouses. Overall, the dissertation applies life course principles to provide a more comprehensive view of social participation and its associations with health outcomes. Findings suggest that social participation in late life should be considered alongside social participation earlier in the life course, and that the social participation of proximate others can also influence our own health outcomes. %B Sociology %I University of Michigan %C Ann Arbor %V Doctor of Philosophy %G eng %U https://deepblue.lib.umich.edu/bitstream/handle/2027.42/155235/shanang_1.pdf?sequence=1&isAllowed=y %0 Journal Article %J Economics & Human Biology %D 2020 %T Valuing pain using the subjective well-being method %A Thorhildur Ólafsdóttir %A Tinna Laufey Ásgeirsdóttir %A Edward C Norton %K Compensating variation %K pain %K Subjective well-being method %K Value %K Willingness-To-Pay %X 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. %B Economics & Human Biology %V 37 %G eng %R 10.1016/j.ehb.2019.100827 %0 Journal Article %J Journal of Labor Research %D 2020 %T Work-Life Balance and Labor Force Attachment at Older Ages %A Marco Angrisani %A Maria Casanova %A Erik Meijer %K Gender difference %K health shock %K Job characteristic %K Retirement %X We use data from the Health and Retirement Study to examine the role of work-life balance as a non-monetary determinant of retirement transitions, conditional on job attributes such as hours of work, compensation, and benefits. We rely on self-reported measures of work-life conflict to proxy for low levels of work-life balance. We show that high levels of work-life conflict are significantly associated with subsequent reductions in labor supply for workers aged 51 to 79, and document heterogeneity by gender and employment status. Moreover, work-life conflict moderates labor supply responses to spousal health shocks. Workers who report higher levels of work-life conflict are significantly more likely to reduce their labor supply in the two years following a spouse's health shock, and this effect is once more heterogeneous. The moderating effect of work-life conflict is stronger for women than men and, among female workers, stronger for those employed part-time at baseline. %B Journal of Labor Research %V 41 %P 34-68 %G eng %N 1-2 %R 10.1007/s12122-020-09301-8 %0 Report %D 2019 %T Aging in the USA: Similarities and disparities across time and space %A Ana Lucia Abeliansky %A Devin Erel %A Holger Strulik %K Aging %K health %K health deficit index %K United States %X We study biological aging of elderly U.S. Americans born 1904-1966. We use thirteen waves of the Health and Retirement Study and construct a health deficit index as the number of health deficits present in a person measured relative to the number of potential deficits. We find that, on average, Americans develop 5 percent more health deficits per year, that men age slightly faster than women, and that, at any age above 50, Caucasians display significantly less health deficits than African Americans. We also document a steady time trend of health improvements. For each year of later birth, health deficits decline on average by about 1 percent. This health trend is about the same across regions and for men and women, but significantly lower for African Americans compared to Caucasians. In non-linear regressions, we find that regional differences in aging follow a particular regularity, akin to the compensation effect of mortality. Health deficits converge for men and women and across American regions and suggest a life span of the American population of about 97 years. %I University of Goettingen (Gottingen) %8 10/2019 %G eng %R https://dx.doi.org/10.2139/ssrn.3465597 %0 Journal Article %J International journal of epidemiology %D 2019 %T Are younger cohorts in the USA and England ageing better? %A de la Fuente, J. %A Francisco Félix Caballero %A Verdes, E. %A Rodríguez-Artalejo, F. %A Cabello, M. %A de la Torre-Luque, A. %A Albert Sánchez-Niubó %A María Haro, J. %A Ayuso-Mateos, J.L. %A Chatterji, S. %K Aged %K Aging %K Article %K Cohort Analysis %K cultural factor %K Education %K England %K Englishman %K Female %K Health Status %K Household %K human %K human experiment %K human tissue %K longitudinal study %K major clinical study %K Male %K mental capacity %K Retirement %K theoretical study %X BACKGROUND: Whether worldwide increases in life expectancy are accompanied by a better health status is still a debate. People age differently, and there is a need to disentangle whether healthy-ageing pathways can be shaped by cohort effects. This study aims to analyse trends in health status in two large nationally representative samples of older adults from England and the USA. METHODS: The sample comprised 55 684 participants from the first seven waves of the English Longitudinal Study of Ageing (ELSA), and the first 11 waves of the Health and Retirement Study (HRS). A common latent health score based on Bayesian multilevel item response theory was used. Two Bayesian mixed-effects multilevel models were used to assess cohort effects on health in ELSA and HRS separately, controlling for the effect of household wealth and educational attainment. RESULTS: Similar ageing trends were found in ELSA (β = -0.311; p < 0.001) and HRS (β = -0.393; p < 0.001). The level of education moderated the life-course effect on health in both ELSA (β = -0.082; p < 0.05) and HRS (β = -0.084; p < 0.05). A birth-year effect was found for those belonging to the highest quintiles of household wealth in both ELSA (β = 0.125; p < 0.001) and HRS (β = 0.170; p < 0.001). CONCLUSIONS: Health inequalities have increased in recent cohorts, with the wealthiest participants presenting a better health status in both the USA and English populations. Actions to promote health in the ageing population should consider the increasing inequality scenario, not only by applying highly effective interventions, but also by making them accessible to all members of society. © The Author(s) 2019; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association. %B International journal of epidemiology %V 48 %P 1906-1913 %G eng %R 10.1093/ije/dyz126 %0 Journal Article %J Journal of the American Geriatrics Society %D 2019 %T Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition. %A Márlon J. R. Aliberti %A Irena Cenzer %A Alexander K Smith %A Sei J. Lee %A Kristine Yaffe %A Kenneth E Covinsky %K Cognition & Reasoning %K Frailty %K Risk Factors %X

BACKGROUND: Physical frailty is a powerful tool for identifying nondisabled individuals at high risk of adverse outcomes. The extent to which cognitive impairment in those without dementia adds value to physical frailty in detecting high-risk individuals remains unclear.

OBJECTIVES: To estimate the effects of combining physical frailty and cognitive impairment without dementia (CIND) on the risk of basic activities of daily living (ADL) dependence and death over 8 years.

DESIGN: Prospective cohort study.

SETTING: The Health and Retirement Study (HRS).

PARTICIPANTS: A total of 7338 community-dwelling people, 65 years or older, without dementia and ADL dependence at baseline (2006-2008). Follow-up assessments occurred every 2 years until 2014.

MEASUREMENTS: The five components of the Cardiovascular Health Study defined physical frailty. A well-validated HRS method, including verbal recall, series of subtractions, and backward count task, assessed cognition. Primary outcomes were time to ADL dependence and death. Hazard models, considering death as a competing risk, associated physical frailty and CIND with outcomes after adjusting for sociodemographics, comorbidities, depression, and smoking status.

RESULTS: The prevalence of physical frailty was 15%; CIND, 19%; and both deficits, 5%. In unadjusted and adjusted analyses, combining these factors identified older adults at an escalating risk for ADL dependence (no deficit = 14% [reference group]; only CIND = 26%, sub-hazard ratio [sHR] = 1.5, 95% confidence interval [CI] = 1.3-1.8; only frail = 33%, sHR = 1.7, 95% CI = 1.4-2.0; both deficits = 46%, sHR = 2.0, 95%CI = 1.6-2.6) and death (no deficit = 21%; only CIND = 41%, HR = 1.6, 95% CI = 1.4-1.9; only frail = 56%, HR = 2.2, 95% CI = 1.7-2.7; both deficits = 66%, HR = 2.6, 95% CI = 2.0-3.3) over 8-year follow-up. Adding the cognitive measure to models that already included physical frailty alone increased accuracy in identifying those at higher risk of ADL dependence (Harrell's concordance [C], 0.74 vs 0.71; P < .001) and death (Harrell's C, 0.70 vs 0.67; P < .001).

CONCLUSION: Physical frailty and CIND are independent predictors of incident disability and death. Because together physical frailty and CIND identify vulnerable older adults better, optimal risk assessment should supplement measures of physical frailty with measures of cognitive function.

%B Journal of the American Geriatrics Society %V 67 %P 477-483 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30468258?dopt=Abstract %R 10.1111/jgs.15683 %0 Journal Article %J JAMA Network Open %D 2019 %T Association between life purpose and mortality among US adults older than 50 years %A Alimujiang, Aliya %A Wiensch, Ashley %A Boss, Jonathan %A Fleischer, Nancy L. %A Mondul, Alison M. %A McLean, Karen %A Mukherjee, Bhramar %A Pearce, Celeste Leigh %K Longevity %K Mortality %K Purpose in life %X **Importance** A growing body of literature suggests that having a strong sense of purpose in life leads to improvements in both physical and mental health and enhances overall quality of life. There are interventions available to influence life purpose; thus, understanding the association of life purpose with mortality is critical. **Objective** To evaluate whether an association exists between life purpose and all-cause or cause-specific mortality among older adults in the United States. **Design, Setting, and Participants** The Health and Retirement Study (HRS) is a national cohort study of US adults older than 50 years. Adults between the ages of 51 to 61 were enrolled in the HRS, and their spouses or partners were enrolled regardless of age. Initially, individuals born between 1931 and 1941 were enrolled starting in 1992, but subsequent cohort enrichment was carried out. The present prospective cohort study sample was drawn from 8419 HRS participants who were older than 50 years and who had filled out a psychological questionnaire during the HRS 2006 interview period. Of these, 1142 nonresponders with incomplete life purpose data, 163 respondents with missing sample weights, 81 participants lost to follow-up, 1 participant with an incorrect survival time, and 47 participants with missing information on covariates were excluded. The final sample for analysis was 6985 individuals. Data analyses were conducted between June 5, 2018, and April 22, 2019. **Exposures** Purpose in life was assessed for the 2006 interview period with a 7-item questionnaire from the modified Ryff and Keyes Scales of Psychological Well-being evaluation using a Likert scale ranging from 1 to 6, with higher scores indicating greater purpose in life; for all-cause and cause-specific mortality analyses, 5 categories of life purpose scores were used (1.00-2.99, 3.00-3.99, 4.00-4.99, 5.00-5.99, and 6.00). **Main Outcomes and Measures** All-cause and cause-specific mortality were assessed between 2006 and 2010. Weighted Cox proportional hazards models were used to evaluate life purpose and mortality. **Results** Of 6985 individuals included in the analysis, 4016 (57.5%) were women, the mean (SD) age of all participants was 68.6 (9.8) years, and the mean (SD) survival time for decedents was 31.21 (15.42) months (range, 1.00-71.00 months). Life purpose was significantly associated with all-cause mortality in the HRS (hazard ratio, 2.43; 95% CI, 1.57-3.75, comparing those in the lowest life purpose category with those in the highest life purpose category). Some significant cause-specific mortality associations with life purpose were also observed (heart, circulatory, and blood conditions: hazard ratio, 2.66; 95% CI, 1.62-4.38). Conclusions and Relevance This study’s results indicated that stronger purpose in life was associated with decreased mortality. Purposeful living may have health benefits. Future research should focus on evaluating the association of life purpose interventions with health outcomes, including mortality. In addition, understanding potential biological mechanisms through which life purpose may influence health outcomes would be valuable. %B JAMA Network Open %V 2 %P e194270 %G eng %N 5 %R 10.1001/jamanetworkopen.2019.4270 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2019 %T The association between pain and prevalent and incident Motoric Cognitive Risk syndrome in older adults %A Guusje van der Leeuw %A Emmeline Ayers %A Annette H. Blankenstein %A Henriëtte E. van der Horst %A Joe Verghese %K Aging %K Cognition %K Dementia %K Epidemiology %K Motoric Cognitive Risk Syndrome %K pain %X Background The Motoric Cognitive Risk Syndrome (MCR) is a pre-dementia syndrome characterized by subjective cognitive complaints and slow gait in the absence of dementia and mobility disability. Worse cognitive and motoric function is associated with chronic pain in older adults. Our aim was to study the association between pain and prevalent and incident MCR in adults aged 65 years and older. Methods We analyzed the cross-sectional association between severity of pain and prevalent MCR in 3,244 older adults participating in the Health and Retirement Study (2008 wave) using logistic regression analysis adjusting for demographic, peripheral, central or biological risk factors. Additionally, we analyzed the longitudinal association between severity of pain and incident MCR in 362 participants in the Central Control of Mobility in Aging Study, using Cox regression analysis. Results The 155 Health and Retirement Study participants with severe pain had an increased risk of prevalent MCR (n = 249), compared to 2245 individuals without pain (adjusted for demographics OR: 2.78, 95% CI:1.74-4.45). Over a mean follow-up of 3.01 years (SD 1.38), 29 individuals in the Central Control of Mobility in Aging Study developed incident MCR. Older adults with severe pain had over a five times increased risk of developing incident MCR, compared to those without pain even after adjusting for demographic variables (HR: 5.44, 95% CI: 1.81-16.40). Conclusion Older adults with severe pain have a higher prevalence and incidence of MCR. These findings should be further explored to establish if pain is a potentially modifiable risk factor to prevent cognitive decline. %B Archives of Gerontology and Geriatrics %P 103991 %G eng %U http://www.sciencedirect.com/science/article/pii/S0167494319302341 %R https://doi.org/10.1016/j.archger.2019.103991 %0 Journal Article %J Nature Genetics %D 2019 %T Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. %A Liu, Mengzhen %A Jiang, Yu %A Wedow, Robbee %A Li, Yue %A Brazel, David M %A Chen, Fang %A Datta, Gargi %A Davila-Velderrain, Jose %A McGuire, Daniel %A Tian, Chao %A Zhan, Xiaowei %A Choquet, Hélène %A Docherty, Anna R %A Jessica Faul %A Foerster, Johanna R %A Fritsche, Lars G %A Gabrielsen, Maiken Elvestad %A Gordon, Scott D %A Jeffrey Haessler %A Jouke-Jan Hottenga %A Huang, Hongyan %A Jang, Seon-Kyeong %A Philip R Jansen %A Ling, Yueh %A Mägi, Reedik %A Matoba, Nana %A McMahon, George %A Mulas, Antonella %A Orrù, Valeria %A Palviainen, Teemu %A Anita Pandit %A Reginsson, Gunnar W %A Skogholt, Anne Heidi %A Smith, Jennifer A %A Taylor, Amy E %A Turman, Constance %A Gonneke Willemsen %A Young, Hannah %A Young, Kendra A %A Zajac, Gregory J M %A Zhao, Wei %A Zhou, Wei %A Bjornsdottir, Gyda %A Boardman, Jason D %A Boehnke, Michael %A Dorret I Boomsma %A Chen, Chu %A Francesco Cucca %A Davies, Gareth E %A Charles B Eaton %A Ehringer, Marissa A %A Tõnu Esko %A Fiorillo, Edoardo %A Gillespie, Nathan A %A Gudbjartsson, Daniel F %A Haller, Toomas %A Kathleen Mullan Harris %A Andrew C Heath %A Hewitt, John K %A Hickie, Ian B %A Hokanson, John E %A Hopfer, Christian J %A Hunter, David J %A Iacono, William G %A Johnson, Eric O %A Kamatani, Yoichiro %A Sharon L R Kardia %A Matthew C Keller %A Kellis, Manolis %A Charles Kooperberg %A Kraft, Peter %A Krauter, Kenneth S %A Laakso, Markku %A Penelope A Lind %A Loukola, Anu %A Lutz, Sharon M %A Pamela A F Madden %A Nicholas G Martin %A McGue, Matt %A Matthew B McQueen %A Sarah E Medland %A Andres Metspalu %A Mohlke, Karen L %A Nielsen, Jonas B %A Okada, Yukinori %A Peters, Ulrike %A Tinca J Polderman %A Posthuma, Danielle %A Reiner, Alexander P %A Rice, John P %A Rimm, Eric %A Rose, Richard J %A Runarsdottir, Valgerdur %A Stallings, Michael C %A Stančáková, Alena %A Stefansson, Hreinn %A Thai, Khanh K %A Hilary A Tindle %A Tyrfingsson, Thorarinn %A Wall, Tamara L %A David R Weir %A Weisner, Constance %A Whitfield, John B %A Winsvold, Bendik Slagsvold %A Yin, Jie %A Zuccolo, Luisa %A Laura Bierut %A Hveem, Kristian %A Lee, James J %A Munafò, Marcus R %A Saccone, Nancy L %A Willer, Cristen J %A Marilyn C Cornelis %A David, Sean P %A Hinds, David A %A Jorgenson, Eric %A Kaprio, Jaakko %A Stitzel, Jerry A %A Stefansson, Kari %A Thorgeirsson, Thorgeir E %A Gonçalo R Abecasis %A Liu, Dajiang J %A Scott Vrieze %K Alcohol Drinking %K Female %K Genetic Variation %K Genome-Wide Association Study %K Humans %K Male %K Middle Aged %K Phenotype %K Risk %K Smoking %K Tobacco %K Tobacco Use Disorder %X

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders. They are heritable and etiologically related behaviors that have been resistant to gene discovery efforts. In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures.

%B Nature Genetics %V 51 %P 237-244 %G eng %N 2 %R 10.1038/s41588-018-0307-5 %0 Journal Article %J Geriatrics (Basel) %D 2019 %T Baseline body mass predicts average depressive symptoms over the next two decades for white but not black older adults. %A Shervin Assari %K BMI %K Depressive symptoms %K Racial/ethnic differences %X

BACKGROUND: Although obesity and depression have a bidirectional association, this link may vary based on race. The current study tested racial variation in bidirectional links between depressive symptoms and body mass index (BMI) over 24 years of follow-up in older adults over the age of 50 in the United States. We hypothesized weaker bidirectional links in Blacks compared to Whites.

METHODS: Data came from waves 1 to 12 (1990 to 2014) of the Health and Retirement Study (HRS), an ongoing state-of-the-art national cohort. The study followed a representative sample of Americans (n = 15,194; 2,200 Blacks and 12,994 Whites) over the age of 50. Dependent variables were average depressive symptoms and BMI over 24 years, based on measurements every other year, from 1990 to 2014. Independent variables included baseline depressive symptoms and BMI. Covariates included age, gender, marital status, veteran status, and activities of daily living. Structural equation models were fitted to the data for data analysis.

RESULTS: In the pooled sample, bidirectional associations were found between BMI and depressive symptoms as baseline BMI predicted average depressive symptoms over time and baseline depressive symptoms predicted average BMI over 24 years. Racial differences were found in the bidirectional association between BMI and depressive symptoms, with both directions of the associations being absent for Blacks. For Whites, baseline BMI predicted average depressive symptoms over the next 24 years.

CONCLUSION: Reciprocal associations between BMI and depressive symptoms over a 24-year period among individuals over the age of 50 vary for Blacks and Whites. As these associations are stronger for Whites than Blacks, clinical and public health programs that simultaneously target comorbid obesity and depression may be more appropriate for Whites than Blacks.

%B Geriatrics (Basel) %V 4 %8 2019 Jan 18 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/31023982?dopt=Abstract %R 10.3390/geriatrics4010014 %0 Journal Article %J Innovation in Aging %D 2019 %T Biological risk profiles among Latino subgroups in the Health and Retirement Study. %A García, Catherine %A Jennifer A Ailshire %K Biomarkers %K Latino population %K Racial/ethnic differences %X

Background and Objectives: Latinos residing in the United States exhibit an increased risk for cardiovascular and metabolic diseases compared to non-Latino whites. This elevated risk contributes to a significantly higher prevalence of diabetes and hypertension among Latino adults. Examining biological risk profiles of older Latinos as a "pan-ethnic group" and by Latino subpopulations may help to explain the increased burden of disease in later life among this population. The objective of this study is to document biological risk profiles among a nationally representative sample of older U.S. Latinos by nativity and country of origin.

Research Design and Methods: We use the 2006-2012 Health and Retirement Study to compare cardiovascular, metabolic, inflammatory and cumulative biological risk among U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, U.S.-born "other" Latinos, foreign-born "other" Latinos, and non-Latino whites.

Results: Older Latinos exhibit heterogeneous biological risk profiles. U.S.-born Mexicans, foreign-born Mexicans, U.S.-born "other" Latinos, and foreign-born "other" Latinos exhibited a higher rate of cardiovascular risk relative to non-Latino whites. In addition, U.S.-born Mexicans, foreign-born Mexicans, island-born Puerto Ricans, and foreign-born "other" Latinos had a higher rate of metabolic risk than non-Latino whites. Island-born Puerto Ricans were the only group to exhibit higher inflammation than non-Latino whites. The observed differences were largely attenuated by socioeconomic status, indicating that high levels of risk among older Latino subpopulations compared to non-Latino whites are associated with lower socioeconomic status.

Discussion and Implications: Older U.S. Latinos are a demographically diverse population with unique sociocultural characteristics which may contribute to differences in biological risk across the life course that influence disease progression. Examining Latinos by nativity and country of origin may help identify risks specific to individual subpopulations that can lead to culturally appropriate interventions which help prevent and reduce the burden of cardiovascular and metabolic diseases.

%B Innovation in Aging %V 3 %P igz017 %8 2019 May %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/31276052?dopt=Abstract %R 10.1093/geroni/igz017 %0 Book Section %B The Econometrics of Complex Survey Data %D 2019 %T Can Internet Match High-quality Traditional Surveys? Comparing the Health and Retirement Study and its Online Version %A Marco Angrisani %E Finley Brian %K internet survey comparison %X Abstract We examine sample characteristics and elicited survey measures of two studies, the Health and Retirement Study (HRS), where interviews are done either in person or by phone, and the Understanding America Study (UAS), where surveys are completed online and a replica of the HRS core questionnaire is administered. By considering variables in various domains, our investigation provides a comprehensive assessment of how Internet data collection compares to more traditional interview modes. We document clear demographic differences between the UAS and HRS samples in terms of age and education. Yet, sample weights correct for these discrepancies and allow one to satisfactorily match population benchmarks as far as key socio- demographic variables are concerned. Comparison of a variety of survey outcomes with population targets shows a strikingly good fit for both the HRS and the UAS. Outcome distributions in the HRS are only marginally closer to population targets than outcome distributions in the UAS. These patterns arise regardless of which variables are used to construct post-stratification weights in the UAS, confirming the robustness of these results. We find little evidence of mode effects when comparing the subjective measures of self-reported health and life satisfaction across interview modes. Specifically, we do not observe very clear primacy or recency effects for either health or life satisfaction. We do observe a significant social desirability effect, driven by the presence of an interviewer, as far as life satisfaction is concerned. By and large, our results suggest that Internet surveys can match high-quality traditional surveys. %B The Econometrics of Complex Survey Data %S Advances in Econometrics %I Emerald Publishing Limited %V 39 %P 3 - 33 %@ 978-1-78756-726-9, 978-1-78756-725-2/0731-9053 %G eng %U https://doi.org/10.1108/S0731-905320190000039001 %0 Web Page %D 2019 %T Can the Mediterranean Diet delay or prevent dementia? %E Claire T McEvoy %K Alzheimer's disease %K Dementia %K Eating habits %K News %B Next Avenue %I Next Avenue %C Twin Cities %V 2019 %G eng %U https://www.nextavenue.org/can-the-mediterranean-diet-delay-or-prevent-dementia/ %0 Journal Article %J The Journals of Gerontology: Series A %D 2019 %T Change in cardiometabolic risk among blacks, whites and Hispanics: findings from the Health and Retirement Study %A Uchechi A Mitchell %A Jennifer A Ailshire %A Eileen M. Crimmins %K Biomarkers %K C-reactive protein %K Cardiovascular health %K Racial/ethnic differences %K Risk Factors %X Background Blacks experience greater multi-system physiological dysregulation, or cumulative biological risk, which is associated with poor cardiometabolic health and mortality. In this study, we assess race differences in change in risk over four years among older whites, blacks and Hispanics. Method We examined race differences in 4-year change in individual biomarkers and a cumulative measure of risk—cardiometabolic risk (CMR)—using data for each respondent from two waves of the Health and Retirement Study’s biomarker assessment (n=5,512). CMR is a count of high-risk cardiovascular and metabolic biomarkers. We estimated mean CMR at baseline and follow-up by race/ethnicity, and used logistic regression to determine whether race differences exist in 4-year transitions between high- and low-risk states for individual biomarkers. Results Blacks had higher baseline CMR than whites and Hispanics and experienced an increase in risk over four years; conversely, CMR decreased among whites and Hispanics. Blacks were more likely to develop high-risk pulse pressure and high-risk hemoglobin A1c, which contributed to increases in CMR. Whites and Hispanics were more likely to become low-risk on C-reactive protein and HDL cholesterol which contributed to declines in CMR. Race differences in transitions between risk states remained after controlling for social, behavioral and health care related factors. However, the racial patterning of these differences was influenced by disease diagnosis and medication use. Conclusions We show that the cardiometabolic health of older blacks worsens as they age both absolutely and relative to that of whites and Hispanics because of poor blood pressure control and diabetes prevention. %B The Journals of Gerontology: Series A %V 74 %P 240-246 %G eng %U https://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/gly026/4857183http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/gly026/23921802/gly026.pdf %N 2 %R 10.1093/gerona/gly026 %0 Journal Article %J SSM - Population Health %D 2019 %T Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort %A Leah R. Abrams %A Neil K Mehta %K Depressive symptoms %K Education %K Gender Differences %K Racial/ethnic differences %K Women and Minorities %X Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994–2014), we estimated mixed effects models to generate depressive symptoms over age by gender, race/ethnicity, education, and birth cohort in 33,280 adults ages 51–90 years. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression scale. Women compared to men, low compared to high education groups, and racial/ethnic minorities compared to whites exhibited higher depressive symptoms. The largest disparity resulted from education, with those without high school degrees exhibiting over two more predicted depressive symptoms in midlife compared to those with college degrees. Importantly, war babies and baby boomers (born 1942–1959) exhibited slightly higher depressive symptoms with more decreasing symptoms over age than their predecessors (born 1931–1941) at ages 51–65. We additionally observed an age-as-leveler pattern by gender, whereby females compared to males had higher depressive symptomology from ages 51–85, but not at ages 86–90. Our findings have implication for gauging the aging population's overall well-being, for public health policies aimed at reducing health disparities, and for anticipating demand on an array of health and social services. %B SSM - Population Health %V 7 %G eng %N 100399 %! SSM - Population Health %R 10.1016/j.ssmph.2019.100399 %0 Journal Article %J Journal of Aging and Health %D 2019 %T Childhood Disadvantage, Psychosocial Resiliency, and Later Life Functioning: Linking Early-Life Circumstances to Recovery From Mobility Limitation. %A Kenzie Latham-Mintus %A Katelyn M. Aman %K Childhood adversity %K Depressive symptoms %K Functional status %K Resilience %X

OBJECTIVE: There is limited knowledge about whether childhood disadvantage, defined as economic and health disadvantage, influences recovery from functional impairment.

METHOD: Using data from the Health and Retirement Study (2008-2010), this research explores whether childhood disadvantage shapes recovery from mobility limitation. In addition, this research examines whether measures of psychosocial resiliency such as mastery, optimism, and religiosity moderate the relationship between childhood disadvantage and recovery.

RESULTS: Childhood disadvantage appeared to shape recovery from mobility limitation in later life. Greater number of chronic childhood conditions and low maternal education decreased the odds of recovery. Mastery was a robust predictor of recovery and also a moderator of childhood disadvantage (i.e., moving for financial reasons) and recovery.

DISCUSSION: Findings suggest that mastery may be able to diminish the negative effects of financial hardship in childhood on recovery outcomes in later life.

%B Journal of Aging and Health %V 31 %P 463-483 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/29254410?dopt=Abstract %R 10.1177/0898264317733861 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2019 %T Childhood Misfortune and Handgrip Strength Among Black, White, and Hispanic Americans. %A Natalie R Smith %A Kenneth F Ferraro %A Blakelee R Kemp %A Patricia M Morton %A Sarah A Mustillo %A Jacqueline L. Angel %K Adult %K Adult Survivors of Child Abuse %K African Americans %K Aged %K European Continental Ancestry Group %K Female %K Hand Strength %K Health Status %K Hispanic Americans %K Humans %K Male %K Risk Factors %K Sex Factors %X

OBJECTIVE: Although early-life insults may affect health, few studies use objective physical measures of adult health. This study investigated whether experiencing misfortune during childhood is associated with handgrip strength (HGS) in later life.

METHOD: Data on childhood misfortune and adult characteristics from the Health and Retirement Study were used to predict baseline and longitudinal change in HGS among White, Black, and Hispanic American men and women.

RESULTS: Regression analyses revealed that multiple indicators of childhood misfortune were related to HGS at baseline, but the relationships were distinct for men and women. Over the study, having one childhood impairment predicted steeper declines in HGS for men, but childhood misfortune was unrelated to HGS change among women. Hispanic Americans had lower baseline HGS than their non-Hispanic counterparts and manifested steeper declines in HGS.

DISCUSSION: The relationship between childhood exposures and adult HGS varied by the type of misfortune, but there was no evidence that the relationship varied by race/ethnicity. The significant and enduring Hispanic disadvantage in HGS warrants greater attention in gerontology.

%B J Gerontol B Psychol Sci Soc Sci %V 74 %P 526-535 %8 2019 02 15 %G eng %U http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw147https://academic.oup.com/psychsocgerontology/article/2645640/Childhood-Misfortune-and-Handgrip-Strength-Among %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/27927743?dopt=Abstract %! GERONB %R 10.1093/geronb/gbw147 %0 Journal Article %J The Annals of Thoracic Surgergy %D 2019 %T Cognitive Change After Cardiac Surgery Versus Cardiac Catheterization: A Population-Based Study. %A Elizabeth L Whitlock %A L Grisell Diaz-Ramirez %A Alexander K Smith %A W John Boscardin %A Michael S. Avidan %A M. Maria Glymour %K Cardiac surgery %K Cardiovascular disease %K Cognition & Reasoning %K Memory %X

BACKGROUND: Despite concern that cardiac surgery may adversely affect cognition, little evidence is available from population-based studies using presurgery data. With the use of the Health and Retirement Study, we compared memory change after participant-reported cardiac catheterization or cardiac surgery.

METHODS: Participants were community-dwelling adults aged 65 years and older who self-reported cardiac catheterization or "heart surgery" at any biennial Health and Retirement Study interview between 2000 and 2014. Participants may have undergone the index procedure any time in the preceding 2 years. We modeled preprocedure to postprocedure change in composite memory score, derived from objective memory testing, using linear mixed effects models. We modeled postprocedure subjective memory decline with logistic regression. To quantify clinical relevance, we used the predicted memory change to estimate impact on ability to manage medications and finances independently.

RESULTS: Of 3,105 participants, 1,921 (62%) underwent catheterization and 1,184 (38%) underwent operation. In adjusted analyses, surgery participants had little difference in preprocedure to postprocedure memory change compared with participants undergoing cardiac catheterization (-0.021 memory units; 95% confidence interval: -0.046 to 0.005 memory units, p = 0.12). If the relationship were causal, the point estimate for memory decline would confer an absolute 0.26% or 0.19% decrease in ability to manage finances or medications, respectively, corresponding to 4.6 additional months of cognitive aging. Cardiac surgery was not associated with subjective memory decline (adjusted odds ratio 0.93, 95% confidence interval: 0.74 to 1.18).

CONCLUSIONS: In this large, population-based cohort, memory declines after heart surgery and cardiac catheterization were similar. These findings suggest intermediate-term population-level adverse cognitive effects of cardiac surgery, if any, are likely subtle.

%B The Annals of Thoracic Surgergy %V 107 %P 1119-1125 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/30578068?dopt=Abstract %R 10.1016/j.athoracsur.2018.10.021 %0 Journal Article %J International Journal of Epidemiology %D 2019 %T Cohort Profile: The Ageing Trajectories of Health - Longitudinal Opportunities and Synergies (ATHLOS) project. %A Sanchez-Niubo, Albert %A Egea-Cortés, Laia %A Olaya, Beatriz %A Caballero, Francisco Félix %A Ayuso-Mateos, Jose L %A Prina, Matthew %A Bobak, Martin %A Arndt, Holger %A Tobiasz-Adamczyk, Beata %A Pająk, Andrzej %A Leonardi, Matilde %A Koupil, Ilona %A Panagiotakos, Demosthenes %A Tamosiunas, Abdonas %A Scherbov, Sergei %A Sanderson, Warren %A Koskinen, Seppo %A Chatterji, Somnath %A Haro, Josep Maria %K Female %K Global Health %K Health Behavior %K Health Status %K Longitudinal Studies %K Male %K Mental Health %K Physical Functional Performance %K Social Environment %K Socioeconomic factors %B International Journal of Epidemiology %V 48 %P 1052-1053i %G eng %N 4 %R 10.1093/ije/dyz077 %0 Journal Article %J European Journal of Human Genetics %D 2019 %T Combined linkage and association analysis identifies rare and low frequency variants for blood pressure at 1q31. %A Wang, Heming %A Nandakumar, Priyanka %A Tekola-Ayele, Fasil %A Bamidele O Tayo %A Erin B Ware %A Gu, C Charles %A Lu, Yingchang %A Yao, Jie %A Zhao, Wei %A Smith, Jennifer A %A Hellwege, Jacklyn N %A Guo, Xiuqing %A Edwards, Todd L %A Ruth J F Loos %A Donna K Arnett %A Myriam Fornage %A Charles N Rotimi %A Sharon L R Kardia %A Cooper, Richard S %A Rao, D C %A Georg B Ehret %A Chakravarti, Aravinda %A Zhu, Xiaofeng %K African Americans %K Chromosomes, Human, Pair 1 %K Gene Frequency %K Genome-Wide Association Study %K Humans %K Hypertension %K Linkage Disequilibrium %K Polymorphism, Single Nucleotide %X

High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD) and is more prevalent in African Americans as compared to other US groups. Although large, population-based genome-wide association studies (GWAS) have identified over 300 common polymorphisms modulating inter-individual BP variation, largely in European ancestry subjects, most of them do not localize to regions previously identified through family-based linkage studies. This discrepancy has remained unexplained despite the statistical power differences between current GWAS and prior linkage studies. To address this issue, we performed genome-wide linkage analysis of BP traits in African-American families from the Family Blood Pressure Program (FBPP) and genotyped on the Illumina Human Exome BeadChip v1.1. We identified a genomic region on chromosome 1q31 with LOD score 3.8 for pulse pressure (PP), a region we previously implicated in DBP studies of European ancestry families. Although no reported GWAS variants map to this region, combined linkage and association analysis of PP identified 81 rare and low frequency exonic variants accounting for the linkage evidence. Replication analysis in eight independent African ancestry cohorts (N = 16,968) supports this specific association with PP (P = 0.0509). Additional association and network analyses identified multiple potential candidate genes in this region expressed in multiple tissues and with a strong biological support for a role in BP. In conclusion, multiple genes and rare variants on 1q31 contribute to PP variation. Beyond producing new insights into PP, we demonstrate how family-based linkage and association studies can implicate specific rare and low frequency variants for complex traits.

%B European Journal of Human Genetics %V 27 %P 269-277 %G eng %N 2 %R 10.1038/s41431-018-0277-1 %0 Journal Article %J Cells %D 2019 %T Comparing the utility of mitochondrial and nuclear DNA to adjust for genetic ancestry in association studies. %A Miller, Brendan %A Thalida E. Arpawong %A Jiao, Henry %A Kim, Su-Jeong %A Yen, Kelvin %A Hemal H Mehta %A Wan, Junxiang %A John Carpten %A Cohen, Pinchas %K Genetics %K GWAS %K Survey Methodology %X Mitochondrial genome-wide association studies identify mitochondrial single nucleotide polymorphisms (mtSNPs) that associate with disease or disease-related phenotypes. Most mitochondrial and nuclear genome-wide association studies adjust for genetic ancestry by including principal components derived from nuclear DNA, but not from mitochondrial DNA, as covariates in statistical regression analyses. Furthermore, there is no standard when controlling for genetic ancestry during mitochondrial and nuclear genetic interaction association scans, especially across ethnicities with substantial mitochondrial genetic heterogeneity. The purpose of this study is to (1) compare the degree of ethnic variation captured by principal components calculated from microarray-defined nuclear and mitochondrial DNA and (2) assess the utility of mitochondrial principal components for association studies. Analytic techniques used in this study include a principal component analysis for genetic ancestry, decision-tree classification for self-reported ethnicity, and linear regression for association tests. Data from the Health and Retirement Study, which includes self-reported White, Black, and Hispanic Americans, was used for all analyses. We report that (1) mitochondrial principal component analysis (PCA) captures ethnic variation to a similar or slightly greater degree than nuclear PCA in Blacks and Hispanics, (2) nuclear and mitochondrial DNA classify self-reported ethnicity to a high degree but with a similar level of error, and 3) mitochondrial principal components can be used as covariates to adjust for population stratification in association studies with complex traits, as demonstrated by our analysis of height-a phenotype with a high heritability. Overall, genetic association studies might reveal true and robust mtSNP associations when including mitochondrial principal components as regression covariates. %B Cells %V 8 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/30987182?dopt=Abstract %R 10.3390/cells8040306 %0 Journal Article %J Innovation in Aging %D 2019 %T CROSS-COUNTRY COMPARISON OF INTERNET USE AND DEPRESSION BY GENDER: THE ROLE OF INTERGENERATIONAL FACTORS %A Shim, Hyunju %A Jennifer A Ailshire %A Eileen M. Crimmins %K depression %K gender %K Intergenerational ties %K International %X Technology may offer one approach to reducing depression as it provides medium to maintain connections (Cotton et al., 2014). Yet, depression, internet use, gender roles, and expectation of intergenerational interaction all differ across countries. Using nationally representative data from the U.S (Health and Retirement Study: HRS) and South Korea (Living Profiles of Older People Survey: LPOPS), the study examines 1) association between internet use and depressive symptoms by gender in two countries; 2) and whether intergenerational factors moderated this association. In the U.S., more than half of men and women aged 65+ used the internet, while approximately 30% of women and 47% of men used the internet in Korea. Using the internet was associated with lower depression for those living far from the closest child for women in the U.S., and for men in Korea. The findings indicate that the association of internet use on depressive symptoms can be influenced by intergenerational factors that may differentially affect men and women depending on the sociohistorical contexts. %B Innovation in Aging %V 3 %P S330 - S331 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840073/ %N Suppl 1 %! Innov Aging %0 Journal Article %J BMJ Open %D 2019 %T A cross-sectional study of self-rated health among older adults: a comparison of China and the United States. %A Xu, Dongjuan %A Arling, Greg %A Wang, Kefang %K CHARLS %K Cross-National %K Self-reported health %K Sister studies %X

OBJECTIVES: We used nationally representative samples of China and the US older population to investigate (1) whether factors influencing self-rated health among older Chinese were similar to those among older Americans; and (2) whether there was a significant cross-national difference in self-rated health between China and the USA after controlling those available influencing factors.

DESIGN: A cross-sectional study. Data came from the 2014 Health and Retirement Study and China Health and Retirement Longitudinal Study conducted from 2014 to 2015.

PARTICIPANTS: Our final sample size totaled 8905 older adults in the USA and 4442 older adults in China.

OUTCOME: The response variable was self-rated health. Ordered logistic regression models were conducted to investigate factors influencing self-rated health among older adults.

RESULTS: More than three-fourths (78%) of older adults in China reported fair or poor health status, while almost 74% of older adults in the USA reported excellent, very good or good health status. In the overall ordered logistic regression model, when controlling statistically for sociodemographics, family structure, functional limitations, cognition, chronic conditions, mental health and health-related behaviours, the Chinese survey respondents were much more likely to rate their health as being poorer than the US respondents. The odds of having better versus poorer health was almost five times greater in American older adults than those in China (OR=4.88, 95% CI 4.06 to 5.86). Older adults in China living alone rated their health better than those living with spouse/partner; however, no significant difference was found between these two living arrangements in older Americans. In contrast, older adults in the USA living with others rated their health worse compared with those living with spouse/partner. In addition, older adults who had more activities of daily living limitations, poorer self-reported memory, worse mental health and chronic health conditions had lower self-rated health in both countries.

CONCLUSIONS: We found a striking difference in self-rated health between China and the USA even after controlling for measures of disease, functional status and other influencing factors. Relative to their American counterparts, Chinese elders were much more likely to report worse health.

%B BMJ Open %V 9 %P e027895 %8 2019 Jul 31 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/31371288?dopt=Abstract %R 10.1136/bmjopen-2018-027895 %0 Journal Article %J Journal of Financial Therapy %D 2019 %T Debt, Religious Beliefs, and Life Satisfaction %A Ammerman, David D. %A Stueve, Cherie %A Hayward, Stephen %K complex data analysis %K debt; religiosity %K Life Satisfaction %X The purpose of this study was to explore religious factors as a resource for coping with indebtedness. Using a sample (n = 3,174) extracted from the Health and Retirement Study (HRS), we examined the relationship between household debt and life satisfaction, and tested for stress-buffering (i.e., moderation) from religious identification, religious beliefs, and prayer frequency. Results suggest that some religious factors may play a small role in moderating the relationship between indebtedness and life satisfaction, and that such moderation is itself dependent on one’s religious identification. Implications for practice (particularly faith-based providers of financial counseling) and recommendations for future research are discussed. %B Journal of Financial Therapy %V 10 %G eng %U https://newprairiepress.org/cgi/viewcontent.cgi?article=1195&context=jft %N 2 %9 Journal %R 10.4148/1944-9771.1195 %0 Journal Article %J SSM - Population Health %D 2019 %T Discrimination in health care and biomarkers of cardiometabolic risk in U.S. adults %A Thu T Nguyen %A Anusha M Vable %A M. Maria Glymour %A Allen, Amani M. %K Biomarkers %K Discrimination %K Racism %K Risk Factors %X Introduction: Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to older adults who are more likely to have existing risk factors or medical conditions that require on-going care. The purpose of this study is to investigate the associations between patient-reported health care discrimination and biomarkers of cardiometabolic risk. Methods: We used 2008–2014 data from the Health and Retirement Study, a nationally representative study of US adults ages 50+ (n=12,695 participants contributing up to 16,179 observations) to examine the association between patient-reported experiences of health care discrimination and biomarkers of cardiometabolic risk: high sensitivity C-reactive protein (CRP), Hemoglobin A1c (HbAlc), high-density lipoprotein (HDL), total cholesterol, cystatin C and blood pressure and whether relationships were modified by race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) or gender. We fit generalized estimating equation (GEE) models specifying a binomial distribution and logit link to account for dependency of repeated measures on individuals. Results: Health care discrimination was associated with higher odds of CRP>3 mg/L (OR: 1.20 (95% CI: 1.10, 1.30) and HbA1c>6.5% (OR: 1.23 (95% CI: 1.10, 1.38) but not associated with other biomarkers of cardiometabolic health in the sample as a whole. However, subgroup differences were detected. While health care discrimination was positively associated with elevated HbA1c for non-Hispanics, it was inversely associated with HbA1c for Hispanics. Conclusions: Health care discrimination was associated with increased cardiometabolic risk based on selected biomarkers. %B SSM - Population Health %V 7 %P 100306 %G eng %R 10.1016/j.ssmph.2018.10.006 %0 Journal Article %J Innovation in Aging %D 2019 %T DOES A PERCEIVED CONNECTION TO A NEIGHBORHOOD REDUCE LONELINESS? %A Kimberly J. Johnson %A Adeniji, Dolapo O %K Loneliness %K neighborhood %X This study investigated whether perceived neighborhood quality was associated with chronic loneliness for adults 60 and older in the United States. Although loneliness can be episodic and overcome, chronic loneliness has been identified as a social determinant of health. Utilizing ecological systems theory we hypothesized that higher levels of neighborhood social cohesiveness would be associated with lower odds of chronic loneliness. We postulated that the networks available to people in the proximal area where they live could provide social opportunities for reducing loneliness. This idea was consistent with prior findings indicating the salience of neighborhoods for retirees, but inconsistent with research indicating the importance of a confidant in reducing loneliness. Data from the 2008 and 2012 Health and Retirement Study Psychosocial Surveys were used (n = 3530). Loneliness was measured using the 3-item scale developed by Hughes and colleagues in 2004. Findings from unadjusted logistic regression indicated that loneliness was inversely related to neighborhood cohesion as measured by an index of the trustworthiness, friendliness and helpfulness of neighbors and cleanliness, occupancy, lack of graffiti, and sense of belonging in the area (OR = .73, p < .001). When demographic and health-related factors were entered into the model the odds of being lonely were significantly lower for those with higher ratings of social cohesion (OR = .83, p < .001). These findings were consistent with the idea that neighborhoods are an important social place for older persons and interventions at the neighborhood level may be more effective than individualized treatment plans. %B Innovation in Aging %V 3 %P S534 - S534 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841328/ %N Suppl 1 %! Innov Aging %0 Journal Article %J Research on Aging %D 2019 %T Does home equity affect decisions on long-term care insurance purchases? Evidence from the United States. %A Richard A Hirth %A Acharya, Yubraj %A Helen G Levy %A Kenneth M. Langa %K Decision making %K Homeownership %K Long-term care insurance %X The low uptake of private long-term care insurance (LTCI) by the elderly in the United States, despite visible risks, has left economists puzzled. Prior studies have hypothesized that home equity can be a substitute for LTCI and hence may partly explain the low uptake. We test this hypothesis empirically. We utilize exogenous variation in house prices at the level of the metropolitan statistical area (MSA) as an instrument for home equity for individuals residing in that MSA and data from the Health and Retirement Study. In the most robust specifications, we find no evidence that the elderly change their decision on LTCI based on variation in their home equity, and even specifications requiring stronger identification assumptions imply only small effect magnitudes. Home equity as a substitute for LTCI does not appear to be a major contributing factor to low LTCI take up. %B Research on Aging %V 41 %8 07/2019 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/30803354?dopt=Abstract %R 10.1177/0164027519830078 %0 Journal Article %J Biodemography and Social Biology %D 2019 %T Does salivary telomere length explain race/ethnic differences in aging? %A Brown, Lauren %A García, Catherine %A Jennifer A Ailshire %K Aging %K Biomarkers %K ethnicity %K race %K Telomere length %X ABSTRACT Telomere length (TL) is a biomarker that can be used to characterize variability in aging and may explain race/ethnic differences in aging. Yet, it remains unclear if TL is related to aging-associated health risks in multi-ethnic populations or if it explains race/ethnic differences in health. We examine whether salivary TL (STL) explains any of the race/ethnic variability in 15 indicators of high-risk biological, physical, and cognitive health among 4,074 White, Black, and Latinx older adults ages 54+ in the 2008 Health and Retirement Study. TL was assayed from saliva using quantitative PCR (T/S ratio). Decomposition analyses from logistic regression models show variation in STL does not account for any of the observed race/ethnic differences health. In age-adjusted, race-stratified models, STL was associated with HDL, total cholesterol, and lung function among Whites, but was not associated with any markers of health among Black or Latinx groups. In this diverse national sample of older adults, STL does not account for race/ethnic differences in late life health, is associated with relatively few indicators of health among Whites, and is not associated with indicators of health among Black or Latinx groups. STL may not be a useful biomarker for understanding racial/ethnic differences in population aging among older adults. %B Biodemography and Social Biology %V 65 %P 351-369 %@ 1948-5565 %G eng %N 4 %R 10.1080/19485565.2020.1798736 %0 Journal Article %J Journal of the American Geriatrics Society %D 2019 %T The Epidemiology of Depressive Symptoms in the Last Year of Life %A Kozlov, Elissa %A Dong, XinQi %A Amy Kelley %A Claire K. Ankuda %K depression %K end of lifemental health %X BACKGROUND/OBJECTIVE Depression impacts quality of life at all life stages, but the epidemiology of depression in the last year of life is unknown. This study's objectives were to document the epidemiology of depressive symptoms in the year prior to death and to assess how the trajectory of depressive symptoms varies by sociodemographic and clinical factors. DESIGN Observational, cross-sectional, cohort study using the Health and Retirement Study. SETTING Population-based survey. PARTICIPANTS A total of 3274 individuals who died within 12 months after assessment. MEASURES Primary outcome: eight-item Center for Epidemiologic Studies Depression Scale (CESD-8). Covariates included sociodemographics, self-reported illnesses, and activity of daily living (ADL) limitations. RESULTS Average CESD-8 score increased over the last year of life, with 59.3% screening positive for depression in the last month before death. Depression symptoms increased gradually from 12 to 4 months before death (increase of 0.05 points/month; 95% confidence interval [CI] = 0.01-0.08 points/month) and then escalated from 4 to 1 months before death (increase of 0.29 points/month; 95% CI = 0.16-0.39 points/month). Women, younger adults, and nonwhite adults all demonstrated higher rates of depressive symptoms. Individuals with cancer reported escalating rates of depressive symptoms at the end of life, while individuals with lung disease and ADL impairment demonstrated persistently high rates throughout the year before death. CONCLUSIONS This study revealed high rates of depressive symptoms in the last year of life as well as differences in the burden of depressive symptoms. A public health approach must be taken to screen for and appropriately treat symptoms of depression across the lifespan. %B Journal of the American Geriatrics Society %V n/a %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16197 %R 10.1111/jgs.16197 %0 Journal Article %J Journal of Aging and Health %D 2019 %T Evaluations of a previous day as a pathway between personality and healthy cognitive aging %A Angelina R Sutin %A Yannick Stephan %A Damaris Aschwanden %A Martina Luchetti %A Jason E Strickhouser %A Antonio Terracciano %K Cognition & Reasoning %K Personality %K Self Report %X

OBJECTIVE: To examine the association between Five-Factor Model personality traits and how individuals evaluate a recent day in their lives (yesterday) and whether these evaluations mediate personality and cognitive function over time.

METHODS: Participants were a subsample from the Health and Retirement Study who completed personality measures in 2008/2010, the day evaluation in 2011, and cognitive tasks in 2012 ( N = 3,454).

RESULTS: Lower Neuroticism and Higher Extraversion, Openness, Agreeableness, and Conscientiousness were associated with a more engaging day, fewer negative feelings, better subjective health, and less time spent alone. Active engagement and subjective health were associated with cognitive function and mediated the prospective associations between Neuroticism, Openness, and Conscientiousness and cognitive function.

DISCUSSION: Personality is associated with how individuals evaluated their previous day, which contributes to cognition over time. The present research contributes to a mechanistic model that aims to identify pathways through which personality contributes to cognitive aging.

%B Journal of Aging and Health %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31030604?dopt=Abstract %R 10.1177/0898264319843451 %0 Journal Article %J Biological Psychiatry %D 2019 %T Exome Chip Meta-analysis Fine Maps Causal Variants and Elucidates the Genetic Architecture of Rare Coding Variants in Smoking and Alcohol Use. %A Brazel, David M %A Jiang, Yu %A Hughey, Jordan M %A Turcot, Valérie %A Zhan, Xiaowei %A Gong, Jian %A Batini, Chiara %A Weissenkampen, J Dylan %A Liu, Mengzhen %A Barnes, Daniel R %A Bertelsen, Sarah %A Chou, Yi-Ling %A Erzurumluoglu, A Mesut %A Jessica Faul %A Jeffrey Haessler %A Anke R Hammerschlag %A Hsu, Chris %A Kapoor, Manav %A Lai, Dongbing %A Le, Nhung %A Christiaan de Leeuw %A Loukola, Anu %A Mangino, Massimo %A Melbourne, Carl A %A Pistis, Giorgio %A Qaiser, Beenish %A Rohde, Rebecca %A Shao, Yaming %A Heather M Stringham %A Wetherill, Leah %A Zhao, Wei %A Agrawal, Arpana %A Laura Bierut %A Chen, Chu %A Charles B Eaton %A Goate, Alison %A Christopher A Haiman %A Andrew C Heath %A Iacono, William G %A Nicholas G Martin %A Tinca J Polderman %A Reiner, Alex %A Rice, John %A Schlessinger, David %A H Steven Scholte %A Smith, Jennifer A %A Tardif, Jean-Claude %A Hilary A Tindle %A Van Der Leij, Andries R %A Boehnke, Michael %A Chang-Claude, Jenny %A Francesco Cucca %A David, Sean P %A Tatiana Foroud %A Howson, Joanna M M %A Sharon L R Kardia %A Charles Kooperberg %A Laakso, Markku %A Lettre, Guillaume %A Pamela A F Madden %A McGue, Matt %A Kari E North %A Posthuma, Danielle %A Timothy Spector %A Stram, Daniel %A Tobin, Martin D %A David R Weir %A Kaprio, Jaakko %A Gonçalo R Abecasis %A Liu, Dajiang J %A Scott Vrieze %K Alcohol Drinking %K Databases, Genetic %K Exome %K Genetic Predisposition to Disease %K Genetic Variation %K Genome-Wide Association Study %K Genotype %K Humans %K Oligonucleotide Array Sequence Analysis %K Phenotype %K Polymorphism, Single Nucleotide %K Smoking %X

BACKGROUND: Smoking and alcohol use have been associated with common genetic variants in multiple loci. Rare variants within these loci hold promise in the identification of biological mechanisms in substance use. Exome arrays and genotype imputation can now efficiently genotype rare nonsynonymous and loss of function variants. Such variants are expected to have deleterious functional consequences and to contribute to disease risk.

METHODS: We analyzed ∼250,000 rare variants from 16 independent studies genotyped with exome arrays and augmented this dataset with imputed data from the UK Biobank. Associations were tested for five phenotypes: cigarettes per day, pack-years, smoking initiation, age of smoking initiation, and alcoholic drinks per week. We conducted stratified heritability analyses, single-variant tests, and gene-based burden tests of nonsynonymous/loss-of-function coding variants. We performed a novel fine-mapping analysis to winnow the number of putative causal variants within associated loci.

RESULTS: Meta-analytic sample sizes ranged from 152,348 to 433,216, depending on the phenotype. Rare coding variation explained 1.1% to 2.2% of phenotypic variance, reflecting 11% to 18% of the total single nucleotide polymorphism heritability of these phenotypes. We identified 171 genome-wide associated loci across all phenotypes. Fine mapping identified putative causal variants with double base-pair resolution at 24 of these loci, and between three and 10 variants for 65 loci. Twenty loci contained rare coding variants in the 95% credible intervals.

CONCLUSIONS: Rare coding variation significantly contributes to the heritability of smoking and alcohol use. Fine-mapping genome-wide association study loci identifies specific variants contributing to the biological etiology of substance use behavior.

%B Biological Psychiatry %V 85 %P 946-955 %G eng %N 11 %R 10.1016/j.biopsych.2018.11.024 %0 Thesis %B Health Services and Policy Management %D 2019 %T Factors Associated with Advance Care Plans and End-of-life Care Choices Among Elderly Americans: An Analysis of Health and Retirement Study Data %A Ajmal,Agha %K 0493:Aging %K 0573:Public health %K 0630:Public policy %K Advance care planning %K Advance directives %K Aging %K Durable Power of Attorney for Health Care %K Elderly Americans %K End-of-life care %K Living will %K Public Health %K Public Policy %X Introduction: Advance care plans (ACPs) allow people to plan for their end-of-life care before they become incompetent to make their treatment decisions. The umbrella term Advance Care Plans (ACP) includes the three most commonly used end-of-life care plans: Advance Care Planning Discussions (ACP discussions) and two advanced directives: living will and Durable Power of Attorney for Health Care (DPAHC). The ACP discussions are the verbal discussions about end-of-life plans, whereas the advance directives are written documents.ACPs are distinct nuances of end-of-life care planning. ACP discussions address a wide array of end-of-life care issues, including terminal care, funeral, burial and the place of death, etc. A living will outlines specific end-of-life care choices and elicits yes or no responses. The choices pertain to use of artificial respiration; artificial feeding and hydration; dialysis; or antibiotics; etc. A DPAHC, appoints a proxy to make treatment decisions on behalf of the incompetent patient at a terminal stage of life.While previous studies have used ACPs as distinct outcomes, in real life the ACPs exist in combinations. People who undertake ACP discussions are more likely to complete advance directives. More than 25 states have combined directives forms. Therefore, it is imperative to evaluate the factors associated with the combinations of ACPs: No ACP; ACP discussions only; a directive (a living will or DPAHC); a directive and ACP discussions; both directives (a living will and DPAHC); and all ACPs (a living will, DPAHC and ACP discussions).Among the factors associated with ACPs, health status has shown an inconsistent association. Some studies have shown that poor health is associated with higher ACP uptake rates, whereas others have noted no association. The possible reasons for inconsistent association include 1) examining the association without controlling for the change in health status and other health factors — prior research shows health status and change in health are closely related in influencing the uptake of ACPs and the end-of-life care choices 2) use of each ACP as a separate outcome instead of using them in combinations. Therefore, our first study attempted to clarify the association between health status, change in health status and interaction between the two measures with the combinations of ACPs.Our second study determined the factors associated with end-of-life care choices. Prior concerning the association between health status and end-of-life care choices have used prospect theory. However, previous research has used convenience samples and end-of-life care scenarios. We tested the prospect theory using a representative population-based sample and using the choices that people make considering their own health status and possible end-of-life circumstances.Methods: We used the Health and Retirement Study (HRS) panel data from 1992-2014 and the HRS exit interview data from 2002-2014. The HRS captures health and retirement characteristics of a representative sample of Americans over 50 years using biennial panel surveys since 1992. It also conducts one-time post-death interviews with the next-of-kin of HRS decedents in the survey waves following their death. The post-death surveys collect information about medical care expenditures and use; advance care planning and end-of-life care choices and distribution of assets towards end-of-life.We used the SAS version 9.4 to examine the association between health status and ACPs, we used a multinomial regression model. The combinations of ACPs were used as the study outcome. To study the association between health status and choices, a separate logistic regression model was used for each choice — limit care in certain situations, comfort care and all care possible.Results: In study 1, self-reported health was not associated with any category of ACP combinations. However, change in health status was associated with ACPs — “worse or somewhat worse” change in health status since the last survey wave was associated with a higher uptake of “two directives” and “all ACPs”, compared with “much or somewhat better or the same”. The number of health conditions and a history of cancer were also associated with “all ACPs”.In study 2, we did not find association between self-reports of health and its change with the two care-limiting choices, including “limit care in certain situations” and “comfort care”. However, change in health status was associated with the “all care possible” option — a decline in health status since the last wave was associated with a higher likelihood of “all care possible” choice than improvement or no change in health status since the last wave. Among other health factors, a psychiatric illness was associated a higher uptake of “all care possible” and a lower uptake of “comfort care”. The decedents with a history of stroke chose less “limit care in certain situations” option.Recommendations: We recommend further research on the factors associated with the combinations of ACPs. Future research should also use the combinations to determine the effects of ACPs on the cost and quality of end-of-life care. %B Health Services and Policy Management %I University of South Carolina %V PhD %P 236 %8 2019 %@ 9781085585590 %G eng %U https://scholarcommons.sc.edu/etd/5126/ %9 phd %0 Journal Article %J Journal of Aging and Health %D 2019 %T From Snapshots to Movies: The Association Between Retirement Sequences and Aging Trajectories in Limitations to Perform Activities of Daily Living. %A Azar, Ariel %A Ursula M. Staudinger %A Slachevsky, Andrea %A Madero-Cabib, Ignacio %A Calvo, Esteban %K Activities of Daily Living %K Disabilities %K Policy %K Retirement Planning and Satisfaction %X

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

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

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

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

%B Journal of Aging and Health %V 31 %P 293-321 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/29952242?dopt=Abstract %R 10.1177/0898264318782096 %0 Journal Article %J International Journal of Preventive Medicine %D 2019 %T Gender, depressive symptoms, chronic medical conditions, and time to first psychiatric diagnosis among American older adults %A Shervin Assari %A Dejman, M. %K Chronic conditions %K depression %K Depressive symptoms %K gender %X Background: To test whether gender moderates the effects of baseline depressive symptoms and chronic medical conditions (CMCs) on risk of receiving subsequent psychiatric diagnosis among older adults. Methods: Data came from ten waves of the Health and Retirement Study, a nationally representative longitudinal study. We followed 9794 individuals older than 52 years without any diagnosed psychiatric disorder at baseline for up to 18 years. Baseline depressive symptoms and CMC were the predictors, time to receiving an emotional diagnosis was the outcome, baseline demographics and socioeconomics were controls, and gender was the moderator. We used Cox proportional hazards models for data analysis. Results: In the pooled sample, female gender increased the effect of baseline depressive symptoms (hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.26-2.00) and reduced the effect of baseline CMC (HR, 0.78; 95% CI, 0.63-0.97) on time to receiving a psychiatric diagnosis. Among men, baseline depressive symptoms (HR, 2.36; 95% CI, 1.87-2.97) increased and baseline CMC (HR, 0.81; 95% CI, 0.69-0.95) decreased time to receiving a psychiatric diagnosis. Among women, depressive symptoms (HR, 1.49; 95% CI, 1.21-1.83) but not CMC (HR, 1.06; 95% CI, 0.91-1.23) were associated with time to receiving a psychiatric diagnosis over time. Conclusions: Men and women differ in how depressive symptoms and CMC influence their risk of receiving a psychiatric diagnosis over time. Depressive symptoms are more salient promotor for men than women while CMC is only a barrier for men. © 2019 International Journal of Preventive Medicine. %B International Journal of Preventive Medicine %V 10 %G eng %R 10.4103/ijpvm.IJPVM_333_15 %0 Journal Article %J Menopause %D 2019 %T Genetic associations with age of menopause in familial longevity. %A Harold Bae %A Kathryn L Lunetta %A Joanne M Murabito %A Andersen, Stacy L %A Schupf, Nicole %A Thomas T Perls %A Sebastiani, Paola %K Genetics %K Menopause %K Women and Minorities %X

OBJECTIVE: We hypothesize that mechanisms associated with extended reproductive age may overlap with mechanisms for the selection of genetic variants that slow aging and decrease risk for age-related diseases. Therefore, the goal of this analysis is to search for genetic variants associated with delayed age of menopause (AOM) among women in a study of familial longevity.

METHODS: We performed a meta-analysis of genome-wide association studies for AOM in 1,286 women in the Long Life Family Study (LLFS) and 3,151 women in the Health and Retirement Study, and then sought replication in the Framingham Heart Study (FHS). We used Cox proportional hazard regression of AOM to account for censoring, with a robust variance estimator to adjust for within familial relations.

RESULTS: In the meta-analysis, a single nucleotide polymorphism (SNP) previously associated with AOM reached genome-wide significance (rs16991615; HR = 0.74, P = 6.99 × 10). A total of 35 variants reached >10 level of significance and replicated in the FHS and in a 2015 large meta-analysis (ReproGen Consortium). We also identified several novel SNPs associated with AOM including rs3094005: MICB, rs13196892: TXNDC5 | MUTED, rs72774935: SSBP2 | ATG10, rs9447453: COL12A1, rs114298934: FHL2 | NCK2, rs6467223: TNPO3, rs9666274 and rs10766593: NAV2, and rs7281846: HSPA13.

CONCLUSIONS: This work indicates novel associations and replicates known associations between genetic variants and AOM. A number of these associations make sense for their roles in aging.

VIDEO SUMMARY: Supplemental Digital Content 1, http://links.lww.com/MENO/A420.

%B Menopause %8 9 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31188284?dopt=Abstract %R 10.1097/GME.0000000000001367 %0 Journal Article %J Neurology %D 2019 %T Genetic basis of motoric cognitive risk syndrome in the Health and Retirement Study. %A Sathyan, Sanish %A Wang, Tao %A Emmeline Ayers %A Joe Verghese %K BMI %K Cognition & Reasoning %K Genetics %K Risk Factors %X

OBJECTIVE: To examine polygenic inheritance of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of subjective cognitive complaints and slow gait.

METHODS: We analyzed 4,915 individuals, age 65 years and above, with European ancestry (mean age 75.0 ± 6.8 years, 56.6% women) in the Health and Retirement Study. Polygenic scores (PGS) were calculated as weighted sums of the effect of single nucleotide polymorphisms, with effect sizes derived from genome-wide association studies. The association between PGSs of 9 phenotypes (general cognition, body mass index [BMI], mean arterial pressure, education, Alzheimer disease [AD], neuroticism, well-being, waist circumference, and depressive symptoms) and MCR as well as its key components (cognitive complaints and slow gait) were examined by logistic regression, adjusting for age, sex, education, and genetic ancestry, and reported as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: There were 260 prevalent MCR cases, 529 with slow gait, and 1,928 with subjective cognitive complaints. Higher PGSs for BMI (OR 1.22, 95% CI 1.07-1.39) and waist circumference (OR 1.23, 95% CI 1.07-1.40) were associated with MCR, and PGS of AD showed a suggestive association (OR 1.16, 95% CI 1.02-1.32). Higher PGS for neuroticism (OR 1.10, 95% CI 1.03-1.18) was associated with cognitive complaints, whereas higher well-being PGS (OR 0.92, 95% CI 0.87-0.98) was protective. PGS for BMI (OR 1.16, 95% CI 1.06-1.28), waist circumference (OR 1.19, 95% CI 1.08-1.31), and AD (OR 1.13, 95% CI 1.03-1.24) was associated with slow gait.

CONCLUSION: Obesity-related genetic traits increase risk of MCR syndrome; further investigation is required to identify potential therapeutic targets.

%B Neurology %V 92 %P e1427-e1434 %8 2019 Mar 26 %G eng %N 13 %1 http://www.ncbi.nlm.nih.gov/pubmed/30737336?dopt=Abstract %R 10.1212/WNL.0000000000007141 %0 Journal Article %J Geroscience %D 2019 %T Genetic heterogeneity of Alzheimer's disease in subjects with and without hypertension. %A Nazarian, Alireza %A Konstantin G Arbeev %A Arseniy P Yashkin %A Alexander M Kulminski %K Aged %K Aged, 80 and over %K Aging %K Alzheimer disease %K Cohort Studies %K disease progression %K Female %K Genetic Heterogeneity %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Hypertension %K Male %K Polymorphism, Single Nucleotide %K Prognosis %K Prospective Studies %K Risk Assessment %X

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

%B Geroscience %V 41 %P 137-154 %8 2019 04 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/31055733?dopt=Abstract %R 10.1007/s11357-019-00071-5 %0 Journal Article %J Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2019 %T Health and social-physical environment profiles among older adults living alone: Associations with depressive symptoms. %A So Jung Park %A Jacqui Smith %A Ruth E Dunkle %A Ingersoll-Dayton, Berit %A Toni C Antonucci %K Depressive symptoms %K Health Conditions and Status %K Living arrangements %X

Objectives: We examined differences in depressive symptoms among people 65 and older who live alone, exploring whether these differences are associated with both health and environmental contexts.

Method: Data are from the 2006 wave of Health Retirement Study (N = 2,956, age range: 65-104). We used a two-step cluster analytical approach to identify subgroups of health-limitation profiles and environmental profiles. Logistic regression models determined associations between subgroups and depressive symptoms.

Results: Cluster analysis identified four health-profile subgroups (sensory-cognitively impaired, physically impaired, multiply impaired, and healthy) and three different physical-social environmental-profile subgroups (physically average/socially unsupported, physically unsupported/socially supported, and physically supported/socially above average). Compared to members of healthier groups, members of the multiply impaired group were the oldest and were more likely both to live in senior housing and to have depressive symptoms if they lived in a physically average/socially unsupported environment. Members of the sensory-cognitively impaired group were more likely to have depressive symptoms when they lived in a physically unsupported/socially supported environment.

Discussion: Findings regarding the range of both health and social-physical environmental profiles as well as the associations between person-environment profiles combinations (fit) and depressive symptomatology have important policy and intervention implications.

%B Journals of Gerontology Series B: Psychological Sciences and Social Sciences %V 74 %P 675-684 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28637214?dopt=Abstract %R 10.1093/geronb/gbx003 %0 Journal Article %J American Journal of Health Economics %D 2019 %T Health Insurance and Early Retirement Plans: Evidence from the Affordable Care Act %A Padmaja Ayyagari %K Affordable Care Act %K Employer Sponsored Retiree Health Insurance %K Job Lock %K Subjective Retirement Expectations %X Understanding how individuals make retirement plans is key to designing effective policy. In particular, access to affordable insurance during retirement can play an important role in the labor supply decisions of older adults. In this study, I examine the impact of the 2010 Affordable Care Act (ACA) on the retirement plans of older adults. The ACA includes several provisions that significantly increase access to affordable insurance not tied to employment. I find that the ACA decreased the subjective probability of working past age 62 by 5.6 percentage points, representing a 9.9 percent decline, among persons without employer sponsored retiree coverage relative to persons with employer sponsored benefits. On average, individuals expect to retire about 3.6 to 7.2 months earlier due to the ACA. %B American Journal of Health Economics %V 5 %P 533-560 %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3281097 %0 Journal Article %J Journal of Gerontological Social Work %D 2019 %T Home and community-based services and life satisfaction among homebound and poor older adults. %A Chen, Qingru %A Amano, Takashi %A So Jung Park %A BoRin Kim %K Community-based services %K Depressive symptoms %K Well-being %X Little evidence exists regarding the role of Home and Community-Based Services (HCBS) utilization on life satisfaction among older people who are both homebound and low-income. Guided by the personal-environment (-E) fit perspective, this study aims to: (1) describe characteristics of older people with homebound and low-income status; (2) investigate how the combination of homebound and low-income status is associated with life satisfaction; and (3) examine whether HCBS utilization moderates the association between homebound and low-income status and life satisfaction. Data were drawn from the 2012 Health and Retirement Study, and the sample included respondents who were 51+ years who completed a questionnaire for HCBS utilization (= 1,662). Results describe sociodemographic, health-related, and environmental characteristics of older adults. Combined homebound and low-income status was a significant predictor of lower life satisfaction ( = -0.15, < .05), but better life satisfaction when they used HCBS ( 0.33, .10). These findings suggest that promoting HCBS utilization is a promising strategy to enhance well-being among those homebound and poor. Further studies are needed to test the effectiveness of HCBS with longitudinal data and to investigate the details of effective HCBS utilization such as frequency of use and types of services. %B Journal of Gerontological Social Work %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31293224?dopt=Abstract %R 10.1080/01634372.2019.1639094 %0 Journal Article %J Environment and Behavior %D 2019 %T Home Environment, Living Alone, and Trajectories of Cognitive Function Among Older Adults With Functional Limitations %A So Jung Park %A BoRin Kim %A Amano, Takashi %A Chen, Qingru %K Cognition %K Functional limitations %K home environment %K Loneliness %X This study aimed to investigate the effects of Person-Environment Fit on trajectories of cognitive function. Data came from the Health Retirement Study (1998-2010), focusing on those aged 65 and above who had at least one limitation in activities of daily living. Using longitudinal mixed-effect modeling, we analyzed the effects of living in supportive home environments on trajectories of cognitive function over time. Disabled older individuals living alone were likely to experience a decline in cognitive function over time. However, the detrimental effects of living alone were moderated when the home was equipped with supportive features and accessibility. The findings reveal the importance of home modifications for socially and physically vulnerable elders. %B Environment and Behavior %P 0013916519879772 %8 2019/10/16 %@ 0013-9165 %G eng %U https://doi.org/10.1177/0013916519879772 %! Environment and Behavior %0 Journal Article %J Journal of the American Medical Directors Association %D 2019 %T Home-based gait speed assessment: Normative data and racial/ethnic correlates among older adults. %A David A. Boulifard %A Emmeline Ayers %A Joe Verghese %K Gait speed %K Racial/ethnic differences %X

OBJECTIVES: To determine home-based gait speed performance and its associations with sociodemographic and health-related factors among older adults.

DESIGN: Cross-sectional analysis of a nationally representative US population sample.

SETTING AND PARTICIPANTS: Homes of Health and Retirement Study (HRS) participants.

METHODS: Walk test data measured at home over 2.5 m were aggregated for 6983 individuals, aged ≥65 years (mean age 74.8 ± 6.9 years, 54.2% women), from the 2006 and 2008 HRS waves. Means for gait speed at normal pace were determined for demographic and clinical groupings; association of gait speed with demographic, socioeconomic status, and health factors were examined. Four-year mortality was predicted from baseline slow gait status defined using demographic-based cutoff scores as well as commonly recommended cutoff scores (100 or 60 cm/s).

RESULTS: Home-based gait speed (cm/s) means were lower for female than male (9.6% difference), older than younger (18.0% difference), African American than white (20.5% difference), and Hispanic than Non-Hispanic (10.3% difference) participants. Differences by age group, race, and ethnicity remained significant within sexes (P < .001). Lower speed was associated with African American race and all health problems; higher speed was associated with higher socioeconomic status and alcohol consumption. Four-year mortality was predicted by slow gait status. Predictive validity was, in general, higher for slow gait cutoff scores defined by demographic characteristics.

CONCLUSIONS AND IMPLICATIONS: Mean gait speed measured at home differs among older (aged ≥65 years) US resident population groups defined by sex, age, race, ethnicity, health status, and combinations of these factors, and predicts 4-year mortality when substantially slower than group-based norms. These findings may assist researchers and clinicians in determining normal and abnormal gait performance in older adults in community settings.

%B Journal of the American Medical Directors Association %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31395494?dopt=Abstract %R 10.1016/j.jamda.2019.06.002 %0 Journal Article %J Innovation in Aging %D 2019 %T HOUSING AFFORDABILITY AND INTER-REGIONAL MOVES AMONG OLDER ADULTS %A Mawhorter, Sarah %A Jennifer A Ailshire %K Housing %K housing affordability %X Housing prices have risen in urban areas across the US since 2000, with only a brief interruption after the housing crisis of 2008. At the same time, prosperous urban areas have pulled away from declining urban and rural areas. Older adults are more likely to be affected by both increases and divergence of housing prices: owners may not be able to afford rising property taxes (though they benefit from increasing home equity), and renters are especially vulnerable. Housing affordability constraints may also affect the places where older adults can afford to move. In this paper, we compare the residential mobility patterns of adults aged 50+ living in high-cost, mid-cost, and low-cost areas from 2000-2014, using data from the Health and Retirement Study with county-level US Census and American Community Survey contextual data, as well as the Zillow Home Value Index. We find that both homeowners and renters living in high-cost areas remain in place at higher rates compared with those living in mid-cost and low-cost areas. Among those who move, older adults living in high-cost regions move towards mid-cost and low-cost regions more often than the reverse. The differences are particularly pronounced for renters. The overall outcome is a net movement of older adults away from high-cost areas towards mid-cost and low-cost areas. These shifts have consequences for the well-being of older adults facing budget constraints that may limit the areas where they can afford to live or move, and broader implications for the future of urban areas. %B Innovation in Aging %V 3 %P S276 - S276 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840162/ %N Suppl 1 %! Innov Aging %0 Report %D 2019 %T How Reliant are Older Americans on State and Local Government Pensions? %A Philip Armour %A Michael D Hurd %A Susann Rohwedder %X State and local government pension plans cover about 19.5 million participants, and many participants are heavily reliant on these pensions for retirement income. Most of these plans, however, are underfunded. Based on data from the Health and Retirement Study, we examined the lifetime work histories of those observed at ages 67 to 72 in 2004, 2008, or 2014. Seventy-seven percent of single persons and 61 percent of couple households had never worked for state or local (S&L) government. Among those single and couple households who did work for S&L government, we found that they have on average more years of education and more economic resources. Among currently retired and near-retirement households, we compared economic preparation for retirement according to their lifetime employment in the S&L sector, and we examined how economic preparation would be affected if pension benefits were cut. Based on stochastic simulations, which account for uncertainty about length of life and out-of-pocket medical expenditures, we found that economic preparation for retirement among those with S&L government work histories would only be modestly reduced if their pension income were cut. Under a 50 percent cut to all pension income of households with any S&L sector work, only an additional three to four percent of these households would no longer be prepared for retirement. The change is modest because households with S&L employment have better preparation than other households; some of the cuts are paid for by reduced taxes; and the affected households will bequeath less. %B MRDRC Working Paper %G eng %U https://mrdrc.isr.umich.edu/pubs/how-reliant-are-older-americans-on-state-and-local-government-pensions/ %9 Report %0 Journal Article %J ILR Review: The Journal of Work and Policy %D 2019 %T The Impact of Income-Related Medicare Part B Premiums on Labor Supply %A Padmaja Ayyagari %A Frank A Sloan %K Labor %K Labor Dynamics %K Medicare %K Medicare Part B %X The 2003 Medicare Modernization Act introduced income-related premiums on Medicare coverage for professional services (Part B) for the first time. Beginning in 2007, higher-income households were required to pay higher premiums for Part B coverage, which raises the price of Medicare relative to employer-sponsored health insurance for these households. The authors exploit this exogenous change in Medicare policy to examine the impact of Part B premiums on the labor supply decisions of older adults. They find that higher Medicare premiums delay retirement. Findings have important implications for Medicare policy and labor markets. %B ILR Review: The Journal of Work and Policy %P 0019793919891973 %G eng %U https://doi.org/10.1177/0019793919891973 %R 10.1177/0019793919891973 %0 Thesis %B Public Policy & Policy Management %D 2019 %T The Impact of Retirement Savings Methods on Retiree Satisfaction %A Albanese,Joseph J., Jr. %K 0630:Public policy %K Defined-benefit %K Defined-contribution %K Pension %K Public Policy %K Retirement %K Satisfaction %K Savings %K Social Sciences %X This paper examines the relationship between sources of retirement income and self-reported retirement satisfaction, as well as the role of financial behavior in retirement savings decisions. The changing landscape of private retirement savings, especially the shift from defined-benefit pensions to defined-contribution plans and IRAs, raises the question of which savings method is associated with the best outcomes. Data from the Health and Retirement Survey show retirees who rely on income from employer-sponsored retirement plans report higher retirement satisfaction than those who depend on Social Security benefits, who in turn report higher satisfaction than those who rely on IRAs. Meanwhile, satisfaction among retirees who participate in defined-benefit pensions exceeds that of those who own defined-contribution plans. Data from the Survey of Consumer Finance additionally indicate that those with worse saving habits and greater aversion to financial risk tend to be less likely to participate in defined-contribution plans and tend to have lower retirement incomes. %B Public Policy & Policy Management %I Georgetown University %V Master of Public Policy %P 51 %@ 9781392076569 %G eng %U https://repository.library.georgetown.edu/handle/10822/1055075 %9 phd %0 Journal Article %J Psychology and Aging %D 2019 %T Loneliness and hostility in older adults: A cross-lagged model. %A Dikla Segel-Karpas %A Liat Ayalon %K Aging %K cross-lagged %K Cynicism %K Hostility %K HRS %K Loneliness %K longitudinal %K Test Construction %K Well Being %X Loneliness takes a meaningful toll on individuals’ physical and mental well-being. One of its possible consequences is the perception that others are not to be trusted and are a source of wrongdoing, defined as cynical hostility. At the same time, cynical hostility could also deter individuals from seeking the comfort of close social relationships. We use the Health and Retirement Study to test a cross-lagged model of hostility and loneliness in a sample of 7500 older adults. The results suggest that there are bidirectional associations between hostility and loneliness. The findings are discussed in light of existing theories on human development, and practical implications are suggested. (PsycINFO Database Record (c) 2019 APA, all rights reserved) %B Psychology and Aging %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31724411 %0 Journal Article %J Journal of Behavioral Finance %D 2019 %T Market Volatility and Financial Satisfaction: The Role of Financial Self-Efficacy %A Asebedo, Sarah D. %A Payne, Patrick %K Economics %K Financial Health %K Market analyses %K Risk Factors %X This study investigates the role of financial self-efficacy (FSE) in moderating the relationship between market volatility and financial satisfaction within a sample of 3,405 adults 50 years old and over from the Health and Retirement Study. Results revealed that market volatility had no statistically significant effect with financial satisfaction for those with moderate or high FSE, but market volatility did have a negative effect for those with low FSE. Results suggest that FSE is an important predictor of financial satisfaction amidst market volatility and should be considered when establishing an appropriate asset allocation for client portfolios. %B Journal of Behavioral Finance %V 20 %P 42-52 %G eng %U https://www.tandfonline.com/doi/full/10.1080/15427560.2018.1434655https://www.tandfonline.com/doi/pdf/10.1080/15427560.2018.1434655 %N 1 %! Journal of Behavioral Finance %R 10.1080/15427560.2018.1434655 %0 Journal Article %J JAMA Network Open %D 2019 %T Measurement of Fall Injury With Health Care System Data and Assessment of Inclusiveness and Validity of Measurement Models %A Lillian C. Min %A Mary Tinetti %A Kenneth M. Langa %A Ha, Jinkyung %A Neil B. Alexander %A Geoffrey J Hoffman %K Fall injury %K Health Care %K Inclusiveness %X National injury surveillance systems use administrative data to collect information about severe fall-related trauma and mortality. Measuring milder injuries in ambulatory clinics would improve comprehensive outcomes measurement across the care spectrum.To assess a flexible set of administrative data–only algorithms for health systems to capture a greater breadth of injuries than traditional fall injury surveillance algorithms and to quantify the algorithm inclusiveness and validity associated with expanding to milder injuries.In this longitudinal diagnostic study of 13 939 older adults (≥65 years) in the nationally representative Health and Retirement Study, a survey was conducted every 2 years and was linked to hospital, emergency department, postacute skilled nursing home, and outpatient Medicare claims (2000-2012). During each 2-year observation period, participants were considered to have sustained a fall-related injury (FRI) based on a composite reference standard of having either an external cause of injury (E-code) or confirmation by the Health and Retirement Study patient interview. A framework involving 3 algorithms with International Classification of Diseases, Ninth Revision codes that extend FRI identification with administrative data beyond the use of fall-related E-codes was developed: an acute care algorithm (head and face or limb, neck, and trunk injury reported at the hospital or emergency department), a balanced algorithm (all acute care algorithm injuries plus severe nonemergency outpatient injuries), and an inclusive algorithm (almost all injuries). Data were collected from January 1, 1998, through December 31, 2012, and statistical analysis was performed from August 1, 2016, to March 1, 2019.Validity, measured as the proportion of potential FRI diagnoses confirmed by the reference standard, and inclusiveness, measured as the proportion of reference-standard FRIs captured by the potential FRI diagnoses.Of 13 939 participants, 1672 (42.4\%) were male, with a mean (SD) age of 77.56 (7.63) years. Among 50 310 observation periods, 9270 potential FRI diagnoses (18.4\%) were identified; these were tested against 8621 reference-standard FRIs (17.1\%). Compared with the commonly used method of E-coded–only FRIs (2-year incidence, 8.8\% [95\% CI, 8.6\%-9.1\%]; inclusion of 51.5\% [95\% CI, 50.4\%-52.5\%] of the reference-standard FRIs), FRI inclusion was increased with use of the study framework of algorithms. With the acute care algorithm (2-year incidence, 12.6\% [95\% CI, 12.4\%-12.9\%]), validity was prioritized (88.6\% [95\% CI, 87.4\%-89.8\%]) over inclusiveness (62.1\% [95\% CI, 61.1\%-63.1\%]). The balanced algorithm showed a 2-year incidence of 14.6\% (95\% CI, 14.3\%-14.9\%), inclusion of 65.3\% (95\% CI, 64.3\%-66.3\%), and validity of 83.2\% (95\% CI, 81.9\%-84.6\%). With the inclusive algorithm, the number of potential FRIs increased compared with the E-code–only method (2-year incidence, 17.4\% [95\% CI, 17.1\%-17.8\%]; inclusion, 68.4\% [95\% CI, 67.4\%-69.3\%]; validity, 75.2\% [95\% CI, 73.7\%-76.6\%]).The findings suggest that use of algorithms with International Classification of Diseases, Ninth Revision codes may increase inclusion of FRIs by health care systems compared with E-codes and that these algorithms may be used by health systems to evaluate interventions and quality improvement efforts. %B JAMA Network Open %V 2 %P e199679-e199679 %G eng %N 8 %R 10.1001/jamanetworkopen.2019.9679 %0 Journal Article %J Journal of Nutrition in Gerontology and Geriatrics %D 2019 %T Mental illness, not obesity status, is associated with food insecurity among the elderly in the Health and Retirement Study. %A Diana P Brostow %A Gunzburger, Elise %A Lauren M. Abbate %A Lisa A Brenner %A Kali S Thomas %K BMI %K Depressive symptoms %K Food insecurity %K Mental Health %X

OBJECTIVES: Food insecurity, limited or uncertain access to adequate nutrition, is an increasingly recognized determinant of health outcomes and is often associated with having obesity. It is unclear, however, if this association persists in elderly populations.

METHODS: We conducted a cross-sectional study of 2868 participants' aged 65+ years from the Health and Retirement Study. Multivariate logistic regression was used to assess associations between food insecurity and body mass index, demographic characteristics, psychiatric history, and medical history.

RESULTS: Participants with overweight/obesity had a higher prevalence of food insecurity than leaner counterparts, however, weight status was not a significant predictor of food insecurity after multivariate adjustment. Instead, mental illness, current smoking status, and non-White race were all independently associated with food insecurity.

DISCUSSION: Beyond financial status, health care providers are encouraged to use these characteristics to identify elderly patients that may be at risk of food insecurity.

%B Journal of Nutrition in Gerontology and Geriatrics %V 38 %P 149-172 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/30794096?dopt=Abstract %R 10.1080/21551197.2019.1565901 %0 Journal Article %J Nature Communications %D 2019 %T A meta-analysis of genome-wide association studies identifies multiple longevity genes. %A Deelen, Joris %A Daniel S Evans %A Dan E Arking %A Tesi, Niccolò %A Nygaard, Marianne %A Liu, Xiaomin %A Wojczynski, Mary K %A Biggs, Mary L %A van der Spek, Ashley %A Atzmon, Gil %A Erin B Ware %A Sarnowski, Chloé %A Albert Vernon Smith %A Seppälä, Ilkka %A Cordell, Heather J %A Dose, Janina %A Amin, Najaf %A Alice M. Arnold %A Kristin L. Ayers %A Barzilai, Nir %A Becker, Elizabeth J %A Beekman, Marian %A Blanché, Hélène %A Christensen, Kaare %A Christiansen, Lene %A Collerton, Joanna C %A Cubaynes, Sarah %A Steven R Cummings %A Davies, Karen %A Debrabant, Birgit %A Deleuze, Jean-François %A Duncan, Rachel %A Jessica Faul %A Franceschi, Claudio %A Galan, Pilar %A Gudnason, Vilmundur %A Tamara B Harris %A Huisman, Martijn %A Hurme, Mikko A %A Jagger, Carol %A Jansen, Iris %A Jylhä, Marja %A Kähönen, Mika %A Karasik, David %A Sharon L R Kardia %A Kingston, Andrew %A Kirkwood, Thomas B L %A Lenore J Launer %A Lehtimäki, Terho %A Lieb, Wolfgang %A Lyytikäinen, Leo-Pekka %A Martin-Ruiz, Carmen %A Min, Junxia %A Nebel, Almut %A Anne B Newman %A Nie, Chao %A Nohr, Ellen A %A Orwoll, Eric S %A Thomas T Perls %A Province, Michael A %A Psaty, Bruce M %A Olli T Raitakari %A Reinders, Marcel J T %A Robine, Jean-Marie %A Rotter, Jerome I %A Sebastiani, Paola %A Jennifer A Smith %A Sørensen, Thorkild I A %A Kent D Taylor %A André G Uitterlinden %A van der Flier, Wiesje %A Sven J van der Lee %A Cornelia M van Duijn %A van Heemst, Diana %A James W Vaupel %A David R Weir %A Ye, Kenny %A Zeng, Yi %A Zheng, Wanlin %A Holstege, Henne %A Douglas P Kiel %A Kathryn L Lunetta %A Eline P Slagboom %A Joanne M Murabito %K genes %K Genome-Wide Association Study %K GWA %K longevity genes %K meta-analysis %X

Human longevity is heritable, but genome-wide association (GWA) studies have had limited success. Here, we perform two meta-analyses of GWA studies of a rigorous longevity phenotype definition including 11,262/3484 cases surviving at or beyond the age corresponding to the 90th/99th survival percentile, respectively, and 25,483 controls whose age at death or at last contact was at or below the age corresponding to the 60th survival percentile. Consistent with previous reports, rs429358 (apolipoprotein E (ApoE) ε4) is associated with lower odds of surviving to the 90th and 99th percentile age, while rs7412 (ApoE ε2) shows the opposite. Moreover, rs7676745, located near GPR78, associates with lower odds of surviving to the 90th percentile age. Gene-level association analysis reveals a role for tissue-specific expression of multiple genes in longevity. Finally, genetic correlation of the longevity GWA results with that of several disease-related phenotypes points to a shared genetic architecture between health and longevity.

%B Nature Communications %V 10 %P 3669 %8 08/2019 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31413261 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/31413261?dopt=Abstract %R 10.1038/s41467-019-11558-2 %0 Thesis %B Nursing %D 2019 %T Modeling the Impact of Chronic Disease on Work Life %A Allman, Violeta Suzara %K Chronic disease %K Disease %K modeling %K working %X This study utilizes historic chronic disease and employment data from the University of Michigan Health and Retirement Study (HRS) to specify a multivariate regression model for forecasting the impact of specific chronic diseases on work life. The purpose of the study is to create a new model for forecasting chronic disease-adjusted work life years, which is a measure of disease burden due to chronic disease. The ability to work may be considered a proxy for quality of life, as it is a means by which a person preserves their financial independence and maintains their financial capacity for self-care. This forecasting model is germane to advanced nursing practice, as it provides practitioners a tool to measure patients’ ability to work given various scenarios of chronic disease – many of which, are preventable. This tool may be useful for motivating patients to adopt healthy lifxestyle behaviors such as smoking cessation, weight loss, exercise, and adopting healthy eating habits so they may change chronic disease trajectories and preserve their ability to work and financially provide for themselves and their families. This advocacy and promotion of patient health through self-care is a cornerstone of advanced nursing practice (Thrasher, 2002). Furthermore, this tool may also be useful for calculating or forecasting disease burden in terms of an individual’s attenuated work years or lost productivity. On a larger scale, this tool may be used to calculate lost labor force participation of a population or group of individuals. These statistics may be used as quality improvement measures, economic forecasting data, or for justifying healthcare policy changes or for the allocation of healthcare resources. %B Nursing %I University of Arizona %C Tucson, AZ %V Ph.D. in D.N.P. %8 2019 %G eng %U http://hdl.handle.net/10150/633228 %0 Journal Article %J Nature Communications %D 2019 %T Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity. %A Kilpeläinen, Tuomas O %A Bentley, Amy R %A Noordam, Raymond %A Yun Ju Sung %A Schwander, Karen %A Thomas W Winkler %A Jakupović, Hermina %A Daniel I Chasman %A Alisa Manning %A Ntalla, Ioanna %A Aschard, Hugues %A Brown, Michael R %A de Las Fuentes, Lisa %A Franceschini, Nora %A Guo, Xiuqing %A Vojinovic, Dina %A Aslibekyan, Stella %A Feitosa, Mary F %A Kho, Minjung %A Musani, Solomon K %A Melissa Richard %A Wang, Heming %A Wang, Zhe %A Traci M Bartz %A Bielak, Lawrence F %A Campbell, Archie %A Dorajoo, Rajkumar %A Fisher, Virginia %A Hartwig, Fernando P %A Horimoto, Andrea R V R %A Li, Changwei %A Kurt Lohman %A Marten, Jonathan %A Sim, Xueling %A Smith, Albert V %A Tajuddin, Salman M %A Alver, Maris %A Amini, Marzyeh %A Boissel, Mathilde %A Jin-Fang Chai %A Chen, Xu %A Divers, Jasmin %A Evangelou, Evangelos %A Gao, Chuan %A Graff, Mariaelisa %A Sarah E Harris %A He, Meian %A Hsu, Fang-Chi %A Jackson, Anne U %A Jing Hua Zhao %A Kraja, Aldi T %A Kühnel, Brigitte %A Laguzzi, Federica %A Lyytikäinen, Leo-Pekka %A Ilja M Nolte %A Rauramaa, Rainer %A Riaz, Muhammad %A Robino, Antonietta %A Rueedi, Rico %A Heather M Stringham %A Takeuchi, Fumihiko %A van der Most, Peter J %A Varga, Tibor V %A Verweij, Niek %A Erin B Ware %A Wen, Wanqing %A Li, Xiaoyin %A Yanek, Lisa R %A Amin, Najaf %A Donna K Arnett %A Boerwinkle, Eric %A Brumat, Marco %A Brian E Cade %A Canouil, Mickaël %A Chen, Yii-Der Ida %A Concas, Maria Pina %A Connell, John %A de Mutsert, Renée %A de Silva, H Janaka %A de Vries, Paul S %A Demirkan, Ayse %A Ding, Jingzhong %A Charles B Eaton %A Jessica Faul %A Friedlander, Yechiel %A Gabriel, Kelley P %A Ghanbari, Mohsen %A Giulianini, Franco %A Gu, Chi Charles %A Gu, Dongfeng %A Tamara B Harris %A He, Jiang %A Heikkinen, Sami %A Heng, Chew-Kiat %A Hunt, Steven C %A Ikram, M Arfan %A Jost Bruno Jonas %A Koh, Woon-Puay %A Komulainen, Pirjo %A Krieger, Jose E %A Stephen B Kritchevsky %A Kutalik, Zoltán %A Kuusisto, Johanna %A Langefeld, Carl D %A Langenberg, Claudia %A Lenore J Launer %A Leander, Karin %A Lemaitre, Rozenn N %A Lewis, Cora E %A Liang, Jingjing %A Liu, Jianjun %A Mägi, Reedik %A Manichaikul, Ani %A Meitinger, Thomas %A Andres Metspalu %A Milaneschi, Yuri %A Mohlke, Karen L %A Thomas H Mosley %A Murray, Alison D %A Michael A Nalls %A Nang, Ei-Ei Khaing %A Nelson, Christopher P %A Nona, Sotoodehnia %A Norris, Jill M %A Nwuba, Chiamaka Vivian %A Jeff O'Connell %A Palmer, Nicholette D %A Papanicolau, George J %A Pazoki, Raha %A Nancy L Pedersen %A Peters, Annette %A Peyser, Patricia A %A Polasek, Ozren %A David J Porteous %A Poveda, Alaitz %A Olli T Raitakari %A Rich, Stephen S %A Neil Risch %A Robinson, Jennifer G %A Rose, Lynda M %A Rudan, Igor %A Schreiner, Pamela J %A Scott, Robert A %A Stephen Sidney %A Sims, Mario %A Smith, Jennifer A %A Snieder, Harold %A Sofer, Tamar %A John M Starr %A Sternfeld, Barbara %A Strauch, Konstantin %A Tang, Hua %A Kent D Taylor %A Tsai, Michael Y %A Tuomilehto, Jaakko %A André G Uitterlinden %A van der Ende, M Yldau %A van Heemst, Diana %A Voortman, Trudy %A Waldenberger, Melanie %A Wennberg, Patrik %A Wilson, Gregory %A Xiang, Yong-Bing %A Yao, Jie %A Yu, Caizheng %A Yuan, Jian-Min %A Zhao, Wei %A Alan B Zonderman %A Becker, Diane M %A Boehnke, Michael %A Bowden, Donald W %A de Faire, Ulf %A Ian J Deary %A Elliott, Paul %A Tõnu Esko %A Freedman, Barry I %A Froguel, Philippe %A Paolo P. Gasparini %A Gieger, Christian %A Kato, Norihiro %A Laakso, Markku %A Lakka, Timo A %A Lehtimäki, Terho %A Patrik K E Magnusson %A Oldehinkel, Albertine J %A Brenda W J H Penninx %A Nilesh J Samani %A Shu, Xiao-Ou %A van der Harst, Pim %A Jana V. van Vliet-Ostaptchouk %A Vollenweider, Peter %A Wagenknecht, Lynne E %A Wang, Ya X %A Wareham, Nicholas J %A David R Weir %A Wu, Tangchun %A Zheng, Wei %A Zhu, Xiaofeng %A Michele K Evans %A Franks, Paul W %A Gudnason, Vilmundur %A Caroline Hayward %A Horta, Bernardo L %A Tanika N Kelly %A Liu, Yongmei %A Kari E North %A Pereira, Alexandre C %A Ridker, Paul M %A Tai, E Shyong %A van Dam, Rob M %A Fox, Ervin R %A Sharon L R Kardia %A Liu, Ching-Ti %A Dennis O Mook-Kanamori %A Province, Michael A %A Redline, Susan %A Cornelia M van Duijn %A Rotter, Jerome I %A Charles Kooperberg %A Gauderman, W James %A Psaty, Bruce M %A Kenneth Rice %A Munroe, Patricia B %A Myriam Fornage %A Cupples, L Adrienne %A Charles N Rotimi %A Alanna C Morrison %A Rao, Dabeeru C %A Ruth J F Loos %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Asians %K Blacks %K Brazil %K Calcium-Binding Proteins %K Cholesterol %K Cholesterol, HDL %K Cholesterol, LDL %K Exercise %K Female %K Genetic Loci %K Genome-Wide Association Study %K Genotype %K Hispanic or Latino %K Humans %K LIM-Homeodomain Proteins %K Lipid Metabolism %K Lipids %K Male %K Membrane Proteins %K Microtubule-Associated Proteins %K Middle Aged %K Muscle Proteins %K Nerve Tissue Proteins %K Transcription Factors %K Triglycerides %K Whites %K Young Adult %X

Many genetic loci affect circulating lipid levels, but it remains unknown whether lifestyle factors, such as physical activity, modify these genetic effects. To identify lipid loci interacting with physical activity, we performed genome-wide analyses of circulating HDL cholesterol, LDL cholesterol, and triglyceride levels in up to 120,979 individuals of European, African, Asian, Hispanic, and Brazilian ancestry, with follow-up of suggestive associations in an additional 131,012 individuals. We find four loci, in/near CLASP1, LHX1, SNTA1, and CNTNAP2, that are associated with circulating lipid levels through interaction with physical activity; higher levels of physical activity enhance the HDL cholesterol-increasing effects of the CLASP1, LHX1, and SNTA1 loci and attenuate the LDL cholesterol-increasing effect of the CNTNAP2 locus. The CLASP1, LHX1, and SNTA1 regions harbor genes linked to muscle function and lipid metabolism. Our results elucidate the role of physical activity interactions in the genetic contribution to blood lipid levels.

%B Nature Communications %V 10 %P 376 %G eng %N 1 %R 10.1038/s41467-018-08008-w %0 Journal Article %J Journal of Applied Gerontology %D 2019 %T Nature of Retirement and Loneliness: The Moderating Roles of Social Support %A Shin, O. %A So Jung Park %A Amano, T. %A Kwon, E. %A BoRin Kim %K Loneliness %K Retirement %K Social Support %X Drawing from the social convoy model, this study investigates whether the nature of retirement (voluntary or involuntary) influences loneliness among retirees, and how different social support types may affect this association. Data come from the 2014 Health and Retirement Study (N = 2,055). Five social support types were identified: weak, ambivalent, strong positive, children strain, and family strain. Involuntary retirement was associated with a higher level of loneliness; however, involuntarily retired individuals with strong positive social support had a relatively lower level of loneliness. Findings from this study suggest that social support may alleviate the negative impacts of involuntary retirement. Our research provides a theoretical basis for developing a practical program to reduce the negative impacts of involuntary retirement on well-being. © The Author(s) 2019. %B Journal of Applied Gerontology %G eng %R 10.1177/0733464819886262 %0 Journal Article %J Nature Human Behaviour %D 2019 %T New alcohol-related genes suggest shared genetic mechanisms with neuropsychiatric disorders. %A Evangelou, Evangelos %A Gao, He %A Chu, Congying %A Ntritsos, Georgios %A Blakeley, Paul %A Butts, Andrew R %A Pazoki, Raha %A Suzuki, Hideaki %A Koskeridis, Fotios %A Yiorkas, Andrianos M %A Karaman, Ibrahim %A Elliott, Joshua %A Luo, Qiang %A Aeschbacher, Stefanie %A Traci M Bartz %A Baumeister, Sebastian E %A Braund, Peter S %A Brown, Michael R %A Brody, Jennifer A %A Clarke, Toni-Kim %A Dimou, Niki %A Jessica Faul %A Homuth, Georg %A Jackson, Anne U %A Kentistou, Katherine A %A Joshi, Peter K %A Lemaitre, Rozenn N %A Penelope A Lind %A Lyytikäinen, Leo-Pekka %A Mangino, Massimo %A Milaneschi, Yuri %A Nelson, Christopher P %A Ilja M Nolte %A Perälä, Mia-Maria %A Polasek, Ozren %A David J Porteous %A Scott M Ratliff %A Smith, Jennifer A %A Stančáková, Alena %A Teumer, Alexander %A Tuominen, Samuli %A Thériault, Sébastien %A Vangipurapu, Jagadish %A Whitfield, John B %A Wood, Alexis %A Yao, Jie %A Yu, Bing %A Zhao, Wei %A Dan E Arking %A Auvinen, Juha %A Liu, Chunyu %A Männikkö, Minna %A Risch, Lorenz %A Rotter, Jerome I %A Snieder, Harold %A Veijola, Juha %A Alexandra I Blakemore %A Boehnke, Michael %A Campbell, Harry %A Conen, David %A Johan G Eriksson %A Hans-Jörgen Grabe %A Guo, Xiuqing %A van der Harst, Pim %A Catharina A Hartman %A Caroline Hayward %A Andrew C Heath %A Järvelin, Marjo-Riitta %A Kähönen, Mika %A Sharon L R Kardia %A Kühne, Michael %A Kuusisto, Johanna %A Laakso, Markku %A Lahti, Jari %A Lehtimäki, Terho %A McIntosh, Andrew M %A Mohlke, Karen L %A Alanna C Morrison %A Nicholas G Martin %A Oldehinkel, Albertine J %A Brenda W J H Penninx %A Psaty, Bruce M %A Olli T Raitakari %A Rudan, Igor %A Nilesh J Samani %A Scott, Laura J %A Timothy Spector %A Verweij, Niek %A David R Weir %A James F Wilson %A Levy, Daniel %A Tzoulaki, Ioanna %A Bell, Jimmy D %A Matthews, Paul M %A Rothenfluh, Adrian %A Desrivières, Sylvane %A Schumann, Gunter %A Elliott, Paul %K Adult %K Aged %K Alcohol Drinking %K Alcoholism %K Brain %K Female %K genes %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Magnetic Resonance Imaging %K Male %K Mental Disorders %K Middle Aged %K Neuroimaging %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %K Schizophrenia %K Whites %X

Excessive alcohol consumption is one of the main causes of death and disability worldwide. Alcohol consumption is a heritable complex trait. Here we conducted a meta-analysis of genome-wide association studies of alcohol consumption (g d) from the UK Biobank, the Alcohol Genome-Wide Consortium and the Cohorts for Heart and Aging Research in Genomic Epidemiology Plus consortia, collecting data from 480,842 people of European descent to decipher the genetic architecture of alcohol intake. We identified 46 new common loci and investigated their potential functional importance using magnetic resonance imaging data and gene expression studies. We identify genetic pathways associated with alcohol consumption and suggest genetic mechanisms that are shared with neuropsychiatric disorders such as schizophrenia.

%B Nature Human Behaviour %V 3 %P 950-961 %G eng %N 9 %R 10.1038/s41562-019-0653-z %0 Journal Article %J JAMA Intern Med %D 2019 %T One-Year Mortality After Dialysis Initiation Among Older Adults. %A Melissa W Wachterman %A O'Hare, Ann M %A Rahman, Omari-Khalid %A Karl A Lorenz %A Edward R Marcantonio %A Alicante, Gabrielle K %A Amy Kelley %K Aged %K Aged, 80 and over %K Female %K Humans %K Male %K Renal Dialysis %K United States %X This cohort study examines the incidence of mortality 1 year after the start of hemodialysis in patients 65 years and older. %B JAMA Intern Med %V 179 %P 987-990 %8 2019 07 01 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/31009039?dopt=Abstract %R 10.1001/jamainternmed.2019.0125 %0 Journal Article %J Journal of Consumer Affairs %D 2019 %T Personality and Saving Behavior Among Older Adults %A Asebedo, Sarah D. %A Wilmarth, Melissa J. %A Martin C. Seay %A Archuleta, Kristy %A Brase, Gary L. %A Maurice MacDonald %K Finances %K Personality %K Retirement Planning and Satisfaction %K Saving %X This study investigates how psychological characteristics influence saving behavior within a sample of 1,380 U.S. preretirees aged 50–70 from the Health and Retirement Study (HRS). Using the 3M Model of Motivation and Personality as a theoretical basis, structural equation model results revealed that financial self‐efficacy (FSE) directly explains saving behavior and is central to understanding the link between other psychological characteristics and the saving behavior of older adults. Through higher FSE, increased positive affect and reduced negative affect indirectly supported saving behavior. Moreover, the results revealed personality traits indirectly explained saving behavior. Conscientiousness and extroversion indirectly supported saving behavior; whereas openness to experience and neuroticism indirectly undermined saving behavior. This study connects broad personality traits with saving behavior, which provides information about how older adults' psychological composition is related to their saving practices. %B Journal of Consumer Affairs %V 53 %P 488-519 %8 09/2019 %G eng %U http://doi.wiley.com/10.1111/joca.12199http://onlinelibrary.wiley.com/wol1/doi/10.1111/joca.12199/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjoca.12199 %N 2 %! J Consum Aff %R 10.1111/joca.12199 %0 Journal Article %J Preventative Med %D 2019 %T Personality traits and preventive cancer screenings in the Health Retirement Study. %A Damaris Aschwanden %A Mary A Gerend %A Martina Luchetti %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Cancer screenings %K Personality %K Preventative Care %X The Five-Factor model of personality has been associated with a wide range of health behaviors and health outcomes. However, few studies have examined whether personality traits are related to cancer screening in older adults. The present study investigated the cross-sectional associations between personality traits and the probability of obtaining a recent preventive screening for breast, cervical, prostate, and colorectal cancer. Participants from the Health and Retirement Study (N = 14,394, M = 68.14 years, range = 50-102 years, 58.6% female) completed a personality inventory and reported on cancer screenings in the 2010-2012 assessment. Logistic regression models were used to analyze the data, including age, race, ethnicity, gender, education, income, and wealth as covariates. Higher conscientiousness was associated with a higher likelihood of obtaining breast, cervical, and prostate screening. Higher extraversion was related to higher odds of breast, cervical, and colorectal screening. Higher neuroticism was linked to higher odds of colorectal screening, and conscientiousness moderated the link between neuroticism and cervical screening. These associations were significant in models that accounted for demographic and socioeconomic factors. The effect sizes were in the range of a 10-20% higher likelihood of cancer screening for 1 SD difference in personality. The present findings suggest that conscientiousness and extraversion were related to preventive cancer screenings, whereas neuroticism, openness and agreeableness were largely unrelated to the likelihood of such screenings. If these results are further replicated, health policy makers may consider personality traits when planning and implementing screening recommendations to improve preventive medicine. %B Preventative Med %V 126 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31260725?dopt=Abstract %R 10.1016/j.ypmed.2019.105763 %0 Journal Article %J Psychology and Aging %D 2019 %T The psychology of portfolio withdrawal rates. %A Asebedo, Sarah D. %A Chris Browning %K agreeableness %K Conscientiousness %K extraversion %K Finance %K Negative Emotions %K Neuroticism %K Openness to Experience %K Personality %K Personality Traits %K portfolio withdrawal rates %K Positive Emotions %K psychological characteristics %K Retirement %K Self-efficacy %X This study investigates how personality and psychological characteristics shape portfolio withdrawal rates (PWR) within a sample of 3,678 U.S. individuals age 50 and over from the Health and Retirement Study. Structural equation model results revealed that those with greater conscientiousness, extraversion, positive affect, and financial self-efficacy have lower PWR; whereas those with greater openness, agreeableness, neuroticism, and negative affect have higher PWR. Findings from this study break new ground by establishing a link between psychological characteristics and PWR. Moreover, results provide insight to financial planning practitioners as they explore retirement income planning beyond its technical aspects and seek to maximize their clients’ satisfaction from the consumption of their retirement portfolios. (PsycINFO Database Record (c) 2019 APA, all rights reserved) %B Psychology and Aging %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31738071 %0 Journal Article %J Journal of Financial Therapy %D 2019 %T Psychosocial attributes and financial self-efficacy among older adults %A Asebedo, S.D. %K Finances %K Psychosocial %K Self-efficacy %X This study investigates the relationship between psychosocial characteristics and financial selfefficacy (FSE) within a sample of 9,187 U.S. individuals over age 50 from the Health and Retirement Study. Psychosocial factors were operationalized through the PERMA well-being construct from positive psychology: positive emotions, engagement, relationships, meaning, and accomplishment. Results of a second-order confirmatory factory analysis (CFA) within a structural equation modeling framework revealed that the PERMA construct was positively associated with FSE for the full sample, the spouse/partner sample, and the sample with children. Results also indicated that all individual PERMA elements were directly and positively associated with FSE except for engagement, which revealed a direct negative relationship. Researchers have found older adults' FSE to be vulnerable to a sustained decline; this study builds upon the literature by providing insight into how the psychosocial environment might contribute to or mitigate this decline. © 2019 Revista Civilistica. %B Journal of Financial Therapy %V 10 %P 1-29 %G eng %R 10.4148/1944-9771.1196 %0 Journal Article %J PLoS One %D 2019 %T Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. %A Ana R Quiñones %A Anda Botoseneanu %A Markwardt, Sheila %A Corey L Nagel %A Jason T Newsom %A David A Dorr %A Heather G. Allore %K Chronic conditions %K Comorbidity %K Racial/ethnic differences %X

BACKGROUND: Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.

METHODS AND FINDINGS: We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.

CONCLUSIONS: Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.

%B PLoS One %V 14 %P e0218462 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/31206556?dopt=Abstract %R 10.1371/journal.pone.0218462 %0 Journal Article %J Innovation in Aging %D 2019 %T RACIAL-ETHNIC DIFFERENCES IN THE EFFECTS OF POSITIVE AND NEGATIVE AFFECT, AND DEPRESSION ON COGNITIVE TRAJECTORIES %A Park, Soohyun %A Su Hyun Shin %A Rebecca S Allen %A Kim, Giyeon %K Cognition %K cognitive trajectories %K depression %K race %K race-ethnicity %X Purpose of study: This study investigated (1) whether positive affect(PA), negative affect(NA), and depression are related to trajectories of cognitive functioning among older adults, (2) whether PA or NA could moderate the relationship between depression and cognitive trajectories, and (3) whether there are racial/ethnic differences in the relationships among PA, NA, depression and cognitive trajectories. Design and Methods: Growth-curve modeling was conducted using the sample of 10,289 individuals in the U.S. aged 50 or older from the 2006-2014 Health and Retirement Study. Racial/ethnic groups in this study were non-Hispanic Whites (NHW, n=8.009), African Americans (AA, n=1,428), Hispanics (n=611), and others (n=241). Results: After adjusting for covariates, PA showed positive effect, and depression had negative effect on cognitive functioning trajectories (p < .05, z = 8.76, 95% CI= 0.27, 0.43; p < .05, z = -6.38, 95% CI= -0.19, -0.10). Racial/ethnic minorities (i.e., AA, Hispanics, others) exhibited lower cognitive functioning over time compared to NHW. PA significantly moderated the effect of depression on cognitive trajectories (p < .05, z = - 8.04, 95% CI = -0.19, -0.11), and the protective effect of PA against cognitive decline was pronounced for AA (p < .05, z = 2.75, 95% CI = 0.10, 0.63). Conclusion: Findings suggest that PA may protect against cognitive decline in older adults, providing a buffer against the negative effect of depression or racial/ethnic minority status on cognitive trajectories. Potential intervention strategies are discussed to assist older adults in maintaining and improving PA to promote cognitive health. %B Innovation in Aging %V 3 %P S652-S652 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igz038.2419 %0 Journal Article %J JAMA Network Open %D 2019 %T Rate of memory change before and after cancer diagnosis. %A Ospina-Romero, Monica %A Abdiwahab, Ekland %A Lindsay C Kobayashi %A Teresa Filshtein %A Willa D Brenowitz %A Elizabeth R Mayeda %A M. Maria Glymour %K Alzheimer's disease %K Cancer %K Cognitive Ability %K Memory %X

Importance: Patients with a history of cancer, even nonfatal cancers, have lower subsequent Alzheimer disease incidence. An inverse biological link between carcinogenesis and neurodegeneration has been hypothesized, although survival and detection biases are possible explanations.

Objective: To compare long-term memory trajectories before and after incident cancer with memory trajectories of similarly aged individuals not diagnosed with cancer.

Design, Setting, and Participants: This population-based cohort study included 14 583 US adults born before 1949 with no cancer history from the Health and Retirement Study. Biennial assessments were performed for up to 16 years from 1998 to 2014. Data analysis was performed from January 8 to October 5, 2018.

Exposures: Self-reported physician diagnosis of any cancer (excluding nonmelanoma skin cancer) during follow-up.

Main Outcomes and Measures: A composite memory score standardized to a mean (SD) of 0 (1) at baseline was based on immediate and delayed word-list recall and proxy assessments. The rate of memory change among people diagnosed with cancer during follow-up before and after diagnosis was compared with rate of memory change in individuals who remained cancer free during follow-up using linear mixed-effect models with random intercepts and slopes.

Results: A total of 14 583 participants were included in the sample (mean [SD] age, 66.4 [10.4] years; 8453 [58.0%] female). The mean (SD) follow-up was 11.5 (5.1) years; 2250 had a cancer diagnosis during follow-up, and 12 333 had no cancer diagnosis during follow-up. The rate of memory decline in the decade before a cancer diagnosis was 10.5% (95% CI, 6.2%-14.9%), which was slower than memory decline in similarly aged cancer-free individuals. For individuals diagnosed at 75 years of age, mean memory function immediately before diagnosis was 0.096 SD units (95% CI, 0.060-0.133 SD units) higher compared with that among similarly aged cancer-free individuals. A new cancer diagnosis was associated with a short-term decline in memory of -0.058 (95% CI, -0.084 to -0.032) SD units compared with memory before diagnosis. After diagnosis, the rate of memory decline was 3.9% (95% CI, 0.9%-6.9%) slower in individuals with cancer than in those without a cancer diagnosis.

Conclusions and Relevance: In this study, older individuals who developed cancer had better memory and slower memory decline than did similarly aged individuals who remained cancer free. These findings support the possibility of a common pathologic process working in opposite directions in cancer and Alzheimer disease.

%B JAMA Network Open %V 2 %P e196160 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/31225893?dopt=Abstract %R 10.1001/jamanetworkopen.2019.6160 %0 Journal Article %J Public Policy & Aging Report %D 2019 %T Reducing Disparities in Healthy Aging Through an Enhanced Medicare Annual Wellness Visit %A Tipirneni, Renuka %A Ganguli, Ishani %A John Z. Ayanian %A Kenneth M. Langa %K Health Disparities %K Medicare %K Well-being %X In its current form, the Medicare annual wellness visit (AWV) is not reaching most older Americans, particularly lower-income or minority adults and those served by safety-net providers (Ganguli, Souza, McWilliams, & Mehrotra, 2018). Yet these underserved seniors face disparities in healthy aging, likely due to individual, social, and behavioral determinants of health, such as low income, limited education, social isolation, food insecurity, poor housing quality, and difficulty affording medications. New AWV models should move beyond traditional assessments of cognition, balance, and vision to identify and address important root causes of poor health, such as individual, social, and behavioral determinants of health. Incorporating these key determinants of health into AWVs has the potential to promote healthy aging among underserved seniors. In this paper, we present local opportunities for AWV-related practice transformation, including screening tools, electronic health record templates, care team member roles, and workflows. At the national level, we suggest updates to Medicare’s current AWV policy guidelines with regard to visit elements and funding models. %B Public Policy & Aging Report %V 29 %P 26-32 %G eng %U https://academic.oup.com/ppar/advance-article/doi/10.1093/ppar/pry048/5251985http://academic.oup.com/ppar/advance-article-pdf/doi/10.1093/ppar/pry048/27184822/pry048.pdf %N 1 %R 10.1093/ppar/pry048 %0 Report %D 2019 %T Retirement Security and Financial Decision Making %A Philip Armour %A Carman, Katherine %A Hung, Angela %K personal savings %K retirement and retirement benefits %X Financial planning for retirement in the United States has never been more important. Americans now have greater control on how much to accumulate during their working years, and how much to deaccumulate during their retirement. With greater control also comes great responsibility for the individual. As this individual-level responsibility has increased so has the relevance of making the right claiming decision about Social Security, which for many will be the only source of life-time income protected against inflation. Longer life spans, and especially longer post-retirement life spans, have also raised long-term care costs for households, further requiring careful financial planning for retirement. The Consumer Financial Protection Bureau's Office of Older Americans seeks to provide older Americans with resources to help them plan for their retirement. To do so, they also need a greater knowledge of which populations are the most at risk. In this report, we seek to identify leading indicators of financial insecurity in retirement that can assist the Office of Older Americans in 1) identifying key decisions prior to retirement that may be correlated with insecurity in later years, and 2) identifying populations who may benefit most from targeted information. Individuals and households who are financially secure are able to meet their financial goals. In this report, we develop three measures of financial security, related to three common financial goals, among retired Health and Retirement Study (HRS) respondents. These measures cover ability to pay for regular expenses, ability to pay for long-term care costs, and the ability to bequest. Since the HRS follows the same households over time, interviewing them every two years, we investigate whether these financial security measures are associated with decisions made leading up to and during retirement. Doing so allows us to track which decisions are associated with more secure finances as retired individuals continue to age. By examining these financial security measures and how certain financial decisions are related to them, we explore whether current retirees' are able to balance between regular expenses, maintaining sufficient wealth to cover the costs of long-term care, should the need arise, protecting against longevity risks, and leaving a bequest to their heirs. %B RAND Working Paper %I RAND Corporation %C Santa Monica, CA %G eng %R https://doi.org/10.7249/WR1224 %0 Thesis %B Social Work %D 2019 %T Social Engagement Among Older Adults With Mild Cognitive Impairment and Conversion to Dementia %A Amano, Takashi %K Cognition %K cognitive impairment %K Dementia %K social engagement %X Promoting social engagement is a promising approach to prevent or delay conversion from cognitive impairment no dementia (CIND) to dementia. However, little is known about social engagement among people with CIND. This dissertation project aimed to improve understanding of social engagement among people with CIND by addressing gaps in the literature. It had three specific aims including: to describe and identify factors associated with heterogeneity of social engagement among older adults with CIND, to assess the association between heterogeneity of social engagement and conversion from CIND to dementia, and to investigate the relationship among heterogeneity of social engagement, other types of activity engagement, and conversion from CIND to dementia. Data from two waves (2010 and 2014) of the Health and Retirement Study (HRS) were used. The sample consisted of 1,227 people who were classified as having CIND in 2010. To identify the heterogeneity of social engagement, Latent Class Analysis (LCA) was utilized. Multinomial logistic regression analysis was conducted to assess the association between factors and patterns of social engagement. Using LCA, three groups were identified: Formal and informal social engagement group, Informal social engagement only group, and Low social engagement group. Some factors from four domains of WHO’s ICF model were associated with probability of having certain patterns of social engagement. To assess the relationship between heterogeneity of social engagement and conversion from CIND to dementia, binary logistic regression was utilized. The result showed that people in the formal and informal social engagement group and informal social engagement only group had significantly lower probabilities of converting to dementia in four years. To investigate the relationship among different types of activity engagement and conversion from CIND to dementia, path analysis with structural equation model was utilized. The result revealed that the relationship between having the pattern of formal and informal social engagement and lower probability of converting to dementia in four years was mediated by having higher cognitive engagements. Findings suggest that social engagement is heterogeneous among people with CIND and there are some modifiable factors to promote social engagement among them. Results of this study also imply that promoting social engagement may be promising intervention to prevent or delay conversion from CIND to dementia. Findings further indicate that promoting social engagement may be more effective and efficient strategy since it promotes other activity engagements that may prevent or delay conversion from CIND to dementia. %B Social Work %I Washington University in St. Louis %C St. Louis, MO %V Ph.D. %P 131 %8 05/2019 %G eng %U https://openscholarship.wustl.edu/art_sci_etds/1845/ %R https://doi.org/10.7936/53kh-ay12 %0 Journal Article %J Psychology and Aging %D 2019 %T Social relations and age-related change in memory. %A Laura B Zahodne %A Kristine J. Ajrouch %A Sharifian, Neika %A Toni C Antonucci %K Cognitive Ability %K Family Roles/Relationships %K Memory %K Social Support %X Previous research suggests that social relations are associated with age-related memory change. However, social relations are complex and multidimensional, and it is not yet clear which aspects (structure, quality) may be beneficial over time. Further, the strength and direction of associations may differ depending on relationship type (partner, children, other family, friends). Using longitudinal data from the Health and Retirement Study (n = 10,390; Mage = 69, SD = 9.53 at baseline), latent growth curve models tested which aspects of social relations predicted 6-year episodic memory trajectories. Both structure and quality of social relations were associated with initial memory level, such that being married/partnered, reporting more frequent contact with children and friends, reporting less support from family members other than partners and children, and reporting less strain across relationship types were each independently associated with better initial memory. In contrast, only structure was associated with subsequent memory decline. Specifically, being married/partnered and reporting more frequent contact with friends were each independently associated with slower memory decline. No evidence of bidirectionality was found, as baseline memory did not predict subsequent changes in social relations. This longitudinal study helps to clarify which aspects of social relations are most likely to influence late-life episodic memory trajectories. Future intervention studies may focus on increasing social interactions with nonfamily members to minimize memory decline with age. (PsycINFO Database Record (c) 2019 APA, all rights reserved). %B Psychology and Aging %V 34 %P 751-765 %G eng %N 6 %R 10.1037/pag0000369 %0 Journal Article %J Acta Psychiatrica Scandinavica %D 2019 %T Stability of clinically relevant depression symptoms in old-age across 11 cohorts: a multi-state study %A de la Torre-Luque, A. %A de la Fuente, J. %A Albert Sánchez-Niubó %A Francisco Félix Caballero %A Matthew Prina %A Muniz-Terrera, G. %A Haro, J. M. %A J. L. Ayuso-Mateos %K ATHLOS project %K clinically relevant symptom episode %K late-life depression %K Loneliness %K multi-state model %X Aims To study the temporal dynamics of depression symptom episodes in old‐age and the related influence of risk factors. Methods Data from 41 362 old adults (54.61% women; mean age = 75.30, SD = 6.20) from the Ageing Trajectories of Health – Longitudinal Opportunities and Synergies (ATHLOS) project were used. Depressive symptoms were followed over an 18‐year period. A multi‐state model, comprising three statuses (no depression, new clinically relevant episode of symptoms and episode persistence), was fitted. Multinomial regression was used to study the role of risk factors in status transition. Results Almost 85% of participants showed no depression, but prevalence became lower over time (B = −0.25, P < 0.001). New episode point prevalence was over 5.30% with a significant probability of moving to persistence status (transition probability = 0.27). Episode persistence became evident in 9.86% of episode status transitions, with increasing rate over time (B = 0.54, P < 0.01). Loneliness was proven to be the strongest predictor of episode emergence (OR = 17.76) and persistence (OR = 5.93). Conclusions The course of depression tends to become chronic and unremitting in old‐age. This study may help to plan interventions to tackle symptom escalation and risk factor influence. %B Acta Psychiatrica Scandinavica %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/acps.13107 %R 10.1111/acps.13107 %0 Journal Article %J Innovation in Aging %D 2019 %T TRACKING CHANGES IN MULTIMORBIDITY AMONG RACIALLY AND ETHNICALLY DIVERSE POPULATIONS %A Ana R Quiñones %A Anda Botoseneanu %A Markwardt, Sheila %A Corey L Nagel %A Jason T Newsom %A David A Dorr %A Heather G. Allore %K multimorbidity %K race-ethnicity %K Racial and ethnic differences %X Multimorbidity is widely recognized as having adverse effects on health and wellbeing above and beyond the risk attributable to individual chronic disease. Much of what is known about multimorbidity rests on research that has largely focused on one point-in-time, or from a static perspective, with little consideration to issues involved in assessing longitudinal changes in multimorbidity. In addition, less focus has been placed on assessing racial and ethnic variations in longitudinal changes of multimorbidity. Addressing this knowledge gap, we highlight important issues and considerations in addressing multimorbidity research from a longitudinal perspective and present findings from longitudinal models that examine differences in the rate of chronic disease accumulation and multimorbidity onset between non-Hispanic white (white), non-Hispanic black (black), and Hispanic study participants in the Health and Retirement Study starting in middle-age and followed for up to 16 years. %B Innovation in Aging %V 3 %P S354-S354 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igz038.1285 %0 Journal Article %J Innovation in Aging %D 2019 %T TRANSITIONING OUT OF GRANDCHILDREN CAREGIVING: EFFECTS ON GRANDPARENTS’ EMOTIONAL WELL-BEING %A Rita Xiaochen Hu %A Lydia W Li %A Toni C Antonucci %K emotional well-being %K grandchildren caregiving %K Grandparent childcare %K Grandparents %X Research has suggested that grandparents caring for grandchildren experience both psychological gains and loss. Less clear is what happens to these grandparents after they exit from the caregiving role. This study used the Health and Retirement Study (HRS) 2010 to 2014 data to examine the effects of transitioning out of caregiving on the psychological well-being of grandparents. Psychological well-being was measured by the Positive and Negative Affect Schedule. We defined caregiving grandparents as grandparents who provide 100+ hours of care per year to their grandchildren. In the first wave, 8,278 respondents in the HRS were identified as caregiving grandparents. Among them, 3,914 continued to be caregivers and 4,364 transitioned out of the caregiving role by indicating they are no longer providing care in the second wave. Grandparents who transitioned out of caregiving are more likely to be older in age, less educated and not married. Linear regression analysis was conducted to compare the two groups (continuing vs. exiting caregiving) on positive and negative affect, controlling for the first wave’s measures of the dependent variable, sociodemographic characteristics and health status of respondents. Results show that grandparents who continued caregiving had less decline in positive affect than grandparents who transitioned out of caregiving (b = -0.05, SE = 0.02, p<0.01), adjusting for covariates. But they were not significantly different in negative affect. These findings indicate that older adults may have fewer sources of joy after exiting the role of caregivers of their grandchildren. %B Innovation in Aging %V 3 %P S280 - S281 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840433/ %N Suppl 1 %! Innov Aging %0 Thesis %B Human Development and Family Studies %D 2019 %T Understanding Racial Health Differences: The Role of Stressor Exposure and Affect Reactivity %A Arredondo,Carla M. %K 0620:Developmental psychology %K 0621:Psychology %K Affect reactivity %K Developmental psychology %K Health and well-being %K Health differences %K Minority health %K Psychology %X Despite all that is known about racial differences in health and well-being outcomes, much less is known about the processes that give rise to these differences. Previous work examining racial differences in stress-health processes has primarily focused on examining stressor exposure as a predictor and posits that mediating effects account for the racial differences in health and well-being outcomes. This study expands on previous work by examining the extent to which different stressor characteristics (i.e., stressor exposure and affect reactivity) may account for racial group differences in the following health and well-being outcomes: grip strength, health conditions, self-rated health, depressive symptoms, loneliness, and life satisfaction, and by testing for both mediating and moderating effects of each stressor characteristic. Results demonstrate that there were racial differences in self-rated health, depressive symptoms, and loneliness. In all instances, Whites demonstrated more favorable outcomes compared to non-Whites. These racial differences, however, were not accounted for by mediating effects of either stressor characteristic. Furthermore, the results indicate that race moderated the association between the stressor characteristics and grip strength, loneliness, and life satisfaction. Results are discussed in light of a stress-health framework and implications for minority health and well-being are discussed. %B Human Development and Family Studies %I Colorado State University %V Master of Science %P 49 %@ 9781085569507 %G eng %U https://mountainscholar.org/handle/10217/195239 %9 phd %0 Journal Article %J Frontiers in Sociology %D 2019 %T Using Polygenic Scores in Social Science Research: Unraveling Childlessness %A Verweij, Renske M. %A Melinda C Mills %A Stulp, Gert %A Ilja M Nolte %A Nicola Barban %A Felix C Tropf %A Carrell, Douglas T. %A Aston, Kenneth I. %A Krina T Zondervan %A Rahmioglu, Nilufer %A Dalgaard, Marlene %A Skaarup, Carina %A Hayes, M. Geoffrey %A Dunaif, Andrea %A Guo, Guang %A Snieder, Harold %K childlessness %K polygenic score %K social science %X Biological, genetic, and socio-demographic factors are all important in explaining reproductive behavior, yet these factors are typically studied in isolation. In this study, we explore an innovative sociogenomic approach, which entails including key socio-demographic (marriage, education, occupation, religion, cohort) and genetic factors related to both behavioral [age at first birth (AFB), number of children ever born (NEB)] and biological fecundity-related outcomes (endometriosis, age at menopause and menarche, polycystic ovary syndrome, azoospermia, testicular dysgenesis syndrome) to explain childlessness. We examine the association of all sets of factors with childlessness as well as the interplay between them. We derive polygenic scores (PGS) from recent genome-wide association studies (GWAS) and apply these in the Health and Retirement Study (N = 10,686) and Wisconsin Longitudinal Study (N = 8,284). Both socio-demographic and genetic factors were associated with childlessness. Whilst socio-demographic factors explain 19–46% in childlessness, the current PGS explains <1% of the variance, and only PGSs from large GWASs are related to childlessness. Our findings also indicate that genetic and socio-demographic factors are not independent, with PGSs for AFB and NEB related to education and age at marriage. The explained variance by polygenic scores on childlessness is limited since it is largely a behavioral trait, with genetic explanations expected to increase somewhat in the future with better-powered GWASs. As genotyping of individuals in social science surveys becomes more prevalent, the method described in this study can be applied to other outcomes. %B Frontiers in Sociology %V 4 %P 74 %G eng %U https://www.frontiersin.org/article/10.3389/fsoc.2019.00074 %R 10.3389/fsoc.2019.00074 %0 Journal Article %J Journals of Gerontology, Series A: Biological Sciences and Medical Sciences %D 2019 %T Validation of a Claims-Based Frailty Index Against Physical Performance and Adverse Health Outcomes in the Health and Retirement Study. %A Dae H Kim %A Robert J Glynn %A Avorn, Jerry %A Lewis A Lipsitz %A Rockwood, Kenneth %A Pawar, Ajinkya %A Schneeweiss, Sebastian %K Frailty %K Medicare expenditures %K Medicare linkage %K Medicare/Medicaid/Health Insurance %X

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.

%B Journals of Gerontology, Series A: Biological Sciences and Medical Sciences %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30165612?dopt=Abstract %R 10.1093/gerona/gly197 %0 Report %D 2018 %T 2018 Alzheimer's Disease Facts & Figures %I Alzheimer's Association %C Chicago, IL %8 03/2018 %G eng %U https://www.alz.org/facts/ %0 Journal Article %J Research on Aging %D 2018 %T The Association Between Cognitive Impairment and Patterns of Activity Engagement Among Older Adults. %A Amano, Takashi %A So Jung Park %A Morrow-Howell, Nancy %K Activity engagement %K Cognitive Ability %X This study aims to assess the association between cognitive impairment and activity engagement patterns. Data from the 2012 Health and Retirement Study were used. A total of 3,943 participants aged 65 or older were included in analyses. Latent class analysis and multinomial logistic regression analysis were used. Four activity engagement profiles were identified: high activity (31.2%), active leisure (18.9%), passive leisure (28.2%), and low activity (21.7%). People in the high activity group engaged in all activities more than people in any other group, whereas people in the low activity group did not actively engage in most activities. Multinomial logistic regression analysis showed that cognitive impairment had an independent effect on the probability of being assigned to the low activity group compared to other groups. Cognitive impairment was associated with inactivity in a variety of activities. Future studies should examine supportive factors, which facilitate active patterns among people with cognitive impairment. %B Research on Aging %V 40 %P 645-667 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/28870115?dopt=Abstract %R 10.1177/0164027517728553 %0 Journal Article %J Annals of Behavioral Medicine %D 2018 %T Association Between Purpose in Life and Glucose Control Among Older Adults. %A Hafez, Dina %A Michele M Heisler %A Choi, Hwajung %A Claire K. Ankuda %A Winkelman, Tyler %A Jeffrey T Kullgren %K Biomarkers %K Diabetes %K Glutamic Acid %K Purpose in life %X

Background: Greater purpose in life is associated with lower rates of certain chronic diseases. Whether purpose in life can protect against development of prediabetes or type 2 diabetes is unknown.

Purpose: To examine the association between purpose in life and blood glucose control among adults ≥50 years.

Methods: We conducted a longitudinal cohort study of 3,907 participants of the Health and Retirement Study who at baseline did not have type 2 diabetes or prediabetes. Baseline purpose in life was measured using the Ryff and Keyes' Scales of Psychological Well-Being and grouped into tertiles (high, medium, and low). We used multivariable linear regression to examine the association between baseline purpose in life and HbA1c over 4 years. Multivariable logistic regression was used to examine the association between baseline purpose and incident prediabetes or type 2 diabetes over the same period.

Results: After adjusting for sociodemographic factors, body mass index, physical activity, and physical and mental health factors, HbA1c was 0.07 percentage points lower among participants with high purpose than those with low purpose (95% confidence interval [CI] -0.12 to -0.02; p = .011). Participants with high purpose had lower odds of developing prediabetes or type 2 diabetes than those with low purpose (adjusted odds ratio 0.78; 95% CI 0.62 to 0.98; p = .037).

Conclusions: Among older adults, greater purpose in life is associated with a lower incidence of prediabetes or type 2 diabetes. Strategies to promote greater purpose in life should be tested as a part of type 2 diabetes prevention efforts.

%B Annals of Behavioral Medicine %V 52 %P 309-318 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/30084896?dopt=Abstract %R 10.1093/abm/kax012 %0 Book Section %B Contextualizing Health and Aging in the Americas %D 2018 %T Cognitive Functioning of U.S. Adults by Race and Hispanic Origin %A Díaz-Venegas, Carlos %A Brian Downer %A Kenneth M. Langa %A Rebeca Wong %E William A. Vega %E Jacqueline L. Angel %E Gutiérrez Robledo, Luis Miguel F. %E Kyriakos S Markides %K Alzheimer's disease %K Cognitive Ability %K Hispanics %K Racial/ethnic differences %X The U.S. older adult population is becoming increasingly diverse. The evidence from research using data from diverse older adult populations indicates that Hispanics have poorer performance on cognitive tests than older non-Hispanic whites (NHW). However, the evidence that older Hispanics are at an increased risk for Alzheimer’s disease or related dementia (ADRD) than NHW is less clear. Interpreting the evidence from existing research on disparities between NHWs and Hispanics is complicated by the fact that few studies have differentiated between Hispanic subgroups by country of origin. In this chapter, we use the ethnic descriptor of Hispanic as interchangeable with Latino. We summarize the current evidence on disparities between Hispanics and NHW in cognitive functioning and ADRD, and factors that may contribute to these disparities. This summary focuses on the rationale for considering specific Hispanic populations when studying differences in cognitive functioning between Hispanics and NHWs. Finally, we present and discuss the findings from an analysis of data from the 2010 wave of the Health and Retirement Study (n = 18,982) in which we examine differences in three cognitive domains by race/ethnicity, including four Hispanic subgroups. In this analysis, all Hispanic subgroups, except Cubans, had significantly lower scores for all cognitive domains compared to NHWs, with Puerto Ricans showing the lowest scores among Hispanics. %B Contextualizing Health and Aging in the Americas %I Springer International Publishing %C Cham %P 85 - 107 %@ 978-3-030-00583-2 %G eng %U https://link.springer.com/chapter/10.1007/978-3-030-00584-9_5 %R 10.1007/978-3-030-00584-910.1007/978-3-030-00584-9_5 %0 Journal Article %J Journal of Endocrinology & Metabolism %D 2018 %T A Common DIO2 Polymorphism and Alzheimer Disease Dementia in African and European Americans %A Elizabeth A. McAninch %A Rajan, Kumar B %A Sungro Jo %A Layal Chaker %A et al. %K Alzheimer's disease %K Cognitive Ability %K Genome %X Context A common single nucleotide polymorphism in DIO2, Thr92AlaD2, has been associated with a transcriptome typically found in neurodegenerative diseases in postmortem human brain tissue. Objective To determine whether Thr92AlaD2 is associated with incident Alzheimer disease (AD). Design Population-based study; human brain tissue microarray. Setting Community-based cohorts from Chicago and northeastern Illinois and religious clergymen from across the United States constituted the primary population. A representative sample of the U.S. population was used for secondary analyses. Participants 3054 African Americans (AAs) and 9304 European Americans (EAs). Main Outcome Measure Incident AD. Results In the primary population, AAs with Thr92AlaD2 had 1.3 times [95% confidence interval (CI), 1.02 to 1.68; P = 0.048] greater odds of developing AD. AAs from a second population with Thr92AlaD2 showed a trend toward increased odds of dementia (odds ratio, 1.33; 95% CI, 0.99 to 1.78; P = 0.06) and 1.35 times greater odds of developing cognitive impairment not demented (CIND; 95% CI, 1.09 to 1.67; P = 0.006). Meta-analysis showed that AAs with Thr92AlaD2 had 1.3 times increased odds of developing AD/dementia (95% CI, 1.07 to 1.58; P = 0.008). In EAs, no association was found between Thr92AlaD2 and AD, dementia, or CIND. Microarray of AA brain tissue identified transcriptional patterns linked to AD pathogenesis. Conclusions Thr92AlaD2 was associated with molecular markers known to underlie AD pathogenesis in AAs, translating to an observed phenotype of increased odds of developing AD/dementia in AAs in these populations. Thr92AlaD2 might represent one factor contributing to racial discrepancies in incident AD. %B Journal of Endocrinology & Metabolism %V 103 %P 118-1826 %8 05/2018 %G eng %U https://academic.oup.com/jcem/article/103/5/1818/4893706 %N 5 %& 1818 %0 Journal Article %J Innovation in Aging %D 2018 %T CORRELATES AND HEALTH OUTCOMES OF LONG-TERM VOLUNTEERING: EVIDENCE FROM 16 YEARS OF THE HEALTH AND RETIREMENT STUDY %A Y Wang %A Shen, H %A Wong, R %A Amano, T %K health %K long-term volunteering %K Volunteering %K volunteering and health %X The importance and benefits of volunteering in later life has long been an interest for gerontological professionals. Most existing literature have studied volunteering using cross-sectional data or within a short period of time. While some people never stop volunteering and some never start, little is known about the profiles of these individuals. This study contributes to the literature by investigating correlates and health outcomes of long-term volunteers and non-volunteers using nationally-representative data from the 1998 to 2014 Health and Retirement Study. The present study includes individuals who were 50+ in 1998 and were alive through 2014. We further selected people who either never-stopped (25.88\%) or never-started (74.12\%) volunteering in the study period, yielding a final sample of 3,408. Logistic regression results showed that compared to non-volunteers, long-term volunteers tend to be younger, white, married, and have higher levels of education, economic status, and health status. Other significant correlates included religiosity (p\<.000), having friends living nearby (p\<.000), and living in non-urban areas (p=0.016). For health outcomes, OLS and ordered logit regression results showed that long-term volunteers had fewer number of depressive symptoms (b= -0.41, p\<.000) and better self-rated health status (OR=1.83, p\<.000), respectively. Given the significant health benefits of long-term volunteering, practitioners and policymakers are encouraged to make volunteering opportunities more accessible for people who were less likely to involve in long-term volunteering, so that they could also benefit from engaging in volunteering. Future research is encouraged to examine the mechanism among correlates, health outcomes and continuous/no engagement in volunteering. %B Innovation in Aging %V 2 %P 331-331 %8 11 %G eng %U https://doi.org/10.1093/geroni/igy023.1211 %R 10.1093/geroni/igy023.1211 %0 Journal Article %J The Journals of Gerontology: Series A %D 2018 %T Cross-Country Comparisons of Disability and Morbidity: Evidence from the Gateway to Global Aging Data %A Jinkook Lee %A Drystan F. Phillips %A Wilkens, Jenny %A Chien, Sandy %A Lin, Yu-Chen %A Marco Angrisani %A Eileen M. Crimmins %K Cross-National %K Disabilities %K Disease %K Gateway to Global Aging %X Background International comparisons of disease prevalence have been useful in understanding what proportion of disease might be preventable and in informing potential policy interventions in different cultural and economic contexts. Using newly available, harmonized data from 20 countries, we compare disability and morbidity of older adults between the ages of 55 and 74. Methods The Gateway to Global Aging Data, a data and information portal, provides access to easy-to-use individual-level longitudinal data from 10 surveys covering over 30 countries. Exploiting harmonized measures available from the Gateway, we descriptively examine how disability and morbidity differ across countries. Results Significant cross-country differences are observed for several health indicators. Comparing countries with the highest and lowest prevalence rates, we observe that hypertension rates vary twofold and stroke rates vary threefold, while disability and arthritis rates vary more than fivefold. Among women, higher gross domestic product and life expectancy are related to lower diabetes, heart disease, and better functioning. Among men, national indicators of economic conditions are not significantly associated with reported disease prevalence. Conclusions We document substantial heterogeneity in disability and morbidity across countries, separately for men and women and after controlling for population age composition and education. Rich data from various surveys across the world offers remarkable opportunities for cross-country analyses, calling for further investigation of what drives observed differences. The Gateway to Global Aging Data provides easy-to-use harmonized data files and tools to facilitate this type of research. %B The Journals of Gerontology: Series A %V 73 %P 1519-1524 %G eng %U http://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/glx224/4683782http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/glx224/22474170/glx224.pdf %N 11 %R 10.1093/gerona/glx224 %0 Journal Article %J American Journal of Medicine %D 2018 %T Death or debt? National estimates of financial toxicity in persons with newly-diagnosed cancer %A Adrienne M. Gilligan %A David S Alberts %A Denise J Roe %A Grant H Skrepnek %K Cancer %K Debt %K Financial burden %K Medical Expenses %X

PURPOSE: To evaluate the impact of cancer upon a patient's depletion of net worth and incursion of debt in the U.S.

METHODS: This longitudinal study used the Health and Retirement Study (HRS) from 1998-2014. Persons ≥50 years with newly-diagnosed malignancies were included, excluding minor skin cancers. Multivariable generalized linear models were employed to assess changes in net worth and debt (consumer, mortgage, home equity) at two-and four-years following diagnosis (Year, Year) after controlling for demographic and clinically-related variables, cancer-specific attributes, economic factors, and mortality. A two-year period prior to cancer diagnosis served as an historical control.

RESULTS: Across 9.5 million total estimated new diagnoses of cancer from 2000-2012, individuals averaged 68.6±9.4 years with slight majorities being married (54.7%), not retired (51.1%), and Medicare beneficiaries (56.6%). At Year, 42.4% depleted their entire life's assets, with higher adjusted odds associated with worsening cancer, requirement of continued treatment, socio-economic factors (i.e., increasing age/income/household size, female sex), clinical characteristics (i.e., current smoker, worse self-reported health, hypertension, diabetes, lung disease), Medicaid, and uninsured (p<0.05); average losses were -$92,098. At Year, financial insolvency extended to 38.2%, with several consistent socio-economic, cancer-related, and clinical characteristics remaining significant predictors of complete asset depletion.

CONCLUSION: Using nationally-representative data, this investigation of an estimated 9.5 million newly-diagnosed persons with cancer ≥50 years of age found a substantial proportion incurring financial toxicity. As large financial burdens have been found to adversely affect access to care and outcomes among cancer patients, the active development of approaches to mitigate these effects among already vulnerable groups remain of key importance.

%B American Journal of Medicine %V 131 %P 1187-1199 %8 10/2018 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/29906429?dopt=Abstract %R 10.1016/j.amjmed.2018.05.020 %0 Journal Article %J PLOS ONE %D 2018 %T Demographic factors and retrieval of object and proper names after age 70 %A Kavé, Gitit %A Fridkin, Shimon %A Liat Ayalon %E Vigliecca, Nora Silvana %K Cognitive Ability %K Education %K Memory %X Purpose This research aimed to investigate whether demographic factors are similarly related to retrieval of object and proper names. Methods The sample included 5,907 individuals above age 70 who participated in the Health and Retirement Study between 2004 and 2012. Participants were asked to name two objects as well as the US President and Vice President. Latent growth curve models examined the associations of age, education, and self-rated health with baseline levels and change trajectories in retrieval. Results Age and education were more strongly related to retrieval of proper names than to retrieval of object names, both for baseline scores and for change trajectory. Similar effects of selfrated health emerged for both types of stimuli. Conclusions The results show that examining object names and proper names together as indication of cognitive status in the HRS might overlook important differences between the two types of stimuli, in both baseline performance and longitudinal change. %B PLOS ONE %V 13 %P e0191876 %G eng %N 1 %! PLoS ONE %R 10.1371/journal.pone.0191876 %0 Journal Article %J Postepy Psychiatrii i Neurologii %D 2018 %T Depression and depressive symptoms as risk factors of labour deactivation and early or disability retirement in economically active adults in different age groups %A Konopko, M. %A Antosik-Wojcinska, A. %A Swiecicki, L. %A Wojnar, M. %A Bienkowski, P. %A Sienkiewicz-Jarosz, H. %K Depressive symptoms %K Disabilities %K Retirement %K SHARE %X Purpose: Over the recent years, the number of people over 54 years of age, who decide to make use of early retirement, has systematically increased. Economic inactivation is also an emerging problem in the group of younger adults. Depression or depressive symptoms should be taken into consideration in analysing variables that may play a role in the decisional process regarding occupational activities. The aim of the present work is to summarise the role of depression or depressive symptoms in the process of decision-making to continue occupational activities or to quit them. Review: The authors listed and discussed the most recent and representative surveys and studies regarding causes of retirement, concentrating especially on depression and depressive symptoms. The studies summarised here include the Health and Retirement Study, English Longitudinal Study of Ageing, Survey of Health, Ageing and Retirement in Europe and WHO's Study on Global Ageing and Adult Health. It has been shown, that prevalence of depressive symptoms of different severity in professionally active people may range from 6% to 32%. Depressive symptoms significantly increase the chance for retirement. Conclusions: Depressive disorders can affect people in all age categories and are one of the main cause of early disability retirement or early retirement tendencies. It is important to consider depressive disorders in policies supporting labour force participation. © 2018 Institute of Psychiatry and Neurology. Production and hosting by Termedia sp. z o.o. %B Postepy Psychiatrii i Neurologii %V 27 %G eng %N 1 %& 59-63 %0 Journal Article %J Journals of Gerontology Series A: Biological Sciences and Medical Sciences %D 2018 %T Determinants of health trajectories in England and the US: an approach to identify different patterns of healthy aging. %A de la Fuente, Javier %A Francisco Félix Caballero %A Albert Sánchez-Niubó %A Demosthenes B Panagiotakos %A Matthew Prina %A Arndt, Holger %A Haro, Josep Maria %A Chatterji, Somnath %A Ayuso-Mateos, José Luis %K Cross-National %K Health Trajectories %K Successful aging %X

Background: Aging is a multidimensional process with a remarkable inter-individual variability. This study is focused on identifying groups of population with similar aging patterns, and to define the health trajectories of these groups. Socio-demographic and health determinants of these trajectories are also identified.

Methods: Data from the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) were used. A set of self-reported health items and measured tests were used to generate a latent health metric by means of a Bayesian multilevel IRT model, assessing the ability of the metric to predict mortality. Then, a Growth Mixture Model (GMM) was conducted in each study to identify latent classes and assess health trajectories. Kaplan-Meier survival curves were obtained for each class and a multinomial logistic regression was used to identify determinants of these trajectories.

Results: The health score generated showed an adequate ability to predict mortality over ten years in ELSA [AUC=0.74; 95% CI=(0.72,0.75)] and HRS [AUC=0.74; 95% CI=(0.73,0.75)]. By means of GMM, four latent classes were identified in ELSA and five in HRS. Chronic conditions, no qualification and low level of household wealth were associated to the classes which showed a higher mortality in both studies.

Conclusion: The method based on the creation of a common metric of health and the use of GMM to identify similar patterns of aging, allows for the comparison of trajectories of health across longitudinal surveys. Multimorbidity, educational level and household wealth could be considered as determinants associated to these trajectories.

%B Journals of Gerontology Series A: Biological Sciences and Medical Sciences %V 73 %P 1512-1518 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/29346518?dopt=Abstract %R 10.1093/gerona/gly006 %0 Journal Article %J Journals of Gerontology Series A: Biological Sciences and Medical Sciences %D 2018 %T Does Telomere Length Indicate Biological, Physical and Cognitive Health Among Older Adults? Evidence from the Health and Retirement Study. %A Lauren L Brown %A Yuan S Zhang %A Colter Mitchell %A Jennifer A Ailshire %K Biomarkers %K Cognitive Ability %K Health Conditions and Status %K Telomeres %X Telomere length (TL) has been suggested as a biomarker that can indicate individual variability in the rate of aging. Yet, it remains unclear whether TL is related to recognized indicators of health in an aging, older nationally representative sample. We examine whether TL is associated with 15 biological, physical and cognitive markers of health among older adults ages 54+. TL was assayed from saliva using quantitative PCR (T/S ratio) in the 2008 Health and Retirement Study (n=4,074). We estimated probability of high risk levels across indictors of health by TL and age-singly and jointly. TL was associated with seven indicators of poor functioning: HDL and total cholesterol, cystatin C, pulse pressure, BMI, lung function, and walking speed. However, after adjusting for age, associations were substantially attenuated; only associations with cholesterol and lung function remained significant. Additionally, findings show TL did not add to the predictive power of chronological age in predicting poor functioning. While TL may not be a useful clinical marker of functional aging in an older adult population, it may still play an important role in longitudinal studies in young and middle aged populations that attempt to understand aging. %B Journals of Gerontology Series A: Biological Sciences and Medical Sciences %V 73 %P 905-905 %8 07/2019 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/29346517?dopt=Abstract %R 10.1093/gerona/gly001 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Drinking Patterns Among Older Couples: Longitudinal Associations With Negative Marital Quality. %A Kira S. Birditt %A James A. Cranford %A Jasmine A Manalel %A Toni C Antonucci %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Family Conflict %K Female %K Humans %K Longitudinal Studies %K Male %K Marriage %K Middle Aged %K Sex Factors %K Spouses %X

Objectives: Research with younger couples indicates that alcohol use has powerful effects on marital quality, but less work has examined the effects of drinking among older couples. This study examined whether dyadic patterns of drinking status among older couples are associated with negative marital quality over time.

Method: Married participants (N = 4864) from the Health and Retirement Study reported on alcohol consumption (whether they drink alcohol and average amount consumed per week) and negative marital quality (e.g., criticism and demands) across two waves (Wave 1 2006/2008 and Wave 2 2010/2012).

Results: Concordant drinking couples reported decreased negative marital quality over time, and these links were significantly greater among wives. Wives who reported drinking alcohol reported decreased negative marital quality over time when husbands also reported drinking and increased negative marital quality over time when husbands reported not drinking.

Discussion: The present findings stress the importance of considering the drinking status rather than the amount of alcohol consumed of both members of the couple when attempting to understand drinking and marital quality among older couples. These findings are particularly salient given the increased drinking among baby boomers and the importance of marital quality for health among older couples.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 655-665 %8 2018 04 16 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27353031 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27353031?dopt=Abstract %R 10.1093/geronb/gbw073 %0 Journal Article %J Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 2018 %T Economic downturns, retirement and long-term cognitive function among older Americans. %A Hessel, Philipp %A Carlos J Riumallo-Herl %A Anja K Leist %A Lisa F Berkman %A Mauricio Avendano %K Cognitive Ability %K Economic Downturn %K Retirement Planning and Satisfaction %X

Objective: Workers approaching retirement may be particularly vulnerable to economic downturns. This study assesses whether exposure to economic downturns around retirement age leads to poorer cognitive function in later life.

Method: Longitudinal data for 13,577 individuals in the Health and Retirement Study were linked to unemployment rates in state of residence. Random- and fixed-effect models were used to examine whether downturns at 55-64 years of age were associated with cognitive functioning levels and decline at ≥65 years, measured by the Wechsler Adult Intelligence Scale-Revised.

Results: Longer exposure to downturns at 55-64 years of age was associated with lower levels of cognitive function at ≥65 years. Compared to individuals experiencing only up to 1 year in a downturn at 55-64 years of age, individuals experiencing two downturns at these ages had 0.09 point (95% Confidence Interval [CI, -0.17, -0.02]) lower cognitive functioning scores at ≥65 years (3 years: b = -0.17, 95%CI [-0.29, -0.06]; 4 years: b = -0.14, 95%CI [-0.25, -0.02]; ≥5 years: b = -0.22, 95%CI [-0.38, -0.06]). Downturns at 55-64 years of age were not associated with rates of cognitive decline.

Discussion: Exposure to downturns around retirement is associated with a long-lasting decline in cognitive function in later life. Policies mitigating the impact of downturns on older workers may help to maintain cognitive function in later life.

%B Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %V 73 %P 744-754 %8 2017 Apr 11 %G eng %N 4 %R 10.1093/geronb/gbx035 %0 Journal Article %J Psychiatry Research %D 2018 %T On the edge: The association between extreme values of proportional felt-age and functioning %A Yuval Palgi %A Liat Ayalon %A Sharon Avidor %A Dikla Segel-Karpas %A Ehud Bodner %K Depressive symptoms %K Loneliness %K Physical limitations %K Subjective age %X The present study examined whether endorsing a felt-age that is extremely divergent from one's actual age (whether older or younger) is related to worse functioning four years later. Data were drawn from 4938 participants, who completed the 2008 and 2012 questionnaires of the Health-and-Retirement-Study (HRS). Participants were divided into four groups according to their reported proportional-felt-age: the normative-young (N = 2229), reported a normative felt-age at the median or younger; normative-old (N = 2226), reported normative felt-age at the median and older; and the extremely young and extremely old proportional-felt-age (upper and lower 5% of felt-age; N’s = 242 and 241, respectively). These groups were compared on chronic medical conditions, depressive symptoms, activities of daily living (ADL), instrumental activities of daily living (IADL), functional limitations, and loneliness. While extremely younger proportional-felt-age participants did not reveal worse (or better) outcomes compared with the normative-young group, extremely old proportional-felt-age participants reported worse physical health, mental health, and functioning in cross-sectional, as well as longitudinal comparisons. Extreme values of older proportional-felt-age are usually not reported randomly and reflect less adaptive adjustment. The findings underscore the importance of studying participants at the extreme values of felt-age, especially extreme old proportional-felt-age, and the need for further inspection of the mechanisms underlying these evaluations. %B Psychiatry Research %V 270 %P 538-543 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S0165178118310175https://api.elsevier.com/content/article/PII:S0165178118310175?httpAccept=text/xmlhttps://api.elsevier.com/content/article/PII:S0165178118310175?httpAccept=text/plain %! Psychiatry Research %R 10.1016/j.psychres.2018.10.035 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Education and Psychosocial Functioning Among Older Adults: 4-Year Change in Sense of Control and Hopelessness. %A Uchechi A Mitchell %A Jennifer A Ailshire %A Lauren L Brown %A Morgan E. Levine %A Eileen M. Crimmins %K Activities of Daily Living %K Aged %K Educational Status %K Female %K Humans %K Internal-External Control %K Male %K Middle Aged %K Psychology %K Sadness %K Social participation %K Social Support %X

OBJECTIVES: This study investigates education differences in levels and change in sense of control and hopelessness among older adults.

METHOD: We used data from the Health and Retirement Study, an ongoing biennial survey of a nationally representative sample of older Americans, to examine education differences in sense of control (e.g., mastery and perceived constraints) and hopelessness. Our sample included 8,495 adults aged 52 and older who were interviewed in 2006/2008 and 2010/2012. We assessed separate models for change in sense of control and hopelessness, accounting for recent changes in social circumstances and health status.

RESULTS: Low mastery, perceived constraints, and hopelessness were highest among individuals with less than a high school education. Over a 4-year period, this group experienced the greatest declines in psychosocial functioning, as indicated by greater increases in low mastery, perceived constraints, and hopelessness. Education differences existed net of recent negative experiences, specifically the loss of intimate social relationships and social support and increases in disease and disability.

DISCUSSION: These findings highlight the importance of education for sense of control and hopelessness in older adulthood and demonstrate the cumulative advantage of higher levels of education for psychosocial functioning.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 849-859 %8 2018 Jun 14 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/23/geronb.gbw031.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27013537?dopt=Abstract %4 Health and Retirement Study/Longitudinal analysis/Mastery/Perceived constraints %$ 999999 %R 10.1093/geronb/gbw031 %0 Journal Article %J Gerontology & Geriatric Medicine %D 2018 %T The Effect of Adherence to Screening Guidelines on the Risk of Alzheimer's Disease in Elderly Individuals Newly Diagnosed With Type 2 Diabetes Mellitus. %A Arseniy P Yashkin %A Akushevich, Igor %A Svetlana Ukraintseva %A Anatoliy Yashin %K Alzheimer's disease %K Cognitive Ability %K Diabetes %K Medicare linkage %K Screenings %X The aim of this study was to examine the possibility that type 2 diabetes and Alzheimer's disease may share common behavioral protective factors such as adherence to type 2 diabetes treatment guidelines given that these two diseases have both epidemiological and metabolic similarities. : The method used in this study is a retrospective cohort study of 3,797 U.S. Medicare fee-for-service beneficiaries aged 66+ newly diagnosed with type 2 diabetes and without a prior record of Alzheimer's disease based on the Health and Retirement Study. : Results of a left-truncated Cox model showed that adherence reduces the risk of Alzheimer's disease by 20% to 24%. Other significant effects were college education (hazard ratio [HR]: 0.65; value: .023), stroke (HR: 1.40; value: .013), and 4+ limitations in physical functioning (HR: 1.33; value: .008). : Risk of Alzheimer's disease can be reduced by behavioral factors. Possible mechanisms may include earlier start of interventions to reduce blood glucose levels and improve insulin sensitivity. %B Gerontology & Geriatric Medicine %V 4 %P 2333721418811201 %8 2018 Jan-Dec %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30450369?dopt=Abstract %R 10.1177/2333721418811201 %0 Journal Article %J Journal of Financial Counseling and Planning %D 2018 %T Financial self-efficacy and the saving behavior of older pre-retirees %A Asebedo, Sarah D. %A Martin C. Seay %K Financial literacy %K Savings %K Self-efficacy %X This study investigates the relationship between financial self-efficacy (FSE) and saving behavior within a sample of 847 U.S. pre-retirees aged 50 to 70 from the Health and Retirement Study. In accordance with the social cognitive theory of self-regulation, results revealed that FSE is positively related to saving behavior after controlling for sociodemographic attributes, financial characteristics, and saving motives. Understanding how FSE contributes to saving behavior is critical as older workers attempt to bridge the retirement saving gap. Financial counselors and planners can help this population save by cultivating and supporting clients 'FSE throughout the financial planning and counseling process. %B Journal of Financial Counseling and Planning %V 29 %P 357-368 %G eng %U http://connect.springerpub.com/lookup/doi/10.1891/1052-3073.29.2.357https://syndication.highwire.org/content/doi/10.1891/1052-3073.29.2.357 %N 2 %! Journal of Financial Counseling and Planning %R 10.1891/1052-3073.29.2.357 %0 Journal Article %J PLoS One %D 2018 %T Frailty Index associates with GRIN2B in two representative samples from the United States and the United Kingdom. %A Mekli, Krisztina %A Stevens, Adam %A Alan Marshall %A Thalida E. Arpawong %A Drystan F. Phillips %A Tampubolon, Gindo %A Lee, Jinkook %A Carol A Prescott %A James Nazroo %A Pendleton, Neil %K ELSA %K Frailty %K Gene Ontology %K Genome-Wide Association Study %K Phenotype %X

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

%B PLoS One %V 13 %P e0207824 %G eng %N 11 %R 10.1371/journal.pone.0207824 %0 Journal Article %J Nature Genetics %D 2018 %T Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals. %A Lee, James J %A Wedow, Robbee %A Okbay, Aysu %A Kong, Edward %A Maghzian, Omeed %A Zacher, Meghan %A Nguyen-Viet, Tuan Anh %A Bowers, Peter %A Sidorenko, Julia %A Richard Karlsson Linnér %A Mark Alan Fontana %A Kundu, Tushar %A Lee, Chanwook %A Hui Liu %A Li, Ruoxi %A Royer, Rebecca %A Pascal N Timshel %A Walters, Raymond K %A Willoughby, Emily A %A Yengo, Loic %A Alver, Maris %A Bao, Yanchun %A Clark, David W %A Day, Felix R %A Furlotte, Nicholas A %A Joshi, Peter K %A Kathryn E Kemper %A Kleinman, Aaron %A Langenberg, Claudia %A Mägi, Reedik %A Joey W Trampush %A Verma, Shefali Setia %A Wu, Yang %A Lam, Max %A Jing Hua Zhao %A Zheng, Zhili %A Jason D Boardman %A Campbell, Harry %A Freese, Jeremy %A Kathleen Mullan Harris %A Caroline Hayward %A Herd, Pamela %A Kumari, Meena %A Lencz, Todd %A Luan, Jian'an %A Anil K. Malhotra %A Andres Metspalu %A Lili Milani %A Ong, Ken K %A Perry, John R B %A David J Porteous %A Ritchie, Marylyn D %A Smart, Melissa C %A Smith, Blair H %A Tung, Joyce Y %A Wareham, Nicholas J %A James F Wilson %A Jonathan P. Beauchamp %A Dalton C Conley %A Tõnu Esko %A Lehrer, Steven F %A Patrik K E Magnusson %A Oskarsson, Sven %A Pers, Tune H %A Matthew R Robinson %A Thom, Kevin %A Watson, Chelsea %A Chabris, Christopher F %A Meyer, Michelle N %A David I Laibson %A Yang, Jian %A Johannesson, Magnus %A Philipp D Koellinger %A Turley, Patrick %A Peter M Visscher %A Daniel J. Benjamin %A Cesarini, David %K Adult %K Aged %K Aged, 80 and over %K Cohort Studies %K Educational Status %K Female %K Genome-Wide Association Study %K Humans %K Male %K Middle Aged %K Multifactorial Inheritance %K Phenotype %K Polymorphism, Single Nucleotide %X

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

%B Nature Genetics %V 50 %P 1112-1121 %8 2018 07 23 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/30038396?dopt=Abstract %R 10.1038/s41588-018-0147-3 %0 Journal Article %J International Journal of Obesity %D 2018 %T Generalized lambda distribution for flexibly testing differences beyond the mean in the distribution of a dependent variable such as body mass index %A Ejima, K %A Gregory Pavela %A Li, P %A Allison, D B %K BMI %K Education %K Survey Methodology %X BACKGROUND/OBJECTIVES: Conventional statistical methods often test for group differences in a single parameter of a distribution, usually the conditional mean (for example, differences in mean body mass index (BMI; kg m(-2)) by education category) under specific distributional assumptions. However, parameters other than the mean may of be interest, and the distributional assumptions of conventional statistical methods may be violated in some situations. SUBJECTS/METHODS: We describe an application of the generalized lambda distribution (GLD), a flexible distribution that can be used to model continuous outcomes, and simultaneously describe a likelihood ratio test for differences in multiple distribution parameters, including measures of central tendency, dispersion, asymmetry and steepness. We demonstrate the value of our approach by testing for differences in multiple parameters of the BMI distribution by education category using the Health and Retirement Study data set. RESULTS: Our proposed method indicated that at least one parameter of the BMI distribution differed by education category in both the complete data set (N=13 571) (P < 0.001) and a randomly resampled data set (N=300 from each category) to assess the method under circumstances of lesser power (P=0.044). Similar method using normal distribution alternative to GLD indicated the significant difference among the complete data set (P < 0.001) but not in the smaller randomly resampled data set (P=0.968). Moreover, the proposed method allowed us to specify which parameters of the BMI distribution significantly differed by education category for both the complete and the random subsample, respectively. CONCLUSIONS: Our method provides a flexible statistical approach to compare the entire distribution of variables of interest, which can be a supplement to conventional approaches that frequently require unmet assumptions and focus only on a single parameter of distribution. %B International Journal of Obesity %V 42 %P 930-933 %G eng %U http://www.nature.com/doifinder/10.1038/ijo.2017.262http://www.nature.com/doifinder/10.1038/ijo.2017.262 %N 4 %! Int J Obes Relat Metab Disord %R 10.1038/ijo.2017.262 %0 Journal Article %J Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %D 2018 %T Genetics of human longevity from incomplete data: New findings from the long life family study. %A Anatoliy Yashin %A Konstantin G Arbeev %A Wu, Deqing %A Liubov S Arbeeva %A Bagley, Olivia %A Stallard, Eric %A Alexander M Kulminski %A Akushevich, Igor %A Fang, Fang %A Wojczynski, Mary K %A Christensen, Kaare %A Anne B Newman %A Boudreau, Robert M %A Province, Michael A %A Stephen M Thielke %A Thomas T Perls %A An, Ping %A Irma Elo %A Svetlana Ukraintseva %K Genetics %K Longevity %X The special design of the Long Life Family Study provides a unique opportunity to investigate the genetics of human longevity by analyzing data on exceptional lifespans in families. In this article, we performed two series of genome wide association studies of human longevity which differed with respect to whether missing lifespan data were predicted or not predicted. We showed that the use of predicted lifespan is most beneficial when the follow-up period is relatively short. In addition to detection of strong associations of SNPs in APOE, TOMM40, NECTIN2, and APOC1 genes with longevity, we also detected a strong new association with longevity of rs1927465, located between the CYP26A1 and MYOF genes on chromosome 10. The association was confirmed using data from the Health and Retirement Study. We discuss the biological relevance of the detected SNPs to human longevity. %B Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %V 73 %P 1472-1481 %8 10/2018 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/30299504?dopt=Abstract %R 10.1093/gerona/gly057 %0 Journal Article %J Nature Genetics %D 2018 %T Genome-wide association meta-analysis in 269,867 individuals identifies new genetic and functional links to intelligence %A Savage, Jeanne E. %A Philip R Jansen %A Stringer, Sven %A Watanabe, Kyoko %A Bryois, Julien %A Christiaan de Leeuw %A Nagel, Mats %A Awasthi, Swapnil %A Barr, Peter B. %A Coleman, Jonathan R. I. %A Grasby, Katrina L. %A Anke R Hammerschlag %A Kaminski, Jakob A. %A Karlsson, Robert %A Krapohl, Eva %A Lam, Max %A Nygaard, Marianne %A Chandra A Reynolds %A Joey W Trampush %A Young, Hannah %A Zabaneh, Delilah %A Hägg, Sara %A Narelle K Hansell %A Ida Karlsson %A Linnarsson, Sten %A Grant W Montgomery %A Muñoz-Manchado, Ana B. %A Quinlan, Erin B. %A Schumann, Gunter %A Skene, Nathan G. %A Webb, Bradley T. %A White, Tonya %A Dan E Arking %A Avramopoulos, Dimitrios %A Robert M Bilder %A Bitsios, Panos %A Katherine E Burdick %A Tyrone D. Cannon %A Chiba-Falek, Ornit %A Christoforou, Andrea %A Elizabeth T. Cirulli %A Congdon, Eliza %A Corvin, Aiden %A Gail Davies %A Ian J Deary %A DeRosse, Pamela %A Dickinson, Dwight %A Djurovic, Srdjan %A Donohoe, Gary %A Conley, Emily Drabant %A Johan G Eriksson %A Espeseth, Thomas %A Nelson A. Freimer %A Giakoumaki, Stella %A Giegling, Ina %A Gill, Michael %A David C. Glahn %A Ahmad R Hariri %A Hatzimanolis, Alex %A Matthew C Keller %A Knowles, Emma %A Koltai, Deborah %A Konte, Bettina %A Lahti, Jari %A Stephanie Le Hellard %A Lencz, Todd %A David C Liewald %A London, Edythe %A Astri J Lundervold %A Anil K. Malhotra %A Melle, Ingrid %A Morris, Derek %A Anna C Need %A William E R Ollier %A Aarno Palotie %A Payton, Antony %A Pendleton, Neil %A Russell A Poldrack %A Katri Räikkönen %A Reinvang, Ivar %A Roussos, Panos %A Rujescu, Dan %A Fred W Sabb %A Matthew A Scult %A Smeland, Olav B. %A Smyrnis, Nikolaos %A John M Starr %A Vidar M Steen %A Nikos C Stefanis %A Richard E Straub %A Sundet, Kjetil %A Henning Tiemeier %A Aristotle N Voineskos %A Daniel R Weinberger %A Elisabeth Widen %A Yu, Jin %A Gonçalo R Abecasis %A Andreassen, Ole A. %A Breen, Gerome %A Christiansen, Lene %A Debrabant, Birgit %A Danielle M. Dick %A Heinz, Andreas %A Hjerling-Leffler, Jens %A Mohammed Arfan Ikram %A Kendler, Kenneth S. %A Nicholas G Martin %A Sarah E Medland %A Nancy L Pedersen %A Plomin, Robert %A Tinca J Polderman %A Ripke, Stephan %A van der Sluis, Sophie %A Patrick F. Sullivan %A Scott Vrieze %A Margaret J Wright %A Posthuma, Danielle %K Genome-Wide Association Study %K Intelligence %K Meta-analyses %X Intelligence is highly heritable1 and a major determinant of human health and well-being2. Recent genome-wide meta-analyses have identified 24 genomic loci linked to variation in intelligence3-7, but much about its genetic underpinnings remains to be discovered. Here, we present a large-scale genetic association study of intelligence (n = 269,867), identifying 205 associated genomic loci (190 new) and 1,016 genes (939 new) via positional mapping, expression quantitative trait locus (eQTL) mapping, chromatin interaction mapping, and gene-based association analysis. We find enrichment of genetic effects in conserved and coding regions and associations with 146 nonsynonymous exonic variants. Associated genes are strongly expressed in the brain, specifically in striatal medium spiny neurons and hippocampal pyramidal neurons. Gene set analyses implicate pathways related to nervous system development and synaptic structure. We confirm previous strong genetic correlations with multiple health-related outcomes, and Mendelian randomization analysis results suggest protective effects of intelligence for Alzheimer's disease and ADHD and bidirectional causation with pleiotropic effects for schizophrenia. These results are a major step forward in understanding the neurobiology of cognitive function as well as genetically related neurological and psychiatric disorders. %B Nature Genetics %V 50 %P 912 - 919 %8 Jan-07-2018 %G eng %U http://www.nature.com/articles/s41588-018-0152-6http://www.nature.com/articles/s41588-018-0152-6.pdfhttp://www.nature.com/articles/s41588-018-0152-6http://www.nature.com/articles/s41588-018-0152-6.pdf %N 7 %! Nat Genet %R 10.1038/s41588-018-0152-6 %0 Journal Article %J Journal of Psychiatric Research %D 2018 %T Genome-wide scan of depressive symptomatology in two representative cohorts in the United States and the United Kingdom. %A Mekli, Krisztina %A Drystan F. Phillips %A Thalida E. Arpawong %A Vanhoutte, Bram %A Tampubolon, Gindo %A James Nazroo %A Lee, Jinkook %A Carol A Prescott %A Stevens, Adam %A Pendleton, Neil %K depression %K ELSA %K Genome-Wide Association Study %X

Unlike the diagnosed Major Depressive Disorder, depressive symptomatology in the general population has received less attention in genome-wide association scan (GWAS) studies. Here we report a GWAS study on depressive symptomatology using a discovery-replication design and the following approaches: To improve the robustness of the phenotypic measure, we used longitudinal data and calculated mean scores for at least 3 observations for each individual. To maximize replicability, we used nearly identical genotyping platforms and identically constructed phenotypic measures in both the Discovery and Replication samples. We report one genome-wide significant hit; rs58682566 in the EPG5 gene was associated (p = 3.25E-08) with the mean of the depression symptom in the Discovery sample, without confirmation in the Replication sample. We also report 4 hits exceeding the genome-wide suggestive significance level with nominal replications. Rs11774887, rs4147527 and rs1379328, close to the SAMD12 gene, were associated with the mean depression symptom score (P-values in Discovery sample: 4.58E-06, 7.65E-06 and 7.66E-06; Replication sample: 0.049, 0.029 and 0.030, respectively). Rs13250896, located in an intergenic region, was associated with the mean score of the three somatic items of the depression symptoms score (p = 3.31E-07 and 0.042 for the Discovery and Replication samples). These results were not supported by evidence in the literature. We conclude that despite the strengths of our approach, using robust phenotypic measures and samples that maximize replicability potential, this study does not provide compelling evidence of a single genetic variant's significant role in depressive symptomatology.

%B Journal of Psychiatric Research %V 100 %P 63-70 %G eng %R 10.1016/j.jpsychires.2018.01.016 %0 Conference Paper %B American Economic Association %D 2018 %T Grandchildren and Grandparents’ Labor Force Attachment %A Brian Asquith %K Family %K Labor %X As workforces age and life expectancy grows, understanding what motivates workers to strengthen or weaken their labor force attachment is a matter of growing policy concern. This paper asks how grandparents change their labor force attachment when grandchildren arrive by first using a multigenerational sample from the Panel Study of Income Dynamics (PSID) to study individual-level responses, and then use Current Population Survey (CPS) data to study how grandparenthood trends change labor force participation rate of older male workers. Grandchildren's impact on age of retirement, hours worked, whether the grandfather is in the labor force, or the grandmother reports non-zero annual hours worked are estimated. Endogeneity between fertility timing and grandparent characteristics is instrumented for by exploiting exogenous state-by-year variation in access to reproductive technologies. I find that grandfathers work 339 fewer hours and become 19.5\% more likely to retire, while grandmothers respond to the marginal grandchild by becoming 10\% more likely to retire and working 132 fewer hours a year if non-retired. This paper shows evidence that the arrival of grandchildren does change grandparents' labor supply, but that trends in grandparenthood have only had a muted impact on trends in older men's labor force participation (LFP) rate. In a predictive exercise simulating labor force participation rates, the response to grandchildren is specification-sensitive, but interactions between grandchildren measures and Social Security benefits indicating that a 1 point increase in the fraction grandparent decreases the LFP rate by 0.18 points, and by 4.1 points with a 1 child rise in the average number of grandchildren. Collectively, across alternative fertility and grandchildren histories, trends in the simulated LFP rates do not meaningfully change from trends in the observed LFP rate, although the levels of participation would have been between 3-5 points higher between 1962-1994 if the Baby Boom had not occurred. %B American Economic Association %I NBER %G eng %U https://www.aeaweb.org/conference/2018/preliminary/3015?q=eNqrVipOLS7OzM8LqSxIVbKqhnGVrJQMlWp1lBKLi %0 Journal Article %J Journal of Medical Internet Research %D 2018 %T The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points %A Shim, Hyunju %A Jennifer A Ailshire %A Elizabeth Zelinski %A Eileen M. Crimmins %K Accessibility %K Health Behavior %K Internet usage %K Survey Methodology %X Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. %B Journal of Medical Internet Research %V 20 %P e200 %8 Jan-01-2018 %G eng %U http://www.jmir.org/2018/5/e200/ %N 5 %! J Med Internet Res %R 10.2196/jmir.8203 %0 Report %D 2018 %T Heterogeneity in expectations, risk tolerance, and household stock shares: The attenuation puzzle %A Ameriks, John %A Kezdi, Gabor %A Lee, Minjoon %A Matthew D. Shapiro %K household portfolio choice %K Risk preference %K Subjective stock returns distribution %K Survey measurement %X This paper jointly estimates the relationship between stock share and expectations and risk preferences. The survey allows individual-level, quantitative estimates of risk tolerance and of the perceived mean and variance of stock returns. These estimates have economically and statistically significant association for the distribution of stock shares with relative magnitudes in proportion with the predictions of theories. Incorporating survey measurement error in the estimation model increases the estimated associations twofold, but they are still substantially attenuated being only about 5 percent of what benchmark finance theories predict. Because of the careful attention in the estimation to measurement error, the attenuation likely arises from economic behavior rather than errors in variables. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w25269 %0 Journal Article %J Experimental Gerontology %D 2018 %T Hidden heterogeneity in Alzheimer's disease: Insights from genetic association studies and other analyses %A Anatoliy Yashin %A Fang, Fang %A Kovtun, Mikhail %A Wu, Deqing %A Duan, Matt %A Konstantin G Arbeev %A Akushevich, Igor %A Alexander M Kulminski %A Culminskaya, Irina %A Zhbannikov, Ilya %A Arseniy P Yashkin %A Stallard, Eric %A Svetlana Ukraintseva %K Alzheimer's disease %K Cancer screenings %K Genetics %K GWAS %X Despite evident success in clarifying many important features of Alzheimer's disease (AD) the efficient methods of its prevention and treatment are not yet available. The reasons are likely to be the fact that AD is a multifactorial and heterogeneous health disorder with multiple alternative pathways of disease development and progression. The availability of genetic data on individuals participated in longitudinal studies of aging health and longevity, as well as on participants of cross-sectional case-control studies allow for investigating genetic and non-genetic connections with AD and to link the results of these analyses with research findings obtained in clinical, experimental, and molecular biological studies of this health disorder. The objective of this paper is to perform GWAS of AD in several study populations and investigate possible roles of detected genetic factors in developing AD hallmarks and in other health disorders. The data collected in the Framingham Heart Study (FHS), Cardiovascular Health Study (CHS), Health and Retirement Study (HRS) and Late Onset Alzheimer's Disease Family Study (LOADFS) were used in these analyses. The logistic regression and Cox's regression were used as statistical models in GWAS. The results of analyses confirmed strong associations of genetic variants from well-known genes APOE, TOMM40, PVRL2 (NECTIN2), and APOC1 with AD. Possible roles of these genes in pathological mechanisms resulting in development of hallmarks of AD are described. Many genes whose connection with AD was detected in other studies showed nominally significant associations with this health disorder in our study. The evidence on genetic connections between AD and vulnerability to infection, as well as between AD and other health disorders, such as cancer and type 2 diabetes, were investigated. The progress in uncovering hidden heterogeneity in AD would be substantially facilitated if common mechanisms involved in development of AD, its hallmarks, and AD related chronic conditions were investigated in their mutual connection. %B Experimental Gerontology %V 107 %P 148-160 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0531556517304242 %! Experimental Gerontology %R 10.1016/j.exger.2017.10.020 %0 Journal Article %J Work, Aging and Retirement %D 2018 %T The impact of changes in episodic memory surrounding retirement on subsequent risk of disability, cardiovascular disease, and mortality %A Frank J Infurna %A Andel, Ross %K Cardiovascular disease %K Cognitive Ability %K Disabilities %K Memory %K Mortality %X Retirement is a key hallmark of life for many in modern society. The Baby Boom generation has resulted in increasing numbers of retirees. Given this trend, it is important to identify key factors that promote better health and longevity in the years following retirement. We used data from 4,266 participants of the Health and Retirement Study who retired over the course of the study to examine whether levels of episodic memory at retirement and rates of change before and after retirement would be associated with disability, cardiovascular disease, and mortality risk following retirement, above and beyond socio-demographics and known risk factors. Individuals who exhibited higher levels of episodic memory at the time of retirement and relative stability in episodic memory prior to and following retirement had a decreased likelihood for disability, cardiovascular disease incidence, and mortality following retirement. The effects of disability remained when controlling for socio-demographics and known risk factors, whereas the effects of level and change prior to retirement on cardiovascular disease incidence and mortality were no longer significant with the inclusion of known risk factors. Better episodic memory was consistently associated with lower risk of disability, cardiovascular disease, and mortality following retirement. Less decline or stability in episodic memory during the time prior to retirement was also associated with lower risk of disability and cardiovascular disease, but not with mortality risk, during the period after retirement. Our discussion focuses on the importance of maintaining episodic memory and possible mechanisms through which it affects health following retirement. %B Work, Aging and Retirement %V 4 %P 10–20 %G eng %U http://academic.oup.com/workar/article/doi/10.1093/workar/wax020/4085175/The-Impact-of-Changes-in-Episodic-Memoryhttp://academic.oup.com/workar/article-pdf/doi/10.1093/workar/wax020/19539531/wax020.pdf %N 1 %R 10.1093/workar/wax020 %0 Report %D 2018 %T Jobs for the Heartland: Place-Based Policies in 21st Century America %A Austin, Benjamin %A Edward L Glaeser %A Summers, Lawrence %K Economics %K Employment and Labor Force %K Retirement Planning and Satisfaction %X The economic convergence of American regions has greatly slowed, and rates of long-term non-employment have even been diverging. Simultaneously, the rate of non-employment for working age men has nearly tripled over the last 50 years, generating a terrible social problem that is disproportionately centered in the eastern parts of the American heartland. Should more permanent economic divisions across space lead American economists to rethink their traditional skepticism about place-based policies? We document that increases in labor demand appear to have greater impacts on employment in areas where not working has been historically high, suggesting that subsidizing employment in such places could particularly reduce the not working rate. Pro-employment policies, such as a ramped up Earned Income Tax Credit, that are targeted towards regions with more elastic employment responses, however financed, could plausibly reduce suffering and materially improve economic performance. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %P 1-85 %8 04/2018 %G eng %U http://www.nber.org/papers/w24548.pdf %R 10.3386/w24548 %0 Journal Article %J Aging Ment Health %D 2018 %T Loneliness and depressive symptoms: the moderating role of the transition into retirement. %A Dikla Segel-Karpas %A Liat Ayalon %A Margie E Lachman %K Aged %K depression %K Female %K Humans %K Loneliness %K Male %K Middle Aged %K Retirement %X

OBJECTIVES: The transition to retirement implies significant changes in daily routine and in the social environment. More specifically, it requires more self-directed efforts in order to stay socially engaged. Hence, for those who suffer from loneliness, the transition to retirement could result in increased depressive symptoms due to the lack of structured daily routine.

METHODS: We used two waves of the Health and Retirement Study, and tested whether the transition to retirement between the two waves moderates the effects of loneliness on depressive symptoms.

RESULTS: The transition to retirement moderated the effect of loneliness in wave 1 on depressive symptoms in wave 2, such that for those who retired, the effect was stronger in comparison to those who stayed employed.

CONCLUSIONS: Although many manage to easily transition into retirement, lonely older workers are at increased risk for maladjustment and the experience of depressive symptoms following retirement. This group could perhaps benefit from interventions aimed at increasing daily social interactions and establishing a socially satisfying routine.

%B Aging Ment Health %V 22 %P 135-140 %8 2018 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27624519?dopt=Abstract %R 10.1080/13607863.2016.1226770 %0 Book %D 2018 %T Long-Term Outcomes of Military Service: The Health and Well-Being of Aging Veterans %A Avron Spiro III %A Richard A. Settersten Jr. %A Aldwin, Carolyn M. %K Military service %K Veterans %I American Psychological Association %C Washington, DC %@ 978-1-4338-2804-1 %G eng %U https://www.apa.org/pubs/books/4316183 %0 Journal Article %J American Journal of Epidemiology %D 2018 %T The Mental Health Benefits of Acquiring a Home in Older Age: A Fixed-Effects Analysis of Older Americans %A Courtin, Emilie %A Jennifer B Dowd %A Mauricio Avendano %K Consumption and Savings %K Housing %K Mental Health %K Retirement Planning and Satisfaction %X Homeownership is consistently associated with better mental health, but whether becoming a homeowner in later in life has positive psychological benefits has not been examined. We assessed whether acquiring a home after 50 is associated with depression in a representative sample of older Americans. We used individual fixed-effects models based on data from 20,524 respondents aged ≥50 from the Health and Retirement Study and interviewed biannually between 1993 and 2010. Depressive symptoms were measured using the 8-item Centre for Epidemiologic Studies Depression scale. Controlling for confounders, becoming a homeowner in later life predicted a decline in depressive symptoms in the same year (β = -0.0768, 95% CI [confidence interval]: -0.152, -0.007). The association remained significant after two years (β = -0.0556, 95% CI: -0.134 to -0.001) but weakened afterwards. Buying a home for reasons associated with positive characteristics of the new house or neighborhood drove this association (β = -0.426, 95% CI: -0.786, -0.066), while acquiring a home for reasons associated with characteristics of the previous home or neighbourhood, the desire to be closer to relatives, downsizing or upsizing did not predict mental health improvements. Findings suggest that there are small but significant benefits for mental health associated with acquiring a home in older age. %B American Journal of Epidemiology %V 187 %P 465–473 %G eng %U http://academic.oup.com/aje/article/doi/10.1093/aje/kwx278/4080981/The-Mental-Health-Benefits-of-Acquiring-a-Home-inhttp://academic.oup.com/aje/article-pdf/doi/10.1093/aje/kwx278/19501585/kwx278.pdf %N 3 %R 10.1093/aje/kwx278 %0 Thesis %B Human Ecology-Personal Financial Planning %D 2018 %T Mortgage debt and retirement transition decisions. %A Anderson, Somer G. %K Bridge Employment; Retirement Transitions; Mortgage Debt %X In this study, a series of logit models for discrete time were employed to investigate the association between home mortgage debt and the retirement transition decisions of older homeowners. Retirement transitions under investigation were a) the transition from the workforce to full retirement and b) the transition from full-time work to the mutually exclusive competing risks of bridge employment and full retirement. With hypotheses informed by both the STREAM framework and results from previous studies, older homeowners with home mortgage debt were expected to exit the workforce later than those without home mortgage debt. Further, a negative relationship was expected between the loan-to-value ratio and the probability of exiting the workforce in a sample of only homeowners with home mortgage debt. Data were utilized from the 2006, 2008, 2010, 2012, and 2014 waves of the Health and Retirement Study. Results from this study revealed that, holding all else equal, older homeowners with home mortgage debt are more likely to delay their exit from the workforce. Further, the results indicate that older homeowners who are male, are college graduates, and are at the lower and upper ends of the net worth spectrum are more likely to delay their withdrawal from the workforce when they carry home mortgage debt. However, homeowners with this type of debt are not necessarily more likely to engage in bridge work between periods of full-time work and full retirement. Further, results revealed that the loan-to-value ratio was not a significant contributor to the retirement transition decisions of older homeowners with home mortgage debt. Because the presence of home mortgage debt was a factor in the retirement transition decisions of older homeowners, but the degree of leverage was not, the results from this study indicate that the psychological impact of mortgage debt might be more important in retirement transition decision-making among older homeowners than the financial impact of mortgage debt. Results from this study provide the foundation for understanding the association between home mortgage debt and the retirement transition decisions among older homeowners and should be of interest to American policymakers, financial planners and educators, business organizations, and other researchers. %B Human Ecology-Personal Financial Planning %I University of Missouri %C Columbia, MO %V Doctor of Philosophy %P 190 %8 05/2019 %G eng %U https://krex.k-state.edu/dspace/handle/2097/39519?show=full %0 Journal Article %J Health Justice %D 2018 %T Older adults in jail: high rates and early onset of geriatric conditions. %A Greene, Meredith %A Cyrus Ahalt %A Stijacic-Cenzer, Irena %A Metzger, Lia %A Brie A Williams %K Criminal justice %K Health Conditions and Status %K Public Health %X

BACKGROUND: The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ("accelerated aging"), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults.

METHODS: This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth.

RESULTS: All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older.

CONCLUSIONS: Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.

%B Health Justice %V 6 %P 3 %8 02/2018 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29455436?dopt=Abstract %R 10.1186/s40352-018-0062-9 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Perceived Age Discrimination: A Precipitator or a Consequence of Depressive Symptoms? %A Liat Ayalon %K Age Factors %K Aged %K Ageism %K depression %K Female %K Humans %K Male %K Middle Aged %K Risk Factors %K Surveys and Questionnaires %X

Objectives: The main purpose of the study was to examine a bidirectional temporal relationship between perceived age discrimination and depressive symptoms. A secondary goal was to examine whether the negative effects of perceived age discrimination on one's depressive symptoms are stronger among respondents older than 70 years old, compared with respondents between the ages of 51 and 70.

Methods: The Health and Retirement Study is a U.S. nationally representative sample of individuals over the age of 50 and their spouse of any age. A cross-lagged model was estimated to examine the reciprocal associations of depressive symptoms and perceived age discrimination, controlling for age, gender, education, ethnicity, marital status, employment status, satisfaction with financial status, number of medical conditions, mobility, strength and fine motor skills, and memory functioning.

Results: The baseline model for the overall sample resulted in adequate fit indices: CFI = .945, TLI = .940, RMSEA = .024 (90% CI = .023, .025). The cross-lagged effect of perceived age discrimination on depressive symptoms was nonsignificant (B [SE] = -.01 [.04], p = .82), whereas the cross-lagged effect of depressive symptoms on perceived age discrimination was small, but significant (B [SE] = .04 [.02], p = .03). This implies that higher levels of depressive symptoms precede a greater likelihood of perceived age discrimination, net of sociodemographic and clinical variables. The cross-lagged effects did not vary according to age group (51-70 vs >70 years old).

Discussion: The subjective nature of perceived age discrimination is discussed.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 860-869 %8 2018 06 14 %G eng %U http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw101 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27540094?dopt=Abstract %! GERONB %R 10.1093/geronb/gbw101 %0 Journal Article %J Nat Genet %D 2018 %T Protein-altering variants associated with body mass index implicate pathways that control energy intake and expenditure in obesity. %A Turcot, Valérie %A Lu, Yingchang %A Highland, Heather M %A Schurmann, Claudia %A Justice, Anne E %A Fine, Rebecca S %A Bradfield, Jonathan P %A Tõnu Esko %A Giri, Ayush %A Graff, Mariaelisa %A Guo, Xiuqing %A Hendricks, Audrey E %A Karaderi, Tugce %A Lempradl, Adelheid %A Locke, Adam E %A Mahajan, Anubha %A Marouli, Eirini %A Sivapalaratnam, Suthesh %A Young, Kristin L %A Alfred, Tamuno %A Feitosa, Mary F %A Masca, Nicholas G D %A Alisa Manning %A Medina-Gomez, Carolina %A Mudgal, Poorva %A Ng, Maggie C Y %A Reiner, Alex P %A Vedantam, Sailaja %A Willems, Sara M %A Thomas W Winkler %A Gonçalo R Abecasis %A Aben, Katja K %A Alam, Dewan S %A Alharthi, Sameer E %A Matthew A. Allison %A Amouyel, Philippe %A Asselbergs, Folkert W %A Auer, Paul L %A Balkau, Beverley %A Bang, Lia E %A Barroso, Inês %A Bastarache, Lisa %A Benn, Marianne %A Bergmann, Sven %A Bielak, Lawrence F %A Blüher, Matthias %A Boehnke, Michael %A Boeing, Heiner %A Boerwinkle, Eric %A Böger, Carsten A %A Bork-Jensen, Jette %A Bots, Michiel L %A Erwin P Bottinger %A Bowden, Donald W %A Brandslund, Ivan %A Breen, Gerome %A Brilliant, Murray H %A Broer, Linda %A Brumat, Marco %A Burt, Amber A %A Adam S Butterworth %A Campbell, Peter T %A Cappellani, Stefania %A Carey, David J %A Catamo, Eulalia %A Caulfield, Mark J %A Chambers, John C %A Daniel I Chasman %A Yii-Der I Chen %A Chowdhury, Rajiv %A Cramer Christensen %A Chu, Audrey Y %A Cocca, Massimiliano %A Collins, Francis S %A Cook, James P %A Corley, Janie %A Jordi Corominas Galbany %A Cox, Amanda J %A Crosslin, David S %A Cuellar-Partida, Gabriel %A D'Eustacchio, Angela %A Danesh, John %A Gail Davies %A Bakker, Paul I W %A Groot, Mark C H %A Mutsert, Renée %A Ian J Deary %A George Dedoussis %A Ellen W Demerath %A Heijer, Martin %A Anneke I den Hollander %A Hester M den Ruijter %A Joe G Dennis %A Denny, Josh C %A Angelantonio, Emanuele %A Drenos, Fotios %A Du, Mengmeng %A Dubé, Marie-Pierre %A Dunning, Alison M %A Easton, Douglas F %A Edwards, Todd L %A Ellinghaus, David %A Ellinor, Patrick T %A Elliott, Paul %A Evangelou, Evangelos %A Farmaki, Aliki-Eleni %A Farooqi, I Sadaf %A Jessica Faul %A Fauser, Sascha %A Feng, Shuang %A Ferrannini, Ele %A Ferrières, Jean %A Florez, Jose C %A Ford, Ian %A Myriam Fornage %A Franco, Oscar H %A Franke, Andre %A Franks, Paul W %A Friedrich, Nele %A Frikke-Schmidt, Ruth %A Galesloot, Tessel E %A Gan, Wei %A Gandin, Ilaria %A Paolo P. Gasparini %A Gibson, Jane %A Giedraitis, Vilmantas %A Gjesing, Anette P %A Gordon-Larsen, Penny %A Gorski, Mathias %A Hans-Jörgen Grabe %A Grant, Struan F A %A Grarup, Niels %A Griffiths, Helen L %A Grove, Megan L %A Gudnason, Vilmundur %A Gustafsson, Stefan %A Jeffrey Haessler %A Hakonarson, Hakon %A Anke R Hammerschlag %A Hansen, Torben %A Tamara B Harris %A Andrew T Hattersley %A Have, Christian T %A Caroline Hayward %A He, Liang %A Heard-Costa, Nancy L %A Andrew C Heath %A Iris M Heid %A Helgeland, Øyvind %A Hernesniemi, Jussi %A Hewitt, Alex W %A Oddgeir L Holmen %A Hovingh, G Kees %A Howson, Joanna M M %A Hu, Yao %A Huang, Paul L %A Huffman, Jennifer E %A Mohammed Arfan Ikram %A Ingelsson, Erik %A Jackson, Anne U %A Jansson, Jan-Håkan %A Jarvik, Gail P %A Jensen, Gorm B %A Jia, Yucheng %A Johansson, Stefan %A Jørgensen, Marit E %A Jørgensen, Torben %A Jukema, J Wouter %A Kahali, Bratati %A Kahn, René S %A Kähönen, Mika %A Kamstrup, Pia R %A Kanoni, Stavroula %A Kaprio, Jaakko %A Karaleftheri, Maria %A Sharon L R Kardia %A Karpe, Fredrik %A Kathiresan, Sekar %A Kee, Frank %A Lambertus A Kiemeney %A Eric S Kim %A Kitajima, Hidetoshi %A Komulainen, Pirjo %A Kooner, Jaspal S %A Charles Kooperberg %A Korhonen, Tellervo %A Kovacs, Peter %A Kuivaniemi, Helena %A Kutalik, Zoltán %A Kuulasmaa, Kari %A Kuusisto, Johanna %A Laakso, Markku %A Lakka, Timo A %A Lamparter, David %A Lange, Ethan M %A Leslie A Lange %A Langenberg, Claudia %A Eric B Larson %A Lee, Nanette R %A Lehtimäki, Terho %A Lewis, Cora E %A Li, Huaixing %A Li, Jin %A Li-Gao, Ruifang %A Lin, Honghuang %A Lin, Keng-Hung %A Lin, Li-An %A Lin, Xu %A Lars Lind %A Lindström, Jaana %A Linneberg, Allan %A Liu, Ching-Ti %A Liu, Dajiang J %A Yongmei Liu %A Ken Sin Lo %A Lophatananon, Artitaya %A Lotery, Andrew J %A Loukola, Anu %A Luan, Jian'an %A Lubitz, Steven A %A Lyytikäinen, Leo-Pekka %A Männistö, Satu %A Marenne, Gaëlle %A Mazul, Angela L %A McCarthy, Mark I %A McKean-Cowdin, Roberta %A Sarah E Medland %A Meidtner, Karina %A Lili Milani %A Mistry, Vanisha %A Mitchell, Paul %A Mohlke, Karen L %A Moilanen, Leena %A Moitry, Marie %A Grant W Montgomery %A Dennis O Mook-Kanamori %A Moore, Carmel %A Mori, Trevor A %A Morris, Andrew D %A Morris, Andrew P %A Müller-Nurasyid, Martina %A Munroe, Patricia B %A Michael A Nalls %A Narisu, Narisu %A Nelson, Christopher P %A Neville, Matt %A Sune Fallgaard Nielsen %A Nikus, Kjell %A Njølstad, Pål R %A Børge G Nordestgaard %A Nyholt, Dale R %A Jeff O'Connell %A O'Donoghue, Michelle L %A Ophoff, Roel A %A Owen, Katharine R %A Packard, Chris J %A Padmanabhan, Sandosh %A Palmer, Colin N A %A Palmer, Nicholette D %A Pasterkamp, Gerard %A Patel, Aniruddh P %A Pattie, Alison %A Pedersen, Oluf %A Peissig, Peggy L %A Peloso, Gina M %A Pennell, Craig E %A Markus Perola %A Perry, James A %A Perry, John R B %A Pers, Tune H %A Person, Thomas N %A Peters, Annette %A Petersen, Eva R B %A Peyser, Patricia A %A Pirie, Ailith %A Polasek, Ozren %A Tinca J Polderman %A Puolijoki, Hannu %A Olli T Raitakari %A Rasheed, Asif %A Rauramaa, Rainer %A Reilly, Dermot F %A Renstrom, Frida %A Rheinberger, Myriam %A Ridker, Paul M %A Rioux, John D %A Rivas, Manuel A %A Roberts, David J %A Neil R Robertson %A Robino, Antonietta %A Rolandsson, Olov %A Rudan, Igor %A Ruth, Katherine S %A Saleheen, Danish %A Veikko Salomaa %A Nilesh J Samani %A Sapkota, Yadav %A Sattar, Naveed %A Schoen, Robert E %A Schreiner, Pamela J %A Schulze, Matthias B %A Scott, Robert A %A Segura-Lepe, Marcelo P %A Svati H Shah %A Sheu, Wayne H-H %A Sim, Xueling %A Slater, Andrew J %A Small, Kerrin S %A Albert Vernon Smith %A Southam, Lorraine %A Timothy Spector %A Elizabeth K Speliotes %A John M Starr %A Stefansson, Kari %A Steinthorsdottir, Valgerdur %A Kathleen E Stirrups %A Strauch, Konstantin %A Heather M Stringham %A Stumvoll, Michael %A Sun, Liang %A Surendran, Praveen %A Swift, Amy J %A Tada, Hayato %A Tansey, Katherine E %A Tardif, Jean-Claude %A Kent D Taylor %A Teumer, Alexander %A Thompson, Deborah J %A Thorleifsson, Gudmar %A Thorsteinsdottir, Unnur %A Thuesen, Betina H %A Tönjes, Anke %A Tromp, Gerard %A Trompet, Stella %A Tsafantakis, Emmanouil %A Tuomilehto, Jaakko %A Tybjaerg-Hansen, Anne %A Tyrer, Jonathan P %A Uher, Rudolf %A André G Uitterlinden %A Uusitupa, Matti %A Laan, Sander W %A Duijn, Cornelia M %A Leeuwen, Nienke %A van Setten, Jessica %A Vanhala, Mauno %A Varbo, Anette %A Varga, Tibor V %A Varma, Rohit %A Digna R Velez Edwards %A Vermeulen, Sita H %A Veronesi, Giovanni %A Vestergaard, Henrik %A Vitart, Veronique %A Vogt, Thomas F %A Völker, Uwe %A Vuckovic, Dragana %A Wagenknecht, Lynne E %A Walker, Mark %A Wallentin, Lars %A Wang, Feijie %A Wang, Carol A %A Wang, Shuai %A Wang, Yiqin %A Erin B Ware %A Wareham, Nicholas J %A Warren, Helen R %A Dawn M Waterworth %A Wessel, Jennifer %A White, Harvey D %A Willer, Cristen J %A Wilson, James G %A Daniel Witte %A Andrew R Wood %A Wu, Ying %A Yaghootkar, Hanieh %A Yao, Jie %A Yao, Pang %A Laura M Yerges-Armstrong %A Young, Robin %A Zeggini, Eleftheria %A Zhan, Xiaowei %A Zhang, Weihua %A Wei Zhao %A Zhou, Wei %A Krina T Zondervan %A Rotter, Jerome I %A Pospisilik, John A %A Fernando Rivadeneira %A Ingrid B Borecki %A Deloukas, Panos %A Timothy M Frayling %A Lettre, Guillaume %A Kari E North %A Lindgren, Cecilia M %A Joel N Hirschhron %A Ruth J F Loos %X

Genome-wide association studies (GWAS) have identified >250 loci for body mass index (BMI), implicating pathways related to neuronal biology. Most GWAS loci represent clusters of common, noncoding variants from which pinpointing causal genes remains challenging. Here we combined data from 718,734 individuals to discover rare and low-frequency (minor allele frequency (MAF) < 5%) coding variants associated with BMI. We identified 14 coding variants in 13 genes, of which 8 variants were in genes (ZBTB7B, ACHE, RAPGEF3, RAB21, ZFHX3, ENTPD6, ZFR2 and ZNF169) newly implicated in human obesity, 2 variants were in genes (MC4R and KSR2) previously observed to be mutated in extreme obesity and 2 variants were in GIPR. The effect sizes of rare variants are ~10 times larger than those of common variants, with the largest effect observed in carriers of an MC4R mutation introducing a stop codon (p.Tyr35Ter, MAF = 0.01%), who weighed ~7 kg more than non-carriers. Pathway analyses based on the variants associated with BMI confirm enrichment of neuronal genes and provide new evidence for adipocyte and energy expenditure biology, widening the potential of genetically supported therapeutic targets in obesity.

%B Nat Genet %V 50 %P 26-41 %8 2018 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29273807?dopt=Abstract %R 10.1038/s41588-017-0011-x %0 Journal Article %J Journal of Banking & Finance %D 2018 %T Public health insurance and household portfolio Choices: Unravelling financial “Side Effects” of Medicare. %A Marco Angrisani %A Atella, Vincenzo %A Brunetti, Marianna %K Finances %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Stocks %X Large, unpredictable and not fully insurable health-care costs represent a source of background risk that might deter households’ financial risk taking. Using panel data from the Health and Retirement Study, we test whether universal health insurance, like Medicare for over-65 Americans, shields against this risk promoting stockholding. We adopt a fixed-effects estimation strategy, thereby taking into account household-level heterogeneity in health status and private insurance coverage. We find that, before Medicare eligibility, households in poor health, who face a higher risk of medical expenses, are less likely to hold stocks than their healthier counterparts. Yet, this gap is mostly eliminated by Medicare. Notably, the offsetting is primarily experienced by households in poor health and without private health insurance over the observation period. %B Journal of Banking & Finance %V 93 %P 198-212 %8 Jan-08-2018 %G eng %! Journal of Banking & Finance %R 10.1016/j.jbankfin.2018.05.001 %0 Journal Article %J Psychiatry Research %D 2018 %T Retirement and depressive symptoms: A 10-year cross-lagged analysis. %A Dikla Segel-Karpas %A Liat Ayalon %A Margie E Lachman %K Depressive symptoms %K Retirement Planning and Satisfaction %X The effect of retirement on depressive symptoms remains a subject of scientific inquiry, given the fact that previous studies have found mixed results. Moreover, the possible effect of depressive symptoms on the propensity to retire remains relatively understudied. Given the sheer number of retirees, and the significance of depressive symptoms for individuals' well-being and ability to work, as well as for societies at large, we used a large longitudinal dataset to examine the reciprocal effects of retirement on depressive symptoms, and of depressive symptoms on the propensity to retire. Using six waves of the Health and Retirement Study (HRS) data collected over a period of 10 years (N = 6584), we tested cross-lagged models of the reciprocal relationships between retirement and depressive symptoms. The analysis revealed that retirement results in increased depressive symptoms, and that depressive symptoms increase the likelihood of retirement. No sex differences in the lagged associations were found. We conclude that depressive symptoms are a risk factor for retirement, and practitioners should try and identify older workers suffering from depression prior to the retirement transition. Similarly, as retirement increases depressive symptoms, the transition should be treated as an important and sometimes risky milestone, where adequate preparation is required. %B Psychiatry Research %V 269 %P 565-570 %8 11/2018 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30199698?dopt=Abstract %R 10.1016/j.psychres.2018.08.081 %0 Journal Article %J American Economic Journal: Economic Policy %D 2018 %T The Role of Information in Disability Insurance Application: An Analysis of the Social Security Statement Phase-In %A Philip Armour %K Disabilities %K Long-term Care %K Social Security %K Survey Methodology %X This paper exploits a natural experiment in information provision on US Disability Insurance (DI) applications: the Social Security statement. Although the effect of the statement on DI application was negligible in the general health and retirement study population, among those previously reporting a work limitation, biennial DI application rates approximately doubled. This effect was driven by previously uninformed individuals. Additional analyses show these were new applicants and were no less likely to be accepted onto DI, accounting for a substantial fraction of the rise in DI rolls from 1994 to 2004 and indicating the importance of informational frictions in disability policymaking. %B American Economic Journal: Economic Policy %V 10 %P 1-41 %G eng %U https://pubs.aeaweb.org/doi/10.1257/pol.20160605https://pubs.aeaweb.org/doi/pdf/10.1257/pol.20160605 %N 3 %! American Economic Journal: Economic Policy %R 10.1257/pol.20160605 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2018 %T Self-perceptions of aging mediate the longitudinal relationship of hopelessness and depressive symptoms. %A Amber M Gum %A Liat Ayalon %K Depressive symptoms %K Health Conditions and Status %K Optimism %K Self-reported health %X

OBJECTIVES: The purpose of the current study was to examine the hypothesis that the prospective relationship between hopelessness and depressive symptoms is mediated by self-perceptions of aging.

METHODS: Data from 3 waves of the US Health and Retirement Study (2008, 2012, and 2014) were used (N = 4606; age M = 65.3, 55.5% female). In mediation analyses, hopelessness in 2008 was the independent variable, self-perceptions of aging in 2012 were the mediator, and depressive symptoms in 2014 were the outcome variable.

RESULTS: After controlling for covariates, hopelessness in 2008 was an independent predictor of self-perceptions of aging in 2012 (β = -.10, P < .001), and self-perceptions of aging in 2012 was an independent predictor of depressive symptoms in 2014 (β = -.41, P < .001). Hopelessness in 2008 showed both direct (β = .09, P < .001) and indirect (β = .03, P < .001) effects on depressive symptoms in 2014, indicating partial mediation by change in self-perceptions of aging.

CONCLUSIONS: As hypothesized, change in self-perceptions of aging partially mediated the relationship of hopelessness with depressive symptoms 6 years later. Findings are consistent with a conceptualization of hopelessness as broad negative expectations about the future that may contribute to negative self-perceptions of aging and subsequent changes in depressive symptoms. Reducing hopelessness, increasing hope, and improving self-perceptions of aging have potential to reduce and prevent depressive symptoms for older adults. Future research should examine the mechanisms of these interrelationships and other aging outcomes.

%B International Journal of Geriatric Psychiatry %V 33 %P 591-597 %8 04/2018 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/29205512?dopt=Abstract %R 10.1002/gps.4826 %0 Journal Article %J Advances in Life Course Research %D 2018 %T Smoking, education and the ability to predict own survival probabilities %A Bruno Arpino %A Valeria Bordone %A Sergei Scherbov %K Education %K Life Expectancy %K Smoking %X Abstract Subjective survival probabilities (SSPs) are a good predictor of mortality, go beyond the aggregate description of survival defined by life tables, and are important for individuals’ decision-making in later life. However, despite the well-known mortality differentials by education as well as by characteristics such as smoking, little investigation has focused on SSPs by population sub-groups defined as a combination of these two characteristics. We use data on individuals aged 50–89 from the Health and Retirement Study (HRS) carried out in the USA between 2000 and 2012 (N = 23,895). Respondents were asked to assess the probability to survive to a given target age according to their age at the time of the survey. We assess how individuals’ SSPs and estimated objective survival probabilities (OSPs) vary by education and smoking and calculate, for each respondent, the gap between them. Consistently with real mortality patterns, smokers report the lowest SSPs in each of the three considered education groups. When comparing SSPs and OSPs we find that all groups tend to underestimate survival. Within each education group, past smokers better predict their survival probability. Current smokers with low education show the highest probability to overestimate their survival. Smokers are aware of their lower life expectancy. Still, a considerable proportion of them overestimate their survival probabilities, independently of their level of education. %B Advances in Life Course Research %V 37 %P 23-30 %G eng %R 10.1016/J.ALCR.2018.06.001 %0 Journal Article %J Advances in Life Course Research %D 2018 %T Smoking, education and the ability to predict own survival probabilities %A Bruno Arpino %A Valeria Bordone %A Sergei Scherbov %K Decision making %K Education %K Mortality %K Probability %K Smoking %X Subjective survival probabilities (SSPs) are a good predictor of mortality, go beyond the aggregate description of survival defined by life tables, and are important for individuals' decision-making in later life. However, despite the well-known mortality differentials by education as well as by characteristics such as smoking, little investigation has focused on SSPs by population sub-groups defined as a combination of these two characteristics. We use data on individuals aged 50-89 from the Health and Retirement Study (HRS) carried out in the USA between 2000 and 2012 (N = 23,895). Respondents were asked to assess the probability to survive to a given target age according to their age at the time of the survey. We assess how individuals' SSPs and estimated objective survival probabilities (OSPs) vary by education and smoking and calculate, for each respondent, the gap between them. Consistently with real mortality patterns, smokers report the lowest SSPs in each of the three considered education groups. When comparing SSPs and OSPs we find that all groups tend to underestimate survival. Within each education group, past smokers better predict their survival probability. Current smokers with low education show the highest probability to overestimate their survival. Smokers are aware of their lower life expectancy. Still, a considerable proportion of them overestimate their survival probabilities, independently of their level of education. %B Advances in Life Course Research %V 37 %P 23 - 30 %8 Jan-09-2018 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S1040260818300650https://api.elsevier.com/content/article/PII:S1040260818300650?httpAccept=text/xmlhttps://api.elsevier.com/content/article/PII:S1040260818300650?httpAccept=text/plain %! Advances in Life Course Research %R 10.1016/j.alcr.2018.06.001 %0 Journal Article %J BMJ %D 2018 %T Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study %A Stringhini, Silvia %A Carmeli, Cristian %A Markus Jokela %A Mauricio Avendano %A McCrory, Cathal %A d’Errico, Angelo %A Bochud, Murielle %A Barros, Henrique %A Costa, Giuseppe %A Chadeau-Hyam, Marc %A Delpierre, Cyrille %A Gandini, Martina %A Fraga, Silvia %A Goldberg, Marcel %A Giles, Graham G %A Lassale, Camille %A Kenny, Rose Anne %A Kelly-Irving, Michelle %A Paccaud, Fred %A Layte, Richard %A Muennig, Peter %A Michael Marmot %A Ribeiro, Ana Isabel %A Severi, Gianluca %A Andrew Steptoe %A Shipley, Martin J %A Zins, Marie %A Johan P Mackenbach %A Vineis, Paolo %A Mika Kivimäki %K Cross-National %K Gait speed %K Risk Factors %K Socioeconomic factors %X Objective To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages. Design Multi-cohort population based study. Setting 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017. Participants 109 107 men and women aged 45-90 years. Main outcome measure Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors. Results According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors. Conclusions The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning. %B BMJ %V 360 %P k1046 %G eng %U http://www.bmj.com/lookup/doi/10.1136/bmj.k1046https://syndication.highwire.org/content/doi/10.1136/bmj.k1046http://data.bmj.org/tdm/10.1136/bmj.k1046 %! BMJ %R 10.1136/bmj.k1046 %0 Journal Article %J Nature Communications %D 2018 %T Study of 300,486 individuals identifies 148 independent genetic loci influencing general cognitive function. %A Gail Davies %A Lam, Max %A Sarah E Harris %A Joey W Trampush %A Luciano, Michelle %A W David Hill %A Hagenaars, Saskia P %A Ritchie, Stuart J %A Riccardo E Marioni %A Fawns-Ritchie, Chloe %A David C Liewald %A Okely, Judith A %A Ahola-Olli, Ari V %A Barnes, Catriona L K %A Bertram, Lars %A Joshua C. Bis %A Katherine E Burdick %A Christoforou, Andrea %A DeRosse, Pamela %A Djurovic, Srdjan %A Espeseth, Thomas %A Giakoumaki, Stella %A Giddaluru, Sudheer %A Gustavson, Daniel E %A Caroline Hayward %A Edith Hofer %A Ikram, M Arfan %A Karlsson, Robert %A Knowles, Emma %A Lahti, Jari %A Leber, Markus %A Li, Shuo %A Mather, Karen A %A Melle, Ingrid %A Morris, Derek %A Christopher J Oldmeadow %A Palviainen, Teemu %A Payton, Antony %A Pazoki, Raha %A Katja E Petrovic %A Chandra A Reynolds %A Sargurupremraj, Muralidharan %A Scholz, Markus %A Smith, Jennifer A %A Smith, Albert V %A Terzikhan, Natalie %A Thalamuthu, Anbupalam %A Trompet, Stella %A Sven J van der Lee %A Erin B Ware %A Windham, B Gwen %A Margaret J Wright %A Yang, Jingyun %A Yu, Jin %A Ames, David %A Amin, Najaf %A Amouyel, Philippe %A Andreassen, Ole A %A Armstrong, Nicola J %A Assareh, Amelia A %A John R. Attia %A Attix, Deborah %A Avramopoulos, Dimitrios %A David A Bennett %A Böhmer, Anne C %A Patricia A. Boyle %A Brodaty, Henry %A Campbell, Harry %A Tyrone D. Cannon %A Elizabeth T. Cirulli %A Congdon, Eliza %A Conley, Emily Drabant %A Corley, Janie %A Cox, Simon R %A Dale, Anders M %A Dehghan, Abbas %A Danielle M. Dick %A Dickinson, Dwight %A Johan G Eriksson %A Evangelou, Evangelos %A Jessica Faul %A Ford, Ian %A Nelson A. Freimer %A Gao, He %A Giegling, Ina %A Gillespie, Nathan A %A Gordon, Scott D %A Gottesman, Rebecca F %A Michael E Griswold %A Gudnason, Vilmundur %A Tamara B Harris %A Hartmann, Annette M %A Hatzimanolis, Alex %A Gerardo Heiss %A Holliday, Elizabeth G %A Joshi, Peter K %A Kähönen, Mika %A Sharon L R Kardia %A Ida Karlsson %A Kleineidam, Luca %A David S Knopman %A Kochan, Nicole A %A Konte, Bettina %A Kwok, John B %A Stephanie Le Hellard %A Lee, Teresa %A Lehtimäki, Terho %A Li, Shu-Chen %A Lill, Christina M %A Liu, Tian %A Koini, Marisa %A London, Edythe %A Longstreth, Will T %A Lopez, Oscar L %A Loukola, Anu %A Luck, Tobias %A Astri J Lundervold %A Lundquist, Anders %A Lyytikäinen, Leo-Pekka %A Nicholas G Martin %A Grant W Montgomery %A Murray, Alison D %A Anna C Need %A Noordam, Raymond %A Nyberg, Lars %A William E R Ollier %A Papenberg, Goran %A Pattie, Alison %A Polasek, Ozren %A Russell A Poldrack %A Psaty, Bruce M %A Reppermund, Simone %A Steffi G Riedel-Heller %A Rose, Richard J %A Rotter, Jerome I %A Roussos, Panos %A Rovio, Suvi P %A Saba, Yasaman %A Fred W Sabb %A Sachdev, Perminder S %A Satizabal, Claudia L %A Schmid, Matthias %A Rodney J Scott %A Matthew A Scult %A Simino, Jeannette %A Slagboom, P Eline %A Smyrnis, Nikolaos %A Soumaré, Aïcha %A Nikos C Stefanis %A Stott, David J %A Richard E Straub %A Sundet, Kjetil %A Taylor, Adele M %A Kent D Taylor %A Tzoulaki, Ioanna %A Tzourio, Christophe %A André G Uitterlinden %A Vitart, Veronique %A Aristotle N Voineskos %A Kaprio, Jaakko %A Wagner, Michael %A Wagner, Holger %A Weinhold, Leonie %A Wen, K Hoyan %A Elisabeth Widen %A Yang, Qiong %A Zhao, Wei %A Hieab H Adams %A Dan E Arking %A Robert M Bilder %A Bitsios, Panos %A Boerwinkle, Eric %A Chiba-Falek, Ornit %A Corvin, Aiden %A Philip L de Jager %A Debette, Stéphanie %A Donohoe, Gary %A Elliott, Paul %A Fitzpatrick, Annette L %A Gill, Michael %A David C. Glahn %A Hägg, Sara %A Narelle K Hansell %A Ahmad R Hariri %A Ikram, M Kamran %A Jukema, J Wouter %A Vuoksimaa, Eero %A Matthew C Keller %A Kremen, William S %A Lenore J Launer %A Lindenberger, Ulman %A Aarno Palotie %A Nancy L Pedersen %A Pendleton, Neil %A David J Porteous %A Katri Räikkönen %A Olli T Raitakari %A Ramirez, Alfredo %A Reinvang, Ivar %A Rudan, Igor %A Schmidt, Reinhold %A Schmidt, Helena %A Peter W Schofield %A Peter R Schofield %A John M Starr %A Vidar M Steen %A Trollor, Julian N %A Turner, Steven T %A Cornelia M van Duijn %A Villringer, Arno %A Daniel R Weinberger %A David R Weir %A James F Wilson %A Anil K. Malhotra %A McIntosh, Andrew M %A Gale, Catharine R %A Seshadri, Sudha %A Thomas H Mosley %A Bressler, Jan %A Lencz, Todd %A Ian J Deary %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Cognition %K Genetic Loci %K Genetic Predisposition to Disease %K Humans %K Mental Disorders %K Middle Aged %K Multifactorial Inheritance %K Neurodegenerative Diseases %K Neurodevelopmental Disorders %K Polymorphism, Single Nucleotide %K Reaction Time %K Young Adult %X

General cognitive function is a prominent and relatively stable human trait that is associated with many important life outcomes. We combine cognitive and genetic data from the CHARGE and COGENT consortia, and UK Biobank (total N = 300,486; age 16-102) and find 148 genome-wide significant independent loci (P < 5 × 10) associated with general cognitive function. Within the novel genetic loci are variants associated with neurodegenerative and neurodevelopmental disorders, physical and psychiatric illnesses, and brain structure. Gene-based analyses find 709 genes associated with general cognitive function. Expression levels across the cortex are associated with general cognitive function. Using polygenic scores, up to 4.3% of variance in general cognitive function is predicted in independent samples. We detect significant genetic overlap between general cognitive function, reaction time, and many health variables including eyesight, hypertension, and longevity. In conclusion we identify novel genetic loci and pathways contributing to the heritability of general cognitive function.

%B Nature Communications %V 9 %P 2098 %G eng %N 1 %R 10.1038/s41467-018-04362-x %0 Journal Article %J Journal of the American Geriatrics Society %D 2018 %T ‘Til Death Do Us Part: End-of-Life Experiences of Married Couples in a Nationally Representative Survey %A Ashwin A Kotwal %A Abdoler, Emily %A L Grisell Diaz-Ramirez %A Amy Kelley %A Katherine A Ornstein %A W John Boscardin %A Alexander K Smith %K End of life decisions %K End-of-life care %K Hospice %K Marriage %X Objectives: To determine whether end-of-life (EOL) experiences in the first spouse in a marriage are associated with EOL experiences in the other spouse. Design: Nationally representative, longitudinal survey. Setting: Health and Retirement Study, Waves 1992–2012 linked to Medicare claims. Participants: Community-dwelling older adults who died (N=4,558), representing 2,279 married heterosexual couples. Measurements: We examined 3 EOL experiences: enrollment in hospice for >3 days before death, lack of advance care planning (ACP) before death, and intensive care unit (ICU) use during the last 30 days of life. We used multiple logistic regression to determine whether the EOL experience of the first spouse was a significant predictor of the EOL experience of the second spouse after adjusting for demographic characteristics, socioeconomic status, health status, and time between the first and second spouses' deaths. Results: First spouses who died were on average 80 years old, and 62% were male; second spouses were on average 85 years old, and 62% were female. After adjustment, second spouses were more likely to use hospice if the first spouse used hospice (odds ratio (OR)=1.68, 95% confidence interval (CI)=1.29–2.20). Second spouses were less likely to have ACP when the first spouse did not have ACP (OR=2.91, 95% CI=2.02–4.21). Hospice and ACP associations were stronger when deaths were closer in time to one another (p-value for interaction <.05). Second spouses were more likely to use ICU services if the first spouse did (OR=1.80, 95% CI=1.27–2.55). Conclusions: The EOL experiences of older spouses are strongly associated, which may be relevant when framing ACP discussions. © 2018, Copyright the Author Journal compilation © 2018, The American Geriatrics Society %B Journal of the American Geriatrics Society %8 Jan-09-2020 %G eng %U http://doi.wiley.com/10.1111/jgs.15573http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15573/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.15573 %! J Am Geriatr Soc %R 10.1111/jgs.15573 %0 Journal Article %J Journal of Alzheimer's Disease %D 2018 %T Time Trends in the Prevalence of Neurocognitive Disorders and Cognitive Impairment in the United States: The Effects of Disease Severity and Improved Ascertainment %A Akushevich, Igor %A Arseniy P Yashkin %A Kravchenko, Julia %A Svetlana Ukraintseva %A Stallard, Eric %A Anatoliy Yashin %K CIND %K Cognitive Ability %K Dementia %K Medicare linkage %K Medicare/Medicaid/Health Insurance %X Background: Trends in the prevalence of cognitive impairment (CI) based on cognitive assessment instruments are often inconsistent with those of neurocognitive disorders (ND) based on Medicare claims records. Objective: We hypothesized that improved ascertainment and resulting decrease in disease severity at the time of diagnosis are responsible for this phenomenon. Methods: Using Medicare data linked to the Health and Retirement Study (1992–2012), we performed a joint analysis of trends in CI and ND to test our hypothesis. Results: We identified two major contributors to the divergent directions in CI and ND trends: reductions in disease severity explained more than 60% of the differences between CI and ND prevalence over the study period; the remaining 40% was explained by a decrease in the fraction of undiagnosed individuals. Discussion: Improvements in the diagnoses of ND diseases were a major contributor to reported trends in ND and CI. Recent forecasts of CI and ND trends in the U.S. may be overly pessimistic. %B Journal of Alzheimer's Disease %V 64 %P 137-148 %G eng %U http://www.medra.org/servlet/aliasResolver?alias=iospress&doi=10.3233/JAD-180060 %N 1 %! JAD %R 10.3233/JAD-180060 %0 Journal Article %J Journal of the American Geriatrics Society %D 2018 %T Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening. %A Geoffrey J Hoffman %A Ha, Jinkyung %A Neil B. Alexander %A Kenneth M. Langa %A Mary Tinetti %A Lillian C. Min %K Doctor visits %K Falls %K Medicare linkage %K Medicare/Medicaid/Health Insurance %X

OBJECTIVES: To compare the accuracy of and factors affecting the accuracy of self-reported fall-related injuries (SFRIs) with those of administratively obtained FRIs (AFRIs).

DESIGN: Retrospective observational study SETTING: United States PARTICIPANTS: Fee-for-service Medicare beneficiaries aged 65 and older (N=47,215).

MEASUREMENTS: We used 24-month self-report recall data from 2000-2012 Health and Retirement Study data to identify SFRIs and linked inpatient, outpatient, and ambulatory Medicare data to identify AFRIs. Sensitivity and specificity were assessed, with AFRIs defined using the University of California at Los Angeles/RAND algorithm as the criterion standard. Logistic regression models were used to identify sociodemographic and health predictors of sensitivity.

RESULTS: Overall sensitivity and specificity were 28% and 92%. Sensitivity was greater for the oldest adults (38%), women (34%), those with more functional limitations (47%), and those with a prior fall (38%). In adjusted results, several participant factors (being female, being white, poor functional status, depression, prior falls) were modestly associated with better sensitivity and specificity. Injury severity (requiring hospital care) most substantively improved SFRI sensitivity (73%).

CONCLUSION: An overwhelming 72% of individuals who received Medicare-reimbursed health care for FRIs failed to report a fall injury when asked. Future efforts to address underreporting in primary care of nonwhite and healthier older adults are critical to improve preventive efforts. Redesigned questions-for example, that address stigma of attributing injury to falling-may improve sensitivity.

%B Journal of the American Geriatrics Society %V 66 %P 1195-1200 %G eng %N 6 %R 10.1111/jgs.15360 %0 Report %D 2018 %T Unequal Places: The Impacts of Socioeconomic and Race/Ethnic Differences in Neighborhoods %A Jennifer A Ailshire %A Garcia, Katherine %K Inequality %K Low income %K Racial/ethnic differences %X The social, economic, and physical environments in which older adults live play a vital role in healthy, active, and engaged lives. But older adults live in unequal environments. Low-income older adults and older racial-ethnic minorities are more likely to live in neighborhoods characterized by poverty, disorder, lack of social cohesion, and pollution. At all income levels there is a greater propor- tion of older racial-ethnic minorities in neighborhoods with economic, social, and physical problems. Neighborhood inequality may contribute to disparities in the aging experience. %B Generations %I American Society on Aging %C San Francisco, California %P 20-27 %G eng %0 Web Page %D 2018 %T Want To Keep Your Brain Sharp? Take Care Of Your Eyes And Ears %A Aubrey, Allison %K Cognitive Ability %K Hearing aids %K Hearing loss %K News %B Shots: Health News from NPR %I NPR %C Washington, DC %V 2018 %G eng %U https://www.npr.org/sections/health-shots/2018/10/22/658810909/can-t-hear-well-fixing-hearing-loss-can-keep-your-memory-sharper %9 Web article/Audio %0 Journal Article %J Work, Aging and Retirement %D 2018 %T Work-Hour Trajectories and Depressive Symptoms Among Midlife and Older Married Couples %A Wylie H Wan %A Toni C Antonucci %A Kira S. Birditt %A Jacqui Smith %A Gwenith G Fisher %K Couples %K Depressive symptoms %K Employment and Labor Force %X Life course theories highlight the importance of understanding psychological health of aging individuals in context. Work and marriage are influential contexts in later life that are increasingly relevant because both spouses of many households work and individuals are delaying retirement. Although there is extensive literature on predictors of depressive symptoms, incorporating life course histories of work and social contexts has been a critical omission in the aging and health field. This study identifies couples’ work trajectories as a function of husband’s and wife’s weekly work hours and examines the link between couple work-hour trajectory membership and individual depressive symptoms. Data are from 1,641 married couples who participated in the 1998–2012 waves (ages 51–89) of the Health and Retirement Study (HRS). Findings revealed 6 distinct subgroups of work-hour trajectories among couples and that membership in these subgroups was associated with depressive symptoms. Retiring husbands with wives who continued to work and wives who worked minimally throughout the years (regardless of whether their husbands worked or retired) reported more depressive symptoms than other subgroups. These results suggest that work trajectories themselves, beyond current health status, may carry differential psychological health risk. Moreover, several sociodemographic and life course factors in 1998 were significant predictors of trajectory membership. These findings provide insight into midlife factors that may influence work trajectories (and the potential health risk) through to older adulthood. They suggest that a life course examination of work and social contexts is needed for a greater understanding of individual and couple health development. %B Work, Aging and Retirement %V 4 %P 108-122 %G eng %U http://academic.oup.com/workar/article/4/1/108/4762667http://academic.oup.com/workar/article-pdf/4/1/108/23002634/wax028.pdf %N 1 %R 10.1093/workar/wax028 %0 Journal Article %J American Journal of Public Health %D 2017 %T 1918 Influenza Pandemic: In Utero Exposure in the United States and Long-Term Impact on Hospitalizations. %A Acquah, Joseph Kofi %A Dahal, Roshani %A Frank A Sloan %K AHEAD %K Historical context %K Hospitalization %K Influenza %K Mortality %X

OBJECTIVES: To explore associations between in utero exposure to the 1918 influenza pandemic and hospitalization rates in old age (≥ 70 years) in the United States.

METHODS: We identified individuals exposed (mild and deadly waves) and unexposed in utero to the 1918 influenza pandemic (a natural experiment) by using birth dates from the Asset and Health Dynamics Among the Oldest Old survey. We analyzed differences in hospitalization rates by exposure status with multivariate linear regression.

RESULTS: In utero exposure to the deadly wave of the 1918 influenza pandemic increased the number of hospital visits by 10.0 per 100 persons. For those exposed in utero to the deadliest wave of the influenza pandemic, high rates of functional limitations are shown to drive the higher rates of hospitalizations in old age.

CONCLUSIONS: In utero exposure to the influenza pandemic increased functional limitations and hospitalization rates in old age. Public Health Implications. To determine investments in influenza pandemic prevention programs that protect fetal health, policymakers should include long-term reductions in hospitalizations in their cost-benefit evaluations.

%B American Journal of Public Health %V 107 %P 1477-1483 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/28727536?dopt=Abstract %R 10.2105/AJPH.2017.303887 %0 Journal Article %J European Journal of Ageing %D 2017 %T Accelerated increase and relative decrease in subjective age and changes in attitudes toward own aging over a 4-year period: results from the Health and Retirement Study %A Ehud Bodner %A Liat Ayalon %A Sharon Avidor %A Yuval Palgi %K Aging %K Cognitive Ability %K Health Conditions and Status %K Older Adults %K Self-reported health %X The passage of time may force people to adjust their subjective age in response to changes in their attitudes toward own aging (ATOA). Although positive associations have been found between well-being and both positive ATOA and younger subjective age, the relationships between changes in these measures have not been examined yet. We expected (1) a decrease in positive ATOA to be associated with an accelerated increase in subjective age and (2) an increase in positive ATOA to be associated with a relative decrease in subjective age. Participants were individuals and their spouses, aged 50 and over, recruited by the Health and Retirement Study, who provided responses to a question concerning one’s subjective age in 2008 and 2012 (n = 4174). A change in subjective age over the two waves was regarded as (1) an accelerated increase if it was greater than 5 years (36.2 % of the sample); (2) a relative decrease (39.1 %), if it was less than the 3 years; (3) no change if it did not comply with criteria 1 or 2 (24.7 %). A decrease in positive ATOA over the two waves resulted in an accelerated increase in subjective age, and an increase resulted in a relative decrease in subjective age. Older age and more physical impairments and depressive symptoms in 2012 compared with 2008 were associated with an accelerated increase in subjective age. Our findings emphasize the consequences ATOA might have on subjective age experiences, and the need to improve them. %B European Journal of Ageing %V 14 %P 17-27 %G eng %U http://link.springer.com/10.1007/s10433-016-0383-2http://link.springer.com/content/pdf/10.1007/s10433-016-0383-2http://link.springer.com/content/pdf/10.1007/s10433-016-0383-2.pdfhttp://link.springer.com/article/10.1007/s10433-016-0383-2/fulltext.html %N 1 %! Eur J Ageing %R 10.1007/s10433-016-0383-2 %0 Web Page %D 2017 %T African-Americans in New York City are two times more likely than white Americans to have Alzheimer's disease %A Alzheimer's Association - NYC Chapter %K Alzheimer's disease %K News %K Racial/ethnic differences %I PR Newswire %G eng %U http://www.prnewswire.com/news-releases/african-americans-in-new-york-city-are-two-times-more-likely-than-white-americans-to-have-alzheimers-disease-300471373.html %0 Journal Article %J Journal of Aging and Health %D 2017 %T Aging in Puerto Rico: A comparison of health status among island Puerto Rican and mainland U.S. older adults. %A Perez, Catherine %A Jennifer A Ailshire %K Cross-National %K Puerto Rico %K Racial/ethnic differences %X

OBJECTIVE: To characterize the health status of older island Puerto Ricans, a segment of the U.S. population that has been largely overlooked in aging research.

METHOD: Data from the 2002 Puerto Rican Elderly Health Conditions Project and the 2002 Health and Retirement Study are used to examine differences in disease, disability, and self-rated health among island Puerto Ricans and the mainland U.S.-born older adult population. Differences are further examined by gender.

RESULTS: Island Puerto Ricans were less likely to have heart disease, stroke, lung disease, cancer, activities of daily living (ADL) limitations, and poor self-rated health, but more likely to have hypertension and diabetes. Island Puerto Rican women had worse health relative to island Puerto Rican men.

DISCUSSION: Recent challenges in the funding and provision of health care in Puerto Rico are worrisome given the large number of aging island adults, many of whom have hypertension and diabetes, two conditions that require long-term medical care.

%B Journal of Aging and Health %V 29 %P 1056-1078 %8 09/2017 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28599584?dopt=Abstract %R 10.1177/0898264317714144 %0 Web Page %D 2017 %T Alzheimer’s Association International Conference (AAIC 2017) %A Alzheimer's Society %K Interviews %K News %B Latest news %I Alzheimer's Society %C London, UK %G eng %U https://www.alzheimers.org.uk/news/article/222/alzheimer_s_association_international_conference_aaic_2017 %0 Journal Article %J Biological Psychiatry %D 2017 %T An Analysis of Two Genome-wide Association Meta-analyses Identifies a New Locus for Broad Depression Phenotype. %A Nese Direk %A Williams, Stephanie %A Smith, Jennifer A %A Ripke, Stephan %A Air, Tracy %A Amare, Azmeraw T %A Amin, Najaf %A Baune, Bernhard T %A David A Bennett %A Blackwood, Douglas H R %A Dorret I Boomsma %A Breen, Gerome %A Buttenschøn, Henriette N %A Byrne, Enda M %A Børglum, Anders D %A Castelao, Enrique %A Cichon, Sven %A Clarke, Toni-Kim %A Marilyn C Cornelis %A Dannlowski, Udo %A Philip L de Jager %A Demirkan, Ayse %A Domenici, Enrico %A Cornelia M van Duijn %A Dunn, Erin C %A Johan G Eriksson %A Tõnu Esko %A Jessica Faul %A Luigi Ferrucci %A Myriam Fornage %A Eco J. C. de Geus %A Gill, Michael %A Gordon, Scott D %A Hans-Jörgen Grabe %A van Grootheest, Gerard %A Hamilton, Steven P %A Catharina A Hartman %A Andrew C Heath %A Karin Hek %A Hofman, Albert %A Homuth, Georg %A Horn, Carsten %A Jouke-Jan Hottenga %A Sharon L R Kardia %A Kloiber, Stefan %A Karestan C Koenen %A Kutalik, Zoltán %A Ladwig, Karl-Heinz %A Lahti, Jari %A Douglas F Levinson %A Lewis, Cathryn M %A Lewis, Glyn %A Li, Qingqin S %A David J Llewellyn %A Lucae, Susanne %A Kathryn L Lunetta %A MacIntyre, Donald J %A Pamela A F Madden %A Nicholas G Martin %A McIntosh, Andrew M %A Andres Metspalu %A Milaneschi, Yuri %A Grant W Montgomery %A Mors, Ole %A Thomas H Mosley %A Joanne M Murabito %A Müller-Myhsok, Bertram %A Markus M Nöthen %A Nyholt, Dale R %A O'Donovan, Michael C %A Brenda W J H Penninx %A Pergadia, Michele L %A Perlis, Roy %A Potash, James B %A Preisig, Martin %A Shaun M Purcell %A Quiroz, Jorge A %A Katri Räikkönen %A Rice, John P %A Rietschel, Marcella %A Rivera, Margarita %A Schulze, Thomas G %A Shi, Jianxin %A Shyn, Stanley %A Sinnamon, Grant C %A Johannes H Smit %A Smoller, Jordan W %A Snieder, Harold %A Toshiko Tanaka %A Tansey, Katherine E %A Teumer, Alexander %A Uher, Rudolf %A Umbricht, Daniel %A Van der Auwera, Sandra %A Erin B Ware %A David R Weir %A Weissman, Myrna M %A Gonneke Willemsen %A Yang, Jingyun %A Zhao, Wei %A Henning Tiemeier %A Patrick F. Sullivan %K Acid Anhydride Hydrolases %K depression %K Depressive Disorder %K Genetic Loci %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Neoplasm Proteins %K Phenotype %K Whites %X

BACKGROUND: The genetics of depression has been explored in genome-wide association studies that focused on either major depressive disorder or depressive symptoms with mostly negative findings. A broad depression phenotype including both phenotypes has not been tested previously using a genome-wide association approach. We aimed to identify genetic polymorphisms significantly associated with a broad phenotype from depressive symptoms to major depressive disorder.

METHODS: We analyzed two prior studies of 70,017 participants of European ancestry from general and clinical populations in the discovery stage. We performed a replication meta-analysis of 28,328 participants. Single nucleotide polymorphism (SNP)-based heritability and genetic correlations were calculated using linkage disequilibrium score regression. Discovery and replication analyses were performed using a p-value-based meta-analysis. Lifetime major depressive disorder and depressive symptom scores were used as the outcome measures.

RESULTS: The SNP-based heritability of major depressive disorder was 0.21 (SE = 0.02), the SNP-based heritability of depressive symptoms was 0.04 (SE = 0.01), and their genetic correlation was 1.001 (SE = 0.2). We found one genome-wide significant locus related to the broad depression phenotype (rs9825823, chromosome 3: 61,082,153, p = 8.2 × 10) located in an intron of the FHIT gene. We replicated this SNP in independent samples (p = .02) and the overall meta-analysis of the discovery and replication cohorts (1.0 × 10).

CONCLUSIONS: This large study identified a new locus for depression. Our results support a continuum between depressive symptoms and major depressive disorder. A phenotypically more inclusive approach may help to achieve the large sample sizes needed to detect susceptibility loci for depression.

%B Biological Psychiatry %V 82 %P 322-329 %G eng %N 5 %R 10.1016/j.biopsych.2016.11.013 %0 Journal Article %J Journal of the American Geriatrics Society %D 2017 %T Association between spousal caregiver well-being and care recipient healthcare expenditures %A Claire K. Ankuda %A Donovan T Maust %A Mohammed U Kabeto %A Ryan J McCammon %A Kenneth M. Langa %A Deborah A Levine %K Caregiving %K Marriage %K Medical Expenses %K Medicare/Medicaid/Health Insurance %K Well-being %X Objectives To measure the association between spousal depression, general health, fatigue and sleep, and future care recipient healthcare expenditures and emergency department (ED) use. Design Prospective cohort study. Setting Health and Retirement Study. Participants Home-dwelling spousal dyads in which one individual (care recipient) was aged 65 and older and had one or more activity of daily living or instrumental activity of daily living disabilities and was enrolled in Medicare Part B (N = 3,101). Exposure Caregiver sleep (Jenkins Sleep Scale), depressive symptoms (Center for Epidemiologic Studies Depression-8 Scale), and self-reported general health measures. Measurements Primary outcome was care recipient Medicare expenditures. Secondary outcome was care recipient ED use. Follow-up was 6 months. Results Caregiver depressive symptoms score and six of 17 caregiver well-being measures were prospectively associated with higher care recipient expenditures after minimal adjustment (P < .05). Higher care recipient expenditures remained significantly associated with caregiver fatigue (cost increase, $1,937, 95% confidence interval (CI) = $770–3,105) and caregiver sadness (cost increase, $1,323, 95% CI = $228–2,419) after full adjustment. Four of 17 caregiver well-being measures, including severe fatigue, were significantly associated with care recipient ED use after minimal adjustment (P < .05). Greater odds of care recipient ED use remained significantly associated with caregiver fatigue (odds ratio (OR) = 1.24, 95% CI = 1.01–1.52) and caregiver fair to poor health (OR = 1.23, 95% CI = 1.04–1.45) after full adjustment. Caregiver total sleep score was not associated with care recipient outcomes. Conclusion Poor caregiver well-being, particularly severe fatigue, is independently and prospectively associated with higher care recipient Medicare expenditures and ED use. %B Journal of the American Geriatrics Society %V 65 %P 2220-2226 %G eng %U http://doi.wiley.com/10.1111/jgs.15039http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15039/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.15039 %N 10 %! J Am Geriatr Soc %R 10.1111/jgs.15039 %0 Journal Article %J Obes Res Clin Pract %D 2017 %T Body weight status and telomere length in U.S. middle-aged and older adults. %A An, Ruopeng %A Yan, Hai %K Aged %K Aging %K Body Mass Index %K Body Weight %K ethnicity %K Female %K Humans %K Linear Models %K Male %K Middle Aged %K Obesity %K Overweight %K Racial Groups %K Risk Factors %K Sex Factors %K Telomere %K Telomere Shortening %K United States %K White People %X

OBJECTIVE: Telomere length has been proposed as a biomarker of biological aging. This study examined the relationship between body weight status and telomere length in U.S. middle-aged and older adults.

METHODS: Nationally representative data (N=2749) came from the Health and Retirement Study. Linear regressions were performed to examine the relationship between baseline body weight status reported in 1992 and telomere length measured in 2008 in the overall sample and by sex and racial/ethnic groups, adjusted for individual characteristics.

RESULTS: Baseline overweight (25kg/m≤body mass index [BMI]<30kg/m) and obesity (BMI≥30kg/m) status positively predicted telomere length 17 years later. Compared with their normal weight counterparts, telomere length ratio was on average 0.062 (95% confidence interval=0.016, 0.109) and 0.125 (0.048, 0.202) larger among overweight and obese adults, respectively. In comparison to women and racial/ethnic minorities, the estimated positive associations between overweight and obesity status and telomere length were more salient among men and non-Hispanic whites, respectively.

CONCLUSIONS: The positive association between body weight status and telomere length found in this study was opposite to what existing biological model predicts, and could partially relate to the nonlinear relationship between body weight status and telomere length across age cohorts, and/or the lack of reliability of BMI as an indicator for adiposity in the older population. Large-scale longitudinal studies with baseline telomere length measures are warranted to replicate this study finding and explore the potential heterogeneous relationship between body weight status and telomere length.

%B Obes Res Clin Pract %V 11 %P 51-62 %8 2017 Jan-Feb %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26895795?dopt=Abstract %R 10.1016/j.orcp.2016.01.003 %0 Journal Article %J PLoS One %D 2017 %T Bringing functional status into a big data world: Validation of national Veterans Affairs functional status data %A Rebecca T Brown %A Kiya D Komaiko %A Shi, Ying %A Kathy Z Fung %A W John Boscardin %A Au-Yeung, Alvin %A Tarasovsky, Gary %A Jacob, Riya %A Michael A Steinman %E Hernandez-Boussard, Tina %K Daily activities %K Functional status %K Veterans %X Background The ability to perform basic daily activities (“functional status”) is key to older adults’ quality of life and strongly predicts health outcomes. However, data on functional status are seldom collected during routine clinical care in a way that makes them available for clinical use and research. Objectives To validate functional status data that Veterans Affairs (VA) medical centers recently started collecting during routine clinical care, compared to the same data collected in a structured research setting. Design Prospective validation study. Setting Seven VA medical centers that collected complete data on 5 activities of daily living (ADLs) and 8 instrumental activities of daily living (IADLs) from older patients attending primary care appointments. Participants Randomly selected patients aged 75 and older who had new ADL and IADL data collected during a primary care appointment (N = 252). We oversampled patients with ADL dependence and applied these sampling weights to our analyses. Measurements Telephone-based interviews using a validated measure to assess the same 5 ADLs and 8 IADLs. Results Mean age was 83 years, 96% were male, and 75% were white. Of 85 participants whom VA data identified as dependent in 1 or more ADLs, 74 (87%) reported being dependent by interview; of 167 whom VA data identified as independent in ADLs, 149 (89%) reported being independent. The sample-weighted sensitivity of the VA data for identifying ADL dependence was 45% (95% CI, 29%, 62%) compared to the reference standard, the specificity was 99% (95% CI, 99%, >99%), and the positive predictive value was 87% (95% CI, 79%, 93%). The weighted kappa statistic was 0.55 (95% CI, 0.41, 0.68) for the agreement between VA data and research-collected data in identifying ADL dependence. Conclusion Overall agreement of VA functional status data with a reference standard was moderate, with fair sensitivity but high specificity and positive predictive value. %B PLoS One %V 12 %P e0178726 %8 Jan-06-2017 %G eng %U http://dx.plos.org/10.1371/journal.pone.0178726 %N 6 %! PLoS ONE %R 10.1371/journal.pone.0178726 Free full text %0 Journal Article %J The Journal of Positive Psychology %D 2017 %T Changes in positive and negative affect as predictors of change in felt age: Results from the Health and Retirement Study %A Yuval Palgi %A Liat Ayalon %A Sharon Avidor %A Ehud Bodner %K Aging %K Mood %K Older Adults %K Perception %K Self-reported health %X The present study aimed to examine how changes in positive and negative affect and their interaction predict changes in felt age in a longitudinal design of two waves drawn from the Health and Retirement Study (HRS). Participants (n = 4174) at an average age of 67.97 completed the 2008 and 2012 left behind questionnaire of the HRS. Our results showed that an increase in positive affect and a decrease in negative affect from Wave 1 to Wave 2 predicted an accelerated decrease in felt age. There was an interaction effect showing that for those with an increase in negative affect, a higher change in positive affect predicted reduced odds for accelerated increase in felt age. To conclude, improving favorable change in the combination between positive and negative affect might in turn relate to the individual’s self-perceptions of aging, in the second half of life. %B The Journal of Positive Psychology %V 12 %P 605-612 %G eng %U https://www.tandfonline.com/doi/full/10.1080/17439760.2016.1221121 %N 6 %! The Journal of Positive Psychology %R 10.1080/17439760.2016.1221121 %0 Journal Article %J Journal of Gerontological Social Work %D 2017 %T Community-based services and depression from person-environment fit perspective: Focusing on functional impairments and living alone. %A BoRin Kim %A So Jung Park %A Bishop-Saucier, Jennifer %A Amorim, Carrie %K Cognitive Ability %K Depressive symptoms %K Disabilities %X As communities encourage aging-in-place, community-based services for older adults are expanding. Guided by the Person-Environment Fit perspective, this study investigated the extent to which personal dimension factors (functional limitations, living alone) and environmental dimension factors (community-based services) influence depression among community-dwelling adults. The data came from the 2012 Health and Retirement Study, a nationally representative survey of individuals over 51 years old. Our sample was restricted to respondents who participated in the special questionnaire about community-based service utilization (N = 1,710). Logistic regressions examined associations between functional limitations/living alone and depression, and how community-based services moderate these associations. Both functional limitations (OR = 1.470; p < .001), and living alone (OR = 1.724; p < .05) were significantly associated with depression. Community-based service participants tended to be more vulnerable populations, but regression results showed community-based service was not significantly associated with depression after controlling for covariates. However, respondents with functional limitations and those living alone were less likely to be depressed when using community-based services (OR = 0.633; p < .05). This study demonstrates that the associations between community-based services and depression differ depending on personal needs. It discusses the importance of community-based services for aging-in-place policy, particularly among vulnerable populations. %B Journal of Gerontological Social Work %V 60 %P 270-285 %G eng %N 4 %R 10.1080/01634372.2017.1310166 %0 Journal Article %J Aging (Albany NY) %D 2017 %T The complex genetics of gait speed: genome-wide meta-analysis approach. %A Ben-Avraham, Dan %A Karasik, David %A Joe Verghese %A Kathryn L Lunetta %A John D Eicher %A Vered, Rotem %A Deelen, Joris %A Alice M. Arnold %A Aron S Buchman %A Toshiko Tanaka %A Jessica Faul %A Nethander, Maria %A Myriam Fornage %A Hieab H Adams %A Amy M Matteini %A Michele L Callisaya %A Albert Vernon Smith %A Lei Yu %A Philip L de Jager %A Denis A Evans %A Gudnason, Vilmundur %A Hofman, Albert %A Pattie, Alison %A Corley, Janie %A Lenore J Launer %A David S Knopman %A Parimi, Neeta %A Stephen T Turner %A Bandinelli, Stefania %A Beekman, Marian %A Gutman, Danielle %A Sharvit, Lital %A Simon P Mooijaart %A David C Liewald %A Jeanine J Houwing-Duistermaat %A Ohlsson, Claes %A Moed, Matthijs %A Vincent J Verlinden %A Mellström, Dan %A Jos N van der Geest %A Karlsson, Magnus %A Dena G Hernandez %A McWhirter, Rebekah %A Yongmei Liu %A Thomson, Russell %A Tranah, Gregory J %A André G Uitterlinden %A David R Weir %A Wei Zhao %A John M Starr %A Mohammed Arfan Ikram %A David A Bennett %A Steven R Cummings %A Ian J Deary %A Tamara B Harris %A Sharon L R Kardia %A Thomas H Mosley %A Velandai K Srikanth %A Beverly G Windham %A Anne B Newman %A Jeremy D Walston %A Gail Davies %A Daniel S Evans %A Eline P Slagboom %A Luigi Ferrucci %A Douglas P Kiel %A Joanne M Murabito %A Atzmon, Gil %K Genetics %K GWAS %X Emerging evidence suggests that the basis for variation in late-life mobility is attributable, in part, to genetic factors, which may become increasingly important with age. Our objective was to systematically assess the contribution of genetic variation to gait speed in older individuals. We conducted a meta-analysis of gait speed GWASs in 31,478 older adults from 17 cohorts of the CHARGE consortium, and validated our results in 2,588 older adults from 4 independent studies. We followed our initial discoveries with network and eQTL analysis of candidate signals in tissues. The meta-analysis resulted in a list of 536 suggestive genome wide significant SNPs in or near 69 genes. Further interrogation with Pathway Analysis placed gait speed as a polygenic complex trait in five major networks. Subsequent eQTL analysis revealed several SNPs significantly associated with the expression of PRSS16, WDSUB1 and PTPRT, which in addition to the meta-analysis and pathway suggested that genetic effects on gait speed may occur through synaptic function and neuronal development pathways. No genome-wide significant signals for gait speed were identified from this moderately large sample of older adults, suggesting that more refined physical function phenotypes will be needed to identify the genetic basis of gait speed in aging. %B Aging (Albany NY) %V 9 %P 209-246 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28077804?dopt=Abstract %R 10.18632/aging.101151 %0 Journal Article %J (Netherlands) Economist %D 2017 %T Consumption behavior, annuity income and mortality risk of retirees %A Kutlu-Koc, Vesile %A Alessie, Rob J.M. %A Kalwij, Adriaan %K Annuitization %K Consumption and Savings %K Mortality %K Retirement Planning and Satisfaction %X Previous empirical studies have found that individuals do not draw down their assets after retirement which is at odds with the predictions of a simple life cycle model without uncertainty. Hurd (Econometrica 57(4):779–813, 1989; Mortality risk and consumption by couples, 1999) explains such saving behavior of retired singles and couples by adding lifetime uncertainty to the simple life cycle model. We tested whether predictions about consumption during retirement of this extended life cycle model hold for a sample of older Americans. We used data from the Health and Retirement Study supplemented with data from the Consumption and Activities Mail Survey. In line with theory we found that, on average, total consumption is greater than their annuity income after retirement and that this difference increases with the level of initial wealth. For older singles but not for couples our results suggest that, as predicted by the extended theoretical model of Hurd, the on average negative consumption growth decreases with higher mortality rates. %B (Netherlands) Economist %V 165 %P 349-380 %8 09/2017 %G eng %U http://link.springer.com/10.1007/s10645-017-9301-z %N 3 %! De Economist %R 10.1007/s10645-017-9301-z %0 Journal Article %J American Journal of Public Health %D 2017 %T Crowdsourced health data: Comparability to a US national survey, 2013–2015 %A Yank, Veronica %A Agarwal, Sanjhavi %A Loftus, Pooja %A Steven Asch %A David Rehkopf %K Survey Methodology %X To determine the generalizability of crowdsourced, electronic health data from self-selected individuals using a national survey as a reference. Using the world's largest crowdsourcing platform in 2015, we collected data on characteristics known to influence cardiovascular disease risk and identified comparable data from the 2013 Behavioral Risk Factor Surveillance System. We used age-stratified logistic regression models to identify differences among groups. Crowdsourced respondents were younger, more likely to be non-Hispanicand White, and had higher educational attainment.Those aged 40 to 59 years were similar to US adults in the rates of smoking, diabetes, hypertension, and hyperlipidemia. Those aged 18 to 39 years were less similar, whereas those aged 60 to 75 years were underrepresented among crowdsourced respondents. Crowdsourced health data might be most generalizable to adults aged 40 to 59 years, but studies of younger or older populations, racial and ethnic minorities, or those with lower educational attainment should approach crowdsourced data with caution. Policymakers, the national Precision Medicine Initiative, and others planning to use crowdsourced data should take explicit steps to define and address anticipated underrepresentation by important population subgroups. %B American Journal of Public Health %V 107 %P 1283-1289 %8 Jan-08-2017 %G eng %U http://ajph.aphapublications.org/doi/10.2105/AJPH.2017.303824 %N 8 %! Am J Public Health %R 10.2105/AJPH.2017.303824 %0 Journal Article %J American Journal of Geriatric Psychiatry %D 2017 %T Depressive symptoms in recipients of home- and community-based services in the United States: Are older adults receiving the care they need? %A Renee Pepin %A Amanda N Leggett %A Amanda Sonnega %A Shervin Assari %K Caregiving %K Community-based services %K Depressive symptoms %X

OBJECTIVE: To understand unmet depression needs of older adults, the current study investigates depressive symptoms, psychiatric treatment, and home- and community-based service (HCBS) use in a nationally representative sample of older adults in the United States.

METHODS: Participants included 5,582 adults aged 60 and over from the 2010-2012 waves of the nationally representative Health and Retirement Study. Weighted bivariate analyses were used to examine the frequency of depressive symptoms (Center for Epidemiologic Studies Depression Scale) and psychiatric treatment among HCBS recipients compared with non-HCBS recipients. Weighted logistic regression models were used to evaluate the effect of depressive symptoms on HCBS use.

RESULTS: HCBS recipients had a higher frequency of depressive symptoms compared with nonrecipients (27.5% versus 10.4%, respectively). In particular, transportation service recipients had the highest frequency of depressive symptoms (37.5%). HCBS recipients with depressive symptoms were no more likely than nonrecipients to receive psychiatric services. Depressive symptoms were associated with HCBS use, above and beyond sociodemographic and health risk factors.

CONCLUSION: Depressive symptoms are more frequent among HCBS recipients compared with nonrecipients; however, depressed HCBS recipients are no more likely to receive psychiatric services, suggesting unmet depression needs. HCBS may be a key setting for depression detection and delivery of mental health interventions.

%B American Journal of Geriatric Psychiatry %V 25 %P 1351-1360 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/28760513?dopt=Abstract %R 10.1016/j.jagp.2017.05.021 %0 Journal Article %J PLoS Genetics %D 2017 %T Discovery and fine-mapping of adiposity loci using high density imputation of genome-wide association studies in individuals of African ancestry: African Ancestry Anthropometry Genetics Consortium. %A Ng, Maggie C Y %A Graff, Mariaelisa %A Lu, Yingchang %A Justice, Anne E %A Mudgal, Poorva %A Liu, Ching-Ti %A Young, Kristin %A Yanek, Lisa R %A Feitosa, Mary F %A Wojczynski, Mary K %A Rand, Kristin %A Brody, Jennifer A %A Brian E Cade %A Dimitrov, Latchezar %A Duan, Qing %A Guo, Xiuqing %A Leslie A Lange %A Michael A Nalls %A Okut, Hayrettin %A Tajuddin, Salman M %A Bamidele O Tayo %A Vedantam, Sailaja %A Bradfield, Jonathan P %A Chen, Guanjie %A Chen, Wei-Min %A Chesi, Alessandra %A Irvin, Marguerite R %A Padhukasahasram, Badri %A Smith, Jennifer A %A Zheng, Wei %A Matthew A. Allison %A Ambrosone, Christine B %A Bandera, Elisa V %A Traci M Bartz %A Berndt, Sonja I %A Bernstein, Leslie %A Blot, William J %A Erwin P Bottinger %A John Carpten %A Chanock, Stephen J %A Chen, Yii-Der Ida %A Conti, David V %A Cooper, Richard S %A Myriam Fornage %A Freedman, Barry I %A Garcia, Melissa %A Phyllis J Goodman %A Hsu, Yu-Han H %A Hu, Jennifer %A Huff, Chad D %A Ingles, Sue A %A John, Esther M %A Rick A Kittles %A Eric A Klein %A Li, Jin %A McKnight, Barbara %A Nayak, Uma %A Nemesure, Barbara %A Ogunniyi, Adesola %A Olshan, Andrew %A Press, Michael F %A Rohde, Rebecca %A Rybicki, Benjamin A %A Babatunde Salako %A Sanderson, Maureen %A Shao, Yaming %A David S Siscovick %A Stanford, Janet L %A Stevens, Victoria L %A Stram, Alex %A Strom, Sara S %A Vaidya, Dhananjay %A Witte, John S %A Yao, Jie %A Zhu, Xiaofeng %A Ziegler, Regina G %A Alan B Zonderman %A Adeyemo, Adebowale %A Ambs, Stefan %A Cushman, Mary %A Jessica Faul %A Hakonarson, Hakon %A Levin, Albert M %A Nathanson, Katherine L %A Erin B Ware %A David R Weir %A Zhao, Wei %A Zhi, Degui %A Donna K Arnett %A Grant, Struan F A %A Sharon L R Kardia %A Oloapde, Olufunmilayo I %A Rao, D C %A Charles N Rotimi %A Sale, Michele M %A L Keoki Williams %A Zemel, Babette S %A Becker, Diane M %A Ingrid B Borecki %A Michele K Evans %A Tamara B Harris %A Hirschhorn, Joel N %A Li, Yun %A Patel, Sanjay R %A Psaty, Bruce M %A Rotter, Jerome I %A Wilson, James G %A Bowden, Donald W %A Cupples, L Adrienne %A Christopher A Haiman %A Ruth J F Loos %A Kari E North %K Adiposity %K Anthropometry %K Blacks %K Body Mass Index %K Chromosome Mapping %K Female %K Gene Frequency %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Linkage Disequilibrium %K Male %K Obesity %K Polymorphism, Single Nucleotide %K Serine Endopeptidases %K Transcription Factor 7-Like 2 Protein %K Waist-Hip Ratio %K Whites %X

Genome-wide association studies (GWAS) have identified >300 loci associated with measures of adiposity including body mass index (BMI) and waist-to-hip ratio (adjusted for BMI, WHRadjBMI), but few have been identified through screening of the African ancestry genomes. We performed large scale meta-analyses and replications in up to 52,895 individuals for BMI and up to 23,095 individuals for WHRadjBMI from the African Ancestry Anthropometry Genetics Consortium (AAAGC) using 1000 Genomes phase 1 imputed GWAS to improve coverage of both common and low frequency variants in the low linkage disequilibrium African ancestry genomes. In the sex-combined analyses, we identified one novel locus (TCF7L2/HABP2) for WHRadjBMI and eight previously established loci at P < 5×10-8: seven for BMI, and one for WHRadjBMI in African ancestry individuals. An additional novel locus (SPRYD7/DLEU2) was identified for WHRadjBMI when combined with European GWAS. In the sex-stratified analyses, we identified three novel loci for BMI (INTS10/LPL and MLC1 in men, IRX4/IRX2 in women) and four for WHRadjBMI (SSX2IP, CASC8, PDE3B and ZDHHC1/HSD11B2 in women) in individuals of African ancestry or both African and European ancestry. For four of the novel variants, the minor allele frequency was low (<5%). In the trans-ethnic fine mapping of 47 BMI loci and 27 WHRadjBMI loci that were locus-wide significant (P < 0.05 adjusted for effective number of variants per locus) from the African ancestry sex-combined and sex-stratified analyses, 26 BMI loci and 17 WHRadjBMI loci contained ≤ 20 variants in the credible sets that jointly account for 99% posterior probability of driving the associations. The lead variants in 13 of these loci had a high probability of being causal. As compared to our previous HapMap imputed GWAS for BMI and WHRadjBMI including up to 71,412 and 27,350 African ancestry individuals, respectively, our results suggest that 1000 Genomes imputation showed modest improvement in identifying GWAS loci including low frequency variants. Trans-ethnic meta-analyses further improved fine mapping of putative causal variants in loci shared between the African and European ancestry populations.

%B PLoS Genetics %V 13 %P e1006719 %G eng %N 4 %R 10.1371/journal.pgen.1006719 %0 Journal Article %J Journal of Financial Therapy %D 2017 %T Does How We Feel About Financial Strain Matter for Mental Health? %A Asebedo, Sarah D. %A Wilmarth, Melissa J. %K Depressive symptoms %K Financial burden %K Mental Health %K Stress %X This study investigated how stress responses to financial strain are related to mental health (i.e., depression) to answer the question: Does how we feel about financial strain matter? Informed by the ABC-X model of family stress and analyzed with data from the Health and Retirement Study (HRS), results reveal that financial strain is significantly related to increased depression; however, financial stress was found to moderate this relationship. Financially strained respondents without a stress response did not have significantly different depression scores than those who were not experiencing financial strain; however, depression scores increased as the stress response to financial strain increased. Consistent with the ABC-X model, results suggest that financial strain is a neutral event until it is processed and interpreted by an individual, with subjective perceptions a more powerful predictor of mental health than objective financial circumstances. These results emphasize an area of synergy for financial and mental health researchers and professionals. %B Journal of Financial Therapy %V 8 %P 63-78 %G eng %U http://newprairiepress.org/jft/vol8/iss1/5 %N 1 %! Journal of Financial Therapy %R 10.4148/1944-9771.1130 %0 Report %D 2017 %T Drawing down retirement wealth: Interactions between Social Security wealth and private retirement savings %A Philip Armour %A Hung, Angela %K Consumption and Savings %K Retirement Planning and Satisfaction %K Social Security %B Working Paper Series %I RAND Corporation %C Santa Monica, CA %8 01/2017 %G eng %U http://www.rand.org/pubs/working_papers/WR1165.html %R 10.7249/WR1165 %0 Journal Article %J Journal of the American Geriatrics Society %D 2017 %T Ethnic Differences in Advance Directive Completion and Care Preferences: What Has Changed in a Decade? %A Portanova, Jaclyn %A Jennifer A Ailshire %A Perez, Catherine %A Rahman, Anna %A Enguidanos, Susan %K Older Adults %K Racial/ethnic differences %X Studies have documented ethnic differences in advance directive (AD) completion, with lower rates in minority groups. Of those with ADs, blacks are more likely than whites to prefer aggressive care, but little is known about how these differences in preferences have changed over time in ethnic groups. This nationally representative study aimed to investigate whether these differences in AD development persisted after adjusting for important confounding variables. Year of death was analyzed to see how AD completion changed over time within ethnic groups, and for those with an AD, the association between these factors and opting for aggressive care was investigated. Data from the 2000 to 2012 Health and Retirement Study (HRS) exit interviews from 7,177 decedents were used. Analyses included logistic regression to determine the relationship between ethnicity and AD completion and preferences for aggressive care and how it changed over time in ethnic groups. Forty-six percent of decedents had completed an AD (whites 51.7%, Hispanics 18.0%, blacks 15.0%). Of blacks completing an AD, 23.8% elected prolonged care, compared with 13.3% of Hispanics and 3.3% of whites. Logistic regression revealed that blacks 75% lower odds of completing an AD and Hispanics had 70% lower odds. Model covariates had a small influence on ethnic differences, although in examining the change in AD completion over time, the odds of having an AD increased with each subsequent death year for blacks and whites but not Hispanics. Additional research is needed to investigate the effect of cultural differences in AD completion rates of ethnic minority groups to ensure that preferences are honored in the clinical setting. %B Journal of the American Geriatrics Society %V 65 %P 1352-1357 %G eng %N 6 %R 10.1111/jgs.14800 %0 Web Page %D 2017 %T Exercising your brain could stave off dementia %A Ashley, Robert %K Dementia %K Exercise %K News %K Older Adults %B Ask the Doctors %I The Californian %C Salinas, CA %G eng %U http://www.thecalifornian.com/story/life/2017/01/11/ask-drs-exercising-brain-stave-dementia/96232212/ %0 Web Page %D 2017 %T Frugal retirees ditch 4 percent rule, hoard savings instead %A Anderson, Tom %K News %K Savings %B Your Money, Your Future %I CNBC %G eng %U http://www.cnbc.com/2017/05/16/frugal-retirees-ditch-4-percent-rule-hoard-savings-instead.html %0 Journal Article %J Alzheimer's & Dementia %D 2017 %T Functional limitations and health care resource utilization for individuals with cognitive impairment without dementia: Findings from a United States population-based survey. %A J. Scott Andrews %A Desai, Urvi %A Noam Y Kirson %A Caroline J. Enloe %A Ristovska, Ljubica %A King, Sarah %A Howard G. Birnbaum %A Adam S. Fleisher %A Ye, Wenyu %A Kahle-Wrobleski, Kristin %K CIND %K Cognitive Ability %K Functional limitations %K Older Adults %X

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

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

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

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

%B Alzheimer's & Dementia %V 6 %P 65-74 %8 2017 %G eng %R 10.1016/j.dadm.2016.11.005 %0 Journal Article %J Int J Environ Res Public Health %D 2017 %T Gene-by-Psychosocial Factor Interactions Influence Diastolic Blood Pressure in European and African Ancestry Populations: Meta-Analysis of Four Cohort Studies. %A Wei Zhao %A Yasutake, Kalyn %A August, Carmella %A Scott M Ratliff %A Jessica Faul %A Boerwinkle, Eric %A Chakravarti, Aravinda %A Ana V. Diez-Roux %A Gao, Yan %A Michael E Griswold %A Gerardo Heiss %A Sharon L R Kardia %A Alanna C Morrison %A Musani, Solomon K %A Mwasongwe, Stanford %A Kari E North %A Rose, Kathryn M %A Sims, Mario %A Yan V Sun %A David R Weir %A Belinda L Needham %K Blood pressure %K Genetics %K GWAS %K Meta-analyses %K Psychosocial %K Socioeconomic factors %X Inter-individual variability in blood pressure (BP) is influenced by both genetic and non-genetic factors including socioeconomic and psychosocial stressors. A deeper understanding of the gene-by-socioeconomic/psychosocial factor interactions on BP may help to identify individuals that are genetically susceptible to high BP in specific social contexts. In this study, we used a genomic region-based method for longitudinal analysis, Longitudinal Gene-Environment-Wide Interaction Studies (LGEWIS), to evaluate the effects of interactions between known socioeconomic/psychosocial and genetic risk factors on systolic and diastolic BP in four large epidemiologic cohorts of European and/or African ancestry. After correction for multiple testing, two interactions were significantly associated with diastolic BP. In European ancestry participants, outward/trait anger score had a significant interaction with the C10orf107 genomic region (p = 0.0019). In African ancestry participants, depressive symptom score had a significant interaction with the HFE genomic region (p = 0.0048). This study provides a foundation for using genomic region-based longitudinal analysis to identify subgroups of the population that may be at greater risk of elevated BP due to the combined influence of genetic and socioeconomic/psychosocial risk factors. %B Int J Environ Res Public Health %V 14 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/29258278?dopt=Abstract %R 10.3390/ijerph14121596 %0 Journal Article %J PLoS One %D 2017 %T Genetic variants specific to aging-related verbal memory: Insights from GWASs in a population-based cohort. %A Thalida E. Arpawong %A Pendleton, Neil %A Mekli, Krisztina %A John J McArdle %A Margaret Gatz %A Armoskus, Chris %A James A Knowles %A Carol A Prescott %K Cognitive Ability %K Genetics %K GWAS %K Memory %X Verbal memory is typically studied using immediate recall (IR) and delayed recall (DR) scores, although DR is dependent on IR capability. Separating these components may be useful for deciphering the genetic variation in age-related memory abilities. This study was conducted to (a) construct individual trajectories in IR and independent aspects of delayed recall, or residualized-DR (rDR), across older adulthood; and (b) identify genetic markers that contribute to four estimated phenotypes: IR and rDR levels and changes after age 60. A cognitively intact sample (N = 20,650 with 125,164 observations) was drawn from the U.S. Health and Retirement Study, a nationally representative study of adults aged 50 and older. Mixed effects regression models were constructed using repeated measures from data collected every two years (1996-2012) to estimate level at age 60 and change in memory post-60 in IR and rDR. Genome-wide association scans (GWAS) were conducted in the genotypic subsample (N = 7,486) using ~1.2 million single nucleotide polymorphisms (SNPs). One SNP (rs2075650) in TOMM40 associated with rDR level at the genome-wide level (p = 5.0x10-08), an effect that replicated in an independent sample from the English Longitudinal Study on Ageing (N = 6,898 with 41,328 observations). Meta-analysis of rDR level confirmed the association (p = 5.0x10-11) and identified two others in TOMM40 (rs71352238 p = 1.0x10-10; rs157582 p = 7.0x10-09), and one in APOE (rs769449 p = 3.1 x10-12). Meta-analysis of IR change identified associations with three of the same SNPs in TOMM40 (rs157582 p = 8.3x10-10; rs71352238 p = 1.9x10-09) and APOE (rs769449 p = 2.2x10-08). Conditional analyses indicate GWAS signals on rDR level were driven by APOE, whereas signals on IR change were driven by TOMM40. Additionally, we found that TOMM40 had effects independent of APOE e4 on both phenotypes. Findings from this first U.S. population-based GWAS study conducted on both age-related immediate and delayed verbal memory merit continued examination in other samples and additional measures of verbal memory. %B PLoS One %V 12 %P e0182448 %8 2017 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/28800603?dopt=Abstract %R 10.1371/journal.pone.0182448 %0 Journal Article %J Nature Communications %D 2017 %T Genome-wide meta-analysis associates HLA-DQA1/DRB1 and LPA and lifestyle factors with human longevity. %A Joshi, Peter K %A Nicola Pirastu %A Kentistou, Katherine A %A Fischer, Krista %A Edith Hofer %A Schraut, Katharina E %A Clark, David W %A Nutile, Teresa %A Barnes, Catriona L K %A Paul Rhj Timmers %A Shen, Xia %A Gandin, Ilaria %A McDaid, Aaron F %A Hansen, Thomas Folkmann %A Gordon, Scott D %A Giulianini, Franco %A Boutin, Thibaud S %A Abdellaoui, Abdel %A Zhao, Wei %A Medina-Gomez, Carolina %A Traci M Bartz %A Trompet, Stella %A Leslie A Lange %A Raffield, Laura %A van der Spek, Ashley %A Galesloot, Tessel E %A Proitsi, Petroula %A Yanek, Lisa R %A Bielak, Lawrence F %A Payton, Antony %A Murgia, Federico %A Concas, Maria Pina %A Biino, Ginevra %A Tajuddin, Salman M %A Seppälä, Ilkka %A Amin, Najaf %A Boerwinkle, Eric %A Børglum, Anders D %A Campbell, Archie %A Ellen W Demerath %A Demuth, Ilja %A Jessica Faul %A Ford, Ian %A Gialluisi, Alessandro %A Gögele, Martin %A Graff, Mariaelisa %A Aroon Hingorani %A Jouke-Jan Hottenga %A Hougaard, David M %A Hurme, Mikko A %A Ikram, M Arfan %A Jylhä, Marja %A Kuh, Diana %A Ligthart, Lannie %A Lill, Christina M %A Lindenberger, Ulman %A Lumley, Thomas %A Mägi, Reedik %A Marques-Vidal, Pedro %A Sarah E Medland %A Lili Milani %A Nagy, Reka %A William E R Ollier %A Peyser, Patricia A %A Pramstaller, Peter P %A Ridker, Paul M %A Fernando Rivadeneira %A Ruggiero, Daniela %A Saba, Yasaman %A Schmidt, Reinhold %A Schmidt, Helena %A Slagboom, P Eline %A Smith, Blair H %A Smith, Jennifer A %A Sotoodehnia, Nona %A Steinhagen-Thiessen, Elisabeth %A van Rooij, Frank J A %A Verbeek, André L %A Vermeulen, Sita H %A Vollenweider, Peter %A Wang, Yunpeng %A Werge, Thomas %A Whitfield, John B %A Alan B Zonderman %A Lehtimäki, Terho %A Michele K Evans %A Pirastu, Mario %A Fuchsberger, Christian %A Bertram, Lars %A Pendleton, Neil %A Sharon L R Kardia %A Ciullo, Marina %A Becker, Diane M %A Wong, Andrew %A Psaty, Bruce M %A Cornelia M van Duijn %A Wilson, James G %A Jukema, J Wouter %A Lambertus A Kiemeney %A André G Uitterlinden %A Franceschini, Nora %A Kari E North %A David R Weir %A Andres Metspalu %A Dorret I Boomsma %A Caroline Hayward %A Daniel I Chasman %A Nicholas G Martin %A Sattar, Naveed %A Campbell, Harry %A Tõnu Esko %A Kutalik, Zoltán %A James F Wilson %K Alleles %K Body Mass Index %K Coronary Disease %K Education %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K HLA-DQ alpha-Chains %K HLA-DRB1 Chains %K Humans %K Insulin Resistance %K Life Style %K Lipoprotein(a) %K Lipoproteins, HDL %K Longevity %K Lung Neoplasms %K Obesity %K Polymorphism, Single Nucleotide %K Smoking %K Socioeconomic factors %X

Genomic analysis of longevity offers the potential to illuminate the biology of human aging. Here, using genome-wide association meta-analysis of 606,059 parents' survival, we discover two regions associated with longevity (HLA-DQA1/DRB1 and LPA). We also validate previous suggestions that APOE, CHRNA3/5, CDKN2A/B, SH2B3 and FOXO3A influence longevity. Next we show that giving up smoking, educational attainment, openness to new experience and high-density lipoprotein (HDL) cholesterol levels are most positively genetically correlated with lifespan while susceptibility to coronary artery disease (CAD), cigarettes smoked per day, lung cancer, insulin resistance and body fat are most negatively correlated. We suggest that the effect of education on lifespan is principally mediated through smoking while the effect of obesity appears to act via CAD. Using instrumental variables, we suggest that an increase of one body mass index unit reduces lifespan by 7 months while 1 year of education adds 11 months to expected lifespan.Variability in human longevity is genetically influenced. Using genetic data of parental lifespan, the authors identify associations at HLA-DQA/DRB1 and LPA and find that genetic variants that increase educational attainment have a positive effect on lifespan whereas increasing BMI negatively affects lifespan.

%B Nature Communications %V 8 %P 910 %G eng %N 1 %R 10.1038/s41467-017-00934-5 %0 Journal Article %J J Epidemiol Community Health %D 2017 %T Glycated haemoglobin (HbA1c), diabetes and trajectories of change in episodic memory performance. %A Pappas, Colleen %A Andel, Ross %A Frank J Infurna %A Seetharaman, Shyam %K Aged %K cognitive aging %K Demography %K Diabetes Mellitus %K Female %K Glycated Hemoglobin A %K Humans %K Longitudinal Studies %K Male %K Memory, Episodic %K Risk Factors %K Sex Factors %K United States %X

BACKGROUND: As the ageing population grows, it is important to identify strategies to moderate cognitive ageing.

OBJECTIVE: We examined glycated haemoglobin (HbA1c) and diabetes in relation to level and change in episodic memory in older adults with and without diabetes.

METHODS: Data from 4419 older adults with (n=950) and without (n=3469) diabetes participating in a nationally representative longitudinal panel study (the Health and Retirement Study) were examined. Average baseline age was 72.66 years and 58% were women. HbA1c was measured in 2006 and episodic memory was measured using immediate and delayed list recall over 4 biennial waves between 2006 and 2012. Growth curve models were used to assess trajectories of episodic memory change.

RESULTS: In growth curve models adjusted for age, sex, education, race, depressive symptoms and waist circumference, higher HbA1c levels and having diabetes were associated with poorer baseline episodic memory (p=0.036 and <0.001, respectively) and greater episodic memory decline (p=0.006 and 0.004, respectively). The effect of HbA1c on episodic memory decline was smaller than the effect of age. The results were stronger for women than men and were not modified by age or race. When the main analyses were estimated for those with and without diabetes separately, HbA1c was significantly linked to change in episodic memory only among those with diabetes.

CONCLUSIONS: Higher HbA1c and diabetes were both associated with declines in episodic memory, with this relationship further exacerbated by having diabetes and elevated HbA1c. HbA1c appeared more important for episodic memory performance among women than men.

%B J Epidemiol Community Health %V 71 %P 115-120 %8 2017 02 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27440936?dopt=Abstract %R 10.1136/jech-2016-207588 %0 Web Page %D 2017 %T Healthy eating habits may preserve cognitive function and reduce the risk of dementia %A Alzheimer's Association %K Cognitive Ability %K Dementia %K Eating habits %K News %K Press releases %B AAIC 2017 %I Alzheimer's Association International Conf. Press Office %C Chicago, IL %G eng %U https://www.alz.org/aaic/releases_2017/AAIC17-Mon-Diet-Release.asp %0 Journal Article %J Anales de Psicología %D 2017 %T Hedonic and eudaimonic well-being in old age through positive psychology studies: a scoping review %A Araujo, Lia %A Ribeiro, Oscar %A Paúl, Constança %K Happiness %K Literature Review %K Well-being %X The study of aging through the lens of Positive Psychology allows looking beyond the decline normally associated with advancing of age and to consider rewarding experiences and strategies to promote a meaningful aging. In order to gather evidence on the key conceptual and empirical advancements that illustrate the commitment of Positive Psychology with aging issues a scoping review was conducted. Papers having “Positive Psychology” AND “Aging” (or similar words to aging) on their title, abstract or key-words were screened across main databases and aging related terms were searched in well-known journals of positive psychology. This strategy yielded 48 articles, 33 original scientific papers and 15 reviews. Main themes, study designs and instruments are presented and the endpoints are discussed according to the hedonic or eudaimonic perspective of the studies. Future directions related with the importance of comprehensive constructs and method approaches in the study of advancing age are highlighted. %B Anales de Psicología %V 33 %P 568-577 %G eng %U http://revistas.um.es/analesps/article/view/analesps.33.3.265621http://revistas.um.es/analesps/article/viewFile/265621/215181 %N 3 %! AN PSICOL-SPAIN %R 10.6018/analesps.33.3.265621 %0 Journal Article %J The Geneva Papers on Risk and Insurance - Issues and Practice %D 2017 %T How the growing gap in life expectancy may affect retirement benefits and reforms %A Auerbach, Alan %A Kerwin K. Charles %A Courtney Coile %A William G. Gale %A Dana P Goldman %A Lee, Ronald %A Lucas, Charles %A Orszag, Peter R. %A Sheiner, Louise %A Tysinger, Bryan %A Weil, David %A Wolfers, Justin %A Rebeca Wong %K Life Expectancy %K Mortality %K Retirement Planning and Satisfaction %K Social Security %B The Geneva Papers on Risk and Insurance - Issues and Practice %V 42 %P 475-499 %8 Jan-07-2017 %G eng %U http://link.springer.com/10.1057/s41288-017-0057-0http://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdfhttp://link.springer.com/article/10.1057/s41288-017-0057-0/fulltext.htmlhttp://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdf %N 3 %! Geneva Pap Risk Insur Issues Pract %R 10.1057/s41288-017-0057-0 %0 Web Page %D 2017 %T Hybrid MIND diet may preserve cognition, cut dementia risk %A Anderson, Pauline %K Cognitive Ability %K Dementia %K Dieting %B Medscape %I Medscape Medical News %C New York, NY %G eng %U http://www.medscape.com/viewarticle/883133 %0 Journal Article %J Ageing and Society %D 2017 %T The impact of health and education on future labour force participation among individuals aged 55–74 in the United States of America: the MacArthur Foundation Research Network on an Aging Society %A David Rehkopf %A Nancy E Adler %A John W Rowe %K Education %K Employment and Labor Force %K Population Health %K Retirement Planning and Satisfaction %X Chronic disease, mobility limitations and low physical functioning are determinants of an earlier age of retirement. Therefore, long-term population trends in these factors may have an impact on the proportion of individuals near traditional retirement age who continue to work. Our objective is to develop a projection model that accounts for trends in these factors in order to estimate the proportion of the population aged 55–74 with the capacity to participate in the labour force. We used logistic regression models to quantify how chronic disease, mobility and functional status predict labour force participation among individuals aged 55–59. Next, we obtained estimates of the population prevalence of each of these predictors for the years 2010–2050. We then used estimated coefficients from the logistic regression models to predict the age-specific probability of capacity for work up to the age of 74. We find that population capacity for work depends on trends in disability and on level of education. Future population capacity for work depends on trends in functional limitations primarily in the population with lower levels of education. Changes in functional limitations, changes in the environment, technology and social policy targeted towards individuals with lower levels of education could result in mitigation of future decreasing capacity for work in the population near retirement age. %B Ageing and Society %V 37 %P 1313-1337 %G eng %U https://www.cambridge.org/core/product/identifier/S0144686X16000295/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X16000295 %N 07 %! Ageing and Society %R 10.1017/S0144686X16000295 %0 Journal Article %J Health Economics %D 2017 %T The Impact of Medicare Part D on Emergency Department Visits. %A Padmaja Ayyagari %A Dan M. Shane %A George L Wehby %K Aged %K Delivery of Health Care %K Emergency Service, Hospital %K Female %K Humans %K Insurance Coverage %K Insurance, Health %K Male %K Medicare Part D %K Middle Aged %K prescription drugs %K Surveys and Questionnaires %K United States %X

The Medicare Part D program introduced prescription drug coverage for seniors in 2006. We examine the impact of this program on the use of emergency department (ED) care. Using a difference-in-differences model, we find declines in the number of ED visits for non-emergency care but not for emergency care, suggesting that Part D may have led to better management of health and reduced unnecessary use of EDs. Copyright © 2016 John Wiley & Sons, Ltd.

%B Health Economics %V 26 %P 536-544 %8 2017 04 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/26865471?dopt=Abstract %R 10.1002/hec.3326 %0 Journal Article %J Journal of Epidemiology and Community Health %D 2017 %T Insomnia as a predictor of job exit among middle-aged and older adults: results from the Health and Retirement Study. %A Dong, Liming %A Agnew, Jacqueline %A Ramin Mojtabai %A Pamela J Surkan %A Adam P Spira %K Employment and Labor Force %K Older Adults %K Sleep %X

OBJECTIVES: Poor health is a recognised predictor of workforce exit, but little is known about the role of insomnia in workforce exit. We examined the association between insomnia symptoms and subsequent job exit among middle-aged and older adults from the Health and Retirement Study (HRS).

METHODS: The study sample consisted of 5746 respondents aged between 50 and 70 who were working for pay when interviewed in the HRS 2004 and were followed up in the HRS 2006. Multinomial logistic regression was used to determine the association between number of insomnia symptoms (0, 1-2, 3-4) and job exit (no exit, health-related exit or exit due to other reasons).

RESULTS: In models adjusting for demographic characteristics, baseline health status and baseline job characteristics, compared with respondents with no insomnia symptoms, those with 3-4 insomnia symptoms had approximately twice the odds of leaving the workforce due to poor health (adjusted relative risk ratio=1.93, 95% CI 1.04 to 3.58, p=0.036). There was no association between insomnia and job exit due to non-health reasons.

CONCLUSIONS: An elevated number of insomnia symptoms is independently associated with leaving paid employment. Workplace screening for and treatment of insomnia symptoms may prolong labour force participation of middle-aged and older adults.

%B Journal of Epidemiology and Community Health %V 71 %P 750-757 %G eng %N 8 %R 10.1136/jech-2016-208630 %0 Journal Article %J BMJ Open %D 2017 %T Likelihood that expectations of informal care will be met at onset of caregiving need: a retrospective study of older adults in the USA. %A Abrahamson, Kathleen %A Hass, Zachary %A Laura Sands %K Caregiving %K Community-dwelling %K Marriage %K Social Support %X

BACKGROUND: Ageing adults are likely to expect informal caregiving assistance from a friend or family member, reflecting the reality that most long-term care (LTC) is provided by family and friends. The purpose of the study was to determine the likelihood that expectations of care will be unmet at the onset of functional disability, and the factors that impact that likelihood.

METHODS: Community-dwelling respondents from biannual repeated assessments (2006-2010) of the Health and Retirement Study over age 65 who expressed a caregiving expectation prior to need were included in the final analytical sample (n=1352). Logistic regression and change models were specified to address impact of variables on unmet expectations.

RESULTS: Expectations of care were unmet for almost one-third (32%) of the sample, among whom 30% were not receiving needed care. Unmet expectations were associated with being unmarried, older and having a higher number of ADL deficits. Change over time in the number of predictor variables influenced the likelihood of unmet expectations.

CONCLUSIONS: Unplanned dependence on formal care systems and/or having unmet care needs places elders at risk of negative outcomes. Knowledge of factors that impact whether expected care is eventually received provides robust evidence for counselling individuals regarding the need to plan for additional LTC services.

%B BMJ Open %V 7 %P e017791 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/29259058?dopt=Abstract %R 10.1136/bmjopen-2017-017791 %0 Journal Article %J International Psychogeriatrics %D 2017 %T Longitudinal associations of hopelessness and loneliness in older adults: results from the US health and retirement study. %A Amber M Gum %A Sharon Shiovitz-Ezra %A Liat Ayalon %K Depressive symptoms %K Loneliness %X

BACKGROUND: Hopelessness and loneliness are potent risk factors for poor mental and physical health in later life, although the nature of their relationships with each other over time is not clear. The aim of the current study was to examine relationships between hopelessness and loneliness over an eight-year study period.

METHODS: Three waves of data from the US Health and Retirement Study (2006, 2010, 2014) were used to test a cross-lagged model of hopelessness and loneliness (N = 7,831), which allows for the simultaneous evaluation of the reciprocal associations of loneliness and hopelessness. Age in 2006, gender, years of education, number of medical conditions, and depressive symptoms were included as covariates.

RESULTS: The autoregressive effects of loneliness (B (SE) = 0.63 (0.02), p < 0.001) and hopelessness (B (SE) = 0.63 (0.02), p < 0.001) were substantive and significant across the three waves, pointing to the stability of both constructs over the eight-year study period. The lagged effect of loneliness on hopelessness was non-significant (B (SE) = 0.05 (0.03), p = 0.16), whereas the lagged effect of hopelessness on loneliness was significant (B (SE) = 0.01 (0.01), p = 0.03). These lagged effects were not significantly different from each other, however, χ2 (1) = 2.016, p = 0.156.

CONCLUSIONS: Participants who were more hopeless tended to become lonelier four years later, but lonelier participants did not become more hopeless four years later. Findings are tentative given the small magnitude and lack of difference between the cross-lagged effects. Future directions include replicating these findings in different samples and time frames, examining potential mechanisms of relationships between hopelessness and loneliness, and potential intervention strategies that might improve both conditions.

%B International Psychogeriatrics %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28539131?dopt=Abstract %R 10.1017/S1041610217000904 %0 Conference Paper %B 2014 Population Association of America (PAA) %D 2017 %T The long-term effect of birth control and abortion laws (1960-1979) on women’s health at old age: Evidence from the US Health and Retirement Study %A Amy Ehntholt %A Erika L. Sabbath %A Lisa F Berkman %A Mauricio Avendano %K abortion law %K birth control %K contraceptives %K gender %K women %K Women's Health %X The oral contraceptive pill, approved by the Food and Drug Administration for contraceptive use in 1960 (Knowles, 2012), has been hypothesized as a major factor explaining the large increase in labor force participation, reduced fertility, and delayed marriage among young women during the second half of the twentieth century. An important, yet untested, hypothesis is that by transforming young women’s life trajectories, contraception laws may also have had unexpected consequences on women’s long-term health trajectories. In addition, recent evidence (Knowles, 2013), suggests that abortion laws were also essential in transforming women’s labor market, marriage, and fertility outcomes. Laws enabling access to the pill often coincided with laws enabling access to contraception. Therefore, a framework that assesses the complete policy environment is essential in understanding the impact of contraception and abortion laws on women’s outcomes. To the best of our knowledge, there have been no studies examining whether the combination of contraception and abortion laws that transformed women’s life trajectories during the second half of the 20th century had any long-term, permanent effects on women’s health. %B 2014 Population Association of America (PAA) %C Boston, Massachusetts %G eng %U http://www.healthandsocietyscholars.org/1866/346164/440484 %0 Journal Article %J Journal of Aging and Health %D 2017 %T Is Memory Decline Associated With Inflammatory Response? %A Amber M Tetlow %A Andel, Ross %A Frank J Infurna %K Biomarkers %K Cognitive Ability %K Inflammation %K Memory %X

OBJECTIVE: To examine whether changes in memory over a 10-year period could predict a change in C-reactive protein (CRP) levels.

METHOD: A mixed model analysis was first conducted to obtain the estimates for change in memory over the 10-year period using data from the Health and Retirement Study. Then a multivariate regression to determine whether a change in episodic memory could predict subsequent CRP levels was conducted. Furthermore, a general linear model was conducted to determine differences in CRP levels among different rates of change in episodic memory.

RESULTS: Greater declines in episodic memory were associated with higher levels of subsequent CRP (Estimate = -0.32, SE = 0.12, β = -.03, p = .008). The general linear model revealed that those with greater memory declines were more likely to have higher levels of CRP, F = 26.50, p < .001.

DISCUSSION: These results highlight the notion that memory decline and inflammation may be intertwined, and we discuss various avenues that warrant further investigation.

%B Journal of Aging and Health %P 898264317742809 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29254429?dopt=Abstract %R 10.1177/0898264317742809 %0 Journal Article %J Circulation: Cardiovascular Genetics %D 2017 %T New Blood Pressure-Associated Loci Identified in Meta-Analyses of 475 000 Individuals. %A Kraja, Aldi T %A Cook, James P %A Warren, Helen R %A Surendran, Praveen %A Liu, Chunyu %A Evangelou, Evangelos %A Alisa Manning %A Grarup, Niels %A Drenos, Fotios %A Sim, Xueling %A Smith, Albert Vernon %A Amin, Najaf %A Alexandra I Blakemore %A Bork-Jensen, Jette %A Brandslund, Ivan %A Farmaki, Aliki-Eleni %A Fava, Cristiano %A Ferreira, Teresa %A Herzig, Karl-Heinz %A Giri, Ayush %A Giulianini, Franco %A Grove, Megan L %A Guo, Xiuqing %A Sarah E Harris %A Have, Christian T %A Havulinna, Aki S %A Zhang, He %A Jørgensen, Marit E %A Käräjämäki, AnneMari %A Charles Kooperberg %A Linneberg, Allan %A Little, Louis %A Liu, Yongmei %A Bonnycastle, Lori L %A Lu, Yingchang %A Mägi, Reedik %A Mahajan, Anubha %A Malerba, Giovanni %A Riccardo E Marioni %A Mei, Hao %A Menni, Cristina %A Alanna C Morrison %A Padmanabhan, Sandosh %A Walter R Palmas %A Poveda, Alaitz %A Rauramaa, Rainer %A Nigel W Rayner %A Riaz, Muhammad %A Rice, Ken %A Melissa Richard %A Smith, Jennifer A %A Southam, Lorraine %A Stančáková, Alena %A Kathleen E Stirrups %A Tragante, Vinicius %A Tuomi, Tiinamaija %A Tzoulaki, Ioanna %A Varga, Tibor V %A Weiss, Stefan %A Yiorkas, Andrianos M %A Young, Robin %A Zhang, Weihua %A Barnes, Michael R %A Cabrera, Claudia P %A Gao, He %A Boehnke, Michael %A Boerwinkle, Eric %A Chambers, John C %A Connell, John M %A Cramer Christensen %A de Boer, Rudolf A %A Ian J Deary %A George Dedoussis %A Deloukas, Panos %A Dominiczak, Anna F %A Dörr, Marcus %A Joehanes, Roby %A Edwards, Todd L %A Tõnu Esko %A Myriam Fornage %A Franceschini, Nora %A Franks, Paul W %A Gambaro, Giovanni %A Leif C Groop %A Hallmans, Göran %A Hansen, Torben %A Caroline Hayward %A Heikki, Oksa %A Ingelsson, Erik %A Tuomilehto, Jaakko %A Järvelin, Marjo-Riitta %A Sharon L R Kardia %A Karpe, Fredrik %A Kooner, Jaspal S %A Lakka, Timo A %A Langenberg, Claudia %A Lars Lind %A Ruth J F Loos %A Laakso, Markku %A McCarthy, Mark I %A Melander, Olle %A Mohlke, Karen L %A Morris, Andrew P %A Palmer, Colin N A %A Pedersen, Oluf %A Polasek, Ozren %A Neil Poulter %A Province, Michael A %A Psaty, Bruce M %A Ridker, Paul M %A Rotter, Jerome I %A Rudan, Igor %A Veikko Salomaa %A Nilesh J Samani %A Peter Sever %A Skaaby, Tea %A Stafford, Jeanette M %A John M Starr %A van der Harst, Pim %A van der Meer, Peter %A Cornelia M van Duijn %A Vergnaud, Anne-Claire %A Gudnason, Vilmundur %A Wareham, Nicholas J %A Wilson, James G %A Willer, Cristen J %A Daniel Witte %A Zeggini, Eleftheria %A Saleheen, Danish %A Adam S Butterworth %A Danesh, John %A Asselbergs, Folkert W %A Wain, Louise V %A Georg B Ehret %A Daniel I Chasman %A Caulfield, Mark J %A Elliott, Paul %A Lindgren, Cecilia M %A Levy, Daniel %A Newton-Cheh, Christopher %A Munroe, Patricia B %A Howson, Joanna M M %K Antiporters %K Blood pressure %K Cell Adhesion Molecules, Neuronal %K Databases, Factual %K Genetic Loci %K Genome-Wide Association Study %K Genotype %K Humans %K Microfilament Proteins %K Phenotype %K Polymorphism, Single Nucleotide %K Receptors, Lymphocyte Homing %X

BACKGROUND: Genome-wide association studies have recently identified >400 loci that harbor DNA sequence variants that influence blood pressure (BP). Our earlier studies identified and validated 56 single nucleotide variants (SNVs) associated with BP from meta-analyses of exome chip genotype data. An additional 100 variants yielded suggestive evidence of association.

METHODS AND RESULTS: Here, we augment the sample with 140 886 European individuals from the UK Biobank, in whom 77 of the 100 suggestive SNVs were available for association analysis with systolic BP or diastolic BP or pulse pressure. We performed 2 meta-analyses, one in individuals of European, South Asian, African, and Hispanic descent (pan-ancestry, ≈475 000), and the other in the subset of individuals of European descent (≈423 000). Twenty-one SNVs were genome-wide significant (<5×10) for BP, of which 4 are new BP loci: rs9678851 (missense, ), rs7437940 (), rs13303 (missense, ), and rs1055144 (). In addition, we identified a potentially independent novel BP-associated SNV, rs3416322 (missense, ) at a known locus, uncorrelated with the previously reported SNVs. Two SNVs are associated with expression levels of nearby genes, and SNVs at 3 loci are associated with other traits. One SNV with a minor allele frequency <0.01, (rs3025380 at ) was genome-wide significant.

CONCLUSIONS: We report 4 novel loci associated with BP regulation, and 1 independent variant at an established BP locus. This analysis highlights several candidate genes with variation that alter protein function or gene expression for potential follow-up.

%B Circulation: Cardiovascular Genetics %V 10 %P e001778 %G eng %N 5 %R 10.1161/CIRCGENETICS.117.001778 %0 Journal Article %J Labour %D 2017 %T Personality and Employment Transitions at Older Ages: Direct and Indirect Effects through Non-Monetary Job Characteristics %A Marco Angrisani %A Michael D Hurd %A Erik Meijer %A Andrew M Parker %A Susann Rohwedder %K Employment and Labor Force %K Jobs %K Older Adults %K Personality %X We study whether individuals with different personality traits systematically exhibit different retirement trajectories. We find weak direct associations between personality and employment transitions. On the other hand, personality does contribute indirectly to these transitions by moderating the effects of non-monetary job characteristics. Specifically, workers with different traits are observed to follow different retirement paths when faced with similar physical demands, computer skills requirements, job flexibility, and age discrimination in the workplace. Contrary with other economic domains, conscientiousness does not have the strongest association with retirement; the other components of the Big Five personality traits show more salient patterns. %B Labour %V 31 %P 127-152 %G eng %U http://doi.wiley.com/10.1111/labr.12090http://onlinelibrary.wiley.com/wol1/doi/10.1111/labr.12090/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Flabr.12090 %N 2 %! Labour %R 10.1111/labr.12090 %0 Journal Article %J Journal of Psychiatric Research %D 2017 %T Personality traits and risk of cognitive impairment and dementia. %A Antonio Terracciano %A Yannick Stephan %A Martina Luchetti %A Albanese, Emiliano %A Angelina R Sutin %K Cognitive Ability %K Dementia %K Older Adults %K Personality %X

We investigated the association between five factor model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and risk of dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia in a large national cohort. Participants from the Health and Retirement Study (N > 10,000) completed a personality scale in 2006-2008 and their cognitive status was tracked for up to 8 years using the modified Telephone Interview for Cognitive Status (TICSm). Adjusting for age, sex, education, race, and ethnicity, lower conscientiousness and agreeableness and higher neuroticism were independently associated with increased risk of dementia. These associations remained significant after adjusting for other risk factors for dementia, including income, wealth, smoking, physical inactivity, obesity, diabetes, hypertension, and blood biomarkers. These associations were not modified by age, sex, race, ethnicity, and education, suggesting that the associations of personality with risk of dementia were similar across demographic groups. Neuroticism and conscientiousness were also associated with risk of CIND. Low conscientiousness predicted conversion from CIND to dementia. Using brief assessments of personality and cognition, we found robust evidence that personality is associated with risk of cognitive impairment and dementia in a large national sample.

%B Journal of Psychiatric Research %V 89 %P 22-27 %8 2017 Jan 22 %G eng %R 10.1016/j.jpsychires.2017.01.011 %0 Journal Article %J Nature %D 2017 %T Rare and low-frequency coding variants alter human adult height. %A Marouli, Eirini %A Graff, Mariaelisa %A Medina-Gomez, Carolina %A Ken Sin Lo %A Andrew R Wood %A Kjaer, Troels R %A Fine, Rebecca S %A Lu, Yingchang %A Schurmann, Claudia %A Highland, Heather M %A Rüeger, Sina %A Thorleifsson, Gudmar %A Justice, Anne E %A Lamparter, David %A Kathleen E Stirrups %A Turcot, Valérie %A Young, Kristin L %A Thomas W Winkler %A Tõnu Esko %A Karaderi, Tugce %A Locke, Adam E %A Masca, Nicholas G D %A Ng, Maggie C Y %A Mudgal, Poorva %A Rivas, Manuel A %A Vedantam, Sailaja %A Mahajan, Anubha %A Guo, Xiuqing %A Gonçalo R Abecasis %A Aben, Katja K %A Adair, Linda S %A Alam, Dewan S %A Albrecht, Eva %A Allin, Kristine H %A Matthew A. Allison %A Amouyel, Philippe %A Appel, Emil V %A Arveiler, Dominique %A Asselbergs, Folkert W %A Auer, Paul L %A Balkau, Beverley %A Banas, Bernhard %A Bang, Lia E %A Benn, Marianne %A Bergmann, Sven %A Bielak, Lawrence F %A Blüher, Matthias %A Boeing, Heiner %A Boerwinkle, Eric %A Böger, Carsten A %A Bonnycastle, Lori L %A Bork-Jensen, Jette %A Bots, Michiel L %A Erwin P Bottinger %A Bowden, Donald W %A Brandslund, Ivan %A Breen, Gerome %A Brilliant, Murray H %A Broer, Linda %A Burt, Amber A %A Adam S Butterworth %A Carey, David J %A Caulfield, Mark J %A Chambers, John C %A Daniel I Chasman %A Yii-Der I Chen %A Chowdhury, Rajiv %A Cramer Christensen %A Chu, Audrey Y %A Cocca, Massimiliano %A Collins, Francis S %A Cook, James P %A Corley, Janie %A Jordi Corominas Galbany %A Cox, Amanda J %A Cuellar-Partida, Gabriel %A Danesh, John %A Gail Davies %A de Bakker, Paul I W %A de Borst, Gert J %A de Denus, Simon %A de Groot, Mark C H %A de Mutsert, Renée %A Ian J Deary %A George Dedoussis %A Ellen W Demerath %A Anneke I den Hollander %A Joe G Dennis %A Di Angelantonio, Emanuele %A Drenos, Fotios %A Du, Mengmeng %A Dunning, Alison M %A Easton, Douglas F %A Ebeling, Tapani %A Edwards, Todd L %A Ellinor, Patrick T %A Elliott, Paul %A Evangelou, Evangelos %A Farmaki, Aliki-Eleni %A Jessica Faul %A Feitosa, Mary F %A Feng, Shuang %A Ferrannini, Ele %A Marco M Ferrario %A Ferrières, Jean %A Florez, Jose C %A Ford, Ian %A Myriam Fornage %A Franks, Paul W %A Frikke-Schmidt, Ruth %A Galesloot, Tessel E %A Gan, Wei %A Gandin, Ilaria %A Paolo P. Gasparini %A Giedraitis, Vilmantas %A Giri, Ayush %A Giorgia G Girotto %A Gordon, Scott D %A Gordon-Larsen, Penny %A Gorski, Mathias %A Grarup, Niels %A Grove, Megan L %A Gudnason, Vilmundur %A Gustafsson, Stefan %A Hansen, Torben %A Kathleen Mullan Harris %A Tamara B Harris %A Andrew T Hattersley %A Caroline Hayward %A He, Liang %A Iris M Heid %A Heikkilä, Kauko %A Helgeland, Øyvind %A Hernesniemi, Jussi %A Hewitt, Alex W %A Lynne J Hocking %A Hollensted, Mette %A Oddgeir L Holmen %A Hovingh, G Kees %A Howson, Joanna M M %A Hoyng, Carel B %A Huang, Paul L %A Hveem, Kristian %A Mohammed Arfan Ikram %A Ingelsson, Erik %A Jackson, Anne U %A Jansson, Jan-Håkan %A Jarvik, Gail P %A Jensen, Gorm B %A Jhun, Min A %A Jia, Yucheng %A Jiang, Xuejuan %A Johansson, Stefan %A Jørgensen, Marit E %A Jørgensen, Torben %A Jousilahti, Pekka %A Jukema, J Wouter %A Kahali, Bratati %A Kahn, René S %A Kähönen, Mika %A Kamstrup, Pia R %A Kanoni, Stavroula %A Kaprio, Jaakko %A Karaleftheri, Maria %A Sharon L R Kardia %A Karpe, Fredrik %A Kee, Frank %A Keeman, Renske %A Lambertus A Kiemeney %A Kitajima, Hidetoshi %A Kluivers, Kirsten B %A Kocher, Thomas %A Komulainen, Pirjo %A Kontto, Jukka %A Kooner, Jaspal S %A Charles Kooperberg %A Kovacs, Peter %A Kriebel, Jennifer %A Kuivaniemi, Helena %A Küry, Sébastien %A Kuusisto, Johanna %A La Bianca, Martina %A Laakso, Markku %A Lakka, Timo A %A Lange, Ethan M %A Leslie A Lange %A Langefeld, Carl D %A Langenberg, Claudia %A Eric B Larson %A Lee, I-Te %A Lehtimäki, Terho %A Lewis, Cora E %A Li, Huaixing %A Li, Jin %A Li-Gao, Ruifang %A Lin, Honghuang %A Lin, Li-An %A Lin, Xu %A Lars Lind %A Lindström, Jaana %A Linneberg, Allan %A Liu, Yeheng %A Yongmei Liu %A Lophatananon, Artitaya %A Luan, Jian'an %A Lubitz, Steven A %A Lyytikäinen, Leo-Pekka %A Mackey, David A %A Pamela A F Madden %A Alisa Manning %A Männistö, Satu %A Marenne, Gaëlle %A Marten, Jonathan %A Nicholas G Martin %A Mazul, Angela L %A Meidtner, Karina %A Andres Metspalu %A Mitchell, Paul %A Mohlke, Karen L %A Dennis O Mook-Kanamori %A Morgan, Anna %A Morris, Andrew D %A Morris, Andrew P %A Müller-Nurasyid, Martina %A Munroe, Patricia B %A Michael A Nalls %A Nauck, Matthias %A Nelson, Christopher P %A Neville, Matt %A Sune Fallgaard Nielsen %A Nikus, Kjell %A Njølstad, Pål R %A Børge G Nordestgaard %A Ntalla, Ioanna %A Jeff O'Connell %A Oksa, Heikki %A Loes M Olde Loohuis %A Ophoff, Roel A %A Owen, Katharine R %A Packard, Chris J %A Padmanabhan, Sandosh %A Palmer, Colin N A %A Pasterkamp, Gerard %A Patel, Aniruddh P %A Pattie, Alison %A Pedersen, Oluf %A Peissig, Peggy L %A Peloso, Gina M %A Pennell, Craig E %A Markus Perola %A Perry, James A %A Perry, John R B %A Person, Thomas N %A Pirie, Ailith %A Polasek, Ozren %A Posthuma, Danielle %A Olli T Raitakari %A Rasheed, Asif %A Rauramaa, Rainer %A Reilly, Dermot F %A Reiner, Alex P %A Renstrom, Frida %A Ridker, Paul M %A Rioux, John D %A Neil R Robertson %A Robino, Antonietta %A Rolandsson, Olov %A Rudan, Igor %A Ruth, Katherine S %A Saleheen, Danish %A Veikko Salomaa %A Nilesh J Samani %A Sandow, Kevin %A Sapkota, Yadav %A Sattar, Naveed %A Schmidt, Marjanka K %A Schreiner, Pamela J %A Schulze, Matthias B %A Scott, Robert A %A Segura-Lepe, Marcelo P %A Svati H Shah %A Sim, Xueling %A Sivapalaratnam, Suthesh %A Small, Kerrin S %A Albert Vernon Smith %A Jennifer A Smith %A Southam, Lorraine %A Timothy Spector %A Elizabeth K Speliotes %A John M Starr %A Steinthorsdottir, Valgerdur %A Heather M Stringham %A Stumvoll, Michael %A Surendran, Praveen %A 't Hart, Leen M %A Tansey, Katherine E %A Tardif, Jean-Claude %A Kent D Taylor %A Teumer, Alexander %A Thompson, Deborah J %A Thorsteinsdottir, Unnur %A Thuesen, Betina H %A Tönjes, Anke %A Tromp, Gerard %A Trompet, Stella %A Tsafantakis, Emmanouil %A Tuomilehto, Jaakko %A Tybjaerg-Hansen, Anne %A Tyrer, Jonathan P %A Uher, Rudolf %A André G Uitterlinden %A Ulivi, Sheila %A van der Laan, Sander W %A Van Der Leij, Andries R %A Cornelia M van Duijn %A van Schoor, Natasja M %A van Setten, Jessica %A Varbo, Anette %A Varga, Tibor V %A Varma, Rohit %A Digna R Velez Edwards %A Vermeulen, Sita H %A Vestergaard, Henrik %A Vitart, Veronique %A Vogt, Thomas F %A Vozzi, Diego %A Walker, Mark %A Wang, Feijie %A Wang, Carol A %A Wang, Shuai %A Wang, Yiqin %A Wareham, Nicholas J %A Warren, Helen R %A Wessel, Jennifer %A Willems, Sara M %A Wilson, James G %A Daniel Witte %A Woods, Michael O %A Wu, Ying %A Yaghootkar, Hanieh %A Yao, Jie %A Yao, Pang %A Laura M Yerges-Armstrong %A Young, Robin %A Zeggini, Eleftheria %A Zhan, Xiaowei %A Zhang, Weihua %A Jing Hua Zhao %A Wei Zhao %A Wei Zhao %A Zheng, He %A Zhou, Wei %A Rotter, Jerome I %A Boehnke, Michael %A Kathiresan, Sekar %A McCarthy, Mark I %A Willer, Cristen J %A Stefansson, Kari %A Ingrid B Borecki %A Liu, Dajiang J %A Kari E North %A Heard-Costa, Nancy L %A Pers, Tune H %A Lindgren, Cecilia M %A Oxvig, Claus %A Kutalik, Zoltán %A Fernando Rivadeneira %A Ruth J F Loos %A Timothy M Frayling %A Joel N Hirschhron %A Deloukas, Panos %A Lettre, Guillaume %X

Height is a highly heritable, classic polygenic trait with approximately 700 common associated variants identified through genome-wide association studies so far. Here, we report 83 height-associated coding variants with lower minor-allele frequencies (in the range of 0.1-4.8%) and effects of up to 2 centimetres per allele (such as those in IHH, STC2, AR and CRISPLD2), greater than ten times the average effect of common variants. In functional follow-up studies, rare height-increasing alleles of STC2 (giving an increase of 1-2 centimetres per allele) compromised proteolytic inhibition of PAPP-A and increased cleavage of IGFBP-4 in vitro, resulting in higher bioavailability of insulin-like growth factors. These 83 height-associated variants overlap genes that are mutated in monogenic growth disorders and highlight new biological candidates (such as ADAMTS3, IL11RA and NOX4) and pathways (such as proteoglycan and glycosaminoglycan synthesis) involved in growth. Our results demonstrate that sufficiently large sample sizes can uncover rare and low-frequency variants of moderate-to-large effect associated with polygenic human phenotypes, and that these variants implicate relevant genes and pathways.

%B Nature %V 542 %P 186-190 %8 2017 Feb 09 %G eng %N 7640 %1 http://www.ncbi.nlm.nih.gov/pubmed/28146470?dopt=Abstract %R 10.1038/nature21039 %0 Journal Article %J PLOS ONE %D 2017 %T Religion, a social determinant of mortality? A 10-year follow-up of the Health and Retirement Study %A Idler, Ellen %A Blevins, John %A Kiser, Mimi %A Hogue, Carol %E Anglewicz, Philip %K Gender Differences %K Mortality %K Racial/ethnic differences %K Religion %X The social determinants of health framework has brought a recognition of the primary importance of social forces in determining population health. Research using this framework to understand the health and mortality impact of social, economic, and political conditions, however, has rarely included religious institutions and ties. We investigate a well-measured set of social and economic determinants along with several measures of religious participation as predictors of adult mortality. Respondents (N = 18,370) aged 50 and older to the Health and Retirement Study were interviewed in 2004 and followed for all-cause mortality to 2014. Exposure variables were religious attendance, importance, and affiliation. Other social determinants of health included gender, race/ethnicity, education, household income, and net worth measured at baseline. Confounders included physical and mental health. Health behaviors and social ties were included as potential explanatory variables. Cox proportional hazards regressions were adjusted for complex sample design. After adjustment for confounders, attendance at religious services had a dose-response relationship with mortality, such that respondents who attended frequently had a 40% lower hazard of mortality (HR = 0.60, 95% CI 0.53–0.68) compared with those who never attended. Those for whom religion was “very important” had a 4% higher hazard (HR = 1.04, 95% CI 1.01–1.07); religious affiliation was not associated with risk of mortality. Higher income and net worth were associated with a reduced hazard of mortality as were female gender, Latino ethnicity, and native birth. Religious participation is multi-faceted and shows both lower and higher hazards of mortality in an adult US sample in the context of a comprehensive set of other social and economic determinants of health. %B PLOS ONE %V 12 %P e0189134 %G eng %N 12 %! PLoS ONE %R 10.1371/journal.pone.0189134 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2017 %T Retrospective Reports of Negative Early Life Events Over a 4-Year Period: A Test of Measurement Invariance and Response Consistency. %A Liat Ayalon %K Aged %K Child %K Child, Preschool %K Female %K Humans %K Life Change Events %K Male %K Memory, Episodic %K Middle Aged %K Models, Statistical %K Psychometrics %K Reproducibility of Results %K Retrospective Studies %K Surveys and Questionnaires %X

OBJECTIVES: The present study examined measurement invariance (i.e., construct validity), response consistency (i.e., test-retest reliability), and potential predictors of response consistency to the Health and Retirement Study (HRS) negative early life events questionnaire over two time points.

METHOD: The study was based on the HRS psychosocial questionnaire, which is a U.S. nationally representative survey of individuals older than 50 years and their spouses of any age. Overall, 4,541 individuals older than 50 years were eligible to complete the questionnaire and responded to all four negative early life events items in 2008 and 2012.

RESULTS: Only partial invariance across the two time points was established (with three of the four loadings and two thresholds remaining constant over time). For 20% of the sample, at least one item was inconsistently reported across waves. A positive response to a negative early life event item in 2008 was the most consistent predictor of response inconsistency over time.

CONCLUSIONS: The measure of negative early life events has limited construct validity and test-retest reliability. Inconsistency is particularly high among those who had first endorsed an item. The use of this retrospective measure for the understanding of age and aging should be considered with caution. Panel surveys might consider probing about early life events repeatedly to better address inconsistencies over time.

%B J Gerontol B Psychol Sci Soc Sci %V 72 %P 901-912 %8 2017 Sep 01 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/09/23/geronb.gbv087.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26405079?dopt=Abstract %4 Confirmatory factor analysis/Epidemiology/Life events/Psychometrics/Recall/Reliability/Retrospective/Validity %$ 999999 %R 10.1093/geronb/gbv087 %0 Journal Article %J PLoS Genetics %D 2017 %T Single-trait and multi-trait genome-wide association analyses identify novel loci for blood pressure in African-ancestry populations. %A Liang, Jingjing %A Le, Thu H %A Digna R Velez Edwards %A Bamidele O Tayo %A Gaulton, Kyle J %A Smith, Jennifer A %A Lu, Yingchang %A Jensen, Richard A %A Chen, Guanjie %A Yanek, Lisa R %A Schwander, Karen %A Tajuddin, Salman M %A Sofer, Tamar %A Kim, Wonji %A Kayima, James %A McKenzie, Colin A %A Fox, Ervin %A Michael A Nalls %A Young, J Hunter %A Yan V Sun %A Lane, Jacqueline M %A Cechova, Sylvia %A Zhou, Jie %A Tang, Hua %A Myriam Fornage %A Musani, Solomon K %A Wang, Heming %A Lee, Juyoung %A Adeyemo, Adebowale %A Dreisbach, Albert W %A Forrester, Terrence %A Chu, Pei-Lun %A Anne Cappola %A Michele K Evans %A Alanna C Morrison %A Martin, Lisa W %A Kerri Wiggins %A Hui, Qin %A Zhao, Wei %A Jackson, Rebecca D %A Erin B Ware %A Jessica Faul %A Reiner, Alex P %A Bray, Michael %A Denny, Joshua C %A Thomas H Mosley %A Walter R Palmas %A Guo, Xiuqing %A George J Papanicolaou %A Alan Penman %A Polak, Joseph F %A Kenneth Rice %A Taylor, Ken D %A Boerwinkle, Eric %A Erwin P Bottinger %A Liu, Kiang %A Neil Risch %A Hunt, Steven C %A Charles Kooperberg %A Alan B Zonderman %A Laurie, Cathy C %A Becker, Diane M %A Cai, Jianwen %A Ruth J F Loos %A Psaty, Bruce M %A David R Weir %A Sharon L R Kardia %A Donna K Arnett %A Won, Sungho %A Edwards, Todd L %A Redline, Susan %A Cooper, Richard S %A Rao, D C %A Rotter, Jerome I %A Charles N Rotimi %A Levy, Daniel %A Chakravarti, Aravinda %A Zhu, Xiaofeng %A Franceschini, Nora %K African Americans %K Animals %K Basic Helix-Loop-Helix Transcription Factors %K Blood pressure %K Cadherins %K Case-Control Studies %K Female %K Genetic Loci %K Genome-Wide Association Study %K Humans %K Hypertension %K Male %K Membrane Proteins %K Mice %K Multifactorial Inheritance %K Polymorphism, Single Nucleotide %X

Hypertension is a leading cause of global disease, mortality, and disability. While individuals of African descent suffer a disproportionate burden of hypertension and its complications, they have been underrepresented in genetic studies. To identify novel susceptibility loci for blood pressure and hypertension in people of African ancestry, we performed both single and multiple-trait genome-wide association analyses. We analyzed 21 genome-wide association studies comprised of 31,968 individuals of African ancestry, and validated our results with additional 54,395 individuals from multi-ethnic studies. These analyses identified nine loci with eleven independent variants which reached genome-wide significance (P < 1.25×10-8) for either systolic and diastolic blood pressure, hypertension, or for combined traits. Single-trait analyses identified two loci (TARID/TCF21 and LLPH/TMBIM4) and multiple-trait analyses identified one novel locus (FRMD3) for blood pressure. At these three loci, as well as at GRP20/CDH17, associated variants had alleles common only in African-ancestry populations. Functional annotation showed enrichment for genes expressed in immune and kidney cells, as well as in heart and vascular cells/tissues. Experiments driven by these findings and using angiotensin-II induced hypertension in mice showed altered kidney mRNA expression of six genes, suggesting their potential role in hypertension. Our study provides new evidence for genes related to hypertension susceptibility, and the need to study African-ancestry populations in order to identify biologic factors contributing to hypertension.

%B PLoS Genetics %V 13 %P e1006728 %G eng %N 5 %R 10.1371/journal.pgen.1006728 %0 Report %D 2017 %T Smoking, Education and the Ability to Predict Own Survival Probabilities: An Observational Study on US Data %A Bruno Arpino %A Valeria Bordone %A Sergei Scherbov %K Education %K Life Expectancy %K Smoking %X Background: Subjective survival probabilities (SSPs) are a good predictor of mortality, go beyond the aggregate description of survival defined by life tables, and are important for individuals’ decision-making in later life. Despite the well-known mortality differentials by education as well as by characteristics such as smoking, little investigation has focused on SSPs by population sub-groups. Methods: We use data on individuals aged 50-89 from the Health and Retirement Study(HRS) carried out in the USA between 2000 and 2012 (N=23,895). Each respondent was asked to assess the probability to survive to a given target age according to their age at the time of the survey. We assess how individuals’ SSPs and estimated objective survival probabilities (OSPs) vary by education and smoking and calculate, for each respondent, the gap between them. Results: Consistently with real mortality patterns, smokers report the lowest SSPs, both among lower and higher educated people. When comparing SSPs and OSPs we find that, irrespectively of the smoking status, higher educated people are more likely to correctly predict their survival probabilities than their lower educated counterparts. Within both education groups, past smokers better predict their survival probability. Current smokers with low education show the highest probability to overestimate their survival probability. Conclusions: Lower educated people and smokers are aware of their lower life expectancy. Still, they overestimate their survival probabilities more than the higher educated and non-smokers. Our findings emphasize the need for policy makers to disseminate information about the risks of smoking, targeting people with lower education. %B IIASA Working Paper %I International Institute for Applied Systems Analysis %C Laxenburg, Austria %G eng %U http://pure.iiasa.ac.at/id/eprint/14692/ %0 Journal Article %J J Aging Health %D 2017 %T Social Inequalities in Inflammation: Age Variations in Older Persons. %A Uchechi A Mitchell %A Carol S Aneshensel %K Age Factors %K Aged %K Aged, 80 and over %K Biomarkers %K C-reactive protein %K Female %K Health Status Disparities %K Humans %K Inflammation %K Male %K Middle Aged %K Racial Groups %K Self Report %K Socioeconomic factors %X

OBJECTIVE: Systemic inflammation is an important risk factor for cardiovascular diseases and inequalities by race/ethnicity, gender, and education have been documented. However, there is incomplete knowledge as to how these disparities present across age, especially in late life. This study assesses whether differences in C-reactive protein (CRP), a marker of inflammation, are contingent on age among older persons.

METHOD: Data are from the 2006/2008 Health and Retirement Study ( n = 10,974) biomarker assessment. CRP was regressed on interactions between age and other status characteristics.

RESULTS: Racial/ethnic differences in inflammation do not vary significantly by age. However, gender and education differences are greatest at younger ages and then narrow steadily with increasing age.

DISCUSSION: There is considerable heterogeneity in how disparities in inflammation present across age and characteristics such as race/ethnicity, gender, and education. Understanding status differences in the influence of age on factors affecting late-life health is useful for health disparities research.

%B J Aging Health %V 29 %P 769-787 %8 2017 Aug %G eng %U http://jah.sagepub.com/content/early/2016/04/24/0898264316645546.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27117593?dopt=Abstract %4 inflammation/health disparities/race/ethnicity/gender/education %$ 999999 %R 10.1177/0898264316645546 %0 Journal Article %J Journal of Aging and Health %D 2017 %T Social Isolation and Medicare Spending: Among Older Adults, Objective Isolation Increases Expenditures While Loneliness Does Not %A Jonathan G Shaw %A Farid, Monica %A Claire Noël-Miller %A Joseph, Neesha %A Houser, Ari %A Steven Asch %A Bhattacharya, Jay %A Flowers, Lynda %K Depressive symptoms %K Isolation %K Loneliness %K Medicare expenditures %K Medicare linkage %K Medicare/Medicaid/Health Insurance %K Social Support %X Objective: The purpose of this study was to evaluate the impact of objective isolation and loneliness on Medicare spending and outcomes. Method: We linked Health and Retirement Study data to Medicare claims to analyze objective isolation (scaled composite of social contacts and network) and loneliness (positive response to three-item loneliness scale) as predictors of subsequent Medicare spending. In multivariable regression adjusting for health and demographics, we determined marginal differences in Medicare expenditures. Secondary outcomes included spending by setting, and mortality. Results: Objective isolation predicts greater spending, US$1,644 (p <.001) per beneficiary annually, whereas loneliness predicts reduced spending, 'US$768 (p <.001). Increased spending concentrated in inpatient and nursing home (skilled nursing facilities [SNFs]) care; despite more health care, objectively isolated beneficiaries had 31% (p <.001) greater risk of death. Loneliness did not predict SNF use or mortality, but predicted slightly less inpatient and outpatient care. Discussion: Objectively isolated seniors have higher Medicare spending, driven by increased hospitalization and institutionalization, and face greater mortality. Policies supporting social connectedness could reap significant savings. %B Journal of Aging and Health %V 29 %P 1119-1143 %G eng %U http://journals.sagepub.com/doi/10.1177/0898264317703559http://journals.sagepub.com/doi/pdf/10.1177/0898264317703559 %N 7 %! J Aging Health %R 10.1177/0898264317703559 %0 Web Page %D 2017 %T Social Security giveth, medical costs taketh away %A Andrews, Michelle %K Medical Expenses %K News %K Social Security %B Chicago Tribune %I Kaiser Health News %C Menlo Park, CA %G eng %U https://khn.org/news/social-security-giveth-medical-costs-taketh-away/ %0 Journal Article %J Journal of the American Society of Nephrology %D 2017 %T SOS2 and ACP1 Loci Identified through Large-Scale Exome Chip Analysis Regulate Kidney Development and Function. %A Li, Man %A Li, Yong %A Weeks, Olivia %A Mijatovic, Vladan %A Teumer, Alexander %A Huffman, Jennifer E %A Tromp, Gerard %A Fuchsberger, Christian %A Gorski, Mathias %A Lyytikäinen, Leo-Pekka %A Nutile, Teresa %A Sedaghat, Sanaz %A Sorice, Rossella %A Tin, Adrienne %A Yang, Qiong %A Ahluwalia, Tarunveer S %A Dan E Arking %A Bihlmeyer, Nathan A %A Böger, Carsten A %A Carroll, Robert J %A Daniel I Chasman %A Marilyn C Cornelis %A Dehghan, Abbas %A Jessica Faul %A Feitosa, Mary F %A Gambaro, Giovanni %A Paolo P. Gasparini %A Giulianini, Franco %A Iris M Heid %A Huang, Jinyan %A Imboden, Medea %A Jackson, Anne U %A Janina Jeff %A Jhun, Min A %A Katz, Ronit %A Kifley, Annette %A Kilpeläinen, Tuomas O %A Kumar, Ashish %A Laakso, Markku %A Li-Gao, Ruifang %A Kurt Lohman %A Lu, Yingchang %A Mägi, Reedik %A Malerba, Giovanni %A Mihailov, Evelin %A Mohlke, Karen L %A Dennis O Mook-Kanamori %A Robino, Antonietta %A Ruderfer, Douglas %A Salvi, Erika %A Schick, Ursula M %A Schulz, Christina-Alexandra %A Smith, Albert V %A Smith, Jennifer A %A Traglia, Michela %A Laura M Yerges-Armstrong %A Zhao, Wei %A Goodarzi, Mark O %A Kraja, Aldi T %A Liu, Chunyu %A Wessel, Jennifer %A Boerwinkle, Eric %A Ingrid B Borecki %A Bork-Jensen, Jette %A Erwin P Bottinger %A Braga, Daniele %A Brandslund, Ivan %A Brody, Jennifer A %A Campbell, Archie %A Carey, David J %A Cramer Christensen %A Coresh, Josef %A Crook, Errol %A Curhan, Gary C %A Cusi, Daniele %A de Boer, Ian H %A de Vries, Aiko P J %A Denny, Joshua C %A Devuyst, Olivier %A Dreisbach, Albert W %A Endlich, Karlhans %A Tõnu Esko %A Franco, Oscar H %A Fulop, Tibor %A Gerhard, Glenn S %A Glümer, Charlotte %A Gottesman, Omri %A Grarup, Niels %A Gudnason, Vilmundur %A Hansen, Torben %A Tamara B Harris %A Caroline Hayward %A Lynne J Hocking %A Hofman, Albert %A Hu, Frank B %A Husemoen, Lise Lotte N %A Jackson, Rebecca D %A Jørgensen, Torben %A Jørgensen, Marit E %A Kähönen, Mika %A Sharon L R Kardia %A König, Wolfgang %A Charles Kooperberg %A Kriebel, Jennifer %A Lenore J Launer %A Lauritzen, Torsten %A Lehtimäki, Terho %A Levy, Daniel %A Linksted, Pamela %A Linneberg, Allan %A Liu, Yongmei %A Ruth J F Loos %A Lupo, Antonio %A Meisinger, Christine %A Melander, Olle %A Andres Metspalu %A Mitchell, Paul %A Nauck, Matthias %A Nürnberg, Peter %A Orho-Melander, Marju %A Parsa, Afshin %A Pedersen, Oluf %A Peters, Annette %A Peters, Ulrike %A Polasek, Ozren %A David J Porteous %A Nicole M Probst-Hensch %A Psaty, Bruce M %A Qi, Lu %A Olli T Raitakari %A Reiner, Alex P %A Rettig, Rainer %A Ridker, Paul M %A Fernando Rivadeneira %A Rossouw, Jacques E %A Schmidt, Frank %A David S Siscovick %A Soranzo, Nicole %A Strauch, Konstantin %A Toniolo, Daniela %A Stephen T Turner %A André G Uitterlinden %A Ulivi, Sheila %A Velayutham, Dinesh %A Völker, Uwe %A Völzke, Henry %A Waldenberger, Melanie %A Wang, Jie Jin %A David R Weir %A Daniel Witte %A Kuivaniemi, Helena %A Caroline S Fox %A Franceschini, Nora %A Goessling, Wolfram %A Köttgen, Anna %A Chu, Audrey Y %K Animals %K Exome %K Genetic Loci %K Genome-Wide Association Study %K Glomerular Filtration Rate %K Humans %K kidney %K Protein Tyrosine Phosphatases %K Proto-Oncogene Proteins %K Son of Sevenless Proteins %K Zebrafish %X

Genome-wide association studies have identified >50 common variants associated with kidney function, but these variants do not fully explain the variation in eGFR. We performed a two-stage meta-analysis of associations between genotypes from the Illumina exome array and eGFR on the basis of serum creatinine (eGFRcrea) among participants of European ancestry from the CKDGen Consortium (: 111,666; : 48,343). In single-variant analyses, we identified single nucleotide polymorphisms at seven new loci associated with eGFRcrea (, , and ; <3.7×10), of which most were common and annotated as nonsynonymous variants. Gene-based analysis identified associations of functional rare variants in three genes with eGFRcrea, including a novel association with the SOS Ras/Rho guanine nucleotide exchange factor 2 gene, (=5.4×10 by sequence kernel association test). Experimental follow-up in zebrafish embryos revealed changes in glomerular gene expression and renal tubule morphology in the embryonic kidney of and -knockdowns. These developmental abnormalities associated with altered blood clearance rate and heightened prevalence of edema. This study expands the number of loci associated with kidney function and identifies novel genes with potential roles in kidney formation.

%B Journal of the American Society of Nephrology %V 28 %P 981-994 %G eng %N 3 %R 10.1681/ASN.2016020131 %0 Journal Article %J SSM - Population Health %D 2017 %T Stress, self-regulation, and context: Evidence from the Health and Retirement Survey. %A Briana Mezuk %A Scott M Ratliff %A Jeannie B. Concha %A Cleopatra M Abdou %A Rafferty, Jane %A Lee, Hedwig %A James S Jackson %K Depressive symptoms %K Health Disparities %K Stress %X Health-related behaviors, such as smoking, alcohol use, exercise, and diet, are major determinants of physical health and health disparities. However, a growing body of experimental research in humans and animals also suggests these behaviors can impact the ways our bodies respond to stress, such that they modulate (that is, serve as a means to self-regulate or cope with) the deleterious impact of stressful experiences on mental health. A handful of epidemiologic studies have investigated the intersection between stress and health behaviors on health disparities (both mental and physical), with mixed results. In this study we use a novel instrument designed to explicitly measure the self-regulatory motivations and perceived effectiveness of eight health-related self-regulatory behaviors (smoking, alcohol, drug use, overeating, prayer, exercise, social support, talking with a councilor) in a subset of the Health and Retirement Study (N=1,354, Mean age=67, 54% female). We find that these behaviors are commonly endorsed as self-regulatory stress-coping strategies, with prayer, social support, exercise, and overeating used most frequently. The likelihood of using particular behaviors as self-regulatory strategies varied significantly by sex, but not by race/ethnicity, education, or wealth. We also find that greater stress exposure is associated with higher likelihood of using these behaviors to self-regulate feelings of emotional distress, particularly health-harming behaviors like smoking, alcohol, and overeating. These findings provide an important link between sociological and psychological theoretical models on stress and empirical epidemiological research on social determinants of health and health disparities. %B SSM - Population Health %V 3 %P 455-463 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29130063?dopt=Abstract %R 10.1016/j.ssmph.2017.05.004 %0 Journal Article %J Journal of the American Geriatrics Society %D 2017 %T Survival, functional status, and eating ability after percutaneous endoscopic gastrostomy tube placement for acute stroke %A Meisel, Karl %A Robert M. Arnold %A Irena Cenzer %A W John Boscardin %K Gastrostomy %K Palliative care %K Stroke %X

OBJECTIVES: To determine the long-term survival and independence of individuals with stroke and percutaneous endoscopic gastrostomy (PEG) tube placement.

DESIGN: Retrospective cohort study.

SETTING: A longitudinal nationally representative community-based sample of older adults.

PARTICIPANTS: Individuals with stroke who had a PEG tube placed (N = 174, mean age 79, 51% female, 29% African American).

MEASUREMENTS: Functional status before incident stroke was determined based on data from the Health and Retirement Study (HRS), a national longitudinal survey of community-dwelling older adults, from 1993 to 2012. Hospitalizations for stroke and PEG placement were determined according to Medicare claims. HRS participants were interviewed, and outcomes of survivors interviewed in the 2 years after hospitalization are described. Survival and functional and eating ability of the cohort were examined. Groups were compared according to age and prestroke functional disability in activities of daily living (ADLs) because it was hypothesized that ADL disability would predict worse outcomes.

RESULTS: In the 2 years after hospitalization, overall mortality was 66%. Fifteen participants survived and regained independent ADL function (9%). Of those who survived to a follow-up interview, 33 (56%) could not eat independently, and 31 (53%) required assistance to walk across the room. Age of 85 and older was associated with worse outcomes (10% vs 29% at 2 years, P < .001), but baseline ADL disability was not.

CONCLUSION: In this community-based sample, individuals who had had a stroke and a PEG tube placed had high mortality, and survivors were unlikely to be functional or mobile or to recover eating ability after hospitalization. A palliative care discussion including goals of care should occur before PEG tube placement is considered.

%B Journal of the American Geriatrics Society %V 65 %P 1848-1852 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/28449220?dopt=Abstract %R 10.1111/jgs.14908 %0 Journal Article %J J Aging Health %D 2017 %T Telomere Length Among Older U.S. Adults: Differences by Race/Ethnicity, Gender, and Age. %A Lauren L Brown %A Belinda L Needham %A Jennifer A Ailshire %K Aged %K Aging %K Biomarkers %K Female %K Health Status Disparities %K Humans %K Interviews as Topic %K Male %K Minority Groups %K Qualitative Research %K Telomere %K United States %X

OBJECTIVE: We examine race/ethnic, gender, and age differences in telomere length (TL) within a diverse, nationally representative sample of older adults.

METHOD: Data come from 5,228 White, Black, and Hispanic respondents aged 54+ in the 2008 Health and Retirement Study. TL was assayed from saliva using quantitative polymerase chain reaction (qPCR) by comparing telomere sequence copy number with a single gene copy number (T/S ratio). Linear regression was used to examine TL by race/ethnicity, gender, and age adjusting for social, economic, and health characteristics.

RESULTS: Women had longer TL than men (p < .05). Blacks ( p < .05) and Hispanics ( p < .10) had longer TL than Whites. Black women and men had the longest TL relative to other groups ( p < .05), while White men had the shortest TL ( p < .05). Black women and Hispanic men showed greater differences in TL with age.

DISCUSSION: Findings indicate social patterns in TL by race/ethnicity, gender, and age among older adults do not reflect differences observed in most population health outcomes.

%B J Aging Health %V 29 %P 1350-1366 %8 2017 12 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27469599 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27469599?dopt=Abstract %R 10.1177/0898264316661390 %0 Journal Article %J J Pain Symptom Manage %D 2017 %T Timing of Advance Directive Completion and Relationship to Care Preferences. %A Enguidanos, Susan %A Jennifer A Ailshire %K Advance care planning %K Advance directives %K Aged %K Aged, 80 and over %K Female %K Humans %K Male %K Middle Aged %K Patient Participation %K Patient Preference %K Retrospective Studies %X

CONTEXT: Given recent Medicare rules reimbursing clinicians for engaging in advance care planning, there is heightened need to understand factors associated with the timing of advance directive (AD) completion before death and how the timing impacts care decisions.

OBJECTIVE: The purpose of this study was to investigate patterns in timing of AD completion and the relationship between timing and documented care preferences. We hypothesize that ADs completed late in the course of illness or very early in the disease trajectory will reflect higher preferences for aggressive care.

METHODS: We conducted a retrospective study using logistic regressions to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults.

RESULTS: The analytic sample included exit interviews conducted from 2000 to 2012 among 2904 proxy reporters of deceased participants who had an AD. Nearly three-quarters (71%) of ADs were completed a year or more before death. Being younger or a racial/ethnic minority, and having lower education, a diagnosis of cancer or lung disease, and an expected death were associated with completing an AD within the three months before death, while having the lowest quartile of assets and memory problems were inversely associated with AD completion. Minorities, those with lower education, expected death, and timing of AD completion were associated with electing aggressive care.

CONCLUSION: Early documentation of care wishes may not be associated with an increased likelihood of electing aggressive care; however, ADs completed in the last months of life have higher rates of election of aggressive care.

%B J Pain Symptom Manage %V 53 %P 49-56 %8 2017 01 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(16)30336-0 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27720793?dopt=Abstract %R 10.1016/j.jpainsymman.2016.08.008 %0 Journal Article %J J Pain Symptom Manage %D 2017 %T The Use of Life-Sustaining Procedures in the Last Month of Life Is Associated With More Depressive Symptoms in Surviving Spouses. %A Katherine A Ornstein %A Melissa D. Aldridge %A Melissa M Garrido %A Rebecca Jean Gorges %A Bollens-Lund, Evan %A Albert L Siu %A Kenneth M. Langa %A Amy Kelley %K Aged %K Aged, 80 and over %K Caregivers %K depression %K Female %K Humans %K Intubation %K Longitudinal Studies %K Male %K Mental Health %K Respiration, Artificial %K Spouses %K Survivors %K Terminal Care %X

CONTEXT: Family caregivers of individuals with serious illness who undergo intensive life-sustaining medical procedures at the end of life may be at risk of negative consequences including depression.

OBJECTIVES: The objective of this study was to determine the association between patients' use of life-sustaining procedures at the end of life and depressive symptoms in their surviving spouses.

METHODS: We used data from the Health and Retirement Study, a longitudinal survey of U.S. residents, linked to Medicare claims data. We included married Medicare beneficiaries aged 65 years and older who died between 2000 and 2011 (n = 1258) and their surviving spouses. The use of life-sustaining procedures (i.e., intubation/mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral/parenteral nutrition, and cardiopulmonary resuscitation) in the last month of life was measured via claims data. Using propensity score matching, we compared change in depressive symptoms of surviving spouses.

RESULTS: Eighteen percent of decedents underwent one or more life-sustaining procedures in the last month of life. Those whose spouses underwent life-sustaining procedures had a 0.32-point increase in depressive symptoms after death (scale range = 0-8) and a greater likelihood of clinically significant depression (odds ratio = 1.51) compared with a matched sample of spouses of those who did not have procedures (P < 0.05).

CONCLUSION: Surviving spouses of those who undergo intensive life-sustaining procedures at the end of life experience a greater magnitude of increase in depressive symptoms than those whose spouses do not undergo such procedures. Further study of the circumstances and decision making surrounding these procedures is needed to understand their relationship with survivors' negative mental health consequences and how best to provide appropriate support.

%B J Pain Symptom Manage %V 53 %P 178-187.e1 %8 2017 02 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0885392416307850http://api.elsevier.com/content/article/PII:S0885392416307850?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0885392416307850?httpAccept=text/xml %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27864126?dopt=Abstract %! Journal of Pain and Symptom Management %R 10.1016/j.jpainsymman.2016.08.023 %0 Report %D 2017 %T Valuing pain using the subjective well-being method %A Thorhildur Ólafsdóttir %A Tinna Laufey Ásgeirsdóttir %A Edward C Norton %K Chronic pain %K Consumption and Savings %K Well-being %X 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. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 08/2017 %G eng %U http://www.nber.org/papers/w23649.pdf %R 10.3386/w23649 %0 Journal Article %J JAMA Internal Medicine %D 2017 %T Wealth-Associated Disparities in Death and Disability in the United States and England. %A Lena K Makaroun %A Rebecca T Brown %A L Grisell Diaz-Ramirez %A Cyrus Ahalt %A W John Boscardin %A Lang-Brown, Sean %A Sei J. Lee %K Cross-National %K Disabilities %K Mortality %K Wealth Inequality %X

Importance: Low income has been associated with poor health outcomes. Owing to retirement, wealth may be a better marker of financial resources among older adults.

Objective: To determine the association of wealth with mortality and disability among older adults in the United States and England.

Design, Setting, and Participants: The US Health and Retirement Study (HRS) and English Longitudinal Study of Aging (ELSA) are nationally representative cohorts of community-dwelling older adults. We examined 12 173 participants enrolled in HRS and 7599 enrolled in ELSA in 2002. Analyses were stratified by age (54-64 years vs 66-76 years) because many safety-net programs commence around age 65 years. Participants were followed until 2012 for mortality and disability.

Exposures: Wealth quintile, based on total net worth in 2002.

Main Outcomes and Measures: Mortality and disability, defined as difficulty performing an activity of daily living.

Results: A total of 6233 US respondents and 4325 English respondents aged 54 to 64 years (younger cohort) and 5940 US respondents and 3274 English respondents aged 66 to 76 years (older cohort) were analyzed for the mortality outcome. Slightly over half of respondents were women (HRS: 6570, 54%; ELSA: 3974, 52%). A higher proportion of respondents from HRS were nonwhite compared with ELSA in both the younger (14% vs 3%) and the older (13% vs 3%) age cohorts. We found increased risk of death and disability as wealth decreased. In the United States, participants aged 54 to 64 years in the lowest wealth quintile (Q1) (≤$39 000) had a 17% mortality risk and 48% disability risk over 10 years, whereas in the highest wealth quintile (Q5) (>$560 000) participants had a 5% mortality risk and 15% disability risk (mortality hazard ratio [HR], 3.3; 95% CI, 2.0-5.6; P < .001; disability subhazard ratio [sHR], 4.0; 95% CI, 2.9-5.6; P < .001). In England, participants aged 54 to 64 years in Q1 (≤£34,000) had a 16% mortality risk and 42% disability risk over 10 years, whereas Q5 participants (>£310,550) had a 4% mortality risk and 17% disability risk (mortality HR, 4.4; 95% CI, 2.7-7.0; P < .001; disability sHR, 3.0; 95% CI, 2.1-4.2; P < .001). In 66- to 76-year-old participants, the absolute risks of mortality and disability were higher, but risk gradients across wealth quintiles were similar. When adjusted for sex, age, race, income, and education, HR for mortality and sHR for disability were attenuated but remained statistically significant.

Conclusions and Relevance: Low wealth was associated with death and disability in both the United States and England. This relationship was apparent from age 54 years and continued into later life. Access to health care may not attenuate wealth-associated disparities in older adults.

%B JAMA Internal Medicine %V 177 %P 1745-1753 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/29059279?dopt=Abstract %R 10.1001/jamainternmed.2017.3903 %0 Journal Article %J Social Science Research %D 2017 %T Workplace bullying, perceived job stressors, and psychological distress: Gender and race differences in the stress process. %A Brandon K. Attell %A Kummerow Brown, Kiersten %A Linda A Treiber %K Depressive symptoms %K Gender Differences %K Racial/ethnic differences %K Stress %X A large body of empirical research documents the adverse mental health consequences of workplace bullying. However, less is known about gender and race differences in the processes that link workplace bullying and poor mental health. In the current study, we use structural equation modeling of survey data from the 2010 Health and Retirement Study (N = 2292) and draw on stress process theory to examine coworker support as a buffering mechanism against workplace bullying, and gender and race differences in the relationships between bullying and psychological distress. The results of the analysis indicate that coworker support serves as a protective buffer against workplace bullying, although the buffering effect is relatively small. We also find that the effects of workplace bullying more heavily impact women and persons of color. Specifically, women and African American individuals in our sample were less protected from the buffering mechanism of co-worker social support. %B Social Science Research %V 65 %P 210-221 %8 07/2017 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28599773?dopt=Abstract %R 10.1016/j.ssresearch.2017.02.001 %0 Journal Article %J Social Science Research %D 2017 %T Workplace bullying, perceived job stressors, and psychological distress: Gender and race differences in the stress process %A Brandon K. Attell %A Kummerow Brown, Kiersten %A Linda A Treiber %K Employment and Labor Force %K Gender Differences %K Job stressors %K Racial/ethnic differences %K Women and Minorities %X A large body of empirical research documents the adverse mental health consequences of workplace bullying. However, less is known about gender and race differences in the processes that link workplace bullying and poor mental health. In the current study, we use structural equation modeling of survey data from the 2010 Health and Retirement Study (N = 2292) and draw on stress process theory to examine coworker support as a buffering mechanism against workplace bullying, and gender and race differences in the relationships between bullying and psychological distress. The results of the analysis indicate that coworker support serves as a protective buffer against workplace bullying, although the buffering effect is relatively small. We also find that the effects of workplace bullying more heavily impact women and persons of color. Specifically, women and African American individuals in our sample were less protected from the buffering mechanism of co-worker social support. %B Social Science Research %V 65 %P 210-221 %G eng %U https://www.sciencedirect.com/science/article/pii/S0049089X16305087 %! Social Science Research %R 10.1016/j.ssresearch.2017.02.001 %0 Journal Article %J Aging Ment Health %D 2016 %T Accelerated increase and decrease in subjective age as a function of changes in loneliness and objective social indicators over a four-year period: results from the health and retirement study. %A Liat Ayalon %A Yuval Palgi %A Sharon Avidor %A Ehud Bodner %K Aged %K Aged, 80 and over %K Aging %K depression %K Female %K Humans %K Loneliness %K Male %K Retirement %K Social Change %X

OBJECTIVES: The study examined the role of changes in loneliness and objective social indicators in the formation of changes in subjective age over a four-year period.

METHODS: The Health and Retirement Study is a US nationally representative study of older adults over 50 and their spouse of any age. We restricted the sample to individuals, 65 years of age and older (n = 2591). An accelerated increase in subjective age was defined as an increase in subjective age over the two waves greater than five years. An accelerated decrease in subjective age was defined as a difference that was lower than three years. These were examined against a change in subjective age in the range of three to five years (i.e., change consistent with the passage of time).

RESULTS: For 23.4% of the sample, changes in subjective age were consistent with the passage of time. A total of 38.3% had an accelerated decrease in subjective age, whereas 38.3% had an accelerated increase. A decrease in loneliness over the two waves resulted in an accelerated decrease in subjective age, whereas an increase in depressive symptoms resulted in an accelerated increase in subjective age. Changes in objective social indicators, physical difficulties or medical comorbidity did not predict changes in subjective age.

CONCLUSIONS: This is one of very few studies that examined changes in subjective age over time. Changes in subjective age represent an important construct that corresponding to other changes in subjective experiences.

%B Aging Ment Health %I 20 %V 20 %P 743-51 %8 2016 07 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84928654923andpartnerID=40andmd5=dc249d3a4a7b131281c68dbbc5ac5bb7 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25925282?dopt=Abstract %4 aloneness/epidemiology/loneliness/social relations/subjective %$ 999999 %R 10.1080/13607863.2015.1035696 %0 Journal Article %J J Aging Health %D 2016 %T Age Differences in the Association Between Body Mass Index Class and Annualized Medicare Expenditures. %A Daniel O. Clark %A Kathleen A Lane %A Ambuehl, Roberta %A Tu, Wanzhu %A Chiung-Ju Liu %A Kathleen T. Unroe %A Christopher M. Callahan %K Age Factors %K Aged %K Body Mass Index %K Female %K Health Expenditures %K Humans %K Male %K Medicare %K Obesity %K United States %X

OBJECTIVE: The aim of the study is to assess the relationship between body mass index (BMI) class and Medicare claims among young-old (65-69), old (70-74), and old-old (75+) adults over a 10-year period.

METHOD: We assessed costs by BMI class and age group among 9,300 respondents to the 1998 Health and Retirement Study (HRS) with linked 1998-2008 Medicare claims data. BMI was classified as normal (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), or severe obesity (35 or above).

RESULTS: Annualized total Medicare claims adjusted for age, gender, ethnicity, education, and smoking history were 109% greater for severely obese young-old adults in comparison with normal weight young-old adults (US$9,751 vs. US$4,663). Total annualized claim differences between the normal weight and severely obese in the old and old-old groups were not statistically significant.

DISCUSSION: Excess Medicare expenditures related to obesity may be concentrated among severely obese young-old adults. Preventing severe obesity among middle and older aged adults may have large cost implications for society.

%B J Aging Health %I 28 %V 28 %P 165-79 %8 2016 Feb %G eng %U http://jah.sagepub.com/content/28/1/165 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26112066?dopt=Abstract %2 PMC4691214 %R 10.1177/0898264315589574 %0 Journal Article %J J Psychosom Res %D 2016 %T Antidepressant use and functional limitations in U.S. older adults. %A An, Ruopeng %A Lu, Lingyun %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Antidepressive Agents %K depression %K Drug Utilization %K Female %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Mobility Limitation %K Muscle, Skeletal %K Prevalence %K Risk Factors %K Socioeconomic factors %K United States %X

OBJECTIVE: The upsurge in prevalence and long-term use of antidepressants among older adults might have profound health implications beyond depressive symptom management. This study examined the relationship between antidepressant use and functional limitation onset in U.S. older adults.

METHODS: Study sample came from 2006 and 2008 waves of the Health and Retirement Study, in combination with data from 2005 and 2007 Prescription Drug Study. Self-reported antidepressant use was identified based on the therapeutic classification of Cerner Multum's Lexicon. Functional limitations were classified into those pertaining to physical mobility, large muscle function, activities of daily living, gross motor function, fine motor function, and instrumental activities of daily living. Cox proportional hazard models were performed to assess the effects of antidepressant use on future functional limitation onset by limitation category, antidepressant type, and length of use, adjusted by depression status and other individual characteristics.

RESULTS: Antidepressant use for one year and longer was associated with an increase in the risk of functional limitation by 8% (95% confidence interval=4%-12%), whereas the relationship between antidepressant use less than a year and function limitation was statistically nonsignificant. Antidepressant use was associated with an increase in the risk of functional limitation by 8% (3%-13%) among currently nondepressed participants but not currently depressed participants.

CONCLUSION: Long-term antidepressant use in older adults should be prudently evaluated and regularly monitored to reduce the risk of functional limitation. Future research is warranted to examine the health consequences of extended and/or off-label antidepressant use in absence of depressive symptoms.

%B J Psychosom Res %I 80 %V 80 %P 31-6 %8 2016 Jan %G eng %U http://www.sciencedirect.com/science/article/pii/S0022399915300167 %1 http://www.ncbi.nlm.nih.gov/pubmed/26721545?dopt=Abstract %R 10.1016/j.jpsychores.2015.11.007 %0 Journal Article %J International Cardiovascular Research Journal %D 2016 %T Baseline Depressive Symptoms Predict Subsequent Heart Disease; A 20-Year Cohort %A Maryam Moghani Lankarani %A Shervin Assari %K Depressive symptoms %K Health Conditions and Status %K Heart disease %K Older Adults %X Background: Depression is common among patients with heart disease. Depression is also associated with worse outcomes among patients with heart disease. Fewer studies have shown whether or not baseline depressive symptoms predict subsequent heart disease in general population. Objectives: This study aimed to investigate whether depressive symptoms at baseline predict risk of developing heart disease during the next 20 years in the United States. Patients and Methods: The data were extracted from the Health and Retirement Study (HRS), 1992 - 2012. The study was conducted on 8,375 individuals who were older than 50 years at entry, did not have heart disease at baseline, and had data on heart disease over the next 20 years. High depressive symptoms (modified Center for Epidemiologic Studies Depression Scale CES-D ) were considered as the independent variable. Self-reported data on physician diagnosis of heart disease were measured on a biannual basis. Baseline demographic data (i.e., age and gender), socioeconomic status (i.e., race, marital status, and education level), health behaviors (i.e., drinking, smoking, and exercise), and body mass index were controlled. Cox proportional hazard model was used for data analysis. Results: Cox proportional hazard model revealed a link between high depressive symptoms at baseline and time to developing heart disease (Hazard ratio = 1.439, 95 CI = 1.253 1.652), suggesting that individuals with high depressive symptoms at baseline developed heart disease sooner than others. The association between baseline depressive symptoms and risk of heart disease was significant after controlling for all the covariates. Conclusions: Individuals with depressive symptomatology are at higher risk of development of heart disease over time. Thus, individuals with depressed mood may need more rigorous evaluation for heart disease. %B International Cardiovascular Research Journal %I 10 %V 10 %P 29-34 %G eng %U http://ircrj.com/?page=article&article_id=25689 %N 1 %R 10.17795/icrj-10(1)29 %0 Journal Article %J Int J Environ Res Public Health %D 2016 %T Changes in Depressive Symptoms among Older Adults with Multiple Chronic Conditions: Role of Positive and Negative Social Support. %A Ahn, SangNam %A Kim, Seonghoon %A Zhang, Hongmei %K Aged %K Aged, 80 and over %K Aging %K depression %K Family %K Female %K Friends %K Humans %K Male %K Multiple Chronic Conditions %K Social Support %K United States %X

Depression severely affects older adults in the United States. As part of the social environment, significant social support was suggested to ameliorate depression among older adults. We investigate how varying forms of social support moderate depressive symptomatology among older adults with multiple chronic conditions (MCC). Data were analyzed using a sample of 11,400 adults, aged 65 years or older, from the 2006-2012 Health and Retirement Study. The current study investigated the moderating effects of positive or negative social support from spouse, children, other family, and friends on the association between MCC and depression. A linear mixed model with repeated measures was used to estimate the effect of MCC on depression and its interactions with positive and negative social support in explaining depression among older adults. Varying forms of social support played different moderating roles in depressive symptomatology among older adults with MCC. Positive spousal support significantly weakened the deleterious effect of MCC on depression. Conversely, all negative social support from spouse, children, other family, and friends significantly strengthened the deleterious effect of MCC on depression. Minimizing negative social support and maximizing positive spousal support can reduce depression caused by MCC and lead to successful aging among older adults.

%B Int J Environ Res Public Health %V 14 %8 2016 12 26 %G eng %U http://www.mdpi.com/1660-4601/14/1/16 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28035968?dopt=Abstract %! IJERPH %R 10.3390/ijerph14010016 %0 Journal Article %J JAMA Internal Medicine %D 2016 %T Characteristics of Decedents in Medicare Advantage and Traditional Medicare %A Byhoff, Elena %A Tamara B Harris %A John Z. Ayanian %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Older Adults %X Approximately 25% of all Medicare expenditures are for care received in the last year of life.1 Much research has been done to understand cost and utilization patterns for Medicare beneficiaries at the end of life (EOL).2 However, when assessing EOL costs, most studies focus on decedents with traditional fee-for-service (FFS) Medicare owing to the lack of cost and utilization data for the 30% of Medicare beneficiaries in Medicare Advantage (MA) plans.3 This gap is a cause for concern because utilization and quality of care may differ between MA and FFS beneficiaries.4- 6 We sought to examine differences in characteristics of decedents in MA and FFS Medicare based on detailed survey data. Methods The Health and Retirement Study (HRS) is a biennial longitudinal survey of a nationally representative cohort of US adults 51 years or older that measures a broad range of questions about health and aging. Between interview cycles, the HRS identifies participants who have died using information from family members and the National Death Index. We included decedents 65 years or older who died between the 1998 and 2012 survey waves and who authorized their HRS responses to be linked to Medicare data. We compared demographic, health, and functional and cognitive characteristics of all HRS decedents enrolled in Medicare FFS and MA plans using χ2 and t test. We performed multivariable ordinal regressions to determine if demographic differences between the Medicare groups explained differences in health, functional, and cognitive status. We used multiple imputation for missing data. The study was exempt from institutional review board approval because the data looked only at decedents. There were no significant differences in results of multivariable analyses using imputed or nonimputed variables (Table 1). Results Of the 9385 decedents included in our analysis, 2280 (24.3%) were continuously enrolled in MA plans for the last 6 months of life and 7105 (75.7%) were continuously enrolled in Medicare FFS. The FFS beneficiaries were significantly older than MA beneficiaries at the time of death, and the 2 groups differed with respect to marital status, race, net worth, and educational attainment (Table 1). The MA decedents were less likely to have supplemental insurance compared with FFS decedents, including Medicaid or private insurance. The MA decedents were more likely to be living in urban areas and in the Northeast or West, whereas FFS decedents resided commonly in the Midwest and South. The MA and FFS decedents did not differ in having an advance directive or having discussed their EOL treatment preferences with their health care proxy. At their last survey before death, FFS beneficiaries were more likely than MA beneficiaries to rate their health as “poor,” to have limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), and to have dementia. After adjusting for demographic differences between FFS and MA decedents in our sample, differences between FFS and MA decedents in self-rated health, functional limitations, and cognitive status remained significant (Table 2). Discussion The FFS beneficiaries were sicker than MA beneficiaries during the last year of life, with worse functional status, higher rates of dementia, and poorer self-rated health. These are important considerations because policymakers and researchers consider patient-specific factors related to high EOL costs in the Medicare population. Because MA beneficiaries are, on average, younger and more independent at the EOL, their health care utilization and costs may differ from those enrolled in FFS. Prior research6 shows that MA beneficiaries have lower inpatient and Emergency Department utilization at the EOL, and increased hospice enrollment compared with FFS beneficiaries. This pattern may arise from improved EOL management by MA plans but could also reflect a less chronically impaired population, with fewer acute care needs at the EOL owing to better social support and functional and cognitive status. %B JAMA Internal Medicine %V 176 %P 1020 %8 Jan-07-2016 %G eng %U http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.2266 %N 7 %! JAMA Intern Med %R 10.1001/jamainternmed.2016.2266 %0 Journal Article %J Lancet Diabetes Endocrinol %D 2016 %T Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis. %A Barbara H. Bardenheier %A Ji Lin %A Zhuo, Xiaohui %A Mohammed K. Ali %A Theodore J Thompson %A Yiling J. Cheng %A Edward W Gregg %K Activities of Daily Living %K Aged %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K United States %X

BACKGROUND: The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years.

METHODS: In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years.

FINDINGS: In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0·8-2·3 year delay in disability across the three metrics (mobility, 63·0 [95% CI 62·3-63·6] to 64·8 [63·6-65·7], p=0·01; instrumental activities of daily living, 63·5 [63·0-64·0] to 64·3 [63·0-65·3], p=0·24; activities of daily living, 62·7 [62·1-63·3] to 65·0 [63·5-65·9], p<0·0001) and 1·3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2·8 [2·5-3·2] to 1·5 [1·3-1·9]; p<0·0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1·1-2·3 year delay in disability across the three metrics (mobility, 61·3 [95% CI 60·5-62·1] to 63·2 [61·5-64·5], p=0·0416; instrumental activities of daily living, 63·0 [62·4-63·7] to 64·1 [62·7-65·2], p=0·16; activities of daily living, 62·3 [61·6-63·0] to 64·6 [63·1-65·6], p<0·0001) and 0·8 fewer life-years lost by age 70 years (1·9 [1·7-2·2] to 1·1 [0·9-1·5]; p<0·0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0·0001 for all comparisons).

INTERPRETATION: Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years.

FUNDING: US Department of Health & Human Services and the US Centers for Disease Control and Prevention.

%B Lancet Diabetes Endocrinol %V 4 %P 686-694 %8 2016 08 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27298181 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27298181?dopt=Abstract %R 10.1016/S2213-8587(16)30090-0 %0 Journal Article %J Psychol Aging %D 2016 %T A cross-lagged model of the reciprocal associations of loneliness and memory functioning. %A Liat Ayalon %A Sharon Shiovitz-Ezra %A Roziner, Ilan %K Aged %K Aging %K depression %K Female %K Humans %K Loneliness %K Male %K Memory %K Models, Psychological %K Social Behavior %K Spouses %K Surveys and Questionnaires %K Time Factors %X

The study was designed to evaluate the reciprocal associations of loneliness and memory functioning using a cross-lagged model. The study was based on the psychosocial questionnaire of the Health and Retirement Study, which is a U.S. nationally representative survey of individuals over the age of 50 and their spouses of any age. A total of 1,225 respondents had complete data on the loneliness measure in 2004 and at least in 1 of the subsequent waves (e.g., 2008, 2012) and were maintained for analysis. A cross-lagged model was estimated to examine the reciprocal associations of loneliness and memory functioning, controlling for age, gender, education, depressive symptoms, number of medical conditions, and the number of close social relationships. The model had adequate fit indices: χ2(860, N = 1,225) = 1,401.54, p < .001, Tucker-Lewis index = .957, comparative fit index = .963, and root mean square error of approximation = .023 (90% confidence interval [.021, .025]). The lagged effect of loneliness on memory functioning was nonsignificant, B(SE) = -.11(.08), p = .15, whereas the lagged effect of memory functioning on loneliness was significant, B(SE) = -.06(.02), p = .01, indicating that lower levels of memory functioning precede higher levels of loneliness 4 years afterward. Further research is required to better understand the mechanisms responsible for the temporal association between reduced memory functioning and increased loneliness. (PsycINFO Database Record

%B Psychol Aging %I 31 %V 31 %P 255-61 %8 2016 05 %G eng %U http://psycnet.apa.org/journals/pag/31/3/255/ %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/26974589?dopt=Abstract %R 10.1037/pag0000075 %0 Generic %D 2016 %T Disability Measurement in the Health and Retirement Study %A Emily M. Agree %A Douglas A. Wolf %K Disability %I National Institute on Aging %C Bethesda, MD %0 Journal Article %J BMC Public Health %D 2016 %T Does retirement mean more physical activity? A longitudinal study %A Feng, Xiaoqi %A Croteau, Karen %A Kolt, Gregory S. %A Astell-Burt, Thomas %K Aging %K Health Conditions and Status %K Older Adults %K Physical activity %K Retirement Planning and Satisfaction %X Background: Evidence on physical activity (PA) and transitions out of full-time employment in middle-to-older age is mainly cross-sectional and focused upon retirement. The purpose was to examine trajectories in PA before and after transitions out of full-time employment. Methods: Data were obtained for 5,754 people in full-time employment aged 50-75 from the US Health and Retirement Survey. Logistic regression was used to examine trajectories in twice-weekly participation in light, moderate and vigorous PA among those transitioning to part-time work, semi-retirement, full retirement, or economic inactivity due to disability, in comparison to those remaining in full-time employment. Results: Twice weekly participation in vigorous and light physical activity changed little for those who remained in full-time employment, while moderate physical activity decreased between baseline and follow-up (OR 0.95, 95 % CI 0.91, 0.99). Differences in physical activity according to transitional categories at follow-up were evident. Baseline differences in physical activity across all intensities were greatest among participants transitioning from full-time to part-time employment compared to those who remained in full-time employment throughout the study period (vigorous OR 1.41 95 % CI 1.23, 1.61; moderate OR 1.28 95 % CI 1.12, 1.46; light OR 1.29 95 % CI 1.12, 1.49). Those transitioning to unemployment were already among the least physically active at baseline, irrespective of intensity (albeit, with 95 % CIs spanning unity). Those transitioning to full-time retirement were also among the least active (e.g. vigorous OR 0.71 95 % CI 0.61, 0.81; moderate OR 0.80 95 % CI 0.71, 0.90). Declines in physical activity were reported for those transitioning to economic inactivity due to a disability (vigorous OR 0.29 95 % CI 0.14, 0.64; moderate OR 0.56 95 % CI 0.33, 0.95; light OR 0.34 95 % CI 0.19, 0.63). Physical activity increased regardless of intensity among participants transitioning to semi-retirement (p > 0.05) and full retirement (e.g. vigorous OR 1.28 95 % CI 1.09, 1. 51; moderate OR 1.24 95 % CI 1.07, 1.43). Light physical activity increased for those transitioning to unemployment (OR 1.40 95 % CI 1.02, 1.93), though less change was evident in moderate or vigorous physical activity. Conclusions: The amount and intensity of PA varies by the type of transition out of full-time employment among people in middle-to-older age. %B BMC Public Health %V 16 %P 1-7 %8 Jan-12-2016 %G eng %U http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3253-0http://link.springer.com/content/pdf/10.1186/s12889-016-3253-0 %N 1 %! BMC Public Health %R 10.1186/s12889-016-3253-0 %0 Thesis %B Public Health %D 2016 %T The effect of lifetime socioeconomic status on cardiovascular health among adults 50-years and older: findings from the 2006-2012 health and retirement study. %A Joseph C. Allegra %K Cardiovascular health %K Older Adults %K Socioeconomic factors %X The relationship between wealth and health continues to have important implications for public health policy as well as for individual behavior. As a result, economists, sociologists, and epidemiologists, among other disciplines, persist in pursuing a plausible working model linking wealth and health. Previous research indicates that childhood socioeconomic status (SES) plays a significant role in late-life health outcomes, however the mechanism by which this effect occurs remains unclear. Four competing models have been developed to explain this association: the critical-period model, the accumulation of risks model, and the pathway model, and the social-mobility model. Using data from the Health and Retirement Study, we conducted three observational investigations in order to 1) establish the prevalence of cardiovascular diseases (CVD) during the baseline year of 2006, 2) determine if social-mobility best explains the relationship between total net worth and incident CVD during the study period 2006-2012, and 3) provide an alternative hypothesis to the social-mobility model. Key findings from our analyses showed an inverse association between total net worth quintiles and prevalent CVD. The odds of any CVD diagnosis were 32% and 38% less among respondents in the two highest quintiles compared to the bottom quintile. Respondents in the top quintile also had lower odds of CHF (OR=0.57; 0.40-0.81, p=0.002) and angina (OR=0.58; 0.43-0.79, p<0.0001). In terms of economic mobility, respondents born into affluence who subsequently fell to the lowest tertile of net worth still had 0.69 times the risk of incident CVD compared to lifetime economically poor respondents. Maintaining middle class status from childhood to adulthood yielded an incidence rate ratio of 0.53 (0.37-0.78, p = 0.001). In addition to social mobility, we investigated the critical-period model. Results from this analysis suggested an association between respondents who identified their childhood socioeconomic status as "about average" and incident CVD (RR=0.73; 0.57-0.93, p=0.01) compared to respondents who identified their childhood SES as "poor". Our results add to a growing body of research concerning the timing of SES circumstance and its effect on health later in life. Accurate early-life SES information will be needed in order to determine the appropriate model driving this association. Advisors/Committee Members: TONI MILES. %B Public Health %I University of Georgia %C Athens, Georgia %V Ph.D. %G eng %U http://purl.galileo.usg.edu/uga_etd/allegra_joseph_c_201608_phd %9 Dissertation %0 Report %D 2016 %T The Effect of Social Security Information on the Labor Supply and Savings of Older Americans %A Philip Armour %A Lovenheim, Michael F. %K Labor Supply %K Social Security %X This paper examines how older workers adjust their labor supply in response to information they receive about their retirement wealth from the provision of the Social Security Statement. We find that older male workers’ labor supply is highly responsive to receiving personalized information about future Social Security benefits, leading to a reduction of 119 hours worked per year, on average. However, our estimates point to significant heterogeneity in this response, with workers at the lower end of the hours-worked distribution increasing their labor supply and those at the high end decreasing their labor supply. We argue differences in knowledge about Social Security benefits across the labor supply distribution can explain much of this heterogeneity. We additionally explore the extent to which the information on the Statement may have led some workers to mistakenly reduce their labor supply by too much due to a lack of understanding of the dynamic nature of the Statement’s benefit projections with respect to earnings. Receipt of a second Statement led all but the lowest hour workers to increase their labor supply relative to workers who did not receive a second Statement. This is consistent with workers misunderstanding the information provided as accumulated rather than projected wealth. Our results point to older workers being very responsive to Social Security information, which highlights the need to accurately convey information about both pension wealth and its sensitivity to changes in earnings. %I Michigan Retirement Research Center- University of Michigan %C Ann Arbor, United States %8 09/2016 %G eng %U https://pdfs.semanticscholar.org/9948/f3430170f13c34b24b71eca001723c55f03a.pdf %0 Journal Article %J Behavior Genetics %D 2016 %T Effects of Recent Stress and Variation in the Serotonin Transporter Polymorphism (5-HTTLPR) on Depressive Symptoms: A Repeated-Measures Study of Adults Age 50 and Older. %A Thalida E. Arpawong %A Jinkook Lee %A Drystan F. Phillips %A Eileen M. Crimmins %A Morgan E. Levine %A Carol A Prescott %K Aged %K Alleles %K depression %K Depressive Disorder %K Ethnic Groups %K Female %K Gene-Environment Interaction %K Genetic Association Studies %K Genetic Predisposition to Disease %K Haplotypes %K Humans %K Life Change Events %K Male %K Middle Aged %K Polymorphism, Single Nucleotide %K Promoter Regions, Genetic %K Serotonin Plasma Membrane Transport Proteins %K Stress, Psychological %X

Depending on genetic sensitivity to it, stress may affect depressive symptomatology differentially. Applying the stress-diathesis hypothesis to older adults, we postulate: (1) recent stress will associate with increased depressive symptom levels and (2) this effect will be greater for individuals with at least one short allele of the serotonin transporter gene promoter region (5-HTTLPR). Further, we employ a design that addresses specific limitations of many prior studies that have examined the 5-HTTLPR × SLE relation, by: (a) using a within-person repeated-measures design to address fluctuations that occur within individuals over time, increase power for detecting G × E, and address GE correlation; (b) studying reports of exogenous stressful events (those unlikely to be caused by depression) to help rule out reverse causation and negativity bias, and in order to assess stressors that are more etiologically relevant to depressive symptomatology in older adults. The sample is drawn from the Health and Retirement Study, a U.S. population-based study of older individuals (N = 28,248; mean age = 67.5; 57.3 % female; 80.7 % Non-Hispanic White, 14.9 % Hispanic/Latino, 4.5 % African American; genetic subsample = 12,332), from whom measures of depressive symptoms and exogenous stressors were collected biannually (1994-2010). Variation in the 5-HTTLPR was characterized via haplotype, using two single nucleotide polymorphisms (SNPs). Ordered logit models were constructed to predict levels of depressive symptoms from 5-HTTLPR and stressors, comparing results of the most commonly applied statistical approaches (i.e., comparing allelic and genotypic models, and continuous and categorical predictors) used in the literature. All models were stratified by race/ethnicity. Overall, results show a main effect of recent stress for all ethnic groups, and mixed results for the variation in 5-HTTLPR × stress interaction, contingent upon statistical model used. Findings suggest there may be a differential effect of stressors and 5-HTTLPR on depressive symptoms by ethnicity, but further research is needed, particularly when using a haplotype to characterize variation in 5-HTTLPR in population-based sample with a diverse ethnic composition.

%B Behavior Genetics %I 46 %V 46 %P 72-88 %G eng %N 1 %2 PMC4720538 %4 5-HTTLPR/Depressive symptoms/G/Older adults/Race differences/Stressful life events/Genetic analysis %$ 999999 %R 10.1007/s10519-015-9740-8 %0 Journal Article %J Nat Commun %D 2016 %T Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function. %A Pattaro, Cristian %A Teumer, Alexander %A Gorski, Mathias %A Chu, Audrey Y %A Li, Man %A Mijatovic, Vladan %A Garnaas, Maija %A Tin, Adrienne %A Sorice, Rossella %A Yong Li %A Taliun, Daniel %A Olden, Matthias %A Foster, Meredith %A Qiong Yang %A Chen, Ming-Huei %A Pers, Tune H %A Andrew D Johnson %A Ko, Yi-An %A Fuchsberger, Christian %A Bamidele O Tayo %A Michael A Nalls %A Feitosa, Mary F %A Isaacs, Aaron %A Dehghan, Abbas %A d'Adamo, Pio %A Adebawole Adeyemo %A Dieffenbach, Aida Karina %A Alan B Zonderman %A Ilja M Nolte %A van der Most, Peter J %A Alan F Wright %A Alan R Shuldiner %A Alanna C Morrison %A Hofman, Albert %A Albert Vernon Smith %A Dreisbach, Albert W %A Franke, Andre %A André G Uitterlinden %A Andres Metspalu %A Tönjes, Anke %A Lupo, Antonio %A Robino, Antonietta %A Johansson, Åsa %A Demirkan, Ayse %A Kollerits, Barbara %A Freedman, Barry I %A Ponte, Belen %A Ben A Oostra %A Paulweber, Bernhard %A Krämer, Bernhard K %A Mitchell, Braxton D %A Buckley, Brendan M %A Peralta, Carmen A %A Caroline Hayward %A Helmer, Catherine %A Charles N Rotimi %A Shaffer, Christian M %A Müller, Christian %A Cinzia Felicita Sala %A Cornelia M van Duijn %A Saint-Pierre, Aude %A Daniel Ackermann %A Daniel Shriner %A Ruggiero, Daniela %A Toniolo, Daniela %A Lu, Yingchang %A Cusi, Daniele %A Czamara, Darina %A Ellinghaus, David %A David S Siscovick %A Ruderfer, Douglas %A Gieger, Christian %A Grallert, Harald %A Rochtchina, Elena %A Atkinson, Elizabeth J %A Holliday, Elizabeth G %A Boerwinkle, Eric %A Salvi, Erika %A Erwin P Bottinger %A Murgia, Federico %A Fernando Rivadeneira %A Ernst, Florian %A Kronenberg, Florian %A Hu, Frank B %A Navis, Gerjan J %A Curhan, Gary C %A Georg B Ehret %A Homuth, Georg %A Coassin, Stefan %A Thun, Gian-Andri %A Pistis, Giorgio %A Gambaro, Giovanni %A Malerba, Giovanni %A Grant W Montgomery %A Guðny Eiríksdóttir %A Jacobs, Gunnar %A Guo Li %A Wichmann, H-Erich %A Campbell, Harry %A Schmidt, Helena %A Wallaschofski, Henri %A Völzke, Henry %A Brenner, Hermann %A Kroemer, Heyo K %A Kramer, Holly %A Lin, Honghuang %A Irene Mateo Leach %A Ford, Ian %A Guessous, Idris %A Rudan, Igor %A Prokopenko, Inga %A Ingrid B Borecki %A Iris M Heid %A Kolcic, Ivana %A Persico, Ivana %A Jukema, J Wouter %A James F Wilson %A Felix, Janine F %A Divers, Jasmin %A Lambert, Jean-Charles %A Stafford, Jeanette M %A Gaspoz, Jean-Michel %A Jennifer A Smith %A Jessica Faul %A Wang, Jie Jin %A Ding, Jingzhong %A Joel N Hirschhron %A John R. Attia %A Whitfield, John B %A Chalmers, John %A Viikari, Jorma %A Coresh, Josef %A Denny, Joshua C %A Karjalainen, Juha %A Fernandes, Jyotika K %A Endlich, Karlhans %A Butterbach, Katja %A Keene, Keith L %A Kurt Lohman %A Portas, Laura %A Lenore J Launer %A Lyytikäinen, Leo-Pekka %A Yengo, Loic %A Lude L Franke %A Luigi Ferrucci %A Rose, Lynda M %A Kedenko, Lyudmyla %A Rao, Madhumathi %A Struchalin, Maksim %A Kleber, Marcus E %A Cavalieri, Margherita %A Haun, Margot %A Marilyn C Cornelis %A Ciullo, Marina %A Pirastu, Mario %A de Andrade, Mariza %A McEvoy, Mark A %A Woodward, Mark %A Adam, Martin %A Cocca, Massimiliano %A Nauck, Matthias %A Imboden, Medea %A Waldenberger, Melanie %A Pruijm, Menno %A Metzger, Marie %A Stumvoll, Michael %A Michele K Evans %A Sale, Michele M %A Kähönen, Mika %A Boban, Mladen %A Bochud, Murielle %A Rheinberger, Myriam %A Verweij, Niek %A Bouatia-Naji, Nabila %A Nicholas G Martin %A Nicholas D Hastie %A Nicole M Probst-Hensch %A Soranzo, Nicole %A Devuyst, Olivier %A Olli T Raitakari %A Gottesman, Omri %A Franco, Oscar H %A Polasek, Ozren %A Paolo P. Gasparini %A Munroe, Patricia B %A Ridker, Paul M %A Mitchell, Paul %A Muntner, Paul %A Meisinger, Christa %A Johannes H Smit %A Kovacs, Peter %A Wild, Philipp S %A Froguel, Philippe %A Rettig, Rainer %A Mägi, Reedik %A Biffar, Reiner %A Schmidt, Reinhold %A Middelberg, Rita P S %A Carroll, Robert J %A Brenda W J H Penninx %A Rodney J Scott %A Katz, Ronit %A Sedaghat, Sanaz %A Sarah Wild %A Sharon L R Kardia %A Ulivi, Sheila %A Hwang, Shih-Jen %A Enroth, Stefan %A Kloiber, Stefan %A Trompet, Stella %A Stengel, Benedicte %A Hancock, Stephen J %A Stephen T Turner %A Rosas, Sylvia E %A Stracke, Sylvia %A Tamara B Harris %A Zeller, Tanja %A Zemunik, Tatijana %A Lehtimäki, Terho %A Illig, Thomas %A Aspelund, Thor %A Nikopensius, Tiit %A Tõnu Esko %A Toshiko Tanaka %A Gyllensten, Ulf %A Völker, Uwe %A Emilsson, Valur %A Vitart, Veronique %A Aalto, Ville %A Gudnason, Vilmundur %A Chouraki, Vincent %A Chen, Wei-Min %A Igl, Wilmar %A März, Winfried %A Koenig, Wolfgang %A Lieb, Wolfgang %A Ruth J F Loos %A Yongmei Liu %A Snieder, Harold %A Pramstaller, Peter P %A Parsa, Afshin %A Jeff O'Connell %A Susztak, Katalin %A Hamet, Pavel %A Tremblay, Johanne %A de Boer, Ian H %A Böger, Carsten A %A Goessling, Wolfram %A Daniel I Chasman %A Köttgen, Anna %A Kao, W H Linda %A Caroline S Fox %K Chronic disease %K Genome-Wide Association Study %K Genotype %K Humans %X

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways.

%B Nat Commun %V 7 %P 10023 %8 2016 Jan 21 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/26831199?dopt=Abstract %R 10.1038/ncomms10023 %0 Journal Article %J Nat Genet %D 2016 %T Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses. %A Okbay, Aysu %A Baselmans, Bart M L %A De Neve, Jan-Emmanuel %A Turley, Patrick %A Nivard, Michel G %A Mark Alan Fontana %A Meddens, S Fleur W %A Richard Karlsson Linnér %A Cornelius A Rietveld %A Derringer, Jaime %A Gratten, Jacob %A Lee, James J %A Liu, Jimmy Z %A de Vlaming, Ronald %A Ahluwalia, Tarunveer S %A Buchwald, Jadwiga %A Cavadino, Alana %A Frazier-Wood, Alexis C %A Furlotte, Nicholas A %A Garfield, Victoria %A Geisel, Marie Henrike %A Gonzalez, Juan R %A Haitjema, Saskia %A Karlsson, Robert %A van der Laan, Sander W %A Ladwig, Karl-Heinz %A J. Lahti %A Sven J van der Lee %A Penelope A Lind %A Tian Liu %A Lindsay K Matteson %A Mihailov, Evelin %A Michael B Miller %A Minica, Camelia C %A Ilja M Nolte %A Dennis O Mook-Kanamori %A van der Most, Peter J %A Christopher J Oldmeadow %A Qian, Yong %A Olli T Raitakari %A Rawal, Rajesh %A Realo, Anu %A Rueedi, Rico %A Schmidt, Börge %A Albert Vernon Smith %A Stergiakouli, Evie %A Toshiko Tanaka %A Kent D Taylor %A Wedenoja, Juho %A Jürgen Wellmann %A Westra, Harm-Jan %A Willems, Sara M %A Wei Zhao %A Amin, Najaf %A Bakshi, Andrew %A Patricia A. Boyle %A Cherney, Samantha %A Cox, Simon R %A Gail Davies %A Davis, Oliver S P %A Ding, Jun %A Nese Direk %A Eibich, Peter %A Emeny, Rebecca T %A Fatemifar, Ghazaleh %A Jessica Faul %A Luigi Ferrucci %A Andreas J Forstner %A Gieger, Christian %A Gupta, Richa %A Tamara B Harris %A Harris, Juliette M %A Holliday, Elizabeth G %A Jouke-Jan Hottenga %A Philip L de Jager %A Marika A Kaakinen %A Kajantie, Eero %A Karhunen, Ville %A Kolcic, Ivana %A Kumari, Meena %A Lenore J Launer %A Lude L Franke %A Li-Gao, Ruifang %A Koini, Marisa %A Loukola, Anu %A Marques-Vidal, Pedro %A Grant W Montgomery %A Mosing, Miriam A %A Paternoster, Lavinia %A Pattie, Alison %A Katja E Petrovic %A Pulkki-Raback, Laura %A Quaye, Lydia %A Katri Räikkönen %A Rudan, Igor %A Rodney J Scott %A Jennifer A Smith %A Angelina R Sutin %A Trzaskowski, Maciej %A Anna A E Vinkhuyzen %A Lei Yu %A Zabaneh, Delilah %A John R. Attia %A David A Bennett %A Klaus Berger %A Bertram, Lars %A Dorret I Boomsma %A Snieder, Harold %A Chang, Shun-Chiao %A Francesco Cucca %A Ian J Deary %A Cornelia M van Duijn %A Johan G Eriksson %A Bültmann, Ute %A Eco J. C. de Geus %A Groenen, Patrick J F %A Gudnason, Vilmundur %A Hansen, Torben %A Catharina A Hartman %A Haworth, Claire M A %A Caroline Hayward %A Andrew C Heath %A Hinds, David A %A Hyppönen, Elina %A Iacono, William G %A Järvelin, Marjo-Riitta %A Jöckel, Karl-Heinz %A Kaprio, Jaakko %A Sharon L R Kardia %A Keltikangas-Järvinen, Liisa %A Kraft, Peter %A Laura D Kubzansky %A Lehtimäki, Terho %A Patrik K E Magnusson %A Nicholas G Martin %A McGue, Matt %A Andres Metspalu %A Melinda C Mills %A de Mutsert, Renée %A Oldehinkel, Albertine J %A Pasterkamp, Gerard %A Nancy L Pedersen %A Plomin, Robert %A Polasek, Ozren %A Power, Christine %A Rich, Stephen S %A Rosendaal, Frits R %A Hester M. den Ruijter %A Schlessinger, David %A Schmidt, Helena %A Svento, Rauli %A Schmidt, Reinhold %A Alizadeh, Behrooz Z %A Thorkild I. A. Sørensen %A Timothy Spector %A Andrew Steptoe %A Antonio Terracciano %A A. Roy Thurik %A Nicholas J Timpson %A Henning Tiemeier %A André G Uitterlinden %A Vollenweider, Peter %A Wagner, Gert G %A David R Weir %A Yang, Jian %A Dalton C Conley %A Hofman, Albert %A Johannesson, Magnus %A David I Laibson %A Sarah E Medland %A Meyer, Michelle N %A Pickrell, Joseph K %A Tõnu Esko %A Krueger, Robert F %A Jonathan P. Beauchamp %A Philipp D Koellinger %A Daniel J. Benjamin %A Bartels, Meike %A Cesarini, David %K Anxiety Disorders %K Bayes Theorem %K depression %K Genome-Wide Association Study %K Humans %K Neuroticism %K Phenotype %K Polymorphism, Single Nucleotide %X

Very few genetic variants have been associated with depression and neuroticism, likely because of limitations on sample size in previous studies. Subjective well-being, a phenotype that is genetically correlated with both of these traits, has not yet been studied with genome-wide data. We conducted genome-wide association studies of three phenotypes: subjective well-being (n = 298,420), depressive symptoms (n = 161,460), and neuroticism (n = 170,911). We identify 3 variants associated with subjective well-being, 2 variants associated with depressive symptoms, and 11 variants associated with neuroticism, including 2 inversion polymorphisms. The two loci associated with depressive symptoms replicate in an independent depression sample. Joint analyses that exploit the high genetic correlations between the phenotypes (|ρ^| ≈ 0.8) strengthen the overall credibility of the findings and allow us to identify additional variants. Across our phenotypes, loci regulating expression in central nervous system and adrenal or pancreas tissues are strongly enriched for association.

%B Nat Genet %V 48 %P 624-33 %8 2016 06 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27089181?dopt=Abstract %R 10.1038/ng.3552 %0 Journal Article %J Nat Genet %D 2016 %T Genome-wide analysis identifies 12 loci influencing human reproductive behavior. %A Nicola Barban %A Jansen, Rick %A de Vlaming, Ronald %A Vaez, Ahmad %A Mandemakers, Jornt J %A Felix C Tropf %A Shen, Xia %A James F Wilson %A Daniel I Chasman %A Ilja M Nolte %A Tragante, Vinicius %A van der Laan, Sander W %A Perry, John R B %A Kong, Augustine %A Ahluwalia, Tarunveer S %A Albrecht, Eva %A Laura M Yerges-Armstrong %A Atzmon, Gil %A Auro, Kirsi %A Kristin L. Ayers %A Bakshi, Andrew %A Ben-Avraham, Danny %A Klaus Berger %A Bergman, Aviv %A Bertram, Lars %A Bielak, Lawrence F %A Bjornsdottir, Gyda %A Bonder, Marc Jan %A Broer, Linda %A Bui, Minh %A Barbieri, Caterina %A Cavadino, Alana %A Chavarro, Jorge E %A Turman, Constance %A Maria Pina Concas %A Cordell, Heather J %A Gail Davies %A Eibich, Peter %A Eriksson, Nicholas %A Tõnu Esko %A Eriksson, Joel %A Falahi, Fahimeh %A Felix, Janine F %A Mark Alan Fontana %A Lude L Franke %A Gandin, Ilaria %A Gaskins, Audrey J %A Gieger, Christian %A Gunderson, Erica P %A Guo, Xiuqing %A Caroline Hayward %A He, Chunyan %A Edith Hofer %A Huang, Hongyan %A Joshi, Peter K %A Kanoni, Stavroula %A Karlsson, Robert %A Kiechl, Stefan %A Kifley, Annette %A Kluttig, Alexander %A Kraft, Peter %A Lagou, Vasiliki %A Lecoeur, Cecile %A Lahti, Jari %A Li-Gao, Ruifang %A Penelope A Lind %A Tian Liu %A Makalic, Enes %A Mamasoula, Crysovalanto %A Lindsay K Matteson %A Mbarek, Hamdi %A McArdle, Patrick F %A McMahon, George %A Meddens, S Fleur W %A Mihailov, Evelin %A Michael B Miller %A Missmer, Stacey A %A Monnereau, Claire %A van der Most, Peter J %A Myhre, Ronny %A Michael A Nalls %A Nutile, Teresa %A Ioanna Panagiota Kalafati %A Porcu, Eleonora %A Prokopenko, Inga %A Rajan, Kumar B %A Rich-Edwards, Janet %A Cornelius A Rietveld %A Robino, Antonietta %A Rose, Lynda M %A Rueedi, Rico %A Ryan, Kathleen A %A Saba, Yasaman %A Schmidt, Daniel %A Jennifer A Smith %A Stolk, Lisette %A Streeten, Elizabeth %A Tönjes, Anke %A Thorleifsson, Gudmar %A Ulivi, Sheila %A Wedenoja, Juho %A Jürgen Wellmann %A Willeit, Peter %A Yao, Jie %A Yengo, Loic %A Jing Hua Zhao %A Wei Zhao %A Zhernakova, Daria V %A Amin, Najaf %A Andrews, Howard %A Balkau, Beverley %A Barzilai, Nir %A Bergmann, Sven %A Biino, Ginevra %A Bisgaard, Hans %A Bønnelykke, Klaus %A Dorret I Boomsma %A Buring, Julie E %A Campbell, Harry %A Cappellani, Stefania %A Ciullo, Marina %A Cox, Simon R %A Francesco Cucca %A Toniolo, Daniela %A Davey-Smith, George %A Ian J Deary %A George Dedoussis %A Deloukas, Panos %A Cornelia M van Duijn %A Eco J. C. de Geus %A Johan G Eriksson %A Jessica Faul %A Cinzia Felicita Sala %A Froguel, Philippe %A Paolo P. Gasparini %A Giorgia G Girotto %A Hans-Jörgen Grabe %A Greiser, Karin Halina %A Groenen, Patrick J F %A de Haan, Hugoline G %A Haerting, Johannes %A Tamara B Harris %A Andrew C Heath %A Heikkilä, Kauko %A Hofman, Albert %A Homuth, Georg %A Holliday, Elizabeth G %A John L Hopper %A Hyppönen, Elina %A Jacobsson, Bo %A Vincent Jaddoe %A Johannesson, Magnus %A Jugessur, Astanand %A Kähönen, Mika %A Kajantie, Eero %A Sharon L R Kardia %A Keavney, Bernard %A Kolcic, Ivana %A Koponen, Päivikki %A Kovacs, Peter %A Kronenberg, Florian %A Kutalik, Zoltán %A La Bianca, Martina %A Lachance, Genevieve %A Iacono, William G %A Lai, Sandra %A Lehtimäki, Terho %A David C Liewald %A Lindgren, Cecilia M %A Yongmei Liu %A Luben, Robert %A Lucht, Michael %A Luoto, Riitta %A Magnus, Per %A Patrik K E Magnusson %A Nicholas G Martin %A McGue, Matt %A McQuillan, Ruth %A Sarah E Medland %A Meisinger, Christa %A Mellström, Dan %A Andres Metspalu %A Traglia, Michela %A Lili Milani %A Mitchell, Paul %A Grant W Montgomery %A Dennis O Mook-Kanamori %A de Mutsert, Renée %A Nohr, Ellen A %A Ohlsson, Claes %A Olsen, Jørn %A Ong, Ken K %A Paternoster, Lavinia %A Pattie, Alison %A Brenda W J H Penninx %A Markus Perola %A Peyser, Patricia A %A Pirastu, Mario %A Polasek, Ozren %A Power, Chris %A Kaprio, Jaakko %A Raffel, Leslie J %A Katri Räikkönen %A Olli T Raitakari %A Ridker, Paul M %A Ring, Susan M %A Roll, Kathryn %A Rudan, Igor %A Ruggiero, Daniela %A Rujescu, Dan %A Veikko Salomaa %A Schlessinger, David %A Schmidt, Helena %A Schmidt, Reinhold %A Schupf, Nicole %A Johannes H Smit %A Sorice, Rossella %A Timothy Spector %A John M Starr %A Stöckl, Doris %A Strauch, Konstantin %A Stumvoll, Michael %A Swertz, Morris A %A Thorsteinsdottir, Unnur %A A. Roy Thurik %A Nicholas J Timpson %A Tung, Joyce Y %A André G Uitterlinden %A Vaccargiu, Simona %A Viikari, Jorma %A Vitart, Veronique %A Völzke, Henry %A Vollenweider, Peter %A Vuckovic, Dragana %A Waage, Johannes %A Wagner, Gert G %A Wang, Jie Jin %A Wareham, Nicholas J %A David R Weir %A Gonneke Willemsen %A Willeit, Johann %A Alan F Wright %A Krina T Zondervan %A Stefansson, Kari %A Krueger, Robert F %A Lee, James J %A Daniel J. Benjamin %A Cesarini, David %A Philipp D Koellinger %A den Hoed, Marcel %A Snieder, Harold %A Melinda C Mills %X

The genetic architecture of human reproductive behavior-age at first birth (AFB) and number of children ever born (NEB)-has a strong relationship with fitness, human development, infertility and risk of neuropsychiatric disorders. However, very few genetic loci have been identified, and the underlying mechanisms of AFB and NEB are poorly understood. We report a large genome-wide association study of both sexes including 251,151 individuals for AFB and 343,072 individuals for NEB. We identified 12 independent loci that are significantly associated with AFB and/or NEB in a SNP-based genome-wide association study and 4 additional loci associated in a gene-based effort. These loci harbor genes that are likely to have a role, either directly or by affecting non-local gene expression, in human reproduction and infertility, thereby increasing understanding of these complex traits.

%B Nat Genet %V 48 %P 1462-1472 %8 2016 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/27798627?dopt=Abstract %R 10.1038/ng.3698 %0 Journal Article %J Depress Anxiety %D 2016 %T GENOME-WIDE ASSOCIATION STUDY (GWAS) AND GENOME-WIDE BY ENVIRONMENT INTERACTION STUDY (GWEIS) OF DEPRESSIVE SYMPTOMS IN AFRICAN AMERICAN AND HISPANIC/LATINA WOMEN. %A Dunn, Erin C %A Wiste, Anna %A Radmanesh, Farid %A Almli, Lynn M %A Gogarten, Stephanie M %A Sofer, Tamar %A Jessica Faul %A Sharon L R Kardia %A Jennifer A Smith %A David R Weir %A Wei Zhao %A Soare, Thomas W %A Saira S Mirza %A Karin Hek %A Henning Tiemeier %A Goveas, Joseph S %A Sarto, Gloria E %A Snively, Beverly M %A Marilyn C Cornelis %A Karestan C Koenen %A Kraft, Peter %A Shaun M Purcell %A Ressler, Kerry J %A Rosand, Jonathan %A Wassertheil-Smoller, Sylvia %A Smoller, Jordan W %K African Americans %K Aged %K depression %K Female %K Gene-Environment Interaction %K Genome-Wide Association Study %K Hispanic Americans %K Humans %K Life Change Events %K Middle Aged %K Phenotype %K Polymorphism, Single Nucleotide %K Risk Factors %K Self Report %X

BACKGROUND: Genome-wide association studies (GWAS) have made little progress in identifying variants linked to depression. We hypothesized that examining depressive symptoms and considering gene-environment interaction (GxE) might improve efficiency for gene discovery. We therefore conducted a GWAS and genome-wide by environment interaction study (GWEIS) of depressive symptoms.

METHODS: Using data from the SHARe cohort of the Women's Health Initiative, comprising African Americans (n = 7,179) and Hispanics/Latinas (n = 3,138), we examined genetic main effects and GxE with stressful life events and social support. We also conducted a heritability analysis using genome-wide complex trait analysis (GCTA). Replication was attempted in four independent cohorts.

RESULTS: No SNPs achieved genome-wide significance for main effects in either discovery sample. The top signals in African Americans were rs73531535 (located 20 kb from GPR139, P = 5.75 × 10(-8) ) and rs75407252 (intronic to CACNA2D3, P = 6.99 × 10(-7) ). In Hispanics/Latinas, the top signals were rs2532087 (located 27 kb from CD38, P = 2.44 × 10(-7) ) and rs4542757 (intronic to DCC, P = 7.31 × 10(-7) ). In the GEWIS with stressful life events, one interaction signal was genome-wide significant in African Americans (rs4652467; P = 4.10 × 10(-10) ; located 14 kb from CEP350). This interaction was not observed in a smaller replication cohort. Although heritability estimates for depressive symptoms and stressful life events were each less than 10%, they were strongly genetically correlated (rG = 0.95), suggesting that common variation underlying self-reported depressive symptoms and stressful life event exposure, though modest on their own, were highly overlapping in this sample.

CONCLUSIONS: Our results underscore the need for larger samples, more GEWIS, and greater investigation into genetic and environmental determinants of depressive symptoms in minorities.

%B Depress Anxiety %V 33 %P 265-80 %8 2016 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27038408?dopt=Abstract %R 10.1002/da.22484 %0 Journal Article %J Nature %D 2016 %T Genome-wide association study identifies 74 loci associated with educational attainment. %A Okbay, Aysu %A Jonathan P. Beauchamp %A Mark Alan Fontana %A Lee, James J %A Pers, Tune H %A Cornelius A Rietveld %A Turley, Patrick %A Chen, Guo-Bo %A Emilsson, Valur %A Meddens, S Fleur W %A Oskarsson, Sven %A Pickrell, Joseph K %A Thom, Kevin %A Pascal N Timshel %A de Vlaming, Ronald %A Abdel Abdellaoui %A Ahluwalia, Tarunveer S %A Bacelis, Jonas %A Baumbach, Clemens %A Bjornsdottir, Gyda %A Brandsma, Johannes H %A Maria Pina Concas %A Derringer, Jaime %A Furlotte, Nicholas A %A Galesloot, Tessel E %A Giorgia G Girotto %A Gupta, Richa %A Hall, Leanne M %A Sarah E Harris %A Edith Hofer %A Horikoshi, Momoko %A Huffman, Jennifer E %A Kaasik, Kadri %A Ioanna Panagiota Kalafati %A Karlsson, Robert %A Kong, Augustine %A Lahti, Jari %A Sven J van der Lee %A Christiaan de Leeuw %A Penelope A Lind %A Lindgren, Karl-Oskar %A Tian Liu %A Mangino, Massimo %A Marten, Jonathan %A Mihailov, Evelin %A Michael B Miller %A van der Most, Peter J %A Christopher J Oldmeadow %A Payton, Antony %A Pervjakova, Natalia %A Wouter J Peyrot %A Qian, Yong %A Olli T Raitakari %A Rueedi, Rico %A Salvi, Erika %A Schmidt, Börge %A Schraut, Katharina E %A Jianxin Shi %A Albert Vernon Smith %A Poot, Raymond A %A St Pourcain, Beate %A Teumer, Alexander %A Thorleifsson, Gudmar %A Verweij, Niek %A Vuckovic, Dragana %A Jürgen Wellmann %A Westra, Harm-Jan %A Yang, Jingyun %A Wei Zhao %A Zhihong Zhu %A Alizadeh, Behrooz Z %A Amin, Najaf %A Bakshi, Andrew %A Baumeister, Sebastian E %A Biino, Ginevra %A Bønnelykke, Klaus %A Patricia A. Boyle %A Campbell, Harry %A Cappuccio, Francesco P %A Gail Davies %A De Neve, Jan-Emmanuel %A Deloukas, Panos %A Demuth, Ilja %A Ding, Jun %A Eibich, Peter %A Eisele, Lewin %A Eklund, Niina %A Jessica Faul %A Feitosa, Mary F %A Andreas J Forstner %A Gandin, Ilaria %A Gunnarsson, Bjarni %A Halldórsson, Bjarni V %A Tamara B Harris %A Andrew C Heath %A Lynne J Hocking %A Holliday, Elizabeth G %A Homuth, Georg %A Horan, Michael A %A Jouke-Jan Hottenga %A Philip L de Jager %A Joshi, Peter K %A Jugessur, Astanand %A Marika A Kaakinen %A Kähönen, Mika %A Kanoni, Stavroula %A Keltigangas-Järvinen, Liisa %A Lambertus A Kiemeney %A Kolcic, Ivana %A Koskinen, Seppo %A Kraja, Aldi T %A Kroh, Martin %A Kutalik, Zoltán %A Latvala, Antti %A Lenore J Launer %A Lebreton, Maël P %A Douglas F Levinson %A Paul Lichtenstein %A Lichtner, Peter %A David C Liewald %A Loukola, Anu %A Pamela A F Madden %A Mägi, Reedik %A Mäki-Opas, Tomi %A Riccardo E Marioni %A Marques-Vidal, Pedro %A Meddens, Gerardus A %A McMahon, George %A Meisinger, Christa %A Meitinger, Thomas %A Milaneschi, Yusplitri %A Lili Milani %A Grant W Montgomery %A Myhre, Ronny %A Nelson, Christopher P %A Nyholt, Dale R %A William E R Ollier %A Aarno Palotie %A Paternoster, Lavinia %A Nancy L Pedersen %A Katja E Petrovic %A David J Porteous %A Katri Räikkönen %A Ring, Susan M %A Robino, Antonietta %A Rostapshova, Olga %A Rudan, Igor %A Rustichini, Aldo %A Veikko Salomaa %A Sanders, Alan R %A Sarin, Antti-Pekka %A Schmidt, Helena %A Rodney J Scott %A Smith, Blair H %A Jennifer A Smith %A Staessen, Jan A %A Steinhagen-Thiessen, Elisabeth %A Strauch, Konstantin %A Antonio Terracciano %A Tobin, Martin D %A Ulivi, Sheila %A Vaccargiu, Simona %A Quaye, Lydia %A van Rooij, Frank J A %A Venturini, Cristina %A Anna A E Vinkhuyzen %A Völker, Uwe %A Völzke, Henry %A Vonk, Judith M %A Vozzi, Diego %A Waage, Johannes %A Erin B Ware %A Gonneke Willemsen %A John R. Attia %A David A Bennett %A Klaus Berger %A Bertram, Lars %A Bisgaard, Hans %A Dorret I Boomsma %A Ingrid B Borecki %A Bültmann, Ute %A Chabris, Christopher F %A Francesco Cucca %A Cusi, Daniele %A Ian J Deary %A George Dedoussis %A Cornelia M van Duijn %A Johan G Eriksson %A Franke, Barbara %A Lude L Franke %A Paolo P. Gasparini %A Gejman, Pablo V %A Gieger, Christian %A Hans-Jörgen Grabe %A Gratten, Jacob %A Groenen, Patrick J F %A Gudnason, Vilmundur %A van der Harst, Pim %A Caroline Hayward %A Hinds, David A %A Hoffmann, Wolfgang %A Hyppönen, Elina %A Iacono, William G %A Jacobsson, Bo %A Järvelin, Marjo-Riitta %A Jöckel, Karl-Heinz %A Kaprio, Jaakko %A Sharon L R Kardia %A Lehtimäki, Terho %A Lehrer, Steven F %A Patrik K E Magnusson %A Nicholas G Martin %A McGue, Matt %A Andres Metspalu %A Pendleton, Neil %A Brenda W J H Penninx %A Markus Perola %A Nicola Pirastu %A Pirastu, Mario %A Polasek, Ozren %A Posthuma, Danielle %A Power, Christine %A Province, Michael A %A Nilesh J Samani %A Schlessinger, David %A Schmidt, Reinhold %A Thorkild I. A. Sørensen %A Timothy Spector %A Stefansson, Kari %A Thorsteinsdottir, Unnur %A A. Roy Thurik %A Nicholas J Timpson %A Henning Tiemeier %A Tung, Joyce Y %A André G Uitterlinden %A Vitart, Veronique %A Vollenweider, Peter %A David R Weir %A James F Wilson %A Alan F Wright %A Dalton C Conley %A Krueger, Robert F %A George Davey Smith %A Hofman, Albert %A David I Laibson %A Sarah E Medland %A Meyer, Michelle N %A Yang, Jian %A Johannesson, Magnus %A Peter M Visscher %A Tõnu Esko %A Philipp D Koellinger %A Cesarini, David %A Daniel J. Benjamin %K Alzheimer's disease %K Bipolar Disorder %K Cognitive Ability %K Education %K Fetus %K Genome-Wide Association Study %K Humans %K Molecular Sequence Annotation %K Polymorphism, Single Nucleotide %K Schizophrenia %K United Kingdom %X

Educational attainment is strongly influenced by social and other environmental factors, but genetic factors are estimated to account for at least 20% of the variation across individuals. Here we report the results of a genome-wide association study (GWAS) for educational attainment that extends our earlier discovery sample of 101,069 individuals to 293,723 individuals, and a replication study in an independent sample of 111,349 individuals from the UK Biobank. We identify 74 genome-wide significant loci associated with the number of years of schooling completed. Single-nucleotide polymorphisms associated with educational attainment are disproportionately found in genomic regions regulating gene expression in the fetal brain. Candidate genes are preferentially expressed in neural tissue, especially during the prenatal period, and enriched for biological pathways involved in neural development. Our findings demonstrate that, even for a behavioural phenotype that is mostly environmentally determined, a well-powered GWAS identifies replicable associated genetic variants that suggest biologically relevant pathways. Because educational attainment is measured in large numbers of individuals, it will continue to be useful as a proxy phenotype in efforts to characterize the genetic influences of related phenotypes, including cognition and neuropsychiatric diseases.

%B Nature %V 533 %P 539-42 %8 2016 05 26 %G eng %N 7604 %1 http://www.ncbi.nlm.nih.gov/pubmed/27225129?dopt=Abstract %R 10.1038/nature17671 %0 Journal Article %J Aging Cell %D 2016 %T GWAS analysis of handgrip and lower body strength in older adults in the CHARGE consortium. %A Amy M Matteini %A Toshiko Tanaka %A Karasik, David %A Atzmon, Gil %A Chou, Wen-Chi %A John D Eicher %A Andrew D Johnson %A Alice M. Arnold %A Michele L Callisaya %A Gail Davies %A Daniel S Evans %A Holtfreter, Birte %A Kurt Lohman %A Kathryn L Lunetta %A Mangino, Massimo %A Albert Vernon Smith %A Jennifer A Smith %A Teumer, Alexander %A Lei Yu %A Dan E Arking %A Aron S Buchman %A Chibinik, Lori B %A Philip L de Jager %A Jessica Faul %A Melissa E Garcia %A Gillham-Nasenya, Irina %A Gudnason, Vilmundur %A Hofman, Albert %A Hsu, Yi-Hsiang %A Ittermann, Till %A Lahousse, Lies %A David C Liewald %A Yongmei Liu %A Lopez, Lorna %A Fernando Rivadeneira %A Rotter, Jerome I %A Siggeirsdottir, Kristin %A John M Starr %A Thomson, Russell %A Tranah, Gregory J %A André G Uitterlinden %A Völker, Uwe %A Völzke, Henry %A David R Weir %A Kristine Yaffe %A Wei Zhao %A Wei Vivian Zhuang %A Zmuda, Joseph M %A David A Bennett %A Steven R Cummings %A Ian J Deary %A Luigi Ferrucci %A Tamara B Harris %A Sharon L R Kardia %A Kocher, Thomas %A Stephen B Kritchevsky %A Psaty, Bruce M %A Seshadri, Sudha %A Timothy Spector %A Velandai K Srikanth %A Beverly G Windham %A Zillikens, M Carola %A Anne B Newman %A Jeremy D Walston %A Douglas P Kiel %A Joanne M Murabito %K Adult %K Aged %K Chromatin Immunoprecipitation %K Cohort Studies %K Epigenesis, Genetic %K Genome-Wide Association Study %K Hand Strength %K Humans %K Molecular Sequence Annotation %K Muscle Strength %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %K Reproducibility of Results %X

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

%B Aging Cell %V 15 %P 792-800 %8 2016 10 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27325353?dopt=Abstract %R 10.1111/acel.12468 %0 Journal Article %J Health Econ %D 2016 %T Health Effects of Short-Term Fluctuations in Macroeconomic Conditions: The Case of Hypertension for Older Americans. %A Marco Angrisani %A Jinkook Lee %K Aged %K Commerce %K Economic Recession %K Female %K Health Status %K Humans %K Hypertension %K Longitudinal Studies %K Male %K Middle Aged %K Socioeconomic factors %K Stress, Psychological %K Surveys and Questionnaires %K Unemployment %K United States %X

We investigate the health effects of short-term macroeconomic fluctuations as described by changes in unemployment rate, house, and stock market price indexes. The 'Great Recession' provides the opportunity to conduct this analysis as it involved contemporaneous shocks to the labor, housing, and stock markets. Using panel data from the Health and Retirement Study over the period 2004-2010, we relate changes in hypertension status to changes in state-level unemployment rate and house prices and to changes in stock market prices. We consider hypertension, a disease related to stress and of high prevalence among older adults, that has received little attention in the literature linking macroeconomic conditions to individual health. Our analysis exploits self-reports of hypertension diagnosis as well as directly measured blood pressure readings. Using both measures, we find that the likelihood of developing hypertension is negatively related to changes in house prices. Also, decreasing house prices lower the probability of stopping hypertension medication treatment for individuals previously diagnosed with the condition. We do not observe significant associations between hypertension and either changes in unemployment rate or stock market prices. We document heterogeneity in the estimated health effects of the recession by gender, education, asset ownership, and work status. Copyright © 2016 John Wiley & Sons, Ltd.

%B Health Econ %V 25 Suppl 2 %P 113-125 %8 2016 11 %G eng %U http://doi.wiley.com/10.1002/hec.3374https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fhec.3374http://onlinelibrary.wiley.com/wol1/doi/10.1002/hec.3374/fullpdf %1 http://www.ncbi.nlm.nih.gov/pubmed/27870298?dopt=Abstract %! Health Econ. %R 10.1002/hec.3374 %0 Journal Article %J American Journal of Preventive Medicine %D 2016 %T Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study. %A Cleopatra M Abdou %A Adam W. Fingerhut %A James S Jackson %A Felicia V Wheaton %K Age Factors %K Aged %K Ageism %K Attitude of Health Personnel %K depression %K Female %K Health Status %K Humans %K Hypertension %K Male %K Mental Health %K Middle Aged %K Overweight %K Physician-Patient Relations %K Physicians %K Prejudice %K Racism %K Sex Factors %K Socioeconomic factors %K Stereotyping %X

INTRODUCTION: Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care.

METHODS: Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use.

RESULTS: Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine.

CONCLUSIONS: The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups.

%B American Journal of Preventive Medicine %I 50 %V 50 %P 191-198 %G eng %N 2 %2 PMC4755717 %4 HEALTH CARE/Stereotypes/PHYSICIAN TRUST/Social identity/Social identity %$ 999999 %R 10.1016/j.amepre.2015.07.034 %0 Journal Article %J Social Science and Medicine %D 2016 %T How does dementia onset in parents influence unmarried adult children's wealth %A Arora, Kanika %K Adult children %K Health Conditions and Status %K Healthcare %K Net Worth and Assets %X There is a growing concern that long-term care (LTC) needs of older adults lead to negative financial consequences for their family members. This paper examines whether the onset of dementia in parents influences wealth change among unmarried adult children regardless of their status as informal caregivers. Longitudinal data from seven waves (1998-2010) of the Health and Retirement Study (1540 person-wave observations) are used to analyze this question. Unconditional quantile regressions demonstrate that as a result of parental dementia diagnosis, unmarried adult children have lower wealth accumulation above the median of the wealth change distribution. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent period as well. Both losses in labor income and nursing home expenditures may play a role in leading to wealth declines. %B Social Science and Medicine %I 152 %V 152 %P 156-165 %G eng %4 Long Term Care/Dementia/adult Children/informal caregiver/wealth Accumulation %$ 999999 %R 10.1016/j.socscimed.2016.01.042 %0 Journal Article %J Mil Med Res %D 2016 %T The impact of hearing impairment and noise-induced hearing injury on quality of life in the active-duty military population: challenges to the study of this issue. %A Alamgir, Hasanat %A Caryn A Turner %A Nicole J Wong %A Sharon P. Cooper %A Jose A. Betancourt %A Henry, James %A Andrew J Senchak %A Tanisha L. Hammill %A Mark D Packer %X

The objectives of this research were to 1) summarize the available evidence on the impact of hearing loss on quality of life (QOL) among U.S. active-duty service members, 2) describe the QOL instruments that have been used to quantify the impact of hearing loss on quality of life, 3) examine national population-level secondary databases and report on their utility for studying the impact of hearing loss on QOL among active-duty service members, and 4) provide recommendations for future studies that seek to quantify the impact of hearing loss in this population. There is a lack of literature that addresses the intersection of hearing impairment, the military population, and quality of life measures. For audiological research, U.S. military personnel offer a unique research population, as they are exposed to noise levels and blast environments that are highly unusual in civilian work settings and can serve as a model population for studying the impact on QOL associated with these conditions. Our team recommends conducting a study on the active-duty service member population using a measurement instrument suitable for determining decreases in QOL specifically due to hearing loss.

%B Mil Med Res %I 3 %V 3 %P 11 %8 2016 %G eng %U http://mmrjournal.biomedcentral.com/articles/10.1186/s40779-016-0082-5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27076916?dopt=Abstract %2 PMC4830069 %R 10.1186/s40779-016-0082-5 %0 Journal Article %J Eastern Economic Journal %D 2016 %T The Impact of Retirement on Smoking Behavior %A Padmaja Ayyagari %K Health Conditions and Status %K Retirement Planning and Satisfaction %X We use data from the Health and Retirement Study to examine the relationship between retirement and smoking decisions. Retirement might affect smoking behavior through a change in the opportunity cost of time, job-related factors or income. To estimate the causal effect of retirement on smoking habits, we exploit eligibility for Social Security benefits at age 62 to account for the endogeneity of retirement. We find suggestive evidence that retirement increases the probability of smoking among ever smokers, but this effect is sensitive to the econometric specification used. We also find evidence of heterogeneity in the impact of retirement. %B Eastern Economic Journal %I 42 %V 42 %P 270-287 %G eng %N 2 %4 smoking behavior/smoking/retirement/opportunity cost %$ 999999 %R 10.1057/eej.2014.51 %0 Journal Article %J American Journal of Hospice and Palliative Medicine %D 2016 %T In a Longevity Society, Loss and Grief Are Emerging Risk Factors for Health Care Use: Findings From the Health and Retirement Survey Cohort Aged 50 to 70 Years %A Toni Miles %A Joseph C. Allegra %A Amara E. Ezeamama %A Simpson, Cherie %A Kerstin Gerst %A Elkins, Jennifer %K Adult children %K Healthcare %X In a society of long lives, parent and child life can overlap by as much as 50 years. Most children now experience the death of their parents as adults. Many of the 2.5 million deaths each year in the United States are parents. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, we estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87 ). A report of any loss increases risk of health care utilization by 20 to 30 . For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care. %B American Journal of Hospice and Palliative Medicine %I 33 %V 33 %P 41-46 %G eng %N 1 %4 parental Longevity/parent death/health Care Utilization/hospitalization %$ 999999 %R 10.1177/1049909114552125 %0 Journal Article %J Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation %D 2016 %T Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey %A Amara E. Ezeamama %A Elkins, Jennifer %A Simpson, Cherie %A Smith, Shaniqua L. %A Joseph C. Allegra %A Toni Miles %K Expectations %K Health Conditions and Status %K Healthcare %X OBJECTIVE: To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50-70years old enrolled in the US 2010 health and retirement survey. METHODS: Multivariable logistic regression models estimated odds ratios (ORs) and 95 confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1-2, 3-4 or 5 events. HCU included hospitalization (any vs. none) and physician visits ( 20 vs. 20) over 2years. FINDINGS: Hospitalization odds declined by 25 (OR 0.75, 95 CI 0.64-0.86), odds of 20 physician visits declined by 47 (OR 0.53, 95 CI 0.45-0.63) and the odds of SRH improvement increased by 49 (OR 1.49, 95 CI 1.17-1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 elevated for participants that reported 1-2, 3-4 and 5 versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician's visits and hospitalizations. CONCLUSION: In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU. %B Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation %I 25 %V 25 %P 1007-15 %G eng %N 4 %4 Resilience/lifetime adversity/HOSPITALIZATION/subjective well-being %$ 999999 %R 10.1007/s11136-015-1144-y %0 Generic %D 2016 %T Integrating objective health measurement using sensors, devices and pervasive computing in large-scale surveys %A Austin, Johanna %A Reynolds, Christina %A Kaye, Jeffrey %K Wellbeing %X While large-scale population studies provide a wealth of insight and knowledge about the health and wellbeing of the aging population, they typically rely on self-report which has been found to be unreliable, especially among older adults. In addition, the assessment strategy usually occurs sporadically, spaced years apart to reduce patient and investigator burden. Finally, the data itself is not fully ecologically relevant being prone to test situation biases. To overcome these shortcomings of self-report and procedural limitations many new developments using pervasive computing and continuous remote sensing strategies, incorporating high dimensional (“big data”) analytics show great promise for transforming health data capture and follow-up. By assessing health and behavior continuously, objectively and longitudinally, it becomes possible to generate more robust models on the inter-relationships between health and behavior. This review describes the various behaviors and parameters that can be collected via continuous assessment and the devices and assessment strategies that are used to capture key behaviors. Using the framework of wellbeing, we review strategies to assess behaviors that fall into three key categories of wellbeing. These include physical and physiological function, cognitive and intellectual wellbeing, and social behaviors and function. Thus, specific behaviors that can be assessed objectively and more continuously include body composition or weight (an example of a basic physiologic measure), medication adherence (an example of an everyday cognitive-functional task as well as an important medical outcome), and time out-of-home (and example of a measure of social engagement with the world). Devices and assessment strategies that are used to capture these key behaviors include an array of wearable devices, in-home sensor platforms, internet based surveys, computer tracking software, and “smart” devices. We review the applicability of these data collection methods to Health and Retirement Study and give suggestions for future avenues of research. %I National Institute on Aging %C Bethesda, MD %0 Journal Article %J BMJ %D 2016 %T Late mortality after sepsis: propensity matched cohort study. %A Hallie C Prescott %A Osterholzer, John J %A Kenneth M. Langa %A Angus, Derek C %A Theodore J Iwashyna %K Aged %K Aged, 80 and over %K Case-Control Studies %K Cause of Death %K Female %K Hospital Mortality %K Hospitalization %K Humans %K Longitudinal Studies %K Male %K Medicare %K Propensity Score %K Prospective Studies %K Sepsis %K Time Factors %K United States %X

OBJECTIVES:  To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

DEIGN:  Observational cohort study.

SETTING:  US Health and Retirement Study.

PARTICIPANTS:  960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

MAIN OUTCOME MEASURES:  Late (31 days to two years) mortality and odds of death at various intervals.

RESULTS:  Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

CONCLUSIONS:  More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

%B BMJ %V 353 %P i2375 %8 2016 May 17 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27189000 %1 http://www.ncbi.nlm.nih.gov/pubmed/27189000?dopt=Abstract %R 10.1136/bmj.i2375 %0 Report %D 2016 %T Late-in-Life Risks and the Under-Insurance Puzzle %A Ameriks, John %A Briggs, Joseph S. %A Caplin, Andrew %A Matthew D. Shapiro %A Tonetti, Christopher %K Affordable Care Act %K Health Insurance %K Health Shocks %K Medicare/Medicaid/Health Insurance %K Older Adults %K Risk Factors %K Social Security %X Individuals face significant late-in-life risks, including needing long-term care (LTC). Yet, they hold little long-term care insurance (LTCI). Using both "strategic survey questions," which identify preferences, and stated demand questions, this paper investigates the degree to which a fundamental lack of interest and poor product features determine low LTCI holdings. It estimates a rich set of individual-level preferences and uses a life-cycle model to predict insurance demand, finding that better insurance would be far more widely held than are products in the market. Comparing stated and model-predicted demand shows that flaws in existing products provide a significant, but partial, explanation for this under-insurance puzzle. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %P 1-62 %8 10/2016 %G eng %U http://www.nber.org/papers/w22726.pdf %R 10.3386/w22726 %0 Journal Article %J Tob Induc Dis %D 2016 %T Latino and Black smokers in the Health and Retirement Study are more likely to quit: the role of light smoking. %A Frank C. Bandiera %A Shervin Assari %A Livaudais-Toman, Jennifer %A Eliseo J Perez-Stable %X

BACKGROUND: Older persons are more vulnerable to tobacco mortality and less likely to make quit attempts. Less is known, however, about the role of race and ethnicity on quit rates in the U.S. Using a nationally representative data source of older adults in U.S., we aimed to study racial and ethnic differences in smoking cessation rates.

METHODS: We used data from all waves of the Health and Retirement Study (HRS) between 1992-2012. The HRS is a longitudinal nationally representative survey of adults over the age of 50 in the United States. We followed current smokers at baseline (year 1992) until time to first quit. Race/ethnicity was the main predictor; gender, age, education, marital status, count of chronic medical conditions, depressive symptoms, and drinking at baseline were control variables. Cox regression was used for analysis of time to quit.

RESULTS: Hazard ratios of quitting during the first ten (Hazard ratio = 1.51, p < 0.05) and 20 years (Hazard ratio = 1.46, p < 0.05) were larger for Latinos over the age of 50 compared to Whites. In addition, hazard ratios of quitting during the first 20 years (Hazard ratio = 1.19, p < 0.05) were larger for Blacks over the age of 50 compared to Whites. These findings were partially explained by cigarette consumption intensity, such that Latinos were lighter smokers and therefore more likely to quit than Whites.

CONCLUSION: Latinos and Blacks were more likely than Whites to quit smoking cigarettes within 20 years. However, this finding may be explained by cigarette consumption intensity.

%B Tob Induc Dis %V 14 %P 23 %8 2016 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27436994 %1 http://www.ncbi.nlm.nih.gov/pubmed/27436994?dopt=Abstract %R 10.1186/s12971-016-0090-y %0 Journal Article %J Proc Natl Acad Sci U S A %D 2016 %T Lifespan adversity and later adulthood telomere length in the nationally representative US Health and Retirement Study. %A Puterman, Eli %A Gemmill, Alison %A Karasek, Deborah %A David R Weir %A Nancy E Adler %A Aric A Prather %A Elissa S Epel %K Aged %K Aged, 80 and over %K Cellular Senescence %K Female %K Humans %K Longevity %K Male %K Middle Aged %K Multivariate Analysis %K Odds Ratio %K Public Health Surveillance %K Risk Factors %K Stress, Psychological %K Telomere %K Telomere Shortening %K United States %X

Stress over the lifespan is thought to promote accelerated aging and early disease. Telomere length is a marker of cell aging that appears to be one mediator of this relationship. Telomere length is associated with early adversity and with chronic stressors in adulthood in many studies. Although cumulative lifespan adversity should have bigger impacts than single events, it is also possible that adversity in childhood has larger effects on later life health than adult stressors, as suggested by models of biological embedding in early life. No studies have examined the individual vs. cumulative effects of childhood and adulthood adversities on adult telomere length. Here, we examined the relationship between cumulative childhood and adulthood adversity, adding up a range of severe financial, traumatic, and social exposures, as well as comparing them to each other, in relation to salivary telomere length. We examined 4,598 men and women from the US Health and Retirement Study. Single adversities tended to have nonsignificant relations with telomere length. In adjusted models, lifetime cumulative adversity predicted 6% greater odds of shorter telomere length. This result was mainly due to childhood adversity. In adjusted models for cumulative childhood adversity, the occurrence of each additional childhood event predicted 11% increased odds of having short telomeres. This result appeared mainly because of social/traumatic exposures rather than financial exposures. This study suggests that the shadow of childhood adversity may reach far into later adulthood in part through cellular aging.

%B Proc Natl Acad Sci U S A %V 113 %P E6335-E6342 %8 2016 10 18 %G eng %U http://www.pnas.org/content/113/42/E6335.long %N 42 %1 http://www.ncbi.nlm.nih.gov/pubmed/27698131?dopt=Abstract %R 10.1073/pnas.1525602113 %0 Journal Article %J PLoS One %D 2016 %T The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older. %A David B. Agus %A Gaudette, Étienne %A Dana P Goldman %A Messali, Andrew %E Song, Qing %K Aged %K Aged, 80 and over %K Anti-Inflammatory Agents, Non-Steroidal %K Aspirin %K Cardiovascular Diseases %K Female %K Humans %K Incidence %K Life Expectancy %K Male %K Middle Aged %K Nutrition Surveys %K Primary Prevention %K Quality-Adjusted Life Years %K Risk Assessment %K United States %X

BACKGROUND: The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease.

METHODS AND FINDINGS: We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08-0.50) and would add 900,000 people (95% CI 300,000-1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345-975) in net health benefits over that period.

CONCLUSIONS: Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively.

%B PLoS One %V 11 %P e0166103 %8 2016 %G eng %U http://dx.plos.org/10.1371/journal.pone.0166103 %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/27902693?dopt=Abstract %! PLoS ONE %R 10.1371/journal.pone.0166103 %0 Journal Article %J American Economic Review %D 2016 %T Medicare Part D and Portfolio Choice %A Padmaja Ayyagari %A Daifeng He %K Healthcare %K Investing %K Medicare/Medicaid/Health Insurance %K Older Adults %X Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk due to the introduction of Medicare Part D in the U.S. in 2006 to identify the causal effect of medical spending risk on portfolio choice. Consistent with theory, we find that Medicare-eligible persons increased risky investment after the introduction of prescription drug coverage, relative to a younger, ineligible cohort. %B American Economic Review %V 106 %P 339 - 342 %8 Jan-05-2016 %G eng %U http://pubs.aeaweb.org/doi/10.1257/aer.p20161125 %N 5 %! American Economic Review %R 10.1257/aer.p20161125 %0 Journal Article %J Nat Genet %D 2016 %T Meta-analysis identifies common and rare variants influencing blood pressure and overlapping with metabolic trait loci. %A Liu, Chunyu %A Kraja, Aldi T %A Jennifer A Smith %A Brody, Jennifer A %A Franceschini, Nora %A Joshua C. Bis %A Kenneth Rice %A Alanna C Morrison %A Lu, Yingchang %A Weiss, Stefan %A Guo, Xiuqing %A Walter R Palmas %A Martin, Lisa W %A Yii-Der I Chen %A Surendran, Praveen %A Drenos, Fotios %A Cook, James P %A Auer, Paul L %A Chu, Audrey Y %A Giri, Ayush %A Wei Zhao %A Jakobsdottir, Johanna %A Lin, Li-An %A Stafford, Jeanette M %A Amin, Najaf %A Mei, Hao %A Yao, Jie %A Voorman, Arend %A Larson, Martin G %A Grove, Megan L %A Albert Vernon Smith %A Hwang, Shih-Jen %A Chen, Han %A Huan, Tianxiao %A Kosova, Gulum %A Stitziel, Nathan O %A Kathiresan, Sekar %A Nilesh J Samani %A Schunkert, Heribert %A Deloukas, Panos %A Li, Man %A Fuchsberger, Christian %A Pattaro, Cristian %A Gorski, Mathias %A Charles Kooperberg %A George J Papanicolaou %A Rossouw, Jacques E %A Jessica Faul %A Sharon L R Kardia %A Bouchard, Claude %A Raffel, Leslie J %A André G Uitterlinden %A Franco, Oscar H %A Ramachandran S Vasan %A O'Donnell, Christopher J %A Kent D Taylor %A Liu, Kiang %A Erwin P Bottinger %A Gottesman, Omri %A Daw, E Warwick %A Giulianini, Franco %A Ganesh, Santhi %A Salfati, Elias %A Tamara B Harris %A Lenore J Launer %A Dörr, Marcus %A Felix, Stephan B %A Rettig, Rainer %A Völzke, Henry %A Eric S Kim %A Lee, Wen-Jane %A Lee, I-Te %A Sheu, Wayne H-H %A Tsosie, Krystal S %A Digna R Velez Edwards %A Yongmei Liu %A Correa, Adolfo %A David R Weir %A Völker, Uwe %A Ridker, Paul M %A Boerwinkle, Eric %A Gudnason, Vilmundur %A Reiner, Alexander P %A Cornelia M van Duijn %A Ingrid B Borecki %A Edwards, Todd L %A Chakravarti, Aravinda %A Rotter, Jerome I %A Psaty, Bruce M %A Ruth J F Loos %A Myriam Fornage %A Georg B Ehret %A Newton-Cheh, Christopher %A Levy, Daniel %A Daniel I Chasman %X

Meta-analyses of association results for blood pressure using exome-centric single-variant and gene-based tests identified 31 new loci in a discovery stage among 146,562 individuals, with follow-up and meta-analysis in 180,726 additional individuals (total n = 327,288). These blood pressure-associated loci are enriched for known variants for cardiometabolic traits. Associations were also observed for the aggregation of rare and low-frequency missense variants in three genes, NPR1, DBH, and PTPMT1. In addition, blood pressure associations at 39 previously reported loci were confirmed. The identified variants implicate biological pathways related to cardiometabolic traits, vascular function, and development. Several new variants are inferred to have roles in transcription or as hubs in protein-protein interaction networks. Genetic risk scores constructed from the identified variants were strongly associated with coronary disease and myocardial infarction. This large collection of blood pressure-associated loci suggests new therapeutic strategies for hypertension, emphasizing a link with cardiometabolic risk.

%B Nat Genet %V 48 %P 1162-70 %8 2016 Oct %G eng %N 10 %R 10.1038/ng.3660 %0 Journal Article %J Journal of the American Medical Directors Association %D 2016 %T Modifiable Risk Factors for New-Onset Slow Gait in Older Adults %A Joe Verghese %A Wang, Cuiling %A Allali, Gilles %A Holtzer, Roee %A Emmeline Ayers %K Health Conditions and Status %K Healthcare %X AbstractObjective Despite the growing importance of slow gait as a universal screen of health, systematic investigation of risk factors for incident slow gait is lacking. Our objective was to identify potentially modifiable risk factors for incident slow gait. Design Prospective cohort study. Setting The Health and Retirement Study, a nationally representative US sample. Participants A total of 2306 individuals age 65 and older (56.5 women) from the 2008 wave with timed walks at baseline and 4 years later. Measurements Incident slow gait (walking speed 1 SD below age and sex means) was the outcome. Fifteen potentially modifiable medical and lifestyle risk factors were examined as predictors. Results Incident slow gait developed in 243 participants (11 ) at 4 years. Physical inactivity (adjusted relative risk aRR 1.94), cognitive impairment (aRR 1.77), muscle weakness (aRR 1.48), pain (aRR 1.45), obesity (aRR 1.35), vision (aRR 1.36), and falls (aRR 1.32) predicted increased risk of developing incident slow gait. Together, these risk factors accounted for 77 (95 confidence interval 14 95) of the Population Attributable Risk for incident slow gait. Conclusion A limited set of potentially modifiable risk factors is associated with new-onset slow gait in older adults. These findings provide a foundation for developing clinical guidelines and preventive interventions for slow gait. %B Journal of the American Medical Directors Association %I 17 %V 17 %P 421-425 %G eng %U http://www.sciencedirect.com/science/article/pii/S1525861016000554 %N 5 %4 epidemiology/incidence %$ 999999 %R 10.1016/j.jamda.2016.01.017 %0 Journal Article %J Alzheimers Dement %D 2016 %T Motoric cognitive risk syndrome and risk of mortality in older adults. %A Emmeline Ayers %A Joe Verghese %K Age Factors %K Aged %K Cognition Disorders %K Cohort Studies %K Dementia %K Early Diagnosis %K Female %K Gait %K Humans %K Male %K Mortality %K Risk Factors %X

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

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

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

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

%B Alzheimers Dement %V 12 %P 556-64 %8 2016 05 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/26545790 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26545790?dopt=Abstract %R 10.1016/j.jalz.2015.08.167 %0 Journal Article %J Economics Letters %D 2016 %T Ownership of a bank account and health of older Hispanics %A Emma Aguila %A Marco Angrisani %A Blanco, Luisa R. %K Cross-National %K Finances %K Healthcare %K Older Adults %K Women and Minorities %X We study health effects of financial inclusion, particularly ownership of a bank account of older minorities, with focus on Hispanics. Using data from the Health and Retirement Study from 2000 to 2012, we find that, for Hispanics, being banked has a positive effect on mental health but is not associated with effects on physical health. Mental health benefits are likely to be larger for those who face greater hurdles to access formal financial institutions. Hispanics in less well-off neighborhoods and with below-median wealth appear to experience the greatest mental-health benefits associated with ownership of a bank account. %B Economics Letters %I 144 %V 144 %P 41-44 %G eng %U http://www.sciencedirect.com/science/article/pii/S0165176516301239 %R 10.1016/j.econlet.2016.04.013 %0 Journal Article %J BMC Health Serv Res %D 2016 %T A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf. %A Frederic D Wolinsky %A Ayres, Lioness %A Michael P Jones %A Yiyue Lou %A George L Wehby %A Fred A Ullrich %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Epidemiologic Methods %K Female %K Health Status %K Hospitalization %K Humans %K Iowa %K Male %K Medicare %K Middle Aged %K Patient Acceptance of Health Care %K Physicians %K Proxy %K Spouses %K United States %X

BACKGROUND: Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.

METHODS: We used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.

RESULTS: PABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = -0.21 to 0.60) for health ratings, and physician and dental visits.

CONCLUSIONS: These results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses' Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.

%B BMC Health Serv Res %V 16 %P 485 %8 2016 09 09 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27612571?dopt=Abstract %R 10.1186/s12913-016-1734-6 %0 Journal Article %J PLoS Genet %D 2016 %T Pleiotropic Associations of Allelic Variants in a 2q22 Region with Risks of Major Human Diseases and Mortality. %A Alexander M Kulminski %A He, Liang %A Culminskaya, Irina %A Loika, Yury %A Kernogitski, Yelena %A Konstantin G Arbeev %A Loiko, Elena %A Liubov S Arbeeva %A Bagley, Olivia %A Duan, Matt %A Arseniy P Yashkin %A Fang, Fang %A Kovtun, Mikhail %A Svetlana Ukraintseva %A Wu, Deqing %A Anatoliy Yashin %E Barsh, Gregory S. %K Activin Receptors, Type II %K Atherosclerosis %K Chromosomes, Human, Pair 2 %K Coronary Disease %K Diabetes Mellitus %K Female %K Genetic Association Studies %K Genetic Diseases, Inborn %K Genetic Pleiotropy %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Heart Failure %K Homeodomain Proteins %K Humans %K Male %K Repressor Proteins %K Risk Factors %K Stroke %K Zinc Finger E-box Binding Homeobox 2 %X

Gaining insights into genetic predisposition to age-related diseases and lifespan is a challenging task complicated by the elusive role of evolution in these phenotypes. To gain more insights, we combined methods of genome-wide and candidate-gene studies. Genome-wide scan in the Atherosclerosis Risk in Communities (ARIC) Study (N = 9,573) was used to pre-select promising loci. Candidate-gene methods were used to comprehensively analyze associations of novel uncommon variants in Caucasians (minor allele frequency~2.5%) located in band 2q22.3 with risks of coronary heart disease (CHD), heart failure (HF), stroke, diabetes, cancer, neurodegenerative diseases (ND), and mortality in the ARIC study, the Framingham Heart Study (N = 4,434), and the Health and Retirement Study (N = 9,676). We leveraged the analyses of pleiotropy, age-related heterogeneity, and causal inferences. Meta-analysis of the results from these comprehensive analyses shows that the minor allele increases risks of death by about 50% (p = 4.6×10-9), CHD by 35% (p = 8.9×10-6), HF by 55% (p = 9.7×10-5), stroke by 25% (p = 4.0×10-2), and ND by 100% (p = 1.3×10-3). This allele also significantly influences each of two diseases, diabetes and cancer, in antagonistic fashion in different populations. Combined significance of the pleiotropic effects was p = 6.6×10-21. Causal mediation analyses show that endophenotypes explained only small fractions of these effects. This locus harbors an evolutionary conserved gene-desert region with non-coding intergenic sequences likely involved in regulation of protein-coding flanking genes ZEB2 and ACVR2A. This region is intensively studied for mutations causing severe developmental/genetic disorders. Our analyses indicate a promising target region for interventions aimed to reduce risks of many major human diseases and mortality.

%B PLoS Genet %V 12 %P e1006314 %8 2016 Nov %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27832070/ %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/27832070?dopt=Abstract %! PLoS Genet %R 10.1371/journal.pgen.1006314 %0 Journal Article %J The Journals of Gerontology Series A: Biological Sciences and Medical Sciences %D 2016 %T Predictors of New Onset Sleep Medication and Treatment Utilization Among Older Adults in the United States %A Amanda N Leggett %A Renee Pepin %A Amanda Sonnega %A Shervin Assari %K Health Conditions and Status %X Background. Sleep disturbances are common among older adults resulting in frequent sleep medication utilization, though these drugs are associated with a number of risks. We examine rates and predictors of new prescription sleep medications and sleep treatments, as well as sleep treatments without a doctor s recommendation.Methods. Participants were 8,417 adults aged 50 and older from two waves of the nationally representative Health and Retirement Study (HRS) who were not using a sleep medication or treatment at baseline (2006). Logistic regression analyses are run with sociodemographic, health, and mental health factors as predictors of three outcomes: new prescription medication use, sleep treatment use, and sleep treatment out of a doctor s recommendation in 2010.Results. New sleep medication prescriptions were started by 7.68 , 12.62 started using a new sleep treatment, and 31.93 were using the treatment outside of their doctor s recommendation. Common predictors included greater severity of insomnia, worsening insomnia, older age, and use of psychiatric medications. New prescription medication use was also associated with poorer mental and physical health, whereas new sleep treatment was associated with being White, higher educated, and drinking less alcohol.Conclusions. Starting a new prescription sleep medication may reflect poorer health and higher health care utilization, whereas beginning a sleep treatment may reflect an individual s awareness of treatments and determination to treat their problem. Clinicians should be aware of predictors of new sleep medication and treatment users and discuss various forms of treatment or behavioral changes to help patients best manage sleep disturbance. %B The Journals of Gerontology Series A: Biological Sciences and Medical Sciences %V 71 %P 954-960 %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2016/01/10/gerona.glv227.abstract %N 7 %4 depression/medication/sleep %$ 999999 %& 954 %R 10.1093/gerona/glv227 %0 Journal Article %J Int J Health Econ Manag %D 2016 %T Prescription drug coverage and chronic pain. %A Padmaja Ayyagari %K Analgesics %K Chronic pain %K Humans %K Insurance Coverage %K Medicare Part D %K prescription drugs %K Retirement %K United States %X

Chronic pain is one of the most common chronic conditions affecting more than 50 % of older adults. While pain management can be quite complex, prescription drugs are the most commonly used treatment modality. In this study, I examine whether increased access to prescription drugs due to the introduction of the Medicare Part D program in 2006 led to better management of pain among the elderly. While prior work has identified increases in the utilization of analgesics due to the introduction of Medicare Part D, the extent to which this increase in drug use actually improved the well-being of older adults is not known. Using data from the Health and Retirement Study, I employ a difference-in-differences strategy that compares pre versus post 2006 changes in pain related outcomes between Medicare eligible persons and a younger ineligible group. I find that Medicare Part D significantly reduced pain related activity limitations among a sample of older adults who report being troubled by pain.

%B Int J Health Econ Manag %V 16 %P 189-200 %8 2016 Jun %G eng %U http://link.springer.com/10.1007/s10754-016-9185-5 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27878715?dopt=Abstract %! Int J Health Econ Manag. %R 10.1007/s10754-016-9185-5 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study. %A David C. Currow %A Amy P Abernethy %A Miriam J Johnson %A Yinghui Miao %A W John Boscardin %A Christine S Ritchie %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Anxiety %K Chronic disease %K Comorbidity %K depression %K Dyspnea %K Female %K Geriatric Assessment %K Hospitalization %K Humans %K Male %K Prevalence %K Proportional Hazards Models %K Risk Assessment %K Risk Factors %K Symptom Assessment %K United States %X

OBJECTIVES: To determine the prevalence and outcomes of breathlessness in older Americans.

SETTING: Community-dwelling older adults.

PARTICIPANTS: Individuals aged 70 and older in the nationally representative Health and Retirement Study (2008, follow-up through 2012) (N = 3,671; mean age 78).

MEASUREMENTS: Breathlessness was assessed by asking the question, "How often do you become short of breath while awake?" Responses of often or sometimes were considered to represent a level of breathlessness sufficient to warrant clinical attention. The prevalence of breathlessness is described overall and in subpopulations, then rates of associated symptoms, well-being, and health services use of participants who were breathless are compared with rates of those who were not. The risk of decline in activities of daily living (ADLs) and death through 2012 was estimated by creating a multivariable Cox proportional hazards model, adjusting for age, sex, race and ethnicity, and education.

RESULTS: Twenty-five percent of participants reported breathlessness. The prevalence of breathlessness was higher in certain subpopulations: chronic lung disease (63%), multimorbidity (≥2 chronic conditions) (45%), current smokers (38%), heart disease (36%), obesity (body mass index ≥30.0 kg/m ) (33%), and education less than high school (32%). Breathlessness was associated with higher rates of depression, anxiety, and severe fatigue; lower ratings of well-being; and higher rates of clinic and emergency department visits and hospitalizations (all P < .001). Breathlessness predicted ADL decline over 5 years (adjusted hazard ratio (aHR) = 1.43, 95% confidence interval (CI) = 1.22-1.68) and death (aHR 1.62, 95% CI = 1.32-2.02).

CONCLUSION: One in four adults aged 70 and older in the United States experiences breathlessness, which is associated with lack of well-being, greater health services use, and a 40% greater risk of worsened function and 60% greater risk of death over the next 5 years.

%B J Am Geriatr Soc %V 64 %P 2035-2041 %8 2016 10 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/27603500?dopt=Abstract %R 10.1111/jgs.14313 %0 Journal Article %J J Racial Ethn Health Disparities %D 2016 %T Race by Gender Group Differences in the Protective Effects of Socioeconomic Factors Against Sustained Health Problems Across Five Domains. %A Shervin Assari %A Nikahd, Amirmasoud %A Malekahmadi, Mohammad Reza %A Maryam Moghani Lankarani %A Zamanian, Hadi %X

BACKGROUND: Despite the existing literature on the central role of socioeconomic status (SES; education and income) for maintaining health, less is known about group differences in this effect. Built on the intersectionality approach, this study compared race by gender groups for the effects of baseline education and income on sustained health problems in five domains: depressive symptoms, insomnia, physical inactivity, body mass index (BMI), and self-rated health (SRH).

METHODS: Data came from waves 7, 8, and 10 of the Health and Retirement Study (HRS), which were collected in 2004, 2006, and 2010, respectively. The study followed 37,495 white and black men and women above age 50 for up to 6 years. This number included 12,495 white men, 15,581 white women, 3839 black men, and 5580 black women. Individuals reported their depressive symptoms (Center for Epidemiological Studies-Depression (CES-D) 11), insomnia, physical inactivity, BMI, and SRH across all waves. Multigroup structural equation modeling (SEM) was used to compare black men, black women, white men, and white women for the effects of education and income in 2004 on sustained health problems from 2004 to 2010.

RESULTS: In the pooled sample, higher education and income at baseline were associated with lower sustained health problems across all five domains. However, race by gender group differences were found in the effects of education and income on sustained insomnia, physical inactivity, and BMI, but not depressive symptoms and SRH. The protective effects of education against insomnia, physical inactivity, and BMI were not found for black men. For black women, the effect of education on BMI was not found. Income had a protective effect against sustained high BMI among white and black women but not white and black men.

CONCLUSION: The intersection of race and gender alters the protective effects of social determinants on sustained health problems such as insomnia, physical inactivity, and BMI. Social groups particularly vary in the operant mechanisms by which SES contributes to maintaining health over time. The health effects are less universal for education than income. Race by gender groups differ more in SES determinants of BMI, insomnia, and physical inactivity than depressive symptoms and SRH.

%B J Racial Ethn Health Disparities %8 2016 Oct 17 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27753050?dopt=Abstract %R 10.1007/s40615-016-0291-3 %0 Journal Article %J The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2016 %T Relationship Status and Long-Term Care Facility Use in Later Life %A Thomeer, Mieke Beth %A Mudrazija, Stipica %A Jacqueline L. Angel %K Demographics %K Healthcare %K Women and Minorities %X Objectives: Most older adults prefer to age in place and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk.Method: We fit hazard models to a sample of adults aged 65 and older from eight waves (1998 2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays.Results: Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use.Discussion: By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options. %B The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %V 71 %P 711-723 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/11/16/geronb.gbv106.abstract %N 4 %4 Family sociology/Gender/Health services use/Longitudinal methods/Long-term care/Minority aging/RACE AND ETHNICITY/Hispanic %$ 999999 %& 711 %R 10.1093/geronb/gbv106 %0 Newspaper Article %B Dallas Morning News %D 2016 %T The risks of meddling with Obamacare while the nation's health is on the line %A Jacqueline L. Angel %K Health Conditions and Status %K Low incomes %K Medicare/Medicaid/Health Insurance %K Older Adults %K Risk Factors %B Dallas Morning News %C Dallas %G eng %U http://www.dallasnews.com/opinion/opinion/2016/11/22/nations-health-running-fever-risks-meddling-obamacare %0 Journal Article %J Health Economics %D 2016 %T The Role of Medical Expenditure Risk in Portfolio Allocation Decisions %A Padmaja Ayyagari %A Daifeng He %K allocation decisions %K Medical Expenses %K Portfolios %X Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk because of the introduction of Medicare Part D in the U.S. in 2006 to identify the causal effect of medical spending risk on portfolio choice. Consistent with theory, we find that Medicare-eligible persons increased risky investment after the introduction of prescription drug coverage, relative to a younger, ineligible cohort. Copyright © 2016 John Wiley & Sons, Ltd. %B Health Economics %V 26 %8 2016/10/09 %G eng %U https://www.researchgate.net/publication/308993822_The_Role_of_Medical_Expenditure_Risk_in_Portfolio_Allocation_Decisions %! Health economics %0 Journal Article %J International Psychogeriatrics %D 2016 %T Satisfaction with Aging Results in Reduced Risk for Falling %A Liat Ayalon %K Health Conditions and Status %K Healthcare %X Background: Falls are highly frequent in older adults and are associated with increased morbidity and mortality. The present study was designed to assess the role of satisfaction with one's aging process as a predictor of the risk for falling over a four-year period and to identify potential mediators of this relationship. Methods: The Health and Retirement Study (HRS) is a US nationally representative sample of individuals over the age of 50 years and their spouse of any age. The present study was based on the 2008 2012 waves of the HRS. Analyses were restricted to 4,121 respondents over the age of 50 years, who had fall data in 2008 and 2012 and were eligible to complete the satisfaction with aging measure as part of the 2008 psychosocial questionnaire. Results: Overall, 38.1 of the sample reported having fallen at least once between 2006 and 2008 and 40.7 reported having fallen at least once between 2010 and 2012. Higher levels of satisfaction with aging in 2008 were found to be protective against falls assessed in 2012 (OR 95 CI = 0.88 0.79 0.98 ) even after adjustment for age, gender, education, ethnicity, medical status, functional status, cognitive functioning, walking speed, balance, vision, depressive symptoms, physical activities, and past falls. Bootstrap procedures have shown that the effect of satisfaction with aging on falls is partially accounted for through its effect on functional decline. Conclusions: The findings point to the important role of satisfaction with aging as a potential protective mechanism against falls. The results call for the development of psychosocial interventions to reduce falls in older adults. %B International Psychogeriatrics %I 28 %V 28 %P 741-747 %G eng %U http://dx.doi.org/10.1017/S1041610215001969 %N 5 %4 epidemiology/satisfaction with aging/falls/frailty/subjective aging/MORBIDITY/Mortality %$ 999999 %R 10.1017/S1041610215001969 %0 Journal Article %J J Palliat Med %D 2016 %T Spousal Characteristics and Older Adults' Hospice Use: Understanding Disparities in End-of-Life Care. %A Katherine A Ornstein %A Melissa D. Aldridge %A Christine A Mair %A Rebecca Jean Gorges %A Albert L Siu %A Amy Kelley %K Hospice Care %K Hospices %K Humans %K Medicare %K Prospective Studies %K Quality of Life %K Terminal Care %K United States %X

BACKGROUND: Hospice use has been shown to benefit quality of life for patients with terminal illness and their families, with further evidence of cost savings for Medicare and other payers. While disparities in hospice use by patient diagnosis, race, and region are well documented and attention to the role of family members in end-of-life decision-making is increasing, the influence of spousal characteristics on the decision to use hospice is unknown.

OBJECTIVES: To determine the association between spousal characteristics and hospice use.

DESIGN: We used data from the Health and Retirement Study (HRS), a prospective cohort study, linked to the Dartmouth Atlas of Health Care and Medicare claims.

SETTING: National study of 1567 decedents who were married or partnered at the time of death (2000-2011).

MEASURES: Hospice use at least 1 day in the last year of life as measured via Medicare claims data. Spousal factors (e.g., education and health status) measured via survey.

RESULTS: In multivariate models controlling for patient factors and regional variation, spouses with lower educational attainment than their deceased spouse had decreased likelihood of hospice use (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.40-0.82). Health of the spouse was not significantly associated with likelihood of decedent hospice use in adjusted models.

IMPLICATIONS: Although the health of the surviving spouse was not associated with hospice use, their educational level was a predictor of hospice use. Spousal and family characteristics, including educational attainment, should be examined further in relation to disparities in hospice use. Efforts to increase access to high-quality end-of-life care for individuals with serious illness must also address the needs and concerns of caregivers and family.

%B J Palliat Med %I 19 %V 19 %P 509-15 %8 2016 05 %G eng %U http://dx.doi.org/10.1089/jpm.2015.0399 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26991831?dopt=Abstract %2 PMC4860657 %4 hospice/medicare/Public Policy/end of life/caregiver burden %$ 999999 %R 10.1089/jpm.2015.0399 %0 Conference Paper %B European Population Conference 2016 %D 2016 %T Subjective Life Expectancy: Differences by Smoking, Education and Gender %A Sergei Scherbov %A Bruno Arpino %A Valeria Bordone %K Education %K Gender Differences %K Longevity %K Mortality %K Older Adults %K Smoking %X Despite the well-known higher mortality rates among smokers than non-smokers, little investigation has focused on subjective survival probabilities (SSP) by smoking behaviour. We give attention to sub-group differences in subjective survival probabilities, comparing subjective predictions to objective ones (SP) and accounting for the role of education. We use biannual data from the Health and Retirement Study (HRS) from 2000 to 2012 carried out in the USA. Based on a sample of 23,895 respondents aged 50-89, we calculate, for each respondent, the “gap” between SSP and the estimated survival probability (SP) from the HRS data. We find that people currently smoking report lower survival probabilities especially if they are low educated. This is consistent with real mortality data that show higher mortality among these groups. When comparing subjective and objective survival probabilities we find that irrespectively of the smoking status, high educated people are more likely to correctly predict their survival probabilities than their low educated counterparts. Within education groups, people who smoked in the past are the best at predicting their mortality. Interestingly, those who currently smoke show the highest probability to incorrectly overestimate their survival probability (i.e., to underestimate the negative effect of smoking on mortality). %B European Population Conference 2016 %G eng %U http://epc2016.princeton.edu/uploads/160554 %0 Journal Article %J Front Aging Neurosci %D 2016 %T Sustained Obesity and Depressive Symptoms over 6 Years: Race by Gender Differences in the Health and Retirement Study. %A Julia D. Carter %A Shervin Assari %X

Although obesity and physical activity influence psychosocial well-being, these effects may vary based on race, gender, and their intersection. Using 6-year follow-up data of a nationally representative sample of adults over age of 50 in the United States, this study aimed to explore race by gender differences in additive effects of sustained high body mass index (BMI) and physical activity on sustained depressive symptoms (CES-D) and self-rated health (SRH). Data came from waves 7, 8, and 10 (2004-2010) of the Health and Retirement Study (HRS), an ongoing national cohort started in 1992. The study enrolled a representative sample of Americans ( = 19,280) over the age of 50. Latent factors were used to calculate sustained high BMI and physical activity (predictors) and sustained poor SRH and high depressive symptoms (outcomes) based on measurements in 2004, 2006, and 2010. Age, education, and income were confounders. Multi-group structural equation modeling (SEM) was used to test the additive effects of BMI and physical activity on depressive symptoms and SRH, where the groups were defined based on race by gender. Group differences were apparent in the direction and significance of the association between sustained high BMI and depressive symptoms. The association between sustained high BMI and depressive symptoms was positive and significant for White women ( = 0.03, = 0.007) and non-significant for White men ( = -0.03, = 0.062), Black men ( = -0.02, = 0.564) and Black women ( = 0.03, = 0.110). No group differences were found in the paths from sustained physical activity to depressive symptoms, or from physical activity or BMI to SRH. Sustained high BMI and high depressive symptoms after age 50 are positively associated only for White women. As the association between sustained health problems such as depression and obesity are not universal across race and gender groups, clinical and public health interventions and programs that simultaneously target multiple health problems may have differential effects across race by gender groups.

%B Front Aging Neurosci %V 8 %P 312 %8 2016 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5209386/ %1 http://www.ncbi.nlm.nih.gov/pubmed/28101050?dopt=Abstract %R 10.3389/fnagi.2016.00312 %0 Thesis %B School of Family Studies and Human Services %D 2016 %T Three essays on financial self-efficacy beliefs and the saving behavior of older pre-retirees %A Asebedo, Sarah D. %K Financial literacy %K Older Adults %K Savings %X This dissertation employed a psychological framework to investigate the saving behavior of older pre-retirees through three essays using data from the Health and Retirement Study (HRS). Understanding the connection between psychological characteristics and saving behavior is critical as this population attempts to bridge the retirement saving gap. Of these characteristics, financial self-efficacy beliefs (FSE) are theoretically vital to saving behavior. With the FSE beliefs of older adults weak and vulnerable to decline, more research is needed to understand how FSE beliefs affect saving behavior and how FSE beliefs can be supported. Essay one investigated the psychological characteristics associated with FSE beliefs according to the Meta-Theoretic Model of Motivation and Personality (3M). Using a sample of 2,070 pre-retirees aged 50 to 70, essay one revealed that FSE beliefs can be supported through the frequent experience of positive affect, reduced negative affect, a stronger perception of mastery, and a higher task orientation, holding all else constant. Essay two investigated the relationship between FSE beliefs and saving behavior (i.e., change in net worth from 2008 to 2012) through the Social Cognitive Theory of Self-Regulation. Using a sample of 844 pre-retirees aged 50 to 70, results revealed that FSE beliefs are significantly and positively related to saving behavior, after controlling for the financial ability and motivation to save. Essay three employed a structural equation model to investigate an integrated psychological approach to saving behavior based upon the 3M. Using a sample of 1,370 pre-retired and partially retired adults aged 50 to 70, essay three revealed that FSE beliefs facilitated the connection between elemental traits (i.e., openness, conscientiousness, extroversion, agreeableness, and neuroticism), compound traits (i.e., positive affect, negative affect, mastery, and task orientation), and saving behavior. Overall, significant evidence was generated supporting a psychological approach to the saving behavior of older pre-retirees. Financial and mental health professionals can utilize this framework to provide holistic retirement saving advice that acknowledges the psychological roots of behavior. Moreover, results established empirical support for the role FSE beliefs play in executing saving behavior. Lastly, results supported the importance of domain specific measurement for self-efficacy beliefs in future research. Advisors/Committee Members: Kristy L. Pederson-ArchuletaMartin Seay. %B School of Family Studies and Human Services %I Kansas State University %C Manhattan, Kansas %V Ph.D. %G eng %U http://hdl.handle.net/2097/32734 %9 Dissertation %0 Journal Article %J Educational Gerontology %D 2016 %T What about African American Older Women and Depressive Symptoms? %A Tamika C. Baldwin %A Halaevalu F. Ofaheng Vakalahi %A Anderson, Brian %K Adult children %K Health Conditions and Status %K Women and Minorities %X Depression is a major problem among African American older women; however, they also tend to be understudied as members of a multiple minority and oppressed group. As matriarchs and grandmothers in their families and communities, depression often emerges and becomes a detrimental problem for these older African American women. This study, a secondary data analysis, utilized the Health and Retirement Study (HRS) 2010 database to examine depression among older African American women. This article discusses the joint impact of age, social support, religion, caregiving, and physical health on depression among older community dwelling African American women. Findings indicate that age, physical health, and marital status as an aspect of social support were significant predictors of whether or not an older African American woman had ever had depression and whether or not she felt depressed in the past year. Receiving help from relatives as an aspect of social support also remained significant for participants who were feeling depressed in the past year. Implications for research, theory, and policy are offered. %B Educational Gerontology %I 42 %V 42 %P 310-320 %G eng %U http://dx.doi.org/10.1080/03601277.2015.1121749 %N 5 %4 African American/women/aging/depression/older community dwellers/Social Support %$ 999999 %R 10.1080/03601277.2015.1121749 %0 Journal Article %J Am J Public Health %D 2016 %T Work-Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries. %A van Hedel, Karen %A Mejía-Guevara, Iván %A Mauricio Avendano %A Erika L. Sabbath %A Lisa F Berkman %A Johan P Mackenbach %A van Lenthe, Frank J %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Cardiovascular Diseases %K Computer Simulation %K Europe %K Female %K Humans %K Middle Aged %K Obesity %K Single Parent %K Smoking %K Socioeconomic factors %K United States %K Women, Working %K Young Adult %X

OBJECTIVES: To investigate whether less-healthy work-family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women.

METHODS: We used sequence analysis to identify distinct work-family typologies for women born between 1935 and 1956 in the United States and 13 European countries. Data came from the US Health and Retirement Study (1992-2006) and the Survey of Health, Aging, and Retirement in Europe (2004-2009).

RESULTS: Work-family typologies were similarly distributed in the United States and Europe. Being a lone working mother predicted a higher risk of heart disease, stroke, and smoking among American women, and smoking for European women. Lone working motherhood was more common and had a marginally stronger association with stroke in the United States than in Europe. Simulations indicated that the higher stroke risk among American women would only be marginally reduced if American women had experienced the same work-family trajectories as European women.

CONCLUSIONS: Combining work and lone motherhood was more common in the United States, but differences in work-family trajectories explained only a small fraction of the higher cardiovascular risk of American relative to European women.

%B Am J Public Health %V 106 %P 1449-56 %8 2016 08 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27310346 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27310346?dopt=Abstract %R 10.2105/AJPH.2016.303264 %0 Book %B Research Reports %D 2016 %T Workforce Downsizing and Restructuring in the Department of Defense: The Voluntary Separation Incentive Payment Program Versus Involuntary Separation %A Asch, Beth %A Hosek, James %A Mattock, Michael %A Knapp, David %A Kavanagh, Jennifer %K Military service %X The U.S. Department of Defense (DoD) plans to reduce the size of its civilian workforce through 2021. An important downsizing tool available to personnel managers is the Voluntary Separation Incentive Payment (VSIP), but its cap, $25,000, has not been adjusted since 1993. The authors of this report used RAND's dynamic retention model (DRM) for DoD civilians to compare the cost-effectiveness of alternative approaches to achieving a given downsizing. These include packages of VSIP, voluntary early retirement authority (VERA), and involuntary separation if also needed, versus using involuntary separation alone. Increasing the VSIP cap to $41,000 (the real value of VSIP in 2015 dollars) increases voluntary separations by about 45 percent and, compared with the $25,000 cap, would result in greater net savings to DoD and greater net savings in government outlays over five years. Although the apparent cost savings, as reflected in the budget, are greater when involuntary separations are used, there are off-budget costs, such as workplace turmoil, disruption, and lower morale, associated with involuntary separation. The authors used the DRM to estimate the cost borne by employees who are involuntarily separated in terms of the value of the loss of employment, net of the severance pay they receive. Such costs could potentially hurt retention and workforce productivity among those who remain. Using this broader concept of cost that includes both the cost to the government and the cost borne by employees, VSIP generates more net savings and is more cost-effective at the margin than involuntary separation. %B Research Reports %I RAND Corporation %C Santa Monica, CA %P 106 %@ 9780833096388 %G eng %U http://www.rand.org/pubs/research_reports/RR1540.html %R 10.7249/RR1540 %0 Journal Article %J International Psychogeriatrics %D 2015 %T Accounting for differences in cognitive health between older adults in New Zealand and the USA %A Christine Stephens %A Spicer,John %A Claire Budge %A Brendan Stevenson %A Fiona M. Alpass %K Cross-National %K Demographics %K Health Conditions and Status %K Other %X Background: National differences in cognitive health of older adults provide an opportunity to shed light on etiological factors. We compared the cognitive health of older adults in New Zealand and the USA, and examined differences in known risk factors. Methods: Two nationally representative samples were derived from the 2010 waves of the New Zealand Longitudinal Study of Ageing (n = 953) and the US Health and Retirement Study (HRS) (n = 3,746). Data from comparable measures of cognitive function, gender, age, income, education, prevalence of cancer, diabetes, heart disease, hypertension and stroke, exercise, alcohol consumption, smoker status, depression, and self-reported health were subjected to hierarchical regression analysis to examine how national differences in cognitive function might be explained by differences in these risk factors. Results: The New Zealand sample scored 4.4 points higher on average than the US sample on the 43 point cognitive scale. Regression analyses of the combined samples showed that poorer cognitive health is more likely in those who are male, older, less educated, have suffered a stroke, consume alcohol less frequently, are more depressed, and report worse overall health. Controlling for age and sex reduced the mean difference to 2.6 and controlling for risk factors further reduced it to 2.3. Conclusions: Older New Zealand adults displayed better cognitive function than those in a US sample. This advantage can be partially explained by age and sex differences and, to some extent, by differences in known risk factors. However, the national advantage remained even when all measured risk factors are statistically controlled. %B International Psychogeriatrics %G eng %U http://dx.doi.org/10.1017/S1041610214002579 %4 cognitive functioning/cognitive health/cognition/older adults/aging/successful aging/cross-national comparison/NZLSA %$ 999999 %R 10.1017/S1041610214002579 %0 Journal Article %J Am J Med %D 2015 %T Antidepressant Use and Cognitive Decline: The Health and Retirement Study. %A Jane S Saczynski %A Allison B Rosen %A Ryan J McCammon %A Zivin, Kara %A Susan E. Andrade %A Kenneth M. Langa %A Sandeep Vijan %A Paul A Pirraglia %A Becky A. Briesacher %K Age Distribution %K Aged %K Aged, 80 and over %K Antidepressive Agents %K Cognition %K Cross-Sectional Studies %K Depressive Disorder %K Female %K Follow-Up Studies %K Geriatric Assessment %K Humans %K Incidence %K Male %K Middle Aged %K Reference Values %K Risk Assessment %K Sex Distribution %K Surveys and Questionnaires %K United States %X

BACKGROUND: Depression is associated with cognitive impairment and dementia, but whether treatment for depression with antidepressants reduces the risk for cognitive decline is unclear. We assessed the association between antidepressant use and cognitive decline over 6 years.

METHODS: Participants were 3714 adults aged 50 years or more who were enrolled in the nationally representative Health and Retirement Study and had self-reported antidepressant use. Depressive symptoms were assessed using the 8-item Center for Epidemiologic Studies Depression Scale. Cognitive function was assessed at 4 time points (2004, 2006, 2008, 2010) using a validated 27-point scale. Change in cognitive function over the 6-year follow-up period was examined using linear growth models, adjusted for demographics, depressive symptoms, comorbidities, functional limitations, and antidepressant anticholinergic activity load.

RESULTS: At baseline, cognitive function did not differ significantly between the 445 (12.1%) participants taking antidepressants and those not taking antidepressants (mean, 14.9%; 95% confidence interval, 14.3-15.4 vs mean, 15.1%; 95% confidence interval, 14.9-15.3). During the 6-year follow up period, cognition declined in both users and nonusers of antidepressants, ranging from -1.4 change in mean score in those with high depressive symptoms and taking antidepressants to -0.5 change in mean score in those with high depressive symptoms and not taking antidepressants. In adjusted models, cognition declined in people taking antidepressants at the same rate as those not taking antidepressants. Results remained consistent across different levels of baseline cognitive function, age, and duration of antidepressant use (prolonged vs short-term).

CONCLUSIONS: Antidepressant use did not modify the course of 6-year cognitive change in this nationally representative sample.

%B Am J Med %I 128 %V 128 %P 739-46 %8 2015 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25644319?dopt=Abstract %2 PMC4618694 %4 Antidepressants/Cognition/Depression/CES Depression Scale/CES Depression Scale/COMORBIDITY/Depressive Symptoms %$ 999999 %R 10.1016/j.amjmed.2015.01.007 %0 Journal Article %J JAMA Intern Med %D 2015 %T Association Between Hospice Use and Depressive Symptoms in Surviving Spouses. %A Katherine A Ornstein %A Melissa D. Aldridge %A Melissa M Garrido %A Rebecca Jean Gorges %A Diane E Meier %A Amy Kelley %K Aged %K Aged, 80 and over %K Caregivers %K depression %K Female %K Hospice Care %K Hospices %K Humans %K Male %K Prospective Studies %K Spouses %K Survivors %X

IMPORTANCE: Family caregivers of individuals with serious illness are at risk for depressive symptoms and depression. Hospice includes the provision of support services for family caregivers, yet evidence is limited regarding the effect of hospice use on depressive symptoms among surviving caregivers.

OBJECTIVE: To determine the association between hospice use and depressive symptoms in surviving spouses.

DESIGN, SETTING, AND PARTICIPANTS: We linked data from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US adults 50 years or older, to Medicare claims. Participants included a propensity score-matched sample of 1016 Health and Retirement Study decedents with at least 1 serious illness and their surviving spouses interviewed between August 2002 and May 2011. We compared the spouses of individuals enrolled in hospice with the spouses of individuals who did not use hospice, performing our analysis between January 30, 2014, and January 16, 2015.

EXPOSURES: Hospice enrollment for at least 3 days in the year before death.

MAIN OUTCOMES AND MEASURES: Spousal depressive symptom scores measured 0 to 2 years after death with the Center for Epidemiologic Studies Depression Scale, which is scored from 0 (no symptoms) to 8 (severe symptoms).

RESULTS: Of the 1016 decedents in the matched sample, 305 patients (30.0%) used hospice services for 3 or more days in the year before death. Of the 1016 spouses, 51.9% had more depressive symptoms over time (mean [SD] change, 2.56 [1.65]), with no significant difference related to hospice use. A minority (28.2%) of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 21.7% of spouses of decedents who did not use hospice, although the difference was not statistically significant (P = .06). Among the 662 spouses who were the primary caregivers, 27.3% of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 20.7% of spouses of decedents who did not use hospice; the difference was not statistically significant (P = .10). In multivariate analysis, the odds ratio for the association of hospice enrollment with improved depressive symptoms after the spouse's death was 1.63 (95% CI, 1.00-2.65).

CONCLUSIONS AND RELEVANCE: After bereavement, depression symptoms increased overall for surviving spouses regardless of hospice use. A modest reduction in depressive symptoms was more likely among spouses of hospice users than among spouses of nonhospice users.

%B JAMA Intern Med %I 175 %V 175 %P 1138-46 %8 2015 Jul %G eng %U http://dx.doi.org/10.1001/jamainternmed.2015.1722 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/26009859?dopt=Abstract %2 PMC4494882 %4 caregiver burden/caregivers/Depressive Symptoms/depression/Hospice/CES Depression Scale/CES Depression Scale/spouses %$ 999999 %R 10.1001/jamainternmed.2015.1722 %0 Journal Article %J Mol Psychiatry %D 2015 %T The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects. %A Wouter J Peyrot %A Lee, S H %A Milaneschi, Y %A Abdel Abdellaoui %A Byrne, E M %A Tõnu Esko %A Eco J. C. de Geus %A Hemani, G %A Jouke-Jan Hottenga %A Kloiber, S %A Douglas F Levinson %A Lucae, S %A Nicholas G Martin %A Sarah E Medland %A Andres Metspalu %A Lili Milani %A Markus M Nöthen %A Potash, J B %A Rietschel, M %A Cornelius A Rietveld %A Ripke, S %A Jianxin Shi %A Gonneke Willemsen %A Zhihong Zhu %A Dorret I Boomsma %A Naomi R. Wray %A Brenda W J H Penninx %K Adult %K Aged %K Cohort Studies %K Depressive Disorder, Major %K Educational Status %K Estonia %K Female %K Gene-Environment Interaction %K Genetic Association Studies %K Genotype %K Humans %K Likelihood Functions %K Male %K Middle Aged %K Netherlands %K Odds Ratio %K Polymorphism, Single Nucleotide %K Psychiatric Status Rating Scales %K Regression Analysis %X

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

%B Mol Psychiatry %V 20 %P 735-43 %8 2015 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/25917368?dopt=Abstract %R 10.1038/mp.2015.50 %0 Journal Article %J Journal of Econometrics %D 2015 %T Asymptotically exact inference in conditional moment inequality models %A Armstrong, Timothy B. %K Healthcare %K Methodology %X This paper derives the rate of convergence and asymptotic distribution for a class of Kolmogorov-Smirnov style test statistics for conditional moment inequality models for parameters on the boundary of the identified set under general conditions. Using these results, I propose tests that are more powerful than existing approaches for choosing critical values for this test statistic. I quantify the power improvement by showing that the new tests can detect alternatives that converge to points on the identified set at a faster rate than those detected by existing approaches. A Monte Carlo study confirms that the tests and the asymptotic approximations they use perform well in finite samples. In an application to a regression of prescription drug expenditures on income with interval data from the Health and Retirement Study, confidence regions based on the new tests are substantially tighter than those based on existing methods. (C) 2015 Elsevier B.V. All rights reserved. %B Journal of Econometrics %I 186 %V 186 %P 51-65 %G eng %N 1 %4 Prescription drug costs/Statistical analysis/Methodology %$ 999999 %R 10.1016/j.jeconom.2015.01.002 %0 Journal Article %J J Popul Ageing %D 2015 %T Awareness of Memory Ability and Change: (In)Accuracy of Memory Self-Assessments in Relation to Performance. %A Elizabeth A. Hahn Rickenbach %A Agrigoroaei, Stefan %A Margie E Lachman %X

Little is known about subjective assessments of memory abilities and decline among middle-aged adults or their association with objective memory performance in the general population. In this study we examined self-ratings of memory ability and change in relation to episodic memory performance in two national samples of middle-aged and older adults from the Midlife in the United States study (MIDUS II in 2005-06) and the Health and Retirement Study (HRS; every two years from 2002 to 2012). MIDUS (Study 1) participants (N=3,581) rated their memory compared to others their age and to themselves five years ago; HRS (Study 2) participants (N=14,821) rated their current memory and their memory compared to two years ago, with up to six occasions of longitudinal data over ten years. In both studies, episodic memory performance was the total number of words recalled in immediate and delayed conditions. When controlling for demographic and health correlates, self-ratings of memory abilities, but not subjective change, were related to performance. We examined accuracy by comparing subjective and objective memory ability and change. More than one third of the participants across the studies had self-assessments that were inaccurate relative to their actual level of performance and change, and accuracy differed as a function of demographic and health factors. Further understanding of self-awareness of memory abilities and change beginning in midlife may be useful for identifying early warning signs of decline, with implications regarding policies and practice for early detection and treatment of cognitive impairment.

%B J Popul Ageing %I 8 %V 8 %P 71-99 %8 2015 Mar 01 %G eng %U http://dx.doi.org/10.1007/s12062-014-9108-5 %N 1-2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25821529?dopt=Abstract %2 PMC4371608 %4 Subjective memory ability/Subjective memory change/Memory self-ratings/Episodic memory/Memory concerns/Memory complaints/Accuracy of self-assessments %$ 999999 %R 10.1007/s12062-014-9108-5 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2015 %T Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100. %A Jennifer A Ailshire %A Hiram Beltrán-Sánchez %A Eileen M. Crimmins %K Activities of Daily Living %K Aged, 80 and over %K Aging %K Chronic disease %K Cognition %K Disability Evaluation %K Educational Status %K Female %K Geriatric Assessment %K Health Status %K Health Surveys %K Humans %K Longevity %K Longitudinal Studies %K Male %K Marital Status %K Prospective Studies %K Sex Factors %K United States %X

BACKGROUND: Little is known about the health and functioning of individuals who become centenarians in the years prior to reaching age 100. We examined long-term trajectories of disease, disability, and cognitive function in a sample of U.S. centenarians to determine how their aging experience differs from their nonsurviving cohort counterparts, and if there is heterogeneity in the aging experience of centenarians.

METHODS: Data are from the 1993-2010 waves of the nationally representative Health and Retirement Study. Among those who had the potential to become centenarians, we identified 1,045 respondents who died before reaching age 100 and 96 who survived to their 100th birthday. Respondents, or their proxies, reported on diagnosis of six major diseases (hypertension, heart disease, lung disease, stroke, cancer, and diabetes), limitations in activities of daily living, and cognitive function.

RESULTS: As they age to 100, centenarians are generally healthier than nonsurviving members of their cohort, and a number of individuals who become centenarians reach 100 with no self-reported diseases or functional impairments. About 23% of centenarians reached age 100 with no major chronic disease and approximately the same number had no disability (18%). Over half (55%) reached 100 without cognitive impairment. Disease and functioning trajectories of centenarians differ by sex, education, and marital status.

CONCLUSIONS: While some centenarians have poor health and functioning upon reaching age 100, others are able to achieve exceptional longevity in relatively good health and without loss of functioning. This study underscores the importance of examining variation in the growing centenarian population.

%B J Gerontol A Biol Sci Med Sci %I 70 %V 70 %P 193-201 %8 2015 Feb %G eng %U http://biomedgerontology.oxfordjournals.org/content/70/2/193.abstract %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25136001?dopt=Abstract %R 10.1093/gerona/glu124 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2015 %T Body weight status and onset of cognitive impairment among US middle-aged and older adults %A Xiang, Xiaoling %A An, Ruopeng %K Health Conditions and Status %X Objective: To examine the relationship between body weight status and onset of cognitive impairment among U.S. middle-aged and older adults. Methods: Study sample came from 1996 to 2010 waves of the Health and Retirement Study, consisting of 6739 community-dwelling adults born between 1931 and 1941 who were free from cognitive impairment in 1996. Body mass index (BMI) was calculated from self-reported height/weight. Cognitive impairment was defined by a composite score of 11 or lower on the immediate and delayed word recall, serial 7's, and backwards counting tests. Kaplan-Meier estimator and Cox proportional hazards model were performed to examine the association between base-year body weight status and future onset of cognitive impairment. Results: Compared with their normal weight counterparts, the unadjusted hazard ratio (HR) for cognitive impairment incidence was 2.03 (95 confidence interval: 1.38-3.00), 1.15 (1.02-1.29), 1.28 (1.14-1.43), and 1.59 (1.33-1.92) among underweight (BMI 18.5), overweight (25 = BMI 30), class I obese (30 = BMI 35), and class II obese or above (BMI = 35) participants, respectively. The unadjusted relationship between obesity and cognitive impairment onset appeared stronger among females than among males. After adjusting for base-year individual sociodemographics, functional limitations and chronic conditions, the estimated associations between body weight status and cognitive impairment were attenuated but remained statistically significant for underweight participants. Conclusion: Underweight is a robust risk factor for onset of cognitive impairment in later life. Weight management programs targeting middle-aged and older adults should focus on achieving and maintaining optimal body weight. (C) 2015 Elsevier Ireland Ltd. All rights reserved. %B Archives of Gerontology and Geriatrics %I 60 %V 60 %P 394-400 %G eng %N 3 %4 body mass index/Body Weight/cognitive Impairment/obesity/Underweight/weight management %$ 999999 %R 10.1016/j.archger.2015.02.008 %0 Journal Article %J Disability and Health Journal %D 2015 %T Body weight status and onset of functional limitations in U.S. middle-aged and older adults %A An, Ruopeng %A Shi, Yuyan %K Demographics %K Disabilities %K Health Conditions and Status %X AbstractBackground The sweeping obesity epidemic could further increase the incidence of functional limitations in the U.S. rapidly aging population. Objective To examine the relationship between body weight status and onset of functional limitations in U.S. middle-aged and older adults. Methods Study sample came from 1992 to 2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling middle-aged and older adults. Body mass index (BMI) was calculated from self-reported height/weight. Functional limitations were classified into physical mobility limitation (PM), large muscle function limitation (LMF), activities of daily living limitation (ADL), gross motor function limitation (GMF), and fine motor function limitation (FMF). Mixed-effect logistic regressions were performed to estimate the relationship between prior-wave body weight status and current-wave onset of functional limitations, adjusted for individual characteristics and survey design. Results Prior-wave body weight status prospectively predicted onset of functional limitation, and the relationship showed a U-shaped pattern. Compared with their normal weight counterparts, the odds ratios (ORs) in underweight (BMI andlt; 18.5) and obese (BMI 30) adults were 1.30 (95 confidence interval, 1.05 1.62) and 2.31 (2.11 2.52) for PM, 1.20 (0.96 1.50) and 1.63 (1.49 1.79) for LMF, 2.02 (1.66 2.46) and 1.40 (1.28 1.54) for ADL, 1.96 (1.60 2.39) and 1.77 (1.62 1.93) for GMF, and 1.66 (1.37 2.02) and 1.34 (1.22 1.46) for FMF, respectively. For PM, LMF and GMF, the impact of obesity appeared more pronounced in women, whereas that of underweight more pronounced in men. Conclusions Proper weight management during aging is crucial in preventing functional limitations in middle-aged and older adults. %B Disability and Health Journal %I 8 %V 8 %P 336-344 %G eng %U http://www.sciencedirect.com/science/article/pii/S1936657415000291 %N 3 %4 Disability/Disability/Functional limitation/Underweight/Obesity/Older adult/body Mass Index %$ 999999 %R 10.1016/j.dhjo.2015.02.003 %0 Journal Article %J J Alzheimers Dis %D 2015 %T Comprehensive gene- and pathway-based analysis of depressive symptoms in older adults. %A Nho, Kwangsik %A Vijay K Ramanan %A Horgusluoglu, Emrin %A Sungeun Kim %A Mark H Inlow %A Shannon L Risacher %A Brenna C McDonald %A Martin R Farlow %A Tatiana Foroud %A Gao, Sujuan %A Christopher M. Callahan %A Hugh C Hendrie %A Alexander B Niculescu %A Andrew J Saykin %K Aged %K Cohort Studies %K depression %K European Continental Ancestry Group %K Female %K Genotyping Techniques %K Humans %K Male %K Psychiatric Status Rating Scales %X

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

%B J Alzheimers Dis %V 45 %P 1197-206 %8 2015 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25690665?dopt=Abstract %R 10.3233/JAD-148009 %0 Journal Article %J Human Molecular Genetics %D 2015 %T Contribution of common non-synonymous variants in PCSK1 to body mass index variation and risk of obesity: a systematic review and meta-analysis with evidence from up to 331 175 individuals. %A Nead, Kevin T %A Li, Aihua %A Wehner, Mackenzie R %A Neupane, Binod %A Gustafsson, Stefan %A Adam S Butterworth %A Engert, James C %A Davis, A Darlene %A Hegele, Robert A %A Miller, Ruby %A den Hoed, Marcel %A Khaw, Kay-Tee %A Kilpeläinen, Tuomas O %A Wareham, Nick %A Edwards, Todd L %A Hallmans, Göran %A Varga, Tibor V %A Sharon L R Kardia %A Smith, Jennifer A %A Zhao, Wei %A Jessica Faul %A David R Weir %A Mi, Jie %A Xi, Bo %A Quinteros, Samuel Canizales %A Cooper, Cyrus %A Sayer, Avan Aihie %A Jameson, Karen %A Grøntved, Anders %A Myriam Fornage %A Stephen Sidney %A Hanis, Craig L %A Highland, Heather M %A Häring, Hans-Ulrich %A Heni, Martin %A Lasky-Su, Jessica %A Weiss, Scott T %A Gerhard, Glenn S %A Still, Christopher %A Melka, Melkaey M %A Pausova, Zdenka %A Paus, Tomáš %A Grant, Struan F A %A Hakonarson, Hakon %A Price, R Arlen %A Wang, Kai %A Scherag, Andre %A Hebebrand, Johannes %A Hinney, Anke %A Franks, Paul W %A Timothy M Frayling %A McCarthy, Mark I %A Hirschhorn, Joel N %A Ruth J F Loos %A Ingelsson, Erik %A Gerstein, Hertzel C %A Yusuf, Salim %A Beyene, Joseph %A Anand, Sonia S %A Meyre, David %K Alleles %K Body Mass Index %K Genetic Predisposition to Disease %K Genetic Variation %K Humans %K Obesity %K Odds Ratio %K Polymorphism, Single Nucleotide %K Proprotein Convertase 1 %X

Polymorphisms rs6232 and rs6234/rs6235 in PCSK1 have been associated with extreme obesity [e.g. body mass index (BMI) ≥ 40 kg/m(2)], but their contribution to common obesity (BMI ≥ 30 kg/m(2)) and BMI variation in a multi-ethnic context is unclear. To fill this gap, we collected phenotypic and genetic data in up to 331 175 individuals from diverse ethnic groups. This process involved a systematic review of the literature in PubMed, Web of Science, Embase and the NIH GWAS catalog complemented by data extraction from pre-existing GWAS or custom-arrays in consortia and single studies. We employed recently developed global meta-analytic random-effects methods to calculate summary odds ratios (OR) and 95% confidence intervals (CIs) or beta estimates and standard errors (SE) for the obesity status and BMI analyses, respectively. Significant associations were found with binary obesity status for rs6232 (OR = 1.15, 95% CI 1.06-1.24, P = 6.08 × 10(-6)) and rs6234/rs6235 (OR = 1.07, 95% CI 1.04-1.10, P = 3.00 × 10(-7)). Similarly, significant associations were found with continuous BMI for rs6232 (β = 0.03, 95% CI 0.00-0.07; P = 0.047) and rs6234/rs6235 (β = 0.02, 95% CI 0.00-0.03; P = 5.57 × 10(-4)). Ethnicity, age and study ascertainment significantly modulated the association of PCSK1 polymorphisms with obesity. In summary, we demonstrate evidence that common gene variation in PCSK1 contributes to BMI variation and susceptibility to common obesity in the largest known meta-analysis published to date in genetic epidemiology.

%B Human Molecular Genetics %V 24 %P 3582-3594 %G eng %N 12 %R 10.1093/hmg/ddv097 %0 Journal Article %J PLoS Genet %D 2015 %T Contribution of large region joint associations to complex traits genetics. %A Pare, Guillaume %A Asma, Senay %A Wei Q. Deng %K Body Mass Index %K C-reactive protein %K Cholesterol, LDL %K Chromosomes, Human %K Female %K Humans %K Male %K Models, Genetic %K Phenotype %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %X

A polygenic model of inheritance, whereby hundreds or thousands of weakly associated variants contribute to a trait's heritability, has been proposed to underlie the genetic architecture of complex traits. However, relatively few genetic variants have been positively identified so far and they collectively explain only a small fraction of the predicted heritability. We hypothesized that joint association of multiple weakly associated variants over large chromosomal regions contributes to complex traits variance. Confirmation of such regional associations can help identify new loci and lead to a better understanding of known ones. To test this hypothesis, we first characterized the ability of commonly used genetic association models to identify large region joint associations. Through theoretical derivation and simulation, we showed that multivariate linear models where multiple SNPs are included as independent predictors have the most favorable association profile. Based on these results, we tested for large region association with height in 3,740 European participants from the Health and Retirement Study (HRS) study. Adjusting for SNPs with known association with height, we demonstrated clustering of weak associations (p = 2x10-4) in regions extending up to 433.0 Kb from known height loci. The contribution of regional associations to phenotypic variance was estimated at 0.172 (95% CI 0.063-0.279; p < 0.001), which compared favorably to 0.129 explained by known height variants. Conversely, we showed that suggestively associated regions are enriched for known height loci. To extend our findings to other traits, we also tested BMI, HDLc and CRP for large region associations, with consistent results for CRP. Our results demonstrate the presence of large region joint associations and suggest these can be used to pinpoint weakly associated SNPs.

%B PLoS Genet %I 11 %V 11 %P e1005103 %8 2015 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25856144?dopt=Abstract %2 PMC4391841 %4 genetics/genetics/trait heritability/regional associations/phenotypic variance/Phenotypes/Phenotypes/Statistical analysis %$ 999999 %R 10.1371/journal.pgen.1005103 %0 Journal Article %J Annals of Applied Statistics %D 2015 %T Covariance pattern mixture models for the analysis of multivariate heterogeneous longitudinal data %A Anderlucci, Laura %A Cinzia Viroli %K Demographics %K Health Conditions and Status %K Methodology %X We propose a novel approach for modeling multivariate longitudinal data in the presence of unobserved heterogeneity for the analysis of the Health and Retirement Study (HRS) data. Our proposal can be cast within the framework of linear mixed models with discrete individual random intercepts; however, differently from the standard formulation, the proposed Covariance Pattern Mixture Model (CPMM) does not require the usual local independence assumption. The model is thus able to simultaneously model the heterogeneity, the association among the responses and the temporal dependence structure. We focus on the investigation of temporal patterns related to the cognitive functioning in retired American respondents. In particular, we aim to understand whether it can be affected by some individual socio-economical characteristics and whether it is possible to identify some homogenous groups of respondents that share a similar cognitive profile. An accurate description of the detected groups allows government policy interventions to be opportunely addressed. Results identify three homogenous clusters of individuals with specific cognitive functioning, consistent with the class conditional distribution of the covariates. The flexibility of CPMM allows for a different contribution of each regressor on the responses according to group membership. In so doing, the identified groups receive a global and accurate phenomenological characterization. %B Annals of Applied Statistics %I 9 %V 9 %P 777-800 %G eng %N 2 %4 methodology/temporal patterns/cognitive functioning/socioeconomic Differences %$ 999999 %R 10.1214/15-aoas816 %0 Journal Article %J Aging and Mental Health %D 2015 %T Depression and onset of cardiovascular disease in the US middle-aged and older adults %A Xiang, Xiaoling %A An, Ruopeng %K Health Conditions and Status %K Healthcare %K Risk Taking %X Objectives: To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults. Methods: The study sample came from 1992-2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51-61 years old in 1992 with no CVD history. A score of 3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan-Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity. Results: Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27 (hazard ratio HR = 1.27, 95 confidence interval = 1.17-1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose-response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant. Conclusion: Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population. %B Aging and Mental Health %I 19 %V 19 %P 1084-1092 %G eng %N 12 %4 depression/cardiovascular disease/Depressive Symptoms/CES Depression Scale/CES Depression Scale/cardiovascular disease/MENTAL HEALTH/DEPRESSION/risk factors/PSYCHIATRY %$ 999999 %R 10.1080/13607863.2014.1003281 %0 Journal Article %J Nature %D 2015 %T Directional dominance on stature and cognition in diverse human populations. %A Joshi, Peter K %A Tõnu Esko %A Mattsson, Hannele %A Eklund, Niina %A Gandin, Ilaria %A Nutile, Teresa %A Jackson, Anne U %A Schurmann, Claudia %A Albert Vernon Smith %A Zhang, Weihua %A Okada, Yukinori %A Stančáková, Alena %A Jessica Faul %A Wei Zhao %A Traci M Bartz %A Maria Pina Concas %A Franceschini, Nora %A Enroth, Stefan %A Vitart, Veronique %A Trompet, Stella %A Guo, Xiuqing %A Daniel I Chasman %A Jeff O'Connell %A Corre, Tanguy %A Nongmaithem, Suraj S %A Chen, Yuning %A Mangino, Massimo %A Ruggiero, Daniela %A Traglia, Michela %A Farmaki, Aliki-Eleni %A Kacprowski, Tim %A Bjonnes, Andrew %A van der Spek, Ashley %A Wu, Ying %A Giri, Anil K %A Yanek, Lisa R %A Wang, Lihua %A Edith Hofer %A Cornelius A Rietveld %A McLeod, Olga %A Marilyn C Cornelis %A Pattaro, Cristian %A Verweij, Niek %A Baumbach, Clemens %A Abdel Abdellaoui %A Warren, Helen R %A Vuckovic, Dragana %A Mei, Hao %A Bouchard, Claude %A Perry, John R B %A Cappellani, Stefania %A Saira S Mirza %A Benton, Miles C %A Broeckel, Ulrich %A Sarah E Medland %A Penelope A Lind %A Malerba, Giovanni %A Alexander W Drong %A Yengo, Loic %A Bielak, Lawrence F %A Zhi, Degui %A van der Most, Peter J %A Daniel Shriner %A Mägi, Reedik %A Hemani, Gibran %A Karaderi, Tugce %A Wang, Zhaoming %A Tian Liu %A Demuth, Ilja %A Jing Hua Zhao %A Meng, Weihua %A Lataniotis, Lazaros %A van der Laan, Sander W %A Bradfield, Jonathan P %A Andrew R Wood %A Bonnefond, Amelie %A Ahluwalia, Tarunveer S %A Hall, Leanne M %A Salvi, Erika %A Yazar, Seyhan %A Carstensen, Lisbeth %A de Haan, Hugoline G %A Abney, Mark %A Afzal, Uzma %A Matthew A. Allison %A Amin, Najaf %A Asselbergs, Folkert W %A Bakker, Stephan J L %A Barr, R Graham %A Baumeister, Sebastian E %A Daniel J. Benjamin %A Bergmann, Sven %A Boerwinkle, Eric %A Erwin P Bottinger %A Campbell, Archie %A Chakravarti, Aravinda %A Chan, Yingleong %A Chanock, Stephen J %A Chen, Constance %A Yii-Der I Chen %A Collins, Francis S %A Connell, John %A Correa, Adolfo %A Cupples, L Adrienne %A Gail Davies %A Dörr, Marcus %A Georg B Ehret %A Ellis, Stephen B %A Feenstra, Bjarke %A Feitosa, Mary F %A Ford, Ian %A Caroline S Fox %A Timothy M Frayling %A Friedrich, Nele %A Geller, Frank %A Scotland, Generation %A Gillham-Nasenya, Irina %A Gottesman, Omri %A Graff, Misa %A Grodstein, Francine %A Gu, Charles %A Haley, Chris %A Hammond, Christopher J %A Sarah E Harris %A Tamara B Harris %A Nicholas D Hastie %A Heard-Costa, Nancy L %A Heikkilä, Kauko %A Lynne J Hocking %A Homuth, Georg %A Jouke-Jan Hottenga %A Huang, Jinyan %A Huffman, Jennifer E %A Hysi, Pirro G %A Mohammed Arfan Ikram %A Ingelsson, Erik %A Joensuu, Anni %A Johansson, Åsa %A Jousilahti, Pekka %A Jukema, J Wouter %A Kähönen, Mika %A Kamatani, Yoichiro %A Kanoni, Stavroula %A Kerr, Shona M %A Khan, Nazir M %A Philipp D Koellinger %A Koistinen, Heikki A %A Kooner, Manraj K %A Kubo, Michiaki %A Kuusisto, Johanna %A Lahti, Jari %A Lenore J Launer %A Lea, Rodney A %A Lehne, Benjamin %A Lehtimäki, Terho %A David C Liewald %A Lars Lind %A Loh, Marie %A Lokki, Marja-Liisa %A London, Stephanie J %A Loomis, Stephanie J %A Loukola, Anu %A Lu, Yingchang %A Lumley, Thomas %A Lundqvist, Annamari %A Männistö, Satu %A Marques-Vidal, Pedro %A Masciullo, Corrado %A Matchan, Angela %A Mathias, Rasika A %A Matsuda, Koichi %A Meigs, James B %A Meisinger, Christa %A Meitinger, Thomas %A Menni, Cristina %A Mentch, Frank D %A Mihailov, Evelin %A Lili Milani %A Montasser, May E %A Grant W Montgomery %A Alanna C Morrison %A Myers, Richard H %A Nadukuru, Rajiv %A Navarro, Pau %A Nelis, Mari %A Nieminen, Markku S %A Ilja M Nolte %A O'Connor, George T %A Ogunniyi, Adesola %A Padmanabhan, Sandosh %A Walter R Palmas %A Pankow, James S %A Patarcic, Inga %A Pavani, Francesca %A Peyser, Patricia A %A Pietilainen, Kirsi %A Neil Poulter %A Prokopenko, Inga %A Ralhan, Sarju %A Redmond, Paul %A Rich, Stephen S %A Rissanen, Harri %A Robino, Antonietta %A Rose, Lynda M %A Rose, Richard %A Cinzia Felicita Sala %A Babatunde Salako %A Veikko Salomaa %A Sarin, Antti-Pekka %A Saxena, Richa %A Schmidt, Helena %A Scott, Laura J %A Scott, William R %A Sennblad, Bengt %A Seshadri, Sudha %A Peter Sever %A Shrestha, Smeeta %A Smith, Blair H %A Jennifer A Smith %A Soranzo, Nicole %A Sotoodehnia, Nona %A Southam, Lorraine %A Stanton, Alice V %A Stathopoulou, Maria G %A Strauch, Konstantin %A Strawbridge, Rona J %A Suderman, Matthew J %A Tandon, Nikhil %A Tang, Sian-Tsun %A Kent D Taylor %A Bamidele O Tayo %A Töglhofer, Anna Maria %A Tomaszewski, Maciej %A Tšernikova, Natalia %A Tuomilehto, Jaakko %A André G Uitterlinden %A Vaidya, Dhananjay %A van Hylckama Vlieg, Astrid %A van Setten, Jessica %A Vasankari, Tuula %A Vedantam, Sailaja %A Vlachopoulou, Efthymia %A Vozzi, Diego %A Vuoksimaa, Eero %A Waldenberger, Melanie %A Erin B Ware %A Wentworth-Shields, William %A Whitfield, John B %A Sarah Wild %A Gonneke Willemsen %A Yajnik, Chittaranjan S %A Yao, Jie %A Zaza, Gianluigi %A Zhu, Xiaofeng %A Salem, Rany M %A Melbye, Mads %A Bisgaard, Hans %A Nilesh J Samani %A Cusi, Daniele %A Mackey, David A %A Cooper, Richard S %A Froguel, Philippe %A Pasterkamp, Gerard %A Grant, Struan F A %A Hakonarson, Hakon %A Luigi Ferrucci %A Scott, Robert A %A Morris, Andrew D %A Palmer, Colin N A %A George Dedoussis %A Deloukas, Panos %A Bertram, Lars %A Lindenberger, Ulman %A Berndt, Sonja I %A Lindgren, Cecilia M %A Nicholas J Timpson %A Tönjes, Anke %A Munroe, Patricia B %A Thorkild I. A. Sørensen %A Charles N Rotimi %A Donna K Arnett %A Oldehinkel, Albertine J %A Sharon L R Kardia %A Balkau, Beverley %A Gambaro, Giovanni %A Morris, Andrew P %A Johan G Eriksson %A Margaret J Wright %A Nicholas G Martin %A Hunt, Steven C %A John M Starr %A Ian J Deary %A Griffiths, Lyn R %A Henning Tiemeier %A Nicola Pirastu %A Kaprio, Jaakko %A Wareham, Nicholas J %A Pérusse, Louis %A Wilson, James G %A Giorgia G Girotto %A Caulfield, Mark J %A Olli T Raitakari %A Dorret I Boomsma %A Gieger, Christian %A van der Harst, Pim %A Hicks, Andrew A %A Kraft, Peter %A Sinisalo, Juha %A Knekt, Paul %A Johannesson, Magnus %A Patrik K E Magnusson %A Hamsten, Anders %A Schmidt, Reinhold %A Ingrid B Borecki %A Vartiainen, Erkki %A Becker, Diane M %A Bharadwaj, Dwaipayan %A Mohlke, Karen L %A Boehnke, Michael %A Cornelia M van Duijn %A Sanghera, Dharambir K %A Teumer, Alexander %A Zeggini, Eleftheria %A Andres Metspalu %A Paolo P. Gasparini %A Ulivi, Sheila %A Ober, Carole %A Toniolo, Daniela %A Rudan, Igor %A David J Porteous %A Ciullo, Marina %A Timothy Spector %A Caroline Hayward %A Dupuis, Josée %A Ruth J F Loos %A Alan F Wright %A Chandak, Giriraj R %A Vollenweider, Peter %A Alan R Shuldiner %A Ridker, Paul M %A Rotter, Jerome I %A Sattar, Naveed %A Gyllensten, Ulf %A Kari E North %A Pirastu, Mario %A Psaty, Bruce M %A David R Weir %A Laakso, Markku %A Gudnason, Vilmundur %A Takahashi, Atsushi %A Chambers, John C %A Kooner, Jaspal S %A David P Strachan %A Campbell, Harry %A Joel N Hirschhron %A Markus Perola %A Polasek, Ozren %A James F Wilson %K Biological Evolution %K Blood pressure %K Body Height %K Cholesterol %K Cognitive Ability %K Cohort Studies %K Education %K Female %K Forced Expiratory Volume %K Genome %K Homozygote %K Humans %K Lung Volume Measurements %K Male %K Phenotype %X

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

%B Nature %V 523 %P 459-62 %8 2015 Jul 23 %G eng %N 7561 %1 http://www.ncbi.nlm.nih.gov/pubmed/26131930?dopt=Abstract %R 10.1038/nature14618 %0 Journal Article %J Diabetes Care %D 2015 %T Disability-Free Life-Years Lost Among Adults Aged ≥50 Years, With and Without Diabetes %A Barbara H. Bardenheier %A Ji Lin %A Zhuo, Xiaohui %A Mohammed K. Ali %A Theodore J Thompson %A Yiling J. Cheng %A Edward W Gregg %K Health Conditions and Status %K Methodology %X OBJECTIVE Quantify the impact of diabetes status on healthy and disabled years of life for older adults in the U.S. and provide a baseline from which to evaluate ongoing national public health efforts to prevent and control diabetes and disability.RESEARCH DESIGN AND METHODS Adults (n = 20,008) aged 50 years and older were followed from 1998 to 2012 in the Health and Retirement Study, a prospective biannual survey of a nationally representative sample of adults. Diabetes and disability status (defined by mobility loss, difficulty with instrumental activities of daily living IADL , and/or difficulty with activities of daily living ADL ) were self-reported. We estimated incidence of disability, remission to nondisability, and mortality. We developed a discrete-time Markov simulation model with a 1-year transition cycle to predict and compare lifetime disability-related outcomes between people with and without diabetes. Data represent the U.S. population in 1998.RESULTS From age 50, adults with diabetes died 4.6 years earlier, developed disability 6 7 years earlier, and spent about 1 2 more years in a disabled state than adults without diabetes. With increasing baseline age, diabetes was associated with significant (P 0.05) reductions in the number of total and disability-free life-years, but the absolute difference in years between those with and without diabetes was less than at younger baseline age. Men with diabetes spent about twice as much of their remaining years disabled (20 24 of remaining life across the three disability definitions) as men without diabetes (12 16 of remaining life across the three disability definitions). Similar associations between diabetes status and disability-free and disabled years were observed among women.CONCLUSIONS Diabetes is associated with a substantial reduction in nondisabled years, to a greater extent than the reduction of longevity. %B Diabetes Care %G eng %U http://care.diabetesjournals.org/content/early/2015/12/17/dc15-1095.abstract %4 Diabetes/methodology/Disabilities/Longevity %$ 999999 %R 10.2337/dc15-1095 %0 Journal Article %J Journal of Aging and Health %D 2015 %T Do Grandchildren Influence How Old You Feel? %A Valeria Bordone %A Bruno Arpino %K Adult children %K Expectations %K Healthcare %X Objectives: Guided by the acknowledged importance of measures of aging alternative to chronological age, we explored the association between subjective age, on the one hand, and having grandchildren and provision of grandchild care, on the other, by gender and age groups. Method: Data from the Health and Retirement Study (HRS; N = 1,701 men and 2,395 women aged 50-85) and linear regression models were used to test two hypotheses. Results: Grandparents feel older than their grandchildless counterparts at younger ages, but such association is reversed in later life if they look after their grandchildren. A cumulative negative association between subjective age and both having grandchildren and providing grandchild care holds for older women. Discussion: This study extends prior research by examining age and gender differences in factors associated with subjective age. The findings suggest that grandparenthood is central in shaping the personal experience of aging. Future studies should address the causality of the factors analyzed. %B Journal of Aging and Health %8 12/2015 %G eng %U http://jah.sagepub.com/content/early/2015/12/08/0898264315618920.abstract %4 subjective age/grandparents/grandchild care/intergenerational relationships/family Structure %$ 999999 %R 10.1177/0898264315618920 %0 Report %D 2015 %T Do Retired Americans Annuitize Too Little? Trends in the Share of Annuitized Income %A Barry Bosworth %A Gary T. Burtless %A Mattan Alalouf %K Annuitization %K Income %K Older Adults %K Retirement Planning and Satisfaction %X This paper examines the importance of annuity-like income as a share of total money income received by aged families. The analysis considers the aged (62+) population as a whole as well as different parts of the aged families’ income distribution during the period from the early 1980s through 2009. We use survey data from 1983 through 2009 from the March Current Population Survey (March CPS) and the Survey of Consumer Finances (SCF). The total income amounts reported in the files are compared with data in the National Income and Product Accounts (NIPA). We calculate the family income consisting of annuitized income flows (primarily Social Security and pensions) and measure it as a share of families’ total money income. We also expand the definition of both annuitized and non-annuitized income to include income flows not captured in the surveys, namely, health insurance subsidies and the housing services received by homeowners. Finally, we consider the potential impact on aged families if they were to convert their wealth into private annuities. %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %P 1-49 %8 06/2015 %G eng %U http://crr.bc.edu/wp-content/uploads/2015/06/wp_2015-9.pdf %0 Journal Article %J Journal of the American Geriatrics Society %D 2015 %T Does Mode of Contact with Different Types of Social Relationships Predict Depression in Older Adults? Evidence from a Nationally Representative Survey %A Alan R Teo %A Choi, Hwajung %A Sarah B. Andrea %A Marcia A. Valenstein %A Jason T Newsom %A Dobscha, Steven K. %A Zivin, Kara %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %X ObjectivesTo determine associations between use of three different modes of social contact (in person, telephone, written or e-mail), contact with different types of people, and risk of depressive symptoms in a nationally representative, longitudinal sample of older adults. DesignPopulation-based observational cohort. SettingUrban and suburban communities throughout the contiguous United States. ParticipantsIndividuals aged 50 and older who participated in the Health and Retirement Survey between 2004 and 2010 (N = 11,065). MeasurementsFrequency of participant use of the three modes of social contact with children, other family members, and friends at baseline were used to predict depressive symptoms (measured using the eight-item Center for Epidemiologic Studies Depression Scale) 2 years later using multivariable logistic regression models. ResultsProbability of having depressive symptoms steadily increased as frequency of in-personbut not telephone or written or e-mail contactdecreased. After controlling for demographic, clinical, and social variables, individuals with in-person social contact every few months or less with children, other family, and friends had a significantly higher probability of clinically significant depressive symptoms 2 years later (11.5 ) than those having in-person contact once or twice per month (8.1 ; P .001) or once or twice per week (7.3 ; P .001). Older age, interpersonal conflict, and depression at baseline moderated some of the effects of social contact on depressive symptoms. ConclusionFrequency of in-person social contact with friends and family independently predicts risk of subsequent depression in older adults. Clinicians should consider encouraging face-to-face social interactions as a preventive strategy for depression. %B Journal of the American Geriatrics Society %I 63 %V 63 %P 2014 %G eng %N 10 %4 social isolation/in-person/telephone/face-to-face/e-mail/written/in person/face to face/e mail/GERIATRICS/GERONTOLOGY/TRIAL/RETIREMENT/THERAPY/HEALTH/LONELINESS/NETWORKS/OUTCOMES/GERONTOLOGY/Surveys/Social aspects/Depression, Mental/Older people/Social interaction/Geriatric psychology/Mental depression %$ 999999 %0 Journal Article %J Journal of Health Economics %D 2015 %T Does prescription drug coverage improve mental health? Evidence from Medicare Part D %A Padmaja Ayyagari %A Dan M. Shane %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %X The introduction of the Medicare Prescription Drug program (Part D) in 2006 resulted in a significant increase in access to coverage for older adults in the U.S. Several studies have documented the impact of this program on prescription drug utilization, expenditures and medication adherence among older adults. However, few studies have evaluated the extent to which these changes have affected the health of seniors. In this study we use data from the Health and Retirement Study to identify the impact of the Medicare Part D program on mental health. Using a difference-in-difference approach, we find that the program significantly reduced depressive symptoms among older adults. We explore the mechanisms through which this effect operates and evaluate heterogeneity in impact. (C) 2015 Elsevier B.V. All rights reserved. %B Journal of Health Economics %I 41 %V 41 %P 46-58 %G eng %4 Medicare Part D/prescription drug costs/medication adherence/depression %$ 999999 %0 Book Section %B Challenges of Latino Aging in the Americas %D 2015 %T The Economic Security of Latino Baby Boomers: Implications for Future Retirees and for Healthcare Funding in the U.S. %A Zachary Gassoumis %A Kathleen H. Wilber %A Torres-Gil, Fernando M. %E William A. Vega %E Kyriakos S Markides %E Jacqueline L. Angel %E Torres-Gil, Fernando M. %K Consumption and Savings %K Healthcare %K Net Worth and Assets %K Public Policy %K Women and Minorities %B Challenges of Latino Aging in the Americas %I Springer %C New York %P 355-378 %G eng %4 health Care Costs/Latinos/economic security/Public Policy/economic disparity %$ 999999 %! The Economic Security of Latino Baby Boomers: Implications for Future Retirees and for Healthcare Funding in the U.S. %& 21 %0 Journal Article %J Neurology %D 2015 %T Factors associated with cognitive evaluations in the United States. %A Vikas Kotagal %A Kenneth M. Langa %A Brenda L Plassman %A Gwenith G Fisher %A Bruno J Giordani %A Robert B Wallace %A James F. Burke %A David C Steffens %A Mohammed U Kabeto %A Roger L. Albin %A Norman L Foster %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cohort Studies %K Dementia %K Female %K Humans %K Logistic Models %K Male %K Marital Status %K Multivariate Analysis %K Neuropsychological tests %K Severity of Illness Index %K United States %X

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

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

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

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

%B Neurology %V 84 %P 64-71 %8 2015 Jan 06 %G eng %U http://www.neurology.org/cgi/doi/10.1212/WNL.0000000000001096 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25428689?dopt=Abstract %! Neurology %R 10.1212/WNL.0000000000001096 %0 Journal Article %J Mol Psychiatry %D 2015 %T FASTKD2 is associated with memory and hippocampal structure in older adults. %A Vijay K Ramanan %A Nho, Kwangsik %A Shen, Li %A Shannon L Risacher %A Brenna C McDonald %A Martin R Farlow %A Tatiana Foroud %A Gao, Sujuan %A Soininen, Hilkka %A Kloszewska, Iwona %A Mecocci, Patrizia %A Tsolaki, Magda %A Vellas, Bruno %A Lovestone, Simon %A Aisen, Paul S. %A Ronald C Petersen %A Jack, Clifford R. %A Shaw, Leslie M. %A Trojanowski, John Q. %A Weiner, Michael W. %A Green, Robert C. %A Arthur W. Toga %A Philip L de Jager %A Lei Yu %A David A Bennett %A Andrew J Saykin %K Age Factors %K Aged %K Aged, 80 and over %K Alzheimer disease %K Female %K Genetic Association Studies %K Genome-Wide Association Study %K Hippocampus %K Humans %K Longitudinal Studies %K Male %K Memory %K Memory Disorders %K Polymorphism, Single Nucleotide %K Protein-Serine-Threonine Kinases %K Structure-Activity Relationship %X

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

%B Mol Psychiatry %I 20 %V 20 %P 1197-204 %8 2015 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/25385369?dopt=Abstract %2 PMC4427556 %4 Genetic analysis/Alzheimer disease/Memory impairment/predictors/FASTKD2 %$ 999999 %R 10.1038/mp.2014.142 %0 Journal Article %J JAMA Intern Med %D 2015 %T Functional impairment and hospital readmission in Medicare seniors. %A S. Ryan Greysen %A Irena Cenzer %A Andrew D. Auerbach %A Kenneth E Covinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Cohort Studies %K Comorbidity %K Female %K Heart Failure %K Humans %K Income %K Logistic Models %K Male %K Medicare %K Myocardial Infarction %K Patient Readmission %K Pneumonia %K Risk Assessment %K Risk Factors %K Sex Factors %K United States %X

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

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

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

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

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

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

%B JAMA Intern Med %I 175 %V 175 %P 559-65 %8 2015 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25642907?dopt=Abstract %2 PMC4388787 %4 Medicare/Functional impairment/hospital readmission/ADL and IADL Impairments %$ 999999 %R 10.1001/jamainternmed.2014.7756 %0 Journal Article %J Journal of Aging and Health %D 2015 %T Functional Limitations as Potential Mediators of the Effects of Self-Reported Vision Status on Fall Risk of Older Adults %A Bernard A Steinman %A Susan M Allen %A Chen, Jie %A Pynoos, Jon %K Health Conditions and Status %X Objective: To test whether limitations in mobility and large-muscle functioning mediate self-reported vision status to increase fall risk among respondents age 65 and above. Method: This study used two waves from the Health and Retirement Study. We conducted binary logistic and negative binomial regression analyses to test indirect paths leading from self-reported vision status to falls, via indices of mobility and large-muscle functioning. Results: Limited evidence was found for a mediating effect among women; however, large-muscle groups were implicated as partially mediating risk factors for falls among men with fair self-reported vision status. Discussion: Implications of these findings are discussed including the need for prioritizing improved muscle strength of older men and women with poor vision as a preventive measure against falls. %B Journal of Aging and Health %I 27 %V 27 %P 158-76 %G eng %U http://jah.sagepub.com/content/early/2014/07/22/0898264314543473.abstract %N 1 %4 falls prevention/self-reported vision/functional impairment/mobility Limitation/Self assessed health %$ 999999 %R 10.1177/0898264314543473 %0 Journal Article %J Womens Health Issues %D 2015 %T Gender Differences in Institutional Long-Term Care Transitions. %A Mudrazija, Stipica %A Thomeer, Mieke Beth %A Jacqueline L. Angel %K Aged %K Aged, 80 and over %K Continuity of Patient Care %K Family Characteristics %K Female %K Geriatric Assessment %K Home Care Services %K Humans %K Length of Stay %K Logistic Models %K Long-term Care %K Male %K Marital Status %K Middle Aged %K Nursing homes %K Patient Discharge %K Residence Characteristics %K Sex Characteristics %K United States %X

INTRODUCTION: This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics.

METHODS: We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n = 3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models.

RESULTS: Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements.

CONCLUSION: Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs.

%B Womens Health Issues %I 25 %V 25 %P 441-9 %8 2015 Sep-Oct %G eng %U http://www.sciencedirect.com/science/article/pii/S1049386715000638 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26123639?dopt=Abstract %2 PMC4569522 %4 Long Term Care/discharge likelihood/discharge planning/sociodemographic differences/sociodemographic differences/LTC discharge %$ 999999 %R 10.1016/j.whi.2015.04.010 %0 Journal Article %J Mol Psychiatry %D 2015 %T Genetic contributions to variation in general cognitive function: a meta-analysis of genome-wide association studies in the CHARGE consortium (N=53949). %A Gail Davies %A Armstrong, N. %A Joshua C. Bis %A Bressler, J. %A Chouraki, V. %A Giddaluru, S. %A Edith Hofer %A Carla A Ibrahim-Verbaas %A Kirin, M. %A J. Lahti %A Sven J van der Lee %A Stephanie Le Hellard %A Tian Liu %A Riccardo E Marioni %A Christopher J Oldmeadow %A Postmus, I. %A Albert Vernon Smith %K Aged %K Aged, 80 and over %K Atherosclerosis %K Cognition %K Cognition Disorders %K Cohort Studies %K Female %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K HMGN1 Protein %K Humans %K Male %K Middle Aged %K Neuropsychological tests %K Phenotype %K Polymorphism, Single Nucleotide %K Scotland %X

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

%B Mol Psychiatry %I 20 %V 20 %P 183-92 %8 2015 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25644384?dopt=Abstract %2 PMC4356746 %4 genetics/genetics/GENOME-WIDE ASSOCIATION/TOMM40/ABCG1/MEF2C/complex train anaysis/Atherosclerosis Risk in Communities Study/cross-national study %$ 999999 %R 10.1038/mp.2014.188 %0 Journal Article %J Nature %D 2015 %T Genetic studies of body mass index yield new insights for obesity biology. %A Locke, Adam E %A Kahali, Bratati %A Berndt, Sonja I %A Justice, Anne E %A Pers, Tune H %A Day, Felix R %A Powell, Corey %A Vedantam, Sailaja %A Buchkovich, Martin L %A Yang, Jian %A Croteau-Chonka, Damien C %A Tõnu Esko %A Fall, Tove %A Ferreira, Teresa %A Gustafsson, Stefan %A Kutalik, Zoltán %A Luan, Jian'an %A Mägi, Reedik %A Randall, Joshua C %A Thomas W Winkler %A Andrew R Wood %A Workalemahu, Tsegaselassie %A Jessica Faul %A Jennifer A Smith %A Jing Hua Zhao %A Wei Zhao %A Chen, Jin %A Rudolf Ferhmann %A Hedman, Åsa K %A Karjalainen, Juha %A Schmidt, Ellen M %A Absher, Devin %A Amin, Najaf %A Anderson, Denise %A Beekman, Marian %A Bolton, Jennifer L %A Bragg-Gresham, Jennifer L %A Buyske, Steven %A Demirkan, Ayse %A Deng, Guohong %A Georg B Ehret %A Feenstra, Bjarke %A Feitosa, Mary F %A Fischer, Krista %A Goel, Anuj %A Gong, Jian %A Jackson, Anne U %A Kanoni, Stavroula %A Kleber, Marcus E %A Kristiansson, Kati %A Lim, Unhee %A Lotay, Vaneet %A Mangino, Massimo %A Irene Mateo Leach %A Medina-Gomez, Carolina %A Sarah E Medland %A Michael A Nalls %A Palmer, Cameron D %A Pasko, Dorota %A Pechlivanis, Sonali %A Peters, Marjolein J %A Prokopenko, Inga %A Shungin, Dmitry %A Stančáková, Alena %A Strawbridge, Rona J %A Yun Ju Sung %A Toshiko Tanaka %A Teumer, Alexander %A Trompet, Stella %A van der Laan, Sander W %A van Setten, Jessica %A Jana V. van Vliet-Ostaptchouk %A Wang, Zhaoming %A Yengo, Loic %A Zhang, Weihua %A Isaacs, Aaron %A Albrecht, Eva %A Ärnlöv, Johan %A Arscott, Gillian M %A Attwood, Antony P %A Bandinelli, Stefania %A Barrett, Amy %A Bas, Isabelita N %A Bellis, Claire %A Bennett, Amanda J %A Berne, Christian %A Blagieva, Roza %A Blüher, Matthias %A Böhringer, Stefan %A Bonnycastle, Lori L %A Böttcher, Yvonne %A Boyd, Heather A %A Bruinenberg, Marcel %A Caspersen, Ida H %A Yii-Der I Chen %A Robert Clark %A Daw, E Warwick %A de Craen, Anton J M %A Delgado, Graciela %A Dimitriou, Maria %A Doney, Alex S F %A Eklund, Niina %A Estrada, Karol %A Eury, Elodie %A Folkersen, Lasse %A Fraser, Ross M %A Melissa E Garcia %A Geller, Frank %A Giedraitis, Vilmantas %A Gigante, Bruna %A Alan S Go %A Golay, Alain %A Goodall, Alison H %A Gordon, Scott D %A Gorski, Mathias %A Hans-Jörgen Grabe %A Grallert, Harald %A Grammer, Tanja B %A Gräßler, Jürgen %A Grönberg, Henrik %A Groves, Christopher J %A Gusto, Gaëlle %A Jeffrey Haessler %A Hall, Per %A Haller, Toomas %A Hallmans, Göran %A Catharina A Hartman %A Hassinen, Maija %A Caroline Hayward %A Heard-Costa, Nancy L %A Helmer, Quinta %A Hengstenberg, Christian %A Oddgeir L Holmen %A Jouke-Jan Hottenga %A James, Alan L %A Janina Jeff %A Johansson, Åsa %A Jolley, Jennifer %A Juliusdottir, Thorhildur %A Kinnunen, Leena %A Koenig, Wolfgang %A Koskenvuo, Markku %A Kratzer, Wolfgang %A Laitinen, Jaana %A Lamina, Claudia %A Leander, Karin %A Lee, Nanette R %A Lichtner, Peter %A Lars Lind %A Lindström, Jaana %A Ken Sin Lo %A Lobbens, Stéphane %A Lorbeer, Roberto %A Lu, Yingchang %A Mach, François %A Patrik K E Magnusson %A Mahajan, Anubha %A McArdle, Wendy L %A McLachlan, Stela %A Menni, Cristina %A Merger, Sigrun %A Mihailov, Evelin %A Lili Milani %A Moayyeri, Alireza %A Monda, Keri L %A Morken, Mario A %A Mulas, Antonella %A Müller, Gabriele %A Müller-Nurasyid, Martina %A Musk, Arthur W %A Nagaraja, Ramaiah %A Markus M Nöthen %A Ilja M Nolte %A Pilz, Stefan %A Nigel W Rayner %A Renstrom, Frida %A Rettig, Rainer %A Ried, Janina S %A Ripke, Stephan %A Neil R Robertson %A Rose, Lynda M %A Sanna, Serena %A Scharnagl, Hubert %A Scholtens, Salome %A Schumacher, Fredrick R %A Scott, William R %A Seufferlein, Thomas %A Jianxin Shi %A Albert Vernon Smith %A Smolonska, Joanna %A Stanton, Alice V %A Steinthorsdottir, Valgerdur %A Kathleen E Stirrups %A Heather M Stringham %A Sundström, Johan %A Swertz, Morris A %A Swift, Amy J %A Syvänen, Ann-Christine %A Tan, Sian-Tsung %A Bamidele O Tayo %A Thorand, Barbara %A Thorleifsson, Gudmar %A Tyrer, Jonathan P %A Uh, Hae-Won %A Vandenput, Liesbeth %A Verhulst, Frank C %A Vermeulen, Sita H %A Verweij, Niek %A Vonk, Judith M %A Lindsay L Waite %A Warren, Helen R %A Dawn M Waterworth %A Michael N Weedon %A Wilkens, Lynne R %A Willenborg, Christina %A Wilsgaard, Tom %A Wojczynski, Mary K %A Wong, Andrew %A Alan F Wright %A Zhang, Qunyuan %A Brennan, Eoin P %A Murim Choi %A Dastani, Zari %A Alexander W Drong %A Eriksson, Per %A Franco-Cereceda, Anders %A Gådin, Jesper R %A Gharavi, Ali G %A Goddard, Michael E %A Handsaker, Robert E %A Huang, Jinyan %A Karpe, Fredrik %A Kathiresan, Sekar %A Keildson, Sarah %A Kiryluk, Krzysztof %A Kubo, Michiaki %A Lee, Jong-Young %A Liang, Liming %A Lifton, Richard P %A Ma, Baoshan %A McCarroll, Steven A %A McKnight, Amy J %A Min, Josine L %A Moffatt, Miriam F %A Grant W Montgomery %A Joanne M Murabito %A Nicholson, George %A Nyholt, Dale R %A Okada, Yukinori %A Perry, John R B %A Dorajoo, Rajkumar %A Reinmaa, Eva %A Salem, Rany M %A Sandholm, Niina %A Scott, Robert A %A Stolk, Lisette %A Takahashi, Atsushi %A Tanaka, Toshihiro %A Ferdinand M van 't Hooft %A Anna A E Vinkhuyzen %A Westra, Harm-Jan %A Wei Zhang %A Krina T Zondervan %A Andrew C Heath %A Arveiler, Dominique %A Bakker, Stephan J L %A Beilby, John %A Bergman, Richard N %A Blangero, John %A Bovet, Pascal %A Campbell, Harry %A Caulfield, Mark J %A Cesana, Giancarlo %A Chakravarti, Aravinda %A Daniel I Chasman %A Chines, Peter S %A Collins, Francis S %A Crawford, Dana C %A Cupples, L Adrienne %A Cusi, Daniele %A Danesh, John %A de Faire, Ulf %A Hester M den Ruijter %A Dominiczak, Anna F %A Erbel, Raimund %A Erdmann, Jeanette %A Johan G Eriksson %A Farrall, Martin %A Felix, Stephan B %A Ferrannini, Ele %A Ferrières, Jean %A Ford, Ian %A Forouhi, Nita G %A Forrester, Terrence %A Franco, Oscar H %A Gansevoort, Ron T %A Gejman, Pablo V %A Gieger, Christian %A Gottesman, Omri %A Gudnason, Vilmundur %A Gyllensten, Ulf %A Hall, Alistair S %A Tamara B Harris %A Andrew T Hattersley %A Hicks, Andrew A %A Hindorff, Lucia A %A Aroon Hingorani %A Hofman, Albert %A Homuth, Georg %A Hovingh, G Kees %A Humphries, Steve E %A Hunt, Steven C %A Hyppönen, Elina %A Illig, Thomas %A Jacobs, Kevin B %A Järvelin, Marjo-Riitta %A Jöckel, Karl-Heinz %A Johansen, Berit %A Jousilahti, Pekka %A Jukema, J Wouter %A Jula, Antti M %A Kaprio, Jaakko %A Kastelein, John J P %A Keinanen-Kiukaanniemi, Sirkka M %A Lambertus A Kiemeney %A Knekt, Paul %A Kooner, Jaspal S %A Charles Kooperberg %A Kovacs, Peter %A Kraja, Aldi T %A Kumari, Meena %A Kuusisto, Johanna %A Lakka, Timo A %A Langenberg, Claudia %A Loic Le Marchand %A Lehtimäki, Terho %A Lyssenko, Valeriya %A Männistö, Satu %A Marette, André %A Matise, Tara C %A McKenzie, Colin A %A McKnight, Barbara %A Moll, Frans L %A Morris, Andrew D %A Morris, Andrew P %A Murray, Jeffrey C %A Nelis, Mari %A Ohlsson, Claes %A Oldehinkel, Albertine J %A Ong, Ken K %A Pamela A F Madden %A Pasterkamp, Gerard %A Peden, John F %A Peters, Annette %A Postma, Dirkje S %A Pramstaller, Peter P %A Price, Jackie F %A Qi, Lu %A Olli T Raitakari %A Rankinen, Tuomo %A Rao, D C %A Rice, Treva K %A Ridker, Paul M %A Rioux, John D %A Ritchie, Marylyn D %A Rudan, Igor %A Veikko Salomaa %A Nilesh J Samani %A Saramies, Jouko %A Sarzynski, Mark A %A Schunkert, Heribert %A Schwarz, Peter E H %A Peter Sever %A Alan R Shuldiner %A Sinisalo, Juha %A Stolk, Ronald P %A Strauch, Konstantin %A Tönjes, Anke %A Trégouët, David-Alexandre %A Tremblay, Angelo %A Tremoli, Elena %A Virtamo, Jarmo %A Vohl, Marie-Claude %A Völker, Uwe %A Waeber, Gérard %A Gonneke Willemsen %A Witteman, Jacqueline C %A Zillikens, M Carola %A Adair, Linda S %A Amouyel, Philippe %A Asselbergs, Folkert W %A Assimes, Themistocles L %A Bochud, Murielle %A Boehm, Bernhard O %A Boerwinkle, Eric %A Bornstein, Stefan R %A Erwin P Bottinger %A Bouchard, Claude %A Cauchi, Stéphane %A Chambers, John C %A Chanock, Stephen J %A Cooper, Richard S %A de Bakker, Paul I W %A George Dedoussis %A Luigi Ferrucci %A Franks, Paul W %A Froguel, Philippe %A Leif C Groop %A Christopher A Haiman %A Hamsten, Anders %A Hui, Jennie %A Hunter, David J %A Hveem, Kristian %A Kaplan, Robert C %A Mika Kivimäki %A Kuh, Diana %A Laakso, Markku %A Yongmei Liu %A Nicholas G Martin %A März, Winfried %A Melbye, Mads %A Andres Metspalu %A Moebus, Susanne %A Munroe, Patricia B %A Njølstad, Inger %A Ben A Oostra %A Palmer, Colin N A %A Nancy L Pedersen %A Markus Perola %A Pérusse, Louis %A Peters, Ulrike %A Power, Chris %A Quertermous, Thomas %A Rauramaa, Rainer %A Fernando Rivadeneira %A Saaristo, Timo E %A Saleheen, Danish %A Sattar, Naveed %A Eric E Schadt %A Schlessinger, David %A Eline P Slagboom %A Snieder, Harold %A Timothy Spector %A Thorsteinsdottir, Unnur %A Stumvoll, Michael %A Tuomilehto, Jaakko %A André G Uitterlinden %A Uusitupa, Matti %A van der Harst, Pim %A Walker, Mark %A Wallaschofski, Henri %A Wareham, Nicholas J %A Watkins, Hugh %A David R Weir %A Wichmann, H-Erich %A James F Wilson %A Zanen, Pieter %A Ingrid B Borecki %A Deloukas, Panos %A Caroline S Fox %A Iris M Heid %A Jeff O'Connell %A David P Strachan %A Stefansson, Kari %A Cornelia M van Duijn %A Gonçalo R Abecasis %A Lude L Franke %A Timothy M Frayling %A McCarthy, Mark I %A Peter M Visscher %A Scherag, Andre %A Willer, Cristen J %A Boehnke, Michael %A Mohlke, Karen L %A Lindgren, Cecilia M %A Beckmann, Jacques S %A Barroso, Inês %A Kari E North %A Ingelsson, Erik %A Joel N Hirschhron %A Ruth J F Loos %A Elizabeth K Speliotes %K Age Factors %K BMI %K Continental Population Groups %K Energy Metabolism %K Europe %K Female %K Genome-Wide Association Study %K Glutamic Acid %K Humans %K Insulin %K Male %K Obesity %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %K Synapses %X

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

%B Nature %V 518 %P 197-206 %8 2015 Feb 12 %G eng %N 7538 %1 http://www.ncbi.nlm.nih.gov/pubmed/25673413?dopt=Abstract %R 10.1038/nature14177 %0 Journal Article %J Alzheimers Dement %D 2015 %T Genetically predicted body mass index and Alzheimer's disease-related phenotypes in three large samples: Mendelian randomization analyses. %A Mukherjee, Shubhabrata %A Stefan Walter %A Kauwe, John S K %A Andrew J Saykin %A David A Bennett %A Eric B Larson %A Paul K Crane %A M. Maria Glymour %K Aged %K Aged, 80 and over %K Alzheimer disease %K Body Mass Index %K Female %K Genotype %K Humans %K Linear Models %K Male %K Mendelian Randomization Analysis %K Obesity %K Phenotype %K Polymorphism, Single Nucleotide %K Risk Factors %X

Observational research shows that higher body mass index (BMI) increases Alzheimer's disease (AD) risk, but it is unclear whether this association is causal. We applied genetic variants that predict BMI in Mendelian randomization analyses, an approach that is not biased by reverse causation or confounding, to evaluate whether higher BMI increases AD risk. We evaluated individual-level data from the AD Genetics Consortium (ADGC: 10,079 AD cases and 9613 controls), the Health and Retirement Study (HRS: 8403 participants with algorithm-predicted dementia status), and published associations from the Genetic and Environmental Risk for AD consortium (GERAD1: 3177 AD cases and 7277 controls). No evidence from individual single-nucleotide polymorphisms or polygenic scores indicated BMI increased AD risk. Mendelian randomization effect estimates per BMI point (95% confidence intervals) were as follows: ADGC, odds ratio (OR) = 0.95 (0.90-1.01); HRS, OR = 1.00 (0.75-1.32); GERAD1, OR = 0.96 (0.87-1.07). One subscore (cellular processes not otherwise specified) unexpectedly predicted lower AD risk.

%B Alzheimers Dement %V 11 %P 1439-1451 %8 2015 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/26079416?dopt=Abstract %R 10.1016/j.jalz.2015.05.015 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2015 %T GWAS of longevity in CHARGE consortium confirms APOE and FOXO3 candidacy. %A Broer, Linda %A Aron S Buchman %A Deelen, Joris %A Daniel S Evans %A Jessica Faul %A Kathryn L Lunetta %A Sebastiani, Paola %A Jennifer A Smith %A Albert Vernon Smith %A Toshiko Tanaka %A Lei Yu %A Alice M. Arnold %A Aspelund, Thor %A Emelia J Benjamin %A Philip L de Jager %A Guðny Eiríksdóttir %A Melissa E Garcia %A Hofman, Albert %A Kaplan, Robert C %A Sharon L R Kardia %A Douglas P Kiel %A Ben A Oostra %A Orwoll, Eric S %A Parimi, Neeta %A Psaty, Bruce M %A Fernando Rivadeneira %A Rotter, Jerome I %A Seshadri, Sudha %A Andrew B Singleton %A Henning Tiemeier %A André G Uitterlinden %A Wei Zhao %A Bandinelli, Stefania %A David A Bennett %A Luigi Ferrucci %A Gudnason, Vilmundur %A Tamara B Harris %A Karasik, David %A Lenore J Launer %A Thomas T Perls %A Eline P Slagboom %A Tranah, Gregory J %A David R Weir %A Anne B Newman %A Cornelia M van Duijn %A Joanne M Murabito %K Aged %K Aged, 80 and over %K Apolipoproteins E %K Cell Adhesion Molecules %K Cohort Studies %K Female %K Forkhead Box Protein O3 %K Forkhead Transcription Factors %K Genome-Wide Association Study %K Humans %K Longevity %K Male %K Middle Aged %K Polymorphism, Single Nucleotide %K Receptors, Kainic Acid %X

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

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

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

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

%B J Gerontol A Biol Sci Med Sci %V 70 %P 110-8 %8 2015 Jan %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296168/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25199915?dopt=Abstract %R 10.1093/gerona/glu166 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2015 %T How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study. %A Thomeer, Mieke Beth %A Mudrazija, Stipica %A Jacqueline L. Angel %K Activities of Daily Living %K African Continental Ancestry Group %K Disability Evaluation %K European Continental Ancestry Group %K Hispanic Americans %K Homes for the Aged %K Humans %K Nursing homes %K Proportional Hazards Models %K Socioeconomic factors %K United States %X

OBJECTIVES: This study investigates how health- and disability-based need factors and enabling factors (e.g., socioeconomic and family-based resources) relate to nursing home admission among 3 different racial and ethnic groups.

METHOD: We use Cox proportional hazard models to estimate differences in nursing home admission for non-Hispanic whites, non-Hispanic blacks, and Hispanics from 1998 to 2010 in the Health and Retirement Study (N = 18,952).

RESULTS: Racial-ethnic differences in nursing home admission are magnified after controlling for health- and disability-based need factors and enabling factors. Additionally, the degree to which specific factors contribute to risk of nursing home admission varies significantly across racial-ethnic groups.

DISCUSSION: Our findings indicate that substantial racial and ethnic variations in nursing home admission continue to exist and that Hispanic use is particularly low. We argue that these differences may demonstrate a significant underuse of nursing homes for racial and ethnic minorities. Alternatively, they could signify different preferences for nursing home care, perhaps due to unmeasured cultural factors or structural obstacles.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 628-38 %8 2015 Jul %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/09/08/geronb.gbu114.abstract %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25204311?dopt=Abstract %2 PMC4462672 %4 Hispanic ethnicity/Long-term care/Nursing homes/ethnicity/race/ethnic differences %$ 999999 %R 10.1093/geronb/gbu114 %0 Journal Article %J Psychiatric Services %D 2015 %T The Impact of Cognitive Impairment and Comorbid Depression on Disability, Health Care Utilization, and Costs %A Xiang, Xiaoling %A An, Ruopeng %K Health Conditions and Status %K Healthcare %X Objectives: This study examined the impact of co-occurring cognitive impairment and depression on functional limitations, hospital and nursing home admissions, and out-of-pocket expenditures (OOPEs) among older adults. Methods: Individual mixed-effects regressions were performed to examine the relationship between cognitive impairment and depression and selected outcomes among 18,315 community-dwelling adults ages 50 and over from the Health and Retirement Study from 1998 to 2010. Results: Cognitive impairment and depression were independently associated with the outcomes of interest, and the estimated effects were largest among individuals with both conditions. Cognitive impairment with comorbid depression predicted limitations in activities of daily living (odds ratio OR =3.02) and instrumental activities of daily living (OR=4.18), hospitalizations (OR=1.53), nursing home admissions (OR=3.34), and an increase of 1,150 in annual OOPEs. Conclusions: Compared with cognitive impairment or depression alone, cognitive impairment plus depression was associated with substantial functional limitations, health services utilization, and costs. %B Psychiatric Services %I 66 %V 66 %P 1245-1248 %G eng %U http://dx.doi.org/10.1176/appi.ps.201400511 %N 11 %4 Patient admissions/Patient admissions/depression/Cognitive impairment/Health services utilization/Mental depression/Health care expenditures/Out of pocket costs %$ 999999 %R 10.1176/appi.ps.201400511 %0 Journal Article %J American Journal of Health Economics %D 2015 %T The Impact of Social Security Income on Cognitive Function at Older Ages %A Padmaja Ayyagari %A Frisvold, David %K Cognition %K cognitive function %K Social Security %K Social Security Benefits %X Prior literature has documented a positive association between income and cognitive function at older ages, however, the extent to which this association represents causal effects is unknown. In this study, we use an exogenous change in Social Security income due to amendments to the Social Security Act in the 1970s to identify the causal impact of Social Security income on cognitive function of elderly individuals. We find that higher benefits led to significant improvements in cognitive function and that these improvements in cognition were clinically meaningful. Our results suggest that interventions even at advanced ages can slow the rate of decline in cognitive function. %B American Journal of Health Economics %G eng %U http://www.nber.org/papers/w21484 %R 10.3386/w21484 %0 Journal Article %J IZA Journal of Labor Policy %D 2015 %T The Impact of the Recession on the Wealth of Older Immigrant and Native Households in the United States %A Amuedo-Dorantes, Catalina %A Pozo, Susan %K Employment and Labor Force %K Housing %K Net Worth and Assets %K Pensions %K Public Policy %K Retirement Planning and Satisfaction %K Women and Minorities %X Using the 2006 and 2010 Health and Retirement Study, we explore how the recent recession impacted the wealth holding and retirement plans of older households in the United States. Of particular interest to us is whether the impact on household asset ownership, asset wealth and household retirement behavior varied with the nativity of the household and its standing in the wealth distribution prior to the onset of the recession. We find that the so-called Great Recession made a significant dent on the portfolios of older American households by eroding the value of specific assets to the point of delaying their planned retirement. Furthermore, its impacts were unevenly distributed across demographic and economic groups, with mixed and immigrant households in the middle and top wealth quartiles prior to the recession enduring significantly larger wealth losses than natives due, primarily, to their greater losses in primary housing ownership and primary housing values. %B IZA Journal of Labor Policy %I 4 %V 4 %G eng %4 Economics of the Handicapped/Minorities/Retirement Policy/public policy/Household assets/housing/assets/great Recession/Retirement planning/pensions/labor Force Participation %$ 999999 %R 10.1186/s40173-015-0033-x %0 Journal Article %J Journal of Epidemiology and Community Health %D 2015 %T Job strain and trajectories of change in episodic memory before and after retirement: results from the Health and Retirement Study %A Andel, Ross %A Frank J Infurna %A Elizabeth A. Hahn Rickenbach %A Crowe, Michael %A Lisa A Marchiondo %A Gwenith G Fisher %K Employment and Labor Force %K Health Conditions and Status %X Background: We examined indicators of job strain in relation to level and change in episodic memory in the years leading up to as well as following retirement. Methods: Our analyses centre on 3779 individuals from the nationally representative Health and Retirement Study (baseline age 57.3 years) who reported gainful employment in an occupation for 10 years prior to retirement, and who were assessed for episodic memory performance over up to 20 years (median 8 waves over 16 years). We used ratings from the Occupational Information Network (O Net) to score occupations for job control and job demands, and to measure job strain (job demands/job control). Results: Controlling for sociodemographic characteristics, depressive symptoms, and cardiovascular disease, less job control and greater job strain were not significantly associated with change in episodic memory in the period leading up to retirement, but were associated with significantly poorer episodic memory at retirement and an accelerated rate of decline in episodic memory following retirement. The results did not vary for men and women or by self-employment status. Conclusions: Job strain expressed mainly as low job control is linked to poorer episodic memory at retirement and more decline after retirement. Job characteristics appear to have implications for cognitive ageing independent of relevant confounds. %B Journal of Epidemiology and Community Health %I 69 %V 69 %P 442-446 %G eng %N 5 %4 Job strain/episodic Memory/Cognitive Aging %$ 999999 %R 10.1136/jech-2014-204754 %0 Journal Article %J Nat Genet %D 2015 %T Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair. %A Day, Felix R %A Ruth, Katherine S %A Thompson, Deborah J %A Kathryn L Lunetta %A Pervjakova, Natalia %A Daniel I Chasman %A Stolk, Lisette %A Finucane, Hilary K %A Sulem, Patrick %A Bulik-Sullivan, Brendan %A Tõnu Esko %A Andrew D Johnson %A Elks, Cathy E %A Franceschini, Nora %A He, Chunyan %A Altmaier, Elisabeth %A Brody, Jennifer A %A Lude L Franke %A Huffman, Jennifer E %A Keller, Margaux F %A McArdle, Patrick F %A Nutile, Teresa %A Porcu, Eleonora %A Robino, Antonietta %A Rose, Lynda M %A Schick, Ursula M %A Jennifer A Smith %A Teumer, Alexander %A Traglia, Michela %A Vuckovic, Dragana %A Yao, Jie %A Wei Zhao %A Albrecht, Eva %A Amin, Najaf %A Corre, Tanguy %A Jouke-Jan Hottenga %A Mangino, Massimo %A Albert Vernon Smith %A Toshiko Tanaka %A Gonçalo R Abecasis %A Andrulis, Irene L %A Anton-Culver, Hoda %A Antoniou, Antonis C %A Arndt, Volker %A Alice M. Arnold %A Barbieri, Caterina %A Beckmann, Matthias W %A Beeghly-Fadiel, Alicia %A Benitez, Javier %A Bernstein, Leslie %A Bielinski, Suzette J %A Blomqvist, Carl %A Boerwinkle, Eric %A Bogdanova, Natalia V %A Bojesen, Stig E %A Manjeet K. Bolla %A Borresen-Dale, Anne-Lise %A Boutin, Thibaud S %A Brauch, Hiltrud %A Brenner, Hermann %A Brüning, Thomas %A Burwinkel, Barbara %A Campbell, Archie %A Campbell, Harry %A Chanock, Stephen J %A Chapman, J Ross %A Yii-Der I Chen %A Chenevix-Trench, Georgia %A Couch, Fergus J %A Coviello, Andrea D %A Cox, Angela %A Czene, Kamila %A Darabi, Hatef %A De Vivo, Immaculata %A Ellen W Demerath %A Joe G Dennis %A Devilee, Peter %A Dörk, Thilo %A Dos-Santos-Silva, Isabel %A Dunning, Alison M %A John D Eicher %A Fasching, Peter A %A Jessica Faul %A Figueroa, Jonine %A Flesch-Janys, Dieter %A Gandin, Ilaria %A Melissa E Garcia %A García-Closas, Montserrat %A Giles, Graham G %A Giorgia G Girotto %A Goldberg, Mark S %A González-Neira, Anna %A Goodarzi, Mark O %A Grove, Megan L %A Gudbjartsson, Daniel F %A Guénel, Pascal %A Guo, Xiuqing %A Christopher A Haiman %A Hall, Per %A Hamann, Ute %A Henderson, Brian E %A Lynne J Hocking %A Hofman, Albert %A Homuth, Georg %A Hooning, Maartje J %A John L Hopper %A Hu, Frank B %A Huang, Jinyan %A Humphreys, Keith %A Hunter, David J %A Jakubowska, Anna %A Jones, Samuel E %A Kabisch, Maria %A Karasik, David %A Knight, Julia A %A Kolcic, Ivana %A Charles Kooperberg %A Kosma, Veli-Matti %A Kriebel, Jennifer %A Kristensen, Vessela %A Lambrechts, Diether %A Langenberg, Claudia %A Li, Jingmei %A Li, Xin %A Lindström, Sara %A Yongmei Liu %A Luan, Jian'an %A Lubinski, Jan %A Mägi, Reedik %A Mannermaa, Arto %A Manz, Judith %A Margolin, Sara %A Marten, Jonathan %A Nicholas G Martin %A Masciullo, Corrado %A Meindl, Alfons %A Michailidou, Kyriaki %A Mihailov, Evelin %A Lili Milani %A Milne, Roger L %A Müller-Nurasyid, Martina %A Michael A Nalls %A Neale, Benjamin M %A Nevanlinna, Heli %A Neven, Patrick %A Anne B Newman %A Børge G Nordestgaard %A Olson, Janet E %A Padmanabhan, Sandosh %A Peterlongo, Paolo %A Peters, Ulrike %A Petersmann, Astrid %A Peto, Julian %A Pharoah, Paul D P %A Nicola Pirastu %A Pirie, Ailith %A Pistis, Giorgio %A Polasek, Ozren %A David J Porteous %A Psaty, Bruce M %A Pylkäs, Katri %A Radice, Paolo %A Raffel, Leslie J %A Fernando Rivadeneira %A Rudan, Igor %A Rudolph, Anja %A Ruggiero, Daniela %A Cinzia Felicita Sala %A Sanna, Serena %A Sawyer, Elinor J %A Schlessinger, David %A Schmidt, Marjanka K %A Schmidt, Frank %A Schmutzler, Rita K %A Schoemaker, Minouk J %A Scott, Robert A %A Seynaeve, Caroline M %A Simard, Jacques %A Sorice, Rossella %A Southey, Melissa C %A Stöckl, Doris %A Strauch, Konstantin %A Swerdlow, Anthony %A Kent D Taylor %A Thorsteinsdottir, Unnur %A Toland, Amanda E %A Tomlinson, Ian %A Truong, Thérèse %A Tryggvadottir, Laufey %A Stephen T Turner %A Vozzi, Diego %A Wang, Qin %A Wellons, Melissa %A Gonneke Willemsen %A James F Wilson %A Winqvist, Robert %A Wolffenbuttel, Bruce B H R %A Alan F Wright %A Yannoukakos, Drakoulis %A Zemunik, Tatijana %A Wei Zhang %A Zygmunt, Marek %A Bergmann, Sven %A Dorret I Boomsma %A Buring, Julie E %A Luigi Ferrucci %A Grant W Montgomery %A Gudnason, Vilmundur %A Timothy Spector %A Cornelia M van Duijn %A Alizadeh, Behrooz Z %A Ciullo, Marina %A Crisponi, Laura %A Easton, Douglas F %A Paolo P. Gasparini %A Gieger, Christian %A Tamara B Harris %A Caroline Hayward %A Sharon L R Kardia %A Kraft, Peter %A McKnight, Barbara %A Andres Metspalu %A Alanna C Morrison %A Reiner, Alex P %A Ridker, Paul M %A Rotter, Jerome I %A Toniolo, Daniela %A André G Uitterlinden %A Ulivi, Sheila %A Völzke, Henry %A Wareham, Nicholas J %A David R Weir %A Laura M Yerges-Armstrong %A Price, Alkes L %A Stefansson, Kari %A Visser, Jenny A %A Ong, Ken K %A Chang-Claude, Jenny %A Joanne M Murabito %A Perry, John R B %A Murray, Anna %K Age Factors %K Aging %K BRCA1 Protein %K Breast Neoplasms %K DNA Repair %K Female %K Genome %K Genome-Wide Association Study %K Genotype %K Humans %K Hypothalamus %K Menopause %K Middle Aged %K Models, Genetic %K Older Adults %K Phenotype %K Reproduction %K Signal Transduction %X

Menopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in ∼70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (∼6% increase in risk per year; P = 3 × 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms.

%B Nat Genet %V 47 %P 1294-303 %8 2015 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/26414677?dopt=Abstract %R 10.1038/ng.3412 %0 Journal Article %J Psychoneuroendocrinology %D 2015 %T Loneliness, eudaimonia, and the human conserved transcriptional response to adversity. %A Steven W. Cole %A Morgan E. Levine %A Jesusa M. G. Arevalo %A Ma, Jeffrey %A David R Weir %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Down-Regulation %K Female %K Humans %K Inflammation %K Loneliness %K Longitudinal Studies %K Male %K Mental Health %K Middle Aged %K social isolation %K Social Support %K Stress, Psychological %K Transcriptome %X

BACKGROUND: Chronic social adversity activates a conserved transcriptional response to adversity (CTRA) marked by increased expression of pro-inflammatory genes and decreased expression of antiviral- and antibody-related genes. Recent findings suggest that some psychological resilience factors may help buffer CTRA activation, but the relative impact of resilience and adversity factors remains poorly understood. Here we examined the relative strength of CTRA association for the two best-established psychological correlates of CTRA gene expression-the risk factor of perceived social isolation (loneliness) and the resilience factor of eudaimonic well-being (purpose and meaning in life).

METHODS: Peripheral blood samples and validated measures of loneliness and eudaimonic well-being were analyzed in 108 community-dwelling older adults participating in the longitudinal US Health and Retirement Study (56% female, mean age 73). Mixed effect linear model analyses quantified the strength of association between CTRA gene expression and measures of loneliness and eudaimonic well-being in separate and joint analyses.

RESULTS: As in previous studies, separate analyses found CTRA gene expression to be up-regulated in association with loneliness and down-regulated in association with eudaimonic well-being. In joint analyses, effects of loneliness were completely abrogated whereas eudaimonic well-being continued to associate with CTRA down-regulation. Similar eudaimonia-dominant effects were observed for positive and negative affect, optimism and pessimism, and anxiety symptoms. All results were independent of demographic and behavioral health risk factors.

CONCLUSIONS: Eudaimonic well-being may have the potential to compensate for the adverse impact of loneliness on CTRA gene expression. Findings suggest a novel approach to targeting the health risks associated with social isolation by promoting purpose and meaning in life.

%B Psychoneuroendocrinology %I 62 %V 62 %P 11-7 %8 2015 Dec %G eng %U http://www.sciencedirect.com/science/article/pii/S0306453015002358 %1 http://www.ncbi.nlm.nih.gov/pubmed/26246388?dopt=Abstract %2 PMC4637182 %4 Social genomics/Psychoneuroimmunology/Gene expression/Transcriptome/Microarray/Stress/Social support/Psychological well-being/Eudaimonia/Positive psychology %$ 999999 %R 10.1016/j.psyneuen.2015.07.001 %0 Journal Article %J Journal of Epidemiology and Community Health %D 2015 %T Mothering alone: cross-national comparisons of later-life disability and health among women who were single mothers %A Lisa F Berkman %A Yuhui Zheng %A M. Maria Glymour %A Mauricio Avendano %A Axel Borsch-Supan %A Erika L. Sabbath %K Adult children %K Cross-National %K Disabilities %K Health Conditions and Status %K Methodology %X Background Single motherhood is associated with poorer health, but whether this association varies between countries is not known. We examine associations between single motherhood and poor later-life health in the USA, England and 13 European countries.Methods Data came from 25 125 women aged 50 who participated in the US Health and Retirement Study, the English Longitudinal Study of Ageing and Survey of Health, Ageing and Retirement in Europe. We tested whether single motherhood at ages 16 49 was associated with increased risk of limitations with activities of daily living (ADL), instrumental ADL and fair/poor self-rated health in later life.Results 33 of American mothers had experienced single motherhood before age 50, versus 22 in England, 38 in Scandinavia, 22 in Western Europe and 10 in Southern Europe. Single mothers had higher risk of poorer health and disability in later life than married mothers, but associations varied between countries. For example, risk ratios for ADL limitations were 1.51 (95 CI 1.29 to 1.98) in England, 1.50 (1.10 to 2.05) in Scandinavia and 1.27 (1.17 to 1.40) in the USA, versus 1.09 (0.80 to 1.47) in Western Europe, 1.13 (0.80 to 1.60) in Southern Europe and 0.93 (0.66 to 1.31) in Eastern Europe. Women who were single mothers before age 20, for 8 years, or resulting from divorce or non-marital childbearing, were at particular risk.Conclusions Single motherhood during early-adulthood or mid-adulthood is associated with poorer health in later life. Risks were greatest in England, the USA and Scandinavia. Selection and causation mechanisms might both explain between-country variation. %B Journal of Epidemiology and Community Health %I 69 %V 69 %P 865-872 %G eng %U http://jech.bmj.com/content/early/2015/04/10/jech-2014-205149.abstract %N 9 %4 ELSA_/SHARE/cross Cultural Comparison/cross-national study/ADL/IADL/single motherhood/disability/disability %$ 999999 %R 10.1136/jech-2014-205149 %0 Journal Article %J International Psychogeriatrics %D 2015 %T Neighborhood physical disorder, social cohesion, and insomnia: results from participants over age 50 in the Health and Retirement Study %A Lenis P. Chen-Edinboro %A Christopher N Kaufmann %A Augustinavicius, J. L. %A Ramin Mojtabai %A Parisi, J. M. %A Alexandra M. V. Wennberg %A Smith, M. T. %A Adam P Spira %K Consumption and Savings %K Demographics %K Health Conditions and Status %X Background:: We determined the association between neighborhood socio-environmental factors and insomnia symptoms in a nationally representative sample of US adults aged 50 years. Methods:: Data were analyzed from two waves (2006 and 2010) of the Health and Retirement Study using 7,231 community-dwelling participants (3,054 men and 4,177 women) in the United States. Primary predictors were neighborhood physical disorder (e.g. vandalism/graffiti, feeling safe alone after dark, and cleanliness) and social cohesion (e.g. friendliness of people, availability of help when needed, etc.); outcomes were insomnia symptoms (trouble falling asleep, night awakenings, waking too early, and feeling unrested). Results:: After adjustment for age, income, race, education, sex, chronic diseases, body mass index, depressive symptoms, smoking, and alcohol consumption, each one-unit increase in neighborhood physical disorder was associated with a greater odds of trouble falling asleep (odds ratio (OR) = 1.09, 95 confidence interval (CI): 1.04 1.14), waking too early (OR = 1.05, 95 CI: 1.00 1.10), and, in adults aged 69 years (adjusting for all variables above except age), feeling unrested in the morning (OR = 1.11, 95 CI: 1.02 1.22 in 2006). Each one-unit increase in lower social cohesion was associated with a greater odds of trouble falling asleep (OR = 1.06, 95 CI: 1.01 1.11) and feeling unrested (OR = 1.09, 95 CI: 1.04 1.15). Conclusions:: Neighborhood-level factors of physical disorder and social cohesion are associated with insomnia symptoms in middle-aged and older adults. Neighborhood-level factors may affect sleep, and consequently health, in our aging population. %B International Psychogeriatrics %V 27 %P 289-296 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84911902104andpartnerID=40andmd5=b1c8afcbfd51895bd32bf5836deba987 %N 2 %4 aging/sociodemographic characteristics/sociodemographic characteristics/insomnia/neighborhood Characteristics/physical disorder/sleep/social cohesion %$ 999999 %& 289 %0 Report %D 2015 %T Nonmonetary Job Characteristics and Employment Transitions at Older Ages %A Marco Angrisani %A Arie Kapteyn %A Erik Meijer %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %X This paper studies to what extent job characteristics such as physical and cognitive demands, use of technologies, responsibility, difficulty, stress, peer pressure, and relations with co-workers are related to full or partial retirement. We study employment transitions and retirement expectations of older workers by exploiting the wealth of information about individuals older than age 50 in the Health and Retirement Study (HRS), and characteristics of different occupations provided by the Occupation Information Network (O NET) database. Controlling for basic demographics, wages, benefits, health, cognitive ability, personality, and other personal characteristics, we find strong and statistically significant relationships between labor force transitions and job characteristics. These relationships are typically more pronounced and more precisely estimated when we use objective job attributes taken from the O NET than when we use self-reported job characteristics taken from the HRS, but self-reported characteristics are more strongly related to moves from full-time to part-time employment. Using expected retirement age or subjective probabilities of working full-time at older ages gives similar results to using actual labor force transitions as the dependent variable. The estimated effects of job characteristics are again stronger and more robust to alternative specifications when measures of job attributes are taken from the O NET than from the HRS. Our findings suggest that nonmonetary job characteristics are important determinants of labor supply decisions at older ages, but our analysis is still preliminary in its attempt to uncover causal relationships: Unobservable individual characteristics responsible for sorting into specific occupations may also shape retirement decisions. %I Ann Arbor, MI, University of Michigan %G eng %4 labor force participation/O NET/job Characteristics/physical demands/cognitive ability/retirement planning %$ 999999 %0 Journal Article %J Journal of psychosomatic research %D 2015 %T Obesity and onset of depression among U.S. middle-aged and older adults %A Xiang, Xiaoling %A An, Ruopeng %K Demographics %K Health Conditions and Status %K Methodology %X Objectives: This paper aims to examine the relationship between obesity and onset of depression among U.S. middle-aged and older adults. Methods: Data came from 1994 to 2010 waves of the Health and Retirement Study. Study sample consisted of 6514 community-dwelling adults born between 1931 and 1941 who were free of clinically relevant depressive symptoms in 1994. Body mass index (BMI) was calculated from self-reported height/weight. Body weight status was classified into normal weight (18.5 kg/m2 BMI andlt; 25 kg/m2), overweight (25 kg/m2 BMI andlt; 30 kg/m2), and obesity (BMI 30 kg/m2). A score of 3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan Meier estimator and time-dependent Cox proportional hazards model were performed to examine the association between body weight status and onset of clinically relevant depressive symptoms. Results: Unhealthy body weight was associated future onset of depression. Compared with their normal weight counterparts, overweight and obese participants were 13 (hazard ratio HR = 1.13, 95 confidence interval CI = 1.04 1.23) and 9 (HR = 1.09, 95 CI = 1.01 1.18) more likely to have onset of clinically relevant depressive symptoms during the 16 years of follow-up, respectively. The relationship between obesity and depression onset appeared stronger among females and non-Hispanic whites than their male and racial/ethnic minority counterparts. Conclusions: Health care providers should be aware of the potential risk for depression among obese older adults. %B Journal of psychosomatic research %V 78 %P 242-248 %G eng %U http://www.sciencedirect.com/science/article/pii/S0022399914004449 %N 3 %4 Obesity/Depression/Older adults/Survival analysis/depressive Symptoms/Body Weight %$ 999999 %& 242 %R 10.1016/j.jpsychores.2014.12.008 %0 Journal Article %J Qual Life Res %D 2015 %T Population-level impact of loss on survivor mortality risk. %A Joseph C. Allegra %A Amara E. Ezeamama %A Simpson, Cherie %A Toni Miles %K Bereavement %K Female %K Humans %K Longevity %K Male %K Quality of Life %K Risk %K Survivors %X

INTRODUCTION: The loss of a loved one adversely affects the bereaved.

MATERIALS AND METHODS: Using data from the 2010 and 2012 waves of Health and Retirement Study (HRS), we estimate the risk for death in a 2-year span after the loss of a parent, spouse, or child for adults aged 50 to 70 years.

CONCLUSION: A respondent with a loss was twice as likely to die when compared similarly aged persons with no loss (OR 2.32; 95 % CI 1.14, 5.30). Loss of either a parent (OR 1.93; 95 % CI 1.01, 4.07), or a child (OR 1.77; 95 % CI 1.08, 2.96) also increased respondent mortality. This elevated risk persists after adjustment for gender and other high-risk health conditions. Any physical activity reduces survivor death rates during this critical period by more than 85 %.

%B Qual Life Res %I 24 %V 24 %P 2959-61 %8 2015 Dec %G eng %U https://link.springer.com/article/10.1007%2Fs11136-015-1048-x %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/26081295?dopt=Abstract %2 PMC4615662 %R 10.1007/s11136-015-1048-x %0 Journal Article %J American Journal of Public Health %D 2015 %T Preparaci n de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional %A Tala M. Al-rousan %A Linda M. Rubenstein %A Robert B Wallace %K Demographics %K Health Conditions and Status %K Public Policy %X We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3 reported participating in an educational program or reading materials about disaster preparation. Nearly 15 reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society. %B American Journal of Public Health %I 105 %V 105 %P S614 %G eng %N S4 %R 10.2105/AJPH.2013.301559s %0 Book Section %B Challenges of Latino Aging in the Americas %D 2015 %T Racial and Ethnic Disparities in Willingness to Pay for Improved Health: Evidence from the Aging and Population %A Odufuwa, Olufolake O. %A Berrens, Robert P. %A Valdez, R. Burciaga %E William A. Vega %E Kyriakos S Markides %E Jacqueline L. Angel %E Torres-Gil, Fernando M. %K Health Conditions and Status %K Net Worth and Assets %K Women and Minorities %B Challenges of Latino Aging in the Americas %I Springer %C New York %P 333-354 %G eng %4 mortality risk reduction/mortality/health status/morbidity/Latinos/statistical life value %$ 999999 %! Racial and Ethnic Disparities in Willingness to Pay for Improved Health: Evidence from the Aging and Population %& 20 %0 Report %D 2015 %T The Retirement and Social Security Benefit Claiming of U.S. Military Retirees %A Knapp, David %A Asch, Beth %A Hosek, James %A Mattock, Michael %K Demographics %K Pensions %K Retirement Planning and Satisfaction %K Social Security %X After serving 20 years in the active component of the U.S. military, service members can retire from the military, as young as age 38, and begin collecting a monthly pension benefit for the remainder of their life. In this paper, we ask: do active duty military retirees exit the labor force earlier or later because of their access to military retirement benefits? Do they alter their Social Security claiming decisions? We theorize that access to a consistent source of income may encourage earlier retirement through a standard income effect, but the military pension may also increase a retiree s post-military job search, allowing for a greater wage and improved job satisfaction due to a better employer-employee match. Access to a steady source of pension income may also reduce short-term liquidity constraints, encouraging military retirees to delay claiming their Social Security benefit in order to benefit from delayed retirement. We estimate the impact of military retiree pension income on retirement empirically using the 1992 Health and Retirement Study cohort. We identify the military pension effect in a difference-in-difference model by exploiting a surprise change in military-retiree benefits in 2001 that extended Tricare health benefits to Medicare eligible military retirees and their spouses through the end of their lives. TFL eliminated the need to purchase Medigap coverage, thereby eliminating a cost that could cut into disposable income from their military annuity. A key limitation of the analysis is that the HRS includes relatively few military retirees. %I Ann Arbor, MI, Michigan Retirement Research Center %G eng %4 retirement/veterans/Social Security/benefit claiming %$ 999999 %0 Journal Article %J Journal of Economic Dynamics and Control %D 2015 %T Risk-Sharing within Families: Evidence from the Health and Retirement Study %A Akin, S. Nuray %A Leukhina, Oksana %K Adult children %K Health Conditions and Status %K Income %K Retirement Planning and Satisfaction %K Risk Factors %X We report strong empirical support for the presence of self-interest-based risk sharing within extended families in the U.S. A standard model of self-interest-based risk sharing predicts that the share of current family income consumed by a child positively depends on that child's permanent income. It follows that parental transfers to children that are expected to earn more over the period of risk-sharing arrangements should exhibit less sensitivity to the recipient's income fluctuations. We test this distinguishing prediction of self-interest-based risk sharing by exploiting the variation of transfer receipts among siblings, observed over 17 years of longitudinal data spanned by the Health and Retirement Study. %B Journal of Economic Dynamics and Control %I 52 %V 52 %P 270-284 %G eng %U http://www.sciencedirect.com/science/article/pii/S0165188914003303 %R 10.1016/j.jedc.2014.12.005 %0 Journal Article %J Journal of the Economics of Ageing %D 2015 %T Smoking and cognitive functioning at older ages: Evidence from the Health and Retirement Study %A Padmaja Ayyagari %A Asia Sikora Kessler %K Demographics %K Health Conditions and Status %K Methodology %X It has long been established that smoking has detrimental health effects on the human body and leads to early mortality. However, the evidence regarding the link between smoking behavior and cognitive function in old age is mixed. While nicotine has been shown to improve cognitive functioning in some medical studies, current smokers typically perform worse than non-smokers on cognitive tests in population based studies. We use the Health and Retirement Study to evaluate the role of unobserved factors in explaining these conflicting findings. Results from individual fixed effects models show that much of the lower cognitive function of current and former smokers relative to never smokers can be attributed to unobserved differences between these groups. %B Journal of the Economics of Ageing %I 6 %V 6 %P 13 %G eng %U http://www.sciencedirect.com/science/article/pii/S2212828X15000183 %4 Smoking/Fixed effects models/Cognitive functioning/Older adults %$ 999999 %R 10.1016/j.jeoa.2015.06.001 %0 Journal Article %J Preventive Medicine %D 2015 %T Smoking, Heavy Drinking, and Depression among U.S. Middle-Aged and Older Adults %A An, Ruopeng %A Xiang, Xiaoling %K Demographics %K Health Conditions and Status %K Methodology %K Other %X Objective To examine the relationship between smoking, heavy drinking and depression among U.S. middle-aged and older adults. Method Individual-level data came from 1992 2012 waves of the Health and Retirement Study. Smoking was ascertained from self-reported cigarette smoking status at the time of interview. Heavy drinking was defined as one or more drinks per day on average or four or more drinks on any occasion in the past three months for women, and two or more drinks per day on average or four or more drinks on any occasion in the past three months for men. Depression was defined as scoring three and above on the eight-item Center for Epidemiologic Studies Depression Scale. Cox proportional hazards regressions were performed to examine the relationship between smoking, heavy drinking and depression. Results Compared to non-smokers, smokers free from depression and heavy drinking at baseline were 20 (95 confidence interval: 12 28 ) and 34 (20 50 ) more likely to develop depression and engage in heavy drinking during follow-up period, respectively. Compared to non-depressed participants, participants with depression who were nonsmokers and non-heavy drinkers at baseline were 41 (14 74 ) and 18 (6 31 ) more likely to smoke and engage in heavy drinking during follow-up, respectively. Compared to non-heavy drinkers, heavy drinkers who were nonsmokers at baseline were 60 (26 104 ) more likely to smoke during follow-up. Conclusion Health promotion programs in midlife and older age should be mindful of the associations between smoking, heavy drinking and depression in order to improve intervention effectiveness. %B Preventive Medicine %I 81 %V 81 %P 295-302 %G eng %U http://www.sciencedirect.com/science/article/pii/S0091743515003114 %4 Smoking/Heavy drinking/Depression/Midlife/Older adult/Alcohol/Survival analysis %$ 999999 %R http://dx.doi.org/10.1016/j.ypmed.2015.09.026 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2015 %T Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age. %A Xiao Xu %A Jersey Liang %A Joan M. Bennett %A Anda Botoseneanu %A Heather G. Allore %K Aged %K Aged, 80 and over %K Aging %K Cognition Disorders %K Disabled Persons %K Educational Status %K Female %K Health Status %K Humans %K Male %K Social Class %K United States %X

OBJECTIVES: This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

METHODS: We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

RESULTS: We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3%, 23.5%, 24.5%, and 22.6% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

DISCUSSION: Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 661-71 %8 2015 Jul %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/08/25/geronb.gbu095.abstract %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25161216?dopt=Abstract %2 PMC4462671 %4 Socioeconomic status/Joint trajectories/Elderly/Disability/Disability/Depression/Cognition. %$ 999999 %R 10.1093/geronb/gbu095 %0 Thesis %D 2015 %T Three Essays on the Supply of Long-Term Care Services to the Elderly in the U.S %A Arora, Kanika %Y Douglas A. Wolf %K Adult children %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Methodology %K Net Worth and Assets %K Public Policy %X Situated in the context of a rapidly aging population, this dissertation examines the implications of supplying long-term care (LTC) services to the elderly in the United States. The first two essays investigate private costs of LTC assistance borne by adult children of elderly parents. In contrast, the third essay focuses on the cost of publicly-provided, formal LTC services. The first essay analyzes whether adult children devote less time to exercise as time allocation in parental caregiving increases. The empirical model is a system of four correlated equations, where the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. I use pooled cross-sectional data from the Health and Retirement Study (HRS) for this analysis. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, nor in hours of work, among either men or women. The second essay goes beyond time resources and examines whether dementia onset in parents leads to a reduction in adult children's household wealth. Towards this, I construct a longitudinal dataset from seven waves of HRS. Estimates from unconditional quantile regressions indicate that parental dementia substantially reduces household wealth of an unmarried adult child in the upper quantiles of the wealth change distribution in the first two years after parental diagnosis. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent time period as well. An examination of mechanisms suggests that both, losses in labor income and nursing home expenditures, may play a role in leading to wealth declines. This paper makes two contributions: first, it focuses on a broader outcome of private cost, and second, unlike previous studies, it does not limit the analysis to adult children who are informal caregivers. The final essay examines the cost implications of publicly provided formal care services. Medicaid's Personal Care Services (PCS) State Plan benefit is a key mechanism through which states provide personal assistance services to eligible beneficiaries. But, it is widely claimed that states are reluctant to adopt the program over fears of runaway spending. Surprisingly, there has been very little empirical work on examining the effect of the PCS State Plan benefit on Medicaid expenditures. Using aggregate state-level data from 1975 through 2009, this study finds that PCS State Plan adoption had no overall effect on Medicaid expenditures, except briefly during the early-growth years in 1980s. Further, findings suggest that states make decisions to adopt the program based on financial experiences of other adopting states. This study provides evidence consistent with the interpretation that when faced with the dilemma of balancing increased access and uncontrolled expenditures, state officials adapt the design of an entitlement benefit in an effort to make it less expensive. In its entirety, the dissertation provides new thinking on two dominant themes in conventional long-term care research: "caregiver burden" and "woodwork effect". In particular, the results of the first and third essay question the presence of "caregiver burden" and "woodwork effect" respectively, while the third essay challenges the pervasiveness of "caregiver burden" among unmarried adult children. These findings, which in some aspect are unexpected in the context of existing literature, have important implications for policy intervention and the direction of future research efforts in this area. %I Syracuse University %C Syracuse, NY %V 3713670 %P 105 %8 2015 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1708672813?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ %9 Ph.D. %M 1708672813 %4 0630:Public policy %! Three Essays on the Supply of Long-Term Care Services to the Elderly in the U.S %0 Journal Article %J Journals of Gerontology Series B-Psychological Sciences and Social Sciences %D 2015 %T The Vicious Cycle of Parental Caregiving and Financial Well-being: A Longitudinal Study of Women %A Lee, Yeonjung %A Tang, Fengyan %A Kim, Kevin H. %A Steven M. Albert %K Adult children %K Healthcare %K Net Worth and Assets %K Women and Minorities %X 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. %B Journals of Gerontology Series B-Psychological Sciences and Social Sciences %I 70 %V 70 %P 425-431 %G eng %N 3 %4 older parents/caregiver burden/household income/women/parental care/financial status %$ 999999 %R 10.1093/geronb/gbu001 %0 Report %D 2015 %T The Wealth of Wealthholders %A Ameriks, John %A Caplin, Andrew %A Lee, Minjoon %A Matthew D. Shapiro %A Tonetti, Christopher %K Adult children %K Consumption and Savings %K Employment and Labor Force %K Event History/Life Cycle %K Net Worth and Assets %K Public Policy %K Women and Minorities %X This paper introduces the Vanguard Research Initiative (VRI), a new panel survey of wealthholders designed to yield high-quality measurements of a large sample of older Americans who arrive at retirement with significant financial assets. The VRI links survey data with a variety of administrative data from Vanguard. The survey features an account-by-account approach to asset measurement and a real-time feedback and correction mechanism that are shown to be highly successful in eliciting accurate measures of wealth. Specifically, the VRI data reflect unbiased and precise estimates of wealth when compared to administrative account data. The VRI sample has characteristics similar to populations meeting analogous wealth and Internet access eligibility conditions in the Health and Retirement Study (HRS) and Survey of Consumer Finances (SCF). To illustrate the value of the VRI, the paper shows that the relationship between wealth and expected retirement date is very different in the VRI than in the HRS and SCF--mainly because those surveys have so few observations where wealth levels are high enough to finance substantial consumption during retirement. %I Cambridge, United States, NBER Working Paper No. 20972 %G eng %U http://search.proquest.com/docview/1687935318/1B5FA0446C27487FPQ/32 %4 Consumption/Saving/Wealth/Fiscal Policy/Fiscal Policy/Public Policy/transfers/Household economics/Intertemporal Household Choice/Life Cycle Models/Economics of the Elderly/Economics of the Handicapped/Non-labor Market Discrimination %$ 999999 %0 Journal Article %J American Journal of Epidemiology %D 2015 %T Who Suffers During Recessions? Economic Downturns, Job Loss, and Cardiovascular Disease in Older Americans %A Noelke, Clemens %A Mauricio Avendano %K Employment and Labor Force %K Health Conditions and Status %K Public Policy %K Risk Taking %X Job loss in the years before retirement has been found to increase risk of cardiovascular disease (CVD), but some studies suggest that CVD mortality among older workers declines during recessions. We hypothesized that recessionary labor market conditions were associated with reduced CVD risk among persons who did not experience job loss and increased CVD risk among persons who lost their jobs. In our analyses, we used longitudinal, nationally representative data from Americans 50 years of age or older who were enrolled in the Health and Retirement Study and surveyed every 2 years from 1992 to 2010 about their employment status and whether they had experienced a stroke or myocardial infarction. To measure local labor market conditions, Health and Retirement Study data were linked to county unemployment rates. Among workers who experienced job loss, recessionary labor market conditions at the time of job loss were associated with a significantly higher CVD risk (hazard ratio = 2.54, 95 confidence interval: 1.39, 4.65). In contrast, among workers who did not experience job loss, recessionary labor market conditions were associated with a lower CVD risk (hazard ratio = 0.50, 95 confidence interval: 0.31, 0.78). These results suggest that recessions might be protective in the absence of job loss but hazardous in the presence of job loss. %B American Journal of Epidemiology %I 182 %V 182 %P 873-882 %G eng %N 10 %4 business cycles/recessions/unemployment/cardiovascular disease/GREAT RECESSION/STROKE/MORTALITY/labor market participation/Risk assessment/Labor market %$ 999999 %R 10.1093/aje/kwv094 %0 Journal Article %J Gerontologist %D 2014 %T Body Mass Trajectories and Mortality Among Older Adults: A Joint Growth MixtureDiscrete-Time Survival Analysis %A Zajacova, Anna %A Jennifer A Ailshire %K Health Conditions and Status %X Purpose of the Study: The aim of this study was to investigate heterogeneity in body weight trajectories among older adults and their association with mortality risks. Design and Methods: Information on body mass index (BMI) and survival come from nine waves of the Health and Retirement Study, a 16-year survey of adults aged 5161 at baseline (N 9,703). We used a sex-stratified joint growth mixture-discrete time survival model to characterize BMI trajectory groups and their associated mortality. Results: Three distinct classes of BMI trajectories were identified: stable overweight, obese gaining, and obese losing. Relative to the stable overweight class, which comprised about 90 of the sample, the obese gaining class had approximately 50 higher mortality risk; the highest mortality was found in the obese losing category (OR 2.7, p .001). The results were similar for men and women. Implications: The findings highlight substantial heterogeneity in weight trajectories of older Americans, as well as large survival differentials across the classes. The direction of weight changes appears inextricably linked to the overall BMI level in terms of predicting older adults longevity. Weight loss is associated with particularly high mortality risk even when the typical BMI change is from obesity to overweight. %B Gerontologist %I 54 %V 54 %P 221-231 %G eng %N 2 %4 Obesity/Body mass index/Body weight trajectories/Mortality/LONGEVITY/INTENTIONAL WEIGHT-LOSS %$ 999999 %R 10.1093/geront/gns164 %0 Journal Article %J Proc Natl Acad Sci U S A %D 2014 %T Common genetic variants associated with cognitive performance identified using the proxy-phenotype method. %A Cornelius A Rietveld %A Tõnu Esko %A Gail Davies %A Pers, Tune H %A Turley, Patrick %A Benyamin, Beben %A Chabris, Christopher F %A Emilsson, Valur %A Andrew D Johnson %A Lee, James J %A Christiaan de Leeuw %A Riccardo E Marioni %A Sarah E Medland %A Michael B Miller %A Rostapshova, Olga %A Sven J van der Lee %A Anna A E Vinkhuyzen %A Amin, Najaf %A Dalton C Conley %A Derringer, Jaime %A Cornelia M van Duijn %A Fehrmann, Rudolf %A Lude L Franke %A Edward L Glaeser %A Narelle K Hansell %A Caroline Hayward %A Iacono, William G %A Carla A Ibrahim-Verbaas %A Vincent Jaddoe %A Karjalainen, Juha %A David I Laibson %A Paul Lichtenstein %A David C Liewald %A Patrik K E Magnusson %A Nicholas G Martin %A McGue, Matt %A McMahon, George %A Nancy L Pedersen %A Pinker, Steven %A David J Porteous %A Posthuma, Danielle %A Fernando Rivadeneira %A Smith, Blair H %A John M Starr %A Henning Tiemeier %A Nicholas J Timpson %A Trzaskowski, Maciej %A André G Uitterlinden %A Verhulst, Frank C %A Mary E Ward %A Margaret J Wright %A George Davey Smith %A Ian J Deary %A Johannesson, Magnus %A Plomin, Robert %A Peter M Visscher %A Daniel J. Benjamin %A Cesarini, David %A Philipp D Koellinger %K Cell Adhesion Molecules, Neuronal %K Cognition %K Female %K Humans %K Learning %K Male %K Memory %K Multifactorial Inheritance %K Nerve Tissue Proteins %K Neuronal Plasticity %K Octamer Transcription Factors %K Polymorphism, Single Nucleotide %K Synaptic Transmission %X

We identify common genetic variants associated with cognitive performance using a two-stage approach, which we call the proxy-phenotype method. First, we conduct a genome-wide association study of educational attainment in a large sample (n = 106,736), which produces a set of 69 education-associated SNPs. Second, using independent samples (n = 24,189), we measure the association of these education-associated SNPs with cognitive performance. Three SNPs (rs1487441, rs7923609, and rs2721173) are significantly associated with cognitive performance after correction for multiple hypothesis testing. In an independent sample of older Americans (n = 8,652), we also show that a polygenic score derived from the education-associated SNPs is associated with memory and absence of dementia. Convergent evidence from a set of bioinformatics analyses implicates four specific genes (KNCMA1, NRXN1, POU2F3, and SCRT). All of these genes are associated with a particular neurotransmitter pathway involved in synaptic plasticity, the main cellular mechanism for learning and memory.

%B Proc Natl Acad Sci U S A %V 111 %P 13790-4 %8 2014 Sep 23 %G eng %N 38 %1 http://www.ncbi.nlm.nih.gov/pubmed/25201988?dopt=Abstract %R 10.1073/pnas.1404623111 %0 Report %D 2014 %T Consumption Behavior, Annuity Income and Mortality Risk of the Elderly %A Kutlu-Koc, Vesile %A Alessie, Rob J.M. %A Kalwij, Adriaan %K Event History/Life Cycle %K Health Conditions and Status %X Previous studies find that individuals do not draw down their assets after retirement which is at odds with the predictions of a simple life cycle model without uncertainty. Hurd (1989, 1999) explains saving behavior of elderly singles and couples by adding lifetime uncertainty and bequest motives to the simple life cycle model. In this paper we aim to test whether predictions of the models proposed by Hurd (1989, 1999) hold for a sample of elderly Americans. We also extend the theoretical model of Hurd (1999) for couples. We use data taken from the Health and Retirement Study (HRS) supplemented with the Consumption and Activities Mail Survey (CAMS). In line with theory we find that, on average, individuals total consumption is greater than their annuity income after retirement and the difference between total consumption and annuity income increases with the wealth level. Our results also suggest that consumption growth decreases with higher mortality rates for elderly singles. On the other hand, for elderly couples, consumption growth does not respond to changes in the mortality risk of the couple. %I Tilburg, The Netherlands, Netspar %G eng %4 life Cycle/mortality Rates %$ 999999 %0 Journal Article %J Bulletin of the Malaysian Mathematical Sciences Society %D 2014 %T Dependence in binary outcomes: A quadratic exponential model approach %A Maboobeh Zangeneh Sirdari %A M. Ataharul Islam %A Norhashidah Awang %K Methodology %K Other %X Repeated measurements data appear in many applications of study subjects such as correlated binary data. Most of studies often focus on the dependence of marginal response probabilities. There is a lack of study based on joint probability distributions that yield estimation and test procedure using conditional probabilities, marginal means and correlated binary data. In this paper, the quadratic exponential form model has been extended for a Markov chain framework. This study extends the quadratic exponential model for displaying the estimation procedure for the nature and extent of dependence among the binary outcomes. In addition, a test procedure is extended to test for the goodness of fit of the model as well as for testing the order of the underlying Markov chain. The proposed model and the test procedures have been examined thoroughly with an application to elderly population data from the Health and Retirement Study (HRS) data. %B Bulletin of the Malaysian Mathematical Sciences Society %I 37 %V 37 %P 129-137 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84890077284andpartnerID=40andmd5=b5707512075fa6411d8415bdec6bf441 %N 1 %4 And dependence in outcomes/Conditional model/Marginal model/Markov model/Quadratic exponential form/Repeated observations %$ 999999 %0 Journal Article %J Field methods %D 2014 %T Does Sequence Matter in Multi-Mode Surveys: Results from an Experiment. %A James Wagner %A Arrieta, Jennifer %A Heidi M Guyer %A Mary Beth Ofstedal %X

Interest in a multi-mode approach to surveys has grown substantially in recent years, in part due to increased costs of face-to-face interviewing and the emergence of the internet as a survey mode. Yet, there is little systematic evidence of the impact of a multimode approach on survey costs and errors. This paper reports the results of an experiment designed to evaluate whether a mixed-mode approach to a large screening survey would produce comparable response rates at a lower cost than a face-to-face screening effort. The experiment was carried out in the Health and Retirement Study (HRS), an ongoing panel study of Americans over age 50. In 2010, HRS conducted a household screening survey to recruit new sample members to supplement the existing sample. The experiment varied the sequence of modes with which the screening interview was delivered. One treatment offered mail first, followed by face-to-face interviewing; the other started with face-to-face and then mail. A control group was offered only face-to-face interviewing. Results suggest that the mixed mode options reduced costs without reducing response rates to the screening interview. There is some evidence, however, that the sequence of modes offered may impact the response rate for a follow-up in-depth interview.

%B Field methods %I 26 %V 26 %P 141-155 %8 2014 May 01 %G eng %U http://fmx.sagepub.com/content/early/2013/07/24/1525822X13491863.abstract %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/24764767?dopt=Abstract %4 Mixed Mode/Nonresponse/Survey research/multimode/Response Rate %$ 999999 %R 10.1177/1525822X13491863 %0 Journal Article %J Am J Epidemiol %D 2014 %T Fine particulate matter air pollution and cognitive function among older US adults. %A Jennifer A Ailshire %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Cognition %K Cognition Disorders %K Cross-Sectional Studies %K Female %K Humans %K Inhalation Exposure %K Male %K Memory, Episodic %K Middle Aged %K Neuropsychological tests %K Particulate Matter %K Socioeconomic factors %K United States %K Urban Population %X

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

%B Am J Epidemiol %I 180 %V 180 %P 359-66 %8 2014 Aug 15 %G eng %U http://aje.oxfordjournals.org/content/early/2014/06/24/aje.kwu155.abstract %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/24966214?dopt=Abstract %R 10.1093/aje/kwu155 %0 Journal Article %J BMC Genet %D 2014 %T Genetic diversity is a predictor of mortality in humans. %A Bihlmeyer, Nathan A %A Brody, Jennifer A %A Albert Vernon Smith %A Kathryn L Lunetta %A Michael A Nalls %A Jennifer A Smith %A Toshiko Tanaka %A Gail Davies %A Lei Yu %A Saira S Mirza %A Teumer, Alexander %A Coresh, Josef %A Pankow, James S %A Franceschini, Nora %A Scaria, Anish %A Oshima, Junko %A Psaty, Bruce M %A Gudnason, Vilmundur %A Guðny Eiríksdóttir %A Tamara B Harris %A Li, Hanyue %A Karasik, David %A Douglas P Kiel %A Melissa E Garcia %A Yongmei Liu %A Jessica Faul %A Sharon L R Kardia %A Wei Zhao %A Luigi Ferrucci %A Allerhand, Michael %A David C Liewald %A Redmond, Paul %A John M Starr %A Philip L de Jager %A Nese Direk %A Mohammed Arfan Ikram %A André G Uitterlinden %A Homuth, Georg %A Lorbeer, Roberto %A Hans-Jörgen Grabe %A Lenore J Launer %A Joanne M Murabito %A Andrew B Singleton %A David R Weir %A Bandinelli, Stefania %A Ian J Deary %A David A Bennett %A Henning Tiemeier %A Kocher, Thomas %A Lumley, Thomas %A Dan E Arking %K Genome-Wide Association Study %K Heterozygote %K Humans %K Mortality %K Polymorphism, Single Nucleotide %K Proportional Hazards Models %X

BACKGROUND: It has been well-established, both by population genetics theory and direct observation in many organisms, that increased genetic diversity provides a survival advantage. However, given the limitations of both sample size and genome-wide metrics, this hypothesis has not been comprehensively tested in human populations. Moreover, the presence of numerous segregating small effect alleles that influence traits that directly impact health directly raises the question as to whether global measures of genomic variation are themselves associated with human health and disease.

RESULTS: We performed a meta-analysis of 17 cohorts followed prospectively, with a combined sample size of 46,716 individuals, including a total of 15,234 deaths. We find a significant association between increased heterozygosity and survival (P = 0.03). We estimate that within a single population, every standard deviation of heterozygosity an individual has over the mean decreases that person's risk of death by 1.57%.

CONCLUSIONS: This effect was consistent between European and African ancestry cohorts, men and women, and major causes of death (cancer and cardiovascular disease), demonstrating the broad positive impact of genomic diversity on human survival.

%B BMC Genet %V 15 %P 159 %8 2014 Dec 29 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301661/ %1 http://www.ncbi.nlm.nih.gov/pubmed/25543667?dopt=Abstract %R 10.1186/s12863-014-0159-7 %0 Journal Article %J PLoS One %D 2014 %T The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease? %A Stefan Walter %A M. Maria Glymour %A Mauricio Avendano %K Aged %K Cardiovascular Diseases %K Female %K Geography %K Humans %K Incidence %K Insurance Benefits %K Insurance, Health %K Longitudinal Studies %K Male %K Middle Aged %K Risk Factors %K Unemployment %K United States %X

OBJECTIVE: Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk.

METHODS: Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50-65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk.

RESULTS: States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71-0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79-1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models.

CONCLUSION: Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.

%B PLoS One %I 9 %V 9 %P e101193 %8 2014 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25025281?dopt=Abstract %2 PMC4098914 %4 Unemployment insurance/Cardiovascular disease/unemployment insurance %$ 999999 %R 10.1371/journal.pone.0101193 %0 Journal Article %J Family and Community Health %D 2014 %T The Impact of Mid- and Late-Life Loss on Insomnia Findings From the Health and Retirement Study, 2010 Cohort %A Simpson, Cherie %A Joseph C. Allegra %A Amara E. Ezeamama %A Elkins, Jennifer %A Toni Miles %K Adult children %K Health Conditions and Status %X Bereavement and insomnia are both well-documented risk factors for illness. We use cohort data to estimate risk of insomnia after death of a family member among adults aged 50 to 70 years. Each day, 6700 persons die in the United States. During the next 20 years, this number will increase. In this cohort, any loss increases the likelihood of insomnia. The highest rates of insomnia occur among women aged 50 to 59 years; men aged 65 to 70 years, and persons reporting death of a spouse/partner or child. Physical activity reduces this risk by one-third. Bereavement is a public health issue requiring a targeted response. %B Family and Community Health %I 37 %V 37 %P 317-326 %G eng %N 4 %4 insomnia/late-life bereavement/sleep/sleep quality/Spousal bereavement/bereavement/depression %$ 999999 %R 10.1097/fch.0000000000000039 %0 Book %D 2014 %T Latinos in an Aging World: Social, Psychological, and Economic Perspectives %A Ronald J. Angel %A Jacqueline L. Angel %K Demographics %K Retirement Planning and Satisfaction %K Women and Minorities %X The introduction motivates the book and sets the stage for the entire discussion. Chapter 1 reviews the histories of the major Hispanic subgroups along with various theories as they relate to race, ethnicity, and gender that provide a conceptual framework for understanding the later chapters. Demographic, economic, and social profiles of the various Hispanic subgroups are explored in chapter 2. Next the Latino population is explored from various perspectives including the economic and social situations of men and women and their educational, marital and family, and labor force experiences. Chapter 4 examines older immigrants and their families and identifies the resources available to them in their communities that often replicate the cultural and social support system of the old country. Major health risks that older Latinos face as a result of the disadvantages they experience throughout life are examined in chapter 5. Family situations and long-term care and living arrangements of older Hispanics are examined in chapter 6. The impact of neighborhood on quality of life in terms of safety and physical and mental wellbeing is explored in chapter 7. The burden that eldercare can place upon those who bear the responsibility of their daily care is explored in chapter 8. Chapter 9 investigates the gaps in income between minority and non-Hispanic white Americans and reviews what individuals with few resources need to know about financial management. The book concludes with the social, political, and economic implications of the growing Hispanic population and the role of NGOs and other organizations in providing services to older populations. %I Routledge %C New York %G eng %U http://www.amazon.com/Latinos-Aging-World-Psychological-Perspectives/dp/184872537X %4 hispanics/retirement planning/Socioeconomic Differences/latinos %$ 999999 %0 Thesis %D 2014 %T Mechanisms of Health Disparities in Inflammation: A Test of the Differential Stress Exposure and Differential Stress Vulnerability Hypotheses %A Uchechi A Mitchell %Y Carol S Aneshensel %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %K Public Policy %X The current study sheds light on the mechanisms through which group differences in exposure to and the impact of discrimination generate disparities in cardiovascular diseases. The study specifically looks at its effects on C-reactive protein (i.e., CRP), a protein produced in response to exposure to stressors. It is a marker of systemic inflammation that is positively associated with cardiovascular diseases such as stroke, atherosclerosis, and myocardial infarction. The current study goes beyond a basic description of the population-level distribution of CRP by focusing on psychosocial factors that mediate and/or moderate these relationships. The specific aims of the dissertation are to investigate: (1) racial/ethnic and gender differences in CRP levels; (2) differential exposure to discrimination as an explanation for the social patterning of CRP; (3) differential vulnerability to discrimination; and (4) the extent to which coping resources dampens these effects. The dissertation uses data from the Health and Retirement Study (HRS), a multi-cohort longitudinal survey of a large and nationally representative sample of adults age 51 years and older. The HRS aims to identify and better understand the social, economic, psychosocial, and physical factors that influence and result from retirement. Since its inception in 1992, data have been collected every two years on the original HRS cohort and on subsequent cohorts added to the study. The "core" HRS interview is conducted face-to-face at baseline and collects data on demographic characteristics; housing and family structure; employment, income, assets, and insurance; health care, health status, cognition, and disability; and life expectations. Beginning in 2004, HRS respondents were asked to complete a psychosocial questionnaire that included measures of everyday and lifetime discrimination, among other factors, and in 2006 biomarkers--including CRP--were collected from one half of the study sample; biomarkers were collected from the other half in 2008. To maintain sufficient statistical power to detect differences in CRP, multivariate analyses are conducted with data from a hybrid 2006/2008 sample. The analysis involves statistical methods needed to appropriately adjust for the complex sampling design of HRS and to test the intricate causal pathways leading to race differences in CRP. In line with our hypotheses, African Americans have higher levels of CRP than non-Hispanic whites and reported greater exposure to everyday and lifetime discrimination. Hispanics do not significantly differ from non-Hispanic whites in CRP levels or in their reports or everyday and lifetime discrimination. In unadjusted models, everyday and major lifetime discrimination are positively associated with CRP. This association remains for lifetime discrimination in fully adjusted models but not for everyday discrimination. Both everyday and lifetime discrimination mediate racial/ethnic and gender differences in inflammation. Lifetime discrimination mediates these differences in and of itself, and in conjunction with other factors, particularly waist circumference. Everyday discrimination also mediates group differences in inflammation in conjunction with waist circumference. Vulnerability to discrimination does not differ by race/ethnicity or by gender, and the coping resources evaluated in this study do not buffer the effects of discrimination on inflammation. This study supports the presence of racial differences in CRP--an indicator of systemic inflammation and a clinical risk factor for cardiovascular diseases--on a population-level. The findings also suggest that exposure to discrimination, a chronic stressor that disproportionately affects racial minorities, is associated with higher levels of CRP and partially explains racial and gender differences in inflammation. In all, these findings provides further support for the significant contributions of the social environment on health and health disparities. (Abstract shortened by UMI.) %I University of California, Los Angeles %C Los Angeles %V 3623220 %P 225 %8 2014 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1550352556?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ %9 Ph.D. %M 1550352556 %4 Public health %$ 999999 %! Mechanisms of Health Disparities in Inflammation: A Test of the Differential Stress Exposure and Differential Stress Vulnerability Hypotheses %0 Book Section %B The interdisciplinary science of consumption %D 2014 %T Older Adults as Consumers: An Examination of Differences by Birth Cohort %A Fin, Debra N. %A Yoon, Carolyn %A Hartsell, Debra L. %A Toni C Antonucci %A Noah J Webster %A McCullough, Wayne R. %K Demographics %K Methodology %X The U.S. and much of the developed world are currently undergoing a demographic transition marked by fundamental changes in the age structure of the population. These changes pose a number of challenges for society such as understanding the consumption patterns of middle aged and older people. In this chapter, the authors use data from the Health and Retirement Study to explore consumption patterns among five cohorts of adults age 50 and older. They found that older, compared to younger, birth cohorts of older adults reported less spending on food, transportation, trips and vacations, and durable goods; they spent more on donations and gifts; all cohorts reported similar levels of spending on health-related expenses. Results also identified a critical middle age group (i.e. ages 70 to 80), in which the greatest differences in consumption patterns were evident. Such findings may be useful for industry and organizations allowing them to be responsive and competitive by helping them target goods and products that meet the changing needs of an aging society %B The interdisciplinary science of consumption %I The MIT Press %P 292-298 %@ 9780262325387 %G eng %4 Health and Retirement Study/Consumer behavior/Older adults/neuropsychology %$ 999999 %! Older Adults as Consumers: An Examination of Differences by Birth Cohort %R 10.7551/mitpress/9780262027670.003.0015 %0 Journal Article %J Biodemography Soc Biol %D 2014 %T A polygenic risk score associated with measures of depressive symptoms among older adults. %A Morgan E. Levine %A Eileen M. Crimmins %A Carol A Prescott %A Drystan F. Phillips %A Thalida E. Arpawong %A Jinkook Lee %K Aged %K Aged, 80 and over %K Depressive Disorder, Major %K Female %K Genetic Predisposition to Disease %K Genetic Variation %K Genome-Wide Association Study %K Humans %K Male %K Middle Aged %K Multifactorial Inheritance %K Odds Ratio %K Risk Factors %X

It has been suggested that depression is a polygenic trait, arising from the influences of multiple loci with small individual effects. The aim of this study is to generate a polygenic risk score (PRS) to examine the association between genetic variation and depressive symptoms. Our analytic sample included N = 10,091 participants aged 50 and older from the Health and Retirement Study (HRS). Depressive symptoms were measured by Center for Epidemiological Studies-Depression scale (CESD) scores assessed on up to nine occasions across 18 years. We conducted a genome-wide association analysis for a discovery set (n = 7,000) and used the top 11 single-nucleotide polymorphisms, all with p < 10(-5) to generate a weighted PRS for our replication sample (n = 3,091). Results showed that the PRS was significantly associated with mean CESD score in the replication sample (β = .08, p = .002). The R(2) change for the inclusion of the PRS was .003. Using a multinomial logistic regression model, we also examined the association between genetic risk and chronicity of high (4+) CESD scores. We found that a one-standard-deviation increase in PRS was associated with a 36 percent increase in the odds of having chronically high CESD scores relative to never having had high CESD scores. Our findings are consistent with depression being a polygenic trait and suggest that the cumulative influence of multiple variants increases an individual's susceptibility for chronically experiencing high levels of depressive symptoms.

%B Biodemography Soc Biol %I 60 %V 60 %P 199-211 %8 2014 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25343367?dopt=Abstract %2 PMC4298361 %4 GENOME-WIDE ASSOCIATION/INDIVIDUAL GENETIC RISK/MAJOR DEPRESSION/DISEASE RISK/HERITABILITY/genetics/genetics/depression/Depressive Symptoms/CES Depression Scale/CES Depression Scale/regression Analysis %$ 999999 %R 10.1080/19485565.2014.952705 %0 Journal Article %J Psychology and Aging %D 2014 %T Positive and Negative Social Exchanges and Cognitive Aging in Young-Old Adults: Differential Associations Across Family, Friend, and Spouse Domains %A Tim D Windsor %A Denis Gerstorf %A Pearson, Elissa %A Lindsay H Ryan %A Kaarin J. Anstey %K End of life decisions %K Event History/Life Cycle %K Health Conditions and Status %K Methodology %K Other %K Retirement Planning and Satisfaction %X We examined how positive and negative social exchanges with friends, family, and spouses were related to cognitive aging in episodic and working memory, and perceptual speed. To do so, we used a large sample of cognitively intact young-old participants from the PATH Through Life Study ( PATH; aged 60 to 64 years at baseline, n = 1,618) who were assessed on 3 occasions over 8 years. Additional replication analyses were conducted using the Health and Retirement Study (HRS), which provided data on episodic memory. The main analysis of PATH Through Life showed that positive exchanges with friends and family were associated with less decline in perceptual speed, with these associations attenuated by adjustment for physical functioning and depressive symptoms. Negative exchanges with spouses were associated with poorer working memory performance. Positive exchanges with friends were associated with better initial episodic memory in both PATH and HRS. More frequent negative exchanges with friends and family were associated with better episodic memory in the PATH sample. However, these findings were not replicated in HRS. Our findings provide indirect support for the role of social exchange quality in contributing to cognitive enrichment. However, the inconsistent pattern of results across cognitive and social exchange domains points to possibilities of reverse causality, and may also indicate that social exchange quality plays a less important role for cognitive enrichment than other psychosocial characteristics. %B Psychology and Aging %I 29 %V 29 %P 28-43 %G eng %N 1 %4 cognition/cognitive aging/social exchanges/social relations/PSYCHOLOGICAL DISTRESS/PERCEPTUAL SPEED/LONGITUDINAL EVIDENCE/MENTAL-HEALTH/LIFE PROJECT/FOLLOW-UP/SUPPORT/DECLINE/RETIREMENT %$ 999999 %0 Journal Article %J Journal of Financial Counseling and Planning %D 2014 %T Positive Psychological Attributes and Retirement Satisfaction %A Asebedo, Sarah D. %A Martin C. Seay %K Demographics %K Expectations %K Health Conditions and Status %K Healthcare %K Retirement Planning and Satisfaction %X This study investigated the association between positive psychological attributes and retirement satisfaction using a sample of 5,146 retired individuals from the 2006 and 2008 waves of the Health and Retirement Study (HRS). Utilizing Seligman s (2012) well-being theory, positive psychological attributes, as represented by the acronym PERMA, were measured by dispositional optimism (Positive emotion), reading the newspaper daily and having a hobby (Engagement), family support (Positive relationships), purpose in life and religiosity (Meaning), and perceived mastery (Accomplishment). Significant evidence was found supporting the association between positive psychological attributes and retirement satisfaction. Specifically, results of the ordinal logistic model revealed that, holding all else constant, dispositional optimism, family support, purpose in life, and perceived mastery were each positively associated with retirement satisfaction. Relevant implications for financial planners, counselors and educators include learning and developing optimism, cultivating family relationships, fostering purpose in life, discovering accomplishment during retirement, and structuring a phased transition to retirement. %B Journal of Financial Counseling and Planning %I 25 %V 25 %P 161-173 %G eng %N 2 %4 positive psychology/psychological well-being/retirement satisfaction/subjective well-being/dispositional optimism/Religiosity/Perceived mastery/retirement planning %$ 999999 %0 Journal Article %J Am J Public Health %D 2014 %T Preparedness for natural disasters among older US adults: a nationwide survey. %A Tala M. Al-rousan %A Linda M. Rubenstein %A Robert B Wallace %K Aged %K Aged, 80 and over %K Disaster Planning %K Female %K Humans %K Male %K Middle Aged %K Surveys and Questionnaires %K United States %X

OBJECTIVES: We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents.

METHODS: We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness.

RESULTS: Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness.

CONCLUSIONS: Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.

%B Am J Public Health %V 104 %P 506-11 %8 2014 Mar %G eng %U http://dx.doi.org/10.2105/AJPH.2013.301559 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24432877?dopt=Abstract %4 disaster preparedness/public policy/emergency management %$ 999999 %& 506 %R 10.2105/AJPH.2013.301559 %0 Journal Article %J Sociological Methods and Research %D 2014 %T Reliability of Self-reports of Financial Data in Surveys: Results From the Health and Retirement Study %A Duane F. Alwin %A Zeiser, K. %A Gensimore, D. %K Income %K Methodology %K Other %X This article reports an investigation of errors of measurement in self-reports of financial data in the Health and Retirement Study (HRS), one of the major social science data resources available to those who study the demography and economics of aging. Results indicate significantly lower levels of reporting reliability of the composite variables in the HRS relative to those found for summary income approaches used in other surveys. Levels of reliability vary by type of income source-reports of monthly benefit levels from sources such as Social Security or the Veterans Administration achieve near-perfect levels of reliability, whereas somewhat less regular sources of household income that vary across time in their amounts are measured less reliably. One major area of concern resulting from this research, which may be beneficial to users of the HRS surveys, involves the use of imputation in the handling of missing data. We found that imputation of values for top-end open income brackets can produce a substantial number of outliers that affect sample estimates of relationships and levels of reliability. Imputed income values in the HRS should be used with great care. The Author(s) 2013. %B Sociological Methods and Research %I 43 %V 43 %P 98-136 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84891856402andpartnerID=40andmd5=bb66890d725617e9a00cace3878d10ee %N 1 %4 Health a.Retirement Study/income reports/measurement/reliability/survey errors %$ 999999 %0 Journal Article %J Social Science and Medicine %D 2014 %T Socioeconomic inequalities in health after age 50: Are health risk behaviors to blame? %A Benjamin A Shaw %A McGeever, Kelly %A Elizabeth Vasquez %A Agahi, Neda %A Fors, Stefan %K Demographics %K Disabilities %K Health Conditions and Status %K Other %X Recent studies indicate that socioeconomic inequalities in health extend into the elderly population, even within the most highly developed welfare states. One potential explanation for socioeconomic inequalities in health focuses on the role of health behaviors, but little is known about the degree to which health behaviors account for health inequalities among older adults, in particular. Using data from the Health and Retirement Study (N = 19,245), this study examined the degree to which four behavioral risk factors smoking, obesity, physical inactivity, and heavy drinking are associated with socioeconomic position among adults aged 51 and older, and whether these behaviors mediate socioeconomic differences in mortality, and the onset of disability among those who were disability-free at baseline, over a 10-year period from 1998 to 2008. Results indicate that the odds of both smoking and physical inactivity are higher among persons with lower wealth, with similar stratification in obesity, but primarily among women. The odds of heavy drinking decrease at lower levels of wealth. Significant socioeconomic inequalities in mortality and disability onset are apparent among older men and women; however, the role that health behaviors play in accounting for these inequalities differs by age and gender. For example, these health behaviors account for between 23 and 45 of the mortality disparities among men and middle aged women, but only about 5 of the disparities found among women over 65 years. Meanwhile, these health behaviors appear to account for about 33 of the disparities in disability onset found among women survivors, and about 9-14 among men survivors. These findings suggest that within the U.S. elderly population, behavioral risks such as smoking and physical inactivity contribute moderately to maintaining socioeconomic inequalities in health. As such, promoting healthier lifestyles among the socioeconomically disadvantaged older adults should help to reduce later life health inequalities. (C) 2013 Elsevier Ltd. All rights reserved. %B Social Science and Medicine %I 101 %V 101 %P 52-60 %G eng %4 Aging/socioeconomic status/Smoking/physical activity/Obesity/Disability/Disability/Mortality/PHYSICAL-ACTIVITY/OLDER-ADULTS/US ADULTS/MORTALITY RISK/MORTALITY RISK/UNITED-STATES/SMOKING/DISPARITIES/OBESITY/ASSOCIATION/LONGEVITY %$ 999999 %R 10.1016/j.socscimed.2013.10.040 %0 Journal Article %J Demography %D 2014 %T Is There a Trade-off Between Parent Care and Self-care? %A Arora, Kanika %A Douglas A. Wolf %K Adult children %K Healthcare %X Caregiving for family members is often described as a 36-hour day. Previous literature has suggested that family caregivers have little time to attend to their own health needs, such as participating in leisure-time physical activity. Using data from the Health and Retirement Study, we analyze whether time-allocation decisions reflect a conflict between time devoted to informal care and time devoted to self-health promotion through physical activity. The empirical model is a system of four correlated equations, wherein the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, or in hours of work, among either men or women. %B Demography %I 51 %V 51 %P 1251-70 %G eng %N 4 %4 caregiving/family caregivers/parental care %$ 999999 %R 10.1007/s13524-014-0309-6 %0 Thesis %D 2014 %T Three Essays in Health, Education, and Retirement %A Arons, Robert %Y Gregorio Kinsler Jo Caetano %K Adult children %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %X In chapter one I examine the impact of Health Maintenance Organization (HMO) coverage on the provision of preventive medicine procedures and undiagnosed disease. Rates of missed preventive care and undiagnosed conditions are substantially lower for middle-aged HMO enrollees compared to non-HMO enrollees. I control for selection with a novel quasi-experiment: turnover in group health insurance contracts at the firm level creates exogenous variation in plan type. The large age heterogeneity in the effect of HMO contracts is consistent with incentive structures in HMOs playing a role in the quality of patient care. In chapter two I use a regression discontinuity framework to analyze the No Child Left Behind (NCLB) Act's attempt to reduce the achievement gap by requiring sociodemographic groups meet group based proficiency count targets. Using a panel of North Carolina public school students in grades three through eight from 2003-2012, I find when a student's group is added to the set of existing accountable groups, it has a small positive impact on subject matter proficiency and test scores. Variation in the application of these laws comes the fact that groups are only held to academic proficiency standards if there are 40 or more tested students in the group within the school. In chapter three I estimate the potential earnings of retirees. Estimating the earnings structure of those no longer working is complex, because (1) health and cognition decline at older ages and drive workers into retirement, (2) retirement may cause changes in health and cognition, and (3) unobserved wage shocks may also drive workers into retirement and bias estimates depending on the direction of selection. Issue (1) is solved by using health and cognitive measures from the data, the Health and Retirement Study. Issues (2)-simultaneity of retirement with health and cognition, and (3)-selection out of the labor force, are controlled for with four instruments, self-reported probability of retirement at age 62 and 65 reported at age 55 and age dummies for 62 and 65. We find that retirees would earn less than a selection corrected estimator would suggest by about $13,000 per year. %I University of Rochester %C Rochester, NY %V 3644859 %P 132 %8 2014 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1638212186?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt: %9 Ph.D. %M 1638212186 %4 health Status %$ 999999 %! Three Essays in Health, Education, and Retirement %0 Journal Article %J Obstetrics and Gynecology %D 2014 %T Urinary Incontinence, Depression, and Economic Outcomes in a Cohort of Women Between the Ages of 54 and 65 Years %A Hung, Kristin J. %A Awtrey, Christopher S. %A Tsai, Alexander C. %K Employment and Labor Force %K Health Conditions and Status %X OBJECTIVE: To estimate the association between urinary incontinence (UI) and probable depression, work disability, and workforce exit. METHODS: The analytic sample consisted of 4,511 women enrolled in the population-based Health and Retirement Study cohort. The analysis baseline was 1996, the year that questions about UI were added to the survey instrument, and at which time study participants were 54 65 years of age. Women were followed-up with biennial interviews until 2010 2011. Outcomes of interest were onset of probable depression, work disability, and workforce exit. Urinary incontinence was specified in different ways based on questions about experience and frequency of urine loss. We fit Cox proportional hazards regression models to the data, adjusting the estimates for baseline sociodemographic and health status variables previously found to confound the association between UI and the outcomes of interest. RESULTS: At baseline, 727 participants (survey-weighted prevalence, 16.6 ; 95 confidence interval CI 15.4 18.0) reported any UI, of which 212 (survey-weighted prevalence, 29.2 ; 95 CI 25.4 33.3) reported urine loss on more than 15 days in the past month; and 1,052 participants were categorized as having probable depression (survey-weighted prevalence, 21.6 ; 95 CI 19.8 23.6). Urinary incontinence was associated with increased risks for probable depression (adjusted hazard ratio, 1.43; 95 CI 1.27 1.62) and work disability (adjusted hazard ratio, 1.21; 95 CI 1.01 1.45), but not workforce exit (adjusted hazard ratio, 1.06; 95 CI 0.93 1.21). CONCLUSION: In a population-based cohort of women between ages 54 and 65 years, UI was associated with increased risks for probable depression and work disability. Improved diagnosis and management of UI may yield significant economic and psychosocial benefits. LEVEL OF EVIDENCE: II %B Obstetrics and Gynecology %I 123 %V 123 %P 822-827 %G eng %U http://journals.lww.com/greenjournal/Fulltext/2014/04000/Urinary_Incontinence,_Depression,_and_Economic.15.aspx %N 4 %4 Depression/Work limitation/Workforce issues/Urinary incontinence %$ 999999 %R 10.1097/AOG.0000000000000186 %0 Journal Article %J Physical and Occupational Therapy in Geriatrics %D 2014 %T Utilization of occupational and physical therapy services in postacute care: Findings from the 2006 health and retirement study and linked medicare claims data %A Chiung-Ju Liu %A Timothy E. Stump %A Ambuehl, Roberta %A Daniel O. Clark %K Healthcare %K Medicare/Medicaid/Health Insurance %X Aims: To describe and determine factors predicting utilization of occupational and physical therapy (PT) services in postacute rehabilitation systems over a 1-year period in Medicare beneficiaries. Methods: Data from 1,667 respondents in the 2006 Health and Retirement Study and linked Medicare claims were analyzed. Results: The average length of inpatient rehabilitation stay ranged between 11 and 17 days. Therapeutic procedures were the most commonly claimed Current Procedural Terminology (CPT) codes in outpatient rehabilitation. Very-high level was the mostly claimed resource utilization group (RUG) in skilled nursing facilities. Additionally, the average number of therapy home visit ranged between 31 and 34. Logistic regression analysis showed that greater age and more comorbidities were associated with using therapy services from two or more postacute care (PAC) systems. Conclusion: The study results increase the understanding of the utilization of rehabilitation therapy services across PAC systems and provide basic information for rehabilitation services planning. 2014 Informa Healthcare USA, Inc. %B Physical and Occupational Therapy in Geriatrics %I 32 %V 32 %P 85-96 %G eng %U https://www.tandfonline.com/doi/full/10.3109/02703181.2014.883044 %N 1 %4 Medicare/Occupational therapy/Physical therapists/Utilization %$ 999999 %0 Journal Article %J Int J Prev Med %D 2014 %T Veterans and risk of heart disease in the United States: a cohort with 20 years of follow up. %A Shervin Assari %X

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.

%B Int J Prev Med %I 5 %V 5 %P 703-9 %8 2014 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/25013689?dopt=Abstract %2 PMC4085922 %4 alcohol/depression/drinking/exercise/heart disease/smoking/Military service/veterans %$ 999999 %0 Journal Article %J Aging and Mental Health %D 2013 %T Associations of loneliness in older married men and women %A Liat Ayalon %A Sharon Shiovitz-Ezra %A Yuval Palgi %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %X We evaluated the associations between loneliness and subjective appraisals of marital relationship as well as reciprocal associations of loneliness in married men and women. The Health and Retirement Study is a national survey of older adults over the age of 50, residing in the US. This study is based on a paper and pencil questionnaire administered in the year 2006. Overall, 2723 couples completed this questionnaire. Loneliness was evaluated using the three-item version of the Revised University of California Los Angeles Loneliness Scale. A non-recursive path analysis was conducted. The model suggested that subjective appraisals of the relationship with spouse play a major role in one's sense of loneliness. In addition, loneliness in men and women shares reciprocal associations. The model explained 24 and 29 of the variability in loneliness reported by married men and women, respectively. Results indicate that capitalizing and enhancing one's social life might also be beneficial for his or her partner. Any intervention to alleviate loneliness in married couples has to take into consideration their perceived marital relationship as well as the reciprocal associations of loneliness in married men and women. %B Aging and Mental Health %I 17 %V 17 %P 33-39 %G eng %N 1 %4 Loneliness/Social network/Gender/Epidemiology/Dyads/Marriage %$ 69118 %R 10.1080/13607863.2012.702725 %0 Journal Article %J The Journals of Gerontology %D 2013 %T Concordance of Physical Activity Trajectories Among Middle-Aged and Older Married Couples: Impact of Diseases and Functional Difficulties %A Li, Kin-Kit %A Cardinal, Bradley J. %A Acock, Alan C. %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %X This study examined spousal concordance of physical activity trajectories among middle-aged and older married couples and the influences of recent diseases and functional difficulties on individuals' trajectories and those of their spouses'. Participants included 5,074 married couples aged 50 or older in the Health and Retirement Study in 2004-2010. Participants were categorized into 4 physical activity trajectories (i.e., stable active, adopters, relapsers, and stable sedentary) using confirmatory latent class growth analysis. Individuals' trajectory memberships were predicted by their spouses' memberships, together with recent diseases and functional difficulties of both couple members. In the main, corresponding husbands' trajectories predicted wives' trajectories and vice versa. More functional difficulties predicted higher likelihoods of unfavorable trajectories among individuals but not of their spouses'. Among wives, more recent diseases predicted slightly more physical activity in subsequent data waves but not trajectory memberships. Results supported spousal concordance in physical activity trajectories. The negative impact of functional difficulties was considerably contained within individuals. Increases in physical activity after acquiring diseases among wives were small and short lived. More research is needed to understand the underlying processes, which can be used to improve the design of future physical activity interventions directed toward women, men, and couples. %B The Journals of Gerontology %I 68 %V 68 %P 794 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1424402869?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Apqrlandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articleandr %N 5 %4 Medical Sciences--Psychiatry And Neurology/Exercise/Couples/Older people/Gerontology/Middle age/Disease %$ 69106 %0 Journal Article %J BMC Medicine %D 2013 %T Depression, antidepressant medications, and risk of Clostridium difficile infection. %A Mary A M Rogers %A M. Todd Greene %A Vincent B Young %A Sanjay Saint %A Kenneth M. Langa %A John Y Kao %A David M. Aronoff %K Antidepressants %K Clostridium %K Depressive symptoms %K Infection %K Older Adults %X

BACKGROUND: An ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.

METHODS: In Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.

RESULTS: The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35% greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone (95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.

CONCLUSIONS: Adults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

%B BMC Medicine %V 11 %P 121 %8 2013 May 07 %G eng %R 10.1186/1741-7015-11-121 %0 Journal Article %J Journal of Applied Statistics %D 2013 %T A generalized bivariate Bernoulli model with covariate dependence %A M. Ataharul Islam %A Abdulhamid A. Alzaid %A Rafiqul I Chowdhury %A Khalaf S. Sultan %K Bernoulli Model %K Covariate Dependence %K Statistics %X Dependence in outcome variables may pose formidable difficulty in analyzing data in longitudinal studies. In the past, most of the studies made attempts to address this problem using the marginal models. However, using the marginal models alone, it is difficult to specify the measures of dependence in outcomes due to association between outcomes as well as between outcomes and explanatory variables. In this paper, a generalized approach is demonstrated using both the conditional and marginal models. This model uses link functions to test for dependence in outcome variables. The estimation and test procedures are illustrated with an application to the mobility index data from the Health and Retirement Survey and also simulations are performed for correlated binary data generated from the bivariate Bernoulli distributions. The results indicate the usefulness of the proposed method. %B Journal of Applied Statistics %V 40 %P 1064-1075 %G eng %U https://doi.org/10.1080/02664763.2013.780156 %R 10.1080/02664763.2013.780156 %0 Journal Article %J Am J Hum Genet %D 2013 %T Genome-wide association analysis of blood-pressure traits in African-ancestry individuals reveals common associated genes in African and non-African populations. %A Franceschini, Nora %A Fox, Ervin %A Zhang, Zhaogong %A Edwards, Todd L %A Michael A Nalls %A Yun Ju Sung %A Bamidele O Tayo %A Yan V Sun %A Gottesman, Omri %A Adebawole Adeyemo %A Andrew D Johnson %A Young, J Hunter %A Kenneth Rice %A Duan, Qing %A Chen, Fang %A Yun Li %A Tang, Hua %A Myriam Fornage %A Keene, Keith L %A Andrews, Jeanette S %A Jennifer A Smith %A Jessica Faul %A Guangfa, Zhang %A Guo, Wei %A Liu, Yu %A Murray, Sarah S %A Musani, Solomon K %A Srinivasan, Sathanur %A Digna R Velez Edwards %A Wang, Heming %A Becker, Lewis C %A Bovet, Pascal %A Bochud, Murielle %A Broeckel, Ulrich %A Burnier, Michel %A Carty, Cara %A Daniel I Chasman %A Georg B Ehret %A Chen, Wei-Min %A Chen, Guanjie %A Wei Chen %A Ding, Jingzhong %A Dreisbach, Albert W %A Michele K Evans %A Guo, Xiuqing %A Melissa E Garcia %A Jensen, Rich %A Keller, Margaux F %A Lettre, Guillaume %A Lotay, Vaneet %A Martin, Lisa W %A Moore, Jason H %A Alanna C Morrison %A Thomas H Mosley %A Ogunniyi, Adesola %A Walter R Palmas %A George J Papanicolaou %A Alan Penman %A Polak, Joseph F %A Ridker, Paul M %A Babatunde Salako %A Andrew B Singleton %A Daniel Shriner %A Kent D Taylor %A Ramachandran S Vasan %A Kerri Wiggins %A Williams, Scott M %A Yanek, Lisa R %A Wei Zhao %A Alan B Zonderman %A Becker, Diane M %A Berenson, Gerald %A Boerwinkle, Eric %A Erwin P Bottinger %A Cushman, Mary %A Charles B Eaton %A Nyberg, Fredrik %A Gerardo Heiss %A Joel N Hirschhron %A Howard, Virginia J %A Karczewsk, Konrad J %A Lanktree, Matthew B %A Liu, Kiang %A Yongmei Liu %A Ruth J F Loos %A Margolis, Karen %A Snyder, Michael %A Psaty, Bruce M %A Schork, Nicholas J %A David R Weir %A Charles N Rotimi %A Sale, Michele M %A Tamara B Harris %A Sharon L R Kardia %A Hunt, Steven C %A Donna K Arnett %A Redline, Susan %A Cooper, Richard S %A Neil Risch %A Rao, D C %A Rotter, Jerome I %A Chakravarti, Aravinda %A Reiner, Alex P %A Levy, Daniel %A Keating, Brendan J %A Zhu, Xiaofeng %K Africa %K African Continental Ancestry Group %K Blood pressure %K Cohort Studies %K Databases, Genetic %K Genetic Loci %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Polymorphism, Single Nucleotide %K Quantitative Trait, Heritable %K Reproducibility of Results %X

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

%B Am J Hum Genet %V 93 %P 545-54 %8 2013 Sep 05 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/23972371?dopt=Abstract %R 10.1016/j.ajhg.2013.07.010 %0 Journal Article %J Annals of the American Academy of Political and Social Science %D 2013 %T The Great Recession and Health: People, Populations, and Disparities %A Sarah A. Burgard %A Jennifer A Ailshire %A Lucie Kalousova %K Consumption and Savings %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %K Public Policy %K Retirement Planning and Satisfaction %X Two research traditions have evolved to assess links between recessions and health, with seemingly divergent findings. Aggregate-level studies generally find that mortality rates decline during recessionary periods. By contrast, individual-level studies generally find that events that frequently occur during recessions, like job loss, unemployment, and material hardship, carry negative health consequences. We comprehensively review evidence from these two bodies of research, illustrate key findings, and show how the different mechanisms can operate in parallel. We also outline some of the limitations of the extant evidence, discuss studies emerging to address these limits and directions for future research, and provide brief empirical examples to illustrate some of these limits and directions using the Health and Retirement Study and the Michigan Recession and Recovery Study. Our review emphasizes the importance of considering both the aggregate- and individual-level associations when evaluating the likely short- and longer-term consequences of the Great Recession for health and health disparities. %B Annals of the American Academy of Political and Social Science %I 650 %V 650 %P 194 %G eng %N 1 %4 material hardship/Morbidity/Retirement/Occupational Safety and Health/Great Recession/Mortality Rates/Recessions/Michigan/health disparities %$ 69342 %0 Journal Article %J Science %D 2013 %T GWAS of 126,559 individuals identifies genetic variants associated with educational attainment. %A Cornelius A Rietveld %A Sarah E Medland %A Derringer, Jaime %A Yang, Jian %A Tõnu Esko %A Martin, Nicolas W %A Westra, Harm-Jan %A Shakhbazov, Konstantin %A Abdel Abdellaoui %A Agrawal, Arpana %A Albrecht, Eva %A Alizadeh, Behrooz Z %A Amin, Najaf %A Barnard, John %A Baumeister, Sebastian E %A Benke, Kelly S %A Bielak, Lawrence F %A Boatman, Jeffrey A %A Patricia A. Boyle %A Gail Davies %A Christiaan de Leeuw %A Eklund, Niina %A Daniel S Evans %A Rudolf Ferhmann %A Fischer, Krista %A Gieger, Christian %A Gjessing, Håkon K %A Hägg, Sara %A Harris, Jennifer R %A Caroline Hayward %A Holzapfel, Christina %A Carla A Ibrahim-Verbaas %A Ingelsson, Erik %A Jacobsson, Bo %A Joshi, Peter K %A Jugessur, Astanand %A Marika A Kaakinen %A Kanoni, Stavroula %A Karjalainen, Juha %A Kolcic, Ivana %A Kristiansson, Kati %A Kutalik, Zoltán %A J. Lahti %A Lee, Sang H %A Lin, Peng %A Penelope A Lind %A Yongmei Liu %A Kurt Lohman %A Loitfelder, Marisa %A McMahon, George %A Vidal, Pedro Marques %A Osorio Meirelles %A Lili Milani %A Myhre, Ronny %A Nuotio, Marja-Liisa %A Christopher J Oldmeadow %A Katja E Petrovic %A Wouter J Peyrot %A Polasek, Ozren %A Quaye, Lydia %A Reinmaa, Eva %A Rice, John P %A Rizzi, Thais S %A Schmidt, Helena %A Schmidt, Reinhold %A Albert Vernon Smith %A Jennifer A Smith %A Toshiko Tanaka %A Antonio Terracciano %A van der Loos, Matthijs J H M %A Vitart, Veronique %A Völzke, Henry %A Jürgen Wellmann %A Lei Yu %A Wei Zhao %A Allik, Jüri %A John R. Attia %A Bandinelli, Stefania %A Bastardot, François %A Jonathan P. Beauchamp %A David A Bennett %A Klaus Berger %A Laura Bierut %A Dorret I Boomsma %A Bültmann, Ute %A Campbell, Harry %A Chabris, Christopher F %A Cherkas, Lynn %A Chung, Mina K %A Francesco Cucca %A de Andrade, Mariza %A Philip L de Jager %A De Neve, Jan-Emmanuel %A Ian J Deary %A George Dedoussis %A Deloukas, Panos %A Dimitriou, Maria %A Guðny Eiríksdóttir %A Elderson, Martin F %A Johan G Eriksson %A Jessica Faul %A Luigi Ferrucci %A Melissa E Garcia %A Grönberg, Henrik %A Guðnason, Vilmundur %A Hall, Per %A Harris, Juliette M %A Tamara B Harris %A Nicholas D Hastie %A Andrew C Heath %A Dena G Hernandez %A Hoffmann, Wolfgang %A Hofman, Adriaan %A Holle, Rolf %A Holliday, Elizabeth G %A Jouke-Jan Hottenga %A Iacono, William G %A Illig, Thomas %A Järvelin, Marjo-Riitta %A Kähönen, Mika %A Kaprio, Jaakko %A Kirkpatrick, Robert M %A Kowgier, Matthew %A Latvala, Antti %A Lenore J Launer %A Lawlor, Debbie A %A Lehtimäki, Terho %A Li, Jingmei %A Paul Lichtenstein %A Lichtner, Peter %A David C Liewald %A Pamela A F Madden %A Patrik K E Magnusson %A Mäkinen, Tomi E %A Masala, Marco %A McGue, Matt %A Andres Metspalu %A Mielck, Andreas %A Michael B Miller %A Grant W Montgomery %A Mukherjee, Sutapa %A Nyholt, Dale R %A Ben A Oostra %A Palmer, Lyle J %A Aarno Palotie %A Brenda W J H Penninx %A Markus Perola %A Peyser, Patricia A %A Preisig, Martin %A Katri Räikkönen %A Olli T Raitakari %A Realo, Anu %A Ring, Susan M %A Ripatti, Samuli %A Fernando Rivadeneira %A Rudan, Igor %A Rustichini, Aldo %A Veikko Salomaa %A Sarin, Antti-Pekka %A Schlessinger, David %A Rodney J Scott %A Snieder, Harold %A St Pourcain, Beate %A John M Starr %A Sul, Jae Hoon %A Surakka, Ida %A Svento, Rauli %A Teumer, Alexander %A Henning Tiemeier %A van Rooij, Frank J A %A Van Wagoner, David R %A Vartiainen, Erkki %A Viikari, Jorma %A Vollenweider, Peter %A Vonk, Judith M %A Waeber, Gérard %A David R Weir %A Wichmann, H-Erich %A Elisabeth Widen %A Gonneke Willemsen %A James F Wilson %A Alan F Wright %A Dalton C Conley %A Davey-Smith, George %A Lude L Franke %A Groenen, Patrick J F %A Hofman, Albert %A Johannesson, Magnus %A Sharon L R Kardia %A Krueger, Robert F %A David I Laibson %A Nicholas G Martin %A Meyer, Michelle N %A Posthuma, Danielle %A A. Roy Thurik %A Nicholas J Timpson %A André G Uitterlinden %A Cornelia M van Duijn %A Peter M Visscher %A Daniel J. Benjamin %A Cesarini, David %A Philipp D Koellinger %K Cognition %K Educational Status %K Endophenotypes %K Female %K Genetic Loci %K Genome-Wide Association Study %K Humans %K Male %K Multifactorial Inheritance %K Polymorphism, Single Nucleotide %X

A genome-wide association study (GWAS) of educational attainment was conducted in a discovery sample of 101,069 individuals and a replication sample of 25,490. Three independent single-nucleotide polymorphisms (SNPs) are genome-wide significant (rs9320913, rs11584700, rs4851266), and all three replicate. Estimated effects sizes are small (coefficient of determination R(2) ≈ 0.02%), approximately 1 month of schooling per allele. A linear polygenic score from all measured SNPs accounts for ≈2% of the variance in both educational attainment and cognitive function. Genes in the region of the loci have previously been associated with health, cognitive, and central nervous system phenotypes, and bioinformatics analyses suggest the involvement of the anterior caudate nucleus. These findings provide promising candidate SNPs for follow-up work, and our effect size estimates can anchor power analyses in social-science genetics.

%B Science %V 340 %P 1467-71 %8 2013 Jun 21 %G eng %N 6139 %1 http://www.ncbi.nlm.nih.gov/pubmed/23722424?dopt=Abstract %R 10.1126/science.1235488 %0 Journal Article %J J Aging Health %D 2013 %T Health status and behavioral risk factors in older adult Mexicans and Mexican immigrants to the United States. %A Emma Aguila %A José J Escarce %A Leng, Mei %A Morales, Leo %K Aged %K Emigrants and Immigrants %K Emigration and Immigration %K Female %K Health Status %K Health Surveys %K Humans %K Male %K Mexican Americans %K Mexico %K Middle Aged %K Risk Factors %K Risk-Taking %K Social Class %K United States %X

OBJECTIVE: Investigate the "salmon-bias" hypothesis, which posits that Mexicans in the U.S. return to Mexico due to poor health, as an explanation for the Hispanic health paradox in which Hispanics in the United States are healthier than might be expected from their socioeconomic status.

METHOD: Sample includes Mexicans age 50 years or above living in the United States and Mexico from the 2003 Mexican Health and Aging Study and the 2004 Health and Retirement Study. Logistic regressions examine whether nonmigrants or return migrants have different odds than immigrants of reporting a health outcome.

RESULTS: The salmon-bias hypothesis holds for select health outcomes. However, nonmigrants and return migrants have better health outcomes than immigrants on a variety of indicators.

DISCUSSION: Overall, the results of this study do not support the salmon-bias hypothesis; other explanations for the paradox could be explored.

%B J Aging Health %I 25 %V 25 %P 136-58 %8 2013 Feb %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663916/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23264441?dopt=Abstract %2 PMC3663916 %R 10.1177/0898264312468155 %0 Report %D 2013 %T Labor Force Transitions at Older Ages: The Roles of Work Environment and Personality %A Marco Angrisani %A Michael D Hurd %A Erik Meijer %A Andrew M Parker %A Susann Rohwedder %K Employment and Labor Force %K Health Conditions and Status %K Other %K Retirement Planning and Satisfaction %X Besides compensation and financial incentives, several other work-related factors may affect individual retirement decisions. Specifically, job characteristics such as autonomy, skill variety, task significance and difficulty, stress and physical demands, peer pressure and relations with co-workers, play a crucial role in determining psychological commitment to work at older ages. While financial preparedness for retirement and health shocks are often cited as main predictors of the choice to exit the labor force, there exists relatively little research documenting the extent to which the work environment itself and its interaction with economic variables influence retirement decisions. We document that job characteristics are associated with labor force transitions at older ages, in particular transitions to retirement and part-time employment. Additionally, we show that while personality traits do not directly drive labor force transitions, the effect of job characteristics on labor supply outcomes varies with the intensity of personality traits. We also document that job characteristics themselves are strongly related to personality traits. This suggests that, depending on their personality, individuals may select into specific jobs, whose characteristics ultimately shape their retirement paths. %I Ann Arbor, The University of Michigan %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp295.pdf %4 retirement planning/part-Time Work/labor Force Participation/transitions/personality traits %$ 69328 %0 Journal Article %J Journal of Risk and Uncertainty %D 2013 %T Life expectancy as a constructed belief: Evidence of a live-to or die-by framing effect %A Payne, John W. %A Sagara, Namika %A Shu, Suzanne B. %A Appelt, Kirstin C. %A Johnson, Eric J %K Expectations %K Health Conditions and Status %K Healthcare %K Methodology %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Life expectations are essential inputs for many important personal decisions. We propose that longevity beliefs are responses constructed at the time of judgment, subject to irrelevant task and context factors, and leading to predictable biases. Specifically, we examine whether life expectancy is affected by the framing of expectations questions as either live-to or die-by, as well as by factors that actually affect longevity such as age, gender, and self-reported health. We find that individuals in a live-to frame report significantly higher chances of being alive at ages 55 through 95 than people in a corresponding die-by frame. Estimated mean life expectancies across three studies and 2300 respondents were 7.38 to 9.17 years longer when solicited in a live-to frame. We are additionally able to show how this framing works on a process level and how it affects preference for life annuities. Implications for models of financial decision making are discussed. PUBLICATION ABSTRACT %B Journal of Risk and Uncertainty %I 46 %V 46 %P 27 %G eng %N 1 %4 Longevity/Annuities/Retirement planning/Economic models/methodology/Life expectancy/behavior %$ 69766 %0 Journal Article %J Journal of Marriage and Family %D 2013 %T Marriage, marital history, and Black-White wealth differentials among older women %A Fenaba R. Addo %A Lichter, Daniel T. %K Adult children %K Older Adults %K Racial/ethnic differences %K Women and Minorities %X This study investigated the impact of union history and marital transitions on wealth inequality between older Black and White women (N = 7,026). Cohort data from the Health and Retirement Study show large and increasing Black - White differences in wealth. Marital and relationship histories are associated with the wealth accumulation process among older women. Women who married and stay married accumulated levels of wealth that exceeded those of other women with disrupted family lives. The marriage - wealth nexus is sensitive to a woman's position in the wealth distribution. Quantile regression results revealed that racial differences in total wealth holdings between Black and White women exist throughout the wealth distribution, whereas the relationship between current union history and wealth differentials is significant at the lower tail and middle of the distribution. Decomposition analyses highlighted the nontrivial role of racial disparities in marital histories in accounting for the racial wealth gap. As members of the baby boom generation enter their retirement years, it will be more important than ever to monitor the wealth accumulation process among older single and racial/ethnic minority women. %B Journal of Marriage and Family %I 75 %V 75 %P 342-362 %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/jomf.12007/abstract %N 2 %R 10.1111/jomf.12007 %0 Report %D 2013 %T Medicaid Spend Down: Implications for Long-Term Services and Supports and Aging Policy %A Joshua M Wiener %A Anderson, Wayne L. %A Khatutsky, Galina %A Kaganova, Yevgeniya %A Janet O'Keeffe %K Healthcare %K Medicare/Medicaid/Health Insurance %K Other %K Public Policy %X Medicaid provides an important safety net for people who are poor or become poor, either because of the high costs of health and long-term services and supports, or for other reasons. The transition from non-Medicaid to Medicaid status can be difficult, especially since it is often associated with illness, disability, and declining income and assets. The high cost of long-term services and supports results in catastrophic out-of-pocket costs for many people needing services, some of whom spend down to Medicaid. For people who have been independent all of their lives, transitioning to Medicaid means depending on a means-tested welfare program for their health and long-term services and supports. Moreover, spending for people transitioning to Medicaid is a substantial portion of state Medicaid expenditures. This study examines transitions to Medicaid eligibility or Medicaid spend down by people age 50 and older over a 12-year period. Data for this study come from the 1996 to 2008 waves of the Health and Retirement Study, which has been merged with Medicare data to help establish Medicaid eligibility. %I Long Beach, CA, The SCAN Foundation %G eng %4 Medicaid/Long Term Care/eligibility/spend down/Medicare/out of pocket costs/Public Policy %$ 69308 %0 Journal Article %J Research on Aging %D 2013 %T Moving Considerations: A Longitudinal Analysis of Parent-Child Residential Proximity for Older Americans %A Zhang, Yiduo %A Michal Engelman %A Emily M. Agree %K Adult children %K Demographics %K Event History/Life Cycle %K Expectations %K Health Conditions and Status %K Healthcare %K Retirement Planning and Satisfaction %X Residential proximity is an important indicator of family members' availability to provide assistance to each other. We investigate proximity-enhancing moves by older parents and their children and the reasons for such moves. Using the 2000-2004 waves of the Health and Retirement Study, we fit multinomial logit models examining 2-year residential transitions for parents and children living 10 or more miles apart at baseline. Our results show that family members collectively adjust intergenerational proximity to facilitate mutual support. Despite the common assumption that older parents move closer to their children to receive assistance, more than two thirds of all proximity-enhancing moves are made by adult children. While greater anticipated longevity raises the probability that older parents will move closer to their children, parents' anticipated longevity does not influence children's moving decisions. Including individual variability in anticipated longevity in the life course framework helps account for relocation that precedes declines in health or increases in the need for support. %B Research on Aging %I 35 %V 35 %P 663-687 %G eng %N 6 %4 Anticipated Longevity/Caregiving/Intergenerational Relations/Life Course Migration/Residential Mobility/Subjective Life Expectancy/Adult Children/Elderly Parents/Living Arrangements/Mobility/Retirement %$ 999999 %R 10.1177/0164027512457787 %0 Journal Article %J World Applied Sciences Journal %D 2013 %T A multistate transition model for analyzing diseases in elderly population %A Noor, Norlida Mohd %A M. Ataharul Islam %A Zalila Ali %K Demographics %K Health Conditions and Status %K Methodology %K Other %K Risk Taking %X In this study, a competing risk model is proposed to analyze the transitions to diseases among elderly people employing the proportional hazards model. This study provides important findings regarding the disease pattern among the elderly people and the factors associated with such transitions. The Health and Retirement Study data are considered for the period of 1992-2000. The major diseases or complications considered in this study are stroke, lung diseases, diabetes mellitus, blood pressure and arthritis. The transitions to different diseases or complications are explained by selected covariates such as gender, race, marital status, smoking, drinking, physical exercise and BMI. The results indicate that gender, race, smoking and BMI are significantly associated with transitions to different diseases or complications. The results are displayed for transitions to each disease or complication separately for competing risk framework as well as for the combined transition to any of the selected diseases or complications. This paper reveals some important health issues related to the transitions to the selected diseases or complications among the elderly people and the factors associated with such transitions are identified. %B World Applied Sciences Journal %I 21 %V 21 %P 1700-1707 %G eng %U http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.388.6381&rep=rep1&type=pdf %N 12 %4 Competing risk/Elderly population/Hazards model/Multistate model/Transition to diseases/GENDER/Smoking %$ 69178 %R 10.5829/idosi.wasj.2013.21.12.2570 %0 Journal Article %J J Am Geriatr Soc %D 2013 %T Pain as a risk factor for disability or death. %A James S Andrews %A Irena Cenzer %A Yelin, Edward %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cohort Studies %K Disabled Persons %K Female %K Geriatric Assessment %K Health Status %K Humans %K Life Style %K Male %K Middle Aged %K pain %K Prevalence %K Prognosis %K Prospective Studies %K Severity of Illness Index %K Sex Distribution %K Sex Factors %K United States %X

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

DESIGN: Prospective cohort study.

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

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

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

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

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

%B J Am Geriatr Soc %I 61 %V 61 %P 583-9 %8 2013 Apr %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1356928876?accountid=14667 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/23521614?dopt=Abstract %2 PMC3628294 %4 Demography/Risk Abstracts/Mortality/Mobility/Risk factors/Disabilities/Survival %$ 68992 %R 10.1111/jgs.12172 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2013 %T Personality profile of the children of long-lived parents. %A Evangelia E Antoniou %A Ambarish Dutta %A Kenneth M. Langa %A David Melzer %A David J Llewellyn %K Aged %K Extraversion, Psychological %K Fathers %K Female %K Health Status %K Humans %K Interviews as Topic %K Longevity %K Longitudinal Studies %K Male %K Mothers %K Parents %K Personality %K Personality Inventory %K Sex Factors %X

OBJECTIVES: Past research has shown that parental longevity is related to offspring physical health and longevity. Preliminary studies suggest that parental longevity may be linked to the offspring's personality traits. A comprehensive 5-factor personality model has been related to physical health, but the association with parental longevity has not yet been investigated. We used a 5-factor personality model to investigate the relationship between parental longevity and offspring personality.

METHOD: Data from the longitudinal Health and Retirement Study (HRS) was used in the analyses. Using the Midlife Development Inventory and the Life Orientation test, the relationship between parental attained age and offspring personality was assessed using regression models for both men and women.

RESULTS: Male offspring of long-lived fathers and mothers were more likely to be open to new experiences (p < .01) and be more extroverted (p = .03) compared with male offspring of short-lived fathers or mothers. Maternal or paternal attained age had no effect on the female offspring personality traits.

DISCUSSION: Personality is an important phenotype to consider when investigating genetic and environmental determinants of longevity. Further research is needed to investigate the potential of gender-specific mechanisms.

%B J Gerontol B Psychol Sci Soc Sci %V 68 %P 730-8 %8 2013 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/23419869?dopt=Abstract %3 23419869 %4 physical health/Longevity/personality/personality/Midlife Development Inventory/Life Orientatin Test %$ 68964 %R 10.1093/geronb/gbt003 %0 Book Section %B Annual Review of Gerontology and Geriatrics %D 2013 %T Physical and biological indicators of health and functioning in U.S. oldest old %A Jennifer A Ailshire %A Eileen M. Crimmins %E Robine, Jean-Marie %E Jagger, Carol %E Eileen M. Crimmins %K End of life decisions %K Health Conditions and Status %K Healthcare %X This chapter examines biomarkers of aging, including indicators of physical performance and biomarkers of physiological dysregulation, among a representative national sample of U.S. adults aged 80 years and older with the aim of addressing three questions about the oldest old U.S. population: (a) How do levels of biomarkers of aging vary by age? (b) Are biomarkers of aging patterned by gender, race, ethnicity, and education? and (c) Which biomarkers of aging predict health and mortality. Data for this study come from the Health and Retirement Study (HRS). This large population-based study of U.S. adults aged 80 years and older provides confirmation of the importance of biomarkers of aging for understanding health and longevity in the oldest old. The results indicate that physical functioning declines across age groups even among the oldest old, and that the oldest adults are more likely to have levels of physical performance, inflammation, and organ function that are considered to be high risk for poor health outcomes. In addition, social disparities in physical functioning continue to be evident among the oldest segment of the U.S. population. We also provide evidence for the value of several biomarkers of aging in predicting poor health outcomes among the oldest old. In particular, indicators of high risk for walking dysfunction and dysregulation in the lungs and kidneys were found to predict hospitalization and short-term mortality. %B Annual Review of Gerontology and Geriatrics %I Springer %C New York %V 33 %P 193-215 %G eng %4 biomarkers/Physical function/health Status/HOSPITALIZATION/Mortality/decline %$ 69276 %! Physical and Biological Indicators of Health and Functioning in U.S. Oldest Old %0 Journal Article %J Twin Research and Human Genetics %D 2013 %T The Project TALENT Twin and Sibling Study. %A Carol A Prescott %A Achorn, Deanna Lyter %A Kaiser, Ashley %A Mitchell, Lindsey %A John J McArdle %A Lapham, Susan J %K Education %K Genetics %K GWAS %K Siblings %X Project TALENT is a US national longitudinal study of about 377,000 individuals born in 1942-1946, first assessed in 1960. Students in about 1,200 schools participated in a 2-day battery covering aptitudes, abilities, interests, and individual and family characteristics (Flanagan, 1962; www.projectTALENT.org). Follow-up assessments 1, 5, and 11 years later assessed educational and occupational outcomes. The sample includes approximately 92,000 siblings from 40,000 families, including 2,500 twin pairs and 1,200 other siblings of twins. Until recently, almost no behavior genetic research has been conducted with the sample. In the original data collection information was not collected with the intent to link family members. Recently, we developed algorithms using names, addresses, birthdates, and information about family structure to link siblings and identify twins. We are testing several methods to determine zygosity, including use of yearbook photographs. In this paper, we summarize the design and measures in Project TALENT, describe the Twin and Sibling sample, and present our twin-sib-classmate model. In most twin and family designs, the 'shared environment' includes factors specific to the family combined with between-family differences associated with macro-level variables such as socioeconomic status. The school-based sampling design used in Project TALENT provides a unique opportunity to partition the shared environment into variation shared by siblings, specific to twins, and associated with school- and community-level factors. The availability of many measured characteristics on the family, schools, and neighborhoods enhances the ability to study the impact of specific factors on behavioral variation. %B Twin Research and Human Genetics %V 16 %P 437-448 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23101474?dopt=Abstract %R 10.1017/thg.2012.71 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2013 %T Re-examining ethnic differences in concerns, knowledge, and beliefs about Alzheimer's disease: results from a national sample %A Liat Ayalon %K Adult children %K Demographics %K Health Conditions and Status %K Other %X ObjectiveThis study aims to evaluate ethnic group differences in concerns, knowledge, and beliefs about Alzheimer's disease (AD) in three ethnic groups of older adults (White, Latino, and Black). MethodsThe Health and Retirement Study is a US national representative study of older adults over the age of 50years and their spouse of any age. The study is based on the 2010 wave. ResultsAnalysis is based on data from 939 White, 120 Latino, and 171 Black respondents who completed a special module about AD concerns, knowledge, and beliefs. There were significant ethnic differences on 7 of 13 items. However, after the adjustment for education, gender, age, having a family member with AD, depressive symptoms, and medical comorbidity, only four items showed significant ethnic group differences; relative to White respondents, Black respondents were less likely to report that having a parent or a sibling with AD increases the chance of developing AD and that genetics was an important risk for AD. In addition, relative to White respondents, both Black and Latino respondents were more likely to perceive stress as a potential risk for AD. Latino respondents were less likely to perceive mental activity as a protective factor. ConclusionsThe study found limited ethnic group differences, with most items showing a similar pattern across groups. Nevertheless, the nature of the ethnic group differences found might be associated with a differential pattern of health service use. Copyright (c) 2013 John Wiley and Sons, Ltd. %B International Journal of Geriatric Psychiatry %I 28 %V 28 %P 1288-1295 %G eng %N 12 %4 Ethnic Differences/Dementia/Attitudes/Family Caregivers/Racial-Differences/Immigrants %$ 999999 %R 10.1002/gps.3959 %0 Journal Article %J Ann Am Acad Pol Soc Sci %D 2013 %T Response Rates in National Panel Surveys. %A Stafford, Frank %A Patricia Andreski %A Katherine A McGonagle %A Robert F. Schoeni %B Ann Am Acad Pol Soc Sci %I 645 %V 645 %P 60-87 %8 2013 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23358122?dopt=Abstract %2 PMC3555140 %4 attrition/Response rates/Sample Design/longitudinal Studies/Income distribution/panel survey/methodology %$ 69768 %R 10.1177/0002716212456363 %0 Report %D 2013 %T Risk-Sharing Within Families: Evidence From the Health and Retirement Study %A Akin, S. Nuray %A Leukhina, Oksana %K Adult children %K Income %K Risk Taking %X We report strong empirical support for the presence of a risk-sharing motive of within-family monetary flows. A standard model of risk-sharing predicts that the share of current family income consumed by a child positively depends on that child's lifetime contribution to the present value of the total family income. Therefore, sensitivity of transfer receipts to fluctuations in recipient's current income is smaller for children who contribute more. We test this distinguishing prediction of the risk-sharing model by exploiting the observed variation of parental transfers to siblings over 17 years in a longitudinal dataset derived from the Health and Retirement Study. %I Coral Gables, FL, University of Miami, Department of Economics %G eng %4 Risk-sharing/Altruism/Within-family transfers/Family income/Family income/Siblings/CHILDREN %$ 69258 %0 Thesis %D 2013 %T Three essays in public economics %A Anderson, Michael Throan %Y John Karl Scholz %K Health Conditions and Status %K Methodology %K Net Worth and Assets %K Other %K Public Policy %K Social Security %X The first and second chapters of this dissertation consider household financial decision making. In the first chapter I examine the phenomenon of early claiming for Social Security retirement benefits. Previous work has shown that early claiming, in particular by the primary earner in married couples, is not consistent with household benefit maximization nor is it predicted by models of utility maximization. I show that observed claiming behavior is explained well by a model in which the primary earner chooses when to claim without taking into consideration the effect of the choice on the secondary earner's spousal and survivor benefits. I find that the decrease in the value of household benefits due to early claiming is borne almost entirely by the surviving spouse. In the second chapter, with John Karl Scholz and Ananth Seshadri, we use the insight of a lifecycle model to better understand the factors that affect household retirement savings targets. Two of the most important determinants of savings targets are households' location in the lifetime income distribution and number of children. We measure the deviation of a set of financial guidelines for retirement saving from the optimal asset accumulation implied by the lifecycle model and suggest an alternate savings heuristic that takes into account insights from the lifecycle model. The third chapter applies a novel estimation strategy to measure the benefit of hazardous waste site remediation. In contrast to previous estimates, this method calculates the benefit of site remediation allowing for diminishing marginal utility. Using data on home sales in Cincinnati, Ohio in 2000 I find the median willingness to pay for a one mile increase to the nearest hazardous waste site is $228 per year. This is lower than previous estimates which range from $284 to $1,065 per year. %I The University of Wisconsin - Madison %C Madison, WI %V 3592578 %P 124 %8 2013 %G English %9 Ph.D. %M 1436977212 %4 0438:Environmental economics %$ 999999 %0 Journal Article %J Demography %D 2013 %T Trends in late-life activity limitations in the United States: an update from five national surveys. %A Vicki A Freedman %A Brenda C Spillman %A Patricia Andreski %A Jennifer C. Cornman %A Eileen M. Crimmins %A Kramarow, Ellen %A Lubitz, James %A Linda G Martin %A Sharon S. Merkin %A Robert F. Schoeni %A Teresa Seeman %A Timothy A Waidmann %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disabled Persons %K Female %K Health Surveys %K Humans %K Male %K Mobility Limitation %K Models, Statistical %K United States %X

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

%B Demography %I 50 %V 50 %P 661-71 %8 2013 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23104207?dopt=Abstract %2 PMC3586750 %4 methodology/Meta-analysis/ADL and IADL Impairments/Public Policy/health Care Costs/PREVALENCE %$ 68982 %R 10.1007/s13524-012-0167-z %0 Journal Article %J Health Econ %D 2013 %T Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals. %A Padmaja Ayyagari %A Deb, Partha %A Jason M. Fletcher %A William T Gallo %A Jody L Sindelar %K Adult %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Alcoholic Beverages %K Behavior %K Body Height %K Costs and Cost Analysis %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Models, Econometric %K Socioeconomic factors %K Taxes %K United States %X

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive. The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities. These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.

%B Health Econ %I 22 %V 22 %P 89-105 %8 2013 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22162113?dopt=Abstract %2 PMC3641566 %4 Alcohol/Price elasticity/alcohol taxation/Public Policy/Elasticity of demand/heterogeneous policy responses/Fiscal policy/Fiscal policy/latent groups %$ 69734 %R 10.1002/hec.1817 %0 Journal Article %J J Epidemiol Community Health %D 2013 %T Urban neighbourhood unemployment history and depressive symptoms over time among late middle age and older adults. %A Richard G Wight %A Carol S Aneshensel %A Barrett, Christopher %A Michelle J Ko %A Joshua Chodosh %A Arun S Karlamangla %K Age Factors %K depression %K Female %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Multilevel Analysis %K Residence Characteristics %K Retirement %K Risk Factors %K Socioeconomic factors %K Stress, Psychological %K Surveys and Questionnaires %K Time Factors %K Unemployment %K United States %K Urban Population %X

BACKGROUND: Little is known about how a neighbourhood's unemployment history may set the stage for depressive symptomatology. This study examines the effects of urban neighbourhood unemployment history on current depressive symptoms and subsequent symptom trajectories among residentially stable late middle age and older adults. Contingent effects between neighbourhood unemployment and individual-level employment status (ie, cross-level interactions) are also assessed.

METHODS: Individual-level survey data are from four waves (2000, 2002, 2004 and 2006) of the original cohort of the nationally representative US Health and Retirement Study. Neighbourhoods are operationalised with US Census tracts for which historical average proportion unemployed between 1990 and 2000 and change in proportion unemployed between 1990 and 2000 are used to characterise the neighbourhood's unemployment history. Hierarchical linear regressions estimate three-level (time, individual and neighbourhood) growth models.

RESULTS: Symptoms in 2000 are highest among those residing in neighbourhoods characterised by high historical average unemployment beginning in 1990 and increasing unemployment between 1990 and 2000, net of a wide range of socio-demographic controls including individual-level employment status. These neighbourhood unemployment effects are not contingent upon individual-level employment status in 2000. 6-year trajectories of depressive symptoms decrease over time on average but are not significantly influenced by the neighbourhood's unemployment history.

CONCLUSIONS: Given the current US recession, future studies that do not consider historical employment conditions may underestimate the mental health impact of urban neighbourhood context. The findings suggest that exposure to neighbourhood unemployment earlier in life may be consequential to mental health later in life.

%B J Epidemiol Community Health %I 67 %V 67 %P 153-8 %8 2013 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22918896?dopt=Abstract %2 PMC3681821 %4 Depressive Symptoms/depression/neighborhood Characteristics/employment status/mental Health/labor Force Participation/Socioeconomic Factors/Great Recession %$ 69198 %R 10.1136/jech-2012-201537 %0 Journal Article %J Gerontologist %D 2012 %T Cohort differences in the availability of informal caregivers: are the Boomers at risk? %A Lindsay H Ryan %A Jacqui Smith %A Toni C Antonucci %A James S Jackson %K Aged %K Aged, 80 and over %K Aging %K Caregivers %K Censuses %K Family Characteristics %K Female %K Health Status %K Humans %K Likelihood Functions %K Longitudinal Studies %K Male %K Middle Aged %K Nuclear Family %K Population Growth %K Residence Characteristics %K Retirement %K Risk %K Socioeconomic factors %X

PURPOSE OF THE STUDY: We compare the close family resources of Baby Boomers (BBs) to previous cohorts of older adults at population level and then examine individual-level cohort comparisons of age-related trajectories of informal care availability from midlife into old age.

DESIGN AND METHODS: Population data from the U.S. Census and from the Health and Retirement Study (HRS) are used to identify a cohort similar to the BBs on marital status and fertility rates. Using generalized linear mixed models and 10-year longitudinal data from Depression and WWII parents (DWP; n = 1,052) and the parents of BBs (PBB; n = 3,573) in the HRS, we examine cohort differences in the time-varying likelihoods of being married and of having an adult child living within 10 miles.

RESULTS: The DWP had similar informal care resources at entry to old age as is expected in the BB. Longitudinal analyses of the DWP and PBB cohorts in HRS reveal that the availability of family changes over time and that the DWP cohort was significantly less likely to have a spouse or a grown child living nearby.

IMPLICATIONS: These findings, and future projections based on them, have significant implications for institutions and public policy concerned with the informal caregiving needs of the Boomer cohort as they age.

%B Gerontologist %I 52 %V 52 %P 177-88 %8 2012 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22298747?dopt=Abstract %2 PMC3304892 %4 Baby boomers/Caregivers/Older people/Public policy/Generalized linear models/Generalized linear models %$ 62838 %R 10.1093/geront/gnr142 %0 Thesis %D 2012 %T Consequences of Government Provision and Regulation of Health Insurance %A Andersen, Martin Sparre %Y McGuire, Thomas G. %K Health Conditions and Status %K Healthcare %K Insurance %K Medicare/Medicaid/Health Insurance %K Other %K Public Policy %X The first two chapters of this dissertation concern the effect of public catastrophic insurance programs. In the first chapter, I show how these programs, which only protect against large health shocks, induce advantageous selection in private insurance. I use data on older Americans with Medicare insurance from the Health and Retirement Study to test if individuals with supplemental private health insurance are systematically lower-risk in states with public catastrophic insurance programs. I find that these programs decrease the average health risk for the privately insured by $700 and that a one standard deviation increase in an individual's health risk decreases her probability of having private insurance by 4 percentage points. In the second chapter, I show that these programs reduce the incentive to invest in risk-reducing activities. I find large decreases in self-protection after a program is introduced and that individuals for whom the program is less generous are more likely to engage in self-protection. These effects are stronger for women than for men and apply to a variety of investments in health, including decisions about smoking, obesity, and cancer screening. The third chapter considers a different form of government intervention in insurance markets. In this chapter, I study laws mandating that employer-sponsored health insurance provide coverage for mental illness. I show that industries for which mental health coverage became more generous had larger increases in the average mental distress of their insured workforce. Part of the increase in generosity was due to regulations mandating coverage of mental health benefits. I then show that these regulations affected the behavior of individuals in the labor market--individuals who value more generous mental health benefits and switch jobs work longer hours after these regulations take effect, but individuals who do not value mental health benefits decrease their labor supply. These results are consistent with firms cutting back on their demand for labor due to the cost of the mandate, which leads to lower wages and a decrease in labor supply by individuals who do not value mental health benefits, but an increase in labor supply by individuals who do value mental health benefits highly. %I Harvard University %C United States -- Massachusetts %V Ph.D. %P 106 %G English %U http://search.proquest.com.proxy.lib.umich.edu/docview/1170965443?accountid=14667 %9 3542944 %M 1170965443 %4 Medicare %$ 69794 %! Consequences of Government Provision and Regulation of Health Insurance %0 Journal Article %J Ageing and Society %D 2012 %T Cross-national insights into the relationship between wealth and wellbeing: a comparison between Australia, the United States of America and South Korea %A Kim, Sarang %A K. A. Sargent-Cox %A D. J. French %A Kendig, H. %A Kaarin J. Anstey %K Demographics %K Health Conditions and Status %K Healthcare %K KLoSA %K Methodology %K Net Worth and Assets %X ABSTRACT The positive relationship between wealth and wellbeing has received considerable attention over the last three decades. However, little is known about how the significance of wealth for the health and wellbeing of older adults may vary across societies. Furthermore, researchers tend to focus mainly on income rather than other aspects of financial resources even though older adults often rely on fixed income, particularly after retirement. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey (N=1,431), the Health and Retirement Study (HRS) in the United States of America (USA; N=4,687), and the Korean Longitudinal Study of Ageing (KLoSA; N=5,447), this exploratory cross-national study examined the relationship between wealth satisfaction and objective wealth and wellbeing (measured as self-rated health and life satisfaction) among older Australians, Americans and Koreans (50 years). Regression analyses showed that wealth satisfaction was associated with wellbeing over and above monetary wealth in all three countries. The relationship between monetary wealth and self-rated health was larger for the US than Australian and Korean samples, while the additional contribution of wealth satisfaction to life satisfaction was larger for the Korean than the Australian and US samples. These findings are discussed in terms of the cultural and economic differences between these countries, particularly as they affect older persons. PUBLICATION ABSTRACT %B Ageing and Society %I 32 %V 32 %P 41 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2529607071andFmt=7andclientId=17822andRQT=309andVName=PQD %N 1 %4 Wealth/Comparative analysis/Quality of life/Older people/Gerontology %$ 62791 %0 Journal Article %J Health Aff (Millwood) %D 2012 %T Despite 'welcome to Medicare' benefit, one in eight enrollees delay first use of part B services for at least two years. %A Frank A Sloan %A Kofi F Acquah %A Paul P Lee %A Devdutta G. Sangvai %K Aged %K Female %K Humans %K Insurance Claim Review %K Male %K Medicare Part B %K Time Factors %K United States %X

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

%B Health Aff (Millwood) %I 31 %V 31 %P 1260-8 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22665838?dopt=Abstract %2 PMC3508513 %4 Health care utilization/Public Health And Safety/Medicare/public policy %$ 69518 %R 10.1377/hlthaff.2011.0479 %0 Journal Article %J J Aging Soc Policy %D 2012 %T Determinants of retirement timing expectations in the United States and Australia: a cross-national comparison of the effects of health and retirement benefit policies on retirement timing decisions. %A K. A. Sargent-Cox %A Kaarin J. Anstey %A Kendig, H. %A Skladzien, E. %K Activities of Daily Living %K Age Factors %K Australia %K Cross-Cultural Comparison %K Florida %K Health Benefit Plans, Employee %K Health Status %K Humans %K Job Satisfaction %K Middle Aged %K Pensions %K Public Policy %K Retirement %K Sex Factors %K Socioeconomic factors %K Time Factors %K United States %X

Data from the U.S. Health and Retirement Study (N = 2,589) and the Australian Household Income and Labour Dynamics survey (N = 1,760) were used to compare the macro-level policy frameworks on individual retirement timing expectations for pre-baby boomers (61+ years) and early baby boomers (45 to 60 years). Australian workers reported younger expected age of retirement compared to the U.S. sample. Reporting poor health was more strongly associated with younger expected retirement age in the United States than in Australia. Cohort and gender differences in the United States were found for the effect of private health insurance on younger expected age at retirement. Our results draw attention to how cross-national comparisons can inform us on the effects of policies on retirement expectations among older workers.

%B J Aging Soc Policy %I 24 %V 24 %P 291-308 %8 2012 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22720888?dopt=Abstract %2 PMC in process %4 cross-national comparison/Australian Household Income and Labour Dynamics/retirement planning/Health insurance %$ 69588 %R 10.1080/08959420.2012.676324 %0 Thesis %D 2012 %T Essays on family demography, household finance, and economics of the family %A Fenaba R. Addo %Y Sassler, Sharon %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Net Worth and Assets %K Public Policy %K Women and Minorities %X This dissertation examines the intersection of financial resources, family demography and economic well-being of American households at transitional periods in the life course. Changes in union formation, the demographic composition of the population, and family structure since the latter part of the twentieth century have challenged existing theories on household formation, individual decision-making, and economic well-being (Bumpass, 1990). With the increase in woman's labor force participation, the rise of cohabitation, pre-marital childbirth, and single-parent households, conventional models used to explain recent trends in marriage market dynamics, intra-household resource allocation, and wealth inequality are continuously tested, challenged, and revamped to keep pace with a society in a current state of demographic and economic flux. Chapter one focuses on early and young adulthood and the role of consumer and education loan debt in transitioning into coresidential relationships using a sample of youth coming of age at the turn of the twenty-first century and during a period of economic expansion, increased college enrollment and growing socioeconomic divide in marital patterns in the United States. Results suggest total debt amount is associated with cohabitation, increasing the odds of cohabitation over marriage and remaining single for both women and men. First marriage is positively associated with greater educational attainment for this cohort of young adults, but women with education loan debt are more likely to delay marrying and cohabit first. Chapter two (co-authored with Daniel T. Lichter) addresses the racial wealth gap by exploring the relationship between marriage and marital histories on wealth accumulation of older Black and White women. Marital and relationship histories are strongly associated with the wealth accumulation process. Women who marry and stay married accumulated levels of wealth that exceeded those of other women with disrupted family lives. The marriage-wealth nexus is sensitive to a women's position in the wealth distribution, and decomposition analyses highlight the non-trivial role of racial disparities in marital histories in accounting for the racial wealth gap. The third and final chapter uses seven waves of individual-level data from the Health and Retirement Survey from 1998-2008 to analyze whether there is a causal effect of being an informal basic needs or financial caregiver to an aging parent on one's health outcomes (self-assessed health and depression) and health behaviors (exercise and smoking). The results suggest a positive effect on depressive symptoms of basic needs caregiving for unmarried adult children, and that they may be selecting into that role because of their poor health. Manifestations of caregiving in future periods include, basic needs caregiving increasing the probability of smoking for married women and financial caregiving increases depressive symptoms for unmarried men. These findings suggest that the financial costs of caregiving can influence adult children's health outcomes, in particular for those not currently in a marital union. %I Cornell University %C Ithaca, NY %V Ph.D. %P 141 %G eng %U https://ecommons.cornell.edu/handle/1813/31034 %M prod.academic_MSTAR_1115315005 %4 socioeconomic Differences %0 Thesis %D 2012 %T Essays on Innovation, Productivity, and Talent Allocation %A Shu, Pian %Y David H. Autor %Y Acemoglu, Daron %Y Stern, Scott %K Disabilities %K Employment and Labor Force %K Methodology %K Other %X This thesis contains three essays on innovation, productivity, and talent allocation. The first essay explores a novel channel through which short-term economic fluctuations affect the long-term innovative output of the economy: innovators' accumulation of human capital. Using a newly constructed data set on the patenting history of all individuals obtaining a bachelor's degree from the Massachusetts Institute of Technology (MIT) between 1980 and 2005, I find that cohorts graduating during booms produce significantly fewer patents over the subsequent two decades. Initial economic conditions do not affect inventors' long-term occupational affiliation, suggesting that the main differences lie in their long-term level of inventive human capital. The decrease in patent output of cohorts graduating during booms is mainly from inventors with relatively low GPAs, and marginal patents receive fewer citations than the rest. The second essay uses the 2008 financial crisis as a natural experiment to study the characteristics of recent graduates from MIT bachelor programs who pursued a career in finance immediately after graduation. I find that finance competes against science and engineering graduate programs for the best talent from MIT but values academic skills less. As a result of endogenous skill development during college, financiers have significantly lower academic skills than students entering graduate school at graduation, despite having similar levels of raw academic talent measured at college entrance. Marginal financiers have lower starting salaries than average financiers, suggesting that there is positive selection into finance. The third essay examines the asset accumulation and labor force participation of Social Security Disability Insurance applicants. Using the RAND Health and Retirement Study panel data, I provide empirical support for the theory that an imperfectly screened disability insurance program encourages individuals who dislike work to save more in the present and plan to apply for disability insurance in the future, regardless of their future health. Despite exhibiting lower labor force attachment and earning less than accepted applicants, rejected applicants have significantly more assets immediately prior to their application, but not in the several years before. Although imperfect, the current screening differentiates the applicants in meaningful ways without using assets as an additional criterion. (Copies available exclusively from MIT Libraries, Rm. 14-0551, Cambridge, MA 02139-4307. Ph. 617-253-5668; Fax 617-253-1690.) %I Massachusetts Institute of Technology %C Cambridge, MA %V Ph.D. %G English %M prod.academic_MSTAR_1315750506 %4 disability insurance %$ 69026 %0 Journal Article %J Health Serv Res %D 2012 %T Ethnic/race differences in the attrition of older American survey respondents: implications for health-related research. %A Natalia A. Zhivan %A Alfonso Ang %A Hortensia Amaro %A William A. Vega %A Kyriakos S Markides %K Bias %K ethnicity %K Female %K Health Care Surveys %K Health Services Research %K Health Surveys %K Hispanic or Latino %K Humans %K Male %K Mexican Americans %K Middle Aged %K Racial Groups %K Risk %K Socioeconomic factors %K United States %X

OBJECTIVE: To compare models of attrition across race/ethnic groups of aging populations and discuss implications for health-related research.

DATA SOURCES: The Health and Retirement Study (1992-2008).

STUDY DESIGN: A competing risks model was estimated using a multinomial logit model when respondents faced competing types of risks, such as dying, being lost from the study, and nonresponse in some years for different groups of elderly. Key explanatory variables were foreign birth, health insurance, and health status.

PRINCIPAL FINDINGS: Variables describing foreign birth, health insurance, and health status differed in their prediction of attrition across ethnic groups of aging populations.

CONCLUSIONS: Differences in the predictors of attrition across ethnic groups of elderly could potentially lead to biased estimates in health-related research using longitudinal data sources.

%B Health Serv Res %I 47 %V 47 %P 241-54 %8 2012 Feb %G eng %N 1 Pt 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22091976?dopt=Abstract %4 Socioeconomic Differences/ethnicity/Attrition/Nonresponse/methodology %$ 62686 %R 10.1111/j.1475-6773.2011.01322.x %0 Report %D 2012 %T The Great Recession, Older Workers with Disabilities, and Implications for Retirement Security %A Onur Altindag %A Lucie Schmidt %A Purvi Sevak %K Disabilities %K Employment and Labor Force %K Health Conditions and Status %K Public Policy %K Retirement Planning and Satisfaction %X Evidence suggests that older workers with disabilities have been hit particularly hard by the recent recession. The increased difficulty in finding a job faced by individuals with disabilities, combined with the longer spells of unemployment experienced by all workers in this recession, could mean that laid-off disabled workers in their pre-retirement years may never return to work. In this paper, we use data from the 2004-2010 waves of the Health and Retirement Study to examine how the great recession has affected workers with chronic health conditions that put them at greater risk of disability. Our results suggest that increases in job losses were 30 greater for those with greater underlying risk of disability than for the general HRS population, and decreases in consumption were 20 greater. These results have important implications for the well-being of disabled individuals nearing retirement. %B MRDRC Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U http://hdl.handle.net/2027.42/95904 %4 great Recession/labor Force Participation/Unemployment/disabled Persons/chronic conditions/DISABILITY/DISABILITY/Job Loss/retirement planning %$ 69826 %0 Report %D 2012 %T Harmonization of Cross-National Studies of Aging to the Health and Retirement Study: Income Measures %A Marco Angrisani %A Jinkook Lee %K CHARLS %K Cross-National %K ELSA %K IFLS %K JSTAR %K KLoSA %K LASI %K Methodology %K SHARE %K TILDA %X This paper summarizes and compares measures of household and individual income in the Health and Retirement Study (HRS) and its sister surveys from other countries: the English Longitudinal Study of Ageing (ELSA), the Survey of Health, Ageing, and Retirement in Europe (SHARE), the Korean Longitudinal Study of Aging (KLoSA), the Japanese Study on Aging and Retirement (JSTAR), the Indonesian Family Life Survey (IFLS), The Irish Longitudinal Study on Aging (TILDA), the Chinese Health and Retirement Longitudinal Study (CHARLS), and the Longitudinal Aging Study in India (LASI). The authors analyze and discuss the extent, to which these measures are comparable, the methodological differences in the way information was collected for these measures, and the implications for secondary data analysis. This paper is one in a series of similar papers, each comparing different domains (e.g., chronic medical conditions, cognition, expectations, transfers, and wealth) across these surveys with an aim to encourage rigorous, cross-national and international comparison research on aging populations. %B RAND Working Paper %I RAND Corporation %C Santa Monica, CA, %G eng %4 cross-national comparison/ELSA_/SHARE/CHARLS/KLOSA/JSTAR/TILDA/Methodology %$ 69602 %R 10.7249/WR861.5 %0 Journal Article %J PLoS One %D 2012 %T Higher rates of Clostridium difficile infection among smokers. %A Mary A M Rogers %A M. Todd Greene %A Sanjay Saint %A Carol E Chenoweth %A Preeti N Malani %A Itishree Trivedi %A David M. Aronoff %K Clostridioides difficile %K Enterocolitis, Pseudomembranous %K Female %K Humans %K Male %K Middle Aged %K Smoking %K United States %X

OBJECTIVES: Cigarette smoking has been shown to be related to inflammatory bowel disease. We investigated whether smoking affected the probability of developing Clostridium difficile infection (CDI).

METHODS: We conducted a longitudinal study of 16,781 older individuals from the nationally representative Health and Retirement Study. Data were linked to files from the Centers for Medicare and Medicaid Services.

RESULTS: Overall, the rate of CDI in older individuals was 220.6 per 100,000 person-years (95% CI 193.3, 248.0). Rates of CDI were 281.6/100,000 person-years in current smokers, 229.0/100,000 in former smokers and 189.1/100,000 person-years in never smokers. The odds of CDI were 33% greater in former smokers (95% CI: 8%, 65%) and 80% greater in current smokers (95% CI: 33%, 145%) when compared to never smokers. When the number of CDI-related visits was evaluated, current smokers had a 75% increased rate of CDI compared to never smokers (95% CI: 15%, 167%).

CONCLUSIONS: Smoking is associated with developing a Clostridium difficile infection. Current smokers have the highest risk, followed by former smokers, when compared to rates of infection in never smokers.

%B PLoS One %I 7 %V 7 %P e42091 %8 2012 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/22848714?dopt=Abstract %2 PMC3407081 %4 cigarette smoking/inflammatory bowel disease/clostridium difficile infection/medicare %$ 69668 %R 10.1371/journal.pone.0042091 %0 Journal Article %J J Gen Intern Med %D 2012 %T How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults. %A Vivien K Sun %A Irena Cenzer %A Helen Kao %A Cyrus Ahalt %A Brie A Williams %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Perception %K Residence Characteristics %K Safety %K Surveys and Questionnaires %X

BACKGROUND: Neighborhood characteristics are associated with health and the perception of safety is particularly important to exercise and health among older adults. Little is known about the relationship between perception of neighborhood safety and functional decline in older adults.

OBJECTIVE: To determine the relationship between perceived neighborhood safety and functional decline in older adults.

DESIGN/SETTING: Longitudinal, community-based.

PARTICIPANTS: 18,043 persons, 50 years or older, who participated in the 1998 and 2008 Health and Retirement Study.

MAIN MEASURES: The primary outcome was 10-year functional decline (new difficulty or dependence in any Activity of Daily Living, new mobility difficulty, and/or death). The primary predictor was perceived neighborhood safety categorized into three groups: "very safe", "moderately safe", and "unsafe." We evaluated the association between perceived neighborhood safety and 10-year functional decline using a modified Poisson regression to generate unadjusted and adjusted relative risks (ARR).

KEY RESULTS: At baseline 11,742 (68.0%) participants perceived their neighborhood to be very safe, 4,477 (23.3%) moderately safe, and 1,824 (8.7%) unsafe. Over 10 years, 10,338 (53.9%) participants experienced functional decline, including 6,266 (50.2%) who had perceived their neighborhood to be very safe, 2,839 (61.2%) moderately safe, and 1,233 (63.6%) unsafe, P < 0.001. For the 11,496 (63.3%) of participants who were functionally independent at baseline, perceived neighborhood safety was associated with 10-year functional decline (moderately safe ARR 1.15 95% CI 1.09-1.20; unsafe ARR 1.21 95% CI: 1.03-1.31 compared to very safe group). The relationship between perceived neighborhood safety and 10-year functional decline was not statistically significant for participants who had baseline functional impairment.

CONCLUSION: Asking older adults about their perceived neighborhood safety may provide important information about their risk of future functional decline. These findings also suggest that future studies might focus on assessing whether interventions that promote physical activity while addressing safety concerns help reduce functional decline in older adults.

%B J Gen Intern Med %V 27 %P 541-7 %8 2012 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/22160889?dopt=Abstract %2 PMC3326109 %4 neighborhood Characteristics/Safety/Functional decline/Functional decline/Activities Of Daily Living/Mobility/HEALTH %$ 62672 %R 10.1007/s11606-011-1943-y %0 Report %D 2012 %T Investment Decisions in Retirement: The Role of Subjective Expectations %A Marco Angrisani %A Michael D Hurd %A Erik Meijer %K Net Worth and Assets %K Pensions %X The rapid transition from defined benefit (DB) pension plans to defined contribution (DC) plans has a potential benefit of offering pension holders greater control over how their pension accumulations are invested. If pension holders are willing to take some risk, investments in the stock market could increase their economic preparation for retirement, and, indeed, economic theory as well as the typical advice of financial advisors calls for stock market investments. Yet, the rate of stock holding is much below what theory suggests it should be, undoing any benefit associated with the greater control coming from DC plans. The leading explanations for this under-investing include excessive risk aversion, costs of entry, and misperceptions about possible returns in the stock market. We show that excessive risk aversion is not able to account for the low fraction of stock holding. However, a model with heterogeneous subjective expectations about stock market returns is able to account for low stock market participation, and tracks the share of risky assets conditional on participation reasonably well. Based on the model with subjective expectations, we estimate a welfare loss of up to 12 compared to investment under rational expectations, if actual returns follow the same distribution as in the past 50 years. The policy implication is that there is considerable scope for welfare improvement as a result of consumer education regarding stock market returns. However, the welfare loss is much smaller if individuals are not very risk averse or if actual returns follow the same distribution as in the past 10 years %I Ann Arbor, The University of Michigan %G eng %U http://www.mrrc.isr.umich.edu/publications/publications_download.cfm?pid=865 %4 pension Plans/defined benefit plans/defined contribution pension plans/investment Decisions/investment Decisions/stock market %$ 69830 %0 Thesis %D 2012 %T Longitudinal changes in self-reported expectations for nursing home use in the health and retirement study %A Haley, Philip Parker %Y Rebecca S Allen %K Expectations %K Healthcare %K Public Policy %X The Behavioral Model of Health Services Use (Andersen, 1968; Andersen & Newman, 1973) is a frequently used framework for examining the factors that bear upon the decision to pursue and utilize health services (Andersen & Newman, 1973; Mui, Choi, & Monk, 1998). According to this model, an individual's predisposing characteristics, their enabling resources, and their degree of need combine to determine whether or not they will pursue health services such as nursing home care. The current study investigated the relations between variables predicted by the Behavioral Model of Health Services Use to influence longitudinal expectations for nursing home use among adults 50 years of age and older. Variables of interest were drawn from the 2002-2008 waves of the Health and Retirement Study (HRS) and included demographics, previous health services use, possession of insurance that pays for nursing home care, social support, cognitive status, emotional health, and functional status. Results suggested that the variables selected based upon the Behavioral Model of Health Services Use exhibited a limited ability to predict changes in nursing home use expectations across time. Limitations of the current study, as well as potential areas for future studies, were discussed. %I The University of Alabama %V Ph.D. %P 93 %8 2012 %G English %N 3539994 %9 Ph.D. %4 Public Policy %$ 69676 %! Longitudinal changes in self-reported expectations for nursing home use in the health and retirement study %0 Thesis %D 2012 %T Neighborhood Conditions and Gender Differences in Depressive Symptoms %A Clinton, Eliva Atieno %Y Carol S Aneshensel %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Public Policy %K Women and Minorities %X Depression is a major public health challenge affecting millions of people worldwide, particularly women. Intra-individual explanations of gender differences in depression include biology (e.g., neurotransmitters, genes, hormones) and psychological factors (e.g., self-concept and esteem, mastery). Social explanations focusing on exposure to stressors (e.g., low socioeconomic status) and social role occupancy (e.g., marital and employment status) also have been considered. The recognition that environmental factors may influence mental health has given rise to studies examining the relationship between neighborhood conditions and risk for depression and psychological distress, but gender differences in neighborhood effects have yet to receive the needed research attention. This dissertation sought an understanding of: (a) gender differences in neighborhood effects on depressive symptoms, and (b) neighborhood influences on variation in depressive symptoms among women. The research is guided by the neighborhood stress process framework focusing on stressors and psychosocial resources as mediators and moderators of the relationships among neighborhood conditions and depressive symptoms. Individual-level cross-sectional data come from the Health and Retirement Survey (HRS: baseline, 2006/2008 interviews and psychosocial questionnaire supplement). The HRS is a U.S. national probability sample of adults over the age of 50. Analyses are performed within a multilevel framework and urban neighborhood data come from the 2000 U.S. Census. Among eight indicators of neighborhood disadvantage, including neighborhood socioeconomic disadvantage (NSD), and five measures of neighborhood advantage examined for gender differences in their effects on depressive symptoms, two were statistically significant but not in the expected direction. Neighborhood proportion non-family households was associated with fewer depressive symptoms among women and it had no effect among men. Neighborhood proportion married-couple households was not significantly related to depressive symptoms among women, but among men, living in a neighborhood with more married-couple households with children was associated with fewer symptoms. Overall, the impact on depressive symptoms of neighborhood characteristics do not differ for men and women. Gender differences in neighborhood effects on three individual-level stressors and three individual-level psychosocial resources also were examined. Nine interactions were statistically significant. Consistent with expectations, people who reside in neighborhoods with more vacant housing units perceived more disorder and less social cohesion in their neighborhoods, and the effects were larger for women than men. Relative to men, women's perceptions of neighborhood social cohesion and social support are more sensitive to neighborhood economic conditions. In general, with a few notable exceptions, neighborhood effects on stressors and psychosocial resources do not vary by gender. In analyses that only included women, NSD was positive and significantly associated with depressive symptoms and neighborhood proportion adults aged 65 and older was negative and significantly associated with symptoms. Perceived neighborhood social cohesion fully mediated the effect of NSD--and partially mediated the effect of neighborhood proportion older adults--on depressive symptoms. The effect on depressive symptoms of neighborhood disadvantage did not vary significantly by levels of stressors and psychosocial resources except for three significant cross-level interactions. Living in a neighborhood with more vacant housing units was associated with more depressive symptoms, and the effect was greater among women who perceived high levels of disorder in the neighborhood than those who perceived less disorder. Also as hypothesized, NSD had the largest positive effect on depressive symptoms among women with less social support than women with more support. However, mastery did not funct on as a stress-buffer. The effect on depressive symptoms of neighb rhood advantage varied significantly by psychosocial factors. Living in a neighborhood with higher proportions of older adults was associated with fewer depressive symptoms more so for women who report low levels of perceived neighborhood physical disorder than women who report average levels of disorder. Also consistent with expectations, higher neighborhood proportion of affluent households and owner-occupied housing units were associated with fewer depressive symptoms, and the effects were larger for women with high levels of mastery than women with low mastery. However, these neighborhood characteristics were less beneficial to the mental health of women with high than low levels of social support. The findings from this dissertation largely indicate that relationships among components of the neighborhood stress process model do not differ by gender or by levels of stressors and psychosocial resources. However, the significant results that emerged make a valuable contribution to the research literature by identifying urban neighborhood conditions that are consequential to the mental health of middle-aged and older adults and that should be the target of interventions. %I University of California, Los Angeles %C Los Angeles %V Ph.D. %G English %U https://escholarship.org/uc/item/86f6m7br %M 1151808850 %4 WOMEN %$ 69228 %0 Journal Article %J BMC Public Health %D 2012 %T A prospective cohort study of health behavior profiles after age 50 and mortality risk. %A Benjamin A Shaw %A Agahi, Neda %K Aged %K Alcohol-Related Disorders %K Female %K Follow-Up Studies %K Humans %K Male %K Middle Aged %K Prospective Studies %K Regression Analysis %K Risk Assessment %K Risk-Taking %K Sedentary Behavior %K Smoking %K United States %X

BACKGROUND: This study examines the mortality risk associated with distinct combinations of multiple risk behaviors in middle-aged and older adults, and assesses whether the mortality risks of certain health behaviors are moderated by the presence of other risk behaviors.

METHODS: Data for this prospective cohort study are from the Health and Retirement Study (HRS), a nationwide sample of adults older than 50 years. Baseline data are from respondents (n = 19,662) to the 1998 wave of the HRS. Twelve distinct health behavior profiles were created, based on each respondent's smoking, physical activity, and alcohol use status in 1998. Mortality risk was estimated through 2008 using Cox regression.

RESULTS: Smoking was associated with elevated risk for mortality within all behavioral profiles, but risk was greatest when combined with heavy drinking, both for middle-aged (ages 51-65) and older (ages 66+) adults. Profiles that included physical inactivity were also associated with increased mortality risk in both age groups. However, the impact of inactivity was clearly evident only among non-smokers; among smokers, the risk of inactivity was less evident, and seemingly overshadowed by the risk of smoking. Moderate drinking was protective relative to abstinence among non-smokers, and relative to heavy drinking among smokers.

CONCLUSIONS: In both middle-aged and older adults, multiple unhealthy behaviors increase mortality risk. However, the level of risk varies across unique combinations of unhealthy behaviors. These findings highlight the role that lifestyle improvements could play in promoting healthy aging, and provide insight into which behavioral combinations should receive top priority for intervention.

%B BMC Public Health %I 12 %V 12 %P 803 %8 2012 Sep 18 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/22989155?dopt=Abstract %4 Alcohol/alcohol Abuse/Alcohol-Related Disorders -- mortality/Regression Analysis/Risk-Taking/Sedentary Lifestyle/Risk Assessment/smoking/Smoking -- mortality/Public Health And Safety/gender Differences %$ 69792 %R 10.1186/1471-2458-12-803 %0 Journal Article %J J Health Soc Behav %D 2012 %T Race-ethnicity and health trajectories: tests of three hypotheses across multiple groups and health outcomes. %A Tyson H Brown %A Angela M O'Rand %A Daniel E Adkins %K Age Factors %K Aging %K Black or African American %K ethnicity %K Female %K Health Behavior %K Health Status Disparities %K Health Surveys %K Humans %K Male %K Mexican Americans %K Middle Aged %K Racial Groups %K Risk Factors %K Socioeconomic factors %K Sociology, Medical %K White People %X

Racial-ethnic disparities in static levels of health are well documented. Less is known about racial-ethnic differences in age trajectories of health. The few studies on this topic have examined only single health outcomes and focused on black-white disparities. This study extends prior research by using a life course perspective, panel data from the Health and Retirement Study, and multilevel growth curve models to investigate racial-ethnic differences in the trajectories of serious conditions and functional limitations among blacks, Mexican Americans, and whites. We test three hypotheses on the nature of racial-ethnic disparities in health across the life course (aging-as-leveler, persistent inequality, and cumulative disadvantage). Results controlling for mortality selection reveal that support for the hypotheses varies by health outcome, racial-ethnic group, and life stage. Controlling for childhood socioeconomic status, adult social and economic resources, and health behaviors reduces but does not eliminate racial-ethnic disparities in health trajectories.

%B J Health Soc Behav %I 53 %V 53 %P 359-77 %8 2012 Sep %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22940814?dopt=Abstract %2 PMC3668643 %4 Minority and ethnic groups/Older people/Cardiovascular disease/Inequality/Cultural differences/Cultural differences/Ethnicity/Diabetes/Socioeconomic Differences %$ 69620 %R 10.1177/0022146512455333 %0 Newspaper Article %B Benefits Selling. Breaking News %D 2012 %T Recession impacted near-retirees housing wealth %A Paula Aven, Gladych %K Net Worth and Assets %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X Using asset and labor market data from the Health and Retirement Study, the organization examined the population that was just reaching retirement age when the recession hit, those aged 53 to 58 in 2006. %B Benefits Selling. Breaking News %I National Underwriter Company dba Summit Business Media %C New York %8 May 22, 2012 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1021020587?accountid=14667 %4 great Recession/Social security/Household wealth/Retirement planning %$ 69628 %! Recession impacted near-retirees housing wealth %0 Journal Article %J Aging Ment Health %D 2012 %T Self- and other-oriented potential lifetime traumatic events as predictors of loneliness in the second half of life. %A Yuval Palgi %A Amit Shrira %A Menachem Ben-Ezra %A Sharon Shiovitz-Ezra %A Liat Ayalon %K Age Factors %K Aged %K Aged, 80 and over %K Child %K Child Abuse %K Cross-Sectional Studies %K depression %K Female %K Forecasting %K Humans %K Life Change Events %K Loneliness %K Male %K Middle Aged %K Self Psychology %K Wounds and Injuries %X

OBJECTIVES: This study examined the relationship between self- and other-oriented potential lifetime traumatic events (PLTE) and loneliness at the second half of life.

METHOD: The sample was comprised of 7446 respondents who completed the Health and Retirement Study (HRS) 2006 psychosocial questionnaire. PLTE were classified into self-oriented PLTE, defined as traumatic events that primarily inflict the self (e.g., being abused by parents) and other-oriented PLTE, defined as events that affect the self by primarily targeting others (e.g., death of one's child). We evaluated the role of self- and other-oriented PLTE as predictors of loneliness, as evaluated by the short R-UCLA. Analyses were stratified by age at which trauma happened categorized into four life periods (0-17, 18-30, 31-49, 50+).

RESULTS: The results showed that PLTE is positively related to loneliness. Moreover, the number of other-oriented PLTE, and even more pronouncedly self-oriented PLTE, that happened up until adulthood were the strongest predictors of loneliness at the second half of life.

CONCLUSION: The study suggests that self- and other-oriented PLTE reported to have occurred early in life are associated with perceived loneliness in the second half of life.

%B Aging Ment Health %I 16 %V 16 %P 423-30 %8 2012 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22296337?dopt=Abstract %3 22296337 %4 psycho-social/potential lifetime traumatic events/loneliness %$ 69464 %R 10.1080/13607863.2011.638903 %0 Journal Article %J J Immigr Minor Health %D 2012 %T Self-reported and measured hypertension among older US- and foreign-born adults. %A White, Kellee %A Mauricio Avendano %A Benjamin D Capistrant %A J Robin Moon %A Sze Y Liu %A M. Maria Glymour %K Aged %K Black or African American %K Blood Pressure Determination %K Emigrants and Immigrants %K Female %K Hispanic or Latino %K Humans %K Hypertension %K Male %K Middle Aged %K Nutrition Surveys %K Reproducibility of Results %K Self Report %K United States %K White People %X

Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n = 13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9%), whites (82.8%), and Hispanics (84.0%), and both foreign-born (83.2%) and US-born (84.0%). Specificity was above 90% for both US-born and foreign-born, but higher for whites (92.8%) than blacks (86.0%). Despite the potential vulnerability of older foreign-born Americans, self-reported hypertension may be considered a reasonable estimate of hypertension status. Future research should confirm these findings in samples with a larger and more ethnically diverse foreign-born population.

%B J Immigr Minor Health %I 14 %V 14 %P 721-6 %8 2012 Aug %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1022672464?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22109587?dopt=Abstract %3 22109587 %4 Social policy/self assessed health/Hypertension/African-americans/Hispanics/Ethnic Interests %$ 69514 %R 10.1007/s10903-011-9549-3 %0 Journal Article %J Bmc Public Health %D 2012 %T A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents %A D. J. French %A Chris Browning %A Kendig, H. %A Luszcz, M. A. %A Saito, Yasuhiko %A K. A. Sargent-Cox %A Kaarin J. Anstey %K Cross-National %K Health Conditions and Status %K KLoSA %K Methodology %X Background: Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea. Methods: Cross-sectional data were drawn from large surveys of older respondents ( = 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH. Results: SRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations. Conclusions: We conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health. %B Bmc Public Health %I 12 %V 12 %G eng %4 cross-national/Self assessed health/SELF-RATED HEALTH/Cross Cultural Comparison %$ 69704 %R 10.1186/1471-2458-12-649 %0 Journal Article %J Stroke %D 2012 %T Stroke incidence in older US Hispanics: is foreign birth protective? %A J Robin Moon %A Benjamin D Capistrant %A Ichiro Kawachi %A Mauricio Avendano %A Subramanian, S V %A Lisa M. Bates %A M. Maria Glymour %K Age Factors %K Aged %K Cohort Studies %K Emigration and Immigration %K Female %K Hispanic or Latino %K Humans %K Incidence %K Longitudinal Studies %K Male %K Middle Aged %K Retrospective Studies %K Risk Factors %K Socioeconomic factors %K Stroke %K United States %K White People %X

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

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

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

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

%B Stroke %I 43 %V 43 %P 1224-9 %8 2012 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/22357712?dopt=Abstract %3 22357712 %4 Hispanic/stroke/Socioeconomic Factors/survival Analysis %$ 69592 %R 10.1161/STROKEAHA.111.643700 %0 Journal Article %J J Gen Intern Med %D 2012 %T Subjective social status and functional decline in older adults. %A Bonnie Chen %A Kenneth E Covinsky %A Irena Cenzer %A Nancy E Adler %A Brie A Williams %K Activities of Daily Living %K Aged %K Aging %K Female %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Risk Factors %K Self Report %K Social Class %X

BACKGROUND: It is unknown whether subjective assessment of social status predicts health outcomes in older adults.

OBJECTIVE: To describe the relationship between subjective social status and functional decline in older adults.

DESIGN: Longitudinal cohort study.

SETTING: The Health and Retirement Study, a nationally representative survey of community-dwelling older adults (2004-2008).

PARTICIPANTS: Two thousand five hundred and twenty-three community-dwelling older adults.

MAIN MEASURES: Self-report of social status (SSS), categorized into three groups, reported by participants who marked a 10-rung ladder to represent where they stand in society. Four-year functional decline (new difficulty in any of five activities of daily living, mobility decline and/or death)

KEY RESULTS: Mean age was 64; 46% were male, 85% were white. At baseline, lower SSS was associated with being younger, unmarried, of nonwhite race/ethnicity, higher rates of chronic medical conditions and ADL impairment (P < 0.01). Over 4 years, 50% in the lowest SSS group declined in function, compared to the middle and highest groups (28% and 26%), P-trend <0.001. Those in the lowest rungs of SSS were at increased risk of 4-year functional decline (unadjusted RR = 1.91, CI 1.-9-2.46). The relationship between a subjective belief that one is worse off than others and functional decline persisted after serial adjustment for demographics, objective SES measures, and baseline health and functional status (RR 1.36, CI 1.08-1.73).

CONCLUSIONS: In older adults, the belief that one is in the lowest rungs of social status is a measure of socioeconomic distress and of significant risk for functional decline. These findings suggest that self-report of low subjective social status may give clinicians additional information about which older adults are at high risk for future functional decline.

%B J Gen Intern Med %V 27 %P 693-9 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22215272?dopt=Abstract %2 PMC3358399 %4 health outcomes/socioeconomic Differences/social status/social status/functional decline/functional decline/ADL and IADL Impairments %$ 62662 %R 10.1007/s11606-011-1963-7 %0 Report %D 2012 %T Tax Elasticity of Labor Earnings for Older Individuals %A Abby Alpert %A David Powell %K Employment and Labor Force %K Public Policy %K Retirement Planning and Satisfaction %X This paper studies the impact of income and payroll taxes on intensive and extensive labor supply decisions for workers ages 55-74 using the Health and Retirement Study. The literature provides little guidance about the responsiveness of this population to tax incentives, though the tax code is potentially an important mechanism that can alter retirement incentives. We model labor force participation decisions and labor earnings as functions of taxes, and we use the intensive margin to inform estimation of the extensive margin equation. Our method accounts for selection into labor force participation with a plausibly exogenous shock to employment. We use the results of our intensive labor supply estimation to predict the after-tax labor earnings of every person in our sample, including those that do not work. This method allows us to generate consistent estimates of the impact of taxes on employment and retirement. We find large compensated elasticities on the intensive margin. These results are imprecise, but they are statistically significant for women. On the extensive margin, we find significant effects on labor force participation and, for men, retirement decisions. Our estimates suggest that an age-targeted tax reform that eliminates payroll taxes for older workers would decrease the percentage of workers dropping out of the labor force by 1 percentage point, a 4 decrease. %B MRRC Working Paper %I Retirement and Disability Research Consortium, University of Michigan %C Ann Arbor, MI %G eng %U https://deepblue.lib.umich.edu/handle/2027.42/94533 %4 income tax/Payroll tax/tax incentives/labor Force Participation/employment/retirement planning %$ 69832 %0 Journal Article %J Journal of Statistical Research %D 2012 %T Tests for Dependence in Binary Repeated Measures Data %A M. Ataharul Islam %E Rafiqul I Chowdhury %E Alzaid, A. %K Dependence Tests %K Statistics %X If we observe repeated binary outcomes over time then there may be dependence in outcomes and a test for dependence may be sought for such data. However, tests for dependence in models for repeated measures remain a challenge where covariates are associated with previous outcomes and both covariates and previous outcomes are included simultaneously in a model. This paper displays the nature of such problems (i.e. dependence among outcomes may depend on the association between covariates and previous outcomes) inherent in models for repeated binary outcomes that can distort the estimates and may produce misleading results. In the context of application of regressive models, this paper discusses conditions for which the regressive models can be safely employed. All these are shown on the basis of simple relationships between the conditional, marginal and joint probability mass functions for the bivariate binary outcomes which can be extended to the multivariate data stemmed from repeated measures. Some test procedures are suggested and applications are demonstrated using both simulations and real life data. Both the applications clearly indicate the utility of the proposed tests. %B Journal of Statistical Research %V 46 %P 203-217 %8 2012 %G eng %N 2 %& 203 %0 Journal Article %J Soc Sci Med %D 2012 %T Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study. %A J Robin Moon %A M. Maria Glymour %A Subramanian, S V %A Mauricio Avendano %A Ichiro Kawachi %K Age Factors %K Aged %K Cardiovascular Diseases %K Female %K Health Behavior %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K Retirement %K Risk Factors %K Sex Factors %K Socioeconomic factors %K Survival Analysis %K Time Factors %K United States %X

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.

%B Soc Sci Med %I 75 %V 75 %P 526-30 %8 2012 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22607954?dopt=Abstract %2 PMC3367095 %4 Transitions/Retirement/Risk factors/Cardiovascular disease/Survival analysis/Medical research/Myocardial Infarction/Stroke %$ 69428 %R 10.1016/j.socscimed.2012.04.004 %0 Thesis %D 2012 %T The Urban Neighborhood, Depressive Symptoms, and Age: Stress and Psychosocial Resources %A Harig, Fredrick A. %Y Carol S Aneshensel %K Demographics %K Health Conditions and Status %K Healthcare %K Public Policy %K Risk Taking %X Background . Existing research shows that residents exposed to neighborhood socioeconomic disadvantage (NSD) have a relatively high risk of some types of mental illness. This study investigated whether this pattern is present for depressive symptoms among persons in late middle age to extreme old age, and if so why. Investigated factors include: stressors (neighborhood physical disorder and financial strain) and psychosocial resources (mastery, social support, and religious service attendance). Age differences were examined. Methods . This was a secondary analysis of data from the 2006 and 2008 Health and Retirement Study Psychosocial Supplemental Assessment. The analytic sample included 8,623 adults aged 52 to 104, residing in 3216 urban neighborhoods (census tracts). NSD was operationalized with a principal component of Census tract indicators (education, poverty, public assistance, and unemployment). Depressive symptoms were measured by an 8-item version of the Center for Epidemiologic Studies Depression Scale. Hierarchical linear regression estimated multilevel models. Results . NSD was positively associated with depressive symptoms, net of individual-level demographic characteristics used to control for selection. Exposure to stressors partially explained the association; while psychosocial resources suppressed it. A significant, curvilinear cross-level interaction with age was found: NSD is positively associated with symptoms among those under 64, but has little effect among persons 65 to 74 year, and is negative at older ages. Conclusion . The mental health disparity for depressive symptoms in NSD is partially due to greater exposure to stressors and fewer resources to counteract this exposure. The counter-intuitive inverse association among the oldest adults warrants further investigation. %I University of California, Los Angeles %C United States -- California %V M.S. %P 104 %8 2012 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2693777921&Fmt=7&clientId=17822&RQT=309&VName=PQD %N AAT 1512042 %4 social environment %$ 69500 %! The Urban Neighborhood, Depressive Symptoms, and Age: Stress and Psychosocial Resources %0 Journal Article %J Research on Aging %D 2012 %T Use of Direct Versus Indirect Approaches to Measure Loneliness in Later Life %A Sharon Shiovitz-Ezra %A Liat Ayalon %K Health Conditions and Status %K Healthcare %X The aim of the current investigation was to compare a direct versus an indirect approach for measuring loneliness by comparing the one-item Center for Epidemiologic Studies Depression Scale, representing the direct approach, with the shortened version of the Revised UCLA Loneliness Scale, representing the indirect approach, using approximately 2,000 observations from the 2002 Health and Retirement Study. The authors artificially identified a cut point of 6 on the three-item Revised UCLA Loneliness Scale to potentially yield the most similar results to the single-item scale and demonstrate the best sensitivity and specificity. Nonetheless, a high rate of respondents (57 ) who reported being lonely on the direct item were classified as not lonely on the indirect scale. Inconsistency between the two approaches was also evident with regard to the associations between loneliness and age, as well as with education. These findings indicate that the different measures of loneliness provide a somewhat different picture of both the prevalence of loneliness and the characteristic of the people who suffer from it. PUBLICATION ABSTRACT %B Research on Aging %I 34 %V 34 %P 572 %G eng %N 5 %4 Gerontology And Geriatrics/depression/Loneliness/depression Symptoms/CES Depression Scale/CES Depression Scale/UCLA Loneliness Scale %$ 69608 %0 Journal Article %J Archives of Internal Medicine %D 2012 %T Use of the Medicare Posthospitalization Skilled Nursing Benefit in the Last 6 Months of Life %A Aragon, Katherine %A Kenneth E Covinsky %A Yinghui Miao %A W John Boscardin %A Flint, Lynn %K Healthcare %K Medicare/Medicaid/Health Insurance %X In the last 6 months of life, many older adults will experience a hospitalization, followed by a transfer to a skilled nursing facility (SNF) for additional care. We sought to examine patterns of Medicare posthospitalization SNF use in the last 6 months of life. We used data from the Health and Retirement Study, a longitudinal survey of older adults, linked to Medicare claims (January 1994 through December 2007). We determined the number of individuals 65 years or older at death who had used the SNF benefit in the last 6 months of life. We report demographic, social, and clinical correlates of SNF use. We examined the relationship between place of death and hospice use for those residing in nursing homes and the community before the last 6 months of life. The mean age at death among 5163 individuals was 82.8 years; 54.5 of the cohort were female, and 23.2 had resided in a nursing home. In total, 30.5 had used the SNF benefit in the last 6 months of life, and 9.2 had died while enrolled in the SNF benefit. The use of the SNF benefit was greater among patients who were 85 years or older, had at least a high school education, did not have cancer, resided in a nursing home, used home health services, and were expected to die soon (P .01 for all). Of community dwellers who had used the SNF benefit, 42.5 died in a nursing home, 10.7 died at home, 38.8 died in the hospital, and 8.0 died elsewhere. In contrast, of community dwellers who did not use the SNF benefit, 5.3 died in a nursing home, 40.6 died at home, 44.3 died in the hospital, and 9.8 died elsewhere. Almost one-third of older adults receive care in a SNF in the last 6 months of life under the Medicare posthospitalization benefit, and 1 in 11 elders will die while enrolled in the SNF benefit. Palliative care services should be incorporated into SNF-level care. %B Archives of Internal Medicine %I 172 %V 172 %P 1573 %G eng %N 20 %4 Medical Sciences/Medicare claims/Skilled Nursing Facilities/ economics/Skilled Nursing Facilities/ economics/HOSPITALIZATION/Palliative care/posthospitalization benefit %$ 69784 %R 10.1001/archinternmed.2012.4451 %0 Journal Article %J Res Aging %D 2011 %T BMI Trajectories During the Transition to Older Adulthood: Persistent, Widening, or Diminishing Disparities by Ethnicity and Education? %A Katrina M Walsemann %A Jennifer A Ailshire %X

Previous research has produced inconsistent results on whether education and ethnic disparities in body mass index (BMI) persist, widen, or diminish over time. The authors investigate how education and ethnicity, independently and conditionally, influence BMI trajectories during the transition to older adulthood. Employing random coefficient modeling, the authors analyzed eight biennial waves of data (1992-2006) from the Health and Retirement Study, a nationally representative longitudinal study of individuals born between 1931 and 1941. After adjusting for health behaviors and health status, education and ethnic disparities in BMI persisted for most groups, but narrowed between high-educated White men and both low-educated Hispanic men and high-educated Black men. As such, the findings generally support the persistent inequality interpretation. Therefore, even though interventions targeted at earlier points in the life course may be effective in reducing BMI disparities in later life, social and health policies directed at reducing obesity among older adults is also warranted.

%B Res Aging %I 33 %V 33 %P 286-311 %8 2011 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30089935?dopt=Abstract %4 Body mass index/Older people/Ethnicity/Education/Health behavior/Obesity/Aging %$ 62500 %R 10.1177/0164027511399104 %0 Journal Article %J Health Affairs %D 2011 %T Complex Medicare Advantage Choices May Overwhelm Seniors—Especially Those With Impaired Decision Making %A J. Michael McWilliams %A Afendulis, Christopher C. %A McGuire, Thomas G. %A Landon, Bruce E. %K Decision making %K Medicare %K Medicare claims data %X The proliferation of Medicare Advantage plans has given Medicare enrollees more choices, but these could be overwhelming for some, especially for those with impaired decision-making capabilities. We analyzed national survey data and linked Medicare enrollment data for the period 2004–07 to examine the effects on enrollment of expanded choices and benefits in the Medicare Advantage program. The availability of more plan options was associated with increased enrollment in Medicare Advantage when elderly Medicare beneficiaries chose from a limited number of plans—for example, fewer than fifteen plans. Enrollment was unchanged or decreased in Medicare Advantage when beneficiaries chose from larger numbers of plans—for example, fifteen to thirty, or more than thirty. Elderly adults with low cognitive function were less responsive to the generosity of available benefits than those with high cognitive function when choosing between traditional Medicare and Medicare Advantage. Simplifying choices in Medicare Advantage could improve beneficiaries’ enrollment decisions, strengthen value-based competition among plans, and extend the benefits of choice to seniors with impaired cognition. It could also lower their out-of-pocket costs. %B Health Affairs %V 30 %P 1786-1794 %G eng %N 9 %R 10.1377/hlthaff.2011.0132 %0 Journal Article %J Journal of General Internal Medicine %D 2011 %T Conducting High-Value Secondary Dataset Analysis: An Introductory Guide and Resources %A John Z. Ayanian %A Kenneth E Covinsky %A Landon, Bruce E. %A Ellen P McCarthy %A Wee, Christina C. %A Michael A Steinman %K Datasets %K Meta-analyses %K Survey Methodology %X Secondary analyses of large datasets provide a mechanism for researchers to address high impact questions that would otherwise be prohibitively expensive and time-consuming to study. This paper presents a guide to assist investigators interested in conducting secondary data analysis, including advice on the process of successful secondary data analysis as well as a brief summary of high-value datasets and online resources for researchers, including the SGIM dataset compendium (www.sgim.org/go/datasets). The same basic research principles that apply to primary data analysis apply to secondary data analysis, including the development of a clear and clinically relevant research question, study sample, appropriate measures, and a thoughtful analytic approach. A real-world case description illustrates key steps: (1) define your research topic and question; (2) select a dataset; (3) get to know your dataset; and (4) structure your analysis and presentation of findings in a way that is clinically meaningful. Secondary dataset analysis is a well-established methodology. Secondary analysis is particularly valuable for junior investigators, who have limited time and resources to demonstrate expertise and productivity. %B Journal of General Internal Medicine %V 26 %P 920-929 %G eng %N 8 %R 10.1007/s11606-010-1621-5 %0 Journal Article %J Immun Ageing %D 2011 %T Cytomegalovirus antibodies in dried blood spots: a minimally invasive method for assessing stress, immune function, and aging. %A Jennifer B Dowd %A Allison E Aiello %A Laura Chyu %A Yuan-Yen Huang %A Thomas W McDade %X

BACKGROUND: Cytomegalovirus (CMV) is a prevalent herpesvirus with links to both stress and aging. This paper describes and validates a minimally invasive method for assessing antibodies against CMV in finger stick whole blood spot samples for use as an indirect marker of an aspect of cell-mediated immunity.

RESULTS: Analysis of CMV in dried blood spot samples (DBS) was based on modifications of a commercially available protocol for quantifying CMV antibodies in serum or plasma. The method was evaluated through analysis of precision, reliability, linearity, and correlation between matched serum and DBS samples collected from 75 volunteers. Correlation between DBS and plasma values was linear and high (Pearson correlation R = .96), and precision, reliability, and linearity of the DBS assay were within acceptable ranges.

CONCLUSIONS: The validity of a DBS assay for CMV antibodies will enable its inclusion in population-based surveys and other studies collecting DBS samples in non-clinical settings, increasing scientific understanding of the interaction of social and biological stress and immune function.

%B Immun Ageing %I 8 %V 8 %P 3 %8 2011 Jan 13 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21232134?dopt=Abstract %2 PMC3031243 %4 Biomarker data %$ 62800 %R 10.1186/1742-4933-8-3 %0 Journal Article %J Int J Health Care Finance Econ %D 2011 %T Education and health: evidence on adults with diabetes. %A Padmaja Ayyagari %A Grossman, Daniel %A Frank A Sloan %K Aged %K Cognition %K Cross-Sectional Studies %K Diabetes Complications %K Diabetes Mellitus %K Female %K Health Behavior %K Health Knowledge, Attitudes, Practice %K Health Services %K Humans %K Male %K Patient Education as Topic %K Self Efficacy %K Sex Factors %K Socioeconomic factors %K Time Factors %X

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

%B Int J Health Care Finance Econ %I 11 %V 11 %P 35-54 %8 2011 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21213044?dopt=Abstract %3 21213044 %4 Cognition/Cross-Sectional Studies/Diabetes Complications/epidemiology/Diabetes Complications/epidemiology/Diabetes Mellitus/ epidemiology/ psychology/Diabetes Mellitus/ epidemiology/ psychology/Female/Health Behavior/Health Knowledge, Attitudes, Practice/Health Knowledge, Attitudes, Practice/Health Services/ utilization/Health Services/ utilization/Humans/Patient Education as Topic/ statistics/Patient Education as Topic/ statistics/numerical data/Self Efficacy/Self Efficacy/Sex Factors/Socioeconomic Factors/Time Factors %$ 62782 %R 10.1007/s10754-010-9087-x %0 Journal Article %J J Health Econ %D 2011 %T The effect of job loss on overweight and drinking. %A Deb, Partha %A William T Gallo %A Padmaja Ayyagari %A Jason M. Fletcher %A Jody L Sindelar %K Alcohol Drinking %K Body Mass Index %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Overweight %K Unemployment %K United States %X

This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g., layoffs). We improve upon this literature using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data from the Health and Retirement Study. For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. These results suggest the health effects of job loss could be concentrated among "at risk" individuals and could lead to negative outcomes for the individuals, their families, and society at large.

%B J Health Econ %I 30 %V 30 %P 317-27 %8 2011 Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21288586?dopt=Abstract %2 PMC3086369 %4 Job loss/Drinking/Business closings/Finite mixture models %$ 25370 %R 10.1016/j.jhealeco.2010.12.009 %0 Journal Article %J JAMA %D 2011 %T The evolution of advance directives. %A Douglas B. White %A Robert M. Arnold %K Advance directives %K Cost Savings %K Decision making %K Health Expenditures %K Humans %K Medicare %K Palliative care %K Terminal Care %K United States %B JAMA %I 306 %V 306 %P 1485-6 %8 2011 Oct 05 %G eng %N 13 %1 http://www.ncbi.nlm.nih.gov/pubmed/21972313?dopt=Abstract %3 21972313 %4 Medicare/Advance directives/Medical technology/Health care expenditures %$ 62612 %R 10.1001/jama.2011.1430 %0 Journal Article %J Soc Sci Med %D 2011 %T Job loss and depression: the role of subjective expectations. %A Mandal, Bidisha %A Padmaja Ayyagari %A William T Gallo %K Adaptation, Psychological %K Aged %K Bias %K depression %K Empirical Research %K Health Surveys %K Humans %K Mental Health %K Middle Aged %K Stress, Psychological %K Unemployment %K United States %X

Although the importance of expectations is well documented in the decision-making literature, a key shortcoming of the empirical research into effects of involuntary job loss on depression is perhaps its neglect of the subjective expectations of job loss. Using data from the US Health and Retirement Study surveys we examine whether the impact of job loss on mental health is influenced by an individual's subjective expectations regarding future displacement. Our results imply that, among older workers in the age range of 55-65 year, subjective expectations are as significant predictors of depression as job loss itself, and ignoring them can bias the estimate of the impact of job loss on mental health.

%B Soc Sci Med %I 72 %V 72 %P 576-83 %8 2011 Feb %G eng %N 4 %L newpubs20110418_Mandal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21183267?dopt=Abstract %2 PMC3684950 %4 Expectations/Older workers/Mental depression/Decision making/Impact analysis/Estimation bias/Mental health %$ 24690 %R 10.1016/j.socscimed.2010.11.014 %0 Journal Article %J Race Soc Probl %D 2011 %T Job Strain, Workplace Discrimination, and Hypertension among Older Workers: The Health and Retirement Study. %A Briana Mezuk %A Kershaw, Kiarri %A Hudson, Darrell %A Ah, Kyuang %A Scott M Ratliff %X

Job strain has been associated with hypertension among younger workers; however, whether this relationship persists among older workers, particularly older racial/ethnic minorities, is unresolved. This study evaluated whether job strain and workplace discrimination are associated with hypertension and poor blood pressure control among older workers and whether these relationships vary by gender and race/ethnicity. Data were drawn from the Health and Retirement Study, and analysis was restricted to employed participants with complete information on job strain and blood pressure (N = 3,794). In adjusted models, high job strain was associated with lower likelihood of hypertension (odds ratio (OR): 0.75, 95% confidence interval (CI): 0.63, 0.89) relative to low job strain. Stratified analyses indicated this association was only significant among white (OR: 0.71, 95% CI: 0.58, 0.86) and male (OR: 0.61, 95% CI: 0.47, 0.79) workers. High job strain was not significantly associated with hypertension among African American (OR: 1.14, 95% CI: 0.63, 2.07) or Hispanic (OR: 0.56, 95% CI: 0.29, 1.09) workers. Workplace discrimination was not associated with hypertension among any group. Neither job strain nor discrimination was associated with poor blood pressure control. These findings suggest that persistence in work characterized by high job strain in later life may signal resilience to the influence of work-related stressors on health. Future research efforts should examine the factors that contribute to gender and racial differences in these relationships.

%B Race Soc Probl %I 3 %V 3 %P 38-50 %8 2011 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/22096475?dopt=Abstract %4 job strain/Discrimination %$ 26220 %R 10.1007/s12552-011-9041-7 %0 Journal Article %J Am J Public Health %D 2011 %T Mortgage delinquency and changes in access to health resources and depressive symptoms in a nationally representative cohort of Americans older than 50 years. %A Dawn E Alley %A Jennifer Lloyd %A José A Pagán %A Craig E Pollack %A Michelle Shardell %A Carolyn Cannuscio %K depression %K Drug Costs %K Economic Recession %K Female %K Health Services Accessibility %K Health Status %K Housing %K Humans %K Male %K Medication Adherence %K Middle Aged %K Socioeconomic factors %K Stress, Psychological %K United States %X

OBJECTIVES: We evaluated associations between mortgage delinquency and changes in health and health-relevant resources over 2 years, with data from the Health and Retirement Study, a longitudinal survey representative of US adults older than 50 years.

METHODS: In 2008, participants reported whether they had fallen behind on mortgage payments since 2006 (n = 2474). We used logistic regression to compare changes in health (incidence of elevated depressive symptoms, major declines in self-rated health) and access to health-relevant resources (food, prescription medications) between participants who fell behind on their mortgage payments and those who did not.

RESULTS: Compared with nondelinquent participants, the mortgage-delinquent group had worse health status and less access to health-relevant resources at baseline. They were also significantly more likely to develop incident depressive symptoms (odds ratio [OR] = 8.60; 95% confidence interval [CI] = 3.38, 21.85), food insecurity (OR = 7.53; 95% CI = 3.01, 18.84), and cost-related medication nonadherence (OR = 8.66; 95% CI = 3.72, 20.16) during follow-up.

CONCLUSIONS: Mortgage delinquency was associated with significant elevations in the incidence of mental health impairments and health-relevant material disadvantage. Widespread mortgage default may have important public health implications.

%B Am J Public Health %I 101 %V 101 %P 2293-8 %8 2011 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/22021301?dopt=Abstract %2 PMC3222434 %R 10.2105/AJPH.2011.300245 %0 Journal Article %J Alzheimers Dement %D 2011 %T Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment-Part 2. %A Seshadri, Sudha %A Alexa S. Beiser %A Au, Rhoda %A Philip A Wolf %A Robert S Wilson %A Ronald C Petersen %A David S Knopman %A Walter A Rocca %A Claudia H Kawas %A Maria M Corrada %A Brenda L Plassman %A Kenneth M. Langa %A Helena C Chui %K Age Factors %K Aging %K Alzheimer disease %K Cognition Disorders %K Community Health Planning %K Humans %K Incidence %K Longitudinal Studies %K Neuropsychological tests %K Prevalence %K United States %X

This article focuses on the effects of operational differences in case ascertainment on estimates of prevalence and incidence of cognitive impairment and/or dementia of the Alzheimer type. Experience and insights are discussed by investigators from the Framingham Heart Study, the East Boston Senior Health Project, the Chicago Health and Aging Project, the Mayo Clinic Study of Aging, the Baltimore Longitudinal Study of Aging, and the Aging, Demographics, and Memory Study. There is a general consensus that the single most important factor determining prevalence estimates of Alzheimer's disease (AD) is the severity of cognitive impairment used as a threshold to define cases. Studies that require a level of cognitive impairment in which persons are unable to provide self-care will have much lower estimates than the studies aimed at identifying persons in the earliest stages of AD. There are limited autopsy data from the aforementioned epidemiological studies to address accuracy in the diagnosis of etiological subtype, namely the specification of AD alone or in combination with other types of pathology. However, other community-based cohort studies show that many persons with mild cognitive impairment and also some persons without dementia or mild cognitive impairment meet pathological criteria for AD, thereby suggesting that the number of persons who would benefit from an effective secondary prevention intervention is probably higher than the published prevalence estimates. Improved accuracy in the clinical diagnosis of AD is anticipated with the addition of molecular and structural biomarkers in the next generation of epidemiological studies.

%B Alzheimers Dement %I 7 %V 7 %P 35-52 %8 2011 Jan %G eng %N 1 %L newpubs20110328_Seshadri.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21255742?dopt=Abstract %2 PMC3039838 %4 Alzheimer disease/cognitive Impairment/PREVALENCE/Incidence/Dementia %$ 24570 %R 10.1016/j.jalz.2010.12.002 %0 Journal Article %J Forum for Health Economics and Policy %D 2011 %T Potential Enhancements to Data on Health Insurance, Health Services, and Medicare in the Health and Retirement Study %A John Z. Ayanian %A Meara, Ellen %A J. Michael McWilliams %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Methodology %X As a nationally representative cohort of middle-aged and elderly adults with longitudinal data spanning nearly two decades, the Health and Retirement Study (HRS) is an important resource for researchers studying the dynamics of health insurance coverage in the United States and the relation of insurance coverage to the use of health services and to health outcomes. We assessed the strengths and limitations of currently available HRS data for such research, focusing on survey items in these domains and Medicare claims data that have been linked to HRS survey data. The process for researchers to obtain Medicare claims has greatly improved in recent years. The additions of biomarkers (e.g. blood pressure and serum cholesterol) and objective measures of physical functioning for HRS participants have also been notable improvements. We propose changes to the HRS to enhance its value for health services research, particularly regarding the effects of health care reform as the Patient Protection and Affordable Care Act of 2010 is implemented over the next decade. %B Forum for Health Economics and Policy %I 14 %V 14 %P Article 3 %G eng %N 3 %L newpubs20110418_Ayanian.pdf %4 health Insurance/health Services/Biomarker data/medicare/mid-term review/mid-term review/Methodology %$ 25120 %R 10.2202/1558-9544.1262 %0 Journal Article %J J Aging Res %D 2011 %T Psychosocial Factors Associated with Longevity in the United States: Age Differences between the Old and Oldest-Old in the Health and Retirement Study. %A Jennifer A Ailshire %A Eileen M. Crimmins %X

Recent growth in the number of adults surviving to advanced ages raises questions about the quality of life associated with increased longevity. Psychosocial factors have received relatively little attention in research on quality of life among the oldest-old. This study uses nationally representative data on older US adults to examine how social relationships, feelings of loneliness, and satisfaction with life and the aging experience differ between the oldest-old, those who have survived to age 90 or older, and older adults in their 70s. We find that the oldest-old are able to maintain social relationships with family and friends and receive more social support than younger elderly adults. Yet, the oldest-old are more likely to feel lonely due to their greater rates of widowhood. Satisfaction with life was higher among the oldest-old, but the oldest-old had more negative perceptions of the aging experience. Psychosocial dimensions of longevity should be considered in research on quality of life among the oldest-old.

%B J Aging Res %I 2011 %V 2011 %P 530534 %8 2011 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/22028969?dopt=Abstract %2 PMC3199053 %R 10.4061/2011/530534 %0 Journal Article %J Aging Ment Health %D 2011 %T The relationships between major lifetime discrimination, everyday discrimination, and mental health in three racial and ethnic groups of older adults. %A Liat Ayalon %A Amber M Gum %K Adaptation, Psychological %K Aged %K Aged, 80 and over %K Asian %K Black or African American %K Cross-Cultural Comparison %K depression %K Discrimination, Psychological %K ethnicity %K Hispanic or Latino %K Humans %K Longitudinal Studies %K Mental Health %K Middle Aged %K Personal Satisfaction %K Prejudice %K Prevalence %K Social Perception %K Socioeconomic factors %K Surveys and Questionnaires %K United States %K White People %X

OBJECTIVES: To evaluate the relationships between perceived exposure to major lifetime discrimination, everyday discrimination, and mental health in three racial/ethnic groups of older adults.

DESIGN: The Health and Retirement Study is a nationally representative sample of individuals 50 years and older living in the United States. A total of 6455 Whites, 716 Latinos, and 1214 Blacks were eligible to complete a self-report psychosocial questionnaire in the year 2006.

RESULTS: Whereas 30% of the general population reported at least one type of major lifetime discrimination, almost 45% of Black older adults reported such discrimination. Relative to the other two racial/ethnic groups (82% Whites, 82.6% Blacks), Latinos were significantly less likely to report any everyday discrimination (64.2%), whereas Blacks reported the greatest frequency of everyday discrimination. Whites reported the highest levels of life satisfaction and the lowest levels of depressive symptoms. Relative to major lifetime discrimination, everyday discrimination had a somewhat stronger correlation with mental health indicators. The relationships between discrimination and mental health outcomes were stronger for White compared to Black older adults, although everyday discrimination was still significantly associated with outcomes for Black older adults.

CONCLUSIONS: Black older adults experience the greatest number of discriminative events, but weaker associated mental health outcomes. This could be because they have become accustomed to these experiences, benefit from social or cultural resources that serve as buffers, or selective survival, with the present sample capturing only the most resilient older adults who have learned to cope with the deleterious effects of discrimination.

%B Aging Ment Health %I 15 %V 15 %P 587-94 %8 2011 Jul 01 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21815851?dopt=Abstract %3 21815851 %4 Adaptation, Psychological/African Americans/psychology/statistics/African Americans/psychology/statistics/numerical data/Aged, 80 and over/Asian Americans/psychology/statistics/Asian Americans/psychology/statistics/numerical data/Cross-Cultural Comparison/Cross-Cultural Comparison/Depression/ethnology/Depression/ethnology/Discrimination (Psychology)/Discrimination (Psychology)/Ethnic Groups/ psychology/statistics/Ethnic Groups/ psychology/statistics/numerical data/European Continental Ancestry Group/psychology/statistics/European Continental Ancestry Group/psychology/statistics/numerical data/Hispanic Americans/psychology/statistics/Hispanic Americans/psychology/statistics/numerical data/Humans/Longitudinal Studies/Mental Health/ ethnology/statistics/Mental Health/ ethnology/statistics/numerical data/Middle Aged/Personal Satisfaction/Personal Satisfaction/Prejudice/Prejudice/Prevalence/Questionnaires/Social Perception/Social Perception/Socioeconomic Factors/United States/epidemiology/United States/epidemiology %$ 62728 %R 10.1080/13607863.2010.543664 %0 Journal Article %J J Am Geriatr Soc %D 2011 %T Social characteristics and health status of exceptionally long-lived Americans in the Health and Retirement Study. %A Jennifer A Ailshire %A Hiram Beltrán-Sánchez %A Eileen M. Crimmins %K Age Factors %K Aged, 80 and over %K Female %K Geriatric Assessment %K Health Status %K Humans %K Longevity %K Longitudinal Studies %K Male %K Social Class %K Sociology %K United States %X

OBJECTIVES: To characterize the social characteristics and physical, functional, mental, and cognitive health of exceptional survivors in the United States and how the experience of exceptional longevity differs according to social status.

DESIGN: Nationally representative longitudinal study of older Americans.

SETTING: United States.

PARTICIPANTS: One thousand six hundred forty-nine men and women born from 1900 to 1911 from the Health and Retirement Study: 1,424 nonsurvivors who died before reaching the age of 97 and 225 exceptional survivors who survived to age 97 and older.

MEASUREMENTS: Self-reported data on sociodemographic characteristics, social environment, physical and mental health, and physical and cognitive function.

RESULTS: At baseline, exceptional survivors were more likely to live independently and had fewer diseases, better mental health, and better physical and cognitive function than those who did not survive to age 97. Exceptional survivors experienced declines from baseline in all health domains upon reaching 97 years of age, but between one-fifth and one-third of exceptional survivors remained disease free, with no functional limitations or depressive symptoms, and one-fifth retained high cognitive function. Of exceptional survivors, men were healthier than women, and whites were generally healthier than nonwhites. Highly educated exceptional survivors had better cognitive function than their less-educated counterparts.

CONCLUSION: On average, exceptional survivors are relatively healthy and high functioning for most of their lives and experience health declines only upon reaching maximum longevity. Heterogeneity in the population of exceptionally old adults indicates that, although many individuals reach maximum longevity in a state of poor health and functioning, a considerable portion of exceptional survivors remain healthy and high-functioning even in very old age.

%B J Am Geriatr Soc %I 59 %V 59 %P 2241-8 %8 2011 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/22188072?dopt=Abstract %2 PMC3470876 %R 10.1111/j.1532-5415.2011.03723.x %0 Journal Article %J The Economic JournalThe Economic Journal %D 2011 %T Technical Progress and Early Retirement* %A Ahituv, Avner %A Zeira, Joseph %K Early retirement %K erosion effect %K Technology %K wage effect %X This article examines the effect of sector technical change on early retirement and identifies two opposing effects. One is caused by the need to learn the new technologies. As older workers have shorter career horizons, they gain less from such learning and retire earlier. This is the erosion effect. The second effect is opposite. Since technologies are positively correlated across sectors and since aggregate technical change raises aggregate wages, sector technical change is negatively related to early retirement. This is the wage effect. Using individual and sector data, we separate the two effects and find empirical support for the theory. %B The Economic JournalThe Economic Journal %V 121 %P 171 - 193 %@ 0013-0133 %G eng %N 551 %R 10.1111/j.1468-0297.2010.02392.x %0 Journal Article %J J Health Soc Behav %D 2011 %T The urban neighborhood and cognitive functioning in late middle age. %A Carol S Aneshensel %A Michelle J Ko %A Joshua Chodosh %A Richard G Wight %K Activities of Daily Living %K Age Factors %K Aged %K Aging %K Chi-Square Distribution %K Cognition %K Cognition Disorders %K ethnicity %K Female %K Health Status Disparities %K Humans %K Male %K Middle Aged %K Psychometrics %K Residence Characteristics %K Risk Factors %K Socioeconomic factors %K United States %K Urban Population %X

This study examines the association of cognitive functioning with urban neighborhood socioeconomic disadvantage and racial/ethnic segregation for a U.S. national sample of persons in late middle age, a time in the life course when cognitive deficits begin to emerge. The key hypothesis is that effects of neighborhood on cognitive functioning are not uniform but are most pronounced among subgroups of the population defined by socioeconomic status and race/ethnicity. Data are from the third wave of the Health and Retirement Survey for the birth cohort of 1931 to 1941, which was 55 to 65 years of age in 1996 (analytic N = 4,525), and the 1990 U.S. Census. Neighborhood socioeconomic disadvantage has an especially large negative impact on cognitive functioning among persons who are themselves poor, an instance of compound disadvantage. These findings have policy implications supporting "upstream" interventions to enhance cognitive functioning, especially among those most adversely affected by neighborhood socioeconomic disadvantage.

%B J Health Soc Behav %I 52 %V 52 %P 163-79 %8 2011 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21673145?dopt=Abstract %2 PMC3152319 %4 Segregation/Cognitive ability/Cognition/reasoning %$ 62634 %R 10.1177/0022146510393974 %0 Journal Article %J Res Aging %D 2011 %T Urban Neighborhoods and Depressive Symptoms in Late Middle Age. %A Richard G Wight %A Michelle J Ko %A Carol S Aneshensel %X

This study examines associations between multiple urban neighborhood characteristics (socioeconomic disadvantage, affluence, and racial/ethnic composition) and depressive symptoms among late middle aged persons and compares findings to those previously obtained for persons age 70 years and older. Survey data are from the Health and Retirement Study (HRS), a U.S. national probability sample of noninstitutionalized persons aged 51 to 61 years in 1992. Neighborhoods are 1990 U.S. census tracts. Hierarchical linear regression is used to estimate multilevel models. Depressive symptoms vary significantly across urban neighborhoods among late middle age persons. Neighborhood socioeconomic disadvantage is significantly associated with depressive symptoms, net of both individual-level sociodemographic and health variables. However, this association is contingent upon individual-level wealth in that persons with low wealth in the most disadvantaged neighborhoods report the most depressive symptoms. Unlike findings for older adults for whom neighborhood effects appear to be entirely compositional in nature, neighborhood context matters to subgroups of late middle age adults.

%B Res Aging %I 33 %V 33 %P 28-50 %8 2011 Jan 01 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21572903?dopt=Abstract %2 PMC3092717 %4 Neighborhoods/Middle age/Urban Population/Urban areas/Mental depression/Socioeconomic factors/Polls and surveys %$ 24530 %R 10.1177/0164027510383048 %0 Journal Article %J Acta Med Port %D 2010 %T [The association between self-rated health and health care utilization in retired]. %A F Aloísio Pimenta %A Santos Amaral, Carlos %A Da Gama Torres, Henrique %A Rezende, Nilton %K Delivery of Health Care %K Health Status %K Humans %K Self Concept %X

OBJECTIVE: This article attests the association between self-rated health and health care utilization in a retired population by a narrative review.

METHOD: A systematic review was carried out from 1967 to 2007 to identify studies on self-rated health, in the databases MEDLINE, LILACS e SCIELO. The OVID software was used to Medline research. Contacts with experts were used. The key words retirement, self-rated health, health care utilization and narrative review were used in Portuguese, Spanish and English versions. Al the abstracts were analyzed, but only trials that associated self-rated health in retirement and health care utilization were fully analyzed.

RESULTS: Thirty one out of 443 abstracts were selected to be fully analyzed. Current data indicates that health deterioration, poor self-rated health and increased health care utilization are associated with early retirement, due to disability, but not with individuals who worked until retirement by age.

CONCLUSION: Retirement is probably associated with increased public expenses and increased health care utilization in retired with a poor self-rated health.

%B Acta Med Port %I 23 %V 23 %P 101-6 %8 2010 Jan-Feb %G por %U https://pubmed.ncbi.nlm.nih.gov/20353712/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/20353712?dopt=Abstract %3 20353712 %4 health Care Utilization/SELF-RATED HEALTH/DISABILITY/DISABILITY/retirement/meta-analysis %$ 22420 %0 Journal Article %J Health Insurance Law Weekly %D 2010 %T Dentistry; Research conducted at University of Maryland has provided new information about dentistry %A Anonymous %K Healthcare %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X 2010 APR 18 - ( http://www.newsrx.com NewsRx.com) -- In this recent study, researchers in the United States conducted a study To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS) (see also http://www.newsrx.com/library/topics/Dentistry.html Dentistry). We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. %B Health Insurance Law Weekly %P 50 %G eng %4 health Insurance/dental Care/retirement status %$ 22360 %0 Journal Article %J Neurology %D 2010 %T Depressive symptoms predict incident stroke independently of memory impairments. %A M. Maria Glymour %A J Maselko %A Gilman, S E %A Kristen K Patton %A Mauricio Avendano %K Aged %K Aged, 80 and over %K depression %K Female %K Health Surveys %K Humans %K Incidence %K Kaplan-Meier Estimate %K Longitudinal Studies %K Male %K Memory Disorders %K Middle Aged %K Neuropsychological tests %K Predictive Value of Tests %K Risk Factors %K Statistics, Nonparametric %K Stroke %K United States %X

BACKGROUND: We evaluated whether depressive symptoms predict the onset of first stroke independently of memory impairment. We conceptualized memory impairment as a marker of preexisting cerebrovascular disease. We hypothesized that if depressive symptoms are causally related to stroke through mechanisms unrelated to cerebrovascular disease, depressive symptoms should predict stroke independently of memory impairment.

METHODS: Incidence of first stroke was assessed with self or proxy reports from 19,087 participants in the Health and Retirement Study cohort (1,864 events). Elevated depressive symptoms (3+ on an 8-item Centers for the Epidemiologic Study of Depression scale) and memory impairment (score of ≤6 on a combined immediate and delayed recall of a 10-word list) were used as predictors of incident stroke in Cox survival models with adjustment for sociodemographic and cardiovascular risk factors.

RESULTS: After adjustment for sociodemographic and cardiovascular risk factors, elevated depressive symptoms (hazard ratio = 1.25; 95% confidence interval 1.12-1.39) and memory impairment (hazard ratio = 1.26; 95% confidence interval 1.13-1.41) each predicted stroke incidence in separate models. Hazard ratios were nearly unchanged and remained significant (1.23 for elevated depressive symptoms and 1.25 for memory impairment) when models were simultaneously adjusted for both elevated depressive symptoms and memory impairment. Elevated depressive symptoms also predicted stroke when restricting analyses to individuals with median memory score or better.

CONCLUSIONS: Memory impairments and depressive symptoms independently predict stroke incidence. Memory impairment may reflect undiagnosed cerebrovascular disease. These results suggest that depressive symptoms might be directly related to stroke rather than merely indicating preexisting cerebrovascular disease.

%B Neurology %I 75 %V 75 %P 2063-70 %8 2010 Dec 07 %G eng %N 23 %1 http://www.ncbi.nlm.nih.gov/pubmed/21135381?dopt=Abstract %2 PMC2995534 %4 Aged, 80 and over/Depression/ etiology/Depression/ etiology/Female/Health Surveys/Humans/Incidence/Kaplan-Meier Estimate/Kaplan-Meier Estimate/Longitudinal Studies/Memory Disorders/complications/ epidemiology/Memory Disorders/complications/ epidemiology/Middle Aged/Neuropsychological Tests/Predictive Value of Tests/Predictive Value of Tests/Risk Factors/Statistics, Nonparametric/Statistics, Nonparametric/Stroke/ complications/ epidemiology/Stroke/ complications/ epidemiology/United States/epidemiology/United States/epidemiology %$ 62788 %R 10.1212/WNL.0b013e318200d70e %0 Report %D 2010 %T Does Retirement Affect Cognitive Functioning? %A Bonsang, Eric %A Adam, Stéphane %A Perelman, Sergio %K Cross-National %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %X This paper analyzes the effect of retirement on cognitive functioning using two large scale surveys. On the one hand the HRS, a longitudinal survey among individuals aged 50 living in the United States, allows us to control for individual heterogeneity and endogeneity of the retirement decision by using the eligibility age for Social Security as an instrument. On the other hand, a comparable international European survey, SHARE, allows us to identify the causal effect of retirement on cognitive functioning by using the cross-country differences in the age-pattern of retirement. The results highlight in both cases a significant negative, and quantitatively comparable, effect of retirement on cognitive functioning. Our results suggest that promoting labor force participation of older workers is not only desirable to insure the viability of retirement schemes, but it could also delay cognitive decline, and thus the occurrence of associated impairments at older age. %I Maastricht: METEOR %G eng %U http://econpapers.repec.org/paper/dgrumamet/2010005.htm %L newpubs20100729_Bonsang.pdf %4 Cognition/SHARE/retirement Planning/labor Force Participation/Cognitive decline %$ 22980 %0 Book Section %B Research Findings in the Economics of Aging %D 2010 %T Education and the Prevalence of Pain %A Atlas, Steven J. %A Jonathan S Skinner %E David A Wise %K Demographics %K Disabilities %K Healthcare %X Many Americans report chronic and disabling pain, even in the absence of identifiable clinical disorders. We first examine the prevalence of pain in the older U.S. population using the Health and Retirement Study (HRS). Among 50-59 year females, for example, pain rates ranged from 26 percent for college graduates to 55 percent for those without a high school degree. Occupation, industry, and marital status attenuated but did not erase these educational gradients. Second, we used a study of patients with lower back pain and sciatica arising from intervertebral disk herniation (IDH). Initially, nearly all patients reported considerable pain and discomfort, with a sizeable fraction undergoing surgery for their IDH. However, baseline severity measures and surgical or medical treatment explained little of the variation in 10-year outcomes. By contrast, education exerted a strong impact on changes over time in pain: just 9 percent of college graduates report leg or back pain always or almost always after 10 years, compared to 34 percent for people without a high school degree. This close association of education with pain is consistent with recent research emphasizing the importance of neurological -- and perhaps economic -- factors in the perception of pain. %B Research Findings in the Economics of Aging %S National Bureau of Economic Research conference report %I University of Chicago Press %C Chicago %P 145-166 %G eng %4 EDUCATION/DISABILITY/DISABILITY/lower back pain/socioeconomic Status %$ 24140 %! Education and the Prevalence of Pain %& 6 %R 10.3386/w14964 %0 Journal Article %J J Aging Soc Policy %D 2010 %T An examination of older immigrants' use of dental services in the United States. %A Christina N Anderson %A Hyungsoo Kim %K Age Factors %K Aged %K Dental Care for Aged %K Educational Status %K Emigrants and Immigrants %K Female %K Health Services Accessibility %K Humans %K Insurance, Dental %K Logistic Models %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Multivariate Analysis %K Sex Factors %K Socioeconomic factors %K United States %X

The recent influx of immigrants aged 65 and older in the United States triggers an increasing need to understand older immigrants' dental services use. This paper uses data (n = 9,617) from the 2004 and 2006 waves of the Health and Retirement Study to examine the dental services use of older Americans. In particular, this study focuses on differences in dental services use between immigrants and natives and potential contributing factors. Multivariate logistic regression analyses showed, contrary to expectation, that older immigrants were more likely to use dental services than older natives despite numerous barriers (odds ratio = 1.30 in 2004). The results in 2006 confirmed these findings. The results from 2004 and 2006 analyses showed dental insurance coverage, sex, and marital status were associated differently with dental services use for immigrants and natives. Implications for current oral health policies and future research of older Americans are discussed, as well as methods for meeting older immigrants' growing dental services needs.

%B J Aging Soc Policy %I 22 %V 22 %P 18-32 %8 2010 Jan %G eng %N 1 %L newpubs20100129_Anderson.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20390710?dopt=Abstract %3 20390710 %4 Immigrants/Dental Care %$ 21730 %R 10.1080/08959420903385593 %0 Journal Article %J Journal of Financial Planning %D 2010 %T Financial Literacy Lacking Among Older Population %A Anonymous %K Demographics %K Net Worth and Assets %K Other %X A new look at the financial literacy and sophistication of people 55 and older reveals the need for educational efforts targeted to specific demographics. Financial Literacy and Financial Sophistication in the Older Population: Evidence from the 2008 HRS, a University of Michigan Retirement Research Center working paper by Annamaria Lusardi, Olivia S. Mitchell, and Vilsa Curto, analyzes new data on financial literacy from the University of Michigan's 2008 Health and Retirement Study. According to the authors, their research suggests it may be particularly important to build retirement human capital through seminars, educational programs, and retirement planning products. %B Journal of Financial Planning %I 23 %V 23 %P 14 %G eng %N 2 %4 Financial literacy/Older people/Research %$ 22900 %0 Journal Article %J B E J Econom Anal Policy %D 2010 %T The Impact of Job Stress on Smoking and Quitting: Evidence from the HRS. %A Padmaja Ayyagari %A Jody L Sindelar %X

Job-related stress might affect smoking behavior because smoking may relieve stress and stress can make individuals more present-focused. Alternatively, individuals may both self-select into stressful jobs and choose to smoke based on unobserved factors. We use data from the Health and Retirement Study to examine how job stress affects the probability that smokers quit and the number of cigarettes smoked for current smokers. To address the potential endogeneity of job stress based on time invariant factors, we include individual fixed effects, which control for factors such as ability to handle stress. Occupational fixed effects are also included to control for occupational characteristics other than stress; time dummies control for the secular decline in smoking rates. Using a sample of people who smoked in the previous wave, we find that job stress is positively related to continuing to smoke among recent smokers. The results indicate that the key impact of stress is on the extensive margin of smoking, as opposed to the number of cigarettes smoked.

%B B E J Econom Anal Policy %I 10 %V 10 %8 2010 Jan 01 %G eng %U http://www.bepress.com/bejeap/vol10/iss1/art27 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21625286?dopt=Abstract %2 PMC3103224 %4 Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Job Satisfaction/Health/Stress/Smoking %$ 23160 %R 10.2202/1935-1682.2259 %0 Journal Article %J Am J Public Health %D 2010 %T The longevity gap between Black and White men in the United States at the beginning and end of the 20th century. %A Frank A Sloan %A Padmaja Ayyagari %A Salm, Martin %A Grossman, Daniel %K Aged %K Black or African American %K Health Status Disparities %K Humans %K Longevity %K Longitudinal Studies %K Male %K Men's health %K Middle Aged %K Mortality %K Proportional Hazards Models %K Survival Analysis %K United States %K Veterans %K White People %X

OBJECTIVES: We sought to assess whether the disparity in mortality rates between Black and White men decreased from the beginning to the end of the 20th century.

METHODS: We used Cox proportional hazard models for mortality to estimate differences in longevity between Black and White Civil War veterans from 1900 to 1914 (using data from a pension program) and a later cohort of male participants (using data from the 1992 to 2006 Health and Retirement Study). In sensitivity analysis, we compared relative survival of veterans for alternative baseline years through 1914.

RESULTS: In our survival analysis, the Black-White male difference in mortality, both unadjusted and adjusted for other influences, did not decrease from the beginning to the end of the 20th century. A 17% difference in Black-White mortality remained for the later cohort even after we controlled for other influences. Although we could control for fewer other influences on longevity, the Black-White differences in mortality for the earlier cohort was 18%.

CONCLUSIONS: In spite of overall improvements in longevity, a major difference in Black-White male mortality persists.

%B Am J Public Health %I 100 %V 100 %P 357-63 %8 2010 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20019309?dopt=Abstract %2 PMC2804648 %4 African Americans/European Continental Ancestry Group/Health Status Disparities/Longevity/Longitudinal Studies/Mens Health: ethnology/Middle Aged/Mortality: ethnology/Mortality: trends/Proportional Hazards Models/Survival Analysis/United States: epidemiology/Veterans: statistics and numerical data %$ 22190 %R 10.2105/AJPH.2008.158188 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2010 %T Physical health and depression: a dyadic study of chronic health conditions and depressive symptomatology in older adult couples. %A Brian J Ayotte %A Frances Margaret Yang %A Richard N Jones %K Age Factors %K Aged %K Chi-Square Distribution %K Chronic disease %K Cohort Studies %K depression %K Female %K Health Status %K Humans %K Hypertension %K Least-Squares Analysis %K Male %K Marriage %K Middle Aged %K Psychiatric Status Rating Scales %K Risk Factors %K Sex Factors %K Socioeconomic factors %K Spouses %K Stroke %X

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

%B J Gerontol B Psychol Sci Soc Sci %V 65 %P 438-48 %8 2010 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20498455?dopt=Abstract %2 PMC2883871 %4 Chronic Disease/depression/Stroke/Stress/Sex Differences %$ 22560 %R 10.1093/geronb/gbq033 %0 Journal Article %J Psychol Assess %D 2010 %T The Process of Retirement Planning Scale (PRePS): development and validation. %A Jack H Noone %A Christine Stephens %A Fiona M. Alpass %K Age Factors %K Aged %K Educational Status %K Factor Analysis, Statistical %K Female %K Financing, Personal %K Goals %K Health Status %K Humans %K Internal-External Control %K Male %K Middle Aged %K Pilot Projects %K Planning Techniques %K Psychological Tests %K Psychology %K Reproducibility of Results %K Retirement %K Surveys and Questionnaires %X

Although a substantial proportion of the western population is approaching retirement age, little is known about how they are preparing for the future. Much attention has been paid to the consumption of educational material and retirement wealth in the present literature, but the process of retirement planning has been ignored. S. L. Friedman and E. K. Scholnick's (1997) theoretical model provided the basis for a comprehensive measure of retirement planning. According to their process theory, individuals develop an understanding of the problem, set goals, make a decision to start preparing, and finally undertake the behaviors needed to fulfill their goals. Fifty-two items were developed to assess each stage of the planning process for financial, health, lifestyle, and psychosocial retirement planning. These were tested on a population sample of 1,449 New Zealanders aged 49-60. Confirmatory factor analysis, bivariate correlations, and hierarchical regression provided support for the valid use of the measure. Necessary antecedents, such as the tendency to look to the future, and locus of control were significantly related to the Process of Retirement Planning Scale (PRePS). The PRePS also outperformed retirement planning measures used in the Health and Retirement Study (F. T. Juster & R. Suzman, 1995) after controlling for socioeconomic and psychological variables. This measure will enable social policy makers to determine which stages of retirement planning require support and intervention. The PRePS will also help to determine which domains of retirement planning predict well-being in later life and the factors which differentiate those who are planning from those who are not.

%B Psychol Assess %I 22 %V 22 %P 520-31 %8 2010 Sep %G eng %N 3 %L newpubs20101012_Noone.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20822264?dopt=Abstract %3 20822264 %4 retirement Planning/methodology/Public Policy %$ 23600 %R 10.1037/a0019512 %0 Journal Article %J Int Psychogeriatr %D 2010 %T Situational versus chronic loneliness as risk factors for all-cause mortality. %A Sharon Shiovitz-Ezra %A Liat Ayalon %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Cause of Death %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Israel %K Life Change Events %K Loneliness %K Male %K Middle Aged %K Risk Factors %K social isolation %K Surveys and Questionnaires %K Time Factors %X

BACKGROUND: Several international studies have substantiated the role of loneliness as a risk factor for mortality. Although both theoretical and empirical research has supported the classification of loneliness as either situational or chronic, research to date has not evaluated whether this classification has a differential impact upon mortality.

METHODS: To establish the definition of situational vs. chronic loneliness, we used three waves of the Health and Retirement Study (HRS), a nationally representative sample of Americans over the age of 50 years. Baseline data for the present study were collected in the years 1996, 1998, and 2000. The present study concerns the 7,638 individuals who completed all three waves; their loneliness was classified as either not lonely, situational loneliness or chronic loneliness. Mortality data were available through to the year 2004.

RESULTS: Those identified as "situationally lonely" (HR = 1.56; 95% CI: 1.52-1.62) as well as those identified as "chronically lonely" (HR = 1.83; 95% CI: 1.71-1.87) had a greater risk for all cause mortality net of the effect of possible demographic and health confounders. Nonetheless, relative to those classified as "situationally lonely," individuals classified as "chronically lonely" had a slightly greater mortality risk.

CONCLUSIONS: The current study emphasizes the important role loneliness plays in older adults' health. The study further supports current division into situational vs. chronic loneliness, yet suggests that both types serve as substantial mortality risks.

%B Int Psychogeriatr %I 22 %V 22 %P 455-62 %8 2010 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/20003631?dopt=Abstract %3 20003631 %4 Loneliness/Older Adults/Isolation/Death/Demography/Dying/chronic loneliness/mortality/situational loneliness %$ 22780 %R 10.1017/S1041610209991426 %0 Journal Article %J J Aging Health %D 2010 %T Trading years for perfect health: results from the health and retirement study. %A Liat Ayalon %A King-Kallimanis, Bellinda L %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Community Participation %K Confidence Intervals %K Culture %K Epidemiologic Methods %K ethnicity %K Female %K Health Surveys %K Humans %K Longevity %K Male %K Multivariate Analysis %K Psychometrics %K Retirement %K Self Report %K Surveys and Questionnaires %K Time Factors %X

OBJECTIVE: To evaluate the preferences of an ethnically diverse national sample of older Americans regarding length of life versus health quality.

METHOD: A time trade-off task administered as part of the 2002 wave of the Health and Retirement Study.

RESULTS: Respondents equated 6.86 (SD = 3.46) years of perfect health with 10 years of life in imperfect health. Women and those who ranked their health less favorably were more likely to give up years of life for perfect health. Relative to Whites, Blacks were more willing to live longer in imperfect health. Those of lower levels of education were more likely to prefer 10 years of life in imperfect health.

DISCUSSION: There is wide variability in responses to the time trade-off task that is partially associated with self-rated health, gender, ethnicity, and education.

%B J Aging Health %I 22 %V 22 %P 1184-97 %8 2010 Dec %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/20660638?dopt=Abstract %3 20660638 %4 SELF-RATED HEALTH/demographics/GENDER/imperfect health %$ 22960 %R 10.1177/0898264310371980 %0 Journal Article %J J Aging Health %D 2010 %T Urban neighborhood context and mortality in late life. %A Richard G Wight %A Janet R. Cummings %A Arun S Karlamangla %A Carol S Aneshensel %K Age Factors %K Aged %K Aging %K Cognition %K Confidence Intervals %K depression %K Female %K Health Status %K Humans %K Los Angeles %K Male %K Middle Aged %K Mortality %K Odds Ratio %K Poverty %K Psychometrics %K Residence Characteristics %K Self Report %K Socioeconomic factors %K Statistics as Topic %K Urban Population %X

OBJECTIVE: To examine the contextual effects of urban neighborhood characteristics on mortality among older adults.

METHOD: Data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). Death is assessed between the baseline assessment (1993) and the first follow-up interview (1995). Neighborhood data are from the 1990 Census.

RESULTS: The log odds of dying between the two time points are higher in high proportion Hispanic neighborhoods, net of individual-level sociodemographic variables, but this effect is partly mediated by individual-level health. The log odds of dying are significantly (p < .05) lower in affluent neighborhoods, controlling for all individual-level variables and neighborhood proportion Hispanic.

DISCUSSION: There are survival-related benefits of living in an affluent urban neighborhood, which we posit may be manifested through the diffusion of innovations in health care and health-promotion activities.

%B J Aging Health %I 22 %V 22 %P 197-218 %8 2010 Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20056813?dopt=Abstract %2 PMC3155256 %4 Neighborhoods/Mortality Rates/Hispanic Americans/Dying/Elderly/Health/mortality/affluence/social work theory %$ 21980 %R 10.1177/0898264309355980 %0 Journal Article %J Stroke %D 2009 %T Can self-reported strokes be used to study stroke incidence and risk factors?: evidence from the health and retirement study. %A M. Maria Glymour %A Mauricio Avendano %K Age Factors %K Aged %K Aged, 80 and over %K Algorithms %K Epidemiologic Methods %K ethnicity %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Risk Factors %K Sex Factors %K Stroke %K Treatment Outcome %K United States %X

BACKGROUND AND PURPOSE: Most stroke incidence studies use geographically localized (community) samples with few national data sources available. Such samples preclude research on contextual risk factors, but national samples frequently collect only self-reported stroke. We examine whether incidence estimates from clinically verified studies are consistent with estimates from a nationally representative US sample assessing self-reported stroke.

METHODS: Health and Retirement Study (HRS) participants (n=17 056) age 50+ years were followed for self- or proxy-reported first stroke (1293 events) from 1998 to 2006 (average, 6.8 years). We compared incidence rates by race, sex, and age strata with those previously documented in leading geographically localized studies with medically verified stroke. We also examined whether cardiovascular risk factor effect estimates in HRS are comparable to those reported in studies with clinically verified strokes.

RESULTS: The weighted first-stroke incidence rate was 10.0 events/1000 person-years. Total age-stratified incidence rates in whites were mostly comparable with those reported elsewhere and were not systematically higher or lower. However, among blacks in HRS, incidence rates generally appeared higher than those previously reported. HRS estimates were most comparable with those reported in the Cardiovascular Health Study. Incidence rates approximately doubled per decade of age and were higher in men and blacks. After demographic adjustment, all risk factors predicted stroke incidence in whites. Smoking, hypertension, diabetes, and heart disease predicted incident stroke in blacks.

CONCLUSIONS: Associations between known risk factors and stroke incidence were verified in HRS, suggesting that misreporting is nonsystematic. HRS may provide valuable data for stroke surveillance and examination of classical and contextual risk factors.

%B Stroke %I 40 %V 40 %P 873-9 %8 2009 Mar %G eng %N 3 %L newpubs20090302_STROKE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19150869?dopt=Abstract %3 19150869 %4 Stroke/SELF-RATED HEALTH/risk factors/Racial Differences %$ 19730 %R 10.1161/STROKEAHA.108.529479 %0 Report %D 2009 %T Education and the Prevalence of Pain %A Atlas, Steven J. %A Jonathan S Skinner %K Demographics %X Many Americans report chronic and disabling pain, even in the absence of identifiable clinical disorders. We first examine the prevalence of pain in the older U.S. population using the Health and Retirement Study (HRS). Among 50-59 year females, for example, pain rates ranged from 26 percent for college graduates to 55 percent for those without a high school degree. Occupation, industry, and marital status attenuated but did not erase these educational gradients. Second, we used a study of patients with lower back pain and sciatica arising from intervertebral disk herniation (IDH). Initially, nearly all patients reported considerable pain and discomfort, with a sizeable fraction undergoing surgery for their IDH. However, baseline severity measures and surgical or medical treatment explained little of the variation in 10-year outcomes. By contrast, education exerted a strong impact on changes over time in pain: just 9 percent of college graduates report leg or back pain always or almost always after 10 years, compared to 34 percent for people without a high school degree. This close association of education with pain is consistent with recent research emphasizing the importance of neurological and perhaps economic -- factors in the perception of pain. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %L newpubs20090908_w14964.pdf %4 Education %$ 20730 %R 10.3386/w14964 %0 Journal Article %J Am J Public Health %D 2009 %T Health disadvantage in US adults aged 50 to 74 years: a comparison of the health of rich and poor Americans with that of Europeans. %A Mauricio Avendano %A M. Maria Glymour %A James Banks %A Johan P Mackenbach %K Age Factors %K Aged %K Chronic disease %K Confidence Intervals %K Disabled Persons %K Europe %K Female %K Health Status Disparities %K Heart Diseases %K Humans %K Male %K Middle Aged %K Odds Ratio %K Poverty %K Prevalence %K Risk Factors %K Socioeconomic factors %K United States %X

OBJECTIVES: We compared the health of older US, English, and other European adults, stratified by wealth.

METHODS: Representative samples of adults aged 50 to 74 years were interviewed in 2004 in 10 European countries (n = 17,481), England (n = 6527), and the United States (n = 9940). We calculated prevalence rates of 6 chronic diseases and functional limitations.

RESULTS: American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI = 1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations.

CONCLUSIONS: American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

%B Am J Public Health %I 99 %V 99 %P 540-8 %8 2009 Mar %G eng %N 3 %L newpubs20101112_Avendano.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19150903?dopt=Abstract %2 PMC2661456 %4 Chronic Disease/cross-national comparison/socioeconomic Factors/Heart disease/health status disparities/risk factors/SHARE/ELSA_ %$ 23710 %R 10.2105/AJPH.2008.139469 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: results from the health and retirement study. %A J Maselko %A Lisa M. Bates %A Mauricio Avendano %A M. Maria Glymour %K Aged %K Cardiovascular Diseases %K Female %K Health Surveys %K Humans %K Incidence %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Risk Factors %K Sexuality %K Stroke %X

OBJECTIVES: To examine the role of sex and marital status in the distribution and consequences of cardiovascular risk factors for stroke.

DESIGN: Longitudinal cohort.

SETTING: U.S. national sample, community based.

PARTICIPANTS: U.S. adults aged 50 and older and their spouses.

MEASUREMENTS: Health and Retirement Study (HRS) participants born between 1900 and 1947 (N=22,818), aged 50 and older, and stroke-free at baseline were followed an average of 9.4 years for self- or proxy-reported stroke (2,372 events). Financial resources, behavioral risk factors, and cardiovascular conditions were used to predict incident stroke in Cox proportional hazard models stratified according to sex and marital status (married, widowed, divorced or separated, or never married).

RESULTS: Women were less likely to be married than men. The distribution of risk factors differed according to sex and marital status. Men had higher incident stroke rates than women, even after full risk factor adjustment (hazard ratio (HR)=1.22, 95% confidence interval (CI)=1.11-1.34). For both sexes, being never married or widowed predicted greater risk, associations that were attenuated after adjustment for financial resources. Widowed men had the highest risk (HR=1.40, 95% CI=1.12-1.74 vs married women). Lower income and wealth were associated with similarly high risk across subgroups, although this risk factor especially affected unmarried women, with this group reporting the lowest income and wealth levels. Most other risk factors had similar HRs across subgroups, although moderate alcohol use did not predict lower stroke risk in unmarried women.

CONCLUSION: Stroke incidence and risk factors vary substantially according to sex and marital status. It is likely that gendered social experiences, such as marriage and socioeconomic disadvantage, mediate pathways linking sex and stroke.

%B J Am Geriatr Soc %I 57 %V 57 %P 2293-9 %8 2009 Dec %G eng %N 12 %L newpubs20100129_Maselko.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19874408?dopt=Abstract %3 19874408 %4 Stroke/risk factors/Marital Status/Sex Differences %$ 21560 %R 10.1111/j.1532-5415.2009.02555.x %0 Report %D 2009 %T Job Loss: Eat, drink and try to be merry? %A Deb, Partha %A William T Gallo %A Padmaja Ayyagari %A Jason M. Fletcher %A Jody L Sindelar %K Employment and Labor Force %K Health Conditions and Status %X This paper examines the impact of job loss from business closings on body mass index (BMI) and alcohol consumption. We improve upon extant literature by using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data (Health and Retirement Study). For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. Thus health effects of job loss could be concentrated among at risk individuals. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %L newpubs20090908_w15122.pdf %4 Job Loss/Body Mass Index/Alcohol Drinking %$ 20750 %R 10.3386/w15122 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Level and change in cognitive test scores predict risk of first stroke. %A Triveni DeFries %A Mauricio Avendano %A M. Maria Glymour %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cohort Studies %K Dementia, Vascular %K Female %K Follow-Up Studies %K Humans %K Interviews as Topic %K Kaplan-Meier Estimate %K Male %K Mental Status Schedule %K Middle Aged %K Predictive Value of Tests %K Psychometrics %K Risk %K Stroke %K United States %X

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

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

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

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

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

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

%B J Am Geriatr Soc %I 57 %V 57 %P 499-505 %8 2009 Mar %G eng %N 3 %L newpubs20090908/DeFriesetal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19175440?dopt=Abstract %3 19175440 %4 Stroke/Cognitive Function %$ 20330 %R 10.1111/j.1532-5415.2008.02132.x %0 Journal Article %J Am J Public Health %D 2009 %T Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age. %A Dawn E Alley %A Beth J Soldo %A José A Pagán %A John McCabe %A deBlois, Madeleine %A Samuel H Field %A David A Asch %A Carolyn Cannuscio %K Aged %K Female %K Food Supply %K Health Status Disparities %K Health Surveys %K Healthcare Disparities %K Housing %K Humans %K Logistic Models %K Male %K Middle Aged %K Poverty %K United States %X

OBJECTIVES: We examined associations between material resources and late-life declines in health.

METHODS: We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15,441).

RESULTS: Disadvantages in health care (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95% CI = 1.29, 2.22), and housing (OR = 1.20; 95% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95% CI = 1.29, 1.58) and food (OR = 1.64; 95% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage.

CONCLUSIONS: Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.

%B Am J Public Health %I 99 %V 99 Suppl 3 %P S693-701 %8 2009 Nov %G eng %N Suppl 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/19890175?dopt=Abstract %2 PMC2774171 %R 10.2105/AJPH.2009.161877 %0 Journal Article %J Am J Public Health %D 2009 %T Measuring socioeconomic differences in use of health care services by wealth versus by income. %A Allin, Sara %A Masseria, Cristina %A Elias Mossialos %K Aged %K Aged, 80 and over %K Aging %K Data collection %K Europe %K Female %K Health Services %K Health Services Accessibility %K Health Status Disparities %K Humans %K Income %K Male %K Middle Aged %K Odds Ratio %K Pensions %K Retirement %K Socioeconomic factors %K Statistics as Topic %K United Kingdom %X

OBJECTIVES: We compared the extent of socioeconomic differences in use of health care services based on wealth (i.e., accumulated assets) as the socioeconomic ranking variable with the extent of differences based on income to explore the sensitivity of the estimates of equity to the choice of the socioeconomic indicator.

METHODS: We used data from the Health and Retirement Study in the United States and the Survey of Health, Ageing, and Retirement in Europe to estimate levels of income- and wealth-related disparity in use of physician and dental services among adults 50 or older in 12 countries.

RESULTS: We found socioeconomic differences in use of physician services after standardizing for need in about half of the countries studied. No consistent pattern in levels of disparity measured by wealth versus those measured by income was found. However, the rich were significantly more likely to use dental services in all countries. Wealth-related differences in dental service use were consistently higher than were income-related differences.

CONCLUSIONS: We found some support for wealth as a more sensitive indicator of socioeconomic status among older adults than was income. Wealth may thus allow more accurate measurements of socioeconomic differences in use of health care services for this population.

%B Am J Public Health %I 99 %V 99 %P 1849-55 %8 2009 Oct %G eng %N 10 %L newpubs20090908_Allin_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19150899?dopt=Abstract %2 PMC2741508 %4 Health Care Utilization/socioeconomic status/Wealth/Cross Cultural Comparison/SHARE/cross-national comparison %$ 21060 %R 10.2105/AJPH.2008.141499 %0 Journal Article %J Annals of Internal Medicine %D 2009 %T Medicare Spending for Previously Uninsured Adults %A J. Michael McWilliams %A Meara, Ellen %A Alan M. Zaslavsky %A John Z. Ayanian %K Healthcare %K Insurance %K Medicare/Medicaid/Health Insurance %X BACKGROUND: Medicare spending after age 65 years may be higher for previously uninsured adults if suboptimal care before this age leads to irreversible complications, persistently elevated clinical risks, or delay of costly elective procedures. OBJECTIVE: To compare Medicare spending for previously uninsured and insured adults by using Medicare claims data. DESIGN: Longitudinal survey data and linked Medicare claims data were used to compare Medicare spending for beneficiaries age 65 to 74 years who were previously insured or previously uninsured before age 65 years. An inverse-probability-of-treatment weighting technique was used to adjust for fixed and time-varying sociodemographic and health characteristics before age 65 years. Condition-specific hospitalizations were compared, and their contribution to differences in Medicare spending was estimated. SETTING: Nationally representative Health and Retirement Study, 1992 to 2006. PARTICIPANTS: 2951 continuously insured adults and 1616 adults who were continuously or intermittently uninsured before age 65 years. MEASUREMENTS: Mean adjusted annual Medicare spending (total and by type of service) and annual rates of condition-specific hospitalizations. RESULTS: Adjusted annual total Medicare spending was significantly higher for previously uninsured than previously insured adults ( 5796 vs. 4773; difference, 1023 95 CI, 29 to 2016 ; P = 0.044). Among relevant clinical subgroups, previously uninsured adults had higher adjusted annual hospitalization rates than previously insured adults for complications related to cardiovascular disease or diabetes (9.1 vs. 6.4 ; P = 0.002) and for joint replacements (2.5 vs. 1.3 ; P = 0.006). Differences in these hospitalizations accounted for 65.7 of the 644 difference in annual Medicare inpatient spending between all previously uninsured and insured adults. LIMITATION: Unobserved confounders could have explained spending differences. CONCLUSION: Costs of expanded coverage before age 65 years may be partially offset by subsequent reductions in Medicare spending after age 65 years, particularly for uninsured adults with cardiovascular disease, diabetes, or severe arthritis. PRIMARY FUNDING SOURCE: The Commonwealth Fund. %B Annals of Internal Medicine %I 151 %V 151 %P 757-66 %G eng %N 11 %L newpubs20100129_McWilliams.pdf %3 19805758 %4 Medicare and Medicaid spending/Insurance Coverage/HOSPITALIZATION %$ 21520 %0 Journal Article %J Soc Work Public Health %D 2009 %T A new measure of medication affordability. %A Becky A. Briesacher %A Ross-Degnan, Dennis %A Adams, Alyce %A Anita K Wagner %A Jerry Gurwitz %A Soumerai, Stephan %K Aged %K Data collection %K Female %K Financing, Personal %K Humans %K Male %K Medicaid %K Middle Aged %K Poverty %K Prescription Fees %K United States %X

This study developed a new measure of medication affordability that examines out-of-pocket drug expenses relative to available household resources. The authors assessed the spending patterns of approximately 2.1 million poor households (< or =100% federal poverty level) of adults aged 51 and older by Medicaid status. The data were drawn from the 2000-2001 Health and Retirement Study. Household spending was categorized into three broad types: basic living, health care, and discretionary. Older (aged 51 or older) poor households without Medicaid allocated about 72% of their total resources ($17,421, SE $783) to basic living needs. In comparison, those with Medicaid had scarcer total resources ($12,498, SE $423) and allocated 85% to basic living needs. Medication costs consumed the largest proportion of health care expenses for both types of poor households (Medicaid: $463, SE $67; non-Medicaid: $970, SE $102). After paying for basic living needs and health care costs, these families had, on average, only $16 left each week. Poor families have very few resources available for anything beyond basic living needs, even when they have Medicaid coverage. There is no great reservoir of discretionary funds to pay for increases in cost-sharing under Medicaid and Medicare Part D.

%B Soc Work Public Health %I 24 %V 24 %P 600-12 %8 2009 Nov-Dec %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/19821195?dopt=Abstract %2 PMC2893303 %4 Medical Expenditures/Prescription Fees/Medicare %$ 21210 %R 10.1080/19371910802672346 %0 Journal Article %J Research on Aging %D 2009 %T Preretirement Planning and Well-Being in Later Life: A Prospective Study %A Jack H Noone %A Christine Stephens %A Fiona M. Alpass %K Methodology %K Retirement Planning and Satisfaction %X Cross-sectional and retrospective research has identified a reliable relationship between preretirement planning and later-life well-being. Although it seems intuitive that retirement planning leads to more positive retirement outcomes, limited longitudinal analysis has confirmed the directionality of this relationship or clarified its complexities. The Health and Retirement Study, a prospective survey of American workers and retirees from 1992 to the present, can help illuminate this relationship. Data signifying the preretirement activities of employed individuals from the 1992 wave were compared with their postretirement ratings of retirement satisfaction and subjective physical and emotional health in 2004. An ordinal regression analysis indicated that those who had discussed retirement with their spouses and had retirement superannuation or savings plans in 1992 reported greater well-being in 2004 (controlling for health status, the reason for retirement, and income in 1992). These results confirm the importance of preretirement preparation and provide a rationale for developing more comprehensive, theory-driven measures of retirement planning. %B Research on Aging %I 31 %V 31 %P 295 %G eng %N 3 %L newpubs20090908/NooneRA.pdf %4 Retirement planning/REGRESSION-ANALYSIS %$ 20380 %0 Journal Article %J Stroke %D 2009 %T Risk factors associated with injury attributable to falling among elderly population with history of stroke. %A Afshin A Divani %A Vazquez, Gabriela %A Anna M Barrett %A Asadollahi, Marjan %A Andreas R Luft %K Accidental Falls %K Aged %K Aged, 80 and over %K Aging %K Causality %K Cohort Studies %K Comorbidity %K disease progression %K Female %K Health Status %K Humans %K Male %K Marital Status %K Mental Disorders %K Movement Disorders %K Prevalence %K Risk Factors %K Risk Reduction Behavior %K Sex Distribution %K Stroke %K Urinary incontinence %K Wounds and Injuries %X

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

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

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

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

%B Stroke %I 40 %V 40 %P 3286-92 %8 2009 Oct %G eng %N 10 %L newpubs20091013_Divani_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19628798?dopt=Abstract %2 PMC2929376 %4 Stroke/Falls/Elderly/risk factors %$ 21090 %R 10.1161/STROKEAHA.109.559195 %0 Journal Article %J Value Health %D 2009 %T Risk perception and preference for prevention of Alzheimer's disease. %A Chung, Sukyung %A Kala M. Mehta %A Shumway, Martha %A Alvidrez, Jennifer %A Eliseo J Perez-Stable %K Age Factors %K Aged %K Aged, 80 and over %K Alzheimer disease %K Cognition %K Female %K Health education %K Health Knowledge, Attitudes, Practice %K Health Surveys %K Humans %K Linear Models %K Male %K Multivariate Analysis %K Psychometrics %K Risk Assessment %K Risk Factors %K Social Perception %K Statistics as Topic %K United States %X

OBJECTIVES: To understand how older adults perceive their risk of Alzheimer's Disease (AD) and how this may shape their medical care decisions, we examined whether presence of established risk factors of AD is associated with individuals' perceived risk of AD, and with preference for preventing AD.

PARTICIPANTS: Data came from the US Health and Retirement Study participants who were asked questions on AD risk perception (N = 778).

MEASUREMENTS: Perceived risk of AD was measured by respondents' estimate of their percent chance (0-100) developing AD in the next 10 years. Preference for AD prevention was measured with questions eliciting willingness to pay for a drug to prevent AD.

ANALYSIS: Multivariate linear regressions were used to estimate correlates of perceived risk and preference for prevention.

RESULTS: Better cognitive functioning and physical activity are associated with decreased perceived risk. Neither age nor cardiovascular disease is associated with perceived risk. African Americans have lower perceived risk than non-Latino whites; the difference is wider among people age 65 and above. Only 4% to 7% of the variation in perceived risk was explained by the model. Preference for prevention is stronger with increased perceived risk, but not with the presence of risk factors. Persons with better cognitive functioning, physical functioning, or wealth status have a stronger preference for prevention.

CONCLUSION: Some known risk factors appear to inform, but only modestly, individuals' perceived risk of AD. Furthermore, decisions about AD prevention may not be determined by objective needs alone, suggesting a potential discrepancy between need and demand for AD preventive care.

%B Value Health %I 12 %V 12 %P 450-8 %8 2009 Jun %G eng %N 4 %L newpubs20100129_Chung_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19900252?dopt=Abstract %3 19900252 %4 Alzheimers Disease/risk factors/Subjective Probabilities/Physical Activity/Cognitive Functioning %$ 21500 %R 10.1111/j.1524-4733.2008.00482.x %0 Report %D 2009 %T Sin Taxes: Do Heterogeneous Responses Undercut Their Value? %A Padmaja Ayyagari %A Deb, Partha %A Jason M. Fletcher %A William T Gallo %A Jody L Sindelar %K Health Conditions and Status %K Methodology %K Public Policy %X This paper estimates the price elasticity of demand for alcohol using Health and Retirement Survey data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price but the other is unresponsive. Differences between these two groups can be explained in part by the behavioral factors of risk aversion, financial planning horizon, forward looking and locus of control. These results have policy implications. Only a subgroup responds significantly to price. Importantly, the unresponsive group drinks more heavily, suggesting that a higher price could fail to curb drinking by those most likely to cause negative externalities. In contrast, those least likely to impose costs on others are more responsive, thus suffering greater deadweight loss yet with less prevention of negative externalities. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %4 Alcohol Abuse/methodology/Public Policy %$ 25530 %R 10.3386/w15124 %0 Journal Article %J Epidemiology %D 2009 %T Socioeconomic differentials in immune response. %A Jennifer B Dowd %A Allison E Aiello %K Adult %K Aged %K Cytomegalovirus %K Cytomegalovirus Infections %K Female %K Health Status Disparities %K Humans %K Male %K Middle Aged %K Nutrition Surveys %K Regression Analysis %K Social Class %K United States %X

BACKGROUND: Lower socioeconomic status (SES) is strongly linked to health outcomes, though the mechanisms are poorly understood. Little is known about the role of the immune system in creating and sustaining health disparities. Here we test whether SES is related to cell-mediated immunity, as measured by the host's ability to keep persistent cytomegalovirus (CMV) antibody levels in a quiescent state.

METHODS: Censored regression models were used to test the cross-sectional relationship of education, income, and race/ethnicity with antibody response to CMV, using a nationally representative sample of 9721 respondents aged 25 years and older in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994).

RESULTS: Among CMV-seropositive respondents, those with less education, lower income, and nonwhite race/ethnicity had higher levels of CMV antibodies at all ages. On average, each additional year of age was associated with CMV antibody levels that were 0.03 units higher (95% confidence interval = 0.03 to 0.04), whereas each additional year of education was associated with antibody levels that were 0.05 units lower (0.02 to 0.09). A doubling of family income was associated with antibody levels that were 0.25 units lower (0.11 to 0.39), the equivalent of 8 fewer years of age-related CMV antibody response. These relationships remained strong after controlling for baseline health conditions, smoking status, and BMI.

CONCLUSIONS: SES is associated with an indirect marker of cell-mediated immunity in a nationally representative sample. SES differences in immune control over CMV may have fundamental implications for health disparities over the life course.

%B Epidemiology %I 20 %V 20 %P 902-8 %8 2009 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/19797966?dopt=Abstract %2 PMC2765221 %4 Socioeconomic Differences/immune response %$ 62790 %R 10.1097/EDE.0b013e3181bb5302 %0 Journal Article %J Arch Intern Med %D 2009 %T Spouse-rated vs self-rated health as predictors of mortality. %A Liat Ayalon %A Kenneth E Covinsky %K Aged %K Cross-Sectional Studies %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Self-Assessment %K Spouses %X

BACKGROUND: The Health and Retirement Study is a national sample of Americans older than 50 years and their spouses. The present study evaluated cross-sectional and longitudinal data from January 2000 through December 2006. The objective of the study was to evaluate the roles of spouse-rated vs self-rated health as predictors of all-cause mortality among adults older than 50 years.

METHODS: A total of 673 dyads of married couples were randomly selected to participate in a Health and Retirement Study module examining spouse-rated health. For each couple, one member was asked to rate his or her overall health status, and his or her spouse was asked to report the partner's overall health status. Mortality data were available through 2006.

RESULTS: Our findings demonstrate that spouse-rated health (area under the curve, 0.75) is as strong a predictor of mortality as self-rated health (area under the curve, 0.73) (chi(2)(1) = 0.36, P = .54). Combining spouse-rated and self-rated health predicts mortality better than using self-rated health alone (area under the curve, 0.77) (chi(2)(1) = 6.72, P = .009).

CONCLUSIONS: Spouse ratings of health are at least as strongly predictive of mortality as self-rated health. This suggests that, when self-rated health is elicited as a prognostic indicator, spouse ratings can be used when self-ratings are unavailable. Both measures together may be more informative than either measure alone.

%B Arch Intern Med %I 169 %V 169 %P 2156-61 %8 2009 Dec 14 %G eng %N 22 %1 http://www.ncbi.nlm.nih.gov/pubmed/20008702?dopt=Abstract %2 PMC2920055 %4 Cross-Sectional Studies/Health Status/SELF-RATED HEALTH/Longitudinal Studies/Middle Aged/Self Assessment/Spouses/MORTALITY %$ 22240 %R 10.1001/archinternmed.2009.386 %0 Journal Article %J Neurology %D 2009 %T Surrogate consent for dementia research: a national survey of older Americans. %A Scott Y H Kim %A H.M. Kim %A Kenneth M. Langa %A Jason H. Karlawish %A David S Knopman %A Appelbaum, P S %K Advance directives %K Age Factors %K Aged %K Aged, 80 and over %K Alzheimer disease %K Biomedical Research %K Caregivers %K Clinical Trials as Topic %K Data collection %K ethnicity %K Female %K Humans %K Informed Consent %K Legal Guardians %K Male %K Mental Competency %K Middle Aged %K Patient Participation %K Proxy %K Research Subjects %K Surveys and Questionnaires %K Therapeutic Human Experimentation %K Third-Party Consent %X

BACKGROUND: Research in novel therapies for Alzheimer disease (AD) relies on persons with AD as research subjects. Because AD impairs decisional capacity, informed consent often must come from surrogates, usually close family members. But policies for surrogate consent for research remain unsettled after decades of debate.

METHODS: We designed a survey module for a random subsample (n = 1,515) of the 2006 wave of the Health and Retirement Study, a biennial survey of a nationally representative sample of Americans aged 51 and older. The participants answered questions regarding one of four randomly assigned surrogate-based research (SBR) scenarios: lumbar puncture study, drug randomized control study, vaccine study, and gene transfer study. Each participant answered three questions: whether our society should allow family surrogate consent, whether one would want to participate in the research, and whether one would allow one's surrogate some or complete leeway to override stated personal preferences.

RESULTS: Most respondents stated that our society should allow family surrogate consent for SBR (67.5% to 82.5%, depending on the scenario) and would themselves want to participate in SBR (57.4% to 79.7%). Most would also grant some or complete leeway to their surrogates (54.8% to 66.8%), but this was true mainly of those willing to participate. There was a trend toward lower willingness to participate in SBR among those from ethnic or racial minority groups.

CONCLUSIONS: Family surrogate consent-based dementia research is broadly supported by older Americans. Willingness to allow leeway to future surrogates needs to be studied further for its ethical significance for surrogate-based research policy.

%B Neurology %I 72 %V 72 %P 149-55 %8 2009 Jan 13 %G eng %N 2 %L newpubs20090302_KimKim_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19139366?dopt=Abstract %2 PMC2663398 %4 Dementia/Surrogate-based research/Surrogate-based research %$ 19740 %R 10.1212/01.wnl.0000339039.18931.a2 %0 Journal Article %J Am J Epidemiol %D 2009 %T Trajectories of cognitive function in late life in the United States: demographic and socioeconomic predictors. %A Arun S Karlamangla %A Miller-Martinez, Dana %A Carol S Aneshensel %A Teresa Seeman %A Richard G Wight %A Joshua Chodosh %K Aged %K Aged, 80 and over %K Aging %K Black or African American %K Cognition %K Confidence Intervals %K Education %K Female %K Geriatric Assessment %K Hispanic or Latino %K Humans %K Income %K Male %K Marital Status %K Mexican Americans %K Poverty %K Sampling Studies %K Socioeconomic factors %K Surveys and Questionnaires %K United States %K White People %X

This study used mixed-effects modeling of data from a national sample of 6,476 US adults born before 1924, who were tested 5 times between 1993 and 2002 on word recall, serial 7's, and other mental status items to determine demographic and socioeconomic predictors of trajectories of cognitive function in older Americans. Mean decline with aging in total cognition score (range, 0-35; standard deviation, 6.00) was 4.1 (0.68 standard deviations) per decade (95% confidence interval: 3.8, 4.4) and in recall score (range, 0-20; standard deviation, 3.84) was 2.3 (0.60 standard deviations) per decade (95% confidence interval: 2.1, 2.5). Older cohorts (compared with younger cohorts), women (compared with men), widows/widowers, and those never married (both compared with married individuals) declined faster, and non-Hispanic blacks (compared with non-Hispanic whites) and those in the bottom income quintile (compared with the top quintile) declined slower. Race and income differences in rates of decline were not sufficient to offset larger differences in baseline cognition scores. Educational level was not associated with rate of decline in cognition scores. The authors concluded that ethnic and socioeconomic disparities in cognitive function in older Americans arise primarily from differences in peak cognitive performance achieved earlier in the life course and less from declines in later life.

%B Am J Epidemiol %I 170 %V 170 %P 331-42 %8 2009 Aug 01 %G eng %N 3 %L newpubs20090908_Karlamangla.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19605514?dopt=Abstract %2 PMC2727175 %4 Cognition/health outcomes/Socioeconomic Factors %$ 20810 %R 10.1093/aje/kwp154 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2009 %T Urban neighborhood context and change in depressive symptoms in late life. %A Richard G Wight %A Janet R. Cummings %A Arun S Karlamangla %A Carol S Aneshensel %K Aged %K Aged, 80 and over %K Aging %K Cultural Diversity %K depression %K Disability Evaluation %K Educational Status %K Female %K Humans %K Longitudinal Studies %K Los Angeles %K Male %K Personality Inventory %K Poverty %K Psychosocial Deprivation %K Residence Characteristics %K Risk Factors %K Urban Population %X

OBJECTIVES: This study examines associations between urban neighborhood sociodemographic characteristics and change over time in late-life depressive symptoms.

METHODS: Survey data are from three waves (1993, 1995, and 1998) of the Study of Assets and Health Dynamics Among the Oldest Old, a U.S. national probability sample of noninstitutionalized persons aged 70 years or older in 1993. Neighborhoods are 1990 U.S. Census tracts. Hierarchical linear regression is used to estimate multilevel models.

RESULTS: The average change over time in depressive symptoms varies significantly across urban neighborhoods. Change in depressive symptoms is significantly associated with neighborhood-level socioeconomic disadvantage and ethnic composition in unadjusted models but not in models that control for individual-level characteristics.

CONCLUSIONS: Findings indicate that apparent neighborhood-level effects on change in depressive symptoms over time among urban-dwelling older adults reflect, for the most part, differences in characteristics of the neighborhood residents.

%B J Gerontol B Psychol Sci Soc Sci %I 64B %V 64 %P 247-51 %8 2009 Mar %G eng %N 2 %L newpubs20090908/Wightetal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19181693?dopt=Abstract %2 PMC2655167 %4 Depressive Symptoms/Neighborhood Characteristics %$ 20350 %R 10.1093/geronb/gbn016 %0 Journal Article %J Am J Geriatr Psychiatry %D 2009 %T Willingness to participate in Alzheimer disease research and attitudes towards proxy-informed consent: results from the Health and Retirement Study. %A Liat Ayalon %K Alzheimer disease %K Attitude %K Community Participation %K Cross-Sectional Studies %K Female %K Human Experimentation %K Humans %K Informed Consent %K Male %K Middle Aged %K Public Opinion %K Risk Assessment %K Third-Party Consent %X

OBJECTIVES: To evaluate public opinion about participation in Alzheimer disease (AD) research and willingness to have a proxy-informed consent.

DESIGN: Cross-sectional.

SETTING: A national survey of community-dwelling adults over the age of 50 and their spouse of any age.

PARTICIPANTS: The 2006 wave of the Health and Retirement Study (N = 1,517).

MEASUREMENTS: Willingness to participate in one of four possible research scenarios and to have a proxy-informed consent for AD research.

RESULTS: Overall, 65.8% agreed to participate in AD research and 70.7% agreed to proxy-informed consent. Relative to a minimal benefit and moderate risk scenario, participants were more likely to favor participation in a moderate benefit and minimal risk scenario and less likely to endorse a minimal benefit and severe risk scenario. Those agreeing to participate in the study were more likely to agree to proxy consent and to give leeway to a research proxy to go against their will.

CONCLUSIONS: Most participants view AD research favorably and are agreeable toward participating in such research as well as toward having a research proxy. Participants are able to distinguish between studies of different levels of benefit and risk. Nevertheless, over 50% agreed to a study of minimal benefit and severe risk. Researchers and clinicians should be aware that those less agreeable toward AD research are less interested in having a research proxy.

%B Am J Geriatr Psychiatry %I 17 %V 17 %P 65-74 %8 2009 Jan %G eng %N 1 %L newpubs20081014_AJGP %1 http://www.ncbi.nlm.nih.gov/pubmed/19092313?dopt=Abstract %3 19092313 %4 Dementia %$ 19310 %R 10.1097/JGP.0b013e31818cd3d3 %0 Journal Article %J J Aging Health %D 2008 %T Educational differentials in life expectancy with cognitive impairment among the elderly in the United States. %A Agnès Lièvre %A Dawn E Alley %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Cognition Disorders %K Educational Status %K Female %K Humans %K Life Expectancy %K Male %K United States %X

OBJECTIVE: This article provides estimates of education differentials in life expectancy with and without cognitive impairment for the noninstitutionalized population aged 70 years and older in the United States.

METHOD: Life expectancy with cognitive impairment was calculated using multistate models, allowing transitions between cognitively intact and cognitively impaired states and from each of these states to death and allowing transition rates to vary across age and education. Four waves of the Assets and Health Dynamics of the Oldest Old survey were used.

RESULTS: Those with low levels of education are more likely to become cognitively impaired and do so at an earlier age. After age 70, persons with low educational levels can expect to live 11.6 years, and persons with high education 14.1 years, without cognitive impairment. Length of life with cognitive impairment differs by education (1.6 years and 1.0 years at age 70, respectively) but differs little by age.

DISCUSSION: Although those with higher education have lower rates of both cognitive impairment and mortality, those who do become cognitively impaired appear to be in poorer health, leading to a reduced probability of improved cognition and increased probability of mortality relative to those with lower educational levels.

%B J Aging Health %I 20 %V 20 %P 456-77 %8 2008 Jun %G eng %N 4 %L newpubs20101112_Lievre %1 http://www.ncbi.nlm.nih.gov/pubmed/18448687?dopt=Abstract %2 PMC2966893 %4 cognition Disorders/cognitive Impairment/educational Status/life Expectancy/education/MORTALITY %$ 23790 %R 10.1177/0898264308315857 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2008 %T Emergency department utilization patterns among older adults. %A Frederic D Wolinsky %A Li Liu %A Thomas R Miller %A An, Hyonggin %A John F Geweke %A Kaskie, Brian %A Kara B Wright %A Elizabeth A Chrischilles %A Claire E Pavlik %A Elizabeth A Cook %A Robert L. Ohsfeldt %A Kelly K Richardson %A Gary E Rosenthal %A Robert B Wallace %K Aged %K Emergency Service, Hospital %K Factor Analysis, Statistical %K Female %K Humans %K Logistic Models %K Male %K Medicare %K Risk Factors %K United States %X

BACKGROUND: We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them.

METHODS: A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used.

RESULTS: The majority (56.6%) of participants had no ED visits during the 4-year period. Just 5.7% had only low-intensity ED use patterns, whereas 28.9% used the ED only for high-intensity visits, and 8.7% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns.

CONCLUSIONS: Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.

%B J Gerontol A Biol Sci Med Sci %I 63A %V 63 %P 204-9 %8 2008 Feb %G eng %N 2 %L newpubs20080528_JoGserA %1 http://www.ncbi.nlm.nih.gov/pubmed/18314459?dopt=Abstract %2 PMC2923576 %4 Medicare/Health Care Utilization/Elderly %$ 19050 %R 10.1093/gerona/63.2.204 %0 Report %D 2008 %T Examining the Relationships between Excess Body Weight, Health and Disability %A Timothy A Waidmann %A Vicki A Freedman %A Christine L Himes %A Ahmad, Saad %K Health Conditions and Status %X The recent rise in the prevalence of obesity and overweight in the overall United States population has raised many concerns about the future. In addition to concerns about the medical costs of treating obesity-related illness, an apparent correlation between obesity and disability has led to concern that the recent declines in rates of disability among the elderly may cease or reverse. In this report, we explore the relationship between excess weight and obesity in a series of cross-sectional and longitudinal analyses in an attempt to evaluate these concerns. Using data from the 1998-2004 waves of the Health and Retirement Study (HRS), we find evidence that the risks of developing difficulties with activities of daily living (ADLs) does increase with the prevalence of obesity, but the effects appear to be less dramatic than the effects on the limitations in physical functioning, which can be precursors of ADL disability. Further, we find only a weak relationship between excess weight and the onset of difficulties with instrumental activities of daily living (IADLs). %B U.S. Department of Health and Human Services %I Office of the Assistant Secretary for Planning and Evaluation %C Washington, D.C. %G eng %U https://aspe.hhs.gov/basic-report/examining-relationships-between-excess-body-weight-health-and-disability %L newpubs20090908/weight.pdf %4 Obesity/Weight/ADL and IADL Impairments %$ 20190 %0 Journal Article %J Med Care %D 2008 %T Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets. %A Amresh D Hanchate %A Zhang, Yuqing %A David T Felson %A Arlene S Ash %K Aged %K Aged, 80 and over %K Arthroplasty, Replacement, Knee %K Comorbidity %K ethnicity %K Female %K Healthcare Disparities %K Humans %K Income %K Insurance, Health %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Sex Distribution %K Socioeconomic factors %K United States %X

OBJECTIVE: To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use.

DATA SOURCE: US longitudinal Health and Retirement Study survey data for the elderly and near-elderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan.

STUDY DESIGN: The outcome is dichotomous, whether the respondent received first TKA in the previous 2 years. Longitudinal, random-effects logistic regression models are used to assess associations with lagged economic indicators.

SAMPLE: Sample was 55,469 person-year observations from 18,439 persons; 663, with first TKA.

RESULTS: Racial/ethnic disparities in TKA were more prominent among men than women. For example, relative to white women, odds ratios (ORs) were 0.94, 0.46, and 0.79, for white, black, and Hispanic men, respectively (P < 0.05 for black men). After adjusting for economic factors, racial/ethnic differences in TKA rates for women essentially disappeared, while the deficit for black men remained large. Among Medicare-enrolled elderly, those with supplemental insurance may be more likely to have first TKA compared with those without it, whether the supplemental coverage was private [OR: 1.27; 95% confidence interval (CI): 0.82-1.96] or Medicaid (OR: 1.18; 95% CI: 0.93-1.49). Among the near-elderly (age 47-64), compared with the privately insured, the uninsured were less likely (OR: 0.61; 95% CI: 0.40-0.92) and those with Medicaid more likely (OR: 1.53; 95% CI: 1.03-2.26) to have first TKA.

CONCLUSIONS: Limited insurance coverage and financial constraints explain some of the racial/ethnic disparities in TKA rates.

%B Med Care %I 46 %V 46 %P 481-8 %8 2008 May %G eng %N 5 %L newpubs20080528_MedCare.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18438196?dopt=Abstract %2 PMC2758246 %4 Health Insurance Coverage/income/Assets/Racial disparities/Ethnicity %$ 18910 %R 10.1097/MLR.0b013e3181621e9c %0 Book %D 2008 %T Handbook of cognitive aging: interdisciplinary perspectives %A Scott M Hofer %A Duane F. Alwin %K Health Conditions and Status %I Sage Publications %C Thousand Oaks, Calif %G eng %4 Cognition / Age factors./Aging / Psychological aspects. %$ 25930 %R 10.4135/9781412976589 %0 Journal Article %J Ann Epidemiol %D 2008 %T Lifecourse social conditions and racial disparities in incidence of first stroke. %A M. Maria Glymour %A Mauricio Avendano %A Steven A Haas %A Lisa F Berkman %K Aged %K Aged, 80 and over %K Black or African American %K Cardiovascular Diseases %K ethnicity %K Female %K Health Status Disparities %K Humans %K Incidence %K Interviews as Topic %K Life Style %K Longitudinal Studies %K Male %K Middle Aged %K Models, Statistical %K Risk Factors %K Social Environment %K Socioeconomic factors %K Stroke %K United States %K White People %X

PURPOSE: Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities.

METHODS: Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models.

RESULTS: Black subjects had a 48% greater risk of first stroke incidence than whites (95% confidence interval, 1.33-1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95% CI, 1.00-1.28).

CONCLUSIONS: Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects.

%B Ann Epidemiol %I 18 %V 18 %P 904-12 %8 2008 Dec %G eng %N 12 %L newpubs20090126_Glymour_AE %1 http://www.ncbi.nlm.nih.gov/pubmed/19041589?dopt=Abstract %2 PMC2796851 %4 Stroke/Socioeconomic Factors/Life Cycle/African-Americans %$ 19650 %R 10.1016/j.annepidem.2008.09.010 %0 Journal Article %J Soc Sci Med %D 2008 %T A multilevel analysis of urban neighborhood socioeconomic disadvantage and health in late life. %A Richard G Wight %A Janet R. Cummings %A Miller-Martinez, Dana %A Arun S Karlamangla %A Teresa Seeman %A Carol S Aneshensel %K Aged %K Female %K Health Behavior %K Health Status Disparities %K Humans %K Male %K Poverty %K Small-Area Analysis %K Socioeconomic factors %K United States %K Urban Population %X

The associations between neighborhood context and various indicators of health are receiving growing empirical attention, but much of this research is regionally circumscribed or assumes similar effects across the life course. This study utilizes a U.S. national sample to investigate the association between urban neighborhood socioeconomic disadvantage and health specifically among older adults. Data are from 3442 participants aged 70 years and older in the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, and the 1990 U.S. Census. Our approach underscores the importance of multiple dimensions of health (self-reported physician-diagnosed cardiovascular disease [CVD], functional status, and self-rated health) as well as multiple dimensions of neighborhood disadvantage, which are conceptualized as environmental hazards that may lead to a physiologically consequential stress response. We find that individual-level factors attenuate the association between neighborhood disadvantage and both CVD and functional status, but not self-rated health. Net of covariates, high neighborhood socioeconomic disadvantage is significantly associated with reporting poor health. In late life, neighborhood socioeconomic disadvantage is more consequential to subjective appraisals of health than diagnosed CVD or functional limitations.

%B Soc Sci Med %I 66 %V 66 %P 862-72 %8 2008 Feb %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/18160194?dopt=Abstract %2 PMC3681874 %4 Urban Population/socioeconomic status/HEALTH %$ 18470 %R 10.1016/j.socscimed.2007.11.002 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2008 %T Spousal caregiving in late midlife versus older ages: implications of work and family obligations. %A Julie C Lima %A Susan M Allen %A Goldscheider, Frances %A Intrator, Orna %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Caregivers %K Employment %K Family Relations %K Female %K Gender Identity %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Spouses %K Time Factors %K United States %X

OBJECTIVES: This study examined life-stage differences in the provision of care to spouses with functional impairment.

METHODS: We examined 1,218 married adults aged 52 and older from the 2000 wave of the Health and Retirement Study who received impairment-related help with at least one activity of daily living. We examined the differential likelihood that spouses served as primary caregiver and the hours of care provided by spousal primary caregivers by life stage.

RESULTS: We found that late middle-aged care recipients were more likely than their older counterparts to receive the majority of their care from their spouse but received fewer hours of spousal care, mostly when spouses worked full time. Competing demands of caring for children or parents did not affect the amount of care provided by a spouse.

DISCUSSION: Late middle-aged adults with functional limitations are more likely than older groups to be married and cared for primarily by spouses; however, they may be particularly vulnerable to unmet need for care. As the baby boom generation ages, retirement ages increase, and federal safety nets weaken, people with health problems at older ages may soon find themselves in the same caregiving predicament as those in late middle age.

%B J Gerontol B Psychol Sci Soc Sci %I 63B %V 63 %P S229-S238 %8 2008 Jul %G eng %N 4 %L newpubs20081014_Lima-etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18689772?dopt=Abstract %3 18689772 %4 ADL and IADL Impairments/Marital Status/Caregiving %$ 19390 %R 10.1093/geronb/63.4.s229 %0 Journal Article %J Am J Prev Med %D 2008 %T Spousal smoking and incidence of first stroke: the Health and Retirement Study. %A M. Maria Glymour %A Triveni DeFries %A Ichiro Kawachi %A Mauricio Avendano %K Age Factors %K Confidence Intervals %K Female %K Humans %K Incidence %K Male %K Middle Aged %K Prospective Studies %K Risk Factors %K Smoking %K Spouses %K Stroke %K Time Factors %K Tobacco Smoke Pollution %K United States %X

BACKGROUND: Few prospective studies have investigated the relationship between spousal cigarette smoking and the risk of incident stroke.

METHODS: Stroke-free participants in the U.S.-based Health and Retirement Study (HRS) aged >or=50 years and married at baseline (n=16,225) were followed, on average, 9.1 years between 1992 and 2006) for proxy or self-report of first stroke (1,130 events). Participants were stratified by gender and own smoking status (never-smokers, former smokers, or current smokers), and the relationship assessed between the spouse's smoking status and the risk of incident stroke. Analyses were conducted in 2007 with Cox proportional hazards models. All models were adjusted for age; race; Hispanic ethnicity; Southern birthstate; parental education; paternal occupation class; years of education; baseline income; baseline wealth; obesity; overweight; alcohol use; and diagnosed hypertension, diabetes, or heart disease.

RESULTS: Having a spouse who currently smoked was associated with an increased risk of first stroke among never-smokers (hazard ratio=1.42, 95% CI=1.05, 1.93) and former smokers (hazard ratio=1.72, 95% CI=1.33, 2.22). Former smokers married to current smokers had a stroke risk similar to respondents who themselves smoked.

CONCLUSIONS: Spousal smoking poses important stroke risks for never-smokers and former smokers. The health benefits of quitting smoking likely extend to both the individual smoker and his or her spouse.

%B Am J Prev Med %I 35 %V 35 %P 245-8 %8 2008 Sep %G eng %N 3 %L newpubs20090126_Glymour_AJPM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18692737?dopt=Abstract %2 PMC2796850 %4 Smoking/Stroke/Spouses %$ 19620 %R 10.1016/j.amepre.2008.05.024 %0 Journal Article %J Stroke %D 2008 %T Stroke disparities in older Americans: is wealth a more powerful indicator of risk than income and education? %A Mauricio Avendano %A M. Maria Glymour %K Age Distribution %K Age Factors %K Aged %K Cohort Studies %K Educational Status %K Female %K Humans %K Incidence %K Income %K Life Style %K Longitudinal Studies %K Male %K Middle Aged %K Proportional Hazards Models %K Risk Factors %K Socioeconomic factors %K Stroke %K United States %X

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

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

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

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

%B Stroke %I 39 %V 39 %P 1533-40 %8 2008 May %G eng %N 5 %L newpubs20090908/Stroke1533.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18436891?dopt=Abstract %2 PMC3079499 %4 Stroke/Socioeconomic Factors/Education/income %$ 20220 %R 10.1161/STROKEAHA.107.490383 %0 Thesis %D 2008 %T Toward a demographic divide? Equity, race, and Social Security %A Accius, Jean C., II %K Healthcare %K Public Policy %K Racial/ethnic differences %K Social Security %X The retirement system within the United States for millions of Americans revolves around Social Security. Social Security is a policy that was designed to ensure economic security to individuals who contributed into the system while working and now have transitioned into retirement. Yet, the combination of conflicting goals, demographic trends, and inadequate assumptions in the design of the Social Security program has threatened its solvency. With these concerns have come various proposals to reform the system, including increasing the retirement age and privatizing the Social Security program. These proposals have spurred social equity concerns regarding the potential adverse impacts on the ability of minorities and/or low-income individuals to retire. While race is typically proffered as social equity concerns when it comes to Social Security and its accompanying reforms, it is possible that this cleavage is not the most important one for policy makers to anticipate and attempt to cope with in the future. As a result, this study seeks to address the following questions in more rigorous, robust, and sophisticated ways than has prior research: Are there differences by race in retirement decisions, controlling for other factors such as class? If differences do exist, what are their social equity implications for society? How might any social inequities that might exist be best addressed in the United States? To address these questions, this study combines qualitative as well as quantitative research using the Health and Retirement Study (HRS) to examine, from 1992 to 2004, the retirement behaviors of Americans born between 1931 and 1941. Logistic regressions were used to decompose the differences in retirement decisions across racial groups while controlling for demographic, economic, and quality of life factors. The analysis revealed that, controlling for economic and health variables, statistically significant differences among races in retirement decisions did not exist. Overall, this study suggests that the most important focus of policymakers seeking the most cost-effective way to address social inequities related to retirement decisions is to focus proactively on ways to address poverty and poor health, and reactively , to focus social services on attenuating the worst impacts of social inequities. %I The American University %C United States -- District of Columbia %8 2008 %G eng %! Toward a demographic divide? Equity, race, and Social Security %0 Journal Article %J Eur J Ageing %D 2008 %T Unhealthy lifestyles among older adults: exploring transitions in Mexico and the US. %A Rebeca Wong %A Mary Beth Ofstedal %A Yount, Kathryn %A Emily M. Agree %X

Lifestyle risk factors are important precursors of old age disease and disability, and the population level impact of these factors likely differs across countries that vary in their economic growth and the attributes of the populations that adopt and abandon unhealthy lifestyles. This paper describes the stage of "lifestyle transition" among older adults in two countries with vastly different trajectories of socio-economic development. A series of hypotheses are proposed on the socioeconomic patterns of health risk factors that would be expected in the two countries, given their economic circumstances and the historical timing of policy interventions that were initiated to mitigate lifestyle risks in these populations. The paper compares the prevalence of smoking tobacco, drinking alcohol, obesity, and lack of physical exercise, as well as the socioeconomic and demographic covariates of these risk factors, among adults aged 55 and older in Mexico and the United States. The findings indicate that smoking- and physical-activity-related transitions toward healthier lifestyles are well under way among older adults in the United States but not in Mexico, whereas a trend toward reduced levels of obesity has just begun in the United States but not in Mexico. There is no evidence of a transition in heavy alcohol drinking in either country among older adults.

%B Eur J Ageing %I 5 %V 5 %P 311-326 %8 2008 Dec %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25419206?dopt=Abstract %4 MHAS_/Cross Cultural Comparison/cross-national comparison/Lifestyle/Obesity/Smoking/Alcohol/Exercise/Mexico/United States %$ 62602 %R 10.1007/s10433-008-0098-0 %0 Journal Article %J Forum for Health Economics and Policy (Aging and Medical Care Costs) %D 2007 %T Cross-Country Variation in Obesity Patterns among Older Americans and Europeans %A Pierre-Carl Michaud %A Arthur H.O. vanSoest %A Andreyeva, Tatiana %K Cross-National %K Demographics %K Health Conditions and Status %K SHARE %X While the fraction of obese people is not as large in Europe as in the United States, obesity is becoming an important issue in Europe as well. Using comparable data from the Survey of Health, Aging and Retirement in Europe (SHARE) and the Health and Retirement Study in the U.S. (HRS), we analyze the correlates of obesity in the population ages 50 and above, focusing on measures of energy intake and expenditure as well as socio-economic status. We find that obesity rates differ substantially on both sides of the Atlantic and across European countries, with most of the difference coming from the right tail of the weight distribution. The well-known SES gradient in the prevalence of obesity differs across countries and cannot be fully explained by the variation in food expenditure or physical activity. Obesity is associated with lack of physical activity, calorie intake, time spent on cooking, and time and money spent on eating at home and away from home, but some of these associations vary across countries. More research is needed to analyze why this is the case. %B Forum for Health Economics and Policy (Aging and Medical Care Costs) %I 10 %V 10 %P 32 %G eng %U https://www.rand.org/pubs/working_papers/WR495.html %N 2 %L newpubs20101112_Michaud.pdf %4 cross-national comparison/SHARE/Obesity/socioeconomic Status/body Mass Index %$ 23740 %0 Journal Article %J Gerontologist %D 2007 %T The economic consequences of widowhood for older minority women. %A Jacqueline L. Angel %A Maren A. Jimenez %A Ronald J. Angel %K Aged %K Black or African American %K Female %K Hispanic or Latino %K Humans %K Longitudinal Studies %K Middle Aged %K United States %K White People %K Widowhood %X

PURPOSE: We compare the economic consequences of widowhood for pre-retirement age and early-retirement age Black, Hispanic, and non-Hispanic White women.

METHODS: We use the 1992 and 2000 waves of the Health and Retirement Study to assess the effects of widowhood on the household incomes and assets of non-Hispanic White, Black, and Hispanic women who were 51 years of age or older at baseline (N = 4,544).

RESULTS: For women of all racial and ethnic groups, marital disruption, including widowhood, results in a substantial decline in household income and assets. Net of demographic controls, the relative loss is far greater for Black and Hispanic widows than for non-Hispanic White widows.

IMPLICATIONS: The data reveal a substantial widowhood penalty for total household income and net worth for women in each racial and ethnic group. However, the findings suggest that minority widows are at a particularly high risk of poverty in late life, given that they have lower incomes and fewer assets to begin with. Implications of the results for the financial security of women approaching retirement are discussed.

%B Gerontologist %I 47 %V 47 %P 224-34 %8 2007 Apr %G eng %N 2 %L newpubs20070403_Angel_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17440127?dopt=Abstract %4 Widowhood/Minorities/Assets/income %$ 17380 %R 10.1093/geront/47.2.224 %0 Journal Article %J Res Aging %D 2007 %T Education and Cognitive Decline in Older Americans: Results From the AHEAD Sample. %A Dawn E Alley %A Suthers, Kristen %A Eileen M. Crimmins %X

Although education is consistently related to better cognitive performance, findings on the relationship between education and age-associated cognitive change have been conflicting. Using measures of multiple cognitive domains from four waves of the Asset and Health Dynamics of the Oldest Old study, a representative sample of Americans aged 70 years and older, the authors performed growth curve modeling to examine the relationships between education, initial cognitive score, and the rate of decline in cognitive function. More years of education were linked to better initial performance on each of the cognitive tests, and higher levels of education were linked to slower decline in mental status. However, more education was unrelated to the rate of decline in working memory, and education was associated with somewhat faster cognitive decline on measures of verbal memory. These findings highlight the role of early-life experiences not only in long-term cognitive performance but also in old-age cognitive trajectories.

%B Res Aging %I 29 %V 29 %P 73-94 %8 2007 Jan 01 %G eng %N 1 %L newpubs20101112_Alley.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19830260?dopt=Abstract %2 PMC2760835 %4 cognitive decline/Cognitive Impairment/EDUCATION/growth curve modeling/methodology %$ 23800 %R 10.1177/0164027506294245 %0 Journal Article %J BMC Health Serv Res %D 2007 %T Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services. %A Frederic D Wolinsky %A An, Hyonggin %A Li Liu %A Thomas R Miller %A Gary E Rosenthal %K Aged %K Aged, 80 and over %K Ambulatory Care %K Cluster Analysis %K Continuity of Patient Care %K Emergency Service, Hospital %K Episode of Care %K Hospital Mortality %K Hospitals, Veterans %K Humans %K Male %K Medicare %K Proportional Hazards Models %K United States %K Veterans %X

BACKGROUND: Older veterans may use both the Veterans Health Administration (VHA) and Medicare, but the association of dual use with health outcomes is unclear. We examined the association of indirect measures of dual use with mortality.

METHODS: Our secondary analysis used survey, claims, and National Death Index data from the Survey on Assets and Health Dynamics among the Oldest Old. The analytic sample included 1,521 men who were Medicare beneficiaries. Veterans were classified as dual users when their self-reported number of hospital episodes or physician visits exceeded that in their Medicare claims. Veterans reporting inpatient or outpatient visits but having no Medicare claims were classified as VHA-only users. Proportional hazards regression was used.

RESULTS: 897 (59%) of the men were veterans, of whom 134 (15%) were dual users. Among dual users, 60 (45%) met the criterion based on inpatient services, 54 (40%) based on outpatient services, and 20 (15%) based on both. 766 men (50%) died. Adjusting for covariates, the independent effect of any dual use was a 38% increased mortality risk (AHR = 1.38; p = .02). Dual use based on outpatient services marginally increased mortality risk by 45% (AHR = 1.45; p = .06), and dual use based on both inpatient and outpatient services increased the risk by 98% (AHR = 1.98; p = .02).

CONCLUSION: Indirect measures of dual use were associated with increased mortality risk. New strategies to better coordinate care, such as shared medical records, should be considered.

%B BMC Health Serv Res %I 7 %V 7 %P 70 %8 2007 May 09 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/17490488?dopt=Abstract %2 PMC1884152 %4 Veterans: statistics/numerical/medicare/mortality/Physician visits/Physician visits/HOSPITALIZATION %$ 25010 %R 10.1186/1472-6963-7-70 %0 Journal Article %J JAMA %D 2007 %T Health of previously uninsured adults after acquiring Medicare coverage. %A J. Michael McWilliams %A Meara, Ellen %A Alan M. Zaslavsky %A John Z. Ayanian %K Aged %K Cardiovascular Diseases %K depression %K Diabetes Mellitus %K Female %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Medically Uninsured %K Medicare %K Middle Aged %K Outcome Assessment, Health Care %K United States %X

CONTEXT: Uninsured near-elderly adults, particularly those with cardiovascular disease or diabetes, experience worse health outcomes than insured adults. However, the health benefits of providing insurance coverage for uninsured adults have not been clearly demonstrated.

OBJECTIVE: To assess the effect of acquiring Medicare coverage on the health of previously uninsured adults.

DESIGN AND SETTING: We conducted quasi-experimental analyses of longitudinal survey data from 1992 through 2004 from the nationally representative Health and Retirement Study. We compared changes in health trends reported by previously uninsured and insured adults after they acquired Medicare coverage at age 65 years.

PARTICIPANTS: Five thousand six adults who were continuously insured and 2227 adults who were persistently or intermittently uninsured from ages 55 to 64 years.

MAIN OUTCOME MEASURES: Differential changes in self-reported trends after age 65 years in general health, change in general health, mobility, agility, pain, depressive symptoms, and a summary measure of these 6 domains; and adverse cardiovascular outcomes (all trend changes reported in health scores per year).

RESULTS: Compared with previously insured adults, previously uninsured adults reported significantly improved health trends after age 65 years for the summary measure (differential change in annual trend, +0.20; P = .002) and several component measures. Relative to previously insured adults with cardiovascular disease or diabetes, previously uninsured adults with these conditions reported significantly improved trends in summary health (differential change in annual trend, +0.26; P = .006), change in general health (+0.02; P = .03), mobility (+0.04; P = .05), agility (+0.08; P = .003), and adverse cardiovascular outcomes (-0.015; P = .02) but not in depressive symptoms (+0.04; P = .32). Previously uninsured adults without these conditions reported differential improvement in depressive symptoms (+0.08; P = .002) but not in summary health (+0.10; P = .17) or any other measure. By age 70 years, the expected difference in summary health between previously uninsured and insured adults with cardiovascular disease or diabetes was reduced by 50%.

CONCLUSION: In this study, acquisition of Medicare coverage was associated with improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.

%B JAMA %I 298 %V 298 %P 2886-94 %8 2007 Dec 26 %G eng %N 24 %L newpubs20080229_joc70139.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18159058?dopt=Abstract %4 Medicare/Insured Status/SELF-RATED HEALTH %$ 18480 %R 10.1001/jama.298.24.2886 %0 Journal Article %J Med Care %D 2007 %T Hospital episodes and physician visits: the concordance between self-reports and medicare claims. %A Frederic D Wolinsky %A Thomas R Miller %A An, Hyonggin %A John F Geweke %A Robert B Wallace %A Kara B Wright %A Elizabeth A Chrischilles %A Li Liu %A Claire E Pavlik %A Elizabeth A Cook %A Robert L. Ohsfeldt %A Kelly K Richardson %A Gary E Rosenthal %K Aged %K Centers for Medicare and Medicaid Services, U.S. %K Episode of Care %K Female %K Hospitalization %K Humans %K Insurance Claim Review %K Interviews as Topic %K Male %K Physicians %K Quality Assurance, Health Care %K Self Disclosure %K United States %X

BACKGROUND: Health services use typically is examined using either self-reports or administrative data, but the concordance between the 2 is not well established.

OBJECTIVE: We evaluated the concordance of hospital and physician utilization data from self-reports and claims data, and identified factors associated with disagreement.

METHODS: We performed a secondary analysis on linked observational and administrative data. A national sample of 4310 respondents who were 70 years old or older at their baseline interviews was used. Self-reported and Medicare claims-based hospital episodes and physician visits for 12 months before baseline were examined. Kappa statistics were used to evaluate concordance, and multivariable multinomial logistic regression was used to identify factors associated with overreporting (self-reports > claims), underreporting (self-reports < claims), and concordant-reporting (self-reports approximately claims).

RESULTS: The concordance of hospital episodes was high (kappa = 0.767 for the 2 x 2 comparison of none vs. some and kappa = 0.671 for the 6 x 6 comparison of none, 1, ..., 4, or 5 or more), but concordance for physician visits was low (kappa = 0.255 for the 2 x 2 comparison of none versus some and kappa = 0.351 for the 14 x 14 comparison of none, 1, ..., 12, and 13 or more). Multivariable multinomial logistic regression indicated that over-, under-, and concordant-reporting of hospital episodes was significantly associated with gender, alcohol consumption, arthritis, cancer, heart disease, psychologic problems, lower body functional limitations, self-rated health, and depressive symptoms. Over-, under-, and concordant-reporting of physician visits were significantly associated with age, gender, race, living alone, veteran status, private health insurance, arthritis, cancer, diabetes, hypertension, heart disease, lower body functional limitations, and poor memory.

CONCLUSIONS: Concordance between self-reported and claims-based hospital episodes was high, but concordance for physician visits was low. Factors significantly associated with bidirectional (over- and underreporting) and unidirectional (over- or underreporting) error patterns were detected. Therefore, caution is advised when drawing conclusions based on just one physician visit data source.

%B Med Care %I 45 %V 45 %P 300-7 %8 2007 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/17496713?dopt=Abstract %2 PMC1904836 %4 health Services/ADMINISTRATIVE DATA/Self-reported health/Medicare/HOSPITALIZATION %$ 25000 %R 10.1097/01.mlr.0000254576.26353.09 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T An interpersonal continuity of care measure for Medicare Part B claims analyses. %A Frederic D Wolinsky %A Thomas R Miller %A John F Geweke %A Elizabeth A Chrischilles %A An, Hyonggin %A Robert B Wallace %A Claire E Pavlik %A Kara B Wright %A Robert L. Ohsfeldt %A Gary E Rosenthal %K Aged %K Aged, 80 and over %K Continuity of Patient Care %K Disability Evaluation %K Female %K Health Services Accessibility %K Health Surveys %K Humans %K Insurance Claim Review %K Male %K Medicare Part B %K Mobility Limitation %K Physician-Patient Relations %K Primary Health Care %K United States %X

OBJECTIVES: This article presents an interpersonal continuity of care measure.

METHODS: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals. We linked Medicare Part A and B claims to baseline survey data for 4,596 respondents to the Survey on Asset and Health Dynamics Among the Oldest Old. We addressed the potential for selection bias by using propensity score methods, and we explored construct validity.

RESULTS: Interpersonal continuity with a primary care physician was 17.3%, and interpersonal continuity of care with any physician was 26.1%. Older participants; men; individuals who lived alone; people who had difficulty walking; and respondents with medical histories of arthritis, cancer, diabetes, heart conditions, hypertension, and stroke were most likely to have continuity. Individuals who had never married, were widowed, were working, or had low subjective life expectancy were least likely to have continuity.

DISCUSSION: Researchers can measure interpersonal continuity of care using Medicare Part B claims. Replication of these findings and further construct validation, however, are needed prior to widespread adoption of this method.

%B J Gerontol B Psychol Sci Soc Sci %I 62B %V 62 %P S160-8 %8 2007 May %G eng %N 3 %L newpubs20071002_JoGS160.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17507591?dopt=Abstract %2 PMC2914469 %4 Medicare/Health Care Utilization %$ 18060 %R 10.1093/geronb/62.3.s160 %0 Book Section %B Retirement Provision in Scary Markets %D 2007 %T Lifetime Earnings Variability and Retirement Shortfalls %A Olivia S. Mitchell %A John W R Phillips %A Au, Andrew %E Hazel Bateman %K Net Worth and Assets %B Retirement Provision in Scary Markets %I Edward Elgar %C Cheltenham:UK %P 78-99 %G eng %4 Retirement Wealth %$ 13112 %! Lifetime Earnings Variability and Retirement Shortfalls %0 Journal Article %J International Economic Review %D 2007 %T Living Rationally Under the Volcano? An Empirical Analysis of Heavy Drinking and Smoking %A Arcidiacono, Peter %A Sieg, Holger %A Frank A Sloan %K Health Conditions and Status %K Methodology %K Risk Taking %X This study investigates whether models of forward-looking behavior explain the observed patterns of heavy drinking and smoking of men in late middle age in the Health and Retirement Study better than myopic models. We develop and estimate a sequence of nested models that differ by their degree of forward-looking behavior. Our empirical findings suggest that forward looking models fit the data better than myopic models. These models also dominate other behavioral models based on out-of-sample predictions using data of men aged 70 and over. Myopic models predict rates of smoking for old individuals, which are significantly larger than those found in the data on elderly men. %B International Economic Review %I 48 %V 48 %P 37 %G eng %U http://www.econ.duke.edu/Papers/Abstracts02/abstract.02.30.html %N 1 %L newpubs20070403_Arcidiacono_etal %4 Risk Behavior/Health/Smoking/Alcohol Drinking/Econometric and Statistical Methods %$ 14900 %0 Journal Article %J Med Care %D 2007 %T New evidence of racial differences in access and their effects on the use of nursing homes among older adults. %A Adaeze B Akamigbo %A Frederic D Wolinsky %K Aged %K Assisted Living Facilities %K Attitude to Health %K Black or African American %K Female %K Health Services Accessibility %K Health Status %K Homes for the Aged %K Humans %K Male %K Nursing homes %K Socioeconomic factors %K Time Factors %K White People %X

BACKGROUND: Historical disparities in rates of nursing home placement between blacks and whites have been well documented, and are thought to result from more extensive and supportive social networks, cultural aversion, and poorer geographic access among African Americans. A few recent studies, however, suggest that these racial disparities may no longer exist. We used comprehensive data to assess whether racial differences in nursing home placement remain, and if so, to identify the reasons for them.

METHODS: Data on 6242 black and white self-respondents to the Survey of Assets and Health Dynamics Among the Oldest Old cohort who were 70 years old or older at baseline (1993) were used. Placement status was ascertained at each biennial follow-up through 2004, and discrete-time hazards models were estimated.

RESULTS: After adjusting for baseline covariates, it was found that blacks were 26% (lambda = 0.74, P < 0.001) less likely to use a nursing home over an 11-year period than whites. Moreover, the supply of skilled nursing beds was more salient for nursing home placement for blacks than whites, as was the increasing supply of assisted living beds.

CONCLUSIONS: The racial gap in nursing home placement remains, despite the increased supply of nursing home beds and the emergence of assisted living facilities as the preferred alternative. As the supply of skilled nursing beds increases, in part due to whites choosing assisted living facilities, the racial gap in the risks of nursing home placement may be lessening. Blacks, however, remain less likely to be placed in a nursing home than whites.

%B Med Care %I 45 %V 45 %P 672-9 %8 2007 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/17571016?dopt=Abstract %R 10.1097/MLR.0b013e3180455677 %0 Thesis %D 2007 %T Nursing home placement among older adults: A national study of risk perceptions, access and placement outcomes %A Adaeze B Akamigbo %K Demographics %K Healthcare %K Nursing homes %K Older Adults %K Risk Factors %X In health services research, race and gender are frequently included as demographic variables along with other relevant predictors. Frequently, however, routine inclusion of race and gender is of a cursory nature, and does not inform researchers of the great differences that can be evident between groups. To address this, particularly in long-term care research, the principle purpose of this dissertation research was to explore the additive and interactive effects of race and gender on several aspects of nursing home use including expectations for placement, the risk for placement, access to nursing home services, and outcomes of nursing home use. Data were drawn from the Health and Retirement Study, specifically, the study on Asset and Health Dynamics among the Oldest Old (AHEAD). 7,447 AHEAD study respondents were 70 years and older at baseline data collection in 1993. The observation period lasted through 2004. Multivariate binary and multinomial logistic regression models, as well as ordinary least squares, and hazard modeling techniques were used. Study results confirmed that risk perceptions as reported by respondents were rational, and that older adults can accurately assess their risk for placement in 5 years. Overwhelmingly, Blacks were at a lower risk for placement in a nursing home in 5 years, or after 11 years. However, the risk for placement was significantly impacted by the growth of assisted living beds over the study period which expanded access for Whites, but limited long-term care options for Blacks to nursing homes. Women experienced higher risk for placements, especially multiple placements over time, suggesting a possible reliance on nursing homes for respite care due to more limited caregiver options in the community. Study results suggest that early identification of individuals at risk informs budget planning for Medicaid and other payers, and directs resources to individuals and communities that are in greatest need. Planning for the anticipated growth in the need for long-term care services are also improved by identifying demographic and other personal and market factors that contribute to temporary, multiple, or terminal use of long-term care services by older adults. %I University of Iowa %8 2007 %G eng %! Nursing home placement among older adults: A national study of risk perceptions, access and placement outcomes %0 Thesis %D 2007 %T Obesity: The role of economic incentives in individuals' bodyweight choice %A Abdus, Salam %K Health Conditions and Status %X This dissertation investigates the economics of obesity, in particular, the role of economic incentives in individuals' bodyweight choice. In the first essay, it is shown that obesity is negatively correlated with income and health insurance coinsurance rate, using data from the Health and Retirement Study (HRS). In the second essay, I develop and estimate a dynamic structural model of individuals' bodyweight choice. In this model, individuals invest in reducing bodyweight to increase productivity, reduce the probability of death and to reduce health care costs. The dynamics of bodyweight is captured by using the energy balance equation of human body, that is, the calculus of calorie intake, calorie expenditure and bodyweight change. The parameters of the model are estimated using nationally representative data sets (HRS, NHIS, NHANES, Build Study). The model can explain the observed heterogeneity in bodyweight and obesity across individuals and over individuals' lifetimes fairly well, based on the differences in opportunity costs of obesity. Individuals with higher income earning capability tend to be less obese because they have higher opportunity costs of sick days, disability and mortality. Similarly, individuals facing a higher price of health care (i.e. high coinsurance rate) are less likely to be obese. The estimates of the policy-invariant parameters of the model give us the opportunity of conducting some policy experiments. First, raising the coinsurance rate to 1 for all individuals reduces the male prevalence of obesity by 7 . However, raising the coinsurance rate to 1 only for the obese individuals (and keeping the coinsurance rate same as before for non-obese people) leads to a large decrease in the prevalence of obesity (40 ). In this case, individuals have an added incentive to reduce obesity, that is, to reduce the price per unit of health care use. %I University of Minnesota %8 2007 %G eng %L newpubs20071203_Abdus.pdf %4 Body Mass Index %$ 18220 %! Obesity: The role of economic incentives in individuals' bodyweight choice %0 Journal Article %J J Pain %D 2007 %T Pain in aging community-dwelling adults in the United States: non-Hispanic whites, non-Hispanic blacks, and Hispanics. %A Reyes-Gibby, Cielito C. %A Aday, Lu Ann %A Todd, Knox H. %A Cleeland, Charles S. %A Anderson, Karen O. %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Black People %K Chronic disease %K Data collection %K ethnicity %K Female %K Hispanic or Latino %K Humans %K Insurance, Health %K Logistic Models %K Male %K Middle Aged %K pain %K Pain Measurement %K Population %K Socioeconomic factors %K United States %K White People %X

UNLABELLED: Racial and ethnic disparities in healthcare persist in the U.S. Although pain is one of the most prevalent and disabling symptoms of disease, only a few studies have assessed disparities in pain in large racially and ethnically diverse, middle- to late aged community samples, thus limiting the generalizability of study findings in broader populations. With data from the 2000 Health and Retirement Study, we assessed the prevalence and impact of pain in a community sample of aging (> or =51 years old) non-Hispanic whites (n = 11,021), non-Hispanic blacks (n = 1,804), and Hispanics (n = 952) in the U.S. Pain, pain severity, activity limitation as a result of pain, comorbid conditions, and sociodemographic variables were assessed. Results showed that pain prevalence was 28%, and 17% of the sample reported activity limitation as a result of pain. Non-Hispanic blacks (odds ratio [OR], 1.78; 99% confidence interval [CI], 1.33-2.37) and Hispanics (OR, 1.80; 99% CI, 1.26-2.56) had higher risk for severe pain compared with non-Hispanic whites. Analyses of respondents with pain (n = 3,811) showed that having chronic diseases (2 comorbid conditions, OR, 1.5; 99% CI, 1.09-2.17), psychological distress (OR, 1.99; 99% CI, 1.54-2.43), being a Medicaid recipient (OR, 1.63; 99% CI, 1.17-2.25), and lower educational level (OR, 1.45; 99% CI, 1.14-1.85) were significant predictors for severe pain and helped to explain racial/ethnic differences in pain severity.

PERSPECTIVE: This study, which used a large racially and ethnically diverse community sample, provided empirical evidence that racial/ethnic difference in pain severity in aging community adults in the U.S. can be accounted for by differential vulnerability in terms of chronic disease, socioeconomic conditions, and access to care.

%B J Pain %I 8 %V 8 %P 75-84 %8 2007 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/16949874?dopt=Abstract %4 Health Care/Racial Differences/Ethnicity %$ 17190 %R 10.1016/j.jpain.2006.06.002 %0 Journal Article %J Stroke %D 2007 %T Is the 'stroke belt' worn from childhood?: risk of first stroke and state of residence in childhood and adulthood. %A M. Maria Glymour %A Mauricio Avendano %A Lisa F Berkman %K Adult %K Child %K Female %K Follow-Up Studies %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Proportional Hazards Models %K Risk Factors %K Southeastern United States %K Stroke %X

BACKGROUND AND PURPOSE: Most Stroke Belt studies define exposure based on residence at stroke onset. We assessed whether residence in the Stroke Belt during childhood confers extra stroke risk in adulthood, even among people who left the region.

METHODS: Stroke-free Health and Retirement Study participants (n=18 070) followed up (average, 8.4 years) for first stroke (1452 events) were classified as living in 1 of 7 Stroke Belt states in childhood or at study enrollment (average age, 63 years). We used Cox proportional-hazards models to compare stroke risk for people who had never lived in the Stroke Belt with those who had lived there at both ages, in childhood only, or in adulthood only.

RESULTS: Compared with never having lived in the Stroke Belt, the hazard ratio for Stroke Belt residence in both childhood and adulthood was 1.23 (95% CI, 1.06, 1.43) and for Stroke Belt residence in childhood only was 1.25 (95% CI, 1.02, 1.55). Stroke Belt residence at enrollment but not during childhood was not significantly related to stroke risk (hazard ratio=1.01; 95% CI, 0.70, 1.46), but the small sample in this group resulted in wide CIs. Results changed little after risk factor adjustment, including comprehensive adult socioeconomic measures. Subgroup analyses found similar patterns by sex and birth cohort. In contrast, blacks who had lived in the Stroke Belt in childhood only did not appear to have significantly elevated stroke risk compared with blacks who had never lived in the Stroke Belt.

CONCLUSIONS: The excess stroke risk for people who had lived in Stroke Belt states during childhood implicates early life exposures in the etiology of the Stroke Belt.

%B Stroke %I 38 %V 38 %P 2415-21 %8 2007 Sep %G eng %N 9 %L newpubs20071002_StrokeBelt.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17673716?dopt=Abstract %4 Stroke/CHILDHOOD/migration %$ 17970 %R 10.1161/STROKEAHA.107.482059 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Urban neighborhoods and depressive symptoms among older adults. %A Carol S Aneshensel %A Richard G Wight %A Miller-Martinez, Dana %A Amanda L. Botticello %A Arun S Karlamangla %A Teresa Seeman %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Comorbidity %K Cross-Sectional Studies %K Depressive Disorder %K Female %K Health Status Indicators %K Health Surveys %K Humans %K Incidence %K Male %K Minority Groups %K Peer Group %K Population Dynamics %K Risk Factors %K Social Environment %K United States %K Urban Population %X

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older.

METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models.

RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population.

DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S52-9 %8 2007 Jan %G eng %N 1 %L newpubs20070403_Aneshensel_etal %1 http://www.ncbi.nlm.nih.gov/pubmed/17284567?dopt=Abstract %4 Depressive Symptoms/Socioeconomic Factors/Urban Population %$ 17280 %R 10.1093/geronb/62.1.s52 %0 Journal Article %J Chiropr Osteopat %D 2007 %T The use of chiropractors by older adults in the United States. %A Frederic D Wolinsky %A Li Liu %A Thomas R Miller %A John F Geweke %A Elizabeth A Cook %A Barry R. Greene %A Kara B Wright %A Elizabeth A Chrischilles %A Claire E Pavlik %A An, Hyonggin %A Robert L. Ohsfeldt %A Kelly K Richardson %A Gary E Rosenthal %A Robert B Wallace %X

BACKGROUND: In a nationally representative sample of United States Medicare beneficiaries, we examined the extent of chiropractic use, factors associated with seeing a chiropractor, and predictors of the volume of chiropractic use among those having seen one.

METHODS: We performed secondary analyses of baseline interview data on 4,310 self-respondents who were 70 years old or older when they first participated in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). The interview data were then linked to their Medicare claims. Multiple logistic and negative binomial regressions were used.

RESULTS: The average annual rate of chiropractic use was 4.6%. During the four-year period (two years before and two years after each respondent's baseline interview), 10.3% had one or more visits to a chiropractor. African Americans and Hispanics, as well as those with multiple depressive symptoms and those who lived in counties with lower than average supplies of chiropractors were much less likely to use them. The use of chiropractors was much more likely among those who drank alcohol, had arthritis, reported pain, and were able to drive. Chiropractic services did not substitute for physician visits. Among those who had seen a chiropractor, the volume of chiropractic visits was lower for those who lived alone, had lower incomes, and poorer cognitive abilities, while it was greater for the overweight and those with lower body limitations.

CONCLUSION: Chiropractic use among older adults is less prevalent than has been consistently reported for the United States as a whole, and is most common among Whites, those reporting pain, and those with geographic, financial, and transportation access.

%B Chiropr Osteopat %I 15 %V 15 %P 12 %8 2007 Sep 06 %G eng %L newpubs20090908/Wolinskyetal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17822549?dopt=Abstract %2 PMC2034378 %4 Chiropractic/Health Care Utilization/Medicare %$ 20280 %R 10.1186/1746-1340-15-12 %0 Journal Article %J N Engl J Med %D 2007 %T Use of health services by previously uninsured Medicare beneficiaries. %A J. Michael McWilliams %A Meara, Ellen %A Alan M. Zaslavsky %A John Z. Ayanian %K Aged %K Cardiovascular Diseases %K Diabetes Mellitus %K Female %K Health Expenditures %K Health Services %K Hospitalization %K Humans %K Insurance, Health %K Logistic Models %K Longitudinal Studies %K Male %K Medically Uninsured %K Medicare %K Middle Aged %K Socioeconomic factors %K United States %X

BACKGROUND: Previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured.

METHODS: We used longitudinal data from the nationally representative Health and Retirement Study to assess self-reported health care use and expenditures from 1992 through 2004 among 5158 adults who were privately insured or uninsured before Medicare coverage began at the age of 65 years. We used propensity-score methods to compare health care use and expenditures for previously insured and uninsured beneficiaries who were similar across numerous characteristics at 59 to 60 years of age and adjusted for differences in supplemental and prescription-drug coverage after 65 years of age.

RESULTS: Among 2951 adults with hypertension, diabetes, heart disease, or stroke diagnosed before 65 years of age, previously uninsured adults who acquired Medicare coverage at the age of 65 reported significantly greater increases in the numbers of doctor visits (P<0.001) and hospitalizations (P=0.001) and in total medical expenditures (P=0.02) than did previously insured adults. Significant differential increases were not evident among the 2207 adults without these conditions (P>0.12 for all comparisons). In analyses adjusted for supplemental and prescription-drug coverage, previously uninsured adults with these conditions reported more doctor visits (13% relative difference, P=0.04), more hospitalizations (20% relative difference, P=0.04), and higher total medical expenditures (51% relative difference, P=0.09) from ages 65 to 72 years than did previously insured adults.

CONCLUSIONS: The costs of expanding health insurance coverage for uninsured adults before they reach the age of 65 years may be partially offset by subsequent reductions in health care use and spending for these adults after the age of 65, particularly if they have cardiovascular disease or diabetes before the age of 65 years.

%B N Engl J Med %I 357 %V 357 %P 143-53 %8 2007 Jul 12 %G eng %N 2 %L newpubs20071002_NEJM143.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17625126?dopt=Abstract %4 Medicare/Health Insurance Coverage/Health Care Utilization %$ 18050 %R 10.1056/NEJMsa067712 %0 Journal Article %J BMC Health Serv Res %D 2006 %T Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes? %A Frederic D Wolinsky %A Thomas R Miller %A An, Hyonggin %A Paul R Brezinski %A Thomas E Vaughn %A Gary E Rosenthal %K Aged %K Aged, 80 and over %K Deductibles and Coinsurance %K Episode of Care %K Health Services Research %K Hospitals, Veterans %K Humans %K Male %K Medicare %K Mortality %K Outcome Assessment, Health Care %K Proportional Hazards Models %K Quality Indicators, Health Care %K Risk Assessment %K Selection Bias %K Surveys and Questionnaires %K United States %K United States Department of Veterans Affairs %K Veterans %X

BACKGROUND: Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.

METHODS: Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.

RESULTS: 96 (11%) of the veterans were classified as dual users. 766 men (50.3%) had died by December 31, 2002, including 64.9% of the dual users and 49.3% of all others, for an attributable mortality risk of 15.6% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1% increased relative risk of mortality (AHR = 1.561; p = .009).

CONCLUSION: An indirect measure of veterans' dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.

%B BMC Health Serv Res %I 6 %V 6 %P 131 %8 2006 Oct 09 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/17029643?dopt=Abstract %2 PMC1617101 %4 Veterans: statistics/numerical/Medicare/public Policy/Mortality %$ 24990 %R 10.1186/1472-6963-6-131 %0 Journal Article %J American Journal of Epidemiology %D 2006 %T Invited Commentary: Considerations about Specificity of Associations, Causal Pathways, and Heterogeneity in Multilevel Thinking %A Galea, Sandro %A Ahern, Jennifer %K Cognition %K Cognition & Reasoning %K Heterogeneity %K Thinking %X During the past decade, there has been a dramatic increase in the use of multilevel modeling in epidemiologic analysis. There were 10 times as many papers in Index Medicus identified by the terms “multilevel” and “epidemiology” in 2005 than there were in 1995. In recent years, the American Journal of Epidemiology has published papers that use multilevel analyses to consider the associations between group-level characteristics and a range of health indicators (1–7). Accompanying these content-specific contributions have been several discussions of the strengths and limitations of multilevel modeling techniques (8, 9) and the rationale for applying these methods to public health (10, 11). %B American Journal of Epidemiology %V 163 %P 1079-1082 %8 05 %G eng %U https://doi.org/10.1093/aje/kwj177 %R 10.1093/aje/kwj177 %0 Journal Article %J Journal of Pain and Symptom Management %D 2006 %T Pain, Depression, and Fatigue in Community-Dwelling Adults With and Without a History of Cancer %A Reyes-Gibby, Cielito C. %A Aday, Lu Ann %A Anderson, Karen O. %A Mendoza, Tito R. %A Cleeland, Charles S. %K Health Conditions and Status %K Risk Taking %X The State of the Science Report by the National Cancer Institute on Symptom Management in Cancer identified gaps in understanding the epidemiology of pain, depression, and fatigue, and called for studies that will identify the extent of risk for these symptoms among those with cancer relative to other populations. Using year 2000 data from the Health and Retirement Study, a survey of a nationally representative sample of adults aged andgt;/=50, we evaluated whether respondents with a history of cancer had excess risk for pain, depression, and fatigue compared to those without a history of cancer. We also compared clustering/co-occurrence of symptoms. Controlling for the confounding effects of comorbidities, sociodemographic, and access to care factors, respondents with a history of cancer had higher risk for fatigue (OR=1.45; 95 CI=1.29,1.63), depression (OR=1.21; 95 CI=1.06,1.37), and pain (OR=1.15; 95 CI=1.03,1.28). Symptom clusters were also more prevalent among those with a history of cancer (Pandlt;0.001), with the pain-depression-fatigue cluster as most prevalent. %B Journal of Pain and Symptom Management %I 32 %V 32 %P 118-28 %G eng %U http://www.sciencedirect.com/ %N 2 %L pubs_2006_Reyes-Gibby.pdf %4 CANCER/Depression/risk factors %$ 16750 %0 Journal Article %J The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 2006 %T Parent Care and the Stress Process: Findings from panel data %A Amirkhanyan, Anna A. %A Douglas A. Wolf %K Health Conditions and Status %K Healthcare %X OBJECTIVE: The purpose of this study was to test with panel data an extended model of the stress process recognizing the separate effects of a parent's need for care and an adult child's caring activities. Methods. Using data from the 1996, 1998, and 2000 waves of the Health and Retirement Study, we estimated nonlinear mixed models of mental health outcomes. We assessed mental health for separate samples of 3,350 men and 3,659 women by using an 8-item scale of depressive symptoms. We also explored the sensitivity of results to alternative measures and model specifications. RESULT: . We found that female, but not male, caregivers whose parents needed care exhibited adverse mental health consequences. However, we found that, generally, both male and female noncaregivers whose parents needed care were more likely to report symptoms of depression than were noncaregivers without disabled parents. Additional findings suggest that the stress process is still more complex among married couples. Discussion. This study distinguishes the outcomes of parental care needs from those attributable to caregiving activities. Adverse psychological outcomes appear to be dispersed throughout the family. To focus narrowly on active caregivers is to underestimate the social burdens of disability at older ages. %B The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %I 61 %V 61 %P S248-55 %G eng %U http://psychsoc.gerontologyjournals.org/contents-by-date.2006.shtml %N 5 %L pubs_2006_JoG_S248.pdf %4 Caregivers/Stress Psychology %$ 13902 %0 Journal Article %J Gerontologist %D 2006 %T Reported expectations for nursing home placement among older adults and their role as risk factors for nursing home admissions. %A Adaeze B Akamigbo %A Frederic D Wolinsky %K Age Factors %K Aged %K Female %K Health Status %K Homes for the Aged %K Humans %K Male %K Nursing homes %K Patient Admission %K Risk Factors %K Sex Factors %K Social Support %K Socioeconomic factors %X

PURPOSE: Individual expectations among community-dwelling older adults and their subsequent effect on placement status have recently been considered. Previous studies, however, have been limited by eligibility and exclusion criteria, treating expectations as a continuous measure, omitting potential confounders, and ignoring Race x Gender interactions.

DESIGN AND METHODS: We used data on 6,242 Black or White self-respondents who were 70 years old or older when they were enrolled in the survey of Assets and Health Dynamics Among the Oldest Old. We modeled expectations for nursing home placement over the next 5 years, as well as actual placement status, by using multivariable multinomial and binomial logistic regression models.

RESULTS: Expectations are not normally distributed: 14% of the participants refused to answer, 51% estimated no chance, 10% indicated a 1% to 50% chance, 21% indicated an 11% to 50% chance and 4% indicated a 51% to 100% chance. Age, gender, education, social supports, and health status were associated with expectations, as well as an interaction effect for Black men. Age, social supports, health status, prior hospital or nursing home use, and expectations were associated with subsequent placement.

IMPLICATIONS: Black and White older adults' expectations for nursing home placement rationally reflect their individual risk profiles and are associated with subsequent placement status. The expectations question may facilitate the early identification of high-risk individuals for further evaluation.

%B Gerontologist %I 46 %V 46 %P 464-73 %8 2006 Aug %G eng %N 4 %L newpubs20071203_Akamigbo.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16921000?dopt=Abstract %R 10.1093/geront/46.4.464 %0 Report %D 2006 %T Savings, Portfolio Choice, and Retirement Expectations %A Arthur H.O. vanSoest %A Katpeyn Arie %K Consumption and Savings %K Expectations %K Net Worth and Assets %X Studying household investment behavior is essential for understanding the full consequences of old age social security benefits. Using data from six waves of the Health and Retirement Study, we analyze the dynamics of portfolio composition before respondents start claiming social security benefits. We consider ownership as well as amounts held of several types of assets and debts. Using panel data censored regression models, portfolio adjustment is explained on the basis of demographics like gender, race, and year of birth, education level, household income, and perceived social security entitlements. We find that expectations of old age social security benefits have little effect on portfolio decisions, although there is some evidence that higher expected social security benefits lead to more risky financial investments, particularly in IRAs. %I The University of Michigan, Michigan Retirement Research Center %G eng %U http://hdl.handle.net/2027.42/49420 %L wp_2006/MRRCwp119.pdf %4 Savings/Portfolio Choice/Retirement Expectations %$ 16740 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2006 %T Social status, risky health behaviors, and diabetes in middle-aged and older adults. %A Linda A. Wray %A Duane F. Alwin %A Ryan J McCammon %A Manning, Timothy %A Best, Latrica E. %K Aged %K Body Mass Index %K Diabetes Mellitus %K Female %K Follow-Up Studies %K Health Behavior %K Humans %K Incidence %K Male %K Middle Aged %K Prevalence %K Risk-Taking %K Social Behavior %K Social Class %K Surveys and Questionnaires %X

OBJECTIVE: This article investigates: (a) how social status influences diabetes prevalence and incidence; (b) how risky health behaviors contribute to the prediction of incident diabetes; (c) if the effects of health behaviors mediate the effects of social status on incident diabetes; and (d) if these effects differ in midlife and older age.

METHODS: We examined nationally representative data from the 1992/1993-1998 panels of the Health and Retirement Study for middle-aged and older adults using logistic regression analyses.

RESULT: The odds of prevalent diabetes were higher for people of older age, men, Black adults, and Latino adults. Higher early-life social status (e.g., parental schooling) and achieved social status (e.g., respondent schooling, economic resources) reduced the odds in both age groups. We observed similar patterns for incident diabetes in midlife but not in older age. Risky health behaviors--particularly obesity--increased the odds of incident diabetes in both age groups independent of social status. The increased odds of incident diabetes in midlife persisted for Black and Latino adults net of other social status factors.

DISCUSSION: Risky health behaviors are key predictors of incident diabetes in both age groups. Economic resources also play an important protective role in incident diabetes in midlife but not in older age.

%B J Gerontol B Psychol Sci Soc Sci %I 61B %V 61 %P S290-8 %8 2006 Nov %G eng %N 6 %L newpubs20070125_Wray_etal_JOG %1 http://www.ncbi.nlm.nih.gov/pubmed/17114308?dopt=Abstract %4 Health Insurance/mortality/health behaviors/diabetes %$ 16970 %R 10.1093/geronb/61.6.s290 %0 Thesis %D 2006 %T A Three-Part Study on the Relationship Between Retirement Planning and Health %A Linda Christine Albert %K Health Conditions and Status %K Healthcare %K Public Policy %K Retirement Planning and Satisfaction %X Researchers consistently conclude that finances and health are the two most significant factors associated with retirement decision-making and a successful retirement experience. Retirement planning is one mechanism by which individuals prepare for the retirement transition; however, retirement planning routinely emphasizes financial concerns, often to the exclusion of health or other significant aspects of retirement. Retirement planning is an increasingly relevant topic at a time when the population is aging, company-sponsored pensions and retiree benefits have diminished significantly, and reform is being sought for the long-standing social programs that have provided support for generations of older Americans. From a financial perspective, few would question the positive benefits associated with retirement planning; however, preparing for a healthy retirement is equally important. If a relationship between retirement planning and health status were to be established, Americans might find increased public and private support for individual retirement planning efforts, particularly among more vulnerable populations such as minorities and women. This dissertation explores the notion that engagement in retirement planning is associated with health status through three studies. Utilizing data from the Health and Retirement Study (HRS), the first article explores prevalence of plans for retirement among worker and retiree respondents, and compares health and other key characteristics associated with planning among the two sub-samples. The second and third articles focus on time order relationships between health status and retirement planning, with article two addressing the question of whether onset of poor health precedes planning for retirement and article three examining health status of planners versus non-planners, over time, to determine whether those who engage in retirement planning are more likely to realize better health outcomes. A brief review of the health, retirement, and retirement planning literature provides the theoretical framework for these research questions and related hypotheses. This dissertation consists of five chapters. Chapter 1 is an introduction to the retirement planning and health literature, Chapters 2-4 describe the series of three studies conducted, and Chapter 5 discusses the overall conclusions as well as future directions for research. %I University of South Florida %C United States -- Florida %8 2006 %G eng %U http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=3436&context=etd %! A Three-Part Study on the Relationship Between Retirement Planning and Health %0 Journal Article %J Am J Epidemiol %D 2006 %T Urban neighborhood context, educational attainment, and cognitive function among older adults. %A Richard G Wight %A Carol S Aneshensel %A Miller-Martinez, Dana %A Amanda L. Botticello %A Janet R. Cummings %A Arun S Karlamangla %A Teresa Seeman %K Aged %K Aged, 80 and over %K Chi-Square Distribution %K Cognition Disorders %K Educational Status %K Female %K Humans %K Linear Models %K Male %K Residence Characteristics %K Risk Factors %K Socioeconomic factors %K United States %K Urban Population %X

Existing research has not addressed the potential impact of neighborhood context--educational attainment of neighbors in particular--on individual-level cognition among older adults. Using hierarchical linear modeling, the authors analyzed data from the 1993 Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a large, nationally representative sample of US adults born before 1924. Data from participants residing in urban neighborhoods (n = 3,442) were linked with 1990 US Census tract data. Findings indicate that 1) average cognitive function varies significantly across US Census tracts; 2) older adults living in low-education areas fare less well cognitively than those living in high-education areas, net of individual characteristics, including their own education; 3) this association is sustained when controlling for contextual-level median household income; and 4) the effect of individual-level educational attainment differs across neighborhoods of varying educational profiles. Promoting educational attainment among the general population living in disadvantaged neighborhoods may prove cognitively beneficial to its aging residents because it may lead to meliorations in stressful life conditions and coping deficiencies.

%B Am J Epidemiol %I 163 %V 163 %P 1071-8 %8 2006 Jun 15 %G eng %N 12 %L pubs_2006_WightAJE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16707655?dopt=Abstract %4 Cognition/EDUCATION/Socioeconomic Factors %$ 16570 %R 10.1093/aje/kwj176 %0 Journal Article %J Military Medicine %D 2006 %T Veterans and Functional Status Transitions in Older Americans %A Xian Li %A Engel, Charles C. %A Han Kang %A Armstrong, David W. %K Older Adults %K Retirement Planning and Satisfaction %K Transitions %K Veterans %X 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. %B Military Medicine %V 171 %P 943 - 949 %8 Jan-10-2006 %G eng %N 10 %R 10.7205/milmed.171.10.943 %0 Journal Article %J Health Services Research %D 2005 %T Do Seniors Understand Their Risk of Moving to a Nursing Home? %A Donald H. Taylor Jr. %A Ostermann, Jan %A Acuff, S. Will %A Truls Ostbye %K Health Conditions and Status %K Healthcare %X Objective: To determine whether seniors understand their risk of moving to a nursing home. Data Sources: We used longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) database. AHEAD is a nationally representative survey (n=8,203) of community dwellers aged 70 years and their spouses. Study Design: We followed respondents for 5 years from the date of the first interview fielded in 1993. Our primary dependent variable was whether respondents moved to a nursing home within 5 years of baseline; self-assessed probability of moving to a nursing home within 5 years, also assessed at baseline, was the primary explanatory variable. Principal Findings: We found that seniors who believed they were more likely to move to a nursing home within 5 years were indeed more likely to do so, and that most elders overestimated their likelihood of moving to a nursing home. Conclusions: Low rates of private long-term care insurance are not plausibly a result of seniors underestimating their personal risk of moving to a nursing home; such an assumption is inherent in many strategies to plan for the future long-term care needs of the baby boom generation. %B Health Services Research %I 40 %V 40 %P 811 %G eng %N 3 %L pubs_2005_Taylor_etal.pdf %4 Long-Term Care/Nursing Homes/Aging %$ 15250 %0 Thesis %D 2005 %T Essays on Intergenerational Transfers in Older Families %A Azuma, Misuzu %K Adult children %K Employment and Labor Force %K Healthcare %K Methodology %X In a series of three essays, I examine intergenerational transfers between elderly parents and their adult children. In the first chapter, I examine the extent to which informal care from family members substitutes for nursing home care. I build a model of families' care decisions for their elderly relatives. My model predicts that nursing home admission is postponed for elderly persons with greater access to informal care. It also predicts that elderly individuals with greater access to informal care enter nursing homes only after their care needs become more severe. To test the predictions of my model, I use data from the 1993-2000 waves of the Assets and Health Dynamics Among the Oldest Old (AHEAD) study. I find that elderly individuals who are married and have more daughters enter nursing homes significantly later. I also find that elderly individuals who are married and are living with their adult children before nursing home entry face significantly higher mortality risk subsequent to nursing home entry. In the second chapter, I examine whether the generosity of the public transfer program for low-income elderly persons, Supplemental Security Income (SSI), displaces private support from family members in the form of coresidence. I use data from the first wave of the AHEAD study. My findings indicate that a $1,000 increase in SSI annual benefits reduces the probability of coresidence by 0.41 percent, implying a small effect of the SSI program on coresidence for the low-income elderly individuals. In the third chapter, coauthor Professor Meta Brown and I examine the motives for holding a trust, using data from the 1995-2002 waves of the Health and Retirement Study. We argue that among households with living trusts, 83 percent of living trusts are created to avoid a probate. We find that few households that are subject to federal estate tax take advantage of living trusts to minimize the estate tax. We also find that among households with estate trusts, 70 percent of estate trusts are created to restrict consumption pattern of the surviving spouse and to guarantee that assets are transferred to their adult children. %I The University of Wisconsin - Madison %C United States -- Wisconsin %8 2005 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1059994081&Fmt=7&clientId=17822&RQT=309&VName=PQD %4 Economics %$ 17560 %! Essays on Intergenerational Transfers in Older Families %0 Report %D 2005 %T Saving Shortfalls and Delayed Retirement %A Au, Andrew %A Olivia S. Mitchell %A John W R Phillips %K Consumption and Savings %K Retirement Planning and Satisfaction %X Prior research has suggested that many older Americans have not saved enough to maintain consumption levels in old age. One way older persons might respond to inadequate savings would be to extend their worklives by delaying retirement. This paper examines evidence on this matter using the Health and Retirement Study, a nationally representative panel survey of people age 51-61 in 1992 followed for several years in a panel. We use the data to project household retirement assets and to determine how much more saving would be needed to preserve post-retirement consumption levels. Our research then examines the links between derived saving shortfall measures and delayed retirement patterns. Among nonmarried persons, there is evidence that larger shortfalls do produce delayed retirement, though the effect is not quantitatively large. For married couples, pre-retirement wealth shortfalls do not appear to be significantly associated with delayed retirement. Evidently couples have other means of handling saving shortfalls. %B University of Michigan Retirement Research Center Working Paper %I Michigan Retirement Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://deepblue.lib.umich.edu/handle/2027.42/50525 %L wp_2005/MRRCwp094.pdf %4 Retirement Saving/Retirement Planning/Consumption %$ 16520 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2005 %T Social status and risky health behaviors: results from the health and retirement study. %A Linda A. Wray %A Duane F. Alwin %A Ryan J McCammon %K Aged %K Aging %K Alcohol Drinking %K Body Weight %K Exercise %K Female %K Health Behavior %K Humans %K Life Style %K Likelihood Functions %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Smoking %K Social Class %K United States %X

OBJECTIVES: We focus on a hypothesized mechanism that may underlie the well-documented link between social status and health-behavioral health risks.

METHODS: We use longitudinal data from representative samples of 6,106 middle-aged and 3,636 older adults from the Health and Retirement Study to examine the relationships between social status-including early life social status (e.g., parental schooling), ascribed social status (e.g., sex, race-ethnicity), and achieved social status (e.g., schooling, economic resources)-and behavioral health risks (e.g., weight, smoking, drinking, physical activity) to (1) assess how early life and ascribed social statuses are linked to behavioral health risks, (2) investigate the role of achieved factors in behavioral health risks, (3) test whether achieved status explains the contributions of early life and ascribed status, and (4) examine whether the social status and health risk relationships differ at midlife and older age.

RESULTS: We find that early life, achieved, and ascribed social statuses strongly predict behavioral health risks, although the effects are stronger in midlife than they are in older age.

DISCUSSION: Ascribed social statuses (and interactions of sex and race-ethnicity), which are important predictors of behavioral health risks even net of early life and achieved social status, should be explored in future research.

%B J Gerontol B Psychol Sci Soc Sci %I 60B %V 60 Spec No 2 %P 85-92 %8 2005 Oct %G eng %L pubs_2005_WrayAlwin.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16251597?dopt=Abstract %4 Social Stratification/Health Behaviors %$ 15420 %R 10.1093/geronb/60.special_issue_2.s85 %0 Journal Article %J J Health Care Poor Underserved %D 2005 %T A socioeconomic profile of older adults with HIV. %A Joyce, Geoffrey F. %A Dana P Goldman %A Leibowitz, Arleen A. %A Abby Alpert %A Bao, Yuhua %K Female %K HIV Infections %K Humans %K Insurance, Health %K Male %K Middle Aged %K Social Class %X

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

%B J Health Care Poor Underserved %I 16 %V 16 %P 19-28 %8 2005 Feb %G eng %N 1 %L newpubs20070125_16.1joyce %1 http://www.ncbi.nlm.nih.gov/pubmed/15741706?dopt=Abstract %4 ADULT HEALTH %$ 17120 %R 10.1353/hpu.2005.0013 %0 Thesis %D 2004 %T Black-White Mental and Physical Well-Being Following Divorce %A Avellar, Sarah A. %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %X Despite the consistent link between divorce and deleterious mental and physical health outcomes, racial variations have been relatively neglected. With divergent socioeconomic statuses, rates of divorce, and other stressors, African-Americans and whites are likely to experience divorce in very different contexts. Racial differences in health outcomes after divorce are often the result of particular constraints and resources, and thus reveal the functioning of social arrangements. I address this issue in three separate but related chapters. In Chapter II, I use five waves of the Health and Retirement Study (HRS) to examine racial differences in divorce outcomes among older people. Today's midlife and elderly cohorts are probably the first to contain a substantial number of divorcees. I model self-rated health, limitations in activities of daily living, other physical limitations, and mortality for 1) the overall sample and 2) a transitioners sample, comprised of respondents who divorce or separate between waves. The results indicate that in the overall sample, divorce affects blacks and whites similarly and negatively, though this is largely accounted for by an individual's wealth. In the transitioners sample, divorce is associated with an improvement in health status, though only for white respondents. In Chapter III, I establish whether the health gap between the divorced and married exists for both blacks and whites. I model self-rated health and depressive symptoms with both waves of the National Survey of Families and Households (NSFH), for a nationally representative sample of all ages. In addition to longitudinal data, I improve on past research by employing multiple estimations of the health gap: ordinary least squares, fixed-effects, and matching models. The results suggest that both blacks and whites experience an increase in depressive symptoms after divorce, but the results for self-rated health are inconsistent and weak. The last analytic chapter, Chapter IV, is an examination of whether other factors can account for the heightened depressive symptoms associated with divorce. Again using the NSFH, I include sociodemographic, psychological, social, and relationship variables in OLS models. For both blacks and whites, the heightened distress can be accounted for by employment, worries about income, and having moved. %I University of Michigan %C United States -- Michigan %8 2004 %G eng %U https://search.proquest.com/docview/305181892?pq-origsite=gscholar&fromopenview=true %4 Depressive Symptoms %$ 17600 %! Black-White Mental and Physical Well-Being Following Divorce %0 Journal Article %J Ann Intern Med %D 2004 %T Brief communication: the relationship between having a living will and dying in place. %A Howard B Degenholtz %A Rhee, YongJoo %A Robert M. Arnold %K Aged %K Death %K Health Status %K Homes for the Aged %K Hospices %K Hospital Mortality %K Housing %K Humans %K Living Wills %K Nursing homes %K Retrospective Studies %X

BACKGROUND: Living wills, a type of advance directive, are promoted as a way for patients to document preferences for life-sustaining treatments should they become incompetent. Previous research, however, has found that these documents do not guide decision making in the hospital.

OBJECTIVE: To test the hypothesis that people with living wills are less likely to die in a hospital than in their residence before death.

DESIGN: Secondary analysis of data from a nationally representative longitudinal study.

SETTING: Publicly available data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

PATIENTS: People older than 70 years of age living in the community in 1993 who died between 1993 and 1995.

MEASUREMENTS: Self-report and proxy informant interviews conducted in 1993 and 1995.

RESULTS: Having a living will was associated with lower probability of dying in a hospital for nursing home residents and people living in the community. For people living in the community, the probability of in-hospital death decreased from 0.65 (95% CI, 0.58 to 0.71) to 0.52 (CI, 0.42 to 0.62). For people living in nursing homes, the probability of in-hospital death decreased from 0.35 (CI, 0.23 to 0.49) to 0.13 (CI, 0.07 to 0.22).

LIMITATIONS: Retrospective survey data do not contain detailed clinical information on whether the living will was consulted.

CONCLUSION: Living wills are associated with dying in place rather than in a hospital. This implies that previous research examining only people who died in a hospital suffers from selection bias. During advance care planning, physicians should discuss patients' preferences for location of death.

%B Ann Intern Med %I 141 %V 141 %P 113-7 %8 2004 Jul 20 %G eng %N 2 %L pubs_2004_Degenholtz.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15262666?dopt=Abstract %4 Advance Directives/HOSPITALIZATION %$ 16020 %R 10.7326/0003-4819-141-2-200407200-00009 %0 Journal Article %J The Journals of Gerontology: Social Sciences %D 2004 %T Disability and Home Care Dynamics Among Unmarried Older Americans %A Vicki A Freedman %A Aykan, Hakan %A John E. Marcotte %A Douglas A. Wolf %K Disabilities %K Healthcare %X Objectives. We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines. Methods. Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models. Results. Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care. Discussion. Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities. %B The Journals of Gerontology: Social Sciences %I 59B %V 59B %P S25-S33 %G eng %U http://psychsoc.gerontologyjournals.org/ %N 1 %L pubs_2004_Freedman_etal.pdf %4 Disability/Disability/Caregiving %$ 12992 %0 Journal Article %J Journal of Labor Economics %D 2004 %T The effect of part-time work on wages: Evidence from the Social Security Rules %A Aaronson, Daniel %A Eric French %K Employment and Labor Force %K Older Adults %K Social Security %X This article identifies the part-time wage effect, using hours variation caused by the Social Security rules. We show that work hours and wages drop sharply at ages 62 and 65. We argue that the hours decline causes the wage decline, resulting in a 25 wage penalty for men who cut their work week from 40 to 20 hours. However, we find little evidence for such an effect among women. We also show that models that fail to account for the joint determination of hours and wages will understate the labor supply response to a tax change by about 26 . %B Journal of Labor Economics %I 22 %V 22 %P 329-352 %G eng %N 2 %R 10.1086/381252 %0 Journal Article %J Health Aff (Millwood) %D 2004 %T Health insurance coverage and mortality among the near-elderly. %A J. Michael McWilliams %A Alan M. Zaslavsky %A Meara, Ellen %A John Z. Ayanian %K Cohort Studies %K Female %K health policy %K Humans %K Insurance Coverage %K Insurance, Health %K Longitudinal Studies %K Male %K Medically Uninsured %K Middle Aged %K Mortality %K United States %X

Uninsured near-elderly people may be particularly at risk for adverse health outcomes. We compared mortality of a nationally representative cohort of insured and uninsured near-elderly people with stratification by race; income; and the presence of diabetes, hypertension, or heart disease, using propensity-score methods to adjust for numerous characteristics. Lacking health insurance was associated with substantially higher adjusted mortality among adults who were white; had low incomes; or had diabetes, hypertension, or heart disease. Expanding coverage to the near-elderly uninsured may greatly improve health outcomes for these groups.

%B Health Aff (Millwood) %I 23 %V 23 %P 223-33 %8 2004 Jul-Aug %G eng %N 4 %L pubs_2004_McWilliams_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15318584?dopt=Abstract %4 Health Insurance Coverage/Elderly/Mortality %$ 12552 %R 10.1377/hlthaff.23.4.223 %0 Thesis %D 2004 %T How Alternative Definitions of Retirement and Social Class Shape Conclusions about the Retired Population %A Araiza, Isabel %K Demographics %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %K Women and Minorities %X The conceptualization and operationalization of retirement remains a challenge in retirement research. Those studies which have examined multiple conceptualizations of retirement often limit the investigation to two, three, or four definitions of retirement. These studies also produce contradictory results with respect to the degree of overlap among various definitions of retirement. Moreover, in the investigation of the relationship between predictor variables and the probability of retirement, push and pull factors (such as pension receipt and health) are often the focal point of the inquiry. While most studies include in their analysis a class measure as a control variable for the model, seldom is the relationship between social class and the probability of retirement the focal point of the investigation. This study employs data from the 1998 wave of the Health and Retirement Study to perform an extensive analysis of seven operationalizations of retirement and five operationalizations of social class to evaluate how the use of alternative definitions of retirement and social class shape conclusions drawn about the composition of the retired population. Analyses are performed for the entire sample selected for this study, as well as for Non-Hispanic White, Hispanic, and Non-Hispanic Black subgroups. The results of the analyses indicate that different operationalizations of retirement affect the characterization the retired population; moreover the use of different operationalizations of social class influences the perceptions of the socio-economic condition of the retired population. Despite socio-economic achievements, the findings suggest that initial inequalities associated with ascriptive traits like race and gender continue to constrain women and minorities' life course trajectories. While it is not possible to conduct a comprehensive examination of operationalizations of retirement in gerontological literature, this study includes operationalizations of retirement that acknowledge retirement as an event, an identity, and a process. %I Boston College %C United States -- Massachusetts %8 2004 %G eng %U https://search.proquest.com/openview/5a3ae1f763042c14661718032d4a886e/1?pq-origsite=gscholar&cbl=18750&diss=y %4 Gerontology %$ 17640 %! How Alternative Definitions of Retirement and Social Class Shape Conclusions about the Retired Population %0 Journal Article %J Health Aff (Millwood) %D 2004 %T Increasing obesity rates and disability trends. %A Sturm, Roland %A Ringel, Jeanne S. %A Andreyeva, Tatiana %K Aged %K Disabled Persons %K Female %K Humans %K Male %K Middle Aged %K Obesity %K Population Surveillance %K United States %X

Are older Americans becoming more or less disabled? Unhealthy body weight has increased dramatically, but other data show that disability rates have declined. We use data from the Health and Retirement Study to estimate the association between obesity and disability, and we combine these data with trend estimates of obesity rates from the Behavioral Risk Factor Surveillance Survey. If current trends in obesity continue, disability rates will increase by 1 percent per year more in the 50-69 age group than if there were no further weight gain.

%B Health Aff (Millwood) %I 23 %V 23 %P 199-205 %8 2004 Mar-Apr %G eng %N 2 %L pubs_2004_Sturm_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15046144?dopt=Abstract %4 Health Status/Obesity/Disability/Disability %$ 12242 %R 10.1377/hlthaff.23.2.199 %0 Report %D 2004 %T The Marginal Propensity to Spend on Adult Children %A Joseph G Altonji %A Villanueva, Ernesto %A Department of Economics %K Adult children %K Net Worth and Assets %X We examine how much of an extra dollar of parental lifetime resources will ultimately be passed on to adult children in the form of intervivos transfers and bequests. We infer bequests from the stock of wealth late in life. We use mortality rates and age specific estimates of the response of transfers and wealth to permanent income to compute the expected present discounted values of these responses to permanent income. Our estimates imply parents pass on between 2 and 3 cents out of an extra dollar of expected lifetime resources in bequests and about 1 cent in transfers. The estimates increase with parental income and are smaller for nonwhites. They imply that about 15 percent of the effect of parental income on lifetime resources of adult children is through transfers and bequests and about 85 percent is through the intergenerational correlation in earnings, although these estimates are sensitive to assumptions about the intergenerational earnings correlation, taxes, and the number of children. We compare our estimates to rough estimates of the marginal propensity to spend on children under 18 and higher education. %I New Haven, Connecticut, Yale University %G eng %L wp_2004/Altonji-Villanueva.pdf %4 Inter Vivos Transfers/Bequests/wealth %$ 14272 %0 Report %D 2004 %T Modeling Lifetime Earnings Paths: Hypothetical versus Actual Workers %A Olivia S. Mitchell %A John W R Phillips %A Au, Andrew %K Net Worth and Assets %K Pensions %K Social Security %X To assess the distributional effects of social security reform proposals, it is essential to have good information on real-world workers lifetime earnings trajectories. Until recently, however, policymakers have relied on hypothetical earnings profiles for policy analysis. We use actual lifetime earnings data from the Health and Retirement Study (HRS) to compare actual workers covered earnings profiles to these hypothetical profiles. We show that the hypothetical profiles do not track earnings patterns of current retirees; thus lifetime pay levels are much higher than for most HRS workers. Therefore, using hypothetical profiles could misrepresent benefits paid and taxes collected under such reforms. %I University of Pennsylvania, Boettner Center for Pe, Pension Research Council WP 2004-3 %G eng %L wp_2004/Mitchell_etal_WP2004-3.pdf %4 Pensions/Retirement Wealth/Social Security %$ 13992 %0 Journal Article %J Obes Res %D 2004 %T Moderate and severe obesity have large differences in health care costs. %A Andreyeva, Tatiana %A Sturm, Roland %A Ringel, Jeanne S. %K Aged %K Ambulatory Care %K Body Mass Index %K Body Weight %K Female %K Health Care Costs %K Hospitalization %K Humans %K Male %K Middle Aged %K Obesity %K Sex Characteristics %X

OBJECTIVE: To analyze health care use and expenditures associated with varying degrees of obesity for a nationally representative sample of individuals 54 to 69 years old.

RESEARCH METHODS AND PROCEDURES: Data from the Health and Retirement Study, a nationwide biennial longitudinal survey of Americans in their 50s, were used to estimate multivariate regression models of the effect of weight class on health care use and costs. The main outcomes were total health care expenditures, the number of outpatient visits, the probability of any inpatient stay, and the number of inpatient days.

RESULTS: The results indicated that there were large differences in obesity-related health care costs by degree of obesity. Overall, a BMI of 35 to 40 was associated with twice the increase in health care expenditures above normal weight (about a 50% increase) than a BMI of 30 to 35 (about a 25% increase); a BMI of over 40 doubled health care costs (approximately 100% higher costs above those of normal weight). There was a difference by gender in how health care use and costs changed with obesity class. The primary effect of increasing weight class on health care use appeared to be through elevated use of outpatient health care services.

DISCUSSION: Obesity imposes an increasing burden on the health care system, and that burden grows disproportionately large for the most obese segment of the U.S. population. Because the prevalence of severe obesity is increasing much faster than that of moderate obesity, average estimates of obesity effects obscure real consequences for individuals, physician practices, hospitals, and health plans.

%B Obes Res %I 12 %V 12 %P 1936-43 %8 2004 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/15687394?dopt=Abstract %4 Body Mass Index/Weight/Health Expenditures/Female/Health Care Costs/Obesity %$ 14330 %R 10.1038/oby.2004.243 %0 Book Section %B Critical Perspectives on Race and Ethnic Differences in Health in Later Life %D 2004 %T Race/Ethnicity, Socioeconomic Status, and Health %A Eileen M. Crimmins %A Mark D Hayward %A Teresa Seeman %E Norman B. Anderson %E Randy A. Bulatao %E Barney Cohen %K Demographics %K Health Conditions and Status %K Healthcare %K Women and Minorities %X Mounting evidence indicates that racial/ethnic differences in morbidity and mortality are tied to socioeconomic resources (Hayward, Crimmins, Miles, and Yu, 2000; Williams and Collins, 1995). Largely because of data availability, most of this evidence is based on the health experiences of blacks and whites, with much less evidence on the role of socioeconomic factors in understanding racial/ethnic disparities when Americans of Asian or Pacific Island descent, Hispanics, and Native Americans are part of the picture. The potential power of the socioeconomic status (SES) paradigm in understanding health disparities—including racial/ethnic disparities—is evident in the fact that socioeconomic differences in health outcomes have been widely documented for most health conditions in most countries. People who are poorer and who have less education are more likely to suffer from diseases, to experience loss of functioning, to be cognitively and physically impaired, and to experience higher mortality rates (Adler, Boyce, Chesney, Folkman, and Syme, 1993; Adler et al., 1994; Marmot, Kogevinas, and Elston, 1987; Marmot, Ryff, Bumpass, Shipley, and Marks, 1997; Preston and Taubman, 1994; Williams, 1990). In the United States, few health problems are more likely to occur among those who are better off, and some health conditions are particularly sensitive to SES. In recent years socioeconomic differences in health also appear to be increasing in the United States and in other developed countries (Crimmins and Saito, 2001; Feldman, Makuc, Kleinman, and Coroni-Huntley, 1989; Manton, 1997; Marmot, 1994; Pappas, Queen, Hadden, and Fisher, 1993; Preston and Elo, 1995). %B Critical Perspectives on Race and Ethnic Differences in Health in Later Life %I National Academy of Sciences %P 310-352 %G eng %U https://www.ncbi.nlm.nih.gov/books/NBK25526/#:~:text=Socioeconomic%20status%20is%20obviously%20related,health%20outcomes%20relative%20to%20whites. %4 Racial Differences/socioeconomic Status/African Americans/Hispanic/health disparities/MORTALITY %$ 23820 %& 9 %0 Journal Article %J Demography %D 2004 %T Resolving inconsistencies in trends in old-age disability: report from a technical working group. %A Vicki A Freedman %A Eileen M. Crimmins %A Robert F. Schoeni %A Brenda C Spillman %A Aykan, Hakan %A Kramarow, Ellen %A Land, Kenneth %A Lubitz, James %A Kenneth G. Manton %A Linda G Martin %A Shinberg, Diane %A Timothy A Waidmann %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Chronic disease %K Disabled Persons %K Female %K Health Surveys %K Homemaker Services %K Humans %K Male %K Models, Statistical %K Self-Help Devices %K United States %X

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

%B Demography %I 41 %V 41 %P 417-41 %8 2004 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/15461008?dopt=Abstract %4 Disability/Disability/ADL and IADL Impairments/Elderly/Caregiving %$ 12982 %R 10.1353/dem.2004.0022 %0 Journal Article %J J Aging Health %D 2003 %T Asking neutral versus leading questions: implications for functional limitation measurement. %A Vicki A Freedman %A Aykan, Hakan %A Kleban, Morton H. %K Activities of Daily Living %K Aged %K Factor Analysis, Statistical %K Health Surveys %K Humans %K Research Design %K Surveys and Questionnaires %K United States %X

UNLABELLED: National surveys of older Americans routinely have included functional limitation items using either a leading approach ("how much difficulty do you have...") or a neutral approach ("do you have any difficulty..."). This article evaluates the performance of scales based on these two approaches.

METHODS: Using responses from 595 randomly selected participants to the 1994 Health and Retirement Study, the authors compared prevalences and evaluated scales based on each approach with respect to the extent of missing data, face validity, reliability, predictive validity, convergent validity, and robustness of odds ratios in predictive models.

RESULTS: The authors found that leading questions provided higher estimates of functional limitations than neutral questions, but both approaches yielded scales with similar validity and reliability. However, for both approaches, scales incorporating degree of difficulty had better validity and reliability than those based on counts of tasks. All four approaches yielded substantially similar coefficients in a model predicting disability onset.

DISCUSSION: The authors conclude that, because they minimize survey time without compromising validity and reliability, items that explicitly capture degree of difficulty by asking "How much difficulty do you have..." may be the optimal approach for survey designers.

%B J Aging Health %I 15 %V 15 %P 661-87 %8 2003 Nov %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/14594023?dopt=Abstract %4 Method of Questioning/Measurement/Survey Methods %$ 12902 %R 10.1177/0898264303256250 %0 Journal Article %J Gerontologist %D 2003 %T Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity. %A Amirkhanyan, Anna A. %A Douglas A. Wolf %K Caregivers %K depression %K Female %K Humans %K Male %K Middle Aged %K Regression Analysis %K Risk Factors %K Stress, Psychological %X

PURPOSE: This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members.

DESIGN AND METHODS: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings.

RESULTS: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers.

IMPLICATIONS: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.

%B Gerontologist %I 43 %V 43 %P 817-27 %8 2003 Dec %G eng %N 6 %L pubs_2003_Amirkhanyan-Wolf_TG2003.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/14704381?dopt=Abstract %4 Caregiving/Stress/Stress Psychology %$ 12302 %R 10.1093/geront/43.6.817 %0 Report %D 2003 %T The Economic Consequences of Marital Disruption for Pre-Retirement Age African-American, Hispanic and Non-Hispanic White Women %A Jacqueline L. Angel %A Cynthia J. Buckley %A Ronald J. Angel %A Maren A. Jimenez %K Adult children %K Net Worth and Assets %K Women and Minorities %I Population Association of America %C Minneapolis, MN %G eng %4 Marital Dissolution/Women/Economic Status %$ 12162 %0 Journal Article %J Journal of Aging and Social Policy %D 2003 %T Effect of Childlessness on Nursing Home and Home Health Care Use %A Aykan, Hakan %K Adult children %K Healthcare %X This study examines the likelihood of nursing home and home health care use for childless older Americans. Four research questions are addressed: 1) Are the childless elderly at a greater risk of nursing home and home health care use? 2) Is it childlessness per se or not having children with particular characteristics that affects the likelihood of using these formal long-term care services? 3) Does having additional children beyond the first one have a significant effect on the use of these services? 4) Are the effects of childlessness different on the likelihood of nursing home and home health care use? Longitudinal data from the first (1993) and second (1995) waves of the Asset and Health Dynamics Among the Oldest Old survey (AHEAD) and multinomial logistic regression models are used for the analyses. Separate models are developed for women and men, each controlling for a variety of demographic, socioeconomic, and health-related characteristics of sample persons. Findings indicate childlessness as an important risk factor, especially for older women's use of nursing home services. Implications of findings for planning for long-term care needs of the baby boom generation are discussed. %B Journal of Aging and Social Policy %I 15 %V 15 %P 33-53 %G eng %N 1 %4 Children/Home Care Services/Nursing Homes %$ 12892 %0 Journal Article %J Journal of Econometrics %D 2003 %T Healthy, wealthy, and wise? Tests for direct casual paths between health and socioeconomic status %A Adams, Peter %A Michael D Hurd %A Daniel McFadden %A Merrill, Angela %A Ribeiro, Tiago %K Demographics %K Health Conditions and Status %K Socioeconomic factors %X This paper provides statistical methods that permit the association of socioeconomic status and health to be partially unraveled in panel data by excluding some postulated causal paths, or delimiting their range of action. These methods are applied to the Asset and Health Dynamics of the Oldest Old (AHEAD) Panel to test for the absence of causal links from socioeconomic status (SES) to health innovations and mortality, and from health conditions to innovations in wealth. We conclude that in this elderly American population, where Medicare covers most acute care and pension income is not affected by ability to work, the evidence supports the hypothesis of no direct causal link from SES to mortality and to incidence of most sudden onset health conditions (accidents and some acute conditions), once initial health conditions are controlled, but there is an association of SES with incidence of gradual onset health conditions (mental conditions, and some degenerative and chronic conditions), due either to causal links or to persistent unobserved behavioral or genetic factors that have a common influence on both SES and innovations in health. There is little evidence to support a broad association of health conditions and wealth changes. The death of a spouse appears to have a negative effect on the wealth of the survivor; this is plausibly a direct causal effect. There is evidence for some association of health conditions with increased dissaving from liquid wealth for intact couples and singles. From these findings, we conclude that there is no evidence that SES-linked therapies for acute diseases induce mortality differentials. The question of whether SES linked preventative care influences onset of chronic and mental diseases remains open. %B Journal of Econometrics %I 112 %V 112 %P 3-56 %G eng %U http://emlab.berkeley.edu/users/mjansson/Courses/ECON242_SPRING02/McFadden.pdf %N 1 %L pubs_2003_Adams_PJEcmetrics.pdf %0 Journal Article %J Journal of the American Medical Association %D 2003 %T Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults %A J. Michael McWilliams %A Alan M. Zaslavsky %A Meara, Ellen %A John Z. Ayanian %K Healthcare %K Medicare/Medicaid/Health Insurance %X Context Uninsured adults receive less appropriate care and have more adverse health consequences than insured adults. Longitudinal studies would help to more clearly define the effects of health insurance on health care and health.Objective To assess the differential effects of gaining Medicare coverage on use of basic clinical services and medications by previously insured and uninsured adults.Design and Setting Household survey data from the nationally representative Health and Retirement Study were used to analyze differences in receipt of basic clinical services by adults in 1996 and 2000, before and after becoming eligible for Medicare at age 65 years.Participants A total of 2203 adults aged 60 to 64 years in 1996 who were classified as continuously uninsured (n=167), intermittently uninsured (n=216), or continuously insured (n=1820) in 1994 and 1996, prior to Medicare eligibility.Main Outcome Measures Individuals' reports of receiving cholesterol testi ng, mammography (in women), prostate examination (in men), and treatment of arthritis and hypertension in the prior 2 years.Results The difference in cholesterol testing between continuously insured and continuously uninsured adults was significantly reduced after Medicare eligibility (35.4 vs 17.7 ; change of -17.7 95 Cl, -29.3 to -6.2 ; P=.003), and the reduction was substantially greater among those with hypertension or diabetes than among other adults (29.2 vs 7.7 ; difference of 21.5 95 Cl, 0.2 to 42.9 1; P=.048). Differences in use were similarly reduced after Medicare eligibility for mammography in women (30.3 vs 15.0 ; change of -15.3 95 Cl, -29.9 to -0.7 1; P=.04) and prostate examination in men (45.2 vs 20.0 ; change of -25.2 95 Cl, -45.4 to -5.1 ; P=.01). Continuously uninsured adults with arthritis reported significantly greater increases in arthritis-related medical visits and limitations of activity than continuously insured adults after Medicare eligibility, but not greater increases in arthritis treatments. Among adults with hypertension, differences in use of antihypertensive medications between continuously uninsured and insured adults were essentially unchanged after Medicare coverage.Conclusions Previously uninsured adults substantially increased their use of covered basic clinical services but not medications after gaining Medicare coverage. An affordable option through which near-elderly uninsured adults could purchase Medicare coverage might have similar effects. %B Journal of the American Medical Association %I 290 %V 290 %P 757-764 %G eng %N 6 %L pubs_2003_McWilliams_JAMA.pdf %4 Medicare/Health Services/Health Insurance Coverage %$ 11562 %0 Report %D 2003 %T Lifetime Earnings Variability and Retirement Wealth %A Olivia S. Mitchell %A John W R Phillips %A Au, Andrew %A McCarthy, David %K Income %K Net Worth and Assets %X This paper explores how earnings variability is related to retirement wealth. Past research has demonstrated that the average American household on the verge of retirement would need to save substantially more, in order to preserve consumption flows in old age. While several socioeconomic factors have been examined that might explain such problems, prior studies have not assessed the role of earnings variability over the lifetime as a potential explanation for poor retirement prospects. Thus two workers having identical levels of average lifetime earnings might have had very different patterns of earnings variability over their lifetimes. Such differences could translate into quite different retirement wealth outcomes. This paper evaluates the effect of earnings variability on retirement wealth using information supplied by respondents to the Health and Retirement Study (HRS). This is a rich and nationally representative dataset on Americans on the verge of retirement, with responses linked to administrative records from the Social Security Administration. Our research illuminates the key links between lifetime earnings variability and retirement wealth. %B Michigan Retirement Research Center Research Working Paper %I Michigan Retirement Research Center at the University of Michigan, %C Ann Arbor, MI %G eng %4 Income Variability/Retirement Wealth %$ 12182 %R https://dx.doi.org/10.2139/ssrn.1091441 %0 Report %D 2003 %T The Marginal Propensity to Spend on Adult Children %A Joseph G Altonji %A Villanueva, Ernesto %K Adult children %K Health Conditions and Status %X We examine how much of an extra dollar of parental lifetime resources will ultimately be passed on to adult children in the form of inter vivos transfers and bequests. We infer bequests from the stock of wealth late in life. We use mortality rates and age specific estimates of the response of transfers and wealth to permanent income to compute the expected present discounted values of these responses to permanent income. Our estimates imply that parents pass on between 2 and 3 cents out of an extra dollar of expected lifetime resources in bequests and about 2 cents in transfers. The estimates increase with parental income and are smaller for nonwhites. They imply that about 15 percent of the effect of parental income on lifetime resources of adult children is through transfers and bequests and about 85 percent is through the intergenerational correlation in earnings, although these estimates are sensitive to assumptions about the intergenerational earnings correlation, taxes, and the number of children. We compare our estimates to the implications of alternative computable benchmark models of savings behavior in order to assess the likely importance of intended bequests for the wealth/income relationship. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %L wp_2003/Altonji_2003.pdf %4 spending patterns/Intergenerational Transfers %$ 11592 %R 10.3386/w9811 %0 Report %D 2003 %T Measuring the Optimal Income Replacement Rate: A Panel Data Analysis %A An, Chong-Bum %A Jeon, Seung-Hoon %K Consumption and Savings %K Retirement Planning and Satisfaction %X In order to analyze welfare of retirees, this paper investigates the optimal income replace rate and analyzes how retirement decision affects the post- and pre-retirement consumption. The data analysis using the HRS shows that consumption decreased after retirement for both early and late retirement groups. The post- and pre-retirement consumption ratio (CRATIO) is computed to be 0.922, which implies that the optimal income replacement rate for all retirees is 92.2 . We investigate the interdependence of the decisions on when to retire and how much to consume after retirement (or CRATIO) by using the switching regression model, which tests the hypothesis that early retirement and short labor period induces the low post-retirement income and low post-retirement consumption. The empirical results from the switching regression model show that early retirement decision may affect the post-retirement consumption. After deciding to retire early, retirees would have consumed less than they actually have. The estimation results that used CRATIO as a dependent variables are similar to the results that used post-retirement consumption as a dependent variable. %I Sungkyunkwan University, Korea; Dept. of Economics %G eng %L wp_2003/An-Jeon_IIPF2003.pdf %4 Consumption/Retirement Behavior %$ 11632 %0 Report %D 2003 %T Retirement Wealth and Lifetime Earnings Variability %A Olivia S. Mitchell %A John W R Phillips %A Au, Andrew %A McCarthy, David %K Net Worth and Assets %K Social Security %X This paper explores understand how earnings variability influences peoples’ retirement preparedness by influencing their accumulated wealth levels as of retirement age. Prior research has demonstrated that the US average household nearing retirement would need to save substantially more in order to preserve consumption in old age. While some socioeconomic factors have been suggested that might explain shortfalls, previous studies have not assessed the role of earnings variability over the lifetime as a potential explanation for poor retirement prospects. Thus two workers having identical levels of average lifetime earnings might have had very different patterns of earnings variability over their lifetimes. Such differences could translate into quite different retirement wealth outcomes. We evaluate the effect of earnings variability on retirement wealth using information supplied by respondents to the Health and Retirement Study (HRS). This is a rich and nationally representative dataset on Americans on the verge of retirement, with responses linked to administrative records from the Social Security Administration. Our research illuminates key links between lifetime earnings variability and retirement wealth. %B Pension Research Council Publications %I University of Pennsylvania, Wharton School %C Philadelphia %G eng %U https://pensionresearchcouncil.wharton.upenn.edu/publications/papers-2018/retirement-wealth-and-lifetime-earnings-variability/ %L wp_2003/Mitchell_etal.pdf %4 Retirement Wealth/Earnings and Benefits File %$ 11582 %0 Journal Article %J Health Affairs %D 2003 %T Trends in Medication Use And Functioning Before Retirement Age: Are They Linked? %A Vicki A Freedman %A Aykan, Hakan %K Chronic disease %K Drug use %K Pharmaceuticals %X This paper explores the extent to which changes in medication use during the 1990s are linked to improvements in functioning among Americans before they reach retirement age. Using two cross-sections from a survey of Americans ages 51 61, we examined changes between 1992 and 1998 in the prevalence of functional limitations and medication use associated with five chronic conditions: hypertension, diabetes, lung disease, stroke, and arthritis. We found no evidence linking increases in medication use to improvements in functioning. Instead, increases in educational attainment offset the negative effects of increases in obesity and arthritis over this period. Findings underscore the need for caution in projecting forward improvements in old-age functioning when considering the future of Medicare, Medicaid, and other programs that serve the elderly with disabilities. %B Health Affairs %I 22 %V 22 %G eng %N 4 %L pubs_2003_Freedman_HA.pdf %4 Health Physical %$ 12602 %R https://doi.org/10.1377/hlthaff.22.4.154 %0 Journal Article %J The Journals of Gerontology Series B %D 2002 %T Another Look at Aggregate Changes in Severe Cognitive Impairment: Further investigation into the cumulative effects of three survey design issues %A Vicki A Freedman %A Aykan, Hakan %A Linda G Martin %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Other %X OBJECTIVES: This study explored whether previously reported declines in severe cognitive impairment were robust to cumulative effects of potentially confounding survey design issues. METHODS: Using the 1993 Asset and Health Dynamics of the Oldest Old study (n = 7,443) and 1998 Health and Retirement Survey (HRS; n = 7,624) the proportion of persons ages 70 and older with severe cognitive impairment was calculated under various assumptions about item nonresponse, differential loss to follow-up, and the size and composition of the nursing home population. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents ratings of memory and judgment were used. Chi-square tests were adjusted to account for complex survey designs. RESULTS: Ignoring loss to follow-up, excluding nursing home residents, and assigning a low score to those refusing subscales yielded a statistically significant decline in severe cognitive impairment from 5.8 in 1993 to 3.8 in 1998, or an average annual decline of 6.9 . When cumulative effects of survey design issues were considered and design effects incorporated into statistical tests, statistically significant declines persisted, albeit at a reduced average annual rate, ranging from 2.5 to 6.9 per year. DISCUSSION: Previously reported improvements in severe cognitive impairment appear to be robust to a variety of specifications. Replication with future waves of the HRS and other data is warranted. %B The Journals of Gerontology Series B %I 57B %V 57 %P S126-31 %G eng %N 2 %L pubs_2002_Freedman_VJGSeriesB.pdf %4 Age Distribution/Aged, 80 and Over/Chi Square Distribution/Cognition Disorders/Classification/Diagnosis/Epidemiology/Confounding Factors (Epidemiology)/Follow up Studies/Geriatric Assessment/Health Surveys/Human/Mass Screening/Methods/Standards/Middle Age/Population Surveillance/Questionnaires/Standards/Research Design/Standards/Severity of Illness Index/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology %$ 4480 %R https://doi.org/10.1093/geronb/57.2.S126 %0 Newspaper Article %B The New York Times %D 2002 %T Does It Cost the Wealthy Too Much to Die? %A Altman, Daniel %K Adult children %B The New York Times %I The New York Times Co. %C New York, NY %P 4 %8 June 30, 2002 %G eng %1 5 %4 Wills %$ 9854 %! Does It Cost the Wealthy Too Much to Die? %& Economic View %0 Journal Article %J Med Care %D 2002 %T Loss of health insurance and the risk for a decline in self-reported health and physical functioning. %A David W. Baker %A Joseph J Sudano %A Jeffrey M. Albert %A Elaine A Borawski %A Avi Dor %K Female %K Health Services Accessibility %K Health Status %K Humans %K Insurance, Health %K Male %K Medically Uninsured %K Middle Aged %K Regression Analysis %K Risk %K Self Efficacy %X

BACKGROUND: Millions of Americans are intermittently uninsured. The health consequences of this are not known.

SETTING: National survey.

PARTICIPANTS: Six thousand seventy-two participants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992.

MEASUREMENTS: Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new physical difficulty between 1994 and 1996.

RESULTS: In 1994, 5768 (95.0%) people continued to have private insurance, 229 (3.8%) reported having lost all insurance, and 75 (1.2%) converted to having only public insurance. Over the subsequent 2 years (1994-1996), the risk for a major decline in overall health was 15.6% for those who lost all insurance versus 7.2% for those with continuous private insurance (P <0.001). After adjusting for baseline sociodemographics, health behaviors, and health status, the adjusted relative risk for a major decline in health for those who lost coverage was 1.82 (95% CI, 1.25-2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5% vs. 20.4%, respectively; P= 0.02), but this was not significant in multivariate analysis (adjusted RR, 1.26; 95% CI, 0.90-1.68).

CONCLUSIONS: Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.

%B Med Care %I 40 %V 40 %P 1126-31 %8 2002 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/12409857?dopt=Abstract %R 10.1097/00005650-200211000-00013 %0 Journal Article %J Journal of Labor Research %D 2002 %T Passed over for promotion because of age: An empirical analysis of the consequences %A Adams, Scott J. %K Consumption and Savings %K Demographics %K Employment and Labor Force %K Retirement Planning and Satisfaction %X I test whether older individuals who report that their firms favor younger workers in promotion decisions are harmed by this often-cited discriminatory practice. Using the Health and Retirement Study, I determine whether such workers are more likely to experience lower wage growth, to separate from their employer, or to retire early, in comparison with workers with similar demographic and job characteristics. The evidence is consistent with lower wage growth and a greater likelihood of early retirement. Much of the effect, however, is likely to stem from a high correlation between delayed-payment contracts and promotion practices. %B Journal of Labor Research %I 23 %V 23 %P 447-61 %G eng %N 3 %L pubs_2002_Adams_SJLR.pdf %R 10.1007/s12122-002-1046-y %0 Newspaper Article %B New York Times on the Web %D 2002 %T Planning; Ready to Quit, but Deep in Debt %A Altman, Daniel %K Retirement Planning and Satisfaction %B New York Times on the Web %I The New York Times Co. %C New York, NY %P 11 %8 March 12, 2002 %G eng %4 Retirement Planning %$ 9858 %! Planning; Ready to Quit, but Deep in Debt %& Retirement %0 Journal Article %J J Am Geriatr Soc %D 2002 %T Prevalence and correlates of depressive symptoms in a community sample of people suffering from heart failure. %A Carolyn L. Turvey %A Schultz, K. %A Arndt, Stephan %A Robert B Wallace %A A. Regula Herzog %K Aged %K depression %K Female %K Heart Failure %K Humans %K Longitudinal Studies %K Male %K Prevalence %K United States %X

OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older.

DESIGN: Cross-sectional.

SETTING: Community-based epidemiological study of older people from the continental United States.

PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier.

MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies-Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070).

RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8% of people with other heart conditions and 3.2% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses.

CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.

%B J Am Geriatr Soc %I 50 %V 50 %P 2003-8 %8 2002 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/12473012?dopt=Abstract %4 Heart Diseases/Depression %$ 12932 %R 10.1046/j.1532-5415.2002.50612.x %0 Journal Article %J Southwest Journal on Aging %D 2002 %T Retirement Planning and Health Outcomes in the Health and Retirement Study %A L.M. Albert %A Sandra L Reynolds %K Healthcare %K Retirement Planning and Satisfaction %B Southwest Journal on Aging %I 18 %V 18 %P 5-16 %G eng %4 Retirement planning/health outcomes %$ 21120 %0 Journal Article %J The Journals of Gerontology: Social Sciences %D 2001 %T Aggregate Changes in Severe Cognitive Impairment Among Older Americans: 1993 and 1998 %A Vicki A Freedman %A Aykan, Hakan %A Linda G Martin %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %X OBJECTIVES: This study explored whether improvements in cognitive functioning occurred during the 1990s among older Americans and investigated several possible explanations for such changes. METHODS: Using the 1993 Asset and Health Dynamics of the Oldest Old study (N = 7,443) and 1998 Health and Retirement Survey (N = 7,624), this study examined aggregate changes in the proportion of the noninstitutionalized population aged 70 and older with severe cognitive impairment. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents, ratings of memory and judgment were used. Logistic regression was used to investigate potential explanations for aggregate changes. RESULTS: The percentage of older Americans with severe cognitive impairment declined from 6.1 in 1993 to 3.6 in 1998 (p .001). The decline was statistically significant among self-respondents but not among those with proxy interviews. Improvements between 1993 and 1998 were not explained by shifts in demographic and socioeconomic factors or by changes in the prevalence of stroke, vision, or hearing impairments. DISCUSSION: As a group, older persons, especially those well into their 80s, appear to have better cognitive functioning today than they did in the early 1990s. %B The Journals of Gerontology: Social Sciences %I 56B %V 56B %P S100-11 %G eng %U http://psychsoc.gerontologyjournals.org/ %N 2 %L pubs_2001_Freedman_VJGSeriesB.pdf %4 Age Factors/Aging/Physiology/Cognition Disorders/Diagnosis/Epidemiology/Educational Status/Female/Middle Age/Neuropsychological Tests/Severity of Illness Index/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/United States/Epidemiology %$ 4485 %0 Journal Article %J Int Psychogeriatr %D 2001 %T Caregiver report of hallucinations and paranoid delusions in elders aged 70 or older. %A Carolyn L. Turvey %A Schultz, Susan K. %A Arndt, Stephan %A Ellingrod, Vicki %A Robert B Wallace %A A. Regula Herzog %K Aged %K Aged, 80 and over %K Aging %K Caregivers %K Cognition Disorders %K Cohort Studies %K Delusions %K depression %K Female %K Follow-Up Studies %K Hallucinations %K Humans %K Male %K Marital Status %K Paranoid Disorders %K Risk Factors %K Stroke %K Surveys and Questionnaires %K United States %K Vision Disorders %X

This study examined the demographic, medical, and psychiatric correlates of hallucinations and paranoid delusions reported by proxy informants for 822 elders aged 70 or older. This sample comprised people who were deemed unable to complete a direct interview in a large nationwide study of aging. Marital status, trouble with vision, and cognitive impairment were associated with report of both paranoid delusions and hallucinations. Depressive symptoms and stroke were associated with hallucinations only. These results suggest that inadequate external stimulation in the elderly leads to psychotic experiences.

%B Int Psychogeriatr %I 13 %V 13 %P 241-9 %8 2001 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/11495398?dopt=Abstract %4 Caregivers/Dementia/Elderly %$ 16250 %R 10.1017/s1041610201007621 %0 Report %D 2001 %T Does the Balance of Power Within a Family Matter? The Case of the Retirement Equity Act %A Aura, Saku %K Adult children %K Pensions %K Public Policy %I Innocenzo Gasparini Institute for Economic Research %G eng %L wp_2002/Aura_Saku.pdf %4 Policy/Pensions/Family %$ 6622 %0 Journal Article %J The Journals of Gerontology: Social Sciences %D 2001 %T Duration or Disadvantage? Exploring Nativity, Ethnicity and Health in Midlife %A Jacqueline L. Angel %A Cynthia J. Buckley %A Sakamoto, Arthur %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Net Worth and Assets %K Women and Minorities %X Objectives This study examined nativity as a risk factor for poor physical and emotional health for an ethnically diverse population making the transition into retirement. The authors addressed whether the health disadvantage observed for immigrants lessens with increased time spent in the country (supporting theories of assimilation) or increases with duration of residence (supporting theories of cumulative disadvantage). Methods The sample was drawn from Waves 1 and 2 of the Health and Retirement Study (HRS), an in-depth economic, social, and health database of persons in midlife and beyond. The analyses were restricted to 9,912 native-born and 1,031 foreign-born individuals. Results The data revealed that after socioeconomic factors were controlled, foreign-born individuals were at higher risk of poor emotional health than their native-born counterparts. Although aging immigrants displayed worse health than the native-born population, this disadvantage was mediated by duration of residence (young age at migration) and socioeconomic incorporation. Discussion These findings extend our understanding of nativity and duration as risk factors for poor physical and emotional health. Immigrants may overcome the nativity disadvantages found for emotional distress with increased duration of residence, but the pattern becomes more complicated with the inclusion of race and Hispanic ethnicity. %B The Journals of Gerontology: Social Sciences %I 56B %V 56B %P S275-285 %G eng %U http://psychsoc.gerontologyjournals.org/ %N 5 %L pubs_2001_Angel_JJGSeriesB.pdf %4 Basic Demographics/Health Status/Duration of Residence/Assimilation/Economic Status %$ 8228 %0 Report %D 2001 %T Evaluation of Social Security reforms under alternative models of retirement and savings %A Aguirregabiria, Victor %K Methodology %K Social Security %I University of Western Ontario %G eng %4 Models, Econometric/Social Security %$ 6543 %0 Newspaper Article %D 2001 %T Improving memory among older americans %A Associated Press %K Health Conditions and Status %I Associated Press %C St. Louis, MO %8 March 19, 2001 %G eng %4 Cognitive Function %$ 9804 %! Improving memory among older americans %0 Journal Article %J New England Journal of Medicine %D 2001 %T Lack of Health Insurance and Decline in Overall Health in Late Middle Age %A David W. Baker %A Joseph J Sudano %A Jeffrey M. Albert %A Elaine A Borawski %A Avi Dor %K Demographics %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Methodology %K Other %X BACKGROUND: The number of adults in their 50s and 60s in the United States who do not have health insurance is increasing. This group may be particularly vulnerable to the ill effects of being uninsured. METHODS: We conducted a prospective cohort study using files from the Health and Retirement Study, a national survey of adults who were 51 to 61 years old in 1992. We determined the risks of a major decline in overall health and of the development of new physical difficulties between 1992 and 1996 for participants who were continuously uninsured (uninsured in 1992 and in 1994), those who were intermittently uninsured (uninsured either in 1992 or in 1994), and those who were continuously insured. We used logistic regression to determine the independent effects of being uninsured on health outcomes after adjustment for base-line sociodemographic factors, preexisting medical conditions, and types of health-related behavior such as smoking and alcohol use. RESULTS: We analyzed data for 7577 participants. The 717 continuously uninsured participants and the 825 intermittently uninsured participants were more likely than the 6035 continuously insured participants to have a major decline in overall health between 1992 and 1996 (21.6 percent, 16.1 percent, and 8.3 percent of the three groups, respectively; P 0.001 for both comparisons). According to a multivariate analysis, the adjusted relative risk of a major decline in overall health was 1.63 (95 percent confidence interval, 1.26 to 2.08) for continuously uninsured participants and 1.41 (95 percent confidence interval, 1.11 to 1.78) for intermittently uninsured participants, as compared with continuously insured participants. A new difficulty in walking or climbing stairs was also more likely to develop in the continuously or intermittently uninsured participants than in the continuously insured participants (28.8 percent, 26.4 percent, and 17.1 percent of the three groups, respectively; P 0.001 for both comparisons). The adjusted relative risk of such a new physical difficulty was 1.23 (95 percent confidence interval, 1.02 to 1.47) for the continuously uninsured participants and 1.26 (95 percent confidence interval, 1.01 to 1.54) for the intermittently uninsured participants. CONCLUSIONS: The lack of health insurance is associated with an increased risk of a decline in overall health among adults 51 to 61 years old. %B New England Journal of Medicine %I 345 %V 345 %P 1106-12. %G eng %N 15 %4 Activities of Daily Living/Female/Health Status/Health Surveys/Human/Insurance, Health/Logistic Models/Medically Uninsured/Statistics and Numerical Data/Middle Age/Multivariate Analysis/Prospective Studies/Socioeconomic Factors/Support, U.S. Government--PHS/United States %$ 4005 %R 10.1056/NEJMsa002887 %0 Journal Article %J International Migration Review %D 2001 %T Nativity and Self-Assessed Health Among Pre-Retirement Age Hispanics and Non-HispanicWhites %A Jacqueline L. Angel %A Cynthia J. Buckley %A Finch, Brian K. %K Demographics %K Health Conditions and Status %K Women and Minorities %X Economic, social and familial resources are known to influence subjective health assessments. We examine the salience of nativity in determining how these resources influence self-assessed health using a large, nationwide sample of Hispanic and non-Hispanic white adults. The results indicate that while education, accumulated assets and marital status benefit the physical and emotional health of the native and foreign-born, family resources and income are significant only for the native-born. English language proficiency is a significant protective factor for both groups and is especially protective for immigrants. These surprising findings call into question previous studies stressing the positive role of the family in maintaining immigrant health. %B International Migration Review %I 35 %V 35 %P 784-804 %G eng %L pubs_2001_Angel_JIntMigRev.pdf %4 Health Status/Hispanic/Nativity %$ 8546 %R 10.1111/j.1747-7379.2001.tb00041.x %0 Report %D 2001 %T Technical progress and early retirement %A Ahituv, Avner %A Zeira, Joseph %K Employment and Labor Force %K Net Worth and Assets %I Hebrew University of Jerusalem %G eng %L wp_2001/Ahituv-Zeira11-01.pdf %4 Labor Force/Human Capital %$ 6578 %0 Newspaper Article %B University Record %D 2000 %T 'Decade of Behavior' project launched %A American Psychological Society %K Retirement Planning and Satisfaction %B University Record %I University of Michigan %C Ann Arbor, MI %P 11 %8 October 9, 2000 %G eng %4 Retirement %$ 9840 %! 'Decade of Behavior' project launched %0 Report %D 2000 %T The Diversity of Risk Among Age-62 Retired Worker Beneficiaries %A Kingson, Eric R. %A Arsenault, Yvonne %K Pensions %X This article focuses on age-62 retired-worker beneficiaries, a group whose well-being may be affected by changes in Social Security retirement ages. The analysis: 1) develops different measures of risk of a poor retirement; 2) applies these measures to developing a range of estimates of the risk for age-62 beneficiaries at the threshold of retirement; and 3) assesses how the circumstances of and risks experienced by these beneficiaries vary by such factors as race, gender, health status and marital status. The findings point to great diversity of circumstances among these early retirees and suggest that narrow conceptions of risk may fall short of fully identifying the distributive consequences of retirement age changes, especially for African Americans, Hispanics, low-income, unmarried individuals and unhealthy early retirees. %B Center for Policy Research Working Paper %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/working-papers/the-diversity-of-risk-among-age-62-retired-worker-beneficiaries/ %L wp_2000/CRRwp_2000-08.pdf %4 Benefits %$ 6588 %0 Report %D 2000 %T Drug Use Among the Elderly: An Assessment of California's Need for Prevention and Treatment Services %A Wong, Mamie M. %A Anglin, M. Douglas %K Health Conditions and Status %K Healthcare %I State of California, Dept. of Alcohol and Drug Programs %G eng %4 Health Status/Drug Use/Health Care %$ 8476 %0 Journal Article %J J Am Geriatr Soc %D 2000 %T Memory complaint in a community sample aged 70 and older. %A Carolyn L. Turvey %A Schultz, Susan K. %A Arndt, Stephan %A Robert B Wallace %A A. Regula Herzog %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cognition %K Depressive Disorder %K Educational Status %K Female %K Geriatric Assessment %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Memory %K Self-Assessment %X

OBJECTIVES: The ability of older people to estimate their own memory, often referred to as "metamemory," has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person's metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged > or = 70.

DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart.

SETTING: A nationwide random sample of community-dwelling older persons.

PARTICIPANTS: A total of 5,444 community-dwelling persons aged > or = 70 and their spouses.

MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini-Mental Status Exam.

RESULTS: In general, people's assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures.

CONCLUSIONS: The conditions that skew people's self-assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.

%B J Am Geriatr Soc %I 48 %V 48 %P 1435-41 %8 2000 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/11083320?dopt=Abstract %4 Aged, 80 and Over/Cognition/Depressive Disorder/Educational Status/Gender/Geriatric Assessment/Longitudinal Studies/Marital Status/Memory/Self Assessment (Psychology)/Support, U.S. Government--PHS %$ 4335 %R 10.1111/j.1532-5415.2000.tb02634.x %0 Journal Article %J J Women Aging %D 2000 %T Nativity and older women's health: constructed reliance in the health and retirement study. %A Cynthia J. Buckley %A Jacqueline L. Angel %A Donahue, Dennis %K Aged %K Emigration and Immigration %K ethnicity %K Female %K Florida %K Health Status %K Humans %K Middle Aged %K Retirement %K Social Support %K Socioeconomic factors %K Women's Health %X

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

%B J Women Aging %I 12 %V 12 %P 21-37 %8 2000 %G eng %N 3-4 %1 http://www.ncbi.nlm.nih.gov/pubmed/11151352?dopt=Abstract %4 Females/Immigrants/Health/Support Networks/Social Support/Family Relations/Socioeconomic Factors/Retirement %$ 1248 %R 10.1300/J074v12n03_03 %0 Thesis %D 2000 %T Three essays on the economics of aging %A Adams, Scott J. %K Demographics %K Employment and Labor Force %K Other %X An aging U.S. population creates many challenges for policy makers, and, thus, renders research that sheds light on the conditions of older Americans of great importance. My aim is to contribute to this research by using economic analysis to address three very important questions: What is the effect of educational attainment on the health of older Americans? Do firms that use age as a discriminatory criterion in promotion decisions adversely affect the labor market outcomes of their older workers? Finally, does legislation aimed at combating age discrimination change firm behavior in employing older workers? Chapter 1 is an attempt to answer the first question. The missing element of investigations of the education-health relationship is an attempt to identify the causal effect of education. Studies that have shown the correlation between education and health fail to account fully for the fact that education and health are jointly determined. Thus, as long as there are unobserved factors that influence both the attainment of more education and the health status of adults, then it is certainly possible that the correlation between education and health is spurious. This paper uses quarter of birth as a source of exogenous variation in education to show that there exists a causal component of the effect of education on health. Chapter 2 uses the Health and Retirement Study to look at the effect of one type of age discrimination-firm preferences in promotion toward younger workers. While the effect of preferences in promotion is an interesting question in itself, for the purposes of this paper it serves as an indicator of firm discrimination in general. First, the paper verifies whether individuals reporting age discrimination are paid less than similarly trained and qualified workers. Second, the paper investigates how the self-assessed probabilities of early retirement are affected by firm discriminatory practices. Finally, workers are tracked to determine whether they ultimately are more likely to experience lower wage growth, to separate from their employer, or to retire early, as a function of their firm's propensity to promote younger workers. The findings show that those reporting discrimination do in fact experience some negative effects in the labor market. The most significant negative effects are on wage growth. Yet, the evidence also suggests that discrimination may affect individual assessments of the probability of retiring early. The latter effect is quite important when viewed in a public policy context. If the aged are driven into early retirement due to firm discriminatory practices, this has implications for social security financing. Chapter 3 concludes the dissertation by studying the effects of state age discrimination legislation on employment outcomes for older individuals. Specifically, it is shown that legislation boosts the probability of employment for older workers. The probability of being a new hire, however, falls. These effects are largely due to more older workers being retained at their jobs after the passage of the legislation. %I Michigan State University %8 2000 %G eng %4 Economics, Labor (0510) %$ 5000 %+ Database ID: DAI-A 61/08, p. 3261, Feb 2001 ISBN 0-599-91580-3 %0 Journal Article %J Am J Psychiatry %D 1999 %T Conjugal loss and syndromal depression in a sample of elders aged 70 years or older. %A Carolyn L. Turvey %A Carney, C. %A Arndt, Stephan %A Robert B Wallace %A A. Regula Herzog %K Age Factors %K Aged %K Aged, 80 and over %K Bereavement %K Cohort Studies %K depression %K Depressive Disorder %K Female %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Marital Status %K Odds Ratio %K Psychiatric Status Rating Scales %K Risk Factors %K Sex Factors %K Widowhood %X

OBJECTIVE: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.

METHOD: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.

RESULTS: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.

CONCLUSIONS: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse's death predicted bereavement-related depression.

%B Am J Psychiatry %I 156 %V 156 %P 1596-601 %8 1999 Oct %G eng %N 10 %L pubs_1999_Turvey_CAJPsy.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10518172?dopt=Abstract %4 Age Factors/Aged, 80 and Over/Bereavement/Cohort Studies/Depression/Depressive Disorders/Logistic Models/Longitudinal Studies/Marital Status/Odds Ratio/Psychiatric Status Rating Scales/Risk Factors/Sex Factors/Support, U.S. Government--PHS/Widowhood %$ 4330 %R 10.1176/ajp.156.10.1596 %0 Thesis %D 1999 %T Essays on Long-Term Care of the Elderly in the United States %A Aykan, Hakan %K Healthcare %K Medicare/Medicaid/Health Insurance %K Public Policy %X This dissertation consists of three independent essays on long-term care of the elderly in the United States. Long-term care encompasses a wide array of increasingly important and rapidly changing issues. These issues can be divided into six broad categories: (1) use, cost, and financing; (2) special populations; (3) data development and methodology; (4) access and quality of care; (5) organization and delivery of care; and (6) consumer and caregiver behavior. The essays in this dissertation fall into the first three of these categories. The first essay uses a continuous-time hazard model to analyze the importance of state Medicaid policies in determining the risk of nursing home use among the elderly. We find that these state policies do not significantly affect the risk of older persons' nursing home use, controlling for a variety of demographic, socioeconomic, and health-related factors. Data for this analysis come from the first two waves of the Assets and Health Dynamics of the Oldest Old (AHEAD) survey. The second essay uses a multinomial logistic regression model to examine how the use of nursing home and home health care services vary for older persons with and without children. Results indicate that older women's (but not men's) use of nursing home care (but not home health care) is significantly increased for those who are childless. This essay also uses data from the first two waves of the AHEAD survey. The third essay analyzes some design issues in the Second Supplement on Aging (SOA-II) to the 1994 National Health Interview Survey (NHIS) and their implications for the use of this survey by itself or in conjunction with the Supplement on Aging conducted ten years earlier. We find that especially one of the design issues, the time-lag between the 1994 NHIS and the SOA-II, could lead to biases in analyses using the SOA-II. We address the design issues by correcting for sample selection in the SOA-II and by developing a re-weighting scheme. %I Syracuse University %8 1999 %G eng %U https://surface.syr.edu/ppa_etd/33/ %4 Medicaid %$ 16340 %! Essays on Long-Term Care of the Elderly in the United States %0 Journal Article %J Soc Sci Med %D 1999 %T The influence of personal care and assistive devices on the measurement of disability. %A Agree, E M %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disability Evaluation %K Female %K Humans %K Life Expectancy %K Logistic Models %K Long-term Care %K Male %K Self-Help Devices %X

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

%B Soc Sci Med %I 48 %V 48 %P 427-43 %8 1999 Feb %G eng %N 4 %L pubs_1999_Agree_ESocSciandMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10075170?dopt=Abstract %R 10.1016/s0277-9536(98)00369-4 %0 Book Section %B Behavioral Dimensions of Retirement Economics %D 1999 %T Information, Expectations, and Savings for Retirement %A Annamaria Lusardi %E Aaron, Henry J. %K Consumption and Savings %K Event History/Life Cycle %K Retirement Planning and Satisfaction %B Behavioral Dimensions of Retirement Economics %I Brookings Institution Press and Russell Sage Foundation %C Washington, D.C. %P 81-115 %G eng %4 Retirement/Retirement Policies/Economics of the Elderly/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Intertemporal Consumer Choice/Life Cycle Models and Saving/Retirement/Saving %$ 1040 %! Information, Expectations, and Savings for Retirement %0 Book Section %B Handbook of labor economics. Volume 3C %D 1999 %T New Developments in the Economic Analysis of Retirement %A Lumsdaine, Robin L. %A Olivia S. Mitchell %E Ashenfelter, Orley %E Card, David %K Consumption and Savings %K Employment and Labor Force %K Pensions %K Retirement Planning and Satisfaction %K Social Security %B Handbook of labor economics. Volume 3C %S Handbooks in Economics %I Elsevier Science, North-Holland %C Amsterdam; New York and Oxford %P 3261-3307 %G eng %U https://eml.berkeley.edu/~saez/course/lumsdaine-mitchell1999handbook.pdf %N 5 %4 Retirement/Retirement Policies/Economics of the Elderly/Social Security and Public Pensions/Nonwage Labor Costs and Benefits/Private Pensions/Labor Force--Demographics/Retirement %$ 1038 %! New Developments in the Economic Analysis of Retirement %& 49 %0 Report %D 1999 %T Nonparametric Modeling of the Anchoring Effect in an Unfolding Bracket Design %A Vazquez Alvarez, Rosalia %A Melenberg, Bertrand %A Arthur H.O. vanSoest %K Methodology %X Household surveys are often plagued by item non-response on economic variables of interest like income, savings or the amount of wealth. Manski (1989,1994, 1995) shows how, in the presence of such non-response, bounds on conditional quantiles of the variable of interest can be derived, allowing for any type of non-random response behavior. Including follow up categorical questions in the form of unfolding brackets for initial item non-respondents, is an effective way to reduce complete item non-response. Recent evidence, however, suggests that such design is vulnerable to a psychometric bias known as the anchoring effect. In this paper, we extend the approach by Manski to take account of the information provided by the bracket respondents. We derive bounds which do and do not allow for the anchoring effect. These bounds are applied to earnings in the 1996 wave of the Health and Retirement Survey (HRS). The results show that the categorical questions can be useful to increase precision of the bounds, even if anchoring is allowed for. %I Tilburg, NE, Tilburg University, Center for Economic Research Discussion Paper %G eng %U https://research.tilburguniversity.edu/en/publications/nonparametric-modeling-of-the-anchoring-effect-in-an-unfolding-br %L wp_1999/VazquezAlvarez.pdf %4 nonparametric models/unfolding bracket design/anchoring effect/item nonreponse/bounding intervals/nonparametrics %$ 10352 %0 Journal Article %J J Health Psychol %D 1999 %T Relations among Socioeconomic Status Indicators and Health for African-Americans and Whites. %A Ostrove, Joan M. %A Feldman, Pamela %A Nancy E Adler %X

This investigation explored the relationship of socioeconomic status (SES) to physical and mental health in two nationally representative samples of whites and African-Americans. We examined the interrelations among SES variables and assessed their contribution to health for the two racial groups. Throughout, we assessed the contribution of a less traditional indicator of SES-wealth-in the SES-health relationship. As we expected, African-Americans had lower levels of education, household income, and wealth than whites. Unexpectedly, however, the strength of the interrelationships among the three SES indicators did not differ for African-Americans and whites. In addition, we found that SES operated to affect health in a very similar fashion for African-Americans and whites. We found that wealth, in addition to more traditional indicators of SES (education and household income), made a unique and significant contribution to explaining both physical and mental health. Examining relations of different SES indicators to health across groups is critical to eliminating persistent social inequalities in health.

%B J Health Psychol %I 4 %V 4 %P 451-63 %8 1999 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22021639?dopt=Abstract %4 Ethnicity/Health/Wealth %$ 11822 %R 10.1177/135910539900400401 %0 Journal Article %J The Journals of Gerontology: Social Sciences %D 1998 %T Older Parents' Expectations of Moving Closer to Their Children. %A Merril Silverstein %A Angelelli, J.J. %K Adult children %K Demographics %K Health Conditions and Status %K Housing %K Income %K Methodology %X Research shows that older parents engage in return migration in older to live closer to children from whom they receive care. However, less is known about how characteristics of adult children influence this process. Data for this analysis are from 5,382 older parents participating in the 1993/4 AHEAD national survey of adults aged 70 years old and older. Findings demonstrate that elderly parents who expect to move closer to adult children tend to be older, female, and have at least one child who is better-off financially than they are. Living alone magnifies the effect of poor self-rated health on expecting to move closer to a child. Random effects modeling of children's characteristics reveals that parents are more likely to expect to move closer to a daughter than to a son. Greater parental functional impairment was found to further depress the selection of sons. Overall, the findings suggest that older parents expect to move closer to adult children out of need and tend to select a target child with greater potential to provide support. %B The Journals of Gerontology: Social Sciences %I 53B %V 53B %P S153-63 %G eng %U https://watermark.silverchair.com/53B-3-S153.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAApgwggKUBgkqhkiG9w0BBwagggKFMIICgQIBADCCAnoGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMNAXM1J8iGScq2A0NAgEQgIICSwK0q6lyxlxs-JeLbHUAd0eX7Sbh-33pv0SkUBYneGeD %N 3 %L pubs_1998_Silverstein_MJGSeriesB.pdf %4 Aged, 80 and Over/Migration/Family/Female/Financial Support/Housing/Intergenerational Relations/Middle Age/Parent Child Relations/Social Support/Support, Non U.S. Government/Support, U.S. Government--PHS %$ 4275 %0 Book %D 1997 %T Who Will Care for Us? Aging and Long-term Care in Multicultural America %A Ronald J. Angel %A Jacqueline L. Angel %K Demographics %K Women and Minorities %I New York University Press %C NY %G eng %4 Minority aged/Social conditions %$ 8156 %0 Journal Article %J Gerontologist %D 1996 %T The extent of private and public health insurance coverage among adult Hispanics. %A Ronald J. Angel %A Jacqueline L. Angel %K Adult %K Aged %K Employment %K Female %K Health Services Accessibility %K Hispanic or Latino %K Humans %K Insurance, Health %K Male %K Medical Assistance %K Middle Aged %K Multivariate Analysis %K United States %X

Data from the Health and Retirement Survey reveal extremely low levels of health insurance coverage among Hispanics and, especially, among Mexican Americans. The data reveal that this lack of insurance is associated with lower rates of employer-based and privately purchased coverage. Even after controlling for a large number of insurance-related factors, Hispanics have rates of health insurance coverage that are lower than those of either non-Hispanic blacks or whites. This serious lack of health insurance coverage among preretirement-age Hispanics has serious implications both for health, because the lack of insurance represents a major barrier to health care, and for the adequacy of retirement coverage, because private insurance represents an important supplement to Medicare.

%B Gerontologist %I Vol. 36 %V 36 %P 332-40 %8 1996 Jun %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/8682331?dopt=Abstract %4 Health Services--type of insurance coverage/Labor/Economic Status/Health Status/Minorities/Health Insurance Coverage/Basic Demographics %$ 8028 %R 10.1093/geront/36.3.332 %0 Journal Article %J Social Science & Medicine (1983) %D 0 %T State-level desegregation in the U.S. South and mid-life cognitive function among Black and White adults. %A Walsemann, Katrina M %A Hair, Nicole L %A Farina, Mateo P %A Tyagi, Pallavi %A Jackson, Heide %A Jennifer A Ailshire %K Education %K historical data %K life course %K school segregation %X

RATIONALE: Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s-1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function.

OBJECTIVE: We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents' educational attainment.

METHODS: We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects.

RESULTS: Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment.

CONCLUSIONS: Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South.

%B Social Science & Medicine (1983) %V 338 %P 116319 %G eng %R 10.1016/j.socscimed.2023.116319