%0 Journal Article %J Alzheimer's & Dementia: The Journal of the Alzheimer's Association %D Forthcoming %T Alzheimer's disease genetic burden is associated with mid-life depression among persons with normal cognition. %A Wingo, Thomas S %A Gerasimov, Ekaterina S %A Canon, Se Min %A Lah, James J %A Levey, Allan I %A Wingo, Aliza P %K Alzheimer's disease %K mid-life depression %K Polygenic risk score %X
INTRODUCTION: Despite an established link between depression and higher Alzheimer's disease (AD) risk, it is unclear whether the conditions share pathophysiology. Here, we investigated whether depression manifesting after age 50 is associated with a genetic predisposition to AD.
METHODS: From the population-based Health and Retirement Study cohort with biennial assessments of depressive symptoms and cognitive performance, we studied 6656 individuals of European ancestry with whole-genome genotyping. Polygenic risk scores (PRSs) for AD were estimated and examined for an association with depression in cognitively normal participants using regression modeling.
RESULTS: Among cognitively normal participants, those with a higher AD PRS were more likely to experience depression after age 50 after accounting for the effects of genetic predisposition to depression, sex, age, and education.
DISCUSSION: Genetic predisposition to AD may be one of the factors contributing to the pathogenesis of mid-life depression. Whether there is a shared genetic basis between mid-life depression and AD merits further study.
%B Alzheimer's & Dementia: The Journal of the Alzheimer's Association %G eng %R 10.1002/alz.12716 %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 %XBACKGROUND: 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 Current Alzheimer Research %D Forthcoming %T The Association of Allergy-Related and Non-Allergy-Related Olfactory Impairment with Cognitive Function in Older Adults: Two Cross-Sectional Studies. %A Chen, Hui %A Ding, Yihong %A Huang, Liyan %A Zhong, Wansi %A Lin, Xiaojun %A Zhang, Baoyue %A Zheng, Yan %A Xu, Xin %A Lou, Min %A Yuan, Changzheng %K allergic status %K cognitive domains %K cognitive impairment %K cross-- sectional studies. %K Global cognitive function %K olfactory impairment %XBACKGROUND: Evidence on the association of Olfactory Impairment (OI) with age-related cognitive decline is inconclusive, and the potential influence of allergy remains unclear.
OBJECTIVE: We aimed to evaluate the cross-sectional associations of allergy-related and non-allergy- related OI to cognitive function.
METHODS: We included 2,499 participants from the Health and Retirement Study (HRS)-Harmonized Cognitive Assessment Protocol (HCAP) sub-study and 1,086 participants from the English Longitudinal Study of Ageing (ELSA)-HCAP. The Olfactory Function Field Exam (OFFE) using Sniffin' Stick odor pens was used to objectively assess olfactory function and an olfactory score <6/11 indicated OI. Mini-Mental Status Examination (MMSE) was used to assess global cognitive function and define cognitive impairment (<24/30). A neuropsychologic battery was used to assess five cognitive domains.
RESULTS: Compared to non-OI participants, individuals with OI had lower MMSE z-score [βHRS = -0.33, 95% Confidence Interval (CI): -0.41 to -0.24; βELSA = -0.31, -0.43 to -0.18] and higher prevalence of cognitive impairment [Prevalence Ratio (PR)HRS = 1.46, 1.06 to 2.01; PRELSA = 1.63, 1.26 to 2.11]. The associations were stronger for non-allergy-related OI (βHRS = -0.36; βELSA = -0.34) than for allergy-related OI (βHRS = -0.26; βELSA = 0.13). Similar associations were observed with domain- specific cognitive function measures.
CONCLUSION: OI, particularly non-allergy-related OI, was related to poorer cognitive function in older adults. Although the current cross-sectional study is subject to several limitations, such as reverse causality and residual confounding, the findings will provide insights into the OI-cognition association and enlighten future attention to non-allergy-related OI for the prevention of potential cognitive impairment.
%B Current Alzheimer Research %G eng %R 10.2174/0115672050284179240215052257 %0 Journal Article %J Archives of Gerontology and Geriatrics %D Forthcoming %T Associations between self-perceptions of aging and social functioning in older adults: An analysis based on health and retirement study data. %A Cai, Yingying %A Ren, Xiaohe %A Wang, Jingyi %A Hou, Yue %A Zhang, Mengyuan %A Chen, Ou %K Attitudes toward own aging %K healthy aging %K Human Activities %XOBJECTIVES: Self-perception of aging (SPA) and social functioning are two important variables in the process of healthy aging, but the relationship between them is still unclear. This study aimed to explore the association between SPA and social functioning in older adults.
METHODS: We conducted a longitudinal study utilizing data from the Health and Retirement Study. The sample comprised individuals aged 50 and above. Socio-demographic, psychosocial, and lifestyle information of study participants was systematically collected at baseline (2012 and 2014) and during follow-up four years later (2016 and 2018). SPA was measured using a scale assessing individuals' attitudes toward their aging process. Social functioning was evaluated through 22 questions, reflecting individuals' abilities to engage in and perform various roles and tasks in their daily lives. Multilevel modeling was employed to analyze the relationship between SPA and social functioning. Differences in social functioning changes among various SPA groups were assessed through the Generalized Estimating Equations methodology.
RESULTS: The study included 8,454 participants with an average age of 68.3 years (SD = 9.92). The multilevel model revealed a significant correlation between SPA and social functioning (β = 0.131; P < 0.001). This relationship persisted after adjusting the model (β = 0.088; P < 0.001). Generalized Estimating Equations indicated noteworthy differences in social functioning changes among distinct SPA groups (P = 0.034).
DISCUSSION: Positive SPA is associated with the healthy social functioning of older adults. Healthcare providers could target modifiable aspects of SPA to enhance the social function of older adults and promote successful aging.
%B Archives of Gerontology and Geriatrics %V 119 %P 105307 %G eng %R 10.1016/j.archger.2023.105307 %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 The Journal of Pain %D Forthcoming %T Chronic Pain Among Middle-Aged and Older Adults in the United States: The Role of Everyday Discrimination and Racial/Ethnic Identity. %A Spector, Antoinette L %A Quinn, Katherine G %A Cruz-Almeida, Yenisel %A Fillingim, Roger B %K Chronic pain %K everyday discrimination %K high impact chronic pain %XChronic pain disproportionately affects middle-aged and older adults in the United States. Everyday discrimination is associated with worse pain outcomes and is more prevalent among adults from racial/ethnic minoritized groups. Yet, there is limited evidence on relationships between everyday discrimination and chronic pain among middle-aged and older adults, as well as how discrimination and racial/ethnic identity may interact to influence this relationship. We used the 2018 Health and Retirement study to evaluate associations between exposure to everyday discrimination and odds to experience any, severe, and high-impact chronic pain among 5,314 Hispanic, non-Hispanic Black, and non-Hispanic White adults over the age of 50. Logistic regression was used to evaluate the main and interaction effects of everyday discrimination on the odds of chronic pain (any, severe, and high-impact) across racial/ethnic groups. Results showed that Hispanic and non-Hispanic Black middle-aged and older adults had a higher, unadjusted prevalence of severe and high-impact chronic pain and reported more exposure to everyday discrimination compared to non-Hispanic White middle-aged and older adults. In fully adjusted models, exposure to everyday discrimination predicted higher odds to experience each type of chronic pain. In addition, study findings showed that exposure to everyday discrimination significantly raised pain risk among Hispanic and non-Hispanic White, but not non-Hispanic Black, middle-aged, and older adults. Findings underscore the influential role of everyday discrimination on the chronic pain experiences of middle-aged and older adults, as well as differential effects across racial/ethnic groups. PERSPECTIVE: Using national data, we examined associations between discrimination and chronic pain among middle-aged and older adults, including interactions between discrimination and race/ethnicity. Exposure to discrimination predicted a higher chronic pain burden, overall. Differential effects within racial/ethnic groups underscored a need for more nuanced investigations into pain disparities among this population.
%B The Journal of Pain %G eng %R 10.1016/j.jpain.2023.11.022 %0 Journal Article %J Clinical gerontologist %D Forthcoming %T Couples' Cognition, Intimacy, and Activity Engagement: An Actor-Partner Interdependence Model Analysis. %A Su, Fan %A Chao, Jianqian %A Zhang, Bowen %A Zhang, Na %A Luo, Zongyu %A Han, Jiaying %K Activity engagement %K Cognition %K dyadic analysis %K spouse relationship %XOBJECTIVES: This study examines the actor and partner effects of cognition on activity engagement and the potential mediating role of intimate relationship in older couple dyadic context.
METHODS: Data for this study were obtained from heterosexual couples who participated in the 2020 wave of the Health and Retirement Study. Constructing a dyadic model of couples' cognitions, activity engagement, and intimacy using structural equation modeling to analyze the relationship between variables and mediating effects.
RESULTS: At the actor level, cognition was positively correlated with their activity participation. At the partner level, wives' cognition and husbands' activity engagement were positively correlated. Husband's cognitive score affect wife's subjective feelings about intimacy. The mediation effect of Wife's intimacy on the relationship between husband's cognition and wife's activity engagement was significant.
CONCLUSIONS: In older couples, cognition influences activity engagement at a binary level, and this association is influenced by the level of intimacy. Improving intimacy can help increase activity engagement in older couples, which in turn promotes health. Clinical Implications Maintaining cognition helps older people enjoy good marriage and participation in activities. For women, the closer the partnership, the higher the frequency of participating in various activities.
%B Clinical gerontologist %P 1-13 %G eng %R 10.1080/07317115.2023.2274524 %0 Journal Article %J JAMA Internal Medicine %D Forthcoming %T Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia. %A Deardorff, W James %A Jeon, Sun Y %A Barnes, Deborah E %A Boscardin, W John %A Kenneth M. Langa %A Covinsky, Kenneth E %A Mitchell, Susan L %A Lee, Sei J %A Smith, Alexander K %K Community-dwelling %K Dementia %K home care %K Nursing %XIMPORTANCE: Most older adults living with dementia ultimately need nursing home level of care (NHLOC).
OBJECTIVE: To develop models to predict need for NHLOC among older adults with probable dementia using self-report and proxy reports to aid patients and family with planning and care management.
DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included data from 1998 to 2016 from the Health and Retirement Study (development cohort) and from 2011 to 2019 from the National Health and Aging Trends Study (validation cohort). Participants were community-dwelling adults 65 years and older with probable dementia. Data analysis was conducted between January 2022 and October 2023.
EXPOSURES: Candidate predictors included demographics, behavioral/health factors, functional measures, and chronic conditions.
MAIN OUTCOMES AND MEASURES: The primary outcome was need for NHLOC defined as (1) 3 or more activities of daily living (ADL) dependencies, (2) 2 or more ADL dependencies and presence of wandering/need for supervision, or (3) needing help with eating. A Weibull survival model incorporating interval censoring and competing risk of death was used. Imputation-stable variable selection was used to develop 2 models: one using proxy responses and another using self-responses. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (calibration plots).
RESULTS: Of 3327 participants with probable dementia in the Health and Retirement Study, the mean (SD) age was 82.4 (7.4) years and 2301 (survey-weighted 70%) were female. At the end of follow-up, 2107 participants (63.3%) were classified as needing NHLOC. Predictors for both final models included age, baseline ADL and instrumental ADL dependencies, and driving status. The proxy model added body mass index and falls history. The self-respondent model added female sex, incontinence, and date recall. Optimism-corrected iAUC after bootstrap internal validation was 0.72 (95% CI, 0.70-0.75) in the proxy model and 0.64 (95% CI, 0.62-0.66) in the self-respondent model. On external validation in the National Health and Aging Trends Study (n = 1712), iAUC in the proxy and self-respondent models was 0.66 (95% CI, 0.61-0.70) and 0.64 (95% CI, 0.62-0.67), respectively. There was excellent calibration across the range of predicted risk.
CONCLUSIONS AND RELEVANCE: This prognostic study showed that relatively simple models using self-report or proxy responses can predict need for NHLOC in community-dwelling older adults with probable dementia with moderate discrimination and excellent calibration. These estimates may help guide discussions with patients and families in future care planning.
%B JAMA Internal Medicine %G eng %R 10.1001/jamainternmed.2023.6548 %0 Journal Article %J Clinical Gerontology %D Forthcoming %T Disentangling the Longitudinal Relationship between Loneliness and Depressive Symptoms in U.S. Adults Over 50. %A Griffin, Sarah C %A Blakey, Shannon M %A Brant, Taylor R %A Eshera, Yasmine M %A Calhoun, Patrick S %K Depressive symptoms %K Loneliness %K path analysis %K RI-CLPM %XOBJECTIVES: A seminal study on loneliness and depression suggested that loneliness influences depression more than the reverse. However, the study's analytic method has since been criticized for failing to account for the trait-like nature of variables. This study aimed to examine the longitudinal relationship between loneliness and depressive symptoms while accounting for the trait-like nature of both variables.
METHODS: Data (n = 16,478) came from the Health and Retirement Study (2006-2016). Measures included the Hughes Loneliness Scale and a modified Center for Epidemiologic Studies Depression scale (loneliness item omitted). Analyses consisted of random intercepts cross-lagged panel models (three time-points evenly spaced across eight years).
RESULTS: There was evidence that loneliness and depressive symptoms are trait-like and these trait-like components are strongly associated. There was not evidence of cross-lagged effects between loneliness and depressive symptoms.
CONCLUSIONS: A tendency toward loneliness corresponded with a tendency toward depressive symptoms. However, deviations in one's typical level of loneliness did not predict deviations in one's typical level of depressive symptoms or vice-versa. These findings do not support past assertions that loneliness shapes subsequent depression more than the reverse.
CLINICAL IMPLICATIONS: By middle to late adulthood, loneliness and depressive symptoms are trait-like phenomena that are strongly associated.
%B Clinical Gerontology %G eng %R 10.1080/07317115.2022.2147115 %0 Journal Article %J American Journal of Preventive Medicine %D Forthcoming %T Education, Income, Wealth, and Discrimination in Black-White Allostatic Load Disparities. %A Cuevas, Adolfo G %A McSorley, Anna-Michelle %A Lyngdoh, Adiammi %A Kaba-Diakité, Fatoumata %A Harris, Adrian %A Rhodes-Bratton, Brennan %A Rouhani, Saba %K Aging %K Discrimination %K Education %K Income %K Wealth %XINTRODUCTION: Allostatic load (AL) is a significant marker of aging, associated with disease and mortality. Research has elucidated the impact of education and income on AL. However, the roles of wealth and discrimination in contributing to AL and shaping AL disparities remain underexplored. This study aimed to investigate the association between wealth and AL, while also examining the independent contributions of education, income, wealth, and everyday discrimination in shaping AL disparities.
METHODS: Using 2016 data from the nationally representative Health and Retirement Study (N=3,866), this study employed multilinear regression analysis to quantify the association between education and income, wealth (calculated as assets minus debts), and everyday discrimination with AL. Oaxaca-Blinder decomposition analysis was conducted to determine the proportion of AL disparities between Black and White participants attributed to education and income, wealth, and everyday discrimination. Analyses were performed in 2023.
RESULTS: Having a college degree or more (b = -0.32; 95% CI: -0.46, -0.17), higher income (b = -0.06; 95% CI: -0.11, -0.01), and greater wealth (b = -0.11; 95% CI: -0.16, -0.07) were linked to reduced AL. Conversely, increased experiences of everyday discrimination were associated with heightened AL (b = 0.07; 95% CI: 0.01, 0.16). Collectively, differences in possessing a college degree or more, wealth, and exposure to discrimination accounted for about 18% of the observed Black-White AL disparities.
CONCLUSIONS: Education, income, wealth, and experiences of discrimination may independently contribute to AL and partially explain Black-White disparities in AL. There is a need to elucidate the underlying mechanisms governing these relationships, particularly wealth, and extend the research to additional social determinants of racial health disparities.
%B American Journal of Preventive Medicine %G eng %R 10.1016/j.amepre.2024.02.021 %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 %XOBJECTIVES: 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 Alzheimer's & Dementia: the journal of the Alzheimer's association %D Forthcoming %T Health care utilization and costs in the years preceding dementia identification. %A Kumar, Raj G %A Lund, Evan Bollens %A Ornstein, Katherine A %A Li, Jing %A Covinsky, Kenneth E %A Kelley, Amy S %K Alzheimer's disease and related dementias %K comorbidities %K Epidemiology %K Health Care Costs %K Health care utilization %K mild cognitive impairment %XINTRODUCTION: There is evidence that health care utilization increases after incident dementia, particularly after dementia diagnosis and toward the end of life; however, less is known about utilization in the years before dementia identification.
METHODS: In this retrospective cohort study we obtained data on n = 5547 beneficiaries from the Health and Retirement Study (HRS)-Medicare linked sample (n = 1241 with and n = 4306 without dementia) to compare longitudinal trends in health care costs and utilization in the 6 years preceding dementia identification relative to a confounder-balanced reference group without dementia.
RESULTS: We found that persons with dementia had a greater prevalence of outpatient emergency department (ED), inpatient hospital, skilled nursing, and home health use, and total health care costs in the years preceding dementia identification compared to their similar counterparts without dementia across a comparable timespan in later life.
CONCLUSIONS: This study provides evidence to suggest greater healthcare burden may exist well before clinical manifestation and identification of dementia.
HIGHLIGHTS: Several studies have documented the tremendous healthcare-related costs of living with dementia, particularly toward the end of life. Dementia is a progressive neurodegenerative disease, which, for some, includes a prolonged pre-clinical phase. However, health services research to date has seldom considered the time before incident dementia. This study documents that health care utilization and costs are significantly elevated in the years before incident dementia relative to a demographically-similar comparison group without dementia.
%B Alzheimer's & Dementia: the journal of the Alzheimer's association %G eng %R 10.1002/alz.13476 %0 Journal Article %J PsyArXiv Preprint %D Forthcoming %T Investigating the broad domains of intrinsic capacity, functional ability and environment: An exploratory graph analysis approach for improving analytical methodologies for measuring healthy aging %A Golino, Hudson %A Thiyagarajan, Jotheeswaran Amuthavalli %A Sadana, Ritu %A Teles, Mariana %A Christensen, Alexander %A Boker, Steven %K health aging %K Methodology %X The current paper compared the empirical structure of 280 variables from the 2016 wave of the Health and Retirement Study (N = 16,327) estimated using exploratory graph analysis with a theoretical structure based on 20 broad domains of intrinsic capacity, functional ability and environment, identified in the International Classification of Functioning, Disability and Health compendium. The results showed that a structure with 21 first-order factors had the best fit to the data (i.e., lowest total entropy fit value) for both the training and validation sample. A second-order exploratory graph analysis was applied on the interfactor correlation matrix and identified five second-order factors. The five-factor structure presented a better fit than the theoretical three-factor structure (approximately) representing intrinsic capacity, functional ability and environment. A close inspection of the network structure generated by analyzing the rotated network loadings of the 21 first-order factors revealed an interplay between cognition, mobility, need for help with daily activities, walking capacity, physical capacity, liver functioning, positive affect and perceived mastery, low perceived control, and depression/negative mood. Combined, our results can help guide future research by providing a framework for estimating the structure of multi-domain aging research as well as generating questions that can be addressed in future research. %B PsyArXiv Preprint %G eng %R 10.31234/osf.io/hj5mc %0 Journal Article %J JOURNAL OF MARRIAGE AND FAMILY %D Forthcoming %T Keeping us young? Grandchild caregiving and older adults' cognitive functioning %A Caputo, Jennifer %A Cagney, Kathleen A. %A Waite, Linda %K Caregiving %K Dementia %K grandchildren %K health %K intergenerational relationships %K Longitudinal research %X Objective; This study investigates longitudinal associations between providing care to grandchildren and cognitive functioning. It also examines heterogeneity in these relationships. Background: Grandchild caregiving may support older adults' cognitive functioning by providing social engagement and emotional meaning. However, studies caution that time-intensive or custodial grandchild caregiving can take a toll on grandparents. The cognitive health implications of grandchild caregiving may thus depend on contexts including time spent providing care and living arrangements. They may also vary across sociodemographic groups and have greater effects on older adults who are more vulnerable to cognitive decline. Method: Data came from the 1998-2016 waves of the Health and Retirement Study (HRS) and represented over 11,000 US adults aged 50+. Using linear growth curve and dynamic panel models, the analysis explored relationships between level of grandchild care and cognitive functioning over time and across sociodemographic, family, work, and health characteristics. Results: Those providing 100-199, 200-499, or 500+ h of care to grandchildren had better cognitive functioning than non-caregivers regardless of whether they lived with grandchildren. Positive links between grandchild caregiving and cognition were stronger for lower income, non-working, and unpartnered adults and grew with age and functional limitations. Conclusion: These findings suggest that providing care to minor grandchildren may help support cognitive functioning as adults age. They also support the hypothesis that more vulnerable or isolated groups of older adults may benefit the most from grandchild caregiving. %B JOURNAL OF MARRIAGE AND FAMILY %G eng %R 10.1111/jomf.12945 %0 Journal Article %J Psychological Reports %D Forthcoming %T Leisure Activity, Leisure Satisfaction, and Hedonic and Eudaimonic Well-Being Among Older Adults With Cancer Experience. %A Chun, Sanghee %A Lee, Sunwoo %A Heo, Jinmoo %A Ryu, Jungsu %A Lee, Kyung Hee %K Cancer %K eudaimonic and hedonic well-being %K Internet use %K leisure activity %K TV watching %XOlder adults with cancer experience are more likely to encounter a notable reduction of participation in physical and social leisure activities, which may threaten their overall well-being. The purpose of this study was to explore how specific types of leisure activities and leisure satisfaction were linked to hedonic and eudaimonic well-being among older adults who had experienced cancer. A nationally representative sample of 2,934 older adults with lifetime cancer experience was retained from the Health and Retirement Study. The results of regression analysis revealed that walking for 20 minutes was reported as the only type of leisure activity related to hedonic well-being for the oldest-old (85+ years old). The current study also found that TV watching was significantly, but negatively associated with eudaimonic well-being for the young-old (50-74 years of age). In contrast, using a computer was positively linked to hedonic and eudaimonic well-being among the young-old and old-old (75-84 years of age). The current study made a significant contribution to build the body of knowledge that the different age groups of older adults who had experienced cancer can enhance eudaimonic and hedonic well-being by participating in different types of leisure activities. Implications for further research are discussed.
%B Psychological Reports %G eng %R 10.1177/00332941221123236 %0 Journal Article %J Clin Gastroenterol Hepatol %D Forthcoming %T Loneliness and Depressive Symptoms Are High Among Older Adults With Digestive Disease and Associated With Lower Perceived Health. %A Cohen-Mekelburg, Shirley %A Jordan, Ariel %A Kenney, Brooke %A Burgess, Helen J %A Chang, Joy W %A Hu, Hsou Mei %A Tapper, Elliot %A Kenneth M. Langa %A Levine, Deborah A %A Waljee, Akbar K %K Epidemiology %K General Practice %K Outcomes Research %K Psychiatric Disorders %XBACKGROUND & AIMS: Current approaches to managing digestive disease in older adults fail to consider the psychosocial factors contributing to a person's health. We aimed to compare the frequency of loneliness, depression, and social isolation in older adults with and without a digestive disease and to quantify their association with poor health.
METHODS: We conducted an analysis of Health and Retirement Study data from 2008 to 2016, a nationally representative panel study of participants 50 years and older and their spouses. Bivariate analyses examined differences in loneliness, depression, and social isolation among patients with and without a digestive disease. We also examined the relationship between these factors and health.
RESULTS: We identified 3979 (56.0%) respondents with and 3131 (44.0%) without a digestive disease. Overall, 60.4% and 55.6% of respondents with and without a digestive disease reported loneliness (P < .001), 12.7% and 7.5% reported severe depression (P < .001), and 8.9% and 8.7% reported social isolation (P = NS), respectively. After adjusting for covariates, those with a digestive disease were more likely to report poor or fair health than those without a digestive disease (odds ratio [OR], 1.25; 95% CI, 1.11-1.41). Among patients with a digestive disease, loneliness (OR, 1.43; 95% CI, 1.22-1.69) and moderate and severe depression (OR, 2.93; 95% CI, 2.48-3.47; and OR, 8.96; 95% CI, 6.91-11.63, respectively) were associated with greater odds of poor or fair health.
CONCLUSIONS: Older adults with a digestive disease were more likely than those without a digestive disease to endorse loneliness and moderate to severe depression and these conditions are associated with poor or fair health. Gastroenterologists should feel empowered to screen patients for depression and loneliness symptoms and establish care pathways for mental health treatment.
%B Clin Gastroenterol Hepatol %G eng %R 10.1016/j.cgh.2023.08.027 %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 %XBACKGROUND: 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 Innovation in Aging %D Forthcoming %T Measuring Psychological Resilience in Aging: Findings from the Health and Retirement Study (HRS) and National Longitudinal Study of Adolescent to Adult Health (Add Health) %A Taylor, Miles G %A Bruefach, Tyler %A Carr, Dawn Celeste %K Adaptation %K coping %K Measurement Invariance %K structural equation modelling %K Wellbeing %X This study aimed to evaluate the measurement properties of two emerging psychological resilience (PR) measures constructed for use in large national data sources and to test their reliability across social axes including race/ethnicity, gender, and socioeconomic status.Using 2006/2008 data, the Simplified Resilience Score (SRS) and the Add Health Resilience Scale (AHRS) were tested using overall and multi-group measurement models in a structural equation modeling (SEM) framework.Both PR measures perform well as reliable, one factor latent constructs capturing adaptive capacity at various life stages. Both measures showed measurement consistency across social axes, with specific differences in item measurement across some racial/ethnic groups.The results indicate these measures represent high quality, consistent measures of PR in nationally representative aging and health data. The availability of reliable, valid measures of PR enables consistent evaluation of resilience in health and aging processes. %B Innovation in Aging %G eng %R 10.1093/geroni/igae013 %0 Journal Article %J Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %D Forthcoming %T Memory trajectories and disability among older couples: the mediating role of depressive symptoms. %A Kong, Dexia %A Lu, Peiyi %A Jiang, Da %A Chan, Helen Yue Lai %K Dyad research %K latent class growth analysis %K Memory %K Older couples %K trajectory %XOBJECTIVE: Using a dyadic approach, this study examined the mediating effect of depressive symptoms on the longitudinal relationships between husbands' and wives' memory trajectories and their prospective disability status.
METHODS: Longitudinal data from the Health and Retirement Study 2004-2018 were used. Older (aged 50+) heterosexual couples who had no limitations in activity of daily living at the baseline (2004) were included (N = 1,310). Latent class growth analysis grouped wives and husbands into distinct memory trajectories in 2004-2014. A structural equation model examined the actor and partner effects of memory trajectories on depressive symptoms in 2016 and disability status in 2018. The mediating effect of depressive symptoms was tested.
RESULTS: Four distinct memory trajectories were found: persistently high, high and slow decline, moderate and slow decline, and low and rapid decline. Only the wife's low and rapid decline memory trajectory predicted her own more depressive symptoms (β = 0.588, 95% CI = 0.209, 0.967) and her husband's more depressive symptoms (β = 0.326, 95% CI = 0.004, 0.648). Meanwhile, depressive symptoms had strong and significant actor effects on disability (β = 0.046, 95% CI = 0.036, 0.057 for wives; β = 0.060, 95% CI = 0.046, 0.074 for husbands).
DISCUSSION: The wife's low and rapid decline trajectory was associated with her own and her husband's more depressive symptoms, which in turn increased the disability risk for both partners. Timely identification and treatment of memory decline among wives have the potential to mitigate couples' depressive symptoms and, ultimately, disability risks.
%B Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %G eng %R 10.1093/geronb/gbad163 %0 Journal Article %J Journal of the American Geriatrics Society %D Forthcoming %T Money may matter: Financial hardship and its association with satisfaction of care among people living with dementia. %A Miller, Katherine E M %A White, Lindsay %A Coe, Norma B %A Khandelwal, Nita %K Dementia %K Finances %K Life Satisfaction %X Financial hardship is a multidimensional construct that includes, but is not limited to, out-of-pocket costs. Financial hardship has mostly been studied in patients with cancer and is independently associated with decreased treatment adherence,1 worse quality of life,2 worse psychological and physical symptoms,2, 3 and mortality4 — outcomes of great importance to people living with dementia (PLWD) as well. However, there are limited data specifically examining the prevalence or the impact of financial hardship among PLWD. Our objectives are to estimate the prevalence of financial hardship among PLWD and describe measures of satisfaction with life and with health care among PLWD, compared to a cancer cohort. %B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.18723 %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 %XMitochondrial 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 American journal of preventive medicine %D Forthcoming %T Neighborhood Features and Cognitive Function: Moderating Roles of Individual Socioeconomic Status. %A Yang, Tse-Chuan %A Kim, Seulki %A Choi, Seung-Won Emily %A Halloway, Shannon %A Mitchell, Uchechi A %A Shaw, Benjamin A %K cognitive function %K low-education %K low-income %K Older Adults %K socioeconomic status %XINTRODUCTION: There is an interest in exploring the associations between neighborhood characteristics and individual cognitive function; however, little is known about whether these relationships can be modified by individual socioeconomic status, such as educational attainment and income.
METHODS: Drawing from the 2010-2018 Health and Retirement Study, this study analyzed 10,621 older respondents (aged 65+) with a total of 33,931 person-waves. These respondents did not have dementia in 2010 and stayed in the same neighborhood throughout the study period. Cognitive function was measured with a 27-point indicator biennially, and neighborhood characteristics (i.e., walkability, concentrated disadvantage, and social isolation) were assessed in 2010. All analyses were performed in 2023.
RESULTS: Cognitive function is positively associated with neighborhood walkability and negatively related to concentrated disadvantage, suggesting that exposures to these neighborhood characteristics have long-lasting impacts on cognitive function. Furthermore, individual socioeconomic status modifies the relationship between neighborhood characteristics and cognitive function. Compared with those graduating from college, respondents without a bachelor's degree consistently have lower cognitive function but the educational gap in cognitive function narrows with increases in walkability (b= -0.152, SE=0.092), and widens when neighborhood concentrated disadvantage (b=0.212, SE=0.070) or social isolation (b=0.315, SE=0.125) rises. The income gap in cognitive function shrinks with increases in walkability (b= -0.063, SE=0.027).
CONCLUSIONS: The moderating role of socioeconomic status indicates that low-socioeconomic status older adults who also live in disadvantaged neighborhoods face a higher risk of poor cognitive function. Low-education and low-income aging adults may have the most to gain from investments to improve neighborhood characteristics.
%B American journal of preventive medicine %G eng %R 10.1016/j.amepre.2023.10.012 %0 Journal Article %J Journal of Alzheimer's Disease %D Forthcoming %T Pre-Analytical Variables Influencing Stability of Blood-Based Biomarkers of Neuropathology. %A Panikkar, Daniel %A Vivek, Sithara %A Crimmins, Eileen %A Jessica Faul %A Kenneth M. Langa %A Bharat Thyagarajan %K Alzheimer %K amyloid-β %K blood-based biomarkers %K pre-analytical variables %K Simoa assay %K stability %XBACKGROUND: Sample collection and preanalytical protocols may significantly impact the results of large-scale epidemiological studies incorporating blood-based biomarkers of neuropathology.
OBJECTIVE: To evaluate the stability and assay variability of several blood-based biomarkers of neuropathology for common preanalytical conditions.
METHODS: We collected serum and plasma samples from 41 participants and evaluated the effect of processing delay of up to 72 h when stored at 4∘C, three freeze-thaw cycles, and a combination of 48-h processing delay when stored at 4∘C and three freeze-thaw cycles on biomarker stability. Using the Simoa assay (Quanterix Inc.), we measured amyloid-β 40 (Aβ40), amyloid-β 42 (Aβ42), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and phosphorylated tau 181 (p-tau-181).
RESULTS: We found that Aβ40 and Aβ42 levels significantly decreased after a 24-h processing delay in both plasma and serum samples, and a single freeze-thaw cycle (p < 0.0001). Nevertheless, serum Aβ42/40 ratio remained stable with a processing delay up to 48 h while plasma Aβ42/40 ratio showed only small but significant increase with a delay up to 72 h. Both plasma and serum GFAP and NfL levels were only modestly affected by processing delay and freeze-thaw cycles. Plasma p-tau-181 levels notably increased with a 24-, 48-, and 72-h processing delay, but remained stable in serum. Intra-individual variation over two weeks was minimal for all biomarkers and their levels were substantially lower in serum when compared with plasma.
CONCLUSION: These results suggest that standardizing preanalytical variables will allow robust measurements of biomarkers of neuropathology in population studies.
%B Journal of Alzheimer's Disease %G eng %R 10.3233/JAD-230384 %0 Journal Article %J Journal of Aging and Health %D Forthcoming %T Preclinical Dementia and Economic Well-Being Trajectories of Racially Diverse Older Adults. %A Mudrazija, Stipica %A Palms, Jordan %A Lee, Ji Hyun %A Maher, Amanda %A Zahodne, Laura B %A Chopik, William J %K Alzheimer’s disease and related dementias %K economic well-being %K Health and Retirement Study %K preclinical %K racial/ethnic disparities %XObjectivesThis study examined the magnitude, changes, and racial/ethnic disparities in the economic costs of the 16-year preclinical phase of dementia-a period of cognitive decline without significant impact on daily activities. The study utilized two dementia algorithms to classify individuals with incident dementia in the Health and Retirement Study. These cases were compared to matched controls in terms of poverty status, labor force participation, and unsecured debts. Older adults classified with dementia were more likely to drop out of the labor force and become poor than similar older adults without dementia. Racial/ethnic disparities in poverty persisted during the preclinical period, with non-Hispanic Black older adults more likely to leave the labor force and Hispanic older adults more likely to have unsecured debt. Findings highlight the economic costs during prodromal phase of dementia, emphasizing need for early interventions to reduce financial strain across diverse older adults.
%B Journal of Aging and Health %P 8982643241237292 %G eng %R 10.1177/08982643241237292 %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 %XBACKGROUND: 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 %J Journal of the American Geriatrics Society %D Forthcoming %T Psychosocial stressors associated with frailty in community-dwelling older adults in the United States. %A Shakya, Shamatree %A Silva, Susan G %A McConnell, Eleanor S %A McLaughlin, Sara J %A Cary, Michael P %K Frailty %K psychosocial stressors %K Social determinants of health %XBACKGROUND: Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial stressors, determine psychosocial stressors contributing to frailty, and explore the mediating psychosocial stressors pathway.
METHODS: This cross-sectional study involved 7679 community-dwelling older adults (≥65) from the Health and Retirement Study (2006 and 2008 waves). Psychosocial stressors such as loneliness, low subjective social status, financial strain, poor neighborhood cohesion, everyday discrimination, and traumatic life events were measured. Frailty was defined by the Fried phenotype measure. Multivariable logistic regressions were used to examine the association of gender, race/ethnicity, and education with psychosocial stressors, psychosocial stressors associated with frailty, and the mediating psychosocial stressors pathway.
RESULTS: Females experienced greater financial strain but lower discrimination (both p < 0.05). Older adults who identified as Hispanic, Black, and racially or ethnically minoritized experienced low subjective social status, high financial strain, low neighborhood cohesion, and high discrimination than their White counterparts (all p < 0.05). Those with lower education experienced high loneliness, low subjective social status, high financial strain, low neighborhood cohesion but lower traumatic life events (all p < 0.05). Psychosocial stressors: High loneliness, low subjective social status, high financial strain, and low neighborhood cohesion (all p < 0.05) independently increased the odds of frailty. The mediating pathway of psychosocial stressors was not significant. CONCLUSION: Disparities exist in exposure to psychosocial stressors associated with frailty. Multilevel interventions are needed to reduce the influence of psychosocial stressors on frailty.
%B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.18821 %0 Journal Article %J Alzheimer's & Dementia %D Forthcoming %T Public spending on acute and long-term care for Alzheimer's disease and related dementias. %A Norma B Coe %A White, Lindsay %A Oney, Melissa %A Basu, Anirban %A Larson, Eric B %K longitudinal costs %K Medicaid %K Medicare %K Spending %XINTRODUCTION: We estimate the spending attributable to Alzheimer's disease and related dementias (ADRD) to the United States government for the first 5 years post-diagnosis.
METHODS: Using data from the Health and Retirement Study matched to Medicare and Medicaid claims, we identify a retrospective cohort of adults with a claims-based ADRD diagnosis along with matched controls.
RESULTS: The costs attributable to ADRD are $15,632 for traditional Medicare and $8833 for Medicaid per dementia case over the first 5 years after diagnosis. Seventy percent of Medicare costs occur in the first 2 years; Medicaid costs are concentrated among the longer-lived beneficiaries who are more likely to need long-term care and become Medicaid eligible.
DISCUSSION: Because the distribution of the incremental costs varies over time and between insurance programs, when interventions occur and the effect on the disease course will have implications for how much and which program reaps the benefits.
%B Alzheimer's & Dementia %G eng %R 10.1002/alz.12657 %0 Journal Article %J Journal of Aging and Health %D Forthcoming %T Race-Ethnic Differences in the Effects of COVID-19 on the Work, Stress, and Financial Outcomes of Older Adults. %A Jason, Kendra %A Carr, Dawn %A Chen, Zhao %K COVID-19 %K financial %K psychological resilience %K race %K Stress %XOBJECTIVES: This study investigates race-ethnic differences among older non-Hispanic Black, non-Hispanic White, and Hispanic adults' financial, employment, and stress consequences of COVID-19.
METHODS: We use data from the Health and Retirement Study, including the 2020 COVID-panel, to evaluate a sample of 2,929 adults using a combination of bivariate tests, OLS regression analysis, and moderation tests.
RESULTS: Hispanic and non-Hispanic Black older adults experienced more financial hardships, higher levels of COVID-19 stress, and higher rates of job loss associated with COVID-19 relative to their Non-Hispanic White counterparts. Non-Hispanic Black and Hispanic adults reported significantly higher levels of COVID-19 resilience resources, yet, these resources were not protective of the consequences of COVID-19.
DISCUSSION: Understanding how the experiences of managing and coping with COVID-19 stressors differ by race-ethnicity can better inform intervention design and support services.
%B Journal of Aging and Health %G eng %R 10.1177/08982643231159705 %0 Journal Article %J Psychosom Med %D Forthcoming %T Short sleep and insomnia are associated with accelerated epigenetic age. %A Kusters, Cynthia D J %A Klopack, Eric T %A Crimmins, Eileen M %A Seeman, Teresa E %A Cole, Steve %A Carroll, Judith E %K Epigenetic Age %K insomnia %K short sleep %XOBJECTIVE: Short sleep and insomnia are each associated with greater risk for age-related disease, which suggests that insufficient sleep may accelerate biological aging. We examine whether short sleep and insomnia alone or together relate to epigenetic age among older adults.
METHODS: A total of 3,795 men (46.3%) and women aged 56-100 years from the Health and Retirement Study were included. Insomnia was defined as reporting at least one insomnia symptom (difficulty falling asleep, waking up at night, or waking up too early in the morning) and feeling unrested when waking up most of the time. Those reporting <6 hours of bedtime were categorized as short sleepers. Three second- or third-generation epigenetic age acceleration clocks were derived from the 2016 HRS Venous Blood Study. The linear regression analysis was adjusted for age, sex, race/ethnicity, education, and obesity status.
RESULTS: Insomnia and short sleep were associated with an 0.49 (95%CI:0.03-0.94; P:0.04) and 1.29 (95%CI:0.52-2.07; P:0.002) years acceleration of GrimAge, respectively, as well as a faster pace of aging (DunedinPACE; 0.018 (95%CI:0.004-0.033; P:0.02); 0.022(95%CI:-0.004-0.048; P:0.11)). Compared to healthy sleepers, individuals with the combination of short sleep and insomnia had an accelerated GrimAge (0.97 years; 95%CI:0.07-1.87; P:0.04) and a greater DunedinPACE (0.032; 95%CI:0.003-0.060; P:0.04).
CONCLUSION: Our findings indicate short sleep, insomnia, and the combination of the two, are linked to epigenetic age acceleration, suggesting that these individuals have an older biological age that may contribute to risk for comorbidity and mortality.
%B Psychosom Med %G eng %R 10.1097/PSY.0000000000001243 %0 Journal Article %J Alzheimers & dementia: the journal of the Alzheimer's Association %D Forthcoming %T Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study. %A Torres, Jacqueline M %A Flores Romero, Karla Renata %A Kotwal, Ashwin A %A Chen, Ruijia %A Hill-Jarrett, Tanisha %A Mitchell, Uchechi A %A Glymour, Medellena Maria %K Dementia %K Epidemiology %K Family %K health equity %K mild cognitive impairment %K Spouses %XBACKGROUND: Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia.
METHODS: Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults ≥ 50 years old co-residing with a spouse with probable CI/dementia. We described their socio-demographic and health characteristics and quantified socio-demographic inequities.
RESULTS: Among community-dwelling adults ≥ 50 years old, 6% of women and 4% of men co-resided with a spouse with probable CI/dementia. Among those who were married/partnered, the prevalence of spousal dementia was greater for Black and Hispanic adults compared to their White counterparts, and for those with lower versus higher educational attainment. Among spouses, activities of daily living disability, depression, and past 2-year hospitalization was common.
DISCUSSION: Millions of older adults, disproportionately Black and Hispanic people and people with lower levels of educational attainment, live with a spouse with CI while also facing their own major health challenges.
%B Alzheimers & dementia: the journal of the Alzheimer's Association %G eng %R 10.1002/alz.13555 %0 Journal Article %J health services research %D Forthcoming %T State home and community-based services expenditures and unmet care needs in the United States: Has everyone benefitted equally? %A Yang, Yulin %A Lee, Ah-Reum %A Rapp, Thomas %A Chen, Ruijia %A Glymour, M Maria %A Torres, Jacqueline M %K aging/elderly/geriatrics %K long term care %K Medicaid %K Social determinants of health %XOBJECTIVE: To test whether the impacts of Medicaid's Home and Community-Based Services (HCBS) expenditures have been equitable.
DATA SOURCES AND STUDY SETTING: This is a secondary data analysis. We linked annual data on state-level Medicaid HCBS expenditures with individual data from U.S. Health and Retirement Study (HRS; 2006-2016).
STUDY DESIGN: We evaluated the association between state-level HCBS expenditure quartiles and the risk of experiencing challenges in basic or instrumental activities of daily living (I/ADLs) without assistance (unmet needs for care). We fitted generalized estimating equations (GEE) with a Poisson distribution, log link function, and an unstructured covariance matrix. We controlled demographics, time, and place-based fixed effects and estimated models stratified by race and ethnicity, gender, and urbanicity. We tested the robustness of results with negative controls.
DATA COLLECTION/EXTRACTION METHODS: Our analytic sample included HRS Medicaid beneficiaries, aged 55+, who had difficulty with ≥1 I/ADL (n = 2607 unique respondents contributing 4719 person-wave observations).
PRINCIPAL FINDINGS: Among adults with IADL difficulty, higher quartiles of HCBS expenditure (vs. the lowest quartile) were associated with a lower overall prevalence of unmet needs for care (e.g., Prevalence Ratio [PR], Q4 vs. Q1: 0.91, 95% CI: 0.84-0.98). This protective association was concentrated among non-Hispanic white respondents (Q4 vs. Q1: 0.82, 95% CI: 0.73-0.93); estimates were imprecise for Hispanic individuals and largely null for non-Hispanic Black participants. We found no evidence of heterogeneity by gender or urbanicity. Negative control robustness checks indicated that higher quartiles of HCBS expenditure were not associated with (1) the risk of reporting I/ADL difficulty among 55+ Medicaid beneficiaries, and (2) the risk of unmet care needs among non-Medicaid beneficiaries.
CONCLUSION: The returns to higher state-level HCBS expenditures under Medicaid for older adults with I/ADL disability do not appear to have been equitable by race and ethnicity.
%B health services research %G eng %R 10.1111/1475-6773.14269 %0 Journal Article %J Aging & Mental Health %D Forthcoming %T Telehealth uptake among middle-aged and older Americans during COVID-19: chronic conditions, social media communication, and race/ethnicity. %A Choi, Shinae L %A Hites, Lisle %A Bolland, Anneliese C %A Lee, Jiyoung %A Payne-Foster, Pamela %A Bissell, Kimberly %K Comorbidity %K COVID-19 %K midlife %K Race/ethnicity %K social media communication %K telehealth %XOBJECTIVES: This study investigated whether and to what extent constructs of the protection motivation theory of health (PMT)-threat appraisal (perceived vulnerability/severity) and coping appraisal (response efficacy and self-efficacy)-are related to telehealth engagement during the COVID-19 pandemic, and how these associations differ by race/ethnicity among middle-aged and older Americans.
METHODS: Data were from the 2020 Health and Retirement Study. Multivariable ordinary least-squares regression analyses were computed adjusting for health and sociodemographic factors.
RESULTS: Some PMT constructs are useful in understanding telehealth uptake. Perceived vulnerability/severity, particularly comorbidity ( = 0.13, 95% confidence interval (CI) [0.11, 0.15], < 0.001), and response efficacy, particularly participation in communication via social media ( = 0.24, 95% CI [0.21, 0.27], < 0.001), were significantly and positively associated with higher telehealth uptake during the COVID-19 pandemic among middle-aged and older Americans. Non-Hispanic Black adults were more likely to engage in telehealth during the pandemic than their non-Hispanic White counterparts ( = 0.20, 95% CI [0.12, 0.28], < 0.001). Multiple moderation analyses revealed the significant association between comorbidity and telehealth uptake was similar across racial/ethnic groups, whereas the significant association between social media communication and telehealth uptake varied by race/ethnicity. Specifically, the association was significantly less pronounced for Hispanic adults ( = -0.11, 95% CI [-0.19, -0.04], < 0.01) and non-Hispanic Asian/other races adults ( = -0.13, 95% CI [-0.26, -0.01], < 0.05) than it was for their non-Hispanic White counterparts.
CONCLUSION: Results suggest the potential of using social media and telehealth to narrow health disparities, particularly serving as a bridge for members of underserved communities to telehealth uptake.
%B Aging & Mental Health %G eng %R 10.1080/13607863.2022.2149696 %0 Journal Article %J International Journal of Obesity %D Forthcoming %T The weight of childhood adversity: evidence that childhood adversity moderates the impact of genetic risk on waist circumference in adulthood. %A Cuevas, Adolfo G %A Mann, Frank D %A Krueger, Robert F %K Genetics %K Risk Factors %K weight %XOBJECTIVE: The present study tested the interactive effects of childhood adversity and polygenic risk scores for waist circumference (PRS-WC) on waist circumference (WC). Consistent with a diathesis-stress model, we hypothesize that the relationship between PRS-WC and WC will be magnified by increasing levels of childhood adversity.
METHODS: Observational study of 7976 adults (6347 European Americans and 1629 African Americans) in the Health and Retirement Study with genotyped data. PRS-WC were calculated by the HRS administrative core using the weighted sum of risk alleles based on a genome-wide association study conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium. Childhood adversity was operationalized using a sum score of three traumatic events that occurred before the age of 18 years.
RESULTS: There was a statistically significant interaction between PRS-WC and childhood adversity for European Americans, whereby the magnitude of PRS-WC predicting WC increased as the number of adverse events increased.
CONCLUSIONS: This study supports the idea of the interactive effects of genetic risks and childhood adversity on obesity. More epidemiological studies, particularly with understudied populations, are needed to better understand the roles that genetics and childhood adversity play on the development and progression of obesity.
%B International Journal of Obesity %G eng %R 10.1038/s41366-022-01191-3 %0 Journal Article %J Heliyon %D 2024 %T Association of perceived discrimination with the risk of depression among US older adults: A prospective population-based cohort study. %A Wang, Yaping %A Liao, Jiaojiao %A Chen, Hongguang %A Tao, Liyuan %A Liu, Jue %K depression %K Dose-response relationship %K Older Adults %K Perceived Discrimination %XAIMS: Association between perceived discrimination and depression has been demonstrated in some sources of discrimination, such as age, sex, and race. However, the effects of perceived discrimination both in any domain and each domain on development of depression are still unclear. We aimed to estimate the association of any and each domain of perceived discrimination with the risk of depression among US older adults.
METHODS: We did a population-based cohort study using eight waves (from 2006 to 2020) of data from the Health and Retirement Study (HRS), a nationally representative study of US older adults aged 51 years and above. Perceived discrimination was measured by the shortened 5-item version of Williams' discrimination scale, including five domains (less courtesy, service setting, not smart, threatened or harassed, and medical setting). Depressive symptoms were assessed with shortened 8-item version of the Center for Epidemiological Depression scale (8-item CES-D). Cox proportional hazards models were used to estimate the crude and adjusted hazards ratio (HRs) and their 95 % confidence intervals (CIs) between perceived discrimination and risk of depression, after controlling for potential confounders.
RESULTS: A total of 18502 participants were included in our final analyses. 42.8 % of them had any perceived discrimination at baseline, and the most prevalent perceived discrimination was feeling less courtesy, which was observed in 5893 people (31.6 %). During a median of 9.8 years follow-up, 44.7 % of participants developed depression. The risk of depression was 46 % (adjusted HR: 1.46, 95 % CI: 1.39-1.52) higher among people with perceived discrimination than those without. The associations between perceived discrimination in each domain and risk of depression were all prominent.
CONCLUSIONS: Both any and each domain of perceived discrimination were associated with an increased risk of depression. Considering the high prevalence of perceived discrimination and the following poor health outcomes, our findings suggested the integrated measures of providing public education and diversified communication to reduce discrimination, as well as accessible emotional supports to prevent depression are urgently needed.
%B Heliyon %V 10 %P e23843 %G eng %N 1 %R 10.1016/j.heliyon.2023.e23843 %0 Journal Article %J Neurology %D 2024 %T Associations of Everyday and Lifetime Experiences of Discrimination With Willingness to Undergo Alzheimer Disease Predictive Testing. %A Hill-Jarrett, Tanisha G %A Choi, Minhyuk %A Buto, Peter T %A Miramontes, Silvia %A Thomas, Marilyn D %A Yang, Yulin %A Kim, Min Hee %A Sims, Kendra D %A Glymour, M Maria %K Alzheimer disease %K Logistic Models %K Odds Ratio %K Propensity Score %K Retirement %XBACKGROUND AND OBJECTIVES: Rapid developments in Alzheimer disease (AD) biomarker research suggest that predictive testing may become widely available. To ensure equal access to AD predictive testing, it is important to understand factors that affect testing interest. Discrimination may influence attitudes toward AD testing, particularly among racially and ethnically minoritized populations, because of structural racism in health care systems. This study examined whether everyday or lifetime discrimination experiences shape interest in AD predictive testing.
METHODS: In the 2010 and 2012 biennial Health and Retirement Study waves, respondents were randomly selected to complete questions on interest in receiving free testing that could determine whether they would develop AD in the future. The exposures were everyday discrimination (6 items) and lifetime discrimination (7 items); both were transformed into a binary variable. Logistic regression models predicting interest in AD testing were controlled for deciles of propensity scores for each discrimination measure. Odds ratios were re-expressed as risk differences (RDs).
RESULTS: Our analytic sample included 1,499 respondents. The mean age was 67 (SD = 10.2) years, 57.4% were women, 65.7% were White, and 80% endorsed interest in AD predictive testing. Most of the participants (54.7%) experienced everyday discrimination in at least one domain; 24.1% experienced major lifetime discrimination in at least one domain. Those interested in predictive testing were younger (66 vs 70 years) and more likely to be Black (20% vs 15%) or Latinx (14% vs 8%) than participants uninterested in testing. The probability of wanting an AD test was not associated with discrimination for Black (RD everyday discrimination = -0.026; 95% CI [-0.081 to 0.029]; RD lifetime discrimination = -0.012; 95% CI [-0.085 to 0.063]) or Latinx (RD everyday discrimination = -0.023, 95% CI [-0.082 to 0.039]; RD lifetime discrimination = -0.011; 95% CI [-0.087 to 0.064]) participants.
DISCUSSION: Despite historical and contemporary experiences of discrimination, Black and Latinx individuals express interest in AD testing. However, Black and Latinx individuals remain underrepresented in AD research, including research on AD testing. Interest in personalized information about dementia risk may be a pathway to enhance their inclusion in research and clinical trials.
%B Neurology %V 102 %P e208005 %G eng %N 4 %R 10.1212/WNL.0000000000208005 %0 Journal Article %J NPJ Aging %D 2024 %T Cost of care for Alzheimer's disease and related dementias in the United States: 2016 to 2060. %A Nandi, Arindam %A Counts, Nathaniel %A Bröker, Janina %A Malik, Sabrina %A Chen, Simiao %A Han, Rachael %A Klusty, Jessica %A Seligman, Benjamin %A Tortorice, Daniel %A Vigo, Daniel %A Bloom, David E %K Alzheimer %K cost %K Dementia %K Health Care %K health policy %XMedical and long-term care for Alzheimer's disease and related dementias (ADRDs) can impose a large economic burden on individuals and societies. We estimated the per capita cost of ADRDs care in the in the United States in 2016 and projected future aggregate care costs during 2020-2060. Based on a previously published methodology, we used U.S. Health and Retirement Survey (2010-2016) longitudinal data to estimate formal and informal care costs. In 2016, the estimated per patient cost of formal care was $28,078 (95% confidence interval [CI]: $25,893-$30,433), and informal care cost valued in terms of replacement cost and forgone wages was $36,667 ($34,025-$39,473) and $15,792 ($12,980-$18,713), respectively. Aggregate formal care cost and formal plus informal care cost using replacement cost and forgone wage methods were $196 billion (95% uncertainty range [UR]: $179-$213 billion), $450 billion ($424-$478 billion), and $305 billion ($278-$333 billion), respectively, in 2020. These were projected to increase to $1.4 trillion ($837 billion-$2.2 trillion), $3.3 trillion ($1.9-$5.1 trillion), and $2.2 trillion ($1.3-$3.5 trillion), respectively, in 2060.
%B NPJ Aging %V 10 %P 13 %G eng %N 1 %R 10.1038/s41514-024-00136-6 %0 Journal Article %J Heliyon %D 2024 %T Development of a diverse osteoporosis screening tool for older US adults from the health and retirement study. %A Gough Courtney, Margaret %A Roberts, Josephine %A Godde, K %K Bone density %K disease screening %K Equity %XExisting osteoporosis screening tools have limitations, including using race as a predictor, and development on homogeneous samples. This biases risk assessment of osteoporosis in diverse populations and increases health inequities. We develop a tool that relies on variables easily learned during point-of-care, known by individuals, and with negligible racial bias. Data from the 2012-2016 waves of the population-based cohort Health and Retirement Study (HRS) were used to build a predictive model of osteoporosis diagnosis on a 75 % training sample of adults ages 50-90. The model was validated on a 25 % holdout sample and a cross-sectional sample of American individuals ages 50-80 from the National Health and Nutrition Examination Survey (NHANES). Sensitivity and specificity were compared across sex and race/ethnicity. The model has high sensitivity in the HRS holdout sample (89.9 %), which holds for those identifying as female and across racial/ethnic groups. Specificity is 57.9 %, and area under the curve (AUC) is approximately 0.81. Validation in the NHANES sample using empirically measured osteoporosis produced relatively good values of sensitivity, specificity, and consistency across groups. The model was used to create a publicly-available, open-source tool called the Osteoporosis Health Equality (& Equity) Evaluation (OsteoHEE). The model provided high sensitivity for osteoporosis diagnosis, with consistently high results for those identifying as female, and across racial/ethnic groups. Use of this tool is expected to improve equity in screening and increase access to bone density scans for those at risk of osteoporosis. Validation on alternative samples is encouraged.
%B Heliyon %V 10 %P e23806 %G eng %N 1 %R 10.1016/j.heliyon.2023.e23806 %0 Journal Article %J American Journal of Human Biology %D 2024 %T Dried blood spot based biomarkers in the Health and Retirement Study: 2006 to 2016. %A Jung K Kim %A Faul, Jessica %A Weir, David R %A Crimmins, Eileen M %K Biomarkers %K C-reactive protein %K Cystatin C %K Dried Blood Spot Testing %K Retirement %XINTRODUCTION: The Health and Retirement Study (HRS) has collected biomarker data over multiple waves. Such data can help improve our understanding of health changes in individuals and the causal pathways related to health. There are, however, technical challenges to using the HRS dried blood spots (DBS) biomarker data due to changes over time in assay protocols, platforms, and laboratories. We provide technical and summary information on biological indicators collected as part of the HRS from 2006 to 2016 that should be helpful to users of the data.
METHODS: We describe the opportunities and challenges provided by the HRS DBS data as well as insights provided by the data. The HRS collected DBS from its nationally representative sample of respondents 51 years of age or older from 2006 to 2016. DBS-based biomarkers were collected from half the sample in 2006, 2010, and 2014, and from the other half of the sample in 2008, 2012, and 2016. These DBS specimens were used to assay total and HDL cholesterol, glycosylated hemoglobin, C-reactive protein, and cystatin C from 2006 to 2016, and Interleukin 6 was added in 2014/2016. Samples included approximately 6000 individuals at each wave, and completion rates ranged from 81% to 90%. HRS transformed DBS values into venous blood equivalents to make them more comparable to those of the whole blood-based assays collected in most other studies and to facilitate longitudinal analysis.
RESULTS: Distribution of changes over time by age shows that total cholesterol levels decreased for each age, while HbA1c levels increased. Cystatin C shows a clear age gradient, but a number of other markers do not. Non-Hispanic Black persons and Hispanic respondents have a higher incidence of risk levels of each biomarker except for CRP among non-Hispanic Black older persons.
CONCLUSION: These public-use DBS data provide analysis opportunities that can be used to improve our understanding of health change with age in both populations and among individuals.
%B American Journal of Human Biology %V 36 %P e23997 %G eng %N 2 %R 10.1002/ajhb.23997 %0 Journal Article %J SSM - Population Health %D 2024 %T The embodiment of parental death in early life through accelerated epigenetic aging: Implications for understanding how parental death before 18 shapes age-related health risk among older adults %A Mateo P. Farina %A Eric Klopack %A Debra Umberson %A Eileen Crimmins %K health risks %K Older Adults %K parental death %X Parental death in early life has been linked to various adverse health outcomes in older adulthood. This study extends prior research to evaluate how parental death in early life is tied to accelerated epigenetic aging, a potentially important biological mechanism from which social and environmental exposures impact age-related health. We used data from the 2016 Venous Blood Study (VBS), a component of the Health and Retirement Study (HRS), to examine the association between parental death in early life and accelerated epigenetic aging as measured by three widely used epigenetic clocks (PCPhenoAge, PCGrimAge, and DunedinPACE). We also assessed whether some of the association is explained by differences in educational attainment, depressive symptoms, and smoking behavior. Methods included a series of linear regression models and formal mediation analysis. Findings indicated that parental death in early life is associated with accelerated epigenetic aging for PCPhenoAge and DunedinPACE. The inclusion of educational attainment, depressive symptoms, and smoking behavior attenuated this association, with formal mediation analysis providing additional support for these observations. Parental death in early life may be one of the most difficult experiences an individual may face. The elevated biological risk associated with parental death in early life may operate through immediate changes but also through more downstream risk factors. This study highlights how early life adversity can set in motion biological changes that have lifelong consequences. %B SSM - Population Health %P 101648 %G eng %R https://doi.org/10.1016/j.ssmph.2024.101648 %0 Journal Article %J Aging & mental health %D 2024 %T Involuntary delayed retirement and mental health of older adults. %A Raihan, Mohammad M H %A Chowdhury, Nashit %A Chowdhury, Mohammad Z I %A Turin, Tanvir C %K Great Recession %K involuntary delayed retirement %K Mental Health %K Older Adults %XOBJECTIVE: This study examined the association of multiple mental health measures with involuntary delayed retirement (IDR) in working older adults (≥ 65 years) in the USA.
METHODS: Data were derived from the Health and Retirement Study, focusing on two combined waves of working older adults in 2010 and 2012. IDR was measured as the desire to stop working but the inability to do so due to financial constraints. In addition, mental health outcomes included depression, anxiety, anger-in, and anger-out. Using Stata 16.0, primary analyses were conducted for descriptive statistics and multivariable logistic regression. The odds ratios were reported with 95% confidence intervals (CIs).
RESULTS: Older adults who reported IDR were more likely to have depression (OR = 3.20, CI = 1.03-9.88), anxiety (OR = 2.12, CI = 1.00-5.18), and anger-in (OR = 1.71, CI = 1.12-2.60) compared to those who did not report IDR. However, IDR was not significantly associated with anger-out in older adults who worked past the traditional retirement age.
CONCLUSION: The findings suggest that IDR is likely to act as a stressor and affects the mental health of older adults aged 65 and more. Policymakers should pay more attention to helping older adults maintain positive mental health even if they are required to work past retirement age.
%B Aging & mental health %V 28 %P 169-177 %G eng %N 1 %R 10.1080/13607863.2023.2230927 %0 Generic %D 2024 %T Long Term Care Risk For Couples and Singles %A Capatina, Elena %A Hansen, Gary %A Hsu, Minchung %K Household Risk %K InformalCare %K long term care %K Medicaid %K Precautionary Savings %X This paper compares the impact of long term care (LTC) risk on single and married households and studies the roles played by informal care (IC), consumption sharing within households, and Medicaid in insuring this risk. We develop a life-cycle model where individuals face survival and health risk, including the possibility of becoming highly disabled and needing LTC. Households are heterogeneous in various important dimensions including education, productivity, and the age difference between spouses. Health evolves stochasti-cally. Agents make consumption-savings decisions in a framework featuring an LTC state-dependent utility function. We find that household expenditures increase significantly when LTC becomes necessary, but married individuals are well insured against LTC risk due to IC. However, they still hold considerable assets due to the concern for the spouse who might become a widow/widower and can expect much higher LTC costs. IC significantly reduces precautionary savings for middle and high income groups, but interestingly, it encourages asset accumulation among low income groups because it reduces the probability of means-tested Medicaid LTC. %G eng %R 10.13140/RG.2.2.34349.87521 %0 Journal Article %J The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences %D 2024 %T Longitudinal Associations of Neighborhood Social Cohesion With Self-Perceptions of Aging and Loneliness. %A Choi, Eun Young %K Aging %K Humans %K Loneliness %K Residence Characteristics %K Self Concept %K social cohesion %XOBJECTIVES: One's aging experience is structurally embedded in the social aspects of the residential environment. However, it is largely unknown how this upstream contextual factor may shape self-perceptions of aging (SPA) and loneliness, critical aspects of later-life psychological well-being with profound health implications. This study examines the longitudinal association of neighborhood social cohesion with SPA and -loneliness, as well as the potential bidirectional associations between outcomes.
METHODS: This study used 8-year data from the Health and Retirement Study, with an analytic sample of 9,299 U.S. adults aged 50 or older. Latent growth curve models were implemented to assess the associations of baseline neighborhood social cohesion with trajectories of SPA and loneliness. Path analysis was conducted to examine the longitudinal mediation mechanisms connecting neighborhood social cohesion with SPA and loneliness.
RESULTS: Respondents from cohesive neighborhoods at baseline started with and maintained more positive initial SPA over time, but their positive perceptions decreased faster over time. Cohesive neighborhoods were associated with lower levels of loneliness over an 8-year study period, but also with slower rates of decline in loneliness. Path analysis revealed that neighborhood social cohesion indirectly affected SPA and loneliness, via bidirectional mechanisms.
DISCUSSION: This study demonstrates the significant role of environmental factors beyond individual predictors and advocates for the potential of neighborhood environments as a target for interventions to foster positive aging perception and tackle loneliness. Furthermore, it indicates that loneliness and SPA could reciprocally influence each other in the context of neighborhood social cohesion, enriching our understanding of their dynamics.
%B The Journals of Gerontology, Series B, Psychological Sciences and Social Sciences %V 79 %G eng %N 1 %R 10.1093/geronb/gbad148 %0 Journal Article %J Social Science & Medicine %D 2024 %T A national longitudinal dyadic analysis of spousal education and cognitive decline in the United States. %A Liu, Hui %A Chopik, William J %A Shrout, M Rosie %A Wang, Juwen %K Cognitive decline %K dyadic relationships %K Education %K spouse %XEducation plays a significant role in shaping cognitive functioning throughout an individual's life. However, existing research has not adequately explored how the educational attainment of the spouse can impact cognitive functioning over time. This study presents one of the first longitudinal analyses of how spousal education is linked to cognitive trajectories of each member within couples during their later life in the United States. Guided by the linked lives perspective, we analyze data from 8370 couples in the Health and Retirement Study spanning from 2000 to 2018. Results from the Actor-Partner Interdependence Model (APIM) integrated with latent growth curve models reveal that cognitive trajectories exhibit a correlation between spouses over time. Moreover, our analysis uncovers gender-specific effects of spousal education on cognition, shedding light on the underlying mechanisms driving this connection. Notably, the lower educational attainment of husbands is associated with a faster cognitive decline in both themselves and their wives. This association is partially explained by economic resources, but not by health and social behaviors. The lower educational attainment of wives is linked to their own faster cognitive decline as well as lower initial cognitive levels of their husbands, in part via economic resources. However, wives' educational attainment is largely unrelated to their husbands' cognitive decline. Intriguingly, wives' education has a more pronounced impact on the health and social behaviors of their husbands than vice versa, although these health and social behaviors do not appear to influence husbands' cognitive decline. In conclusion, these results underscore the importance of considering spousal education in comprehending the complexities of cognitive decline within dyadic relationships.
%B Social Science & Medicine %V 343 %P 116603 %G eng %R 10.1016/j.socscimed.2024.116603 %0 Web Page %D 2024 %T Newly discovered genetic mutation protects against Parkinson's disease and offers hope for new therapies %A University of Southern California %K genes %K genetic mutation %K Parkinson Disease %I Leonard Davis School of Gerontology, University of Southern California %G eng %U https://gero.usc.edu/2024/01/02/newly-discovered-genetic-mutation-protects-against-parkinsons-disease-and-offers-hope-for-new-therapies/#:~:text=The%20variant%2C%20located%20in%20a,who%20do%20not%20carry%20it. %0 Journal Article %J Frontiers in Public Health %D 2024 %T Perceived neighborhood disorder and type 2 diabetes disparities in Hispanic, Black, and White Americans. %A Yu, Min Ying %A Velasquez, Alfredo J %A Campos, Belinda %A Robinette, Jennifer W %K Adult %K Aged %K Diabetes Mellitus, Type 2 %K ethnicity %K Hispanic or Latino %K Humans %K Middle Aged %K United States %K White %K White People %XINTRODUCTION: Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across racial/ethnic groups both in reporting rates of neighborhood disorder and in the extent to which neighborhood disorder is interpreted as posing a threat to health and well-being.
METHODS: Using 2016-2018 Health and Retirement Study data (n = 10,419, mean age = 67 years), a representative sample of older US adults, this study examined the possibility of racial/ethnic differences in associations between perceived neighborhood disorder and type 2 diabetes risk. Participants reported their perceptions of neighborhood disorder and type 2 diabetes status. Weighted logistic regression models predicted type 2 diabetes risk by perceived neighborhood disorder, race/ethnicity, and their interaction.
RESULTS: Non-Hispanic Blacks and Hispanics had higher type 2 diabetes risk; these two groups also reported more disorder in their neighborhoods compared to non-Hispanic Whites. Perceiving more neighborhood disorder was associated with increased type 2 diabetes risk, but the interaction between race/ethnicity and disorder was not significant.
DISCUSSION: Findings from the current study suggest that the negative effects of perceiving neighborhood disorder, a neighborhood-level stressor, extend to increased type 2 diabetes risk.
%B Frontiers in Public Health %V 12 %P 1258348 %G eng %R 10.3389/fpubh.2024.1258348 %0 Journal Article %J Sports Medicine Open %D 2024 %T Physical Activity Participation Decreases the Risk of Depression in Older Adults: The ATHLOS Population-Based Cohort Study. %A Lima, Rodrigo A %A Condominas, Elena %A Sanchez-Niubo, Albert %A Olaya, Beatriz %A Koyanagi, Ai %A de Miquel, Carlota %A Haro, Josep Maria %K Data harmonization %K depression %K Health metric %K KLoSA %K lifestyle behaviors %K Physical activity %K SHARE %XBACKGROUND: To which extent physical activity is associated with depression independent of older adults' physical and cognitive functioning is largely unknown. This cohort study using harmonised data by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies consortium, including over 20 countries, to evaluate the longitudinal association of physical activity (light-to-moderate or vigorous intensity) with depression in older adults (aged ≥ 50 years).
RESULTS: We evaluated 56,818 participants (light-to-moderate models; 52.7% females, age 50-102 years) and 62,656 participants (vigorous models; 52.7% females, age 50-105 years). Compared to never, light-to-moderate or vigorous physical activity was associated with a lower incidence rate ratio (IRR) of depression (light-to-moderate model: once/week: 0.632, 95% CI 0.602-0.663; twice or more/week: 0.488, 95% CI 0.468-0.510; vigorous model: once/week: 0.652, 95% CI 0.623-0.683; twice or more/week: 0.591, 95% CI 0.566-0.616). Physical activity remained associated with depression after adjustment for the healthy ageing scale, which is a scale that incorporated 41 items of physical and cognitive functioning (light-to-moderate model: once/week: 0.787, 95% CI 0.752-0.824; twice or more/week: 0.711, 95% CI 0.682-0.742; vigorous model: once/week: 0.828, 95% CI 0.792-0.866; twice or more/week: 0.820, 95% CI 0.786-0.856).
CONCLUSIONS: Physical activity, of any intensity and weekly frequency, was a strong protective factor against depression, independent of physical and mental functioning. Health policies could stimulate the incorporation of lower physical activity intensity to protect against depression, which might be more feasible at the population level.
%B Sports Medicine Open %V 10 %P 1 %G eng %N 1 %R 10.1186/s40798-023-00664-7 %0 Journal Article %J Physical Therapy %D 2024 %T The Prevalence of Cognitive Impairment Among Medicare Beneficiaries Who Use Outpatient Physical Therapy. %A Miller, Matthew J %A Cenzer, Irena %A Barnes, Deborah E %A Kelley, Amy S %A Covinsky, Kenneth E %K Aged %K Cognitive Dysfunction %K Cross-Sectional Studies %K Dementia %K Female %K Humans %K Male %K Medicare %K Mobility Limitation %K Outpatients %K pain %K Physical Therapy Modalities %K Prevalence %K United States %XOBJECTIVE: The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice.
METHODS: This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) ≤1×/week, and sleep disturbance frequency using multinomial logistic regression.
RESULTS: Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3% (CIND:15.2%, dementia:5.1%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8%, difficulty walking 1 block was 25.9%, difficulty walking several blocks was 20.8%, and no difficulty walking was 16.3%. Additionally, prevalence of cognitive impairment among those with MVPA ≤1×/week was 27.1% and MVPA >1×/week was 14.1%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance.
CONCLUSION: One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity.
IMPACT: Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient's ability to remember and process rehabilitation recommendations.
%B Physical Therapy %V 104 %G eng %N 1 %R 10.1093/ptj/pzad115 %0 Journal Article %J Communications in Statistics: Simulation and Computation %D 2024 %T Regressive class models for machine learning algorithms to predict trajectories of repeated multinomial outcomes: an application to the activity of daily living of elderly data %A Chowdhury, R.I. %A Hasan, M.T. %A Huda, S. %A Sneddon, G. %K Categorical outcomes %K Large complex data %K Machine learning %K Markov chain %K repeated measures %X Due to the advancement of electronic data capturing, the amount of repeated categorical data being collected and stored has increased. This massive amount of data is complex and poses significant statistical challenges in methodology and computation. To analyze such big data, the divide and recombine method is commonly used. First, a large data set is partitioned into subsets, and each subset is analyzed separately. Then, the results are recombined in a manner that produces statistically valid output. However, available literature can only accommodate cross-sectional data. We propose a new simpler approach to analyze large, repeated categorical data using a joint modeling framework. In the proposed method, follow-up time is a natural conditioning variable that allows big data to be divided into subsets. Then, using the relationship between joint, marginal, and conditional probabilities, we can recombine the results in a statistically valid way. Several machine learning algorithms for cross-sectional data are extended for repeated outcomes to predict trajectories using the proposed framework. As an illustration, the proposed methodology is used to analyze repeatedly measured activity of daily living (ADL) data from the Health and Retirement Study (HRS), USA. We also check model performances under multiple machine learning algorithms using bootstrap simulations. %B Communications in Statistics: Simulation and Computation %G eng %R 10.1080/03610918.2024.2311774 %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 %XBACKGROUND: 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 Journal Article %J Canadian Journal of Diabetes %D 2023 %T Age-related differences in T cell subsets and markers of subclinical inflammation in aging are independently associated with type 2 diabetes in the Health and Retirement Study. %A Vivek, Sithara %A Crimmins, Eileen M %A Prizment, Anna E %A Meier, Helen C S %A Ramasubramanian, Ramya %A Barcelo, Helene %A Jessica Faul %A Bharat Thyagarajan %K age-related immune phenotype %K CMV Seropositivity %K Inflammation %K memory T cells %XAIMS: Age-related changes in adaptive immunity and subclinical inflammation are both important risk factors for diabetes in older adults. We evaluated the independent association between T cell subsets, subclinical inflammation, and diabetes risk in the Health and Retirement Study (HRS).
METHODS: We measured 11 T cell subsets, five pro-inflammatory markers, and two anti-inflammatory markers from the 2016 wave of HRS (baseline). Diabetes/prediabetes status was estimated at the 2016, 2018, and 2020 waves of HRS based on levels of blood glucose/HbA1C in plasma or self-reported status. We used survey generalized logit models to evaluate the cross-sectional associations and Cox proportional hazard models to evaluate longitudinal associations.
RESULTS: Among 8540 participants (age 56-107), 27.6% had prevalent type 2 diabetes and 31.1% had prediabetes in the 2016 survey. After adjusting for age, sex, race/ethnicity, education, obesity, smoking, comorbidity index and cytomegalovirus (CMV) seropositivity, individuals with type 2 diabetes had lower naïve T cells and higher memory and terminal effector T cells as compared to normoglycemic individuals. Among 3230 normoglycemic participants at the 2016 survey, the incidence of diabetes was 1.8% over four years of follow up. The baseline percentage of CD4+ effector memory T cells was associated with a lower risk of incident diabetes (HR=0.63; 95% CI [0.49, 0.80], p=0.0003) after adjustment for covariates. Baseline levels of Interleukin-6 (IL-6) was associated with risk of incident diabetes (HR=1.52; 95% CI [1.18, 1.97], p=0.002). The associations between age-related changes in CD4+ effector memory T cells and risk of incident diabetes remained unchanged after adjustment for subclinical inflammation, though adjusting for CD4+ effector memory T cells nullified the association between IL-6 and incident diabetes.
CONCLUSIONS: This study showed that the baseline percentage of CD4+ effector memory T cells was inversely associated with incident diabetes independent of subclinical inflammation, though CD4+ effector memory T cell subsets affected the relationship between IL-6 and incident diabetes. Further studies are needed to confirm and investigate mechanisms by which T cell immunity affects diabetes risk.
%B Canadian Journal of Diabetes %V 47 %P 594-602.e6 %G eng %N 7 %R 10.1016/j.jcjd.2023.05.010 %0 Journal Article %J Aging Ment Health %D 2023 %T Aging alone and financial insecurity predict depression: a path analysis of objective and subjective indices. %A Choi, Shinae L %A Choi, Jaimie M %A McDonough, Ian M %A Jiang, Zhehan %A Black, Sheila R %K Depressive symptoms %K financial insecurity %K Living Alone %K social isolation %K Social Support %XOBJECTIVES: This study draws on conservation of resources theory and transactional stress theory to guide our understanding of how social isolation, financial insecurity, and social support serve as a balance of both risk and protection for late-life depression.
METHODS: Data were from the Leave-Behind Questionnaire in the 2016 ( = 4293) and 2018 ( = 4714) waves of the Health and Retirement Study. We conducted a cross-sectional path analysis via structural equation modeling, including objective and subjective perspectives. The same model was tested in both samples.
RESULTS: Both social isolation and financial insecurity were associated with depression. We found several mediating risks and protective factors of these relationships. Objective financial status affected depression through both perceived financial insecurity and perceived social isolation, whereas objective isolation affected depression through perceived social support. This mediation model was -significant after adjusting for confounders.
CONCLUSION: This study underscores the importance of investigating the balance between risk and protection for depression, in the rising number of older adults aging alone in society. Findings suggest that objective and perceived measures offer unique windows into psychological constructs. Considering both objective and subjective perspectives may provide alternative targets for subsequent interventions to improve mental health in later life.
%B Aging Ment Health %P 1-10 %G eng %R 10.1080/13607863.2023.2243446 %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 %XOBJECTIVES: 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 Gerontologist %D 2023 %T Alcohol Use and Mortality among Older Couples in the United States: Evidence of Individual and Partner Effects. %A Birditt, Kira %A Turkelson, Angela %A Polenick, Courtney A %A Cranford, James A %A Smith, Jennifer A %A Ware, Erin B %A Blow, Frederic C %XBACKGROUND: Spouses with concordant (i.e., similar) drinking behaviors often report better quality marriages and are married longer compared to those who report discordant drinking behaviors. Less is known regarding whether concordant or discordant patterns have implications for health, as couples grow older. The present study examined whether drinking patterns among older couples are associated with mortality over time.
METHODS: The Health and Retirement Study (HRS) is a nationally representative sample of individuals and their partners (married/cohabiting) over age 50 in the United States, in which participants completed surveys every two years. Participants included 4,656 married/cohabiting different-sex couples (9,312 individuals) who completed at least three waves of the HRS from 1996 to 2016. Participants reported whether they drank alcohol at all in the last three months, and if so, the average amount they drank per week. Mortality data were from 2016.
RESULTS: Analyses revealed concordant drinking spouses (both indicated they drank in the last three months) survived longer than discordant drinking spouses (one partner drinks and other does not) and concordant non-drinking spouses. Analysis of average drinks per week showed a quadratic association with mortality such that light drinking predicted better survival rates among individuals and their partners compared to abstaining and heavy drinking. Further, similar levels of drinking in terms of the amount of drinking was associated with greater survival, particularly among wives.
CONCLUSIONS: This study moves the field forward by showing that survival varies as a function of one's own and one's partner's drinking.
%B Gerontologist %8 2023 Jul 24 %G eng %R 10.1093/geront/gnad101 %0 Journal Article %J Alzheimer's & Dementia %D 2023 %T Alzheimer's disease medication use and adherence patterns by race and ethnicity. %A Olchanski, Natalia %A Daly, Allan T %A Zhu, Yingying %A Breslau, Rachel %A Cohen, Joshua T %A Neumann, Peter J %A Jessica Faul %A Fillit, Howard M %A Freund, Karen M %A Lin, Pei-Jung %K acetylcholinesterase inhibitors %K Alzheimer's disease %K anti-dementia medication %K Cognitive health %K Dementia %K Health Disparities %K Medicaid %K Medicare %XBACKGROUND: We examined racial and ethnic differences in medication use for a representative US population of patients with Alzheimer's disease and related dementias (ADRD).
METHODS: We examined cholinesterase inhibitors and memantine initiation, non-adherence, and discontinuation by race and ethnicity, using data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims.
RESULTS: Among newly diagnosed ADRD patients (n = 1299), 26% filled an ADRD prescription ≤90 days and 36% ≤365 days after diagnosis. Among individuals initiating ADRD-targeted treatment (n = 1343), 44% were non-adherent and 24% discontinued the medication during the year after treatment initiation. Non-Hispanic Blacks were more likely than Whites to not adhere to ADRD medication therapy (odds ratio: 1.50 [95% confidence interval: 1.07-2.09]).
DISCUSSION: Initiation of ADRD-targeted medications did not vary by ethnoracial group, but non-Hispanic Blacks had lower adherence than Whites. ADRD medication non-adherence and discontinuation were substantial and may relate to cost and access to care.
HIGHLIGHTS: Initiation of anti-dementia medications among newly diagnosed Alzheimer's disease and related dementias (ADRD) patients was low in all ethnoracial groups. ADRD medication non-adherence and discontinuation were substantial and may relate to cost and access to care. Compared to Whites, Blacks and Hispanics had lower use, poorer treatment adherence, and more frequent discontinuation of ADRD medication, but when controlling for disease severity and socioeconomic factors, racial disparities diminish. Our findings demonstrate the importance of adjusting for socioeconomic characteristics and disease severity when studying medication use and adherence in ADRD patients.
%B Alzheimer's & Dementia %G eng %R 10.1002/alz.12753 %0 Journal Article %J Asian American Journal of Psychology %D 2023 %T Antecedents of Rowe and Kahn’s successful aging model for Asian Americans. %A Leong, Frederick T. L. %A William J. Chopik %A Somaraju, Ajay V. %A Kuang, Sarah %K Asian Americans %K Successful aging %X The present study evaluated the antecedents of the successful aging model for Asian Americans. Current knowledge on Asian American aging is minimal, and research suggests many reasons to expect aging for Asian Americans to be different from what is often proposed in Eurocentric models of aging. However, due to a lack of large-scale panel data, few of these processes linking individual and social characteristics to successful aging have been empirically tested. An illustrative analysis of the successful aging model is presented using the few Asian Americans recruited in the Health and Retirement Study (N = 29,095; N = 466 Asian Americans; Mage = 60.87, SD = 11.53; 55.4% female). The present study tested the associations between predictors and outcomes of successful aging across two cultural subgroups (i.e., White and Asian American older adults). Asian Americans do not derive emotional and health benefits in the same fashion and from the same sources as White Americans. The results challenge the idea that Asian Americans age in the same fashion as White Americans. Future directions for research on Asian American aging and a call for more focused attention to the cultural context that shapes successful aging are provided. %B Asian American Journal of Psychology %G eng %R https://doi.org/10.1037/aap0000292 %0 Journal Article %J SSM Popul Health %D 2023 %T Are loneliness and social isolation equal threats to health and well-being? An outcome-wide longitudinal approach. %A Hong, Joanna H %A Nakamura, Julia S %A Berkman, Lisa F %A Chen, Frances S %A Shiba, Koichiro %A Chen, Ying %A Kim, Eric S %A VanderWeele, Tyler J %K health %K Loneliness %K social isolation %K Well-being %XThe detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging tools to create interventions and policies aimed at reducing loneliness and social isolation at scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to improve specific health and well-being outcomes, decision-makers are often unsure whether to target loneliness, social isolation, or both. Filling this knowledge gap will inform the development and refinement of effective interventions. Using data from the Health and Retirement Study (13,752 participants (59% women and 41% men, mean [SD] age = 67 [10] years)), we examined how changes in loneliness and social isolation over a 4-year follow-up period (from t0:2008/2010 to t1:2012/2014) were associated with 32 indicators of physical-, behavioral-, and psychosocial-health outcomes 4-years later (t2:2016/2018). We used multiple logistic-, linear-, and generalized-linear regression models, and adjusted for sociodemographic, personality traits, pre-baseline levels of both exposures (loneliness and social isolation), and all outcomes (t0:2008/2010). We incorporated data from all participants into the overall estimate, regardless of whether their levels of loneliness and social isolation changed from the pre-baseline to baseline waves. After adjusting for a wide range of covariates, we observed that both loneliness and social isolation were associated with several physical health outcomes and health behaviors. However, social isolation was more predictive of mortality risk and loneliness was a stronger predictor of psychological outcomes. Loneliness and social isolation have independent effects on various health and well-being outcomes and thus constitute distinct targets for interventions aimed at improving population health and well-being.
%B SSM Popul Health %V 23 %P 101459 %G eng %R 10.1016/j.ssmph.2023.101459 %0 Journal Article %J J Manag Care Spec Pharm %D 2023 %T Assessing out-of-pocket expenses and indirect costs for the Alzheimer disease continuum in the United States. %A Monfared, Amir Abbas Tahami %A Hummel, Noemi %A Chandak, Aastha %A Khachatryan, Artak %A Zhang, Quanwu %XThe societal costs of Alzheimer disease (AD) are considerable. Cost data stratified by cost category (direct and indirect) and AD severity in the United States are limited. To describe out-of-pocket (OOP) expenses and indirect costs from unpaid caregiving and work impairment among patients with AD by severity and among patients with mild cognitive impairment (MCI) in a representative sample of the US population. Data from the Health and Retirement Study (HRS) were used. HRS respondents were included if they reported an AD diagnosis or were considered as having MCI based on their cognitive performance. MCI and AD severity staging was performed using a crosswalk from results of the modified Telephone Interview of Cognitive Status to the Mini-Mental State Examination. OOP expenses were assessed along with indirect costs (costs to caregivers from providing unpaid help and costs to employers). Sensitivity analyses were performed by varying assumptions of caregiver employment, missed workdays, and early retirement. Patients with AD were stratified by nursing home status, type of insurance, and income level. All cost calculations applied sampling weights. A total of 18,786 patients were analyzed. Patients with MCI (n = 17,885) and AD (n = 901) were aged 67.8 ± 10.7 and 80.9 ± 9.3 years, were 55.7% and 63.3% female, and were 28.3% and 0.9% employed, respectively. OOP expenses per patient per month increased with AD severity, ranging from $420 in mild to $903 in severe AD but were higher in MCI ($554) than in mild AD. Indirect costs to employers were similar across the AD continuum ($197-$242). Costs from unpaid caregiving generally increased by disease severity, from $72 (MCI) to $1,298 (severe AD). Total OOP and indirect costs increased by disease severity, from $869 (MCI) to $2,398 (severe AD). Sensitivity analysis assuming nonworking caregivers and zero costs to employers decreased the total OOP and indirect costs by 32%-53%. OOP expenses were higher for patients with AD who had private insurance ( < 0.01), had higher incomes ( < 0.01), or were in nursing homes ( < 0.01). Indirect costs to caregivers were lower for patients with AD in nursing homes ($600 vs $1,372, < 0.01). Total indirect costs were higher for patients with AD with lower incomes ($1,498 vs $1,136, < 0.01) and for those not in nursing homes ($1,571 vs $799, < 0.01). This study shows that OOP expenses and indirect costs increase with AD severity, OOP expenses increase with higher income, subscription of private insurance, and nursing home residency, and total indirect costs decrease with higher income and nursing home residency in the United States. This study was financially sponsored by Eisai. Drs Zhang and Tahami are employees of Eisai. Drs Chandak, Khachatryan, and Hummel are employees of Certara; Certara is a paid consultant to Eisai. The views expressed here are those of the authors and are not to be attributed to their respective affiliations. Laura De Benedetti, BSc, provided medical writing support to the manuscript; she is an employee of Certara.
%B J Manag Care Spec Pharm %P 1-13 %G eng %R 10.18553/jmcp.2023.23013 %0 Journal Article %J Intelligence %D 2023 %T The association between intelligence and financial literacy: A conceptual and meta-analytic review %A Zoe Callis %A Paul Gerrans %A Dana L. Walker %A Gilles E. Gignac %K Cognitive Ability %K Comprehension knowledge %K Financial literacy %K Intelligence %K Numeracy %X Financial literacy is positively associated with intelligence, with typically moderate to large effect sizes across studies. The magnitude of the effect, however, has not yet been estimated meta-analytically. Such results suggest financial literacy may be conceptualised as a possible cognitive ability within the Cattel-Horn-Carroll (CHC) model of cognitive abilities. Consequently, we present a psychometric meta-analysis that estimated the true score correlation between cognitive ability and financial literacy. We identified a large, positive correlation with general intelligence (r’ = .62; k = 64, N = 62,194). We also found that financial literacy shared a substantial amount of variance with quantitative knowledge (Gq; via numeracy; r’ = .69; k = 42, N = 35,611), comprehension knowledge (crystallised intelligence; Gc; r’ = .48; k = 14, N = 10,835), and fluid reasoning (fluid intelligence; Gf; r’ = .48; k =20, N = 15,101). Furthermore, meta-analytic structural equation modelling revealed Gq partially mediated the association between cognitive ability (excluding Gq) and financial literacy. Additionally, both Gc and Gq had significant direct effects on financial literacy, whereas the total effect of Gf on financial literacy was fully mediated by a combination of Gc and Gq. While the meta-analyses provide preliminary support for the potential inclusion of financial literacy as primarily a Gc or Gq ability within the CHC taxonomy (rather than Gf), the review revealed that very few studies employed comprehensive cognitive ability measures and/or psychometrically robust financial literacy tests. Consequently, the review highlighted the need for future factor analytic research to evaluate financial literacy as a candidate for inclusion in the CHC taxonomy. %B Intelligence %V 100 %P 101781 %G eng %U https://www.sciencedirect.com/science/article/pii/S0160289623000624 %R https://doi.org/10.1016/j.intell.2023.101781 %0 Journal Article %J Arch Gerontol Geriatr %D 2023 %T The association between subjective cognitive decline and trajectories of objective cognitive decline: Do social relationships matter? %A Pai, Manacy %A Lu, Wentian %A Chen, Miaoqi %A Xue, Baowen %K Cognition %K Cognitive Dysfunction %K Humans %K Interpersonal Relations %K Memory, Episodic %K Neuropsychological tests %XOBJECTIVES: We examine the association between subjective cognitive decline (SCD) and the trajectories of objective cognitive decline (OCD); and the extent to which this association is moderated by social relationships.
METHODS: Data come from waves 10 (2010) through 14 (2018) of the Health and Retirement Study, a nationally representative panel survey of individuals aged 50 and above in the United States. OCD is measured using episodic memory, and overall cognition. SCD is assessed using a baseline measure of self-rated memory. Social relationships are measured by social network size and perceived positive and negative social support. Growth curve models estimate the longitudinal link between SCD and subsequent OCD trajectories and the interactions between SCD and social relationship variables on OCD.
RESULTS: SCD is associated with subsequent OCD. A wider social network and lower perceived negative support are linked to slower decline in memory, and overall cognition. None of the social relationship variables, however, moderate the link between SCD and future OCD.
CONCLUSION: Knowing that SCD is linked to subsequent OCD is useful because at SCD stage, deficits are more manageable relative to those at subsequent stages of OCD. Future work on SCD and OCD should consider additional dimensions of social relationships.
%B Arch Gerontol Geriatr %V 111 %P 104992 %G eng %R 10.1016/j.archger.2023.104992 %0 Journal Article %J Neurology %D 2023 %T Association Between Supplemental Nutrition Assistance Program Use and Memory Decline: Findings From the Health and Retirement Study. %A Lu, Peiyi %A Kezios, Katrina %A Lee, Jongseong %A Calonico, Sebastian %A Wimer, Christopher %A Al Hazzouri, Adina Zeki %K cognitive aging %K government food benefits %K health policy %K SNAP %XBACKGROUND AND OBJECTIVES: Studies on the effect of the Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. We sought to examine the associations between SNAP use and memory decline among SNAP-eligible US older adults.
METHODS: Participants aged 50+ and SNAP-eligible in 1996 from the Health and Retirement Study were included. Participants' SNAP eligibility was constructed using federal criteria. Participants also self-reported whether they used SNAP. Memory function was assessed biennially from 1996 through 2016 using a composite score. To account for pre-existing differences in characteristics between SNAP users and non-users, we modeled the probability of SNAP use using demographic and health covariates. Using linear mixed-effect models, we then modeled trajectories of memory function for SNAP users and non-users using inverse probability (IP) weighting and propensity score (PS) matching techniques. In all models, we accounted for study attrition.
RESULTS: Of the 3,555 SNAP-eligible participants, a total of 15.7% were SNAP users. At baseline, SNAP users had lower socioeconomic status and a greater number of chronic conditions than non-users, and were more likely to be lost to follow-up. Our multivariable IP-weighted models (N=3,555) suggested SNAP users had worse memory scores at baseline but slower rates of memory decline compared with non-users (annual decline rate is -0.038 standardized units [95%CI=-0.044, -0.032] for users and -0.046 [95%CI=-0.049, -0.043] for non-users). Results were slightly stronger from the PS-matched sample (N=1,014) (annual decline rate was -0.046 units [95%CI=-0.050; -0.042] for users and -0.060 units [95%CI=-0.064, -0.056] for non-users). Put in other words, our findings suggested that SNAP users had about 2 fewer years of cognitive aging over a 10-year period compared with non-users.
DISCUSSION: After accounting for pre-existing differences between SNAP users and non-users as well as differential attrition, we find SNAP use to be associated with slower memory function decline.
%B Neurology %G eng %R 10.1212/WNL.0000000000201499 %0 Journal Article %J Innov Aging %D 2023 %T Association of Arts Event Attendance With Cognitive Function Among Older Adults Enrolled in the Health and Retirement Study. %A Ike, John David %A Choi, Hwa Jung %A Cho, Tsai-Chin %A Howell, Joel D %A Kenneth M. Langa %K Arts engagement; Cognition; Community activity; Geriatrics; Humanities %XBACKGROUND AND OBJECTIVES: Among the cognitively impaired, arts engagement is associated with improved neurocognitive symptoms. Less is known about arts engagement as a potentially modifiable lifestyle factor to prevent or slow cognitive decline. Our aim was to evaluate the association between arts event attendance and cognition.
RESEARCH DESIGN AND METHODS: We used data from the 2014 and 2016 waves of the Health and Retirement Study to evaluate the association between arts event attendance and cognition using multivariable linear regressions. Arts event attendance in 2014 was our exposure of interest and included visiting an art museum or art gallery; attending an arts or crafts fair; attending a live performance (concert, play, or reading); and/or going to a movie theater. Cognitive function in 2016 measured on a 27-point scale by the Telephone Interview for Cognitive Status was our main outcome of interest.
RESULTS: Of the 1,149 participants included in the final analysis, 70.7% attended an arts event. The mean baseline cognitive score was higher among those who attended art events (16.8 [standard deviation {}, ±3.8] vs 13.8 [, ±5.0]; < .001). In our multivariable regressions, those who attended arts events in 2014 exhibited higher cognitive scores in 2016 after controlling for demographic, socioeconomic, health, and baseline cognitive covariates (β, 1.07 [95% confidence interval {CI}, 0.50-1.64]; < .001). This association was primarily observed in those with lower baseline cognitive function (β, 1.19 [95% CI, 0.33-2.06]; = .008).
DISCUSSION AND IMPLICATIONS: Arts event attendance may be associated with better cognitive function. Given concerns for residual confounding and reverse causality, this association warrants further study.
%B Innov Aging %V 7 %P igad015 %G eng %N 3 %R 10.1093/geroni/igad015 %0 Journal Article %J PNAS %D 2023 %T Association of cumulative loneliness with all-cause mortality among middle-aged and older adults in the United States, 1996 to 2019. %A Yu, Xuexin %A Cho, Tsai-Chin %A Westrick, Ashly C %A Chen, Chen %A Kenneth M. Langa %A Lindsay C Kobayashi %K cumulative loneliness %K excess death %K Mortality %XLoneliness is a growing public health concern worldwide. We characterized the association between cumulative loneliness and subsequent all-cause mortality, using data from 9,032 participants aged 50+ in the population-based US Health and Retirement Study (HRS) from 1996 to 2019. Loneliness status (yes; no) was measured biennially from 1996 to 2004, and we categorized the experience of cumulative loneliness over the 8-y period as never, one time point, two time points, and ≥three time points. A multivariable-adjusted age-stratified Cox proportional hazards regression model was fitted to examine the association between cumulative loneliness from 1996 to 2004 and all-cause mortality from 2004 to 2019. Excess deaths due to each category of cumulative loneliness were calculated. Compared to those who never reported loneliness from 1996 to 2004, participants experiencing loneliness at one time point, two time points, and ≥three time points respectively had 1.05 (95% CI: 0.96 to 1.15), 1.06 (95% CI: 0.95 to 1.19), and 1.16 (95% CI: 1.02 to 1.33) times higher hazards of mortality from 2004 to 2019 ( trend = 0.01). These results correspond to 106 (95% CI: 68 to 144), 202 (95% CI: 146 to 259), and 288 (95% CI: 233 to 343) excess deaths per 10,000 person-years, for those experiencing loneliness at each of one, two, or ≥three time points from 1996 to 2004. Cumulative loneliness in mid-to-later life may thus be a mortality risk factor with a notable impact on excess mortality. Loneliness may be an important target for interventions to improve life expectancy in the United States.
%B PNAS %V 120 %P e2306819120 %G eng %N 51 %R 10.1073/pnas.2306819120 %0 Journal Article %J JAMA Internal Medicine %D 2023 %T Association of Social Isolation With Hospitalization and Nursing Home Entry Among Community-Dwelling Older Adults. %A Pomeroy, Mary Louise %A Cudjoe, Thomas K M %A Cuellar, Alison E %A Ihara, Emily S %A Ornstein, Katherine A %A Bollens-Lund, Evan %A Kotwal, Ashwin A %A Gimm, Gilbert W %K community dwelling %K health outcomes %K Hospitalization %K Nursing homes %K social isolation %XIMPORTANCE: Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood.
OBJECTIVE: To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms.
DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023.
MAIN OUTCOMES AND MEASURES: Social isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time.
RESULTS: A total of 57% of this study's 11 517 participants were female, 43% were male, 8.4% were Black, 6.7% were Hispanic or Latino, 88.1% were White, 3.5% were other ("other" includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2% were aged 65 to 74 years. Approximately 15% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95% CI, 1.06-1.28) during 2 years. With each point increase in an individual's social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates.
CONCLUSIONS AND RELEVANCE: This cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.
%B JAMA Internal Medicine %V 183 %P 955-962 %G eng %N 9 %R 10.1001/jamainternmed.2023.3064 %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 %XIMPORTANCE: 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 Journal of Pain and Symptom Management %D 2023 %T Associations Between Baseline Pain, Depression, and Caregiving and One-Year Post-Discharge Outcomes Among Seriously Ill Older Adults Admitted for Trauma (Sch411) %A Hiba DhananiScM %A Yihan Wang %A Evan Bollens-Lund %A Amanda Reich %A Amy KelleyMSHS %A Zara Cooper %X {Outcomes 1. Understand how pain, depression, and caregiving in seriously ill trauma patients impacts healthcare utilization costs 1 year after discharge. 2. Conceptualize how palliative care intervention targeting pain, depression, and caregiving in seriously ill trauma patients may improve healthcare outcomes 1-year post discharge. Introduction Many older trauma patients have preexisting serious illness (SI) like dementia, frailty, and organ insufficiency and are candidates for palliative care to improve outcomes and reduce downstream healthcare utilization. However, there are few data about targets for palliative care in these patients. We hypothesized that older SI adults with pain, depression, and caregiving needs before trauma admission have higher 1-year postdischarge healthcare utilization compared to trauma patients without SI. Methods Using data from the Health and Retirement Study (2008-2018) linked to Medicare claims, we identified seriously ill adults over 66 years old and assessed patient characteristics including demographics, comorbidity, baseline pain (none/mild versus moderate/severe), depression (CES-D ≥3) and caregiving needs (≥30 hours/month), as well as hospital characteristics including trauma center designation and palliative care service. Comparisons between pain, depression, caregiving, and SI were reported using chi square tests. Differences in healthcare utilization between groups with palliative care, pain, depression, and caregiving were reported using t-tests. Results The study cohort included 513. Mean age was 82.1 years (SD 8.1), 73.1% were female, and 84.1% were non-Hispanic white. Most (70.5%) were admitted to a trauma center and (88.8%) hospital with a palliative care service. Compared to those without preexisting pain, depression, and caregiving needs, SI older trauma patients with these conditions were less likely to be alive a year after discharge (71.2% vs 81.6% %B Journal of Pain and Symptom Management %V 65 %P e584-e585 %G eng %R https://doi.org/10.1016/j.jpainsymman.2023.02.148 %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 %XBACKGROUND: 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 Investigative Ophthalmology & Visual Science %D 2023 %T Associations Between Diabetes, Visual Difficulty, and Economic Well-Being: A Cross-Sectional Analysis of the Health and Retirement Study %A Grace Chung %A David Flood %A Joshua R Ehrlich %X Purpose : Diabetic retinopathy is the leading non-refractive cause of vision loss in working-age U.S. adults. Prior studies have found that individuals with diabetes have lower levels of economic well-being. Therefore, we tested the hypothesis that adverse economic circumstances in working-age U.S. adults with diabetes are exacerbated among those with visual difficulty. Methods : We used cross-sectional data from the 2016-17 Health and Retirement Study (HRS). Diabetes was defined as self-reported use of glucose-lowering medication or biochemical (glycosylated hemoglobin) evidence of diabetes. Visual difficulty was indicated by self-reported “fair” or “poor” distance vision. Outcome measures included annual income and household wealth. We used generalized linear models with gamma and log links to model these outcomes. Age, gender, race, marital status, education, and difficulty with any activities of daily living were included as covariates. All analyses were weighted with the HRS-provided respondent-level sample weights to make population-representative parameter estimates. Results : Of 10,683 adults aged 40 to 64 with data on vision or diabetes status, 70.7% had no visual difficulty or diabetes, 10.5%, 14.8%, and 4.0% had visual difficulty alone, diabetes alone, and co-occurring visual difficulty and diabetes, respectively. When compared to adults without visual difficulty or diabetes, those with visual difficulty and diabetes had an average marginal decrease of income equal to -$20,827 (95% CI: -24,620, -17,035; p<0.001) and of household wealth equal to -$121,060 (95% CI: -173,738, -68,382; p<0.001). Adults with visual difficulty alone had an average marginal decrease of income equal to -$8,110 (95% CI: -11,543, -4,676; p<0.001) and of household wealth equal to -$63,738 (95% CI: -113,784, -13,691; p=0.013); adults with diabetes alone had an average marginal decrease of income equal to -$4,476 (95% CI: -6,877, -2,074; p<0.001) and of household wealth equal to -$89,315 (95% CI: -113,970, -64,661; p<0.001). Conclusions : Working-age adults with co-occurring visual difficulty and diabetes have fewer financial resources and may be more prone to economic hardship than those with visual difficulty or diabetes alone. Public policies aimed at improving the economic well-being of individuals with multimorbidity should be prioritized. %B Investigative Ophthalmology & Visual Science %G eng %U https://iovs.arvojournals.org/article.aspx?articleid=2789220 %0 Journal Article %J Social Science & Medicine %D 2023 %T Attribution for everyday discrimination typologies and mortality risk among older black adults %A Ryon J. Cobb %A Violeta J. Rodriguez %A Tyson H. Brown %A Patricia Louie %A Heather R. Farmer %A Connor M. Sheehan %A Dawne M. Mouzon %A Roland J. Thorpe %K Psychosocial factors %K Public Health %K race %K Racism %X The present study assessed how attributions of everyday discrimination typologies relate to all-cause mortality risk among older Black adults. Methods This study utilized data from a subsample of older Black adults from the 2006/2008 Health and Retirement Study (HRS). Attributions for everyday discrimination (i.e., ancestry, age, gender, race, physical appearance, physical disability, sexual orientation, weight, and other factors) were based on self-reports, while their vital statuses were obtained from the National Death Index and reports from key informants (spanning 2006–2019). We applied latent class analysis (LCA) to identify subgroups of older Black adults based on their attributions to everyday discrimination. Cox proportional hazards models were used to analyze time to death as a function of LCA group membership and other covariates. Results Based on fit statistics, we selected a four-class model that places respondents into one of the following classes: Class One (7%) attributed everyday discrimination to age, race, and physical disability; Class Two (72%) attributed everyday discrimination to few/no sources, Class Three (19%) attributed everyday discrimination to race and national origin; and Class Four (2%) attributed everyday discrimination to almost every reason. After adjusting for sociodemographic, behavioral, cardiometabolic, and socioeconomic characteristics, we found that the relative risk of death remained higher for the respondents in Class One (Hazard Ratio [H.R.]: 1.80, 95% Confidence Interval [C.I.]: (1.09–2.98) and Class Four (H.R.: 3.92, 95% C.I.: 1.62–9.49) compared to respondents in Class Two. Conclusions Our findings illustrate the utility of using attribution for everyday discrimination typologies in research on the psychosocial dimensions of mortality risk among older Black adults. Future research should assess the mechanisms that undergird the link between everyday discrimination classes and all-cause mortality risk among older Black adults. %B Social Science & Medicine %V 316 %P 115166 %G eng %R https://doi.org/10.1016/j.socscimed.2022.115166 %0 Journal Article %J Social Science and Medicine %D 2023 %T Attribution for everyday discrimination typologies and mortality risk among older black adults: Evidence from the health and retirement study? %A Cobb, Ryon J %A Rodriguez, Violeta J %A Brown, Tyson H %A Louie, Patricia %A Farmer, Heather R %A Sheehan, Connor M %A Mouzon, Dawne M %A Thorpe, Roland J %K Black People %K Disabled Persons %K Minority health %K Perceived Discrimination %K Psychosocial factors %K Public Health %K Retirement %K Social Perception %XBACKGROUND: The present study assessed how attributions of everyday discrimination typologies relate to all-cause mortality risk among older Black adults.
METHODS: This study utilized data from a subsample of older Black adults from the 2006/2008 Health and Retirement Study (HRS). Attributions for everyday discrimination (i.e., ancestry, age, gender, race, physical appearance, physical disability, sexual orientation, weight, and other factors) were based on self-reports, while their vital statuses were obtained from the National Death Index and reports from key informants (spanning 2006-2019). We applied latent class analysis (LCA) to identify subgroups of older Black adults based on their attributions to everyday discrimination. Cox proportional hazards models were used to analyze time to death as a function of LCA group membership and other covariates.
RESULTS: Based on fit statistics, we selected a four-class model that places respondents into one of the following classes: Class One (7%) attributed everyday discrimination to age, race, and physical disability; Class Two (72%) attributed everyday discrimination to few/no sources, Class Three (19%) attributed everyday discrimination to race and national origin; and Class Four (2%) attributed everyday discrimination to almost every reason. After adjusting for sociodemographic, behavioral, multisystem physiological dysregulation, and socioeconomic characteristics, we found that the relative risk of death remained higher for the respondents in Class One (Hazard Ratio [H.R.]: 1.80, 95% Confidence Interval [C.I.]: (1.09-2.98) and Class Four (H.R.: 3.92, 95% C.I.: 1.62-9.49) compared to respondents in Class Two.
CONCLUSIONS: Our findings illustrate the utility of using attribution for everyday discrimination typologies in research on the psychosocial dimensions of mortality risk among older Black adults. Future research should assess the mechanisms that undergird the link between everyday discrimination classes and all-cause mortality risk among older Black adults.
%B Social Science and Medicine %V 316 %P 115166 %G eng %R 10.1016/j.socscimed.2022.115166 %0 Journal Article %J The Gerontologist %D 2023 %T Attributions for Everyday Discrimination and All-Cause Mortality Risk Among Older Black Women: A Latent Class Analysis Approach. %A Erving, Christy L %A Cobb, Ryon J %A Sheehan, Connor %K African Americans %K death index %K Health Disparities %K Intersectionality %K Mortality %K women %XBACKGROUND AND OBJECTIVES: This study examined the relationship between number of attributed reasons for everyday discrimination and all-cause mortality risk, developed latent classes of discrimination attribution, and assessed whether these latent classes were related to all-cause mortality risk among US older Black women.
RESEARCH DESIGN AND METHOD: Participants were from the 2006 and 2008 waves of the Health and Retirement Study (N = 1133; 335 deaths). Vital status was collected through the National Death Index through 2013 and key informant reports through 2019. Latent Class Analyses were conducted on discrimination attributions. Weighted Cox proportional hazards model were used to predict all-cause mortality. Analyses controlled for demographic characteristics, socioeconomic status, and health.
RESULTS: Reporting greater attributions for everyday discrimination was associated with higher mortality risk (HR = 1.117; 95% CI: 1.038 - 1.202; p <.01), controlling for demographic characteristics, socioeconomic status, and health as well as health behaviors. A four-class solution of the Latent Class Analysis specified the following attribution classes: No/Low Attribution; Ancestry/Gender/Race/Age; Age/Physical Disability; High on All Attributions. When compared to the No/Low Attribution class, membership in the High on All Attributions class was associated with greater mortality risk (HR = 2.809; CI: 1.458 - 5.412; p < .01).
DISCUSSION AND IMPLICATIONS: Findings underscore the importance of everyday discrimination experiences from multiple sources in shaping all-cause mortality risk among older Black women. Accordingly, this study problematizes the homogenization of Black women in aging research and suggests the need for health interventions that consider Black women's multiplicity of social statuses.
%B The Gerontologist %V 63 %P 887-899 %G eng %N 5 %R 10.1093/geront/gnac080 %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 %XBACKGROUND: 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 Report %D 2023 %T BMI, waist circumferences and urinary incontinence in older women compared with older men: findings from three prospective longitudinal cohort studies %A Xiyin Chen %A Shaoxiang Jiang %A Yao Yao %K BMI %X Background Obesity and urinary incontinence (UI) among older people, particularly older men, are yet to be fully explored. Utilising multiple nationwide prospective longitudinal cohorts representative of the US, UK, and European samples, we examined the association of body mass index (BMI) and waist circumference (WC) with UI among both older women and men. Methods We derived the data from the Health and Retirement Study (HRS, 2010-2018), the English Longitudinal Study of Aging (ELSA, 2011-2019), and the Survey of Health, Ageing and Retirement in Europe (SHARE, 2004-2010) that surveyed UI. Participants were asked if they had experienced urine leakage within the past 12 months (HRS and ELSA) or within the past six months (SHARE). The measure of obesity was based on BMI and WC. We employed a random-effect logistic model to associate BMI and WC with UI, adjusting for covariates including age, race, education, residence area, marital status, number of children, smoking, drinking, hypertension, diabetes, cancer, stroke, functional ability, and cognitive impairment. We visualised the associations by using restricted cubic spline curves. Findings A total of 200,717 participants with 718,822 observations (207,805 in HRS; 98,158 in ELSA; 412,859 in SHARE) were included in the baseline analysis. The 12-months prevalence of UI among female and male participants were 15.6% and 6.6% in the HRS, 10.6% and 4.4% in the ELSA. The 6-months prevalence of UI were 2.8% and 1.4% in the SHARE’s female and male participants. Compared to those without UI, both female and male participants with UI demonstrated a higher BMI and WC. Among females, the fully adjusted models showed linear associations between BMI, WC, and UI (Ps<0.001) in three cohorts. However, we observed U-shaped associations of BMI, WC with UI among males. The lowest likelihood of having UI was found among male participants with a BMI between 24 and 35 kg/m2 . Interpretation Findings from our study revealed that the associations of obesity indices with UI varied among older men compared to older women. As a result, weight loss interventions could be applied to older women rather than older men as a means of treating UI. Interventions aimed at preventing UI among older adults must take sex into account. %G eng %R https://doi.org/10.21203/rs.3.rs-2441866/v1 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2023 %T Body mass index and cognition: Associations across mid- to late-life and gender differences. %A Crane, Breanna M %A Nichols, Emma %A Carlson, Michelle C %A Deal, Jennifer A %A Gross, Alden L %K Body Mass Index %K Cognition %K Gender Differences %XBACKGROUND: Higher mid-life body mass index (BMI) is associated with lower late-life cognition. Associations between later-life BMI and cognition are less consistent; evidence suggests reverse causation may play a role. We aimed to characterize associations between BMI and cognition across a wide age range during mid- to late-life (55-85 years) and examine whether associations vary by gender.
METHODS: We used data from the Health and Retirement Survey (HRS) (N=39,153) to examine the association between BMI and three cognitive outcomes: cognitive level, cognitive decline, and cognitive impairment. We used a series of linear regression, mixed effects regression, and logistic regression models, adjusting for potential confounders.
RESULTS: Higher BMI before age 65 (mid-life) was associated with lower cognitive performance, faster rates of cognitive decline, and higher odds of cognitive impairment in late-life. Averaging across analyses assessing associations between BMI measured before age 60 and late-life cognition, a 5-unit higher level of BMI was associated with a 0.26 point lower cognitive score. Beyond age 65, associations flipped, and higher BMI was associated with better late-life cognitive outcomes. Associations in both directions were stronger in women. Excluding those with BMI loss attenuated findings among women in older ages, supporting the reverse causation hypothesis.
CONCLUSIONS: In this sample, age 65 represented a critical turning point between mid- and late-life for the association between BMI and cognition, which has important implications for recruitment strategies for studies focused on risk factors for late-life cognitive outcomes. Evidence of gender differences raises the need to further investigate plausible mechanisms.
%B J Gerontol A Biol Sci Med Sci %G eng %R 10.1093/gerona/glad015 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Breast and prostate cancer screening rates by cognitive status in US older adults. %A Schoenborn, Nancy L %A Cidav, Tom %A Boyd, Cynthia M %A Pollack, Craig E %A Sekhon, Vishaldeep Kaur %A Yasar, Sevil %K Aged %K Breast Neoplasms %K Cognition %K Dementia %K Early Detection of Cancer %K Humans %K Male %K Mass Screening %K Medicare %K Prostate-Specific Antigen %K Prostatic Neoplasms %K United States %XINTRODUCTION: For most older adults with dementia, the short-term harms and burdens of routine cancer screening likely outweigh the delayed benefits. We aimed to provide a more updated assessment of the extent that US older adults with dementia receive breast and prostate cancer screenings.
METHODS: Using the Health and Retirement Study (HRS) Wave 12 (2014-2015) linked to Medicare, we examine rates of breast and prostate cancer screenings in adults 65+ years by cognitive status. We used claims data to identify eligibility for screening and receipt of screening. We used a validated method using HRS data to define cognitive status.
RESULTS: The analytic sample included 2439 women in the breast cancer screening cohort and 1846 men in the prostate cancer screening cohort. Average ages were 76.8 years for women and 75.6 years for men, with 9.0% and 7.6% with dementia in each cohort, respectively. Among women with dementia, 12.3% were screened for breast cancer. When stratified by age, 10.6% of those 75+ and have dementia were screened for breast cancer. When stratified by predicted life expectancy, 10.4% of those with predicted life expectancy of <10 years and have dementia were screened for breast cancer. Among men with dementia, 33.9% were screened for prostate cancer. When stratified by age, 30.9% of those 75+ and have dementia were screened for prostate cancer. When stratified by predicted life expectancy, 34.4% of those with predicted life expectancy of <10 years and have dementia were screened for prostate cancer. Using multivariable logistic regression, dementia was associated with lower odds of receiving breast cancer screening (OR 0.36, 95% CI 0.23-0.57) and prostate cancer screening (OR 0.58, 95% CI 0.36-0.96).
DISCUSSION: Our results suggest potential over-screening in older adults with dementia. Better supporting dementia patients and caregivers to make informed cancer screening decisions is critical.
%B J Am Geriatr Soc %V 71 %P 1558-1565 %G eng %N 5 %R 10.1111/jgs.18222 %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 %XINTRODUCTION: 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 %XINTRODUCTION: 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 Human Resource Management Journal %D 2023 %T Change of productivity loss due to presenteeism among the ageing workforce: Role of work support, workplace discrimination, and the work‐nonwork interface %A Yang, Tianan %A Liu, Yexin %A Chen, Zhenjiao %A Deng, Jianwei %K ageing workforce %K cognitive functions %K Presenteeism %K productivity decline %X Presenteeism behaviour (working while one is ill or experiencing cognitive or emotional difficulties) and the consequent productivity loss are attracting growing attention. Without proper support, employees who are under stress or ill are prone to presenteeism, which incurs invisible burdens on organizations. In this study, we focussed on productivity loss due to presenteeism (PRE) among the ageing workforce, because this group may be more vulnerable to productivity loss due to age-related deteriorating cognitive functions and physical abilities. We established a longitudinal latent difference score model over a two-wave period so we could examine whether and how the work–nonwork interface mediates the effects of work support and workplace discrimination (DIS) on PRE. The results showed that the work–nonwork interface fully mediated the positive influence of DIS on PRE as well as the negative influence of supervisor support. %B Human Resource Management Journal %V 33 %G eng %R 10.1111/1748-8583.12475 %0 Report %D 2023 %T Changes in childhood caregiving impressions among middle-aged and older adults %A William J. Chopik %A Jeewon Oh %A Sneha R. Challa %A Hannah L. Hua %A Julia M. Maahs %A Jacqui Smith %K caregiving impressions %K divorce/separation %K Health and Retirement Study %K life span development %K reminiscence bump %X Childhood experiences and impressions are important for individuals' health and well-being—they often set the stage for how people approach relationships across the lifespan and how they make sense of their relational worlds. However, impressions of these experiences are likely not static and can change over time, even years after these experiences happened. The current study examined how impressions of parental relationships in childhood changed over time, and predictors of these changes, among middle-aged and older adults followed over a 4-year period (N = 2692; Mage = 66.67, SD = 9.15; 64.1% women). Childhood impressions of parental care were mostly stable over time, with 53.5%–65.0% of participants reporting consistent impressions. Becoming divorced/separated as an adult was associated with more negative impressions about relationships with fathers in the past. Having a mother pass away was associated with more positive impressions of mothers' caregiving when participants were children. Higher depressive symptoms at follow-up were associated with darker perceptions of the past— more negative impressions of mothers and fathers as caregivers. The current study is one of the most comprehensive studies of late-life changes in childhood impressions to date, suggesting future directions for studying the organization of relational experiences and recollection over time. %G eng %R 10.1111/pere.12499 %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 %XOBJECTIVES: 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 JBMR Plus %D 2023 %T Childhood Family Environment and Osteoporosis in a Population-Based Cohort Study of Middle-to Older-Age Americans. %A Courtney, Margaret Gough %A Roberts, Josephine %A Quintero, Yadira %A Godde, K %K americans %K Childhood %K middle-age %K older-age %K Osteoporosis %XDemographic and early-life socioeconomic and parental investment factors may influence later-life health and development of chronic and progressive diseases, including osteoporosis, a costly condition common among women. The "long arm of childhood" literature links negative early-life exposures to lower socioeconomic attainment and worse adult health. We build on a small literature linking childhood socioeconomic status (SES) and bone health, providing evidence of whether associations exist between lower childhood SES and maternal investment and higher risk of osteoporosis diagnosis. We further examine whether persons identifying with non-White racial/ethnic groups experience underdiagnosis. Data from the nationally representative, population-based cohort Health and Retirement Study ( = 5,490-11,819) were analyzed for participants ages 50-90 to assess these relationships. Using a machine learning algorithm, we estimated seven survey-weighted logit models. Greater maternal investment was linked to lower odds of osteoporosis diagnosis (odds ratio [OR] = 0.80, 95% confidence interval [CI] = 0.69, 0.92), but childhood SES was not (OR = 1.03, 95% CI = 0.94, 1.13). Identifying as Black/African American (OR = 0.56, 95% CI = 0.40, 0.80) was associated with lower odds, and identifying as female (OR = 7.22, 95% CI = 5.54, 9.40) produced higher odds of diagnosis. There were differences in diagnosis across intersectional racial/ethnic and sex identities, after accounting for having a bone density scan, and a model predicting bone density scan receipt demonstrated unequal screening across groups. Greater maternal investment was linked to lower odds of osteoporosis diagnosis, likely reflecting links to life-course accumulation of human capital and childhood nutrition. There is some evidence of underdiagnosis related to bone density scan access. Yet results demonstrated a limited role for the long arm of childhood in later-life osteoporosis diagnosis. Findings suggest that (1) clinicians should consider life-course context when assessing osteoporosis risk and (2) diversity, equity, and inclusivity training for clinicians could improve health equity. © 2023 The Authors. published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
%B JBMR Plus %V 7 %P e10735 %8 2023 May %G eng %N 5 %R 10.1002/jbm4.10735 %0 Journal Article %J Aging Health Res %D 2023 %T Childhood health conditions and insomnia among adults in mid-life. %A Sheehan, Connor %A Cantu, Phillip %A Powell, Danielle %A Tran, Sydney %XBACKGROUND: Little is known regarding the influence of childhood health broadly and childhood health conditions specifically on insomnia throughout adulthood.
METHODS: Health and Retirement Study (HRS) Baby Boomers born 1954-1965 were investigated. We fitted regression models predicting self-reported insomnia based on twenty-three retrospectively reported specific childhood health conditions (e.g., measles) and general childhood health measures and adjusted for demographics, childhood socioeconomic status, and adult socioeconomic status.
RESULTS: Nearly all the measures of childhood health significantly increased insomnia symptoms in adulthood. In a model where all measures were included, we found that respiratory disorders, headaches, stomach problems, and concussions were particularly strong predictors of insomnia.
CONCLUSIONS: Our findings extend past work illustrating the "long arm" of childhood conditions for health, showing that specific health conditions in childhood may indelibly imprint insomnia risk.
%B Aging Health Res %V 3 %8 2023 Mar %G eng %N 1 %R 10.1016/j.ahr.2023.100124 %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 %XIMPORTANCE: 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 Gerontology %D 2023 %T Cognitive Aging in Same- and Different-Sex Relationships: Comparing Age of Diagnosis and Rate of Cognitive Decline in the Health and Retirement Study. %A Hanes, Douglas William %A Clouston, Sean A P %K Alzheimer disease %K bisexual %K Cognition %K cognitive aging %K Cognitive Dysfunction %K Gay %K Lesbian %K Retirement %K same-sex relationship %K sexual orientation %XINTRODUCTION: The ongoing marginalization of lesbian, gay, and bisexual people has been hypothesized to produce poorer late-in-life cognitive outcomes, according to mechanisms posited by minority stress and allostatic load theories. Yet the existence of those outcomes remains understudied, and results of existing studies have been contradictory. Using a population-based longitudinal aging study, this paper will compare age at diagnosis of Alzheimer's disease (AD) or a related dementia and rates of cognitive decline between participants in same-sex relationships (SSRs) and different-sex relationships (DSRs).
METHODS: The study used longitudinal cognitive-health data from the Health and Retirement Study (HRS; 1998-2018; N = 26,344) to analyze the onset of cognitive impairment and AD/dementia and the rates of cognitive change between participants in SSRs and those in DSRs. We hypothesized that SSR participants would have worse overall cognitive functioning in old age and would experience earlier onset of cognitive impairment. Using multiple regression, we compared the ages at which participants in SSRs and DSRs first reported AD or dementia diagnoses and the ages at which they first scored below cutoffs for cognitive impairment, not dementia (CIND) and possible dementia as determined using the cognitive assessment. The study then compared rates of cognitive decline over time across the SSR and DSR groups, including stratified analyses by education, race/ethnicity, wealth, and sex/gender.
RESULTS: Participants in SSRs reported dementia diagnoses (β = -12.346; p = 0.001), crossed the threshold into CIND (β = -8.815; p < 0.001) and possible dementia (β = -13.388; p < 0.001) at a younger age than participants in DSRs. When adjusted for covariates, participants in SSRs also had lower cognition at baseline (β = 0.745; p = 0.003), though having slower rates of cognitive decline when SSR was interacted with time (β = 0.066; p = 0.003). In separate analyses, cognitive differences for SSR participants were only found in participants without undergraduate degrees, with below-median household incomes, and women.
CONCLUSION: Our findings support theories suggesting that marginalization and stigma cause premature cognitive impairment. Findings also suggest that higher education might mitigate the adverse effects of sexuality-minority status on cognitive aging. Results do not support these theories' claims of more rapid cognitive decline; the lower slopes of cognitive decline with time are compatible with the possibility of slower rates of decline for aging individuals in SSRs.
%B Gerontology %V 69 %P 356-369 %G eng %N 3 %R 10.1159/000526922 %0 Journal Article %J Brain, Behavior, and Immunity - Health %D 2023 %T Cohabitation as a determinant of adaptive and innate immune cell profiles: Findings from the Health and Retirement Study. %A Ramasubramanian, Ramya %A Kim, Jae Won %A Guan, Weihua %A Meier, Helen C S %A Crimmins, Eileen %A Jessica Faul %A Bharat Thyagarajan %K cohabition %K Immune System %XINTRODUCTION: Non-genetic factors are important but poorly understood determinants of immune profiles. Age and Cytomegalovirus (CMV) infection remain two well documented non-genetic determinants of the immune profile. Recently, one study identified cohabitation in the same household as an important determinant of immune profiles.
METHODS: We used immunophenotyping data from the Health and Retirement Study (HRS) to evaluate the association between cohabitation and the adaptive (subsets of T-cells, B-cells) and innate immune profiles (subsets of monocytes, natural killer cells and neutrophils). We compared adaptive and innate immune cell profiles using immunophenotyping data from 1184 same-household pairs (cohabitating partners) to 1184 non-household pairs to evaluate the association between cohabitation and adaptive immune cell profiles. We used data from 1737 same-household pairs and 1737 non-household pairs to evaluate the association between cohabitation and innate cell profiles. Household and non-household pairs were matched on age (±2years), educational background and race/ethnicity to minimize confounding due to these factors. The adaptive immune cells and innate immune cell profiles were compressed to two coordinates using multidimensional scaling (MDS). The Euclidean distances between same-household pairs were compared to the distances between non-household pairs for the adaptive and innate cell profiles separately using two sample independent t-tests. We also performed additional adjustment for age and BMI differences, CMV serostatus and smoking concordance/discordance status among household members.
RESULTS: For adaptive immune cell profiles, the mean Euclidean distance between same-household pairs was 4% lower than the non-household pairs (p = 0.03). When stratified by concordance for CMV serostatus among household pairs, the Euclidean distance was significantly lower by 8% in the same-household pairs as compared to non-household pairs among those who were discordant for CMV serostatus (p = 0.01) and among same-household pairs who were CMV seronegative (p = 0.02) after covariate adjustment. The mean Euclidian distance between same-household pairs was also 8% lower than non-household pairs for the innate immune cell profiles (p-value <0.0001) and this difference remained consistent across all strata of CMV infection.
DISCUSSION: This study confirms that cohabitation is associated with similarity in immune cell profiles. The differential effects of cohabitation on the adaptive and innate immune profiles suggest that further studies into the common environmental factors that influence individual immune cell subsets need to be evaluated in greater detail.
%B Brain, Behavior, and Immunity - Health %V 33 %P 100676 %G eng %R 10.1016/j.bbih.2023.100676 %0 Journal Article %J Res Aging %D 2023 %T Communication Modalities, Personality Traits, and Change in Perceived Control Over Social Life Following Onset of the COVID-19 Pandemic Among Older Americans. %A Choi, Shinae L %A Hill, Kyrsten C %A Parmelee, Patricia A %XWe examined associations between change in social contact communication modalities and change in perceived control over social life (PCOSL) following onset of the COVID-19 pandemic among older Americans and evaluated the extent to which associations were moderated by personality. Data were from the 2016 and 2020 waves of the Health and Retirement Study. Multivariate ordinary least squares regression analyses were computed adjusting for baseline PCOSL, sociodemographic, health, and psychosocial factors. Multiple moderation analyses revealed that extraversion moderated the association between change in social media communication and change in PCOSL before to during COVID-19. As levels of engagement in social media communication increased, those with high extraversion experienced increases in PCOSL, whereas those with low extraversion experienced decreases in PCOSL. Findings suggest that social interventions targeting perceived control and communication modality may be useful for older adults during global health events and that personality characteristics can help to inform intervention choices.
%B Res Aging %P 1640275231178809 %G eng %R 10.1177/01640275231178809 %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 %XOBJECTIVES: 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 J Epidemiol Community Health %D 2023 %T Cumulative exposure to extreme heat and trajectories of cognitive decline among older adults in the USA. %A Choi, Eun Young %A Lee, Haena %A Chang, Virginia W %K Aging %K Climate Change %K Cognition %K Cohort Studies %XBACKGROUND: The projected increase in extreme heat days is a growing public health concern. While exposure to extreme heat has been shown to negatively affect mortality and physical health, very little is known about its long-term consequences for late-life cognitive function. We examined whether extreme heat exposure is associated with cognitive decline among older adults and whether this association differs by race/ethnicity and neighbourhood socioeconomic status.
METHODS: Data were drawn from seven waves of the Health and Retirement Study (2006-2018) merged with historical temperature data. We used growth curve models to assess the role of extreme heat exposure on trajectories of cognitive function among US adults aged 52 years and older.
RESULTS: We found that high exposure to extreme heat was associated with faster cognitive decline for blacks and residents of poor neighbourhoods, but not for whites, Hispanics or residents of wealthier neighbourhoods.
CONCLUSION: Extreme heat exposure can disproportionately undermine cognitive health in later life for socially vulnerable populations. Our findings underscore the need for policy actions to identify and support high-risk communities for increasingly warming temperatures.
%B J Epidemiol Community Health %G eng %R 10.1136/jech-2023-220675 %0 Journal Article %J Int J Aging Hum Dev %D 2023 %T Determinants of Hispanic and non-Hispanic Workers' Intent to Work Past Age 65: An Analysis From the Life Course Perspective. %A Diaz-Valdes, Antonia %A Matz-Costa, Christina %A Rutledge, Mathew S %A Calvo, Esteban %K Hispanics retirement intentions; decomposition analysis; delayed retirement; life course theory; retirement timing %XThe average retirement age in the United States (U.S.) has increased over the past few decades. However, the rate of increase for Hispanics is lower than that for non-Hispanics. For Hispanics, the decision to retire later may be more influenced by their migration history and context rather than health or finances. This study aims to explore the differences in the determinants of intentions to delay retirement (i.e., work beyond the age of 65) between Hispanics and non-Hispanic Whites in the U.S. A pooled sample was generated from all waves of the Health and Retirement Study (1992-2014), including a unique record for each non-institutionalized individual aged 55-61 who was employed. All eligible Hispanics ( = 3,663) were included, while a random sample of non-Hispanic Whites ( = 3,663) was selected. Logistic mixed models were conducted for each group, and a Two-fold Oaxaca-Blinder decomposition analysis was used to explore differences between the groups. The results indicate that non-Hispanic Whites are more likely to plan to postpone retirement. Furthermore, significant differences were found between Hispanics and non-Hispanic Whites regarding their intentions to delay retirement, specifically related to socioeconomic indicators such as individual earnings, amount of debt, level of education, and parents' level of education. The differences between the groups were primarily influenced by the amount of debt, having a defined benefit plan, and parents' level of education, reflecting the cumulative disadvantage experienced by Hispanics over their life course. Most existing research on the topic has focused on middle-class Whites, while few studies have examined race or ethnicity as the primary focus or explored the extent to which commonly identified predictors of delayed retirement apply to different ethno-racial groups. This is significant because Hispanics and other disadvantaged groups tend to experience financial insecurity during retirement, which directly impacts their health and well-being.
%B Int J Aging Hum Dev %P 914150231196095 %G eng %R 10.1177/00914150231196095 %0 Journal Article %J Journal of the American Geriatrics Society %D 2023 %T Development and validation of novel multimorbidity indices for older adults. %A Steinman, Michael A %A Jing, Bocheng %A Shah, Sachin J %A Rizzo, Anael %A Lee, Sei J %A Covinsky, Kenneth E %A Ritchie, Christine S %A Boscardin, W John %K claims data %K functional impairment %K multimorbidity %K prognostic models %XBACKGROUND: Measuring multimorbidity in claims data is used for risk adjustment and identifying populations at high risk for adverse events. Multimorbidity indices such as Charlson and Elixhauser scores have important limitations. We sought to create a better method of measuring multimorbidity using claims data by incorporating geriatric conditions, markers of disease severity, and disease-disease interactions, and by tailoring measures to different outcomes.
METHODS: Health conditions were assessed using Medicare inpatient and outpatient claims from subjects age 67 and older in the Health and Retirement Study. Separate indices were developed for ADL decline, IADL decline, hospitalization, and death, each over 2 years of follow-up. We validated these indices using data from Medicare claims linked to the National Health and Aging Trends Study.
RESULTS: The development cohort included 5012 subjects with median age 76 years; 58% were female. Claims-based markers of disease severity and disease-disease interactions yielded minimal gains in predictive power and were not included in the final indices. In the validation cohort, after adjusting for age and sex, c-statistics for the new multimorbidity indices were 0.72 for ADL decline, 0.69 for IADL decline, 0.72 for hospitalization, and 0.77 for death. These c-statistics were 0.02-0.03 higher than c-statistics from Charlson and Elixhauser indices for predicting ADL decline, IADL decline, and hospitalization, and <0.01 higher for death (p < 0.05 for each outcome except death), and were similar to those from the CMS-HCC model. On decision curve analysis, the new indices provided minimal benefit compared with legacy approaches. C-statistics for both new and legacy indices varied substantially across derivation and validation cohorts.
CONCLUSIONS: A new series of claims-based multimorbidity measures were modestly better at predicting hospitalization and functional decline than several legacy indices, and no better at predicting death. There may be limited opportunity in claims data to measure multimorbidity better than older methods.
%B Journal of the American Geriatrics Society %V 71 %P 121-135 %G eng %N 1 %R 10.1111/jgs.18052 %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 %XBACKGROUND: 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 Nutrients %D 2023 %T Dietary Intake Levels of Iron, Copper, Zinc, and Manganese in Relation to Cognitive Function: A Cross-Sectional Study. %A Zhao, Dong %A Huang, Yilun %A Wang, Binghan %A Chen, Hui %A Pan, Wenfei %A Yang, Min %A Xia, Zhidan %A Zhang, Ronghua %A Yuan, Changzheng %K Aged %K Cognition %K Copper %K Cross-Sectional Studies %K Eating %K Humans %K Iron %K Manganese %K Trace Elements %K Zinc %X: Previous studies have related circulating levels of trace metal elements, of which dietary intake is the major source, to cognitive outcomes. However, there are still relatively few studies evaluating the associations of dietary intake levels of iron, copper, zinc, and manganese with cognitive function (CF). : We leveraged the data of 6863 participants (mean [standard deviation] age = 66.7 [10.5] years) in the Health and Retirement Study (2013/2014). Dietary intake levels of iron, copper, zinc, and manganese were calculated from a semi-quantitative food frequency questionnaire. CF was assessed using the 27-point modified Telephone Interview for Cognitive Status (TICS). We used linear regression models to calculate the mean differences in global CF scores by quintiles of dietary intake levels of trace metal elements. : Among the study participants, the mean (SD) values of daily dietary intake were 13.3 (6.3) mg for iron, 1.4 (0.7) mg for copper, 10.7 (4.6) mg for zinc, and 3.3 (1.6) mg for manganese. Compared with the lowest quintile of dietary iron intake (<8.1 mg), the highest quintile (≥17.7 mg) was associated with a lower cognitive score (-0.50, -0.94 to -0.06, P-trend = 0.007). Higher dietary copper was significantly associated with poorer CF (P-trend = 0.002), and the mean difference in cognitive score between extreme quintiles (≥1.8 vs. <0.8 mg) was -0.52 (95% confidence interval: -0.94 to -0.10) points. We did not observe significant associations for dietary intake of zinc (P-trend = 0.785) and manganese (P-trend = 0.368). : In this cross-sectional study, higher dietary intake of iron and copper was related to worse CF, but zinc and manganese intake levels were not significantly associated with CF.
%B Nutrients %V 15 %8 2023 Jan 30 %G eng %N 3 %R 10.3390/nu15030704 %0 Journal Article %J Lifestyle Genom %D 2023 %T Discrimination Exposure and Polygenic Risk for Obesity in Adulthood: Testing Gene-Environment Correlations and Interactions. %A Cuevas, Adolfo G %A Mann, Frank D %A Krueger, Robert F %K Adulthood %K discrimination exposure %K Obesity %XINTRODUCTION: Exposure to discrimination has emerged as a risk factor for obesity. It remains unclear, however, whether the genotype of the individual can modulate the sensitivity or response to discrimination exposure (gene x environment interaction) or increase the likelihood of experiencing discrimination (gene-environment correlation).
METHODS: This was an observational study of 4,102 White/European Americans in the Health and Retirement Study with self-reported, biological assessments, and genotyped data from 2006 to 2014. Discrimination was operationalized using the average of nine Everyday Discrimination scale items. Polygenic risk scores (PRS) for body mass index (BMI) and waist circumference (WC) were calculated using the weighted sum of risk alleles based on studies conducted by the Genetic Investigation of Anthropometric Traits (GIANT) consortium.
RESULTS: We found that greater PRS-BMI were significantly associated with more reports of discrimination (β= 0.04 ± 0.02; p= 0.037). Further analysis showed that measured BMI partially mediated the association between PRS-BMI and discrimination. There was no evidence that the association between discrimination and BMI, or the association between discrimination and WC, differed by PRS-BMI or PRS-WC, respectively.
DISCUSSION/CONCLUSION: Our findings suggest that individuals with genetic liability for obesity may experience greater discrimination in their lifetime, consistent with a gene-environment correlation hypothesis. There was no evidence of a gene-environment interaction. More genome-wide association studies in diverse populations are needed to improve generalizability of study findings. In the meantime, prevention and clinical intervention efforts that seek to reduce exposure to all forms of discrimination may help reduce obesity at the population-level.
%B Lifestyle Genom %8 2023 Feb 07 %G eng %R 10.1159/000529527 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Disparities in advance care planning among older US immigrants. %A Mindo-Panusis, Dallas %A Sudore, Rebecca L %A Cenzer, Irena %A Smith, Alexander K %A Kotwal, Ashwin A %K care planning %K Disparities %K Immigrants %K United States %XBACKGROUND: Despite known racial disparities in advance care planning (ACP), little is known about ACP disparities experienced by US immigrants.
METHODS: We used data from the 2016 wave of the Health and Retirement Study. We defined ACP engagement as self-reported end-of-life (EOL) discussions, designation of a power of attorney (DPOA), documented living will, or "any" of the three behaviors. Immigration status was determined by respondent-reported birth outside the United States. Time in the United States was calculated by subtracting the year of arrival in the United States from the survey year of 2016. We used multivariable logistic regression to estimate the association between ACP engagement and immigration status and the relationship of acculturation to ACP engagement, adjusting for sociodemographics, religiosity, and life expectancy.
RESULTS: Of the total cohort (N = 9928), 10% were immigrants; 45% of immigrants identified as Hispanic. After adjustment, immigrants had significantly lower adjusted probability of any ACP engagement (immigrants: 74% vs. US-born: 83%, p < 0.001), EOL discussions (67% vs. 77%, p < 0.001), DPOA designation (50% vs. 59%, p = 0.001) and living will documentation (50% vs. 56%, p = 0.03). Among immigrants, each year in the United States was associated with a 4% increase in the odds of any ACP engagement (aOR 1.04, 95% CI 1.03-1.06), ranging from 36% engaged 10 years after immigration to 78% after 70 years.
CONCLUSION: ACP engagement was lower for US immigrants compared to US-born older adults, particularly for those that recently immigrated. Future studies should explore strategies to reduce disparities in ACP and the unique ACP needs among different immigrant populations.
%B J Am Geriatr Soc %G eng %R 10.1111/jgs.18498 %0 Report %D 2023 %T Documentation of lnterleukin-6 (IL-6) Assays from Dried Blood Spots 2014 and 2016 %A Crimmins, Eileen %A Jessica Faul %A Jung K Kim %A David R Weir %K User guide %X This document describes the collection of lnterleukin-6 (IL-6) in 2014 and 2016 Assays from Dried Blood Spots. %I Institute for Social Research, University of Michigan %C Ann Arbor, MI %G eng %0 Journal Article %J Arch Gerontol Geriatr %D 2023 %T Does cumulative psychosocial stress explain frailty disparities in community-dwelling older adults? %A Shakya, Shamatree %A Silva, Susan G %A McConnell, Eleanor S %A McLaughlin, Sara J %A Cary, Michael P %XOBJECTIVE: Frailty is a leading predictor of adverse outcomes in older adults. Although disparities in frailty are well-documented, it is unclear whether psychosocial stressors explain these disparities. This study aimed to examine the potential mediating role of psychosocial stress.
METHODS: This cross-sectional study included 7,679 community-dwelling older adults (≥ 65) from Health and Retirement Study in the US (2006 and 2008). We used six dichotomized psychosocial stressors: a) loneliness, b) discrimination, c) financial strain, d) low subjective status, e) poor neighborhood cohesion, and f) traumatic life events to compute cumulative psychosocial stress. The Fried frailty phenotype defined frailty based on three features: slowness, poor strength, weight loss, fatigue, and low physical activity. Multivariable regressions were used to examine the structural determinants (gender, education, race, and ethnicity) frailty relationship and test whether cumulative psychosocial stress has a mediating role.
RESULTS: The frailty prevalence was 22%. Females, Hispanics, Blacks, and those with less education had higher odds of frailty (p<.01). Race and ethnic minorities and non-college graduates experienced greater cumulative psychosocial stress relative to their White and college graduate counterparts (p<.05), respectively. Greater cumulative psychosocial stress was associated with increased odds of frailty (p < .001); however, it did not mediate the structural determinants and frailty relationship.
CONCLUSION: Contrary to expectations, cumulative psychosocial stress did not mediate the relationship between structural determinants and frailty. Rather, high cumulative psychosocial stress was independently associated with frailty. Further research should examine other psychosocial mediators to inform interventions to prevent/delay frailty.
%B Arch Gerontol Geriatr %V 113 %P 105055 %G eng %R 10.1016/j.archger.2023.105055 %0 Journal Article %J Journal of the American College of Cardiology %D 2023 %T DOES INCIDENT CARDIOVASCULAR DISEASE LEAD TO GREATER ODDS OF DISABILITY? INSIGHTS FROM THE HEALTH AND RETIREMENT STUDY %A Katherine L. Stone %A Judy Zhong %A Chen Lyu %A Joshua Chodosh %A Nina Blachman %A John A. Dodson %K Cardiovascular disease %B Journal of the American College of Cardiology %V 81 %P 1779-1779 %G eng %R 10.1016/S0735-1097(23)02223-4 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2023 %T Does Incident Cardiovascular Disease Lead to Greater Odds of Functional and Cognitive Impairment? Insights from the Health and Retirement Study. %A Stone, Katherine L %A Zhong, Judy %A Lyu, Chen %A Chodosh, Joshua %A Blachman, Nina L %A Dodson, John %K Cardiovascular disease %K cognitive impairment %K functional impairment %XBACKGROUND: While studies to date have broadly shown that cardiovascular disease (CVD) increases cognitive and physical impairment risk, there is still limited understanding of the magnitude of this risk among relevant CVD subtypes or age cohorts.
METHODS: We analyzed longitudinal data from 16,679 U.S. Health and Retirement Study (HRS) participants who were age ≥65 years at study entry. Primary endpoints were physical impairment (ADL impairment) or cognitive impairment (Langa-Weir Classification of dementia). We compared these endpoints among participants who developed incident CVD versus those who were CVD-free, both in the short-term (<2 years post diagnosis) and long-term (>5 years), controlling for sociodemographic and health characteristics. We then analyzed effects by CVD subtype (atrial fibrillation, congestive heart failure, ischemic heart disease, stroke) and age-at-diagnosis (65-74, 75-84, ≥85).
RESULTS: Over a median follow-up of 10 years, 8,750 participants (52%) developed incident CVD. Incident CVD was associated with a significantly higher adjusted odds [aOR] of short-term and long-term physical and cognitive impairment. The oldest (≥85) age-at-diagnosis subgroup had the highest risk of short-term physical (aOR 3.01, 95% confidence-interval [CI] 2.40-3.77) and cognitive impairment (aOR 1.96, 95% CI 1.55-2.48), as well as long-term impairment. All CVD subtypes were associated with higher odds of physical and cognitive impairment, with the highest risk for patients with incident stroke.
CONCLUSIONS: Incident CVD was associated with increased risk of physical and cognitive impairment across CVD subtypes. Impairment risk after CVD was highest among the oldest patients (≥85 years) who should therefore remain a target for prevention efforts.
%B J Gerontol A Biol Sci Med Sci %G eng %R 10.1093/gerona/glad096 %0 Web Page %D 2023 %T Dollars and sense: The case for teaching personal finance %A Crawford, Krysten %K Financial literacy %K Personal finance %K Retirement Planning %I Institute for Economic Policy Research, Stanford University %G eng %U https://siepr.stanford.edu/news/dollars-and-sense-case-teaching-personal-finance %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 %XOBJECTIVES: 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 Web Page %D 2023 %T Education may be the best way to protect against cognitive decline, new research suggests %A Carroll, Linda %K Cognitive decline %K Education %I NBC News %G eng %U https://www.nbcnews.com/health/aging/protect-memory-education-key-new-science-suggests-rcna69400 %0 Journal Article %J Journal of General Internal Medicine %D 2023 %T The Epidemiology of Smoking in Older Adults: A National Cohort Study. %A Hunt, Lauren J %A Covinsky, Kenneth E %A Cenzer, Irena %A Espejo, Edie %A Boscardin, W John %A Leutwyler, Heather %A Lee, Alexandra K %A Cataldo, Janine %K Epidemiology %K Geriatrics %K Public Health %K Smoking %XBACKGROUND: Older smokers account for the greatest tobacco-related morbidity and mortality in the USA, while quitting smoking remains the single most effective preventive health intervention for reducing the risk of smoking-related illness. Yet, knowledge about patterns of smoking and smoking cessation in older adults is lacking.
OBJECTIVE: Assess trends in prevalence of cigarette smoking between 1998 and 2018 and identify patterns and predictors of smoking cessation in US older adults.
DESIGN: Retrospective cohort study PARTICIPANTS: Individuals aged 55+ enrolled in the nationally representative Health and Retirement Study, 1998-2018 MAIN MEASURES: Current smoking was assessed with the question: "Do you smoke cigarettes now?" Quitting smoking was defined as having at least two consecutive waves (between 2 and 4 years) in which participants who were current smokers in 1998 reported they were not currently smoking in subsequent waves.
KEY RESULTS: Age-adjusted smoking prevalence decreased from 15.9% in 1998 (95% confidence interval (CI) 15.2, 16.7) to 11.2% in 2018 (95% CI 10.4, 12.1). Among 2187 current smokers in 1998 (mean age 64, 56% female), 56% of those living to age 90 had a sustained period of smoking cessation. Smoking less than 10 cigarettes/day was strongly associated with an increased likelihood of quitting smoking (subdistribution hazard ratio 2.3; 95% CI 1.9, 2.8), compared to those who smoked more than 20 cigarettes/day.
CONCLUSIONS: Smoking prevalence among older persons has declined and substantial numbers of older smokers succeed in quitting smoking for a sustained period. These findings highlight the need for continued aggressive efforts at tobacco cessation among older persons.
%B Journal of General Internal Medicine %V 38 %P 1697-1704 %G eng %N 7 %R 10.1007/s11606-022-07980-w %0 Journal Article %J Clin Epigenetics %D 2023 %T Epigenetic age acceleration mediates the association between smoking and diabetes-related outcomes. %A Chang, Xue-Yong %A Lin, Wan-Yu %K Aging %K Diabetes Mellitus %K DNA Methylation %K Epigenesis, Genetic %K Humans %K Plasminogen Activator Inhibitor 1 %K Smoking %XBACKGROUND: Smoking can lead to the deterioration of lung function and susceptibility to diabetes. Recently, smoking was found to induce DNA methylation (DNAm) changes in some cytosine-phosphate-guanine sites (CpGs). As linear combinations of DNAm levels of aging-related CpGs, five measures of epigenetic age acceleration (EAA) have received extensive attention: HannumEAA, IEAA, PhenoEAA, GrimEAA, and DunedinPACE. It is of interest to explore whether some measures of EAA can mediate the associations of smoking with diabetes-related outcomes and indices of ventilatory lung function.
METHODS AND RESULTS: In this study, we included self-reported smoking variables (smoking status, the number of pack-years, and years since smoking cessation), seven DNAm markers (HannumEAA, IEAA, PhenoEAA, GrimEAA, DNAm-based smoking pack-years, DNAm plasminogen activator inhibitor 1 [PAI-1] levels, and DunedinPACE), and four health outcomes (fasting glucose, hemoglobin A1C, forced expiratory volume in 1.0 s [FEV1], and forced vital capacity [FVC]) from 2474 Taiwan Biobank participants. Mediation analyses were conducted while adjusting for chronological age, sex, body mass index, drinking status, regular exercise status, educational attainment, and five cell-type proportions. We demonstrated that GrimEAA, DNAm-based smoking pack-years, DNAm PAI-1 levels, DunedinPACE, and PhenoEAA mediated smoking associations with diabetes-related outcomes. Moreover, current and former smoking both had an adverse indirect effect on FVC through DNAm PAI-1 levels. For former smokers, a long time since smoking cessation had a positive indirect impact on FVC through GrimEAA and on FEV1 through PhenoEAA.
CONCLUSIONS: This is one of the first studies to comprehensively investigate the role of five measures of EAA in mediating the associations of smoking with the health outcomes of an Asian population. The results showed that the second-generation epigenetic clocks (GrimEAA, DunedinPACE, and PhenoEAA) significantly mediated the associations between smoking and diabetes-related outcomes. In contrast, the first-generation epigenetic clocks (HannumEAA and IEAA) did not significantly mediate any associations of smoking variables with the four health outcomes. Cigarette smoking can, directly and indirectly, deteriorate human health through DNAm changes in aging-related CpG sites.
%B Clin Epigenetics %V 15 %P 94 %G eng %N 1 %R 10.1186/s13148-023-01512-x %0 Journal Article %J PNAS %D 2023 %T Epigenetic-based age acceleration in a representative sample of older Americans: Associations with aging-related morbidity and mortality. %A Jessica Faul %A Jung K Kim %A Levine, Morgan E %A Bharat Thyagarajan %A David R Weir %A Eileen M. Crimmins %K Acceleration %K Aging %K Biomarkers %K Cross-Sectional Studies %K DNA Methylation %K Epigenesis %K genetic %XBiomarkers developed from DNA methylation (DNAm) data are of growing interest as predictors of health outcomes and mortality in older populations. However, it is unknown how epigenetic aging fits within the context of known socioeconomic and behavioral associations with aging-related health outcomes in a large, population-based, and diverse sample. This study uses data from a representative, panel study of US older adults to examine the relationship between DNAm-based age acceleration measures in the prediction of cross-sectional and longitudinal health outcomes and mortality. We examine whether recent improvements to these scores, using principal component (PC)-based measures designed to remove some of the technical noise and unreliability in measurement, improve the predictive capability of these measures. We also examine how well DNAm-based measures perform against well-known predictors of health outcomes such as demographics, SES, and health behaviors. In our sample, age acceleration calculated using "second and third generation clocks," PhenoAge, GrimAge, and DunedinPACE, is consistently a significant predictor of health outcomes including cross-sectional cognitive dysfunction, functional limitations and chronic conditions assessed 2 y after DNAm measurement, and 4-y mortality. PC-based epigenetic age acceleration measures do not significantly change the relationship of DNAm-based age acceleration measures to health outcomes or mortality compared to earlier versions of these measures. While the usefulness of DNAm-based age acceleration as a predictor of later life health outcomes is quite clear, other factors such as demographics, SES, mental health, and health behaviors remain equally, if not more robust, predictors of later life outcomes.
%B PNAS %V 120 %P e2215840120 %G eng %N 9 %R 10.1073/pnas.2215840120 %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 Journal Article %J Neuroepidemiology %D 2023 %T Estimating the Prevalence of Dementia in India Using a Semi-Supervised Machine Learning Approach. %A Jin, Haomiao %A Crimmins, Eileen %A Kenneth M. Langa %A Dey, A B %A Lee, Jinkook %K Aged %K Aging %K Dementia %K Female %K Humans %K India %K Male %K Middle Aged %K Prevalence %K supervised machine learning %XINTRODUCTION: Accurate estimation of dementia prevalence is essential for making effective public and social care policy to support individuals and families suffering from the disease. The purpose of this paper is to estimate the prevalence of dementia in India using a semi-supervised machine learning approach based on a large nationally representative sample.
METHODS: The sample of this study is adults 60 years or older in the wave 1 (2017-2019) of the Longitudinal Aging Study in India (LASI). A subsample in LASI received extensive cognitive assessment and clinical consensus ratings and therefore has diagnoses of dementia. A semi-supervised machine learning model was developed to predict the status of dementia for LASI participants without diagnoses. After obtaining the predictions, sampling weights and age standardization to the World Health Organization (WHO) standard population were applied to generate the estimate for prevalence of dementia in India.
RESULTS: The prevalence of dementia for those aged 60 years and older in India was 8.44% (95% CI: 7.89%-9.01%). The age-standardized prevalence was estimated to be 8.94% (95% CI: 8.36%-9.55%). The prevalence of dementia was greater for those who were older, were females, received no education, and lived in rural areas.
DISCUSSION: The prevalence of dementia in India may be higher than prior estimates derived from local studies. These prevalence estimates provide the information necessary for making long-term planning of public and social care policy. The semi-supervised machine learning approach adopted in this paper may also be useful for other large population aging studies that have a similar data structure.
%B Neuroepidemiology %V 57 %P 43-50 %G eng %N 1 %R 10.1159/000528904 %0 Journal Article %J Neurol Ther %D 2023 %T Estimating Transition Probabilities Across the Alzheimer's Disease Continuum Using a Nationally Representative Real-World Database in the United States. %A Tahami Monfared, Amir Abbas %A Fu, Shuai %A Hummel, Noemi %A Qi, Luyuan %A Chandak, Aastha %A Zhang, Raymond %A Zhang, Quanwu %XINTRODUCTION: Clinical Alzheimer's disease (AD) begins with mild cognitive impairment (MCI) and progresses to mild, moderate, or severe dementia, constituting a disease continuum that eventually leads to death. This study aimed to estimate the probabilities of transitions across those disease states.
METHODS: We developed a mixed-effects multi-state Markov model to estimate the transition probabilities, adjusted for 5 baseline covariates, using the Health and Retirement Study (HRS) database. HRS surveys older adults in the United States bi-annually. Alzheimer states were defined using the modified Telephone Interview of Cognitive Status (TICS-m).
RESULTS: A total of 11,292 AD patients were analyzed. Patients were 70.8 ± 9.0 years old, 54.9% female, and with 12.0 ± 3.3 years of education. Within 1 year from the initial state, the model estimated a higher probability of transition to the next AD state in earlier disease: 12.8% from MCI to mild AD and 5.0% from mild to moderate AD, but < 1% from moderate to severe AD. After 10 years, the probability of transition to the next state was markedly higher for all states, but still higher in earlier disease: 29.8% from MCI to mild AD, 23.5% from mild to moderate AD, and 5.7% from moderate to severe AD. Across all AD states, the probability of transition to death was < 5% after 1 year and > 15% after 10 years. Older age, fewer years of education, unemployment, and nursing home stay were associated with a higher risk of disease progression (p < 0.01).
CONCLUSIONS: This analysis shows that the risk of progression is greater in earlier AD states, increases over time, and is higher in patients who are older, with fewer years of education, unemployed, or in a nursing home at baseline. The estimated transition probabilities can provide guidance for future disease management and clinical trial design optimization, and can be used to refine existing cost-effectiveness frameworks.
%B Neurol Ther %G eng %R 10.1007/s40120-023-00498-1 %0 Journal Article %J Maturitas %D 2023 %T Examining racial and ethnic differences in disability among older adults: A polysocial score approach. %A Tang, Junhan %A Chen, Ying %A Liu, Hua %A Wu, Chenkai %K Activities of Daily Living %K Aged %K Cohort Studies %K Disabled Persons %K ethnicity %K Health Status Disparities %K Humans %K Racial Groups %K United States %XOBJECTIVES: Racial and ethnic disparities in disability in activities of daily living (ADL) continue to be a public concern. We evaluated whether the polysocial score approach could provide a more comprehensive method for modifying racial and ethnic differences in such disability.
STUDY DESIGN: Cohort study.
MAIN OUTCOME MEASURES: We included 5833 participants from the Health and Retirement Study, who were aged 65 years or more and were initially free of ADL disability. We considered six ADLs: bathing, eating, using the toilet, dressing, walking across a room, and getting in/out of bed. We included 20 social factors spanning economic stability, neighborhood and physical environment, education, community and social context, and health system. We used forward stepwise logistic regression to derive a polysocial score for ADL disability. We created a polysocial score using 12 social factors and categorized the score as low (0-19), intermediate (20-30), and high (31+). We used multivariable logistic regression to estimate the incident risk of ADL disability and examine additive interactions between race/ethnicity and polysocial score.
RESULTS: A higher polysocial score is associated with a lower incidence of ADL disability among older adults in the United States. We found additive interactions between race/ethnicity and polysocial score categories. In the low polysocial score category, White and Black/Hispanic participants had a 18.5 % and 24.4 % risk of ADL disability, respectively. Among White participants, the risk of ADL disability decreased to 14.1 % and 12.1 % in the intermediate and high polysocial score categories, respectively; among Black/Hispanic participants, those in the intermediate and high categories had a 11.9 % and 8.7 % risk of ADL disability, respectively.
CONCLUSIONS: The polysocial score approach provides a new opportunity for explaining racial/ethnic disparities in functional capacity among older adults.
%B Maturitas %V 172 %P 1-8 %G eng %R 10.1016/j.maturitas.2023.03.010 %0 Journal Article %J Aging Clin Exp Res %D 2023 %T Examining the role of different weakness categories for mobility and future falls in older Americans. %A McGrath, Ryan %A Jurivich, Donald A %A Christensen, Bryan K %A Choi, Bong-Jin %A Langford, Matthew %A Rhee, Yeong %A Tomkinson, Grant R %A Hackney, Kyle J %K mobility %K Older Americans %XBACKGROUND: Recently developed absolute and body size normalized handgrip strength (HGS) cut-points could be used individually and collectively to predict mobility problems and falls.
AIMS: We examined the associations of (1) each absolute and normalized weakness cut-point, (2) collective weakness categories, and (3) changes in weakness status on future falls in older Americans.
METHODS: The analytic sample included 11,675 participants from the 2006-2018 waves of the Health and Retirement Study. Falls were self-reported. Men were classified as weak if their HGS was < 35.5-kg (absolute), < 0.45 kg/kg (body mass normalized), or < 1.05 kg/kg/m (body mass index normalized). While, women were considered weak if their HGS was < 20.0-kg, < 0.337 kg/kg, or < 0.79 kg/kg/m. Collective weakness categorized those below 1, 2, or all 3 cut-points. The collective weakness categories were also used to observe changes in weakness status over time.
RESULTS: Older Americans below each absolute and normalized cut-point had greater odds for future falls: 1.23 (95% confidence interval (CI): 1.15-1.32) for absolute weakness, 1.20 (CI 1.11-1.29) for body mass index normalized weakness, and 1.26 (CI 1.17-1.34) for body mass normalized weakness. Persons below 1, 2, or all 3 weakness cut-points had 1.17 (CI 1.07-1.27), 1.29 (CI 1.18-1.40), and 1.36 (CI 1.24-1.48) greater odds for future falls, respectively. Those in some changing weakness categories had greater odds for future falls: 1.26 (CI 1.08-1.48) for persistent and 1.31 (CI 1.11-1.55) for progressive.
DISCUSSION: Collectively using these weakness cut-points may improve their predictive value.
CONCLUSION: We recommend HGS be evaluated in mobility and fall risk assessments.
%B Aging Clin Exp Res %G eng %R 10.1007/s40520-023-02516-6 %0 Journal Article %J Alzheimers Res Ther %D 2023 %T Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis. %A Mattke, Soeren %A Jun, Hankyung %A Chen, Emily %A Liu, Ying %A Becker, Andrew %A Wallick, Christopher %K cognitive impairment %K Medicare %K United States %XBACKGROUND: With the emergence of disease-modifying Alzheimer's treatments, timely detection of early-stage disease is more important than ever, as the treatment will not be indicated for later stages. Contemporary population-level data for detection rates of mild cognitive impairment (MCI), the stage at which treatment would ideally start, are lacking, and detection rates for dementia are only available for subsets of the Medicare population. We sought to compare documented diagnosis rates of MCI and dementia in the full Medicare population with expected rates based on a predictive model.
METHODS: We performed an observational analysis of Medicare beneficiaries aged 65 and older with a near-continuous enrollment over a 3-year observation window or until death using 100% of the Medicare fee-for-service or Medicare Advantage Plans beneficiaries from 2015 to 2019. Actual diagnoses for MCI and dementia were derived from ICD-10 codes documented in those data. We used the 2000-2016 data of the Health and Retirement Study to develop a prediction model for expected diagnoses for the included population. The ratios between actually diagnosed cases of MCI and dementia over number of cases expected, the observed over expected ratio, reflects the detection rate.
RESULTS: Although detection rates for MCI cases increased from 2015 to 2019 (0.062 to 0.079), the results mean that 7.4 of 8 million (92%) expected MCI cases remained undiagnosed. The detection rate for MCI was 0.039 and 0.048 in Black and Hispanic beneficiaries, respectively, compared with 0.098 in non-Hispanic White beneficiaries. Individuals dually eligible for Medicare and Medicaid had lower estimated detection rates than their Medicare-only counterparts for MCI (0.056 vs 0.085). Dementia was diagnosed more frequently than expected (1.086 to 1.104) from 2015 to 2019, mostly in non-Hispanic White beneficiaries (1.367) compared with 0.696 in Black beneficiaries and 0.758 in Hispanic beneficiaries.
CONCLUSIONS: These results highlight the need to increase the overall detection rates of MCI and of dementia particularly in socioeconomically disadvantaged groups.
%B Alzheimers Res Ther %V 15 %P 128 %G eng %N 1 %R 10.1186/s13195-023-01272-z %0 Journal Article %J Neurology %D 2023 %T Expected vs Diagnosed Rates of Mild Cognitive Impairment and Dementia in the US Medicare Population (S15.010) %A Soeren Mattke %A Hankyung Jun %A Emily Chen %A Ying Liu %A Andrew Becker %A Chris Wallick %X Objective: We sought to derive contemporary population-level diagnosis rates of mild cognitive impairment (MCI) and dementia from US Medicare data and compare those rates to expected rates based on a predictive model.Background: Cognitive impairment is common in elderly populations but remains under diagnosed.Design/Methods: We analyzed data from 2017–2019 100% samples for Medicare fee-for-service and Medicare Advantage; diagnoses were identified based on ICD-10 codes. To estimate the expected prevalence of MCI and dementia, we used the Health and Retirement Study, a nationally representative, longitudinal survey of older US adults, which includes formal cognitive assessments. We predicted MCI, dementia, and any cognitive impairment based on age, sex, race/ethnicity, dual eligibility status (ie, individuals covered by both Medicare and Medicaid), and a continuous linear trend to account for the secular decline in dementia incidence with a probit model. The model was calibrated using 2000–2014 data, validated using 2016 data, and applied to 2017–2019 Medicare data to generate expected diagnosis rates.Results: The prediction model performed well, with areas under the curve of 0.7128 (MCI), 0.8156 (dementia), and 0.7449 (any cognitive impairment). Differences between model-predicted rates and observed diagnosis rates were 0.2013 (MCI), 0.015 (dementia), and 0.1487 (MCI or dementia). A total of 7,291,008 MCI cases and 483,649 dementia cases were undiagnosed.Conclusions: Dementia is diagnosed in the US Medicare population at approximately the expected rate; however, MCI remains substantially underdiagnosed. If failure to diagnose is not addressed, it will have negative implications for timely access to a disease-modifying treatment for Alzheimer’s disease.Disclosure: Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for C2N. Dr. Mattke has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Senscio Systems. The institution of Dr. Mattke has received research support from various companies, CMS. Dr. Jun has nothing to disclose. Ms. Chen has nothing to disclose. Dr. Liu has nothing to disclose. Mr. Becker has received personal compensation for serving as an employee of University of Southern California. Chris Wallick has nothing to disclose. %B Neurology %V 100 %G eng %R 10.1212/WNL.0000000000201996 %0 Journal Article %J Journal of the Royal Statistical Society Series A: Statistics in Society %D 2023 %T An experimental evaluation of a stopping rule aimed at maximizing cost-quality trade-offs in surveys %A Wagner, James %A Zhang, Xinyu %A Elliott, Michael R %A Brady T. West %A Coffey, Stephanie M %X Surveys face difficult choices in managing cost-error trade-offs. Stopping rules for surveys have been proposed as a method for managing these trade-offs. A stopping rule will limit effort on a select subset of cases to reduce costs with minimal harm to quality. Previously proposed stopping rules have focused on quality with an implicit assumption that all cases have the same cost. This assumption is unlikely to be true, particularly when some cases will require more effort and, therefore, more costs than others. We propose a new rule that looks at both predicted costs and quality. This rule is tested experimentally against another rule that focuses on stopping cases that are expected to be difficult to recruit. The experiment was conducted on the 2020 data collection of the Health and Retirement Study (HRS). We test both Bayesian and non-Bayesian (maximum-likelihood or ML) versions of the rule. The Bayesian version of the prediction models uses historical data to establish prior information. The Bayesian version led to higher-quality data for roughly the same cost, while the ML version led to small reductions in quality with larger reductions in cost compared to the control rule. %B Journal of the Royal Statistical Society Series A: Statistics in Society %G eng %R 10.1093/jrsssa/qnad059 %0 Journal Article %J Research on Aging %D 2023 %T Exploring the Relationship Between Engagement in Enriching Early-Life Activities During Adolescence and Cognition in Later-Life: Results From the Health and Retirement Study. %A Crane, Breanna M %A Bandeen-Roche, Karen %A Carlson, Michelle C %K adolescence %K cognitive function %K early-life enrichment %K life course %K Lifestyle activities %XThe cognitive benefits associated with mid- to late-life engagement have been demonstrated in several studies. However, the link between engagement in enriching early-life activities (EELAs) during adolescence and later-life cognition has been relatively unexplored in major epidemiological studies. We examined the EELA-cognition relationship in a nationally representative sample of adults aged 50+. A subset of Health and Retirement Study respondents (=3482) completed cognitive tests and returned a retrospective early-life activity inventory. Linear regression models analyzed the EELA-cognition relationship, and multiple imputation addressed missingness. Each additional EELA was associated with a 0.36 point higher cognitive score (95% CI: 0.24, 0.47). This relationship remained significant after adjusting for potential confounders (B=0.16; 95% CI: [0.06, 0.26]). EELA engagement was associated with better later-life cognitive performance. This study is understood to be the first to examine the EELA-cognition relationship using a large, nationally representative dataset. The findings highlight the importance of early-life engagement during an important developmental period (e.g., adolescence).
%B Research on Aging %G eng %R 10.1177/01640275221085660 %0 Journal Article %J DEMOGRAPHY %D 2023 %T Exposure to Family Member Deaths Across the Life Course for His panic Individuals %A Donnelly, Rachel %A Garcia, Michael A. %A Cha, Hyungmin %A Hummer, Robert A. %A Umberson, Debra %K deaths %K family members %K panic %B DEMOGRAPHY %V 60 %P 539-562 %G eng %R 10.1215/00703370-10604036 %0 Journal Article %J Demography %D 2023 %T Exposure to Family Member Deaths Across the Life Course for Hispanic Individuals. %A Donnelly, Rachel %A Garcia, Michael A %A Cha, Hyungmin %A Hummer, Robert A %A Umberson, Debra %K Adolescent %K Adult %K Child %K Death %K Family %K Hispanic or Latino %K Humans %K Life Change Events %K Longitudinal Studies %K Middle Aged %K United States %K White %K Young Adult %XThe present study documents differences in exposure to family member deaths among foreign-born and U.S.-born Hispanic individuals compared with non-Hispanic Black and non-Hispanic White individuals. We use data from the Health and Retirement Study (HRS; 1992-2016, ages 51+; N = 23,228) and the National Longitudinal Study of Adolescent to Adult Health (Add Health; Waves I-V, ages 12-43; N = 11,088) to estimate the risk of exposure to the death of a mother, father, spouse, sibling, and child across the life course. HRS results show more inequities in exposure to family deaths compared with Add Health results, suggesting differences by age or birth cohort. Compared with non-Hispanic Whites, U.S.-born Hispanic individuals in the HRS have a higher risk of experiencing a child's death throughout adulthood and a sibling's death in later life; the latter is explained by larger sibship size, indicating a greater lifetime risk of bereavement experiences. The higher risk of parental death during childhood for U.S.-born and foreign-born Hispanic individuals is explained by covariates (e.g., lower levels of educational attainment). Hispanic individuals generally have a lower risk of family deaths than non-Hispanic Black individuals, but at times a higher risk of exposure relative to non-Hispanic White individuals.
%B Demography %V 60 %P 539-562 %G eng %N 2 %R 10.1215/00703370-10604036 %0 Journal Article %J The Journals of Gerontology, Series A %D 2023 %T Factors Associated with Healthcare Delays Among Adults Over 50 During the COVID-19 Pandemic. %A Chan, Athena C Y %A Sneed, Rodlescia S %K COVID-19 %K geographical region %K healthcare delay %K Race/ethnicity %XBACKGROUND: Adults over 50 have high healthcare needs, but also face high coronavirus disease 2019 (COVID-19)-related vulnerability. This may result in reluctance to enter public spaces, including healthcare settings. Here, we examined factors associated with healthcare delays among adults over 50 early in the COVID-19 pandemic.
METHODS: Using data from the 2020 wave of the Health and Retirement Study (N=7615), we evaluated how race/ethnicity, age, geographic region, and pandemic-related factors were associated with healthcare delays.
RESULTS: In our sample, 3 in 10 participants who were interviewed from March 2020 to June 2021 reported delays in medical or dental care in the early stages of the COVID-19 pandemic. Non-Hispanic Whites (OR: 1.37; 95% CI: 1.19-1.58) and those of other racial/ethnic backgrounds (OR: 1.31; 95% CI: 1.02-1.67) delayed care more than Non-Hispanic Blacks. Other factors associated with delayed care included younger age, living in the Midwest or West, knowing someone diagnosed with or who died from COVID-19, and having high COVID-19-related concerns. There were no differences in care delays among adults aged >70; however, among those ≤70, those who knew someone diagnosed with COVID-19 were more likely to delay care than those who did not. Additionally, among those ≤70, Non-Hispanic Whites and those of other racial/ethnic backgrounds delayed care more than Non-Hispanic Blacks and Hispanics.
CONCLUSIONS: There is considerable heterogeneity in care delays among older adults based on age, race/ethnicity, and pandemic-related factors. As the pandemic continues, future studies should examine whether these patterns persist.
%B The Journals of Gerontology, Series A %G eng %R 10.1093/gerona/glac174 %0 Journal Article %J Cancer Medicine %D 2023 %T Financial burden among cancer patients: A national-level perspective. %A Mudaranthakam, Dinesh Pal %A Wick, Jo %A Calhoun, Elizabeth %A Gurley, Tami %K cancer treatment %K Financial burden %K financial challenges %K treatment burden %XBACKGROUND: This research study aimed to evaluate the financial burden among older cancer patients and its corresponding risk factors. Factors such as increasing treatment costs and work limitations often lead cancer patients to bankruptcy and poor quality of life. These consequences, in turn, can cause higher mortality rates among these patients.
METHODS: This retrospective cohort study utilized data from the Health Retirement Study (HRS), conducted by the University of Michigan (N = 18,109). Eligible participants had responses captured from years 2002 to 2016. Participants were classified according to any self-reported cancer diagnosis (yes or no) and were compared on the basis of financial, work, and health-related outcomes. Propensity score (PS) matching was applied to reduce the effects of potential confounding factors. Also only, individuals with an age ≥50 and ≤85 during Wave 6 were retained.
RESULTS: Multivariate analysis with random effects revealed several indicators of financial burden when comparing participants with a cancer diagnosis to those with no history of cancer. Mean out-of-pocket costs associated with a cancer diagnosis were $1058 higher when compared to participants with no history of cancer, suggesting that even cancer patients with insurance coverage faced out-of-pocket costs. Respondents with cancer patients had higher odds of encountering financial hardship if they are facing Work Limitations (OR = 2.714), Regular use of Medications (OR = 2.518), Hospital Stays (OR = 2.858), Declining Health (OR = 2.349), or were being covered under government health insurance (OR = 5.803) than respondents who did not have cancer, or suffered from mental health issues such as Depression (OR = 0.901).
CONCLUSION: Cancer patients contend with increasing financial costs during their treatment. However, most newly diagnosed patients are not aware of these costs and are given few resources to handle them.
%B Cancer Medicine %G eng %R 10.1002/cam4.5049 %0 Journal Article %J Social Science & Medicine %D 2023 %T Financial hardship and change in emotional well-being before to during COVID-19 pandemic among middle-aged and older Americans: Moderating effects of internal coping resources. %A Choi, Shinae L %A Lee, Yoon G %K Adaptation %K COVID-19 %K financial stress %K Leave Behind Questionnaire %K Pandemics %K Psychological %XOBJECTIVE: The purpose of this study was to investigate associations between financial hardship and change in emotional well-being-positive and negative affect-before to during the COVID-19 pandemic among middle-aged and older Americans and to examine the extent to which associations were moderated by internal coping resources-dispositional mastery and optimism.
METHOD: Data derived from the Leave-Behind Questionnaire in the 2016 and 2020 waves of the Health and Retirement Study, a nationally representative longitudinal survey of U.S. adults aged 51 and older (N = 1312). We estimated multivariate ordinary least squares regression models with interaction terms to evaluate prospectively the benefits of mastery and optimism as internal coping resources for middle-aged and older adults.
RESULTS: Dispositional mastery moderated the effects of financial hardship on changes in negative and positive affect, respectively, before to during the COVID-19 pandemic; however, optimism did not significantly moderate the effects of financial hardship on change in negative and positive affect before to during the COVID-19 pandemic.
CONCLUSIONS: Our findings have implications for interventions aimed at improving middle-aged and older adults' emotional well-being by promoting internal coping resources. Specifically, interventions should focus on financial hardship and mastery for vulnerable middle-aged and older adults in the context of public health crises.
%B Social Science & Medicine %V 317 %P 115572 %G eng %R 10.1016/j.socscimed.2022.115572 %0 Journal Article %J Health Affairs %D 2023 %T The Forgotten Middle: Worsening Health And Economic Trends Extend To Americans With Modest Resources Nearing Retirement. %A Chapel, Jack M %A Tysinger, Bryan %A Goldman, Dana P %A Rowe, John W %K Future Elderly Model %K health %K middle class %K Retirement %XIn an aging US society, anticipating the challenges that future seniors will face is essential. This study analyzed the health and economic well-being of five cohorts of Americans in their mid-fifties between 1994 and 2018 using the Future Elderly Model, a dynamic microsimulation based on the Health and Retirement Study. We projected mortality, quality-adjusted life years, health expenditures, and income and benefits. We classified individuals by economic status and focused on the lower middle and upper middle of the economic distribution. Outcome disparities between people in these two groups widened substantially between the 1994 and 2018 cohorts. Quality-adjusted life expectancy increased (5 percent) for the upper-middle economic status group but stagnated for their lower-middle peers. We found that the combined value of the current stock (financial and housing wealth) and the present value of the expected flow of resources (income, health expenditures, and quality-adjusted life-years) after age sixty grew 13 percent for the upper-middle group between cohorts, whereas people in the lower-middle group in 2018 were left scarcely better off (3 percent growth) than their peers two decades earlier. The relatively neglected "forgotten middle" group of near-retirees in the lower-middle group may require stronger supports than are currently available to them.
%B Health Affairs %V 42 %P 1230-1240 %G eng %N 9 %R 10.1377/hlthaff.2023.00134 %0 Journal Article %J MedComm (2020) %D 2023 %T Frailty trajectory predicts subsequent cognitive decline: A 26-year population-based longitudinal cohort study. %A Li, Ruidan %A Liu, Zheran %A Huang, Rendong %A Chen, Ye %A Wei, Zhigong %A Wang, Jingjing %A He, Ling %A Pei, Yiyan %A Su, Yonglin %A Hu, Xiaolin %A Peng, Xingchen %XFrailty refers to a decline in the physiological functioning of one or more organ systems. It remained unclear whether variations in the trajectory of frailty over time were associated with subsequent cognitive change. The aim of the current study was to investigate the association between frailty trajectories and subsequent cognitive decline based on the Health and Retirement Study (HRS). A total of 15,454 participants were included. The frailty trajectory was assessed using the Paulson-Lichtenberg Frailty Index, while the cognitive function was evaluated using the Langa-Weir Classification. Results showed that severe frailty was significantly associated with the subsequent decline in cognitive function ( [95% CI] = -0.21 [-0.40, -0.03], = 0.03). In the five identified frailty trajectories, participants with mild frailty (inverted U-shaped, [95% CI] = -0.22 [-0.43, -0.02], = 0.04), mild frailty (U-shaped, [95% CI] = -0.22 [-0.39, -0.06], = 0.01), and frailty (β [95% CI] = -0.34 [-0.62, -0.07], = 0.01) were all significantly associated with the subsequent cognition decline in the elderly. The current study suggested that monitoring and addressing frailty trajectories in older adults may be a critical approach in preventing or mitigating cognitive decline, which had significant implications for healthcare.
%B MedComm (2020) %V 4 %P e296 %G eng %N 3 %R 10.1002/mco2.296 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Frequency and implications of coexistent manifestations of serious illness in older adults with dementia. %A Nothelle, Stephanie %A Bollens-Lund, Evan %A Covinsky, Kenneth E %A Kelley, Amy %K Dementia %K Older Adults %K serious illness %XBACKGROUND: In older adults, serious illness comprises three manifestations: dementia, activity of daily living (ADL) impairment, and other advanced medical conditions (AMC; e.g., end-stage renal disease). Little is known about how dementia and other manifestations of serious illness co-occur. We aim to describe the prevalence of persons with dementia (PWD) who are living with additional manifestations of serious illness, and the implications on healthcare utilization, Medicare costs, caregiving hours and out-of-pocket expenses.
METHODS: In this cross-sectional study, we use data from the 2016 Health and Retirement Study (HRS) linked to Medicare fee-for-service claims. We limited inclusion to adults >65 years. Dementia was determined using validated methodology that incorporates functional and cognitive test scores from HRS. We classified PWD as having dementia alone, dementia and an AMC (irrespective of ADL impairment) or dementia and ADL impairment (without an AMC). Healthcare utilization and Medicare costs were measured in claims, caregiving hours and out-of-pocket expenses were self-reported.
RESULTS: Most PWD (67%) met criteria for another manifestation of serious illness (24% advanced medical condition, 44% ADL impairment). PWD and an AMC had the highest proportion of hospital use and the highest median total Medicare costs ($17,900 vs. $8962 dementia + ADL impairment vs. $4376 dementia alone). Mean total hours of caregiving per month were similar for PWD and an AMC and PWD and ADL impairment (142.9 and 141.9 h, respectively), while mean hours were much lower for PWD alone (47.7 h). Median out-of-pocket costs were highest for PWD and ADL impairment ($13,261) followed by PWD and an AMC ($10,837) and PWD alone ($7017).
CONCLUSIONS: PWD commonly face another manifestation of serious illness. Dementia and ADL impairment was associated with the highest costs for PWD and families while dementia and an AMC was associated with the highest costs for Medicare.
%B J Am Geriatr Soc %G eng %R 10.1111/jgs.18309 %0 Journal Article %J The International Journal of Aging and Human Development %D 2023 %T Gender and the Subjective Well-Being of Older Widows and Widowers. %A Geng, Jing %A Calasanti, Toni M %K gender repertoires %K Happiness %K inequalities %K Life Satisfaction %XPrevious research on older adults who are widowed often focuses on the immediate subjective impacts of spousal loss, and how gender might influence this. Our interest here is on the factors that influence subjective well-being after a period of at least two years' post-bereavement, and how this might differ for men and women. We draw on theoretical considerations from previous research on gender and on widowhood and use two different measures-life satisfaction and happiness-to assess possible differences in this subjective outcome. We used data from the 2014 Health and Retirement Study on 692 widowed adults aged 65 and over (578 females and 114 males) and employed regression and postestimation analyses to examine whether and how gender influences their subjective well-being. Our findings show that gender did not affect overall levels of subjective well-being, regardless of measure. However, gender did influence the predictors, such as total household income, total wealth, and social support from children and friends, for life satisfaction and happiness somewhat differently. Our study highlights the importance of examining gender differences among older widows and widowers and also underlines the importance of introducing different measures of subjective well-being that might yield different yet valuable findings.
%B The International Journal of Aging and Human Development %G eng %R 10.1177/00914150221092990 %0 Journal Article %J Biodemography Soc Biol %D 2023 %T Gender differences in the association of polygenic risk and divergent depression trajectories from mid to late life: a national longitudinal study. %A Chen, Ping %A Li, Yi %A Wu, Fang %K Adult %K Aged %K Aged, 80 and over %K depression %K Depressive Disorder, Major %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Risk Factors %K Sex Factors %XOur research fills a critical gap in the depression literature by utilizing a life course perspective to examine gender-gene interactions in association with depression trajectories over time. Using data from the Health and Retirement Study, we estimated multi-level negative binomial and logistic mixed models to analyze gender-specific trajectories of depressive symptoms (CESD-8) and potential clinical depression risk from middle to late adulthood in relation to gender-by-polygenic-risk (PRS) interactions. We found increasingly greater female-male gaps in the CESD-8 scale and a higher probability of clinical depression risk with increasing polygenic risk scores. Furthermore, females' higher genetic vulnerabilities to depressive conditions than males vary from ages 51 to 90 years, (e.g. 0.28 higher CESD-8 scale for females at ages 76-85 years than for similar-aged males; higher 3.44% probability of depression risk for females at ages 81-85 compared to similar-aged males) (e.g. about 2.40% higher probability of depression risk for females at ages 61-70 years than for similar-aged males) . This study contributes to new knowledge of how gender-by-polygenic-risk interactions are associated with depression trajectories across the life course.
%B Biodemography Soc Biol %V 68 %P 32-53 %G eng %N 1 %R 10.1080/19485565.2023.2196710 %0 Journal Article %J The International Journal of Aging and Human Development %D 2023 %T Gender Disparities in Healthy Aging: A Cross-National Comparative Study in the United States and South Korea from 2006 to 2016. %A Chu, Lanlan %A Lor, Anjelynt %A Moisan, Mary-Genevieve %A Phi, Kieu My %K cross-national studies %K Disparities %K gender %K health %K KLoSA %K Policy %XUsing the 2006-2016 wave of Health and Retirement Study and Korean Longitudinal Study of Aging, this study explores the gender disparities in the health of older adults in the United States and South Korea. A logit model is adopted to explore the differences in the likelihood of aging healthily by gender in two countries. Results indicate that older females in the United States have a significantly higher probability of healthy aging than their male counterparts. However, the opposite finding is demonstrated among the older population in South Korea. These results are verified using various robustness check methods. The heterogeneities in the gender disparities in healthy aging across age groups and income levels are further explored. The gender effect in each healthy aging domain is investigated to understand the underlying causes of gender disparities. These findings can provide cross-national insights for policymakers to establish targeted aging policies with a gender perspective.
%B The International Journal of Aging and Human Development %G eng %R 10.1177/00914150221106643 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Gender of study partners and research participants associated with differences in study partner ratings of cognition and activity level. %A Stites, Shana D %A Gurian, Anna %A Coykendall, Cameron %A Largent, Emily A %A Harkins, Kristin %A Karlawish, Jason %A Coe, Norma B %K activity level %K Cognition %K gender %XOBJECTIVE: Studies of Alzheimer's disease (AD) typically include "study partners" (SPs) who report on participants' cognition and function. Prior studies show SP reports differ depending on the relationship between the SP and participant, that is, spouse or adult child. Adult children SPs are typically female. Could differing reports be due to gender? Knowing this may help explain variability in measurement.
METHODS: The Aging, Demographics and Memory Study (ADAMS) enrolled a subset of participants from the Health and Retirement Study (HRS). Each participant had a SP. Bivariate and multivariable regression models compared 718 SP-participant dyads.
RESULTS: In analyses of four groups defined by SP and participant gender, dyads composed of two women were less likely to identify as White (75.8%, 95%CI 70.4 to 80.5) than dyads composed of two men (93.3%, 95%CI 81.2 to 97.8). In analyses adjusted for severity of cognitive and functional impairment, women SPs rated women participants as more active than they rated men, mean 2.15 (95%CI, 2.07 to 2.22) versus mean 2.30 (95%CI, 2.24 to 2.37), respectively, on a 4-point scale. Similarly, men SPs rated women participants as more active than they rated men, mean 2.1 (95%CI, 2.0 to 2.2) and mean 2.4 (95%CI, 2.3 to 2.5), respectively. In an analysis of cognitively unimpaired participants, women SPs rated participants' memory worse than men SPs did (p<0.05).
DISCUSSION: SP and participant gender influence SPs' reports of another person's cognition and activity level. Our findings expand what is understood about how non-disease factors influence measures of disease severity.
%B J Gerontol B Psychol Sci Soc Sci %8 2023 Feb 15 %G eng %R 10.1093/geronb/gbad026 %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 %XGenetic 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 Journal of Cachexia, Sarcopenia and Muscle %D 2023 %T Grip strength is inversely associated with DNA methylation age acceleration. %A Peterson, Mark D %A Collins, Stacey %A Meier, Helen C S %A Brahmsteadt, Alexander %A Jessica Faul %K Ageing %K DNA Methylation %K Grip strength %K Strength training %XBACKGROUND: There is a large body of evidence linking muscular weakness, as determined by low grip strength, to a host of negative ageing-related health outcomes. Given these links, grip strength has been labelled a 'biomarker of aging'; and yet, the pathways connecting grip strength to negative health consequences are unclear. The objective of this study was to determine whether grip strength was associated with measures of DNA methylation (DNAm) age acceleration.
METHODS: Middle age and older adults from the 2006 to 2008 waves of the Health and Retirement Study with 8-10 years of follow-up were included. Cross-sectional and longitudinal regression modelling was performed to examine the association between normalized grip strength (NGS) and three measures of DNAm age acceleration, adjusting for cell composition, sociodemographic variables and smoking. Longitudinal modelling was also completed to examine the association between change in absolute grip strength and DNAm age acceleration. The three DNAm clocks used for estimating age acceleration include the established DunedinPoAm, PhenoAge and GrimAge clocks.
RESULTS: There was a robust and independent cross-sectional association between NGS and DNAm age acceleration for men using the DunedinPoAm (β: -0.36; P < 0.001), PhenoAge (β: -8.27; P = 0.01) and GrimAge (β: -4.56; P = 0.01) clocks and for women using the DunedinPoAm (β: -0.36; P < 0.001) and GrimAge (β: -4.46; P = 0.01) clocks. There was also an independent longitudinal association between baseline NGS and DNAm age acceleration for men (β: -0.26; P < 0.001) and women (β: -0.36; P < 0.001) using the DunedinPoAm clock and for women only using the PhenoAge (β: -8.20; P < 0.001) and GrimAge (β: -5.91; P < 0.001) clocks. Longitudinal modelling revealed a robust association between change in grip strength from wave 1 to wave 3 was independently associated with PhenoAgeAA (β: -0.13; 95% CI: -0.23, -0.03) and GrimAgeAA (β: -0.07; 95% CI: -0.14, -0.01) in men only (both P < 0.05).
CONCLUSIONS: Our findings provide some initial evidence of age acceleration among men and women with lower NGS and loss of strength over time. Future research is needed to understand the extent to which DNAm age mediates the association between grip strength and chronic disease, disability and mortality.
%B Journal of Cachexia, Sarcopenia and Muscle %G eng %R 10.1002/jcsm.13110 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Have Middle-Aged and Older Americans Become Lonelier? 20-Year Trends From the Health and Retirement Study. %A Surkalim, Daniel L %A Clare, Philip J %A Eres, Robert %A Gebel, Klaus %A Bauman, Adrian %A Ding, Ding %XOBJECTIVES: Despite media and public dialog portraying loneliness as a worsening problem, little is known about how the prevalence of loneliness has changed over time. Our study aims to identify (a) temporal trends in episodic and sustained loneliness (lonely in 1 wave vs consistently lonely in 3 consecutive waves); (b) trends across sociodemographic subgroups by sex, race/ethnicity, birth cohort, education, employment status, marital status, and living alone; and (c) longitudinal predictors of loneliness in middle-aged and older Americans (≥50 years).
METHODS: Based on Waves 3 (1996) to 14 (2018) of the Health and Retirement Study (n = 18,841-23,227), we conducted a series of lagged mixed-effects Poisson regression models to assess trends of episodic and sustained loneliness in the overall and sociodemographic subgroup samples (by sex, race/ethnicity, birth cohort, education, employment, relationship, and living alone status). To examine the predictors of episodic and sustained loneliness, we used a multivariate mixed-effects Poisson regression model with all sociodemographic variables entered into the same model.
RESULTS: Episodic loneliness prevalence decreased from 20.1% to 15.5% and sustained loneliness from 4.6% to 3.6%. Trends were similar across most subgroups. Males, Caucasians, those born in 1928-1945, with university education, working, married/partnered, and those not living alone reported lower episodic and sustained loneliness, although associations with sustained loneliness were stronger.
DISCUSSION: Contrary to common perceptions, loneliness has decreased over 20 years of follow-up in middle-aged and older Americans. Several sociodemographic subgroups have been identified as having a higher risk of loneliness, prompting targeted public health attention.
%B J Gerontol B Psychol Sci Soc Sci %G eng %R 10.1093/geronb/gbad062 %0 Journal Article %J International Studies of Economics %D 2023 %T Health insurance coverage and marriage behavior: Is there evidence of marriage lock? %A Chen, Tianxu %K employer-sponsored health insurance; marriage behavior; marriage lock; Medicare %X Premiums and eligibility for health insurance may cause a “marriage lock,” in which couples stay married for the sake of maintaining health insurance coverage. By using the Health and Retirement Study for adults aged 60–70, I examine whether employer-based health insurance coverage for the spouse discourages divorce for spousal health insurance coverage-dependent individuals. Diverse difference-in-difference models provide evidence of a 7 percentage points increase in the number of divorces upon achieving Medicare eligibility at age 65 for people with spousal insurance coverage relative to those without it. The estimates thus provide evidence that marriage lock exists. © 2023 The Authors. International Studies of Economics published by John Wiley & Sons Australia, Ltd on behalf of Shanghai University of Finance and Economics. %B International Studies of Economics %G eng %R 10.1002/ise3.45 %0 Journal Article %J Journal of Applied Gerontology %D 2023 %T Health Insurance Coverage as a Social Determinant of Osteoporosis Diagnosis in a Population-Based Cohort Study of Older American Adults. %A Godde, Kanya %A Gough Courtney, Margaret %A Roberts, Josephine %K access to care %K Health Disparities %K Insurance %XSocial determinants of health theoretical frameworks identify health insurance coverage as a determinant of older adults' osteoporosis diagnoses, which results in health inequities. In this research, we used the longitudinal Health and Retirement Study dataset of older United States adults, sampled biennially from 2012 to 2016. Logistic regressions estimated odds of osteoporosis diagnosis with and without a bone scan and/or hip fracture, holding insurance type, and health and demographic factors constant. Results were validated using the National Health and Nutrition Examination Survey. Probable underdiagnosing is present in older adults identifying as Black/African American and as males without a bone scan, regardless of fracture status, potentially as products of structural racism and sexism. Models including a bone scan show a reduction in disparities. These findings suggest having a bone scan is still crucial for addressing health inequities in older adults, and remedying barriers to accessing a scan is paramount.
%B Journal of Applied Gerontology %V 42 %P 302-312 %G eng %N 2 %R 10.1177/07334648221132792 %0 Journal Article %J Innovation and Aging %D 2023 %T The Hidden Toll of Incarceration: Exploring the Link Between Incarceration Histories and Pain Among Older Adults in the United States. %A Yang, Yulin %A Lutz, Gabriel %A Zhang, Yilin %A Chen, Chixiang %A Kheirbek, Raya Elfadel %K incarceration %K pain %K Palliative care %XBACKGROUND AND OBJECTIVES: Incarceration is linked to poor health outcomes across the life course. However, little is known whether and to what extent incarceration histories shape pain in later life. This study examines the relationships between incarceration histories and pain outcomes among middle-aged and older adults in the United States.
RESEARCH DESIGN AND METHODS: Data from a nationally representative sample of community-dwelling adults aged 51 and over in the 2012-2018 biennial waves of the U.S. Health and Retirement Study was analyzed to examine how incarceration histories influence older adults' risks of reporting moderate-to-severe pain and pain with physical limitations. We relied on a propensity score matching approach to account for the potential confounding bias. We fit weighted generalized estimating equation models to assess the relationships between incarceration history and pain outcomes. Models were further stratified by gender.
RESULTS: After propensity score matching, our sample included 2,516 respondents aged 65 years on average ( = 8.72), 21% female, and 838 with incarceration histories. Persons with incarceration histories have a greater risk of reporting moderate-to-severe pain (prevalence ratio [PR] = 1.30, 95% confidence Interval [CI]: 1.20, 1.52) and pain with physical limitations (PR = 1.48, 95% CI: 1.30, 1.68) even after adjusting for sociodemographic covariates and early life experiences. In the models stratified by gender, the associations between incarceration histories and incarceration were similar among women and men.
DISCUSSION AND IMPLICATIONS: In a nationally representative sample of older adults (with or without incarceration history), our study demonstrates an independent association between a history of incarceration and pain in later life. Our findings highlight the far-reaching impact of incarceration and the need for developing optimal management strategies to reduce the burden of disabling pain. Interventions should prioritize socioeconomically vulnerable groups who may have the least access to pain treatment in later life.
%B Innovation and Aging %V 7 %P igad116 %G eng %N 10 %R 10.1093/geroni/igad116 %0 Journal Article %J JAMA Network Open %D 2023 %T History of Incarceration and Its Association With Geriatric and Chronic Health Outcomes in Older Adulthood. %A Garcia-Grossman, Ilana R %A Cenzer, Irena %A Steinman, Michael A %A Williams, Brie A %K Activities of Daily Living %K Chronic disease %K Diabetes Mellitus %K Health Care %K Lung Diseases %K Outcome Assessment %XIMPORTANCE: Although incarcerated older adults experience higher rates of chronic disease and geriatric syndromes, it is unknown whether community-dwelling older adults with a history of incarceration are also at risk for worse health outcomes.
OBJECTIVE: To evaluate the association between a history of incarceration and health outcomes, including chronic health conditions and geriatric syndromes, in older age.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study using population-based data from the nationally representative Health and Retirement Study included US community-dwelling adults aged 50 years or older who completed the 2012 or 2014 survey waves assessing self-reported history of incarceration. Statistical analysis was completed from December 2021 to July 2022.
EXPOSURES: Self-reported history of incarceration.
MAIN OUTCOMES AND MEASURES: Geriatric health outcomes included cognitive impairment, mobility impairment, vision impairment, hearing impairment, urinary incontinence, and impairment of activities of daily living (ADLs). Chronic health outcomes included high blood pressure, diabetes, chronic lung disease, heart disease, stroke, mental health conditions, heavy alcohol use, and self-reported health. Survey weights were applied to adjust for the survey design.
RESULTS: Among 13 462 participants, 946 (7.6%) had experienced incarceration (mean [SD] age, 62.4 [7.8] years); compared with 12 516 people with no prior incarceration (mean [SD] age, 66.7 [10.0] years), previously incarcerated adults were more likely to be male (83.0% vs 42.8%; P < .001) and in the lowest quartile of wealth (44.1% vs 21.4%; overall P < .001). After adjusting for age, sex, race and ethnicity, wealth, educational attainment, and uninsured status, a history of incarceration was associated with a 20% to 80% increased risk of all geriatric syndromes evaluated, including impairment of ADLs (relative risk [RR], 1.62; 95% CI, 1.40-1.88) and hearing impairment (RR, 1.22; 95% CI, 1.04-1.44). Incarceration was also associated with increased risk of some chronic diseases, including chronic lung disease (RR, 1.56; 95% CI, 1.27-1.91), mental health conditions (RR, 1.80; 95% CI, 1.55-2.08), and heavy alcohol use (RR, 2.13; 95% CI, 1.59-2.84). Prior incarceration was not associated with diabetes or cardiovascular conditions.
CONCLUSIONS AND RELEVANCE: In this study, at least 1 in 15 older US adults reported a history of incarceration in their lifetime. Past incarceration was associated with many chronic diseases and geriatric syndromes even after accounting for socioeconomic status. These findings suggest that attention to incarceration history may be an important consideration in understanding and mitigating health risks in older age.
%B JAMA Network Open %V 6 %P e2249785 %G eng %N 1 %R 10.1001/jamanetworkopen.2022.49785 %0 Journal Article %J JAMA %D 2023 %T History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers. %A Kezios, Katrina L %A Lu, Peiyi %A Calonico, Sebastian %A Al Hazzouri, Adina Zeki %K Employment %K Income %K Poverty %K Salaries and Fringe Benefits %XIMPORTANCE: Earning a low wage is an increasingly recognized public health concern, yet little research exists on the long-term health consequences of sustained low-wage earning.
OBJECTIVE: To examine the association of sustained low-wage earning and mortality in a sample of workers with hourly wage reported biennially during peak midlife earning years.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal study included 4002 US participants, aged 50 years or older, from 2 subcohorts of the Health and Retirement Study (1992-2018) who worked for pay and reported earning hourly wages at 3 or more time points during a 12-year period during their midlife (1992-2004 or 1998-2010). Outcome follow-up occurred from the end of the respective exposure periods until 2018.
EXPOSURES: Low-wage-less than the hourly wage for full-time, full-year work at the federal poverty line-earning history was categorized as never earning a low wage, intermittently earning a low wage, and sustained earning a low wage.
MAIN OUTCOMES AND MEASURES: Cox proportional hazards and additive hazards regression models sequentially adjusted for sociodemographics, and economic and health covariates were used to estimate associations between low-wage history and all-cause mortality. We examined interaction with sex or employment stability on multiplicative and additive scales.
RESULTS: Of the 4002 workers (aged 50-57 years at the beginning of exposure period and 61-69 years at the end), 1854 (46.3%) were female; 718 (17.9%) experienced employment instability; 366 (9.1%) had a history of sustained low-wage earning; 1288 (32.2%) had intermittent low-wage earning periods; and 2348 (58.7%) had never earned a low wage. In unadjusted analyses, those who had never earned low wages experienced 199 deaths per 10 000 person-years, those with intermittent low wages, 208 deaths per 10 000 person-years, and those with sustained low wages, 275 deaths per 10 000 person-years. In models adjusted for key sociodemographic variables, sustained low-wage earning was associated with mortality (hazard ratio [HR], 1.35; 95% CI, 1.07-1.71) and excess deaths (66; 95% CI, 6.6-125); these findings were attenuated with additional adjustments for economic and health covariates. Significant excess death and elevated mortality risk were observed for workers with sustained low-wage exposure and employment fluctuations (eg, for sustained low-wage × employment fluctuated, HR, 2.18; 95% CI, 1.35-3.53; for sustained low-wage × stable employment, HR, 1.17; 95% CI, 0.89,-1.54; P for interaction = .003).
CONCLUSIONS AND RELEVANCE: Sustained low-wage earning may be associated with elevated mortality risk and excess deaths, especially when experienced alongside unstable employment. If causal, our findings suggest that social and economic policies that improve the financial standing of low-wage workers (eg, minimum wage laws) could improve mortality outcomes.
%B JAMA %V 329 %P 561-573 %G eng %N 7 %R 10.1001/jama.2023.0367 %0 Web Page %D 2023 %T How does physical mobility affect working years and income? %A National Safety Council %K Income %K physical mobility %K working years %I National Safety Council %G eng %U https://www.safetyandhealthmagazine.com/articles/24810-study-explores-physical-mobility-in-later-years-and-income %0 Journal Article %J J Aging Soc Policy %D 2023 %T How Medicaid Financial Eligibility Rules Exclude Financially and Medically Vulnerable Older Adults. %A Cohen, Marc A %A Tavares, Jane %K Finances %K Medicaid %K Older Adults %XMillions of older Americans rely on Medicaid because it is the largest payer of long-term services and supports. To qualify for the program, low-income individuals age 65 and over must meet income standards based on the dated Federal Poverty Level as well as asset tests that are often viewed as quite stringent. There has long been concern that current eligibility standards exclude many adults with significant health and financial vulnerabilities. We use updated household socio-demographic and financial information to simulate the impacts of five alternative financial eligibility standards on the number and profile of older adults that would gain Medicaid coverage. The study clearly demonstrates that a large number of financially- and health-vulnerable older adults are excluded from the Medicaid program under current policy. The study highlights the implications for policymakers of updating Medicaid financial eligibility standards to assure that Medicaid benefits are targeted to vulnerable older adults who need them.
%B J Aging Soc Policy %P 1-16 %G eng %R 10.1080/08959420.2023.2195784 %0 Journal Article %J Frontiers in immunology %D 2023 %T Immune cells are associated with mortality: the Health and Retirement Study. %A Seshadri, Gokul %A Vivek, Sithara %A Prizment, Anna %A Crimmins, Eileen M %A Klopack, Eric T %A Jessica Faul %A Guan, Weihua %A Meier, Helen C S %A Bharat Thyagarajan %K Aging %K Humans %K Immunosenescence %K Inflammation %K Retirement %K T-Lymphocyte Subsets %XINTRODUCTION: Age-related immunosenescence is characterized by changes in immune cell subsets and is associated with mortality. However, since immunosenescence is associated with other concurrent age-related changes such as inflammation and multi-organ dysfunction, it is unclear whether the association between age-related immunosenescence and mortality is independent of other concurrent age-related changes. To address these limitations, we evaluated the independent association between immune cell subsets and mortality after adjustment for age-related inflammation and biologic age.
METHODS: Data for this study was obtained from the 2016 interview of the Health and Retirement Study (N=6802). Cox proportional hazards regression models were used to estimate the association between 25 immune cell subsets (11 T-cell subsets, 4 B-cell subsets, 3 monocyte subsets, 3 natural killer cell subsets, 3 dendritic cell subsets, and neutrophils) and 4-year mortality adjusting for covariates such as the Klemera-Doubal algorithm biological age, chronological age, gender, race/ethnicity, BMI, smoking status, comorbidity index, CMV seropositivity, and inflammatory latent variable comprising C-reactive protein, and 4 cytokines (interleukin-10, interleukin-1 receptor antagonist, interleukin-6, and soluble tumor necrosis factor).
RESULTS: Four hundred and seventy-six participants died during the study period with an overall median follow up time of 2.5 years. After controlling for covariates and adjustment for sample-weights, total T cells [HR: 0.86, p=0.004], NK CD56LO cells [HR: 0.88, p=0.005], and neutrophils [HR: 1.22, p=0.004] were significantly associated with mortality.
CONCLUSIONS: These findings support the idea that an aging immune system is associated with short-term mortality independent of age-related inflammation or other age-related measures of physiological dysfunction. If replicated in other external cohorts, these findings could identify novel targets for both monitoring and intervention to reduce the age-related mortality.
%B Frontiers in immunology %V 14 %P 1280144 %G eng %R 10.3389/fimmu.2023.1280144 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Impacts of Caregiving on Health of New Spousal Caregivers to Older Adults in the United States: A Coarsened Exact Matching Analysis. %A Liu, Ruotong %A Chi, Iris %A Wu, Shinyi %XOBJECTIVES: Spousal caregivers of older adults, especially new spousal caregivers, face increased risks of negative health outcomes due to the demands of caregiving and their own health decline. Estimating the impacts of caregiving on health without controlling for caregivers' own aging-related health decline could exaggerate the negative health consequences of caregiving, while focusing solely on caregivers could result in selection bias where healthier individuals enter and/or remain in caregiving. This study aims to estimate the impacts of caregiving on health of new spousal caregivers while controlling for observable confounders.
METHODS: We utilized coarsened exact matching analysis to compare health outcomes between new spousal caregivers and spousal non-caregivers using pooled panel data from 2006 to 2018 in the Health and Retirement Study. We analyzed 242,123 person-wave observations from 42,180 unique individuals, among whom 3,927 were new spousal caregivers. Variables used for matching were classified into three categories: care needs, willingness to provide care, and ability to provide care. Two-year outcomes assessed are spouse's self-rated health, depressive symptoms, and cognitive functioning.
RESULTS: A total of 3,417 (87.01%) new spousal caregivers were matched with 129,798 observations of spousal non-caregivers. Regression analysis indicated being a new spousal caregiver was associated with a 0.18 (SE=0.05) unit increase in number of depressive symptoms. No statistically significant results were identified for self-rated health and cognitive functioning.
DISCUSSION: Our results highlighted the needs to address mental health among new spousal caregivers and emphasized the importance of addressing mental health in long-term care programs and policies.
%B J Gerontol B Psychol Sci Soc Sci %G eng %R 10.1093/geronb/gbad064 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia. %A Hsu, Kristie Y %A Cenzer, Irena %A Harrison, Krista L %A Ritchie, Christine S %A Waite, Linda %A Kotwal, Ashwin %K Dementia %K depression %K health %K Loneliness %K Marital quality %K sickness %K Spouses %XBACKGROUND: Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes.
METHODS: We used a US population-based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3-item scale), depressive symptoms (CESD-8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health-related characteristics. We then tested for interaction terms between marital quality (4-item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms.
RESULTS: The sample was 55% women and on average 67-years-old (range: 50-97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20%, CIND: 23%, PLwD: 29%; p = 0.04), depressed (NCI: 8%, CIND: 15%, PLwD: 14%; p < 0.01), and both (NCI: 4%, CIND: 9%, PLwD: 7%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p-value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37).
CONCLUSIONS: One in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high-quality social connection, clinical teams might improve the lives of older couples facing dementia.
%B J Am Geriatr Soc %G eng %R 10.1111/jgs.18520 %0 Journal Article %J Res Aging %D 2023 %T Income-Related Inequalities in Physical and Cognitive Health Domains Over the Later Life Course: Longitudinal Evidence From the U.S. (1992-2016). %A Cheng, Mengling %A Sommet, Nicolas %A Jopp, Daniela S %A Spini, Dario %K cognitive %K Income %K inequalities %K physical %XThis study aims to investigate changes in the income-health gradient over the later life course. We test the age-as-leveler, the cumulative advantage/disadvantage, and the persistent inequality pattern for physical and cognitive health domains, and analyze whether these patterns are gendered. We used HRS data (1992-2016) and Poisson growth curve models to predict multimorbidity (33,860 participants) as an indicator of physical health and memory (25,291 participants) as an indicator of cognitive health. We disentangled the within-participant from the between-participant effects. For multimorbidity, the income-health gradient weakened as individuals aged; whereas for memory, the income-health gradient strengthened as individuals aged. The cumulative advantage/disadvantage of higher/lower income on memory may be more pronounced among women than men. Findings were confirmed by sensitivity analyses. Findings suggest that the support for the age-as-leveler or cumulative advantage/disadvantage pattern may depend on health domains and the effect strength may depend on gender.
%B Res Aging %P 1640275231183438 %G eng %R 10.1177/01640275231183438 %0 Generic %D 2023 %T Inequalities in disability-free and disabling multimorbid life expectancy in Costa Rica, Mexico, and the United States %A Anastasia A. Lam %A Katherine Keenan %A Genevieve Cezard %A Hill Kulu %A Mikko Myrskylä %K Ageing %K Chronic Diseases %K Costa Rica %K Developing Countries %K Inequality %K Life Expectancy %K Mexico %K USA %X Existing research on multimorbidity (two or more co-existing chronic diseases) has mainly been cross-sectional, prevalence-based, and from high-income countries, although rates of chronic diseases and related mortality are highest in low- and middle-income countries. There is also a lack of research comparing countries at varying levels of development to determine how multimorbidity progression might differ. This study uses longitudinal data from Costa Rica, Mexico, and the United States and an incidence-based multistate Markov approach to estimate multimorbid life expectancy (MMLE): the years someone is expected to live with multimorbidity. We disaggregate MMLE into disability-free and disabling states to understand severity progression and stratify models by gender and education to study within-country heterogeneity. Individuals from Costa Rica have the lowest MMLE, followed by those from Mexico, then the United States. Individuals from the United States spend about twice as long with disability-free MMLE compared to others. Women generally have higher MMLE than men across countries. In the United States, disability-free MMLE increases and disabling MMLE decreases with education. This study found widespread MMLE inequalities in gender, education, and disability status. More attention must be paid to the drivers of these disparities, such as life course and health system differences across contexts. %G eng %R 10.4054/MPIDR-WP-2023-002 %0 Journal Article %J Journal of the American Geriatrics Society %D 2023 %T Internet usage and the prospective risk of dementia: A population-based cohort study. %A Cho, Gawon %A Betensky, Rebecca A %A Chang, Virginia W %K Dementia %K Health Disparities %K Internet usage %XBACKGROUND: Little is known about the long-term cognitive impact of internet usage among older adults. This research characterized the association between various measures of internet usage and dementia.
METHODS: We followed dementia-free adults aged 50 to 64.9 for a maximum of 17.1 (median=7.9) years using the Health and Retirement Study. The association between time-to-dementia and baseline internet usage was examined using cause-specific Cox models, adjusting for delayed entry and covariates. We also examined the interaction between internet usage and education, race-ethnicity, sex, and generation. Furthermore, we examined whether the risk of dementia varies by the cumulative period of regular internet usage to see if starting or continuing usage in old age modulates subsequent risk. Finally, we examined the association between the risk of dementia and daily hours of usage. Analyses were conducted from September 2021 to November 2022.
RESULTS: In 18,154 adults, regular internet usage was associated with approximately half the risk of dementia compared to non-regular usage, CHR (Cause-specific Hazard Ratio)=0.57, 95%CI=0.46-0.71. The association was maintained after adjustments for self-selection into baseline usage (CHR=0.54, 95%CI=0.41-0.72) and signs of cognitive decline at the baseline (CHR=0.62, 95%CI=0.46-0.85). The difference in risk between regular and non-regular users did not vary by educational attainment, race-ethnicity, sex, and generation. In addition, additional periods of regular usage were associated with significantly reduced dementia risk, CHR=0.80, 95%CI=0.68-0.95. However, estimates for daily hours of usage suggested a U-shaped relationship with dementia incidence. The lowest risk was observed among adults with 0.1-2 hours of usage, though estimates were non-significant due to small sample sizes.
CONCLUSIONS: Regular internet users experienced approximately half the risk of dementia than non-regular users. Being a regular internet user for longer periods in late adulthood was associated with delayed cognitive impairment, although further evidence is needed on potential adverse effects of excessive usage. This article is protected by copyright. All rights reserved.
%B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.18394 %0 Journal Article %J Research on Aging %D 2023 %T Job Quality in the Late Career in Sweden, Japan and the United States. %A Platts, Loretta G %A Sacco, Lawrence B %A Hiyoshi, Ayako %A Westerlund, Hugo %A Cahill, Kevin E %A König, Stefanie %K international comparative study %K post-retirement work %K Working conditions %K working retirees %XIncreasing numbers of older workers continue to work after being eligible to claim a state pension, yet little is known about the quality of these jobs. We examine how psychosocial and physical job quality as well as job satisfaction vary over the late career in three contrasting national settings: Sweden, Japan and the United States. Analyses using random effects modelling drew on data from the Swedish Longitudinal Occupational Survey of Health ( = 13,936-15,520), Japanese Study of Ageing and Retirement ( = 3704) and the Health and Retirement Study ( = 6239 and 8002). Age was modelled with spline functions in which two knots were placed at ages indicating eligibility for pensions claiming or mandatory retirement. In each country, post-pensionable-age jobs were generally less stressful, freer and more satisfying than jobs held by younger workers, results that held irrespective of gender or education level.
%B Research on Aging %G eng %R 10.1177/01640275221075985 %0 Journal Article %J Population Research and Policy Review %D 2023 %T Life, Longevity, and the Pursuit of Happiness: The Role of Disability in Shaping Racial and Sex Disparities in Living a Long and Happy Life %A Bardo,Anthony R. %A Cummings,Jason L. %K Activities of Daily Living %K Black People %K Black white differences %K Black women %K Business And Economics–Economic Situation And Conditions %K Data quality %K Demographers %K Demography %K Disability %K Disadvantaged %K Gender Differences %K Happiness %K health %K Inequality %K Intersectionality %K Life Expectancy %K Life span %K limitations %K Longevity %K Marital Status %K Men %K Older people %K Peers %K Quality of Life %K race %K Racial differences %K Racial inequality %K Retirement %K Severity %K Sex differences %K Subjective well-being %K Wealth %K women %X Disability-free life expectancy is a common measure used by demographers to gauge quantity and quality of life. Yet, the extent to which positive dimensions of quality of life differ by disability status remains unexplored. Using data from the Health and Retirement Study (N = 16,614), we estimated happy life expectancy by age, race, sex, and severe Activities of Daily Living (ADL) limitations. First, results show that happy life expectancy differed substantially by disability status, as older adults with severe ADL limitations experienced 50–60% fewer remaining years of their life happy compared to their more able-bodied peers. Second, healthy Black women and men at age fifty can expect to live five fewer years of their remaining life happy compared to their White peers, but there were no significant race or sex differences among individuals with severe ADL limitations. Finally, the racial gap in Happy Life Expectancy between Black and White women was largely accounted for by group differences in marital status, education, and wealth, but Black men continued to be disadvantaged compared to their White peers. Implications of this study point to a need to critically examine the intersections of race and sex to develop a clearer portrait of the pattern and underlying factors associated with social disparities in longevity and quality of life. Findings highlight the importance of considering positive dimensions of quality of life alongside measures of illness, disability, or disease when determining whether we are adding life to years or just years to life. %B Population Research and Policy Review %V 42 %P 72 %@ 01675923 %G eng %U https://proxy.lib.umich.edu/login?url=https://www.proquest.com/scholarly-journals/life-longevity-pursuit-happiness-role-disability/docview/2849184861/se-2 %0 Journal Article %J Journal of Aging and Health %D 2023 %T Life Satisfaction and Intergenerational Mobility Among Older Hispanics in the United States. %A Ramirez Surmeier, Ladanya %A Taylor, Miles G %A Carr, Dawn C %K Hispanics %K intergenerational mobility %K Life Satisfaction %XOBJECTIVES: To investigate the impact of intergenerational mobility-measured as the difference between one's own and one's father's education level-on overall life-satisfaction among Hispanic, White, and Black older Americans.
METHODS: Data from the Health and Retirement Study were used to estimate life satisfaction by race/ethnicity using ordinary least squares regression (N = 5,057).
RESULTS: Hispanic and Black older Americans report greater educational gains relative to their fathers compared to Whites. Despite having the lowest reported education levels, Hispanics report the highest life satisfaction across race/ethnic groups. However, net of education level and other factors, intergenerational mobility decreased rather than increased life satisfaction for Hispanic older Americans.
DISCUSSION: These results indicate that intergenerational mobility may not confer equal benefits for overall life satisfaction across racial/ethnic groups. As Hispanic individuals continue to achieve higher education levels, it is unclear whether upward mobility will translate to positive or negative assimilation consequences.
%B Journal of Aging and Health %V 35 %P 50-61 %G eng %N 1-2 %R 10.1177/08982643221100788 %0 Journal Article %J Journal of Alzheimer's Disease : JAD %D 2023 %T Life-Sustaining Treatments Among Medicare Beneficiaries with and without Dementia at the End of Life. %A Zhu, Yingying %A Olchanski, Natalia %A Cohen, Joshua T %A Freund, Karen M %A Jessica Faul %A Fillit, Howard M %A Neumann, Peter J %A Lin, Pei-Jung %K Aged %K Alzheimer disease %K Cohort Studies %K Death %K Humans %K Medicare %K Terminal Care %K United States %XBACKGROUND: Older adults with dementia including Alzheimer's disease may have difficulty communicating their treatment preferences and thus may receive intensive end-of-life (EOL) care that confers limited benefits.
OBJECTIVE: This study compared the use of life-sustaining interventions during the last 90 days of life among Medicare beneficiaries with and without dementia.
METHODS: This cohort study utilized population-based national survey data from the 2000-2016 Health and Retirement Study linked with Medicare and Medicaid claims. Our sample included Medicare fee-for-service beneficiaries aged 65 years or older deceased between 2000 and 2016. The main outcome was receipt of any life-sustaining interventions during the last 90 days of life, including mechanical ventilation, tracheostomy, tube feeding, and cardiopulmonary resuscitation. We used logistic regression, stratified by nursing home use, to examine dementia status (no dementia, non-advanced dementia, advanced dementia) and patient characteristics associated with receiving those interventions.
RESULTS: Community dwellers with dementia were more likely than those without dementia to receive life-sustaining treatments in their last 90 days of life (advanced dementia: OR = 1.83 [1.42-2.35]; non-advanced dementia: OR = 1.16 [1.01-1.32]). Advance care planning was associated with lower odds of receiving life-sustaining treatments in the community (OR = 0.84 [0.74-0.96]) and in nursing homes (OR = 0.68 [0.53-0.86]). More beneficiaries with advanced dementia received interventions discordant with their EOL treatment preferences.
CONCLUSIONS: Community dwellers with advanced dementia were more likely to receive life-sustaining treatments at the end of life and such treatments may be discordant with their EOL wishes. Enhancing advance care planning and patient-physician communication may improve EOL care quality for persons with dementia.
%B Journal of Alzheimer's Disease : JAD %V 96 %P 1183-1193 %G eng %N 3 %R 10.3233/JAD-230692 %0 Journal Article %J Obesity (Silver Spring) %D 2023 %T Longitudinal body weight dynamics in relation to cognitive decline over two decades: A prospective cohort study. %A Zhou, Tianjing %A Chen, Hui %A Huang, Yuhui %A Wang, Binghan %A Zheng, Yan %A Wang, Liang %A Rong, Shuang %A Ma, Yuan %A Yuan, Changzheng %K Aged %K Body Weight %K Cognitive Dysfunction %K Humans %K Longitudinal Studies %K Middle Aged %K Prospective Studies %K Weight Gain %K Weight Loss %XOBJECTIVE: The aim of this study was to investigate the associations of body weight change (BWC) and body weight variability (BWV) with changes in cognitive function.
METHODS: In 10,340 Health and Retirement Study participants (mean age: 68.0 years), body weight was reported biennially from 1993/1994 to 2016, and cognitive function was measured biennially from 1998 to 2016. We calculated BWC and BWV as the slope and root-mean-square error by regressing body weight on time for each individual. BWC was categorized by quintiles (Q): stable weight (Q2 to Q4), weight loss (Q1), and weight gain (Q5). BWV was categorized by tertiles. We used linear mixed regression models to assess associations with cognitive change.
RESULTS: Compared with stable weight (median: 0 kg/y), weight loss (median: -1.3 kg/y) predicted faster cognitive decline as demonstrated by mean difference of -0.023 (95% CI: -0.027 to -0.019) in cognitive change z score per year, whereas weight gain (median: 1 kg/y) was related to slower cognitive decline (β = 0.006; 95% CI: 0.003 to 0.009). Larger BWV was also associated with faster cognitive decline (β comparing the top with bottom tertile = -0.003; 95% CI: -0.006 to -0.0002). Similar associations were observed for episodic and working memory.
CONCLUSIONS: Weight loss and large BWV over a long time independently predicted faster cognitive decline in middle-aged and older adults, underscoring the importance of long-term dynamic body weight monitoring.
%B Obesity (Silver Spring) %V 31 %P 852-860 %8 2023 Mar %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/36782381?dopt=Abstract %R 10.1002/oby.23671 %0 Journal Article %J BMC Med %D 2023 %T Long-term variability in physiological measures in relation to mortality and epigenetic aging: prospective studies in the USA and China. %A Chen, Hui %A Zhou, Tianjing %A Wu, Shaowei %A Cao, Yaying %A Zong, Geng %A Yuan, Changzheng %K Aging %K China %K Epigenesis, Genetic %K Humans %K Longitudinal Studies %K Prospective Studies %XBACKGROUND: Visit-to-visit body weight variability (BWV), pulse rate variability (PRV), and blood pressure variability (BPV) have been respectively linked to multiple health outcomes. The associations of the combination of long-term variability in physiological measures with mortality and epigenetic age acceleration (EAA) remain largely unknown.
METHODS: We constructed a composite score of physiological variability (0-3) of large variability in BWV, PRV, and BPV (the top tertiles) in 2006/2008-2014/2016 in the Health and Retirement Study (HRS) and 2011-2015 in the China Health and Retirement Longitudinal Study (CHARLS). All-cause mortality was documented through 2018. EAA was calculated using thirteen DNA methylation-based epigenetic clocks among 1047 participants in a substudy of the HRS. We assessed the relation of the composite score to the risk of mortality among 6566 participants in the HRS and 6906 participants in the CHARLS by Cox proportional models and then investigated its association with EAA using linear regression models.
RESULTS: A higher score of variability was associated with higher mortality risk in both cohorts (pooled hazard ratio [HR] per one-point increment, 1.27; 95% confidence interval [CI], 1.18, 1.39; P-heterogeneity = 0.344), after adjustment for multiple confounders and baseline physiological measures. Specifically, each SD increment in BWV, PRV, and BPV was related to 21% (95% CI: 15%, 28%), 6% (0%, 13%), and 12% (4%, 19%) higher hazard of mortality, respectively. The composite score was significantly related to EAA in second-generation clocks trained on health outcomes (e.g., standardized coefficient = 0.126 in the Levine clock, 95% CI: 0.055, 0.196) but not in most first-generation clocks trained on chronological age.
CONCLUSIONS: Larger variability in physiological measures was associated with a higher risk of mortality and faster EAA.
%B BMC Med %V 21 %P 20 %8 2023 Jan 16 %G eng %N 1 %R 10.1186/s12916-022-02674-w %0 Web Page %D 2023 %T Lower-Middle Class Americans Near Retirement are Worse Off Than 20 Years Ago, New USC and Columbia Study Shows %A USC Schaeffer Center %K lower-middle class %K Retirement %I Schaeffer Center, University of Southern California %G eng %U https://healthpolicy.usc.edu/article/forgotten-middle/ %0 Journal Article %J Journal of Applied Gerontology %D 2023 %T Marital Quality and Alcohol Use among Couples in Mid- and Later-Life. %A Bulanda, Jennifer Roebuck %A Curl, Angela L %A Roberts, Amy Restorick %K actor-partner interdependence model %K Drinking %K Marriage %K relationship satisfaction %XSpouses influence one another's drinking behavior, but little research has explored how relationship quality may impact older couples' alcohol use. Using data from the 2014-2018 waves of the Health and Retirement Study (HRS) and actor-partner interdependence models, we examined how marital quality is related to total alcohol consumption and risk of heavy drinking for married couples over age 50. Neither husbands' nor wives' perceptions of negative marital quality were related to changes in heavy drinking or number of drinks consumed over the observation period. However, wives' positive marital quality was associated with increased risk of heavy alcohol use for both wives and husbands, and with an increase in the number of drinks wives consume over time. Couples over age 50 do not appear to use alcohol as a way of coping with negative marital relationships, but rather may increase their drinking in the context of positive relationships.
%B Journal of Applied Gerontology %V 42 %P 1068-1077 %G eng %N 5 %R 10.1177/07334648221143305 %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 %XFew 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 Social Science & Medicine %D 2023 %T Measuring spatial availability of children for older adults with disability. %A Cho, Tsai-Chin %A Park, Bona %A Choi, Hwajung %K ADL/IADL disability %K Family availability %K Geographic dispersion of children %K Intergenerational caregiving %K Sociodemographic disparity %XBACKGROUND: Having an adult child living with or nearby may prevent parents with disability from moving to nursing homes and reduce the use of paid care services. Despite the profound implications for care resources and utilization among older adults, there is no measure summarizing the spatial availability of all adult children for an older adult. Our study aims to develop a holistic measure of adult children's spatial availability to assess potential family care resources for older adults with disability.
METHODS: Data were obtained from the population-based, longitudinal study in the U.S., the Health and Retirement Study (HRS). We selected a nationally representative sample of older adults 55+ years with disability. Using multivariable two-part regression models, we developed a care-weighted child spatial availability for caregiving (CSAC) index, which summarizes the spatial dispersion of all adult children accounting for potential caregiving associated with distance. We also constructed a reference index of child spatial proximity (CSP) focusing only on spatial distance by employing Gaussian kernel weighting functions.
RESULTS: CSAC index highlights the great importance of having an adult child in the same household (vs. nearby or far) for receiving care among older adults with disability, compared to the CSP index, showing relatively a gradual decline over the spatial distance. Both indices vary substantially by older adults' sociodemographic attributes.
CONCLUSIONS: The holistic indices of adult child spatial availability will contribute to assessing care resources for older adults, albeit future development is needed to extend the utility of the indices tailored for specific care needs.
%B Social Science & Medicine %V 335 %P 116201 %G eng %R 10.1016/j.socscimed.2023.116201 %0 Journal Article %J Alzheimer's & Dementia (Amsterdam, Netherlands) %D 2023 %T Memory and language cognitive data harmonization across the United States and Mexico. %A Arce Rentería, Miguel %A Briceño, Emily M %A Chen, Diefei %A Saenz, Joseph %A Lindsay C Kobayashi %A Gonzalez, Christopher %A Vonk, Jet M J %A Richard N Jones %A Jennifer J Manly %A Wong, Rebeca %A David R Weir %A Kenneth M. Langa %A Gross, Alden L %K Alzheimer's disease %K cognitive aging %K cross‐cultural %K cultural neuropsychology %K harmonization %XINTRODUCTION: We used cultural neuropsychology-informed procedures to derive and validate harmonized scores representing memory and language across population-based studies in the United States and Mexico.
METHODS: Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS-HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We statistically co-calibrated memory and language domains and performed differential item functioning (DIF) analysis using a cultural neuropsychological approach. We examined relationships among harmonized scores, age, and education.
RESULTS: We included 3170 participants from the HRS-HCAP (age = 76.6 [standard deviation (SD): 7.5], 60% female) and 2042 participants from the Mex-Cog (age = 68.1 [SD: 9.0], 59% female). Five of seven memory items and one of twelve language items demonstrated DIF by study. Harmonized memory and language scores showed expected associations with age and education.
DISCUSSION: A cultural neuropsychological approach to harmonization facilitates the generation of harmonized measures of memory and language function in cross-national studies.
HIGHLIGHTS: We harmonized memory and language scores across studies in the United States and Mexico.A cultural neuropsychological approach to data harmonization was used.Harmonized scores showed minimal measurement differences between cohorts.Future work can use these harmonized scores for cross-national studies of Alzheimer's disease and related dementias.
%B Alzheimer's & Dementia (Amsterdam, Netherlands) %V 15 %P e12478 %G eng %N 3 %R 10.1002/dad2.12478 %0 Journal Article %J Sleep %D 2023 %T Mental and Physical Health Pathways Linking Insomnia Symptoms to Cognitive Performance 14 Years Later. %A Zaheed, Afsara B %A Chervin, Ronald D %A Spira, Adam P %A Zahodne, Laura B %K cognitive aging %K Dementia %K depression %K gender %K insomnia %K neuropsychology %K vascular diseases %XSTUDY OBJECTIVES: Insomnia may be a modifiable risk factor for later-life cognitive impairment. We investigated: (1) which insomnia symptoms are associated with subsequent cognitive functioning across domains; (2) whether insomnia-cognition associations are mediated by mental and physical health; and (3) whether these associations are modified by gender.
METHODS: Participants included 2,595 adults ages 51-88 at baseline (Mage=64.00±6.66, 64.5% women) in the Health and Retirement Study. The frequency of insomnia symptoms (difficulty initiating sleep, nighttime awakenings, early awakenings, and feeling unrested upon awakening) at baseline (2002) were quantified using a modified Jenkins Sleep Questionnaire. Cognition was assessed in 2016 via the Harmonized Cognitive Assessment Protocol and operationalized with factor scores corresponding to five domains. Depressive symptoms and vascular conditions in 2014 were assessed via self-report. Structural equation models estimated total, indirect, and direct effects of insomnia symptoms on subsequent cognition through depressive symptoms and vascular diseases, controlling for baseline sociodemographics and global cognition.
RESULTS: Frequent difficulty initiating sleep was associated with poorer episodic memory, executive function, language, visuoconstruction, and processing speed 14 years later (-0.06≤β≤-0.04; equivalent to 2.2-3.4 years of aging). Depressive symptoms explained 12.3%-19.5% of these associations and vascular disease explained 6.3%-14.6% of non-memory associations. No other insomnia symptoms were associated with cognition, and no associations were modified by gender.
CONCLUSIONS: Difficulty initiating sleep in later life may predict future cognitive impairment through multiple pathways. Future research with longitudinal assessments of insomnia, insomnia treatments, and cognition is needed to evaluate insomnia as a potential intervention target to optimize cognitive aging.
%B Sleep %V 46 %P zsac262 %G eng %N 3 %R 10.1093/sleep/zsac262 %0 Report %D 2023 %T Methods and (Lack of) Theory in Digital Inclusion, Digital Divide, and Digital Equity Research on Older Adults %A Alfred Chikomba %A Anne Goulding %A Lara Sanderson %A Allan Sylvester %A Jennifer Campbell-Meier %K and Inclusion in Digital Government: Narrowing the Divides %K Digital Divide %K digital equity %K digital inclusion %K Diversity %K Equity %K Literature Review %K maturity %X Older adults, as a group, have been the focus of considerable attention from digital inclusion researchers. The paper analyses literature on the digital inclusion, digital divide, and digital equity of older adults from the last five years (2017-2022) to explore the extent to which recent digital inclusion research considers developments in the field and explores how research has progressed from exploration to theory building and the empirical testing of models. The paper contributes to our understanding of digital inclusion research on older adults through an analysis of methodologies and theories employed, and the topics investigated. Trends, deficits and gaps for future research are identified, with suggestions for how our knowledge, understanding and conceptualization of older adults’ digital inclusion may be advanced further. %B 56th Hawaii International Conference on System Sciences %I Victoria University of Wellington %C Wellington, New Zealand %P 1869 %G eng %0 Journal Article %J Chronic Stress (Thousand Oaks, Calif.) %D 2023 %T More Problems, More Pain: The Role of Chronic Life Stressors and Racial/Ethnic Identity on Chronic Pain Among Middle-Aged and Older Adults in the United States. %A Spector, Antoinette L %A Quinn, Katherine G %A Wang, Inga %A Gliedt, Jordan A %A Fillingim, Roger B %A Cruz-Almeida, Yenisel %K Chronic pain %K Chronic stressors %K Health and Retirement Study %K high-impact chronic pain %K middle-aged and older adults %XThere is a high prevalence of chronic pain among middle-aged and older adults in the United States. Chronic life stressors have been shown to have detrimental consequences for myriad health conditions, including chronic pain. However, there is limited evidence on the types of chronic life stressors that affect middle-aged and older adults and how these stressors influence the chronic pain burden in this population. Moreover, the interaction between chronic life stressors and racial/ethnic identity remains poorly understood as it relates to chronic pain. The current analysis used the 2018 Health and Retirement Study to investigate relationships between chronic life stressors and odds to experience any chronic pain and high-impact chronic pain. Chronic life stressors were characterized, overall and by racial/ethnic identity, and the main and interaction effects were calculated to evaluate relationships between chronic life stressors, racial/ethnic identity, and odds of experiencing any chronic pain and high-impact chronic pain. Results indicate that in 2018, the most common chronic life stressor among middle-aged and older adults was dealing with their own health problems (68%), followed by dealing with the physical or emotional issues affecting a spouse or child (46%). Adjusted analyses showed that a higher total of chronic life stressors increased the odds of middle-aged and older adults experiencing any chronic pain and high-impact chronic pain. There were no significant interactions between the overall chronic life stress burden and racial/ethnic identity as a predictor of odds to experience any chronic pain or high-impact chronic pain, but significant interaction effects were found related to specific chronic life stressors. Findings underscore the significant impact of chronic life stressors on the chronic pain burden among middle-aged and older adults in the United States, which cut across racial/ethnic identity.
%B Chronic Stress (Thousand Oaks, Calif.) %V 7 %P 24705470231208281 %G eng %R 10.1177/24705470231208281 %0 Journal Article %J PLoS One %D 2023 %T More than just a bad day? Traumatic life events and self-control in old age. %A Choung, Youngjoo %A Pak, Tae-Young %K Armed Conflicts %K Child %K Humans %K Retrospective Studies %K Self-control %K Stress Disorders, Post-Traumatic %K Surveys and Questionnaires %XThe behavioral economics literature suggests that exposure to traumatic events shifts preference features including risk aversion and time preference. In this study, we examined the association between traumatic life events and self-control in old age. Data were obtained from the Health and Retirement Study, which offers retrospective data on trauma exposure and early life characteristics. The results showed that experiences of serious physical attacks or assaults is associated with a 3.1% reduction in self-control, adjusted for demographic and childhood socioeconomic characteristics. The attacks or assaults were experienced approximately 30 years prior to the survey, indicating that traumatic life events exert a lasting influence on self-control. Further analyses found no difference in the association between the experience of serious physical attacks or assaults and self-control according to the timing of occurrence. Our findings are consistent with the evidence that experiences of natural disasters or armed conflicts increase impatience among survivors.
%B PLoS One %V 18 %P e0266312 %8 2023 %G eng %N 2 %R 10.1371/journal.pone.0266312 %0 Journal Article %J Alzheimer's & Dementia %D 2023 %T Multimorbidity burden and developmental trajectory in relation to later-life dementia: A prospective study. %A Chen, Hui %A Zhou, Yaguan %A Huang, Liyan %A Xu, Xiaolin %A Yuan, Changzheng %K Dementia %K healthy aging %K multimorbidity %XINTRODUCTION: This study assessed the associations of multimorbidity burden and its developmental trajectory with later-life dementia.
METHODS: Among 5923 Health and Retirement Study participants, major chronic conditions including hypertension, diabetes mellitus, cancer, lung diseases, heart disease, stroke, psychological disorders, and arthritis were self- or proxy-reported in 1994-2008. Dementia diagnosis was self- or proxy-reported in 2008-2018. We used Cox regression to assess the associations of multimorbidity with incident dementia.
RESULTS: During follow-up (median = 8 years), 701 participants developed dementia. Each additional chronic condition in 2008 was related to 15% (confidence interval: 9% to 22%) higher hazard of dementia. Multimorbidity trajectories in 1994-2008 were classified as "rapid growth", "steady growth", "slow growth", and "no new condition" by the group-based trajectory modelling methods. Compared to "no new condition", the "rapid growth" trajectory was related to 32% (3% to 69%) higher dementia risk.
CONCLUSIONS: Both multimorbidity burden and its developmental trajectory were prospectively associated with risk of dementia.
%B Alzheimer's & Dementia %G eng %R 10.1002/alz.12840 %0 Journal Article %J Ann Am Thorac Soc %D 2023 %T National Prevalence of Social Isolation and Loneliness in Adults with Chronic Obstructive Pulmonary Disease. %A Suen, Angela O %A Iyer, Anand S %A Cenzer, Irena %A Farrand, Erica %A White, Douglas B %A Singer, Jonathan %A Sudore, Rebecca %A Kotwal, Ashwin %XRATIONALE: Social isolation and loneliness are gaining recognition for their role in health outcomes, yet have not been defined in people with COPD.
OBJECTIVE: To determine the national prevalence of and characteristics associated with social isolation and loneliness in people with COPD.
METHODS: This is a cross-sectional study of community-dwelling adults aged ≥50 years in the nationally-representative Health and Retirement Study (HRS) (2016-2018). Participants self-reported COPD and supplemental oxygen use and were categorized into three groups: 1) no COPD; 2) COPD; and 3) COPD on oxygen. Social isolation was defined using a 9-item scale indicating minimal household contacts, social network interaction, and community engagement. Loneliness was measured using the 3-item UCLA Loneliness Scale. Multivariable logistic regression defined prevalence and associated characteristics for both.
RESULTS: Participants (n=10,384) were on average 68 years old (SD±10.5), 54% female, 10% Black, 11% self-reported COPD, and 2% self-reported supplemental oxygen. Overall, 12% were socially isolated, 12% lonely, and 3% both socially isolated and lonely. People with COPD had a higher adjusted prevalence of social isolation (no COPD: 11%, COPD: 16%, COPD on oxygen: 20%, p<0.05) and loneliness (no COPD: 11%, COPD: 18%, COPD on oxygen: 22%, p<0.001). In those with COPD, characteristics associated with social isolation (p<0.05) included gender (men: 22%, women: 13%), non-Hispanic White ethnicity (White: 19%, Black: 7%), low net-worth ($<6000: 32%, $81,001-239,000: 10%), depression (depression: 24%, no depression: 14%), having ≥1 ADL difficulty (≥1 difficulty: 22%, no difficulty: 14%), and current cigarette use (current: 24%, never: 13%). Characteristics associated with loneliness (p<0.05) included younger age (50-64 years: 22%, 75-84 years: 12%), being single (single: 32%, married: 12%), depression (depression: 36%, no depression: 13%), having ≥1 ADL difficulty (≥1 difficulty: 29%, no difficulty: 15%), diabetes (diabetes: 26%, no diabetes: 17%), and heart disease (heart disease 23%, no heart disease: 17%).
CONCLUSIONS: Nearly 1 in 6 adults with COPD experience social isolation, and 1 in 5 experience loneliness, with almost twice the prevalence among those on supplemental oxygen compared to the general population. Demographic and clinical characteristics identify those at highest risk to guide clinical and policy interventions. Primary source of funding: NIH NHLBI T32HL007185-45.
%B Ann Am Thorac Soc %G eng %R 10.1513/AnnalsATS.202304-288OC %0 Journal Article %J Lancet Healthy Longev %D 2023 %T Negative wealth shocks in later life and subsequent cognitive function in older adults in China, England, Mexico, and the USA, 2012-18: a population-based, cross-nationally harmonised, longitudinal study. %A Cho, Tsai-Chin %A Yu, Xuexin %A Gross, Alden L %A Zhang, Yuan S %A Lee, Jinkook %A Kenneth M. Langa %A Lindsay C Kobayashi %XBACKGROUND: Household wealth is positively related to cognitive health outcomes in later life. However, the association between negative wealth shocks and cognitive function in later life, and whether this association might differ across countries at different levels of economic development, is unclear. We aimed to investigate whether negative wealth shocks in later life are associated with cognitive function in older adults in China, England, Mexico, and the USA, and whether this association is modified by country income level.
METHODS: For this population-based, cross-nationally harmonised, longitudinal study, data were analysed from core interviews of the population-based US Health and Retirement Study (2012 and 2016) and its partner studies in China (the China Health and Retirement Longitudinal Study; 2015 and 2018), England (the English Longitudinal Study of Ageing; 2012 and 2016), and Mexico (Mexican Health and Aging Study; 2012 and 2015-16), and their respective Harmonized Cognitive Assessment Protocols (HCAPs). Negative wealth shocks over the follow-up periods of the respective cohorts were defined in two ways: an extreme loss of 75% or greater from the baseline amount of wealth, and a decline in within-population wealth quintile rank. The primary outcome was the harmonised general cognitive function (GCF) factor score, which was constructed with factor analysis on the HCAP neuropsychological assessments of memory, orientation, attention, executive function, and verbal fluency performance (mean 0; SD 1). We used sampling-weighted, multivariable-adjusted linear models to examine associations.
FINDINGS: Data from 9465 participants were included in this analysis: 3796 from China, 1184 from England, 1193 from Mexico, and 3292 from the USA. The mean baseline age of participants was 68·5 (SD 5·4) years in China (49·8% women), 72·0 (7·0) years in England (54·6% women), 70·6 (6·8) years in Mexico (55·1% women), and 72·7 (7·5) years in the USA (60·4% women). A wealth loss of 75% or greater was negatively associated with subsequent cognitive function in the USA (β -0·16 SD units; 95% CI -0·29 to -0·04) and China (-0·14; -0·21 to -0·07), but not in England (-0·01; -0·24 to 0·22) or Mexico (-0·11; -0·24 to 0·03). Similarly, within-population wealth quintile rank declines were negatively associated with subsequent cognitive function in the USA (β -0·07 per quintile rank decline; 95% CI -0·11 to -0·03) and China (β -0·07; -0·09 to -0·04), but not in England (-0·05; -0·11 to 0·01) or Mexico (-0·03; -0·07 to 0·01).
INTERPRETATION: The impact of wealth shocks in later life on subsequent lower level of cognitive function of older adults in China, England, Mexico, and the USA differed across macro-level socioeconomic structures. These findings suggest that government policies and social safety nets in countries with different levels of economic development might have a role in protecting older adults from adverse health effects of wealth losses in later life.
FUNDING: US National Institute on Aging, US National Institutes of Health.
%B Lancet Healthy Longev %G eng %R 10.1016/S2666-7568(23)00113-7 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Neighborhood Cohesion Across the Life Course and Effects on Cognitive Aging. %A Choi, Jean %A Han, Sae Hwang %A Ng, Yee To %A Muñoz, Elizabeth %XOBJECTIVES: Greater neighborhood cohesion is associated with better cognitive function in adulthood and may serve as a protective factor against cognitive impairment and decline. We build on prior work by examining the effects of perceived neighborhood cohesion across the life course on level and change in cognitive function in adulthood.
METHODS: Utilizing longitudinal data from the Health and Retirement Study (1998-2016) and its Life History Mail Survey, we leveraged data from 3,599 study participants (baseline age: 51-89) who participated in up to 10 waves. Respondents provided retrospective ratings of neighborhood cohesion at childhood (age 10), young adulthood (age at first full-time job), early midlife (age 40), and concurrently at baseline (i.e., late midlife/adulthood); they completed the modified version of the Telephone Interview for Cognitive Status (mTICS). We fit a univariate latent growth curve model of change in cognitive function across waves and tested whether neighborhood cohesion during each recollected life stage predicted level and change in cognitive function.
RESULTS: Greater neighborhood cohesion during childhood and late midlife/adulthood each predicted higher cognitive function at baseline but not rate of cognitive decline. The final model showed that greater neighborhood cohesion in childhood and in late midlife/adulthood remained significantly associated with higher baseline cognitive function, even after accounting for one another.
DISCUSSION: Findings provide insight into life course neighborhood contextual influences on cognitive aging. Our results emphasize the need for more research to understand the life course dynamics between neighborhood environments and cognitive aging.
%B J Gerontol B Psychol Sci Soc Sci %G eng %R 10.1093/geronb/gbad095 %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 %XBACKGROUND 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 %XOccupational 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 Report %D 2023 %T Old Age Risks, Consumption, and Insurance %A Richard Blundell %A Margherita Borella %A Jeanne Commault %A Mariacristina De Nardi %X In the U.S, after age 65, households face income and health risks and a large fraction of these risks are transitory. While consumption significantly responds to transitory income shocks, out-of-pocket medical expenses do not. In contrast, both consumption and out-of-pocket medical expenses respond to transitory health shocks. Thus, most U.S. elderly keep their out-of-pocket medical expenses close to a satiation point that varies with health. Consumption responds to health shocks mostly because adverse health shocks reduce the marginal utility of consumption. The effect of health on marginal utility changes the optimal transfers due to health shocks. %I Economic and Social Research Council %G eng %U https://ifs.org.uk/sites/default/files/2023-03/WP202312-Old-age-risks-consumption-and-insurance.pdf %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 %XBACKGROUND 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 Soc Sci Med %D 2023 %T Parental education and epigenetic aging in middle-aged and older adults in the United States: A life course perspective. %A Korous, Kevin M %A Surachman, Agus %A Rogers, Charles R %A Cuevas, Adolfo G %K DNA methylation; Educational attainment; Epigenetic Age; Life course; United States; socioeconomic status %XEpigenetic aging is one plausible mechanism by which socioeconomic status (SES) contributes to disparities in morbidity and mortality. Although the association between SES and epigenetic aging is well documented, the role of parental education into adulthood remains understudied. We examined (1) if parental education was independently associated with epigenetic aging, (2) whether upward educational mobility buffered this association, and (3) if the benefit of parental education was differentiated by race/ethnicity. Secondary data analysis of a subsample (n = 3875) of Non-Hispanic [NH] Black, Hispanic, NH White, and NH other race participants from the Venous Blood Study within Health and Retirement Study were examined. Thirteen clocks based on DNA methylation of cytosine-phosphate-guanine sites were used to calculate epigenetic aging. Participants' education (personal) and their report of their respective parent's education (parental; mother's and/or father's) were included as independent variables; several potential confounders were also included. Direct associations and interactions between parental and personal education were estimated via survey-weighted generalized linear models; marginal means for epigenetic aging were estimated and contrasts were made between the education subcategories. Analyses were also stratified by race/ethnicity. Our results showed that higher parental education was independently associated with slower epigenetic aging among four clocks, whereas higher personal education magnified this association among four different epigenetic clocks. Participants with the lowest parental and personal education had higher marginal means (i.e., accelerated aging) compared to participants with the highest parental and personal education, and there was little evidence of upward mobility. These associations were more frequently observed among NH White participants, whereas fewer were observed for Hispanic and NH Black participants. Overall, our findings support that early-life circumstances may be biologically embedded through epigenetic aging, which may also limit the biological benefits associated with one's own education.
%B Soc Sci Med %V 333 %P 116173 %8 2023 Aug 12 %G eng %R 10.1016/j.socscimed.2023.116173 %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 %XOBJECTIVES: 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 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 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 %XBACKGROUND: 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 Journal Article %J The American Journal of Psychiatry %D 2023 %T Polygenic Risk and Social Support in Predicting Depression Under Stress. %A Cleary, Jennifer L %A Fang, Yu %A Zahodne, Laura B %A Bohnert, Amy S B %A Burmeister, Margit %A Sen, Srijan %K depression %K Risk Factors %K Social Environment %K Social Support %K Stress %XOBJECTIVE: Despite substantial progress in identifying genomic variation associated with major depression, the mechanisms by which genomic and environmental factors jointly influence depression risk remain unclear. Genomically conferred sensitivity to the social environment may be one mechanism linking genomic variation and depressive symptoms. The authors assessed whether social support affects the likelihood of depression development differently across the spectrum of genomic risk in two samples that experienced substantial life stress: 1,011 first-year training physicians (interns) in the Intern Health Study (IHS) and 435 recently widowed Health and Retirement Study (HRS) participants.
METHODS: Participants' depressive symptoms and social support were assessed with questionnaires that were administered before and after the life stressor. Polygenic risk scores (PRSs) for major depressive disorder were calculated for both samples.
RESULTS: Depressive symptom scores increased by 126% after the start of internship in the IHS sample and by 34% after widowing in the HRS sample. There was an interaction between depression PRS and change in social support in the prediction of depressive symptoms in both the IHS sample (incidence rate ratio [IRR]=0.96, 95% CI=0.93, 0.98) and the HRS sample (IRR=0.78, 95% CI=0.66, 0.92), with higher depression PRS associated with greater sensitivity to changes in social support. Johnson-Neyman intervals indicated a crossover effect, with losses and gains in social support moderating the effect of PRS on depressive symptoms. (Johnson-Neyman interval in the IHS sample, -0.02, 0.71; in the HRS sample, -0.49, 1.92).
CONCLUSIONS: The study findings suggest that individuals with high genomic risk for developing increased depressive symptoms under adverse social conditions also benefit more from nurturing social environments.
%B The American Journal of Psychiatry %V 180 %P 139-145 %G eng %N 2 %R 10.1176/appi.ajp.21111100 %0 Journal Article %J Arch Phys Med Rehabil %D 2023 %T Positive Self-perceptions of Aging Increase Physical Resilience to Facilitate Social Re-engagement of Older Adults Who Fall: Analysis Based on Health and Retirement Study Data. %A Zhang, Zeyi %A Wang, Jingjing %A Ma, Bin %A Wang, Jingyi %A Jia, Yuanmin %A Chen, Ou %K Aging %K Older Adults %K physical resilience %XOBJECTIVE: To determine whether self-perceptions of aging (SPAs) predict physical resilience after a fall and whether SPA and physical resilience affect subsequent social engagement in older adults with a fall.
DESIGN: Prospective cohort study.
SETTING: General community.
PARTICIPANTS: Older adults who reported a fall within 2 years after baseline data collection (N=1707, mean age 72.9 years, 60.9% women).
MAIN OUTCOME MEASURE: Physical resilience indicates the ability to resist or recover from functional decline from a stressor. The change in frailty status from directly after the fall to up to 2 years of follow-up was used to generate 4 physical resilience phenotypes. Social engagement was dichotomized based on the presence at 1 of the 5 social activities at least once a month. The 8-item Attitudes Toward Own Aging Scale was used to assess SPA at baseline. Multinomial logistic regression and nonlinear mediation analysis were used.
RESULTS: Positive prefall SPA predicted more resilient phenotypes after a fall. Both positive SPA and physical resilience affected subsequent social engagement. Physical resilience partially mediated the association between SPA and social re-engagement (mediated percentage of 14.5%, P=.004). This mediation effect was fully driven by those with previous falls.
CONCLUSION: Positive SPA promotes physical resilience in older adults with a fall, both of which affect subsequent social engagement. Physical resilience partially mediated the effect of SPA on social engagement but only for previous fallers. Multidimensional recovery incorporating psychological, physiological, and social aspects should be stressed in the rehabilitation of older adults who fall.
%B Arch Phys Med Rehabil %G eng %R 10.1016/j.apmr.2023.02.006 %0 Journal Article %J PLoS One %D 2023 %T Predictors of cognitive functioning trajectories among older Americans: A new investigation covering 20 years of age- and non-age-related cognitive change. %A Zheng, Hui %A Cagney, Kathleen %A Choi, Yoonyoung %K Cognitive decline %K depression %K Education %K Occupation %K race %K Wealth %XDespite the extensive study of predictors of cognitive decline in older age, a key uncertainty is how much these predictors explain both the intercept and age- and non-age-related change in cognitive functioning (CF). We examined the contribution of a broad range of life course determinants to CF trajectories. Data came from 7,068 participants in the 1996-2016 Health and Retirement Study. CF was measured as a summary score on a 27-point cognitive battery of items. We estimated multilevel growth curve models to examine the CF trajectories in individuals ages 54-85. We found that the variation in CF level at age 54 was three times as much as the variation in age slope. All the observed individual predictors explained 38% of the variation in CF at age 54. Personal education was the most important predictor (25%), followed by race, household wealth and income, parental education, occupation, and depression. The contributions of activity limitations, chronic diseases, health behaviors (obesity, smoking, vigorous activity), childhood conditions (childhood health, nutrition, financial situation), gender, marital status, and religion were rather small (<5%). Even though the age slope varied with many adulthood factors, they only explained 5.6% of the between-person variation in age slope. Moreover, age explained 23% of within-person variation in CF from age 54 to 85. The rest non-age-related within-person variation could not be explained by the observed time-varying factors. These findings suggest that future research is urgently needed to discover the main determinants of the slope of cognitive decline to slow down the progression of cognitive impairment and dementia.
%B PLoS One %V 18 %P e0281139 %G eng %N 2 %R 10.1371/journal.pone.0281139 %0 Journal Article %J Front Public Health %D 2023 %T Predictors of food insecurity among older adults before and during COVID-19 in the United States. %A Nicklett, Emily Joy %A Cheng, Greta Jianjia %A Morris, Zachary A %K Aged %K COVID-19 %K diet %K Food insecurity %K Food Supply %K Humans %K Middle Aged %K Pandemics %K United States %XBACKGROUND: The COVID-19 pandemic has strained the health and wellbeing of older adult populations through increased morbidity, mortality, and social exclusion. However, the impact of COVID-19 on the health of older adults through food security has received relatively little attention, despite the strong impact of diet quality on the health and longevity of older adults.
OBJECTIVE: The objective of this study was to identify sociodemographic and socioeconomic predictors of self-reported food insecurity before and early in the COVID-19 pandemic among community-dwelling older adults in the United States.
METHODS: Using longitudinal data from the Health and Retirement Study, a nationally representative sample of middle-aged and older adults in the United States, we examined the associations between sociodemographic and socioeconomic predictors of self-reported food insecurity between 2018 ( = 2,413) and June 2020 ( = 2,216) using population-weighted multivariate logistic regression models.
RESULTS: The prevalence of food insecurity doubled among participants from 2018 (4.83%) to June 2020 (9.54%). In 2018, non-Hispanic Black and rural residents were more likely to report food insecurity, while individuals with higher education and greater wealth were less likely to report food insecurity in adjusted models. In June 2020, those who were relatively younger, not working due to a disability, and renting were more likely to report food insecurity. Those with an increased number of functional limitations, a recent onset of a work-limiting disability, and those who were no longer homeowners experienced an elevated longitudinal risk for food insecurity.
CONCLUSION: Future research should examine effective policies and interventions to address the disproportionate impacts of COVID-19 on populations at a heightened risk of experiencing food insecurity.
%B Front Public Health %V 11 %P 1112575 %8 = %G eng %R 10.3389/fpubh.2023.1112575 %0 Journal Article %J Adv Geriatr Med Res %D 2023 %T Prevalence and Trends of Handgrip Strength Asymmetry in the United States. %A McGrath, Ryan %A Lang, Justin J %A Clark, Brian C %A Cawthon, Peggy M %A Black, Kennedy %A Kieser, Jacob %A Fraser, Brooklyn J %A Tomkinson, Grant R %K Handgrip strength %K United States %XBACKGROUND: Strength asymmetries are a type of muscle function impairment that is associated with several health conditions. However, the prevalence of these asymmetries among adults from the United States remains unknown. We sought to estimate the prevalence and trends of handgrip strength (HGS) asymmetry in American adults.
METHODS: The unweighted analytic sample included 23,056 persons aged at least 50-years with information on HGS for both hands from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS, with the highest recorded values for each hand used to calculate asymmetry. Persons were categorized into the following asymmetry severity categories: (1) >10%, (2) >20.0%, and (3) >30.0%. Survey weights were used to generate nationally-representative asymmetry estimates.
RESULTS: Overall, there were no statistically significant trends in HGS asymmetry categories over time. The prevalence of HGS asymmetry in the 2014-2016 wave was 53.4% (CI: 52.2-54.4), 26.0% (CI: 25.0-26.9), and 11.7% (CI: 10.9-12.3) for asymmetry at >10%, >20%, and >30%, respectively. HGS asymmetry was generally higher in older Americans compared to middle-aged adults at each wave. In the 2014-2016 wave, >30% asymmetry prevalence was 13.7% (CI: 12.7-14.6) in females and 9.3% (CI: 8.4-10.2) in males. Some differences in asymmetry prevalence by race and ethnicity were observed.
CONCLUSIONS: The prevalence of asymmetry was generally high, especially in women and older adults. Ongoing surveillance of strength asymmetry will help monitor trends in muscle dysfunction, guide screening for disablement, identify subpopulations at risk for asymmetry, and inform relevant interventions.
%B Adv Geriatr Med Res %V 5 %G eng %N 2 %R 10.20900/agmr20230006 %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 %XGait 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 %XMcGrath, 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 %XINTRODUCTION: 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 Research on Aging %D 2023 %T Productive Aging Lifestyles: A Latent Class Analysis of Work and Volunteer Patterns over the Retirement Transition. %A Carr, Dawn C %A Kail, Ben L %A Taylor, Miles %K Latent Class Analysis %K Older workers %K productive aging %K Retirement %K Volunteerism %XFrank Caro and colleagues' foundational work set the stage for a broad and multifaceted productive aging (PA) literature. Recent PA research has focused on health benefits associated with work and volunteering, respectively. However, these activities are often assumed to have independent associations with health and wellbeing. Less clear is whether and in what ways older adults participate in productive engagement lifestyles including multiple activities over a long period of time. This paper uses latent class analyses and the Health and Retirement Study to examine combined engagement in work and volunteer activities over 12 years between ages 56-68 to (1) identify patterns of work and volunteer activities across the retirement transition, (2) evaluate characteristics of individuals within these patterns, and (3) explore whether particular patterns are associated with markers of health and wellbeing. We describe how our findings inform successful aging by incentivizing socially and individually beneficial PA lifestyles.
%B Research on Aging %G eng %R 10.1177/01640275221103793 %0 Journal Article %J iScience %D 2023 %T Progression and trajectory network of age-related functional impairments and their combined associations with mortality %A Chen, Hui %A Wang, Binghan %A Lv, Rongxia %A Zhou, Tianjing %A Shen, Jie %A Song, Huan %A Xu, Xiaolin %A Ma, Yuan %A Yuan, Changzheng %K Age %K association analysis %K Bioinformatics %K Health sciences %X Age-related functional impairments (ARFIs) contribute to the loss of independence in older adults, but their progressions, interrelations, and combined relations with mortality are largely unknown. We conducted a prospective study among 17,914 participants in the Health and Retirement Study (2000–2020). The incidence rates of visual impairment, hearing impairment, physical frailty, and cognitive impairment increased exponentially with age, while those of restless sleep and depression increased relatively slowly. These ARFIs were associated with each other in temporal sequence and constituted a hazard network. We observed a dose-response relationship between the number of ARFIs and mortality risk, and the dyads involving physical frailty demonstrated the strongest associations with mortality. Our findings may assist in the identification of individuals at higher mortality risk and highlight the potential for future investigations to explore the impact of multiple ARFIs in aging. %B iScience %V 26 %G eng %R 10.1016/j.isci.2023.108368 %0 Journal Article %J Epidemiology %D 2023 %T Propensity Scores in Health Disparities Research: The Example of Cognitive Aging and the Hispanic Paradox. %A Kezios, Katrina L %A Zimmerman, Scott C %A Zhang, Adina %A Calonico, Sebastian %A Jawadekar, Neal %A Glymour, M Maria %A Zeki Al Hazzouri, Adina %K Adult %K cognitive aging %K Hispanic or Latino %K Humans %K Mexican Americans %K Propensity Score %K Risk Factors %K United States %XBACKGROUND: Individuals of Mexican ancestry in the United States experience substantial socioeconomic disadvantages compared with non-Hispanic white individuals; however, some studies show these groups have similar dementia risk. Evaluating whether migration selection factors (e.g., education) associated with risk of Alzheimer disease and related dementia (ADRD) explain this paradoxical finding presents statistical challenges. Intercorrelation of risk factors, common with social determinants, could make certain covariate patterns very likely or unlikely to occur for particular groups, which complicates their comparison. Propensity score (PS) methods could be leveraged here to diagnose nonoverlap and help balance exposure groups.
METHODS: We compare conventional and PS-based methods to examine differences in cognitive trajectories between foreign-born Mexican American, US-born Mexican American, and US-born non-Hispanic white individuals in the Health and Retirement Study (1994-2018). We examined cognition using a global measure. We estimated trajectories of cognitive decline from linear mixed models adjusted for migration selection factors also associated with ADRD risk conventionally or with inverse probability weighting. We also employed PS trimming and match weighting.
RESULTS: In the full sample, where PS overlap was poor, unadjusted analyses showed both Mexican ancestry groups had worse baseline cognitive scores but similar or slower rates of decline compared with non-Hispanic white adults; adjusted findings were similar, regardless of method. Focusing analyses on populations where PS overlap was improved (PS trimming and match weighting) did not alter conclusions.
CONCLUSIONS: Attempting to equalize groups on migration selection and ADRD risk factors did not explain paradoxical findings for Mexican ancestry groups in our study.
%B Epidemiology %V 34 %P 495-504 %G eng %N 4 %R 10.1097/EDE.0000000000001620 %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 %XBACKGROUND: 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 Research on Aging %D 2023 %T Race-Discordant School Attendance and Cognitive Function in Later Life. %A Carr, Dawn C %A Reynolds, John %K Cognitive health %K Racial/Ethnic Groups %K school segregation %XEarly schooling plays an important role in shaping cognitive development. This study explored benefits of cognitive functioning in later life related to attending diverse schools in early life. Specifically, we explored the effects of having attended schools composed primarily of different race peers-race discordant schools (RDS)-among Black and White older adults. Using retrospective and prospective data from the Health and Retirement Study, we examined the association between RDS exposure and two measures of cognitive function (working memory, episodic memory) at age 55 and at age 70. We found that RDS exposed Blacks experienced significant benefits in cognitive function at age 55 and at age 70. In general, RDS exposed Whites did not experience cognitive benefits or deficits. Results suggest that exposure to more racially diverse school environments provides potentially beneficial effects for cognitive function, particularly in later phases of the life course.
%B Research on Aging %G eng %R 10.1177/01640275221103791 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2023 %T Racial and Ethnic Trajectories of Sleep Disturbances: Variations by Age and Cohort. %A Chen, Jen-Hao %K Aging effects %K Cohort Effects %K Longitudinal analysis %K Racial and ethnic disparities %K Sleep trajectories %XBACKGROUND: The racial and ethnic differences in trajectories of sleep disturbances in later life is crucial for addressing health disparities, but not well understood. This study examines (1) how trajectories of sleep disturbances vary by race and ethnicity and birth cohort and (2) whether social and health risk factors explain such variations.
METHODS: The study uses longitudinal data from the 2002-2018 Health and Retirement Study (N=21,963) and the multilevel growth curve model to assess trajectories of sleep disturbances and their variations across six cohorts of White, Black, and Hispanic older adults. Sleep disturbances are measured using a modified Jenkins Sleep Scale.
RESULTS: Without controls, sleep disturbances increased with aging for all racial and ethnic groups, but more rapidly among minorities, particularly younger cohorts of Hispanic older adults. When controlling for social and health risks, sleep disturbances did not change with aging for Whites and Blacks and increased for younger cohorts of Hispanics. Cohort effects were observed among White older adults, with higher sleep disturbances in younger cohorts. Importantly, the racial and ethnic disparities in age and cohort effects were not fully explained by social and health risks. Of the symptoms, the most salient racial and ethnic disparities were found in "waking up at night" and "not feeling rested."
CONCLUSIONS: Findings reveal several differences by race and ethnicity and birth cohort in trajectories of sleep disturbances. Efforts should be made to improve sleep health for older adults as they age, especially for younger cohorts of Blacks and Hispanics.
%B J Gerontol A Biol Sci Med Sci %8 2023 Jan 26 %G eng %R 10.1093/gerona/glad031 %0 Journal Article %J Journal of Aging and Health %D 2023 %T Racial/Ethnic Differences in Biological Aging and Their Life Course Socioeconomic Determinants: The 2016 Health and Retirement Study. %A Farina, Mateo P %A Jung K Kim %A Eileen M. Crimmins %K accelerated biological aging %K racial/ethnic disparities %XThis study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56-74, but not for adults aged 75+. These findings provide insight into biological differences underlying racial/ethnic disparities in health.
%B Journal of Aging and Health %G eng %R 10.1177/08982643221120743 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Readmissions and postdischarge mortality by race and ethnicity among Medicare beneficiaries with multimorbidity. %A Wei, Melissa Y %A Cho, Jinmyoung %XBACKGROUND: Disparities in readmission risk and reasons they might exist among diverse complex patients with multimorbidity, disability, and unmet social needs have not been clearly established. These characteristics may be underestimated in claims-based studies where individual-level data are limited. We sought to examine the risk of readmissions and postdischarge mortality by race and ethnicity after rigorous adjustment for multimorbidity, physical functioning, and sociodemographic and lifestyle characteristics.
METHODS: We used Health and Retirement Study (HRS) data linked to Medicare claims. To obtain ICD-9-CM diagnostic codes to compute the ICD-coded multimorbidity-weighted index (MWI-ICD) we used Medicare Parts A and B (inpatient, outpatient, carrier) files between 1991-2015. Participants must have had at least one hospitalization between January 1, 2000 and September 30, 2015 and continuous enrollment in fee-for-service Medicare Part A 1-year prior to hospitalization. We used multivariable logistic regression to assess the association of MWI-ICD with 30-day readmissions and mortality 1-year postdischarge. Using HRS data, we adjusted for age, sex, BMI, smoking, physical activity, education, household net worth, and living arrangement/marital status, and examined for effect modification by race and ethnicity.
RESULTS: The final sample of 10,737 participants had mean ± SD age 75.9 ± 8.7 years. Hispanic adults had the highest mean MWI-ICD (16.4 ± 10.1), followed by similar values for White (mean 14.8 ± 8.9) and Black (14.7 ± 8.9) adults. MWI-ICD was associated with a higher odds of readmission, and there was no significant effect modification by race and ethnicity. For postdischarge mortality, a 1-point increase MWI-ICD was associated with a 3% higher odds of mortality (OR = 1.03, 95% CI: 1.03-1.04), which did not significantly differ by race and ethnicity.
CONCLUSIONS: Multimorbidity was associated with a monotonic increased odds of 30-day readmission and 1-year postdischarge mortality across all race and ethnicity groups. There was no significant difference in readmission or mortality risk by race and ethnicity after robust adjustment.
%B J Am Geriatr Soc %8 2023 Jan 27 %G eng %R 10.1111/jgs.18251 %0 Journal Article %J Psychoneuroendocrinology %D 2023 %T Reduced epigenetic age in older adults who volunteer. %A Nakamura, Julia S %A Kwok, Cherise %A Huang, Andrew %A Strecher, Victor J %A Kim, Eric S %A Cole, Steven W %K DNA Methylation %K Epigenetic age acceleration %K Health behaviors %K Volunteering %XBACKGROUND: Volunteering is associated with improved health and well-being outcomes, including a reduced risk of mortality. However, the biological mechanisms underlying the association between volunteering and healthy aging and longevity have not been well-established. We evaluated if volunteering was associated with reduced epigenetic age acceleration in older adults.
METHODS: We evaluated associations between volunteering and age acceleration, measured by 13 DNA methylation (DNAm) "epigenetic clocks" in 4011 older adults (M=69 years; SD=10 years) who participated in the Health and Retirement Study. We assessed 9 first-generation clocks (Horvath, Hannum, Horvath Skin, Lin, Garagnani, Vidalbralo, Weidner, Yang, and Bocklandt, which predict chronological age) and 4 second-generation clocks (Zhang, PhenoAge, GrimAge, and DunedinPoAm, which predict future disease or longevity). We quantified the total associations between volunteering and DNAm age acceleration as well as the extent to which these associations might be attributable to potential confounding by individual demographics (e.g., race), social demographics (e.g., income), health factors (e.g., diabetes), and health behaviors (e.g., smoking).
RESULTS: Volunteering was associated with reduced epigenetic age acceleration across 6 epigenetic clocks optimized for predicting health and longevity (False Discovery Rate [FDR] q < 0.0001 for epigenetic clocks: PhenoAge, GrimAge, DunedinPoAm, Zhang mortality, Yang mitotic; FDR q < 0.01: Hannum). These associations were mostly independent of demographic and health factors, but substantially attenuated after adjusting for health behaviors.
CONCLUSION: Volunteering was associated with reduced epigenetic age acceleration in 6 of 13 (mostly second-generation) epigenetic clocks. Results provide preliminary evidence that volunteering might provide health benefits through slower biological aging and implicate health behaviors as one potential mechanism of such effects.
%B Psychoneuroendocrinology %V 148 %P 106000 %G eng %R 10.1016/j.psyneuen.2022.106000 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2023 %T Reduced Epigenetic Age in Older Adults with High Sense of Purpose in Life. %A Kim, Eric S %A Nakamura, Julia S %A Strecher, Victor J %A Cole, Steven W %XPsychosocial risk factors have been linked with accelerated epigenetic aging, but little is known about whether psychosocial resilience factors (e.g., Sense of Purpose in Life) might reduce epigenetic age acceleration. In this study, we tested if older adults who experience high levels of Purpose might show reduced epigenetic age acceleration. We evaluated the relationship between Purpose and epigenetic age acceleration as measured by 13 DNA methylation (DNAm) "epigenetic clocks" assessed in 1,572 older adults from the Health and Retirement Study (mean age 70 years). We quantified the total association between Purpose and DNAm age acceleration as well as the extent to which that total association might be attributable to demographic factors, chronic disease, other psychosocial variables (e.g., positive affect), and health-related behaviors (heavy drinking, smoking, physical activity, BMI). Purpose in Life was associated with reduced epigenetic age acceleration across 4 "second-generation" DNAm clocks optimized for predicting health and longevity (FDR q < .0001: PhenoAge, GrimAge, Zhang epigenetic mortality index; FDR q < .05: DunedinPoAm). These associations were independent of demographic and psychosocial factors, but substantially attenuated after adjusting for health-related behaviors (drinking, smoking, physical activity, BMI). Purpose showed no significant association with 9 "first-generation" DNAm epigenetic clocks trained on chronological age. Older adults with greater Purpose in Life show "younger" DNAm epigenetic age acceleration. These results may be due in part to associated differences in health-related behaviors. Results suggest new opportunities to reduce biological age acceleration by enhancing Purpose and its behavioral sequalae in late adulthood.
%B J Gerontol A Biol Sci Med Sci %G eng %R 10.1093/gerona/glad092 %0 Journal Article %J Journal of Gerontological Social Work %D 2023 %T The Relationship Between Volunteering and the Occurrence of Loneliness Among Older Adults: A Longitudinal Study with 12 Years of Follow-Up. %A Cho, Joonyoung %A Xiang, Xiaoling %K Gender Differences %K Loneliness %K Volunteering %XInformed by the social model of health promotion, this study examined the association between formal volunteering and the occurrence of loneliness among older adults over 12 years of follow-up and whether the association differs by gender. Data came from the Health and Retirement Study (2006-2018). The study sample included 5,000 individuals aged 60 and over who did not experience loneliness in 2006. Self-reported participation in formal volunteer work was classified into three levels: (0) no volunteering, (1) less than 100 hours of volunteering per year, and (2) more than 100 hours of volunteering per year. Cox regression was used to examine the relationship between volunteering level and the onset of loneliness during the 12 years of follow-up. Volunteering more than 100 hours per year was associated with a lower risk of loneliness compared to non-volunteers (HR = 0.55, p = .008). This protective effect was not observed for those who volunteered less than 100 hours per year (HR = 0.84, p = .246). The benefits of volunteering in mitigating loneliness did not differ by gender. Engagement in moderate to high levels of volunteering can protect against loneliness. More volunteering programs can be offered to older adults to reduce loneliness in later life.
%B Journal of Gerontological Social Work %G eng %R 10.1080/01634372.2022.2139322 %0 Journal Article %J Research on Aging %D 2023 %T Relocation Later in Life and Contact Frequency With Friends: Do Contact Modes Matter? %A Cho, Joonyoung %A Jacqui Smith %K friendship %K relocation %K Social networks %XWe examined changes in the frequencies of in-person, telephone, and written or email contact with friends in older adults who move short or longer distances. 3820 adults aged 50 years or older were included from a nationally representative sample from the Health and Retirement Study. Using ordinal logistic regression, we found differential effects of geographical distances on the in-person, telephone, and write or email contact with friends. Specifically, in-person contact frequency was most sensitive to distance. Telephone contact frequency was only impacted by long-distance moves; however, email contact frequency was not influenced by distance. Findings suggest that the impact of relocation on contact frequency exists even though communication technology gives older adults flexibility in maintaining frequent contact with their friends. We discuss our findings through the lens of socioemotional selective theory and social convoy model. Future studies could examine factors linked to changes in the amount and modes of contact.
%B Research on Aging %G eng %R 10.1177/01640275221126103 %0 Journal Article %J Social Science & Medicine %D 2023 %T Resilience resources may buffer some middle-aged and older Black Americans from memory decline despite experiencing discrimination %A McDonough, Ian M %A Byrd, DeAnnah R %A Choi, Shinae L %K Black adults %K Discrimination %K memory decline %K Resilience %XRATIONALE: Experiences of discrimination have been associated with poorer episodic memory in Black Americans. However, resilience resources at multiple levels (individual, social, and endowed) may act as a buffer to protect future memory decline, especially in the face of discrimination.
OBJECTIVE: Using longitudinal data from the 2006-2016 Health and Retirement Study (N = 1862), we tested whether Black Americans aged 50 and older would show different trajectories of episodic memory depending on their reported experiences of discrimination (everyday and major lifetime) and resilience resources.
METHODS: Analyses were conducted in three steps: (1) joint latent cluster mixed modeling (JLCMM) to estimate the number of classes, (2) barycentric discriminant analyses (BADA) to model the combined influence of discrimination and resilience resources between each memory class, and (3) multinomial regression analyses to explore interactions between discrimination and resilience resources.
RESULTS: JLCMM resulted in three memory classes that differentiated baseline from longitudinal memory performance: "High Decliners," "Low Decliners," and "Low Stable." Two independent patterns described the relationships between the three classes in the context of discrimination and resilience resources. First, compared with High Decliners, the two lower baseline memory classes (Low Decliners and Low Stable) reported more everyday discrimination and lower individual and endowed resilience resources. Second, although the Low Stable class did not report different levels of discrimination, they had more social resilience resources (greater social support and more social contact) than both declining classes.
CONCLUSIONS: Black Americans in later life have heterogeneous patterns of memory trajectories as demonstrated by the three memory classes identified. Those with lower baseline memory experienced more everyday discrimination and had fewer resilience resources compared to those with high baseline performance (High Decliners). Greater social resilience resources were associated with maintained episodic memory over time in Black Americans.
%B Social Science & Medicine %G eng %R 10.1016/j.socscimed.2022.114998 %0 Journal Article %J Journal of Social Service Research %D 2023 %T The Role of Gender and Marital Status in the Relationship between Caregiving for Older Parents with Alzheimer’s Disease and Depressive Symptoms among Baby Boomer Adult Child Caregivers: Evidence from the Health and Retirement Study %A Min Kyoung Park %A Ji Hyang Cheon %A Rachel McPherson %K Alzheimer disease %K Baby Boomers %K Depressive symptoms %K Marital Status %X The present study applied a multilevel approach to assess the effects of caregiving for older parents with Alzheimer’s disease (AD) on a level of depressive symptoms among adult child caregivers in the Baby Boomer generation. Along with the main effect, this study focused on the interaction effects between AD caregiving, gender and marital status. The present study’s findings revealed that AD caregiving experience is associated with worsening depressive symptoms. However, there are differences between individuals in changes in depressive symptoms. Additionally, the results of the interaction effect showed that in the case of unmarried female caregivers, the level of depressive symptoms associated with AD caregiving worsens faster than their counterparts. These results highlight the need for social policies that address the mental health needs of adult child caregivers who are vulnerable to AD caregiving experience. %B Journal of Social Service Research %V 49 %P 272-285 %G eng %U https://doi.org/10.1080/01488376.2023.2226170 %R 10.1080/01488376.2023.2226170 %0 Journal Article %J Ageing & Society %D 2023 %T The role of social communication technologies in cognition and affect in older adults %A Resor, Jessica %A Cooke, Steph %A Katz, Benjamin %K Cognition %K Communication %K depression %K technologies %X Affect and cognition have both been associated with communication across one's social network during ageing. Thus, it is important to consider how communication varies by different aspects of one's social network, and by communication mode, including phone, email and social media. This study aimed to investigate the relationship between technology-mediated communication, depression and an executive function-related fluid-reasoning measure among older adults. Data were drawn from the Health and Retirement dataset's 2016 wave. Hierarchical regression analyses were conducted to examine the link between communication modes (phone, email and social media) with children, family and friends with a fluid-reasoning cognition measure and Center for Epidemiologic Studies Depression Scale, controlling for demographic covariates, among 3,798 older American adults. Phone and email communication, but not social media, were significantly related to depression and cognition. The model fit was considerably stronger for the analyses with cognition than depression. Curvilinear associations were found for communication via phone and email with cognition, suggesting moderate amounts of communication by phone and email across social groups were most closely linked with higher scores on fluid reasoning. For depression, curvilinear relationships were found for talking on the phone with family and friends, and emailing for children and family, indicating that moderate communication levels revealed the lowest depression levels. Implications for how older adults’ social support may contribute to depression and cognition status are discussed. %B Ageing & Society %V 43 %P 24 - 52 %G eng %N 1 %R 10.1017/S0144686X21000386 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Rural disparities in use of family and formal caregiving for older adults with disabilities. %A Miller, Katherine E M %A Ornstein, Katherine A %A Coe, Norma B %XBACKGROUND: As federal and state policies rebalance long-term care from institutional settings to home- and community-based settings, reliance on formal (paid) and family (unpaid) caregivers for support at home nationally has increased in recent years. Yet, it is unknown if use of formal and family care varies by rurality.
METHODS: Using the Health and Retirement Study, we describe patterns in receipt of combinations of formal and family home care and self-reported expectation of nursing home use by rurality among community-dwelling adults aged 65+ with functional limitations from 2004 to 2016.
RESULTS: Older adults residing in rural areas are more likely to receive any family care than those in urban areas. From 2004 to 2016, a higher proportion of older adults in rural areas receive care from family caregivers exclusively while a lower proportion receive care from formal caregivers exclusively. When examining older adults in urban areas, we find the opposite - a higher proportion of urban adults rely exclusively on formal care and a lower proportion rely exclusively on family care in 2016 compared to 2004.
CONCLUSION: We find that national estimates of sources of caregiving and their changes over time mask significant heterogeneity in uptake by rurality. Understanding how older adults in rural areas are, or are not, receiving home-based care compared to their urban peers and how these patterns are changing over time is the first step to informing supports for family and formal caregivers.
%B J Am Geriatr Soc %8 2023 Apr 20 %G eng %R 10.1111/jgs.18376 %0 Journal Article %J Acta Diabetologica %D 2023 %T Salivary telomere length and the risks of prediabetes and diabetes among middle-aged and older adults: findings from the Health and Retirement Study. %A Yu, Hong-Jie %A Ho, Mandy %A Chau, Pui Hing %A Geng, Leiluo %A Fong, Daniel Yee Tak %K Cardiovascular Diseases %K Diabetes Mellitus %K Obesity %K Overweight %K Prediabetic State %K Telomere %K Telomere Shortening %XAIM: To assess the association of telomere length (TL) with prediabetes/diabetes and to explore the potential factors affecting TL among individuals with prediabetes/diabetes by weight status.
METHODS: This study included 3,379 eligible adults (aged 45-85 years, males: 42%) from the US Health and Retirement Study in 2008. TL was assayed using quantitative PCR of saliva (T/S ratio). Linear and nonlinear associations between TL and prediabetes/diabetes were assessed using the logistic regression and restricted cubic spline model, respectively, adjusting for TL-plate numbers, age, sex, race, body mass index, lifestyles, diabetes medications, and cardiometabolic parameters (blood pressure, C-reactive protein, and total cholesterol). Multiple linear regression was used for testing any factors associated with TL.
RESULTS: Among 3,379 participants, 868 (25.7%) had prediabetes with a mean TL of 1.34 ± 0.37 (T/S ratio) and 858 (25.4%) had diabetes with a mean TL of 1.36 ± 0.43 (T/S ratio). Neither linear nor nonlinear association of TL with prediabetes/diabetes was significant by weight status. Age was negatively associated with TL in both normal-weight (β = - 0.002, p = 0.025) and overweight/obese (β = - 0.002, p = 0.006) prediabetes, but non-significant in normal-weight and overweight/obese diabetes. BMI and cardiometabolic parameters were not associated with TL in prediabetes/diabetes by weight status.
CONCLUSIONS: Salivary TL was not associated with prediabetes/diabetes among the US middle-aged and older adults. Further longitudinal studies are required to establish the link between TL and diabetes development and to identify potential factors affecting TL shortening, particularly in normal-weight diabetic patients.
%B Acta Diabetologica %V 60 %P 273-283 %G eng %N 2 %R 10.1007/s00592-022-02004-9 %0 Journal Article %J The Journals of Gerontology, Series B %D 2023 %T Shifting of Cognitive Assessments Between Face-to-Face and Telephone Administration: Measurement Considerations. %A Smith, Jason R %A Gibbons, Laura E %A Crane, Paul K %A Mungas, Dan M %A Glymour, M Maria %A Jennifer J Manly %A Zahodne, Laura B %A Mayeda, Elizabeth Rose %A Richard N Jones %A Gross, Alden L %K Cognition %K Mode effects %K Psychometrics %K Telephone %XOBJECTIVES: Telephone-administered cognitive assessments are a cost-effective and sometimes necessary alternative to face-to-face assessments. There is limited information in large studies concerning mode effects, or differences in cognition attributable to assessment method, as a potential measurement threat. We evaluated mode effects on cognitive scores using a population-based sample of community-living older adults.
METHODS: We used data from participants aged 65-79 in the 2014 Health and Retirement Study for whom interview mode was randomized (n=6825). We assessed mode differences in test means, whether mode modifies associations of cognition with criterion variables, and formal measurement invariance testing.
RESULTS: Relative to face-to-face assessment, telephone assessment was associated with higher scores for memory and calculation (0.06 to 0.013 standard deviations (SD)) and lower scores for non-memory items (-0.09 to -0.01 SD). Cognition was significantly differentially related to IADL difficulty depending on assessment mode. Measurement invariance testing identified evidence of mode differences in certain tests as a function of mode: adjusting for underlying cognition, the largest mode differences in memory and attention: immediate noun recall, delayed word recall, and serial-7s scores were higher given telephone administration.
DISCUSSION: Differences by mode of administration are apparent in cognitive measurement in older adults albeit to a small degree in our study, and most pronounced for tests of memory and attention. The importance of accounting for mode differences ultimately depends on one's research question and study sample: not all associations may be affected by mode differences and such modification may only be apparent among those with lower cognitive functioning.
%B The Journals of Gerontology, Series B %V 78 %P 191-200 %G eng %N 2 %R 10.1093/geronb/gbac135 %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 Proc Natl Acad Sci U S A %D 2023 %T Social Frailty Index: Development and validation of an index of social attributes predictive of mortality in older adults. %A Shah, Sachin J %A Oreper, Sandra %A Jeon, Sun Young %A Boscardin, W John %A Fang, Margaret C %A Covinsky, Kenneth E %K Aged %K Child %K Frailty %K Humans %K Longitudinal Studies %K Retirement %K Sociological Factors %XWhile social characteristics are well-known predictors of mortality, prediction models rely almost exclusively on demographics, medical comorbidities, and function. Lacking an efficient way to summarize the prognostic impact of social factor, many studies exclude social factors altogether. Our objective was to develop and validate a summary measure of social risk and determine its ability to risk-stratify beyond traditional risk models. We examined participants in the Health and Retirement Study, a longitudinal, survey of US older adults. We developed the model from a comprehensive inventory of 183 social characteristics using least absolute shrinkage and selection operator, a penalized regression approach. Then, we assessed the predictive capacity of the model and its ability to improve on traditional prediction models. We studied 8,250 adults aged ≥65 y. Within 4 y of the baseline interview, 22% had died. Drawn from 183 possible predictors, the Social Frailty Index included age, gender, and eight social predictors: neighborhood cleanliness, perceived control over financial situation, meeting with children less than yearly, not working for pay, active with children, volunteering, feeling isolated, and being treated with less courtesy or respect. In the validation cohort, predicted and observed mortality were strongly correlated. Additionally, the Social Frailty Index meaningfully risk-stratified participants beyond the Charlson score (medical comorbidity index) and the Lee Index (comorbidity and function model). The Social Frailty Index includes age, gender, and eight social characteristics and accurately risk-stratifies older adults. The model improves upon commonly used risk prediction tools and has application in clinical, population health, and research settings.
%B Proc Natl Acad Sci U S A %V 120 %P e2209414120 %8 2023 Feb 14 %G eng %N 7 %R 10.1073/pnas.2209414120 %0 Journal Article %J Brain, behavior and immunity %D 2023 %T Social relationships and epigenetic aging in older adulthood: Results from the Health and Retirement Study. %A Rentscher, Kelly E %A Klopack, Eric T %A Crimmins, Eileen M %A Seeman, Teresa E %A Cole, Steve W %A Carroll, Judith E %K biological aging %K DNA Methylation %K epigenetic clock %K Social Relationships %K Social strain %K Social Support %XGrowing evidence suggests that social relationship quality can influence age-related health outcomes, although how the quality of one's relationships directly relates to the underlying aging process is less clear. We hypothesized that the absence of close relationships as well as lower support and higher strain within existing relationships would be associated with an accelerated epigenetic aging profile among older adults in the Health and Retirement Study. Adults (N = 3,647) aged 50-100 years completed ratings of support and strain in relationships with their spouse, children, other family members, and friends. They also provided a blood sample that was used for DNA methylation profiling to calculate a priori-specified epigenetic aging measures: Horvath, Hannum, PhenoAge, GrimAge, and Dunedin Pace of Aging methylation (DunedinPoAm38). Generalized linear models that adjusted for chronological age, sex, and race/ethnicity and applied a false discovery rate correction revealed that the absence of marital and friend relationships related to an older GrimAge and faster DunedinPoAm38. Among those with existing relationships, lower support from a spouse, child, other family, and friends and higher strain with friends related to an older PhenoAge and GrimAge and faster DunedinPoAm38. In secondary analyses that further adjusted for socioeconomic and lifestyle factors, lower support from other family members and friends was associated with greater epigenetic aging. Findings suggest that the absence of close relationships and lower support within existing relationships-particularly with family members and friends-relate to accelerated epigenetic aging in older adulthood, offering one mechanism through which social relationships might influence risk for age-related declines and disease.
%B Brain, behavior and immunity %V 114 %P 349-359 %G eng %R 10.1016/j.bbi.2023.09.001 %0 Journal Article %J Geriatr Nurs %D 2023 %T Sociodemographic characteristics, lifestyle behaviors, and symptoms associated with fluid overload among non-hospitalized and community-dwelling older adults with heart failure: A population-based approach. %A Gharzeddine, Rida %A Cypress, Brigette %A Dahan, Thomas %A Fu, Mei R %K fluid overload %K Heart Failure %K lifestyle behaviors %K non-hospitalized %K Older Adults %K sociodemographic characteristics %XBACKGROUND: Fluid overload is a major complication in patients with heart failure (HF) and the main reason for hospitalization. The purpose of the study was to explore the associations of fluid overload with sociodemographic characteristics, lifestyle behaviors, and symptoms among non-hospitalized and community-dwelling older adults with HF using large population data.
METHODS: Descriptive and multivariate analyses were conducted on the Health and Retirement Study 2016.
RESULTS: Fluid overload was prevalent in almost half of the sample. Female older adults with HF were more likely to have fluid overload (OR:1.43, p = 0.037) as well as being Black (OR:1.40, p = 0.041). Higher physical activity scores were associated with less likelihood of having fluid overload (OR:0.99, p = 0.025). Symptoms of shortness of breath (OR=2.18, p = 0.001), pain (OR=1.82, p < 0.001), and fatigue (OR=1.45, p = 0.025) were significantly associated with fluid overload.
CONCLUSION: Female and Black community-dwelling older adults with HF are at higher risk of fluid overload. Symptoms of shortness of breath, pain, and fatigue are significant manifestations of fluid overload. Effective patient-centered interventions to promote fluid flow via physical activity may help older adults with HF manage fluid overload and alleviate associated symptoms.
%B Geriatr Nurs %V 53 %P 66-71 %G eng %R 10.1016/j.gerinurse.2023.06.017 %0 Journal Article %J Arch Public Health %D 2023 %T Socioeconomic disparities in health outcomes in the United States in the late 2010s: results from four national population-based studies. %A Kim, Yeonwoo %A Vazquez, Christian %A Cubbin, Catherine %K health outcomes %K socioeconomic disparities %XBACKGROUND: Despite the importance of monitoring health disparities by multiple socioeconomic categories, there have been no recent updates on the prevalence of general health indicators by socioeconomic categories. The present study aims to update the prevalence estimates of health indicators by education and income categories across three age groups (children, young and middle-aged adults, and older adults) in the late 2010s by using four nationally representative data sources. We also examine socioeconomic differences in health by race/ethnicity subgroups.
METHODS: Data were obtained from four nationally representative data sources from the U.S.: The National Health Interview Survey (2015-2018); the National Health and Nutrition Examination Survey, NHANES (2017-2020); the Behavioral Risk Factor Surveillance System (2016-2020); and the Health & Retirement Study (2016). Respondent-rated health and obesity were selected as the health indicators of interest. Socioeconomic factors included percentages of the federal poverty level and years of educational attainment. We conducted logistic regression analyses to calculate adjusted prevalence rates of respondent-rated (or measured, in the case of obesity in NHANES) poor health and obesity by income and education categories after controlling for sociodemographic characteristics. The complex sampling designs were accounted for in all analyses.
RESULTS: Prevalence rates across racial/ethnic groups and age groups demonstrated clear and consistent socioeconomic gradients in respondent-rated poor health, with the highest rates among those in the lowest income and education categories, and decreased rates as income and education levels increased. On the other hand, there were less evident socioeconomic differences in obesity rates across all data sources, racial/ethnic groups, and age groups.
CONCLUSIONS: Our results confirmed earlier, persistent evidence indicating socioeconomic disparities in respondent-rated poor health across all age and race/ethnicity groups by using four nationally representative datasets. In comparison to a decade earlier, socioeconomic disparities in poor health appeared to shrink while they emerged or increased for obesity. The results suggest an urgent need for action to alleviate pervasive health disparities by socioeconomic status. Further research is needed to investigate potentially modifiable factors underlying socioeconomic disparities in health, which may help design targeted health promotion programs.
%B Arch Public Health %V 81 %P 15 %8 2023 Feb 04 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/36739440?dopt=Abstract %R 10.1186/s13690-023-01026-1 %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 %XBACKGROUND: 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 Journal Article %J Journal of Pain and Symptom Management %D 2023 %T Spousal Loneliness, Depression, and Closeness Among Older Adults Married to Persons with Dementia: A Nationally Representative Study (SA314B) %A Kristie Hsu %A Irena Cenzer %A Krista Harrison %A Christine Ritchie %A Linda Waite %A Linda Waite %K closeness %K depression %K Loneliness %K Older Adults %X Outcomes 1. Analyze the role of marriage in serious illness and dementia 2. Discuss interactive biopsychosocial model underlying marriage and health among older adults with serious illness, and key social measures 3. Describe the prevalence of loneliness, depression, or both among spouses married to persons with dementia 4. Discuss how one's partner's cognitive decline is associated with higher levels of loneliness and depression Background Older adults married to persons with dementia (PWD) may be at risk for loneliness and depression. However, it is unclear how often each occur and the extent to which they are distinct. Research objectives To determine the prevalence of loneliness and depression among older adults married to PWD or mild cognitive impairment (MCI) and the role of marital closeness in mediating these outcomes Methods We used a nationally representative sample of 3,666 married couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PWD (N=201), married to persons with MCI (N=778), or married to persons with normal cognition (N=2,687). We determined the prevalence of loneliness using multivariable logistic regression adjusting for socio-demographic characteristics, then tested for interaction between marital closeness and degree of spousal cognitive impairment. We assessed the prevalence of depression, and both loneliness and depression, using the same method. Results The sample was 54% women and on average 67 years old (Range: 50–97). After adjustment, older adults married to PWD were more likely to be lonely (Normal: 20%, MCI: 21%, PWD: 30%; p=0.02), depressed (Normal: 7%, MCI: 14%, PWD: 16%; p< 0.01), and both (Normal: 4%, MCI: 8%, PWD: 9%; p< 0.01). The association between spousal cognition and loneliness differed by marital closeness (interaction p-value=0.01); among “close” couples, spousal cognitive impairment was associated with higher likelihood of loneliness (p=0.01). In contrast, no association existed between spousal cognitive impairment and loneliness among “not close” couples (p=0.24). Conclusion Nearly 1 in 3 spouses of PWD experienced loneliness and 1 in 6 experienced depression. The association between spousal cognition and loneliness was stronger among those with close marital bonds. Implications Findings highlight substantial opportunity to identify and address loneliness and depression among spouses of PWD with close relational bonds to improve quality of life. %B Journal of Pain and Symptom Management %V 65 %P e304-e305 %G eng %R https://doi.org/10.1016/j.jpainsymman.2022.12.132 %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 %XBACKGROUND: 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 Journal Article %J Inquiry %D 2023 %T Structural Inequity and Socioeconomic Status Link to Osteoporosis Diagnosis in a Population-Based Cohort of Middle-Older-Age Americans. %A Gough Courtney, Margaret %A Roberts, Josephine %A Godde, Kanya %K Adult %K Aged %K Aged, 80 and over %K Black or African American %K Humans %K Income %K Logistic Models %K Middle Aged %K Osteoporosis %K Social Class %K Socioeconomic factors %XSocioeconomic status (SES) is an important social determinant of health inequities that has been linked to chronic conditions, including osteoporosis, but research tends to focus on socioeconomic disadvantage rather than how socioeconomic advantage may facilitate these inequities. This study accounts for structural inequities and assesses the relationship between early-life and later-life SES, and risk of osteoporosis diagnosis. Data come from the nationally representative, population-based cohort Health and Retirement Study and include individuals ages 50 to 90. The outcome variable is osteoporosis diagnosis. Logistic regression models of the relationship between SES and osteoporosis diagnosis are estimated, accounting for demographic, health, and childhood variables. Higher levels of childhood and adult SES link to lower odds of osteoporosis diagnosis. Structural inequities in income and underdiagnosis of osteoporosis among persons identifying as Black/African American were detected. Accounting for bone density scan access, inequities in osteoporosis diagnosis appear to stem from barriers to accessing health care due to financial constraints. The important role of SES and evidence of structural inequities leading to underdiagnosis suggest the critical importance of clinicians receiving Diversity, Equity, and Inclusion training to reduce health inequities.
%B Inquiry %V 60 %P 469580231155719 %8 2023 Jan-Dec %G eng %R 10.1177/00469580231155719 %0 Web Page %D 2023 %T Study Shows Retirees Underestimate Social Security by Nearly $2,000 — How To Resolve This Issue %A Cariaga, Vance %K Retirement %K Social Security %I Yahoo! %G eng %U https://www.yahoo.com/entertainment/study-shows-retirees-underestimate-social-111329408.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAA5lZBA4yel0NU_bHYLyy4BMVJ5pJwu10CEkndY8y8C6Wdmh5BMHN_Q9xwgS_laKOs2f4yyCom5f9nJ3g %0 Journal Article %J Journal of Risk and Financial Management %D 2023 %T Sustaining Retirement during Lockdown: Annuitized Income and Older American’s Financial Well-Being before and during the COVID-19 Pandemic %A Sun, Qi %A Curnutt, Gary %K annuitized income %K defined contribution plans %K Financial well-being %K longevity risk %X The landscape of employer-sponsored retirement plans in the U.S. has changed dramatically during the past few decades as more and more private-sector employers have decided to freeze or terminate traditional pension plans. Defined contribution (DC) plans became the primary choice or the only choice for employees to participate in employer-sponsored retirement plans. In the next ten to twenty years, the income from pension plans will only count for a third of the total retirement income for GenXers when compared to their baby boomer counterparts. It is important for research to provide evidence on how the change in retirement income resources impacts retirees’ retirement security and financial wellness. Using Health and Retirement Study (HRS) data before and during the COVID-19 pandemic, this study examines the association between annuitized income and various measures of older Americans’ financial well-being over time, particularly during the pandemic. This study finds that receiving annuitized income has a statistically significant relationship with reduced subjective financial well-being for both measurements, while only one of the measures of objective well-being, having liquid assets greater than the median household income, has a statistically significant positive relationship with receiving annuitized income. © 2023 by the authors. %B Journal of Risk and Financial Management %V 16 %G eng %R 10.3390/jrfm16100432 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Telehealth Use Among Older Adults with Sensory, Cognitive, and Physical Impairments: A Substitute or Supplement to Traditional Care? %A Choi, Shinae L %A Carr, Deborah %A Namkung, Eun Ha %XOBJECTIVES: Telehealth use flourished during the COVID-19 pandemic, as older patients faced obstacles to seeking in-person care. Heavy reliance on telehealth may continue post-pandemic, due to increased Medicare investments in its use. However, it is unclear if older adults with disabilities face obstacles to effective telehealth use. We evaluate: (1) how sensory, physical, and cognitive impairments affect older adults' use of telehealth only, traditional in-person care only, neither, or both (i.e., combined care); and (2) whether these effects differ on the basis of socioeconomic and social resources that may facilitate telehealth use.
METHOD: Data are from the Self-Administered Questionnaire in the 2020 wave of the Health and Retirement Study (n = 4,453). We estimated multinomial logistic regression models to evaluate associations between impairments and health care service use and tested two-way interaction terms to evaluate moderation effects.
RESULTS: Persons without impairments were most likely to use combined care, considered the optimal form of care. Persons with vision or cognitive impairment were more likely to use telehealth or traditional care only, whereas persons with three or more physical limitations were least likely to use telehealth alone, relative to combined care. Patterns did not differ significantly on the basis of any of the potential moderators.
DISCUSSION: We discuss implications for health care policy and practice, in light of reimbursement changes proposed by the Centers for Medicare and Medicaid Services for telehealth services. These proposals include the elimination of voice-only services which may be particularly beneficial to vision-impaired older adults.
%B J Gerontol B Psychol Sci Soc Sci %G eng %R 10.1093/geronb/gbad098 %0 Web Page %D 2023 %T This is your brain at work %A Capos, Claudia %K Brain health %K Cognition %K Retirement %I Michigan Today, University of MIchigan %C Ann Arbor, MI %G eng %U https://michigantoday.umich.edu/2023/01/27/this-is-your-brain-at-work/ %0 Thesis %B ProQuest Dissertations and Theses %D 2023 %T Three Essays on Intergenerational Transfers %A Cheng,Kent J. G. %K 0347:Mental health %K 0351:Gerontology %K 0626:Sociology %K 0938:Demography %K childhood circumstances %K Demography %K depression %K Gerontology %K Intergenerational transfers %K life course %K Mental Health %K Older Adults %K Sociology %K Transfer motives %X Intergenerational transfers of money, time, and other resources are major drivers of wealth inequality in the United States (U.S.). Wealth confers a wide array of advantages, from financial security to social prestige, power, and health. Wealth also can be used to accumulate more wealth. Given that intergenerational transfers generate economic inequality, this three-essay dissertation will seek to examine the causes and consequences of intergenerational transfers in the U.S. The first two essays are devoted to the understanding of the precedents of intergenerational transfers, while the last essay assess the consequence of intergenerational transfers on mental health.Essay 1: Cumulative inequality theory (CIT) posits that disadvantage experienced in early life may not only adversely affect one’s life course, it may also shape one’s ability to provide assistance to the next generation. Since intergenerational exchanges can either promote or set back the next generation’s success, this study therefore aims to determine how childhood disadvantages of parents are associated with the inter vivos downward transfers. Data from the Panel Study of Income Dynamics Childhood Retrospective Circumstances Survey and Rosters and Transfers Module were used to estimate linear regression models. Childhood experiences were measured in the following ways: an aggregate index, categorical variables, or as separate domains. Following CIT, domains included were economic, psychosocial (family, peer), environmental, and health. Downward transfers considered in this study were measured in terms of time transfers and money transfers in the past year, for aid in schooling, for home purchase, and for other purposes. Controlling for adult children’s characteristics that reflect needs for parental assistance, and upward time and money transfers to account for reciprocity, the results indicate that parent’s assistance to their adult children vary by their early-life experiences, and some childhood domains matter more (i.e., economic, family, environmental) than others (i.e., peer, health). Those with less affluent upbringing gave significantly more time transfers but less money to their adult children. Money earmarked for schooling purposes were at most $9,000 less for those with the worst level of childhood misfortunes. The forces that shape parental assistance to adult children, therefore, date as far back as the grandparent generation.Essay 2: Whether private intergenerational transfers crowd out or crowd in public welfare, have been subject to debate for almost half a century. Crowding out considers public and private transfers as substitutes, whereas when crowding in occurs the public sector frees up family’s resources via social welfare provisions, allowing families to transfer resources amongst their members. Often, studies on this topic either use cross-country variation from different welfare regimes or average social welfare expenditure per capita, without consideration of the varied social welfare experiences among givers and receivers. This is the first study to document how parental financial transfers and time transfers in the form of grandchild care are associated with the relative welfare experiences of the parent (giver) and the adult child (beneficiary) by exploiting the heterogeneity of public welfare across U.S. states. Parent-child dyadic data come from the Health and Retirement Study (HRS), a longitudinal and nationally representative study of older adults in the U.S. I linked data from the HRS respondent file and the child-level file constructed by the RAND Corporation with state-specific public welfare expenditures per capita from the Government Finance Database. Controlling for parent, adult child, and reciprocity related determinants of downward transfers, mixed effects logistic regressions clustered by households showed that compared to dyads who both live in a state with low levels of welfare generosity: (1) dyads whose parents live in a less generous state compared to their children have lower odds of downward money and time transfers and (2) dyads whose parents live in a more generous state while the child lives in a relatively less generous states have lower odds of providing both money and time transfers. The results from this study provide partial support for both crowding out and crowding in while implying support for both altruistic and selfish transfer motives. These mixed results call for scholars to reevaluate the consensus of the crowding in hypothesis as the main explanation of downward transfers of money and time from aging parents to adult children, and suggest that better data on both givers’ and receivers’ public welfare experiences are needed to fully contextualize family transfers.Essay 3: Intergenerational transfers are potential social determinants of health, as multiple generations coexisting has become a commonplace in aging societies and austere social protections push families to support their members. This study therefore aims to assess the association between intergenerational transfers between parents, adult children, and other kin, and depressive symptoms among U.S. older adults aged 51+ using data from the Health and Retirement Study waves 2010-2018. Two subsamples were constructed to account for the effect of kin: (1) respondents with at least one adult child and deceased parents/ parents-in-law, and (2) respondents with at least one adult child and one living parent/ parent-in-law throughout the study period. Transfers were categorized as either giving or receiving money and time. Net of relevant sociodemographic factors, random effects logistic regression models revealed that for both subsamples, the odds of having high depressive symptoms were greater for those who have given money transfers. Receiving money transfers and time transfers were also found to be detrimental for mental health. The findings are consistent with the stress process model and also provide partial support for economic exchange theory and contingency exchange. Understanding the factors that are related to older adult well-being is vital as this age group is at risk of mental health decline due to the life course challenges that typically occur in advanced ages like social isolation, bereavement, as well as illnesses and functional limitations. %B ProQuest Dissertations and Theses %I Syracuse University %C New York %V Ph.D. %P 163 %@ 9798380339124 %G eng %U https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/three-essays-on-intergenerational-transfers/docview/2864812703/se-2 %9 phd %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T A Time of Healing: Can Social Engagement after Bereavement Reduce Trajectories of Depression after the Death of a Child? %A Cha, Hyungmin %A Thomas, Patricia A %XOBJECTIVES: We work from a stress and life course perspective to examine the mental health of parents who experienced the death of their child. We examine whether mental health eventually returns to pre-bereavement levels and how social engagement after bereavement may shape the recovery process of depressive symptoms.
METHODS: We analyze discontinuous growth curve models to assess the association between a child's death and trajectories of parents' depressive symptoms from the 1998-2016 Health and Retirement Study. The sample includes 16,182 parents aged 50 years and older.
RESULTS: Those who transitioned to bereavement experience an elevation in depressive symptoms and a relatively long recovery time (e.g., seven years) to their pre-bereavement mental health in our findings. However, when engaging in volunteer work after their loss, depressive symptoms reduce more quickly to their pre-bereavement levels. Volunteering offsets up to three years of the negative consequences of child loss.
DISCUSSION: The death of a child is a traumatic event with extensive health consequences, but research should more fully examine the dynamic nature and potential mitigation of these health consequences over time. Our findings expand the temporal lens to encompass healing processes after bereavement, incorporating the importance of social engagement.
%B J Gerontol B Psychol Sci Soc Sci %G eng %R 10.1093/geronb/gbad094 %0 Journal Article %J J Aging Health %D 2023 %T Time Path of Weight Status Before and After Incident Dementia. %A Zhang, Yuan S %A Chang, Virginia W %XIdentifying whether obesity is a risk factor for dementia is complicated by the possibility of weight change as dementia evolves. This article investigates an extended time path of body mass index (BMI) before and after incident dementia in a nationally representative sample. Using the Health and Retirement Study (2000-2016), we examine (1) the longitudinal relationship between BMI and incident dementia and (2) heterogeneity in the BMI trajectory by initial BMI level. Weight loss begins at least one decade before incident dementia, then accelerates in the years immediately preceding dementia onset and continues after incident dementia. Those with higher levels of BMI at baseline experienced a much greater decline relative to those with a normal weight. Our results help explain the contradicting findings in the literature regarding the relationship between obesity and dementia and highlight the need for using extended longitudinal data to understand dementia risk.
%B J Aging Health %P 8982643231170711 %G eng %R 10.1177/08982643231170711 %0 Journal Article %J Psychoneuroendocrinology %D 2023 %T Towards a consensus definition of allostatic load: a multi-cohort, multi-system, multi-biomarker individual participant data (IPD) meta-analysis. %A McCrory, Cathal %A McLoughlin, Sinead %A Layte, Richard %A NiCheallaigh, Cliona %A O'Halloran, Aisling M %A Barros, Henrique %A Berkman, Lisa F %A Bochud, Murielle %A M Crimmins, Eileen %A T Farrell, Meagan %A Fraga, Silvia %A Grundy, Emily %A Kelly-Irving, Michelle %A Petrovic, Dusan %A Seeman, Teresa %A Stringhini, Silvia %A Vollenveider, Peter %A Kenny, Rose Anne %K Allostasis %K Biomarkers %K C-reactive protein %K Consensus %K Glycated Hemoglobin %XBACKGROUND: Allostatic load (AL) is a multi-system composite index for quantifying physiological dysregulation caused by life course stressors. For over 30 years, an extensive body of research has drawn on the AL framework but has been hampered by the lack of a consistent definition.
METHODS: This study analyses data for 67,126 individuals aged 40-111 years participating in 13 different cohort studies and 40 biomarkers across 12 physiological systems: hypothalamic-pituitary-adrenal (HPA) axis, sympathetic-adrenal-medullary (SAM) axis, parasympathetic nervous system functioning, oxidative stress, immunological/inflammatory, cardiovascular, respiratory, lipidemia, anthropometric, glucose metabolism, kidney, and liver. We use individual-participant-data meta-analysis and exploit natural heterogeneity in the number and type of biomarkers that have been used across studies, but a common set of health outcomes (grip strength, walking speed, and self-rated health), to determine the optimal configuration of parameters to define the concept.
RESULTS: There was at least one biomarker within 9/12 physiological systems that was reliably and consistently associated in the hypothesised direction with the three health outcomes in the meta-analysis of these cohorts: dehydroepiandrosterone sulfate (DHEAS), low frequency-heart rate variability (LF-HRV), C-reactive protein (CRP), resting heart rate (RHR), peak expiratory flow (PEF), high density lipoprotein cholesterol (HDL-C), waist-to-height ratio (WtHR), HbA1c, and cystatin C. An index based on five biomarkers (CRP, RHR, HDL-C, WtHR and HbA1c) available in every study was found to predict an independent outcome - mortality - as well or better than more elaborate sets of biomarkers.
DISCUSSION: This study has identified a brief 5-item measure of AL that arguably represents a universal and efficient set of biomarkers for capturing physiological 'wear and tear' and a further biomarker (PEF) that could usefully be included in future data collection.
%B Psychoneuroendocrinology %V 153 %P 106117 %G eng %R 10.1016/j.psyneuen.2023.106117 %0 Journal Article %J Review of Economics of the Household %D 2023 %T Trade-offs in intergenerational family care provision %A Carney, Monica Harber %K care provision %K Death %K Elderly %K grandchildren %B Review of Economics of the Household %G eng %R 10.1007/s11150-023-09668-4 %0 Journal Article %J Innov Aging %D 2023 %T Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults With Cognitive Impairment Living Alone, 2000-2018. %A Chen, Shanquan %A Zhang, Huanyu %A Underwood, Benjamin R %A Wang, Dan %A Chen, Xi %A Cardinal, Rudolf N %K gender %K Racial and ethnic disparities. physical disability. social support %XBACKGROUND AND OBJECTIVES: Informal care is the primary source of support for older adults with cognitive impairment, yet is less available to those who live alone. We examined trends in the prevalence of physical disability and social support among older adults with cognitive impairment living alone in the United States.
RESEARCH DESIGN AND METHODS: We analyzed 10 waves of data from the U.S. Health and Retirement Survey spanning 2000-2018. Eligible people were those aged ≥65, having cognitive impairment, and living alone. Physical disability and social support were measured via basic and instrumental activities of daily living (BADLs, IADLs). We estimated linear temporal trends for binary/integer outcomes via logistic/Poisson regression, respectively.
RESULTS: A total of 20 070 participants were included. Among those reporting BADL/IADL disability, the proportion unsupported for BADLs decreased significantly over time (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), and the proportion unsupported for IADLs increased (OR = 1.02, CI 1.01-1.04). Among those receiving IADL support, the number of unmet IADL support needs increased significantly over time (relative risk [RR] 1.04, CI 1.03-1.05). No gender disparities were found for these trends. Over time, Black respondents had a relatively increasing trend of being BADL-unsupported (OR = 1.03, CI 1.0-1.05) and Hispanic and Black respondents had a relatively increasing trend in the number of unmet BADL needs (RR = 1.02, CI 1.00-1.03; RR = 1.01, CI 1.00-1.02, respectively), compared to the corresponding trends in White respondents.
DISCUSSION AND IMPLICATIONS: Among lone-dwelling U.S. older adults with cognitive impairment, fewer people received IADL support over time, and the extent of unmet IADL support needs increased. Racial/ethnic disparities were seen both in the prevalence of reported BADL/IADL disability and unmet BADL/IADL support needs; some but not all were compatible with a reduction in disparity over time. This evidence could prompt interventions to reduce disparities and unmet support needs.
%B Innov Aging %V 7 %P igad028 %G eng %N 4 %R 10.1093/geroni/igad028 %0 Journal Article %J American Journal of Preventive Medicine %D 2023 %T Trends in Geographic Proximity to Substance Use Disorder Treatment. %A Kapinos, Kandice A %A DeYoreo, Maria %A Gracner, Tadeja %A Stein, Bradley D %A Cantor, Jonathan %K geographic accessibility %K substance use %K treatment facilities %XINTRODUCTION: This study aims to assess the trends in the number and characteristics of substance use disorder treatment facilities within the county of residence of adults aged 50+ years over time.
METHODS: Using retrospective longitudinal data from the 1992-2018 Health and Retirement Study merged with the county-level data on all licensed treatment facilities in the country, linear mixed models were estimated to calculate geographic accessibility to substance use disorder treatment, adjusted for person-level demographics, state-level controls, and calendar year-fixed effects. Analysis was conducted in 2022.
RESULTS: Overall, older adults experienced a decline in the average number of substance use disorder treatment facilities within their counties of residence from 4.80 per 100,000 residents (95% CI=4.69, 4.92) in 1992 to 4.50 (95% CI=4.35, 4.64) in 2018. However, the number accepting Medicare increased from 0.26 (95% CI=0.21, 0.30) in 1992 to 1.88 (95% CI=1.80, 1.96) facilities per 100,000 (42% of facilities); Medicaid increased from 0.20 (95% CI=0.13, 0.26) in 1992 to 3.50 (95% CI=3.39, 3.62) facilities per 100,000 (78% of facilities) in 2018. Older adults living in more rural areas experienced the most growth in substance use disorder treatment facilities per capita in their counties but with less significant growth in facilities offering medication for opioid use disorder than those living in more urban areas.
CONCLUSIONS: Despite increases in the number of substance use disorder treatment facilities in rural areas, there has been less growth in nearby facilities offering evidence-based medication treatment for opioid use disorder.
%B American Journal of Preventive Medicine %G eng %R 10.1016/j.amepre.2023.03.019 %0 Journal Article %J Demography %D 2023 %T Under Different Roofs? Coresidence With Adult Children and Parents' Mental Health Across Race and Ethnicity Over Two Decades. %A Caputo, Jennifer %A Cagney, Kathleen A %K Adult %K Adult children %K ethnicity %K Humans %K Intergenerational Relations %K Mental Health %K Parents %K Residence Characteristics %XMany U.S. parents share a household with an adult child in later life. However, the reasons parents and adult children coreside may vary over time and across family race/ethnicity, shaping relationships with parents' mental health. Using the Health and Retirement Study, this study investigates the determinants and mental health correlates of coresidence with adult children from 1998 to 2018 among White, Black, and Hispanic parents under age 65 and aged 65+. Findings show that the predictors of coresidence shifted with increasing odds that parents lived with an adult child, and several varied by parents' age group and race/ethnicity. Compared with White parents, Black and Hispanic parents were more likely to live with adult children, especially at older ages, and to indicate that they helped their children with household finances or functional limitations. Living with adult children was associated with higher depressive symptoms among White parents, and mental health was negatively related to living with adult children who were not working or were helping parents with functional limitations. The findings highlight increasing diversity among adult child-coresident parents and underscore persistent differences in the predictors and meaning of coresidence with adult children across race/ethnicity.
%B Demography %V 60 %P 461-492 %8 2023 Apr 01 %G eng %N 2 %R 10.1215/00703370-10571923 %0 Journal Article %J Epidemiology and Psychiatric Sciences %D 2023 %T United we thrive: friendship and subsequent physical, behavioural and psychosocial health in older adults (an outcome-wide longitudinal approach). %A Kim, E S %A Chopik, W J %A Chen, Y %A Wilkinson, R %A VanderWeele, T J %K Aged %K Aging %K Friends %K Humans %K Interpersonal Relations %K Prospective Studies %XAIMS: Three factors converge to underscore the heightened importance of evaluating the potential health/well-being effects of friendships in older adulthood. First, policymakers, scientists, and the public alike are recognizing the importance of social relationships for health/well-being and creating national policies to promote social connection. Second, many populations are rapidly aging throughout the world. Third, we currently face what some call a 'friendship recession'. Although, growing research documents associations between friendship with better health and well-being, friendship can also have a 'dark side' and can potentially promote negative outcomes. To better capture friendship's potential heterogeneous effects, we took an outcome-wide analytic approach.
METHODS: We analysed data from 12,998 participants in the Health and Retirement Study (HRS) - a prospective and nationally representative cohort of U.S. adults aged >50, and, evaluated if increases in friendship strength (between ; 2006/2008 and ; 2010/2012) were associated with better health/well-being across 35 outcomes (in ; 2014/2016). To assess friendship strength, we leveraged all available friendship items in HRS and created a composite 'friendship score' that assessed the following three domains: (1) friendship network size, (2) friendship network contact frequency and (3) friendship network quality.
RESULTS: Stronger friendships were associated with better outcomes on some indicators of physical health (e.g. reduced risk of mortality), health behaviours (e.g. increased physical activity) and nearly all psychosocial indicators (e.g. higher positive affect and mastery, as well as lower negative affect and risk of depression). Friendship was also associated with increased likelihood of smoking and heavy drinking (although the latter association with heavy drinking did not reach conventional levels of statistical significance).
CONCLUSIONS: Our findings indicate that stronger friendships can have a dual impact on health and well-being. While stronger friendships appear to mainly promote a range of health and well-being outcomes, stronger friendships might also promote negative outcomes. Additional research is needed, and any future friendship interventions and policies that aim to enhance outcomes should focus on how to amplify positive outcomes while mitigating harmful ones.
%B Epidemiology and Psychiatric Sciences %V 32 %P e65 %G eng %R 10.1017/S204579602300077X %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 %XBACKGROUND 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 Journal Article %J Genes %D 2023 %T Weight Loss Is a Strong Predictor of Memory Disorder Independent of Genetic Influences %A Chen, Sunny %A Sarasua, Sara M. %A Davis, Nicole J. %A DeLuca, Jane M. %A Thielke, Stephen M. %A Yu, Chang-En %K genetic influences %K memory disorder %K Weight Loss %B Genes %V 14 %P 1563 %G eng %R 10.3390/genes14081563 %0 Report %D 2023 %T What Happened to Late Boomers’ Retirement Wealth? %A Chen, Anqi %A Alicia H. Munnell %A Quinby, Laura D. %K Great Recession %K late boomers %K Retirement %K Wealth %X The brief’s key findings are: Late Boomers have less retirement wealth than earlier cohorts, including surprisingly low 401(k) assets. To explain this drop, the analysis explored both changing demographics and labor market experiences. The results show that part of the drop is due to a decline in the share of Late Boomers who are White, married, and have college degrees. The main factor, though, is that Late Boomers saw a weakening in the link between work and wealth due to the Great Recession. The Great Recession story is a bit of good news for younger cohorts, as some of the downward pressure on their wealth holdings should abate. %B Issue in Brief %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/what-happened-to-late-boomers-retirement-wealth/ %0 Journal Article %J Journal of Applied Gerontology %D 2023 %T When Living Wills go Missing: Associations With Hospice Use and Hospital Death Using National Longitudinal Data. %A Zhang, Peiyuan %A Cagle, John G %K Advance directives %K Hospice Care %K Hospices %K Hospital Mortality %K Living Wills %XDespite documented benefits of advance care planning (ACP), understandings about the impact of advance directives (AD)-critical steps in the ACP process-remain limited. As a type of AD, living wills (LWs) are often misplaced or forgotten about. This study explores the prevalence of missing LWs among older adults in the U.S. and its association with in-hospital death and hospice care use. Analyses are based on 692 participants who responded to LW completion questions in the 2016 Core and 2018 wave of the Health and Retirement Study Nearly a fifth of American older adults age 65+ had an LW that went missing. Stepwise logistic regression results show that completed LWs confirmed by both individuals and their proxies were associated with increased hospice use and fewer hospital deaths. Individuals whose LWs went missing still had better end-of-life care than those who did not have an LW.
%B Journal of Applied Gerontology %V 42 %P 1108-1112 %G eng %N 5 %R 10.1177/07334648221146774 %0 Web Page %D 2023 %T Where the government draws the line for Medicaid coverage leaves out many older Americans who may need help paying for medical and long-term care bills – new research %A Cohen, Marc A %A Tavares, Jane %K Long-term Care %K Medicaid %K medical bills %I The Conversation %G eng %U https://theconversation.com/where-the-government-draws-the-line-for-medicaid-coverage-leaves-out-many-older-americans-who-may-need-help-paying-for-medical-and-long-term-care-bills-new-research-208527 %0 Journal Article %J SSM Population Health %D 2022 %T Accelerated epigenetic aging mediates link between adverse childhood experiences and depressive symptoms in older adults: Results from the Health and Retirement Study. %A Klopack, Eric T %A Eileen M. Crimmins %A Cole, Steve W %A Seeman, Teresa E %A Carroll, Judith E %K ACEs %K Adverse childhood events %K Ageing %K depression %K Epigenetic aging %XAdverse childhood experiences (ACEs) increase risk for depression at subsequent ages and have been linked to accelerated biological aging. We hypothesize that accelerated epigenetic aging may partially mediate the link between ACEs and depression. This study examines 3 three second-generation epigenetic aging measures (viz., GrimAge, PhenoAge, and DunedinPoAm38) as mediators of the link between ACEs and depressive symptoms in older adulthood. We utilize structural equation modeling to assess mediation in the Health and Retirement Study (N = 2672). Experiencing ACEs is significantly associated with an older GrimAge and a faster pace of aging via the DunedinPoAm38. Having an older GrimAge and faster DunedinPoAm38 pace of aging were also significantly associated with more depressive symptoms. PhenoAge was not significantly associated with depressive symptoms and was only associated with experiencing three ACEs. These associations were reduced by socioeconomic and lifestyle factors, including obesity and substance use. GrimAge explained between 9 and 14% of the association between ACEs and adult depressive symptoms, and DunedinPoAm38 explained between 2 and 7% of the association between ACEs and adult depressive symptoms. Findings indicate accelerated aging, as measured by GrimAge and DunedinPoAm38, is associated with ACEs and with depressive symptoms in older Americans. Findings also show these epigenetic aging measures mediate a portion of the association between ACEs and adult depressive symptoms. Epigenetic aging may represent a physiological mechanism underlying the link between early life adversity and adult depression. Weight maintenance and substance use are potentially important areas for intervention.
%B SSM Population Health %V 17 %P 101071 %G eng %R 10.1016/j.ssmph.2022.101071 %0 Journal Article %J Journal of Economics and Finance %D 2022 %T Adjustable consumption model for retirees to balance spending and risk %A Cobb, Barry R %A Murray, Tim %A Smith, Jeffrey S %K consumption %K Monte Carlo simulation %K Retirement %K Social Security %X A retirement consumption strategy that suggests initial consumption and a consumption adjustment factor that adapts spending to returns in the retiree’s investment portfolio while considering appropriate risk tolerance is introduced. This approach allows households to increase their spending earlier in retirement as compared to constant real consumption strategies while still achieving a bequest motive and maintaining investment liquidity. Failure in the model is defined as living only on Social Security payments, and this risk is not significantly increased by employing the adjustable consumption model. Consumption and wealth patterns throughout retirement tend to follow empirical data from the Health and Retirement Study. Results for retirees at varying levels of accumulated wealth, Social Security income level, and risk level are provided. %B Journal of Economics and Finance %V 46 %G eng %N 420–451 %R 10.1007/s12197-022-09572-0 %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Age-related differences in T cell subsets in a nationally representative sample of people over age 55: Findings from the Health and Retirement Study. %A Bharat Thyagarajan %A Jessica Faul %A Vivek, Sithara %A Jung K Kim %A Nikolich-Žugich, Janko %A David R Weir %A Eileen M. Crimmins %K Aging %K CMV Seropositivity %XThough T cell immunosenescence is a major risk factor for age-related diseases, susceptibility to infections, and responses to vaccines, differences in T cells subset counts and representation by age and sex have not been determined for a large sample representative of the national population of the US. We evaluated the counts of T cell subsets including total, CD4+ and CD8+ T cells, and their naïve (Tn), effector memory (Tem) and effector subsets, in the context of age, sex and exposure to cytomegalovirus (CMV) infection among 8,848 Health and Retirement Study (HRS) participants, a nationally representative study of adults over 55 years. Total T cells (CD3+) and CD4+ cells declined markedly with age; CD8+ T cells declined somewhat less. While CD4+ T cell declines with age occurred for both CMV seropositive and CMV seronegative groups, total T cells and CD8+ cells were both substantially higher among the CMV seropositive group. Numbers of Tn CD4+ and CD8+ cells were strongly and inversely related to age, were better conserved among women, and were independent of CMV seropositivity. By contrast, accumulation of the CD8+ and CD4+ Tem and effector subsets was CMV-associated. This is the first study to provide counts of T cell subsets by age and sex in a national sample of older US adults over the age of 55 years. Understanding T cell changes with age and sex is an important first step in determining strategies to reduce its impact on age-related diseases and susceptibility to infection.
%B The Journals of Gerontology, Series A %V 77 %P 927-933 %G eng %N 5 %R 10.1093/gerona/glab300 %0 Journal Article %J Financial Planning Review %D 2022 %T Aging and loneliness: Why financial advisors should help clients and how %A Gibson, Philip %A Cheng, Yuanshan %A Sam, Janine K. %K behavioral finance %K Financial planning %K Retirement %X The primary goal of this study is to examine loneliness in retirement and explore steps that a financial planner can take to mitigate client loneliness. Using data from the Participant Lifestyle Questionnaire, and Leave-Behind Module from the Health and Retirement Study database, we show that even after controlling for relationship status and having a purpose in life, leisure activities can help reduce loneliness. When compared to increasing household wealth, the authors find that engaging in social activities has a greater impact on decreasing loneliness, signaling a possible duty of care owed to clients as it relates to well-being. We conclude with implications and practical strategies financial advisors can implement to help clients as they plan for and navigate retirement. %B Financial Planning Review %V 5 %P e1136 %G eng %N 1 %R 10.1002/cfp2.1136 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Alcohol Use and Blood Pressure among Older Couples: The Moderating Role of Negative Marital Quality. %A Birditt, Kira %A Turkelson, Angela %A Polenick, Courtney A %A Cranford, James A %A Blow, Fred %K alcohol use %K Blood pressure %K Marital quality %XOBJECTIVES: Spouses often have concordant drinking behaviors and important influences on one another's cardiovascular health. However, little is known about the implications of dyadic drinking patterns for blood pressure, and the marital factors that confer risk or resilience. This paper examined links between alcohol use and blood pressure within individuals and opposite sex couples over time, and whether those links vary by negative marital quality among older adults.
METHODS: Participants were from the nationally representative longitudinal Health and Retirement Study which included 4,619 respondents in 2,682 opposite sex couples who participated in at least two of the waves from 2006 to 2016. Participants reported the number of drinks they typically consume per week, negative marital quality, and had their blood pressure measured via a cuff.
RESULTS: Analyses revealed that greater drinking was associated with increased systolic blood pressure among both husbands and wives. Further, husbands who drank more had higher blood pressure when wives drank more alcohol, whereas there was no association between husbands' drinking and blood pressure when wives drank less alcohol. Interactions with negative marital quality showed that drinking concordance may be associated with increased blood pressure over time in more negative marriages.
DISCUSSION: Findings indicated that spousal drinking concordance, although often associated with positive marital quality, may have negative long-term health effects.
%B The Journals of Gerontology, Series B %V 77 %P 1592-1602 %G eng %N 9 %R 10.1093/geronb/gbac015 %0 Journal Article %J Frontiers in Public Health %D 2022 %T American older adults in COVID-19 Times: Vulnerability types, aging attitudes and emotional responses %A Fu, Mingqi %A Guo, Jing %A Chen, Xi %A Zhang, Qilin %K Aging attitudes %K COVID-19 %K emotion %K Vulnerability %X Background: The coronavirus disease aroused challenges to the emotional well-being of vulnerable older adults in hard-hit areas. This study investigates different vulnerability types among American older adults and how modes of vulnerability are associated with aging attitudes and emotional responses. Methods: Using Latent Class Analysis, we investigated 2003 respondents aged over 50 from HRS. Hierarchical linear regressions with the affective profile as cluster identity were used to examine the relationship between vulnerability type and positive aging attitudes with positive and negative emotional responses. Results: We detected three vulnerability types among American older adults: the slight vulnerability (72%), the healthcare use vulnerability (19%), and the dual vulnerabilities (9%). No significant difference in positive emotions was found between vulnerability types. However, more negative emotions were found among older adults with healthcare use vulnerability (B=0.746 %B Frontiers in Public Health %V 8 %P 778084 %G eng %N 9 %R 10.1101/2021.04.29.21256178 %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Association Between Baseline Buccal Telomere Length and Progression of Kidney Function: The Health and Retirement Study. %A Westbrook, Adrianna %A Zhang, Ruiyuan %A Shi, Mengyao %A Razavi, Alexander C %A Huang, Zhijie %A Chen, Jing %A He, Jiang %A Tanika N Kelly %A Shen, Ye %A Li, Changwei %K Kidney disease %K Kidney function %K Telomere %XWe aimed to evaluate associations of baseline telomere length with overall and annual change in estimated glomerular filtration rate (eGFR) and trajectory of kidney function during an 8-year follow-up. A total of 3,964 participants of the Health and Retirement Study (HRS) were included. We identified three trajectory groups of kidney function: consistently normal (n=1,163 or 29.3%), normal to impaired (n=2,306 or 58.2%), and consistently impaired groups (n=495 or 12.5%). After controlling for age, sex, race, education, smoking, drinking, diabetes, heart disease, blood pressure, body mass index, total cholesterol, and hemoglobin A1c, participants with longer telomere length were 20% less likely (odds ratio [OR]=0.80, 95% confidence interval [CI]: 0.69-0.93, P=0.003) to have a normal to impaired kidney function trajectory than a consistently normal function trajectory. Telomere length was not associated with changing rate of eGFR over 8 years (P=0.45). Participants with longer telomere length were more likely to have consistently normal kidney function.
%B The Journals of Gerontology, Series A %V 77 %P 471-476 %G eng %N 3 %R 10.1093/gerona/glac004 %0 Journal Article %J International Journal of Exercise Science %D 2022 %T The Association Between Handgrip Strength Asymmetry Severity and Future Morbidity Accumulation: Results from the Health and Retirement Study %A Klawitter, Lukus %A Collins, Kyle S. %A Ringhofer, Dawson %A Christensen, Bryan K. %A McGrath, Ryan %K environment %K Health Status %K multimorbidity %K muscular atrophy %K Public Health %X Analyzing the severity of handgrip strength (HGS) asymmetry in aging populations may help to screen for morbidities and add utility to handgrip dynamometer testing. Our study sought to determine the relationships between HGS asymmetry severity and future accumulating morbidities in older Americans. Secondary analyses from the 2006-2016 waves of the Health and Retirement Study included 18,506 adults ≥ 50 years old. The highest recorded HGS values from each hand were used to calculate HGS asymmetry ratio (non-dominant HGS/dominant HGS). If the HGS asymmetry ratio < 1.0, it was inversed to make all asymmetry ratios ≥ 1.0. Participants were categorized into groups based on the severity of their HGS asymmetry ratio: 1) 0.0% - 10.0%, 2) 10.1% - 20.0%, 3) 20.1% - 30.0%, and 4) > 30.0%. Healthcare provider-diagnosed morbidities (hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems) were self-reported. Covariate-adjusted ordinal generalized estimating equations evaluated the relationships between HGS asymmetry severity on future accumulating morbidities. Results showed 8,936 (48.3%) participants had HGS asymmetry 0.0%-10.0%, 6,105 (33.0%) participants had HGS asymmetry 10.1%-20.0%, 2,411 (13.0%) participants had HGS asymmetry 20.1%-30.0%, and 1,054 (5.7%) participants had HGS asymmetry > 30.0%. Overall, every 10% increase in HGS asymmetry was associated with a 1.17 (CI: 1.05, 1.32) greater odds of future morbidity accumulation. Additionally, asymmetry between 10.1% - 20.0%, 20.1% - 30.0%, and > 30.0% was associated with a 1.10 (CI: 1.05, 1.15), 1.11 (CI: 1.04, 1.18), and 1.20 (CI: 1.09, 1.33) greater odds for morbidity accumulation during aging. These findings suggest that severe functional asymmetries may elevate the odds for accumulating morbidities. %B International Journal of Exercise Science %V 15 %P 1133-1141 %G eng %U https://digitalcommons.wku.edu/cgi/viewcontent.cgi?article=3327&context=ijes %N 3 %0 Journal Article %J Maturitas %D 2022 %T Association between marital relationship and multimorbidity in middle-aged adults: A longitudinal study across the US, UK, Europe, and China %A Danyang Wang %A Duanhui Li %A Shiva Raj Mishra %A Carmen Lim %A Xiaochen Dai %A Shu Chen %A Xiaolin Xu %K Marital Status %K marriage duration %K multimorbidity %K Prevalence %X Background Marital relationship plays an important role in health and wellbeing. However, how marriage is associated with multimorbidity (the co-occurrence of two or more chronic conditions) has not been comprehensively investigated. We aimed to assess the association between marriage and multimorbidity in middle-aged adults. Methods We used nationally representative data on 23641 adults aged 50-60 years who participated in four longitudinal studies in the US, UK, Europe, and China (Health and Retirement Study, English Longitudinal Study on Ageing, Survey of Health, Ageing and Retirement in Europe, and China Health and Retirement Longitudinal Study). Respondents were followed up in 2010-11 (baseline), 2012-13, and 2014-15. We used generalized estimating equations to evaluate the associations between marital status (married/partnered or non-married [separated/devoiced/widowed/never married]), marriage duration and multimorbidity, adjusting for socioeconomic and lifestyle factors. Results Over 4-year follow-up, 24% (n=5699) of respondents experienced separation, divorce, widowhood, or never-married status, and approximately 43% (n=10228) of respondents reported multimorbidity. Those who were not married had a higher odds of multimorbidity (age-, sex- and region-adjusted odds ratio 1.19; 95% confidence interval 1.14 to 1.25). Those who had been married for 21-30 years had a lower odds of experiencing multimorbidity than those married for less than 10 years. The associations remained robust after adjusting for socioeconomic and lifestyle factors. Conclusions Marital relationship (status and length) was associated with multimorbidity in middle-aged adults, highlighting the role of marital relationship in shaping the trajectory of health and wellbeing across the life course. These findings provide insight for the prevention and management of chronic disease and multimorbidity. %B Maturitas %V 155 %P 32-39 %G eng %R https://doi.org/10.1016/j.maturitas.2021.09.011 %0 Journal Article %J Journal of Clinical Sleep Medicine %D 2022 %T The association between obstructive sleep apnea risk and cognitive disorders: A population-based study. %A Shieu, Monica M %A Galit L Dunietz %A Paulson, Henry L %A Ronald D Chervin %A Braley, Tiffany J %K cognitive disorders %K Dementia %K effect modification %K obstructive sleep apnea %XSTUDY OBJECTIVES: To examine the association between OSA risk and cognitive disorders among US adults.
METHODS: Data from the 2016 wave of the Health and Retirement Study (HRS) were utilized. Probable OSA cases were identified with survey items that resembled critical elements of a clinically validated OSA screen (STOP-Bang questionnaire). Weighted prevalence of cognitive impairment not dementia (CIND) and dementia among individuals with and without probable OSA were assessed. Cross-sectional analyses of associations between OSA risk and cognitive outcomes, along with effect modification by race and ethnicity, were estimated using imputed data.
RESULTS: Of the 20,910 HRS participants, 60% had probable OSA. CIND and dementia were more common among adults with probable OSA as compared to those without (12.7% vs. 8.0% for CIND; 3.2% vs 2.0% for dementia). Probable OSA was associated with CIND (OR=1.22, 1.08-1.37) and dementia (OR=1.27, 1.04-1.54). Race/ethnicity significantly modified the association between probable OSA and CIND, with a higher risk for CIND in Whites (OR=1.35, 1.17-1.57) as compared to non-Whites (OR=0.98, 0.81-1.19).
CONCLUSIONS: CIND and dementia are more common among older adults who are at high risk for OSA, as compared to low-risk individuals. These data highlight the importance of consideration of OSA risk in large-scale studies of OSA and cognitive disorders.
%B Journal of Clinical Sleep Medicine %V 18 %P 1177-1185 %G eng %N 4 %R 10.5664/jcsm.9832 %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 %XOBJECTIVES: 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 JAMA Network Open %D 2022 %T Association Between Racial Wealth Inequities and Racial Disparities in Longevity Among US Adults and Role of Reparations Payments, 1992 to 2018. %A Himmelstein, Kathryn E W %A Lawrence, Jourdyn A %A Jahn, Jaquelyn L %A Ceasar, Joniqua N %A Morse, Michelle %A Bassett, Mary T %A Wispelwey, Bram P %A Darity, William A %A Venkataramani, Atheendar S %K Black People %K ethnicity %K Income %K Socioeconomic factors %XIMPORTANCE: In the US, Black individuals die younger than White individuals and have less household wealth, a legacy of slavery, ongoing discrimination, and discriminatory public policies. The role of wealth inequality in mediating racial health inequities is unclear.
OBJECTIVE: To assess the contribution of wealth inequities to the longevity gap that exists between Black and White individuals in the US and to model the potential effects of reparations payments on this gap.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study, a nationally representative panel study of community-dwelling noninstitutionalized US adults 50 years or older that assessed data collected from April 1992 to July 2019. Participants included 7339 non-Hispanic Black (hereinafter Black) and 26 162 non-Hispanic White (hereinafter White) respondents. Data were analyzed from January 1 to September 17, 2022.
EXPOSURES: Household wealth, the sum of all assets (including real estate, vehicles, and investments), minus the value of debts.
MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality by the end of survey follow-up in 2018. Using parametric survival models, the associations among household wealth, race, and survival were evaluated, adjusting for age, sex, number of household members, and marital status. Additional models controlled for educational level and income. The survival effects of eliminating the current mean wealth gap with reparations payments ($828 055 per household) were simulated.
RESULTS: Of the 33 501 individuals in the sample, a weighted 50.1% were women, and weighted mean (SD) age at study entry was 59.3 (11.1) years. Black participants' median life expectancy was 77.5 (95% CI, 77.0-78.2) years, 4 years shorter than the median life expectancy for White participants (81.5 [95% CI, 81.2-81.8] years). Adjusting for demographic variables, Black participants had a hazard ratio for death of 1.26 (95% CI, 1.18-1.34) compared with White participants. After adjusting for differences in wealth, survival did not differ significantly by race (hazard ratio, 1.00 [95% CI, 0.92-1.08]). In simulations, reparations to close the mean racial wealth gap were associated with reductions in the longevity gap by 65.0% to 102.5%.
CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that differences in wealth are associated with the longevity gap that exists between Black and White individuals in the US. Reparations payments to eliminate the racial wealth gap might substantially narrow racial inequities in mortality.
%B JAMA Network Open %V 5 %P e2240519 %G eng %N 11 %R 10.1001/jamanetworkopen.2022.40519 %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Association of Long-Term Body Weight Variability With Dementia: A Prospective Study. %A Chen, Hui %A Zhou, Tianjing %A Guo, Jie %A Ji, John S %A Huang, Liyan %A Xu, Weili %A Zuo, Guangmin %A Lv, Xiaozhen %A Zheng, Yan %A Hofman, Albert %A Ma, Yuan %A Yuan, Changzheng %K Body Weight %K Proportional Hazards Models %K Prospective Studies %K Risk Factors %K Weight Loss %XBACKGROUND: Body weight variability (BWV) refers to intraindividual weight loss and gain over a period. The association of long-term BWV with dementia remains unclear and whether this association is beyond body weight change is undetermined.
METHODS: In the Health and Retirement Study, a total of 5 547 dementia-free participants (56.7% women; mean [SD] age, 71.1 [3.2] years) at baseline (2008) were followed up to 8 years (mean = 6.8 years) to detect incident dementia. Body weight was self-reported biennially from 1992 to 2008. BWV was measured as the coefficient of variation utilizing the body weight reported 9 times across 16 years before baseline. Cox-proportional hazard model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI).
RESULTS: Among the 5 547 participants, a total of 427 incident dementia cases were identified during follow-up. Greater long-term BWV was significantly associated with a higher risk of dementia (HR comparing extreme quartiles: 2.01, 95% CI: 1.48-2.72; HR of each SD increment: 1.21, 95% CI: 1.10-1.32; p-trend < .001) independent of mean body weight and body weight change. This significant association was even observed for BWV estimated approximately 15 years preceding dementia diagnosis (HR of each SD increment: 1.13, 95% CI: 1.03-1.23) and was more pronounced for that closer to diagnosis.
CONCLUSION: Our prospective study suggested that greater BWV may be a novel risk factor for dementia.
%B The Journals of Gerontology, Series A %V 77 %P 2116-2122 %G eng %N 10 %R 10.1093/gerona/glab372 %0 Journal Article %J JAMA Network Open %D 2022 %T Association of Perceived Job Insecurity With Subsequent Memory Function and Decline Among Adults 55 Years or Older in England and the US, 2006 to 2016. %A Yu, Xuexin %A Kenneth M. Langa %A Cho, Tsai-Chin %A Lindsay C Kobayashi %K COVID-19 %K ELSA %K Employment %K England %K Female %K Male %K Memory Disorders %K Pandemics %K Prospective Studies %XImportance: Intensified global economic competition and recent financial crises, including those associated with the COVID-19 pandemic, have contributed to uncertainty about job security. However, little is known about the association of perceived job insecurity with memory function and decline among older adults.
Objectives: To investigate the association between perceived job insecurity and subsequent memory function and rate of memory decline among older adults in the US and England.
Design, Setting, and Participants: This 10-year prospective population-based cohort study used data from the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) collected from 2006 to 2016. Participants included 9538 adults 55 years or older. Data were analyzed from August 1 to 31, 2021.
Exposures: Perceived job insecurity (yes vs no) at baseline.
Main Outcomes and Measures: Episodic memory z scores at baseline and rate of decline during the follow-up.
Results: Among the 9538 study participants, the mean (SD) age at baseline was 60.97 (6.06) years, and 4981 (52.22%) were women. A total of 2320 participants (24.32%) reported job insecurity at baseline (1088 of 3949 [27.55%] in England and 1232 of 5589 [22.04%] in the US). Perceived job insecurity after 55 years of age was associated with lower baseline memory z scores in the fully adjusted model (β = -0.04 [95% CI, -0.08 to -0.01]) but not with rate of memory decline (β = 0.01 [95% CI, -0.01 to 0.01]). The association appeared to be stronger in the US than in England (job insecurity × US, β = -0.05 [95% CI, -0.11 to 0.02]), but the estimate was imprecise, potentially owing to low statistical power.
Conclusions and Relevance: The findings of this cohort study suggest that exposure to job insecurity in middle to late life was associated with worse memory function among older adults in the US and England. This association may vary across socioeconomic and social welfare contexts, although future studies with large samples from diverse socioeconomic settings are warranted.
%B JAMA Network Open %V 5 %P e227060 %G eng %N 4 %R 10.1001/jamanetworkopen.2022.7060 %0 Journal Article %J Scientific Reports %D 2022 %T Association of plasma cystatin C with all-cause and cause-specific mortality among middle-aged and elderly individuals: a prospective community-based cohort study. %A Wu, Jinhua %A Liang, Yuemei %A Chen, Rong %A Xu, Linli %A Ou, Zejin %A Liang, Haiying %A Zhao, Lina %K Cardiovascular Diseases %K Cause of Death %K Cohort Studies %K Cystatin C %K Mortality %K Neoplasms %K Proportional Hazards Models %K Prospective Studies %K Risk Factors %XWe investigated the associations of plasma cystatin C with all-cause and cause-specific mortality risk and identified potential modifying factors affecting these associations in middle-aged and elderly people (≥ 50 years). This community-based prospective cohort study included 13,913 individuals aged ≥ 50 years from the Health and Retirement Study. Cox proportional hazard models were used to estimate the associations between cystatin C concentrations and the risk of all-cause and cardiovascular and cancer mortality after adjustment for sociodemographic characteristics, lifestyle factors, self-reported medical history, and other potential confounding factors. During a total of 71,988 person-years of follow-up (median: 5.8 years; interquartile range 3.3-7.6 years), 1893 all-cause deaths were documented, including 714 cardiovascular-related and 406 cancer-related deaths. The comparisons of the groups with the highest (quartile 4) and lowest (quartile 1) cystatin C concentrations revealed that the adjusted hazard ratios and 95% confidence intervals were 1.92 (1.62-2.28) for all-cause mortality, 1.98 (1.48-2.65) for cardiovascular mortality, and 1.62 (1.13-2.32) for cancer mortality. The associations of cystatin C concentrations with all-cause, cardiovascular and cancer mortality did not differ substantially when participants were stratified by sex, age, BMI, current smoking status, current alcohol consumption, and regular exercise (all P for interactions > 0.05). Our study indicates that an elevated plasma cystatin C concentration is associated with an increased risk of all-cause, cardiovascular and cancer mortality both men and women among the middle-aged and elderly individuals.
%B Scientific Reports %V 12 %P 22265 %G eng %N 1 %R 10.1038/s41598-022-24722-4 %0 Journal Article %J JAMA Network Open %D 2022 %T Association of Social Risk Domains With Poor Cardiovascular Risk Factor Control in US Adults With Diabetes, From 2006 to 2016. %A Corwin, Timothy %A Ozieh, Mukoso N %A Garacci, Emma %A Walker, Rebekah J %A Egede, Leonard E %K Cardiovascular Diseases %K Diabetes Mellitus %K Glycated Hemoglobin A %K HDL %K Heart Disease Risk Factors %K Lipoproteins %K Risk Factors %XImportance: Few studies have examined the association between social risk factors and poor control of cardiovascular disease (CVD) risk factors.
Objective: To examine the sequential association between social risk domains and CVD risk control over time in older adults with diabetes.
Design, Setting, and Participants: This cohort study analyzed core interviews from 4877 US adults with diabetes who were participating in the Health and Retirement Study, a national longitudinal survey of US adults. Participants were older than 50 years, completed the social risk domain questions, and had data on CVD risk factor measures from January 2006 to December 2016. Data were analyzed from June to July 2022.
Exposures: Five social risk domains were created: (1) economic stability, (2) neighborhood or built environment, (3) education access, (4) health care access, and (5) social or community context.
Main Outcomes and Measures: The 4 primary outcomes were (1) poor glycemic control (hemoglobin A1c [HbA1c] level ≥8.0%), (2) poor blood pressure (BP) control (systolic BP≥140 mm Hg and diastolic BP ≥90 mm Hg), (3) poor cholesterol control (total cholesterol/high-density lipoprotein ratio ≥5), and (4) a composite of poor CVD risk control (≥2 poorly controlled glucose level, BP, or cholesterol level).
Results: Among this cohort of 4877 older adults with diabetes (mean [SD] age, 68.6 [9.8] years; 2715 women [55.7%]), 890 participants (18.3%) had an HbA1c level of 8% or higher, 774 (15.9%) had systolic BP of 140 mm Hg or higher and diastolic BP of 90 mm Hg or higher, 962 (19.7%) had total cholesterol/high-density lipoprotein ratio of 5 or higher, and 437 (9.0%) had at least 2 poorly controlled CVD risk factors. Neighborhood or built environment (ie, adverse social support) was independently associated with poor glycemic control (odds ratio [OR], 1.31; 95% CI, 1.06-1.63), whereas economic stability (ie, medication cost-related nonadherence) (OR, 1.40; 95% CI, 1.04-1.87) and health care access (ie, lack of health insurance) (OR, 1.58; 95% CI, 1.20-2.09) were independently associated with poor BP control after full adjustment. Education access (ie, lack of education) (OR, 1.24; 95% CI, 1.01-1.52) and health care access (ie, lack of health insurance) (OR, 1.31; 95% CI, 1.02-1.68) were independently associated with poor cholesterol control. Health care access (ie, lack of health insurance) was the only social risk domain that was independently associated with having at least 2 poorly controlled CVD risk factors (OR, 1.72; 95% CI, 1.26-2.37).
Conclusions and Relevance: Results of this study suggest that certain social risk domains are associated with control of CVD risk factors over time. Interventions targeting domains, such as neighborhood or built environment, economic stability, and education access, may be beneficial to controlling CVD risk factors in older adults with diabetes.
%B JAMA Network Open %V 5 %P e2230853 %G eng %N 9 %R 10.1001/jamanetworkopen.2022.30853 %0 Journal Article %J JAMA Internal Medicine %D 2022 %T Association of Social Support With Functional Outcomes in Older Adults Who Live Alone. %A Sachin J Shah %A Margaret C Fang %A Wannier, S Rae %A Michael A Steinman %A Kenneth E Covinsky %K health outcomes %K Social Support %XImportance: Older adults who live alone are at risk for poor health outcomes. Whether social support mitigates the risk of living alone, particularly when facing a sudden change in health, has not been adequately reported.
Objective: To assess if identifiable support buffers the vulnerability of a health shock while living alone.
Design, Setting, and Participants: In this longitudinal, prospective, nationally representative cohort study from the Health and Retirement Study (enrollment March 2006 to April 2015), 4772 community-dwelling older adults 65 years or older who lived alone in the community and could complete activities of daily living (ADLs) and instrumental ADLs independently were followed up biennially through April 2018. Statistical analysis was completed from May 2020 to March 2021.
Exposures: Identifiable support (ie, can the participant identify a relative/friend who could help with personal care if needed), health shock (ie, hospitalization, new diagnosis of cancer, stroke, heart attack), and interaction (multiplicative and additive) between the 2 exposures.
Main Outcomes and Measures: The primary outcomes were incident ADL dependency, prolonged nursing home stay (≥30 days), and death.
Results: Of 4772 older adults (median [IQR] age, 73 [68-81] years; 3398 [71%] women) who lived alone, at baseline, 1813 (38%) could not identify support, and 3013 (63%) experienced a health shock during the study. Support was associated with a lower risk of a prolonged nursing home stay at 2 years (predicted probability, 6.7% vs 5.2%; P = .002). Absent a health shock, support was not associated with a prolonged nursing home stay (predicted probability over 2 years, 1.9% vs 1.4%; P = .21). However, in the presence of a health shock, support was associated with a lower risk of a prolonged nursing home stay (predicted probability over 2 years, 14.2% vs 10.9%; P = .002). Support was not associated with incident ADL dependence or death.
Conclusions and Relevance: In this longitudinal cohort study among older adults who live alone, identifiable support was associated with a lower risk of a prolonged nursing home stay in the setting of a health shock.
%B JAMA Internal Medicine %V 182 %P 26-32 %G eng %N 1 %R 10.1001/jamainternmed.2021.6588 %0 Journal Article %J JAMA Network Open %D 2022 %T Associations Between Satisfaction With Aging and Health and Well-being Outcomes Among Older US Adults. %A Julia S Nakamura %A Hong, Joanna H %A Jacqui Smith %A William J. Chopik %A Chen, Ying %A Tyler J VanderWeele %A Eric S Kim %K Aged %K Aging %K Female %K Health Behavior %K Humans %K Male %K Middle Aged %K Personal Satisfaction %K United States %XImportance: Researchers and policy makers are expanding the focus from risk factors of disease to seek potentially modifiable health factors that enhance people's health and well-being. Understanding if and to what degree aging satisfaction (one's beliefs about their own aging) is associated with a range of health and well-being outcomes aligns with the interests of older adults, researchers, health systems, and politicians.
Objectives: To evaluate associations between changes in aging satisfaction and 35 subsequent health and well-being outcomes.
Design, Setting, and Participants: This cohort study used data from the Health and Retirement Study, a national, diverse, and longitudinal sample of 13 752 US adults older than 50 years, to evaluate if changes in aging satisfaction (between combined cohorts from 2008 and 2010 and 4 years later, in 2012 and 2014) were subsequently associated with 35 indicators of physical, behavioral, and psychosocial health and well-being in 2016 and 2018. Statistical analysis was conducted from July 24, 2020, to November 6, 2021.
Exposure: Aging satisfaction.
Main Outcomes and Measures: A total of 35 physical (eg, stroke), behavioral (eg, sleep problems), and psychosocial (eg, depression) outcomes were evaluated using multiple linear and generalized linear regression models. Data from all participants, irrespective of how their levels of aging satisfaction changed from the prebaseline to baseline waves, were incorporated into the overall estimate, which was conditional on prior satisfaction.
Results: During the 4-year follow-up period, participants (N = 13 752; 8120 women [59%]; mean [SD] age, 65 [10] years; median age, 64 years [IQR, 56-72 years]; 7507 of 11 824 married [64%]) in the highest (vs lowest) quartile of aging satisfaction had improved physical health (eg, 43% reduced risk of mortality [risk ratio, 0.57; 95% CI, 0.46-0.71]), better health behaviors (eg, 23% increased likelihood of frequent physical activity [risk ratio, 1.23; 95% CI, 1.12-1.34]), and improved psychosocial well-being (eg, higher positive affect [β = 0.51; 95% CI, 0.44-0.58] and lower loneliness [β = -0.41; 95% CI, -0.48 to -0.33]), conditional on prebaseline aging satisfaction.
Conclusions and Relevance: This study suggests that higher aging satisfaction is associated with improved subsequent health and well-being. These findings highlight potential outcomes if scalable aging satisfaction interventions were developed and deployed at scale; they also inform the efforts of policy makers and interventionists who aim to enhance specific health and well-being outcomes. Aging satisfaction may be an important target for future interventions aiming to improve later-life health and well-being.
%B JAMA Network Open %V 5 %P e2147797 %G eng %N 2 %R 10.1001/jamanetworkopen.2021.47797 %0 Journal Article %J JAMA Network Open %D 2022 %T Associations of Age at Diagnosis and Duration of Diabetes With Morbidity and Mortality Among Older Adults. %A Cigolle, Christine T %A Blaum, Caroline S %A Lyu, Chen %A Ha, Jinkyung %A Kabeto, Mohammed %A Zhong, Judy %K Diabetes %K Diagnosis %K Mortality %XImportance: Older adults vary widely in age at diagnosis and duration of type 2 diabetes, but treatment often ignores this heterogeneity.
Objectives: To investigate the associations of diabetes vs no diabetes, age at diagnosis, and diabetes duration with negative health outcomes in people 50 years and older.
Design, Setting, and Participants: This cohort study included participants in the 1995 through 2018 waves of the Health and Retirement Study (HRS), a population-based, biennial longitudinal health interview survey of older adults in the US. The study sample included adults 50 years or older (n = 36 060) without diabetes at entry. Data were analyzed from June 1, 2021, to July 31, 2022.
Exposures: The presence of diabetes, specifically the age at diabetes diagnosis, was the main exposure of the study. Age at diagnosis was defined as the age when the respondent first reported diabetes. Adults who developed diabetes were classified into 3 age-at-diagnosis groups: 50 to 59 years, 60 to 69 years, and 70 years and older.
Main Outcomes and Measures: For each diabetes age-at-diagnosis group, a propensity score-matched control group of respondents who never developed diabetes was constructed. The association of diabetes with the incidence of key outcomes-including heart disease, stroke, disability, cognitive impairment, and all-cause mortality-was estimated and the association of diabetes vs no diabetes among the age-at-diagnosis case and matched control groups was compared.
Results: A total of 7739 HRS respondents developed diabetes and were included in the analysis (4267 women [55.1%]; mean [SD] age at diagnosis, 67.4 [9.9] years). The age-at-diagnosis groups included 1866 respondents at 50 to 59 years, 2834 at 60 to 69 years, and 3039 at 70 years or older; 28 321 HRS respondents never developed diabetes. Age at diagnosis of 50 to 59 years was significantly associated with incident heart disease (hazard ratio [HR], 1.66 [95% CI, 1.40-1.96]), stroke (HR, 1.64 [95% CI, 1.30-2.07]), disability (HR, 2.08 [95% CI, 1.59-2.72]), cognitive impairment (HR, 1.30 [95% CI, 1.05-1.61]), and mortality (HR, 1.49 [95% CI, 1.29-1.71]) compared with matched controls, even when accounting for diabetes duration. These associations significantly decreased with advancing age at diagnosis. Respondents with diabetes diagnosed at 70 years or older only showed a significant association with the outcome of elevated mortality (HR, 1.08 [95% CI, 1.01-1.17]).
Conclusions and Relevance: The findings of this cohort study suggest that age at diabetes diagnosis was differentially associated with outcomes and that younger age groups were at elevated risk of heart disease, stroke, disability, cognitive impairment, and all-cause mortality. These findings reinforce the clinical heterogeneity of diabetes and highlight the importance of improving diabetes management in adults with earlier diagnosis.
%B JAMA Network Open %V 5 %P e2232766 %G eng %N 9 %R 10.1001/jamanetworkopen.2022.32766 %0 Journal Article %J Journal of the American Geriatrics Society %D 2022 %T Bad company: Loneliness longitudinally predicts the symptom cluster of pain, fatigue, and depression in older adults. %A Powell, Victoria D %A Kumar, Navasuja %A Galecki, Andrzej T %A Kabeto, Mohammed %A Clauw, Daniel J %A Williams, David A %A Hassett, Afton %A Silveira, Maria J %K complex pain %K Psychosocial stress %K Quality of Life %K Social Support %XBACKGROUND: Pain, fatigue, and depression frequently co-occur as a symptom cluster. While commonly occurring in those with cancer and autoimmune disease, the cluster is also found in the absence of systemic illness or inflammation. Loneliness is a common psychosocial stressor associated with the cluster cross-sectionally. We investigated whether loneliness predicted the development of pain, fatigue, depression, and the symptom cluster over time.
METHODS: Data from the Health and Retirement Study were used. We included self-respondents ≥50 year-old who had at least two measurements of loneliness and the symptom cluster from 2006-2016 (n = 5974). Time-varying loneliness was used to predict pain, fatigue, depression, and the symptom cluster in the subsequent wave(s) using generalized estimating equations (GEE) and adjusting for sociodemographic covariates, living arrangement, and the presence of the symptom(s) at baseline.
RESULTS: Loneliness increased the odds of subsequently reporting pain (aOR 1.22, 95% CI 1.08, 1.37), fatigue (aOR 1.47, 95% CI 1.32, 1.65), depression (aOR 2.33, 95% CI 2.02, 2.68), as well as the symptom cluster (aOR 2.15, 95% CI 1.74, 2.67). The median time between the baseline and final follow-up measurement was 7.6 years (IQR 4.1, 8.2).
CONCLUSIONS: Loneliness strongly predicts the development of pain, fatigue, and depression as well as the cluster of all three symptoms several years later in a large, nonclinical sample of older American adults. Future studies should examine the multiple pathways through which loneliness may produce this cluster, as well as examine whether other psychosocial stressors also increase risk. It is possible that interventions which address loneliness in older adults may prevent or mitigate the cluster of pain, fatigue, and depression.
%B Journal of the American Geriatrics Society %V 70 %P 2225-2234 %G eng %N 8 %R 10.1111/jgs.17796 %0 Report %D 2022 %T Beyond Income: Health, Wealth, and Racial Welfare Gaps Among Older Americans %A Chin, Sayorn %A Miller, Ray %K consumption %K health %K Inequality %K Mortality %K race %K Wealth %X We estimate racial disparities in well-being among the older U.S. population using an expected utility framework that incorporates differences in consumption, leisure, health, mortality, and wealth. We find large racial disparities in expected welfare later in life. Moreover, disparity measures based on cross-sectional consumption substantially underestimate racial welfare gaps by ignoring disparities in expected elderly health, wealth, and mortality. Our decomposition exercises show that a majority of the estimated welfare gaps are determined by age sixty initial conditions as opposed to racial differences in dynamic processes after age sixty. This suggests that policies aimed at closing racial gaps in late-life may be more successful and efficient if targeted earlier in the life-cycle. In other words, outside of direct wealth transfers, it may largely be too late to target such interventions directly at older populations. %G eng %U https://schinlfc.github.io/files/pdf/research/Racial_Welfare_Chin_Miller_2022.pdf %0 Journal Article %J Biological Research for Nursing %D 2022 %T The Brain-Derived Neurotrophic Factor Functional Polymorphism and Hand Grip Strength Impact the Association between Brain-Derived Neurotrophic Factor Levels and Cognition in Older Adults in the United States. %A Liu, Tingting %A Li, Hongjin %A Conley, Yvette P %A Primack, Brian A %A Wang, Jing %A Li, Changwei %K Brain-Derived Neurotrophic Factor %K Cognition %K Exercise %K Gene-Environment Interaction %K Hand Strength %XINTRODUCTION: Aging is associated with subtle cognitive decline in attention, memory, executive function, processing speed, and reasoning. Although lower brain-derived neurotrophic factor (BDNF) has been linked to cognitive decline among older adults, it is not known if the association differs among individuals with various Val66Met (rs6265) genotypes. In addition, it is not clear whether these associations vary by hand grip strength or physical activity (PA).
METHODS: A total of 2904 older adults were included in this study using data from the Health and Retirement Study. Associations between serum BDNF and measures of cognitive function were evaluated using multivariable linear regression models stratified by Met allele status. PA and hand grip strength were added to the model to evaluate whether including these variables altered associations between serum BDNF and cognition.
RESULTS: Mean age was 71.4 years old, and mean body mass index was 28.3 kg/m. Serum BDNF levels were positively associated with higher total cognitive score (beta = 0.34, = .07), mental status (beta = 0.16, = .07), and word recall (beta = 0.22, =.04) among Met carriers, while serum BDNF levels were negatively associated with mental status (beta = -0.09, = .07) among non-Met carriers. Furthermore, associations changed when hand grip strength was added to the model but not when PA was added to the model.
CONCLUSIONS: The Val66Met variant may moderate the association between serum BDNF levels and cognitive function in older adults. Furthermore, such associations differ according to hand grip strength but not PA.
%B Biological Research for Nursing %V 24 %P 226-234 %G eng %N 2 %R 10.1177/10998004211065151 %0 Journal Article %J The Journal of Gerontology, Series B %D 2022 %T A Brief Report on Older Working Caregivers: Developing a Typology of Work Environments. %A Dawn C Carr %A Kendra Jason %A Taylor, Miles %A Tiffany R Washington %K latent class %K Older workers %K productive engagement %XOBJECTIVES: A growing proportion of the US labor force juggles paid work with family caregiving of older adults. However, no research has examined caregivers' work environments. The purpose of this brief report is to develop typologies of the work environments of family caregivers.
METHODS: This study used data drawn from the 2008-2012 waves of the Health and Retirement Study. Our sample includes employed individuals who also provided regular help with daily activities to a parent or spouse (n=976). We used latent class analysis to develop caregiver work environment typologies.
RESULTS: Our analyses revealed four typologies among caregivers: a) high quality work environments (n=340; 35%); b) average work environments with high job lock (n=293; 30%); c) low-quality work environments (n=203; 21%), and d) high personal interference in supportive work environments (n=140; 14%). Although only 21% of working caregivers were in a low-quality work environment (Type C), descriptive results suggest that these workers were most likely to be minorities who needed to work for financial reasons, reporting the highest number of health problems, and the most work hours.
DISCUSSION: Our findings provide insights into the types of environments that caregivers work in, and the characteristics of individuals in those environments. We discuss implications of our findings for future research and work-based policy development.
%B The Journal of Gerontology, Series B %V 77 %P 1263-1268 %G eng %N 7 %R 10.1093/geronb/gbab131 %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Changes in the Hierarchy of Functional Impairment from Middle Age to Older Age. %A Brown, Rebecca T %A L Grisell Diaz-Ramirez %A W John Boscardin %A Anne Cappola %A Lee, Sei J %A Michael A Steinman %K Activities of Daily Living %K functional impairment %XBACKGROUND: Understanding the hierarchy of functional impairment in older adults has helped illuminate mechanisms of impairment and inform interventions, but little is known about whether hierarchies vary by age. We compared the pattern of new-onset impairments in activities of daily living (ADLs) and instrumental ADLs (IADLs) from middle age through older age.
METHODS: We conducted a cohort study using nationally representative data from 32486 individuals enrolled in the Health and Retirement Study. The outcomes were new-onset impairment in each ADL and IADL, defined as self-reported difficulty performing each task, assessed yearly for 9 years. We used multi-state models and competing risks survival analysis to estimate the cumulative incidence of impairment in each task by age group (ages 50-64, 65-74, 75-84, and 85 or older).
RESULTS: The pattern of incident ADL impairments differed by age group. Among individuals ages 50-64 and 65-74 who were independent at baseline, over 9 years' follow-up, difficulties dressing and transferring were the most common impairments to develop. In individuals ages 75-84 and 85 or older who were independent at baseline, difficulties bathing, dressing, and walking were most common. For IADLs, the pattern of impairments was similar across age groups; difficulty shopping was most common followed by difficulty managing money and preparing meals. Complementary analyses demonstrated a similar pattern.
CONCLUSIONS: These findings suggest that the hierarchy of ADL impairment differs by age. These findings have implications for the development of age-specific interventions to prevent or delay functional impairment.
%B The Journals of Gerontology, Series A %V 77 %P 1577-1584 %G eng %N 8 %R 10.1093/gerona/glab250 %0 Journal Article %J Frontiers in Psychology %D 2022 %T Childhood adversity and cognitive impairment in later life. %A Xiang, Xiaoling %A Cho, Joonyoung %A Sun, Yihang %A Wang, Xiafei %K ACE %K Adverse childhood events %K Childhood adversity %K cognitive impairment %K Dementia %K life course %XObjectives: This study examined the association between childhood adversity and cognitive impairment in later life and explored the potential moderation effect of gender and race.
Methods: The study sample included 15,133 participants of the Health and Retirement Study (1998-2016 surveys) who had complete data on key study measures and were more than 50. The outcome variable is a dichotomous indicator of cognitive impairment as assessed by the Telephone Interview for Cognitive Status for self-respondents and the 16-item Informant Questionnaire on Cognitive Decline in the Elderly for proxies. A total of six childhood adversity indicators included grade retention, parental substance abuse, physical abuse, trouble with the police, moving due to financial hardship, and receipt of help due to financial hardship in early life. The estimation of the association between childhood adversity and cognitive impairment involved Cox proportional hazards regression. Results: Grade retention had the largest effect on incident cognitive impairment (HR = 1.3, 95% CI = 1.23-1.38, < 0.001), followed by physical abuse by a parent (HR = 1.10, 95% CI = 1.00-1.20, = 0.001). The impact of grade retention was more detrimental to women than men (interaction term HR = 0.89, 95% CI = 0.80-1.00, = 0.048, female as the reference). Parental substance abuse was associated with a lower risk of incident cognitive impairment for most racial groups (HR = 0.89, 95% CI = 0.83-0.95, = 0.001), but this association was reversed in "non-Hispanic other" race, consisting mainly of Asians (HR = 1.54, 95% CI = 1.05-2.26, = 0.025).
Discussion: Some aspects of childhood adversity continue to harm cognitive functioning in later life, while some events may have the opposite effect, with evidence of heterogeneity across gender and race.
%B Frontiers in Psychology %V 13 %P 935254 %G eng %R 10.3389/fpsyg.2022.935254 %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 Nature Aging %D 2022 %T A computational solution for bolstering reliability of epigenetic clocks: implications for clinical trials and longitudinal tracking %A Higgins-Chen, Albert T. %A Thrush, Kyra L. %A Wang, Yunzhang %A Minteer, Christopher J. %A Kuo, Pei-Lun %A Wang, Meng %A Niimi, Peter %A Sturm, Gabriel %A Lin, Jue %A Ann Zenobia Moore %A Bandinelli, Stefania %A Vinkers, Christiaan H. %A Vermetten, Eric %A Rutten, Bart P. F. %A Geuze, Elbert %A Okhuijsen-Pfeifer, Cynthia %A van der Horst, Marte %A Schreiter, Stefanie %A Gutwinski, Stefan %A Luykx, Jurjen J. %A Picard, Martin %A Ferrucci, Luigi %A Eileen M. Crimmins %A Boks, Marco P. %A Hägg, Sara %A Hu-Seliger, Tina T. %A Morgan E. Levine %K Aging %K Bioinformatics %K computational models %K DNA Methylation %K predictive markers %X Epigenetic clocks are widely used aging biomarkers calculated from DNA methylation data, but this data can be surprisingly unreliable. Here we show that technical noise produces deviations up to 9 years between replicates for six prominent epigenetic clocks, limiting their utility. We present a computational solution to bolster reliability, calculating principal components (PCs) from CpG-level data as input for biological age prediction. Our retrained PC versions of six clocks show agreement between most replicates within 1.5 years, improved detection of clock associations and intervention effects, and reliable longitudinal trajectories in vivo and in vitro. This method entails only one additional step compared to traditional clocks, requires no replicates or previous knowledge of CpG reliabilities for training, and can be applied to any existing or future epigenetic biomarker. The high reliability of PC-based clocks is critical for applications to personalized medicine, longitudinal tracking, in vitro studies and clinical trials of aging interventions. %B Nature Aging %V 2 %P 644–661 %G eng %R 10.1038/s43587-022-00248-2 %0 Journal Article %J Journal of Medical Economics %D 2022 %T Cost-utility and cost-benefit analysis of TAVR availability in the US severe symptomatic aortic stenosis patient population. %A Sevilla, J P %A Klusty, Jessica M %A Song, Younghwan %A Russo, Mark J %A Thompson, Christin A %A Jiao, Xiayu %A Clancy, Seth J %A Bloom, David E %K Aortic Valve %K Aortic Valve Stenosis %K Cost-Benefit Analysis %K Health Care Costs %K Heart Valve Prosthesis Implantation %K Risk Factors %K Transcatheter Aortic Valve Replacement %K Treatment Outcome %XAIMS: We evaluated the availability of transcatheter aortic valve replacement (TAVR) to determine its value across all severe symptomatic aortic stenosis (SSAS) patients, especially those untreated because of concerns regarding invasive surgical AVR (SAVR) and its impact on active aging.
METHODS: We performed payer perspective cost-utility analysis (CUA) and societal perspective cost-benefit analysis (CBA). The CBA's benefit measure is active time: salaried labor, unpaid work, and active leisure. The study population is a cohort of US elderly SSAS patients. We compared a "TAVR available" scenario in which SSAS patients distribute themselves across TAVR, SAVR, and medical management (MM); and a "TAVR not available" scenario with only SAVR and MM. We structured each scenario with a decision-tree model of SSAS patient treatment allocation. We measured the association between health and active time in the US Health and Retirement Study and used this association to impute active time to SSAS patients given their health.
RESULTS: The incremental cost-effectiveness ratio (ICER) and rate of return (RoR) of TAVR availability were $8,533 and 395%, respectively. CUA net monetary benefits (NMB) were $212,199 per patient and $43.4 billion population-wide. CBA NMB were $50,530 per patient and $10.3 billion population-wide.
LIMITATIONS: Among study limitations were scarcity of evidence regarding key parameters and the lack of long-term survival, health utility, and treatment cost data. Our analysis did not account for TAVR durability, retreatments, and valve-in-valve treatments.
CONCLUSION: Across risk-, age-, and treatment-eligibility groups, TAVR is the economically optimal treatment choice. It represents strong value-for-money per patient and population-wide. The vast majority of TAVR value involves raising treatment uptake among the untreated.
%B Journal of Medical Economics %V 25 %P 1051-1060 %G eng %N 1 %R 10.1080/13696998.2022.2112442 %0 Web Page %D 2022 %T Could Correcting Your Vision Lower Your Alzheimer’s Risk? %A Crouch, Michelle %K Alzheimer's %K Dementia %K vision functioning %I AARP %G eng %U https://www.aarp.org/health/conditions-treatments/info-2022/vision-loss-and-dementia.html %0 Report %D 2022 %T Creating a Public Resource: O*NET Job Characteristics Data Set for Use with the Health and Retirement Study and Other Surveys %A Helppie-McFall, Brooke %A Carr, Dawn C %A Amanda Sonnega %K O*NET %K occupational information %K Older workers %K Social Security Administration %K work environments %X Creating a public resource of historical occupational information from the O*NET database linked with survey data in the HRS will allow researchers to better inform policy makers about the impact of long-term exposure to different types of tasks or work environments on the ability and willingness of older adults to work longer. This is relevant to informing potential behavioral responses and other effects of potential SSA policy changes such as increasing the age of eligibility for OASI. With a growing need to understand how individuals within the same work environments experience different outcomes, particularly among those from under-represented groups (e.g., racial and ethnic minorities), pairing O*NET data with HRS data has important implications for scientific advances that can promote more equitable work environments. This project will complete the documentation report of the data set linking 2019 O*NET measures to the 2010 Census occupation code frame; link 2019 O*NET-Census 2010 data set to HRS occupations from 2010 forward; write documentation report of the data set linking 2019 O*NET measures to the HRS occupation data from 2010 forward for the HRS website; and conduct validation and quality control analyses. %B MRDRC Projects %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/projects/creating-a-public-resource-onet-job-characteristics-data-set-for-use-with-the-health-and-retirement-study-and-other-surveys/ %0 Journal Article %J Cancer Causes & Control %D 2022 %T Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors. %A Vivek, Sithara %A Heather Hammond Nelson %A Anna Prizment %A Jessica Faul %A Eileen M. Crimmins %A Bharat Thyagarajan %K Cancer survivor %K CMV Seropositivity %K Dementia %K Inflammation %XPURPOSE: The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia.
METHODS: Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters.
RESULTS: CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95% CI [6.1, 56.1]).
CONCLUSION: The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.
%B Cancer Causes & Control %V 33 %P 81-90 %G eng %N 1 %R https://doi.org/10.1007/s10552-021-01504-3 %0 Journal Article %J Innovation in Aging %D 2022 %T CROSS-NATIONAL COMPARISONS OF STRESS AND WELL-BEING IN THE INTERNATIONAL FAMILY OF HEALTH AND RETIREMENT STUDIES %A Yoobin Park %A Alexandra Crosswell %A Drystan Phillips %K Stress %K Well-being %X Strong evidence demonstrates the long-term influence of stress and well-being on psychological, social, and physical health outcomes across the lifespan. Because of this, stress and well-being measures have been added to nearly all of the International Family of Health and Retirement Studies. However, this newly available data has not been compared cross-nationally or within-country to unpack how culture influences these important predictors of healthy aging. Using the Gateway to Global Aging Data, which provides harmonized data from the Health and Retirement Study and its sibling nationally representative studies, levels of self-reported stress (e.g. job stress, discrimination, loneliness) and well-being (e.g. quality of life, life satisfaction) are compared across 30 countries. Data come from the following studies: HRS, ELSA, SHARE, TILDA, CHARLS, KLoSA, MHAS, and JSTAR. We used data from the latest study wave for which the relevant survey was implemented. Average age of participants across studies is 67 and 55% are women. Initial analyses show stressor specific findings such as participants in Korea reported greater work stress than participants in Japan, England, the United States, and across Europe, and the United States reported higher loneliness than China and England, but not higher than Ireland. Reporting cross-national and within-country variation in these measures will be generative in pointing to new research directions for understanding how culture influences health and aging trajectories. %B Innovation in Aging %V 6 %8 12/2022 %G eng %N Supplement_1 %9 Journal Article %& 729 %R 10.1093/geroni/igac059.2656 %0 Web Page %D 2022 %T Cumulative loneliness associated with accelerated memory aging in older adults %A Cook, Destiny %K Loneliness %K memory decline %I Michigan News, University of Michigan %C Ann Arbor, MI %G eng %U https://news.umich.edu/cumulative-loneliness-associated-with-accelerated-memory-aging-in-older-adults/ %0 Journal Article %J Journal of Longitudinal and Life Course Studies %D 2022 %T Data quality and response distributions in a mixed-mode survey. %A Ofstedal, Mary Beth %A Kezdi, Gabor %A Couper, Mick P %K intent-to-treat analysis %K Mode effects %K sequential mixed-mode %K Telephone %K web %XLongitudinal surveys traditionally conducted by interviewers are facing increasing pressures to explore alternatives such as sequential mixed-mode designs, which start with a cheaper self-administered mode (online) then follow up using more expensive methods such as telephone or face-to-face interviewing. Using a designed experiment conducted as part of the 2018 wave of the Health and Retirement Study (HRS) in the US, we compare a sequential mixed-mode design (web then telephone) with the standard telephone-only protocol. Using an intent-to-treat analysis, we focus on response quality and response distributions for several domains key to HRS: physical and psychological health, financial status, expectations and family composition. Respondents assigned to the sequential mixed-mode (web) had slightly higher missing data rates and more focal responses than those assigned to telephone-only. However, we find no evidence of differential quality in verifying and updating roster information. We find slightly lower rates of asset ownership reported by those assigned to the web mode. Conditional on ownership, we find no detectable mode effects on the value of assets. We find more negative (pessimistic) expectations for those assigned to the web mode. We find little evidence of poorer health reported by those assigned to the web mode. We find that effects of mode assignment on measurement are present, but for most indicators the effects are small. Finding ways to remediate the differences in item-missing data and focal values should help reduce mode effects in mixed-mode surveys or those transitioning from interviewer- to self-administration.
%B Journal of Longitudinal and Life Course Studies %G eng %R 10.1332/175795921X16494126913909 %0 Journal Article %D 2022 %T Dementia and Care Transitions: Do Transition Care Management Codes Make a Difference? %A Micah Hoeksema %A Jennifer L. Carnahan %K care transitions %K Dementia %X Background: For older adults living with dementia, care transitions from acute or subacute care back to their community can have adverse outcomes such as hospital readmissions, medication errors, or even permanent nursing home placement. To address these adverse outcomes, Transition Care Management (TCM) codes were introduced by the Centers for Medicare and Medicaid Services (CMS) in October 2012. The efficacy of TCM codes has not been examined in the population of persons living with dementia. Thus, this study examines the effect of TCM codes on hospital readmission rates and hypothesizes that TCM codes are effective in decreasing readmission rates after care transitions for persons living with dementia. Methods: After an extensive literature review, we identified the Bynum Standard method for identifying persons living with dementia. We used a linked dataset from the Health and Retirement Study (HRS) and CMS claims to identify persons living with dementia with a hospital discharge between 2015 and 2018. Results: Our initial search has identified a cohort of 4,282 persons living with dementia. 1,584 (37%) are male and 2,698 (63%) are female. 3,433 are White, 656 are Black, 126 are Hispanic, 14 are Native American, 4 are Asian, and 49 are either of another race or did not report their race. Conclusion and Potential Impact: Thus far, we have identified a cohort of persons living with dementia from HRS-CMS linked data but have yet to identify who have had the TCM codes used by their provider. In the future, we will examine the effect that TCM codes have on hospital readmission rates within the studied population. Not only will this study determine if these billing codes provide effective care, but it can also tell us if it aids historically underserved groups. %V 5 %G eng %R https://doi.org/10.18060/26804 %0 Journal Article %J Innovation in Aging %D 2022 %T DEMENTIA LIFE EXPECTANCIES: NEW KNOWLEDGE AND CONSIDERATIONS FROM THE HEALTH AND RETIREMENT STUDY %A Garcia, Marc %A Tarraf, Wassim %A Chi-Tsun Chiu %A Joseph L Saenz %A Reyes, Adriana M %K Dementia %K life expectancies %X Alzheimer's disease and related dementias (ADRD) are a growing public health crisis. Estimates on the prevalence and incidence of ADRD across and within population-based studies have varied in part due to competing measures to assess dementia status. Disentangling these inconsistencies is crucial for understanding dementia disparities among racial/ethnic, and nativity groups among older adults. Based on the Health and Retirement Study we examined across (Whites, Blacks) and within-group differences (US- and non-US-born Latinos) in estimates of dementia life expectancy, using four competing algorithmic techniques (i.e., the Langa-Weir, Expert, Hurd, and Lasso) for the classification of dementia ascertainment. Estimates of dementia life expectancy across algorithms largely point to dementia disparities in the prevalence of the disease across racial/ethnic, and nativity groups, regardless of the algorithmic technique utilized. Elucidating algorithms that can be utilized with different racial/ethnic groups may reduce bias in dementia assessment in the future. %B Innovation in Aging %V 6 %P 341 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1349 %0 Journal Article %J Journal of Public Health Dentisty %D 2022 %T Dental care use and other population characteristics of older Americans with self-reported chronic conditions in the Health and Retirement Study. %A John F Moeller %A Richard J. Manski %A Chen, Haiyan %A Meyerhoefer, Chad %A John V Pepper %A Terrin, Michael %K Chronic condition %K Dental Care %K Self-reported health %XOBJECTIVES: To analyze relative differences in oral health care utilization, oral health, and other population characteristics of older Americans with respect to self-reported chronic conditions in the health and retirement study.
METHODS: Differences in estimated percentages of those with specific chronic conditions by selected attributes were tested for statistical significance with standardized normal Z tests and logistic regressions. All estimates were based on weighted data from 1992 to 2016 Early Release RAND HRS Longitudinal file. SE estimates for the percentages accounted for the complex sample design of the survey.
RESULTS: We establish that the strength of the associations between regular use of dental care and the absence of a chronic condition is similar in magnitude to having a college education, living in a high-income family, never smoking, not having certain functional limitations, and being under 65 years of age.
DISCUSSION: These cross-sectional findings establish the relative strength of relationships between dental care use, oral health status, and other population characteristics and eight diagnosed conditions. Further work beyond the scope of this paper is needed to confirm these results as either attributes of those with the disease or causal risk factors for the onset of the condition.
%B Journal of Public Health Dentisty %V 82 %P 40-52 %G eng %N 1 %R 10.1111/jphd.12471 %0 Journal Article %J Journal of Behavioral and Experimental Economics %D 2022 %T Depression and financial planning horizon %A Youngjoo Choung %A Swarn Chatterjee %A Tae-Young Pak %K Clinical depression %K financial planning horizon %K Intertemporal choice %K Major depressive episode %K Myopic decision %K Time preference %X Major depression is associated with biased information processing and decision making. Previous research suggests that people dealing with depression view the future negatively and exhibit a higher discounting rate than healthy people do. This study tests the hypothesis that depression is associated with financial planning horizon–the time horizon by which individuals and households formulate their saving and spending schedules. Analyses conducted using data drawn from multiple waves of the Health and Retirement Study showed an inverse association between major depressive episodes and financial planning horizon, indicating that depressed people plan their finances over a shorter horizon. We also found that major depression is associated with various health and financial outcomes representing evidence of myopic decision making. The link between depression and financial planning horizon is partially explained by depression-oriented differences in behavioral traits, such as optimism/pessimism, perceived control, perceived mastery, and self-assessed survival probability. Overall, our findings point to a significant economic cost of depression, which compounds through myopic financial planning. %B Journal of Behavioral and Experimental Economics %V 98 %P 101877 %G eng %R 10.1016/j.socec.2022.101877 %0 Journal Article %J JAMA Internal Medicine %D 2022 %T Development and External Validation of a Mortality Prediction Model for Community-Dwelling Older Adults With Dementia. %A Deardorff, W James %A Barnes, Deborah E %A Jeon, Sun Y %A Boscardin, W John %A Kenneth M. Langa %A Covinsky, Kenneth E %A Mitchell, Susan L %A Whitlock, Elizabeth L %A Smith, Alexander K %A Lee, Sei J %K community dwelling %K Dementia %K mortality risk %XImportance: Estimating mortality risk in older adults with dementia is important for guiding decisions such as cancer screening, treatment of new and chronic medical conditions, and advance care planning.
Objective: To develop and externally validate a mortality prediction model in community-dwelling older adults with dementia.
Design, Setting, and Participants: This cohort study included community-dwelling participants (aged ≥65 years) in the Health and Retirement Study (HRS) from 1998 to 2016 (derivation cohort) and National Health and Aging Trends Study (NHATS) from 2011 to 2019 (validation cohort).
Exposures: Candidate predictors included demographics, behavioral/health factors, functional measures (eg, activities of daily living [ADL] and instrumental activities of daily living [IADL]), and chronic conditions.
Main Outcomes and Measures: The primary outcome was time to all-cause death. We used Cox proportional hazards regression with backward selection and multiple imputation for model development. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (plots of predicted and observed mortality).
Results: Of 4267 participants with probable dementia in HRS, the mean (SD) age was 82.2 (7.6) years, 2930 (survey-weighted 69.4%) were female, and 785 (survey-weighted 12.1%) identified as Black. Median (IQR) follow-up time was 3.9 (2.0-6.8) years, and 3466 (81.2%) participants died by end of follow-up. The final model included age, sex, body mass index, smoking status, ADL dependency count, IADL difficulty count, difficulty walking several blocks, participation in vigorous physical activity, and chronic conditions (cancer, heart disease, diabetes, lung disease). The optimism-corrected iAUC after bootstrap internal validation was 0.76 (95% CI, 0.75-0.76) with time-specific AUC of 0.73 (95% CI, 0.70-0.75) at 1 year, 0.75 (95% CI, 0.73-0.77) at 5 years, and 0.84 (95% CI, 0.82-0.85) at 10 years. On external validation in NHATS (n = 2404), AUC was 0.73 (95% CI, 0.70-0.76) at 1 year and 0.74 (95% CI, 0.71-0.76) at 5 years. Calibration plots suggested good calibration across the range of predicted risk from 1 to 10 years.
Conclusions and Relevance: We developed and externally validated a mortality prediction model in community-dwelling older adults with dementia that showed good discrimination and calibration. The mortality risk estimates may help guide discussions regarding treatment decisions and advance care planning.
%B JAMA Internal Medicine %V 182 %P 1161-1170 %G eng %N 11 %R 10.1001/jamainternmed.2022.4326 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Differential trends in disability among rich and poor adults in the US and England from 2002 to 2016. %A Choi, Hwa Jung %A Robert F. Schoeni %A Andrew Steptoe %A Cho, Tsai-Chin %A Kenneth M. Langa %K ADL limitation %K Disability trend %K ELSA %K health disparity %K IADL limitation %XOBJECTIVE: Disability in the US has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the US and England, would inform public policy aimed at reducing disparities in disability.
METHODS: Using the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimated annual percent change from 2002 to 2016 in disability among community dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with five instrumental activities of daily living (IADLs) and six activities of daily living (ADLs). We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design.
RESULTS: The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002--2016. For ages 55-64 and 65-74, disability prevalence was unchanged in the US but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55-64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC=-3.60 95% CI [-6.57,-0.63] for the US; AAPC=-6.06 95% CI [-8.77,-3.35] for England).
DISCUSSION: Improvements in disability were more widespread in England than in the US between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.
%B The Journals of Gerontology, Series B %V 77 %P S189-S198 %G eng %N Supplement_2 %R 10.1093/geronb/gbac029 %0 Journal Article %J BMC Geriatrics %D 2022 %T Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study. %A Chen, Shanquan %A Jones, Linda A %A Jiang, Shan %A Jin, Huajie %A Dong, Dong %A Chen, Xi %A Wang, Dan %A Zhang, Yun %A Xiang, Li %A Zhu, Anna %A Cardinal, Rudolf N %K Activities of Daily Living %K COVID-19 %K Domiciliary care %K Living Alone %XBACKGROUND: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure.
METHODS: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers' corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness.
RESULTS: During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19.
CONCLUSION: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises.
%B BMC Geriatrics %V 22 %P 181 %G eng %N 1 %R 10.1186/s12877-022-02799-w %0 Journal Article %J Journal of Aging and Health %D 2022 %T Disparities in Mental Health and Well-Being between Heterosexual and Sexual Minority Older Adults during the COVID-19 Pandemic. %A Chen, Jen-Hao %K Coronavirus impact %K COVID-19 %K Health Inequality %K LGBTQ %K minority experience %K psychosocial health %XThis study examines disparities in older adults' mental health and well-being during the pandemic by sexual minority status. This study analyzed data on older adults from the Health and Retirement Study's COVID-19 Module (N = 3142 for heterosexuals and N = 75 for sexual minorities). Weighted regressions linked concern about COVID-19, depression, pandemic emotional stress, and changes in loneliness, in-person contacts, income, and work to sexual minority status, controlling for sociodemographic characteristics. Compared to heterosexuals, sexual minority older adults had more concern about the pandemic and emotional stress and showed a decrease in in-person contact during the pandemic-these differences were not explained by sociodemographic characteristics. Sexual minority older adults were also more likely to have changes in income and work during the pandemic, but these differences were explained by sociodemographic characteristics. Sexual minority older adults have experienced worse mental health outcomes than heterosexuals during the COVID-19 pandemic, which merits intervention.
%B Journal of Aging and Health %V 34 %P 939-950 %G eng %N 6-8 %R 10.1177/08982643221081965 %0 Journal Article %J Research on Aging %D 2022 %T Do Early-Life Social, Behavioral, and Health Exposures Increase Later-Life Arthritis Incidence? %A Blakelee R Kemp %A Kenneth F Ferraro %A Patricia M Morton %A Thomas, Patricia A %A Sarah A Mustillo %A Eileen M. Crimmins %K Adverse Childhood Experiences %K Body Mass Index %K Cumulative inequality theory %K Osteoarthritis %K rheumatoid arthritis %XOBJECTIVES: This study investigates direct and indirect influences of childhood social, behavioral, and health exposures on later-life osteoarthritis and rheumatoid arthritis development.
METHODS: Drawing from cumulative inequality theory and six waves of the Health and Retirement Study (2004-2014), we estimate structural equation modeling-based discrete-time survival analysis of the association between six childhood exposure domains and both osteoarthritis and rheumatoid arthritis incidence for men ( = 2720) and women ( = 2974). Using the delta method to test for mediation, we examine indirect effects via selected health-related risks and resources.
RESULTS: Risky adolescent behavior is associated with rheumatoid arthritis incidence for women (h.O.R. = 1.883, 95% C.I. [1.016, 3.490]), whereas several types of childhood exposures are associated with later-life osteoarthritis development for both men and women. Experiencing two or more childhood socioeconomic disadvantages is indirectly associated with osteoarthritis (men: coef. = 0.024, 95% C.I. [0.003, 0.045]; women: coef. = 0.111, 95% C.I. [0.071, 0.150]) and rheumatoid arthritis (men: coef. = 0.037, 95% C.I. [0.000, 0.074]; women: coef. = 0.097, 95% C.I. [0.035, 0.159]) development through adult body mass index.
DISCUSSION: Findings highlight the importance of childhood contexts in understanding the development of later-life osteoarthritis and rheumatoid arthritis.
%B Research on Aging %V 44 %P 479-493 %G eng %N 7-8 %R 10.1177/01640275211044979 %0 Report %D 2022 %T Do Households Save More When the Kids Leave? Take Two %A Andrew G. Biggs %A Anqi Chen %A Alicia H. Munnell %K consumption %K Income %K Saving %X When kids leave home, parents consume less but they don’t save more. So where is the money going? The analysis looks at three ways to square the circle: define saving more broadly: parents could be paying down debt faster; define consumption more broadly: they could be assisting grown children; and define income more precisely: they could be earning less than before. The results support the third explanation: when kids leave, parents work and earn less. But the results also show that consumption still declines relative to income without any rise in net worth, so this study does not fully resolve the puzzle. %B Briefs %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/briefs/do-households-save-more-when-the-kids-leave-take-two/ %0 Journal Article %J Work, Aging and Retirement %D 2022 %T Does Bridge Employment Mitigate or Exacerbate Inequalities Later in Life? %A Cahill, Kevin E %A Giandrea, Michael D %A Quinn, Joseph F %A Sacco, Lawrence B %A Platts, Loretta G %K Bridge employment %K inequalities %K labor force %K Social Security Benefits %X Most older Americans with career employment change jobs at least once before retiring from the labor market. Much is known about the prevalence and determinants of these bridge jobs, yet relatively little is known about the implications of such job changes—compared to direct exits from a career job—upon economic disparities in later life. In this article, we use 26 years of longitudinal data from the Health and Retirement Study to document the various pathways that older Americans take when exiting the labor force, and examine how bridge employment affects nonhousing wealth and total wealth, including the present discounted value of Social Security benefits. We find that gradual retirement in the form of bridge employment neither exacerbates nor mitigates wealth inequalities among Americans who hold career jobs later in life. That said, we do find some evidence that wealth inequalities grow among the subset of older career workers who transition from career employment to bridge employment at older ages. One policy implication of our article is that it provides evidence that might allay concerns about the potential for disparate financial impacts associated with the gradual retirement process. %B Work, Aging and Retirement %G eng %R 10.1093/workar/waac020 %0 Journal Article %J Innovation in Aging %D 2022 %T DOES NEIGHBORHOOD DISADVANTAGE ALTER MEMORY AFTER A CANCER DIAGNOSIS? A US HEALTH AND RETIREMENT STUDY %A Ashly Westrick %A Monica Ospina-Romero %A Philippa Clarke %A Lindsay C Kobayashi %K Cancer %K Memory %X We aimed to determine the influence of neighborhood socioeconomic status (NSES) on long-term cancer-related memory decline of older adults. Incident cancer diagnosis and memory were assessed in the U.S. Health and Retirement Study (N=15,074, 1998-2016). Proportion of female-headed households with children, households with public assistance income, people with income below poverty, and proportion 16+ years unemployed was categorized into NSES tertiles. Linear mixed-effects models compared the standardized memory trajectories by cancer status and NSES. Cancer-free individuals living in more disadvantaged neighborhoods had worse mean memory function at age 75 and steeper memory declines than participants from less disadvantaged neighborhoods. An incident cancer diagnosis was associated with an acute memory drop at diagnosis for those living in the least disadvantaged neighborhoods. Cancer survivors had better memory prior to but not after diagnosis compared to cancer-free individuals across NSES. These findings could inform future interventions to promote cancer survivor’s long-term aging. %B Innovation in Aging %V 6 %8 12/2022 %G eng %N Supplement_1 %9 Journal Article %& 8 %R 10.1093/geroni/igac059.026 %0 Journal Article %J Collabra: Psychology %D 2022 %T Dyadic Associations Between Conscientiousness Facets, Health, and Health Behavior Over Time %A Chopik, William %A Lee, Ji Hyun %K actor-partner interdependence model %K Conscientiousness %K depression %K health %K personality facets %X Previous studies show consistent associations between conscientiousness and health outcomes. However, less is known about how various facets of conscientiousness, of both individuals and their partners, are associated with changes in health in older adults over time. Applying the actor–partner interdependence model, we examined dyadic associations of broader conscientiousness and its six facets and changes in health, health behavior, and well-being in middle-aged and older couples. With a sample of 3,271 couples (N=6,542) from the Health and Retirement Study, we found that actor conscientiousness, orderliness, and industriousness were most reliably associated with better health outcomes over time. Partner orderliness was associated with better health and more positive health behavior. The remaining associations were near-zero in their effect sizes. Many of these associations persisted over the 10-year period of the study, and there was little evidence for gender differences or multiplicative interactions. %B Collabra: Psychology %V 8 %P 37611 %G eng %N 1 %R 10.1525/collabra.37611 %0 Report %D 2022 %T Economic Crises and Mental Health: Effects of the Great Recession on Older Americans %A David M Cutler %A Sportiche, Noémie %K economic conditions %K Great Recession %K health impacts %K housing prices %K Mental Health %X We examine the effect of the Great Recession of 2007-2009 on the mental health of older adults, using longitudinal Health and Retirement Study data linked to area-level data on house prices. We use a variety of measures to capture mental health and rely on the very large cross-sectional variation in falling house prices to identify the impact of the Great Recession on those outcomes. We also account for people who moved in response to falling prices by fixing each person’s location immediately prior to the house price collapse. Our central finding is that the Great Recession had heterogeneous effects on health. While mental health was not affected for the average older adult, mental health declined among homeowners with few financial assets, who were therefore more vulnerable to falling house prices. Importantly, health impacts in this group differed by race and ethnicity: depression and functional limitations worsened among Black and other non-white homeowners and medication use increased among white homeowners. There were no measurable impacts for Hispanic homeowners. These results highlight the importance of examining heterogeneity across multiple dimensions when examining the health impacts of economic conditions. %B Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w29817 %0 Journal Article %J Innovation in Aging %D 2022 %T EDUCATION GRADIENTS IN LATER-LIFE COGNITIVE FUNCTION ACROSS LOW-, MIDDLE-, AND HIGH-INCOME COUNTRIES %A Yuan Zhang %A Brendan O'Shea %A Xuexin Yu %A Tsai-Chin Cho %A Kenneth M. Langa %A Alden Gross %A Lindsay C Kobayashi %K Education gradient %X Education is positively related to cognitive function. However, educational gradients in cognitive function may vary across older populations with different educational compositions and physical and social environments. We conducted one of the first cross-national comparative studies on educational differences in later-life cognitive function using harmonized data. Multivariable linear regressions were employed to estimate the association between education according to International Standard Classification of Education (ISCED) categories and cognitive function for adults ages 60+ from the United States, England, Mexico, South Africa, India, and China. Cross-country differences were tested using fully interacted models. Controlling for demographics and parental education, we found significant educational gradients in cognitive function in low- and middle-income countries; however, in high-income countries, only those with upper secondary education and above had a consistent cognitive advantage over those with primary education. This study suggests substantial country-level differences in cognitive benefits of educational attainment. %B Innovation in Aging %V 6 %8 12/2022 %G eng %N Supplement_1 %9 Journal Article %& 103 %R 10.1093/geroni/igac059.409 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T The Effect of Physical Limitations on Depressive Symptoms over the Life Course: Is Optimism a Protective Buffer? %A Choi, Shinae L %A Namkung, Eun Ha %A Carr, Deborah %K Depressive symptoms %K Disability %K Functional Limitation %K life course %K Optimism %K Stress %XOBJECTIVES: We examined the extent to which optimism buffers the effects of physical limitations on depressive symptoms, across four mid- and later-life age groups (ages 40-49, 50-64, 65-74, 75+ at baseline). Analyses are motivated by stress theories, which hold that the protective effects of coping resources are evidenced only at high levels of stress. We further explore whether these purportedly protective effects diminish with age, as health-related stressor(s) intensify and become irreversible.
METHODS: We use data from two waves (2004-06 and 2013-14) of the Health and Retirement Study (HRS, n = 4,515) and Midlife in the United States (MIDUS, n = 2,138). We estimate OLS regression models with three-way interaction terms to examine prospectively the benefits of optimism as a coping resource for persons with physical limitations across four age groups. Physical limitations are assessed with a composite measure encompassing mobility and activity of daily living (ADL) limitations.
RESULTS: In HRS and MIDUS, persons with 3+ limitations reported significantly more depressive symptoms than persons with 0-2 limitations, yet these disparities diminished at higher levels of optimism. Buffering effects of optimism vary by age. For midlife and young-old persons with 3+ limitations, optimism is strongly and inversely related to depressive symptoms at follow-up. Comparable protective effects are not evident among oldest sample members.
DISCUSSION: Stress and coping models should consider more fully factors that limit older adults' capacity to deploy purportedly protective personal resources. Investments in structural or institutional supports may be more effective than interventions to enhance positive thinking.
%B The Journals of Gerontology, Series B %V 77 %P 1661-1673 %G eng %N 9 %R 10.1093/geronb/gbac058 %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Elevated C-Reactive Protein in Alzheimer's Disease without Depression in Older Adults: Findings from the Health and Retirement Study. %A Natale, Ginny %A Sean A. P. Clouston %A Smith, Dylan %K Alzheimer disease %K C-reactive protein %K Dementia %K depression %K Inflammation %K major stroke %XWe examined the association between differential diagnoses of major stroke and probable Alzheimer's disease (AD) and Mixed AD on c-reactive protein (CRP) in older adults with and without depression. Secondary data analyses examined associations between blood-based measures of probable peripheral inflammation using CRP collected from dried blood spots in the Health and Retirement Study (HRS), a nationally representative sample of individuals aged 50 and older. A validated pattern recognition algorithm was utilized to identify cognitive decline indicative of probable AD, Mixed AD, and major stroke. Negative binomial regressions were utilized to model concentrations of serologic CRP. On average, participants (N=4,601) were 70 years old, female, and non-Hispanic white. Mixed AD participants had 0.26 mg/dL increase in CRP compared to unimpaired participants, controlling for demographics, health behaviors and comorbidities. Those with Mixed AD had 2.14 times increased odds of having high CRP (OR=2.14; [1.19-3.85]). In analyses stratified by depression, adults with Mixed AD and without depression had an additional 0.37 mg/dL increase in CRP (SE=0.06; p<0.001) compared to unimpaired adults. Those with AD without depression had an 0.20 mg/dL increase in CRP (SE=0.07; p<0.01). Age was not associated with increased CRP in non-depressed older adults. Depressed adults with major stroke had a -0.26 mg/dL decrease in CRP (SE=0.11; p=0.02), controlling for hypertension, alcoholic drinks/beverages per week and smoking status. Concentration modeling revealed that participants with major stroke, probable AD and probable mixed AD without depression had significantly higher CRP concentrations when compared to unimpaired older adults.
%B The Journals of Gerontology, Series A %V 77 %P 673-682 %G eng %N 4 %R 10.1093/gerona/glab282 %0 Journal Article %J Alzheimer's & Dementia %D 2022 %T End-of-life burdensome interventions among Medicare fee-for-service beneficiaries with no dementia, non-advanced dementia, and advanced dementia %A Yingying Zhu %A Natalia Olchanski %A Karen M Freund %A Jessica Faul %A Howard M Fillit %A Rachel M Breslau %A Joshua T Cohen %A Peter J Neumann %A Pei-Jung Lin %K Dementia %K end-of-life %K Medicare %X Background Older adults with dementia have difficulties communicating their treatment preferences and experience end-of-life burdensome interventions with discomfort and limited benefits. This study compared utilization of burdensome interventions during the last 90 days of life among Medicare fee-for-service (FFS) beneficiaries with no dementia, non-advanced dementia, and advanced dementia. Method This study utilized data from 2000-2016 Health and Retirement Study (HRS) linked with Medicare and Medicaid claims, and HRS Exit Interviews. We quantified rates of imaging tests and life-sustaining treatments during the last 90 days of life among those with no dementia, non-advanced dementia, and advanced dementia. Life-sustaining treatments include tube feeding, intensive care unit care, cardiopulmonary resuscitation, and invasive mechanical ventilation. Among patients with a claims-based diagnosis of dementia, we classified them as having advanced dementia if they had three or more activities of daily living limitations and any diagnosis of malnutrition, pressure ulcer, incontinence, or aspiration pneumonia. We used logistic regression to examine factors associated with end-of-life imaging tests and life-sustaining treatments. Result A higher proportion of beneficiaries with non-advanced dementia (68%) and advanced dementia (79%) had end-of-life imaging tests, compared to those without dementia (57%) (p<0.01). Beneficiaries with dementia were more likely than non-dementia beneficiaries to receive these imaging tests, controlling for patient characteristics (non-advanced dementia: OR = 2.2 [95% CI 2.0-2.5]; advanced dementia: OR = 5.4 [4.5-6.5]). The proportion of receiving end-of-life life-sustaining treatments was lower among the non-advanced dementia cohort (23%), compared to non-dementia (27%) and advanced-dementia (27%) individuals (p<0.01). After adjusting for patient characteristics, beneficiaries with dementia were more likely than those without dementia to receive at least one life-sustaining treatment (non-advanced dementia: OR = 1.1 [1.0-1.2]; advanced dementia: OR = 1.9 [1.6-2.3]). Younger age, survey self-respondents, beneficiaries with fewer instrumental activities of daily living limitations and no advance care planning were more likely to have end-of-life imaging tests and life-sustaining treatments. Conclusion Our findings suggest that older adults with dementia, especially advanced dementia, are more likely to receive end-of-life burdensome interventions compared to individuals without dementia. Advance care planning involving patients with dementia, their families, and physicians about end-of-life treatment may improve the quality of care. %B Alzheimer's & Dementia %V 18 %P e063807 %G eng %N S9 %R 10.1002/alz.063807 %0 Journal Article %J Alzheimer's & Dementia %D 2022 %T End-of-life burdensome interventions among Medicare fee-for-service beneficiaries with no dementia, non-advanced dementia, and advanced dementia %A Zhu, Yingying %A Olchanski, Natalia %A Freund, Karen M %A Jessica Faul %A Fillit, Howard M %A Breslau, Rachel M %A Cohen, Joshua T %A Neumann, Peter J %A Lin, Pei-Jung %K Alzheimer %K Dementia %K End-of-life planning %K Medicare %X Abstract Background Older adults with dementia have difficulties communicating their treatment preferences and experience end-of-life burdensome interventions with discomfort and limited benefits. This study compared utilization of burdensome interventions during the last 90 days of life among Medicare fee-for-service (FFS) beneficiaries with no dementia, non-advanced dementia, and advanced dementia. Method This study utilized data from 2000-2016 Health and Retirement Study (HRS) linked with Medicare and Medicaid claims, and HRS Exit Interviews. We quantified rates of imaging tests and life-sustaining treatments during the last 90 days of life among those with no dementia, non-advanced dementia, and advanced dementia. Life-sustaining treatments include tube feeding, intensive care unit care, cardiopulmonary resuscitation, and invasive mechanical ventilation. Among patients with a claims-based diagnosis of dementia, we classified them as having advanced dementia if they had three or more activities of daily living limitations and any diagnosis of malnutrition, pressure ulcer, incontinence, or aspiration pneumonia. We used logistic regression to examine factors associated with end-of-life imaging tests and life-sustaining treatments. Result A higher proportion of beneficiaries with non-advanced dementia (68%) and advanced dementia (79%) had end-of-life imaging tests, compared to those without dementia (57%) (p<0.01). Beneficiaries with dementia were more likely than non-dementia beneficiaries to receive these imaging tests, controlling for patient characteristics (non-advanced dementia: OR = 2.2 [95% CI 2.0-2.5]; advanced dementia: OR = 5.4 [4.5-6.5]). The proportion of receiving end-of-life life-sustaining treatments was lower among the non-advanced dementia cohort (23%), compared to non-dementia (27%) and advanced-dementia (27%) individuals (p<0.01). After adjusting for patient characteristics, beneficiaries with dementia were more likely than those without dementia to receive at least one life-sustaining treatment (non-advanced dementia: OR = 1.1 [1.0-1.2]; advanced dementia: OR = 1.9 [1.6-2.3]). Younger age, survey self-respondents, beneficiaries with fewer instrumental activities of daily living limitations and no advance care planning were more likely to have end-of-life imaging tests and life-sustaining treatments. Conclusion Our findings suggest that older adults with dementia, especially advanced dementia, are more likely to receive end-of-life burdensome interventions compared to individuals without dementia. Advance care planning involving patients with dementia, their families, and physicians about end-of-life treatment may improve the quality of care. %B Alzheimer's & Dementia %V 18 %P e063807 %@ 1552-5260 %G eng %N S9 %R 10.1002/alz.063807 %0 Journal Article %J Innovation in Aging %D 2022 %T END-OF-LIFE CARE PLANNING AND SATISFACTION AMONG THE HEALTH AND RETIREMENT STUDY DECEDENTS %A Rahemi, Zahra %A Malatyali, Ayse %A Cidav, Tom %A Jarrin, Olga %A Dye, Cheryl %A McMahan, Christopher %K End-of-life (EOL) care and planning %K Satisfaction %X The frequency and timing of advance care planning among individuals living with cognitive impairments vary by race/ethnicity and other sociodemographic factors. This study examined relationships between advance care planning and end-of-life care satisfaction among participants in the Health and Retirement Study (Exit files 2002-2018). Among decedents with cognitive impairment (n=3,102), Black and Hispanic participants were less likely to have a living will (OR=0.22, 0.19) and less likely to discuss end-of-life care (OR=0.422, 0.544) compared to White and non-Hispanic participants, respectively. Black and Hispanic participants were more likely to prefer all possible end-of-life care (OR=3.29, 3.34) and less likely to refuse extensive-care measures (OR=0.34, 0.48) compared to White and non-Hispanic participants. Participants dissatisfied with end-of-life care were 48% less likely to have a living will. End-of-life care planning disparities among racial/ethnic groups can inform interventional and educational programs to improve equity in end-of-life care. %B Innovation in Aging %V 6 %P 353-354 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1398 %0 Journal Article %J Journal of Pain and Symptom Management %D 2022 %T End-of-Life Health Care Use Among Socially Isolated Older Adults with Cognitive Impairment %A Ashwin Kotwal %A Irena Cenzer %A Alexander Smith %K cognitive impairment %K End-of-life care %K Medicare %K socially isolated %X Outcomes 1. Understand how social isolation is defined and should be considered among older adults with cognitive impairment. 2. Understand how social isolation and cognitive impairment can lead to reduced healthcare use at the end of life and the role of clinicians in addressing social needs Original Research Background At the end of life, older adults may rely on others to access healthcare, particularly if they have impaired cognition. Research Objectives To determine whether socially isolated older adults with and without cognitive impairment have different patterns of end-of-life healthcare use. Methods We used nationally representative 2006-2016 Health and Retirement Study data linked to Medicare claims to examine adults age >50 interviewed once in the last 4 years of life (N = 2,073). We measured three self-report subscales of social relationships: household contacts, social network interaction, and community engagement. The three subscales were combined to create an overall social isolation measure. End-of-life health outcomes included emergency department (ED) visits, hospitalizations, ICU stays, and hospice use in the last months of life. Cognitive impairment (CI) included CIND or dementia. We used logistic regression to test the adjusted association of each social measure with each end-of-life outcome and tested for significant interactions with CI (p < 0.1). Results Our sample had a mean age of 82 (52% female, 9% Black, 5% Hispanic, 47% had CI). There were significant interactions between social isolation or network interaction and CI for all end-of-life outcomes; social isolation was associated with lower hospice use (aOR = 0.61, p = 0.05), ED use (aOR = 0.55, p = 0.03), ICU use (aOR = 0.62, p = 0.05), and hospitalizations (aOR = 0.63, p = 0.04) for patients with CI, whereas there was no association for those with no CI (hospice, aOR = 1.1; ED, aOR = 1.1; ICU, aOR = 1.0; hospitalizations, aOR = 1.1). Conclusion Cognitively impaired older adults who were socially isolated or had reduced social network interaction had fewer ED visits, hospitalizations, ICU stays, and hospice use at the end of life. Implications for Research, Policy, or Practice Cognitively impaired, isolated older adults may struggle to access end-of-life healthcare. Further research is needed to determine whether low rates of acute care and hospice are concordant with their wishes or are due to a lack of support in accessing health services. %B Journal of Pain and Symptom Management %V 63 %P 867-868 %G eng %N 5 %R https://doi.org/10.1016/j.jpainsymman.2022.02.057 %0 Journal Article %J Aging Clinical and Experimental Research %D 2022 %T The estimated prevalence of no reported dementia-related diagnosis in older Americans living with possible dementia by healthcare utilization. %A Parker, Kelly %A Brenda Vincent %A Rhee, Yeong %A Choi, Bong-Jin %A Sheria G Robinson-Lane %A Hamm, Jeremy M %A Klawitter, Lukus %A Donald A Jurivich %A Ryan P McGrath %K Alzheimer disease %K Geriatric Assessment %K Geriatrics %K Mental Status and Dementia Tests %XBACKGROUND: Screening for dementia in relevant healthcare settings may help in identifying low cognitive functioning for comprehensive cognitive assessments and subsequent dementia treatment after diagnosis.
AIMS: This study sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally-representative sample of older Americans with a cognitive impairment consistent with dementia (CICD) by healthcare utilization.
METHODS: The unweighted analytical sample included 1514 Americans aged ≥ 65 years that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. An adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores ≤ 6 had a CICD. Dementia-related diagnosis was self-reported. Respondents indicated if they visited a physician, received home healthcare, or experienced an overnight nursing home stay in the previous two years.
RESULTS: The prevalence of no reported dementia-related diagnosis in persons with a CICD who visited a physician was 89.9% (95% confidence interval (CI): 85.4%-93.1%). Likewise, the prevalence of no reported diagnosis in those with a CICD who received home healthcare was 84.3% (CI: 75.1-90.5%). For persons with a CICD that had an overnight nursing home stay, the prevalence of no reported dementia-related diagnosis was 83.0% (CI: 69.1-91.4%).
DISCUSSION: Although the prevalence of no reported dementia-related diagnosis in individuals with a CICD differed across healthcare settings, the prevalence was generally high nonetheless.
CONCLUSIONS: We recommend increased awareness and efforts be given to dementia screenings in various clinical settings.
%B Aging Clinical and Experimental Research %V 34 %P 359-365 %G eng %N 2 %R 10.1007/s40520-021-01980-2 %0 Journal Article %J Immunity & Ageing %D 2022 %T Evaluation of T-cell aging-related immune phenotypes in the context of biological aging and multimorbidity in the Health and Retirement Study. %A Ramasubramanian, Ramya %A Meier, Helen C S %A Vivek, Sithara %A Klopack, Eric %A Eileen M. Crimmins %A Jessica Faul %A Nikolich-Žugich, Janko %A Bharat Thyagarajan %K Adaptive immunity %K biological aging %K immune aging %K multimorbidity %XBACKGROUND: Cellular changes in adaptive immune system accompany the process of aging and contribute to an aging-related immune phenotype (ARIP) characterized by decrease in naïve T-cells (T) and increase in memory T-cells (T). A population-representative marker of ARIP and its associations with biological aging and age-related chronic conditions have not been studied previously.
METHODS: We developed two ARIP indicators based on well understood age-related changes in T cell distribution: T/(T (Central Memory) + T (Effector Memory) + T (Effector)) (referred as T/T) in CD4 + and CD8 + T-cells. We compared them with existing ARIP measures including CD4/CD8 ratio and CD8 + TN cells by evaluating associations with chronological age and the Klemera Doubal measure of biological age (measured in years) using linear regression, multimorbidity using multinomial logistic regression and two-year mortality using logistic regression.
RESULTS: CD8 + T and CD8 + T/T had the strongest inverse association with chronological age (beta estimates: -3.41 and -3.61 respectively; p-value < 0.0001) after adjustment for sex, race/ethnicity and CMV status. CD4 + T/T and CD4 + T had the strongest inverse association with biological age (β = -0.23; p = 0.003 and β = -0.24; p = 0.004 respectively) after adjustment for age, sex, race/ethnicity and CMV serostatus. CD4/CD8 ratio was not associated with chronological age or biological age. CD4 + T/T and CD4 + T was inversely associated with multimorbidity. For CD4 + T/T, people with 2 chronic conditions had an odds ratio of for 0.74 (95%CI: 0.63-0.86 p = 0.0003) compared to those without any chronic conditions while those with 3 chronic conditions had an odds ratio of 0.75 (95% CI: 0.63-0.90; p = 0.003) after adjustment for age, sex, race/ethnicity, CMV serostatus, smoking, and BMI. The results for the CD4 + T subset were very similar to the associations seen with the CD4 + T/T. CD4 + T/T and CD4 + T were both associated with two-year mortality (OR = 0.80 (95% CI: 0.67-0.95; p = 0.01) and 0.81 (0.70-0.94; p = 0.01), respectively).
CONCLUSION: CD4 + T/T and CD4 + T had a stronger association with biological age, age-related morbidity and mortality compared to other ARIP measures. Future longitudinal studies are needed to evaluate the utility of the CD4 + subsets in predicting the risk of aging-related outcomes.
%B Immunity & Ageing %V 19 %P 33 %G eng %N 1 %R 10.1186/s12979-022-00290-z %0 Journal Article %J Genes %D 2022 %T Exome Array Analysis of 9721 Ischemic Stroke Cases from the SiGN Consortium. %A Xu, Huichun %A Nguyen, Kevin %A Gaynor, Brady J %A Ling, Hua %A Zhao, Wei %A McArdle, Patrick F %A O'Connor, Timothy D %A Stine, O Colin %A Ryan, Kathleen A %A Lynch, Megan %A Smith, Jennifer A %A Jessica Faul %A Hu, Yao %A Haessler, Jeffrey W %A Fornage, Myriam %A Kooperberg, Charles %A Perry, James A %A Hong, Charles C %A Cole, John W %A Pugh, Elizabeth %A Doheny, Kimberly %A Sharon L R Kardia %A David R Weir %A Kittner, Steven J %A Mitchell, Braxton D %K Exome %K Gene Frequency %K Genome-Wide Association Study %K Ischemic stroke %K Stroke %XRecent genome wide association studies have identified 89 common genetic variants robustly associated with ischemic stroke and primarily located in non-coding regions. To evaluate the contribution of coding variants, which are mostly rare, we performed an exome array analysis on 106,101 SNPs for 9721 ischemic stroke cases from the SiGN Consortium, and 12,345 subjects with no history of stroke from the Health Retirement Study and SiGN consortium. We identified 15 coding variants significantly associated with all ischemic stroke at array-wide threshold (i.e., < 4.7 × 10), including two common SNPs in that have previously been associated with stroke. Twelve of the remaining 13 variants were extremely rare in European Caucasians (MAF < 0.1%) and the associations were driven by African American samples. There was no evidence for replication of these associations in either TOPMed Stroke samples ( = 5613 cases) or UK Biobank ( = 5874 stroke cases), although power to replicate was very low given the low allele frequencies of the associated variants and a shortage of samples from diverse ancestries. Our study highlights the need for acquiring large, well-powered diverse cohorts to study rare variants, and the technical challenges using array-based genotyping technologies for rare variant genotyping.
%B Genes %V 14 %P 61 %G eng %N 1 %R 10.3390/genes14010061 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T Experiences of Older Adults During the 2020 COVID-19 Pandemic in the United States: An Initial Exploration of Nationally Representative Data at the Intersection of Gender and Race. %A Takashi Yamashita %A Punksungka, Wonmai %A Van Vleet, Samuel %A Helsinger, Abigail %A Cummins, Phyllis %K COVID-19 %K gender %K Intersectionality %K race %XLittle is known about the overall experiences and feelings of diverse older populations during the 2020 COVID-19 pandemic. To provide the baseline information for future research and policy, this study analyzed the 2020 Health and Retirement Study COVID-19 project data ( = 1782). More than 70% of older adults reported the following activities: watching TV (98%), reading (90%), using a computer and the internet (83%), gardening (82%), walking (75%), baking and cooking (73%), and praying (73%). Volunteering and attending community groups, which are known to benefit well-being, were unpopular (less than 8%). During the pandemic, older adults were generally satisfied with their lives, but more than half of them were concerned about their own health, family's health, and future prospects. Our study also showed the differences in the experiences and feelings by gender and race as well as the intersection of gender and race in the United States.
%B Journal of Applied Gerontology %V 41 %G eng %N 619-627 %& 3 %R https://doi.org/10.1177/07334648211048258 %0 Journal Article %J Epidemiology %D 2022 %T Explaining the variance in cardiovascular disease risk factors: A comparison of demographic, socioeconomic, and genetic predictors. %A Hamad, Rita %A M. Maria Glymour %A Calmasini, Camilla %A Thu T Nguyen %A Stefan Walter %A David Rehkopf %K Cardiovascular disease %K Demographics %K Genetics %K Risk Factors %K socioeconomics %XBACKGROUND: Efforts to explain the burden of cardiovascular disease (CVD) often focus on genetic factors or social determinants of health. There is little evidence on the comparative predictive value of each, which could guide clinical and public health investments in measuring genetic versus social information. We compared the variance in CVD-related outcomes explained by genetic versus socioeconomic predictors.
METHODS: Data were drawn from the Health and Retirement Study (N=8,720). We examined self-reported diabetes, heart disease, depression, smoking, and body mass index, and objectively measured total and high-density lipoprotein cholesterol. For each outcome, we compared the variance explained by demographic characteristics, socioeconomic position (SEP), and genetic characteristics including a polygenic score for each outcome and principal components (PCs) for genetic ancestry. We used R-squared values derived from race-stratified multivariable linear regressions to evaluate the variance explained.
RESULTS: The variance explained by models including all predictors ranged from 3.7% to 14.3%. Demographic characteristics explained more than half this variance for most outcomes. SEP explained comparable or greater variance relative to the combination of the polygenic score and PCs for most conditions among both white and Black participants. The combination of SEP, polygenic score, and PCs performed substantially better, suggesting that each set of characteristics may independently contribute to prediction of CVD related outcomes.
CONCLUSIONS: Focusing on genetic inputs into personalized medicine predictive models, without considering measures of social context that have clear predictive value, needlessly ignores relevant information that is more feasible and affordable to collect on patients in clinical settings.
%B Epidemiology %V 33 %P 25-33 %G eng %N 1 %R 10.1097/EDE.0000000000001425 %0 Journal Article %J BMC Geriatrics %D 2022 %T Explanatory role of sociodemographic, clinical, behavioral, and social factors on cognitive decline in older adults with diabetes. %A O'Toole, Sean M %A Rebekah J Walker %A Emma Garacci %A Aprill Z Dawson %A Campbell, Jennifer A %A Leonard E Egede %K Cognitive decline %K Diabetes %K Health Disparities %XBACKGROUND: The aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes.
METHODS: Adults aged 50+ years with diabetes from the Health and Retirement Survey were assessed for cognitive function (normal, mild cognitive impairment [MCI], and dementia). Generalized estimating equation (GEE) logistic regression models were used to account for repeating measures over time. Models were adjusted for sociodemographic (gender, age, education, household income and assets), behavioral (smoking), clinical (ie. comorbidities, body mass index), and social (social support, loneliness, social participation, perceived constraints and perceived mastery on personal control) factors.
RESULTS: Unadjusted models showed non-Hispanic Blacks (NHB) and Hispanics were significantly more likely to progress from normal cognition to dementia (NHB OR: 2.99, 95%CI 2.35-3.81; Hispanic OR: 3.55, 95%CI 2.77-4.56), and normal cognition to MCI (NHB OR = 2.45, 95%CI 2.14-2.82; Hispanic OR = 2.49, 95%CI 2.13-2.90) compared to non-Hispanic Whites (NHW). Unadjusted models for the transition from mild cognitive decline to dementia showed Hispanics were more likely than NHW to progress (OR = 1.43, 95%CI 1.11-1.84). After adjusting for sociodemographic, clinical/behavioral, and social measures, NHB were 3.75 times more likely (95%CI 2.52-5.56) than NHW to reach dementia from normal cognition. NHB were 2.87 times more likely (95%CI 2.37-3.48) than NHW to reach MCI from normal. Hispanics were 1.72 times more likely (95%CI 1.17-2.52) than NHW to reach dementia from MCI.
CONCLUSION: Clinical/behavioral and social factors did not explain racial/ethnic disparities. Racial/ethnic disparities are less evident from MCI to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important.
%B BMC Geriatrics %V 22 %P 39 %G eng %N 1 %R 10.1186/s12877-021-02740-7 %0 Journal Article %J Disability and Health Journal %D 2022 %T Factors influencing participation among adults aging with long-term physical disability. %A Heeb, Rachel %A Putnam, Michelle %A Keglovits, Marian %A Weber, Courtney %A Campbell, Margaret %A Stark, Susan %A Morgan, Kerri %K Aging %K environment %K Participation %K Physical disability %K Qualitative methods %XBACKGROUND: People aging with long-term physical disability (AwPD) experience barriers to participation and independent living. There are currently limited evidence-based interventions that address issues regarding participation for people AwPD.
OBJECTIVE: This study examined factors influencing participation in personal and life activities among people AwPD to inform future interventions.
METHODS: A cross-sectional study within an ongoing, community-based cohort study of participation was conducted. A purposive sample of people AwPD aged 45-65, living with a physical disability for at least five years, and who speak English was recruited through disability organizations, aging organizations, and social media. Participants answered open-ended questions about what supports they needed to successfully participate in nine activity categories derived from the Health and Retirement Study participation items (e.g., employment, community leisure). A content analysis was conducted using NVivo to categorize responses, and member checking occurred with four additional people AwPD.
RESULTS: A total of 215 participants completed the survey. Eight categories of factors emerged from the data: physical environment factors, social factors, symptoms, economic factors, policy factors, body structure and functions, mental and emotional state, and temporal factors. Participant responses illuminated a combination of environmental and individual factors. Physical effects of disability and accelerated aging, such as pain and fatigue, paired with environmental factors, such as accessibility of transportation, were reported as influencing participation.
CONCLUSIONS: People AwPD experience a range of factors that substantially impact their ability to remain independent and participate in society. By identifying barriers to participation, new interventions addressing these barriers may be developed, resulting in more effective service provision, enhanced participation in personal and life activities, and improved health and well-being.
%B Disability and Health Journal %V 15 %P 101169 %G eng %N 1 %R 10.1016/j.dhjo.2021.101169 %0 Report %D 2022 %T Family Proximity and CoResidence in Retirement Heterogeneity in Residential Changes Across Older Adults’ Care Contexts %A Megan Doherty Bea %A Somalis Chy %K Grandchild Care %K residential mobility %K Retirement %X Residential changes to live near or with family can facilitate caregiving for children and older adults, along with other supports, but family-based residential changes could also have implications for economic security in retirement, including if changes correspond with earlier receipt of retirement benefits through the Social Security Administration (SSA). This study examines: 1) How often do residential changes to live near or with family coincide with retirement? 2) How do caregiving responsibilities impact the risk of such a residential change? and 3) How do these associations correspond with early SSA claiming around retirement? Using the longitudinal data of the Health and Retirement Study (HRS) from 2000 to 2018, we follow 2,798 households pre- and post-retirement. Results show that the risk of a residential change that puts an older adult household in close proximity to their child is significantly higher at the onset of retirement, compared to pre-retirement years, while the risks of residential changes that result in co-residence with children are less tied to retirement. There is evidence that grandchild-caregiving responsibilities for the older adult increase the risk of these residential changes. Finally, we find little evidence that such changes are tied to earlier Social Security retirement benefits claiming when comparing those who make such changes around retirement to those who do not. Thus, although many older adults are making significant changes to their living arrangements as they manage family-care needs, they are not at disproportionate risk of claiming SSA retirement benefits early when doing so.ability due to economic needs. Findings will reveal social and economic determinants of family-focused residential changes and consequences for benefit receipt. %I Center for Financial Security, University of Wisconsin-Madison %C Madison, WI %G eng %U https://cfsrdrc.wisc.edu/project/wi22-03 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Financial Hardship and Psychological Resilience during COVID-19: Differences by Race/Ethnicity. %A Taylor, Miles G %A Carr, Dawn C %A Jason, Kendra %K COVID-19 %K Health Disparities %K Income %K Race/ethnicity %K Successful aging %K Wellbeing %XOBJECTIVES: Research on the impact of COVID-19 among older adults has primarily focused on relatively acute virus outcomes, but it is likely financial hardships during this time have eroded the adaptive capacity of older adults. It is also possible these impacts vary by race and ethnicity. We examine changes in psychological resilience (PR) among older adults before and during the pandemic to determine whether financial hardships and other stressors have altered this resource for White, Black, and Hispanic older adults.
METHOD: Using the COVID module released by the HRS (n=735), we examined changes in PR between 2016 and 2020 related to financial hardships during COVID. We tested interactions to determine whether the effects were patterned by race and ethnicity.
RESULTS: Consistent with previous literature, resilience was relatively stable during this time on average. Financial hardship during COVID-19 diminished resilience, but this effect was concentrated primarily among White Americans.
DISCUSSION: The results suggest that PR is a relatively stable resource in later life, even during the pandemic. However, this resource may be impacted in the face of specific challenges in later life. Policies related to financial hardship during the pandemic should be seen as supporting the capacity for older adults to adapt to current as well as future challenges.
%B The Journals of Gerontology, Series B %V 77 %P e117-e122 %G eng %N 7 %R 10.1093/geronb/gbab173 %0 Journal Article %J Journal of Psychosomatic Research %D 2022 %T Five-factor model personality traits and grip strength: Meta-analysis of seven studies %A Yannick Stephan %A Angelina R. Sutin %A Brice Canada %A Maxime Deshayes %A Tiia Kekäläinen %A Antonio Terracciano %K five-factor model %K Grip strength %K health %K Neuroticism %K Personality %X Objective To examine the association between Five-Factor Model personality traits and grip strength. Method Adults aged 16 to 104 years old (N > 40,000) were from the Health and Retirement Study, the Midlife in the United States Study, The English Longitudinal Study of Aging, the National Health and Aging Trends Survey, the United Kingdom Household Longitudinal Study, and the Wisconsin Longitudinal Study graduate and sibling samples. Participants had data on personality traits, demographic factors, grip strength, and mediators such as depressive symptoms, physical activity, body mass index (BMI), and c-reactive protein (CRP). Results Across all samples and a meta-analysis, higher neuroticism was related to lower grip strength (meta-analytic estimate: -0.07, 95%CI: −0.075; −0.056). Higher extraversion (0.04, 95%CI: 0.022; 0.060), openness (0.05, 95%CI: 0.032; 0.062), and conscientiousness (0.05, 95%CI: 0.04; 0.065) were associated with higher grip strength across most samples and the meta-analysis. Depressive symptoms were the most consistent mediators between neuroticism and grip strength. Depressive symptoms and physical activity partly mediated the associations with extraversion, openness, and conscientiousness. Lower CRP partly mediated the association with conscientiousness. Sex moderated the associations for extraversion, openness, and conscientiousness, with stronger associations among males. Age moderated the neuroticism association, with stronger associations among younger individuals. Conclusion This study provides replicable evidence that personality is related to grip strength and identifies potential moderators and mediators of these associations. Overall, higher neuroticism is a risk factor for low grip strength, whereas high extraversion, openness, and conscientiousness may be protective. %B Journal of Psychosomatic Research %V 160 %P 110961 %G eng %R https://doi.org/10.1016/j.jpsychores.2022.110961 %0 Web Page %D 2022 %T Fixed Vial Sizes For Alzheimer’s Drug Could Waste $605M In Medicare Spending Each Year %A University of California, Los Angeles %K Alzheimer's disease %K drugs %K Medicare %K Spending %I ScienceBlog %G eng %U https://scienceblog.com/531622/fixed-vial-sizes-for-alzheimers-drug-could-waste-605m-in-medicare-spending-each-year/ %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 %XFood 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 PLoS One %D 2022 %T Frailty does not cause all frail symptoms: United States Health and Retirement Study. %A Chao, Yi-Sheng %A Wu, Chao-Jung %A Po, June Y T %A Huang, Shih-Yu %A Wu, Hsing-Chien %A Hsu, Hui-Ting %A Cheng, Yen-Po %A Lai, Yi-Chun %A Chen, Wei-Chih %K Frail Elderly %K Frailty %K Geriatric Assessment %K Retirement %XBACKGROUND: Frailty is associated with major health outcomes. However, the relationships between frailty and frailty symptoms haven't been well studied. This study aims to show the associations between frailty and frailty symptoms.
METHODS: The Health and Retirement Study (HRS) is an ongoing longitudinal biannual survey in the United States. Three of the most used frailty diagnoses, defined by the Functional Domains Model, the Burden Model, and the Biologic Syndrome Model, were reproduced according to previous studies. The associations between frailty statuses and input symptoms were assessed using odds ratios and correlation coefficients.
RESULTS: The sample sizes, mean ages, and frailty prevalence matched those reported in previous studies. Frailty statuses were weakly correlated with each other (coefficients = 0.19 to 0.38, p < 0.001 for all). There were 49 input symptoms identified by these three models. Frailty statuses defined by the three models were not significantly correlated with one or two symptoms defined by the same models (p > 0.05 for all). One to six symptoms defined by the other two models were not significantly correlated with each of the three frailty statuses (p > 0.05 for all). Frailty statuses were significantly correlated with their own bias variables (p < 0.05 for all).
CONCLUSION: Frailty diagnoses lack significant correlations with some of their own frailty symptoms and some of the frailty symptoms defined by the other two models. This finding raises questions like whether the frailty symptoms lacking significant correlations with frailty statuses could be included to diagnose frailty and whether frailty exists and causes frailty symptoms.
%B PLoS One %V 17 %P e0272289 %G eng %N 11 %R 10.1371/journal.pone.0272289 %0 Journal Article %J Drugs & Aging %D 2022 %T Frailty Risks of Prescription Analgesics and Sedatives across Frailty Models: the Health and Retirement Study. %A Bergen, Andrew W %A Cil, Gulcan %A Sargent, Lana J %A Dave, Chintan V %K Analgesics %K Frail Elderly %K Frailty %K Humans %K Hypnotics and Sedatives %K Opioid %K prescription drugs %K Prescriptions %K Retirement decisions %XINTRODUCTION: Limited evidence for incident frailty risks associated with prescription analgesics and sedatives in older (≥ 65 years) community-living adults prompted a more comprehensive investigation.
METHODS: We used data from older Health and Retirement Study respondents and three frailty models (frailty index, functional domain, frailty phenotype with 8803, 10,470, and 6850 non-frail individuals, respectively) and estimated sub-hazard ratios of regular prescription drug use (co-use, analgesic use, and sedative use), by frailty model. We addressed confounding with covariate adjustment and propensity score matching approaches.
RESULTS: The baseline prevalence of analgesic and sedative co-use, analgesic use, and sedative use among non-frail respondents was 1.8%, 12.8%, and 4.7% for the frailty index model, 4.2%, 16.2%, and 5.3% for the functional domain model, and 4.3%, 15.4%, and 6.1% for the frailty phenotype model, respectively. Cumulative frailty incidence over 10 years was 39.3%, 36.1%, and 14.2% for frailty index, functional domain, and frailty phenotype models, respectively; covariate-adjusted sub-hazard ratio estimates were 2.00 (1.63-2.45), 1.83 (1.57-2.13), and 1.68 (1.21-2.33) for co-use; 1.72 (1.56-1.89), 1.38 (1.27-1.51), and 1.51 (1.27-1.79) for analgesic use; and 1.46 (1.24-1.72), 1.25 (1.07-1.46), and 1.31 (0.97-1.76) for sedative use. Frailty risk ranking (co-use > analgesic use > sedative use) persisted across all model sensitivity analyses.
DISCUSSION: Consistently significant frailty risk estimates of regular prescription analgesic and sedative co-use and of prescription analgesic use support existing clinical, public health, and regulatory guidance on opioid and benzodiazepine co-prescription, on opioid prescription, and on NSAID prescription. Frailty phenotype measurement administration limited power to detect significant frailty risks. Research into specific pharmaceutical exposures and comparison of results across cohorts will be required to contribute to the deprescribing evidence base.
%B Drugs & Aging %V 39 %P 377-387 %G eng %N 5 %R 10.1007/s40266-022-00941-2 %0 Journal Article %J Journal of Pain and Symptom Management %D 2022 %T Frequency and Implications of Co-occurring Serious Illness in Older Adults (S544) %A Stephanie Nothelle %A Cynthia Yee %A Evan Bollens-Lund %A Kenneth Covinsky %A Amy Kelley %K Caregivers %K Dementia %K Medicare %K serious illness %X Outcomes 1. Describe how frequently the three categories of serious illness (dementia, functional impairment, advanced medical conditions) overlap in older adults 2. List two ways health service use or caregiving needs differ by type of serious illness Original Research Background Serious illness is a condition with high risk of mortality that negatively affects function or quality of life or excessively strains caregivers. In older adults, serious illness predominantly comprises three overlapping categories: dementia, functional impairment, and other advanced medical conditions. Research Objectives We estimate the frequency and co-occurrence of three categories of serious illness in older adults and describe differences in health service use and caregiving hours by category. Methods Using 2016 data from the nationally representative Health and Retirement Study, we selected those with 12 months of linked fee-for-service Medicare claims pre- and post-interview. Dementia status was determined by a survey-based algorithm, functional impairment by self-report of help with ≥1 activity of daily living, and advanced medical condition by claims-based ICD10 codes. Results We included 4,503 adults >65 years. Approximately 27% were seriously ill (9% dementia, 13% functional impairment, 16% advanced medical condition). Approximately 70% of persons with dementia (PWDs) and 65% with functional impairment had another category of serious illness, whereas only 31% with an advanced medical condition did. Functional impairment and advanced medical condition in combination increased prevalence of hospitalization compared to either alone (52% combined, 32% functional impairment, 30% advanced medical condition), but combining dementia with another serious illness category did not meaningfully change hospitalization (39% alone, 33% with functional impairment, 39% with advanced medical condition). PWDs and those with functional impairment reported more than twice the caregiving hours per month (113 and 130 hours, respectively) than those with an advanced medical condition (51 hours). Conclusion Older adults with serious illness due to dementia or functional impairment are more likely than those with an advanced medical condition to have another category of serious illness and have higher caregiving needs. Implications for Research, Policy, or Practice Caregiving policies and interventions for older adults with serious illness may need to be tailored by category of serious illness. %B Journal of Pain and Symptom Management %V 63 %P 930 %G eng %U https://www.sciencedirect.com/science/article/pii/S088539242200252 %N 5 %R https://doi.org/10.1016/j.jpainsymman.2022.02.167 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T Functional Limitations and Access to Long-Term Services and Supports Among Sexual Minority Older Adults. %A Travers, Jasmine L %A Shippee, Tetyana P %A Flatt, Jason D %A Caceres, Billy A %K Functional limitations %K long-term support %K sexual identity %K sexual minorities %XLittle is known about sexual minority (SM) older adults' activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations and their subsequent access to long-term services and supports (LTSS). We analyzed cross-sectional data from the 2016 Health and Retirement Study limited to individuals ≥50 years old. Bivariate analyses were performed to examine 1) sexual identity differences in the prevalence of ADL/IADL limitations and 2) associations of sexual identity with having ADL/IADL limitations and having access to help with ADL/IADL limitations. Our sample consisted of 3833 older adults, 6% ( = 213) were SM. Compared to heterosexual participants, bisexual older adults had greater reports of ADL/IADL limitations (20.9% vs. 35.9%, = 0.013). Among those who reported having ADL/IADL limitations ( = 803), there were no sexual identity differences in accessing help for ADL/IADL limitations ( = .901). Our findings contribute to the limited research on LTSS access among SM older adults.
%B Journal of Applied Gerontology %V 41 %P 2056-2062 %G eng %N 9 %R 10.1177/07334648221099006 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Gender, Age of Migration, and Cognitive Life Expectancies among Older Latinos: Evidence from the Health and Retirement Study. %A Garcia, Marc A %A Tarraf, Wassim %A Reyes, Adriana M %A Chiu, Chi-Tsun %K cognitive aging %K Migration and the Life-course %K race and ethnicity %XOBJECTIVES: Migration and gender are important factors that differentiate the Latino immigrant experience in the United States. We investigate the association between nativity status, age of migration, and cognitive life expectancies among a nationally representative sample of Latino adults aged 50 and older to explore whether age of migration and gender influence cognitive aging across the life course.
METHODS: This study used data from the Health and Retirement Study (1998-2016) to estimate Sullivan-based life tables of cognitive life expectancies by nativity, age of migration, and gender for older Latino adults. Cognitive status was based on the Langa-Weir (LW) algorithm. We test for both within-group (i.e., nativity and age of migration) and gender differences to explore the overall burden of disease among this rapidly growing population.
RESULTS: Foreign-born Latinos, regardless of age of migration or gender, spend a greater number of years after age 50 with cognitive impairment/no dementia than U.S.-born Latinos. However, the number of years spent with dementia varied by subgroup with mid-life immigrant men and late-life immigrant men and women exhibiting a significant disadvantage relative to the U.S.-born. Furthermore, we document a gender disadvantage for all Latino women, regardless of immigrant status.
DISCUSSION: The robust relationship between nativity, age of migration, and cognitive aging suggests that older foreign-born Latinos experiencing cognitive decline may place serious burdens on families. Future research should target the needs of different subgroups of older Latinos who are entering their last decades of life to develop culturally appropriate long-term care programs.
%B The Journals of Gerontology, Series B %V 77 %P e226-e233 %G eng %N 12 %R 10.1093/geronb/gbac133 %0 Journal Article %J Journal of Health and Social Behavior %D 2022 %T Gender and Social Isolation across the Life Course. %A Umberson, Debra %A Lin, Zhiyong %A Cha, Hyungmin %K Adolescent %K Life Change Events %K Marriage %K Sex Factors %K social isolation %XSocial isolation has robust adverse effects on health, well-being, dementia risk, and longevity. Although most studies suggest similar effects of isolation on the health of men and women, there has been much less attention to gendered patterns of social isolation over the life course-despite decades of research suggesting gender differences in social ties. We build on theoretical frames of constrained choice and gender-as-relational to argue that gender differences in isolation are apparent but depend on timing in the life course and marital/partnership history. Results indicate that boys/men are more isolated than girls/women through most of the life course, and this gender difference is much greater for the never married and those with disrupted relationship histories. Strikingly, levels of social isolation steadily increase from adolescence through later life for both men and women.
%B Journal of Health and Social Behavior %V 63 %P 319-335 %G eng %N 3 %R 10.1177/00221465221109634 %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 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 %XThe 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 %XUnderstanding 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 %XOBJECTIVES: 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 The Journal of Strength and Conditioning Research %D 2022 %T Handgrip Strength Asymmetry and Weakness Are Associated With Future Morbidity Accumulation in Americans %A Klawitter, Lukus %A Brenda Vincent %A Choi, Bong-Jin %A Smith, Joseph %A Hammer, Kimberly D. %A Donald A Jurivich %A Lindsey J Dahl %A Ryan P McGrath %K Chronic disease %K Exercise %K Mass Screening %K Risk Factors %K sarcopenia %X Identifying strength asymmetries in physically deconditioned populations may help in screening and treating persons at risk for morbidities linked to muscle dysfunction. Our investigation sought to examine the associations between handgrip strength (HGS) asymmetry and weakness on accumulating morbidities in aging Americans. The analytic sample included 18,506 Americans aged ≥50 years from the 2006–2016 Health and Retirement Study. Handgrip strength was measured on each hand with a handgrip dynamometer, and persons with an imbalance in strength >10% between hands had HGS asymmetry. Men with HGS <26 kg and women with HGS <16 kg were considered as weak. Subjects reported the presence of healthcare provider–diagnosed morbidities: hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems. Covariate-adjusted ordinal generalized estimating equations analyzed the associations for each HGS asymmetry and weakness group on future accumulating morbidities. Of those included in our study, subjects at baseline were aged 65.0 ± 10.2 years, 9,570 (51.7%) had asymmetric HGS, and 996 (5.4%) were weak. Asymmetry alone and weakness alone were associated with 1.09 (95% confidence interval [CI]: 1.04–1.14) and 1.27 (CI: 1.11–1.45) greater odds for future accumulating morbidities, respectively. Having both HGS asymmetry and weakness was associated with 1.46 (CI: 1.29–1.65) greater odds for future accumulating morbidities. Handgrip-strength asymmetry, as another potential indicator of impaired muscle function, is associated with future morbidity status during aging. Exercise professionals and related practitioners should consider examining asymmetry and weakness with handgrip dynamometers as a simple and noninvasive screening method for helping to determine muscle dysfunction and future chronic disease risk. %B The Journal of Strength and Conditioning Research %V 36 %P 106-112 %G eng %N 1 %R 10.1519/JSC.0000000000004166 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2022 %T Handgrip strength asymmetry is associated with slow gait speed and poorer standing balance in older Americans. %A McGrath, Ryan %A Lang, Justin J %A Ortega, Francisco B %A Chaput, Jean-Philippe %A Zhang, Kai %A Smith, Joseph %A Vincent, Brenda %A Piñero, Jose Castro %A Garcia, Magdalena Cuenca %A Tomkinson, Grant R %K Geriatric Assessment %K Geriatrics %K muscle strength dynamometer %K Physical Functional Performance %K walking speed %XINTRODUCTION: Handgrip strength (HGS) asymmetry may help identify the functional asymmetries that contribute to mobility limitations. We sought to determine the associations of HGS asymmetry on gait speed and standing balance in older Americans.
MATERIALS AND METHODS: The analytic sample included 8,396 adults aged ≥65-years for the last wave in which they participated in the 2006-2016 Health and Retirement Study. Participants were categorized into asymmetry groups based on the degree of HGS asymmetry. Persons with gait speed <0.8 meters/second were slow. Balance scores ranged from 0-4 with lower scores representing poorer standing balance.
RESULTS: Older Americans with 20.1%-30.0% asymmetry had 1.22 (95% confidence interval (CI): 1.05-1.42) greater odds for slow gait speed, while those with >30.0% asymmetry had 1.23 (CI: 1.05-1.44) greater odds. Persons with 10.1%-20.0%, 20.1%-30.0%, and >30% asymmetry had 1.09 (CI: 1.07-1.22), 1.23 (CI: 1.07-1.42) and 1.40 (CI: 1.22-1.61) greater odds for poorer static balance, respectively. Those in each individual asymmetry group had greater odds for slow gait speed: 1.14 (CI: 1.03-1.26) for >10.0%, 1.19 (CI: 1.07-1.33) for >20.0%, and 1.16 (CI: 1.01-1.35) for >30.0%. Similar results were observed for poorer balance: 1.20 (CI: 1.09-1.32) for >10.0%, 1.27 (CI: 1.15-1.41) for >20.0%, and 1.31 (CI: 1.16-1.49) for >30.0%. Every 10% asymmetry increase was associated with 1.62 (CI: 1.32-1.99) greater odds for poorer balance.
CONCLUSIONS: The bimanual aspects of HGS asymmetry may reflect the bilateral movements required for mobility, and the relationship between upper and lower extremity strength and function may elucidate our findings.
%B Archives of Gerontology and Geriatrics %V 102 %P 104716 %G eng %R 10.1016/j.archger.2022.104716 %0 Report %D 2022 %T Harmonization of Cross-National Studies of Aging to the Health and Retirement Study %A Jacqui Smith %A Lindsay Ryan %A Yoobin Park %A Alexandra D. Crosswell %A Drystan F. Phillips %A Lee, Jinkook %K cross-national studies %K harmonization %B CESR-SCHAEFFER WORKING PAPER SERIES %I CESR-SCHAEFFER, University of Southern California %G eng %U https://cesr.usc.edu/documents/WP_2022_006.pdf %0 Journal Article %J Genwell Project %D 2022 %T Helping others: A path to social connectedness, health, and well-being for older Canadians %A Julia Nakamura %A Marisa Nelson %A Michelle Lin %A Frances S. Chen %K health %K older Canadians %K Well-being %B Genwell Project %G eng %U https://genwellproject.org/helping-others-a-path-to-social-connectedness-health-and-well-being-for-older-canadians/ %0 Generic %D 2022 %T HOPELESSNESS AMONG MIDDLE-AGED AND OLDER ADULTS: A COMPARISON OF NATIVE WHITES, NATIVE MINORITIES, AND IMMIGRANTS %A Guo, Man %A Wang, Yi %A Carter, Kara %K hopelessness %K Immigrants %K middle-aged adult %K minorities %K Older adult %K Whites %X Abstract Sense of hopelessness is closely linked to poor physical/mental health and elevated suicidal risk. The aging and immigration processes put middle-aged and older immigrants at a greater risk of feeling hopeless. However, we know little about hopelessness among this population. This study asks two questions: do middle-aged and older immigrants have higher levels of hopelessness compared to native-born Whites and native-born ethnic minorities? If so, what factors contribute to such differences? Data was from the 2018 psychosocial assessment of the Health and Retirement Study (N = 5,534). ANOVA was used to compare levels of hopelessness among three groups of middle-aged/older adults (50 yrs+): native-born Whites (n =3,603), native-born minorities (n = 1,209), and immigrants (n = 722). Linear regressions were used to examine the association between nativity/race and hopelessness, with five sets of explanatory variables (i.e., SES, health, social support, social engagement, and neighborhood characteristics) entered in the models individually and then collectively. The findings showed that middle-aged/older immigrants had the highest levels of hopelessness, followed by native minorities, and then native Whites. Controlling for each set of the explanatory variables respectively reduced the group differences between native Whites and native ethnic minorities, but not between Whites and immigrants. When controlling for all the explanatory variables, the levels of hopelessness no longer differed significantly between immigrants and native Whites. Findings suggest that immigrants’ multiple disadvantages in personal, family, and social lives may contribute to their heightened levels of hopelessness. Interventions are sorely needed to protect against hopelessness for this population. %G eng %R 10.1093/geroni/igac059.047 %0 Report %D 2022 %T How Does COVID-Induced Early Retirement Compare to the Great Recession? %A Chen, Anqi %A Liu, Siyan %A Alicia H. Munnell %K COVID-19 %K Early retirement %K Great Recession %K Pandemic %X In early 2020, the COVID Recession seemed like it would result in an increase in early Social Security claiming, similar to the Great Recession. However, pretty quickly the COVID Recession turned out to be quite different. It was spurred by a health crisis, potentially increasing the likelihood of early claiming among older workers and accompanied by a quick recovery in the stock market followed by rapidly-rising prices that could enable many with assets to retire early. On the other hand, the unprecedented expansion and generosity of unemployment insurance (UI) offered a way for lower-paid workers to stay in the labor force. The following analysis, using data from the Health and Retirement Study (HRS), compares how the claiming pattern changed in the recession years 2008-2010 from the expansion years 2004-2006 with how the pattern changed in the recession year 2020 from the expansion years 2016-2018. %B Working Papers %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/how-does-covid-induced-early-retirement-compare-to-the-great-recession/ %0 Journal Article %J Scientific Reports %D 2022 %T How social/environmental determinants and inflammation affect salivary telomere length among middle-older adults in the health and retirement study. %A Courtney, Margaret Gough %A Roberts, Josephine %A Godde, Kanya %K C-reactive protein %K Inflammation %K Retirement %K Social determinants of health %K Telomere %K Telomere Shortening %XSocial epidemiology posits that chronic stress from social determinants will lead to a prolonged inflammatory response that may induce accelerated aging as measured, for example, through telomere length (TL). In this paper, we hypothesize variables across demographic, health-related, and contextual/environmental domains influence the body's stress response, increase inflammation (as measured through high-sensitivity C-reactive protein (hs-CRP)), and thereby lead to shortening of telomeres. This population-based research uses data from the 2008 Health and Retirement Study on participants ages ≤ 54-95 + years, estimating logistic regression and Cox proportional hazards models of variables (with and without confounders) across the domains on shortened TL. A mediation analysis is also conducted. Contrary to expectations, hs-CRP is not associated with risk of shortened TL. Rather, factors related to accessing health care, underlying conditions of frailty, and social inequality appear to predict risk of shorter TL, and models demonstrate considerable confounding. Further, hs-CRP is not a mediator for TL. Therefore, the social determinants of health examined do not appear to follow an inflammatory pathway for shortened TL. The finding of a relationship to social determinants affecting access to health care and medical conditions underscores the need to address social determinants alongside primary care when examining health inequities.
%B Scientific Reports %V 12 %P 8882 %G eng %N 1 %R 10.1038/s41598-022-12742-z %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 %XOBJECTIVES: 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 Scientific Reports %D 2022 %T Identifying pathways to increased volunteering in older US adults. %A Nakamura, Julia S %A Lee, Matthew T %A Chen, Frances S %A Archer Lee, Yeeun %A Fried, Linda P %A VanderWeele, Tyler J %A Kim, Eric S %K Physical Health %K Volunteering %K Well-being %XWhile growing evidence documents strong associations between volunteering and improved health and well-being outcomes, less is known about the health and well-being factors that lead to increased volunteering. Using data from 13,771 participants in the Health and Retirement Study (HRS)-a diverse, longitudinal, and national sample of older adults in the United States-we evaluated a large range of candidate predictors of volunteering. Specifically, using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (over a 4-year follow-up between t; 2006/2008 and t; 2010/2012) were associated with volunteer activity four years later (t; 2014/2016). After adjusting for a rich set of covariates, certain changes in some health behaviors (e.g., physical activity ≥ 1x/week), physical health conditions (e.g., physical functioning limitations, cognitive impairment), and psychosocial factors (e.g., purpose in life, constraints, contact with friends, etc.) were associated with increased volunteering four years later. However, there was little evidence that other factors were associated with subsequent volunteering. Changes in several indicators of physical health, health behaviors, and psychosocial well-being may predict increased volunteering, and these factors may be novel targets for interventions and policies aiming to increase volunteering in older adults.
%B Scientific Reports %V 12 %P 12825 %G eng %N 1 %R 10.1038/s41598-022-16912-x %0 Journal Article %J PLoS One %D 2022 %T Identifying pathways to religious service attendance among older adults: A lagged exposure-wide analysis. %A Cowden, Richard G %A Nakamura, Julia S %A Chen, Zhuo Job %A Case, Brendan %A Kim, Eric S %A VanderWeele, Tyler J %K Health Behavior %K Prospective Studies %K psychological distress %K Psychosocial Intervention %K Retirement %XWe used prospective data (spanning 8 years) from a national sample of older U.S. adults aged > 50 years (the Health and Retirement Study, N = 13,771) to evaluate potential factors that lead to subsequent religious service attendance. We applied a lagged exposure-wide epidemiologic design and evaluated 60 candidate predictors of regular subsequent religious service attendance. Candidate predictors were drawn from the following domains: health behaviors, physical health, psychological well-being, psychological distress, social factors, and work. After rigorous adjustment for a rich set of potential confounders, we observed modest evidence that changes in some indices of physical health, psychological well-being, psychological distress, and social functioning predicted regular religious service attendance four years later. Our findings suggest that there may be opportunities to support more regular religious service attendance among older adults who positively self-identify with a religious/spiritual tradition (e.g., aid services for those with functional limitations, psychological interventions to increase hope), which could have downstream benefits for various dimensions of well-being in the later years of life.
%B PLoS One %V 17 %P e0278178 %G eng %N 11 %R 10.1371/journal.pone.0278178 %0 Journal Article %J Sustainability %D 2022 %T The Impact of COVID-19 on Depressive Symptoms and Loneliness for Middle-Aged and Older Adults %A Curl, Angela L. %A Wolf, Katie E. %K COVID-19 %K Depressive symptoms %K Loneliness %X This study examines the impact of the COVID-19 pandemic on depressive symptoms and loneliness in older adults, using the Protection Motivation Theory Framework. Using data collected between March 2020 and May 2021 as part of the Health and Retirement Study (N = 2145 adults over age 50), the roles of threat and coping appraisals as predictors of protective health behaviors and, ultimately, mental health outcomes, were analyzed using structural equation modeling. Being at high risk for COVID-19 complications and death was associated with more depressive symptoms and loneliness. Higher levels of concern about COVID-19 were associated with more depressive symptoms while knowing someone who had died of the coronavirus was associated with less loneliness. Lower scores for perceived control over one’s health and social life were associated with more depressive symptoms and higher loneliness. These results suggest that moving forward, mental health assessments should consider the impact of the pandemic and include measures specifically asking about COVID-19 concerns and experiences (e.g., death of close friends or family due to COVID-19, protective health measures). Additionally, future responses to this pandemic and other public health emergencies should consider the influence that self-efficacy has on health behaviors and mental health. The pandemic has raised public awareness of the negative consequences of social isolation and acted to destigmatize mental illness, and this greater awareness could encourage middle-aged and older adults to seek various treatments for depression and loneliness. %B Sustainability %V 14 %P 6316 %G eng %R 10.3390/su14106316 %0 Journal Article %J Journal of Economics, Race, and Policy %D 2022 %T The Impact of the COVID-19 Pandemic on Business Ownership Across Racial/Ethnic Groups and Gender. %A Choi, Shinae L %A Harrell, Erin R %A Watkins, Kimberly %K COVID-19 %K Entrepreneurship %K gender %K Race/ethnicity %XThis study examined the economic impact of the COVID-19 pandemic on US older entrepreneurs' businesses using the Health and Retirement Study. We estimated logistic regression models to document the odds of experiencing economic impact. The COVID-19 pandemic has affected nearly 76% of US older entrepreneurs but has disproportionately impacted the businesses of Black, Hispanic, Asian/other races, and women entrepreneurs. Older Black entrepreneurs had significantly higher odds of facing business closure (OR = 2.31, < .01), implementing new procedures (OR = 2.44, < .01), workers quitting (OR = 2.95, < .001), and difficulty paying regular bills (OR = 2.88, < .001) than their White counterparts. Older Hispanic entrepreneurs also had significantly higher odds of instituting new procedures (OR = 2.27, < .05), workers quitting (OR = 2.26, < .01), and difficulty paying regular bills (OR = 2.35, < .01) than their White counterparts. Similarly, older Asian/other races entrepreneurs were significantly more likely to report difficulty paying regular bills since the start of the pandemic than their White counterparts (OR = 3.11, < .01). Women entrepreneurs were significantly more likely to close their businesses than their male counterparts (OR = 2.11, < .001). These significant associations persisted after controlling for confounders. Support for underserved racial/ethnic groups and older women entrepreneurs should focus on accessibility to financial services, capital, and support packages as well as legislative support for ensuring business continuity and success.
%B Journal of Economics, Race, and Policy %V 5 %P 307-317 %G eng %N 4 %R 10.1007/s41996-022-00102-y %0 Web Page %D 2022 %T In retirement, you may not need to spend so much %A Coy, Peter %K Retirement %K Spending %I The New York Times %G eng %U https://www.nytimes.com/2022/09/28/opinion/retirement-spending.html %0 Journal Article %J The Journal of the Economics of Ageing %D 2022 %T Income trajectories in later life: Longitudinal evidence from the Health and Retirement Study %A Olivia S. Mitchell %A Robert L. Clark %A Annamaria Lusardi %K Aging %K Financial literacy %K Financial resilience %K Vulnerable groups %X We track low-income respondents in the longitudinal Health and Retirement Study for 23 years, to observe how their financial situations unfolded as they aged. We document that (a) real incomes remained relatively stable as individuals entered retirement and progressed through their later years; and (b) labor force participation declined and thus earnings became less important with age, while Social Security and retirement savings rose as a proportion of annual income. Low-income people near retirement also tended to fare poorly during retirement. %B The Journal of the Economics of Ageing %V 22 %P 100371 %G eng %R 10.1016/j.jeoa.2022.100371 %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 American Journal of Health Promotion %D 2022 %T The Influence of Loneliness on the Smoking and Physical Activity of Community-Dwelling Older Adults: Results from the Health and Retirement Study. %A Yang, Jie %A Yockey, R Andrew %A Chu, Yoosun %A Lee, Joseph G L %K Exercise %K perceived isolation %K purpose %K Smoking %XPURPOSE: To use the loneliness model in examining the influence of loneliness on the number cigarettes smoked per day and the different intensity levels of physical activity among community-dwelling older Americans in the United States.
DESIGN, SETTING, SAMPLE: This study analyzed a nationally representative sample of older adults aged 65+ in two waves (2010 and 2012) of data from the Health and Retirement Study. Response rates for the two waves were 81% and 89.1%. The sample size for smoking model was 199, and for physical activity models was 3018.
MEASURES: Outcomes included number of cigarettes smoked per day and physical activity at three intensity levels: light, moderate, and vigorous. Independent variable was the UCLA loneliness scale.
ANALYSIS: A lagged dependent approach for modeling longitudinal data was adopted. Models controlled for outcomes at the first timepoint (Wave 1), health/physical functioning, and demographic variables.
RESULTS: Loneliness was associated with an increased number of cigarettes smoked per day (β = 2.93, < .05) and decreased engagement in moderate and vigorous physical activity for older adults (β = .12, < .05; β = .12, <. 05), after controlling for these behaviors at baseline and other covariates.
CONCLUSION: The findings call for smoking reduction and physical activity enhancement interventions targeting older adults who have high levels of loneliness. Efforts to enhance social support will be crucial to eradicating the harmful health impact of loneliness. Critical limitations include self-reported measures and unobserved confounders.
%B American Journal of Health Promotion %V 36 %P 959-966 %G eng %N 6 %R 10.1177/08901171221081136 %0 Thesis %B Psychology %D 2022 %T The Influence of Work-Life Balance Directionality on Retirement Decisions %A Craig, Joshua %K Bridge employment %K Income %K Retirement Decision %K Work-life balance %X The retirement landscape is ever shifting and has become a dual-decision process more so now than ever before. Employees consider retirement through a family lens and particularly so when there is conflict between life and work domains. Researchers have suggested that work-life directionality does influence work-related decisions (Wiktorowicz, 2018). The impact of work-life directionality, however, on retirement choices has not been substantially examined. Further, socioeconomic status (SES) has been found to influence retirement decisions to some degree (Dushi et al., 2017). Therefore, in the present study, data from a total of 17,146 participants were used from the 2018 wave of the Health and Retirement Study (HRS) to examine the influence of work-life directionality, as well as the moderating effects of income, on bridge employment and planned age to stop working permanently. The findings indicate that work-life and life-work conflict influence planned age to stop working permanently, as the presence of work-life conflict reduces the planned age and life-work conflict increases the planned age. Also, the interaction between work-life and life-work significantly influences planned age to stop working but not bridge employment. Implications of these finding for both theory and practice are discussed. %B Psychology %I California State University, San Bernardino %C San Bernardino, CA %V M.S. %G eng %U https://scholarworks.lib.csusb.edu/etd/1550/ %0 Journal Article %J Health Affairs %D 2022 %T Informal Caregivers Provide Considerable Front-Line Support In Residential Care Facilities And Nursing Homes. %A Norma B Coe %A Werner, Rachel M %K Caregiving %K Informal care %XInformal care, or care provided by family and friends, is the most common form of care received by community-dwelling older adults with functional limitations. However, less is known about informal care provision within residential care settings including residential care facilities (for example, assisted living) and nursing homes. Using data from the Health and Retirement Study (2016) and the National Health and Aging Trends Study (2015), we found that informal care was common among older adults with functional limitations, whether they lived in the community, a residential care facility, or a nursing home. The hours of informal care provided were also nontrivial across all settings. This evidence suggests that informal caregiving and some of the associated burdens do not end when a person transitions from the community to residential care or a nursing home setting. It also points to the large role that families play in the care and well-being of these residents, which is especially important considering the recent visitor bans during the COVID-19 epidemic. Family members are an invisible workforce in nursing homes and residential care facilities, providing considerable front-line work for their loved ones. Providers and policy makers could improve the lives of both the residents and their caregivers by acknowledging, incorporating, and supporting this workforce.
%B Health Affairs %V 41 %P 105-111 %G eng %N 1 %R 10.1377/hlthaff.2021.01239 %0 Journal Article %J Social Psychiatry and Psychiatric Epidemiology %D 2022 %T Inner child of the past: long-term protective role of childhood relationships with mothers and fathers and maternal support for mental health in middle and late adulthood. %A Chen, Ping %K depression %K Mental Health %K Paternal support %XPURPOSE: National longitudinal studies that investigate the long-term association between early family life and mental health in middle and older adulthood are limited. This study aims to fill the gap by examining the protective effect of positive childhood relationships with mothers and fathers and parental support against depression among women and men in middle and late adulthood.
METHODS: The sample of 12,606 adults (7319 females; 5287 males) from the US Health and Retirement Study was nationally representative with the inclusion of 7 depression measures from 2008 to 2018. Two depression measures, CESD-8 scale and binary indicators of severe depressive symptoms, were used. Generalized estimation equations (GEE)-negative binomial models were estimated for CESD-8 and GEE-logit models were estimated for the binary indicator of severe depression. This study aimed to assess how positive parent-child relationships and maternal support protect the mental health of women and men in adulthood. Other risk and psychosocial factors, such as childhood depression, traumatic life events, stressful life events, marital status, and social support in adulthood were adjusted for.
RESULTS: Positive childhood relationships with mothers, fathers, or both parents and increased maternal support were associated with a lower risk of depression among both females and males from middle to old age, even if they experienced trauma, stressful life events, divorce, singlehood, widowhood, or little social support. Females benefited more psychologically than males from positive mother-daughter relationships and high-quality relationships with both parents. However, compared to mother-child relationships, positive father-child relationships protected men better psychosocially than females.
CONCLUSION: Findings underscore the importance of fathers' roles in promoting their children's, especially sons', emotional well-being. Interventions in early mother-child and father-child relationships and parental support are crucial for healthy aging in mental development.
%B Social Psychiatry and Psychiatric Epidemiology %V 57 %P 1399-1416 %G eng %N 7 %R 10.1007/s00127-021-02200-y %0 Journal Article %J BMC Geriatrics %D 2022 %T Interactions between the apolipoprotein E4 gene and modifiable risk factors for cognitive impairment: a nationally representative panel study. %A Kolli, Ajay %A Zhou, Yunshu %A Chung, Grace %A Ware, Erin B %A Kenneth M. Langa %A Ehrlich, Joshua R %K Apolipoprotein E4 %K Cognitive Dysfunction %K Dementia %K Risk Factors %XBACKGROUND: Few studies using rigorous clinical diagnosis have considered whether associations with cognitive decline are potentiated by interactions between genetic and modifiable risk factors. Given the increasing burden of cognitive impairment (CI) and dementia, we assessed whether Apolipoprotein E ε4 (APOE4) genotype status modifies the association between incident CI and key modifiable risk factors .
METHODS: Older adults (70+) in the US were included. APOE4 status was genotyped. Risk factors for CI were self-reported. Cognitive status (normal, CI, or dementia) was assigned by clinical consensus panel. In eight separate Cox proportional hazard models, we assessed for interactions between APOE4 status and other CI risk factors.
RESULT: The analytical sample included 181 participants (mean age 77.7 years; 45.9% male). APOE4 was independently associated with a greater hazard of CI in each model (Hazard Ratios [HR] between 1.81-2.66, p < 0.05) except the model evaluating educational attainment (HR 1.65, p = 0.40). The joint effects of APOE4 and high school education or less (HR 2.25, 95% CI: 1.40-3.60, p < 0.001), hypertension (HR 2.46, 95% CI: 1.28-4.73, p = 0.007), elevated depressive symptoms (HR 5.09, 95% CI: 2.59-10.02, p < 0.001), hearing loss (HR 3.44, 95% CI: 1.87-6.33, p < 0.0001), vision impairment (HR 5.14, 95% CI: 2.31-11.43, p < 0.001), smoking (HR 2.35, 95% CI: 1.24-4.47, p = 0.009), or obesity (HR 3.80, 95% CI: 2.11-6.85, p < 0.001) were associated with the hazard of incident CIND (compared to no genetic or modifiable risk factor) in separate models. The joint effect of Apolipoprotein ε4 and type 2 diabetes was not associated with CIND (HR 1.58, 95% CI: 0.67-2.48, p = 0.44).
DISCUSSION: The combination of APOE4 and selected modifiable risk factors conveys a stronger association with incident CI than either type of risk factor alone.
%B BMC Geriatrics %V 22 %P 938 %G eng %N 1 %R 10.1186/s12877-022-03652-w %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2022 %T The intersectionality of life course socioeconomic status, race, and cognitive decline: An 18-year follow-up %A Zeng, Yue %A Sang Lum, Terry Yat %A Chen, Yu-Chih %K Cognitive decline %K race %K socioeconomic status %K trajectory %X Objectives Studies have documented the impact of childhood socioeconomic status (SES) on cognition. However, research that simultaneously considers SES in varied life stages, the multidimensional mechanisms, and racial differences is relatively understudied. This study examines the intersectionality across age, SES, and race and its impact on cognitive trajectories. Methods Using 8,376 respondents aged 65+ from the 1998-2016 Health and Retirement Study, we used latent growth curve modeling to examine the effects of four life course models (latency, pathway, accumulation, and mobility) on 18-year trajectories of mental status and episodic memory. We further tested for differences in the links between SES and cognitive trajectories between black and white respondents. Results Cognitive function declines with age and is interrelated with SES and race. Adulthood has a stronger effect on cognitive performance than childhood. However, linked positive childhood and adulthood SES contributes to positive cognition. Accumulated SES disadvantages were associated with lower cognition. Older adults with downward mobility and low SES throughout their lifespans had the lowest cognition scores. Life course models operated differently on trajectories of cognitive decline, yet these effects were particularly evident among older black respondents. Overall, those with socioeconomic advantages tended to have a slower decline in cognition, while a faster decline occurred for those with accrued disadvantages. Conclusions Cognitive performance is a complex, longitudinal process intertwined with socioeconomic conditions and population heterogeneity shaped by life course contexts. Policies that facilitate healthy cognitive performance and address SES inequality could equalize health opportunities and address racial cognitive disparities later in life. %B International Journal of Geriatric Psychiatry %V 37 %G eng %N 8 %R 10.1002/gps.5774 %0 Journal Article %J Journal of Insurance Issues %D 2022 %T Life Insurance Ownership Among Seniors-A Perspective of Spousal Quality Among the Elderly %A Cheng, Yuanshan %A Gibson, Philip %A Guo, Tao %A Sam, Janine %K Elderly %K Life insurance %K seniors %K spousal quality %X Life insurance is commonly used to protect against the loss of future human capital earnings. Using data from the Health and Retirement Study (HRS) Leave Behind survey, this study investigates the impact that the quality of a marriage has on the demand for life insurance ownership. The results suggest that spousal relationship quality is a strong and dominating factor in life insurance ownership among the elderly. Our findings indicate that elderly individuals are more motivated to provide financial protection to their spouse when the quality level of their marriage is "good "- in addition to the influence of other factors predicted by classic economic theories. We perform several robustness tests and find consistent results. [Key words: relationship quality, life insurance ownership, household risk management] %B Journal of Insurance Issues %V 45 %P 1-24 %G eng %N 2 %0 Journal Article %J Clinical Epigenetics %D 2022 %T Lifetime exposure to smoking, epigenetic aging, and morbidity and mortality in older adults. %A Klopack, Eric T %A Carroll, Judith E %A Cole, Steve W %A Seeman, Teresa E %A Eileen M. Crimmins %K DNA Methylation %K Epigenesis %K genetic %K Morbidity %K Smoking %K Tobacco %K Venous Blood Study %XBACKGROUND: Cigarette smoke is a major public health concern. Epigenetic aging may be an important pathway by which exposure to cigarette smoke affects health. However, little is known about how exposure to smoke at different life stages affects epigenetic aging, especially in older adults. This study examines how three epigenetic aging measures (GrimAge, PhenoAge, and DunedinPoAm38) are associated with parental smoking, smoking in youth, and smoking in adulthood, and whether these epigenetic aging measures mediate the link between smoke exposure and morbidity and mortality. This study utilizes data from the Health and Retirement Study (HRS) Venous Blood Study (VBS), a nationally representative sample of US adults over 50 years old collected in 2016. 2978 participants with data on exposure to smoking, morbidity, and mortality were included.
RESULTS: GrimAge is significantly increased by having two smoking parents, smoking in youth, and cigarette pack years in adulthood. PhenoAge and DunedinPoAm38 are associated with pack years. All three mediate some of the effect of pack years on cancer, high blood pressure, heart disease, and mortality and GrimAge and DunedinPoAm38 mediate this association on lung disease.
CONCLUSIONS: Results suggest epigenetic aging is one biological mechanism linking lifetime exposure to smoking with development of disease and earlier death in later life. Interventions aimed at reducing smoking in adulthood may be effective at weakening this association.
%B Clinical Epigenetics %V 14 %P 72 %G eng %N 1 %R 10.1186/s13148-022-01286-8 %0 Journal Article %J Methods %D 2022 %T Linear linking for related traits (LLRT): A novel method for the harmonization of cognitive domains with no or few common items. %A Nichols, Emma L %A Cadar, Dorina %A Lee, Jinkook %A Richard N Jones %A Gross, Alden L %K Cognition %K HCAP %K Research Design %XHarmonization means to make data comparable. Recent efforts to generate comparable data on cognitive performance of older adults from many different countries around the world have presented challenges for direct comparison. Neuropsychological instruments vary in many respects, including language, administration techniques and cultural differences, which all present important obstacles to assumptions regarding the presence of linking items. Item response theory (IRT) methods have been previously used to harmonize cross-national data on cognition, but these methods rely on linking items to establish the shared metric. We introduce an alternative approach for linking cognitive performance across two (or more) groups when the fielded assessments contain no items that can be reasonably considered linking items: Linear Linking for Related Traits (LLRT). We demonstrate this methodological approach in a sample from a single United States study split by educational attainment, and in two sets of cross-national comparisons (United States to England, and United States to India). All data were collected as part of the Harmonized Cognitive Assessment Protocol (HCAP) and are publicly available. Our method relies upon strong assumptions, and we offer suggestions for how the method can be extended to relax those assumptions in future work.
%B Methods %V 204 %P 179-188 %G eng %R 10.1016/j.ymeth.2021.11.011 %0 Journal Article %J Brain, Behavior, & Immunity - Health %D 2022 %T Links between inflammation and immune functioning with cognitive status among older Americans in the Health and Retirement Study. %A Farina, Mateo P %A Jung K Kim %A Hayward, Mark D %A Eileen M. Crimmins %K Biomarkers %K Dementia %K immune functioning %K Inflammation %XElevated inflammation and poor immune functioning are tied to worse cognitive health. Both processes are fundamental to aging and are strongly implicated in the development of age-related health outcomes, including cognitive status. However, results from prior studies evaluating links between indicators of inflammation and immune function and cognitive impairment have been inconsistent due to biomarker selection, sample selection, and cognitive outcome. Using the Health and Retirement Study (HRS), a nationally representative study of older adults in the United States, we assessed how indicators of inflammation (neutrophil-lymphocyte ratio (NLR), albumin, CRP, IL6, IL10, IL-1Ra, sTNFR1, and TGFβ1) and immune functioning (CMV, CD4 T/T and CD8 T/T) are associated with cognitive status. First, to examine the association between each biomarker and cognitive status, we tested whether markers of inflammation and immune functioning varied across cognitive status categories. We found that dementia and cognitive impairment without dementia (CIND) were associated with elevated inflammation and poorer immune functioning across biomarkers except for CD4 T/T. Next, we estimated multinomial logistic regression models to assess which biomarkers would continue to be associated with dementia and CIND, net of each other. In these models, albumin, cytokines, CMV, CD4 T/T and CD8 T/T are associated with cognitive status. Because poor immune functioning and increased inflammation are associated with cognitive impairment, improving immune functioning and reducing inflammation may provide a mechanism for reducing ADRD risk in the population.
%B Brain, Behavior, & Immunity - Health %V 26 %P 100559 %G eng %R 10.1016/j.bbih.2022.100559 %0 Journal Article %J Journal of Psychosomatic Research %D 2022 %T Loneliness and functional limitations among older adults with diabetes: Comparing directional models. %A Corno, Daniela %A Burns, Rachel J %K Diabetes %K Functional limitations %K Loneliness %K Model comparison %XOBJECTIVE: Middle-aged and older adults with diabetes are at increased risk for loneliness and functional limitations. Cross-sectional and longitudinal associations between loneliness and functional limitations have been demonstrated among the general population, but have not been established among those with diabetes. The purpose of this study was to directly compare the following models describing the direction of the association between loneliness and functional limitations among people with diabetes: (1) loneliness leads to functional limitations, (2) functional limitations lead to loneliness, and (3) a bidirectional association between loneliness and functional limitations.
METHODS: Data came from the Health and Retirement Study. Participants were middle-aged and older individuals with diabetes in the United States (n = 2934). Loneliness and functional limitations were measured at baseline, 4-year follow-up, and 8-year follow-up. Path models for each of the three models, as well as a stability model, were created. Model fit was compared using Akaike's Information Criteria (AIC).
RESULTS: Participants were 54.6% female, 74.98% White, had a mean age of 69.66 years, had an average of 1.48 comorbid chronic conditions, and had diabetes for an average of 10.40 years. The bidirectional model best fit the data as evidenced by the lowest AIC value (AIC = 171,162.81). ∆AIC between the bidirectional model and the next best fitting model was 16.19, indicating strong support for selecting the bidirectional model. Higher levels of loneliness were associated with subsequent higher levels of functional limitations at some time points (βs = 0.07, 0.02) and higher levels of functional limitations were associated with subsequent higher levels of loneliness (βs = 0.13, 0.06) at all time points.
CONCLUSION: Results suggest that the association between loneliness and functional limitations among individuals with diabetes is bidirectional. This study demonstrates the value of directly comparing directional models.
%B Journal of Psychosomatic Research %V 154 %P 110740 %G eng %R 10.1016/j.jpsychores.2022.110740 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2022 %T Lonely older adults are more likely to delay or avoid medical care during the coronavirus disease 2019 pandemic. %A Li, Yue %A Cheng, Zijing %A Cai, Xueya %A Holloway, Melissa %A Maeng, Daniel %A Simning, Adam %K Aged %K COVID-19 %K Humans %K Independent Living %K Loneliness %K Pandemics %K SARS-CoV-2 %XOBJECTIVES: To examine the relationship between loneliness and self-reported delay or avoidance of medical care among community-dwelling older adults during the coronavirus disease 2019 (COVID-19) pandemic.
METHODS: Analyses of data from a nationally representative survey administered in June of 2020, in COVID-19 module of the Health and Retirement Study. Bivariate and multivariable analyses determined associations of loneliness with the likelihood of, reasons for, and types of care delay or avoidance.
RESULTS: The rate of care delay or avoidance since March of 2020 was 29.1% among all respondents (n = 1997), and 10.1% higher for lonely (n = 1,150%, 57.6%) versus non-lonely respondents (33.5% vs. 23.4%; odds ratio = 1.59, p = 0.003 after covariate adjustment). The differences were considerably larger among several subgroups such as those with emotional/psychiatric problems. Lonely older adults were more likely to cite "Decided it could wait," "Was afraid to go," and "Couldn't afford it" as reasons for delayed or avoided care. Both groups reported dental care and doctor's visit as the two most common care delayed or avoided.
CONCLUSIONS: Loneliness is associated with a higher likelihood of delaying or avoiding medical care among older adults during the pandemic.
%B International Journal of Geriatric Psychiatry %V 37 %G eng %N 3 %R 10.1002/gps.5694 %0 Journal Article %J Journal of Affective Disorders %D 2022 %T Longitudinal association between depressive symptoms and cognitive decline among middle-aged and elderly population. %A Huang, Wentao %A Zhu, Wenjing %A Chen, Hongyan %A Li, Feng %A Huang, Jingxin %A Zhou, Ye %A Sun, Xibin %A Lan, Yutao %K Cognitive decline %K Depressive symptoms %K Latent growth curve modeling %K Longitudinal association %XBACKGROUND: Depression is considered a risk factor for cognitive decline. The long-term impact of depressive symptoms on cognitive performance has not been established thus far.
OBJECTIVES: This study aimed to determine the longitudinal associations between depressive symptoms and cognitive performance among middle-aged and elderly population.
METHODS: We included 10,387 adults aged ≥45 years from the Health and Retirement Study (2004 to 2014) in this study. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CESD) scale. Participant's cognitive function was assessed via the telephone interview for cognitive status (TICS); the total cognitive score ranged from 0 to 35. We classified the participants into four clusters according to the quartile of the total cognitive score (TCS). We examined the change of depressive symptoms and cognitive performance by using the unconditional latent growth curve modeling (LGCM) method, and a parallel LGCM method was used to examine the longitudinal associations between depressive symptoms and cognitive performance among middle-aged and elderly adults in each cluster.
RESULTS: Participants with lower levels of cognitive performance were associated with a greater risk of high depressive symptoms. Results from unconditional LGCM showed a sustained decline in cognitive performance and an increasing trend in depressive symptoms per 2 years for each cluster of participants. The parallel LGCM indicated that baseline levels of depression showed a significant negative correlation with the cognitive performance at baseline (β [95% CI] of intercept predicting intercept were -0.33 [-0.41, -0.26], -0.03[-0.06, -0.00], -0.05 [-0.07, -0.02] and -0.64 [-0.70,-0.58], for clusters of Q1 to Q3 and the entire population, respectively). Further, a significant positive prospective association was observed between baseline levels of depression and changes in cognitive performance (intercept predicting slope were -0.05 [-0.08, -0.02], -0.09[-0.13, -0.05], -0.12 [-0.15, -0.08], -0.11 [-0.15, -0.06] and -0.04 [-0.06,-0.02] for clusters of Q1 to Q4 and the entire population, respectively). Moreover, for participants with the highest quartile of TCS, the rising trend of depressive symptoms accelerated the decline of cognitive performance during the follow-up period (Slope predicting Slope: -0.44 [-0.86, -0.01]).
CONCLUSION: Our results suggest that depressive symptoms were associated with lower cognitive performance and larger subsequent decline during follow-up period. Adults with depression may require more medical attention, and early intervention is required to delay the development of cognitive impairment and dementia.
%B Journal of Affective Disorders %V 303 %P 18-23 %G eng %R 10.1016/j.jad.2022.01.107 %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 %XOBJECTIVE: 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 Journal of Aging and Health %D 2022 %T A Longitudinal Examination of the Association Between Loss of Control and Loneliness Among Older Adults Diagnosed with Cancer. %A Morris, Zachary %A Malik, Sana %A Burke, Shanna %A Grudzien, Adrienne %A Cadet, Tamara %K Cancer %K Disability %K Loneliness %K Mental Health %K Social work %XThe objective of this paper is to examine whether feeling a loss of control over one's life is associated with an increased risk for loneliness among those diagnosed with cancer. We draw on data from the Health and Retirement Study to identify three baseline and follow-up cohorts of cancer survivors age 50 and older. Ordinary least squared regression is used to examine predictors for future loneliness. Upon adjusting for other known predictors of loneliness, feelings of loss of control was significantly predictive of loneliness among 4-year cancer survivors. Social workers and other health care practitioners should seek to provide evidence-based interventions to reduce the risk for loneliness for cancer survivors feeling a loss of control.
%B Journal of Aging and Health %V 34 %P 1092-1100 %G eng %N 6-8 %R 10.1177/08982643221092735 %0 Journal Article %J Journal of Hospital Medicine %D 2022 %T Long-term functional outcomes and mortality after hospitalization for extracranial hemorrhage %A Parks, Anna L. %A Jeon, Sun Y. %A Boscardin, W. John %A Steinman, Michael A. %A Smith, Alexander K. %A Covinsky, Kenneth E. %A Fang, Margaret C. %A Shah, Sachin J. %K extracranial hemorrhage %K functional independence %K Hospitalization %K Mortality %K Survival %X Background The effects of extracranial hemorrhage (ECH), or bleeding outside the brain, are often considered transient. Yet, there are few data on the long-term and functional consequences of ECH. Objective Define the association of ECH hospitalization with functional independence and survival in a nationally representative cohort of older adults. Design Longitudinal cohort study. Settings and Participants Data from the Health and Retirement Study from 1995 to 2016, a nationally representative, biennial survey of older adults. Adults aged 66 and above with Medicare linkage and at least 12 months of continuous Medicare Part A and B enrollment. Intervention Hospitalization for ECH. Main Outcomes and Measures Adjusted odds ratios and predicted likelihood of independence in all activities of daily living (ADLs), independence in all instrumental activities of daily living (IADLs) and extended nursing home stay. Adjusted hazard ratio and predicted likelihood for survival. Results In a cohort of 6719 subjects (mean age 77, 59% women) with average follow-up time of 8.3 years (55,767 person-years), 736 (11%) were hospitalized for ECH. ECH was associated with a 15% increase in ADL disability, 15% increase in IADL disability, 8% increase in nursing home stays, and 4% increase in mortality. After ECH, subjects became disabled and died at the same annual rate as pre-ECH but never recovered to pre-ECH levels of function. In conclusion, hospitalization for ECH was associated with significant and durable declines in independence and survival. Clinical and research efforts should incorporate the long-term harms of ECH into decision-making and strategies to mitigate these effects. %B Journal of Hospital Medicine %V 17 %P 235-242 %G eng %N 4 %R 10.1002/jhm.12799 %0 Journal Article %J The Journal of Clinical Endocrinology & Metabolism %D 2022 %T Long-term weight change and its temporal relation to later-life dementia in the Health and Retirement Study. %A Shen, Jie %A Chen, Hui %A Zhou, Tianjing %A Zhang, Simei %A Huang, Liyan %A Lv, Xiaozhen %A Ma, Yuan %A Zheng, Yan %A Yuan, Changzheng %K Dementia %K physical frailty %K prospective cohort %K Weight Change %XBACKGROUND: Weight loss among middle and older adults has been associated with a higher risk of subsequent dementia. However, most of studies have limited follow-up time or suboptimal control for the potential influence of physical frailty (PF).
OBJECTIVES: Our study aimed to investigate the long-term and temporal relation of weight change to risk of dementia among U.S. middle-aged and older adults.
METHODS: A total of 5985 participants aged 50 years and older were included from the Health and Retirement Study (HRS). History of long-term weight change was calculated using nine repeated BMI measurements from 1992-2008. We then followed their dementia status from 2008 to 2018. Multivariable cox proportional hazard models were used.
RESULTS: During the study follow-up (mean = 7.54 years), a total of 682 (11.39%) dementia cases were documented. After controlling for basic demographic and lifestyle, participants with weight loss (median: -0.23 kg/m 2 per year) were at a significantly higher risk of dementia (HR = 1.60, 95% CI, 1.33, 1.92), compared with the stable-weight group (median: 0.11 kg/m 2 per year). This association was attenuated but remained strong and significant after further adjustment for PF (HR = 1.57, 95% CI, 1.30, 1.89). The significant association was observed for weight loss assessed approximately 14-18 years preceding dementia diagnosis (HR = 1.30, 95% CI, 1.07, 1.58), and was consistent for that closer to diagnosis.
CONCLUSIONS: Both recent and remote weight loss were associated with a higher risk of later-life dementia among middle-aged and older adults independent of the status of physical frailty.
%B The Journal of Clinical Endocrinology & Metabolism %V 107 %P e2710-e2716 %G eng %N 7 %R 10.1210/clinem/dgac229 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T A Matched Cohort Analysis for Examining the Association Between Slow Gait Speed and Shortened Longevity in Older Americans %A McGrath, Brenda M %A Johnson, Pamela Jo %A McGrath, Ryan %A Cawthon, Peggy M %A Klawitter, Lukus %A Choi, Bong-Jin %K Aging %K Epidemiology %K Geriatric Assessment %K Physical Functional Performance %K walk test %XThis investigation examined the association between slow gait speed, as defined with newly established cut-points, and all-cause mortality in older Americans with a matched cohort analysis. The analytic sample included 10,259 Americans aged ≥65 years from the 2006-2014 waves of the Health and Retirement Study. Walking speed was measured in participant residences. Slow gait speed cut-points of <0.60 and <0.75 m/s were used separately for classifying participants as having slow walking speed. Nearest-neighbor propensity score matching was used to match the slow to the not-slow cohorts separately using both cut-points using relevant covariates. Persons with gait speed <0.60 m/s had a 1.42 higher hazard for mortality (95% CI: 1.28-1.57). Older Americans with gait speed <0.75 m/s had a 1.36 higher hazard for mortality (95% CI: 1.23-1.50). Slow gait speed may represent failing health and addressing how slow gait speed could be improved may help with referrals to appropriate interventions.
%B Journal of Applied Gerontology %V 41 %P 1905-1913 %G eng %N 8 %R 10.1177/07334648221092399 %0 Report %D 2022 %T Measuring Valuation of Liquidity with Penalized Withdrawals %A Coyne, David %A Fadlon, Itzik %A Porzio, Tommaso %K Great Recession %K Liquidity %K penalized withdrawals %X We propose using penalized withdrawals from retirement savings accounts, identified from U.S. tax records, as a revealed-preference tool to characterize households' valuation of liquidity. A simple dynamic model formalizes the notion that the prevalence of withdrawals can be used to characterize American households' valuation of liquidity over time and space. We find pervasive evidence of high valuation of liquidity, hence that shocks are imperfectly insured. Declines in households' income lead to sudden, large, and persistent jumps in the probability of penalized withdrawals. Both local economic conditions and persistent household characteristics play an important role, with the average valuation of liquidity being higher in financially underdeveloped areas as well as in black communities which are plausibly marginalized from the credit market. Finally, applying our tool to the Great Recession, we find that more affected areas saw larger increases in penalized withdrawals, plausibly driven by tightening of local credit conditions. Our analysis offers a new tool to study the valuation of liquidity and our results point to sizable welfare gains from social insurance policies targeted at both households and locations over time. %B NBER Working Paper %I National Bureau of Economic Research %G eng %R 10.3386/w30007 %0 Journal Article %J Reviews in Endocrine and Metabolic Disorders %D 2022 %T Mortality and morbidity in ageing men: Biology, Lifestyle and Environment. %A Zhao, Erfei %A Eileen M. Crimmins %K Cholesterol %K Diabetes %K Epigenetic aging %K gender %K Heart disease %K Hypertension %K Life Expectancy %K sex %K Stroke %XMales live shorter lives than women in all countries. The universality of shorter male life expectancy is a 21st Century phenomena. It occurs with the decline in infectious diseases and the rise in cardiovascular diseases accounting for mortality. Male/female differences in morbidity are not as succinctly characterized. Men have a higher prevalence of lethal diseases, which is linked to their lower life expectancy. Women have more non-lethal conditions such as depression and arthritis; which may also be linked in part to longer survival. Men have better physical functioning and less disability which is partly explained by gender differences in diseases and also by their greater strength, size, and stamina. Gender differences in risk factors for disease have changed over time with the prevalence and treatment of risk as well as differential behavior by gender. Examination of what are seen as basic molecular and cellular measures related to aging indicates men age faster than women; however, even these basic biological measures result from a combination of biology, behavior, and social factors.
%B Reviews in Endocrine and Metabolic Disorders %V 23 %P 1285-1304 %G eng %N 6 %R 10.1007/s11154-022-09737-6 %0 Journal Article %J Housing and Society %D 2022 %T Mortgage delinquency, foreclosure, and cognition in later life %A Gillian L Marshall %A Sarah L. Canham %A Eva Kahana %A Eric B Larson %K Cognition %K Foreclosure %K mortgage delinquency %K Stress %X The rapid growth in housing insecurity among older adults is a major public health concern. While there is evidence that stress contributes to poor health, the relationship between housing-related financial stressors and cognitive functioning is relatively unknown. We investigated the association between the personal experiences of mortgage delinquency and foreclosure and cognition and its sub-components of episodic memory and mental status among Americans age 65 years and older. Using the data from two concatenated waves (2010, 2012) of the Health and Retirement Study, we analyzed data for respondents (N = 6,612) across both waves using generalized linear regressions. Our findings suggest that there is a negative association between mortgage delinquency/foreclosure and cognitive scores. Further, we found a negative association between mortgage delinquency and mental status among women, specifically. These results highlight the importance of financial well-being vis-à-vis housing stability and its significance to mental well-being and cognition of adults in later life. Future research is needed to identify macro-level stressors such as mortgage delinquency and/or foreclosure. Such information would improve strategies for prevention and intervention particularly for older adults living on fixed incomes who have little opportunity to earn pre-retirement levels of income. %B Housing and Society %V 49 %P 113-127 %G eng %N 2 %R https://doi.org/10.1080/08882746.2021.2006548 %0 Journal Article %J Journal of Health and Social Behavior %D 2022 %T Multiple Family Member Deaths and Cardiometabolic Health among Black and White Older Adults. %A Donnelly, Rachel %A Cha, Hyungmin %A Umberson, Debra %K Bereavement %K cardiometabolic health %K race %K racial disadvantage %K Stress %XAlthough the bereavement literature is voluminous, we know very little about how exposure to multiple family member deaths across the life course shapes health trajectories as people age and whether unequal exposure to bereavement contributes to racial inequities in cardiometabolic health. We use longitudinal data from the Health and Retirement Study (1992-2016) to consider how multiple family member deaths before midlife shape trajectories of cardiometabolic health after age 50 for Black and white adults (n = 22,974). Results show that multiple family member deaths prior to age 50 are associated with more cardiometabolic conditions at age 50 and a faster increase in conditions with advancing age. Moreover, Black adults are significantly disadvantaged by a greater risk of bereavement and more cardiometabolic conditions regardless of bereavement status. The life course trauma of exposure to multiple family member deaths uniquely contributes to the cardiometabolic risk of Black Americans.
%B Journal of Health and Social Behavior %G eng %R 10.1177/00221465221114485 %0 Journal Article %J The Journals of Gerontology: Series A %D 2022 %T Multiple Reasons for Perceived Everyday Discrimination and All-Cause Mortality Risk Among Older Black Adults. %A Ryon J. Cobb %A Connor M Sheehan %A Louie, Patricia %A Christy L Erving %K Aging %K Black Americans %K Discrimination %K Mortality %XBACKGROUND: The present study assessed whether reporting multiple reasons for perceived everyday discrimination was associated with an increased risk for all-cause mortality risk among older Black adults.
METHODS: This study utilized data from a subsample of older Black adults from the Health and Retirement Study (HRS), a nationally representative panel study of older adults in the United States. Our measure of multiple reasons for perceived everyday discrimination was based on self-reports from the 2006/2008 HRS waves. Respondents' vital status was obtained from the National Death Index and reports from key household informants (spanning 2006-2019). Cox proportional hazard models, which accounted for covariates linked to mortality, were used to estimate the risk of all-cause mortality.
RESULTS: During the observation period, 563 deaths occurred. Twenty percent of Black adults attributed perceived everyday discrimination to three or more sources. In demographic adjusted models, attributing perceived everyday discrimination to three or more sources was a statistically significant predictor of all-cause mortality risk (hazard ratio= 1.45; 95%, confidence interval=1.12 - 1.87). The association remained significant (hazard ratio=1.49, 95%, confidence interval=1.15 - 1.93) after further adjustments for health, behavioral, and economic characteristics.
CONCLUSION: Examining how multiple reasons for perceived everyday discrimination relate to all-cause mortality risk has considerable utility in clarifying the unique contributions of perceived discrimination to mortality risk among older Black adults. Our findings suggest that multiple reasons for perceived everyday discrimination are a particularly salient risk factor for mortality among older Black adults.
%B The Journals of Gerontology: Series A %V 77 %P 310-314 %G eng %N 2 %R 10.1093/gerona/glab281 %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 %XChronic 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 The Journal of the Economics of Ageing %D 2022 %T Next to Kin: How Children Influence the Residential Mobility Decisions of Older Adults %A Jaclene Begley %A Sewin Chan %K Aging %K children %K Housing %K mobility %K Parents %K Proximity %X This paper explores the residential mobility of older adults, with a focus on the influence of distance to children on those decisions. Using the geocoded Health and Retirement Study, we statistically estimate the importance of adult child proximity on older adult moves after controlling for a host of other factors. We find that having adult children nearby is associated with a lower propensity to move, with closer proximity generally having a stronger negative relationship, up to a distance of 50 miles. These results are more pronounced if we define mobility as having moved at least 30 miles, or across metropolitan areas. We also show that the relationship is stronger for those with care needs, and for renters compared with homeowners. Results for the baby boomer cohort suggest that the proximity of children continues to have an important influence on older adult mobility among more recent cohorts of older adults. %B The Journal of the Economics of Ageing %V 23 %P 100394 %G eng %R https://doi.org/10.1016/j.jeoa.2022.100394 %0 Journal Article %J Journal of General Internal Medicine %D 2022 %T Observational study of patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment without dementia. %A White, Lindsay %A Ingraham, Bailey %A Eric B Larson %A Fishman, Paul %A Park, Sungchul %A Norma B Coe %K cognitive impairment %K Dementia %K Diagnosis %K Disparities %XBACKGROUND: Timely diagnosis of cognitive impairment is a key goal of the National Plan to Address Alzheimer's Disease, but studies of factors associated with a timely diagnosis are limited.
OBJECTIVE: To identify patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment (MCI).
DESIGN: Retrospective observational study using survey data from the Health and Retirement Study (HRS) from 1995-2016 (interview waves 3-13).
PARTICIPANTS: 4,760 respondents with incident dementia and 1,864 with incident MCI identified using longitudinal measures of cognitive functioning.
MAIN MEASURES: Timely or delayed diagnosis based on the timing of a self or proxy report of a healthcare provider diagnosis in relation to respondents first dementia or MCI-qualifying cognitive score, sociodemographic characteristics, health status, health care utilization, insurance provider, and year of first qualifying score.
KEY RESULTS: Only 26.0% of the 4,760 respondents with incident dementia and 11.4% of the 1,864 respondents with incident MCI received a timely diagnosis. Non-Hispanic Black respondents and respondents with less than a college degree were significantly less likely to receive a timely diagnosis of either dementia or MCI than Non-Hispanic White respondents (dementia odds ratio (OR): 0.61, 95% CI: 0.50, 0.75; MCI OR: 0.40, 95% CI: 0.23, 0.70) and those with a college degree (dementia OR for less than high school degree: 0.30, 95% CI: 0.23, 0.38; MCI OR: 0.36, 95% CI: 0.22, 0.60). Respondents that lived alone were also less likely to receive a timely diagnosis of dementia (OR: 0.69, 95% CI: 0.59, 0.81), though not MCI. Timely diagnosis of both conditions increased over time.
CONCLUSIONS: Targeting resources for timely diagnosis of cognitive impairment to individuals from racial and ethnic minorities, lower educational attainment, and living alone may improve detection and reduce disparities around timely diagnosis of dementia and MCI.
%B Journal of General Internal Medicine %V 37 %P 2957-2965 %G eng %N 12 %R https://doi.org/10.1007/s11606-021-07169-7 %0 Journal Article %J Neurology %D 2022 %T Offspring Sex and Parental Cognition in Mid-life and Older Adulthood (P1-3.004) %A Wolfova, Katrin %A Wu, Di %A Weiss, Jordan %A Cermakova, Pavla %A Kohler, Hans-Peter %A Skirbekk, Vegard Fykse %A Stern, Yaakov %A Gemmill, Alison %A Tom, Sarah %K Cognition %K Cognitive decline %K offspring sex %K Parents %X Objective: We aim to examine the relationship between offspring sex and parental baseline level of cognition and rate of cognitive decline in older adults.Background: Studies suggest a link between offspring sex and maternal long-term health outcomes, including dementia. One of the proposed explanations is male microchimerism of foetal origin. We hypothesize that mothers of at least 1 boy would have better cognition than mothers with no boys, and there would be no differences in fathers.Design/Methods: We analysed a cohort of 13,777 adults age >= 50 years from the US Health and Retirement Study. Offspring sex was classified as no boy vs. at least 1 boy in primary analysis and as number of boys (0 boys, 1 boy, 2 boys, 3 or more boys) and number of girls (0 girls, 1 girl, 2 girls, 3 or more girls) in secondary analysis. Cognition was assessed using a sum of scores from immediate and delayed 10-noun free recall tests, a serial 7s subtraction test, and a backwards counting test. Associations were evaluated using linear mixed-effects models, adjusting for 1) baseline age, sex, ethnicity, parity; 2) socioeconomic factors; and 3) health-related factors and marital status.Results: A total of 17.7% of respondents had no boy and 60.1% of respondents were female. Stratifying on parental sex, mothers and fathers of at least 1 boy had a significantly higher baseline cognition in comparison to those with no boy. Associations were attenuated in adjusted models. In secondary analysis, having 3 or more boys was associated with higher baseline cognition in fathers, there were no differences in mothers. We found a significant association of cognitive decline with number of boys, but not with number of girls.Conclusions: Offspring sex was associated with cognitive aging among both mothers and fathers, suggesting interplay of biological and social influences.Disclosure: Dr. Wolfova has nothing to disclose. Mr. Wu has nothing to disclose. Mr. Kohler has nothing to disclose. Prof. Skirbekk has nothing to disclose. Dr. Stern has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Stern has received intellectual property interests from a discovery or technology relating to health care. Dr. Stern has received publishing royalties from a publication relating to health care. Prof. Gemmill has received research support from National Institutes of Health and the Robert Wood Johnson Foundation. Prof. Gemmill has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with World Health Organization. The institution of Sarah Tom has received research support from National Institutes of Health . Sarah Tom has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Alzheimer’s Association . %B Neurology %V 98 %P 970 %G eng %U https://n.neurology.org/content/98/18_Supplement/970 %N 18 Supplement %0 Journal Article %J Journal of Family and Economic Issues %D 2022 %T Older Adults’ Relationship Trajectories and Estate Planning %A Choi, Shinae L %A Carr, Deborah %K Cohabitation %K Divorce %K estate planning %K Marital Status %K Singlehood %K Wealth Widowhood %X This study investigated whether romantic relationship trajectories in later life are associated with estate planning (i.e., having a will or trust), and how these associations differ by gender among older U.S. adults. We considered 11 relationship trajectory categories which reflect stability and change in one’s partnership status (i.e., never married, cohabiting, married, divorced/separated, or widowed) over a six-year observation period. Analyses were based on longitudinal data from the 2010–2016 Health and Retirement Study (N = 14,032). Multivariable logistic regression models predicting estate planning were adjusted for wealth, health, and sociodemographic characteristics. In fully adjusted models, married persons at baseline who became widowed during the study period had significantly higher odds of estate planning relative to continuously married persons, whereas never married and continuously divorced persons had significantly lower odds. Moderation analyses revealed that the effects of becoming widowed and of being divorced were significantly larger for women than men. Never married men and women were about half as likely as their continuously married counterparts to do estate planning. Financial literacy and legal assistance programs should target older adults whose relationship trajectories diverge from the historical norm of one long-term marriage or widowhood following a long-term marriage. Divorce, cohabitation, and lifelong singlehood are increasingly common relationship statuses among older adults, yet these statuses may undermine access to or use of legal instruments that can be critical to the financial stability of their families in the longer term. %B Journal of Family and Economic Issues %G eng %R 10.1007/s10834-022-09839-y %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 %XAlthough 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 Journal of the American Geriatrics Society %D 2022 %T Out-of-pocket costs attributable to dementia: A longitudinal analysis. %A Oney, Melissa %A White, Lindsay %A Norma B Coe %K Dementia %K Long-term services and supports %K out-of-pocket costs %XBACKGROUND: Alzheimer's disease and related dementias (ADRD) affect 5.7 million Americans, and are expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, even though one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare.
METHODS: In this paper, we use survey data for 2002-2016 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after the onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization.
RESULTS: We identified a cohort of 3619 incident dementia cases, 38.9% were male, and 66.9% were non-Hispanic White. Dementia onset was 77.7 years of age, on average. OOP costs attributable to dementia are $8751 over the first 8 years after the onset. These incremental costs are driven by nursing home expenditures, which are largely uninsured in the US. OOP spending is highest for whites and women.
CONCLUSION: The financial burden of ADRD is significant, and largely attributable to the lack of wide-spread long-term care insurance.
%B Journal of the American Geriatrics Society %V 70 %P 1538-1545 %G eng %N 5 %R 10.1111/jgs.17746 %0 Journal Article %J Journal of Pain and Symptom Management %D 2022 %T Pain and the Alzheimer's Disease and Related Dementia Spectrum in Community-Dwelling Older Americans: A Nationally Representative Study. %A Wang, Jinjiao %A Cheng, Zijing %A Kim, Yeunkyung %A Yu, Fang %A Heffner, Kathi L %A Quiñones-Cordero, Maria M %A Li, Yue %K Alzheimer %K Dementia %K pain %K Pain Management %XCONTEXT: Pain is a significant concern among older adults with Alzheimer's disease and related dementias (ADRD).
OBJECTIVES: Examine the association between cognitive impairment across the ADRD spectrum and pain assessment and treatment in community-dwelling older Americans.
METHODS: This cross-sectional, population-based study included 16,836 community-dwelling participants ≥ 50 years in the 2018 Health and Retirement Study. ADRD, assessed by validated cognitive measures, was categorized into "dementia," "cognitive impairment, no dementia (CIND)" and "intact cognition." Pain assessment included pain presence (often being troubled with pain), pain severity (degree of pain most of the time [mild/moderate/severe]), and pain interference (pain making it difficult to do usual activities). Pain treatment included recent use of over-the-counter pain medications and opioids (past 3 months), and regular intake of prescriptions for pain.
RESULTS: Dementia were associated with lower likelihood of reporting pain presence (Odds Ratio [OR]= 0.61, P = 0.01), pain interference (OR = 0.46, P < 0.001), reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.38, P < 0.001), and lower likelihood of receiving pain treatment, that is, recent use of over-the-counter pain medications (OR = 0.60, P = 0.02) and opioids (OR = 0.33, P < 0.001), and regular intake of prescriptions for pain (OR = 0.461, P = 0.002). CIND was associated with reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.75, P = 0.021), lower likelihood of reporting pain interference (OR = 0.79, P = 0.045) and recent over-the-counter pain medication use (OR = 0.74, P = 0.026).
CONCLUSION: CIND and dementia increased the risk of under-report and under-treatment of pain. Systematic efforts are needed to improve pain recognition and treatment among older adults with cognitive impairment, regardless of dementia diagnosis.
%B Journal of Pain and Symptom Management %V 63 %P 654-664 %G eng %N 5 %R 10.1016/j.jpainsymman.2022.01.012 %0 Journal Article %J Computers in Human Behavior %D 2022 %T Partner influences on ICT use variety among middle-aged and older adults: The role of need for cognition %A William J. Chopik %A Jess Francis %K actor-partner interdependence model %K Cognition %K Dyadic influence %K Unified theory of acceptance and use of technology %X This exploratory study examined individual and dyadic predictors of variety of ICT use. Need for cognition is associated with engaging in a variety of intellectually stimulating practices and a prominent individual difference predictor of the types of ICTs people use. Participants were a subset of 542 heterosexual couples (N = 1084 individuals; 50% women; Mage = 63.65; 83.9% Caucasian) from the Health and Retirement Study with access to the internet. Individuals high in need for cognition were more likely to use ICTs for a variety of reasons. Being married to someone high in need for cognition was associated with a greater variety of ICT ownership, use of ICTs for financial/transactional activities, and use of ICTs for miscellaneous reasons (e.g., research), although these effects were relatively small and the evidence for partner effects was relatively weak according to the distribution of p-values. Partner effects were not significant for social technology or internet-enabling ICTs; cross-partner interactions provided suggestive evidence for compensatory partner effects of need for cognition. Findings are discussed with respect to the relational and contextual determinants of ICT use in older adulthood. %B Computers in Human Behavior %V 126 %P 107028 %G eng %R 10.1016/j.chb.2021.107028 %0 Journal Article %J The Journal of the Economics of Ageing %D 2022 %T Pathways to Retirement Among Dual Earning Couples %A Carman, Katherine %A Edwards, Kathryn A. %A Brown, Kristine M %K Employment %K financial decision making %K Households %K Retirement %K retirement benefits %K Unemployment %X Research indicates significant roles for gradual transitions to full retirement and for coordination between spouses in the typical retirement experience. However, there is little research exploring the potentially important interactions between the two. This paper addresses this gap in the literature and provides a more robust understanding of retirement behavior by examining the transition from full-time work to fully retired among dual earning couples, which we call joint retirement trajectories. We analyze 12 waves of the Health and Retirement Study to map out the distribution of potential pathways that couples undertake when retiring. We aimed to present the fullest picture possible of joint retirement trajectories under the hypothesis that if there were a common, dominant, or typical path, it would emerge. Instead, the consistent finding is variation across couples in the length, sequence, leader, concordance, and labor supply in the move from full-time work to fully retired. Using simple heuristics to classify joint retirement trajectories allows us to gain perspective in the rarity of full simultaneous retirement and motivates future research into the joint use of partial retirement by couples. %B The Journal of the Economics of Ageing %V 22 %G eng %R 10.1016/j.jeoa.2022.100384 %0 Journal Article %J Social Science & Medicine %D 2022 %T Patterns in older adults' perceived chronic stressor types and cognitive functioning trajectories: Are perceived chronic stressors always bad? %A Kun Wang %A Alexander R. Marbut %A Zainab Suntai %A Dianhan Zheng %A Xiayu Chen %K Challenge-hindrance perspective %K cognitive functioning %K Egocentric stressor %K Nonegocentric stressor %X Purpose Previous studies have linked levels of perceived chronic stress to older adults' cognitive functioning, but few have focused on the impact of chronic stressor types. Thus, this study aimed to (1) identify patterns of chronic stressor types and (2) examine the effects of these patterns on cognitive functioning trajectories among older adults. Methods Two longitudinal studies were conducted separately to test the study aims and ensure replicability across samples and time points. Both used three timepoints (Study 1: 2006, 2008, and 2010, n = 6974; Study 2: 2012, 2014, and 2016, n = 6604) collected from older Americans in the Health and Retirement Study. Participants did not overlap between the two studies. Latent class analyses were conducted to identify chronic stressor-type patterns. Latent growth curve models were used to test the effects of chronic stressor-type patterns on cognitive functioning trajectories. Results Three latent classes of stressor types were identified in both studies: egocentric (4.56%; 5.85%), nonegocentric (8.58%; 10.03%), and low stressor (86.86%; 84.12%). In both studies, compared to the low stressor class, the egocentric stressor class had significantly lower initial cognitive scores (B = −0.72, ρ < 0.001; B = −0.46, ρ < 0.05), while the nonegocentric stressor class did not have significantly different initial scores, with covariates controlled. Additionally, in Study 1, the nonegocentric stressor class had significantly slower cognitive decline rates than the low stressor class (B = 0.11, ρ < 0.05). Conclusions Findings suggested that nonegocentric stressors are an important stressor source in late adulthood but are less detrimental to cognitive functioning than egocentric stressors. Health management interventions may reduce older adults' cognitive health disparities caused by self-health and financial stressors. More support, including financial subsidies, caregiver stress management training, or support groups, should be provided to older caregivers, especially those with few resources. %B Social Science & Medicine %V 311 %P 115297 %G eng %R https://doi.org/10.1016/j.socscimed.2022.115297 %0 Web Page %D 2022 %T Patterns of depressive symptoms over 16 years with incident dementia %A Cunningham, Scott %K Dementia %K Depressive symptoms %I MDLinx %G eng %U https://www.mdlinx.com/journal-summary/patterns-of-depressive-symptoms-over-16-years-with-incident-dementia/4inBTk4XVl2R8EXPt2iKns %0 Journal Article %J Journal of the American Geriatrics Society %D 2022 %T Perceived dementia risk and advance care planning among older adults. %A Lee, Yu Kyung %A Fried, Terri R %A Costello, Darcé M %A Hajduk, Alexandra M %A O'Leary, John R %A Cohen, Andrew B %K Advance care planning %K Dementia %K Health Literacy %K risk perception %XBACKGROUND: Although advance care planning (ACP) is beneficial if dementia develops, and virtually all older adults are at risk for this disease, older adults do not consistently engage in ACP. Health behavior models have highlighted the importance of perceived susceptibility to medical conditions in motivating behavior. Following these models, we sought to determine how often older adults believe they are not at risk of developing dementia and to examine the association between perceived dementia risk and ACP participation.
METHODS: We performed a cross-sectional study of community-dwelling adults without cognitive impairment, aged ≥65 years, who were interviewed for the Health and Retirement Study in 2016 and asked about their perceived dementia risk (n = 711). Perceived dementia risk was ascertained with this question: "on a scale of 0 to 100, what is the percent chance that you will develop dementia sometime in the future?" We used multivariable-adjusted logistic regression to evaluate the association between perceived risk (0% versus >0%) and completion of a living will, appointment of a durable power of attorney for healthcare decisions, and discussion of treatment preferences.
RESULTS: Among respondents, 10.5% reported a perceived dementia risk of 0%. Perceived risk of 0% was associated with lower odds of completing a living will (OR 0.53; 95% CI, 0.30-0.93) and discussing treatment preferences (OR 0.51; 95% CI, 0.28-0.93) but not appointment of a durable power of attorney (OR 0.77; 95% CI, 0.42-1.39). Many respondents with perceived dementia risk >0% had not completed ACP activities, including a substantial minority of those with perceived risk >50%.
CONCLUSIONS: Older adults with no perceived dementia risk are less likely to participate in several forms of ACP, but the fact that many older adults with high levels of perceived risk had not completed ACP activities suggests that efforts beyond raising risk awareness are needed to increase engagement.
%B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.17721 %0 Journal Article %J Personality and Individual Differences %D 2022 %T Personal control and financial well-being among the elderly: Moderating role of the big five %A Chhatwani, Malvika %K Big Five personality traits %K COVID-19 %K Financial well-being %K Personal control %X The increasing financial worry among retirees is a major concern for the government. To address this concern, we examine the linkage between a sense of personal control and financial well-being among the elderly during COVID-19 using nationally representative data of 934 respondents. Based on personal control theory, we find a positive relationship between personal control and financial well-being. We also investigate whether the big five personality traits moderate the given relationship and find that openness to experience and conscientiousness positively, whereas neuroticism negatively moderates this linkage. The implications for the theory and practice are discussed. %B Personality and Individual Differences %V 184 %P 111171 %@ 0191-8869 %G eng %R 10.1016/j.paid.2021.111171 %0 Journal Article %J Personality and Individual Difference %D 2022 %T Personality and compliance with COVID-19 protective measures among older Americans: Moderating effects of age, gender, and race/ethnicity. %A Choi, Shinae L %A Peter Martin %A Cho, Jinmyoung %A Ryou, Yeon Ji %A Heinz, Melinda %K COVID-19 %K gender %K Personality %K Prevention %K Race/ethnicity %XFollowing the growing evidence that personality is related to various health behaviors, we examined whether personality traits were related to compliance with COVID-19 protective measures and evaluated the extent to which associations were moderated by age, gender, or race/ethnicity among older adults during a summer 2020 surge of COVID-19 cases in the United States. Data were from the 2020 Health and Retirement Study COVID-19 module. Multivariate ordinary least squares regression analyses were computed adjusting for health, psychosocial, and sociodemographic factors. Results indicated the significant associations between personality traits and compliance with COVID-19 measures varied by age, gender, and race/ethnicity. Specifically, the associations of agreeableness with wearing a mask and frequent handwashing were less pronounced among older compared with younger individuals. The association between extraversion and wearing masks was stronger for men than for women. The associations of agreeableness with handwashing and physical distancing were weaker for Hispanic older adults, whereas the associations of extraversion with physical distancing and using sanitizers were stronger for Hispanic older adults than for their non-Hispanic White counterparts. Implications regarding behavioral science underlying the current pandemic and future public health crises are discussed.
%B Personality and Individual Difference %V 189 %P 111499 %G eng %R 10.1016/j.paid.2022.111499 %0 Journal Article %J Scientific Reports %D 2022 %T Personality and fatigue: meta-analysis of seven prospective studies. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Canada, Brice %A Terracciano, Antonio %K Cross-Sectional Studies %K ELSA %K Fatigue %K Personality %K Prospective Studies %XThe present study examined the cross-sectional and longitudinal associations between the five major personality traits and fatigue. Participants were adults aged 16-104 years old (N > 40,000 at baseline) from the Health and Retirement Study, the National Social Life, Health, and Aging Project, the Wisconsin Longitudinal Study graduate and sibling samples, the National Health and Aging Trends Survey, the Longitudinal Internet Studies for the Social Sciences and the English Longitudinal Study of Ageing. Personality traits, fatigue, demographic factors, and other covariates were assessed at baseline, and fatigue was assessed again 5-20 years later. Across all samples, higher neuroticism was related to a higher risk of concurrent (meta-analytic OR = 1.73, 95% CI 1.62-1.86) and incident (OR = 1.38, 95% CI 1.29-1.48) fatigue. Higher extraversion, openness, agreeableness, and conscientiousness were associated with a lower likelihood of concurrent (meta-analytic OR range 0.67-0.86) and incident (meta-analytic OR range 0.80-0.92) fatigue. Self-rated health and physical inactivity partially accounted for these associations. There was little evidence that age or gender moderated these associations. This study provides consistent evidence that personality is related to fatigue. Higher neuroticism and lower extraversion, openness, agreeableness, and conscientiousness are risk factors for fatigue.
%B Scientific Reports %V 12 %P 9156 %G eng %N 1 %R 10.1038/s41598-022-12707-2 %0 Journal Article %J European Journal of Personality %D 2022 %T Personality and limitations in instrumental activities of daily living in old age: Reciprocal associations across 12 years %A Flavia S. Chereches %A Yvonne Brehmer %A Gabriel Olaru %K Big Five %K cross-lagged panel model %K instrumental activities of daily living %K Personality Traits %X Personality traits have been reported to predict difficulties in performing instrumental activities of daily living (IADL) in old age, such as preparing meals or shopping. However, little is known about the reciprocal effects on personality. In this study, we examined bidirectional relationships between personality traits and the capacity to perform IADL using four waves of longitudinal data from 3540 older adults (aged 65 years and older) from the Health and Retirement Study. We applied a random-intercept cross-lagged panel model to separate between- and within-person effects across time and compared it to a traditional cross-lagged panel model. At the between-person level, higher neuroticism and lower conscientiousness were associated with more IADL limitations. Within individuals across time, increases in neuroticism and decreases in conscientiousness and extraversion were associated with increases in IADL limitations 4 years later. In contrast, increases in IADL limitations only predicted increases in neuroticism and decreases in extraversion. These results indicate that some personality traits affect and are affected by limitations in functional capacities in old age. Results of the within-person model build a strong foundation for future personality interventions as a pathway to maintain high functioning in old age. %B European Journal of Personality %G eng %R 10.1177/08902070221111856 %0 Journal Article %J Psychology and Aging %D 2022 %T Personality and subjective age: Evidence from six samples. %A Yannick Stephan %A Angelina R Sutin %A Kornadt, Anna %A Canada, Brice %A Antonio Terracciano %K health-related outcomes %K Personality Traits %K Subjective age %XSubjective age is associated with health-related outcomes across adulthood. The present study examined the cross-sectional and longitudinal associations between personality traits and subjective age. Participants ( > 31,000) were from the Midlife in the United States Study (MIDUS), the Health and Retirement Study (HRS), the National Health and Aging Study (NHATS), the Wisconsin Longitudinal Study Graduate (WLSG) and Siblings (WLSS) samples, and the English Longitudinal Study of Aging (ELSA). Demographic factors, personality traits, and subjective age were assessed at baseline. Subjective age was assessed again in the MIDUS, the HRS, and the NHATS, 4 to almost 20 years later. Across the samples and a meta-analysis, higher neuroticism was related to an older subjective age, whereas higher extraversion, openness, agreeableness, and conscientiousness were associated with a younger subjective age. Self-rated health, physical activity, chronic conditions, and depressive symptoms partially mediated these relationships. There was little evidence that chronological age moderated these associations. Multilevel longitudinal analyses found similar associations with the intercept and weak evidence for an association with the slope in the opposite of the expected direction: Lower neuroticism and higher extraversion, agreeableness, and conscientiousness were related to feeling relatively older over time. The present study provides replicable evidence that personality is related to subjective age. It extends existing conceptualization of subjective age as a biopsychosocial marker of aging by showing that how old or young individuals feel partly reflects personality traits. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
%B Psychology and Aging %V 37 %P 401-412 %G eng %N 3 %R 10.1037/pag0000678 %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 Anthrozoös %D 2022 %T Pet Caretaking and Risk of Mild Cognitive Impairment and Dementia in Older US Adults %A Sandra Branson %A Stanley Cron %K Alzheimer’s disease %K Dementia %K Exercise %K Pets %K Physical activity %X The purpose of this study was to compare risk factors for dementia in pet caretakers and non-pet caretakers in adults aged 50 years and older, and to examine the association between pet caretaking and conversion of normal baseline cognition to mild cognitive impairment (MCI) and conversion of baseline MCI to dementia over a 12-year timespan, accounting for confounding variables. Data were drawn from the Health and Retirement Study, a longitudinal cohort study based on a national probability sample of US adults aged 50 years and older. Study participants included those who reported taking care of a pet (n = 673) and those who reported not taking care of a pet (n = 1,578) for 12 years (2002–2014). As age increased, the odds of pet caretaking decreased, Black participants had lower odds of pet caretaking than White participants, and those engaging in more physical activity had higher odds of pet caretaking, yet those who had diabetes and a history of smoking also had higher odds of pet caretaking. When adjusted for potentially confounding baseline factors, there was no evidence that the risk of MCI among those with normal baseline cognition or dementia among those with baseline MCI differed between pet caretakers and non-caretakers (p = 0.52 and p = 0.39, respectively). This study provides evidence for the associations between pet caretaking with younger age, race (White), and more physical activity in older adults. However, pet caretakers had higher odds of diabetes and history of smoking, and there was no link with incident MCI or dementia. More research is warranted to determine if physically active older adults acquire pets, if pet caretaking improves physical activity, if pets are the reason why older adults with diabetes decide to own pets, and if pets affect diabetes or other health outcomes. %B Anthrozoös %V 35 %P 203-217 %G eng %N 2 %R https://doi.org/10.1080/08927936.2021.1986259 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Physical Disability and Older Adults' Perceived Food and Economic Insecurity During the COVID-19 Pandemic. %A Choi, Shinae L %A Deborah Carr %A Namkung, Eun Ha %K COVID-19 %K Disability %K Financial hardship %K Food insecurity %K Job insecurity %XOBJECTIVES: We examined whether older adults with physical disability were vulnerable to three types of perceived economic insecurity (difficulty paying regular bills, difficulty paying medical bills, income loss) and two types of perceived food insecurity (economic obstacles, logistical obstacles) during the early months of the COVID-19 pandemic. We evaluated the extent to which associations are moderated by three personal characteristics (age, sex, race/ethnicity) and two pandemic-specific risk factors (job loss, COVID-19 diagnosis).
METHODS: Data are from a random 25 percent subsample of Health and Retirement Study (HRS) participants who completed a COVID-19 module introduced in June 2020. We estimated logistic regression models to predict each of five self-reported hardships during the pandemic.
RESULTS: Bivariate analyses showed that persons with three or more functional limitations were more likely to report both types of food insecurity, and difficulty paying regular and medical bills since the start of the pandemic, relative to those with no limitations. After controlling for health conditions, effects were no longer significant for paying medical bills, and attenuated yet remained statistically significant for other outcomes. Patterns did not differ significantly on the basis of the moderator variables. Job loss substantially increased the risk of economic insecurity but not food insecurity.
DISCUSSION: Older adults with more functional limitations were vulnerable to economic and food insecurity during the pandemic, potentially exacerbating the physical and emotional health threats imposed by COVID-19. Supports for older adults with disability should focus on logistical as well as financial support for ensuring their food security.
%B The Journals of Gerontology, Series B %V 77 %P e123-e133 %G eng %N 7 %R 10.1093/geronb/gbab162 %0 Journal Article %J Aging Clinical and Experimental Research %D 2022 %T Physical inactivity in older adults with cognitive impairment without dementia: room for improvement. %A Miller, Matthew J %A Irena Cenzer %A Deborah E Barnes %A Kenneth E Covinsky %K cognitive impairment %K Disability %K Physical activity %K Physical function %XBACKGROUND: Persons with cognitive impairment without dementia are at high risk of adverse health outcomes. Tailored intervention targeting moderate-vigorous physical activity (MVPA) may reduce these risks.
AIMS: To identify the prevalence and predictors of physical inactivity among older adults with cognitive impairment, no dementia (CIND); and estimate the proportion of inactive people with CIND who are capable of greater MVPA.
METHODS: We studied 1875 community dwelling participants (over age 65) with CIND in the Health and Retirement Study. Physical inactivity was defined as MVPA ≤ 1x/week. Associations of physical inactivity with sociodemographic, health, and physical function were examined using chi-square and modified Poisson regression. We considered physically inactive participants capable of greater MVPA if they reported MVPA at least 1-3x/month, no difficulty walking several blocks, or no difficulty climbing several flights of stairs.
RESULTS: Fifty-six percent of participants with CIND were physically inactive. Variables with the highest age, sex, and race/ethnicity adjusted risk ratio (ARR) for physical inactivity were self-rated health (poor [76.9%]vs. excellent [34.2%]; ARR [95% CI] 2.27 [1.56-3.30]), difficulty walking (across the room [86.5%] vs. none [40.5%]; ARR [95% CI] 2.09 [1.87-2.35]), total assets (lowest quartile [62.6%] vs. highest quartile [43.1%]; ARR [95% CI] 1.54 [1.29-1.83]), and lower education attainment (less than high school [59.6%] vs college graduate [42.8%]; ARR [95% CI] 1.46 [1.17-1.83]). Among physically inactive older adults with CIND, 61% were estimated to be capable of greater MVPA.
CONCLUSIONS: Although physical inactivity is prevalent among older adults with CIND, many are capable of greater MVPA. Developing tailored physical activity interventions for this vulnerable population may improve cognitive, health, and quality of life outcomes.
%B Aging Clinical and Experimental Research %V 34 %P 837-845 %G eng %N 4 %R 10.1007/s40520-021-01999-5 %0 Report %D 2022 %T Physically Demanding Jobs and Involuntary Retirement Worsen Retirement Insecurity %A Forden, Jessica %A Radpour, Siavash %A Conway, Eva %A Cook, Christopher %A Ghilarducci, Teresa %K involuntary retirement %K Older workers %K Physically demanding jobs %K retirement security %X Contrary to the hope that technology and machines have made work easier for most, more than 25 percent of older white workers and over 40 percent of older Black and Hispanic workers toil in physically demanding jobs. These realities have crucial implications for the retirement security of older workers. Physically demanding jobs make it more difficult for older workers to continue working at older ages as such jobs can be harsh on aging bodies and cause health problems. This puts older workers at risk of involuntarily exiting the labor force earlier than planned, creating significant financial hurdles to a secure retirement. For these reasons, though working longer may help mitigate today’s growing retirement insecurity, it is not a viable solution to the retirement crisis. As the share of older workers in the labor force increases in the next decade due to demographic changes,1 policymakers should support higher quality jobs for older workers while also ensuring that those who are no longer able to work can retire with financial security. %I Schwartz Center for Economic Policy Analysis, The New School %C New York, New York %G eng %U https://www.economicpolicyresearch.org/images/Retirement_Project/status_of_older_workers_reports/November_2022/OWAG_November_2022_Final.pdf %0 Journal Article %J Innovation in Aging %D 2022 %T PLACE OF DEATH AND CARE SATISFACTION AMONG THE HEALTH AND RETIREMENT STUDY DECEDENTS %A Malatyali, Ayse %A Rahemi, Zahra %A Cidav, Tom %A Dye, Cheryl %A Jarrin, Olga %A McMahan, Christopher %K cognitive impairment %K End of life care %K place of death %X The place of care at the time of death can influence the satisfaction, type, and cost of end-of-life care. This study investigated factors associated with place of death among older adults in the Health and Retirement Study (Exit files 2002-2018) with cognitive impairment (n=3,102). Black and Hispanic participants were more likely to die in the hospital (OR=1.80, 1.47) and less likely to die in a nursing home (OR=0.54, 0.37) than white and non-Hispanic participants. Hispanic participants were also 50% more likely to die at home than non-Hispanics. Compared to other places, participants who died at home were 43% more satisfied, and participants who died at nursing homes were 32% less satisfied with the care they received. There was no significant effect of ethnicity on the relationship between place of death and satisfaction with care. Investigating the moderating role of other demographic factors can shed more light on this relationship. %B Innovation in Aging %V 6 %P 354 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1401 %0 Journal Article %J Innovation in Aging %D 2022 %T POSITIVE SELF-PERCEPTIONS OF AGING AS PREDICTORS OF COVID-RELATED PREVENTIVE BEHAVIOR AND RESILIENCE %A Hannah L. Giasson %A Chopik, William %A Carrillo, Alejandro %K COVID-19 %K positive self-perceptions of aging %X Individuals have faced extraordinary challenges throughout the COVID-19 pandemic. Psychosocial strengths may promote individuals’ resilience during this time. Positive self-perceptions of aging (SPA) have been found to predict a variety of health and well-being indicators. We examined SPA as a predictor of COVID-19-related behavior, adaptation, and resilience in a sample of 3,620 adults (Mage=65.88; 61.1% women; 65.4% white) from the 2016 and 2020 waves of the Health and Retirement Study. Linear regression results revealed that more positive SPA in 2016 was associated with more preventative health behavior (β=.03, p=.04), a higher likelihood of staying at home (β=.07, p<.001), less worry (β=-.27, p<.001), less stress (β=-.24, p<.001), less loneliness (β=-.27, p<.001), and greater resilience (β=.20, p<.001) during the first year of the pandemic (2020). Associations held after controlling for demographic covariates. Findings support SPA theories, suggesting linkages between SPA and adaptive behaviors and outcomes in the face of external challenges. %B Innovation in Aging %V 6 %P 95 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.376 %0 Journal Article %J Bulletin of the Malaysian Mathematical Sciences Society %D 2022 %T Predictive Models for Trajectory Risks Prediction from Repeated Ordinal Outcomes %A Rafiqul I Chowdhury %A M. Ataharul Islam %K Big data modeling %K Markov chain %K Ordinal outcomes %K Trajectory risk prediction %X This paper proposes new regressive proportional and partial proportional odds models and a framework to predict trajectories of repeated ordinal outcomes, which is a new development. We illustrated the proposed models using repeated ordinal responses on activities of daily living from older adults collected biannually through the Health and Retirement Study in the USA. The proposed framework uses the marginal and conditional modeling approach to obtain the joint model and predict the joint probability of a sequence of ordinal outcomes and trajectories. Besides, these models significantly reduce over-parameterization, as one needs to fit one model for each follow-up. This model allows assessing the effect of prior responses on current outcomes, including interaction terms among previous responses and between prior outcomes and covariates in the model. Also, it permits the varying number of risk factors for each follow-up. The prediction accuracy for full, training, and test data is close and varies between 0.91 and 0.94. The bootstrap simulation demonstrates the bias of parameter estimates, accuracy, and predicted joint probabilities are negligible with very low mean squared error. This model and framework would be instrumental in studying trajectories generated from longitudinal studies. The proposed framework can be used to analyze big data generated from repeated measures. This model readily uses a divide and recombine approach for big data in a statistically valid manner. %B Bulletin of the Malaysian Mathematical Sciences Society %G eng %R 10.1007/s40840-022-01277-1 %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 %XINTRODUCTION: 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 Behavioral Medicine %D 2022 %T The Prospective Association of Patient Hospitalization with Spouse Depressive Symptoms and Self-Reported Heath. %A Cornelius, Talea %A Birk, Jeffrey L %A Shechter, Ari %K Couples %K distress %K Hospitalization %K Marriage %K post-hospital syndrome %K Self-reported health %XAfter hospital discharge, patients experience a period of generalized risk for adverse mental and physical health outcomes (post-hospital syndrome [PHS]). Hospital stressors can explain these effects in patients (e.g., sleep disruption, deconditioning). Patients' partners also experience adverse outcomes following patient hospitalization, but mechanisms of these effects are unknown. The purpose of this study was to test whether greater times and nights of patient hospitalization (proxies for partner exposure to hospital stressors) are prospectively associated with greater increases in partner depression and in partner self-reported poor health. Participants were 7,490 married couples (11,208 individuals) enrolled in the Health and Retirement Study. Outcomes were prospective changes in depressive symptoms and self-reported poor health, and primary predictors were spouse hospitalization over the past two years (/), spouse hospitalized ≥ two times (/), and spouse spent ≥ eight nights in-hospital (/). Covariates included age, gender, race, ethnicity, income, own hospitalization experiences during the past 12 months, and one's own and spouse comorbidities. Having a spouse who experienced two or more hospitalizations was associated with an increase in one's own depression over time, as was having a spouse who spent eight or more nights in-hospital. Spouse hospitalization was not associated with prospective changes in self-reported health. Results suggest that PHS mechanisms may account for adverse post-hospitalization outcomes in patients' partners.
%B Behavioral Medicine %V 48 %P 230-237 %G eng %N 3 %R 10.1080/08964289.2020.1870431 %0 Journal Article %J Aging & Mental Health %D 2022 %T Racial and ethnic differences in cognitive health appraisals: a comparison of non-Hispanic White, non-Hispanic Black, and Hispanic older adults. %A Yuri Jang %A Choi, E Y %A Franco, Y %A Park, N S %A Chiriboga, D A %A Kim, M T %K cognitive aging %K HCAP %K Hispanics; depressive symptoms %K non-Hispanic Blacks %K older racial/ethnic minorities %K self-rated cognitive health %XOBJECTIVES: To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group variations by examining interactions between cognitive performance and background and health variables.
METHOD: The sample ( = 3,099) included 2,260 non-Hispanic White, 498 non-Hispanic Black, and 341 Hispanic adults aged 65 or older, from the 2016-2017 Harmonized Cognitive Assessment Protocol. Regression models of cognitive health appraisals, indicated by self-rated cognitive health, were examined in the entire sample and in racial and ethnic subgroups to test direct and interactive effects of cognitive performance, indicated by the Mini-Mental State Examination (MMSE).
RESULTS: The regression model for the entire sample showed direct effects of cognitive performance and race/ethnicity on cognitive health appraisals, as well as a significant interaction between cognitive performance and being non-Hispanic Black. Cognitive performance and cognitive health appraisals were positively associated in non-Hispanic Whites but not significantly associated in non-Hispanic Blacks. Our subsequent analysis within each racial/ethnic group showed that the effect of cognitive performance in non-Hispanic Blacks and Hispanics became either reversed or nonsignificant when background and health variables were considered. Modification by age or chronic medical conditions in each racial and ethnic group was also observed.
CONCLUSION: Overall, these findings suggest that perceptions and appraisals of cognitive health vary by race and ethnicity and hold implications for how these differences should be considered in research and practice with diverse groups of older adults.
%B Aging & Mental Health %V 26 %P 519-525 %G eng %N 3 %R 10.1080/13607863.2021.1899132 %0 Journal Article %J JAMA Network Open %D 2022 %T Racial and Ethnic Differences in Hospice Use and Hospitalizations at End-of-Life Among Medicare Beneficiaries With Dementia. %A Lin, Pei-Jung %A Zhu, Yingying %A Olchanski, Natalia %A Cohen, Joshua T %A Neumann, Peter J %A Jessica Faul %A Fillit, Howard M %A Freund, Karen M %K Activities of Daily Living %K Death %K Dementia %K Female %K Hospice Care %K Hospices %K Hospitalization %K Medicare %XImportance: The pool of studies examining ethnic and racial differences in hospice use and end-of-life hospitalizations among patients with dementia is limited and results are conflicting, making it difficult to assess health care needs of underresourced racial and ethnic groups.
Objective: To explore differences in end-of-life utilization of hospice and hospital services among patients with dementia by race and ethnicity.
Design, Setting, and Participants: This cohort study used national survey data from the Health and Retirement Study linked with Medicare and Medicaid claims that reflected a range of socioeconomic, health, and psychosocial characteristics. Eligible participants were Medicare fee-for-service beneficiaries aged 65 years or older diagnosed with dementia who died between 2000 and 2016. Analyses were performed from June to December 2021.
Exposures: Race and ethnicity.
Main Outcomes and Measures: We examined the frequency and costs of hospice care, emergency department (ED) visits, and hospitalizations during the last 180 days of life among Medicare decedents with dementia. We analyzed the proportion of dementia decedents with advance care planning and their end-of-life care preferences.
Results: The cohort sample included 5058 beneficiaries with dementia (mean [SD] age, 85.5 [8.0] years; 3038 women [60.1%]; 809 [16.0%] non-Hispanic Black, 357 [7.1%] Hispanic, and 3892 non-Hispanic White respondents [76.9%]). In adjusted analysis, non-Hispanic Black decedents (odds ratio [OR], 0.65; 95% CI, 0.55-0.78), nursing home residents (OR, 0.81; 95% CI, 0.71-0.93), and survey respondents represented by a proxy (OR, 0.84; 95% CI, 0.71-0.99) were less likely to use hospice, whereas older decedents (age 75-84 vs 65-74 years: OR, 1.39; 95% CI, 1.12-1.72; age ≥85 vs 65-74 years: OR, 1.39; 95% CI, 1.13-1.71), women (OR, 1.19; 95% CI, 1.05-1.35), and decedents with higher education (high school vs less than high school: OR, 1.17; 95% CI, 1.01-1.36; more than high school vs less than high school: OR, 1.32; 95% CI, 1.13-1.54), more severe cognitive impairment (OR, 1.51; 95% CI, 1.02-2.23), and more instrumental activities of daily living limitations (OR, 1.07; 95% CI, 1.01-1.12) were associated with higher hospice enrollment. A higher proportion of Black and Hispanic decedents with dementia used ED (645 of 809 [79.7%] and 274 of 357 [76.8%] vs 2753 of 3892 [70.7%]; P < .001) and inpatient services (625 of 809 [77.3%] and 275 of 357 [77.0%] vs 2630 of 3892 [67.5%]; P < .001) and incurred roughly 60% higher inpatient expenditures at the end of life compared with White decedents (estimated mean: Black, $23 279; 95% CI, $20 690-$25 868; Hispanic, $23 471; 95% CI, $19 532-$27 410 vs White, $14 609; 95% CI, $13 800-$15 418). A higher proportion of Black and Hispanic than White beneficiaries with dementia who were enrolled in hospice were subsequently admitted to the ED (56 of 309 [18.1%] and 22 of 153 [14.4%] vs 191 of 1967 [9.7%]; P < .001) or hospital (48 of 309 [15.5%] and 17 of 153 [11.1%] vs 119 of 1967 [6.0%]; P < .001) before death. The proportion of dementia beneficiaries completing advance care planning was lower among Black (146 of 704 [20.7%]) and Hispanic (66 of 308 [21.4%]) beneficiaries compared with White beneficiaries (1871 of 3274 [57.1%]). A higher proportion of Black and Hispanic decedents with dementia had written instructions choosing all care possible to prolong life (30 of 144 [20.8%] and 12 of 65 [18.4%] vs 72 of 1852 [3.9%]), whereas a higher proportion of White decedents preferred to limit care in certain situations (1708 of 1840 [92.8%] vs 114 of 141 [80.9%] and 51 of 64 [79.7%]), withhold treatments (1448 of 1799 [80.5%] vs 87 of 140 [62.1%] and 41 of 62 [66.1%]), and forgo extensive life-prolonging measures (1712 of 1838 [93.1%] vs 120 of 138 [87.0%] and 54 of 65 [83.1%]).
Conclusions and Relevance: The results of this cohort study highlight unique end-of-life care utilization and treatment preferences across racial and ethnic groups among patients with dementia. Medicare should consider alternative payment models to promote culturally competent end-of-life care and reduce low-value interventions and costs among the population with dementia.
%B JAMA Network Open %V 5 %P e2216260 %G eng %N 6 %R 10.1001/jamanetworkopen.2022.16260 %0 Journal Article %J Journal of Aging and Health %D 2022 %T Racial and Ethnic Differences in the Relationship Between Neighborhood Environment and Physical Activity Among Middle-Aged and Older Adults. %A Cheng, Greta Jianjia %A Nicklett, Emily J %K Minority health %K neighborhood physical environment %K neighborhood social cohesion %K Physical activity %XTo examine the associations between neighborhood environment-perceived neighborhood social cohesion and perceived neighborhood physical environment-and physical activity (PA) and whether these associations differ by race/ethnicity. We analyzed data from the Health and Retirement Study, a longitudinal study of US adults aged 50+ from 2006 to 2014 ( = 17,974), using multivariate mixed-effects linear models. PA was repeatedly measured using metabolic equivalent of task estimated values accounting for the vigor and frequency of self-reported PA. In multivariate models, higher levels of PA were positively associated with higher rated neighborhood social cohesion and neighborhood physical environment scores. The effects of social cohesion were stronger among non-Hispanic Whites than among non-Hispanic Black and Hispanic/Latinx participants, while race/ethnicity did not moderate the association between PA and physical environment. Intervention strategies that address social and physical barriers of neighborhoods could promote PA in older adults. Key implications for future research are discussed.
%B Journal of Aging and Health %G eng %R 10.1177/08982643221103359 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Racial and Ethnic Disparities in Advance Care Planning: Assessing the Role of Subjective Life Expectancy. %A Lou, Yifan %A Deborah Carr %K Advance care planning %K Racial Disparities %K Subjective life expectancy %XOBJECTIVES: Persistent race disparities in advance care planning (ACP) are troubling, given Black and Hispanic older adults' elevated risk of disease, some dementias, and receipt of care that may not align with their preferences. A potentially important yet underexplored explanation for these disparities is subjective life expectancy (SLE), or beliefs about one's future survival which may impel or impede ACP.
METHODS: Data are from the Health and Retirement Study (HRS; n=8,912). We examined the extent to which perceived chances of living another 10 years are associated with three components of ACP (living will, durable power of attorney for health care [DPAHC], and informal discussions). We used multilevel logistic regression models to evaluate the extent to which SLE mediates the association between race and ACP, adjusting for demographic, socioeconomic, psychosocial, and health characteristics.
RESULTS: Black and Hispanic older adults have significantly lower rates of ACP relative to whites. These disparities persist even when SLE is controlled. Blacks report especially optimistic whereas Hispanics report pessimistic survival expectations, although these differences do not explain racial disparities in ACP. SLE has direct effects on ACP, such that persons who report an "uncertain" SLE are less likely to have a living will or a DPAHC, whereas those who perceive a 50 percent chance of survival have significantly greater odds of discussions, relative to those who perceive a 0 percent chance of survival.
DISCUSSION: Doctor-patient conversations about the likely course of one's illness may inform patients' knowledge of their SLE, which may motivate timely ACP.
%B The Journals of Gerontology, Series B %V 77 %P 1508-1518 %G eng %N 8 %R 10.1093/geronb/gbac003 %0 Journal Article %J The American Journal of Geriatric Psychiatry %D 2022 %T Racial/Ethnic Differences in Correspondence between Subjective Cognitive Ratings and Cognitive Impairment %A Yuri Jang %A William E. Haley %A Eun-Young Choi %A Yujin Franco %K cognitive impairment %K Dementia %K Racial and ethnic minorities %K Self-rated cognition %X Objectives : Responding to racial/ethnic disparities in dementia diagnosis and care, we examined the role of race/ethnicity in the correspondence between subjective and objective ratings of cognitive impairment. Our examination focused on the two types of discordance: (1) positive ratings in the presence of cognitive impairment and (2) negative ratings in the absence of cognitive impairment. Design and Participants : A cross-sectional assessment was conducted using the data from the Harmonized Cognitive Assessment Protocol (HCAP) project, a sub-study of the Health and Retirement Study (HRS). Our analytic sample included 3,096 participants: 2,257 non-Hispanic Whites, 498 Blacks, and 341 Hispanics. Measurements : Discordant groups were identified based on self-ratings of cognition (positive vs. negative) and the Langa–Weir classification of cognitive impairment (normal vs. impaired). Results : Blacks and Hispanics were more prone to falsely positive perceptions of their cognitive function in the presence of cognitive impairment than non-Hispanic Whites. On the other hand, non-Hispanic Whites were more likely to manifest negative ratings even in the absence of cognitive impairment. Conclusions : Our findings demonstrate the critical role of race/ethnicity in determining discordance between subjective and objective measures of cognition and highlight the importance of a tailored effort to promote dementia diagnosis and care. %B The American Journal of Geriatric Psychiatry %V 30 %P 627-635 %G eng %N 5 %R https://doi.org/10.1016/j.jagp.2021.10.015 %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 %XOBJECTIVE: 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 PLOS Global Public Health %D 2022 %T Relation of incident chronic disease with changes in muscle function, mobility, and self-reported health: Results from the Health and Retirement Study %A Davis, James %A Lim, Eunjung %A Taira, Deborah A. %A Chen, John %K Chronic disease %K mobility %K muscle function %K Self-reported health %X The primary objective was to learn the extent that muscle function, mobility, and self-reported health decline following incident diabetes, stroke, lung problem, and heart problems. A secondary objective was to measure subsequent recovery following the incident events. A longitudinal panel study of the natural history of four major chronic diseases using the Health and Retirement Study, a nationally representative sample of adults over age 50 years. People first interviewed from 1998–2004 were followed across five biannual exams. The study included 5,665 participants who reported not having diabetes, stroke, lung problems, and heart problems at their baseline interview. Their mean age was 57.3 years (SD = 6.0). They were followed for an average of 4.3 biannual interviews. Declines and subsequent recovery in self-reported health, muscle function, and mobility were examined graphically and modeled using negative binomial regression. The study also measured the incidence rates and prevalence of single and multiple chronic diseases across the follow-up years.Self-reported health and muscle function declined significantly following incident stroke, heart problems, lung problems, and multiple chronic diseases. Mobility declined significantly except following incident diabetes. Self-reported health improved following incident multiple chronic conditions, but recovery was limited compared to initial decline. Population prevalence after five follow-up waves reached 9.0% for diabetes, 8.1% for heart problems, 3.4% for lung disease, 2.1% for stroke, and 5.2% for multiple chronic diseases. Significant declines in self-reported health, muscle function, and mobility occurred within two years of chronic disease incidence with only limited subsequent recovery. Incurring a second chronic disease further increased the declines. Early intervention following incident chronic disease seems warranted to prevent declines in strength, mobility, and perceptions of health. %B PLOS Global Public Health %V 2 %P e0000283 %G eng %N 9 %R https://doi.org/10.1371/journal.pgph.0000283 %0 Journal Article %J Social Work in Public Health %D 2022 %T Relationships Between Perceived Neighborhood Disorder and Depressive Symptomatology: The Stress Buffering Effects of Social Support Among Older Adults. %A Cho, Seungjong %K Depressive symptoms %K Perceived neighborhood disorder %K Social Support %XExisting research indicates neighborhood is an important determinant of depressive symptoms. However, this research has several limitations. These include a lack of investigation of older adults' experiences and of social support as a possible moderator. The current study aims to fill these gaps by increasing knowledge about the relationships between perceived neighborhood disorder and depressive symptoms among older adults. Applying stress process theory, this study investigated the relationships between two subjective indicators of neighborhood stressors - physical and social perceived neighborhood disorder and depressive symptoms. This study also tested whether social support moderated the effects of the neighborhood stressors on depressive symptoms. This study was based on secondary data analysis from the Health and Retirement Study 2016 ( = 3,684; age 50+). This study applied a negative binomial regression in that the outcome was a count variable. The results showed the stress buffering effects of social support were not significant for both perceived neighborhood social disorder and physical disorder. Not as a moderator but as the main effect, lower social support was significantly related to higher depressive symptoms. Having a depression history, lower self-rated health, female, and lower education were also related to higher depressive symptoms. This study contributes to social work practice by addressing older adults' depressive symptomatology. Findings identified vulnerable older adults to target for interventions based on individual characteristics. Focusing on social support should be a vital component of interventions. Social workers can help older adults maintain and strengthen their social support, with beneficial effects on their depressive symptomatology.
%B Social Work in Public Health %V 37 %P 45-56 %G eng %N 1 %R 10.1080/19371918.2021.1974636 %0 Web Page %D 2022 %T Retirement Depression: Coping with the Emotional Pain %A Chamlou, Nina %K depression %K Mental Health %K Retirement %X The loss of a routine and sense of purpose could lead you to experience symptoms of depression after retirement. Help is available and relief is possible. %I PyschCentral %G eng %U https://psychcentral.com/depression/retirement-depression %0 Journal Article %D 2022 %T Retirement Reforms Are Necessary—So Is Strengthening Social Security %A Owen Davis %A Siavash Radpour %A Eva Conway %A Teresa Ghilarducci %K Retirement Reforms %K Social Security %G eng %0 Thesis %D 2022 %T The Retirement Transition and Retirement-Savings Behaviors: Three Essays Analyzing Various Retirement Concerns Focusing on Military Veterans %A Cantu, Jayson %K Retirement %K savings for retirement %K Veterans %I Texas Tech University %C Lubbock, TX %V Ph.D. %G eng %U https://ttu-ir.tdl.org/bitstream/handle/2346/89211/CANTU-DISSERTATION-2022.pdf?sequence=1 %0 Journal Article %J Informatics in Medicine Unlocked %D 2022 %T Risk prediction for repeated measures health outcomes: A divide and recombine framework %A Rafiqul I Chowdhury %A Jabed H. Tomal %K Marginal and conditional models %K repeated measures %K Response sequence %K risk prediction %K Trajectory of health conditions %X We propose a machine learning framework for risk prediction for binary response sequence observed over time, creating a trajectory for disease progression and regression. The proposed framework employs a divide and recombine technique using the relation between marginal, conditional, and joint probability models from probability theory. To demonstrate the framework, the data from the US Health and Retirement Study with seven follow-ups for the response, the activity of daily living index (ADL), and risk factors have been used. To assess the effects of the risk factors on ADL, the proposed framework adapted regressive logistic regression, logistic regression with the lasso, support vector machines, classification tree, random forests, and neural network models. The models are tuned and evaluated on the training and test data containing 75% and 25% of the cases, respectively. The test data accuracies varied from 92% to 95% across different follow-ups with high specificity and sensitivity. The accuracy, sensitivity, and specificity for the ensemble of the six models are found very high, all above 90%. Inclusion of interaction terms between the risk factors, risk factors and historical ADL, and historical ADL from different follow-ups in the regressive logistic model shows noticeable improvements in accuracy, sensitivity, and specificity. Adjusting the probability threshold for classification shows a considerable increase in sensitivity. The framework provides a general and flexible approach in addressing the issue of risk predictions for health-related response, which is repeated over time and longitudinal in nature. This method can be used in other applications to analyze big data. %B Informatics in Medicine Unlocked %V 28 %P 100847 %G eng %R https://doi.org/10.1016/j.imu.2022.100847 %0 Journal Article %J American Journal of Clinical Pathology %D 2022 %T The role of cohabitation on adaptive and innate immune cell profiles in the Health and Retirement Study %A Ramasubramanian, Ramya %A Meier, Helen %A Eileen M. Crimmins %A Jessica Faul %A Bharat Thyagarajan %K adaptive immune cells %K Cohabitation %K Households %X Immune cells distribution is shaped by numerous factors including environmental factors, age, and genetics. Cohabitation has been associated with similar microbiomes, possibly due to dietary patterns and exposure to similar pathogens but has not been studied in the context of adaptive and innate immune systems previously. We used immunophenotyping data of 2283 households with participants living in the same household and compared it to 2283 randomly generated pairs of participants from the Health and Retirement study. The adaptive immune cells (subsets of T-cells and B-cells), and innate immune cells (monocytes, natural killer cells, and neutrophils) were compressed to two coordinates using multidimensional scaling. The Euclidean distances between participants in the same household were compared to the distances between the random pairs of participants using two sample independent t-tests. The mean distances of the immune coordinate points for adaptive immune cells between participants in the same household were lower than the randomly paired participants (p-value < 0.0001) and the variability of intra-household distances was lower than the random pairs (IQR: 7.18 vs 8.99). For the innate immune cells, the mean distances between participants in the same household were slightly lower than the randomly paired participants (p-value = 0.03) but the variability of the intra-household distances was higher than the random pairs (IQR: 4.08 vs 3.65). Variability in the adaptive immune system among participants living in the same household were substantially lower indicating the influence of shared environmental conditions in determining the adaptive immune profiles. %B American Journal of Clinical Pathology %V 158 %P S2 %G eng %R 10.1093/ajcp/aqac126.002 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T The Role of Incarceration as a Risk Factor for Cognitive Impairment. %A Cox, Robynn J A %A Robert B Wallace %K cognitive impairment %K Cognitive Reserve %K formerly incarcerated %K Health Disparities %K reentry %XOBJECTIVES: The objective of this study was to understand disparities in cognitive impairment between middle aged formerly incarcerated (FI) and nonincarcerated (NI) individuals.
METHODS: The 1979 National Longitudinal Survey of Youth is a nationally representative longitudinal dataset containing information on incarceration, cognitive functioning, and other health conditions. Using a modified version of the Telephone Interview for Cognitive Status (TICS-m), adapted from the Health and Retirement Study, we analyzed the association between incarceration and cognitive impairment, cognitive impairment-not dementia, and dementia. Multivariable regression models were estimated including prior incarceration status and covariates associated with incarceration and cognitive functioning.
RESULTS: FI individuals had lower unadjusted scores on TICS-m (-2.5, p<.001), and had significantly greater unadjusted odds ratios (OR) for scoring in the cognitive impairment (OR=2.4, p<.001) and dementia (OR=2.7, p<.001) range. Differences were largely explained by a combination of risk factors associated with incarceration and cognition. Education and premorbid cognition (measured by Armed Forces Qualifying Test) separately and completely explained differences in the odds of dementia. Regardless of incarceration status, Blacks and Hispanics had significantly greater odds of cognitive impairment and dementia relative to Whites, holding other factors constant.
DISCUSSION: The association between prior incarceration and cognitive impairment in middle age was largely explained by differences in educational attainment and premorbid cognitive functioning, supporting the cognitive reserve hypothesis. Greater prevalence of cognitive impairment and dementia among the FI could create challenges and should be considered in reentry planning. Structural and institutional factors should be considered when addressing health disparities in ADRD.
%B The Journals of Gerontology, Series B %V 77 %P e247-e262 %G eng %N 12 %R 10.1093/geronb/gbac138 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T The Role of Optimism on the Relationship Between Activity Limitations and Life Satisfaction Among Middle-Aged and Older Adults in the United States: A Growth Curve Model of Changes Over Time. %A Cheng, Kent Jason Go %A McMaughan, Darcy Jones Dj %A Smith, Matthew Lee %K Activities of Daily Living %K Activity limitation %K instrumental activities of daily living %K Leave Behind Survey %K Life Satisfaction %K Optimism %XActivity limitations can diminish life satisfaction. This study explored the role of optimism on the relationship between changes in activities of daily living and instrumental activities of daily living (ADL/IADL) limitations and life satisfaction over time among middle-aged and older adults. Growth curve modeling accounting for intra- and inter-individual changes in life satisfaction was applied to the 2008-2018 waves of the Health and Retirement Study Leave Behind Survey subsample ( = 39,122 person-years). After controlling for sociodemographic factors, physical functioning decline adversely affected life satisfaction ( = -0.12, = -0.13, 0.001), but the negative consequences reduced slightly through optimism ( = -0.11, = -0.12, = 0.47, 0.001). Increasing optimism could reduce the negative consequences of ADL/IADL limitations on life satisfaction among middle-aged to older adults.
%B Journal of Applied Gerontology %V 41 %P 993-1001 %G eng %N 4 %R 10.1177/07334648211056638 %0 Journal Article %J Sleep %D 2022 %T The Role of Race-Gender Intersectionality in Associations between Insomnia Patterns and Late-Life Memory Trajectories %A Zaheed, Afsara %A Ronald D Chervin %A Laura B Zahodne %K depressive disorders %K gender %K insomnia %K Latinos/Hispanics %K Memory %K Mental Recall %K Racial Disparities %K Sleep %X Introduction Difficulty initiating sleep (DIS) may be a stronger predictor of neurodegenerative risk than other insomnia symptoms. This study examined whether longitudinal patterns of DIS are associated with subsequent memory trajectories, and whether associations differ across non-Hispanic Black and White men and women. Methods 12,565 participants in the Health and Retirement Study (Mage=67.8±9.1, 59.1% women) who self-identified as non-Hispanic Black (14.5%) or non-Hispanic White were included. DIS (“How often do you have trouble falling asleep?”) at three biennial waves (2002-2006) was dichotomized (“never/rarely/sometimes”=0, “often”=1). Participants were categorized into three mutually exclusive groups: low (reference group), persistent, and variable DIS. Episodic memory was assessed using a 10-item word list recall test at five biennial waves (2008-2016). Latent growth curves modeled associations between DIS patterns and subsequent memory level and change, adjusting for sociodemographics (model 1), health conditions (model 2), and depressive symptoms (model 3) in 2002. Stratified models compared associations across White men, Black men, White women, and Black women. Results Compared to low DIS, persistent (β=-0.03, p<.001) or variable (β=-0.07, p<.001) DIS was associated with worse subsequent memory in models 1 and 2. The effect of variable (β=-0.05, p<.001), but not persistent (β=-0.01, p=.271), DIS remained in model 3. Persistent DIS was most prevalent among White women (5.4% vs. 2.4-4%), and variable DIS was most prevalent among Black women (24.1% vs. 14-22.2%). Persistent DIS was only significantly associated with memory among White women (β=-0.04, p=.003 vs. β=-0.04, p=.324 for Black Men; β=-0.03, p=.087 for White men; and β=0.01, p=.859 for Black women). Variable DIS was most strongly associated with memory among Black men (β=-0.141, p=.003), followed by White men (β=-0.09, p<.001), White women (β=-0.06, p<.001) and Black women (β=-0.06, p=.064). There were no associations between DIS patterns and memory change. Conclusion While links between persistent DIS and subsequent memory may reflect negative cognitive effects of depression, variable DIS may presage worse memory above and beyond depression. Race/gender differences in the prevalence and predictive value of DIS patterns for subsequent cognitive function highlight the value of an intersectional lens. Gender disparities in DIS may be more prominent than racial disparities. %B Sleep %V 45 %P A150–A151 %G eng %N Suppl _1 %R https://doi.org/10.1093/sleep/zsac079.332 %0 Journal Article %J American Economic Review %D 2022 %T A Satellite Account for Health in the United States. %A Cutler, David M %A Ghosh, Kaushik %A Messer, Kassandra L %A Raghunathan, Trivellore %A Rosen, Allison B %A Stewart, Susan T %K Health Care %K health outcome %K health spending %XThis paper develops a satellite account for the US health sector and measures productivity growth in health care for the elderly population between 1999 and 2012. We measure the change in medical spending and health outcomes for a comprehensive set of 80 conditions. Medical care has positive productivity growth over the time period, with aggregate productivity growth of 1.5% per year. However, there is significant heterogeneity in productivity growth. Care for cardiovascular disease has had very high productivity growth. In contrast, care for people with musculoskeletal conditions has been costly but has not led to improved outcomes.
%B American Economic Review %V 112 %P 494-533 %G eng %N 2 %R 10.1257/aer.20201480 %0 Web Page %D 2022 %T Self-Employment Linked To Better Heart Health In Women: Study %A Chan, Athena %K BMI %K Exercise %K heart health %K self-employed %K women %I International Business Times %G eng %U https://www.ibtimes.com/self-employment-linked-better-heart-health-women-study-3599510 %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 %XDepression 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 Web Page %D 2022 %T The severity of depressive symptoms over time may help predict stroke risk %A Christensen, Thor %K depression %K stroke risk %X People who consistently have higher depressive symptoms may be at higher risk for a stroke, according to new research. But stroke risk did not increase in those with decreasing severity of symptoms over time, even if they had high depressive symptoms early on. %I American Heart Association News %G eng %U https://www.heart.org/en/news/2022/05/23/the-severity-of-depressive-symptoms-over-time-may-help-predict-stroke-risk#:~:text=The%20severity%20of%20depressive%20symptoms%20over%20time%20may%20help%20predict%20stroke%20risk,-By%20Thor%20Christensen&text=Peop %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Sex Differences in the Association between Metabolic Dysregulation and Cognitive Aging: The Health and Retirement Study. %A Chanti-Ketterl, Marianne %A Rebecca C Stebbins %A Obhi, Hardeep K %A Daniel W. Belsky %A Brenda L Plassman %A Yang, Yang Claire %K Biomarkers %K Brain Aging %K Diabetes %K Epidemiology %XBACKGROUND: Dysregulation of some metabolic factors increases the risk of dementia. It remains unclear if overall metabolic dysregulation, or only certain components, contribute to cognitive aging and if these associations are sex-specific.
METHODS: Data from the 2006-2016 waves of the Health and Retirement Study (HRS) was used to analyze 7,103 participants aged 65+ at baseline (58% women). We created a metabolic-dysregulation risk score (MDRS) composed of blood pressure/hypertension status, HbA1c/diabetes status, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and waist circumference, and assessed cognitive trajectories from repeated measures of the HRS-Telephone Interview for Cognitive Status (HRS-TICS) over 10 years of follow-up. Linear mixed-effects models estimated associations between MDRS or individual metabolic factors (biomarkers) with mean and change in HRS-TICS scores and assessed sex-modification of these associations.
RESULTS: Participants with higher MDRSs had lower mean HRS-TICS scores, but there were no statistically significant differences in rate of decline. Sex-stratification showed this association was present for women only. MDRS biomarkers revealed heterogeneity in the strength and direction of associations with HRS-TICS. Lower HRS-TICS levels were associated with hypertension, higher HbA1c/diabetes, and lower HDL-C and TC; while faster rate of cognitive decline was associated with hypertension, higher HbA1c/diabetes and higher TC. Participants with higher HbA1c/diabetes presented worse cognitive trajectories. Sex-differences indicated women with higher HbA1c/diabetes to have lower HRS-TICS levels while hypertensive males presented better cognitive trajectory.
CONCLUSIONS: Our results demonstrate that metabolic dysregulation is more strongly associated with cognition in women compared to men, though sex-differences vary by individual biomarker.
%B The Journals of Gerontology, Series A %V 77 %P 1827-1835 %G eng %N 9 %R 10.1093/gerona/glab285 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Sibling Deaths, Racial/Ethnic Disadvantage, and Dementia in Later Life. %A Hyungmin Cha %A Thomas, Patricia A %A Debra Umberson %K Bereavement %K Dementia %K Minority aging %K Race/ethnicity %K Stress %XOBJECTIVES: Sibling loss is understudied in the bereavement and health literature. The present study considers whether experiencing the death of siblings in mid-to-late life is associated with subsequent dementia risk and how differential exposure to sibling losses by race/ethnicity may contribute to racial/ethnic disparities in dementia risk.
METHODS: We use discrete-time hazard regression models, a formal mediation test, and a counterfactual simulation to reveal how sibling loss in mid-to-late life affects dementia incidence and whether unequal exposures by race/ethnicity mediate the racial/ethnic disparities in dementia. We analyze data from the Health and Retirement Study (2000-2016). The sample includes 13,589 respondents (10,607 non-Hispanic White, 1,761 non-Hispanic Black, and 1,158 Hispanic adults) aged 65 years and older in 2000 who show no evidence of dementia at baseline.
RESULTS: Discrete-time hazard regression results show that sibling loss in mid-to-late life is associated with up to 54% higher risk for dementia. Sibling loss contributes to Black-White disparities in dementia risk. In addition, a simulation analysis shows that dementia rates would be 14% lower for Black adults if they experienced the lower rates of sibling loss experienced by White adults. This pattern was not observed among Hispanic adults.
DISCUSSION: The death of a sibling in mid-to-late life is a stressor that is associated with increased dementia risk. Black adults are disadvantaged in that they are more likely than Whites to experience the death of siblings, and such losses contribute to the already substantial racial/ethnic disadvantage in dementia.
%B The Journals of Gerontology, Series B %V 77 %P 1539-1549 %G eng %N 8 %R 10.1093/geronb/gbab202 %0 Report %D 2022 %T Social isolation increases from adolescence through later life but varies by gender, age, and partnership status %A Umberson, Debra %A Lin, Zhiyong %A Cha, Hyungmin %K Mortality %K negative health impacts %K social isolation %X Substantial evidence has found that people who are socially isolated experience worse mental and physical health and are more likely to die compared to their less isolated peers. And while the negative health impacts of social isolation affect both men and women, social isolation unfolds over the life course and perhaps in different ways for men and women. In this research brief, CAPS director and PRC faculty scholar Debra Umberson, along with PRC faculty affiliate Zhiyong Lin, and CAPS/PRC graduate student trainee Hyungmin Cha, report on a recent study that explores the gendered patterns of social isolation from adolescence to old age. Using Add Health and Health and Retirement Study data, they find that social isolation increases from adolescence through later life and that men are more socially isolated than women across all age and partnership categories with one exception: after age 62, married women are more socially isolated than married men. %B CAPS Research Brief Series %I Population Research Center, The University of Texas at Austin %C Austin, TX %G eng %R http://dx.doi.org/10.26153/tsw/42860 %0 Report %D 2022 %T Social Security Claiming: COVID-19 vs. Great Recession %A Chen, Anqi %A Liu, Siyan %A Alicia H. Munnell %K COVID-19 %K Great Recession %K Social Security claiming %X In early 2020, many thought the COVID crisis – like the Great Recession – might force many workers to claim Social Security early.But the COVID economy turned out very different, with robust growth in the stock market and substantial unemployment relief. The analysis compared the relative impacts of the two recessions on early claiming by earnings group and found that: During COVID, the booming stock market induced early claiming among workers with retirement assets ;while the generous unemployment benefits decreased early claiming for many lower-paid workers. Overall, the latter effect more than cancelled out the former, so COVID actually led to a slight decline in early claiming. %B Briefs %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/briefs/social-security-claiming-covid-19-vs-great-recession/ %0 Report %D 2022 %T Social Security Claiming: COVID-19 vs. Great Recession. %A Alicia H. Munnell %A Chen, Anqi %A Liu, Siyan %K COVID-19 %K Great Recession %K Social Security claiming %X The brief’s key findings are: In early 2020, many thought the COVID crisis – like the Great Recession – might force many workers to claim Social Security early. But the COVID economy turned out very different, with robust growth in the stock market and substantial unemployment relief. The analysis compared the relative impacts of the two recessions on early claiming by earnings group and found that: During COVID, the booming stock market induced early claiming among workers with retirement assets; while the generous unemployment benefits decreased early claiming for many lower-paid workers. Overall, the latter effect more than cancelled out the former, so COVID actually led to a slight decline in early claiming. %B Issue in Brief %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/briefs-social-security/social-security-claiming-covid-19-vs-great-recession/ %0 Journal Article %J Proceedings of the National Academy of Sciences %D 2022 %T Social stressors associated with age-related T lymphocyte percentages in older US adults: Evidence from the US Health and Retirement Study. %A Klopack, Eric T %A Eileen M. Crimmins %A Cole, Steve W %A Seeman, Teresa E %A Carroll, Judith E %K Aging %K Immunosenescence %K socioeconomic status %K Stress %XExposure to stress is a risk factor for poor health and accelerated aging. Immune aging, including declines in naïve and increases in terminally differentiated T cells, plays a role in immune health and tissue specific aging, and may contribute to elevated risk for poor health among those who experience high psychosocial stress. Past data have been limited in estimating the contribution of life stress to the development of accelerated immune aging and investigating mediators such as lifestyle and cytomegalovirus (CMV) infection. This study utilizes a national sample of 5,744 US adults over age 50 to assess the relationship of social stress (viz., everyday discrimination, stressful life events, lifetime discrimination, life trauma, and chronic stress) with flow cytometric estimates of immune aging, including naïve and terminally differentiated T cell percentages and the ratio of CD4 to CD8 cells. Experiencing life trauma and chronic stress was related to a lower percentage of CD4 naïve cells. Discrimination and chronic stress were each associated with a greater percentage of terminally differentiated CD4 cells. Stressful life events, high lifetime discrimination, and life trauma were related to a lower percentage of CD8 naïve cells. Stressful life events, high lifetime discrimination, and chronic stress were associated with a higher percentage of terminally differentiated CD8 cells. High lifetime discrimination and chronic stress were related to a lower CD4:CD8 ratio. Lifestyle factors and CMV seropositivity partially reduced these effects. Results identify psychosocial stress as a contributor to accelerating immune aging by decreasing naïve and increasing terminally differentiated T cells.
%B Proceedings of the National Academy of Sciences %V 119 %P e2202780119 %G eng %N 25 %R 10.1073/pnas.2202780119 %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 Biodemography and Social Biology %D 2022 %T Socioeconomic status and immune aging in older US adults in the health and retirement study. %A Klopack, Eric T %A Bharat Thyagarajan %A Jessica Faul %A Meier, Helen C S %A Ramasubramanian, Ramya %A Jung K Kim %A Crimmins, Eileen M %K Child %K Educational Status %K ethnicity %K Hispanic or Latino %K Retirement %K Social Class %XSocioeconomic and demographic factors including educational attainment, race and ethnicity, and childhood socioeconomic status (SES) are powerful predictors of inequalities in aging, morbidity, and mortality. Immune aging, including accumulation of late-differentiated, senescent-like lymphocytes and lower levels of naïve lymphocytes, may play a role in the development of the age-related health inequalities. This study used nationally representative data from more than 9,000 US adults from the Health and Retirement Study to investigate associations between educational attainment, race and ethnicity, and childhood SES and lymphocyte percentages. Respondents with lower educational attainment, Hispanic adults, and those who had a parent with less than a high school education had lymphocyte percentages consistent with more immune aging compared to those with greater educational attainment, non-Hispanic White adults, and respondents who had parents with a high school education, respectively. Associations between education, Hispanic ethnicity, and parents' education and late differentiated senescent-like T lymphocytes (TemRA) and B cells were largely driven by cytomegalovirus (CMV), suggesting it is a factor in observed SES inequalities in immunosenescence. Naïve T lymphocytes may be particularly affected by socioeconomic position and may therefore be of particular interest to research interested in inequalities in health and aging.
%B Biodemography and Social Biology %V 67 %P 187-202 %G eng %N 3-4 %R 10.1080/19485565.2022.2149465 %0 Journal Article %J Journal of Psychiatric Research %D 2022 %T Sons and parental cognition in mid-life and older adulthood. %A Wolfova, Katrin %A Wu, Di %A Weiss, Jordan %A Cermakova, Pavla %A Kohler, Hans-Peter %A Skirbekk, Vegard Fykse %A Stern, Yaakov %A Gemmill, Alison %A Tom, Sarah E %K cognitive aging %K Dementia %K offspring sex %XPrior research suggests a relationship between number of sons and maternal long-term health outcomes, including dementia. We assessed the relationship between having sons and parental cognitive aging. Specifically, we investigated the relationship between having at least 1 son and parental baseline cognition level and rate of cognitive decline, accounting for life course sociodemographic characteristics in a cohort of 13 222 adults aged ≥50 years from the US Health and Retirement Study. We included only participants with at least one child. We further explored whether this relationship varies by parental sex and whether the magnitude of the relationship increases with each additional son. Cognition was assessed biennially for a maximum of nine times as a sum of scores from immediate and delayed 10-noun free recall tests, a serial 7s subtraction test, and a backwards counting test. Associations were evaluated using linear mixed-effects models, stepwise adjusting for sociodemographic and health-related factors. In our analytic sample of parents, a total of 82.3% of respondents had at least 1 son and 61.6% of respondents were female. Parents of at least 1 son had a faster rate of cognitive decline in comparison to parents without any son. Our results also suggest that cognitive decline was faster among parents of multiple sons, compared to parents with only daughters. Thus, the results support the theory that having sons might have a long-term negative effect on parental cognition.
%B Journal of Psychiatric Research %V 156 %P 284-290 %G eng %R 10.1016/j.jpsychires.2022.10.026 %0 Journal Article %J Innovation in Aging %D 2022 %T SPOUSAL ASSOCIATIONS BETWEEN GRANDPARENT CAREGIVING AND WELL-BEING: FINDINGS FROM THE HEALTH AND RETIREMENT STUDY %A Chan, Athena Chung Yin %A Sneed, Rodlescia %K Caregiving %K grandparent %K Spouses %K Well-being %X Numerous studies document the impact of grandparent caregiving on the health and well-being of grandparents; however, there has been little dyadic research on how the caregiving and health-related outcomes of one grandparent influence partner couples The purpose of this study was to determine the interdependence of grandparents’ intensity of caregiving and well-being (i.e., depressive symptoms and self-rated health) over time. Participants were 7,133 dyads of American grandparents aged ≥ 50 who participated in the Health and Retirement Study, a population-based study of community-dwelling adults, in 2010 and 2012. Data on hours of grandparent caregiving in the past two years, depressive symptoms, and self-rated health were obtained via self-report. Two longitudinal, dyadic path analyses were conducted using the Actor-Partner Interdependence Model. Within individuals (actor effects), greater depressive symptoms and better self-rated health at baseline, predicted greater depressive symptoms and better self-rated health two years later. Between spouses (partner effects), an individuals’ greater depressive symptoms predicted the spouses’ greater depressive symptoms. However, grandfathers’ better self-rated health predicted subsequent better grandmothers’ self-rated health, but not vice versa. Further, greater depressive symptoms among grandmothers predicted lower subsequent caregiving intensity among both grandmothers and grandfathers. Additionally, better self-rated health among grandfathers predicted better self-rated health and lower subsequent self and spousal grandparenting caregiving intensity. Our findings demonstrate that depressive symptoms, self-rated health, and caregiving intensity are interrelated among grandparent couples. Interventions for improving well-being and caregiving outcomes that focus on couples may be more effective than those that focus on individuals. %B Innovation in Aging %V 6 %P 558 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.2108 %0 Journal Article %J Population Health Metrics %D 2022 %T State-level metabolic comorbidity prevalence and control among adults age 50-plus with diabetes: estimates from electronic health records and survey data in five states. %A Mardon, Russell %A Campione, Joanne %A Nooney, Jennifer %A Merrill, Lori %A Johnson, Maurice %A Marker, David %A Jenkins, Frank %A Saydah, Sharon %A Rolka, Deborah %A Zhang, Xuanping %A Shrestha, Sundar %A Gregg, Edward %K Comorbidity %K Diabetes Mellitus %K Electronic Health Records %K Prevalence %K Self Report %XBACKGROUND: Although treatment and control of diabetes can prevent complications and reduce morbidity, few data sources exist at the state level for surveillance of diabetes comorbidities and control. Surveys and electronic health records (EHRs) offer different strengths and weaknesses for surveillance of diabetes and major metabolic comorbidities. Data from self-report surveys suffer from cognitive and recall biases, and generally cannot be used for surveillance of undiagnosed cases. EHR data are becoming more readily available, but pose particular challenges for population estimation since patients are not randomly selected, not everyone has the relevant biomarker measurements, and those included tend to cluster geographically.
METHODS: We analyzed data from the National Health and Nutritional Examination Survey, the Health and Retirement Study, and EHR data from the DARTNet Institute to create state-level adjusted estimates of the prevalence and control of diabetes, and the prevalence and control of hypertension and high cholesterol in the diabetes population, age 50 and over for five states: Alabama, California, Florida, Louisiana, and Massachusetts.
RESULTS: The estimates from the two surveys generally aligned well. The EHR data were consistent with the surveys for many measures, but yielded consistently lower estimates of undiagnosed diabetes prevalence, and identified somewhat fewer comorbidities in most states.
CONCLUSIONS: Despite these limitations, EHRs may be a promising source for diabetes surveillance and assessment of control as the datasets are large and created during the routine delivery of health care.
TRIAL REGISTRATION: Not applicable.
%B Population Health Metrics %V 20 %P 22 %G eng %N 1 %R 10.1186/s12963-022-00298-z %0 Web Page %D 2022 %T Study: Boomers have more medical woes than their parents did at same age %A Clanton, Nancy %K boomers %K Chronic condition %K depression %I The Atlanta Journal-Constitution %G eng %U https://www.ajc.com/pulse/study-boomers-have-more-medical-woes-than-their-parents-did-at-same-age/IKVEPLNZU5DFPFQHJ3RFWSSBG4/ %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Subjective Age and Falls in Older Age: Evidence from two Longitudinal Cohorts. %A Fundenberger, Hervé %A Stephan, Yannick %A Terracciano, Antonio %A Dupré, Caroline %A Bongue, Bienvenu %A Hupin, David %A Barth, Nathalie %A Canada, Brice %K falling %K Felt age %K Survival Analysis %XOBJECTIVES: Falls are a common and serious health problem. The present study examined the association between subjective age (i.e., feeling younger or older than one's chronological age) and falls in two large national samples.
METHOD: Participants, aged 65 to 105 years old, were drawn from the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Data on falls, subjective age, demographic factors, was available from 2,382 participants in HRS and 3,449 in NHATS. Falls were tracked for up to 8 (HRS) and 7 (NHATS) years.
RESULTS: Cox regression analyses that included demographic covariates indicated that older subjective age increased the risk of falling in HRS (hazard ratio [HR]=1.17, 95% confidence interval [CI]=1.08-1.27), and in NHATS (HR=1.06, 95%CI=1.00-1.13). When compared to people who felt younger, people who reported an older subjective age had a higher risk of fall (HRS: HR=1.65, 95% CI=1.33-2.04; NHATS: HR=1.44, 95% CI=1.15-1.79). The associations remained significant after accounting for depressive symptoms, handgrip strength, chronic diseases, and cognitive impairment in HRS only.
DISCUSSION: These results confirm the role of subjective age as an important health marker in the aging population. Subjective age assessment can help identify individuals at greater risk of falls.
%B The Journals of Gerontology, Series B %V 77 %P 1814-1819 %G eng %N 10 %R 10.1093/geronb/gbac094 %0 Journal Article %J American Journal of Epidemiology %D 2022 %T Testing Black-White Disparities in Biological Aging Among Older Adults in the United States: Analysis of DNA-Methylation and Blood-Chemistry Methods %A Graf, GH %A Crowe, CL %A Kothari, M %A Kwon, D %A Jennifer J Manly %A Turney, IC %A Valeri, L %A Daniel W. Belsky %K aging clocks %K biological aging %K healthy aging %K pace of aging %K Racial Disparities %X Biological aging is a proposed mechanism through which social determinants drive health disparities. We conducted proof-of-concept testing of 8 DNA-methylation (DNAm) and blood-chemistry quantifications of biological aging as mediators of disparities in healthspan between Black and White participants in the 2016 wave of the Health and Retirement Study (n = 9,005). We quantified biological aging from 4 DNAm "clocks" (Horvath, Hannum, PhenoAge, and GrimAge clock), a DNAm pace-of-aging measure (DunedinPoAm), and 3 blood-chemistry measures (PhenoAge, Klemera-Doubal method biological age, and homeostatic dysregulation). We quantified Black-White disparities in healthspan from cross-sectional and longitudinal data on physical performance tests, self-reported limitations in activities of daily living, and physician-diagnosed chronic diseases, self-rated health, and survival. DNAm and blood-chemistry quantifications of biological aging were moderately correlated (Pearson's r = 0.1-0.4). The GrimAge clock, DunedinPoAm, and all 3 blood-chemistry measures were associated with healthspan characteristics (e.g., mortality effect-size hazard ratios were 1.71-2.32 per standard deviation of biological aging) and showed evidence of more advanced/faster biological aging in Black participants than in White participants (Cohen's d = 0.4-0.5). These measures accounted for 13%-95% of Black-White differences in healthspan-related characteristics. Findings suggest that reducing disparities in biological aging can contribute to building health equity. %B American Journal of Epidemiology %V 191 %P 613-625 %G eng %N 4 %R https://doi.org/10.1093/aje/kwab281 %0 Journal Article %J American Journal of Epidemiology %D 2022 %T Testing Black-White Disparities in Biological Aging Among Older Adults in the United States: Analysis of DNA-Methylation and Blood-Chemistry Methods. %A Graf, Gloria H %A Crowe, Christopher L %A Kothari, Meeraj %A Kwon, Dayoon %A Jennifer J Manly %A Turney, Indira C %A Valeri, Linda %A Belsky, Daniel W %K Activities of Daily Living %K Cross-Sectional Studies %K DNA %K DNA Methylation %XBiological aging is a proposed mechanism through which social determinants drive health disparities. We conducted proof-of-concept testing of 8 DNA-methylation (DNAm) and blood-chemistry quantifications of biological aging as mediators of disparities in healthspan between Black and White participants in the 2016 wave of the Health and Retirement Study (n = 9,005). We quantified biological aging from 4 DNAm "clocks" (Horvath, Hannum, PhenoAge, and GrimAge clock), a DNAm pace-of-aging measure (DunedinPoAm), and 3 blood-chemistry measures (PhenoAge, Klemera-Doubal method biological age, and homeostatic dysregulation). We quantified Black-White disparities in healthspan from cross-sectional and longitudinal data on physical performance tests, self-reported limitations in activities of daily living, and physician-diagnosed chronic diseases, self-rated health, and survival. DNAm and blood-chemistry quantifications of biological aging were moderately correlated (Pearson's r = 0.1-0.4). The GrimAge clock, DunedinPoAm, and all 3 blood-chemistry measures were associated with healthspan characteristics (e.g., mortality effect-size hazard ratios were 1.71-2.32 per standard deviation of biological aging) and showed evidence of more advanced/faster biological aging in Black participants than in White participants (Cohen's d = 0.4-0.5). These measures accounted for 13%-95% of Black-White differences in healthspan-related characteristics. Findings suggest that reducing disparities in biological aging can contribute to building health equity.
%B American Journal of Epidemiology %V 191 %P 613-625 %G eng %N 4 %R 10.1093/aje/kwab281 %0 Thesis %D 2022 %T Three Essays on Post-Retirement Labor %A Curnutt, Gary %K Bridge employment %K Labor %K leave-behind survey %K post-retirement %K unretired %I Texas Tech University %C Lubbock, TX %V Ph.D. %G eng %U https://ttu-ir.tdl.org/bitstream/handle/2346/89225/CURNUTT-DISSERTATION-2022.pdf?sequence=1 %0 Thesis %D 2022 %T Three Essays on Risk Aversion %A Chen, Ruizhi %K financial satisfaction %K Risk Aversion %I Texas Tech University %C Lubbock, TX %V Ph.D. %G eng %U https://ttu-ir.tdl.org/bitstream/handle/2346/89994/CHEN-DISSERTATION-2022.pdf?sequence=1 %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 %XBackground 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 Journal Article %J Journal of Aging and Health %D 2022 %T Trends in Dementia Prevalence, Incidence, and Mortality in the United States (2000-2016). %A Mateo P Farina %A Yuan S Zhang %A Jung K Kim %A Mark D Hayward %A Eileen M. Crimmins %K dementia incidence %K educational composition %XThe prevalence of dementia has declined in the United States; how this parallels to changes in incidence and mortality, and how improvements in educational attainment may have influences these trends, is not known. Using the Health and Retirement Study (2000-2016), we estimated logistic regression models to examine trends in dementia prevalence and incidence, and mortality for those with and without dementia. The relative decline was about 2.4% per year for dementia prevalence and 1.9% for dementia incidence. Mortality declined similarly for those with and without dementia. Improved educational attainment accounted for decline in incidence, some of the decline in prevalence, and had a negligible role in mortality. The declines in dementia incidence provide evidence that dementia prevalence should continue to decline in the near future. These declines are most likely largely driven by continued improvements in older adult education.
%B Journal of Aging and Health %V 34 %P 100-108 %G eng %N 1 %R 10.1177/08982643211029716 %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 %XOBJECTIVES: 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 Journal Article %J Journal of Applied Gerontology %D 2022 %T Urban/Rural Digital Divide Exists in Older Adults: Does It Vary by Racial/Ethnic Groups? %A Choi, Eun Young %A Kanthawala, Shaheen %A Kim, Young Sun %A Lee, Hee Yun %K Information technology %K race %K rural and urban issues %K Social determinants of health %XDespite the overall increase in older adults' internet use, the digital divide within older Americans remains substantial, particularly for those in rural areas and with racial/ethnic minority backgrounds. The current study examines how one's residential area and racial/ethnicity relate to internet access, both singularly and in concert. Data were from the 2016 Health and Retirement Study. The sample consisted of 17,372 Americans aged 50 and above. Logistic regression analyses were performed to test the direct effects of residence and race/ethnicity and their interaction effects on internet use. The odds of internet use were significantly lower for older adults living in suburban and rural residences as well as for Black and Hispanic individuals. Furthermore, rural living reduced the probability of using the internet more for Blacks than Whites. These findings underscore the need for targeted interventions to narrow the digital divide, with particular attention required for older Blacks in rural communities.
%B Journal of Applied Gerontology %V 41 %P 1348-1356 %G eng %N 5 %R 10.1177/07334648211073605 %0 Web Page %D 2022 %T USC Scientists Identify Genetic Variants Linked to Mobility Changes in Aging %A USC Leonard David Office of Communications %K Age-related changes %K ALDH4A1 %K Genetic Variation %I University of Southern California %G eng %U https://gero.usc.edu/2022/05/02/genetic-variants-mobility-changes-in-aging/ %0 Web Page %D 2022 %T Use of government food benefits may slow cognitive aging in eligible seniors, study finds %A Christensen, Jen %K cognitive aging %K government food benefits %K SNAP %I CNN %G eng %U https://www.cnn.com/2022/11/09/health/elderly-snap-slower-memory-loss-wellness %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Validation of Claims Algorithms to Identify Alzheimer's Disease and Related Dementias. %A Ellen P McCarthy %A Chang, Chiang-Hua %A Tilton, Nicholas %A Mohammed U Kabeto %A Kenneth M. Langa %A Julie P W Bynum %K Accuracy %K algorithm %K Dementia %K Diagnosis %K Medicare %XBACKGROUND: Using billing data generated through healthcare delivery to identify individuals with dementia has become important in research. To inform tradeoffs between approaches, we tested the validity of different Medicare claims-based algorithms.
METHODS: We included 5,784 Medicare-enrolled, Health and Retirement Study participants aged >65 years in 2012 clinically assessed for cognitive status over multiple waves and determined performance characteristics of different claims-based algorithms.
RESULTS: Positive predictive value (PPV) of claims ranged from 53.8-70.3% and was highest using a revised algorithm and 1-year of observation. The trade-off of greater PPV was lower sensitivity; sensitivity could be maximized using 3-years of observation. All algorithms had low sensitivity (31.3-56.8%) and high specificity (92.3-98.0%). Algorithm test performance varied by participant characteristics, including age and race.
CONCLUSIONS: Revised algorithms for dementia diagnosis using Medicare administrative data have reasonable accuracy for research purposes, but investigators should be cognizant of the trade-offs in accuracy among the approaches they consider.
%B The Journals of Gerontology, Series A %V 77 %P 1261-1271 %G eng %N 6 %R 10.1093/gerona/glab373 %0 Thesis %D 2022 %T Weight Maintenance, a Prognostic Factor That Mediates the Incidence of Dementia: From Genetics to Etiologies %A Chen, Sunny %K Dementia %K weight management %X Objectives: Alzheimer’s disease-related dementia is a devastating neurodegenerative disease that affects millions of people. The goal of this work is to investigate biological mechanisms such as weight loss and mitochondrial function that can serve as prognostic factors for dementia, healthy aging, and longevity. Methodologies: This work consists of two separate systematic literature reviews, and an investigational study. The first review examined existing studies on weight trends in dementia. The second review investigated the role of mitochondria and its associated gene TOMM40 in aging. The third paper included a nested case control analysis of weight change patterns before and after diagnosis with dementia while controlling for genetic risk factors. Results: The first literature review revealed that weight loss can be detected at least a decade prior to a diagnosis of dementia, and weight loss continued after diagnosis. The second review on genetic variants in the TOMM40 gene found associations with longevity, cognitive function, and body mass index. A statistical analysis of 11,000 participants from the Health and Retirement Study revealed that people who lost weight in middle to late age had a two-fold increased risk of developing dementia even after adjusting for APOE gene variants, and genetic predictors for longevity and body mass index. Conclusions: Although the review suggested that polymorphisms in genes APOE and TOMM40 are associated with changes in cognition, BMI, and longevity; the analysis suggested that weight loss in dementia is an independent biological process. Pre-dementia weight loss may be useful for predicting future incidence of cognitive decline. %I Clemson University %C Clemson, SC %V Ph.D. %G eng %U https://tigerprints.clemson.edu/all_dissertations/3085 %0 Journal Article %J Journal of Economic Behavior & Organization %D 2022 %T The welfare cost of late-life depression %A Ray Miller %A Sayorn Chin %A Ashish Kumar Sedai %K consumption %K Cost-utility analysis %K depression %K Mental Health %K Retirement %X We quantify the welfare cost of depression among older Americans by estimating a panel VAR model of mental and physical health, labor supply, and consumption using data from the Health and Retirement Study. We use the estimated model and age sixty joint distribution of outcomes to simulate life-cycle paths with and without prevalence of depressive symptoms after age sixty. We estimate that the prevalence of late-life depressive symptoms costs an average of between 0.85 and 2.1 years in quality-adjusted life expectancy per person. Moreover, depression may result in an average loss of labor supply of up to 1.1 months and lifetime consumption of up to $16,000. Combining into a single compensating variation welfare metric, we estimate a bound on the average welfare cost of depression of 8–15% of annual consumption after age sixty. On aggregate, this amounts to roughly $180–360 billion annually. We also project that while the average welfare cost of late-life depression is declining slightly over birth cohorts, the welfare burden is becoming significantly more unequal. %B Journal of Economic Behavior & Organization %V 204 %P 15-36 %G eng %R 10.1016/j.jebo.2022.10.001 %0 Journal Article %J SSM - Population Health %D 2022 %T What makes life purposeful? Identifying the antecedents of a sense of purpose in life using a lagged exposure-wide approach %A Julia S. Nakamura %A Ying Chen %A Tyler J. VanderWeele %A Eric S. Kim %K Health behaviors %K Physical Health %K Psychosocial factors %K Public Health %K Purpose in life %X Prior research documents strong associations between an increased sense of purpose in life and improved health and well-being outcomes. However, less is known about candidate antecedents that lead to more purpose among older adults. Methods We used data from 13,771 participants in the Health and Retirement Study (HRS) — a diverse, national panel study of adults aged >50 in the United States, to evaluate a large number of candidate predictors of purpose. Specifically, using linear regression with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (between t0;2006/2008 and t1;2010/2012) were associated with purpose four years later (t2;2014/2016) after adjustment for a rich set of baseline covariates. Results Some health behaviors (e.g., physical activity ≥1x/week [β = 0.14, 95% CI: 0.09, 0.19]), physical health conditions (e.g., stroke [β = −0.25, 95% CI: −0.40, −0.10]), and psychosocial factors (e.g., depression [β = −0.21, 95% CI: −0.27, −0.15]) were associated with subsequent purpose four years later. However, there was little evidence that other health behaviors, physical health conditions, and psychosocial factors such as smoking, drinking, or financial strain, were associated with subsequent purpose. Conclusions Several of our candidate predictors such as volunteering, time with friends, and physical activity may be important targets for interventions and policies aiming to increase purpose among older adults. However, some effect sizes were modest and contrast with prior work on younger populations, suggesting purpose may be more easily formed earlier in life. %B SSM - Population Health %V 19 %P 101235 %G eng %R https://doi.org/10.1016/j.ssmph.2022.101235 %0 Journal Article %J Innovation in Aging %D 2022 %T WHICH NEIGHBORHOOD FEATURES MATTER MOST FOR MUSCLE STRENGTH? FINDINGS FROM THE HEALTH AND RETIREMENT STUDY %A Kate A Duchowny %A L Grisell Diaz-Ramirez %A W John Boscardin %A Peggy Cawthon %A Maria Glymour %A Scarlett Lin Gomez %K Grip strength %K Muscle Strength %K Neighborhood characteristics %X Linking data from the National Neighborhood Data Archive (NaNDA) to the 2006-2018 Health and Retirement Study (N=22,245), we fit linear mixed models to assess which of 22 built and social neighborhood environment variables predicted grip strength, a measure of total-body muscle strength. Among 22,245 respondents (mean age=63 years, SD=9.2) with up to 4 grip strength measures, neighborhood physical disorder (B= -0.25 kg, 95% CI= -0.37,-0.13), number of parks (B= 0.05 kg, 95% CI= 0.01, 0.10), number of gyms/fitness centers (B=-0.44 kg, 95% CI= -0.82, -0.07), proportion of highly developed land (B=-2.06 kg, 95% CI=-4.06, -0.07), and % urban (B=-0.66 kg, 95% CI=-1.27, -0.05) were associated with grip strength level after adjustment. No social neighborhood variables were associated with grip strength. Although preliminary, findings suggest that highly developed urbanized land may be a barrier to maintaining muscle strength in later life, but resources such as parks are associated with better outcomes. %B Innovation in Aging %V 6 %P 254–255 %G eng %N 1Suppl %R 10.1093/geroni/igac059.1010 %0 Report %D 2022 %T Will Survivors of the First Year of the COVID-19 Pandemic Have Lower Mortality? %A Gal Wettstein %A Gok, Nilufer %A Anqi Chen %A Alicia H. Munnell %K COVID-19 %K Mortality %X The mortality burden of the COVID-19 pandemic was particularly heavy among older adults, racial and ethnic minorities, and those with underlying health conditions. These groups are known to have higher mortality rates than others even in the absence of COVID. Using data from the 2019 American Community Survey, the 2018 Health and Retirement Study, and the 2020 National Vital Statistics System, this paper estimates how much lower the overall mortality rate will be for those who lived through the acute phase of the early pandemic after accounting for this selection effect of those who died from COVID. Such selection may have implications for life insurance and annuity premiums, as well as assessments of the financial standing of Social Security – if the selection is large enough to substantially alter projected survivor mortality. The paper found that: 10-year mortality rates, absent direct COVID deaths and long COVID, will likely be lower in 2021 than anticipated in 2019.However, these differences are small, ranging from a decline of 0.4 percentage points for people in their 60s to 1 percentage point for those in their 90s.The small difference is in spite of the fact that COVID mortality was, indeed, very selective, with mortality declines exceeding half the maximum possible declines, holding total COVID deaths constant, for every age group. The policy implications of the findings are: That declines in mortality due to COVID selection likely will not impact overall population mortality substantially enough to affect Social Security cost projections.Any impact of selection effects on Social Security costs will likely be swamped by ongoing mortality increases directly attributable to acute and long COVID. %B Working Papers %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/will-survivors-of-the-first-year-of-the-covid-19-pandemic-have-lower-mortality/ %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 Journal of Applied Gerontology %D 2021 %T A 2-Year Longitudinal Relationship Between Work-Family Conflict and Health Among Older Workers: Can Gardening Help? %A Eunae Cho %A Tuo-Yu Chen %A Megan C Janke %K Chronic conditions %K depression %K Disability %K Leisure activities %K Self-rated health %K Senior workers %K work-family interference %X With the graying workforce worldwide, identifying factors that facilitate older workers' health is critically important. We examined whether gardening mitigates the relationship of work-family conflict with disability, chronic conditions, depressive symptoms, and self-rated health among older workers. We drew a subsample of older workers aged 55 years and above from the Health and Retirement Study (N= 1,598). Our results indicate that the relationships of work-to-family conflict at baseline with disability and with poorer self-rated health at a 2-year follow-up were stronger for those who gardened less than those who gardened more. No significant interaction was found between family-to-work conflict and gardening in predicting the health outcomes. This study is the first to show that gardening may have a protective effect against the adverse impact of work-to-family conflict on older workers' health. %B Journal of Applied Gerontology %V 40 %P 1330-1341 %G eng %N 10 %R 10.1177/0733464820934678 %0 Journal Article %J Journal of Gerontological Social Work %D 2021 %T Acknowledging Systemic Discrimination in the Context of a Pandemic: Advancing an Anti-Racist and Anti-Ageist Movement. %A Gonzales, Ernest %A Gordon, Stacey %A Whetung, Cliff %A Connaught, Gerri %A Collazo, Jasmin %A Hinton, Jill %K COVID-19 %K Health Disparities %K systemic racism %XThis commentary draws together the confluence of current events - COVID-19 pandemic and racial injustice. Vulnerability to COVID-19 cannot be understood by age alone but within the context of inequity. We first review how COVID-19 has disproportionately affected Black and Latinx populations across the life span with the latest data from New York City Department of Health. We then discuss critical race theory and analyze longstanding inequities in health, economic, and social conditions that heighten the risk for vulnerability. We conclude with a discussion for the social work profession on the issues of defunding the police to undoing stereotypes.
%B Journal of Gerontological Social Work %V 64 %P 223-237 %G eng %N 3 %R 10.1080/01634372.2020.1870604 %0 Journal Article %J Journal of Affective Disorders %D 2021 %T Age and sex trends in depressive symptoms across middle and older adulthood: Comparison of the Canadian Longitudinal Study on Aging to American and European cohorts %A John R. Best %A Daniel R.Y. Gan %A Andrew V. Wister %A Theodore D. Cosco %K Cross-cohort comparison %K Gender Differences %K Mental Health %K Population-based trends %K SHARE %X Background : The literature suggests depressive symptoms differ in a non-linear fashion across adulthood and are more commonly reported in women as compared to men. Whether these trends are observed across countries in population-based cohorts is unclear. Methods : Cross-sectional observational study of approximately 138,000 women and men between the ages of 45 and 95 from three population-based cohorts representing Canadian, European, and American populations. Age, gender, educational attainment and annual income were assessed in each cohort. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale in the US and Canadian cohorts, and by the EURO-D in the European cohort. Results : Across all three cohorts, non-linear age trends and gender differences were observed in the report of depressive symptoms, independent from educational attainment and annual income effects. The non-linear age trends reflected a negative association between depressive symptoms and age during midlife and then a positive association in late life. Females reported greater depressive symptoms than males; however, an interaction between gender and age was also observed in the Canadian and European cohorts. Among Canadians, the gender differences were largest after age 70, whereas among Europeans, gender differences where largest among those approximately aged 60. Limitations : Limitations include: 1) the cross-sectional nature of the study, resulting in age differences potentially reflecting cohort effects rather than a developmental process; and 2) the use of different depressive symptoms measures across cohorts. Conclusions : Characterization of depressive symptoms over mid and late adulthood in women and men provides insights into potential focal points for intervention and allocation of resources. %B Journal of Affective Disorders %V 295 %P 1169-1176 %G eng %R 10.1016/j.jad.2021.08.109 %0 Journal Article %J Alzheimer's & Dementia %D 2021 %T Analysis of pleiotropic genetic effects on cognitive decline and systemic inflammation in the Women’s Health Initiative Memory Study %A Michael W Lutz %A Brown, Mark M. %A Kucgibhatla, Maragatha %A Brenda L Plassman %A Saldana, Santiago %A Snively, Beverly M %A Chen, Jiu-Chiuan %A Henderson, Victor %A JoAnn E Manson %A Pal, Lubna %A Shadyab, Aladdin H. %A Rapp, Stephen R. %A Kathleen M Hayden %K Cognitive decline %K health %K systemic inflammation %K women %X Background SNPs associated with C-reactive protein (CRP) and plasma lipids have been investigated for polygenic overlap with Alzheimer’s disease (AD) risk SNPs. Previously, we reported pleiotropic effects between SNPs associated with cognitive impairment (CI) and SNPs associated with systemic inflammation as measured by CRP and plasma lipids in the Health and Retirement Study (HRS). We sought to replicate our results in the Women’s Health Initiative Memory Study (WHIMS). Method Analysis of SNP pleiotropic effects was completed using data from 6,078 non-Hispanic White women (aged 71.4 [SD 7.4] at baseline) for whom genetic, cognitive, and/or biomarker data were available. We identified CI using WHIMS adjudicated case status (normal vs. mild cognitive impairment or probable dementia). Secondary phenotypes included baseline CRP and plasma lipid levels (HDL, LDL, and total cholesterol [TC]). Genome-wide association analyses were conducted for all phenotypes. A conditional false discovery rate framework defined genetic pleiotropy. Genetic pleiotropy was identified if SNPs were associated with CI conditional on association with secondary phenotypes (CRP, HDL, LDL, TC) at an FDR < 0.05. Functional genomic bioinformatics analysis and comparison with prior findings were conducted. Result Genetic pleiotropy was observed for CI conditional on association with the secondary phenotypes of plasma CRP, HDL, LDL, and TC. These results replicate associations for SNPs in the APOE, APOC1, PVRL2/NECTIN2 loci reported in the prior HRS study for CRP, LDL, TC. The odds ratios for the association of these SNPs with CI ranged from 0.5 to 4.0, consistent with moderate effect sizes for the APOE ε2 or ε4 alleles. For WHIMS, FDR significant results were observed in both directions for several of the traits (CRP, lipids), further supporting evidence of genetic pleiotropy. Moreover, we observed associations for SNPs in the APOE, APOC1, PVRL2/NECTIN2 loci for CI conditional on HDL. Conclusion We identified polygenic overlap between CI and CRP, LDL, HDL, and TC phenotypes in WHIMS, largely replicating prior results in the HRS. The variants and associated genes identified are involved in pathological processes including metabolic, cardiovascular, and immune response and are potentially important for AD risk prediction and development of therapeutic approaches based on anti-inflammatory mechanisms. %B Alzheimer's & Dementia %V 17 %P e050784 %G eng %R 10.1002/alz.050784 %0 Journal Article %J The Gerontologist %D 2021 %T Ask Again: Including Gender Identity in Longitudinal Studies of Aging %A Douglas William Hanes %A Sean A. P. Clouston %K cisgender %K nonbinary %K sex %K Transgender %X Information on transgender people’s health, and especially their experiences of aging, is lacking, including from major longitudinal studies of aging like the Health and Retirement Study and its sister studies in the Gateway to Global Aging Data project. This paper surveys the state of gender-data collection among major longitudinal studies and finds that all but one fail to collect adequate information on participants’ gender to determine participants’ gender identities. It identifies the unique challenges that population-wide longitudinal data-collection poses to current best practices for identifying transgender survey participants and proposes a modified “two-question model”: one question for sex assigned at birth, and a second for gender identity, both of which offer three responses. %B The Gerontologist %V 61 %P 640-649 %@ 0016-9013 %G eng %N 5 %R 10.1093/geront/gnaa107 %0 Journal Article %J Archives of Osteoporosis %D 2021 %T Assessing the roles of demographic, social, economic, environmental, health-related, and political factors on risk of osteoporosis diagnosis among older adults. %A Gough Courtney, Margaret %A Quintero, Yadira %A Godde, K %K Biomarkers %K Bone health %K Social determinants of health %XChronic stress from social/environmental pressures has been proposed to affect bone health through increased inflammation. We demonstrate that inflammation from prolonged stress does not cause changes to bone health through inflammation but instead impacts access to health care, social inequalities, and overall health, which in turn impact bone health.
PURPOSE: The study provides a comprehensive assessment of how determinants of health across demographic, psychological, mobility-related, health, environmental, and economic domains are associated with the diagnosis of osteoporosis and tests three hypotheses: (1) a diverse set of variables across domains will predict osteoporosis, (2) chronic inflammation as a result of stress (represented by high-sensitivity C-reactive protein) will not be associated with osteoporosis, and (3) the model developed will have high accuracy in predicting osteoporosis.
METHODS: Logistic regression and Cox proportional hazards models of osteoporosis diagnosis were estimated using data from 14,792 and 13,169 participants (depending on model) in the 2012-2016 waves of the Health and Retirement Study, including the Biomarker Study, the Contextual Data Resource, and validated measures of childhood socioeconomic status. Predictive accuracy was assessed using k-Nearest Neighbors Discriminant Analysis.
RESULTS: Demographic, environmental, and health-related factors were associated with osteoporosis diagnosis, and predictive accuracy of the models was good. High-sensitivity C-reactive protein was not associated with osteoporosis diagnosis.
CONCLUSION: Social determinants identified indicate access to health care, inequalities in the greater social environment (e.g., access to resources), and overall health (i.e., underlying medical conditions) are key components for developing osteoporosis and indicate underlying health inequities in this sample. There is a need to further address the interplay between primary health care and social determinants of health.
%B Archives of Osteoporosis %V 16 %P 177 %G eng %N 1 %R 10.1007/s11657-021-01042-0 %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 %XPain 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 Network Open %D 2021 %T Association Between Receipt of Cancer Screening and All-Cause Mortality in Older Adults. %A Schoenborn, Nancy L %A Sheehan, Orla C %A David L. Roth %A Cidav, Tansu %A Huang, Jin %A Chung, Shang-En %A Zhang, Talan %A Lee, Sei %A Xue, Qian-Li %A Cynthia Boyd %K all-cause mortality %K cancer screening %K Medicare %XImportance: Guidelines recommend against routine breast and prostate cancer screenings in older adults with less than 10 years' life expectancy. One study using a claims-based prognostic index showed that receipt of cancer screening itself was associated with lower mortality, suggesting that the index may misclassify individuals when used to inform cancer screening, but this finding was attributed to residual confounding because the index did not account for functional status.
Objective: To examine whether cancer screening remains significantly associated with all-cause mortality in older adults after accounting for both comorbidities and functional status.
Design, Setting, and Participants: This cohort study included individuals older than 65 years who were eligible for breast or prostate cancer screening and who participated in the 2004 Health and Retirement Study. Data were linked to Medicare claims from 2001 to 2015. Data analysis was conducted from January to November 2020.
Main Outcomes and Measures: A Cox model was used to estimate the association between all-cause mortality over 10 years and receipt of screening mammogram or prostate-specific antigen (PSA) test, adjusting for variables in a prognostic index that included age, sex, comorbidities, and functional status. Potential confounders (ie, education, income, marital status, geographic region, cognition, self-reported health, self-care, and self-perceived mortality risk) of the association between cancer screening and mortality were also tested.
Results: The breast cancer screening cohort included 3257 women (mean [SD] age, 77.8 [7.5] years); the prostate cancer screening cohort included 2085 men (mean [SD] age, 76.1 [6.8] years). Receipt of screening mammogram was associated with lower hazard of all-cause mortality after accounting for all index variables (adjusted hazard ratio [aHR], 0.67; 95% CI, 0.60-0.74). A weaker, but still statistically significant, association was found for screening PSA (aHR 0.88; 95% CI, 0.78-0.99). None of the potential confounders attenuated the association between screening and mortality except for cognition, which attenuated the aHR for mammogram from 0.67 (95% CI, 0.60-0.74) to 0.73 (95% CI, 0.64-0.82) and the aHR for PSA from 0.88 (95% CI, 0.78-0.99) to 0.92 (95% CI, 0.80-1.05), making PSA screening no longer statistically significant.
Conclusions and Relevance: In this study, cognition attenuated the observed association between cancer screening and mortality among older adults. These findings suggest that existing mortality prediction algorithms may be missing important variables that are associated with receipt of cancer screening and long-term mortality. Relying solely on algorithms to determine cancer screening may misclassify individuals as having limited life expectancy and stop screening prematurely. Screening decisions need to be individualized and not solely dependent on life expectancy prediction.
%B JAMA Network Open %V 4 %P e2112062 %G eng %N 6 %R 10.1001/jamanetworkopen.2021.12062 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T The Association between Subjective Age and Motoric Cognitive Risk Syndrome: Results from a Population-Based Cohort Study. %A Yannick Stephan %A Angelina R Sutin %A Canada, Brice %A Antonio Terracciano %K BMI %K cognitive complaint %K motoric cognitive risk %K Subjective age %K walking speed %XOBJECTIVES: The motoric cognitive risk (MCR) syndrome, characterized by cognitive complaints and slower gait speed, is a pre-dementia syndrome associated with dementia and mortality risk. The present study examined whether subjective age, that is how old or young individuals feel relative to their chronological age, is related to concurrent and incident MCR syndrome. A relation between subjective age and MCR will inform knowledge on psychological factors related to dementia risk, identify who is at greater risk, and suggest a potential target of intervention.
METHOD: The study sample was composed of 6,341 individuals aged 65 to 107 years without dementia from the Health and Retirement Study (HRS), a longitudinal study of adults aged 50 years and older. Participants completed measures of subjective age, cognitive complaints, and gait speed and provided information on demographic factors, cognition, physical activity, depressive symptoms, and body mass index (BMI) at baseline in 2008/2010. Incident MCR was assessed four and eight years later.
RESULTS: Controlling for demographic factors, an older subjective age was related to more than 60% higher likelihood of MCR at baseline and to around 50% higher risk of incident MCR over time. These associations remained significant when cognition, physical inactivity, depressive symptoms, and BMI were included in the analytic models.
CONCLUSION: This study provides evidence that how old individuals feel is related to concurrent and incident MCR beyond the effect of chronological age, other demographic factors, physical inactivity, depressive symptoms, BMI, and cognitive functioning.
%B The Journals of Gerontology: Series B %V 76 %P 2023-2028 %G eng %N 10 %R 10.1093/geronb/gbab047 %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 Innovation in Aging %D 2021 %T Association of GrimAge DNA methylation components and 2-year mortality in the Health and Retirement Study %A Meier, Helen %A Colter Mitchell %A Eileen M. Crimmins %A Bharat Thyagarajan %A Jessica Faul %K 2-year mortality %K DNA Methylation %K GrimAge %X DNA methylation (DNAm) patterns related to age and aging phenotypes (i.e., epigenetic clocks) are of growing interest as indicators of biological age and risk of negative health outcomes. We investigated associations between the components of GrimAge, an epigenetic clock estimated from DNAm patterns for seven blood protein levels and smoking pack years, and 2-year mortality in the Health and Retirement Study (HRS) to determine if any of the DNAm subcomponents were driving observed associations. A representative subsample of individuals who participated in the HRS 2016 Venus Blood Study were included in this analysis (N=3430). DNAm was measured with the Infinium Methylation EPIC BeadChip. Deaths that occurred between 2016 and 2018 contributed to 2-year mortality estimates (N=159, 4.5% of the sample). Weighted logistic regression estimated the association first between GrimAge and 2-year mortality and second between the DNAm subcomponents and 2-year mortality. All models were adjusted for age, sex, race/ethnicity, education, current smoking status, smoking pack years and cell composition of the biological sample. The average GrimAge for participants with and without 2-year mortality was 77 years 68 years respectively. A one-year increase in GrimAge was associated with 17% higher odds of 2-year mortality (95% CI: 1.16, 1.17). Two of the seven DNAm blood protein subcomponents of GrimAge (TIMP metallopeptidase inhibitor 1, adrenomedullin) and DNAm smoking pack years were associated with 2-year mortality and DNAm smoking pack years appeared to drive the overall GrimAge association with 2-year mortality. GrimAge was a better predictor of 2-year mortality than the DNAm subcomponents individually. %B Innovation in Aging %V 5 %P 675 %G eng %N Suppl _1 %R https://doi.org/10.1093/geroni/igab046.2525 %0 Journal Article %J The Journals of Gerontology: Series A %D 2021 %T Associations of Age, Sex, Race/Ethnicity and Education with 13 Epigenetic Clocks in a Nationally Representative US Sample: The Health and Retirement Study. %A Eileen M. Crimmins %A Bharat Thyagarajan %A Morgan E. Levine %A David R Weir %A Jessica Faul %K DNA Methylation %K DunedinPoAm38 %K Epigenetic Age %K GrimAge %K PhenoAgeAcceleration %XBACKGROUND: Many DNA methylation based indicators have been developed as summary measures of epigenetic aging. We examine the associations between 13 epigenetic clocks, including 4 second generation clocks, as well as the links of the clocks to social, demographic and behavioral factors known to be related to health outcomes: sex, race/ethnicity, socioeconomic status, obesity and lifetime smoking pack years.
METHODS: The Health and Retirement Study is the data source which is a nationally representative sample of Americans over age 50. Assessment of DNA methylation was based on the EPIC chip and epigenetic clocks were developed based on existing literature.
RESULTS: The clocks vary in the strength of their relationships with age, with each other and with independent variables. Second generation clocks trained on health related characteristics tend to relate more strongly to the sociodemographic and health behaviors known to be associated with health outcomes in this age group.
CONCLUSIONS: Users of this publicly available data set should be aware that epigenetic clocks vary in their relationships to age and to variables known to be related to the process of health change with age.
%B The Journals of Gerontology: Series A %V 76 %P 1117-1123 %G eng %N 6 %R 10.1093/gerona/glab016 %0 Journal Article %J The Journals of Gerontology: Series A %D 2021 %T Associations of Loneliness and Social Isolation with Health Span and Life Span in the US Health and Retirement Study %A Crowe, CL %A Benjamin W Domingue %A Hu, G %A Keyes, KM %A Kwon, Dy %A Daniel W. Belsky %K Healthspan %K Loneliness %K social isolation %X Background Loneliness and social isolation are emerging public health challenges for aging populations.Methods We followed N=11,302 US Health and Retirement Study (HRS) participants aged 50-95 from 2006-2014 to measure persistence of experiences of loneliness and exposure to social isolation. We tested associations of longitudinal loneliness and social isolation phenotypes with disability, morbidity, mortality, and biological aging through 2018.Results During follow-up, 18% of older adults met criteria for loneliness, with 6% meeting criteria at two or more follow-up assessments. For social isolation, these fractions were 21% and 8%. HRS participants who experienced loneliness and were exposed to social isolation were at increased risk for disease, disability, and mortality. Those experiencing persistent loneliness were at a 57% increased hazard of mortality compared to those who never experienced loneliness. For social isolation, the increase was 28%. Effect-sizes were somewhat larger for counts of prevalent activity limitations and somewhat smaller for counts of prevalent chronic diseases. Covariate adjustment for socioeconomic and psychological risks attenuated but did not fully explain associations. Older adults who experienced loneliness and were exposed to social isolation also exhibited physiological indications of advanced biological aging (Cohen’s-d for persistent loneliness and social isolation=0.26 and 0.21, respectively). For loneliness, but not social isolation, persistence was associated with increased risk.Conclusion Deficits in social connectedness prevalent in a national sample of US older adults were associated with morbidity, disability, and mortality and with more advanced biological aging. Bolstering social connectedness to interrupt experiences of loneliness may promote healthy aging.Competing Interest StatementThe authors have declared no competing interest.Funding StatementThis research was supported by the Robert N Butler Columbia Aging Center, Russel Sage Foundation (grant 1810-08987), and the Jacobs Foundation. CLC is supported by a fellowship from the National Institute of Mental Health (5T32MH013043).Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The Columbia University Irving Medical Center IRB approved this research.All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data are publicly available on the Health and Retirement Study (HRS) website. %B The Journals of Gerontology: Series A %V 76 %P 1997-2006 %G eng %N 11 %R 10.1093/gerona/glab128 %0 Journal Article %J Journal of National Medical Association %D 2021 %T Attending to the Psychosocial Needs of Older Hispanic, Black and Non-Hispanic White Women and Their Breast Cancer Screening Behaviors %A Tamara J. Cadet %A Shanna Lynn Burke %A Bakk, Louanne %A Frances R. Nedjat-Haiem %A Tracy Schroepfer %K Blacks %K Mammograms %K Older women %K Psychosocial factors %X Background Cancer risk increases with age. Despite breast cancer screening guidelines, older minorities are less likely to obtain screenings. Many factors influence cancer screening participation, though the literature rarely examines factors influencing cancer screening in older adult minority populations. Methods Using 2008 and 2012 waves of data from the Health and Retirement study, we examined and compared the relationships between psychosocial factors and breast screening participation among older African American, Hispanic and non-Hispanic White women. We utilized logistic regression to determine the influence of psychosocial factors (satisfaction with aging, religiosity, perceived control, emotions, purpose in life) in 2008 predicting breast cancer screening participation in 2012, given the increasing importance of understanding health behaviors as predicted by prior circumstances. While controlling for other variables, the major findings demonstrated that the odds of having a mammogram among Hispanics decreased as feelings that ‘things were getting worse’ with age intensified; and screening was more likely among Hispanic religious women. The odds of obtaining a mammogram increased with increasing purpose in life for Hispanics. Conclusions and Implications These findings suggest the need for comprehensive geriatric assessments to understand the perspectives of older minority women, and provides formative data to inform shared decision-making interventions. %B Journal of National Medical Association %V 113 %P 342-350 %@ 0027-9684 %G eng %N 3 %R https://doi.org/10.1016/j.jnma.2020.09.145 %0 Journal Article %J BMJ Open %D 2021 %T Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial. %A Paula, Tassiane Cristine Santos %A Chagas, Camila %A Noto, Ana Regina %A Formigoni, Maria Lucia Oliveira Souza %A Pereira, Tiago Veiga %A Ferri, Cleusa Pinheiro %K Aged %K Alcohol Drinking %K Alcoholism %K Brazil %K Community Health Workers %K Cost-Benefit Analysis %K Crisis Intervention %K Humans %K Primary Health Care %K Quality of Life %K Randomized Controlled Trials as Topic %XINTRODUCTION: Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this.
METHODS AND ANALYSIS: Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde).6 months.The primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance-assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity-assessed by the International Physical Activity Questionnaire, depression-assessed by the Geriatric Depression Scale and quality of life-assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle.
ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations.
TRIAL REGISTRATION NUMBER: RBR-8rcxkk.
%B BMJ Open %V 11 %P e043918 %G eng %N 5 %R 10.1136/bmjopen-2020-043918 %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 %XBACKGROUND: 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 Journal Article %J The Journals of Gerontology, Series B %D 2021 %T Change in Mobility: Consistency of Estimates and Predictors Across Studies of Older Adults. %A Jennifer C. Cornman %A Dana A Glei %A Weinstein, Maxine %K Decline %K Measures %K physical functioning %K Recovery %K Risk Factors %XOBJECTIVES: This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.
METHODS: Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables.
RESULTS: Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages.
DISCUSSION: To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.
%B The Journals of Gerontology, Series B %V 76 %P 209-218 %G eng %N 1 %R 10.1093/geronb/gbz091 %0 Journal Article %J Sustainability %D 2021 %T Cognitive Functioning: An Underlying Mechanism of Age and Gender Differences in Self-Assessed Risk Tolerance among an Aging Population %A Sharma, Muna %A Chatterjee, Swarn %K Age %K Cognition %K gender %K mediation %K Risk tolerance %X Attitude toward risk plays a vital role in an individual’s financial decision-making and well-being. Past studies have found significant association of age and gender with risk tolerance. However, studies on the factors affecting the underlying mechanism are scant. The purpose of this research is to test whether cognitive functioning mediates the association between age, gender, and self-assessed risk tolerance. Using the 2014 wave of the Health and Retirement Study, path analysis was conducted to test the hypothesized model. Results revealed a negative direct association between age and risk tolerance. Moreover, the study also found a lower level of risk tolerance in women. A bootstrap-based confidence interval revealed that a significant portion of the relationship between age and risk tolerance was mediated by cognition. However, the gender difference in risk tolerance was not explained by cognition. Financial planning practitioners and policymakers should understand the contribution of cognitive functioning toward the difference in risk tolerance in older populations and implement strategies to reinforce cognitive functioning to mitigate the adversity of a low level of risk tolerance. %B Sustainability %V 13 %P 2361 %G eng %N 4 %R 10.3390/su13042361 %0 Report %D 2021 %T Cognitive Impairment and Prevalence of Memory-Related Diagnoses among U.S. Older Adults %A Qian, Yuting %A Chen, Xi %A Tang, Diwen %A Amy Kelley %A Li, Jing %K cognitive aging %K cognitive impairment %K Dementia %K Medicare %K memory-related diagnosis %X Cognitive impairment creates significant challenges to health and well-being of the fast-growing aging population. Early recognition of cognitive impairment may confer important advantages, allowing for diagnosis and appropriate treatment, education, psychosocial support, and improved decision-making regarding life planning, health care, and financial matters. Yet the prevalence of memory-related diagnoses among older adults with early symptoms of cognitive impairment is unknown. Using 2000-2014 Health and Retirement Survey - Medicare linked data, we leveraged within-individual variation in a longitudinal cohort design to examine the relationship between incident cognitive impairment and receipt of diagnosis among American older adults. Receipt of a memory-related diagnosis was determined by ICD-9-CM codes. Incident cognitive impairment was assessed using the modified Telephone Interview of Cognitive Status (TICS). We found overall low prevalence of early memory-related diagnosis, or high rate of underdiagnosis, among older adults showing symptoms of cognitive impairment, especially among non-whites and socioeconomically disadvantaged subgroups. Our findings call for targeted interventions to improve the rate of early diagnosis, especially among vulnerable populations. %B GLO Discussion Paper %I Global Labor Organization %C Essen, Germany %G eng %U https://www.econstor.eu/bitstream/10419/229436/1/GLO-DP-0777.pdf %0 Thesis %D 2021 %T Comparison of Functional and Cognitive Capacity Among Cancer Survivors and Cancer-free Individuals in an Older US population %A Chen, Xueyu %K Cancer Survivors %K cancer-free %K Cognition %X Background The global population is aging rapidly, and cancer is one of the major health concerns of an aging population. Older cancer survivors can be challenged by the toxicities associated with cancer and its treatment in addition to the normal declines in functional and cognitive capacities due to aging. However, we only have limited data on whether older cancer survivors have worse functional and cognitive capacity profiles than their cancer-free counterparts. Method For this study, 7,459 participants from Health and Retirement Study (HRS) and completed functional capacity questionnaire between Feb 2016 to April 2018 were included, among which 1,238 are cancer survivors, and the rest are cancer-free. Answers from biennial HRS questionnaires were used for exposure and outcome ascertainment. Poisson regression models with robust variance were used to estimate the risk ratio (RR) for the association between cancer history and prevalence of functional and cognitive limitation. Stratified analysis by race/ethnicity was performed to explore potential race/ethnic group differences. Sensitivity analyses excluding demented participants were performed to evaluate the reliability of the primary analyses. Results A significant positive association was observed between cancer history and any disability in basic ADLs (adjusted Risk Ratio = 1.09, 95% CI (1.01, 1.18). A significant positive association was observed between cancer history and any disability in IADLs (adjusted Risk Ratio = 1.11 (1.02, 1.22). Cognitive capacity did not differ significantly between cancer survivors and cancer-free participants. Low educational level, depressive symptoms within 12-month, and dementia history may also contribute to poor functional and cognitive capacities. Stratified analyses showed that non-Hispanic white has similar results to the analytic population. Because of group size, other race/ethnic groups do not show statistically significant associations, but the point estimate directions are similar to the analytic population except for gender. Sensitivity analysis results were similar to that of the primary analysis. Conclusion Older U.S. individuals with cancer history have reduced functional capacities but not cognitive capacity compared to older U.S. individuals without cancer history. More research is needed to study these differences and how to improve older cancer survivors’ functional capacity, therefore optimizing health in elderly cancer survivors. %I Johns Hopkins University %C Baltimore, MD %G eng %U http://jhir.library.jhu.edu/handle/1774.2/64163 %0 Report %D 2021 %T The Consequences of Current Benefit Adjustments for Early and Delayed Claiming %A Andrew G. Biggs %A Anqi Chen %A Alicia H. Munnell %K interest rates %K Life Expectancy %K Social Security claiming %X Workers have the option of claiming Social Security retirement benefits at any age between 62 and 70, with later claiming resulting in higher monthly benefits. These higher monthly benefits reflect an actuarial adjustment designed to keep lifetime benefits equal, for an individual with average life expectancy, regardless of when benefits are claimed. The actuarial adjustments, however, are decades old. Since then, interest rates have declined; life expectancy has increased; and longevity improvements have been much greater for high earners than low earners. This paper explores how changes in longevity and interest rates have affected the fairness of the actuarial adjustment over time and how the disparity in life expectancy affects the equity across the income distribution. It also looks at the impact of these developments on the costs of the program and the progressivity of benefits. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston, MA %G eng %U https://crr.bc.edu/working-papers/the-consequences-of-current-benefit-adjustments-for-early-and-delayed-claiming/ %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 %XBACKGROUND 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 Psychology and Aging %D 2021 %T Cross-sectional and prospective association between personality traits and IADL/ADL limitations. %A Canada, Brice %A Yannick Stephan %A Fundenberger, Hervé %A Angelina R Sutin %A Antonio Terracciano %K ADL disability %K ELSA %K IADLS %K Personality Traits %XPrior research has shown that personality traits are associated with activities of daily living (ADLs) and instrumental ADLs (IADLs). To advance research on the psychological factors related to aging-related functional limitations, this study examined the relation between personality traits and both concurrent and incident functional limitations, tested whether these associations are similar across IADLs and ADLs, and tested potential mediators of these associations. Participants were drawn from eight longitudinal samples from the U.S., England, and Japan. Participants provided data on demographic variables, the five major personality traits, and on the Katz ADL-scale and Lawton IADL-scales. IADL/ADL limitations were assessed again 3-18 years later. A consistent pattern of associations was found between personality traits and functional limitations, with associations slightly stronger for IADLs than ADLs, and robust across samples that used different measures and from different cultural contexts. The meta-analysis indicated that higher neuroticism was related to a higher likelihood of concurrent and incident IADL/ADL limitations, and higher conscientiousness, extraversion, and openness were associated with lower risk. Higher agreeableness was associated with lower risk of concurrent IADL/ADL, but unrelated to incident limitations. Physical activity, disease burden, depressive symptoms, self-rated health, handgrip strength, falls, and smoking status mediated the relation between personality traits and incident IADL/ADL limitations. The present study indicates that personality traits are risk factors for both IADL and ADL limitations across multiple national cohorts, identifies potential mediators, and informs conceptual models on psychological risk factors for functional decline. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
%B Psychology and Aging %V 36 %P 309-321 %G eng %N 3 %R 10.1037/pag0000502 %0 Journal Article %J Medical Care %D 2021 %T Dementia Diagnosis Disparities by Race and Ethnicity. %A Lin, Pei-Jung %A Allan T Daly %A Olchanski, Natalia %A Joshua T Cohen %A Peter J Neumann %A Jessica Faul %A Howard M Fillit %A Karen M Freund %K dementia diagnosis %K Racial Disparities %XBACKGROUND: Dementia is often underdiagnosed and this problem is more common among some ethnoracial groups.
OBJECTIVE: The objective of this study was to examine racial and ethnic disparities in the timeliness of receiving a clinical diagnosis of dementia.
RESEARCH DESIGN: This was a prospective cohort study.
SUBJECTS: A total of 3966 participants age 70 years and above with probable dementia in the Health and Retirement Study, linked with their Medicare and Medicaid claims.
MEASURES: We performed logistic regression to compare the likelihood of having a missed or delayed dementia diagnosis in claims by race/ethnicity. We analyzed dementia severity, measured by cognition and daily function, at the time of a dementia diagnosis documented in claims, and estimated average dementia diagnosis delay, by race/ethnicity.
RESULTS: A higher proportion of non-Hispanic Blacks and Hispanics had a missed/delayed clinical dementia diagnosis compared with non-Hispanic Whites (46% and 54% vs. 41%, P<0.001). Fully adjusted logistic regression results suggested more frequent missed/delayed dementia diagnoses among non-Hispanic Blacks (odds ratio=1.12; 95% confidence interval: 0.91-1.38) and Hispanics (odds ratio=1.58; 95% confidence interval: 1.20-2.07). Non-Hispanic Blacks and Hispanics had a poorer cognitive function and more functional limitations than non-Hispanic Whites around the time of receiving a claims-based dementia diagnosis. The estimated mean diagnosis delay was 34.6 months for non-Hispanic Blacks and 43.8 months for Hispanics, compared with 31.2 months for non-Hispanic Whites.
CONCLUSIONS: Non-Hispanic Blacks and Hispanics may experience a missed or delayed diagnosis of dementia more often and have longer diagnosis delays. When diagnosed, non-Hispanic Blacks and Hispanics may have more advanced dementia. Public health efforts should prioritize racial and ethnic underrepresented communities when promoting early diagnosis of dementia.
%B Medical Care %V 59 %P 679-686 %G eng %N 8 %R 10.1097/MLR.0000000000001577 %0 Journal Article %J Medical Care %D 2021 %T Demographic Characteristics Driving Disparities in Receipt of Long-term Services and Supports in the Community Setting. %A Travers, Jasmine L %A Naylor, Mary D %A Norma B Coe %A Meng, Can %A Li, Fangyong %A Cohen, Andrew B %K community setting %K Demographics %K Long-term services and supports %K Minority %K race disparity %XBACKGROUND: Research suggests that growth in Black and Hispanic (minority) older adults' nursing home (NH) use may be the result of disparities in access to community-based and alternative long-term services and supports (LTSS).
OBJECTIVE: We aimed to determine whether minority groups receiving care in NHs versus the community had fewer differences in their functional needs compared with the differences in nonminority older adults, suggesting a disparity.
METHODS: We identified respondents aged 65 years or above with a diagnosis of Alzheimer disease or dementia in the 2016 Health and Retirement Study who reported requiring LTSS help. We performed unadjusted analyses to assess the difference in functional need between community and NH care. Functional need was operationalized using a functional limitations score and 6 individual activities of daily living. We compared the LTSS setting for minority older adults to White older adults using difference-in-differences.
RESULTS: There were 186 minority older adults (community=75%, NH=25%) and 357 White older adults (community=50%, NH=50%). Between settings, minority older adults did not differ in education or marital status, but were younger and had greater income in the NH versus the community. The functional limitations score was higher in NHs than in the community for both groups. Functional needs for all 6 activities of daily living for the minority group were greater in NHs compared with the community.
CONCLUSION: Functional need for minority older adults differed by setting while demographics varied in unexpected ways. Factors such as familial and financial support are important to consider when implementing programs to keep older adults out of NHs.
%B Medical Care %V 59 %P 537-542 %G eng %N 6 %R 10.1097/MLR.0000000000001544 %0 Journal Article %J Journal of Aging and Health %D 2021 %T Depressive Symptoms and Multimorbidity: Is There an Association for Older Black Americans? %A Cho, Seungjong %A Tyrone C Hamler %K Chronic Diseases %K Depressive symptoms %K mental health disparities %XMany existing studies have reported a higher prevalence of depressive symptoms among older Black Americans. They also experience a disproportionate burden of multimorbidity, the presence of multiple chronic conditions. Therefore, this study was to identify the association between depressive symptomatology and multimorbidity among older Black Americans. This study analyzed the 2014 Health and Retirement Study ( = 1206). A negative binomial regression was applied to assess the association between multimorbidity and depressive symptomatology. Higher levels of chronic health problems were associated with higher levels of depressive symptomatology among older Black Americans ( = 1.093; = .002). Lower self-reported health, lower income, and lower educational attainment were also related to higher depressive symptoms. Older Black Americans experience vulnerability on multiple levels, and shouldering additional psychosocial and financial burdens adds to already established physical health disparities. This requires critical attention from both practice and policy.
%B Journal of Aging and Health %V 33 %P 310-316 %G eng %N 5-6 %R 10.1177/0898264320981244 %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 %XBACKGROUND: 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 %XAlthough 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 Journal Article %J JAMA Psychiatry %D 2021 %T Discriminating Heterogeneous Trajectories of Resilience and Depression After Major Life Stressors Using Polygenic Scores. %A Schultebraucks, Katharina %A Choi, Karmel W %A Isaac R Galatzer-Levy %A George A. Bonanno %K depression %K polygenic score %K Resilience %XImportance: Major life stressors, such as loss and trauma, increase the risk of depression. It is known that individuals show heterogeneous trajectories of depressive symptoms following major life stressors, including chronic depression, recovery, and resilience. Although common genetic variation has been associated with depression risk, genomic factors that could help discriminate trajectories of risk vs resilience following adversity have not been identified.
Objective: To assess the discriminatory accuracy of a deep neural net combining joint information from 21 psychiatric and health-related multiple polygenic scores (PGSs) for discriminating resilience vs other longitudinal symptom trajectories with use of longitudinal, genetically informed data on adults exposed to major life stressors.
Design, Setting, and Participants: The Health and Retirement Study is a longitudinal panel cohort study in US citizens older than 50 years, with data being collected once every 2 years between 1992 and 2010. A total of 2071 participants who were of European ancestry with available depressive symptom trajectory information after experiencing an index depressogenic major life stressor were included. Latent growth mixture modeling identified heterogeneous trajectories of depressive symptoms before and after major life stressors, including stable low symptoms (ie, resilience), as well as improving, emergent, and preexisting/chronic symptom patterns. Twenty-one PGSs were examined as factors distinctively associated with these heterogeneous trajectories. Local interpretable model-agnostic explanations were applied to examine PGSs associated with each trajectory. Data were analyzed using the DNN model from June to July 2020.
Exposures: Development of depression and resilience were examined in older adults after a major life stressor, such as bereavement, divorce, and job loss, or major health events, such as myocardial infarction and cancer.
Main Outcomes and Measures: Discriminatory accuracy of a deep neural net model trained for the multinomial classification of 4 distinct trajectories of depressive symptoms (Center for Epidemiologic Studies-Depression scale) based on 21 PGSs using supervised machine learning.
Results: Of the 2071 participants, 1329 were women (64.2%); mean (SD) age was 55.96 (8.52) years. Of these, 1638 (79.1%) were classified as resilient, 160 (7.75) in recovery (improving), 159 (7.7%) with emerging depression, and 114 (5.5%) with preexisting/chronic depression symptoms. Deep neural nets distinguished these 4 trajectories with high discriminatory accuracy (multiclass micro-average area under the curve, 0.88; 95% CI, 0.87-0.89; multiclass macro-average area under the curve, 0.86; 95% CI, 0.85-0.87). Discriminatory accuracy was highest for preexisting/chronic depression (AUC 0.93), followed by emerging depression (AUC 0.88), recovery (AUC 0.87), resilience (AUC 0.75).
Conclusions and Relevance: The results of the longitudinal cohort study suggest that multivariate PGS profiles provide information to accurately distinguish between heterogeneous stress-related risk and resilience phenotypes.
%B JAMA Psychiatry %V 78 %P 744-752 %G eng %N 7 %R 10.1001/jamapsychiatry.2021.0228 %0 Journal Article %J The Journal of Retirement %D 2021 %T Do Households Increase Their Savings When the Kids Leave Home? %A Irena Dushi %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %A Anthony Webb %A Anqi Chen %K children %K consumption %K Households %K Savings %X Much of the disagreement over whether households are adequately prepared for retirement reflects differences in assumptions regarding the extent to which consumption declines when the kids leave home. If consumption declines substantially when the kids leave home, as some life-cycle models of retirement saving assume, households need to achieve lower replacement rates in retirement and need to accumulate less wealth. Using administrative tax data from the Health and Retirement Study (HRS), as well as the Survey of Income and Program Participation (SIPP), this article investigates whether household consumption declines when kids leave the home and, if so, by how much. Because consumption data are noisy and savings is the flip side of consumption, this article examines whether savings in 401(k) plans increase when the kids leave home. The article also investigates alternative methods of saving, including non-401(k) savings and increased mortgage payments. %B The Journal of Retirement %V 9 %P 21-35 %G eng %N 2 %R https://doi.org/10.3905/jor.2021.1.091 %0 Report %D 2021 %T Do Retirees Want to Consume More, Less, or the Same as They Age? %A Anqi Chen %A Alicia H. Munnell %K consumption %K Retirees %X The conventional view is that retirees prefer steady consumption as they age, but research focusing on new retirees tends to show a sharp drop right at retirement. This study looks at consumption over longer periods and explores whether wealth and health constraints might cause retirees to consume less than they prefer. The findings confirm that, for households as a whole, consumption does decline. However, these declines are at least partly driven by constraints, because households that are wealthier and healthier have relatively flat consumption. %B Briefs %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/briefs/do-retirees-want-to-consume-more-less-or-the-same-as-they-age/ %0 Journal Article %J Social Work Research %D 2021 %T Does Perceived Loneliness Matter for Diverse Older Men and Their Prostate-Specific Antigen Testing Behaviors? %A Tamara J. Cadet %A Shanna Lynn Burke %A Mitchell, Jamie %A Conner, Kyaien O %A Frances R. Nedjat-Haiem %K Antigens %K Men %K perceived loneliness %K prostate %X Loneliness is associated with poorer health practices and fewer health-promoting behaviors and may be associated with greater use of the health care system. Given national conversations about aging in context, this investigation explored the relationship between perceptions of loneliness in 2008 and prostate cancer screening participation in 2008 and 2012. Using data from the Health and Retirement Study, authors examined the relationship between loneliness and prostate cancer screening in 2008 and 2012 among Black, Hispanic, and non-Hispanic White men, ages 50 to 74 years (N = 4,875) using a series of logistic regression models. Findings indicate that White men who indicated being more lonely were less likely to participate in screening in 2008 and 2012. For Black men, there was a reduced likelihood of screening in 2012 with one aspect of decreasing loneliness. Social workers have unique training focusing on the person-in-environment model. Use of the person-in-environment model can help health care providers understand men’s experiences and their feelings or needs related to cancer screening participation. Given the lack of focus on men’s health-promoting behaviors related to loneliness, this study provides formative data to test interventions to increase the well-being of older men. %B Social Work Research %V 45 %P 117–128 %@ 1070-5309 %G eng %N 2 %R 10.1093/swr/svab002 %0 Journal Article %J Innovation in Aging %D 2021 %T Does Relationship End Precede Cognitive Decline? An Analysis of the Health and Retirement Study %A Hanes, Douglas %A Clouston, Sean %K Cognitive decline %K Divorce %K Relationships %X Relationship status is thought to be associated with cognitive health in older adults, with married persons performing better on memory assessments than unmarried-cohabitating, single, divorced, and widowed persons. However, questions remain about whether relationship termination causes cognitive decline, is a result of it, or whether they share a cause; and the mechanisms by which such a relationship might operate. To address this gap in the literature, we hypothesized that relationship termination could affect cognition via the following five pathways: (1) post-termination depression; (2) loss of distributed-cognition partner; (3) cognitive depletion from caring for partner in declining and ultimately terminal health; (4) divorce to preserve assets to qualify for Medicaid to cover healthcare for cognitive decline; and (5) post-termination changes in neuropsychiatric symptoms alongside a pre-existing neurodegenerative condition that also causes cognitive decline. Using data from the 2000–2016 waves of the Health and Retirement Study (HRS; N = 23,393), we found that relationship termination, whether due to divorce or widowhood, was associated with cognitive decline. Using mixed-effects regression we found that the rate of cognitive decline increased after relationship termination (widowhood: □ = -0.587, p \<0.001; divorce: □ = -0.221, p \<0.001), supporting mechanism (5). Using HRS data for respondents and their spouses’ mental and physical health, health insurance, and activities of daily living, we also find support for mechanisms (1) and (3). Relationship termination is a critical juncture in a person’s life course that has multiple implications and may, ultimately, worsen patients’ conditions. %B Innovation in Aging %V 5 %P 281 %G eng %R 10.1093/geroni/igab046.1092 %0 Journal Article %J Statistics in Medicine %D 2021 %T Dynamic latent variable models for the analysis of cognitive abilities in the elderly population. %A Bianconcini, Silvia %A Cagnone, Silvia %K generalized linear latent variable models %K health mental status %K intractable likelihood %K vector autoregressive process %XCognitive functioning is a key indicator of overall individual health. Identifying factors related to cognitive status, especially in later life, is of major importance. We concentrate on the analysis of the temporal evolution of cognitive abilities in the elderly population. We propose to model the individual cognitive functioning as a multidimensional latent process that accounts also for the effects of individual-specific characteristics (gender, age, and years of education). The proposed model is specified within the generalized linear latent variable framework, and its efficient estimation is obtained using a recent approximation technique, called dimensionwise quadrature. It provides a fast and streamlined approximate inference for complex models, with better or no degradation in accuracy compared with standard techniques. The methodology is applied to the cognitive assessment data from the Health and Retirement Study combined with the Asset and Health Dynamic study in the years between 2006 and 2010. We evaluate the temporal relationship between two dimensions of cognitive functioning, that is, episodic memory and general mental status. We find a substantial influence of the former on the evolution of the latter, as well as evidence of severe consequences on both cognitive abilities among less-educated and older individuals.
%B Statistics in Medicine %V 40 %P 4410-4429 %G eng %N 20 %R 10.1002/sim.9038 %0 Journal Article %J The Gerontologist %D 2021 %T Educational Benefits and Cognitive Health Life Expectancies: Racial/Ethnic, Nativity, and Gender Disparities %A Marc Garcia %A Brian Downer %A Chi-Tsun Chiu %A Joseph L Saenz %A Ortiz, Kasim %A Rebeca Wong %K cognitive impairment %K Dementia %K Life Expectancy %K nativity %K Race/ethnicity %X To examine racial/ethnic, nativity, and gender differences in the benefits of educational attainment on cognitive life expectancies among older adults in the United States.We used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively healthy, cognitively impaired/no dementia (CIND), and dementia life expectancies by gender for older White, Black, U.S.-born and foreign-born Hispanic adults with less than high school, high school, and some college or more.White respondents lived a greater percentage of their remaining lives cognitive healthy than their minority Black or Hispanic counterparts, regardless of level of education. Among respondents with some college or more, versus less than high school, Black and U.S.-born Hispanic women exhibited the greatest increase (both 37 percentage points higher) in the proportion of total life expectancy spent cognitively healthy; whereas White women had the smallest increase (17 percentage points higher). For men, the difference between respondents with some college or more, versus less than high school, was greatest for Black men (35 percentage points higher) and was lowest for U.S.-born Hispanic men (21 percentage points higher).Our results provide evidence that the benefits of education on cognitive life expectancies are largest for Black men and women, and U.S.-born Hispanic women. The combination of extended longevity and rising prevalence of Alzheimer’s disease point to the need for understanding why certain individuals spend an extended period of their lives with poor cognitive health. %B The Gerontologist %V 61 %P 330-340 %@ 0016-9013 %G eng %N 3 %R 10.1093/geront/gnaa112 %0 Conference Proceedings %B 32nd Reves Meeting %D 2021 %T Educational Differences in Life Span Variation in Dementia Incidence %A Hyungmin Cha %A Mateo P Farina %A Chi-Tsun Chiu %A Mark D Hayward %K Dementia %K Education %X Objective: To examine educational differences in life span variation in dementia in the United States and assess the role of adult income in explaining the variation within educational levels. Method: We use the Health and Retirement Study (2000-2014) and techniques of microsimulation and bootstrap to estimate the age distribution of dementia incidence for major education groups, controlling and not controlling for adult income. Hypotheses: We anticipate that life span variation in dementia incidence will be substantially larger among less educated persons than among highly educated persons. Part of the reason for the larger educational variation among less educated persons may reflect both economic vulnerability in later adulthood (a large frail tail) and economic success (a smaller but visible robust tail). Among well educated people, we expect to see a compression of dementia reflecting a very small frail tail and the postponement of dementia until ages proximate to death %B 32nd Reves Meeting %I Reves Network on Health Expectancy %C Virtual %G eng %U https://www.reves2021.org/sites/reves2021.org/files/2021-05/Schedule_REVES2021_withAbstract.pdf %0 Journal Article %J Journal of the American Geriatrics Society %D 2021 %T The epidemiology of social isolation and loneliness among older adults during the last years of life. %A Ashwin A Kotwal %A Irena Cenzer %A Linda J. Waite %A Kenneth E Covinsky %A Perissinotto, Carla M %A W John Boscardin %A Louise C Hawkley %A Dale, William %A Smith, Alexander K %K Cognition %K end of life %K Loneliness %K Palliative care %K social isolation %XBACKGROUND: Social isolation and loneliness are critical to the health of older adults, but they have not been well-described at the end of life.
OBJECTIVES: To determine the prevalence and correlates of social isolation and loneliness among older adults in the last years of life.
DESIGN: Nationally representative, cross-sectional survey.
SETTING: Health and Retirement Study, 2006-2016 data.
PARTICIPANTS: Adults age > 50 interviewed once in the last 4 years of life (n = 3613).
MEASUREMENTS: We defined social isolation using a 15-item scale measuring household contacts, social network interaction, and community engagement, and frequent loneliness using the 3-item UCLA Loneliness Scale. We used multivariable logistic regression to determine their adjusted prevalence by time prior-to-death and by subgroups of interest.
RESULTS: Approximately 19% experienced social isolation, 18% loneliness, and 5% both in the last 4 years of life (correlation = 0.11). The adjusted prevalence of social isolation was higher for individuals nearer to death (4 years: 18% vs 0-3 months: 27%, p = 0.05) and there was no significant change in loneliness (4 years: 19% vs 0-3 months: 23%, p = 0.13). Risk factors for both isolation and loneliness included (p < 0.01): low net-worth (Isolation: 34% vs 14%; Loneliness: 29% vs 13%), hearing impairment (Isolation: 26% vs 20%; Loneliness: 26% vs 17%), and difficulty preparing meals (Isolation: 27% vs 19%; Loneliness: 29% vs 15%). Factors associated with loneliness, but not social isolation, included being female, pain, incontinence, and cognitive impairment.
CONCLUSIONS: Social isolation and loneliness are common at the end of life, affecting 1 in 4 older adults, but few experience both. Rates were higher for older adults who were poor and experienced functional or sensory impairments. Results can inform clinical efforts to identify and address end-of-life psychosocial suffering and health policies which prioritize social needs at the end of life.
%B Journal of the American Geriatrics Society %V 69 %P 3081-3091 %G eng %N 11 %R 10.1111/jgs.17366 %0 Journal Article %J Innovation in Aging %D 2021 %T Epigenome Wide Associations of Smoking Behavior in the Health and Retirement Study %A Fisher, Jonah %A Meier, Helen %A Jessica Faul %A Colter Mitchell %A Eileen M. Crimmins %A Bharat Thyagarajan %K DNA Methylation %K epigenome-wide association studies %K Smoking %X DNA methylation (DNAm) is an increasingly popular biomarker of health and aging outcomes. Smoking behaviors have a significant and well documented correlation with methylation signatures within the epigenome and are important confounding variables to account for in epigenome-wide association studies (EWAS). However, the common classification of individuals as ‘current’, ‘former’, and ‘never’ smokers may miss crucial DNAm patterns associated with other smoking behaviors such as duration, intensity, and frequency of cigarette smoking, resulting in an underestimation of the contribution of smoking behaviors to DNAm and potentially biasing EWAS results. We investigated associations between multiple smoking behavioral phenotypes (smoking pack years, smoking duration, smoking start age, and smoking end age) and single site DNAm using linear regressions adjusting for age, sex, race/ethnicity, education, and cell-type proportions in a subsample of individuals who participated in the HRS 2016 Venous Blood Study (N=1,775). DNAm was measured using the Infinium Methylation EPIC BeadChip. All 4 phenotypes had significant associations (FDR < 0.05) with many methylation sites (packyears=6859, smoking duration=6572, start age=11374, quit age=773). There was not much overlap in DNAm sites between the full set of models with only 6 overlapping between all 4. However, the phenotypes packyears and smoking duration showed large overlap (N=3782). Results suggest additional smoking phenotypes beyond current/former/never smoker classification should be included in EWAS analyses to appropriately account for the influence of smoking behaviors on DNAm. %B Innovation in Aging %V 5 %P 668 %G eng %N Suppl _1 %R https://doi.org/10.1093/geroni/igab046.2503 %0 Journal Article %J International Journal of Obesity %D 2021 %T Evidence for a causal association between milk intake and cardiometabolic disease outcomes using a two-sample Mendelian Randomization analysis in up to 1,904,220 individuals. %A Vimaleswaran, Karani Santhanakrishnan %A Zhou, Ang %A Cavadino, Alana %A Hyppönen, Elina %K Epidemiology %K Nutrition %K nutrition disorders %XBACKGROUND: High milk intake has been associated with cardio-metabolic risk. We conducted a Mendelian Randomization (MR) study to obtain evidence for the causal relationship between milk consumption and cardio-metabolic traits using the lactase persistence (LCT-13910 C > T, rs4988235) variant as an instrumental variable.
METHODS: We tested the association of LCT genotype with milk consumption (for validation) and with cardio-metabolic traits (for a possible causal association) in a meta-analysis of the data from three large-scale population-based studies (1958 British Birth Cohort, Health and Retirement study, and UK Biobank) with up to 417,236 participants and using summary statistics from consortia meta-analyses on intermediate traits (N = 123,665-697,307) and extended to cover disease endpoints (N = 86,995-149,821).
RESULTS: In the UK Biobank, carriers of 'T' allele of LCT variant were more likely to consume milk (P = 7.02 × 10). In meta-analysis including UK Biobank, the 1958BC, the HRS, and consortia-based studies, under an additive model, 'T' allele was associated with higher body mass index (BMI) (P = 4.68 × 10) and lower total cholesterol (TC) (P = 2.40 × 10), low-density lipoprotein cholesterol (LDL-C) (P = 2.08 × 10) and high-density lipoprotein cholesterol (HDL-C) (P = 9.40 × 10). In consortia meta-analyses, 'T' allele was associated with a lower risk of coronary artery disease (OR:0.86, 95% CI:0.75-0.99) but not with type 2 diabetes (OR:1.06, 95% CI:0.97-1.16). Furthermore, the two-sample MR analysis showed a causal association between genetically instrumented milk intake and higher BMI (P = 3.60 × 10) and body fat (total body fat, leg fat, arm fat and trunk fat; P < 1.37 × 10) and lower LDL-C (P = 3.60 × 10), TC (P = 1.90 × 10) and HDL-C (P = 3.00 × 10).
CONCLUSIONS: Our large-scale MR study provides genetic evidence for the association of milk consumption with higher BMI but lower serum cholesterol levels. These data suggest no need to limit milk intakes with respect to cardiovascular disease risk, with the suggested benefits requiring confirmation in further studies.
%B International Journal of Obesity %V 45 %P 1751-1762 %G eng %N 8 %R 10.1038/s41366-021-00841-2 %0 Journal Article %J Social Work in Public Health %D 2021 %T Examining the Family Support Role of Older Hispanics, African Americans, and Non-Hispanic Whites and Their Breast Cancer Screening Behaviors. %A Tamara J. Cadet %A Shanna Lynn Burke %A Naseh, Mitra %A Grudzien, Adrienne %A Kozak, Rebecca Shoaf %A Romeo, Jessica %A Bullock, Karen %A Davis, Cindy %K Blacks %K family support %K Health Promotion %K Hispanics %K Mammograms %K Older women %K Social Support %XDisparities in breast cancer mortality rates among older Black and Hispanic women are due in part to low participation in cancer screening. Participation in cancer screening could be affected by an array of factors, including social support. Understanding the complex interplay between social support and breast cancer screening among older female adults, specifically among groups with higher mortality rates, is extremely important for timely and appropriate interventions to increase survival rates. Thus, utilizing the social network theory as the conceptual framework, this study aims to examine effects of social support on receiving a mammogram among a representative sample of older adults, specifically African American and Hispanic populations in the United States. Logistic regression models were conducted using the 2008 and 2012 Health and Retirement Study data. Findings from this study indicate that specific aspects of social support influence breast cancer screening participation among older Hispanic and non-Hispanic White women. However, this was not the case for the older Black women after adjusting for the sociodemographic factors. Given the role that family members play in the care of older adults, it is critical that social workers consider both the possible positive and negative interactions older women may have and how these interactions may affect their cancer screening behaviors. Findings can provide formative data to develop public health and social work interventions to increase positive social support and reduce negative social support by spouses and children to enhance breast cancer screening among older adults.
%B Social Work in Public Health %V 36 %P 38-53 %G eng %N 1 %R 10.1080/19371918.2020.1852993 %0 Journal Article %J China Population and Development Studies %D 2021 %T Factors associated with healthy ageing: a comparative study between China and the United States %A Chu, Lanlan %A Chen, Lu %K CHARLS %K China %K health policy %K healthy aging %X This study compares the associators of healthy ageing in China and the United States, using the 2005–2014 Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the 2004–2014 Health and Retirement Study (HRS). Health ageing is measured using an overall healthy ageing index (HAI), defined according to five dimensions: no major chronic diseases, free of physical functional impairment, free of cognitive impairment, no depressive symptoms, and socially active engagement. Multilevel logistic regression analysis is adopted to explore the association of demographic characteristics, socioeconomic status, and healthy lifestyles with the odds ratios of healthy ageing in China and the United States. Results indicate that the proportion of individuals experiencing healthy ageing is slightly higher in US than Chinese older adults aged 65–100 (25.67% vs 23.27%). Nevertheless, Chinese oldest-old (80–100) have a higher proportion of healthy ageing than American oldest-old (15.05% vs. 12.19%). Our results indicate that the odds of healthy ageing decrease with age, whereas they increase with education, income, marriage, and health behaviours. The odds of healthy ageing are lower for older Chinese women than men, whereas the odds are higher for older US women. Moreover, non-white elders in the United States have significantly lower odds of healthy ageing than their white counterparts. These findings suggest certain similar patterns of healthy ageing across two countries, but distinct patterns do exist. Promoting gender and racial equalities in healthy ageing are crucial for Chinese and American policymakers, respectively. %B China Population and Development Studies %@ 2523-8965 %G eng %R https://doi.org/10.1007/s42379-020-00071-5 %0 Journal Article %J Health Affairs %D 2021 %T Family Care Availability And Implications For Informal And Formal Care Used By Adults With Dementia In The US. %A Choi, Hwajung %A Michele M Heisler %A Edward C Norton %A Kenneth M. Langa %A Cho, Tsai-Chin %A Cathleen M. Connell %K Dementia %K family caregivers %K formal care %K Informal care %XDespite the important role that family members can play in dementia care, little is known about the association between the availability of family members and the type of care, informal (unpaid) or formal (paid), that is actually delivered to older adults with dementia in the US. Using data about older adults with dementia from the Health and Retirement Study, we found significantly lower spousal availability but greater adult child availability among women versus men, non-Hispanic Blacks versus non-Hispanic Whites, and people with lower versus higher socioeconomic status. Adults with dementia and disability who have greater family availability were significantly more likely to receive informal care and less likely to use formal care. In particular, the predicted probability of a community-dwelling adult moving to a nursing home during the subsequent two years was substantially lower for those who had a co-resident adult child (11 percent) compared with those who did not have a co-resident adult child but had at least one adult child living close (20 percent) and with those who have all children living far (23 percent). Health care policies on dementia should consider potential family availability in predicting the type of care that people with dementia will use and the potential disparities in consequences for them and their families.
%B Health Affairs %V 40 %P 1359-1367 %G eng %N 9 %R 10.1377/hlthaff.2021.00280 %0 Journal Article %J The Journals of Gerontology, Series A %D 2021 %T Feature selection algorithms enhance the accuracy of frailty indexes as measures of biological age. %A Kim, Sangkyu %A Fuselier, Jessica %A Welsh, David A %A Cherry, Katie E %A Myers, Leann %A Jazwinski, S Michal %K Biological age %K DNA Methylation %K frailty index %K Mortality %XBiological age captures some of the variance in life expectancy for which chronological age is not accountable, and it quantifies the heterogeneity in the presentation of the aging phenotype in various individuals. Among the many quantitative measures of biological age, the mathematically uncomplicated frailty/deficit index is simply the proportion of the total health deficits in various health items surveyed in different individuals. We used three different statistical methods that are popular in machine learning to select 17-28 health items that together are highly predictive of survival/mortality, from independent study cohorts. From the selected sets, we calculated frailty indexes and Klemera-Doubal's biological age estimates, and then compared their mortality prediction performance using Cox proportional hazards regression models. Our results indicate that the frailty index outperforms age and Klemera-Doubal's biological age estimates, especially among the oldest old who are most prone to biological aging-caused mortality. We also showed that a DNA methylation index, which was generated by applying the frailty/deficit index calculation method to 38 CpG sites that were selected using the same machine learning algorithms, can predict mortality even better than the best performing frailty index constructed from health, function, and blood chemistry.
%B The Journals of Gerontology, Series A %V 76 %P 1347-1355 %G eng %N 8 %R 10.1093/gerona/glab018 %0 Journal Article %J Applied Economics Letters %D 2021 %T Financial hardship and depression experienced by pre-retirees during the COVID-19 pandemic: the mitigating role of stimulus payments %A Liu, Yingyi %A Zhang, Yu %A Chatterjee, Swarn %K COVID-19 %K depression %K Financial hardship %K pre-retirees %K stimulus checks %X This study examines the association between financial hardship and depression among pre-retirees (ages 50 to 65) using the Health and Retirement Study (HRS) and its 2020 COVID-19 supplement. We find a negative association between the amount of stimulus received and financial hardship experienced by respondents during the pandemic. Additionally, the results indicate that African American households were less likely to increase spending, Hispanic households were more likely to increase savings, and households with lower educational attainment were more likely to pay down debt using their stimulus money. Financial wealth was negatively associated with the perception of feeling depressed. Overall, the findings from this study underscore the important role that the stimulus checks and other financial resources played in buffering the economic shock experienced by American households during the COVID-19 pandemic. %B Applied Economics Letters %@ 1350-4851 %G eng %R https://doi.org/10.1080/13504851.2021.1989364 %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 Public Health %D 2021 %T Food Insecurity Associated with Higher COVID-19 Infection in Households with Older Adults %A Shinae L. Choi %A Fei Men %K COVID-19 %K Food insecurity %K Health Disparities %X ABSTRACT Objectives As a well-documented social determinant of health, food insecurity may be associated with COVID infection in households with older adults. We examined whether older adults were vulnerable to COVID infection during the early pandemic if they were food insecure versus food secure. Study design Cross-sectional study using a nationally representative population-based survey of US older adults. Methods We used a random subsample of Health and Retirement Study (HRS) drawn in June 2020 (N = 3,212). We compared the odds of reporting COVID infection in a household, COVID infection and mortality among acquaintances, and respondent’s perceived fair or poor health across household food insecurity status resulted from financial or nonfinancial barriers. Baseline health and socioeconomic circumstances were adjusted in the models. Results Results showed higher COVID infection rate among food-insecure households than among their food-secure counterparts during the pandemic. Food insecurity due to nonfinancial obstacles was associated with greater likelihood of COVID infection both within respondents’ households (adjusted odds ratio [aOR] = 1.73, 95% confidence interval [CI]: 1.03–2.90) and among their acquaintances (aOR = 1.32, 95% CI: 1.05–1.65). Food insecurity caused by both nonfinancial and financial constraints was associated with twice the likelihood of knowing someone who died from COVID than their food-secure counterparts (aOR = 2.14, 95% CI: 1.27–3.61). Conclusions Food insecurity driven by nonfinancial constraints played an important role in the ongoing pandemic among US older adults. Policies addressing COVID need to recognize the vulnerability of food-insecure older adults beyond lack of monetary resources. %B Public Health %V 200 %P 7-14 %G eng %R 10.1016/j.puhe.2021.09.002 %0 Web Page %D 2021 %T For breakthroughs in slowing aging, scientists must look beyond biology %A University of Southern California %K Aging %K Behavior %K Demography %K Gerontology %K Longevity %K Mortality %X A trio of recent studies highlight the need to incorporate behavioral and social science alongside the study of biological mechanisms in order to slow aging. The three papers, published in concert in Ageing Research Reviews, emphasized how behavioral and social factors are intrinsic to aging. This means they are causal drivers of biological aging. In fact, the influence of behavioral and social factors on how fast people age are large and meaningful. However, geroscience--the study of how to slow biological aging to extend healthspan and longevity--has traditionally not incorporated behavioral or social science research. These papers are by three pioneers in aging research and members of the National Academy of Medicine who study different aspects of the intersection of biology and social factors in shaping healthy aging through the lifespan. %B Research News %I EurekAlert/AAAS %G eng %U https://www.eurekalert.org/pub_releases/2021-02/uosc-fbi022221.php %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults %A Esther M Friedman %A Houle, Jason %A Kathleen A. Cagney %A Mary E Slaughter %A Regina A Shih %K Cognitive decline %K Community physical disorder %K Community social cohesion %K Foreclosures %X Objectives While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition. Method This paper uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults’ cognitive health and the mechanisms responsible. Results We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship. Discussion This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults %B The Journals of Gerontology: Series B %V 76 %P 956-967 %G eng %N 5 %R 10.1093/geronb/gbaa047 %0 Journal Article %J The Gerontologist %D 2021 %T Gender Disparities in Life Satisfaction after Retirement: The Role of Leisure, Family, and Finances. %A Calasanti, Toni %A Dawn C Carr %A Patricia Homan %A Coan, Victoria %K Diversity in aging %K Gender relations %K Longitudinal methods %XBACKGROUND AND OBJECTIVES: Recent research on life satisfaction in retirement explores gender differences but yields inconsistent patterns and does not consider gendered sources of satisfaction. We use a gender relations framework to examine whether women and men experience different changes in life satisfaction with retirement, and whether observed differences are a consequence of different assessments of the leisure, family, and financial situations that characterize their post-retirement lives.
RESEARCH DESIGN AND METHODS: We use longitudinal data drawn from men and women in the Health and Retirement Study who transitioned into retirement between ages 62-72 for the first time between 2008 and 2016 (N=593). We employ Ordinary Least Squares regression and mediation tests to assess gender differences in overall and domain-specific life satisfaction (i.e., leisure, family, finances).
RESULTS: Men reported increased life satisfaction following retirement, but women did not. No gender differences related to leisure or family life post-retirement emerged. Gender was associated with post-retirement satisfaction with finances (p<0.001), with men reporting higher financial satisfaction. Mediation models confirmed a gender disparity in overall life satisfaction mediated by satisfaction with finances post-retirement (p<0.01), explaining approximately one-third of the disparity.
DISCUSSION AND IMPLICATIONS: This study shows men derive greater improvements in life satisfaction in association with retirement than do women, and some of this disparity relates to women's lower satisfaction with their finances. These findings should caution policy-makers from assuming how women's increased labor force participation influences financial security in retirement, and encourage scholars to consider how gender influences subjective assessments of later life.
%B The Gerontologist %V 61 %P 1277-1286 %G eng %N 8 %R 10.1093/geront/gnab015 %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 %XEducational 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 Journal Article %J Demography %D 2021 %T Genome-Wide Heritability Estimates for Family Life Course Complexity. %A Van Winkle, Zachary %A Dalton C Conley %K biodemography %K Family %K heritability %K life course %K Sequence analysis %XSequence analysis is an established method used to study the complexity of family life courses. Although individual and societal characteristics have been linked with the complexity of family trajectories, social scientists have neglected the potential role of genetic factors in explaining variation in family transitions and events across the life course. We estimate the genetic contribution to sequence complexity and a wide range of family demographic behaviors using genomic relatedness-based, restricted maximum likelihood models with data from the U.S. Health and Retirement Study. This innovative methodological approach allows us to provide the first estimates of the heritability of composite life course outcomes-that is, sequence complexity. We demonstrate that a number of family demographic indicators (e.g., the age at first birth and first marriage) are heritable and provide evidence that composite metrics can be influenced by genetic factors. For example, our results show that 11% of the total variation in the complexity of differentiated family sequences is attributable to genetic influences. Moreover, we test whether this genetic contribution varies by social environment as indexed by birth cohort over a period of rapid changes in family norms during the twentieth century. Interestingly, we find evidence that the complexity of fertility and differentiated family trajectories decreased across cohorts, but we find no evidence that the heritability of the complexity of partnership trajectories changed across cohorts. Therefore, our results do not substantiate claims that lower normative constraints on family demographic behavior increase the role of genes.
%B Demography %V 58( %P 1575-1602 %G eng %N 4 %R 10.1215/00703370-9373608 %0 Book Section %B Handbook of Aging and the Social Sciences (Ninth Edition)Handbooks of Aging %D 2021 %T Genomic data measures and methods: a primer for social scientists %A Erin B Ware %A Jessica Faul %E Kenneth F Ferraro %E Deborah Carr %K epigenetics %K Genetics %K Genomics %K Telomeres %X Recent advances in the field of genetics have produced a multitude of genomic data, which researchers are integrating increasingly into social science research. In this chapter, we discuss types of genomic data arising from the technological advances in the field of genetics including genome-wide variant data, DNA methylation, and telomere length. We outline several statistical genetics methodologies used to assess relationships between genomics and specific outcome such as genome-wide association studies, gene-region based tests, epigenetic aging clocks, and pathway enrichment tests. We highlight important social, epidemiological, and statistical considerations for incorporating genomics in the field of aging. Finally, we discuss what is on the horizon for aging, social science, and genomics. %B Handbook of Aging and the Social Sciences (Ninth Edition)Handbooks of Aging %I Academic Press %P 49-62 %@ 978-0-12-815970-5 %G eng %& 4 %R https://doi.org/10.1016/B978-0-12-815970-5.00004-8 %0 Journal Article %J Journal of the American Geriatrics Society %D 2021 %T Geriatric Syndromes and Atrial Fibrillation: Prevalence and Association with Anticoagulant Use in a National Cohort of Older Americans. %A Sachin J Shah %A Margaret C Fang %A Sun Y Jeon %A Gregorich, Steven E %A Kenneth E Covinsky %K anticoagulants %K Atrial Fibrillation %K Epidemiology %K geriatric syndromes %XBACKGROUND: Although guidelines recommend focusing primarily on stroke risk to recommend anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls and disability) are important when considering anticoagulants. Little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use.
METHODS: We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older Americans. Participants were asked questions to assess domains of aging, including function, cognition, and medical conditions. We included participants 65 years and older with 2 years of continuous Medicare enrollment who met AF diagnosis criteria by claims codes. We examined five geriatric syndromes: one or more falls within the last 2 years, receiving help with activities of daily living (ADLs) or instrumental ADLs (IADL), experienced incontinence, and cognitive impairment. We determined the prevalence of geriatric syndromes and their association with anticoagulant use, adjusting for ischemic stroke risk (i.e., CHA DS -VASc score [congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, and sex]).
RESULTS: In this study of 779 participants with AF (median age = 80 years; median CHA DS -VASc score = 4), 82% had one or more geriatric syndromes. Geriatric syndromes were common: 49% reported falls, 38% had ADL impairments, 42% had IADL impairments, 37% had cognitive impairments, and 43% reported incontinence. Overall, 65% reported anticoagulant use; guidelines recommend anticoagulant use for 97% of participants. Anticoagulant use rate decreased for each additional geriatric syndrome (average marginal effect = -3.7%; 95% confidence interval = -1.4% to -5.9%). Lower rates of anticoagulant use were reported in participants with ADL dependency, IADL dependency, and dementia.
CONCLUSION: Most older adults with AF had at least one geriatric syndrome, and geriatric syndromes were associated with reduced anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulant use in older adults.
%B Journal of the American Geriatrics Society %V 69 %P 349-356 %G eng %N 2 %R 10.1111/jgs.16822 %0 Journal Article %J The Journals of Gerontology: Series A %D 2021 %T Handgrip Strength Asymmetry and Weakness Together are Associated with Functional Disability in Aging Americans %A Ryan P McGrath %A Brenda Vincent %A Donald A Jurivich %A Kyle J Hackney %A Grant R Tomkinson %A Lindsey J Dahl %A Brian C Clark %K Biomarkers %K Disablement Process %K Epidemiology %K Functional Performance %X Evaluating handgrip strength (HGS) asymmetry may help to improve the prognostic value of HGS. This study sought to determine the associations of HGS asymmetry and weakness on future activities of daily living (ADL) disability in a national sample of aging Americans.The analytic sample included 18,468 Americans aged ≥50-years from the 2006-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured HGS. Those with HGS \>10\% stronger on either hand were considered as having any HGS asymmetry. Individuals with HGS \>10\% stronger on their dominant hand were considered as having dominant HGS asymmetry, while those with HGS \>10\% stronger on their non-dominant hand were classified as having non-dominant HGS asymmetry. Men with HGS \<26-kilograms and women with HGS \<16-kilograms were considered weak. ADLs were self-reported. Generalized estimating equations were used for analyses.Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had increased odds for future ADL disability: 1.11 (95\% confidence interval (CI): 1.02-1.20) for any HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, and 1.81 (CI: 1.52-2.16) for both any HGS asymmetry and weakness. Most weakness and HGS asymmetry dominance groups had increased odds for future ADL disability: 1.30 (CI: 1.13-1.50) for non-dominant HGS asymmetry alone, 1.42 (CI: 1.16-1.74) for weakness alone, 1.72 (CI: 1.29-2.29) for both weakness and non-dominant HGS asymmetry, and 1.86 (CI: 1.52-2.28) for both weakness and dominant HGS asymmetry.HGS asymmetry and weakness together may increase the predictive utility of handgrip dynamometers. %B The Journals of Gerontology: Series A %V 76 %P 291 %G eng %N 2 %R 10.1093/gerona/glaa100 %0 Journal Article %J Aging Clinical and Experimental Research %D 2021 %T Handgrip strength asymmetry is associated with future falls in older Americans. %A Ryan P McGrath %A Brian C Clark %A Cesari, Matteo %A Johnson, Carol %A Donald A Jurivich %K Asymmetric HGS %K Falls %K impaired neuromuscular function %XBACKGROUND: Examining handgrip strength (HGS) asymmetry could extend the utility of handgrip dynamometers for screening future falls.
AIMS: We sought to determine the associations of HGS asymmetry on future falls in older Americans.
METHODS: The analytic sample included 10,446 adults aged at least 65 years from the 2006-2016 waves of the Health and Retirement Study. Falls were self-reported. A handgrip dynamometer measured HGS. The highest HGS on each hand was used for determining HGS asymmetry ratio: (non-dominant HGS/dominant HGS). Those with HGS asymmetry ratio < 1.0 had their ratio inverted to make all HGS asymmetry ratios ≥ 1.0. Participants were categorized into asymmetry groups based on their inverted HGS asymmetry ratio: (1) 0.0-10.0%, (2) 10.1-20.0%, (3) 20.1-30.0%, and (4) > 30.0%. Generalized estimating equations were used for the analyses.
RESULTS: Every 0.10 increase in HGS asymmetry ratio was associated with 1.26 (95% confidence interval (CI) 1.07-1.48) greater odds for future falls. Relative to those with HGS asymmetry 0.0-10.0%, participants with HGS asymmetry > 30.0% had 1.15 (CI 1.01-1.33) greater odds for future falls; however, the associations were not significant for those with HGS asymmetry 10.1-20.0% (odds ratio: 1.06; CI 0.98-1.14) and 20.1-30.0% (odds ratio: 1.10; CI 0.99-1.22). Compared to those with HGS asymmetry 0.0-10.0%, participants with HGS asymmetry > 10.0% and > 20.0% had 1.07 (CI 1.01-1.16) and 1.12 (CI 1.02-1.22) greater odds for future falls, respectively.
DISCUSSION: Asymmetric HGS, as a possible biomarker of impaired neuromuscular function, may help predict falls.
CONCLUSIONS: We recommend that HGS asymmetry be considered in HGS protocols and fall risk assessments.
%B Aging Clinical and Experimental Research %V 33 %P 2461-2469 %G eng %N 9 %R 10.1007/s40520-020-01757-z %0 Journal Article %J Aging %D 2021 %T Healthy memory aging - the benefits of regular daily activities increase with age. %A Krakovska, Olga %A Christie, Gregory J %A Farzan, Faranak %A Sixsmith, Andrew %A Ester, Martin %A Moreno, Sylvain %K Cognitive decline %K Daily activities %K healthy aging %K Machine learning %XAs the number of older adults increases, so does the pressure on health care systems due to age-related disorders. Attempts to reduce cognitive decline have focused on individual interventions such as exercise or diet, with limited success. This study adopted a different approach by investigating the impact of combined daily activities on memory decline. We used data from the National Institute of Aging's Health and Retirement Study to explore two new questions: does combining activities affect memory decline, and if yes, does this impact change across the lifespan? We created a new machine learning model using 33 daily activities and involving 3210 participants. Our results showed that the effect of combined activities on memory decline was stronger than any individual activity's impact. Moreover, this effect increased with age, whereas the importance of historical factors such as education, and baseline memory decreased. The present findings point out the importance of selecting multiple, diverse activities for older adults as they age. These results could have a significant impact on aging health policies promoting new programs such as social prescribing.
%B Aging %V 13 %P 25643-25652 %G eng %N 24 %R 10.18632/aging.203753 %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 Report %D 2021 %T How Do Households Adjust Their Earnings, Saving, and Consumption After Children Leave? %A Andrew G. Biggs %A Anqi Chen %A Alicia H. Munnell %K children %K consumption %K Earnings %K Household %K Savings %X Whether parents adjust their consumption after their children leave home has important implications for our understanding of retirement income adequacy. Prior studies have found that parents reduce consumption after their children become independent, allowing them to save more for retirement. Other studies, however, have found that savings for retirement does not increase. If households are both consuming less but not saving more after the children leave, where are the resources going? The project examines three ways to reconcile these seemingly inconsistent results: 1) parents may be saving by paying down debt faster, 2) parents may still be providing financial support to their grown children, and 3) parents may be adjusting their labor. %B CRR Working Paper %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/how-do-households-adjust-their-earnings-saving-and-consumption-after-children-leave/ %0 Conference Paper %B Retirement and Disability Research Consortium 23rd Annual Meeting %D 2021 %T How Do Households Adjust Their Saving After Children Leave Home? %A Andrew G. Biggs %A Anqi Chen %A Alicia H. Munnell %K children %K Households %K Savings %X Whether parents adjust their savings and consumption after their children leave home has important implications for our understanding of retirement adequacy. Life-cycle savings studies suggest that people are saving optimally (Scholz and Seshadri 2006, 2008). On the other hand, studies based on the assumption of steady consumption over the working years conclude that many households will end up unprepared for retirement (Mitchell and Moore 1998; Munnell, Orlova, and Webb 2013). Assumptions about how consumption changes after children leave have an important effect on estimates of retirement preparedness. Munnell, Rutledge, and Webb (2014) show that differences in the treatment of children explain about half of the difference in the estimates of the percent of households with inadequate savings. Several studies have tried to examine empirically which of these two theories better describes household behavior once children leave but have not answered the question. Biggs (2019), for example, found that parents decrease their consumption more than non-parent households at older ages, suggesting that parents may be increasing their savings. At the same time, Dushi et al. (2016), using W-2 tax data, found that parents did not increase their 401(k) contributions after their children became financially independent. If households are both consuming less but not saving more after their children leave, the question that arises is where are the resources going? One potential way to square the circle is recognizing that 401(k) accounts are not the only way for households to save; parents could be saving by paying down their mortgage or other forms of debt after their children leave home. Another possible explanation is that typical measures of consumption do not capture all the ways that households expend their resources – parents could continue to provide financial support for their children by helping with down payments or paying off student loans. A broader definition of consumption that includes financial transfers might suggest that parents are not reducing consumption after children leave. Finally, parents may also opt for more leisure, and, as a result earn less after their children become independent, which could produce a decline in consumption and no increase in saving. Reconciling the seemingly conflicting findings will help shed light on whether household are saving enough for retirement. %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 impact of late-career job loss and genetic risk on body mass index: Evidence from variance polygenic scores. %A Lauren L Schmitz %A Goodwin, Julia %A Miao, Jiacheng %A Lu, Qiongshi %A Dalton C Conley %K Body Mass Index %K Job loss %K polygenic score %XUnemployment shocks from the COVID-19 pandemic have reignited concerns over the long-term effects of job loss on population health. Past research has highlighted the corrosive effects of unemployment on health and health behaviors. This study examines whether the effects of job loss on changes in body mass index (BMI) are moderated by genetic predisposition using data from the U.S. Health and Retirement Study (HRS). To improve detection of gene-by-environment (G × E) interplay, we interacted layoffs from business closures-a plausibly exogenous environmental exposure-with whole-genome polygenic scores (PGSs) that capture genetic contributions to both the population mean (mPGS) and variance (vPGS) of BMI. Results show evidence of genetic moderation using a vPGS (as opposed to an mPGS) and indicate genome-wide summary measures of phenotypic plasticity may further our understanding of how environmental stimuli modify the distribution of complex traits in a population.
%B Scientific Reports %V 11 %P 7647 %G eng %N 1 %R 10.1038/s41598-021-86716-y %0 Journal Article %J Journal of Aging and Health %D 2021 %T The Impact of Military Service Exposures and Psychological Resilience on the Mental Health Trajectories of Older Male Veterans. %A Urena, Stephanie %A Miles G Taylor %A Dawn C Carr %K latent growth curves %K life course %XWe examine the impact of exposure to the dead, dying, and wounded (DDW) during military service on the later-life depressive symptom trajectories of male United States veterans, using psychological resilience as an internal resource that potentially moderates negative consequences. The Health and Retirement Study (2006-2014) and linked Veteran Mail Survey were used to estimate latent growth curve models of depressive symptom trajectories, beginning at respondents' first report of resilience. Veterans with higher levels of resilience do not have increased depressive symptoms in later life, despite previous exposure to DDW. Those with lower levels of resilience and previous exposure to DDW experience poorer mental health in later life. Psychological resilience is important for later-life mental health, particularly for veterans who endured potentially traumatic experiences. We discuss the importance acknowledging the role individual resources play in shaping adaptation to adverse life events and implications for mental health service needs.
%B Journal of Aging and Health %V 33 %P 237-248 %G eng %N 3-4 %R 10.1177/0898264320975231 %0 Journal Article %J The Journals of Gerontology, Series B %D 2021 %T The Importance of Improving Educational Attainment for Dementia Prevalence Trends from 2000-2014, among Older non-Hispanic Black and White Americans. %A Mark D Hayward %A Mateo P Farina %A Yuan S Zhang %A Jung K Kim %A Eileen M. Crimmins %K Cognitive health %K Educational attainment %XOBJECTIVES: While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess 1) how the trends in dementia prevalence may have differed across age and race groups and 2) the role of changing educational attainment in understanding these trends.
METHOD: This paper estimates a series of logistic regression models using data from the Health and Retirement Study (2000-2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks.
RESULTS: Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65-74 had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States.
DISCUSSION: This study shows the importance of improvement in educational attainment in the early part of the 20 th century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014.
%B The Journals of Gerontology, Series B %V 76 %P 1870-1879 %G eng %N 9 %R 10.1093/geronb/gbab015 %0 Journal Article %J The Journals of Gerontology, Series B %D 2021 %T Increasing Education-Based Disparities in Healthy Life Expectancy Among U.S. Non-Hispanic Whites, 2000-2010. %A Cantu, Phillip A %A Connor M Sheehan %A Sasson, Isaac %A Mark D Hayward %K Disability %K Education %K Healthy life expectancy %K Mortality %XOBJECTIVES: To examine changes in Healthy Life Expectancy (HLE) against the backdrop of rising mortality among less-educated white Americans during the first decade of the twenty-first century.
METHODS: This study documented changes in HLE by education among U.S. non-Hispanic whites, using data from the U.S. Multiple Cause of Death public-use files, the Integrated Public Use Microdata Sample (IPUMS) of the 2000 Census and the 2010 American Community Survey, and the Health and Retirement Study (HRS). Changes in HLE were decomposed into contributions from: (i) change in age-specific mortality rates; and (ii) change in disability prevalence, measured via Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL).
RESULTS: Between 2000 and 2010, HLE significantly decreased for white men and women with less than 12 years of schooling. In contrast, HLE increased among college-educated white men and women. Declines or stagnation in HLE among less-educated whites reflected increases in disability prevalence over the study period, whereas improvements among the college educated reflected decreases in both age-specific mortality rates and disability prevalence at older ages.
DISCUSSION: Differences in HLE between education groups increased among non-Hispanic whites from 2000 to 2010. In fact, education-based differences in HLE were larger than differences in total life expectancy. Thus, the lives of less-educated whites were not only shorter, on average, compared with their college-educated counterparts, but they were also more burdened with disability.
%B The Journals of Gerontology, Series B %V 76 %P 319-329 %G eng %N 2 %R 10.1093/geronb/gbz145 %0 Journal Article %J Health Affairs %D 2021 %T Increasing Medicaid's Stagnant Asset Test For People Eligible For Medicare And Medicaid Will Help Vulnerable Seniors. %A Cornelio, Noelle %A Melissa McInerney %A Jennifer M Mellor %A Roberts, Eric T %A Lindsay M Sabik %K Eligibility Determination %K Medicaid %K Medicare %XLow-income Medicare beneficiaries rely on Medicaid for supplemental coverage but must meet income and asset tests to qualify. We examined states' income and asset tests for full-benefit Medicaid during the period 2006-18 and examined how alternative asset tests would affect eligibility for community-dwelling Medicare beneficiaries ages sixty-five and older. Most states have not updated the dollar limit of Medicaid's asset test since 1989, making the asset test increasingly restrictive in inflation-adjusted terms. We estimated that increasing Medicaid's asset limit by the Consumer Price Index, to Medicare Savings Program levels, or to $10,000 for individuals and $20,000 for couples would increase Medicaid eligibility by 1.7 percent, 4.4 percent, and 7.5 percent, respectively. Simplifying Medicaid's asset test to focus only on certain high-value assets would increase eligibility by 20.5 percent. Increasing asset limits would lessen restrictions on Medicaid eligibility that arise from stagnant asset tests, broadening eligibility for certain low-income Medicare beneficiaries and allowing them to retain higher, yet still modest, savings.
%B Health Affairs %V 40 %P 1943-1952 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/34871073?dopt=Abstract %R 10.1377/hlthaff.2021.00841 %0 Journal Article %J Sleep %D 2021 %T Insomnia Symptoms and Subsequent Cognitive Performance in Older Adults: Are Depressive Symptoms and Vascular Disease Mediators? %A Afsara B. Zaheed %A Adam P Spira %A Ronald D Chervin %A Laura B Zahodne %K Cognition %K Depressive symptoms %K insomnia %K vascular disease %X Alzheimer’s disease and related dementias (ADRD) are growing public health concerns, and poor sleep may represent a modifiable risk factor. However, there is limited research on insomnia as a predictor of subsequent performance in different cognitive domains and mechanisms that might underlie domain-specific associations. The current study examined: (1) which insomnia symptoms predicted performance across five cognitive domains 14 years later, and (2) whether depressive symptoms and/or vascular diseases mediated these associations.Participants included 2,496 adults aged 51+ in the Health and Retirement Study. Insomnia symptoms in 2002 (i.e., “baseline”) were quantified by four self-reported items on frequency of trouble falling asleep, nighttime awakenings, early awakenings, and feeling rested upon awakening. Cognition was assessed in 2016 as part of the Harmonized Cognitive Assessment Protocol and operationalized with five factor scores corresponding to episodic memory, executive function, language, visuoconstruction, and processing speed. Multiple regressions examined associations between baseline insomnia symptoms and subsequent cognitive performance, controlling for sociodemographics and baseline global cognitive performance. Mediation models tested whether associations were explained by self-reported depressive symptoms and/or vascular diseases (i.e., hypertension, heart disease, diabetes, and/or stroke) in 2014, controlling for baseline values.Only trouble falling asleep in 2002 was associated with cognition in 2016. Specifically, more frequent trouble falling asleep predicted poorer episodic memory, executive function, language and processing speed performance, but not visuoconstruction. These associations were mediated by depressive symptoms and vascular diseases in 2014 for all domains except episodic memory; only depressive symptoms mediated the association involving memory. After accounting for these mediators, direct effects of trouble falling asleep remained for episodic memory, executive function and language, but not processing speed.Difficulty with sleep initiation may be more consequential for later-life cognition than other insomnia symptoms. Depressive symptoms and vascular diseases may partially drive these associations. We speculate that sleep-onset insomnia could mean less total sleep, immune dysfunction, or endocrine effects that worsen mood, vascular health, and cognition. Remaining associations indicate that additional research is needed to characterize other mechanisms through which sleep initiation problems could contribute to later impairments in frontal and temporal cognitive systems, which are implicated early in ADRD.Support (if any): %B Sleep %V 44 %P A212 - A212 %@ 0161-8105 %G eng %N Supplement_2 %R 10.1093/sleep/zsab072.535 %0 Journal Article %J Age and Ageing %D 2021 %T Life satisfaction among older adults with impairment in activities of daily living. %A Boccaccio, Dominic E %A Irena Cenzer %A Kenneth E Covinsky %K Activities of Daily Living %K functional impairment %K Life Satisfaction %XBACKGROUND: Many older adults experience decline in function, but maintain high levels of life satisfaction. The factors associated with high life satisfaction among those with functional impairment are not well understood.
OBJECTIVE: Examine the proportion of older adults with functional impairment reporting high life satisfaction and the predictors of high life satisfaction.
DESIGN: Cross-sectional cohort study.
SETTING: Health and Retirement Study.
SUBJECTS: A total of 7,287 community-dwelling participants, 65 years or older, who completed the leave-behind questionnaire in 2014 or 2016.
METHODS: The main predictor was having difficulty or needing help in performing Activities of Daily Living (ADL). The primary outcome was reporting high life satisfaction, defined using a three-item Diener scale. Significant factors were identified using modified Poisson regression models adjusted for demographic characteristics.
RESULTS: Those with no ADL impairment were more likely to report high levels of life satisfaction than those with ADL difficulty or ADL dependence (54.4 vs 38.6 vs 27.6%, P < 0.001). Among those with ADL dependence, we identified several factors associated with high life satisfaction, including: not being lonely (38.2 vs 23.2%, ARR = 1.6 (1.2, 2.2)), satisfied with family life (35.1 vs 12.8%, ARR = 2.7 (1.6, 4.4)), and satisfied with financial situation (40.8 vs 16.6%, ARR = 2.5 (1.8, 3.6)). Similar associations were present among those with ADL difficulty.
CONCLUSIONS: A substantial proportion of older adults with ADL impairment report high life satisfaction, and it is associated with social and economic well-being. Understanding the factors associated with high life satisfaction can lead to clinical practices and policy guidelines that promote life satisfaction in older adults.
%B Age and Ageing %V 50 %P 2047-2054 %G eng %N 6 %R 10.1093/ageing/afab172 %0 Journal Article %J The Milbank Quarterly %D 2021 %T Life Satisfaction and Subsequent Physical, Behavioral, and Psychosocial Health in Older Adults. %A Eric S Kim %A Scott W Delaney %A Tay, Louis %A Chen, Ying %A Diener, E D %A Tyler J VanderWeele %K Life Satisfaction %K Outcome-wide epidemiology %K psychological well-being %K Public Health %XPolicy Points Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction. The results of this study suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes.
CONTEXT: Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction.
METHODS: We evaluated whether positive change in life satisfaction (between t ;2006/2008 and t ;2010/2012) was associated with better outcomes on 35 indicators of physical, behavioral, and psychosocial health and well-being (in t ;2014/2016). Data were from 12,998 participants in the University of Michigan's Health and Retirement Study-a prospective and nationally representative cohort of US adults over age 50.
FINDINGS: Participants with the highest (versus lowest) life satisfaction had better subsequent outcomes on some physical health indicators (lower risk of pain, physical functioning limitations, and mortality; lower number of chronic conditions; and higher self-rated health) and health behaviors (lower risk of sleep problems and more frequent physical activity), and nearly all psychosocial indicators (higher positive affect, optimism, purpose in life, mastery, health mastery, financial mastery, and likelihood of living with spouse/partner; and lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints, and loneliness) over the 4-year follow-up period. However, life satisfaction was not subsequently associated with many specific health conditions (i.e., diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, or cognitive impairment), other health behaviors (i.e., binge drinking or smoking), or frequency of contact with children, family, or friends.
CONCLUSIONS: These results suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes.
%B The Milbank Quarterly %V 99 %P 209-239 %G eng %N 1 %R 10.1111/1468-0009.12497 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Loneliness Following Widowhood: The Role of the Military and Social Support. %A Brittany M. King %A Dawn C Carr %A Miles G Taylor %K Bereavement %K Life course analysis %K Social networks %K Veteran widows %XOBJECTIVES: Increased loneliness is a common consequence of widowhood in later life. However, individuals with high levels of perceived social support from friends tend to cope more effectively following major social losses like widowhood. Military service is associated with cultivation of strong social support structures. This effect may not only influence those who serve, but also their spouses. Roughly half of older women today are married to veterans, which could shape how they cope with widowhood. We tested two hypotheses: (a) widows of veterans will be less lonely following widowhood compared to their nonveteran counterparts, and (b) this effect will be explained by perceived social support from friends.
METHODS: We used the Health and Retirement Study (HRS) to examine changes in loneliness following widowhood among wives of veterans and nonveterans. We used Ordinary Least Squares regression and mediation tests to address our hypotheses.
RESULTS: Net of baseline differences, widows of veterans reported statistically lower levels of loneliness (p < .05) following widowhood compared to widows of nonveterans. Widows of veterans retained the same level of perceived social support from friends pre- and postwidowhood, whereas nonveteran wives experienced a loss. Perceived social support from friends mediated the association between veteran status of the deceased spouse and loneliness.
DISCUSSION: Our findings suggest wives of veterans may have more resilient social support structures than nonveteran spouses, helping them cope at widowhood. Future research should explore whether these effects persist in association with other major stressful events in later life.
%B The Journals of Gerontology: Series B %V 76 %P 403-414 %G eng %N 2 %R 10.1093/geronb/gbz164 %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 %XOBJECTIVE: 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 %XOBJECTIVES: 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 Archives of Gerontology and Geriatrics %D 2021 %T Longitudinal associations between cancer history and cognitive functioning among older adults %A Kun Wang %A Leah P. Cheatham %A Alexander R. Marbut %A Xiayu Chen %K Cancer history %K Chemotherapy %K cognitive functioning %K Middle-old adults %K Mixed-effects modeling %X Objectives This study aimed to examine 1) whether cancer history accelerates older adults’ rates of cognitive decline over time and 2) whether chemotherapy increases older cancer patients’/ survivors’ rates of cognitive decline over time. Methods This longitudinal study drew a subsample of 8,811 adults aged 65 or older from Wave 6 of the Health and Retirement Study in 2002 and followed biannually until Wave 13 in 2016. Linear mixed-effects models were performed to test whether cancer history and chemotherapy were associated with accelerated rates of cognitive decline over time among older adults in different age groups. Results Middle-old adults (aged 75-84) with a cancer history had significantly reduced rates of cognitive decline over time, including the global measure of cognitive functioning (B= .16, p< .01), mental status (B= .08, p< .01), and episodic memory (B= .09, p< .05) compared to their counterparts without a cancer history. This effect was not significant for the youngest-old (aged 65-74) or oldest-old adults (aged 85 or older). Also, chemotherapy was not significantly associated with older cancer patients’/survivors’ cognitive functioning at baseline or over time in different age groups. Conclusions This study finds that cancer history and chemotherapy do not further exacerbate older adults’ cognitive functioning over time. On the contrary, cancer history shows a “protective†effect on middle-old adults’ cognitive functioning. This encouraging finding indicates that older adults can be more actively engaged in the decision-making of treatments and following care plans. Future mediation studies are needed to further investigate underlying mechanisms. %B Archives of Gerontology and Geriatrics %V 97 %P 104521 %G eng %R 10.1016/j.archger.2021.104521 %0 Journal Article %J Journal of Aging and Health %D 2021 %T Longitudinal Associations Between Physical Activity and Purpose in Life Among Older Adults: A Cross-Lagged Panel Analysis. %A Zhang, Zhanjia %A Chen, Weiyun %K meaning %K Older Adults %K Physical activity %K purpose %XThe purpose of the current study was to examine the bidirectional relationship between physical activity (PA) and purpose in life in an older adult sample using longitudinal data. Data were collected from three waves (2006, 2010, and 2014) of the Health and Retirement Study. A total of 4591 participants who had complete information of PA and purpose in life at baseline were included in the current study. A series of cross-lagged models were tested separately for vigorous-intensity PA, moderate-intensity PA, and light-intensity PA. While higher levels of purpose in life were associated with more frequent engagement in future vigorous-intensity PA, moderate-intensity PA, and light-intensity PA, none of the PA variables predicted subsequent purpose in life. The results did not support a reciprocal relationship between PA and purpose in life in older adults. It is more likely that purpose in life predicts PA, rather than vice versa.
%B Journal of Aging and Health %V 33 %P 941-952 %G eng %N 10 %R 10.1177/08982643211019508 %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 Journal Article %J Sleep Medicine %D 2021 %T Longitudinal effects of nocturnal insomnia symptom subtypes and nonrestorative sleep on the incidence of depression among community-dwelling older adults: Results from the Health and Retirement Study %A Chen, Tuo-Yu %A Saito, Yasuhiko %K depression %K insomnia subtypes %K Older Adults %K temporal effects %X Objective The relationships between different insomnia symptom subtypes and the onset of depression among older adults are inconsistent. It may be that each subtype has a distinct temporal effect on depression not easily captured by the different follow-up intervals used in past studies. We systemically investigated the temporal effects by examining the links between subtypes and the onset of depression at different follow-up intervals among community-dwelling older adults. Methods We used the 2006 wave of the Health and Retirement Study as baseline (n=9,151). The outcome was the onset of depression at 2-year (2008 wave), 4-year (2010 wave), and 6-year (2012 wave) follow-ups. The independent variables were difficulty with falling asleep (initial insomnia), waking up during the night (middle insomnia), waking up too early and being unable to fall asleep again (late insomnia), and nonrestorative sleep at baseline. Factors known to be related to depression among older adults were included as covariates. Results Our findings showed that each insomnia symptom subtype had distinct temporal effects on the onset of depression. It appeared that the effects of initial insomnia may take longer to emerge than indicated in previous studies. Middle insomnia and late insomnia had weak relationships with depression. Nonrestorative sleep predicted the onset of depression at every follow-up period. Conclusions We found that documenting the temporal effects of insomnia symptom subtypes helps both to classify individuals’ insomnia symptoms and predict the onset of depression. We recommend taking temporal effects of insomnia symptom subtypes into account in future investigations and clinical practice. %B Sleep Medicine %V 79 %P 155-163 %@ 1389-9457 %G eng %R https://doi.org/10.1016/j.sleep.2021.01.003 %0 Report %D 2021 %T Long-Term Care Partnership Effects on Medicaid and Private Insurance %A Costa-Font, Joan %A Raut, Nilesh %K difference-in-differences %K Long-term care insurance %K long-term care partnerships %K Medicaid %X Can the expansion of Medicaid, a means-tested health and long-term care insurance, be slowed down by incentivising the purchase of private long-term care insurance (LTCI)? We study the implementation of the long-term care insurance partnership (LTCIP) program, a joint federal and state-level program that intended to promote LTCI coverage. Drawing on a difference-in-differences (DD) design we study the effect of the rollout of the LTCIP program between 2005 and 2016 on both LTCI uptake and Medicaid eligibility, and we estimate the effect on Medicaid savings. Drawing on a difference-in-differences (DD) design, we find that, unlike previous estimates, the introduction of the LTCIP does significantly increase LTCI coverage and reduce the uptake of Medicaid. The effects are driven by the introduction of LTCIP in states after 2010. We estimate that the adoption of LTCIP has given rise to an average Medicaid saving of $36 for every 65-year-old. This suggests scope for LTCI arrangements to reduce Medicaid spending. %B Discussion Paper Series %I Institute of Labor Economics (IZA) %C Bonn, Germany %G eng %U https://ftp.iza.org/dp14753.pdf %0 Journal Article %J Circulation %D 2021 %T Long-Term Functional Outcomes in Older Adults After Hospitalization for Extracranial Hemorrhage %A Anna L Parks %A Sun Y Jeon %A John J Boscardin %A Michael A Steinman %A Alexander K Smith %A Margaret C Fang %A Kenneth E Covinsky %A Sachin J Shah %K anticoagulation %K antiplatelet drugs %K hemorrhage %X Introduction: Antiplatelet and anticoagulant medications often used to manage cardiovascular disease increase the risk of extracranial hemorrhage (ECH), such as gastrointestinal bleeding. There are few long-term data on the loss of function following ECH. This study’s goal was to measure the acute and persistent loss of independence in activities of daily living (ADLs) after ECH hospitalization. Methods: We used data from 1995-2015 from the Health and Retirement Study, a longitudinal, nationally representative survey of older Americans. We included subjects over age 65 who consented to Medicare linkage. We examined the association of ECH hospitalization with ability to perform all ADLs independently (walk across a room, dress, bathe, eat, toilet, get out of bed). To compare rates of ADL independence over time between those with ECH and a control group without ECH, we fit a logistic regression model that included an interaction term between ECH hospitalization and time and adjusted for comorbidities and sociodemographics. Results: In a cohort of 8950 with an average follow-up time of 7.3 years (65,335 person-years), 882 (10%) participants were hospitalized for ECH. Mean age was 78, and 59% were women. In the control group without ECH, the baseline rate of ADL independence declined by an average of 3.1% per year (average marginal effect [AME], 95% CI -3.1% to -3.3%). Assuming hospitalization for ECH at 5.2 years, the median time to ECH in this cohort, ECH was associated with an immediate decrease in ADL independence from 68% to 53% (AME -15%, 95% CI -11% to -18%). Following ECH, the average annual baseline rate of function loss did not change. Conclusions: In this nationally representative cohort, ECH hospitalization was associated with an immediate and pronounced decline in function that was equivalent to accelerating ADL disability by 5 years. After ECH, ADL independence continued to decline and did not recover to pre-ECH levels of independence over time. %B Circulation %V 144 %P A10778 %G eng %N Suppl _1 %R 10.1161/circ.144.suppl_1.10778 %0 Journal Article %J Social Science & Medicine %D 2021 %T Marital loss and risk of dementia: Do race and gender matter? %A Zhang, Zhenmei %A Hui Liu %A Seung-won Emily Choi %K Dementia %K Divorce %K gender %K Income %K Marital Status %K race %K Widowhood %XRecent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p < 0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.
%B Social Science & Medicine %V 275 %P 113808 %G eng %R 10.1016/j.socscimed.2021.113808 %0 Report %D 2021 %T Marital Transitions, Housing, and Long-Term Care in Old Age %A Chang, Minsu %A Ko, Ami %K Couples %K Housing %K Retirement %X Retired couples dissave housing wealth at a much slower rate than singles, conditional on income. This paper studies mechanisms through which marital transitions affect housing decisions of retirees. We develop and estimate a life-cycle savings model where marital transitions affect long-term care arrangements, bequest motives, and eligibility for means-tested welfare programs. We find that the key driver behind the stark difference in dissaving of housing wealth between retired couples and singles varies substantially by income. For low-income households, how means-tested public insurance treats housing has the most impact on their housing decisions. For middle- and highincome households, family caregiving and bequest motives are the dominant driver, respectively. Our counterfactual policy experiments show that the current structure of the Medicaid estate recovery program which exempts housing wealth only for couples is more desirable than alternative rules, such as extending the homestead exemption to singles or providing the exemption to singles only. By inducing lower-income couples to decumulate housing wealth at a slower rate, the current Medicaid program reduces impoverishment risk in retirement. %G eng %U http://www.ko-ami.com/uploads/1/0/5/9/105963965/chang_ko_march2021.pdf %0 Book Section %B Advances in Longitudinal Survey Methodology %D 2021 %T Measuring Cognition in a Multi-Mode Context %A Ofstedal, Mary Beth %A McClain, Colleen A. %A Couper, Mick P. %A Lynn, Peter %K administration protocol %K Cognitive Ability %K cognitive assessments %K longitudinal surveys %K mixed-mode design %X Although multi-mode studies may present complications for a variety of survey measures, tests of cognitive ability are particularly problematic. Measures of cognitive ability have been incorporated in many surveys, and they are especially common in longitudinal surveys of health and ageing. Despite these challenges, there are few mode comparisons that focus on cognitive measures, and the implications of mixed-mode design decisions for the measurement of cognition in longitudinal surveys remain largely unclear. In general, cognitive assessments in surveys share several qualities that complicate implementation across modes. If comparability of tests is a priority, it is important to identify tests that are suitable for administration across different modes. Regardless of how comparable the tests are in terms of administration protocol, however, there are still likely to be some measurement differences by mode. %B Advances in Longitudinal Survey Methodology %I John Wiley & Sons, Ltd %P 250-271 %@ 9781119376965 %G eng %& 11 %R https://doi.org/10.1002/9781119376965.ch11 %0 Book Section %B Handbook of Aging and the Social Sciences (Ninth Edition)Handbooks of Aging %D 2021 %T Measuring life course events and life histories %A Jacqui Smith %A Hu, Mengyao %A Lee, Haena %E Kenneth F Ferraro %E Deborah Carr %K calendar interview methods %K Life event inventories %K methodological issues %K report accuracy %K retrospective life histories %K Sequence analysis %X Whereas some life events are considered potential sources of stress, others are viewed as markers of interconnected life course transitions and processes. In this chapter, we first review the theoretical roots of measures of life events and discuss longstanding methodological critiques regarding the categorization of life events and factors associated with the reliability and validity of reports. We then review calendar interview methods that employ an Event (or Life) History Calendar approach to collect timeline data. These methods, based on cognitive theories of autobiographical memory, are designed to facilitate retrospective recall of thematic temporal sequences of personal memories. We describe the challenges of collecting retrospective life histories in studies of older adults, strategies used to evaluate the veracity of retrospective life history recall, and summarize recent analytic methods that examine the heterogeneity and dynamics of domain-specific and cross-domain timing and sequencing of transitions and events in the lives of individuals. %B Handbook of Aging and the Social Sciences (Ninth Edition)Handbooks of Aging %I Academic Press %P 33-47 %@ 978-0-12-815970-5 %G eng %& 3 %R https://doi.org/10.1016/B978-0-12-815970-5.00003-6 %0 Journal Article %J Health Affairs %D 2021 %T Medicaid Coverage 'Cliff' Increases Expenses And Decreases Care For Near-Poor Medicare Beneficiaries. %A Roberts, Eric T %A Glynn, Alexandra %A Cornelio, Noelle %A Donohue, Julie M %A Gellad, Walid F %A McWilliams, J Michael %A Lindsay M Sabik %K Medicaid %K Medicare %XCost sharing in traditional Medicare can consume a substantial portion of the income of beneficiaries who do not have supplemental insurance from Medicaid, an employer, or a Medigap plan. Near-poor Medicare beneficiaries (with incomes more than 100 percent but less than 200 percent of the federal poverty level) are ineligible for Medicaid but frequently lack alternative supplemental coverage, resulting in a supplemental coverage "cliff" of 25.8 percentage points just above the eligibility threshold for Medicaid (100 percent of poverty). We estimated that beneficiaries affected by this supplemental coverage cliff incurred an additional $2,288 in out-of-pocket spending over the course of two years, used 55 percent fewer outpatient evaluation and management services per year, and filled fewer prescriptions. Lower prescription drug use was partly driven by low take-up of Part D subsidies, which Medicare beneficiaries automatically receive if they have Medicaid. Expanding eligibility for Medicaid supplemental coverage and increasing take-up of Part D subsidies would lessen cost-related barriers to health care among near-poor Medicare beneficiaries.
%B Health Affairs %V 40 %P 552-561 %G eng %N 4 %R 10.1377/hlthaff.2020.02272 %0 Report %D 2021 %T Medicaid Expansion and the Mental Health of Spousal Caregivers %A Costa-Font, Joan %A Raut, Nilesh %K ACA %K Informal care %K insurance expansion %K Medicaid %K mental wellbeing %K spousal mental health %X Health insurance expansions can exert wellbeing effects on individuals who provide informal care to their loved ones, reducing their experience of depression. This study exploits evidence from the Affordable Care Act’s (ACA) Medicaid expansion to examine the effects on the mental wellbeing of informal caregivers. Drawing on an event study and a Difference-in-Differences (DID) design we investigate the policy impact of ACA Medicaid expansion using longitudinal evidence (from the Health and Retirement Study, HRS) for 2010 to 2018 for low-income individuals aged 64 or below. We find that ACA’s Medicaid expansion reduced depressive symptoms among caregivers, and specifically we estimate that exposure to ACA Medicaid expansion gives rise to a 0.38 points (equivalent to 4-5%) reduction in the CESD score (a negative scale in which the lowest scale indicates the best mental wellbeing). We also find that ACA Medicaid causes a spillover effect at the household level, improving the well-being of the spouse care recipient. Our results are robust to various specifications, and we identify several potential driving mechanisms for the findings: reductions in out-of-pocket expenses and labor supply and, as expected, increased Medicaid uptake. The evidence from falsification tests confirms that the estimated effects are purely due to ACA’s Medicaid expansion and no other phenomena. %B Discussion Paper Series %I Institute of Labor Economics %C Bonn, Germany %G eng %U https://ftp.iza.org/dp14754.pdf %0 Journal Article %J The Journal of Pain %D 2021 %T Moderate to severe chronic pain in later life: risk and resilience factors for recovery %A Li, Rui %A Dworkin, Robert H. %A Chapman, Benjamin P %A Becerra, Adan Z %A Yang, Luoying %A Christopher J Mooney %A Christopher L Seplaki %K biopsychosocial %K high-impact chronic pain %K Moderate to severe chronic pain %K Recovery %X Despite extensive research on the development and risk factors of chronic pain, the process of recovery from chronic pain in later life has been rarely studied. We estimated the recovery rate of moderate to severe chronic pain (chronic pain of moderate or severe severity or interfering with usual activities) among older adults and investigated predictors of recovery. Leveraging the longitudinal Health and Retirement Study 2006–2016 data (6 waves), we estimated the biennial national attrition-adjusted recovery rate of moderate to severe chronic pain among 6,132 US adults aged 65–75 at baseline. Generalized estimating equation Poisson models examined pain-related, sociodemographic, psychosocial and health-related factors in relation to recovery within any 2-year interval using longitudinal lagged design. Between 2006–2016, the prevalence of moderate to severe chronic pain increased from 28% to 33% with the incidence increasing from 14% to 18% and the recovery rate approximately 30%. Previous chronic pain duration, age, chronic diseases and a personality trait (agreeableness) were associated with a lower probability of recovery. Greater financial wealth and physical activity, better sleep quality and self-reported health were associated with a greater probability of recovery. Interventions that improve physical activity and sleep quality may be important avenues for reducing chronic pain burden among older adults. %B The Journal of Pain %V 22 %P 1657-1671 %G eng %N 12 %R 10.1016/j.jpain.2021.05.007 %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 %XPsychological 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 Scientific Reports %D 2021 %T A multidimensional measure of polypharmacy for older adults using the Health and Retirement Study. %A Carr, Ewan %A Federman, Alex %A Dzahini, Olubanke %A Dobson, Richard J %A Bendayan, Rebecca %K Diseases %K Health Care %K Medical research %K Risk Factors %XPolypharmacy is commonly defined based on the number of medications taken concurrently using standard cut-offs, but several studies have highlighted the need for a multidimensional assessment. We developed a multidimensional measure of polypharmacy and compared with standard cut-offs. Data were extracted for 2141 respondents of the 2007 Prescription Drug Survey, a sub-study of the Health Retirement Study. Latent classes were identified based on multiple indicators of polypharmacy, including quantity, temporality and risk profile. A four-class model was selected based on fit statistics and clinical interpretability: 'High risk, long-term' (Class 1), 'Low risk, long-term' (Class 2), 'High risk, short-term' (Class 3), and 'High risk for drug interactions, medium-term, regular' (Class 4). Classes differed regarding sex, cohabitation, disability and multimorbidity. Participants in the 'low risk' class tended to be male, cohabitating, and reported fewer health conditions, compared to 'high risk' classes. Polypharmacy classes were compared to standard cut-offs (5+ or 9+ medications) in terms of overlap and mortality risk. The three 'high risk' classes overlapped with the groups concurrently taking 5+ and 9+ medications per month. However, the multidimensional measure further differentiated individuals in terms of risk profile and temporality of medication taking, thus offering a richer assessment of polypharmacy.
%B Scientific Reports %V 11 %P 8783 %G eng %N 1 %R 10.1038/s41598-021-86331-x %0 Journal Article %J Experimental Gerontology %D 2021 %T Muscle weakness is a prognostic indicator of disability and chronic disease multimorbidity. %A Mark D Peterson %A Casten, Kimberly %A Collins, Stacey %A Hassan, Halimah %A García-Hermoso, Antonio %A Jessica Faul %K Aging %K Chronic disease %K Dementia %K Disability %K Grip strength %K weakness %XBACKGROUND: The objective of this study was to use nationally-representative data on Americans greater than 50 years of age to determine the association between grip strength and inflammation as independent predictors of incident disability, chronic multimorbidity and dementia.
METHODS: Middle age and older adults (n = 12,618) from the 2006-2008 waves of the Health and Retirement Study with 8-years of follow-up were included. Longitudinal modeling was performed to examine the association between baseline grip strength (normalized to body mass: NGS) and high sensitivity C-reactive protein (hs-CRP) (≥3.0 mg/L) with incident physical disabilities (i.e., ≥2 limitations to activities of daily living), chronic multimorbidity (≥2 of chronic conditions), and dementia.
RESULTS: The odds of incident disability were 1.25 (95% CI: 1.20-1.30) and 1.31 (95% CI: 1.26-1.36) for men and women respectively, for each 0.05-unit lower NGS. The odds of incident chronic multimorbidity were 1.14 (95% CI: 1.08-1.20) and 1.14 (95% CI: 1.07-1.21) for men and women respectively for each 0.05-unit lower NGS. The odds of incident dementia were 1.10 for men (95% CI: 1.02-1.20) for each 0.05-unit lower NGS, but there was no significant association for women. Elevated hs-CRP was only associated with chronic multimorbidity among men (OR = 1.29; 95% CI: 1.00-1.73) and women (OR = 1.60; 95% CI: 1.26-2.02).
CONCLUSIONS: Our findings indicate a robust inverse association between NGS and disability and chronic, multimorbidity in older men and women, and dementia in men. Elevated hs-CRP was only associated with chronic multimorbidity in men and women. Healthcare providers should implement measures of grip strength in routine health assessments and discuss the potential dangers of weakness as well as interventions to improve strength with their patients.
%B Experimental Gerontology %V 152 %P 111462 %G eng %R 10.1016/j.exger.2021.111462 %0 Journal Article %J Innovation in Aging %D 2021 %T Music Engagement and Episodic Memory among Middle-Aged and Older Adults: A National Longitudinal Analysis %A Rouse, Hillary J %A Hueluer, Gizem %A Torres, Mia %A Du, Yan %A Conner, Kyaien O %A Meng, Hongdao %K Episodic Memory %K Music %X Recent research suggests that engagement with particular activities, such as music, can influence age-related changes in episodic memory. However, it is unclear whether, and to what, extent music engagement is associated with the trajectory of episodic memory. The objective of this study is to examine how passive (i.e., listening to music) and/or active (i.e., singing or playing an instrument) music engagement influences episodic memory over a period of 12 years. Secondary data analysis of a sample (N=5095) of cognitively healthy adults from the Health and Retirement Study were used for this study. Linear mixed effects models were used to examine the independent effect of different levels of music engagement (i.e., low, medium, and high) on changes in performance on episodic memory tasks, while controlling for confounding factors. Compared to those with low engagement (i.e., neither listening nor singing/ playing an instrument), respondents who reported being engaged at the medium (i.e., either listening or singing/ playing an instrument) or high (i.e., both listening and singing/ playing an instrument) level performed 0.24 (p=0.003) and 0.52 (p<0.001) points better, respectively. We found evidence that music engagement attenuated the decline in episodic memory. The findings suggest that music engagement may be a protective factor against aged-related decline in episodic memory. Therefore, music engagement may offer a promising non-pharmacological intervention for dementia risk mitigation among community-living middle-aged and older adults. Future research should examine whether interventions to increase music engagement can affect the trajectories of aged-related decline in cognition in this large and growing population. %B Innovation in Aging %V 5 %P 707 %G eng %N Suppl _1 %R https://doi.org/10.1093/geroni/igab046.2625 %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 Journal Article %J BMC Rheumatology %D 2021 %T No association between rheumatoid arthritis and cognitive impairment in a cross-sectional national sample of older U.S. adults. %A Booth, Michael J %A Mary R Janevic %A Lindsay C Kobayashi %A Daniel Clauw %A John D Piette %K cognitive impairment %K Epidemiology %K National health survey %K rheumatoid arthritis %XBACKGROUND: Studies suggest an increased prevalence of cognitive impairment (CI) among people with rheumatoid arthritis (RA). However, most prior studies have used convenience samples which are subject to selection biases or have failed to adjust for key confounding variables. We thus examined the association between CI and RA in a large national probability sample of older US adults.
METHODS: Data were from interviews with 4462 participants in the 2016 wave of the nationally representative U.S. Health and Retirement Study with linked Medicare claims. RA diagnoses were identified via a minimum of two ICD-9CM or ICD-10 codes in Medicare billing records during the prior 2 years. The Langa-Weir Classification was used to classify cognitive status as normal, cognitively impaired non-dementia (CIND), or dementia based on a brief neuropsychological battery for self-respondents and informant reports for proxy respondents. We compared the odds of CI between older adults with and without RA using logistic regression, adjusted for age, education, gender, and race.
RESULTS: Medicare records identified a 3.36% prevalence of RA (150/4462). While age, gender, education, and race independently predicted CI status, controlling for these covariates we found no difference in CI prevalence according to RA status (prevalent CI in 36.7% of older adults with RA vs. 34.0% without RA; adjusted OR = 1.08, 95% CI 0.74-1.59, p = .69).
CONCLUSION: There was no association between RA and CI in this national sample of older U.S. adults.
%B BMC Rheumatology %V 5 %P 24 %G eng %N 1 %R 10.1186/s41927-021-00198-z %0 Journal Article %J BMC Rheumatology %D 2021 %T No increased risk of Alzheimer's disease among people with immune-mediated inflammatory diseases: findings from a longitudinal cohort study of U.S. older adults. %A Booth, Michael J %A Lindsay C Kobayashi %A Mary R Janevic %A Daniel Clauw %A John D Piette %K Alzheimer %K immune-mediated inflammatory disease %K Medicare claims data %XOBJECTIVE: Immune-mediated inflammatory diseases (IMID) are characterized by systemic inflammation affecting the joints and bodily organs. Studies examining the association between individual IMIDs and the risk of Alzheimer's disease (AD) have yielded inconsistent findings. This study examines AD risk across a group of IMIDs in a large population-based sample of older adults.
METHODS: Data on a national sample of US adults over age 50 was drawn from the Health and Retirement Study (HRS) and linked Medicare claims from 2006 to 2014. IMIDs include rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, and related conditions. We identified IMIDs from 2006 to 2009 Medicare claims using International Classification of Diseases (ICD9-CM) codes. The date of incident AD was derived from Chronic Conditions Warehouse (CCW) identifiers. We examined the risk of AD from 2009 to 2014 using Cox proportional hazards models, both unadjusted and adjusted for age, gender, education, race, and the genetic risk factor APOE-e4.
RESULTS: One hundred seventy-one (6.02%) of the 2842 total HRS respondents with Medicare coverage and genetic data were classified with IMIDs. Over the subsequent 6 years, 9.36% of IMID patients developed AD compared to 8.57% of controls (unadjusted hazard ratio (HR): 1.09, 95% CI .66-1.81, p = 0.74). Adjusted HR 1.27 (95% CI 0.76-2.12, p = 0.35). Age (HR for 10-year increment 3.56, p < .001), less than high school education (HR 1.70, p = .007), and APOE-e4 (HR 2.61, p < .001 for one or two copies), were also statistically significant predictors of AD.
CONCLUSION: HRS respondents with common IMIDs do not have increased risk of Alzheimer's disease over a 6-year period.
%B BMC Rheumatology %V 5 %P 48 %G eng %N 1 %R 10.1186/s41927-021-00219-x %0 Journal Article %J Medical Care %D 2021 %T A Novel Metric for Developing Easy-to-Use and Accurate Clinical Prediction Models: The Time-cost Information Criterion. %A Lee, Sei J %A Alexander K Smith %A Ramirez-Diaz, Ledif G %A Kenneth E Covinsky %A Gan, Siqi %A Chen, Catherine L %A W John Boscardin %K Bayesian Information Criterion %K Methodology %XBACKGROUND: Guidelines recommend that clinicians use clinical prediction models to estimate future risk to guide decisions. For example, predicted fracture risk is a major factor in the decision to initiate bisphosphonate medications. However, current methods for developing prediction models often lead to models that are accurate but difficult to use in clinical settings.
OBJECTIVE: The objective of this study was to develop and test whether a new metric that explicitly balances model accuracy with clinical usability leads to accurate, easier-to-use prediction models.
METHODS: We propose a new metric called the Time-cost Information Criterion (TCIC) that will penalize potential predictor variables that take a long time to obtain in clinical settings. To demonstrate how the TCIC can be used to develop models that are easier-to-use in clinical settings, we use data from the 2000 wave of the Health and Retirement Study (n=6311) to develop and compare time to mortality prediction models using a traditional metric (Bayesian Information Criterion or BIC) and the TCIC.
RESULTS: We found that the TCIC models utilized predictors that could be obtained more quickly than BIC models while achieving similar discrimination. For example, the TCIC identified a 7-predictor model with a total time-cost of 44 seconds, while the BIC identified a 7-predictor model with a time-cost of 119 seconds. The Harrell C-statistic of the TCIC and BIC 7-predictor models did not differ (0.7065 vs. 0.7088, P=0.11).
CONCLUSION: Accounting for the time-costs of potential predictor variables through the use of the TCIC led to the development of an easier-to-use mortality prediction model with similar discrimination.
%B Medical Care %V 59 %P 418-424 %G eng %N 5 %R 10.1097/MLR.0000000000001510 %0 Journal Article %J Social Science & Medicine %D 2021 %T Occupational differences in advance care planning: Are medical professionals more likely to plan? %A Deborah Carr %A Lucie Kalousova %A Lin, Katherine %A Sarah A. Burgard %K Advance care planning %K Employment %K end-of-life %K health %K Occupations %K Social stratification %X Advance care planning (ACP) helps ensure that treatment preferences are met at the end of life. Medical professionals typically are responsible for facilitating patients' ACP, and may be especially effective in doing so if they have first-hand insights from their own planning. However, no large-scale U.S. studies examine whether persons working on the front lines of health care are more likely than other workers to have done ACP. We contrast the use of three ACP components (living wills, durable power of attorney for health care, and informal discussions) among persons working in medical, legal, social/health support services, other professional, and other non-professional occupations. Data are from the Health and Retirement Study (n = 7668) and Wisconsin Longitudinal Study (n = 5464). Multivariable logistic regression analyses are adjusted for socioeconomic, demographic, health, and psychosocial factors that may confound associations between occupational group and ACP. Medical professionals in both samples are more likely than other professional workers to discuss their own treatment preferences, net of all controls. Medical professionals in the WLS are more likely to execute living wills and DPAHC designations, whereas legal professionals in the HRS are more likely to name a DPAHC. Non-professional workers are significantly less likely to do all three types of planning, although these differences are accounted for by socioeconomic factors. Social and health services professionals are no more likely than other professionals to do ACP. The on-the-job experiences and expertise of medical professionals may motivate them to discuss their own end-of-life preferences, which may render them more trustworthy sources of information for patients and clients. The Affordable Care Act provides reimbursement for medical professionals' end-of-life consultations with Medicare beneficiary patients, yet practitioners uncomfortable with such conversations may fail to initiate them. Programs to increase medical professionals’ own ACP may have the secondary benefit of increasing ACP among their patients. %B Social Science & Medicine %V 272 %P 113730 %@ 0277-9536 %G eng %R https://doi.org/10.1016/j.socscimed.2021.113730 %0 Journal Article %J Journal of Financial Therapy %D 2021 %T Older Adults’ Life Satisfaction: The Roles of Seeking Financial Advice and Personality Traits %A Chatterjee, Swarn %A Fan, Lu %K Cognitive Ability %K Financial help seeking %K financial therapy %K Health Status %K Life Satisfaction %K Personality %X This paper uses 1,237 respondents from the Health and Retirement Study dataset to examine the relationships among personality, financial advice-seeking, and life satisfaction of U.S. older adults. The results indicate that extraversion is negatively associated with seeking professional financial advice, while conscientiousness and openness were associated positively with seeking professional financial advice. Individuals with a neurotic personality trait were positively associated with seeking financial advice from families and friends. Additionally, seeking professional financial advice, and being extraverted and conscientious, were positively associated with life satisfaction among older adults. The implications for financial therapists and counselors include suggestions for implementation of cross-functional collaborative counseling strategies when working with older clients who may be experiencing physical and mental health-related problems. Implications of the findings for policymakers are also discussed. %B Journal of Financial Therapy %V 12 %G eng %N 1 %R https://doi.org/10.4148/1944-9771.1253 %0 Journal Article %J Advances in Geriatric Medicine and Research %D 2021 %T Oral Conditions, Oral Health Related Quality of Life and Cognitive Function: Preliminary Results from the Health and Retirement Study %A Joshi, Prajakta %A Kaufman, Laura B. %A Cabral, Howard %K Cognition %K Dementia %K Oral Health %K oral health related quality of life %X Background: Growing evidence suggests that cognitive functioning is influenced by oral health status. This study examines the association between the status or condition of the mouth as measured by self-report (OH), oral health related quality of life (OHRQoL) and dental care utilization on cognitive function. Design: Population‐based cross‐sectional study. Setting: United States Health and Retirement Study (2018). Participants: Community‐dwelling adults above 50 years of age (N = 1268; Mean age (SD) 67.14 ± 10.54 years). Measurements: Self-reported condition of mouth and teeth, number of teeth and denture use were used to determine the OH. OHRQoL was assessed as a composite score using self-reported pain or distress due to gums or teeth, difficulty to relax, avoiding eating certain foods, or socializing due to oral health issues. Validated cognitive score cut-offs were used: (i) (≥12) representing normal cognition (ii) (6–11) “cognitive impairment, not demented” (CIND), and (iii) (<6) dementia. Results: We found that participants with worse OHRQoL had 0.15 units lower global cognitive scores (β = −0.15, SE = 0.03, p = < 0.0001). Compared to those with dementia, participants in normal and CIND categories had greater odds of better OH (ORNormal = 1.76, (95%CI: 1.09–2.84); ORCIND = 2.86, (95%CI: 1.60–5.09)). Furthermore, participants in the CIND category had greater odds of using dentures compared to participants with dementia (ORCIND = 2.71, (95%CI: 1.49–4.93)). We did not find any statistically significant association between tooth loss or dental utilization and dementia. Conclusions: This study provides valuable preliminary insights into the potential association between OH and OHRQoL and cognitive function. If further validated, this method may allow dental and cognitive triage for follow-up assessments in community dwelling adults who may have limited access to care. %B Advances in Geriatric Medicine and Research %V 3 %P e210020 %G eng %N 4 %R https://doi.org/10.20900/agmr20210020 %0 Journal Article %J Psychosomatic Medicine %D 2021 %T Personality and Headaches: Findings From Six Prospective Studies. %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Canada, Brice %A Antonio Terracciano %K headaches %K Personality %XOBJECTIVE: The present study examined the association between personality traits and concurrent and incident headaches.
METHODS: Participants (n = 34,989), aged 16 to 107 years were from the Midlife in the United States study, the Midlife in Japan study, the Health and Retirement Study, the Wisconsin Longitudinal Study Graduate and Siblings samples, and the Longitudinal Internet Studies for the Social Sciences. Demographic factors, personality traits, and headaches were assessed at baseline. Headaches were assessed again 4 to almost 20 years later.
RESULTS: Across the samples, higher neuroticism was related to a higher likelihood of concurrent (combined odd ratio = 1.41, 95% confidence interval [CI] = 1.28-1.55, p < .001) and incident (combined odd ratio = 1.28, 95% CI = 1.12-1.46, p < .001) headaches, whereas higher extraversion was associated with a lower likelihood of concurrent (combined odd ratio = 0.87, 95% CI = 0.84-0.89, p < .001) and incident (combined odd ratio = 0.90, 95% CI = 0.85-0.96, p = .001) headaches. Higher conscientiousness (combined odd ratio = 0.90, 95% CI = 0.86-0.94, p < .001) and openness (combined odd ratio = 0.95, 95% CI = 0.90-0.99, p = .025) were associated with a lower probability of reporting concurrent headaches. Agreeableness was unrelated to headaches. Sex was not a consistent moderator.
CONCLUSIONS: The present study provides robust evidence that neuroticism and introversion are risk factors for headaches in concurrent and prospective analyses across multiple cohorts.
%B Psychosomatic Medicine %V 83 %P 118-124 %G eng %N 2 %R 10.1097/PSY.0000000000000902 %0 Web Page %D 2021 %T Poorer and minority older adults are suspicious of the US health care system – a new study shows why %A Marc A Cohen %A Jane Tavares %K health care system %K Income inequality %K Racial Disparities %X We analyzed information collected in a biannual national survey called the Health and Retirement Study. Along with colleagues at the LeadingAge LTSS Center at the University of Massachusetts Boston and the Center for Consumer Engagement in Health Innovation, we found that fully one-third of U.S. respondents age 50 and older reported the health care system “never,” or only “sometimes,” considered their care preferences. The other two-thirds reported their preferences were “usually” or “always” taken into account. %I The Conversation %G eng %U https://theconversation.com/poorer-and-minority-older-adults-are-suspicious-of-the-us-health-care-system-a-new-study-shows-why-156117 %0 Journal Article %J Preventative Medicine %D 2021 %T The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: An outcome-wide approach. %A Hong, Joanna H %A Margie E Lachman %A Susan T Charles %A Chen, Ying %A Wilson, Caitlyn L %A Tyler J VanderWeele %A Julia S Nakamura %A Eric S Kim %K physical well-being %K psychosocial health %XAccumulating research indicates robust associations between sense of control and salutary health and well-being outcomes. However, whether change in sense of control is associated with subsequent outcomes has been under-evaluated. Participants (N = 12,998) were from the Health and Retirement Study-a diverse, nationally representative, and longitudinal sample of U.S. adults aged >50 years. We examined how increase in sense of control (from t:2006/2008 to t: 2010/2012) was associated with better outcomes on 35 indicators of: physical-, behavioral-, and psychosocial-health (t:2014/2016). We used multiple logistic-, linear-, and generalized-linear regression models and controlled for sociodemographic characteristics, personality traits, sense of control, and all outcomes in the pre-baseline wave (t:2006/2008). During the 4-year follow-up, people in the highest (vs. lowest) quartile of sense of control, conditional on prior sense of control, had reduced risk of mortality and improved physical-health outcomes (lower risk of: stroke, lung disease, physical limitations, cognitive impairment, chronic pain and higher self-rated health). Sense of control was related to better health-behaviors (increased physical activity, reduced sleep problems), higher psychological well-being (positive affect, life satisfaction, optimism, purpose, personal-, health-, financial-mastery), lower psychological distress (depression, hopelessness, negative affect, perceived constraints), decreased loneliness, and increased contact with friends. Sense of control was unrelated to other physical health indicators (diabetes, hypertension, heart disease, cancer, arthritis, overweight/obesity), health behaviors (binge drinking, smoking), and social factors (living with spouse/partner, frequency of contact with children and other family). These findings underscore the importance of sense of control as a potential intervention target for fostering physical-, behavioral-, and psychosocial-health.
%B Preventative Medicine %V 149 %P 106612 %G eng %R 10.1016/j.ypmed.2021.106612 %0 Journal Article %J The Journal of Retirement %D 2021 %T Post-Retirement Labor and Non-Retirement Risky Asset Allocation %A Curnutt, Gary %A Sun, Qi %A Michael A. Guillemette %K legal/regulatory/public policy %K performance measurement %K Retirement %K risk management %X This article studies how post-retirement labor is related to non-retirement risky asset allocation. By using panel data from the 1992–2018 Health and Retirement Study, this article empirically finds a negative relationship over time between non-retirement risky asset allocation and post-retirement labor. Furthermore, this article explores the forced retirement risk (a type of labor income risk) for the post-retirement labor group. Descriptive findings indicate that members of the post-retirement labor group have a greater risk of being forced to retire, and the trend of forced retirement risk is inversely related to equity returns. This latter finding suggests a potential correlation between forced retirement risk and stock returns. If an individual’s human capital is at greater risk or becomes more stock-like (i.e., labor income risk correlates with stock returns), then investing in fewer risky assets would be justifiable. When both of these findings are accounted for, they corroborate the findings of this article: post-retirement labor is negatively associated with risky asset allocation. %B The Journal of Retirement %V 9 %P 112-123 %G eng %N 1 %R 10.3905/jor.2021.1.087 %0 Journal Article %J Practical Applications %D 2021 %T Practical Applications of Post-Retirement Labor and Non-Retirement Risky Asset Allocation %A Curnutt, Gary %A Sun, Qi %A Michael A. Guillemette %K non-retirement financial assets %K non-retirement stock accounts %X In Post-Retirement Labor and Non-Retirement Risky Asset Allocation, from the Summer 2021 issue of The Journal of Retirement, Gary Curnutt, Qi Sun, and Michael Guillemette, researchers at Texas Tech University’s School of Financial Planning, focus their study on older individuals engaged in post-retirement labor. Traditionally, earned labor is viewed as a low-risk asset that substitutes for bond-like assets in one’s portfolio and is balanced against riskier assets like stocks. However, the authors push back against this traditional view, cautioning that post-retirement labor earnings may not be a suitable substitute for risk-free assets.Using data from the 1992–2018 Health and Retirement Study (HRS), the authors look at the value of non-retirement stock accounts relative to all non-retirement financial assets. They find that those working post-retirement invested in a lower percentage of stocks than retirees do. The authors suggest that this reduction in risky assets may in part be explained by the high risk of post-retirement labor income. Due to the high-risk nature of post-retirement labor and the increasing likelihood of forced retirement, the authors urge advisors to consider reducing the weights of risky assets in the portfolios of those who return to work after retirement. %B Practical Applications %V 9 %G eng %N 2 %R 10.3905/pa.2021.pa473 %0 Web Page %D 2021 %T Probing the Link Between Chronic Pain and Cognitive Impairment %A Chan, Nicholas %K Chronic pain %K Cognitive decline %I Being Patient %G eng %U https://www.beingpatient.com/persistent-pain-cognition/ %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Psychological Resilience and Health Among Older Adults: A Comparison of Personal Resources. %A Miles G Taylor %A Dawn C Carr %K hopelessness %K Mastery %K Optimism %K Trajectories %K Well-being %XOBJECTIVES: Research on life course inequality and successful aging has sought to understand how events and challenges may lead to poor outcomes in later life for some individuals, while others fare well in the face of adversity. Among internalized resources, research suggests psychological resilience is protective in the face of challenges, but little is known about the predictive efficacy of this measure compared to other resources such as mastery. This paper examines connections between psychological resilience and later life health compared to other internalized resources.
METHOD: Standardized associations between 4 resources (resilience, mastery, optimism, hopelessness) and 5 health outcomes were tested using short-term health transitions and longer term health trajectories in a structural equation modeling (SEM) framework using the Leave Behind Questionnaire (LBQ) and linked Health and Retirement Study (HRS) between 2006/2008 and 2014/2016 (n = 11,050-12,823).
RESULTS: Psychological resilience had consistent and robust associations with health transitions and trajectories. Further, the effects of this resource were generally 4-10 times greater than for mastery, optimism, and hopelessness in combined models. Trajectory analyses replicate these findings and suggest the beneficial associations of resilience over time were persistent for some health outcomes, and cumulative for others.
DISCUSSION: The results suggest that psychological resilience is powerfully associated with health in later life, with substantially greater predictive efficacy than other commonly used resource measures. Future research should establish how this intrapersonal resource works alongside structural and interpersonal resources to promote and protect health and functioning in the face of challenges and adversity.
%B The Journals of Gerontology: Series B %V 76 %P 1241-1250 %G eng %N 6 %R 10.1093/geronb/gbaa116 %0 Journal Article %J Geroscience %D 2021 %T Quest for a summary measure of biological age: The Health and Retirement Study. %A Eileen M. Crimmins %A Bharat Thyagarajan %A Jung K Kim %A David R Weir %A Jessica Faul %K Biological age %K Biomarkers %K Phenotypic age %K TAME markers %XMeasures of biological age and its components have been shown to provide important information about individual health and prospective change in health as there is clear value in being able to assess whether someone is experiencing accelerated or decelerated aging. However, how to best assess biological age remains a question. We compare prediction of health outcomes using existing summary measures of biological age with a measure created by adding novel biomarkers related to aging to measures based on more conventional clinical chemistry and exam measures. We also compare the explanatory power of summary biological age measures compared to the individual biomarkers used to construct the measures. To accomplish this, we examine how well biological age, phenotypic age, and expanded biological age and five sets of individual biomarkers explain variability in four major health outcomes linked to aging in a large, nationally representative cohort of older Americans. We conclude that different summary measures of accelerated aging do better at explaining different health outcomes, and that chronological age has greater explanatory power for both cognitive dysfunction and mortality than the summary measures. In addition, we find that there is reduction in the variance explained in health outcomes when indicators are combined into summary measures, and that combining clinical indicators with more novel markers related to aging does best at explaining health outcomes. Finally, it is hard to define a set of assays that parsimoniously explains the greatest amount of variance across the range of health outcomes studied here. All of the individual markers considered were related to at least one of the health outcomes.
%B Geroscience %V 43 %P 395-408 %G eng %N 1 %R 10.1007/s11357-021-00325-1 %0 Journal Article %J BMC Nephrology %D 2021 %T The relationship between financial hardship and incident diabetic kidney disease in older US adults - a longitudinal study. %A Corwin, Timothy R %A Mukoso N. Ozieh %A Emma Garacci %A Palatnik, Anna %A Leonard E Egede %K Diabetes %K Financial hardship %XBACKGROUND: Financial hardship is associated with poor health, however the association of financial hardship and incident diabetic kidney disease (DKD) is unknown. This study aimed to examine the longitudinal relationship between financial hardship and incident DKD among older adults with diabetes.
METHODS: Analyses were conducted in 2735 adults age 50 or older with diabetes and no DKD using four waves of data (2006-2012) from the Health and Retirement Study, a national longitudinal cohort. The primary outcome was incident DKD. Financial hardship was based on three measures: 1) difficulty paying bills; 2) food insecurity; and 3) cost-related medication non-adherence using validated surveys. A dichotomous financial hardship variable (0 vs 1 or more) was constructed based on all three measures. Cox regression models were used to estimate the association between financial hardship, change in financial hardship experience and incident DKD adjusting for demographics, socioeconomic status, and comorbidities.
RESULTS: During the median follow-up period of 4.1 years, incident DKD rate was higher in individuals with versus without financial hardship (41.2 versus 27/1000 person years). After adjustment, individuals with financial hardship (HR 1.32, 95% CI 1.04-1.68) had significantly increased likelihood of developing DKD compared to individuals without financial hardship. Persistent financial hardship (adjusted HR 1.52 95% CI 1.06-2.18) and negative financial hardship (adjusted HR 1.54 95% CI 1.02-2.33) were associated with incident DKD compared with no financial hardship experience. However, positive financial hardship was not statistically significant in unadjusted and adjusted (adjusted HR 0.89 95% CI 0.55-1.46) models. Cost-related medication non-adherence (adjusted HR 1.43 95% CI 1.07-1.93) was associated with incident DKD independent of other financial hardship measures.
CONCLUSIONS: Financial hardship experience is associated with a higher likelihood of incident DKD in older adults with diabetes. Future studies investigating factors that explain the relationship between financial hardship and incident DKD are needed.
%B BMC Nephrology %V 22 %P 167 %G eng %N 1 %R 10.1186/s12882-021-02373-3 %0 Journal Article %J Journal of Applied Gerontology %D 2021 %T Relationship Between Multiple Measures of Financial Hardship and Glycemic Control in Older Adults With Diabetes %A Walker, R.J. %A Emma Garacci %A Campbell, J.A. %A Harris, M. %A Mosley-Johnson, E. %A Leonard E Egede %K Chronic illness %K Diabetes %K socioeconomic status %X Aim: To examine the relationship between multiple measures of financial hardship and glycemic control in older adults with diabetes. Methods: Using data from Health and Retirement Study (HRS), we investigated four measures of financial hardship: difficulty paying bills, ongoing financial strain, decreasing food intake due to money, and taking less medication due to cost. Using linear regression models, we investigated the relationship between each measure, and a cumulative score of hardships per person, on glycemic control (HbA1c). Results: After adjustment, a significant relationship existed with each increasing number of hardships associated with increasing HbA1c (0.09, [95%CI 0.04, 0.14]). Difficulty paying bills (0.25, [95%CI 0.14, 0.35]) and decreased medication usage due to cost (0.17, [95%CI 0.03, 0.31]) remained significantly associated with HbA1c. Conclusion: In older adults, difficulty paying bills and cost-related medication nonadherence is associated with glycemic control, and every additional financial hardship was associated with an increased HbA1c by nearly 0.1%. © The Author(s) 2020. %B Journal of Applied Gerontology %V 40 %P 162-169 %G eng %N 2 %9 Journal %R 10.1177/0733464820911545 %0 Journal Article %J Journal of Pension Economics and Finance %D 2021 %T Retirement incentives and behavior of private and public sector workers %A Courtney Coile %A Stewart, Susan %K Pensions %K Private Sector %K Public Sector %K Retirement %K retirement incentives %X Over the past several decades, private sector workers in the USA with employed-sponsored pensions have experienced a dramatic shift from defined benefit (DB) to defined contribution plans, while this trend has been less pronounced for public sector workers. In this paper, we use data from the Health and Retirement Study to explore changes in the retirement incentives and retirement behavior of public and private sector workers over the past quarter-century. We find that both groups have become less likely to report having a DB pension or any pension. Compared to their private sector counterparts, public sector workers have a higher level of retirement wealth and a larger financial gain from continued work at older ages, and these differences by sector are growing across cohorts. Both groups respond to financial incentives in making retirement decisions. However, growing differences by sector in the gain to continued work do not appear to have translated into diverging retirement behavior, as we observe similar trends in the two groups. %B Journal of Pension Economics and Finance %V 20 %P 393-409 %@ 1474-7472 %G eng %N 3 %R 10.1017/S1474747219000416 %0 Journal Article %J The Journal of Gerontology: Series B %D 2021 %T Revisiting the Role of Gender and Marital Status as Risk Factors for Nursing Home Entry. %A Maria Casanova %K gender %K Living arrangements %K Long-term Care %K Nursing home entry %XOBJECTIVE: To study the role of gender and marital status as risk factors for nursing home entry in the United States.
METHOD: The paper uses data from the Health and Retirement Study, a nationally representative survey of the older population in the United States. Multivariate logit models of the risk of nursing home entry over a 2-year follow-up period were estimated for noninstitutionalized individuals over the age of 65. A multiple imputation procedure was used to explore the sensitivity of the results to alternative assumptions about the data-generating process of missing outcome values.
RESULTS: In an analysis based on complete observations, women exhibited the same risk of nursing home entry as men (risk ratio [RR] = 1.01; CI: 0.90, 1.13). However, after expanding the sample to include information on nursing home use for individuals who died during the follow-up period, women were found to have a statistically lower risk of nursing home entry (RR = 0.85; CI: 0.79, 0.92). The latter result was robust to alternative assumptions about the nature of missing data. The type of sample used in the analysis did not affect the conclusions regarding the role of marital status. Divorced and widowed individuals were found to be at higher risk of nursing home admissions than married individuals in all specifications.
DISCUSSION: The findings clarify the role of gender as a predictor of nursing home admissions and may provide useful prognostic information for clinicians and caregivers regarding nursing home entry risk. The study also sheds light on how conclusions about predictors of nursing home risk obtained from prospective studies with long follow-up periods can be affected by the treatment of missing outcomes due to death or attritions.
%B The Journal of Gerontology: Series B %V 76 %P S86-S96 %G eng %N Supplement_1 %R 10.1093/geronb/gbab004 %0 Journal Article %J Journal of Financial Planning %D 2021 %T Right-Sizing Retirement: Exploring the Retirement Consumption Gap in Early Retirement %A David Blanchett %A Cormier, Warren %K consumption %K Early retirement %K Financial planning %K Investments %K Personal finance %K Retirement %K Retirement Planning %X * Research suggests some households underspend in retirement, resulting in a "retirement consumption gap." This paper explores this effect, specifically during the first 10 years of retirement, and incorporates both household assets and preretirement spending using data from the Health and Retirement Study. * Only 18 percent of households have enough wealth to cover pre-retirement consumption when they retire, which suggests most households will not be able to maintain their pre-retirement lifestyle in retirement-a finding consistent with other general estimates of the retirement readiness of Americans. * Real financial assets decline for 65 percent of households during the first 10 years of retirement, with a median real decline of 35 percent. * Real retiree spending declines for 75 percent of households during the first 10 years of retirement, with a median annual decline of approximately 2 percent per year. This suggests financial planners should consider changes in retirement spending that are less than inflation as part of a retirement plan. The percentage of households that can fund their retirement consumption increases dramatically during the first 10 years of retirement, from 18 percent to 48 percent, primarily due to reductions in spending. This suggests households "right-size" their spending early in retirement to better align with available resources. It is not clear, though, to what extent this behavior persists further into retirement (due to data limitations). Many well-funded households could increase consumption, but appear not to do so (i.e., exhibit a retirement consumption gap). Potential reasons include the desire to leave a bequest, uncertain medical expenses (especially late in retirement), uncertain life expectancy, etc. While this group is a minority of retiree households, understanding what drives this behavior is especially important to financial planners since this group tends to have the most accumulated wealth and are, therefore, more likely to seek the services of, or use, a financial planner. %B Journal of Financial Planning %V 34 %P 68-81 %@ 10403981 %G eng %N 2 %0 Journal Article %J Gerontechnology %D 2021 %T Rural and non-rural digital divide persists in older adults: Internet access, usage, and attitudes toward technology %A Lee, Hee Yun %A Kanthawala, Shaheen %A Eun-Young Choi %A Kim, Young Sun %K Attitude %K Digital Divide %K rural %K Technology %K urban %X Background: The digital age divide remains persistent despite the recent increase in internet use among older adults. Additionally, older rural residents are at greater risk of being digitally disconnected. Objective: Guided by the social determinants of health framework, our study aims to examine how one’s residential area relates to (1) internet use, (2) subtypes of usage patterns, and (3) attitudes toward technology use in later life. Method: Cross-sectional data were drawn from the 2012 Health and Retirement Study. The analytic sample consisted of 1,566 older adults aged 50 and above. Chi-square tests and logistic regression analyses were performed. Results: Internet access rates were significantly lower in rural residents (54%) compared to the urban (66%) or the suburban group (61%). Compared to urban residents, those residing in suburban areas were less likely to use health technology while those living in rural areas had lower odds of communication, financial, and media technology use. Furthermore, the association between urban-rural residence and attitudes toward technology was compared among non-users (N = 633). Older adults in rural areas showed more unfavorable perceptions of technology than urban residents. They were less likely to conceive technology as “easily available,” but more likely to perceive it as “too complicated” and “too hard to learn.” No significant differences were found between rural and suburban residents. Conclusion: Our findings suggest that older adults in rural areas, notably lag in using and adopting digital technology. Comprehensive intervention efforts are needed to narrow the digital divide for rural communities. %B Gerontechnology %V 20 %P 1-9 %G eng %N 2 %R https://doi.org/10.4017/gt.2021.20.2.32-472.12 %0 Journal Article %J Journal of Alzheimer's Disease %D 2021 %T Self-Reported Dementia-Related Diagnosis Underestimates the Prevalence of Older Americans Living with Possible Dementia. %A Ryan P McGrath %A Sheria G Robinson-Lane %A Brian C Clark %A Suhr, Julie A %A Bruno J Giordani %A Brenda Vincent %K Aging %K Cognitive Dysfunction %K Geriatric Assessment %K Geriatrics %K Healthcare Disparities %XBACKGROUND: Dementia screening is an important step for appropriate dementia-related referrals to diagnosis and treat possible dementia.
OBJECTIVE: We sought to estimate the prevalence of no reported dementia-related diagnosis in a nationally representative sample of older Americans with a cognitive impairment consistent with dementia (CICD).
METHODS: The weighted analytical sample included 6,036,224 Americans aged at least 65 years old that were identified as having a CICD without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 Health and Retirement Study. The adapted Telephone Interview of Cognitive Status assessed cognitive functioning. Those with scores≤6 were considered as having a CICD. Healthcare provider dementia-related diagnosis was self-reported. Age, sex, educational achievement, and race and ethnicity were also self-reported.
RESULTS: The overall estimated prevalence of no reported dementia-related diagnosis for older Americans with a CICD was 91.4%(95%confidence interval (CI): 87.7%-94.1%). Persons with a CICD who identified as non-Hispanic black had a high prevalence of no reported dementia-related diagnosis (93.3%; CI: 89.8%-95.6%). The estimated prevalence of no reported dementia-related diagnosis was greater in males with a CICD (99.7%; CI: 99.6%-99.8%) than females (90.2%; CI: 85.6%-93.4%). Moreover, the estimated prevalence of no reported dementia-related diagnosis for non-high school graduates with a CICD was 93.5%(CI: 89.3%-96.1%), but 90.9%(CI: 84.7%-94.7%) for those with at least a high school education.
CONCLUSION: Dementia screening should be encouraged during routine geriatric health assessments. Continued research that evaluates the utility of self-reported dementia-related measures is also warranted.
%B Journal of Alzheimer's Disease %V 82 %P 373-380 %G eng %N 1 %R 10.3233/JAD-201212 %0 Journal Article %J American Journal of Health Promotion %D 2021 %T Sense of Purpose in Life and Subsequent Physical, Behavioral, and Psychosocial Health: An Outcome-Wide Approach. %A Eric S Kim %A Chen, Ying %A Julia S Nakamura %A Carol D Ryff %A Tyler J VanderWeele %K Epidemiology %K psychological well-being %K Purpose in life %K Sense of purpose %K Well-being %XPURPOSE: Growing evidence indicates that a higher sense of in life () is associated with reduced risk of chronic diseases and mortality. However, epidemiological studies have not evaluated if change in is associated with subsequent health and well-being outcomes.
DESIGN: We evaluated if positive change in (between t; 2006/2008 and t;2010/2012) was associated with better outcomes on 35 indicators of physical health, health behaviors, and psychosocial well-being (at t;2014/2016).
SAMPLE: We used data from 12,998 participants in the Health and Retirement study-a prospective and nationally representative cohort of U.S. adults aged >50.
ANALYSIS: We conducted multiple linear-, logistic-, and generalized linear regressions.
RESULTS: Over the 4-year follow-up period, people with the highest (versus lowest) purpose had better subsequent physical health outcomes (e.g., 46% reduced risk of mortality (95% CI [0.44, 0.66])), health behaviors (e.g., 13% reduced risk of sleep problems (95% CI [0.77, 0.99])), and psychosocial outcomes (e.g., higher optimism (β = 0.41, 95% CI [0.35, 0.47]), 43% reduced risk of depression (95% CI [0.46, 0.69]), lower loneliness (β = -0.35, 95% CI [-0.41, -0.29])). Importantly, however, purpose was not associated with other physical health outcomes, health behaviors, and social factors.
CONCLUSION: With further research, these results suggest that sense of purpose might be a valuable target for innovative policy and intervention work aimed at improving health and well-being.
%B American Journal of Health Promotion %V 36 %P 137-147 %G eng %N 1 %R 10.1177/08901171211038545 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Sex, Race, and Age Differences in Prevalence of Dementia in Medicare Claims and Survey Data %A Zhu, Yingying %A Chen, Yi %A Eileen M. Crimmins %A Julie M Zissimopoulos %K cognitive tests %K diagnosis codes %K neuropsychological assessment %K racial/ethnic minorities %K Trends %X This study provides the first comparison of trends in dementia prevalence in the US population using three different dementia ascertainments/data sources: neuropsychological assessment, cognitive tests, and diagnosis codes from Medicare claims.We used data from the nationally representative Health and Retirement Study and Aging, Demographics and Memory Study, and a 20% random sample of Medicare beneficiaries. We compared dementia prevalence across the three sources by race, gender, and age. We estimated trends in dementia prevalence from 2006 to 2013 based on cognitive tests and diagnosis codes utilizing logistic regression.Dementia prevalence among older adults aged 70 and above in 2004 was 16.6% (neuropsychological assessment), 15.8% (cognitive tests), and 12.2% (diagnosis codes). The difference between dementia prevalence based on cognitive tests and diagnosis codes diminished in 2012 (12.4% and 12.9% respectively), driven by decreasing rates of cognitive test-based and increasing diagnosis codes-based dementia prevalence. This difference in dementia prevalence between the two sources by sex and for age groups 75 to 79 and 90 and above vanished over time. However, there remained substantial differences across measures in dementia prevalence among blacks and Hispanics (10.9 and 9.8 percentage points respectively) in 2012.Our results imply that ascertainment of dementia through diagnosis may be improving over time, but gaps across measures among racial/ethnic minorities highlight the need for improved measurement of dementia prevalence in these populations. %B The Journals of Gerontology: Series B %V 76 %P 596-606 %@ 1079-5014 %G eng %N 3 %R 10.1093/geronb/gbaa083 %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 Sleep Medicine %D 2021 %T Sleep disturbance and pain in U.S. adults over 50: Evidence for reciprocal, longitudinal effects %A Sarah C. Griffin %A Ravyts, Scott G. %A Bourchtein, Elizaveta %A Ulmer, Christi S. %A Leggett, Melanie K. %A Joseph M. Dzierzewski %A Patrick S Calhoun %K pain %K path analysis %K RI-CLPM %K Sleep %X ObjectiveTo examine the relationship between sleep disturbance and pain over a 14-year period.MethodsThis study used data from the 2002-2016 waves of the Health and Retirement Study (HRS), an observational study of U.S. adults over age 50 (n=17,756). Sleep disturbance was measured via four items (assessing difficulty falling asleep, staying asleep, and waking up too early as well as restedness) and pain via two items assessing the presence and degree of pain. Analyses consisted of path analysis; more specifically, random intercept cross-lagged panel modeling (RI-CLPM) was used to examine how pain and sleep disturbance predict one another over two-year intervals after accounting for the trait-like nature of both factors.ResultsThere was evidence of reciprocal effects between sleep disturbance and pain across some, but not all, intervals. Moreover, the latent variables representing the trait-like nature of sleep disturbance and pain both showed significant variance (p <.001), indicating stable differences between persons in sleep and pain. These trait-like characteristics were strongly associated (β=.51, p <.001). The findings remained after adjusting the model for baseline age, self-reported health, partner status, depression, years of education, and sex.ConclusionSleep disturbance and pain are stable experiences. Moreover, there was some evidence that sleep disturbance and pain are bidirectionally linked across time among adults over 50, whereby across some intervals deviations in one’s typical level of sleep disturbance predicted corresponding deviations in one’s typical level of pain and vice versa. Clinically, this comorbidity and potential longitudinal bidirectionality underscore the importance of evidence-based interventions that target both sleep and pain among older individuals. Further studies should replicate these findings by collecting validated and/or objective sleep and pain measures on a more frequent basis. %B Sleep Medicine %V 86 %P 32-39 %@ 1389-9457 %G eng %R 10.1016/j.sleep.2021.08.006 %0 Journal Article %J Journal of Evidence-Based Social Work (2019) %D 2021 %T Social Support and Depressive Symptoms among Trauma-Impacted Older Adults. %A Cho, Seungjong %A Bulger, Morgan %K depression %K Social Support %K trauma-impacted older adults %K trauma-informed research %X: The present study investigates the association between social support and depressive symptomatology among older adults who have been impacted by trauma. Previous studies have not sufficiently explored this topic to date. : The current study analyzed public-use data from the 2012 Health and Retirement Study ( = 4,195), focusing specifically on community-dwelling older adults (> 50). They had at least one traumatic event in their lifetime. : This study found that higher levels of social support were significantly associated with lower levels of depressive symptoms after controlling for life satisfaction, age, gender, race, ethnicity, and education.. : The recent emergence of trauma-informed research has consistently emphasized the importance of social interaction for mental health. The current study shows that social support can reduce depressive symptoms of those who have experienced trauma.
%B Journal of Evidence-Based Social Work (2019) %V 18 %P 371-378 %G eng %N 4 %R 10.1080/26408066.2020.1866729 %0 Report %D 2021 %T Societal Impact of Research Funding for Women's Health in Alzheimer's Disease and Alzheimer's Disease - Related Dementias %A Baird, Matthew D. %A Melanie A. Zaber %A Andrew W. Dick %A Chloe E. Bird %A Annie Chen %A Molly Waymouth %A Grace Gahlon %A Denise D. Quigley %A Hamad Al Ibrahim %A Lori Frank %K Alzheimer's disease %K Dementia %K health %K women %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, beginning with a focus on Alzheimer's disease and Alzheimer's disease–related dementias (AD/ADRD), which result in substantial illness burden, health care costs, caregiving burden, and mortality. 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 Report %I RAND Corporation %C Santa Monica, CA %G eng %R 10.7249/RR-A708-1 %0 Journal Article %J SSM - Population Health %D 2021 %T Socioeconomic status across the life course and dementia-status life expectancy among older Americans %A Hyungmin Cha %A Mateo P Farina %A Mark D Hayward %K Dementia %K Life Expectancy %K Mortality %K socioeconomic status %X This study examines how socioeconomic status (SES) across the life course is associated with individuals’ lifetime dementia experience – the years of life persons can expect to live and without with dementia. Conceptually, dementia-free life expectancy reflects the ability to postpone dementia onset while dementia life expectancy reflects the average lifetime period with the condition. How SES across the life course contributes to dementia-status life expectancy is the focus of this study. We assess whether persons who are advantaged in their lifetime SES live the most years without dementia and the fewest years with dementia compared to less advantaged persons. Using the Health and Retirement Study (2000–2016), we examine these questions for U.S. adults aged 65 and older using multistate life tables and a microsimulation approach. The results show that higher SES persons can expect to live significantly more years of life without dementia and that the period of life with dementia is compressed compared to less advantaged persons. The results also underscore that importance of cumulative exposure, showing that adults from disadvantaged childhoods who achieve high education levels often have dementia experiences that are similar to or better than those of adults from advantaged childhoods who achieved low education levels. %B SSM - Population Health %V 15 %P 100921 %G eng %R 10.1016/j.ssmph.2021.100921 %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 Report %D 2021 %T Tracking Progress on Person-Centered Care for Older Adults: How Are We Doing? %A Jane Tavares %A Hwang, Ann %A Marc A Cohen %K Health Care %K Income %K person-centered care %K race %X Person-centered care is essential to a high-quality system of care, emphasizing a holistic approach oriented around individuals’ goals and preferences. Analyzing the 2014 and 2016 Health and Retirement Study, we measure the extent to which older adults experience person-centered care, differences by race, income and other variables, and how receipt of person-centered care affects overall health care satisfaction and service utilization. Roughly one-third of older adults reported that their preferences were only rarely or sometimes taken into account. Results varied greatly by race. One in four Hispanics reported never having their preferences taken into account compared to roughly one in ten whites and one in six Blacks. When people’s preferences are ignored, they are more likely to forgo medical care and report lower satisfaction with the health care system. New efforts are needed to strengthen and advance person-centered care, particularly for people of color and low-income populations. %I Center for Consumer Engagement in Health Innovation %C Boston, MA %G eng %U https://www.healthinnovation.org/resources/publications/body/Person-Centered-Care-Report_Jan-2021.pdf %0 Journal Article %J Journal of Aging and Health %D 2021 %T Trajectories of Multiple Behavioral Risk Factors and Their Associations With Cognitive Function Trajectories Among Older African Americans and White Americans. %A Li, Chien-Ching %A Chen, Yi-Fan %A Jersey Liang %A Alicia K Matthews %A Lisa L. Barnes %K behavioral risk factor %K cognitive function %K Health Disparities %XThis study examined the joint trajectories of behavioral risk factors (smoking, alcohol drinking, and body mass index) and their associations with cognitive function trajectories among older African Americans and white Americans. Data from the Health and Retirement Study (1998-2014) were used. Group-based mixture modeling and multinomial logistic regression analysis were performed. Three joint trajectories of behavioral risk factors (overweight, smoking and drinking, and drinking and overweight) and three cognitive function trajectories (low, moderate, and high) were identified. A significantly higher percentage of African Americans were in the "overweight," "smoking and drinking," and "low" cognitive functioning groups as measured by the total cognition composite score compared to white Americans. After accounting for covariates, the "drinking and overweight" group was associated with the "moderate" or "high" cognitive functioning group. Future interventions targeting the combinations of behavioral risk factors are needed to promote healthy aging among high-risk populations.
%B Journal of Aging and Health %V 33 %P 674-684 %G eng %N 9 %R 10.1177/08982643211005905 %0 Book Section %B Handbook of the Biology of Aging (Ninth Edition)Handbooks of Aging %D 2021 %T Trends in morbidity, healthy life expectancy, and the compression of morbidity %A Eileen M. Crimmins %A Yuan S Zhang %A Jung K Kim %A Morgan E. Levine %E Musi, Nicolas %E Hornsby, Peter J. %K compression of morbidity %K health trends %K Healthy life expectancy %K Morbidity %X This chapter lays out the dimensions of morbidity and the processes linking morbidity and mortality. It provides evidence of recent trends in morbidity of the older American population: decline in some types of disability but not others, disease, and physiological dysregulation among the older American population. In addition, the chapter uses data from two recent cohorts to look at survival without disease and the age at onset of diseases. We have generally seen an increase in the prevalence and time with disease; but disease appears less disabling now than in the past. In addition, the onset of myocardial infarction appears to have been delayed by the recent control of biological risk. Most of the evidence does not support the idea that we have experienced a recent compression of morbidity; it does support some delay and retarding of progression of the morbidity process. %B Handbook of the Biology of Aging (Ninth Edition)Handbooks of Aging %I Academic Press %P 405-414 %@ 978-0-12-815962-0 %G eng %& 19 %R https://doi.org/10.1016/B978-0-12-815962-0.00019-6 %0 Journal Article %J JAMA Neurology %D 2021 %T Trends in Relative Incidence and Prevalence of Dementia Across Non-Hispanic Black and White Individuals in the United States, 2000-2016 %A Melinda C Power %A Bennett, Erin E. %A Robert W. Turner %A Dowling, N. Maritza %A Ciarleglio, Adam %A M. Maria Glymour %A Kan Z Gianattasio %K Cognition %K Dementia %K Health Disparities %K Neurology %X In the US, dementia risk is higher in non-Hispanic Black individuals than in non-Hispanic White individuals. To evaluate progress toward reducing such disparities, tracking secular trends in racial disparities in dementia prevalence is essential.To examine whether relative racial disparities in dementia prevalence or incidence have changed in the US from 2000 to 2016.The Health and Retirement Study (HRS) is a nationally representative study of adults 50 years or older. New participants are recruited every 6 years, and study visits occur biennially. Approximately 17 000 to 22 000 respondents have been surveyed at each wave since 2000, achieving response rates of 81% to 89%. Data for this cohort study were obtained from non-Hispanic White and non-Hispanic Black participants aged 70 years and older from the 2000 to 2016 waves. For analyses of secular trends in racial disparities in dementia prevalence, each HRS wave was considered separately (range of participants meeting eligibility criteria in each wave, 6322-7579). For analyses of secular trends in racial disparities in dementia incidence, 7 subcohorts were created (range of participants meeting eligibility criteria in each subcohort, 5322-5961) following up people without dementia for 4 years from subcohort baseline visits in 2000, 2002, 2004, 2006, 2008, 2010, and 2012. Data were analyzed from October 2019 to August 2020.Race based on self-response to closed-ended survey questions.Dementia status was determined using 3 algorithms with similar sensitivity and specificity across non-Hispanic White and Black participants. Disparities were characterized using ratio measures.In this study, the mean age and percentage of male participants eligible for inclusion in analyses of racial disparities in dementia prevalence increased over time among non-Hispanic White participants (from 78.2 years and 40% in 2000 to 78.7 years and 44% in 2016) but remained steady in non-Hispanic Black participants during the same period (from 78.0 years and 37% in 2000 to 77.9 years and 38% in 2016). Prevalence ratios comparing Black and White participants ranged from approximately 1.5 to 1.9 across algorithms and years, whereas hazard ratios ranged from approximately 1.4 to 1.8. Although results suggest stable or declining dementia risk overall, there was no evidence suggesting change in relative racial disparities in dementia prevalence or incidence during follow-up.This study did not find evidence to suggest that the ratio of dementia risk across Black and White individuals changed in the US between 2000 and 2016. Additional efforts to identify and mitigate the source of these disparities is warranted. %B JAMA Neurology %V 78 %P 275-284 %@ 2168-6149 %G eng %N 3 %R https://doi.org/10.1001/jamaneurol.2020.4471 %0 Journal Article %J ACR Open Rheumatology %D 2021 %T Validation of Self-Reported Rheumatoid Arthritis Using Medicare Claims: A Nationally Representative Longitudinal Study of Older Adults. %A Booth, Michael J %A Daniel Clauw %A Mary R Janevic %A Lindsay C Kobayashi %A John D Piette %K Medicare claims %K rheumatoid arthritis %K self reported %XOBJECTIVE: To determine the validity of self-reported physician diagnosis of rheumatoid arthritis (RA) using multiple gold-standard measures based on Medicare claims in a nationally representative sample of older adults and to verify whether additional questions about taking medication and having seen a physician in the past two years for arthritis can improve the positive predictive value (PPV) and other measures of the validity of self-reported RA.
METHODS: A total of 3768 Medicare-eligible respondents with and without incident self-reported RA were identified from the 2004, 2008, and 2012 waves of the United States Health and Retirement Study. Self-reported RA was validated using the following three claims-based algorithms: 1) a single International Classification of Diseases, ninth edition, Clinical Modification claim for RA, 2) two or more claims no greater than 2 years apart, and 3) two or more claims with at least one diagnosis by a rheumatologist. Additional self-report questions of medication use and having seen a doctor for arthritis in the past two years were validated against the same criteria.
RESULTS: A total of 345 respondents self-reported a physician diagnosis of RA. Across all three RA algorithms, the PPV of self-report ranged from 0.05 to 0.16., the sensitivity ranged from 0.23 to 0.55., and the κ statistic ranged from 0.07 to 0.15. Additional self-report data regarding arthritis care improved the PPV and other validity measures of self-report; however, the values remained low.
CONCLUSION: Most older adults who self-report RA do not have a Medicare claims history consistent with that diagnosis. Revisions to current self-reported RA questions may yield more valid identification of RA in national health surveys.
%B ACR Open Rheumatology %V 3 %P 239-249 %G eng %N 4 %R 10.1002/acr2.11229 %0 Report %D 2021 %T What Explains Low Old-Age Income? Evidence from the Health and Retirement Study %A Olivia S. Mitchell %A Clark, Robert L. %A Annamaria Lusardi %K Income %K retirement savings %K Social Security %X We examine respondents in the Health and Retirement Study (HRS) to observe how their financial situations unfolded as they aged. We focus on low income older adults and follow them over time to identify the factors associated with having low income at baseline and thereafter. We find that (a) real income remained relatively stable as individuals approach and enter retirement, and progress through their retirement years, and (b) labor force participation declined and thus earnings became less important with age, while Social Security and retirement savings rose as a proportion of annual income. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w28721 %0 Report %D 2021 %T What Level of Long-Term Services and Supports Do Retirees Need? %A Belbase, Anek %A Anqi Chen %A Alicia H. Munnell %K Long-term services and supports %X The brief’s key findings are: Many retirees are concerned about the risk of requiring substantial long-term care as they age, but the likelihood is unclear. This analysis, using two decades of data from the Health and Retirement Study, classifies the severity of care needs, accounting for both intensity and duration. The results suggest about one-fifth of retirees will need no support at all and about one-quarter will have severe needs, with the rest facing low to moderate needs. The demographic patterns are as expected: those who are married, better educated, white, or in better health have more manageable needs. Subsequent briefs will explore the resources available to meet care needs and the types of people most at risk of facing unmet needs. %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/briefs/what-level-of-long-term-services-and-supports-do-retirees-need/ %0 Journal Article %J The Journals of Gerontology, Series B %D 2021 %T You say tomato, I say radish: can brief cognitive assessments in the US Health Retirement Study be harmonized with its International Partner Studies? %A Lindsay C Kobayashi %A Alden L Gross %A Laura E Gibbons %A Tommet, Doug %A Sanders, R Elizabeth %A Choi, Seo-Eun %A Mukherjee, Shubhabrata %A M. Maria Glymour %A Jennifer J Manly %A Lisa F Berkman %A Paul K Crane %A Mungas, Dan M %A Richard N Jones %K cognitive function %K health survey %K international comparison %K item response theory %K statistical harmonization %XOBJECTIVES: To characterize the extent to which brief cognitive assessments administered in the population-representative US Health and Retirement Study (HRS) and its International Partner Studies can be considered to be measuring a single, unidimensional latent cognitive function construct.
METHOD: Cognitive function assessments were administered in face-to-face interviews in 12 studies in 26 countries (N=155,690), including the US HRS and selected International Partner Studies. We used the time point of first cognitive assessment for each study to minimize differential practice effects across studies, and documented cognitive test item coverage across studies. Using confirmatory factor analysis models, we estimated single factor general cognitive function models, and bifactor models representing memory-specific and non-memory-specific cognitive domains for each study. We evaluated model fits and factor loadings across studies.
RESULTS: Despite relatively sparse and inconsistent cognitive item coverage across studies, all studies had some cognitive test items in common with other studies. In all studies, the bifactor models with a memory-specific domain fit better than single factor general cognitive function models. The data fit the models at reasonable thresholds for single factor models in six of the 12 studies, and for the bifactor models in all 12 of the 12 studies.
DISCUSSION: The cognitive assessments in the US HRS and its International Partner Studies reflect comparable underlying cognitive constructs. We discuss the assumptions underlying our methods, present alternatives, and future directions for cross-national harmonization of cognitive aging data.
%B The Journals of Gerontology, Series B %V 76 %P 1767-1776 %G eng %N 9 %R 10.1093/geronb/gbaa205 %0 Report %D 2020 %T The 80%: The True Scope of Financial Insecurity in Retirement %A Popham, Lauren %A Silberman, Susan %A Berke, Liz %A Tavares, Jane %A Cohen, Marc %K financial insecurity %K Retirement %B Issue Brief %I National Council on Aging %G eng %U chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://assets-us-01.kc-usercontent.com/ffacfe7d-10b6-0083-2632-604077fd4eca/302be397-f6e1-482b-ac71-ff2957dbe5bb/2021-FWP-DG02_The%2080_Issue%20Brief_FINAL.pdf %0 Journal Article %J Journal of General Internal Medicine %D 2020 %T Advance Care Planning Prior to Death in Older Adults with Hip Fracture %A Kata, Anna %A Irena Cenzer %A Rebecca L. Sudore %A Kenneth E Covinsky %A Victoria L. Tang %K Advance care planning %K advance directive %K Hip fracture %K Older Adults %K surrogate decision-making %X Background Although hip fractures in older adults are associated with a high degree of mortality and disability, the use of advance care planning (ACP) in this population is unknown. Objective To determine the prevalence of ACP and need for surrogate decision-making prior to death in older adults with hip fracture and to identify factors associated with ACP. Design Retrospective cohort study using Health and Retirement Study (HRS) interviews linked to Medicare fee-for-service claims data. Participants Six hundred six decedent participants aged 65 or older who sustained a hip fracture during HRS enrollment and had a proxy participate in the exit HRS survey. Main Measures Survey responses by proxies were used to determine ACP, defined by either advance directive completion or surrogate designation, and to assess decision-making at the end of life. Multivariate logistic regression was used to analyze correlates of ACP. Key Results Prior to death, 54.9% of all participants had an advance directive and 68.9% had designated a surrogate decision-maker; however, 24.5% had no ACP. Of the total cohort, 32.5% required decisions to be made about treatment at the end of life and lacked capacity to make these decisions themselves. In this subset, 19.9% had no ACP. In all participants, ACP was less likely in non-white individuals (adjusted odds ratio (aOR) 0.14, 95% CI 0.06–0.31), those with less than a high school education (aOR 0.58, 95% CI 0.35–0.97), and those with a net worth below the median of the cohort (aOR 0.49, 95% CI 0.26–0.72). No clinical factors were found to be associated with ACP completion prior to death. Conclusions A considerable number of older adults with hip fracture required surrogate decision-making at the end of life, of whom one fifth had no ACP prior to death. Clinicians providing care for these patients are uniquely poised to address ACP. %B Journal of General Internal Medicine %@ 1525-1497 %G eng %! Journal of General Internal Medicine %R 10.1007/s11606-020-05644-1 %0 Journal Article %J The Journals of Gerontology: Series B %D 2020 %T Advancing research on psychosocial stress and aging with the Health and Retirement Study: Looking back to launch the field forward %A Alexandra D. Crosswell %A Suresh, Madhuvanthi %A Puterman, Eli %A Tara L Gruenewald %A Jinkook Lee %A Elissa S Epel %K Aging %K Measurement %K Population Health %K Psychosocial %K Stress %X The Health and Retirement Study (HRS) was designed as an interdisciplinary study with a strong focus on health, retirement, and socioeconomic environment, to study their dynamic relationships over time in a sample of mid-life adults. The study includes validated self-report measures and individual items that capture the experiences of stressful events (stressor exposures) and subjective assessments of stress (perceived stress) within specific life domains. %B The Journals of Gerontology: Series B %G eng %U https://academic.oup.com/psychsocgerontology/advance-article/doi/10.1093/geronb/gby106/5096750 %9 Journal %R 10.1093/geronb/gby106 %0 Journal Article %J Journal of Urban Health %D 2020 %T Age-Friendly Features in Home and Community and the Self-Reported Health and Functional Limitation of Older Adults: the Role of Supportive Environments %A Choi, Yeon Jin %K community assessment %K outdoor spaces %K Transportation %X This study aims to identify age-friendly community features that are associated with better health for older adults. This cross-sectional study utilized the 2015 AARP Age-Friendly Communities (AFC) Survey, which includes 66 home and community features that fall within the eight domains specified by the World Health Organization (WHO)’s age-friendly cities guidelines. Two measures of health (self-rated health and functional limitations) were examined using multi-level linear and logistic regressions. Both a greater perceived availability of age-friendly features in communities and a good person-environment fit were associated with better self-rated health and a lower likelihood of reporting functional limitations. The domains of outdoor spaces and buildings, transportation, and social participation and inclusion were consistently associated with these outcomes. Promoting age-friendliness in outdoor spaces and buildings, transportation, and social participation and inclusion domains by providing green spaces, neighborhood safety programs, transportation options, and social opportunities may be the most effective way to support healthy and active aging. %B Journal of Urban Health %V 97 %P 471 - 485 %@ 1468-2869 %G eng %N 4 %R https://doi.org/10.1007/s11524-020-00462-6 %0 Journal Article %J Public Policy and Aging Report %D 2020 %T Age-Related Vulnerability to Coronavirus Disease 2019 (COVID-19): Biological, Contextual, and Policy-Related Factors. %A Eileen M. Crimmins %K COVID-19 %K Immunosenescence %K Mortality %K Nursing homes %X The detailed facts surrounding the coronavirus disease 2019 (COVID-19) pandemic are still evolving; however, one of the most shocking aspects of the COVID-19 pandemic is how lethal this condition is for the older population (Dowd et al., 2020). The risk for death and severe illness with COVID-19 is best predicted by age. The likelihood of death increases exponentially with age among those who contract the virus in all countries where this has been examined (Figure 1). Figure 1 shows the percent of confirmed cases ending in mortality, by age, for five countries near the beginning of June. In every country, the percent dying increases sharply after age 50, and the highest rates occur among the oldest persons. The age pattern is clear across the countries even though the mortality levels are quite different; the United States has had a much greater number of cases and deaths than the other countries in this figure, but the mortality level was higher in Italy. This difference in levels could be influenced by the proportion of diagnosed cases, which depends on testing, treatment of cases, and whether COVID-19 deaths include only those confirmed with a diagnostic test or include both confirmed and probable deaths (Sung & Kaplan, 2020). Even with these differences, the pattern of an exponential increase in death with age is clear. %B Public Policy and Aging Report %V 30 %P 142-146 %G eng %N 4 %R 10.1093/ppar/praa023 %0 Report %D 2020 %T Alternative Pathways to Retirement in a Household Context %A Brown, Kristine M. %A Carman, Katherine %A Edwards, Kathryn A. %K financial decision making %K Households %K marriage and divorce %K retirement and retirement benefits %X Research indicates significant roles for gradual transitions to full retirement and for coordination between spouses in the typical retirement experience. However, there is little research exploring the potentially important interactions between the two. This paper addresses this gap in the literature and provides a more robust understanding of retirement decisions by examining joint work-to-retirement trajectories. We analyze 12 waves of the Health and Retirement Study to develop detailed descriptions of couples' realized joint retirement trajectories. We use two strategies to classify joint work-to-retirement trajectories. First, we use simple researcher defined rules or heuristics to categorize trajectories that share common features. Second, we use an algorithmic sequence analysis method to identify trajectories that share common properties into clusters, creating a statistically derived typology of retirement pathways. A key finding of our research is the vast variation in retirement sequences followed by couples; our sample includes over 2,600 couples and over 1,400 unique retirement trajectories. We document the frequency of couples' joint work-to-retirement trajectories observed in the data and the characteristics of these joint trajectories. We also explore the extent to which couples' personal and employment characteristics correlate with their joint work-to-retirement transitions and trajectories. %B RAND Working Paper %I RAND Corporation %C Santa Monica, CA %G eng %R https://doi.org/10.7249/WRA822-1 %0 Journal Article %J The Gerontologist %D 2020 %T Alternative retirement paths and cognitive performance: Exploring the role of preretirement job complexity. %A Dawn C Carr %A Robert J. Willis %A Ben Lennox Kail %A Carstensen, Lisbeth %K Cognitive Ability %K Employment and Labor Force %K Trajectories %XBACKGROUND AND OBJECTIVES: Recent research suggests that working longer may be protective of cognitive functioning in later life, especially for workers in low complexity jobs. As postretirement work becomes increasingly popular, it is important to understand how various retirement pathways influence cognitive function. The present study examines cognitive changes as a function of job complexity in the context of different types of retirement transitions.
RESEARCH DESIGN AND METHODS: We use data from the Health and Retirement Study (HRS) to examine change in cognitive function for workers who have held low, moderate, and high complexity jobs and move through distinct retirement pathways-retiring and returning to work, partial retirement-compared with those who fully retire or remain full-time workers. Inverse probability weighted regression adjustment (a propensity score method) is used to adjust for selection effects.
RESULTS: There are systematic variations in the relationships between work and cognitive performance as a function of job complexity and retirement pathways. All retirement pathways were associated with accelerated cognitive decline for workers in low complexity jobs. In contrast, for high complexity workers retirement was not associated with accelerated cognitive decline and retiring and returning to work was associated with modest improvement in cognitive functioning.
DISCUSSION AND IMPLICATIONS: Both policy makers and individuals are beginning to embrace longer working lives which offer variety of potential benefits. Our findings suggest that continued full-time work also may be protective for cognitive health in workers who hold low complexity jobs.
%B The Gerontologist %V 60 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/31289823?dopt=Abstract %N 3 %9 Journal %& 460-471 %R 10.1093/geront/gnz079 %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 %XThe 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 Journal of Personality %D 2020 %T The Association between Actor/Partner Optimism and Cognitive Functioning among Older Couples %A Oh, Jeewon %A William J. Chopik %A Eric S Kim %K actor-partner interdependence model %K cognitive functioning %K Health and Retirement Study %K Optimism %X Objective Higher optimism has been linked with health, well‐being, and cognitive functioning. Spouses also play an important role on people's health, especially in older adulthood. Yet, whether a spouse's optimism is associated with an individual's cognitive functioning is understudied. Thus, we examined this question. Method Participants were 4,457 heterosexual couples (N = 8,914; Mage = 66.73, SD = 9.67) from the Health and Retirement Study—a large, diverse, prospective, and nationally representative sample of U.S. adults aged > 50. Optimism was assessed at baseline (t1) and cognition was measured every two years with up to five repeated assessments of cognition data over the eight‐year follow‐up period (t1; t2; t3; t4; t5). Results Results from multi‐level dyadic data analyses showed small but positive associations between actor optimism and actor cognitive functioning (memory: r = 0.16, mental status =0.10), as well as partner optimism and actor cognitive functioning (memory: r = 0.04, mental status = 0.03). These associations mostly persisted over time. Conclusions Possessing higher optimism, and also having a partner with higher optimism, were both associated with higher cognitive functioning. Thus, with further research, optimism (at both the individual and couple level) might emerge as an innovative intervention target that helps adults maintain cognitive functioning as they age. %B Journal of Personality %V 88 %P 822-832 %G eng %N 4 %R 10.1111/jopy.12529 %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 %XBackground 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 Environmental Factors, Race, and Cognitive Status %A Cheung, Ethan Siu Leung %A Mui, Ada %K Cognitive Status %K Environmental factors %K race %X Based on the data from National Social Life, Health and Aging Project, Wave 3, this study examined two research questions: what is the role of race in predicting cognitive status? and what are predictors of cognitive status between white and black older adults? Cognitive status was assessed using the 18-item survey-adapted Montreal Cognitive Assessment. Using the ecological framework, correlates of cognitive status were conceptualized in three levels of environments: micro- (personal health), meso- (social relationship), and macro-environments (community characteristics). Hierarchical regressions analyses were employed. Findings indicated that 83% of the sample (n= 2,829) were whites and the mean age was 72.95. Bivariate analyses suggested significant racial differences in cognitive status, marital status, income, education, health, social relationship, and community characteristics. Additive and interactive models showed that race had an independent effect as well as joint effects with the three levels of environments in explaining cognitive status. Parallel regression analyses for each racial group were undertaken and models were significant (P < .0001). In two separate models, common predictors for better cognition included being younger, more educated, fewer IADL impairments, and less depression. For older whites, unique correlates for better cognition were being female, higher income, sense of control in life, safer community, and neighbor relations. The only unique correlate for older blacks to have better cognition was community cohesion. Results provided insights on racial differences in cognition experienced among community-dwelling older Americans, and emphasized the need for social programs that promote race-sensitive, age-friendly communities to protect against cognitive decline. %B Innovation in Aging %V 4 %P 894 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.3296 %0 Journal Article %J Aging & Mental Health %D 2020 %T The association between the number of chronic health conditions and advance care planning varies by race/ethnicity. %A Shinae L Choi %A Ian M McDonough %A Kim, Minjung %A Kim, Giyeon %K Advance care planning %K Comorbidity %K Racial/ethnic differences %XOBJECTIVES: Although a national consensus exists on the need to increase the rates of advance care planning (ACP) for all adults, racial/ethnic differences in ACP have been consistently observed. This study investigated the intersection of racial/ethnic differences and the number of chronic health conditions on ACP among middle-aged and older adults in the United States.
METHOD: Responses from 8,926 adults from the 2014 wave of the Health and Retirement Study were entered into multilevel hierarchical logistic regression analyses with generalized linear mixed models to predict ACP focused on assigning a durable power of attorney for healthcare (DPOAHC) and having a written living will after adjusting for covariates.
RESULTS: We found a significant positive relationship between the number of chronic health conditions and ACP. Non-Hispanic Blacks/African Americans and Hispanics were less likely to engage in ACP than non-Hispanic Whites/Caucasians. Racial/ethnic disparities were even starker for completing a living will. The number of chronic health conditions had a greater effect for Hispanics than non-Hispanic Whites/Caucasians on ACP through assigning a DPOAHC and having a living will. The initial disparity in ACP among Hispanics with no chronic health conditions decreased as the number of chronic health conditions increased.
CONCLUSION: Our findings suggest that more chronic health conditions increase the likelihood that Hispanics will complete ACP documents. These ACP differences should be highlighted to researchers, policymakers, and healthcare professionals to reduce stark racial/ethnic disparities in ACP. A comprehensive and culturally caring decision-making approach should be considered when individuals and families engage in ACP.
%B Aging & Mental Health %V 24 %P 453-463 %G eng %U https://www.tandfonline.com/doi/abs/10.1080/13607863.2018.1533521?journalCode=camh20 %N 3 %9 Journal %1 http://www.ncbi.nlm.nih.gov/pubmed/30593253?dopt=Abstract %R 10.1080/13607863.2018.1533521 %0 Journal Article %J JAMA Surgery %D 2020 %T Association of Functional, Cognitive, and Psychological Measures With 1-Year Mortality in Patients Undergoing Major Surgery %A Victoria L. Tang %A Jing, Bocheng %A W John Boscardin %A Ngo, Sarah %A Silvestrini, Molly %A Finlayson, Emily %A Kenneth E Covinsky %K Cognition %K Mortality %K Surgery %X More older adults are undergoing major surgery despite the greater risk of postoperative mortality. Although measures, such as functional, cognitive, and psychological status, are known to be crucial components of health in older persons, they are not often used in assessing the risk of adverse postoperative outcomes in older adults.To determine the association between measures of physical, cognitive, and psychological function and 1-year mortality in older adults after major surgery.Retrospective analysis of a prospective cohort study of participants 66 years or older who were enrolled in the nationally representative Health and Retirement Study and underwent 1 of 3 types of major surgery.Major surgery, including abdominal aortic aneurysm repair, coronary artery bypass graft, and colectomy.Our outcome was mortality within 1 year of major surgery. Our primary associated factors included functional, cognitive, and psychological factors: dependence in activities of daily living (ADL), dependence in instrumental ADL, inability to walk several blocks, cognitive status, and presence of depression. We adjusted for other demographic and clinical predictors.Of 1341 participants, the mean (SD) participant age was 76 (6) years, 737 (55\%) were women, 99 (7\%) underwent abdominal aortic aneurysm repair, 686 (51\%) coronary artery bypass graft, and 556 (42\%) colectomy; 223 (17\%) died within 1 year of their operation. After adjusting for age, comorbidity burden, surgical type, sex, race/ethnicity, wealth, income, and education, the following measures were significantly associated with 1-year mortality: more than 1 ADL dependence (29\% vs 13\%; adjusted hazard ratio [aHR], 2.76; P = .001), more than 1 instrumental ADL dependence (21\% vs 14\%; aHR, 1.32; P = .05), the inability to walk several blocks (17\% vs 11\%; aHR, 1.64; P = .01), dementia (21\% vs 12\%; aHR, 1.91; P = .03), and depression (19\% vs 12\%; aHR, 1.72; P = .01). The risk of 1-year mortality increased within the increasing risk factors present (0 factors: 10.0\%; 1 factor: 16.2\%; 2 factors: 27.8\%).In this older adult cohort, 223 participants (17\%) who underwent major surgery died within 1 year and poor function, cognition, and psychological well-being were significantly associated with mortality. Measures in function, cognition, and psychological well-being need to be incorporated into the preoperative assessment to enhance surgical decision-making and patient counseling. %B JAMA Surgery %G eng %U https://jamanetwork.com/journals/jamasurgery/article-abstract/2762522 %9 Journal %R 10.1001/jamasurg.2020.0091 %0 Journal Article %J JAMA Network Open %D 2020 %T Association of Low to Moderate Alcohol Drinking With Cognitive Functions From Middle to Older Age Among US Adults %A Zhang, Ruiyuan %A Shen, Luqi %A Toni Miles %A Shen, Ye %A Cordero, Jose %A Qi, Yanling %A Liang, Lirong %A Li, Changwei %K Aging %K Cognition %K moderate alcohol drinking %X Studies examining the association of low to moderate drinking with various cognitive functions have yielded mixed findings.To investigate whether associations exist between low to moderate alcohol drinking and cognitive function trajectories or rates of change in cognitive function from middle age to older age among US adults.A prospective cohort study of participants drawn from the Health and Retirement Study (HRS), a nationally representative sample of US adults, with mean (SD) follow-up of 9.1 (3.1) years. In total, 19 887 participants who had their cognitive functions measured in the HRS starting in 1996 through 2008 and who had participated in at least 3 biennial surveys were included. The data analysis was conducted from June to November 2019.Alcohol consumption and aging.Trajectories and annual rates of change for the cognitive domains of mental status, word recall, and vocabulary and for the total cognitive score, which was the sum of the mental status and word recall scores. Participants were clustered into 2 cognitive function trajectories for each cognition measure assessed based on their scores at baseline and through at least 3 biennial surveys: a consistently low trajectory (representing low cognitive scores throughout the study period) and a consistently high trajectory (representing high cognitive scores throughout the study period).The mean (SD) age of 19 887 participants was 61.8 (10.2) years, and the majority of the HRS participants were women (11 943 [60.1%]) and of white race/ethnicity (16 950 [85.2%]). Low to moderate drinking (<8 drinks per week for women and <15 drinks per week for men) was significantly associated with a consistently high cognitive function trajectory and a lower rate of cognitive decline. Compared with never drinkers, low to moderate drinkers were less likely to have a consistently low trajectory for total cognitive function (odds ratio [OR], 0.66; 95% CI, 0.59-0.74), mental status (OR, 0.71; 95% CI, 0.63-0.81), word recall (OR, 0.74; 95% CI, 0.69-0.80), and vocabulary (OR, 0.64; 95% CI, 0.56-0.74) (all P < .001). In addition, low to moderate drinking was associated with decreased annual rates of total cognitive function decline (β coefficient, 0.04; 95% CI, 0.02-0.07; P = .002), mental status (β coefficient, 0.02; 95% CI, 0.01-0.03; P = .002), word recall (β coefficient, 0.02; 95% CI, 0.01-0.04; P = .01), and vocabulary (β coefficient, 0.01; 95% CI, 0.00-0.03; P = .08). A significant racial/ethnic difference was observed for trajectories of mental status (P = .02 for interaction), in which low to moderate drinking was associated with lower odds of having a consistently low trajectory for white participants (OR, 0.65; 95% CI, 0.56-0.75) but not for black participants (OR, 1.02; 95% CI, 0.74-1.39). Finally, the dosage of alcohol consumed had a U-shaped association with all cognitive function domains for all participants, with an optimal dose of 10 to 14 drinks per week.These findings suggested that low to moderate alcohol drinking was associated with better global cognition scores, and these associations appeared stronger for white participants than for black participants. Studies examining the mechanisms underlying the association between alcohol drinking and cognition in middle-aged or older adults are needed. %B JAMA Network Open %V 3 %@ 2574-3805 %G eng %N 6 %R 10.1001/jamanetworkopen.2020.7922 %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 Sleep Health %D 2020 %T The bidirectional relationships between effort-reward imbalance and sleep problems among older workers %A Eunae Cho %A Tuo-Yu Chen %K Changes %K Effort-reward imbalance model %K longitudinal %K Reciprocal %K Senior workers %X Background Sleep problems are common among working individuals. A growing body of research has documented that effort-reward imbalance (ERI) predicts poor sleep outcomes. Objective Extending this literature, we investigated the bidirectional relationship between ERI and sleep problems; for each direction, we tested predictor’s baseline level and its changes over time. Data We drew a subsample of older workers aged 55 years and older from the Health and Retirement Study (N=860). Design We examined whether baseline ERI and ERI changes predict sleep problems at follow-up. In parallel, we examined whether baseline sleep problems and sleep problem changes predict ERI at follow-up. Results For the ERI-to-sleep-problems direction, baseline ERI predicted the experience of any sleep problems at follow-up. The odds of experiencing sleep problems at follow-up was higher among respondents who consistently perceived ERI over the 4-year compared with those who remain balanced. For the sleep-problems-to-ERI direction, baseline sleep problems predicted ERI at follow-up. Older workers who repeatedly reported sleep problems over the 4-year period had the greatest odds to perceive ERI at follow-up. Conclusion ERI and sleep problems are reciprocally related among older workers. Both ERI and sleep problems change over time, hence considering their dynamic nature may provide additional insights. %B Sleep Health %G eng %9 Journal %R 10.1016/j.sleh.2020.01.008 %0 Journal Article %J Personality and Individual Differences %D 2020 %T Big Five personality traits, dispositional affect, and financial satisfaction among older adults %A Derek T. Tharp %A Martin C. Seay %A Andrew T. Carswell %A Maurice MacDonald %K Big Five personality traits %K financial satisfaction %K Negative affect %K Positive affect %K Subjective well-being %X While previous studies have found that personality is one of the strongest predictors of life satisfaction, the associations between personality and financial satisfaction have not been assessed using large, nationally representative datasets. This study investigates relationships between personality (Big Five personality traits and dispositional positive/negative affect) and financial satisfaction using data from the 2012 wave of the Health and Retirement Study (HRS). Results from a three-block ordinal logistic regression model (n = 3984) indicate that personality traits are important predictors of financial satisfaction. When incorporating Big Five personality traits into a leading model of financial satisfaction, extraversion was positively associated with financial satisfaction, while neuroticism and agreeableness were negatively associated with financial satisfaction. However, when positive affect and negative affect were added to the model including Big Five traits, only agreeableness and negative affect were found to be negatively associated with financial satisfaction, while positive affect was positively associated with financial satisfaction. Additionally, this study examined the convergent validity, test-retest reliability, and presence of common method bias among the Big Five and dispositional affect measures used within the HRS, finding that the measures are reasonable for use in personality research. %B Personality and Individual Differences %V 166 %G eng %R 10.1016/j.paid.2020.110211 %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 Journal of Clinical Cardiology and Cardiovascular Therapy %D 2020 %T Blood Pressure and Mortality: Joint Effect of Blood Pressure Measures %A Jung K Kim %A Eileen M. Crimmins %K diastolic blood pressure %K Mortality %K pulse pressure %K Systolic blood pressure %X We examine how combinations of systolic and diastolic blood pressure levels and pulse pressure levels predicted mortality risk. Respondents are those aged over 50 from the Health and Retirement Study (N=10,366) who provided blood pressure measures in 2006/2008. Systolic and diastolic blood pressures were measured three times; and we averaged the three readings. Pulse pressure was calculated as systolic minus diastolic blood pressure. Seven combinations of systolic and diastolic blood pressure (low/normal/high of each) and three levels of pulse pressure (low/normal/high) were used to categorize blood pressure. Over 1 to 10 years of follow-up (average follow-up time of 7.8 years), 2,820 respondents died after blood pressure measurement in 2006/2008. Potential covariates including age, gender, education, BMI, total cholesterol, HbA1c, antihypertensive medication intake and lifetime-smoking pack years were adjusted in Cox proportional hazard models and survival curves. The blood pressure subgroup with low systolic blood pressure (<90 mmHg) and low diastolic blood pressure (< 60 mmHg) had the highest relative risk of mortality (HR=2.34, 95% CI: 1.45-3.80), followed by those with normal systolic blood pressure but low diastolic blood pressure (HR=1.45, 95% CI: 1.17-1.81) among those with cardiovascular conditions at baseline. For those without cardiovascular conditions at baseline, low blood pressure, either systolic or diastolic, was not related to mortality. Those with high levels of both systolic and diastolic blood pressure had a higher risk of mortality than those with both blood pressures normal but no other subgroups with low blood pressure differed from normal/normal in predicting mortality. Pulse pressure did not predict mortality. How high and low blood pressures are related to mortality needs to be examined by jointly looking at systolic and diastolic blood pressure. %B Journal of Clinical Cardiology and Cardiovascular Therapy %V 2 %G eng %N 1.1009 %R https://doi.org/10.31546/2633-7916.1009 %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 Conference Proceedings %B Conference of American-College-of-Cardiology (ACC) / World Congress of Cardiology (WCC) %D 2020 %T Cardiovascular Disease and Cumulative Incidence of Cognitive Impairment: Longitudinal Findings from The Health and Retirement Study %A Covello, Allyson %A Horwitz, Leora %A Singhal, Shreya %A Caroline S Blaum %A John A. Dodson %B Conference of American-College-of-Cardiology (ACC) / World Congress of Cardiology (WCC) %7 11 %I Journal of the American College of Cardiology %C Chicago, IL %V 75 %P 726 %G eng %U https://apps.webofknowledge.com/InboundService.do?product=WOS&Func=Frame&DestFail=http%3A%2F%2Fwww.webofknowledge.com&SrcApp=search&SrcAuth=Alerting&SID=7EI254HJQZJyroHmyfS&customersID=Alerting&mode=FullRecord&IsProductCode=Yes&AlertId=2547ce2d-b446-4503- %0 Journal Article %J Jamia Open %D 2020 %T Cardiovascular disease risk prediction for people with type 2 diabetes in a population-based cohort and in electronic health record data %A Szymonifka, Jackie %A Conderino, Sarah %A Christine T Cigolle %A Ha, Jinkyung %A Mohammed U Kabeto %A Yu, Jaehong %A John A. Dodson %A Thorpe, Lorna %A Caroline S Blaum %A Zhong, Judy %K Cardiovascular disease %K type 2 diabetes %X Electronic health records (EHRs) have become a common data source for clinical risk prediction, offering large sample sizes and frequently sampled metrics. There may be notable differences between hospital-based EHR and traditional cohort samples: EHR data often are not population-representative random samples, even for particular diseases, as they tend to be sicker with higher healthcare utilization, while cohort studies often sample healthier subjects who typically are more likely to participate. We investigate heterogeneities between EHR- and cohort-based inferences including incidence rates, risk factor identifications/quantifications, and absolute risks.This is a retrospective cohort study of older patients with type 2 diabetes using EHR from New York University Langone Health ambulatory care (NYULH-EHR, years 2009–2017) and from the Health and Retirement Survey (HRS, 1995–2014) to study subsequent cardiovascular disease (CVD) risks. We used the same eligibility criteria, outcome definitions, and demographic covariates/biomarkers in both datasets. We compared subsequent CVD incidence rates, hazard ratios (HRs) of risk factors, and discrimination/calibration performances of CVD risk scores.The estimated subsequent total CVD incidence rate was 37.5 and 90.6 per 1000 person-years since T2DM onset in HRS and NYULH-EHR respectively. HR estimates were comparable between the datasets for most demographic covariates/biomarkers. Common CVD risk scores underestimated observed total CVD risks in NYULH-EHR.EHR-estimated HRs of demographic and major clinical risk factors for CVD were mostly consistent with the estimates from a national cohort, despite high incidences and absolute risks of total CVD outcome in the EHR samples. %B Jamia Open %@ 2574-2531 %G eng %R https://doi.org/10.1093/jamiaopen/ooaa059 %0 Journal Article %J JAMA network open %D 2020 %T Changes in Health Insurance Coverage Over Time by Immigration Status Among US Older Adults, 1992-2016 %A Cobian, J. %A Maynor G González %A Ying Jessica Cao %A Xu, Huiwen %A Li, R. %A Mendis, M. %A Noyes, K. %A Becerra, A.Z. %K Emigrants and Immigrants %K health %K Immigrant population %X Importance: Disparities in health insurance coverage by immigration status are well documented; however, there are few data comparing long-term changes in insurance coverage between immigrant and nonimmigrant adults as they age into older adulthood. Objective: To compare longitudinal changes in insurance coverage over 24 years of follow-up between recent immigrant, early immigrant, and nonimmigrant adults in the US. Design, Setting, and Participants: This population-based cohort study used data from the nationally representative Health and Retirement Study. Data were collected biennially from 1992 to 2016. The population included community-dwelling US adults born between 1931 and 1941 and aged 51 to 61 years at baseline. Statistical analysis was performed from February 3, 2017, to January 10, 2020. Exposures: Participants were categorized as nonimmigrants (born in the US), early immigrants (immigrated to the US before the age of 18 years), and recent immigrants (immigrated to the US from the age of 18 years onward). Main Outcomes and Measures: Self-reported data on public, employer, long-term care, and other private insurance were used to define any insurance coverage. Longitudinal changes in insurance coverage were examined over time by immigration status using generalized estimating equations accounting for inverse probability of attrition weights. The association between immigration status and continuous insurance coverage was also evaluated. Results: A total of 9691 participants were included (mean [SD] age, 56.0 [3.2] years; 5111 [52.6%] female). Nonimmigrants composed 90% (n = 8649) of the cohort; early immigrants, 2% (n = 201); and recent immigrants, 8% (n = 841). Insurance coverage increased from 68%, 83%, and 86% of recent immigrant, early immigrant, and nonimmigrant older adults, respectively, in 1992 to 97%, 100%, and 99% in 2016. After accounting for selective attrition, recent immigrants were 15% less likely than nonimmigrants to have any insurance at baseline (risk ratio, 0.85; 95% CI, 0.82-0.88), driven by lower rates of private insurance. However, disparities in insurance decreased incrementally over time and were eliminated, such that insurance coverage rates were similar between groups as participants attained Medicare age eligibility. Furthermore, recent immigrants were less likely than nonimmigrants to be continuously insured (risk ratio, 0.89; 95% CI, 0.85-0.94). Conclusions and Relevance: Among community-dwelling adults who were not age eligible for Medicare, recent immigrants had lower rates of health insurance, but this disparity was eliminated over the 24-year follow-up period because of uptake of public insurance among all participants. Future studies should evaluate policies and health care reforms aimed at reducing disparities among vulnerable populations such as recent immigrants who are not age eligible for Medicare. %B JAMA network open %V 3 %G eng %U https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081691720&doi=10.1001%2fjamanetworkopen.2020.0731&partnerID=40&md5=9a3c12cf98521d4455f3c49d64c60fc8 %N 3 %9 Journal %& e200731 %R 10.1001/jamanetworkopen.2020.0731 %0 Journal Article %J Journal of Research in Personality %D 2020 %T Changes in optimism and pessimism in response to life events: Evidence from three large panel studies %A William J. Chopik %A Oh, Jeewon %A Eric S Kim %A Schwaba, Ted %A Krämer, Michael D. %A Richter, David %A Jacqui Smith %K Adult personality development %K Aging %K Life events %K Lifespan development %K Optimism %K Time perspective %X Although individuals vary in how optimistic they are about the future, one assumption that researchers make is that optimism is sensitive to changes in life events and circumstances. We examined how optimism and pessimism changed across the lifespan and in response to life events in three large panel studies (combined N = 74,886). In the American and Dutch samples, we found that optimism increased across younger adulthood, plateaued in midlife, and then decreased in older adulthood. In the German sample, there were inconsistent results with respect to age differences and mean level changes in optimism. Associations between life events and changes in optimism/pessimism were inconsistent across samples. We discuss our results in the context of life events and lifespan development. %B Journal of Research in Personality %V 88 %@ 0092-6566 %G eng %R 10.1016/j.jrp.2020.103985 %0 Journal Article %J Alzheimer's & Dementia %D 2020 %T Changes in physical and mental health of Black, Hispanic, and White caregivers and non-caregivers associated with onset of spousal dementia. %A Chen, Cynthia %A Thunell, Johanna %A Julie M Zissimopoulos %K Caregiving %K Dementia %K depression %K Racial Disparities %XIntroduction: We aim to determine whether racial/ethnic health disparities are a consequence of caregiving for persons with dementia and/or health status before becoming a caregiver.
Methods: Longitudinal data from the Health and Retirement Study (1998-2012) on 7859 Black, Hispanic, and White couples were analyzed for changes in physical and mental health with incident dementia of a spouse.
Results: Blacks and Hispanics, but not Whites, had poorer health before becoming caregivers for a spouse with dementia, than those who did not become caregivers. Spouse's dementia onset was associated with caregiver's higher odds of depressive disorder, with no racial/ethnic variation. Racial disparities in caregiver's health were attributed to health differences before caregiving, not differential health changes due to caregiving.
Discussion: Older Blacks and Hispanics with poor health are at increased risk of caregiving for a spouse with dementia. Protecting the health of persons supporting spouses with dementia requires understanding socioeconomic and cultural factors driving care provision.
%B Alzheimer's & Dementia %V 6 %P e12082 %G eng %N 1 %R 10.1002/trc2.12082 %0 Journal Article %J Chest %D 2020 %T Changes in Self-Rated Health After Sepsis in Older Adults: A Retrospective Cohort Study. %A Carey, Matthew R %A Hallie C Prescott %A Theodore J Iwashyna %A Wilson, Michael E %A Angela Fagerlin %A Valley, Thomas S %K Aging %K health-related quality of life %K Quality of Life %K Sepsis %XBACKGROUND: As more individuals survive sepsis, there is an urgent need to understand its effects on patient-reported outcomes.
RESEARCH QUESTION: What is the effect of sepsis on self-rated health, and what role, if any, does functional disability play in mediating this effect?
STUDY DESIGN AND METHODS: We conducted a survey- and administrative claims-based retrospective cohort study using the US Health and Retirement Study, a nationally representative cohort-based survey of older adults in the United States, from 2000 through 2016. We matched Medicare beneficiaries hospitalized with sepsis in 2000 to 2008 to nonhospitalized individuals. Self-rated health and functional disability were tracked biannually for 8 years. Differences in self-rated health between the cohorts were measured using mixed models with and without controlling for changes in functional disability.
RESULTS: Seven hundred fifty-eight individuals with sepsis were matched 1:1 to 758 nonhospitalized individuals, all aged 65 years and older. Among survivors, sepsis was associated with worse self-rated health in years 2 and 4 (adjusted absolute difference in self-rated health on a 5-point scale in year 2: -0.24 [95% CI, -0.38 to -0.10] and year 4: -0.17 [95% CI, -0.33 to -0.02]) but not in years 6 or 8. After accounting for changes in functional status, the association between sepsis and self-rated health was still present but reduced in year 2 (adjusted absolute difference in self-rated health, -0.18 [95% CI, -0.31 to -0.05]) and was not present in years 4, 6, or 8.
INTERPRETATION: Self-rated health worsened initially after sepsis but returned to the level of that of nonhospitalized control subjects by year 6. Mitigating sepsis-related functional disability may play a key role in improving self-rated health after sepsis.
%B Chest %V S0012-3692 %P 31732-3 %8 2020 Nov %G eng %N 20 %R 10.1016/j.chest.2020.05.606 %0 Journal Article %J Social Indicators Research %D 2020 %T Childhood Circumstances and Health Inequality in Old Age: Comparative Evidence from China and the USA %A Chen, Xi %A Yan, Binjian %A Thomas M Gill %K childhood circumstances %K Frailty %K inequality of opportunity %K life course approach %K Mental Health %K Self-rated health %X This paper estimates the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the USA and China. We link two waves of the China Health and Retirement Longitudinal Study in 2013 and 2015 with the newly released 2014 Life History Survey, and two waves of the Health and Retirement Study in 2014 and 2016 with the newly released 2015 Life History Mail Survey in the USA, to quantify health inequality due to childhood circumstances for which they have little control. Using the Shapley value decomposition approach, we show that childhood circumstances may explain 7–16 and 14–30% of health inequality in old age in China and the USA, respectively. Specifically, the contribution of childhood circumstances to health inequality is larger in the USA than in China for self-rated health, mental health, and physical health. Examining domains of childhood circumstance, regional and rural/urban status contribute more to health inequality in China, while family socioeconomic status contributes more to health inequality in the USA. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity. %B Social Indicators Research %@ 1573-0921 %G eng %R 10.1007/s11205-020-02436-2 %0 Report %D 2020 %T Childhood Circumstances and Health Inequality in Old Age: Comparative Evidence from China and the United States %A Chen, Xi %A Yan, Binjian %A Thomas M Gill %K childhood circumstances %K Frailty %K inequality of opportunity %K life course approach %K Mental Health %K Self-rated health %X This paper estimates the extent to which childhood circumstances contribute to health inequality in old age and evaluates the importance of major domains of childhood circumstances to health inequalities in the USA and China. We link two waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2013 and 2015 with the newly released 2014 Life History Survey (LHS), and two waves of the Health and Retirement Study (HRS) in 2014 and 2016 with the newly released 2015 Life History Mail Survey (LHMS) in the USA, to quantify health inequality due to childhood circumstances for which they have little control. Using the Shapley value decomposition approach, we show that childhood circumstances may explain 7-16 percent and 14-30 percent of health inequality in old age in China and the USA, respectively. Specifically, the contribution of childhood circumstances to health inequality is larger in the USA than in China for self-rated health, mental health, and physical health. Examining domains of childhood circumstance, regional and rural/ urban status contribute more to health inequality in China, while family socioeconomic status (SES) contributes more to health inequality in the USA. Our findings support the value of a life course approach in identifying the key determinants of health in old age. Distinguishing sources of health inequality and rectifying inequality due to early childhood circumstances should be the basis of policy promoting health equity. %B IZA Discussion Paper Series %I IZA Institute of Labor Economics %C Bonn, Germany %G eng %U http://ftp.iza.org/dp13460.pdf %0 Journal Article %J Journal of the American Geriatrics Society %D 2020 %T Cognitive Function and Cardiometabolic-Inflammatory Risk Factors Among Older Indians and Americans. %A Hu, Peifeng %A Jinkook Lee %A Beaumaster, Sidney %A Jung K Kim %A Dey, Sharmistha %A David R Weir %A Eileen M. Crimmins %K cardiometabolic risk %K Cognition %K HCAP %K LASI-DAD %XOBJECTIVES: To investigate how cardiometabolic-inflammatory risk factors are related to cognition among older adults in India and the United States.
DESIGN: The Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) and the Harmonized Cognitive Assessment Protocol of the Health and Retirement Study (HRS-HCAP) in the United States conducted an in-depth assessment of cognition, using protocols designed for international comparison.
SETTING: Cognitive tests were conducted in hospital or household settings in India and in household settings in the United States.
PARTICIPANTS: Respondents aged 60 years and older from LASI-DAD (N = 1,865) and respondents aged 65 years and older from HRS-HCAP (N = 2,111) who provided venous blood specimen.
MEASUREMENTS: We used total composite scores from the common cognitive tests administered. Cardiovascular risk was indicated by systolic and diastolic blood pressure, pulse rate, pro-B-type natriuretic peptide (proBNP), and homocysteine. Metabolic risk was measured by body mass index, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, and lipoprotein (a) (only in India). Inflammatory risk was indicted by white blood cell count, C-reactive protein, albumin, and uric acid (only in India).
RESULTS: The distribution of both total cognition scores and of cardiometabolic risk factors differed significantly between India and the United States. In both countries, lower cognition was associated with older age, lower education, elevated homocysteine, elevated proBNP, and lower albumin levels. The associations between HbA1c levels and cognitive measures were statistically significant in both countries, but in the opposite direction, with a coefficient of 1.5 (P < .001) in India and -2.4 (P < .001) in the United States for one percentage increase in absolute HbA1c value.
CONCLUSION: Cardiometabolic-inflammatory biomarkers are associated with cognitive functional levels in each country, but the relationships may vary across countries. J Am Geriatr Soc 68:S36-S44, 2020.
%B Journal of the American Geriatrics Society %V 68 %P S36-S44 %G eng %N Suppl 3 %R 10.1111/jgs.16734 %0 Journal Article %J Health Policy %D 2020 %T Comparing the education gradient in health deterioration among the elderly in six OECD countries %A Aurelie Côté-Sergent %A Raquel Fonseca %A Erin Strumpf %K Education %K Health deterioration %K Older ages %X Inequalities in health by educational attainment are persistent both over time and across countries. However, their magnitudes, evolution, and main drivers are not necessarily consistent across jurisdictions. We examine the health deterioration-education gradient among older adults in the United States, Canada, France, the Netherlands, Spain and Italy, including how it changes over time between 2004 and 2010. Using longitudinal survey data, we first assess how rates of health deterioration in terms of poor health, difficulties with activities of daily living, and chronic conditions vary by educational attainment. We find systematic differences in rates of health deterioration, as well as in the health deterioration-education gradients, across countries. We then examine how potential confounders, including demographic characteristics, income, health care utilisation and health behaviours, affect the health deterioration-education gradient within countries over time. We demonstrate that while adjusting for confounders generally diminishes the health deterioration-education gradient, the impacts of these variables vary somewhat across countries. Our findings suggest that determinants of, and policy levers to affect, the health deterioration-education gradient likely vary across countries and health systems. %B Health Policy %V 124 %P 326 - 335 %G eng %U http://www.sciencedirect.com/science/article/pii/S0168851018302537 %R https://doi.org/10.1016/j.healthpol.2019.12.015 %0 Journal Article %J Alzheimer's & Dementia: Translational Research & Clinical Interventions %D 2020 %T Comparison of Cox proportional hazards regression and generalized Cox regression models applied in dementia risk prediction %A Goerdten, Jantje %A Carrière, Isabelle %A Muniz-Terrera, Graciela %K ADAMS %K Cox proportional hazards regression %K Dementia %K dementia risk model %K Prediction %K SHARE %K splines %X Abstract Introduction The frequently used Cox regression applies two critical assumptions, which might not hold for all predictors. In this study, the results from a Cox regression model (CM) and a generalized Cox regression model (GCM) are compared. Methods Data are from the Survey of Health, Ageing and Retirement in Europe (SHARE), which includes approximately 140,000 individuals aged 50 or older followed over seven waves. CMs and GCMs are used to estimate dementia risk. The results are internally and externally validated. Results None of the predictors included in the analyses fulfilled the assumptions of Cox regression. Both models predict dementia moderately well (10-year risk: 0.737; 95% confidence interval [CI]: 0.699, 0.773; CM and 0.746; 95% CI: 0.710, 0.785; GCM). Discussion The GCM performs significantly better than the CM when comparing pseudo-R2 and the log-likelihood. GCMs enable researcher to test the assumptions used by Cox regression independently and relax these assumptions if necessary. %B Alzheimer's & Dementia: Translational Research & Clinical Interventions %V 6 %G eng %N 1 %R 10.1002/trc2.12041 %0 Journal Article %J JAMA Intern Med %D 2020 %T Comparison of Health Outcomes Among High- and Low-Income Adults Aged 55 to 64 Years in the US vs England %A Choi, Hwajung %A Andrew Steptoe %A Michele M Heisler %A Philippa J Clarke %A Robert F. Schoeni %A Jivraj, Stephen %A Cho, Tsai-Chin %A Kenneth M. Langa %K Demographics %K ELSA %K Income %K socioeconomic status %X Socioeconomic differences in life expectancy, health, and disability have been found in European countries as well as in the US. Identifying the extent and pattern of health disparities, both within and across the US and England, may be important for informing public health and public policy aimed at reducing these disparities.To compare the health of US adults aged 55 to 64 years with the health of their peers in England across the high and low ranges of income in each country.Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) for 2008-2016, a pooled cross-sectional analysis of comparably measured health outcomes, with adjustment for demographic characteristics and socioeconomic status, was conducted. The analysis sample included community-dwelling adults aged 55 to 64 years from the HRS and ELSA, resulting in 46 887 person-years of observations. Data analysis was conducted from September 17, 2019, to May 12, 2020.Residence in the US or England and yearly income.Sixteen health outcomes were compared, including 5 self-assessed outcomes, 3 directly measured outcomes, and 8 self-reported physician-diagnosed health conditions.This cross-sectional study included 12 879 individuals and 31 928 person-years from HRS (mean [SD] age, 59.2 [2.8] years; 51.9% women) and 5693 individuals and 14 959 person-years from ELSA (mean [SD] age, 59.3 [2.9] years; 51.0% women). After adjusting for individual-level demographic characteristics and socioeconomic status, a substantial health gap between lower-income and higher-income adults was found in both countries, but the health gap between the bottom 20% and the top 20% of the income distribution was significantly greater in the US than England on 13 of 16 measures. The adjusted US-England difference in the prevalence gap between the bottom 20% and the top 20% ranged from 3.6 percentage points (95% CI, 2.0-5.2 percentage points) in stroke to 9.7 percentage points (95% CI, 5.4-13.9 percentage points) for functional limitation. Among individuals in the lowest income group in each country, those in the US group vs the England group had significantly worse outcomes on many health measures (10 of 16 outcomes in the bottom income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the bottom income decile ranged from 7.6% (95% CI, 6.0%-9.3%) vs 3.8% (95% CI, 2.6%-4.9%) for stroke to 75.7% (95% CI, 72.7%-78.8%) vs 59.5% (95% CI, 56.3%-62.7%) for functional limitation. Among individuals in the highest income group, those in the US group vs England group had worse outcomes on fewer health measures (4 of 16 outcomes in the top income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the top income decile ranged from 36.9% (95% CI, 33.4%-40.4%) vs 30.0% (95% CI, 27.2%-32.7%) for hypertension to 35.4% (95% CI, 32.0%-38.7%) vs 22.5% (95% CI, 19.9%-25.1%) for arthritis.For most health outcomes examined in this cross-sectional study, the health gap between adults with low vs high income appeared to be larger in the US than in England, and the health disadvantages in the US compared with England are apparently more pronounced among individuals with low income. Public policy and public health interventions aimed at improving the health of adults with lower income should be a priority in the US. %B JAMA Intern Med %8 2020 %@ 2168-6106 %G eng %R 10.1001/jamainternmed.2020.2802 %0 Journal Article %J Scientific Reports %D 2020 %T Composite diagnostic criteria are problematic for linking potentially distinct populations: the case of frailty %A Yi-Sheng Chao %A Chao-Jung Wu %A Hsing-Chien Wu %A Hui-Ting Hsu %A Tsao, L.-C. %A Cheng, Y.-P. %A Lai, Y.-C. %A Wei-Chih Chen %K Frail Elderly %K Frailty Phenotype %K Residence Characteristics %X {Composite diagnostic criteria are common in frailty research. We worry distinct populations may be linked to each other due to complicated criteria. We aim to investigate whether distinct populations might be considered similar based on frailty diagnostic criteria. The Functional Domains Model for frailty diagnosis included four domains: physical, nutritive, cognitive and sensory functioning. Health and Retirement Study participants with two or more deficiencies in the domains were diagnosed frail. The survival distributions were analyzed using discrete-time survival analysis. The distributions of the demographic characteristics and survival across the groups diagnosed with frailty were significantly different (p < 0.05). A deficiency in cognitive functioning was associated with the worst survival pattern compared with a deficiency in the other domains (adjusted p < 0.05). The associations of the domains with mortality were cumulative without interactions. Cognitive functioning had the largest effect size for mortality prediction (Odds ratios %B Scientific Reports %V 10 %G eng %U https://www.scopus.com/inward/record.uri?eid=2-s2.0-85079339704&doi=10.1038%2fs41598-020-58782-1&partnerID=40&md5=ba7c890ffb416ce5b17f819b2c21936a %N 1 %9 Article %R 10.1038/s41598-020-58782-1 %0 Journal Article %J BMC Health Services Research %D 2020 %T Comprehensive review of ICD-9 code accuracies to measure multimorbidity in administrative data %A Melissa Y Wei %A Jamie E Luster %A Chan, Chiao-Li %A Lillian C. Min %K ICD-9 %K Literature Review %K multimorbidity %K Validation %X Background Quantifying the burden of multimorbidity for healthcare research using administrative data has been constrained. Existing measures incompletely capture chronic conditions of relevance and are narrowly focused on risk-adjustment for mortality, healthcare cost or utilization. Moreover, the measures have not undergone a rigorous review for how accurately the components, specifically the International Classification of Diseases, Ninth Revision (ICD-9) codes, represent the chronic conditions that comprise the measures. We performed a comprehensive, structured literature review of research studies on the accuracy of ICD-9 codes validated using external sources across an inventory of 81 chronic conditions. The conditions as a weighted measure set have previously been demonstrated to impact not only mortality but also physical and mental health-related quality of life. Methods For each of 81 conditions we performed a structured literature search with the goal to identify 1) studies that externally validate ICD-9 codes mapped to each chronic condition against an external source of data, and 2) the accuracy of ICD-9 codes reported in the identified validation studies. The primary measure of accuracy was the positive predictive value (PPV). We also reported negative predictive value (NPV), sensitivity, specificity, and kappa statistics when available. We searched PubMed and Google Scholar for studies published before June 2019. Results We identified studies with validation statistics of ICD-9 codes for 51 (64%) of 81 conditions. Most of the studies (47/51 or 92%) used medical chart review as the external reference standard. Of the validated using medical chart review, the median (range) of mean PPVs was 85% (39–100%) and NPVs was 91% (41–100%). Most conditions had at least one validation study reporting PPV ≥70%. Conclusions To help facilitate the use of patient-centered measures of multimorbidity in administrative data, this review provides the accuracy of ICD-9 codes for chronic conditions that impact a universally valued patient-centered outcome: health-related quality of life. These findings will assist health services studies that measure chronic disease burden and risk-adjust for comorbidity and multimorbidity using patient-centered outcomes in administrative data. %B BMC Health Services Research %V 20 %@ 1472-6963 %G eng %! BMC Health Services Research %& 489 %R 10.1186/s12913-020-05207-4 %0 Journal Article %J Proceedings of the National Academy of Sciences %D 2020 %T Decoding the mystery of American pain reveals a warning for the future %A Case, Anne %A Deaton, Angus %A Arthur A. Stone %K birth cohort analysis %K educational divide %K international comparisons %K pain prevalence %X The elderly in the United States report less pain than those in midlife—suggesting, perhaps, that once people move into old age, their morbidity will fall. Unfortunately, assessing pain by age at one point in time masks the fact that each successive birth cohort reports more pain at any given age than the cohorts that came before it. We cannot use the experience of the elderly today to project pain prevalence of the elderly tomorrow. Today’s elderly have experienced less pain throughout their lives than those in midlife today, who will be tomorrow’s elderly. If these patterns continue, pain prevalence will continue to increase for all adults; tomorrow’s elderly will be sicker than today’s elderly, with serious implications for healthcare.There is an expectation that, on average, pain will increase with age, through accumulated injury, physical wear and tear, and an increasing burden of disease. Consistent with that expectation, pain rises with age into old age in other wealthy countries. However, in America today, the elderly report less pain than those in midlife. This is the mystery of American pain. Using multiple datasets and definitions of pain, we show today’s midlife Americans have had more pain throughout adulthood than did today’s elderly. Disaggregating the cross-section of ages by year of birth and completion of a bachelor’s degree, we find, for those with less education, that each successive birth cohort has a higher prevalence of pain at each age—a result not found for those with a bachelor’s degree. Thus, the gap in pain between the more and less educated has widened in each successive birth cohort. The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950. If these patterns continue, pain prevalence will continue to increase for all adults; importantly, tomorrow’s elderly will be sicker than today’s elderly, with potentially serious implications for healthcare.The European and US official data are publicly available, although the European data require permission from Eurostat. The US data can be freely downloaded from the Web. We have prepared code that can be used to replicate our results. The underlying Gallup data are proprietary, and are not publicly available. We have prepared a replication dataset, containing all of the data that will allow replication of the results. Gallup will hold these data, but researchers can obtain permission from Gallup, and Gallup will give them access to the data for replication or further research. Please contact permissionsatgallup.com for more information. %B Proceedings of the National Academy of Sciences %G eng %R 10.1073/pnas.2012350117 %0 Journal Article %J Gerontology and Geriatric Medicine %D 2020 %T Dementia Is Associated With Earlier Mortality for Men and Women in the United States. %A White, Lindsay %A Fishman, Paul %A Basu, Anirban %A Paul K Crane %A Eric B Larson %A Norma B Coe %K Dementia %K gender %K Medicare %K Medicare administrative data %XSociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. Our study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, we identified a retrospective cohort of adults with at least one International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM) dementia diagnosis code ( = 3,714). For each case, we randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year ( = 9,531), and assigned comparators the diagnosis date of their matched case. Participants were followed for up to 60 months following diagnosis. We estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. On average, dementia cases were 80.5 years old at diagnosis. Most were female, had less than college-level education, and approximately 40% were married at diagnosis. In multivariate analyses, dementia diagnosis was associated with earlier mortality for women (predicted median survival of 54.5 months vs. 62.5 months; dementia coefficient = -0.13; 95% confidence interval [CI] = [-0.22, -0.04]; = .003), but even more so among men (predicted median survival of 35.5 months vs. 54.5 months; dementia coefficient = -0.42; 95% CI = [-0.52, -0.31]; < .001). We found substantial heterogeneity in the relationship between dementia and survival, associated with both education and marital status. Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.
%B Gerontology and Geriatric Medicine %V 6 %P 2333721420945922 %G eng %R 10.1177/2333721420945922 %0 Thesis %B Financial Planning, Housing and Consumer Economics %D 2020 %T Depression and the Financial Planning Horizon %A Choung, Youngjoo %K Depressed people %K financial decision making %K Financial security %X With greater numbers of people living longer, the question of how to prepare for financial security is an important issue. However, there is a noticeable increase in the prevalence of mental disorders, which deteriorates financial well-being in later life. Especially, depression is amongst the most common psychological disorders in older adults. People with depression have great difficulty tackling the task of planning and are more likely to make short-sighted financial decisions. Designing and managing a long-term financial plan can be particularly challenging for depressed people. To mitigate this problem, there is a growing need for research on factors that may affect the financial time preferences of older adults who suffer from depression. This is because financial time preference plays a vital role in determining the choices that people make when deciding between their saving and consumption trade-offs within the constraints of their financial resources and time horizon. Previous literature has found that people with depression have a lower preference for long-term economic benefits than healthy people when they face intertemporal choices. Depressed people’s abnormal time perception, insufficient resources, and negative expectations with regards to the future have a significant influence on their time preference. Hence, financial decision making for the future with a far-sighted perspective is especially needed for older adults who suffer from depression. However, there exist scant studies on the extent to which the financial planning horizon shifts with the onset of depressive symptoms. To fill this gap in the literature, this study utilized a five-category financial planning horizon measure in the Health and Retirement Study (HRS) and estimated regression models that identify depression as a determinant of the financial planning horizon. The purpose of this study is to explore whether depression contributes to greater preference for a shorter financial planning horizon of individuals. The result from the empirical analyses of this study finds that depression is negatively associated with the financial planning horizon. The implications of this finding can have ramifications for individuals with depression who need a long-term financial plan for the future. %B Financial Planning, Housing and Consumer Economics %I University of Georgia %C Athens, GA %V Doctor of Philosophy %@ 9798645489533 %G eng %0 Journal Article %J Epidemiology %D 2020 %T Development of Algorithmic Dementia Ascertainment for Racial/Ethnic Disparities Research in the US Health and Retirement Study. %A Kan Z Gianattasio %A Ciarleglio, Adam %A Melinda C Power %K Algorithms %K Alzheimer’s disease %K Dementia %K Disparities %K Machine learning %K Measurement %XBACKGROUND: Disparities research in dementia is limited by lack of large, diverse, and representative samples with systematic dementia ascertainment. Algorithmic diagnosis of dementia offers a cost-effective alternate approach. Prior work in the nationally representative Health and Retirement Study has demonstrated that existing algorithms are ill-suited for racial/ethnic disparities work given differences in sensitivity and specificity by race/ethnicity.
METHODS: We implemented traditional and machine learning methods to identify an improved algorithm that: (1) had ≤5 percentage point difference in sensitivity and specificity across racial/ethnic groups; (2) achieved ≥80% overall accuracy across racial/ethnic groups; and (3) achieved ≥75% sensitivity and ≥90% specificity overall. Final recommendations were based on robustness, accuracy of estimated race/ethnicity-specific prevalence and prevalence ratios compared to those using in-person diagnoses, and ease of use.
RESULTS: We identified six algorithms that met our prespecified criteria. Our three recommended algorithms achieved ≤3 percentage point difference in sensitivity and ≤5 percentage point difference in specificity across racial/ethnic groups, as well as 77%-83% sensitivity, 92%-94% specificity, and 90%-92% accuracy overall in analyses designed to emulate out-of-sample performance. Pairwise prevalence ratios between non-Hispanic whites, non-Hispanic blacks, and Hispanics estimated by application of these algorithms are within 1%-10% of prevalence ratios estimated based on in-person diagnoses.
CONCLUSIONS: We believe these algorithms will be of immense value to dementia researchers interested in racial/ethnic disparities. Our process can be replicated to allow minimally biasing algorithmic classification of dementia for other purposes.
%B Epidemiology %V 31 %P 126-133 %G eng %N 1 %R 10.1097/EDE.0000000000001101 %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 Alzheimer's & DementiaAlzheimer's & DementiaAlzheimer's Dement. %D 2020 %T Difficulty and help with activities of daily living among older adults living alone with cognitive impairment %A Ryan D. Edwards %A Willa D Brenowitz %A Portacolone, Elena %A Kenneth E Covinsky %A Bindman, Andrew %A M. Maria Glymour %A Jacqueline M Torres %K Activities of Daily Living %K Aging in place %K CIND %K Dementia %K Disability %K limitations %K Living arrangement %K population-based study %K service gaps %X Abstract Introduction There is limited research on difficulties with activities of daily living (I/ADLs) among older adults living alone with cognitive impairment, including differences by race/ethnicity. Methods For U.S. Health and Retirement Study (2000?2014) participants aged 55+ living alone with cognitive impairment (4,666 individuals; 9,091 observations), we evaluated I/ADL difficulty and help. Results Among 4.3 million adults aged 55+ living alone with cognitive impairment, an estimated 46% reported an I/ADL difficulty; 72% reported not receiving help with an I/ADL. Women reported more difficulty than men. Compared to white women, black women were 22% more likely to report a difficulty without help, and Latina women were 36% more likely to report a difficulty with help. Among men, racial/ethnic differences in outcomes were not significant. Patterns of difficulty without help by race/ethnicity were similar among Medicaid beneficiaries. Discussion Findings call for targeted efforts to support older adults living alone with cognitive impairment. %B Alzheimer's & DementiaAlzheimer's & DementiaAlzheimer's Dement. %8 2020/06/26 %@ 1552-5260 %G eng %R 10.1002/alz.12102 %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 %XBACKGROUND: 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 Working, Aging and Retirement %D 2020 %T Disrespect at Work, Distress at Home: A Longitudinal Investigation of Incivility Spillover and Crossover Among Older Workers %A Lisa A Marchiondo %A Gwenith G Fisher %A Cortina, Lilia M. %A Matthews, Russell A. %K Older Adults %K Workplace incivility %X The prevalence of workplace mistreatment toward older adults is well-documented, yet its effects are understudied. We applied the strength and vulnerability integration model (SAVI) to hypothesize that, despite its low intensity, workplace incivility has numerous deleterious outcomes for older employees over time. Specifically, we investigated whether and how incivility relates to well-being outside of work, among both targeted employees and their partners. We drew on affective events theory to examine how incivility “spills over” to older targets’ personal lives. We also tested whether incivility is potent enough to “crossover” to the well-being of older targets’ partners at home. Based on longitudinal data from a national study of older workers (N = 598; 299 couples), results demonstrate that workplace incivility related to decrements in targets’ affective well-being, which in turn, was associated with life dissatisfaction, interference with work, and lower overall health. Workplace incivility also predicted declines in partner well-being, although these crossover effects varied by gender: Men’s postincivility affective well-being predicted their female partners’ life satisfaction but not vice versa. However, women’s uncivil experiences directly related to the affective well-being of their male partners. These results suggest that for both older workers and their partners, the harms of incivility eventually extend beyond the organizations where they originate. %B Working, Aging and Retirement %G eng %9 Journal %R 10.1093/workar/waaa007 %0 Report %D 2020 %T DO WEALTH SHOCKS MATTER FOR THE LIFE SATISFACTION OF THE ELDERLY? EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY %A Cozzi, Marco %A Li, Qiushan %K Life Satisfaction %K Subjective well-being %K Uninsurable shocks %K Wealth %X This note studies the determinants of life satisfaction for the elderly and near-elderly in the U.S., using data from the Health and Retirement Study. The econometric analysis exploits the 2008-09 financial crisis as a source of exogenous variation in wealth, caused by a long-lasting decrease in asset prices. Although absolute changes in wealth are not found to systematically affect individuals' well-being, losing 60% or more of the pre-crisis wealth negatively impacted measures of life satisfaction. %B Department Discussion Paper %I Department of Economics, University of Victoria %C Victoria, B.C., Canada %G eng %U https://www.uvic.ca/socialsciences/economics/assets/docs/discussion/ddp2002.pdf %0 Journal Article %J Gerontologist %D 2020 %T Does Perceived Ageism Widen the Digital Divide? And Does It Vary by Gender? %A Eun-Young Choi %A Kim, Youngsun %A Chipalo, Edson %A Lee, Hee Yun %K Ageism %K gender issues %K Technology %X Existing literature presents a widening digital divide among older adults in addition to the consideration of the potential adverse impacts of ageism on internet use among the older adult population. Our study aimed to investigate (1) whether older adults’ perceived ageism will be associated with their use of the internet and (2) whether the relationship between perceived ageism and internet use will be moderated by age groups and binary gender.Using the data from the 2016 Health and Retirement Study, regression analyses were separately performed by gender. Two measures of perceived ageism were considered: (1) self-perception of aging and (2) perceived age discrimination.Our findings suggested that greater exposure to ageism is generally related to less use of the internet. In addition, we found divergent patterns in the relationship between ageism and internet use by gender. For women, a lower level of internet use was predicted by more negative perceptions of aging, whereas men’s internet use was associated with the experience of age discrimination. Furthermore, interaction effects between age groups and ageism varied across gender. The negative perception of aging was more strongly associated with less internet use in older women than middle-aged women. In comparison, the perceived age discrimination predicted less internet use in middle-aged men than older men.Our findings suggest that perceived ageism is significantly associated with internet use, and its association differs by gender. %B Gerontologist %V 60 %P 1213-1223 %@ 0016-9013 %G eng %N 7 %R 10.1093/geront/gnaa066 %0 Journal Article %J Innovation in Aging %D 2020 %T Does Spouse’s Dementia Diagnosis Make Individuals Skimp on Health Care? %A Chen, Yi %K Dementia %K spouse %X Dementia is a costly disease that places great burden on individuals, families, and health care systems. The substantial time and financial resources taken away by living with persons with dementia (PWDs) may make their spouses forgo needed health care, thus deteriorating long-term health. To quantify the effect of dementia on spouses’ health investment, I employed a difference-in-difference approach, comparing use of preventive services and doctor visits before and after spouses’ dementia onset. Using Health and Retirement Study (HRS) with linkage to Medicare claims, I identified 650 older adults whose spouses had incident dementia during 1993 to 2007, and matched them to 1,816 controls whose spouses were dementia-free. Primary analysis reveals that individuals whose spouse had dementia did not change their use of most health services, relative to dementia-free controls. In stratified analysis, middle-class individuals skimped on flu shot and diabetes screening. Providing help for activities of daily living (ADLs) was associated with 1.9 less doctor visits, the effect of which was stronger among females (2.5 less visits). Help with instrumental activities of daily living (IADLs) was not a predictor of any utilization outcome. In conclusion, externalities of dementia imposed on family members are more profound and complex than deprivation of time. Certain subgroups were worse off in health investment when facing the trade-off between caring for spouses with dementia and caring for themselves. When understanding dementia burden, the externality imposed on spouses and its heterogeneity should be considered. %B Innovation in Aging %V 4 %P 475 %8 2020/12/16 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1537 %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 Activities, Adaptation & AgingActivities, Adaptation & Aging %D 2020 %T Driving Status and Religious Service Attendance among Older Americans %A Sara J McLaughlin %A Brown, Karen M. %A Jonathon M Vivoda %A Cathleen M. Connell %K Church attendance %K driving cessation %K Social participation %K Transportation %X ABSTRACTWe investigated the relationship between driving status and religious service attendance among older Americans and how the perceived importance of religion influences the relationship. Data are from the 2012 wave of the Health and Retirement Study (n = 9,660). After controlling for covariates, the odds of regular religious service attendance were reduced by 55% for non-drivers relative to active drivers among those who indicated that religion was very important in their lives. No significant association was observed in those who rated religion as somewhat/not too important. Future research should explore how non-drivers who value religion make decisions about religious service attendance. %B Activities, Adaptation & AgingActivities, Adaptation & Aging %V 44 %P 132 - 145 %@ 0192-4788 %G eng %N 2 %! Activities, Adaptation & Aging %R 10.1080/01924788.2019.1618688 %0 Thesis %B Economics %D 2020 %T DYNAMIC STRUCTURE OF THE U.S. HEALTH SPENDING %A Chen, Xinyan %K Health Shocks %K health spending %K Healthcare %X Health expenditure is a compelling problem to study in the context of US economic resources allocation. At the individual level, healthcare consumption is high, ranking fifth in consumption categories only after food, housing, apparel and services, and transportation. Additionally, there is a big heterogeneity in individual health spending. For people who face severe health conditions, the health spending burden could be extremely large. In the context of the life-cycle model, De Nardi et al (2011) pointed out that health spending affected households’ saving and consumption decisions over a lifetime. In this dissertation, I look at individuals’ health spending from the lifetime perspective to study the long-term effects of health shocks. The research question of aggregating an individual’s health spending over time is complicated by the inter-temporal relationship of an individuals’ health spending. To address this question, I start by looking at health spending from a cross-sectional perspective, then study the dynamic evolution of individuals’ spending. The research is based on panel data from the Health and Retirement Study (HRS) by RAND Center, focusing on the original HRS cohort from survey year 1996 to year 2014 (wave 3 to wave 12). %B Economics %I State University of New York at Buffalo %C Buffalo, NY %V Doctor of Philosophy %G eng %0 Journal Article %J Research in Human DevelopmentResearch in Human Development %D 2020 %T Early Cognitive Decline and Its Impact On Spouse’s Loneliness %A Amanda N Leggett %A Choi, Hwajung %A William J. Chopik %A Hui Liu %A Gonzalez, Richard %K cognition impairment %K depression %K Loneliness %K Spouses %X Loneliness is common in dementia caregivers as cognitive impairment (CI) alters marital and social relationships. Unexplored is how an individual's loneliness is affected at earlier, more ambiguous, periods of their spouse's CI. Using the Health and Retirement Study, our study participants included 2,206 coupled individuals with normal cognitive function at the 2006/8 baseline. Loneliness outcomes at baseline, 4-year, and 8-year follow-up are assessed by the status of transition to cognitive impairment no dementia (TCIND) (2010/12 & 2014/16) using linear mixed models. Individual's loneliness was stable when their spouse's cognition remained normal, but increased with the spouse's TCIND. The increase in loneliness did not vary by gender. Loneliness, a key risk factor for reduced life quality and increased depression, increases even at early stages of a partner's CIND. This work suggests the potential impact of early intervention and social support for partners of individuals with CIND. %B Research in Human DevelopmentResearch in Human Development %V 17 %P 78 - 93 %@ 1542-7609 %G eng %N 1 %R 10.1080/15427609.2020.1750293 %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 %XCritical 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 Thesis %B Financial Planning, Housing and Consumer Economics %D 2020 %T The Effect of Income on Quality of Life and Survival Expectation Among Older Adults in America: Evidence from the Social Security Notch %A Chung, Sae Rom %K Effect of income %K Instrumental variable estimation %K Older Adults %K Quality of Life %K Social Security Notch %K Survival expectation %X The Social Security retirement income program provides financial support for older adults in America and is the primary source of income for retirees. As the inflows into the Social Security Trust Fund become smaller than outflows, it is projected that the Social Security Trust Fund will become insolvent by 2035. A potential future reduction in retirement benefits may constitute a significant risk for quality of life of older adults. Previous studies examined the relationships between income, life satisfaction, well-being, and quality of life among older adults, but the causal pathways are not yet fully explained. The purpose of this study is to identify latent dimensions of the perceived quality of life of older Americans and to estimate the causal effect of Social Security retirement income on these aspects of life quality, as well as on a 10-year survival expectation. To overcome the problem of endogeneity of income, I adopt a two-stage estimation procedure which uses the Social Security “notch” as an instrument for retirement income. The term “notch” refers to variation in Social Security benefits paid to people born between 1917 and 1921 that resulted from the Social Security administration’s unintended mistake in the formula for cost-of-living adjustment. The data is drawn upon the 1993 Asset and Health Dynamics Among the Oldest Old, a supplement to the Health and Retirement Study. I find positive and statistically significant relationship between the amount of Social Security retirement income received and the perceived quality of life as measured by items that correspond to feelings of living a fulfilled life and being in control of one’s life. At the same time, income does not appear to be a determinant of being forward-looking or hopeful among older adults in America. Similarly, I do not find convincing evidence that income significantly affects optimism regarding survival as measured by reports of one’s expected longevity. Overall, my findings suggest that a potential reduction in future Social Security benefits may inflict damage on some aspects of perceived quality of life among older adults. %B Financial Planning, Housing and Consumer Economics %I University of Georgia %C Athens, GA %V Doctor of Philosophy %@ 9798672123011 %G eng %0 Journal Article %J Sustainability %D 2020 %T Effect of Work Environment on Presenteeism among Aging American Workers: The Moderated Mediating Effect of Cynical Hostility %A Deng, Jianwei %A Wu, Zhennan %A Tianan Yang %A Cao, Yunfei %A Chen, Zhenjiao %K chronic work discrimination %K cynical hostility %K Presenteeism %K work environment %X Cynical hostility in the workplace has been studied. However, there is still no complete study examining how cynical hostility affects work performance. We examined how work environment impacts presenteeism through the mediation of cynical hostility and how chronic work discrimination moderates the relationship between work environment and cynical hostility among ageing workforces. The psychosocial vulnerability model supplies theoretical support for our model. We analyzed data from a sample of 2926 aging workforces from the Health and Retirement Study. Structural equation modeling (SEM) was used to examine the relationships with a moderated mediation model. In the final SEM model, our results showed that work environment was directly negatively associated with presenteeism. Moreover, cynical hostility was significantly inversely correlated with work environment and positively correlated with presenteeism. We found that the significant indirect effect between work environment and presenteeism can be significantly mediated by cynical hostility. In addition, cynical hostility is more likely to be affected by work environment among ageing workforces with lower levels of chronic work discrimination than those with higher levels. Enterprise, government, and employees themselves should be aware of the impact of presenteeism on ageing workforces with high levels of cynical hostility. %B Sustainability %V 12 %G eng %N 13 %R https://doi.org/10.3390/su12135314 %0 Journal Article %J JAMA Neurology %D 2020 %T Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records %A Andrew C. Stokes %A Weiss, Jordan %A Lundberg, Dielle J. %A Xie, Wubin %A Jung K Kim %A Samuel H. Preston %A Eileen M. Crimmins %K Dementia %K Mortality %X Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed.To estimate the percentage of deaths attributable to dementia in the US.A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults.Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff.Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates.Of the 7342 total sample, 4348 participants (60.3%) were women. At baseline, 4533 individuals (64.0%) were between ages 70 and 79 years, 2393 individuals (31.0%) were between 80 and 89 years, and 416 individuals (5.0%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6% (95% CI, 12.2%-15.0%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7%; 95% CI, 17.3-31.4) than non-Hispanic White participants (12.2%; 95% CI, 10.7-13.6) and among adults with less than a high school education (16.2%; 95% CI, 13.2%-19.0%) compared with those with a college education (9.8%; 95% CI, 7.0%-12.5%). Underlying cause of death recorded on death certificates (5.0%; 95% CI, 4.3%-5.8%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation.The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia. %B JAMA Neurology %V 77 %P 1543-1550 %@ 2168-6149 %G eng %N 12 %R 10.1001/jamaneurol.2020.2831 %0 Journal Article %J The Journals of Gerontology: Series A %D 2020 %T Everyday Discrimination and Kidney Function Among Older Adults: Evidence From the Health and Retirement Study %A Ryon J. Cobb %A Roland J. Thorpe Jr. %A Norris, Keith C %K Discrimination %K kidney %X With advancing age, there is an increase in the time of and number of experiences with psychosocial stressors that may lead to the initiation and/or progression of chronic kidney disease (CKD). Our study tests whether one type of experience, everyday discrimination, predicts kidney function among middle and older adults.The data were from 10 973 respondents (ages 52–100) in the 2006/2008 Health and Retirement Study, an ongoing biennial nationally representative survey of older adults in the United States. Estimated glomerular filtration rate (eGFR) derives from the Chronic Kidney Disease Epidemiology Collaboration equation. Our indicator of everyday discrimination is drawn from self-reports from respondents. Ordinary Least Squared regression (OLS) models with robust standard errors are applied to test hypotheses regarding the link between everyday discrimination and kidney function.Everyday discrimination was associated with poorer kidney function among respondents in our study. Respondents with higher everyday discrimination scores had lower eGFR after adjusting for demographic characteristics (B = −1.35, p \< .05), and while attenuated, remained significant (B = −0.79, p \< .05) after further adjustments for clinical, health behavior, and socioeconomic covariates.Our study suggests everyday discrimination is independently associated with lower eGFR. These findings highlight the importance of psychosocial factors in predicting insufficiency in kidney function among middle-aged and older adults. %B The Journals of Gerontology: Series A %V 75 %P 517-521 %G eng %U https://doi.org/10.1093/gerona/glz294 %R 10.1093/gerona/glz294 %0 Report %D 2020 %T The Evolution of Late-Life Income and Assets: Measurement in IRS Tax Data and Three Household Surveys %A Choi, James %A Goodman, Lucas %A Katz, Justin %A David I. Laibson %A Ramnath, Shanthi %K Assets %K Income %K late-life finances %X Using a 5% random sample of administrative IRS tax records covering households born from 1933 to 1952, we evaluate how three widely-used household surveys—the Health and Retirement Study, the Survey of Income and Program Participation, and the Current Population Survey—capture the level of and trends in late-life income and assets. First, relative to the tax data, survey data underestimate total income levels and overestimate declines in income at the median during the initial transition from working life to retirement. Survey estimates of median income at age 73 are lower than tax data estimates by an average of 4.5% in the HRS, 14.2% in the SIPP, and 25.1% in the CPS. Median total income declined from 58 to 68 by an average of only 11.7% in the tax data, compared with 24.4% in HRS, 16.8% in SIPP, and 29.0% in CPS. Second, survey sources overestimate income growth across birth cohorts at older ages but do a better job of capturing these trends at younger ages. Third, lower-income households have not experienced income growth across birth cohorts outside of the Social Security system. Averaging across ages 68 to 74, the 25th percentile income excluding Social Security fell by 16.5% from the 1933 birth cohort to the 1943 birth cohort in the tax data. These declines are larger in the HRS (26.9%) and SIPP (45.5%) and smaller in the CPS (11.1%). The fraction of households in the tax data with no non-Social Security income and no assets at age 72 rose from 18.9% to 20.5% from cohorts born in 1933 to 1945. The fraction of such households is captured well by the HRS and SIPP, but overstated by the CPS. %B NBER RDRC %I National Bureau of Economic Research, Retirement and Disability Research Center %C Cambridge, MA %G eng %U https://www.nber.org/programs-projects/projects-and-centers/retirement-and-disability-research-center/center-papers/nb20-04 %0 Journal Article %J Psychology & Health %D 2020 %T An examination of potential mediators of the relationship between polygenic scores of BMI and waist circumference and phenotypic adiposity %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Pauline Caille %A Antonio Terracciano %K BMI %K depression %K Education %K Personality %K Physical activity %K polygenic score %K Waist Circumference %X AbstractObjective: The present study examined whether physical activity, personality, cognition, education, and depressive symptoms mediate the association between polygenic scores (PGS) for body mass index (BMI) and waist circumference and the corresponding phenotypic adiposity measures.Design: Participants were 9,139 individuals aged 50 to 107 years (57% women; Mean Age: 68.17, SD: 10.06) from the Health and Retirement Study who were genotyped. Trained staff measured their height, weight, and waist circumference, and participants answered questions on physical activity, personality, education, cognitive function, and depressive symptoms.Main Outcome Measures: BMI and waist circumference.Results: A higher PGS for both BMI and waist circumference were related to higher phenotypic BMI and waist circumference, respectively, in part through their association with lower physical activity, conscientiousness, education, and higher depressive symptoms but not cognition. The mediators accounted for 6.6% of the association between PGS and BMI and 9.6% of the association between PGS and waist circumference.Conclusion: The present study provides new evidence on the multiple, distinct pathways through which genetic propensity to higher BMI and waist circumference may lead to higher adiposity in adulthood. Individuals with a higher genetic predisposition to obesity may gain more weight through less adaptive behavioral, personality and educational profiles. %B Psychology & Health %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/32275177 %9 Journal %R 10.1080/08870446.2020.1743839 %0 Journal Article %J Aging & Mental Health %D 2020 %T Examining the relationship between changes in personality and depression in older adult cancer survivors. %A Philip I. Chow %A Kelly M Shaffer %A Matthew C. Lohman %A Virginia T LeBaron %A Karen L. Fortuna %A Lee M Ritterband %K Cancer %K Chronic stressors %K Depressive symptoms %K Personality %XOBJECTIVES: Despite widespread agreement that personality traits change across the lifespan into older adulthood, the association between changes in personality and depression among older adult cancer survivors is unknown. It was hypothesized that older adults with (vs. without) a past cancer diagnosis would experience an increase in neuroticism, and decreases in conscientiousness, agreeableness, openness, and extraversion, and that changes in these traits would mediate the relationship between receiving a cancer diagnosis and change in depression. Two hypotheses were tested in a cancer survivor sample. First, that increased chronic stressors and decreased physical health would mediate the link between personality change and increased depression. Second, that personality change would mediate the link between changes in chronic stressors/health and increased depression.
METHOD: Secondary data analysis utilizing three waves of data from the Health and Retirement Study. Data was compiled from 5,217 participants, among whom 707 received a cancer diagnosis.
RESULTS: Older adults with (vs. without) a cancer diagnosis decreased in conscientiousness, which was associated with increased depression. Among cancer survivors, worsening chronic stressors/health mediated many pathways between personality change and an increased depression. Increased neuroticism mediated the link between worsening health/chronic stressors and increased depression.
CONCLUSION: With the exception of conscientiousness, changes in personality did not mediate the link between cancer survivor status and depression. Among older adult cancer survivors, changes in personality traits may increase depression through worsening physical health and chronic stressors, potentially informing targeted interventions. Interventions that target increased neuroticism may be particularly useful in older adult cancer survivors.
%B Aging & Mental Health %V 24 %P 1237-1245 %G eng %N 8 %R 10.1080/13607863.2019.1594158 %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 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 Journal of Empirical Finance %D 2020 %T Forced retirement risk and portfolio choice %A Chen, Guodong %A Lee, Minjoon %A Tong Yob Nam %K Forced retirement %K Human capital %K Portfolio choice %X Current literature on the effect of labor income on portfolio choice overlooks that workers face a risk of being forced to retire before their planned retirement age. Using data from the Health and Retirement Study, this paper finds that the forced retirement risk is both significant and highly correlated with stock market fluctuations. Using a life-cycle portfolio choice model, this paper shows that forced retirement risk makes labor income near retirement stock-like. Therefore, contrary to conventional wisdom, those who are still working but near retirement should have a lower share of risky assets in their financial portfolios than retirees do. %B Journal of Empirical Finance %V 58 %P 293 - 315 %@ 0927-5398 %G eng %R 10.1016/j.jempfin.2020.06.007 %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 Thesis %D 2020 %T Geriatrics principles in health care of older adults and the use of real-world data in aging-related research %A Irena Cenzer %K Aging %K Healthcare %X In this PhD project, we investigate how taking into consideration unique characteristics of older patients, as well as using appropriate research methods and data to study this group, would allow for better healthcare for this growing part of the population. As part of this PhD project, we performed two studies using RWDs, which examined the role of geriatric principles in care of older adults. In the first study, we used national survey of physicians to examine the use of potentially harmful first generation antihistamines in older adults. In the second study, we examined the patient relevant measures of wellbeing in older adults diagnosed with multiple myeloma using longitudinal survey and claims data. The structure of this thesis is as follows. The reminder of Section 1 contains the background on the two topics that the PhD project focuses on – geriatrics principles in health care and RWDs. In subsection 1.2. we starts with describing the geriatric principles of care, and presenting the rationale for using them in clinical care of older adults. Next, in subsection 1.3. we describe what RWDs are, and discuss their potentials and limitations in health care research. Section 2 presents the overall goal of this PhD project, as well as the detailed objectives of each of the two studies that are part of this PhD project. We summarize each study in detail in Section 3, including the methodology, main results, and the studies’ contribution to understanding the two topics of the PhD project (geriatric principles in health care and RWDs). The last subsection of Section 3, subsection 3.3., outlines the main conclusions the two PhD studies. Section 4 includes the bibliography of sources used in this PhD project. Finally, section 5 includes the two publications included in this PhD project, as they were published. %I Ludwig Maximilian University of Munich %C Munich %V Doctor of Philosophy %G eng %U https://edoc.ub.uni-muenchen.de/26876/1/Cenzer_Irena.pdf %0 Journal Article %J JOURNAL OF HEALTH AND SOCIAL BEHAVIOR %D 2020 %T Grandparenting and Mortality: How Does Race-Ethnicity Matter? %A Seung-won Emily Choi %K Caregiving %K grandparent %K intergenerational relationships %K Mortality %K race-ethnicity %X Little is known about whether and how intergenerational relationships influence older adult mortality. This study examines the association between caring for grandchildren (i.e., grandparenting) and mortality and how the link differs by race-ethnicity. Drawing from the Health and Retirement Study (1998-2014, N = 13,705), I found different racial-ethnic patterns in the effects of grandparenting on mortality risk. White grandparents who provide intensive noncoresident grandparenting (i.e., over 500 hours of babysitting per two years) and multigenerational household grandparenting have a lower risk of mortality compared to noncaregiving grandparents. In contrast, black grandparents have a higher mortality risk than their noncaregiving counterparts when providing intensive noncoresident, multigenerational household, and skipped-generation household (i.e., grandparent-headed family) grandparenting. Caregiving Hispanic grandparents are not significantly different from their noncaregiving counterparts in mortality risk. These findings suggest that important variations in social and cultural contexts for racial-ethnic groups shape the consequences of grandparenting for older adult mortality. %B JOURNAL OF HEALTH AND SOCIAL BEHAVIOR %V 61 %P 96-112 %G eng %N 1 %R 10.1177/0022146520903282 %0 Journal Article %J Journal of the American Geriatrics Society %D 2020 %T Handgrip Strength Asymmetry and Weakness Are Associated with Lower Cognitive Function: A Panel Study %A Ryan P McGrath %A Peggy M Cawthon %A Cesari, Matteo %A Soham Al Snih %A Brian C Clark %K Aging %K functional laterality %K Geriatric Assessment %K Geriatrics %K muscle strength dynamometer %X BACKGROUND/OBJECTIVES Examining handgrip strength (HGS) asymmetry and weakness together may extend the predictive capacity of HGS for capturing possible health problems such as cognitive impairment. The purpose of this study was to determine the associations of HGS asymmetry and weakness on lower cognitive functioning in a national sample of aging Americans. DESIGN Longitudinal panel. SETTING Participant residences. PARTICIPANTS The analytic sample included 17,163 Americans aged 65.0 years (standard deviation = 10.1 years) who participated in the 2006 to 2016 waves of the Health and Retirement Study (HRS). MEASUREMENTS A handgrip dynamometer was used to measure HGS; weakness was defined as HGS below 26 kg (men) or below 16 kg (women). Persons with HGS above 10% stronger on either hand were considered as having any HGS asymmetry. Those with HGS that was more than 10% stronger on their dominant or nondominant hand were considered as having dominant or nondominant HGS asymmetry, respectively. The Telephone Interview of Cognitive Status determined lower cognitive functioning (≤11 for ages 50-64 years; ≤10 for ages ≥65 years). Covariate-adjusted linear mixed-effects models analyzed the associations of each HGS asymmetry and weakness group on lower cognitive functioning. RESULTS Relative to those with symmetric HGS and no weakness, each HGS asymmetry and weakness group had greater odds for lower cognitive functioning: 1.15 (95% confidence interval [CI] = 1.03-1.27) for any HGS asymmetry alone, 1.64 (95% CI = 1.21-2.23) for weakness alone, and 1.95 (95% CI = 1.51-2.53) for any HGS asymmetry and weakness. Each HGS asymmetry dominance and weakness group also had greater odds for lower cognitive functioning: 1.12 (95% CI = 1.01-1.25) for asymmetric dominant HGS alone, 1.27 (95% CI = 1.05-1.53) for asymmetric nondominant HGS alone, 1.64 (95% CI = 1.21-2.23) for weakness alone, 1.89 (95% CI = 1.39-2.57) for weakness and asymmetric dominant HGS, and 2.10 (95% CI = 1.37-3.20) for weakness and asymmetric nondominant HGS. Conclusion The presence of both HGS asymmetry and weakness may predict accelerated declines in cognitive functioning. %B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.16556 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Health effects of late-career unemployment %A Maren W Voss %A Lori Wadsworth %A Wendy Church Birmingham %A Merryman, M. Beth %A Crabtree, Lisa %A Subasic, Kathy %A Hung, Man %K Job loss %K Retirement Planning and Satisfaction %K Unemployment %X Objective: Job loss has a demonstrated negative impact on physical and mental health. Involuntary retirement has also been linked to poorer physical and mental health outcomes. This study examined whether late-career unemployment is related to involuntary retirement and health declines postretirement. Method: Analysis was conducted using the 2000-2012 U.S. Health and Retirement Study (HRS) survey data with unemployment months regressed with demographic and baseline health measures on physical and mental health. Results: Individuals with late-career unemployment reported more involuntary retirement timing (47.0%) compared with those reporting no unemployment (27.9%). Late-career unemployment had no significant effect on self-reported physical health (β =.003, p =.84), but was significantly associated with lower levels of mental health (β =.039; p <.01). Conclusion: Self-reports of late-career unemployment are not associated with physical health in retirement, but unemployment is associated with involuntary retirement timing and mental health declines in retirement. Unemployment late in the working career should be addressed as a public mental health concern. %B Journal of Aging and Health %V 32 %P 106-116 %G eng %U https://journals.sagepub.com/doi/10.1177/0898264318806792 %N 1 %9 Journal %! J Aging Health %R 10.1177/0898264318806792 %0 Journal Article %J Journal of the American Geriatrics Society %D 2020 %T Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths %A John G. Cagle %A Lee, Joonyup %A Katherine A Ornstein %A Jack M. Guralnik %K End-of-life care %K Health and Retirement Study %K healthcare utilization %K Hospice %X OBJECTIVES Reliable national estimates of hospice use and underuse are needed. Additionally, drivers of hospice use in the United States are poorly understood, especially among noncancer populations. Thus the objectives of this study were to (1) provide reliable estimates of hospice use among adults in the United States; and (2) identify factors predicting use among decedents and within subsamples of cancer and noncancer deaths. DESIGN We conducted a prospective cohort study using the Health and Retirement Study survey. Excluding sudden deaths, we used data from the 2012 survey wave to predict hospice use in general, and then separately for cancer and non-cancer deaths. SETTING Study data were provided by a population-based sample of older adults from the U.S. PARTICIPANTS We constructed a sample of 1,209 participants who died between the 2012 and 2014 survey waves. MEASUREMENTS Hospice utilization was reported by proxy. Exposure variables included demographics, functionality (activities of daily living [ADLs]), health, depression, dementia, advance directives, nursing home residency, and cause of death. RESULTS Hospice utilization rate was 52.4% for the sample with 70.8% for cancer deaths and 45.4% for noncancer deaths. Fully adjusted model results showed being older (odds ratio [OR] = 1.54), less healthy (OR = .79), having dementia (OR = 1.52), and having cancer (OR = 5.47) were linked to greater odds of receiving hospice. Among cancer deaths, being older (OR = 1.64) and female (OR = 2.54) were the only predictors of hospice use. Among noncancer deaths, increased age (OR = 1.58), more education (OR = 1.56), being widowed (OR = 1.55), needing help with ADLs (OR = 1.13), and poor health (OR = .77) were associated with hospice utilization. CONCLUSION Findings suggest hospice remains underutilized, especially among individuals with noncancer illness. Extrapolating results to the US population, we estimate that annually nearly a million individuals who are likely eligible for hospice die without its services. Most (84%) of these decedents have a noncancer condition. Interventions are needed to increase appropriate hospice utilization, particularly in noncancer care settings. %B Journal of the American Geriatrics Society %V 68 %P 783-793 %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16294 %N 4 %R 10.1111/jgs.16294 %0 Report %D 2020 %T How Much Taxes Will Retirees Owe on Their Retirement Income? %A Anqi Chen %A Alicia H. Munnell %K Retirement %K Taxes %X To evaluate their retirement resources, households approaching retirement will examine their Social Security statements, defined benefit pensions, defined contribution balances, and other financial assets. However, many households may forget that not all of these resources belong to them; they will need to pay some portion to federal and state government in taxes. It is unclear, however, just how large the tax burden is for the typical retired household and for households with different income levels. This project aims to shed light on the tax burdens that retirees face by estimating lifetime taxes for a group of recently retired households. The project uses data from the Health and Retirement Study (HRS) linked to administrative earnings to determine Social Security benefits and administrative records on state of residence to estimate state tax liabilities. Income is then projected over the expected retirement of each household. Federal and state taxes, are estimated with TAXSIM, for each household on its reported and projected income. %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/how-much-taxes-will-retirees-owe-on-their-retirement-income/ %0 Web Page %D 2020 %T How the Affordable Care Act Is Helping Fight the Coronavirus Outbreak %A Marc A Cohen %A Jane Tavares %K Affordable Care Act %K Coronavirus %K COVID-19 %K depression %K Health Insurance %K Medicare %K Pandemic %X Ten years after the passage of the Affordable Care Act, the Trump administration is now asking the Supreme Court to overturn it. Yet it’s now clear that the ACA has brought significant improvements to the lives of millions of Americans. Today, they enjoy more health care coverage, with greater access, better outcomes and less cost. %B The Conversation: Health %I The Conversation %C Boston %G eng %U https://theconversation.com/obamacares-unexpected-bonus-how-the-affordable-care-act-is-helping-middle-aged-americans-during-the-pandemic-139267 %0 Journal Article %J Frontiers %D 2020 %T Identifying Moderators in the Link Between Workplace Discrimination and Health/Well-Being %A Yue Ethel Xu %A William J. Chopik %K Health and well-being %K Personality %K workplace discrimination %K workplace support %X The stress that arises from workplace discrimination can have a large impact on an employee’s work attitude, their work and life satisfaction, and oftentimes whether or not they stay in a job. Workplace discrimination can also have a considerable influence on employees’ short- and long-term health. However, less is known about the factors that might mitigate or exacerbate the effects of discrimination on health. The current study focused not only on the links between workplace discrimination and health, and but also on the effects of potential moderators of the discrimination-health link (i.e., perceived control, Big Five personality traits, optimism, and coworker/supervisor support). People with high neuroticism, high extraversion and high agreeableness were more negatively affected by workplace discrimination than those low on neuroticism, extraversion, and agreeableness. Perceived control was found to be a protective factor, such that those high in perceived control had fewer chronic illnesses in the context of high levels of workplace discrimination. %B Frontiers %G eng %U https://www.frontiersin.org/articles/10.3389/fpsyg.2020.00458/full %9 Journal %R 10.3389/fpsyg.2020.00458 %0 Journal Article %J Research in Human Development %D 2020 %T The Impact of Region and Urbanicity on the Discrimination-Cognitive Health Link Among Older Blacks %A Kimson E Johnson %A Sol, Ketlyne %A Sprague, Briana N. %A Tamara J. Cadet %A Muñoz, Elizabeth %A Noah J Webster %K Cognitive health %K Discrimination %K non-urban versus urban areas %X Little research has examined how the link between discrimination and cognitive health varies by where people live. This study investigates how living in non-urban versus urban areas in different regions in the United States moderates the discrimination-cognitive health link among older non-Hispanic Blacks. Data are from the 2012 and 2014 waves of the Health and Retirement Study (HRS; N = 2,347). Regression analyses indicate that experiencing more everyday discrimination is significantly associated with lower episodic memory when living in urban areas. Among non-Hispanic Blacks, the discrimination-episodic memory link does not significantly vary across U.S. regional contexts. Findings highlight variation in the association between everyday discrimination and cognitive health by where older non-Hispanic Blacks live. Results suggest the importance of socio-environmental factors in shaping how stressful experiences such as discrimination are linked to cognitive health in later life. %B Research in Human Development %V 17 %P 4 - 19 %@ 1542-7609 %G eng %N 1 %R 10.1080/15427609.2020.1746614 %0 Journal Article %J Neuroepidemiology %D 2020 %T Implications of the Use of Algorithmic Diagnoses or Medicare Claims to Ascertain Dementia. %A Melinda C Power %A Kan Z Gianattasio %A Ciarleglio, Adam %K Algorithms %K Dementia %K Diagnosis %K Medicare %K Sensitivity and Specificity %XINTRODUCTION: Formal dementia ascertainment with research criteria is resource-intensive, prompting the growing use of alternative approaches. Our objective was to illustrate the potential bias and implications for study conclusions introduced through the use of alternate dementia ascertainment approaches.
METHODS: We compared dementia prevalence and risk factor associations obtained using criterion-standard dementia diagnoses to those obtained using algorithmic or Medicare-based dementia ascertainment in participants of the baseline visit of the Aging, Demographics, and Memory Study (ADAMS), a Health and Retirement Study (HRS) sub-study.
RESULTS: Estimates of dementia prevalence derived using algorithmic or Medicare-based ascertainment differ substantially from those obtained using criterion-standard ascertainment. Use of algorithmic or Medicare-based dementia ascertainment can, but does not always, lead to risk factor associations that substantially differ from those obtained using criterion-standard ascertainment.
DISCUSSION/CONCLUSIONS: Absolute estimates of dementia prevalence should rely on samples with formal dementia ascertainment. The use of multiple algorithms is recommended for risk factor studies when formal dementia ascertainment is not available.
%B Neuroepidemiology %G eng %R 10.1159/000510753 %0 Journal Article %J Public Policy & Aging Report %D 2020 %T The Importance of Gradual Retirement in America Today %A Kevin E. Cahill %A Joseph F. Quinn %K bridge jobs %K economics of aging %K gradual retirement %B Public Policy & Aging Report %V 30 %P 107 - 112 %8 2020 %@ 1055-3037 %G eng %N 3 %R https://doi.org/10.1093/ppar/praa013 %0 Report %D 2020 %T Income Security and Financial Wellbeing of Older Workers Transitioning into Retirement %A Robert Clark %A Liu, Siyan %K income changes %K pension benefits %K Retirement %X This report begins with a discussion of the literature on income replacement and income security as older workers transition into retirement. In addition, literature on the financial distress and financial literacy of elderly households is reviewed. Section III describes our data sources and dataset construction. Section IV presents descriptive statistics on income replacement of recent retirees while Section V examines the characteristics of subgroups experiencing large income changes. Finally, Section VI shows regression analysis of the factors associated with income changes and studies the link between income changes and financial distress. Appendix A and Appendix B offers description of our samples of North Carolina public workers and HRS respondents in greater detail. Appendix C includes tables on sample characteristics and regression analysis of additional outcomes. Appendix D records the survey questions we use to create key variables for our North Carolina dataset. %I North Carolina State University %C Raleigh, NC %G eng %U https://siyanliu.wordpress.ncsu.edu/files/2020/11/Liu_Siyan_ICMM_Report.pdf %0 Journal Article %J Biological Research for Nursing %D 2020 %T The Influence of the BDNFVal66Met Polymorphism on the Association of Regular Physical Activity With Cognition Among Individuals With Diabetes. %A Liu, Tingting %A Canon, McKenzie D %A Shen, Luqi %A Marples, Benjamin A %A Colton, Joseph P %A Lo, Wen-Juo %A Gray, Michelle %A Li, Changwei %K Brain-Derived Neurotrophic Factor %K Cognition %K Diabetes Mellitus %K Exercise %K Gene-Environment Interaction %XINTRODUCTION: Diabetes is associated with cognitive dysfunction that comes with substantial lifetime consequences, such as interference with diabetes self-management and reduced quality of life. Although regular physical activity has been consistently shown to enhance cognitive function among healthy subjects, significant interpersonal differences in exercise-induced cognitive outcomes have been reported among (BDNF) Val/Val vs. Met carriers. However, the evidence on how the Val66Met variant influences the relationship between regular physical activity and cognition among individuals with diabetes is currently lacking.
METHODS: A total of 3,040 individuals with diabetes were included in this analysis using data from the Health and Retirement Study. Associations among moderate and vigorous physical activities (MVPA) and measures of cognitive function were evaluated using multivariable linear regression models within each stratum of the Val66Met genotypes.
RESULTS: MVPA was more strongly associated with total cognitive score, mental status, and words recall among Met/Met carriers, compared to Val/Val and Val/Met carriers.
CONCLUSIONS: This study provided preliminary findings on how variants may modulate the exercise-induced cognitive benefits among mid-aged and older adults with diabetes. Given the limitations of the current study, it is necessary for randomized controlled trials to stratify by genotypes to more conclusively determine whether Met carriers benefit more from increased physical activity. In addition, future research is needed to examine how the interplay of Val66Met variants, DNA methylation, and physical activity may have an impact on cognitive function among adults with diabetes.
%B Biological Research for Nursing %G eng %R 10.1177/1099800420966648 %0 Journal Article %J Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %D 2020 %T Investigating predictors of cognitive decline using machine learning. %A Casanova, Ramon %A Saldana, Santiago %A Michael W Lutz %A Brenda L Plassman %A Kuchibhatla, Maragatha %A Kathleen M Hayden %K Alzheimer's disease %K Cognitive Ability %K Machine learning %XObjectives: Genetic risks for cognitive decline are not modifiable; however their relative importance compared to modifiable factors is unclear. We used machine learning to evaluate modifiable and genetic risk factors for Alzheimer's disease(AD), to predict cognitive decline.
Methods: Health and Retirement Study participants, aged 65-90, with DNA and >2 cognitive evaluations, were included (n=7,142). Predictors included age, body mass index, gender, education, APOE ε4, CVD, hypertension, diabetes, stroke, neighborhood socio-economic status(NSES), and AD risk genes. Latent class trajectory analyses of cognitive scores determined the form and number of classes. Random Forests (RF) classification investigated predictors of cognitive trajectories. Performance metrics (accuracy, sensitivity and specificity) were reported.
Results: Three classes were identified. Discriminating highest from lowest classes produced the best RF performance: accuracy=78%(1.0%), sensitivity=75%(1.0%) and specificity=81%(1.0%). Top ranked predictors were education, age, gender, stroke, NSES, and diabetes, APOE ε4 carrier status and BMI. When discriminating high from medium classes, top predictors were education, age, gender, stroke, diabetes, NSES and BMI. When discriminating medium from the low classes, education, NSES, age, diabetes and stroke were top predictors.
Discussion: The combination of latent trajectories and RF classification techniques suggested that non-genetic factors contribute more to cognitive decline than genetic factors. Education was the most relevant predictor for discrimination.
%B Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29718387?dopt=Abstract %R 10.1093/geronb/gby054 %0 Journal Article %J SSM - Population Health %D 2020 %T Life course trauma and muscle weakness in older adults by gender and race/ethnicity: Results from the U.S. health and Retirement Study %A Kate A Duchowny %A Margaret T Hicken %A Peggy M Cawthon %A M. Maria Glymour %A Philippa J Clarke %K Grip strength %K Muscle Weakness %K Trauma %X Muscle weakness, as measured by handgrip strength, is a primary determinant of physical functioning and disability. There is a high burden of muscle weakness in the United States with close to 50 percent of older Americans meeting criteria for clinical muscle weakness. While previous racial/ethnic disparities have been documented among older adults, the extent to which lifecourse trauma shapes muscle strength trajectories is unknown. Using U.S. Health and Retirement Study (N = 20,472, Mean Age = 63.8 years) data on grip strength (2006–2014, up to 3 assessments) and retrospectively reported traumatic events, we fit gender-stratified growth curve models to investigate whether traumatic events experienced across the lifecourse or at distinct sensitive periods (childhood, early/emerging adulthood or mid-life) predicted later-life trajectories of grip strength. There was no association between cumulative trauma and trajectories of grip strength and the main effects for the life stage models were largely null. However, among White women, our results suggest that traumatic events experienced during childhood (β = −0.012; 95% CI = −0.024, 0.0004) compared to middle adulthood are associated with faster declines in grip strength in later life. Traumatic events reported during childhood was related to a slower decline in grip strength over time among Hispanic women compared to that for White women (β = 0.086, 95% CI = 0.044, 0.128). Among Black men, the association between traumatic events during early/emerging adulthood and age-related declines in grip strength was stronger for Black men than for White men (interaction β = −0.070; 95% CI = −0.138, 0.001). Traumatic events experienced during distinct life stages may influence later life declines in grip strength and exacerbate racial inequalities in later life. This study addresses an important gap by investigating the life course social determinants of later life muscle strength, which is a key driver of physical functioning and mobility. %B SSM - Population Health %V 11 %P 100587 %G eng %R 10.1016/j.ssmph.2020.100587 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Life partner influence on uptake of preventive services: Evidence from flu vaccine adoption among the aging population. %A Ying Jessica Cao %A Noyes, Katia %A Gregory G Homish %K Health care utilization %K Vaccines %XOBJECTIVES: This study examines how the patterns of life partner concordance on preventive health service uptake vary by a partner's previous behavioral history and between genders.
METHOD: This study uses 2008 and 2012 waves of Health and Retirement Study (HRS), a nationally representative sample of U.S. aging population, to examine one's decision to receive a preventive service as a function of the partner's decision changes over time ( N = 2,680).
RESULTS: Life partner concordance on preventive service use is different by the partner's previous use history and gender. Positive partner preventive engagement showed greater association than negative ones. Women are more responsive to the positive health behaviors (of their partners), and men are more sensitive to the negative partner health behaviors.
CONCLUSION: The asymmetric partner concordance by gender and the partner's previous usage experience provide implications to develop efficient and culturally acceptable interventions to increase the uptake of preventive health services.
%B Journal of Aging and Health %V 32 %P 441-452 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/30793640?dopt=Abstract %N 5-6 %R 10.1177/0898264319829979 %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 Research on Aging %D 2020 %T Life-Course Religious Attendance and Cognitive Functioning in Later Life %A Terrence D. Hill %A Dawn C Carr %A Amy M. Burdette %A Benjamin Dowd-Arrow %K Cognitive health %K Memory %K Mental Status %K Religion %X Although several studies suggest that religious attendance is associated with better cognitive functioning in later life, researchers have generally failed to connect with any established life-course perspectives or theories of cognitive aging. Building on previous work, we examine the effects of life-course religious attendance on a range of cognitive functioning outcomes. We employ data from the religious life histories module of the 2016 Health and Retirement Study, a subsample of 516 adults aged 65 and older. Our key findings demonstrate that older adults who attended religious services for more of their life course tend to exhibit poorer working memory and mental status and better self-rated memory than older adults who attended less often. We contribute to previous research by reconceptualizing religious attendance as a cumulative life-course exposure, exploring the effects of religious attendance net of secular social engagement, and examining a wider range of cognitive functioning outcomes. %B Research on Aging %G eng %9 Journal %R 10.1177/0164027520917059 %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 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 Injury Prevention %D 2020 %T A marginal structural model approach to analyse work-related injuries: An example using data from the Health and Retirement Study. %A Navneet Kaur Baidwan %A Susan Goodwin Gerberich %A Kim, Hyun %A Andrew D Ryan %A Timothy Church %A Benjamin D Capistrant %K Survey Methodology %K Working conditions %XBACKGROUND: Biases may exist in the limited longitudinal data focusing on work-related injuries among the ageing workforce. Standard statistical techniques may not provide valid estimates when the data are time-varying and when prior exposures and outcomes may influence future outcomes. This research effort uses marginal structural models (MSMs), a class of causal models rarely applied for injury epidemiology research to analyse work-related injuries.
METHODS: 7212 working US adults aged ≥50 years, obtained from the Health and Retirement Study sample in the year 2004 formed the study cohort that was followed until 2014. The analyses compared estimates measuring the associations between physical work requirements and work-related injuries using MSMs and a traditional regression model. The weights used in the MSMs, besides accounting for time-varying exposures, also accounted for the recurrent nature of injuries.
RESULTS: The results were consistent with regard to directionality between the two models. However, the effect estimate was greater when the same data were analysed using MSMs, built without the restriction for complete case analyses.
CONCLUSIONS: MSMs can be particularly useful for observational data, especially with the inclusion of recurrent outcomes as these can be incorporated in the weights themselves.
%B Injury Prevention %8 2019 Apr 24 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31018941?dopt=Abstract %R 10.1136/injuryprev-2018-043124 %0 Journal Article %J Journal of Aging & Social Policy %D 2020 %T Medicaid Utilization among Middle-age and Older Adults: A Health and Retirement Study Longitudinal Analysis (1998 to 2014). %A Jane Tavares %A Marc A Cohen %A Silberman, Susan %A Popham, Lauren %K medicaid beneficiaries %K medicaid spend-down %K Medicaid utilization %XWith over fifteen million older adults in the United States relying on the means-tested Medicaid program for healthcare coverage, there has been concern over rising Medicaid costs among this rapidly growing age group. Few studies have longitudinally examined trends among older beneficiaries over time to identify factors related to Medicaid utilization and to better understand how potential coverage changes might impact this group. This study used the 1998 to 2014 waves of the Health and Retirement Study (N = 8,162) to analyze a representative sample of those aged 50 and older to ascertain demographic, health, and economic factors associated with Medicaid utilization over a sixteen-year period. The analyses showed stable probabilities of accessing the program over time and observed that the most vulnerable older adults make up the pool of Medicaid beneficiaries. There is no evidence of significant asset divestment in order to qualify for benefits. Multivariate analyses further revealed those who were older, female, minority race/ethnicity, less educated, in poorer health, below the federal poverty line, and with lower net wealth had a higher risk of utilizing Medicaid during the observed time period than their counterparts. Findings highlight the importance of monitoring changes in the documented risk factors over time in terms of their impact on Medicaid utilization and underscore the need to consider how these factors may be interrelated.
%B Journal of Aging & Social Policy %P 1-17 %8 2020 Sep 30 %G eng %R 10.1080/08959420.2020.1824538 %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 %XSmoking 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 Book Section %B International Handbooks of Population: International Handbook of Health Expectancies %D 2020 %T Microsimulation of Health Expectancies, Life Course Health, and Health Policy Outcomes %A Laditka, Sarah B. %A Laditka, James N. %A Jagger, Carol %E Jagger, Carol %E Eileen M. Crimmins %E Saito, Yasuhiko %E De Carvalho Yokota, Renata Tiene %E Van Oyen, Herman %E Robine, Jean-Marie %K Active life expectancy %K Forecasting %K Health expectancy %K health policy %K Population Health %X Active life expectancy measures life expectancy and the proportions of remaining life with and without disease or disability. Microsimulation, a useful tool for life course research, estimates active life expectancy by simulating individual lifetime health biographies, where the individual's status in one or more outcomes is known for each measured unit of life. In this chapter we describe how researchers use microsimulation to study active life expectancy, focusing on research of the past 20 years. We summarize the microsimulation process. We describe how researchers model current and future population health, calculate new active life expectancy measures, and forecast effects of policy change. We illustrate the application of microsimulation to active life expectancy research with a study of interval need, a measure of need for health care and other services focused on resource use. We describe strengths of microsimulation, considerations regarding its use, and directions for future research. %B International Handbooks of Population: International Handbook of Health Expectancies %I Springer International Publishing %C Basel %V 9 %P 129–138 %@ 978-3-030-37668-0 %G eng %R 10.1007/978-3-030-37668-0_9 %0 Conference Paper %B Proceedings - 20th International Congress on Modelling and Simulation, MODSIM 2013 %D 2020 %T A model for assessing the association in the repeated measures of depression among the elderly %A M. Ataharul Islam %A Rafiqul I Chowdhury %A Bae, S. %A Singh, K.P. %K Bivariate binary outcomes %K Conditional model %K joint model %K marginal model %K regressive model %K Transition probability %X The dependence in the outcome variables is a major issue of concern in modeling the correlated data stemmed from the repeated observations. The marginal models such as GEE and the conditional models based on Markov chain have been employed for longitudinal data in the past. However, it has been evident that without addressing the underlying association parameters, the analysis of repeated outcome variables remains far from being resolved. In this paper, a method has been demonstrated to model such data using the underlying dependence in the outcome variables as well as dependence between outcome and explanatory variables. An extension of the regressive model is shown in this paper and a comparison is demonstrated between the existing model (reduced model) and the proposed model (extended model). The models are illustrated for depression among the elderly population in the USA using the Health and Retirement Study data from 1992 to 1998. © International Congress on Modelling and Simulation, MODSIM 2013.All right reserved. %B Proceedings - 20th International Congress on Modelling and Simulation, MODSIM 2013 %C Adelaide, Australia %G eng %U https://www.scopus.com/inward/record.uri?eid=2-s2.0-85080923221&partnerID=40&md5=3ec1edb7d724b41427a9f89bc8043c6c %0 Journal Article %J The Journals of Gerontology: Series B %D 2020 %T More than Selection Effects: Volunteering is Associated with Benefits in Cognitive Functioning %A Ben Lennox Kail %A Dawn C Carr %K Alzheimer’s disease %K Cognition %K Health Promotion %K Volunteer activity %X Volunteering is a lifestyle behavior that bolsters cognitive resilience. However, previous studies have not assessed the degree to which cognitive functioning is predictive of becoming a volunteer (i.e., selection into volunteering), and how this might contribute to superior cognitive performance observed among volunteers. The purpose of this brief report is to address the role of cognition-related selection into becoming a volunteer in the association between formal volunteering and two cognitive measures: (1) overall cognitive function, and (2) self-rated memory.The Health and Retirement Study was used to assess whether, net of cognitive selection into volunteering, formal volunteering is associated with cognitive function.Selection explained between 4.9% and 29% of the effect of volunteering on cognitive function (depending on the cognitive outcome and the level of volunteering). However, net of cognitive selection into volunteering, among all cognitive measures there are beneficial effects of formal volunteering on cognitive function. %B The Journals of Gerontology: Series B %@ 1079-5014 %G eng %R https://doi.org/10.1093/geronb/gbaa101 %0 Journal Article %J Aging, Neuropsychology, and CognitionAging, Neuropsychology, and Cognition %D 2020 %T Multiple chronic conditions and risk of cognitive impairment and dementia among older Americans: findings from the Aging, Demographics, and Memory Study (ADAMS) %A Yura Lee %A Cho, Youngjoo %A Oh, Hyunkyoung %K Aging %K and memory study %K cognitive impairment with no dementia %K Dementia %K Demographics %K multimorbidity %K Multiple Chronic Conditions %X ABSTRACT This study examined the relationship between multiple chronic conditions (MCC) and risk of cognitive impairment with no dementia (CIND) and dementia among older Americans. A sample of 637 individuals aged 70 or older was drawn from the Aging, Demographics, and Memory Study, a supplementary dataset of the larger national Health and Retirement Study. Multinomial logistic regression analysis was conducted to investigate the association between MCC and cognition categorized as (a) no cognitive impairment, (b) CIND, or (c) dementia. Having MCC, particularly three or more chronic conditions, was significantly related to being diagnosed with CIND in our study, but not dementia. Our findings suggest that the presence of MCC may be a risk factor for cognitive impairment in later life. However, further investigation using a longitudinal design is needed to better understand the mechanism of how MCC may be related to CIND and dementia among older adults in the United States. %B Aging, Neuropsychology, and CognitionAging, Neuropsychology, and Cognition %8 2020/07/07 %@ 1382-5585 %G eng %R 10.1080/13825585.2020.1790492 %0 Journal Article %J Innovation in Aging %D 2020 %T Multiple Dimensions of Perceived Discrimination, Race-Ethnicity, and Mortality Risk Among Older Adults %A Ryon J. Cobb %K mortality risk %K Perceived Discrimination %K race-ethnicity %X The present study utilized data from the Health and Retirement Study (N=12,988) to investigate the joint consequences of multiple dimensions of perceived discrimination on mortality risk. Perceived discrimination is based on responses from the 2006/2008 HRS waves and included everyday discrimination, the number of attributed reasons for everyday discrimination, and major lifetime discrimination. Vital status was obtained from the National Death Index and reports from key household informants (spanning 2006–2016). Cox proportional hazard models were used to estimate the risk of mortality. During the observation period, 3,494 deaths occurred. Only the number of attributed reasons for discrimination predicted mortality risk when all discrimination measures were estimated in the same model (Hazard Ratio [HR]=1.09; 95%, Confidence Interval [CI]=1.05 - 1.14), holding all else constant. Overall, the number of attributed reasons for everyday discrimination is a particularly salient risk factor for mortality in later life. %B Innovation in Aging %V 4 %P 581 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1936 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Neighborhood Disorder, Social Ties, and Preventive Healthcare Utilization among Urban-Dwelling Older Adults %A Kenzie Latham-Mintus %A Ashley Vowels %A Swapnali Chavan %K environment %K healthcare utilization %K neighborhood disorder %K Neighborhoods %K preventive health care %K Social Support %K social ties %X This research examines whether perceived neighborhood disorder influences the use of preventive healthcare services (i.e. influenza vaccine, pneumonia vaccine, cholesterol screening, colonoscopy, and dental care) by older adults and whether social ties buffer the potential adverse effects of perceived neighborhood disorder. Methods: Using data from the 2012 wave of the Health and Retirement Study, binary logistic regression was used to generate odds ratio estimates of preventive healthcare use in the past 2 years. Results: We find that greater levels of neighborhood disorder were associated with fewer dental care visits net of social and health factors. Regular participation in four or more social activities was associated with decreased odds of restricted use and increased odds of receiving a pneumonia vaccine and colonoscopy. Discussion: This research provides evidence that perceived neighborhood disorder may act as a barrier for specific preventive healthcare services and highlights the need for targeted intervention. %B Journal of Aging and Health %G eng %R 10.1177/0898264320929544 %0 Journal Article %J Journal of Applied Gerontology %D 2020 %T Neighborhood Engagement, Dogs, and Life Satisfaction in Older Adulthood. %A Angela L Curl %A Bibbo, Jessica %A Rebecca A Johnson %K Engagement %K Life Satisfaction %K neighborhood %XOBJECTIVES: This study examined the relationships between dog ownership, dog walking, and the emotional bond with a dog to neighborhood engagement and life satisfaction among those over age 50.
METHOD: Using data from the Health and Retirement Study ( = 476), two path analysis models were conducted to test the research hypotheses.
RESULTS: Findings indicated that dog ownership did not have a direct or indirect relationship on life satisfaction. However, time spent in dog walking was associated with frequency of social interactions, which itself had a positive association with life satisfaction. The bond with a dog was not directly associated with life satisfaction but was associated with dog walking.
DISCUSSION: Dog walking is a promising strategy for simultaneously promoting better health and social engagement, and these factors in turn can promote greater life satisfaction of older adults.
%B Journal of Applied Gerontology %8 2020 Sep 10 %G eng %R 10.1177/0733464820953725 %0 Journal Article %J Psychology and Aging %D 2020 %T Novel information processing at work across time is associated with cognitive change in later life: A 14-year longitudinal study. %A Ursula M. Staudinger %A Yu, Yan-Liang %A Cheng, Bin %K Cognitive Ability %K cognitive aging %K Cognitive Processes %K health %K Job characteristics %K job complexity %K novelty processing %K Retirement %K Stimulus Novelty %K Test Construction %X This study examined whether the degree of novel information processing at work (NPW) attenuates cognitive aging across 14 years for adults 50+ in the United States and how NPW links with job complexity. To answer these questions, we used data (N = 4,252) from the Health and Retirement Study. Detailed information on occupational characteristics from ONet between 2000 and 2014 was used to assess NPW and matched with participants’ occupational codes across time. Multilevel transition models were employed to estimate the relationship between NPW and cognitive functioning across time and to explore the moderating effect of cognitive level. Our results showed that exposure to more NPW across time attenuates cognitive decline as indicated by immediate word recall and serial 7s performance, while adjusting for baseline age, leisure, volunteering activities, cognition at previous wave, and other covariates. This buffering effect of NPW is reduced but sustained when controlling for change in jo %B Psychology and Aging %V 35 %P 793–805 %G eng %U http://proxy.lib.umich.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2020-27251-001&site=ehost-live&scope=site %N 6 %9 Journal %R 10.1037/pag0000468 %0 Thesis %B Sociology %D 2020 %T OLDER WOMEN AND DISCRIMINATION AT WORK %A Swapnali Chavan %K Discrimination %K women %K work force %X Increasing numbers of older people are working past retirement age. However, older women are leaving the work force earlier compared with men, despite having longer life expectancies. Given the economic and health benefits of staying in the labor force in later life, it is important to understand which factors may contribute to older women exiting the labor force. With advancing ages, women may experience increasing work discrimination due to ageism and sexism. Using data from Wave 11 (2012) the Health and Retirement Study (HRS), I examine whether age is a predictor of work discrimination among older women workers. I conducted multivariable linear regression to assess whether age predicts perceived work discrimination among older women workers, net of all covariates. Additionally, an interaction between race and age was investigated to assess whether women of color experienced more work discrimination with advancing ages. I observed that age was negatively associated with work discrimination. Findings suggest that experiences with work discrimination may push older women out the labor force prematurely. Older women may desire to escape discriminatory work environments with less favorable conditions. %B Sociology %I Indiana University %C Bloomington, IN %V Master of Arts %G eng %U https://scholarworks.iupui.edu/bitstream/handle/1805/24747/Revised%20Swapnali%20Chavan%20-IUPUI%20Thesis%20Final%2012.4.20.pdf?sequence=3&isAllowed=y %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 %XOBJECTIVE: 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 Innovation in Aging %D 2020 %T Out-of-Pocket Costs Attributable to Dementia: A Longitudinal Analysis %A Oney, Melissa %A White, Lindsay %A Norma B Coe %K Alzheimer disease %K Dementia %K Out-of-pocket medical expenses %X Alzheimer’s disease and related dementias (ADRD) affects 5.5 million Americans, and is expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, despite the fact that one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare. In this paper, we use survey data for 2002-2014 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization. We consider total out-of-pocket expenditures, as well as out-of-pocket expenditures by category (i.e. hospital, nursing home, doctor, prescription drug, and other). Our results suggest that the out-of-pocket costs of ADRD are quite substantial over the first 8 years after onset. We also find that out-of-pocket spending is decreasing over the first 8 years, similar to the trend seen in Medicare expenditures. The results of this study highlight the financial burden of ADRD, particularly for the population paying out-of-pocket for care. %B Innovation in Aging %V 4 %P 475-476 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1539 %0 Thesis %B Biostatistics %D 2020 %T Parsimonious Covariate Selection for Interval Censored Data %A Cui,Yi %K Parsimonious covariate selection %K Statistics %X Interval censored outcomes widely arise in many clinical trials and observational studies. In many cases, subjects are only followed-up periodically. As a result, the event of interest is known only to occur within a certain interval. We provided a method to select the parsimonious set of covariates associated with the interval censored outcome. First, the iterative sure independence screening (ISIS) method was applied to all interval censored time points across subjects to simultaneously select a set of potentially important covariates; then multiple testing approaches were used to improve the selection accuracy through refining the selection criteria, i.e. determining a refined common cutoff value. We compared the improvement of selection accuracy by using both familywise error rate (FWER)and generalized FWER (gFWER) methods. Our method shows good performance in simultaneously in selecting non-zero effects and deselecting zero-effects, respectively. %B Biostatistics %I State University of New York at Albany %C Albany, NY %V Doctor of Philosophy %@ 9781658404419 %G eng %0 Journal Article %J Aging Clinical and Experimental Research %D 2020 %T Patient-reported measures of well-being in older multiple myeloma patients: use of secondary data source %A Irena Cenzer %A Karin Berger %A Rodriguez, A.M. %A Ostermann, H. %A Kenneth E Covinsky %X Background: Changes in well-being of patients with multiple myeloma (MM) before and after diagnosis have not been quantified. Aims: Explore the use of secondary data to examine the changes in the well-being of older patients with MM. Methods: We used the Health and Retirement Study (HRS), linked to Medicare claims to identify older MM patients. We compared patient-reported measures (PRM), including physical impairment, sensory impairment, and patient experience (significant pain, self-rated health, depression) in the interviews before and after MM diagnosis using McNemar’s test. We propensity-matched each MM patient to five HRS participants without MM diagnosis based on baseline characteristics. We compared the change in PRM between the MM patients and their matches. Results: We identified 92 HRS patients with MM diagnosis (mean age = 74.6, SD = 8.4). Among the surviving patients, there was a decline in well-being across most measures, including ADL difficulty (23% to 40%, p value = 0.016), poor or fair self-rated health (38% to 61%, p value = 0.004), and depression (15% to 30%, p value = 0.021). Surviving patients reported worse health than participants without MM across most measures, including ADL difficulty (40% vs. 27%, p value = 0.04), significant pain (38% vs. 22%, p value = 0.01), and depression (29% vs. 11%, p value = 0.003). Discussion: Secondary data were used to identify patients with MM diagnosis, and examine changes across multiple measures of well-being. MM diagnosis negatively affects several aspects of patients’ well-being, and these declines are larger than those experienced by similar participants without MM. Conclusion: The results of this study are valuable addition to understanding the experience of patients with MM, despite several data limitations. © 2020, The Author(s). %B Aging Clinical and Experimental Research %G eng %R 10.1007/s40520-019-01465-3 %0 Journal Article %J Neuroepidemiology %D 2020 %T Pattern Recognition to Objectively Differentiate the Etiology of Cognitive Decline: Analysis of the Impact of Stroke and Alzheimer's Disease. %A Sean A. P. Clouston %A Richmond, Lauren L %A Scott, Stacey B %A Luhmann, Christian C %A Natale, Ginny %A Douglas William Hanes %A Yun Zhang %A Dylan M Smith %K Adaptive diagnostics %K Cerebrovascular disease %K Neuroepidemiology %K Pattern recognition %XBACKGROUND: Undetected Alzheimer's disease (AD) and stroke neuropathology is believed to account for a large proportion of decline in cognitive performance that is attributed to normal aging. This study examined the amount of variance in age-related cognitive change that is accounted for by AD and stroke using a novel pattern recognition protocol.
METHOD: Secondary analyses of data collected for the Health and Retirement Study (N = 17,579) were used to objectively characterize patterns of cognitive decline associated with AD and stroke. The rate of decline in episodic memory and orientation was the outcome of interest, while algorithms indicative of AD and stroke pathology were the predictors of interest.
RESULTS: The average age of the sample was 67.54 ± 10.45 years at baseline, and they completed, on average, 14.20 ± 3.56 years of follow-up. After adjusting for demographics, AD and stroke accounted for approximately half of age-associated decline in cognition (51.07-55.6% for orientation and episodic memory, respectively) and explained variance attributed to random slopes in longitudinal multilevel models.
DISCUSSION: The results of this study suggested that approximately half of the cognitive decline usually attributed to normal aging are more characteristic of AD and stroke.
%B Neuroepidemiology %G eng %R 10.1159/000510133 %0 Journal Article %J Health & Place %D 2020 %T Perceived neighborhood social cohesion and subsequent health and well-being in older adults: An outcome-wide longitudinal approach %A Eric S Kim %A Ying Chen %A Ichiro Kawachi %A Tyler J VanderWeele %K Health and well-being %K Older Adults %K Outcome-wide epidemiology %K Perceived neighborhood social cohesion %K Public Health %K social cohesion %X Background Growing research documents associations between neighborhood social cohesion with better health and well-being. However, other work has identified social cohesion's “dark side” and its ability to promote negative outcomes. It remains unclear if such diverging findings are attributable to differences in study design, or other reasons. To better capture its potential heterogeneous effects, we took an outcome-wide analytic approach to examine perceived neighborhood social cohesion in relation to a range of health and well-being outcomes. Methods Data were from 12,998 participants in the Health and Retirement Study—a large, diverse, prospective, and nationally representative cohort of U.S. adults age >50. Multiple regression models evaluated if social cohesion was associated with physical health, health behavior, psychological well-being, psychological distress, and social well-being outcomes. All models adjusted for sociodemographics, personality, and numerous baseline health and well-being characteristics. To evaluate the effects of change in cohesion, we adjusted for prior social cohesion. Bonferroni correction was used to account for multiple testing. Results Perceived neighborhood social cohesion was not associated with most physical health outcomes (except for reduced risk of physical functioning limitations and better self-rated health) nor health behavior outcomes (except for more binge drinking). However, it was associated with numerous subsequent psychosocial well-being (i.e., higher: positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; reduced likelihood of infrequent contact with friends) and psychological distress outcomes (i.e., lower depression, hopelessness, negative affect, loneliness) over the 4-year follow-up period.ConclusionsWith further research, these results suggest that perceived neighborhood social cohesion might be a valuable target for innovative policies aimed at improving well-being. %B Health & Place %V 66 %P 102420 %8 2020/11/01/ %@ 1353-8292 %G eng %R https://doi.org/10.1016/j.healthplace.2020.102420 %0 Journal Article %J Journal of Epidemiology & Community Health %D 2020 %T Is perceived neighbourhood physical disorder associated with muscle strength in middle aged and older men and women? Findings from the US health and retirement study %A Kate A Duchowny %A M. Maria Glymour %A Peggy M Cawthon %X {Background Research documenting the relevance of neighbourhoods for the health of older adults has focused on global physical functioning outcomes, such as disability, rather than physiologic impairments that lead to disability. Muscle weakness is an age-related impairment and a central mechanism of disability. Evaluating neighbourhood effects on muscle weakness may offer insight into physiologic mechanisms of disability. We examined the association between perceived neighbourhood disorder and muscle strength in a nationally representative sample of US adults aged 51+.Methods Among 11 277 participants (57% women; mean age: 66.6 years) in the Health and Retirement Study (2012–2014), we investigated whether self-reported neighbourhood physical disorder (1–7 scale) %B Journal of Epidemiology & Community Health %V 74 %P 240–247 %G eng %U https://jech.bmj.com/content/74/3/240 %R 10.1136/jech-2019-213192 %0 Journal Article %J Journal of Gerontological Social Work %D 2020 %T Perceived Usefulness and Easiness of Information and Communication Technologies and Volunteering among Older Adults %A Joonyoung Cho %A BoRin Kim %A Jehoon Jeon %A Sojung Park %K Poverty %K productive aging %K Technology %K Volunteerism %X ABSTRACTThis study investigates the association between older adults’ perception of usefulness and easiness (PUE) of Internet Communication and Technologies (ICTs) and volunteering, and if this association differs across their income status. Data were obtained from the 2012 wave of the Health and Retirement Study (HRS), and the sample was restricted to respondents aged between 60 and 84 (N = 901) and who completed the 2012 HRS technology module. Multinomial logistic regression was employed to examine the independent and joint influence of PUE of ICTs and of low-income status on volunteering. The results show that only people with high PUE engaged in more than 100 hours of volunteering among older adults after controlling for covariates. The positive effect of high PUE was found to be more significant in the low-income group. This is the first known research to investigate the PUE of ICTs and volunteering among older adults. This study expands the knowledge of volunteering among older adults by exploring ICTs which can be considered as one of the most influential macrosocial changes in the current society. Moreover, our findings provide some insights and an empirical foundation in volunteering programs for older adults of different PUE levels. %B Journal of Gerontological Social Work %V 63 %G eng %N 3 %R 10.1080/01634372.2020.1760992 %0 Journal Article %J The Journals of Gerontology, Series B %D 2020 %T Personality and falls among older adults: Evidence from a longitudinal cohort. %A Canada, Brice %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Falls %K Longitudinal data %K Personality %XOBJECTIVES: Falls can have catastrophic consequences, especially for older adults. The present study examined whether personality traits predict the incidence of falls in older age.
METHOD: Participants were older adults aged from 65 to 99 years (N = 4,759) drawn from the Health and Retirement Study. Personality traits and demographic factors were assessed at baseline. Falls were tracked for up to 11 years.
RESULTS: Over the follow-up period, 2,811 individuals reported falls. Cox regression analyses that included demographic covariates indicated that lower conscientiousness and higher neuroticism increased the risk of falling. Disease burden, depressive symptoms, and physical inactivity mediated the associations between both traits and falls incidence, whereas smoking status and handgrip strength mediated the neuroticism-falls incidence association.
DISCUSSION: This study provides new prospective evidence that personality predicts the incidence of falls in older adults and suggest that personality assessment may help identifying individuals at higher risk of falling.
%B The Journals of Gerontology, Series B %V 75 %P 1905-1910 %G eng %N 9 %R 10.1093/geronb/gbz040 %0 Journal Article %J Psychoneuroendocrinology %D 2020 %T Personality and HbA1c: Findings from Six Samples %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Canada, Brice %A Antonio Terracciano %K Diabetes %K ELSA %K HbA1c %K Personality %X Personality traits are associated with risk of diabetes, but most research to date has relied on participants reported diagnosis rather than objective markers of glycaemia. The present study examined the association between the five major domains of personality (neuroticism, extraversion, openness, agreeableness and conscientiousness) and haemoglobin A1c (HbA1c). Participants (N > 26,000) were individuals aged from 16 to 104 years from six large community samples from the US, Europe, and Japan who had data on personality, demographic factors, body mass index (BMI), physical activity, and HbA1c. Of the five factors, only higher conscientiousness was related consistently to lower HbA1c level across most samples and in the meta-analysis. Conscientiousness was also related to lower risk of HbA1c ≥6.5% (OR = .85, 95%CI = 0.80-0.90). BMI and physical activity partially mediated the link between conscientiousness and HbA1c. There were not consistent associations for the other four traits across the six samples and no consistent associations between personality and likelihood of undiagnosed diabetes. The present study found replicable associations between conscientiousness and HbA1c in adulthood. Assessment of conscientiousness may improve the identification of individuals at risk of diabetes and guide personalized interventions for regulation of HbA1c level. %B Psychoneuroendocrinology %@ 0306-4530 %G eng %R 10.1016/j.psyneuen.2020.104782 %0 Journal Article %J Social Science & Medicine %D 2020 %T Personality And Self-Rated Health Across Eight Cohort Studies %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Hognon, Louis %A Canada, Brice %A Antonio Terracciano %K Adulthood %K ELSA %K longitudinal %K Personality %K Self-rated health %X Rationale There is substantial evidence for the predictive value of single-item selfrated health measures for a range of health outcomes. Past research has found an association between personality traits and self-rated health. However, there has not been a multi-cohort large-scale study that has examined this link, and few studies have examined the association between personality and change in self-rated health. Objective To examine the concurrent and longitudinal association between personality and self-rated health.MethodParticipants were individuals aged from 16 to 107 years (N> 46,000) drawn from eight large longitudinal samples from the US, Europe, and Japan. Brief measures of the five-factor model of personality, a single item measure of self-rated health, and covariates (age, sex, and education, and race) were assessed at baseline and self-rated health was measured again 3 to 20 years later. Results In cross-sectional analyses, higher neuroticism was related to lower self-rated health whereas higher extraversion, openness, agreeableness and conscientiousness were associated with better self-rated health across most samples. A meta-analysis revealed that a one standard deviation higher neuroticism was related to more than 50% higher risk of fair to poor health, whereas a one standard deviation higher extraversion, openness, agreeableness and conscientiousness was associated with at least 15% lower risk of fair or poor health. A similar pattern was found in longitudinal analyses: personality was associated with risk of self-rated excellent/very good/good health at baseline becoming fair/poor at follow-up. In multilevel analyses, however, personality was weakly related to trajectories of self-rated health and in the opposite of the expected direction. Conclusions The present study shows replicable cross-sectional and small longitudinal associations between personality and self-rated health. This study suggests that lower neuroticism, higher extraversion, openness, agreeableness and conscientiousness are related to more favorable self-evaluations of health. %B Social Science & Medicine %@ 0277-9536 %G eng %R https://doi.org/10.1016/j.socscimed.2020.113245 %0 Thesis %B Philosophy %D 2020 %T Personality Traits and Financial Risks Among Older Americans: Living Too Long, Dying Too Early, and Living Too Sick. %A Cherry, Preston D. %K Long-term Care %K longevity risk %K Retirement %X Individuals are susceptible to financial uncertainty across the financial life cycle. The financial life cycle consists of three stages, which are (a) borrow to build human capital (b) accumulate wealth during the working life, and (c) distribute the accumulated wealth to fund retirement. Individuals maximize utility by smoothing consumption utility over the life cycle while managing uncertainty events. Such life cycle events are (a) the untimely loss of human capital, (b) longevity risk (risk of outliving one’s savings), and (c) the potential need for long-term care support and services (the severe financial loss due to the high costs of formal LTCSS). Pre-cautionary savings are transferred from low marginal utility periods to high marginal utility periods, which is accomplished through the exchange of low-cost insurance premiums for the coverage of high cost 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, sociodemographic factors, and individual preferences, which this current paper controls for a majority. Researchers suggest that further analysis beyond economic and social factors is necessary to investigate the potential behavioral and psychosocial factors that could partially explain the uncertainty puzzles. Research is growing yet limited when considering individuals personality traits as potential explanations for personal finance behaviors. This study investigates and provides results that suggests that, after controlling for factors mentioned in the previous literature, personality traits could partially explain the low demand for financial uncertainty insurance. %B Philosophy %I Texas Tech University %C Lubbock %V Doctor of Philosophy %G eng %U https://ttu-ir.tdl.org/bitstream/handle/2346/85730/CHERRY-DISSERTATION-2020.pdf?sequence=1 %0 Journal Article %J BMC Biology %D 2020 %T Population structure and pharmacogenomic risk stratification in the United States. %A Nagar, Shashwat Deepali %A Conley, Andrew B %A Jordan, I King %K Ethnic Groups %K Genetics, Population %K Genome, Human %K Genotype %K Humans %K Pharmacogenetics %K Risk Assessment %K United States %XBACKGROUND: Pharmacogenomic (PGx) variants mediate how individuals respond to medication, and response differences among racial/ethnic groups have been attributed to patterns of PGx diversity. We hypothesized that genetic ancestry (GA) would provide higher resolution for stratifying PGx risk, since it serves as a more reliable surrogate for genetic diversity than self-identified race/ethnicity (SIRE), which includes a substantial social component. We analyzed a cohort of 8628 individuals from the United States (US), for whom we had both SIRE information and whole genome genotypes, with a focus on the three largest SIRE groups in the US: White, Black (African-American), and Hispanic (Latino). Our approach to the question of PGx risk stratification entailed the integration of two distinct methodologies: population genetics and evidence-based medicine. This integrated approach allowed us to consider the clinical implications for the observed patterns of PGx variation found within and between population groups.
RESULTS: Whole genome genotypes were used to characterize individuals' continental ancestry fractions-European, African, and Native American-and individuals were grouped according to their GA profiles. SIRE and GA groups were found to be highly concordant. Continental ancestry predicts individuals' SIRE with > 96% accuracy, and accordingly, GA provides only a marginal increase in resolution for PGx risk stratification. In light of the concordance between SIRE and GA, taken together with the fact that information on SIRE is readily available to clinicians, we evaluated PGx variation between SIRE groups to explore the potential clinical utility of race and ethnicity. PGx variants are highly diverged compared to the genomic background; 82 variants show significant frequency differences among SIRE groups, and genome-wide patterns of PGx variation are almost entirely concordant with SIRE. The vast majority of PGx variation is found within rather than between groups, a well-established fact for almost all genetic variants, which is often taken to argue against the clinical utility of population stratification. Nevertheless, analysis of highly differentiated PGx variants illustrates how SIRE partitions PGx variation based on groups' characteristic ancestry patterns. These cases underscore the extent to which SIRE carries clinically valuable information for stratifying PGx risk among populations, albeit with less utility for predicting individual-level PGx alleles (genotypes), supporting the concept of population pharmacogenomics.
CONCLUSIONS: Perhaps most interestingly, we show that individuals who identify as Black or Hispanic stand to gain far more from the consideration of race/ethnicity in treatment decisions than individuals from the majority White population.
%B BMC Biology %V 18 %P 140 %8 2020 10 13 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/33050895?dopt=Abstract %R 10.1186/s12915-020-00875-4 %0 Journal Article %J Journals of Gerontology - Series B Psychological Sciences and Social Sciences %D 2020 %T Postretirement life satisfaction and financial vulnerability: The moderating role of control %A Dawn C Carr %A Moen, P. %A Perry Jenkins, M. %A Smyer, M. %K Personal control %K Retirement %K Successful aging %X Objectives: This article examines changes in life satisfaction around retirement exits for those with varying preretirement incomes, testing whether constraints on personal control and control over finances moderate the relationship between retiring and preretirement income. Method: This longitudinal study draws data from the 2004-2014 waves of the Health and Retirement Study to examine changes in life satisfaction pre- versus postretirement for three groups (the poor/near poor, financially vulnerable, and financially stable) of full-time workers aged 51-87 years (N = 970), and a subset (N = 334) who fully retire over a 4-year period. Results: Controlling for baseline life satisfaction, health, job/demographic characteristics, and social engagement, ordinary least squares regression results show financially stable retirees report higher levels of postretirement life satisfaction relative to their full-time working counterparts, whereas the poor/near poor and the financially vulnerable report similar life satisfaction to those who continue working full time. Constraints on personal control and control over finances moderate postretirement life satisfaction for the financially vulnerable. Discussion: Results suggest full retirement predicts improved life satisfaction only for those most advantaged financially. Financially vulnerable older workers may adjust more effectively to retirement if they have access to resources that facilitate greater control over their lives. © 2018 The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. %B Journals of Gerontology - Series B Psychological Sciences and Social Sciences %V 75 %P 849-860 %G eng %U https://www.scopus.com/inward/record.uri?eid=2-s2.0-85081528537&doi=10.1093%2fgeronb%2fgby105&partnerID=40&md5=6dbfe386a5b903c47e3a8926acb571fd %N 4 %9 Journal %R 10.1093/geronb/gby105 %0 Journal Article %J TheGerontologist %D 2020 %T Psychological Health Benefits of Companion Animals Following a Social Loss %A Dawn C Carr %A Miles G Taylor %A Nancy R Gee %A Natalie J Sachs-Ericsson %K Human–animal interaction %K Spousal loss %X BACKGROUND AND OBJECTIVES: In later life, the loss of a spouse due to divorce or widowhood is common and can lead to elevated depressive symptoms and loneliness. Research suggests that companion animal (CA) may be beneficial for psychological health, but limited research has explored whether CA can buffer negative consequences of social losses. RESEARCH DESIGN AND METHODS: This study uses data drawn from the Health and Retirement Study (HRS) to examine changes in depressive symptoms and loneliness in relation to a social loss among those with/without a CA. We used inverse-probability weighted regression to adjust for selection factors and isolate effects of CA ownership on changes in psychological health. RESULTS: Regardless of CA ownership, spousal loss was associated with psychological health consequences. Facing a social loss without a CA was related to statistically greater increases in depressive symptoms relative to those with a pet (2.580 vs. 1.207 symptoms, respectively). Similarly, experiencing a loss was associated with significantly greater increases in loneliness, with statistically greater increases in loneliness among those without a CA (p < .01). However, those with a CA did not experience greater increases in loneliness than those who did not experience a loss. DISCUSSION AND IMPLICATIONS: In later life, CA ownership may buffer against the detrimental consequences of major social losses on psychological health. Future research on the therapeutic effects of CA ownership, as well as pet therapy, during other major life stage transitions is needed to help isolate potential mechanisms driving the benefits of human-animal interactions. %B TheGerontologist %V 60 %P 428-438 %G eng %N 3 %9 Journal %R 10.1093/geront/gnz109 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2020 %T Quantitative and Qualitative Role of Antagonistic Heterogeneity in Genetics of Blood Lipids. %A Alexander M Kulminski %A Loika, Yury %A Nazarian, Alireza %A Culminskaya, Irina %K blood lipids %K genetic %K Genetic Heterogeneity %K Qualitative Research %K Quantitative data %XPrevailing strategies in genome-wide association studies (GWAS) mostly rely on principles of medical genetics emphasizing one gene, one function, one phenotype concept. Here, we performed GWAS of blood lipids leveraging a new systemic concept emphasizing complexity of genetic predisposition to such phenotypes. We focused on total cholesterol, low- and high-density lipoprotein cholesterols, and triglycerides available for 29,902 individuals of European ancestry from seven independent studies, men and women combined. To implement the new concept, we leveraged the inherent heterogeneity in genetic predisposition to such complex phenotypes and emphasized a new counter intuitive phenomenon of antagonistic genetic heterogeneity, which is characterized by misalignment of the directions of genetic effects and the phenotype correlation. This analysis identified 37 loci associated with blood lipids but only one locus, FBXO33, was not reported in previous top GWAS. We, however, found strong effect of antagonistic heterogeneity that leaded to profound (quantitative and qualitative) changes in the associations with blood lipids in most, 25 of 37 or 68%, loci. These changes suggested new roles for some genes, which functions were considered as well established such as GCKR, SIK3 (APOA1 locus), LIPC, LIPG, among the others. The antagonistic heterogeneity highlighted a new class of genetic associations emphasizing beneficial and adverse trade-offs in predisposition to lipids. Our results argue that rigorous analyses dissecting heterogeneity in genetic predisposition to complex traits such as lipids beyond those implemented in current GWAS are required to facilitate translation of genetic discoveries into health care.
%B J Gerontol A Biol Sci Med Sci %V 75 %P 1811-1819 %8 2020 Sep 25 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/31566214?dopt=Abstract %R 10.1093/gerona/glz225 %0 Journal Article %J The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 2020 %T Racial and educational disparities in cognitive life expectancies. %A Mateo P Farina %A Mark D Hayward %A Eileen M. Crimmins %A Jung K Kim %K Cognition & Reasoning %K Mortality %K Racial/ethnic differences %XOBJECTIVES: We estimate life expectancy with and without dementia for Americans 65 years and older by education and race to examine how these stratification systems combine to shape disparities in later-life cognitive health.
METHOD: Based on the Health and Retirement Study (2000-2014), we use a multivariate, incidence-based life table approach to estimate life expectancy by cognitive health status for race-education groups. The models also simulate group differences in the prevalence of dementia implied by these rates.
RESULTS: The life table results document notable race-education differences in dementia and dementia-free life expectancy, as well as stark differences in implied dementia prevalence. At each education level, blacks can expect to live more years with dementia and they have significantly higher rates of dementia prevalence. This distribution of disparities in the older population is anchored by two groups -- blacks without a high school diploma and whites with some college or more.
DISCUSSION: Dementia experience and dementia burden differ dramatically along race-education lines. Race and education combine to exaggerate disparities and they both have enduring effects. Future research should explicitly consider how race and education combine to influence dementia in the older American population.
%B The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %V 75 %P e105-e112 %G eng %N 7 %R 10.1093/geronb/gbz046 %0 Journal Article %J Journal of American Geriatrics Society %D 2020 %T Racial and Ethnic Differences in Knowledge About One's Dementia Status %A Lin, Pei-Jung %A Emerson, Joanna %A Jessica Faul %A Joshua T Cohen %A Peter J Neumann %A Howard M Fillit %A Allan T Daly %A Margaretos, Nikoletta %A Karen M Freund %K Cognitive health %K Dementia %K Health Disparities %X OBJECTIVES To examine racial and ethnic differences in knowledge about one?s dementia status. DESIGN Prospective cohort study. SETTING The 2000 to 2014 Health and Retirement Study. PARTICIPANTS Our sample included 8,686 person-wave observations representing 4,065 unique survey participants, aged 70?years or older, with dementia, as identified by a well-validated statistical prediction model based on individual demographic and clinical characteristics. MEASUREMENTS Primary outcome measure was knowledge of one?s dementia status, as reported in the survey. Patient characteristics included race/ethnicity, age, sex, survey year, cognition, function, comorbidity, and whether living in a nursing home. RESULTS Among subjects identified as having dementia by the prediction model, 43.5% to 50.2%, depending on the survey year, reported that they were informed of the dementia status by their physician. This proportion was lower among Hispanics (25.9%-42.2%) and non-Hispanic blacks (31.4%-50.5%) than among non-Hispanic whites (47.7%-52.9%). Our fully adjusted regression model indicated lower dementia awareness among non-Hispanic blacks (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.58-0.94) and Hispanics (OR = 0.60; 95% CI = 0.43-0.85), compared to non-Hispanic whites. Having more instrumental activity of daily living limitations (OR = 1.65; 95% CI = 1.56-1.75) and living in a nursing home (OR = 2.78; 95% CI = 2.32-3.32) were associated with increased odds of subjects reporting being told about dementia by a physician. CONCLUSION Less than half of individuals with dementia reported being told by a physician about the condition. A higher proportion of non-Hispanic blacks and Hispanics with dementia may be unaware of their condition, despite higher dementia prevalence in these groups, compared to non-Hispanic whites. Dementia outreach programs should target diverse communities with disproportionately high disease prevalence and low awareness. %B Journal of American Geriatrics Society %@ 0002-8614 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/32282058 %9 Journal %! Journal of the American Geriatrics Society %R 10.1111/jgs.16442 %0 Journal Article %J Innovation in Aging %D 2020 %T Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning %A Lou, Yifan %A Deborah Carr %K Advance care planning %K race difference %K Subjective life expectancy %X The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates. %B Innovation in Aging %V 4 %P 903 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.3325 %0 Journal Article %J Biometrical Journal %D 2020 %T Regressive models for risk prediction of repeated multinomial outcomes: An illustration using Health and Retirement Study data %A Rafiqul I Chowdhury %A M. Ataharul Islam %K multinomial outcomes %K regressive model %K repeated measures %K risk prediction %K sequence of events %X Abstract Life expectancy is increasing in many countries and this may lead to a higher frequency of adverse health outcomes. Therefore, there is a growing demand for predicting the risk of a sequence of events based on specified factors from repeated outcomes. We proposed regressive models and a framework to predict the joint probabilities of a sequence of events for multinomial outcomes from longitudinal studies. The Markov chain is used to link marginal and sequence of conditional probabilities to predict the joint probability. Marginal and sequence of conditional probabilities are estimated using marginal and regressive models. An application is shown using the Health and Retirement Study data. The bias of parameter estimates for all models from all bootstrap simulation is less than 1% in most of the cases. The estimated mean squared error is also very low. Results from the simulation study show negligible bias and the usefulness of the proposed model. The proposed model and framework would be useful to solve real-life problems from various fields and big data analysis. %B Biometrical Journal %V n/a %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1002/bimj.201800101 %R 10.1002/bimj.201800101 %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 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 Thesis %B Social Welfare %D 2020 %T RELATIONSHIPS BETWEEN NEIGHBORHOOD STRESSORS AND DEPRESSIVE SYMPTOMS: THE MODERATING EFFECTS OF SOCIAL SUPPORT AMONG OLDER ADULTS %A Cho, Seungjong %K Depressive symptoms %K neighborhood stressors %K Older Adults %K Social Support %X About 20% of Americans have experienced depressive symptoms in their lives. Prior research has shown one’s neighborhood of residence is an important determinant of one’s mental health. However, major limitations in existing research are limited research on older adults, limited studies including both objective and subjective neighborhood stressors, and limited studies including social support as a possible moderator. The purpose of this dissertation was to increase knowledge about the relationships between neighborhood stressors and depressive symptoms among older adults. Applying social disorganization theory and stress process theory, this study investigated the associations between four neighborhood stressors (three objective indicators of neighborhood disadvantage – neighborhood poverty, racial and ethnic composition, residential instability – and one subjective characteristic – perceived neighborhood disorder) and a count of depressive symptoms. This study also tested whether social support (from spouse, child, relatives, and friends) moderated the effects of the neighborhood stressors on depressive symptoms. This dissertation was based on secondary analysis of merged data from the Health and Retirement Study 2010, RAND HRS, U.S. Census 2010, and HRS restricted-use data. The final sample (N = 1,468) were all urban-dwelling; age 50 or older; married or partnered; having at least one child, relative, and friend. This study applied structural equation modeling with Full Information Maximum Likelihood estimation. Findings of this dissertation did not support the neighborhood effects hypotheses. Contrary to previous studies, this study found higher neighborhood poverty was associated with lower levels of depressive symptoms. No other neighborhood stressors were associated with depressive symptoms. Stress buffering effects of social support were not significant, for any neighborhood stressor. Not as a moderator but as a main effect, lower social support was significantly related to higher depressive symptoms. Lower income, female, lower education, and poorer health were also related to higher depressive symptoms. This dissertation contributes to social work practice by addressing older adults’ depressive symptomatology. Findings identified vulnerable older adults to target for interventions, based on individual characteristics. Focusing on social support should be a vital component of interventions. Social workers can help older adults to maintain and strengthen their social support, with beneficial effects for their depressive symptomatology. %B Social Welfare %I Case Western Reserve University %C Cleveland, OH %V Doctor of Philosophy %G eng %U http://rave.ohiolink.edu/etdc/view?acc_num=case1592324389134903 %0 Report %D 2020 %T Right-Sizing Retirement: Exploring the Retirement Consumption Gap in Early Retirement %A Cormier, Warran %A David Blanchett %K Retirement %K retirement consumption gap %K Underconsumption %X The research described in this paper estimates the pervasiveness of underconsumption. Specifically, this paper explores the retirement consumption gap and considers both the wealth available to fund retirement—defined as either financial assets, such as a taxable account or an IRA, or guaranteed income, such as Social Security retirement benefits, a private pension, or annuity—and spending (i.e., consumption), both before and after retirement. Considering both the assets and pre-retirement spending provides a richer context around spending decisions during retirement. The analysis uses data from the RAND Health and Retirement Study and focused specifically on changes in spending during the first 10 years of retirement. %B DCIIA Retirement Research Center %I Defined Contribution Institutional Investment Association %C Washington, D.C. %G eng %U https://cdn.ymaws.com/dciia.org/resource/resmgr/resource_library/DCIIA-RRC_RightSizing_091020.pdf %0 Journal Article %J Global Epidemiology %D 2020 %T The role of Hope in subsequent health and well-being for older adults: An outcome-wide longitudinal approach %A Long, Katelyn N.G. %A Eric S Kim %A Chen, Ying %A Wilson, Matthew F. %A Worthington Jr., Everett L. %A Tyler J VanderWeele %K Hope %K hopelessness %K Older Adults %K outcome-wide analysis %K Physical Health %K Well-being %X Hope is a topic widely discussed in the humanities and researched in the field of psychology. To explore the potential public health implications of hope for subsequent health and well-being outcomes, we prospectively examined the relation between baseline hope and a wide range of outcomes that included indicators of: physical health, health behaviors, and psychosocial well-being in older adults using an outcome-wide approach. Data from the Health and Retirement Study (N = 12,998, mean age = 66 years) were analyzed. Bonferroni correction was used to account for multiple testing. All models controlled for a wide array of factors including: sociodemographic characteristics, personality factors, and prior values of the exposure (hope) and all outcomes. A greater sense of hope was associated with: better physical health and health behavior outcomes on some indicators (e.g., reduced risk of all cause-mortality, fewer number of chronic conditions, lower risk of cancer, and fewer sleep problems), higher psychological well-being (e.g., increased positive affect, life satisfaction, and purpose in life), lower psychological distress, and better social well-being. A secondary analysis explored antecedents of hope. We identified several potentially modifiable factors that may lead to increased hope. These results may have important population-level implications for increasing hope and improving the physical, psychological, and social well-being of our growing older adult population. %B Global Epidemiology %V 2 %P 100018 %G eng %R https://doi.org/10.1016/j.gloepi.2020.100018 %0 Journal Article %J JOURNAL OF THE AMERICAN GERIATRICS SOCIETY %D 2020 %T Sarcopenia Definition & Outcomes Consortium Defined Low Grip Strength in Two Cross-Sectional, Population-Based Cohorts %A Patel, Sheena M. %A Kate A Duchowny %A Douglas P Kiel %A Correa-de-Araujo, Rosaly %A Fielding, Roger A. %A Travison, Thomas %A Magaziner, Jay %A Manini, Todd %A Xue, Qian-Li %A Anne B Newman %A Pencina, Karol M. %A Santanasto, Adam J. %A Bhasin, Shalender %A Peggy M Cawthon %K Gait %K muscle %K Physical performance %K sarcopenia %X BACKGROUND/OBJECTIVES The extent to which the prevalence of muscle weakness in the US population varies by different putative grip strength constructs developed by the Sarcopenia Definitions and Outcomes Consortium (SDOC) has not been described. DESIGN Cross-sectional analysis. SETTING Two nationally representative cohorts-2010 and 2012 waves of the Health and Retirement Survey and round 1 (2011) of the National Health and Aging Trends Survey. PARTICIPANTS Adults aged 65 years and older (n = 12,984) were included in these analyses. MEASUREMENTS We analyzed three constructs of muscle weakness developed by the SDOC, and found to be associated with mobility disability for men and women, respectively: absolute grip strength (<35.5 kg and 20 kg); grip strength standardized to body mass index (<1.05 kg/kg/m(2) and 0.79 kg/kg/m(2)); and grip strength standardized to weight (<0.45 kg/kg and 0.337 kg/kg). We estimated the prevalence of muscle weakness defined by each of these constructs in the overall older US population, and by age, sex, race, and ethnicity. We also estimated the sensitivity and specificity of each of the grip strength constructs to discriminate slowness (gait speed <0.8 m/s) in these samples. RESULTS The prevalence of muscle weakness ranged from 23% to 61% for men and from 30% to 66% for women, depending on the construct used. There was substantial variation in the prevalence of muscle weakness by race and ethnicity. The sensitivity and specificity of these measures for discriminating slowness varied widely, ranging from 0.30 to 0.92 (sensitivity) and from 0.17 to 0.88 (specificity). CONCLUSIONS The prevalence of muscle weakness, defined by the putative SDOC grip strength constructs, depends on the construct of weakness used. %B JOURNAL OF THE AMERICAN GERIATRICS SOCIETY %V 68 %P 1438-1444 %8 JUL %G eng %N 7 %9 Article %R 10.1111/jgs.16419 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Self-Perceptions of Aging and Control of Life in Late Adulthood: Between-Person and Within-Person Associations %A Luo, M.S. %A Lydia W Li %A Ernest Wing Tak Chui %K attitude toward aging %K control belief %K Self-efficacy %K sold age %X Objectives: This study aimed to examine the longitudinal relationship between two central concepts in aging research—self-perceptions of aging (SPA) and perceived control of life (COL). Method: The data came from three measurement points over a 9-year period in the Health and Retirement Study (HRS). A random intercepts cross-lagged panel model (RI-CLPM) was estimated. Results: The covariations between SPA and COL across 9 years were evident at both the between-person level and the within-person within-time level. The results revealed a reciprocal relationship between SPA and COL: Higher than usual negative SPA predicted within-person decreases in COL 4 years later, and lower than usual COL predicted future within-person increases in negative SPA. Furthermore, SPA were found to have a somewhat larger effect on COL than the corresponding influence of COL on SPA. Discussion: This study enriches the stereotype embodiment theory and the practice by documenting a reciprocal interrelationship between SPA and COL. %B Journal of Aging and Health %G eng %R 10.1177/0898264320917303 %0 Journal Article %J Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %D 2020 %T Self-Reported Instances of Major Discrimination, Race/Ethnicity, and Inflammation Among Older Adults: Evidence from the Health and Retirement Study. %A Ryon J. Cobb %A Lauren J Parker %A Roland J. Thorpe Jr. %K Discrimination %K Racial/ethnic differences %K Self-reports %XBACKGROUND: This study examines the relationship between self-reported instances of major discrimination and inflammation among older adults, and explores whether this relationship varies in accordance with race/ethnicity. We hypothesized that self-reported instances of major discrimination would be associated with higher levels of high-risk inflammation, and that this relationship would be stronger for racial/ethnic minorities than Whites.
METHODS: Data from the 2006/2008 Health and Retirement Study (HRS), an ongoing biennial nationally representative sample of older adults in the United States, was used to collect measures of self-reported instances of major discrimination and high-risk C-reactive protein (CRP), which was assayed from blood samples. Modified Poisson regression with robust standard errors was applied to estimate the prevalence ratios of self-reported instances of major discrimination, as it relates to high-risk CRP (CRP≥ 22 kg/m2), and test whether this relationship varies by race/ethnicity.
RESULTS: Respondents who experienced any instances of major discrimination had a higher likelihood of high-risk CRP (prevalence ratio [PR]: 1.14, 95% confidence interval [CI] = 1.07-1.22) than those who did not report experiencing any instances of major discrimination. This association was independent of differences in newly diagnosed health conditions and socioeconomic status. The relationship between any self-reported instance of major discrimination and high-risk CRP was weaker for Blacks than Whites (PR: 0.81, 95% CI = 0.69-0.95).
CONCLUSIONS: Our study confirms that self-reported instances of major lifetime discrimination is a psychosocial factor that is adversely associated with high-risk CRP among older adults; this association is especially pronounced among older Whites. Future studies among this population are required to examine whether the relationship between self-reported instances of major discrimination and high-risk CRP changes over time.
%B Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30508069?dopt=Abstract %R 10.1093/gerona/gly267 %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 Ageing Research Reviews %D 2020 %T Social hallmarks of aging: Suggestions for geroscience research %A Eileen M. Crimmins %K Biological age – chronological age %K Hallmarks of aging %K Social determinants of aging %X This paper focuses on the idea that there are clear social hallmarks of aging including low lifetime socioeconomic status, adversity in childhood and adulthood, being a member of a minority group, adverse health behaviors, and adverse psychological states. The “Social Hallmarks of Aging” are analogous to the “Geroscience Hallmarks of Aging” in reflecting a set of underlying and interrelated social causes of multiple agerelated health outcomes. This paper presents empirical work incorporating the social hallmarks of aging with indicators of multiple biological hallmarks of aging as well downstream biology in explaining a range of health outcomes in order to show the relative strength of the associations of social and biological measures with important health outcomes. Social factors are strongly related to physical and cognitive functioning and multimorbidity in this older population and this remains true when the significant number of biological measures are controlled. This can be interpreted to mean that a significant amount of social variance in age-related health outcomes is not explained by these measures of biology. Indicators of the geroscience hallmarks of aging only relate modestly to the variability in human health outcomes. Attention to the social hallmarks related to human aging can usefully be incorporated into work on the biological hallmarks of aging to make greater progress in understanding human aging. %B Ageing Research Reviews %V 63 %P 101136 %@ 1568-1637 %G eng %R https://doi.org/10.1016/j.arr.2020.101136 %0 Report %D 2020 %T Socioeconomic Status and the Experience of Pain: An Example from Knees %A David M Cutler %A Meara, Ellen %A Stewart, Susan %K pain %K socioeconomic status %X Reports of pain differ markedly across socioeconomic groups and are correlated with outcomes such as functional limitations and disability insurance receipt. This paper examines the differential experience of pain by education. We focus on knee pain, the most common musculoskeletal complaint. Comparing clinical interpretation of knee x-rays of people with and without pain, there are few differences in presence or clinical severity of arthritis across education groups. In contrast, less educated people report more pain for any given objective measure of arthritis. After confirming that reported pain maps to objective measures like walking speed and range of motion, we test four theories for differential experience of pain: differences in obesity, physically demanding occupations, psychological factors, and medical treatment differences. We find that physical demands on the job and obesity each explain about one-third of the education gradient in knee pain. There is an interaction between the two; physical requirements on the job are associated with knee pain primarily in those who are obese. In contrast, psychological traits and access to medical care explain little of the difference in reported pain by education level. These findings imply that educational gradients in pain are likely to persist or even widen as the need for physically demanding occupations—like home health aides and personal service workers—grows in importance with the aging population, and the working population continues to be obese. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w27974 %0 Report %D 2020 %T The State of Mental Health Among the Elderly Chinese %A Chen, Yi %A Fang, Hanming %K China %K Mental Health %X China introduced its stringent family planning policies from the early 1970s, known as the "Later, Longer, Fewer" policies, and followed it with the One-Child Policy from 1979. The number of children born to Chinese parents significantly decreased from 5.7 in late 1960s to 2.5 in 1988. In Chen and Fang (2019), we show that family planning policies have drastically different effects on elderly parents' physical and mental well-beings. Whereas parents more exposed to the family planning policies consume more and enjoy slightly better physical health status, they report more severe depression symptoms. In this paper, we present a more complete picture of the difference in mental health among residents in rural and urban areas, between males and females, between different education groups, between those with one child and those with more than one children, and between widowed and non-widowed. We highlight the role of family support (from children and spouse) for the mental health status among the elderly Chinese. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %G eng %U http://www.nber.org/papers/w26690 %9 Report %R 10.3386/w26690 %0 Journal Article %J Journals of Gerontology Series B Psychological Sciences and Social Sciences %D 2020 %T Structural Social Support and Changes in Depression during the Retirement Transition: "I Get by With a Little Help from My Friends". %A Ben Lennox Kail %A Dawn C Carr %K depression %K Retirement %K Social Support %XOBJECTIVES: This study evaluated whether (a) retirement was associated with increased depressive symptoms, (b) four sources social support were associated with decreased depressive symptoms, and (c) whether the relationship between retirement and depressive symptoms varied across four sources social support.
METHOD: Health and Retirement Study data were used to assess whether four measures of structural support moderated the association between transitioning to full retirement (relative to remaining in full time work) and symptoms of depression.
RESULTS: Results from two stage mixed-effects multilevel models indicated (a) on average retirement was associated with a small but significant increase in depressive symptoms after adjusting for pre-retirement social support, (b) on average, social support not associated with changes in symptoms of depression, but (c) social support from friends moderates the association between retirement and symptoms of depression such that at low levels of social support, retirement was associated with a sizeable increase in depressive symptoms, but this association decreased as level of social support from friends increased.
DISCUSSION: Results suggest people with low levels of social support may benefit from actively cultivating friendships in retirement to help mitigate some of deleterious effects of retirement.
%B Journals of Gerontology Series B Psychological Sciences and Social Sciences %V 75 %P 2040-2049 %G eng %N 9 %R 10.1093/geronb/gbz126 %0 Journal Article %J Innovation in Aging %D 2020 %T Trends in Disability Among Adults 55-64 in the United States and England From 2002 to 2016 %A Choi, Hwajung %A Robert F. Schoeni %A Cho, Tsai-Chin %A Kenneth M. Langa %K Disability %K ELSA %X The paper’s goal is to assess whether and, if so, the extent to which prevalence in disability of adults near retirement ages in the US increased over time compared to their peers in England and examine income group differences in the relative trends. This study uses 2002-2016 Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) focusing on adults aged 55-64. Annual percent changes over the period of 2002-2016 for limitations in instrumental activities of daily living (IADL) and activities of daily living (ADL) are estimated for each survey (HRS and ELSA) using multivariable logistic regressions to adjust for individual-level characteristics While disability prevalence of adults ages 55-64 in England improved over the years of 2002-2016 (annual % change= -2.01 for IADL; - 2.53 for ADL), disability prevalence of US adults has not improved and in fact even worsened in terms of IADL (annual % change= +1.35). There are substantial variations in the IADL/ADL trends by income groups. In the US, the adverse trends in disability were more pronounced among the lowest income groups (annual % change in IADL=1.76 for bottom 20% vs. -2.08 for top 20%; annual % change in ADL=1.08 for bottom 20% vs. -2.08 for top 20%). In England, the disability status improved over time for all but the lowest income group. We will examine further to identify specific factors contributing to divergent/convergent trends in disability between the US and England. %B Innovation in Aging %V 4 %P 303 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.970 %0 Journal Article %J JAMA Network Open %D 2020 %T Use of Health Savings Accounts Among US Adults Enrolled in High-Deductible Health Plans. %A Jeffrey T Kullgren %A Cliff, Elizabeth Q %A Krenz, Christopher %A Brady T. West %A Helen G Levy %A A. Mark Fendrick %A Angela Fagerlin %K Costs and Cost Analysis %K Deductibles and Coinsurance %K Female %K health %K Insurance %K Male %K Medical Savings Accounts %XImportance: Health savings accounts (HSAs) can be used by enrollees in high-deductible health plans (HDHPs) to save for health care expenses before taxes. Expansion of and encouraging contributions to HSAs have been centerpieces of recent federal legislation. Little is known about how US residents who may be eligible for HSAs are using them to save for health care.
Objective: To determine which patients who may be eligible for an HSA do not have one and what decisions patients with HSAs make about contributing to them.
Design, Setting, and Participants: This cross-sectional national survey assessed an online survey panel representative of the US adult population. Adults aged 18 to 64 years and enrolled in an HDHP for at least 12 months were eligible to participate. Data were collected from August 26 to September 19, 2016, and analyzed from November 1, 2019, to April 30, 2020.
Main Outcomes and Measures: Prevalence of not having an HSA or not making HSA contributions in the last 12 months and reasons for not making the HSA contributions.
Results: Based on data from 1637 individuals (American Association of Public Opinion Research response rate 4, 54.8%), half (50.6% [95% CI, 47.7%-53.6%]) of US adults in HDHPs were female, and most were aged 36 to 51 (35.7% [95% CI, 32.8%-38.6%]) or 52 to 64 (36.8% [95% CI, 34.1%-39.5%]) years. Approximately 1 in 3 (32.5% [95% CI, 29.8%-35.3%]) did not have an HSA. Those who obtained their health insurance through an exchange were more likely to lack an HSA (70.3% [95% CI, 61.9%-78.6%]) than those who worked for an employer that offered only 1 health insurance plan (36.5% [95% CI, 30.9%-42.1%]; P < .001). More than half of individuals with an HSA (55.0% [95% CI, 51.1%-58.8%]) had not contributed money into it in the last 12 months. Among HDHP enrollees with an HSA, those with at least a master's degree (46.1% [95% CI, 38.3%-53.9%]; P = .02) or a high level of health insurance literacy (47.3% [95% CI, 40.7%-54.0%]; P = .03) were less likely to have made no HAS contributions. Common reasons for not contributing to an HSA included not considering it (36.8% [95% CI, 30.8%-42.8%]) and being unable to afford saving for health care (31.9% [95% CI, 26.2%-37.6%]).
Conclusions and Relevance: These findings suggest that many US adults enrolled in an HDHP lack an HSA, and few with an HSA saved for health care in the last year. Targeted interventions should be explored by employers, health plans, and health systems to encourage HSA uptake and contributions among individuals who could benefit from their use.
%B JAMA Network Open %V 3 %P e2011014 %G eng %N 7 %R 10.1001/jamanetworkopen.2020.11014 %0 Journal Article %J Scientific Reports %D 2020 %T Using syndrome mining with the Health and Retirement Study to identify the deadliest and least deadly frailty syndromes %A Yi-Sheng Chao %A Chao-Jung Wu %A Hsing-Chien Wu %A Hui-Ting Hsu %A Tsao, Lien-Cheng %A Cheng, Yen-Po %A Lai, Yi-Chun %A Wei-Chih Chen %K Epidemiology %K Geriatrics %X Syndromes are defined with signs or symptoms that occur together and represent conditions. We use a data-driven approach to identify the deadliest and most death-averse frailty syndromes based on frailty symptoms. A list of 72 frailty symptoms was retrieved based on three frailty indices. We used data from the Health and Retirement Study (HRS), a longitudinal study following Americans aged 50 years and over. Principal component (PC)-based syndromes were derived based on a principal component analysis of the symptoms. Equal-weight 4-item syndromes were the sum of any four symptoms. Discrete-time survival analysis was conducted to compare the predictive power of derived syndromes on mortality. Deadly syndromes were those that significantly predicted mortality with positive regression coefficients and death-averse ones with negative coefficients. There were 2,797 of 5,041 PC-based and 964,774 of 971,635 equal-weight 4-item syndromes significantly associated with mortality. The input symptoms with the largest regression coefficients could be summed with three other input variables with small regression coefficients to constitute the leading deadliest and the most death-averse 4-item equal-weight syndromes. In addition to chance alone, input symptoms’ variances and the regression coefficients or p values regarding mortality prediction are associated with the identification of significant syndromes. %B Scientific Reports %V 10 %@ 2045-2322 %G eng %9 Journal %! Scientific Reports %R 10.1038/s41598-020-60869-8 %0 Journal Article %J Scientific Reports %D 2020 %T Validation of a hybrid approach to standardize immunophenotyping analysis in large population studies: The Health and Retirement Study %A Hunter-Schlichting, DeVon %A Lane, John %A Cole, Benjamin %A Flaten, Zachary %A Barcelo, Helene %A Ramasubramanian, Ramya %A Cassidy, Erin %A Jessica Faul %A Eileen M. Crimmins %A Pankratz, Nathan %A Bharat Thyagarajan %K Bioinformatics %K high-throughput screening %X Traditional manual gating strategies are often time-intensive, place a high burden on the analyzer, and are susceptible to bias between analyzers. Several automated gating methods have shown to exceed performance of manual gating for a limited number of cell subsets. However, many of the automated algorithms still require significant manual interventions or have yet to demonstrate their utility in large datasets. Therefore, we developed an approach that utilizes a previously published automated algorithm (OpenCyto framework) with a manually created hierarchically cell gating template implemented, along with a custom developed visualization software (FlowAnnotator) to rapidly and efficiently analyze immunophenotyping data in large population studies. This approach allows pre-defining populations that can be analyzed solely by automated analysis and incorporating manual refinement for smaller downstream populations. We validated this method with traditional manual gating strategies for 24 subsets of T cells, B cells, NK cells, monocytes and dendritic cells in 931 participants from the Health and Retirement Study (HRS). Our results show a high degree of correlation (r ≥ 0.80) for 18 (78%) of the 24 cell subsets. For the remaining subsets, the correlation was low (<0.80) primarily because of the low numbers of events recorded in these subsets. The mean difference in the absolute counts between the hybrid method and manual gating strategy of these cell subsets showed results that were very similar to the traditional manual gating method. We describe a practical method for standardization of immunophenotyping methods in large scale population studies that provides a rapid, accurate and reproducible alternative to labor intensive manual gating strategies. %B Scientific Reports %V 10 %P 8759 %@ 2045-2322 %G eng %N 1 %R 10.1038/s41598-020-65016-x %0 Journal Article %J American Journal of Preventive Medicine %D 2020 %T Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach %A Eric S Kim %A Whillans, Ashley V. %A Lee, Matt %A Ying Chen %A Tyler J VanderWeele %K Prosocial Behavior %K Volunteering %K Well-being %X Growing evidence documents strong associations between volunteering and favorable health and well-being outcomes. However, epidemiological studies have not evaluated whether changes in volunteering are associated with subsequent health and well-being outcomes. %B American Journal of Preventive Medicine %V 59 %P 176-186 %G eng %U https://www.hbs.edu/faculty/Pages/item.aspx?num=57873 %N 2 %0 Journal Article %J Journal of Aging & Social Policy %D 2020 %T Who are the Most At-Risk Older Adults in the COVID-19 Era? It’s Not Just Those in Nursing Homes %A Marc A Cohen %A Jane Tavares %K COVID-19 %K home care workers %K respiratory illnesses %K seniors %K social isolation %X ABSTRACTCOVID-19 has taken a terrible toll on the nursing home population. Yet, there are five times the number of seniors living in the community who are also extremely vulnerable because they suffer from respiratory illnesses. Using the 2018 wave of the Health and Retirement Study we analyze this group of roughly 7 million seniors living in the community and find that they have multiple risk factors that make them particularly exposed. We also show how current strategies for protecting this population may be exacerbating risks and suggest concrete steps for better protecting this group. %B Journal of Aging & Social Policy %G eng %R 10.1080/08959420.2020.1764310 %0 Journal Article %J Journal of General Internal Medicine %D 2020 %T Who Becomes a High Utilizer? A Case-Control Study of Older Adults in the USA %A Smith, Grant M. %A Irena Cenzer %A Kenneth E Covinsky %A David B. Reuben %A Alexander K Smith %X Frequently hospitalized patients represent a high-cost population at risk of poor outcomes. These high-utilizers represent only 1.6% of admitted patients, but they account for 8% of admissions and 7% of direct costs.1,2 While prior studies have identified risk factors for 30-day readmissions,3 little is known about risk factors associated with patients who accrue multiple admissions over a longer period of time. Prior studies using cross-sectional analyses have also neglected to identify upstream risk factors for becoming a high-utilizer.3,4 Proactively identifying patients years before entering a cycle of frequent hospitalizations may allow for early intervention to prevent hospitalizations and improve outcomes. We sought to identify distinguishing comorbid conditions, functional limitations, and social risk factors that differentiate patients, who had 5 or more hospitalizations over a 2-year period, years before they became high-utilizers. %B Journal of General Internal Medicine %V 35 %P 596 - 598 %8 2020/02/01 %@ 1525-1497 %G eng %U https://doi.org/10.1007/s11606-019-05331-w %N 2 %! Journal of General Internal Medicine %0 Report %D 2020 %T Why Do Late Boomers Have So Little Retirement Wealth? %A Anqi Chen %A Wenliang Hou %A Alicia H. Munnell %K Retirement wealth %K Social Security %X Over the last 40 years, the retirement system has shifted from defined benefit plans to defined contribution plans, primarily 401(k)s and Individual Retirement Accounts (IRAs). This shift has been accompanied by a decline in Social Security benefits relative to pre-retirement earnings as the program’s Full Retirement Age has moved from 65 to 67. Thus, the expected pattern when examining retirement wealth across cohorts is relatively less wealth from defined benefit plans and Social Security and much more from 401(k)s and IRAs. However, the numbers for the most recent cohort in the Health and Retirement Study – the Late Boomers – show not only the predicted declines in defined benefit plans and Social Security but also an unexpected drop in 401(k)/IRA assets. This drop is alarming given that Late Boomers, who were ages 51-56 in 2016, would have spent the majority of their careers in a defined contribution world. This brief is a first pass at trying to explain why this younger cohort has less in 401(k)/IRA assets than older cohorts had at the same age and what that means for the future of retirement security. The discussion proceeds as follows. The first section identifies the cohorts that are examined and the calculation of retirement wealth. The second section identifies a turn in the fortunes of Late Boomers during the Great Recession, when a significant share stopped working. But lack of employment does not explain the whole problem, so the third section follows working households and finds that after the Great Recession they had lower earnings, less 401(k) participation, and flat 401(k) balances, ending up well below earlier cohorts. A look at more recent cohorts offers a mixed picture for the future. The final section concludes that the Late Boomers’ low 401(k)/IRA wealth can be explained by particularly high levels of unemployment during the Great Recession and more reliance on lower-paid jobs when they re-entered the labor market. Why they were so hard hit, wh %B Center for Retirement Research at Boston College %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/wp-content/uploads/2020/02/IB_20-4.pdf %9 Report %0 Report %D 2020 %T Why Does Consumption Fluctuate in Old Age and How Should the Government Insure it? %A Richard Blundell %A Commault, Jeanne %A Borella, Margherita %A Mariacristina De Nardi %K CAMS %K health %K Income %X In old age, consumption can fluctuate because of shocks to available resources and because health shocks affect utility from consumption. We find that even temporary drops in income and health are associated with drops in consumption and most of the effect of temporary drops in health on consumption stems from the reduction in the marginal utility from consumption that they generate. More precisely, after a health shock, richer households adjust their consumption of luxury goods because their utility of consuming them changes. Poorer households, instead, adjust both their necessary and luxury consumption because of changing resources and utility from consumption. %B Institute Working Paper %I Federal Reserve Bank of Minneapolis %C Minneapolis, MN %G eng %R https://doi.org/10.21034/iwp.40 %0 Report %D 2020 %T Why Does Consumption Fluctuate in Old Age and How Should the Government Insure It? %A Richard Blundell %A Borella, Margherita %A Commault, Jeanne %A Mariacristina De Nardi %K consumption %K Finance %K health %X In old age, consumption can fluctuate because of shocks to available resources and because health shocks affect utility from consumption. We find that even temporary drops in income and health are associated with drops in consumption and most of the effect of temporary drops in health on consumption stems from the reduction in the marginal utility from consumption that they generate. More precisely, after a health shock, richer households adjust their consumption of luxury goods because their utility of consuming them changes. Poorer households, instead, adjust both their necessary and luxury consumption because of changing resources and utility from consumption. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge %G eng %U https://www.nber.org/papers/w27348 %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 Journal Article %J Alcoholism, Clinical and Experimental Research %D 2019 %T Alcohol consumption in later life and mortality in the United States: Results from 9 waves of the Health and Retirement Study. %A Katherine M Keyes %A Calvo, Esteban %A Katherine A Ornstein %A Rutherford, Caroline %A Matthew P Fox %A Ursula M. Staudinger %A Linda P Fried %K Alcohol Consumption %K Mortality %K NDI %XBACKGROUND: Alcohol consumption in later life has increased in the past decade, and the relationship between alcohol consumption and mortality is controversial. Recent studies suggest little, if any, health benefit to alcohol. Yet most rely on single-time point consumption assessments and minimal confounder adjustments.
METHODS: We report on 16 years of follow-up from the Health and Retirement Study (HRS) cohorts born 1931 to 1941 (N = 7,904, baseline mean age = 61, SD = 3.18). Respondents were queried about drinking frequency/quantity. Mortality was established via exit interviews and confirmed with the national death index. Time-varying confounders included but were not limited to household assets, smoking, body mass index, health/functioning, depression, chronic disease; time-invariant confounders included baseline age, education, sex, and race.
RESULTS: After adjustment, current abstainers had the highest risk of subsequent mortality, consistent with sick quitters, and moderate (men: HR = 0.74, 95% CI: 0.60 to 0.91; women: HR = 0.82, 95% CI: 0.63 to 1.07) drinking was associated with a lower mortality rate compared with occasional drinking, though smokers and men evidenced less of an inverse association. Quantitative bias analyses indicated that omitted confounders would need to be associated with ~4-fold increases in mortality rates for men and ~9-fold increases for women to change the results.
CONCLUSIONS: There are consistent associations between moderate/occasional drinking and lower mortality, though residual confounding remains a threat to validity. Continued efforts to conduct large-scale observational studies of alcohol consumption and mortality are needed to characterize the changing patterns of consumption in older age.
%B Alcoholism, Clinical and Experimental Research %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31276233?dopt=Abstract %R 10.1111/acer.14125 %0 Journal Article %J Alzheimers Dement (N Y) %D 2019 %T Analysis of dementia in the US population using Medicare claims: Insights from linked survey and administrative claims data. %A Chen, Yi %A Tysinger, Bryan %A Eileen M. Crimmins %A Julie M Zissimopoulos %K Cognitive Ability %K Dementia %K Education %K Medicare claims %K Medicare linkage %K Racial/ethnic differences %XIntroduction: Medicare claims data may be a rich data source for tracking population dementia rates. Insufficient understanding of completeness of diagnosis, and for whom, limits their use.
Methods: We analyzed agreement in prevalent and incident dementia based on cognitive assessment from the Health and Retirement Study for persons with linked Medicare claims from 2000 to 2008 (N = 10,450 persons). Multinomial logistic regression identified sociodemographic factors associated with disagreement.
Results: Survey-based cognitive tests and claims-based dementia diagnosis yielded equal prevalence estimates, yet only half were identified by both measures. Race and education were associated with disagreement. Eighty-five percent of respondents with incident dementia measured by cognitive decline received a diagnosis or died within the study period, with lower odds among blacks and Hispanics than among whites.
Discussions: Claims data are valuable for tracking dementia in the US population and improve over time. Delayed diagnosis may underestimate rates within black and Hispanic populations.
%B Alzheimers Dement (N Y) %V 5 %P 197-207 %8 2019 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31198838?dopt=Abstract %R 10.1016/j.trci.2019.04.003 %0 Journal Article %J Neurobiology of Aging %D 2019 %T Analysis of pleiotropic genetic effects on cognitive impairment, systemic inflammation, and plasma lipids in the Health and Retirement Study. %A Michael W Lutz %A Casanova, Ramon %A Saldana, Santiago %A Kuchibhatla, Maragatha %A Brenda L Plassman %A Kathleen M Hayden %K Cognitive Ability %K Genetics %K Inflammation %X Variants associated with modulation of c-reactive protein (CRP) and plasma lipids have been investigated for polygenic overlap with Alzheimer's disease risk variants. We examined pleiotropic genetic effects on cognitive impairment conditioned on genetic variants (SNPs) associated with systemic inflammation as measured by CRP and with plasma lipids using data from the Health and Retirement Study. SNP enrichment was observed for cognitive impairment conditioned on the secondary phenotypes of plasma CRP and lipids. Fold enrichment of 100%-800% was observed for increasingly stringent p-value thresholds for SNPs associated with cognitive impairment conditional on plasma CRP, 80%-800% for low-density lipoprotein, and 80%-600% for total cholesterol. Significant associations (false discovery rate Q ≤ 0.05) between cognitive impairment, conditional with either CRP, low-density lipoprotein, or total cholesterol, were found for the locus on chromosome 19 that contains the APOE, TOMM40, APOC1, and PVRL2 genes. Relative numbers of significant SNPs in each of the genes differed by the conditional associations with the secondary phenotypes. Biological interpretation of both the genetic pleiotropy results and the individual genome-wide association results showed that the variants and proximal genes identified are involved in multiple pathological processes including cholesterol metabolism, inflammation, and mitochondrial transport. These findings are potentially important for Alzheimer's disease risk prediction and development of novel therapeutic approaches. %B Neurobiology of Aging %V 80 %P 173-186 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31201950?dopt=Abstract %R 10.1016/j.neurobiolaging.2018.10.028 %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 %XBACKGROUND: 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 Aging & Mental Health %D 2019 %T The association between neighborhood socioeconomic status, cardiovascular and cerebrovascular risk factors, and cognitive decline in the Health and Retirement Study (HRS). %A Kuchibhatla, Maragatha %A Jaimie C Hunter %A Brenda L Plassman %A Michael W Lutz %A Casanova, Ramon %A Saldana, Santiago %A Kathleen M Hayden %K Cardiovascular health %K Cognition & Reasoning %K Risk Factors %K Socioeconomic factors %XBACKGROUND: A small but growing body of evidence supports a relationship between neighborhood socioeconomic status (NSES) and cognitive decline. Additional work is needed to characterize this relationship controlling for risk factors such as cardiovascular, cerebrovascular, and genetic risk factors.
METHODS: Cognitive decline was assessed in association with NSES, and cardiovascular and cerebrovascular risk factors (heart disease, diabetes, hypertension, and stroke) in 8,198 individuals from the 1992-2010 waves of the Health and Retirement Study (HRS). Latent class trajectory analysis determined the number of cognitive trajectory classes that best fit the data, and a multinomial logistic regression model in the latent class framework assessed the risk for cognitive classes conferred by NSES index score and heart disease, diabetes, hypertension, and stroke across three trajectory classes of cognitive function. The analyses controlled for genetic risk for cognitive decline (including APOE genotype) and demographic variables, including education.
RESULTS: The HRS sample was 57.6% female and 85.5% White, with a mean age of 67.5(3.5) years at baseline. The three-quadratic-class model best fit the data, where higher classes represented better cognitive function. Those with better cognitive function were mainly younger white females. Those in the highest quartile of NSES had 57% higher odds of being in the high cognitive function class. Heart disease, diabetes, hypertension, and stroke each increased the odds having of lower cognitive function.
CONCLUSIONS: In examining the relationship of cognitive status with various variables, neighborhood socioeconomic status, cardiovascular risk, and cerebrovascular risk persisted across the cognitive trajectory classes.
%B Aging & Mental Health %G eng %9 Journal %R 10.1080/13607863.2019.1594169 %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 %XTobacco 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 Innovation in Aging %D 2019 %T ASSOCIATIONS OF GENETICS AND LIFE COURSE CIRCUMSTANCES WITH A NOVEL AGING MEASURE THAT CAPTURES MORTALITY RISK %A Liu, Zuyun %A Chen, Xi %A Thomas M Gill %A Ma, Chao %A Eileen M. Crimmins %A Morgan E. Levine %K Genetics %K Mortality %K mortality risk %X We aimed to evaluate associations between a comprehensive set of factors, including genetics and childhood and adulthood circumstances, and a novel aging measure, Phenotypic Age (PhenoAge), which has been shown to capture mortality and morbidity risk in the U.S. population. Using data from 2339 adults (aged 51+) from the U.S. Health and Retirement Study, we found that together all 11 study domains (4 childhood and adulthood circumstances domains, 5 polygenic scores [PGSs] domains, and 1 demographics, and 1 behaviors domains) accounted for about 30\% of variance in PhenoAge after accounting for chronological age. Among the 4 circumstances domains, adulthood adversity was the largest contributor (9\%), while adulthood socioeconomic status (SES), childhood adversity, and childhood SES accounted for 2.8\%, 2.1\%, 0.7\%, respectively. All PGSs contributed 3.8\% of variance in PhenoAge (after accounting for chronological age). Further, using Hierarchical Clustering, we identified 6 distinct subpopulations/clusters based on the 4 circumstances domains, and 3 subpopulations/clusters of them that appear to represent disadvantaged circumstances were associated with higher PhenoAge. Finally, there was a significant gene-by-environment interaction between a previously validated PGS for coronary artery disease and the most apparently disadvantaged subpopulation/cluster, suggesting a multiplicative effect of adverse life course circumstances coupled with genetic risk on phenotypic aging. We concluded that socioenvironmental circumstances during childhood and adulthood account for a sizable proportion of differences in phenotypic aging among U.S. older adults. The disadvantaged subpopulations exhibited accelerated aging and the detrimental effects may be further exacerbated among persons with genetic predisposition to coronary artery disease. %B Innovation in Aging %V 3 %P S322-S323 %8 11 %G eng %U https://doi.org/10.1093/geroni/igz038.1177 %R 10.1093/geroni/igz038.1177 %0 Journal Article %J PLoS Medicine %D 2019 %T Associations of genetics, behaviors, and life course circumstances with a novel aging and healthspan measure: Evidence from the Health and Retirement Study. %A Liu, Zuyun %A Chen, Xi %A Thomas M Gill %A Ma, Chao %A Eileen M. Crimmins %A Morgan E. Levine %K Genetics %K Health Behavior %K Life trajectories %XBACKGROUND: An individual's rate of aging directly influences his/her susceptibility to morbidity and mortality. Thus, quantifying aging and disentangling how various factors coalesce to produce between-person differences in the rate of aging, have important implications for potential interventions. We recently developed and validated a novel multi-system-based aging measure, Phenotypic Age (PhenoAge), which has been shown to capture mortality and morbidity risk in the full US population and diverse subpopulations. The aim of this study was to evaluate associations between PhenoAge and a comprehensive set of factors, including genetic scores, childhood and adulthood circumstances, and health behaviors, to determine the relative contributions of these factors to variance in this aging measure.
METHODS AND FINDINGS: Based on data from 2,339 adults (aged 51+ years, mean age 69.4 years, 56% female, and 93.9% non-Hispanic white) from the US Health and Retirement Study, we calculated PhenoAge and evaluated the multivariable associations for a comprehensive set of factors using 2 innovative approaches-Shapley value decomposition (the Shapley approach hereafter) and hierarchical clustering. The Shapley approach revealed that together all 11 study domains (4 childhood and adulthood circumstances domains, 5 polygenic score [PGS] domains, and 1 behavior domain, and 1 demographic domain) accounted for 29.2% (bootstrap standard error = 0.003) of variance in PhenoAge after adjustment for chronological age. Behaviors exhibited the greatest contribution to PhenoAge (9.2%), closely followed by adulthood adversity, which was suggested to contribute 9.0% of the variance in PhenoAge. Collectively, the PGSs contributed 3.8% of the variance in PhenoAge (after accounting for chronological age). Next, using hierarchical clustering, we identified 6 distinct subpopulations based on the 4 childhood and adulthood circumstances domains. Two of these subpopulations stood out as disadvantaged, exhibiting significantly higher PhenoAges on average. Finally, we observed a significant gene-by-environment interaction between a previously validated PGS for coronary artery disease and the seemingly most disadvantaged subpopulation, suggesting a multiplicative effect of adverse life course circumstances coupled with genetic risk on phenotypic aging. The main limitations of this study were the retrospective nature of self-reported circumstances, leading to possible recall biases, and the unrepresentative racial/ethnic makeup of the population.
CONCLUSIONS: In a sample of US older adults, genetic, behavioral, and socioenvironmental circumstances during childhood and adulthood account for about 30% of differences in phenotypic aging. Our results also suggest that the detrimental effects of disadvantaged life course circumstances for health and aging may be further exacerbated among persons with genetic predisposition to coronary artery disease. Finally, our finding that behaviors had the largest contribution to PhenoAge highlights a potential policy target. Nevertheless, further validation of these findings and identification of causal links are greatly needed.
%B PLoS Medicine %V 16 %P e1002827 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/31211779?dopt=Abstract %R 10.1371/journal.pmed.1002827 %0 Journal Article %J Immunity & Ageing %D 2019 %T Associations of plasma high-sensitivity C-reactive protein concentrations with all-cause and cause-specific mortality among middle-aged and elderly individuals %A Li, Zhi-Hao %A Zhong, Wen-Fang %A Lv, Yue-Bin %A Virginia Byers Kraus %A Gao, Xiang %A Chen, Pei-Liang %A Huang, Qing-Mei %A Ni, Jin-Dong %A Shi, Xiao-Ming %A Mao, Chen %A Wu, Xian-Bo %K C-reactive protein %K Genetics %K Mortality %X Background The association of high-sensitivity C-reactive protein (hsCRP) with mortality is controversial. We aimed to investigate the associations of hsCRP concentrations with the risks of all-cause and cause-specific mortality and identify potential modifying factors affecting these associations among middle-aged and elderly individuals. Methods This community-based prospective cohort study included 14,220 participants aged 50+ years (mean age: 64.9 years) from the Health and Retirement Study. Cox proportional hazard models were employed to estimate the associations between the hsCRP concentrations and the risk of all-cause and cause-specific mortality with adjustment for sociodemographic and lifestyle factors, self-reported medical history, and other potential confounders. Results In total, 1730 all-cause deaths were recorded, including 725 cardiovascular- and 417 cancer-related deaths, after an 80,572 person-year follow-up (median: 6.4 years; range: 3.6–8.1 years). The comparisons of the groups with the highest (quartile 4) and lowest (quartile 1) hsCRP concentrations revealed that the adjusted hazard ratios and 95% confidence intervals were 1.50 (1.31–1.72) for all-cause mortality, 1.44 (1.13–1.82) for cardiovascular mortality, and 1.67 (1.23–2.26) for cancer mortality. The associations between high hsCRP concentrations and the risks of all-cause, cardiovascular, and cancer mortality were similar in the men and women (P for interaction > 0.05). Conclusions Among middle-aged and older individuals, elevated hsCRP concentration could increase the risk of all-cause, cardiovascular, and cancer mortality in men and women. %B Immunity & Ageing %V 16 %P 28 %8 Nov 2019 %G eng %U https://doi.org/10.1186/s12979-019-0168-5 %R 10.1186/s12979-019-0168-5 %0 Journal Article %J FINANCIAL PLANNING REVIEW %D 2019 %T Bequest expectations among the U.S. older adults: The roles of generational differences and personality traits %A Fan, Lu %A Chatterjee, Swarn %K bequest motive %K generational difference %K personality trait %X Abstract This study used the 2012 and 2014 panels of the Health and Retirement Study, a nationally representative dataset, to examine the associations between personality traits, generational cohorts, and bequest expectations among elderly households in the United States. The results indicated that neuroticism was associated with a lower subjective probability of leaving a bequest, and extroversion was associated with a higher subjective probability of leaving a bequest. Income, assets, and educational attainment were also positively associated with self-reported bequest expectations. Generational differences were observed in the subjective probabilities of leaving bequests. The results of this study help in understanding the psychosocial factors associated with leaving bequests in an aging society, and provide implications for financial planners, practitioners, and policy makers. %B FINANCIAL PLANNING REVIEW %P e1057 %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1002/cfp2.1057 %R 10.1002/cfp2.1057 %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 Leisure Sciences %D 2019 %T Change in leisure participation among older adults after falling %A Tuo-Yu Chen %A Megan C Janke %K Disabilities %K Falls %K Older Adults %K Participation %X Falls among older adults can lead to severe physical and psychological consequences. However, whether leisure participation changes after falling is not clear. We investigated whether falls resulted in reduced leisure participation in terms of duration, number, and intensity among older adults. Secondary data from the Health and Retirement Study and the Consumption and Activities Mail Survey (n = 1163) were analyzed. The results showed falls did not predict future leisure participation. Female, white, higher education, fewer functional limitations, and good balance were significant predictors of leisure participation at follow-up. Being white also predicted a significant decline in total number of leisure activities from baseline to follow-up, whereas higher education protected older adults from a significant reduction in total intensity of leisure activity. Our findings suggest falls may not directly affect leisure participation, but its risk factors, such as demographics, functional limitations, and balance, have a direct impact on leisure participation. %B Leisure Sciences %G eng %U https://www.tandfonline.com/doi/full/10.1080/01490400.2018.1536568?scroll=top&needAccess=true %9 Journal %! Leisure Sciences %R 10.1080/01490400.2018.1536568 %0 Journal Article %J The Journals of Gerontology: Series A %D 2019 %T Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study %A Eileen M. Crimmins %A Yuan S Zhang %A Jung K Kim %A Morgan E. Levine %K disease incidence %K disease prevalence %K Mortality %X This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study.We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years.The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke.While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive. %B The Journals of Gerontology: Series A %V 74 %P S21-S26 %8 11 %G eng %U https://doi.org/10.1093/gerona/glz075 %R 10.1093/gerona/glz075 %0 Journal Article %J Journals of Gerontology Series A: Biological Sciences & Medical Sciences %D 2019 %T Changing impact of obesity on active life expectancy of older Americans. %A Yuan S Zhang %A Saito, Yasuhiko %A Eileen M. Crimmins %K Health Trajectories %K Longevity %K Obesity %XBACKGROUND: The rise in the number and earlier age of onset of obese persons has raised critical concerns about consequences of obesity; however, recent evidence suggests that the impact of obesity on health outcomes may have changed. This study aims to assess the change of the impact of obesity on active life expectancy among Americans 70 years and older over almost two decades, 1993-1998 to 2010-2014.
METHODS: For each period, we use three waves of data from the Health and Retirement Study to estimate age-specific transition probabilities between health states. The average number of years active and disabled are calculated with Interpolated Markov Chain software based on estimated transition probabilities.
RESULTS: Overall obesity and severe obesity increased markedly over time yet active life expectancy expanded for all individuals and the increases are greater among the obese and women. Increases in total and active life expectancy occurred because of the changing association of obesity with disability and mortality.
CONCLUSION: Individuals at age 70 in the later period in each weight group could expect to live a smaller proportion of remaining life with ADL disability than those in the earlier period. High levels of obesity continue to have significant adverse effects on the quality of life. The increasing prevalence of severe obesity and the growing number of older persons may result in substantial additional health care needs and costs. Continued effort to improve cardiovascular health is required to control the burden of obesity in later life in an era of rising obesity.
%B Journals of Gerontology Series A: Biological Sciences & Medical Sciences %8 11/2019 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31120111?dopt=Abstract %R 10.1093/gerona/glz133 %0 Conference Paper %B World Social Security Forum %D 2019 %T The changing nature of work and public pension coverage: Evidence from the US and Europe %A Axel Borsch-Supan %A Courtney Coile %A Jonathan Cribb %A Carl Emmerson %A Yuri Pettinicchi %K International %K Pension Coverage %K Pensions %K Social Security %X We examine nonstandard work and its impact on pension coverage via a case study of the United States, the United Kingdom, and Germany. We define nonstandard work broadly to include alternative work, contingent work, and self-employment. We discuss how nonstandard work may affect public pension coverage, as both the pension rules and the level of actual and reported earnings of workers engaged in nonstandard work can differ from those of workers engaged in standard work. Current nonstandard workers receive essentially symmetric treatment from the pension systems in both the U.S. and U.K., but this is not the case in Germany and is a recent development in the U.K. We find that the share of workers engaged in nonstandard work has changed only modestly over time in these three countries, despite the popular perception that a more significant transformation in the nature of work may be underway. We also find that workers who spent much of their career in self-employment (one type of nonstandard work) have higher levels of financial distress in retirement and rely more on financial assets outside the public pension system. %B World Social Security Forum %I International Social Security Association %C Brussels, Belgium %G eng %U https://ww1.issa.int/sites/default/files/documents/events/2-TCResearch-WSSF2019-report2%20changing%20nature%20of%20work-full-263559.pdf %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2019 %T Chronic Stress and Negative Marital Quality Among Older Couples: Associations With Waist Circumference. %A Kira S. Birditt %A Nicky J Newton %A James A. Cranford %A Noah J Webster %K Family Conflict %K Female %K Humans %K Interviews as Topic %K Longitudinal Studies %K Male %K Marriage %K Middle Aged %K Obesity %K Stress, Psychological %K Surveys and Questionnaires %K Waist Circumference %XObjective: More than a third of the U.S. population of older adults is obese. The present study tests the Dyadic Biopsychosocial Model of Marriage and Health, which hypothesizes that, among married couples, individual and partner chronic stress predicts increased waist circumference and these links are exacerbated in negative quality marriages.
Method: Participants were from the nationally representative longitudinal Health and Retirement Study (HRS). A total of 2,042 married individuals (in 1,098 married couples) completed psychosocial and waist circumference assessments in 2006 and 2010. Analyses examined whether negative marital quality and chronic stress in Wave 1 (2006) were associated with changes in waist circumference over time.
Results: Actor-partner interdependence models revealed that greater partner stress, rather than individuals' own reports of stress, was associated with increased waist circumference over time. Higher perceived negative marital quality among husbands and lower negative marital quality among wives exacerbated the positive link between partner stress and waist circumference.
Discussion: Consistent with the Dyadic Biopsychosocial Model of Marriage and Health, partner stress has direct associations with waist circumference among couples and this link is moderated by negative marital quality. Thus, dyadic perceptions of stress and negative marital quality are important to consider for understanding marriage and obesity.
%B J Gerontol B Psychol Sci Soc Sci %V 74 %P 318-328 %8 2019 01 10 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27664418?dopt=Abstract %R 10.1093/geronb/gbw112 %0 Journal Article %J Journal of Research in Personality %D 2019 %T Cigarette smoking and personality change across adulthood: Findings from five longitudinal samples %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Pauline Caille %A Antonio Terracciano %K Cigarette smoking %K longitudinal study %K Personality change %X Personality traits are related to cigarette smoking. However, little is known about the link between smoking and change in personality. Therefore, the present study examined whether current cigarette smoking and smoking cessation are associated with personality change across adulthood. Participants (n = 15,572) aged from 20 to 92 years were drawn from five longitudinal cohorts with follow-ups that ranged from 4 to 20 years. Compared to non-smokers, current smokers were more likely to increase on neuroticism and to decline on extraversion, openness, agreeableness and conscientiousness over time. Compared to the persistent smokers, those who quit had a steeper decline in agreeableness. Cigarette smoking is related to detrimental personality changes across adulthood, and the pattern was not improved by smoking cessation. %B Journal of Research in Personality %V 81 %P 187 - 194 %G eng %U http://www.sciencedirect.com/science/article/pii/S0092656618300825 %9 Journal %R doi.org/10.1016/j.jrp.2019.06.006 %0 Journal Article %J Journal of the American Geriatrics Society %D 2019 %T Cognitive Performance Among Older Persons in Japan and the United States %A Saito, Yasuhiko %A Jung K Kim %A Davarian, Shieva %A Hagedorn, Aaron %A Eileen M. Crimmins %K cognitive performance %K Education %K Japan %K Nihon University Japanese Longitudinal Study of Aging %K United States %X OBJECTIVE To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance. DESIGN Nationally representative studies with harmonized collection of data on cognitive functioning. SETTING Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study. PARTICIPANTS A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older. MEASUREMENTS Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s. RESULTS Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20-point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5-point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years. CONCLUSION Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition. %B Journal of the American Geriatrics Society %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16163 %R 10.1111/jgs.16163 %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 Journal of Aging and Health %D 2019 %T Cohort Trends in the Gender Distribution of Household Tasks in the United States and the Implications for Understanding Disability %A Connor M Sheehan %A Benjamin W Domingue %A Eileen M. Crimmins %K Cohort Studies %K Disabilities %K Gender Differences %K Household %K Women and Minorities %X Objectives: Measures of disability depend on health and social roles in a given environment. Yet, social roles can change over time as they have by gender. We document how engagement in Instrumental Activities of Daily Living (IADLs) is shifting by gender and birth cohort among older adults, and the challenges these shifts can create for population-level estimates of disability. Method: We used the Health and Retirement Study (N = 25,047) and multinomial logistic regression models with an interaction term between gender and birth cohort to predict limitation and nonperformance relative to no difficulty conducting IADLs. Results: Nonperformance of IADLs have significantly decreased among younger cohorts. Women in younger cohorts were more likely to use a map, whereas men in younger cohorts were more likely to prepare meals and shop. Discussion: Failing to account for gender and cohort changes in IADL, performance may lead to systematic bias in estimates of population-level disability. %B Journal of Aging and Health %G eng %! J Aging Health %R 10.1177/0898264318793469 %0 Journal Article %J Innovation in Aging %D 2019 %T COMBINED EFFECT OF CMV SEROPOSITIVITY AND SYSTEMIC INFLAMMATION ON DEMENTIA PREVALENCE IN CANCER SURVIVORS %A Vivek, Sithara %A Bharat Thyagarajan %A Heather Hammond Nelson %A Anna Prizment %A Eileen M. Crimmins %A Jessica Faul %K Cancer %K cnv %K Dementia %K Inflammation %K seropositivity %X Though cancer patients treated with multi-modal therapies demonstrate higher levels of systemic inflammation, which is associated with dementia, cancer survivors have not shown a consistent association with dementia. Since several studies reported an independent association between cytomegalovirus (CMV) infection, inflammation and dementia in non-cancer populations, we have evaluated whether CMV infection and systemic inflammation were associated with increased prevalence of dementia in cancer survivors in Health and Retirement Study (HRS). We evaluated prevalence of dementia (using score ≤7 on the 27-point scale) among 1607 cancer survivors, in whom we measured CMV seropositivity and two biomarkers of systemic inflammation: C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR). The prevalence of CMV seropositivity was 68.26\% (n=1097), while prevalence of increased systemic inflammation [CRP \>5mg/L and NLR \>4] was 4.23\% (n=68). Using survey logistic regression, adjusted for age, race, gender, BMI (Body Mass Index) and sampling design, cancer survivors who were both CMV seropositive and had increased systemic inflammation had the highest odds of dementia compared to those who were CMV seronegative and had low levels of systemic inflammation (OR=6.59; 95\% CI [2.81, 15.44]; p\<.0001). Cancer survivors who were CMV seropositive without evidence of systemic inflammation had a lower but increased odds of dementia (OR=2.02; 95\% CI [1.17, 3.47]; p=0.01). Odds of dementia among those who were CMV seronegative with elevated systemic inflammation was not significant (p=0.09). Our study demonstrates a possible role for ongoing CMV induced inflammation in determining dementia prevalence among cancer survivors that needs further confirmation. %B Innovation in Aging %V 3 %P S461-S461 %G eng %R 10.1093/geroni/igz038.1724 %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 %XHigh 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 The Gerontologist %D 2019 %T Complex multimorbidity and breast cancer screening among midlife and older women: The role of perceived need %A David F Warner %A Siran M Koroukian %A Nicholas K Schiltz %A Kathleen A Smyth %A Cooper, Gregory S %A Owusu, Cynthia %A Kurt C Stange %A Nathan A. Berger %K Cancer screenings %K Comorbidity %K Decision making %K Women and Minorities %X Background and Objectives There is minimal survival benefit to cancer screening for those with poor clinical presentation (complex multimorbidity) or at advanced ages. The current screening mammography guidelines consider these objective indicators. There has been less attention, however, to women’s subjective assessment of screening need. This study examines the interplay between complex multimorbidity, age, and subjective assessments of health and longevity for screening mammography receipt. Research Design and Method This cross-sectional study uses self-reported data from 8,938 women over the age of 52 in the 2012 Health and Retirement Study. Logistic regression models estimated the association between women’s complex multimorbidity (co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes), subjective health and longevity assessments, age, and screening mammography in the 2 years before the interview. These associations were evaluated adjusting for sociodemographic and behavioral factors. Results Both age and complex multimorbidity were negatively associated with screening mammography. However, women’s perceived need for screening moderated these effects. Most significantly, women optimistic about their chances of living another 10–15 years were more likely to have had screening mammography regardless of their health conditions or advanced age. Discussion and Implications Women with more favorable self-assessed health and perceived life expectancy were more likely to receive screening mammography even if they have poor clinical presentation or advanced age. This is contrary to current cancer screening guidelines and suggests an opportunity to engage women’s subjective health and longevity assessments for cancer screening decision making in both for screening policy and in individual clinician recommendations. %B The Gerontologist %V 59 %P S77 - S87 %G eng %U https://academic.oup.com/gerontologist/article/59/Supplement_1/S77/5491135http://academic.oup.com/gerontologist/article-pdf/59/Supplement_1/S77/28667857/gny180.pdf %N Supplement_1 %R 10.1093/geront/gny180 %0 Journal Article %J Educational Gerontology %D 2019 %T Computer usage and cognitive capability of older adults: Analysis of data from the Health and Retirement Study %A Denise Calhoun %A Lee, Seung Bok %K Cognitive Ability %K Education %K Technology %X As America’s older population continues to grow, more individuals are experiencing cognitive decline in the United States. At the same time, we live in an age where technology has increasingly become an integral part of our daily lives. Although numerous studies have examined cognitive functions of older adults from a diverse range of perspectives, research on the relationship between the technology adoption and adult cognitive capacity has been limited. Using nationally representative data (n = 5,259) from the Health and Retirement Study (HRS), this study analyzed the effect of computer usage on the cognitive capabilities of individuals aged 50 and older in the United States. Findings show that computer use in older adults declines with age but rises for those with higher levels of education. Results also indicate that an increased use of computers is significantly associated with improved cognitive capability, when controlling for age, gender, and years of education. Further research is needed to better understand the patterns of technology adoption among older adults and assess its effects on their cognitive abilities. %B Educational Gerontology %V 45 %P 22-23 %G eng %U https://www.tandfonline.com/doi/full/10.1080/03601277.2019.1575026https://www.tandfonline.com/doi/pdf/10.1080/03601277.2019.1575026 %N 1 %! Educational Gerontology %R 10.1080/03601277.2019.1575026 %0 Journal Article %J Journal of Gerontological Social Work %D 2019 %T Consolidated measures of activity among older adults: results of a three data set comparison. %A Lee, Yung Soo %A Putnam, Michelle %A Morrow-Howell, Nancy %A Inoue, Megumi %A Jennifer C. Greenfield %A Chen, Huajuan %K Physical activity %X This study explores the potential to consolidate a broad range of activity items to create more manageable measures that could be used in statistical modeling of multi-activity engagement. We utilized three datasets in the United States: Panel Study of Income Dynamics, Health and Retirement Study, and Midlife in the United States. After identifying activity items, exploratory and confirmatory factor analysis were used to empirically explore composite activity measures. Findings suggest that discrete activity items can be consolidated into activity domains; however, activity domains differ across datasets depending on availability of activity items. Implications for research and practice are further discussed. %B Journal of Gerontological Social Work %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30786817?dopt=Abstract %R 10.1080/01634372.2019.1582123 %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 Journal of Health and Social Behavior %D 2019 %T Crowded nests: Parent-adult child coresidence transitions and parental mental health following the Great Recession. %A Caputo, Jennifer %K Adult children %K Depressive symptoms %K Great Recession %K Parents %X Although many studies have examined contemporary increases in parent-adult child coresidence, questions about what this demographic shift means for the well-being of parents remain. This article draws on insights from the life course perspective to investigate the relationship between parent-adult child coresidence and parental mental health among U.S. adults ages 50+, distinguishing between parents stably living with and without adult children and those who transitioned into or out of coresidence with an adult child. Based on analyses of the 2008 to 2012 waves of the Health and Retirement Study ( = 11,277), parents with a newly coresidential adult child experienced an increase in depressive symptoms relative to their peers without coresidential adult children. Further analyses suggest that transitions to coresidence that occurred in the southern United States or involved out-of-work children were particularly depressing for parents. These findings highlight the significance of evolving intergenerational living arrangements for the well-being of older adults. %B Journal of Health and Social Behavior %V 60 %P 204-221 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/31122076?dopt=Abstract %R 10.1177/0022146519849113 %0 Journal Article %J Journal of Frailty and Aging %D 2019 %T Decreased handgrip strength is associated with impairments in each autonomous living task for aging adults in the United States. %A Ryan P McGrath %A Erlandson, Kristine M. %A Brenda Vincent %A Kyle J Hackney %A Stephen D. Herrmann %A Brian C Clark %K Cognitive Ability %K Grip strength %K Muscle Weakness %K Physical measures %XOBJECTIVES: The primary purpose of this study was to determine the time-varying associations between decreased handgrip strength (HGS) and individual instrumental activities of daily living (IADL) impairments for a nationally-representative sample of aging adults in the United States.
DESIGN: Longitudinal-Panel.
SETTING: Detailed interviews were completed in person and core interviews were typically completed over the telephone.
PARTICIPANTS: A total of 15,336 participants aged at least 50 years who participated in the 2006 wave of the Health and Retirement Study were followed biennially for 8-years.
MEASUREMENTS: A hand-held dynamometer assessed HGS and performance in IADLs were self-reported.
RESULTS: Every 5-kilogram decrease in HGS was associated with an increased odds ratio for the following IADL impairments: 1.11 (95% confidence interval (CI): 1.09, 1.13) for using a map, 1.10 (CI: 1.07, 1.12) for grocery shopping, 1.09 (CI: 1.05, 1.14) for taking medications, 1.07 (CI: 1.05, 1.09) for preparing hot meals, 1.06 (CI: 1.04, 1.08) for managing money, and 1.05 (CI: 1.02, 1.09) for using a telephone.
CONCLUSIONS: Decreased HGS was associated with each IADL impairment, and slightly different associations were observed in individual IADL tasks for aging adults in the United States. Our findings suggest that decreased HGS, which is reflective of reduced function of the neuromuscular system, is associated with diminished performance in autonomous living tasks during aging. Losses in HGS may lead to the development of an IADL impairment. Therefore, health-care providers working with aging adults should utilize measures of HGS as a screening tool for identifying future deficits in neuromuscular functioning. Interventions designed to preserve IADLs in aging adults should also include measures of HGS for detecting early changes in IADL capacity, and intervening at the onset of HGS declines may help aging adults retain their ability to live autonomously.
%B Journal of Frailty and Aging %V 8 %P 141-145 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/31237315?dopt=Abstract %R 10.14283/jfa.2018.47 %0 Journal Article %J Mental Health Weekly %D 2019 %T Depression symptoms increase sharply in last months of life %A Canady, Valerie A. %K depression %X Although depression impacts quality of life at all stages, not much is known about depressive symptoms in the year prior to death, according to researchers of a new study who say that patients with depression have worse survival outcomes than nondepressed patients. Consequently, depression becomes a critical issue to screen for and manage in the context of serious illness, they stated. %B Mental Health Weekly %V 29 %P 4–5 %8 12 %G eng %U https://doi.org/10.1002/mhw.32154 %R 10.1002/mhw.32154 %0 Journal Article %J The Gerontologist %D 2019 %T Depressive Symptoms and the Buffering Effect of Resilience on Widowhood by Gender %A Brittany M. King %A Dawn C Carr %A Miles G Taylor %K depression %K gender %K Gender Differences %K Widowhood %K Widows %X BACKGROUND AND OBJECTIVES: Spousal loss is a stressful life event that often results in significant depressive symptoms, with men often experiencing more significant depressive symptoms than women. Recent research suggests that psychological resilience may play a role in shaping how well people recover from the loss of a spouse. This study examined the moderating effect of resilience on widowhood in relation to changes in depressive symptoms for men and women. RESEARCH DESIGN AND METHODS: This study used data from the Health and Retirement Study to examine a change in depressive symptoms for men and women who experience spousal loss compared to those who remain continuously married (N = 5,626). We used the Simplified Resilience Score, which is based on measures drawn from the psychosocial and lifestyle questionnaire. Ordinary least squares regression was used to assess depression following reported spousal loss for widows relative to their continuously married counterparts. RESULTS: Results show resilience moderated depressive symptoms following spousal loss, but these effects varied by gender. Resilience was significantly and negatively associated with depressive symptoms for married but not for widowed women. However, for widowed men, resilience was significantly and negatively associated with depressive symptoms, and a high resilience score buffered the effect of widowhood. DISCUSSION AND IMPLICATIONS: Our study suggests that having high levels of resilience prior to spousal loss may help offset persistent depressive symptoms, especially for men. Implications for future research and clinical practice are discussed. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. %B The Gerontologist %V 59 %P 1122-1130 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/30247641 %R 10.1093/geront/gny115 %0 Journal Article %J The Gerontologist %D 2019 %T Determinants of Hearing Aid Use Among Older Americans With Hearing Loss %A Michael M McKee %A Choi, Hwajung %A Wilson, Shelby %A Melissa J DeJonckheere %A Zazove, Philip %A Helen G Levy %K Hearing aids %K Hearing loss %K Social Support %K Stigma %X Background and Objectives Hearing loss (HL) is common among older adults and is associated with significant psychosocial, cognitive, and physical sequelae. Hearing aids (HA) can help, but not all individuals with HL use them. This study examines how social determinants may impact HA use. Research Design and Methods We conducted an explanatory sequential mixed methods study involving a secondary analysis of a nationally representative data set, the Health and Retirement Study (HRS; n = 35,572). This was followed up with 1:1 qualitative interviews (n = 21) with community participants to clarify our findings. Both samples included individuals aged 55 and older with a self-reported HL, with or without HA. The main outcome measure was the proportion of participants with a self-reported HL who use HA. Results and Discussion Analysis of HRS data indicated that younger, nonwhite, non-Hispanic, lower income, and less-educated individuals were significantly less likely to use HA than their referent groups (all p values < .001). Area of residence (e.g., urban) were not significantly associated with HA use. Qualitative findings revealed barriers to HA included cost, stigma, vanity, and a general low priority placed on addressing HL by health care providers. Facilitators to obtaining and using HA included family/friend support, knowledge, and adequate insurance coverage for HA. Implications Many socioeconomic factors hinder individuals’ ability to obtain and use HA, but these obstacles appeared to be mitigated in part when insurance plans provided adequate HA coverage, or when their family/friends provided encouragement to use HA. %B The Gerontologist %G eng %U https://academic.oup.com/gerontologist/advance-article/doi/10.1093/geront/gny051/5000029http://academic.oup.com/gerontologist/advance-article-pdf/doi/10.1093/geront/gny051/24836322/gny051.pdf %R 10.1093/geront/gny051 %0 Journal Article %J Journal of Epidemiology & Community Health %D 2019 %T Differential vulnerability to neighbourhood disorder: a gene×environment interaction study %A Jennifer W Robinette %A Jason D Boardman %A Eileen M. Crimmins %K Diabetes %K Genetics %K neighborhood %X Background Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D.Method We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D.Results Greater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10 %B Journal of Epidemiology & Community Health %V 73 %P 388–392 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935762/ %N 5 %R 10.1136/jech-2018-211373 %0 Journal Article %J Journal of Epidemiology and Community Health %D 2019 %T Differential vulnerability to neighbourhood disorder: a gene×environment interaction study %A Jennifer W Robinette %A Jason D Boardman %A Eileen M. Crimmins %K Diabetes %K Genetics %K Neighborhoods %X Background: Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D. Method: We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D. Results: Greater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10, p=0.001). This significant gene×environment interaction was observed after adjusting for years of schooling, age, gender, levels of physical activity and obesity. Conclusion: Findings in the present study suggested that minimising people's exposure to vandalism, vacant buildings, trash and circumstances viewed by residents as unsafe may reduce the burden of this prevalent chronic health condition, particularly for subgroups of the population who carry genetic liability for T2D. %B Journal of Epidemiology and Community Health %V 73 %P 388-392 %8 05/2019 %G eng %U http://jech.bmj.com/lookup/doi/10.1136/jech-2018-211373https://syndication.highwire.org/content/doi/10.1136/jech-2018-211373 %N 5 %! J Epidemiol Community Health %R 10.1136/jech-2018-211373 %0 Journal Article %J Gerontologist %D 2019 %T The Digital Divide in Health-Related Technology Use: The Significance of Race/Ethnicity. %A Uchechi A Mitchell %A Perla G. Chebli %A Ruggiero, Laurie %A Muramatsu, Naoko %K Health Services Utilization %K Racial/ethnic differences %K Technology %XBackground and Objectives: Technology can enhance the health and quality of life of diverse populations and may play an important role in reducing health disparities. Although a "digital divide" between the young and the old has been noted, it is unclear whether the use of technology for managing health differs by race/ethnicity among older adults. This study uses nationally representative data from community-dwelling older Americans to characterize racial/ethnic differences in health-related technology use.
Design and Methods: Data came from 1,336 white, black, and Hispanic adults aged 54 and older who completed the 2014 technology module of the Health and Retirement Study. Racial/ethnic differences in overall health-related technology use were assessed using Poisson regression. Then, F-tests were used to assess differences in the use of phone calls, text messages, E-mails, social media, health management sites, health-related mobile applications, web searches, and brain games for health purposes.
Results: Compared to whites, older blacks and Hispanics were less likely to use technology for health-related purposes after accounting for demographic characteristics, education, and health conditions. They were also less likely to make or receive phone calls, use health management sites, search the web for health information, and use brain games for their health.
Discussion and Implications: Older racial and ethnic minorities are less likely than whites to use certain technologies when managing their health. These findings highlight the importance of understanding the patterns of health-related technology use across racially and ethnically diverse populations to appropriately tailor interventions aimed at improving minority health and eliminating health disparities.
%B Gerontologist %V 59 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30452660?dopt=Abstract %R 10.1093/geront/gny138 %0 Journal Article %J Medical Care %D 2019 %T Disputes of self-reported chronic disease over time: The role of race, ethnicity, nativity, and language of interview. %A Ana R Quiñones %A Melekin, Amanuel %A Christine T Cigolle %A Corey L Nagel %K Chronic conditions %K Racial/ethnic differences %K Survey Methodology %XBACKGROUND: Respondents in longitudinal health interview surveys may inconsistently report their chronic diseases across interview waves. Racial/ethnic minority adults have an increased burden of chronic diseases and may dispute chronic disease reports more frequently.
OBJECTIVE: We evaluated the longitudinal association between race/ethnicity, nativity, and language of interview with disputing previously reported chronic diseases.
METHODS: We performed secondary data analysis of nationally representative longitudinal data (Health and Retirement Study, 1998-2010) of adults 51 years or older (n=23,593). We estimated multilevel mixed-effects logistic models of disputes of previously reported chronic disease (hypertension, heart disease, lung disease, diabetes, cancer, stroke, arthritis).
RESULTS: Approximately 22% of Health and Retirement Study respondents disputed prior chronic disease self-reports across the entire study period; 21% of non-Latino white, 20.5% of non-Latino black, and 28% of Latino respondents disputed. In subgroup comparisons of model-predicted odds using postestimation commands, Latinos interviewed in Spanish have 34% greater odds of disputing compared with non-Latino whites interviewed in English and 35% greater odds of dispute relative to non-Latino blacks interviewed in English.
CONCLUSIONS: The odds of disputing a prior chronic disease report were substantially higher for Latinos who were interviewed in Spanish compared with non-Latino white or black counterparts interviewed in English, even after accounting for other sociodemographic factors, cognitive declines, and time-in-sample considerations. Our findings point toward leveraging of multiple sources of data to triangulate information on chronic disease status as well as investigating potential mechanisms underlying the higher probability of dispute among Spanish-speaking Latino respondents.
%B Medical Care %V 57 %P 625-632 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/31299025?dopt=Abstract %R 10.1097/MLR.0000000000001148 %0 Journal Article %J Aging & Mental Health %D 2019 %T Do older adults with Alzheimer's disease engage in estate planning and advance care planning preparation? %A Shinae L Choi %A Kim, Minjung %A Ian M McDonough %K Advance directives %K Alzheimer's disease %K Estate tax %X Objectives: This study investigated the estate planning and advance care planning (ACP) of older adults diagnosed with Alzheimer's disease (AD) for the presence of (1) a valid will, (2) a durable power of attorney for health care, and (3) a living will. Method: We analyzed 10,273 adults aged 65 and older from the 2012 Health and Retirement Study (HRS) using multilevel logistic regression. Results: We found that a diagnosis of AD was significantly associated with the ACP variables. Older adults with AD were more likely to assign a durable power of attorney for health care and have a written living will than older adults without an AD diagnosis. However, we found no significant association between a diagnosis of AD and having a valid will. These findings were robust when adjusting for demographic and socioeconomic variables. Other factors decreased engagement in estate planning and ACP, including lower socioeconomic status, being male, and being a minority. Conclusion: Our findings suggest that a diagnosis of AD is associated with more engagement in ACP for individuals and their families, but important barriers exist for people with fewer resources. %B Aging & Mental Health %V 23 %P 872-879 %G eng %U https://www.tandfonline.com/doi/full/10.1080/13607863.2018.1461192https://www.tandfonline.com/doi/pdf/10.1080/13607863.2018.1461192 %N 7 %! Aging & Mental Health %R 10.1080/13607863.2018.1461192 %0 Journal Article %J Evolution and Human Behavior %D 2019 %T Do post-menopausal women provide more care to their kin?: Evidence of grandparental caregiving from two large-scale national surveys %A Hofer, Marlise K. %A Collins, Hanne K. %A Mishra, Gita D. %A Schaller, Mark %K Family Roles/Relationships %K Grandparents %K Menopause %K Women and Minorities %X Drawing on the logical principles of life-history theory, it may be hypothesized that—compared to pre-menopausal women—post-menopausal women will spend more time caring for grandchildren and other kin. This hypothesis was tested in two studies, on results obtained from two large datasets documenting altruistic behaviors of pre-menopausal and post-menopausal women in the United States (n = 7161) and Australia (N = 25,066). Results from both studies revealed that (even when controlling statistically for age, health, financial resources, and other pertinent variables), post-menopausal women devoted more time to grandparental caregiving. This effect was specific to kin care: Menopause status was not as strongly related to a measure of non-kin-directed altruistic behavior (time spent volunteering). These results provide the first empirical support for a previously-untested behavioral implication of menopause. %B Evolution and Human Behavior %V 40 %P 355-364 %G eng %N 4 %! Evolution and Human Behavior %R 10.1016/j.evolhumbehav.2019.04.002 %0 Journal Article %J Journal of Aging and Health %D 2019 %T Early Life Displacement Due to Armed Conflict and Violence, Early Nutrition, and Older Adult Hypertension, Diabetes, and Obesity in the Middle-Income Country of Colombia. %A Mary McEniry %A Samper-Ternent, Rafael %A Flórez, Carmen Elisa %A Cano-Gutierrez, Carlos %K Childhood adversity %K Cross-National %K Diabetes %K Obesity %K SAGE %XOBJECTIVE: We examine the importance of early life displacement and nutrition on hypertension (HTN) and diabetes in older Colombian adults (60+ years) exposed to rapid demographic, epidemiological, and nutritional transitions, and armed conflict. We compare early life nutritional status and adult health in other middle- and high-income countries.
METHOD: In Colombia (Survey of Health, Wellbeing and Aging [SABE]-Bogotá), we estimate the effects of early life conditions (displacement due to armed conflict and violence, hunger, low height, and not born in the capital city) and obesity on adult health; we compare the effects of low height on adult health in Mexico, South Africa (Study on Global Ageing and Adult Health [SAGE]), the United States, and England (Health and Retirement Study [HRS], English Longitudinal Study of Ageing [ELSA]).
RESULTS: Early life displacement, early poor nutrition, and adult obesity increase the risk of HTN and diabetes in Colombia. Being short is most detrimental for HTN in Colombian males.
DISCUSSION: Colombian data provide new evidence into how early life conditions and adult obesity contribute to older adult health.
%B Journal of Aging and Health %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29916766?dopt=Abstract %R 10.1177/0898264318778111 %0 Journal Article %J Journal of Gerontology Series B: Psychological Sciences & Social Sciences %D 2019 %T Early-Life Military Exposures and Functional Impairment Trajectories Among Older Male Veterans: The Buffering Effect of Psychological Resilience. %A Miles G Taylor %A Urena, Stephanie %A Dawn C Carr %A Min, Stella %K Early Life %K Functional limitations %K Psychosocial %K Resilience %K Veterans %XObjectives: Drawing on the life course framework and theoretical concept of resilience, we examine the impact of early-life service-related exposures (SREs) on later-life functional impairment trajectories among older U.S. male veterans. We conceptualize resilience as a psychological resource potentially moderating the lasting negative consequences of traumatic military exposures.
Method: Using the 2013 Veterans Mail Survey linked to the Health and Retirement Study 2006-2014 Leave Behind Questionnaire and RAND Data File (v.N), we estimate latent growth curve models of functional impairment trajectories.
Results: SRE to death has a persistent positive effect on functional limitations and activities of daily living limitations. Psychological resilience significantly moderates this association, such that veterans maintaining higher levels of resilience in the face of adverse exposures have considerably less functional impairment over time compared to their counterparts with low levels of resilience.
Discussion: Our findings point to the importance of psychological resilience in later life, especially within the realm of traumas occurring in early life. We discuss implications for current military training programs, stressing the importance of research considering individual resources and processes that promote adaptation in the face of adverse life events.
%B Journal of Gerontology Series B: Psychological Sciences & Social Sciences %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29788363?dopt=Abstract %R 10.1093/geronb/gby029 %0 Journal Article %J Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %D 2019 %T Education and cognitive decline: An integrative analysis of global longitudinal studies of cognitive aging. %A Sean A. P. Clouston %A Dylan M Smith %A Mukherjee, Soumyadeep %A Yun Zhang %A Hou, Wei %A Bruce G Link %A Richards, Marcus %K Alzheimer's disease %K Cognition & Reasoning %K Cross-National %K Education %XBACKGROUND: The objective of this study was to examine the association between education and incidence of accelerated cognitive decline.
METHODS: Secondary analyses of data from the Health and Retirement Study (HRS), a nationally representative prospective cohort study of U.S. residents were conducted (N=28,417). Cox proportional hazards survival models were layered on longitudinal mixed-effects modeling to jointly examine healthy cognitive aging and incidence of accelerated cognitive decline consistent with patterns seen in preclinical Alzheimer's disease and related dementias (ADRD). Replication analyses were completed on a database including 62,485 additional respondents from HRS sister-studies. Life-expectancy ratios (LER) and 95% confidence intervals were reported.
RESULTS: This study replicated research showing that education was positively associated with cognition at baseline. Model fit improved using the survival method compared to random-slopes models alone. Analyses of HRS data revealed that higher education was associated with delayed onset of accelerated cognitive decline (LER=1.031 95% C.I. = [1.013-1.015], P<1E-06). Replication analyses using data from 14 countries identified similar results.
CONCLUSIONS: These results are consistent with cognitive reserve theory, suggesting that education reduces risk of ADRD-pattern cognitive decline. Follow-up work should seek to differentiate specific dementia types involved and consider potential mechanisms.
%B Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %G eng %R 10.1093/geronb/gbz053 %0 Journal Article %J SSM - Population Health %D 2019 %T Educational differences in the compression of disability incidence in the United States %A Chi-Tsun Chiu %A Mark D Hayward %A Chan, Angelique %A Matchar, David B. %K Activities of Daily Living %K Disabilities %K Education %X Objective: To examine educational differences in the compression of disability incidence in the United States. Method: We use the Health and Retirement Study and techniques of microsimulation and bootstrap to estimate the distribution of mortality and disability incidence for major education groups. Results: Higher education is associated with a right shift in the age distributions of both mortality and disability incidence, and more compressed distributions above the modal ages (p<0.05). Our study also points to gender differences in the association between education and compression of mortality and disability incidence (p<0.05). Discussion: To our knowledge, no prior studies have examined educational difference in compression of disability incidence and conducted formal tests for statistical significance. Educational differences in life span variation in mortality correspond closely with life span variation in disability incidence. One long-range implication of this work is growing inequality in life-span variation in disability incidence given trends in educational differences in life-span variation in mortality. %B SSM - Population Health %V 7 %P 100347 %G eng %! SSM - Population Health %R 10.1016/j.ssmph.2018.100347 %0 Journal Article %J Journal of Palliative Medicine %D 2019 %T End-of-life care planning: The importance of older adults' marital status and gender. %A Teresa M Cooney %A Shapiro, Adam %A Channing E Tate %K Advance care planning %K Gender Differences %K Marriage %XBACKGROUND: As the U.S. population ages, dramatic shifts are occurring in the proportion of older adults who are divorced and widowed. Health status and behaviors are known to differ across marital status groups, yet research on end-of-life (EOL) care planning has only compared married and unmarried persons, overlooking differences between divorced and widowed individuals, by gender.
OBJECTIVE: This study aimed to examine marital status differences in EOL care planning by comparing the likelihood of discussions about EOL care, designation of medical durable power of attorney (MDPOA) for health care decisions, and completion of a living will for married, divorced, and widowed older adults, by gender.
METHODS: Analyses used data from the U.S. Health and Retirement Study for 2243 adults (50 years of age and older), who died during the course of the study. Post-death, proxy respondents reported on the decedents' EOL care discussions, living will completion, and establishment of an MDPOA. Multivariate regressions were estimated to test differences in care planning across marital status groups, for men and women.
RESULTS: Divorced men were less likely than married men to have had care discussions and to have engaged in any of the three planning behaviors. Widowers were more likely to have established an MDPOA. Both divorced and widowed women were more likely to have performed any of these EOL planning activities than married women.
CONCLUSIONS: Divorced men and married women are at risk for lacking EOL care planning. Practitioners are encouraged to discuss the importance of such planning as they encounter these at-risk groups.
%B Journal of Palliative Medicine %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30715999?dopt=Abstract %R 10.1089/jpm.2018.0451 %0 Journal Article %J FINANCIAL PLANNING REVIEW %D 2019 %T Estate planning among older Americans: The moderating role of race and ethnicity %A Shinae L Choi %A Ian M McDonough %A Kim, Minjung %A Kim, Giyeon %K bequest expectations %K charitable giving %K estate planning %K ethnicity %K race %K valid will %X This study investigated whether race and ethnicity moderated the associations of bequest expectations to leave an inheritance and charitable giving with having a valid will among older Americans. Drawn from the 2014 Health and Retirement Study, we analyzed 13,261 respondents using multilevel logistic regression with generalized linear mixed models. People with higher bequest expectations and more charitable giving were more likely to have a valid will. Ethnic minorities had much lower bequest expectations and much less charitable giving than non-Hispanic Whites, controlling for socioeconomic indicators. Hispanics showed a stronger effect of bequest expectations but a weaker effect of charitable giving on having a valid will compared with non-Hispanic Whites. Our findings reveal novel racial and ethnic disparities in engagement in estate planning among older adults and suggest alternative means are needed to promote interest in estate planning in later life depending on one's racial and ethnic background. %B FINANCIAL PLANNING REVIEW %V 2 %P e1058 %G eng %N 3-4 %R 10.1002/cfp2.1058 %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 %XBACKGROUND: 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 Journal Article %J Journal of Aging and Health %D 2019 %T Expanding the Happiness Paradox: Ethnoracial Disparities in Life Satisfaction Among Older Immigrants in the United States %A Rocío Calvo %A Dawn C Carr %A Matz-Costa, Christina %K Health Disparities %K Racial/ethnic differences %X Objective: This study investigated nativity disparities in life satisfaction among ethnoracial groups of older adults in the United States and the factors associated with such disparities. Method: Cross-sectional data from 7,348 respondents aged 60 and older from the 2012/2014 waves of the Health and Retirement Study (HRS) were used to estimate linear regression models. Results: Older immigrants experienced higher levels of life satisfaction than comparable native-born individuals. This “happiness advantage” was particularly salient for Hispanic immigrants, who reported the highest levels of life satisfaction of all groups included in the study. With increasing education, life satisfaction increased for White and “Other Race” groups, regardless of nativity. However, for both Black groups and native-born Hispanics, higher levels of education were associated with lower life satisfaction. Discussion: Findings suggest that the “happiness paradox” may not only be a matter of Hispanic ethnicity, but that it may also extend to immigrants from other ethnoracial backgrounds. %B Journal of Aging and Health %V 31 %P 231-255 %8 Jun-02-2021 %G eng %N 2 %! J Aging Health %R 10.1177/0898264317726608 %0 Journal Article %J Innovation in Aging %D 2019 %T FACTORS ASSOCIATED WITH LIFE-SPACE CONSTRICTION IN LATER LIFE: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY %A Moon Choi %A Briana Mezuk %K life-space %K space constriction %X This study aimed to examine factors associated with life-space constriction, using the data from the Health and Retirement Study, a nationally representative sample. We limited our analysis to those who were 65 years and older and answered to the 2012 experimental module on life-space (N=895; mean age=75.3; 59.4% women). Life-space was assessed with the modified version of the UAB Study of Aging Life-Space Assessment, ranging nine zones: room, home, own property, immediate neighborhood, town, community, county, state, and region. A series of logistic regression models were used to estimate odds ratios for life-space constriction by sociodemographic and health characteristics. The results showed that 3.0% and 6.7% of older adults reported that they had never been to places beyond their home and own property/apartment building for the past four weeks, i.e. the critical boundaries in terms of social isolation. The significant factor associated with the life-space constriction within home, immediate neighborhood, and town was physical mobility limitation (OR: 1.18, 1.09, 1.11, respectively), while the constriction within county was associated with education level (OR: 0.91). Driving a car was negatively associated with the life-space constriction within own property/apartment building and home (OR: 0.48 and 0.22, respectively). Policy makers need to pay more attention to social and environmental factors influencing social isolation among older adults such as transportation options and social class disparity. %B Innovation in Aging %V 3 %P S520 - S520 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841504/ %N Suppl 1 %! Innov Aging %0 Journal Article %J Journal of Community Health %D 2019 %T A Framework for Addressing Diabetes-Related Disparities in US Latino Populations %A Marquez, Ivan %A Calman, Neil %A Crump, Casey %K Diabetes %K Literature Review %K Racial/ethnic differences %X Despite national efforts to redress racial/ethnic disparities, Latino Americans continue to share a disproportionate burden of diabetes-related morbidity and mortality. A better understanding of underlying causes and influencing factors is needed to guide future efforts to eliminate racial/ethnic disparities in diabetes control. The objectives of this review are: (1) to summarize our understanding of determinants and modifiable predictors of glycemic control; (2) to provide an overview of existing strategies to reduce diabetes-related disparities; and (3) to identify gaps in the literature regarding whether these interventions effectively address disparities in US Latino populations. Key findings include evidence that diabetes care services can be designed to accommodate heterogeneity within the Latino American community by addressing key modifiable predictors of poor glycemic control, including insurance status, diabetes care utilization, patient self-management, language access, culturally appropriate care, and social support services. Future research efforts should evaluate the effect of structurally tailored interventions that address these key modifiable predictors by targeting patients, providers, and health care delivery systems. %B Journal of Community Health %V 44 %P 412–422 %G eng %U http://link.springer.com/10.1007/s10900-018-0574-1http://link.springer.com/content/pdf/10.1007/s10900-018-0574-1.pdfhttp://link.springer.com/content/pdf/10.1007/s10900-018-0574-1.pdfhttp://link.springer.com/article/10.1007/s10900-018-0574-1/fulltext.html %N 2 %! J Community Health %R 10.1007/s10900-018-0574-1 %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 %XOBJECTIVE: 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 Preventative Medicine Reports %D 2019 %T Gender differences in the association between modifiable risk factors and financial hardship among middle-aged and older adults. %A Gillian L Marshall %A Bryson, William %A Ronstant, Ola %A Sarah L. Canham %K Cigarette smoking %K Drinking %K Financial hardship %K Modifiable risk factors %K Obesity %XObjective: To identify associations between modifiable risk factors (cigarette smoking, alcohol consumption, and obesity) and financial hardship (difficulty paying bills, food insecurity and medication need) among middle-aged and older Americans in a nationally representative sample.
Methods: This was a cross-sectional study of 8212 persons age 50 years and older who completed the core 2010 Health and Retirement Study survey and the psychosocial questionnaire. We ran separate multinomial logistic regressions to assess the association of three modifiable risk factors and three different financial hardship indicators.
Results: Adjusting for all covariates, compared to men of normal weight, men who were obese had a 1.4 greater odds of difficulty paying their bills (95% CI: 1.08-1.76); former smokers had a 1.8 greater odds of being food insecure (95% CI: 1.05-2.95); current smokers were twice as likely to be food insecure (95% CI: 1.21-3.73); Compared to women who never smoked, current smokers had a 1.5 greater odds of having difficulty paying their bills (95% CI: 1.11-2.02); current smokers had a 1.8 greater odds of being food insecure (95% CI: 1.13-2.91); and women who were obese had a 1.5 greater odds of reducing medication due to cost (95% CI: 1.11, 2.02).
Conclusion: Our findings contribute to the literature on health behaviors and financial hardship by highlighting the cyclical nature between different indicators of socioeconomic status, modifiable risk factors, and poor health outcomes among middle-aged and older adults. Furthermore, findings highlight how modifiable risk factors may culminate in financial hardship in later life.
%B Preventative Medicine Reports %V 16 %P 100962 %8 12/2019 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31453074 %1 http://www.ncbi.nlm.nih.gov/pubmed/31453074?dopt=Abstract %R 10.1016/j.pmedr.2019.100962 %0 Journal Article %J Elife %D 2019 %T Genomics of 1 million parent lifespans implicates novel pathways and common diseases and distinguishes survival chances. %A Paul Rhj Timmers %A Mounier, Ninon %A Lall, Kristi %A Fischer, Krista %A Ning, Zheng %A Feng, Xiao %A Bretherick, Andrew D %A Clark, David W %A Shen, Xia %A Tõnu Esko %A Kutalik, Zoltán %A James F Wilson %A Joshi, Peter K %K Age Factors %K Aged %K Bayes Theorem %K Disease %K DNA Methylation %K Female %K Genetic Loci %K Genome-Wide Association Study %K Genomics %K Humans %K Longevity %K Male %K Middle Aged %K Multifactorial Inheritance %K Parents %K Polymorphism, Single Nucleotide %K Risk Factors %K Sex Characteristics %K Signal Transduction %K Survival Analysis %XWe use a genome-wide association of 1 million parental lifespans of genotyped subjects and data on mortality risk factors to validate previously unreplicated findings near , , , , , and 13q21.31, and identify and replicate novel findings near , , and . We also validate previous findings near 5q33.3/ and , whilst finding contradictory evidence at other loci. Gene set and cell-specific analyses show that expression in foetal brain cells and adult dorsolateral prefrontal cortex is enriched for lifespan variation, as are gene pathways involving lipid proteins and homeostasis, vesicle-mediated transport, and synaptic function. Individual genetic variants that increase dementia, cardiovascular disease, and lung cancer - but not other cancers - explain the most variance. Resulting polygenic scores show a mean lifespan difference of around five years of life across the deciles.
Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).
%B Elife %V 8 %P e39856 %G eng %R 10.7554/eLife.39856 %0 Journal Article %J Journal of Clinical Endocrinology and Metabolism %D 2019 %T Glycated hemoglobin and all-cause and cause-specific mortality among adults with and without diabetes. %A Li, Fu-Rong %A Zhang, Xi-Ru %A Zhong, Wen-Fang %A Li, Zhi-Hao %A Gao, Xiang %A Virginia Byers Kraus %A Lv, Yue-Bin %A Zou, Meng-Chen %A Chen, Guo-Chong %A Chen, Pei-Liang %A Zhang, Min-Yi %A Kur, Akech Kuol Akech %A Shi, Xiao-Ming %A Wu, Xian-Bo %A Mao, Chen %K Biomarkers %K Diabetes %K Mortality %XCONTEXT: The patterns of associations between glycated hemoglobin (HbA1c) and mortality are still unclear.
OBJECTIVE: To explore the extent to which ranges of HbA1c levels are associated with the risk of mortality among participants with and without diabetes.
DESIGN: Setting and patients: This was a nationwide, community-based prospective cohort study. Included were 15,869 participants (median age 64 years) of the Health and Retirement Study, with available HbA1c data and without a history of cancer. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (95% CIs) for mortality.
RESULTS: A total of 2,133 participants died during a median follow-up of 5.8 years. In participants with diabetes, those with an HbA1c level of 6.5% were at the lowest risk of all-cause mortality. When HbA1c level was lower than 5.6% or higher than 7.4%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 6.5%. As for participants without diabetes, those with an HbA1c level of 5.4% were at the lowest risk of all-cause mortality. When HbA1c level was lower than 5.0%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 5.4%. However, we did not observe a statistically significant elevated risk of all-cause mortality above an HbA1c level of 5.4%.
CONCLUSIONS: A U-shaped and a reverse J-shaped association for all-cause mortality were found among participants with and without diabetes. The corresponding Optimal ranges for overall survival are predicted to be 5.6-7.4% and 5.0-6.5%, respectively.
%B Journal of Clinical Endocrinology and Metabolism %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30896760?dopt=Abstract %R 10.1210/jc.2018-02536 %0 Journal Article %J Journal of Alzheimer's Disease %D 2019 %T Handgrip strength is associated with poorer cognitive functioning in aging Americans. %A Ryan P McGrath %A Sheria G Robinson-Lane %A Cook, Summer %A Brian C Clark %A Stephen D. Herrmann %A Melissa L O'Connor %A Kyle J Hackney %K Alzheimer's disease %K Cognitive Ability %K Dementia %K Physical measures %XBACKGROUND: Measures of handgrip strength may show promise for detecting cognitive erosion during aging.
OBJECTIVE: To determine the associations between lower handgrip strength and poorer cognitive functioning for aging Americans.
METHODS: There were 13,828 participants aged at least 50 years from the 2006 wave of the Health and Retirement Study included and followed biennially for 8 years. Handgrip strength was assessed with a hand-held dynamometer and cognitive functioning was assessed with a modified version of the Mini-Mental State Examination. Participants aged <65 years with scores 7- 11 had a mild cognitive impairment, ≤6 had a severe cognitive impairment, and ≤11 had any cognitive impairment. Respondents aged ≥65 years with scores 8- 10 had a mild cognitive impairment, ≤7 had a severe cognitive impairment, and ≤10 had any cognitive impairment Separate covariate-adjusted multilevel logistic models examined the associations between lower handgrip strength and any or severe cognitive impairment. A multilevel ordered logit model analyzed the association between lower handgrip strength and poorer cognitive functioning.
RESULTS: Every 5-kg lower handgrip strength was associated with 1.10 (95% confidence interval (CI): 1.04, 1.15) and 1.18 (CI: 1.04, 1.32) greater odds for any and severe cognitive impairment, respectively. Similarly, every 5-kg lower handgrip strength was associated with 1.10 (CI: 1.05, 1.14) greater odds for poorer cognitive functioning.
CONCLUSIONS: Measurement of handgrip strength is a simple, risk-stratifying method for helping healthcare providers determine poorer cognitive functioning. Interventions aiming to prevent or delay cognitive dysfunction should also implement measures of handgrip strength as an assessment tool for determining efficacy.
%B Journal of Alzheimer's Disease %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31322562?dopt=Abstract %R 10.3233/JAD-190042 %0 Journal Article %J JOURNAL OF THE ECONOMICS OF AGEING %D 2019 %T Health disparities and the socioeconomic gradient in elderly life-cycle consumption %A Ray Miller %A Bairoliya, Neha %A Canning, David %K Aging %K Consumption inequality %K Education gradient %K health %K Life-cycle %X We quantify the importance of health disparities in explaining consumption differences at older ages by estimating a panel VAR model of elderly consumption, health, and mortality using data from the Health and Retirement Study. We use the estimated model and initial joint distribution of health and consumption to simulate elderly life-cycle paths and construct a measure of the net present value of expected remaining lifetime consumption at age sixty (NPVC). We first document a steep education gradient in elderly lifetime consumption. We then decompose the gradient in NPVC to quantify the effect of 1) differences in the health distribution at age sixty and 2) differential health and mortality transitions after age sixty. Our decomposition results suggest that roughly 10-12% of the education gradient in NPVC at age sixty could be closed by eliminating elderly health differences. %B JOURNAL OF THE ECONOMICS OF AGEING %V 14 %P UNSP 100176 %G eng %9 Article %R 10.1016/j.jeoa.2018.11.001 %0 Journal Article %J Prehospital and Disaster Medicine %D 2019 %T Health Risk Behaviors after Disaster Exposure Among Older Adults %A Bell, Sue Anne %A Choi, Hwajung %A Kenneth M. Langa %A Theodore J Iwashyna %K BMI %K Health behaviors %K Risk Factors %B Prehospital and Disaster Medicine %V 34 %P 95-97 %G eng %U https://www.cambridge.org/core/product/identifier/S1049023X18001231/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1049023X18001231 %N 1 %! Prehosp. Disaster med. %R 10.1017/S1049023X18001231 %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 Innovation in Aging %D 2019 %T How Does Subjective Age Get “Under the Skin”? The Association Between Biomarkers and Feeling Older or Younger Than One’s Age: The Health and Retirement Study %A Bharat Thyagarajan %A Shippee, Nathan %A Parsons, Helen %A Vivek, Sithara %A Eileen M. Crimmins %A Jessica Faul %A Shippee, Tetyana %K Age discrepancy score %K Biological domains %K Physiological aging %X Though subjective age is a well-recognized risk factor for several chronic diseases, the biological basis for these associations remains poorly understood.We used new comprehensive biomarker data from the 2016 wave of the nationally representative Health and Retirement Study (HRS) to evaluate the association between biomarker levels and self-reported subjective age in a subset of 3,740 HRS participants who provided a blood sample. We measured biomarkers in seven biological domains associated with aging: inflammation, glycemia, lipids, liver function, endocrine function, renal function, and cardiac function. The primary outcome was the age discrepancy score (subjective age − chronological age) categorized as those who felt younger, older, or the same as their chronological age (reference group). Analyses adjusted for comprehensive psychosocial factors (chronic stress index, depression score), demographic factors (race, sex, body mass index, marital status, physical activity), and prevalence of chronic health conditions (comorbidity index).The prevalence of clinically relevant reduced levels of albumin concentrations was lower in those who felt younger (8.8\% vs. 16.0\%; p = .006) and higher in those who felt older (20.4\% vs. 16.0\%; p = .03) when compared with the reference category. The prevalence of clinically significant elevation in liver enzymes such as alanine aminotransferase was also significantly lower among those who felt younger (7.1\% vs. 8.6\%; p = .04) when compared with the reference category. Prevalence of clinically elevated levels in cystatin C was also lower among those who felt younger when compared with the reference category (50.0\% vs. 59.1\%; p = .04). There was no association between lipids, glucose, or C-reactive protein (inflammatory marker) and subjective age categories.These results suggest that people who feel younger may have favorable biomarker profiles and as a result may have lower prevalence of age-related diseases when compared with those who feel older or those who feel the same as their chronological age. %B Innovation in Aging %V 3 %P igz035 %G eng %N 4 %R 10.1093/geroni/igz035 %0 Journal Article %J Journal of the American Medical Directors Association %D 2019 %T Impairments in Individual Autonomous Living Tasks and Time to Self-Care Disability in Middle-Aged and Older Adults %A Ryan P McGrath %A Brian C Clark %A Erlandson, Kristine M. %A Stephen D. Herrmann %A Brenda Vincent %A Orman T Hall %A Kyle J Hackney %K Activities of Daily Living %K Caregiving %K Cognitive Ability %K Disabilities %X Objectives: Impairments in specific tasks that are necessary for independent living may identify future self-care limitations, and the use of time-varying covariates can better capture the fluidity in functional capacity trajectories over time. The purpose of this study was to determine the associations between individual instrumental activities of daily living (IADL) impairments and time to activities of daily living (ADL) disability for middle-aged and older adults in the United States. Design: Longitudinal panel. Setting: Detailed interviews that included physical, biological, and psychosocial measures were completed in person. The core interview was typically completed over the telephone. Participants: A nationally representative sample of 15,336 adults aged at least 50 years from the 2006 wave of the Health and Retirement Study was followed for 8 years. Measures: Ability to perform IADL and ADL were self-reported at each wave. Separate covariate-adjusted Cox models were used to examine the time-varying associations between individual IADL impairments and time to ADL disability. Results: The presence of each IADL impairment was associated with a higher hazard ratio for an ADL disability for the following functions: 2.52 [95% confidence interval (CI) 2.35, 2.70] for grocery shopping, 1.91 (CI 1.77, 2.06) for preparing hot meals, 1.55 (CI 1.37, 1.76) for taking medications, 1.48 (CI 1.36, 1.61) for managing money, 1.41 (CI 1.27, 1.57) for using a telephone, and 1.38 (CI 1.29, 1.48) for using a map. Conclusions/Implications: Our findings provide insights into the disabling process by revealing how impairments in each IADL are differentially associated with time to ADL disability. Interventions aiming to retain function during aging should be informed by fluctuations in IADL performance and how specific IADL impairments may exacerbate functional capacity declines more so than others. %B Journal of the American Medical Directors Association %V 20 %P 730-735 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S1525861018305875https://api.elsevier.com/content/article/PII:S1525861018305875?httpAccept=text/xmlhttps://api.elsevier.com/content/article/PII:S1525861018305875?httpAccept=text/plain %9 Journal %! Journal of the American Medical Directors Association %R 10.1016/j.jamda.2018.10.014 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2019 %T Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education. %A Audrey R Murchland %A Chloe W Eng %A Joan A Casey %A Jacqueline M Torres %A Elizabeth R Mayeda %K Depressive symptoms %K Education %K Place of residence %K Rural Settings %XOBJECTIVES: To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity.
METHODS: We identified the prevalence of depressive symptoms among U.S.-born adults ages ≥50 years in the 1998-2014 waves of the Health and Retirement Study (n=16,022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus non-rural childhood residence (self-report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms.
RESULTS: In age, race/ethnicity, and sex-adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR=1.20; 95% CI: 1.12, 1.29; marginal predicted probability 10.5% for rural and 8.9% for non-rural childhood residence). Adjusting for U.S. Census birth region and parental education attenuated this association (OR=1.07; 95% CI: 0.99, 1.15; marginal predicted probability 9.9% for rural and 9.3% for non-rural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR=0.94; 95% CI: 0.87, 1.01; marginal predicted probability 9.2% for rural and 9.8% for non-rural).
CONCLUSIONS: Rural childhood residence was associated with elevated depressive symptoms in middle-aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.
%B International Journal of Geriatric Psychiatry %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31318472?dopt=Abstract %R 10.1002/gps.5176 %0 Journal Article %J The European Journal of Health Economics %D 2019 %T The joint effect of health shocks and eligibility for Social Security on labor supply %A Candon, David %K Employment and Labor Force %K Gender Differences %K Health Conditions and Status %K Health Shocks %K Social Security %X This paper investigates whether or not suffering a health shock, and becoming eligible for social security, have a joint effect on labor supply. Despite millions of people experiencing both of these events each year, no paper has focused exclusively on the joint effect that these events may have on work outcomes. This is surprising given that experiencing a health shock may impact on how a worker responds to becoming eligible for social security. With data from the Health and Retirement Study, I model weekly hours of work as a function of health shocks, social security eligibility, and their interaction. I find that this interaction leads to a 3–4 h reduction in weekly hours of work for men, but has no effect for women. The results are robust to using different work outcomes, age groups, health shock definitions, subgroups, as well as falsification and placebo tests. The results appear to be driven by men who would have had to return to work with impaired health. Policies that promote a more flexible work situation for older men may alleviate these problems in the future. %B The European Journal of Health Economics %P 969–988 %G eng %U https://link.springer.com/article/10.1007%2Fs10198-019-01053-2 %N 20 %9 Journal %! Eur J Health Econ %R 10.1007/s10198-019-01053-2 %0 Journal Article %J Disability and Health Journal %D 2019 %T Late life disability and experienced wellbeing: Are economic resources a buffer? %A Vicki A Freedman %A Jennifer C. Cornman %A Deborah Carr %A Richard E Lucas %K Disabilities %K Financial Health %K Well-being %XBACKGROUND: Disablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.
OBJECTIVE: Drawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.
METHODS: We use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.
RESULTS: We find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.
CONCLUSIONS: Future research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.
%B Disability and Health Journal %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30871953?dopt=Abstract %R 10.1016/j.dhjo.2019.02.003 %0 Thesis %B Education and Psychology %D 2019 %T Linking Communicative Interaction to Cognitive Functioning: Implications for Older Adults %A Denise Calhoun %K 0351:Gerontology %K 0493:Aging %K 0516:Adult education %K Adult education %K Aging %K Cognition %K Communication %K Communicative interaction %K Dementia %K Gerontology %K Memory %K Neuroscience %X As the percentage of older adults within the U.S. steadily increases, long-term care options are being impacted with growing numbers of seniors to provide for. The reality of these elevated numbers have sparked an interest in researchers to conduct studies on human development, plasticity in the brain, and training and intervention programs in search for ways to halt or lessen the cognitive and communicative decline, in older adults.As an alternative path to help older adults maintain quality of life, this study proposes to examine the link between communicative interaction and cognitive functioning to educate family members and healthcare providers on how communicative interactions and language influence cognition. Data (n = 3130) used in this study was retrieved from the University of Michigan’s Health and Retirement Study (HRS) 2014 for participants 65 years and older. Examination of the link between communicative interaction and cognition encompassed all factors of the learning process such as socio-emotional influences, environmental experiences, health and nutrition, and cognitive and physical development. Analysis of the study also included exploratory studies on social cognitive neuroscience and how brain training affects dementia.Findings in this study revealed that cognitive functioning declines with age, but rises with higher levels of education. Results also indicate that increased communicative interaction is significantly associated with improved cognitive functioning, when controlling for age, gender, and education. Considering other influential factors, determining the degree of association may require further investigation. %B Education and Psychology %I Pepperdine University %V Doctor of Education in Organizational Leadership %P 130 %@ 9781085631990 %G eng %U https://search.proquest.com/docview/2284211091?pq-origsite=gscholar %9 phd %0 Journal Article %J PLoS One %D 2019 %T Living arrangements and disability-free life expectancy in the United States. %A Chi-Tsun Chiu %K Living arrangements %K Mortality %X No studies have investigated the association between living arrangements and disability-free life expectancy in the United States, nor worldwide. This study aims to examine the differences in total and disability-free life expectancy among older Americans according to living arrangements. Data from the Health and Retirement Study (1998 to 2014) for non-Hispanic whites aged 50 and over (N = 21,612). Disability-free life expectancy by gender, living arrangement, and education are obtained from incidence-based multistate life tables. Overall, those who live only with their spouses/partners live 1-19 years longer with 3-25 more years without disability and 1-7 fewer years with disability than do those with other living arrangements. Among those with the same living arrangement, the higher educated live up to 6 years longer with up to 8 more years in a disability-free state and up to 2 fewer years in a disabled state. The study shows strong association between living arrangement and disability-free life expectancy by gender and education. Long-term care policy should take into account the length of life with/without disability by living arrangements and socioeconomic status and make use of the potential family resources. %B PLoS One %V 14 %P e0211894 %8 2019 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/30735515?dopt=Abstract %R 10.1371/journal.pone.0211894 %0 Journal Article %J American Journal of Epidemiology %D 2019 %T The Longitudinal Association of Perceived Neighborhood Disorder and Lack of Social Cohesion With Depression Among Adults Aged 50 and Over: An Individual Participant Data Meta-Analysis From 16 High-Income Countries. %A Baranyi, Gergő %A Sieber, Stefan %A Cullati, Stéphane %A Pearce, Jamie %A Chris J.L. Dibben %A Courvoisier, Delphine S %K depression %K neighborhood disorder %K social cohesion %XAlthough residential environment might be an important predictor of depression among older adults, systematic reviews point to a lack of longitudinal investigations and the generalizability of the findings is limited to a few countries. We used longitudinal data collected after 2012 in three surveys, including 15 European countries and the United States, and comprising 32,531 adults aged 50 and over. The risk of perceived neighborhood disorder and lack of social cohesion on depression was estimated using two-stage individual participant data metaanalysis; country-specific parameters were analyzed by meta-regression. We ran additional analyses on individuals reaching retirement. Neighborhood disorder [Odds Ratio (OR)=1.25] and lack of social cohesion (OR=1.76) were significantly associated with depression in the fully adjusted models. In retirement, the risk of depression was even higher (neighborhood disorder: OR=1.35; lack of social cohesion: OR=1.93). Heterogeneity across countries was low and significantly reduced by the addition of country-level income inequality and population density. Perceived neighborhood problems increased the overall risk of depression among adults aged 50 and over. Policies, especially in countries with stronger links between neighborhood and depression, should focus on improving physical environment and supporting social ties in communities, which can reduce depression and contribute to healthy ageing.
%B American Journal of Epidemiology %8 10/2019 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31573028 %1 http://www.ncbi.nlm.nih.gov/pubmed/31573028?dopt=Abstract %R 10.1093/aje/kwz209 %0 Journal Article %J Aging & Mental Health %D 2019 %T The Longitudinal Associations between Physical Health and Mental Health among Older Adults. %A Luo, Meng Sha %A Ernest Wing Tak Chui %A Lydia W Li %K Depressive symptoms %K Mental Health %K Physical Ability %K Physical Health %X This study examines the lead-lag relationship between physical and mental health among older adults. Data are collected from 16,417 older adults aged 50 years and older participating in the biannual Health and Retirement Study (HRS). Participants were assessed on up to 11 measurement points over a 21-year period from 1994 to 2014. Physical health was measured as a composite of chronic diseases, functional limitations, and difficulties in basic and instrumental activities of daily living. Mental health was measured with the modified CES-D. Bivariate latent change score models (BLCSM) were estimated. : Both physical and mental health declined in the observed years, with slower declining rates over time. A reciprocal relationship emerged, with the prior level of physical health acting as the leading indicator of subsequent change in mental health, and the prior mental health state acting as the leading indicator of subsequent changes in physical health. Additionally, the influence of physical health on mental health changes was larger than the corresponding effect of mental health on subsequent physical health. This study demonstrates the reciprocal relationship between physical and mental health in later adulthood and highlights the need to pay attention to the mental health of older people with physical health problems. %B Aging & Mental Health %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31429303?dopt=Abstract %R 10.1080/13607863.2019.1655706 %0 Journal Article %J Journal of the American Medical Directors Association %D 2019 %T The Longitudinal Associations of Handgrip Strength and Cognitive Function in Aging Americans %A Ryan P McGrath %A Brenda Vincent %A Kyle J Hackney %A Sheria G Robinson-Lane %A Brian Downer %A Brian C Clark %K Alzheimer's disease %K Dementia %K Geriatrics %K Muscle Strength %K Muscle Weakness %K sarcopenia %X Objectives Factors that are responsible for age-related neurologic deterioration of noncognitive and cognitive processes may have a shared cause. We sought to examine the temporal, directional associations of handgrip strength and cognitive function in a national sample of aging Americans. Design Longitudinal panel. Setting Enhanced interviews that included physical, biological, and psychosocial measures were completed in person. Core interviews were often conducted over the telephone. Participants The analytic sample included 14,775 Americans aged at least 50 years who participated in at least 2 waves of the 2006-2016 waves of the Health and Retirement Study. Measures Handgrip strength was measured with a hand-held dynamometer. Participants were considered cognitively intact, mildly impaired, or severely impaired according to the Telephone Interview of Cognitive Status questionnaire. Separate lagged general estimating equations analyzed the directional associations of handgrip strength and cognitive function. Results The overall time to follow-up was 2.1 ± 0.4 years. Every 5 kg higher handgrip strength was associated with 0.97 [95% confidence interval (CI) 0.93, 0.99] lower odds for both future cognitive impairment and worse cognitive impairment. Those who were not weak had 0.54 (CI 0.43, 0.69) lower odds for future cognitive impairment and 0.57 (CI 0.46, 0.72) lower odds for future worse cognitive impairment. Conversely, any (β = −1.09; CI –1.54, −0.64), mild (β = −0.85; CI –1.34, −0.36), and severe cognitive impairment (β = −2.34; CI –3.25, −1.42) predicted decreased handgrip strength. Further, the presence of any, mild, and severe cognitive impairment was associated with 1.82 (CI 1.48, 2.24), 1.65 (CI 1.31, 2.08), and 2.53 (CI 1.74, 3.67) greater odds for future weakness, respectively. Conclusions/Implications Strength capacity and cognitive function may parallel each other, whereby losses of functioning in 1 factor may forecast losses of functioning in the other. Handgrip strength could be used for assessing cognitive status in aging Americans and strength capacity should be monitored in those with cognitive impairment. %B Journal of the American Medical Directors Association %G eng %U http://www.sciencedirect.com/science/article/pii/S1525861019306498 %R https://doi.org/10.1016/j.jamda.2019.08.032 %0 Journal Article %J American Journal of Epidemiology %D 2019 %T The Longitudinal Associations of Perceived Neighborhood Disorder and Lack of Social Cohesion With Depression Among Adults Aged 50 Years or Older: An Individual-Participant-Data Meta-Analysis From 16 High-Income Countries %A Baranyi, Gergő %A Sieber, Stefan %A Cullati, Stéphane %A Pearce, Jamie %A Chris J.L. Dibben %A Courvoisier, Delphine S %K Cohort Studies %K depression %K Mental Health %K meta-analysis %K multicenter studies %K Residence Characteristics %X Although residential environment might be an important predictor of depression among older adults, systematic reviews point to a lack of longitudinal investigations, and the generalizability of the findings is limited to a few countries. We used longitudinal data collected between 2012 and 2017 in 3 surveys including 15 European countries and the United States and comprising 32,531 adults aged 50 years or older. The risk of depression according to perceived neighborhood disorder and lack of social cohesion was estimated using 2-stage individualparticipant-data meta-analysis; country-specific parameters were analyzed by meta-regression. We conducted additional analyses on retired individuals. Neighborhood disorder (odds ratio (OR) = 1.25) and lack of social cohesion (OR = 1.76) were significantly associated with depression in the fully adjusted models. In retirement, the risk of depression was even higher (neighborhood disorder: OR = 1.35; lack of social cohesion: OR = 1.93). Heterogeneity across countries was low and was significantly reduced by the addition of country-level data on income inequality and population density. Perceived neighborhood problems increased the overall risk of depression among adults aged 50 years or older. Policies, especially in countries with stronger links between neighborhood and depression, should focus on improving the physical environment and supporting social ties in communities, which can reduce depression and contribute to healthy aging. %B American Journal of Epidemiology %G eng %U https://www.researchgate.net/profile/Gergo_Baranyi/publication/336217860_The_Longitudinal_Association_of_Perceived_Neighborhood_Disorder_and_Lack_of_Social_Cohesion_With_Depression_Among_Adults_Aged_50_and_Over_An_Individual_Participant_Data_Meta-Analysis %9 Report %R 10.1093/aje/kwz209 %0 Journal Article %J Journal of Diabetes Investigation %D 2019 %T Longitudinal investigation of the reciprocal relationship between depressive symptoms and glycemic control: The moderation effects of sex and perceived support. %A Chiu, Ching-Ju %A Du, Ye-Fong %K Biomarkers %K Depressive symptoms %K Diabetes %K Gender Differences %K Social Support %XAIMS/INTRODUCTION: The present study investigated the longitudinal associations between depressive symptoms and glycemic control in nationally representative adults with type 2 diabetes, and tested the effects of sex and perceived family support in moderating this association.
MATERIALS AND METHODS: In this longitudinal study of middle-aged and older adults who participated in the 2002 and 2006 Health and Retirement Study, and the 2003 and 2006 Diabetes Study (n = 398), we applied a cross-lagged structural equation model to examine the reciprocal relationship between depressive symptoms and glycemic control over a 3-year period.
RESULTS: Men and women were not different in terms of the depressive symptoms and glycemic control relationship, with a stronger association noted for higher depressive symptom scores predicting worse glycemic control (β = 0.22, critical ratio 3.03), as opposed to worse glycemic control predicting higher depressive symptom scores. Family and friend support for diabetes self-management serves as an important buffer. In patients with low family and friend support, more depressive symptoms at baseline were associated with subsequent worse glycemic levels (β = 0.36, critical ratio 4.03). In contrast, in individuals who had strong support, depressive symptoms did not predict subsequent glycemic control.
CONCLUSIONS: The present study provided evidence for the relationship between glycemic control and depression, finding that depressive symptoms predicted poorly controlled glycemic status, especially when the participants perceived inadequate support from their family or friends. A quick survey in clinics to assess the level of family or friend support for diabetes management and depressive symptoms might be an important part of individualized diabetic care.
%B Journal of Diabetes Investigation %V 10 %P 801-808 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30390387?dopt=Abstract %R 10.1111/jdi.12969 %0 Journal Article %J American Journal of Industrial Medicine %D 2019 %T A longitudinal study of work-related psychosocial factors and injuries: Implications for the aging United States workforce. %A Navneet Kaur Baidwan %A Susan Goodwin Gerberich %A Kim, Hyun %A Andrew D Ryan %A Timothy Church %A Benjamin D Capistrant %K Employment and Labor Force %K Psychosocial %K Risk Factors %X Introduction: This study aimed to identify psychosocial work factors that may individually or, in combination, influence injury outcomes among aging United States (U.S.) workers. Methods: Data from the U.S. Health and Retirement Study (HRS) of 3305 working adults, aged 50 years and above, were used to identify associations between work-related psychosocial factors and injury incidence from 2006 to 2014, using adjusted incidence rate ratios. Results: Employees perceiving their work as high in psychological and physical demands/efforts, low in support, and rewards, compared to those in workplaces with low demands, high support, and high rewards, had a risk of injury two times greater. Males, compared with females, had a greater risk for injuries when interactions among several psychosocial work-related factors were modeled. Conclusions: The fact that important gender-based differences emerged when interactions among the psychosocial factors and injury were modeled, suggests opportunities for further research and potential interventions to enhance the working environment. %B American Journal of Industrial Medicine %V 62 %P 212-221 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30675734?dopt=Abstract %R 10.1002/ajim.22945 %0 Journal Article %J Health Services Research %D 2019 %T Medicare expenditures attributable to dementia. %A Lindsay L Waite %A Fishman, Paul %A Basu, Anirban %A Paul K Crane %A Eric B Larson %A Norma B Coe %K Cognition & Reasoning %K Dementia %K Medicare linkage %K Medicare/Medicaid/Health Insurance %XOBJECTIVE: To estimate dementia's incremental cost to the traditional Medicare program.
DATA SOURCES: Health and Retirement Study (HRS) survey-linked Medicare part A and B claims from 1991 to 2012.
STUDY DESIGN: We compared Medicare expenditures for 60 months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group.
DATA COLLECTION/EXTRACTION METHODS: We used a cost estimator that accounts for differential survival between individuals with and without dementia and decomposes incremental costs into survival and cost intensity components.
PRINCIPAL FINDINGS: Dementia's five-year incremental cost to the traditional Medicare program is approximately $15 700 per patient, nearly half of which is incurred in the first year after diagnosis. Shorter survival with dementia mitigates the incremental cost by about $2650. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services. The incremental cost of dementia was about $7850 higher for females than for males because of sex-specific differential mortality associated with dementia.
CONCLUSIONS: Dementia's cost to the traditional Medicare program is significant. Interventions that target early identification of dementia and preventable inpatient and post-acute care services could produce substantial savings.
%B Health Services Research %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30868557?dopt=Abstract %R 10.1111/1475-6773.13134 %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 %XHuman 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 Journal Article %J Journal of Family and Economic Issues %D 2019 %T The Moderating Role of Depressive Symptoms Between Financial Assets and Bequests Expectation %A Shinae L Choi %A Wilmarth, Melissa J. %K Decision making %K Depressive symptoms %K Financial Health %X This study investigated the association between financial assets and bequests expectation, specifically whether having depression moderated the association. Our sample included 10,340 middle-aged and older Americans from the 2014 Health and Retirement Study. Results from ordinary least squares regression models showed a positive association between financial assets and bequests expectation, whereas a negative association between depression and bequests expectation. Furthermore, a moderating role of depression was revealed. Specifically, the relationship between financial assets and bequests expectation was stronger for individuals with depression than for individuals without depression. Future research and practice should incorporate perspectives of both financial assets and depressive symptoms to more effectively help individuals and families deal their current financial situation as well as identify their estate planning needs. We also discuss public policy implications of the findings. %B Journal of Family and Economic Issues %V 40 %P 498–510 %G eng %N 3 %! J Fam Econ Iss %R 10.1007/s10834-019-09621-7 %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 %XMany 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 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 %XExcessive 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 Annals of the American Thoracic Society %D 2019 %T Paths into sepsis: Trajectories of presepsis healthcare use. %A Hallie C Prescott %A Alicia G Carmichael %A Kenneth M. Langa %A Gonzalez, Richard %A Theodore J Iwashyna %K Hospitalization %K Risk Factors %K Sepsis %XRATIONALE: Sepsis is a leading cause of death and disability whose heterogeneity is often cited as a key impediment to translational progress.
OBJECTIVES: To test the hypothesis that there are consequential and significant differences in sepsis outcomes that result from differences in a patient's clinical course leading up to sepsis hospitalization.
METHODS: We conducted an observational cohort study of U.S. Health and Retirement Study (HRS) participants in Medicare (1998-2012) and U.S. Department of Veterans Affairs beneficiaries (2009). Using latent profile analysis, we identified patient subtypes based on trajectory of presepsis healthcare facility use. Subtypes were identified in the derivation cohort (1,512 sepsis hospitalizations among earlier HRS participants), then validated them in two additional cohorts (1,992 sepsis hospitalizations among later HRS participants; 32,525 sepsis hospitalizations among U.S. Department of Veterans Affairs beneficiaries). We measured the association between presepsis path and 90-day mortality using chi-square tests and multivariable logistic regression.
RESULTS: We identified three subtypes: low use of inpatient healthcare facilities, comprising 84% of the derivation cohort; rising use, 12%; and high use, 4%. The shape and distribution of presepsis trajectories were similar in all three cohorts. In the derivation cohort, 90-day mortality differed by presepsis trajectory as follows: 38% (low use), 63% (rising use), and 48% (high use) (P < 0.001). This association persisted in the validation cohorts (P < 0.001 for each). The rising use class remained an independent predictor of mortality after adjustment for potential confounders, including detailed physiologic data.
CONCLUSIONS: In national cohorts of patients with sepsis, we have shown that several distinct paths into sepsis exist. These paths, identified by trajectories of presepsis healthcare use, are predictive of 90-day mortality.
%B Annals of the American Thoracic Society %V 16 %P 116-123 %8 2019 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30212640?dopt=Abstract %R 10.1513/AnnalsATS.201806-391OC %0 Journal Article %J Cerebrovascular Diseases Extra %D 2019 %T Pattern Recognition to Identify Stroke in the Cognitive Profile: Secondary Analyses of a Prospective Cohort Study %A Sean A. P. Clouston %A Yun Zhang %A Dylan M Smith %K Cognition %K Stroke %X Background: Stroke can produce subtle changes in the brain that may produce symptoms that are too small to lead to a diagnosis. Noting that a lack of diagnosis may bias research estimates, the current study sought to examine the utility of pattern recognition relying on serial assessments of cognition to objectively identify stroke-like patterns of cognitive decline (pattern-detected stroke, p-stroke). Methods: Secondary data analysis was conducted using participants with no reported history of stroke in the Health and Retirement Study, a large (n = 16,113) epidemiological study of cognitive aging among respondents aged 50 years and older that measured episodic memory consistently biennially between 1996 and 2014. Analyses were limited to participants with at least 4 serial measures of episodic memory. Occurrence and date of p-stroke events were identified utilizing pattern recognition to identify stepwise declines in cognition consistent with stroke. Descriptive statistics included the percentage of the population with p-stroke, the mean change in episodic memory resulting in stroke-positive testing, and the mean time between p-stroke and first major diagnosed stroke. Statistical analyses comparing cases of p-stroke with reported major stroke relied on the area under the receiver-operating curve (AUC). Longitudinal modeling was utilized to examine rates of change in those with/without major stroke after adjusting for demographics. Results: The pattern recognition protocol identified 7,499 p-strokes that went unreported. On average, individuals with p-stroke declined in episodic memory by 1.986 (SD = 0.023) words at the inferred time of stroke. The resulting pattern recognition protocol was able to identify self-reported major stroke (AUC = 0.58, 95% CI = 0.57-0.59, p < 0.001). In those with a reported major stroke, p-stroke events were detectable on average 4.963 (4.650-5.275) years (p < 0.001) before diagnosis was first reported. The incidence of p-stroke was 40.23/1,000 (95% CI = 39.40-41.08) person-years. After adjusting for sex, age was associated with the incidence of p-stroke and major stroke at similar rates. Conclusions: This is the first study to propose utilizing pattern recognition to identify the incidence and timing of p-stroke. Further work is warranted examining the clinical utility of pattern recognition in identifying p-stroke in longitudinal cognitive profiles. © 2019 The Author(s) Published by S. Karger AG, Basel. %B Cerebrovascular Diseases Extra %P 114-122 %G eng %R 10.1159/000503002 %0 Journal Article %J Innovation in Aging %D 2019 %T PATTERNS OF WEALTH TRAJECTORY IN LATER LIFE: CRITICAL PERIOD, ACCUMULATION, AND SOCIAL MOBILITY MODELS %A Chen, Yu-Chih %A So Jung Park %A Morrow-Howell, Nancy %K modeling %K social mobility %K Wealth %K wealth trajectory %X Wealth, an important financial cushion for older adults to buffer economic stress, requires a longer time to accumulate and develop in one’s course of life. However, little is known about the trajectories of wealth in later life, and how the life course socioeconomic status (SES) may contribute to the development of wealth at old-age. This study investigated longitudinal patterns of wealth trajectory and whether SES across the life course affects these trajectories using critical period, accumulation, and social mobility models. Using data from 16,189 adults aged 51 and older from the 2004-2014 Health and Retirement Study, a growth mixture model was used to explore distinct wealth trajectories. Impacts of life course models were studied using multinomial logistic regression. Results showed that four heterogeneous latent classes of wealth were identified: Stable high (reference group), Low and increasing, Stable low, and High but decline. Disadvantaged adulthood SES, accumulated exposure to socioeconomic risks, and downward or persistent socioeconomic disadvantage over the life course were associated with Stable low, Low and increasing, and High but decline, supporting all three life course mechanisms on wealth development in later life. Evidence suggests that wealth development is heterogeneous across individuals, and a strong gradient effect of life-course SES on wealth trajectories are clearly observed. Programs and policies should address the effects of life course on wealth development to strengthen the economic well-being in later life. %B Innovation in Aging %V 3 %P S382 - S382 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840301/ %N Suppl 1 %! Innov Aging %0 Web Page %D 2019 %T People Who Survive Cancer May Be Less Likely to Develop Alzheimer’s %A Citroner, George %K Alzheimer's disease %K Cancer %B Healthline %I Healthline %C San Francisco, CA %G eng %U https://www.healthline.com/health-news/people-whove-had-cancer-may-be-less-likely-to-develop-alzheimers %0 Journal Article %J BIODEMOGRAPHY AND SOCIAL BIOLOGY %D 2019 %T Perceived neighborhood social cohesion and cardiometabolic risk: a gene x environment study %A Jennifer W Robinette %A Jason D Boardman %A Eileen M. Crimmins %K BODY-MASS INDEX; BLOOD-PRESSURE; OBESITY; DETERMINANTS; PREDICTION; %X People living in socially cohesive neighborhoods generally have better health. We extend this research by evaluating the hypothesis that perceived neighborhood cohesion may influence health by attenuating genetic liability for cardiometabolic risk factors. Using data from the Health and Retirement Study (n = 6615; mean age 69.7), we conducted a gene x environment interaction study hypothesizing that perceived neighborhood cohesion would attenuate the link between polygenic scores for waist-to-hip ratio (WHR) and body mass index and a measure of multisystem cardiometabolic risk (systolic and diastolic blood pressure, heart rate, A1c, C-reactive protein, and total and high-density lipoprotein cholesterol). In support of the hypothesis, results indicated that among people perceiving low neighborhood cohesion, higher WHR polygenic scores were associated with greater cardiometabolic risk. In contrast, the genetic-cardiometabolic risk link was much attenuated among those living in neighborhoods perceived as socially cohesive. Our results support community-level interventions to enhance the social cohesiveness of individuals' neighborhoods which may provide health benefits by reducing the risks associated with known genetic risk factors. %B BIODEMOGRAPHY AND SOCIAL BIOLOGY %V 65 %P 1-15 %G eng %N 1 %R 10.1080/19485565.2019.1568672 %0 Journal Article %J Journal of Women & Aging %D 2019 %T Perceived neighborhood social disorder as a predictor of depressive symptoms among unmarried older women and the stress-buffering effect of friends support. %A Cho, Seungjong %A Aloen L. Townsend %K Depressive symptoms %K friends support %K No terms assigned %K Perceived neighborhood social disorder %K unmarried older women %X The current study examined whether perceived neighborhood social disorder predicted depressive symptoms among unmarried older women (N = 823) drawn from the 2016 Health and Retirement Study. This study also tested the stress-buffering effect of friends support. A negative binomial regression model showed that higher perceived neighborhood social disorder was associated with higher depressive symptoms. The number of close friends was a significant factor, but no stress-buffering effect of friends support was identified. This study highlights the adverse effect of negative perceptions of the neighborhood social environment on unmarried older women’s depressive symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved) %B Journal of Women & Aging %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31635542 %R 10.1080/08952841.2019.1682922 %0 Journal Article %J Journal of the American Geriatrics Society %D 2019 %T Perceived Stress, Social Support, and Dry Mouth Among US Older Chinese Adults %A Mao, Weiyu %A Chen, Yiwei %A Bei Wu %A Ge, Shaoqing %A Yang, Wei %A Iris Chi %A Dong, XinQi %K Dry Mouth %K Stress %K US Chinese Adults %X OBJECTIVESDry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We conducted a study to examine the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the potential moderating role of social support and social strain from different sources in the relationship.DESIGNCross‐sectional analysis.SETTINGBaseline of the Population Study of Chinese Elderly in Chicago, a community‐engaged, population‐based longitudinal study of health and well‐being among community‐dwelling US older Chinese adults.PARTICIPANTSIndividuals 60 years or older (N = 3157).MEASUREMENTSPerceived stress was measured by the 10‐item Chinese Perceived Stress Scale to evaluate the degree to which life situations were perceived as stressful during the preceding month on a 5‐point scale, ranging from 0 (“never”) to 4 (“very often”). Dry mouth was a binary self‐reported outcome variable (1 = “dry mouth”). Social support was measured by the Health and Retirement Study's social support and strain scale from sources including spouse, other family members, and friends with a 3‐point response set, ranging from 0 (“hardly ever”) to 2 (“often”). Sociodemographics and disease processes were assessed as covariates. We conducted stepwise logistic regressions with interaction terms.RESULTSHaving higher levels of perceived stress was significantly associated with a higher likelihood of reporting dry mouth (odds ratio = 1.03; 95% confidence interval = 1.02‐1.04). The effect of perceived stress on dry mouth may vary by levels of family and friend support.CONCLUSIONPerceived stress may influence dry mouth either directly or indirectly. To prevent or reduce dry mouth, in addition to disease processes, interventions need to consider psychosocial factors in dry mouth, especially perceived stress and social support, in this growing population. J Am Geriatr Soc 67:S551–S556, 2019.OBJECTIVESDry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We conducted a study to examine the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the potential moderating role of social support and social strain from different sources in the relationship.DESIGNCross‐sectional analysis.SETTINGBaseline of the Population Study of Chinese Elderly in Chicago, a community‐engaged, population‐based longitudinal study of health and well‐being among community‐dwelling US older Chinese adults.PARTICIPANTSIndividuals 60 years or older (N = 3157).MEASUREMENTSPerceived stress was measured by the 10‐item Chinese Perceived Stress Scale to evaluate the degree to which life situations were perceived as stressful during the preceding month on a 5‐point scale, ranging from 0 (“never”) to 4 (“very often”). Dry mouth was a binary self‐reported outcome variable (1 = “dry mouth”). Social support was measured by the Health and Retirement Study's social support and strain scale from sources including spouse, other family members, and friends with a 3‐point response set, ranging from 0 (“hardly ever”) to 2 (“often”). Sociodemographics and disease processes were assessed as covariates. We conducted stepwise logistic regressions with interaction terms.RESULTSHaving higher levels of perceived stress was significantly associated with a higher likelihood of reporting dry mouth (odds ratio = 1.03; 95% confidence interval = 1.02‐1.04). The effect of perceived stress on dry mouth may vary by levels of family and friend support.CONCLUSIONPerceived stress may influence dry mouth either directly or indirectly. To prevent or reduce dry mouth, in addition to disease processes, interventions need to consider psychosocial factors in dry mouth, especially perceived stress and social support, in this growing population. J Am Geriatr Soc 67:S551–S556, 2019. %B Journal of the American Geriatrics Society %V 67 %P S551-S556 %8 2019 %@ 0002-8614 %G eng %U https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15890 %! Journal of the American Geriatrics Society %R https://doi.org/10.1111/jgs.15890 %0 Journal Article %J Psychosomatic medicine %D 2019 %T Personality and hearing acuity: Evidence from the Health and Retirement Study and the English Longitudinal Study of Ageing %A Yannick Stephan %A Angelina R Sutin %A Pauline Caille %A Antonio Terracciano %K English Longitudinal Study of Ageing %K hearing %K hearing acuity %K Personality %X OBJECTIVE:Several determinants of age-related hearing impairment have been identified, but little is known about the predictive value of psychological factors. The present study examined whether five-factor model personality traits are prospectively associated with hearing acuity in middle-aged and older adults. METHODS:Participants were adults aged 50 to 97 years (N> 10,000) drawn from the Health and Retirement Study (HRS, 2012-2016) and the English Longitudinal Study of Ageing (ELSA, 2010-2014). In each sample, personality, demographic factors, health-related behaviors, BMI, and memory function were assessed at baseline and objective hearing acuity was measured four years later. RESULTS:In both samples, higher conscientiousness and openness were associated with better hearing acuity and lower risk of impairment, whereas neuroticism was associated with a higher risk of hearing impairment. In the HRS and ELSA respectively, 1 SD higher conscientiousness and openness and 1 SD lower neuroticism were related to a 13-10%, 8-6%, and 10-13% lower likelihood of hearing impairment, respectively. In both samples, additional analyses revealed that physical activity and memory mediated the association between personality and hearing. CONCLUSIONS:The present study provides robust evidence for an association between personality traits and hearing function. The findings broaden knowledge on risk and mitigating factors for age-related hearing impairment, which has implications for the quality of life of middle-aged and older adults. %B Psychosomatic medicine %8 07/2019 %G eng %U https://europepmc.org/abstract/med/31335490 %R 10.1097/psy.0000000000000734 %0 Journal Article %J JOURNAL OF THE AMERICAN GERIATRICS SOCIETY %D 2019 %T Personality and Motoric Cognitive Risk Syndrome %A Yannick Stephan %A Angelina R Sutin %A Canada, Brice %A Antonio Terracciano %K cognitive complaint %K motoric cognitive risk %K Personality %K walking speed %X OBJECTIVES To examine whether five major personality traits are related to the motoric cognitive risk (MCR) syndrome, a pre-dementia syndrome characterized by cognitive complaints and slow gait speed. DESIGN Cross-sectional. SETTING Health and Retirement Study (HRS) and the National Health and Aging Trends Survey (NHATS). PARTICIPANTS Dementia-free older adults aged 65 to 107 years (N > 8000). MEASUREMENTS In both samples, participants provided data on personality, cognitive complaints, and measures of gait speed, as well as on demographic factors, physical activity, depressive symptoms, and body mass index (BMI). RESULTS Across the two samples and a meta-analysis, higher neuroticism was related to higher risk of MCR (combined odds ratio [OR] = 1.32; 95% confidence interval [CI] = 1.21-1.45; P < .001), whereas higher extraversion (combined OR = .71; 95% CI = .65-.79; P < .001) and conscientiousness (combined OR = .70; 95% CI = .62-.78; P < .001) were associated with a lower likelihood of MCR. Higher openness was also related to a lower risk of MCR in the HRS and the meta-analysis (combined OR = .77; 95% CI = .70-.85; P < .001), whereas agreeableness was protective only in the HRS (OR = .83; 95% CI = .74-.92; P < .001). Additional analyses indicated that physical activity, depressive symptoms, and BMI partially accounted for these associations. CONCLUSION This study adds to existing research on the factors related to the risk of MCR by showing an association with personality traits. Personality assessment may help to identify individuals who may be targeted by interventions focused on reducing the risk of MCR and ultimately of dementia. %B JOURNAL OF THE AMERICAN GERIATRICS SOCIETY %G eng %9 Article; Early Access %R 10.1111/jgs.16282, Early Access Date = {DEC 2019 %0 Journal Article %J Anthrozoös %D 2019 %T Pets in the lives of older adults: A life course perspective %A Bibbo, Jessica %A Angela L Curl %A Rebecca A Johnson %K Decision making %K Life trajectories %K Pets %X This study employed the life course perspective to investigate the convergence of two demographic shifts: the aging of the population and the increase of pet ownership. Specifically, we examined whether pet ownership, the degree of bond with a pet, and reasons for and against pet ownership differed between three age cohorts: the young-old (ages 51–64 years), older adults (ages 65–84), and the oldest-old (ages 85 and over). This study analyzed data from 1,367 respondents of the 2012 wave of the Health and Retirement Study (HRS) using bivariate statistics and multivariate regression models. We found evidence for differences in rates of pet ownership by race, ethnicity, age, number living in household, and whether someone was living with a spouse or partner, but not by gender, education, income, wealth, or health. The bond with a pet did not differ across age cohorts. Companionship was the most common reason for owning a pet across the three age groups, while concern about the resources (e.g., time and work) required of pet ownership was the most common reason for not living with a pet. Results were interpreted at the individual level using the life course perspective’s tenets of timing in lives, linked lives, and human agency, while taking the societal level tenet of historical time and place into account. While rates of pet ownership differed by age cohort, all participants reported a strong bond with their companion animal. Programs and policies can help facilitate these ongoing relationships. The life course perspective provides a useful framework to gain a deeper understanding of pet ownership and the human–animal bond throughout people’s lives. %B Anthrozoös %V 32 %P 541 - 554 %8 Apr-07-2019 %G eng %N 4 %! Anthrozoös %R 10.1080/08927936.2019.1621541 %0 Journal Article %J GeroScience %D 2019 %T Polygenic risk score for disability and insights into disability-related molecular mechanisms %A Alexander M Kulminski %A Kang, Chansuk %A Kolpakov, Stanislav A. %A Loika, Yury %A Nazarian, Alireza %A Anatoliy Yashin %A Stallard, Eric %A Culminskaya, Irina %K Disabilities %K Disability %K Polygenic risk score %X Late life disability is a highly devastating condition affecting 20% or more of persons aged 65 years and older in the USA; it is an important determinant of acute medical and long-term care costs which represent a growing burden on national economies. Disability is a multifactorial trait that contributes substantially to decline of health/wellbeing. Accordingly, gaining insights into the genetics of disability could help in identifying molecular mechanisms of this devastating condition and age-related processes contributing to a large fraction of specific geriatric conditions, concordantly with geroscience. We performed a genome-wide association study of disability in a sample of 24,068 subjects from five studies with 12,550 disabled individuals. We identified 30 promising disability-associated polymorphisms in 19 loci at p < 10−4; four of them attained suggestive significance, p < 10−5. In contrast, polygenic risk scores aggregating effects of minor alleles of independent SNPs that were adversely or beneficially associated with disability showed highly significant associations in meta-analysi %B GeroScience %8 Nov %G eng %U https://doi.org/10.1007/s11357-019-00125-8 %R 10.1007/s11357-019-00125-8 %0 Journal Article %J Innovation in Aging %D 2019 %T RACE BY AGE PATTERNS IN KIDNEY FUNCTIONING AMONG OLDER ADULTS: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY %A Ryon J. Cobb %K kidney %K kidney functioning %K race %K race-ethnicity %X The present study considers how race combines with chronological age to shape kidney function among older adults. We analyzed cross-sectional data from a nationally representative study of older adults. Our measure of kidney function derived from the cystatin C-based estimated glomerular filtration rate. We use a pattern variable to divide White and Black respondents into four groups based on their age group membership: early midlife (age 52–59), late midlife (age 60–69), young old (age 70–79), and oldest old (80s+ years). Results from our ordinary least squares models reveal that Blacks and Whites in late midlife, young old, and oldest old exhibited poorer kidney function than Whites in early midlife. Our study uncovers evidence of race by age disparities in kidney function among older adults. Future longitudinal studies will provide further insight into how and why race combines with age to pattern kidney function over time. %B Innovation in Aging %V 3 %P S354-S354 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igz038.1284 %0 Journal Article %J Alzheimer's and Dementia: Translational Research and Clinical Interventions %D 2019 %T Racial disparities and temporal trends in dementia misdiagnosis risk in the United States %A Kan Z Gianattasio %A Prather, C. %A M. Maria Glymour %A Ciarleglio, A. %A Melinda C Power %K Aged %K algorithm %K ancestry group %K Article %K Black person %K Caucasian %K Dementia %K diagnostic error %K ethnic group %K Female %K health disparity %K human %K ICD-9-CM %K major clinical study %K Male %K Medicare %K priority journal %K Retirement %K risk factor %K sensitivity analysis %K Sensitivity and Specificity %K United States %X Introduction: Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010. Methods: We linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time. Results: Non-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups. Discussion: Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted. © 2019 The Authors %B Alzheimer's and Dementia: Translational Research and Clinical Interventions %V 5 %P 891-898 %G eng %R 10.1016/j.trci.2019.11.008 %0 Journal Article %J Journal of Nursing Scholarship %D 2019 %T The Relationship Between Depression and Frailty in Community-Dwelling Older People: A Systematic Review and Meta-Analysis of 84,351 Older Adults. %A Chu, Wen %A Chang, Shu-Fang %A Ho, Hsu-Yu %A Lin, Hsiang-Chun %K depression %K Frailty %K meta-analysis %K systematic review %XOBJECTIVES: In this study we investigated the correlation between depression and frailty in older adults. Additionally, correlations among study designs (prospective vs. cross-sectional), regions, depression indices, frailty indices, covariance corrections, and sexes were explored to support the analysis.
METHODS: A systematic literature review and meta-analysis were conducted. A total of 84,351 older adults, all 65 years of age or older, were analyzed. Both authors independently extracted and examined retrieved articles. Searched keywords included "depression" or "depressive"; "frailty" or "frail"; and "older people," "elderly," "geriatric," or "senior." Articles published between January 2000 and December 2016 were searched. A literature quality assessment was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic REVIEWS AND META-ANALYSES: Systematic literature searches were conducted on the Embase, PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases, and collected studies were analyzed using a random effects model.
RESULTS: Fourteen studies on people 65 years of age or older were collected, and a correlation analysis was conducted for depression and frailty. According to the meta-analysis, the risk for frailty due to depression was nonsignificant among the subgroups for study design (p for heterogeneity = .149), region (p = .429), depression criteria (p = .934), covariate adjustment (p = .702), and frailty criteria (p = .661). Notably, the risk for frailty due to depression was significantly higher in men than in women (pooled odds ratios for men and women: 4.76 and 2.25, respectively; Qbetween χ = 9.93, p = .002).
CONCLUSION: Older adults with depression are more prone to frailty than are those without depression. Regardless of study design, region, depression index, frailty index, and covariance corrections, no significant differences were observed in the results of studies on depression and frailty in older adults. The only factor that had a significant influence was sex; older men with depression were at a higher risk for frailty than were older women with depression.
CLINICAL RELEVANCE: Depression and frailty are pertinent health concerns related to geriatric syndromes. Because older adults with depression have a high risk for frailty, nursing personnel should use a depression index as early as possible to screen for depression and further reduce the occurrence of frailty in older adults. Furthermore, based on the aforementioned differences between the sexes, special attention should be paid to older men with depression to reduce their risk for frailty.
%B Journal of Nursing Scholarship %V 51 %P 547-559 %8 2019 Sep %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31328878 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/31328878?dopt=Abstract %R 10.1111/jnu.12501 %0 Journal Article %J The Journals of Gerontology: Series B %D 2019 %T Religion, Life Expectancy and Disability-Free Life Expectancy Among Older Women and Men in the United States %A Mary Beth Ofstedal %A Chi-Tsun Chiu %A Jagger, Carol %A Saito, Yasuhiko %K Disabilities %K Gender Differences %K Mortality %K Religion %X OBJECTIVES Existing literature shows religion is associated with health and survival separately. We extend this literature by considering health and survival together using a multi-state life table approach to estimate total, disability-free and disabled life expectancy, separately for women and men, for two disability measures, and by two indicators of religion. METHOD Data come from the Health and Retirement Study (1998-2014 waves). Predictors include importance of religion and attendance at religious services. The disability measures are defined by ADLs and IADLs. Models control for sociodemographic and health covariates. RESULTS Attendance at religious services shows a strong and consistent association with life and health expectancy. Men and women who attend services at least once a week (compared to those who attend less frequently or never) have between 1.1 and 5.1 years longer total life expectancy and between 1.0 and 4.3 years longer ADL disability-free life expectancy. Findings for IADL disability are similar. Importance of religion is related to total and disabled life expectancy (both ADL and IADL), but the differentials are smaller and less consistent. Controlling for sociodemographic and health factors does not explain these associations. DISCUSSION By estimating total, disability-free and disabled life expectancy we are able to quantify the advantage of religion for health. Results are consistent with previous studies that have focused on health and mortality separately. %B The Journals of Gerontology: Series B %V 74 %P e107–e118 %G eng %U https://academic.oup.com/psychsocgerontology/article-abstract/74/8/e107/5078835?redirectedFrom=fulltext %N 8 %9 Journal %R 10.1093/geronb/gby098 %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 Journal Article %J Health Psychology %D 2019 %T Retrospective memories of parental care and health from mid- to late life. %A William J. Chopik %A Robin S. Edelstein %K Childhood %K Cognitive Ability %K Health Conditions and Status %K Memory %B Health Psychology %V 38 %P 84-93 %G eng %U http://doi.apa.org/getdoi.cfm?doi=10.1037/hea0000694http://psycnet.apa.org/psycarticles/2018-55763-001.pdf %N 1 %! Health Psychology %R 10.1037/hea0000694 %0 Journal Article %J Innovation in Aging %D 2019 %T The role of maternal relationship in the persisting effect of combat exposure. %A Dawn C Carr %A Miles G Taylor %A Meyer, Alex %A Natalie J Sachs-Ericsson %K Family Roles/Relationships %K Motherhood %K Veterans %K Well-being %XBackground and Objectives: The veteran population is aging. Combat exposure is associated with negative health and psychological outcomes in some, but not all veterans; others even appear to experience gains. One mechanism driving these varied responses might be early life relationships. This study investigated the extent to which the quality of early maternal relationships influences the association between combat exposures and life satisfaction (LS) among older male veterans.
Research Design and Methods: Data were drawn from a pooled sample of male veterans in the Health and Retirement Study who completed the 2013 Veteran Mail Survey ( = 1,160). We used ordinary least squares regression to examine the association between combat exposures (with and without exposure to death) and LS, and the moderating effect of maternal relationship quality on this association.
Results: We found a significant positive association between maternal relationship quality and LS, and a significant association of combat that was dependent on maternal relationship quality. Specifically, combat-exposed veterans with poor maternal relationship quality reported lower LS, whereas combat-exposed veterans with high relationship quality reported higher LS-relative to their noncombat-exposed counterparts. The effects of exposure to death of hazardous toxins did not mediate or moderate this relationship.
Discussion and Implications: Findings indicate that maternal relationships had a lasting influence on whether combat contributed to a positive, negative, or neutral long-term effect on wellbeing. Findings support previous studies that suggest early life factors may play an important role in the fostering of resilient health outcomes over the life course. Implications for preventative strategies in soldiers are discussed.
%B Innovation in Aging %V 3 %P igz007 %8 2019 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30972373?dopt=Abstract %R 10.1093/geroni/igz007 %0 Journal Article %J Journal of the American Geriatrics Society %D 2019 %T Self-Reported Prescription Drug Use for Pain and for Sleep and Incident Frailty %A Cil, G. %A Juyoung Park %A Bergen, A.W. %K pain %K prescription drugs %K Sleep %X OBJECTIVES: We aimed to estimate incident frailty risks of prescription drugs for pain and for sleep in older US adults. DESIGN: Longitudinal cohort. SETTING: Health and Retirement Study. PARTICIPANTS: Community-living respondents aged 65 years and older, excluding individuals who received recent treatment for cancer (N = 14 208). Our longitudinal analysis sample included respondents who were not frail at baseline and had at least one follow-up wave with complete information on both prescription drug use and frailty, or date of death (N = 7201). MEASUREMENTS: Prescription drug use for pain and sleep, sociodemographics, other drug and substance use, and Burden frailty model components. Multivariable drug use stratified hazard models with death as a competing risk evaluated frailty risks associated with co-use and single use of prescription drugs for pain and for sleep. RESULTS: Proportions endorsing prescription drug use were 22.1% for pain only, 6.8% for sleep only, and 7.7% for both indications. Burden frailty model prevalence was 41.0% and varied significantly by drug use. Among non-frail individuals at baseline, proportions endorsing prescription drug use were 14.9%, 5.6%, and 2.2% for the three indications. Prescription drug use was associated with increased risk of frailty (co-use adjusted subhazard ratio [sHR] = 1.95; 95% confidence interval [CI] = 1.6-2.4; pain only adjusted sHR = 1.58; CI = 1.4-1.8; sleep-only adjusted sHR = 1.35; CI = 1.1-1.6; no use = reference group). Cumulative incidence of frailty over 8 years for the four groups was 60.6%, 50.9%, 45.8%, and 34.1%. Sensitivity analyses controlling for chronic diseases associated with persistent pain resulted in minor risk reductions. CONCLUSION: Prescription pain and sleep drug use is significantly associated with increased incidence of frailty. Research to estimate effects of pain and sleep indications and of drug class–specific dosage and duration on incident frailty is indicated before advocating deprescribing based on these findings. © 2019 The American Geriatrics Society %B Journal of the American Geriatrics Society %V 67 %P 2474-2481 %G eng %N 12 %R 10.1111/jgs.16214 %0 Web Page %D 2019 %T Seniors who feel their life has purpose may live longer %A Carroll, Linda %K Longevity %K News %K Purpose in life %B Reuters %I Reuters %C Canary Wharf %G eng %U https://www.reuters.com/article/us-health-longevity-purpose/seniors-who-feel-their-life-has-purpose-may-live-longer-idUSKCN1SU2DM %0 Journal Article %J Health Economics %D 2019 %T Smoking, life expectancy, and chronic disease in South Korea, Singapore, and the United States: A microsimulation model %A Kim, Daejung %A Chen, Cynthia %A Tysinger, Bryan %A Park, Sungchul %A Chong, Ming Zhe %A Wang, Lijia %A Zhao, Michelle %A Yuan, Jian-Min %A Koh, Woon-Puay %A Yoong, Joanne %A Bhattacharya, Jay %A Eggleston, Karen %K healthy aging %K heavy smokers %K KLoSA %K microsimulation %K Singapore %K smoking interventions %K South Korea %K tobacco control %X Abstract The substantial social and economic burden attributable to smoking is well-known, with heavy smokers at higher risk of chronic disease and premature mortality than light smokers and nonsmokers. In aging societies with high rates of male smoking such as in East Asia, smoking is a leading preventable risk factor for extending lives (including work-lives) and healthy aging. However, little is known about whether smoking interventions targeted at heavy smokers relative to light smokers lead to disproportionately larger improvements in life expectancy and prevalence of chronic diseases and how the effects vary across populations. Using a microsimulation model, we examined the health effects of smoking reduction by simulating an elimination of smoking among subgroups of smokers in South Korea, Singapore, and the United States. We found that life expectancy would increase by 0.2 to 1.5 years among light smokers and 2.5 to 3.7 years among heavy smokers. Whereas both interventions led to an increased life expectancy and decreased the prevalence of chronic diseases in all three countries, the life-extension benefits were greatest for those who would otherwise have been heavy smokers. Our findings illustrate how smoking interventions may have significant economic and social benefits, especially for life extension, that vary across countries. %B Health Economics %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3978 %R 10.1002/hec.3978 %0 Journal Article %J Journal of Aging and Health %D 2019 %T Spousal breadwinning across 30 years of marriage and husbands' health: A gendered life course stress approach. %A Kristen W Springer %A Lee, Chioun %A Deborah Carr %K Gender Differences %K Income %K Marriage %K Women and Minorities %XOBJECTIVE: Wives increasingly outearn their husbands, and gender relations theory suggests this arrangement may undermine men's well-being. We explore how long-term histories of spousal breadwinning may be associated with older men's self-rated mental and physical health, and risk of nine health diagnoses.
METHOD: Using 30 years of couple-level income data from the Health and Retirement Study ( n = 1,095 couples), we use latent class analyses to identify six classes that differ with respect to the timing and level of wife breadwinning. We link these classes to older husbands' later-life health.
RESULTS: Classes that transitioned from husband breadwinning to wife breadwinning in early or later adulthood were associated with husbands' poorer overall physical health and risk of cardiometabolic and stress-related diseases. Patterns persist net of sociodemographics, depressive symptoms, health behaviors, and adolescent health.
DISCUSSION: Violating cultural expectations, such as the masculinity ideal of male breadwinning, is associated with older men's poorer health.
%B Journal of Aging and Health %V 31 %P 37-66 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28782397?dopt=Abstract %R 10.1177/0898264317721824 %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 Advances in Life Course Research %D 2019 %T Stress and salivary telomere length in the second half of life: A comparison of life-course models %A Willis, Margaret %A Ursula M. Staudinger %A Factor-Litvak, Pam %A Calvo, Esteban %K Biomarkers %K Depressive symptoms %K Telomeres %B Advances in Life Course Research %V 39 %P 34-41 %G eng %! Advances in Life Course Research %R 10.1016/j.alcr.2019.02.001 %0 Thesis %B Clinical Psychology and Industrial-Organizational Psychology %D 2019 %T Successful Aging among Bridge Employment Workers %A Campbell,Tiffany C. %K 0624:Occupational psychology %K 0703:Organizational behavior %K Bridge employment %K Full retirement %K Occupational psychology %K Organizational behavior %K Psychology %K Social Sciences %K Successful aging %X As life expectancy rates expand and health care advancements continue to improve, countless older workers have the capacity to work in older age, and many are opting to participate in bridge employment rather than full retirement (Topa, Alcover, Moriano, & Depolo, 2014). Due to this surge in bridge employment participation, there has been an increased interest in the topic (Müller, De Lange, Weigl, Oxfart, & Van der Heijden, 2013; Munnell & Sass, 2008; Topa et al., 2014; Zhan, Wang, Liu, & Shultz, 2009). Therefore, the current study attempts to explore the experience of aging among the population of individuals who have elected to participate in bridge employment. In the current study, two of the most commonly used theoretical perspectives of successful aging: continuity theory, and resource-based dynamic theory, have been examined. Using this integrated perspective, the current study has attempts to explain the relationships between subjective socioeconomic status continuity and individual resources, and their impact on the change of successful aging over time among bridge employment workers. The analyses were conducted on data from a panel dataset collected by the Health and Retirement Study (HRS). This dataset included a large representative sample of U.S. older adults and used a longitudinal design. The analyses revealed that continuity theory is a suitable theoretical perspective to use when investigating the change of successful aging among bridge employment workers. Additionally, continuity in subjective socioeconomic status was found to have a significant, positive relationship with the level of successful aging among bridge employment workers and the change of successful aging over time. The results from the current study underscore the importance of stability in one’s sense of standing in the social hierarchy and its impact of successful aging among this population. %B Clinical Psychology and Industrial-Organizational Psychology %I Alliant International University %C San Diego %V PhD %P 167 %@ 9781392121658 %G eng %U https://search.proquest.com/docview/2226092065?pq-origsite=gscholar %9 phd %0 Thesis %B Social Work %D 2019 %T Trajectories and Patterns of Wealth in Later Life: Implications for Physical, Mental, and Cognitive Health %A Chen, Yu-shih %K health %K Wealth %X This study aims to contribute to our understanding of the longitudinal link between wealth and health in later life. Prior research on the wealth-health relationship has focused on general households, with little consideration for older adults. Further, several gaps are identified in the literature. For example, studies often utilize a shorter window of observation and treat wealth as a static measure without considering the trajectory and the heterogeneity of wealth over time. In addition, prior studies often explore the impact of wealth on a single aspect of health, ignoring the “codependent” nature of health at older ages. Further, the impacts of life course factors on the development of wealth are not often tested, and such effects are not accounted for when examining the “wealth-health” nexus, creating issues of endogeneity. Using life-cycle hypothesis, cumulative dis/advantage model, and asset-based welfare theory, this study addresses these issues by exploring how life course factors relate to wealth trajectory in later life, and investigating the longitudinal relationship between wealth and multidimensional health when life course factors are simultaneously modeled. Using latent growth curve modeling (LGCM) and latent growth mixture modeling (LGMM) via the structural equation modeling approach and generalized propensity score analysis, this study analyzes data from six biennial waves of the Health and Retirement Study (HRS), a national representative panel study of Americans aged 51 and older. This study has three research aims. It first explores the trajectory of wealth of older Americans between 2004 and 2014, and examines how life course factors correlate with wealth trajectory. Models of quadratic function and piece-wise function that allow the testing of the spline in the wealth trajectory are used as additional tests to examine the impact of the 2008 economic recession on the wealth trajectory. Second, physical, mental, and cognitive health are entered in the model to examine how health outcomes individually and jointly respond to the wealth trajectory. Finally, it uses LGMM to identify heterogeneous patterns in both wealth and health, and employs generalized propensity score analysis to explore the longitudinal associations between wealth patterns and health patterns when the effect of life course factors on wealth were modeled. This study contributes to the field methodologically and substantively. It uses novel methods to explore the trajectory and patterns of wealth in later life and examines the longitudinal wealth-health nexus by accounting for endogeneity. It offers strong evidence about the relationship between wealth and health, and provides policy and research implications for strengthening economic security and positive health at older ages. %B Social Work %I Washington University in St. Louis %V PhD %G eng %U https://openscholarship.wustl.edu/art_sci_etds/1892/ %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2019 %T Trajectories of major depression in middle-aged and older adults: A population-based study. %A Xiang, Xiaoling %A Cheng, Jianjia %K Depressive symptoms %K Health Trajectories %XOBJECTIVES: This study aimed to examine depression trajectories and correlates in a nationally representative sample of middle-aged and older adults in the United States.
METHODS: The study sample consisted of 15 661 participants aged over 50 years from the US Health and Retirement Study. Major depression was assessed using the Composite International Diagnostic Interview (CIDI-SF). Depression trajectories were identified using a group-based trajectory modeling enhanced to account for nonrandom attrition. Multinomial logistic regression was conducted to investigate predictors of depression trajectories.
RESULTS: Four depression trajectory groups were identified: "never" (85.8%), "increasing" (6.3%), "decreasing" (3.2%), and "persistently moderate/high" (4.7%). Baseline depressive symptom severity was a strong predictor of depression trajectories. Older age, male sex, and non-Hispanic African American race were associated with a lower risk of the three trajectories with small to high depression burden, whereas chronic disease count was associated with a higher risk of these trajectories. The risk of being on the increasing trajectory increased with mobility difficulties. Difficulties in household activities predicted membership in the persistently moderate/high group.
CONCLUSIONS: A small but nonignorable proportion of middle-aged and older adults have chronic major depression. Initial symptom severity and chronic disease burden are consistent risk factors for unfavorable depression trajectories and potential targets for screening and intervention.
%B International Journal of Geriatric Psychiatry %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31179582?dopt=Abstract %R 10.1002/gps.5161 %0 Journal Article %J Journal of Aging and Health %D 2019 %T Transitioning From Successful Aging: A Life Course Approach. %A Teresa M Cooney %A Angela L Curl %K Successful aging %K Well-being %XOBJECTIVE: The life course perspective and representative U.S. data are used to test Rowe and Kahn's Successful Aging (SA) conceptualization. Four sets of influences (childhood experiences, social structural factors, adult attainments, and later life behaviors) on SA transitions are examined to determine the relative role of structural factors and individual behaviors in SA.
METHOD: Eight waves of Health and Retirement Study data for 12,108 respondents, 51 years and older, are used in logistic regression models predicting transitions out of SA status.
RESULTS: Social structural factors and childhood experiences had a persistent influence on transitions from SA, even after accounting for adult attainments and later life behaviors-both of which also impact SA outcomes.
DISCUSSION: The findings on sustained social structural influences call into question claims regarding the modifiability of SA outcomes originally made in presentation of the SA model. Implications for policy and the focus and timing of intervention are considered.
%B Journal of Aging and Health %V 31 %P 528-551 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/29254405?dopt=Abstract %R 10.1177/0898264317737892 %0 Journal Article %J Aging & Mental Health %D 2019 %T Typologies of older adult companion animal owners and non-owners: moving beyond the dichotomy. %A Dawn C Carr %A Miles G Taylor %A Nancy R Gee %A Natalie J Sachs-Ericsson %K Pets %K Social Support %XOBJECTIVES: Research on the influence of companion animals (CA) on the health of older adults has yielded contradictory results. Selection factors, leading to heterogeneity both between and within groups of CA owners and non-owners, likely bias results. We conduct analyses to identify typologies of owners and non-owners.
METHODS: Using data on older adults (60+) from the 2012 Health and Retirement Study (HRS), and the HRS companion animal module, (owners = 478) and (non-owners = 624), we conducted latent class analyses (LCA). We used key demographic, health, daily engagement, and pet characteristic variables to complete our analyses.
RESULTS: Analyses revealed five clusters of CA owners and four clusters of non-owners. Health and CA related characteristics distinguishing clusters suggest important sources of variability and reflect qualitatively different profiles of owners and non-owners. We also found CA owners were more likely than non-owners to be high on neuroticism and to be less extroverted than non-owners-but again there was considerable within group variability.
IMPLICATIONS: Factors that select people into pet ownership not only work individually to characterize ownership, they create distinct typologies of CA owners and non-owners that likely contribute to subsequent health outcomes. In order to determine if having a CA is beneficial to health in later life and for whom, future research should consider selection factors like those identified in the typologies. Statistical analyses, such as LCA, that can adequately account for these selection factors is necessary to avoid biases in the interpretation of results.
%B Aging & Mental Health %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30380913?dopt=Abstract %R 10.1080/13607863.2018.1503999 %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 Aging Clinical and Experimental Research %D 2019 %T Weakness and cognitive impairment are independently and jointly associated with functional decline in aging Americans %A Ryan P McGrath %A Brenda Vincent %A Kyle J Hackney %A Soham Al Snih %A Graham, J. %A Thomas, L. %A Ehlers, D.K. %A Brian C Clark %K Cognition %K cognitive impairment %K Decline %K functional health %X Background: Discovering how certain health factors contribute to functional declines may help to promote successful aging. Aims: To determine the independent and joint associations of handgrip strength (HGS) and cognitive function with instrumental activities of daily living (IADL) and activities of daily living (ADL) disability decline in aging Americans. Methods: Data from 18,391 adults aged 50 years and over who participated in at least one wave of the 2006–2014 waves of the Health and Retirement Study were analyzed. A hand-held dynamometer assessed HGS and cognitive functioning was examined with a modified version of the Telephone Interview of Cognitive Status. IADL and ADL abilities were self-reported. Participants were stratified into four distinct groups based on their HGS and cognitive function status. Separate covariate-adjusted multilevel models were conducted for the analyses. Results: Participants who were weak, had a cognitive impairment, and had both weakness and a cognitive impairment had 1.70 (95% confidence interval (CI) 1.57–1.84), 1.97 (CI 1.74–2.23), and 3.13 (CI 2.73–3.59) greater odds for IADL disability decline, respectively, and 2.26 (CI 2.03–2.51), 1.26 (CI 1.05–1.51), and 4.48 (CI 3.72–5.39) greater odds for ADL disability decline, respectively. Discussion: HGS and cognitive functioning were independently and jointly associated with IADL and ADL disability declines. Individuals with both weakness and cognitive impairment demonstrated substantially higher odds for functional decline than those with either risk factor alone. Conclusions: Including measures of both HGS and cognitive functioning in routine geriatric assessments may help to identify those at greatest risk for declining functional capacity. © 2019, Springer Nature Switzerland AG. %B Aging Clinical and Experimental Research %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31520335 %R 10.1007/s40520-019-01351-y %0 Journal Article %J Journal of the American Medical Directors Association %D 2019 %T Weakness May Have a Causal Association With Early Mortality in Older Americans: A Matched Cohort Analysis %A Ryan P McGrath %A Brenda Vincent %A Mark D Peterson %A Donald A Jurivich %A Lindsey J Dahl %A Kyle J Hackney %A Brian C Clark %K Aging %K Epidemiology %K Geriatrics %K Hand Strength %K Muscle Strength %K sarcopenia %X Objectives Quantifying the association between muscle weakness and mortality with carefully matched cohorts will help to better establish the impact of weakness on premature death. We used a matched cohort analysis in a national sample of older Americans to determine if those who were weak had a higher risk for mortality compared with control groups with incrementally higher strength capacities. Design Longitudinal panel. Setting Detailed interviews that included physical measures were conducted in person, whereas core interviews were often performed over the telephone. Participants Data from 19,729 Americans aged at least 50 years from the 2006-2014 waves of the Health and Retirement Study were analyzed. Measures A handgrip dynamometer was used to assess handgrip strength (HGS) in each participant. Men with HGS <26 kg were considered weak, ≥26 kg were considered not weak, and ≥32 kg were considered strong. Women with HGS <16 kg were classified as weak, ≥16 kg were classified as not-weak, and ≥20 kg were classified as strong. The National Death Index and postmortem interviews determined the date of death. The greedy matching algorithm was used to match cohorts. Results Of the 1077 weak and not-weak matched pairs, 401 weak (37.2%) and 296 not-weak (27.4%) older Americans died over an average 4.4 ± 2.5-year follow-up. There were 392 weak (37.0%) and 243 strong (22.9%) persons who died over a mean 4.5 ± 2.5-year follow-up from the 1057 weak and strong matched pairs. Those in the weak cohort had a 1.40 [95% confidence interval (CI) 1.19, 1.64] and 1.54 (CI 1.30, 1.83) higher hazard for mortality relative to persons in the not-weak and strong control cohorts, respectively. Conclusions and Implications Our findings may indicate a causal association between muscle weakness and mortality in older Americans. Health care providers should include measures of HGS as part of routine health assessments and discuss the health risks of muscle weakness with their patients. %B Journal of the American Medical Directors Association %G eng %U http://www.sciencedirect.com/science/article/pii/S152586101930756X %R https://doi.org/10.1016/j.jamda.2019.10.016 %0 Journal Article %J Journal of Family and Economic Issues %D 2019 %T Wealth Management While Dealing with Memory Loss %A Cheung, Cheuk Hee %A Tansel Yilmazer %K Cognition & Reasoning %K Dementia %K Memory %K Mortality %X This study aims to understand the mechanisms through which severe memory problems could affect portfolio choice of older households. We focus on two potential mediators, cognitive ability and survival expectations, which are both expected to be adversely affected by memory disorders. Using data from the Health and Retirement Study, our findings show that cognitive ability and survival expectations are negatively associated with severe memory problems. Through the mediating role of cognitive ability, memory problems negatively affect the probability of holding risky assets, the amount of risky assets in the investment portfolios and financial wealth. Survival expectations, on the other hand, do not play a significant mediating role in portfolio allocation. In addition, the financial burden of severe memory problems does not seem to directly affect portfolio decisions. %B Journal of Family and Economic Issues %V 40 %P 470–485 %G eng %U https://link.springer.com/article/10.1007%2Fs10834-019-09610-w %9 Journal %! J Fam Econ Iss %R 10.1007/s10834-019-09610-w %0 Journal Article %J Journal of Personality %D 2019 %T When God is your only friend: Religious beliefs compensate for purpose in life in the socially disconnected. %A Chan, Todd %A Nicholas M Michalak %A Ybarra, Oscar %K Depressive symptoms %K Loneliness %K Purpose in life %K Religion %XOBJECTIVE: Social relationships supply purpose to life. How can socially disconnected people, who show lower levels of purpose, compensate for purpose in life? We propose that religious beliefs can compensate for the purpose in life that social relationships would otherwise provide, through providing (a) greater purpose to turn to and (b) divine figures that can substitute for social relationships.
METHOD: In three studies, we analyze three nationally representative and longitudinal data sets (N = 19,775) using moderated regression and cross-lagged panel analyses.
RESULTS: Consistent with our hypotheses, religious beliefs were of minimal influence on purpose in life for socially connected individuals, who already held higher levels of purpose than socially disconnected individuals. However, for socially disconnected individuals, being highly religious predicted higher levels of purpose in life.
CONCLUSIONS: Results suggest that although people primarily derive purpose from social relationships, socially disconnected individuals may leverage their religious beliefs for purpose and social comfort until they can reconnect.
%B Journal of Personality %V 87 %P 455-471 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30079518?dopt=Abstract %R 10.1111/jopy.12401 %0 Journal Article %J Health Economics %D 2018 %T 2SLS versus 2SRI: Appropriate methods for rare outcomes and/or rare exposures %A Basu, Anirban %A Norma B Coe %A Cole G. Chapman %K Clinical trials %K Health Care Outcomes %K Insurance %K Monte-Carlo Simulations %X This study used Monte Carlo simulations to examine the ability of the two‐stage least squares (2SLS) estimator and two‐stage residual inclusion (2SRI) estimators with varying forms of residuals to estimate the local average and population average treatment effect parameters in models with binary outcome, endogenous binary treatment, and single binary instrument. The rarity of the outcome and the treatment was varied across simulation scenarios. Results showed that 2SLS generated consistent estimates of the local average treatment effects (LATE) and biased estimates of the average treatment effects (ATE) across all scenarios. 2SRI approaches, in general, produced biased estimates of both LATE and ATE under all scenarios. 2SRI using generalized residuals minimized the bias in ATE estimates. Use of 2SLS and 2SRI is illustrated in an empirical application estimating the effects of long‐term care insurance on a variety of binary health care utilization outcomes among the near‐elderly using the Health and Retirement Study. %B Health Economics %V 27 %P 937 - 955 %8 Jan-06-2018 %G eng %U http://doi.wiley.com/10.1002/hec.v27.6http://doi.wiley.com/10.1002/hec.3647http://onlinelibrary.wiley.com/wol1/doi/10.1002/hec.3647/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fhec.3647 %N 6 %! Health Economics %R 10.1002/hec.v27.610.1002/hec.3647 %0 Journal Article %J Health Economics %D 2018 %T 2SLS vs 2SRI: Appropriate methods for rare outcomes and/or rare exposures %A Basu, Anirban %A Norma B Coe %K Health Care Outcomes %K Monte-Carlo Simulations %X Using Monte-Carlo simulations, we compare the two-stage least-squares estimator with two-stage residual inclusion estimators, with varying forms of residuals, to estimate the local average treatment effect parameter for a binary outcome and endogenous binary treatment model in the presence of binary covariates and a binary instrumental variable. We vary the rarity of both the outcome and the treatment and find different estimators to produce the least bias in different settings. We develop guidance for applied researchers and illustrate the utility of this guidance with estimating the effects of long-term care insurance on a variety of binary health care use outcomes among the near-elderly using the Health and Retirement Study. %B Health Economics %V 27 %P 937-955 %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3647 %N 6 %9 Journal %! Health Econ. %R 10.1002/hec.3490 %0 Journal Article %J The Gerontologist %D 2018 %T Activity Patterns and Health Outcomes in Later Life: The Role of Nature of Engagement %A Chen, Yu-Chih %A Putnam, Michelle %A Lee, Yung Soo %A Morrow-Howell, Nancy %K Activity engagement %K Cognition %K depression %K Self-rated health %X The health benefit of activity participation at older ages is documented in the current literature. Many studies, however, only explored the health benefits of engaging in a few activities and did not examine mechanisms connecting activity participation to health. We investigated the pathway between activity and health by testing the mediation role of the nature of engagement (physical, cognitive, and social) on physical, mental, and cognitive health of older adults.We analyzed data of 6,044 older adults from the 2010 and 2012 Health and Retirement Study linked with 2011 Consumption and Activity Mail Survey. We used latent class analysis to identify the patterns of participating in 33 activities as well as patterns of nature of engagement, and examined how these patterns were associated with cognition, depressive symptoms, and self-rated health in later life.Meaningful patterns of activity (high, medium, low, passive leisure, and working) and the nature of activity engagement (full, partial, and minimal) were identified. High and working groups, compared to the passive leisure group, showed better health and cognition outcomes. The nature of engagement mediated the relationship between activity patterns and health, especially for older adults who were either full or partially engaged.The nature of engagement may play a more important role than the activity itself in relation to health. Identifying the heterogeneity in activity engagement in later life is critical for tailoring interventions and designing programs that can improve the health of older adults. %B The Gerontologist %V 59 %P 698-708 %8 04 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/29659800 %R 10.1093/geront/gny023 %0 Journal Article %J Gerontologist %D 2018 %T Adjustment to Widowhood and Loneliness Among Older Men: The Influence of Military Service. %A Dawn C Carr %A Urena, Stephanie %A Miles G Taylor %K Bereavement %K Depressive symptoms %K Loneliness %K Men's health %K Resilience %K Veterans %K Widowhood %XBackground and Objectives: Men are at higher risk of experiencing poorer adjustment to widowhood compared to women, a transition that is associated with increased loneliness. Military service may play an important role in how men process widowhood, particularly among current cohorts of older men. The present study explores whether military experiences relate to better adjustment to widowhood, that is, reduction of loneliness associated with widowhood for men. We examine (a) whether military experience, especially exposure to death, shapes changes in loneliness following widowhood relative to those without military experience, and (b) if any observed benefits of military experience are explained by greater social engagement.
Research Design and Methods: We use the Health and Retirement Study and linked Veterans Mail Survey to address respondents while they are continuously married (T1) and at widowhood four years later (T2) using Ordinary Least Squares (OLS) regression. To address our hypotheses, we examine whether military experience without exposure to death, and/or military experience with exposure to death moderates the overall negative effect of widowhood for loneliness relative to civilians.
Results: There is a significantly lower level of loneliness among veterans with exposure to death relative to civilians who become widowed; however, veterans without exposure to death remain similar to civilian widowers. Social engagement does not explain the benefits associated with military exposures for widowers.
Discussion and Implications: Although exposure to death early in life is traumatic, our research suggests that such adversity within the specific context of the military may help enhance resilience during the transition to widowhood.
%B Gerontologist %V 58 %P 1085-1095 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28977488?dopt=Abstract %R 10.1093/geront/gnx110 %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 %XBackground: 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 Journal Article %J Neurobiology of Aging %D 2018 %T Association of telomere length with general cognitive trajectories: a meta-analysis of four prospective cohort studies %A Zhan, Yiqiang %A Clements, Mark S. %A Rosebud O. Roberts %A Vassilaki, Maria %A Druliner, Brooke R. %A Boardman, Lisa A. %A Ronald C Petersen %A Chandra A Reynolds %A Nancy L Pedersen %A Hägg, Sara %K Cognitive Ability %K Gender Differences %K Telomeres %X To investigate the association of telomere length (TL) with trajectories of general cognitive abilities, we used data on 5955 participants from the Sex Differences in Health and Aging Study and the Swedish Adoption/Twin Study of Aging in Sweden, and the Mayo Clinic Study of Aging, and the Health and Retirement Study in the United States. TL was measured at baseline, while general cognitive ability was assessed repeatedly up to 7 occasions. Latent growth curve models were used to examine the associations. One standard deviation increase of TL was associated with 0.021 unit increase (95% confidence interval [CI]: 0.001, 0.042) of standardized mean general cognitive ability. After controlling for sex, the point estimate remained similar (0.019) with a wider CI (95% CI: 0.002, 0.039). The association was attenuated with adjustment for educational attainment (0.009, 95% CI: 0.009, 0.028). No strong evidence was observed for the association of TL and decline in general cognitive ability. Longer TL was associated with higher general cognitive ability levels in the age-adjusted models but not in the models including all covariates, nor with cognitive decline. %B Neurobiology of Aging %V 69 %P 111 - 116 %8 Jan-09-2018 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S019745801830160Xhttps://api.elsevier.com/content/article/PII:S019745801830160X?httpAccept=text/xmlhttps://api.elsevier.com/content/article/PII:S019745801830160X?httpAccept=text/plain %! Neurobiology of Aging %R 10.1016/j.neurobiolaging.2018.05.004 %0 Journal Article %J Social Work in Public Health %D 2018 %T Awareness of the Medicare Part D Low-Income Subsidy among Older non-Hispanic Blacks and Hispanics. %A Bakk, Louanne %A Tamara J. Cadet %K Medicare Part D %K Medicare/Medicaid/Health Insurance %K Racial/ethnic differences %X Using nationally representative data from the Health and Retirement Study, this study examined (1) whether awareness of the Medicare Part D Low-Income Subsidy (LIS) varies by race and ethnicity among beneficiaries age 65 and older (N = 1,504), and (2) the impact of factors associated with health benefits knowledge and need for assistance on LIS awareness. Logistic regression results showed that compared with older non-Hispanic Whites, older non-Hispanic Blacks (odds ratio [OR] = .61, p < .001) and Hispanics (OR = .55, p < .01) were less likely to be aware of the LIS. Ethnic differences in LIS awareness were largely explained by language or Spanish-speaking preference (OR = 1.07, p = .808). However, accounting for demographics, health and socioeconomic status, and language did not reduce racial disparities (OR = .63, p < .01). Differences in LIS awareness among racial and ethnic minority groups highlight the need for culturally and linguistically sensitive community-based education, communication, programs, and services that increase knowledge of and access to this critical support. %B Social Work in Public Health %V 33 %P 250-258 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/29694273?dopt=Abstract %R 10.1080/19371918.2018.1462285 %0 Journal Article %J American Journal of Preventive Medicine %D 2018 %T BMI and Central Obesity With Falls Among Community-Dwelling Older Adults %A Cho, Beom-Young %A Seo, Dong-Chul %A Hsien-Chang Lin %A David K Lohrmann %A Andrea K. Chomistek %K BMI %K Community-dwelling %K Falls %K Risk Factors %X Introduction: This study examined the associations of BMI category and central obesity status, with falls among community-dwelling older adults in the U.S. Methods: Data were drawn from the 2012 and 2014 U.S. Health and Retirement Study, a nationally representative longitudinal panel study funded by the National Institute of Aging. The study participants were U.S. community-dwelling older adults aged ≥65 years (N=3,383). Multiple logistic regression and Poisson regression analyses examined the associations of BMI category and central obesity (waist circumference >102 cm in men and >88 cm in women) with experiencing a fall and fall injury, after adjusting for all other covariates. A prospective analysis was conducted in which independent variables from 2012 were examined in relation to dependent variables measured in the same participants in 2014. Results: Overall, 35.2% of older adults experienced at least one fall in the past 2 years. Compared with those who were not, centrally obese older adults were more likely to experience a fall (AOR=1.37, 95% CI=1.01, 1.85) and fall more frequently (incidence rate ratio=1.15, 95% CI=1.03, 1.29). Fallers in the obese BMI category were less likely than normal-weight fallers to experience a fall injury (AOR=0.56, 95% CI=0.35, 0.91). Conclusions: These findings suggest that (1) central obesity be measured when assessing older adults' fall risk and (2) specific community prevention strategies for centrally obese older adults be developed to better prevent falls and fall-related injuries. %B American Journal of Preventive Medicine %V 54 %P e59-e66 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0749379717307523http://api.elsevier.com/content/article/PII:S0749379717307523?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0749379717307523?httpAccept=text/plain %N 4 %! American Journal of Preventive Medicine %R 10.1016/j.amepre.2017.12.020 %0 Journal Article %J Work, Aging and Retirement %D 2018 %T Is Bridge Job Activity Overstated? %A Kevin E. Cahill %A Michael D. Giandrea %A Joseph F. Quinn %E Henkens, Kene %K Bridge employment %K Employment and Labor Force %K Gender Differences %K Retirement Planning and Satisfaction %X Considerable prior research has shown that most older Americans with career employment transition to bridge jobs before exiting the labor force. One criticism of this research is that bridge job activity may be overstated because the definition of a bridge job in the existing literature does not require a change in occupation. For some, the "bridge job" may just be another in a series of job changes, and not a prelude to retirement. This article investigates the extent to which bridge jobs involve a change in occupation or a switch to part-time status, both of which may signal the start of a retirement transition, as opposed to continued career employment, albeit with a different employer. We utilize the Health and Retirement Study (HRS), a nationally representative longitudinal dataset of older Americans that began in 1992. Among HRS respondents who were on a full-time career job at the time of the first interview and who changed jobs in subsequent waves, 48% of the men and 39% of the women also changed their (two-digit) occupation at the time of their first transition. Further, when hours worked is also considered, about 3 quarters of men and women experienced a change in occupation and/or a switch from full-time to part-time status. We conclude that most career workers who changed jobs later in life did in fact do so as part of a retirement transition. Ignoring these subtleties does result in an overestimate of bridge job activity, but only a modest one. %B Work, Aging and Retirement %V 4 %P 330-351 %G eng %U https://academic.oup.com/workar/article/4/4/330/4999804http://academic.oup.com/workar/article-pdf/4/4/330/25835505/way006.pdf %N 4 %R 10.1093/workar/way006 %0 Newspaper Article %B The Washington Post %D 2018 %T Cliches about only being as old as you feel are starting to have scientific backing %A Cimons, Marlene %K News %K Optimism %B The Washington Post %C Washington, D.C. %G eng %U https://www.washingtonpost.com/national/health-science/cliches-about-only-being-as-old-as-you-feel-are-starting-to-have-scientific-backing/2018/04/13/4ccd9c4a-3125-11e8-8abc-22a366b72f2d_story.html?utm_term=.2ebefb4f43f0 %0 Journal Article %J International Journal of Behavioral Medicine %D 2018 %T Comfort Eating and All-Cause Mortality in the US Health and Retirement Study. %A Jenna R. Cummings %A Ashley E Mason %A Puterman, Eli %A A Janet Tomiyama %K BMI %K Depressive symptoms %K Health Conditions and Status %K Mortality %XPURPOSE: Comfort eating is a prevalent behavior. Prior research shows that comfort eating is associated with reduced stress responses and increased metabolic risk across adolescence, young adulthood, and middle adulthood. The purpose of the current research was to test if comfort eating prospectively predicted all-cause mortality in older adulthood.
METHOD: The US Health and Retirement Study is an ongoing, nationally representative, longitudinal study of older adults. The final sample for the present study (N = 1445) included participants randomly selected to report how often they comfort ate. Comfort eating data were collected in 2008 and all-cause mortality data were collected in 2014. Participants also reported how often they consumed high-fat/sugar food as well as their height and weight in 2008.
RESULTS: For each 1-unit increase in comfort eating, the expected odds of all-cause mortality (n = 255 deceased) decreased by 14%, OR = 0.86, p = 0.048, 95% CI [0.74, 0.99]. This analysis statistically accounted for other predictors of mortality in the sample including age, biological sex, race, highest educational degree attained, moderate and vigorous exercise, smoking, and cumulative illness. High-fat/sugar intake did not mediate (or diminish) the association but body mass index did.
CONCLUSION: Comfort eating-irrespective of consuming high-fat/sugar food-may be associated with reduced mortality in older adults because it may promote greater body mass, and greater body mass is associated with lower risk of mortality in nationally representative samples. Interventionists might consider both beneficial and detrimental aspects of comfort eating across the lifespan.
%B International Journal of Behavioral Medicine %V 25 %P 473-478 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/29243156?dopt=Abstract %R 10.1007/s12529-017-9706-8 %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 Journal of the American Geriatrics Society %D 2018 %T A Comprehensive Measure of the Costs of Caring for a Parent: Differences According to Functional Status %A Norma B Coe %A Meghan M. Skira %A Eric B Larson %K Caregiving %K Informal care %K Well-being %X Approximately 34 million family and friends provided unpaid care to individuals aged 50 and older in 2015. It is difficult to place a value on that time, because no payment is made to the caregiver, and multiplying caregiving hours by a wage does not account for the value of lost leisure time, implications for future employability and wages, or any intrinsic benefits accrued to the care provider. This study used a dynamic discrete choice model to estimate the costs of informal care provided by a daughter to her mother, including these other costs and benefits not typically accounted for, and compared these cost estimates for 4 categories of the mother's functional status: doctor-diagnosed memory-related disease, limitations in activities of daily living (ADLs), combination of both, cannot be left alone for 1 hour or more. We studied women aged 40 to 70 with a living mother at the start of the sample period (N=3,427 adult daughters) using data from the Health and Retirement Study (1998–2012). The primary outcome was the monetized change in well-being due to caregiving, what economists call “welfare costs.” We estimate that the median cost to the daughter's well-being of providing care to an elderly mother ranged from $144,302 to $201,896 over 2 years, depending on the mother's functional status. These estimates suggest that informal care cost $277 billion in 2011, 20% more than estimates that account only for current foregone wages. © 2018, Copyright the Author Journal compilation © 2018, The American Geriatrics Society %B Journal of the American Geriatrics Society %V 66 %P 2003 - 2008 %8 Jan-10-2018 %G eng %U https://pubmed.ncbi.nlm.nih.gov/30222183/ %N 10 %! J Am Geriatr Soc %R 10.1111/jgs.15552 %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 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 %XBackground: 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 B: Psychological Sciences & Social Sciences %D 2018 %T Does Becoming A Volunteer Attenuate Loneliness Among Recently Widowed Older Adults? %A Dawn C Carr %A Ben Lennox Kail %A Matz-Costa, Christina %A Yochai Z Shavit %K Bereavement %K Depressive symptoms %K Loneliness %K Volunteerism %K Widowhood %XObjectives: Loneliness is a significant public health concern, particularly for those who have lost a spouse through widowhood. This study examines whether becoming a volunteer at the time of widowhood is associated with reduction of these risks.
Method: A pooled sample of 5,882 married adults age 51+, drawn from the 2006-2014 waves of the Health and Retirement Study, was used to estimate regression models of the relationship between becoming widowed (relative to staying continuously married) and loneliness, and whether the associated loneliness of having lost a spouse is moderated by starting to volunteer (<2 hr, 2+ hr/week).
Results: Our results show that for those who become widowed, loneliness is significantly higher than those who stay continuously married. However, starting to volunteer 2+ hr per week is related to attenuated loneliness among the widowed such that widows who volunteer at that intensity have levels of loneliness similar to those of continuously married individuals volunteering at the same intensity.
Discussion: This study suggests higher intensity volunteering may be a particularly important pathway for alleviating loneliness among older adults who have recently become widowed. Results are discussed in light of theory, future research, and potential interventions.
%B Journals of Gerontology Series B: Psychological Sciences & Social Sciences %V 73 %P 501-510 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/28977483?dopt=Abstract %R 10.1093/geronb/gbx092 %0 Journal Article %J Journal of Research in Personality %D 2018 %T Does personality change following spousal bereavement? %A William J. Chopik %K Bereavement %K Marriage %K Personality %X Personality has been shown to be a large predictor of intrapersonal adjustment during the bereavement transition. However, the degree to which bereaved spouses' personalities change is relatively unclear, and extant studies that have examined this phenomenon have provided mixed results. In the current study, personality change following spousal bereavement was examined in two samples (N = 9944 and N = 535). There was little evidence for differences in mean-level changes in personality between bereaved and control participants. However, rank-order stability was considerably lower among bereaved participants over time, suggesting that personality change occurs less systematically than previously thought. The current study provides additional information about the conditions under which personality changes and suggests exciting new avenues for future research. (C) 2016 Elsevier Inc. All rights reserved. %B Journal of Research in Personality %V 72 %P 10-21 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0092656616301076http://api.elsevier.com/content/article/PII:S0092656616301076?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0092656616301076?httpAccept=text/plain %! Journal of Research in Personality %R 10.1016/j.jrp.2016.08.010 %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 %XObjectives: 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 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 %XOBJECTIVES: 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 Journals of Gerontology Series B: Psychological Sciences & Social Sciences %D 2018 %T Educational Differences in the Prevalence of Dementia and Life Expectancy with Dementia: Changes from 2000 to 2010. %A Eileen M. Crimmins %A Saito, Yasuhiko %A Jung K Kim %A Yuan S Zhang %A Sasson, Isaac %A Mark D Hayward %K Dementia %K Education %K Mortality %XObjectives: This article provides the first estimates of educational differences in age-specific prevalence, and changes in prevalence over time, of dementia by education levels in the United States. It also provides information on life expectancy, and changes in life expectancy, with dementia and cognitively healthy life for educational groups.
Method: Data on cognition from the 2000 and 2010 Health and Retirement Study are used to classify respondents as having dementia, cognitive impairment without dementia (CIND), or being cognitively intact. Vital statistics data are used to estimate life tables for education groups and the Sullivan method is used to estimate life expectancy by cognitive state.
Results: People with more education have lower prevalence of dementia, more years of cognitively healthy life, and fewer years with dementia. Years spent in good cognition increased for most sex-education groups and, conversely, years spent with dementia decreased for some. Mortality reduction was the most important factor in increasing cognitively healthy life. Change in the distribution of educational attainment has played a major role in the reduction of life with dementia in the overall population.
Discussion: Differences in the burden of cognitive loss by education point to the significant cost of low social status both to individuals and to society.
%B Journals of Gerontology Series B: Psychological Sciences & Social Sciences %V 73 %P S20-S28 %G eng %N suppl_1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29669097?dopt=Abstract %R 10.1093/geronb/gbx135 %0 Journal Article %J Economics & Human Biology %D 2018 %T The effect of cancer on the labor supply of employed men over the age of 65 %A Candon, David %K Cancer %K Employment and Labor Force %K Gender Differences %X This paper investigates the relationship between cancer diagnosis and the labor supply of employed men over the age of 65. While almost 60% of male cancers are diagnosed in men over the age of 65, no previous research has examined the effect that cancer has on this age group, which is surprising given the relevance of this group to public policy. With data from the Health and Retirement Study, I show that cancer has a significant negative effect on the labor supply of these workers. Using a combination of linear regression models and propensity score matching, I find that respondents who are diagnosed with cancer work 3 fewer hours per week than their non-cancer counterparts. They are also 10 percentage points more likely to stop working. This reduction seems to be driven by a deterioration in physical and mental health. %B Economics & Human Biology %V 31 %P 184-199 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S1570677X17302605https://api.elsevier.com/content/article/PII:S1570677X17302605?httpAccept=text/xmlhttps://api.elsevier.com/content/article/PII:S1570677X17302605?httpAccept=text/plain %! Economics & Human Biology %R 10.1016/j.ehb.2018.08.010 %0 Journal Article %J Journal of Immunological Methods %D 2018 %T Effect of delayed cell processing and cryopreservation on immunophenotyping in multicenter population studies. %A Bharat Thyagarajan %A Barcelo, Helene %A Eileen M. Crimmins %A David R Weir %A Minnerath, Sharon %A Vivek, Sithara %A Jessica Faul %K Cell Separation %K Cryopreservation %K Immunophenotyping %K Leukocytes %K Time Factors %XVariability induced by delayed cell processing and cell cryopreservation presents unique challenges for immunophenotyping in large population studies. We conducted a pilot study to evaluate the effect of delayed cell processing and cryopreservation on cell percentages obtained by immunophenotyping. We collected blood from 20 volunteers and compared the effect of (a) delayed cell processing up to 72 h (b) cryopreservation and (c) the combined effect of delayed cell processing and cryopreservation on immunophenotyping of 31 cell subsets that included several subsets of T, B, Natural Killer (NK) cells, monocytes and dendritic cells using both whole blood collected in EDTA tubes and peripheral blood mononuclear cells collected in CPT tubes. We found the delayed cell processing up to 72 h or cryopreservation alone did not significantly affect the percentages T cells, dendritic cells or monocytes but significantly increased the percentage of B cells and NK cells (p for trend ≤0.01) but. However combination of delayed cell processing up to 72 h and cryopreservation significantly increased the percentage of T cells as compared to cells processed immediately (p for trend <0.0001) while a delayed cell processing followed by cryopreservation decreased the percentage of NK cells (p for trend <0.0001). Total B-cells increased significantly with a 24-48 h delay in cell processing and cryopreservation but not at 72 h. The percentages of monocytes and dendritic cells remained unaffected by the combination of delayed cell processing and cryopreservation. These findings suggest that immunophenotyping of several immune cell subsets can be successfully implemented in large population studies as long as blood is processed within 48 h of biospecimen collection though some cell subsets may be more susceptible to a combination of delayed cell processing and cryopreservation.
%B Journal of Immunological Methods %V 463 %P 61-70 %G eng %R 10.1016/j.jim.2018.09.007 %0 Journal Article %J Regional Science and Urban Economics %D 2018 %T The effect of housing wealth shocks on work and retirement decisions %A Jaclene Begley %A Sewin Chan %K Housing wealth %K Retirement %K Retirement reversals %K Social Security %K Unanticipated shocks %X Using panel data from 2000 to 2012, we show that unanticipated zip code-level shocks to home values affect retirement, retirement reversals, and Social Security claims. Among older men, homeowners experiencing moderately negative housing price shocks are less likely to retire, more likely to reverse retirement in some cases, and more likely to delay claiming Social Security relative to those experiencing positive shocks. We find similar responses among specific subgroups of older women, though not in general. Overall, our results imply that adverse housing shocks have substantial influence on labor market participation for older individuals. %B Regional Science and Urban Economics %V 73 %P 180 - 195 %G eng %U http://www.sciencedirect.com/science/article/pii/S0166046217302211 %R https://doi.org/10.1016/j.regsciurbeco.2018.10.001 %0 Journal Article %J Psychology and Aging %D 2018 %T The effects of work–family experiences on health among older workers. %A Eunae Cho %A Tuo-Yu Chen %K Disabilities %K Employment and Labor Force %K Family Roles/Relationships %K Work-life balance %X With the rapidly aging workforce worldwide, the need to retain healthy older workers is greater than ever. To promote health among older workers, a better understanding of the factors that contribute to their health is crucial. With this in mind, we investigated the impact of work-family conflict and work-family enrichment on older workers' health. Five waves of longitudinal data from the Health and Retirement Study were used. A total of 4,509 workers aged 55 years and older at baseline were included. Multilevel modeling was conducted to analyze the data. Our findings showed that greater work-to-family conflict was related to higher comorbidity and greater disability over time, controlling for other known predictors of health (employment status, total household income, living arrangement, marital status, depressive symptoms, and baseline demographic characteristics). No other work-family variables significantly predicted the health outcomes. Comorbidity and disability were also found to predict work-to-family conflict. Using five waves of longitudinal data, our research showed that work that interferes with family negatively affects older workers' physical and functional health and that health relates to work-to-family conflict. Given the growing number of older workers and changing work and family situations, continued monitoring of work-family experiences among older workers is warranted. %B Psychology and Aging %V 33 %P 993-1006 %G eng %U http://doi.apa.org/getdoi.cfm?doi=10.1037/pag0000293http://psycnet.apa.org/psycarticles/2018-50330-001.pdf %N 7 %! Psychology and Aging %R 10.1037/pag0000293 %0 Journal Article %J Journal of Behavioral Finance %D 2018 %T Eliciting Stock Market Expectations: The Effects of Question Wording on Survey Experience and Response Validity %A Chin, Alycia %A Bruine De Bruin, Wändi %K Financial literacy %K Meta-analyses %K Survey Methodology %K Validation %X Expectations about stock market movements are an important factor in models of investments and savings. To better understand consumers' financial behavior, economic surveys such as the Health and Retirement Study (HRS) ask participants to report expectations about the stock market. However, readability statistics suggest that the HRS' stock market expectations questions use relatively complex wording, which may contribute to their relatively high rates of missing responses. Here, the authors build on survey design research to improve the readability of these questions. In 2 experiments using national online panels, they test whether revising stock market expectation questions to reduce their difficulty affects respondents' (1) survey experience, as measured by percent of missing answers and ratings of question clarity and difficulty, and (2) response validity, as assessed by respondents' confidence in their answer and comparisons between expectations and stock market outcomes. In both studies, the authors' revisions improved survey experience. Unfortunately, revisions also decreased the perceived (Study 1) and actual (Study 2) validity of responses. The authors discuss implications of question revisions for the design of economic surveys. %B Journal of Behavioral Finance %V 19 %P 101-110 %G eng %U https://www.tandfonline.com/doi/full/10.1080/15427560.2017.1373353https://www.tandfonline.com/doi/pdf/10.1080/15427560.2017.1373353 %N 1 %! Journal of Behavioral Finance %R 10.1080/15427560.2017.1373353 %0 Thesis %B Depertment of Economics %D 2018 %T Essays on Elderly Decision Making %A Chakravorty, Arpita %K Decision making %X The dissertation consists of two studies on decision making of the elderly in India and the United States. The first study uses data from the India Human Development Survey (IHDS), a nationally representative survey in India, to examine the effect of pension on the health and labor market decisions of individuals above 50 years. The study also examines its effect on the health of young children living with the pension beneficiaries. In particular, I examine the impact of the 2011 expansion of the Indira Gandhi National Old Age Pension Scheme on the labor and health outcomes of the elderly and co-residing grandchildren. The results suggest that elderly men and women work less as a result of pension from this program, with no detectable impact on their health status. I also compare the oldest individual above and below the state cutoff and those before and after the pension expansion, to find that children aged 0 to 5 years living with their grandmothers have better health than those living with grandfathers. The second study explores the relationship between home equity and risk preferences of individuals above 50 year using the restricted panel dataset of the Health and Retirement Study between 1992 and 2014. Risk aversion is measured using hypothetical income gamble questions asked every two years between 1998 and 2006. I also examine the effect of home equity on portfolio allocation of these individuals. Following earlier literature, I define home equity as the difference between self-reported property value and mortgage, and use the zip code level housing prices to examine the causal relationship between home equity and risk aversion. The results suggest that an increase in home equity decreases risk aversion, but the effect is not significant. %B Depertment of Economics %I University of Houston %C Houston, United States %V Doctor of Philosophy %P 111 %8 05/2018 %G eng %9 Dissertation %0 Journal Article %J Health Psychology %D 2018 %T An examination of dyadic changes in optimism and physical health over time. %A William J. Chopik %A Eric S Kim %K Couples %K Longitudinal data %K Mortality %K Optimism %K Psychosocial %X Objective: Having a partner high in optimism is associated with better health in older adults. However, partners, just like individuals, are not static entities and likely change considerably over time. The current study examined whether changes in one person's optimism was associated with corresponding changes in his or her partner's health over a 4-year period. Method: We employed a sample of 2,758 heterosexual couples (5,516 individuals; M-age = 65.81, SD = 9.00), married an average of 36.06 years. Median level of education was at least a high school education (13.0% had less than a high school education; 56.1% had a high school education; 30.9% had at least some college education). Both couple members filled out measures of optimism and health twice over a 4-year period. Results: Having a partner high in optimism at baseline was associated with increases in an actor's optimism 4 years later, r = .08, p < .001. Baseline self-rated health and chronic illness of actors and their partners were mostly unrelated to changes in optimism. However, actor (rs > .05) and partner (rs > .03) changes in optimism were associated with changes in self-rated health and chronic illnesses over time. There was also some evidence for an interaction effect (rs > .03), such that the worst outcomes were experienced among couples in which both members decreased in optimism. Conclusion: This is the first study to examine how changes in psychological characteristics are associated with changes in health within and across romantic partners. Possible mechanisms are discussed. %B Health Psychology %V 37 %P 42-50 %G eng %U http://doi.apa.org/getdoi.cfm?doi=10.1037/hea0000549http://psycnet.apa.org/journals/hea/37/1/42.pdf %N 1 %! Health Psychology %R 10.1037/hea0000549 %0 Report %D 2018 %T Exploring the Rise of Mortgage Borrowing among Older Americans %A Collins, J. Michael %A Hembre, Erik %A Urban, Carly %K Financial Health %K Homeownership %K Mortgages %K Retirement Planning and Satisfaction %X This paper documents and examines the rise in mortgage usage among older Americans over the past 30 years. It uses data from a variety of sources including the Health and Retirement Study, Decennial Census, American Community Survey, Survey of Consumer Finances, and the American Housing Survey. We begin by documenting the large increase in mortgage usage among older Americans across age and income distributions. We then use regression analysis to test for causes of the mortgage increase and subgroup heterogeneity, in particular focusing on changing health, bequest motives, and tax policy incentives. This paper found that: Americans over age 60 are more than three times as likely to have mortgage debt in 2015 compared to 1980, a 24-percentage point increase. This is a consistent increase across the income distribution.Increases to homeownership account for some of the rise in mortgages, but this has increased by only 9 percentage points among Americans over age 60 between 1980 and 2015.Younger age groups have had much smaller increases, and sometimes decreases, in mortgage usage and homeownership over the same time period.Changes in household characteristics, such as education, urbanization, race, income, and marriage rates explain only a small portion of the increase in mortgage rates. Households with below-median assets, and those without pensions, account for a greater share of the rise in older households’ mortgage borrowing. Changes in subjective health and bequest motives explain little of the rise in mortgage rates. Variation in the mortgage interest deduction explains part of the differential increase in mortgage usage by age. The policy implications of the paper are: Policymakers should be aware that the beneficiaries of mortgage and homeownership subsidies, such as the mortgage interest deduction, have changed substantially over the past 30 years.Increased mortgage usage has coincided with less total debt among seniors relative to younger cohorts and has not resulted in increased delinquency. This may indicate that the negative aspects of increased mortgage usage are limited. Further investigation into the causes and consequences of mortgage usage is needed in considering appropriate policy responses. %B Center for Retirement Research at Boston College Working Paper Series %I Center for Retirement Research at Boston College %C Chestnut Hill %8 05/2018 %G eng %U http://crr.bc.edu/working-papers/exploring-the-rise-of-mortgage-borrowing-among-older-americans/ %0 Journal Article %J Korean Journal of Adult Nursing %D 2018 %T Factors associated with the decision to withhold life-sustaining treatments among middle-aged and older adults who die in hospital %A Cheon, Jooyoung %K Advance care planning %K Decision making %K Hospitalization %X Purpose: As advanced medical care has resulted in the unintended consequence of prolonging deaths, there is a growing interest in the decision to withhold life-sustaining treatments. The purpose of this study was to determine factors associated with the decision to withhold life-sustaining treatments in middle-aged and older adults who die in hospital in the United States. Methods: This cross-sectional correlational study conducted secondary analysis of 2000-2012 exit interview data from the Health and Retirement Study. Adults aged 50 and older who died in hospital and who had made a decision regarding life-sustaining treatments were included. Multivariable logistic regression was used to identify factors related to the decision to withhold life-sustaining treatments. Results: Among 1,412 adults, the prevalence of the decision to withhold life-sustaining treatments was 61.1%. Significant factors associated with the decision to withhold life-sustaining treatments were being African American (Adjusted Odds Ratio [AOR]=0.50, 95% Confidential Interval [CI]=0.30~0.86), Catholic (AOR=0.5, 95% CI=0.32~0.93), having at least one private insurance policy (AOR=1.40, 95% CI=1.02~1.92), having a living will (AOR=1.71, 95% CI=1.04~2.83), and having discussed end-of-life care with someone (AOR=1.810, 95% CI=1.25~2.62). Conclusion: Differences in race and religious affiliation should be considered when older adults, family members, and health care providers make decisions regarding life-sustaining treatments at the end-of-life. Also, health insurance coverage for advance care planning makes it easier for people to discuss life-sustaining treatments with health care providers. %B Korean Journal of Adult Nursing %V 30 %P 527 %G eng %U https://synapse.koreamed.org/DOIx.php?id=10.7475/kjan.2018.30.5.527 %N 5 %! Korean J Adult Nurs %R 10.7475/kjan.2018.30.5.527 %0 Generic %D 2018 %T Family, Income, & Medicaid Policy: Multinomial Logistic Model of Long-Term Care Decisions %A Selena Caldera %K Family %K Income %K Long-term Care %K Medicaid %K medicaid beneficiaries %K Policy %X Providing care for older family members is a difficult and costly decision; in 2015, 34 million Americans provided care to an elder loved one (National Alliance for Caregiving & AARP Public Policy Institute, 2015). Formal long-term care (LTC) in a facility outside the home is expensive and caregivers that provide informal LTC at home may incur high opportunity costs, including limiting work hours or forgoing employment outside the home. Existing research focuses on this supply issue and ignores how characteristics of elders and their family members and Medicaid LTC policy jointly factor into the decision between formal and informal LTC. In this paper, I examine informal LTC in the context of all other alternatives for care (no care, informal LTC, formal LTC) and include demographic and economic measures of the elder care recipient and potential family caregivers as explanatory variables. %G eng %U https://appam.confex.com/appam/2018/webprogram/Paper26576.html %0 Newspaper Article %B The Windsor Star %D 2018 %T Feel-Good, Age-Old Cliches; Researchers find there's some truth to notion that the older we get, the better we feel %A Cimons, Marlene %K Cognitive Ability %K Dementia %K Stereotypes %X [...]there is evidence that positive attitudes about aging may reduce the risk of dementia, which among the most dreaded consequences of aging. [...]people could be perpetually pushing what is considered an older adult into the future." Researchers at the Boston University School of Public Health compared healthy and long-living children of centenarians - average age 82 - with three groups: %B The Windsor Star %C Windsor, Ontario %8 30 Apr 2018 %G eng %& You %0 Report %D 2018 %T Feeling Squeezed? Impact of Social Security Benefit Cuts on Labor Supply and Savings of the Elderly %A Christopher John Cruz %K Labor %K Labor Supply %K Savings %K Social Security %X While there is a general consensus that reforms are needed to improve the financial viability of the Social Security program, these reforms may have welfare implications — both intended and unintended — that remain unexamined. I revisit the 1983 Social Security reforms to examine how a large, potentially unanticipated wealth shock affects elderly workers. I exploit the nonlinearity in the design of the reforms to estimate causal effects on the labor supply and on the savings of older workers at different stages of the lifecycle. The identification highlights the relevance of cohort effects which tend to be assumed away in previous research Evidence suggests that among men, affected cohorts responded by altering their labor supply, but only when they were very close to retirement. Women also contributed through increased labor supply, both at the extensive and intensive margins. In addition, there is evidence that affected workers also responded through higher savings prior to retirement. Nonetheless, the Social Security amendments appear to have disproportionate effects, with some lowereducated workers remaining in the labor force in later years. Enhancing public understanding of the implications of future reforms could mitigate potentially adverse effects particularly on vulnerable subpopulations. %I University of Illinois at Chicago %G eng %U http://www.christopherjohncruz.com/uploads/1/1/2/3/112318225/cruz_jpm2_socsec.pdf %0 Journal Article %J Support Care Cancer %D 2018 %T Financial and socio-economic factors influencing pre- and post-cancer therapy oral care. %A Derek K Smith %A Emily H. Castellanos %A Barbara A Murphy %K Cancer screenings %K Dental Care %K Finances %K Health Conditions and Status %K Socioeconomic factors %XPURPOSE: The primary objective of this study is to evaluate how attendance at dental visits may change as cancer patients move through pre-diagnosis, diagnosis, and into survivorship.
METHODS: The Health and Retirement Study consists of longitudinal survey data collected biannually detailing financial and health information in subjects over 51 years old. We assessed a subset of 4195 patients who received a new cancer diagnosis during the study period. The odds of reporting a dental visit were examined using a mixed effects logistic regression model. A propensity score weighted analysis of the association between dental attendance and survival was also undertaken.
RESULTS: The odds of attending a dental visit were substantially lower in the peri-diagnosis period OR = 0.784 (0.700, 0.876) and the post-diagnosis period OR = 0.734 (0.655, 0.823) compared to pre-diagnosis. This effect persisted in patients who survived for at least 2 years indicating that the decline in oral health visits was not due to low expected survival. After propensity score weighting, patients who attended a dental visit in the peri-diagnosis period demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance.
CONCLUSIONS: Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy despite guideline recommendations encouraging dental referral and monitoring for many types of cancer therapy. Attendance at dental appointments during cancer therapy is associated with improved survival, which is likely due to a combination of direct and indirect effects.
%B Support Care Cancer %V 26 %P 2143-2148 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/29372394?dopt=Abstract %R 10.1007/s00520-017-4033-9 %0 Newspaper Article %B The New York Times %D 2018 %T For a Better Marriage, Act Like a Single Person %A Coontz, Stephanie %K Couples %K Interviews %K News %B The New York Times %C New York City %V 02/11/2018 %P SR6 %8 02/11/2018 %G eng %U https://www.nytimes.com/2018/02/10/opinion/sunday/for-a-better-marriage-act-like-a-single-person.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region®ion=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region %& SR %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 %XHere 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 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 Molecular Psychiatry %D 2018 %T A genome-wide association study for extremely high intelligence %A Zabaneh, D %A Krapohl, E %A Gaspar, H A %A Curtis, C %A Lee, S H %A Patel, H %A Newhouse, S %A Wu, H M %A Simpson, M A %A Putallaz, M %A Lubinski, D %A Plomin, R %A Breen, G %K Cognitive Ability %K Education %K Genome %K Hereditary %K Humans %X We used a case-control genome-wide association (GWA) design with cases consisting of 1238 individuals from the top 0.0003 (~170 mean IQ) of the population distribution of intelligence and 8172 unselected population-based controls. The single-nucleotide polymorphism heritability for the extreme IQ trait was 0.33 (0.02), which is the highest so far for a cognitive phenotype, and significant genome-wide genetic correlations of 0.78 were observed with educational attainment and 0.86 with population IQ. Three variants in locus ADAM12 achieved genome-wide significance, although they did not replicate with published GWA analyses of normal-range IQ or educational attainment. A genome-wide polygenic score constructed from the GWA results accounted for 1.6% of the variance of intelligence in the normal range in an unselected sample of 3414 individuals, which is comparable to the variance explained by GWA studies of intelligence with substantially larger sample sizes. The gene family plexins, members of which are mutated in several monogenic neurodevelopmental disorders, was significantly enriched for associations with high IQ. This study shows the utility of extreme trait selection for genetic study of intelligence and suggests that extremely high intelligence is continuous genetically with normal-range intelligence in the population. %B Molecular Psychiatry %V 23 %P 1226 - 1232 %8 Apr-05-2018 %G eng %U http://www.nature.com/doifinder/10.1038/mp.2017.121http://www.nature.com/doifinder/10.1038/mp.2017.121 %N 5 %! Mol Psychiatry %R 10.1038/mp.2017.121 %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 Newspaper Article %B Chicago Tribune %D 2018 %T Healthy resolutions for the year ahead %K News %K Optimism %K Reading %B Chicago Tribune %C Chicago, IL %P 1 %8 01/04/2018 %G eng %U http://www.chicagotribune.com/suburbs/advertising/newyearnewyou/ct-ss-nyny-healthy-resolutions-for-the-year-ahead-20180103dto-story.html %9 Advertorial %& New Year, New You %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 Report %D 2018 %T The Hidden Risk of Retirement: The Impact of Retirement on Mental Health %A Christopher Crouch %K Mental and Physical Health %K Mental Disorders %K Mental Health %K Retirement %X Early retirement is a popular goal for many Americans but little research has been conducted to investigate the impact of this decision. This paper estimates the effects of retirement on several mental health outcomes using an ordered-probit model. Results suggest that retirement is negatively related to mental health in four of the tested categories: cognitive skills, mental status, memory, and Alzheimer’s symptoms. This implies that early retirement may have hidden costs and that working longer may help to preserve mental health. %I SSRN %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3254547 %0 Journal Article %J Journal of the American Geriatrics Society %D 2018 %T High Burden of Palliative Care Needs of Older Adults During Emergency Major Abdominal Surgery %A Cooper, Zara %A Elizabeth J Lilley %A Bollens-Lund, Evan %A Susan L Mitchell %A Christine S Ritchie %A Stuart R Lipsitz %A Amy Kelley %K Medicare %K Mortality %K Palliative care %K Surgery %X Objectives: To quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge. Design: Retrospective study using data from Health and Retirement Study interviews linked to Medicare claims (2000–2012). Setting: National population-based dataset. Participants: Medicare beneficiaries who underwent EMAS. Measurements: High illness burden, defined as ≥2 of the following vulnerabilities: functional dependence, dementia, use of helpers, multimorbidity, poor prognosis, high healthcare utilization. In-hospital outcomes were complications and mortality. Postdischarge outcomes included emergency department (ED) visits, hospitalization, intensive care unit (ICU) stay, and 365-day mortality. For individuals discharged alive who died within 365 days of surgery, outcomes included hospice use, hospitalization, ICU use, and ED use in the last 30 days of life. Multivariable regression was used to determine the association between illness burden and outcomes. Results: Of 411 participants, 57% had high illness burden. More individuals with high illness burden had complications (45% vs 28% p=0.00) and in-hospital death (20% vs 9%, p=0.00) than those without. After discharge (n=349), individuals with high illness burden experienced more ED visits (57% vs 46%, P=.04) and were more likely to die (35% vs 13%, p=0.00). Of those who died after discharge (n=86), 75% had high illness burden, median survival was 67 days (range 21–141 days), 48% enrolled in hospice, 32% died in the hospital, 23% were in the ICU in the last 30 days of life and 37% had an ED visit in the last 30 days of life. Conclusion: Most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life. Concurrent surgical and palliative care may improve quality of life and end-of-life care in these people. © 2018, Copyright the Author Journal compilation © 2018, The American Geriatrics Society %B Journal of the American Geriatrics Society %8 Dec-09-2019 %G eng %U http://doi.wiley.com/10.1111/jgs.15516http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15516/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.15516 %! J Am Geriatr Soc %R 10.1111/jgs.15516 %0 Report %D 2018 %T How much income do retirees actually have? Evaluating the evidence from five national datasets. %A Anqi Chen %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %K Finances %K Income %K Retirement Planning and Satisfaction %X Recent research by Bee and Mitchell (2017) has refocused attention on the fact that the Current Population Survey (CPS) underestimates retirement income. In the wake of this study, some observers have questioned whether other surveys more frequently used by retirement researchers also understate retirement income and, if so, whether prior research suggesting that many households are unprepared for retirement is accurate. This paper addresses both questions by examining retirement income data from the CPS and four other surveys: 1) the Survey of Consumer Finances (SCF); 2) the Health and Retirement Study (HRS); 3) the Panel Survey of Income Dynamics (PSID); and 4) the Survey of Income and Program Participation (SIPP). The paper compares the income measures from each survey to administrative data from tax and Social Security records, both in aggregate and across the income distribution. It then uses a common measure of retirement income adequacy, the replacement rate, to assess overall household preparedness for retirement. %B Center for Retirement Research at Boston College Working Paper Series %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %8 11/2018 %G eng %U http://crr.bc.edu/wp-content/uploads/2018/11/wp_2018-14__.pdf %0 Journal Article %J The Journals of Gerontology: Series B %D 2018 %T The Impact of Changes in Population Health and Mortality on Future Prevalence of Alzheimer’s Disease and Other Dementias in the United States %A Julie M Zissimopoulos %A Tysinger, Bryan %A Patricia A St Clair %A Eileen M. Crimmins %K Alzheimer's disease %K Dementia %K Mortality %K Population Health %X Objectives We assessed potential benefits for older Americans of reducing risk factors associated with dementia. Methods A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project dementia onset and mortality in risk reduction scenarios for diabetes, hypertension, and dementia. Results We found reducing incidence of diabetes by 50% did not reduce number of years a person ages 51 or 52 lived with dementia and increased the population ages 65 and older in 2040 with dementia by about 115,000. Eliminating hypertension at middle and older ages increased life expectancy conditional on survival to age 65 by almost 1 year, however, it increased years living with dementia. Innovation in treatments that delay onset of dementia by 2 years increased longevity, reduced years with dementia, and decreased the population ages 65 and older in 2040 with dementia by 2.2 million. Conclusions Prevention of chronic disease may generate health and longevity benefits but does not reduce burden of dementia. A focus on treatments that provide even short delays in onset of dementia can have immediate impacts on longevity and quality of life and reduce the number of Americans with dementia over the next decades. %B The Journals of Gerontology: Series B %V 73 %P S38-S47 %G eng %U https://academic.oup.com/psychsocgerontology/article/73/suppl_1/S38/4971567http://academic.oup.com/psychsocgerontology/article-pdf/73/suppl_1/S38/24626796/gbx147.pdf %N suppl_1 %R 10.1093/geronb/gbx147 %0 Journal Article %J Health Services Research %D 2018 %T The Impact of Policy Incentives on Long-Term Care Insurance and Medicaid Costs: Does Underwriting Matter? %A Portia Y. Cornell %A David C Grabowski %K Long-term Care %K Medicare/Medicaid/Health Insurance %K Policy %K Taxes %XOBJECTIVE: To test whether underwriting modifies the effect of state-based incentives on individuals' purchase of long-term care insurance.
DATA SOURCE: Health and Retirement Study (HRS), 1996-2012.
STUDY DESIGN: We estimated difference-in-difference regression models with an interaction of state policy indicators with individuals' probabilities of being approved for long-term care insurance.
DATA EXTRACTION: We imputed probabilities of underwriting approval for respondents in the HRS using a model developed with underwriting decisions from two U.S. insurance firms. We measured the elasticity response to long-term care insurance price using changes in simulated after-tax price as an instrumental variable for premium price.
PRINCIPAL FINDINGS: Tax incentives and Partnership programs increased insurance purchase by 3.62 percentage points and 1.8 percentage points, respectively, among those with the lowest risk (highest approval probability). Neither had any statistically significant effects among the highest risk individuals.
CONCLUSIONS: We show that ignoring the effects of underwriting may lead to biased estimates of the potential state budget savings of long-term care insurance tax incentives. If the private market is to play a role in financing long-term care, policies need to address the underlying adverse selection problems.
%B Health Services Research %V 53 %P 3728-3749 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/29770443?dopt=Abstract %R 10.1111/1475-6773.12870 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Inconsistency in the Self-report of Chronic Diseases in Panel Surveys: Developing an Adjudication Method for the Health and Retirement Study. %A Christine T Cigolle %A Corey L Nagel %A Caroline S Blaum %A Jersey Liang %A Ana R Quiñones %K Aged %K Chronic disease %K Data Accuracy %K Epidemiologic Methods %K Female %K Health Surveys %K Humans %K Interviews as Topic %K Longitudinal Studies %K Male %K Middle Aged %K Self Report %XObjectives: Chronic disease data from longitudinal health interview surveys are frequently used in epidemiologic studies. These data may be limited by inconsistencies in self-report by respondents across waves. We examined disease inconsistencies in the Health and Retirement Study and investigated a multistep method of adjudication. We hypothesized a greater likelihood of inconsistences among respondents with cognitive impairment, of underrepresented race/ethnic groups, having lower education, or having less income/wealth.
Method: We analyzed Waves 1995-2010, including adults 51 years and older (N = 24,156). Diseases included hypertension, heart disease, lung disease, diabetes, cancer, stroke, and arthritis. We used questions about the diseases to formulate a multistep adjudication method to resolve inconsistencies across waves.
Results: Thirty percent had inconsistency in their self-report of diseases across waves, with cognitive impairment, proxy status, age, Hispanic ethnicity, and wealth as key predictors. Arthritis and hypertension had the most frequent inconsistencies; stroke and cancer, the fewest. Using a stepwise method, we adjudicated 60%-75% of inconsistent responses.
Discussion: Discrepancies in the self-report of diseases across multiple waves of health interview surveys are common. Differences in prevalence between original and adjudicated data may be substantial for some diseases and for some groups, (e.g., the cognitively impaired).
%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 901-912 %8 2018 06 14 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27260670 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27260670?dopt=Abstract %R 10.1093/geronb/gbw063 %0 Journal Article %J PLoS One %D 2018 %T Index or illusion: The case of frailty indices in the Health and Retirement Study. %A Yi-Sheng Chao %A Hsing-Chien Wu %A Chao-Jung Wu %A Wei-Chih Chen %K Frailty %XINTRODUCTION: Frailty is a geriatric syndrome that has been defined differently with various indices. Without a uniform definition, it remains unclear how to interpret and compare different frailty indices (FIs). With the advances in index mining, we find it necessary to review the implicit assumptions about the creation of FIs. We are concerned the processing of frailty data may introduce measurement error and bias. We aim to review the assumptions, interpretability and predictive power of FIs regarding mortality.
METHODS: Three FIs, the Functional Domains Model proposed by Strawbridge et al. (1998), the Burden Model by Rockwood et al. (2007) and the Biologic Syndrome Model by Fried et al. (2004), were directly compared using the data from the Health and Retirement Study (HRS), a longitudinal study since 1996 mainly following up Americans aged 50 years and over. The FIs were reproduced according to Cigolle et al. (2009) and interpreted with their input variables through forward-stepwise regression. Biases were the residuals of the FIs that could not be explained by own input variables. Any four of the input variables were used to create alternative indices. Discrete-time survival analysis was conducted to compare the predictive power of FIs, input variables and alternative indices on mortality.
RESULTS: We found frailty a syndrome not unique to the elderly. The FIs were produced with different degrees of bias. The FIs could not be fully interpreted with the theory-based input variables. The bias induced by the Biological Syndrome Model better predicted mortality than frailty status. A complicated FI, the Burden Model, could be simplified. The input variables better predicted mortality than the FIs. The continuous FIs predicted mortality better than the frailty statuses. At least 6865 alternative indices better predicted mortality than the FIs.
CONCLUSION: FIs have been used as outcome in clinical trials and need to be reviewed for adequacy based on our findings. The three FIs are not closely linked to the theories because of bias introduced by data manipulation and excessive numbers of input variables. We are developing new algorithms to develop and validate innovative indices.
%B PLoS One %V 13 %P e0197859 %8 07/2018 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/30020923?dopt=Abstract %R 10.1371/journal.pone.0197859 %0 Journal Article %J Gerontologist %D 2018 %T Later-Life Disability in Environmental Context: Why Living Arrangements Matter. %A Carrie Elizabeth Henning-Smith %A Shippee, Tetyana %A Benjamin D Capistrant %K Disabilities %K Living arrangements %K Nursing homes %K Older Adults %XBackground and Objectives: Household social and environmental context are key elements of the disablement process, yet few studies explicitly examine the relationship between household composition, housing type, and disability progression. This study investigates the risk of older adults' disability progression by type of living arrangement (e.g., household composition, housing type) and whether the relationship varies by socioeconomic status.
Research Design and Methods: We used Health and Retirement Study data (waves 1998-2012; n = 41,467 total observations) and fit time-series logistic regression models to estimate increases in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) limitations. Because living arrangements are influenced by financial resources, we also stratified analyses by wealth.
Results: Disability rates were highest among those living alone or with nonfamily others and in self-described fair/poor quality housing. Overall, disability risk was more strongly associated with wealth than living arrangements. For more affluent older adults, living alone was associated with a decreased risk of IADL disability; for the least affluent older adults, living alone had the opposite association-increased risk of both ADL and IADL disability.
Discussion and Implications: Later-life disability progression should be understood in the context of both household environment and wealth. Household composition and housing characteristics were associated with disability progression and the risk of increasing disability was consistently higher for those in the lowest wealth quintile. These findings identify where older adults with disabilities live and that comprehensive interventions to reduce disability progression should consider household social and environmental context, as well as wealth.
%B Gerontologist %V 58 %8 04/2018 %G eng %N 5 %R 10.1093/geront/gnx019 %0 Journal Article %J Ageing and Society %D 2018 %T Life transitions and leisure activity engagement in later life: findings from the Consumption and Activities Mail Survey (CAMS) %A Yura Lee %A Joohong Min %A Iris Chi %K CAMS %K Engagement %K Leisure activities %K Life transitions %X This study examined engagement in leisure activities among older adults, specifically focusing on how life transition factors in later life, including retirement and marital status, are associated with leisure activity engagement using a national sample of older American men and women. We conducted multiple regression analyses with a sample of 5,405 individuals (2,318 men; 3,087 women) from the Consumption and Activities Mail Survey, a supplementary sample of the Health and Retirement Study. We analysed activity engagement in each of four domains of leisure activities: mental, physical, social and religious. Retirement status was categorised into three groups: working (referent), completely retired and partly retired. Marital status was categorised into four groups: married (referent), divorced or separated, widowed and never married. We found an overall trend of a positive relationship between retirement and leisure activity engagement, which suggests that retirement provides a chance for older adults to participate in leisure activities after withdrawal from the labour force. The overall trend of a negative relationship between non-married status and leisure activity engagement suggests that the loss or absence of a spouse may serve as a barrier to participate in leisure activities. Nevertheless, variation among retirees and non-married individuals suggests future studies should compare completely and partly retired individuals or those who are widowed, divorced or separated, or never married to elucidate distinguishable leisure activity profiles. Copyright © Cambridge University Press 2017 %B Ageing and Society %V 38 %P 1603-1623 %G eng %U https://www.cambridge.org/core/product/identifier/S0144686X17000216/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X17000216 %N 8 %! Ageing and Society %R 10.1017/S0144686X17000216 %0 Journal Article %J Scientific Reports %D 2018 %T Lifestyle index for mortality prediction using multiple ageing cohorts in the USA, UK and Europe. %A Liao, Jing %A Muniz-Terrera, Graciela %A Shaun Scholes %A Hao, Yuantao %A Chen, Yu-Ming %K Cross-National %K Functional status %K Mortality %X Current mortality prediction indexes are mainly based on functional morbidity and comorbidity, with limited information for risk prevention. This study aimed to develop and validate a modifiable lifestyle-based mortality predication index for older adults. Data from 51,688 participants (56% women) aged ≥50 years in 2002 Health and Retirement Study, 2002 English Longitudinal Study of Ageing and 2004 Survey of Health Ageing and Retirement in Europe were used to estimate coefficients of the index with cohort-stratified Cox regression. Models were validated across studies and compared to the Lee index (having comorbid and morbidity predictors). Over an average of 11-year follow-up, 10,240 participants died. The lifestyle index includes smoking, drinking, exercising, sleep quality, BMI, sex and age; showing adequate model performance in internal validation (C-statistic 0.79; D-statistic 1.94; calibration slope 1.13) and in all combinations of internal-external cross-validation. It outperformed Lee index (e.g. differences in C-statistic = 0.01, D-statistic = 0.17, P < 0.001) consistently across health status. The lifestyle index stratified participants into varying mortality risk groups, with those in the top quintile having 13.5% excess absolute mortality risk over 10 years than those in the bottom 50th centile. Our lifestyle index with easy-assessable behavioural factors and improved generalizability may maximize its usability for personalized risk management. %B Scientific Reports %V 8 %P 6644 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29703919?dopt=Abstract %R 10.1038/s41598-018-24778-1 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Linked Lives: Dyadic Associations of Mastery Beliefs With Health (Behavior) and Health (Behavior) Change Among Older Partners. %A Drewelies, Johanna %A William J. Chopik %A Christiane A Hoppmann %A Jacqui Smith %A Denis Gerstorf %K Aged %K Aged, 80 and over %K Dominance-Subordination %K Female %K Health Behavior %K Health Status %K Humans %K Male %K Marriage %K Middle Aged %K Models, Theoretical %K Psychological Tests %K Risk Reduction Behavior %K Surveys and Questionnaires %XObjectives: Mastery beliefs are known to contribute to healthy aging. However, it is an open question whether individual mastery-health associations impact the health of close long-term partners.
Method: We applied actor-partner interdependence models to 4-wave, 6-year longitudinal dyadic data from married and cohabitating partners in the Health and Retirement Study (N = 1,981 partners; age at baseline: M = 67 years, SD = 8.93, range 50-94 years).
Results: Higher individual mastery beliefs were associated with better individual physical health and health behaviors. Higher mastery beliefs were associated with subsequent increases in light physical activity. Having a partner with higher levels of mastery was uniquely associated with fewer functional limitations, better self-rated health, and more physical activity. Actor × Partner interaction effects for functional limitations indicated multiplicative associations of actor and partner mastery with health. Of note, mastery-health associations for individuals and their partners were invariant across age, gender, education, employment status, perceived stress over one's own and partner's health, and cognition.
Discussion: Findings suggest that partner mastery beliefs matter for the health (behaviors) of older adults. We discuss possible mechanisms underlying partner interrelations in mastery and health, their age invariance, and consider implications arising from our results.
%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 787-798 %8 2018 06 14 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27229003 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27229003?dopt=Abstract %R 10.1093/geronb/gbw058 %0 Journal Article %J Health Education Journal %D 2018 %T Longitudinal state-level effects on change in body mass index among middle-aged and older adults in the USA %A Chen, Cheng-Chia %A Seo, Dong-Chul %A Hsien-Chang Lin %K BMI %K Eating habits %K Gender Differences %K Health Trajectories %K Regional associations %K Socioeconomic factors %X Objective: The purpose of this longitudinal study was to examine the effects of state-level socioeconomic status (SES), the density of fast food restaurants and walking to work on body mass index (BMI) among US adults aged 50 years and older. The study sought further to account for the interaction effects of three different hierarchical levels of variables, including time-varying variables and time-invariant variables such as individual and state-level variables. Confounding related to environmental/neighbourhood effects was controlled for through sample selection. Methods: Data were drawn from the 2000–2010 Health and Retirement Study (HRS) and the 2010 US Census. HRS survey participants aged 50 years and older in 2000, residing in the same census tract during 2000–2010 (N = 6,156) comprised the study sample. A three-level growth model was fitted to BMI trajectories. Results: BMI significantly increased over time showing both a linear and quadratic decelerating trajectory (p < .001) where BMI grew faster among sampled adults in their early 50s. Women living in the US states with a lower state-level SES had higher BMIs, while men with higher state-level SES had a higher BMI (b = −.242, p = .013). In states with a higher proportion of people who walked to work, Hispanics had higher BMIs at baseline and a lower BMI growth rate, compared with non-Hispanic whites (b = −.033, p < .001). Conclusions: Obesity interventions specific to adults aged 50 years and older require greater emphasis. Potential health inequalities regarding weight gain can be ameliorated through tailoring interventions based on sex, environmental and state-level SES influences. %B Health Education Journal %V 77 %P 59-72 %G eng %N 1 %! Health Education Journal %R 10.1177/0017896917733016 %0 Journal Article %J Injury Epidemiology %D 2018 %T A longitudinal study of work-related injuries: comparisons of health and work-related consequences between injured and uninjured aging United States adults %A Navneet Kaur Baidwan %A Susan Goodwin Gerberich %A Kim, Hyun %A Andrew D Ryan %A Timothy Church %A Benjamin D Capistrant %K health %K Injury %K Physical Health %K Workers' compensation %X Background: Age may affect one’s susceptibility to the myriad physical hazards that may pose risks for work-related injuries. Aging workers are not only at risk for work-related injuries but, also, at even higher risk for more severe health and work-related consequences. However, limited longitudinal research efforts have focused on such injuries among the aging workforce. This study aimed to investigate the association between physical work-related factors and injuries among United States (U.S.) workers, and then compare the injured and uninjured workers with regard to consequences including, functional limitations, and reduced working hours post injury. A cohort of 7212 U.S. workers aged 50 years and above from the U.S. Health and Retirement Study were retrospectively followed from 2004 to 2014. Data on exposures were lagged by one survey wave prior to the outcome of work-related injuries and consequences, respectively. Crude and adjusted incident rate ratios, and hazard ratios were estimated using generalized estimating equations and Cox models. Results: Risk of experiencing a work-related injury event was over two times greater among those whose job had work requirements for physical effort, lifting heavy loads, and stooping/kneeling/crouching, compared to those who did not. Over time, injured compared to uninjured workers had higher risks of functional limitations and working reduced hours. Conclusions: The aging workforce is at a high risk of experiencing injuries. Further, injured adults were not only more likely to incur a disability prohibiting daily life-related activities, over time, but, also, were more likely to work reduced hours. It will be important to consider accommodations to minimize functional limitations that may impair resulting productivity. © 2018, The Author(s). %B Injury Epidemiology %V 5 %8 Jan-12-2018 %G eng %U https://www.scopus.com/record/display.uri?eid=2-s2.0-85053897689&origin=SingleRecordEmailAlert&dgcid=raven_sc_search_en_us_email&txGid=c198e96897366b934b1253093117b258 %N 1 %! Inj. Epidemiol. %R 10.1186/s40621-018-0166-7 %0 Thesis %B Philosophy %D 2018 %T Long-Term Care Utilization of Older Adults: Does Caregivers' Employment Matter? %A Chang, Chiung-Yun %K Caregiving %K Family Roles/Relationships %K Informal care %K Long-term Care %X This study investigated the associations between caregivers’ employment status and the use of a combination of informal and formal care among old Americans aged 65 and older, considering predisposing, enabling and need factors of older adults as well as of the caregivers. This study also examined whether such association differed by older adults’ gender and race/ethnicity. Data source included the 2010 and 2014 Health and Retirement Study. Multinomial logistic regressions were used to estimate probabilities of the combination of long-term care. Results indicated that although caregivers’ employment status was not significantly associated with older adults’ use of a combination of informal and community-based services, full-time employment status had significantly higher likelihoods of using a combination of informal and institutional care. Such association differed by older adults’ gender and race/ethnicity. In addition, older adults’ age, education, income and assets, chronic illnesses and functional limitations in relation to activities of daily living, and caregivers’ sole caregiving status were significantly associated with the use of informal care in combination with either community-based services or institutional care. Having fewer co-resident children or having cognitive impairments significantly increased the likelihoods of using a combination of informal and institutional care. Implications for social work, policy and research were discussed based upon these findings. %B Philosophy %I New York University %C New York City %V PhD %P 138 %8 2018 %G eng %9 Dissertation %0 Web Page %D 2018 %T Losing a spouse late in life linked to cognitive decline %A Crist, Carolyn %K Bereavement %K Cognitive Ability %K Marriage %B Reuters %I Reuters %C London %V 2018 %G eng %U https://www.reuters.com/article/us-health-widowhood/losing-a-spouse-late-in-life-linked-to-cognitive-decline-idUSKBN1HR27E %0 Web Page %D 2018 %T Loss of life savings is a killer, say researchers: Health Study [Europe Region] %A Cookson, Clive %K Cardiovascular disease %K Life Expectancy %K Mortality %K Savings %I Financial Times %C London, UK %V 2018 %G eng %0 Report %D 2018 %T Measuring Cognition in a Multi-mode Context %A McClain, Colleen A. %A Mary Beth Ofstedal %A Mick P. Couper %K Cognitive Ability %K Mode effects %K Survey Methodology %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %P 1-48 %8 05-2018 %G eng %0 Journal Article %J Int J Health Serv %D 2018 %T Medicare Part D Implementation and Associated Health Impact Among Older Adults in the United States. %A Chen, Cheng-Chia %A Hsien-Chang Lin %A Seo, Dong-Chul %K Aged %K Health Services for the Aged %K Humans %K Medicare Part D %K United States %XThis study examined the effect of Medicare (Part D) implementation on health outcomes among U.S. older adults. Study participants were initially extracted from the 2004-2008 Health and Retirement Study (HRS). Data from respondents who further participated in the HRS 2005-2007 Prescription Drug Study were analyzed (N = 746). This was a retrospective pre-post design with a treatment and a control group. The difference-in-differences approach with panel ordered logistic regressions was used to examine the Part D effect on three patient health outcomes before and after the implementation, controlling for patient sociodemographic characteristics. People with continuous Part D enrollment from 2006-2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (odds ratio [OR] = 0.48; p < .05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activities of daily living impairment (ORs = 1.12, 1.17, and 1.36, respectively; all ps < .001). The Part D implementation appears to have a positive effect on older adults' overall health outcomes. A decrease in out-of-pocket cost for health care may encourage older adults to utilize more needed medications, which in turn helped maintain better health.
%B Int J Health Serv %V 48 %P 42-56 %8 2018 01 %G eng %U http://joh.sagepub.com/lookup/doi/10.1177/0020731416676226 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27799594?dopt=Abstract %! International Journal of Health Services %R 10.1177/0020731416676226 %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 Journal Article %J Health Services Research %D 2018 %T Modeling Health Care Spending Growth of Older Adults %A Hatfield, Laura A. %A Melissa Favreault %A McGuire, Thomas G. %A M.E. Chernew %K Health Care Costs %K Health Insurance %K Medicare Beneficiaries %K simulations %X Objective To forecast out-of-pocket health care spending among older adults. Long-term forecasts allow policy makers to explore potential impacts of policy scenarios, but existing microsimulations do not incorporate details of supplemental insurance coverage and income effects on health care spending. Data Sources Dynamic microsimulation calibrated to survey and administrative data. Study Design We augment Urban Institute's Dynamic Simulation of Income Model (DYNASIM) with modules that incorporate demand responses and economic equilibria, with dynamics driven by exogenous technological change. A lengthy technical appendix provides details of the microsimulation model and economic assumptions for readers interested in applying these techniques. Principal Findings The model projects total out-of-pocket spending (point of care plus premiums) as a share of income for adults aged 65 and older. People with lower incomes and poor health fare worse, despite protections of Medicaid. Spending rises 40 percent from 2012 to 2035 (from 10 to 14 percent of income) for the median beneficiary, but it increases from 5 to 25 percent of income for low-income beneficiaries and from 23 to 29 percent for the near poor who are in fair/poor health. Conclusions Despite Medicare coverage, near-poor seniors will face out-of-pocket spending that would render them, in practical terms, underinsured. %B Health Services Research %V 53 %P 138-155 %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/1475-6773.12640 %R 10.1111/1475-6773.12640 %0 Thesis %B Institute of Statistical Research and Training %D 2018 %T A multistage model for prediction of sequence of events. %A Rafiqul I Chowdhury %K model %X This dissertation investigates the existing methods for risk prediction of a sequence of events from longitudinal studies for the continuous time data, in addition to, proposing a simple alternative method. These outcomes (events) can change status at different followups that may produce a large number of paths or trajectories. Also, regressive models for multinomial and ordinal outcomes for discrete time data to obtain a joint model for a sequence of events for risk prediction is proposed. A key challenge is the simplification and generalization of the existing method for continuous time data for risk prediction for a large sequence of events at different stages. Most of the models are proposed to solve the problem arising from the progression of specific diseases process. The proposed alternative multistage procedure simplifies the transition models for risk prediction of a sequence of events for continuous time data. This framework provides the estimates for each stage in the process conditionally and the conditional estimates are linked based on marginal and conditional models to obtain the joint probabilities needed for predicting the status of disease based on the potential risk factors. The proposed method of prediction is a new development using a series of events in conditional setting arising from the beginning to the endpoint. Also, a general form of integral is developed for predicting the joint probability of a sequence of events from longitudinal studies for (i) different types of trajectories and (ii) any segment of a trajectory along with the generalization to any number of stages which is a new development. In follow-up or panel studies, multinomial outcomes may occur within an interval where transition times are not exactly known, or the time of the event is itself discrete. Available models for risk prediction for multinomial outcomes with specified risk factors are only for a single response and are not extended for prediction of a sequence of events for discrete time data for different stages. The regressive models for multinomial outcomes are proposed and then a modeling framework is developed to predict the joint probabilities for a sequence of events. The proposed models link the marginal and sequence of conditional models to provide the joint model needed for predicting the probability of a trajectory based on specified covariate patterns. The marginal model uses the outcome variable at the baseline and the models at the subsequent follow-ups provide the estimates of the parameters of the conditional models. The major improvement of the proposed framework is that one needs to fit a significantly smaller number of models compared to the conditional models such as Markov models. The independence of the repeated outcomes will allow using simpler models, and the goodness-of-fit of the joint model is required for model performance. The proposed goodness-of-fit test for joint model is obtained by linking marginal and conditional models. The test for independence uses marginal models for each repeated outcomes. The simulation study and application using real data prove the usefulness and illustrate the performance of these tests. For ordinal outcomes from longitudinal studies regressive proportional odds model, and in the case of violation of proportional odds assumption regressive partial proportional odds model are proposed. Then a framework is developed to predict joint probabilities for a sequence of ordinal outcomes. The major improvement of the proposed model is that only one model is required for each repeated outcome compared to the sequence of conditional models such as Markov models. Results from these two models are compared to that from the proposed regressive multinomial logistic model. Also, test for goodnessof-fit and test for independence are shown. The proposed models provide the estimates for each stage in the process conditionally, and the joint model can be obtained for any order to predict the risk of a sequence of events. Proposed regressive partial proportional odds model and regressive multinomial models showed better performance compared to the regressive proportional odds model when proportional odds assumption is violated. Simulation studies showed satisfactory performance of the proposed regressive models for ordinal outcomes. All the proposed model and the risk prediction framework for both continuous and discrete time data are a new development. The major improvement of the proposed model is that it reduces the over-parameterization. One can easily add interaction terms among previous outcomes, and predictors in the proposed framework which may provide a better understanding of the underlying process and the relationships between outcomes and risk factors. Using the developed framework, modeling and risk prediction for a sequence of events can be performed in many fields of studies such as epidemiology, public health, survival analysis, genetics, reliability, environmental studies, etc. This model would be very useful for analyzing big data. One can use the existing software for model fitting, and risk prediction of a sequence of events. %B Institute of Statistical Research and Training %I University of Dhaka %C Dhaka, Bangladesh %V PhD %P 131 %G eng %U http://repository.library.du.ac.bd/xmlui/handle/123456789/1290 %0 Journal Article %J The Journal of Nutrition, Health & Aging %D 2018 %T Muscle weakness and physical disability in older Americans: Longitudinal findings from the U.S. Health and Retirement Study %A Kate A Duchowny %A Philippa J Clarke %A Mark D Peterson %K Activities of Daily Living %K Disabilities %K Muscle Weakness %X Importance: Muscle weakness is an important indicator of disability, chronic disease and mortality. While we recently proposed sex/race specific grip strength cutpoints for clinical muscle weakness in a diverse, nationally representative sample of older Americans, the extent to which these cutpoints predict physical disability remains unknown. Objective: To examine whether sex/race specific muscle weakness cutpoints predict physical disability status in a nationally representative sample of Americans age 65+. Design: We used data from the 2006-2010 Health and Retirement Study. Fully-adjusted, weighted multinomial logistic regression models were used to quantify the odds of experiencing the onset, progression or persistence of disability in activities of daily living (ADL) among weak versus non-weak individuals over a 2-year period. Setting: General community, nationally representative sample of older Americans. Participants: Population-based, community dwelling sample of older American adults aged 65-years+; 57 percent were women, 91% were White and the mean age was 75 years. Main Outcome(s) and Measure(s): The primary outcome of interest was disability dynamics, defined by changes in ADL status across at 2- year period. The primary exposure was clinical muscle weakness as defined by previously identified cutpoints. Hypotheses were formulated before analyses were conducted. Results: In this nationally representative sample (n= 8,725), 44% of individuals were classified as weak at baseline. At follow-up, 55% remained independent with no change in their ADL status, 11% had an onset of disability and 4% progressed in their disability status. The odds of experiencing an onset of ADL disability was 54% higher among weak individuals compared those who were not weak at baseline (OR= 1.54, 95% CI= 1.54, 1.5, p<.0001); the odds of experiencing a progression in physical disability status was 2.16 times higher among those who were weak at baseline compared to non-weak individuals (OR= 2.16, 95% CI= 2.15, 2.16, p<.0001). Conclusions: This is the first study to use grip strength weakness cut-points to identify those who may be at greatest risk for experiencing physical disability in later life. Results underscore the importance of using population-specific cutpoints for clinical weakness in order to identify individuals at greatest risk for adverse health outcomes. %B The Journal of Nutrition, Health & Aging %V 22 %8 04/2018 %G eng %U http://link.springer.com/10.1007/s12603-017-0951-yhttp://link.springer.com/content/pdf/10.1007/s12603-017-0951-y.pdfhttp://link.springer.com/content/pdf/10.1007/s12603-017-0951-y.pdfhttp://link.springer.com/article/10.1007/s12603-017-0951-y/fulltext.html %N 4 %! J Nutr Health Aging %R 10.1007/s12603-017-0951-y %0 Journal Article %J Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %D 2018 %T A National Portrait of Stepfamilies in Later Life. %A Lin, I-Fen %A Susan L. Brown %A Cassandra Jean Cupka %A Deborah Carr %K Cohabitation %K Couples %K Stepchildren %XObjectives: Scholars have documented increases in the prevalence and complexity of stepfamilies earlier in the life course, but no one has systematically investigated U.S. stepfamily structure in later life. Guided by a family systems approach, we described the prevalence and composition of later-life stepfamilies.
Method: The analysis was based on 6,250 married and cohabiting couples participating in the 2012 Health and Retirement Study. We identified the prevalence of later-life stepfamilies, decomposed stepfamily structures, and compared the sociodemographic characteristics and relationship quality of the couples in stepfamilies with those in married families (with only joint children and no stepchildren), paying attention to differences between married and cohabiting stepfamilies.
Results: Roughly 40% of middle-aged and older couples with children were in stepfamilies. Of all stepfamilies, 86% were married couples and 14% were cohabiting couples. Cohabiting stepfamilies more often included children from both partners' previous relationships, but couples in married stepfamilies more often had joint children. Cohabiting stepfamilies appeared to be the most socially and economically disadvantaged, followed by married stepfamilies, and lastly married families. Despite these compositional differences, partner relationship quality was largely similar across married families, married stepfamilies, and cohabiting stepfamilies.
Discussion: This study underscores the high prevalence and complexity of later-life stepfamilies and foregrounds the urgency of additional research on this topic.
%B Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %V 73 %P 1043-1054 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/29190365?dopt=Abstract %R 10.1093/geronb/gbx150 %0 Journal Article %J Alzheimer's & Dementia %D 2018 %T Neighborhoods, sleep quality, and cognitive decline: Does where you live and how well you sleep matter? %A Jaimie C Hunter %A Elizabeth P. Handing %A Casanova, Ramon %A Kuchibhatla, Maragatha %A Michael W Lutz %A Saldana, Santiago %A Brenda L Plassman %A Kathleen M Hayden %K Cognitive Ability %K Neighborhoods %K Sleep %K Socioeconomic factors %X Introduction We evaluated the association between neighborhood socioeconomic status (NSES) and sleep quality on cognitive decline in the Health and Retirement Study. Methods Health and Retirement Study participants (n = 8090), aged 65+ with DNA and multiple biennial cognitive observations (abbreviated Telephone Interview for Cognitive Status), were included. Participants were grouped into quartiles of NSES and sleep quality scores. We adjusted for apolipoprotein E ε4, demographic, and cardiovascular risk factors. Random effects modeling evaluated cognitive change over time. Results NSES and sleep were significantly associated with cognitive decline, and there was a significant interaction between them (P = .02). Significant differences between high/low NSES and high/low sleep quality (P < .0001) were found. Discussion Sleep and NSES were associated with cognitive decline; the association between sleep and cognition appeared stronger among those with low NSES. The association between low NSES, poor sleep quality, and cognitive decline was roughly equivalent to the association between apolipoprotein E ε4 and cognitive decline. %B Alzheimer's & Dementia %V 14 %P 454-461 %G eng %U https://pubmed.ncbi.nlm.nih.gov/29396109/ %N 4 %! Alzheimer's & Dementia %R 10.1016/j.jalz.2017.10.007 %0 Journal Article %J Occupational and Environmental Medicine %D 2018 %T Occupational and educational inequalities in exit from employment at older ages: evidence from seven prospective cohorts %A Carr, Ewan %A Fleischmann, Maria %A Goldberg, Marcel %A Kuh, Diana %A Murray, Emily T %A Stafford, Mai %A Stansfeld, Stephen %A Vahtera, Jussi %A Xue, Baowen %A Zaninotto, Paola %A Zins, Marie %A Head, Jenny %K Education %K Employment and Labor Force %K Europe %K Health Disparities %K Work %X Objectives Past studies have identified socioeconomic inequalities in the timing and route of labour market exit at older ages. However, few studies have compared these trends cross-nationally and existing evidence focuses on specific institutional outcomes (such as disability pension and sickness absence) in Nordic countries. We examined differences by education level and occupational grade in the risks of work exit and health-related work exit. Methods Prospective longitudinal data were drawn from seven studies (n=99 164). Participants were in paid work at least once around age 50. Labour market exit was derived based on reductions in working hours, changes in self-reported employment status or from administrative records. Health-related exit was ascertained by receipt of health-related benefit or pension or from the reported reason for stopping work. Cox regression models were estimated for each study, adjusted for baseline self-rated health and birth cohort. Results There were 50 003 work exits during follow-up, of which an average of 14% (range 2-32%) were health related. Low level education and low occupational grade were associated with increased risks of health-related exit in most studies. Low level education and occupational grade were also associated with an increased risk of any exit from work, although with less consistency across studies. Conclusions Workers with low socioeconomic position have an increased risk of health-related exit from employment. Policies that extend working life may disadvantage such workers disproportionally, especially where institutional support for those exiting due to poor health is minimal. %B Occupational and Environmental Medicine %V 75 %P 369 - 377 %8 Dec-05-2018 %G eng %U http://oem.bmj.com/content/75/5/369 %N 5 %! Occup Environ Med %R 10.1136/oemed-2017-10461910.1136/oemed-2017-104619.supp1 %0 Journal Article %J BMC Geriatrics %D 2018 %T Overweight or obese BMI is associated with earlier, but not later survival after common acute illnesses %A Hallie C Prescott %A Virginia W Chang %K BMI %K Hospitalization %K Mortality %K Recovery %X Background: Obesity has been associated with improved short-term mortality following common acute illness, but its relationship with longer-term mortality is unknown. Methods: Observational study of U.S. Health and Retirement Study (HRS) participants with federal health insurance (fee-for-service Medicare) coverage, hospitalized with congestive heart failure (N = 4287), pneumonia (N = 4182), or acute myocardial infarction (N = 2001), 1996-2012. Using cox proportional hazards models, we examined the association between overweight or obese BMI (BMI ≥ 25.0 kg/m2) and mortality to 5 years after hospital admission, adjusted for potential confounders measured at the same time as BMI, including age, race, sex, education, partnership status, income, wealth, and smoking status. Body mass index (BMI) was calculated from self-reported height and weight collected at the HRS survey prior to hospitalization (a median 1.1 year prior to hospitalization). The referent group was patients with a normal BMI (18.5 to < 25.0 kg/m2). Results: Patients were a median of 79 years old (IQR 71-85 years). The majority of patients were overweight or obese: 60.3% hospitalized for heart failure, 51.5% for pneumonia, and 61.6% for acute myocardial infarction. Overweight or obese BMI was associated with lower mortality at 1 year after hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction - with adjusted hazard ratios of 0.68 (95% CI 0.59-0.79), 0.74 (95% CI: 0.64-0.84), and 0.65 (95%CI: 0.53-0.80), respectively. Among participants who lived to one year, however, subsequent survival was similar between patients with normal versus overweight/obese BMI. Conclusions: In older Americans, overweight or obese BMI was associated with improved survival following hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction. This association, however, is limited to the shorter-term. Conditional on surviving to one year, we did not observe a survival advantage associated with excess weight. %B BMC Geriatrics %V 18 %G eng %U https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-018-0726-2http://link.springer.com/content/pdf/10.1186/s12877-018-0726-2.pdf %N 1 %! BMC Geriatr %R 10.1186/s12877-018-0726-2 %0 Journal Article %J Psychology and Aging %D 2018 %T Perceived control and frailty: The role of affect and perceived health. %A Ari J. Elliot %A Christopher J Mooney %A Frank J Infurna %A Chapman, Benjamin P %K Frailty %K Optimism %K Perception %K Self-reported health %X Mechanisms underlying prospective associations of perceived control with frailty and other health outcomes are not well understood. In the present study we used 3 waves of data from the Health and Retirement Study (N = 2,127) to test potential psychological and biological pathways linking perceived control with frailty over an 8-year period, and whether 4-year change in control predicts frailty independent of initial control. Lower odds of increasing frailty were associated with higher initial levels of perceived control (odds ratio [OR] = .74, p < .001, 95% confidence interval [CI] [.65, .83]) and a more positive change in perceived control (OR = .82, p = .006, 95% CI [.73, .92]), independent of the personality traits neuroticism and conscientiousness. In cross-lagged mediation models, the association of initial perceived control with frailty was partially mediated by positive affect, negative affect, and self-rated health, but not C-reactive protein or allostatic load. Associations of perceived control with positive and negative affect were bidirectional, with mediation in both directions. Initial frailty status was not related to 4-year change in perceived control. Perceived control may affect frailty risk through influences on affective states as well as perceived health. Findings also extend evidence that changes in perceived control may be prognostic of future health outcomes in older adults. %B Psychology and Aging %V 33 %P 473-481 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/29446967?dopt=Abstract %R 10.1037/pag0000218 %0 Journal Article %J Journal of Psychiatric Research %D 2018 %T Polygenic Score for Alzheimer Disease and cognition: The mediating role of personality. %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Pauline Caille %A Antonio Terracciano %K Alzheimer's disease %K Cognition & Reasoning %K Personality %K PGS %X Alzheimer's disease (AD) polygenic risk score (PGS) is associated with lower cognitive functioning even among older individuals without dementia. We tested the hypothesis that personality traits mediate the association between AD genetic risk and cognitive functioning. Participants (N > 7,000, aged 50-99 years old) from the Health and Retirement Study were genotyped and completed personality and cognition tests at baseline. Cognition was assessed again four years later. Bootstrap analysis revealed that a higher AD polygenic risk score was associated with lower cognitive scores at baseline through higher neuroticism, lower conscientiousness, and lower levels of the industriousness facet of conscientiousness. In addition, a higher polygenic score for AD was associated with decline in cognition over four years in part through higher neuroticism and lower conscientiousness. The findings support the hypothesis that the genetic vulnerability for AD contributes to cognitive functioning in part through its association with personality traits. %B Journal of Psychiatric Research %V 107 %P 110-113 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30384091?dopt=Abstract %R 10.1016/j.jpsychires.2018.10.015 %0 Journal Article %J Journal of Gerontological Social Work %D 2018 %T Postretirement work and volunteering by poverty groups informed by role theory. %A Joonyoung Cho %A BoRin Kim %A So Jung Park %A Jang, Jakyung %K Volunteerism %X This study uses role theory to examine the association between postretirement work and volunteering among retirees and to determine whether this association varies across poverty status. Data came from the 2012 wave of the Health and Retirement Study (HRS). The sample was restricted to respondents of older retirees (N = 6,619). We found that postretirement work positively influenced volunteering. However, poverty can be a risk factor of volunteering among older retirees. The positive effect of post-retirement work was found to be more significant in the near-poverty group. We provide an empirical foundation to help inform volunteer programs for retirees. %B Journal of Gerontological Social Work %V 61 %P 243-260 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/29236613?dopt=Abstract %R 10.1080/01634372.2017.1416719 %0 Government Document %D 2018 %T Poverty among the aged population: The role of out-of-pocket medical expenditures and annuitized assets in supplemental poverty measure estimates %A William J. Chopik %A Wimer, Christopher %A Betson, David M. %A Manfield, Lucas %K Annuitization %K Medical Expenses %K Out-of-pocket payments %K Poverty %X We examine the extent to which the Supplemental Poverty Measure (SPM) overestimates the poverty rate of the aged population because it does not account for asset holdings. Following a conservative annuity approach, we use 2010 Health and Retirement Study data to estimate high and low bounds of potential annuitized asset withdrawals and then recalculate 2009 SPM poverty rates. Including annuitized asset principal in family resources reduces the estimated SPM poverty rate for the aged, especially among those who are in poverty because of medical out-of-pocket expenditures. For example, between 30.8 percent and 45.2 percent of the latter group would be reclassified as not SPM poor if they were to annuitize their financial assets. To better represent available family resources, poverty measurements for the aged should incorporate (at minimum) the conservative estimates of available assets produced by the bounded-annuity approach. %I Social Security Bulletin %P 47-75 %G eng %0 Journal Article %J Current Protocols in Cytometry %D 2018 %T A Practical Cryopreservation and Staining Protocol for Immunophenotyping in Population Studies. %A Barcelo, Helene %A Jessica Faul %A Eileen M. Crimmins %A Bharat Thyagarajan %K Cryopreservation %K Quality control %K Survey Methodology %X Large population-based cohort studies, through their prospective collection of a broad range of health information, represent an invaluable resource for novel insights into the pathogenesis of human diseases. Collection and cryopreservation of viable cells from blood samples is becoming increasingly common in large cohorts as these cells are a valuable resource for immunophenotyping and functional studies. The cryopreservation of peripheral blood mononuclear cells (PBMCs), thawing, and immunophenotyping protocols used to immunophenotype 9938 participants in the Health and Retirement Study (HRS) are described. The extensive quality control involved in a large-scale immunophenotyping epidemiological study is also outlined. The existing literature on the effect of cryopreservation on various immune cell subsets including T, B, NK cells, monocytes, and dendritic cells is provided. © 2018 by John Wiley & Sons, Inc. %B Current Protocols in Cytometry %V 84 %P e35 %8 04/2018 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30040214?dopt=Abstract %R 10.1002/cpcy.35 %0 Journal Article %J Biodemography and Social Biology %D 2018 %T Predictors and implications of accelerated cognitive aging %A Morgan E. Levine %A Harrati, Amal %A Eileen M. Crimmins %K BMI %K Cognition & Reasoning %K Risk Factors %K Socioeconomic factors %X Aging is a major risk factor for both normal and pathological cognitive decline. However, individuals vary in their rate of age-related decline. We developed an easily interpretable composite measure of cognitive age, and related both the level of cognitive age and cognitive slope to sociodemographic, genetic, and disease indicators and examined its prediction of dementia transition. Using a sample of 19,594 participants from the Health and Retirement Study, cognitive age was derived from a set of performance tests administered at each wave. Our findings reveal different conclusions as they relate to levels versus slopes of cognitive age, with more pronounced differences by sex and race/ethnicity for absolute levels of cognitive decline rather than for rates of declines. We also find that both level and slope of cognitive age are inversely related to education, as well as increased for persons with APOE ?4 and/or diabetes. Finally, results show that the slope in cognitive age predicts subsequent dementia among non-demented older adults. Overall, our study suggests that this measure is applicable to cross-sectional and longitudinal studies on cognitive aging, decline, and dementia with the goal of better understanding individual differences in cognitive decline. %B Biodemography and Social Biology %V 64 %P 83-101 %G eng %U https://www.tandfonline.com/doi/full/10.1080/19485565.2018.1552513https://www.tandfonline.com/doi/pdf/10.1080/19485565.2018.1552513 %N 2 %! Biodemography and Social Biology %R 10.1080/19485565.2018.1552513 %0 Journal Article %J Journal of Palliative Medicine %D 2018 %T Prospective identification of patients at risk for unwarranted variation in treatment. %A Amy Kelley %A Bollens-Lund, Evan %A Kenneth E Covinsky %A Jonathan S Skinner %A R Sean Morrison %K Health Services %XBACKGROUND: Understanding factors associated with treatment intensity may help ensure higher value healthcare.
OBJECTIVE: To investigate factors associated with Medicare costs among prospectively identified, seriously ill older adults and examine if baseline prognosis influences the impact of these factors.
DESIGN/SUBJECTS: Prospective observation of Health and Retirement Study cohort with linked Medicare claims.
MEASUREMENTS: We identified people with incident serious illness (a serious medical condition, for example, metastatic cancer or functional impairment); calculated subjects' one-year mortality risk; and then followed them for one year. We examined relationships between individual and regional characteristics and total Medicare costs, and then stratified analyses by one-year mortality risk: low, moderate, and high.
RESULTS: From 2002 to 2012, 5208 subjects had incident serious illness: mean age 78 years, 60% women, 76% non-Hispanic white, and 39% hospitalized in the past year. During one-year follow-up, 12% died. Total Medicare costs averaged $20,607. In multivariable analyses, indicators of poor health (e.g., cancer, advanced heart and lung disease, multimorbidity, functional impairment, and others) were significantly associated with higher costs (p < 0.05). However, among those with high mortality risk, health-related variables were not significant. Instead, African American race (rate ratio [RR] 1.56) and moderate-to-high spending regions (RR 1.31 and 1.54, respectively) were significantly associated with higher costs. For this high-risk population, residence in high-spending regions was associated with $31,476 greater costs among African Americans, and $11,162 among other racial groups, holding health constant.
CONCLUSIONS: Among seriously ill older adults, indicators of poor health are associated with higher costs. Yet, among those with poorest prognoses, nonmedical characteristics-race and regional practice patterns-have greater influence on treatment. This suggests there may be novel opportunities to improve care quality and value by assuring patient-centered, goal-directed care.
%B Journal of Palliative Medicine %V 21 %P 44-54 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28772096?dopt=Abstract %R 10.1089/jpm.2017.0063 %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 %XGenome-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 Gerontological Social Work %D 2018 %T Race and income disparities in disaster preparedness in old age %A Cox, Kate %A BoRin Kim %K Emergency preparedness %K Income %K Racial/ethnic differences %K Women and Minorities %X This study investigated to what extent income status and race/ethnicity in old age interplayed with disaster preparedness. Data came from the 2010 Health and Retirement Study, a nationally representative panel survey of older Americans over 51 years old. Our sample was restricted to respondents who participated in a special survey about disaster preparedness (N=1,711). Disaster preparedness was measured as a score, which includes 13 variables. Race/ethnicity was categorized by White, Black, and Hispanic. Low income was defined as below 300% of the federal poverty line. OLS regression was used to examine the main and interaction effects of race/ethnicity and lower income status on disaster preparedness scores. We found that older adults in lower income status had lower preparedness level than those in higher income (Coef. =-0.318, p<.01). Hispanics tend to be less prepared compared to White and Blacks (Coef. =-0.608, p<.001). Preparedness of Black elders was not significantly different from that of Whites. However, interestingly, Black elders in lower income status were significantly less prepared for disaster than other groups (Coef. =- 0.622, p<.05). This study identified vulnerable subgroups of older adults for disaster preparedness and suggests that preparedness programs should target minority and low income elders. %B Journal of Gerontological Social Work %V 61 %P 719-734 %G eng %U https://www.tandfonline.com/doi/full/10.1080/01634372.2018.1489929https://www.tandfonline.com/doi/pdf/10.1080/01634372.2018.1489929 %N 7 %! Journal of Gerontological Social Work %R 10.1080/01634372.2018.1489929 %0 Journal Article %J Alzheimer's & Dementia (N Y) %D 2018 %T Racial and ethnic differences in trends in dementia prevalence and risk factors in the United States. %A Chen, Cynthia %A Julie M Zissimopoulos %K Cognition & Reasoning %K Dementia %K Racial/ethnic differences %K Risk Factors %XIntroduction: Disparities in dementia prevalence across racial/ethnic groups in the United States may not be narrowing over time.
Methods: Data from Health and Retirement Study (2000 to 2012) were analyzed. Dementia was ascertained based on cognitive, functional measures. Logistic regression was used to quantify association between dementia and risk factors, including chronic conditions, use of drug treatment for them, separately for whites, blacks, and Hispanics.
Results: Disparities in dementia prevalence declined between blacks and whites and increased between Hispanics and whites. Adjusting for risk factors reduced but did not eliminate disparities. Compared to no hypertension, untreated hypertension was associated with increased risk of dementia for all racial/ethnic groups while treated hypertension was associated with reduced risk for whites. Diabetes treated with oral drugs was not associated with increased dementia risk.
Discussion: Racial disparities in dementia may be reduced by prevention and management of disease and promoting educational attainment among blacks and Hispanics.
%B Alzheimer's & Dementia (N Y) %V 4 %P 510-520 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30364652?dopt=Abstract %R 10.1016/j.trci.2018.08.009 %0 Journal Article %J Gerontologist %D 2018 %T Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States. %A Marc Garcia %A Brian Downer %A Chi-Tsun Chiu %A Joseph L Saenz %A Rote, Sunshine %A Rebeca Wong %K Cognitive Ability %K Dementia %K Mortality %K Racial/ethnic differences %XBackground and Objectives: To document racial/ethnic and nativity differences by gender in cognitive life expectancies among older adults in the United States.
Research Design and Methods: Sullivan-based life tables were used to estimate cognitively normal, cognitively impaired/no dementia (CIND), and dementia life expectancies by gender for White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults 50 years and older in the Health and Retirement Study.
Results: Among women, the number of years spent living with dementia for Whites, Blacks, U.S.-born Hispanics, and foreign-born Hispanics was 1.6, 3.9, 4.7, and 6.0 years, respectively. For men, Whites lived 1.1 years with dementia compared to 3.1 years for Blacks, 3.0 years for U.S.-born Hispanics and 3.2 years for foreign-born Hispanics. Similar patterns were observed for race/ethnic and nativity differences in CIND life expectancies. Blacks and Hispanics spend a larger fraction of their remaining years with CIND and dementia relative to Whites, regardless of gender. Foreign-born Hispanic men and women and Black men are particularly disadvantaged in the proportion of years spent after age 50 with CIND and/or dementia.
Discussion and Implications: Disparities in cognitive life expectancies indicate that intervention strategies should target the specific needs of minority and immigrant older adults with dementia. Given that education is a strong predictor of cognitive health, improving access to the social and economic resources that delay dementia onset is key to improving the well-being of diverse older adults.
%B Gerontologist %V 38 %P 155-168 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28958071?dopt=Abstract %R 10.1093/geront/gnx142 %0 Journal Article %J Journals of Gerontology Series B: Psychological Sciences & Social Sciences %D 2018 %T The Relation of Volunteering and Subsequent Changes in Physical Disability in Older Adults. %A Dawn C Carr %A Ben Lennox Kail %A John W Rowe %K Disabilities %K Health Conditions and Status %K Volunteerism %XObjectives: To describe the association between initiating volunteering and changes in physical disability in older adults, and whether intensity and gender modify this relationship.
Methods: Employing propensity score weighted regression adjustment, we calculate changes in disability using a sample of U.S. adults (n = 7,135) in the Health and Retirement Study (1996-2012) not volunteering at baseline but later initiating volunteering (1-99 hr/year or 100+ hours per year) or remaining a nonvolunteer.
Results: Relative to continuous nonvolunteers, low-intensity volunteering is related to 34% lower disability in the low-intensity group (average treatment effect [ATE] = -0.12) and 63% lower in the higher-intensity group (ATE = -0.23). For men, progression was lower only in the highest intensity group (ATE = +0.02), but women experienced similarly less progression of disability (38%-39%) at either level of new engagement (ATE = -0.17 and -0.18).
Discussion: Initiating a new volunteer role in later life is related to decreased progression of disability, at low or high levels for women and only at higher levels for men. This study suggests that volunteer intervention programs may represent a major public health strategy to delay the progression of physical disability for older adults.
%B Journals of Gerontology Series B: Psychological Sciences & Social Sciences %V 73 %P 511-521 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28958062?dopt=Abstract %R 10.1093/geronb/gbx102 %0 Journal Article %J American Journal of Hospital Palliative Care %D 2018 %T Relationship Between Expectation of Death and Location of Death Varies by Race/Ethnicity. %A Rafael D Romo %A Irena Cenzer %A Brie A Williams %A Alexander K Smith %K End of life decisions %K Mortality %K Racial/ethnic differences %K Subjective Expectations %XBACKGROUND: Older black and Latino Americans are more likely than white Americans to die in the hospital. Whether ethnic differences in expectation of death account for this disparity is unknown.
OBJECTIVES: To determine whether surviving family members' expectation of death has a differential association with site of death according to race or ethnicity.
METHODS: We conducted an analysis of decedents from the Health and Retirement Study, a nationally representative study of US older adults. Telephone surveys were conducted with family members for 5979 decedents (decedents were 55% were women, 85% white, 9% black, and 6% Latino). The outcome of interest was death in the hospital; the predictor variable was race/ethnicity, and the intervening variable was expectation of death. Covariates included sociodemographics (gender, age, household net worth, educational attainment level, religion) and health factors (chronic conditions, symptoms, health-care utilization).
RESULTS: Decedents' race/ethnicity was statistically related to the expectation of death and death in the hospital. When death was not expected, whites and Latinos were more likely to die in the hospital than when death was expected (49% vs 29% for whites and 55% vs 37% for Latinos; P < .001). There was no difference in site of death according to family's expectation of death among blacks.
CONCLUSION: Expectation of death did not fully account for site of death and played a greater role among whites and Latinos than among black Americans. Discussing prognosis by itself is unlikely to address ethnic disparities. Other factors appear to play an important role as well.
%B American Journal of Hospital Palliative Care %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29724110?dopt=Abstract %R 10.1177/1049909118773989 %0 Thesis %B Social Work %D 2018 %T Religion/Spirituality and Disability in Older Adults %A Cantin,Alyssa %K 0201:Disability studies %K 0318:Religion %K 0347:Mental health %K depression %K Disability %K Disability studies %K Health and environmental sciences %K Mental Health %K Philosophy %K Religion %K religion and theology %K Stress %X A secondary data analysis was conducted using data from the Health and Retirement Study (HRS) to explore the relationships between physical disability, religion/spirituality (R/S), and mental health outcomes. The sample consisted of older adults randomly sampled from the United States. Ordinary least square regressions were done to test the proposed hypotheses that severity of disability would be associated with more R/S, more depression and more stress, and that R/S would be associated with less depression and less stress. The main effects were significant, and a mediation regression analysis was completed to determine if R/S significantly mediates the relationship of disability severity with depression and stress. The mediated effect was small but statistically significant, indicating that R/S potentially protects against negative mental health outcomes like depression and stress, as disabilities become more severe. Such findings have important research and practice implications in the treatment of older adults. %B Social Work %I Fordham University %V PhD %P 52 %@ 9780355877892 %G eng %U https://fordham.bepress.com/dissertations/AAI10807818/ %9 phd %0 Journal Article %J Public Finance Review %D 2018 %T Retirement Reversals and Health Insurance %A Joshua Congdon-Hohman %K Medicare/Medicaid/Health Insurance %K Policy %K Retirement Planning and Satisfaction %X This article uses the longitudinal aspect of the Health and Retirement Study to explore the characteristics associated with reversals in retirement (referred to here as “unretirement”). Through the use of survival-time analysis with time-variant covariates, this article shows that health insurance status and its source are significant predictors of unretirement decisions. The relationship is important, as the potential impacts of the Affordable Care Act (ACA) are considered. The analysis finds that insurance is equally as predictive of retirement reversals as other financial explanations such as pensions and wealth at retirement. The analysis also shows that health insurance sources play a particularly predictive role for early retirees and those who were previously open to the idea of working in retirement. Rough estimates suggest that the ACA might reduce the number of reversals by between two and four percentage points, which would translate to 80,000 and 170,000 retirees annually. %B Public Finance Review %V 46 %P 583-608 %G eng %U http://journals.sagepub.com/doi/10.1177/1091142116673146http://journals.sagepub.com/doi/pdf/10.1177/1091142116673146http://journals.sagepub.com/doi/pdf/10.1177/1091142116673146http://journals.sagepub.com/doi/full-xml/10.1177/1091142116673146 %N 4 %! Public Finance Review %R 10.1177/1091142116673146 %0 Journal Article %J Gerontologist %D 2018 %T Retirement sequences of older Americans: Moderately destandardized and highly stratified across gender, class, and race. %A Calvo, Esteban %A Madero-Cabib, Ignacio %A Ursula M. Staudinger %K Gender Differences %K Racial/ethnic differences %K Retirement Planning and Satisfaction %K Women and Minorities %XPurpose of the Study: A destandardization of labor-force patterns revolving around retirement has been observed in recent literature. It is unclear, however, to which degree and of which kind. This study looked at sequences rather than individual statuses or transitions and argued that differentiating older Americans' retirement sequences by type, order, and timing and considering gender, class, and race differences yields a less destandardized picture.
Design and Methods: Sequence analysis was employed to analyze panel data from the Health and Retirement Study (HRS) for 7,881 individuals observed 6 consecutive times between ages 60-61 and 70-71.
Results: As expected, types of retirement sequences were identified that cannot be subsumed under the conventional model of complete retirement from full-time employment around age 65. However, these retirement sequences were not entirely destandardized, as some irreversibility and age-grading persisted. Further, the degree of destandardization varied along gender, class, and race. Unconventional sequences were archetypal for middle-level educated individuals and Blacks. Also, sequences for women and individuals with lower education showed more unemployment and part-time jobs, and less age-grading.
Implications: A sequence-analytic approach that models group differences uncovers misjudgments about the degree of destandardization of retirement sequences. When a continuous process is represented as individual transitions, the overall pattern of retirement sequences gets lost and appears destandardized. These patterns get further complicated by differences in social structures by gender, class, and race in ways that seem to reproduce advantages that men, more highly educated individuals, and Whites enjoy in numerous areas over the life course.
%B Gerontologist %V 58 %P 1166-1176 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28586409?dopt=Abstract %R 10.1093/geront/gnx052 %0 Journal Article %J Journal of Poverty and Social Justice %D 2018 %T Social exclusion factors influencing life satisfaction among older adults %A Lee, Joonyup %A John G. Cagle %K Depressive symptoms %K Life Satisfaction %K Social capital %K Social Support %X This study aims to examine the relative impact of social exclusion factors on older adults' life satisfaction. This study conducted a cross-sectional analysis of psychosocial measures from the 2012 wave of the Health and Retirement Study (N=4,139). Results found that social exclusion factors indeed affect life satisfaction. Health had the strongest effect on life satisfaction. Good social relationships also positively affect life satisfaction. These findings call for considering multidimensionality of social exclusion in the future research. Researchers and practitioners could pay greater attention to social exclusion, ways to measure it, and its impact on life satisfaction through this study. %B Journal of Poverty and Social Justice %V 26 %P 35-50 %G eng %U http://www.ingentaconnect.com/content/10.1332/175982717X15127351091521http://www.ingentaconnect.com/content/tpp/jpsj/2018/00000026/00000001/art00003http://www.ingentaconnect.com/content/tpp/jpsj/2018/00000026/00000001/art00003 %N 1 %! j poverty soc justice %R 10.1332/175982717X15127351091521 %0 Journal Article %J Health Psychology %D 2018 %T Social integration and age-related decline in lung function. %A Crittenden, Crista N. %A Murphy, Michael L. M. %A Cohen, Sheldon %K Lung Volume Measurements %K Mortality %K Population Health %K Social Support %X We tested the hypothesis that social integration, measured as number of social roles, is associated with less age-related loss of lung function, an important marker of health and longevity. We also investigated possible psychological factors through which social integration might influence lung health. Methods: Data were analyzed from the Health and Retirement Study (ages 52-94, n = 4,224). Results and Conclusions: Each additional social role reported at baseline was associated with less of a decline in lung function between baseline and the ifollow-up assessment four years later. The association withstood controls for demographics, weight, and height and was mediated by more positive and less negative affect and lower rates of cigarette smoking and more physical activity. Roles were mostly substitutable, with both high (spouse, parent, friends, relatives) and low (employee, religious service attendee, volunteer, members of other groups) intimacy roles independently contributing to less age related decline in lung function. %B Health Psychology %V 37 %P 472-480 %G eng %U http://doi.apa.org/getdoi.cfm?doi=10.1037/hea0000592http://psycnet.apa.org/journals/hea/37/5/472.pdf %N 5 %! Health Psychology %R 10.1037/hea0000592 %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 Statistics in Medicine %D 2018 %T State-level estimation of diabetes and prediabetes prevalence: Combining national and local survey data and clinical data. %A David A Marker %A Mardon, Russ %A Jenkins, Frank %A Campione, Joanne %A Nooney, Jennifer %A Li, Jane %A Saydeh, Sharon %A Zhang, Xuanping %A Shrestha, Sundar %A Deborah B. Rolka %K Bias %K California %K Diabetes Mellitus %K Electronic Health Records %K Health Surveys %K Humans %K Insurance Claim Review %K New York City %K Nutrition Surveys %K Prediabetic State %K Prevalence %K Statistics as Topic %K United States %XMany statisticians and policy researchers are interested in using data generated through the normal delivery of health care services, rather than carefully designed and implemented population-representative surveys, to estimate disease prevalence. These larger databases allow for the estimation of smaller geographies, for example, states, at potentially lower expense. However, these health care records frequently do not cover all of the population of interest and may not collect some covariates that are important for accurate estimation. In a recent paper, the authors have described how to adjust for the incomplete coverage of administrative claims data and electronic health records at the state or local level. This article illustrates how to adjust and combine multiple data sets, namely, national surveys, state-level surveys, claims data, and electronic health record data, to improve estimates of diabetes and prediabetes prevalence, along with the estimates of the method's accuracy. We demonstrate and validate the method using data from three jurisdictions (Alabama, California, and New York City). This method can be applied more generally to other areas and other data sources.
%B Statistics in Medicine %V 37 %P 3975-3990 %G eng %N 27 %R 10.1002/sim.7848 %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 %XGeneral 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 Report %D 2018 %T A Test of Supply-side Explanations of Geographic Variation in Health Care Use %A Callison, Kevin %A Kaestner, Robert %A Ward, Jason %K Geography %K Health care utilization %K Medicare/Medicaid/Health Insurance %X Evidence of regional variation in health care utilization has been well-documented over the past 40 years. Yet uncertainty persists about whether this variation is primarily the result of supply-side or demand-side forces, and the difference matters for both theory and policy. In this article, we provide new evidence as to the cause of geographic variation in health care utilization. We do so by examining changes in health care use by the near-elderly as they transition from being uninsured into Medicare. Results provide support for a causal supply-side explanation of regional variation. Estimates indicate that gaining Medicare coverage in above-median spending regions increases the probability of at least one hospital visit by 36% and the probability of having more than five doctor visits by 25% relative to similar individuals in below-median spending regions. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 09/2018 %G eng %U http://www.nber.org/papers/w25037.pdf %R 10.3386/w25037 %0 Web Page %D 2018 %T There's More Than One Way To Retire %A Coombes, Andrea %K News %K Personality %K Retirement Planning and Satisfaction %I Forbes %C New York City %G eng %U https://www.forbes.com/sites/andreacoombes/2018/12/05/theres-more-than-one-way-to-retire/#7c4bf50c3669 %0 Report %D 2018 %T Transitions From Career Employment Among Public- and Private-Sector Workers %A Joseph F. Quinn %A Kevin E. Cahill %A Michael D. Giandrea %K Employment and Labor Force %K Private vs public sector %K Retirement Planning and Satisfaction %X Do the retirement patterns of public-sector workers differ from those in the private sector? Most private-sector workers today face a do-it-yourself retirement income landscape characterized by an exposure to market forces through defined-contribution pension plans and private saving, and the risk of financial insecurity later in life. Public-sector workers, in contrast, are typically covered by defined-benefit pension plans that both encourage retirement at relatively young ages and offer financial security at older ages. As a result, the consequences of private- and public-sector workers’ retirement decisions could differ in important ways. For workers generally, and for private-sector workers in particular, a focus among researchers and policymakers has been the importance of continued work later in life for improving financial security at older ages. Such concerns might be of less consequence for public-sector workers due to the prevalence of defined-benefit pensions. Public-sector workers’ departures from the labor force might also differ from those in the private sector, all else equal, because of the age-specific incentives within their defined-benefit plans. Despite these important differences, the private-public distinction has received relatively little attention in the retirement literature. Our paper examines how private- and public-sector workers transition from career employment to complete labor force withdrawal, with a focus on the role of bridge employment, phased retirement, and re-entry. We identify the prevalence and determinants of each pathway to retirement using longitudinal data on four cohorts of private- and public-sector career older workers from the Health and Retirement Study (HRS). Our findings suggest that the prevalence of work after leaving career employment among public-sector workers resembles that of private-sector workers, although with a higher prevalence of part-time bridge employment, a result that has important implications for public policy as the pace of societal aging accelerates. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 09/2018 %G eng %U http://www.nber.org/papers/w25003.pdf %R 10.3386/w25003 %0 Journal Article %J Journals of Gerontology Series B: Psychological Sciences & Social Sciences %D 2018 %T Trends in the Prevalence and Disparity in Cognitive Limitations of Americans 55-69 Years Old. %A Choi, Hwajung %A Robert F. Schoeni %A Linda G Martin %A Kenneth M. Langa %K Cognitive Ability %K Functional limitations %XObjectives: To determine whether the prevalence of cognitive limitation (CL) among Americans ages 55 to 69 years changed between 1998 and 2014, and to assess the trends in socioeconomic disparities in CL among groups defined by race/ethnicity, education, income, and wealth.
Method: Logistic regression using 1998-2014 data from the biennial Health and Retirement Study, a nationally representative data set. CL is defined as a score of 0-11 on a 27-point cognitive battery of items focused on memory. Socioeconomic status (SES) measures are classified as quartiles.
Results: In models controlling for age, gender, and previous cognitive testing, we find no significant change over time in the overall prevalence of CL, widening disparities in limitation by income and, in some cases, wealth, and improvements among non-Hispanic whites but not other racial/ethnic groups.
Discussion: Among people 55-69, rates of CL are many times higher for groups with lower SES than those with higher SES, and recent trends show little indication that the gaps are narrowing.
%B Journals of Gerontology Series B: Psychological Sciences & Social Sciences %V 73 %P S29-S37 %G eng %N suppl_1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29669102?dopt=Abstract %R 10.1093/geronb/gbx155 %0 Journal Article %J Journal of Gerontological Social Work %D 2018 %T Understanding work enjoyment among older workers: The significance of flexible work options and age discrimination in the workplace %A Choi, Eunhee %A Ospina, Javier %A Steger, Michael F. %A Orsi, Rebecca %K Ageism %K Retirement %K Work %K Work-life balance %K Working conditions %X Although the number of older workers in the U.S. is increasing, there is a gap in knowledge on whether or not they actually enjoy working. This study, based on a conceptual framework focusing on job resources and demands, explored likely workplace determinants of work enjoyment among older workers aged 50 or over. Using the 2012 wave of the Health and Retirement Study, a partial proportional odds model was used to detect determinants of work enjoyment. Results showed that higher levels of work enjoyment were significantly and negatively associated with the level of perceived retirement pressure and promotion preference for younger workers, and positively associated with moving to less demanding positions. Self-employment showed a noticeable enhancement of work enjoyment. This study highlights the significance of flexible work options and age discrimination in the workplace in understanding work enjoyment later in life. © 2018, © 2018 Taylor & Francis Group, LLC. %B Journal of Gerontological Social Work %P 1 - 20 %8 Feb-09-2019 %G eng %U https://www.tandfonline.com/doi/full/10.1080/01634372.2018.1515140https://www.tandfonline.com/doi/pdf/10.1080/01634372.2018.1515140 %! Journal of Gerontological Social Work %R 10.1080/01634372.2018.1515140 %0 Journal Article %J European Journal of Ageing %D 2018 %T What do we know about grandparents? Insights from current quantitative data and identification of future data needs %A Hank, Karsten %A Cavrini, Giulia %A Giorgio Di Gessa %A Tomassini, Cecilia %K Cross-National %K Grandparents %K Quantitative data %K Transitions %X Against the background of a ‘new wave’ of empirical studies investigating various aspects of grandparenthood across a broad range of regional contexts, this article aims to take stock of what has been achieved so far and which lessons we can learn from this for the future. Our focus is on the measurement of grandparenthood and grandparenting in quantitative social surveys and the implications this has for the substantive questions we can ask and the answers we can get out of such data. For several broader questions—who is a grandparent and when does this transition happen; what does it mean to be a grandparent; and what are the implications of grandparenthood for families?—we review previous questionnaire items from a variety of surveys as well as studies in which they were used. We identify relevant issues related to these questions which cannot be adequately addressed with currently available data, but should be considered in new or ongoing survey projects. The answers provided by recent studies as well as the many still open questions identified here indicate excellent prospects for scholarship on grandparents in the years to come. %B European Journal of Ageing %V 15 %P 225–235 %G eng %N 3 %! Eur J Ageing %R 10.1007/s10433-018-0468-1 %0 Report %D 2017 %T Access to Long-Term Care After a Wealth Shock: Evidence from the Housing Bubble and Burst %A Costa-Font, Joan %A Richard G Frank %A Swartz, Katherine %K Long-term Care %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %K Wealth Shocks %X Home equity is the primary self-funding mechanism for long term services and supports (LTSS). Using data from the relevant waves of the Health and Retirement Study (1996-2010), we exploit the exogenous variation in the form of wealth shocks resulting from the value of housing assets, to examine the effect of wealth on use of home health, unpaid help and nursing home care by older adults. We find a significant increase in the use of paid home health care and unpaid informal care but no effect on nursing home care access. We conduct a placebo test on individuals who do not own property; their use of LTSS was not affected by the housing wealth changes. The findings suggest that a wealth shock exerts a positive and significant effect on the uptake of home health and some effect on unpaid care but no significant effect on nursing home care. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 09/2017 %G eng %U http://www.nber.org/papers/w23781.pdf %R 10.3386/w23781 %0 Journal Article %J Computational Economics %D 2017 %T Adaptive Quadrature for Maximum Likelihood Estimation of a Class of Dynamic Latent Variable Models %A Cagnone, Silvia %A Francesco Bartolucci %K Older Adults %K Survey Methodology %X Maximum likelihood estimation of models based on continuous latent variables generally requires to solve integrals that are not analytically tractable. Numerical approximations represent a possible solution to this problem. We propose to use the adaptive Gaussian–Hermite (AGH) numerical quadrature approximation for a particular class of continuous latent variable models for time-series and longitudinal data. These dynamic models are based on time-varying latent variables that follow an autoregressive process of order 1, AR(1). Two examples are the stochastic volatility models for the analysis of financial time series and the limited dependent variable models for the analysis of panel data. A comparison between the performance of AGH methods and alternative approximation methods proposed in the literature is carried out by simulation. Empirical examples are also used to illustrate the proposed approach. %B Computational Economics %V 49 %P 599 - 622 %8 Jan-04-2017 %G eng %N 4 %! Comput Econ %R 10.1007/s10614-016-9573-4 %0 Book Section %B Oxford Textbook of Geriatric Medicine %D 2017 %T Ageing in North America: Canada and the United States %A Eileen M. Crimmins %A Hiram Beltrán-Sánchez %A Lauren L Brown %A Yon, Yongjie %A Michel, Jean-Pierre %A Beattie, B. Lynn %A Martin, Finbarr C. %A Jeremy D Walston %K Aging %K Cross-National %B Oxford Textbook of Geriatric Medicine %7 3rd %I Oxford University Press %C Cary, NC %P 19-26 %@ 978-0198701590 %G eng %& 3 %0 Journal Article %J Research on Aging %D 2017 %T Aging with disability for midlife and older adults %A Verbrugge, Lois M. %A Kenzie Latham %A Philippa J Clarke %K Disabilities %K Functional status %X This analysis brings "aging with disability" into middle and older ages. We study U.S. adults ages 51+ and ages 65+ with persistent disability (physical, household management, personal care; physical limitations, instrumental activities of daily living [IADLs], activities of daily living [ADLs]), using Health and Retirement Study data. Two complementary approaches are used to identify persons with persistent disability, one based directly on observed data and the other on latent classes. Both approaches show that persistent disability is more common for persons ages 65+ than ages 51+ and more common for physical limitations than IADLs and ADLs. People with persistent disability have social and health disadvantages compared to people with other longitudinal experiences. The analysis integrates two research avenues, aging with disability and disability trajectories. It gives empirical heft to government efforts to make aging with disability an age-free (all ages) rather than age-targeted (children and youths) perspective. %B Research on Aging %V 39 %P 741-777 %G eng %U http://journals.sagepub.com/doi/10.1177/0164027516681051 %N 6 %! Research on Aging %R 10.1177/0164027516681051 %0 Journal Article %J Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %D 2017 %T Alzheimer's disease genetic risk variants beyond APOE ε4 predict mortality %A Mez, Jesse %A Jessica R Marden %A Mukherjee, Shubhabrata %A Stefan Walter %A Laura E Gibbons %A Alden L Gross %A Laura B Zahodne %A Paola Gilsanz %A Brewster, Paul %A Nho, Kwangsik %A Paul K Crane %A Eric B Larson %A M. Maria Glymour %K Alzheimer's disease %K APoE4 %K Cognitive Ability %K Genetics %K Mortality %K Risk Factors %X We hypothesized that, like apolipoprotein E (APOE), other late-onset Alzheimer's disease (LOAD) genetic susceptibility loci predict mortality. Methods We used a weighted genetic risk score (GRS) from 21 non-APOE LOAD risk variants to predict survival in the Adult Changes in Thought and the Health and Retirement Studies. We meta-analyzed hazard ratios and examined models adjusted for cognitive performance or limited to participants with dementia. For replication, we assessed the GRS-longevity association in the Cohorts for Heart and Aging Research in Genomic Epidemiology, comparing cases surviving to age ≥90 years with controls who died between ages 55 and 80 years. Results Higher GRS predicted mortality (hazard ratio = 1.05; 95% confidence interval: 1.00–1.10, P =.04). After adjusting for cognitive performance or restricting to participants with dementia, the relationship was attenuated and no longer significant. In case-control analysis, the GRS was associated with reduced longevity (odds ratio = 0.64; 95% confidence interval: 0.41–1.00, P =.05). Discussion Non-APOE LOAD susceptibility loci confer risk for mortality, likely through effects on dementia incidence. %B Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %V 8 %P 188-195 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S2352872917300416http://api.elsevier.com/content/article/PII:S2352872917300416?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2352872917300416?httpAccept=text/plain %! Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %R 10.1016/j.dadm.2017.07.002 %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 %XBACKGROUND: 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 Applied Statistics %D 2017 %T Analyzing dependence in incidence of diabetes and heart problem using generalized bivariate geometric models with covariates %A M. Ataharul Islam %A Rafiqul I Chowdhury %A Khalaf S. Sultan %K Diabetes %K Heart disease %X For analyzing incidence data on diabetes and health problems, the bivariate geometric probability distribution is a natural choice but remained unexplored largely due to lack of models linking covariates with the probabilities of bivariate incidence of correlated outcomes. In this paper, bivariate geometric models are proposed for two correlated incidence outcomes. The extended generalized linear models are developed to take into account covariate dependence of the bivariate probabilities of correlated incidence outcomes for diabetes and heart diseases for the elderly population. The estimation and test procedures are illustrated using the Health and Retirement Study data. Two models are shown in this paper, one based on conditional-marginal approach and the other one based on the joint probability distribution with an association parameter. The joint model with association parameter appears to be a very good choice for analyzing the covariate dependence of the joint incidence of diabetes and heart diseases. Bootstrapping is performed to measure the accuracy of estimates and the results indicate very small bias. © 2016 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. %B Journal of Applied Statistics %V 44 %P 2890-2907 %8 Feb-12-2017 %G eng %U https://www.tandfonline.com/doi/full/10.1080/02664763.2016.1266467 %N 16 %! Journal of Applied Statistics %R 10.1080/02664763.2016.1266467 %0 Report %D 2017 %T Annuity Options in Public Pension Plans:The Curious Case of Social Security Leveling %A Robert Clark %A Hammond, Robert %A Morrill, Melinda %A Vanderweide, David %K Annuitization %K Older Adults %K Pensions %K Social Security %X Social Security Leveling is an annuity option that allows participants to receive a level income before and after age 62. The retiree receives a larger pension benefit prior to age 62, but then the pension benefit is lowered at age 62 when the individual is expected to claim Social Security benefits. This option is not uncommon in public pension plans, yet little is known about how this option is used in practice and its impact on well-being in retirement. Our study uses a combination of administrative records and survey data from recent North Carolina public sector retirees. We find that one-third of all retirees selecting a single life annuity between 2009 and 2014 opted for Social Security Leveling. The evidence suggests that individuals are choosing this option in a way that is consistent with their stated preferences and a consumption smoothing motive. However, we also see higher rates of ex post “regret” in the annuity choice among those choosing the level income option. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 03/2017 %G eng %U http://www.nber.org/papers/w23262.pdf %R 10.3386/w23262 %0 Journal Article %J J Aging Health %D 2017 %T Another Paradox? The Life Satisfaction of Older Hispanic Immigrants in the United States. %A Rocío Calvo %A Dawn C Carr %A Matz-Costa, Christina %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Emigrants and Immigrants %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Models, Theoretical %K Personal Satisfaction %K Surveys and Questionnaires %XOBJECTIVE: To investigate disparities in life satisfaction among older Hispanic immigrants in the United States relative to their native-born Hispanic and non-Hispanic White counterparts, and to identify factors associated with such disparities.
METHOD: Cross-sectional data from 9,798 individuals age 60 and above from the Health and Retirement Study (HRS) were used to estimate ordinary least squares (OLS) regression models.
RESULTS: Hispanic immigrants reported the highest levels of life satisfaction of all groups. Wealthier older adults, who were socially engaged, had social support, and experienced fewer functional limitations and lower exposure to discrimination, were more satisfied with their lives in the overall sample. Interaction effects revealed that although education was associated with greater life satisfaction only among non-Hispanic Whites, co-residing with children was associated with greater life satisfaction only among Hispanics.
DISCUSSION: Although older Hispanic immigrants had the least amount of socioeconomic resources of all groups in our study, they were the most satisfied with their lives. Possible explanations and directions for future research are discussed.
%B J Aging Health %V 29 %P 3-24 %8 2017 Feb %G eng %U http://jah.sagepub.com/content/early/2016/01/14/0898264315624901.abstract %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26772911?dopt=Abstract %R 10.1177/0898264315624901 %0 Journal Article %J Social Science & Medicine %D 2017 %T Anticipated support from children and later-life health in the United States and China %A Cheng, Cheng %K Caregiving %K China %K Cross-National %K Older Adults %B Social Science & Medicine %V 179 %P 201 - 209 %8 Jan-04-2017 %G eng %U https://www.sciencedirect.com/science/article/pii/S0277953617301466 %! Social Science & Medicine %R 10.1016/j.socscimed.2017.03.007 %0 Journal Article %J JAMA Internal Medicine %D 2017 %T Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders %A Elizabeth L Whitlock %A L Grisell Diaz-Ramirez %A M. Maria Glymour %A W John Boscardin %A Kenneth E Covinsky %K Chronic pain %K Cognitive Ability %K Memory %X Importance: Chronic pain is common among the elderly and is associated with cognitive deficits in cross-sectional studies; the population-level association between chronic pain and longitudinal cognition is unknown. Objective: To determine the population-level association between persistent pain, which may reflect chronic pain, and subsequent cognitive decline. Design, Setting, and Participants: Cohort study with biennial interviews of 10 065 community-dwelling older adults in the nationally representative Health and Retirement Study who were 62 years or older in 2000 and answered pain and cognition questions in both 1998 and 2000. Data analysis was conducted between June 24 and October 31, 2016. Exposures: “Persistent pain,” defined as a participant reporting that he or she was often troubled with moderate or severe pain in both the 1998 and 2000 interviews. Main Outcomes and Measures: Coprimary outcomes were composite memory score and dementia probability, estimated by combining neuropsychological test results and informant and proxy interviews, which were tracked from 2000 through 2012. Linear mixed-effects models, with random slope and intercept for each participant, were used to estimate the association of persistent pain with slope of the subsequent cognitive trajectory, adjusting for demographic characteristics and comorbidities measures in 2000 and applying sampling weights to represent the 2000 US population. We hypothesized that persistent pain would predict accelerated memory decline and increased probability of dementia. To quantify the impact of persistent pain on functional independence, we combined our primary results with information on the association between memory and ability to manage medications and finances independently. Results: Of the 10,065 eligible HRS sample members, 60% were female, and median baseline age was 73 years (interquartile range, 67-78 years). At baseline, persistent pain affected 10.9% of participants and was associated with worse depressive symptoms and more limitations in activities of daily living. After covariate adjustment, persistent pain was associated with 9.2% (95% CI, 2.8%-15.0%) more rapid memory decline compared with those without persistent pain. After 10 years, this accelerated memory decline implied a 15.9% higher relative risk of inability to manage medications and an 11.8% higher relative risk of inability to manage finances independently. Adjusted dementia probability increased 7.7% faster (95% CI, 0.55%-14.2%); after 10 years, this translates to an absolute 2.2% increase in dementia probability for those with persistent pain. Conclusions and Relevance: Persistent pain was associated with accelerated memory decline and increased probability of dementia. %B JAMA Internal Medicine %V 177 %G eng %U https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2629448 %N 8 %& 1146-1153 %R 10.1001/jamainternmed.2017.1622 %0 Journal Article %J JAMA Psychiatry %D 2017 %T Association Between Purpose in Life and Objective Measures of Physical Function in Older Adults. %A Eric S Kim %A Ichiro Kawachi %A Ying Chen %A Laura D Kubzansky %K Physical Ability %K Purpose in life %K Self-reported health %XImportance: Higher purpose in life is hypothesized to reduce the likelihood of developing weak grip strength and slow walking speed because purpose has been linked with a range of positive health behaviors and biological processes that are potentially protective against declining physical function. However, the association between purpose in life and objective physical function has not been examined.
Objective: To assess whether higher purpose in life among adequately functioning older adults is associated with lower risk of developing weak grip strength and slow walking speed over time.
Design, Setting, and Participants: Data for a longitudinal cohort study were collected in 2006 and again in 2010 from the Health and Retirement Study, a nationally representative study of US adults older than 50 years. Data analysis was conducted from November 23, 2016, to June 2, 2017.
Main Outcomes and Measures: The risk of developing weak grip strength (assessed as a binary yes or no outcome) or slow walking speed (yes or no) during the 4-year follow-up period. Grip strength was assessed using Smedley spring-type hand dynamometers, and walking speed was assessed by asking respondents to walk 2.5 m at their normal walking pace.
Results: In this study, 4486 adults had grip scores at baseline indicating adequate function (2665 women and 1821 men; mean [SD] age, 63.0 [8.2] years) and 1461 adults had walking scores at baseline indicating adequate function (801 women and 660 men; mean [SD] age, 70.8 [6.5] years). After controlling for sociodemographic factors, each 1-SD increase in purpose was associated with a 13% decreased risk (95% CI, 1%-23%) of developing weak grip strength and a 14% decreased risk (95% CI, 8%-20%) of developing slow walking speed. Associations with walking speed were maintained in all covariate models (fully adjusted model: risk ratio, 0.89; 95% CI, 0.83-0.95), but associations with grip strength did not reach conventional levels of statistical significance after additionally adjusting for relevant baseline health factors, depressive symptoms, and health behaviors (fully adjusted model: risk ratio, 0.91; 95% CI, 0.80-1.04).
Conclusions and Relevance: Purpose in life was prospectively associated with a decreased risk of developing weak grip strength and slow walking speed, although the findings were more robust for walking speed than for grip strength. These findings suggest that a sense of purpose in life, a modifiable factor, may play an important role in maintaining physical function among older adults.
%B JAMA Psychiatry %V 74 %P 1039-1045 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/28813554?dopt=Abstract %R 10.1001/jamapsychiatry.2017.2145 %0 Journal Article %J Psychosomatic Medicine %D 2017 %T Associations of lifetime trauma and chronic stress with C-reactive protein in adults ages 50 and older %A Ari J. Elliot %A Christopher J Mooney %A Frank J Infurna %A Chapman, Benjamin P %K C-reactive protein %K Chronic stress %K Trauma %X OBJECTIVE: To investigate whether high perceived control mitigates systemic inflammatory risk associated with traumatic and chronic stress exposures in older adults. METHODS: A sample of community-dwelling adults ages 50 and older (N=4,779) was drawn from the Health and Retirement Study (HRS). Structural equation models tested interactions of lifetime trauma and chronic stress with mastery and perceived constraints predicting baseline levels and four-year change in C-reactive protein (CRP). RESULTS: There were significant interactions of lifetime trauma (β = -.058, p = .012) and chronic stress (β =-0.069, p =.010) with mastery as related to baseline CRP levels. Both measures were associated with higher CRP at low (β =.102, p =.003; β =.088, p = .015) but not high levels of mastery. In addition, chronic stress interacted with baseline mastery (β =.056, p =.011) and change in mastery (β =-.056, p =.016) to predict 4-year change in CRP. Chronic stress was associated with an increase in CRP at high baseline mastery (β =.071, p =.022) and when mastery decreased during follow-up (β =.088, p =.011). There were no main effects of stress or control variables other than an association of constraints with a larger increase in CRP (β =.062, p =.017). Interactions were minimally attenuated (<15%) upon further adjustment for negative affect, body mass index, smoking, and physical activity. CONCLUSIONS: High mastery may protect against elevated systemic inflammation associated with substantial lifetime trauma exposure. Individuals who experience declines in mastery may be most susceptible to increases in inflammation associated with chronic stress. %B Psychosomatic Medicine %V 79 %P 622-630 %G eng %U http://Insights.ovid.com/crossref?an=00006842-900000000-98829http://Insights.ovid.com/crossref?an=00006842-900000000-98829 %N 6 %! Psychosomatic Medicine %R 10.1097/PSY.0000000000000476 %0 Report %D 2017 %T The Benefits and Challenges of Collecting Physical Measures and Biomarkers in Cross-National Studies %A Heidi M Guyer %A Mary Beth Ofstedal %A Lessof, Carli %A Cox, Kate %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %8 04/2017 %G eng %0 Journal Article %J The Journals of Gerontology Series A: Biological Sciences and Medical Sciences %D 2017 %T Clinical Trials Targeting Aging and Age-Related Multimorbidity %A Mark A. Espeland %A Eileen M. Crimmins %A Brandon R. Grossardt %A Jill P. Crandall %A Jonathan A. L. Gelfond %A Tamara B Harris %A Stephen B Kritchevsky %A JoAnn E Manson %A Jennifer G Robinson %A Walter A Rocca %A Temprosa, Marinella %A Thomas, Fridtjof %A Robert B Wallace %A Barzilai, Nir %K Chronic disease %K Clinical trials %K Older Adults %X Background: There is growing interest in identifying interventions that may increase health span by targeting biological processes underlying aging. The design of efficient and rigorous clinical trials to assess these interventions requires careful consideration of eligibility criteria, outcomes, sample size, and monitoring plans. Methods: Experienced geriatrics researchers and clinical trialists collaborated to provide advice on clinical trial design. Results: Outcomes based on the accumulation and incidence of age-related chronic diseases are attractive for clinical trials targeting aging. Accumulation and incidence rates of multimorbidity outcomes were developed by selecting at-risk subsets of individuals from three large cohort studies of older individuals. These provide representative benchmark data for decisions on eligibility, duration, and assessment protocols. Monitoring rules should be sensitive to targeting aging-related, rather than disease-specific, outcomes. Conclusions: Clinical trials targeting aging are feasible, but require careful design consideration and monitoring rules. %B The Journals of Gerontology Series A: Biological Sciences and Medical Sciences %V 72 %P 355-361 %G eng %U https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glw220https://academic.oup.com/biomedgerontology/article/2328606/Clinical-Trials-Targeting-Aging-and-AgeRelated %N 3 %! GERONA %R 10.1093/gerona/glw220 %0 Report %D 2017 %T Comparing 2SLS vs 2SRI for Binary Outcomes and Binary Exposures %A Basu, Anirban %A Norma B Coe %A Cole G. Chapman %K Economics %K Health Services Utilization %K Long-term Care %X This study uses Monte Carlo simulations to examine the ability of the two-stage least-squares (2SLS) estimator and two-stage residual inclusion (2SRI) estimators with varying forms of residuals to estimate the local average and population average treatment effect parameters in models with binary outcome, endogenous binary treatment, and single binary instrument. The rarity of the outcome and the treatment are varied across simulation scenarios. Results show that 2SLS generated consistent estimates of the LATE and biased estimates of the ATE across all scenarios. 2SRI approaches, in general, produce biased estimates of both LATE and ATE under all scenarios. 2SRI using generalized residuals minimizes the bias in ATE estimates. Use of 2SLS and 2SRI is illustrated in an empirical application estimating the effects of long-term care insurance on a variety of binary healthcare utilization outcomes among the near-elderly using the Health and Retirement Study. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 09/2017 %G eng %U http://www.nber.org/papers/w23840.pdf %R 10.3386/w23840 %0 Journal Article %J JAMA Intern Med %D 2017 %T A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. %A Kenneth M. Langa %A Eric B Larson %A Eileen M. Crimmins %A Jessica Faul %A Deborah A Levine %A Mohammed U Kabeto %A David R Weir %K Aged %K Dementia %K Female %K Humans %K Male %K Prevalence %K Risk Factors %K United States %XImportance: The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.
Objective: To compare the prevalence of dementia in the United States in 2000 and 2012.
Design, Setting, and Participants: We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.
Main Outcomes and Measures: Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.
Results: The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.
Conclusions and Relevance: The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.
%B JAMA Intern Med %V 177 %P 51-58 %8 2017 01 01 %G eng %U http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.6807http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2587084 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27893041?dopt=Abstract %! JAMA Intern Med %R 10.1001/jamainternmed.2016.6807 %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 Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2017 %T Consumer decision-making abilities and long-term care insurance purchase. %A Brian E McGarry %A Tempkin-Greener, Helena %A David C Grabowski %A Chapman, Benjamin P %A Li, Yue %K Decision making %K Long-term Care %XObjectives: To determine the impact of consumer decision-making abilities on making a long-term care insurance (LTCi) purchasing decision that is consistent with normative economic predictions regarding policy ownership.
Method: Using data from the Health and Retirement Study, multivariate analyses are implemented to estimate the effect of decision-making ability factors on owning LTCi. Stratified multivariate analyses are used to examine the effect of decision-making abilities on the likelihood of adhering to economic predictions of LTCi ownership.
Results: In the full sample, better cognitive capacity was found to significantly increase the odds of ownership. When the sample was stratified based on expected LTCi ownership status, cognitive capacity was positively associated with ownership among those predicted to own and negatively associated with ownership among those predicted not to own who could likely afford a policy.
Discussion: Consumer decision-making abilities, specifically cognitive capacity, are an important determinant of LTCi decision outcomes. Deficits in this ability may prevent individuals from successfully preparing for future long-term care expenses. Policy makers should consider changes that reduce the cognitive burden of this choice, including the standardization of the LTCi market, the provision of consumer decision aids, and alternatives to voluntary and private insuring mechanisms.
%B Journals of Gerontology Series B: Psychological Sciences and Social Sciences %8 9999 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28541583?dopt=Abstract %R 10.1093/geronb/gbx059 %0 Journal Article %J American Journal of Epidemiology %D 2017 %T Contemporaneous Social Environment and the Architecture of Late-Life Gene Expression Profiles. %A Morgan E. Levine %A Eileen M. Crimmins %A David R Weir %A Steven W. Cole %K Genetics %K Socioeconomic factors %X Environmental or social challenges can stimulate a cascade of coordinated physiological changes in stress response systems. Unfortunately, chronic activation of these adaptations under conditions such as low socioeconomic status (SES) can have negative consequences for long-term health. While there is substantial evidence tying low SES to increased disease risk and reduced life expectancy, the underlying biology remains poorly understood. Using pilot data on 120 older adults from the Health and Retirement Study (United States, 2002-2010), we examined the associations between SES and gene expression levels in adulthood, with particular focus on a gene expression program known as the conserved transcriptional response to adversity. We also used a bioinformatics-based approach to assess the activity of specific gene regulation pathways involved in inflammation, antiviral responses, and stress-related neuroendocrine signaling. We found that low SES was related to increased expression of conserved transcriptional response to adversity genes and distinct patterns of proinflammatory, antiviral, and stress signaling (e.g., sympathetic nervous system and hypothalamic-pituitary-adrenal axis) transcription factor activation. %B American Journal of Epidemiology %V 186 %P 503-509 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/28911009?dopt=Abstract %R 10.1093/aje/kwx147 %0 Journal Article %J Review of Finance %D 2017 %T The credit card debt puzzle and noncognitive ability %A Choi, Hwan-sik %A Laschever, Ron A. %K Cognitive Ability %K Financial literacy %K Personality %X Many households concurrently hold low-yield liquid assets while incurring costly credit card debt. In our sample, more than 80% of households with credit card debt also have low-yield liquid assets. Using data from the Health and Retirement Study (N=30,517), we examine the role of noncognitive skills as well as the economic, financial, and demographic factors that affect the likelihood of co-holding. We find that the "Big Five" personality traits have a statistically significant and economically important effect: households with a more agreeable, introvert, and less conscientious head of household are more likely to co-hold. We also examine the role of intra-household dynamics. %B Review of Finance %V 22 %P 2109-2137 %G eng %U https://academic.oup.com/rof/article/22/6/2109/3970879http://academic.oup.com/rof/article-pdf/22/6/2109/26172467/rfx020.pdf %N 6 %R 10.1093/rof/rfx020 %0 Journal Article %J Health Care for Women International %D 2017 %T Cultural and emotional determinants of cervical cancer screening among older Hispanic women %A Tamara J. Cadet %A Shanna Lynn Burke %A Stewart, Kathleen %A Howard, Tenial %A Schonberg, Mara %K Cancer screenings %K Depressive symptoms %K Hispanics %K Women and Minorities %X Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics' cervical cancer screening behaviors. %B Health Care for Women International %V 38 %P 1289-1312 %G eng %U https://www.tandfonline.com/doi/full/10.1080/07399332.2017.1364740https://www.tandfonline.com/doi/pdf/10.1080/07399332.2017.1364740 %N 12 %! Health Care for Women International %R 10.1080/07399332.2017.1364740 %0 Journal Article %J American Journal of Preventative Medicine %D 2017 %T Cut points for clinical muscle weakness among older Americans. %A Kate A Duchowny %A Mark D Peterson %A Philippa J Clarke %K Cut points %K Gender Differences %K Grip strength %K Muscle Weakness %K Older Adults %K Racial/ethnic differences %XINTRODUCTION: Muscle weakness is an important indicator of disability, chronic disease, and early mortality. Grip strength is a simple, cost-effective measure of overall muscle strength. The Foundation of the National Institutes of Health recently proposed sex-specific grip strength cut points for clinical muscle weakness. However, these criteria were established using non-nationally representative data. This study used nationally representative data on Americans aged ≥65 years to identify race- and sex-specific cut points for clinical muscle weakness and quantify prevalence among older blacks and whites by sex.
METHODS: Classification and Regression Tree models were used to identify cut points based on individual-level grip strength associated with slow gait speed (<0.8 m/second) among 7,688 individuals (57% female; 8% black; mean age, 74.6 [SD=6.79] years) from the 2010/2012 Health and Retirement Study during January-April 2016. Identified cut points were then used to quantify the prevalence of weakness by race/sex subgroup.
RESULTS: Fifty-five percent of men (maximum grip strength <39 kg) and 47% of women (maximum grip strength <22 kg) were classified as weak. Higher cut points were identified for black men (maximum grip strength <40 kg) and women (maximum grip strength <31 kg), and the prevalence of weakness (57% and 88%, respectively) was higher compared with whites. Fifty-five percent of individuals had slow gait speed (<0.8 m/second).
CONCLUSIONS: Prevalence of weakness was substantially higher than previous reports, underscoring the importance of using population-level data to identify individuals at greatest risk for adverse health outcomes. This is the first study to establish cut points for muscle weakness in a nationally representative sample by race and sex.
%B American Journal of Preventative Medicine %V 53 %P 63-69 %G eng %N 1 %R 10.1016/j.amepre.2016.12.022 %0 Journal Article %J Death Stud %D 2017 %T Death across the lifespan: Age differences in death-related thoughts and anxiety. %A William J. Chopik %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Aging %K Anxiety %K Attitude to Death %K Cross-Sectional Studies %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Thinking %K Young Adult %XMany studies have found age-related declines in death-related anxiety. Why do death-related thoughts and anxiety decline across the lifespan when exposure to, and likelihood of, death increase over time? In Study 1, a cross-sectional survey of 2,363 adults, death-related thoughts declined across the lifespan. In Study 2, a longitudinal study of 9,815 adults followed over a 4-year period, death anxiety declined across the lifespan. Further, greater social support predicted lower levels of death anxiety over time, after controlling for self-rated health and chronic illnesses. Close relationships serve emotion regulation functions to decrease death anxiety and thoughts across the lifespan.
%B Death Stud %V 41 %P 69-77 %8 2017 02 %G eng %U https://www.tandfonline.com/doi/full/10.1080/07481187.2016.1206997 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27573253?dopt=Abstract %! Death Studies %R 10.1080/07481187.2016.1206997 %0 Journal Article %J Proceedings of the National Academy of Sciences of the United States of America %D 2017 %T Death of family members as an overlooked source of racial disadvantage in the United States. %A Debra Umberson %A Olson, Julie Skalamera %A Crosnoe, Robert %A Hui Liu %A Tetyana Pudrovska %A Rachel Donnelly %K Bereavement %K Death & Dying %K Disadvantage %K Loss %K Older Adults %K Racial/ethnic differences %XLong-standing racial differences in US life expectancy suggest that black Americans would be exposed to significantly more family member deaths than white Americans from childhood through adulthood, which, given the health risks posed by grief and bereavement, would add to the disadvantages that they face. We analyze nationally representative US data from the National Longitudinal Study of Youth (n = 7,617) and the Health and Retirement Study (n = 34,757) to estimate racial differences in exposure to the death of family members at different ages, beginning in childhood. Results indicate that blacks are significantly more likely than whites to have experienced the death of a mother, a father, and a sibling from childhood through midlife. From young adulthood through later life, blacks are also more likely than whites to have experienced the death of a child and of a spouse. These results reveal an underappreciated layer of racial inequality in the United States, one that could contribute to the intergenerational transmission of health disadvantage. By calling attention to this heightened vulnerability of black Americans, our findings underscore the need to address the potential impact of more frequent and earlier exposure to family member deaths in the process of cumulative disadvantage.
%B Proceedings of the National Academy of Sciences of the United States of America %V 114 %P 915-920 %8 2017 Jan 31 %G eng %N 5 %R 10.1073/pnas.1605599114 %0 Government Document %D 2017 %T The Decline in Earnings Prior to Application for Disability Insurance Benefits %A Costa, Jackson %K Disabilities %K Income %K Medicare/Medicaid/Health Insurance %K Older Adults %K Social Security %7 1 %I Social Security Bulletin %V 77 %P 1-15 %G eng %U https://www.ssa.gov/policy/docs/ssb/v77n1/v77n1p1.html %0 Journal Article %J The Journal of the Economics of Ageing %D 2017 %T Diabetes and labor market exits: Evidence from the Health & Retirement Study (HRS) %A Chatterji, Pinka %A Heesoo Joo %A Kajal Chatterji Lahiri %K Chronic disease %K Diabetes %K Employment and Labor Force %K Retirement Planning and Satisfaction %X The objective of this paper is to estimate the effect of diabetes on labor market exit using longitudinal data from the 1992-2010 Health and Retirement Study (HRS). We estimate a discrete time hazard model to test whether diabetes affects the hazard of leaving employment among individuals who were working for pay at the age of 55-56. Using a probit model, we also estimate the effect of having undiagnosed or poorly controlled diabetes on the probability of labor market exit two years later. Our results indicate that diabetes is associated with an increased hazard of exiting the labor market for males, but not for females. This effect for males persists when we include controls for onset of other health conditions, two of which are documented complications of diabetes (stroke and heart conditions). We also find that diagnosed diabetes with medication use, regardless of whether or not it is under control, is associated with large negative effects on the likelihood of employment two years later. (C) 2016 Elsevier B.V. All rights reserved. %B The Journal of the Economics of Ageing %V 9 %P 100-110 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S2212828X16300639http://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2212828X16300639?httpAccept=text/plain %! The Journal of the Economics of Ageing %R 10.1016/j.jeoa.2016.08.005 %0 Journal Article %J Journal of the American Geriatrics Society %D 2017 %T Difficulty managing medications and finances in older adults: A 10-year cohort study. %A Bleijenberg, Nienke %A Sei J. Lee %A Irena Cenzer %A W John Boscardin %A Kenneth E Covinsky %K Financial literacy %K Older Adults %K Prescription Medication %K Risk Factors %XBACKGROUND: Difficulty managing medicines and finances becomes increasingly common with advanced age, and compromises the ability to live safely and independently. Remarkably little is known how often this occurs.
OBJECTIVES: To provide population-based estimates of the risk of developing incident difficulty managing medications and finances in older adults.
DESIGN: A prospective cohort study.
SETTING: The Health and Retirement Study (HRS), a nationally representative study of older adults.
PARTICIPANTS: 9,434 participants aged 65 and older who did not need help in managing medications or managing finances in 2002. Follow-up assessments occurred every 2 years until 2012.
MEASUREMENTS: The primary outcomes were time to difficulty managing medications and time to difficulty managing finances. Risk factors such as demographics, comorbidities, functional status, and cognitive status were assessed at baseline. Hazard models that considered the competing risk of death were used to estimate both the cumulative incidence of developing difficulty managing medications and finances and to identify potential risk factors. Analyses were adjusted for age, gender, race, marital status, wealth and education.
RESULTS: The 10 years incidence of difficulty increased markedly with age, ranging from 10.3% (95% CI 9.3-11.6) for managing medications and 23.1% (95% CI 21.6-24.7) for managing finances in those aged 65-69, to 38.2% (95% CI 33.4-43.5) for medicines and 69% (95% CI 63.7-74.3) for finances in those over age 85. Women had a higher probability of developing difficulty managing medications and managing finances than men.
CONCLUSION: This study highlights the importance of preparing older adults for the likelihood they will need assistance with managing their medicines and finances as the risk for having difficulty with these activities over time is substantial.
%B Journal of the American Geriatrics Society %V 65 %P 1455-1461 %G eng %N 7 %R 10.1111/jgs.14819 %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 %XGenome-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 International Dental Journal %D 2017 %T Disparity in dental out-of-pocket payments among older adult populations: a comparative analysis across selected European countries and the USA. %A Richard J. Manski %A John F Moeller %A Haiyan Chen %A Widstrom, Eeva %A Listl, Stefan %K Cross-National %K Dental Care %K Older Adults %K Out-of-pocket payments %K SHARE %XBACKGROUND: The current study addresses the extent to which diversity exists in dental out-of-pocket (OOP) payments across population subgroups within and between the USA and selected European countries. This represents the final paper in a series in which the previous two papers addressed diversity in dental coverage and dental utilisation, respectively, using similar data and methods.
METHOD: We used data from the 2006/2007 Health and Retirement Study (HRS) and from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents ≥51 years of age. We estimated the impacts of dental-care coverage and of demographic, socio-economic and health status on the likelihood and amount of dental OOP payments.
RESULTS: In the USA, older persons with the least education, lowest income and worst health are most likely to pay nothing OOP for their dental care and, for persons with an OOP payment, the amount of this payment increases with income and education and is higher for persons who are uninsured and in fair or poor health. However, these results were not consistently found in the 10 European countries we studied.
CONCLUSIONS: European countries classified according to social welfare state or the presence of social health insurance (SHI) showed no effect on the likelihood of making payments OOP for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within countries with SHI, as well as differing needs, tastes and access to care across countries, contribute to this finding.
%B International Dental Journal %V 67 %P 157-171 %G eng %N 3 %R 10.1111/idj.12284 %0 Journal Article %J J Aging Health %D 2017 %T Do Regular Cholesterol Screenings Lead to Lower Cholesterol Levels and Better Health Behaviors for All? Spotlight on Middle-Aged and Older Adults in the United States. %A Choi, Yool %A Lee, Hyo Jung %K Aged %K Aged, 80 and over %K Cholesterol %K Female %K Health Behavior %K Humans %K Longitudinal Studies %K Male %K Mass Screening %K Middle Aged %K Preventive Health Services %K United States %XOBJECTIVE: This study investigates how the causal effects of cholesterol screening differ by likelihood of using this preventive care service in terms of accessibility gaps and effects on health-related outcomes across groups with advantaged and disadvantaged backgrounds.
METHOD: We use propensity score matching to analyze a nationally representative sample using data from 2008, 2010, and 2012 waves of the Health and Retirement Study ( N = 3,907).
RESULTS: We find that respondents who are least likely to get their cholesterol tested benefit most from the use of cholesterol screening when they do use it, while its effects are smallest for those who are most likely to use this service.
DISCUSSION: Understanding the heterogeneous effects of preventive health service has important policy implications, particularly in terms of how to maximize the public health benefits of preventive care.
%B J Aging Health %V 29 %P 389-414 %8 2017 Apr %G eng %U http://europepmc.org/abstract/MED/26921271 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/26921271?dopt=Abstract %R 10.1177/0898264316635588 %0 Report %D 2017 %T Do State Laws Protecting Older Workers from Discrimination Reduce Age Discrimination in Hiring? Experimental (and Nonexperimental) Evidence %A David Neumark %A Ian Burn %A Patrick Button %A Nanneh Chehras %K Ageism %K Discrimination %K Labor force participation %X We provide evidence from a field experiment — a correspondence study — on age discrimination in hiring for retail sales jobs. We collect experimental data in all 50 states and then relate measured age discrimination — the difference in callback rates between old and young applicants — to variation across states in antidiscrimination laws offering protections to older workers that are stronger than the federal age and disability discrimination laws. We do a similar analysis for nonexperimental data on differences across states in hiring rates of older versus younger workers. The experimental evidence points consistently to evidence of hiring discrimination against older men and, more so, against older women. However, the evidence on the relationship between hiring discrimination against older workers and state variation in age and disability discrimination laws is not so clear; at a minimum, there is not a compelling case that stronger state protections reduce hiring discrimination against older workers. In contrast, the non-experimental evidence suggests that stronger disability discrimination protections increase the relative hiring of older workers. %B Working Papers %I Michigan Retirement Research Center %C Ann Arbor, MI %P 1-79 %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp360.pdf %0 Report %D 2017 %T Documentation of Blood-Based Biomarkers in the 2014 Health and Retirement Study %A Eileen M. Crimmins %A Jessica Faul %A Jung K Kim %A David R Weir %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %8 12/2017 %G eng %0 Journal Article %J The Gerontologist %D 2017 %T Does Caring for a Spouse With Dementia Accelerate Cognitive Decline? Findings From the Health and Retirement Study. %A Kara B. Dassel %A Dawn C Carr %A Vitaliano, Peter %K Caregiving %K Cognitive Ability %K Dementia %K Older Adults %XPURPOSE OF THE STUDY: The purpose of this study is to expand our recent work, which showed that spousal dementia caregivers compared to spousal nondementia caregivers experience an accelerated rate of frailty over time, by exploring cognitive health outcomes between dementia and nondementia caregivers.
DESIGN AND METHODS: Using 8 biannual waves of the Health and Retirement Study data and performance on the modified Telephone Interview for Cognitive Status, we examined changes in cognitive health among surviving spousal caregivers (N = 1,255) of individuals with dementia (n = 192) and without dementia (n = 1,063), 2 waves prior and 2 waves following the death of the care recipient.
RESULTS: Controlling for baseline health and contextual factors (e.g., frailty status, age, education), results revealed that dementia caregivers had significantly greater cognitive decline (p < .01) compared to nondementia caregivers. Relative to 2 waves prior to the death of their spouse, dementia caregivers declined by 1.77 points relative to nondementia caregivers (0.87 points) at the time their spouses' deaths were reported and 1.89 relative to the 1.18 points at the wave following these deaths, respectively.
IMPLICATIONS: The findings from this study show that spousal caregivers of persons with dementia experience accelerated cognitive decline themselves compared to nondementia caregivers. These results, along with our previous study findings, suggest that this vulnerable group could benefit from early cognitive screening and psychosocial interventions designed to help dementia caregivers better maintain their cognitive and physical health during and following their intensive caregiving responsibilities.
%B The Gerontologist %V 57 %P 319 %G eng %N 2 %R 10.1093/geront/gnv148 %0 Journal Article %J Gerontologist %D 2017 %T Dog Walking, the Human-Animal Bond and Older Adults' Physical Health. %A Angela L Curl %A Bibbo, Jessica %A Rebecca A Johnson %K Aged %K Animals %K Dogs %K Female %K Health Status %K Human-Animal Bond %K Humans %K Least-Squares Analysis %K Linear Models %K Logistic Models %K Male %K Middle Aged %K Ownership %K Walking %XPURPOSE OF THE STUDY: This study explored the associations between dog ownership and pet bonding with walking behavior and health outcomes in older adults.
DESIGN AND METHODS: We used data from the 12th wave (2012) of the Health and Retirement Study which included an experimental human-animal interaction module. Ordinary least squares regression and binary logistic regression models controlling for demographic variables were used to answer the research questions.
RESULTS: Dog walking was associated with lower body mass index, fewer activities of daily living limitations, fewer doctor visits, and more frequent moderate and vigorous exercise. People with higher degrees of pet bonding were more likely to walk their dog and to spend more time walking their dog each time, but they reported walking a shorter distance with their dog than those with weaker pet bonds. Dog ownership was not associated with better physical health or health behaviors.
IMPLICATIONS: This study provides evidence for the association between dog walking and physical health using a large, nationally representative sample. The relationship with one's dog may be a positive influence on physical activity for older adults.
%B Gerontologist %V 57 %P 930-939 %8 2017 Oct 01 %G eng %U http://gerontologist.oxfordjournals.org/content/early/2016/03/18/geront.gnw051.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27002004?dopt=Abstract %4 Exercise/physical activity/Recreational therapy/activities/Preventative medicine/care/services/Function/mobility/Dog walking %$ 999999 %R 10.1093/geront/gnw051 %0 Journal Article %J Economics of Education Review %D 2017 %T The Effect of Vietnam-Era Conscription and Genetic Potential for Educational Attainment on Schooling Outcomes. %A Lauren L Schmitz %A Dalton C Conley %K Education %K Genetics %K GWAS %K PGS %K Veterans %X This study examines whether draft lottery estimates of the causal effects of Vietnam-era military service on schooling vary by an individual's genetic propensity toward educational attainment. To capture the complex genetic architecture that underlies the bio-developmental pathways, behavioral traits and evoked environments associated with educational attainment, we construct polygenic scores (PGS) for respondents in the Health and Retirement Study (HRS) that aggregate thousands of individual loci across the human genome and weight them by effect sizes derived from a recent genome-wide association study (GWAS) of years of education. Our findings suggest veterans with below average PGSs for educational attainment may have completed fewer years of schooling than comparable non-veterans. On the other hand, we do not find any difference in the educational attainment of veterans and non-veterans with above average PGSs. Results indicate that public policies and exogenous environments may induce heterogeneous treatment effects by genetic disposition. %B Economics of Education Review %V 61 %P 85-97 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29375175?dopt=Abstract %R 10.1016/j.econedurev.2017.10.001 %0 Journal Article %J Annals of Leisure Research %D 2017 %T The effects of leisure-time physical activity for optimism, life satisfaction, psychological well-being, and positive affect among older adults with loneliness %A Kim, Junhyoung %A Lee, Sunwoo %A Sanghee Chun %A Areum Han %A Jinmoo Heo %K Optimism %K Retirement Planning and Satisfaction %K Well-being %X The purpose of this study was to examine the effects of leisure-time physical activity (LTPA) involvement among older adults suffering from loneliness. Using data released from the Health and Retirement Study in 2008, this study investigated how participation in LTPA leads to well-being such as optimism, life satisfaction, psychological well-being, and positive affect among older adults with loneliness. Results indicated that the LTPA involvement was a significant predictor of optimism, life satisfaction, positive affect, and psychological well-being for older adults with a high level of loneliness. The interesting findings of this study were that LTPA enhanced positive emotions for older adults with loneliness and that positive emotions are one of the important factors in protecting individuals from illnesses. %B Annals of Leisure Research %V 20 %P 406-415 %G eng %U https://www.tandfonline.com/doi/full/10.1080/11745398.2016.1238308https://www.tandfonline.com/doi/pdf/10.1080/11745398.2016.1238308 %N 4 %! Annals of Leisure Research %R 10.1080/11745398.2016.1238308 %0 Journal Article %J Translational Issues in Psychological Science %D 2017 %T Effects of Pre-Retirement Personality, Health and Job Lock on Post-Retirement Subjective Well-being. %A Lindsay H Ryan %A Nicky J Newton %A Preet K. Chauhan %A William J. Chopik %K Health Conditions and Status %K Personality %K Positive beliefs %K Retirement Planning and Satisfaction %K Self-reported health %K Well-being %X Retirement can be difficult, and experiences vary greatly. Although health, financial status, and family responsibilities have been associated with retirement adjustment, individual psychosocial characteristics may also play a role. Moreover, relatively little is known about the impact of perceived 'job lock'-the belief that retirement is impossible due to financial or health constraints-and its relationship with later retirement adjustment. The current study addresses these limitations in the literature by examining the retirement transition over four years in a large sample of U.S. adults, with a particular focus on the ways in which personality may affect this transition. Data collected at baseline (2008/2010) and again four years later (2012/2014) included the Big Five personality traits, pre-retirement job lock, self-rated health, and multiple indicators of post-retirement well-being, such as global and experienced well-being (anchored within activities in a single day). Participants were drawn from the Health and Retirement Study (= 716;= 61.9 at baseline). Results indicated that experienced positive affect was the only post-retirement well-being outcome with a significant association with job lock, although only for those with low conscientiousness. Findings also suggest that pre-retirement personality and subjective health play an important role for post-retirement well-being. Thus, the current study highlights the importance for researchers and practitioners to consider both pre-retirement personality and health when evaluating individuals' management of the retirement transition. %B Translational Issues in Psychological Science %V 3 %P 378-387 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/29430485?dopt=Abstract %R 10.1037/tps0000138 %0 Journal Article %J Public Health Nutrition %D 2017 %T Food insecurity and emotional health in the USA: a systematic narrative review of longitudinal research %A Bruening, Meg %A Dinour, Lauren M. %A Chavez, Jose B. Rosales %K Depressive symptoms %K Food insecurity %K Literature Review %K Stress %B Public Health Nutrition %V 20 %P 3200-3208 %G eng %U https://www.cambridge.org/core/product/identifier/S1368980017002221/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S1368980017002221 %N 17 %! Public Health Nutr. %R 10.1017/S1368980017002221 %0 Journal Article %J Journal of the American Geriatrics Society %D 2017 %T Functional impairment: An unmeasured marker of Medicare costs for postacute care of older adults. %A S. Ryan Greysen %A Irena Cenzer %A W John Boscardin %A Kenneth E Covinsky %K Functional limitations %K Medicare linkage %K Medicare/Medicaid/Health Insurance %XOBJECTIVES: To assess the effects of preadmission functional impairment on Medicare costs of postacute care up to 365 days after hospital discharge.
DESIGN: Longitudinal cohort study.
SETTING: Health and Retirement Study (HRS).
PARTICIPANTS: Nationally representative sample of 16,673 Medicare hospitalizations of 8,559 community-dwelling older adults from 2000 to 2012.
MEASUREMENTS: The main outcome was total Medicare costs in the year after hospital discharge, assessed according to Medicare claims data. The main predictor was functional impairment (level of difficulty or dependence in activities of daily living (ADLs)), determined from HRS interview preceding hospitalization. Multivariable linear regression was performed, adjusted for age, race, sex, income, net worth, and comorbidities, with clustering at the individual level to characterize the association between functional impairment and costs of postacute care.
RESULTS: Unadjusted mean Medicare costs for 1 year after discharge increased with severity of impairment in a dose-response fashion (P < .001 for trend); 68% had no functional impairment ($25,931), 17% had difficulty with one ADL ($32,501), 7% had dependency in one ADL ($39,928), and 8% had dependency in two or more ADLs ($45,895). The most severely impaired participants cost 77% more than those with no impairment; adjusted analyses showed attenuated effect size (33% more) but no change in trend. Considering costs attributable to comorbidities, only three conditions were more expensive than severe functional impairment (lymphoma, metastatic cancer, paralysis).
CONCLUSION: Functional impairment is associated with greater Medicare costs for postacute care and may be an unmeasured but important marker of long-term costs that cuts across conditions.
%B Journal of the American Geriatrics Society %V 65 %P 1996-2002 %8 09/2017 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/28636200?dopt=Abstract %R 10.1111/jgs.14955 %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 A generalized right truncated bivariate Poisson regression model with applications to health data. %A M. Ataharul Islam %A Rafiqul I Chowdhury %K Poisson regression model %K Survey Methodology %X A generalized right truncated bivariate Poisson regression model is proposed in this paper. Estimation and tests for goodness of fit and over or under dispersion are illustrated for both untruncated and right truncated bivariate Poisson regression models using marginal-conditional approach. Estimation and test procedures are illustrated for bivariate Poisson regression models with applications to Health and Retirement Study data on number of health conditions and the number of health care services utilized. The proposed test statistics are easy to compute and it is evident from the results that the models fit the data very well. A comparison between the right truncated and untruncated bivariate Poisson regression models using the test for nonnested models clearly shows that the truncated model performs significantly better than the untruncated model. %B PLoS One %V 12 %P e0178153 %8 2017 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28586344?dopt=Abstract %R 10.1371/journal.pone.0178153 %0 Journal Article %J Nature Communications %D 2017 %T Genetic architecture of epigenetic and neuronal ageing rates in human brain regions %A Lu, Ake T %A Hannon, Eilis %A Morgan E. Levine %A Eileen M. Crimmins %A Lunnon, Katie %A Mill, Jonathan %A Daniel H. Geschwind %A Horvath, Steve %K Genetics %X Identifying genes regulating the pace of epigenetic ageing represents a new frontier in genome-wide association studies (GWASs). Here using 1,796 brain samples from 1,163 individuals, we carry out a GWAS of two DNA methylation-based biomarkers of brain age: the epigenetic ageing rate and estimated proportion of neurons. Locus 17q11.2 is significantly associated (P=4.5 × 10 -9 ) with the ageing rate across five brain regions and harbours a cis-expression quantitative trait locus for EFCAB5 (P=3.4 × 10-20 ). Locus 1p36.12 is significantly associated (P=2.2 × 10-8 ) with epigenetic ageing of the prefrontal cortex, independent of the proportion of neurons. Our GWAS of the proportion of neurons identified two genome-wide significant loci (10q26 and 12p13.31) and resulted in a gene set that overlaps significantly with sets found by GWAS of age-related macular degeneration (P=1.4 × 10 -12 ), ulcerative colitis (P<1.0 × 10-20 ), type 2 diabetes (P=2.8 × 10-13 ), hip/waist circumference in men (P=1.1 × 10-9 ), schizophrenia (P=1.6 × 10-9 ), cognitive decline (P=5.3 × 10-4 ) and Parkinson's disease (P=8.6 × 10-3 ). %B Nature Communications %V 8 %8 Jun-05-2018 %G eng %U http://www.nature.com/doifinder/10.1038/ncomms15353http://www.nature.com/doifinder/10.1038/ncomms15353 %! Nat Comms %R 10.1038/ncomms15353 %0 Journal Article %J Neuropsychopharmacology %D 2017 %T Genome-Wide Association Study of Loneliness Demonstrates a Role for Common Variation. %A Gao, Jianjun %A Lea K. Davis %A Amy B. Hart %A Sanchez-Roige, Sandra %A Han, Lide %A John T. Cacioppo %A Abraham A Palmer %K Aged %K depression %K Extraversion, Psychological %K Female %K Genome-Wide Association Study %K Humans %K Loneliness %K Male %K Mental Disorders %K Middle Aged %K Neuroticism %K Phenotype %XLoneliness is a complex biological trait that has been associated with numerous negative health outcomes. The measurement and environmental determinants of loneliness are well understood, but its genetic basis is not. Previous studies have estimated the heritability of loneliness between 37 and 55% using twins and family-based approaches, and have explored the role of specific candidate genes. We used genotypic and phenotypic data from 10 760 individuals aged ⩾50 years that were collected by the Health and Retirement Study (HRS) to perform the first genome-wide association study of loneliness. No associations reached genome-wide significance (p>5 × 10). Furthermore, none of the previously published associations between variants within candidate genes (BDNF, OXTR, RORA, GRM8, CHRNA4, IL-1A, CRHR1, MTHFR, DRD2, APOE) and loneliness were replicated (p>0.05), despite our much larger sample size. We estimated the chip heritability of loneliness and examined coheritability between loneliness and several personality and psychiatric traits. Our estimates of chip heritability (14-27%) support a role for common genetic variation. We identified strong genetic correlations between loneliness, neuroticism, and a scale of 'depressive symptoms.' We also identified weaker evidence for coheritability with extraversion, schizophrenia, bipolar disorder, and major depressive disorder. We conclude that loneliness, as defined in this study, is a modestly heritable trait that has a highly polygenic genetic architecture. The coheritability between loneliness and neuroticism may reflect the role of negative affectivity that is common to both traits. Our results also reflect the value of studies that probe the common genetic basis of salutary social bonds and clinically defined psychiatric disorders.
%B Neuropsychopharmacology %V 42 %P 811-821 %8 2017 Mar %G eng %U http://www.nature.com/doifinder/10.1038/npp.2016.197 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27629369?dopt=Abstract %! Neuropsychopharmacology %R 10.1038/npp.2016.197 %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 %XGenomic 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 Nature Genetics %D 2017 %T Genotype–covariate interaction effects and the heritability of adult body mass index %A Matthew R Robinson %A English, Geoffrey %A Moser, Gerhard %A Lloyd-Jones, Luke R. %A Triplett, Marcus A. %A Zhihong Zhu %A Ilja M Nolte %A Jana V. van Vliet-Ostaptchouk %A Snieder, Harold %A Tõnu Esko %A Lili Milani %A Mägi, Reedik %A Andres Metspalu %A Patrik K E Magnusson %A Nancy L Pedersen %A Ingelsson, Erik %A Johannesson, Magnus %A Yang, Jian %A Cesarini, David %A Peter M Visscher %K BMI %K Genetics %K GWAS %X Obesity is a worldwide epidemie, with major health and economic costs. Here we estimate heritability for body mass index (BMI) in 172,000 sibling pairs and 150,832 unrelated individuals and explore the contribution of genotype-covariate interaction effects at common SNP loci. We find evidence for genotype-age interaction (likelihood ratio test (LRT) = 73.58, degrees of freedom (df) = 1, P = 4.83 x 10-18), which contributed 8.1 % (1.4% s.e.) to BMI variation. Across eight self-reported lifestyle factors, including diet and exercise, we find genotype-environment interaction only for smoking behavior (LRT = 19.70, P = 5.03 x 10-5 and LRT = 30.80, P = 1.42 x 10-8), which contributed 4.0% (0.8% s.e.) to BMI variation. Bayesian association analysis suggests that BMI is highly polygenic, with 75% of the SNP heritability attributable to loci that each explain <0.01 % of the phenotypic variance. Our findings imply that substantially larger sample sizes across ages and lifestyles are required to understand the full genetic architecture of BMI. %B Nature Genetics %V 49 %P 1174-1181 %G eng %N 8 %! Nat Genet %R 10.1038/ng.3912 %0 Journal Article %J Sleep %D 2017 %T A Greater Extent of Insomnia Symptoms and Physician-Recommended Sleep Medication Use Predict Fall Risk in Community-Dwelling Older Adults. %A Tuo-Yu Chen %A Lee, Soomi %A Orfeu M. Buxton %K Community-dwelling %K Drug use %K Falls %K Risk Factors %K Sleep %XStudy Objectives: Cross-sectional studies suggest that insomnia symptoms are associated with falls in later life. This longitudinal study examines the independent and interactive effects of the extent of insomnia symptoms (i.e., multiple co-existing insomnia symptoms) and sleep medications on fall risk over a 2-year follow-up among community-dwelling older adults.
Methods: Using data from the Health and Retirement Study (2006-2014, N = 6882, Mage = 74.5 years ± 6.6 years), we calculated the extent of insomnia symptoms (range = 0-4) participants reported (i.e., trouble falling asleep, waking up during the night, waking up too early, and not feeling rested). At each wave, participants reported recent sleep medications use and falls since the last wave, and were evaluated for balance and walking speed.
Results: A greater burden of insomnia symptoms and using physician-recommended sleep medications at baseline independently predicted falling after adjusting for known risk factors of falling. The effects of insomnia symptoms on fall risk differed by sleep medications use. The extent of insomnia symptoms exhibited a positive, dose-response relation with risk of falling among those not using sleep medications. Older adults using physician-recommended sleep medications exhibited a consistently higher fall risk irrespective of the extent of insomnia symptoms.
Conclusions: The number of insomnia symptoms predicts 2-year fall risk in older adults. Taking physician-recommended sleep medications increases the risks for falling in older adults, irrespective of the presence of insomnia symptoms. Future efforts should be directed toward treating insomnia symptoms, and managing and selecting sleep medications effectively to decrease the risk of falling in older adults.
%B Sleep %V 40 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/29029240?dopt=Abstract %R 10.1093/sleep/zsx142 %0 Journal Article %J Health Affairs %D 2017 %T Health Of Americans Who Must Work Longer To Reach Social Security Retirement Age %A Choi, Hwajung %A Robert F. Schoeni %K Retirement Planning and Satisfaction %K Social Security %K Working Longer %X To receive full Social Security benefits, Americans born after 1937 must claim those benefits at an older age than earlier birth cohorts. Additionally, proposals to improve the fiscal position of Social Security typically include increasing the age at which workers can receive full benefits. Birth cohorts required to work longer are in worse health at ages 49–60, based on multiple measures of morbidity, than cohorts who could retire earlier. %B Health Affairs %V 36 %P 1815 - 1819 %8 Jan-10-2017 %G eng %U http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2017.0217https://syndication.highwire.org/content/doi/10.1377/hlthaff.2017.0217 %N 10 %! Health Aff %R 10.1377/hlthaff.2017.0217 %0 Conference Paper %B MedEq %D 2017 %T Hearing health equity: Social determinants of hearing aid receipts %A Michael M McKee %A Choi, Hwajung %K Hearing loss %K Restricted data %B MedEq %I Wayne State University %C Detroit, MI %8 02/2017 %G eng %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2017 %T Hierarchy and Speed of Loss in Physical Functioning: A Comparison Across Older U.S. and English Men and Women. %A Bendayan, Rebecca %A Cooper, Rachel %A Elizabeth G Wloch %A Scott M Hofer %A Andrea M Piccinin %A Graciela Muñiz Terrera %K Activities of Daily Living %K Aged %K Aging %K Cross-Cultural Comparison %K Disability Evaluation %K Female %K Geriatric Assessment %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Self Report %K Statistics, Nonparametric %K United Kingdom %K United States %XBackground: We aimed to identify the hierarchy of rates of decline in 16 physical functioning measures in U.S. and English samples, using a systematic and integrative coordinated data analysis approach.
Methods: The U.S. sample consisted of 13,612 Health and Retirement Study participants, and the English sample consisted of 5,301 English Longitudinal Study of Ageing participants. Functional loss was ascertained using self-reported difficulties performing 6 activities of daily living and 10 mobility tasks. The variables were standardized, rates of decline were computed, and mean rates of decline were ranked. Mann-Whitney U tests were performed to compare rates of decline between studies.
Results: In both studies, the rates of decline followed a similar pattern; difficulty with eating was the activity that showed the slowest decline and climbing several flights of stairs and stooping, kneeling, or crouching the fastest declines. There were statistical differences in the speed of decline in all 16 measures between countries. American women had steeper declines in 10 of the measures than English women. Similar differences were found between American and English men.
Conclusions: Reporting difficulties climbing several flights of stairs without resting, and stooping, kneeling, or crouching are the first indicators of functional loss reported in both populations.
%B J Gerontol A Biol Sci Med Sci %V 72 %P 1117-1122 %8 2017 Aug 01 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27753610?dopt=Abstract %R 10.1093/gerona/glw209 %0 Journal Article %J J Occup Environ Med %D 2017 %T Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement? %A Maren W Voss %A Wendy Church Birmingham %A Lori Wadsworth %A Wei Chen %A Bounsanga, Jerry %A Gu, Yushan %A Hung, Man %K Age Factors %K Aged %K Chronic disease %K depression %K Female %K Health Status %K Health Surveys %K Humans %K Male %K Mental Health %K Middle Aged %K Personal Satisfaction %K Retirement %K Unemployment %K United States %K Work %XOBJECTIVE: Unemployment among older adults during recessionary cycles has been tied to early retirement decisions and negative health outcomes. This study explored episodes of unemployment experienced between age 50 and retirement as predictors of retirement age and health outcomes.
METHODS: A total of 1540 participants from the U.S. Health and Retirement Study aged 50 years and older who transitioned from workforce to retirement were analyzed with descriptive statistics and multiple regression controlling for unemployment, demographics, and health status.
RESULTS: Late-life unemployment significantly related to earlier retirement age and lowered life satisfaction, independent of income effects. We found no main effect for late-life unemployment on physical health status.
CONCLUSIONS: Potential improvements in future life satisfaction might be gained if job search obstacles are removed for older unemployed adults, reducing reliance on involuntary early retirement as an income source.
%B J Occup Environ Med %V 59 %P 184-190 %8 2017 02 %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00043764-900000000-98945 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28002355?dopt=Abstract %! Journal of Occupational and Environmental Medicine %R 10.1097/JOM.0000000000000933 %0 Journal Article %J Economics Bulletin %D 2017 %T Household demand for private long term care insurance: An exploratory note %A Chatterjee, Swarnankur %K Financial literacy %K Long-term Care %K Medicare/Medicaid/Health Insurance %K Risk Factors %X This study uses the most recent wave of the Health and Retirement Study (HRS) to examine participation of aging households in the long-term care insurance market. Results suggest that households who perceived a need to move to a nursing home within the next five years and households with higher preference for risk management through insurance were more likely to have long-term care coverage. Interestingly, the households with higher levels of risk tolerance were less likely to have long-term care coverage. Conversely, households with a bequest motive were more likely to have long-term care coverage. Additionally, the empirical results of this study indicate that the probability of having long-term care coverage was higher for women. Households with greater educational attainment and greater net worth were also more likely to have long-term care coverage. %B Economics Bulletin %V 37 %P 1975-1981 %G eng %N 3 %0 Report %D 2017 %T Household finance in China %A Cooper, Russell %A Zhu, Guozhong %K CHARLS %K Cross-National %K Finances %X This paper studies household finance in China, focusing on the high savings rate, the low participation rate in the stock market, and the low stock share in household portfolios. These salient features are studied in a lifecycle model in which households receive both income and medical expense shocks and decide on stock market participation and portfolio adjustment. The structural estimation explicitly takes into account important regime changes in China, such as the re-opening of the stock market, the privatization of the housing market and the labor market reforms that changed household income processes. The paper also compares household finance patterns in China to those in the US, and shows that between-country differences in financial choices are driven by both institutional factors (e.g. higher costs associated with stock market participation and a lower consumption floor in China) and preferences (e.g. higher discount factors of Chinese households). %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/w23741.pdf %R 10.3386/w23741 %0 Report %D 2017 %T Household Retirement Saving: The Location of Savings Between Spouses %A Carman, Katherine %A Hung, Angela %K Consumption and Savings %K Marriage %K Retirement Planning and Satisfaction %X Retirement planning is often a joint household decision-making process, and therefore the household is often the more appropriate unit of analysis. However, retirement savings in tax advantaged accounts are held in the name of one individual. While spouses have rights to these assets in the case of divorce and in most cases of death, the separation of accounts in name may cause couples to treat their accounts as separate, with each spouse making decisions separately. In order to optimize retirement planning, couples should consider the entire household portfolio together, accounting for the characteristics of the retirement accounts, the age of the spouses, and income differences between spouses. With separate accounts, one spouse may not be aware of the contributions or assets accumulated in the other spouse's accounts. This may lead to sub-optimal decision-making, as individuals in a couple may not fully optimize across all available retirement accounts. Little is known about how households divide retirement contributions and assets between spouses. In this project, we investigate how households locate contributions across tax deferred savings accounts that are nominally held in one spouse's name and how these decisions may impact accumulated assets. In particular we first document who within a couple nominally holds retirement assets. Using data from the Health and Retirement Study and Survey of Consumer Finances, we find that household retirement assets and contributions are more likely to be located in accounts held in the husband's name or the primary earner's name. In our regression analysis, we find that the location of contributions is largely driven by the distribution of earnings within couples. %I RAND Corporation %C Santa Monica, CA %G eng %U http://www.rand.org/pubs/working_papers/WR1166.html %R 10.7249/WR1166 %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 Journal Article %J Disabil Health J %D 2017 %T Identifying adults aging with disability using existing data: The case of the Health and Retirement Study. %A Caitlin E. Coyle %A Putnam, Michelle %K Activities of Daily Living %K Adolescent %K Age of Onset %K Aged %K Aged, 80 and over %K Aging %K Child %K Child Health %K Chronic disease %K Disabled Persons %K Female %K health %K Health Status %K Health Surveys %K Humans %K Male %K Middle Aged %K Retirement %K Self Report %K Work %XBACKGROUND: The population of persons aging with disabilities is growing. Being able to segment aging with disability sub-populations within national data sets is becoming increasingly important in order to understand the relationship of aging with disability to a range of outcomes in later life including health and wellness, economic security, and health and long-term service and support need and use.
OBJECTIVE: The purpose of this study was to identify viable sub-samples of adults aging with disabilities within the Health and Retirement Study, one of the most used secondary data sets to study aging and older adults.
METHOD: Samples used in this research are drawn from wave 11 (2012) of the HRS. Five operationalizations of disability were used: childhood disability (n = 719), childhood chronic condition (n = 3070), adult chronic condition (n = 13,723), functional limitation in adulthood (n = 4448) and work disability (n = 5632).
RESULTS: These subsamples are not mutually exclusive. Among respondents that reported having a childhood disability, 87% also report having at least one chronic disease in adulthood, 50% report having functional limitations in adulthood and 38% report interruption in their ability to work due to a disability. Compared to the childhood disability samples, rates of reporting fair/poor health are nearly double among adults with functional limitations or those with work disruptions because of disability.
CONCLUSION: Work disability and functional limitation appeared to be the most viable sub-sample options to consider when using the HRS to study experiences of adults aging with disability. Overall, age at onset is unclear.
%B Disabil Health J %V 10 %P 611-615 %8 2017 Oct %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S1936-6574(16)30191-1 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28082002?dopt=Abstract %R 10.1016/j.dhjo.2016.12.016 %0 Journal Article %J Health Serv Res %D 2017 %T Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care. %A Amy Kelley %A Kenneth E Covinsky %A Rebecca Jean Gorges %A McKendrick, Karen %A Bollens-Lund, Evan %A R Sean Morrison %A Christine S Ritchie %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Critical Illness %K Early Diagnosis %K Female %K Health Care Costs %K Hospitalization %K Humans %K Male %K Medicare %K Nursing homes %K Prospective Studies %K Quality Improvement %K United States %XOBJECTIVE: To create and test three prospective, increasingly restrictive definitions of serious illness.
DATA SOURCES: Health and Retirement Study, 2000-2012.
STUDY DESIGN: We evaluated subjects' 1-year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12 months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization. Definitions are increasingly restrictive, but not mutually exclusive.
DATA COLLECTION: Of 11,577 eligible subjects, 5,297 met definition A; 3,151 definition B; and 1,447 definition C.
PRINCIPAL FINDINGS: One-year outcomes were as follows: hospitalization 33 percent (A), 44 percent (B), 47 percent (C); total average Medicare costs $20,566 (A), $26,349 (B), and $30,828 (C); and mortality 13 percent (A), 19 percent (B), 28 percent (C). In comparison, among those meeting no definition, 12 percent had hospitalizations, total Medicare costs averaged $7,789, and 2 percent died.
CONCLUSIONS: Prospective identification of older adults with serious illness is feasible using clinically accessible criteria and may be a critical step toward improving health care value. These definitions may aid clinicians and health systems in targeting patients who could benefit from additional services.
%B Health Serv Res %V 52 %P 113-131 %8 2017 02 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/26990009 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26990009?dopt=Abstract %4 Medicare; geriatrics; palliative medicine; population health %R 10.1111/1475-6773.12479 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2017 %T The impact of multimorbidity on grip strength in adults age 50 and older: Data from the Health and Retirement Survey (HRS) %A Amy M Yorke %A Amy B. Curtis %A Shoemaker, Michael %A Vangsnes, Eric %K Comorbidity %K Grip strength %K Health Conditions and Status %X Background: Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength. Methods: A cross-sectional analysis was conducted of 5877 respondents (2744 = male, 3103 = female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg). Results: As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b = 3.1, 95% CI = 2.3–3.9, p < 0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength. Conclusion: Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity. %B Archives of Gerontology and Geriatrics %V 72 %P 164-168 %G eng %! Archives of Gerontology and Geriatrics %R 10.1016/j.archger.2017.05.011 %0 Journal Article %J Computers in Human Behavior %D 2017 %T Individual difference predictors of ICT use in older adulthood: A study of 17 candidate characteristics %A William J. Chopik %A Rikard, R.V. %A Cotten, Shelia Drentea Patricia %K Cognitive Ability %K ICT %K Personality %X Given the benefits of information and communication technology (ICT) use in older adulthood, a natural question is which individual difference characteristics predict ICT use and adoption. Research has provided mixed findings drawn from studies that generally focus on a narrow set of ICTs, a narrow set of individual difference constructs, and younger adults. Using data from the 2012 wave of the Health and Retirement Study, we examined 17 individual difference predictors of ICT use among older adults. Need for cognition, perceived mastery, and optimism positively predicted ICT use after controlling for all the constructs simultaneously; cynical hostility also emerged as a negative predictor of ICT use. Further, viewing more benefits of ICT use explained why those high in need for cognition used more ICTs. Directions for future research include examining the processes that link individual differences to ICT use and its subsequent benefits during the second half of life. %B Computers in Human Behavior %V 76 %P 526-533 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0747563217304818http://api.elsevier.com/content/article/PII:S0747563217304818?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0747563217304818?httpAccept=text/plain %! Computers in Human Behavior %R 10.1016/j.chb.2017.08.014 %0 Journal Article %J American Journal of Alzheimer's Disease & Other Dementias %D 2017 %T The influence of psychosocial and cognitive factors on perceived threat of Alzheimer’s Disease %A Jenny E Ostergren %A Steven G Heeringa %A Carlos F. Mendes de Leon %A Cathleen M. Connell %A J Scott Roberts %K Alzheimer's disease %K Perception %K Psychosocial %X This study explored psychosocial and cognitive predictors of perceived threat of Alzheimer’s disease (AD). Respondents were 1641 adults (mean age: 64.4; 54% female; 82% white) who completed a module in the Health and Retirement Study, a nationally representative survey of adults aged ≥50. Findings show that perceived threat was significantly higher for those aged 50 to 64 (P < .001) and 65 to 74 (P < .05) than for those ≥75. Respondents with a family history of AD had significantly greater perceived threat (P < .001) than those with no experience. Stronger endorsement of the beliefs that stress (P < .01) or genetics (P < .01) are important AD risk factors was significantly associated with greater perceived threat, as was having more depressive symptoms (P < .01), poorer self-rated memory (P < .01), and lower cognitive function (P < .01). Personal experience moderated the relationship between perceived threat and 2 variables: age and self-rated memory. Understanding perceived AD threat may inform practice and policies centered on early and accurate diagnosis. %B American Journal of Alzheimer's Disease & Other Dementias %V 32 %P 289-299 %G eng %U http://journals.sagepub.com/doi/10.1177/1533317517714552 %N 5 %! American Journal of Alzheimer's Disease & Other Dementias® %R 10.1177/1533317517714552 %0 Journal Article %J Gerontologist %D 2017 %T The Influence of the Transportation Environment on Driving Reduction and Cessation. %A Jonathon M Vivoda %A Steven G Heeringa %A Amy J Schulz %A Grengs, Joe %A Cathleen M. Connell %K Aged %K Aging %K Automobile Driving %K environment %K Family Characteristics %K Female %K Geographic Information Systems %K Health Status %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Risk %K Survival Analysis %K Transportation %K United States %XPurpose of the Study: Driving is by far the most common mode of transportation in the United States, but driving ability is known to decline as people experience age-related functional declines. Some older adults respond to such declines by self-limiting their driving to situations with a low perceived risk of crashing, and many people eventually stop driving completely. Previous research has largely focused on individual and interpersonal predictors of driving reduction and cessation (DRC). The purpose of this study was to assess the influence of the transportation environment on DRC.
Design and Methods: Data were combined from the Health and Retirement Study, the Urban Mobility Scorecard, and StreetMap North America (GIS data). Longitudinal survival analysis techniques were used to analyze seven waves of data spanning a 12-year period.
Results: As roadway density and congestion increased in the environment, the odds of DRC also increased, even after controlling for individual and interpersonal predictors. Other predictors of DRC included demographics, relationship status, health, and household size.
Implications: The current study identified an association between the transportation environment and DRC. Future research is needed to determine whether a causal link can be established. If so, modifications to the physical environment (e.g., creating livable communities with goods and services in close proximity) could reduce driving distances in order to improve older drivers' ability to remain engaged in life. In addition, older individuals who wish to age in place should consider how their local transportation environment may affect their quality of life.
%B Gerontologist %V 57 %P 824-832 %8 2017 10 01 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27342439 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27342439?dopt=Abstract %R 10.1093/geront/gnw088 %0 Journal Article %J Advances in Life Course Research %D 2017 %T Later-life employment trajectories and health %A McDonough, Peggy %A Worts, Diana %A Corna, Laurie M. %A McMunn, Anne %A Sacker, Amanda %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Background: Despite the recent policy push to keep older adults in the labour force, we know almost nothing about the potential health consequences of working longer. Drawing on a life course approach that considers stability and change in employment patterns, this study examines the relationship between long-term labour market involvement in later life and self-rated health. Methods: Our data are from the Health and Retirement Study (1992-2012) for the cohort born 1931-1941 (N = 6522). We used optimal matching analysis to map employment trajectories from ages 52-69, and then logistic regression to examine associations between these trajectories and self-rated health in the early 70s, net of socio-demographics, household resources and prior health. Findings: Women prevail in groups characterized by a weak(er) attachment to the labour market and men, in groups signifying a strong(er) attachment. Men who downshifted from full-time to part-time work around age 65 were the least likely to report poor health in their early 70s.Women had the best health if they remained employed, either full-time or part-time. However, unlike men, they appeared to benefit most in health terms when part-time hours were part of a longer-term pattern. Conclusion: While our study findings show that continuing to work in later life may be positively associated with health, they also suggest the need for flexible employment policies that foster opportunities to work part-time. %B Advances in Life Course Research %V 34 %P 22-33 %G eng %! Advances in Life Course Research %R 10.1016/j.alcr.2017.09.002 %0 Journal Article %J Res Aging %D 2017 %T A Longitudinal Analysis of Site of Death: The Effects of Continuous Enrollment in Medicare Advantage Versus Conventional Medicare. %A Elizabeth Edmiston Chen %A Edward Alan Miller %K Aged %K Aged, 80 and over %K Decision making %K Fee-for-Service Plans %K Female %K health policy %K Hospices %K Hospital Mortality %K Humans %K Longitudinal Studies %K Male %K Medicare Part C %K Terminal Care %K United States %XThis study assessed the odds of dying in hospital associated with enrollment in Medicare Advantage (M-A) versus conventional Medicare Fee-for-Service (M-FFS). Data were derived from the 2008 and 2010 waves of the Health and Retirement Study ( n = 1,030). The sample consisted of elderly Medicare beneficiaries who died in 2008-2010 (34% died in hospital, and 66% died at home, in long-term senior care, a hospice facility, or other setting). Logistic regression estimated the odds of dying in hospital for those continuously enrolled in M-A from 2008 until death compared to those continuously enrolled in M-FFS and those switching between the two plans. Results indicate that decedents continuously enrolled in M-A had 43% lower odds of dying in hospital compared to those continuously enrolled in M-FFS. Financial incentives in M-A contracts may reduce the odds of dying in hospital.
%B Res Aging %V 39 %P 960-986 %8 2017 09 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27193048 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27193048?dopt=Abstract %R 10.1177/0164027516645843 %0 Journal Article %J Journal of Behavioral Medicine %D 2017 %T Longitudinal associations between marital quality and sleep quality in older adulthood. %A Ji Hyun Lee %A William J. Chopik %A Lawrence B Schiamberg %K Marriage %K Sleep %X The current study examined how changes in marital quality are associated with changes in sleep quality in older adults over an 8-year period. Older adults from the Health and Retirement Study completed measures of both marital support/strain and sleep quality in 2006, 2010, and 2014 (N = 4981). We used latent growth curve models to examine intraindividual change in support, strain, and sleep quality. Further, we examined interrelationships between changes in each of these three indicators. Results showed that higher marital quality was associated with better sleep at baseline. We also found that marital quality and sleep quality were coordinated over time-as marital quality increased, so did sleep quality. When this covariation was accounted, the prospective effects of baseline marital quality on changes in sleep quality were not found. The current study provided evidence for a long-term temporal coordination of marital quality and sleep quality in older adults. %B Journal of Behavioral Medicine %8 2017 Apr 11 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28396970?dopt=Abstract %R 10.1007/s10865-017-9850-2 %0 Journal Article %J J Women Aging %D 2017 %T Mental health and breast cancer screening utilization among older Hispanic women. %A Tamara J. Cadet %A Berrett-Abebe, Julie %A Stewart, Kathleen %K Affect %K Aged %K Anxiety %K Breast Neoplasms %K Early Detection of Cancer %K Female %K Hispanic Americans %K Humans %K Logistic Models %K Middle Aged %K Motivation %K Patient Acceptance of Health Care %K United States %K Vulnerable Populations %XConsiderable racial and ethnic differences exist in the way the burden of cancer is experienced in the United States for older Hispanic women. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the mental health factors associated with older Hispanic women's participation in breast cancer screening services. Logistic regression models were used. Findings indicated that anxiety and positive affect were associated with a greater likelihood of participating in breast cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.
%B J Women Aging %V 29 %P 163-172 %8 2017 Mar-Apr %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27485158 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27485158?dopt=Abstract %R 10.1080/08952841.2015.1113726 %0 Journal Article %J Social Science & Medicine %D 2017 %T Mental retirement and health selection: Analyses from the U.S. Health and Retirement Study. %A Sean A. P. Clouston %A Denier, Nicole %K Cognitive Ability %K Memory %K Older Adults %K Retirement Planning and Satisfaction %XBACKGROUND: Research has recently suggested that retirement may decrease cognitive engagement, resulting in cognitive aging. Few studies have systematically documented whether or how selectivity into retirement shapes the relationship between retirement and cognitive aging.
METHODS: We draw on data from the Health and Retirement Study (1998-2012) to examine the relationship between cognition and retirement for 18,575 labor force participants. Longitudinal regression discontinuity modeling was used to examine performance and decline in episodic memory. Models differentiated three forms of selection bias: indirect and direct selection as well as reverse causation. To further interrogate the disuse hypothesis, we adjust for confounding from health and socioeconomic sources.
RESULTS: Results revealed that individuals who retired over the course of the panel were substantially different in terms of health, wealth and cognition when compared to those who remained employed. However, accounting for observed selection biases, significant associations were found linking longer retirement with more rapid cognitive decline.
DISCUSSION: This study examined respondents who were in the labor force at baseline and transitioned into retirement. Analyses suggested that those who retired over the course of the panel had worse overall functioning, but also experienced more rapid declines after retirement that increased the rate of aging by two-fold, resulting in yearly losses of 3.7% (95% CI = [3.5, 4.0]) of one standard deviation in functioning attributable to retirement. Results are supportive of the view that retirement is associated with more rapid cognitive aging.
%B Social Science & Medicine %V 178 %P 78-86 %8 2017 Jan 22 %G eng %R 10.1016/j.socscimed.2017.01.019 %0 Journal Article %J International Journal of Epidemiolpgy %D 2017 %T Mortality selection in a genetic sample and implications for association studies. %A Benjamin W Domingue %A Daniel W. Belsky %A Harrati, Amal %A Dalton C Conley %A David R Weir %A Jason D Boardman %K Genetics %K GWAS %K Mortality %XBackground: Mortality selection occurs when a non-random subset of a population of interest has died before data collection and is unobserved in the data. Mortality selection is of general concern in the social and health sciences, but has received little attention in genetic epidemiology. We tested the hypothesis that mortality selection may bias genetic association estimates, using data from the US-based Health and Retirement Study (HRS).
Methods: We tested mortality selection into the HRS genetic database by comparing HRS respondents who survive until genetic data collection in 2006 with those who do not. We next modelled mortality selection on demographic, health and social characteristics to calculate mortality selection probability weights. We analysed polygenic score associations with several traits before and after applying inverse-probability weighting to account for mortality selection. We tested simple associations and time-varying genetic associations (i.e. gene-by-cohort interactions).
Results: We observed mortality selection into the HRS genetic database on demographic, health and social characteristics. Correction for mortality selection using inverse probability weighting methods did not change simple association estimates. However, using these methods did change estimates of gene-by-cohort interaction effects. Correction for mortality selection changed gene-by-cohort interaction estimates in the opposite direction from increased mortality selection based on analysis of HRS respondents surviving through 2012.
Conclusions: Mortality selection may bias estimates of gene-by-cohort interaction effects. Analyses of HRS data can adjust for mortality selection associated with observables by including probability weights. Mortality selection is a potential confounder of genetic association studies, but the magnitude of confounding varies by trait.
%B International Journal of Epidemiolpgy %V 46 %8 08/2017 %G eng %N 4 %R 10.1093/ije/dyx041 %0 Journal Article %J The Gerontologist %D 2017 %T Multiple Chronic Conditions, Resilience, and Workforce Transitions in Later Life: A Socio-Ecological Model. %A Kendra Jason %A Dawn C Carr %A Tiffany R Washington %A Tandrea S Hilliard %A Chivon A Mingo %K Comorbidity %K Resilience %K Retirement Planning and Satisfaction %XPurpose of the Study: Despite the growing prevalence of multiple chronic conditions (MCC), a problem that disproportionally affects older adults, few studies have examined the impact of MCC status on changes in workforce participation in later life. Recent research suggests that resilience, the ability to recover from adversity, may buffer the negative impact of chronic disease. Guided by an adapted socio-ecological risk and resilience conceptual model, this study examined the buffering effect of resilience on the relationship between individual and contextual risks, including MCC, and workforce transitions (i.e., leaving the workforce, working fewer hours, working the same hours, or working more hours).
Design and Methods: Using the Health and Retirement Study, this study pooled a sample of 4,861 older workers aged 51 and older with 2 consecutive biannual waves of data. Nonnested multinomial logistic regression analysis was applied.
Results: MCC are related to higher risk of transitioning out of the workforce. Resilience buffered the negative effects of MCC on workforce engagement and remained independently associated with increased probability of working the same or more hours compared with leaving work.
Implications: MCC are associated with movement out of the paid workforce in later life. Despite the challenges MCC impose on older workers, having higher levels of resilience may provide the psychological resources needed to sustain work engagement in the face of new deficits. These findings suggest that identifying ways to bolster resilience may enhance the longevity of productive workforce engagement.
%B The Gerontologist %V 57 %P 269-281 %8 2017 Apr 01 %G eng %N 2 %R 10.1093/geront/gnv101 %0 Journal Article %J Soc Sci Med %D 2017 %T Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S. %A Esther M Friedman %A Regina A Shih %A Mary E Slaughter %A Margaret M Weden %A Kathleen A. Cagney %K Aged %K Aged, 80 and over %K Aging %K Cognition %K Female %K Health Status %K Humans %K Interpersonal Relations %K Male %K Residence Characteristics %K Social Support %K Socioeconomic factors %K United States %XRecent evidence suggests that living in a neighborhood with a greater percentage of older adults is associated with better individual health, including lower depression, better self-rated health, and a decreased risk of overall mortality. However, much of the work to date suffers from four limitations. First, none of the U.S.-based studies examine the association at the national level. Second, no studies have examined three important hypothesized mechanisms - neighborhood socioeconomic status and neighborhood social and physical characteristics - which are significantly correlated with both neighborhood age structure and health. Third, no U.S. study has longitudinally examined cognitive health trajectories. We build on this literature by examining nine years of nationally-representative data from the Health and Retirement Study (2002-2010) on men and women aged 51 and over linked with Census data to examine the relationship between the percentage of adults 65 and older in a neighborhood and individual cognitive health trajectories. Our results indicate that living in a neighborhood with a greater percentage of older adults is related to better individual cognition at baseline but we did not find any significant association with cognitive decline. We also explored potential mediators including neighborhood socioeconomic status, perceived neighborhood cohesion and perceived neighborhood physical disorder. We did not find evidence that neighborhood socioeconomic status explains this relationship; however, there is suggestive evidence that perceived cohesion and disorder may explain some of the association between age structure and cognition. Although more work is needed to identify the precise mechanisms, this work may suggest a potential contextual target for public health interventions to prevent cognitive impairment.
%B Soc Sci Med %V 174 %P 149-158 %8 2017 02 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0277953616306669http://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/xml %1 http://www.ncbi.nlm.nih.gov/pubmed/28033564?dopt=Abstract %! Social Science & Medicine %R 10.1016/j.socscimed.2016.12.005 %0 Journal Article %J Social Science & Medicine %D 2017 %T Neighborhood cohesion, neighborhood disorder, and cardiometabolic risk. %A Jennifer W Robinette %A Susan T Charles %A Tara L Gruenewald %K Depressive symptoms %K Neighborhoods %K Social Relationships %X Perceptions of neighborhood disorder (trash, vandalism) and cohesion (neighbors trust one another) are related to residents' health. Affective and behavioral factors have been identified, but often in studies using geographically select samples. We use a nationally representative sample (n = 9032) of United States older adults from the Health and Retirement Study to examine cardiometabolic risk in relation to perceptions of neighborhood cohesion and disorder. Lower cohesion is significantly related to greater cardiometabolic risk in 2006/2008 and predicts greater risk four years later (2010/2012). The longitudinal relation is partially accounted for by anxiety and physical activity. %B Social Science & Medicine %V 198 %P 70-76 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29276988?dopt=Abstract %R 10.1016/j.socscimed.2017.12.025 %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 %XBACKGROUND: 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 Preventing Chronic Disease %D 2017 %T Novel Methods and Data Sources for Surveillance of State-Level Diabetes and Prediabetes Prevalence %A Mardon, Russ %A David A Marker %A Nooney, Jennifer %A Campione, Joanne %A Jenkins, Frank %A Johnson, Maurice %A Merrill, Lori %A Deborah B. Rolka %A Saydah, Sharon %A Geiss, Linda S. %A Zhang, Xuanping %A Shrestha, Sundar %K Diabetes %K Methodology %K prediabetes %X States bear substantial responsibility for addressing the rising rates of diabetes and prediabetes in the United States. However, accurate state-level estimates of diabetes and prediabetes prevalence that include undiagnosed cases have been impossible to produce with traditional sources of state-level data. Various new and nontraditional sources for estimating state-level prevalence are now available. These include surveys with expanded samples that can support state-level estimation in some states and administrative and clinical data from insurance claims and electronic health records. These sources pose methodologic challenges because they typically cover partial, sometimes nonrandom subpopulations; they do not always use the same measurements for all individuals; and they use different and limited sets of variables for case finding and adjustment. We present an approach for adjusting new and nontraditional data sources for diabetes surveillance that addresses these limitations, and we present the results of our proposed approach for 2 states (Alabama and California) as a proof of concept. The method reweights surveys and other data sources with population undercoverage to make them more representative of state populations, and it adjusts for nonrandom use of laboratory testing in clinically generated data sets. These enhanced diabetes and prediabetes prevalence estimates can be used to better understand the total burden of diabetes and prediabetes at the state level and to guide policies and programs designed to prevent and control these chronic diseases. %B Preventing Chronic Disease %V 14 %G eng %R 10.5888/pcd14.160572 %0 Journal Article %J PLoS One %D 2017 %T The obesity paradox and incident cardiovascular disease: A population-based study. %A Virginia W Chang %A Kenneth M. Langa %A David R Weir %A Theodore J Iwashyna %K BMI %K Cardiovascular disease %K Obesity %XBACKGROUND: Prior work suggests that obesity may confer a survival advantage among persons with cardiovascular disease (CVD). This obesity "paradox" is frequently studied in the context of prevalent disease, a stage in the disease process when confounding from illness-related weight loss and selective survival are especially problematic. Our objective was to examine the association of obesity with mortality among persons with incident CVD, where biases are potentially reduced, and to compare these findings with those based on prevalent disease.
METHODS: We used data from the Health and Retirement Study, an ongoing, nationally representative longitudinal survey of U.S. adults age 50 years and older initiated in 1992 and linked to Medicare claims. Cox proportional hazard models were used to estimate the association between weight status and mortality among persons with specific CVD diagnoses. CVD diagnoses were established by self-reported survey data as well as Medicare claims. Prevalent disease models used concurrent weight status, and incident disease models used pre-diagnosis weight status.
RESULTS: We examined myocardial infarction, congestive heart failure, stroke, and ischemic heart disease. A strong and significant obesity paradox was consistently observed in prevalent disease models (hazard of death 18-36% lower for obese class I relative to normal weight), replicating prior findings. However, in incident disease models of the same conditions in the same dataset, there was no evidence of this survival benefit. Findings from models using survey- vs. claims-based diagnoses were largely consistent.
CONCLUSION: We observed an obesity paradox in prevalent CVD, replicating prior findings in a population-based sample with longer-term follow-up. In incident CVD, however, we did not find evidence of a survival advantage for obesity. Our findings do not offer support for reevaluating clinical and public health guidelines in pursuit of a potential obesity paradox.
%B PLoS One %V 12 %P e0188636 %8 2017 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/29216243?dopt=Abstract %R 10.1371/journal.pone.0188636 %0 Journal Article %J Journal of Ethnic & Cultural Diversity in Social Work %D 2017 %T Older Hispanic women and breast cancer screening: Do cultural factors matter? %A Tamara J. Cadet %A Bakk, Louanne %A Stewart, Kathleen %A Maramaldi, Peter %K Cancer screenings %K Hispanics %K Women and Minorities %X High morbidity and mortality cancer rates among older minority adults underscores the importance of identifying and addressing health disparities related to age and cultural factors that may influence participation in cancer screening and early detection of disease. Disparities for Hispanic women exist in part due to behavior, including lower participation in cancer screenings. Using data from the 2008 wave of the Health and Retirement Study, this study investigated the relationships among cultural factors, time orientation, and uncertainty avoidance among Hispanic women. Results indicate that time orientation and uncertainty avoidance predicted older Hispanic women’s participation in breast cancer screening services. %B Journal of Ethnic & Cultural Diversity in Social Work %V 26 %P 382-398 %G eng %U https://www.tandfonline.com/doi/full/10.1080/15313204.2017.1315627https://www.tandfonline.com/doi/pdf/10.1080/15313204.2017.1315627 %N 4 %! Journal of Ethnic & Cultural Diversity in Social Work %R 10.1080/15313204.2017.1315627 %0 Thesis %B Computational Social Sciences %D 2017 %T Patients, Premiums, and Public Policy: Modeling Health Insurance Markets using Agent Computing %A Comer, Kevin T. %K Economics %K Medicare/Medicaid/Health Insurance %K Public Policy %X This dissertation focuses on the assessment of adverse selection as a result of uncertainty and asymmetric information in a market of buyers and sellers. This dissertation seeks to provide two novel contributions to science – the development of a true-scale (one agent to one household) agent-based model of the individual health insurance market at the state level, and the assessment of the impacts of various policy implementations on the individual health insurance market. These impacts will cover not only the participation rates of individuals in the market, but also the price of coverage, the distribution of subscribers across simulated plans, and the expected net revenue of policy elements. After a short introduction, the second chapter is an agentized replication of the seminal model by Rothschild and Stiglitz, assessing the effect of asymmetric information on a stylized insurance market of buyers and sellers. The agent-based model replication is able to validate the findings of Rothschild and Stiglitz, that the heterogeneous nature of the propensity of risk across the buyer population, and the vested interest of the buyer to not disclose their probability of risk, leads to adverse selection and a failure in the insurance market. However, the assertion of the effectiveness of signaling that Rothschild and Stiglitz is assessed in this model, as well as the inclusion of subjective probability, or the uncertainty a perspective buyer might have over their own risk of accident. The third chapter is the discussion of a baseline agent-based model representation of the individual health insurance market at the state level, representing one hundred thousand (100,000) buyer agents (termed “patients”) and ten (10) seller agents (termed “payers”). Using only empirical data for the income distribution and medical expenditure distribution, the baseline model is able to quantitatively reproduce large-scale behaviors seen in the health insurance market, most notably the price point elasticity of demand for health insurance, estimated at -0.6 by the RAND Health Insurance Experiment. The fourth and penultimate chapter of this dissertation analyzes the six major components of the Patient Protection and Affordable Care Act or ACA, enacted on March 23, 2010, using modeled policy extensions from the baseline model described in the previous chapter. The coverage mandate leads to an increase in premium prices, while decreasing the number of subscribers that choose to participate in the individual health insurance market, which is indicative of adverse selection. While the individual mandate helps to mitigate the latter, the true mitigation policy is risk adjustment across the market. However, this leads to the consolidation of patients into fewer plans, and the departure of firms from the marketplace entirely. %B Computational Social Sciences %I George Mason University %C Fairfax, VA %V Ph.D %P 129 %G eng %9 Dissertation %0 Journal Article %J Neurology %D 2017 %T Physical activity, but not body mass index, predicts less disability before and after stroke. %A Pamela M. Rist %A Benjamin D Capistrant %A Elizabeth R Mayeda %A Sze Y Liu %A M. Maria Glymour %K BMI %K Disabilities %K Older Adults %K Physical activity %K Stroke %XOBJECTIVE: To determine whether physical activity and body mass index (BMI) predict instrumental or basic activities of daily living (I/ADL) trajectories before or after stroke compared to individuals who remained stroke-free.
METHODS: Using a prospective cohort, the Health and Retirement Study, we followed adults without a history of stroke in 1998 (n = 18,117) for up to 14 years. We estimated linear regression models of I/ADL trajectories comparing individuals who remained stroke-free throughout follow-up (n = 16,264), those who survived stroke (n = 1,374), and those who died after stroke and before the next interview wave (n = 479). We evaluated whether I/ADL trajectories differed by physical activity or BMI at baseline (before stroke), adjusting for demographic and socioeconomic covariates.
RESULTS: Compared to those who were physically active, stroke survivors who were physically inactive at baseline had a lower probability of independence in ADLs and IADLs 3 years after stroke (risk difference = -0.18 and -0.16 for ADLs and IADLs, respectively). However, a similar difference in the probability of independence was also present 3 years before stroke, and we observed no evidence that physical activity slowed the rate of decline in independence before or after stroke. Unlike the results for physical activity, we did not observe a consistent pattern for the probability of independence in ADLs or IADLs comparing obese stroke survivors to normal-weight or to overweight stroke survivors 3 years before stroke or 3 years after stroke.
CONCLUSIONS: Physical inactivity predicts a higher risk of being dependent both before and after stroke.
%B Neurology %V 88 %P 1718-1726 %8 05/2017 %G eng %N 18 %R 10.1212/WNL.0000000000003888 %0 Report %D 2017 %T Planning for retirement? The importance of time preferences %A Robert Clark %A Hammond, Robert %A Khalaf, Christelle %A Morrill, Melinda %K Consumption and Savings %K Retirement Planning and Satisfaction %X Ensuring retirement income security is a priority for individuals, employers, and policymakers. Using merged administrative and survey data for public sector workers in North Carolina, we explore how workers’ characteristics and preferences are associated with planning and saving for retirement. We then assess the “quality” of a retirement plan and whether retirement behavior is consistent with these plans. The findings indicate that the way that individuals discount future consumption is associated with the extent of their retirement planning and preparedness. We find that individuals who engage in retirement planning are better prepared to meet their retirement goals upon leaving their career jobs. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 06/2017 %G eng %U http://www.nber.org/papers/w23501.pdf %R 10.3386/w23501 %0 Journal Article %J The Lancet %D 2017 %T Population health in an era of rising income inequality: USA, 1980–2015 %A Bor, Jacob %A Cohen, Gregory H. %A Galea, Sandro %K Income inequality %K Population Health %K Socioeconomic factors %X Income inequality in the USA has increased over the past four decades. Socioeconomic gaps in survival have also increased. Life expectancy has risen among middle-income and high-income Americans whereas it has stagnated among poor Americans and even declined in some demographic groups. Although the increase in income inequality since 1980 has been driven largely by soaring top incomes, the widening of survival inequalities has occurred lower in the distribution-ie, between the poor and upper-middle class. Growing survival gaps across income percentiles since 2001 reflect falling real incomes among poor Americans as well as an increasingly strong association between low income and poor health. Changes in individual risk factors such as smoking, obesity, and substance abuse play a part but do not fully explain the steeper gradient. Distal factors correlated with rising inequality including unequal access to technological innovations, increased geographical segregation by income, reduced economic mobility, mass incarceration, and increased exposure to the costs of medical care might have reduced access to salutary determinants of health among low-income Americans. Having missed out on decades of income growth and longevity gains, low-income Americans are increasingly left behind. Without interventions to decouple income and health, or to reduce inequalities in income, we might see the emergence of a 21st century health-poverty trap and the further widening and hardening of socioeconomic inequalities in health. %B The Lancet %V 389 %P 1475-1490 %8 04/2017 %G eng %N 10077 %R 10.1016/S0140-6736(17)30571-8 %0 Book %D 2017 %T Preventing Cognitive Decline and Dementia: A Way Forward %E Leshner, Alan I. %E Landis, Story %E Stroud, Clare %E Downey, Autumn %K Alzheimer's disease %K Cognitive Ability %K Dementia %K Preventative Medicine %X Societies around the world are concerned about dementia and the other forms of cognitive impairment that affect many older adults. We now know that brain changes typically begin years before people show symptoms, which suggests a window of opportunity to prevent or delay the onset of these conditions. Emerging evidence that the prevalence of dementia is declining in high-income countries offers hope that public health interventions will be effective in preventing or delaying cognitive impairments. Until recently, the research and clinical communities have focused primarily on understanding and treating these conditions after they have developed. Thus, the evidence base on how to prevent or delay these conditions has been limited at best, despite the many claims of success made in popular media and advertising. Today, however, a growing body of prevention research is emerging. Preventing Cognitive Decline and Dementia: A Way Forward assesses the current state of knowledge on interventions to prevent cognitive decline and dementia, and informs future research in this area. This report provides recommendations of appropriate content for inclusion in public health messages from the National Institute on Aging. %I National Academies Press %C Washington, D.C. %@ 978-0-309-45959-4 %G eng %U https://www.nap.edu/catalog/24782 %R 10.17226/24782 %0 Newspaper Article %B Chicago Tribune %D 2017 %T Pros and cons of retiring near children %A Clark, Jane Bennett %K Adult children %K News %K Older Adults %B Chicago Tribune %G eng %U http://www.chicagotribune.com/business/success/kiplinger/tca-pros-and-cons-of-retiring-near-children-20170331-story.html %& Business/Success/Kiplinger %0 Journal Article %J Soc Work Health Care %D 2017 %T Psychosocial correlates of cervical cancer screening among older Hispanic women. %A Tamara J. Cadet %A Stewart, Kathleen %A Howard, Tenial %K Adult %K Aged %K Aged, 80 and over %K Attitude to Health %K Early Detection of Cancer %K Female %K Hispanic Americans %K Humans %K Logistic Models %K Mass Screening %K Middle Aged %K Uterine Cervical Neoplasms %XEarly detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women's participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.
%B Soc Work Health Care %V 56 %P 124-139 %8 2017 02 %G eng %U https://www.tandfonline.com/doi/full/10.1080/00981389.2016.1263268 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27960632?dopt=Abstract %! Social Work in Health Care %R 10.1080/00981389.2016.1263268 %0 Journal Article %J Journal of Social Service Research %D 2017 %T Racial/Ethnic Inequality Among Older Workers: Focusing On Whites, Blacks, and Latinos Within the Cumulative Advantage/Disadvantage Framework %A Choi, Eunhee %A Tang, Fengyan %A Valire Carr Copeland %K Employment and Labor Force %K Racial/ethnic differences %K Women and Minorities %X The experience of older racial/ethnic minority workers may differ from that of their non-Hispanic White counterparts because of persistent racial/ethnic differences; however, our knowledge of older minority workers is fragmentary. Using the cumulative advantage/disadvantage framework, this study aimed to identify factors that explain older Americans’ labor market participation after age 65 and whether racial/ethnic differences exist among those factors. Using the 2004 and 2008 waves of the Health and Retirement Study data, racially separate analyses were performed to systematically compare factors by race. The results showed that factors influencing labor force participation after age 65 were indeed conditioned by race. Health and meaning of work significantly influenced non-Hispanic Whites, whereas home ownership increased the odds of working among non-Hispanic Blacks, and Latinos were concerned with health alone. The findings suggest that older ethnic minorities appear to experience a greater vulnerability to involuntary labor market exit—as opposed to personal preference or financial necessity. This racial/ethnic inequality should be understood not as sudden occurrences in old age, but as a by-product of the interplay between the individuals’ lifetime experiences and the social structures that impose cumulative advantages/disadvantages on them. Continued research will help reduce racial gaps in the next generation of older workers. %B Journal of Social Service Research %V 43 %P 18 - 36 %8 Mar-01-2019 %G eng %U https://www.tandfonline.com/doi/full/10.1080/01488376.2016.1235068https://www.tandfonline.com/doi/pdf/10.1080/01488376.2016.1235068 %N 1 %! Journal of Social Service Research %R 10.1080/01488376.2016.1235068 %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 %XHeight 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 Genetics %D 2017 %T Rare variants in fox-1 homolog A (RBFOX1) are associated with lower blood pressure. %A He, Karen Y %A Wang, Heming %A Brian E Cade %A Nandakumar, Priyanka %A Giri, Ayush %A Erin B Ware %A Jeffrey Haessler %A Liang, Jingjing %A Smith, Jennifer A %A Franceschini, Nora %A Le, Thu H %A Charles Kooperberg %A Edwards, Todd L %A Sharon L R Kardia %A Lin, Xihong %A Chakravarti, Aravinda %A Redline, Susan %A Zhu, Xiaofeng %K Adult %K Blood pressure %K Body Mass Index %K Chromosomes, Human, Pair 16 %K Family Health %K Female %K Gene Expression %K Gene Frequency %K Genetic Linkage %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Genotype %K Humans %K Male %K Middle Aged %K Pedigree %K Polymorphism, Single Nucleotide %K RNA Splicing Factors %K Whites %XMany large genome-wide association studies (GWAS) have identified common blood pressure (BP) variants. However, most of the identified BP variants do not overlap with the linkage evidence observed from family studies. We thus hypothesize that multiple rare variants contribute to the observed linkage evidence. We performed linkage analysis using 517 individuals in 130 European families from the Cleveland Family Study (CFS) who have been genotyped on the Illumina OmniExpress Exome array. The largest linkage peak was observed on chromosome 16p13 (MLOD = 2.81) for systolic blood pressure (SBP). Follow-up conditional linkage and association analyses in the linkage region identified multiple rare, coding variants in RBFOX1 associated with reduced SBP. In a 17-member CFS family, carriers of the missense variant rs149974858 are normotensive despite being obese (average BMI = 60 kg/m2). Gene-based association test of rare variants using SKAT-O showed significant association with SBP (p-value = 0.00403) and DBP (p-value = 0.0258) in the CFS participants and the association was replicated in large independent replication studies (N = 57,234, p-value = 0.013 for SBP, 0.0023 for PP). RBFOX1 is expressed in brain tissues, the atrial appendage and left ventricle in the heart, and in skeletal muscle tissues, organs/tissues which are potentially related to blood pressure. Our study showed that associations of rare variants could be efficiently detected using family information.
%B PLoS Genetics %V 13 %P e1006678 %G eng %N 3 %R 10.1371/journal.pgen.1006678 %0 Journal Article %J J Gen Intern Med %D 2017 %T Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. %A Victoria L. Tang %A Rebecca L. Sudore %A Irena Cenzer %A W John Boscardin %A Alexander K Smith %A Christine S Ritchie %A Margaret Wallhagen %A Finlayson, Emily %A Petrillo, Laura %A Kenneth E Covinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Comorbidity %K Dementia %K Female %K Geriatric Assessment %K Hip Fractures %K Humans %K Longitudinal Studies %K Male %K Mobility Limitation %K Recovery of Function %K Walking %XBACKGROUND: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.
OBJECTIVES: To determine rates of functional recovery in older adults who sustained a hip fracture based on one's previous function.
DESIGN: Observational study.
PARTICIPANTS: We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2 years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.
MAIN MEASURES: Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.
KEY RESULTS: A total of 733 HRS subjects ≥65 years of age sustained a hip fracture (mean age 84 ± 7 years, 77 % female). Thirty-one percent returned to pre-fracture ADL function, 34 % to pre-fracture mobility function, and 41 % to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36 % returned to independence, 27 % survived but needed ADL assistance, and 37 % died. Return to ADL independence was less likely for those ≥85 years old (26 % vs. 44 %), with dementia (8 % vs. 39 %), and with a Charlson comorbidity score >2 (23 % vs. 44 %). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.
CONCLUSIONS: Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.
%B J Gen Intern Med %V 32 %P 153-158 %8 2017 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27605004?dopt=Abstract %R 10.1007/s11606-016-3848-2 %0 Journal Article %J Res Aging %D 2017 %T Reciprocal Effects Between Health and Social Support in Older Adults' Relationships With Their Children and Friends. %A Jung-Hwa Ha %A Kahng, Sang Kyoung %A Namkee G Choi %XThis study examined the longitudinal reciprocal effects between health and social support in older adults' relationships with their children and friends. Data are from the 2006 and 2010 waves of the Health and Retirement Study ( N = 3,760). We focused on three specific aspects of social support: frequency of contact, positive interactions, and negative interactions. We used autoregressive cross-lagged models to examine the bidirectional effects between social support and health. When the bidirectional effects between health and social support were simultaneously examined, the longitudinal effect of social support on health was not significant. In contrast, older adults' poor health was associated with decreased contact and decreased positive interactions with friends as well as with increased negative interactions with their adult children and friends. The findings suggest that older adults' poor health has a negative impact on their social relationships and that such effect surpasses the impact of social relationships on health.
%B Res Aging %V 39 %P 300-321 %8 2017 Feb %G eng %U http://roa.sagepub.com/content/early/2015/10/15/0164027515611182.abstract %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/26475653?dopt=Abstract %4 health/social support/social relationships/autoregressive cross-lagged models %$ 999999 %R 10.1177/0164027515611182 %0 Journal Article %J Journal of Occupational and Environmental Medicine %D 2017 %T Relating Older Workers' Injuries to the Mismatch Between Physical Ability and Job Demands. %A Laura A Fraade-Blanar %A Jeanne M Sears %A Kwun Chuen G. Chan %A Hilaire J Thompson %A Paul K Crane %A Beth E. Ebel %K Disabilities %K Employment and Labor Force %K Health Shocks %K Job loss %K Older Adults %K Retirement Planning and Satisfaction %XOBJECTIVE: We examined the association between job demand and occupational injury among older workers.
METHODS: Participants were workers aged 50+ enrolled in the Health and Retirement Study, 2010 to 2014. Participants reported physical ability within three domains: physical effort, stooping/kneeling/crouching, and lifting. To measure subjective job demand, participants rated their job's demands within domains. We generated objective job demand measures through the Occupational Information Network (ONET). Using Poisson regression, we modeled the association between physical ability, job demand, and self-reported occupational injury. A second model explored interaction between job demand and physical ability.
RESULTS: The injury rate was 22/1000 worker-years. Higher job demand was associated with increased injury risk. Within high job demands, lower physical ability was associated with increased injury risk.
CONCLUSIONS: Older workers whose physical abilities do not meet job demands face increased injury risk.
%B Journal of Occupational and Environmental Medicine %V 59 %P 212-221 %8 2017 Feb %G eng %N 2 %R 10.1097/JOM.0000000000000941 %0 Journal Article %J Psychol Health Med %D 2017 %T The relationship between family support; pain and depression in elderly with arthritis. %A Hung, Man %A Bounsanga, Jerry %A Maren W Voss %A Anthony B. Crum %A Wei Chen %A Wendy Church Birmingham %K Aged %K Aged, 80 and over %K Aging %K Arthralgia %K Arthritis %K depression %K Family %K Female %K Humans %K Male %K Middle Aged %K Social Support %K United States %XThe prevalence and chronic nature of arthritis make it the most common cause of disability among U.S.A adults. Family support reduces the negative impact of chronic conditions generally but its role in pain and depression for arthritic conditions is not well understood. A total of 844 males (35.0%) and 1567 females (65.0%) with arthritic conditions (n = 2411) were drawn from the 2012 Health and Retirement Study to examine the effect of family support on pain and depressive symptoms. Using regression analysis and controlling for age, ethnicity, gender, marital/educational status and employment/income, physical function/disability status, pain and antidepressant medications, and other clinical indicators of chronic health conditions, we examined the effects of family support (spouse, children, other) on pain and depression levels. Results indicated that depressive symptoms decreased significantly with strong family and spousal support (p < .05). Pain decreased as support levels increased, but was non-statistically significant. This study provides new insights into the relationship between family support, pain, and depression for individuals with arthritis. Future longitudinal studies are needed to evaluate family support and relationships over a wider spectrum of demographics.
%B Psychol Health Med %V 22 %P 75-86 %8 2017 01 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27427504 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27427504?dopt=Abstract %R 10.1080/13548506.2016.1211293 %0 Journal Article %J The Journal of Rural Health %D 2017 %T The Role of Primary Care for the Oral Health of Rural and Urban Older Adults. %A Julia T. Caldwell %A Lee, Haena %A Kathleen A. Cagney %K Dental Care %K Health Conditions and Status %K Rural Settings %K urban life %XCONTEXT: Rural populations often have restricted access to dental care and poor oral health. These problems may disproportionately affect older blacks in rural areas. Little is known about how access to primary health care may improve the oral health of rural seniors.
PURPOSE: This study examines whether the relationship between having a usual source of health care and oral health varies for white and black older adults in rural and urban areas in the United States.
METHODS: We draw on cross-sectional data of adults (50 years+) from the nationally representative Health and Retirement Study (n = 15,473). Multivariate logistic regression examined the role of a usual source of health care in conditioning racial differences in complete tooth loss and a dental visit in the past 2 years. A usual source of health care is a place, not including an emergency room, where a person goes when he or she is sick or needs health advice.
FINDINGS: In rural areas, blacks had high rates of tooth loss (28%) and low rates of dental visits (34%). Having a usual source of health care was associated with higher odds of a dental visit for all adults. In rural areas, the association between a usual source of health care and tooth loss varied by race (P < .001); blacks had more tooth loss than whites even with a usual source of health care.
CONCLUSIONS: Access to primary health care was associated with improved oral health outcomes, but it did not close the gap between whites and blacks in rural areas.
%B The Journal of Rural Health %V 33 %P 409-418 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28905422?dopt=Abstract %R 10.1111/jrh.12269 %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 %XHypertension 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 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 %XGenome-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 J Gerontol B Psychol Sci Soc Sci %D 2017 %T Successful Aging in the Context of the Disablement Process: Working and Volunteering as Moderators on the Association Between Chronic Conditions and Subsequent Functional Limitations. %A Ben Lennox Kail %A Dawn C Carr %K Aged %K Aged, 80 and over %K Aging %K Disabled Persons %K Employment %K Female %K Humans %K Male %K United States %K Volunteers %XObjectives : This study evaluated the successful aging model by assessing the impact of two forms of productive engagement-working and volunteering-as potential interventions in the process of disablement.
Method : The Health and Retirement Study was used to (a) estimate two-stage selection equations of (i) currently working part time and full time and (ii) currently volunteering less than 100 hours and volunteering 100 hours or more per year (net of chronic health problems) and (b) assess whether, net of selection, working, and volunteering moderate the association between chronic conditions and subsequent functional limitations.
Results : Chronic conditions were associated with elevated levels of subsequent functional limitations, whereas both working and volunteering were associated with lower levels of subsequent functional limitations. Moreover, workers and volunteers of less than 100 hours per year experienced a reduction in the association of chronic conditions on subsequent functional limitations.
Discussion : This research highlights the role of productive engagement as a key element in successful aging. Not only do work and volunteering have direct associations with health outcomes themselves, but they also act as potential interventions in the process of disablement by attenuating the way in which chronic conditions are translated into subsequent functional limitations. This suggests that (a) future research should apply successful aging models to health processes as well as health outcomes and (b) policy makers should support social institutions that foster late-life productive engagement.
%B J Gerontol B Psychol Sci Soc Sci %V 72 %P 340-350 %8 2017 Mar 01 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27225973 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27225973?dopt=Abstract %R 10.1093/geronb/gbw060 %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 %XOBJECTIVES: 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 Vienna Yearbook of Population Research %D 2017 %T Time-to-death patterns in markers of age and dependency %A Riffe, Tim %A Chung, Pil H. %A Spijker, Jeroen %A MacInnes, John %E Lutz, Wolfgang %K Disabilities %K Gender Differences %K Mortality %X We aim to determine the extent to which variables commonly used to describe health, well-being, and disability in old age vary primarily as a function of years lived (chronological age), years left (thanatological age), or as a function of both. We analyze data from the U.S. Health and Retirement Study to estimate chronological age and time-to-death patterns in 78 such variables.We describe results for the birth cohort 1915-1919 in the final 12 years of life. Our results show that most of the markers used to study well-being in old age vary along both the age and the timeto- death dimensions, but that some markers are exclusively a function of either time to death or chronological age, while other markers display different patterns in men and women. %B Vienna Yearbook of Population Research %V 1 %P 229-254 %G eng %U http://hw.oeaw.ac.at/1728-4414http://hw.oeaw.ac.at/populationyearbook2016http://hw.oeaw.ac.at?arp=0x0036e636 %! Populationyearbook %R 10.1553/populationyearbook10.1553/populationyearbook201610.1553/populationyearbook2016s229 %0 Journal Article %J Work, Aging and Retirement %D 2017 %T To What Extent is Gradual Retirement a Product of Financial Necessity? %A Kevin E. Cahill %A Michael D. Giandrea %A Joseph F. Quinn %K Bridge employment %K Financial literacy %K Older Adults %K Retirement Planning and Satisfaction %X Changes in the retirement income landscape over the past 30 years have left older Americans more exposed to market forces than prior generations, and more reliant on earnings to ensure their financial stability at older ages. These earnings come from a variety of nontraditional paths to retirement. Most older Americans reduce hours in career employment, change employers later in life, reenter the labor force after an initial retirement, or follow some combination of these 3 paths. The many pathways to retirement are undoubtedly the product of a flexible labor market and may be good news on balance; however, for some these job changes may reflect hardship, as vulnerable populations seek whatever employment they can find to prevent falling into poverty at older ages. We assess the magnitude of this segment of older workers using data from the Health and Retirement Study (HRS), a large, nationally-representative longitudinal survey of older Americans that began in 1992. We find that bridge job prevalence among those with little or no financial assets resembles that of individuals in the middle of the wealth distribution, implying that financial insecurity does not appear to be a main driver of gradual retirement transitions among career workers. Bridge employment among those with little or no financial assets is, however, more likely to consist of full-time wage-and-salary work. With the prospect of increased financial insecurity among older Americans, this analysis suggests that gradual retirements consisting of short-term, full-time wage-and-salary employment may become more prevalent in the years ahead. %B Work, Aging and Retirement %V 3 %P 25 - 54 %8 Jul-01-2018 %G eng %U https://academic.oup.com/workar/article-lookup/doi/10.1093/workar/waw027https://academic.oup.com/workar/article/2623812/To-What-Extent-is-Gradual-Retirement-a-Product-of %N 1 %! WORKAR %R 10.1093/workar/waw027 %0 Journal Article %J Journal of Consumer Affairs %D 2017 %T Understanding the Formation of Consumers' Stock Market Expectations %A Chin, Alycia %A Bruine De Bruin, Wändi %K Investing %K Survey Methodology %X To understand consumers' investment decisions, national surveys such as the Health and Retirement Study elicit consumers' expectations about stock market movements. Analyses of stock market expectations show substantial heterogeneity between consumers. It is commonly speculated that this heterogeneity reflects variations in the beliefs underlying consumers' stock market expectations, that is, their mental models. In an online survey of American adults, we find that consumers think about different economic and political issues when generating stock market expectations for the next year. Regardless of the specific issues on which consumers focused, however, their assessments of the issues seemed to reflect a single underlying perception of changes in economic conditions. Regression analyses show that variation in stock market expectations is related to consumers' overall assessments of economic developments. We discuss the implications of these results for economic surveys and investment communications. %B Journal of Consumer Affairs %V 51 %P 200 - 210 %8 Jan-03-2017 %G eng %N 1 %! J Consum Aff %R 10.1111/joca.2017.51.issue-110.1111/joca.12110 %0 Journal Article %J Ageing International %D 2017 %T Using the Social Determinants of Health as a Framework to Examine and Address Predictors of Depression in Later Life %A Cross-Denny, Bronwyn %A Robinson, Michael A. %K Depressive symptoms %K Health Predictors %K Social status %X Depression in later life is an important public health concern. Comprehensive assessments incorporating all key areas of the social determinants of health (SDOH) framework can assist in developing effective interventions to ensure mental health for the increasing older adult population. This study uses the SDOH model for identifying, evaluating, and addressing risk factors that contribute to depression in older adults. Secondary data analysis of the Health and Retirement Study was used to conduct a hierarchical multiple regression analysis to examine predictors of depression in later life. The SDOH key areas were used as a framework for the regression model. The main findings showed predictors of depression were health and social support, emphasizing the importance of aging in place. Implications for practice include the provision of services within the home, neighborhood, and community to maintain older adults within the least restrictive environments where they can maximize healthy living and continue to maintain connections with their social support networks. %B Ageing International %V 42 %P 393-412 %G eng %U http://link.springer.com/10.1007/s12126-017-9278-6http://link.springer.com/content/pdf/10.1007/s12126-017-9278-6.pdfhttp://link.springer.com/content/pdf/10.1007/s12126-017-9278-6.pdfhttp://link.springer.com/article/10.1007/s12126-017-9278-6/fulltext.html %N 4 %! Ageing Int %R 10.1007/s12126-017-9278-6 %0 Journal Article %J American Journal of Geriatric Psychiatry %D 2017 %T Validating the 11-Item Revised University of California Los Angeles Scale to Assess Loneliness Among Older Adults: An Evaluation of Factor Structure and Other Measurement Properties. %A Lee, Joonyup %A John G. Cagle %K Depressive symptoms %K Loneliness %K R-UCLA %K Survey Methodology %XOBJECTIVE: To examine the measurement properties and factor structure of the short version of the Revised University of California Los Angeles (R-UCLA) loneliness scale from the Health and Retirement Study (HRS).
METHODS: Based on data from 3,706 HRS participants aged 65 + who completed the 2012 wave of the HRS and its Psychosocial Supplement, the measurement properties and factorability of the R-UCLA were examined by conducting an exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) on randomly split halves.
RESULTS: The average score for the 11-item loneliness scale was 16.4 (standard deviation: 4.5). An evaluation of the internal consistency produced a Cronbach's α of 0.87. Results from the EFA showed that two- and three-factor models were appropriate. However, based on the results of the CFA, only a two-factor model was determined to be suitable because there was a very high correlation between two factors identified in the three-factor model, available social connections and sense of belonging.
CONCLUSION: This study provides important data on the properties of the 11-item R-UCLA scale by identifying a two-factor model of loneliness: feeling isolated and available social connections. Our findings suggest the 11-item R-UCLA has good factorability and internal reliability.
%B American Journal of Geriatric Psychiatry %V 25 %P 1173-1183 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/28864097?dopt=Abstract %R 10.1016/j.jagp.2017.06.004 %0 Report %D 2017 %T Venous Blood Collection and Assay Protocol in the 2016 Health and Retirement Study %A Eileen M. Crimmins %A Jessica Faul %A Bharat Thyagarajan %A David R Weir %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %0 Journal Article %J Personality and Individual Differences %D 2016 %T Age differences in conscientiousness facets in the second half of life: Divergent associations with changes in physical health %A William J. Chopik %K Conscientiousness %K Health Conditions and Status %K Older Adults %K Self-control %X The development of personality across the lifespan has captivated researchers for several years. However, lower order facets may show different developmental trends and divergent associations with outcomes compared to their higher order traits. In a sample of 12,762 older adults, age differences in conscientiousness and its facets were examined. Further, the degree to which conscientiousness and its facets differentially predicted physical health over a four-year period was also examined. Broader conscientiousness, orderliness, and industriousness were lowest in late life. Traditionalism and virtue were highest in late life. Responsibility was highest around age 70. Self-control did not show any significant age-related differences. Conscientiousness, orderliness, industriousness, and responsibility were most consistently related to physical health over time. The findings are discussed in the context of the mechanisms that give rise to personality development and divergent associations in outcomes among seemingly related facets. %B Personality and Individual Differences %I 96 %V 96 %P 202-211 %8 07/2016 %G eng %U http://www.sciencedirect.com/science/article/pii/S0191886916301325 %R 10.1016/j.paid.2016.02.076 %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 %XOBJECTIVE: 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 PLoS One %D 2016 %T Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans. %A Anusha M Vable %A Ichiro Kawachi %A Canning, David %A M. Maria Glymour %A Marcia P Jimenez %A S. V. Subramanian %K Adult %K Aged %K depression %K Female %K Humans %K Korean War %K Male %K Mental Disorders %K Mental Health %K Middle Aged %K Odds Ratio %K Population Surveillance %K Social Class %K Spouses %K Veterans %K Veterans Health %XBACKGROUND: The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated.
METHODS: Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent's educational attainment in a subset of analyses.
RESULTS: Husband's Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28).
CONCLUSIONS: We found no evidence of a relationship between husband's Korean War GI Bill eligibility and wives' mental health in these data, however there may be a true effect that our analysis was underpowered to detect.
%B PLoS One %V 11 %P e0154203 %8 2016 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27186983 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27186983?dopt=Abstract %R 10.1371/journal.pone.0154203 %0 Journal Article %J Value in Health %D 2016 %T The Association Between Alcohol Consumption And Cognitive Function In The Middle-Aged And Older Population: A Study Using The Health And Retirement Study (Hrs) Data %A Chen, C. %A Raisch, D. W. %K Alcohol Consumption %K Cognitive Ability %K Health Conditions and Status %K Older Adults %B Value in Health %V 19 %P A190 %8 Jan-05-2016 %G eng %N 3 %R 10.1016/j.jval.2016.03.1336 %0 Journal Article %J J Aging Health %D 2016 %T Association of Alcohol Use and Loneliness Frequency Among Middle-Aged and Older Adult Drinkers. %A Sarah L. Canham %A Pia M Mauro %A Christopher N Kaufmann %A Sixsmith, Andrew %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Binge drinking %K Cross-Sectional Studies %K Female %K Humans %K Loneliness %K Male %K Middle Aged %K Risk-Taking %XOBJECTIVES: We examined the association between alcohol use, at-risk drinking, and binge drinking, and loneliness in a sample of middle-aged and older adults.
METHOD: We studied participants aged 50+ years from the 2008 wave of the Health and Retirement Study who reported alcohol use. We ran separate multinomial logistic regressions to assess the association of three alcohol use outcomes (i.e., weekly alcohol consumption, at-risk drinking, and binge drinking) and loneliness.
RESULTS: After adjusting for covariates, being lonely was associated with reduced odds of weekly alcohol consumption 4 to 7 days per week, but not 1 to 3 days per week, compared with average alcohol consumption 0 days per week in the last 3 months. No association was found between at-risk drinking or binge drinking and loneliness.
DISCUSSION: Results suggest that among a sample of community-based adults aged 50+, loneliness was associated with reduced alcohol use frequency, but not with at-risk or binge drinking.
%B J Aging Health %I 28 %V 28 %P 267-84 %8 2016 Mar %G eng %U http://jah.sagepub.com/content/early/2015/06/09/0898264315589579.abstract %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/26082130?dopt=Abstract %2 PMC4681688 %R 10.1177/0898264315589579 %0 Journal Article %J Cyberpsychol Behav Soc Netw %D 2016 %T The Benefits of Social Technology Use Among Older Adults Are Mediated by Reduced Loneliness. %A William J. Chopik %K Aged %K Aged, 80 and over %K Attitude to Computers %K depression %K Female %K Health Status %K Humans %K Interpersonal Relations %K Loneliness %K Male %K Middle Aged %K Personal Satisfaction %K Social Networking %K Telecommunications %XTechnology has the ability to enhance and enrich the lives of older adults by facilitating better interpersonal relationships. However, few studies have directly examined associations between technology use for social reasons and physical and psychological health among older adults. The current study examines the benefits of technology use in 591 older adults from the 2012 wave of the Health and Retirement Study (Mage = 68.18, SD = 10.75; 55.5% female). Social technology use was assessed through five technology-based behaviors (i.e., using e-mail, social networking sites, online video/phone calls, online chatting/instant messaging, using a smartphone). Attitudes toward the usability and benefits of technology use were also assessed. Older adults had generally positive attitudes toward technology. Higher social technology use was associated with better self-rated health, fewer chronic illnesses, higher subjective well-being, and fewer depressive symptoms. Furthermore, each of the links between social technology use and physical and psychological health was mediated by reduced loneliness. Close relationships are a large determinant of physical health and well-being, and technology has the potential to cultivate successful relationships among older adults.
%B Cyberpsychol Behav Soc Netw %V 19 %P 551-6 %8 2016 Sep %G eng %U http://online.liebertpub.com/doi/10.1089/cyber.2016.0151 %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/27541746?dopt=Abstract %! Cyberpsychology, Behavior, and Social Networking %R 10.1089/cyber.2016.0151 %0 Thesis %B Epidemiological Science %D 2016 %T Bridge Employment and Health %A Cho, Jihyun %K Bridge employment %K Health Conditions and Status %K Older Adults %X Due to the increasing longevity, advancing yet skyrocketing health care costs, and the lack of funds for elderly welfare, post-retirement health among older adults has become a crucial issue both at the individual and societal level. Concurrently, with widespread implementation of pro-work policies and the notion of retirement as a gradual process rather than one-time transition, bridge employment rate in the US has increased continually for last few decades. However, little is known regarding how the two major societal trends are related. Determinants of bridge employment are not fully understood, and how bridge employment affects post-retirement health is largely unknown. In addition, there is little systematic information on gender difference in the precursors and consequences of bridge employment despite distinct occupational experiences and biological differences in men and women. This dissertation focuses on the complex relationship between bridge employment and post-retirement health. Using data from Health and Retirement Study, a nationally representative longitudinal survey of individuals over age 50, major determinants of bridge employment among men and women were identified. Then, the effects of bridge employment on physical and mental health were investigated. Statistical analyses accounted for time-dependent confounders and potential bidirectional association in the relationship between bridge employment and health outcomes. Via separate analyses for men and women, this study shows that men’s bridge employment is often driven especially by his early-life socioeconomic status, rather than his high occupational ability or self-esteem in the work place, while women’s bridge employment is significantly influenced by her marital status, which may partly be due to women’s nonlinear career trajectories. Bridge employment was associated with fewer depressive symptoms, while it was found to have deteriorative effects on physical functioning. Both associations did not differ by potential modifiers such as gender, income, education, and pre-retirement occupation. By investigating the antecedents of bridge employment and examining its physical and mental health effects, this dissertation provides an insight on the mechanism of the non-traditional retirement process. Our findings may be useful for policy implications to improve well-being of a number of prospective retirees who may engage in bridge employment in the next few decades. Advisors/Committee Members: Mendes de Leon, Carlos (committee member), Elliott, Michael R (committee member), Liang, Jersey (committee member), Needham, Belinda L (committee member), Schoeni, Bob (committee member). %B Epidemiological Science %I University of Michigan %C Ann Arbor, Michigan %V Ph.D. %G eng %U http://hdl.handle.net/2027.42/135855 %9 Dissertation %0 Journal Article %J Ann Epidemiol %D 2016 %T Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression. %A Anusha M Vable %A Canning, David %A M. Maria Glymour %A Ichiro Kawachi %A Marcia P Jimenez %A S. V. Subramanian %K Aged %K Aged, 80 and over %K depression %K Health Status Disparities %K Humans %K Korean War %K Male %K Public Policy %K Residence Characteristics %K Risk Factors %K Socioeconomic factors %K Veterans %XPURPOSE: The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities.
METHODS: Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents ≥ 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups.
RESULTS: Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β = -0.64, 95% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [β = -0.76, 95% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [β = -11.7, 95% CI = (-8.2, -22.6), P = .035].
CONCLUSIONS: Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers.
%B Ann Epidemiol %I 26 %V 26 %P 129-135.e3 %8 2016 Feb %G eng %U http://www.sciencedirect.com/science/article/pii/S1047279715300107 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/26778285?dopt=Abstract %R 10.1016/j.annepidem.2015.12.003 %0 Journal Article %J SSM Popul Health %D 2016 %T Change in Cognitively Healthy and Cognitively Impaired Life Expectancy in the United States: 2000-2010. %A Eileen M. Crimmins %A Saito, Yasuhiko %A Jung K Kim %XOBJECTIVE: To determine how cognitively healthy and cognitively impaired life expectancy have changed from 2000 to 2010 among American men and women 65 years of age and over.
METHODS: The prevalence of dementia, cognitive impairment without dementia (CIND), and normal cognition is determined from the nationally representative data from the U.S. Health and Retirement Study (HRS). Mortality rates are from U.S. Decennial Life Table for 2000 and the U.S. annual life table for 2010. Life expectancy by cognitive status is estimated using the Sullivan method.
RESULTS: Most of the increase in life expectancy has been concentrated in cognitively healthy years in this 10 year period. The increase in expected years cognitively intact at age 65, which exceeded that in total life expectancy, was 1.8 for men and 1.6 for women.
CONCLUSION: This study provides evidence suggesting that there has been a compression of cognitive morbidity.
%B SSM Popul Health %V 2 %P 793-797 %8 2016 Dec %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S2352827316301148http://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/xml %1 http://www.ncbi.nlm.nih.gov/pubmed/27917398?dopt=Abstract %! SSM - Population Health %R 10.1016/j.ssmph.2016.10.007 %0 Journal Article %J Ophthalmic Epidemiol %D 2016 %T Changes in Visual Function in the Elderly Population in the United States: 1995-2010. %A Chen, Yiqun %A Hahn, Paul %A Frank A Sloan %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Chronic disease %K Cross-Sectional Studies %K Female %K Humans %K Male %K Medicare Part B %K Prevalence %K Self Report %K Socioeconomic factors %K United States %K Visual Acuity %K Visually Impaired Persons %XPURPOSE: To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes).
METHODS: Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent).
RESULTS: Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma.
CONCLUSION: Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.
%B Ophthalmic Epidemiol %V 23 %P 137-44 %8 2016 Jun %G eng %U http://dx.doi.org/10.3109/09286586.2015.1057603 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/27142717?dopt=Abstract %& 1 %R 10.3109/09286586.2015.1057603 %0 Journal Article %J Behav Genet %D 2016 %T Cohort Effects in the Genetic Influence on Smoking. %A Benjamin W Domingue %A Dalton C Conley %A Jason M. Fletcher %A Jason D Boardman %K Aged %K Cohort Effect %K Female %K Gene Frequency %K Genetic Predisposition to Disease %K Genotype %K Humans %K Male %K Middle Aged %K Multifactorial Inheritance %K Smoking %K Twins %XWe examine the hypothesis that the heritability of smoking has varied over the course of recent history as a function of associated changes in the composition of the smoking and non-smoking populations. Classical twin-based heritability analysis has suggested that genetic basis of smoking has increased as the information about the harms of tobacco has become more prevalent-particularly after the issuance of the 1964 Surgeon General's Report. In the present paper we deploy alternative methods to test this claim. We use data from the Health and Retirement Study to estimate cohort differences in the genetic influence on smoking using both genomic-relatedness-matrix restricted maximum likelihood and a modified DeFries-Fulker approach. We perform a similar exercise deploying a polygenic score for smoking using results generated by the Tobacco and Genetics consortium. The results support earlier claims that the genetic influence in smoking behavior has increased over time. Emphasizing historical periods and birth cohorts as environmental factors has benefits over existing GxE research. Our results provide additional support for the idea that anti-smoking policies of the 1980s may not be as effective because of the increasingly important role of genotype as a determinant of smoking status.
%B Behav Genet %I 46 %V 46 %P 31-42 %8 2016 Jan %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84938496073andpartnerID=40andmd5=76a4f2cefad88fc22ebca2e435b4323e %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26223473?dopt=Abstract %2 PMC4720550 %R 10.1007/s10519-015-9731-9 %0 Journal Article %J J Aging Health %D 2016 %T A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States. %A Chi-Tsun Chiu %A Mark D Hayward %A Saito, Yasuhiko %K Activities of Daily Living %K Age Distribution %K Aged %K Cause of Death %K Cross-Cultural Comparison %K Educational Status %K Employment %K Family Characteristics %K Female %K Health Status %K Health Surveys %K Healthy Lifestyle %K Humans %K Japan %K Life Expectancy %K Life Tables %K Longitudinal Studies %K Male %K Middle Aged %K Regression Analysis %K Retirement %K Sex Distribution %K United States %XOBJECTIVE: This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States.
METHOD: This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables.
RESULTS: Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles.
DISCUSSION: Japan's compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States.
%B J Aging Health %V 28 %P 1256-78 %8 2016 10 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27590801?dopt=Abstract %R 10.1177/0898264316656505 %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 %XBACKGROUND: 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 Int Psychogeriatr %D 2016 %T Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights. %A Cohen-Mansfield, Jiska %A Hazan, Haim %A Lerman, Yaffa %A Shalom, Vera %K Aged %K Aged, 80 and over %K Aging %K Cross-Sectional Studies %K Female %K Focus Groups %K Humans %K Loneliness %K Male %K Marital Status %K Motor Activity %K Qualitative Research %K Quality of Life %K Residence Characteristics %K Sex Factors %K Social Environment %K social isolation %K Socioeconomic factors %XBACKGROUND: Older persons are particularly vulnerable to loneliness because of common age-related changes and losses. This paper reviews predictors of loneliness in the older population as described in the current literature and a small qualitative study.
METHODS: Peer-reviewed journal articles were identified from psycINFO, MEDLINE, and Google Scholar from 2000-2012. Overall, 38 articles were reviewed. Two focus groups were conducted asking older participants about the causes of loneliness.
RESULTS: Variables significantly associated with loneliness in older adults were: female gender, non-married status, older age, poor income, lower educational level, living alone, low quality of social relationships, poor self-reported health, and poor functional status. Psychological attributes associated with loneliness included poor mental health, low self-efficacy beliefs, negative life events, and cognitive deficits. These associations were mainly studied in cross-sectional studies. In the focus groups, participants mentioned environmental barriers, unsafe neighborhoods, migration patterns, inaccessible housing, and inadequate resources for socializing. Other issues raised in the focus groups were the relationship between loneliness and boredom and inactivity, the role of recent losses of family and friends, as well as mental health issues, such as shame and fear.
CONCLUSIONS: Future quantitative studies are needed to examine the impact of physical and social environments on loneliness in this population. It is important to better map the multiple factors and ways by which they impact loneliness to develop better solutions for public policy, city, and environmental planning, and individually based interventions. This effort should be viewed as a public health priority.
%B Int Psychogeriatr %V 28 %P 557-76 %8 2016 Apr %G eng %U http://www.journals.cambridge.org/abstract_S1041610215001532 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/26424033?dopt=Abstract %! Int. Psychogeriatr. %R 10.1017/S1041610215001532 %0 Journal Article %J International Journal of Epidemiology %D 2016 %T Data Resource Profile: Cross-national and cross-study sociodemographic and health-related harmonized domains from SAGE plus ELSA, HRS and SHARE (SAGE+, Wave 1) %A Minicuci, Nadia %A Naidoo, Nirmala %A Chatterji, Somnath %A Kowal, Paul %K Cross-National %K ELSA %K Older Adults %K SAGE %K SHARE %X Four longitudinal studies were included in this rigorous harmonization process: the Study on global AGEing and adult health (SAGE); English Longitudinal Study on Ageing (ELSA); US Health and Retirement Study (HRS); and Survey of Health, Ageing and Retirement in Europe (SHARE). An ex-post harmonized process was applied to nine health-related thematic domains (socio-demographic and economic, health states, overall self-report of health and mental state, health examinations, physical and mental performance tests, risk factors, chronic conditions, social network and subjective well-being) for data from the 2004 wave of each study. Large samples of adults aged 50 years and older were available from each study: SAGE, n = 18 886; ELSA, n = 9181; HRS, n = 19 303; and SHARE, n = 29 917. The microdata, along with further details about the harmonization process and all metadata, are available through the World Health Organization (WHO) data archive at [http://apps.who.int/healthinfo/systems/surveydata/index.php/catalog]. Further information and enquiries can be made to [sagesurvey@who.int] or the corresponding author. The data resource will continue to be updated with data across additional waves of these surveys and new waves. %B International Journal of Epidemiology %V 45 %P 1403 - 1403j %8 Aug-10-2016 %G eng %U http://ije.oxfordjournals.org/lookup/doi/10.1093/ije/dyw181 %N 5 %! Int. J. Epidemiol. %R 10.1093/ije/dyw181 %0 Journal Article %J Alzheimer Dis Assoc Disord %D 2016 %T Diabetic Phenotypes and Late-Life Dementia Risk: A Mechanism-specific Mendelian Randomization Study. %A Stefan Walter %A Jessica R Marden %A Laura D Kubzansky %A Elizabeth R Mayeda %A Paul K Crane %A Chang, Shun-Chiao %A Marilyn C Cornelis %A David Rehkopf %A Mukherjee, Shubhabrata %A M. Maria Glymour %K Alzheimer disease %K Diabetes Mellitus, Type 2 %K Genetic Predisposition to Disease %K Humans %K Insulin %K Mendelian Randomization Analysis %K Phenotype %K Polymorphism, Single Nucleotide %K Risk Factors %XBACKGROUND: Mendelian Randomization (MR) studies have reported that type 2 diabetes (T2D) was not associated with Alzheimer disease (AD). We adopted a modified, mechanism-specific MR design to explore this surprising result.
METHODS: Using inverse-variance weighted MR analysis, we evaluated the association between T2D and AD using data from 39 single nucleotide polymorphisms (SNPs) significantly associated with T2D in DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) and the corresponding associations of each SNP with AD risk obtained from the International Genomics of Alzheimer's Project (IGAP, n=17,008 AD cases and n=37,154 controls). We evaluated mechanism-specific genetic subscores, including β-cell function, insulin sensitivity, and adiposity, and repeated analyses in 8501 Health and Retirement Study participants for replication and model validation.
RESULTS: In IGAP, the overall T2D polygenic score did not predict AD [odds ratio (OR) for the T2D polygenic score=1.01; 95% confidence interval (CI), 0.96, 1.06] but the insulin sensitivity polygenic score predicted higher AD risk (OR=1.17; 95% CI, 1.02, 1.34). In the Health and Retirement Study, polygenic scores were associated with T2D risk; the associations between insulin sensitivity genetic polygenic score and cognitive phenotypes were not statistically significant.
CONCLUSIONS: Evidence from polygenic scores suggests that insulin sensitivity specifically may affect AD risk, more than T2D overall.
%B Alzheimer Dis Assoc Disord %I 30 %V 30 %P 15-20 %8 2016 Jan-Mar %G eng %U http://europepmc.org/abstract/MED/26650880 %N 1 %M 00002093-201601000-00003 %1 http://www.ncbi.nlm.nih.gov/pubmed/26650880?dopt=Abstract %R 10.1097/WAD.0000000000000128 %0 Journal Article %J Inquiry %D 2016 %T Differences Among Older Adults in the Types of Dental Services Used in the United States. %A Richard J. Manski %A Jody Schimmel Hyde %A Haiyan Chen %A John F Moeller %K Aged %K Dental Care %K Female %K Humans %K Insurance, Dental %K Male %K Middle Aged %K Surveys and Questionnaires %K United States %XThe purpose of this article is to explore differences in the socioeconomic, demographic characteristics of older adults in the United States with respect to their use of different types of dental care services. The 2008 Health and Retirement Study (HRS) collected information about patterns of dental care use and oral health from individuals aged 55 years and older in the United States. We analyze these data and explore patterns of service use by key characteristics before modeling the relationship between service use type and those characteristics. The most commonly used service category was fillings, inlays, or bonding, reported by 43.6% of those with any utilization. Just over one third of those with any utilization reported a visit for a crown, implant, or prosthesis, and one quarter reported a gum treatment or tooth extraction. The strongest consistent predictors of use type are denture, dentate, and oral health status along with dental insurance coverage and wealth. Our results provide insights into the need for public policies to address inequalities in access to dental services among an older US population. Our findings show that lower income, less wealthy elderly with poor oral health are more likely to not use any dental services rather than using only preventive dental care, and that cost prevents most non-users who say they need dental care from going to the dentist. These results suggest a serious access problem and one that ultimately produces even worse oral health and expensive major procedures for this population in the future.
%B Inquiry %V 53 %8 2016 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27284127 %1 http://www.ncbi.nlm.nih.gov/pubmed/27284127?dopt=Abstract %R 10.1177/0046958016652523 %0 Book Section %B Social Security Programs and Retirement Around the World: Disability INsurance Programs and Retirement %D 2016 %T Disability Insurance Incentives and the Retirement Decision: Evidence from the United States %A Courtney Coile %E David A Wise %K Employment and Labor Force %K Insurance %K Older Adults %K Public Policy %K Retirement Planning and Satisfaction %X Public programs that benefit older individuals, such as Social Security and Medicare, may be changed in the future in ways that reflect an expectation of longer work lives. But do older Americans have the health capacity to work longer? This paper explores this question by asking how much older individuals could work if they worked as much as those with the same mortality rate in the past or as much as their younger counterparts in similar health. Using both methods, we estimate that there is significant additional capacity to work at older ages. We also explore whether there are differences in health capacity across education groups and whether health has improved more over time for the highly educated, using education quartiles to surmount the challenge of changing levels of education over time. %B Social Security Programs and Retirement Around the World: Disability INsurance Programs and Retirement %I Chicago University Press %C Chicago %P 45-80 %G eng %! Disability Insurance Incentives and the Retirement Decision: Evidence from the United States %0 Journal Article %J Int Dent J %D 2016 %T Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA. %A Richard J. Manski %A John F Moeller %A Haiyan Chen %A Widstrom, Eeva %A Listl, Stefan %K Aged %K Aged, 80 and over %K Demography %K Dental Care %K Europe %K Female %K Humans %K Insurance Coverage %K Interviews as Topic %K Male %K Middle Aged %K Oral Health %K Patient Acceptance of Health Care %K United States %XBACKGROUND: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries.
METHOD: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents≥51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use.
RESULTS: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance.
CONCLUSIONS: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.
%B Int Dent J %I 66 %V 66 %P 36-48 %8 2016 Feb %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/idj.12190/epdf %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26465093?dopt=Abstract %2 PMC4728006 %R 10.1111/idj.12190 %0 Journal Article %J Gerontologist %D 2016 %T Do Higher Levels of Resilience Buffer the Deleterious Impact of Chronic Illness on Disability in Later Life? %A Lydia K Manning %A Dawn C Carr %A Ben Lennox Kail %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Chronic disease %K Disability Evaluation %K Disabled Persons %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Resilience, Psychological %K Retirement %K Surveys and Questionnaires %XPURPOSE OF THE STUDY: In examining the ability of resilience, or the ability to navigate adversity in a manner that protects well-being, to buffer the impact of chronic disease onset on disability in later life, the authors tested 2 hypotheses: (a) People with greater levels of resilience will have lower levels of disability and (b) resilience will moderate the association between the onset of a new chronic condition and subsequent disability.
DESIGN AND METHODS: This study used a sample of 10,753 Americans between the ages of 51 and 98, derived from 3 waves of the Health and Retirement Study (2006-2010). Ordinary least squares regression was used to estimate the impact of resilience on changes in disability (measured as difficulty with activities of daily living [ADLs] and instrumental activities of daily living [IADLs]) over a 2-year period using a simplified resilience score.
RESULTS: Resilience protects against increases in ADL and IADL limitations that are often associated with aging. Resilience mitigates a considerable amount of the deleterious consequences related to the onset of chronic illness and subsequent disability.
IMPLICATIONS: Our results support our hypotheses and are consistent with claims that high levels of resilience can protect against the negative impact of disability in later life.
%B Gerontologist %V 56 %P 514-24 %8 2016 06 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/25063353 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25063353?dopt=Abstract %R 10.1093/geront/gnu068 %0 Report %D 2016 %T Do Households Save More When the Kids Leave Home? %A Alicia H. Munnell %A Irena Dushi %A Geoffrey T. Sanzenbacher %A Anthony Webb %A Anqi Chen %K 401(k) %K Family %K Family Characteristics %X Kids are expensive. As a result, when children become financially independent, parents often have a substantial amount of extra money on hand. In this case, they have two basic choices: spend more on themselves or increase their saving for retirement. What they actually do is an open question. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/briefs/do-households-save-more-when-the-kids-leave-home/ %0 Journal Article %J The Gerontologist %D 2016 %T Does Dementia Caregiving Accelerate Frailty? Findings From the Health and Retirement Study %A Kara B. Dassel %A Dawn C Carr %K Adult children %K End of life decisions %K Health Conditions and Status %K Healthcare %K Public Policy %X Purpose of the Study: Numerous studies have discovered negative health consequences associated with spousal caregiving at the end of life; however, little is known about how care-recipient cognitive status impacts caregiver health outcomes, specifically in the area of frailty, and whether health consequences remain over time. This study examines differences in frailty between spousal caregivers of persons with and without a dementia diagnosis. Design and Methods: Using 7 biannual waves of the Health and Retirement Study data (1998 2010), we examined odds of becoming frailer among surviving spouses of individuals who died between 2000 and 2010 (N = 1,246) with and without dementia. To assess increased frailty, we used a Frailty Index, which assesses chronic diseases, mobility, functional status, depressive symptoms, and subjective health. Logistic regression was used to examine the relationship between care-recipient cognitive status and whether, compared with the wave prior to death of the care-recipient, spousal caregivers were frailer: (1) in the wave the death was reported and (2) 2 years after the death was reported.Results: Dementia caregivers had 40.5 higher odds of experiencing increased frailty by the time the death was reported and 90 higher odds in the following wave compared with non-dementia caregivers.Implications: Given our findings, we discuss public health implications regarding the health and well-being of caregivers of persons with dementia. Given projected increases in dementia diagnoses as the population ages, we propose a need for interventions that provide enhanced support for dementia caregivers. %B The Gerontologist %V 56 %P 444-450 %G eng %U http://gerontologist.oxfordjournals.org/content/early/2014/08/25/geront.gnu078.abstract %N 3 %4 Dementia/Decline/cognition/spousal caregiving/Frail Elderly/Public Health/caregiver burden %$ 999999 %& 444 %R 10.1093/geront/gnu078 %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 Report %D 2016 %T Does Socioeconomic Status Lead People to Retire Too Soon? %A Alicia H. Munnell %A Anthony Webb %A Anqi Chen %K Retirement %K socioeconomic status %X Working longer is a powerful lever to enhance retirement security. Individuals, on average, are healthier, live longer, and face less physically demanding jobs, so they should be able to extend the number of years worked. But averages are misleading when differences in health, job prospects, and life expectancy have widened between individuals with low and high socioeconomic status (SES). Thus, a single prescription for all no longer seems appropriate. Rather, it is important to know: 1) how long individuals in different SES groups have to work to maintain their preretirement standard of living; 2) how long they plan to work; and 3) what explains any gap between the two. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/briefs/does-socioeconomic-status-lead-people-to-retire-too-soon/ %0 Report %D 2016 %T Does the Option of Continued Work Later in Life Result in a More Optimistic View of Retirement? %A Kevin E. Cahill %A Smeaton, Deborah %A Principi, Andrea %A Socci, Marco %A Santini, Sara %K Bridge employment %K Optimism %K Retirement Planning and Satisfaction %X This paper explores the link between work options and individuals’ views about retirement and overall well-being. Data for this paper come from 133 qualitative interviews of older individuals in the United States, United Kingdom, and Italy that were conducted in 2014 and from the Health and Retirement Study (HRS). Results from the qualitative interviews reveal that respondents in the US, relative to those in the UK and Italy, reported both a higher frequency of expecting to work in retirement and a more positive outlook for their retirement years. An examination of interview transcripts suggested a bifurcation among those who planned to work in retirement between: 1) those who viewed work as a contingency plan, for whom the outlook was generally positive; and 2) those who viewed work as a necessity for financial reasons, for whom the outlook was generally negative. This explanation was partly supported using data from the HRS. In both a descriptive and multivariate context, career wage-and-salary male respondents who reported some chance of working past age 65 had better retirement experiences and better mental health outcomes compared with those who expected to work past age 65 with certainty, while among women differences were not statistically significant. The findings from this paper suggest that optimism about retirement is related to the optionality of work in the years ahead. %B Work Retirement and Wellbeing Working Paper %8 05/2016 %G eng %U https://scholar.google.com/scholar_url?url=http://workandretirement.uk/wp-content/uploads/2017/06/Cahill-et-al-Optionality-of-Work-in-Retirement-working-paper-8.docx&hl=en&sa=X&scisig=AAGBfm0CmMKDSLAvhfZvJhg6KbUDVh0ohg&nossl=1&oi=scholaralrt %0 Conference Paper %B AcademyHealth Annual Research Meeting %D 2016 %T The effect of individual decision-making abilities on long-term care insurance purchase %A Brian E McGarry %A Temkin-Greener, Helena %A David C Grabowski %A Chapman, Benjamin P %A Yun Li %K Decision making %K Long-term Care %K Restricted data %B AcademyHealth Annual Research Meeting %C Boston, MA %G eng %0 Journal Article %J Labour Economics %D 2016 %T The effect of job loss on health: Evidence from biomarkers %A Pierre-Carl Michaud %A Eileen M. Crimmins %A Michael D Hurd %K Biomarkers %K Health Shocks %K Job loss %K Older Adults %K Retirement Planning and Satisfaction %X We estimate the effect of job loss on objective measures of physiological dysregulation using biomarker measures collected by the Health and Retirement Study in 2006 and 2008 and longitudinal self-reports of work status. We distinguish between group or individual layoffs, and business closures. Workers who are laid off from their job have lower health as measured by biomarker, whereas workers laid off in the context of a business closure do not. Estimates matching respondents wave-by-wave on self-reported health conditions and subjective job loss expectations prior to job loss, suggest strong effects of layoffs on biomarkers, in particular for glycosylated hemoglobin (HbA1c). A layoff could increase annual mortality rates by 10.3%, consistent with other evidence of the effect of group layoffs on mortality. %B Labour Economics %V 41 %P 194 - 203 %8 Jan-08-2016 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0927537116300288http://api.elsevier.com/content/article/PII:S0927537116300288?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0927537116300288?httpAccept=text/plain %! Labour Economics %R 10.1016/j.labeco.2016.05.014 %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 %XDepending 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 Curr Gerontol Geriatr Res %D 2016 %T Elder Orphans Hiding in Plain Sight: A Growing Vulnerable Population. %A Maria T. Carney %A Fujiwara, Janice %A Brian E. Emmert %A Tara A Liberman %A Paris, Barbara %XAdults are increasingly aging alone with multiple chronic diseases and are geographically distant from family or friends. It is challenging for clinicians to identify these individuals, often struggling with managing the growing difficulties and the complexities involved in delivering care to this population. Clinicians often may not recognize or know how to address the needs that these patients have in managing their own health. While many such patients function well at baseline, the slightest insult can initiate a cascade of avoidable negative events. We have resurrected the term to describe individuals living alone with little to no support system. Using public data sets, including the US Census and University of Michigan's Health and Retirement Study, we estimated the prevalence of adults 65 years and older to be around 22%. Thus, in this paper, we strive to describe and quantify this growing vulnerable population and offer practical approaches to identify and develop care plans that are consistent with each person's goals of care. The complex medical and psychosocial issues for elder orphans significantly impact the individual person, communities, and health-care expenditures. We hope to encourage professionals across disciplines to work cooperatively to screen elders and implement policies to prevent from hiding in plain sight.
%B Curr Gerontol Geriatr Res %V 2016 %P 4723250 %8 2016 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097795/ %1 http://www.ncbi.nlm.nih.gov/pubmed/27843450?dopt=Abstract %! Current Gerontology and Geriatrics Research %R 10.1155/2016/4723250 %0 Journal Article %J Journal of Survey Statistics and Methodology %D 2016 %T Estimation of Mode Effects in the Health and Retirement Study Using Measurement Models %A Cernat, Alexandru %A Mick P. Couper %A Mary Beth Ofstedal %K Meta-analyses %K Mixed models %K Mode effects %K Survey Methodology %X Using multiple modes to collect data is becoming a standard practice in surveys. While this should lower costs and reduce nonresponse error, it may have detrimental effects on measurement quality. This is of special concern in panel surveys where a key focus is on measuring change over time and where changing modes may have an effect on key measures. In this paper, we use a quasi-experimental design from the Health and Retirement Study to compare the measurement quality of two scales between face-to-face, telephone, and Web modes. Panel members were randomly assigned to receive a telephone survey or enhanced face-to-face survey in the 2010 core wave, while this was reversed in the 2012 core wave. In 2011, panelists with Internet access completed a Web survey containing selected questions from the core waves. We examine the responses from 3,251 respondents who participated in all three waves, using latent variable models to identify measurement mode effects. The two scales, depression and physical activity, show systematic differences between interviewer-administered modes (i.e., face-to-face and telephone) and the self-administered one (i.e., Web). Possible explanations are discussed. %B Journal of Survey Statistics and Methodology %V 4 %P 501 - 524 %8 May-12-2018 %G eng %U https://academic.oup.com/jssam/article-lookup/doi/10.1093/jssam/smw021https://academic.oup.com/jssam/article/2670256/Estimation-of-Mode-Effects-in-the-Health-and %N 4 %! J Surv Stat Methodol %R 10.1093/jssam/smw021 %0 Journal Article %J Ageing Soc %D 2016 %T Female disability disadvantage: a global perspective on sex differences in physical function and disability. %A Felicia V Wheaton %A Eileen M. Crimmins %XThe objectives were to determine whether women always fare more poorly in terms of physical function and disability across countries that vary widely in terms of their level of development, epidemiologic context and level of gender equality. Sex differences in self-reported and objective measures of disability and physical function were compared among older adults aged 55-85 in the United States of America, Taiwan, Korea, Mexico, China, Indonesia and among the Tsimane of Bolivia using population-based studies collected between 2001 and 2011. Data were analysed using logistic and ordinary least-squares regression. Confidence intervals were examined to see whether the effect of being female differed significantly between countries. In all countries, women had consistently worse physical functioning (both self-reported and objectively measured). Women also tended to report more difficulty with activities of daily living (ADL), although differences were not always significant. In general, sex differences across measures were less pronounced in China. In Korea, women had significantly lower grip strength, but sex differences in ADL difficulty were non-significant or even reversed. Education and marital status helped explain sex differences. Overall, there was striking similarity in the magnitude and direction of sex differences across countries despite considerable differences in context, although modest variations in the effect of sex were observed.
%B Ageing Soc %V 36 %P 1136-1156 %8 2016 Jul %G eng %U http://www.journals.cambridge.org/abstract_S0144686X15000227 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27453613?dopt=Abstract %! Ageing and Society %R 10.1017/S0144686X15000227 %0 Journal Article %J Am J Obstet Gynecol %D 2016 %T Functional status in older women diagnosed with pelvic organ prolapse. %A Tatiana V D Sanses %A Nicholas K Schiltz %A Bruna M. Couri %A Sangeeta T Mahajan %A Holly E Richter %A David F Warner %A Jack M. Guralnik %A Siran M Koroukian %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Cross-Sectional Studies %K Female %K Health Status %K Health Surveys %K Humans %K Medicare %K Middle Aged %K Mobility Limitation %K Muscle Strength %K Pelvic Organ Prolapse %K United States %K Upper Extremity %XBACKGROUND: Functional status plays an important role in the comprehensive characterization of older adults. Functional limitations are associated with an increased risk of adverse treatment outcomes, but there are limited data on the prevalence of functional limitations in older women with pelvic floor disorders.
OBJECTIVE: The aim of the study was to describe the prevalence of functional limitations based on health status in older women with pelvic organ prolapse (POP).
STUDY DESIGN: This pooled, cross-sectional study utilized data from the linked Health and Retirement Study and Medicare files from 1992 through 2008. The analysis included 890 women age ≥65 years with POP. We assessed self-reported functional status, categorized in strength, upper and lower body mobility, activities of daily living (ADL), and instrumental ADL (IADL) domains. Functional limitations were evaluated and stratified by respondents self-reported general health status. Descriptive statistics were used to compare categorical and continuous variables, and logistic regression was used to measure differences in the odds of functional limitation by increasing age.
RESULTS: The prevalence of functional limitations was 76.2% in strength, 44.9% in upper and 65.8% in lower body mobility, 4.5% in ADL, and 13.6% in IADL. Limitations were more prevalent in women with poor or fair health status than in women with good health status, including 91.5% vs 69.9% in strength, 72.9% vs 33.5% in upper and 88.0% vs 56.8% in lower body mobility, 11.6% vs 0.9% in ADL, and 30.6% vs 6.7% in IADL; all P < .01. The odds of all functional limitations also increased significantly with advancing age.
CONCLUSION: Functional limitations, especially in strength and body mobility domains, are highly prevalent in older women with POP, particularly in those with poor or fair self-reported health status. Future research is necessary to evaluate if functional status affects clinical outcomes in pelvic reconstructive and gynecologic surgery and whether it should be routinely assessed in clinical decision-making when treating older women with POP.
%B Am J Obstet Gynecol %I 214 %V 214 %P 613.e1-7 %8 2016 May %G eng %U http://www.sciencedirect.com/science/article/pii/S0002937815024783 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26704893?dopt=Abstract %2 PMC4851569 %4 activities of daily living/functional status/limitations/mobility/pelvic organ prolapse/strength %$ 999999 %R 10.1016/j.ajog.2015.11.038 %0 Journal Article %J Journal of Aging and Health %D 2016 %T Gender Differences in Trajectories of Physical Activity Among Older Americans With Diabetes %A Sara J McLaughlin %A Cathleen M. Connell %A Mary R Janevic %K Demographics %K Health Conditions and Status %K Methodology %X Objective: The primary objective of this study was to examine gender differences in engagement in physical activity over time among older U.S. adults with diabetes. Method: Using data from the Health and Retirement Study, we investigated physical activity between 2004 and 2010 among 1,857 adults aged 65 years and above with diabetes. Results: Less than half of adults were physically active at baseline. The probability of physical activity declined over the 6-year period, with no significant gender variation in the effect of time. Because the odds of physical activity were lower for women at baseline and the effect of time did not vary by gender, the trajectory of physical activity was less favorable for women than men. Discussion: The women in this cohort of older Americans started and remained less active than their male counterparts. Investigations covering a larger portion of the life course and those examining the impact of life events and transitions on physical activity among adults with diabetes are needed. %B Journal of Aging and Health %I 28 %V 28 %P 460-480 %G eng %U http://jah.sagepub.com/content/early/2015/07/14/0898264315594136.abstract %N 3 %4 diabetes/gender/health behavior/longitudinal/physical activity/trajectories %$ 999999 %R 10.1177/0898264315594136 %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 %XReduced 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 J Gerontol A Biol Sci Med Sci %D 2016 %T A Genetic Network Associated With Stress Resistance, Longevity, and Cancer in Humans. %A Morgan E. Levine %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Aging %K Alleles %K Case-Control Studies %K Gene Regulatory Networks %K Genome-Wide Association Study %K Genotype %K Humans %K Longevity %K Longitudinal Studies %K Middle Aged %K Neoplasms %K Phenotype %K Polymorphism, Single Nucleotide %K Smoking %K Stress, Physiological %K United States %XHuman longevity and diseases are likely influenced by multiple interacting genes within a few biologically conserved pathways. Using long-lived smokers as a phenotype (n = 90)-a group whose survival may signify innate resilience-we conducted a genome-wide association study comparing them to smokers at ages 52-69 (n = 730). These results were used to conduct a functional interaction network and pathway analysis, to identify single nucleotide polymorphisms that collectively related to smokers' longevity. We identified a set of 215 single nucleotide polymorphisms (all of which had p <5×10(-3) in the genome-wide association study) that were located within genes making-up a functional interaction network. These single nucleotide polymorphisms were then used to create a weighted polygenic risk score that, using an independent validation sample of nonsmokers (N = 6,447), was found to be significantly associated with a 22% increase in the likelihood of being aged 90-99 (n = 253) and an over threefold increase in the likelihood of being a centenarian (n = 4), compared with being at ages 52-79 (n = 4,900). Additionally, the polygenic risk score was also associated with an 11% reduction in cancer prevalence over up to 18 years (odds ratio: 0.89, p = .011). Overall, using a unique phenotype and incorporating prior knowledge of biological networks, this study identified a set of single nucleotide polymorphisms that together appear to be important for human aging, stress resistance, cancer, and longevity.
%B J Gerontol A Biol Sci Med Sci %V 71 %P 703-12 %8 2016 06 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26355015?dopt=Abstract %R 10.1093/gerona/glv141 %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 %XVery 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 Commun %D 2016 %T Genetic variants near MLST8 and DHX57 affect the epigenetic age of the cerebellum. %A Lu, Ake T %A Hannon, Eilis %A Morgan E. Levine %A Hao, Ke %A Eileen M. Crimmins %A Lunnon, Katie %A Kozlenkov, Alexey %A Mill, Jonathan %A Dracheva, Stella %A Horvath, Steve %K Adaptor Proteins, Signal Transducing %K Aging %K Cell Line %K Cerebellum %K Epigenesis, Genetic %K Gene Expression Regulation %K Genetic Variation %K Genome-Wide Association Study %K Humans %K Linkage Disequilibrium %K mTOR Associated Protein, LST8 Homolog %XDNA methylation (DNAm) levels lend themselves for defining an epigenetic biomarker of aging known as the 'epigenetic clock'. Our genome-wide association study (GWAS) of cerebellar epigenetic age acceleration identifies five significant (P<5.0 × 10(-8)) SNPs in two loci: 2p22.1 (inside gene DHX57) and 16p13.3 near gene MLST8 (a subunit of mTOR complex 1 and 2). We find that the SNP in 16p13.3 has a cis-acting effect on the expression levels of MLST8 (P=6.9 × 10(-18)) in most brain regions. In cerebellar samples, the SNP in 2p22.1 has a cis-effect on DHX57 (P=4.4 × 10(-5)). Gene sets found by our GWAS analysis of cerebellar age acceleration exhibit significant overlap with those of Alzheimer's disease (P=4.4 × 10(-15)), age-related macular degeneration (P=6.4 × 10(-6)), and Parkinson's disease (P=2.6 × 10(-4)). Overall, our results demonstrate the utility of a new paradigm for understanding aging and age-related diseases: it will be fruitful to use epigenetic tissue age as endophenotype in GWAS.
%B Nat Commun %V 7 %P 10561 %8 2016 Feb 02 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/26830004?dopt=Abstract %R 10.1038/ncomms10561 %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 %XThe 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 %XBACKGROUND: 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 %XEducational 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 Biodemography and Social Biology %D 2016 %T The Geographic Distribution of Genetic Risk as Compared to Social Risk for Chronic Diseases in the United States. %A David Rehkopf %A Benjamin W Domingue %A Cullen, Mark R %K Chronic conditions %K Genetics %K Geography %K Social Factors %X There is an association between chronic disease and geography, and there is evidence that the environment plays a critical role in this relationship. Yet at the same time, there is known to be substantial geographic variation by ancestry across the United States. Resulting geographic genetic variation-that is, the extent to which single nucleotide polymorphisms (SNPs) related to chronic disease vary spatially-could thus drive some part of the association between geography and disease. We describe the variation in chronic disease genetic risk by state of birth by taking risk SNPs from genome-wide association study meta-analyses for coronary artery disease, diabetes, and ischemic stroke and creating polygenic risk scores. We compare the amount of variability across state of birth in these polygenic scores to the variability in parental education, own education, earnings, and wealth. Our primary finding is that the polygenic risk scores are only weakly differentially distributed across U.S. states. The magnitude of the differences in geographic distribution is very small in comparison to the distribution of social and economic factors and thus is not likely sufficient to have a meaningful effect on geographic disease differences by U.S. state. %B Biodemography and Social Biology %V 62 %P 126-42 %8 2016 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27050037?dopt=Abstract %R 10.1080/19485565.2016.1141353 %0 Journal Article %J Gerontologist %D 2016 %T A Global View on the Effects of Work on Health in Later Life. %A Ursula M. Staudinger %A Finkelstein, Ruth %A Calvo, Esteban %A Sivaramakrishnan, Kavita %K Aged %K Aging %K Employment %K Humans %K Public Policy %K Retirement %K Socioeconomic factors %XPURPOSE OF THE STUDY: Work is an important environment shaping the aging processes during the adult years. Therefore, the cumulative and acute effects of work characteristics on late-life health deserve great attention. Given that population aging has become a global trend with ensuing changes in labor markets around the world, increased attention is paid to investigating the effects of the timing of retirement around the world and the macroeconomic benefits often associated with delaying retirement. It will be essential for societies with aging populations to maintain productivity given an aging workforce and for individuals it will be crucial to add healthy and meaningful years rather than just years to their lives.
DESIGN AND METHODS: We first describe the available evidence about participation of older workers (65+) in the labor force in high, middle, and low-income countries. Second, we discuss the individual-level and societal influences that might govern labor-force participation of older adults. Thirdly, we review evidence on the association between work on the one and physical, mental, and cognitive health in later life on the other.
RESULTS AND IMPLICATIONS: Globally, both is true: work supports healthy aging and jeopordizes it. We draw implications for policymaking in terms of social protection, HR policies, and older employee employability.
%B Gerontologist %V 56 Suppl 2 %P S281-92 %8 2016 Apr %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/26994267 %1 http://www.ncbi.nlm.nih.gov/pubmed/26994267?dopt=Abstract %4 Work Late-life work Retirement Aging Labor markets %R 10.1093/geront/gnw032 %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 %XDecline 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 Survey Research Methods %D 2016 %T Helping Respondents Provide Good Answers in Web Surveys %A Mick P. Couper %A Zhang, Chan %K Methodology %X This paper reports on a series of experiments to explore ways to use the technology of Web surveys to help respondents provide well-formed answers to questions that may be difficult to answer. Specifically, we focus on the use of drop-down or select lists and JavaScript lookup tables as alternatives to open text fields for the collection of information on prescription drugs. The first two experiments were conducted among members of opt-in panels in the U.S. The third experiment was conducted in the 2013 Health and Retirement Study Internet Survey. Respondents in each of the studies were randomly assigned to one of three input methods: text field, drop box, or JavaScript lookup, and asked to provide the names of prescription drugs they were taking. We compare both the quality of answers obtained using the three methods, and the effort (time) taken to provide such answers. We examine differences in performance on the three input format types by key respondent demographics and Internet experience. We discuss some of the technical challenges of implementing complex question types and offer some recommendations for the use of such tools in Web surveys. %B Survey Research Methods %I 10 %V 10 %G eng %N 1 %4 Web survey/Instrument design/methodology %$ 999999 %R 10.18148/srm/2016.v10i1.6273 %0 Journal Article %J J Pain Symptom Manage %D 2016 %T High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture. %A Christine S Ritchie %A Amy Kelley %A Irena Cenzer %A Margaret Wallhagen %A Kenneth E Covinsky %K Activities of Daily Living %K Aged, 80 and over %K Dementia %K depression %K Female %K Hip Fractures %K Humans %K Interviews as Topic %K Male %K multimorbidity %K pain %K Palliative care %K Patient Acceptance of Health Care %K Prodromal Symptoms %K Vulnerable Populations %XCONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care.
OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture.
METHODS: Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression.
RESULTS: Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls.
CONCLUSIONS: A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.
%B J Pain Symptom Manage %V 52 %P 533-538 %8 2016 10 %G eng %U http://www.sciencedirect.com/science/article/pii/S0885392416302214 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27521282?dopt=Abstract %R 10.1016/j.jpainsymman.2016.07.003 %0 Journal Article %J Health Serv Res %D 2016 %T The Impact of Consumer Numeracy on the Purchase of Long-Term Care Insurance. %A Brian E McGarry %A Temkin-Greener, Helena %A Chapman, Benjamin P %A David C Grabowski %A Li, Yue %K Consumer Behavior %K Financing, Personal %K Health Surveys %K Humans %K Insurance, Long-Term Care %K Middle Aged %XOBJECTIVE: To determine the effect of consumers' numeric abilities on the likelihood of owning private long-term care insurance.
DATA SOURCE: The 2010 wave of the Health and Retirement Study, a nationally representative survey of Americans age 50 and older, was used (n = 12,796).
STUDY DESIGN: Multivariate logistic regression was used to isolate the relationship between numeracy and long-term care insurance ownership.
PRINCIPAL FINDINGS: Each additional question answered correctly on a numeracy scale was associated with a 13 percent increase in the likelihood of holding LTCI, after controlling for predictors of policy demand, education, and cognitive function.
CONCLUSIONS: Poor numeracy may create barriers to long-term care insurance purchase. Policy efforts aimed at increasing consumer decision support or restructuring the marketplace for long-term care insurance may be needed to increase older adults' ability to prepare for future long-term care expenses.
%B Health Serv Res %V 51 %P 1612-31 %8 2016 08 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/26799778 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/26799778?dopt=Abstract %4 Older adults Long-term care Insurance Health insurance %R 10.1111/1475-6773.12439 %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 %XThe 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 Report %D 2016 %T The Impact of Late-Career Job Loss and Genotype on Body Mass Index %A Lauren L Schmitz %A Dalton C Conley %K BMI %K Genome %K Job loss %K Older Adults %X This study examines whether the effect of job loss on body mass index (BMI) at older ages is moderated by genotype using twenty years of socio-demographic and genome-wide data from the Health and Retirement Study (HRS). To avoid any potential confounding we interact layoffs due to a plant or business closure—a plausibly exogenous environmental exposure—with a polygenic risk score for BMI in a regression-adjusted semiparametric differences-in-differences matching framework that compares the BMI of those before and after an involuntary job loss with a control group that has not been laid off. Results indicate genetically-at-risk workers who lost their job before they were eligible for Social Security benefits, or before age 62, were more likely to gain weight. Further analysis reveals heterogeneous treatment effects by demographic, health, and socioeconomic characteristics. In particular, we find high risk individuals who gained weight after a job loss were more likely to be male, in worse health, single, and at the bottom half of the wealth distribution. Across the board, effects are concentrated among high-risk individuals who were not overweight prior to job loss, indicating unemployment at older ages may trigger weight gain in otherwise healthy or normal weight populations. %I National Bureau of Economic Research %C Cambridge, MA %P 1-44 %8 06/2016 %G eng %U http://www.nber.org/papers/w22348.pdf %R 10.3386/w22348 %0 Thesis %B Family Resource Management %D 2016 %T The Influence of Mental Health on Portfolio Choice of Older Households. %A Cheung, Cheuk Hee %K Decision making %K Mental Health %K Older Adults %K Portfolios %X With an aging population, an increasing number of people including the baby boomers are entering their retirement age. The need for appropriate financial planning for the elderly is an important issue as most of them will need to depend on their retirement savings for expenditures in their retirement. The elderly people’s well-being will hinge on how well they manage their personal finances. Yet there are many challenges facing the older population with respect to personal financial management. One of the most important challenges is that many elderly people have mental health conditions which may affect their ability to manage their household portfolios. This study examines the influences of different kinds of mental health conditions including depression, memory problems, sleep problems and psychiatric problems on household portfolio choice. This study specifically examines two potential significant mechanisms by which mental health conditions might affect household portfolio choice, namely direct influence of mental health on portfolio choice and indirect influence of mental health on portfolio choice through affecting cognitive ability. Based on the theoretical background on the relationship among mental health conditions, cognitive ability and portfolio choice, a model concerning these factors is established. Empirical specifications are built based on health and personal financial management literature. Several research hypotheses are developed to test the direct and indirect influences of mental health conditions on household portfolio choice. Panel regression analyses with fixed effects and mediation models are used to test the hypotheses concerning portfolio decisions in older households in various empirical specifications.Using data from the Health and Retirement Study, this study finds that elderly persons suffering from mental health conditions, including memory problems and depression, have significantly lower cognitive ability than those without these conditions. Fixed effects regressions and mediation models show that memory problems and depression are indirectly associated with a decrease in ownership of risky assets mediated by cognitive ability. Sleep problems, however, are indirectly associated with increase in ownership of risky assets mediated by cognitive ability. On the other hand, sleep problems, memory problems, depression and psychiatric problems are not significantly associated with the proportion of risky assets in the investment portfolios of older households.The results of this study have important policy implications in the area of personal financial management of the elderly. This study establishes the possible mechanism by which mental health conditions influence household portfolio choice. Policy makers may wish to suggest laws to protect elderly people suffering from mental health conditions while they make important investment decisions on their portfolios. One example is to make it mandatory for financial institutions to provide the mentally ill with adequate access to certified… Advisors/Committee Members: Yilmazer, Tansel (Advisor). %B Family Resource Management %I The Ohio State University %C Columbus, Ohio %V Ph.D. %G eng %U http://rave.ohiolink.edu/etdc/view?acc_num=osu1460215976 %9 Dissertation %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 OMEGA - Journal of Death and Dying %D 2016 %T Late-Life Bereavement: Association Between Familial Death and Weight Loss Among Elderly in the United States %A Murat Anil Mercan %A Barlin, Hande %A Cebeci, Ali F. %K Bereavement %K BMI %K Death & Dying %K Older Adults %X Healthy aging is critical for the elderly to be independent and enjoy at least a satisfactory quality of life. However, late-life bereavement threatens healthy aging, as it may lead to adverse health effects. Using data from the Health and Retirement Survey, this study investigates the relationship between weight—specifically, body mass index (BMI)—and the loss of a parent, sibling, or spouse at an older age. It is the first attempt to investigate this relationship among the elderly population in the United States and makes the following notable contributions to the literature: (a) use of a large longitudinal dataset, (b) estimation of the effects of a familial death on a person’s BMI, and (c) investigation of the consequences of the bereavement for older people. Our results suggest that losing a family member at an older age results in a decrease in BMI. %B OMEGA - Journal of Death and Dying %P 0030222816649082 %8 Sep-05-2016 %G eng %U http://ome.sagepub.com/lookup/doi/10.1177/0030222816649082 %! Omega (Westport) %R 10.1177/0030222816649082 %0 Journal Article %J Int J Aging Hum Dev %D 2016 %T Life Satisfaction and Psychological Well-Being of Older Adults With Cancer Experience: The Role of Optimism and Volunteering. %A Jinmoo Heo %A Sanghee Chun %A Lee, Sunwoo %A Kim, Junhyoung %K Aged %K Aged, 80 and over %K Aging %K Female %K Humans %K Male %K Middle Aged %K Neoplasms %K Optimism %K Personal Satisfaction %K Volunteers %XPromoting health and well-being among individuals of advancing age is a significant issue due to increased incidence of cancer among older adults. This study demonstrates the benefits of expecting positive outcomes and participating in volunteer activities among older adults with cancer. We used a nationally representative sample of 2,670 individuals who have experienced cancer from the 2008 wave of the Health and Retirement Study. We constructed a structural equation model to explore the associations of optimism, volunteerism, life satisfaction, and psychological well-being. The level of optimism was a significant predictor of volunteerism, which in turn affected life satisfaction and psychological well-being. The level of engagement in volunteer activities was found to have significant path coefficients toward both life satisfaction and psychological well-being. Our study provides evidence that older adults who have experienced cancer and maintained a positive outlook on their lives and engaged in personally meaningful activities tended to experience psychological well-being and life satisfaction.
%B Int J Aging Hum Dev %V 83 %P 274-89 %8 2016 09 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27273518 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/27273518?dopt=Abstract %R 10.1177/0091415016652406 %0 Journal Article %J Int J Aging Hum Dev %D 2016 %T Longitudinal Relationships Between Productive Activities and Functional Health in Later Years: A Multivariate Latent Growth Curve Modeling Approach. %A Choi, Eunhee %A Tang, Fengyan %A Turk, Phillip %K Activities of Daily Living %K Aged %K Aging %K Employment %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Volunteers %XThis study examined the longitudinal relationships between functional health in later years and three types of productive activities: volunteering, full-time, and part-time work. Using the data from five waves (2000-2008) of the Health and Retirement Study, we applied multivariate latent growth curve modeling to examine the longitudinal relationships among individuals 50 or over. Functional health was measured by limitations in activities of daily living. Individuals who volunteered, worked either full time or part time exhibited a slower decline in functional health than nonparticipants. Significant associations were also found between initial functional health and longitudinal changes in productive activity participation. This study provides additional support for the benefits of productive activities later in life; engagement in volunteering and employment are indeed associated with better functional health in middle and old age.
%B Int J Aging Hum Dev %V 83 %P 418-40 %8 2016 10 %G eng %U http://ahd.sagepub.com/content/early/2016/07/21/0091415016657557.long %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27461262?dopt=Abstract %R 10.1177/0091415016657557 %0 Journal Article %J Behav Genet %D 2016 %T The Long-Term Consequences of Vietnam-Era Conscription and Genotype on Smoking Behavior and Health. %A Lauren L Schmitz %A Dalton C Conley %K Adult %K Aged %K Female %K Gene-Environment Interaction %K Genetic Predisposition to Disease %K Genotype %K Humans %K Male %K Middle Aged %K Risk Factors %K Smoking %K Tobacco Use Disorder %K Veterans %K Vietnam Conflict %XResearch is needed to understand the extent to which environmental factors moderate links between genetic risk and the development of smoking behaviors. The Vietnam-era draft lottery offers a unique opportunity to investigate whether genetic susceptibility to smoking is influenced by risky environments in young adulthood. Access to free or reduced-price cigarettes coupled with the stress of military life meant conscripts were exposed to a large, exogenous shock to smoking behavior at a young age. Using data from the Health and Retirement Study (HRS), we interact a genetic risk score for smoking initiation with instrumented veteran status in an instrumental variables (IV) framework to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on smoking behavior and smoking-related morbidities. We find evidence that veterans with a high genetic predisposition for smoking were more likely to have been smokers, smoke heavily, and are at a higher risk of being diagnosed with cancer or hypertension at older ages. Smoking behavior was significantly attenuated for high-risk veterans who attended college after the war, indicating post-service schooling gains from veterans' use of the GI Bill may have reduced tobacco consumption in adulthood.
%B Behav Genet %V 46 %P 43-58 %8 2016 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26341507?dopt=Abstract %R 10.1007/s10519-015-9739-1 %0 Journal Article %J J Health Soc Behav %D 2016 %T Marital Histories and Heavy Alcohol Use among Older Adults. %A Reczek, Corinne %A Tetyana Pudrovska %A Deborah Carr %A Thomeer, Mieke Beth %A Debra Umberson %K Adult %K Age Factors %K Aged %K Alcohol Drinking %K Divorce %K Female %K Humans %K Male %K Marital Status %K Marriage %K Middle Aged %K Models, Psychological %K Socioeconomic factors %XWe develop a gendered marital biography approach-which emphasizes the accumulating gendered experiences of singlehood, marriage, marital dissolution, and remarriage-to examine the relationship between marital statuses and transitions and heavy alcohol use. We test this approach using individual-level (n = 10,457) and couple-level (n = 2,170) longitudinal data from the Health and Retirement Study, and individual-level (n = 46) and couple-level (n = 42) in-depth interview data. Quantitative results show that marriage, including remarriage, reduces men's but increases women's drinking relative to being never married and previously married, whereas divorce increases men's but decrease women's drinking, with some variation by age. Our qualitative findings reveal that social control and convergence processes underlie quantitative results. We call attention to how men's and women's heavy drinking trajectories stop, start, and change direction as individuals move through their distinctive marital biography.
%B J Health Soc Behav %I 57 %V 57 %P 77-96 %8 2016 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26957135?dopt=Abstract %2 PMC4785832 %4 marital status/alcohol use/drinking trajectories/drinking %$ 999999 %R 10.1177/0022146515628028 %0 Journal Article %J The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2016 %T Marital Quality and Health in Middle and Later Adulthood: Dyadic Associations %A Choi, Heejeong %A Yorgason, Jeremy B. %A Johnson, David R. %K Adult children %K Health Conditions and Status %K Methodology %X Objectives. We investigated associations between positive marital quality and health among married persons aged 50 or older and their spouses. Prior research using data from married individuals has yielded inconsistent findings regarding the association between positive marital quality and global health outcomes. The present study involved married couples to examine how spouses positive marital quality affect their own and each other s health, and whether these effects vary by age.Methods. Using data from 3 waves of the Health and Retirement Study (2006, 2008, 2010), we estimated a series of actor partner interdependence models using mixed linear models.Results. Analyses found that over the 4-year period (2006 2010) increases in positive marital quality of both spouses were independently associated with increases in their self-rated health in midlife and old age as well as with declines in disability in old age. Increases in positive marital quality were also linked with declines in functional limitations for middle-aged and older adults.Discussion. Being perceived as a supportive spouse, as well as perceiving one s partner as such, has significant health implications. Overall, positive marital quality of both spouses contributes to health protection for middle-aged and older spouses. %B The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %I 71 %V 71 %P 154-164 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/03/16/geronb.gbu222.abstract %N 1 %4 Actor partner interdependence model/Functional limitations/Marital quality/Perceived support/Self-rated health/Health and Retirement Study %$ 999999 %R 10.1093/geronb/gbu222 %0 Newspaper Article %B Reuters %D 2016 %T Marital status, history linked to survival after stroke %A Crist, Carolyn %B Reuters %8 12/15/2016 %G eng %U http://www.reuters.com/article/us-health-stroke-marriage-idUSKBN1432T2?feedType=RSS&feedName=healthNews&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+reuters%2FhealthNews+(Reuters+Health+News) %0 Thesis %B Community Health Sciences %D 2016 %T Measuring the Impact of Volunteering on Physical Activity Using Data from the Health and Retirement Study %A Clark, Julia R. %K Older Adults %K Volunteerism %X BACKGROUND: This study measures the impact of volunteering type and intensity on different aspects of physical activity including meeting recommended activity guidelines and level of intensity. METHODS: Four waves and eight years of longitudinal data on a nationally representative sample of Americans, 50 and older were used. RESULTS: As predicted, volunteering was associated with increased physical activity with respect to likelihood to meet guidelines and higher intensity of physical activity after adjusting for baseline age, gender, education, self-rated health and comorbidities and physical activity. Volunteers were more likely to meet physical activity guidelines and to maintain a higher likelihood of meeting guidelines than non-volunteers. In addition, volunteers were less likely to exhibit depressive symptoms, report decreases in functional limitation or decreases in self-rated health than those who did not volunteer. Number of hours of volunteering was significantly and positively associated with increased likelihood to meet guidelines. Finally, analyses found that older adults who volunteered with children had lower likelihood of depression and improvements in several psychosocial variables including social network and social support scores compared to older adults who volunteered but did not volunteer with children. CONCLUSIONS: Results suggest that volunteering could be a mechanism to help older adults meet and maintain the meeting of physical activity guidelines over time. Volunteering also appears to be associated with reduction of depressive symptoms, functional limitations and decreases in self-rated health over time. Finally, volunteering with children could act as a buffer to mediate lower social support and reports of negative familial support. The amount of volunteering required to confer maximum health benefits should be further explored. Future studies should also further examine the casual relationship between volunteering and physical activity. %B Community Health Sciences %I University of Illinois at Chicago %C Chicago, Illinois %V Ph.D. %G eng %U http://indigo.uic.edu/handle/10027/21292 %9 Dissertation %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 %XMeta-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 Report %D 2016 %T Mortality Inequality: The Good News from a County-Level Approach %A Currie, Janet %A Schwandt, Hannes %K Childhood adversity %K Life Expectancy %K Mortality %K Socioeconomic factors %X Analysts who have concluded that inequality in life expectancy is increasing have generally focused on life expectancy at age 40 to 50. However, we show that among infants, children, and young adults, mortality has been falling more quickly in poorer areas with the result that inequality in mortality has fallen substantially over time. This is an important result given the growing literature showing that good health in childhood predicts better health in adulthood and suggests that today’s children are likely to face considerably less inequality in mortality as they age than current adults. We also show that there have been stunning declines in mortality rates for African-Americans between 1990 and 2010, especially for black men. The fact that inequality in mortality has been moving in opposite directions for the young and the old, as well as for some segments of the African-American and non-African-American populations argues against a single driver of trends in mortality inequality, such as rising income inequality. Rather, there are likely to be multiple specific causes affecting different segments of the population. %I National Bureau of Economic Research %C Cambridge, MA %P 1-54 %8 04/2016 %G eng %U http://www.nber.org/papers/w22199.pdf %R 10.3386/w22199 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2016 %T Neighborhood Support and Aging-in-Place Preference Among Low-Income Elderly Chinese City-Dwellers. %A Terry Y S Lum %A Vivian W Q Lou %A Chen, Yanyan %A Wong, Gloria %A Luo, Hao %A Tracy Tong %K Aged %K Aged, 80 and over %K Aging %K Asian Continental Ancestry Group %K Female %K Hong Kong %K Humans %K Independent Living %K Interview, Psychological %K Male %K Middle Aged %K Poverty %K Quality of Life %K Residence Characteristics %K Social Support %K Urban Population %XOBJECTIVES: Preferences for aging-in-place are unclear among low-income elderly Chinese city-dwellers, who are more likely to be geographically bound, to have little care support, but possess strong filial values and family cohesiveness. This study investigated the preferences for aging-in-place and its contributing neighborhood factors among low-income Chinese elderly in a metropolitan city.
METHOD: We conducted interviews with 400 older people residing in public housing estates in Hong Kong.
RESULTS: The majority of low-income elderly persons (80.4%) prefer to age in place even if their health and functioning has deteriorated beyond independent living. Logistic regression showed that (a) having very low income ( DISCUSSION: Low-income elderly Chinese city-dwellers prefer to age in place, given appropriate neighborhood support. These findings can be interpreted in light of Lawton's ecological theory of aging and suggest a service model similar to the Naturally Occurring Retirement Community with Supportive Service Programs. OBJECTIVE: To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort. METHODS: Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n = 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n = 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate. RESULTS: For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1% in the VA (p < 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0% in the VA (p < 0.001), and the difference persisted after excluding nontarget conditions. CONCLUSIONS: Overuse of neuroimaging is likely less common in the VA than in a Medicare population. Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing. OBJECTIVES: To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains. DESIGN: Retrospective cohort study. SETTINGS: Health and Retirement Study (HRS). PARTICIPANTS: HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857). MEASUREMENTS: Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism. RESULTS: Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting. CONCLUSION: The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture. Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains. The current study tests the indirect effect of activity-related physical activity, cognitive activity, social interaction, and emotional exchange on the relationship between activity involvement and health (physical and emotional) in later life. Longitudinal data from the Health and Retirement Study (N = 5,442) were used to estimate a series of linear regression models. We found significant indirect effects for social interaction and benefit to others (emotional exchange) on emotional health (depressive symptoms) and indirect effects for use of body and benefit to others (physical) on physical health (frailty). The most potent indirect effect associated with emotional and physical health was experienced by those engaged in all four domains (use of body, use of mind, social interaction, and benefit to others). While effect sizes are small and results should be interpreted with caution, findings shed light on ways in which public health interventions aimed toward increasing role engagement in later life could be improved. 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. Although dual-energy X-ray absorptiometry (DXA) is recommended for all women ≥65 and is covered by Medicare, 40 % of women on Medicare report never having had a DXA. In a longitudinal cohort of 3492 women followed for two decades, we identified several risk factors that should be targeted to improve DXA testing rates. INTRODUCTION: DXA is used to measure bone mineral density, screen for osteoporosis, and assess fracture risk. DXA is recommended for all women ≥65 years old. Although Medicare covers DXA every 24 months for women, about 40 % report never having had a DXA test, and little is known from prospective cohort studies about which subgroups of women have low use rates and should be targeted for interventions. Our objective was to identify predictors of DXA use in a nationally representative cohort of women on Medicare. METHODS: We used baseline and biennial follow-up survey data (1993-2012) for 3492 women ≥70 years old from the nationally representative closed cohort known as the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The survey data for these women were then linked to their Medicare claims (1991-2012), yielding 17,345 person years of observation. DXA tests were identified from the Medicare claims, and Cox proportional hazard regression models were used with both fixed and time-dependent predictors from the survey interviews including demographic characteristics, socioeconomic factors, health status, health habits, and the living environment. RESULTS: DXA use was positively associated with being Hispanic American, better cognition, higher income, having arthritis, using other preventative services, and living in Florida or other southern states. DXA use was negatively associated with age, being African-American, being overweight or obese, having mobility limitations, and smoking. CONCLUSIONS: Interventions to increase DXA use should target the characteristics that were observed here to be negatively associated with such screening. 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. BACKGROUND: Despite growing numbers of older-adult illicit drug users, research on this topic is rare. This study examined the relationship between marijuana and/or other illicit drug use and major depressive episode (MDE) and serious suicidal thoughts among those aged 50+ years in the USA. METHODS: The public use files of the 2008 to 2012 US National Survey on Drug Use and Health (NSDUH) provided data on 29,634 individuals aged 50+ years. Logistic regression analysis was used to test hypothesized associations between past-year marijuana and/or other illicit drug use and MDE and serious suicidal thoughts. RESULTS: Nearly 6% of the 50+ years age group reported past-year marijuana and/or other illicit drug use. Compared to non-users of any illicit drug, the odds of past-year MDE among those who used marijuana only, other illicit drugs only, and marijuana and other illicit drugs were 1.54 (95% CI = 1.17-2.03), 2.75 (95% CI = 1.75-4.33), and 2.12 (95% CI = 1.45-3.09), respectively. Those who used marijuana and other drugs also had higher odds (2.44, 95% CI = 1.58-3.77) of suicidal thoughts than non-users of any illicit drug. However, among users of any illicit drug, no difference was found among users of marijuana only, marijuana and other illicit drugs, and other illicit drugs only. Among marijuana users, marijuana use frequency was a significant correlate of suicidal thoughts only among those with MDE. CONCLUSIONS: Health and mental health (MH) service providers should pay close attention to the potential reciprocal effects of marijuana and other illicit drug use and MDE and suicidal thoughts among late middle-aged and older adults. OBJECTIVES: To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare. DESIGN: Nationally representative cross-sectional study. SETTING: Nationally representative Health and Retirement Study linked to Medicare claims. PARTICIPANTS: Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included. MEASUREMENTS: Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED&C) (least intensive, lowest cost)), according to procedure code. RESULTS: Most KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer. CONCLUSION: A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences. BACKGROUND: Major depressive disorder (MDD) is moderately heritable, however genome-wide association studies (GWAS) for MDD, as well as for related continuous outcomes, have not shown consistent results. Attempts to elucidate the genetic basis of MDD may be hindered by heterogeneity in diagnosis. The Center for Epidemiological Studies Depression (CES-D) scale provides a widely used tool for measuring depressive symptoms clustered in four different domains which can be combined together into a total score but also can be analysed as separate symptom domains. METHOD: We performed a meta-analysis of GWAS of the CES-D symptom clusters. We recruited 12 cohorts with the 20- or 10-item CES-D scale (32 528 persons). RESULTS: One single nucleotide polymorphism (SNP), rs713224, located near the brain-expressed melatonin receptor (MTNR1A) gene, was associated with the somatic complaints domain of depression symptoms, with borderline genome-wide significance (p discovery = 3.82 × 10-8). The SNP was analysed in an additional five cohorts comprising the replication sample (6813 persons). However, the association was not consistent among the replication sample (p discovery+replication = 1.10 × 10-6) with evidence of heterogeneity. CONCLUSIONS: Despite the effort to harmonize the phenotypes across cohorts and participants, our study is still underpowered to detect consistent association for depression, even by means of symptom classification. On the contrary, the SNP-based heritability and co-heritability estimation results suggest that a very minor part of the variation could be captured by GWAS, explaining the reason of sparse findings. OBJECTIVES: The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives. METHOD: Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time. RESULTS: The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations. DISCUSSION: Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health. 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. OBJECTIVES: To measure the incidence of urinary incontinence (UI) over 10 years in older women who did not report UI at baseline in 1998, to estimate the prevalence of female UI according to severity and type, and to explore potential risk factors for development of UI. DESIGN: Secondary analysis of a prospective cohort. SETTING: Health and Retirement Study. PARTICIPANTS: Women participating in the Health and Retirement Study between 1998 and 2008 who did not have UI at baseline (1998). MEASUREMENTS: UI was defined as an answer of "yes" to the question, "During the last 12 months, have you lost any amount of urine beyond your control?" UI was characterized according to severity (according to the Sandvik Severity Index) and type (according to International Continence Society definitions) at each biennial follow-up between 1998 and 2008. RESULTS: In 1998, 5,552 women aged 51 to 74 reported no UI. The cumulative incidence of UI in older women was 37.2% (95% confidence interval (CI)=36.0-38.5%). The most common incontinence type at the first report of leakage was mixed UI (49.1%, 95% CI=46.5-51.7%), and women commonly reported their symptoms at first leakage as moderate to severe (46.4%, 95% CI=43.8-49.0%). CONCLUSION: Development of UI in older women was common and tended to result in mixed type and moderate to severe symptoms. Statistics show that an increase in the statutory retirement age in the UK will mean that many more people will develop a dementia while still in employment. A review of the literature confirmed that there are no existing studies in the UK which examine this issue in any detail. The aim of this study was to investigate the experiences of people who develop a dementia while still in employment and to understand how they make sense of these experiences; therefore a qualitative explorative inquiry based on an Interpretive Phenomenological Analysis methodology was used. Interviews with five people who had developed a dementia while still in employment were carried out, with ages ranging from 58 to 74 years. Interview transcripts were analysed and four super-ordinate themes were identified: the realization that something is wrong; managing the situation in the workplace; trying to make sense of change; and coming to terms with retirement or unemployment. The results showed that people who develop a dementia while still in employment do not always receive the 'reasonable adjustments' in the workplace to which they are entitled under the Equality Act (2010). Some of the participants felt that they were poorly treated by their workplace and described some distressing experiences. The study highlights the need for more effective specialized advice and support regarding employment issues and more research into the numbers of people in the UK that are affected by this issue. AIMS: Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality. METHODS: Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8). RESULTS: Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95% CI: 0.68-0.94); renal failure (OR=0. 82; 95% CI: 0.71-0.95); and death (OR=0.86; 95% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95% CI: 0.45-0.90), renal failure (OR=0.71; 95% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95% CI: 0.11-0.85), and death (OR=0.56, 95% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95% CI: 0.13-0.93). CONCLUSIONS: Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures. We assessed the potential contextual effect of income inequality on health by: 1) comparing individuals with similar socioeconomic status (SES) but who reside in counties with different levels of income inequality; and 2) examining whether the potential effect of county-level income inequality on health varies across SES groups. We used the Health and Retirement Study, a nationally representative study of Americans over the age of 50. Using propensity score matching, we selected SES-comparable individuals living in high-income inequality counties and in low-income inequality counties. We examined differences in self-rated overall health outcomes and in other specific physical/mental health outcomes between the two groups using logistic regression (n = 34,994) and imposing different sample restrictions based on residential duration in the area. We then used logistic regression with interactions to assess whether, and if so how, health outcomes differed among participants of different SES groups defined by wealth, income, and education. In bivariate analyses of the unmatched full sample, adults living in high-income inequality counties have worse health outcomes for most health measures. After propensity score matching, adults in high-income inequality counties had worse self-rated health status (AOR = 1.12; 95% CI 1.04-1.19) and were more likely to report diagnosed psychiatric problems (AOR = 1.08; 95% CI 0.99-1.19) than their matched counterparts in low-income inequality counties. These associations were stronger with longer-term residents in the area. Adverse health outcomes associated with living in high-income inequality counties were significant particularly for individuals in the 30(th) or greater percentiles of income/wealth distribution and those without a college education. In summary, after using more precise matching methods to compare individuals with similar characteristics and addressing measurement error by excluding more recently arrived county residents, adults living in high-income inequality counties had worse reported overall physical and mental health than adults living in low-income inequality counties. 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. BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit. METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was ≥3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (≥65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95% CI 0.98 to 5.67). CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke. Little is known about how optimism differs by age and changes over time, particularly among older adults. Even less is known about how changes in optimism are related to changes in physical health. We examined age differences and longitudinal changes in optimism in 9,790 older adults over a four-year period. We found an inverted U-shaped pattern between optimism and age both cross-sectionally and longitudinally, such that optimism generally increased in older adults before decreasing. Increases in optimism over a four-year period were associated with improvements in self-rated health and fewer chronic illnesses over the same time frame. The findings from the current study are consistent with changes in emotion regulation strategies employed by older adults and age-related changes in well-being. Adverse experiences in early life have the ability to "get under the skin" and affect future health. This study examined the relative influence of adversities during childhood and adulthood in accounting for individual differences in pro-inflammatory gene expression in late life. Using a pilot-sample from the Health and Retirement Study (N = 114) aged from 51 to 95, OLS regression models were run to determine the association between a composite score from three proinflammatory gene expression levels (PTGS2, ILIB, and IL8) and 1) childhood trauma, 2) childhood SES, 3) childhood health, 4) adult traumas, and 5) low SES in adulthood. Our results showed that only childhood trauma was found to be associated with increased inflammatory transcription in late life. Furthermore, examination of interaction effects showed that childhood trauma exacerbated the influence of low SES in adulthood on elevated levels of inflammatory gene expression-signifying that having low SES in adulthood was most damaging for persons who had experienced traumatic events during their childhood. Overall our study suggests that traumas experienced during childhood may alter the stress response, leading to more sensitive reactivity throughout the lifespan. As a result, individuals who experienced greater adversity in early life may be at higher risk of late life health outcomes, particularly if adulthood adversity related to SES persists. BACKGROUND: Cardiovascular disease is often studied through patient self-report and administrative data. However, these 2 sources provide different information, and few studies have compared them. METHODS AND RESULTS: We compared data from a longitudinal, nationally representative survey of older Americans with matched Medicare claims. Self-reported heart attack in the previous 2 years was compared with claims-identified acute myocardial infarction (AMI) and acute coronary syndrome. Among the 3.1% of respondents with self-reported heart attack, 32.8% had claims-identified AMI, 16.5% had non-AMI acute coronary syndrome, and 25.8% had other cardiac claims; 17.3% had no inpatient visits in the previous 2.5 years. Claims-identified AMIs were found in 1.4% of respondents; of these, 67.8% reported a heart attack. Self-reports were less likely among respondents >75 years of age (62.7% versus 74.6%; P=0.006), with less than high school education (61.6% versus 71.4%; P=0.015), with at least 1 limitation in activities of daily living (59.6% versus 74.7%; P=0.001), or below the 25th percentile of a word recall memory test (60.7% versus 71.3%; P=0.019). Both self-reported and claims-identified cardiac events were associated with increased mortality; the highest mortality was observed among those with claims-identified AMI who did not self-report (odds ratio, 2.8; 95% confidence interval, 1.5-5.1) and among those with self-reported heart attack and claims-identified AMI (odds ratio, 2.5; 95% confidence interval, 1.7-3.6) or non-AMI acute coronary syndrome (odds ratio, 2.7; 95% confidence interval, 1.8-4.1). CONCLUSIONS: There is considerable disagreement between self-reported and claims-identified events. Although self-reported heart attack may be inaccurate, it indicates increased risk of death, regardless of whether the self-report is confirmed by Medicare claims. 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. 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. OBJECTIVE: To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans. DATA SOURCES/STUDY SETTING: We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS). STUDY DESIGN: We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured. DATA COLLECTION/EXTRACTION METHODS: The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ). PRINCIPAL FINDINGS: We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older. CONCLUSIONS: Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users. 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. Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79. BACKGROUND: Education has been robustly associated with cognitive reserve and dementia, but not with the rate of cognitive aging, resulting in some confusion about the mechanisms of cognitive aging. This study uses longitudinal data to differentiate between trajectories indicative of healthy versus pathological cognitive aging. METHODS: Participants included 9,401 Health and Retirement Study respondents aged 55 and older who completed cognitive testing regularly over 17.3 years until most recently in 2012. Individual-specific random change-point modeling was used to identify age of incident pathological decline; acceleration is interpreted as indicating likely onset of pathological decline when it is significant and negative. RESULTS: These methods detect incident dementia diagnoses with specificity/sensitivity of 89.3%/44.3%, 5.6 years prior to diagnosis. Each year of education was associated with 0.09 (95% CI, 0.087-0.096; P<0.001) standard deviation higher baseline cognition and delayed onset of cognitive pathology (HR, 0.98; 95% CI, 0.96-0.99; P=0.006). CONCLUSION: Longitudinal random change-point modeling was able to reliably identify incident dementia. Accounting for incident cognitive pathology, we find that education predicts cognitive capability and delayed onset pathological declines. We examined the effects of co-worker and supervisor support on job stress and presenteeism in an aging workforce. Structural equation modelling was used to evaluate data from the 2010 wave of the Health and Retirement Survey in the United States (n = 1649). The level of presenteeism was low and the level of job stress was moderate among aging US workers. SEM revealed that co-worker support and supervisor support were strongly correlated (β = 0.67; p < 0.001). Job stress had a significant direct positive effect on presenteeism (β = 0.30; p < 0.001). Co-worker support had a significant direct negative effect on job stress (β = -0.10; p < 0.001) and presenteeism (β = -0.11; p < 0.001). Supervisor support had a significant direct negative effect on job stress (β = -0.40; p < 0.001) but not presenteeism. The findings suggest that presenteeism is reduced by increased respect and concern for employee stress at the workplace, by necessary support at work from colleagues and employers, and by the presence of comfortable interpersonal relationships among colleagues and between employers and employees. BACKGROUND: A well-known challenge in estimating the mortality risks of obesity is reverse causality attributable to illness-associated and smoking-associated weight loss. Given that the likelihood of chronic and acute illnesses rises with age, reverse causality is most threatening to estimates derived from elderly populations. METHODS: I analyzed data from 12,523 respondents over 50 years old from a nationally representative longitudinal dataset, the Health and Retirement Study (HRS). The effects of both baseline body weight and time-varying weight change on mortality are estimated, adjusting for demographic and socio-economic variables, as well as time-varying confounders including illness and smoking. Body weight is measured by body mass index (BMI). In survival models for mortality, illness and smoking were lagged to minimize bias from reverse causality in estimates of the effect of weight change. Furthermore, because illness both causes and is caused by changes in BMI, I used a marginal structural model (MSM) rather than standard adjustment to control confounding by this and other time-dependent factors. RESULTS: Overall, relative to normal weight, underweight and Class II/III at baseline are associated with hazard ratios that are 2.07 (95% confidence interval (CI): 1.28-3.37) and 1.82 (1.54-2.16) respectively, whereas overweight and Class I obesity do not significantly lower or raise the mortality risks. Furthermore, relative to stable weight change, all types of weight change lead to significantly increased risk of mortality. Specifically, large weight loss results in a mortality risk that is nearly 3.86 (3.26-4.58) times of staying in the stable weight range and small weight loss is about 1.81 (1.55-2.11 ) times riskier. In contrast, large weight gain and small weight gain are associated with hazard ratios that are 1.98 (1.67-2.35) and 1.20 (1.02-1.41) respectively. CONCLUSIONS: Being underweight or severe obese at baseline is associated with excess mortality risk, and weight change tend to raise mortality risk. Both the confounding by illness and by smoking lead to overestimates of the effects of being underweight at baseline and of weight loss, but underestimates the effect of being obese at baseline. OBJECTIVE: To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends. DATA SOURCE: 1996-2010 waves of the Health and Retirement Study. STUDY DESIGN: We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010. PRINCIPAL FINDINGS: Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability. CONCLUSIONS: Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased. 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. 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. 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. 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. OBJECTIVE: To harmonize measures of cognitive performance using item response theory (IRT) across two international aging studies. METHOD: Data for persons ≥65 years from the Health and Retirement Study (HRS, N = 9,471) and the English Longitudinal Study of Aging (ELSA, N = 5,444). Cognitive performance measures varied (HRS fielded 25, ELSA 13); 9 were in common. Measurement precision was examined for IRT scores based on (a) common items, (b) common items adjusted for differential item functioning (DIF), and (c) DIF-adjusted all items. RESULTS: Three common items (day of date, immediate word recall, and delayed word recall) demonstrated DIF by survey. Adding survey-specific items improved precision but mainly for HRS respondents at lower cognitive levels. DISCUSSION: IRT offers a feasible strategy for harmonizing cognitive performance measures across other surveys and for other multi-item constructs of interest in studies of aging. Practical implications depend on sample distribution and the difficulty mix of in-common and survey-specific items. OBJECTIVES: Efforts to prevent activity of daily living (ADL) dependency may be improved through models that assess older adults' dependency risk. We evaluated whether cognition and gait speed measures improve the predictive validity of interview-based models. METHOD: Participants were 8,095 self-respondents in the 2006 Health and Retirement Survey who were aged 65 years or over and independent in five ADLs. Incident ADL dependency was determined from the 2008 interview. Models were developed using random 2/3rd cohorts and validated in the remaining 1/3rd. RESULTS: Compared to a c-statistic of 0.79 in the best interview model, the model including cognitive measures had c-statistics of 0.82 and 0.80 while the best fitting gait speed model had c-statistics of 0.83 and 0.79 in the development and validation cohorts, respectively. CONCLUSION: Two relatively brief models, one that requires an in-person assessment and one that does not, had excellent validity for predicting incident ADL dependency but did not significantly improve the predictive validity of the best fitting interview-based models. OBJECTIVES: To establish the prevalence and correlates of disability during the 2 years before hip fracture. DESIGN: Data from participants who experienced hip fracture in the Health and Retirement Study (HRS) with hip fracture identified using linked Medicare claims. Each participant was interviewed at varying time points in the 2 years before hip fracture. Disability was defined as self-report of the need for assistance in any activity of daily living (walking across the room, eating, bathing, dressing, using the toilet, transferring). Based on the timing between interview and hip fracture, prevalence of disability was calculated in the cohort as a whole over the 2 years before hip fracture and in subgroups defined according to demographic and clinical characteristics. SETTING: The HRS is a nationally representative longitudinal study (1992-2010). PARTICIPANTS: HRS participants aged ≥65 with hip fracture (mean age at fracture 84, 77% female). RESULTS: The adjusted prevalence of disability was 20% (95% confidence interval (CI) = 14-25%) 2 years before hip fracture, with little change until approximately 10 months before fracture, when it started to rise, reaching 44% (95% CI = 33-55%) in the month before hip fracture. The prevalence of disability was highest in the last month before fracture for persons aged 85 and older (53%) and for those with dementia (60%). CONCLUSION: Care models for hip fracture need to consider not only the acute medical and surgical needs, but also the high level of need for supportive care and caregiver assistance that chronically disabled individuals require. 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. The past century was a period of increasing life expectancy throughout the age range. This resulted in more people living to old age and to spending more years at the older ages. It is likely that increases in life expectancy at older ages will continue, but life expectancy at birth is unlikely to reach levels above 95 unless there is a fundamental change in our ability to delay the aging process. We have yet to experience much compression of morbidity as the age of onset of most health problems has not increased markedly. In recent decades, there have been some reductions in the prevalence of physical disability and dementia. At the same time, the prevalence of disease has increased markedly, in large part due to treatment which extends life for those with disease. Compressing morbidity or increasing the relative healthspan will require "delaying aging" or delaying the physiological change that results in disease and disability. While moving to life expectancies above age 95 and compressing morbidity substantially may require significant scientific breakthroughs; significant improvement in health and increases in life expectancy in the United States could be achieved with behavioral, life style, and policy changes that reduce socioeconomic disparities and allow us to reach the levels of health and life expectancy achieved in peer societies. 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. OBJECTIVE: To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis. METHODS: The 1996-2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients ≥65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls. RESULTS: We identified 953 peripheral neuropathy cases and 953 propensity-matched controls. The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32% vs 25%, p = 0.008), 5.0 years for pain (36% vs 27%, p = 0.002), and 5.0 years for good to excellent self-rated health (61% vs 74%, p < 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p = 0.002), but no differences in pain (p = 0.08) or self-rated health (p = 0.9) were observed. CONCLUSIONS: In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patient-oriented outcome. OBJECTIVES: To assess changes in family residential proximity after a first cardiovascular (CV) event among older adults and to identify families most likely to experience such moves. METHOD: Using a nationally representative longitudinal study of older adults in the United States, we identified respondents with no prior diagnosis of CV disease (CVD). We examined subsequent development of stroke, heart attack, and/or heart failure among these older adults and examined changes in their residential proximity to their closest child before and after the CV event. We then compared the likelihood of changes in proximity between families with and without CV events. Finally, we determined which types of families are most likely to relocate following a CV event. RESULTS: Having a first CV event increases the 2-year predicted probability of children and adult parents moving in with and closer to each other (relative risk ratio = 1.61 and 1.55, respectively). Families are especially likely to move after a first CV event if the older person experiencing the event is spouseless or has a daughter. DISCUSSION: CVD is a leading cause of disability, which in turn creates a significant need for personal care among older adults. Assessment of changes in family residential proximity responding to CV events is important to fully understand the consequences of older adults' CV events including the cost of caregiving. OBJECTIVE: To examine whether perceived discrimination based on multiple personal characteristics is associated with physical, emotional, and cognitive health concurrently, prospectively, and with change in health over time among older adults. DESIGN: Longitudinal. SETTING: Health and Retirement Study (HRS). PARTICIPANTS: Participants (N = 7,622) who completed the Leave-Behind Questionnaire as part of the 2006 HRS assessment (mean age 67 years); participants (N = 6,450) completed the same health measures again in 2010. MEASUREMENTS: Participants rated their everyday experience with discrimination and attributed those experiences to eight personal characteristics: race, ancestry, sex, age, weight, physical disability, appearance, and sexual orientation. At both the 2006 and 2010 assessments, participants completed measures of physical health (subjective health, disease burden), emotional health (life satisfaction, loneliness), and cognitive health (memory, mental status). RESULTS: Discrimination based on age, weight, physical disability, and appearance was associated with poor subjective health, greater disease burden, lower life satisfaction, and greater loneliness at both assessments and with declines in health across the four years. Discrimination based on race, ancestry, sex, and sexual orientation was associated with greater loneliness at both time points, but not with change over time. Discrimination was mostly unrelated to cognitive health. CONCLUSIONS: The detrimental effect of discrimination on physical and emotional health is not limited to young adulthood but continues to contribute to health and well-being in old age. These effects were driven primarily by discrimination based on personal characteristics that change over time (e.g., age, weight) rather than discrimination based on more stable characteristics (e.g., race, sex). OBJECTIVES: To identify factors associated with mortality in older adults 30, 180, and 365 days after emergency major abdominal surgery. DESIGN: A retrospective study linked to Medicare claims from 2000 to 2010. SETTING: Health and Retirement Study (HRS). PARTICIPANTS: Medicare beneficiaries aged 65.5 enrolled in the HRS from 2000 to 2010 with at least one urgent or emergency major abdominal surgery and a core interview from the HRS within 3 years before surgery. MEASUREMENTS: Survival analysis was used to describe all-cause mortality 30, 180, and 365 days after surgery. Complementary log-log regression was used to identify participant characteristics and postoperative events associated with poorer survival. RESULTS: Four hundred individuals had one of the urgent or emergency surgeries of interest, 24% of whom were aged 85 and older, 50% had coronary artery disease, 48% had cancer, 33% had congestive heart failure, and 37% experienced a postoperative complication. Postoperative mortality was 20% at 30 days, 31% at 180 days, and 34% at 365 days. Of those aged 85 and older, 50% were dead 1 year after surgery. After multivariate adjustment including postoperative complications, dementia (hazard ratio (HR) = 2.02, 95% confidence interval (CI) = 1.24-3.31), hospitalization within 6 months before surgery (HR = 1.63, 95% CI = 1.12-2.28), and complications (HR = 3.45, 95% CI = 2.32-5.13) were independently associated with worse 1-year survival. CONCLUSION: Overall mortality is high in many older adults up to 1 year after undergoing emergency major abdominal surgery. The occurrence of a complication is the clinical factor most strongly associated with worse survival. OBJECTIVES: The phenomenon of grandparents caring for grandchildren is disproportionately observed among different racial/ethnic groups in the United States. This study examines the influence of childcare provision on older adults' health trajectories in the United States with a particular focus on racial/ethnic differentials. METHOD: Analyzing nationally representative, longitudinal data on grandparents over the age of 50 from the Health and Retirement Study (1998-2010), we conduct growth curve analysis to examine the effect of living arrangements and caregiving intensity on older adults' health trajectories, measured by changing Frailty Index (FI) in race/ethnic subsamples. We use propensity score weighting to address the issue of potential nonrandom selection of grandparents into grandchild care. RESULTS: We find that some amount of caring for grandchildren is associated with a reduction of frailty for older adults, whereas coresidence with grandchildren results in health deterioration. For non-Hispanic black grandparents, living in a skipped generation household appears to be particularly detrimental to health. We also find that Hispanic grandparents fare better than non-Hispanic black grandparents despite a similar level of caregiving and rate of coresidence. Finally, financial and social resources assist in buffering some of the negative effects of coresidence on health (though this effect also differs by race/ethnicity). DISCUSSION: Our findings suggest that the health consequences of grandchild care are mixed across different racial/ethnic groups and are further shaped by individual characteristics as well as perhaps cultural context. OBJECTIVE: We analyze correlates of the direction and magnitude of changes in out-of-pocket (OOP) payments for dental care by older Americans over a recent 4-year period. METHODS: We analyzed data from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of the direction and linear regression models of the amounts of OOP changes over survey periods. RESULTS: Financial-based factors were more strongly associated with the direction and magnitude of changing self-payments for dental care than were health factors. DISCUSSION: Findings suggested that dental coverage, income, and wealth and changes in these financial factors were more strongly correlated with the persistence of and changes in OOP payments for dental care over time than were health status and changes in health status. The sensitivity to dental coverage changes should be considered as insurance and retirement policy reforms are deliberated. OBJECTIVES: Evidence suggests social relationships may be important facilitators for recovery from functional impairment, but the extant literature is limited in its measurement of social relationships including an over emphasis on filial social support and a paucity of nationally representative data. METHODS: Using data from Waves 4-9 (1998-2008) of the Health and Retirement Study (HRS), this research examines the association between social relationships and recovery from severe mobility limitation (i.e., difficulty walking one block or across the room) among older Americans. Using a more nuanced measure of recovery that includes complete and partial recovery, a series of discrete-time event history models with multiple competing recovery outcomes were estimated using multinomial logistic regression. RESULTS: Providing instrumental support to peers increased the odds of complete and partial recovery from severe mobility limitation, net of numerous social, and health factors. Having relatives living nearby decreased the odds of complete recovery, while being engaged in one's neighborhood increased the odds of partial recovery. The influence of partner status on partial and complete recovery varied by gender, whereby partnered men were more likely to experience recovery relative to partnered women. The effect of neighborhood engagement on partial recovery also varied by gender. Disengaged women were the least likely to experience partial recovery compared with any other group. DISCUSSION: The rehabilitative potential of social relationships has important policy implications. Interventions aimed at encouraging older adults with mobility limitation to be engaged in their neighborhoods and/or provide instrumental support to peers may improve functional health outcomes. OBJECTIVES: To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults. METHOD: We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics. RESULTS: Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s. DISCUSSION: Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies. The prevalence of alcohol, drug, and tobacco use among US middle-aged and older adults is increasing. A subset of this population uses substances to cope with stress, but the characteristics of these individuals, and the association between substance-use coping and health outcomes remain unclear. We identified correlates of substance-use coping and measured its association with self-rated health in a community-based sample of adults aged 54-99 in the Health and Retirement Study (HRS). In the 2008 HRS, 1351 participants reported their frequency of prescription/other drug-, alcohol-, and cigarette-use coping with stress and reported self-rated health (excellent/very good, good, or fair/poor); 1201 of these participants also reported self-rated health in 2010. One in six participants frequently used substances to cope. The oldest participants were least likely to engage in frequent alcohol-use coping. Those with elevated depressive symptoms were more likely to frequently engage in cigarette- and prescription/other drug-use coping. In multivariable-adjusted analyses, participants who frequently used cigarettes (compared to participants who infrequently used cigarettes) to cope had 2.7 times (95% CI=1.1-6.7) the odds of poor (vs. excellent) self-rated health. Relative to participants who infrequently used prescription/other drugs to cope, participants who frequently used prescription/other drugs to cope had 2.4 times (95% CI=1.1-5.1) the odds of reporting poor self-rated health. The association between prescription/other drug-use coping in 2008 and self-rated health in 2010 was statistically significant (relative OR=3.5, 95% CI=1.7-7.2). Participants engaging in substance-use coping likely have particular demographic and clinical characteristics. Interventions to reduce substance-use coping may prevent adverse health outcomes. BACKGROUND: The use of online surveys for data collection has increased exponentially, yet it is often unclear whether interview-based cognitive assessments (such as face-to-face or telephonic word recall tasks) can be adapted for use in application-based research settings. OBJECTIVE: The objective of the current study was to compare and characterize the results of online word recall tasks to those of the Health and Retirement Study (HRS) and determine the feasibility and reliability of incorporating word recall tasks into application-based cognitive assessments. METHODS: The results of the online immediate and delayed word recall assessment, included within the Women's Health and Valuation (WHV) study, were compared to the results of the immediate and delayed recall tasks of Waves 5-11 (2000-2012) of the HRS. RESULTS: Performance on the WHV immediate and delayed tasks demonstrated strong concordance with performance on the HRS tasks (ρc=.79, 95% CI 0.67-0.91), despite significant differences between study populations (P<.001) and study design. Sociodemographic characteristics and self-reported memory demonstrated similar relationships with performance on both the HRS and WHV tasks. CONCLUSIONS: The key finding of this study is that the HRS word recall tasks performed similarly when used as an online cognitive assessment in the WHV. Online administration of cognitive tests, which has the potential to significantly reduce participant and administrative burden, should be considered in future research studies and health assessments. OBJECTIVE: Optimism has been linked with an array of positive health outcomes at the individual level. However, researchers have not examined how a spouse's optimism might impact an individual's health. We hypothesized that being optimistic (and having an optimistic spouse) would both be associated with better health. METHODS: Participants were 3940 adults (1970 couples) from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50. Participants were tracked for four years and outcomes included: physical functioning, self-rated health, and number of chronic illnesses. We analyzed the dyadic data using the actor-partner interdependence model. RESULTS: After controlling for several psychological and demographic factors, a person's own optimism and their spouse's optimism predicted better self-rated health and physical functioning (bs = .08-.25, ps<.01). More optimistic people also reported better physical functioning (b = -.11, p<.01) and fewer chronic illnesses (b=-.01, p<.05) over time. Further, having an optimistic spouse uniquely predicted better physical functioning (b = -.09, p<.01) and fewer chronic illnesses (b = -.01, p<.05) over time. The strength of the relationship between optimism and health did not diminish over time. CONCLUSIONS: Being optimistic and having an optimistic spouse were both associated with better health. Examining partner effects is important because such analyses reveal the unique role that spouses play in promoting health. These findings may have important implications for future health interventions. 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. OBJECTIVE: The purpose of this article is to examine the relationship between changes in household finances (wealth and income) and changes in dental utilization at the onset of the recent recession in a population of older Americans. METHODS: Data from the Health and Retirement Study (HRS) were analyzed for U.S. individuals aged 51 years and older during the 2006 and 2008 waves of the HRS. We estimated logistic models of (a) starting and (b) stopping dental use between 2006 and 2008 survey periods as a function of changes in household wealth and income, controlling for other potentially confounding covariates. RESULTS: We found that only when household wealth falls by 50 percent or more were older adults less likely to seek dental care. Changes in household income and other changes in household wealth were not associated with changes in dental utilization among this population. CONCLUSIONS: Older Americans' dental care utilization appeared to be fairly resilient to changes in household finances; only when wealth fell by 50 percent or more did individuals decrease dental use. This finding might extend to other health-care services that are preventive, routine, and relatively inexpensive. BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace. METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace. RESULTS: Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke. CONCLUSION: Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities. OBJECTIVES: To assess the association of current and long-term spousal caregiving with risk of depression in a nationally (U.S.) representative sample of older adults. METHODS: We studied married and depression-free Health and Retirement Study respondents aged 50 years and older (n = 9,420) at baseline from 2000 to 2010. Current (≥14 hours per week of help with instrumental/activities of daily living for a spouse in the most recent biennial survey) and long-term caregiving (care at two consecutive surveys) were used to predict onset of elevated depressive symptoms (≥3 on a modified Centers for Epidemiologic Studies Depression scale) with discrete-time hazards models and time-updated exposure and covariate information. RESULTS: Current caregiving was associated with significant elevations in risk of depression onset (hazard ratio: 1.64; Wald χ(2), 1 df: 28.34; p <0.0001). Effect estimates for long-term caregiving were similar (hazard ratio: 1.52, Wald χ(2), 1 df: 3.63; p = 0.06). CONCLUSIONS: Current spousal caregiving significantly predicted onset of depression; the association was not exacerbated by longer duration of caregiving. OBJECTIVES: Either dysphoria (sadness) or anhedonia (loss of interest in usually pleasurable activities) is required for a diagnosis of major depression. Although major depression is a known risk factor for disability in older persons, few studies have examined the relationship between the two core symptoms of major depression and disability or mortality. Our objective was to examine the relationship between these two core symptoms and time to disability or death. METHODS: In a longitudinal cohort study, we used the nationally representative Health and Retirement Study to examine this relationship in 11,353 persons older than 62 years (mean: 73 years) followed for up to 13 years. Dysphoria and anhedonia were assessed with the Short Form Composite International Diagnostic Interview. Our outcome measure was time to either death or increased disability, defined as the new need for help in a basic activity of daily living. We adjusted for a validated disability risk index and other confounders. RESULTS: Compared with subjects without either dysphoria or anhedonia, the risk for disability or death was not elevated in elders with dysphoria without anhedonia (adjusted hazard ratio [HR]: 1.11; 95% confidence interval [CI]: 0.91-1.36). The risk was elevated in those with anhedonia without dysphoria (HR: 1.30; 95% CI: 1.06-1.60) and those with both anhedonia and dysphoria (HR: 1.28; 95% CI: 1.13-1.46). CONCLUSION: Our results highlight the need for clinicians to learn whether patients have lost interest in usually pleasurable activities, even if they deny sadness. 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. Understanding the social and biological mechanisms that lead to homogamy (similar individuals marrying one another) has been a long-standing issue across many fields of scientific inquiry. Using a nationally representative sample of non-Hispanic white US adults from the Health and Retirement Study and information from 1.7 million single-nucleotide polymorphisms, we compare genetic similarity among married couples to noncoupled pairs in the population. We provide evidence for genetic assortative mating in this population but the strength of this association is substantially smaller than the strength of educational assortative mating in the same sample. Furthermore, genetic similarity explains at most 10% of the assortative mating by education levels. Results are replicated using comparable data from the Framingham Heart Study. 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. Genome-wide association study results have yielded evidence for the association of common genetic variants with crude measures of completed educational attainment in adults. Whilst informative, these results do not inform as to the mechanism of these effects or their presence at earlier ages and where educational performance is more routinely and more precisely assessed. Single nucleotide polymorphisms exhibiting genome-wide significant associations with adult educational attainment were combined to derive an unweighted allele score in 5,979 and 6,145 young participants from the Avon Longitudinal Study of Parents and Children with key stage 3 national curriculum test results (SATS results) available at age 13 to 14 years in English and mathematics respectively. Standardised (z-scored) results for English and mathematics showed an expected relationship with sex, with girls exhibiting an advantage over boys in English (0.433 SD (95%CI 0.395, 0.470), p<10(-10)) with more similar results (though in the opposite direction) in mathematics (0.042 SD (95%CI 0.004, 0.080), p = 0.030). Each additional adult educational attainment increasing allele was associated with 0.041 SD (95%CI 0.020, 0.063), p = 1.79×10(-04) and 0.028 SD (95%CI 0.007, 0.050), p = 0.01 increases in standardised SATS score for English and mathematics respectively. Educational attainment is a complex multifactorial behavioural trait which has not had heritable contributions to it fully characterised. We were able to apply the results from a large study of adult educational attainment to a study of child exam performance marking events in the process of learning rather than realised adult end product. Our results support evidence for common, small genetic contributions to educational attainment, but also emphasise the likely lifecourse nature of this genetic effect. Results here also, by an alternative route, suggest that existing methods for child examination are able to recognise early life variation likely to be related to ultimate educational attainment. OBJECTIVES: To examine whether out-of-pocket expenditures (OOPEs) exhibit the same geographic variation as Medicare claims, given wide variation in the costs of U.S. health care, but no information on how that translates into OOPEs or financial burden for older Americans. DESIGN: Retrospective cohort study. SETTING: Data from the Health and Retirement Study linked to Medicare claims. PARTICIPANTS: A nationally representative cohort of 4,657 noninstitutionalized, community-dwelling, fee-for-service elderly Medicare beneficiaries interviewed in 2006 and 2008. MEASUREMENTS: The primary predictor was per capita Medicare spending quintile according to hospital referral region. The primary outcome was a self-reported, validated measure of annual OOPEs excluding premiums. RESULTS: Mean and median adjusted per capita Medicare payments were $5,916 and $2,635, respectively; mean and median adjusted OOPEs were $1,525 and $779, respectively. Adjusted median Medicare payments were $3,474 in the highest cost quintile and $1,942 in the lowest cost quintile (ratio 1.79, P < .001 for difference). In contrast, adjusted median OOPEs were not higher in the highest than in the lowest Medicare cost quintile ($795 vs $764 for a Q5:Q1 ratio of 1.04, P = .42). The Q5:Q1 ratio was 1.48 for adjusted mean Medicare payments and 1.04 for adjusted mean OOPEs (both P < .001). CONCLUSION: Medicare payments vary widely between high- and low-cost regions, but OOPEs do not. BACKGROUND: Guidelines recommend incorporating life expectancy (LE) into clinical decision-making for preventive interventions such as cancer screening. Previous research focused on mortality risk (e.g. 28% at 4 years) which is more difficult to interpret than LE (e.g. 7.3 years) for both patients and clinicians. Our objective was to utilize the Gompertz Law of Human Mortality which states that mortality risk doubles in a fixed time interval to transform the Lee mortality index into a LE calculator. METHODS: We examined community-dwelling older adults age 50 and over enrolled in the nationally representative 1998 wave of the Health and Retirement Study or HRS (response rate 81%), dividing study respondents into development (n = 11701) and validation (n = 8009) cohorts. In the development cohort, we fit proportional hazards Gompertz survival functions for each of the risk groups defined by the Lee mortality index. We validated our LE estimates by comparing our predicted LE with observed survival in the HRS validation cohort and an external validation cohort from the 2004 wave of the English Longitudinal Study on Ageing or ELSA (n = 7042). RESULTS: The ELSA cohort had a lower 8-year mortality risk (14%) compared to our HRS development (23%) and validation cohorts (25%). Our model had good discrimination in the validation cohorts (Harrell's c 0.78 in HRS and 0.80 in the ELSA). Our predicted LE's were similar to observed survival in the HRS validation cohort without evidence of miscalibration (Hosmer-Lemeshow, p = 0.2 at 8 years). However, our predicted LE's were longer than observed survival in the ELSA cohort with evidence of miscalibration (Hosmer-Lemeshow, p<0.001 at 8 years) reflecting the lower mortality rate in ELSA. CONCLUSION: We transformed a previously validated mortality index into a LE calculator that incorporated patient-level risk factors. Our LE calculator may help clinicians determine which preventive interventions are most appropriate for older US adults. OBJECTIVES: In this study, we advance knowledge about activity engagement by considering many activities simultaneously to identify profiles of activity among older adults. Further, we use cross-sectional data to explore factors associated with activity profiles and prospective data to explore activity profiles and well-being outcomes. METHOD: We used the core survey data from the years 2008 and 2010, as well as the 2009 Health and Retirement Study Consumption and Activities Mail Survey (HRS CAMS). The HRS CAMS includes information on types and amounts of activities. We used factor analysis and latent class analysis to identify activity profiles and regression analyses to assess antecedents and outcomes associated with activity profiles. RESULTS: We identified 5 activity profiles: Low Activity, Moderate Activity, High Activity, Working, and Physically Active. These profiles varied in amount and type of activities. Demographic and health factors were related to profiles. Activity profiles were subsequently associated with self-rated health and depression symptoms. DISCUSSION: The use of a 5-level categorical activity profile variable may allow more complex analyses of activity that capture the "whole person." There is clearly a vulnerable group of low-activity individuals as well as a High Activity group that may represent the "active ageing" vision. BACKGROUND: The critical need to expand and develop the palliative care evidence base was recently highlighted by the Journal of Palliative Medicine's series of articles describing the Research Priorities in Geriatric Palliative Care. The Health and Retirement Study (HRS) is uniquely positioned to address many priority areas of palliative care research. This nationally representative, ongoing, longitudinal study collects detailed survey data every 2 years, including demographics, health and functional characteristics, information on family and caregivers, and personal finances, and also conducts a proxy interview after each subject's death. The HRS can also be linked with Medicare claims data and many other data sources, e.g., U.S. Census, Dartmouth Atlas of Health Care. SETTING: While the HRS offers innumerable research opportunities, these data are complex and limitations do exist. Therefore, we assembled an interdisciplinary group of investigators using the HRS for palliative care research to identify the key palliative care research gaps that may be amenable to study within the HRS and the strengths and weaknesses of the HRS for each of these topic areas. CONCLUSION: In this article we present the work of this group as a potential roadmap for investigators contemplating the use of HRS data for palliative care research. BACKGROUND: The relative contributions of depression, cognitive impairment without dementia (CIND), and dementia to the risk of potentially preventable hospitalizations in older adults are not well understood. OBJECTIVE(S): To determine if depression, CIND, and/or dementia are each independently associated with hospitalizations for ambulatory care-sensitive conditions (ACSCs) and rehospitalizations within 30 days after hospitalization for pneumonia, congestive heart failure (CHF), or myocardial infarction (MI). DESIGN: Prospective cohort study. PARTICIPANTS: Population-based sample of 7,031 Americans > 50 years old participating in the Health and Retirement Study (1998-2008). MAIN MEASURES: The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. The Modified Telephone Interview for Cognitive Status and/or ICD-9-CM dementia diagnoses were used to identify baseline CIND or dementia. Primary outcomes were time to hospitalization for an ACSC and presence of a hospitalization within 30 days after hospitalization for pneumonia, CHF, or MI. KEY RESULTS: All five categories of baseline neuropsychiatric disorder status were independently associated with increased risk of hospitalization for an ACSC (depression alone: Hazard Ratio [HR]: 1.33, 95% Confidence Interval [95%CI]: 1.18, 1.52; CIND alone: HR: 1.25, 95%CI: 1.10, 1.41; dementia alone: HR: 1.32, 95%CI: 1.12, 1.55; comorbid depression and CIND: HR: 1.43, 95%CI: 1.20, 1.69; comorbid depression and dementia: HR: 1.66, 95%CI: 1.38, 2.00). Depression (Odds Ratio [OR]: 1.37, 95%CI: 1.01, 1.84), comorbid depression and CIND (OR: 1.98, 95%CI: 1.40, 2.81), or comorbid depression and dementia (OR: 1.58, 95%CI: 1.06, 2.35) were independently associated with increased odds of rehospitalization within 30 days after hospitalization for pneumonia, CHF, or MI. CONCLUSIONS: Depression, CIND, and dementia are each independently associated with potentially preventable hospitalizations in older Americans. Older adults with comorbid depression and cognitive impairment represent a particularly at-risk group that could benefit from targeted interventions. OBJECTIVES: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index. DESIGN: Observational cohort study. SETTING: U.S. hospitals. PATIENTS: We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64). CONCLUSIONS: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories. 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. BACKGROUND: The purpose of this study was to assess public beliefs and knowledge about risk and protective factors for Alzheimer's disease (AD). METHODS: A brief survey module was added to the Health and Retirement Study, a longstanding national panel study of the U.S. population over the age of 50. RESULTS: Respondents were 1641 adults (mean age=64.4 years, 53.6% female, 81.7% White). Most (60.1%) indicated interest in learning their AD risk, with 29.4% expressing active worry. Many failed to recognize that medications to prevent AD are not available (39.1%) or that having an affected first-degree relative is associated with increased disease risk (32%). Many respondents believed that various actions (e.g., mental activity, eating a healthy diet) would be effective in reducing AD risk. CONCLUSION: Older and middle-aged adults are interested in their AD risk status and believe that steps can be taken to reduce disease risk. Tailored education efforts are needed to address potential misconceptions about risk and protective factors. OBJECTIVE: Although the link between enhanced social relationships and better health has generally been well established, few studies have examined the role of leisure activity in this link. This study examined how leisure influences the link between social relationships and health in older age. METHOD: Using data from the 2006 and 2010 waves of the nationally representative U.S. Health and Retirement Study and structural equation modeling analyses, we examined data on 2,965 older participants to determine if leisure activities mediated the link between social relationships and health in 2010, controlling for race, education level, and health in 2006. RESULTS: The results demonstrated that leisure activities mediate the link between social relationships and health in these age groups. Perceptions of positive social relationships were associated with greater involvement in leisure activities, and greater involvement in leisure activities was associated with better health in older age. CONCLUSION: The contribution of leisure to health in these age groups is receiving increasing attention, and the results of this study add to the literature on this topic, by identifying the mediating effect of leisure activity on the link between social relationships and health. Future studies aimed at increasing leisure activity may contribute to improved health outcomes in older adults. Comparing genetic and phenotypic similarity among unrelated individuals seems a promising way to quantify the genetic component of traits while avoiding the problematic assumptions plaguing twin- and other kin-based estimates of heritability. One approach uses a Genetic Relatedness Estimation through Maximum Likelihood (GREML) model for individuals who are related at less than 0.025 to predict their phenotypic similarity by their genetic similarity. Here we test the key underlying assumption of this approach: that genetic relatedness is orthogonal to environmental similarity. Using data from the Health and Retirement Study (and two other surveys), we show two unrelated individuals may be more likely to have been reared in a similar environment (urban versus nonurban setting) if they are genetically similar. This effect is not eliminated by controls for population structure. However, when we include this environmental confound in GREML models, heritabilities do not change substantially and thus potential bias in estimates of most biological phenotypes is probably minimal. Assessment of health in large population studies has increasingly incorporated measures of blood-based biomarkers based on the use of dried blood spots (DBS). The validity of DBS assessments made by labs used by large studies is addressed by comparing assay values from DBS collected using conditions similar to those used in the field with values from whole blood samples. The DBS approach generates values that are strongly related to whole blood levels of HbA1c, cystatin C, and C-reactive protein. Assessing lipid levels reliably with DBS appears to be a greater challenge. However, even when DBS values and values from venous blood are highly correlated, they are often on a different scale, and using conventional cutoffs may be misleading. Alzheimer's disease (AD) extracts a heavy societal toll. The value of medical advances that delay onset of AD could be significant. Using data from nationally representative samples from the Health and Retirement Study (1998-2008) and Aging Demographics and Memory Study (2001-2009), we estimate the prevalence and incidence of AD and the formal and informal health care costs associated with it. We use microsimulation to project future prevalence and costs of AD under different treatment scenarios. We find from 2010 to 2050, the number of individuals ages 70+ with AD increases 153%, from 3.6 to 9.1 million, and annual costs increase from $307 billion ($181B formal, $126B informal costs) to $1.5 trillion. 2010 annual per person costs were $71,303 and double by 2050. Medicare and Medicaid are paying 75% of formal costs. Medical advances that delay onset of AD for 5 years result in 41% lower prevalence and 40% lower cost of AD in 2050. For one cohort of older individuals, who would go on to acquire AD, a 5-year delay leads to 2.7 additional life years (about 5 AD-free), slightly higher formal care costs due to longer life but lower informal care costs for a total value of $511,208 per person. We find Medical advances delaying onset of AD generate significant economic and longevity benefits. The findings inform clinicians, policymakers, businesses and the public about the value of prevention, diagnosis, and treatment of AD. This paper investigates the prevalence of incapacity in performing daily activities and the associations between household composition and availability of family members and receipt of care among older adults with functioning problems in Spain, England and the United States of America (USA). We examine how living arrangements, marital status, child availability, limitations in functioning ability, age and gender affect the probability of receiving formal care and informal care from household members and from others in three countries with different family structures, living arrangements and policies supporting care of the incapacitated. Data sources include the 2006 Survey of Health, Ageing and Retirement in Europe for Spain, the third wave of the English Longitudinal Study of Ageing (2006), and the eighth wave of the USA Health and Retirement Study (2006). Logistic and multinomial logistic regressions are used to estimate the probability of receiving care and the sources of care among persons age 50 and older. The percentage of people with functional limitations receiving care is higher in Spain. More care comes from outside the household in the USA and England than in Spain. The use of formal care among the incapacitated is lowest in the USA and highest in Spain. Little is known about the health impact of helping behaviors among individuals with high-risk chronic diseases such as cardiovascular disease (CVD). Using a nationally representative, longitudinal survey, we examined the subsequent health of adults with CVD (n = 4,491) who spent time providing non-paid assistance to family and friends outside of their households compared with those who had provided no assistance. After both adjusting for baseline characteristics and using propensity score matching methods, spending up to 200 h over the prior 12 months helping others was associated with lower odds of experiencing a new CVD event or dying in the subsequent 2 years. Providing up to 100 h of assistance was associated with reporting fewer depressive symptoms. This threshold effect raises the question of whether assistance beyond a certain number of hours may impose a burden that mitigates health benefits from helping others. Health care providers could play an important role exploring ways that patients with CVD can provide beneficial levels of assistance to others in their own social networks or communities, thereby possibly also improving their own health. BACKGROUND: Few longitudinal studies have examined associations between body mass index (BMI) changes in adults with diabetes and the development of disability. OBJECTIVE: To investigate association patterns between BMI and disability in middle-aged adults with diabetes. DESIGN AND SETTING: Retrospective cohort design with data from the 1992-2006 Health and Retirement Study (HRS). A group-based joint trajectory method identified distinct BMI change trajectories and their link to subsequent disability trajectories. PARTICIPANTS: U.S. nationally representative adults aged 51-61 who reported a diagnosis of diabetes in the 1992 HRS (N = 1,064). MEASUREMENTS: BMI and self-reported disability score were the main variables. Sociodemographic, clinical, behavioral, and diabetes-related factors were also examined. RESULTS: Four distinct weight trajectories (stable normal weight, 28.7 %; stable overweight, 46.2 %; loss and regain obese, 18.0 %; weight cumulating morbidly obese, 7.1 %) and three disability trajectories (little or low increase, 34.4 %; moderate increase, 45.4 %; chronic high increase, 20.2 %) best characterized the long-term patterns of BMI and disability change in middle-aged adults with diabetes. Adults in stable normal weight had the highest probability of being in the little/low increase disability group; however, one in five adults in that group progressed into chronic high disability, a higher proportion compared to the stable overweight group. CONCLUSIONS: Although there were various ways in which the two trajectories were linked, the beneficial impacts of optimizing weight in adults with diabetes were supported. In addition, the complexity of diabetes control in those with relatively normal weight was highlighted from this study. IMPORTANCE: Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life. OBJECTIVE: To determine national estimates of disability during the last 2 years of life. DESIGN: Prospective cohort study. SETTING: A nationally representative study of older adults in the United States. PARTICIPANTS: Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex. MAIN OUTCOMES AND MEASURES: Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet. RESULTS: There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52% women). The prevalence of disability increased from 28% (95% CI, 24%-31%) 2 years before death to 56% (95% CI, 52%-60%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14%; 70-79 years, 21%; 80-89 years, 32%; 90 years or more, 50%; P for trend, <.001). Disability was more common in women 2 years before death (32% [95% CI, 28%-36%]) than men (21% [95% CI, 18%-25%]; P < .001), even after adjustment for older age at death. CONCLUSIONS AND RELEVANCE: Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men. OBJECTIVE: To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites. DESIGN, SETTING AND PARTICIPANTS: 2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years. OUTCOME MEASURE: Cause of death (per ICD codes) and month of death were identified from National Death Index linkages. METHODS: The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale). RESULTS: For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95% CI: 1.33, 1.61; Blacks: HR=1.42, 95% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13% excess hazard of CVD mortality (HR=1.13, 95% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65. CONCLUSION: Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor. Prior research found that Americans born in 6 southeastern states (the AF-risk zone) had elevated risk of AF-related mortality, but no mechanisms were identified. We hypothesized the association between AF-related mortality and AF-risk zone birth is explained by indicators of childhood social disadvantage or adult risk factors. In 24,323 participants in the US Health and Retirement Study, we found that birth in the AF-risk zone was significantly associated with hazard of AF-related mortality. Among whites, the relationship was specific to place of birth, rather than place of adult residence. Neither paternal education nor subjectively assessed childhood SES predicted AF-related mortality. Conventional childhood and adult cardiovascular risk factors did not explain the association between place of birth and AF-related mortality. We report on two experiments to encourage record use by respondents in an Internet survey. The experiments were conducted in the 2009 Health and Retirement Study (HRS) Internet Survey, administered to those in the HRS panel with Internet access, and in the 2011 HRS Internet Survey. Encouraging respondents to consult records at the relevant point in the questionnaire significantly increased reported record use (from 39 percent to 47 percent), but was insufficient to produce significant changes in the precision (amount of rounding) of the information reported. Including the encouragement in the mailed invitation to the Web survey in 2011 resulted in a lower response rate (77 percent with encouragement, 80 percent without), but increased reported record use among respondents (from 46 percent to 55 percent). In neither case was the increase in reported record use large enough to produce significant differences in the precision of the information reported between the groups with and without encouragement. To optimize care in the evaluation of peripheral neuropathy, we sought to define which tests drive expenditures and the role of the provider type. We investigated test utilization and expenditures by provider type in those with incident neuropathy in a nationally representative elderly, Medicare population. Multivariable logistic regression was used to determine predictors of MRI and electrodiagnostic utilization. MRIs of the neuroaxis and electrodiagnostic tests accounted for 88% of total expenditures. Mean and aggregate diagnostic expenditures were higher in those who saw a neurologist. Patients who saw a neurologist were more likely to receive an MRI and an electrodiagnostic test. MRIs and electrodiagnostic tests are the main contributors to expenditures in the evaluation of peripheral neuropathy, and should be the focus of future efficiency efforts. OBJECTIVES: To determine whether falling would be a marker for future difficulty with activities of daily (ADLs) that would vary according to fall frequency and associated injury. DESIGN: Longitudinal analysis. SETTING: Community. PARTICIPANTS: Nationally representative cohort of 2,020 community-living, functionally independent older adults aged 65 to 69 at baseline followed from 1998 to 2008. MEASUREMENTS: ADL difficulty. RESULTS: Experiencing one fall with injury (odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.29-2.48), at least two falls without injury (OR = 2.36, 95% CI = 1.80-3.09), or at least two falls with at least one injury (OR = 3.75, 95% CI = 2.55-5.53) in the prior 2 years was independently associated with higher rates of ADL difficulty after adjustment for sociodemographic, behavioral, and clinical covariates. CONCLUSION: Falling is an important marker for future ADL difficulty in younger, functionally independent older adults. Individuals who fall frequently or report injury are at highest risk. Translational research is needed to leverage discoveries from the frontiers of genome science to improve public health. So far, public health researchers have largely ignored genetic discoveries, and geneticists have ignored important aspects of population health science. This mutual neglect should end. In this article, we discuss 3 areas where public health researchers can help to advance translation: (1) risk assessment: investigate genetic profiles as components in composite risk assessments; (2) targeted intervention: conduct life-course longitudinal studies to understand when genetic risks manifest in development and whether intervention during sensitive periods can have lasting effects; and (3) improved understanding of environmental causation: collaborate with geneticists on gene-environment interaction research. We illustrate with examples from our own research on obesity and smoking. 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. 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. Little is known about health care use in the cognitive impairment, not dementia (CIND) subpopulation. Using a cohort of 7130 persons aged 71 years or over from the Health and Retirement Survey, we compared mean and total health care use from 2002 to 2008 for those with no cognitive impairment, CIND, or dementia in 2002. Cognitive status was determined using a validated method based on self or proxy interview measures. Health care use was also based on self or proxy reports. On the basis of the Health and Retirement Survey, the CIND subpopulation in 2002 was 5.3 million or 23% of the total population 71 years of age or over. Mean hospital nights was similar and mean nursing home nights was less in persons with CIND compared with persons with dementia. The CIND subpopulation, however, had more total hospital and nursing home nights--71,000 total hospital nights and 223,000 total nursing home nights versus 32,000 hospital nights and 138,000 nursing home nights in the dementia subpopulation. A relatively large population and high health care use result in a large health care impact of the CIND subpopulation. PURPOSE: Continued employment after retirement and engagement in unpaid work are both important ways of diminishing the negative economic effects of the retirement of baby boomer cohorts on society. Little research, however, examines the relationship between paid and unpaid work at the transition from full-time work. Using a resource perspective framework this study examines how engagement in unpaid work prior to and at the transition from full-time work influences whether individuals partially or fully retire. DESIGN AND METHODS: This study used a sample of 2,236 Americans between the ages 50 and 68, who were interviewed between 1998 and 2008. Logistic regression was used to estimate transitioning into partial retirement (relative to full retirement) after leaving full-time work. RESULTS: We found that the odds of transitioning into part-time work were increased by continuous volunteering (78%) and reduced by starting parental (84%), grandchild (41%), and spousal (90%) caregiving and unaffected by all other patterns of engagement in unpaid work. IMPLICATIONS: Our findings suggest that volunteering is complementary with a transition to part-time work, and starting a new caregiving role at this transitioncreates a barrier to continued employment. In order to provide workers the opportunity to engage in the work force longer at the brink of retirement, it may be necessary to increase the support mechanisms for those who experience new caregiving responsibilities. 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. OBJECTIVES: We analyzed correlates of older Americans' continuous and transitional health care utilization over 4 years. METHODS: We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004-2008 survey periods. RESULTS: Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction. CONCLUSIONS: Older individuals' health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms. The purpose of the current study was to determine whether volunteerism is prospectively associated with hypertension risk among older adults. Participants provided data during the 2006 and 2010 waves of the Health and Retirement Study, a longitudinal panel survey using a nationally representative sample of community-dwelling older adults (age > 50 years). Volunteerism and blood pressure were measured at baseline and again 4 years later. Analyses excluded individuals hypertensive at baseline and controlled for age, race, sex, education, baseline systolic/diastolic blood pressure, and major chronic illnesses. Those who had volunteered at least 200 hr in the 12 months prior to baseline were less likely to develop hypertension (OR = 0.60; 95% CI [0.40, 0.90]) than nonvolunteers. There was no association between volunteerism and hypertension risk at lower levels of volunteer participation. Volunteering at least 200 hr was also associated with greater increases in psychological well-being (B = 0.99, β = .05, p = .006) and physical activity (B = 0.21, β = .05, p = .04) compared with nonvolunteers; however, these factors did not explain the association of volunteerism with hypertension risk. Prior research has documented a link between perceived neighborhood safety and functional limitations including incident mobility limitation, yet no research has explored the association between perceived neighborhood safety and recovery from functional limitations. This study investigates whether perceived neighborhood safety independently predicts recovery. Using longitudinal data from the Health and Retirement Study (HRS) (1996-2008), discrete-time event history models with multiple competing events were estimated using multinomial logistic regression. Robust standard errors were used to adjust for clustering. In the unadjusted model, the odds ratio for recovery from mobility limitations was 1.22 (CI: 1.17, 1.27) for respondents reporting greater neighborhood safety, while, in the fully adjusted model, the odds ratio was 1.11 (CI: 1.05, 1.17). Even after controlling for sociodemographic characteristics and numerous health risk factors, perceived neighborhood safety was a robust predictor of mobility limitation recovery. This research provides further evidence that environmental factors shape functional health outcomes including recovery. BACKGROUND: Stroke often results in chronic disability and the need for long-term assistance, which is provided in large part by spouses. Stroke caregivers experience poorer health and well-being compared with non-caregivers, but less is known about the specific toll that caregiving may exact on cognitive functioning. OBJECTIVE: To investigate whether persons caring for a spouse who experienced a recent stroke may be at risk for poor cognitive functioning compared with non-caregivers. METHODS: Existing data from the United States' Health and Retirement Study (HRS) were used to identify 146 caregivers from among couples in which 1 individual reported surviving a recent stroke and experiencing functional limitations. This cross-sectional population-based analysis compared the stroke caregivers with 3,416 non-caregivers in time orientation, working memory, semantic memory, learning, and episodic memory. RESULTS: Overall, the caregiver group was considerably more disadvantaged than the non-caregiver group in terms of background characteristics, socioeconomic status, health, and well-being. Results of weighted Poisson regression models indicated that stroke caregivers were at risk for poorer performance than non-caregivers in working memory, semantic memory, learning, and episodic memory. The gap between stroke caregivers and non-caregivers in episodic memory remained after adjusting for systematic differences between the 2 groups across an array of risk factors. CONCLUSIONS: Spousal caregivers of stroke survivors may be at risk for poor cognitive functioning. More work is needed to identify the processes that may contribute to the diminished cognitive capacity among these adults so that interventions may be developed to reduce caregiver burden and promote cognitive health. OBJECTIVES: To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke. DESIGN: Prospective, observational study. SETTING: Community-dwelling Health and Retirement Study (HRS) cohort. PARTICIPANTS: HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441). MEASUREMENTS: Strokes were assessed using self- or proxy-report of a doctor's diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates. RESULTS: Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards. CONCLUSION: In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia. 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. PURPOSE: Educational attainment is a robust predictor of disability in elderly Americans: older adults with high-school (HS) diplomas have substantially lower disability than individuals who did not complete HS. General Educational Development (GED) diplomas now comprise almost 20% of new HS credentials issued annually in the United States but it is unknown whether the apparent health advantages of HS diplomas extend to GED credentials. This study examines whether adults older than 50 years with GEDs have higher odds of incident instrumental or basic activities of daily living (IADLs) limitations compared with HS degree holders. METHODS: We compared odds of incident IADL limitations by HS credential type using discrete-time survival models among 9,426 Health and Retirement Study participants followed from 1998 through 2008. RESULTS: HS degree holders had lower odds of incident IADLs than GED holders (OR = 0.72, 95% CI = 0.58, 0.90 and OR = 0.69, 95% CI = 0.56, 0.86 for ADLs and IADLs, respectively). There was no significant difference in odds of incident IADL limitations between GED holders and respondents without HS credentials (OR = 0.89, 95% CI = 0.71, 1.11 for ADLs; OR = 0.88, 95% CI = 0.70, 1.12 for IADLs). IMPLICATIONS: Although GEDs are widely accepted as equivalent to high school diplomas, they are not associated with comparable health advantages for physical limitations in older age. 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. We study racial/ethnic disparities in awareness of chronic diseases using biomarker data from the 2006 Health and Retirement Study. We explore two alternative definitions of awareness and estimate a trivariate probit model with selection, which accounts for common, unmeasured factors underlying the following: (1) self-reporting chronic disease; (2) participating in biomarker collection; and (3) having disease, conditional on participating in biomarker collection. Our findings suggest that current estimates of racial/ethnic disparities in chronic disease are sensitive to selection, and also to the definition of disease awareness used. We find that African-Americans are less likely to be unaware of having hypertension than non-Latino whites, but the magnitude of this effect falls appreciably after we account for selection. Accounting for selection, we find that African-Americans and Latinos are more likely to be unaware of having diabetes compared to non-Latino whites. These findings are based on a widely used definition of awareness - the likelihood of self-reporting disease among those who have disease. When we use an alternative definition of awareness, which considers an individual to be unaware if he or she actually has the disease conditional on self-reporting not having it, we find higher levels of unawareness among racial/ethnic minorities versus non-Latino whites for both hypertension and diabetes. BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit. METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models. RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8%; Self-Management Difficulty Group, 79.4%; and Uncertain Benefit Group, 52.5%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50%. CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities. BACKGROUND: A simple method of identifying elders at high risk for activity of daily living (ADL) dependence could facilitate essential research and implementation of cost-effective clinical care programs. OBJECTIVE: We used a nationally representative sample of 9446 older adults free from ADL dependence in 2006 to develop simple models for predicting ADL dependence at 2008 follow-up and to compare the models to the most predictive published model. Candidate predictor variables were those of published models that could be obtained from interview or medical record data. METHODS: Variable selection was performed using logistic regression with backward elimination in a two-third random sample (n = 6233) and validated in a one-third random sample (n = 3213). Model fit was determined using the c-statistic and evaluated vis-a-vis our replication of a published model. RESULTS: At 2-year follow-up, 8.0% and 7.3% of initially independent persons were ADL dependent in the development and validation samples, respectively. The best fitting, simple model consisted of age and number of hospitalizations in past 2 years, plus diagnoses of diabetes, chronic lung disease, congestive heart failure, stroke, and arthritis. This model had a c-statistic of 0.74 in the validation sample. A model of just age and number of hospitalizations achieved a c-statistic of 0.71. These compared with a c-statistic of 0.79 for the published model. Sensitivity analyses demonstrated model robustness. CONCLUSIONS: Models based on a widely available data achieve very good validity for predicting ADL dependence. Future work will assess the validity of these models using medical record data. BACKGROUND: Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans. METHODS: Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living ≥14 h/week according to the care recipients' report in the most recent prior biennial survey; we define providing ≥14 h/week of care at two consecutive biennial surveys as 'long-term caregiving'. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD. RESULTS: Caregiving significantly predicted CVD incidence (HR=1.35, 95% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95% CI 0.06 to 1.28). CONCLUSIONS: Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white. Cognitive impairment has emerged as a major driver of disability in old age, with profound effects on individual well-being and decision making at older ages. In the light of policies aimed at postponing retirement ages, an important question is whether continued labour supply helps to maintain high levels of cognition at older ages. We use data of older men from the US Health and Retirement Study to estimate the effect of continued labour market participation at older ages on later-life cognition. As retirement itself is likely to depend on cognitive functioning and may thus be endogenous, we use offers of early retirement windows as instruments for retirement in econometric models for later-life cognitive functioning. These offers of early retirement are legally required to be nondiscriminatory and thus, inter alia, unrelated to cognitive functioning. At the same time, these offers of early retirement options are significant predictors of retirement. Although the simple ordinary least squares estimates show a negative relationship between retirement duration and various measures of cognitive functioning, instrumental variable estimates suggest that these associations may not be causal effects. Specifically, we find no clear relationship between retirement duration and later-life cognition for white-collar workers and, if anything, a positive relationship for blue-collar workers. Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N = 18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27%) and Hispanics (33%) than whites/others (18%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR = 1.53; 95% CI: 1.36-1.73) and among blacks (HR = 1.31; 95% CI: 1.05-1.65). The HR was similar but only marginally statistically significant among Hispanics (HR = 1.33; 95% CI: 0.92-1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3% for whites/others, 7.8% for blacks, and 10.3% for Hispanics. BACKGROUND: Although the notion of healthy aging has gained wide acceptance in gerontology, measuring the phenomenon is challenging. Guided by a prominent conceptualization of healthy aging, we examined how shifting from a more to less stringent definition of healthy aging influences prevalence estimates, demographic patterns, and validity. METHODS: Data are from adults aged 65 years and older who participated in the Health and Retirement Study. We examined four operational definitions of healthy aging. For each, we calculated prevalence estimates and examined the odds of healthy aging by age, education, gender, and race-ethnicity in 2006. We also examined the association between healthy aging and both self-rated health and death. RESULTS: Across definitions, the prevalence of healthy aging ranged from 3.3% to 35.5%. For all definitions, those classified as experiencing healthy aging had lower odds of fair or poor self-rated health and death over an 8-year period. The odds of being classified as "healthy" were lower among those of advanced age, those with less education, and women than for their corresponding counterparts across all definitions. CONCLUSIONS: Moving across the conceptual continuum--from a more to less rigid definition of healthy aging--markedly increases the measured prevalence of healthy aging. Importantly, results suggest that all examined definitions identified a subgroup of older adults who had substantially lower odds of reporting fair or poor health and dying over an 8-year period, providing evidence of the validity of our definitions. Conceptualizations that emphasize symptomatic disease and functional health may be particularly useful for public health purposes. This study examines whether participation in gardening predicts reduced fall risk and performance on balance and gait-speed measures in older adults. Data on adults age 65 and older (N = 3,237) from the Health and Retirement Study and Consumption and Activities Mail Survey were analyzed. Participants who spent 1 hr or more gardening in the past week were defined as gardeners, resulting in a total of 1,585 gardeners and 1,652 nongardeners. Independent t tests, chi square, and regression analyses were conducted to examine the relationship between gardening and health outcomes. Findings indicate that gardeners reported significantly better balance and gait speed and had fewer chronic conditions and functional limitations than nongardeners. Significantly fewer gardeners than nongardeners reported a fall in the past 2 yr. The findings suggest that gardening may be a potential activity to incorporate into future fall-prevention programs. Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,158 [corrected] decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life. 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. 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. OBJECTIVE: To examine the influence of diabetes psychosocial attributes and self-management on glycemic control and diabetes status change. METHODS: Using data from the Health and Retirement Study, a nationally representative longitudinal study of U.S. adults >51 years, we examined cross-sectional relationships among diabetes psychosocial attributes (self-efficacy, risk awareness, care understanding, prioritization of diabetes, and emotional distress), self-management ratings, and glycemic control. We then explored whether self-management ratings and psychosocial attributes in 2003 predicted change in diabetes status in 2004. RESULTS: In multivariate analyses (N=1834), all diabetes psychosocial attributes were associated with self-management ratings, with self-efficacy and diabetes distress having the strongest relationships (adj coeff=8.1, p<0.01 and -4.1, p<0.01, respectively). Lower self-management ratings in 2003 were associated cross-sectionally with higher hemoglobin A1C (adj coeff=0.16, p<0.01), and with perceived worsening diabetes status in 2004 (adj OR=1.36, p<0.05), with much of this latter relationship explained by diabetes distress. CONCLUSION: Psychosocial attributes, most notably diabetes-related emotional distress, contribute to difficulty with diabetes self-management, poor glycemic control, and worsening diabetes status over time. PRACTICE IMPLICATIONS: Self-management and adherence interventions should target psychosocial attributes such as disease-related emotional distress. Survey records are increasingly being linked to administrative databases to enhance the survey data and increase research opportunities for data users. A necessary prerequisite to linking survey and administrative records is obtaining informed consent from respondents. Obtaining consent from all respondents is a difficult challenge and one that faces significant resistance. Consequently, data linkage consent rates vary widely from study-to-study. Several studies have found significant differences between consenters and non-consenters on socio-demographic variables, but no study has investigated the underlying mechanisms of consent from a theory-driven perspective. In this study, we describe and test several hypotheses related to respondents' willingness to consent to an earnings and benefit data linkage request based on mechanisms related to financial uncertainty, privacy concerns, resistance towards the survey interview, level of attentiveness during the interview, the respondents' preexisting relationship with the administrative data agency, and matching respondents and interviewers on observable characteristics. The results point to several implications for survey practice and suggestions for future research. This study examined the relationship between loneliness, health, and mortality using a U.S. nationally representative sample of 2101 adults aged 50 years and over from the 2002 to 2008 waves of the Health and Retirement Study. We estimated the effect of loneliness at one point on mortality over the subsequent six years, and investigated social relationships, health behaviors, and health outcomes as potential mechanisms through which loneliness affects mortality risk among older Americans. We operationalized health outcomes as depressive symptoms, self-rated health, and functional limitations, and we conceptualized the relationships between loneliness and each health outcome as reciprocal and dynamic. We found that feelings of loneliness were associated with increased mortality risk over a 6-year period, and that this effect was not explained by social relationships or health behaviors but was modestly explained by health outcomes. In cross-lagged panel models that tested the reciprocal prospective effects of loneliness and health, loneliness both affected and was affected by depressive symptoms and functional limitations over time, and had marginal effects on later self-rated health. These population-based data contribute to a growing literature indicating that loneliness is a risk factor for morbidity and mortality and point to potential mechanisms through which this process works. BACKGROUND: Loneliness is a common source of distress, suffering, and impaired quality of life in older persons. We examined the relationship between loneliness, functional decline, and death in adults older than 60 years in the United States. METHODS: This is a longitudinal cohort study of 1604 participants in the psychosocial module of the Health and Retirement Study, a nationally representative study of older persons. Baseline assessment was in 2002 and follow-up assessments occurred every 2 years until 2008. Subjects were asked if they (1) feel left out, (2) feel isolated, or (3) lack companionship. Subjects were categorized as not lonely if they responded hardly ever to all 3 questions and lonely if they responded some of the time or often to any of the 3 questions. The primary outcomes were time to death over 6 years and functional decline over 6 years on the following 4 measures: difficulty on an increased number of activities of daily living (ADL), difficulty in an increased number of upper extremity tasks, decline in mobility, or increased difficulty in stair climbing. Multivariate analyses adjusted for demographic variables, socioeconomic status, living situation, depression, and various medical conditions. RESULTS: The mean age of subjects was 71 years. Fifty-nine percent were women; 81% were white, 11%, black, and 6%, Hispanic; and 18% lived alone. Among the elderly participants, 43% reported feeling lonely. Loneliness was associated with all outcome measures. Lonely subjects were more likely to experience decline in ADL (24.8% vs 12.5%; adjusted risk ratio [RR], 1.59; 95% CI, 1.23-2.07); develop difficulties with upper extremity tasks (41.5% vs 28.3%; adjusted RR, 1.28; 95% CI, 1.08-1.52); experience decline in mobility (38.1% vs 29.4%; adjusted RR, 1.18; 95% CI, 0.99-1.41); or experience difficulty in climbing (40.8% vs 27.9%; adjusted RR, 1.31; 95% CI, 1.10-1.57). Loneliness was associated with an increased risk of death (22.8% vs 14.2%; adjusted HR, 1.45; 95% CI, 1.11-1.88). CONCLUSION: Among participants who were older than 60 years, loneliness was a predictor of functional decline and death. BACKGROUND AND PURPOSE: Memory impairment is a predictor and a consequence of stroke, but memory decline is common even in healthy elderly individuals. We compared the long-term trajectory of memory functioning before and after stroke with memory change in stroke-free elderly individuals. METHODS: Health and Retirement Study participants aged 50 years and older (n=17 340) with no stroke history at baseline were interviewed biennially up to 10 years for first self-reported or proxy-reported stroke (n=1574). Age-, sex-, and race-adjusted segmented linear regression models were used to compare annual rates of change in a composite memory score before and after stroke among 3 groups: 1189 stroke survivors; 385 stroke decedents; and 15 766 cohort members who remained stroke-free. RESULTS: Before stroke onset, individuals who later survived stroke had significantly (P<0.001) faster average annual rates of memory decline (-0.143 points per year) than those who remained stroke-free throughout follow-up (-0.101 points per year). Stroke decedents had even faster prestroke memory decline (-0.212 points per year). At stroke onset, memory declined an average of -0.369 points among stroke survivors, comparable with 3.7 years of age-related decline in stroke-free cohort members. After stroke, memory in stroke survivors continued to decline at -0.142 points per year, similar to their prestroke rates (P=0.93). Approximately 50% of the memory difference between stroke survivors soon after stroke and age-matched stroke-free individuals was attributable to prestroke memory. CONCLUSIONS: Although stroke onset induced large decrements in memory, memory differences were apparent years before stroke. Memory declines before stroke, especially among those who did not survive the stroke, were faster than declines among stroke-free adults. OBJECTIVE: To examine the measurement equivalence of items on disability across three international surveys of aging. METHOD: Data for persons aged 65 and older were drawn from the Health and Retirement Survey (HRS, n = 10,905), English Longitudinal Study of Aging (ELSA, n = 5,437), and Survey of Health, Ageing and Retirement in Europe (SHARE, n = 13,408). Differential item functioning (DIF) was assessed using item response theory (IRT) methods for activities of daily living (ADL) and instrumental activities of daily living (IADL) items. RESULTS: HRS and SHARE exhibited measurement equivalence, but 6 of 11 items in ELSA demonstrated meaningful DIF. At the scale level, this item-level DIF affected scores reflecting greater disability. IRT methods also spread out score distributions and shifted scores higher (toward greater disability). Results for mean disability differences by demographic characteristics, using original and DIF-adjusted scores, were the same overall but differed for some subgroup comparisons involving ELSA. DISCUSSION: Testing and adjusting for DIF is one means of minimizing measurement error in cross-national survey comparisons. IRT methods were used to evaluate potential measurement bias in disability comparisons across three international surveys of aging. The analysis also suggested DIF was mitigated for scales including both ADL and IADL and that summary indexes (counts of limitations) likely underestimate mean disability in these international populations. OBJECTIVES: Using data from the national Health and Retirement Study, we sought to: (a) estimate the proportion of the US adults with diabetes above the age of 50 who do not meet physical activity guidelines but believe they are sufficiently active; and (b) examine demographic and health-related correlates of such "overestimation." RESEARCH DESIGN: Respondents who were classified as underactive according to a detailed activity inventory but reported exercising at least the "right amount," were designated as overestimating their physical activity. Multiple logistic regression was used to examine the association of demographic and health-related correlates with the odds of overestimation. RESULTS: Fifty-four percent of the survey sample did not meet physical activity guidelines, and one quarter of this underactive group overestimated their physical activity. The adjusted odds of overestimation were higher among respondents who held the perception that they were about the right weight or underweight [odds ratio (OR)=2.42; 95% confidence interval (CI), 1.49-3.94), who had good or better self-assessed diabetes control (OR=1.84; 95% CI, 1.12-3.04), and who were Black or Hispanic (OR=1.89; 95% CI, 1.13-3.16). Experiencing shortness of breath reduced the odds of overestimation (OR=0.34; 95% CI, 0.19-0.61). CONCLUSIONS: Overestimation of physical activity is common among adults with diabetes, and is associated with the perceptions that one is about the right weight and that one has good control of diabetes, and with being Black or Hispanic. Clinicians should be aware that these factors may affect their patients' beliefs about how much physical activity is adequate. BACKGROUND: Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims. METHODS AND RESULTS: Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged ≥ 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6%. Self-report of HF and claims agreement was 87% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with ≥ 4 HF claims (OR, 2.74; 95% CI, 1.36-5.52). Blacks (OR, 0.28; 95% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model. CONCLUSIONS: Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis. BACKGROUND: Restless legs syndrome (RLS) is a common condition associated with decreased quality of life in older adults. This study estimates the prevalence, risk factors, and functional correlates of among U.S. elders. METHODS: Subjects (n = 1,008) were sub-sampled from the 2002 cross-sectional interview survey of the Health and Retirement Study (HRS), a nationally representative study of U.S. elders. Symptoms and sleep disturbances consistent with RLS were identified. Activities of daily living (ADL), instrumental activities of daily living (IADL), and limitations for mobility, large muscle groups, gross and fine motor function were measured using standardized questions. Incident functional limitations were detected over six years of observation. RESULTS: The prevalence of RLS among U.S. elders born before 1947 was 10.6%. Factors associated with increased prevalence RLS at baseline included: overweight body mass index (multivariate adjusted prevalence ratio = 1.77; 95% confidence interval (CI) 1.05-2.99); mild-to-moderate pain (2.67, 1.47-4.84) or pain inferring with activity (3.44, 2.00-5.93); three or more chronic medications (2.54, 1.26-5.12), highest quartile of out-of-pocket medical expenses (2.12, 1.17-3.86), frequent falls (2.63, 1.49-4.66), health limiting ability to work (2.91, 1.75-4.85), or problems with early waking or frequent wakening (1.69, 1.09-2.62 and 1.55, 1.00-2.41, respectively). Current alcohol consumption (0.59, 0.37-0.92) and frequent healthcare provider visits (0.49, 0.27-0.90) were associated with decreased RLS prevalence. RLS did not predict incident disability for aggregate measures but was associated with increased risk for specific limitations, including: difficulty climbing several stair flights (multivariate-adjusted hazard ratio = 2.38, 95% CI 1.39-4.06), prolonged sitting (2.17, 1.25-3.75), rising from a chair (2.54, 1.62-3.99), stooping (2.66, 1.71-4.15), moving heavy objects (1.79, 1.08-2.99), carrying ten pounds (1.61, 1.05-2.97), raising arms (1.76, 1.05-2.97), or picking up a dime (1.97, 1.12-3.46). CONCLUSIONS: RLS sufferers are more likely to have functional disability, even after adjusting for health status and pain syndrome correlates. 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. Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population's socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process. OBJECTIVE: To examine the relationship of social isolation, loneliness and health outcomes among older adults. METHODS: Using data from the Leave Behind Questionnaire of the Health and Retirement Study (2006 and 2008), (n = 11,825) several indicators of social isolation were scaled and the Hughes 3-Item Loneliness Scale was used. Two measures of health (self-rated health and mental health conditions) were examined using logistic regression. RESULTS: Loneliness and social isolation were not highly correlated with one another (r = 0.201, p = 0.000). Loneliness was associated with higher odds of having a mental health problem (OR: 1.17; CI: [1.13, 1.21], p = 0.000); and isolation was associated with higher odds of reporting one's health as being fair/poor (OR:1.39; CI: [1.21, 1.59], p = 0.000). DISCUSSION: The results suggest that global measures of isolation, that fail to distinguish between social isolation and feelings of loneliness, may not detect the impact on physical and mental health in older adults. BACKGROUND: Caring for one's spouse has been associated with poor health, including risk of cardiovascular disease (CVD) onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults. METHODS: Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n = 5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (IADLs) 14+ h/week; we define providing ≥14 h/week of care at two consecutive biennial surveys as "long-term caregiving." We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs. RESULTS: After adjusting for demographic, socioeconomic, and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (risk ratio (RR) = 1.36, 95% confidence interval (CI): 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR = 2.29, 95% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings. CONCLUSIONS: Providing IADL care to a spouse significantly predicted hypertension onset in a nationally representative sample of US adults. RATIONALE: Survivors of critical illness suffer significant limitations and disabilities. OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs. METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory. MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls. CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions. 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. 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. BACKGROUND: Peripheral neuropathy is a common disorder in which an extensive evaluation is often unrevealing. METHODS: We sought to define diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care. The 1996-2007 Health and Retirement Study Medicare claims-linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months. Focusing on 15 relevant tests, we examined the number and patterns of tests and specific test utilization 6 months before and after the incident neuropathy diagnosis. Medicare expenditures were assessed during the baseline, diagnostic, and follow-up periods. RESULTS: Of the 12, 673 patients, 1031 (8.1%) received a new International Classification of Diseases, Ninth Revision, diagnosis of neuropathy and met the study inclusion criteria. Of the 15 tests considered, a median of 4 (interquartile range, 2-5) tests were performed, with more than 400 patterns of testing. Magnetic resonance imaging of the brain or spine was ordered in 23.2% of patients, whereas a glucose tolerance test was rarely obtained (1.0%). Mean Medicare expenditures were significantly higher in the diagnostic period than in the baseline period ($14,362 vs $8067, P < .001). CONCLUSIONS: Patients diagnosed as having peripheral neuropathy typically undergo many tests, but testing patterns are highly variable. Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests. Expenditures increase substantially in the diagnostic period. More research is needed to define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy. BACKGROUND: The rate of hospitalization for venous thromboembolism (VTE) is increasing in the United States. Although predictors of hospital-acquired VTE are well-known, triggers of VTE before hospitalization are not as clearly defined. The objective of this study was to evaluate triggers of hospitalization for VTE. METHODS AND RESULTS: A case-crossover study was conducted. Subjects were participants in the Health and Retirement Study, a nationally representative sample of older Americans. Data were linked to Medicare files for hospital and nursing home stays, emergency department visits, outpatient visits including physician visits, and home health visits from years 1991 to 2007 (n=16 781). The outcome was hospitalization for venous thromboembolism (n=399). Exposures during the 90-day period before hospitalization for VTE were compared with exposures occurring in 4 comparison periods. Infection was the most common trigger of hospitalization for VTE, occurring in 52.4% of the risk periods before hospitalization. The adjusted incidence rate ratios (IRRs; 95% confidence interval) were 2.90 (2.13, 3.94) for all infection, 2.63 (1.90, 3.63) for infection without a previous hospital or skilled nursing facility stay, and 6.92 (4.46, 10.72) for infection with a previous hospital or skilled nursing facility stay. Erythropoiesis-stimulating agents and blood transfusion were also associated with VTE hospitalization (IRR=9.33, 95% confidence interval: 1.19, 73.42; IRR=2.57, 95% confidence interval: 1.17, 5.64; respectively). Other predictors included major surgeries, fractures (IRR=2.81), immobility (IRR=4.23), and chemotherapy (IRR=5.70). These predictors, combined, accounted for a large proportion (69.7%) of exposures before VTE hospitalization as opposed to 35.3% in the comparison periods. CONCLUSIONS: Risk prediction algorithms for VTE should be reevaluated to include infection, erythropoiesis-stimulating agents, and blood transfusion. OBJECTIVES: We investigate cross-national differences in late-life health outcomes and focus on an intriguing difference in beliefs about personal control found between older adult populations in the U.K. and United States. We examine the moderating role of control beliefs in the relationship between physical function and self-reported difficulty with daily activities. METHOD: Using national data from the United States (Health and Retirement Study) and England (English Longitudinal Study on Ageing), we examine the prevalence in disability across the two countries and show how it varies according to the sense of control. Poisson regression was used to examine the relationship between objective measures of physical function (gait speed) and disability and the modifying effects of control. RESULTS: Older Americans have a higher sense of personal control than the British, which operates as a psychological resource to reduce disability among older Americans. However, the benefits of control are attenuated as physical impairments become more severe. DISCUSSION: These results emphasize the importance of carefully considering cross-national differences in the disablement process as a result of cultural variation in underlying psychosocial resources. This paper highlights the role of culture in shaping health across adults aging in different sociopolitical contexts. OBJECTIVES: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]). METHODS: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS. RESULTS: The cognitive tests in HRS predict the ADAMS diagnosis in 74% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84% and 93%, respectively. DISCUSSION: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function. Survey response rates are an important measure of the quality of a survey; this is true for both longitudinal and cross-sectional surveys. However, the concept of a response rate in the context of a panel survey is more complex than is the case for a cross-sectional survey. There are typically many different response rates that can be calculated for a panel survey, each of which may be relevant for a specific purpose. The main objective of our paper is to document and compare response rates for two long-term panel studies of ageing, the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) in the United States. To guide our selection and calculation of response rates for the two studies, we use a framework that was developed by Peter Lynn (2005) and present several different types of longitudinal response rates for the two surveys. We discuss similarities and differences in the study designs and protocols and how some of the differences affect comparisons of response rates across the two studies. 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. Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinical markers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data sets - the Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA - in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences. BACKGROUND: Differences in functional limitations between adults with and without diabetes are more evident in women than they are in men. PURPOSE: This study aims to investigate if there are gender differences in biological, behavioral, and psychosocial variables, and how these gender-related variables explain the gender-functional limitations relationship in adults with type 2 diabetes. METHODS: We drew data on 1,619 adults with type 2 diabetes from the Health and Retirement Study and its diabetes-specific mail survey. The fit of a series of mediation models to the data was assessed by structural equation modeling. RESULTS: Although women had better diet and blood glucose self-monitoring behaviors than did men, they reported less favorable body mass index, glycosylated hemoglobin (HbA1c) value, blood pressure, early complications, exercise behaviors, perceived control, self-efficacy, coping, depressive symptoms, and family support than did men. Psychosocial factors made an indirect contribution in the gender-functional limitations relationship by way of their strong association with biological and behavioral factors, two factors that directly and completely mediated the gender-functional limitations relationship. CONCLUSIONS: Interventions promoting psychosocial well-being and empowering perceived diabetes control, coping, and self-efficacy in women with type 2 diabetes may help improve biological and behavioral determinants, and further, their long-term functional health. BACKGROUND: We examine gender differences in health at ages 50 years and older in 11 European countries, England and the USA. METHODS: We use the Survey of Health, Ageing and Retirement (SHARE) for 11 Continental European countries; the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) for the USA to examine gender differences in health behaviours, functioning problems, disability, disease prevalence and self-rated health. RESULTS: Women in all countries are more likely than men to have disabling, non-lethal conditions including functioning problems [odds ratio (OR) indicating the effect of female is 1.57-2.43], IADL difficulties (OR 1.45-2.94), arthritis (OR 1.46-2.90) and depressive symptoms (OR 1.45-3.35). On the other hand, self-reported heart disease is more common among men (OR indicating effect of female ranges from 0.43 to 0.86). These differences are not eliminated by controlling for smoking behaviour and weight. Self-reported hypertension (OR 0.72-1.53) is generally more common among women; stroke and diabetes do not show consistent sex differences. While subjective assessment of health is poorer among women, this is not true when indicators of functioning, disability and diseases are controlled. CONCLUSION: There is remarkable consistency in direction of gender differences in health across these 13 countries. The size of the differences is affected in many cases by the similarity in behaviours of men and women. BACKGROUND: Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions. OBJECTIVE: To investigate the prevalence and incidence of geriatric conditions in middle-aged and older-aged adults with diabetes. DESIGN: Secondary analysis of nationally-representative, longitudinal health interview survey data (Health and Retirement Study waves 2004 and 2006). PARTICIPANTS: Respondents 51 years and older in 2004 (n=18,908). MAIN MEASURES: Diabetes mellitus. Eight geriatric conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment, pain. KEY RESULTS: Adults with diabetes, compared to those without, had increased prevalence and increased incidence of geriatric conditions across the age spectrum (p< 0.01 for each age group from 51-54 years old to 75-79 years old). Differences between adults with and without diabetes were most marked in middle-age. Diabetes was associated with the two-year cumulative incidence of acquiring new geriatric conditions (odds ratio, 95% confidence interval: 1.8, 1.6-2.0). A diabetes-age interaction was discovered: as age increased, the association of diabetes with new geriatric conditions decreased. CONCLUSIONS: Middle-aged, as well as older-aged, adults with diabetes are at increased risk for the development of geriatric conditions, which contribute substantially to their morbidity and functional impairment. Our findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than previously thought. OBJECTIVES: We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status. METHODS: We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates. RESULTS: We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods. CONCLUSIONS: Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health. 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. 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. PURPOSE: This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education. DESIGN AND METHODS: Data were examined on 20,433 adults aged 51 and older from the 1998 to 2006 Health and Retirement Study. Multilevel models and a cohort-sequential design were applied to quantitatively depict the age norm of physical disability after age 50. RESULTS: Adults with diabetes not only experience greater levels of physical disability but also faster rates of deterioration over time. This pattern is net of attrition, time-invariant sociodemographic factors, and time-varying chronic disease conditions. Differences in physical disability between adults with and without diabetes were more pronounced in women, non-White, and those of lower education. The moderating effects of gender and education remained robust even after controlling for selected covariates in the model. IMPLICATIONS: This study highlighted the consistently greater development of disability over time in adults with diabetes and particularly in those who are women, non-White, or adults of lower education. Future studies are recommended to examine the mechanisms underlying the differential effects of diabetes on physical disability by gender and education. 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. 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. 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. OBJECTIVE: This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period. METHOD: Data were taken from the Health and Retirement Study. The study sample included individuals ages 51-61 in 1992 who survived the sample period (1992-2006) and had at least five interviews with alcohol consumption information, yielding an analysis sample of 6,787 (3,760 women). We employed linear regression to determine drinking trajectories over 1992-2006. Based on these findings, each sample person was classified into one of five drinking categories. We used multinomial logit analysis to assess the relationship between personal demographic, income, health, and attitudinal characteristics as well as life events and drinking-trajectory category. RESULTS: Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09, 95% CI [1.05, 1.12]), highly educated (RRR = 1.20, 95% CI [1.09, 1.31]), male, White (RRR = 3.54, 95% CI [1.01, 12.39]), unmarried, less religious, and in excellent to good health. A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems. CONCLUSIONS: There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life. We examine the consequences of child health for economic and health outcomes in adulthood, using height as a marker of childhood health. After reviewing previous evidence, we present a conceptual framework that highlights data limitations and methodological problems that complicate the study of this topic. We then present estimates of the associations between height and a range of outcomes--including schooling, employment, earnings, health, and cognitive ability--measured in five data sets from early to late adulthood. These results indicate that, on average, taller individuals attain higher levels of education. Height is also positively associated with better economic, health, and cognitive outcomes. These associations are only partially explained by the higher average educational attainment of taller individuals. We then use data from the National Longitudinal Survey of Youth 1979 Children and Young Adults survey to document the associations between health, cognitive development, and growth in childhood. Even among children with the same mother, taller siblings score better on cognitive tests and progress through school more quickly. Part of the differences found between siblings arises from differences in their birth weights and lengths attributable to mother's behaviors while pregnant. Taken together, these results support the hypothesis that childhood health influences health and economic status throughout adulthood. BACKGROUND: Collecting physical measurements in population-based health surveys has increased in recent years, yet little is known about the characteristics of those who consent to these measurements. OBJECTIVE: To examine the characteristics of persons who consent to physical measurements across several domains, including one's demographic background, health status, resistance behavior toward the survey interview, and interviewer characteristics. RESEARCH DESIGN, SUBJECTS, AND MEASURES: We conducted a secondary data analysis of the 2006 Health and Retirement Study, a nationally-representative panel survey of older adults aged 51 and older. We performed multilevel logistic regressions on a sample of 7457 respondents who were eligible for physical measurements. The primary outcome measure was consent to all physical measurements. RESULTS: Seventy-nine percent (unweighted) of eligible respondents consented to all physical measurements. In weighted multilevel logistic regressions controlling for respondent demographics, current health status, survey resistance indicators, and interviewer characteristics, the propensity to consent was significantly greater among Hispanic respondents matched with bilingual Hispanic interviewers, patients with diabetes, and those who visited a doctor in the past 2 years. The propensity to consent was significantly lower among younger respondents, those who have several Nagi functional limitations and infrequently participate in "mildly vigorous" activities, and those interviewed by black interviewers. Survey resistance indicators, such as number of contact attempts and interviewer observations of resistant behavior in prior wave iterations of the Health and Retirement Study were also negatively associated with physical measurement consent. The propensity to consent was unrelated to prior medical diagnoses, including high blood pressure, cancer (excluding skin), lung disease, heart abnormalities, stroke, and arthritis, and matching of interviewer and respondent on race and gender. CONCLUSIONS: Physical measurement consent is not strongly associated with one's health status, though the findings are somewhat mixed. We recommend that physical measurement results be adjusted for characteristics associated with the likelihood of consent, particularly functional limitations, to reduce potential bias. Otherwise, health researchers should exercise caution when generalizing physical measurement results to the population at large, including persons with functional limitations that may affect their participation. BACKGROUND: Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions. OBJECTIVE: To investigate how many older and middle-aged adults with diabetes have such health status characteristics. DESIGN: Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey. SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million). MEASUREMENTS: Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c. RESULTS: Nearly 22% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6% vs. 7.3%, P < 0.04.). CONCLUSIONS: Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups. BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality. METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met. RESULTS: Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care, whereas 31%, 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure). CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality. The present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific. BACKGROUND: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization. METHODS: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity. RESULTS: Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001). CONCLUSIONS: We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization. OBJECTIVES: 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). METHODS: 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. We also estimate a multivariate model controlling for potentially confounding variables. RESULTS: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage. CONCLUSIONS: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans. OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS). METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables. RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status. CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees. OBJECTIVE: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS). METHODS: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables. RESULTS: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate. CONCLUSIONS: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables. OBJECTIVES: To determine whether middle-aged persons with depressive symptoms are at higher risk for developing activity of daily living (ADL) and mobility limitations as they advance into older age than those without. DESIGN: Prospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative sample of people aged 50 to 61. PARTICIPANTS: Seven thousand two hundred seven community living participants in the 1992 wave of the HRS. MEASUREMENTS: Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D 11), with scores of 9 or more (out of 33) classified as significant depressive symptoms. Difficulty with five ADLs and basic mobility tasks (walking several blocks or up one flight of stairs) was measured every 2 years through 2006. The primary outcome was persistent difficulty with ADLs or mobility, defined as difficulty in two consecutive waves. RESULTS: Eight hundred eighty-seven (12%) subjects scored 9 or higher on the CES-D 11 and were classified as having significant depressive symptoms. Over 12 years of follow-up, subjects with depressive symptoms were more likely to reach the primary outcome measure of persistent difficulty with mobility or difficulty with ADL function (45% vs 23%, Cox hazard ratio (HR)=2.33, 95% confidence interval (CI)=2.06-2.63). After adjusting for age, sex, measures of socioeconomic status, comorbid conditions, high body mass index, smoking, exercise, difficulty jogging 1 mile, and difficulty climbing several flights of stairs, the risk was attenuated but still statistically significant (Cox HR=1.44, 95% CI=1.25-1.66). CONCLUSION: Depressive symptoms independently predict the development of persistent limitations in ADLs and mobility as middle-aged persons advance into later life. Middle-aged persons with depressive symptoms may be at greater risk for losing their functional independence as they age. OBJECTIVE: We examine the financial impact of major illnesses on the near-elderly and how this impact is affected by health insurance. DATA SOURCES: We use RAND Corporation extracts from the Health and Retirement Study from 1992 to 2006.(1) STUDY DESIGN: Our dependent variable is the change in household assets, excluding the value of the primary home. We use triple difference median regressions on a sample of newly ill/uninsured near elderly (under age 65) matched to newly ill/insured near elderly. We also include a matched control group of households whose members are not ill. RESULTS: Controlling for the effects of insurance status and illness, we find that the median household with a newly ill, uninsured individual suffers a statistically significant decline in household assets of between 30 and 50 percent relative to households with matched insured individuals. Newly ill, insured individuals do not experience a decline in wealth. CONCLUSIONS: Newly ill/uninsured households appear to be one illness away from financial catastrophe. Newly ill insured households who are matched to uninsured households appear to be protected against financial loss, at least in the near term. BACKGROUND: The epidemiology of pain during the last years of life has not been well described. OBJECTIVE: To describe the prevalence and correlates of pain during the last 2 years of life. DESIGN: Observational study. Data from participants who died while enrolled in the Health and Retirement Study were analyzed. The survey interview closest to death was used. Each participant or proxy was interviewed once in the last 24 months of life and was classified into 1 of 24 cohorts on the basis of the number of months between the interview and death. The relationship between time before death and pain was modeled and was adjusted for age, sex, race or ethnicity, education level, net worth, income, terminal diagnosis category, presence of arthritis, and proxy status. SETTING: The Health and Retirement Study, a nationally representative survey of community-living older adults (1994 to 2006). PARTICIPANTS: Older adult decedents. MEASUREMENTS: Clinically significant pain, as indicated by a report that the participant was "often troubled" by pain of at least moderate severity. RESULTS: The sample included 4703 decedents. Mean age (SD) of participants was 75.7 years (SD, 10.8); 83.1% were white, 10.7% were black, 4.7% were Hispanic; and 52.3% were men. The adjusted prevalence of pain 24 months before death was 26% (95% CI, 23% to 30%). The prevalence remained flat until 4 months before death (28% [CI, 25% to 32%]), then it increased, reaching 46% (CI, 38% to 55%) in the last month of life. The prevalence of pain in the last month of life was 60% among patients with arthritis versus 26% among patients without arthritis (P < 0.001) and did not differ by terminal diagnosis category (cancer [45%], heart disease [48%], frailty [50%], sudden death [42%], or other causes [47%]; P = 0.195). LIMITATION: Data are cross-sectional; 19% of responses were from proxies; and information about cause, location, and treatment of pain was not available. CONCLUSION: Although the prevalence of pain increases in the last 4 months of life, pain is present in more than one quarter of elderly persons during the last 2 years of life. Arthritis is strongly associated with pain at the end of life. PRIMARY FUNDING SOURCE: National Institute on Aging, National Center for Research Resources, National Institute on Musculoskeletal and Skin Diseases, and National Palliative Care Research Center. INTRODUCTION: Few studies have prospectively assessed the explanatory effects of demographics, clinical conditions, treatment modality, and general lifestyle behaviors on glycemic control in large heterogeneous samples of middle-aged and older adults with type 2 diabetes. We hierarchically examined these factors, focused especially on the effects of modifiable factors (ie, general lifestyle behaviors), and compared predictive patterns between middle-aged and older adults. METHODS: We used nationally representative data from the 1998 and 2000 Health and Retirement Study (HRS) and the HRS 2003 Diabetes Study. We analyzed data from 379 middle-aged adults (aged 51-64 y) and 430 older adults (aged >or=65 y) who self-reported having type 2 diabetes at baseline. RESULTS: Among middle-aged adults, demographic factors and clinical conditions were the strongest predictors of hemoglobin A1c (HbA1c) levels. However, among older adults, treatment modality (diet only, oral medication, or insulin only or in combination with other regimens) significantly affected HbA1c levels. Lifestyle (physical activity, smoking, drinking, and body weight control), independent of the effects of demographics, clinical conditions, and treatment modality, significantly affected HbA1c levels. An increase of 1 healthy behavior was associated with a decrease in HbA1c levels of more than 1 percentage point. CONCLUSION: Our findings provide support for current diabetes guidelines that recommend a lifestyle regimen across the entire span of diabetes care and highlight the need to help both sociodemographically and clinically disadvantaged middle-aged adults with type 2 diabetes as well as older adults who exhibit poor adherence to medication recommendations to achieve better glycemic control. CONTEXT: It is well-documented that the financial burden of out-of-pocket expenditures for prescription drugs often leads people with medication-sensitive chronic illnesses to restrict their use of these medications. Less is known about the extent to which such cost-related medication underuse is associated with increases in subsequent hospitalizations and deaths. OBJECTIVE: We compared the risk of hospitalizations among 5401 and of death among 6135 middle-aged and elderly adults with one or more cardiovascular diseases (diabetes, coronary artery disease, heart failure, and history of stroke) according to whether participants did or did not report restricting prescription medications because of cost. DESIGN AND SETTING: A retrospective biannual cohort study across 4 cross-sectional waves of the Health and Retirement Study, a nationally representative survey of adults older than age 50. Using multivariate logistic regression to adjust for baseline differences in sociodemographic and health characteristics, we assessed subsequent hospitalizations and deaths between 1998 and 2006 for respondents who reported that they had or had not taken less medicine than prescribed because of cost. RESULTS: Respondents with cardiovascular disease who reported underusing medications due to cost were significantly more likely to be hospitalized in the next 2 years, even after adjusting for other patient characteristics (adjusted predicted probability of 47% compared with 38%, P < 0.001). The more survey waves respondents reported cost-related medication underuse during 1998 to 2004, the higher the probability of being hospitalized in 2006 (adjusted predicted probability of 54% among respondents reporting cost-related medication underuse in all 4 survey waves compared with 42% among respondents reporting no underuse, P < 0.001). There was no independent association of cost-related medication underuse with death. CONCLUSIONS: In this nationally representative cohort, middle-aged and elderly adults with cardiovascular disease who reported cutting back on medication use because of cost were more likely to report being hospitalized over a subsequent 2-year period after they had reported medication underuse. The more extensively respondents reported cost-related underuse over time, the higher their adjusted predicted probability of subsequent hospitalization. OBJECTIVES: We evaluated mammography rates for cognitively impaired women in the context of their life expectancies, given that guidelines do not recommend screening mammography in women with limited life expectancies because harms outweigh benefits. METHODS: We evaluated Medicare claims for women aged 70 years or older from the 2002 wave of the Health and Retirement Study to determine which women had screening mammography. We calculated population-based estimates of 2-year screening mammography prevalence and 4-year survival by cognitive status and age. RESULTS: Women with severe cognitive impairment had lower rates of mammography (18%) compared with women with normal cognition (45%). Nationally, an estimated 120,000 screening mammograms were performed among women with severe cognitive impairment despite this group's median survival of 3.3 years (95% confidence interval = 2.8, 3.7). Cognitively impaired women who had high net worth and were married had screening rates approaching 50%. CONCLUSIONS: Although severe cognitive impairment is associated with lower screening mammography rates, certain subgroups with cognitive impairment are often screened despite lack of probable benefit. Given the limited life expectancy of women with severe cognitive impairment, guidelines should explicitly recommend against screening these women. OBJECTIVES: To describe lengths of stay of nursing home decedents. DESIGN: Retrospective cohort study. SETTING: The Health and Retirement Study (HRS), a nationally representative survey of U.S. adults aged 50 and older. PARTICIPANTS: One thousand eight hundred seventeen nursing home residents who died between 1992 and 2006. MEASUREMENTS: The primary outcome was length of stay, defined as the number of months between nursing home admission and date of death. Covariates were demographic, social, and clinical factors drawn from the HRS interview conducted closest to the date of nursing home admission. RESULTS: The mean age of decedents was 83.3 ± 9.0; 59.1% were female, and 81.5% were white. Median and mean length of stay before death were 5 months (interquartile range 1-20) and 13.7 ± 18.4 months, respectively. Fifty-three percent died within 6 months of placement. Large differences in median length of stay were observed according to sex (men, 3 months vs women, 8 months) and net worth (highest quartile, 3 months vs lowest quartile, 9 months) (all P <.001). These differences persisted after adjustment for age, sex, marital status, net worth, geographic region, and diagnosed chronic conditions (cancer, hypertension, diabetes mellitus, lung disease, heart disease, and stroke). CONCLUSION: Nursing home lengths of stay are brief for the majority of decedents. Lengths of stay varied markedly according to factors related to social support. As a social species, humans rely on a safe, secure social surround to survive and thrive. Perceptions of social isolation, or loneliness, increase vigilance for threat and heighten feelings of vulnerability while also raising the desire to reconnect. Implicit hypervigilance for social threat alters psychological processes that influence physiological functioning, diminish sleep quality, and increase morbidity and mortality. The purpose of this paper is to review the features and consequences of loneliness within a comprehensive theoretical framework that informs interventions to reduce loneliness. We review physical and mental health consequences of loneliness, mechanisms for its effects, and effectiveness of extant interventions. Features of a loneliness regulatory loop are employed to explain cognitive, behavioral, and physiological consequences of loneliness and to discuss interventions to reduce loneliness. Loneliness is not simply being alone. Interventions to reduce loneliness and its health consequences may need to take into account its attentional, confirmatory, and memorial biases as well as its social and behavioral effects. OBJECTIVE: To determine associations between changes in obesity and vigorous physical activity (PA) status and depressive symptoms in a cohort aged 51 to 61 years at baseline. METHOD: Two waves (1992, 1998) of Health and Retirement Study data were used to divide participants into four obesity and four vigorous PA status categories based on change in or maintenance of their 1992 status in 1998. Depressive symptoms were defined as the upper quintile score (women >/= 4, men >/= 3) on the eight-item Center for Epidemiologic Studies-Depression Scale. Logistic regression determined adjusted odds ratios for depressive symptoms associated with obesity and vigorous PA status. RESULTS: Among men, no significant associations were found. Among women, decreasing from high vigorous PA status and maintenance of obese status were independently associated with increased odds for depressive symptoms in 1998. DISCUSSION: The findings illustrate the importance of examining gender differences in studies of risk factors for depression. OBJECTIVE: This study examined the relationship between older adults' expectations to move and actual residential relocation in the community or to a nursing facility within 2 years. METHOD: Two waves of data (2000, 2002) from the Health and Retirement Study were used to compare expectations with subsequent moves. Logistic regression techniques were used to analyze the association between decision outcomes and expectations to move, health and functioning, physical environment, informal supports, and formal services. RESULTS: Findings indicated that expectations to move did predict community-based moves but did not predict moves to nursing facilities. Additional factors had significant effects but did not diminish relationships between expectations and actual moves. DISCUSSION: Results support the residential decision process as a dynamic one based on the cumulative effect of factors from an ecological model. Findings will inform policy makers and practitioners as they work to support older adults' preferences to remain living in their homes. BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old. METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect. RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8%) suffered postbaseline heart attacks, with 423 participants (7.7%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented. OBJECTIVES: We investigated the longitudinal association between depressive symptoms and glycemic control (HbA1c) in adults with type 2 diabetes, and the extent to which that association was explained by health behaviors. METHODS: This study assessed data on 998 adults (aged 51 and above) with type 2 diabetes in the US nationally representative Health and Retirement Study and its diabetes-specific mail survey. Participants' depressive symptoms and baseline health behaviors (exercise, body weight control, and smoking status) were collected in 1998. Follow-up health behaviors and the glycemic control outcome were measured at a 2- and 5-year intervals, respectively. RESULTS: Nearly one in four of participants (23%) reported moderate or high levels of depressive symptoms at baseline (CES-D score >or=3). Adults with higher levels of depressive symptoms at baseline showed lower scores on baseline and follow-up health behaviors as well as higher HbA1c levels at a 5-year follow-up. Structural equation models (SEM) reveal that health behaviors accounted for 13% of the link between depressive symptoms and glycemic control. CONCLUSIONS: The long-term relationship between depressive symptoms and glycemic control was supported in the present study. Health behaviors, including exercise, body weight control, and smoking status, explained a sizable amount of the association between depressive symptoms and glycemic control. More comprehensive diabetes self-care behaviors should be examined with available data. Other competing explicators for the link, such as endocrinological process and antidepressant effects, also warrant further examination. OBJECTIVES: To estimate the prevalence of successful aging in the United States, with the broad aim of contributing to the dialogue on Rowe and Kahn's concept of successful aging. METHODS: Using data from the Health and Retirement Study, the prevalence of successful aging was calculated for adults aged 65 years and older at four time points: 1998, 2000, 2002, and 2004. Successful aging was operationalized in accordance with Rowe and Kahn's definition, which encompasses disease and disability, cognitive and physical functioning, social connections, and productive activities. RESULTS: No greater than 11.9% of older adults were aging "successfully" in any year. The adjusted odds of successful aging were generally lower for those of advanced age, male gender, and lower socioeconomic status. Between 1998 and 2004, the odds of successful aging declined by 25%, after accounting for demographic changes in the older population. DISCUSSION: Few older adults meet the criteria put forth in Rowe and Kahn's definition of successful aging, suggesting the need for modification if the concept is to be used for broad public health purposes. Disparities in successful aging were evident for socially defined subgroups, highlighting the importance of structural factors in enabling successful aging. 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. BACKGROUND: 5.8 M living Americans have experienced a stroke at some time in their lives, 780K had either their first or a recurrent stroke this year, and 150K died from strokes this year. Stroke costs about $66B annually in the US, and also results in serious, long-term disability. Therefore, it is prudent to identify all possible risk factors and their effects so that appropriate intervention points may be targeted. METHODS: Baseline (1993-1994) interview data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to 1993-2005 Medicare claims. Participants were 5,511 self-respondents >or= 70 years old. Two ICD9-CM case-identification approaches were used. Two approaches to stroke case-identification based on ICD9-CM codes were used, one emphasized sensitivity and the other emphasized specificity. Participants were censored at death or enrollment into managed Medicare. Baseline risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting post-baseline non-stroke hospitalizations was included to reflect health shocks, and sensitivity analyses were conducted to identify its peak effect. Competing risk, proportional hazards regression was used. RESULTS: Post-baseline strokes occurred for 545 (9.9%; high sensitivity approach) and 374 (6.8%; high specificity approach) participants. The greatest static risks involved increased age, being widowed or never married, living in multi-story buildings, reporting a baseline history of diabetes, hypertension, or stroke, and reporting difficulty picking up a dime, refusing to answer the delayed word recall test, or having poor cognition. Risks were similar for both case-identification approaches and for recurrent and first-ever vs. only first-ever strokes. The time-dependent health shock (recent hospitalization) marker did not alter the static model effect estimates, but increased stroke risk by 200% or more. CONCLUSION: The effect of our health shock marker (a time-dependent recent hospitalization indicator) was large and did not mediate the effects of the traditional risk factors. This suggests an especially vulnerable post-hospital transition period from adverse effects associated with both their underlying health shock (the reasons for the recent hospital admission) and the consequences of their treatments. The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993-2005. There were 495 postbaseline hip fractures among 5,511 respondents aged >or=69 years. Mean age at hip fracture was 85 years; 73% of fracture patients were white women, 45% had pertrochanteric fractures, and 55% underwent surgical pinning. Most patients (58%) were discharged to a nursing facility, with 14% being discharged to their homes. In-hospital, 6-month, and 1-year mortality were 2.7%, 19%, and 26%, respectively. Declines in functional-status-scale scores ranged from 29% on the fine motor skills scale to 56% on the mobility index. Mean scale score declines were 1.9 for activities of daily living, 1.7 for instrumental activities of daily living, and 2.2 for depressive symptoms; scores on mobility, large muscle, gross motor, and cognitive status scales worsened by 2.3, 1.6, 2.2, and 2.5 points, respectively. Hip fracture characteristics, socioeconomic status, and year of fracture were significantly associated with discharge placement. Sex, age, dementia, and frailty were significantly associated with mortality. This is one of the few studies to prospectively capture these declines in functional status after hip fracture. BACKGROUND: A low level of formal education is becoming accepted as a risk factor for Alzheimer's disease (AD). Although increasing attention has been paid to differences in educational quality, no previous studies addressed participants' own characterizations of their overall performance in school. We examined whether self-assessed school performance is associated with AD beyond the effects of educational level alone. METHODS: Participants were drawn from the population-representative Aging, Demographics, and Memory Study (ADAMS, 2000-2002). The ADAMS participants were asked about their performance in school. Possible response options included "above average," "average," or "below average." The ADAMS participants also underwent a full neuropsychological battery, and received a research diagnosis of possible or probable AD. RESULTS: The 725 participants (mean age, 81.8 years; 59% female; 16% African-American) varied in self-assessed educational performance: 29% reported "above average," 64% reported "average," and 7% reported "below average" school performance. Participants with a lower self-assessed school performance had higher proportions of AD: 11% of participants with "above average" self-assessed performance had AD, as opposed to 12% of participants with "average" performance and 26% of participants with "below average" performance (P < 0.001). After controlling for subjects' years in school, a literacy test score (Wide-Range Achievement Test), age, sex, race/ethnicity, apolipoprotein E-epsilon4 status, socioeconomic status, and self-reported comorbidities, respondents with "below average" self-assessed school performance were four times more likely to have AD compared with those of "average" performance (odds ratio, 4.0; 95% confidence interval, 1.2-14). "Above average" and "average" self-assessed school performance did not increase or decrease the odds of having AD (odds ratio, 0.9; 95% confidence interval, 0.5-1.7). CONCLUSIONS: We suggest an association between "below average" self-assessed school performance and AD beyond the known association with formal education. Efforts to increase cognitive reserve through better school performance, in addition to increasing the number of years of formal education in early life, may be important in reducing vulnerability throughout the life course. OBJECTIVES: We assessed the potential health and economic benefits of reducing common risk factors in older Americans. METHODS: A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project their health and medical spending in prevention scenarios for diabetes, hypertension, obesity, and smoking. RESULTS: The gain in life span from successful treatment of a person aged 51 or 52 years for obesity would be 0.85 years; for hypertension, 2.05 years; and for diabetes, 3.17 years. A 51- or 52-year-old person who quit smoking would gain 3.44 years. Despite living longer, those successfully treated for obesity, hypertension, or diabetes would have lower lifetime medical spending, exclusive of prevention costs. Smoking cessation would lead to increased lifetime spending. We used traditional valuations for a life-year to calculate that successful treatments would be worth, per capita, $198,018 (diabetes), $137,964 (hypertension), $118,946 (smoking), and $51,750 (obesity). CONCLUSIONS: Effective prevention could substantially improve the health of older Americans, and--despite increases in longevity--such benefits could be achieved with little or no additional lifetime medical spending. OBJECTIVES: To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model). DESIGN: Cross-sectional analysis. SETTING: 2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey. PARTICIPANTS: Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States. MEASUREMENTS: The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics. RESULTS: Almost one-third (30.2%) of respondents were frail according to at least one model; 3.1% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1% of those classified as frail according to the Biologic Syndrome model and 72.1% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95% confidence interval (CI)=6.1-18.5), female sex (OR=1.7, 95% CI=1.2-2.5), and African-American ethnicity (OR=2.1, % CI=1.0-4.4). CONCLUSION: Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death. OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality. DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS). SETTING: Nationally representative health interview survey. PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older. MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education). RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58% were female, 8% were African American, and 4% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23% had two or more. Of respondents with one condition, 20% to 55% (depending on the index condition) had two or more additional conditions. CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes. OBJECTIVES: We analyzed factors associated with improvement in walking ability among respondents to the nationally representative Health and Retirement Study. METHODS: We analyzed data from 6574 respondents aged 53 years or older who reported difficulty walking several blocks, 1 block, or across the room in 2000 or 2002. We examined associations between improvement (versus no change, deterioration, or death) and baseline health status, chronic conditions, baseline walking difficulty, demographic characteristics, socioeconomic status, and behavioral risk factors. RESULTS: Among the 25% of the study population with baseline walking limitations, 29% experienced improved walking ability, 40% experienced no change in walking ability, and 31% experienced deteriorated walking ability or died. In a multivariate analysis, we found positive associations between walking improvement and more recent onset and more severe walking difficulty, being overweight, and engaging in vigorous physical activity. A history of diabetes, having any difficulty with activities of daily living, and being a current smoker were all negatively associated with improvement in walking ability. After we controlled for baseline health, improvement in walking ability was equally likely among racial and ethnic minorities and those with lower socioeconomic status. CONCLUSIONS: Interventions to reduce smoking and to increase physical activity may help improve walking ability in older Americans. OBJECTIVE: To examine dental insurance transition dynamics in the context of changing employment and retirement status. STUDY DESIGN: Data from the Health and Retirement Study (HRS) were analyzed for individuals 51 years and older between the 2004 and 2006 waves of the HRS. METHODS: The primary focus of the analysis is the relationship between retirement and transitions in dental care coverage. We calculate and present bivariate relationships between dental coverage and retirement status transitions over time and estimate a multivariable model of dental coverage controlling for retirement and other potentially confounding covariates. RESULTS: Older adults are likely to lose their dental coverage on entering retirement compared with those who remain in the labor force between waves of the HRS. While more than half of those persons in the youngest group (51-64 years) were covered over this entire period, two-thirds of those in the oldest group (>or=75 years) were without coverage over the same period. We observe a high percentage of older persons flowing into and out of dental coverage over the period of our study, similar to flows into and out of poverty. CONCLUSIONS: Dental insurance is an important factor in the decision to seek dental care. Yet, no dental coverage is provided by Medicare, which provides medical insurance for almost all Americans 65 years and older. This loss of coverage could lead to distortions in the timing of when to seek care, ultimately leading to worse oral and overall health. This paper assesses the effect of payment caps for Medicare home health care on the use of informal care by older adults with functional limitations. We find that individuals exposed to more restrictive payment caps offset reductions in Medicare home health care with increased informal care, although we only observe this effect for lower-income individuals. This suggests that home care payment restrictions may have increased the caregiving burden on some low-income families, but that many higher-income families were able to either forgo the care or finance it privately. Home care payment policies should recognize these effects, balancing costs of the program with the desire to protect families from the burdens associated with providing informal home care. OBJECTIVES: People who are close to retirement age show the highest rates of weight gain and obesity. We investigate the effect of retirement on the change in body mass index (BMI) in diverse groups varying by wealth status and occupation type. METHODS: Six panels of the Health and Retirement Study (1992-2002) on individuals aged 50-71 were used (N = 37,807). We used fixed-effects regression models with instrumental variables method to estimate the causal effect of retirement on change in the BMI. RESULTS: Retirement leads to modest weight gain, 0.24 BMI on average. Weight gain with retirement was found among people who were already overweight and those with lower wealth retiring from physically demanding occupations. The cumulative effect of aging among people in their 50s, however, outweighs the effect of retirement; the average BMI gain between ages 50 and 60 is 1.30, 5 times the effect of retirement. CONCLUSIONS: Given the increasing number of people approaching retirement age, the population level impact of the weight gain ascribed to retirement on health outcomes and health care system might be significant. Future research should evaluate programs targeted to older adults who are most likely to gain weight with retirement. Two statistical methods were compared to identify key factors associated with long-stay nursing home (LSNH) admission among the U.S. elderly population. Social Work's interest in services to the elderly makes this research critical to the profession. Effectively transitioning the "baby boomer" population into appropriate long-term care will be a great societal challenge. It remains a challenge paramount to the practice of social work. Secondary data analyses using four waves (1995, 1998, 2000, and 2002) of the Health Retirement Study (HRS) coupled with the Assets and Health Dynamics among the Oldest Old (AHEAD) surveys were conducted. Multivariable logistic regression and Cox proportional hazards model were performed and compared. Older age, lower self-perceived health, worse instrumental activities of daily living (IADL), psychiatric problems, and living alone were found significantly associated with increased risk of LSNH admission. In contrast, being female, African American, or Hispanic; owning a home; and having lower level of cognitive impairment reduced the admission risk. Home ownership showed a significant effect in logistic regression, but a marginal effect in the Cox model. The Cox model generally provided more precise parameter estimates than logistic regression. Logistic regression, used frequently in analyses, can provide a good approximation to the Cox model in identifying factors of LSNH admission. However, the Cox model gives more information on how soon the LSNH admission may happen. Our analyses, based on two models, dually identified the factors associated with LSNH admission; therefore, results discussed confidently provide implications for both public and private long-term care policies, as well as improving the assessment capabilities of social work practitioners for development of screening programs among at-risk elderly. Given the predicted surge in this population, significant factors found from this study can be utilized in a strengths-based empowerment approach by social workers to aid in avoiding LSNH utilization. OBJECTIVES: To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations. DESIGN: Prospective cohort. SETTING: The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older. PARTICIPANTS: Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS. MEASUREMENTS: Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure. RESULTS: Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95% confidence interval (CI)=0.40-0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95% CI=0.46-0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95% CI=0.57-0.91). CONCLUSION: Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors. OBJECTIVE: To determine whether Medicare enrollment at age 65 has an effect on the health trajectory of the near-elderly uninsured. DATA SOURCES: Eight biennial waves (1992-2006) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61 year olds and their spouses. STUDY DESIGN: We use a quasi-experimental approach to compare the health effects of insurance for the near-elderly uninsured with previously insured contemporaneous controls. The primary outcome measure is overall self-reported health status combined with mortality (i.e., excellent to very good, good, fair to poor, dead). RESULTS: The change in the trajectory of overall health status for the previously uninsured that can be attributed to Medicare is small and not statistically significant. For every 100 persons in the previously uninsured group, joining Medicare is associated with 0.6 fewer in excellent or very good health (95 percent CI: -4.8, 3.3), 0.3 more in good health (95 percent CI: -3.8, 4.1), 2.5 fewer in fair or poor health (95 percent CI: -7.4, 2.3), and 2.8 more dead (-4.0, 10.0) by age 73. The health trajectory patterns from physician objective health measures are similarly small and not statistically significant. CONCLUSIONS: Medicare coverage at age 65 for the previously uninsured is not linked to improvements in overall health status. 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. Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992-2004). Although class II/III obesity (BMI > or = or = 35.0 kg/m2) increases mortality by 40% in females and 62% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI > or = 35.0) is responsible for approximately 4% of deaths among females and 3% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36% in females and 50% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality. OBJECTIVES: To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age. DESIGN: Cross-sectional study. SETTING: The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older. PARTICIPANTS: Eighteen thousand five hundred thirty-one participants in the 2004 HRS. MEASUREMENTS: Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help). RESULTS: Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37% were able to jog 1 mile, 91% were able to walk several blocks, and 96% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9% were able to jog 1 mile, 50% were able to walk several blocks, and 69% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4% were able to jog 1 mile, 55% were able to walk several blocks, and 72% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95% CI=2.48-3.26, for stair climbing; AOR=3.96, 95% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95% CI=3.71-5.06, for ADL function). CONCLUSION: Subjects with pain develop the functional limitations classically associated with aging at much earlier ages. BACKGROUND: This study examined how physician contacts and hospitalizations vary in relation to cognitive function level among community-residing older adults. METHODS: Analysis of the 1998 wave of the Health and Retirement Survey (HRS) was conducted to create three levels of cognitive function among 6,991 older adults by using direct measures for self-respondents and proxy evaluations. Ordinary least square regression analyses were used to estimate the probability of physician outpatient contacts, number of hospitalizations, and nights hospitalized during the last 2 years. RESULTS: Lower cognitive function level was found to be associated with decreasing levels of physician contacts and increasing levels of hospitalizations as well as nights hospitalized. In addition, lower cognitive function levels were consistently related to a variety of comorbidities. Moreover, many older adults with low cognitive function levels reported or were reported by their proxies as not having a diagnosis of a memory-related disease (MRD). Finally, having a diagnosis of an MRD was found to be associated with more physician contacts but fewer hospital nights compared with those who had never received such a diagnosis. CONCLUSIONS: The findings suggest the need for increased outreach targeted at identification of community-dwelling older adults with decline in cognitive function who are in need of care but are underdiagnosed, underutilize physician care, and are overhospitalized. BACKGROUND: We identified hip fracture risks in a prospective national study. METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included. RESULTS: A total of 495 (8.9%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001). CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates. BACKGROUND: Older adults close to retirement age show the lowest level of physical activity. Changes in lifestyle with retirement may alter physical activity levels. This study investigated whether retirement changes physical activity and how the effect differs by occupation type and wealth level. METHODS: This longitudinal study used the Health and Retirement Study (1996-2002), U.S. population-based data. Analyses were conducted in 2007 and 2008. Physical activity was measured by a composite indicator of participation in either work-related or leisure-time physical activity. Fixed-effects regression models were used to account for confounders and unobserved heterogeneity. The dependent variable was a composite indicator of participation in regular physical activity either at work or during nonworking hours. RESULTS: Physical activity decreased with retirement from a physically demanding job but increased with retirement from a sedentary job. Occupation type interacted with wealth level, with the negative impact on physical activity of retirement exacerbated by lack of wealth and the positive effect of retirement on physical activity enhanced by wealth. CONCLUSIONS: Substantial differences in the effect of retirement on physical activity occurred across subgroups. As the number of people approaching retirement age rapidly increases, findings suggest that a growing segment of the nation's population may not sustain an adequate level of physical activity. 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. 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. 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. 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. BACKGROUND: It is not known how the relationship between weight change and mortality is influenced by initial body mass index (BMI) or the magnitude of weight change. METHODS: We use the nationally representative Health and Retirement Study (n = 13,104; follow-up 1992-2006) and Cox regression analysis to estimate relative mortality risks for 2-year weight change by initial BMI among 50- to-70-year-old Americans. We defined small weight loss or gain as a change of 1-2.9 BMI units and large weight loss or gain as a change of 3-5 BMI units. RESULTS: Large and small weight losses were associated with excess mortality for all initial BMI levels below 32 kg/m (eg, hazard ratio [HR] for large weight loss from BMI of 30 = 1.61 [95% confidence interval = 1.31-1.98]; HR for small weight loss from BMI of 30 = 1.19 [1.06-1.28]). Large weight gains were associated with excess mortality only at high BMIs (eg, HR for large weight gain from BMI of 35 = 1.33 [1.00-1.77]). Small weight gains were not associated with excess mortality for any initial BMI level. The weight loss-mortality association was robust to adjustments for health status and to sensitivity analyses considering unobserved confounders. CONCLUSIONS: Weight loss is associated with excess mortality among normal, overweight, and mildly obese middle- and older-aged adults. The excess risk increases for larger losses and lower initial BMI. These results suggest that the potential benefits of a lower BMI may be offset by the negative effects associated with weight loss. Weight gain may be associated with excess mortality only among obese people with an initial BMI over 35. BACKGROUND: Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed. OBJECTIVE: This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries. DESIGN: Longitudinal (1998-2004) Health and Retirement Study. SETTING: National probability sample of US community-dwelling adults. SAMPLE: A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older. MEASUREMENTS: The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population. RESULTS: Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences. CONCLUSIONS: These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or above, consistent with other national studies. However, utilization rates for black versus white under age 65 do not differ. Lower utilization among Hispanics versus whites in both age groups is largely explained by medical access factors. National utilization patterns may vary by age and merit further investigation. OBJECTIVES: We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults. METHODS: Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality. RESULTS: As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50-59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90-99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004). CONCLUSIONS: The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years. Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations. OBJECTIVE: To determine whether late middle-aged U.S. workers with depression are at an increased risk for retirement. DATA SOURCE: Six biennial waves (1992-2002) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61-year-olds and their spouses started in 1992. STUDY DESIGN: Workers aged 53-58 years in 1994 were followed every 2 years thereafter, through 2002. Depression was coded as lagged time-dependent variables measuring active depression and severity of depression. The main outcome variable was a transition to retirement which was measured using two distinct definitions to capture different stages in the retirement process: (1) Retirement was defined as a transition out of the labor force in the sample of all labor force participants (N=2,853); (2) In addition a transition out of full time work was used as the retirement definition in the subset of labor force participants who were full time workers (N=2,288). PRINCIPAL FINDINGS: In the sample of all labor force participants, the presence of active depression significantly increased the hazard of retirement in both late middle-aged men (adjusted OR: 1.37 [95 percent CI 1.05, 1.80]) and women (adjusted OR: 1.40 [95 percent CI 1.10, 1.78]). For women, subthreshold depression was also a significant predictor of retirement. In the sample of full time workers, the relationship between depression and retirement was considerably weaker for women yet remained strong for men. CONCLUSIONS: Depression and depressive symptoms were significantly associated with retirement in late middle-aged U.S. workers. Policymakers must consider the potentially adverse impact of these labor market outcomes when estimating the cost of untreated depression and evaluating the value of interventions to improve the diagnosis and treatment of depression. 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. OBJECTIVES: To examine whether symptomatic arthritis in middle age predicts the earlier onset of functional difficulties (difficulty with activities of daily living (ADLs) and walking) that are associated with loss of independence in older persons. DESIGN: Prospective longitudinal study. SETTING: The Health and Retirement Study, a nationally representative sample of persons aged 50 to 62 at baseline who were followed for 10 years. PARTICIPANTS: Seven thousand five hundred forty-three subjects with no difficulty in mobility or ADL function at baseline. MEASUREMENTS: Arthritis was measured at baseline according to self-report. The primary outcome was time to persistent difficulty in one of five ADLs or mobility (walking several blocks or up a flight of stairs). Difficulty with ADLs or mobility was assessed according to subject interview every 2 years. Analyses were adjusted for other comorbid conditions, body mass index, exercise, and demographic characteristics. RESULTS: Twenty-nine percent of subjects reported arthritis at baseline. Subjects with arthritis were more likely to develop persistent difficulty in mobility or ADL function over 10 years of follow-up (34% vs 18%, adjusted hazard ratio (HR)=1.63, 95% confidence interval (CI)=1.43-1.86). When each component of the primary outcome was assessed separately, arthritis was also associated with persistent difficulty in mobility (30% vs 16%, adjusted HR=1.55, 95% CI=1.41-1.71) and persistent difficulty in ADL function (13% vs 5%, adjusted HR=1.85, 95% CI=1.58-2.16). CONCLUSION: Middle-aged persons who report a history of arthritis are more likely to develop mobility and ADL difficulties as they enter old age. This finding highlights the need to develop interventions and treatments that take a life-course approach to preventing the disabling effect of arthritis. 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. BACKGROUND: Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion. OBJECTIVES: To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs. METHODS: Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s. RESULTS: Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects. CONCLUSIONS: Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice. This study uses six waves of the Health and Retirement Study (HRS) to measure dynamics of health insurance coverage as people approach and pass age-eligibility for Medicare. Thirteen percent of 59- to 64-year-olds were uninsured and 13% of 65- to 70-year-olds relied solely on Medicare. Those unmarried, in good health, and in poor health had an increased likelihood of being uninsured before age-eligibility for Medicare, while non-whites and those in good health had an increased likelihood of having Medicare-only coverage after age-eligibility for Medicare. Although only a small percentage was continually without coverage or with Medicare-only coverage, a substantial percentage had these coverage types at some point. Limitations and policy implications are included. OBJECTIVE: To estimate the proportion of seniors with dementia from three independent data sources and their agreement. DATA SOURCES: The longitudinal Asset and Health Dynamics among the Oldest Old (AHEAD) study (n=7,974), Medicare claims, and death certificate data. STUDY DESIGN: Estimates of the proportion of individuals with dementia from: (1) self- or proxy-reported cognitive status measures from surveys, (2) Medicare claims, and (3) death certificates. Agreement using Cohen's kappa; multivariate logistic regression. PRINCIPAL FINDINGS: The proportion varied substantially among the data sources. Agreement was poor (kappa: 0.14-0.46 depending upon comparison assessed); the individuals identified had relatively modest overlap. CONCLUSIONS: Estimates of dementia occurrence based on cognitive status measures from three independent data sources were not interchangeable. Further validation of these sources is needed. Caution should be used if policy is based on only one data source. This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men. 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. BACKGROUND: The majority of Americans die in institutions although most prefer to die at home. States vary greatly in their proportion of home deaths. Although individuals' circumstances largely determine where they die, health policies may affect the range of options available to them. OBJECTIVE: To examine whether states' spending on home- and community-based services (HCBS) affects place of death, taking into consideration county health care resources and individuals' family, sociodemographic, and health factors. METHODS: Using exit interview data from respondents in the Health and Retirement Study born in 1923 or earlier who died between 1993 and 2002 (N = 3362), we conducted discrete-time survival analysis of the risk of end-of-life nursing home relocation to examine whether states' HCBS spending would delay or prevent end-of-life nursing home admission. Then we ran logistic regression analysis to investigate the HCBS effects on place of death separately for those who relocated to a nursing home and those who remained in the community. RESULTS: Living in a state with higher HCBS spending was associated with lower risk of end-of-life nursing home relocation, especially among people who had Medicaid. However, state HCBS support was not directly associated with place of death. CONCLUSIONS: States' generosity for HCBS increases the chance of dying at home via lowering the risk of end-of-life nursing home relocation. State-to-state variation in HCBS spending may partly explain variation in home deaths. Our findings add to the emerging encouraging evidence for continued efforts to enhance support for HCBS. OBJECTIVE: To compare incident disability patterns across racial and ethnic groups. DESIGN: Prospective cohort study with 6-year follow-up (1998-2004). SETTING: National probability sample. PARTICIPANTS: A 1998 Health and Retirement Study sample of 12,288 non-Hispanic whites, 1952 African Americans, 575 Hispanics interviewed in Spanish (Hispanic-Spanish), and 518 Hispanics interviewed in English (Hispanic-English), older than 51 years, and free of disability at baseline. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Disability in activities of daily living (ADL) tasks (walking, dressing, transferring, bathing, toileting, feeding). RESULTS: Hispanic-Spanish reported disproportionately lower rates of walking disability (standardized rates, 4.31% vs Hispanic-English [8.57%], black [7.54%], white [7.20%]) despite higher reported Hispanic-Spanish frequencies of lower-extremity dysfunction than other racial and ethnic groups. Across the 6 ADL tasks, the development of walking disability was most frequent among Hispanic-English subjects, African Americans, and whites. In contrast, Hispanic-Spanish subjects reported dressing as the most frequent ADL task disability, whereas walking ranked fourth. CONCLUSIONS: Aggregating all Hispanics, regardless of interview language, may be inappropriate. Future research on linguistic group differences in self-reported health outcomes is necessary to ensure that health status measures will be appropriate for use in diverse racial and ethnic groups. OBJECTIVE: Although racial and ethnic disparities in disability are well established and technology is increasingly used to bridge gaps between functional deficits and environmental demands, little research has focused on racial and ethnic disparities in device use. This study investigated whether use of mobility devices differs by race and ethnicity and explored several reasons for this difference. METHODS: The sample included community-dwelling adults aged 65 and older from the 2002 and 2004 waves of the Health and Retirement Study. We used predisposing, need, and enabling factors to predict mobility device use alone and combined with personal care. RESULT: Blacks had the highest rates of using mobility devices, followed by Hispanics and then Whites. Need and enabling factors explained differences between Blacks and Whites in wheelchair use but not cane use or use of devices without personal care. Other predisposing factors explained most differences between Hispanics and Whites. DISCUSSION: Because minorities appear to be using mobility devices in proportion to underlying need, increasing device use by minorities may not reduce disparities in mobility disability. Efforts to address racial/ethnic disparities in mobility disability in late life, therefore, may need to focus on differences in underlying functional decline rather than the accommodation of it. BACKGROUND: Hip and knee joint replacement rates vary by demographic group. This article describes the epidemiology of need for joint replacement, and of subsequent receipt of a joint replacement by those in need. METHODS: Data from the Health and Retirement Study were used to assess need for hip or knee joint replacement in a total of 14,807 adults aged 60 years or older in 1998, 2000, and 2002 and receipt of needed surgery 2 years later. "Need" classification was based on difficulty walking, joint pain, stiffness, or swelling and receipt of treatment for arthritis, without contraindications to surgery. RESULTS: Need in 2002 was greater in participants who were older than 74 years (vs 60-64: adjusted odds ratio 2.06; 95% confidence interval, 1.68-2.53), women (vs men: 1.81; 1.53-2.14), less educated (vs college educated: 1.27; 1.06-1.52), in the poorest third (vs richest: 2.20; 1.78-2.72), or obese (vs nonobese: 2.39; 2.02-2.81). One hundred sixty-eight participants in need received a joint replacement, with lower receipt in black or African American participants (vs white: 0.47; 0.26-0.83) or less educated (vs college educated: 0.65; 0.44-0.96). These differences were not explained by current employment, access to medical care, family responsibilities, disability, living alone, comorbidity, or exclusion of those younger than Medicare eligibility age. CONCLUSIONS: After taking variations in need into consideration, being black or African American or lacking a college education appears to be a barrier to receiving surgery, whereas age, sex, relative poverty, and obesity do not. These disparities maintain disproportionately high levels of pain and disability in disadvantaged groups. BACKGROUND: Wealthy women have higher rates of screening mammography than poor women do. Screening mammography is beneficial for women with substantial life expectancies, but women with limited life expectancies are unlikely to benefit. It is unknown whether higher screening rates in wealthy women are due to increased screening in women with substantial life expectancies, limited life expectancies, or both. This study examines the relationship between wealth and screening mammography use in older women according to life expectancy. METHODS: A cohort study was performed of 4222 women 65 years or older with Medicare participating in the 2002 and 2004 Health and Retirement Survey. Women were categorized according to wealth and life expectancy (based on 5-year prognosis from a validated prognostic index). The outcome was self-reported receipt of screening mammography within 2 years. RESULTS: Overall, within 2 years, 68% of women (2871 of 4222) received a screening mammogram. Screening was associated with wealth (net worth, > $100 000) and good prognosis (< or = 10% probability of dying in 5 years). Screening mammography was more common among wealthy women than among poor women (net worth, < $10 000) both for women with good prognosis (82% vs 68%; P < .001) and for women with limited prognoses (> or = 50% probability of dying in 5 years) (48% vs 32%; P = .02). These associations remained after multivariate analysis accounting for age, race, education, proxy report, and rural residence. CONCLUSIONS: Poorer older women with favorable prognoses are at risk of not receiving screening mammography when they are likely to benefit. Wealthier older women with limited prognoses are often screened when they are unlikely to benefit. The well-known association between height and earnings is often thought to reflect factors such as self esteem, social dominance, and discrimination. We offer a simpler explanation: height is positively associated with cognitive ability, which is rewarded in the labor market. Using data from the US and the UK, we show that taller children have higher average cognitive test scores, and that these test scores explain a large portion of the height premium in earnings. Children who have higher test scores also experience earlier adolescent growth spurts, so that height in adolescence serves as a marker of cognitive ability. BACKGROUND: Recent medical, demographic, and social trends might have had an important impact on the cognitive health of older adults. To assess the impact of these multiple trends, we compared the prevalence and 2-year mortality of cognitive impairment (CI) consistent with dementia in the United States in 1993 to 1995 and 2002 to 2004. METHODS: We used data from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of U.S. adults. Individuals aged 70 years or older from the 1993 (N = 7,406) and 2002 (N = 7,104) waves of the HRS were included. CI was determined by using a 35-point cognitive scale for self-respondents and assessments of memory and judgment for respondents represented by a proxy. Mortality was ascertained with HRS data verified by the National Death Index. RESULTS: In 1993, 12.2% of those aged 70 or older had CI compared with 8.7% in 2002 (P < .001). CI was associated with a significantly higher risk of 2-year mortality in both years. The risk of death for those with moderate/severe CI was greater in 2002 compared with 1993 (unadjusted hazard ratio, 4.12 in 2002 vs 3.36 in 1993; P = .08; age- and sex-adjusted hazard ratio, 3.11 in 2002 vs 2.53 in 1993; P = .09). Education was protective against CI, but among those with CI, more education was associated with higher 2-year mortality. CONCLUSIONS: These findings support the hypothesis of a compression of cognitive morbidity between 1993 and 2004, with fewer older Americans reaching a threshold of significant CI and a more rapid decline to death among those who did. Societal investment in building and maintaining cognitive reserve through formal education in childhood and continued cognitive stimulation during work and leisure in adulthood might help limit the burden of dementia among the growing number of older adults worldwide. Using the Health and Retirement Study, we examine the prevalence of depression in different groups of Hispanic older adults. Respondents (n = 759) were aged 59 and older and identified themselves as Mexican American (56%), Cuban American (13%), Puerto Rican (8%), other (8%), or not specified (15%). We used a modified version of the Center for Epidemiologic Studies-Depression scale and the Composite International Diagnostic Interview to assess depressive symptoms and the presence of major depression. Relative to Puerto Ricans, each Hispanic group had significantly lower levels of depressive symptoms, except for Cuban Americans; and each Hispanic group had lower prevalence rates for major depression, except for other Hispanics, even after we adjusted for sociodemographic, cultural factors, socioeconomic, functional limitations, and chronic health conditions. This study used data from the 2000 interview wave of the Health and Retirement Study to examine age group differences in the likelihood of self-reported depressive symptomatology among a nationally representative sample of 3,035 adults age 55 years or older who had at least one activities of daily living (ADL) or instrumental activities of daily living (IADL) limitation. Depression was defined as scoring three points or higher on the eight-point Center for Epidemiological Studies Depression Scale. The results show that respondents age 75 years or older with one ADL/IADL impairment or more were significantly less likely to be depressed than were those between ages 55 and 64 with the same degree of functional impairment. It is recommended that doctors, social workers, and other health care and social services providers pay special attention to younger old adults with health problems and functional limitations because they have a greater risk of being depressed. Childhood socioeconomic status (SES) acts over a lifetime to influence adult health outcomes. Whether the impact of childhood SES differs by age or race/ethnicity is unclear. The authors studied 20,566 community-living US adults aged > or =50 years. Parental education was the main predictor. Outcomes evaluated (1998-2002) included self-reported health and functional limitation. The influence of childhood SES on later-life health was also examined in groups stratified by age and race/ethnicity, with adjustment for demographic factors and current SES. Participants' mean age was 67 years; 57% were women. By race/ethnicity, 76% were White, 14% were Black, and 8% were Latino. The relation between low parental education and fair/poor self-rated health declined with advancing age (age 50-64 years: adjusted odds ratio (AOR) = 1.42, 95% confidence interval (CI): 1.24, 1.63; age > or =80 years: AOR = 1.14, 95% CI: 0.96, 1.36). The relation between low parental education and fair/poor self-rated health differed across racial/ethnic groups and was significant in White (AOR = 1.33, 95% CI: 1.21, 1.47) and Black (AOR = 1.37, 95% CI: 1.14, 1.64) participants but not Latinos. These findings suggest that childhood SES affects health status through midlife but the effects may abate in late life; its effects also may be weaker in Latinos than in Whites or Blacks. BACKGROUND: Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication-provision of information (PCOM) and participatory decision-making (PDM)-for older patients' diabetes self-management and glycemic control. METHODS: We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81%). Independent associations were examined between patients' ratings of their physician's PCOM and PDM with patients' reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n=1233), the relationship was assessed between patient self-management and HbA1c values. RESULTS: In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p<.001) and with all self-management domains (p<.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p=.001) and foot care (p=.002). PDM alone was associated with exercise and blood glucose monitoring (both p<.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values (B= -.10, p=.005). CONCLUSION: Among these older adults, both their diabetes providers' provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring. 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. OBJECTIVES: The purpose of this study was to estimate educational differences in the prevalence and mortality consequence of physical vulnerability among older adults in the United States. METHODS: Data came from the 1998 and 2000 waves of the Health and Retirement Study, a nationally representative cross-sectional and prospective cohort study of community-based adults aged 65 and older. We created a physical vulnerability score from age, gender, and self-reported disability measures and measured socioeconomic status via educational attainment. Mortality data came from the National Death Index. RESULTS: In the 1998 cohort, high physical vulnerability was more than 3 times more prevalent in individuals with less than 12 years of education compared to those with 16 or more years of education. Although less educated older adults had a higher probability of death overall, evidence of educational differences in the mortality consequence of high physical vulnerability was limited. In 2000, 2.16 million older adults had high physical vulnerability, and more than one half (53%) of these adults had less than 12 years of education. DISCUSSION: In persons 65 years of age or older, educational differences are more apparent in the prevalence of physical vulnerability than in the mortality consequence of that vulnerability. In recent decades, elderly Americans have enjoyed enormous gains in longevity and reductions in disability. The causes of this progress remain unclear, however. This paper investigates the role of fetal programming, exploring how economic progress early in the 20th century might be related to declining disability today. Specifically, we match sudden unexpected economic changes experienced in utero in America's Dust Bowl during the Great Depression to unusually detailed individual-level information about old-age disability and chronic disease. We are unable to detect any meaningful relationship between early life factors and outcomes in later life. We conclude that, if such a relationship exists in the United States, it is most likely not a quantitatively important explanation for declining disability today. BACKGROUND: Geriatric conditions, such as incontinence and falling, are not part of the traditional disease model of medicine and may be overlooked in the care of older adults. The prevalence of geriatric conditions and their effect on health and disability in older adults has not been investigated in population-based samples. OBJECTIVE: To investigate the prevalence of geriatric conditions and their association with dependency in activities of daily living by using nationally representative data. DESIGN: Cross-sectional analysis. SETTING: Health and Retirement Study survey administered in 2000. PARTICIPANTS: Adults age 65 years or older (n = 11 093, representing 34.5 million older Americans) living in the community and in nursing homes. MEASUREMENTS: Geriatric conditions (cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment) and dependency in activities of daily living (bathing, dressing, eating, transferring, toileting). RESULTS: Of adults age 65 years or older, 49.9% had 1 or more geriatric conditions. Some conditions were as prevalent as common chronic diseases, such as heart disease and diabetes. The association between geriatric conditions and dependency in activities of daily living was strong and significant, even after adjustment for demographic characteristics and chronic diseases (adjusted risk ratio, 2.1 [95% CI, 1.9 to 2.4] for 1 geriatric condition, 3.6 [CI, 3.1 to 4.1] for 2 conditions, and 6.6 [CI, 5.6 to 7.6] for > or =3 conditions). LIMITATIONS: The study was cross-sectional and based on self-reported data. Because measures were limited by the survey questions, important conditions, such as delirium and frailty, were not assessed. Survival biases may influence the estimates. CONCLUSIONS: Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability. The findings suggest that geriatric conditions, although not a target of current models of health care, are important to the health and function of older adults and should be addressed in their care. 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. 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. Longitudinal models are commonly used for studying data collected on individuals repeatedly through time. While there are now a variety of such models available (marginal models, mixed effects models, etc.), far fewer options exist for the closely related issue of variable selection. In addition, longitudinal data typically derive from medical or other large-scale studies where often large numbers of potential explanatory variables and hence even larger numbers of candidate models must be considered. Cross-validation is a popular method for variable selection based on the predictive ability of the model. Here, we propose a cross-validation Markov chain Monte Carlo procedure as a general variable selection tool which avoids the need to visit all candidate models. Inclusion of a 'one-standard error' rule provides users with a collection of good models as is often desired. We demonstrate the effectiveness of our procedure both in a simulation setting and in a real application. 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. This study examined the unique effects of four variable groups on changes in older adults' depressive symptoms for a 2-year period: (1) baseline health and disability status, (2) changes in health and disability since baseline, (3) stability and changes in marital and caregiving status and in work and volunteering, and (4) stability and changes in health-related behaviors. With data from the 1998 and 2000 interview waves of the Health and Retirement Study, the authors used gender-separate multistep (hierarchical) residualized regression analyses in which the Center for Epidemiological Studies Depression scale (CES-D) score at follow-up is modeled as a function of the effect of each group of independent variables. As hypothesized, changes in health, disability, marital, and caregiving status explained a larger amount of variance than the existing and stable conditions, although each group of variables explained a relatively small amount (0.3-3.4%) of variance in the follow-up CES-D score. OBJECTIVES: We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English. METHODS: We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference. RESULTS: The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2). CONCLUSIONS: Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability. OBJECTIVES: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship. DESIGN: Prospective cohort. SETTING: Communities in the United States. PARTICIPANTS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older. MEASUREMENTS: Subjects were asked to self-identify their race and their overall health by answering the question, "Would you say your health is excellent, very good, good, fair, or poor?" Death was determined according to the National Death Index. RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95% confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95% CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH. CONCLUSION: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects. OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects. METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier. RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%. DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness. BACKGROUND: Health researchers rarely measure accumulated wealth to reflect socioeconomic status/position (SES). In order to determine whether health research should more frequently include measures of wealth, this study assessed the relationship between wealth and health. METHODS: Studies published between 1990 to 2006 were systematically reviewed. Included studies used wealth and at least one other SES measure as independent variables, and a health-related dependent variable. RESULTS: Twenty-nine studies met inclusion criteria. Measures of wealth varied greatly. In most studies, greater wealth was associated with better health, even after adjusting for other SES measures. The findings appeared most consistent when using detailed wealth measures on specific assets and debts, rather than a single question. Adjusting for wealth generally decreased observed racial/ethnic disparities in health. CONCLUSIONS: Health studies should include wealth as an important SES indicator. Failure to measure wealth may result in under-estimating the contribution of SES to health, such as when studying the etiology of racial/ethnic disparities. Validation is needed for simpler approaches to measuring wealth that would be feasible in health studies. 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. OBJECTIVES: To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race. DESIGN: Cross-sectional. SETTING: Community based. PARTICIPANTS: Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older. MEASUREMENTS: Families were interviewed within 2 years of the HRS participant's death. The primary outcome was whether death was expected. The primary predictors were the decedent's functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent's race. RESULTS: Overall, 58% of families reported that their family member's death was expected. Expecting death was strongly associated with functional impairment; 71% of families of decedents with ADL disability expected death, compared with 24% of those without ADL disability (P < .01). Death was expected more often in families of white decedents (60%) than African Americans (49%) (P < .01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR) = 3.58, 95% confidence interval (CI) 2.73-4.70), and families of African Americans expected death less often than families of white decedents (OR = 0.63, 95% CI = 0.46-0.86). CONCLUSION: Family members of older adults expected death only 58% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites. This study examined whether retirement implies complete withdrawal from the labor force and the role that increased wealth and income play in regard to the nature of retirement. Data came from the Health & Retirement Study, Waves 1-5. Findings indicated that most study sample pre-retirees remained in the labor force as they moved into what are considered the normal retirement years. As they moved on average from 50+ years of age to 60+ years of age, increasing percentages of study sample pre-retirees reported themselves as completely retired. Those who viewed themselves as completely retired were far less likely to work than those who did not view themselves as completely retired. Of particular importance was the finding that increased income in 2000 decreased the likelihood of self-reported complete retirement. Equally important was the finding that increased assets had no effect on retirement status with the exception of survey year 1998 when increased assets decreased the likelihood of viewing oneself as completely retired. Findings suggested that pro-work retirement policies aimed at increasing labor force participation among pre-retirees and increasing the normal retirement age can be effective. Five pro-work policies were discussed. The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults. PURPOSE: This article investigates how older Americans leave their career jobs and estimates the extent of intermediate labor force activity (bridge jobs) between full-time work on a career job and complete labor-force withdrawal. DESIGN AND METHODS: Using data from the Health and Retirement Study, we explored the work histories and retirement patterns of a cohort of retirees aged 51 to 61 in 1992 during a 10-year period in both cross-sectional and longitudinal contexts. We examined determinants of retirement patterns in a multinomial logistic regression model. RESULTS: We found that a majority of older Americans with career jobs retire gradually, in stages, rather than all at once. We also found that the utilization of bridge jobs was more common among younger respondents, respondents without defined-benefit pension plans, and respondents at both the lower and upper ends of the wage distribution. IMPLICATIONS: Older Americans are now working longer than pre-1980s trends would have predicted. Given concerns about the traditional sources of retirement income (Social Security, employer pensions, and prior savings), older Americans may have to rely more on earnings. This article suggests that many are already doing so by moving to bridge jobs after leaving their career employment. 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. OBJECTIVES: The objective of this article was to assess the determinants of an individual's decision to purchase long-term-care (LTC) insurance. This article focuses on the decision to purchase a new policy as opposed to renewing an existing policy. This study gave special consideration to the role of policy price, the savings associated with buying a policy now as opposed to later, the purchaser's education, and the purchaser's income. METHODS: Using data from the 2002 Health and Retirement Survey, we estimated logistic regressions to model consumer decisions to purchase LTC insurance. We explored several alternative measures of the price of a policy. RESULTS: Price was a significant determinant in decisions to purchase coverage. The demand for coverage, however, was price inelastic, with elasticities ranging from -0.23 to -0.87, depending on the specification of the model. The education level and income of the purchaser were also important. DISCUSSION: This analysis provides the first estimates of price elasticity of demand for LTC insurance. The finding that demand is very price inelastic suggests that state initiatives that effectively subsidize premiums as a way of stimulating purchases are likely to meet with very limited success in the present environment. PURPOSE: The purpose of this article is to estimate the effect of obesity on both the length of life and length of nondisabled life for older Americans. DESIGN AND METHODS: Using data from the first 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, this article develops estimates of total, active, and disabled life expectancy for obese and nonobese older men and women. We used the Interpolation of Markov Chains (IMaCh) method to estimate the average number of years obese and nonobese older persons can expect to live with and without activity of daily living (ADL) disability. RESULTS: Our findings indicate that obesity has little effect on life expectancy in adults aged 70 years and older. However, the obese are more likely to become disabled. This means that obese older adults live both more years and a higher proportion of their remaining lives disabled. IMPLICATIONS: The lack of significant differences in life expectancy by obesity status among the old suggests that obesity-related death is less of a concern than disability in this age range. Given steady increases in obesity among Americans at all ages, future disability rates may be higher than anticipated among older U.S. adults. In order to reduce disability among future cohorts of older adults, more research is needed on the causes and treatment of obesity and evaluations done on interventions to accomplish and maintain weight loss. BACKGROUND: Self-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time. OBJECTIVES: The purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time. METHODS: Using 5 waves of data (1992-2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time. RESULTS: The final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors--comorbidity, vigorous activity less than 3 times per week, and current smoking--had the same influence on all 3 classes. DISCUSSION: The differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH. OBJECTIVE: To investigate factors that predict the onset of limitations in activities of daily living (ADLs) in adults 65 years old or older who have arthritis, in order to develop public health programs for minorities (African and Hispanic Americans) and white Americans. DESIGN: Longitudinal cohort study. SETTING: National probability sample. PARTICIPANTS: Older adults with arthritis (N=3541) who participated in the 1998 and 2000 Health and Retirement Study interviews and who had no baseline ADL limitations. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Onset of ADL limitations was identified from reports of 1 or more ADL task limitations at 2-year follow-up. RESULTS: Onset is most frequent among African Americans (24.4%), followed by Hispanics (22.2%), and whites (16.9%). Race specific multivariate analysis showed that the strongest risk factor predicting onset of limitations across all racial and ethnic groups is physical limitations. Low household income was significant for older minorities but not for whites. Comorbid cardiovascular disease was a unique multivariate risk factor among African Americans. CONCLUSIONS: Physical limitation is a strong risk factor for ADL limitation onset that is shared by all racial and ethnic groups. Early identification and treatment of physical limitations may prevent the onset of ADL limitations and thus improve quality of life. Race specific public health interventions should be considered to reduce the development of ADL limitations among older adults with arthritis. OBJECTIVES: To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served. DESIGN: Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older. SETTING: Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey. PARTICIPANTS: Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries). MEASUREMENTS: Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency. RESULTS: A small portion of Medicare beneficiaries (1.3-5.8%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population. CONCLUSION: Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults. PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy. DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices). RESULTS: Of respondents over 65 years of age, 88% used CAM, with dietary supplements and chiropractic most commonly reported (65% and 46%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases. IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers. Many studies have reported the benefits of a comprehensive stroke team including occupational therapy/physical therapy (OT/PT) services; however, factors associated with access to these services are less known. This study used a subsample of the Health and Retirement Study database, a cross-sectional survey of more than 11,126 Americans aged 65 to 106 years within the contiguous United States. The purposes of this study were to determine the associational factors that contribute to attending OT/PT and determine if attending OT/PT leads to a reduced report of stroke-related problems. The findings indicated that fewer than 10% of stroke survivors in a noninstitutionalized, community-based setting were currently accessing OT/PT. Additionally, access to OT/PT services was highly associated with report of having an attending physician, report of stroke-related weakness, higher monthly income, and older age. The increased odds of reported continued problems associated with a past stroke were associated with failure to access OT/PT services, lower monthly income, Hispanic culture, and age. OT/PT services were typically provided to patients who reported a higher level of physical dysfunction. Despite the greater degree of severity, OT/PT intervention led to reports of lower levels of disability and problems over time. OBJECTIVE: To determine whether caregiving grandparents are at an increased risk for depressive symptoms. DATA SOURCE: National sample (n=10,293) of grandparents aged 53-63 years in 1994, and their spouse/partners, who took part in the Health and Retirement Study (HRS). STUDY DESIGN: Grandparents were surveyed in 1994 and resurveyed every two years thereafter, through 2000. Over that period, 977 had a grandchild move in or out of their home. These grandparents served as their own controls to assess the impact of having a grandchild in the home. Data Extraction. Depressive symptoms were measured using an abbreviated form of the Center for Epidemiologic Studies-Depression (CES-D) scale, scored 1-8, with a score > or =4 associated with depression "caseness". PRINCIPAL FINDINGS: At the time of the 1994 interview, 8.2 percent of grandparents had a grandchild in their home. However, there was substantial variation across demographic groups (e.g., 29.4 percent of single nonwhite grandmothers, but only 2.0 percent of single white grandfathers had a grandchild in residence). The impact of having a grandchild in the home varied by grandparent demographic group, with single grandparents and those without coresident adult children experiencing the greatest probability of elevation in depressive symptoms when a grandchild was in residence. For example, single nonwhite grandmothers experienced an 8 percentage point increase in the probability of having a CES-D score > or =4 when a grandchild was in their home, compared to when a grandchild was not in their home, controlling for changes in health care, income, and household composition over time (95 percent CI=0.1 to 15.0 percentage points). CONCLUSIONS: Grandparents have a greater probability of elevated depressive symptoms when a grandchild is in their home, versus when a grandchild is not in their home. Single women of color bear a disproportionate burden of the depression associated with caring for grandchildren. Since an increasing number of grandparents function as a de facto safety net keeping their grandchildren out of formal foster care, identifying strategies to support the health and well-being of caregiving grandparents is an emerging priority. BACKGROUND: The role of stress in the development of cardiovascular disease is well established. Previous research has demonstrated that involuntary job loss in the years immediately preceding retirement can be a stressful life event shown to produce adverse changes in physical and affective health. The objective of this study was to estimate the risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers nearing retirement in the United States. METHODS: We used multivariable survival analysis to analyze data from the first four waves of the Health and Retirement Survey (HRS), a nationally representative sample of older individuals in the US. The analytic sample includes 457 workers who experienced job loss and a comparison group of 3,763 employed individuals. RESULTS: The results indicate that involuntary job loss is not associated with subsequent risk of MI (adjusted HR = 1.89; 95% CI = 0.91, 3.93); the risk of subsequent stroke associated with involuntary job loss is more than double (adjusted HR = 2.64; 95% CI = 1.01, 6.94). CONCLUSIONS: Our findings present new data to suggest that involuntary job loss should be considered as a plausible risk factor for subsequent cardiovascular and cerebrovascular illness among older workers. This study examined the relationship between three midlife transitions and depressive symptoms among 952 women 50 to 59 years of age. Using longitudinal data from women interviewed for the 1992 and 2000 Health and Retirement Study, the study described changes in marital status, change to a parental caregiving role, and changes in perceived health across the eight years. Further, it examined the impact of these changes on mental health. The findings indicate that becoming widowed, becoming a caregiver, and perceiving health declines significantly increased depressive symptoms in the year 2000, even when controlling for pre-transition levels of depressive symptoms. The findings are consistent with the lifecourse perspective that individual development occurs in context and across the lifespan. The findings confirm and add to current midlife research literature. OBJECTIVE: There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx). METHODS: We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated. RESULTS: Of the 6370 respondents, 5382 (84%) reported No CA, 812 (13%) reported CA/No Tx, and 176 (3%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were 1210 dollars, 1450 dollars, and 1880 dollars, respectively (P < .01). Prescription medications (1120 dollars per year) and home care services (250 dollars) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27% of their yearly income on OOPE compared to only 5% of yearly income for high-income individuals with no cancer history (P < .01). CONCLUSIONS: Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer. 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. Most studies of social relationships in later life focus on the amount of social contact, not on individuals' perceptions of social isolation. However, loneliness is likely to be an important aspect of aging. A major limiting factor in studying loneliness has been the lack of a measure suitable for large-scale social surveys. This article describes a short loneliness scale developed specifically for use on a telephone survey. The scale has three items and a simplified set of response categories but appears to measure overall loneliness quite well. The authors also document the relationship between loneliness and several commonly used measures of objective social isolation. As expected, they find that objective and subjective isolation are related. However, the relationship is relatively modest, indicating that the quantitative and qualitative aspects of social relationships are distinct. This result suggests the importance of studying both dimensions of social relationships in the aging process. OBJECTIVES: To determine whether urinary incontinence (UI) is an independent predictor of death, nursing home admission, decline in activities of daily living (ADLs), or decline in instrumental activities of daily living (IADLs). DESIGN: A population-based prospective cohort study from 1993 to 1995. SETTING: Community-dwelling within the United States. PARTICIPANTS: Six thousand five hundred six of the 7,447 subjects aged 70 and older in the Asset and Health Dynamics Among the Oldest Old study who had complete information on continence status and did not require a proxy interview at baseline. MEASUREMENTS: The predictor was UI, and the outcomes were death, nursing home admission, ADL decline, and IADL decline. Potential confounders considered were comorbid conditions, baseline function, sensory impairment, cognition, depressive symptoms, body mass index, smoking and alcohol, demographics, and socioeconomic status. RESULTS: The prevalence of UI was 14.8% (18.5% in women; 8.5% in men). At 2-year follow-up, subjects incontinent at baseline were more likely to have died (10.9% vs 8.7%; unadjusted odds ratio (OR)=1.29, 95% confidence interval (CI)=1.02-1.64), be admitted to a nursing home (4.4% vs 2.6%, OR=1.77; 95% CI=1.18-2.63), and to have declined in ADL function (13.6% vs 8.1%; OR=1.78, 95% CI=1.36-2.33) and IADL function (21.2% vs 13.8%; OR 1.69, 95% CI 1.39-2.05). However, after adjusting for confounders, UI was not an independent predictor of death (adjusted OR (AOR)= 0.90, 95% CI=0.67-1.21), nursing home admission (AOR=1.33, 95% CI=0.86-2.04), or ADL decline (AOR=1.24, 95% CI=0.92-1.68). Incontinence remained a predictor of IADL decline (AOR=1.31; 95% CI=1.05-1.63), although adjustment markedly reduced the strength of this association. CONCLUSION: Higher levels of baseline illness severity and functional impairment appear to mediate the relationship between UI and adverse outcomes. The results suggest that, although UI appears to be a marker of frailty in community-dwelling elderly, it is not a strong independent risk factor for death, nursing home admission, or functional decline. OBJECTIVES: This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits. METHODS: Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview. RESULTS: Women's disability onset and health problems appear less related to job characteristics than men's. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions. CONCLUSIONS: Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development. BACKGROUND: Poor cognitive function and depressive symptoms are common in the elderly, frequently coexist, and are interrelated. Both risk factors are independently associated with mortality. Few studies have comprehensively described how the combination of poor cognitive function and depressive symptoms affect the risk for mortality. Our aim was to examine whether the combination of varying levels of cognitive function and depressive symptoms affect the risk of mortality in community-living elderly adults. METHODS: We studied 6301 elderly adults (mean age, 77 years; 62% women; 81% white) enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study, a prospective study of community-living participants conducted from 1993 to 1995. Cognitive function and depressive symptoms were measured using two validated measures developed for the AHEAD study. On each measure, participants were divided into tertiles representing the best, middle, and worst scores, and then placed into one of nine mutually exclusive groups ranging from best functioning on both measures to worst functioning on both measures. Mortality rates were assessed in each of the nine groups. Cox proportional hazards models were used to control for potentially confounding characteristics such as demographics, education, income, smoking, alcohol consumption, comorbidity, and baseline functional impairment. RESULTS: During 2 years of follow-up, 9% (548) of the participants died. Together, cognitive function and depressive symptoms differentiated between elderly adults at markedly different risk for mortality, ranging from 3% in those with the best function on both measures to 16% in those with the worst function on both measures (p <.001). Furthermore, for each level of cognitive function, more depressive symptoms were associated with higher mortality rates, and for each level of depressive symptoms, worse cognitive function was associated with higher mortality rates. In participants with the best cognitive function, mortality rates were 3%, 5%, and 9% in participants with low, middle, and high depressive symptoms, respectively (p <.001 for trend). The corresponding rates were 6%, 7%, and 12% in participants with the middle level of cognitive function (p <.001 for trend), and 10%, 13%, and 16% in participants with the worst level of cognitive function (p <.001 for trend). After adjustment for confounders, participants with the worst function on both measures remained at considerably higher risk for death than participants with the best function on both measures (adjusted hazard ratio, 3.1; 95% confidence interval, 2.0-4.7). CONCLUSIONS: Cognitive function and depressive symptoms can be used together to stratify elderly adults into groups that have significantly different rates of death. These two risk factors are associated with an increased risk in mortality in a progressive, additive manner. Using data from the 1992 and 1994 waves of the Health and Retirement Study (HRS), this study described reasons reported by pre- and early-retirement populations for perceived changes in global health status over a 2-year period. It then analyzed the association between self-perceptions of change and the actual changes in objective health conditions, controlling for demographics, emotional health status, and the changes in work status and health-affecting habits. The results were compared to the determinants of self-ratings of health at wave 2. Existing or increasing impairments in functional abilities were found to contribute to self-perceptions of decline. However, a diagnosis of new chronic disease and the experience of a major medical event per se did not universally contribute to self-perception of decline. The relationship between cross-sectional self-ratings of health and objective health conditions was more straightforward. Self-perception of improvement among people with serious health problems most likely owed to medical interventions and improvement in symptoms, the most frequently mentioned reasons for perceived improvement, and reflected the subjects' selective optimization and resiliency. Data from the Health and Retirement Study, 1992-1994, were used to analyze (1) the prevalence and incidence of self-reported work disability among older working-age populations over a two-year period, and (2) the effect of the stability/changes in physical and functional health conditions, controlling for socioeconomic and occupational characteristics, on the stability/changes in self-reported work ability/disability. Findings show a high rate of transitions into and out of work-disabled status over the two-year period. Findings also show that, although objective physical and functional health problems and low self-ratings of health at wave 1 were significant determinants of self-reported work disability at wave 1, most subsequent changes in objective physical and functional health conditions over the two-year period were not significantly associated with the changes in self-report of work disability between wave 1 and wave 2. Especially, improved health conditions were not significantly associated with regained work ability between the two waves. Of the demographic variables, female gender significantly increased the likelihood of reporting work disability at wave 2, and being Black or Hispanic significantly decreased the likelihood of reporting regained work ability at wave 2. Research and policy implications of the findings are discussed. OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect. METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician's visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources. RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis. CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis. OBJECTIVES: This research draws from social integration theory to explain the relationship between living arrangements and depressive symptoms among middle-aged and older adults. Particular attention is given to identifying differences between nonimmigrants and immigrants. METHODS: The data come from the baseline and first 2-year follow-up of the Health and Retirement Study, which were collected in 1992 and 1994. The analysis is based on 6,391 primary respondents who were aged 51 to 61 at the baseline. Descriptive statistics, cross-sectional ordinary least squares regression models, and longitudinal residualized regression models are estimated for the entire sample and by immigrant status. RESULTS: Living arrangements and immigrant status interact to influence depressive symptoms. The results confirm that depressive symptoms are higher among those who live alone, particularly among immigrants. Living with family or others is related to higher cross-sectional levels of depressive symptoms, especially for immigrants, and greater longitudinal increases in depressive symptoms among nonimmigrants. DISCUSSION: The results highlight the important influence of social integration on mental health while demonstrating that context shapes the effect of social integration. They suggest that interventions should promote social integration, particularly among older adults living alone or with family or others. However, those programs should be sensitive to the unique needs of native-born and immigrant populations. OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated. METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment. RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy. DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition. BACKGROUND: Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample. OBJECTIVE: This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons. DESIGN: Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study. SETTING: National probability sample of US community-dwelling older adults. PATIENT POPULATION: AHEAD participants (n = 6159) aged 69 to 103 years. MEASUREMENTS: The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance). RESULTS: Older minorities reported arthritis-related joint replacements (black: 0.98%; Hispanic: 0.97%, annually) less frequently compared with white persons (1.48% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95% CI, 0.22, 0.95). CONCLUSIONS: These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities. OBJECTIVES: We estimated racial/ethnic differences in rates of major depression and investigated possible mediators. METHODS: Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders. RESULTS: African Americans (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites. CONCLUSIONS: Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention. OBJECTIVE: To determine the correlates of incontinence in middle-aged women and to test for an association between incontinence and depression. METHODS: This was a population-based cross-sectional study of 5701 women who were residents of the United States, aged 50-69 years, and participated in the third interview of the Health and Retirement Study. The primary outcome measure was self-reported urinary incontinence. Depression was ascertained based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders, using a short form of the Composite International Diagnostic Interview. In addition, depressive symptoms were assessed using the revised Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models were constructed to determine the independent association between incontinence and depression, after adjusting for confounders. RESULTS: Approximately 16% reported either mild-moderate or severe incontinence. Depression, race, age, body mass index, medical comorbidities, and limited activities of daily living were associated with incontinence. After adjusting for medical morbidity, functional status, and demographic variables, women with severe and mild-moderate incontinence were 80% (odds ratio [OR] 1.82; 95% confidence interval [CI] 1.26, 2.63) and 40% (OR 1.41; 95% CI 1.06, 1.87) more likely, respectively, to have depression than continent women. The association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjusting for covariates. CONCLUSION: Depression and incontinence are associated in middle-aged women. The strength of the association depends on the instrument used to classify depression. This reinforces the need to screen patients presenting for treatment of urinary incontinence for depression. OBJECTIVE: To determine the effect of body-mass index (BMI) categories (a proxy for adiposity) on 4-year changes in health-related quality of life (HRQL) independent of baseline disease severity. DESIGN: Secondary analyses of a prospective, longitudinal study. PARTICIPANTS: Data on 7,895 adults ages 51 to 61 years who responded to the Health and Retirement Surveys in 1992, 1994, and 1996 were included. RESULTS: Estimates of the effect of BMI on changes in HRQL were adjusted by disease severity. Each BMI category was associated with an increasing risk of decline in perceived health, with the highest risk in the higher categories. A BMI of between 30 and 35 was associated with a risk of decline in mobility. CONCLUSIONS: The findings suggest a significant impact of BMI on changes in HRQL that is independent of disease severity and baseline HRQL. OBJECTIVES: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care. METHODS: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM. RESULTS: Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p <.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM. DISCUSSION: Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease. OBJECTIVE: Identify the point-in-time relationship between Parkinson's disease (PD) signs and symptoms and measures of health-related quality of life (HRQL). BACKGROUND: Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms. DESIGN/METHODS: A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews. RESULTS: The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures. CONCLUSION: PD patients' well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment. Despite wide state variation in commitment to home and community-based services (HCBS) for functionally impaired older persons, little is known about how such variation affects older adults' strategies to compensate for their functional limitations. This study examines the association of state HCBS expenditures with use of formal and informal personal assistance among non-institutionalized older Americans aged 70 and older with functional limitations. We conducted multilevel multinomial logistic regression analysis using data from the first wave of the Assets and Health Dynamics among the Oldest Old Survey, combined with data on state HCBS expenditures. Controlling for individuals' demographic, socioeconomic, and care needs factors, persons residing in states with higher HCBS expenditures were more likely to use formal personal assistance, but not less likely to use informal assistance. Our study suggests state variation in HCBS expenditures leads to inequitable access to formal personal assistance, especially among those with high functional limitations. OBJECTIVE: To evaluate the prevalence of arthritis and activity limitations among older Americans by assessing their demographic, ethnic, and economic characteristics. METHODS: Data from the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults born before 1924, were analyzed cross-sectionally. Arthritis that resulted in a physician's visit or a joint replacement not associated with a hip fracture was ascertained by self-report. RESULTS: The prevalence of arthritis in older adults ranged from 25% in non-Hispanic whites to 40% in non-Hispanic blacks to 44% in Hispanics. A higher prevalence of arthritis was associated with less education as well as lower income and less wealth. The prevalence of limitations in activities of daily living (ADL) among non-Hispanic white, non-Hispanic black, and Hispanic adults who reported arthritis only was 29%, 30%, and 37%, respectively, and increased to 48%, 57%, and 56%, respectively, among those reporting arthritis plus other chronic conditions, after adjustment for age and sex. CONCLUSION: Non-Hispanic black and Hispanic older adults reported having arthritis at a substantially higher frequency than did non-Hispanic whites. In addition, Hispanics reported higher rates of ADL limitations than did non-Hispanic whites with comparable disease burden. Further study is needed to confirm and elucidate the reasons for these racial and economic disparities in older populations. PURPOSE: As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients. MATERIALS AND METHODS: To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT). RESULTS: Of the 7,443 subjects surveyed, 6,422 (86%) reported NC, 718 (10%) reported CNT, and 303 (4%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26%, it was 34% for those reporting CT (P <.05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P <.05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally. CONCLUSION: Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly. OBJECTIVE: Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services. METHODS: The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members. RESULTS: Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05). CONCLUSIONS: The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children. OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia. DESIGN: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443). SETTING: National population-based sample of the community-dwelling elderly. MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status. RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars. CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care. OBJECTIVES: This study analyzed rates of prevalence and incidence of, and transitions in, disease and disability statuses of those aged 51 to 61 years and the predictors of the transition outcomes-remaining free of disease or disability, getting better, or getting worse-over a 2-year period. METHODS: Data from the 1992 and 1994 interview waves of the Health and Retirement Study were used for gender-separate binary and multinomial logistic regression analyses. RESULTS: Despite high prevalence and incidence rates of chronic disease and functional limitations, the improvement rates in disabilities were also high. For both genders, age, years of education, health-related behaviors, and comorbidity factors were significant predictors of the transition outcomes. DISCUSSION: The significance of health-related behaviors as predictors of transitions suggests that lifestyle factors may have a bigger influence on this age group than on older groups. UNLABELLED: To estimate age group differences in the prevalence and outcomes of three common and often comorbid metabolic conditions (i.e., obesity, hypertension, and diabetes) and heart disease. DESIGN: Nationally representative prospective cohort study. SETTING: PARTICIPANTS' homes. PARTICIPANTS: 9825 adults aged 51 to 61 years (middle-age) in 1992, and 7370 adults aged 70 years and over (older-age) in 1993. MEASUREMENTS: Two-year dichotomous outcomes included: doctor visits, hospitalization, mobility difficulty, activity of daily living limitation, poor perceived health, and mortality. Odds ratios (OR) were adjusted for sociodemographic characteristics and history of cancer or lung disease. RESULTS: Those with one condition represented 80% and 70% of the middle- and older-age groups, respectively, while just 1-2% of each age group reported all three metabolic conditions. Thirteen percent and 32%, respectively, reported heart disease with or without metabolic conditions. Diabetes comorbid with other metabolic conditions, and particularly with heart disease, substantially elevated the risk of adverse outcomes such as health-related quality of life deficits, health services use, and mortality in both middle- and older-age adults. In the middle-age group, the OR was 6.81 for mortality in patients with a combination of obesity and diabetes and 6.10 in those with a combination of heart disease and diabetes. There also were significant ORs for mortality in middle-aged patients with heart disease (OR = 2.40), diabetes (OR = 2.63) and for those with a combination of obesity, hypertension, and diabetes (OR = 3.26). CONCLUSION: The impact of these often comorbid conditions underscores the importance of targeted and aggressive prevention, particularly among middle-age adults. OBJECTIVE: Little is known about patients who skip doses or otherwise avoid using their medications because of cost. We sought to identify which elderly patients are at highest risk of restricting their medications because of cost, and how prescription coverage modifies this risk. DESIGN AND PARTICIPANTS: Cross-sectional study from the 1995-1996 wave of the Survey of Asset and Health Dynamics Among the Oldest Old, a population-based survey of Americans age 70 years and older. MEASUREMENTS: Subjects were asked the extent of their prescription coverage, and whether they had taken less medicine than prescribed for them because of cost over the prior 2 years. We used bivariate and multivariate analyses to identify risk factors for medication restriction in subjects who lacked prescription coverage. Among these high-risk groups, we then examined the effect of prescription coverage on rates of medication restriction. MAIN RESULTS: Of 4,896 seniors who regularly used prescription medications, medication restriction because of cost was reported by 8% of subjects with no prescription coverage, 3% with partial coverage, and 2% with full coverage (P <.01 for trend). Among subjects with no prescription coverage, the strongest independent predictors of medication restriction were minority ethnicity (odds ratio [OR], 2.9 compared with white ethnicity; 95% confidence interval [95% CI], 2.0 to 4.2), annual income <$10,000 (OR, 3.8 compared with income > or =$20,000; 95% CI, 2.4 to 6.1), and out-of-pocket prescription drug costs >$100 per month (OR, 3.3 compared to costs < or =$20; 95% CI, 1.5 to 7.2). The prevalence of medication restriction in members of these 3 risk groups was 21%, 16%, and 13%, respectively. Almost half (43%) of subjects with all 3 risk factors and no prescription coverage reported restricting their use of medications. After multivariable adjustment, high-risk subjects with no coverage had 3 to 15 times higher odds of medication restriction than subjects with partial or full coverage (P <.01). CONCLUSIONS: Medication restriction is common in seniors who lack prescription coverage, particularly among certain vulnerable groups. Seniors in these high-risk groups who have prescription coverage are much less likely to restrict their use of medications. OBJECTIVE: To investigate how baseline health insurance coverage affects subsequent out-of-pocket costs and utilization of health services over a two-year period. DATA SOURCE: The first two waves of the Health and Retirement Study, a nationally representative survey of the noninstitutionalized population, ages 51 to 61 at baseline. Interviews were conducted in 1992 and 1994. Our sample consisted of 7,018 respondents who did not report public insurance as their sole source of coverage at baseline. STUDY DESIGN: We compared self-reports of physician visits, hospitalizations, and out-of-pocket health care costs, measured as payments to physicians, hospitals, and nursing homes, by type of insurance coverage at the beginning of the period. We estimated multivariate models of costs and service use to control for individual health, demographic, and economic characteristics and employed instrumental variable techniques to account for the endogeneity of insurance coverage. PRINCIPAL FINDINGS: Controlling for personal characteristics and accounting for the endogeneity of insurance coverage, persons at midlife with job-related health benefits went on to spend only about $50 per year less in out-of-pocket payments for health services than persons who lacked health insurance at the beginning of the period. However, they spent about $650 more per year in insurance premiums than the uninsured. The uninsured used relatively few health services, except when they were seriously ill, in which case they were likely to acquire public insurance. CONCLUSIONS: The medically uninsured appear to avoid substantial out-of-pocket health care costs by using relatively few health services when they are not seriously ill, and then relying upon health care safety nets when they experience medical problems. These results suggest that the main impact of non-insurance at midlife is not to place the locus of responsibility for costly health care upon individuals. Instead, it discourages routine care and transfers the costs of care for severe health events to other payers. Our findings on the high cost of employment-based coverage are consistent with evidence that the proportion of workers accepting health benefits from employers has been declining in recent years. 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. OBJECTIVES: To examine racial-ethnic differences in the allocation of financial transfers to parents, children, and others by middle-aged couples. METHODS: Multinomial specification of alternative recipients of financial transfers, using data from the 1992 Health and Retirement Survey. RESULTS: Transfer patterns are sensitive to parental health and wealth, to children being young or in school, as well as to the donors' health and wealth. Controlling for these and other factors, including family size and structure, Blacks and Whites are the most likely, and Hispanics the least likely, to financially help their parents compared to assisting offspring. Black couples are the most likely to sacrifice their own consumption to assist parents financially. DISCUSSION: Future research on transfers should attempt to capture unmeasured noneconomic sources of variation proxied by the race-ethnicity indicator. Information from pension providers was examined to investigate gender differences in pension wealth at midlife. For full-time wage and salary workers approaching retirement age who had pension coverage, median pension wealth on the current job was 76% greater for men than women. Differences in wages, years of job tenure, and industry between men and women accounted for most of the gender gap in pension wealth on the current job. Less than one third of the wealth difference could not be explained by gender differences in education, demographics, or job characteristics. The less-advantaged employment situation of working women currently in midlife carries over into worse retirement income prospects. However, the gender gap in pensions is likely to narrow in the future as married women's employment experiences increasingly resemble those of men. The relationship between multiple role participation and depressive symptoms experienced by African American (n = 547) and White (n = 2,152) women aged 55-61 was explored. Data were obtained from the Health and Retirement Study (HRS). Racial differences in the social roles of marriage, employment, grandmother, care provider, and volunteer and their influence on level of depressive symptoms were examined. African Americans reported higher levels of depressive symptoms than Whites. Additionally, marriage, employment, and total number of social roles were the most powerful predictors of depressive symptoms for both African American and White women. However, employment was more important in diminishing depressive symptoms among African American than White women occupying multiple social roles. Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings. OBJECTIVES: This study addresses three issues. (1) What are demographic wealth, employment, and health characteristics of near-elderly persons losing or acquiring health insurance coverage? Specifically, (2) what are the effects of life transitions, including changes in employment status, health, and marital status? (3) To what extent do public policies protect such persons against coverage loss, including various state policies recently implemented to increase access to insurance? METHODS: The authors used the 1992 and 1994 waves of the Health and Retirement Study to analyze coverage among adults aged 51 to 64 years. RESULTS: One in five near-elderly persons experienced a change in insurance coverage from 1992 to 1994. Yet, there was no significant change in the mix of coverage as those losing one form of coverage were replaced by others acquiring similar coverage. CONCLUSIONS: Individuals whose health deteriorated significantly were not more likely than others to suffer a subsequent loss of coverage, due to substitution of retiree or individual coverage for those losing private coverage and acquisition of Medicaid and Medicare coverage for one in five uninsured. State policies to increase access to private health insurance generally did not prevent individuals from losing coverage or allow the uninsured to gain coverage. Major determinants of the probability of being insured were education, employment status of person and spouse, and work disability status. Other measures of health and functional status did not affect the probability of being insured, but had important impacts on the probability of having public coverage, conditional on being insured. A majority of African-American women over the age of 50 are obese, have at least one chronic disease, and experience mobility difficulty. Using self-reported data from the 1992 Health and Retirement Study of 1,150 African-American women aged 30-70 years, this report first compares chronic disease prevalence and severity, pain, sensory deficits, and mobility difficulty across four categories of body mass index and, second, investigates whether body mass index affects the association of chronic disease with mobility difficulty. Body mass index was categorized as low, medium, high, and severe, being equal to 19-24 (20%), 25-29 (38%), 30-34 (24%), and 35 or over (18%), respectively. There were few differences when comparing the medium category with either the low or high category. Those in the severe body mass index category, however, reported significantly more frequent and severe hypertension, diabetes, cancer, heart disease, arthritis, pain, sensory deficits, and mobility difficulty than did those in the medium body mass index category. Obesity did not appear to affect the association between chronic disease and mobility difficulty. The relatively high rates of mobility difficulty observed among the severe body mass index group appear to be more likely a result of relatively high chronic disease prevalence and severity than to a disproportionate impact of these on mobility. Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, including Hispanics, low-wage earners, and the recently disabled. Sixty percent of individuals with health benefits are enrolled in health maintenance organizations (HMOs) or preferred provider organizations (PPOs). In addition, one-fourth of enrollees in fee-for-service (FFS) plans report restrictions in their access to specialists. BACKGROUND: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites. METHODS: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha = .80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups. RESULTS: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group. CONCLUSIONS: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention. Prior attempts to identify factors associated with physical function (here, major lower body movements) among African Americans have been constrained by a narrow range of measures, small sample sizes, or both. The 1992 Health and Retirement Study (HRS) contains a substantial over-sample of African Americans (649 men and 957 women self-respondents aged 51 to 61 years), and detailed measures of high-risk behaviors, disease prevalence and severity, impairment, and physical function. We extend the natural history of disease to the natural history of functional status and model sociodemographic characteristics, high-risk behaviors, disease prevalence and severity, and impairments as direct and indirect influences on physical function in this African American sample. This natural history of functional status model fits the data well for both men (ROC = .88) and women (ROC = .83), although there are gender differences. Slightly over one-half of the women report some difficulty in physical function, compared with one-third of the men. Women also have a higher mean body-mass and report a greater prevalence and severity in 6 of 9 chronic diseases and more pain, but are less likely to smoke or abuse alcohol than men. Importantly, many of the factors with the largest direct and indirect associations with difficulty in physical function among these African American men (alcohol abuse, smoking, body mass, diabetes, heart disease, cerebrovascular disease, arthritis, and pain) and women (alcohol abuse, body mass, arthritis, and respiratory illness) are all potentially preventable or manageable. Using the 1992 and 1994 Waves of the Health and Retirement Survey, we compare individuals who first take Social Security benefits at age 62 with those who don't and find that the income and net assets of these two groups are similar in the years just prior to eligibility. However, there is great diversity within the groups, so that poor health appears to be more closely related to lower economic well-being than is early Social Security acceptance status. Our results suggest that raising the Social Security retirement age is not likely to dramatically lower the economic well-being of the typical person aged 62 since only 3% of men aged 62 are receiving Social Security retirement benefits, are in poor health, and have Social Security retirement benefits as their only source of pension income.