%0 Journal Article %J Value in Health %D Forthcoming %T Access to Disease-Modifying Alzheimer's Therapies: Addressing Possible Challenges Using Innovative Payment Models. %A Hlávka, Jakub P %A Tysinger, Bryan %A Yu, Jeffrey C %A Lakdawalla, Darius N %K disease-modifying therapies %K payment %K prescription drugs %X

OBJECTIVES: Aduhelm is the first approved disease-modifying therapies (DMT) for Alzheimer disease (AD). Nevertheless, under current payment models, AD DMTs-especially because they treat broader populations-will pose challenges to patient access since costs may accrue sooner than benefits do. New payment approaches may be needed to address this difference in timing.

METHODS: We use the Future Elderly Model that draws on nationally representative data sets such as the Health and Retirement Study to estimate the potential benefits because of hypothetical AD DMTs in 4 stylized treatment scenarios for patients with mild cognitive impairment or mild AD, and develop a payment model to estimate the accrual of net costs and benefits to private and public payers.

RESULTS: The modeled AD DMTs result in clinical benefit of 0.30 to 0.55 quality-adjusted life-years gained per patient in the baseline treatment scenario and 0.13 to 0.24 quality-adjusted life-years gained per patient in the least optimistic scenario. Private payers may observe a net loss in patients at the age of 61 to 65 years under the status quo (payment upon treatment). Constant and deferred installment payment models resolve this issue.

CONCLUSIONS: Innovative payment solutions, such as installment payments, may be required to address misaligned incentives that AD DMTs may create among patients younger than the age of 65 years and may help address concerns about the timing and magnitude of costs and benefits accrued to private payers.

%B Value in Health %G eng %R 10.1016/j.jval.2022.06.003 %0 Journal Article %J The Journals of Gerontology, Series B %D Forthcoming %T Childhood Stressors, Relationship Quality, and Cognitive Health in Later Life. %A Thomas, Patricia A %A Williams-Farrelly, Monica M %A Sauerteig, Madison R %A Ferraro, Kenneth F %K cognitive impairment %K Early-Life Stressors %K Social Relationships %X

OBJECTIVES: The rising prevalence of cognitive impairment, Alzheimer's disease, and related disorders signals the need for a better understanding of how social factors may affect cognitive health for millions of Americans. Drawing from cumulative inequality theory, we aim to understand the implications of a stressful childhood on social relationships and cognitive health in later life.

METHODS: This study utilizes longitudinal data (2006-2016) from the Health and Retirement Study to examine pathways, both direct and indirect through social relationships in adulthood, from childhood stressors to cognitive health trajectories over time.

RESULTS: Respondents reporting a greater number of stressors in childhood had worse cognitive health over time, but those negative effects were not as steep as time progressed. Early-life stressors are also associated with less social support and more social strain in adulthood which, in turn, are associated with initial cognitive health. Finally, pathway analyses confirm that childhood stressors are indirectly associated with initial cognitive health through social strain and social support.

DISCUSSION: Findings reveal that a stressful childhood creates chains of risks that have lifelong implications for cognitive health, both directly and indirectly by creating obstacles for developing healthy and supportive social relationships.

%B The Journals of Gerontology, Series B %G eng %R 10.1093/geronb/gbac007 %0 Journal Article %J Journal of General Internal Medicine %D Forthcoming %T Comparison of Advance Care Planning and End-of-Life Care Intensity Between Dementia Versus Cancer Patients. %A Gotanda, Hiroshi %A Nuckols, Teryl K %A Lauzon, Marie %A Tsugawa, Yusuke %K Advance care planning %K Cancer %K dementia. %X

BACKGROUND: While advanced care planning (ACP) is recommended in dementia and cancer care, there are unique challenges in ACP for individuals with dementia, such as the insidious onset and progression of cognitive impairment, potentially leading to high-intensity care at the end of life (EOL) for this population.

OBJECTIVE: To compare ACP completion and receipt of high-intensity care at the EOL between decedents with dementia versus cancer.

DESIGN: Retrospective longitudinal cohort study.

PARTICIPANTS: Participants of the U.S. Health and Retirement Study who died between 2000 and 2014 with dementia (n = 2099) and cancer (n = 1137).

MAIN MEASURES: Completion of three types of ACP (living will, durable power of attorney for healthcare [DPOAH], discussions of preferences for EOL care) and three measures of EOL care intensity (in-hospital death, intensive care unit [ICU] care in the last 2 years of life, life support use in the last 2 years of life).

KEY RESULTS: Use of living will was lower in dementia than in cancer (adjusted proportion, 49.9% vs. 56.9%; difference, - 7.0 percentage points [pp, 95% CI, - 13.3 to - 0.7]; p = 0.03). Use of DPOAH was similar between the two groups, but a lower proportion of decedents with dementia had discussed preferences compared to decedents with cancer (53.0% vs. 68.1%; - 15.1 pp [95% CI, - 19.3 to - 10.9]; p < 0.001). In-hospital death was higher in dementia than in cancer (29.5% vs. 19.8%; + 9.7 pp [95% CI, + 5.9 to + 13.5]; p < 0.001), although use of ICU care was lower (20.9% vs. 26.1%; - 5.2 pp [95% CI, - 9.8 to - 0.7]; p = 0.03). Use of life support was similar between the two groups.

CONCLUSIONS: Individuals with dementia complete ACP less frequently and might be receiving higher-intensity EOL care than those with cancer. Interventions targeting individuals with dementia may be necessary to further improve EOL care for this population.

%B Journal of General Internal Medicine %G eng %R 10.1007/s11606-021-07330-2 %0 Journal Article %J Omega %D Forthcoming %T The Effects of Religiosity on Depression Trajectories After Widowhood. %A Hawes, Frances M %A Jane Tavares %A Corina R Ronneberg %A Miller, Edward Alan %K depression %K Depressive symptoms %K religiosity %K Social Support %K Widowhood %X

This longitudinal study analyzed data from the 2006-2016 waves of the nationally representative Health and Retirement Study (HRS). Trajectories of depression among older adults ≥ 50 years ( = 1254) were examined over time to explore patterns of depression among those entering widowhood and the potential impact of religiosity on depressive symptoms during various stages of widowhood. Ordinary least squares (OLS) regression analysis was used to examine the association between widowhood and depression and the role of religiosity as a moderator of this association. Older adults experienced a statistically significant increase in depressive symptomology after the onset of widowhood, and depressive symptomology decreased post widowhood, but did not return to pre-widowhood levels. Additionally, high religious service attendance and higher intrinsic religiosity were both associated with lower depressive symptomology. High religious service attendance moderated the relationship between widowhood and depression among widowed older adults living alone.

%B Omega %G eng %R 10.1177/00302228211051509 %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 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 %X

BACKGROUND & 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 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 International Psychogeriatrics %D Forthcoming %T Perceived discrimination and nativity status: risk of cognitive impairment among Latin American older adults. %A Tibiriçá, Lize %A Jester, Dylan J %A Kohn, Jordan N %A Williams, Allison P %A McEvoy, Linda K %A Palmer, Barton W %K Cognition %K Discrimination %K Latinx %K nativity status %X

OBJECTIVES: We examined the association between perceived discrimination and the risk of cognitive impairment with no dementia (CIND) and Alzheimer's disease and related dementias (ADRD) while considering the potential effects of nativity status.

DESIGN: A prospective analysis of discrimination and nativity status with dementia and cognitive impairment was conducted among Latinx adults aged 51 years and older who participated in the Health and Retirement Study.

SETTING: A national representative sample.

PARTICIPANTS: A sample of 1,175 Latinx adults aged 51 years and older.

MEASUREMENTS: Demographics, cognitive functioning, perceived discrimination, and nativity status (US-born vs. non-US born) were assessed. Traditional survival analysis methods (Fine and gray models) were used to account for the semi-competing risk of death with up to 10 years of follow-up.

RESULTS: According to our results, neither everyday discrimination nor nativity status on their own had a statistically significant association with CIND/ADRD; however, non-US-born Latinx adults who reported no discrimination had a 42% lower risk of CIND/ADRD (SHR = 0.58 [0.41, 0.83], = .003) than US-born adults.

CONCLUSIONS: These results highlight the need for healthcare providers to assess for discrimination and provide support and resources for those experiencing discrimination. It also highlights the need for better policies that address discrimination and reduce health disparities.

%B International Psychogeriatrics %P 1-13 %G eng %R 10.1017/S1041610223004374 %0 Journal Article %J Aging & Mental Health %D Forthcoming %T Physical, cognitive, and social activities as mediators between personality and cognition: evidence from four prospective samples. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K activities %K Aging %K Cognition %K lifestyle %K longitudinal %K Personality %X

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

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

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

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

%B Aging & Mental Health %P 1-10 %G eng %R 10.1080/13607863.2024.2320135 %0 Journal Article %J Journal of 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 %X

BACKGROUND: 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 psychosomatic research %D Forthcoming %T Purpose in life and markers of immunity and inflammation: Testing pathways of episodic memory. %A Sutin, Angelina R %A Stephan, Yannick %A Luchetti, Martina %A Terracciano, Antonio %K cognitive aging %K Episodic Memory %K Immunity %K Inflammation %K Mechanism %K Purpose in life %X

OBJECTIVE: This prospective cohort study examines whether purpose in life is associated with markers of immunity and inflammation and tests these markers as mediators between purpose and episodic memory.

METHODS: Participants from the Venous Blood Study of the Health and Retirement Study reported on their purpose in life, had their blood assayed for markers of immunity and inflammation, and were administered an episodic memory task (N = 8999). Regression analyses tested the association between purpose and each marker. Prospective mediation analyses (N = 6092) tested whether these markers measured in 2016 were mediators between purpose measured in 2012/2014 and episodic memory measured in 2018.

RESULTS: Higher purpose in life was associated with lower neutrophil counts (β = -0.08, p < .001), lower ratio of neutrophils/lymphocytes (β = -0.05, p < .001), and lower systemic immune inflammation index (β = -0.04, p < .001); purpose was unrelated to monocyte, platelet, and lymphocyte counts or the ratio of platelets/lymphocytes (all ns). Purpose was associated negatively with c-reactive protein (β = -0.07, p < .001), Interleukin-6 (β = -0.08, p < .001), Interleukin-10 (β = -0.07, p < .001), Interleukin-1ra (β = -0.08, p < .001), and soluble Tumor Necrosis Factor Receptor 1 (sTNFR1; β = -0.10, p < .001); purpose was unrelated to Transforming Growth Factor beta 1. These associations were largely not moderated by age, sex, race, ethnicity, and education. Lower neutrophils, Interleukin-6, and sTNFR1 were associated prospectively with better episodic memory and mediated the association between purpose and episodic memory.

CONCLUSION: Purpose in life is associated with markers of immunity and inflammation, some of which are one mechanism in the pathway between purpose and healthier episodic memory.

%B Journal of psychosomatic research %V 174 %P 111487 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/37696089?dopt=Abstract %R 10.1016/j.jpsychores.2023.111487 %0 Journal Article %J Community Mental Health Journal %D Forthcoming %T Racial differences in Financial Hardship and depressive symptoms among older adults. %A Marshall, Gillian L %A Thorpe, Roland J %A Bruce, Marino A %K Depressive symptoms %K Financial hardship %K Minority aging %K Racial differences %X

BACKGROUND: The purpose of this study was to examine the association between three specific indicators of financial hardship (difficulty paying bills, food insecurity, reduced medication use due to cost) and depressive symptoms by race.

METHODS: This was a cross sectional study using the Health and Retirement Study to analyze the data by conducting a logistic regression (N = 3014).

RESULTS: When stratified by race, White participants who were food insecure had nearly a 3.0 higher odds of high depressive symptoms (95% CI: 1.59-5.51) and African Americans who took less medication due to cost had a 5.1 higher odds of reporting higher depressive symptoms (95% CI: 2.30-11.2) compared to those who did not report these hardships.

CONCLUSIONS: This research highlights the important role expanded socioeconomic measures such as hardship play in the lives of older adult populations. It further elucidates the differences in the specific measures of hardship that impact older adults by race.

%B Community Mental Health Journal %G eng %R 10.1007/s10597-022-00965-3 %0 Journal Article %J Journal of Applied Gerontology %D Forthcoming %T Religious Involvement and the Impact on Living Alone and Depression: An Examination of Gendered Pathways Post-Widowhood. %A Hawes, Frances M %A Tavares, Jane L %K depression %K gender %K Religion %K Social Support %K Widows %X

This study analyzed data from the nationally representative Health and Retirement Study (HRS) to examine the association between widowhood and depression. The results revealed that both men and women experienced increased depression after widowhood, with women exhibiting a better recovery pattern over time. Religiosity, especially attending religious services, was found to be a beneficial coping mechanism for both genders, although men were less religious than women. Living alone was a significant factor associated with depression in widowhood for both men and women. High religious service attendance moderated the association between living alone and depression for women, while both high and moderate religious service attendance moderated this association for men. These findings emphasize the importance of considering gender differences and the potential benefits of religious involvement in addressing depression during widowhood, highlighting the need for tailored interventions and support services for widows and widowers, particularly those living alone.

%B Journal of Applied Gerontology %P 7334648231225355 %G eng %R 10.1177/07334648231225355 %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 %X

BACKGROUND: 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 %X

OBJECTIVE: 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 JAMA Internal Medicine %D Forthcoming %T Wealth Redistribution to Extend Longevity in the US. %A Himmelstein, Kathryn E W %A Tsai, Alexander C %A Venkataramani, Atheendar S %K health outcomes %K Longevity %K reduce inequalities %K Wealth Inequality %X

IMPORTANCE: The US is unique among wealthy countries in its degree of wealth inequality and its poor health outcomes. Wealth is known to be positively associated with longevity, but little is known about whether wealth redistribution might extend longevity.

OBJECTIVE: To examine the association between wealth and longevity and estimate the changes in longevity that could occur with simulated wealth distributions that were perfectly equal, similar to that observed in Japan (among the most equitable of Organisation for Economic Co-operation and Development [OECD] countries), generated by minimum inheritance proposals, and produced by baby bonds proposals.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study (1992-2018), a nationally representative panel study of middle-aged and older (≥50 years) community-dwelling, noninstitutionalized US adults. The data analysis was performed between November 15, 2022, and September 24, 2023.

EXPOSURE: Household wealth on study entry, calculated as the sum of all assets minus the value of debts and classified into deciles.

MAIN OUTCOMES AND MEASURES: Weibull survival models were used to estimate the association between per-person wealth decile and survival, adjusting for age, sex, marital status, household size, and race and ethnicity. Changes in longevity that might occur under alternative wealth distributions were then estimated.

RESULTS: The sample included 35 164 participants (mean [SE] age at study entry, 59.1 [0.1] years; 50.1% female and 49.9% male [weighted]). The hazard of death generally decreased with increasing wealth, wherein participants in the highest wealth decile had a hazard ratio of 0.59 for death (95% CI, 0.53-0.66) compared with those in the lowest decile, corresponding to a 13.5-year difference in survival. A simulated wealth distribution of perfect equality would increase populationwide median longevity by 2.2 years (95% CI, 2.2-2.3 years), fully closing the mortality gap between the US and the OECD average. A simulated minimum inheritance proposal would increase populationwide median longevity by 1.7 years; a simulated wealth distribution similar to Japan's would increase populationwide median longevity by 1.2 years; and a simulated baby bonds proposal would increase populationwide median longevity by 1.0 year.

CONCLUSIONS AND RELEVANCE: These findings suggest that wealth inequality in the US is associated with significant inequities in survival. Wealth redistribution policies may substantially reduce those inequities and increase population longevity.

%B JAMA Internal Medicine %G eng %R 10.1001/jamainternmed.2023.7975 %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 %X

AIMS: 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 %X

BACKGROUND 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 %X

Medical 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 SSM Population Health %D 2024 %T First-generation college graduates have similar depressive symptoms in midlife as multi-generational college graduates. %A Meza, Erika %A Hebert, Jillian %A Garcia, Maria E %A Torres, Jacqueline M %A Glymour, M Maria %A Vable, Anusha M %K First-generation %K Intergenerational education %K Midlife depressive symptoms %X

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

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

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

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

%B SSM Population Health %V 25 %P 101633 %G eng %R 10.1016/j.ssmph.2024.101633 %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 %X

OBJECTIVE: 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 Journal Article %J The Journals of Gerontology, Series B %D 2024 %T Personality and Cognition: The Mediating Role of Inflammatory Markers. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K Cognition %K Inflammation %K longitudinal %K Personality %X

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

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

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

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

%B The Journals of Gerontology, Series B %V 79 %P gbad152 %G eng %N 1 %R 10.1093/geronb/gbad152 %0 Journal Article %J BMC Medicine %D 2024 %T Trajectories of health conditions and their associations with the risk of cognitive impairment among older adults: insights from a national prospective cohort study. %A Du, Min %A Tao, Liyuan %A Liu, Min %A Liu, Jue %K Activities of Daily Living %K Cognitive Dysfunction %K multimorbidity %K Sleep Wake Disorders %X

BACKGROUND: The associations between trajectories of different health conditions and cognitive impairment among older adults were unknown. Our cohort study aimed to investigate the impact of various trajectories, including sleep disturbances, depressive symptoms, functional limitations, and multimorbidity, on the subsequent risk of cognitive impairment.

METHODS: We conducted a prospective cohort study by using eight waves of national data from the Health and Retirement Study (HRS 2002-2018), involving 4319 adults aged 60 years or older in the USA. Sleep disturbances and depressive symptoms were measured using the Jenkins Sleep Scale and the Centers for Epidemiologic Research Depression (CES-D) scale, respectively. Functional limitations were assessed using activities of daily living (ADLs) and instrumental activities of daily living (IADLs), respectively. Multimorbidity status was assessed by self-reporting physician-diagnosed diseases. We identified 8-year trajectories at four examinations from 2002 to 2010 using latent class trajectory modeling. We screened participants for cognitive impairment using the 27-point HRS cognitive scale from 2010 to 2018 across four subsequent waves. We calculated hazard ratios (HR) using Cox proportional hazard models.

RESULTS: During 25,914 person-years, 1230 participants developed cognitive impairment. In the fully adjusted model 3, the trajectories of sleep disturbances and ADLs limitations were not associated with the risk of cognitive impairment. Compared to the low trajectory, we found that the increasing trajectory of depressive symptoms (HR = 1.39; 95% CI = 1.17-1.65), the increasing trajectory of IADLs limitations (HR = 1.88; 95% CI = 1.43-2.46), and the high trajectory of multimorbidity status (HR = 1.48; 95% CI = 1.16-1.88) all posed an elevated risk of cognitive impairment. The increasing trajectory of IADLs limitations was associated with a higher risk of cognitive impairment among older adults living in urban areas (HR = 2.30; 95% CI = 1.65-3.21) and those who smoked (HR = 2.77; 95% CI = 1.91-4.02) (all P for interaction < 0.05).

CONCLUSIONS: The results suggest that tracking trajectories of depressive symptoms, instrumental functioning limitations, and multimorbidity status may be a potential and feasible screening method for identifying older adults at risk of cognitive impairment.

%B BMC Medicine %V 22 %P 20 %G eng %N 1 %R 10.1186/s12916-024-03245-x %0 Journal Article %J Circulation %D 2023 %T Abstract 54: Newly Initiation of Antihypertensive Medication on Reduction of Incident Dementia: Emulation of Target Trials Based on the Health and Retirement Study %A Jingkai Wei %A Hanzhang Xu %A Donglan Zhang %A Huilin Tang %A Tiansheng Wang %A Susan E Steck %A Jiajia Zhang %A Jasmin Divers %A Anwar T Merchant %K incident dementia %X Background: Although antihypertensive medication use is associated with a lower risk of dementia in observational studies, such an effect is rarely found in randomized controlled trials (RCTs). As midlife high blood pressure is more predictive of incident dementia than hypertension in late life, so midlife hypertension may be the target for intervention. However, no such an RCT has been conducted to prevent incident dementia through reducing high blood pressure from midlife. Therefore, we aimed to emulate a target trial with an observational study design to estimate the effect of initiating antihypertensive medication from midlife on reducing incident dementia. Hypothesis: We assessed the hypothesis that newly initiating antihypertensive medication among midlife adults with hypertension reduces incident dementia. Methods: New-user design was used to emulate a target trial using data from the Health and Retirement Study from 1996 to 2018 with non-institutional dementia-free participants aged 45 to 65 years without taking antihypertensive medication in past two years. Participants with information of self-reported hypertension diagnosis and new use of antihypertensive medication, as well as no dementia based on algorithm were included in the analysis and represented group with/without initiating antihypertensive medication. An intention-to-treat approach was applied for analysis, and sequential emulation was used to increase the efficiency of intention-to-treat analysis. Proportional hazards models were applied to estimate the effect of initiating antihypertensive medication on incident dementia. Inverse probability of treatment and censoring weights were created to adjust for confounding and selection bias due to loss to follow-up, and death was considered as a competing event. Another emulated target trial with the same specifications was conducted among late-life adults aged 66 years or older for comparison. Results: A total of 3,151 non-unique participants (baseline mean age: 59.0 ± 4.0 years, 54.6% (n=1,719) women, 78.3% (n=2468) Whites, 71.4% (n=2,249) initiating antihypertensive medication) were included in the analysis. Initiating antihypertensive medication showed benefit in reducing incident dementia over a total of 22-year follow-up, with a reduction of risk by 19% (hazards ratio=0.81, 95% confidence interval: 0.66, 0.99). No significant reduction was observed for initiators of antihypertensive medication from late life. Conclusions: Initiating antihypertensive medication from midlife, but not from late life may reduce incident dementia. Future studies are warranted to estimate the effect of blood pressure lowering in midlife through other means of intervention in reducing incident dementia. %B Circulation %V 147 %P A54-A54 %G eng %R 10.1161/circ.147.suppl_1.54 %0 Conference Paper %B INTERNATIONAL STROKE CONFERENCE %D 2023 %T Abstract 85: Food Swamps Are Associated With Incident Stroke In The Health And Retirement Study %A Dixon Yang %A Imama A Naqvi %A Jose Gutierrez %A Sarah Tom %K food %K Stroke %X Introduction: The role of “food swamps”, an area characterized by a high-density of establishments selling fast-food and junk food relative to healthier options, on incident stroke is not well studied. Hypothesis We hypothesized that a higher retail food environment index (RFEI), indicative of food swamps, would be associated with greater odds of incident stroke. Methods: The sample comprised of community-dwelling stroke-free participants aged ≥50 years who enrolled in the 2010 epoch of the Health and Retirement Study (HRS), which is representative of the US population. If a participant moved to a new area during follow-up through 2016, we only considered incident strokes reported before relocation. The traditional RFEI is a county’s ratio of the number of fast-food restaurants and convenience stores to the number of grocers. The expanded RFEI additionally includes full-service restaurants as unhealthy food options, and farmers’ markets and specialized food stores as healthy food retailers. We averaged RFEI across all included follow-up years and dichotomized RFEI using a threshold of 5, previously shown to discriminate obesity rates. We used logistic regression models to assess the association between RFEI groups and incident stroke, adjusting for key covariates and weighting to account for survey design. Results: Among 84,023,542 participants (mean age 64±10 years, 54% female, 84% white) in weighted analysis, 3,224,378 (3.8%) reported an incident stroke during follow-up. The average traditional and expanded RFEI were 6.5±2.7 (72% in ≥5 group) and 6.9±2.3 (84% in ≥5 group), respectively. In fully adjusted weighted analyses, the higher traditional RFEI group had greater odds of incident stroke compared to the lower group (OR [95% CI]: 1.135 [1.132-1.138]). We found a similar association with expanded RFEI groups and incident stroke (OR [95% CI]: 1.095 [1.092-1.098]). Conclusions: Among community-dwelling adults in HRS, RFEI was associated with incident stroke, independent of demographics and health characteristics. Results highlight the potential importance of an area’s food options as a structural determinant in stroke, especially given most participants resided in areas with 6 times the amount of relative unhealthy to healthy food choices. %B INTERNATIONAL STROKE CONFERENCE %G eng %R https://doi.org/10.1161/str.54.suppl_1.85 %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 %X

AIMS: 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 Web Page %D 2023 %T Air pollution exposure associated with dementia risk, UMich researchers find %A Taeckens, Nadia %K Air Pollution %K dementia risk %I The Michigan Daily, University of Michigan %C Ann Arbor, MI %G eng %U https://www.michigandaily.com/research/air-pollution-exposure-associated-with-dementia-risk-umich-researchers-find/ %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 %X

BACKGROUND: 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 %D 2023 %T Association Between COVID-19 Vaccine Hesitancy and Religiosity Among Elderly with Comorbidities %A Kingsley A. Kalu %A Ho-Jui Tung %K comorbidities %K COVID-19 %K Elderly %K Health and Retirement Study %K Population %K religiosity %K vaccine hesitancy %X Background: Evidence has indicated that COVID-19 vaccines are effective in preventing hospitalizations and deaths. Higher percentages of older adults with chronic conditions are more susceptible to developing severe outcomes when infected with the virus. However, there are studies documenting vaccine hesitancy associated with religiosity. This study tries to examine the association between COVID-19 vaccine hesitancy and religiosity among older adults with comorbidities. Method: This study used secondary data from the Health and Retirement Study (HRS), which is a nationally representative sample of older adults living in the United States. Vaccine hesitancy was measured by the single item, “How likely are you to take the coronavirus vaccine when it becomes available to you? Responses to the item was dichotomized by collapsing the “not at all likely” and “ not very likely” against the “very likely” and “somewhat likely” categories. Religiosity was measured by the weekly frequencies of attending religious services. Results: Logistic regression results showed that HRS participants who attended religious service more than once a week expressed a higher hesitancy (OR=2.02 p<.05) in taking a COVID-19 vaccine if available. Compared to other races, the black participants had higher vaccine hesitancy (OR=2.49; p<.05) with lower odds of taking the COVID-19 vaccine if available. However, there was no association between the number of comorbidities and COVID-19 vaccine hesitancy. Conclusion: The results seem to suggest an association between religiosity and the likelihood of COVID-19 vaccination among older Americans. More research is needed to evaluate religiosity as a social determinant of health for vaccine hesitancy. Keywords Keywords: Religiosity, vaccine hesitancy, Health and Retirement Study, comorbidities, elderly, population, COVID-19. %G eng %U https://digitalcommons.georgiasouthern.edu/gapha-conference/2023/2023/7/ %0 Journal Article %J J Am Heart Assoc %D 2023 %T Association of Joint Genetic and Social Environmental Risks With Incident Myocardial Infarction: Results From the Health and Retirement Study. %A Tang, Junhan %A Sheng, Chen %A Wu, Yan Yan %A Yan, Lijing L %A Wu, Chenkai %K Adult %K Genetic Predisposition to Disease %K Humans %K Myocardial Infarction %K Proportional Hazards Models %K Retirement %K Risk Factors %X

Background Myocardial infarction (MI) is a significant clinical and public health problem worldwide. However, little research has assessed the interplay between genetic susceptibility and social environment in the development of MI. Methods and Results Data were from the HRS (Health and Retirement Study). The polygenic risk score and polysocial score for MI were classified as low, intermediate, and high. Using Cox regression models, we assessed the race-specific association of polygenic score and polysocial score with MI and examined the association between polysocial score and MI in each polygenic risk score category. We also examined the joint effect of genetic (low, intermediate, and high) and social environmental risks (low/intermediate, high) on MI. A total of 612 Black and 4795 White adults aged ≥65 years initially free of MI were included. We found a risk gradient of MI across the polygenic risk score and polysocial score among White participants; no significant risk gradient across the polygenic risk score was found among Black participants. A disadvantaged social environment was associated with a higher risk of incident MI among older White adults with intermediate and high genetic risk but not those with low genetic risk. We revealed the joint effect of genetics and social environment in the development of MI among White participants. Conclusions Living in a favorable social environment is particularly important for people with intermediate and high genetic risk for MI. It is critical to developing tailored interventions to improve social environment for disease prevention, especially among adults with a relatively high genetic risk.

%B J Am Heart Assoc %V 12 %P e028200 %G eng %N 6 %R 10.1161/JAHA.122.028200 %0 Journal Article %J JAMA Psychiatry %D 2023 %T Association of the Mediterranean Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) Diet With the Risk of Dementia. %A Chen, Hui %A Dhana, Klodian %A Huang, Yuhui %A Huang, Liyan %A Tao, Yang %A Liu, Xiaoran %A Melo van Lent, Debora %A Zheng, Yan %A Ascherio, Alberto %A Willett, Walter %A Yuan, Changzheng %K Dementia %K Hypertension %K Mediterranean diet %X

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

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

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

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

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

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

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

%B JAMA Psychiatry %G eng %R 10.1001/jamapsychiatry.2023.0800 %0 Journal Article %J 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 %X

BACKGROUND: 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 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 Journal of Economic Psychology %D 2023 %T Challenges in studying the interplay of genes and environment. A study of childhood financial distress moderating genetic predisposition for peak smoking %A Laura Bierut %A Pietro Biroli %A Titus J. Galama %A Kevin Thom %K G×E %K Health Inequality %K Polygenic index %K Smoking %X Smoking is one of the leading causes of preventable disease and death in the U.S., and it is strongly influenced both by genetic predisposition and childhood adversity. Using polygenic indices (PGIs) of predisposition to smoking, we evaluate whether childhood financial distress (CFD; a composite measure of financial adversity) moderates genetic risk in explaining peak-cigarette consumption in adulthood. Using the Health and Retirement Study (HRS), we find a substantial reduction in the relationship between genetic risk and peak smoking for those who did not suffer financial adversity in childhood. Among adult smokers who grew up in high-CFD households, a one standard deviation higher PGI is associated with 2.9 more cigarettes smoked per day at peak. By contrast, among smokers who grew up in low-CFD households, this gradient is reduced by 37 percent (or 1.1 fewer). These results are robust to controlling for a host of prime confounders. By contrast, we find no evidence of interactions between the PGI and typical measures of childhood SES such as parental education - a null result that we replicate in the Wisconsin Longitudinal Study (WLS) and the English Longitudinal Study of Aging (ELSA). This suggests the role of childhood financial distress in the relationship with peak smoking is distinct from that of low childhood SES, with high CFD potentially reflecting more acute distress than do measures of low childhood SES. Our evidence also suggests low childhood SES is a weaker proxy for acute distress, providing an alternative explanation for the childhood SES null result. %B Journal of Economic Psychology %V 98 %P 102636 %G eng %R https://doi.org/10.1016/j.joep.2023.102636 %0 Journal Article %J JAMA Network Open %D 2023 %T Change in Purpose in Life Before and After Onset of Cognitive Impairment. %A Sutin, Angelina R %A Luchetti, Martina %A Stephan, Yannick %A Terracciano, Antonio %K Aged %K Aging %K Awareness %K Cognitive Dysfunction %K Cohort Studies %K Female %K Humans %K Male %K Middle Aged %K Retirement %X

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

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

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

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

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

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

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

%B JAMA Network Open %V 6 %P e2333489 %8 2023 Sep 05 %G eng %N 9 %R 10.1001/jamanetworkopen.2023.33489 %0 Journal Article %J J Am Med Dir Assoc %D 2023 %T Changes in Personality Before and During Cognitive Impairment. %A Terracciano, Antonio %A Luchetti, Martina %A Stephan, Yannick %A Löckenhoff, Corinna E %A Ledermann, Thomas %A Sutin, Angelina R %X

OBJECTIVES: Clinical observations and studies of retrospective observer ratings point to changes in personality in persons with cognitive impairment or dementia. The timing and magnitude of such changes, however, are unclear. This study used prospective self-reported data to examine the trajectories of personality traits before and during cognitive impairment.

DESIGN: Longitudinal observational cohort study.

SETTING AND PARTICIPANTS: Older adults from the United States in the Health and Retirement Study were assessed for cognitive impairment and completed a measure of the 5 major personality traits every 4 years from 2006 to 2020 (N = 22,611; n = 5507 with cognitive impairment; 50,786 personality and cognitive assessments).

METHODS: Multilevel modeling examined changes before and during cognitive impairment, accounting for demographic differences and normative age-related trajectories.

RESULTS: Before cognitive impairment was detected, extraversion (b = -0.10, SE = 0.02), agreeableness (b = -0.11, SE = 0.02), and conscientiousness (b = -0.12, SE = 0.02) decreased slightly; there was no significant change in neuroticism (b = 0.04, SE = 0.02) or openness (b = -0.06, SE = 0.02). During cognitive impairment, faster rates of change were found for all 5 personality traits: neuroticism (b = 0.10, SE = 0.03) increased, and extraversion (b = -0.14, SE = 0.03), openness (b = -0.15, SE = 0.03), agreeableness (b = -0.35, SE = 0.03), and conscientiousness (b = -0.34, SE = 0.03) declined.

CONCLUSIONS AND IMPLICATIONS: Cognitive impairment is associated with a pattern of detrimental personality changes across the preclinical and clinical stages. Compared with the steeper rate of change during cognitive impairment, the changes were small and inconsistent before impairment, making them unlikely to be useful predictors of incident dementia. The study findings further indicate that individuals can update their personality ratings during the early stages of cognitive impairment, providing valuable information in clinical settings. The results also suggest an acceleration of personality change with the progression to dementia, which may lead to behavioral, emotional, and other psychological symptoms commonly observed in people with cognitive impairment and dementia.

%B J Am Med Dir Assoc %G eng %R 10.1016/j.jamda.2023.05.011 %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 %X

BACKGROUND: 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 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 %X

INTRODUCTION: 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 Neurobiology & Aging %D 2023 %T A comparison of cognitive performances based on differing rates of DNA methylation GrimAge acceleration among older men and women. %A O'Shea, Deirdre M %A Alaimo, Hannah %A Davis, Jennifer D %A Galvin, James E %A Tremont, Geoffrey %K Aging %K Cognition %K DNA Methylation %K Executive function %K GrimAge %K Memory %K sex/gender differences %X

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

%B Neurobiology & Aging %V 123 %P 83-91 %G eng %R 10.1016/j.neurobiolaging.2022.12.011 %0 Journal Article %D 2023 %T Decomposing interaction and mediating effects of race/ethnicity and circulating blood levels of cystatin C on cognitive status in the United States health and retirement study %A Higgins Tejera, César %A Ware, Erin B %A Lindsay C Kobayashi %A Fu, Mingzhou %A Hicken, Margaret %X Background and objectives: Elevated circulating cystatin C is associated with cognitive impairment in non-Hispanic Whites, but its role in racial disparities in dementia is understudied. In a nationally representative sample of older non-Hispanic White, non-Hispanic Black, and Hispanic adults in the United States, we use mediation-interaction analysis to understand how racial disparities in the cystatin C physiological pathway may contribute to racial disparities in prevalent dementia. Results: Overall, elevated cystatin C was associated with dementia (prevalence ratio [PR] = 1.4; 95%CI: 1.2, 1.8). Among non-Hispanic Black relative to non-Hispanic White participants, the relative excess risk due to interaction was 1.7 (95% CI: -0.2, 3.7), the attributable proportion was 0.2 (95%CI: 0.0, 0.5), and the synergy index was 1.4 (95% CI: 1.0, 2.0) in a fully-adjusted model. Elevated cystatin C was estimated to account for 2% (95% CI: -0%, 4%) for the racial disparity in prevalent dementia, and the interaction accounted for 9% (95% CI: -4%, 23%). Analyses for Hispanic relative to non-White participants suggested moderation by race/ethnicity, but not mediation. Discussion: Elevated cystatin C was associated with dementia prevalence. Our mediation-interaction decomposition analysis suggested that the effect of elevated cystatin C on the racial disparity might be moderated by race/ethnicity, which indicates that the racialization process affects not only the distribution of circulating cystatin C across minoritized racial groups, but also the strength of association between the biomarker and dementia prevalence. These results provide evidence that cystatin C is associated with adverse brain health and this effect is larger than expected for individuals racialized as minorities had they been racialized and treated as non-Hispanic White. %G eng %R 10.3389/fnhum.2023.1052435 %0 Journal Article %J Journal of Dental Research %D 2023 %T Diabetes, Edentulism, and Cognitive Decline: A 12-Year Prospective Analysis. %A Wu, B %A Luo, H %A Tan, C %A Qi, X %A Sloan, F A %A Kamer, A R %A Schwartz, M D %A Martinez, M %A Plassman, B L %K dental health %K Epidemiology %K Gerontology %K oral-systemic disease(s) %K Public Health %X

Diabetes mellitus (DM) is a recognized risk factor for dementia, and increasing evidence shows that tooth loss is associated with cognitive impairment and dementia. However, the effect of the co-occurrence of DM and edentulism on cognitive decline is understudied. This 12-y cohort study aimed to assess the effect of the co-occurrence of DM and edentulism on cognitive decline and examine whether the effect differs by age group. Data were drawn from the 2006 to 2018 Health and Retirement Study. The study sample included 5,440 older adults aged 65 to 74 y, 3,300 aged 75 to 84 y, and 1,208 aged 85 y or older. Linear mixed-effect regression was employed to model the rates of cognitive decline stratified by age cohorts. Compared with their counterparts with neither DM nor edentulism at baseline, older adults aged 65 to 74 y (β = -1.12; 95% confidence interval [CI], -1.56 to -0.65; < 0.001) and those aged 75 to 84 y with both conditions (β = -1.35; 95% CI, -2.09 to -0.61; < 0.001) had a worse cognitive function. For the rate of cognitive decline, compared to those with neither condition from the same age cohort, older adults aged 65 to 74 y with both conditions declined at a higher rate (β = -0.15; 95% CI, -0.20 to -0.10; < 0.001). Having DM alone led to an accelerated cognitive decline in older adults aged 65 to 74 y (β = -0.09; 95% CI, -0.13 to -0.05; < 0.001); having edentulism alone led to an accelerated decline in older adults aged 65 to 74 y (β = -0.13; 95% CI, -0.17 to -0.08; < 0.001) and older adults aged 75 to 84 (β = -0.10; 95% CI, -0.17 to -0.03; < 0.01). Our study finds the co-occurrence of DM and edentulism led to a worse cognitive function and a faster cognitive decline in older adults aged 65 to 74 y.

%B Journal of Dental Research %V 102 %P 879-886 %G eng %N 8 %R 10.1177/00220345231155825 %0 Journal Article %J J Head Trauma Rehabil %D 2023 %T Differences in Risk of Alzheimer's Disease Following Later-Life Traumatic Brain Injury in Veteran and Civilian Populations. %A Yashkin, Arseniy P %A Gorbunova, Galina A %A Tupler, Larry %A Yashin, Anatoliy I %A Doraiswamy, Murali %A Akushevich, Igor %K Alzheimer disease %K Traumatic Brain Injury %K veteran %X

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

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

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

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

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

%B J Head Trauma Rehabil %G eng %R 10.1097/HTR.0000000000000865 %0 Journal Article %J Am J Psychiatry %D 2023 %T Differences in Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being: Study of 11,143 Older Adults. %A Jester, Dylan J %A Kohn, Jordan N %A Tibiriçá, Lize %A Thomas, Michael L %A Brown, Lauren L %A Murphy, James D %A Jeste, Dilip V %X

OBJECTIVE: The authors sought to determine the impact of selected social determinants of health (SDoH) on psychological health and well-being (defined as depression, cognition, and self-rated health) among Black and Hispanic/Latinx adults relative to White adults 51-89 years of age.

METHODS: Disparities in depressive symptomatology, cognition, and self-rated health were measured among 2,306 non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 non-Hispanic/Latinx White adults who participated in the Health and Retirement Study (N=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected SDoH explained a larger share of the disparities than age, sex, measures of health, health behaviors, and health care utilization. Selected SDoH included education, parental education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage.

RESULTS: Black and Hispanic/Latinx adults reported worse depressive symptomatology, cognition, and self-rated health than White adults. Selected SDoH were associated with a larger proportion of the Black-White disparities in depressive symptomatology (51%), cognition (39%), and self-rated health (37%) than were age, sex, measures of health, health behaviors, and health care utilization. SDoH were associated with a larger proportion of the Hispanic/Latinx-White disparity in cognition (76%) and self-rated health (75%), but age and physical health correlated with the disparity in depressive symptomatology (28%). Education, parental education, years worked, income, and insurance parity were SDoH associated with these disparities.

CONCLUSIONS: Differences in SDoH underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key SDoH.

%B Am J Psychiatry %P appiajp20220158 %G eng %R 10.1176/appi.ajp.20220158 %0 Journal Article %J Respir Med %D 2023 %T Does peak expiratory flow moderate trajectories of cognitive function among individuals with lung diseases? A longitudinal analysis of the National Health and Aging Trends Study. %A Wiley, Elise %A Brooks, Dina %A MacDermid, Joy C %A Sakakibara, Brodie %A Stratford, Paul W %A Tang, Ada %K Aging %K Cognition %K Female %K Humans %K Lung Diseases %K Male %K Peak Expiratory Flow Rate %K Respiratory Function Tests %X

INTRODUCTION: Impaired cognitive function can co-exist in chronic respiratory diseases. However, it is not clear if peak expiratory flow (PEF) impacts changes in cognitive function. Our objective was to explore whether peak expiratory flow moderates trajectories of memory, visuospatial abilities, and executive function in individuals with chronic respiratory diseases.

METHODS: This was an analysis of individuals with lung diseases from the National Health and Aging Trends Study. Multivariable-adjusted generalized linear mixed models were used to estimate trajectories of immediate and delayed recall, and clock drawing over a 10-year follow-up. The interaction between PEF and time were plotted using sex-specific values for peak expiratory flow at 10th, 50th and 90th percentiles.

RESULTS: In females, interactions of time-by-PEF were found for both immediate (n = 489, t = 2.73, p<0.01) and delayed recall (n = 489, t = 3.38, p<0.01). Females in the 10th vs. 90th percentile of PEF declined in immediate recall at 0.14 vs. 0.065 words/year, and 0.17 vs. 0.032 words/year for delayed recall. Among males, recall declined linearly over 10 years (immediate recall: n = 296, t = -3.08, p < 0.01; delayed recall: n = 292, t = -2.46, p = 0.02), with no interaction with PEF. There were no time-by-PEF interactions nor declines over time in clock drawing scores in both sexes (females: n = 484, t = 0.25, p = 0.81; males: n = 291, t = -0.61, p = 0.55).

CONCLUSION: Females with the lowest PEF values experienced the greatest rates of decline in immediate and delayed recall over 10 years of follow-up, whereas males experienced similar declines in memory outcomes across all levels of PEF. Clock drawing scores remained stable over 10 years in both sexes.

%B Respir Med %V 207 %P 107120 %G eng %R 10.1016/j.rmed.2023.107120 %0 Journal Article %J J Health Econ %D 2023 %T The effect of housing wealth on older adults' health care utilization: Evidence from fluctuations in the U.S. housing market. %A Tran, My %A Gannon, Brenda %A Rose, Christiern %K Aged %K Housing %K Humans %K Patient Acceptance of Health Care %K prescription drugs %K Retirement %X

Do wealthier individuals use more health care services than those less affluent? Our paper addresses this question by examining the relationship between housing wealth and health care utilization. Exploiting fluctuations in the U.S. housing market, we estimate the effect of unanticipated wealth shocks on older adults' health care utilization, using county-year variation in house prices to construct an instrumental variable. Using data from the 1996-2016 Health and Retirement Study, we find that an increase in wealth significantly increases numbers of doctor visits, prescription drugs, outpatient surgery, and dental services. Notably, an economic downturn like that in the Great Recession, when housing wealth declined by 16 percent on average, could reduce the utilization of prescription drugs by 0.4 percent, outpatient services by 0.5 percent, dental care by 0.6 percent, and numbers of doctor visits by 0.5 visits annually.

%B J Health Econ %V 88 %P 102737 %8 2023 Mar %G eng %R 10.1016/j.jhealeco.2023.102737 %0 Journal Article %J Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %D 2023 %T The Effects of Midlife Acute and Chronic Stressors on Black-White Differences in Cognitive Decline. %A Mitchell, Uchechi A %A Shaw, Benjamin A %A Torres, Jacqueline M %A Brown, Lauren L %A Barnes, Lisa L %K Black or African American %K Cognition %K Cognitive Dysfunction %K Humans %K Middle Aged %K Stress, Psychological %K White %X

OBJECTIVES: Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black-White differences in trajectories of cognition among middle-aged adults and the effects of acute and chronic stressors on these trajectories.

METHODS: Data come from 4,011 cognitively healthy individuals aged 51-64 (620 Black and 3,391 White) who participated in the 2006-2018 waves of the Health and Retirement Study. Stressors included a count of recent life events and measures of financial strain and everyday discrimination. Global cognition was assessed using a modified version of the Telephone Interview for Cognitive Status. Linear mixed models with random slopes and intercepts assessed change in cognition over time. Race-by-time, race-by-stressor, time-by-stressor, and race-by-stressor-by-time interactions were assessed as were quadratic terms for time and each stressor.

RESULTS: After adjusting for sociodemographic, health behaviors, and health-related factors, Black respondents had lower initial cognitive performance scores (b = -1.75, p < .001) but experienced earlier but slower decline in cognitive performance over time (Black × Time2 interaction: b = 0.02, p < .01). Financial strain, discrimination, and recent life events each had distinct associations with cognitive performance but did not influence racial differences in levels of or change in cognition over time.

DISCUSSION: Middle-aged Black adults have lower initial cognition levels and experience earlier but less accelerated cognitive decline compared to White middle-aged adults. Midlife acute and chronic stressors influence baseline cognition but do so in different ways. Future research should examine the influence of other stressors on racial differences in cognitive decline at other points in the life course.

%B Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %V 78 %P 2147-2155 %G eng %N 12 %R 10.1093/geronb/gbad143 %0 Journal Article %J Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %D 2023 %T The Effects of Midlife Acute and Chronic Stressors on Black-White Differences in Cognitive Decline. %A Mitchell, Uchechi A %A Shaw, Benjamin A %A Torres, Jacqueline M %A Brown, Lauren L %K Black or African American %K Cognition %K Cognitive Dysfunction %K Humans %K Middle Aged %K Stress, Psychological %K White %X

OBJECTIVES: Midlife stressors may be particularly consequential for cognitive performance and disparities in cognitive decline. This study examined Black-White differences in trajectories of cognition among middle-aged adults and the effects of acute and chronic stressors on these trajectories.

METHODS: Data come from 4,011 cognitively healthy individuals aged 51-64 (620 Black and 3,391 White) who participated in the 2006-2018 waves of the Health and Retirement Study. Stressors included a count of recent life events and measures of financial strain and everyday discrimination. Global cognition was assessed using a modified version of the Telephone Interview for Cognitive Status. Linear mixed models with random slopes and intercepts assessed change in cognition over time. Race-by-time, race-by-stressor, time-by-stressor, and race-by-stressor-by-time interactions were assessed as were quadratic terms for time and each stressor.

RESULTS: After adjusting for sociodemographic, health behaviors, and health-related factors, Black respondents had lower initial cognitive performance scores (b = -1.75, p < .001) but experienced earlier but slower decline in cognitive performance over time (Black × Time2 interaction: b = 0.02, p < .01). Financial strain, discrimination, and recent life events each had distinct associations with cognitive performance but did not influence racial differences in levels of or change in cognition over time.

DISCUSSION: Middle-aged Black adults have lower initial cognition levels and experience earlier but less accelerated cognitive decline compared to White middle-aged adults. Midlife acute and chronic stressors influence baseline cognition but do so in different ways. Future research should examine the influence of other stressors on racial differences in cognitive decline at other points in the life course.

%B Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %V 78 %P 2147-2155 %G eng %N 12 %R 10.1093/geronb/gbad143 %0 Journal Article %J Physiol Behav %D 2023 %T Effects of weight stigma on BMI and inflammatory markers among people living with obesity. %A Nicolau, Joana %A Tofé, Santiago %A Bonet, Aina %A Sanchís, Pilar %A Pujol, Antelm %A Ayala, Luisa %A Gil, Apolonia %A Masmiquel, Lluís %K Adult %K Body Mass Index %K C-reactive protein %K Ferritins %K Humans %K Hydrocortisone %K Obesity %K Weight Loss %K Weight Prejudice %X

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

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

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

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

%B Physiol Behav %V 262 %P 114088 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/36657653?dopt=Abstract %R 10.1016/j.physbeh.2023.114088 %0 Journal Article %J 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 %X

Biomarkers 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 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 %X

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

STUDY DESIGN: Cohort study.

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

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

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

%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 %X

BACKGROUND: 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 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 %X

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

%B Health Affairs %V 42 %P 1230-1240 %G eng %N 9 %R 10.1377/hlthaff.2023.00134 %0 Journal Article %J Biometrics %D 2023 %T Generalized case-control sampling under generalized linear models. %A Maronge, Jacob M %A Tao, Ran %A Schildcrout, Jonathan S %A Rathouz, Paul J %K conditional likelihood %K Efficiency %K generalized case-control studies %K generalized linear models %K outcome-dependent sampling %X

A generalized case-control (GCC) study, like the standard case-control study, leverages outcome-dependent sampling (ODS) to extend to nonbinary responses. We develop a novel, unifying approach for analyzing GCC study data using the recently developed semiparametric extension of the generalized linear model (GLM), which is substantially more robust to model misspecification than existing approaches based on parametric GLMs. For valid estimation and inference, we use a conditional likelihood to account for the biased sampling design. We describe analysis procedures for estimation and inference for the semiparametric GLM under a conditional likelihood, and we discuss problems with estimation and inference under a conditional likelihood when the response distribution is misspecified. We demonstrate the flexibility of our approach over existing ones through extensive simulation studies, and we apply the methodology to an analysis of the Asset and Health Dynamics Among the Oldest Old study, which motives our research. The proposed approach yields a simple yet versatile solution for handling ODS in a wide variety of possible response distributions and sampling schemes encountered in practice.

%B Biometrics %G eng %R 10.1111/biom.13571 %0 Journal Article %J Nat Hum Behav %D 2023 %T Genetic associations with parental investment from conception to wealth inheritance in six cohorts. %A Wertz, Jasmin %A Moffitt, Terrie E %A Arseneault, Louise %A Barnes, J C %A Boivin, Michel %A Corcoran, David L %A Danese, Andrea %A Hancox, Robert J %A Harrington, HonaLee %A Houts, Renate M %A Langevin, Stephanie %A Liu, Hexuan %A Poulton, Richie %A Sugden, Karen %A Tanksley, Peter T %A Williams, Benjamin S %A Caspi, Avshalom %K genetic associations %K parental investment %K wealth inheritance %X

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

%B Nat Hum Behav %G eng %R 10.1038/s41562-023-01618-5 %0 Journal Article %J Alzheimers Dement (Amst) %D 2023 %T Harmonization of cognitive screening tools for dementia across diverse samples: A simulation study. %A Gavett, Brandon E %A Ilango, Sindana D %A Koscik, Rebecca %A Ma, Yue %A Helfand, Benjamin %A Eng, Chloe W %A Gross, Alden %A Trittschuh, Emily H %A Richard N Jones %A Mungas, Dan %K cognitive screening %K Dementia %K Simulation %X

INTRODUCTION: Research focusing on cognitive aging and dementia is a global endeavor. However, cross-national differences in cognition are embedded in other sociocultural differences, precluding direct comparisons of test scores. Such comparisons can be facilitated by co-calibration using item response theory (IRT). The goal of this study was to explore, using simulation, the necessary conditions for accurate harmonization of cognitive data.

METHOD: Neuropsychological test scores from the US Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) were subjected to IRT analysis to estimate item parameters and sample means and standard deviations. These estimates were used to generate simulated item response patterns under 10 scenarios that adjusted the quality and quantity of linking items used in harmonization. IRT-derived factor scores were compared to the known population values to assess bias, efficiency, accuracy, and reliability of the harmonized data.

RESULTS: The current configuration of HRS and MHAS data was not suitable for harmonization, as poor linking item quality led to large bias in both cohorts. Scenarios with more numerous and higher quality linking items led to less biased and more accurate harmonization.

DISCUSSION: Linking items must possess low measurement error across the range of latent ability for co-calibration to be successful.

HIGHLIGHTS: We developed a statistical simulation platform to evaluate the degree to which cross-sample harmonization accuracy varies as a function of the quality and quantity of linking items.Two large studies of aging-one in Mexico and one in the United States-use three common items to measure cognition.These three common items have weak correspondence with the ability being measured and are all low in difficulty.Harmonized scores derived from the three common linking items will provide biased and inaccurate estimates of cognitive ability.Harmonization accuracy is greatest when linking items vary in difficulty and are strongly related to the ability being measured.

%B Alzheimers Dement (Amst) %V 15 %P e12438 %G eng %N 2 %R 10.1002/dad2.12438 %0 Journal Article %J PLoS One %D 2023 %T History of incarceration and age-related neurodegeneration: Testing models of genetic and environmental risks in a longitudinal panel study of older adults. %A Tanksley, Peter T %A Logan, Matthew W %A Barnes, J C %K environment %K genetic %K incarceration %K Neurodegeneration %X

History of incarceration is associated with an excess of morbidity and mortality. While the incarceration experience itself comes with substantive health risks (e.g., injury, psychological stress, exposure to infectious disease), most individuals eventually return from prison to the general population where they will be diagnosed with the same age-related conditions that drive mortality in the non-incarcerated population but at exaggerated rates. However, the interplay between history of incarceration as a risk factor and more traditional risk factors for age-related diseases (e.g., genetic risk factors) has not been studied. Here, we focus on cognitive impairment, a hallmark of neurodegenerative conditions like Alzheimer's disease, as an age-related state that may be uniquely impacted by the confluence of environmental stressors (e.g., incarceration) and genetic risk factors. Using data from the Health and Retirement Study, we found that incarceration and APOE-ε4 genotype (i.e., the chief genetic risk factor for Alzheimer's disease) both constituted substantive risk factors for cognitive impairment in terms of overall risk and earlier onset. The observed effects were mutually independent, however, suggesting that the risk conveyed by incarceration and APOE-ε4 genotype operate across different risk pathways. Our results have implications for the study of criminal-legal contact as a public health risk factor for age-related, neurodegenerative conditions.

%B PLoS One %V 18 %P e0288303 %8 2023 %G eng %N 12 %R 10.1371/journal.pone.0288303 %0 Journal Article %J Research on Aging %D 2023 %T How Do Marital Transitions Affect Self-Perceptions of Aging? %A Turner, Shelbie G %A Witzel, Dakota D %A Stawski, Robert S %A Hooker, Karen %K Divorce %K Marriage %K self-perceptions of aging %K Widowhood %X

OBJECTIVES: We analyzed whether marital status and experiences of marital loss or gain were associated with self-perceptions of aging (SPA), a major psychosocial mechanism of healthy aging.

METHOD: We used data from 7028 participants of the Health and Retirement Study. Participants reported their marital status and their positive and negative SPA on two occasions 4 years apart. We ran general linear models to analyze differences in SPA between men and women who remained married, became divorced or widowed, or remarried following divorce or widowhood.

RESULTS: Participants who experienced marital loss had lower positive SPA than participants who remained marred. Participants who experienced marital gain had lower negative SPA than participants who remained married. None of the associations differed between men and women.

DISCUSSION: Results suggest that it may not be marital status itself, but rather the transition into or out of marriage, that impacts how people appraise their own aging.

%B Research on Aging %G eng %R 10.1177/01640275221113219 %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 %X

Millions 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 Age and Ageing %D 2023 %T How to construct a frailty index from an existing dataset in 10 steps. %A Theou, Olga %A Haviva, Clove %A Wallace, Lindsay %A Searle, Samuel D %A Rockwood, Kenneth %K Aged %K Aging %K Frail Elderly %K Frailty %K Geriatric Assessment %K Humans %K Retrospective Studies %X

BACKGROUND: The frailty index is commonly used in research and clinical practice to quantify health. Using a health deficit accumulation model, a frailty index can be calculated retrospectively from data collected via survey, interview, performance test, laboratory report, clinical or administrative medical record, or any combination of these. Here, we offer a detailed 10-step approach to frailty index creation, with a worked example.

METHODS: We identified 10 steps to guide the creation of a valid and reliable frailty index. We then used data from waves 5 to 12 of the Health and Retirement Study (HRS) to illustrate the steps.

RESULTS: The 10 steps are as follows: (1) select every variable that measures a health problem; (2) exclude variables with more than 5% missing values; (3) recode the responses to 0 (no deficit) through 1 (deficit); (4) exclude variables when coded deficits are too rare (< 1%) or too common (> 80%); (5) screen the variables for association with age; (6) screen the variables for correlation with each other; (7) count the variables retained; (8) calculate the frailty index scores; (9) test the characteristics of the frailty index; (10) use the frailty index in analyses. In our worked example, we created a 61-item frailty index following these 10 steps.

CONCLUSIONS: This 10-step procedure can be used as a template to create one continuous health variable. The resulting high-information variable is suitable for use as an exposure, predictor or control variable, or an outcome measure of overall health and ageing.

%B Age and Ageing %V 52 %G eng %N 12 %R 10.1093/ageing/afad221 %0 Journal Article %J Age and Ageing %D 2023 %T How to construct a frailty index from an existing dataset in 10 steps %A Theou, Olga %A Haviva, Clove %A Wallace, Lindsay %A Searle, Samuel D %A Rockwood, Kenneth %K frail %K Frailty %K Health and Retirement Study %K health measurement %K Morbidity %K Older people %X Background: The frailty index is commonly used in research and clinical practice to quantify health. Using a health deficit accumulation model, a frailty index can be calculated retrospectively from data collected via survey, interview, performance test, laboratory report, clinical or administrative medical record, or any combination of these. Here, we offer a detailed 10-step approach to frailty index creation, with a worked example. Methods: We identified 10 steps to guide the creation of a valid and reliable frailty index. We then used data from waves 5 to 12 of the Health and Retirement Study (HRS) to illustrate the steps. Results: The 10 steps are as follows: (1) select every variable that measures a health problem; (2) exclude variables with more than 5% missing values; (3) recode the responses to 0 (no deficit) through 1 (deficit); (4) exclude variables when coded deficits are too rare (< 1%) or too common (> 80%); (5) screen the variables for association with age; (6) screen the variables for correlation with each other; (7) count the variables retained; (8) calculate the frailty index scores; (9) test the characteristics of the frailty index; (10) use the frailty index in analyses. In our worked example, we created a 61-item frailty index following these 10 steps. Conclusions: This 10-step procedure can be used as a template to create one continuous health variable. The resulting high-information variable is suitable for use as an exposure, predictor or control variable, or an outcome measure of overall health and ageing. © 2023 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. %B Age and Ageing %V 52 %G eng %R 10.1093/ageing/afad221 %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 %X

INTRODUCTION: 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 Soc Sci Med %D 2023 %T The impact of a partner's nursing home admission on individuals' mental well-being. %A Teo, Hansel %K Caregivers %K Hospitalization %K Humans %K Mental Health %K Nursing homes %K psychological well-being %X

This study analyzes the effect of a partner's nursing home admission on individuals' mental well-being. To do so, we use longitudinal data on couples from the Health and Retirement Study and a quasi-experimental difference-in-differences design to isolate the causal effect of the transition. We hypothesize that: (i) a partner's nursing home admission has a negative impact on individuals' mental well-being and (ii) the size of the negative effect is decreasing in the amount of caregiving provided by respondents pre-admission. We find that a partner's nursing home admission raises respondents' depressive symptomology scores by 0.839, corresponding to a 50 percent increase from the average pre-admission baseline. Amongst respondents providing care to their partners pre-admission, a nursing home transition raises depression scores by 0.670, corresponding to a 36.8 increase from baseline. Non-caregiving respondents experience a corresponding 1.05 increase in depression scores, representing a 67.2 percent rise from baseline. Amongst pre-admission caregivers, we find that the negative well-being impact of a partner's admission decreases in the duration and intensity of caregiving pre-admission. We also find that partners of care recipients with more severe physical and cognitive impairment pre-admission experience less deterioration in mental well-being compared to their counterparts. Overall, our findings indicate that a partner's transition into residential care can provide respite from caregiving-related stressors. However, on average, the negative well-being effects of the transition tend to outweigh this positive respite effect. The policy implications are twofold: first, there is a need for continued support to families of care recipients during the latter's transition into institutional care. Second, nursing homes and other institutions have a role in providing respite care, especially for high-intensity caregivers.

%B Soc Sci Med %V 327 %P 115941 %G eng %R 10.1016/j.socscimed.2023.115941 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults. %A Jester, Dylan J %A Palmer, Barton W %A Thomas, Michael L %A Brown, Lauren L %A Tibiriçá, Lize %A Jeste, Dilip V %A Gilmer, Todd %X

BACKGROUND: The effect of years of education on the maintenance of healthy cognitive functioning may differ by race and ethnicity given historical and ongoing inequities in educational quality.

METHODS: We examined 20,311 Black, Latinx, and White adults aged 51-100 from the Health and Retirement Study (2008-2016). Telephone Interview for Cognitive Status-27 data was used to measure cognitive functioning. Generalized additive mixed models were stratified by race and ethnicity and educational attainment (≥12 vs. <12 years). Selected social determinants of health, all-cause mortality, time-varying health and healthcare utilization characteristics, and study wave were included as covariates.

RESULTS: On average, Black and Latinx adults scored lower at baseline compared to White adults regardless of educational attainment (p < 0.001), with a significant overlap in the distributions of scores. The rate of cognitive decline was non-linear for Black, Latinx, and White adults (p < 0.001), and a period of stability was witnessed for those with higher educational attainment irrespective of race and ethnicity. Compared to Black, Latinx, and White adults with lower educational attainment, higher-educated White adults received the greatest protection from cognitive decline (13 years; 64 vs. 51), followed by Latinx (12 years; 67 vs. 55), and Black adults (10 years; 61 vs. 51). Latinx adults experienced cognitive decline beginning at a later age.

CONCLUSIONS: The extent to which higher educational attainment protects adults from cognitive decline differs by race and ethnicity, such that higher-educated White adults received a greater benefit than higher-educated Black or Latinx adults.

%B J Am Geriatr Soc %G eng %R 10.1111/jgs.18340 %0 Journal Article %J Gerodontology %D 2023 %T Incident edentulism and number of comorbidities among middle-aged and older Americans. %A TUNG, HO-JUI %A Ford, Randall %K americans %K middle-aged %X

BACKGROUNDS: Certain chronic non-communicable diseases have been associated with the loss of all natural permanent teeth, referred to as edentulism. It has been suggested that edentulism, a chronic dental state, involving the loss of all teeth and poorer masticatory efficiency, could be associated with multiple chronic conditions as people age. In this study, we describe the association between the number of comorbidities and incident edentulism in a representative sample of older Americans.

METHODS: We took data from the Health and Retirement Study (HRS). Dentate participants aged 50 or older at the baseline of 2006 (N = 13 221) and 2012 (N = 13 938) were linked to their dentate and survival status at the follow-up interviews in 2012 and 2018, respectively. The association between the number of comorbidities and incident edentulism was investigated by using multinomial logistic regression models.

RESULTS: Over the two observation periods, the number of selected chronic conditions was predictive of edentulism 6 years later. A 10% higher chance of becoming edentulous by 2012 (OR = 1.10, 95% CI = 1.01, 1.20) was found for every additional comorbid condition to those who remained dentate in 2012. A similar association was identified for the 2012-2018 period.

CONCLUSION: Among older adults, the number of comorbidities was predictive of incident edentulism, and the same association pattern was found across two longitudinal study periods. Older adults with an increase in the number of comorbidities may experience a higher chance of tooth loss later in time.

%B Gerodontology %8 2023 Jan 27 %G eng %R 10.1111/ger.12675 %0 Journal Article %J Journal of Alzheimer's Disease : JAD %D 2023 %T Initiation of Antihypertensive Medication from Midlife on Incident Dementia: The Health and Retirement Study. %A Wei, Jingkai %A Xu, Hanzhang %A Zhang, Donglan %A Tang, Huilin %A Wang, Tiansheng %A Steck, Susan E %A Divers, Jasmin %A Zhang, Jiajia %A Merchant, Anwar T %K Antihypertensive Agents %K Cognition %K Humans %K Hypertension %K Retirement %K Risk Factors %X

BACKGROUND: Hypertension has been identified as a risk factor of dementia, but most randomized trials did not show efficacy in reducing the risk of dementia. Midlife hypertension may be a target for intervention, but it is infeasible to conduct a trial initiating antihypertensive medication from midlife till dementia occurs late life.

OBJECTIVE: We aimed to emulate a target trial to estimate the effectiveness of initiating antihypertensive medication from midlife on reducing incident dementia using observational data.

METHODS: The Health and Retirement Study from 1996 to 2018 was used to emulate a target trial among non-institutional dementia-free subjects aged 45 to 65 years. Dementia status was determined using algorithm based on cognitive tests. Individuals were assigned to initiating antihypertensive medication or not, based on the self-reported use of antihypertensive medication at baseline in 1996. Observational analog of intention-to-treat and per-protocol effects were conducted. Pooled logistic regression models with inverse-probability of treatment and censoring weighting using logistic regression models were applied, and risk ratios (RRs) were calculated, with 200 bootstrapping conducted for the 95% confidence intervals (CIs).

RESULTS: A total of 2,375 subjects were included in the analysis. After 22 years of follow-up, initiating antihypertensive medication reduced incident dementia by 22% (RR = 0.78, 95% CI: 0.63, 0.99). No significant reduction of incident dementia was observed with sustained use of antihypertensive medication.

CONCLUSION: Initiating antihypertensive medication from midlife may be beneficial for reducing incident dementia in late life. Future studies are warranted to estimate the effectiveness using large samples with improved clinical measurements.

%B Journal of Alzheimer's Disease : JAD %V 94 %P 1431-1441 %G eng %N 4 %R 10.3233/JAD-230398 %0 Journal Article %J Journal of the American Geriatrics Society %D 2023 %T Life satisfaction among persons living with dementia and those without dementia. %A Gotanda, Hiroshi %A Tsugawa, Yusuke %A Xu, Haiyong %A Reuben, David B %K Dementia %K Life Satisfaction %K Well-being %X

BACKGROUND: Despite possible major adverse cognitive, physical, social, and behavioral consequences, little is known about how persons living with dementia perceive satisfaction with life, a key component of well-being. We sought to examine (i) whether persons living with dementia perceive a lower level of satisfaction compared to their peers without dementia and (ii) whether the associations between individual characteristics and life satisfaction are different between persons living with and without dementia.

METHODS: Using a nationally representative sample of community-dwelling older adults aged ≥70 years in the U.S. from the Health and Retirement Study, we compared scores on the Satisfaction with Life Scale (SWLS), a self-reported 5-item scale ranging from 1 to 7 (more satisfaction), between persons with probable dementia (n = 341) and those without (n = 5530), adjusting for individual characteristics. We also tested whether the associations between the individual characteristics and SWLS differ by dementia status.

RESULTS: Scores on SWLS did not differ between persons with probable dementia and those without when adjusting for individual characteristics including limitations in activities of daily living (ADL) (adjusted difference, -0.09; 95% CI, -0.33 to +0.15; p-value, 0.45). However, dementia status was associated with lower life satisfaction through the mediation of limitations in ADL (total effect, -0.29; bootstrapped 95% CI, -0.47 to -0.12). Most individual characteristics associated with lower life satisfaction were similar in the two groups, including younger age, more limitations in ADL, and depression. Less wealth was associated with lower satisfaction among persons without dementia but not among those with probable dementia.

CONCLUSIONS: Dementia status was only modestly associated with lower life satisfaction through the mediation of limitations in ADL among participants who were able to provide response. Future research is warranted to determine whether life satisfaction can be used as a meaningful outcome when evaluating well-being among persons living with dementia.

%B Journal of the American Geriatrics Society %V 71 %P 1105-1116 %G eng %N 4 %R 10.1111/jgs.18174 %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 %X

OBJECTIVES: 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 Frontiers in aging neuroscience %D 2023 %T Longitudinal trajectories of memory among middle-aged and older people with hearing loss: the influence of cochlear implant use on cognitive functioning. %A Völter, Christiane %A Götze, Lisa %A Dazert, Stefan %A Thomas, Jan Peter %A Kamin, Stefan Thomas %K cochlear implantation; cognitive decline; dementia; hearing loss; multilevel growth model %X

INTRODUCTION: Cochlear implants (CI) are the gold standard intervention for severe to profound hearing loss, a known modifiable risk factor for dementia. However, it remains unknown whether CI use might prevent the age-related cognitive decline. Recent studies are encouraging but are limited, mainly by short follow-up periods and, for ethical reasons, lack of appropriate control groups. Further, as age-related cognitive decline is multifaceted and not linear, other statistical approaches have to be evaluated.

MATERIALS AND METHODS: Immediate and delayed recall as measures of cognitive function were assessed in 75 newly implanted CI users (mean age 65.41 years ± 9.19) for up to 5 years (mean 4.5 ± 0.5) of CI use and compared to 8,077 subjects of the same age range from two longitudinal cohort studies, the Health and Retirement Study (HRS) and the English Longitudinal Study of Aging (ELSA). Linear and quadratic changes in cognitive trajectories were analyzed in detail using mixed growth models, considering possible confounders.

RESULTS: For CI users, the linear time slope showed a significant improvement in the specific domains (recall and delayed recall) over time. The quadratic time slope clearly indicated that the predicted change after CI provision followed an inverted U-shape with a predicted decline 2 years after CI provision. In the hearing-impaired group, a significant decline over time was found, with steeper declines early on and the tendency to flatten out in the follow-up.

CONCLUSION: Cochlear implant use seems to boost cognitive trajectories in the first years after implantation. However, long-term prevention of dementia seems to need far more than restoration of hearing loss.

%B Frontiers in aging neuroscience %V 15 %P 1220184 %8 2023 %G eng %R 10.3389/fnagi.2023.1220184 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2023 %T Measures of physical performance as mediators between personality and cognition in two prospective studies. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Cabibel, Vincent %A Terracciano, Antonio %K Cognition %K Personality %K Physical Functional Performance %X

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

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

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

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

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

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

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

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

%B Biol Psychol %V 178 %P 108525 %8 2023 Mar %G eng %R 10.1016/j.biopsycho.2023.108525 %0 Journal Article %J MINDFULNESS %D 2023 %T Meditation and Cognitive Outcomes: A Longitudinal Analysis Using Data From the Health and Retirement Study 2000-2016 %A Lopes, Snehal %A Shi, Lu %A Pan, Xi %A Gu, Yian %A Dengler-Crish, Christine %A Li, Yan %A Tiwari, Biplav %A Zhang, Donglan %K Aging %K Cognition %K Complementary. Alternative Medicine %K meditation %X ObjectiveWe aimed to assess the association between meditation practice and cognitive function over time among middle-aged and older adults.MethodWe included Health and Retirement Study (HRS) participants assessed for meditation practice in the year 2000 as part of the HRS alternative medicine module (n = 1,160) and were followed up for outcomes over 2000-2016 period. We examined the association between meditation & GE; twice a week vs none/less frequent practice and changes in the outcomes of recall, global cognitive function, and quantitative reasoning using generalized linear regression models. Stratified analyses among persons with/without self-reported baseline depressive symptoms were conducted to assess the link between meditation and cognitive outcomes.ResultsAmong our full study sample, meditation & GE; twice a week was not significantly associated with total recall [& beta; = -0.20; 95% CI: -0.97, 0.57; p = 0.61], global cognitive function [& beta; = 0.05; 95% CI: -1.01, 1.12; p = 0.92], and quantitative reasoning [& beta; = -11.48; 95% CI: -31.27, 8.32; p = 0.26]. However, among those who did not have self-reported depressive symptoms at baseline, meditation & GE; twice a week was associated with improvement in cognitive outcomes such as total recall [& beta; = 0.11; 95% CI: 0.03, 0.18; p = 0.01] and global cognitive function [& beta; = 0.22; 95% CI: 0.05, 0.40; p = 0.01] over time.ConclusionsFrequent meditation practice might have a protective effect on cognitive outcomes over time, but this protection could be limited to those without self-reported baseline depressive symptoms. Future studies could incorporate more precise meditation practice assessment, investigate the effect of meditation on cognitive outcomes over time, and include more rigorous study designs with randomized group assignment.Pre-registrationThis study is not preregistered. %B MINDFULNESS %V 14 %P 1705-1717 %G eng %R 10.1007/s12671-023-02165-w %0 Web Page %D 2023 %T Methodology for Analysis of the U.S. Health and Retirement Study %A The New York Times %A KFF Health News %K cognitive function %K Langa-Weir classification %K Methodology %B Dying Broke %I The New York Times %C New York, NY %G eng %U https://www.nytimes.com/2023/11/14/health/retirement-survey-analysis.html?action=click&module=RelatedLinks&pgtype=Article %0 Report %D 2023 %T Mortality Risks, Subjective Well-Being and Polygenic Scores: Evidence from the Health and Retirement Study %A Lisa Posey %A Sharon Tennyson %A Nan Zhu %K mortality risks %K polygenic scores %K Well-being %X The relationship between an individual’s subjective well-being and their future mortality prospects has been well documented. Using data from the Health and Retirement Study combined with genetic information, we present empirical evidence of how this relationship operates through various channels. Our findings reveal that both the genetic and environmental factors contributing to subjective well-being have a significant impact not only on the objective mortality of participants in our study, but also on the bias in their survival estimation—measured as the disparity between individuals’ subjective and objective survival probabilities. Our gender-specific analyses further reveal diverging observations for females and males in terms of explaining the bias in survival estimation. %G eng %U https://static1.squarespace.com/static/57cef2a1197aea734bbcf35c/t/63ee9ed4d4495627dae0725c/1676582613273/Mortality_genetics_SWB_Feb2023.pdf %0 Report %D 2023 %T Not Just for Kids: Child and Dependent Care Credit Benefits for Adult Care %A Gabrielle Pepin %A Yulya Truskinovsky %K adult care %X The Child and Dependent Care Credit (CDCC) allows households to receive tax credits for certain expenses associated with the care of a spouse or adult dependent who is incapable of self care, but very few childless households claim the credit. We examine the value of the CDCC for qualifying households caring for adults. We find that, as of 2016, more than 10 percent of individuals aged 50 to 65 had a coresident spouse or parent likely to be a qualifying individual for the CDCC. We document how state and federal CDCC benefits decrease post-tax costs of typical caregiving services, such as hiring a home health aide, across states. We find that a temporary expansion during 2021 led to substantial decreases in post-tax care costs but generated considerable differences in benefits across households with spouse and nonspouse qualifying individuals. We discuss expected effects on taxpayers’ behavior of permanently expanding the CDCC and find that making the credit refundable would nearly double the number of eligible spousal caregivers aged 50 to 65, with eligibility rates increasing substantially among female, nonwhite, and lowincome caregivers. %I W.E Upjohn Institute for Employment Research %C Kalamazoo, Michigan %G eng %U https://research.upjohn.org/cgi/viewcontent.cgi?article=1400&context=up_workingpapers %0 Web Page %D 2023 %T Past obesity can have lasting effects on mental health, study finds %A Thomas, Tobi %K Anxiety %K depression %K Mental Health %K Obesity %I The Guardian %G eng %U https://www.theguardian.com/society/2023/may/17/past-obesity-can-have-lasting-effects-on-mental-health-study-finds %0 Journal Article %J J Aging Health %D 2023 %T Perceived Neighborhood Characteristics and Later-Life Pain Outcomes: Evidence From the Health and Retirement Study. %A Yang, Yulin %A Sims, Kendra D %A Lane, Nancy E %A Duchowny, Kate A %A Torres, Jacqueline M %X

This study examines whether perceived neighborhood characteristics relate to pain outcomes among middle-aged and older adults. Data were from the Health and Retirement Study (2006-2014; = 18,814). Perceived neighborhood characteristics were physical disorder, social cohesion, safety, and social ties. We fitted adjusted generalized estimating equation models to evaluate prevalence, incidence, and recovery of moderate-to-severe limiting pain 2 years later. The mean age of our sample was 65.3 years; 54.6% were female and 24.2% reported moderate-to-severe limiting pain at baseline. Positive neighborhood characteristics were associated with low prevalence (e.g., prevalence ratio [PR]: .71 for ) and reduced incidence (e.g., PR: .63 for ) of moderate-to-severe limiting pain. Positive neighborhood characteristics were associated with a high recovery rate from moderate-to-severe limiting pain (e.g., PR = 1.15 for ), though the 95% CIs for disorder and cohesion crossed the null. Neighborhood characteristics may be important determinants in predicting pain in later life.

%B J Aging Health %P 8982643231185382 %G eng %R 10.1177/08982643231185382 %0 Journal Article %J Psychoneuroendocrinology %D 2023 %T Personality and aging-related immune phenotype. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Aschwanden, Damaris %A Terracciano, Antonio %K Female %K Humans %K Immunoglobulin G %K Male %K Neuroticism %K Personality %K Personality Disorders %X

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

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

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

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

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

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

%B Stroke %V 54 %P 2069-2076 %G eng %N 8 %R 10.1161/STROKEAHA.123.042617 %0 Journal Article %J Respiratory Medicine %D 2023 %T Personality associations with lung function and dyspnea: Evidence from six studies %A Yannick Stephan %A Angelina R. Sutin %A Martina Luchetti %A Damaris Aschwanden %A Pauline Caille %A Antonio Terracciano %K Dyspnea %K lung function %K Peak expiratory flow %K Personality %X Objective The present study examined the association between Five Factor Model personality traits and lung function and dyspnea. Methods Participants were middle aged and older adults aged 34–103 years old (N > 25,000) from the Midlife in the United States Study (MIDUS), the Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA), the National Health and Aging Trends Survey (NHATS), and the Wisconsin Longitudinal Study graduate (WLSG) and sibling (WLSS) samples. Data on peak expiratory flow (PEF), dyspnea, personality traits, smoking, physical activity, body mass index (BMI), emotional/psychiatric problems, and demographic factors were obtained in each sample. Results A meta-analysis indicated that higher neuroticism was related to lower PEF, higher risk of PEF less than 80% of predicted value, and higher risk of dyspnea. In contrast, higher extraversion and conscientiousness were associated with higher PEF, lower likelihood of PEF lower than 80% of the predicted value, and lower risk of dyspnea. Higher openness was related to higher PEF and lower risk of PEF less than 80%, whereas agreeableness was related to higher PEF and lower risk of dyspnea. Smoking, physical activity, BMI and emotional/psychiatric problems partially accounted for these associations. There was little evidence that lung disease moderated the association between personality and PEF and dyspnea. Conclusions Across cohorts, this study found replicable evidence that personality is associated with lung function and associated symptomatology. %B Respiratory Medicine %V 208 %P 107127 %G eng %R https://doi.org/10.1016/j.rmed.2023.107127 %0 Journal Article %J United European Gastroenterol Journal %D 2023 %T A pilot genome-wide association study meta-analysis of gastroparesis. %A Tavares, Leticia Camargo %A Zheng, Tenghao %A Kwicklis, Madeline %A Mitchell, Emily %A Pandit, Anita %A Pullapantula, Suraj %A Bernard, Cheryl %A Teder-Laving, Maris %A Marques, Francine Z %A Esko, Tonu %A Kuo, Braden %A Shulman, Robert J %A Chumpitazi, Bruno P %A Koch, Kenneth L %A Sarosiek, Irene %A Abell, Thomas L %A McCallum, Richard W %A Parkman, Henry P %A Pasricha, Pankaj J %A Hamilton, Frank A %A Tonascia, James %A Zawistowski, Matthew %A Farrugia, Gianrico %A Grover, Madhusudan %A D'Amato, Mauro %K abdominal pain %K delayed gastric emptying %K Diabetes %K enteric nervous system %K gastroparesis %K Genetics %K immune dysregulation %K Inflammation %K motor function. %K PXDNL %X

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

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

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

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

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

%B United European Gastroenterol Journal %V 11 %P 784-796 %G eng %N 8 %R 10.1002/ueg2.12453 %0 Journal Article %J J Am Heart Assoc %D 2023 %T Preoperative Factors Predict Memory Decline After Coronary Artery Bypass Grafting or Percutaneous Coronary Intervention in an Epidemiological Cohort of Older Adults. %A Tang, Angelina B %A Diaz-Ramirez, L Grisell %A Smith, Alexander K %A Lee, Sei J %A Whitlock, Elizabeth L %K Aged %K Aged, 80 and over %K Coronary Artery Bypass %K Coronary Artery Bypass, Off-Pump %K Coronary Artery Disease %K Female %K Humans %K Male %K Memory Disorders %K Percutaneous Coronary Intervention %K Treatment Outcome %X

Background Durable memory decline may occur in older adults after surgical (coronary artery bypass grafting [CABG]) or nonsurgical (percutaneous coronary intervention) coronary revascularization. However, it is unknown whether individual memory risk can be predicted. We reanalyzed an epidemiological cohort of older adults to predict memory decline at ≈1 year after revascularization. Methods and Results We studied Health and Retirement Study participants who underwent CABG or percutaneous coronary intervention at age ≥65 years between 1998 and 2015 and participated in ≥1 biennial postprocedure assessment. Using a memory score based on direct and proxy cognitive tests, we identified participants whose actual postprocedure memory score was 1-2 ("mild") or >2 ("major") SDs below expected postprocedure performance. We modeled probability of memory decline using logistic regression on preoperatively known factors and evaluated model discrimination and calibration. A total of 1390 participants (551 CABG, 839 percutaneous coronary intervention) underwent CABG/percutaneous coronary intervention at 75±6 years old; 40% were women. The cohort was 83% non-Hispanic White, 8.4% non-Hispanic Black, 6.4% Hispanic ethnicity, and 1.7% from other groups masked by the HRS (Health and Retirement Study) to preserve participant confidentiality. At a median of 1.1 (interquartile range, 0.6-1.6) years after procedure, 267 (19%) had mild memory decline and 88 (6.3%) had major memory decline. Factors predicting memory decline included older age, frailty, and off-pump CABG; obesity was protective. The optimism-corrected area under the receiver operator characteristic curve was 0.73 (95% CI, 0.71-0.77). A cutoff of 50% probability of memory decline identified 14% of the cohort as high risk, and was 94% specific and 30% sensitive for late memory decline. Conclusions Preoperative factors can be used to predict late memory decline after coronary revascularization in an epidemiological cohort with high specificity.

%B J Am Heart Assoc %V 12 %G eng %N 1 %R 10.1161/JAHA.122.027849 %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 %X

BACKGROUND: 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 J Alzheimers Dis Rep %D 2023 %T The Prevalence and Trends of Instrumental Activities of Daily Living Impairments in the United States from 2008-2018. %A Knoll, Kelly %A Rhee, Yeong %A Hamm, Jeremy M %A Hammer, Kimberly D P %A Heimbuch, Halli %A Holloway, Jeremy %A Jurivich, Donald %A Lahr, Peyton %A McGrath, Brenda %A Parker, Kelly %A Robinson-Lane, Sheria %A Stover, Emily %A Tomkinson, Grant R %A McGrath, Ryan %X

BACKGROUND: Instrumental activities of daily living (IADL) are neuropsychological-driven tasks that are linked to cognitive dysfunction. Examining population-based IADL deficits may reveal insights for the presence of these impairments in the United States.

OBJECTIVE: This investigation sought to evaluate the prevalence and trends of IADL impairments in Americans.

METHODS: A secondary analysis of data from the 2006-2018 waves of the Health and Retirement Study was conducted. The overall unweighted analytic sample included 29,764 Americans aged≥50 years. Respondents indicated their ability to perform six IADLs: manage money, manage medications, use a telephone, prepare hot meals, shop for groceries, and use a map. Persons reporting difficulty or an inability to complete an individual IADL were considered as having a task-specific impairment. Similarly, those indicating difficulty or an inability to perform any IADL were classified as having an IADL impairment. Sample weights were utilized to generate nationally-representative estimates.

RESULTS: Having an impairment in using a map (2018 wave: 15.7% (95% confidence interval (CI): 15.0-16.4) had the highest prevalence in individual IADLs regardless of wave examined. The overall prevalence of IADL impairments declined during the study period ( < 0.001) to 25.4% (CI: 24.5-26.2) in the 2018 wave. Older Americans and women had a consistently higher prevalence of IADL impairments compared to middle-aged Americans and men, respectively. The prevalence of IADL impairments was also highest among Hispanics and non-Hispanic Blacks.

CONCLUSION: IADL impairments have declined over time. Continued surveillance of IADLs may help inform cognitive screening, identify subpopulations at risk of impairment, and guide relevant policy.

%B J Alzheimers Dis Rep %V 7 %P 271-278 %G eng %N 1 %R 10.3233/ADR-220107 %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 %X

Frank 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 Psychophysiology %D 2023 %T The prospective relationship between subjective aging and inflammation: Evidence from the health and retirement study. %A Stephan, Yannick %A Sutin, Angelina R %A Luchetti, Martina %A Terracciano, Antonio %K anti-inflammatory cytokines %K pro-inflammatory cytokines %K self-perceptions of aging %K Subjective age %K systemic inflammation %X

This study tested the prospective associations and potential mediators between subjective aging, indexed by subjective age and self-perceptions of aging (SPA), and a range of inflammatory markers, including C-reactive proteins (CRP) and pro- and anti-inflammatory cytokines among older adults. Participants (N = 6099, 59% women, age range = 50 to 94, Mean Age = 65.32, SD = 8.85) were drawn from the Health and Retirement Study. Subjective age, SPA, and demographic factors were assessed in 2008/2010. Assessments of soluble transformation growth factor-beta 1 (sTGF-β1), interleukin 10 (IL-10), interleukin-1 receptor antagonist (IL-1Ra), interleukin 6 (IL-6), soluble tumor necrosis factor receptors (sTNFR1), and high sensitivity CRP (hsCRP) were measured in 2016. Potential mediators (body mass index, disease burden, physical inactivity, and depressive symptoms) were asssessed at baseline and in 2012/2014. Linear regression analyses indicated that an older subjective age and negative SPA were related to higher level of IL-10, IL-1Ra, IL-6, sTNFR1 and hsCRP. These associations were mediated by higher disease burden and physical inactivity. Negative SPA (but not subjective age) was associated with lower sTGF-β1. The link between subjective aging and inflammatory markers was relatively independent from chronological age. The present study provides new evidence that subjective aging is prospectively associated with inflammation, including systemic inflammation and pro-and anti-inflammatory cytokines.

%B Psychophysiology %G eng %R 10.1111/psyp.14177 %0 Journal Article %J J Int Neuropsychol Soc %D 2023 %T Purpose in life and cognitive performance and informant ratings of cognitive decline, affect, and activities. %A Sutin, Angelina R %A Luchetti, Martina %A Stephan, Yannick %A Terracciano, Antonio %K HCAP; cognitive domains; cognitive function; informant ratings; purpose in life; well-being %X

OBJECTIVE: To examine (1) the association between purpose in life and multiple domains of cognitive function and informant-rated cognitive decline, affect, and activities; (2) whether these associations are moderated by sociodemographic factors, cognitive impairment, or depression; (3) whether the associations are independent of other aspects of well-being and depressive symptoms.

METHOD: As part of the 2016 Harmonized Cognitive Assessment Protocol from the Health and Retirement Study, participants completed a battery of cognitive tests and nominated a knowledgeable informant to rate their cognitive decline, affect, and activities. Participants with information available on their purpose in life from the 2014/2016 Leave Behind Questionnaire were included in the analytic sample ( = 2,812).

RESULTS: Purpose in life was associated with better performance in every cognitive domain examined (episodic memory, speed-attention, visuospatial skills, language, numeric reasoning; median =.10, <.001; median =.53). Purpose was likewise associated with informant-rated cognitive decline and informant-rated affective and activity profiles beneficial for cognitive health (median =.18, < .001; median =.55). There was little evidence of moderation by sociodemographic or other factors (e.g., depression). Life satisfaction, optimism, positive affect, and mastery were generally associated with cognition. When tested simultaneously with each other and depressive symptoms, most dimensions were reduced to non-significance; purpose remained a significant predictor.

CONCLUSIONS: Purpose in life is associated with better performance across numerous domains of cognition and with emotional and behavioral patterns beneficial for cognitive health that are observable by knowledgeable others. These associations largely generalize across demographic and clinical groups and are independent of other aspects of well-being.

%B J Int Neuropsychol Soc %P 1-9 %G eng %R 10.1017/S1355617723000516 %0 Journal Article %J JAMA Intern Med %D 2023 %T Racial and Ethnic Disparities in Health Care Use and Access Associated With Loss of Medicaid Supplemental Insurance Eligibility Above the Federal Poverty Level. %A Roberts, Eric T %A Kwon, Youngmin %A Hames, Alexandra G %A McWilliams, J Michael %A Ayanian, John Z %A Tipirneni, Renuka %K Aged %K Cross-Sectional Studies %K Female %K Healthcare Disparities %K Humans %K Male %K Medicaid %K Medicare %K Middle Aged %K Poverty %K United States %X

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

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

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

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

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

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

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

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

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

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

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

%B SSM Popul Health %V 22 %P 101375 %G eng %R 10.1016/j.ssmph.2023.101375 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2023 %T Racial-Ethnic Disparities in Dual-Function Life Expectancy. %A Bauldry, Shawn %A Thomas, Patricia A %A Sauerteig-Rolston, Madison R %A Ferraro, Kenneth F %K Life Expectancy %X

BACKGROUND: This study develops a new concept, dual functionality, that integrates physical and cognitive function. We use the concept to define a measure of dual-function life expectancy and assess racial-ethnic inequalities in aging.

METHODS: Drawing on data from the National Health Interview Study Linked Mortality Files and the Health and Retirement Study, we define dual functionality as having no limitations in activities of daily living and being free of dementia. We use this measure and Sullivan life tables to estimate age-50 total life expectancy and age-50 dual-function life expectancy (2FLE) for women and men across four racial-ethnic and nativity groups.

RESULTS: At ages 50 to 54, between 79.0% (95% CI: 73.5, 84.5) and 87.6% (95% CI: 84.0, 91.2) of (non-Hispanic) Black, foreign-born Hispanic, and US-born Hispanic women and men remain dual functional as compared with 90.4% (95% CI: 89.3, 91.4) and 91.4% (95% CI: 90.2, 92.5) of (non-Hispanic) White women and men respectively. These and corresponding racial-ethnic disparities in dual functionality through ages 85 and older translate into substantial inequalities in 2FLE. For instance, the Black-White gap in age-50 2FLE is 6.9 years (95% CI: -7.5, -6.4) for women and 6.0 years (95% CI: -6.6, -5.4) for men.

CONCLUSIONS: Black, foreign-born Hispanic, and US-born Hispanic older adults are estimated to live a smaller percentage of their remaining years with dual functionality than White older adults. These results reveal stark racial-ethnic inequalities in aging that have significant implications for quality of life, caregiving, and health needs.

%B J Gerontol A Biol Sci Med Sci %8 2023 Feb 17 %G eng %R 10.1093/gerona/glad059 %0 Journal Article %J Int J Environ Res Public Health %D 2023 %T Relationships between Interpersonal Goals and Loneliness in Older Adults: A Cross-Sectional Study. %A Ezeokonkwo, Francesca C %A Sekula, Kathleen L %A Stokes, Jeffrey E %A Theeke, Laurie A %A Zoucha, Rick %A Troutman-Jordan, Meredith %A Sharma, Dinesh %K Aged %K Cross-Sectional Studies %K Ecosystem %K Female %K Goals %K Humans %K Interpersonal Relations %K Loneliness %X

Loneliness is linked to many physiological and psychological issues and disproportionately affects older adults. Interpersonal goals (compassion and self-image) are essential to interpersonal relationships; however, how they relate to loneliness in older adults is unknown. We investigated the impact of interpersonal goals on loneliness using the Ecosystem-Egosystem Theory of Social Motivation. This study, adopting a descriptive cross-sectional correlational design, used data from the 2016 Health and Retirement Study. Participants ( = 3212) included people aged >65 years (mean age: 75; female: 60.1%). We performed exploratory factor analysis with principal axis factoring and varimax rotation to examine the suitability of compassionate and self-image goals as separate factors. The complex samples general linear model was used to assess the relationship between loneliness and interpersonal goals. Interpersonal goals were significantly negatively associated with loneliness. Respondents with higher compassion and self-image goals reported lower loneliness levels. Our results contribute to understanding how interpersonal goals relate to loneliness in older adults. These initial findings warrant further investigation.

%B Int J Environ Res Public Health %V 20 %G eng %N 3 %R 10.3390/ijerph20031914 %0 Journal Article %J Journal of the American Directors Association %D 2023 %T The Role of Different Weakness Cut-Points for Future Cognitive Impairment in Older Americans. %A McGrath, Ryan %A Tomkinson, Grant R %A Hamm, Jeremy M %A Juhl, Kirsten %A Knoll, Kelly %A Parker, Kelly %A Smith, Ashleigh E %A Rhee, Yeong %K Aged %K Body Mass Index %K Cognition %K Cognitive Dysfunction %K Female %K Geriatric Assessment %K Hand Strength %K Humans %K Male %X

OBJECTIVES: New absolute and normalized handgrip strength (HGS) cut-points may not yield similar predictive value for cognitive performance. We sought to determine the associations of (1) each absolute and normalized weakness cut-point, and (2) compounding weakness on future cognitive impairment in older Americans.

DESIGN: Longitudinal panel.

SETTING AND PARTICIPANTS: The analytic sample included 11,116 participants aged ≥65 years from the 2006 to 2018 waves of the Health and Retirement Study. Participants from the Health and Retirement Study completed detailed interviews that included physical measures and core interviews.

METHODS: The modified Telephone Interview of Cognitive Status assessed cognitive function and persons scoring <11 were classified as having a cognitive impairment. A handgrip dynamometer measured HGS. Men were considered weak if their HGS was <35.5 kg (absolute), <0.45 kg/kg (body mass normalized), or <1.05 kg (body mass index normalized), whereas women were classified as weak if their HGS was <20.0 kg, <0.337 kg/kg, or <0.79 kg. Compounding weakness included those below 1, 2, or all 3 cut-points. Generalized estimating equations quantified the associations.

RESULTS: Persons considered weak under the absolute cut-point had 1.62 (95% CI 1.34-1.96) greater odds for future cognitive impairment, but no significant associations were observed for those classified as weak under the body mass [odds ratio (OR) 1.12, CI 0.91-1.36] and body mass index normalized (OR 1.17, CI 0.95-1.43) cut-points. Older Americans below all 3 weakness cut-points had 1.47 (CI 1.15-1.88) greater odds for future cognitive impairment, but no significant associations were found for persons classified as weak under 1 (OR 1.08, CI 0.83-1.42) or 2 (OR 1.19, CI 0.91-1.55) cut-points.

CONCLUSIONS AND IMPLICATIONS: Our findings suggest that each weakness cut-point has differential prognostic value for future cognitive impairment, and aggregating weakness cut-points may improve their predictive utility. Consideration should be given to how weakness categories are uniquely linked to cognitive function.

%B Journal of the American Directors Association %V 24 %P 1936-1941.e2 %G eng %N 12 %R 10.1016/j.jamda.2023.07.021 %0 Journal Article %J Int J Environ Res Public Health %D 2023 %T Self-Rated Health and Mortality: Moderation by Purpose in Life. %A Friedman, Elliot M %A Teas, Elizabeth %K ethnicity %K Humans %K Longevity %K Longitudinal Studies %K Mortality %K Racial Groups %K United States %K White %X

Poor self-rated health consistently predicts reduced longevity, even when objective disease conditions and risk factors are considered. Purpose in life is also a reliable predictor of diverse health outcomes, including greater longevity. Given prior work in which we showed that purpose in life moderated the association between chronic conditions and health-related biological factors, the aim of the current study was to examine the role of purpose in life in moderating the relationship between subjective health and mortality. We also examined potential differences in these associations by race/ethnicity. Data were from two large national longitudinal studies-the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study-with a 12- to 14-year follow-up period for mortality estimates. Results of logistic regression analyses showed that purpose in life and self-rated health were both significantly positively associated with longevity, and that purpose in life significantly moderated the relationship between self-rated health and mortality. Stratified analyses showed similar results across all racial/ethnic groups, with the exception of Black MIDUS participants. These results suggest that greater purpose in life may provide a buffer against the greater probability of mortality associated with poor subjective health.

%B Int J Environ Res Public Health %V 20 %G eng %N 12 %R 10.3390/ijerph20126171 %0 Journal Article %J Arch Clin Neuropsychol %D 2023 %T Sense of Purpose in Life and Beliefs and Knowledge of Alzheimer's Disease. %A Sutin, Angelina R %A Stephan, Yannick %A Luchetti, Martina %A Aschwanden, Damaris %A Sesker, Amanda A %A Zhu, Xianghe %A Terracciano, Antonio %K Alzheimer's disease %K beliefs %K Knowledge %X

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

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

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

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

%B Arch Clin Neuropsychol %8 2023 Feb 04 %G eng %R 10.1093/arclin/acad014 %0 Journal Article %J Aging and Health Research %D 2023 %T Sense of purpose in life and work-life tension: Perceptions of interference and enhancement %A Sutin, Angelina R. %A Luchetti, Martina %A Stephan, Yannick %A Terracciano, Antonio %B Aging and Health Research %V 3 %G eng %U https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166003472&doi=10.1016%2fj.ahr.2023.100154&partnerID=40&md5=61d5d1146dfd6872bbf04e77ab2d2232 %9 Article %R 10.1016/j.ahr.2023.100154 %0 Journal Article %J J Alzheimers Dis %D 2023 %T A Simple Single Item Rated by an Interviewer Predicts Incident Dementia Over 15 Years. %A Sutin, Angelina R %A Aschwanden, Damaris %A Luchetti, Martina %A Stephan, Yannick %A Terracciano, Antonio %X

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

%B J Alzheimers Dis %G eng %R 10.3233/JAD-230417 %0 Web Page %D 2023 %T Social isolation linked to higher likelihood of nursing home admission: study %A Towhey, Jessica %K health outcomes %K Nursing homes %K social isolation %I McKnights %G eng %U https://www.mcknights.com/news/social-isolation-linked-to-higher-likelihood-of-nursing-home-admission-study/ %0 Journal Article %J Journal of Aging and Health %D 2023 %T Sociodemographic Factors and Neighborhood/Environmental Conditions Associated with Social Isolation Among Black Older Adults. %A Taylor, Harry O %A Tsuchiya, Kazumi %A Nguyen, Ann W %A Mueller, Collin %K African Americans %K environment %K Leave Behind Questionnaire %K Neighborhoods %K Social Support %X

To investigate sociodemographic factors and neighborhood/environmental conditions associated with social isolation (SI) among Black older adults. We utilized data from the 2014 and 2016 Leave-Behind Questionnaire from the Health and Retirement Study (HRS LBQ) among those who self-identified as Black ( = 2.323). Outcome variables for our study included SI from adult children, other family members, friends, disengagement from social participation and religious services, being unmarried, and living alone. These indicators were also combined into an overall SI index. Critical predictors included gender, age, household income, education, employment status, neighborhood cohesion, neighborhood disorder, urbanicity, and region of residence. Sociodemographic factors of gender, education and household income were significantly associated with SI indicators. Additionally, some neighborhood/environmental conditions were associated with SI indicators. SI was found to be patterned by sociodemographic factors. These results can be used to develop effective interventions to mitigate SI among Black older adults.

%B Journal of Aging and Health %V 35 %P 294-306 %G eng %N 3-4 %R 10.1177/08982643221118427 %0 Journal Article %J The Gerontologist %D 2023 %T Subjective Memory Decline Predicts Incident Cognitive Impairment among White-but Not Black or Hispanic-Older Adults. %A Ferraro, Kenneth F %A Sauerteig-Rolston, Madison R %A Barnes, Lisa L %A Friedman, Elliot %A Sands, Laura P %A Thomas, Patricia A %K cognitive function %K Disparities %K Racial-ethnic differences %K Self-reported memory %X

BACKGROUND AND OBJECTIVES: This study investigates whether subjective memory decline in a racially diverse sample of older adults without cognitive impairment at baseline is associated with incident cognitive impairment during a 12-year follow-up period.

RESEARCH DESIGN AND METHODS: With panel data from a national sample (N=9,244) of cognitively-intact Black, White, and Hispanic Americans 65 years or older in 2004, we examine if subjective memory decline is associated with the loss of normal cognition by 2016. Cognitive status was assessed every two years with a modified version of the Telephone Interview for Cognitive Status to identify the transition from normal cognition to cognitive impairment.

RESULTS: Estimates from Weibull accelerated failure-time models reveal that subjective memory decline is associated with earlier incident cognitive impairment (time ratio = 0.96, p<.05). In subsequent models stratified by race-ethnicity, this association was evident among White respondents (time ratio = 0.95, p<.01) but not among Black, US-born Hispanic, or foreign-born Hispanic respondents.

DISCUSSION AND IMPLICATIONS: Given that the prognostic validity of subjective memory decline differs by race and ethnicity, caution is warranted when using it as a screening or clinical tool in diverse populations.

%B The Gerontologist %G eng %R 10.1093/geront/gnac086 %0 Journal Article %J Gerodontology %D 2023 %T Ten-year cross-sectional and longitudinal assessment and factors associated with unfavourable self-rated oral health in older adults in the United States. %A Tembhe, Amrita %A Preisser, John S %A Batorsky, Anna %A Weintraub, Jane A %K Older Adults %K Oral Health %K United States %X

OBJECTIVE: To investigate the association of demographic and socio-economic characteristics with self-reported oral health (SROH) among older adults who participated in the Health and Retirement Study (HRS) in 2008, 2018, or both, and to describe temporal changes.

METHODS: Data were from the University of Michigan's Health and Retirement Study (HRS), a nationally representative longitudinal survey of Americans aged 51 and older. Responses from participants who completed the Core HRS survey and Dental Module (DM) in 2008 (n = 1310), 2018 (n = 1330), and the "common group" at both timepoints (n = 559) were analysed. Using the common group, the outcome measure was 2018 self-rated oral health (Favourable vs Unfavourable). Potential explanatory variables included 2008 self-rated oral health (SROH), sociodemographic, and dental utilisation-related factors. Survey logistic regression analysis was used to identify factors that were associated with unfavourable 2018 SROH in 2018.

RESULTS: Unfavourable SROH prevalence was 28.5% and 31.6% in 2008 and 2018, respectively. Among the common, longitudinal group, the unfavourable prevalence remained the same, 26.1% at both timepoints. A positive association was seen between 2018 unfavourable SROH and baseline variables of 2008 unfavourable SROH, male gender, less education, and lower levels of wealth.

CONCLUSIONS: Over a quarter of participants reported unfavourable SROH. There was little change in SROH during this period. Sociodemographic factors influence the SROH of the older population. Policies and programs to promote and protect the oral health of older adults should be designed and implemented to reduce social inequalities and improve the SROH of disadvantaged older adults.

%B Gerodontology %G eng %R 10.1111/ger.12710 %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 %X

OBJECTIVES: 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 Age Ageing %D 2023 %T Trajectories of self-reported hearing and their associations with cognition: evidence from the United Kingdom and United States of America. %A Matthews, Katey %A Dawes, Piers %A Elliot, Rebecca %A Pendleton, Neil %A Tampubolon, Gindo %A Maharani, Asri %K Cognition %K hearing %K Humans %K Longitudinal Studies %K Memory, Episodic %K Self Report %K United Kingdom %K United States %X

OBJECTIVE: This study aimed to investigate the relationships between trajectories of change in self-reported hearing over eight years with subsequent effects on cognition, measured using episodic memory.

METHODS: Data were drawn from 5 waves (2008-2016) of the English Longitudinal Study of England (ELSA) and the Health and Retirement Study (HRS), involving 4,875 individuals aged 50+ at the baseline in ELSA and 6,365 in HRS. The latent growth curve modelling was used to identify trajectories of hearing over eight years, and linear regression models were performed to investigate the relationship between hearing trajectory memberships and episodic memory scores, controlling for confounding factors.

RESULTS: Five trajectories of hearing (stable very good, stable fair, poor to fair/good, good to fair, and very good to good) were retained in each study. Individuals whose hearing remains suboptimal and those whose hearing deteriorates within suboptimal levels throughout eight years have significantly poorer episodic memory scores at follow-up than those with stable very good hearing. Conversely, individuals whose hearing declines but is within an optimal category at baseline do not see significantly poorer episodic memory scores than those with consistently optimal hearing. There was no significant relationship between individuals whose hearing improved from suboptimal baseline levels to optimal by follow-up and memory in ELSA. However, analysis using HRS data shows a significant improvement for this trajectory group (-1.260, P < 0.001).

CONCLUSIONS: Either stable fair or deterioration in hearing is associated with worse cognitive function, both stable good or improving hearing is associated with better cognitive function specifically episodic memory.

%B Age Ageing %V 52 %8 2023 Feb 01 %G eng %N 2 %R 10.1093/ageing/afad017 %0 Journal Article %J Journal of Pain and Symptom Management %D 2023 %T Trends in Obesity Prevalence among US Older Adults in the Last Two Years of Life, 1998-2018. %A Harris, John A %A Kavalieratos, Dio %A Thoonkuzhy, Matthew %A Shieu, Bianca %A Schenker, Yael %K Body Mass Index %K Morbid %K Obesity %K Prevalence %K Thinness %X

CONTEXT: The prevalence of obesity has grown in the US over the decades. The temporal trends of body mass index categories in the last two years of life are poorly understood.

OBJECTIVES: To describe the trends in body mass categories in the last two years of life over the past two decades controlling for other demographic changes.

METHODS: We performed a cross-sectional study of prospectively collected survey data from the nationally representative Health and Retirement Study (HRS) among decedents who died between 1998 and 2018. We categorized BMI into five categories and calculated the proportion of decedents with each BMI category during each four epochs (1998-2003, 2004-2008, 2009-2013, 2014-2018). We examined trends in regression models with survey wave groupings modeled as an orthogonal polynomial and adjusted for factors commonly associated with BMI: sex, age, race, ethnicity, education, and tobacco use.

RESULTS: The analytic cohort included 14,797 decedents. From 1998-2003 to 2014-2018 time periods, those categorized as having mild-to-moderate obesity in the last two years of life increased from 12.4% to 14.8% (linear trend P < 0.001), a 19% increase. Severe obesity increased from 1.9% to 4.3%, a 126% increase (linear trend P < 0.001). Underweight decreased from 9.9% to 5.9%, a 40% decrease (linear trend P < 0.001), adjusted for demographic factors. Adjusted quadratic temporal trends for BMI category were nonsignificant, except for in mild-to-moderate obesity.

CONCLUSION: Severe obesity has increased greatly while underweight has decreased. As obesity increases in the final years of life, it is critical to assess how the existing and future palliative services and end of life care system address body size and weight.

%B Journal of Pain and Symptom Management %V 65 %P 81-86 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/36384180?dopt=Abstract %R 10.1016/j.jpainsymman.2022.11.004 %0 Journal Article %J Journal of the American Geriatric Society %D 2023 %T Understanding the relationship between perceived discrimination, allostatic load, and all-cause mortality in US older adults: A mediation analysis. %A Obaoye, Joanna O %A Dawson, Aprill Z %A Thorgerson, Abigail %A Ikonte, Chijioke O %A Williams, Joni S %A Egede, Leonard E %K all-cause mortality %K Allostatic load %K Perceived Discrimination %X

OBJECTIVE: To understand the relationship between perceived discrimination, allostatic load, and all-cause mortality; and to determine whether allostatic load is a mediator in the relationship between perceived discrimination and all-cause mortality among an older adult US population.

METHODS: Data from the Health and Retirement Study (2006-2012) was analyzed. Cox proportional hazard models were used to investigate the relationship between all-cause mortality and perceived discrimination, and all-cause mortality and allostatic load. Linear regression models were used to investigate the relationship between perceived discrimination and allostatic load. A mediation model with perceived discrimination and allostatic loads as independent variables was used to determine the association with all-cause mortality.

RESULTS: There were 5062 adults over the age of 50 included in the analysis. The relationship between perceived discrimination and allostatic load was statistically significant (b:0.14, [95%CI 0.10,0.19]; p < 0.001). The relationship between perceived discrimination and all-cause mortality was statistically significant (HR: 1.12, [95%CI 1.03,1.22]; p = 0.01). The relationship between allostatic load and all-cause mortality was statistically significant (HR: 1.11, [95%CI 1.08,1.13]; p < 0.001). The mediation model resulted in a decrease in hazard ratio and loss of statistical significance for perceived discrimination (HR: 1.09, [95%CI 0.98,1.21]; p = 0.13) when allostatic load (HR: 1.17, [95%CI 1.10,1.24]; p < 0.001) was added to the Cox regression model, indicating full mediation.

CONCLUSIONS: Allostatic load fully mediates the relationship between perceived discrimination and all-cause mortality. Understanding the role of allostatic load in this relationship provides an additional implication for screening and indications for tighter control of the modifiable components of allostatic load by healthcare providers, especially among individuals who experience discrimination.

%B Journal of the American Geriatric Society %V 71 %P 1515-1525 %G eng %N 5 %R 10.1111/jgs.18215 %0 Journal Article %J Healthcare (Basel) %D 2023 %T Use of Advance Directives in US Veterans and Non-Veterans: Findings from the Decedents of the Health and Retirement Study 1992-2014. %A TUNG, HO-JUI %A Yeh, Ming-Chin %K Advance directives %K United States %K Veterans %X

Evidence shows that older patients with advance directives such as a living will, or durable power of attorney for healthcare, are more likely to receive care consistent with their preferences at the end of life. Less is known about the use of advance directives between veteran and non-veteran older Americans. Using data from the decedents of a longitudinal survey, we explore whether there is a difference in having an established advance directive between the veteran and non-veteran decedents. Data were taken from the Harmonized End of Life data sets, a linked collection of variables derived from the Health and Retirement Study (HRS) Exit Interview. Only male decedents were included in the current analysis (N = 4828). The dependent variable, having an established advance directive, was measured by asking the proxy, "whether the deceased respondent ever provided written instructions about the treatment or care he/she wanted to receive during the final days of his/her life" and "whether the deceased respondent had a Durable Power of Attorney for healthcare?" A "yes" to either of the two items was counted as having an advance directive. The independent variable, veteran status, was determined by asking participants, "Have you ever served in the active military of the United States?" at their first HRS core interview. Logistic regression was used to predict the likelihood of having an established advance directive. While there was no difference in having an advance directive between male veteran and non-veteran decedents during the earlier follow-up period (from 1992 to 2003), male veterans who died during the second half of the study period (from 2004 to 2014) were more likely to have an established advance directive than their non-veteran counterparts (OR = 1.24, < 0.05). Other factors positively associated with having an established advance directive include dying at older ages, higher educational attainment, needing assistance in activities of daily living and being bedridden three months before death, while Black decedents and those who were married were less likely to have an advance directive in place. Our findings suggest male veterans were more likely to have an established advance directive, an indicator for better end-of-life care, than their non-veteran counterparts. This observed difference coincides with a time when the Veterans Health Administration (VHA) increased its investment in end-of-life care. More studies are needed to confirm if this higher utilization of advance directives and care planning among veterans can be attributed to the improved access and quality of end-of-life care in the VHA system.

%B Healthcare (Basel) %V 11 %G eng %N 13 %R 10.3390/healthcare11131824 %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 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 Thesis %B Education %D 2023 %T Word is Bond! Exploration Into Organizational Culture and Community Cultural Wealth Values, Observations of Financial Literacy and Economic Equity of Blacks %A Turner-Washington, L. Sherea %K Black English %K Black workers %K capitalism %K community cultural wealth %K cultural capital %K economic equity %K entrepreneur %K Financial literacy %K organizational culture %K slavery/enslavement %K spiritual capital %K training and development %K worker management %K Workforce %X Community cultural wealth has value in the workforce. The individual’s cultural capital and financial literacy values are not a separate experience to the organization culture. The dominant culture within the organization has a role of understanding and accepting the whole of Black American workers. This study will explore organizational culture and community cultural wealth values through observations of the financial literacy and economic equity of Blacks. The study includes findings from eight generations of Black workers and entrepreneurs from three data sets and interviews. Few studies examine how Community Cultural Wealth (CCW) factors into the survival and empowerment of cultural capital values throughout the lifespan of Blacks in the workforce. It is not enough to know that Blacks acquire less wealth—inquiries into financial literacy, illiteracy, and decisions made in an organizational culture context are insightful. A key component could be how Blacks view themselves in their communities, Blackness in the workforce, or are they viewed as breathing bitcoins. The study discussed conclusions such as workforce oppression that is not to be labeled as workplace conflict, diversity initiatives are not cultural capital assessments, Black English, and a seventh form of cultural capital drawn from the research and introduced recommendations for workforce training development stakeholders, academia, and policymakers. The study can be replicated by institutions or organizations with an interest in expanding cultural values and economic equity models. %B Education %I University of Wisconsin-Stout %C Menomonie, WI %V Doctor in Education in Career and Technical Education Degree %G eng %U https://minds.wisconsin.edu/handle/1793/84878 %0 Journal Article %J The Journal of the Economics of Ageing %D 2023 %T Working longer and population aging in the U.S.: Why delayed retirement isn’t a practical solution for many %A Lisa F. Berkman %A Beth C. Truesdale %K Delayed retirement %K Economic inequalities %K population aging %K retirement security %K Working Longer %X We argue that if the United States wants to make delayed retirement a healthy reality in the future, policymakers must level the social and economic playing field for young and middle-aged workers. As it stands, precarious working conditions, family caregiving responsibilities, poor health, and age discrimination make it difficult or impossible for manytowork into their late 60s and beyond. Investments in better jobs today could lead to more secure retirements tomorrow. At the same time, we need a renovation of America’s retirement and disability systems to provide financial security for all Americans as they age. Our findings suggest that working longer is set in motion long before one’s 60s; it is structured by a life course history of working steadily through one’s 50s. We argue that policies affecting work and policies affecting retirement are two sides of the same coin and must be considered together. %B The Journal of the Economics of Ageing %V 24 %P 100438 %G eng %R https://doi.org/10.1016/j.jeoa.2022.100438 %0 Journal Article %J The Journals of Gerontology: Series B %D 2022 %T Age at Immigration and Depression: The Mediating Role of Contemporary Relationships with Adult Children among Older Immigrants. %A Heejung Jang %A Pilkauskas, Natasha V %A Tang, Fenyan %K depression %K Intergenerational Relations %K Later-life immigration %K Migration %X

OBJECTIVES: For the growing population of older immigrants in the United States, both age at immigration and familial relationships are important factors affecting psychological well-being. This study explores how age at immigration and contemporary relationships with adult children combine to explain older immigrants' depressive symptoms.

METHOD: This study uses 2014 Health and Retirement Study data from a sample of 759 immigrants age 65 and older who have at least one adult child age 21 or older. A series of ordinary least squares regressions and mediational analyses were conducted.

RESULTS: Findings indicate that structural solidarity significantly mediates the association between age at immigration and depressive symptoms. Specifically, immigrating in later life was associated with a lower level of depressive symptoms through its relationship with structural solidarity. In addition, giving monetary support to children and providing care for grandchildren may alleviate depressive symptoms for older immigrants.

DISCUSSION: This study suggests that relationships with adult children may differ with age at immigration. The types of support that older immigrants provide to their adult children may be crucial because such support may instill a sense of obligation and reciprocity that may be beneficial to the psychological well-being of older immigrants.

%B The Journals of Gerontology: Series B %V 77 %P 413-423 %G eng %N 2 %R 10.1093/geronb/gbaa209 %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 %X

Though 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 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 %X

OBJECTIVES: 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 Book Section %B Improving Representation in Clinical Trials and Research: Building Research Equity for Women and Underrepresented Groups. %D 2022 %T Appendix A Quantifying the Potential Health and Economic Impacts of Increased Trial Diversity %A Tysinger, Bryan %A Bibbins-Domingo, K. %A Helman, A. %K Chronic illness %K Future Elderly Model %K gender %K labor force %K Quality of Life %K Race/ethnicity %X Chronic illness decreases quantity of life, quality of life, and years spent in the labor force. Less appreciated is the potential for differential impact of disease for different race/ethnicity-gender groups. In other words, while chronic illness affects outcomes for all groups, some groups might experience a larger impact. The goal in this analysis is to quantify the differential impact of chronic illness for groups that have historically been underrepresented in clinical trials, as clinical trials are a potential way to identify approaches to reduce these disparities. We examine three key outcomes: quantity of life (measured by life expectancy), quality of life (measured by disability-free life), and working life (measured by years in the labor force). The thought experiment considers a hypothetical world where the differential impact is eliminated, that is, that all groups share the same impact of chronic illness. %B Improving Representation in Clinical Trials and Research: Building Research Equity for Women and Underrepresented Groups. %I National Academies Press (US) %C Washington, D.C. %G eng %U https://www.ncbi.nlm.nih.gov/books/NBK584406/ %0 Journal Article %J Journal of Personality %D 2022 %T The Association Between Facets of Conscientiousness and Performance-based and Informant-Rated Cognition, Affect, and Activities in Older Adults. %A Angelina R Sutin %A Damaris Aschwanden %A Yannick Stephan %A Antonio Terracciano %K attention %K cognitive function %K Conscientiousness %K Facets %K Five factor model %K Memory %X

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

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

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

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

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

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

%B Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition %V 29 %P 297-317 %G eng %N 2 %R 10.1080/13825585.2021.1872481 %0 Journal Article %J JAMA Network Open %D 2022 %T Association of Playing College American Football With Long-term Health Outcomes and Mortality. %A Phelps, Alyssa %A Alosco, Michael L %A Baucom, Zachary %A Hartlage, Kaitlin %A Palmisano, Joseph N %A Weuve, Jennifer %A Mez, Jesse %A Tripodis, Yorghos %A Stern, Robert A %K Aged %K Brain Concussion %K Cohort Studies %K Female %K Football %K Health Care %K Humans %K Male %K Neurodegenerative Diseases %K Outcome Assessment %X

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

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

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

Exposure: Participation in football at ND.

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

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

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

%B JAMA Network Open %V 5 %P e228775 %G eng %N 4 %R 10.1001/jamanetworkopen.2022.8775 %0 Journal Article %J Journal of Alzheimer's Disease %D 2022 %T Associations Between Midlife Functional Limitations and Self-Reported Health and Cognitive Status: Results from the 1998-2016 Health and Retirement Study. %A Wu, Benson %A Toseef, Mohammad Usama %A Stickel, Ariana M %A González, Hector M %A Tarraf, Wassim %K Activities of Daily Living %K Age Factors %K Cognitive Dysfunction %K ethnicity %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Mobility Limitation %K Neuropsychological tests %K Psychomotor Performance %K Retirement %K Risk Factors %K Self Report %K Surveys and Questionnaires %X

BACKGROUND: Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging.

OBJECTIVE: We examined how midlife self-rated physical functioning and health may predict cognitive health in older age.

METHODS: We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications.

RESULTS: After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment.

CONCLUSION: Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

%B Journal of Alzheimer's Disease %V 85 %P 1621-1637 %G eng %N 4 %R 10.3233/JAD-215192 %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 %X

OBJECTIVES: 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 Innovation in Aging %D 2022 %T CHANGES IN FUNCTIONAL STATUS AMONG US ADULTS IN LATE MID-LIFE FROM THE HEALTH AND RETIREMENT STUDY 2004–2016 %A Doza, Adit %A Mahmoudi, Elham %A Tarraf, Wassim %K Functional status %K racial/ethnic disparities %X Reducing racial/ethnic disparities in health and functioning among older adults are salient key goals in the U.S. health policy. This study examined whether and how the functioning have progressed between White and minority populations in late midlife in recent years. We analyzed the Health and Retirement Study (HRS) among adults ages 45-64 years across two time periods (2004-2010 and 2010-2016). Using generalized linear regression, we modeled changes in activities of daily living (ADL) and changes in instrumental activities of daily living (IADL) as a function of race/ethnicity and sequentially adjusted for period specific risk factors including sociodemographic factors, health insurance, health behaviors and social networks. Oaxaca-Blinder Regression Decomposition (OBRD) techniques are used to assess the contributions of these factors to the observed trends in ADL/IADL. We find changes in ADL is significantly higher for Blacks (Odds Ratios of 1.23, CI 1.01-1.48) and US-born Hispanics (Odd Ratios of 1.54, CI 1.12-2.12) after adjusting for all the risk factors in the second period. About two-thirds of the disparity in functional status of adults is explained in our OBRD model and more than 70% of these explained differences among minorities is related to socio-demographic factors. This probably occurred due to the differences in income and net wealth which began to widen during the time of 2008 financial crisis. Although recently there is a decline in disability trends for older adults in U.S., our findings point to an increase in racial/ethnic disparities in functional status for adults in late midlife. %B Innovation in Aging %V 6 %P 291 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1155 %0 Report %D 2022 %T Cognitive Decline, Limited Awareness, Imperfect Agency, and Financial Well-being %A Ameriks, John %A Caplin, Andrew %A Lee, Minjoon %A Matthew D. Shapiro %A Tonetti, Christopher %K Cognitive decline %K Financial well-being %X Cognitive decline may lead older Americans to make poor financial decisions. Preventing poor decisions may require timely transfer of financial control to a reliable agent. Cognitive decline, however, can develop unnoticed, creating the possibility of suboptimal timing of the transfer of control. This paper presents survey-based evidence that wealthholders regard suboptimal timing of the transfer of control, in particular delay due to unnoticed cognitive decline, as a substantial risk to financial well-being. This paper provides a theoretical framework to model such a lack of awareness and the resulting welfare loss. %B Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w29634 %0 Journal Article %J Journal of Aging and Health %D 2022 %T Cognitive Impairment and the Trajectory of Loneliness in Older Adulthood: Evidence from the Health and Retirement Study. %A Lee, Ji Hyun %A Martina Luchetti %A Damaris Aschwanden %A Sesker, Amanda A %A Jason E Strickhouser %A Antonio Terracciano %A Angelina R Sutin %K cognitive impairment %K cognitive impairment no dementia %K Dementia %K Loneliness %X

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

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

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

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

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

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

%B The Journals of Gerontology: Series A %V 77 %P 570-578 %G eng %N 3 %R 10.1093/gerona/glab164 %0 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 Aging and Health %D 2022 %T Contemporary Research on Older Black Americans, a Special Issue of Journal of Aging and Health in Honor of the Life and Legacy of James S. Jackson. %A Taylor, Robert Joseph %K African Americans %K lifecourse %K Mental Health %K Social Factors %K Well-being %X

This special issue of the Journal of Aging and Health honors the memory of James Jackson by elevating his many research contributions to the physical and mental health of older Black Americans. The articles focus on the central problems and questions that James Jackson addressed throughout his illustrious career. All articles in the special issue focus on older Black Americans and include at least one of the following elements: (1) articles based on the National Survey of American Life, the data set for which James Jackson was the Principal Investigator; (2) articles that utilize the Environmental Affordances Model which was developed by James Jackson; (3) articles that include the Everyday Discrimination scale which was originally published by David Williams, James Jackson, and colleagues; (4) and articles based on the Health and Retirement Study (HRS), the data set for which James Jackson served as Editor for a special issue of .

%B Journal of Aging and Health %V 34 %P 301-306 %G eng %N 3 %R 10.1177/08982643221086334 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Correlates of Elevated C-Reactive Protein among Black Older Adults: Evidence from the Health and Retirement Study. %A Heather R. Farmer %A Thomas Tobin, Courtney S %A Roland J. Thorpe Jr. %K Black Americans %K Black men %K Black women %K C-reactive protein %X

OBJECTIVES: Substantial evidence documents gender and racial disparities in C-reactive protein (CRP), a measure of systemic inflammation, among older adults. Yet, the comparative approaches of these studies may obscure distinct risk and protective factors associated with elevated CRP among older Black Americans. To pinpoint opportunities for intervention, this study utilizes a "within-group approach" to identify the sociodemographic, psychosocial, behavioral, and health-related correlates of elevated CRP among older Black women and men.

METHOD: The sample consisted of 2,420 Black respondents aged 51+ in the Health and Retirement Study (2006-2016). Gender-stratified, random effects logistic regression models were used to examine correlates of elevated CRP (>3.0 mg/L).

RESULTS: More than 50% of Black women had elevated CRP, and younger age, Medicaid, lower mastery, religiosity, overweight/obesity, physical inactivity, and ADLs contributed to elevated CRP among this group. In contrast, elevated CRP was reported among only 37.25% of Black men, for whom financial distress was associated with lower odds of elevated CRP; religiosity, less neighborhood cohesion, current smoking, overweight/obesity, ADLs, and more chronic conditions were associated with greater odds of elevated CRP among this group.

DISCUSSION: Sociodemographic factors had a limited association with elevated CRP among older Black Americans. Rather, a range of psychosocial, behavioral, and health-related factors were more influential determinants of elevated CRP among older Black Americans. Most notably, findings demonstrate distinct correlates of CRP among Black women and men, underscoring the critical need to further evaluate the risk and protective mechanisms undergirding disparities among this aging population.

%B The Journals of Gerontology, Series B %V 77 %P 1964-1977 %G eng %N 11 %R 10.1093/geronb/gbac033 %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 %X

AIMS: 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 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 %X

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

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

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

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

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

%B PLoS One %V 17 %P e0264166 %G eng %N 2 %R 10.1371/journal.pone.0264166 %0 Journal Article %J Sleep %D 2022 %T Decreased Risk of 2-Year Incidence of Alzheimer’s Disease Among Older Adults Who Report Sleep Symptoms %A Mason, Brooke %A Wills, Chloe %A Tubbs, Andrew %A Seixas, Azizi %A Turner, Arlener %A Jean-Louis, Girardin %A Killgore, William %A Grandner, Michael %K Alzheimer disease %K cognitive-behavioral therapy %K Dementia %K Depressive Disorder %K ethnic group %K insomnia %K pharmacotherapy %K sleep disorders %X Introduction Those with dementia or Alzheimer’s Disease report an elevated amount of sleep difficulties compared to age-matched controls. Sleep-based interventions may be especially useful for this group, such as cognitive behavioral therapy for insomnia or pharmacological interventions. Therefore, it is important to expand the current understanding of the nature of sleep difficulties in those with Alzheimer’s Disease. Methods Data from the 2018 Health and Retirement Survey was collected from 17,146 older adults. Poisson regression analyses were used to explore the relationship between Alzheimer’s Disease as diagnosed by a doctor and sleep difficulties. Individuals who reported no Alzheimer’s Disease in the previous wave (N=16,751) were asked if they had since become diagnosed. N=101 individuals reported incident Alzheimer’s Disease in the 2-year gap between assessments. Sleep difficulties were assessed by asking participants if they had difficulties initiating or maintaining sleep, waking up too early, and how rested they felt upon awakening. All 4 of these symptoms were coded as “never,” “sometimes,” or “often.” Results Unexpectedly, there was a significant decreased risk of developing Alzheimer’s Disease among those who reported difficulties maintaining sleep (IRR=0.9962; 95%CI[0.9936,0.9988]; p=0.004), and early morning awakenings (IRR=0.9961; 95%CI[0.9938,0.9984]; p=0.001) “sometimes”. When the model was adjusted for sex, race, ethnicity, age, and depression, a similar finding of decreased risk for Alzheimer’s Disease for those who reported difficulties maintaining sleep (IRR=0.9953; 95%CI[0.9927,0.9980]; p<0.001), and early morning awakenings (IRR=0.9954; 95%CI[0.9930,0.9978]; p=0.001), “sometimes” were maintained. Conclusion Although previous studies have shown that poor sleep may lead to increased risk of Alzheimer’s and related dementias, the present study, which examined longitudinal data from a large, national sample of older adults, found that there was no association between frequent sleep disturbances and 2-year incidence of Alzheimer’s Disease, and a small association between more mild symptoms and decreased risk. It is possible that the 2-year observation window was insufficient to detect effects. Also, there is a risk of measurement error in collecting self-reported data on sleep and Alzheimer’s diagnoses. %B Sleep %V 45 %P A122–A123 %G eng %U https://doi.org/10.1093/sleep/zsac079.270 %N Suppl _1 %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 Innovation in Aging %D 2022 %T DEMENTIA TRAJECTORIES, MEDICAID COVERAGE, AND HEALTHCARE SERVICES USE %A Tarraf, Wassim %A Garcia, Marc %K Dementia %K healthcare services %K Medicaid %X The evidence base linking dementia risk trajectories to transitions in Medicaid coverage and levels of health services is underdeveloped. We use Health and Retirement Study (2007/08-2015/16) data on adults 70-years and older (Unweighted N=8,227) at baseline to test how longitudinal dementia classifications (Langa-Weir), over 8-years, influence change in Medicaid coverage, nursing-home use (NHU) and inpatient hospitalizations (IH). We fit Joint Growth and Discrete-time Survival Mixture models to generate longitudinal risk classifications for dementia accounting for survival, and generalized linear models to test associations of these classifications with change in Medicaid coverage, NHU, and IH. Average baseline age was 78.4 years (SD=7.1), 3-in-5 were female, 1-in-4 had less than high school education, and 4-in-5 were non-Hispanic Whites. A three-class solution (C1=high dementia prevalence and mortality risk (8.6%), C2=low prevalence (68.3%), and C3=accelerated dementia prevalence and mortality risk (23.1%)) provided the best fit to the data. We observed substantial increase in rates of for Medicaid coverage for C1 (21%; 95%CI=[18-25] to 51%[36-65] among survivors) and C3 (12%; 95%CI=[10-14] to 32%[27-37]), but not C2 (6% to 8%). NHU also accelerated substantially from 10 to 37% in C1 and 7 to 38% in C2. Rates of inpatient hospitalizations remained stable over time for all groups, with C1 and C2 being more likely to be hospitalized and have multiple re-admissions. Estimates were differentially attenuated through adjustment to covariables. We report important longitudinal dementia risk classifications, profile their socioeconomic and health attributes, and identify differential associations with critical health policy outcomes (Medicaid coverage and healthcare utilization). %B Innovation in Aging %V 6 %P 132-132 %8 12 %G eng %R 10.1093/geroni/igac059.526 %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 %X

OBJECTIVES: 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 The Journals of Gerontology, Series B %D 2022 %T The Devastating Economic Impact of COVID-19 on Older Black and Latinx Adults: Implications for Health and Well-Being. %A Garcia, Marc A %A Amy D Thierry %A Pendergrast, Claire B %K COVID-19 %K economic inequality %K Health Disparities %X

OBJECTIVES: While disparities in COVID-19 infections and mortality have been documented for older Black and Latinx populations, pandemic-related economic impacts have been less studied for these groups. Minoritized older adults may be particularly vulnerable to financial hardships given their precarious socioeconomic positions. Thus, we aim to highlight the devastating economic impact of the ongoing COVID-19 pandemic and subsequent economic recession on older Black and Latinx adults, with a particular focus on the foreign-born population.

METHODS: This study used data from the 2020 COVID-19 module of the Health and Retirement Study. The sample included adults >50 years of age who were U.S.-born non-Latinx White and Black, U.S.-born Latinx, and foreign-born Latinx (n=2,803). We estimated age-standardized prevalence and means of variables indicating financial impact and economic hardship during the pandemic. We further examined differences in these measures across racial/ethnic and nativity groups.

RESULTS: Our findings document stark racial/ethnic inequalities in the pandemic's economic impact on older adults. Results show the pandemic has negatively affected older Black and Latinx adults across a host of economic factors (e.g., paying bills, affording health-related needs, or purchasing food), with foreign-born Latinx experiencing greater economic hardships relative to other groups.

DISCUSSION: During the COVID-19 pandemic, older Black and Latinx adults are experiencing disparate economic effects, including lacking money to cover basic needs, compared to older White adults. The implications of the economic shocks of the pandemic for the health and well-being of older Black and Latinx adults warrant policy-oriented action towards promoting equity.

%B The Journals of Gerontology, Series B %V 77 %P 1501-1507 %G eng %N 8 %R 10.1093/geronb/gbab218 %0 Journal Article %J The Journal of Nutrition, Health & Aging %D 2022 %T Dietary Supplement Use in Middle-aged and Older Adults. %A Tan, E C K %A Eshetie, T C %A Gray, S L %A Marcum, Z A %K Animals %K Cross-Sectional Studies %K Dietary Supplements %K Female %K Male %K Nutrition Surveys %K Nutritional Status %K United States %K Vitamins %X

OBJECTIVES: Despite limited evidence of clinical benefits, dietary supplement use is increasingly common among older adults. The aim of this study was to characterise the prevalence of dietary supplement use in a national sample of community-dwelling middle-aged and older adults and investigate factors associated with its use.

DESIGN/SETTING/PARTICIPANTS: This was a cross-sectional study using data from the Health and Retirement Study (HRS), a biennial, nationally representative survey of individuals aged 50 years and older in the United States. This study combined data from the 2013/14 Health Care and Nutrition Survey (HCNS) and 2012 Core Survey.

MEASUREMENTS: The primary outcome was the use of any dietary supplement at least once a week. Secondary outcomes were the use of multivitamins and specific vitamin and supplement types. Multivariable regression models were used to identify factors associated with any dietary supplement use.

RESULTS: A total of 6045 participants (weighted n = 71,268,015) were included in the final analytical sample (mean age 67.7 years, 59.3% female). Of these, 84.6% (n=60,292,704) were regular dietary supplement users, with participants taking a mean of 3.2±0.1 different dietary supplements and 41.9% taking four or more. Multivitamins were the most common, used by 57.5% (n=41,147,146) of participants. Other commonly used dietary supplements were vitamin D, fish oil, calcium, vitamin C, and vitamin B12. Older age (75+ years), female sex, higher education, daily alcohol use, vigorous physical activity, regular medication use, and arthritis were associated with higher odds of dietary supplement use.

CONCLUSIONS: In this sample of middle-aged and older Americans, more than 4 out of 5 used a dietary supplement. Certain demographic, behavioural, and clinical factors were associated with their use. Given the lack of evidence for improving health outcomes, our findings suggest potential overuse of dietary supplements in people over the age of 50.

%B The Journal of Nutrition, Health & Aging %V 26 %P 133-138 %G eng %N 2 %R 10.1007/s12603-022-1732-9 %0 Journal Article %J Journal of Alzheimer's Disease %D 2022 %T Difficulties with Activities of Daily Living and Receipt of Care Among Older Adults with Cognitive Impairment: Differences Between Those Living Alone and Those Living with Others. %A Yang, Yulin %A Swinnerton, Kaitlin %A Portacolone, Elena %A Allen, Isabel Elaine %A Torres, Jacqueline M %A Duchowny, Kate %K Activities of Daily Living %K Cognitive Dysfunction %K home environment %K Independent Living %K Prevalence %X

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

%B Journal of Alzheimer's Disease %V 89 %P 31-37 %G eng %N 1 %R 10.3233/JAD-220172 %0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T DNA methylation "GrimAge" acceleration mediates sex/gender differences in verbal memory and processing speed: Findings from the Health and Retirement Study. %A O'Shea, Deirdre M %A Maynard, Taylor %A Tremont, Geoffrey %K Biological age %K Cognition %K DNA Methylation %K GrimAge %K HCAP %K sex/gender differences %X

Whether sex/gender differences in rates of biological aging mediate sex/gender differences in cognition in older adults has not been fully examined. The aim of the current study was to investigate this association. Data from up to 1,928 participants (mean age = 75, SD = 7.04, female = 57%) who took part in the 2016 Harmonized Cognitive Assessment Protocol and Venous Blood Study; sub-studies of the Health and Retirement Study were included in the current study. The residuals from four age-adjusted epigenetic clocks (Horvath, Hannum, PhenoAge, and GrimAge) were used to measure biological age acceleration. Sex/gender differences in cognition were tested using a series of ANCOVAs. Mediation analyses tested whether the measures of age acceleration accounted for these sex/gender differences, controlling for age, education, smoking status, and white blood cell count. Women outperformed men on measures of verbal learning, verbal memory, visual scanning, and processing speed. No other significant sex/gender differences were identified. Results from mediation analyses revealed that women's slower rates of GrimAge fully accounted for their faster processing speeds and partially accounted for their better performances on verbal learning, verbal memory, and visual scanning measures. None of the other measures of age acceleration were significant mediators. Accounting for sex/gender differences in biological aging may differentiate between cognitive sex/gender differences that are driven by universal (i.e., age-related) versus sex-specific mechanisms. More broadly, these findings support the growing evidence that the GrimAge clock outperforms other clocks in predicting cognitive outcomes.

%B The Journals of Gerontology, Series A %G eng %R 10.1093/gerona/glac133 %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 %X

OBJECTIVES: 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 Journal Article %J Stroke %D 2022 %T Eight-Year Depressive Symptom Trajectories and Incident Stroke: A 10-Year Follow-Up of the HRS (Health and Retirement Study). %A Soh, Yenee %A Tiemeier, Henning %A Kawachi, Ichiro %A Berkman, Lisa F %A Kubzansky, Laura D %K depression %K Follow-Up Studies %K Prospective Studies %K Retirement %K Risk Factors %K Stroke %X

BACKGROUND: Evidence suggests a link between depressive symptoms and risk of subsequent stroke. However, most studies assess depressive symptoms at only one timepoint, with few examining this relationship using repeatedly measured depressive symptoms. This study aimed to examine the relationship between depressive symptom trajectories and risk of incident stroke.

METHODS: This prospective cohort included 12 520 US individuals aged ≥50 years enrolled in the Health and Retirement Study, free of stroke at study baseline (1998). We used the 8-item Center for Epidemiologic Studies Depression scale to assess depressive symptoms (high defined as ≥3 symptoms; low <3 symptoms) at 4 consecutive, biennial timepoints from 1998 to 2004. We assigned individuals to 5 predefined trajectories based on their scores at each timepoint (consistently low, decreasing, fluctuating, increasing, and consistently high). Using self-reported doctors' diagnoses, we assessed incident stroke over a subsequent 10-year period from 2006 to 2016. Cox regression models estimated the association of depressive symptom trajectories with risk of incident stroke, adjusting for demographics, health behaviors, and health conditions.

RESULTS: During follow-up, 1434 incident strokes occurred. Compared with individuals with consistently low symptoms, individuals with consistently high depressive symptoms (adjusted hazard ratio, 1.18 [95% CI, 1.02-1.36]), increasing symptoms (adjusted hazard ratio, 1.31 [95% CI, 1.10-1.57]), and fluctuating symptoms (adjusted hazard ratio, 1.21 [95% CI, 1.01-1.46]) all had higher hazards of stroke onset. Individuals in the decreasing symptom trajectory group did not show increased stroke risk.

CONCLUSIONS: Depressive symptom trajectories characterized by high symptoms at multiple timepoints were associated with increased stroke risk. However, a trajectory with depressive symptoms that started high but decreased over time was not associated with higher stroke risk. Given the remitting-relapsing nature of depressive symptoms, it is important to understand the relationship between depressive symptoms and stroke risk over time through repeated assessments.

%B Stroke %V 53 %P 2569-2576 %G eng %N 8 %R 10.1161/STROKEAHA.121.037768 %0 Journal Article %J Journal of Pain and Symptom Management %D 2022 %T The Epidemiology of Pre-Existing Geriatric and Palliative Conditions in Older Adults with Poor Prognosis Cancers (GP712) %A Mazie Tsang %A Siqi Gan %A John Boscardin %A Melisa Wong %A Louise Walter %A Alexander Smith %K Cancer %K geriatric conditions %K Medicare %K palliative conditions %X Outcomes 1. Explain how geriatric and palliative care principles are important in the care of older adults with poor prognosis cancers 2. Characterize the prevalence of preexisting geriatric and palliative care conditions for older adults with poor prognosis cancers Importance Older adults with poor prognosis cancers are vulnerable to toxicities from cancer-directed therapies. The benefits and burdens of treatment should be contextualized within their overall prognosis and their functional, social, and symptom experience. Due to lack of routine assessment, however, the geriatric and palliative are needs of this population are unclear. Objective(s) To characterize the prevalence of preexisting geriatric and palliative conditions among older adults with poor prognosis cancers. Method(s) We used the Health and Retirement Study linked with Medicare (1998-2016) to identify adults age ≥65 with poor prognosis cancers (median overall survival <1 year). Using the interview prior to the cancer diagnosis, we determined the presence of clinically significant geriatric and palliative conditions across multiple domains: functional impairment, mobility, falls, unintentional weight loss, self-rated health, social support, mentation, use of pain or sleep medications, and advance care planning. Results Of 2,105 participants, mean age was 76, 52.7% were female, 34.1% had lung cancer, and the median overall survival was 9 months. After adjusting for age and sex, the prevalence of preexisting geriatric and palliative conditions were as follows: 65% had difficulty climbing stairs (95% CI 63-67%), 49% had not completed an advance directive (95% CI 45-54%), 35% lived alone (95% CI 32.5-36.7%), 35% fell in the last 2 years (95% CI 33-37%), and 32% rated their memory as poor (95% CI 29-34%). Functional impairment, impaired mobility, and falls were highest among those age >85. Those aged 65-74 were less likely to have an advance directive. Women had a higher rate of preexisting physical impairments when compared with men (e.g., for difficulty climbing stairs, the adjusted RR 1.25 [95% CI 1.14-1.36]). Conclusion(s) Because of a high prevalence of preexisting conditions across multiple domains, all older adults with poor prognosis cancers should be screened for geriatric and palliative care conditions. Impact Geriatric and palliative care principles should be implemented for older adults with poor prognosis cancers. %B Journal of Pain and Symptom Management %V 63 %P 1118 %G eng %N 6 %R 10.1016/j.jpainsymman.2022.04.103 %0 Journal Article %J JAMA Health Forum %D 2022 %T Estimated Annual Spending on Aducanumab in the US Medicare Program %A Mafi, John N. %A Leng, Mei %A Arbanas, Julia Cave %A Tseng, Chi-Hong %A Damberg, Cheryl L. %A Catherine A Sarkisian %A Landon, Bruce E. %K aducanumab %K annual spending %K Medicare %X The US Food and Drug Administration’s June 2021 decision to approve aducanumab for treatment for Alzheimer dementia raised concerns that a drug with uncertain benefit and high cost could, in aggregate, threaten Medicare's solvency. In response to these concerns, Biogen recently announced a 50% annual drug price reduction from $56 000 to $28 200 per patient. Preliminary US spending estimates either used extrapolated Alzheimer dementia prevalence data from 2012 or did not explicitly quantify ancillary costs, such as additional diagnostic imaging to monitor the amyloid-associated imaging abnormalities (ARIAs) that occur in 41% of treated patients, and did not incorporate the recently announced price reduction.1-3 We estimated upper bound and lower bound annualized Medicare costs for administering aducanumab to beneficiaries with the approved indications of mild cognitive impairment (MCI) or mild dementia, focusing on the degree to which associated ancillary health services affect spending.1 %B JAMA Health Forum %V 3 %P e214495 - e214495 %@ 2689-0186 %G eng %N 1 %R https://doi.org/10.1001/jamahealthforum.2021.4495 %0 Journal Article %J 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 %X

BACKGROUND: 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 Journal of Psychiatric Research %D 2022 %T Facets of conscientiousness and motoric cognitive risk syndrome %A Yannick Stephan %A Angelina R. Sutin %A Martina Luchetti %A Damaris Aschwanden %A Antonio Terracciano %K cognitive complaint %K Conscientiousness %K motoric cognitive risk %K walking speed %X Conscientiousness is related to a lower risk of motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by slow gait speed and cognitive complaints. The present study examines which facets of conscientiousness are related to concurrent and incident MCR. Participants were dementia-free older adults aged 65–99 years (N = 6001) from the Health and Retirement Study (HRS). Baseline data on conscientiousness facets and MCR (cognitive complaints and gait speed) were collected in 2008/2010, along with the covariates: demographic factors, cognition, physical activity, disease burden, depressive symptoms, and body mass index (BMI). MCR was assessed again in 2012/2014 and 2016/2018. Controlling for demographic factors, higher industriousness was related to a nearly 30% lower likelihood of concurrent MCR (Odds Ratio [OR] = 0.75, 95%CI: 0.67–0.85, p < .001) and to about 60% reduced risk of incident MCR (Hazard ratio [HR] = 0.63, 95%CI: 0.56–0.71, p < .001). Self-control, order, and responsibility were also associated with a lower likelihood of concurrent (OR range: 0.82–0.88) and incident (HR range: 0.72–0.82) MCR. Traditionalism (HR = 0.84, 95%CI: 0.75–0.93, p < .01) and virtue (HR = 0.84, 95%CI: 0.75–0.93, p < .01) were related to a lower risk of incident MCR. Cognition, physical activity, disease burden, depressive symptoms, and BMI partially accounted for these associations. Industriousness is the facet of conscientiousness with the strongest association with risk of MCR. This facet could be targeted in interventions to reduce MCR and, ultimately, dementia. %B Journal of Psychiatric Research %V 151 %P 73-77 %G eng %R 10.1016/j.jpsychires.2022.03.050 %0 Journal Article %J 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 %X

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

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

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

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

%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 Book Section %B Overtime: America's Aging Workforce and the Future of Working Longer %D 2022 %T Forecasting Employment of the Older Population %A Michael D Hurd %A Rohwedder, Susann %E Berkman, Lisa F %E Truesdale, Beth C. %K Employment %K Older workers %K Retirement %B Overtime: America's Aging Workforce and the Future of Working Longer %I Oxford University Press %P 155-174 %G eng %& 7 %R 10.1093/oso/9780197512067.003.0008 %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 %X

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

%B Journal of Applied Gerontology %V 41 %P 2056-2062 %G eng %N 9 %R 10.1177/07334648221099006 %0 Journal Article %J Forum for Health Economics and Policy %D 2022 %T Future Directions for the HRS Harmonized Cognitive Assessment Protocol. %A Torres, Jacqueline M %A M. Maria Glymour %K Alzheimer %K Dementia %K HCAP %K Measurement %X

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

%B Forum for Health Economics and Policy %G eng %R 10.1515/fhep-2021-0064 %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 %X

OBJECTIVES: 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 Molecular Psychiatry %D 2022 %T Genome-wide meta-analyses reveal novel loci for verbal short-term memory and learning. %A Lahti, Jari %A Tuominen, Samuli %A Yang, Qiong %A Pergola, Giulio %A Ahmad, Shahzad %A Amin, Najaf %A Armstrong, Nicola J %A Beiser, Alexa %A Bey, Katharina %A Bis, Joshua C %A Boerwinkle, Eric %A Bressler, Jan %A Campbell, Archie %A Campbell, Harry %A Chen, Qiang %A Corley, Janie %A Cox, Simon R %A Davies, Gail %A De Jager, Philip L %A Derks, Eske M %A Jessica Faul %A Fitzpatrick, Annette L %A Fohner, Alison E %A Ford, Ian %A Fornage, Myriam %A Gerring, Zachary %A Grabe, Hans J %A Grodstein, Francine %A Gudnason, Vilmundur %A Simonsick, Eleanor %A Holliday, Elizabeth G %A Joshi, Peter K %A Kajantie, Eero %A Kaprio, Jaakko %A Karell, Pauliina %A Kleineidam, Luca %A Knol, Maria J %A Kochan, Nicole A %A Kwok, John B %A Leber, Markus %A Lam, Max %A Lee, Teresa %A Li, Shuo %A Loukola, Anu %A Luck, Tobias %A Marioni, Riccardo E %A Mather, Karen A %A Medland, Sarah %A Mirza, Saira S %A Nalls, Mike A %A Nho, Kwangsik %A O'Donnell, Adrienne %A Oldmeadow, Christopher %A Painter, Jodie %A Pattie, Alison %A Reppermund, Simone %A Risacher, Shannon L %A Rose, Richard J %A Sadashivaiah, Vijay %A Scholz, Markus %A Satizabal, Claudia L %A Schofield, Peter W %A Schraut, Katharina E %A Scott, Rodney J %A Simino, Jeannette %A Smith, Albert V %A Smith, Jennifer A %A Stott, David J %A Surakka, Ida %A Teumer, Alexander %A Thalamuthu, Anbupalam %A Trompet, Stella %A Turner, Stephen T %A van der Lee, Sven J %A Villringer, Arno %A Völker, Uwe %A Wilson, Robert S %A Wittfeld, Katharina %A Vuoksimaa, Eero %A Xia, Rui %A Yaffe, Kristine %A Yu, Lei %A Zare, Habil %A Zhao, Wei %A Ames, David %A Attia, John %A Bennett, David A %A Brodaty, Henry %A Chasman, Daniel I %A Goldman, Aaron L %A Hayward, Caroline %A Ikram, M Arfan %A Jukema, J Wouter %A Sharon L R Kardia %A Lencz, Todd %A Loeffler, Markus %A Mattay, Venkata S %A Palotie, Aarno %A Psaty, Bruce M %A Ramirez, Alfredo %A Ridker, Paul M %A Riedel-Heller, Steffi G %A Sachdev, Perminder S %A Saykin, Andrew J %A Scherer, Martin %A Schofield, Peter R %A Sidney, Stephen %A Starr, John M %A Trollor, Julian %A Ulrich, William %A Wagner, Michael %A David R Weir %A Wilson, James F %A Wright, Margaret J %A Weinberger, Daniel R %A Debette, Stéphanie %A Eriksson, Johan G %A Mosley, Thomas H %A Launer, Lenore J %A van Duijn, Cornelia M %A Deary, Ian J %A Seshadri, Sudha %A Räikkönen, Katri %K Genome %K health outcomes %K Memory %K neurocognitive outcomes %K polygenic score %K Verbal Learning %X

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

%B Molecular Psychiatry %G eng %R 10.1038/s41380-022-01710-8 %0 Journal Article %J Research on Aging %D 2022 %T Grandparenting, Social Relations, and Mortality in Old Age. %A Heejung Jang %A Tang, Fengyan %A Fusco, Rachel A %A Engel, Rafael J %A Steven M. Albert %K Grandparenting %K Mortality %K Social networks %K Social Support %X

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

%B Research on Aging %V 44 %P 265-275 %G eng %N 3-4 %R 10.1177/01640275211015433 %0 Journal Article %J 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 %X

INTRODUCTION: 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 Journal Article %J The Journal of Financial Data Science %D 2022 %T Health State Risk Categorization: A Machine Learning Clustering Approach Using Health and Retirement Study Data %A Tan, Fu %A Mehta, Dhagash %K health state risk %K Machine learning %X For countries such as the United States, which lacks a universal health care system, future health care costs can create significant uncertainty that a retirement investment strategy must be built to manage. One of the most important factors determining health care costs is the individual’s health status. Hence, categorizing individuals into meaningful health risk types is an essential task. The conventional approach is to use individuals’ self-rated health state categorization. In this work, the authors provide an objective and data-driven machine learning (ML)–based approach to categorize heath state risk by using the most widely used US household surveys on older Americans, the Health and Retirement Study (HRS). The authors propose an approach of employing the K-modes clustering method to algorithmically cluster on an exhaustive list of categorical health-related variables in the HRS. The resulting clusters are shown to provide an objective, interpretable, and practical health state risk categorization. The authors then compare and contrast the ML-based and self-rated health state categorizations and discuss the implications of the differences. They also illustrate the difficulty in predicting out-of-pocket costs based on self-rated health status and how ML-based categorizations can generate more-accurate health care cost estimates for personalized retirement planning. The results in this article open different avenues of research, including behavioral science analysis for health and retirement study. %B The Journal of Financial Data Science %V 4 %P 139–167 %G eng %N 2 %R 10.3905/jfds.2022.4.2.139 %0 Journal Article %J Social Science Research %D 2022 %T Incarceration, polygenic risk, and depressive symptoms among males in late adulthood %A Hexuan Liu %A Peter T. Tanksley %A Ryan T. Motz %A Rachel M. Kail %A J.C. Barnes %K Depressive symptoms %K incarceration %K Male %K polygenic risk %X This study demonstrates how social and genetic factors jointly influence depression in late adulthood. We focus on the effect of incarceration, a major life event consistently found to be associated with mental health problems. Drawing on data from males in the Wisconsin Longitudinal Study and the Health and Retirement Study, we conduct a polygenic score analysis based on a genome-wide association study on depressive symptoms. Our analysis produces two important findings. First, incarceration experience mediates the association between the depression polygenic score and depressive symptoms in late adulthood (i.e., greater polygenic scores are associated with elevated incarceration risk, which increases depressive symptoms in late adulthood). Second, about one-fifth of the association between incarceration experience and late-adulthood depressive symptoms is accounted for by the depression polygenic score and childhood depression. These findings reveal complex biological and social mechanisms in the development of depression and, more broadly, provide important insights for causal inference in social science research. %B Social Science Research %V 104 %P 102683 %G eng %R https://doi.org/10.1016/j.ssresearch.2021.102683 %0 Journal Article %J Journal of Social and Personal Relationships %D 2022 %T Loneliness, age at immigration, family relationships, and depression among older immigrants: A moderated relationship %A Heejung Jang %A Tang, Fengyan %K age at immigration %K depression %K family relationships %K Loneliness %K Migration %X Guided by a convoy model of social relations, this study explores the complex relationships between loneliness, age at immigration, familial relationships, and depressive symptoms among older immigrants. This study used 2010 Health and Retirement Study data from a sample of 575 immigrants (52% female, age range 65-99 years). Ordinary least squares regression models were estimated. The findings indicate that for older immigrants who came to the United States at age 45 or older, loneliness was significantly positively associated with depressive symptoms. Further, perceived negative strain and hours spent helping family moderated this relationship such that the effect of loneliness on depressive symptoms was stronger among respondents who perceived more negative family strain and spent fewer hours helping family. Familial relationships are crucial for the psychological well-being of older immigrants because they can be a source of either stress or support. The results have implications for how research and practices can support the immigrant families. %B Journal of Social and Personal Relationships %V 39 %P 1602-1622 %@ 0265-4075 %G eng %N 6 %R https://doi.org/10.1177/02654075211061279 %0 Journal Article %J Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %D 2022 %T The long arm of childhood socioeconomic deprivation on mid- to later-life cognitive trajectories: A cross-cohort analysis. %A Tsang, Ruby S M %A Gallacher, John E %A Bauermeister, Sarah %K childhood socioeconomic status %K cognitive aging %K Cognitive decline %K latent class mixed models %X

Introduction: Earlier studies of the effects of childhood socioeconomic status (SES) on later-life cognitive function consistently report a social gradient in later-life cognitive function. Evidence for their effects on cognitive decline is, however, less clear.

Methods: The sample consists of 5324 participants in the Whitehall II study, 8572 in the Health and Retirement Study (HRS), and 1413 in the Kame Project, who completed self-report questionnaires on their early life experiences and underwent repeated cognitive assessments. We characterized cognitive trajectories using latent class mixed models, and explored associations between childhood SES and latent class membership using logistic regressions.

Results: We identified distinct trajectories classes for all cognitive measures examined. Childhood socioeconomic deprivation was associated with an increased likelihood of being in a lower trajectory class.

Discussion: Our findings support the notions that cognitive aging is a heterogeneous process and early life circumstances may have lasting effects on cognition across the life-course.

%B Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %V 14 %P e12322 %G eng %N 1 %R 10.1002/dad2.12322 %0 Journal Article %J Psychology and Aging Publisher: American Psychological Association %D 2022 %T Longitudinal associations between chronic condition discordance and perceived control among older couples. %A Polenick, Courtney A %A Birditt, Kira S %A Turkelson, Angela %A Shattuck, Sadie M %A Kales, Helen C %K chronic condition discordance %K perceived control %X

Chronic health conditions among individuals and their partners may diminish perceived control, particularly when these conditions are highly complex. We considered how chronic condition discordance (i.e., the extent that two or more conditions have nonoverlapping self-management requirements) at the individual level and the couple level (i.e., between spouses) was linked to health-related control and personal mastery across an 8-year period, and whether these links varied by age. The U.S. sample included 879 wives ( = 53.81 years) and husbands ( = 57.19 years) from three waves (2006, 2010, and 2014) of the Health and Retirement Study. Dyadic growth curve models controlled for age, minority status, education, own and partner baseline negative marital quality, and own and partner time-varying depressive symptoms, and number of chronic health conditions. Overall, both individual-level and couple-level degrees of chronic condition discordance were associated with initial levels of and rates of change in perceived control. When wives had greater individual-level discordance, they reported lower initial personal mastery. When husbands had greater individual-level discordance, they reported lower initial health-related control and faster declines in health-related control and personal mastery, and their wives reported faster declines in personal mastery. When there was greater couple-level discordance, wives reported lower initial health-related control. Age moderated the associations between wives' individual-level discordance and their own initial level of health-related control and rate of change in personal mastery. Interventions to improve later-life well-being may be enhanced by targeting increases in perceived control among individuals and couples managing complex patterns of chronic conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

%B Psychology and Aging Publisher: American Psychological Association %V 37 %P 371-387 %G eng %N 3 %R 10.1037/pag0000679 %0 Journal Article %J The International Journal of Aging and Human Development %D 2022 %T Marital Transitions, Change in Depressive Symptomology, and Quality of Social Relationships in Midlife and Older U.S. Adults: An Analysis of the Health and Retirement Study. %A Julia E Tucker %A Nicholas J Bishop %A Wang, Kaipeng %A Phillips, Farya %K depression %K Divorce %K marital transitions %K Mental Health %K Social Support %K Widowhood %X

Preventing negative health outcomes following marital transitions can promote personal recovery and well-being. We used the Health and Retirement Study (HRS) (2012, 2014) to test whether social relationship quality moderated the association between marital transition and change in depressive symptomology among U.S. adults aged 50 and older (n = 3,705). Marital status transitions between 2012 and 2014 included remained married/partnered, divorced/separated, and widowed. Depressive symptomology was measured using the Center for Epidemiological Studies Depression Scale 8 Short Form (CES-D 8). Social support, social contact, and social strain were indicators of social relationship quality. Change in depressive symptomology was modeled using autoregressive multiple regression. Social relationship quality appeared to influence depressive symptomatology for those experiencing divorce/separation. Compared to individuals who remained married/partnered, depressive symptomatology in those experiencing separation/divorce decreased among those reporting low social support, increased among those reporting high social support, and increased among those who reported low social strain. Limitations and clinical implications are discussed.

%B The International Journal of Aging and Human Development %V 95 %P 349-371 %G eng %N 3 %R 10.1177/00914150211066551 %0 Journal Article %J Behavior Genetics %D 2022 %T Modeling Interaction and Dispersion Effects in the Analysis of Gene-by-Environment Interaction. %A Benjamin W Domingue %A Kanopka, Klint %A Mallard, Travis T %A Trejo, Sam %A Elliot M Tucker-Drob %K Gene × environment interaction %K Gene-by-environment interaction %K GxE %K G×E %K Heteroscedasticity %K vQTL %X

Genotype-by-environment interaction (GxE) studies probe heterogeneity in response to risk factors or interventions. Popular methods for estimation of GxE examine multiplicative interactions between individual genetic and environmental measures. However, risk factors and interventions may modulate the total variance of an epidemiological outcome that itself represents the aggregation of many other etiological components. We expand the traditional GxE model to directly model genetic and environmental moderation of the dispersion of the outcome. We derive a test statistic, [Formula: see text], for inferring whether an interaction identified between individual genetic and environmental measures represents a more general pattern of moderation of the total variance in the phenotype by either the genetic or the environmental measure. We validate our method via extensive simulation, and apply it to investigate genotype-by-birth year interactions for Body Mass Index (BMI) with polygenic scores in the Health and Retirement Study (N = 11,586) and individual genetic variants in the UK Biobank (N = 380,605). We find that changes in the penetrance of a genome-wide polygenic score for BMI across birth year are partly representative of a more general pattern of expanding BMI variation across generations. Three individual variants found to be more strongly associated with BMI among later born individuals, were also associated with the magnitude of variability in BMI itself within any given birth year, suggesting that they may confer general sensitivity of BMI to a range of unmeasured factors beyond those captured by birth year. We introduce an expanded GxE regression model that explicitly models genetic and environmental moderation of the dispersion of the outcome under study. This approach can determine whether GxE interactions identified are specific to the measured predictors or represent a more general pattern of moderation of the total variance in the outcome by the genetic and environmental measures.

%B Behavior Genetics %V 52 %P 56-64 %G eng %N 1 %R 10.1007/s10519-021-10090-8 %0 Journal Article %J Journal of Multimorbidity and Comorbidity %D 2022 %T Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults. %A Quiñones, Ana R %A Nagel, Corey L %A Botoseneanu, Anda %A Newsom, Jason T %A Dorr, David A %A Kaye, Jeffrey %A Thielke, Stephen M %A Allore, Heather G %K Cognition %K depression %K joint trajectories %K multimorbidity %X

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

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

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

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

%B Journal of Multimorbidity and Comorbidity %V 12 %P 26335565221143012 %G eng %R 10.1177/26335565221143012 %0 Journal Article %J The Journals of Gerontology: Series B %D 2022 %T Music Engagement and Episodic Memory among Middle-Aged and Older Adults: A National Cross-Sectional Analysis. %A Rouse, Hillary J %A Jin, Ying %A Hueluer, Gizem %A Huo, Meng %A Bugos, Jennifer A %A Veal, Britney %A Torres, Mia %A Peterson, Lindsay %A Dobbs, Debra %A Meng, Hongdao %K age norms %K healthcare policy %K lifestyle %K Memory %K Music %K regression methods %X

OBJECTIVES: To determine whether music engagement influences middle-aged and older adults' performance on episodic memory tasks.

METHODS: Secondary data analysis of a sample (N = 4,592) of cognitively healthy adults from the 2016 Health and Retirement Study were used for this study. Multivariable regression models were used to analyze the cross-sectional differences in performance on tasks of episodic memory between participants who listened to music (n= 3,659) or sang or played an instrument (n= 989).

RESULTS: On average, participants recalled 10.3 words out of a possible 20. Regression analyses showed that both music listening and singing or playing an instrument were independently associated with significantly better episodic memory.

DISCUSSION: The findings provide the first population-based evidence that music engagement is associated with better episodic memory among middle-aged and older adults. Future studies should examine whether the association is causal or has a dose response.

%B The Journals of Gerontology: Series B %V 77 %P 558-566 %G eng %N 3 %R 10.1093/geronb/gbab044 %0 Journal Article %J Research on Aging %D 2022 %T My Wife Is My Insurance Policy: Household Bargaining and Couples' Purchase of Long-Term Care Insurance. %A Tennyson, Sharon %A Yang, Hae Kyung %A Woolley, Frances %K Household bargaining %K Long-term care insurance %K random-effects multinomial logistic regression %X

This paper examines household decisions over long-term care insurance (LTCI) purchases through a bargaining lens. Long-term care insurance purchase is a discrete decision around which spouses' interests may diverge substantially. The cost of buying LTCI is typically borne by both spouses, but the benefits of LTCI go disproportionately to women, who are more likely to need long-term care for themselves, and to benefit from the asset protection and other support LTCI offers in the event their husband needs care. Using panel data on married couples ages 50-75 from the US Health and Retirement Study (HRS), we test and find support for the hypothesis that spouses' relative bargaining power is related to LTCI purchase decisions. In particular, when husbands have final say in household decisions, LTCI coverage is less likely. The findings suggest that spouse's relative bargaining power matters for health care choices and, therefore, for the welfare of older men and women.

%B Research on Aging %V 44 %P 692-708 %G eng %N 9-10 %R 10.1177/01640275211046322 %0 Journal Article %J The Journals of Gerontology: Series A %D 2022 %T Neighborhood Characteristics and Inflammation among Older Black Americans: The Moderating Effects of Hopelessness and Pessimism. %A Ann W Nguyen %A Harry Owen Taylor %A Karen D Lincoln %A Qin, Weidi %A Tyrone C Hamler %A Wang, Fei %A Uchechi A Mitchell %K C-reactive protein %K cognitive disposition %K neighborhood physical disadvantage %K neighborhood social cohesion %X

BACKGROUND: Research documents the adverse health effects of systemic inflammation. Overall, older Black Americans tend to have higher inflammation than older non-Hispanic white adults. Given that inflammation is related to a range of chronic health problems that disproportionately affect Blacks compared to whites, this racial disparity in inflammation may contribute to racial disparities in particular chronic health problems. Thus, a better understanding of its determinants in the older Black population is of critical importance. This analysis examined the association between neighborhood characteristics and inflammation in a national sample of older non-Hispanic Black Americans. An additional aim of this study was to determine whether hopelessness and pessimism moderates the association between neighborhood characteristics and inflammation.

METHODS: A sample of older non-Hispanic Black Americans aged 60+ were drawn from the Health and Retirement Study (N=1,004). Neighborhood characteristics included neighborhood physical disadvantage and neighborhood social cohesion. Inflammation was assessed by C-reactive protein (CRP).

RESULTS: The analyses indicated that neighborhood physical disadvantage and social cohesion were not associated with CRP. Hopelessness and pessimism moderated the association between neighborhood physical disadvantage and CRP.

CONCLUSIONS: Knowledge regarding the role of hopelessness and pessimism as moderator in the neighborhood-inflammation association can inform cognitive-behavioral interventions targeted at changes in cognition patterns.

%B The Journals of Gerontology: Series A %V 77 %P e82-e88 %G eng %N 2 %R 10.1093/gerona/glab121 %0 Report %D 2022 %T Not Just for Kids—Child and Dependent Care Credit Benefits for Elder Care %A Gabrielle Pepin %A Yulya Truskinovsky %K care credit benefits %X A growing number of adults in the United States care for a relative with a long-term illness or disability. Family caregivers provide critical support while incurring substantial private costs, including out of pocket expenses. The Child and Dependent Care Credit (CDCC) allows households to receive tax credits for certain expenses associated with the care of a dependent, defined as a child under 13 or a spouse or other dependent who is incapable of self-care. However, very few childless households claim tax benefits that may be used for elder care. In this paper, we examine the value of the CDCC for qualifying households caring for adults. We first describe CDCC eligibility requirements and benefits across the income distribution and by the relationship of the dependent. We show that potential benefits during 2021 are substantially higher for a coresident dependent parent than for a spouse. We then use data from the Health and Retirement Study to document the size of the population most likely affected by tax credits for elder care, finding that, as of 2016, more than 10 percent of individuals aged 50 to 65 had a coresident spouse or parent in need of assistance with activities of daily living. Using median cost-of-care data, we estimate how state and federal CDCC benefits affect post-tax costs of typical qualifying caregiving services, such as home health aides. We show that the different tax treatment of households with coresident parents and spouses in need of help substantially affects post-tax costs of care. This paper demonstrates the potential benefits of the CDCC for families caring for older adults, highlights important heterogeneity in the value of the credit across family types, and lays the groundwork for future investigations into how to design comprehensive tax credits for older adults and their caregivers. %G eng %U https://www.upjohn.org/sites/default/files/inline-files/Pepin_Truskinovsky_CDCC_elder_care.pdf %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 Web Page %D 2022 %T Optimizing Vision May Slow Cognitive Decline, Helping Prevent Dementia %A Taron, Adrienne %K Alzheimer %K Dementia %K neurocognitive disorders %X Vision impairment could prove to be a beneficial addition to the Lancet Commission’s life-course model of potentially modifiable dementia risk factors. The estimated population attributable fractions (PAFs) of dementia associated with vision impairment and other dementia risk factors (11 of those included in the Lancet Commission’s life-course model) were calculated to assess and strengthen an existing model of potentially modifiable dementia risk factors, say researchers of study published in JAMA Neurology. %I Neurology Advisor %G eng %U https://www.neurologyadvisor.com/topics/alzheimers-disease-and-dementia/vision-impairment-is-a-modifiable-dementia-risk-factor/ %0 Journal Article %J The Gerontologist %D 2022 %T Out-of-pocket health expenditures and healthcare services use among older Americans with cognitive impairment: Results from the 2008-2016 Health and Retirement Study. %A Jenkins, Derek %A Stickel, Ariana %A Hector M González %A Wassim Tarraf %K cognitive aging %K Dementia %K Health services use %K Out-of-pocket spending %X

BACKGROUND AND OBJECTIVES: The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how change in cognitive impairment status influences nursing-home use, hospitalizations, and out-of-pocket expenditures (OOP).

RESEARCH DESIGN AND METHODS: We use prospective data from the Health and Retirement Study (2007/08-2015/16) on adults 70-years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (Unweighted N=1,692) to fit two-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing-home use, hospitalizations, and OOP.

RESULTS: Over 8-years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use that were particularly pronounced among those that transitioned or died during follow-up, and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval=832;1,479]), maintainers ($1,145 [993;1,296]), and transitioners ($1,385 [1,041;1,730]). Individuals that died during follow-up spent $2,529 [2,101;2,957]. By the 8th year of follow-up, spending among reverters increased to $1,402 [869;1,934], and $2,188 [1,402;2,974], and $8,988 [5,820;12,157] for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 [4,345;11,094]. Estimates were only partly attenuated through adjustment to covariables.

DISCUSSION AND IMPLICATIONS: A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning.

%B The Gerontologist %V 62 %P 911-922 %G eng %N 6 %R https://doi.org/10.1093/geront/gnab160 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Pathways from early life SES to dementia risk in old age: The role of personality. %A Sesker, Amanda A %A O'Súilleabháin, Páraic S %A Lee, Ji Hyun %A Damaris Aschwanden %A Martina Luchetti %A Yannick Stephan %A Antonio Terracciano %A Angelina R Sutin %K CIND %K Conscientiousness %K cSES %K Dementia %K Neuroticism %X

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

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

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

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

%B The Journals of Gerontology, Series B %V 77 %P 850-859 %G eng %N 5 %R 10.1093/geronb/gbab159 %0 Journal Article %J Personality and Individual Differences %D 2022 %T Personality and change in perceived control during the acute stage of the coronavirus pandemic. %A Sesker, Amanda A %A Lee, Ji Hyun %A Luchetti, Martina %A Damaris Aschwanden %A Stephan, Yannick %A Terracciano, Antonio %A Sutin, Angelina R %K COVID-19 %K perceived control %K Personality Traits %X

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

%B Personality and Individual Differences %V 192 %P 111607 %G eng %R 10.1016/j.paid.2022.111607 %0 Journal Article %J 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 %X

The 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 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 %X

Subjective 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 Journal of the American College of Surgeons %D 2022 %T Postoperative Functional Health Status in Older Adults Undergoing Minor Surgery: An Observational Study %A Dharmasukrit, Charlie %A Shinall, Myrick Clements %A Jeon, Sun Young %A John Boscardin %A Tang, Victoria %K minor surgery %K postoperative function %X Introduction: Postoperative function is an important patient-centered outcome in older adults. While functional decline is likely in older adults undergoing major surgery, less is known about the functional outcomes of older adults undergoing minor surgery. We aimed to describe the long-term functional outcomes after minor surgery and to examine geriatric-specific risk factors associated with these outcomes. Methods: We identified subjects who underwent minor surgery while enrolled in the nationally representative Health and Retirement Study (HRS) between 1995-2017 using linked Medicare claims. Using preoperative and postoperative (≥ 6 months) interviews, logistic regression was used to determine risk factors of decline in activities in daily living (ADL) and walking. Results: Of the 9640 subjects who met inclusion criteria, 45.5% were age 75+ years at the time of surgery and 55.6% female. 2056 subjects (21.3%) experienced a decline in ADL ability, including death. Decline in ADL was more likely for those who were of advanced age (>75 years), non-married, had impaired cognition or dementia, income less than the median, high comorbidity burden, a history of falls, and impaired cognitive strength (P < 0.01 for all comparisons). These factors were also significant for decline in walking ability. Conclusion: Over 21% of the cohort experienced a decline in functional status (in ADL or walking) or death before their postoperative interview. Preoperative counseling, including anticipatory guidance for postoperative functional decline, should occur with older adult patients undergoing minor surgery. %B Journal of the American College of Surgeons %V 235 %P S38-S39 %G eng %N 5 %R 10.1097/01.XCS.0000895968.16739.d1 %0 Web Page %D 2022 %T Psychological Research Says Wealth Is Created By Chasing Positive Emotions, Not Money Alone %A Travers, Mark %K Emotions %K Wealth %I Forbes %G eng %U https://www.forbes.com/sites/traversmark/2022/10/02/psychological-research-says-wealth-is-created-by-chasing-positive-emotions-not-money-alone/?sh=1384fa2a6328 %0 Journal Article %J Gerontology and Geriatric Medicine %D 2022 %T Psychological Resilience and Cognitive Function Among Older Military Veterans. %A McDaniel, Justin T %A Hascup, Erin R %A Hascup, Kevin N %A Trivedi, Mehul %A Henson, Harvey %A Rados, Robert %A York, Mary %A Albright, David L %A Weatherly, Taryn %A Frick, Kaitlyn %K neurocognitive disorders %K psychological resilience %K Veterans Health %X

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

%B Gerontology and Geriatric Medicine %V 8 %P 23337214221081363 %G eng %R 10.1177/23337214221081363 %0 Journal Article %J Health Psychology %D 2022 %T Psychological well-being, education, and mortality. %A Boylan, Jennifer Morozink %A Tompkins, Justin L %A Patrick M. Krueger %K Education %K Life Satisfaction %K Mortality %K Optimism %K Purpose in life %K Social Support %K Wellbeing %X

OBJECTIVES: Research on older adults often focuses on mitigating health risks, and less is known about protective factors that contribute to longer, healthier lives. We examine longitudinal associations between psychological well-being and mortality among a national sample of older adults and test competing hypotheses about whether the education/mortality association depends on the level of psychological well-being.

METHOD: We use six waves (2006-2016) of the Health and Retirement Study, a national sample of adults over age 50 ( = 21,172), with 14 years of mortality follow-up. Psychological well-being is measured up to three times and includes positive affect, life satisfaction, purpose in life, social support, and optimism. Discrete-time survival models examine (a) the association between time-varying psychological well-being and mortality, and (b) interactions between psychological well-being and education on mortality.

RESULTS: Higher purpose in life, positive affect, optimism, social support, and life satisfaction predicted lower mortality. A 1 increase in most measures of psychological well-being was associated with a 2-4 year increase in life expectancy at age 50. Positive affect and purpose in life moderated the education/mortality association-the inverse association between education and mortality was stronger for those with high psychological well-being.

CONCLUSIONS: We find strong evidence that psychological well-being predicts lower mortality risk and modifies the association between education and mortality. The inverse association between education and mortality becomes stronger at higher levels of purpose in life and positive affect. Therefore, efforts to promote life satisfaction, social support, and optimism may support longer lives without widening education disparities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

%B Health Psychology %V 41 %P 225-234 %G eng %N 3 %R 10.1037/hea0001159 %0 Journal Article %J Aging and Mental Health %D 2022 %T The quality of relationships with adult children and depressive symptoms among grandparents. %A Heejung Jang %A Rauktis, Mary E %A Tang, Fengyan %K Depressive symptoms %K Grandparenting %K intergenerational relationships %X

The present study aims to identify distinct types of relationships between grandparents and their adult children, measure the associations between these relationship types and depressive symptoms among grandparents, and determine whether these associations vary by grandparent status.This study uses data from a sample of 1,196 grandparents age 51 and older from the 2014 Health and Retirement Study. Latent class analysis (LCA) is applied and identifies types of grandparent-adult children relationships. Ordinary Least Squares (OLS) regression models are used to estimate the association between relationship types and depressive symptoms by grandparent status. LCA identified four grandparent-adult children relationship types: amicable, ambivalent, detached, and disharmonious. Custodial and co-parenting grandparents were most likely to report having an ambivalent relationship with their adult children. Among co-parenting and custodial grandparents, disharmonious relationships were associated with more depressive symptoms. Interventions are suggested to improve emotional relationships with adult children and dyadic family relationships among grandparent families.

%B Aging and Mental Health %G eng %R 10.1080/13607863.2021.1998349 %0 Journal Article %J Population Studies %D 2022 %T Quantifying self-rated age. %A Verropoulou, Georgia %A Papachristos, Apostolos %A Ploubidis, George B %A Tsimbos, Cleon %K Biological age %K HMD %K self-rated age %K SHARE %K Subjective age %K subjective ageing indicator %K Subjective survival probabilities %X

Chronological age, in conjunction with population life tables, is widely used for estimating future life expectancy. The aims of this study are to estimate a subjective ageing indicator, namely self-rated age, and to evaluate its concurrent validity in comparison with other age indicators: subjective survival probabilities, subjective age, and biological age. We use data from the Wave 6 of the Survey of Health, Ageing and Retirement in Europe, Wave 12 of the Health and Retirement Study in the United States, and life tables from the Human Mortality Database. For the statistical analysis we use multinomial regression models. Our results indicate that health status and frequency of physical activities imply similar patterns of self- rated age, subjective survival probabilities, subjective age, and biological age. However, the impact of cognitive function differs by geographical region. Self-rated age can be interpreted as a subjective adjustment that better reflects the ageing process.

%B Population Studies %G eng %R 10.1080/00324728.2022.2030490 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Race/Ethnic Differences, Skin Tone and Cognitive Aging among Older Latinos in the U.S. %A Liu, Mao-Mei %A Telles, Edward %A Tucker, Katherine L %A Falcon, Luis M %A Jiménez Velázquez, Ivonne Z %A Dow, William %K cognitive aging %K Hispanic aging %K Hispanic health %K Racial Disparities %K skin color %X

OBJECTIVES: U.S. Latino populations are diverse. Research on racial identity, skin tone and Latino health is imperative for understanding and combatting racism and colorism. We examined differences in memory performance: among non-Latinos and Latinos who identified as Black, other and white in the U.S.; and then among Puerto Ricans in Boston whose skin tones ranged from dark, medium, light to 'white'.

METHODS: We used 2010 Health and Retirement Study and 2004 Boston Puerto Rican Health Survey data, respectively, to examine racial and color differences in memory performance among 50+ year older adults in the U.S. and Puerto Rican older adults in Boston. We applied OLS regression to immediate and delayed word recall test scores and adjusted for education, health conditions and health behaviors.

RESULTS: In adjusted models, white non-Latinos had better memory performance than white Latinos. Black Latinos, other Latinos, and Black non-Latinos had lower delayed word recall scores than white Latinos. Black Latinos and Black non-Latinos had similar scores. Intra-Latino racial disparities endured despite inclusion of education and other covariates. Among Puerto Ricans in Boston, medium-toned individuals had higher scores than 'white'-toned individuals.

DISCUSSION: Findings support the importance of examining self-identified race and skin tone in Latino aging research. Further investigation is needed to understand the stubborn intra-Latino racial disparities in memory performance and surprising adverse cognitive performance among 'white'-toned relative to darker-toned Puerto Ricans in Boston.

%B The Journals of Gerontology, Series B %V 77 %P 2038-2048 %G eng %N 11 %R 10.1093/geronb/gbac043 %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 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 Preventive Medicine Reports %D 2022 %T The role of smoking history in longitudinal changes in C-reactive protein between Black and White older adults in the US %A Nancy C. Jao %A Aresha Martinez-Cardoso %A Moin Vahora %A Marcia M. Tan %K African Americans %K C-reactive protein %K Smoking %X Smoking cessation is associated with decreases in C-reactive protein (CRP), a biomarker of systemic inflammation and cancer risk; yet CRP levels remain higher long-term in individuals who quit vs. those who never smoked. While non-Hispanic, Black/African American (NHB) have higher levels of CRP vs. non-Hispanic, White/Caucasian (NHW) adults, the association between CRP and race has not been examined in individuals with smoking history. Utilizing longitudinal data from the Health and Retirement Study (HRS), the current study examined the effects of race and smoking history on CRP in older adults. NHB (n = 242) and NHW (n = 1529) participants completed HRS assessments in 2006, 2010, and 2014. Dried blood spots collected at each wave were assayed for CRP. Linear mixed models were used to examine the effect of race and smoking history on CRP across waves – controlling for sociodemographics, physical activity, body mass index (BMI), and current smoking. Overall, results showed no significant effects of race or current smoking on CRP; rather age, sex, education, BMI, physical activity, smoking history, and time × race predicted CRP (ps<.04). However, while age, sex, education, BMI, physical activity, and smoking history were also predictive of CRP in NHWs (ps<.04) in race-stratified models, only BMI was a significant predictor of CRP in NHBs (p=.012). BMI may be important in explaining inflammation-related disease risk in NHBs with a history of smoking. NHBs may not experience the same reductions in CRP with smoking cessation as NHWs – potentially contributing to tobacco-related health disparities. %B Preventive Medicine Reports %V 28 %P 101885 %G eng %R https://doi.org/10.1016/j.pmedr.2022.101885 %0 Journal Article %J Journal of Gerontological Social Work %D 2022 %T The Role of Solitary Activity in Moderating the Association between Social Isolation and Perceived Loneliness among U.S. Older Adults. %A Li, Ke %A Tang, Fengyan %K Isolation %K Loneliness %K Social networks %X

Social isolation has been recognized as a critical public health problem. As the most vulnerable population, older adults are disproportionately affected by social isolation during the COVID-19 pandemic. The purposes of this study were to examine the association between social isolation and loneliness among U.S. older adults and to explore the moderating effect of solitary activity by using data from the Health and Retirement Study (HRS). Social isolation was measured by six indicators, including marital status, living arrangement, social participation in any clubs or social organizations, and the frequency of social contact with children, family members, and friends. Loneliness was assessed by eleven questions derived from the UCLA Loneliness Scale. Solitary activity included 11 types of activities that respondents could perform alone with limited or no social interaction. Results from the multivariate regression analyses indicated that unmarried status and lower frequency of social contact were associated with more perceived loneliness. Solitary activity significantly moderated the negative effects of the low frequency of social contact with family members on loneliness. The findings implicate that social work programs and interventions can aim to expand social networks and provide more opportunities for solitary activities, particularly for isolated older adults.

%B Journal of Gerontological Social Work %V 65 %P 252-270 %G eng %N 3 %R 10.1080/01634372.2021.1958115 %0 Journal Article %J Journal of Aging & Social Policy %D 2022 %T Sample Selection Bias Due to Differential Mortality: A Supplementary Measure of Old-Age Poverty. %A Leslie A. Muller %A John A. Turner %K Poverty %K survivorship bias %X

Traditional "head count" measures of poverty at advanced older ages understate the risk of falling into poverty because of survivorship bias due to the income-mortality gradient, which indicates that people in poverty have higher mortality rates than people with higher income. Survivorship bias is a form of sample selection bias. This paper presents a supplementary measure for poverty at older ages, based on an adaption of a model for correcting survivorship bias in rate of return data for mutual funds. Using U.S. longitudinal data from the Health and Retirement Study (HRS) for 1996 and 2002-2012 for the same cohort, we develop a new estimate of poverty at older ages that suggests that traditional cross-sectional measures understate the risk of falling into poverty by roughly a quarter. This finding has important implications for social programs that relate to the causes and consequences of the selectivity bias.

%B Journal of Aging & Social Policy %V 34 %P 496-514 %G eng %N 3 %R 10.1080/08959420.2021.1926196 %0 Journal Article %J Aging and Mental Health %D 2022 %T Self-reported sense of purpose in life and proxy-reported behavioral and psychological symptoms of dementia in the last year of life. %A Angelina R Sutin %A Martina Luchetti %A Yannick Stephan %A Antonio Terracciano %K Behavioral Symptoms %K BPSD %K Dementia %K end of life %K Purpose in life %X

Behavioral and psychological symptoms of dementia (BPSD) are among the most challenging aspects of dementia for individuals living with dementia and their caregivers. Identifying factors associated with resilience to BPSD may inform interventions to reduce them. The present research examines whether purpose in life is associated with BPSD in the last year of life.Participants from the Health and Retirement Study were selected if they reported on their sense of purpose, had evidence of a memory impairment, died across the follow-up, and a proxy completed the End of Life survey that included BPSD ( = 2473). Self-reported sense of purpose was tested as a predictor of the sum of symptoms and each indivdual symptom in the last year of life.Purpose in life was associated with fewer BPSD overall. Of the individual symptoms, purpose was associated with less risk of psychological symptoms, specfiically less depression, periodic confusion, uncontrolled temper, but not with motor or perceptual symptoms. These results are consistent with growing evidence that purpose is associated with better cognitive outcomes. Purpose may be a useful target of intervention to improve outcomes across the spectrum of dementia.

%B Aging and Mental Health %V 26 %P 1693-1698 %G eng %N 8 %R 10.1080/13607863.2021.1937055 %0 Journal Article %J Gerontology %D 2022 %T Sense of Purpose in Life and Markers of Hearing Function: Replicated Associations across Two Longitudinal Cohorts. %A Angelina R Sutin %A Martina Luchetti %A Damaris Aschwanden %A Yannick Stephan %A Antonio Terracciano %K Episodic Memory %K hearing acuity %K Hearing loss %K Replication %K Sense of purpose %X

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

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

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

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

%B Gerontology %V 68 %P 943-950 %G eng %N 8 %R 10.1159/000521257 %0 Journal Article %J PLoS One %D 2022 %T Serum Cystatin-C is linked to increased prevalence of diabetes and higher risk of mortality in diverse middle-aged and older adults. %A González, Kevin A %A Stickel, Ariana M %A Kaur, Sonya S %A Ramos, Alberto R %A González, Hector M %A Tarraf, Wassim %K Diabetes Mellitus %K Hispanic or Latino %K Kidney diseases %K Prevalence %K Risk Factors %K Type 2 %X

OBJECTIVE: Type 2 Diabetes Mellitus (henceforth diabetes) affects roughly 35 million individuals in the US and is a major risk factor for cardiovascular and kidney disease. Serum Cystatin-C is used to monitor renal function and detect kidney damage. Recent research has focused on linking Cystatin-C to cardiovascular risk and disease, but most findings focus on small sample sizes and generalize poorly to diverse populations, thus limiting epidemiological inferences. The aim of this manuscript is to study the association between Cystatin-C, diabetes, and mortality and test for possible sex or racial/ethnic background modifications in these relationships.

METHODS: We analyzed 8-years of biennial panel data from Health and Retirement Study participants 50-years and older who self-identified as White (unweighted N (uN) = 5,595), Black (uN = 867), or Latino (uN = 565) for a total of uN = 7,027 individuals. We modeled diabetes and death over 8-years as function of baseline Cystatin-C (log transformed) adjusting for covariates and tested modifications in associations by race/ethnic background and sex.

RESULTS: Mean log Cystatin-C at visit 1 was 0.03±0.32 standard deviation. A 10% increase in Cystatin-C levels was associated with 13% increased relative risk of diabetes at baseline (11% and 9% by years 4 and 8). A 10% increase in Cystatin-C was highly associated with increased relative risk of death (28% and 31% by years 4 and 8). These associations were present even after adjusting for possible confounders and were not modified by sex or racial/ethnic background.

CONCLUSION: Despite differential risks for diabetes and mortality by racial/ethnic groups, Cystatin-C was equally predictive of these outcomes across groups. Cystatin-C dysregulations could be used as a risk indicator for diabetes and as a warning sign for accelerated risk of mortality.

%B PLoS One %V 17 %P e0270289 %G eng %N 9 %R 10.1371/journal.pone.0270289 %0 Journal Article %J PLoS One %D 2022 %T Sex differences in post-stroke cognitive decline: A population-based longitudinal study of nationally representative data. %A Bako, Abdulaziz T %A Potter, Thomas %A Tannous, Jonika %A Pan, Alan P %A Johnson, Carnayla %A Baig, Eman %A Downer, Brian %A Vahidy, Farhaan S %K Cognition %K Cognitive Dysfunction %K Female %K Male %K Sex Characteristics %K Stroke %X

BACKGROUND: Sex differences in post-stroke cognitive decline have not been systematically evaluated in a nationally representative cohort. We use a quasi-experimental design to investigate sex differences in rate of post-stroke cognitive decline.

METHODS: Utilizing the event study design, we use the Health and Retirement Study (HRS) data (1996-2016) to evaluate the differences (percentage points [95% Confidence interval]) in the rate of change in cognitive function, measured using the modified version of the Telephone Interview for Cognitive Status (TICS-m) score, before and after incident stroke, and among patients with and without incident stroke. We estimated this event study model for the overall study population and separately fit the same model for male and female participants.

RESULTS: Of 25,872 HRS participants included in our study, 14,459 (55.9%) were females with an overall mean age (SD) of 61.2 (9.3) years. Overall, 2,911 (11.3%) participants reported experiencing incident stroke. Participants with incident stroke (vs. no stroke) had lower baseline TICS-m score (15.6 vs. 16.1). Among participants with incident stroke, the mean pre-stroke TICS-m score was higher than the mean post-stroke TICS-m score (14.9 vs. 12.7). Event study revealed a significant short-term acceleration of cognitive decline for the overall population (4.2 [1.7-6.6] percentage points, p value = 0.001) and among female participants (5.0 [1.7-8.3] percentage points, p value = 0.003). We, however, found no evidence of long-term acceleration of cognitive decline after stroke. Moreover, among males, incident stroke was not associated with significant changes in rate of post-stroke cognitive decline.

CONCLUSION: Females, in contrast to males, experience post-stroke cognitive deficits, particularly during early post-stroke period. Identifying the sex-specific stroke characteristics contributing to differences in post stroke cognitive decline may inform future strategies for reducing the burden of post-stroke cognitive impairment and dementia.

%B PLoS One %V 17 %P e0268249 %G eng %N 5 %R 10.1371/journal.pone.0268249 %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 %X

OBJECTIVES: 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 Journal Article %J Sleep %D 2022 %T Sleep Disorders as a Potential Risk Factor for Dementia in Elderly Adults %A Kuhler, Cassandra %A Wills, Chloe %A Tubbs, Andrew %A Seixas, Azizi %A Turner, Arlener %A Jean-Louis, Girardin %A Killgore, William %A Grandner, Michael %K Alzheimer disease %K Comorbidity %K Dementia %K depressive disorders %K Early Diagnosis %K ethnic group %K Health Personnel %K insomnia %K memory impairment %K sleep disorders %X Introduction Sleep disorders such as insomnia are seen in the early onset of Alzheimer’s disease, the most common form of dementia. Simultaneously, sleep disorders may indicate increased risk for the development of dementia. Due to the rate of comorbidity of these two conditions seen in the elderly population, the relationship between dementia and sleep disorders is a topic of interest for researchers. A bidirectional correlation between the two could have important implications in the clinical field exploring factors that lead to dementia Methods Data was assessed from 17,146 older adults from the 2018 Health and Retirement Survey. Participants were surveyed using questionnaires regarding both incident dementia or serious memory impairment in the past 2 years and the presence of a sleep disorder, as diagnosed by a doctor or health professional. Those who reported no dementia in the previous wave (N=16,547) were asked if they had been diagnosed since they were last asked. N=185 individuals reported incident dementia in the 2-years between assessments. Responses were coded to either “Yes” or “No”. A Poisson regression analysis was conducted to explore the relationship between incident dementia and sleep disorders. Results In a sample of older adults, unadjusted results indicate that having a sleep disorder was associated with a 0.6% increased risk of new onset dementia (PRR=1.006; 95%CI[1.001,1.012]; p=0.026). These results were sustained when adjusted for sex, age, race, ethnicity, and depression (PRR=1.006; 95%CI[1.001,1.012]; p=0.013). Conclusion Chronic sleep disturbances may be a factor used to indicate increased risk for dementia and help with early detection of the disease. These results demonstrate the value of sleep disorders screening among those at risk for dementia. Further research is needed to clarify these findings (e.g., explore specific sleep disorders) and expand the follow-up window (i.e., beyond 2 years). %B Sleep %V 45 %P A123 %G eng %N Suppl _1 %R 10.1093/sleep/zsac079.271 %0 Journal Article %J Journal of the American College of Surgeons %D 2022 %T Social Strain Is Associated with Functional Health in Older Adults after Major Surgery %A Tang, Victoria %A Finlayson, Emily %A John Boscardin %A Ashwin Kotwal %K major surgery %K psychosocial impairments %K Social strain %X Introduction: Psychosocial impairments in older surgical patients may predict postoperative functional recovery. We investigated the association of social strain, an under-studied and important social variable, with 1-year functional health in older adults after major surgery. Methods: With Health and Retirement Study-Medicare claims data, we identified N = 3868 participants, age ≥65 years, who underwent major surgery. Outcome included postoperative 1-year functional decline in activities of daily living (ADL) as compared with preoperative ADL function. Predictor social strain was determined by asking how often one’s spouse, children, family, or friends a) “criticize you?,” b) “make too many demands on you?,” c) “let you down,” or d) “get on your nerves?”; response of “a lot” to any classified strain from that specific relationship. Analysis included multivariable logistic regression adjusted for age, gender, race/ethnicity, education. Results: Mean age 76±5 years, 54% women, 8% Black, 5% Hispanic, 32% reported social strain from any relationship source (spouse: 14%, children: 8%, family: 7%, friends: 3%). Over 15% sustained decline within 2 years of operation. Individuals experiencing social strain from children had higher rates of 2-year functional decline (15% vs 8%, p = 0.007), those with social strain from any source had higher rates of 2-year functional decline (11% vs 5%, p = 0.001). After multivariable adjustment, social strain was significantly associated with 2-year functional decline (odds ratio [OR]=1.44 (1.02, 2.02), p value 0.04). Conclusion: Social strain was associated with 1-year ADL functional decline in older adults undergoing major surgery. Psychosocial vulnerability should be assessed preoperatively and intervention to help patients cope with social strain should be investigated in the surgical setting. %B Journal of the American College of Surgeons %V 235 %P S39 %G eng %N 5 %R 10.1097/01.XCS.0000895972.97246.3a %0 Journal Article %J Epigenetics %D 2022 %T The Socioeconomic Gradient in Epigenetic Ageing Clocks: Evidence from the Multi-Ethnic Study of Atherosclerosis and the Health and Retirement Study. %A Lauren L Schmitz %A Zhao, Wei %A Scott M Ratliff %A Goodwin, Julia %A Miao, Jiacheng %A Lu, Qiongshi %A Guo, Xiuqing %A Kent D Taylor %A Ding, Jingzhong %A Liu, Yongmei %A Morgan E. Levine %A Smith, Jennifer A %K DNA methylation age %K epigenetic clock %K polygenic score %K socioeconomic status %X

Epigenetic clocks have been widely used to predict disease risk in multiple tissues or cells. Their success as a measure of biological ageing has prompted research on the connection between epigenetic pathways of ageing and the socioeconomic gradient in health and mortality. However, studies examining social correlates of epigenetic ageing have yielded inconsistent results. We conducted a comprehensive, comparative analysis of associations between various dimensions of socioeconomic status (SES) (education, income, wealth, occupation, neighbourhood environment, and childhood SES) and eight epigenetic clocks in two well-powered US ageing studies: The Multi-Ethnic Study of Atherosclerosis (MESA) (n = 1,211) and the Health and Retirement Study (HRS) (n = 4,018). In both studies, we found robust associations between SES measures in adulthood and the GrimAge and DunedinPoAm clocks (Bonferroni-corrected -value < 0.01). In the HRS, significant associations with the Levine and Yang clocks were also evident. These associations were only partially mediated by smoking, alcohol consumption, and obesity, which suggests that differences in health behaviours alone cannot explain the SES gradient in epigenetic ageing in older adults. Further analyses revealed concurrent associations between polygenic risk for accelerated intrinsic epigenetic ageing, SES, and the Levine clock, indicating that genetic risk and social disadvantage may contribute additively to faster biological aging.

%B Epigenetics %V 17 %P 589-611 %G eng %N 6 %R 10.1080/15592294.2021.1939479 %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 %X

Socioeconomic 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 Neurology %D 2022 %T Socioeconomic Status, Biological Aging, and Memory in a Diverse National Sample of Older US Men and Women. %A Avila-Rieger, Justina %A Turney, Indira C %A Vonk, Jet M J %A Esie, Precious %A Seblova, Dominika %A Weir, Vanessa R %A Belsky, Daniel W %A Jennifer J Manly %K biological aging %K Cognition %K DNA Methylation %K Race/ethnicity %K sex/gender %K socio-economic status %X

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

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

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

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

%B Neurology %V 99 %P e2114-e2124 %G eng %N 19 %R 10.1212/WNL.0000000000201032 %0 Journal Article %J Journal of 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 %X

Prior 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 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 %X

OBJECTIVES: 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 The Journals of Gerontology, Series B %D 2022 %T Subjective Aging and Objectively Assessed Hearing Function: A Prospective Study of Older Adults. %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K hearing acuity %K self-perceptions of aging %K Subjective age %X

OBJECTIVES: Subjective aging is consistently related to a range of health-related outcomes, but little is known about its relationship with sensory functioning. The present prospective study tested whether subjective age and self-perceptions of aging (SPA) are associated with objective hearing function.

METHOD: Participants were 7,085 individuals aged 50 to 93 years (60% women, Mean= 65.15, SD= 8.71) from the Health and Retirement Study (HRS). Measures of subjective age, SPA, and information on demographic factors were obtained in 2008/2010. Objective hearing function was assessed eight years later in 2016/2018. Furthermore, potential mediating variables (c-reactive protein, body mass index, physical inactivity, and chronic conditions) were assessed in 2012/2014.

RESULTS: In regression analyses that accounted for demographic factors, older subjective age and negative SPA were associated with lower hearing acuity eight years later. In addition, 1 SD older subjective age and negative SPA were related to a 9% and 7% higher likelihood of hearing impairment. Mediation analyses revealed that physical inactivity and chronic conditions partially mediated subjective age and SPA associations with hearing acuity. There was little evidence that the link between subjective aging and hearing was moderated by hearing aids and partial support for a moderating role of age.

CONCLUSION: This study provides new evidence that subjective aging is prospectively related to hearing function. Individuals with older subjective age or negative SPA have unfavorable behavioral and clinical profiles that explain part of their lower hearing function. Individuals' experience with their aging process is a marker of risk for impaired hearing.

%B The Journals of Gerontology, Series B %V 77 %P 1637-1644 %G eng %N 9 %R 10.1093/geronb/gbac018 %0 Journal Article %J Journal of Alzheimer's Disease %D 2022 %T Subjective Cognitive Decline: Is a Resilient Personality Protective Against Progression to Objective Cognitive Impairment? Findings from Two Community-Based Cohort Studies. %A Aschwanden, Damaris %A Sutin, Angelina R %A Ledermann, Thomas %A Luchetti, Martina %A Stephan, Yannick %A Sesker, Amanda A %A Zhu, Xianghe %A Terracciano, Antonio %K Apolipoprotein E4 %K Cognitive Dysfunction %K Personality %K Personality Disorders %X

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

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

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

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

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

%B Journal of Alzheimer's Disease %V 89 %P 87-105 %G eng %N 1 %R 10.3233/JAD-220319 %0 Journal Article %J 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 %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 10.1093/aje/kwab281 %0 Journal Article %J Journal of the American Geriatrics Society %D 2022 %T Trends in advance care planning and end-of-life care among persons living with dementia requiring surrogate decision-making. %A Gotanda, Hiroshi %A Walling, Anne M %A David B. Reuben %A Lauzon, Marie %A Tsugawa, Yusuke %K Advance care planning %K Dementia %K End-of-life care %X

BACKGROUND: Previous studies have demonstrated positive impacts of advance care planning (ACP) on end-of-life (EOL) care. We sought to examine trends in ACP and EOL care intensity among persons living with dementia who required surrogate decision-making in their final days of life.

METHODS: We analyzed the participants of the Health and Retirement Study (HRS), a nationally representative longitudinal panel study of U.S. residents, with dementia 70 years and older who required surrogate decision-making in the final days of life and died between 2000 and 2014. Based on surrogate reports after the death of a participant, our study measured the completion of three specific types of patient-engaged ACP (written EOL care instructions, assignment of a durable power of attorney for healthcare, patient engagement in EOL care discussions) and four measures of EOL care in the final days of life (death in hospital, receipt of life-prolonging treatments, limiting or withholding certain treatments, and receipt of comfort-oriented care). All analyses accounted for the complex survey design of HRS.

RESULTS: Among 870 adults (weighted N = 2,812,380) with dementia who died in 2000-2014 and required surrogate decision-making at EOL, only 34.8% of patients participated in all three aspects of ACP, and there was not a significant increase in ACP completion between 2000 and 2014. The receipt of life-prolonging treatments in the final days of life has increased over time (adjusted change per year, 1.4 percentage points [pp]; 95% CI, 0.5 to 2.2 pp; P-for-trend = 0.002), while the percentage of death in hospital, limiting or withholding certain treatments, or comfort-oriented care did not change.

CONCLUSIONS: Our findings suggest that the rates of ACP completion have not increased over time despite its potential benefits and life-prolonging treatments are still common among PLWD who require surrogate decision-making, a population who might benefit greatly from early ACP.

%B Journal of the American Geriatrics Society %V 70 %P 1394-1404 %G eng %N 5 %R 10.1111/jgs.17680 %0 Journal Article %J The Journals of Gerontology: Series B %D 2022 %T Trends in the Use of Residential Settings Among Older Adults. %A Toth, Matt %A Palmer, Lauren %A Lawren E. Bercaw %A Voltmer, Helena %A Sarita Karon %K Activities of Daily Living %K Aged %K Comorbidity %K Cross-Sectional Studies %K Dementia %K Female %K Health Status Disparities %K Health Transition %K Homes for the Aged %K Humans %K Independent Living %K Male %K Medicare %K Nursing homes %K United States %X

OBJECTIVES: As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time.

METHODS: A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRFs), and nursing facilities using 3 data sources: the Medicare Current Beneficiary Survey (MCBS), 2008 and 2013; the Health and Retirement Study (HRS), 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated the age-standardized prevalence of older adults by setting, functional limitations, and comorbidities and tested for health characteristics changes relative to the baseline year (2002).

RESULTS: The proportion of older adults in traditional housing increased over time, relative to baseline (p < .05), while the proportion of older adults in CBRFs was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < .05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < .05).

DISCUSSION: The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on noninstitutional LTSS.

%B The Journals of Gerontology: Series B %V 77 %P 424-428 %G eng %N 2 %R 10.1093/geronb/gbab092 %0 Journal Article %J PLoS One %D 2022 %T Using dynamic microsimulation to project cognitive function in the elderly population. %A Wei, Yifan %A Heun-Johnson, Hanke %A Tysinger, Bryan %K Alzheimer disease %K Cognition %K Cognitive Dysfunction %K Neuropsychological tests %K ROC Curve %X

BACKGROUND: A long-term projection model based on nationally representative data and tracking disease progression across Alzheimer's disease continuum is important for economics evaluation of Alzheimer's disease and other dementias (ADOD) therapy.

METHODS: The Health and Retirement Study (HRS) includes an adapted version of the Telephone Interview for Cognitive Status (TICS27) to evaluate respondents' cognitive function. We developed an ordered probit transition model to predict future TICS27 score. This transition model is utilized in the Future Elderly Model (FEM), a dynamic microsimulation model of health and health-related economic outcomes for the US population. We validated the FEM TICS27 model using a five-fold cross validation approach, by comparing 10-year (2006-2016) simulated outcomes against observed HRS data.

RESULTS: In aggregate, the distribution of TICS27 scores after ten years of FEM simulation matches the HRS. FEM's assignment of cognitive/mortality status also matches those observed in HRS on the population level. At the individual level, the area under the receiver operating characteristic (AUROC) curve is 0.904 for prediction of dementia or dead with dementia in 10 years, the AUROC for predicting significant cognitive decline in two years for mild cognitive impairment patients is 0.722.

CONCLUSIONS: The FEM TICS27 model demonstrates its predictive accuracy for both two- and ten-year cognitive outcomes. Our cognition projection model is unique in its validation with an unbiased approach, resulting in a high-quality platform for assessing the burden of cognitive decline and translating the benefit of innovative therapies into long-term value to society.

%B PLoS One %V 17 %P e0274417 %G eng %N 9 %R 10.1371/journal.pone.0274417 %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 %X

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

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

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

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

%B The Journals of Gerontology, Series A %V 77 %P 1261-1271 %G eng %N 6 %R 10.1093/gerona/glab373 %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 Web Page %D 2021 %T 3 Retirement Myths, Debunked: Social Security, The Stock Market And Savings %A Tepper, Taylor %K home appreciation %K retirement risks %K stock market returns %X Retirement should inspire thoughts of mixed drinks on the beach and long afternoons with the grandkids. But for many people, just mentioning the word spurs anxiety. Younger Americans are waiting too long to put money away, middle-aged workers rarely make up for lost time and people approaching retirement hope to hold onto their jobs long enough to save just a few dollars more. Most people know they should be doing more to save for retirement, yet too few of us are doing the right thing. As a result, about half of Americans are in store for a lower standard of living and less financial freedom once they quit working and rely on a fixed income. Part of this looming retirement crisis is driven by a host of common myths and misconceptions about retirement that have seeped into our collective consciousness. Correcting them may help you feel more confident in your ability to prepare for your golden years—and banish those sinking feelings of anxiety. %B Advisor %I Forbes %G eng %U https://www.forbes.com/advisor/retirement/retirement-myths-debunked/ %0 Journal Article %J Statistics in Medicine %D 2021 %T Accounting for selection bias due to death in estimating the effect of wealth shock on cognition for the Health and Retirement Study. %A Yaoyuan V. Tan %A Carol A C Flannagan %A Lindsay R Pool %A Michael R. Elliott %K Bayesian additive regression trees %K Causal inference %K Missing data %X

The Health and Retirement Study (HRS) is a longitudinal study of U.S. adults enrolled at age 50 and older. We were interested in investigating the effect of a sudden large decline in wealth on the cognitive ability of subjects measured using a dataset provided composite score. However, our analysis was complicated by the lack of randomization, time-dependent confounding, and a substantial fraction of the sample and population will die during follow-up leading to some of our outcomes being censored. The common method to handle this type of problem is marginal structural models (MSM). Although MSM produces valid estimates, this may not be the most appropriate method to reflect a useful real-world situation because MSM upweights subjects who are more likely to die to obtain a hypothetical population that over time, resembles that would have been obtained in the absence of death. A more refined and practical framework, principal stratification (PS), would be to restrict analysis to the strata of the population that would survive regardless of negative wealth shock experience. In this work, we propose a new algorithm for the estimation of the treatment effect under PS by imputing the counterfactual survival status and outcomes. Simulation studies suggest that our algorithm works well in various scenarios. We found no evidence that a negative wealth shock experience would affect the cognitive score of HRS subjects.

%B Statistics in Medicine %V 40 %P 2613-2625 %G eng %N 11 %R 10.1002/sim.8921 %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 %X

OBJECTIVES: 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 Aging Clinical and Experimental Research %D 2021 %T Association between vision impairment and cognitive decline in older adults with stroke: Health and Retirement Study. %A Hreha, Kimberly P %A Brian Downer %A Joshua R Ehrlich %A Bret Howrey %A Taglialatela, Guilio %K Aging %K cognitive impairment %K Stroke %K vision impairment %X

Stroke survivors may experience multiple residual symptoms post-stroke, including vision impairment (VI) and cognitive decline. Prior studies have shown that VI is associated with cognitive decline, but have not evaluated the contribution of VI to post-stroke cognitive changes. We used data from four waves (2010-2016) of the Health and Retirement Study to investigate the cognitive trajectories of stroke survivors with and without VI. Vision (excellent-very good[ref], good, fair-poor) and stroke diagnosis were self-reported. Cognition was defined using the Telephone Interview for Cognitive Status. Regression was used to model the association between vision and change in cognitive function, adjusting for confounders. The final sample included 1,439 stroke survivors and the average follow-up time was 4.1 years. Fair-poor overall (B = -1.30, p < 0.01), near (B = -1.53, p < 0.001), and distance (B = -1.27, p < 0.001) vision were associated with significantly lower baseline cognitive function. VI was not associated with the rate of cognitive decline. Future research should determine whether specific types of VI potentiate the risk of cognitive impairment and dementia in stroke survivors.

%B Aging Clinical and Experimental Research %V 33 %P 2605-2610 %G eng %N 9 %R 10.1007/s40520-020-01776-w %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 Journal of Applied Gerontology %D 2021 %T Associations Between Alzheimer’s Disease and Related Dementias and Depressive Symptoms of Partner Caregivers %A Harris, Melissa L. %A Marita G. Titler %A Geoffrey J Hoffman %K Alzheimer’s disease %K Caregiving %K Dementia %K depression %K quantitative methods %X Family members - mainly spouses and partners - are the primary caregivers for individuals with Alzheimer's disease and related dementias (ADRDs), chronic progressive illnesses requiring increasing levels of care. We performed a retrospective observational analysis comparing depressive symptoms of 16,650 older individuals with partners without ADRDs, and those recently (within 2 years) or less recently diagnosed (≥2 years prior), controlling for lagged sociodemographic and health characteristics. The mean number of reported depressive symptoms was 1.2 (SD = 1.8). Compared with respondents with partners with no ADRD, having a partner with any ADRD was associated with a 0.35 increase (95% confidence interval [CI] = [0.30, 0.41]), or 30% increase, in depressive symptoms. A less recent partner diagnosis was associated with a 33% increase, while a recent diagnosis was associated with a 27% increase. Clinically meaningful and longitudinally worsening depressive symptoms amplify the need to prioritize partner health and family-centered care following an ADRD diagnosis. %B Journal of Applied Gerontology %V 40 %P 772-780 %@ 0733-4648 %G eng %N 7 %R 10.1177/0733464820952252 %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 %X

BACKGROUND: 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 Journal of Gerontology: Series B %D 2021 %T Changes in Health Care Access and Utilization for Low-SES Adults Age 51-64 after Medicaid Expansion. %A Tipirneni, Renuka %A Helen G Levy %A Kenneth M. Langa %A Ryan J McCammon %A Zivin, Kara %A Jamie E Luster %A Karmakar, Monita %A John Z. Ayanian %K Affordable Care Act %K Hospitalization %K Medicaid %K Retirement %X

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

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

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

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

%B The Journal of Gerontology: Series B %V 76 %P 1218-1230 %G eng %N 6 %R 10.1093/geronb/gbaa123 %0 Journal Article %J Alzheimer's & Dementia %D 2021 %T Childhood and adulthood traumatic events differentially associate with cognitive aging among Black and White elders in the Health and Retirement Study %A Zuelsdorff, Megan %A Sonnega, Amanda %A Byrd, DeAnnah R %A Norton, Derek %A Deng, Xinyue %A Turner, Robert %K Black adults %K childhood trauma %K Cognition %K Racial Disparities %X Background Modifiable sociocontextual factors powerfully shape ADRD risk, and demonstrably contribute to well-established racial disparities in cognitive aging. Stressful experiences occurring across the lifespan associate with brain aging and poor cognitive outcomes. However, the importance of timing and even type of stressor remains understudied. We examined relationships between childhood and adulthood traumatic events and cognition among non-Hispanic Black and White older adults in the Health and Retirement Study (HRS). Method The sample included non-demented adults (N=5,725) aged 65+ with lifetime stress data and complete cognitive testing at the 2006/08, 2010/12, and/or 2014/16 waves. Trauma measures included childhood (0-11), and adulthood (0-7) traumatic event counts. Outcomes included global cognition, immediate recall, and delayed recall (Telephone Interview for Cognitive Status). Each exposure-outcome pair was investigated in separate linear mixed effect models including baseline trauma count, a quadratic trauma term to test for non-linear relationships, and subject-specific random intercept. Omnibus Likelihood Ratio Tests (LRT) were conducted to determine if number of traumatic events associated overall with each cognitive outcome. The sample was stratified by race before analysis. Result Black participants (N=651) were younger and reported less formal education than White participants (N=5,074). Number of traumatic events in adulthood did not vary by race, but Black participants reported slightly fewer childhood traumas (Table 1) than Whites. Among Whites, childhood traumas associated with poorer global cognition scores but traumas in adulthood showed very modest positive associations across cognitive domains. Among Black participants, no association between childhood trauma and later-life cognition was observed. A significant non-linear term for traumatic events indicated cross-domain cognitive detriment associated with high exposure to adulthood trauma (Table 2; Figure 1). Conclusion Average exposure to traumas (eg., physical abuse, life-threatening illness) was low, and in both Black and White older adults, some limited exposure to traumatic events during adulthood predicted modest cognitive benefit. Black HRS participants reporting many traumatic events during adulthood, but not childhood, showed dysfunction in global cognition and recall. Findings highlight importance of adverse events across the full life course, potential threshold effects and co-occuring chronic stress conditions, and a need to identify resources that buffer impacts of trauma on biology and personal environment. %B Alzheimer's & Dementia %V 17 %P e056419 %@ 1552-5260 %G eng %N S10 %R 10.1002/alz.056419 %0 Journal Article %J Health Psychology %D 2021 %T Chronic condition discordance and physical activity among midlife and older couples. %A Courtney A Polenick %A Kira S. Birditt %A Turkelson, Angela %A Helen C Kales %K Chronic conditions %K Couples %K Physical activity %X

OBJECTIVE: Chronic conditions in middle and later life are associated with lower physical activity. Yet little is known about chronic condition discordance (i.e., the extent to which conditions have nonoverlapping self-management requirements) within older individuals and couples and its implications for physical activity. We determined how the degrees of chronic condition discordance at the individual level and the couple level (i.e., between spouses) were linked to moderate physical activity across an 8-year period.

METHOD: The U.S. sample included 1,621 couples from five waves of the Health and Retirement Study (2006-2014). Dyadic growth curve models estimated how individual-level and couple-level chronic condition discordance were linked to initial levels of and rates of change in moderate activity. Models controlled for age, minority status, education, and own and partner reports of baseline negative marital quality, time-varying depressive symptoms, and time-varying number of chronic conditions.

RESULTS: A considerable proportion of wives (25.4%) and husbands (18.9%) reported moderate activity less than once a week. When individuals (wives: β = -0.10; husbands: β = -0.09) or their spouses (wives: β = -0.04; husbands: β = -0.05) had greater individual-level chronic condition discordance, lower initial moderate activity was reported. When husbands had greater individual-level discordance, both wives (β = -0.16) and husbands (β = -0.19) had a faster rate of decline in moderate activity over time. Couple-level chronic condition discordance was not significantly linked to moderate activity.

CONCLUSIONS: These findings suggest the importance of promoting physical activity among individuals and couples managing complex chronic conditions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

%B Health Psychology %V 40 %P 11-20 %G eng %N 1 %R 10.1037/hea0001040 %0 Report %D 2021 %T Cognitive abilities, self-efficacy, and financial behavior %A Tang, Ning %K Cognition %K financial behavior %K Self-efficacy %B Trends and Issues %I TIAA Institute %G eng %U https://www.tiaainstitute.org/sites/default/files/presentations/2021-04/TIAA%20Institute_Cognitive%20abilities_TI_Tang_April%202021_0.pdf %0 Journal Article %J Journal of Economic Psychology %D 2021 %T Cognitive abilities, self-efficacy, and financial behavior %A Tang, N. %K Cognition %K Personal finance %K Self-efficacy %X This paper investigates the effect of cognitive abilities on financial behavior among older adults. Using the U.S. Health and Retirement Study, I find that cognitive abilities significantly affect financial behavior through two channels: ability and self-efficacy. People with higher cognition scores achieve better financial outcomes. This positive association is especially strong in tasks having high demand of cognitive abilities, which confirms the ability channel of the cognitive ability effect. In addition, there is evidence for the self-efficacy channel as a secondary source of cognitive influence. Lower cognitive abilities decrease people's sense of self-efficacy, which, in turn, significantly decreases financial management efficiency. The findings have important policy implications, specifically that more effort is needed to assist the growing older population through the cognitive aging process and that noncognitive skills, as a secondary source of influence, also warrant attention. © 2021 The Author %B Journal of Economic Psychology %V 87 %P 102447 %G eng %R 10.1016/j.joep.2021.102447 %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 Journal Article %J BMC Public Health %D 2021 %T Comparisons of disease cluster patterns, prevalence and health factors in the USA, Canada, England and Ireland. %A Hernandez, Belinda %A Voll, Stacey %A Nathan A Lewis %A McCrory, Cathal %A White, Arthur %A Stirland, Lucy %A Kenny, Rose Anne %A Reilly, Richard %A Hutton, Craig P %A Griffith, Lauren E %A Kirkland, Susan A %A Graciela Muñiz Terrera %A Scott M Hofer %K disease clusters %K ELSA %K Latent Class Analysis %K multimorbidity %K Sister studies %K TILDA %X

BACKGROUND: Identification of those who are most at risk of developing specific patterns of disease across different populations is required for directing public health policy. Here, we contrast prevalence and patterns of cross-national disease incidence, co-occurrence and related risk factors across population samples from the U.S., Canada, England and Ireland.

METHODS: Participants (n = 62,111) were drawn from the US Health and Retirement Study (n = 10,858); the Canadian Longitudinal Study on Ageing (n = 36,647); the English Longitudinal Study of Ageing (n = 7938) and The Irish Longitudinal Study on Ageing (n = 6668). Self-reported lifetime prevalence of 10 medical conditions, predominant clusters of multimorbidity and their specific risk factors were compared across countries using latent class analysis.

RESULTS: The U.S. had significantly higher prevalence of multimorbid disease patterns and nearly all diseases when compared to the three other countries, even after adjusting for age, sex, BMI, income, employment status, education, alcohol consumption and smoking history. For the U.S. the most at-risk group were younger on average compared to Canada, England and Ireland. Socioeconomic gradients for specific disease combinations were more pronounced for the U.S., Canada and England than they were for Ireland. The rates of obesity trends over the last 50 years align with the prevalence of eight of the 10 diseases examined. While patterns of disease clusters and the risk factors related to each of the disease clusters were similar, the probabilities of the diseases within each cluster differed across countries.

CONCLUSIONS: This information can be used to better understand the complex nature of multimorbidity and identify appropriate prevention and management strategies for treating multimorbidity across countries.

%B BMC Public Health %V 21 %P 1674 %G eng %N 1 %R 10.1186/s12889-021-11706-8 %0 Journal Article %J Journal of Traumatic Stress %D 2021 %T Compounding Stress: Childhood Adversity as a Risk Factor for Adulthood Trauma Exposure in the Health and Retirement Study. %A David Bürgin %A Cyril Boonmann %A Schmeck, Klaus %A Marc Schmid %A Paige Tripp %A Nishimi, Kristen %A Aoife O'Donovan %K Adulthood %K Childhood adversity %K Trauma %X

Childhood adversity (CA) and adulthood traumatic experiences (ATEs) are common and unequally distributed in the general population. Early stressors may beget later stressors and alter life-course trajectories of stressor exposure. Gender differences exist regarding the risk of specific stressors. However, few studies have examined the associations between specific types of CA and ATEs. Using a large-scale sample of older adults, we aimed to (a) determine if specific or cumulative CA increased the risk for specific or cumulative ATEs and (b) examine whether these associations were moderated by gender. In a sample from the U.S. Health and Retirement Study (N = 15,717; M = 67.57 years, SD = 10.54), cross-sectional Poisson and logistic regression models were fitted to assess the specific and cumulative associations between CA and ATEs. Overall, cumulative CA was associated with a larger risk ratio of ATEs, adjusted for covariates: aRRRs = 1.28, 1.63, and 1.97 for 1, 2, and 3-4 adverse events in childhood, respectively. Cumulative CA was particularly strongly associated with adulthood physical attacks, aOR = 5.66, and having a substance-abusing spouse or child, aOR = 4.00. Childhood physical abuse was the strongest independent risk factor for cumulative ATEs, aRRR = 1.49, and most strongly associated with adulthood physical attacks, aOR = 3.41. Gender moderated the association between cumulative CA and cumulative ATEs, with slightly stronger associations between cumulative CA and ATEs for women than men. Given that CA and ATEs perpetuate health disparities worldwide, reducing their incidence and effects should be major priorities for public health.

%B Journal of Traumatic Stress %V 34 %P 124-136 %G eng %N 1 %R 10.1002/jts.22617 %0 Report %D 2021 %T COVID-19 Has Had Devastating Economic Impacts on Older Black and Latinx Adults %A Pendergrast, Claire B %A Amy D Thierry %A Garcia, Marc A %K COVID-19 %K economic impact %K race disparity %X Key findings: Compared to older White and Black adults, a greater proportion of older U.S.-born and foreign-born Latinx adults reported that their income decreased during the pandemic. • A larger portion of older Black adults reported increased household spending compared to other racial/ethnic and groups. • Latinx adults were disproportionately affected by economic hardships, with 56% of foreignborn Latinx adults and 49% of U.S.-born Latinx adults reporting at least one economic hardship. • Foreign-born Latinx adults were more likely to report missing a rent or mortgage payment, not being able to pay medical bills, and lacking money for food than other racial/ethnic groups. %I Center for Aging and Policy Studies %G eng %U https://surface.syr.edu/cgi/viewcontent.cgi?article=1162&context=lerner %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 %X

Prior 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 Innovation in Aging %D 2021 %T Current and Future Directions in Minority Aging: Embracing Interdisciplinary Models %A Heather R. Farmer %A Amy D Thierry %A Keith E Whitfield %K interdisciplinary models %K Minority aging %K racial/ethnic disparities %X Racial/ethnic disparities in health among older adults are well-documented. More research is needed to clarify the complex and multifactorial mechanisms underlying these associations. This symposium will feature research that employs innovative theoretical and methodological approaches to understand the biopsychosocial mechanisms that underlie racial/ethnic disparities in older adults’ health and determine sources of within-group heterogeneity in minority aging. Dr. Forrester will integrate stress biology and intersectionality to demonstrate the importance of stress and resilience (e.g., John Henryism) with biological aging within Black adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Dr. Brown Hughes will present innovative research using data from the African American United Memory and Aging Project (AA-UMAP) on the importance of Alzheimer’s disease-specific knowledge and perceptions among Black older adults. Dr. Gamaldo will employ a within-race approach to understand how knowledge and perceptions of Alzheimer’s disease and related dementias (ADRD) shape cognitive performance among Black older adults in the AA-UMAP study. Dr. Mitchell will use Health and Retirement Study data to explore the role of midlife stress exposure in accounting for racial disparities in trajectories of cognitive functioning. Drs. Thierry and Farmer will use HRS data to examine how psychosocial resilience (e.g., mastery) affects the relationship between perceived neighborhood conditions (e.g., disorder) and cognition among Black older adults. This work highlights the importance of applying an interdisciplinary lens to move the study of minority aging forward and ultimately, to reduce the unnecessary burden of morbidity and mortality among minoritized groups. %B Innovation in Aging %V 5 %P 98 %G eng %N Suppl _1 %R https://doi.org/10.1093/geroni/igab046.368 %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 %X

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

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

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

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

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

%B International Journal of Epidemiology %V 50 %P 880-892 %G eng %N 3 %R 10.1093/ije/dyaa236 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Discordant Chronic Conditions and Depressive Symptoms: Longitudinal Associations Among Middle-Aged and Older Couples %A Courtney A Polenick %A Kira S. Birditt %A Turkelson, Angela %A Bugajski, Benjamin C %A Helen C Kales %K Chronic conditions %K Couples %K Depressive symptoms %K Longitudinal analysis %X Individuals often manage chronic conditions in middle and later life that may diminish well-being. Little is known, however, about discordant conditions (i.e., two or more conditions with competing self-management requirements) among older couples and their links to depressive symptoms. We considered discordant conditions at both the individual level and the couple level (i.e., between spouses), along with their long-term implications for depressive symptoms.The U.S. sample included 1,116 middle-aged and older couples drawn from five waves (2006–2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models evaluated whether individual-level and couple-level discordant chronic health conditions were concurrently linked to depressive symptoms, and whether these associations became stronger over time. Models controlled for age, minority status, education, prior wave depressive symptoms, and each partner’s baseline report of negative marital quality and number of chronic conditions in each wave.Wives and husbands reported significantly greater depressive symptoms when they had individual-level discordant conditions about 2 years after baseline, and these links intensified over time. Beyond this association, husbands had significantly greater depressive symptoms when there were couple-level discordant conditions.Individual-level and couple-level discordant conditions may have lasting implications for depressive symptoms during midlife and older adulthood. %B The Journals of Gerontology: Series B %V 76 %P 451-460 %G eng %N 3 %R 10.1093/geronb/gbz137 %0 Journal Article %J The American Journal of Human Genetics %D 2021 %T Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry. %A Graff, Mariaelisa %A Justice, Anne E %A Young, Kristin L %A Marouli, Eirini %A Zhang, Xinruo %A Fine, Rebecca S %A Lim, Elise %A Buchanan, Victoria %A Rand, Kristin %A Feitosa, Mary F %A Wojczynski, Mary K %A Yanek, Lisa R %A Shao, Yaming %A Rohde, Rebecca %A Adeyemo, Adebowale A %A Aldrich, Melinda C %A Matthew A. Allison %A Ambrosone, Christine B %A Ambs, Stefan %A Amos, Christopher %A Donna K Arnett %A Atwood, Larry %A Bandera, Elisa V %A Traci M Bartz %A Becker, Diane M %A Berndt, Sonja I %A Bernstein, Leslie %A Bielak, Lawrence F %A Blot, William J %A Erwin P Bottinger %A Bowden, Donald W %A Bradfield, Jonathan P %A Brody, Jennifer A %A Broeckel, Ulrich %A Burke, Gregory %A Brian E Cade %A Cai, Qiuyin %A Caporaso, Neil %A Carlson, Chris %A John Carpten %A Casey, Graham %A Chanock, Stephen J %A Chen, Guanjie %A Chen, Minhui %A Chen, Yii-Der I %A Chen, Wei-Min %A Chesi, Alessandra %A Chiang, Charleston W K %A Chu, Lisa %A Coetzee, Gerry A %A Conti, David V %A Cooper, Richard S %A Cushman, Mary %A Ellen W Demerath %A Deming, Sandra L %A Dimitrov, Latchezar %A Ding, Jingzhong %A Diver, W Ryan %A Duan, Qing %A Michele K Evans %A Falusi, Adeyinka G %A Jessica Faul %A Myriam Fornage %A Caroline S Fox %A Freedman, Barry I %A Garcia, Melissa %A Gillanders, Elizabeth M %A Phyllis J Goodman %A Gottesman, Omri %A Grant, Struan F A %A Guo, Xiuqing %A Hakonarson, Hakon %A Haritunians, Talin %A Tamara B Harris %A Harris, Curtis C %A Henderson, Brian E %A Hennis, Anselm %A Dena G Hernandez %A Hirschhorn, Joel N %A McNeill, Lorna Haughton %A Howard, Timothy D %A Howard, Barbara %A Hsing, Ann W %A Hsu, Yu-Han H %A Hu, Jennifer J %A Huff, Chad D %A Huo, Dezheng %A Ingles, Sue A %A Irvin, Marguerite R %A John, Esther M %A Johnson, Karen C %A Jordan, Joanne M %A Kabagambe, Edmond K %A Kang, Sun J %A Sharon L R Kardia %A Keating, Brendan J %A Rick A Kittles %A Eric A Klein %A Kolb, Suzanne %A Kolonel, Laurence N %A Charles Kooperberg %A Kuller, Lewis %A Kutlar, Abdullah %A Leslie A Lange %A Langefeld, Carl D %A Loic Le Marchand %A Leonard, Hampton %A Lettre, Guillaume %A Levin, Albert M %A Li, Yun %A Li, Jin %A Liu, Yongmei %A Liu, Youfang %A Liu, Simin %A Kurt Lohman %A Lotay, Vaneet %A Lu, Yingchang %A Maixner, William %A JoAnn E Manson %A McKnight, Barbara %A Meng, Yan %A Monda, Keri L %A Monroe, Kris %A Moore, Jason H %A Thomas H Mosley %A Mudgal, Poorva %A Murphy, Adam B %A Nadukuru, Rajiv %A Michael A Nalls %A Nathanson, Katherine L %A Nayak, Uma %A N'Diaye, Amidou %A Nemesure, Barbara %A Neslund-Dudas, Christine %A Neuhouser, Marian L %A Nyante, Sarah %A Ochs-Balcom, Heather %A Ogundiran, Temidayo O %A Ogunniyi, Adesola %A Ojengbede, Oladosu %A Okut, Hayrettin %A Olopade, Olufunmilayo I %A Olshan, Andrew %A Padhukasahasram, Badri %A Palmer, Julie %A Palmer, Cameron D %A Palmer, Nicholette D %A George J Papanicolaou %A Patel, Sanjay R %A Pettaway, Curtis A %A Peyser, Patricia A %A Press, Michael F %A Rao, D C %A Rasmussen-Torvik, Laura J %A Redline, Susan %A Reiner, Alex P %A Rhie, Suhn K %A Rodriguez-Gil, Jorge L %A Charles N Rotimi %A Rotter, Jerome I %A Ruiz-Narvaez, Edward A %A Rybicki, Benjamin A %A Babatunde Salako %A Sale, Michele M %A Sanderson, Maureen %A Eric E Schadt %A Schreiner, Pamela J %A Schurmann, Claudia %A Schwartz, Ann G %A Daniel Shriner %A Signorello, Lisa B %A Andrew B Singleton %A David S Siscovick %A Smith, Jennifer A %A Smith, Shad %A Elizabeth K Speliotes %A Spitz, Margaret %A Stanford, Janet L %A Stevens, Victoria L %A Stram, Alex %A Strom, Sara S %A Sucheston, Lara %A Yan V Sun %A Tajuddin, Salman M %A Taylor, Herman %A Taylor, Kira %A Bamidele O Tayo %A Michael J Thun %A Tucker, Margaret A %A Vaidya, Dhananjay %A Van Den Berg, David J %A Vedantam, Sailaja %A Vitolins, Mara %A Wang, Zhaoming %A Erin B Ware %A Wassertheil-Smoller, Sylvia %A David R Weir %A Wiencke, John K %A Williams, Scott M %A L Keoki Williams %A Wilson, James G %A Witte, John S %A Wrensch, Margaret %A Wu, Xifeng %A Yao, Jie %A Zakai, Neil %A Zanetti, Krista %A Zemel, Babette S %A Zhao, Wei %A Jing Hua Zhao %A Zheng, Wei %A Zhi, Degui %A Zhou, Jie %A Zhu, Xiaofeng %A Ziegler, Regina G %A Zmuda, Joe %A Alan B Zonderman %A Psaty, Bruce M %A Ingrid B Borecki %A Cupples, L Adrienne %A Liu, Ching-Ti %A Christopher A Haiman %A Ruth J F Loos %A Ng, Maggie C Y %A Kari E North %K Africa %K African Americans %K Blacks %K Body Height %K Europe %K Female %K Genome-Wide Association Study %K Humans %K Male %K Polymorphism, Single Nucleotide %X

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

%B The American Journal of Human Genetics %V 108 %P 564-582 %G eng %N 4 %R 10.1016/j.ajhg.2021.02.011 %0 Journal Article %J European Journal of Ageing %D 2021 %T Education, wealth, and duration of life expected in various degrees of frailty %A Zachary Zimmer %A Saito, Yasuhiko %A Theou, Olga %A Haviva, Clove %A Rockwood, Kenneth %K Aging %K Frailty %K health %K Multistate life tables %K socioeconomic status %K Transition probability %X Multistate life tables are used to estimate life expected in three frailty states: frailty free, mild/moderate frailty, severe frailty. Estimates are provided for the combination of education and wealth by age, stratified by sex. Data consider 17,115 cases from the Health and Retirement Study, 2000–2014. Frailty is measured using a 59 item frailty index based on deficit accumulation. Estimates are derived using stochastic population analysis for complex events. Population-based and status-based results are reported. Findings confirm a hypothesis that the combination of higher education and wealth results in longer lives in more favorable degrees of frailty. Also, as hypothesized, wealth generally affords a greater advantage than does education among those with severe frailty at baseline. For instance, high wealth provides a 70-year-old woman with severe frailty at baseline 0.70 more total years and 0.81 more frailty free years then her counterpart with low wealth, compared to gains of 0.39 and 0.54, respectively, for those with high education. Unexpectedly, wealth also has a greater role among those frailty free at baseline. A 70-year-old woman frailty free at baseline with high wealth lives 3.19 more net years and 4.13 more years frailty free than her counterpart with low wealth, while the same comparison for high versus low education indicates advantages of 2.00 total and 1.96 frailty free years. Relative change ratios also indicate more robust results for wealth versus education. In sum, there is evidence that inequality in duration of life in degrees of frailty is socially patterned. %B European Journal of Ageing %V 18 %P 393-404 %@ 1613-9380 %G eng %N 3 %R 10.1007/s10433-020-00587-2 %0 Journal Article %J Health Economics %D 2021 %T The effects of sudden health reductions on labor market outcomes: Evidence from incidence of stroke. %A Tanaka, Atsuko %K Earnings %K effect heterogeneity %K health shock %K hours worked %K labor market effects %K Labor Supply %K return to work %K Stroke %X

While increasing attention is given to how health reductions affect workers, estimating its their effects is usually challenging. This paper aims to identify the causal effect of health deterioration on labor market outcomes by exploiting the incidence of stroke. Stroke, which often reduces health suddenly and unexpectedly, allows us to exploit the within-person random variation of the timing and isolate the effects of health reduction. By applying the fixed-effects method to a sample of stroke survivors in the University of Michigan Health and Retirement Study data, I find that stroke immediately halves the employment probability as well as hours and weeks worked 1 year after the occurrence and its effects persist for at least 3 years, while earnings reduction is relatively moderate and gradual. I also find the negative effects of stroke are larger among men with severe stroke and women with longer pre-stroke job tenure, while the effects are mitigated for younger women. These results make a stark contrast with the studies on other health events such as cancer diagnosis, which generally find much smaller effects and significant heterogeneity by education and occupation. This analysis shows that the labor market effects largely differ by types of diseases and calls for disease-specific studies in order to understand the social gradient in health and how workers adjust to work limitations.

%B Health Economics %V 30 %P 1480-1497 %G eng %N 6 %R 10.1002/hec.4259 %0 Journal Article %J Current Alzheimer Research %D 2021 %T Effects of the Co-occurrence of Diabetes Mellitus and Tooth Loss on Cognitive Function. %A Luo, Huabin %A Tan, Chenxin %A Adhikari, Samrachana %A Brenda L Plassman %A Kamer, Angela R %A Frank A Sloan %A Schwartz, Mark D %A Qi, Xiang %A Bei Wu %K cognitive function %K Dementia %K Diabetes %K effects of co-occurrence %K Population %K Tooth Loss %X

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

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

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

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

%B Current Alzheimer Research %V 18 %P 1023-1031 %G eng %N 13 %R 10.2174/1567205019666211223093057 %0 Journal Article %J BMJ Open %D 2021 %T Epidemiology of undiagnosed depression in people with diabetes mellitus: a comparative analysis of Ireland, England and the USA. %A McGrath, Niamh %A O Neill, Kate %A McHugh, Sheena M %A Toomey, Elaine %A Kearney, Patricia M %K depression %K Diabetes %K Epidemiology %X

OBJECTIVES: Improving detection of depression in people with diabetes is recommended. However, little is known about how different health systems compare in depression detection. We estimated and compared the (1) prevalence of depression detection in people with and without diabetes, and (2) association between diabetes and undiagnosed depression across three health systems.

DESIGN: Cross-sectional analysis of three nationally representative studies: The Irish Longitudinal Study on Ageing, the English Longitudinal Study on Ageing and the Health and Retirement Study.

SETTING: Community-dwelling adults in Ireland, England and the USA.

PARTICIPANTS: Adults aged ≥50 years.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was depression diagnosis. The secondary outcome was any depression. Any depression was defined by the presence of self-reported doctor-diagnosed depression or current depression symptoms on the Centre for Epidemiological Studies-Depression scale. Depression diagnosis was categorised as: undiagnosed, symptomatic and diagnosed, and asymptomatic and diagnosed. We estimated age-standardised prevalence of depression diagnosis by country and diabetes status. Anyone who self-reported having ever received a doctor diagnosis of diabetes was classified as having diabetes. Among respondents with depression, we estimated the association between diabetes and undiagnosed depression by country using multivariable logistic regression.

RESULTS: The prevalence of depression (diagnosed and undiagnosed) was higher in people with diabetes in each country with absolute rates varying by country; undiagnosed prevalence (Ireland: diabetes 10.1% (95% CI 7.5% to 12.8%) vs no diabetes 7.5% (95% CI 6.8% to 8.2%), England: diabetes 19.3% (95% CI 16.5% to 22.2%) vs no diabetes 11.8% (95% CI 11.0% to 12.6%), USA: diabetes 7.4% (95% CI 6.4% to 8.4%) vs no diabetes 6.1% (95% CI 5.7% to 6.6%)). In the fully adjusted model, there was no clear pattern of association between diabetes status and undiagnosed depression; Ireland: OR=0.82 (95% CI 0.5 to 1.3), England: OR=1.47 (95% CI 1.0 to 2.1), USA: OR=0.80 (95% CI 0.7 to 1.0).

CONCLUSIONS: Although undiagnosed depression was more prevalent among people with diabetes, the relationship between diabetes and undiagnosed depression differed by country. Targeted efforts are needed to improve depression detection among community-dwelling older adults, particularly those with diabetes.

%B BMJ Open %V 11 %P e049155 %G eng %N 10 %R 10.1136/bmjopen-2021-049155 %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 Annals of Epidemiology %D 2021 %T Estimating the effects of Mexico to U.S. migration on elevated depressive symptoms: evidence from pooled cross-national cohorts. %A Audrey R Murchland %A Adina Zeki Al Hazzouri %A Zhang, Lanyu %A Elfassy, Tali %A Grasset, Leslie %A Riley, Alicia %A Wong, Rebecca %A Mary Haan %A Richard N Jones %A Jacqueline M Torres %A M. Maria Glymour %K depression %K Immigration %K Mental Health %K MHAS %K Selection %X

BACKGROUND: Migrating from Mexico to the U.S. is a major, stressful life event with potentially profound influences on mental health. However, estimating the health effects of migration is challenging because of differential selection into migration and time-varying confounder mediators of migration effects on health.

METHODS: We pooled data from the Mexican Health and Aging Study (N=17,771) and Mexican-born U.S. Health and Retirement Study (N=898) participants to evaluate the effects of migration to the U.S. (at any age and in models for migration in childhood or adulthood) on depressive symptom-count, measured with a modified Centers for Epidemiologic Studies-Depression scale. We modeled probability of migrating in each year of life from birth to either age at initial migration to the U.S. or enrollment and used these models to calculate inverse probability of migration weights. We applied the weights to covariate-adjusted negative binomial GEE models, estimating the ratio of average symptom-count associated with migration.

RESULTS: Mexico to U.S. migration was unrelated to depressive symptoms among men (ratio of average symptom-count= 0.98 [95% CI: 0.89, 1.08]) and women (ratio of average symptom-count=1.00 [95% CI: 0.92, 1.09]). Results were similar for migration in childhood, early adulthood, or later adulthood.

CONCLUSIONS: In this sample of older Mexican-born adults, migration to the U.S. was unrelated to depressive symptoms.

%B Annals of Epidemiology %V 64 %P 53-66 %G eng %R 10.1016/j.annepidem.2021.08.014 %0 Journal Article %J American Journal of Men's Health %D 2021 %T Examining the Association of Pain and Financial Hardship Among Older Men by Race in the United States. %A Song, Chiho %A Gillian L Marshall %A Reed, Alyssa %A Tamara A. Baker %A Roland J. Thorpe Jr. %K Financial hardship %K Men %K pain %K race %X

Pain associated with financial hardship among older men varies by race. The purpose of this study was to examine the association of financial hardship with the presence of pain in men 50 years and older by race. Using the Health and Retirement Study (HRS) 2010 wave, bivariate and multivariate logistic regression models were used to assess the association between four financial hardship indicators and total financial hardship as a composite score, and the presence of pain by race. Among White men, the association between the presence of pain and hardship controlling for demographic factors was statistically significant across four indicators and one composite score: ongoing financial hardship (OR = 1.29, 95% CI [1.02, 1.64]), food insecurity (OR = 2.55, 95% CI [1.51, 4.31]), taking less medication due to cost (OR = 2.12, 95% CI [1.40, 3.22]), difficulty paying bills (OR = 1.36, 95% CI [1.07, 1.73]), and total financial hardship (OR = 1.27, 95% CI [1.12, 1.44]). Among African American men, the association between the presence of pain and taking less medication due to cost (OR = 2.99, 95% CI [1.31, 6.85]) was significant. With increasing comorbidities among older adults, particularly African Americans, it is imperative to fully understand the mechanisms of this underexplored area in both the pain and financial hardship literature.

%B American Journal of Men's Health %V 15 %P 15579883211049605 %G eng %N 5 %R 10.1177/15579883211049605 %0 Generic %D 2021 %T Future Directions for the HRS Harmonized Cognitive Assessment Protocol %A Torres, W. Jackeline %A M. Maria Glymour %K Alzheimer %K Dementia %K HCAP %X In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer’s disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve both our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of HCAP demonstrated feasibility and value of the more detailed cognitive assessments. To achieve its full potential, we recommend that the HCAP: 1) increase the representation of racial/ethnic minority participants disproportionately affected by ADRDs, 2) administer the HCAP repeatedly and with greater frequency to facilitate longitudinal analyses, cross-national harmonization, and precise characterization of practice and period effects, 3) field a clinical dementia assessment for at least a subset of HCAP participants, 4) phase-in a baseline assessment for people under age 60 in order to facilitate research on the earlier stages of cognitive impairment and midlife dementia prevention, 5) consider dropping lower performing items from the HCAP to increase feasibility of scaling the assessment to more participants at more frequent intervals, 6) enhance the documentation, multi-lingual options, training activities, and randomized sub-studies of language effects or other tools to promote the use of the HCAP and cross-national comparisons, 7) incorporate blood-based AD biomarkers, and 8) improve the capacity of the HCAP to understand the consequences of dementia, including for caregivers and for policy-relevant outcomes such as use of home and community-based services. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions. %I National Institute on Aging %C Bethesda, MD %0 Journal Article %J Mol Psychiatry %D 2021 %T Gene-educational attainment interactions in a multi-ancestry genome-wide meta-analysis identify novel blood pressure loci. %A de Las Fuentes, Lisa %A Yun Ju Sung %A Noordam, Raymond %A Thomas W Winkler %A Feitosa, Mary F %A Schwander, Karen %A Bentley, Amy R %A Brown, Michael R %A Guo, Xiuqing %A Alisa Manning %A Daniel I Chasman %A Aschard, Hugues %A Traci M Bartz %A Bielak, Lawrence F %A Campbell, Archie %A Cheng, Ching-Yu %A Dorajoo, Rajkumar %A Hartwig, Fernando P %A Horimoto, A R V R %A Li, Changwei %A Li-Gao, Ruifang %A Liu, Yongmei %A Marten, Jonathan %A Musani, Solomon K %A Ntalla, Ioanna %A Rankinen, Tuomo %A Melissa Richard %A Sim, Xueling %A Smith, Albert V %A Tajuddin, Salman M %A Bamidele O Tayo %A Vojinovic, Dina %A Warren, Helen R %A Xuan, Deng %A Alver, Maris %A Boissel, Mathilde %A Jin-Fang Chai %A Chen, Xu %A Christensen, Kaare %A Divers, Jasmin %A Evangelou, Evangelos %A Gao, Chuan %A Giorgia G Girotto %A Sarah E Harris %A He, Meian %A Hsu, Fang-Chi %A Kühnel, Brigitte %A Laguzzi, Federica %A Li, Xiaoyin %A Lyytikäinen, Leo-Pekka %A Ilja M Nolte %A Poveda, Alaitz %A Rauramaa, Rainer %A Riaz, Muhammad %A Rueedi, Rico %A Shu, Xiao-Ou %A Snieder, Harold %A Sofer, Tamar %A Takeuchi, Fumihiko %A Verweij, Niek %A Erin B Ware %A Weiss, Stefan %A Yanek, Lisa R %A Amin, Najaf %A Dan E Arking %A Donna K Arnett %A Bergmann, Sven %A Boerwinkle, Eric %A Brody, Jennifer A %A Broeckel, Ulrich %A Brumat, Marco %A Burke, Gregory %A Cabrera, Claudia P %A Canouil, Mickaël %A Chee, Miao Li %A Chen, Yii-Der Ida %A Cocca, Massimiliano %A Connell, John %A de Silva, H Janaka %A de Vries, Paul S %A Eiriksdottir, Gudny %A Jessica Faul %A Fisher, Virginia %A Forrester, Terrence %A Fox, Ervin F %A Friedlander, Yechiel %A Gao, He %A Gigante, Bruna %A Giulianini, Franco %A Gu, Chi Charles %A Gu, Dongfeng %A Tamara B Harris %A He, Jiang %A Heikkinen, Sami %A Heng, Chew-Kiat %A Hunt, Steven %A Ikram, M Arfan %A Irvin, Marguerite R %A Kähönen, Mika %A Kavousi, Maryam %A Khor, Chiea Chuen %A Kilpeläinen, Tuomas O %A Koh, Woon-Puay %A Komulainen, Pirjo %A Kraja, Aldi T %A Krieger, J E %A Langefeld, Carl D %A Li, Yize %A Liang, Jingjing %A David C Liewald %A Liu, Ching-Ti %A Liu, Jianjun %A Kurt Lohman %A Mägi, Reedik %A McKenzie, Colin A %A Meitinger, Thomas %A Andres Metspalu %A Milaneschi, Yuri %A Lili Milani %A Dennis O Mook-Kanamori %A Michael A Nalls %A Nelson, Christopher P %A Norris, Jill M %A Jeff O'Connell %A Ogunniyi, Adesola %A Padmanabhan, Sandosh %A Palmer, Nicholette D %A Nancy L Pedersen %A Thomas T Perls %A Peters, Annette %A Petersmann, Astrid %A Peyser, Patricia A %A Polasek, Ozren %A David J Porteous %A Raffel, Leslie J %A Rice, Treva K %A Rotter, Jerome I %A Rudan, Igor %A Rueda-Ochoa, Oscar-Leonel %A Sabanayagam, Charumathi %A Babatunde Salako %A Schreiner, Pamela J %A Shikany, James M %A Stephen Sidney %A Sims, Mario %A Sitlani, Colleen M %A Smith, Jennifer A %A John M Starr %A Strauch, Konstantin %A Swertz, Morris A %A Teumer, Alexander %A Tham, Yih Chung %A André G Uitterlinden %A Vaidya, Dhananjay %A van der Ende, M Yldau %A Waldenberger, Melanie %A Wang, Lihua %A Wang, Ya-Xing %A Wei, Wen-Bin %A David R Weir %A Wen, Wanqing %A Yao, Jie %A Yu, Bing %A Yu, Caizheng %A Yuan, Jian-Min %A Zhao, Wei %A Alan B Zonderman %A Becker, Diane M %A Bowden, Donald W %A Ian J Deary %A Dörr, Marcus %A Tõnu Esko %A Freedman, Barry I %A Froguel, Philippe %A Paolo P. Gasparini %A Gieger, Christian %A Jost Bruno Jonas %A Kammerer, Candace M %A Kato, Norihiro %A Lakka, Timo A %A Leander, Karin %A Lehtimäki, Terho %A Patrik K E Magnusson %A Marques-Vidal, Pedro %A Brenda W J H Penninx %A Nilesh J Samani %A van der Harst, Pim %A Wagenknecht, Lynne E %A Wu, Tangchun %A Zheng, Wei %A Zhu, Xiaofeng %A Bouchard, Claude %A Cooper, Richard S %A Correa, Adolfo %A Michele K Evans %A Gudnason, Vilmundur %A Caroline Hayward %A Horta, Bernardo L %A Tanika N Kelly %A Stephen B Kritchevsky %A Levy, Daniel %A Walter R Palmas %A Pereira, A C %A Province, Michael M %A Psaty, Bruce M %A Ridker, Paul M %A Charles N Rotimi %A Tai, E Shyong %A van Dam, Rob M %A Cornelia M van Duijn %A Wong, Tien Yin %A Kenneth Rice %A Gauderman, W James %A Alanna C Morrison %A Kari E North %A Sharon L R Kardia %A Caulfield, Mark J %A Elliott, Paul %A Munroe, Patricia B %A Franks, Paul W %A Rao, Dabeeru C %A Myriam Fornage %K Blood pressure %K Epistasis, Genetic %K Genetic Loci %K Genome-Wide Association Study %K Humans %K Hypertension %K Polymorphism, Single Nucleotide %X

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

%B Mol Psychiatry %V 26 %P 2111-2125 %G eng %N 6 %R 10.1038/s41380-020-0719-3 %0 Journal Article %J World Journal of Biological Psychiatry %D 2021 %T Genome-wide association study of suicidal behaviour severity in mood disorders. %A Zai, Clement C %A Fabbri, Chiara %A Hosang, Georgina M %A Zhang, Ruo Su %A Koyama, Emiko %A de Luca, Vincenzo %A Tiwari, Arun K %A King, Nicole %A Strauss, John %A Jones, Ian %A Jones, Lisa %A Breen, Gerome %A Farmer, Anne E %A McGuffin, Peter %A Vincent, John B %A Kennedy, James L %A Lewis, Cathryn M %K Bipolar Disorder %K Genome-Wide Association Study %K major depressive disorder %K Mood Disorders %K Suicidal Ideation %K suicidality %K suicide attempt %X

OBJECTIVE: Suicide is a major public health problem and it has a prominent genetic component. We performed a genome-wide association study (GWAS) of suicidal behaviour severity.

METHODS: Suicide behaviour severity was assessed within the Schedules for Clinical Assessment in Neuropsychiatry in our mood disorder sample (N = 3506) for the GWAS. We also performed polygenic risk score analyses to explore genetic sharing between suicidal behaviour severity and a number of phenotypes, including bipolar disorder, major depressive disorder, alcoholism, post-traumatic stress disorder, impulsivity, insomnia, educational attainment, loneliness, maltreatment, and amygdala volume.

RESULTS: We did not detect genome-wide significant findings at the single-marker or gene level. We report a number of suggestive single-marker and gene-based findings. Our polygenic risk score analyses did not yield significant findings with these phenotypes.

CONCLUSIONS: Larger sample sizes are required to detect moderate effects.

%B World Journal of Biological Psychiatry %V 22 %P 722-731 %G eng %N 9 %R 10.1080/15622975.2021.1907711 %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 Journal of the American Medical Directors Association %D 2021 %T Handgrip Weakness and Asymmetry Independently Predict the Development of New Activity Limitations: Results From Analyses of Longitudinal Data From the US Health and Retirement Study. %A Parker, Kelly %A Rhee, Yeong %A Grant R Tomkinson %A Brenda Vincent %A Melissa L O'Connor %A Ryan P McGrath %K Cognitive Dysfunction %K Geriatric Assessment %K Independent Living %K muscle strength dynamometer %K Muscle Weakness %X

OBJECTIVES: Examining strength asymmetries in assessments of muscle function may improve screenings for limitations in independent living tasks such as instrumental activities of daily living (IADL). We sought to determine the associations between handgrip strength (HGS) asymmetry and future IADL limitations in aging Americans.

DESIGN: Longitudinal-panel.

SETTING AND PARTICIPANTS: Secondary analyses of data from participants aged at least 50 years from the 2006-2016 waves of the Health and Retirement Study. The analytic sample included 18,235 Americans who identified hand dominance and had measures of HGS for both hands in a single wave.

METHODS: Hand dominance was self-reported, and a handgrip dynamometer measured HGS on each hand. The highest HGS values on each hand were used to calculate the HGS asymmetry ratio: (nondominant HGS/dominant HGS). Individuals with HGS asymmetry ratio <0.80 or >1.20 had HGS asymmetry. Persons with HGS asymmetry ratio <0.80 had dominant HGS asymmetry, whereas participants with HGS asymmetry ratio >1.20 had nondominant HGS asymmetry. Persons with HGS asymmetry ratio <1.0 also had their ratio inversed to make all HGS asymmetry ratios ≥1.0. IADL were self-reported. Covariate-adjusted generalized estimating equations were used for the analyses.

RESULTS: Participants with HGS asymmetry had 1.12 [95% confidence interval (CI): 1.03-1.20] greater odds for future IADL limitations. Each HGS asymmetry dominance group also had greater odds for future IADL limitations: 1.09 (CI: 1.01-1.18) for individuals with dominant HGS asymmetry and 1.29 (CI: 1.09-1.52) for persons with nondominant HGS asymmetry. Every 0.10 increase in inverted HGS asymmetry ratio was associated with 1.30 (CI: 1.07-1.57) greater odds for future IADL limitations.

CONCLUSIONS AND IMPLICATIONS: Assessing HGS asymmetry, as another potential biomarker of impaired muscle function, may provide novel insights for predicting IADL limitations. Future research should continue examining how strength asymmetries, and other aspects of muscle function beyond maximal strength, factor into the disabling cascade.

%B Journal of the American Medical Directors Association %V 22 %P 821-826.e1 %G eng %N 4 %R 10.1016/j.jamda.2020.11.006 %0 Web Page %D 2021 %T How Employees Handle Their Retirement Savings During Work Transitions %A The Pew Charitable Trusts %K retirement savings %K Transitions %X This brief examines the common characteristics among people who took money from their accounts, and those who left their accounts untouched, during the 2014-16 time period. The research uses data from the University of Michigan’s Health and Retirement Study (HRS), a nationally representative survey that follows workers and retirees ages 50 and over. %B Issue Brief %I The Pew Charitable Trusts %C Washington, D.C. %G eng %U https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/05/how-employees-handle-their-retirement-savings-during-work-transitions %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 %X

We 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 Report %D 2021 %T Improving the Measurement of Retirement Income of the Aged Population %A Irena Dushi %A Trenkamp, Brad %K Income %K Measurement error %X Research has shown that survey-reported income measures, particularly pension and retirement income, suffer from reporting errors, which lead to biased estimates of income and poverty of the aged population. Two of the Social Security Administration's main publications—Income of the Population 55 or Older and the Income of the Aged Chartbook—are published biennially and are based exclusively on publicly available data from the U.S. Census Bureau. In this paper, we use data from the Census' 2016 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC) merged with administrative data—Internal Revenue Service (IRS) tax records and Social Security earnings and benefit records—to examine whether and to what extent using these additional data improves income estimates. We also compare those estimates with public-use data from the 2016 Health and Retirement Study (HRS), which has the reputation of being a reliable source of income measures for the aged population. We find that for the population aged 65 or older, supplementing the CPS ASEC with IRS and Social Security administrative data results in a higher estimate of pension income's share of aggregate income, less estimated reliance on Social Security, and a lower estimated rate of poverty. Furthermore, we find that the HRS provides better estimates of the income of the aged population than the public-use CPS data. %B ORES Working Papers %I Office of Retirement and Disability Policy, Social Security Administration %C Washington, D.C. %G eng %U https://www.ssa.gov/policy/docs/workingpapers/wp116.html %0 Journal Article %J The Journals of Gerontology: Series A %D 2021 %T Interaction between physical activity and polygenic score on type 2 diabetes mellitus in older Black and White participants from the Health and Retirement Study. %A Wu, Yan Yan %A Mika D. Thompson %A Youkhana, Fadi %A Catherine M. Pirkle %K Physical activity %K Polygenic risk score %K Racial differences %K type 2 diabetes %X

This study investigated the association of lifestyle factors and polygenic risk scores (PGS), and their interaction, on type 2 diabetes mellitus (T2D). We examined data from the United States Health and Retirement Study, a prospective longitudinal cohort of ≥50-year-old adults containing nationally representative samples of Black and White Americans with pre-calculated PGS for T2D (N=14,001). Predicted prevalence and incidence of T2D were calculated with logistic regression models. We calculated differences in T2D prevalence and incidence by PGS percentiles and for interaction variables using nonparametric bootstrap method. Black participants had approximately twice the prevalence of Whites (26.2% vs. 14.2%), with a larger difference between the 90 th and 10 th PGS percentile from age 50-80 years. Significant interaction (Pinteraction=0.0096) was detected between PGS and physical activity among Whites. Among Whites in the 90 th PGS percentile, T2D prevalence for moderate physical activity was 17.0% (95%CI:14.8,19.6), 6.8% lower compared to no/some physical activity (23.8%, 95%CI:20.4,27.5). T2D prevalence was similar (~10%) for both groups in the 10 th PGS percentile. Incident T2D in Whites followed a similar pattern (Pinteraction=0.0325). No significant interactions with PGS were detected among Black participants. Interaction of different genetic risk profiles with lifestyle factors may inform understanding of varying inventions' efficacy for different groups of people, potentially improving clinical and prevention interventions.

%B The Journals of Gerontology: Series A %V 76 %P 1214-1221 %G eng %N 7 %R 10.1093/gerona/glab025 %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 %X

Policy 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 %X

OBJECTIVES: 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 Health Services Research %D 2021 %T Long-term care service mix in the Veterans Health Administration after home care expansion %A Jacobs, Josephine C. %A Wagner, Todd H. %A Trivedi, Ranak %A Karl A Lorenz %A Courtney Harold Van Houtven %K home- and community-based services %K institutional care %K Long-term Care %K unpaid caregiving %K Veterans Health Administration %X Objective To determine whether the Veterans Health Administration's (VHA) efforts to expand access to home- and community-based services (HCBS) after the 2001 Millennium Act significantly changed Veterans' utilization of institutional, paid home, and unpaid home care relative to a non-VHA user Medicare population that was not exposed to HCBS expansion efforts. Data Sources We used linkages between the Health and Retirement Study and VHA administrative data from 1998 until 2012. Study Design We conducted a retrospective-matched cohort study using coarsened exact matching to ensure balance on observable characteristics for VHA users (n =?943) and nonusers (n =?6106). We used a difference-in-differences approach with a person fixed-effects estimator. Data Collection/Extraction Methods Individuals were eligible for inclusion in the analysis if they were age 65 or older and indicated that they were covered by Medicare insurance in 1998. Individuals were excluded if they were covered by Medicaid insurance at baseline. Individuals were considered exposed to VHA HCBS expansion efforts if they were enrolled in the VHA and used VHA services. Principal Findings Theory predicts that an increase in the public allocation of HCBS will decrease the utilization of its substitutes (e.g., institutional care and unpaid caregiving). We found that after the Millennium Act was passed, there were no observed differences between VHA users and nonusers in the probability of using institutional long-term care (0.7% points, 95% CI: ?0.009, 0.022) or in receiving paid help with activities of daily living (0.06% points, 95% CI: ?0.011, 0.0125). VHA users received more hours of unpaid care post-Millennium Act (1.48, 95% CI: ?0.232, 3.187), though this effect was not significant once we introduced controls for mental health. Conclusions Our findings indicate that mandating access to HCBS services does not necessarily imply that access to these services will follow suit. %B Health Services Research %V 56 %P 1126-1136 %@ 0017-9124 %G eng %N 6 %R 10.1111/1475-6773.13687 %0 Journal Article %J Annals of Internal Medicine %D 2021 %T Measuring the COVID-19 Mortality Burden in the United States : A Microsimulation Study. %A Julian Reif %A Heun-Johnson, Hanke %A Tysinger, Bryan %A Darius Lakdawalla %K COVID-19 %K mortality burden %X

BACKGROUND: Fully assessing the mortality burden of the COVID-19 pandemic requires measuring years of life lost (YLLs) and accounting for quality-of-life differences.

OBJECTIVE: To measure YLLs and quality-adjusted life-years (QALYs) lost from the COVID-19 pandemic, by age, sex, race/ethnicity, and comorbidity.

DESIGN: State-transition microsimulation model.

DATA SOURCES: Health and Retirement Study, Panel Study of Income Dynamics, data on excess deaths from the Centers for Disease Control and Prevention, and nursing home death counts from the Centers for Medicare & Medicaid Services.

TARGET POPULATION: U.S. population aged 25 years and older.

TIME HORIZON: Lifetime.

PERSPECTIVE: Individual.

INTERVENTION: COVID-19 pandemic through 13 March 2021.

OUTCOME MEASURES: YLLs and QALYs lost per 10 000 persons in the population. The estimates account for the age, sex, and race/ethnicity of decedents, along with obesity, smoking behavior, lung disease, heart disease, diabetes, cancer, stroke, hypertension, dementia, and nursing home residence.

RESULTS OF BASE-CASE ANALYSIS: The COVID-19 pandemic resulted in 6.62 million QALYs lost (9.08 million YLLs) through 13 March 2021, with 3.6 million (54%) lost by those aged 25 to 64 years. The greatest toll was on Black and Hispanic communities, especially among men aged 65 years or older, who lost 1138 and 1371 QALYs, respectively, per 10 000 persons. Absent the pandemic, 38% of decedents would have had average or above-average life expectancies for their subgroup defined by age, sex, and race/ethnicity.

RESULTS OF SENSITIVITY ANALYSIS: Accounting for uncertainty in risk factors for death from COVID-19 yielded similar results.

LIMITATION: Estimates may vary depending on assumptions about mortality and quality-of-life projections.

CONCLUSION: Beyond excess deaths alone, the COVID-19 pandemic imposed a greater life expectancy burden on persons aged 25 to 64 years, including those with average or above-average life expectancies, and a disproportionate burden on Black and Hispanic communities.

PRIMARY FUNDING SOURCE: National Institute on Aging.

%B Annals of Internal Medicine %V 174 %P 1700-1709 %G eng %N 12 %R 10.7326/M21-2239 %0 Journal Article %J The Journals of Gerontology, Series B %D 2021 %T Memory and Personality Development in Adulthood: Evidence From Four Longitudinal Studies. %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Antonio Terracciano %K Adulthood %K longitudinal %K Memory %K Personality Development %X

OBJECTIVES: Personality traits have been related to concurrent memory performance. Most studies, however, have focused on personality as a predictor of memory; comparatively less is known about whether memory is related to personality development across adulthood. Using 4 samples, the present study tests whether memory level and change are related to personality change in adulthood.

METHOD: Participants were drawn from 2 waves of the Wisconsin Longitudinal Study Graduates (WLSG; N = 3,232, mean age = 64.28, SD = 0.65) and Wisconsin Longitudinal Study Siblings (WLSS; N = 1,570, mean age = 63.52, SD = 6.69) samples, the Midlife in the United States (MIDUS; N = 1,901, mean age = 55.43, SD = 10.98), and the Health and Retirement Study (HRS; N = 6,038, mean age = 65.47, SD = 8.28). Immediate and delayed recall and the 5 major personality traits were assessed at baseline and follow-up.

RESULTS: There was heterogeneity in the associations across samples. A meta-analysis of latent change in the four samples indicated that lower baseline memory performance was related to an increase in neuroticism (B = -0.002; 95% CI = -0.004, -0.0008) and a decrease in agreeableness (B = 0.004; 95% CI = 0.002, 0.007) and conscientiousness (B = 0.005; 95% CI = 0.0008, 0.010). In addition, declines in memory were related to steeper declines in extraversion (B = 0.06; 95% CI = 0.003, 0.11), openness (B = 0.04; 95% CI = 0.007, 0.069), and conscientiousness (B = 0.05; 95% CI = 0.019, 0.09).

DISCUSSION: The present study indicates that poor memory and declines in memory over time are related to maladaptive personality change. These associations, however, were small and inconsistent across samples.

%B The Journals of Gerontology, Series B %V 76 %P 88-97 %G eng %N 1 %R 10.1093/geronb/gbaa086 %0 Journal Article %J Human Genetics and Genomics Advances %D 2021 %T Multi-Ancestry Genome-wide Association Study Accounting for Gene-Psychosocial Factor Interactions Identifies Novel Loci for Blood Pressure Traits. %A Sun, Daokun %A Melissa Richard %A Musani, Solomon K %A Yun Ju Sung %A Thomas W Winkler %A Schwander, Karen %A Jin-Fang Chai %A Guo, Xiuqing %A Kilpeläinen, Tuomas O %A Vojinovic, Dina %A Aschard, Hugues %A Traci M Bartz %A Bielak, Lawrence F %A Brown, Michael R %A Chitrala, Kumaraswamy %A Hartwig, Fernando P %A Horimoto, Andrea R V R %A Liu, Yongmei %A Alisa Manning %A Noordam, Raymond %A Smith, Albert V %A Sarah E Harris %A Kühnel, Brigitte %A Lyytikäinen, Leo-Pekka %A Ilja M Nolte %A Rauramaa, Rainer %A van der Most, Peter J %A Wang, Rujia %A Erin B Ware %A Weiss, Stefan %A Wen, Wanqing %A Yanek, Lisa R %A Dan E Arking %A Donna K Arnett %A Barac, Ana %A Boerwinkle, Eric %A Broeckel, Ulrich %A Chakravarti, Aravinda %A Chen, Yii-Der Ida %A Cupples, L Adrienne %A Davigulus, Martha L %A de Las Fuentes, Lisa %A de Mutsert, Renée %A de Vries, Paul S %A Delaney, Joseph A C %A Ana V Diez Roux %A Dörr, Marcus %A Jessica Faul %A Fretts, Amanda M %A Gallo, Linda C %A Hans-Jörgen Grabe %A Gu, C Charles %A Tamara B Harris %A Hartman, Catharina C A %A Heikkinen, Sami %A Ikram, M Arfan %A Isasi, Carmen %A Johnson, W Craig %A Jost Bruno Jonas %A Kaplan, Robert C %A Komulainen, Pirjo %A Krieger, Jose E %A Levy, Daniel %A Liu, Jianjun %A Kurt Lohman %A Luik, Annemarie I %A Martin, Lisa W %A Meitinger, Thomas %A Milaneschi, Yuri %A Jeff O'Connell %A Walter R Palmas %A Peters, Annette %A Peyser, Patricia A %A Pulkki-Raback, Laura %A Raffel, Leslie J %A Reiner, Alex P %A Kenneth Rice %A Robinson, Jennifer G %A Rosendaal, Frits R %A Schmidt, Carsten Oliver %A Schreiner, Pamela J %A Schwettmann, Lars %A Shikany, James M %A Shu, Xiao-Ou %A Stephen Sidney %A Sims, Mario %A Smith, Jennifer A %A Sotoodehnia, Nona %A Strauch, Konstantin %A Tai, E Shyong %A Taylor, Kent %A André G Uitterlinden %A Cornelia M van Duijn %A Waldenberger, Melanie %A Wee, Hwee-Lin %A Wei, Wen-Bin %A Wilson, Gregory %A Xuan, Deng %A Yao, Jie %A Zeng, Donglin %A Zhao, Wei %A Zhu, Xiaofeng %A Alan B Zonderman %A Becker, Diane M %A Ian J Deary %A Gieger, Christian %A Lakka, Timo A %A Lehtimäki, Terho %A Kari E North %A Oldehinkel, Albertine J %A Brenda W J H Penninx %A Snieder, Harold %A Wang, Ya-Xing %A David R Weir %A Zheng, Wei %A Michele K Evans %A Gauderman, W James %A Gudnason, Vilmundur %A Horta, Bernardo L %A Liu, Ching-Ti %A Dennis O Mook-Kanamori %A Alanna C Morrison %A Pereira, Alexandre C %A Psaty, Bruce M %A Amin, Najaf %A Fox, Ervin R %A Charles Kooperberg %A Sim, Xueling %A Laura Bierut %A Rotter, Jerome I %A Sharon L R Kardia %A Franceschini, Nora %A Rao, Dabeeru C %A Myriam Fornage %K blood pressure traits %X

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

%B Human Genetics and Genomics Advances %V 2 %P 100013 %G eng %N 1 %R 10.1016/j.xhgg.2020.100013 %0 Journal Article %J Innovation in Aging %D 2021 %T 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 Psychology and Aging %D 2021 %T An older subjective age is related to accelerated epigenetic aging. %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Antonio Terracciano %K Epigenetic Age %K Subjective age %X

The present study examined the prospective association between subjective age and epigenetic clock in 2,253 adults (Mean age = 67.40, SD = 8.17) from the Health and Retirement Study. Subjective age and demographic factors were assessed in 2008/2010 and epigenetic clock was assessed in 2016 using the DNA methylation (DNAm) PhenoAge. Regression analysis revealed that an older subjective age was associated with accelerated epigenetic aging; mediation analysis revealed that self-rated health and CRP accounted for this association. The findings indicate that individuals who feel older than their chronological age are biologically older, in part because of their perceived health and inflammatory profiles. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

%B Psychology and Aging %V 36 %P 767-772 %G eng %N 6 %R 10.1037/pag0000607 %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2021 %T Perceived Neighborhood Characteristics and Cognitive Functioning among Diverse Older Adults: An Intersectional Approach %A Amy D Thierry %A Kyler J. Sherman-Wilkins %A Armendariz, Marina %A Allison R Sullivan %A Heather R. Farmer %K cognitive functioning %K Health Disparities %K Intersectionality %K Neighborhoods %K Older Adults %X Unfavorable neighborhood conditions are linked to health disparities. Yet, a dearth of literature examines how neighborhood characteristics contribute to cognitive health in diverse samples of older adults. The present study uses an intersectional approach to examine how race/ethnicity, gender, and education moderate the association between neighborhood perceptions and cognitive functioning in later life. We used data from adults ≥65 years old (n = 8023) in the 2010–2016 waves of the nationally representative Health and Retirement Study (HRS). We conducted race/ethnicity-stratified linear regression models where cognitive functioning, measured using the 35-point Telephone Interview Cognitive Screen (TICS), was regressed on three neighborhood characteristics—cleanliness, safety, and social cohesion. We examine whether there is heterogeneity within race/ethnicity by testing if and how the relationship between neighborhood characteristics and cognitive functioning differs by gender and education. Among White adults, worse neighborhood characteristics were associated with lower cognitive functioning among those with less education. However, for Black adults, poor perceived quality of one’s neighborhood was associated with worse cognitive functioning among those with more years of education compared to those with fewer years of education. Among Mexicans, perceived neighborhood uncleanliness was associated with lower cognitive functioning among those with less education, but higher cognitive functioning for those with higher levels of education. Thus, this study contributes to the literature on racial/ethnic disparities in cognitive aging disparities by examining neighborhood contextual factors as determinants of cognitive functioning. In particular, we find that higher education in the context of less favorable neighborhood environments does not confer the same benefits to cognitive functioning among all older adults. %B International Journal of Environmental Research and Public Health %V 18 %P 1-14 %G eng %N 5 %R 10.3390/ijerph18052661 %0 Journal Article %J Elderly Health Journal %D 2021 %T Personal Mastery and All-Cause Mortality among Older Americans Living with Diabetes %A TUNG, HO-JUI %A Yeh, Ming-Chin %A Ford, Randall %A Shah, Gulzar %K Aged %K Diabetes %K Immigrants %K Mortality %K personal mastery %X Introduction: Higher personal mastery is associated with better physical functioning, wellbeing, and longevity among older populations. However, few studies have focused on whether personal mastery is protective against mortality among older adults living with diabetes over time. Methods: A total of 1,779 participants were identified from an off-year survey of the Health and Retirement Study. Proportional Hazard Models were used to evaluate the significance of selected variables in predicting the survival of participants over a 13-year period. Results: A substantial proportion (46.7%) of the diabetic patients had survived by the end of 2016. Adults with lower mastery scores were more likely to die (Hazard Ratio = .94, p < .001). Gender differences in the association patterns between personal mastery and survival were identified. Personal mastery had an independent health-protective effect on the survival of diabetes patients over the study period. With lower educational attainment, the foreign-born female diabetics scored higher in personal mastery measure when compared to their male counterparts. In the face of more severe diabetes comorbidity, foreign-born female diabetics also outlived their male counterparts over the study period. Conclusion: As a crucial psychological resource and a modifiable factor, personal mastery holds a potential for improving the health status among lower SES groups of older adults. Further investigations into the identified gender difference could be applied to break the cycle of poor health among lower Socio-Economic Status groups of older adults. %B Elderly Health Journal %V 7 %P 3-10 %G eng %N 1 %R ‎10.18502/ehj.v7i1.6545 %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 %X

OBJECTIVE: 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 Journal of Clinical Oncology %D 2021 %T Pre-existing geriatric conditions in older adults with poor prognosis cancers. %A Tsang, Mazie %A Gan, Siqi %A Wong, Melisa L. %A Louise C Walter %A Alexander K Smith %K Cancer %K Geriatric Assessment %K Medicare %K Pre-existing Conditions %X Background: Older adults with poor prognosis cancers are more likely to experience toxicity from cancer-directed therapies. Although geriatric assessment (GA) reduces chemotherapy toxicity by detecting pre-existing conditions, GA can be difficult for oncologists to perform because of limited time and resources. We aim to determine the prevalence of pre-existing geriatric conditions that could be detected if GA were performed during routine oncology care. Methods: We used the Health and Retirement Study (HRS) linked with Medicare (1998-2016) to identify adults age >65 with poor prognosis cancers (median overall survival < 1 year). The HRS is a biennial nationally representative survey that asks about pre-existing geriatric conditions. Using the interview prior to the cancer diagnosis, we determined the presence of conditions included in GA: functional status (i.e. difficulty with climbing stairs, walking one block, getting up from a chair, bathing or showering, taking medications, and managing money), falls and injurious falls, unintentional weight loss, self-rated health, social support, mentation, advanced care planning, use of pain or sleep medications, and mobility. To identify groups with the highest prevalence of pre-existing geriatric conditions, we stratified results by age (adjusted for gender) and gender (adjusted for age). Results: Our study included 2,121 participants. At the time of cancer diagnosis, mean age was 76, 51% were female, 79% were non-Hispanic White, 26% had lung cancer, 14% had a GI cancer, and 60% had other metastatic cancers. Mean time between the HRS interview and cancer diagnosis was 12.7 months. The median overall survival of the entire cohort was 9.6 months with a 45% 1-year survival rate. The adjusted prevalence of pre-existing geriatric concerns were as follows: 65% had difficulty with climbing several flights of stairs, 27% had difficulty with walking one block, 47% had difficulty getting up from a chair after sitting down, 12% had difficulty in bathing or showering, 6% had difficulty taking medications, 11% had difficulty in managing money, 35% had a fall in the last 2 years with 12% of participants reporting injury after their fall. Those who were aged 85+, vs those aged 65-74, had higher rates of conditions indicative of cognitive impairment (e.g. 12 vs 4% had difficulty taking medications, p = 0.000, 26% vs 6% had difficulty managing money, p = 0.000) and physical impairments (e.g. 54% vs 30% had falls, respectively, p = 0.000). Rates of geriatric conditions indicative of physical impairment were higher in women vs men (e.g. 72% vs 58% had difficulty climbing stairs, p = 0.000 and 52% vs 41% had difficulty getting up from a chair, p = 0.000). Conclusions: Patients with poor prognosis cancers have high rates of pre-existing geriatric conditions that can be detected by GA. Geriatric assessments could find important impairments that could be addressed prior to cancer therapy to reduce adverse effects.12044Background: Older adults with poor prognosis cancers are more likely to experience toxicity from cancer-directed therapies. Although geriatric assessment (GA) reduces chemotherapy toxicity by detecting pre-existing conditions, GA can be difficult for oncologists to perform because of limited time and resources. We aim to determine the prevalence of pre-existing geriatric conditions that could be detected if GA were performed during routine oncology care. Methods: We used the Health and Retirement Study (HRS) linked with Medicare (1998-2016) to identify adults age >65 with poor prognosis cancers (median overall survival < 1 year). The HRS is a biennial nationally representative survey that asks about pre-existing geriatric conditions. Using the interview prior to the cancer diagnosis, we determined the presence of conditions included in GA: functional status (i.e. difficulty with climbing stairs, walking one block, getting up from a chair, bathing or showering, taking medications, and managing money), falls and injurious falls, unintentional weight loss, self-rated health, social support, mentation, advanced care planning, use of pain or sleep medications, and mobility. To identify groups with the highest prevalence of pre-existing geriatric conditions, we stratified results by age (adjusted for gender) and gender (adjusted for age). Results: Our study included 2,121 participants. At the time of cancer diagnosis, mean age was 76, 51% were female, 79% were non-Hispanic White, 26% had lung cancer, 14% had a GI cancer, and 60% had other metastatic cancers. Mean time between the HRS interview and cancer diagnosis was 12.7 months. The median overall survival of the entire cohort was 9.6 months with a 45% 1-year survival rate. The adjusted prevalence of pre-existing geriatric concerns were as follows: 65% had difficulty with climbing several flights of stairs, 27% had difficulty with walking one block, 47% had difficulty getting up from a chair after sitting down, 12% had difficulty in bathing or showering, 6% had difficulty taking medications, 11% had difficulty in managing money, 35% had a fall in the last 2 years with 12% of participants reporting injury after their fall. Those who were aged 85+, vs those aged 65-74, had higher rates of conditions indicative of cognitive impairment (e.g. 12 vs 4% had difficulty taking medications, p = 0.000, 26% vs 6% had difficulty managing money, p = 0.000) and physical impairments (e.g. 54% vs 30% had falls, respectively, p = 0.000). Rates of geriatric conditions indicative of physical impairment were higher in women vs men (e.g. 72% vs 58% had difficulty climbing stairs, p = 0.000 and 52% vs 41% had difficulty getting up from a chair, p = 0.000). Conclusions: Patients with poor prognosis cancers have high rates of pre-existing geriatric conditions that can be detected by GA. Geriatric assessments could find important impairments that could be addressed prior to cancer therapy to reduce adverse effects. %B Journal of Clinical Oncology %V 39 %P 12044-12044 %@ 0732-183X %G eng %N 15_suppl %R 10.1200/JCO.2021.39.15_suppl.12044 %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 %X

OBJECTIVES: 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 Journal of the American Geriatrics Society %D 2021 %T Purpose in Life and Motoric Cognitive Risk Syndrome: Replicable Evidence from Two National Samples. %A Angelina R Sutin %A Martina Luchetti %A Yannick Stephan %A Antonio Terracciano %K impairment well‐being %K pre‐dementia risk %K Purpose in life %K syndrome cognitive %X

BACKGROUND/OBJECTIVES: Motoric cognitive risk (MCR) syndrome is characterized by cognitive complaints and slow gait speed in the absence of dementia. Consistent evidence indicates that it predicts dementia and premature mortality. Less is known about its antecedents, particularly the role of psychological function. Purpose in life is an aspect of well-being that reflects a goal-oriented and -driven life that has been implicated in cognitive aging. We aimed to examine the cross-sectional association between purpose in life and MCR and to test the hypothesis that purpose is associated with a lower risk of new cases of MCR over an up to 12-year follow-up.

DESIGN: Cross-sectional and longitudinal multi-cohort design.

SETTING: Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS).

PARTICIPANTS: A total of 6,785 individuals from the HRS and 5,665 from the NHATS.

MEASUREMENTS: Participants reported on their purpose in life and cognitive complaints and completed a walking speed assessment. Cognitive complaints and walking speed were assessed again up to 12 years later in HRS and up to 7 years later in NHATS.

RESULTS: Higher purpose in life was associated with a 33% lower risk of MCR concurrently (meta-analytic odds ratio = .75; 95% confidence interval [CI] = .62-.90; P = .002) and an about 26% lower risk of incident MCR longitudinally (meta-analytic hazard ratio = .77; 95% CI = .70-.84; P < .001). These associations were significant in each sample, were independent of sociodemographic covariates, and persisted after controlling for personality and health-related factors (depressive symptoms, physical activity, disease burden).

CONCLUSION: Purpose in life is associated with a lower risk of incident MCR, an association that was replicated in two independent samples. Purpose is a malleable aspect of psychological function that is a promising target of intervention for healthier cognitive aging.

%B Journal of the American Geriatrics Society %V 69 %P 381-388 %G eng %N 2 %R 10.1111/jgs.16852 %0 Journal Article %J Epidemiology %D 2021 %T Quantifying Lifecourse Drivers of International Migration: A Cross-national Analysis of Mexico and the United States. %A Adina Zeki Al Hazzouri %A Zhang, Lanyu %A Audrey R Murchland %A Grasset, Leslie %A Jacqueline M Torres %A Richard N Jones %A Rebeca Wong %A M. Maria Glymour %K long-term health consequences %K MHAS %K migrants %X

BACKGROUND: Evaluating the long-term health consequences of migration requires longitudinal data on migrants and non-migrants to facilitate adjustment for time-varying confounder-mediators of the effect of migration on health.

METHODS: We merged harmonized data on subjects aged 50+ from the US-based Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS). Our exposed group includes MHAS-return migrants (n = 1555) and HRS Mexican-born migrants (n = 924). Our unexposed group includes MHAS-never migrants (n = 16,954). We constructed a lifecourse data set from birth (age 0) until either age at migration to the United States or age at study entry. To account for confounding via inverse probability of treatment weights (IPTW), we modeled the probability of migration at each year of life using time-varying pre-migration characteristics. We then evaluated the effect of migration on mortality hazard estimated with and without IPTW.

RESULTS: Mexico to the United States migration was predicted by time-varying factors that occurred before migration. Using measured covariates at time of enrollment to account for selective migration, we estimated that, for women, migrating reduces mortality risk by 13%, although this estimate was imprecise and results were compatible with either large protective or deleterious associations (hazard ratio [HR] =0.87, 95% confidence interval [CI]: 0.60, 1.27). When instead using IPTWs, the estimated effect on mortality was similarly imprecise (HR = 0.98, 95% CI: 0.77, 1.25). The relationship among men was similarly uncertain in both models.

CONCLUSIONS: Although time-varying social factors predicted migration, IPTW weighting did not affect our estimates. Larger samples are needed to precisely estimate the health effects of migration.

%B Epidemiology %V 32 %P 50-60 %G eng %N 1 %R 10.1097/EDE.0000000000001266 %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 %X

Measures 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 The Journals of Gerontology: Series B %D 2021 %T Racial/Ethnic Differences in Mortality in Late Midlife: Have They Narrowed in Recent Years? %A Doza, Adit %A Gail A Jensen %A Wassim Tarraf %K Death Rates %K Disparities %K minorities %X

OBJECTIVES: Examine whether racial/ethnic differences in mortality rates have changed in recent years among adults in late midlife, and if so, how.

METHODS: We analyze Health and Retirement Study data on non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks), and English- and Spanish-speaking Hispanics (Hispanic-English and Hispanic-Spanish), ages 50-64 from two periods: 1998-2004 (P1, n=8920) and 2004-2010 (P2, n=7224). Using survey-generalized linear regression techniques we model death-by-end-of-period as a function of race/ethnicity, and sequentially adjust for a series of period-specific baseline risk factors including demographics, health status, health insurance, health behaviors, and social networks. Regression decomposition techniques are used to assess the contribution of these factors to observed racial/ethnic differences in mortality rates.

RESULTS: The odds ratio for death (ORD) was not statistically different for Blacks (vs. Whites) in P1 but was 33% higher in P2 (OR=1.33; 95% CI=1.05-1.69). The adjusted ORD among Hispanic-English (vs. Whites) was not statistically different in both periods. The adjusted ORD among Hispanic-Spanish (vs. Whites) was lower (ORD=0.36; 95% CI= 0.22-0.59) in P1 but indistinguishable in P2. In P1, 50.1% of the disparity in mortality rates among Blacks was explained by baseline health status, 53.1% was explained by financial factors. In P2, 55.8% of the disparity in mortality rates was explained by health status, 40.0% by financial factors and 16.2% by health insurance status.

DISCUSSION: Mortality rates among Blacks and Hispanic-Spanish have risen since the mid-1990s. Hispanic-Spanish, may be losing their advantageous lower risk of mortality, long known as the "Hispanic Paradox."

%B The Journals of Gerontology: Series B %V 76 %P 1475-1487 %G eng %N 7 %R 10.1093/geronb/gbaa175 %0 Journal Article %J Journal of Psychiatric Research %D 2021 %T Self-Rated Health and Incident Dementia over Two Decades: Replication Across Two Cohorts %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Damaris Aschwanden %A Antonio Terracciano %K Dementia %K longitudinal %K Risk Factors %K Self-rated health %X This prospective study examined the association between self-rated health and incident dementia in two large cohorts of middle-aged and older adults. Participants were drawn from the Health and Retirement Study (HRS, N= 13,839, Mean Age= 64.32, SD= 9.04) and the English Longitudinal Study of Ageing (ELSA, N=4649, Mean Age = 64.44, SD= 9.97). Self-rated health and covariates were assessed at baseline in 1998 and 2002, and cognitive status was tracked for up to 21 years in HRS and 17 years in ELSA, respectively. Controlling for demographic factors, poorer self-rated health was associated with higher risk of incident dementia in HRS (HR: 1.18, 95%CI: 1.12-1.24, p<.001) and ELSA (HR: 1.38, 95%CI: 1.23-1.55, p<.001). These associations remained significant when diabetes, hypertension, smoking, physical inactivity, depressive symptoms, personality, and polygenic risk for Alzheimer’s Disease were included as additional covariates or when cases occurring within the first ten years of follow-up were excluded from the analyses. There was no replicable evidence that age, sex, education, race or ethnicity moderated the association. Self-rated health is a long-term, replicable predictor of incident dementia that is independent of genetic, clinical, and behavioral risk factors. %B Journal of Psychiatric Research %V 143 %P 462-466 %@ 0022-3956 %G eng %R 10.1016/j.jpsychires.2021.06.036 %0 Book Section %B Annual Review of Gerontology and Geriatrics, Volume 41, 2021: Black Older Adults in the Era of Black Lives Matter %D 2021 %T Social Isolation, Loneliness, and Physical and Mental Health Among Black Older Adults %A Taylor, Harry O %K African Americans %K Black older adults %K Loneliness %K Mental Health %K Social determinants of health %K social isolation %X Social isolation and loneliness are consistently associated with worse health and well-being outcomes among older adults. However, many studies have not examined their concurrent impact on health and well-being, and even fewer studies examine their influence among Black older adults. The 2014 and 2016 waves of the Health and Retirement Study were used to examine the influence of social isolation and loneliness among a nationally representative sample of Black older adults. Social isolation was measured using a social network index based on marital and household status, contact with family members and friends, and participation in social and religious activities. Loneliness was measured by the 3-item loneliness scale. Health outcomes were self-rated physical health and number of chronic health conditions, depressive symptoms, and lifetime occurrence of a psychiatric disorder. Each health outcome was examined using: (a) social isolation, (b) loneliness, and (c) social isolation and loneliness, controlling for sociodemographic covariates. Social isolation was associated with self-rated health and depressive symptoms, while loneliness was associated with all health outcomes. When examined jointly, social isolation was associated with self-rated health, while loneliness was associated with all health outcomes. Study findings suggest that due to its association with multiple physical and mental health measures, loneliness may be a more significant factor for health that should be routinely assessed in working with Black older adults. %B Annual Review of Gerontology and Geriatrics, Volume 41, 2021: Black Older Adults in the Era of Black Lives Matter %I Springer Publishing Company %V 41 %P 123 – 144 %@ 978-082616632-6; 978-082616631-9 %G eng %& 5 %R 10.1891/0198-8794.41.123 %0 Journal Article %J Psychology and Aging %D 2021 %T Subjective age and informant-rated cognition and function: A prospective study. %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Antonio Terracciano %K Cognition %K HCAP %K Subjective age %X

The present study examined whether subjective age is related to informant-rated cognition. Participants were adults ( = 2,337, mean age = 69.84 years, = 7.45) from the Health and Retirement Study who provided subjective age and demographic factors in 2008/2010 and informant-rated cognition in 2016 as part of the Harmonized Cognitive Assessment Protocol. An older subjective age was associated with informant reports of steeper cognitive decline, worse cognitive function, lower ability, and loss of ability to do everyday activities. The present study indicates that subjective age predicts cognitive function in everyday life as observed by knowledgeable informants. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

%B Psychology and Aging %V 36 %P 338-343 %G eng %N 3 %R 10.1037/pag0000566 %0 Journal Article %J Journal of Psychosomatic Research %D 2021 %T Subjective age and multiple cognitive domains in two longitudinal samples %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Damaris Aschwanden %A Antonio Terracciano %K Adulthood %K Cognition %K Executive function %K Memory %K numeric reasoning %K Subjective age %K verbal fluency %K Visuospatial ability %X Objective Subjective age is consistently related to memory performance and global cognitive function among older adults. The present study examines whether subjective age is prospectively related to specific domains of cognitive function. Method Participants were drawn from the Health and Retirement Study (HRS, N = 2549, Mean Age = 69.66, SD = 7.36) and the Midlife in the United States Survey (MIDUS, N = 2499, Mean Age = 46.24, SD = 11.25). In both samples, subjective age, depressive symptoms, chronic conditions, and demographic factors were assessed at baseline. Four domains of cognition were assessed 8 years later in the HRS and almost 20 years later in the MIDUS: episodic memory, speed-attention-executive, verbal fluency, and numeric reasoning. HRS also assessed visuospatial ability. Results Regression analysis revealed that an older subjective age was related to worse performance in the domains of episodic memory and speed-attention-executive in both samples. The effect size for the difference between a younger and an older subjective age was d = 0.14 (MIDUS) and d = 0.24 (HRS) for episodic memory and d = 0.25 (MIDUS) and d = 0.33 (HRS) for speed-attention-executive. Feeling older was related to lower verbal fluency in HRS (d = 0.30) but not in MIDUS, whereas no association was found with numeric reasoning in either sample. An older subjective age was related to lower visuospatial ability in HRS (d = 0.25). Conclusion Subjective age is prospectively related to performance in different cognitive domains. The associations between subjective age and both episodic memory and speed-attention-executive functions were replicable and robust over up to 20 years of follow-up. %B Journal of Psychosomatic Research %V 150 %P 110616 %G eng %R 10.1016/j.jpsychores.2021.110616 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2021 %T Subjective Age and Verbal Fluency among Middle Aged and Older Adults: A Meta-Analysis of Five Cohorts %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Damaris Aschwanden %A Antonio Terracciano %K Adulthood %K ELSA %K Sister studies %K Subjective age %K verbal fluency %X Objectives This study aimed to examine the relation between subjective age and verbal fluency in five large samples of older adults to advance knowledge on the role of subjective age in a complex cognitive function that is an intermediate marker of cognitive impairment and dementia risk. Methods Participants (N > 27,000), aged 32 to 99 years old, predominantly white, were from the Wisconsin Longitudinal Study Graduate (WLSG) and Siblings (WLSS) samples, the Health and Retirement Study (HRS), the Midlife in the United States Study (MIDUS), and the English Longitudinal Study of Ageing (ELSA). They provided complete data on subjective age, demographic factors and verbal fluency. Estimates from each sample were combined in a meta-analysis. Results Across each of the five samples and in the meta-analysis, an older subjective age was related to lower performance on the verbal fluency task. This association was independent of chronological age and was not moderated by age, sex, nor education. The difference in fluency between individuals with an older and younger subjective age ranged from d= .09 to d= .37 across the five samples. Conclusions This study found replicable evidence for an association between an older subjective age and lower verbal fluency, extending knowledge about an intermediate marker of cognitive function. %B Archives of Gerontology and Geriatrics %V 97 %P 104527 %G eng %R 10.1016/j.archger.2021.104527 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Subjective Aging and Incident Cardiovascular Disease. %A Yannick Stephan %A Angelina R Sutin %A Wurm, Susanne %A Antonio Terracciano %K ardiovascular disease %K self-perceptions of aging %K Stroke %K Subjective age %X

OBJECTIVES: Subjective aging, including subjective age and self-perceptions of aging (SPA), predicts health-related outcomes in older adults. Despite its association with cardiovascular risk factors, little is known about the association between subjective aging and the incidence of cardiovascular disease. Therefore, the present study examined whether subjective age and SPA are related to the incidence of heart conditions and stroke.

METHODS: The sample comprises 10,695 participants aged 50-100 years from the Health and Retirement Study. Subjective age, SPA, demographic factors, and health-related behaviors, body mass index (BMI), hypertension, diabetes, and depressive symptoms were assessed at baseline. Self-reported physician diagnosis of heart conditions and stroke were assessed biennially over up to 9 years of follow-up.

RESULTS: Controlling for demographic factors, an older subjective age and more negative SPA were related to a higher risk of incident heart conditions and stroke. Feeling older and holding negative SPA were associated with around 40% higher risk of experiencing heart conditions over time. An older subjective age and negative SPA were related to almost twofold and 30% higher risk of incident stroke, respectively. Health risk behaviors, BMI, hypertension, diabetes, and depressive symptoms accounted for part of the associations between subjective aging and heart diseases and stroke.

CONCLUSIONS: Consistent with the literature on subjective aging and cardiovascular risk factors, this large prospective study indicates that an older subjective age and negative SPA increase the risk of incident stroke and other cardiovascular diseases.

%B The Journals of Gerontology: Series B %V 76 %P 910-919 %G eng %N 5 %R 10.1093/geronb/gbaa106 %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 General Internal Medicine %D 2021 %T Trends and Disparities in Functional Impairment among US Adults Age 55-64, 2002 to 2016. %A Tipirneni, Renuka %A Karmakar, Monita %A Donovan T Maust %K Mortality %K Racial Disparities %K socioeconomic status %X Over the past decade, US midlife morbidity and mortality have increased, contributing to declines in life expectan cy.1 This worsening health status has been experienced disproportionately by low–socioeconomic status (SES) and racial/ethnic minority individuals2, 3 and is associated with functional deterioration among low-SES middle-aged adults.4 Yet it is unclear if disparities in functional status are rising. Functional impairment may not be recognized as a health problem for middle-aged adults, but it is common and, as for older adults, associated with disability and death.5 Our objective was to examine functional trends among US midlife adults to determine whether and how changes in disparities are concentrated among particular demographic groups. %B Journal of General Internal Medicine %V 36 %P 3903-3906 %G eng %N 12 %R 10.1007/s11606-020-06209-y %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 Aging Clinical and Experimental Research %D 2021 %T Verbal memory is associated with adherence to COVID-19 protective behaviors in community dwelling older adults. %A O'Shea, Deirdre M %A Davis, Jennifer D %A Tremont, Geoffrey %K Adherence %K Aging %K community living %K COVID-19 %K Memory %X

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

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

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

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

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

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

%B Aging Clinical and Experimental Research %V 33 %P 2043-2051 %G eng %N 7 %R 10.1007/s40520-021-01905-z %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 %X

OBJECTIVES: 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 Journal of Alzheimer's Disease %D 2020 %T Age of Migration and Cognitive Function Among Older Latinos in the United States %A Marc Garcia %A Ortiz, Kasim %A Arévalo, Sandra P. %A Diminich, Erica D. %A Emily Briceño %A Vega, Irving E. %A Wassim Tarraf %K Alzheimer’s disease and related dementias %K cognitive function %K Immigration %K Latino %K nativity %K Sex differences %X Background: Age of migration has been shown to have a robust association with Latino immigrant health outcomes; however, the relationship between timing of migration and cognition is less understood. Objective: To examine associations between race/ethnicity, nativity, age of migration, and cognitive aging among US-born (USB) non-Latino Whites (NLW) and USB and foreign-born Latinos 50 years and older. Methods: We used longitudinal biennial data from the Health and Retirement Study (HRS; 2006-2014) to fit generalized linear and linear latent growth curve models for: 1) global cognition (Modified Telephone Interview for Cognitive Status; TICS-M); 2) memory and attention subdomains of TICS-M; and 3) cognitive dysfunction. We also tested for sex modifications. Results: In age and sex adjusted models, all Latino subgroups, independent of nativity and age of migration, had lower global and domain-specific cognitive scores and higher propensity of cognitive impairment classification compared to USB-NLWs. Differences between USB Latinos, but not other Latino subgroups, and USB-NLWs remained after full covariate adjustment. Latinas, independent of nativity or age of migration, had poorer cognitive scores relative to NLW females. Differences between all Latinos and USB-NLWs were principally expressed at baseline. Racial/ethnic, nativity, and age of migration grouping was not associated with slope (nor explained variance) of cognitive decline. Conclusion: Older US-born Latinos, regardless of sex exhibit poorer cognitive function than older USB-NLWs and foreign-born Latinos. Social determinants that differentially affect cognitive function, particularly those that compensate for education and sex differences among US-born Latinos and foreign-born Latinos, require further exploration. %B Journal of Alzheimer's Disease %V 76 %P 1493-1511 %@ 1875-8908 %G eng %N 4 %R 10.3233/JAD-191296 %0 Journal Article %J Innovation in Aging %D 2020 %T The Association Between Depressive Symptoms and Accumulation of Stress Among Black Men in the Health and Retirement Study. %A Roland J. Thorpe Jr. %A Ryon J. Cobb %A King, Keyonna %A Bruce, Marino A %A Archibald, Paul %A Jones, Harlan P %A Norris, Keith C %A Keith E Whitfield %A Hudson, Darrell %K Allostatic load %K Black men %K Depressive symptoms %K health %K Inequities %K Men %K Stress %X

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

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

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

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

%B Innovation in Aging %V 4 %P igaa047 %G eng %N 5 %R 10.1093/geroni/igaa047 %0 Journal Article %J Innovation in Aging %D 2020 %T The Association Between Diabetes and Cognition Among Older Hispanics in the United States and Mexicans in Mexico %A Jaqueline C Avila %A Rebeca Wong %A Ternent, Rafael Samper %K Cognition %K Diabetes %K Latinos/Hispanics %K MHAS %X The objective is to assess if the effect of diabetes on cognition differs by race/ethnicity in the U.S. and how this association differs between older Hispanics in the U.S. and older Mexicans in Mexico. Data comes from a sample of older adults 50 and older with direct interviews from the 2012 waves of the Health and Retirement Study (N=17,810) and the Mexican Health and Aging Study (N=13,270). Cognition was measured as a total cognition score. OLS regressions were used to test the association between diabetes and cognition by race/ethnicity in the U.S. and among older Mexicans in Mexico. Results showed that Non-Hispanic Whites (NHW) had the highest cognition scores in the U.S., followed by Hispanics and non-Hispanic blacks (NHB). Mean cognition score of older Mexicans was higher than for NHB and Hispanics in the U.S. but lower than NHWs. The prevalence of diabetes was highest among Hispanics (32.3%), followed by NHB (30.6%) and NHW (19.9%). The prevalence of diabetes in Mexico was like those NHW in the U.S. (19.9%). In the U.S., the effect of being NHB and Hispanic (compared to white) on cognition was equivalent to having 5.3 and 2.4 fewer years of education, respectively. However, the effect of diabetes on cognition did not differ by race/ethnicity. The final analysis will include a direct comparison between Hispanics in the U.S. and a matched sample of older adults in Mexico with similar sex and age to test differences in the effect of diabetes on cognition between these two samples. %B Innovation in Aging %V 4 %P 159 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.517 %0 Journal Article %J Health and Place %D 2020 %T Association between telomere length and neighborhood characteristics by race and region in US midlife and older adults %A Amy D Thierry %K Adult %K Aged %K Aging %K Article %K Black person %K Caucasian %K controlled study %K Health Disparities %K health disparity %K human %K neglect %K neighborhood %K Neighborhood characteristics %K race %K race difference %K Retirement %K Telomere length %X Disadvantaged neighborhoods are correlated with worse health outcomes, particularly among US Blacks. However, less is known about the link between neighborhood characteristics and biomarkers of cellular age, such as telomere length (TL), which may be implicated in racial health inequities. Moreover, this relationship may vary across US region given patterns of racial segregation across the US. Therefore, this study analyzed 2008 Health and Retirement Study data on 3,869 US-born white and Black adults >50 years old to examine race differences in the relationship between salivary TL and (1) neighborhood safety, cleanliness, and social cohesion and (2) interactions between neighborhood characteristics and US region. Neighborhood characteristics were not associated with TL in whites. However, significant associations were found among Blacks with variation by region. Blacks living in less clean neighborhoods in the Northeast (b = −0.03, SE = 0.01, p < 0.05), Midwest (b = −0.04, SE = 0.01, p < 0.01), and South (b = −0.05, SE = 0.01, p < 0.01) as well as those reporting less neighborhood safety and social cohesion in the Midwest (b = −0.03, SE = 0.02, p < 0.05 and b = −0.03, SE = 0.01, p < 0.05) and South (b = −0.03, SE = 0.01, p < 0.05 for both characteristics) had shorter TL than Blacks in the West. Therefore, exposure to neighborhood level historical discrimination and neglect may be detrimental to TL in Blacks. Future research should further examine how neighborhoods contribute to aging disparities. © 2019 Elsevier Ltd %B Health and Place %V 62 %@ 13538292 (ISSN) %G eng %U https://www.sciencedirect.com/science/article/pii/S1353829219303752 %! Health Place %R 10.1016/j.healthplace.2019.102272 %0 Journal Article %J PLoS One %D 2020 %T Association of a genetic risk score with BMI along the life-cycle: Evidence from several US cohorts. %A Anna Sanz-de-Galdeano %A Terskaya, Anastasia %A Upegui, Angie %K BMI %K BMI polygenic scores %X

We use data from the National Longitudinal Study of Adolescent to Adult Health and from the Health and Retirement Study to explore how the effect of individuals' genetic predisposition to higher BMI -measured by BMI polygenic scores- changes over the life-cycle for several cohorts. We find that the effect of BMI polygenic scores on BMI increases significantly as teenagers transition into adulthood (using the Add Health cohort, born 1974-83). However, this is not the case for individuals aged 55+ who were born in earlier HRS cohorts (1931-53), whose life-cycle pattern of genetic influence on BMI is remarkably stable as they move into old-age.

%B PLoS One %V 15 %P e0239067 %8 2020 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/32941506?dopt=Abstract %R 10.1371/journal.pone.0239067 %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 Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %D 2020 %T Associations between self-reported sensory impairment and risk of cognitive decline and impairment in the Health and Retirement Study (HRS) cohort. %A Maharani, Asri %A Dawes, Piers %A James Nazroo %A Tampubolon, Gindo %A Pendleton, Neil %K Cognition & Reasoning %K Hearing loss %K Risk Factors %K Self Report %X

OBJECTIVES: We aimed to determine whether self-assessed single (hearing or visual) and dual sensory (hearing and visual) impairments are associated with cognitive decline and incident possible Cognitive Impairment, No Dementia (CIND) and probable dementia.

METHOD: Data were drawn from the 1996-2014 surveys of the Health and Retirement Study (HRS), involving 19,618 respondents who had no probable dementia and who were aged 50 years or older at the baseline. We used linear mixed models to test the association between self-assessed sensory impairment and cognitive decline followed by a Cox proportional hazard model to estimate the relative risk of incident possible CIND and probable dementia associated with the presence of sensory impairment.

RESULTS: Respondents with self-assessed single and dual sensory impairment performed worse in cognitive tests than those without sensory impairment. The fully adjusted incidence of developing possible CIND was 17% higher for respondents with hearing impairment than those without hearing impairment. Respondents with visual impairment had 35% and 25% higher risk for developing possible CIND and probable dementia, respectively, than those without visual impairment. Respondents with dual sensory impairment at baseline were 38% and 26% more likely to develop possible CIND and probable dementia, respectively, than those with no sensory impairment.

DISCUSSION: Self-assessed sensory impairment is independently associated with cognitive decline and incident possible CIND and probable dementia. Further studies are needed to identify the mechanism underlying this association and to determine whether treatment of sensory impairment could ameliorate cognitive decline and delay the onset of dementia among older adults.

%B Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %V 75 %G eng %N 6 %9 Journal %& 1230-1242 %R 10.1093/geronb/gbz043 %0 Report %D 2020 %T Better jobs, longer working lives: Proposals to improve the low-wage labor market for older workers %A Truesdale, Beth C. %X Working longer – in the sense of choosing to delay retirement beyond traditional retirement ages – is widely proposed as the best way for older Americans to boost their fragile retirement security. But the policy goal of increasing labor force participation among older Americans is fundamentally in tension with a precarious low-wage economy because jobs that feature low wages, high turnover rates, and few benefits do not provide a solid foundation for sustained employment at older ages. Many Americans in their 50s are already out of the labor force, and many retire involuntarily before traditional retirement ages – a situation that has been exacerbated by the COVID-19 pandemic. Better jobs for prime-age workers help to pave the way for longer working lives. I outline three specific policy proposals: improved minimum wage, fair workweek laws, and a universal paid family and medical leave benefit. As others have argued, these policies would improve the well-being of prime-age workers. What has been less appreciated is that these policies would also put older Americans in a better position to extend their working years. %B Economic Studies at Brookings %I The Brookings Institute %C Washington, D.C. %G eng %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 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 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 %X

Introduction: 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 Innovation in Aging %D 2020 %T Chronic Condition Discordance and Physical Activity: Longitudinal Associations Among Older Couples %A Courtney A Polenick %A Kira S. Birditt %A Turkelson, Angela %A Helen C Kales %K chronic condition discordance %K Physical activity %X Chronic condition discordance (i.e., the extent that two or more conditions have non-overlapping self-management requirements) is detrimental for functional health but little is known about mechanisms accounting for these associations. We examined links between chronic condition discordance at both the individual level and the couple level (i.e., between spouses) and physical activity over time. Participants included 1,095 couples from five waves (2006-2014) of the Health and Retirement Study. Dyadic growth curve models showed that greater individual-level discordance was associated with lower baseline physical activity among individuals and their partners. When husbands had greater individual-level discordance, wives and husbands had faster declines in physical activity. The findings highlight the importance of considering both members of a couple when examining the implications of chronic illness for physical activity in middle and later life. %B Innovation in Aging %V 4 %P 605 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.2044 %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 J Health Econ %D 2020 %T The cyclicality of informal care. %A Corina D Mommaerts %A Yulya Truskinovsky %K Informal care %X

This paper measures the cyclicality of an important input into elderly health: informal care. Using independent survey measures of informal caregiving and care receipt over the past two decades, we find that informal care from adult children to their elderly parents is countercyclical. By contrast, informal care from spouses is procyclical among individuals in their sixties. We find little corresponding change in the use of formal care, highlighting the potential for unmet care needs across the business cycle. These findings suggest that informal health inputs may play an important role in the interpretation of the cyclicality of elderly mortality.

%B J Health Econ %V 71 %P 102306 %8 2020 May %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/32171128?dopt=Abstract %R 10.1016/j.jhealeco.2020.102306 %0 Journal Article %J Small Business Economics %D 2020 %T A decade of research on the genetics of entrepreneurship: a review and view ahead %A Cornelius A Rietveld %A Eric Slob %A A. Roy Thurik %K Entrepreneurship %K Genetics %K Polygenic risk scores %X Studies analyzing the heritability of entrepreneurship indicate that explanations for why people engage in entrepreneurship that ignore genes are incomplete. However, despite promises that were solidly backed up with ex ante power calculations, attempts to identify specific genetic variants underlying the heritable variation in entrepreneurship have until now been unsuccessful. We describe the methodological issues hampering the identification of associations between genetic variants and entrepreneurship, but we also outline why this search will eventually be successful. Nevertheless, we argue that the benefits of using these individual genetic variants for empirical research in the entrepreneurship domain are likely to be small. Instead, the use of summary indices comprising multiple genetic variants, so-called polygenic risk scores, is advocated. In doing so, we stress the caveats associated with applying population-level results to the individual level. By drawing upon the promises of “genoeconomics,” we sketch how the use of genetic information may advance the field of entrepreneurship research. %B Small Business Economics %8 2020/04/28 %@ 1573-0913 %G eng %! Small Business Economics %R 10.1007/s11187-020-00349-5 %0 Journal Article %J Psychological Medicine %D 2020 %T Depression and memory function – evidence from cross-lagged panel models with unit fixed effects in ELSA and HRS %A Jindra, Christoph %A Li, Chenlu %A Tsang, Ruby S. M. %A Bauermeister, Sarah %A Gallacher, John %K Cognition %K cross-lagged panel models %K depression %K ELSA %K fixed effects %X Background Individuals with depression are often found to perform worse on cognitive tests and to have an increased risk of dementia. The causes and the direction of these associations are however not well understood. We looked at two specific hypotheses, the aetiological risk factor hypothesis and the reverse causality hypothesis. Method We analysed observational data from two cohorts, English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS), using cross-lagged panel models with unit fixed effects. Each model was run once with depression and repeated with cognition as the dependent variable and the other variable as the main explanatory variable. All models were estimated separately for contemporaneous effects and lagged effects up to 8 years in the past. We contrasted the results with models making the random effects assumption. Results Evidence from the fixed effects models is mixed. We find no evidence for the reverse causality hypothesis in ELSA and HRS. While there is no evidence for the aetiological risk factors hypothesis in ELSA, results from HRS indicate some effects. Conclusion Our findings suggest that current levels of cognitive function do not influence future levels of depression. Results in HRS provide some evidence that current levels of depressive symptoms influence future cognition. %B Psychological Medicine %G eng %R 10.1017/S0033291720003037 %0 Journal Article %J Innovation in Aging %D 2020 %T Depressive Symptoms and Loneliness Among Black and White Older Adults: The Moderating Effects of Race. %A Taylor, Harry O %A Ann W Nguyen %K Mental Health %K Negative interactions %K Social networks %K Social Support %X

Background and Objectives: Loneliness is consistently linked to worse depression/depressive symptoms; however, there are few studies that have examined whether the relationship between loneliness and depressive symptoms varies by race. The purpose of this study was to determine whether race moderated the relationship between loneliness and depressive symptoms.

Research Design and Methods: Data come from the 2014 wave of the Health and Retirement Study (HRS) Core survey and Psychosocial Leave-Behind Questionnaire; only black and white older adults were included in the analysis ( = 6,469). Depressive symptoms were operationalized by the eight-item Center for Epidemiological Studies-Depression scale; however, the "felt lonely" item was removed given concerns with collinearity. Loneliness was operationalized using the Hughes 3-Item Loneliness Scale. Sociodemographic variables included gender, age, education, household income, employment status, marital status, and living alone or with others. Furthermore, social support and negative interactions from family members and friends, and religious service attendance were included in the analysis. Lastly, we created an interaction term between race and loneliness. All analyses used survey weights to account for the complex multistage sampling design of the HRS. Missing data were multiply imputed.

Results: In multivariable analysis, we found race significantly moderated the relationship between loneliness and depressive symptoms while controlling for sociodemographic covariates, social support and negative interaction variables, and religious service attendance.

Discussion and Implications: Our findings demonstrate a differential racial effect for loneliness and depressive symptoms. For both blacks and whites, greater loneliness affected depressive symptoms; however, the effect was stronger among whites than it was for blacks. Given this is one of the first studies to examine the differential effects of race on loneliness and depressive symptoms, more research is necessary to determine the consistency of these results.

%B Innovation in Aging %V 4 %P igaa048 %G eng %N 5 %R 10.1093/geroni/igaa048 %0 Journal Article %J Public Health Nutrition %D 2020 %T Dietary lutein and zeaxanthin are associated with working memory in an older population %A Krystle E Zuniga %A Nicholas J Bishop %A Turner, Alexandria S %K Carotenoid %K Cognition %K Episodic Memory %K Lutein %K Memory %K Older adult %K Zeaxanthin %X Objective: The purpose of the study was to examine the association between dietary lutein and zeaxanthin (L + Z) intake and immediate word recall (IWR) and delayed word recall (DWR), and to identify the major contributors to dietary L + Z intake in a recent and representative sample of the older US population. Design: In this cross-sectional analysis, multivariate path analytic models estimated the association between L + Z consumption and cognitive performance while adjusting for covariates. Setting: Observations were drawn from the 2014 Health and Retirement Study, a nationally representative panel study of older US adults, and the 2013 Health Care and Nutrition Study, which assessed dietary intake via FFQ in a subsample of respondents. Participants: The analytic sample included 6390 respondents aged ≥50 years. Results: L + Z intake was 2·44 ± 2·32 mg/d on average, and L + Z intake differed significantly across quartiles (P < 0·001). For example, average L + Z intake in Q1 was 0·74 ± 0·23 mg/d and in Q4 was 5·46 ± 2·88 mg/d. In covariate adjusted models, older adults in the highest quartiles of L + Z intake had significantly greater IWR and DWR scores than those in the lowest quartile. Leafy vegetables, cruciferous vegetables, dark yellow vegetables, fish and seafood, legumes, eggs and fruit were significant and meaningful predictors of dietary L + Z intake. Conclusion: A high consumption of vegetables, fish and seafood, legumes, eggs and fruit is associated with a higher intake of L + Z and greater word recall among older adults. %B Public Health Nutrition %G eng %R 10.1017/S1368980019005020 %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 Applied Economics %D 2020 %T Do Hispanic immigrants spend less on medical care? Implications of the Hispanic health paradox %A Basu Roy, S. %A Olsen, R.N. %A Tseng, H. %K Demand for medical care %K healthcare utilization %K Hispanic health paradox %K latent health stock %X The literature of the Hispanic heath paradox has found that in the U.S. Hispanic immigrants have better health than U.S. natives, even though they tend to have lower socioeconomic status. The main objective of the current study is to investigate whether Hispanic immigrants also use less medical care goods and services. Main contributions of the article include using a data set of older Americans from the Health and Retirement Study covering the period from 1992 to 2012 as well as using three new measures of health, rather than the more common use of morbidity or mortality. We estimate the impact of relevant factors including health, race, and immigrant status upon five different measures of healthcare usage. Even though Hispanic immigrants do have lower mean levels of most measures of healthcare usage, when controlling for other factors in our regressions we find some evidence of increased healthcare usage for Hispanic immigrants. Increased health care utilization may be one explanation for the Hispanic health paradox. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group. %B Applied Economics %G eng %U https://www.scopus.com/inward/record.uri?eid=2-s2.0-85080038143&doi=10.1080%2f00036846.2020.1726863&partnerID=40&md5=cfb70e4c0ea2a9569335cb2ae3905bc4 %9 Journal %R 10.1080/00036846.2020.1726863 %0 Journal Article %J Journals of Gerontology Series B: Psychological Sciences & Social Sciences %D 2020 %T Double Disadvantage in the Process of Disablement: Race as a Moderator in the Association Between Chronic Conditions and Functional Limitations. %A Ben Lennox Kail %A Miles G Taylor %A Rogers, Nick %K Chronic conditions %K Functional limitations %K Racial/ethnic differences %X

Objectives: This study evaluated (a) whether the association between chronic conditions and functional limitations vary by race/ethnicity, and (b) whether socioeconomic status accounted for any observed racial variation in the association between chronic conditions and functional limitations.

Method: The Health and Retirement Study data were used to assess whether race/ethnicity moderated the association between chronic conditions and functional limitations, and whether education, income, and/or wealth mediated any of the observed moderation by race/ethnicity.

Results: Results from structural equation models of latent growth curves with random onset indicated that (a) the positive association between chronic conditions and functional limitations onset was larger for African Americans and Hispanics than it was for Whites, but (b) this difference largely persisted net of socioeconomic status.

Discussion: African Americans and Hispanics endure a multiplicative double disadvantage in the early stages of the disablement process where they experience (a) a more rapid onset and higher levels of functional limitations, and (b) greater risk of functional limitation onset associated with chronic conditions compared to their White counterparts. Moreover, basic economic policies are unlikely to curtail the greater risk of functional limitations onset associated with chronic conditions encountered by African Americans and Hispanics.

%B Journals of Gerontology Series B: Psychological Sciences & Social Sciences %8 2018 Apr 16 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29669010?dopt=Abstract %R 10.1093/geronb/gby027 %0 Journal Article %J Innovation in Aging %D 2020 %T The Effect of Cognitive Impairment on Loneliness in Older Adulthood: Evidence From HRS 2008-2018 %A Ji Hyun Lee %A Martina Luchetti %A Angelina R Sutin %A Antonio Terracciano %K cognitive impairment %K Loneliness %X Background: People experience loneliness when there is a mismatch between desired and actual social interaction. Demographic and health factors have been implicated in loneliness; less is known about the unique association of cognitive impairment on loneliness in older adulthood. Purpose: This study examined the link between cognitive impairment status and level and change in loneliness over a 9-year period and whether it is independent of physical health, depression, and social isolation. We examine the associations for overall and the emotional and social loneliness sub-domains of loneliness. Methods: Data were from the Health and Retirement Study 2008-2018 waves (N = 8,269, age 50+). Cognitive impairment status was categorized using mTICS. Loneliness was measured with 11-item UCLA Loneliness scale. Multilevel modeling was used to analyze the effects of cognitive status on loneliness, controlling for time-varying functional limitation, disease burden, social contact, and depression. Results: Cognitive impairment not dementia (CIND) was associated with higher loneliness (b = .04, p < .001). CIND (b = .03, p = .036) and dementia (b = .09, p = .017) were linked to higher emotional loneliness but were not independent of social isolation and depression. Those with CIND had higher social loneliness (b = .04, p = .016), even after adjusting for covariates. The trajectory of loneliness did not vary by cognitive status. Conclusions: Cognitive impairment is a risk factor for loneliness among older adults. Those with mild cognitive impairment experienced heightened loneliness, especially for social belongingness. Cognitive function should be considered in designing interventions for loneliness. %B Innovation in Aging %V 4 %P 322 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.1031 %0 Journal Article %J Medical Care %D 2020 %T The Effect of Physical and Cognitive Impairments on Caregiving %A Jutkowitz, Eric %A Gozalo, Pedro %A Amal Trivedi %A Lauren L Mitchell %A Joseph E Gaugler %K Alzheimer disease %K cognitive impairment %K Dementia %X BACKGROUND: Many older adults receive caregiving; however, less is known about how a change in a care recipient's functional activity limitations [instrumental activities of daily living (IADL) and basic activities of daily living (ADL)] as well as their cognitive impairment influence the amount of caregiving received. METHODS: Using the Health and Retirement Study (2002-2014) we identified community-dwelling respondents with Alzheimer disease and related dementias (ADRD; n=674), cognitive impairment no dementia (CIND; n=530), and no cognitive impairment (n=6126). We estimated a series of two-part regression models to identify the association between care recipients' level of cognitive impairment, change in total number of IADL/ADL limitations and amount of caregiving received. RESULTS: Persons with ADRD received 235.8 (SD=265.6) monthly hours of care compared with 26.0 (SD=92.6) and 6.0 (SD=40.7) for persons with CIND and no cognitive impairment, respectively. An increase in one IADL/ADL limitation resulted in persons with ADRD and CIND receiving 4.90 (95% confidence interval: 3.40-6.39) and 1.43 (95% confidence interval: 0.17-2.69) more hours of caregiving than persons with no cognitive impairment. Increases in total IADL/ADL limitations were associated with persons with ADRD, but not CIND, receiving more days of caregiving and having more caregivers than persons with no cognitive impairment. CONCLUSIONS: Compared with persons with no cognitive impairment, increases in IADL/ADL limitations disproportionally increases the caregiving received for persons with ADRD. Policies and programs must pay attention to functional impairments among those living with ADRD. %B Medical Care %V 58 %P 601-609 %@ 0025-7079 %G eng %N 7 %9 Journal %R 10.1097/mlr.0000000000001323 %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 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 European Journal of Psychotraumatology %D 2020 %T Fact or artefact? Childhood adversity and adulthood trauma in the U.S. population-based Health and Retirement Study %A David Bürgin %A Cyril Boonmann %A Marc Schmid %A Paige Tripp %A Aoife O'Donovan %K Childhood adversity %K Trauma %X Background: Despite the well-known deleterious health effects of childhood adversity (CA) and adulthood trauma (AT) and ageing of the global population, little is known about self-reported CA and AT in older populations. Existing findings are mixed due to methodological and sampling artefacts, in particular, recall and selection biases, and due to age-period-cohort effects. Objectives: We aim to first, provide data on the prevalence of retrospective self-reported CA and AT in a large population-based sample of older adults and, second, to discuss the data in the context of major methodological and sampling artefacts, and age-period-cohort effects. Method: Data are derived from the U.S. population-based Health and Retirement Study (N = 19,547, mean age = 67.24 ± 11.33, 59% female). Seven birth-cohorts were included (<1924, 1924–1930, 1931–1941, 1942–1947, 1948–1953, 1954–1959, >1959).Results: Overall, 35% of participants reported CA and 62% AT, with strong variability among birth-cohorts. Opposing trends were observed regarding prevalence of CA and AT. As age of cohorts increased, prevalence of CAs decreased while that of ATs increased. Investigating the distributions of incidence of specific ATs across age and period per cohort revealed incidence of exposure was associated with (1) age (e.g. having lost a child), (2) time-period (e.g. major disaster), and (3) cohort (e.g. military combat). Conclusions: Retrospective self-reported CA and AT in older samples should be interpreted with caution and with regard to major methodological challenges, including recall and selection biases. Untangling fact from artefact and examining age, period, and cohort effects will help elucidate profiles of lifetime exposures in older populations. %B European Journal of Psychotraumatology %V 11 %P 1721146 %G eng %U https://doi.org/10.1080/20008198.2020.1721146 %R 10.1080/20008198.2020.1721146 %0 Journal Article %J Heart & Lung %D 2020 %T Falls in community-dwelling older adults with heart failure: A retrospective cohort study %A Kayoung Lee %A Matthew A. Davis %A John E. Marcotte %A Susan J Pressler %A Jersey Liang %A Nancy A. Gallagher %A Marita G. Titler %K Aging %K Falls %K Heart Failure %K Nursing %K Older Adults %X Background While heart failure (HF) in older adults is associated with fall risk, little is known about this in the U.S. Objective To examine the independent effect of functional impairments related to HF on falls among community-dwelling older adults in the U.S. Methods A retrospective cohort study was conducted with 17,712 community-dwelling older adults aged 65 and above with (n = 1693) and without HF, using mixed-effects logistic regression to examine the association between HF and falls. Results HF patients had 14% greater odds of falling than those without HF. Moreover, HF patients with functional difficulties in mobility, large muscle difficulty, instrumental activities of daily living difficulty, poor vision, and urinary incontinence demonstrated an increased likelihood of falling. Conclusion Community-dwelling older adults with HF and functional difficulties have a higher fall risk than those without HF, indicating that fall prevention programs should be developed, tested, and implemented for this population. %B Heart & Lung %G eng %U http://www.sciencedirect.com/science/article/pii/S014795631930559X %R https://doi.org/10.1016/j.hrtlng.2019.12.005 %0 Journal Article %J BMC Geriatrics %D 2020 %T Family caregiving in the community up to 8-years after onset of dementia %A Jutkowitz, Eric %A Joseph E Gaugler %A Amal Trivedi %A Lauren L Mitchell %A Gozalo, Pedro %K Alzheimer’s disease and related dementias %K Community based long-term care %K Health Services %K Public Health %X Background Persons with Alzheimer’s disease and related dementias (ADRD) receive care from family/friends, but how care changes from the onset of dementia remains less understood. Methods We used the Health and Retirement Study (2002–2012) to identify community-dwelling individuals predicted to have incident ADRD. We investigated the amount of caregiving received for activities of daily living in the 8-years after disease onset. Results At incidence (n = 1158), persons with ADRD received 151 h (SD = 231) of caregiving a month, 25 (SD = 26) caregiving days a month and had 1.3 (SD = 1.4) caregivers a month. By 8-years post incidence, 187 (16%) individuals transitioned to a nursing home and 662 (57%) died in the community. Community-dwelling persons with ADRD at 8-years post incidence (n = 30) received 283 h (SD = 257) of caregiving, 38 (SD = 24) caregiving days, and had 2.2 (SD = 1.3) caregivers. Conclusions Community-dwelling persons with ADRD receive a substantial amount of caregiving over the first 8-years after disease onset. %B BMC Geriatrics %V 20 %@ 1471-2318 %G eng %N 1 %R 10.1186/s12877-020-01613-9 %0 Journal Article %J Journal of the European Economic Association %D 2020 %T Genes, Education, and Labor Market Outcomes: Evidence from the Health and Retirement Study %A Nicholas Papageorge %A Thom, Kevin %K Childhood %K Education %K labor earnings %K polygenic score %K socioeconomic status %X Recent advances have led to the discovery of specific genetic variants that predict educational attainment. We study how these variants, summarized as a linear index—known as a polygenic score—are associated with human capital accumulation and labor market outcomes in the Health and Retirement Study (HRS). We present two main sets of results. First, we find evidence that the genetic factors measured by this score interact strongly with childhood socioeconomic status in determining educational outcomes. In particular, although the polygenic score predicts higher rates of college graduation on average, this relationship is substantially stronger for individuals who grew up in households with higher socioeconomic status relative to those who grew up in poorer households. Second, the polygenic score predicts labor earnings even after adjusting for completed education, with larger returns in more recent decades. These patterns suggest that the genetic traits that promote education might allow workers to better accommodate ongoing skill biased technological change. Consistent with this interpretation, we find a positive association between the polygenic score and nonroutine analytic tasks that have benefited from the introduction of new technologies. Nonetheless, the college premium remains a dominant determinant of earnings differences at all levels of the polygenic score. Given the role of childhood SES in predicting college attainment, this raises concerns about wasted potential arising from limited household resources. %B Journal of the European Economic Association %V 18 %P 1351 - 1399 %@ 1542-4766 %G eng %N 3 %R 10.1093/jeea/jvz072 %0 Journal Article %J Journal of Political Economy %D 2020 %T Genetic Endowments and Wealth Inequality. %A Barth, Daniel %A Papageorge, Nicholas W %A Thom, Kevin %K beliefs %K Education %K Genetics %K Inequality %K portfolio decisions %K Wealth %X

We show that genetic endowments linked to educational attainment strongly and robustly predict wealth at retirement. The estimated relationship is not fully explained by flexibly controlling for education and labor income. We therefore investigate a host of additional mechanisms that could account for the gene-wealth gradient, including inheritances, mortality, risk preferences, portfolio decisions, beliefs about the probabilities of macroeconomic events, and planning horizons. We provide evidence that genetic endowments related to human capital accumulation are associated with wealth not only through educational attainment and labor income, but also through a facility with complex financial decision-making.

%B Journal of Political Economy %V 128 %P 1474-1522 %G eng %N 4 %R 10.1086/705415 %0 Journal Article %J International Journal of Obesity %D 2020 %T Gene–obesogenic environment interactions on body mass indices for older black and white men and women from the Health and Retirement Study %A Mika D. Thompson %A Catherine M. Pirkle %A Youkhana, Fadi %A Wu, Yan Yan %K Genetics %K Obesity %K Risk Factors %X Background Gene–obesogenic environment interactions influence body mass index (BMI) across the life course; however, limited research examines how these interactions may differ by race and sex. Methods Utilizing mixed-effects models, we examined the interaction effects of a polygenic risk score (PGS) generated from BMI-associated single-nucleotide polymorphisms, and environmental factors, including age, physical activity, alcohol intake, and childhood socioeconomic status on measured longitudinal BMI from the Health and Retirement Study (HRS). HRS is a population representative survey of older adults in the United States. This study used a subsample of genotyped Black (N = 1796) and White (N = 4925) men and women (50–70 years) with measured BMI. Results Higher PGS was associated with higher BMI. The association between PGS and BMI weakened as individuals aged among White men (Pinteraction = 0.0383) and White women (Pinteraction = 0.0514). The mean BMI difference between the 90th and 10th PGS percentile was 4.25 kg/m2 among 50-year-old White men, and 3.11 kg/m2 among the 70 years old’s, i.e., a 1.14 kg/m2 (95% CI: −0.27, 2.82) difference. The difference among 50- and 70-year-old White women was 1.34 kg/m2 (95% CI: 0.09, 2.60). In addition, the protection effect of physical activity was stronger among White women with higher PGS (Pinteraction = 0.0546). Vigorous physical activity (compared with never) was associated with 1.66 kg/m2 (95% CI: 1.06, 2.29) lower mean BMI among those in the 90th PGS percentile, compared with 0.83 kg/m2 (95% CI: 0.37, 1.29) lower among those in the 10th PGS percentile. Interactions were also observed between both PGS and alcohol intake among White men (Pinteraction = 0.0034) and women (Pinteraction = 0.0664) and Black women (Pinteraction = 0.0108), and PGS and childhood socioeconomic status among White women (Pinteraction = 0.0007). Conclusions Our findings reinforce the importance of physical activity among those with an elevated genetic risk; additionally, other detected interactions may underscore the influence of broader social environments on obesity-promoting genes. %B International Journal of Obesity %@ 1476-5497 %G eng %U https://www.nature.com/articles/s41366-020-0589-4.epdf?sharing_token=dcGoy9qOloYheiOIjgiIw9RgN0jAjWel9jnR3ZoTv0OdnAxNnZKvDHpc27CbgU2Vj5CTrCekNuiSilBXKwZO8PfWIY-1LXuNTi1FOUmVF52AILTnAcluAAWEMu2pbuhw358vUoIeJpg_mgNlFNU3xCmKKSsDHaZ_ChoP4QpkEGI%3D %! International Journal of Obesity %R 10.1038/s41366-020-0589-4 %0 Journal Article %J Translational Psychiatry %D 2020 %T Genome-wide association study of cognitive function in diverse Hispanics/Latinos: results from the Hispanic Community Health Study/Study of Latinos. %A Jian, Xueqiu %A Sofer, Tamar %A Wassim Tarraf %A Bressler, Jan %A Jessica Faul %A Zhao, Wei %A Scott M Ratliff %A Lamar, Melissa %A Lenore J Launer %A Laurie, Cathy C %A Schneiderman, Neil %A David R Weir %A Wright, Clinton B %A Kristine Yaffe %A Zeng, Donglin %A DeCarli, Charles %A Thomas H Mosley %A Smith, Jennifer A %A Hector M González %A Myriam Fornage %K Aged %K Cognition %K Genome-Wide Association Study %K Hispanic or Latino %K Humans %K Middle Aged %K Neuropsychological tests %K Public Health %K Ubiquitin-Conjugating Enzymes %X

Cognitive function such as reasoning, attention, memory, and language is strongly correlated with brain aging. Compared to non-Hispanic whites, Hispanics/Latinos have a higher risk of cognitive impairment and dementia. The genetic determinants of cognitive function have not been widely explored in this diverse and admixed population. We conducted a genome-wide association analysis of cognitive function in up to 7600 middle aged and older Hispanics/Latinos (mean = 55 years) from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL). Four cognitive measures were examined: the Brief Spanish English Verbal Learning Test (B-SEVLT), the Word Fluency Test (WFT), the Digit Symbol Substitution Test (DSST), the Six-Item Screener (SIS). Four novel loci were identified: one for B-SEVLT at 4p14, two for WFT at 3p14.1 and 6p21.32, and one for DSST at 10p13. These loci implicate genes highly expressed in brain and previously connected to neurological diseases (UBE2K, FRMD4B, the HLA gene complex). By applying tissue-specific gene expression prediction models to our genotype data, additional genes highly expressed in brain showed suggestive associations with cognitive measures possibly indicating novel biological mechanisms, including IFT122 in the hippocampus for SIS, SNX31 in the basal ganglia for B-SEVLT, RPS6KB2 in the frontal cortex for WFT, and CSPG5 in the hypothalamus for DSST. These findings provide new information about the genetic determinants of cognitive function in this unique population. In addition, we derived a measure of general cognitive function based on these cognitive tests and generated genome-wide association summary results, providing a resource to the research community for comparison, replication, and meta-analysis in future genetic studies in Hispanics/Latinos.

%B Translational Psychiatry %V 10 %P 245 %G eng %N 1 %R 10.1038/s41398-020-00930-2 %0 Journal Article %J Research in Human Development %D 2020 %T Glycosylated Hemoglobin Level, Race/Ethnicity, and Cognition in Midlife and Early Old Age %A Ortiz, Kasim %A Marc Garcia %A Emily Briceño %A Diminich, Erica D. %A Arévalo, Sandra P. %A Vega, Irving E. %A Wassim Tarraf %K biomarker data %K cognitive function %K Racial/ethnic differences %X Empirical evidence linking racial/ethnic differences in glycosylated hemoglobin levels (HbA1c) to cognitive function in midlife and early old age is limited. We use biomarker data from the Health and Retirement Study (HRS, 2006?2014), on adults 50?64 years at baseline (57?73 years by 2014), and fit multinomial logistic regression models to assess the association between baseline HbA1c, cognitive function (using Langa?Weir classifications) and mortality across 8 years. Additionally, we test for modification effects by race/ethnicity. In age- and sex-adjusted models high HbA1c level was associated with lower baseline cognition and higher relative risk ratios (RRR; vs. normal cognition) for cognitive impairment no dementia (CIND; RRR = 2.3; 95%CI = [1.38;3.84]; p < .01), and dementia (RRR = 4.00; 95%CI = [1.76;9.10]; p < .01). Adjusting for sociodemographic, behavioral risk factors, and other health conditions explained the higher RRR for CIND and attenuated the RRR for dementia by approximately 30%. HbA1c levels were not linked to the slope of cognitive decline, and we found no evidence of modification effects for HbA1c by race/ethnicity. Targeting interventions for glycemic control in the critical midlife period can protect baseline cognition and buffer against downstream development of cognitive impairment. This can yield important public health benefits and reductions in burdens associated with cognitive impairment, particularly among race/ethnic minorities who are at higher risk for metabolic diseases. %B Research in Human Development %V 17 %P 20 - 40 %@ 1542-7609 %G eng %N 1 %R 10.1080/15427609.2020.1743810 %0 Journal Article %J Journal of the American Medical Directors Association %D 2020 %T Handgrip Strength Asymmetry and Weakness May Accelerate Time to Mortality in Aging Americans %A Ryan P McGrath %A Grant R Tomkinson %A Dain P. LaRoche %A Brenda Vincent %A Colin W. Bond %A Kyle J Hackney %K Death %K Frailty %K Geriatric Assessment %K Muscle Strength %K muscle strength dynamometer %X Objectives Assessing handgrip strength (HGS) asymmetry may provide insights into HGS as a prognostic assessment of strength capacity and vitality. This study sought to determine the associations of HGS asymmetry and weakness on time to mortality in aging Americans. Design Longitudinal panel. Setting Secondary analyses of data from participants aged ≥50 years from the 2006‒2014 waves of the Health and Retirement Study. Participants The analytic sample included 19,325 Americans who identified hand dominance and had measures of HGS for both hands in a single wave. Measures A handgrip dynamometer was used to measure HGS. Men and women who were considered weak had HGS <26 kg and <16 kg, respectively. The highest HGS values from the dominant and nondominant hands were used to calculate HGS ratio: (nondominant HGS/dominant HGS). Those with HGS ratio <0.90 or >1.10 had any HGS asymmetry. Moreover, participants with HGS ratio <0.90 had dominant HGS asymmetry, whereas those with HGS ratio >1.10 had nondominant HGS asymmetry. The National Death Index and postmortem interviews verified date of death. Covariate-adjusted Cox models were used for analyses. Results Those with any HGS asymmetry had a 1.10 [95% confidence interval (CI) 1.03‒1.17] higher hazard for mortality, while those with weakness had a 1.44 (CI 1.32‒1.58) higher hazard for mortality. Likewise, participants with dominant HGS asymmetry had a 1.11 (CI 1.03‒1.18) higher hazard for mortality, and those with weakness had a 1.45 (CI 1.32‒1.58) higher hazard for mortality; however, the association was not significant for those with nondominant HGS asymmetry (hazard ratio: 1.07; CI 0.96‒1.18). Conclusions and Implications HGS asymmetry and weakness are markers of impaired strength capacity that independently accelerate time to mortality, but the magnitude of these associations was more prominent for weakness. Nevertheless, assessments of asymmetric HGS are a simple adjunct analysis that may show promise for increasing the prognostic value of handgrip dynamometers. %B Journal of the American Medical Directors Association %G eng %R 10.1016/j.jamda.2020.04.030 %0 Journal Article %J Collabra: Psychology %D 2020 %T Is Healthy Neuroticism Associated with Health Behaviors? A Coordinated Integrative Data Analysis %A Graham, Eileen %A Sara J Weston %A Nicholas A. Turiano %A Damaris Aschwanden %A Booth, Tom %A Harrison, Fleur %A James, Byran %A Nathan A Lewis %A Makkar, Steven %A Mueller, Swantje %A Wisniewski, Kristi %A Yoneda, Tomiko %A Zhaoyang, Ruixue %A Avron Spiro III %A Willis, Sherry %A K. Warner Schaie %A Sliwinski, Martin %A Lipton, Richard %A Katz, Mindy %A Ian J Deary %A Elizabeth Zelinski %A David A Bennett %A Sachdev, P S %A Brodaty, H %A Troller, Julian %A Ames, David %A Margaret J Wright %A Denis Gerstorf %A Allemand, Mathias %A Drewelies, Johanna %A Wagner, Gert G %A Muniz-Terrera, Graciela %A Andrea M Piccinin %A Scott M Hofer %A Daniel K. Mroczek %K Coordinated IDA %K Health behaviors %K Healthy Neuroticism %X Current literature suggests that neuroticism is positively associated with maladaptive life choices, likelihood of disease, and mortality. However, recent research has identified circumstances under which neuroticism is associated with positive outcomes. The current project examined whether “healthy neuroticism”, defined as the interaction of neuroticism and conscientiousness, was associated with the following health behaviors: smoking, alcohol consumption, and physical activity. Using a pre-registered multi-study coordinated integrative data analysis (IDA) approach, we investigated whether “healthy neuroticism” predicted the odds of engaging in each of the aforementioned activities. Each study estimated identical models, using the same covariates and data transformations, enabling optimal comparability of results. These results were then meta-analyzed in order to estimate an average (N-weighted) effect and to ascertain the extent of heterogeneity in the effects. Overall, these results suggest that neuroticism alone was not related to health behaviors, while individuals higher in conscientiousness were less likely to be smokers or drinkers, and more likely to engage in physical activity. In terms of the healthy neuroticism interaction of neuroticism and conscientiousness, significant interactions for smoking and physical activity suggest that the association between neuroticism and health behaviors was smaller among those high in conscientiousness. These findings lend credence to the idea that healthy neuroticism may be linked to certain health behaviors and that these effects are generalizable across several heterogeneous samples. %B Collabra: Psychology %V 6 %G eng %N 1 %R http://doi.org/10.1525/collabra.266 %0 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 Conference Paper %D 2020 %T Income-poor but Asset-rich: Effect of housing wealth on older adults’ healthcare utilization %A Tran, My %A Gannon, Brenda %A Rose, Christiern %K healthcare utilization %K Housing wealth %K Identification %X Do wealthier individuals use more healthcare services than those less affluent? We investigate this question by exploiting the booms and busts in the U.S. housing market – a natural experiment that generated considerable gains and losses for homeowners. We estimate the effect of wealth on older adults’ healthcare utilization using the Instrumental Variables (IVs) approach with the region - year variations in house prices and households’ loan-to-value (LTV) ratios to construct an instrument. As a robustness check for count-valued outcomes, we employ a new method of identification using heteroskedasticity (Lewbel, 2012). This method may be used to estimate a count model with endogenous regressors, where external instruments are not available. Using data from the 1996-2014 Health and Retirement Study (HRS), we find that an increase in wealth lowers the probability of hospital admissions, visits to doctors, prescription drug use, outpatient surgery and the use of special facilities or services. On the other hand, an increase in wealth leads to a higher probability of using dental services. At the intensive margin, the number of doctor visits decreases in response to positive wealth shock, but there is no significant effect on the number of nights in hospital. Overall, we find consistent evidence that wealthier individuals demand fewer health services but they have more out-of-pocket health expenditures compared to less wealthy individuals. %I IZA Institute of Labor Economics %G eng %U http://conference.iza.org/conference_files/UniDuisburg_2020/tran_m29963.pdf %0 Journal Article %J Annals of Behavioral Medicine %D 2020 %T Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability %A Courtney A Polenick %A Kira S. Birditt %A Turkelson, Angela %A Helen C Kales %K Chronic illness %K Disability %K multimorbidity %K Spouses %X Multiple chronic conditions may erode physical functioning, particularly in the context of complex self-management demands and depressive symptoms. Yet, little is known about how discordant conditions (i.e., those with management requirements that are not directly related and increase care complexity) among couples are linked to functional disability.We evaluated own and partner individual-level discordant conditions (i.e., discordant conditions within individuals) and couple-level discordant conditions (i.e., discordant conditions between spouses), and their links to levels of and change in functional disability.The U.S. sample included 3,991 couples drawn from nine waves (1998–2014) of the Health and Retirement Study. Dyadic growth curve models determined how individual-level and couple-level discordant conditions were linked to functional disability over time, and whether depressive symptoms moderated these links. Models controlled for age, minority status, education, each partner’s baseline depressive symptoms, and each partner’s number of chronic conditions across waves.Wives and husbands had higher initial disability when they had their own discordant conditions and when there were couple-level discordant conditions. Husbands also reported higher initial disability when wives had discordant conditions. Wives had a slower rate of increase in disability when there were couple-level discordant conditions. Depressive symptoms moderated links between disability and discordant conditions at the individual and couple levels.Discordant chronic conditions within couples have enduring links to disability that partly vary by gender and depressive symptoms. These findings generate valuable information for interventions to maintain the well-being of couples managing complex health challenges. %B Annals of Behavioral Medicine %V 54 %P 455 - 469 %@ 0883-6612 %G eng %N 7 %R 10.1093/abm/kaz061 %0 Journal Article %J Research in Human Development %D 2020 %T Interactive Effects of Chronic Health Conditions And Financial Hardship On Episodic Memory Among Older Blacks: Findings From The Health And Retirement Study %A Byrd, DeAnnah R. %A Gonzales, Ernest %A Beatty Moody, Danielle L. %A Gillian L Marshall %A Laura B Zahodne %A Roland J. Thorpe Jr. %A Keith E Whitfield %K Chronic disease %K Cognition %K Financial hardship %X Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the 2006 Health and Retirement Study . Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p = .010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks. %B Research in Human Development %V 17 %P 41 - 56 %8 2020/01/02 %@ 1542-7609 %G eng %N 1 %R 10.1080/15427609.2020.1746159 %0 Journal Article %J American Economic Association Papers and Proceedings %D 2020 %T Legal Access to Reproductive Control Technology, Women’s Education, and Earnings Approaching Retirement %A Jason Lindo %A Mayra Pineda-Torres %A David Pritchard %A Hedieh Tajali %K Reproduction %K Retirement Planning %K women's education %K Women's Health %X What do historical changes in legal access to reproductive health care technology tell us about the long-run effects of such changes? We investigate this question using data from the Health and Retirement Study and an identification strategy leveraging variation in exposure to legal changes in access across cohorts born in the same states. We find positive effects on educational attainment that align with prior work but are not statistically significant. We also find positive effects on working in a Social Security-covered job in women's 20s and 30s but no evidence of positive effects on women's earnings in their 50s. %B American Economic Association Papers and Proceedings %V 110 %P 231-35 %G eng %R 10.1257/pandp.20201108 %0 Report %D 2020 %T The Life-Course Association of Birth-Weight Genes with Self-rated Health %A Guangyu Tong %A Guo, Guang %K Birth Weight %K Birth-weight Genes; Life Course %K Gene Cohort Interaction %K Gene-Age Interaction %K Generalized Estimating Equations %K Self-rated health %X This study examines the impact of genes associated with normal-range birth weight (2500 – 4500 grams) on self-rated health in mid-to-late life course. Fifty-eight previously identified genetic variants that explain the variation in the normal-range birth weight were used to construct a genetic measure of birth weight for the non-Hispanic white sample from the Health and Retirement Study. Our results show that the genetic tendency towards higher birth weight predicts better self-rated health in mid-to-late life course net of various demographic, socioeconomic, and health behavioral factors. When predicting health, birth-weight genes also exert heterogeneous effects across birth cohorts and age groups. Moreover, to clarify the paradox that higher birth weight can predict both better self-rated health and higher BMI, we show the positive association between birth weight genes and BMI can only hold within the normal-range BMI (18 ≤BMI <30). Overall, these findings suggest the genetic factors underlying the normal-range birth weight can have life-course impacts on health. %I Duke University %C Durham %G eng %U https://www.researchgate.net/profile/Guangyu_Tong/publication/341131391_The_Life-Course_Association_of_Birth-Weight_Genes_with_Self-rated_Health/links/5eb02ebf92851cb267732ac9/The-Life-Course-Association-of-Birth-Weight-Genes-with-Self-rated-Health.pdf %0 Journal Article %J The Journals of Gerontology: Series B %D 2020 %T Loneliness and Risk of Dementia %A Angelina R Sutin %A Yannick Stephan %A Martina Luchetti %A Antonio Terracciano %K Dementia %K Depressive symptoms %K Loneliness %K Risk Factors %X Objective The present study tests whether loneliness is associated with risk of dementia in the largest sample to date and further examines whether the association is independent of social isolation, a related but independent component of social integration, and whether it varies by demographic factors and genetic vulnerability. Method Participants from the Health and Retirement Study (N = 12,030) reported on their loneliness, social isolation, and had information on clinical, behavioral, and genetic risk factors. Cognitive status was assessed at baseline and every 2 years over a 10-year follow-up with the modified Telephone Interview for Cognitive Status (TICSm). A TICSm score of 6 or less was indicative of dementia. Results Cox proportional hazards regression indicated that loneliness was associated with a 40% increased risk of dementia. This association held controlling for social isolation, and clinical, behavioral, and genetic risk factors. The association was similar across gender, race, ethnicity, education, and genetic risk. Discussion Loneliness is associated with increased risk of dementia. It is one modifiable factor that can be intervened on to reduce dementia risk. %B The Journals of Gerontology: Series B %V 75 %P 1414-1422 %G eng %N 7 %R 10.1093/geronb/gby112 %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 Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco %D 2020 %T Longitudinal and Reciprocal Relationships Between Psychological Well-Being and Smoking %A Lappan, S. %A Thorne, C.B. %A Long, D. %A Hendricks, P.S. %K Adult %K Aged %K Article %K Education %K Female %K human %K Life Satisfaction %K Male %K Middle Aged %K Optimism %K people by smoking status %K psychological well-being %K Retirement %K Smoking cessation %K structural equation modeling %X INTRODUCTION: Smoking cessation treatments currently succeed at a rate of approximately 20%-30%, underscoring the importance of exploring factors that might increase intervention effectiveness. Although negative affect has been studied extensively in relation to smoking cessation, psychological well-being (PWB; eg, life satisfaction, optimism, positive affect, purpose in life) has received little attention. This study tested longitudinal and reciprocal relationships between PWB and smoking status in older adults. METHODS: Panel data were obtained from the biennial, longitudinal Health and Retirement Study. Using structural equation modeling, we developed cross-lagged models to examine the relationships of PWB in 2006 with smoking status in 2010 and of smoking status in 2006 with PWB in 2010 while controlling for covariates (Ns = 2939-4230, 55% women, 89% white, mean age = 64 years, mean years of education = 13, 25% smokers in 2006 and 21% smokers in 2010). Separate cross-lagged models were developed for each of the PWB variables: life satisfaction, optimism, positive affect, and purpose in life. RESULTS: Greater life satisfaction (standardized path coefficient = -0.04), optimism (standardized path coefficient = -0.07), and positive affect (standardized path coefficient = -0.08) in 2006 predicted a reduced likelihood of smoking in 2010. Being a smoker in 2006 predicted lower life satisfaction (standardized path coefficient = -0.25), optimism (standardized path coefficient = -0.10), positive affect (standardized path coefficient = -0.10), and purpose in life (standardized path coefficient = -0.13) in 2010. CONCLUSIONS: Findings warrant further exploration of the relationships between PWB and smoking, and support the incorporation of PWB-boosting components into existing treatments. IMPLICATIONS: Given the relatively low success rate of current smoking cessation treatments, the present results suggest that increasing PWB might promote abstinence and therefore warrant consideration as a focus of future cessation treatment research. Moreover, these results suggest that smoking might inhibit PWB, illuminating a negative consequence of smoking not previously identified. Helping smokers increase their PWB may benefit them beyond promoting cessation and contribute to a flourishing society. These results warrant further investigation of PWB and smoking, and support the continued evaluation of PWB-boosting components in smoking cessation treatments. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. %B Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco %V 22 %P 18-23 %G eng %R 10.1093/ntr/nty185 %0 Journal Article %J Innovation in Aging %D 2020 %T Longitudinal Daily Living Limitations and Cognitive Status: Results from the 1998-2016 Health and Retirement Study %A Wu, Benson %A Toseef, Mohammad Usama %A Wassim Tarraf %A Stickel, Ariana %A Kaur, Sonya %A Ramos, Alberto %A Hector M González %K cognition impairment %K midlife health %K older health outcomes %X Data increasingly points to midlife health and modifiable risk factors as critical targets for improving older-age health outcomes and mitigating potential cognitive impairment and disease. We used biennial Health and Retirement Study data (1998-2016) collected on adults ages 50-64 years who did not meet criteria for dementia at baseline and who remained living by 2016 (unweighted-n=4,803). Cognitive status was defined using Langa-Weir criteria: Normal, Cognitively Impaired Not Dementia (CIND), and Dementia. We examined how 18-year patterns in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) predicted cognitive status in 2016. We used latent class analysis to extract longitudinal phenotypes of activities limitations, followed by survey multinomial logistic regressions to examine their associations with cognitive status and test for race/ethnic modifications. We identified three groups of functional impairment: (1) gradually increasing (15.7%), (2) stable elevated (5.6%), and (3) minimal dysfunction (78.7%). After covariates adjustment, both the gradual and stable elevated impairment groups (vs. minimal) had substantially higher relative risk ratios (RRR) for dementia (RRR=5.71[3.89;8.39] and RRR=7.87[4.23,14.64]) and CIND (RRR=2.21 [1.69,2.88] and RRR=1.92[1.16;3.17]). We detected modifications by race/ethnicity such that Hispanics with stable elevated impairment had a higher probability of dementia compared to their White counterparts. The results varied for Blacks and did not significantly differ from Whites. Data-driven methods may improve our understanding of heterogeneous functional impairment patterns among late middle-aged adults and allow for tailored ADRD prevention strategies. Focused risk-based interventions can yield important public health savings and reductions in structural, social, and individual health burdens. %B Innovation in Aging %V 4 %P 897 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.3306 %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 %X

With 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 %X

Smoking is a major heritable and modifiable risk factor for many diseases, including cancer, common respiratory disorders and cardiovascular diseases. Fourteen genetic loci have previously been associated with smoking behaviour-related traits. We tested up to 235,116 single nucleotide variants (SNVs) on the exome-array for association with smoking initiation, cigarettes per day, pack-years, and smoking cessation in a fixed effects meta-analysis of up to 61 studies (up to 346,813 participants). In a subset of 112,811 participants, a further one million SNVs were also genotyped and tested for association with the four smoking behaviour traits. SNV-trait associations with P < 5 × 10 in either analysis were taken forward for replication in up to 275,596 independent participants from UK Biobank. Lastly, a meta-analysis of the discovery and replication studies was performed. Sixteen SNVs were associated with at least one of the smoking behaviour traits (P < 5 × 10) in the discovery samples. Ten novel SNVs, including rs12616219 near TMEM182, were followed-up and five of them (rs462779 in REV3L, rs12780116 in CNNM2, rs1190736 in GPR101, rs11539157 in PJA1, and rs12616219 near TMEM182) replicated at a Bonferroni significance threshold (P < 4.5 × 10) with consistent direction of effect. A further 35 SNVs were associated with smoking behaviour traits in the discovery plus replication meta-analysis (up to 622,409 participants) including a rare SNV, rs150493199, in CCDC141 and two low-frequency SNVs in CEP350 and HDGFRP2. Functional follow-up implied that decreased expression of REV3L may lower the probability of smoking initiation. The novel loci will facilitate understanding the genetic aetiology of smoking behaviour and may lead to the identification of potential drug targets for smoking prevention and/or cessation.

%B Molecular Psychiatry %V 25 %P 2392-2409 %G eng %N 10 %R 10.1038/s41380-018-0313-0 %0 Report %D 2020 %T Molecular Genetics, Risk Aversion, Return Perceptions, and Stock Market Participation %A Sias, Richard %A Starks, Laura %A Turtle, Harry J. %K Genetics %K return perceptions %K Risk Aversion %K stock market participation %X We show that molecular variation in DNA related to cognition, personality, health, and body shape, predicts an individual’s equity market participation and risk aversion. Moreover, the molecular genetic endowments predict individuals’ return perceptions, most of which we find to be strikingly biased. The genetic endowments also strongly associate with many of the investor characteristics (e.g., trust, sociability, wealth) shown to explain heterogeneity in equity market participation. Our analysis helps elucidate why financial choices are heritable and how genetic endowments can help explain the links between financial choices, risk aversion, beliefs, and other variables known to explain stock market participation. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w27638 %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 %X

OBJECTIVES: 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 Journal Article %J GENES BRAIN AND BEHAVIOR %D 2020 %T Polygenic score for neuroticism is related to sleep difficulties %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Antonio Terracciano %K Neuroticism %K polygenic score %K sleep quality %X Neuroticism, a broad trait measure of the tendency to experience negative emotions and vulnerability to stress, is consistently related to poor sleep quality. Less is known about potential pleiotropy in the genetic risk for high neuroticism and poor sleep. Therefore, the present study examined whether polygenic score (PGS) for neuroticism is related to sleep quality in two large samples of adults. In addition, depressive symptoms, anxiety and phenotypical neuroticism were tested as mediators in both samples. Participants were 8316 individuals aged from 50 to 101 years (mean age = 68.29, SD = 9.83) from the Health and Retirement Study, and 4973 individuals aged from 63 to 67 years (mean age = 64.30, SD = 0.68) from the Wisconsin Longitudinal Study. Participants from both samples were genotyped and answered questions on sleep quality. A higher PGS for neuroticism was related to lower sleep quality concurrently and over time in both samples. Anxiety, depressive symptoms and neuroticism mediated these relationships in the two samples. Although effect sizes were small, the present study provides replicable evidence that individuals with a higher genetic predisposition to experience negative emotions and distress are at risk of sleep difficulties. %B GENES BRAIN AND BEHAVIOR %P e12644 %G eng %9 Article; Early Access %R 10.1111/gbb.12644 %0 Journal Article %J Journal of Alzheimer's disease : JAD %D 2020 %T Predicting Cognitive Impairment and Dementia: A Machine Learning Approach %A Damaris Aschwanden %A Aichele, S. %A Ghisletta, P. %A Antonio Terracciano %A Kliegel, M. %A Angelina R Sutin %A Justin Brown %A Allemand, M. %K Aging %K cognitive impairment %K Cox proportional hazard survival analysis %K Dementia %K Machine learning %K Protective factors %K random forest survival analysis %K Risk Factors %X BACKGROUND: Efforts to identify important risk factors for cognitive impairment and dementia have to date mostly relied on meta-analytic strategies. A comprehensive empirical evaluation of these risk factors within a single study is currently lacking. OBJECTIVE: We used a combined methodology of machine learning and semi-parametric survival analysis to estimate the relative importance of 52 predictors in forecasting cognitive impairment and dementia in a large, population-representative sample of older adults. METHODS: Participants from the Health and Retirement Study (N = 9,979; aged 50-98 years) were followed for up to 10 years (M = 6.85 for cognitive impairment; M = 7.67 for dementia). Using a split-sample methodology, we first estimated the relative importance of predictors using machine learning (random forest survival analysis), and we then used semi-parametric survival analysis (Cox proportional hazards) to estimate effect sizes for the most important variables. RESULTS: African Americans and individuals who scored high on emotional distress were at relatively highest risk for developing cognitive impairment and dementia. Sociodemographic (lower education, Hispanic ethnicity) and health variables (worse subjective health, increasing BMI) were comparatively strong predictors for cognitive impairment. Cardiovascular factors (e.g., smoking, physical inactivity) and polygenic scores (with and without APOEɛ4) appeared less important than expected. Post-hoc sensitivity analyses underscored the robustness of these results. CONCLUSIONS: Higher-order factors (e.g., emotional distress, subjective health), which reflect complex interactions between various aspects of an individual, were more important than narrowly defined factors (e.g., clinical and behavioral indicators) when evaluated concurrently to predict cognitive impairment and dementia. %B Journal of Alzheimer's disease : JAD %V 75 %P 717-728 %G eng %N 3 %R 10.3233/JAD-190967 %0 Journal Article %J Health Economics %D 2020 %T Predicting quantity and quality of life with the Future Elderly Model. %A Leaf, Duncan Ermini %A Tysinger, Bryan %A Dana P Goldman %A Darius Lakdawalla %K forecasting and prediction methods %K model evaluation %K simulation methods %K validation and selection %X

The Future Elderly Model (FEM) is a microsimulation model designed to forecast health status, longevity, and a variety of economic outcomes. Compared to traditional actuarial models, microsimulation models provide greater opportunities for policy forecasting and richer detail, but they typically build upon smaller samples of data that may mitigate forecasting accuracy. We perform validation analyses of the FEM's mortality and quality of life forecasts using a version of the FEM estimated exclusively on early waves of data from the Health and Retirement Study. First, we compare FEM mortality and longevity projections to the actual mortality and longevity experience observed over the same period of time. We also compare the FEM results to actuarial forecasts of mortality and longevity during the same time. We find that FEM projections are generally in line with observed mortality rates and closely match longevity. Then, we assess the FEM's performance at predicting quality of life and longitudinal outcomes, two features missing from traditional actuarial models. Our analysis suggests the FEM performs at least as well as actuarial forecasts of mortality, while providing policy simulation features that are not available in actuarial models.

%B Health Economics %8 2020 Oct 07 %G eng %R 10.1002/hec.4169 %0 Journal Article %J JAMA Network Open %D 2020 %T Prehospital and Posthospital Fall Injuries in Older US Adults %A Geoffrey J Hoffman %A Mary Tinetti %A Ha, Jinkyung %A Neil B. Alexander %A Lillian C. Min %K Fall injury %K Hospitalization %K Medicare %X To date, measurement and treatment of older adult fall injury has been siloed within specific care settings, such as a hospital or within a nursing home or community. Little is known about changes in fall risk across care settings. Understanding the occurrence of falls across settings has implications for measuring and incentivizing high-value care across care settings.To estimate the risk of older adult fall injury within and across discrete periods during a 12-month care episode anchored by an acute hospitalization.This cohort study is a longitudinal analysis of 12-month periods that include an anchor hospital stay using national data from 2006 to 2014. Participants included older (aged ≥65 years) Medicare fee-for-service beneficiaries from the Health and Retirement Study. Weekly fall injury rates were computed for 4 periods compared with the anchor hospitalization: at baseline (1-6 months before hospitalization), just before (<1 month before hospitalization), just after (<1 month after hospitalization), and at follow-up (1-6 months after hospitalization). Piecewise logistic regression models estimated weekly marginal risk of fall injury within each period, adjusting for sociodemographic and health characteristics. Fall injury risks for high-risk beneficiaries with a fall injury during the anchor hospitalization were also estimated. Data analysis was performed from November 2019 to April 2020.Fall injuries.In total, 10 106 anchor hospitalizations for 4101 beneficiaries (mean [SD] age, 77.1 [7.6] years; 5912 hospitalizations among women [58.5%]) were identified. The overall fall injury risk was 0.77%. In adjusted models, marginal increases in weekly fall injury risk just before hospitalization (0.27 percentage points [95% CI, 0.22 to 0.33 percentage points], or 30.0%; P < .001) were 4 times greater than decreases just after hospitalization (−0.18 percentage points [95% CI, −0.23 to −0.13 percentage points], or −9.2%; P < .001)]. A greater risk differential before and after hospitalization was observed for patients with an inpatient fall injury (1.89 percentage points [95% CI, 1.37 to 2.40], or 309.8%; P < .001; vs −0.39 percentage points [95% CI, −0.73 to −0.04], or −11.6%; P = .03).An episode-based assessment of fall injury illustrates substantial variability in period-specific risks over an extended period including an anchor hospitalization. Risk transitions between periods include sizable increases just before hospitalization that do not fully subside after hospital discharge. Financial incentives to coordinate hospital and posthospital care for patients at risk for fall injury are needed. These could include bundled payments for fall injury episodes that incentivize coordination across settings. %B JAMA Network Open %V 3 %@ 2574-3805 %G eng %N 8 %R https://doi.org/10.1001/jamanetworkopen.2020.13243 %0 Journal Article %J Aging & Mental Health %D 2020 %T The price of mental well-being in later life: the role of financial hardship and debt %A Gillian L Marshall %A Eva Kahana %A William T Gallo %A Kim L. Stansbury %A Stephen M Thielke %K Anxiety %K Debt %K depression %K Financial hardship %K Mental Health %X Objective: This study investigated the associations between various financial hardship and debt indicators and mental health status among older adults. Methods: Using data from the Health and Retirement Study (HRS), we considered the association between different forms of financial hardship and debt of those who were identified as having high levels of depressive symptoms (N = 7678) and anxiety (N = 8079). Financial hardship indicators: difficulty paying bills, food insecurity, and medication need; debt indicators: credit card and medical debt. Associations were tested using multiple logistic regression analyses and are reported as relative risk (RR) ratios and 95% confidence intervals (CIs). Results: Participants who had difficulty paying bills were more likely to have high levels of depressive symptoms (RR = 2.06, CI = 1.75–2.42, p < 0.001) and anxiety (RR = 1.46, CI = 1.02–2.05, p < 0.001) compared to those who did not have financial difficulty. Similarly, medical debt was associated with depressive symptoms (RR = 1.43, CI = 1.14–1.74, p < 0.01) and anxiety (RR = 1.20, CI = 0.96–1.50, p < 0.01). Credit card debt was not significantly associated with either mental health outcome. Conclusion: Indicators of financial hardship and medical debt were associated with depressive symptoms and anxiety in a cohort of older adults. In contrast, the influence of credit card debt appeared to be more complex and vary by individual. These findings indicate that doing without meeting personal salient needs has a particularly adverse effect on psychological well-being. %B Aging & Mental Health %P 1-7 %G eng %R 10.1080/13607863.2020.1758902 %0 Journal Article %J Journal of Research in Personality %D 2020 %T Psychological and Social Functioning Are Associated with Reports of Perceived Weight Discrimination Across Eight Years %A Angelina R Sutin %A Mary A Gerend %A Maner, Jon K. %A Yannick Stephan %A Antonio Terracciano %K Loneliness %K Obesity %K Perceived Discrimination %K Personality %K Social contact %K Stigma %X This research uses the Health and Retirement Study to identify psychological and social factors that prospectively predict new reports of perceived weight discrimination among individuals who measure in the obese weight category. Participants (Mage=66.89, SD=8.33; 58% women) reported on their personality and social isolation, had a body mass index (BMI)≥30, reported no perceived weight discrimination at baseline, and completed at least one assessment over the up to 8-year follow-up (N=3,064). Eleven percent of participants reported new experiences of perceived weight discrimination. Higher Neuroticism and loneliness at baseline were associated with new reports; Conscientiousness was protective. This research adds to models of weight stigma by identifying psychological and social factors that contribute to reporting new instances of perceived weight discrimination. %B Journal of Research in Personality %@ 0092-6566 %G eng %R https://doi.org/10.1016/j.jrp.2020.104002 %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 Research in Human Development %D 2020 %T Race/Ethnic Differences in Social Resources as Cognitive Risk and Protective Factors %A Katz, Benjamin %A Turney, Indira %A Ji Hyun Lee %A Amini, Reza %A Kristine J. Ajrouch %A Toni C Antonucci %K Cognition %K HCAP %K Race/ethnicity %K social network %X Overall social network size, often the sum of common lifetime relationships, including children, family, and friends, has been linked to cognitive impairment and Alzheimer?s Disease. However, little research has examined the association between network size composition and cognitive function in middle-aged and older adults in the context of race/ethnicity. We investigated the associations between the number of close children, family, and friends independently with executive function (EF) and memory across a subsample of non-Hispanic Black, Hispanic, and non-Hispanic White participants who completed the Health and Retirement Study Harmonized Cognitive Assessment Protocol (N = 2,395). We found that network size composition was more closely linked to EF than memory and that these associations varied by race/ethnicity. Specifically, the strongest associations existed between EF and quadratic estimates of the number of close children of non-Hispanic Black participants, and number of close family members for Hispanic participants. Among Black participants, a curvilinear relationship indicated that two close children were associated with greater EF, while a smaller or larger number of close children were associated with lower EF. On the other hand, among Hispanic participants, higher EF was associated with fewer (0?1) and greater (4-5+) numbers of family member contacts. Overall, these results indicate that examining children, family, and friends independently may be more useful than the common practice of aggregation of overall network size, especially in the context of race/ethnicity. %B Research in Human Development %V 17 %P 57-77 %@ 1542-7609 %G eng %N 1 %R 10.1080/15427609.2020.1743809 %0 Journal Article %J PSYCHOSOMATIC MEDICINE %D 2020 %T The Relation of Optimism to Relative Telomere Length in Older Men and Women %A Eric S Kim %A Hilary A Tindle %A Laura D Kubzansky %A Liu, Simin %A Duncan, Meredith S. %A JoAnn E Manson %A Springfield, Sparkle %A Salmoirago-Blotcher, Elena %A Shadyab, Aladdin H. %A Liu, Buyun %A Grodstein, Francine %A De Vivo, Immaculata %K Aging %K Optimism %K psychological well-being %K Telomere length %X Objective Mounting evidence suggests that higher optimism is associated with reduced risk of age-related morbidities and premature mortality. However, possible biological mechanisms underlying these associations remain understudied. One hypothesized mechanism is a slower rate of cellular aging, which in turn delays age-related declines in health. Methods We used data from two large cohort studies to test the hypothesis that higher optimism is associated with longer leukocyte telomere length. With cross-sectional data from the Health and Retirement Study (HRS; n = 6417; mean age = 70 years) and the Women's Health Initiative (WHI; N = 3582; mean age = 63 years), we used linear regression models to examine the association of optimism with relative telomere length (assessed in leukocytes from saliva [HRS] or plasma [WHI]). Models adjusted for sociodemographics, depression, health status, and health behaviors. Results Considering both optimism and telomere length as continuous variables, we found consistently null associations in both cohorts, regardless of which covariates were included in the models. In models adjusting for demographics, depression, comorbidities, and health behaviors, optimism was not associated with mean relative telomere length (HRS: beta = -0.002, 95% confidence interval = -0.014 to 0.011; WHI: beta = -0.004, 95% confidence interval = -0.017 to 0.009). Conclusions Findings do not support mean telomere length as a mechanism that explains observed relations of optimism with reduced risk of chronic disease in older adults. Future research is needed to evaluate other potential biological markers and pathways. %B PSYCHOSOMATIC MEDICINE %V 82 %P 165-171 %G eng %U https://journals.lww.com/psychosomaticmedicine/Abstract/2020/02000/The_Relation_of_Optimism_to_Relative_Telomere.6.aspx %N 2 %9 Article %R 10.1097/PSY.0000000000000764 %0 Report %D 2020 %T Replication Data for: Legal Access to Reproductive Control Technology, Women's Education, and Earnings Approaching Retirement %A Jason Lindo %A Mayra Pineda-Torres %A David Pritchard %A Hedieh Tajali %K abortion %K contraception %K Earnings %K Education %K Social Security %X We investigate how historical changes in contraception and abortion access impact women’s long-run outcomes. We use data from the Health and Retirement Study and an identification strategy that leverages variation in exposure to legal changes in access across cohorts born in the same states during the 1960s and 1970s. We follow the methodology of Bailey, Hershbein, and Miller (2012), who used the National Longitudinal Survey of Young Women and documented significant increases in contraception use at ages 18-20 associated with unmarried women’s ability to consent for contraception at such ages. They also documented increased educational attainment and increased earnings in women’s 30s and 40s associated with this confidential access to contraception. Our analysis revisits the effects on education and earnings. We also investigate the sensitivity of the estimated impacts to the legal coding and control variables used in Myers’ (2017) study of the effects on fertility and marriage. The results for educational attainment align with prior work but are not statistically significant. The results for earnings indicate increases in the probability of working in a Social Security (SS) covered job in women’s 20s and 30s associated with early access to contraception and abortion, but we find no evidence of positive effects on women’s earnings in their 50s. %B AEA Papers and Proceedings %I American Economic Association %C Nashville, TN %P 231–35 %G eng %R https://doi.org/10.1257/pandp.20201108 %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 The Gerontologist %D 2020 %T Self-Perceptions of Aging: Factorial Structure and Invariance by Gender %A Turner, Shelbie G %A Hooker, Karen %A G John Geldhof %K Confirmatory factor analyses %K Measurement %K Views on aging %X Self-perceptions of aging (SPA)—the appraisals people place on their own aging processes—predict well-being in later life. Researchers are increasingly hypothesizing that the overarching construct of SPA is comprised of two factors—positive SPA and negative SPA—and that SPA are gendered. The purpose of this study was to empirically test the hypothesized two-factor structure of SPA and to analyze how the two-factor structure varies between men and women.Data come from the 2012 wave of the Health and Retirement Study (N = 7,029; Mage = 68.08), which includes an 8-item SPA scale. We used confirmatory factor analysis (CFA) to assess (i) the positive SPA and negative SPA two-factor solution for the 8-item scale and (ii) whether the two-factor solution had configural, strong, or weak invariance across men and women.CFAs indicated a two-factor latent structure of the 8-item scale, with SPA being comprised of both a positive SPA factor and a negative SPA factor. The latent structure was the same for both men and women.Results suggest that SPA is a broader construct made up of positive and negative latent factors. Researchers should consider separating the SPA by positive and negative factors to analyze how each factor uniquely shapes health. Moreover, the two-factor solution was equivalent across men and women, possibly because of the generalized nature of the 8-item scale. Researchers can use the 8-item scale similarly for men and women and should continue to elucidate possible gender differences in SPA. %B The Gerontologist %8 2020 %@ 0016-9013 %G eng %R 10.1093/geront/gnaa059 %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 %X

BACKGROUND: 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 Journal Article %J Age and Ageing %D 2020 %T Self-reported vision and hallucinations in older adults: results from two longitudinal US health surveys %A Ali G Hamedani %A Thibault, Dylan P %A Shea, Judy A %A Allison W Willis %K blindness %K Hallucinations %K Health Surveys %K Older adult %K Proxy %K self-report %K vision %X Vision loss may be a risk factor for hallucinations, but this has not been studied at the population level.To determine the association between self-reported vision loss and hallucinations in a large community-based sample of older adults, we performed a cross-sectional and longitudinal analysis of two large, nationally representative US health surveys: the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Visual impairment and hallucinations were self- or proxy-reported. Multivariate single and mixed effects logistic regression models were built to examine whether visual impairment and history of cataract surgery were associated with hallucinations.In NHATS (n = 1520), hallucinations were more prevalent in those who reported difficulty reading newspaper print (OR 1.77, 95\% confidence interval (CI): 1.32–2.39) or recognising someone across the street (OR 2.48, 95\% CI: 1.86–3.31) after adjusting for confounders. In HRS (n = 3682), a similar association was observed for overall (OR 1.32, 95\% CI: 1.08–1.60), distance (OR 1.61, 95\% CI: 1.32–1.96) and near eyesight difficulties (OR 1.52, 95\% CI: 1.25–1.85). In neither sample was there a significant association between cataract surgery and hallucinations after adjusting for covariates.Visual dysfunction is associated with increased odds of hallucinations in the older US adult population. This suggests that the prevention and treatment of vision loss may potentially reduce the prevalence of hallucinations in older adults. %B Age and Ageing %G eng %U https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afaa043/5816673 %9 Journal %R 10.1093/ageing/afaa043 %0 Journal Article %J Innovation in Aging %D 2020 %T Sleep Difficulties and Cognition over a 10-Year Period in a National Sample of U.S. Older Adults %A Robbins, Rebecca %A Amanda Sonnega %A Robert W. Turner %A Jean-Louis, Girardin %A Butler, Mark %A Osorio, Ricardo M %A Kenneth M. Langa %K cognitive function %K Gerontology %K healthy aging %K Sleep %K Translational medicine %X Sleep difficulties are common among older adults and are associated with cognitive decline. We used data from a large, nationally representative longitudinal survey of adults over the age of 50 in the U.S. to examine the relationship between specific sleep difficulties and cognitive function over time.Longitudinal data from the 2004-2014 waves of the Health and Retirement Study were used in the current study. We examined sleep difficulties and cognitive function within participants and across time (n=16,201). Sleep difficulty measures included difficulty initiating sleep, nocturnal awakenings, early morning awakenings, and waking feeling rested from rarely/never (1) to most nights (3). The modified Telephone Interview for Cognitive Status (TICS-m) was used to measure cognitive function. Generalized Linear Mixed Models (GLMM) were used with time varying covariates to examine the relationship between sleep difficulties and cognitive function over time.In covariate-adjusted models, compared to “never” reporting sleep difficulty, difficulty initiating sleep “most nights” was associated with worse cognitive function over time (Year 2014: b=-0.40, 95%CI: -0.63 to -0.16, p<.01) as was difficulty waking up too early “most nights” (Year 2014: b=-0.31, 95%CI: -0.56 to -0.07, p<.05). In covariate-adjusted analyses, compared to “never” reporting waking up feeling rested, cognitive function was higher among those who reported waking up feeling rested “some nights” (Year 2010: b=0.21, 95%CI: 0.02 to 0.40, p<.05).Our findings highlight an association between early morning awakenings and worse cognitive function, but also an association between waking feeling rested and better cognitive function over time.Sleep difficulties are common among older adults yet reduce quality of life and also contribute to the development of and potentially accelerate cognitive decline. This study examines specific sleep difficulties (e.g., difficulty falling asleep) and their unique relationship to cognition over time among older adults in the U.S. The primary aim of this work is to illuminate the specific sleep difficulties that are most concerning from the standpoint of cognitive impairment so as to inform the design of future tailored sleep improvement programs for older adults. %B Innovation in Aging %@ 2399-5300 %G eng %R 10.1093/geroni/igaa025 %0 Journal Article %J Clinical Social Work Journal %D 2020 %T Social isolation’s influence on loneliness among older adults. %A Harry Owen Taylor %K Loneliness %K No terms assigned %K Older Adults %K social isolation %K Social networks %X Social isolation and loneliness are significant risks to health among older adults. Previous studies have found a significant association between social isolation and loneliness; however, few studies examined the association between social isolation and loneliness in a multivariate context and how specific types of social isolation influence loneliness. This study fills this gap by examining social isolation’s overall influence on loneliness and how specific social isolation indicators influence loneliness. Data comes from 2014 Wave of the Health and Retirement Study, a nationally representative study of adults aged 50 and older. Social isolation was operationalized using seven indicators as social isolation from: (1) adult–children, (2) other family members, (3) friends, (4) living alone, (5) being unmarried, and (6) not participating in social groups or (7) religious activities. Loneliness was operationalized by the Hughes 3-item loneliness scale. Loneliness was regressed on social isolation and key socio-demographic factors. Results found when social isolation indicators were combined into an index, every unit increase in overall social isolation was associated with an increase in loneliness. Furthermore older adults who were isolated from other family members and from friends, lived alone, were single, and did not participate in social groups or religious activities reported greater loneliness. Study findings demonstrate that greater overall social isolation and specific social isolation indicators are associated with greater loneliness. Clinical practice with older adults can be enhanced by understanding the connections between social isolation and loneliness and which forms of social isolation are more meaningful for perceived loneliness. %B Clinical Social Work Journal %V 48 %P 140-151 %G eng %R https://doi.org/10.1007/s10615-019-00737-9 %0 Journal Article %J Innovation in Aging %D 2020 %T Social Support and Depressive Outcomes in Older Adults: An Analysis of the Health and Retirement Study %A Julia E Tucker %A Nicholas J Bishop %K depressive outcomes %K Social Support %X Given population aging and impact of both spousal and social support on the health of older adults, the protective role of social support amongst recently bereaved older adults represents an important area of research. The aim of this study is to identify the relationship between recent widowhood and change in depressive symptoms in older adults, and how social support moderates this association. Utilizing observations from the nationally representative Health and Retirement Study, the analytic sample consisted of 2,890 adults age 50 and over who were partnered or married in 2012. Depression was measured using the Center for Epidemiological Studies Depression scale short form (CESD-8). Positive social support was measured as perceived social support from family, friends, and children. Widowhood was a dichotomous measure indicating mortality of spouse between 2012 and 2014. Autoregressive multiple regression was used to determine if widowhood was associated with change in depression from 2012-2104 and whether positive social support moderated this relationship. Widowhood was associated with an increase in depressive symptoms from 2012-2014 (b=0.967, SE=0.145, p <.001) and social support was negatively associated with change in depression (b=-0.021, SE=0.004, p <.001). Social support appeared to moderate the association between widowhood and change in depression (b=0.068, SE=0.026, p =.010), though widowed older adults with higher social support appear to have more rapid increase in depression than those with lower social support. These preliminary findings and implications for supporting bereaved older adults will be discussed. %B Innovation in Aging %V 4 %P 69 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.226 %0 Journal Article %J The Journals of Gerontology Series B: Psychological Sciences & Social Sciences %D 2020 %T Trajectories of Aging among US Older Adults: Mixed Evidence for a Hispanic Paradox. %A Wassim Tarraf %A Gail A Jensen %A Heather E Dillaway %A Priscilla M Vásquez %A Hector M González %K Aging trajectories %K cognitive aging %K healthy aging %K Hispanic paradox %K Immigrant health %X

Objectives: A well-documented paradox is that Hispanics tend to live longer than non-Hispanic Whites (NHW), despite structural disadvantages. We evaluate whether the "Hispanic paradox" extends to more comprehensive longitudinal aging classifications and examine how lifecourse factors relate to these groupings.

Methods: We used biennial data (1998-2014) on adults 65-years and older at baseline from the Health and Retirement Study. We use joint latent class discrete time and growth curve modeling to identify trajectories of aging, and multinomial logit models to determine whether US-born (USB-H) and Foreign-born (FB-H) Hispanics experience healthier styles of aging than non-Hispanic Whites (NHW), and test how lifecycle factors influence this relationship.

Results: We identify four trajectory classes including, "cognitive unhealthy," "high morbidity," "non-accelerated", and "healthy." Compared to NHWs, both USB-H and FB-H have higher relative risk ratios (RRR) of "cognitive unhealthy" and "high morbidity" classifications, relative to "non-accelerated." These patterns persist upon controlling for lifecourse factors. Both Hispanic groups, however, also have higher RRRs for "healthy" classification (vs. "non-accelerated") upon adjusting for adult achievements and health behaviors.

Discussion: Controlling for lifefcourse factors USB-H and FB-H have equal or higher likelihood for "high morbidity" and "cognitive unhealthy" classifications, respectively, relative to NHWs. Yet, both groups are equally likely of being in the "healthy" group compared to NHWs. These segregations into healthy and unhealthy groups require more research and could contribute to explaining the paradoxical patterns produced when population heterogeneity is not taken into account.

%B The Journals of Gerontology Series B: Psychological Sciences & Social Sciences %V 75 %P 601-612 %G eng %U https://apps.webofknowledge.com/InboundService.do?product=WOS&Func=Frame&DestFail=https%3A%2F%2Fwww.webofknowledge.com&SrcApp=search&SrcAuth=Alerting&SID=8BR9UbZLRdbYq1kUVAS&customersID=Alerting&mode=FullRecord&IsProductCode=Yes&AlertId=2547ce2d-b446-4503 %N 3 %9 Journal %1 http://www.ncbi.nlm.nih.gov/pubmed/29788310?dopt=Abstract %R 10.1093/geronb/gby057 %0 Report %D 2020 %T TRENDS IN THE USE OF RESIDENTIAL SETTINGS AMONG OLDER ADULTS ISSUE BRIEF %A Toth, Matthew %A Palmer, Lauren A. Martin %A Lawren E. Bercaw %A Voltmer, Helena %A Sarita Karon %K Health Services %K housing services %K Older Adults %X This brief presents data on the estimated change in the size of residential care population and characteristics of older adults within different settings. %I U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy %C Washington, D.C. %G eng %U https://aspe.hhs.gov/basic-report/trends-use-residential-settings-among-older-adults-issue-brief %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 Behav Med %D 2020 %T When Is Hope Enough? Hopefulness, Discrimination and Racial/Ethnic Disparities in Allostatic Load. %A Uchechi A Mitchell %A Dellor, Elinam D %A Sharif, Mienah Z %A Lauren L Brown %A Jacqueline M Torres %A Ann W Nguyen %K Aging %K physiological dysregulation %K psychosocial resources %K Resilience %K stress and coping %X

Hopefulness is associated with better health and may be integral for stress adaptation and resilience. Limited research has prospectively examined whether hopefulness protects against physiological dysregulation or does so similarly for U.S. whites, blacks and Hispanics. We examined the association between baseline hopefulness and future allostatic load using data from the Health and Retirement Study (n = 8,486) and assessed differences in this association by race/ethnicity and experiences of discrimination. Four items measured hopefulness and allostatic load was a count of seven biomarkers for which a respondent's measured value was considered high-risk for disease. A dichotomous variable assessed whether respondents experienced at least one major act of discrimination in their lifetime. We used Poisson regression to examine the association between hopefulness and allostatic load and included a multiplicative interaction term to test racial/ethnic differences in this association. Subsequent analyses were stratified by race/ethnicity and tested the interaction between hopefulness and discrimination within each racial/ethnic group. Hopefulness was associated with lower allostatic load scores, but its effects varied significantly by race/ethnicity. Race-stratified analyses suggested that hopefulness was protective among whites and not associated with allostatic load among Hispanics irrespective of experiencing discrimination. Hopefulness was associated with lower allostatic load among blacks reporting discrimination but associated with higher allostatic load among those who did not. Findings suggest that hopefulness plays differing roles for older whites, blacks and Hispanics and, for blacks, its protective effects on physiological dysregulation are intricately tied to their experiences of discrimination.

%B Behav Med %V 46 %P 189-201 %G eng %N 3-4 %R 10.1080/08964289.2020.1729086 %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 Pension Economics and Finance %D 2019 %T The Affordable Care Act as retiree health insurance: implications for retirement and Social Security claiming %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Affordable Care Act %K Pensions %K Policy %K Retirement Planning and Satisfaction %K Social Security %X This paper investigates the effects of the Affordable Care Act (ACA) on retirement. The first part of the paper is a difference-in-difference analysis of changes in retirement (and retirement expectations) before and after adoption of the ACA. We find no statistically significant evidence that ACA increased the propensity to retire or changed retirement expectations. The second part of the analysis is based on a structural retirement model. For those age 50 at the time ACA was introduced, the overall reduction in full-time work over the age span 54–65 is simulated to be about 0.1 percentage points. Data are from the Health and Retirement Study. %B Journal of Pension Economics and Finance %V 18 %P 415-449 %G eng %U https://www.cambridge.org/core/journals/journal-of-pension-economics-and-finance/article/affordable-care-act-as-retiree-health-insurance-implications-for-retirement-and-social-security-claiming/24601D49E42B0714381FC2B9F4D55D10 %N 3 %9 Journal %! Journal of Pension Economics and Finance %R 10.1017/S1474747218000033 %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 %X

Introduction: 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 Web Page %D 2019 %T Are pre-retirees in the gig economy prepared for retirement? %A Thornton, Nick %K Economy %K Retirement Planning %X For some in the so-called gig economy, independence has not meant sacrificing retirement savings. But they're a minority, a Pew Charitable Trusts study finds. %B Benefits Pro %I Benefits Pro %V 2019 %G eng %U https://www.benefitspro.com/2019/09/13/are-pre-retirees-in-the-gig-economy-prepared-for-retirement/?slreturn=20190830174151 %9 tABLOID %0 Journal Article %J Nature Genetics %D 2019 %T Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. %A Liu, Mengzhen %A Jiang, Yu %A Wedow, Robbee %A Li, Yue %A Brazel, David M %A Chen, Fang %A Datta, Gargi %A Davila-Velderrain, Jose %A McGuire, Daniel %A Tian, Chao %A Zhan, Xiaowei %A Choquet, Hélène %A Docherty, Anna R %A Jessica Faul %A Foerster, Johanna R %A Fritsche, Lars G %A Gabrielsen, Maiken Elvestad %A Gordon, Scott D %A Jeffrey Haessler %A Jouke-Jan Hottenga %A Huang, Hongyan %A Jang, Seon-Kyeong %A Philip R Jansen %A Ling, Yueh %A Mägi, Reedik %A Matoba, Nana %A McMahon, George %A Mulas, Antonella %A Orrù, Valeria %A Palviainen, Teemu %A Anita Pandit %A Reginsson, Gunnar W %A Skogholt, Anne Heidi %A Smith, Jennifer A %A Taylor, Amy E %A Turman, Constance %A Gonneke Willemsen %A Young, Hannah %A Young, Kendra A %A Zajac, Gregory J M %A Zhao, Wei %A Zhou, Wei %A Bjornsdottir, Gyda %A Boardman, Jason D %A Boehnke, Michael %A Dorret I Boomsma %A Chen, Chu %A Francesco Cucca %A Davies, Gareth E %A Charles B Eaton %A Ehringer, Marissa A %A Tõnu Esko %A Fiorillo, Edoardo %A Gillespie, Nathan A %A Gudbjartsson, Daniel F %A Haller, Toomas %A Kathleen Mullan Harris %A Andrew C Heath %A Hewitt, John K %A Hickie, Ian B %A Hokanson, John E %A Hopfer, Christian J %A Hunter, David J %A Iacono, William G %A Johnson, Eric O %A Kamatani, Yoichiro %A Sharon L R Kardia %A Matthew C Keller %A Kellis, Manolis %A Charles Kooperberg %A Kraft, Peter %A Krauter, Kenneth S %A Laakso, Markku %A Penelope A Lind %A Loukola, Anu %A Lutz, Sharon M %A Pamela A F Madden %A Nicholas G Martin %A McGue, Matt %A Matthew B McQueen %A Sarah E Medland %A Andres Metspalu %A Mohlke, Karen L %A Nielsen, Jonas B %A Okada, Yukinori %A Peters, Ulrike %A Tinca J Polderman %A Posthuma, Danielle %A Reiner, Alexander P %A Rice, John P %A Rimm, Eric %A Rose, Richard J %A Runarsdottir, Valgerdur %A Stallings, Michael C %A Stančáková, Alena %A Stefansson, Hreinn %A Thai, Khanh K %A Hilary A Tindle %A Tyrfingsson, Thorarinn %A Wall, Tamara L %A David R Weir %A Weisner, Constance %A Whitfield, John B %A Winsvold, Bendik Slagsvold %A Yin, Jie %A Zuccolo, Luisa %A Laura Bierut %A Hveem, Kristian %A Lee, James J %A Munafò, Marcus R %A Saccone, Nancy L %A Willer, Cristen J %A Marilyn C Cornelis %A David, Sean P %A Hinds, David A %A Jorgenson, Eric %A Kaprio, Jaakko %A Stitzel, Jerry A %A Stefansson, Kari %A Thorgeirsson, Thorgeir E %A Gonçalo R Abecasis %A Liu, Dajiang J %A Scott Vrieze %K Alcohol Drinking %K Female %K Genetic Variation %K Genome-Wide Association Study %K Humans %K Male %K Middle Aged %K Phenotype %K Risk %K Smoking %K Tobacco %K Tobacco Use Disorder %X

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders. They are heritable and etiologically related behaviors that have been resistant to gene discovery efforts. In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures.

%B Nature Genetics %V 51 %P 237-244 %G eng %N 2 %R 10.1038/s41588-018-0307-5 %0 Report %D 2019 %T Bequest Motives and the Social Security Notch %A Siha Lee %A Kegon T. K. Tan %K Assets %K Bequests %K late life savings %K Social Security %X Bequests may be a key driver of late life savings behavior and more broadly, a determinant of intergenerational inequality. However, distinguishing bequest motives from precautionary savings is challenging. Using data from the Health and Retirement Study, we exploit an unanticipated change in Social Security benefits, commonly called the Social Security Notch, as an instrument to identify the effect of benefits on bequests. We show that an increase in benefits leads to a sizable increase in bequest amounts. We combine our instrumental variable estimates with a model of late life savings behavior that accounts for mortality risk and unobserved expenditure shocks to identify bequest motives. The model is used to analyze two counterfactuals. The results demonstrates the importance of bequest motives as a driver of late life savings by comparing asset profiles with and without utility from bequests. We find that roughly one-third of accumulated assets and bequests are attributable to bequest motives among retirees. Our second counterfactual features a more progressive Social Security benefits schedule that reduces benefits for the richest retirees. We show that although wealth declines, consumption remains largely unchanged since wealth generated by bequest motives acts as a cushion against benefit reduction. %I Human Capital and Economic Opportunity Global Working Group %G eng %U https://ideas.repec.org/p/hka/wpaper/2019-061.html %0 Journal Article %J Psychology & Health %D 2019 %T Change in weight and personality in middle-aged and older adults. %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K health %K longitudinal %K No terms assigned %K Personality %K weight %X Objective: Personality is associated with weight change and the development of obesity across adulthood. The present study examines whether significant weight change, including weight loss and weight gain, is related to personality change in a large longitudinal sample of middle-aged and older adults.Design: Participants were adults aged 50–92 years (N > 5000; 59% women, Mean age= 65.51, SD= 8.20) drawn from the Health and Retirement Study (HRS). Personality, demographic, health and staff assessed weight and height were obtained at baseline and 8 years later.Main Outcome Measures: Personality traits.Results: Both weight loss and weight gain greater than 10% of baseline weight were related to a steeper decline in extraversion, openness and conscientiousness. Weight loss was further associated with the maintenance of neuroticism and to a steeper decline in agreeableness. This overall pattern of personality change was also associated with both unhealthy and healthy weight change. The associations were not moderated by BMI and generally remained significant after accounting for disease burden.Conclusion: The present study provides new evidence that both weight loss and weight gain are related to change in personality. %B Psychology & Health %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31631712 %R 10.1080/08870446.2019.1679372 %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 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 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 %X

High blood pressure (BP) is a major risk factor for cardiovascular disease (CVD) and is more prevalent in African Americans as compared to other US groups. Although large, population-based genome-wide association studies (GWAS) have identified over 300 common polymorphisms modulating inter-individual BP variation, largely in European ancestry subjects, most of them do not localize to regions previously identified through family-based linkage studies. This discrepancy has remained unexplained despite the statistical power differences between current GWAS and prior linkage studies. To address this issue, we performed genome-wide linkage analysis of BP traits in African-American families from the Family Blood Pressure Program (FBPP) and genotyped on the Illumina Human Exome BeadChip v1.1. We identified a genomic region on chromosome 1q31 with LOD score 3.8 for pulse pressure (PP), a region we previously implicated in DBP studies of European ancestry families. Although no reported GWAS variants map to this region, combined linkage and association analysis of PP identified 81 rare and low frequency exonic variants accounting for the linkage evidence. Replication analysis in eight independent African ancestry cohorts (N = 16,968) supports this specific association with PP (P = 0.0509). Additional association and network analyses identified multiple potential candidate genes in this region expressed in multiple tissues and with a strong biological support for a role in BP. In conclusion, multiple genes and rare variants on 1q31 contribute to PP variation. Beyond producing new insights into PP, we demonstrate how family-based linkage and association studies can implicate specific rare and low frequency variants for complex traits.

%B European Journal of Human Genetics %V 27 %P 269-277 %G eng %N 2 %R 10.1038/s41431-018-0277-1 %0 Journal Article %J 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 Gerontology & Geriatric Medicine %D 2019 %T Do race and everyday discrimination predict mortality risk? Evidence from the Health and Retirement Study. %A Heather R. Farmer %A Linda A. Wray %A Jason R Thomas %K Discrimination %K Mortality %K Racial/ethnic differences %X Everyday discrimination is a potent source of stress for racial minorities, and is associated with a wide range of negative health outcomes, spanning both mental and physical health. Few studies have examined the relationships linking race and discrimination to mortality in later life. We examined the longitudinal association among race, everyday discrimination, and all-cause mortality in 12,081 respondents participating in the Health and Retirement Study. Cox proportional hazards models showed that everyday discrimination, but not race, was positively associated with mortality; depressive symptoms and lifestyle factors partially accounted for the relationship between everyday discrimination and mortality; and race did not moderate the association between everyday discrimination and mortality. These findings contribute to a growing body of evidence on the role that discrimination plays in shaping the life chances, resources, and health of people, and, in particular, minority members, who are continuously exposed to unfair treatment in their everyday lives. %B Gerontology & Geriatric Medicine %V 5 %P 2333721419855665 %8 2019 Jan-Dec %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31276018?dopt=Abstract %R 10.1177/2333721419855665 %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 %X

Objectives: 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 GERIATRICS %D 2019 %T Education as the Great Equalizer? Racial and Ethnic Differences in the Effect of Education on Cognitive Impairment in Later Life %A Kyler J. Sherman-Wilkins %A Amy D Thierry %K cognitive functioning %K cognitive impairment %K Education %K Racial/ethnic differences %X Though evidence suggests that the prevalence of cognitive impairment has declined, there still exists a disproportionate burden of ill cognitive health for people of color. In this paper, we test two alternative mechanisms to explain the interactive effect of education and race/ethnicity on cognitive impairment risk: the minority poverty and diminishing returns hypotheses. Drawing on data from the 2012 wave of the Health and Retirement Study (HRS) (n = 8093), we estimate logistic regression models to determine differential effects of education on cognitive impairment. We find that non-Hispanic black and Mexican American older adults have higher odds of being cognitively impaired compared to whites, though the ethnic difference (whites vs. Mexican Americans) is mediated by education. Further, we find that while high levels of education are protective against cognitive impairment at older ages, it is more protective for non-Hispanic blacks than for whites and more protective for whites than Mexican Americans. Lastly, we find that racial/ethnic disparities are widest at lower levels of education, consistent with the minority poverty hypothesis. We conclude that the results herein highlight the importance of attending to how factors that are protective for cognitive functioning (e.g., education) may operate differently across racial and ethnic groups. %B GERIATRICS %V 4 %P UNSP 51 %8 SEP %G eng %9 Article %R 10.3390/geriatrics4030051 %0 Journal Article %J Gerontologist %D 2019 %T Effects of age discrimination on self-perceptions of aging and cancer risk behaviors. %A Hooker, Karen %A Shannon T. Mejia %A Sandi Phibbs %A Erwin J Tan %A Stevens, Jonathan %K Ageism %K Cancer %K Discrimination %K Racial/ethnic differences %X

BACKGROUND AND OBJECTIVES: Almost one-third of older adults report experiencing age discrimination. We hypothesized sequential links between older adults' everyday experiences of age discrimination and future health behaviors related to cancer risk through self-perceptions of aging (SPA).

RESEARCH DESIGN AND METHODS: Participants were community-dwelling respondents (age: 51-96 years) from the 2008, 2012, and 2014 waves of the Health and Retirement Study (N = 4,467). Generalized path models estimated the immediate and enduring effects of age discrimination in 2008 on proximal SPA in 2012 and distal health behaviors in 2014.

RESULTS: Age discrimination was associated with lower positive SPA and higher negative SPA in 2012. The effect of age discrimination on physical activity, smoking, and drinking in 2014 was mediated by positive and negative SPA in 2012. Through subsequent SPA, those who experienced age discrimination in 2008 were less likely to engage in regular moderate physical activity, more likely to smoke, and less likely to drink more than 3 times per week in 2014. Analysis of change in positive and negative SPA showed the effect of age discrimination on physical activity to be mediated by change in positive, but not negative, SPA.

DISCUSSION AND IMPLICATIONS: The enduring effects of age discrimination were found through a reduction in positive SPA. Elevating positive SPA could be as important as reducing negative SPA for future health behaviors related to cancer risk.

%B Gerontologist %V 59 %P S28-S37 %G eng %N Suppl 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/31100138?dopt=Abstract %R 10.1093/geront/gny183 %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 %X

BACKGROUND: 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 Thesis %B Economics %D 2019 %T Essays in Macroeconomics and Labor Economics %A Tan,Fu %K 0501:Economics %K 0510:Labor economics %K Economics %K Information technology %K Labor economics %K Life-cycle %K Long-term Care %K Medicaid %K Medicare %K Occupational employment %K Social Sciences %X The first chapter studies the interaction between family insurance and social insurance. In particular, this paper assesses the value of Medicaid for recent retirees in insuring against long-term care risks while taking into account child-to-parent transfers. Parent retirees receive substantial transfers in the forms of informal care and financial transfers from children. To understand the role of upward intergenerational insurance for old-age health risks, I develop a dynamic model for parent-child pairs and childless retirees. A vital feature of the model is that a parent and her child interact strategically to make decisions about transfers in a non-cooperative game. I estimate and calibrate the model to match the Health and Retirement Study (HRS) data. Using the calibrated model, I calculate the insurance values of Medicaid relative to its cost for retirees and child households. Compensating variation calculations suggest that childless retirees value every dollar of Medicaid insurance at $2.20, which is twice the value for parent retirees ($1.10). Furthermore, I find that middle-income parent retirees value Medicaid insurance less than poor and wealthy parent retirees. An additional result of the paper is that child households also value Medicaid. This decomposition provides a new consideration for the efficient design of Medicaid benefits, particularly in light of a growing population aging without children. The second chapter studies the role of medical expenditure risks in elderly consumption choices. Old-age medical expenditure risks have been documented to have significant impacts on elderly savings. However, little is known about the consumption effects of elderly medical expenditure risks. In this study, we examine the effect of medical expenditure risk on elderly household consumption behaviors. We identify the causal effect by exploiting the exogenous reduction in prescription drug spending risk as a result of the introduction of Medicare Part D in the U.S. in 2006. Using the Health and Retirement Study (HRS) data during 2004–2010, we find that declining medical expenditure risks had little impact on total consumption, regardless of nondurable or durable consumption. The third chapter explores the reasons why the growth rate of non-routine cognitive occupations employment has significantly declined during 2000–2014, compared to 1985–2000. I propose and test the hypothesis that tasks related to information gathering and processing have been substituted by recent information technology after 2000. For that, I develop a model of production process. A novel feature of the model is that outputs are produced using a set of tasks, which combine occupation-specific labor and capital inputs. Recent information technological change is modeled as the declines in the occupation-specific cost of capital. I estimate the conditional labor and product demand using U.S. data. Results of the estimation show that the cost of capital, which is used with occupations related to information gathering and processing in production, has declined faster after 2000. My work contributes to the job polarization literature by documenting and exploring the new dynamics of technological change. %B Economics %I University of Wisconsin-Madison %V PhD %P 119 %@ 9781392287149 %G eng %9 phd %0 Journal Article %J Journal of Aging and Health %D 2019 %T Evaluations of a previous day as a pathway between personality and healthy cognitive aging %A Angelina R Sutin %A Yannick Stephan %A Damaris Aschwanden %A Martina Luchetti %A Jason E Strickhouser %A Antonio Terracciano %K Cognition & Reasoning %K Personality %K Self Report %X

OBJECTIVE: To examine the association between Five-Factor Model personality traits and how individuals evaluate a recent day in their lives (yesterday) and whether these evaluations mediate personality and cognitive function over time.

METHODS: Participants were a subsample from the Health and Retirement Study who completed personality measures in 2008/2010, the day evaluation in 2011, and cognitive tasks in 2012 ( N = 3,454).

RESULTS: Lower Neuroticism and Higher Extraversion, Openness, Agreeableness, and Conscientiousness were associated with a more engaging day, fewer negative feelings, better subjective health, and less time spent alone. Active engagement and subjective health were associated with cognitive function and mediated the prospective associations between Neuroticism, Openness, and Conscientiousness and cognitive function.

DISCUSSION: Personality is associated with how individuals evaluated their previous day, which contributes to cognition over time. The present research contributes to a mechanistic model that aims to identify pathways through which personality contributes to cognitive aging.

%B Journal of Aging and Health %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31030604?dopt=Abstract %R 10.1177/0898264319843451 %0 Journal Article %J Biological Psychiatry %D 2019 %T Exome Chip Meta-analysis Fine Maps Causal Variants and Elucidates the Genetic Architecture of Rare Coding Variants in Smoking and Alcohol Use. %A Brazel, David M %A Jiang, Yu %A Hughey, Jordan M %A Turcot, Valérie %A Zhan, Xiaowei %A Gong, Jian %A Batini, Chiara %A Weissenkampen, J Dylan %A Liu, Mengzhen %A Barnes, Daniel R %A Bertelsen, Sarah %A Chou, Yi-Ling %A Erzurumluoglu, A Mesut %A Jessica Faul %A Jeffrey Haessler %A Anke R Hammerschlag %A Hsu, Chris %A Kapoor, Manav %A Lai, Dongbing %A Le, Nhung %A Christiaan de Leeuw %A Loukola, Anu %A Mangino, Massimo %A Melbourne, Carl A %A Pistis, Giorgio %A Qaiser, Beenish %A Rohde, Rebecca %A Shao, Yaming %A Heather M Stringham %A Wetherill, Leah %A Zhao, Wei %A Agrawal, Arpana %A Laura Bierut %A Chen, Chu %A Charles B Eaton %A Goate, Alison %A Christopher A Haiman %A Andrew C Heath %A Iacono, William G %A Nicholas G Martin %A Tinca J Polderman %A Reiner, Alex %A Rice, John %A Schlessinger, David %A H Steven Scholte %A Smith, Jennifer A %A Tardif, Jean-Claude %A Hilary A Tindle %A Van Der Leij, Andries R %A Boehnke, Michael %A Chang-Claude, Jenny %A Francesco Cucca %A David, Sean P %A Tatiana Foroud %A Howson, Joanna M M %A Sharon L R Kardia %A Charles Kooperberg %A Laakso, Markku %A Lettre, Guillaume %A Pamela A F Madden %A McGue, Matt %A Kari E North %A Posthuma, Danielle %A Timothy Spector %A Stram, Daniel %A Tobin, Martin D %A David R Weir %A Kaprio, Jaakko %A Gonçalo R Abecasis %A Liu, Dajiang J %A Scott Vrieze %K Alcohol Drinking %K Databases, Genetic %K Exome %K Genetic Predisposition to Disease %K Genetic Variation %K Genome-Wide Association Study %K Genotype %K Humans %K Oligonucleotide Array Sequence Analysis %K Phenotype %K Polymorphism, Single Nucleotide %K Smoking %X

BACKGROUND: Smoking and alcohol use have been associated with common genetic variants in multiple loci. Rare variants within these loci hold promise in the identification of biological mechanisms in substance use. Exome arrays and genotype imputation can now efficiently genotype rare nonsynonymous and loss of function variants. Such variants are expected to have deleterious functional consequences and to contribute to disease risk.

METHODS: We analyzed ∼250,000 rare variants from 16 independent studies genotyped with exome arrays and augmented this dataset with imputed data from the UK Biobank. Associations were tested for five phenotypes: cigarettes per day, pack-years, smoking initiation, age of smoking initiation, and alcoholic drinks per week. We conducted stratified heritability analyses, single-variant tests, and gene-based burden tests of nonsynonymous/loss-of-function coding variants. We performed a novel fine-mapping analysis to winnow the number of putative causal variants within associated loci.

RESULTS: Meta-analytic sample sizes ranged from 152,348 to 433,216, depending on the phenotype. Rare coding variation explained 1.1% to 2.2% of phenotypic variance, reflecting 11% to 18% of the total single nucleotide polymorphism heritability of these phenotypes. We identified 171 genome-wide associated loci across all phenotypes. Fine mapping identified putative causal variants with double base-pair resolution at 24 of these loci, and between three and 10 variants for 65 loci. Twenty loci contained rare coding variants in the 95% credible intervals.

CONCLUSIONS: Rare coding variation significantly contributes to the heritability of smoking and alcohol use. Fine-mapping genome-wide association study loci identifies specific variants contributing to the biological etiology of substance use behavior.

%B Biological Psychiatry %V 85 %P 946-955 %G eng %N 11 %R 10.1016/j.biopsych.2018.11.024 %0 Thesis %B Sociology %D 2019 %T Exploring Ethnoracial Disparities in Planning for End-of-Life Care %A Tompkins,Joanne %K 0351:Gerontology %K 0573:Public health %K 0626:Sociology %K Advance care planning %K Advance directives %K Aging %K End of life care %K Ethnoracial difference %K Gerontology %K health %K Health and environmental sciences %K Public Health %K Social Sciences %K Sociology %X Over the last 35 years, high profile court cases have drawn attention to planning for end-of-life care. Despite strong opinions about life-sustaining medical treatment, expressed through public protests and political debates, the majority of Americans do not have advance directives, which state preferences for end-of-life care. Rates are significantly lower for blacks and Hispanics than for non-Hispanic whites; however, the reasons for these disparities remain unclear. Using data from the 2012 and 2014 waves of the Health and Retirement Study (HRS), I examine ethnoracial differences in completing three types of advance care planning: (1) having discussions about life-sustaining treatment preferences; (2) designating a proxy—legally called a durable power of attorney for health care (DPAHC)—to make end-of-life care decisions on one’s behalf; and (3) writing a living will that states treatment preferences. Specifically, I conduct an exploratory descriptive analysis, estimate logistic regression models, and apply Fairlie’s decomposition technique—an extension of the Blinder-Oaxaca decomposition method for nonlinear models—to investigate the likelihood of planning for end-of-life care and to quantify the reasons for ethnoracial differences in advance care planning among non-Hispanic black, non-Hispanic white, and Hispanic adults age 65 and older. Findings suggest that education, wealth, income, and having a last will and testament predict the likelihood of and account for most of the explained ethnoracial gap in advance care planning. This study helps to improve our understanding of population characteristics that influence advance care planning. Additionally, while research generally presumes that advance care planning is beneficial, this study also discusses the potential flaws with this view. %B Sociology %I University at Buffalo %C Buffalo, NY %V PhD %P 113 %@ 9780438944572 %G eng %U https://ubir.buffalo.edu/xmlui/handle/10477/79346 %9 phd %0 Journal Article %J Journal of Psychosomatic Research %D 2019 %T Facets of conscientiousness and longevity: Findings from the Health and Retirement Study. %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Antonio Terracciano %K Conscientiousness %K Longevity %K Mortality %X Objectives: Conscientiousness is the strongest personality predictor of longevity. The present study examined which facets of conscientiousness are the most strongly related to mortality risk in a large longitudinal sample of middle-aged and older adults. Method: Seven-year mortality data were obtained from participants (total N > 11,000) from the Health and Retirement Study (HRS, 2008–2014). Six facets of conscientiousness, demographic factors, disease burden, smoking and physical inactivity were assessed at baseline. Results: Controlling for demographic factors, every standard deviation higher order, traditionalism, virtue, and responsibility was related to an approximately 10% reduced risk of mortality; industriousness was associated with an almost 25% lower likelihood of mortality. Except for traditionalism, these associations were partially accounted by health and behavioral covariates. Self-control was not related to longevity. When all facets and the covariates were simultaneously included, only industriousness was significantly associated with mortality. Conclusions: The present study provides new evidence about the specific facets of conscientiousness that are related to longevity. %B Journal of Psychosomatic Research %V 116 %P 1-5 %8 01/2019 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30654983?dopt=Abstract %R 10.1016/j.jpsychores.2018.11.002 %0 Journal Article %J Journal of Financial Counseling and Planning %D 2019 %T Financial Ratios and Financial Satisfaction: Exploring Associations Between Objective and Subjective Measures of Financial Well-Being Among Older Americans %A Tenney, Jacob A. %A Charlene M. Kalenkoski %K Finance %K Financial hardship %K financial satisfaction %X This study explores the relationship between objective measures and perceptions of financial well-being for older Americans. Financial well-being is measured objectively using three financial ratios including the liquidity ratio, the debt-to-asset ratio, and the investment ratio. Individuals' perceptions of their financial well-being are measured by a question in the Health and Retirement Study that asks respondents how satisfied they are with their present financial condition. An ordered probit model is used to examine the relationship between the perceptions of financial well-being and the three financial ratios. The findings in this analysis suggest that there is a positive relationship between the investment ratio and perceptions of financial well-being. There is also a small but statistically significant improvement in the perception of financial well-being with increases in the liquidity ratio. For large categorical differences, the positive relationship also holds for the debt-to-asset ratio. %B Journal of Financial Counseling and Planning %V 30 %P 231-243 %G eng %U https://connect.springerpub.com/content/sgrjfcp/30/2/231 %R 10.1891/1052-3073.30.2.231 %0 Journal Article %J BMC Geriatrics %D 2019 %T Five-factor model personality traits and cognitive function in five domains in older adulthood %A Angelina R Sutin %A Yannick Stephan %A Martina Luchetti %A Antonio Terracciano %K Cognition %K cognitive function %K five-factor model %K Personality %X Background Five-factor model (FFM) personality traits have been associated consistently with risk of Alzheimer’s disease and related dementias (ADRD). Less is known about how these traits are associated with functioning in specific domains of cognitive function in older adulthood. Methods Participants (N = 2865) were drawn from the 2016 Harmonized Cognitive Assessment Protocol sub-study of the Health and Retirement Study (HRS). Participants completed a battery of cognitive tasks that measured performance in five domains: Memory (eight tasks), speed-attention-executive (five tasks), visuospatial ability (three tasks), fluency (one task), and numeric reasoning (one task). Participants completed an FFM personality measure as part of the regular HRS assessment in either 2014 or 2016. Linear regression was used to examine the association between the traits and each cognitive task and composite scores for the five domains, controlling for age, sex, race, ethnicity, and education. We also tested whether the associations were moderated by these sociodemographic factors or mental status. Results Neuroticism was associated with worse performance on all of the cognitive tasks. Conscientiousness was associated with better performance across all five cognitive domains, although not necessarily with every task. Openness and Agreeableness were associated with better performance in all domains, except for numeric reasoning. Extraversion was associated with better speed-attention-executive and fluency. There was no robust evidence that the association between personality and cognition was moderated by sociodemographic characteristics or global cognitive function. Conclusions Personality traits have pervasive associations with functioning across five cognitive domains. Consistent with the literature on personality and risk of ADRD, Neuroticism and Conscientiousness were associated with cognitive performance in the expected direction in all domains. Extraversion was the only trait that showed domain-specific associations. The present research supports models of personality and health in the context of cognition and suggests that personality is associated with intermediate markers of cognitive health. %B BMC Geriatrics %V 19 %P 343 %8 Dec %G eng %U https://doi.org/10.1186/s12877-019-1362-1 %R 10.1186/s12877-019-1362-1 %0 Journal Article %J JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES %D 2019 %T Gendered Expectations Distort Male-Female Differences in Instrumental Activities of Daily Living in Later Adulthood %A Connor M Sheehan %A Elliot M Tucker-Drob %K Disability %K gender %K Independent Living %K Measurement %X Objectives: The ability of older adults to live independently is often assessed with a battery of questions known as Instrumental Activities of Daily Living (IADLs). Many of these questions query the difficulty conducting household activities that have been predominantly conducted by women (e.g., the ability to prepare a meal), especially for cohorts now in old age. Although previous research has documented gender differences in IADL limitations, it has not been documented whether IADLs equivalently measure the same latent construct for men and women. Methods: We apply psychometric tests of measurement invariance to data from the 1998 Health and Retirement Study. We then estimate corrected models that account for violations of measurement invariance across genders. Results: We find that IADLs do not equivalently measure same latent construct for men and women. We find that men are more likely not to do the IADL activities for reasons unrelated to health limitations, which may reflect gendered expectations regarding household activities. Accounting for this we still find that women report greater health-related IADL limitations than men. Discussion: Researchers should be cautious making gender comparisons for IADLs without attending to the gender-specific measurement properties of many of the items of which the IADL is comprised. %B JOURNALS OF GERONTOLOGY SERIES B-PSYCHOLOGICAL SCIENCES AND SOCIAL SCIENCES %V 74 %P 715-723 %8 MAY %G eng %R 10.1093/geronb/gbw209 %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 %X

We 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 International Journal of Health Economics & Management %D 2019 %T The Hispanic health paradox for older Americans: an empirical note. %A Olsen, Reed %A Basuroy, Subhasree %A Tseng, Hui-Kuan %K Hispanics %K Self-reported health %X Previous researchers have found that Hispanic immigrants tend to have better health than could be reasonably explained by their socioeconomic status and other demographic variables. The main objective of this study is to re-investigate the Hispanic health paradox covering the period from 1992 to 2012. Main contributions of the paper include using a data set of older Americans from the Health and Retirement Study. More importantly, we use two new measures of health. Previous research on the paradox had primarily used mortality or morbidity to measure health. In contrast, the HRS includes a measure of self-reported poor health from which we construct a latent health variable. Using both poor health and latent health we find that even among our sample of older Americans that Hispanic Immigrants remain more healthy than could be explained by their socioeconomic status and their other health inputs. %B International Journal of Health Economics & Management %V 19 %P 33-51 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29682677?dopt=Abstract %R 10.1007/s10754-018-9241-4 %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 Thesis %B Economics %D 2019 %T The Impact of Medicare Part D on Mortality and Financial Stability %A Toran, Katherine %K Economics %K Health Economics %K Health Insurance %K Life Expectancy %K Medicare Part D %K Public Economics %K Racial Disparities %X Using the Health and Retirement Study Panel core files from 1996 to 2014, I analyze how Medicare Part D impacted access to prescription drug coverage by various demographic factors such as race, gender, and income. In Chapter 1, I find the highest take-up rates for those who were white, female, and with higher incomes. However, increases in coverage were high across the board, such that Medicare Part D also improved drug insurance coverage for those who were black, male, and with lower income. Thus, although Medicare Part D did increase prescription drug insurance coverage for seniors across the board, I also find potential for improvement in enrollment for difficult-to-reach groups. Next, Chapter 2 examines the impact of Medicare Part D on mortality. Although I do not find an impact on the life expectancy of respondents as a whole, I do find a significant positive effect for black respondents, indicating that Medicare Part D may have mattered more for disadvantaged groups. The largest impact is for black men, who have an additional 9 percentage point chance of living to age 73 for an additional 8 years of coverage (significant at the 5% level). When looking only at cardiovascular mortality, which is more likely to be influenced by drug coverage, I find improvements in life expectancy for the total population, with stronger effects for minorities and men. Overall, my findings suggest that Medicare Part D did move the needle on its goal: to improve the health of those who, without government intervention, had the most difficulty paying for prescription drugs. Chapter 3 looks at the impact of Medicare Part D prescription drug coverage on cost-related medication adherence, food insecurity, and finances among seniors. It would be reasonable to assume that Medicare Part D, which led to near-universal drug coverage among senior citizens, could allow seniors to shift money previously spent on drug expenditures to other areas. The strongest effect of Medicare Part D is on cost-related medication nonadherence, leading to a 21% decrease for an additional 8 years of Medicare Part D coverage. The impact is even stronger for the black male population (30%). I fail to reject the null hypothesis that Medicare Part D did not reduce food insecurity or household debt. Overall, Medicare Part D appears to have improved the financial stability of seniors. %B Economics %I University of Kentucky %C Lexington, United States %V Doctor of Philosophy %P 168 %8 2019 %G eng %U https://uknowledge.uky.edu/economics_etds/45/ %R https://doi.org/10.13023/etd.2019.325 %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 %X

OBJECTIVES: 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 JAMA Network Open %D 2019 %T Measurement of Fall Injury With Health Care System Data and Assessment of Inclusiveness and Validity of Measurement Models %A Lillian C. Min %A Mary Tinetti %A Kenneth M. Langa %A Ha, Jinkyung %A Neil B. Alexander %A Geoffrey J Hoffman %K Fall injury %K Health Care %K Inclusiveness %X National injury surveillance systems use administrative data to collect information about severe fall-related trauma and mortality. Measuring milder injuries in ambulatory clinics would improve comprehensive outcomes measurement across the care spectrum.To assess a flexible set of administrative data–only algorithms for health systems to capture a greater breadth of injuries than traditional fall injury surveillance algorithms and to quantify the algorithm inclusiveness and validity associated with expanding to milder injuries.In this longitudinal diagnostic study of 13 939 older adults (≥65 years) in the nationally representative Health and Retirement Study, a survey was conducted every 2 years and was linked to hospital, emergency department, postacute skilled nursing home, and outpatient Medicare claims (2000-2012). During each 2-year observation period, participants were considered to have sustained a fall-related injury (FRI) based on a composite reference standard of having either an external cause of injury (E-code) or confirmation by the Health and Retirement Study patient interview. A framework involving 3 algorithms with International Classification of Diseases, Ninth Revision codes that extend FRI identification with administrative data beyond the use of fall-related E-codes was developed: an acute care algorithm (head and face or limb, neck, and trunk injury reported at the hospital or emergency department), a balanced algorithm (all acute care algorithm injuries plus severe nonemergency outpatient injuries), and an inclusive algorithm (almost all injuries). Data were collected from January 1, 1998, through December 31, 2012, and statistical analysis was performed from August 1, 2016, to March 1, 2019.Validity, measured as the proportion of potential FRI diagnoses confirmed by the reference standard, and inclusiveness, measured as the proportion of reference-standard FRIs captured by the potential FRI diagnoses.Of 13 939 participants, 1672 (42.4\%) were male, with a mean (SD) age of 77.56 (7.63) years. Among 50 310 observation periods, 9270 potential FRI diagnoses (18.4\%) were identified; these were tested against 8621 reference-standard FRIs (17.1\%). Compared with the commonly used method of E-coded–only FRIs (2-year incidence, 8.8\% [95\% CI, 8.6\%-9.1\%]; inclusion of 51.5\% [95\% CI, 50.4\%-52.5\%] of the reference-standard FRIs), FRI inclusion was increased with use of the study framework of algorithms. With the acute care algorithm (2-year incidence, 12.6\% [95\% CI, 12.4\%-12.9\%]), validity was prioritized (88.6\% [95\% CI, 87.4\%-89.8\%]) over inclusiveness (62.1\% [95\% CI, 61.1\%-63.1\%]). The balanced algorithm showed a 2-year incidence of 14.6\% (95\% CI, 14.3\%-14.9\%), inclusion of 65.3\% (95\% CI, 64.3\%-66.3\%), and validity of 83.2\% (95\% CI, 81.9\%-84.6\%). With the inclusive algorithm, the number of potential FRIs increased compared with the E-code–only method (2-year incidence, 17.4\% [95\% CI, 17.1\%-17.8\%]; inclusion, 68.4\% [95\% CI, 67.4\%-69.3\%]; validity, 75.2\% [95\% CI, 73.7\%-76.6\%]).The findings suggest that use of algorithms with International Classification of Diseases, Ninth Revision codes may increase inclusion of FRIs by health care systems compared with E-codes and that these algorithms may be used by health systems to evaluate interventions and quality improvement efforts. %B JAMA Network Open %V 2 %P e199679-e199679 %G eng %N 8 %R 10.1001/jamanetworkopen.2019.9679 %0 Journal Article %J Journal of Nutrition in Gerontology and Geriatrics %D 2019 %T Mental illness, not obesity status, is associated with food insecurity among the elderly in the Health and Retirement Study. %A Diana P Brostow %A Gunzburger, Elise %A Lauren M. Abbate %A Lisa A Brenner %A Kali S Thomas %K BMI %K Depressive symptoms %K Food insecurity %K Mental Health %X

OBJECTIVES: Food insecurity, limited or uncertain access to adequate nutrition, is an increasingly recognized determinant of health outcomes and is often associated with having obesity. It is unclear, however, if this association persists in elderly populations.

METHODS: We conducted a cross-sectional study of 2868 participants' aged 65+ years from the Health and Retirement Study. Multivariate logistic regression was used to assess associations between food insecurity and body mass index, demographic characteristics, psychiatric history, and medical history.

RESULTS: Participants with overweight/obesity had a higher prevalence of food insecurity than leaner counterparts, however, weight status was not a significant predictor of food insecurity after multivariate adjustment. Instead, mental illness, current smoking status, and non-White race were all independently associated with food insecurity.

DISCUSSION: Beyond financial status, health care providers are encouraged to use these characteristics to identify elderly patients that may be at risk of food insecurity.

%B Journal of Nutrition in Gerontology and Geriatrics %V 38 %P 149-172 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/30794096?dopt=Abstract %R 10.1080/21551197.2019.1565901 %0 Journal Article %J Nature Communications %D 2019 %T A meta-analysis of genome-wide association studies identifies multiple longevity genes. %A Deelen, Joris %A Daniel S Evans %A Dan E Arking %A Tesi, Niccolò %A Nygaard, Marianne %A Liu, Xiaomin %A Wojczynski, Mary K %A Biggs, Mary L %A van der Spek, Ashley %A Atzmon, Gil %A Erin B Ware %A Sarnowski, Chloé %A Albert Vernon Smith %A Seppälä, Ilkka %A Cordell, Heather J %A Dose, Janina %A Amin, Najaf %A Alice M. Arnold %A Kristin L. Ayers %A Barzilai, Nir %A Becker, Elizabeth J %A Beekman, Marian %A Blanché, Hélène %A Christensen, Kaare %A Christiansen, Lene %A Collerton, Joanna C %A Cubaynes, Sarah %A Steven R Cummings %A Davies, Karen %A Debrabant, Birgit %A Deleuze, Jean-François %A Duncan, Rachel %A Jessica Faul %A Franceschi, Claudio %A Galan, Pilar %A Gudnason, Vilmundur %A Tamara B Harris %A Huisman, Martijn %A Hurme, Mikko A %A Jagger, Carol %A Jansen, Iris %A Jylhä, Marja %A Kähönen, Mika %A Karasik, David %A Sharon L R Kardia %A Kingston, Andrew %A Kirkwood, Thomas B L %A Lenore J Launer %A Lehtimäki, Terho %A Lieb, Wolfgang %A Lyytikäinen, Leo-Pekka %A Martin-Ruiz, Carmen %A Min, Junxia %A Nebel, Almut %A Anne B Newman %A Nie, Chao %A Nohr, Ellen A %A Orwoll, Eric S %A Thomas T Perls %A Province, Michael A %A Psaty, Bruce M %A Olli T Raitakari %A Reinders, Marcel J T %A Robine, Jean-Marie %A Rotter, Jerome I %A Sebastiani, Paola %A Jennifer A Smith %A Sørensen, Thorkild I A %A Kent D Taylor %A André G Uitterlinden %A van der Flier, Wiesje %A Sven J van der Lee %A Cornelia M van Duijn %A van Heemst, Diana %A James W Vaupel %A David R Weir %A Ye, Kenny %A Zeng, Yi %A Zheng, Wanlin %A Holstege, Henne %A Douglas P Kiel %A Kathryn L Lunetta %A Eline P Slagboom %A Joanne M Murabito %K genes %K Genome-Wide Association Study %K GWA %K longevity genes %K meta-analysis %X

Human longevity is heritable, but genome-wide association (GWA) studies have had limited success. Here, we perform two meta-analyses of GWA studies of a rigorous longevity phenotype definition including 11,262/3484 cases surviving at or beyond the age corresponding to the 90th/99th survival percentile, respectively, and 25,483 controls whose age at death or at last contact was at or below the age corresponding to the 60th survival percentile. Consistent with previous reports, rs429358 (apolipoprotein E (ApoE) ε4) is associated with lower odds of surviving to the 90th and 99th percentile age, while rs7412 (ApoE ε2) shows the opposite. Moreover, rs7676745, located near GPR78, associates with lower odds of surviving to the 90th percentile age. Gene-level association analysis reveals a role for tissue-specific expression of multiple genes in longevity. Finally, genetic correlation of the longevity GWA results with that of several disease-related phenotypes points to a shared genetic architecture between health and longevity.

%B Nature Communications %V 10 %P 3669 %8 08/2019 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31413261 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/31413261?dopt=Abstract %R 10.1038/s41467-019-11558-2 %0 Journal Article %J Nature Communications %D 2019 %T Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity. %A Kilpeläinen, Tuomas O %A Bentley, Amy R %A Noordam, Raymond %A Yun Ju Sung %A Schwander, Karen %A Thomas W Winkler %A Jakupović, Hermina %A Daniel I Chasman %A Alisa Manning %A Ntalla, Ioanna %A Aschard, Hugues %A Brown, Michael R %A de Las Fuentes, Lisa %A Franceschini, Nora %A Guo, Xiuqing %A Vojinovic, Dina %A Aslibekyan, Stella %A Feitosa, Mary F %A Kho, Minjung %A Musani, Solomon K %A Melissa Richard %A Wang, Heming %A Wang, Zhe %A Traci M Bartz %A Bielak, Lawrence F %A Campbell, Archie %A Dorajoo, Rajkumar %A Fisher, Virginia %A Hartwig, Fernando P %A Horimoto, Andrea R V R %A Li, Changwei %A Kurt Lohman %A Marten, Jonathan %A Sim, Xueling %A Smith, Albert V %A Tajuddin, Salman M %A Alver, Maris %A Amini, Marzyeh %A Boissel, Mathilde %A Jin-Fang Chai %A Chen, Xu %A Divers, Jasmin %A Evangelou, Evangelos %A Gao, Chuan %A Graff, Mariaelisa %A Sarah E Harris %A He, Meian %A Hsu, Fang-Chi %A Jackson, Anne U %A Jing Hua Zhao %A Kraja, Aldi T %A Kühnel, Brigitte %A Laguzzi, Federica %A Lyytikäinen, Leo-Pekka %A Ilja M Nolte %A Rauramaa, Rainer %A Riaz, Muhammad %A Robino, Antonietta %A Rueedi, Rico %A Heather M Stringham %A Takeuchi, Fumihiko %A van der Most, Peter J %A Varga, Tibor V %A Verweij, Niek %A Erin B Ware %A Wen, Wanqing %A Li, Xiaoyin %A Yanek, Lisa R %A Amin, Najaf %A Donna K Arnett %A Boerwinkle, Eric %A Brumat, Marco %A Brian E Cade %A Canouil, Mickaël %A Chen, Yii-Der Ida %A Concas, Maria Pina %A Connell, John %A de Mutsert, Renée %A de Silva, H Janaka %A de Vries, Paul S %A Demirkan, Ayse %A Ding, Jingzhong %A Charles B Eaton %A Jessica Faul %A Friedlander, Yechiel %A Gabriel, Kelley P %A Ghanbari, Mohsen %A Giulianini, Franco %A Gu, Chi Charles %A Gu, Dongfeng %A Tamara B Harris %A He, Jiang %A Heikkinen, Sami %A Heng, Chew-Kiat %A Hunt, Steven C %A Ikram, M Arfan %A Jost Bruno Jonas %A Koh, Woon-Puay %A Komulainen, Pirjo %A Krieger, Jose E %A Stephen B Kritchevsky %A Kutalik, Zoltán %A Kuusisto, Johanna %A Langefeld, Carl D %A Langenberg, Claudia %A Lenore J Launer %A Leander, Karin %A Lemaitre, Rozenn N %A Lewis, Cora E %A Liang, Jingjing %A Liu, Jianjun %A Mägi, Reedik %A Manichaikul, Ani %A Meitinger, Thomas %A Andres Metspalu %A Milaneschi, Yuri %A Mohlke, Karen L %A Thomas H Mosley %A Murray, Alison D %A Michael A Nalls %A Nang, Ei-Ei Khaing %A Nelson, Christopher P %A Nona, Sotoodehnia %A Norris, Jill M %A Nwuba, Chiamaka Vivian %A Jeff O'Connell %A Palmer, Nicholette D %A Papanicolau, George J %A Pazoki, Raha %A Nancy L Pedersen %A Peters, Annette %A Peyser, Patricia A %A Polasek, Ozren %A David J Porteous %A Poveda, Alaitz %A Olli T Raitakari %A Rich, Stephen S %A Neil Risch %A Robinson, Jennifer G %A Rose, Lynda M %A Rudan, Igor %A Schreiner, Pamela J %A Scott, Robert A %A Stephen Sidney %A Sims, Mario %A Smith, Jennifer A %A Snieder, Harold %A Sofer, Tamar %A John M Starr %A Sternfeld, Barbara %A Strauch, Konstantin %A Tang, Hua %A Kent D Taylor %A Tsai, Michael Y %A Tuomilehto, Jaakko %A André G Uitterlinden %A van der Ende, M Yldau %A van Heemst, Diana %A Voortman, Trudy %A Waldenberger, Melanie %A Wennberg, Patrik %A Wilson, Gregory %A Xiang, Yong-Bing %A Yao, Jie %A Yu, Caizheng %A Yuan, Jian-Min %A Zhao, Wei %A Alan B Zonderman %A Becker, Diane M %A Boehnke, Michael %A Bowden, Donald W %A de Faire, Ulf %A Ian J Deary %A Elliott, Paul %A Tõnu Esko %A Freedman, Barry I %A Froguel, Philippe %A Paolo P. Gasparini %A Gieger, Christian %A Kato, Norihiro %A Laakso, Markku %A Lakka, Timo A %A Lehtimäki, Terho %A Patrik K E Magnusson %A Oldehinkel, Albertine J %A Brenda W J H Penninx %A Nilesh J Samani %A Shu, Xiao-Ou %A van der Harst, Pim %A Jana V. van Vliet-Ostaptchouk %A Vollenweider, Peter %A Wagenknecht, Lynne E %A Wang, Ya X %A Wareham, Nicholas J %A David R Weir %A Wu, Tangchun %A Zheng, Wei %A Zhu, Xiaofeng %A Michele K Evans %A Franks, Paul W %A Gudnason, Vilmundur %A Caroline Hayward %A Horta, Bernardo L %A Tanika N Kelly %A Liu, Yongmei %A Kari E North %A Pereira, Alexandre C %A Ridker, Paul M %A Tai, E Shyong %A van Dam, Rob M %A Fox, Ervin R %A Sharon L R Kardia %A Liu, Ching-Ti %A Dennis O Mook-Kanamori %A Province, Michael A %A Redline, Susan %A Cornelia M van Duijn %A Rotter, Jerome I %A Charles Kooperberg %A Gauderman, W James %A Psaty, Bruce M %A Kenneth Rice %A Munroe, Patricia B %A Myriam Fornage %A Cupples, L Adrienne %A Charles N Rotimi %A Alanna C Morrison %A Rao, Dabeeru C %A Ruth J F Loos %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Asians %K Blacks %K Brazil %K Calcium-Binding Proteins %K Cholesterol %K Cholesterol, HDL %K Cholesterol, LDL %K Exercise %K Female %K Genetic Loci %K Genome-Wide Association Study %K Genotype %K Hispanic or Latino %K Humans %K LIM-Homeodomain Proteins %K Lipid Metabolism %K Lipids %K Male %K Membrane Proteins %K Microtubule-Associated Proteins %K Middle Aged %K Muscle Proteins %K Nerve Tissue Proteins %K Transcription Factors %K Triglycerides %K Whites %K Young Adult %X

Many genetic loci affect circulating lipid levels, but it remains unknown whether lifestyle factors, such as physical activity, modify these genetic effects. To identify lipid loci interacting with physical activity, we performed genome-wide analyses of circulating HDL cholesterol, LDL cholesterol, and triglyceride levels in up to 120,979 individuals of European, African, Asian, Hispanic, and Brazilian ancestry, with follow-up of suggestive associations in an additional 131,012 individuals. We find four loci, in/near CLASP1, LHX1, SNTA1, and CNTNAP2, that are associated with circulating lipid levels through interaction with physical activity; higher levels of physical activity enhance the HDL cholesterol-increasing effects of the CLASP1, LHX1, and SNTA1 loci and attenuate the LDL cholesterol-increasing effect of the CNTNAP2 locus. The CLASP1, LHX1, and SNTA1 regions harbor genes linked to muscle function and lipid metabolism. Our results elucidate the role of physical activity interactions in the genetic contribution to blood lipid levels.

%B Nature Communications %V 10 %P 376 %G eng %N 1 %R 10.1038/s41467-018-08008-w %0 Journal Article %J Nature Human Behaviour %D 2019 %T New alcohol-related genes suggest shared genetic mechanisms with neuropsychiatric disorders. %A Evangelou, Evangelos %A Gao, He %A Chu, Congying %A Ntritsos, Georgios %A Blakeley, Paul %A Butts, Andrew R %A Pazoki, Raha %A Suzuki, Hideaki %A Koskeridis, Fotios %A Yiorkas, Andrianos M %A Karaman, Ibrahim %A Elliott, Joshua %A Luo, Qiang %A Aeschbacher, Stefanie %A Traci M Bartz %A Baumeister, Sebastian E %A Braund, Peter S %A Brown, Michael R %A Brody, Jennifer A %A Clarke, Toni-Kim %A Dimou, Niki %A Jessica Faul %A Homuth, Georg %A Jackson, Anne U %A Kentistou, Katherine A %A Joshi, Peter K %A Lemaitre, Rozenn N %A Penelope A Lind %A Lyytikäinen, Leo-Pekka %A Mangino, Massimo %A Milaneschi, Yuri %A Nelson, Christopher P %A Ilja M Nolte %A Perälä, Mia-Maria %A Polasek, Ozren %A David J Porteous %A Scott M Ratliff %A Smith, Jennifer A %A Stančáková, Alena %A Teumer, Alexander %A Tuominen, Samuli %A Thériault, Sébastien %A Vangipurapu, Jagadish %A Whitfield, John B %A Wood, Alexis %A Yao, Jie %A Yu, Bing %A Zhao, Wei %A Dan E Arking %A Auvinen, Juha %A Liu, Chunyu %A Männikkö, Minna %A Risch, Lorenz %A Rotter, Jerome I %A Snieder, Harold %A Veijola, Juha %A Alexandra I Blakemore %A Boehnke, Michael %A Campbell, Harry %A Conen, David %A Johan G Eriksson %A Hans-Jörgen Grabe %A Guo, Xiuqing %A van der Harst, Pim %A Catharina A Hartman %A Caroline Hayward %A Andrew C Heath %A Järvelin, Marjo-Riitta %A Kähönen, Mika %A Sharon L R Kardia %A Kühne, Michael %A Kuusisto, Johanna %A Laakso, Markku %A Lahti, Jari %A Lehtimäki, Terho %A McIntosh, Andrew M %A Mohlke, Karen L %A Alanna C Morrison %A Nicholas G Martin %A Oldehinkel, Albertine J %A Brenda W J H Penninx %A Psaty, Bruce M %A Olli T Raitakari %A Rudan, Igor %A Nilesh J Samani %A Scott, Laura J %A Timothy Spector %A Verweij, Niek %A David R Weir %A James F Wilson %A Levy, Daniel %A Tzoulaki, Ioanna %A Bell, Jimmy D %A Matthews, Paul M %A Rothenfluh, Adrian %A Desrivières, Sylvane %A Schumann, Gunter %A Elliott, Paul %K Adult %K Aged %K Alcohol Drinking %K Alcoholism %K Brain %K Female %K genes %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Magnetic Resonance Imaging %K Male %K Mental Disorders %K Middle Aged %K Neuroimaging %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %K Schizophrenia %K Whites %X

Excessive alcohol consumption is one of the main causes of death and disability worldwide. Alcohol consumption is a heritable complex trait. Here we conducted a meta-analysis of genome-wide association studies of alcohol consumption (g d) from the UK Biobank, the Alcohol Genome-Wide Consortium and the Cohorts for Heart and Aging Research in Genomic Epidemiology Plus consortia, collecting data from 480,842 people of European descent to decipher the genetic architecture of alcohol intake. We identified 46 new common loci and investigated their potential functional importance using magnetic resonance imaging data and gene expression studies. We identify genetic pathways associated with alcohol consumption and suggest genetic mechanisms that are shared with neuropsychiatric disorders such as schizophrenia.

%B Nature Human Behaviour %V 3 %P 950-961 %G eng %N 9 %R 10.1038/s41562-019-0653-z %0 Journal Article %J American Journal of Epidemiology %D 2019 %T Optimism and healthy aging in women and men. %A Eric S Kim %A James, Peter %A Emily S Zevon %A Trudel-Fitzgerald, Claudia %A Laura D Kubzansky %A Grodstein, Francine %K Gender Differences %K Health Trajectories %K Optimism %K Personality %K Well-being %X Mounting evidence indicates specific associations between higher levels of optimism and healthier behaviors, reduced risk of chronic diseases, and lower mortality. Yet, for public health purposes, it is critical to consider how optimism may be related to a full scope of health conditions in aging-from cognitive to physical health. Using prospective data from the Health and Retirement Study (N=5,698), we examined if higher baseline optimism was associated with subsequent increased likelihood of maintaining healthy aging over 6-8 years of follow-up. Optimism was assessed at study baseline (2006 or 2008), and components of healthy aging were assessed every two years, defined as: 1) remaining free of major chronic diseases; 2) having no cognitive impairment; and 3) good physical functioning. Hazard ratios were obtained using Cox proportional hazards models, and a range of relevant covariates were considered (sociodemographics, depressive symptoms, health behaviors). After adjusting for sociodemographics and depression, the most (top quartile) versus least (bottom quartile) optimistic participants had a 24% increased likelihood of maintaining healthy aging (95% CI: 1.11, 1.38). Further adjustment for health behaviors did not meaningfully change the findings. Optimism, a potentially modifiable health asset, merits further research for its potential to improve likelihood of health in aging. %B American Journal of Epidemiology %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30834429?dopt=Abstract %R 10.1093/aje/kwz056 %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 Psychosomatic Research %D 2019 %T Perceived weight discrimination and performance in five domains of cognitive function. %A Angelina R Sutin %A Yannick Stephan %A Mary A Gerend %A Robinson, Eric %A Daly, Michael %A Antonio Terracciano %K cognitive aging %K Neuropsychological tests %K Psychosocial stressor %K Weight stigma %X

OBJECTIVE: Individuals who perceive unfair treatment because of their body weight have been found to be at increased risk of poor health outcomes, including risk of dementia. The present research examines the relation between weight discrimination and performance in five cognitive domains (episodic memory, speed-attention, visuospatial ability, language, numeric reasoning) and whether the associations extend to other common attributions for discrimination (age, gender, race).

METHOD: Participants (n = 2593) were from the Harmonized Cognitive Assessment Protocol (HCAP) sub-study of the Health and Retirement Study (HRS). HCAP participants completed a battery of cognitive tasks that measured the five focal cognitive domains. Participants reported on their perceived experiences with discrimination at the previous regular HRS assessment.

RESULTS: In models that accounted for demographic covariates and BMI, weight discrimination (reported by 6% of participants) was associated with a two-fold increased risk of poor performance on tasks of episodic memory, speed-attention, visuospatial ability, and numeric reasoning. Body mass index was largely unrelated to performance in the five cognitive domains. The other attributions for discrimination were generally unrelated to cognition, but there were sex- and race-specific associations for gender and race discrimination, respectively.

CONCLUSIONS: The present study identified attribution- and domain-specific associations between discrimination and cognitive performance in older adulthood.

%B Journal of Psychosomatic Research %P 109793 %8 08/2019 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31439334 %1 http://www.ncbi.nlm.nih.gov/pubmed/31439334?dopt=Abstract %R 10.1016/j.jpsychores.2019.109793 %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 Preventative Med %D 2019 %T Personality traits and preventive cancer screenings in the Health Retirement Study. %A Damaris Aschwanden %A Mary A Gerend %A Martina Luchetti %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Cancer screenings %K Personality %K Preventative Care %X The Five-Factor model of personality has been associated with a wide range of health behaviors and health outcomes. However, few studies have examined whether personality traits are related to cancer screening in older adults. The present study investigated the cross-sectional associations between personality traits and the probability of obtaining a recent preventive screening for breast, cervical, prostate, and colorectal cancer. Participants from the Health and Retirement Study (N = 14,394, M = 68.14 years, range = 50-102 years, 58.6% female) completed a personality inventory and reported on cancer screenings in the 2010-2012 assessment. Logistic regression models were used to analyze the data, including age, race, ethnicity, gender, education, income, and wealth as covariates. Higher conscientiousness was associated with a higher likelihood of obtaining breast, cervical, and prostate screening. Higher extraversion was related to higher odds of breast, cervical, and colorectal screening. Higher neuroticism was linked to higher odds of colorectal screening, and conscientiousness moderated the link between neuroticism and cervical screening. These associations were significant in models that accounted for demographic and socioeconomic factors. The effect sizes were in the range of a 10-20% higher likelihood of cancer screening for 1 SD difference in personality. The present findings suggest that conscientiousness and extraversion were related to preventive cancer screenings, whereas neuroticism, openness and agreeableness were largely unrelated to the likelihood of such screenings. If these results are further replicated, health policy makers may consider personality traits when planning and implementing screening recommendations to improve preventive medicine. %B Preventative Med %V 126 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31260725?dopt=Abstract %R 10.1016/j.ypmed.2019.105763 %0 Journal Article %J European Journal of Ageing %D 2019 %T Physical activity and subjective age across adulthood in four samples %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Physical activity %K Subjective age %X The present study examined the prospective association between physical activity and subjective age across adulthood and factors that mediate this association. Participants were adults aged from 20 to 90 years (N\thinspace>\thinspace10,000) drawn from the Wisconsin Longitudinal Study graduates and siblings samples, the Health and Retirement Study and the Midlife in the United States Survey. In the four samples, physical activity was assessed at baseline and subjective age was measured 8 to 20 years later. Personality, self-rated health, disease burden, depressive symptoms, and cognition were assessed as potential mediators. In the four samples, higher physical activity at baseline was associated with a younger subjective age at follow-up. Logistic regression revealed that physical activity was related to a 30–50% higher likelihood of feeling younger 8 to 20 years later. Significant indirect effects were found through openness to experience and self-rated health in the four samples. This study provides new evidence on the link between a health-related behavior and subjective age. Physically active individuals may sustain health and an open psychological disposition that is associated with feeling younger. %B European Journal of Ageing %8 Oct 2019 %G eng %U https://doi.org/10.1007/s10433-019-00537-7 %R 10.1007/s10433-019-00537-7 %0 Journal Article %J Psychology and Aging %D 2019 %T Polygenic scores for education, health, and personality as predictors of subjective age among older individuals of European ancestry: Evidence from the Health and Retirement Study. %A Yannick Stephan %A Angelina R Sutin %A Kornadt, Anna %A Antonio Terracciano %K Education %K GWAS %K Personality %K PGS %K Subjective age %X The present study aimed to identify whether polygenic scores (PGSs) for education, health and psychological factors are related to subjective age in a large sample of older adults. Participants were 7,763 individuals of European ancestry (57% women, age = 69.15, = 10.18) from the Health and Retirement Study who were genotyped and provided subjective age data. Higher PGSs for educational achievement and well-being were related to a younger subjective age, whereas higher PGSs for neuroticism, body mass index, waist circumference, and depressive symptoms were associated with an older subjective age. This study provides new evidence on the potential genetic underpinnings of subjective age. %B Psychology and Aging %V 34 %P 139-144 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30080057?dopt=Abstract %R 10.1037/pag0000283 %0 Journal Article %J Aggression and Violent Behavior %D 2019 %T The propensity for aggressive behavior and lifetime incarceration risk: A test for gene-environment interaction (G × E) using whole-genome data %A Barnes, J.C. %A Hexuan Liu %A Motz, R.T. %A Tanksley, P.T. %A Kail, R. %A Beckley, A.L. %A Daniel W. Belsky %A Benjamin W Domingue %A Terrie E Moffitt %A Pratt, T.C. %A Wertz, J. %K Adult %K aggression %K controlled study %K criminology %K Female %K genetic association %K genetic risk score %K genetic susceptibility %K genotype environment interaction %K high school %K human %K major clinical study %K Male %K mental capacity %K Retirement %K review %X Incarceration is a disruptive event that is experienced by a considerable proportion of the United States population. Research has identified social factors that predict incarceration risk, but scholars have called for a focus on the ways that individual differences combine with social factors to affect incarceration risk. Our study is an initial attempt to heed this call using whole-genome data. We use data from the Health and Retirement Study (HRS) (N = 6716) to construct a genome-wide measure of genetic propensity for aggressive behavior and use it to predict lifetime incarceration risk. We find that participants with a higher genetic propensity for aggression are more likely to experience incarceration, but the effect is stronger for males than females. Importantly, we identify a gene-environment interaction (G × E)—genetic propensity is reduced, substantively and statistically, to a non-significant predictor for males raised in homes where at least one parent graduated high school. We close by placing these findings in the broader context of concerns that have been raised about genetics research in criminology. © 2019 %B Aggression and Violent Behavior %V 49 %G eng %U https://www.sciencedirect.com/science/article/pii/S1359178919300631 %R 10.1016/j.avb.2019.07.002 %0 Journal Article %J Journal of Psychosomatic Research %D 2019 %T The prospective association between personality traits and persistent pain and opioid medication use. %A Angelina R Sutin %A Yannick Stephan %A Martina Luchetti %A Antonio Terracciano %K Chronic pain %K Personality %K Prescription Medication %X

OBJECTIVE: Pain and prescription opioid medication use are prevalent and a major source of psychological and physical health burden. This research examines whether Five Factor Model personality traits prospectively predict who will experience persistent pain and use prescription opioid medication over a 10-year follow-up.

METHODS: Participants (N = 8491) were drawn from the Health and Retirement Study. At baseline, participants reported on their personality and whether they were in pain. Every two years, participants reported on their pain and, at the most recent assessment, their current use of prescription opioid medication. Logistic regression was used to test whether personality was associated with persistent pain over the up to 10-year follow-up and whether it predicted who would be taking prescription opioid medication.

RESULTS: Neuroticism was associated with higher risk of persistent pain (OR = 1.44, 95% CI = 1.38-1.51) and opioid medication use (OR = 1.21, 95% CI = 1.14-1.29) over the follow-up. Extraversion was associated with lower risk of persistent pain (OR = 0.83, 95% CI = 0.80-0.87) and opioid medication use (OR = 0.92, 95% CI = 0.86-0.97). Similarly, Conscientiousness was associated with lower risk of persistent pain (OR = 0.83, 95% CI = 0.79-0.87) and opioid medication use (OR = 0.91, 95% CI = 0.86-0.97).

CONCLUSIONS: The findings suggest that personality traits are one psychological characteristic that modulates the likelihood of persistent pain and opioid medication use.

%B Journal of Psychosomatic Research %V 123 %P 109721 %G eng %U https://www.sciencedirect.com/science/article/pii/S0022399919300315 %9 Journal %1 http://www.ncbi.nlm.nih.gov/pubmed/31103210?dopt=Abstract %R 10.1016/j.jpsychores.2019.04.019 %0 Journal Article %J Ageing and Society %D 2019 %T The race paradox in subjective wellbeing among older Americans %A Tang, Fengyan %A Heejung Jang %A Mary Beth Rauktis %A Donald Musa %A Scott Beach %K Happiness %K Racial/ethnic differences %K Social Support %K Well-being %X This study aims to assess racial differences in subjective wellbeing (SWB) and to examine whether the pathways of social support and social engagement to SWB vary by racial groups in the United States of America. Using a local sample (N = 1,035) and a nationally representative sample of the Health and Retirement Study (N = 7,718), we compared life satisfaction and happiness between non-Hispanic Whites and Blacks aged 55 and over. We evaluated the extent to which race, other socio-demographic characteristics, health, social engagement and social support explained the variances in SWB and examined the moderation effects of race on the relationships of SWB with age, social support and social engagement. Multiple regression analyses showed that non-Hispanic Blacks were at least as satisfied as, and even happier than White peers, after equalising social resources and health variables. Social support was significantly related to SWB, and it seemed that positive support was more important to Whites than to Blacks in predicting life satisfaction. In addition, the racial crossover effect existed, that is, the old-old (80+) Blacks were happier than their White peers. Findings indicate a national trend of the race paradox in SWB and underscore the importance of social support in promoting older adults’ wellbeing. Future research is recommended to investigate other potential mechanisms among Black older Americans to explain their relatively better SWB. %B Ageing and Society %V 39 %P 568-589 %G eng %U https://www.cambridge.org/core/product/identifier/S0144686X17001064/type/journal_articlehttps://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0144686X17001064 %N 3 %! Ageing and Society %R 10.1017/S0144686X17001064 %0 Journal Article %J Public Policy & Aging Report %D 2019 %T Reducing Disparities in Healthy Aging Through an Enhanced Medicare Annual Wellness Visit %A Tipirneni, Renuka %A Ganguli, Ishani %A John Z. Ayanian %A Kenneth M. Langa %K Health Disparities %K Medicare %K Well-being %X In its current form, the Medicare annual wellness visit (AWV) is not reaching most older Americans, particularly lower-income or minority adults and those served by safety-net providers (Ganguli, Souza, McWilliams, & Mehrotra, 2018). Yet these underserved seniors face disparities in healthy aging, likely due to individual, social, and behavioral determinants of health, such as low income, limited education, social isolation, food insecurity, poor housing quality, and difficulty affording medications. New AWV models should move beyond traditional assessments of cognition, balance, and vision to identify and address important root causes of poor health, such as individual, social, and behavioral determinants of health. Incorporating these key determinants of health into AWVs has the potential to promote healthy aging among underserved seniors. In this paper, we present local opportunities for AWV-related practice transformation, including screening tools, electronic health record templates, care team member roles, and workflows. At the national level, we suggest updates to Medicare’s current AWV policy guidelines with regard to visit elements and funding models. %B Public Policy & Aging Report %V 29 %P 26-32 %G eng %U https://academic.oup.com/ppar/advance-article/doi/10.1093/ppar/pry048/5251985http://academic.oup.com/ppar/advance-article-pdf/doi/10.1093/ppar/pry048/27184822/pry048.pdf %N 1 %R 10.1093/ppar/pry048 %0 Journal Article %J Soc Sci Med %D 2019 %T The relationship between cognitive decline and a genetic predictor of educational attainment. %A Ding, Xuejie %A Nicola Barban %A Felix C Tropf %A Melinda C Mills %K Cognitive decline %K Educational attainment %K Fluid/crystallised intelligence %K Genetic predictor %K Growth curve modelling %K Polygenic risk score %X

Genetic and environmental factors both make substantial contributions to the heterogeneity in individuals' levels of cognitive ability. Many studies have examined the relationship between educational attainment and cognitive performance and its rate of change. Yet there remains a gap in knowledge regarding whether the effect of genetic predictors on individual differences in cognition becomes more or less prominent over the life course. In this analysis of over 5000 older adults from the Health and Retirement Study (HRS) in the U.S., we measured the change in performance on global cognition, episodic memory, attention & concentration, and mental status over 14 years. Growth curve models are used to evaluate the association between a polygenic risk score for education (education PGS) and cognitive change. Using the most recent education PGS, we find that individuals with higher scores perform better across all measures of cognition in later life. Education PGS is associated with a faster decline in episodic memory in old age. The relationships are robust even after controlling for phenotypic educational attainment, and are unlikely to be driven by mortality bias. Future research should consider genetic effects when examining non-genetic factors in cognitive decline. Our findings represent a need to understand the mechanisms between genetic endowment of educational attainment and cognitive decline from a biological angle.

%B Soc Sci Med %V 239 %P 112549 %8 2019 Sep 13 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31546143 %1 http://www.ncbi.nlm.nih.gov/pubmed/31546143?dopt=Abstract %R 10.1016/j.socscimed.2019.112549 %0 Thesis %B Social Work %D 2019 %T Risk Factors for Loneliness and Social Isolation among Black Older Adults %A Harry Owen Taylor %K 0325:Black studies %K 0351:Gerontology %K 0452:Social work %K Black older adults %K Black studies %K Gerontology %K Loneliness %K social isolation %K Social work %X There are limited empirical research studies examining loneliness and social isolation among Black older adults. Studying loneliness and social isolation among older Black populations is important given the projected growth of the Black older adult population in coming years, Black older adults disproportionately experience life situations associated with greater loneliness and social isolation compared to White older adults, Black older adults are significantly less likely to use health and social services compared to older Whites, and Black Americans are more likely to live in environments that lack economic and social resources, and have severe hazards in terms of the built environment. Given the limited knowledge in this area and significance of this topic, the purpose of my dissertation is to determine risk factors for loneliness and social isolation among Black older adults and whether risk factors for loneliness and social isolation among Black older adults vary by sex, age, and environmental context. I utilize the Health and Retirement Study (HRS) to address my study aims. The HRS is a nationally representative longitudinal panel survey of adults 50 and older living in the United States of America. Loneliness was operationalized using the Hughes 3-item loneliness scale. Social isolation was operationalized using a social network index. Risk factors for loneliness and social isolation included demographic factors (e.g., age, education), health factors (e.g., self-rated health, depressive symptoms), and environmental factors (e.g., neighborhood social cohesion, neighborhood physical disorder). In addition to main effect regression models, I tested the moderating effects of sex (women and men), age, and environmental context (living in an urban, suburban, or rural environment) to determine if these factors moderated the relationships between the risk factors and loneliness/social isolation. A variety of demographic, health, and environmental factors were associated with loneliness and social isolation among Black older adults. Risk factors for loneliness were younger age, greater years of education, lower total household income, worse self-rated health, greater depressive symptoms, less neighborhood social cohesion, and greater social isolation. Risk factors for social isolation were lower total household income, worse self-rated health, living in an urban community (compared to living in a suburban community), and greater loneliness. Additionally, several of these risk factors varied according to sex, age, and environmental context. This is one of the first studies to examine risk factors for loneliness and social isolation among a nationally representative sample of Black older adults. I found that there was little overlap in risk factors for loneliness and social isolation among Black older adults, further indicating these are distinct conditions. Study implications include the need to raise awareness of loneliness and social isolation among Black older adults and to further explore and intervene upon risk factors for these conditions. Finally, evidence that several risk factors vary by sex, age, and environmental context underscores the heterogeneity with the older Black population. Strengths, limitations, and future research directions are discussed. %B Social Work %I Washington University in St. Louis %V PhD %P 153 %G eng %9 phd %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 %X

Background 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 Alzheimer's Disease %D 2019 %T Self-Reported Personality Traits and Informant-Rated Cognition: A 10-Year Prospective Study %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Aged %K agreeableness %K Article %K Cognition %K Conscientiousness %K extraversion %K Female %K follow up %K human %K major clinical study %K Male %K neurosis %K openness %K Personality %K priority journal %K prospective study %K Self Report %X Personality traits, such as higher Neuroticism and lower Conscientiousness, are associated with risk of Alzheimer's disease and other dementias. A diagnosis of dementia relies, in part, on informant ratings of the individual's cognitive status. Here we examine whether self-reported personality traits are associated with four measures of informant-rated cognition up to a decade later. Participants from the Health and Retirement Study (N = 2,536) completed a five-factor model measure of personality in 2006 or 2008. Informants completed the 2016 Harmonized Cognitive Assessment Protocol (HCAP), which included ratings of the participant's current cognitive functioning and change in cognitive function over the last decade assessed with the IQCODE, Blessed, 1066, and CSID. Controlling for characteristics of the participant, informant, and their relationship, higher Neuroticism and lower Conscientiousness were associated consistently with worse informant-rated cognition. The association between Openness and better informant-rated cognition was due primarily to higher baseline cognitive function. Extraversion and Agreeableness were associated with better informant-rated cognition only among participants who were cognitively intact at follow-up. The present research suggests that knowledgeable informants are able to detect cognitive deficits associated with personality. © 2019 - IOS Press and the authors. All rights reserved. %B Journal of Alzheimer's Disease %V 72 %P 181-190 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31561364 %R 10.3233/JAD-190555 %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 Religion, Spirituality & Aging %D 2019 %T Stress and inflammation among older adults: The moderating role of religiosity %A Jane Tavares %A Corina R Ronneberg %A Edward Alan Miller %A Jeffrey A Burr %K Depressive symptoms %K Religion %K Social Factors %X Chronic stress weakens the immune system and leads to heightened bodily inflammation, which in turn is linked with serious health conditions. This study examined whether religiosity moderates the relationship between stress and inflammation (measured by C-reactive Protein (CRP)). A sample of 4,734 community-dwelling older adults was drawn from the 2006 wave of the Health and Retirement Study. Logistic regression was used to analyze the relationship between chronic stress (8-item index), inflammation (high CRP level), and religiosity (organizational, nonorganizational, and intrinsic), controlling for other factors. Higher levels of stress were significantly associated with high inflammation/CRP (p =.039). Further, intrinsic religiosity acted as a moderator of this relationship (p =.024), such that the relationship between stress and inflammation is lessened for persons with higher levels of intrinsic religiosity. Higher intrinsic religiosity attenuated the effects of stress on inflammation, suggesting that individuals with stronger religious commitment/motivation may better cope with stress. %B Journal of Religion, Spirituality & Aging %V 31 %P 187-202 %G eng %U https://www.tandfonline.com/doi/full/10.1080/15528030.2018.1536910https://www.tandfonline.com/doi/pdf/10.1080/15528030.2018.1536910 %N 2 %! Journal of Religion, Spirituality & Aging %R 10.1080/15528030.2018.1536910 %0 Journal Article %J Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %D 2019 %T Subjective Age and Cystatin C Among Older Adults. %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %A Shevaun Neupert %K Cystatin C %K Health Conditions and Status %K Subjective age %X

Objective: Cystatin C (CysC) is a marker of kidney function that is relevant for the health and cognition of older adults. Little is known about the link between psychological factors and CysC. Therefore, the present study examined whether subjective age is related to CysC level and changes in CysC over time.

Method: Participants were 5,066 individuals drawn from the Health and Retirement Study aged from 50 to 107 years (60% women, mean age = 69.36 years, SD = 9.54). They provided data on subjective age, demographic covariates, and CysC at baseline. CysC was assessed again 4 years later.

Results: Analysis revealed that an older subjective age was related to higher level of CysC at baseline and to an increase in CysC over 4 years, controlling for demographic factors. An older subjective age was also related to higher risk of exceeding the clinical threshold of CysC at baseline and 4 years later. Additional analysis revealed that disease burden, depressive symptoms, physical inactivity, and BMI partly mediated these associations.

Conclusion: The present study provides new evidence on the role of subjective age as a psychological factor associated with individuals' risk of kidney dysfunction, an association beyond chronological age.

%B Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %V 74 %P 382-388 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/29045722?dopt=Abstract %R 10.1093/geronb/gbx124 %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 %X

OBJECTIVES: 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 American Journal of Geriatric Psychiatry %D 2019 %T Using Skype to Beat the Blues: Longitudinal Data from a National Representative Sample. %A Alan R Teo %A Markwardt, Sheila %A Hinton, Ladson %K Depressive symptoms %K Social Support %K Technology %X

OBJECTIVES: This study aimed to determine whether use of certain types of online communication technology is associated with subsequent depressive symptoms.

DESIGN: Nationally representative, population-based prospective cohort.

SETTING: Data were obtained from the 2012 and 2014 waves of the Health and Retirement Study (HRS).

PARTICIPANTS: 1,424 community-residing older adults (mean age, 64.8) in the United States.

MEASUREMENTS: We examined associations between use of four communication technologies (email, social networks, video chat, and instant messaging) in 2012 and depressive symptoms (eight-item Center for Epidemiologic Studies Depression scale) at two-year follow-up.

RESULTS: 564 participants (39.6%) did not use any communication technologies, 314 (22.1%) used email only, and 255 (17.9%) used video chat (e.g., Skype). Compared to non-users (13.1%, 95% CI: 9.5-16.7%) or those who used only email (14.3%, 95% CI: 10.1-18.5%), users of video chat had approximately half the probability of depressive symptoms (6.9%, 95% CI: 3.5-10.3%, Wald Chi test, Chi=13.82, p < 0.001; 7.6%, 95% CI: 3.6-11.6, Wald Chi test, Chi=13.56, p < 0.001). Use of email, social media, and instant messaging were not associated with a lower risk of depression.

CONCLUSIONS: Older adults who use video chat such as Skype, but not other common communication technologies, have a lower risk of developing depression.

%B American Journal of Geriatric Psychiatry %V 27 %P 254-262 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30442532?dopt=Abstract %R 10.1016/j.jagp.2018.10.014 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2019 %T Verbal fluency and risk of dementia. %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Alzheimer's disease %K Cognition & Reasoning %X

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

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

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

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

%B International Journal of Geriatric Psychiatry %V 34 %P 863-867 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/30729575?dopt=Abstract %R 10.1002/gps.5081 %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 The Journal of Nutrition, Health & Aging %D 2019 %T Weakness is Associated with Time to Incident Chronic Heart Failure in Aging Americans %A Ryan P McGrath %A Lee, D.-C. %A William J Kraemer %A Brenda Vincent %A Shaughnessy, K. A. %A Terbizan, D. J. %K Heart Failure %K weakness %X Objective Handgrip strength is considered a biomarker of nutritional status and strength capacity, which are both linked to heart complications. However, it is not well understood how weakness, as measured by handgrip strength, factors into common heart conditions seen in aging adults such as chronic heart failure (CHF). The purpose of this study was to determine the association between weakness and incident CHF for aging Americans. Design Longitudinal-Panel. Setting Physical measures were completed during enhanced face-to-face interviews. The core interview was typically conducted over the telephone. Participants Data from 17,431 adults aged at least 50 years who identified as Black or White, completed interviews without a proxy, and participated in at least one wave of the 2006–2014 waves of the Health and Retirement Study were included. Measurements Handgrip strength was measured with a hand-held dynamometer. Healthcare provider diagnosed CHF was self-reported at each wave. Sex- and race-specific maximal handgrip strength cut-points were used for determining weakness (Black men: <40-kilograms, Black women: <31-kilograms, White men: <35-kilograms, White women: <22-kilograms). A covariate-adjusted Cox model analyzed the association between weakness and incident CHF. Results Of those included, 5,397 (31.0%) were weak and 327 (1.9%) developed CHF during the mean follow-up of 4.7±2.7 years. Those who were weak had a 35% higher risk (hazard ratio: 1.35; 95% confidence interval: 1.05, 1.74) of developing CHF, compared to those who were not-weak. Conclusion Measures of handgrip strength should be utilized by healthcare providers for assessing age-related weakness, nutritional status, and CHF risk. Likewise, interventions aiming to prevent or treat CHF in aging adults should incorporate measures of handgrip strength for helping to determine efficacy of intervention programs. %B The Journal of Nutrition, Health & Aging %P 1-4 %8 2019/10/03 %@ 1760-4788 %G eng %U https://doi.org/10.1007/s12603-019-1266-y %! The journal of nutrition, health & aging %0 Journal Article %J Journal of Primary Prevention %D 2019 %T Is weight discrimination associated with physical activity among middle aged and older adults? %A Sandi Phibbs %A Thorburn, Sheryl %A Adam J. Branscum %K BMI %K Discrimination %K Physical activity %X Older adults (> 65) are less physically active than all other adult age groups. Although experiences of weight discrimination have been inversely associated with physical activity in several studies of middle-aged and older adults, the role of weight discrimination in this relationship has not been sufficiently explicated. Using data from the Health and Retirement Study (a longitudinal panel study of U.S. adults aged 50 and older), we hypothesized that, among middle aged and older adults, weight discrimination would (a) be inversely related to respondents' reported level of physical activity; and (b) partially mediate the relationship between BMI and physical activity. Using multiple logistic regression analysis, we found an inverse relationship between weight discrimination and vigorous physical activity (OR = 0.79; 95% CI [0.66, 0.94]), as well as between weight discrimination and moderate physical activity (OR = 0.76; 95% CI [0.62, 0.92]). Weight discrimination mediated 13% of the relationship between BMI and vigorous physical activity, as well as 9% of the relationship between BMI and moderate physical activity. Weight discrimination may thus pose a barrier to regular physical activity among middle aged and older adults. Future research and interventions should identify effective ways of mitigating barriers experienced because of weight discrimination in the promotion of physical activity among these age groups, as well as how we may effectively reduce the perpetration of weight discrimination in various settings. %B Journal of Primary Prevention %8 2019 Mar 20 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30895424?dopt=Abstract %R 10.1007/s10935-019-00546-3 %0 Report %D 2018 %T Accounting for selection bias due to death in estimating the effect of wealth shock on cognition for the Health and Retirement Study %A Yaoyuan V. Tan %A Carol A C Flannagan %A Lindsay R Pool %A Michael R. Elliott %K Cognition & Reasoning %K Survey Methodology %K Wealth Shocks %X The Health and Retirement Study is a longitudinal study of US adults enrolled at age 50 and older. We were interested in investigating the effect of a sudden large decline in wealth on the cognitive score of subjects. Our analysis was complicated by the lack of randomization, confounding by indication, and a substantial fraction of the sample and population will die during follow-up leading to some of our outcomes being censored. Common methods to handle these problems for example marginal structural models, may not be appropriate because it upweights subjects who are more likely to die to obtain a population that over time resembles that would have been obtained in the absence of death. We propose a refined approach by comparing the treatment effect among subjects who would survive under both sets of treatment regimes being considered. We do so by viewing this as a large missing data problem and impute the survival status and outcomes of the counterfactual. To improve the robustness of our imputation, we used a modified version of the penalized spline of propensity methods in treatment comparisons approach. We found that our proposed method worked well in various simulation scenarios and our data analysis. %B Statistics > Applications %I arXiv.org %C Ithaca %8 12/2018 %G eng %U https://arxiv.org/abs/1812.08855 %0 Journal Article %J Work, Aging and Retirement %D 2018 %T Activities Matter: Personality and Resource Determinants of Activities and their Effect on Mental and Physical Well-being and Retirement Expectations %A Beier, Margaret E. %A Torres, W. Jackeline %A Gilberto, Jacqueline M. %K Activities of Daily Living %K Health Conditions and Status %K Personality %K Psychosocial %K Retirement Planning and Satisfaction %K Well-being %X Remaining active throughout the lifespan is central to healthy aging. The current study tests a model derived from investment and resource theories that examines the extent to which activities mediate the relationship between individual differences in personality and resources on mental and physical well-being and retirement expectations. A subsample (N = 400; 58% women) of participants from the nationally representative Health and Retirement Study (HRS) was used. Self-reported activities were grouped into 4 broad categories: productive, physical, social, and leisure. Activity variety, operationalized as the number of different activity categories in which a person reported participating over a specified period of time, was also examined. Correlations and path analysis results suggest small but significant effects between personality traits and activity participation, and more consistent effects of personality for predicting activity variety. Personality was also significantly correlated with well-being and retirement expectations as was activity variety. There was limited evidence, however, that activity variety mediated the relationship between personality and resources and mental and physical well-being and retirement expectations as would be predicted by investment theory. %B Work, Aging and Retirement %V 4 %P 67-78 %G eng %U https://academic.oup.com/workar/article-abstract/4/1/67/2660320?redirectedFrom=fulltext %N 1 %! WORKAR %R 10.1093/workar/waw034 %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 %X

Background 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 Journal of Personality %D 2018 %T Alcohol use and personality change in middle and older adulthood: Findings from the Health and Retirement Study. %A Martina Luchetti %A Antonio Terracciano %A Yannick Stephan %A Angelina R Sutin %K Alcohol Consumption %K Personality %K Self-reported health %X

OBJECTIVE: Personality is known to predict alcohol consumption, but how alcohol use is related to personality change is less clear, especially at older ages. The present study examined the effects of level of alcohol consumption and history of dependence on change in the Five-Factor Model personality traits in a national cohort of Americans aged over 50.

METHOD: Over 10,000 adults who participated in 2006-2008 waves of the Health and Retirement Study reported on personality and alcohol use and were followed over 4 years.

RESULTS: Latent difference score models indicated decreases in Extraversion to be attenuated for individuals categorized as light-to-moderate drinkers at baseline, whereas decreases in Conscientiousness were accentuated by having experienced alcohol dependence symptoms. Moreover, personality difference scores correlated with changes in the amount of alcohol consumed at follow-up.

CONCLUSIONS: The findings suggest that patterns of alcohol consumption are associated with changes in personality across the second half of the life span.

%B Journal of Personality %V 86 %P 1003-1016 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/29357105?dopt=Abstract %R 10.1111/jopy.12371 %0 Journal Article %J Annals of Epidemiology %D 2018 %T The association between hardship and self-rated health: does the choice of indicator matter? %A Gillian L Marshall %A Reginald D. Tucker-Seeley %K Depressive symptoms %K Finances %K Gender Differences %K Self Report %X Purpose: The purpose of this study was to investigate the association between four specific forms of hardship (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) and self-rated health among older men and women. Methods: Cross-sectional logistic regression analysis was conducted using the 2010 wave of the Health and Retirement Study Leave-Behind Questionnaire (N = 7619) to determine the association between four hardship indicators and self-rated health. Hardship indicators (difficulty paying bills, ongoing financial stress, medication reduction due to cost, and food insecurity) were dichotomized (0 = no hardship, 1 = yes hardship) for this analysis. Results: After adjusting for sociodemographic factors, participants reporting difficulty paying bills had an 1.8 higher odds of reporting poor self-rated health (95% confidence intervals [CI]: 1.57, 2.15) and those reporting taking less medication due to cost had a 2.5 times higher odds of poor self-rated health (95% CI: 1.97, 3.09) compared to those not reporting these hardships. When stratified by gender, and adjusting for sociodemographic factors, men who took less medication due to cost had a 1.93 higher odds of low self-rated health (95% CI: 1.39, 2.67) and women who took less medications due to cost had a 2.9 higher odds of reporting poor self-rated health (95% CI: 2.23, 2.70) compared to women not reporting these hardships. Conclusions: Research in this area can provide greater conceptual and measurement clarity on the hardship experience and further elucidate the pathway between specific hardships and poor health outcomes to inform intervention development. %B Annals of Epidemiology %V 28 %P 462-467 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S1047279717306178http://api.elsevier.com/content/article/PII:S1047279717306178?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1047279717306178?httpAccept=text/plain %N 7 %! Annals of Epidemiology %R 10.1016/j.annepidem.2018.03.013 %0 Journal Article %J Journal of Occupational and Environmental Medicine %D 2018 %T The Associations between Falls, Fall Injuries and Labor Market Outcomes among U.S. Workers 65 Years and Older. %A Kenneth A Scott %A Gwenith G Fisher %A Barón, Anna E %A Tompa, Emile %A Stallones, Lorann %A DiGuiseppi, Carolyn %K Employment and Labor Force %K Falls %K Retirement Planning and Satisfaction %X

OBJECTIVE: To examine whether falls are associated with the subsequent ability to work among workers 65 years and older.

METHODS: This longitudinal cohort study followed older workers enrolled in the Health and Retirement Study. Outcomes included time to health-related work limitation and to labor force exit.

RESULTS: After adjustment multiple falls with or without a medically-treated injury were associated with time to limitation (HR = 1.77, 95% CI: 1.30-2.40; HR = 1.48, 95% CI: 1.26-1.73, respectively). Adjustment mitigated a crude relationship between falls and time to exit. Significant interactions suggest the relationship between falls and labor force exit depends on age, race and job demands.

CONCLUSIONS: Falls, both non-injurious and injurious, are associated with subsequent health-related work limitation among workers 65 and older. Fall prevention activities would benefit workers who want or need to keep working past age 65.

%B Journal of Occupational and Environmental Medicine %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29905647?dopt=Abstract %R 10.1097/JOM.0000000000001379 %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 %X

PURPOSE: 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 Thesis %B Sociology %D 2018 %T Cumulative Inequality and Housing Insecurity Severity among Renters in Later Life %A True-Funk,Arielle %K 0351:Gerontology %K 0626:Sociology %K Gerontology %K life course %K Social Sciences %K Sociology %X Housing insecurity, lack of access to safe and affordable housing, has become a national public health crisis, especially among vulnerable populations such as renters and the aged. For everyone, housing insecurity is associated with poorer mental and physical health and shortened lifespans. With data from the 2014 Health and Retirement Study and ordered logistic regression models, this study examined housing insecurity severity among renters age 50 and older using a CI framework providing explanation of systemic and individual forces result in differential and unequal outcomes dependent on exposure to risk and opportunity. Over half of respondents experienced any level of housing insecurity. Of housing insecure respondents, three out of five were observed as severely housing insecure. Those from urban areas, less than a high school diploma, widows, and over the age of 80 had enhanced odds of experiencing more severe housing insecurity. Additional research is needed to identify other aspects of cumulative inequality that may be related to housing insecurity to better guide policy change with respect to this important issue. %B Sociology %I Iowa State University %C Ames, Iowa %V Master of Science %P 88 %@ 9780438417618 %G eng %U https://www.semanticscholar.org/paper/Cumulative-inequality-and-housing-insecurity-among-True-Funk/76202cef00ce0862db5763d09d821818ddc2ed28 %9 phd %0 Thesis %B Personal Financial Planning %D 2018 %T Do perceptions reflect reality? Three essays exploring how perceptions are related to objective measures of financial well-being and knowledge. %A Tenney, Jacob A. %K Finance %K Financial well-being %K Perception %X Financial well-being is likely a factor in many individual’s utility function. Financial wellness can be measured using objective measures as well as subjective perceptions. In the first two essays, objective measures are compared to subjective perceptions to see if there is a relationship between the two. Three financial ratios, including the liquidity ratio, the debt-to-asset ratio, and the investment ratio, are used as objective measures of financial wellness. Subjective perceptions are measured by a question that asks respondents how satisfied they are with their financial condition. The first essay analyzes at older Americans using the Health and Retirement Study. The second essay analyzes early-to-mid-career Americans using the Panel Study of Income Dynamics. The findings in this analysis suggest that there is a statistically and economically significant relationship between the investment ratio and individuals perceptions of financial satisfaction, particularly for older individuals. Financial ratios only play a small but important role in the overall financial situation. The goal of the third study is to analyze the relationship between objective measures of financial knowledge and individuals’ perceptions of their own financial knowledge. In addition, this paper looks at how perceptions of financial knowledge change over time. The focus of this paper is emerging adults who attend college and then transition into careers after college. The data for this study are from the Arizona Pathways to Life Success for University Students (APLUS) survey. The findings of this research suggest a positive correlation between objective measures and perceptions of financial wellness. College seniors in this study have a higher probability of perceiving themselves as financially knowledgeable compared to when they were in their first year of college. However, these same college seniors perceive themselves as more financially literate then they do 2 and 5 years after college. This study highlights the importance of financial education during college. It also shows that individuals are likely to perceive themselves as more financially literate than they are. %B Personal Financial Planning %I Texas Tech University %C Lubbock, TX %V Doctor of Philosophy %P 87 %8 08/2018 %G eng %U https://ttu-ir.tdl.org/handle/2346/74372?show=full %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 %X

Variability 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 Thesis %B Criminal Justice %D 2018 %T Elder victimization and routine activities: An examination of the predictors of fraud and burglary for those age 60 and older %A Tapp, Susannah Naomi %K Financial literacy %K Fraud %K Risk Factors %X As the elderly population continues to grow, the victimization of the elderly becomes an increasingly important topic. While there is a great deal of research on victimization, most of that research has focused on young adults, those who commit the majority of crimes. What research on the elderly and crime does exist has focused on either fear of crime or elder abuse. The criminal victimization of the elderly is not considered. The current study tested the applicability of routine activities lifestyles theory to the criminal victimization of the elderly for two crimes: burglary and fraud. Using multiple waves of data from the Health and Retirement Study, the roles of target vulnerability, exposure to motivated offenders, presence of guardians, and engaging in risky behavior on criminal victimization were examined. A series of binary logistic regressions were run to test the impact of these factors. Additionally, two subsamples, looking at family related factors, were examined. The study found that findings based on studies of younger individuals that prior victimization is one of the strongest predictors of victimization could be applied to the elderly. Most individuals age out of crime and victimization, but others who do not. Additionally, being Hispanic, having financial difficulties, and, in some cases, relationship quality and problems with family members also influenced the odds of victimization. %B Criminal Justice %I Georgia State University %C Atlanta, GA %V Doctor of Philosophy %P 141 %G eng %U https://scholarworks.gsu.edu/cj_diss/11 %9 Dissertation %0 Journal Article %J Psychology & Health %D 2018 %T Facets of conscientiousness and objective markers of health status %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Biomarkers %K BMI %K Conscientiousness %K Physical Ability %K Risk Taking %X Objective: To examine the association between six facets of conscientiousness (self-control, order, industriousness, traditionalism, virtue, responsibility) and objective markers of health status, including adiposity, blood markers and physical performance. Design: Cross-sectional analysis of participants from the health and retirement study (N = 12,188). Main Outcome Measures: Adiposity (body mass index, waist circumference), blood markers (A1c, HDL cholesterol, total cholesterol, cystatin c, c-reactive protein) and physical performance (lung function, grip strength, walking speed). Results: Four of the six facets of conscientiousness were associated with nearly all of the health markers: Self-control, organisation, industriousness and responsibility were related to lower adiposity, healthier metabolic, cardiovascular and inflammatory markers, and better performance on physical assessments. Traditionalism and virtue had fewer associations with these objective markers. Conclusion: This research took a facet-level approach to the association between conscientiousness and objective markers of health status. This research builds on models of conscientiousness and health to suggest that, in addition to health-risk behaviours, facets of conscientiousness are associated with more favourable biomedical markers of health status. © 2018 Informa UK Limited, trading as Taylor & Francis Group %B Psychology & Health %P 1 - 16 %8 Feb-05-2018 %G eng %U https://www.tandfonline.com/doi/full/10.1080/08870446.2018.1464165https://www.tandfonline.com/doi/pdf/10.1080/08870446.2018.1464165 %! Psychology & Health %R 10.1080/08870446.2018.1464165 %0 Journal Article %J Psychological Medicine %D 2018 %T Facets of conscientiousness and risk of dementia. %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Cognitive Ability %K Conscientiousness %K Dementia %K Risk Factors %X

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

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

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

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

%B Psychological Medicine %V 48 %P 974-982 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28874220?dopt=Abstract %R 10.1017/S0033291717002306 %0 Journal Article %J PLoS One %D 2018 %T Frailty Index associates with GRIN2B in two representative samples from the United States and the United Kingdom. %A Mekli, Krisztina %A Stevens, Adam %A Alan Marshall %A Thalida E. Arpawong %A Drystan F. Phillips %A Tampubolon, Gindo %A Lee, Jinkook %A Carol A Prescott %A James Nazroo %A Pendleton, Neil %K ELSA %K Frailty %K Gene Ontology %K Genome-Wide Association Study %K Phenotype %X

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

%B PLoS One %V 13 %P e0207824 %G eng %N 11 %R 10.1371/journal.pone.0207824 %0 Journal Article %J Nature Genetics %D 2018 %T Gene discovery and polygenic prediction from a genome-wide association study of educational attainment in 1.1 million individuals. %A Lee, James J %A Wedow, Robbee %A Okbay, Aysu %A Kong, Edward %A Maghzian, Omeed %A Zacher, Meghan %A Nguyen-Viet, Tuan Anh %A Bowers, Peter %A Sidorenko, Julia %A Richard Karlsson Linnér %A Mark Alan Fontana %A Kundu, Tushar %A Lee, Chanwook %A Hui Liu %A Li, Ruoxi %A Royer, Rebecca %A Pascal N Timshel %A Walters, Raymond K %A Willoughby, Emily A %A Yengo, Loic %A Alver, Maris %A Bao, Yanchun %A Clark, David W %A Day, Felix R %A Furlotte, Nicholas A %A Joshi, Peter K %A Kathryn E Kemper %A Kleinman, Aaron %A Langenberg, Claudia %A Mägi, Reedik %A Joey W Trampush %A Verma, Shefali Setia %A Wu, Yang %A Lam, Max %A Jing Hua Zhao %A Zheng, Zhili %A Jason D Boardman %A Campbell, Harry %A Freese, Jeremy %A Kathleen Mullan Harris %A Caroline Hayward %A Herd, Pamela %A Kumari, Meena %A Lencz, Todd %A Luan, Jian'an %A Anil K. Malhotra %A Andres Metspalu %A Lili Milani %A Ong, Ken K %A Perry, John R B %A David J Porteous %A Ritchie, Marylyn D %A Smart, Melissa C %A Smith, Blair H %A Tung, Joyce Y %A Wareham, Nicholas J %A James F Wilson %A Jonathan P. Beauchamp %A Dalton C Conley %A Tõnu Esko %A Lehrer, Steven F %A Patrik K E Magnusson %A Oskarsson, Sven %A Pers, Tune H %A Matthew R Robinson %A Thom, Kevin %A Watson, Chelsea %A Chabris, Christopher F %A Meyer, Michelle N %A David I Laibson %A Yang, Jian %A Johannesson, Magnus %A Philipp D Koellinger %A Turley, Patrick %A Peter M Visscher %A Daniel J. Benjamin %A Cesarini, David %K Adult %K Aged %K Aged, 80 and over %K Cohort Studies %K Educational Status %K Female %K Genome-Wide Association Study %K Humans %K Male %K Middle Aged %K Multifactorial Inheritance %K Phenotype %K Polymorphism, Single Nucleotide %X

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

%B Nature Genetics %V 50 %P 1112-1121 %8 2018 07 23 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/30038396?dopt=Abstract %R 10.1038/s41588-018-0147-3 %0 Journal Article %J Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %D 2018 %T Genetics of human longevity from incomplete data: New findings from the long life family study. %A Anatoliy Yashin %A Konstantin G Arbeev %A Wu, Deqing %A Liubov S Arbeeva %A Bagley, Olivia %A Stallard, Eric %A Alexander M Kulminski %A Akushevich, Igor %A Fang, Fang %A Wojczynski, Mary K %A Christensen, Kaare %A Anne B Newman %A Boudreau, Robert M %A Province, Michael A %A Stephen M Thielke %A Thomas T Perls %A An, Ping %A Irma Elo %A Svetlana Ukraintseva %K Genetics %K Longevity %X The special design of the Long Life Family Study provides a unique opportunity to investigate the genetics of human longevity by analyzing data on exceptional lifespans in families. In this article, we performed two series of genome wide association studies of human longevity which differed with respect to whether missing lifespan data were predicted or not predicted. We showed that the use of predicted lifespan is most beneficial when the follow-up period is relatively short. In addition to detection of strong associations of SNPs in APOE, TOMM40, NECTIN2, and APOC1 genes with longevity, we also detected a strong new association with longevity of rs1927465, located between the CYP26A1 and MYOF genes on chromosome 10. The association was confirmed using data from the Health and Retirement Study. We discuss the biological relevance of the detected SNPs to human longevity. %B Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %V 73 %P 1472-1481 %8 10/2018 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/30299504?dopt=Abstract %R 10.1093/gerona/gly057 %0 Journal Article %J Nature Genetics %D 2018 %T Genome-wide association meta-analysis in 269,867 individuals identifies new genetic and functional links to intelligence %A Savage, Jeanne E. %A Philip R Jansen %A Stringer, Sven %A Watanabe, Kyoko %A Bryois, Julien %A Christiaan de Leeuw %A Nagel, Mats %A Awasthi, Swapnil %A Barr, Peter B. %A Coleman, Jonathan R. I. %A Grasby, Katrina L. %A Anke R Hammerschlag %A Kaminski, Jakob A. %A Karlsson, Robert %A Krapohl, Eva %A Lam, Max %A Nygaard, Marianne %A Chandra A Reynolds %A Joey W Trampush %A Young, Hannah %A Zabaneh, Delilah %A Hägg, Sara %A Narelle K Hansell %A Ida Karlsson %A Linnarsson, Sten %A Grant W Montgomery %A Muñoz-Manchado, Ana B. %A Quinlan, Erin B. %A Schumann, Gunter %A Skene, Nathan G. %A Webb, Bradley T. %A White, Tonya %A Dan E Arking %A Avramopoulos, Dimitrios %A Robert M Bilder %A Bitsios, Panos %A Katherine E Burdick %A Tyrone D. Cannon %A Chiba-Falek, Ornit %A Christoforou, Andrea %A Elizabeth T. Cirulli %A Congdon, Eliza %A Corvin, Aiden %A Gail Davies %A Ian J Deary %A DeRosse, Pamela %A Dickinson, Dwight %A Djurovic, Srdjan %A Donohoe, Gary %A Conley, Emily Drabant %A Johan G Eriksson %A Espeseth, Thomas %A Nelson A. Freimer %A Giakoumaki, Stella %A Giegling, Ina %A Gill, Michael %A David C. Glahn %A Ahmad R Hariri %A Hatzimanolis, Alex %A Matthew C Keller %A Knowles, Emma %A Koltai, Deborah %A Konte, Bettina %A Lahti, Jari %A Stephanie Le Hellard %A Lencz, Todd %A David C Liewald %A London, Edythe %A Astri J Lundervold %A Anil K. Malhotra %A Melle, Ingrid %A Morris, Derek %A Anna C Need %A William E R Ollier %A Aarno Palotie %A Payton, Antony %A Pendleton, Neil %A Russell A Poldrack %A Katri Räikkönen %A Reinvang, Ivar %A Roussos, Panos %A Rujescu, Dan %A Fred W Sabb %A Matthew A Scult %A Smeland, Olav B. %A Smyrnis, Nikolaos %A John M Starr %A Vidar M Steen %A Nikos C Stefanis %A Richard E Straub %A Sundet, Kjetil %A Henning Tiemeier %A Aristotle N Voineskos %A Daniel R Weinberger %A Elisabeth Widen %A Yu, Jin %A Gonçalo R Abecasis %A Andreassen, Ole A. %A Breen, Gerome %A Christiansen, Lene %A Debrabant, Birgit %A Danielle M. Dick %A Heinz, Andreas %A Hjerling-Leffler, Jens %A Mohammed Arfan Ikram %A Kendler, Kenneth S. %A Nicholas G Martin %A Sarah E Medland %A Nancy L Pedersen %A Plomin, Robert %A Tinca J Polderman %A Ripke, Stephan %A van der Sluis, Sophie %A Patrick F. Sullivan %A Scott Vrieze %A Margaret J Wright %A Posthuma, Danielle %K Genome-Wide Association Study %K Intelligence %K Meta-analyses %X Intelligence is highly heritable1 and a major determinant of human health and well-being2. Recent genome-wide meta-analyses have identified 24 genomic loci linked to variation in intelligence3-7, but much about its genetic underpinnings remains to be discovered. Here, we present a large-scale genetic association study of intelligence (n = 269,867), identifying 205 associated genomic loci (190 new) and 1,016 genes (939 new) via positional mapping, expression quantitative trait locus (eQTL) mapping, chromatin interaction mapping, and gene-based association analysis. We find enrichment of genetic effects in conserved and coding regions and associations with 146 nonsynonymous exonic variants. Associated genes are strongly expressed in the brain, specifically in striatal medium spiny neurons and hippocampal pyramidal neurons. Gene set analyses implicate pathways related to nervous system development and synaptic structure. We confirm previous strong genetic correlations with multiple health-related outcomes, and Mendelian randomization analysis results suggest protective effects of intelligence for Alzheimer's disease and ADHD and bidirectional causation with pleiotropic effects for schizophrenia. These results are a major step forward in understanding the neurobiology of cognitive function as well as genetically related neurological and psychiatric disorders. %B Nature Genetics %V 50 %P 912 - 919 %8 Jan-07-2018 %G eng %U http://www.nature.com/articles/s41588-018-0152-6http://www.nature.com/articles/s41588-018-0152-6.pdfhttp://www.nature.com/articles/s41588-018-0152-6http://www.nature.com/articles/s41588-018-0152-6.pdf %N 7 %! Nat Genet %R 10.1038/s41588-018-0152-6 %0 Journal Article %J Journal of Psychiatric Research %D 2018 %T Genome-wide scan of depressive symptomatology in two representative cohorts in the United States and the United Kingdom. %A Mekli, Krisztina %A Drystan F. Phillips %A Thalida E. Arpawong %A Vanhoutte, Bram %A Tampubolon, Gindo %A James Nazroo %A Lee, Jinkook %A Carol A Prescott %A Stevens, Adam %A Pendleton, Neil %K depression %K ELSA %K Genome-Wide Association Study %X

Unlike the diagnosed Major Depressive Disorder, depressive symptomatology in the general population has received less attention in genome-wide association scan (GWAS) studies. Here we report a GWAS study on depressive symptomatology using a discovery-replication design and the following approaches: To improve the robustness of the phenotypic measure, we used longitudinal data and calculated mean scores for at least 3 observations for each individual. To maximize replicability, we used nearly identical genotyping platforms and identically constructed phenotypic measures in both the Discovery and Replication samples. We report one genome-wide significant hit; rs58682566 in the EPG5 gene was associated (p = 3.25E-08) with the mean of the depression symptom in the Discovery sample, without confirmation in the Replication sample. We also report 4 hits exceeding the genome-wide suggestive significance level with nominal replications. Rs11774887, rs4147527 and rs1379328, close to the SAMD12 gene, were associated with the mean depression symptom score (P-values in Discovery sample: 4.58E-06, 7.65E-06 and 7.66E-06; Replication sample: 0.049, 0.029 and 0.030, respectively). Rs13250896, located in an intergenic region, was associated with the mean score of the three somatic items of the depression symptoms score (p = 3.31E-07 and 0.042 for the Discovery and Replication samples). These results were not supported by evidence in the literature. We conclude that despite the strengths of our approach, using robust phenotypic measures and samples that maximize replicability potential, this study does not provide compelling evidence of a single genetic variant's significant role in depressive symptomatology.

%B Journal of Psychiatric Research %V 100 %P 63-70 %G eng %R 10.1016/j.jpsychires.2018.01.016 %0 Journal Article %J Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 2018 %T Health benefits associated with three helping behaviors: Evidence for incident cardiovascular disease. %A Jeffrey A Burr %A Sae Hwang Han %A Lee, Hyo Jung %A Jane Tavares %A Jan E Mutchler %K Caregiving %K Heart disease %K Mortality %K Volunteerism %X

Objective: The purpose of this study was to investigate the association between three helping behaviors and incident cardiovascular disease (CVD; heart attack, stroke; fatal and nonfatal), with an exploration of gender differences. The study is framed within the caregiving system model. Helping others is argued to be an evolved characteristic of humans that yields beneficial health effects.

Methods: Data were taken from the 2004-2014 waves of the Health and Retirement Study. The three forms of helping others considered were formal volunteering, informal helping, and caregiving for a parent or spouse. Cox proportional hazards models were estimated for gender-stratified samples.

Results: Women who volunteered showed a lower risk of incident CVD compared to women who did not volunteer. Men who informally helped others in the community exhibited a lower risk of incident CVD compared to men who did not provide this form of help. Caregiving status was generally not associated with incident CVD for women or men.

Discussion: The results demonstrated that specific types of prosocial behavior may be beneficial for women and men. However, tests for effect differences showed that gender did not moderate the relationships between these helping behaviors and CVD risk.

%B Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %V 73 %P 492-500 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/28637329?dopt=Abstract %R 10.1093/geronb/gbx082 %0 Journal Article %J Research on Aging %D 2018 %T Healthy aging after age 65: A life-span health production function approach. %A Nasim B Ferdows %A Gail A Jensen %A Wassim Tarraf %K Health Behavior %K Lifecycles %X This article examines the determinants of healthy aging using Grossman's framework of a health production function. Healthy aging, sometimes described as successful aging, is produced using a variety of inputs, determined in early life, young adulthood, midlife, and later life. A healthy aging production function is estimated using nationally representative data from the 2010 and 2012 Health and Retirement Study on 7,355 noninstitutionalized seniors. Using a simultaneous equation mediation model, we quantify how childhood factors contribute to healthy aging, both directly and indirectly through their effects on mediating adult outcomes. We find that favorable childhood conditions significantly improve healthy aging scores, both directly and indirectly, mediated through education, income, and wealth. We also find that good health habits have positive effects on healthy aging that are larger in magnitude than the effects of childhood factors. Our findings suggest that exercising, maintaining proper weight, and not smoking are likely to translate into healthier aging. %B Research on Aging %V 40 %P 480-507 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/28610549?dopt=Abstract %R 10.1177/0164027517713312 %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 Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %D 2018 %T The impacts of service related exposures on trajectories of mental health among aging veterans. %A Urena, Stephanie %A Miles G Taylor %A Ben Lennox Kail %K Depressive symptoms %K Health Trajectories %K Veterans %X Objectives: Drawing on life-course perspective and cumulative advantage theory, we examined whether service related exposures (SREs)-combat and exposure to death-have lasting impacts on depressive symptom and psychiatric problem trajectories of aging veterans. Methods: The Health and Retirement Study and linked 2013 Veterans Mail Survey were used to examine SREs and mental health among older veterans between 2002 and 2012 (N = 1,662). Latent growth curves were used to measure how individuals vary from average mental health trajectories based on SREs and other important covariates. Results: Exposure to death had a significant and lasting effect on depressive symptoms for veterans in late life but was reduced to nonsignificance when physical health trajectories were included. Combat and exposure to death had independent and robust impacts on psychiatric problems, which were robust in final models. Discussion: SREs presented varied and significant impacts, suggesting that combat does not work alone in driving poor mental health trajectories, and that exposure to death is a more robust risk marker for later outcomes. %B Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %V 73 %P e131-e142 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/28158777?dopt=Abstract %R 10.1093/geronb/gbw149 %0 Journal Article %J Journal of the American Geriatrics Society %D 2018 %T Longitudinal Relationship Between Hearing Aid Use and Cognitive Function in Older Americans %A Maharani, Asri %A Dawes, Piers %A James Nazroo %A Tampubolon, Gindo %A Pendleton, Neil %K Cognitive Ability %K Hearing aids %K Hearing loss %K Longitudinal data %X Objectives: To test whether hearing aid use alters cognitive trajectories in older adults. Design: US population-based longitudinal cohort study Setting: Data were drawn from the Health and Retirement Study (HRS), which measured cognitive performance repeatedly every 2 years over 18 years (1996-2014). Participants: Adults aged 50 and older who who took part in a minimum of 3 waves of the HRS and used hearing aids for the first time between Waves 4 and 11 (N=2,040). Measurements: Cognitive outcomes were based on episodic memory scores determined according to the sum of immediate and delayed recall of 10 words. Results: Hearing aid use was positively associated with episodic memory scores (β=1.53, p<.001). Decline in episodic memory scores was slower after (β=-0.02, p<.001) than before using hearing aids (β=-0.1, p<.001). These results were robust to adjustment for multiple confounders and to attrition, as accounted for using a joint model. Conclusions: Hearing aids may have a mitigating effect on trajectories of cognitive decline in later life. Providing hearing aids or other rehabilitative services for hearing impairment much earlier in the course of hearing impairment may stem the worldwide rise of dementia. %B Journal of the American Geriatrics Society %V 66 %P 1130-1136 %G eng %U http://doi.wiley.com/10.1111/jgs.15363http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15363/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.15363 %N 6 %! J Am Geriatr Soc %R 10.1111/jgs.15363 %0 Journal Article %J SSM Popul Health %D 2018 %T Machine learning approaches to the social determinants of health in the Health and Retirement study. %A Seligman, Benjamin %A Tuljapurkar, Shripad %A David Rehkopf %K Biomarkers %K Computer science %K Machine learning %K Neural network %K Social Factors %K Social Support %X

Background: Social and economic factors are important predictors of health and of recognized importance for health systems. However, machine learning, used elsewhere in the biomedical literature, has not been extensively applied to study relationships between society and health. We investigate how machine learning may add to our understanding of social determinants of health using data from the Health and Retirement Study.

Methods: A linear regression of age and gender, and a parsimonious theory-based regression additionally incorporating income, wealth, and education, were used to predict systolic blood pressure, body mass index, waist circumference, and telomere length. Prediction, fit, and interpretability were compared across four machine learning methods: linear regression, penalized regressions, random forests, and neural networks.

Results: All models had poor out-of-sample prediction. Most machine learning models performed similarly to the simpler models. However, neural networks greatly outperformed the three other methods. Neural networks also had good fit to the data (between 0.4-0.6, versus <0.3 for all others). Across machine learning models, nine variables were frequently selected or highly weighted as predictors: dental visits, current smoking, self-rated health, serial-seven subtractions, probability of receiving an inheritance, probability of leaving an inheritance of at least $10,000, number of children ever born, African-American race, and gender.

Discussion: Some of the machine learning methods do not improve prediction or fit beyond simpler models, however, neural networks performed well. The predictors identified across models suggest underlying social factors that are important predictors of biological indicators of chronic disease, and that the non-linear and interactive relationships between variables fundamental to the neural network approach may be important to consider.

%B SSM Popul Health %V 4 %P 95-99 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29349278?dopt=Abstract %R 10.1016/j.ssmph.2017.11.008 %0 Journal Article %J Human Molecular Genetics %D 2018 %T Meta-analysis of genome-wide association studies for height and body mass index in ∼700000 individuals of European ancestry %A Yengo, Loic %A Sidorenko, Julia %A Kathryn E Kemper %A Zheng, Zhili %A Andrew R Wood %A Michael N Weedon %A Timothy M Frayling %A Joel N Hirschhron %A Yang, Jian %A Peter M Visscher %K BMI %K Genetics %K GWAS %K Height %X Recent genome-wide association studies (GWAS) of height and body mass index (BMI) in similar to 250000 European participants have led to the discovery of similar to 700 and similar to 100 nearly independent single nucleotide polymorphisms (SNPs) associated with these traits, respectively. Here we combine summary statistics from those two studies with GWAS of height and BMI performed in similar to 450000 UK Biobank participants of European ancestry. Overall, our combined GWAS meta-analysis reaches N similar to 700000 individuals and substantially increases the number of GWAS signals associated with these traits. We identified 3290 and 941 near-independent SNPs associated with height and BMI, respectively (at a revised genome-wide significance threshold of P < 1 x 10(-8)), including 1185 height-associated SNPs and 751 BMI-associated SNPs located within loci not previously identified by these two GWAS. The near-independent genome-wide significant SNPs explain similar to 24.6% of the variance of height and similar to 6.0% of the variance of BMI in an independent sample from the Health and Retirement Study (HRS). Correlations between polygenic scores based upon these SNPs with actual height and BMI in HRS participants were similar to 0.44 and similar to 0.22, respectively. From analyses of integrating GWAS and expression quantitative trait loci (eQTL) data by summary-data-based Mendelian randomization, we identified an enrichment of eQTLs among lead height and BMI signals, prioritizing 610 and 138 genes, respectively. Our study demonstrates that, as previously predicted, increasing GWAS sample sizes continues to deliver, by the discovery of new loci, increasing prediction accuracy and providing additional data to achieve deeper insight into complex trait biology. All summary statistics are made available for follow-up studies. %B Human Molecular Genetics %V 27 %P 3641-3649 %G eng %N 20 %R 10.1093/hmg/ddy271 %0 Thesis %B Psychology %D 2018 %T Modeling Job-demand Conditional Dynamics in Physical and Cognitive Functioning on Changes in Older Workers' Wellbeing over Time %A Toomey,Eileen C. %K 0624:Occupational psychology %K Aging %K Fluid intelligence %K health %K Health and Retirement Study %K Job demands %K Occupational psychology %K Psychology %K Wellbeing %X Workforce aging presents organizations and researchers with the possibility that older workers will eventually retire, taking with them their accumulated skills and industry knowledge. Thus, it is important to understand the factors that promote the working individual’s wellbeing across the lifespan to maintain their employability. Part of these efforts is the study of successful aging at work, which can be generally understood as achieving and maintaining positive outcomes across one’s work lifespan. Successful aging theories emphasize the importance of understanding the person and contextual factors that influence wellbeing across the lifespan. Indeed, person factors such as health and fluid intelligence both indicate decrements in older individuals that likely result in decreases in wellbeing over time. The Job-Demands Resources (JD-R) model provides insight into how contextual, work-related factors like levels of job demands are also likely to have a negative, main effect on wellbeing over time. Moreover, older workers likely differ in the extent to which changes in health and cognition impact wellbeing, and job demands likely serve as a moderator of these relationships. The current study draws from the JD-R model and lifespan theories to understand the extent to which job demands exacerbate the effects that changes in health and fluid intelligence have on changes in wellbeing in a sample of older workers from the Health and Retirement Study. %B Psychology %I Saint Louis University %V PhD %P 104 %@ 9780438127869 %G eng %U https://search.proquest.com/docview/2070621126?pq-origsite=gscholar %9 phd %0 Thesis %B Biostatistics %D 2018 %T Novel Applications and Extensions for Bayesian Additive Regression Trees (BART) in Prediction, Imputation, and Causal Inference %A Yaoyuan V. Tan %K 0308:Biostatistics %K Bayesian additive regression trees %K Biological sciences %K Biostatistics %K Causal inference %K Imputation %K Prediction %X The Bayesian additive regression trees (BART) is a method proposed by Chipman et al. (2010) that can handle non-linear main and multiple-way interaction effects for independent continuous or binary outcomes. It has enjoyed much success in areas like causal inference, economics, environmental sciences, and genomics. However, extensions of BART and application of these extensions are limited. This thesis discusses three novel applications and extensions for BART. We first discuss how BART can be extended to clustered outcomes by adding a random intercept. This work was motivated by the need to accurately predict driver behavior using observable speed and location information with application to communication of key human-driver intention to nearby vehicles in traffic. Although our extension can be considered a special case of the spatial BART (Zhang et al., 2007), our approach differs by providing a relatively simple algorithm that allows application to clustered binary outcomes. We next focus on the use of BART in missing data settings. Doubly robust (DR) methods allow consistent estimation of population means when either non-response propensity or modeling of the mean of the outcome is correctly specified. Kang and Schafer (2007) showed that DR methods produce biased and inefficient estimates when both propensity and mean models are misspecified. We consider the use of BART for modeling means and/or propensities to provide a ``robust-squared'' estimator that reduces bias and improves efficiency. We demonstrate this result, using simulations, for the two commonly used DR methods: Augmented Inverse Probability Weighting (AIPWT, Robbins et al., 1994) and penalized splines of propensity prediction (PSPP, Zhang and Little, 2009). We successfully applied our proposed model to two national crash datasets to impute missing change in deceleration values (delta-v) and missing Blood Alcohol Concentration (BAC) levels respectively. Our final effort considers how a negative wealth shock (sudden large decline in wealth) affects the cognitive outcome of late middle aged US adults using the Health Retirement Study, a longitudinal study of US adults, enrolled at age 50 and older and surveyed biennially since 1992. Our analysis faced three issues: lack of randomization, confounding by indication, and censoring of the cognitive outcome by a substantial number of deaths in our subjects. Marginal structural models (MSM), a commonly used method to deal with censoring by death, is arguably inappropriate because it upweights subjects who are more likely to die, creating a pseudo-population which resembles one where death is absent. We propose to compare the negative wealth shock effect only among subjects who survived under both sets of treatment regimens - a special case of principal stratification (Frangakis and Rubin, 2002). Because the counterfactual survival status would be unobserved, we imputed their survival status and restrict analysis to subjects who were observed and predicted to survive under both treatment regimes. We used a modified version of penalized spline of propensity methods in treatment comparisons (PENCOMP, Zhou et. al, 2018) to obtain a robust imputation of the counterfactual cognitive outcomes. Finally, we consider several possible extensions of these efforts for future work. %B Biostatistics %I University of Michigan %C Ann Arbor, MI %V PhD %P 201 %@ 9780438885981 %G eng %U https://deepblue.lib.umich.edu/handle/2027.42/147594 %9 phd %0 Journal Article %J Personality and Individual Differences %D 2018 %T Parental Educational Attainment and Offspring Subjective Well-being and Self-Beliefs in Older Adulthood. %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Education %K Multigenerational %K Self-perception %K Subjective Expectations %K Well-being %X This research examines whether parental educational attainment and subjective childhood socioeconomic status (SES) is associated with adult offspring well-being and self-beliefs (broadly defined). Participants from the Health and Retirement Study were included if they completed the leave-behind questionnaire in 2006 or 2008 (=10,827;=68.38;=9.81; range=50-101). Participants reported on their own and both parents educational attainment, subjective childhood financial situation, and financial difficulties in childhood at study entry and on well-being in 2006/2008. Linear regression was used to examine the association between offspring education, parental education, childhood SES and three aspects of well-being and self-beliefs: positive affect (e.g., positive emotions, optimism), negative affect (e.g., loneliness, hostility), and cognitive evaluation (e.g., life satisfaction). Participants with more education reported higher well-being (median β=.12). Parental educational attainment, subjective childhood SES, and a significant financial event during childhood were associated with more positive affect, less negative affect, and higher life satisfaction (median β=.05); these associations held controlling for offspring education. The educational and financial environment of childhood may hamper well-being into older adulthood; the offspring's own experiences and achievements do not completely attenuate the association with these aspects of the childhood environment. %B Personality and Individual Differences %V 128 %P 139-145 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29527082?dopt=Abstract %R 10.1016/j.paid.2018.01.023 %0 Journal Article %J Journal of Population Economics %D 2018 %T Parental retirement timing: the role of unanticipated events in the lives of adult children %A Miller, Marina %A Tamborini, Christopher R. %A Reznik, Gayle L. %K Adult children %K Parents %K Retirement Planning and Satisfaction %K Wealth Shocks %X Although anecdotal evidence of older parents postponing retirement to financially support their grown children is common, the empirical evidence is scarce. In this paper, we use data from the 1992 to 2010 waves of the Health and Retirement Study to identify a broad set of pivotal events in the lives of adult children. First, we determine whether these events affect subsequent financial transfers from parents to children over multiple years. Next, we determine whether those events that result in subsequent transfers also shift parental retirement expectations. Finally, we quantify the impact of the unexpected children’s events on retirement realizations, moving beyond the correlational analyses in prior literature. Our findings show that a child’s move out of a parental home decreases both expectations and realizations of working after age 65. The magnitude of this effect is similar to that of an own health shock experienced during pre-retirement years. %B Journal of Population Economics %V 31 %P 747–781 %G eng %N 3 %! J Popul Econ %R 10.1007/s00148-018-0698-8 %0 Journal Article %J International Journal of Obesity %D 2018 %T Perceived weight discrimination and risk of incident dementia %A Angelina R Sutin %A Yannick Stephan %A Robinson, Eric %A Daly, Michael %A Antonio Terracciano %K BMI %K Cognitive Ability %K Dementia %K Obesity %K Stigma %X Body mass index (BMI) and obesity have a complex relation with risk of dementia that evolves over the lifespan. Research in other domains indicates that the social experience of body weight, not just BMI, is associated with worse health outcomes. The present research uses data from the Health and Retirement Study (N = 12,053) to test whether weight discrimination is associated with increased risk of dementia over an up to 10-year follow-up independent of BMI and other relevant clinical and behavioral risk factors. Participants who reported weight discrimination had a 40% increased risk of incident dementia (Hazard Ratio = 1.40; 95% Confidence Interval = 1.12–1.74), controlling for age, sex, race, ethnicity, and education. The association between weight discrimination and incident dementia held controlling for BMI, diabetes, hypertension, depressive symptoms, smoking, physical activity, and genetic risk status. The present research indicates that the stigma associated with weight is associated with dementia risk independent from obesity. This research highlights that the detrimental effect of obesity on cognitive health in older adulthood may occur through the adverse social experience of body weight in addition to the biological consequences of excess weight. © 2018, Springer Nature Limited. %B International Journal of Obesity %8 Dec-09-2019 %G eng %U http://www.nature.com/articles/s41366-018-0211-1http://www.nature.com/articles/s41366-018-0211-1.pdfhttp://www.nature.com/articles/s41366-018-0211-1.pdfhttp://www.nature.com/articles/s41366-018-0211-1 %! Int J Obes %R 10.1038/s41366-018-0211-1 %0 Journal Article %J Health Psychology %D 2018 %T Personality and Sleep Quality: Evidence From Four Prospective Studies. %A Yannick Stephan %A Angelina R Sutin %A Bayard, Sophie %A Križan, Zlatan %A Antonio Terracciano %K Meta-analyses %K Personality %K Sleep %X Objective: The present study examined the longitudinal association between personality traits and sleep quality in 4 samples of middle-aged and older adults. Method: Participants (N > 22,000) were adults aged 30 to 107 years old from the Wisconsin Longitudinal Study (WLS), the Midlife in the United States Study (MIDUS), the Health and Retirement Study (HRS), and the Midlife in Japan Study (MIDJA). Personality and sleep quality were assessed at baseline and again 4 to 10 years later. Results: Scoring lower on neuroticism and higher on extraversion was associated with better sleep quality at baseline and over time, with effect sizes larger than those of demographic factors. Low conscientiousness was associated with a worsening of sleep quality over time. Openness and agreeableness were unrelated to sleep quality. Poor sleep quality at baseline was associated with steeper declines in extraversion, agreeableness, and conscientiousness and a smaller decrease in neuroticism over time. Conclusion: Replicable findings across samples support longitudinal associations between personality and sleep quality. This study identified specific personality traits that are associated with poor and worsening sleep quality, and substantiated previous findings that poor sleep quality is associated with detrimental personality trajectories. %B Health Psychology %V 37 %P 271-281 %G eng %U http://doi.apa.org/getdoi.cfm?doi=10.1037/hea0000577http://psycnet.apa.org/psycarticles/2017-52631-001.pdf %N 3 %! Health Psychology %R 10.1037/hea0000577 %0 Journal Article %J Social Psychological and Personality Science %D 2018 %T Personality and walking speed across adulthood: Prospective evidence from five samples %A Yannick Stephan %A Angelina R Sutin %A Bovier-Lapierre, Gabriel %A Antonio Terracciano %K Cognition & Reasoning %K Gait speed %K Personality %X Walking speed is one marker of health in adulthood. Although personality may contribute to gait speed, there is limited longitudinal data on this association. Thus, the present study examined whether personality traits are prospectively associated with walking speed among middle aged and older adults. Participants were adults aged from 25 to 100 years old (N > 15,000) drawn from the Wisconsin Longitudinal Study Graduate and Sibling samples, the Midlife in the United States Survey, the Health and Retirement Study, and the National Health and Aging Trends Survey. Across most samples and in a meta-analysis, lower neuroticism and higher extraversion, conscientiousness, and openness at baseline were prospectively related to faster gait speed. In the HRS, lower neuroticism and higher extraversion, conscientiousness, and openness were related to slower gait speed decline. This study provides robust evidence that walking speed in adulthood reflects, in part, the individual's personality. %B Social Psychological and Personality Science %V 9 %P 773-780 %G eng %N 7 %! Social Psychological and Personality Science %R 10.1177/1948550617725152 %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 PLOS ONE %D 2018 %T Poverty dynamics, poverty thresholds and mortality: An age-stage Markovian model %A Bernstein, Shayna Fae %A David Rehkopf %A Tuljapurkar, Shripad %A Horvitz, Carol C. %E Komarova, Natalia L. %K Life Expectancy %K Mortality %K Poverty %K Socioeconomic factors %X Recent studies have examined the risk of poverty throughout the life course, but few have considered how transitioning in and out of poverty shape the dynamic heterogeneity and mortality disparities of a cohort at each age. Here we use state-by-age modeling to capture individual heterogeneity in crossing one of three different poverty thresholds (defined as 1×, 2× or 3× the “official” poverty threshold) at each age. We examine age-specific state structure, the remaining life expectancy, its variance, and cohort simulations for those above and below each threshold. Survival and transitioning probabilities are statistically estimated by regression analyses of data from the Health and Retirement Survey RAND data-set, and the National Longitudinal Survey of Youth. Using the results of these regression analyses, we parameterize discrete state, discrete age matrix models. We found that individuals above all three thresholds have higher annual survival than those in poverty, especially for mid-ages to about age 80. The advantage is greatest when we classify individuals based on 1× the “official” poverty threshold. The greatest discrepancy in average remaining life expectancy and its variance between those above and in poverty occurs at mid-ages for all three thresholds. And fewer individuals are in poverty between ages 40-60 for all three thresholds. Our findings are consistent with results based on other data sets, but also suggest that dynamic heterogeneity in poverty and the transience of the poverty state is associated with income-related mortality disparities (less transience, especially of those above poverty, more disparities). This paper applies the approach of age-by-stage matrix models to human demography and individual poverty dynamics. In so doing we extend the literature on individual poverty dynamics across the life course. %B PLOS ONE %V 13 %P e0195734 %8 Apr-05-2019 %G eng %U http://dx.doi.org/10.1371/journal.pone.0195734 %N 5 %! PLoS ONE %R 10.1371/journal.pone.0195734 %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 Nat Genet %D 2018 %T Protein-altering variants associated with body mass index implicate pathways that control energy intake and expenditure in obesity. %A Turcot, Valérie %A Lu, Yingchang %A Highland, Heather M %A Schurmann, Claudia %A Justice, Anne E %A Fine, Rebecca S %A Bradfield, Jonathan P %A Tõnu Esko %A Giri, Ayush %A Graff, Mariaelisa %A Guo, Xiuqing %A Hendricks, Audrey E %A Karaderi, Tugce %A Lempradl, Adelheid %A Locke, Adam E %A Mahajan, Anubha %A Marouli, Eirini %A Sivapalaratnam, Suthesh %A Young, Kristin L %A Alfred, Tamuno %A Feitosa, Mary F %A Masca, Nicholas G D %A Alisa Manning %A Medina-Gomez, Carolina %A Mudgal, Poorva %A Ng, Maggie C Y %A Reiner, Alex P %A Vedantam, Sailaja %A Willems, Sara M %A Thomas W Winkler %A Gonçalo R Abecasis %A Aben, Katja K %A Alam, Dewan S %A Alharthi, Sameer E %A Matthew A. Allison %A Amouyel, Philippe %A Asselbergs, Folkert W %A Auer, Paul L %A Balkau, Beverley %A Bang, Lia E %A Barroso, Inês %A Bastarache, Lisa %A Benn, Marianne %A Bergmann, Sven %A Bielak, Lawrence F %A Blüher, Matthias %A Boehnke, Michael %A Boeing, Heiner %A Boerwinkle, Eric %A Böger, Carsten A %A Bork-Jensen, Jette %A Bots, Michiel L %A Erwin P Bottinger %A Bowden, Donald W %A Brandslund, Ivan %A Breen, Gerome %A Brilliant, Murray H %A Broer, Linda %A Brumat, Marco %A Burt, Amber A %A Adam S Butterworth %A Campbell, Peter T %A Cappellani, Stefania %A Carey, David J %A Catamo, Eulalia %A Caulfield, Mark J %A Chambers, John C %A Daniel I Chasman %A Yii-Der I Chen %A Chowdhury, Rajiv %A Cramer Christensen %A Chu, Audrey Y %A Cocca, Massimiliano %A Collins, Francis S %A Cook, James P %A Corley, Janie %A Jordi Corominas Galbany %A Cox, Amanda J %A Crosslin, David S %A Cuellar-Partida, Gabriel %A D'Eustacchio, Angela %A Danesh, John %A Gail Davies %A Bakker, Paul I W %A Groot, Mark C H %A Mutsert, Renée %A Ian J Deary %A George Dedoussis %A Ellen W Demerath %A Heijer, Martin %A Anneke I den Hollander %A Hester M den Ruijter %A Joe G Dennis %A Denny, Josh C %A Angelantonio, Emanuele %A Drenos, Fotios %A Du, Mengmeng %A Dubé, Marie-Pierre %A Dunning, Alison M %A Easton, Douglas F %A Edwards, Todd L %A Ellinghaus, David %A Ellinor, Patrick T %A Elliott, Paul %A Evangelou, Evangelos %A Farmaki, Aliki-Eleni %A Farooqi, I Sadaf %A Jessica Faul %A Fauser, Sascha %A Feng, Shuang %A Ferrannini, Ele %A Ferrières, Jean %A Florez, Jose C %A Ford, Ian %A Myriam Fornage %A Franco, Oscar H %A Franke, Andre %A Franks, Paul W %A Friedrich, Nele %A Frikke-Schmidt, Ruth %A Galesloot, Tessel E %A Gan, Wei %A Gandin, Ilaria %A Paolo P. Gasparini %A Gibson, Jane %A Giedraitis, Vilmantas %A Gjesing, Anette P %A Gordon-Larsen, Penny %A Gorski, Mathias %A Hans-Jörgen Grabe %A Grant, Struan F A %A Grarup, Niels %A Griffiths, Helen L %A Grove, Megan L %A Gudnason, Vilmundur %A Gustafsson, Stefan %A Jeffrey Haessler %A Hakonarson, Hakon %A Anke R Hammerschlag %A Hansen, Torben %A Tamara B Harris %A Andrew T Hattersley %A Have, Christian T %A Caroline Hayward %A He, Liang %A Heard-Costa, Nancy L %A Andrew C Heath %A Iris M Heid %A Helgeland, Øyvind %A Hernesniemi, Jussi %A Hewitt, Alex W %A Oddgeir L Holmen %A Hovingh, G Kees %A Howson, Joanna M M %A Hu, Yao %A Huang, Paul L %A Huffman, Jennifer E %A Mohammed Arfan Ikram %A Ingelsson, Erik %A Jackson, Anne U %A Jansson, Jan-Håkan %A Jarvik, Gail P %A Jensen, Gorm B %A Jia, Yucheng %A Johansson, Stefan %A Jørgensen, Marit E %A Jørgensen, Torben %A Jukema, J Wouter %A Kahali, Bratati %A Kahn, René S %A Kähönen, Mika %A Kamstrup, Pia R %A Kanoni, Stavroula %A Kaprio, Jaakko %A Karaleftheri, Maria %A Sharon L R Kardia %A Karpe, Fredrik %A Kathiresan, Sekar %A Kee, Frank %A Lambertus A Kiemeney %A Eric S Kim %A Kitajima, Hidetoshi %A Komulainen, Pirjo %A Kooner, Jaspal S %A Charles Kooperberg %A Korhonen, Tellervo %A Kovacs, Peter %A Kuivaniemi, Helena %A Kutalik, Zoltán %A Kuulasmaa, Kari %A Kuusisto, Johanna %A Laakso, Markku %A Lakka, Timo A %A Lamparter, David %A Lange, Ethan M %A Leslie A Lange %A Langenberg, Claudia %A Eric B Larson %A Lee, Nanette R %A Lehtimäki, Terho %A Lewis, Cora E %A Li, Huaixing %A Li, Jin %A Li-Gao, Ruifang %A Lin, Honghuang %A Lin, Keng-Hung %A Lin, Li-An %A Lin, Xu %A Lars Lind %A Lindström, Jaana %A Linneberg, Allan %A Liu, Ching-Ti %A Liu, Dajiang J %A Yongmei Liu %A Ken Sin Lo %A Lophatananon, Artitaya %A Lotery, Andrew J %A Loukola, Anu %A Luan, Jian'an %A Lubitz, Steven A %A Lyytikäinen, Leo-Pekka %A Männistö, Satu %A Marenne, Gaëlle %A Mazul, Angela L %A McCarthy, Mark I %A McKean-Cowdin, Roberta %A Sarah E Medland %A Meidtner, Karina %A Lili Milani %A Mistry, Vanisha %A Mitchell, Paul %A Mohlke, Karen L %A Moilanen, Leena %A Moitry, Marie %A Grant W Montgomery %A Dennis O Mook-Kanamori %A Moore, Carmel %A Mori, Trevor A %A Morris, Andrew D %A Morris, Andrew P %A Müller-Nurasyid, Martina %A Munroe, Patricia B %A Michael A Nalls %A Narisu, Narisu %A Nelson, Christopher P %A Neville, Matt %A Sune Fallgaard Nielsen %A Nikus, Kjell %A Njølstad, Pål R %A Børge G Nordestgaard %A Nyholt, Dale R %A Jeff O'Connell %A O'Donoghue, Michelle L %A Ophoff, Roel A %A Owen, Katharine R %A Packard, Chris J %A Padmanabhan, Sandosh %A Palmer, Colin N A %A Palmer, Nicholette D %A Pasterkamp, Gerard %A Patel, Aniruddh P %A Pattie, Alison %A Pedersen, Oluf %A Peissig, Peggy L %A Peloso, Gina M %A Pennell, Craig E %A Markus Perola %A Perry, James A %A Perry, John R B %A Pers, Tune H %A Person, Thomas N %A Peters, Annette %A Petersen, Eva R B %A Peyser, Patricia A %A Pirie, Ailith %A Polasek, Ozren %A Tinca J Polderman %A Puolijoki, Hannu %A Olli T Raitakari %A Rasheed, Asif %A Rauramaa, Rainer %A Reilly, Dermot F %A Renstrom, Frida %A Rheinberger, Myriam %A Ridker, Paul M %A Rioux, John D %A Rivas, Manuel A %A Roberts, David J %A Neil R Robertson %A Robino, Antonietta %A Rolandsson, Olov %A Rudan, Igor %A Ruth, Katherine S %A Saleheen, Danish %A Veikko Salomaa %A Nilesh J Samani %A Sapkota, Yadav %A Sattar, Naveed %A Schoen, Robert E %A Schreiner, Pamela J %A Schulze, Matthias B %A Scott, Robert A %A Segura-Lepe, Marcelo P %A Svati H Shah %A Sheu, Wayne H-H %A Sim, Xueling %A Slater, Andrew J %A Small, Kerrin S %A Albert Vernon Smith %A Southam, Lorraine %A Timothy Spector %A Elizabeth K Speliotes %A John M Starr %A Stefansson, Kari %A Steinthorsdottir, Valgerdur %A Kathleen E Stirrups %A Strauch, Konstantin %A Heather M Stringham %A Stumvoll, Michael %A Sun, Liang %A Surendran, Praveen %A Swift, Amy J %A Tada, Hayato %A Tansey, Katherine E %A Tardif, Jean-Claude %A Kent D Taylor %A Teumer, Alexander %A Thompson, Deborah J %A Thorleifsson, Gudmar %A Thorsteinsdottir, Unnur %A Thuesen, Betina H %A Tönjes, Anke %A Tromp, Gerard %A Trompet, Stella %A Tsafantakis, Emmanouil %A Tuomilehto, Jaakko %A Tybjaerg-Hansen, Anne %A Tyrer, Jonathan P %A Uher, Rudolf %A André G Uitterlinden %A Uusitupa, Matti %A Laan, Sander W %A Duijn, Cornelia M %A Leeuwen, Nienke %A van Setten, Jessica %A Vanhala, Mauno %A Varbo, Anette %A Varga, Tibor V %A Varma, Rohit %A Digna R Velez Edwards %A Vermeulen, Sita H %A Veronesi, Giovanni %A Vestergaard, Henrik %A Vitart, Veronique %A Vogt, Thomas F %A Völker, Uwe %A Vuckovic, Dragana %A Wagenknecht, Lynne E %A Walker, Mark %A Wallentin, Lars %A Wang, Feijie %A Wang, Carol A %A Wang, Shuai %A Wang, Yiqin %A Erin B Ware %A Wareham, Nicholas J %A Warren, Helen R %A Dawn M Waterworth %A Wessel, Jennifer %A White, Harvey D %A Willer, Cristen J %A Wilson, James G %A Daniel Witte %A Andrew R Wood %A Wu, Ying %A Yaghootkar, Hanieh %A Yao, Jie %A Yao, Pang %A Laura M Yerges-Armstrong %A Young, Robin %A Zeggini, Eleftheria %A Zhan, Xiaowei %A Zhang, Weihua %A Wei Zhao %A Zhou, Wei %A Krina T Zondervan %A Rotter, Jerome I %A Pospisilik, John A %A Fernando Rivadeneira %A Ingrid B Borecki %A Deloukas, Panos %A Timothy M Frayling %A Lettre, Guillaume %A Kari E North %A Lindgren, Cecilia M %A Joel N Hirschhron %A Ruth J F Loos %X

Genome-wide association studies (GWAS) have identified >250 loci for body mass index (BMI), implicating pathways related to neuronal biology. Most GWAS loci represent clusters of common, noncoding variants from which pinpointing causal genes remains challenging. Here we combined data from 718,734 individuals to discover rare and low-frequency (minor allele frequency (MAF) < 5%) coding variants associated with BMI. We identified 14 coding variants in 13 genes, of which 8 variants were in genes (ZBTB7B, ACHE, RAPGEF3, RAB21, ZFHX3, ENTPD6, ZFR2 and ZNF169) newly implicated in human obesity, 2 variants were in genes (MC4R and KSR2) previously observed to be mutated in extreme obesity and 2 variants were in GIPR. The effect sizes of rare variants are ~10 times larger than those of common variants, with the largest effect observed in carriers of an MC4R mutation introducing a stop codon (p.Tyr35Ter, MAF = 0.01%), who weighed ~7 kg more than non-carriers. Pathway analyses based on the variants associated with BMI confirm enrichment of neuronal genes and provide new evidence for adipocyte and energy expenditure biology, widening the potential of genetically supported therapeutic targets in obesity.

%B Nat Genet %V 50 %P 26-41 %8 2018 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29273807?dopt=Abstract %R 10.1038/s41588-017-0011-x %0 Journal Article %J Journal of Alzheimer's Disease %D 2018 %T Psychological Distress, Self-Beliefs, and Risk of Cognitive Impairment and Dementia. %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Alzheimer's disease %K Cognitive Ability %K Dementia %K Depressive symptoms %X Depressive symptoms and a history of mental disorders are associated with increased risk for dementia. Less is known about whether other aspects of psychological distress and negative self-beliefs also increase risk. The purpose of this research is to examine 1) whether eight aspects of psychological distress and self-beliefs (anxiety, negative affect, hostility, anger-in, anger-out, hopelessness, pessimism, perceived constraints) are associated with risk of incident dementia and cognitive impairment not dementia (CIND), 2) whether the associations are independent of depressive symptoms and history of a mental health diagnosis, and 3) whether the associations are also independent of behavioral, clinical, and genetic risk factors. A total of 9,913 participants (60% female) from the Health and Retirement Study completed the baseline measures, scored in the non-impaired range of cognition at baseline, and had cognitive status assessed across the 6-8-year follow-up. Baseline measures included eight aspects of psychological distress and self-beliefs, cognitive performance, depressive symptoms, and genetic, clinical, and behavioral risk factors. Participants who scored higher on anxiety, negative affect, hostility, pessimism, hopelessness, and perceived constraints were at a 20-30% increased risk of dementia and a 10-20% increased risk of CIND. The associations held controlling for baseline depressive symptoms, history of a mental health diagnosis, clinical and behavioral risk factors, and genetic risk. Anger-in and anger-out were unrelated to risk of either dementia or CIND. Independent of the core experience of depressed affect, other aspects of negative emotionality and self-beliefs increase risk of mild and severe cognitive impairment, which suggests additional targets of intervention. %B Journal of Alzheimer's Disease %V 65 %P 1041-1050 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30103318?dopt=Abstract %R 10.3233/JAD-180119 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2018 %T Psychological well-being and risk of dementia. %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Alzheimer's disease %K Dementia %K Depressive symptoms %K Health Conditions and Status %K Well-being %X

OBJECTIVE: Well-being is a psychological resource that buffers against age-related disease. We test whether this protective effect extends to dementia and whether it is independent of distress.

METHODS: Participants (N = 10,099) were from the Health and Retirement Study. Five aspects of positive psychological functioning (life satisfaction, optimism, mastery, purpose in life, and positive affect) were tested as predictors of incident dementia over 6 to 8 years.

RESULTS: Purpose in life was associated with a 30% decreased risk of dementia, independent of psychological distress, other clinical and behavioral risk factors, income/wealth, and genetic risk. After controlling for distress and other risk factors, the other aspects of well-being were not associated with dementia risk.

CONCLUSIONS: After considering psychological distress, we found that measures of well-being were generally not protective against risk of dementia. An exception is purpose in life, which suggests that a meaningful and goal-driven life reduces risk of dementia.

%B International Journal of Geriatric Psychiatry %V 33 %P 743-747 %8 05/2018 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/29314273?dopt=Abstract %R 10.1002/gps.4849 %0 Thesis %B Public Health %D 2018 %T Psychological Well-being and Smoking Cessation %A Thorne,Christopher B. %K 0680:Health education %K Education %K Health education %K Life Satisfaction %K Optimism %K Positive psychology %K Purpose in life %K Resilience %K Smoking cessation %X Introduction: The substantial death toll from smoking combined with the low success rates of current treatment approaches warrants further investigation into mechanisms that promote cessation. While the role of negative affect has been studied extensively in relationship to smoking cessation, the role of psychological well-being (PWB; e.g., life satisfaction, optimism, positive affect, purpose in life, resilience) has received little attention. Treatment outcomes might improve with a better understanding of PWB’s role in smoking cessation. Methods: Relationships between smoking and PWB were examined in three studies. First, using panel data from the biennial, longitudinal Health and Retirement Study, I developed separate cross-lagged models examining the relationships between smoking status in 2006 and PWB in 2010 and of PWB in 2006 with smoking status in 2010. Second, using data collected from a pilot study of withdrawal regulation training for smoking cessation, I used logistic regression to model the effects of 1) baseline optimism and 2) the change in optimism on cessation outcomes at the three month follow-up. Third, using data from the same pilot study, Generalized Estimating Equations modeled the role of resilience in withdrawal symptom variation over time. Results: For the first study, greater life satisfaction, optimism, and positive affect in 2006 predicted a reduced likelihood of smoking in 2010. Being a smoker in 2006 predicted lower life satisfaction, lower optimism, and lower purpose in life in 2010. For study two, analyses showed no statistically significant relationship between pre-treatment optimism levels and smoking cessation. Alternatively, an increase in optimism from baseline to two month follow-up was associated with an increased likelihood of abstinence at three month follow-up. For study three, the resilience scales Planned Future and Structured Style were found to be psychological predictors of withdrawal symptoms, such that greater resilience predicted reduced withdrawal symptom severity. Conclusions: These initial findings that greater PWB reduces the likelihood of smoking and smoking reduces PWB, that an increase in optimism is associated with cessation outcomes, and that greater resilience may buffer against withdrawal symptoms warrant further exploration into the associations between PWB and smoking. Existing treatments may benefit from incorporating PWB-boosting components. %B Public Health %I The University of Alabama at Birmingham %V PhD %P 90 %@ 9780438344310 %G eng %U https://search.proquest.com/docview/2108556620?pq-origsite=gscholar %0 Book %D 2018 %T The role of health in retirement %A Alan L Gustman %A Thomas L. Steinmeier %E Solomon W. Polachek %E Tatsiramos, Konstantinos %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X A dynamic model of the evolution of health for those over the age of 50 is embedded in a structural, econometric model of retirement and saving. Effects of smoking, obesity, alcohol consumption, depression, and other proclivities on medical conditions are analyzed, including hypertension, diabetes, cancer, lung disease, heart problems, stroke, psychiatric problems, and arthritis. Compared to a population in good health, the current health of the population reduces retirement age by about one year. Including detailed health dynamics in a retirement model does not influence estimates of the marginal effects of economic incentives on retirement. %I Emerald Publishing Limited %C Bingley %V 46 %P 229 - 297 %@ 978-1-78756-462-6 %G eng %R 10.1108/rlec10.1108/S0147-912120184610.1108/S0147-912120180000046007 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2018 %T Self-reported personality traits are prospectively associated with proxy-reported behavioral and psychological symptoms of dementia at the end of life. %A Angelina R Sutin %A Yannick Stephan %A Martina Luchetti %A Antonio Terracciano %K Cognitive Ability %K Dementia %K Personality %K Self-reported health %X

OBJECTIVE: Behavioral and psychological symptoms of dementia (BPSD) are among the most challenging aspects of Alzheimer disease for patients and their families. Previous studies have found associations between informant-reported retrospective personality and BPSD; we test whether prospective, self-reported personality predicts who will experience these symptoms.

METHODS: Deceased participants from the Health and Retirement Study who had evidence of cognitive impairment at the end of life (N = 1988) were selected to examine whether self-reported five-factor model personality traits, measured up to 8 years before death, were associated with proxy-reported BPSD.

RESULTS: Neuroticism was associated with increased risk of the 7 BPSD: got lost in familiar places, wandered off, were not able to be left alone, experienced hallucinations, suffered from depression, had periodic confusion, and an uncontrolled temper. These associations were not moderated by age, gender, race, or education. Conscientiousness was associated with fewer symptoms overall and especially with lower risk of getting lost in familiar places and not being able to be left alone.

CONCLUSIONS: The present research indicates that self-reported personality, particularly Neuroticism, is associated prospectively with risk for a wide range of behavioral symptoms for individuals who had cognitive impairment at the end of life. The use of self-reported personality traits can help aid in identifying who is most at risk for behavioral symptoms. Such information may be useful for nonpharmacological interventions tailored to the individual's personality to reduce the prevalence and burden of these BPSD.

%B International Journal of Geriatric Psychiatry %V 33 %P 489-494 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/28869657?dopt=Abstract %R 10.1002/gps.4782 %0 Thesis %B Gerontology %D 2018 %T Social Relationships and Obesity in Later Life %A Jane Tavares %K 0384:Behavioral psychology %K 0451:Social psychology %K 0493:Aging %K Aging %K Behavioral psychology %K Health and environmental sciences %K Obesity %K Psychology %K Social psychology %K Social Relationships %K Social structural location %K Social Support %K Weight Change %X The majority of U.S. older adults are overweight or obese. Social relationships are a key factor linked to obesity among younger age groups, but there are no known investigations of this association among older adults. This study examined the association between quantitative and qualitative indicators of social relationships and obesity among middle-aged and older adults. Further, this study investigated psychosocial and health behavior variables as mediators and moderators of the association between social relationships and obesity as well as explored demographic differences in this relationship. Using the 2004, 2006, and 2010 waves of the Health and Retirement Study, a series of ordinary least squared (OLS) regression models were used to examine the hypothesized association between social relationships and obesity both cross-sectionally and longitudinally. Psychosocial and health behaviors variables were sequentially added into the OLS regression models to explore the potential mediation of these variables and interaction terms were utilized to estimate their moderation effects. The sample was stratified by age, gender, and race to investigate demographic differences in the cross-sectional and longitudinal regression model analyses. In summary, the analyses showed that only qualitative indicators of social relationships were significantly related to obesity for the full sample. Specifically, results indicated that higher positive social support and lower negative social support were associated with lower waist circumference cross-sectionally and longitudinally. Daily exercise was observed to be a full mediator of these associations and anxiety was a partial mediator; both variables also acted as moderators. Longitudinal analyses also revealed that higher positive support and lower negative support were associated with decreased self-reported BMI from 2004 to 2010. In the stratified analyses, higher loneliness was associated with lower waist circumference for those 65 and older compared to middle-aged adults and higher social participation and weekly contact with friends were associated with lower waist circumference for non-Hispanic blacks compared to non-Hispanic whites. There were generally no other significant demographic differences. Findings from this study highlight several conceptual, programmatic, and policy implications and recommendations based upon these findings are presented. Healthcare providers are encouraged to inquire about older adults’ levels of social support and loneliness in order to achieve a more comprehensive assessment of wellness. Service providers and policymakers are encouraged to develop and fund programs that provide widespread and ample opportunities for older adults to engage socially, particularly those that incorporate or encourage physical activity and healthy eating. %B Gerontology %I University of Massachusetts Boston %V PhD %P 243 %@ 9780438003767 %G eng %U https://scholarworks.umb.edu/doctoral_dissertations/392/ %9 phd %0 Journal Article %J RSF: The Russell Sage Foundation Journal of the Social Sciences %D 2018 %T The Sociogenomics of Polygenic Scores of Reproductive Behavior and Their Relationship to Other Fertility Traits %A Melinda C Mills %A Nicola Barban %A Felix C Tropf %K Education %K Fertility %K Genetics %K GWAS %K PGS %X Human reproductive behavior until relatively recently has been explained exclusively via individual and social characteristics. This article applies results from a recent Genome-Wide Association Study that combined sixty-two data sources to isolate twelve genetic loci associated with reproductive behavior. We create polygenic scores that allow us to include a summary variable of genetic factors into our statistical models. We use four datasets: the U.S. Health and Retirement Study, Dutch LifeLines, TwinsUK and the Swedish Twin register. First, we provide a brief overview of the dominant explanations of reproductive behavior. Second, we test the predictive power of polygenic scores. Third, we interrogate the robustness of our models using a series of sensitivity analyses to take into account possible confounders due to population stratification and selection. %B RSF: The Russell Sage Foundation Journal of the Social Sciences %V 4 %P 122-136 %8 Jan-01-2018 %G eng %U http://www.jstor.org/stable/10.7758/rsf.2018.4.4.07 %N 4 %! RSF: The Russell Sage Foundation Journal of the Social Sciences %R 10.7758/rsf.2018.4.4.07 %0 Journal Article %J Nature Communications %D 2018 %T Study of 300,486 individuals identifies 148 independent genetic loci influencing general cognitive function. %A Gail Davies %A Lam, Max %A Sarah E Harris %A Joey W Trampush %A Luciano, Michelle %A W David Hill %A Hagenaars, Saskia P %A Ritchie, Stuart J %A Riccardo E Marioni %A Fawns-Ritchie, Chloe %A David C Liewald %A Okely, Judith A %A Ahola-Olli, Ari V %A Barnes, Catriona L K %A Bertram, Lars %A Joshua C. Bis %A Katherine E Burdick %A Christoforou, Andrea %A DeRosse, Pamela %A Djurovic, Srdjan %A Espeseth, Thomas %A Giakoumaki, Stella %A Giddaluru, Sudheer %A Gustavson, Daniel E %A Caroline Hayward %A Edith Hofer %A Ikram, M Arfan %A Karlsson, Robert %A Knowles, Emma %A Lahti, Jari %A Leber, Markus %A Li, Shuo %A Mather, Karen A %A Melle, Ingrid %A Morris, Derek %A Christopher J Oldmeadow %A Palviainen, Teemu %A Payton, Antony %A Pazoki, Raha %A Katja E Petrovic %A Chandra A Reynolds %A Sargurupremraj, Muralidharan %A Scholz, Markus %A Smith, Jennifer A %A Smith, Albert V %A Terzikhan, Natalie %A Thalamuthu, Anbupalam %A Trompet, Stella %A Sven J van der Lee %A Erin B Ware %A Windham, B Gwen %A Margaret J Wright %A Yang, Jingyun %A Yu, Jin %A Ames, David %A Amin, Najaf %A Amouyel, Philippe %A Andreassen, Ole A %A Armstrong, Nicola J %A Assareh, Amelia A %A John R. Attia %A Attix, Deborah %A Avramopoulos, Dimitrios %A David A Bennett %A Böhmer, Anne C %A Patricia A. Boyle %A Brodaty, Henry %A Campbell, Harry %A Tyrone D. Cannon %A Elizabeth T. Cirulli %A Congdon, Eliza %A Conley, Emily Drabant %A Corley, Janie %A Cox, Simon R %A Dale, Anders M %A Dehghan, Abbas %A Danielle M. Dick %A Dickinson, Dwight %A Johan G Eriksson %A Evangelou, Evangelos %A Jessica Faul %A Ford, Ian %A Nelson A. Freimer %A Gao, He %A Giegling, Ina %A Gillespie, Nathan A %A Gordon, Scott D %A Gottesman, Rebecca F %A Michael E Griswold %A Gudnason, Vilmundur %A Tamara B Harris %A Hartmann, Annette M %A Hatzimanolis, Alex %A Gerardo Heiss %A Holliday, Elizabeth G %A Joshi, Peter K %A Kähönen, Mika %A Sharon L R Kardia %A Ida Karlsson %A Kleineidam, Luca %A David S Knopman %A Kochan, Nicole A %A Konte, Bettina %A Kwok, John B %A Stephanie Le Hellard %A Lee, Teresa %A Lehtimäki, Terho %A Li, Shu-Chen %A Lill, Christina M %A Liu, Tian %A Koini, Marisa %A London, Edythe %A Longstreth, Will T %A Lopez, Oscar L %A Loukola, Anu %A Luck, Tobias %A Astri J Lundervold %A Lundquist, Anders %A Lyytikäinen, Leo-Pekka %A Nicholas G Martin %A Grant W Montgomery %A Murray, Alison D %A Anna C Need %A Noordam, Raymond %A Nyberg, Lars %A William E R Ollier %A Papenberg, Goran %A Pattie, Alison %A Polasek, Ozren %A Russell A Poldrack %A Psaty, Bruce M %A Reppermund, Simone %A Steffi G Riedel-Heller %A Rose, Richard J %A Rotter, Jerome I %A Roussos, Panos %A Rovio, Suvi P %A Saba, Yasaman %A Fred W Sabb %A Sachdev, Perminder S %A Satizabal, Claudia L %A Schmid, Matthias %A Rodney J Scott %A Matthew A Scult %A Simino, Jeannette %A Slagboom, P Eline %A Smyrnis, Nikolaos %A Soumaré, Aïcha %A Nikos C Stefanis %A Stott, David J %A Richard E Straub %A Sundet, Kjetil %A Taylor, Adele M %A Kent D Taylor %A Tzoulaki, Ioanna %A Tzourio, Christophe %A André G Uitterlinden %A Vitart, Veronique %A Aristotle N Voineskos %A Kaprio, Jaakko %A Wagner, Michael %A Wagner, Holger %A Weinhold, Leonie %A Wen, K Hoyan %A Elisabeth Widen %A Yang, Qiong %A Zhao, Wei %A Hieab H Adams %A Dan E Arking %A Robert M Bilder %A Bitsios, Panos %A Boerwinkle, Eric %A Chiba-Falek, Ornit %A Corvin, Aiden %A Philip L de Jager %A Debette, Stéphanie %A Donohoe, Gary %A Elliott, Paul %A Fitzpatrick, Annette L %A Gill, Michael %A David C. Glahn %A Hägg, Sara %A Narelle K Hansell %A Ahmad R Hariri %A Ikram, M Kamran %A Jukema, J Wouter %A Vuoksimaa, Eero %A Matthew C Keller %A Kremen, William S %A Lenore J Launer %A Lindenberger, Ulman %A Aarno Palotie %A Nancy L Pedersen %A Pendleton, Neil %A David J Porteous %A Katri Räikkönen %A Olli T Raitakari %A Ramirez, Alfredo %A Reinvang, Ivar %A Rudan, Igor %A Schmidt, Reinhold %A Schmidt, Helena %A Peter W Schofield %A Peter R Schofield %A John M Starr %A Vidar M Steen %A Trollor, Julian N %A Turner, Steven T %A Cornelia M van Duijn %A Villringer, Arno %A Daniel R Weinberger %A David R Weir %A James F Wilson %A Anil K. Malhotra %A McIntosh, Andrew M %A Gale, Catharine R %A Seshadri, Sudha %A Thomas H Mosley %A Bressler, Jan %A Lencz, Todd %A Ian J Deary %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Cognition %K Genetic Loci %K Genetic Predisposition to Disease %K Humans %K Mental Disorders %K Middle Aged %K Multifactorial Inheritance %K Neurodegenerative Diseases %K Neurodevelopmental Disorders %K Polymorphism, Single Nucleotide %K Reaction Time %K Young Adult %X

General cognitive function is a prominent and relatively stable human trait that is associated with many important life outcomes. We combine cognitive and genetic data from the CHARGE and COGENT consortia, and UK Biobank (total N = 300,486; age 16-102) and find 148 genome-wide significant independent loci (P < 5 × 10) associated with general cognitive function. Within the novel genetic loci are variants associated with neurodegenerative and neurodevelopmental disorders, physical and psychiatric illnesses, and brain structure. Gene-based analyses find 709 genes associated with general cognitive function. Expression levels across the cortex are associated with general cognitive function. Using polygenic scores, up to 4.3% of variance in general cognitive function is predicted in independent samples. We detect significant genetic overlap between general cognitive function, reaction time, and many health variables including eyesight, hypertension, and longevity. In conclusion we identify novel genetic loci and pathways contributing to the heritability of general cognitive function.

%B Nature Communications %V 9 %P 2098 %G eng %N 1 %R 10.1038/s41467-018-04362-x %0 Journal Article %J Psychosomatic Medicine %D 2018 %T Subjective Age and Mortality in Three Longitudinal Samples. %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Mortality %K Subjective age %K Subjective Expectations %X

OBJECTIVE: Subjective age has been implicated in a range of health outcomes. The present study extends existing research by providing new data on the relation between subjective age and mortality in three large national samples.

METHODS: Participants (total N > 17,000) were drawn from the Health and Retirement Study (HRS, 2008-2014), the Midlife in the United State Survey (MIDUS, 1995-2014), and the National Health and Aging Trends Study (NHATS, 2011-2014). Subjective age, demographic factors, disease burden, functional limitations, depressive symptoms, and physical inactivity were assessed at baseline and mortality data were tracked for up to 20 years. Cognition was also included as a covariate in the HRS and the NHATS.

RESULTS: Individuals felt on average 15% to 16% younger relative to their chronological age. Feeling approximately 8, 11, and 13 years older in the MIDUS, HRS, and NHATS, was related to an 18%, 29% and 25% higher risk of mortality, respectively. This pattern was confirmed by a meta-analysis of the three samples (HR = 1.24; 95%CI = 1.17-1.31, p<.001). Multivariate analyses showed that disease burden, physical inactivity, functional limitations, and cognitive problems, but not depressive symptoms, accounted for the associations between subjective age and mortality.

CONCLUSIONS: The present study provides robust evidence for an association between an older subjective age and a higher risk of mortality across adulthood. These findings support the role of subjective age as a biopsychosocial marker of aging.

%B Psychosomatic Medicine %V 80 %P 659-664 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/29864106?dopt=Abstract %R 10.1097/PSY.0000000000000613 %0 Journal Article %J BMC Geriatrics %D 2018 %T Trajectories of allostatic load among older Americans and Britons: Longitudinal cohort studies. %A Tampubolon, Gindo %A Maharani, Asri %K Cross-National %K Depressive symptoms %K Gender Differences %X

BACKGROUND: Difference in life expectancy between males and females has been suggested to rest on sex difference in physiological dysregulation. But allostatic load, a physiological index, has not been carefully examined for an extended period beyond middle age. We aim to draw longitudinal trajectories of allostatic load in a national sample of older Americans and Britons; also to examine sex-based trajectories and factors behind their differences.

METHODS: We studied men and women aged ≥50 years participating in the Health and Retirement Study Waves 8-11, 2006-2012 (N = 15,583 person-years) and the English Longitudinal Study of Ageing Waves 2, 4 and 6, 2004-2012 (N = 14,765 person-years). Because of the difference in provenance, we included different number of biomarkers to calculate allostatic load in HRS and ELSA. In HRS we used 8 biomarkers (systolic and diastolic blood pressure, haemoglobin A1c, high-density lipoprotein, total cholesterol, waist circumference, cystatin C, and C-reactive protein), while ELSA allostatic load was constructed from 10 biomarkers (systolic and diastolic blood pressure, haemoglobin A1c, high-density lipoprotein, total cholesterol, waist circumference, BMI, triglyceride, fibrinogen and C-reactive protein). A growth curve model was fitted to repeated observations of allostatic load, demographic characteristics, socioeconomic position, comorbidities and health behaviours (smoking, drinking, and physical exercise). To account for attrition, a joint model was applied.

RESULTS: The analysis showed that allostatic load increases linearly with age in the U.S. However, there are different levels for males and females. In England allostatic load follows such different paths that their trajectories cross in later life.

CONCLUSIONS: Sex-based trajectories of allostatic load showed distinct female advantage and are mostly consistent with female advantage in life expectancy.

%B BMC Geriatrics %V 18 %P 255 %8 2018 Oct 23 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30352552?dopt=Abstract %R 10.1186/s12877-018-0947-4 %0 Journal Article %J Diabetes Care %D 2018 %T Trajectory of Disability in Older Adults With Newly Diagnosed Diabetes: Role of Elevated Depressive Symptoms. %A Chao-Yi Wu %A Terhorst, Lauren %A Jordan F Karp %A Elizabeth R Skidmore %A Rodakowski, Juleen %K Depressive symptoms %K Diabetes %K Disabilities %K Health Trajectories %X

OBJECTIVE: We examined whether the trajectory of disability differed between older adults with and without elevated depressive symptoms before and after the onset of diabetes mellitus (DM) over 10 years (2004-2014) and explored difficulties in basic and instrumental activities of daily living between the two groups.

RESEARCH DESIGN AND METHODS: A generalized linear mixed-model analysis was conducted using five waves (8th-12th) of Health and Retirement Study (HRS) data. We included 419 older adults who self-reported new DM diagnosis within the previous 2 years and used the Center of Epidemiologic Studies Depression Scale to measure elevated depressive symptoms. Disability was measured by 10 items defined in the HRS data set.

RESULTS: The trajectory of disability differed between older adults with and without elevated depressive symptoms after newly diagnosed DM over time. Significant and clinically meaningful between-group differences were found in disability after the onset of DM (waves 10 and 11) but not before the onset of DM (waves 8 and 9). Among older adults with elevated depressive symptoms, disability at pre-DM waves (8 and 9) was significantly less than post-DM waves (10-12). Difficulties with shopping, walking, and dressing were mostly reported by older adults with elevated depressive symptoms.

CONCLUSIONS: Older adults with newly diagnosed DM and elevated depressive symptoms have a clinically meaningful and faster disablement trajectory than those without elevated depressive symptoms. Future interventions may take an indicated approach to disability prevention in older adults with newly diagnosed DM, especially in those with a change in depression severity.

%B Diabetes Care %V 41 %P 2072-2078 %8 08/2018 %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/30072401?dopt=Abstract %R 10.2337/dc18-0007 %0 Journal Article %J Journal of the American Geriatrics Society %D 2018 %T Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening. %A Geoffrey J Hoffman %A Ha, Jinkyung %A Neil B. Alexander %A Kenneth M. Langa %A Mary Tinetti %A Lillian C. Min %K Doctor visits %K Falls %K Medicare linkage %K Medicare/Medicaid/Health Insurance %X

OBJECTIVES: To compare the accuracy of and factors affecting the accuracy of self-reported fall-related injuries (SFRIs) with those of administratively obtained FRIs (AFRIs).

DESIGN: Retrospective observational study SETTING: United States PARTICIPANTS: Fee-for-service Medicare beneficiaries aged 65 and older (N=47,215).

MEASUREMENTS: We used 24-month self-report recall data from 2000-2012 Health and Retirement Study data to identify SFRIs and linked inpatient, outpatient, and ambulatory Medicare data to identify AFRIs. Sensitivity and specificity were assessed, with AFRIs defined using the University of California at Los Angeles/RAND algorithm as the criterion standard. Logistic regression models were used to identify sociodemographic and health predictors of sensitivity.

RESULTS: Overall sensitivity and specificity were 28% and 92%. Sensitivity was greater for the oldest adults (38%), women (34%), those with more functional limitations (47%), and those with a prior fall (38%). In adjusted results, several participant factors (being female, being white, poor functional status, depression, prior falls) were modestly associated with better sensitivity and specificity. Injury severity (requiring hospital care) most substantively improved SFRI sensitivity (73%).

CONCLUSION: An overwhelming 72% of individuals who received Medicare-reimbursed health care for FRIs failed to report a fall injury when asked. Future efforts to address underreporting in primary care of nonwhite and healthier older adults are critical to improve preventive efforts. Redesigned questions-for example, that address stigma of attributing injury to falling-may improve sensitivity.

%B Journal of the American Geriatrics Society %V 66 %P 1195-1200 %G eng %N 6 %R 10.1111/jgs.15360 %0 Journal Article %J Age and Ageing %D 2018 %T Visual and hearing impairments are associated with cognitive decline in older people. %A Maharani, Asri %A Dawes, Piers %A James Nazroo %A Tampubolon, Gindo %A Pendleton, Neil %K Cognitive Ability %K Cross-National %K GWAS %K Hearing loss %K Visual function %X

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

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

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

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

%B Age and Ageing %V 47 %P 575-581 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/29697748?dopt=Abstract %R 10.1093/ageing/afy061 %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 Journal Article %J Biological Psychiatry %D 2017 %T An Analysis of Two Genome-wide Association Meta-analyses Identifies a New Locus for Broad Depression Phenotype. %A Nese Direk %A Williams, Stephanie %A Smith, Jennifer A %A Ripke, Stephan %A Air, Tracy %A Amare, Azmeraw T %A Amin, Najaf %A Baune, Bernhard T %A David A Bennett %A Blackwood, Douglas H R %A Dorret I Boomsma %A Breen, Gerome %A Buttenschøn, Henriette N %A Byrne, Enda M %A Børglum, Anders D %A Castelao, Enrique %A Cichon, Sven %A Clarke, Toni-Kim %A Marilyn C Cornelis %A Dannlowski, Udo %A Philip L de Jager %A Demirkan, Ayse %A Domenici, Enrico %A Cornelia M van Duijn %A Dunn, Erin C %A Johan G Eriksson %A Tõnu Esko %A Jessica Faul %A Luigi Ferrucci %A Myriam Fornage %A Eco J. C. de Geus %A Gill, Michael %A Gordon, Scott D %A Hans-Jörgen Grabe %A van Grootheest, Gerard %A Hamilton, Steven P %A Catharina A Hartman %A Andrew C Heath %A Karin Hek %A Hofman, Albert %A Homuth, Georg %A Horn, Carsten %A Jouke-Jan Hottenga %A Sharon L R Kardia %A Kloiber, Stefan %A Karestan C Koenen %A Kutalik, Zoltán %A Ladwig, Karl-Heinz %A Lahti, Jari %A Douglas F Levinson %A Lewis, Cathryn M %A Lewis, Glyn %A Li, Qingqin S %A David J Llewellyn %A Lucae, Susanne %A Kathryn L Lunetta %A MacIntyre, Donald J %A Pamela A F Madden %A Nicholas G Martin %A McIntosh, Andrew M %A Andres Metspalu %A Milaneschi, Yuri %A Grant W Montgomery %A Mors, Ole %A Thomas H Mosley %A Joanne M Murabito %A Müller-Myhsok, Bertram %A Markus M Nöthen %A Nyholt, Dale R %A O'Donovan, Michael C %A Brenda W J H Penninx %A Pergadia, Michele L %A Perlis, Roy %A Potash, James B %A Preisig, Martin %A Shaun M Purcell %A Quiroz, Jorge A %A Katri Räikkönen %A Rice, John P %A Rietschel, Marcella %A Rivera, Margarita %A Schulze, Thomas G %A Shi, Jianxin %A Shyn, Stanley %A Sinnamon, Grant C %A Johannes H Smit %A Smoller, Jordan W %A Snieder, Harold %A Toshiko Tanaka %A Tansey, Katherine E %A Teumer, Alexander %A Uher, Rudolf %A Umbricht, Daniel %A Van der Auwera, Sandra %A Erin B Ware %A David R Weir %A Weissman, Myrna M %A Gonneke Willemsen %A Yang, Jingyun %A Zhao, Wei %A Henning Tiemeier %A Patrick F. Sullivan %K Acid Anhydride Hydrolases %K depression %K Depressive Disorder %K Genetic Loci %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Neoplasm Proteins %K Phenotype %K Whites %X

BACKGROUND: The genetics of depression has been explored in genome-wide association studies that focused on either major depressive disorder or depressive symptoms with mostly negative findings. A broad depression phenotype including both phenotypes has not been tested previously using a genome-wide association approach. We aimed to identify genetic polymorphisms significantly associated with a broad phenotype from depressive symptoms to major depressive disorder.

METHODS: We analyzed two prior studies of 70,017 participants of European ancestry from general and clinical populations in the discovery stage. We performed a replication meta-analysis of 28,328 participants. Single nucleotide polymorphism (SNP)-based heritability and genetic correlations were calculated using linkage disequilibrium score regression. Discovery and replication analyses were performed using a p-value-based meta-analysis. Lifetime major depressive disorder and depressive symptom scores were used as the outcome measures.

RESULTS: The SNP-based heritability of major depressive disorder was 0.21 (SE = 0.02), the SNP-based heritability of depressive symptoms was 0.04 (SE = 0.01), and their genetic correlation was 1.001 (SE = 0.2). We found one genome-wide significant locus related to the broad depression phenotype (rs9825823, chromosome 3: 61,082,153, p = 8.2 × 10) located in an intron of the FHIT gene. We replicated this SNP in independent samples (p = .02) and the overall meta-analysis of the discovery and replication cohorts (1.0 × 10).

CONCLUSIONS: This large study identified a new locus for depression. Our results support a continuum between depressive symptoms and major depressive disorder. A phenotypically more inclusive approach may help to achieve the large sample sizes needed to detect susceptibility loci for depression.

%B Biological Psychiatry %V 82 %P 322-329 %G eng %N 5 %R 10.1016/j.biopsych.2016.11.013 %0 Journal Article %J Research on Aging %D 2017 %T Biopsychosocial Predictors of Fall Events Among Older African Americans. %A Emily J Nicklett %A Taylor, Robert Joseph %A Rostant, Ola %A Kimson E Johnson %A Evans, Linnea %K Falls %K Health Shocks %K Older Adults %K Racial/ethnic differences %K Women and Minorities %X This study identifies risk and protective factors for falls among older, community-dwelling African Americans. Drawing upon the biopsychosocial perspective, we conducted a series of sex- and age-adjusted multinomial logistic regression analyses to identify the correlates of fall events among older African Americans. Our sample consisted of 1,442 community-dwelling African Americans aged 65 and older, participating in the 2010-2012 rounds of the Health and Retirement Study. Biophysical characteristics associated with greater relative risk of experiencing single and/or multiple falls included greater functional limitations, poorer self-rated health, poorer self-rated vision, chronic illnesses (high blood pressure, diabetes, cancer, lung disease, heart problems, stroke, and arthritis), greater chronic illness comorbidity, older age, and female sex. Physical activity was negatively associated with recurrent falls. Among the examined psychosocial characteristics, greater depressive symptoms were associated with greater relative risk of experiencing single and multiple fall events. Implications for clinicians and future studies are discussed. %B Research on Aging %V 39 %P 501-525 %8 04/2017 %G eng %N 4 %R 10.1177/0164027516651974 %0 Journal Article %J PLoS One %D 2017 %T Bringing functional status into a big data world: Validation of national Veterans Affairs functional status data %A Rebecca T Brown %A Kiya D Komaiko %A Shi, Ying %A Kathy Z Fung %A W John Boscardin %A Au-Yeung, Alvin %A Tarasovsky, Gary %A Jacob, Riya %A Michael A Steinman %E Hernandez-Boussard, Tina %K Daily activities %K Functional status %K Veterans %X Background The ability to perform basic daily activities (“functional status”) is key to older adults’ quality of life and strongly predicts health outcomes. However, data on functional status are seldom collected during routine clinical care in a way that makes them available for clinical use and research. Objectives To validate functional status data that Veterans Affairs (VA) medical centers recently started collecting during routine clinical care, compared to the same data collected in a structured research setting. Design Prospective validation study. Setting Seven VA medical centers that collected complete data on 5 activities of daily living (ADLs) and 8 instrumental activities of daily living (IADLs) from older patients attending primary care appointments. Participants Randomly selected patients aged 75 and older who had new ADL and IADL data collected during a primary care appointment (N = 252). We oversampled patients with ADL dependence and applied these sampling weights to our analyses. Measurements Telephone-based interviews using a validated measure to assess the same 5 ADLs and 8 IADLs. Results Mean age was 83 years, 96% were male, and 75% were white. Of 85 participants whom VA data identified as dependent in 1 or more ADLs, 74 (87%) reported being dependent by interview; of 167 whom VA data identified as independent in ADLs, 149 (89%) reported being independent. The sample-weighted sensitivity of the VA data for identifying ADL dependence was 45% (95% CI, 29%, 62%) compared to the reference standard, the specificity was 99% (95% CI, 99%, >99%), and the positive predictive value was 87% (95% CI, 79%, 93%). The weighted kappa statistic was 0.55 (95% CI, 0.41, 0.68) for the agreement between VA data and research-collected data in identifying ADL dependence. Conclusion Overall agreement of VA functional status data with a reference standard was moderate, with fair sensitivity but high specificity and positive predictive value. %B PLoS One %V 12 %P e0178726 %8 Jan-06-2017 %G eng %U http://dx.plos.org/10.1371/journal.pone.0178726 %N 6 %! PLoS ONE %R 10.1371/journal.pone.0178726 Free full text %0 Journal Article %J The Consultant Pharmacist %D 2017 %T Characteristics of older adults who consume alcohol while on antidepressants %A Ulrich, Erin E. %A Vonderhaar, Jacqueline %A Tenhouse, Allison %K Alcohol Consumption %K Depressive symptoms %K Prescription Medication %X OBJECTIVES: Determine the characteristics of older Americans who self-report consuming alcohol and taking at least one antidepressant. DESIGN: This study utilized cross-sectional analyses. SETTING: The University of Michigan Health and Retirement Study and its subsurvey Prescription Drug Study (PDS). PATIENTS, PARTICIPANTS: Those who reported taking at least one antidepressant prescription medication, were 65 years of age or older, and were enrolled in Medicare or Medicaid between 2002 and 2004. INTERVENTIONS: Chi-square tests were conducted between demographic groups and alcohol consumption variables. Relationships between antidepressant quantity and behaviors of those consuming alcohol while taking antidepressants were also addressed. MAIN OUTCOME MEASURES: Demographics, alcohol consumption, number of antidepressants, psychiatric problem status, and alcohol behaviors. RESULTS: There were 412 subjects from the 2007 PDS (N = 3,536) who self-reported taking at least one antidepressant prescription medication. A total of 102 (24.8%) of the 412 subjects taking antidepressants reported using alcohol. Ethnicity, education level attained, and geographic region all showed a statistical difference between alcohol drinkers and nondrinkers. Most subjects were only on one antidepressant medication. Also, none of the subjects felt they needed to cut down on their drinking though they also did not feel annoyed by criticism from others about their drinking habits. CONCLUSION: This study showed that 24.8% of older Americans in the community were consuming some amount of alcohol while on antidepressants. These results show that there is an opportunity for consultant pharmacists to educate older American adults about the safety concerns with alcohol consumption and antidepressant use. %B The Consultant Pharmacist %V 32 %P 415-422 %8 Jan-07-2017 %G eng %U http://www.ingentaconnect.com/content/10.4140/TCP.n.2017.415 %N 7 %! consult pharm %R 10.4140/TCP.n.2017.415 %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 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 %X

Objectives: 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 Contribution of socioeconomic status at three lifecourse periods to late life memory function and decline: Early and late predictors of dementia risk. %A Jessica R Marden %A Eric J. Tchetgen Tchetgen %A Ichiro Kawachi %A M. Maria Glymour %K Cognitive Ability %K Dementia %K Memory %K Risk Factors %K Socioeconomic factors %X Both early life and adult socioeconomic status (SES) predict late life level of memory; however, evidence is mixed on the relationship between SES and rate of memory decline. Further, the relative importance of different lifecourse periods for rate of late life memory decline has not been evaluated. We examined associations between lifecourse SES and late life memory function and decline. Health and Retirement Study participants (n = 10,781) were interviewed biennially from 1998-2012. SES measures for childhood (composite score including parents' educational attainment), early adulthood (high school or college completion), and older adulthood (income, mean age 66) were all dichotomized. Word list memory (non-responders retained via proxy assessments) was modeled via inverse probability weighted longitudinal models accounting for differential attrition, survival, and time-varying confounding. Compared to low SES at all three points (reference), stable high SES predicted the best memory function and slowest decline. High school completion had the largest estimated effect on memory (β = 0.19; 95% Confidence Interval = 0.15, 0.22), but high late life income had the largest estimated benefit for slowing declines (β for 10 year memory change = 0.35; 95% Confidence Interval = 0.24, 0.46). Both early and late life interventions are potentially relevant for reducing dementia risk by improving memory function or slowing decline. %B American Journal of Epidemiology %V 186 %P 805-814 %8 10/2017 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/28541410?dopt=Abstract %R 10.1093/aje/kwx155 %0 Journal Article %J PLoS Genetics %D 2017 %T Discovery and fine-mapping of adiposity loci using high density imputation of genome-wide association studies in individuals of African ancestry: African Ancestry Anthropometry Genetics Consortium. %A Ng, Maggie C Y %A Graff, Mariaelisa %A Lu, Yingchang %A Justice, Anne E %A Mudgal, Poorva %A Liu, Ching-Ti %A Young, Kristin %A Yanek, Lisa R %A Feitosa, Mary F %A Wojczynski, Mary K %A Rand, Kristin %A Brody, Jennifer A %A Brian E Cade %A Dimitrov, Latchezar %A Duan, Qing %A Guo, Xiuqing %A Leslie A Lange %A Michael A Nalls %A Okut, Hayrettin %A Tajuddin, Salman M %A Bamidele O Tayo %A Vedantam, Sailaja %A Bradfield, Jonathan P %A Chen, Guanjie %A Chen, Wei-Min %A Chesi, Alessandra %A Irvin, Marguerite R %A Padhukasahasram, Badri %A Smith, Jennifer A %A Zheng, Wei %A Matthew A. Allison %A Ambrosone, Christine B %A Bandera, Elisa V %A Traci M Bartz %A Berndt, Sonja I %A Bernstein, Leslie %A Blot, William J %A Erwin P Bottinger %A John Carpten %A Chanock, Stephen J %A Chen, Yii-Der Ida %A Conti, David V %A Cooper, Richard S %A Myriam Fornage %A Freedman, Barry I %A Garcia, Melissa %A Phyllis J Goodman %A Hsu, Yu-Han H %A Hu, Jennifer %A Huff, Chad D %A Ingles, Sue A %A John, Esther M %A Rick A Kittles %A Eric A Klein %A Li, Jin %A McKnight, Barbara %A Nayak, Uma %A Nemesure, Barbara %A Ogunniyi, Adesola %A Olshan, Andrew %A Press, Michael F %A Rohde, Rebecca %A Rybicki, Benjamin A %A Babatunde Salako %A Sanderson, Maureen %A Shao, Yaming %A David S Siscovick %A Stanford, Janet L %A Stevens, Victoria L %A Stram, Alex %A Strom, Sara S %A Vaidya, Dhananjay %A Witte, John S %A Yao, Jie %A Zhu, Xiaofeng %A Ziegler, Regina G %A Alan B Zonderman %A Adeyemo, Adebowale %A Ambs, Stefan %A Cushman, Mary %A Jessica Faul %A Hakonarson, Hakon %A Levin, Albert M %A Nathanson, Katherine L %A Erin B Ware %A David R Weir %A Zhao, Wei %A Zhi, Degui %A Donna K Arnett %A Grant, Struan F A %A Sharon L R Kardia %A Oloapde, Olufunmilayo I %A Rao, D C %A Charles N Rotimi %A Sale, Michele M %A L Keoki Williams %A Zemel, Babette S %A Becker, Diane M %A Ingrid B Borecki %A Michele K Evans %A Tamara B Harris %A Hirschhorn, Joel N %A Li, Yun %A Patel, Sanjay R %A Psaty, Bruce M %A Rotter, Jerome I %A Wilson, James G %A Bowden, Donald W %A Cupples, L Adrienne %A Christopher A Haiman %A Ruth J F Loos %A Kari E North %K Adiposity %K Anthropometry %K Blacks %K Body Mass Index %K Chromosome Mapping %K Female %K Gene Frequency %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Linkage Disequilibrium %K Male %K Obesity %K Polymorphism, Single Nucleotide %K Serine Endopeptidases %K Transcription Factor 7-Like 2 Protein %K Waist-Hip Ratio %K Whites %X

Genome-wide association studies (GWAS) have identified >300 loci associated with measures of adiposity including body mass index (BMI) and waist-to-hip ratio (adjusted for BMI, WHRadjBMI), but few have been identified through screening of the African ancestry genomes. We performed large scale meta-analyses and replications in up to 52,895 individuals for BMI and up to 23,095 individuals for WHRadjBMI from the African Ancestry Anthropometry Genetics Consortium (AAAGC) using 1000 Genomes phase 1 imputed GWAS to improve coverage of both common and low frequency variants in the low linkage disequilibrium African ancestry genomes. In the sex-combined analyses, we identified one novel locus (TCF7L2/HABP2) for WHRadjBMI and eight previously established loci at P < 5×10-8: seven for BMI, and one for WHRadjBMI in African ancestry individuals. An additional novel locus (SPRYD7/DLEU2) was identified for WHRadjBMI when combined with European GWAS. In the sex-stratified analyses, we identified three novel loci for BMI (INTS10/LPL and MLC1 in men, IRX4/IRX2 in women) and four for WHRadjBMI (SSX2IP, CASC8, PDE3B and ZDHHC1/HSD11B2 in women) in individuals of African ancestry or both African and European ancestry. For four of the novel variants, the minor allele frequency was low (<5%). In the trans-ethnic fine mapping of 47 BMI loci and 27 WHRadjBMI loci that were locus-wide significant (P < 0.05 adjusted for effective number of variants per locus) from the African ancestry sex-combined and sex-stratified analyses, 26 BMI loci and 17 WHRadjBMI loci contained ≤ 20 variants in the credible sets that jointly account for 99% posterior probability of driving the associations. The lead variants in 13 of these loci had a high probability of being causal. As compared to our previous HapMap imputed GWAS for BMI and WHRadjBMI including up to 71,412 and 27,350 African ancestry individuals, respectively, our results suggest that 1000 Genomes imputation showed modest improvement in identifying GWAS loci including low frequency variants. Trans-ethnic meta-analyses further improved fine mapping of putative causal variants in loci shared between the African and European ancestry populations.

%B PLoS Genetics %V 13 %P e1006719 %G eng %N 4 %R 10.1371/journal.pgen.1006719 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2017 %T Feeling Older and the Development of Cognitive Impairment and Dementia. %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Antonio Terracciano %K Aged %K Aged, 80 and over %K Aging %K Alzheimer disease %K Cognitive Dysfunction %K depression %K disease progression %K Female %K Health Behavior %K Humans %K Life Style %K Likelihood Functions %K Logistic Models %K Longitudinal Studies %K Male %K Risk Factors %K Self Concept %X

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

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

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

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

%B J Gerontol B Psychol Sci Soc Sci %V 72 %P 966-973 %8 2017 Oct 01 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27436103 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27436103?dopt=Abstract %R 10.1093/geronb/gbw085 %0 Journal Article %J The Journal of Nutrition, Health & Aging %D 2017 %T Food insecurity among veterans: Findings from the Health and Retirement study %A Diana P Brostow %A Gunzburger, E. %A Kali S Thomas %K Nutrition %K Veterans %X Objectives: We examined the prevalence of food insecurity in an older population, specifically assessing factors associated with food insecurity among U.S. military Veterans. Methods: Data from the 2012 wave of the Health and Retirement Study and the 2013 Health Care and Nutrition Mail Survey of 2560 male participants (1254 Veterans) were used to estimate the prevalence of food insecurity and to identify significant predictors of food insecurity among male Veterans. Results: Among male Veterans, 6.4% reported food insecurity, compared to 11.9% of male non-veterans (p < 0.01). Younger age, difficulty with daily activities and depression were significantly associated with increased odds of food insecurity among male Veterans aged 50 to 64. In male Veterans age 65 years and older, current smoking, a psychiatric diagnosis and depression were significantly associated with increased odds of food insecurity. Conclusions: This study identified significant factors that may be used to target interventions to improve nutritional status among older male Veterans © 2017 Serdi and Springer-Verlag France %B The Journal of Nutrition, Health & Aging %V 21 %P 1358-1364 %G eng %N 10 %! J Nutr Health Aging %R 10.1007/s12603-017-0910-7 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2017 %T Genome-wide Association Study of Parental Life Span. %A Toshiko Tanaka %A Ambarish Dutta %A Luke C Pilling %A Xue, Luting %A Kathryn L Lunetta %A Joanne M Murabito %A Bandinelli, Stefania %A Robert B Wallace %A David Melzer %A Luigi Ferrucci %K Aged %K Aged, 80 and over %K Chromosomes, Human, Pair 18 %K Female %K Genome-Wide Association Study %K Humans %K Longevity %K Male %K Middle Aged %K Parents %K Phenotype %K Polymorphism, Single Nucleotide %K Trans-Activators %X

Background: Having longer lived parents has been shown to be an important predictor of health trajectories and life span. As such, parental life span is an important phenotype that may uncover genes that affect longevity.

Methods: A genome-wide association study of parental life span in participants of European and African ancestry from the Health and Retirement Study was conducted.

Results: A genome-wide significant association was observed for rs35715456 (log10BF = 6.3) on chromosome 18 for the dichotomous trait of having at least one long-lived parent versus not having any long-lived parent. This association was not replicated in an independent sample from the InCHIANTI and Framingham Heart Study. The most significant association among single nucleotide polymorphisms in longevity candidate genes (APOE, MINIPP1, FOXO3, EBF1, CAMKIV, and OTOL1) was observed in the EBF1 gene region (rs17056207, p = .0002).

Conclusions: A promising genetic signal for parental life span was identified but was not replicated in independent samples.

%B J Gerontol A Biol Sci Med Sci %V 72 %P 1407-1410 %8 2017 Oct 01 %G eng %U http://biomedgerontology.oxfordjournals.org/lookup/doi/10.1093/gerona/glw206https://academic.oup.com/biomedgerontology/article/2422264/Genomewide-Association-Study-of-Parental-Life-Span %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/27816938?dopt=Abstract %! GERONA %R 10.1093/gerona/glw206 %0 Journal Article %J Nature Communications %D 2017 %T Genome-wide meta-analysis associates HLA-DQA1/DRB1 and LPA and lifestyle factors with human longevity. %A Joshi, Peter K %A Nicola Pirastu %A Kentistou, Katherine A %A Fischer, Krista %A Edith Hofer %A Schraut, Katharina E %A Clark, David W %A Nutile, Teresa %A Barnes, Catriona L K %A Paul Rhj Timmers %A Shen, Xia %A Gandin, Ilaria %A McDaid, Aaron F %A Hansen, Thomas Folkmann %A Gordon, Scott D %A Giulianini, Franco %A Boutin, Thibaud S %A Abdellaoui, Abdel %A Zhao, Wei %A Medina-Gomez, Carolina %A Traci M Bartz %A Trompet, Stella %A Leslie A Lange %A Raffield, Laura %A van der Spek, Ashley %A Galesloot, Tessel E %A Proitsi, Petroula %A Yanek, Lisa R %A Bielak, Lawrence F %A Payton, Antony %A Murgia, Federico %A Concas, Maria Pina %A Biino, Ginevra %A Tajuddin, Salman M %A Seppälä, Ilkka %A Amin, Najaf %A Boerwinkle, Eric %A Børglum, Anders D %A Campbell, Archie %A Ellen W Demerath %A Demuth, Ilja %A Jessica Faul %A Ford, Ian %A Gialluisi, Alessandro %A Gögele, Martin %A Graff, Mariaelisa %A Aroon Hingorani %A Jouke-Jan Hottenga %A Hougaard, David M %A Hurme, Mikko A %A Ikram, M Arfan %A Jylhä, Marja %A Kuh, Diana %A Ligthart, Lannie %A Lill, Christina M %A Lindenberger, Ulman %A Lumley, Thomas %A Mägi, Reedik %A Marques-Vidal, Pedro %A Sarah E Medland %A Lili Milani %A Nagy, Reka %A William E R Ollier %A Peyser, Patricia A %A Pramstaller, Peter P %A Ridker, Paul M %A Fernando Rivadeneira %A Ruggiero, Daniela %A Saba, Yasaman %A Schmidt, Reinhold %A Schmidt, Helena %A Slagboom, P Eline %A Smith, Blair H %A Smith, Jennifer A %A Sotoodehnia, Nona %A Steinhagen-Thiessen, Elisabeth %A van Rooij, Frank J A %A Verbeek, André L %A Vermeulen, Sita H %A Vollenweider, Peter %A Wang, Yunpeng %A Werge, Thomas %A Whitfield, John B %A Alan B Zonderman %A Lehtimäki, Terho %A Michele K Evans %A Pirastu, Mario %A Fuchsberger, Christian %A Bertram, Lars %A Pendleton, Neil %A Sharon L R Kardia %A Ciullo, Marina %A Becker, Diane M %A Wong, Andrew %A Psaty, Bruce M %A Cornelia M van Duijn %A Wilson, James G %A Jukema, J Wouter %A Lambertus A Kiemeney %A André G Uitterlinden %A Franceschini, Nora %A Kari E North %A David R Weir %A Andres Metspalu %A Dorret I Boomsma %A Caroline Hayward %A Daniel I Chasman %A Nicholas G Martin %A Sattar, Naveed %A Campbell, Harry %A Tõnu Esko %A Kutalik, Zoltán %A James F Wilson %K Alleles %K Body Mass Index %K Coronary Disease %K Education %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K HLA-DQ alpha-Chains %K HLA-DRB1 Chains %K Humans %K Insulin Resistance %K Life Style %K Lipoprotein(a) %K Lipoproteins, HDL %K Longevity %K Lung Neoplasms %K Obesity %K Polymorphism, Single Nucleotide %K Smoking %K Socioeconomic factors %X

Genomic analysis of longevity offers the potential to illuminate the biology of human aging. Here, using genome-wide association meta-analysis of 606,059 parents' survival, we discover two regions associated with longevity (HLA-DQA1/DRB1 and LPA). We also validate previous suggestions that APOE, CHRNA3/5, CDKN2A/B, SH2B3 and FOXO3A influence longevity. Next we show that giving up smoking, educational attainment, openness to new experience and high-density lipoprotein (HDL) cholesterol levels are most positively genetically correlated with lifespan while susceptibility to coronary artery disease (CAD), cigarettes smoked per day, lung cancer, insulin resistance and body fat are most negatively correlated. We suggest that the effect of education on lifespan is principally mediated through smoking while the effect of obesity appears to act via CAD. Using instrumental variables, we suggest that an increase of one body mass index unit reduces lifespan by 7 months while 1 year of education adds 11 months to expected lifespan.Variability in human longevity is genetically influenced. Using genetic data of parental lifespan, the authors identify associations at HLA-DQA/DRB1 and LPA and find that genetic variants that increase educational attainment have a positive effect on lifespan whereas increasing BMI negatively affects lifespan.

%B Nature Communications %V 8 %P 910 %G eng %N 1 %R 10.1038/s41467-017-00934-5 %0 Journal Article %J 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 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 %X

Background: 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 Alzheimer Disease and Associated Disorders %D 2017 %T High Hemoglobin A1c and Diabetes Predict Memory Decline in the Health and Retirement Study. %A Jessica R Marden %A Elizabeth R Mayeda %A Eric J. Tchetgen Tchetgen %A Ichiro Kawachi %A M. Maria Glymour %K Cognitive Ability %K Diabetes %K Memory %K Older Adults %X

BACKGROUND: Type 2 diabetes (T2D) is an established risk factor for dementia, but evidence for T2D and memory decline is less consistent. Understanding how T2D and blood glucose relate to memory decline is crucial to elucidating the mechanisms linking T2D and dementia.

MATERIALS AND METHODS: For 8888 Health and Retirement Study participants aged 50+, glycosylated hemoglobin (HbA1c) was measured in either 2006 or 2008 and physician's diagnosis of diabetes was self-reported in the same year. Composite memory (z scored) was assessed biennially through 2012 using immediate and delayed word list recall or the Informant Questionnaire for Cognitive Decline. Marginal mean regression models for repeated outcomes were specified to predict memory decline as a function of diabetes or HbA1c, using age as the timescale and adjusting for health and social confounders.

RESULTS: Diabetes was associated with a 10% faster rate of memory decline [β=-0.04 per decade; 95% confidence interval (CI), -0.06 to -0.01). A 1 U increase in HbA1c corresponded with a 0.05 SD decrease in memory score per decade (95% CI, -0.08 to -0.03). Even among individuals with HbA1c<6.5% (threshold for diabetes), higher HbA1c was associated with memory decline (β=-0.05 per decade; 95% CI, -0.08 to -0.03).

DISCUSSION: Diabetes accelerated memory loss and higher HbA1c predicted memory decline even in nondiabetics.

%B Alzheimer Disease and Associated Disorders %V 31 %P 48-54 %8 2017 Jan-Mar %G eng %N 1 %R 10.1097/WAD.0000000000000182 %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 Aging %D 2017 %T Human longevity: 25 genetic loci associated in 389,166 UK biobank participants %A Luke C Pilling %A Kuo, Chia-Ling %A Sicinski, Kamil %A Tamosauskaite, Jone %A George A Kuchel %A Lorna W. Harries %A Herd, Pamela %A Robert B Wallace %A Luigi Ferrucci %A David Melzer %K Cross-National %K Genetics %K Genome %K GWAS %K Longevity %X We undertook a genome-wide association study (GWAS) of parental longevity in European descent UK Biobank participants. For combined mothers' and fathers' attained age, 10 loci were associated (p<5*10(-8)), including 8 previously identified for traits including survival, Alzheimer's and cardiovascular disease. Of these, 4 were also associated with longest 10% survival (mother's age >= 90 years, father's >= 87 years), with 2 additional associations including MC2R intronic variants (coding for the adrenocorticotropic hormone receptor). Mother's age at death was associated with 3 additional loci (2 linked to autoimmune conditions), and 8 for fathers only. An attained age genetic risk score associated with parental survival in the US Health and Retirement Study and the Wisconsin Longitudinal Study and with having a centenarian parent (n=1,181) in UK Biobank. The results suggest that human longevity is highly polygenic with prominent roles for loci likely involved in cellular senescence and inflammation, plus lipid metabolism and cardiovascular conditions. There may also be gender specific routes to longevity. %B Aging %V 9 %P 2504-2520 %G eng %U http://www.aging-us.com/article/101334/texthttp://www.aging-us.com/article/101334/text?_escaped_fragment_= %N 12 %! aging %R 10.18632/aging.101334 %0 Journal Article %J Biometrics %D 2017 %T Instrumental variables estimation of exposure effects on a time-to-event endpoint using structural cumulative survival models. %A Martinussen, Torben %A Vansteelandt, Stijn %A Eric J. Tchetgen Tchetgen %A David M Zucker %K Survey Methodology %X The use of instrumental variables for estimating the effect of an exposure on an outcome is popular in econometrics, and increasingly so in epidemiology. This increasing popularity may be attributed to the natural occurrence of instrumental variables in observational studies that incorporate elements of randomization, either by design or by nature (e.g., random inheritance of genes). Instrumental variables estimation of exposure effects is well established for continuous outcomes and to some extent for binary outcomes. It is, however, largely lacking for time-to-event outcomes because of complications due to censoring and survivorship bias. In this article, we make a novel proposal under a class of structural cumulative survival models which parameterize time-varying effects of a point exposure directly on the scale of the survival function; these models are essentially equivalent with a semi-parametric variant of the instrumental variables additive hazards model. We propose a class of recursive instrumental variable estimators for these exposure effects, and derive their large sample properties along with inferential tools. We examine the performance of the proposed method in simulation studies and illustrate it in a Mendelian randomization study to evaluate the effect of diabetes on mortality using data from the Health and Retirement Study. We further use the proposed method to investigate potential benefit from breast cancer screening on subsequent breast cancer mortality based on the HIP-study. %B Biometrics %V 73 %P 1140-1149 %8 12/2017 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28493302?dopt=Abstract %R 10.1111/biom.12699 %0 Journal Article %J Journal of Aging and Health %D 2017 %T Is Memory Decline Associated With Inflammatory Response? %A Amber M Tetlow %A Andel, Ross %A Frank J Infurna %K Biomarkers %K Cognitive Ability %K Inflammation %K Memory %X

OBJECTIVE: To examine whether changes in memory over a 10-year period could predict a change in C-reactive protein (CRP) levels.

METHOD: A mixed model analysis was first conducted to obtain the estimates for change in memory over the 10-year period using data from the Health and Retirement Study. Then a multivariate regression to determine whether a change in episodic memory could predict subsequent CRP levels was conducted. Furthermore, a general linear model was conducted to determine differences in CRP levels among different rates of change in episodic memory.

RESULTS: Greater declines in episodic memory were associated with higher levels of subsequent CRP (Estimate = -0.32, SE = 0.12, β = -.03, p = .008). The general linear model revealed that those with greater memory declines were more likely to have higher levels of CRP, F = 26.50, p < .001.

DISCUSSION: These results highlight the notion that memory decline and inflammation may be intertwined, and we discuss various avenues that warrant further investigation.

%B Journal of Aging and Health %P 898264317742809 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29254429?dopt=Abstract %R 10.1177/0898264317742809 %0 Journal Article %J Circulation: Cardiovascular Genetics %D 2017 %T New Blood Pressure-Associated Loci Identified in Meta-Analyses of 475 000 Individuals. %A Kraja, Aldi T %A Cook, James P %A Warren, Helen R %A Surendran, Praveen %A Liu, Chunyu %A Evangelou, Evangelos %A Alisa Manning %A Grarup, Niels %A Drenos, Fotios %A Sim, Xueling %A Smith, Albert Vernon %A Amin, Najaf %A Alexandra I Blakemore %A Bork-Jensen, Jette %A Brandslund, Ivan %A Farmaki, Aliki-Eleni %A Fava, Cristiano %A Ferreira, Teresa %A Herzig, Karl-Heinz %A Giri, Ayush %A Giulianini, Franco %A Grove, Megan L %A Guo, Xiuqing %A Sarah E Harris %A Have, Christian T %A Havulinna, Aki S %A Zhang, He %A Jørgensen, Marit E %A Käräjämäki, AnneMari %A Charles Kooperberg %A Linneberg, Allan %A Little, Louis %A Liu, Yongmei %A Bonnycastle, Lori L %A Lu, Yingchang %A Mägi, Reedik %A Mahajan, Anubha %A Malerba, Giovanni %A Riccardo E Marioni %A Mei, Hao %A Menni, Cristina %A Alanna C Morrison %A Padmanabhan, Sandosh %A Walter R Palmas %A Poveda, Alaitz %A Rauramaa, Rainer %A Nigel W Rayner %A Riaz, Muhammad %A Rice, Ken %A Melissa Richard %A Smith, Jennifer A %A Southam, Lorraine %A Stančáková, Alena %A Kathleen E Stirrups %A Tragante, Vinicius %A Tuomi, Tiinamaija %A Tzoulaki, Ioanna %A Varga, Tibor V %A Weiss, Stefan %A Yiorkas, Andrianos M %A Young, Robin %A Zhang, Weihua %A Barnes, Michael R %A Cabrera, Claudia P %A Gao, He %A Boehnke, Michael %A Boerwinkle, Eric %A Chambers, John C %A Connell, John M %A Cramer Christensen %A de Boer, Rudolf A %A Ian J Deary %A George Dedoussis %A Deloukas, Panos %A Dominiczak, Anna F %A Dörr, Marcus %A Joehanes, Roby %A Edwards, Todd L %A Tõnu Esko %A Myriam Fornage %A Franceschini, Nora %A Franks, Paul W %A Gambaro, Giovanni %A Leif C Groop %A Hallmans, Göran %A Hansen, Torben %A Caroline Hayward %A Heikki, Oksa %A Ingelsson, Erik %A Tuomilehto, Jaakko %A Järvelin, Marjo-Riitta %A Sharon L R Kardia %A Karpe, Fredrik %A Kooner, Jaspal S %A Lakka, Timo A %A Langenberg, Claudia %A Lars Lind %A Ruth J F Loos %A Laakso, Markku %A McCarthy, Mark I %A Melander, Olle %A Mohlke, Karen L %A Morris, Andrew P %A Palmer, Colin N A %A Pedersen, Oluf %A Polasek, Ozren %A Neil Poulter %A Province, Michael A %A Psaty, Bruce M %A Ridker, Paul M %A Rotter, Jerome I %A Rudan, Igor %A Veikko Salomaa %A Nilesh J Samani %A Peter Sever %A Skaaby, Tea %A Stafford, Jeanette M %A John M Starr %A van der Harst, Pim %A van der Meer, Peter %A Cornelia M van Duijn %A Vergnaud, Anne-Claire %A Gudnason, Vilmundur %A Wareham, Nicholas J %A Wilson, James G %A Willer, Cristen J %A Daniel Witte %A Zeggini, Eleftheria %A Saleheen, Danish %A Adam S Butterworth %A Danesh, John %A Asselbergs, Folkert W %A Wain, Louise V %A Georg B Ehret %A Daniel I Chasman %A Caulfield, Mark J %A Elliott, Paul %A Lindgren, Cecilia M %A Levy, Daniel %A Newton-Cheh, Christopher %A Munroe, Patricia B %A Howson, Joanna M M %K Antiporters %K Blood pressure %K Cell Adhesion Molecules, Neuronal %K Databases, Factual %K Genetic Loci %K Genome-Wide Association Study %K Genotype %K Humans %K Microfilament Proteins %K Phenotype %K Polymorphism, Single Nucleotide %K Receptors, Lymphocyte Homing %X

BACKGROUND: Genome-wide association studies have recently identified >400 loci that harbor DNA sequence variants that influence blood pressure (BP). Our earlier studies identified and validated 56 single nucleotide variants (SNVs) associated with BP from meta-analyses of exome chip genotype data. An additional 100 variants yielded suggestive evidence of association.

METHODS AND RESULTS: Here, we augment the sample with 140 886 European individuals from the UK Biobank, in whom 77 of the 100 suggestive SNVs were available for association analysis with systolic BP or diastolic BP or pulse pressure. We performed 2 meta-analyses, one in individuals of European, South Asian, African, and Hispanic descent (pan-ancestry, ≈475 000), and the other in the subset of individuals of European descent (≈423 000). Twenty-one SNVs were genome-wide significant (<5×10) for BP, of which 4 are new BP loci: rs9678851 (missense, ), rs7437940 (), rs13303 (missense, ), and rs1055144 (). In addition, we identified a potentially independent novel BP-associated SNV, rs3416322 (missense, ) at a known locus, uncorrelated with the previously reported SNVs. Two SNVs are associated with expression levels of nearby genes, and SNVs at 3 loci are associated with other traits. One SNV with a minor allele frequency <0.01, (rs3025380 at ) was genome-wide significant.

CONCLUSIONS: We report 4 novel loci associated with BP regulation, and 1 independent variant at an established BP locus. This analysis highlights several candidate genes with variation that alter protein function or gene expression for potential follow-up.

%B Circulation: Cardiovascular Genetics %V 10 %P e001778 %G eng %N 5 %R 10.1161/CIRCGENETICS.117.001778 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2017 %T Personality and Lung Function in Older Adults. %A Antonio Terracciano %A Yannick Stephan %A Martina Luchetti %A Gonzalez-Rothi, Ricardo %A Angelina R Sutin %K Aged %K Aged, 80 and over %K Anxiety Disorders %K Character %K Disease Susceptibility %K Dyspnea %K Female %K Follow-Up Studies %K Health Behavior %K Humans %K Male %K Medical History Taking %K Middle Aged %K Neuroticism %K Peak Expiratory Flow Rate %K Pulmonary Disease, Chronic Obstructive %K Risk Factors %X

OBJECTIVES: Lung disease is a leading cause of disability and death among older adults. We examine whether personality traits are associated with lung function and shortness of breath (dyspnea) in a national cohort with and without chronic obstructive pulmonary disease (COPD).

METHOD: Participants (N = 12,670) from the Health and Retirement Study were tested for peak expiratory flow (PEF) and completed measures of personality, health behaviors, and a medical history.

RESULTS: High neuroticism and low extraversion, openness, agreeableness, and conscientiousness were associated with lower PEF, and higher likelihood of COPD and dyspnea. Conscientiousness had the strongest and most consistent associations, including lower risk of PEF less than 80% of the predicted value (OR = 0.67; 0.62-0.73) and dyspnea (OR = 0.52; 0.47-0.57). Although attenuated, the associations remained significant when accounting for smoking, physical activity, and chronic diseases including cardiovascular and psychiatric disorders. The associations between personality and PEF or dyspnea were similar among those with or without COPD, suggesting that psychological links to lung function are not disease dependent. In longitudinal analyses, high neuroticism (β = -0.019) and low conscientiousness (β = 0.027) predicted steeper declines in PEF.

DISCUSSION: A vulnerable personality profile is common among individuals with limited lung function and COPD, predicts shortness of breath and worsening lung function.

%B J Gerontol B Psychol Sci Soc Sci %V 72 %P 913-921 %8 2017 Oct 01 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/01/18/geronb.gbv161.abstract %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26786321?dopt=Abstract %4 Chronic obstructive pulmonary disease/Conscientiousness/Conscientiousness/Lung function/Peak expiratory flow/Personality/Personality/Shortness of breath %$ 999999 %R 10.1093/geronb/gbv161 %0 Journal Article %J Journal of Psychiatric Research %D 2017 %T Personality traits and risk of cognitive impairment and dementia. %A Antonio Terracciano %A Yannick Stephan %A Martina Luchetti %A Albanese, Emiliano %A Angelina R Sutin %K Cognitive Ability %K Dementia %K Older Adults %K Personality %X

We investigated the association between five factor model personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and risk of dementia, cognitive impairment not dementia (CIND), and conversion from CIND to dementia in a large national cohort. Participants from the Health and Retirement Study (N > 10,000) completed a personality scale in 2006-2008 and their cognitive status was tracked for up to 8 years using the modified Telephone Interview for Cognitive Status (TICSm). Adjusting for age, sex, education, race, and ethnicity, lower conscientiousness and agreeableness and higher neuroticism were independently associated with increased risk of dementia. These associations remained significant after adjusting for other risk factors for dementia, including income, wealth, smoking, physical inactivity, obesity, diabetes, hypertension, and blood biomarkers. These associations were not modified by age, sex, race, ethnicity, and education, suggesting that the associations of personality with risk of dementia were similar across demographic groups. Neuroticism and conscientiousness were also associated with risk of CIND. Low conscientiousness predicted conversion from CIND to dementia. Using brief assessments of personality and cognition, we found robust evidence that personality is associated with risk of cognitive impairment and dementia in a large national sample.

%B Journal of Psychiatric Research %V 89 %P 22-27 %8 2017 Jan 22 %G eng %R 10.1016/j.jpsychires.2017.01.011 %0 Journal Article %J Scandinavian Journal of Public Health %D 2017 %T Predictive validity of the Work Ability Index and its individual items in the general population. %A Lundin, Andreas %A Leijon, Ola %A Vaez, Marjan %A Hallgren, Mats %A Torgén, Margareta %K Older Adults %K Self-reported health %X

AIM: This study assesses the predictive ability of the full Work Ability Index (WAI) as well as its individual items in the general population.

METHODS: The Work, Health and Retirement Study (WHRS) is a stratified random national sample of 25-75-year-olds living in Sweden in 2000 that received a postal questionnaire ( n = 6637, response rate = 53%). Current and subsequent sickness absence was obtained from registers. The ability of the WAI to predict long-term sickness absence (LTSA; ⩾ 90 consecutive days) during a period of four years was analysed by logistic regression, from which the Area Under the Receiver Operating Characteristic curve (AUC) was computed.

RESULTS: There were 313 incident LTSA cases among 1786 employed individuals. The full WAI had acceptable ability to predict LTSA during the 4-year follow-up (AUC = 0.79; 95% CI 0.76 to 0.82). Individual items were less stable in their predictive ability. However, three of the individual items: current work ability compared with lifetime best, estimated work impairment due to diseases, and number of diagnosed current diseases, exceeded AUC > 0.70. Excluding the WAI item on number of days on sickness absence did not result in an inferior predictive ability of the WAI.

CONCLUSIONS: The full WAI has acceptable predictive validity, and is superior to its individual items. For public health surveys, three items may be suitable proxies of the full WAI; current work ability compared with lifetime best, estimated work impairment due to diseases, and number of current diseases diagnosed by a physician.

%B Scandinavian Journal of Public Health %V 45 %P 350-356 %G eng %N 4 %R 10.1177/1403494817702759 %0 Journal Article %J BMC Geriatrics %D 2017 %T Racial and ethnic differences in smoking changes after chronic disease diagnosis among middle-aged and older adults in the United States. %A Ana R Quiñones %A Corey L Nagel %A Jason T Newsom %A Nathalie Huguet %A Sheridan, Paige %A Stephen M Thielke %K Chronic disease %K Health Conditions and Status %K Older Adults %K Racial/ethnic differences %K Smoking %X

BACKGROUND: Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US.

METHODS: We use longitudinal data from the Health and Retirement Study (HRS 1992-2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers.

RESULTS: The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14% after diabetes diagnosis to 32% after cancer diagnosis; for black smokers, the percentage ranged from 15% after lung disease diagnosis to 40% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38% quit. In logistic models, black (OR = 0.43, 95% CI: 0.19-0.99) and Latino (OR = 0.26, 95% CI: 0.11-0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95% CI [1.05-6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes.

CONCLUSIONS: A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults.

%B BMC Geriatrics %V 17 %P 48 %8 2017 Feb 08 %G eng %N 1 %R 10.1186/s12877-017-0438-z %0 Journal Article %J The Journal of Pain: Official Journal of the American Pain Society %D 2017 %T Racial and socioeconomic disparities in disabling chronic pain: Findings from the Health and Retirement Study. %A Mary R Janevic %A Sara J McLaughlin %A Alicia A Heapy %A Thacker, Casey %A John D Piette %K Chronic pain %K Racial/ethnic differences %K Socioeconomic factors %X The U.S. National Pain Strategy calls for increased population research on "high impact chronic pain," i.e., longstanding pain that substantially limits participation in daily activities. Using data from the nationally-representative Health and Retirement Study (HRS), we investigated the prevalence of high-impact chronic pain in U.S. adults over age 50 overall and within population subgroups. We also explored sociodemographic variation in pain-related disability within specific activity domains. Data are from a subsample of HRS respondents (n=1,925) who were randomly selected for a supplementary pain module in 2010. Our outcome was operationalized as pain duration of >7 months and a disability rating of >7 (0 to 10 scale) in at least one domain: family/home, leisure, social activities, work, or basic activities. Overall, 8.2% (95% C.I. = 6.7 to 10.1%) of adults over age 50 met criteria for high-impact chronic pain. This proportion rose to 17.1% (95% C.I. = 12.3 to 23.4%) among individuals in the lowest wealth quartile. Prevalence differences by education, race/ethnicity and age were not significant. Arthritis and depression were significantly associated with high-impact pain in multivariable analysis. Among adults with any chronic pain, African Americans and individuals in the lowest wealth quartile reported more pain-related disability across activity domains.

PERSPECTIVE: High-impact chronic pain is unequally distributed among midlife and older U.S. adults. Efforts to reduce the burden of disabling chronic pain should prioritize socioeconomically vulnerable groups, who may have the least access to multi-modal pain treatment to improve function. %B The Journal of Pain: Official Journal of the American Pain Society %V 18 %P 1459-1467 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/28760648?dopt=Abstract %R 10.1016/j.jpain.2017.07.005 %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 %X

Height is a highly heritable, classic polygenic trait with approximately 700 common associated variants identified through genome-wide association studies so far. Here, we report 83 height-associated coding variants with lower minor-allele frequencies (in the range of 0.1-4.8%) and effects of up to 2 centimetres per allele (such as those in IHH, STC2, AR and CRISPLD2), greater than ten times the average effect of common variants. In functional follow-up studies, rare height-increasing alleles of STC2 (giving an increase of 1-2 centimetres per allele) compromised proteolytic inhibition of PAPP-A and increased cleavage of IGFBP-4 in vitro, resulting in higher bioavailability of insulin-like growth factors. These 83 height-associated variants overlap genes that are mutated in monogenic growth disorders and highlight new biological candidates (such as ADAMTS3, IL11RA and NOX4) and pathways (such as proteoglycan and glycosaminoglycan synthesis) involved in growth. Our results demonstrate that sufficiently large sample sizes can uncover rare and low-frequency variants of moderate-to-large effect associated with polygenic human phenotypes, and that these variants implicate relevant genes and pathways.

%B Nature %V 542 %P 186-190 %8 2017 Feb 09 %G eng %N 7640 %1 http://www.ncbi.nlm.nih.gov/pubmed/28146470?dopt=Abstract %R 10.1038/nature21039 %0 Journal Article %J 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 %X

BACKGROUND: 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 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 %X

OBJECTIVE: 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 Newspaper Article %B The New York Times %D 2017 %T Rising Risks for Retirement Savers %? The Editorial Board %K News %K Older Adults %K Risk Factors %B The New York Times %C New York City, New York %8 04/06/2017 %G eng %U https://www.nytimes.com/2017/04/06/opinion/rising-risks-for-retirement-savers.html %& Opinion %0 Journal Article %J SSM - Population Health %D 2017 %T The role of literacy in the association between educational attainment and depressive symptoms %A Thu T Nguyen %A Eric J. Tchetgen Tchetgen %A Ichiro Kawachi %A Stephen E. Gilman %A Stefan Walter %A M. Maria Glymour %K Depressive symptoms %K Education %K Literacy %X There is a consistent association between education and depressive symptoms, but research on the mechanisms to explain this association remains limited. No study has formally evaluated the extent to which the association between education and depressive symptoms is mediated through a foundational skill such as literacy. Inverse odds ratio weighting (IORW) was used to estimate total, natural direct, and natural indirect effects in examining literacy as a mediator of the association between education and depressive symptoms. Health and Retirement Study participants born in the U.S. between 1900 and 1947 were interviewed biennially for up to 12 years (N = 16,718). Literacy was assessed with a brief vocabulary measure. Depressive symptoms were measured using the 8-item Centers for Epidemiologic Studies-Depression (CES-D) scale. Decomposition estimates were derived using regression analyses of repeated measures of depressive symptoms. Standard errors were obtained using a nonparametric bootstrap with the individual as the independent unit to account for dependence of observations within an individual. In a large cohort of older Americans, a one standard deviation difference in educational attainment (~ 3 years) was associated with a 0.35-point decrement in CES-D score (95% CI: -0.38, -0.32). This decrement represents a 0.22 standard deviation difference in depressive symptoms. Using IORW, the estimated effect of education on depressive symptoms mediated through literacy was -0.10 (95% CI: -0.18, -0.01), which represents 28% of the total effect. Education confers many benefits; as demonstrated by this study for depressive symptoms, one important benefit is literacy. %B SSM - Population Health %V 3 %P 586-593 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S2352827316301197http://api.elsevier.com/content/article/PII:S2352827316301197?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2352827316301197?httpAccept=text/plain %! SSM - Population Health %R 10.1016/j.ssmph.2017.07.002 %0 Journal Article %J Psychology and Aging %D 2017 %T Sensory functioning and personality development among older adults. %A Yannick Stephan %A Angelina R Sutin %A Bosselut, Grégoire %A Antonio Terracciano %K Older Adults %K Personality %X Deficits in sensory functioning, such as poor vision and hearing, take a significant toll on quality of life. Little is known, however, about their relation with personality development across adulthood. This study examined whether baseline and change in vision and hearing were associated with personality change over a 4-year period. Participants (N = 7,471; Mage = 66.89; 59% women) were drawn from the Health and Retirement Study. They provided data on vision, hearing, and personality both at baseline and 4 years later. Poor vision and hearing at baseline and declines in vision and hearing over time were independently related to steeper declines in extraversion, agreeableness, openness, and conscientiousness, and less decline in neuroticism, controlling for demographic factors, disease burden, and depressive symptoms. Sensory functioning was generally a stronger predictor of personality change than disease burden or depressive symptoms. Consistent with evidence that poor and worsening sensory functions compromise individuals' interactions with the social and physical environment, this study found deficits in hearing and vision were also associated with maladaptive personality trajectories in older adults. %B Psychology and Aging %V 32 %P 139-147 %8 03/2017 %G eng %N 2 %R 10.1037/pag0000159 %0 Journal Article %J PLoS Genetics %D 2017 %T Single-trait and multi-trait genome-wide association analyses identify novel loci for blood pressure in African-ancestry populations. %A Liang, Jingjing %A Le, Thu H %A Digna R Velez Edwards %A Bamidele O Tayo %A Gaulton, Kyle J %A Smith, Jennifer A %A Lu, Yingchang %A Jensen, Richard A %A Chen, Guanjie %A Yanek, Lisa R %A Schwander, Karen %A Tajuddin, Salman M %A Sofer, Tamar %A Kim, Wonji %A Kayima, James %A McKenzie, Colin A %A Fox, Ervin %A Michael A Nalls %A Young, J Hunter %A Yan V Sun %A Lane, Jacqueline M %A Cechova, Sylvia %A Zhou, Jie %A Tang, Hua %A Myriam Fornage %A Musani, Solomon K %A Wang, Heming %A Lee, Juyoung %A Adeyemo, Adebowale %A Dreisbach, Albert W %A Forrester, Terrence %A Chu, Pei-Lun %A Anne Cappola %A Michele K Evans %A Alanna C Morrison %A Martin, Lisa W %A Kerri Wiggins %A Hui, Qin %A Zhao, Wei %A Jackson, Rebecca D %A Erin B Ware %A Jessica Faul %A Reiner, Alex P %A Bray, Michael %A Denny, Joshua C %A Thomas H Mosley %A Walter R Palmas %A Guo, Xiuqing %A George J Papanicolaou %A Alan Penman %A Polak, Joseph F %A Kenneth Rice %A Taylor, Ken D %A Boerwinkle, Eric %A Erwin P Bottinger %A Liu, Kiang %A Neil Risch %A Hunt, Steven C %A Charles Kooperberg %A Alan B Zonderman %A Laurie, Cathy C %A Becker, Diane M %A Cai, Jianwen %A Ruth J F Loos %A Psaty, Bruce M %A David R Weir %A Sharon L R Kardia %A Donna K Arnett %A Won, Sungho %A Edwards, Todd L %A Redline, Susan %A Cooper, Richard S %A Rao, D C %A Rotter, Jerome I %A Charles N Rotimi %A Levy, Daniel %A Chakravarti, Aravinda %A Zhu, Xiaofeng %A Franceschini, Nora %K African Americans %K Animals %K Basic Helix-Loop-Helix Transcription Factors %K Blood pressure %K Cadherins %K Case-Control Studies %K Female %K Genetic Loci %K Genome-Wide Association Study %K Humans %K Hypertension %K Male %K Membrane Proteins %K Mice %K Multifactorial Inheritance %K Polymorphism, Single Nucleotide %X

Hypertension is a leading cause of global disease, mortality, and disability. While individuals of African descent suffer a disproportionate burden of hypertension and its complications, they have been underrepresented in genetic studies. To identify novel susceptibility loci for blood pressure and hypertension in people of African ancestry, we performed both single and multiple-trait genome-wide association analyses. We analyzed 21 genome-wide association studies comprised of 31,968 individuals of African ancestry, and validated our results with additional 54,395 individuals from multi-ethnic studies. These analyses identified nine loci with eleven independent variants which reached genome-wide significance (P < 1.25×10-8) for either systolic and diastolic blood pressure, hypertension, or for combined traits. Single-trait analyses identified two loci (TARID/TCF21 and LLPH/TMBIM4) and multiple-trait analyses identified one novel locus (FRMD3) for blood pressure. At these three loci, as well as at GRP20/CDH17, associated variants had alleles common only in African-ancestry populations. Functional annotation showed enrichment for genes expressed in immune and kidney cells, as well as in heart and vascular cells/tissues. Experiments driven by these findings and using angiotensin-II induced hypertension in mice showed altered kidney mRNA expression of six genes, suggesting their potential role in hypertension. Our study provides new evidence for genes related to hypertension susceptibility, and the need to study African-ancestry populations in order to identify biologic factors contributing to hypertension.

%B PLoS Genetics %V 13 %P e1006728 %G eng %N 5 %R 10.1371/journal.pgen.1006728 %0 Journal Article %J J Aging Health %D 2017 %T Social Activities, Incident Cardiovascular Disease, and Mortality. %A Sae Hwang Han %A Jane Tavares %A Evans, Molly %A Jane S Saczynski %A Jeffrey A Burr %K Aged %K Aged, 80 and over %K Cardiovascular Diseases %K Female %K Humans %K Incidence %K Leisure activities %K Logistic Models %K Male %K Middle Aged %K Retirement %K United States %X

OBJECTIVE: This study examined the relationships between social activities, incident cardiovascular disease (CVD), and non-CVD mortality among older adults in the United States.

METHOD: Data from the Health and Retirement Study (2006-2010) were employed. Two measures of social engagement, volunteering and informal helping, along with two measures of social participation, attendance at religious services and social group meetings, were included. Mediation models for health behaviors were estimated.

RESULTS: Multinomial logistic regression models demonstrated that volunteering provided the most consistent results in terms of a lower risk of incident CVD and mortality. Furthermore, volunteering at higher time commitments is related to lower CVD incidence and death; informally helping others at a modest time commitment is related to lower risk of death only. Health behaviors mediated the relationships. Social participation was not related to either CVD or mortality.

DISCUSSION: Social activity is a modifiable behavior that may be considered a potential health intervention.

%B J Aging Health %V 29 %P 268-288 %8 2017 Mar %G eng %U http://jah.sagepub.com/content/early/2016/03/03/0898264316635565.abstract %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/26944804?dopt=Abstract %4 volunteering/heart disease/informal help/social groups/smoking/physical activity %$ 999999 %R 10.1177/0898264316635565 %0 Journal Article %J Journal of the American Society of Nephrology %D 2017 %T SOS2 and ACP1 Loci Identified through Large-Scale Exome Chip Analysis Regulate Kidney Development and Function. %A Li, Man %A Li, Yong %A Weeks, Olivia %A Mijatovic, Vladan %A Teumer, Alexander %A Huffman, Jennifer E %A Tromp, Gerard %A Fuchsberger, Christian %A Gorski, Mathias %A Lyytikäinen, Leo-Pekka %A Nutile, Teresa %A Sedaghat, Sanaz %A Sorice, Rossella %A Tin, Adrienne %A Yang, Qiong %A Ahluwalia, Tarunveer S %A Dan E Arking %A Bihlmeyer, Nathan A %A Böger, Carsten A %A Carroll, Robert J %A Daniel I Chasman %A Marilyn C Cornelis %A Dehghan, Abbas %A Jessica Faul %A Feitosa, Mary F %A Gambaro, Giovanni %A Paolo P. Gasparini %A Giulianini, Franco %A Iris M Heid %A Huang, Jinyan %A Imboden, Medea %A Jackson, Anne U %A Janina Jeff %A Jhun, Min A %A Katz, Ronit %A Kifley, Annette %A Kilpeläinen, Tuomas O %A Kumar, Ashish %A Laakso, Markku %A Li-Gao, Ruifang %A Kurt Lohman %A Lu, Yingchang %A Mägi, Reedik %A Malerba, Giovanni %A Mihailov, Evelin %A Mohlke, Karen L %A Dennis O Mook-Kanamori %A Robino, Antonietta %A Ruderfer, Douglas %A Salvi, Erika %A Schick, Ursula M %A Schulz, Christina-Alexandra %A Smith, Albert V %A Smith, Jennifer A %A Traglia, Michela %A Laura M Yerges-Armstrong %A Zhao, Wei %A Goodarzi, Mark O %A Kraja, Aldi T %A Liu, Chunyu %A Wessel, Jennifer %A Boerwinkle, Eric %A Ingrid B Borecki %A Bork-Jensen, Jette %A Erwin P Bottinger %A Braga, Daniele %A Brandslund, Ivan %A Brody, Jennifer A %A Campbell, Archie %A Carey, David J %A Cramer Christensen %A Coresh, Josef %A Crook, Errol %A Curhan, Gary C %A Cusi, Daniele %A de Boer, Ian H %A de Vries, Aiko P J %A Denny, Joshua C %A Devuyst, Olivier %A Dreisbach, Albert W %A Endlich, Karlhans %A Tõnu Esko %A Franco, Oscar H %A Fulop, Tibor %A Gerhard, Glenn S %A Glümer, Charlotte %A Gottesman, Omri %A Grarup, Niels %A Gudnason, Vilmundur %A Hansen, Torben %A Tamara B Harris %A Caroline Hayward %A Lynne J Hocking %A Hofman, Albert %A Hu, Frank B %A Husemoen, Lise Lotte N %A Jackson, Rebecca D %A Jørgensen, Torben %A Jørgensen, Marit E %A Kähönen, Mika %A Sharon L R Kardia %A König, Wolfgang %A Charles Kooperberg %A Kriebel, Jennifer %A Lenore J Launer %A Lauritzen, Torsten %A Lehtimäki, Terho %A Levy, Daniel %A Linksted, Pamela %A Linneberg, Allan %A Liu, Yongmei %A Ruth J F Loos %A Lupo, Antonio %A Meisinger, Christine %A Melander, Olle %A Andres Metspalu %A Mitchell, Paul %A Nauck, Matthias %A Nürnberg, Peter %A Orho-Melander, Marju %A Parsa, Afshin %A Pedersen, Oluf %A Peters, Annette %A Peters, Ulrike %A Polasek, Ozren %A David J Porteous %A Nicole M Probst-Hensch %A Psaty, Bruce M %A Qi, Lu %A Olli T Raitakari %A Reiner, Alex P %A Rettig, Rainer %A Ridker, Paul M %A Fernando Rivadeneira %A Rossouw, Jacques E %A Schmidt, Frank %A David S Siscovick %A Soranzo, Nicole %A Strauch, Konstantin %A Toniolo, Daniela %A Stephen T Turner %A André G Uitterlinden %A Ulivi, Sheila %A Velayutham, Dinesh %A Völker, Uwe %A Völzke, Henry %A Waldenberger, Melanie %A Wang, Jie Jin %A David R Weir %A Daniel Witte %A Kuivaniemi, Helena %A Caroline S Fox %A Franceschini, Nora %A Goessling, Wolfram %A Köttgen, Anna %A Chu, Audrey Y %K Animals %K Exome %K Genetic Loci %K Genome-Wide Association Study %K Glomerular Filtration Rate %K Humans %K kidney %K Protein Tyrosine Phosphatases %K Proto-Oncogene Proteins %K Son of Sevenless Proteins %K Zebrafish %X

Genome-wide association studies have identified >50 common variants associated with kidney function, but these variants do not fully explain the variation in eGFR. We performed a two-stage meta-analysis of associations between genotypes from the Illumina exome array and eGFR on the basis of serum creatinine (eGFRcrea) among participants of European ancestry from the CKDGen Consortium (: 111,666; : 48,343). In single-variant analyses, we identified single nucleotide polymorphisms at seven new loci associated with eGFRcrea (, , and ; <3.7×10), of which most were common and annotated as nonsynonymous variants. Gene-based analysis identified associations of functional rare variants in three genes with eGFRcrea, including a novel association with the SOS Ras/Rho guanine nucleotide exchange factor 2 gene, (=5.4×10 by sequence kernel association test). Experimental follow-up in zebrafish embryos revealed changes in glomerular gene expression and renal tubule morphology in the embryonic kidney of and -knockdowns. These developmental abnormalities associated with altered blood clearance rate and heightened prevalence of edema. This study expands the number of loci associated with kidney function and identifies novel genes with potential roles in kidney formation.

%B Journal of the American Society of Nephrology %V 28 %P 981-994 %G eng %N 3 %R 10.1681/ASN.2016020131 %0 Journal Article %J Psychology & Health %D 2017 %T Subjective age and sleep in middle-aged and older adults. %A Yannick Stephan %A Angelina R Sutin %A Bayard, Sophie %A Antonio Terracciano %K Anxiety %K Depressive symptoms %K Sleep %X

OBJECTIVE: Chronological age is commonly used to explain change in sleep. The present study examines whether subjective age is associated with change in sleep difficulties across middle adulthood and old age.

DESIGN: Participants were drawn from the second (2004-2005) and third (2013-2014) waves of the Midlife in the United States Survey (MIDUS, N = 2350; Mean Age: 55.54 years), the 2008 and 2014 waves of the Health and Retirement Study (HRS, N = 4066; Mean Age: 67.59 years) and the first (2011) and fourth (2014) waves of the National Health and Aging Trends Survey (NHATS, N = 3541; Mean Age: 76.46). In each sample, subjective age, sleep difficulties, depressive symptoms, anxiety and chronic conditions were assessed at baseline. Sleep difficulties was assessed again at follow-up.

MAIN OUTCOME MEASURES: Sleep difficulties.

RESULTS: An older subjective age at baseline was related to an increase in sleep difficulties over time in the three samples, and was mediated, in part, through more depressive symptoms, anxiety and chronic conditions. Feeling older was associated with an increased likelihood of major sleeping difficulties at follow-up in the three samples.

CONCLUSION: Subjective age is a salient marker of individuals' at risk for poor sleep quality, beyond chronological age.

%B Psychology & Health %V 32 %P 1140-1151 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/28480746?dopt=Abstract %R 10.1080/08870446.2017.1324971 %0 Newspaper Article %B The Wall Street Journal %D 2017 %T Is There Really a Retirement-Savings Crisis? %A Anne Tergesen %K News %K Retirement Planning and Satisfaction %B The Wall Street Journal %C New York City %8 04/24/2017 %G eng %U https://www.wsj.com/articles/is-there-really-a-retirement-savings-crisis-1492999861 %& Life %0 Web Page %D 2017 %T University Study Finds That Blacks Are More Likely Than Whites to Be Bullied at Work %A The Journal of Black in Higher Education %K Gender Differences %K News %K Racial/ethnic differences %I Journal of Blacks in Higher Education (Online) %C New York City, NY %G eng %U https://www.jbhe.com/2017/04/university-study-finds-that-blacks-are-more-likely-than-whites-to-be-bullied-at-work/ %0 Journal Article %J Medical Care %D 2017 %T Using self-reports or claims to assess disease prevalence: It's complicated. %A Patricia A St Clair %A Gaudette, Étienne %A Zhao, Henu %A Tysinger, Bryan %A Seyedin, Roxanna %A Dana P Goldman %K Medicare linkage %K Medicare/Medicaid/Health Insurance %K Survey Methodology %X

BACKGROUND: Two common ways of measuring disease prevalence include (1) using self-reported disease diagnosis from survey responses; (2) using disease-specific diagnosis codes found in administrative data. Because they do not suffer from self-report biases, claims are often assumed to be more objective. However, it is not clear that claims always produce better prevalence estimates.

OBJECTIVE: Conduct an assessment of discrepancies between self-report and claims-based measures for 2 diseases in the US elderly to investigate definition, selection, and measurement error issues which may help explain divergence between claims and self-report estimates of prevalence.

DATA: Self-reported data from 3 sources are included: the Health and Retirement Study, the Medicare Current Beneficiary Survey, and the National Health and Nutrition Examination Survey. Claims-based disease measurements are provided from Medicare claims linked to Health and Retirement Study and Medicare Current Beneficiary Survey participants, comprehensive claims data from a 20% random sample of Medicare enrollees, and private health insurance claims from Humana Inc.

METHODS: Prevalence of diagnosed disease in the US elderly are computed and compared across sources. Two medical conditions are considered: diabetes and heart attack.

RESULTS: Comparisons of diagnosed diabetes and heart attack prevalence show similar trends by source, but claims differ from self-reports with regard to levels. Selection into insurance plans, disease definitions, and the reference period used by algorithms are identified as sources contributing to differences.

CONCLUSIONS: Claims and self-reports both have strengths and weaknesses, which researchers need to consider when interpreting estimates of prevalence from these 2 sources.

%B Medical Care %V 55 %P 782-788 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/28617703?dopt=Abstract %R 10.1097/MLR.0000000000000753 %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 The American Journal of Geriatric Psychiatry %D 2017 %T When did old age stop being depressing? Depression trajectories of older Americans and Britons 2002–2012 %A Tampubolon, Gindo %A Maharani, Asri %K Cross-National %K Depressive symptoms %X Objective: This study aims to investigate the implications of the heterogeneous cohort composition on depression trajectories of older adults in the United States and England. Methods: Using growth curve models to identify depressive symptom trajectories and data spanning six waves over 10 years (2002-2012) from the U.S. Health Retirement Study and the English Longitudinal Study of Ageing, community-dwelling Americans and Britons aged 50 years and older were studied. Depressive symptoms were measured using the eight-item Center for Epidemiologic Studies Depression Scale. Results: The sample included 11,919 respondents (7,095 women [59.53%]) in the United States and 10,606 respondents (5,802 women [54.7%]) in England aged 50 and older. Older cohorts were shown to have higher depressive symptoms than younger cohorts in the United States and England. The trajectories of depression of older cohorts, particularly those of the prewar cohorts in both countries and the war cohort in England, followed a U-shape. Conversely, the trajectories of depression of the younger cohort, particularly those of the postwar cohorts in both countries and the war cohort in the United States, took an inverted U-shape. Conclusion: The trajectories of depression in later life between cohorts took different shapes. This finding may lead to the development of more cost-effective policies for treating depression in later life. %B The American Journal of Geriatric Psychiatry %V 25 %P 1187-1195 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S1064748117303500http://api.elsevier.com/content/article/PII:S1064748117303500?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1064748117303500?httpAccept=text/plain %N 11 %! The American Journal of Geriatric Psychiatry %R 10.1016/j.jagp.2017.06.006 %0 Journal Article %J Social Science Research %D 2017 %T Workplace bullying, perceived job stressors, and psychological distress: Gender and race differences in the stress process. %A Brandon K. Attell %A Kummerow Brown, Kiersten %A Linda A Treiber %K Depressive symptoms %K Gender Differences %K Racial/ethnic differences %K Stress %X A large body of empirical research documents the adverse mental health consequences of workplace bullying. However, less is known about gender and race differences in the processes that link workplace bullying and poor mental health. In the current study, we use structural equation modeling of survey data from the 2010 Health and Retirement Study (N = 2292) and draw on stress process theory to examine coworker support as a buffering mechanism against workplace bullying, and gender and race differences in the relationships between bullying and psychological distress. The results of the analysis indicate that coworker support serves as a protective buffer against workplace bullying, although the buffering effect is relatively small. We also find that the effects of workplace bullying more heavily impact women and persons of color. Specifically, women and African American individuals in our sample were less protected from the buffering mechanism of co-worker social support. %B Social Science Research %V 65 %P 210-221 %8 07/2017 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28599773?dopt=Abstract %R 10.1016/j.ssresearch.2017.02.001 %0 Journal Article %J Social Science Research %D 2017 %T Workplace bullying, perceived job stressors, and psychological distress: Gender and race differences in the stress process %A Brandon K. Attell %A Kummerow Brown, Kiersten %A Linda A Treiber %K Employment and Labor Force %K Gender Differences %K Job stressors %K Racial/ethnic differences %K Women and Minorities %X A large body of empirical research documents the adverse mental health consequences of workplace bullying. However, less is known about gender and race differences in the processes that link workplace bullying and poor mental health. In the current study, we use structural equation modeling of survey data from the 2010 Health and Retirement Study (N = 2292) and draw on stress process theory to examine coworker support as a buffering mechanism against workplace bullying, and gender and race differences in the relationships between bullying and psychological distress. The results of the analysis indicate that coworker support serves as a protective buffer against workplace bullying, although the buffering effect is relatively small. We also find that the effects of workplace bullying more heavily impact women and persons of color. Specifically, women and African American individuals in our sample were less protected from the buffering mechanism of co-worker social support. %B Social Science Research %V 65 %P 210-221 %G eng %U https://www.sciencedirect.com/science/article/pii/S0049089X16305087 %! Social Science Research %R 10.1016/j.ssresearch.2017.02.001 %0 Report %D 2016 %T The Affordable Care Act as Retiree Health Insurance: Implications for Retirement and Social Security Claiming %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Affordable Care Act %K Health Insurance %K Older Adults %K Retirement Planning and Satisfaction %K Social Security %X Using data from the Health and Retirement Study, we examine the effects of the Affordable Care Act (ACA) on retirement. We first calculate retirements (and in related analyses changes in expected ages of retirement and/or Social Security claiming) between 2010, before ACA, and 2014, after ACA, for those with health insurance at work but not in retirement. This group experienced the sharpest change in retirement incentives from ACA. We then compare retirement measures for those with health insurance at work but not in retirement with retirement measures for two other groups, those who, before ACA, had employer provided health insurance both at work and in retirement, and those who had no health insurance either at work or in retirement. To complete a difference-in-difference analysis, we make the same calculations for members of an older cohort over the same age span. We find no evidence that ACA increases the propensity to retire or changes the retirement expectations of those who, before ACA, had coverage when working but not when retired. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %P 1-55 %8 11/2016 %G eng %U http://www.nber.org/papers/w22815.pdf %R 10.3386/w22815 %0 Journal Article %J J Aging Health %D 2016 %T Age Differences in the Association Between Body Mass Index Class and Annualized Medicare Expenditures. %A Daniel O. Clark %A Kathleen A Lane %A Ambuehl, Roberta %A Tu, Wanzhu %A Chiung-Ju Liu %A Kathleen T. Unroe %A Christopher M. Callahan %K Age Factors %K Aged %K Body Mass Index %K Female %K Health Expenditures %K Humans %K Male %K Medicare %K Obesity %K United States %X

OBJECTIVE: The aim of the study is to assess the relationship between body mass index (BMI) class and Medicare claims among young-old (65-69), old (70-74), and old-old (75+) adults over a 10-year period.

METHOD: We assessed costs by BMI class and age group among 9,300 respondents to the 1998 Health and Retirement Study (HRS) with linked 1998-2008 Medicare claims data. BMI was classified as normal (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), or severe obesity (35 or above).

RESULTS: Annualized total Medicare claims adjusted for age, gender, ethnicity, education, and smoking history were 109% greater for severely obese young-old adults in comparison with normal weight young-old adults (US$9,751 vs. US$4,663). Total annualized claim differences between the normal weight and severely obese in the old and old-old groups were not statistically significant.

DISCUSSION: Excess Medicare expenditures related to obesity may be concentrated among severely obese young-old adults. Preventing severe obesity among middle and older aged adults may have large cost implications for society.

%B J Aging Health %I 28 %V 28 %P 165-79 %8 2016 Feb %G eng %U http://jah.sagepub.com/content/28/1/165 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26112066?dopt=Abstract %2 PMC4691214 %R 10.1177/0898264315589574 %0 Journal Article %J Psychosom Med %D 2016 %T Allostatic Load and Personality: A 4-Year Longitudinal Study. %A Yannick Stephan %A Angelina R Sutin %A Martina Luchetti %A Antonio Terracciano %K Aged %K Aged, 80 and over %K Aging %K Allostasis %K Anxiety Disorders %K Biomarkers %K Conscience %K Extraversion, Psychological %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Neuroticism %K Personality %X

OBJECTIVE: Dysregulation across multiple physiological systems, referred to as allostatic load, has pervasive consequences for an individual's health. The present study examined whether allostatic load is associated with personality and personality changes during a 4-year follow-up.

METHODS: A total of 5200 participants aged from 50 to 99 years (59.5% women, mean [standard deviation] age = 66.91 [8.88] years) from the Health and Retirement Study provided data on cardiovascular, metabolic, and immune markers at baseline and personality both at baseline and at 4 years later.

RESULTS: Higher allostatic load was related to higher neuroticism (β = 0.03, p = .042), lower extraversion (β = -0.06, p < .001), and lower conscientiousness (β = -0.06, p < .001) at baseline, and to declines in extraversion (β = -0.03, p = .007), conscientiousness (β = -0.04, p < .001), and agreeableness (β = -0.02, p = .020) over the 4-year period, controlling for demographic covariates. A significant quadratic relation between allostatic load and changes in openness (β = -0.03, p = .002) suggested that openness declines when individuals exceed a high level of cumulative physiological dysregulation. No association was found with changes in neuroticism.

CONCLUSIONS: Allostatic load is associated with personality change across adulthood and old age. The findings indicate that physiological dysregulation across multiple systems challenges personality stability and is associated with accelerated personality traits change.

%B Psychosom Med %I 78 %V 78 %P 302-10 %8 2016 04 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/26716813 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/26716813?dopt=Abstract %R 10.1097/PSY.0000000000000281 %0 Journal Article %J Epidemiology %D 2016 %T Comparing Alternative Effect Decomposition Methods: The Role of Literacy in Mediating Educational Effects on Mortality. %A Thu T Nguyen %A Eric J. Tchetgen Tchetgen %A Ichiro Kawachi %A Stephen E. Gilman %A Stefan Walter %A M. Maria Glymour %K Aged %K Aged, 80 and over %K Educational Status %K Female %K Humans %K Literacy %K Longitudinal Studies %K Male %K Middle Aged %K Mortality %K Odds Ratio %K Proportional Hazards Models %K United States %X

BACKGROUND: Inverse odds ratio weighting, a newly proposed tool to evaluate mediation in exposure-disease associations, may be valuable for a host of research questions, but little is known about its performance in real data. We compare this approach to a more conventional Baron and Kenny type of decomposition on an additive hazards scale to estimate total, direct, and indirect effects using the example of the role of literacy in mediating the effects of education on mortality.

METHODS: Health and Retirement Study participants born in the United States between 1900 and 1947 were interviewed biennially for up to 12 years (N = 17,054). Literacy was measured with a brief vocabulary assessment. Decomposition estimates were derived based on Aalen additive hazards models.

RESULTS: A 1 standard deviation difference in educational attainment (3 years) was associated with 6.7 fewer deaths per 1000 person-years (β = -6.7, 95% confidence interval [CI]: -7.9, -5.4). Of this decrease, 1.3 fewer deaths (β = -1.3, 95% CI: -4.0, 1.2) were attributed to the literacy pathway (natural indirect), representing 19% of the total effect. Baron and Kenny estimates were consistent with inverse odds ratio weighting estimates but were less variable (natural indirect effect: -1.2 [95% CI: -1.7, -0.69], representing 18% of total effect).

CONCLUSION: In a cohort of older Americans, literacy partially mediated the effect of education on mortality. See Video Abstract at http://links.lww.com/EDE/B78.

%B Epidemiology %V 27 %P 670-6 %8 2016 09 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27280331 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27280331?dopt=Abstract %R 10.1097/EDE.0000000000000517 %0 Journal Article %J Lancet Diabetes Endocrinol %D 2016 %T Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis. %A Barbara H. Bardenheier %A Ji Lin %A Zhuo, Xiaohui %A Mohammed K. Ali %A Theodore J Thompson %A Yiling J. Cheng %A Edward W Gregg %K Activities of Daily Living %K Aged %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K United States %X

BACKGROUND: The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years.

METHODS: In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years.

FINDINGS: In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0·8-2·3 year delay in disability across the three metrics (mobility, 63·0 [95% CI 62·3-63·6] to 64·8 [63·6-65·7], p=0·01; instrumental activities of daily living, 63·5 [63·0-64·0] to 64·3 [63·0-65·3], p=0·24; activities of daily living, 62·7 [62·1-63·3] to 65·0 [63·5-65·9], p<0·0001) and 1·3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2·8 [2·5-3·2] to 1·5 [1·3-1·9]; p<0·0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1·1-2·3 year delay in disability across the three metrics (mobility, 61·3 [95% CI 60·5-62·1] to 63·2 [61·5-64·5], p=0·0416; instrumental activities of daily living, 63·0 [62·4-63·7] to 64·1 [62·7-65·2], p=0·16; activities of daily living, 62·3 [61·6-63·0] to 64·6 [63·1-65·6], p<0·0001) and 0·8 fewer life-years lost by age 70 years (1·9 [1·7-2·2] to 1·1 [0·9-1·5]; p<0·0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0·0001 for all comparisons).

INTERPRETATION: Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years.

FUNDING: US Department of Health & Human Services and the US Centers for Disease Control and Prevention.

%B Lancet Diabetes Endocrinol %V 4 %P 686-694 %8 2016 08 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27298181 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27298181?dopt=Abstract %R 10.1016/S2213-8587(16)30090-0 %0 Report %D 2016 %T Distributional Effects of Means Testing Social Security: An Exploratory Analysis %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Net Worth and Assets %K Public Policy %K Social Security %X This paper examines the distributional implications of introducing additional means testing of Social Security benefits where proceeds are used to help balance Social Security's finances. Benefits of the top quarter of households ranked according to the relevant measure of means are reduced using a modified version of the Social Security Windfall Elimination Provision (WEP). The replacement rate in the first bracket of the benefit formula, determining the Primary Insurance Amount (PIA), would be reduced from 90 percent to 40 percent of Average Indexed Monthly Earnings (AIME). Four measures of means are considered: total wealth; an annualized measure of AIME; the wealth value of pensions; and a measure of average indexed lifetime W2 earnings. The empirical analysis is based on data from the Health and Retirement Study. These means tests would reduce total lifetime household benefits by 7 to 9 percentage points. We find that the basis for means testing Social Security makes a substantial difference as to which households have their benefits reduced, and that different means tests may have different effects on the benefits of families in similar circumstance. We also find that the measure of means used to evaluate the effects of a means test makes a considerable difference as to how one would view the effects of the means test on the distribution of benefits. %B NBER Working Paper Series %I Cambridge, MA, National Bureau of Economic Research %P 1-28 %G eng %4 social Security/Public Policy/means testing/wealth/pension wealth %$ 999999 %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 Thesis %B Biobehavioral Health %D 2016 %T Examining Biobehavioral Mechanisms of Physical Disability Disparities in US Midlife and Older Adults. %A Amy D Thierry %K Chronic stress %K Disabilities %K Telomeres %X US population projections estimate that the number of adults over the age of 65 will double by 2050. In addition, chronic conditions and associated physical disability are increasing, particularly among racial/ethnic minorities. Although the role of psychosocial factors has been acknowledged in promoting development of physical disability, there is a dearth of research examining if chronic stress contributes to disparities. Therefore, three studies examined chronic stress-associated biobehavioral mechanisms that may explain higher rates of disability in black and Mexican American midlife and older adults compared to whites. Data used in these studies were drawn from the Health and Retirement Study (HRS), a longitudinal survey of a nationally representative sample of US adults over the age of 50. Using data from the 2006 HRS wave of data collection, the first study examined differences in prevalence of eight chronic stressors by race/ethnicity and gender. Then, the relationship between number of chronic stressors and number of physical disabilities, measured as difficulty with functional limitations, activities of daily living (ADLs), and instrumental activities of daily living (IADLs), was tested. Differences in the chronic stress-disability relationship were assessed by race/ethnicity and gender. Because unhealthy behaviors may be used as mechanisms to cope with stress, a second study using 2006 HRS data tested if unhealthy behavior-related risk factors—including currently smoking, heavy drinking, and being obese—moderated the relationship between chronic stress and physical disability. The contribution of unhealthy behaviors to racial/ethnic and gender disparities in physical disability outcomes, net of age, SES, and health status, was also assessed. Lastly, a third study assessed if telomere length, a biomarker of cellular age that may shorten from exposure to stress, may be implicated in physical disability development. This study tested the relationship between telomere length measured in 2008 and change in number of physical disabilities across a 6-year study period. Analytic results demonstrated that, on average, blacks and Mexican Americans reported more chronic stressors than whites. Overall, chronic stress was positively associated with physical disability. The gap in number of ADLs and IADLs between blacks and whites widened with increasing numbers of chronic stressors, while the number of these disabilities in Mexican Americans was less dependent upon chronic stress. Unhealthy behavioral risk factors moderated the chronic stress-disability relationship for ADLs and IADLs, such that increasing disability and number of chronic stressors were more pronounced in individuals with one or more unhealthy behavioral risks. Lastly, individuals with longer telomeres accumulated fewer disabilities over time. However, this relationship was found only in adults over 65, and did not depend on race/ethnicity or gender. Results from these three studies suggest that chronic stress may differentially increase risk for physical disability in blacks, and unhealthy behavioral risks may exacerbate disability development. Finally, telomere length may be involved in the disablement process such that shorter telomeres may promote the development of disability over time. %B Biobehavioral Health %I Pennsylvania State University %C Happy Valley, PA %V Ph.D. %8 06/2016 %G eng %U https://etda.libraries.psu.edu/catalog/bg257f05g %9 Dissertation %0 Journal Article %J J Palliat Med %D 2016 %T Factors Associated with Family Reports of Pain, Dyspnea, and Depression in the Last Year of Life. %A Adam E Singer %A Meeker, Daniella %A Joan M Teno %A Lynn, Joanne %A June R Lunney %A Karl A Lorenz %X

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

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

DESIGN: Retrospective cohort study.

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

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

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

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

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

%B J Palliat Med %V 19 %P 1066-1073 %8 2016 Oct %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27454900 %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/27454900?dopt=Abstract %R 10.1089/jpm.2015.0391 %0 Journal Article %J Health Psychology %D 2016 %T Feeling older and risk of hospitalization: Evidence from three longitudinal cohorts %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Health Conditions and Status %K Healthcare %K Risk Taking %X Objective: Subjective age is a biopsychosocial marker of aging with a range of health-related implications. Using 3 longitudinal samples, this study examined whether subjective age predicts hospitalization among older adults. Method: Participants were adults aged from 24 to 102 years old, drawn from the 1995 1996 and 2004 2005 waves of the Midlife in the United States Survey (MIDUS, N = 3209), the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 3779), and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 3418). In each sample, subjective age and covariates were assessed at baseline and hospitalization was assessed at follow-up. Results: Consistent across the 3 samples, participants who felt subjectively older at baseline had an increased likelihood of hospitalization (combined effect size: 1.17, 95 CI 1.11 1.23), controlling for age, sex, race, and education. Further adjusting for disease burden and depression reduced the magnitude of the association between subjective age and hospitalization in the 3 samples, but it remained significant in the MIDUS and HRS. Conclusion: This study provides consistent evidence that subjective age predicts incident hospitalization. Subjective age assessment can help identify individuals at greater risk of hospitalization, who may benefit from prevention and intervention efforts. (PsycINFO Database Record (c) 2016 APA, all rights reserved) %B Health Psychology %I 35 %V 35 %P 634-637 %G eng %N 6 %4 Aging/Hospitalization/Major Depression/Risk Factors/Subjectivity/Symptoms %$ 999999 %R 10.1037/hea0000335 %0 Newspaper Article %B The Wall Street Journal %D 2016 %T Five Myths About Landing a Good Job Later in Life %A Anne Tergesen %K Job loss %K Jobs %K Older Adults %X The conventional wisdom says it’s impossible. The facts say otherwise. %B The Wall Street Journal %C New York City %8 11/29/2016 %G eng %U http://www.wsj.com/articles/five-myths-about-landing-a-good-job-later-in-life-1480302842 %0 Journal Article %J Nat Commun %D 2016 %T Genetic associations at 53 loci highlight cell types and biological pathways relevant for kidney function. %A Pattaro, Cristian %A Teumer, Alexander %A Gorski, Mathias %A Chu, Audrey Y %A Li, Man %A Mijatovic, Vladan %A Garnaas, Maija %A Tin, Adrienne %A Sorice, Rossella %A Yong Li %A Taliun, Daniel %A Olden, Matthias %A Foster, Meredith %A Qiong Yang %A Chen, Ming-Huei %A Pers, Tune H %A Andrew D Johnson %A Ko, Yi-An %A Fuchsberger, Christian %A Bamidele O Tayo %A Michael A Nalls %A Feitosa, Mary F %A Isaacs, Aaron %A Dehghan, Abbas %A d'Adamo, Pio %A Adebawole Adeyemo %A Dieffenbach, Aida Karina %A Alan B Zonderman %A Ilja M Nolte %A van der Most, Peter J %A Alan F Wright %A Alan R Shuldiner %A Alanna C Morrison %A Hofman, Albert %A Albert Vernon Smith %A Dreisbach, Albert W %A Franke, Andre %A André G Uitterlinden %A Andres Metspalu %A Tönjes, Anke %A Lupo, Antonio %A Robino, Antonietta %A Johansson, Åsa %A Demirkan, Ayse %A Kollerits, Barbara %A Freedman, Barry I %A Ponte, Belen %A Ben A Oostra %A Paulweber, Bernhard %A Krämer, Bernhard K %A Mitchell, Braxton D %A Buckley, Brendan M %A Peralta, Carmen A %A Caroline Hayward %A Helmer, Catherine %A Charles N Rotimi %A Shaffer, Christian M %A Müller, Christian %A Cinzia Felicita Sala %A Cornelia M van Duijn %A Saint-Pierre, Aude %A Daniel Ackermann %A Daniel Shriner %A Ruggiero, Daniela %A Toniolo, Daniela %A Lu, Yingchang %A Cusi, Daniele %A Czamara, Darina %A Ellinghaus, David %A David S Siscovick %A Ruderfer, Douglas %A Gieger, Christian %A Grallert, Harald %A Rochtchina, Elena %A Atkinson, Elizabeth J %A Holliday, Elizabeth G %A Boerwinkle, Eric %A Salvi, Erika %A Erwin P Bottinger %A Murgia, Federico %A Fernando Rivadeneira %A Ernst, Florian %A Kronenberg, Florian %A Hu, Frank B %A Navis, Gerjan J %A Curhan, Gary C %A Georg B Ehret %A Homuth, Georg %A Coassin, Stefan %A Thun, Gian-Andri %A Pistis, Giorgio %A Gambaro, Giovanni %A Malerba, Giovanni %A Grant W Montgomery %A Guðny Eiríksdóttir %A Jacobs, Gunnar %A Guo Li %A Wichmann, H-Erich %A Campbell, Harry %A Schmidt, Helena %A Wallaschofski, Henri %A Völzke, Henry %A Brenner, Hermann %A Kroemer, Heyo K %A Kramer, Holly %A Lin, Honghuang %A Irene Mateo Leach %A Ford, Ian %A Guessous, Idris %A Rudan, Igor %A Prokopenko, Inga %A Ingrid B Borecki %A Iris M Heid %A Kolcic, Ivana %A Persico, Ivana %A Jukema, J Wouter %A James F Wilson %A Felix, Janine F %A Divers, Jasmin %A Lambert, Jean-Charles %A Stafford, Jeanette M %A Gaspoz, Jean-Michel %A Jennifer A Smith %A Jessica Faul %A Wang, Jie Jin %A Ding, Jingzhong %A Joel N Hirschhron %A John R. Attia %A Whitfield, John B %A Chalmers, John %A Viikari, Jorma %A Coresh, Josef %A Denny, Joshua C %A Karjalainen, Juha %A Fernandes, Jyotika K %A Endlich, Karlhans %A Butterbach, Katja %A Keene, Keith L %A Kurt Lohman %A Portas, Laura %A Lenore J Launer %A Lyytikäinen, Leo-Pekka %A Yengo, Loic %A Lude L Franke %A Luigi Ferrucci %A Rose, Lynda M %A Kedenko, Lyudmyla %A Rao, Madhumathi %A Struchalin, Maksim %A Kleber, Marcus E %A Cavalieri, Margherita %A Haun, Margot %A Marilyn C Cornelis %A Ciullo, Marina %A Pirastu, Mario %A de Andrade, Mariza %A McEvoy, Mark A %A Woodward, Mark %A Adam, Martin %A Cocca, Massimiliano %A Nauck, Matthias %A Imboden, Medea %A Waldenberger, Melanie %A Pruijm, Menno %A Metzger, Marie %A Stumvoll, Michael %A Michele K Evans %A Sale, Michele M %A Kähönen, Mika %A Boban, Mladen %A Bochud, Murielle %A Rheinberger, Myriam %A Verweij, Niek %A Bouatia-Naji, Nabila %A Nicholas G Martin %A Nicholas D Hastie %A Nicole M Probst-Hensch %A Soranzo, Nicole %A Devuyst, Olivier %A Olli T Raitakari %A Gottesman, Omri %A Franco, Oscar H %A Polasek, Ozren %A Paolo P. Gasparini %A Munroe, Patricia B %A Ridker, Paul M %A Mitchell, Paul %A Muntner, Paul %A Meisinger, Christa %A Johannes H Smit %A Kovacs, Peter %A Wild, Philipp S %A Froguel, Philippe %A Rettig, Rainer %A Mägi, Reedik %A Biffar, Reiner %A Schmidt, Reinhold %A Middelberg, Rita P S %A Carroll, Robert J %A Brenda W J H Penninx %A Rodney J Scott %A Katz, Ronit %A Sedaghat, Sanaz %A Sarah Wild %A Sharon L R Kardia %A Ulivi, Sheila %A Hwang, Shih-Jen %A Enroth, Stefan %A Kloiber, Stefan %A Trompet, Stella %A Stengel, Benedicte %A Hancock, Stephen J %A Stephen T Turner %A Rosas, Sylvia E %A Stracke, Sylvia %A Tamara B Harris %A Zeller, Tanja %A Zemunik, Tatijana %A Lehtimäki, Terho %A Illig, Thomas %A Aspelund, Thor %A Nikopensius, Tiit %A Tõnu Esko %A Toshiko Tanaka %A Gyllensten, Ulf %A Völker, Uwe %A Emilsson, Valur %A Vitart, Veronique %A Aalto, Ville %A Gudnason, Vilmundur %A Chouraki, Vincent %A Chen, Wei-Min %A Igl, Wilmar %A März, Winfried %A Koenig, Wolfgang %A Lieb, Wolfgang %A Ruth J F Loos %A Yongmei Liu %A Snieder, Harold %A Pramstaller, Peter P %A Parsa, Afshin %A Jeff O'Connell %A Susztak, Katalin %A Hamet, Pavel %A Tremblay, Johanne %A de Boer, Ian H %A Böger, Carsten A %A Goessling, Wolfram %A Daniel I Chasman %A Köttgen, Anna %A Kao, W H Linda %A Caroline S Fox %K Chronic disease %K Genome-Wide Association Study %K Genotype %K Humans %X

Reduced glomerular filtration rate defines chronic kidney disease and is associated with cardiovascular and all-cause mortality. We conducted a meta-analysis of genome-wide association studies for estimated glomerular filtration rate (eGFR), combining data across 133,413 individuals with replication in up to 42,166 individuals. We identify 24 new and confirm 29 previously identified loci. Of these 53 loci, 19 associate with eGFR among individuals with diabetes. Using bioinformatics, we show that identified genes at eGFR loci are enriched for expression in kidney tissues and in pathways relevant for kidney development and transmembrane transporter activity, kidney structure, and regulation of glucose metabolism. Chromatin state mapping and DNase I hypersensitivity analyses across adult tissues demonstrate preferential mapping of associated variants to regulatory regions in kidney but not extra-renal tissues. These findings suggest that genetic determinants of eGFR are mediated largely through direct effects within the kidney and highlight important cell types and biological pathways.

%B Nat Commun %V 7 %P 10023 %8 2016 Jan 21 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/26831199?dopt=Abstract %R 10.1038/ncomms10023 %0 Journal Article %J Nat Genet %D 2016 %T Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses. %A Okbay, Aysu %A Baselmans, Bart M L %A De Neve, Jan-Emmanuel %A Turley, Patrick %A Nivard, Michel G %A Mark Alan Fontana %A Meddens, S Fleur W %A Richard Karlsson Linnér %A Cornelius A Rietveld %A Derringer, Jaime %A Gratten, Jacob %A Lee, James J %A Liu, Jimmy Z %A de Vlaming, Ronald %A Ahluwalia, Tarunveer S %A Buchwald, Jadwiga %A Cavadino, Alana %A Frazier-Wood, Alexis C %A Furlotte, Nicholas A %A Garfield, Victoria %A Geisel, Marie Henrike %A Gonzalez, Juan R %A Haitjema, Saskia %A Karlsson, Robert %A van der Laan, Sander W %A Ladwig, Karl-Heinz %A J. Lahti %A Sven J van der Lee %A Penelope A Lind %A Tian Liu %A Lindsay K Matteson %A Mihailov, Evelin %A Michael B Miller %A Minica, Camelia C %A Ilja M Nolte %A Dennis O Mook-Kanamori %A van der Most, Peter J %A Christopher J Oldmeadow %A Qian, Yong %A Olli T Raitakari %A Rawal, Rajesh %A Realo, Anu %A Rueedi, Rico %A Schmidt, Börge %A Albert Vernon Smith %A Stergiakouli, Evie %A Toshiko Tanaka %A Kent D Taylor %A Wedenoja, Juho %A Jürgen Wellmann %A Westra, Harm-Jan %A Willems, Sara M %A Wei Zhao %A Amin, Najaf %A Bakshi, Andrew %A Patricia A. Boyle %A Cherney, Samantha %A Cox, Simon R %A Gail Davies %A Davis, Oliver S P %A Ding, Jun %A Nese Direk %A Eibich, Peter %A Emeny, Rebecca T %A Fatemifar, Ghazaleh %A Jessica Faul %A Luigi Ferrucci %A Andreas J Forstner %A Gieger, Christian %A Gupta, Richa %A Tamara B Harris %A Harris, Juliette M %A Holliday, Elizabeth G %A Jouke-Jan Hottenga %A Philip L de Jager %A Marika A Kaakinen %A Kajantie, Eero %A Karhunen, Ville %A Kolcic, Ivana %A Kumari, Meena %A Lenore J Launer %A Lude L Franke %A Li-Gao, Ruifang %A Koini, Marisa %A Loukola, Anu %A Marques-Vidal, Pedro %A Grant W Montgomery %A Mosing, Miriam A %A Paternoster, Lavinia %A Pattie, Alison %A Katja E Petrovic %A Pulkki-Raback, Laura %A Quaye, Lydia %A Katri Räikkönen %A Rudan, Igor %A Rodney J Scott %A Jennifer A Smith %A Angelina R Sutin %A Trzaskowski, Maciej %A Anna A E Vinkhuyzen %A Lei Yu %A Zabaneh, Delilah %A John R. Attia %A David A Bennett %A Klaus Berger %A Bertram, Lars %A Dorret I Boomsma %A Snieder, Harold %A Chang, Shun-Chiao %A Francesco Cucca %A Ian J Deary %A Cornelia M van Duijn %A Johan G Eriksson %A Bültmann, Ute %A Eco J. C. de Geus %A Groenen, Patrick J F %A Gudnason, Vilmundur %A Hansen, Torben %A Catharina A Hartman %A Haworth, Claire M A %A Caroline Hayward %A Andrew C Heath %A Hinds, David A %A Hyppönen, Elina %A Iacono, William G %A Järvelin, Marjo-Riitta %A Jöckel, Karl-Heinz %A Kaprio, Jaakko %A Sharon L R Kardia %A Keltikangas-Järvinen, Liisa %A Kraft, Peter %A Laura D Kubzansky %A Lehtimäki, Terho %A Patrik K E Magnusson %A Nicholas G Martin %A McGue, Matt %A Andres Metspalu %A Melinda C Mills %A de Mutsert, Renée %A Oldehinkel, Albertine J %A Pasterkamp, Gerard %A Nancy L Pedersen %A Plomin, Robert %A Polasek, Ozren %A Power, Christine %A Rich, Stephen S %A Rosendaal, Frits R %A Hester M. den Ruijter %A Schlessinger, David %A Schmidt, Helena %A Svento, Rauli %A Schmidt, Reinhold %A Alizadeh, Behrooz Z %A Thorkild I. A. Sørensen %A Timothy Spector %A Andrew Steptoe %A Antonio Terracciano %A A. Roy Thurik %A Nicholas J Timpson %A Henning Tiemeier %A André G Uitterlinden %A Vollenweider, Peter %A Wagner, Gert G %A David R Weir %A Yang, Jian %A Dalton C Conley %A Hofman, Albert %A Johannesson, Magnus %A David I Laibson %A Sarah E Medland %A Meyer, Michelle N %A Pickrell, Joseph K %A Tõnu Esko %A Krueger, Robert F %A Jonathan P. Beauchamp %A Philipp D Koellinger %A Daniel J. Benjamin %A Bartels, Meike %A Cesarini, David %K Anxiety Disorders %K Bayes Theorem %K depression %K Genome-Wide Association Study %K Humans %K Neuroticism %K Phenotype %K Polymorphism, Single Nucleotide %X

Very few genetic variants have been associated with depression and neuroticism, likely because of limitations on sample size in previous studies. Subjective well-being, a phenotype that is genetically correlated with both of these traits, has not yet been studied with genome-wide data. We conducted genome-wide association studies of three phenotypes: subjective well-being (n = 298,420), depressive symptoms (n = 161,460), and neuroticism (n = 170,911). We identify 3 variants associated with subjective well-being, 2 variants associated with depressive symptoms, and 11 variants associated with neuroticism, including 2 inversion polymorphisms. The two loci associated with depressive symptoms replicate in an independent depression sample. Joint analyses that exploit the high genetic correlations between the phenotypes (|ρ^| ≈ 0.8) strengthen the overall credibility of the findings and allow us to identify additional variants. Across our phenotypes, loci regulating expression in central nervous system and adrenal or pancreas tissues are strongly enriched for association.

%B Nat Genet %V 48 %P 624-33 %8 2016 06 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27089181?dopt=Abstract %R 10.1038/ng.3552 %0 Journal Article %J Nat Genet %D 2016 %T Genome-wide analysis identifies 12 loci influencing human reproductive behavior. %A Nicola Barban %A Jansen, Rick %A de Vlaming, Ronald %A Vaez, Ahmad %A Mandemakers, Jornt J %A Felix C Tropf %A Shen, Xia %A James F Wilson %A Daniel I Chasman %A Ilja M Nolte %A Tragante, Vinicius %A van der Laan, Sander W %A Perry, John R B %A Kong, Augustine %A Ahluwalia, Tarunveer S %A Albrecht, Eva %A Laura M Yerges-Armstrong %A Atzmon, Gil %A Auro, Kirsi %A Kristin L. Ayers %A Bakshi, Andrew %A Ben-Avraham, Danny %A Klaus Berger %A Bergman, Aviv %A Bertram, Lars %A Bielak, Lawrence F %A Bjornsdottir, Gyda %A Bonder, Marc Jan %A Broer, Linda %A Bui, Minh %A Barbieri, Caterina %A Cavadino, Alana %A Chavarro, Jorge E %A Turman, Constance %A Maria Pina Concas %A Cordell, Heather J %A Gail Davies %A Eibich, Peter %A Eriksson, Nicholas %A Tõnu Esko %A Eriksson, Joel %A Falahi, Fahimeh %A Felix, Janine F %A Mark Alan Fontana %A Lude L Franke %A Gandin, Ilaria %A Gaskins, Audrey J %A Gieger, Christian %A Gunderson, Erica P %A Guo, Xiuqing %A Caroline Hayward %A He, Chunyan %A Edith Hofer %A Huang, Hongyan %A Joshi, Peter K %A Kanoni, Stavroula %A Karlsson, Robert %A Kiechl, Stefan %A Kifley, Annette %A Kluttig, Alexander %A Kraft, Peter %A Lagou, Vasiliki %A Lecoeur, Cecile %A Lahti, Jari %A Li-Gao, Ruifang %A Penelope A Lind %A Tian Liu %A Makalic, Enes %A Mamasoula, Crysovalanto %A Lindsay K Matteson %A Mbarek, Hamdi %A McArdle, Patrick F %A McMahon, George %A Meddens, S Fleur W %A Mihailov, Evelin %A Michael B Miller %A Missmer, Stacey A %A Monnereau, Claire %A van der Most, Peter J %A Myhre, Ronny %A Michael A Nalls %A Nutile, Teresa %A Ioanna Panagiota Kalafati %A Porcu, Eleonora %A Prokopenko, Inga %A Rajan, Kumar B %A Rich-Edwards, Janet %A Cornelius A Rietveld %A Robino, Antonietta %A Rose, Lynda M %A Rueedi, Rico %A Ryan, Kathleen A %A Saba, Yasaman %A Schmidt, Daniel %A Jennifer A Smith %A Stolk, Lisette %A Streeten, Elizabeth %A Tönjes, Anke %A Thorleifsson, Gudmar %A Ulivi, Sheila %A Wedenoja, Juho %A Jürgen Wellmann %A Willeit, Peter %A Yao, Jie %A Yengo, Loic %A Jing Hua Zhao %A Wei Zhao %A Zhernakova, Daria V %A Amin, Najaf %A Andrews, Howard %A Balkau, Beverley %A Barzilai, Nir %A Bergmann, Sven %A Biino, Ginevra %A Bisgaard, Hans %A Bønnelykke, Klaus %A Dorret I Boomsma %A Buring, Julie E %A Campbell, Harry %A Cappellani, Stefania %A Ciullo, Marina %A Cox, Simon R %A Francesco Cucca %A Toniolo, Daniela %A Davey-Smith, George %A Ian J Deary %A George Dedoussis %A Deloukas, Panos %A Cornelia M van Duijn %A Eco J. C. de Geus %A Johan G Eriksson %A Jessica Faul %A Cinzia Felicita Sala %A Froguel, Philippe %A Paolo P. Gasparini %A Giorgia G Girotto %A Hans-Jörgen Grabe %A Greiser, Karin Halina %A Groenen, Patrick J F %A de Haan, Hugoline G %A Haerting, Johannes %A Tamara B Harris %A Andrew C Heath %A Heikkilä, Kauko %A Hofman, Albert %A Homuth, Georg %A Holliday, Elizabeth G %A John L Hopper %A Hyppönen, Elina %A Jacobsson, Bo %A Vincent Jaddoe %A Johannesson, Magnus %A Jugessur, Astanand %A Kähönen, Mika %A Kajantie, Eero %A Sharon L R Kardia %A Keavney, Bernard %A Kolcic, Ivana %A Koponen, Päivikki %A Kovacs, Peter %A Kronenberg, Florian %A Kutalik, Zoltán %A La Bianca, Martina %A Lachance, Genevieve %A Iacono, William G %A Lai, Sandra %A Lehtimäki, Terho %A David C Liewald %A Lindgren, Cecilia M %A Yongmei Liu %A Luben, Robert %A Lucht, Michael %A Luoto, Riitta %A Magnus, Per %A Patrik K E Magnusson %A Nicholas G Martin %A McGue, Matt %A McQuillan, Ruth %A Sarah E Medland %A Meisinger, Christa %A Mellström, Dan %A Andres Metspalu %A Traglia, Michela %A Lili Milani %A Mitchell, Paul %A Grant W Montgomery %A Dennis O Mook-Kanamori %A de Mutsert, Renée %A Nohr, Ellen A %A Ohlsson, Claes %A Olsen, Jørn %A Ong, Ken K %A Paternoster, Lavinia %A Pattie, Alison %A Brenda W J H Penninx %A Markus Perola %A Peyser, Patricia A %A Pirastu, Mario %A Polasek, Ozren %A Power, Chris %A Kaprio, Jaakko %A Raffel, Leslie J %A Katri Räikkönen %A Olli T Raitakari %A Ridker, Paul M %A Ring, Susan M %A Roll, Kathryn %A Rudan, Igor %A Ruggiero, Daniela %A Rujescu, Dan %A Veikko Salomaa %A Schlessinger, David %A Schmidt, Helena %A Schmidt, Reinhold %A Schupf, Nicole %A Johannes H Smit %A Sorice, Rossella %A Timothy Spector %A John M Starr %A Stöckl, Doris %A Strauch, Konstantin %A Stumvoll, Michael %A Swertz, Morris A %A Thorsteinsdottir, Unnur %A A. Roy Thurik %A Nicholas J Timpson %A Tung, Joyce Y %A André G Uitterlinden %A Vaccargiu, Simona %A Viikari, Jorma %A Vitart, Veronique %A Völzke, Henry %A Vollenweider, Peter %A Vuckovic, Dragana %A Waage, Johannes %A Wagner, Gert G %A Wang, Jie Jin %A Wareham, Nicholas J %A David R Weir %A Gonneke Willemsen %A Willeit, Johann %A Alan F Wright %A Krina T Zondervan %A Stefansson, Kari %A Krueger, Robert F %A Lee, James J %A Daniel J. Benjamin %A Cesarini, David %A Philipp D Koellinger %A den Hoed, Marcel %A Snieder, Harold %A Melinda C Mills %X

The genetic architecture of human reproductive behavior-age at first birth (AFB) and number of children ever born (NEB)-has a strong relationship with fitness, human development, infertility and risk of neuropsychiatric disorders. However, very few genetic loci have been identified, and the underlying mechanisms of AFB and NEB are poorly understood. We report a large genome-wide association study of both sexes including 251,151 individuals for AFB and 343,072 individuals for NEB. We identified 12 independent loci that are significantly associated with AFB and/or NEB in a SNP-based genome-wide association study and 4 additional loci associated in a gene-based effort. These loci harbor genes that are likely to have a role, either directly or by affecting non-local gene expression, in human reproduction and infertility, thereby increasing understanding of these complex traits.

%B Nat Genet %V 48 %P 1462-1472 %8 2016 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/27798627?dopt=Abstract %R 10.1038/ng.3698 %0 Journal Article %J Depress Anxiety %D 2016 %T GENOME-WIDE ASSOCIATION STUDY (GWAS) AND GENOME-WIDE BY ENVIRONMENT INTERACTION STUDY (GWEIS) OF DEPRESSIVE SYMPTOMS IN AFRICAN AMERICAN AND HISPANIC/LATINA WOMEN. %A Dunn, Erin C %A Wiste, Anna %A Radmanesh, Farid %A Almli, Lynn M %A Gogarten, Stephanie M %A Sofer, Tamar %A Jessica Faul %A Sharon L R Kardia %A Jennifer A Smith %A David R Weir %A Wei Zhao %A Soare, Thomas W %A Saira S Mirza %A Karin Hek %A Henning Tiemeier %A Goveas, Joseph S %A Sarto, Gloria E %A Snively, Beverly M %A Marilyn C Cornelis %A Karestan C Koenen %A Kraft, Peter %A Shaun M Purcell %A Ressler, Kerry J %A Rosand, Jonathan %A Wassertheil-Smoller, Sylvia %A Smoller, Jordan W %K African Americans %K Aged %K depression %K Female %K Gene-Environment Interaction %K Genome-Wide Association Study %K Hispanic Americans %K Humans %K Life Change Events %K Middle Aged %K Phenotype %K Polymorphism, Single Nucleotide %K Risk Factors %K Self Report %X

BACKGROUND: Genome-wide association studies (GWAS) have made little progress in identifying variants linked to depression. We hypothesized that examining depressive symptoms and considering gene-environment interaction (GxE) might improve efficiency for gene discovery. We therefore conducted a GWAS and genome-wide by environment interaction study (GWEIS) of depressive symptoms.

METHODS: Using data from the SHARe cohort of the Women's Health Initiative, comprising African Americans (n = 7,179) and Hispanics/Latinas (n = 3,138), we examined genetic main effects and GxE with stressful life events and social support. We also conducted a heritability analysis using genome-wide complex trait analysis (GCTA). Replication was attempted in four independent cohorts.

RESULTS: No SNPs achieved genome-wide significance for main effects in either discovery sample. The top signals in African Americans were rs73531535 (located 20 kb from GPR139, P = 5.75 × 10(-8) ) and rs75407252 (intronic to CACNA2D3, P = 6.99 × 10(-7) ). In Hispanics/Latinas, the top signals were rs2532087 (located 27 kb from CD38, P = 2.44 × 10(-7) ) and rs4542757 (intronic to DCC, P = 7.31 × 10(-7) ). In the GEWIS with stressful life events, one interaction signal was genome-wide significant in African Americans (rs4652467; P = 4.10 × 10(-10) ; located 14 kb from CEP350). This interaction was not observed in a smaller replication cohort. Although heritability estimates for depressive symptoms and stressful life events were each less than 10%, they were strongly genetically correlated (rG = 0.95), suggesting that common variation underlying self-reported depressive symptoms and stressful life event exposure, though modest on their own, were highly overlapping in this sample.

CONCLUSIONS: Our results underscore the need for larger samples, more GEWIS, and greater investigation into genetic and environmental determinants of depressive symptoms in minorities.

%B Depress Anxiety %V 33 %P 265-80 %8 2016 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27038408?dopt=Abstract %R 10.1002/da.22484 %0 Journal Article %J Nature %D 2016 %T Genome-wide association study identifies 74 loci associated with educational attainment. %A Okbay, Aysu %A Jonathan P. Beauchamp %A Mark Alan Fontana %A Lee, James J %A Pers, Tune H %A Cornelius A Rietveld %A Turley, Patrick %A Chen, Guo-Bo %A Emilsson, Valur %A Meddens, S Fleur W %A Oskarsson, Sven %A Pickrell, Joseph K %A Thom, Kevin %A Pascal N Timshel %A de Vlaming, Ronald %A Abdel Abdellaoui %A Ahluwalia, Tarunveer S %A Bacelis, Jonas %A Baumbach, Clemens %A Bjornsdottir, Gyda %A Brandsma, Johannes H %A Maria Pina Concas %A Derringer, Jaime %A Furlotte, Nicholas A %A Galesloot, Tessel E %A Giorgia G Girotto %A Gupta, Richa %A Hall, Leanne M %A Sarah E Harris %A Edith Hofer %A Horikoshi, Momoko %A Huffman, Jennifer E %A Kaasik, Kadri %A Ioanna Panagiota Kalafati %A Karlsson, Robert %A Kong, Augustine %A Lahti, Jari %A Sven J van der Lee %A Christiaan de Leeuw %A Penelope A Lind %A Lindgren, Karl-Oskar %A Tian Liu %A Mangino, Massimo %A Marten, Jonathan %A Mihailov, Evelin %A Michael B Miller %A van der Most, Peter J %A Christopher J Oldmeadow %A Payton, Antony %A Pervjakova, Natalia %A Wouter J Peyrot %A Qian, Yong %A Olli T Raitakari %A Rueedi, Rico %A Salvi, Erika %A Schmidt, Börge %A Schraut, Katharina E %A Jianxin Shi %A Albert Vernon Smith %A Poot, Raymond A %A St Pourcain, Beate %A Teumer, Alexander %A Thorleifsson, Gudmar %A Verweij, Niek %A Vuckovic, Dragana %A Jürgen Wellmann %A Westra, Harm-Jan %A Yang, Jingyun %A Wei Zhao %A Zhihong Zhu %A Alizadeh, Behrooz Z %A Amin, Najaf %A Bakshi, Andrew %A Baumeister, Sebastian E %A Biino, Ginevra %A Bønnelykke, Klaus %A Patricia A. Boyle %A Campbell, Harry %A Cappuccio, Francesco P %A Gail Davies %A De Neve, Jan-Emmanuel %A Deloukas, Panos %A Demuth, Ilja %A Ding, Jun %A Eibich, Peter %A Eisele, Lewin %A Eklund, Niina %A Jessica Faul %A Feitosa, Mary F %A Andreas J Forstner %A Gandin, Ilaria %A Gunnarsson, Bjarni %A Halldórsson, Bjarni V %A Tamara B Harris %A Andrew C Heath %A Lynne J Hocking %A Holliday, Elizabeth G %A Homuth, Georg %A Horan, Michael A %A Jouke-Jan Hottenga %A Philip L de Jager %A Joshi, Peter K %A Jugessur, Astanand %A Marika A Kaakinen %A Kähönen, Mika %A Kanoni, Stavroula %A Keltigangas-Järvinen, Liisa %A Lambertus A Kiemeney %A Kolcic, Ivana %A Koskinen, Seppo %A Kraja, Aldi T %A Kroh, Martin %A Kutalik, Zoltán %A Latvala, Antti %A Lenore J Launer %A Lebreton, Maël P %A Douglas F Levinson %A Paul Lichtenstein %A Lichtner, Peter %A David C Liewald %A Loukola, Anu %A Pamela A F Madden %A Mägi, Reedik %A Mäki-Opas, Tomi %A Riccardo E Marioni %A Marques-Vidal, Pedro %A Meddens, Gerardus A %A McMahon, George %A Meisinger, Christa %A Meitinger, Thomas %A Milaneschi, Yusplitri %A Lili Milani %A Grant W Montgomery %A Myhre, Ronny %A Nelson, Christopher P %A Nyholt, Dale R %A William E R Ollier %A Aarno Palotie %A Paternoster, Lavinia %A Nancy L Pedersen %A Katja E Petrovic %A David J Porteous %A Katri Räikkönen %A Ring, Susan M %A Robino, Antonietta %A Rostapshova, Olga %A Rudan, Igor %A Rustichini, Aldo %A Veikko Salomaa %A Sanders, Alan R %A Sarin, Antti-Pekka %A Schmidt, Helena %A Rodney J Scott %A Smith, Blair H %A Jennifer A Smith %A Staessen, Jan A %A Steinhagen-Thiessen, Elisabeth %A Strauch, Konstantin %A Antonio Terracciano %A Tobin, Martin D %A Ulivi, Sheila %A Vaccargiu, Simona %A Quaye, Lydia %A van Rooij, Frank J A %A Venturini, Cristina %A Anna A E Vinkhuyzen %A Völker, Uwe %A Völzke, Henry %A Vonk, Judith M %A Vozzi, Diego %A Waage, Johannes %A Erin B Ware %A Gonneke Willemsen %A John R. Attia %A David A Bennett %A Klaus Berger %A Bertram, Lars %A Bisgaard, Hans %A Dorret I Boomsma %A Ingrid B Borecki %A Bültmann, Ute %A Chabris, Christopher F %A Francesco Cucca %A Cusi, Daniele %A Ian J Deary %A George Dedoussis %A Cornelia M van Duijn %A Johan G Eriksson %A Franke, Barbara %A Lude L Franke %A Paolo P. Gasparini %A Gejman, Pablo V %A Gieger, Christian %A Hans-Jörgen Grabe %A Gratten, Jacob %A Groenen, Patrick J F %A Gudnason, Vilmundur %A van der Harst, Pim %A Caroline Hayward %A Hinds, David A %A Hoffmann, Wolfgang %A Hyppönen, Elina %A Iacono, William G %A Jacobsson, Bo %A Järvelin, Marjo-Riitta %A Jöckel, Karl-Heinz %A Kaprio, Jaakko %A Sharon L R Kardia %A Lehtimäki, Terho %A Lehrer, Steven F %A Patrik K E Magnusson %A Nicholas G Martin %A McGue, Matt %A Andres Metspalu %A Pendleton, Neil %A Brenda W J H Penninx %A Markus Perola %A Nicola Pirastu %A Pirastu, Mario %A Polasek, Ozren %A Posthuma, Danielle %A Power, Christine %A Province, Michael A %A Nilesh J Samani %A Schlessinger, David %A Schmidt, Reinhold %A Thorkild I. A. Sørensen %A Timothy Spector %A Stefansson, Kari %A Thorsteinsdottir, Unnur %A A. Roy Thurik %A Nicholas J Timpson %A Henning Tiemeier %A Tung, Joyce Y %A André G Uitterlinden %A Vitart, Veronique %A Vollenweider, Peter %A David R Weir %A James F Wilson %A Alan F Wright %A Dalton C Conley %A Krueger, Robert F %A George Davey Smith %A Hofman, Albert %A David I Laibson %A Sarah E Medland %A Meyer, Michelle N %A Yang, Jian %A Johannesson, Magnus %A Peter M Visscher %A Tõnu Esko %A Philipp D Koellinger %A Cesarini, David %A Daniel J. Benjamin %K Alzheimer's disease %K Bipolar Disorder %K Cognitive Ability %K Education %K Fetus %K Genome-Wide Association Study %K Humans %K Molecular Sequence Annotation %K Polymorphism, Single Nucleotide %K Schizophrenia %K United Kingdom %X

Educational attainment is strongly influenced by social and other environmental factors, but genetic factors are estimated to account for at least 20% of the variation across individuals. Here we report the results of a genome-wide association study (GWAS) for educational attainment that extends our earlier discovery sample of 101,069 individuals to 293,723 individuals, and a replication study in an independent sample of 111,349 individuals from the UK Biobank. We identify 74 genome-wide significant loci associated with the number of years of schooling completed. Single-nucleotide polymorphisms associated with educational attainment are disproportionately found in genomic regions regulating gene expression in the fetal brain. Candidate genes are preferentially expressed in neural tissue, especially during the prenatal period, and enriched for biological pathways involved in neural development. Our findings demonstrate that, even for a behavioural phenotype that is mostly environmentally determined, a well-powered GWAS identifies replicable associated genetic variants that suggest biologically relevant pathways. Because educational attainment is measured in large numbers of individuals, it will continue to be useful as a proxy phenotype in efforts to characterize the genetic influences of related phenotypes, including cognition and neuropsychiatric diseases.

%B Nature %V 533 %P 539-42 %8 2016 05 26 %G eng %N 7604 %1 http://www.ncbi.nlm.nih.gov/pubmed/27225129?dopt=Abstract %R 10.1038/nature17671 %0 Journal Article %J Aging Cell %D 2016 %T GWAS analysis of handgrip and lower body strength in older adults in the CHARGE consortium. %A Amy M Matteini %A Toshiko Tanaka %A Karasik, David %A Atzmon, Gil %A Chou, Wen-Chi %A John D Eicher %A Andrew D Johnson %A Alice M. Arnold %A Michele L Callisaya %A Gail Davies %A Daniel S Evans %A Holtfreter, Birte %A Kurt Lohman %A Kathryn L Lunetta %A Mangino, Massimo %A Albert Vernon Smith %A Jennifer A Smith %A Teumer, Alexander %A Lei Yu %A Dan E Arking %A Aron S Buchman %A Chibinik, Lori B %A Philip L de Jager %A Jessica Faul %A Melissa E Garcia %A Gillham-Nasenya, Irina %A Gudnason, Vilmundur %A Hofman, Albert %A Hsu, Yi-Hsiang %A Ittermann, Till %A Lahousse, Lies %A David C Liewald %A Yongmei Liu %A Lopez, Lorna %A Fernando Rivadeneira %A Rotter, Jerome I %A Siggeirsdottir, Kristin %A John M Starr %A Thomson, Russell %A Tranah, Gregory J %A André G Uitterlinden %A Völker, Uwe %A Völzke, Henry %A David R Weir %A Kristine Yaffe %A Wei Zhao %A Wei Vivian Zhuang %A Zmuda, Joseph M %A David A Bennett %A Steven R Cummings %A Ian J Deary %A Luigi Ferrucci %A Tamara B Harris %A Sharon L R Kardia %A Kocher, Thomas %A Stephen B Kritchevsky %A Psaty, Bruce M %A Seshadri, Sudha %A Timothy Spector %A Velandai K Srikanth %A Beverly G Windham %A Zillikens, M Carola %A Anne B Newman %A Jeremy D Walston %A Douglas P Kiel %A Joanne M Murabito %K Adult %K Aged %K Chromatin Immunoprecipitation %K Cohort Studies %K Epigenesis, Genetic %K Genome-Wide Association Study %K Hand Strength %K Humans %K Molecular Sequence Annotation %K Muscle Strength %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %K Reproducibility of Results %X

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

%B Aging Cell %V 15 %P 792-800 %8 2016 10 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27325353?dopt=Abstract %R 10.1111/acel.12468 %0 Magazine Article %D 2016 %T Happy People Make Their Spouses Healthier %A TIME %K Happiness %K Marriage %K News %K Older Adults %B TIME Magazine %G eng %U http://time.com/4506490/happy-people-make-their-spouses-healthier/ %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 %X

OBJECTIVE: 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 %X

The objectives of this research were to 1) summarize the available evidence on the impact of hearing loss on quality of life (QOL) among U.S. active-duty service members, 2) describe the QOL instruments that have been used to quantify the impact of hearing loss on quality of life, 3) examine national population-level secondary databases and report on their utility for studying the impact of hearing loss on QOL among active-duty service members, and 4) provide recommendations for future studies that seek to quantify the impact of hearing loss in this population. There is a lack of literature that addresses the intersection of hearing impairment, the military population, and quality of life measures. For audiological research, U.S. military personnel offer a unique research population, as they are exposed to noise levels and blast environments that are highly unusual in civilian work settings and can serve as a model population for studying the impact on QOL associated with these conditions. Our team recommends conducting a study on the active-duty service member population using a measurement instrument suitable for determining decreases in QOL specifically due to hearing loss.

%B Mil Med Res %I 3 %V 3 %P 11 %8 2016 %G eng %U http://mmrjournal.biomedcentral.com/articles/10.1186/s40779-016-0082-5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27076916?dopt=Abstract %2 PMC4830069 %R 10.1186/s40779-016-0082-5 %0 Journal Article %J Ann Epidemiol %D 2016 %T Instrumental variable approaches to identifying the causal effect of educational attainment on dementia risk. %A Thu T Nguyen %A Eric J. Tchetgen Tchetgen %A Ichiro Kawachi %A Stephen E. Gilman %A Stefan Walter %A Sze Y Liu %A Jennifer J Manly %A M. Maria Glymour %K Aged %K Aged, 80 and over %K Dementia %K Education, Nonprofessional %K Educational Status %K Female %K Genetic Predisposition to Disease %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Polymorphism, Single Nucleotide %K Protective factors %K Risk Factors %K Schools %K United States %X

PURPOSE: Education is an established correlate of cognitive status in older adulthood, but whether expanding educational opportunities would improve cognitive functioning remains unclear given limitations of prior studies for causal inference. Therefore, we conducted instrumental variable (IV) analyses of the association between education and dementia risk, using for the first time in this area, genetic variants as instruments as well as state-level school policies.

METHODS: IV analyses in the Health and Retirement Study cohort (1998-2010) used two sets of instruments: (1) a genetic risk score constructed from three single-nucleotide polymorphisms (SNPs; n = 7981); and (2) compulsory schooling laws (CSLs) and state school characteristics (term length, student teacher ratios, and expenditures; n = 10,955).

RESULTS: Using the genetic risk score as an IV, there was a 1.1% reduction in dementia risk per year of schooling (95% confidence interval, -2.4 to 0.02). Leveraging compulsory schooling laws and state school characteristics as IVs, there was a substantially larger protective effect (-9.5%; 95% confidence interval, -14.8 to -4.2). Analyses evaluating the plausibility of the IV assumptions indicated estimates derived from analyses relying on CSLs provide the best estimates of the causal effect of education.

CONCLUSIONS: IV analyses suggest education is protective against risk of dementia in older adulthood.

%B Ann Epidemiol %I 26 %V 26 %P 71-6.e1-3 %8 2016 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26633592?dopt=Abstract %2 PMC4688127 %4 Cognitive status/Genetic analysis/Dementia/EDUCATION %$ 999999 %R 10.1016/j.annepidem.2015.10.006 %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 Newspaper Article %B The New York Times %D 2016 %T Life Spans of the Rich Leave the Poor Behind %A Tavernise, Sabrina %K Income %K Life Expectancy %K Older Adults %K Wage gap %B The New York Times %7 February 13, 2016 %G eng %U http://www.nytimes.com/2016/02/13/health/disparity-in-life-spans-of-the-rich-and-the-poor-is-growing.html %! Disparity in Life Spans of the Rich and the Poor Is Growing %& A %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 %X

This 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 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 %X

We 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 Disability and Health Journal %D 2016 %T Measures of aging with disability in U.S. secondary data sets: Results of a scoping review %A Putnam, Michelle %A Molton, Ivan R. %A Truitt, Anjali R. %A Smith, Amanda E. %A Jensen, Mark P. %K Disabilities %K Health Conditions and Status %K Methodology %X AbstractBackground There remain significant knowledge gaps in our understanding of aging with long-term disability. It is possible that important advances in knowledge could be gained using existing secondary data sets. However, little is known regarding which of the data sets available to researchers contain the age-related measures needed for this purpose, specifically age of onset and/or duration of disability measures. Objective To better understand the capacity to investigate aging with long-term disability (e.g. mobility limitation) and aging with long-term chronic conditions (e.g. spinal cord injury, multiple sclerosis) using extant data. Methods Public use national and regional data sets were identified through existing reports, web-based searches, and expert nomination. The age- and disability-related variables, including age of onset and duration of disability, were tabulated for data sets meeting inclusion criteria. Analysis was descriptive. Results A total of N = 44 data sets were reviewed. Of these, 22 contained both age and disability variables. Within these 22 data sets, 9 contained an age of onset or duration of disability variable. Six of the nine data sets contained age of diagnosis for a single or set of health conditions. Onset of functional limitation is in two, and onset of self-reported and/or employment disability is in four, of the nine data sets respectively. Conclusions There is some, but limited opportunity to investigate aging with long-term disability in extant U.S. public use secondary data sets. %B Disability and Health Journal %I 9 %V 9 %P 5-10 %G eng %U http://www.sciencedirect.com/science/article/pii/S1936657415000990 %N 1 %4 Aging/Disability/Disability/Secondary data/Measurement/Quantitative analysis %$ 999999 %R 10.1016/j.dhjo.2015.07.002 %0 Journal Article %J Nat Genet %D 2016 %T Meta-analysis identifies common and rare variants influencing blood pressure and overlapping with metabolic trait loci. %A Liu, Chunyu %A Kraja, Aldi T %A Jennifer A Smith %A Brody, Jennifer A %A Franceschini, Nora %A Joshua C. Bis %A Kenneth Rice %A Alanna C Morrison %A Lu, Yingchang %A Weiss, Stefan %A Guo, Xiuqing %A Walter R Palmas %A Martin, Lisa W %A Yii-Der I Chen %A Surendran, Praveen %A Drenos, Fotios %A Cook, James P %A Auer, Paul L %A Chu, Audrey Y %A Giri, Ayush %A Wei Zhao %A Jakobsdottir, Johanna %A Lin, Li-An %A Stafford, Jeanette M %A Amin, Najaf %A Mei, Hao %A Yao, Jie %A Voorman, Arend %A Larson, Martin G %A Grove, Megan L %A Albert Vernon Smith %A Hwang, Shih-Jen %A Chen, Han %A Huan, Tianxiao %A Kosova, Gulum %A Stitziel, Nathan O %A Kathiresan, Sekar %A Nilesh J Samani %A Schunkert, Heribert %A Deloukas, Panos %A Li, Man %A Fuchsberger, Christian %A Pattaro, Cristian %A Gorski, Mathias %A Charles Kooperberg %A George J Papanicolaou %A Rossouw, Jacques E %A Jessica Faul %A Sharon L R Kardia %A Bouchard, Claude %A Raffel, Leslie J %A André G Uitterlinden %A Franco, Oscar H %A Ramachandran S Vasan %A O'Donnell, Christopher J %A Kent D Taylor %A Liu, Kiang %A Erwin P Bottinger %A Gottesman, Omri %A Daw, E Warwick %A Giulianini, Franco %A Ganesh, Santhi %A Salfati, Elias %A Tamara B Harris %A Lenore J Launer %A Dörr, Marcus %A Felix, Stephan B %A Rettig, Rainer %A Völzke, Henry %A Eric S Kim %A Lee, Wen-Jane %A Lee, I-Te %A Sheu, Wayne H-H %A Tsosie, Krystal S %A Digna R Velez Edwards %A Yongmei Liu %A Correa, Adolfo %A David R Weir %A Völker, Uwe %A Ridker, Paul M %A Boerwinkle, Eric %A Gudnason, Vilmundur %A Reiner, Alexander P %A Cornelia M van Duijn %A Ingrid B Borecki %A Edwards, Todd L %A Chakravarti, Aravinda %A Rotter, Jerome I %A Psaty, Bruce M %A Ruth J F Loos %A Myriam Fornage %A Georg B Ehret %A Newton-Cheh, Christopher %A Levy, Daniel %A Daniel I Chasman %X

Meta-analyses of association results for blood pressure using exome-centric single-variant and gene-based tests identified 31 new loci in a discovery stage among 146,562 individuals, with follow-up and meta-analysis in 180,726 additional individuals (total n = 327,288). These blood pressure-associated loci are enriched for known variants for cardiometabolic traits. Associations were also observed for the aggregation of rare and low-frequency missense variants in three genes, NPR1, DBH, and PTPMT1. In addition, blood pressure associations at 39 previously reported loci were confirmed. The identified variants implicate biological pathways related to cardiometabolic traits, vascular function, and development. Several new variants are inferred to have roles in transcription or as hubs in protein-protein interaction networks. Genetic risk scores constructed from the identified variants were strongly associated with coronary disease and myocardial infarction. This large collection of blood pressure-associated loci suggests new therapeutic strategies for hypertension, emphasizing a link with cardiometabolic risk.

%B Nat Genet %V 48 %P 1162-70 %8 2016 Oct %G eng %N 10 %R 10.1038/ng.3660 %0 Journal Article %J Journal of Health and Social Behavior %D 2016 %T Multiple Chronic Conditions, Spouse's Depressive Symptoms, and Gender within Marriage %A Thomeer, Mieke Beth %K Adult children %K Health Conditions and Status %X Multiple chronic conditions (i.e., multimorbidity) increase a person's depressive symptoms more than having one chronic condition. Little is known regarding whether multimorbidity similarly increases the depressive symptoms of one's spouse and whether this depends on type of condition, gender, or both spouses' health status. Analysis of multiple waves of the Health and Retirement Study reveals husband's number of chronic conditions is positively related to wife's depressive symptoms when both spouses are chronically ill. The association between wife's chronic conditions and husband's depressive symptoms is weaker and less robust. Type of chronic condition also matters but which type depends on the gender and health status of both spouses. By highlighting key contexts where chronic conditions are connected to spousal depressive symptoms, this study identifies areas of vulnerability and urges researchers and clinicians to consider multimorbidity when designing and implementing interventions, along with gender, both spouses' chronic conditions, and condition type. %B Journal of Health and Social Behavior %I 57 %V 57 %P 59-76 %G eng %N 1 %4 chronic conditions/COMORBIDITY/Depressive Symptoms/spouse health conditions/health status/marital status %$ 999999 %R 10.1177/0022146516628179 %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 %X

OBJECTIVES: 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.

%B J Gerontol B Psychol Sci Soc Sci %V 71 %P 98-105 %8 2016 Jan %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/25384636 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25384636?dopt=Abstract %4 Aged Aged, 80 and over Aging/psychology Asian Continental Ancestry Group/psychology Female Hong Kong Humans *Independent Living/psychology/statistics & numerical data Interview, Psychological Male Middle Aged *Poverty/psychology/statistics & numerical data *Quality of Life *Residence Characteristics *Social Support Urban Population %R 10.1093/geronb/gbu154 %0 Report %D 2016 %T Occupation and Industry Coding in HRS/AHEAD %A Michael A. Nolte %A Servais, Marita %A Turf, Megan %K Methodology %X This document describes the codeframes that have been used to classify occupation and industry in each wave of the Health and Retirement Study. For AHEAD data collections in 1993 and 1995, occupation was coded using the SRC 2-Digit Occupation Code (adapted from the 1980 U. S. Census Occupation Code) which masked for public release.1 Unmasked codes for 1995 (but not 1993) have been released. Industry was not asked. For HRS data collections in 1992, 1994, 1996, 1998, 2000, and 2004, occupation was coded using the 3-digit 1980 U. S. Census Occupation Code and masked for public release. Industry was coded using the 3-digit 1980 U. S. Census Industry Code which was masked for public release. Except for 1994, unmasked codes have been released as restricted data. For the 2006 and 2008 interviewing periods, occupation was coded using the 3-digit 2000 U.S. Census Occupation Code; and industry was coded using the 3-digit 2002 U. S. Census Industry Code; occupation and industry were masked for public release. Unmasked versions of these codes have been released as restricted data. For HRS 2010 and beyond, occupation information was coded using the 2010 Census Occupational Classification System. Industry information reported by HRS respondents was coded using the 2007 Census Industrial Classification system. Unmasked versions of these codes have been released as restricted data. %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 Data management/survey Methods/occupation coding/industry coding %$ 62920 %0 Journal Article %J Int J Geriatr Psychiatry %D 2016 %T Older adults with poor self-rated memory have less depressive symptoms and better memory performance when perceived self-efficacy is high. %A O'Shea, Deirdre M %A Vonetta M Dotson %A Fieo, Robert A %A Tsapanou, Angeliki %A Laura B Zahodne %A Stern, Yaakov %K Aged %K Aged, 80 and over %K depression %K Female %K Humans %K Male %K Memory %K Middle Aged %K Regression Analysis %K Self Efficacy %K Surveys and Questionnaires %X

OBJECTIVE: To investigate whether self-efficacy moderates the association between self-rated memory and depressive symptoms in a large sample of older adults. The influence of self-efficacy and depressive symptoms on memory performance was also examined in a subsample of individuals who reported poor memory.

METHODS: Non-demented participants (n = 3766) were selected from the 2012 wave of the Health and Retirement Study. Depressive symptomatology was assessed with the 8-item Center for Epidemiologic Studies Depression Scale. A modified version of the Midlife Developmental Inventory Questionnaire was used as the measure of self-efficacy. Participants were asked to rate their memory presently on a five-point scale from Excellent (1) to Poor (5). Immediate memory and delayed memory (after a 5-min interval) were measured by the number of correct words recalled from a 10-item word list.

RESULTS: Multiple regression analyses revealed that negative ratings of memory were significantly associated with greater levels of depressive symptoms, with this effect being greatest in those with low levels of self-efficacy. Additionally, greater self-efficacy was associated with optimal objective memory performances but only when depressive symptoms were low in individuals who reported poor memory function (n = 1196).

CONCLUSION: Self-efficacy moderates the relationship between self-rated memory function and depressive symptoms. Higher self-efficacy may buffer against the impact of subjective memory difficulty on one's mood and thereby mitigating the effect of depressive symptoms on memory. Interventions should focus on increasing perceived self-efficacy in older adults reporting poor memory function to potentially minimize memory impairment.

%B Int J Geriatr Psychiatry %V 31 %P 783-90 %8 2016 07 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/26679474 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/26679474?dopt=Abstract %4 Depression Depressive symptoms Self-rated memory Memory Self-efficacy %R 10.1002/gps.4392 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. %A Irena Cenzer %A Victoria L. Tang %A W John Boscardin %A Christine S Ritchie %A Margaret Wallhagen %A Espaldon, Roxanne %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cause of Death %K Cohort Studies %K Comorbidity %K Disability Evaluation %K Female %K Hip Fractures %K Humans %K Incidence %K Longitudinal Studies %K Male %K Prognosis %K Retrospective Studies %K Risk Assessment %K Survival Analysis %K United States %X

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.

%B J Am Geriatr Soc %V 64 %P 1863-8 %8 2016 09 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27295578 %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/27295578?dopt=Abstract %R 10.1111/jgs.14237 %0 Journal Article %J Developmental Psychology %D 2016 %T Perceived discrimination and personality development in adulthood %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Health Conditions and Status %K Methodology %X Perceived discrimination is common and a significant source of stress that may have implications for personality development across adulthood. In this study, we examined whether experiences with discrimination were associated with maladaptive changes in the 5 major dimensions of personality using 2 longitudinal samples that differed in age and follow-up interval. In the Health and Retirement Study, participants who perceived discrimination increased in their tendency to experience negative emotions (neuroticism), decreased in their tendency to be trusting (agreeableness), and decreased in their tendency to be organized and disciplined (conscientiousness). These associations replicated using participants from the Midlife in the United States study. The findings indicate that social pathways, in addition to biological and developmental tasks, are important for adult personality development. (PsycINFO Database Record %B Developmental Psychology %I 52 %V 52 %P 155 %G eng %N 1 %4 Five Factor Model/Perceived discrimination/Personality development/Longitudinal/article %$ 999999 %0 Journal Article %J Twin Res Hum Genet %D 2016 %T Personality Polygenes, Positive Affect, and Life Satisfaction. %A Weiss, Alexander %A Baselmans, Bart M L %A Edith Hofer %A Yang, Jingyun %A Okbay, Aysu %A Penelope A Lind %A Michael B Miller %A Ilja M Nolte %A Wei Zhao %A Hagenaars, Saskia P %A Jouke-Jan Hottenga %A Lindsay K Matteson %A Snieder, Harold %A Jessica Faul %A Catharina A Hartman %A Patricia A. Boyle %A Henning Tiemeier %A Mosing, Miriam A %A Pattie, Alison %A Gail Davies %A David C Liewald %A Schmidt, Reinhold %A Philip L de Jager %A Andrew C Heath %A Markus Jokela %A John M Starr %A Oldehinkel, Albertine J %A Johannesson, Magnus %A Cesarini, David %A Hofman, Albert %A Sarah E Harris %A Jennifer A Smith %A Keltikangas-Järvinen, Liisa %A Pulkki-Raback, Laura %A Schmidt, Helena %A Jacqui Smith %A Iacono, William G %A McGue, Matt %A David A Bennett %A Nancy L Pedersen %A Patrik K E Magnusson %A Ian J Deary %A Nicholas G Martin %A Dorret I Boomsma %A Bartels, Meike %A Luciano, Michelle %K Genetics %K Happiness %K Polygenic Prediction %K SSGAC %K Well-being %X

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.

%B Twin Res Hum Genet %V 19 %P 407-17 %8 2016 Oct %G eng %N 5 %R 10.1017/thg.2016.65 %0 Journal Article %J EBioMedicine %D 2016 %T Racial and Socioeconomic Variation in Genetic Markers of Telomere Length: A Cross-Sectional Study of U.S. Older Adults. %A Hamad, Rita %A Tuljapurkar, Shripad %A David Rehkopf %K Age Factors %K Aged %K Aged, 80 and over %K Alleles %K Cross-Sectional Studies %K Ethnic Groups %K Female %K Gene Frequency %K Genetic Markers %K Genome-Wide Association Study %K Geriatric Assessment %K Humans %K Male %K Middle Aged %K Polymorphism, Single Nucleotide %K Population Surveillance %K Socioeconomic factors %K Telomere Homeostasis %K United States %X

BACKGROUND: Shorter telomere length (TL) has been associated with stress and adverse socioeconomic conditions, yet U.S. blacks have longer TL than whites. The role of genetic versus environmental factors in explaining TL by race and socioeconomic position (SEP) remains unclear.

METHODS: We used data from the U.S. Health and Retirement Study (N=11,934) to test the hypothesis that there are differences in TL-associated SNPs by race and SEP. We constructed a TL polygenic risk score (PRS) and examined its association with race/ethnicity, educational attainment, assets, gender, and age.

RESULTS: U.S. blacks were more likely to have a lower PRS for TL, as were older individuals and men. Racial differences in TL were statistically accounted for when controlling for population structure using genetic principal components. The GWAS-derived SNPs for TL, however, may not have consistent associations with TL across different racial/ethnic groups.

CONCLUSIONS: This study showed that associations of race/ethnicity with TL differed when accounting for population stratification. The role of race/ethnicity for TL remains uncertain, however, as the genetic determinants of TL may differ by race/ethnicity. Future GWAS samples should include racially diverse participants to allow for better characterization of the determinants of TL in human populations.

%B EBioMedicine %V 11 %P 296-301 %G eng %R 10.1016/j.ebiom.2016.08.015 %0 Journal Article %J The American Journal of Geriatric Psychiatry %D 2016 %T Racial/Ethnic Differences in Insomnia Trajectories Among U.S. Older Adults %A Christopher N Kaufmann %A Ramin Mojtabai %A Hock, Rebecca S. %A Roland J. Thorpe Jr. %A Sarah L. Canham %A Chen, Lian-Yu %A Alexandra M. V. Wennberg %A Lenis P. Chen-Edinboro %A Adam P Spira %K Health Conditions and Status %K Other %X Objectives Insomnia is reported to be more prevalent in minority racial/ethnic groups. Little is known, however, about racial/ethnic differences in changes in insomnia severity over time, particularly among older adults. We examined racial/ethnic differences in trajectories of insomnia severity among middle-aged and older adults. Design Data were drawn from five waves of the Health and Retirement Study (2002 2010), a nationally representative longitudinal biennial survey of adults aged andgt; 50 years. Setting Population-based. Participants 22,252 participants from non-Hispanic white, non-Hispanic black, Hispanic, and other racial/ethnic groups. Measurements Participants reported the severity of four insomnia symptoms; summed scores ranged from 4 (no insomnia) to 12 (severe insomnia). We assessed change in insomnia across the five waves as a function of race/ethnicity. Results Across all participants, insomnia severity scores increased 0.19 points (95 CI: 0.14 0.24; t = 7.52; design df = 56; p andlt; 0.001) over time after adjustment for sex, race/ethnicity, education, and baseline age. After adjusting for the number of accumulated health conditions and body mass index, this trend decreased substantially and even changed direction (B = 0.24; 95 CI: 0.29 to 0.19; t = 9.22; design df = 56; p andlt; 0.001). The increasing trajectory was significantly more pronounced in Hispanics compared with non-Hispanic whites, even after adjustment for number of accumulated health conditions, body mass index, and number of depressive symptoms. Conclusions Although insomnia severity increases with age largely due to the accumulation of health conditions this trend appears more pronounced among Hispanic older adults than in non-Hispanic whites. Further research is needed to determine the reasons for a different insomnia trajectory among Hispanics. %B The American Journal of Geriatric Psychiatry %V 24 %P 575-584 %G eng %U http://www.sciencedirect.com/science/article/pii/S1064748116002153 %N 7 %4 Disparities/Aging/Insomnia/Chronic health conditions %$ 999999 %& 575 %R 10.1016/j.jagp.2016.02.049 %0 Journal Article %J IZA Journal of Labor Policy %D 2016 %T Reforming retirement age in DB and DC pension systems in an aging OLG economy with heterogenous agents %A Tyrowicz, Joanna %A Makarski, Krzysztof %A Bielecki, Marcin %K Economics %K Pensions %K Retirement Age %K Welfare %X We analyze the effects of increasing the retirement age in two economies with overlapping generations and within cohort ex ante heterogeneity. The first economy has a defined benefit system, and the second economy is in transition from a defined benefit to a defined contribution. We find that if increase in the retirement age is phased in a way that allows agents to adjust, welfare is not reduced and welfare effects have a similar magnitude and between-cohort distribution in both types of the pension systems. %B IZA Journal of Labor Policy %V 5 %8 Jan-12-2016 %G eng %U https://izajolp.springeropen.com/articles/10.1186/s40173-016-0067-8 %N 1 %! IZA J Labor Policy %R 10.1186/s40173-016-0067-8 %0 Journal Article %J The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2016 %T Relationship Status and Long-Term Care Facility Use in Later Life %A Thomeer, Mieke Beth %A Mudrazija, Stipica %A Jacqueline L. Angel %K Demographics %K Healthcare %K Women and Minorities %X Objectives: Most older adults prefer to age in place and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk.Method: We fit hazard models to a sample of adults aged 65 and older from eight waves (1998 2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays.Results: Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use.Discussion: By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options. %B The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %V 71 %P 711-723 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/11/16/geronb.gbv106.abstract %N 4 %4 Family sociology/Gender/Health services use/Longitudinal methods/Long-term care/Minority aging/RACE AND ETHNICITY/Hispanic %$ 999999 %& 711 %R 10.1093/geronb/gbv106 %0 Journal Article %J Nonprofit and Voluntary Sector Quarterly %D 2016 %T Retirement Patterns and Their Relationship to Volunteering %A Tang, Fengyan %K Adult children %K Employment and Labor Force %K Retirement Planning and Satisfaction %X This study examines the relationships of volunteering behaviors with work retirement patterns and transition among middle-aged and older Americans using the Health and Retirement Study data (1998-2008). Latent class analysis was used to identify retirement status and cluster respondents into five latent classes: the not-retired, partial retiree, full retiree, non-worker (e.g., homemakers), and the transitioned (i.e., the newly retired from paid work). Generalized linear mixed models showed those experiencing work retirement transitions were significantly more involved in volunteering than the not-retired. Partial retirees and full retirees were more likely to start volunteering, and full retirees were also more likely to end volunteering than the not-retired over the 10-year observation period. Volunteer organizations are advised to recruit older adults who have time available and social connections with the workforce and to target the newly retired who are likely to increase their volunteer time during the transition process. %B Nonprofit and Voluntary Sector Quarterly %V 45 %G eng %U http://nvs.sagepub.com/content/early/2015/08/26/0899764015602128.abstract %N 5 %4 older adult volunteer/paid work/retirement transition/formal volunteering %$ 999999 %R 10.1177/0899764015602128 %0 Journal Article %J The Gerontologist %D 2016 %T Service-Related Exposures and Physical Health Trajectories Among Aging Veteran Men %A Miles G Taylor %A Urena, Stephanie %A Ben Lennox Kail %K Demographics %K Healthcare %X PURPOSE OF THE STUDY: We examined the association of military service-related exposures (SREs) with physical health trajectories to establish whether combat and other hazards have lasting connections to health in later life. We also examined potential confounders and mechanisms to further understand the associations. DESIGN AND METHODS: We used the 2013 HRS Veterans Mail Survey linked to the longitudinal Health and Retirement Study (HRS) to examine military service experiences and health over a decade (2000-2010) among veteran men. We employed latent class analysis to disaggregate trajectories of health in later life. RESULTS: Most veteran men experienced good health over the decade. Although we found a connection between combat and later health, it was driven primarily by hazardous or traumatic exposures. Service-related disability, current health behaviors, and mental health were not likely explanations for these associations. IMPLICATIONS: The measurement of service experiences is primary in understanding health implications of military service and projecting the health service needs of aging veterans. SREs are varied and complex and have differential connections to health. These connections remain unexplained by current behaviors and mental health, suggesting the need to examine earlier life course pathways and mechanisms. %B The Gerontologist %I 56 %V 56 %P 92-103 %G eng %N 1 %4 health trajectories/health trajectories/military service/service related exposures/Combat exposure %$ 999999 %R 10.1093/geront/gnv662 %0 Journal Article %J Psychol Med %D 2016 %T Somatic, positive and negative domains of the Center for Epidemiological Studies Depression (CES-D) scale: a meta-analysis of genome-wide association studies. %A Demirkan, A %A J. Lahti %A Nese Direk %A Viktorin, A. %A Kathryn L Lunetta %A Antonio Terracciano %A Michael A Nalls %A Toshiko Tanaka %A Karin Hek %A Myriam Fornage %A Jürgen Wellmann %A Marilyn C Cornelis %A Ollila, H. M. %A Lei Yu %A Luke C Pilling %A Isaacs, A %A Aarno Palotie %A Wei Vivian Zhuang %A Alan B Zonderman %A Jessica Faul %A Angelina R Sutin %A Osorio Meirelles %A Mulas, A %A Hofman, A %A André G Uitterlinden %A Fernando Rivadeneira %A Markus Perola %A Wei Zhao %A Veikko Salomaa %A Kristine Yaffe %A Luik, A I %A Yongmei Liu %A Ding, J %A Paul Lichtenstein %A Landén, M %A Elisabeth Widen %A David R Weir %A David J Llewellyn %A Murray, A %A Sharon L R Kardia %A Johan G Eriksson %A Karestan C Koenen %A Patrik K E Magnusson %A Luigi Ferrucci %A Thomas H Mosley %A Francesco Cucca %A Ben A Oostra %A David A Bennett %A Paunio, T. %A Klaus Berger %A Tamara B Harris %A Nancy L Pedersen %A Joanne M Murabito %A Henning Tiemeier %A Cornelia M van Duijn %A Katri Räikkönen %K depression %K Depressive Disorder, Major %K Genome-Wide Association Study %K Humans %K Polymorphism, Single Nucleotide %K Receptor, Melatonin, MT1 %K Somatoform Disorders %X

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.

%B Psychol Med %V 46 %P 1613-23 %8 2016 06 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/26997408 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/26997408?dopt=Abstract %R 10.1017/S0033291715002081 %0 Journal Article %J The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2016 %T Subjective Age and Changes in Memory in Older Adults %A Yannick Stephan %A Angelina R Sutin %A Caudroit, Johan %A Antonio Terracciano %K Expectations %K Health Conditions and Status %X Objective. The subjective experience of aging, indexed by how old or young an individual feels, has been related to well-being and health-related outcomes among older adults. The present study examined whether subjective age is associated with memory level and changes, as indexed by measures of immediate and delayed recall. A complementary purpose was to test the mediating role of depressive symptoms and physical activity in the relation between subjective age and memory changes. Method. Participants were drawn from three waves of the Health and Retirement Study. Subjective age, baseline memory measures, and covariates were assessed during the 2008 wave (N = 5809), depressive symptoms and physical activity were assessed again in the 2010 wave, and the follow-up memory measures were assessed in the 2012 wave. Results. Regression analyses that included demographic, metabolic, and vascular covariates revealed that a younger subjective age at baseline was associated with better concurrent performance and with slower decline in immediate and delayed recall. Bootstrap procedures indicated that fewer depressive symptoms mediated these associations. Additional analyses revealed that memory level and change were unrelated to changes in subjective age. Conclusion. Beyond chronological age, the subjective experience of age is associated with cognitive aging. %B The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %V 71 %P 675-683 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/03/05/geronb.gbv010.abstract %N 4 %4 depression/Depressive Symptoms/memory/physical activity/subjective age/Cognition %$ 999999 %& 675 %R 10.1093/geronb/gbv010 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T Ten-Year Prevalence and Incidence of Urinary Incontinence in Older Women: A Longitudinal Analysis of the Health and Retirement Study. %A Erekson, Elisabeth A %A Cong, Xiangyu %A Mary K Townsend %A Ciarleglio, Maria M %K Aged %K Female %K Humans %K Incidence %K Longitudinal Studies %K Prevalence %K Prospective Studies %K Surveys and Questionnaires %K United States %K Urinary incontinence %X

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.

%B J Am Geriatr Soc %V 64 %P 1274-80 %8 2016 06 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27321606 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27321606?dopt=Abstract %R 10.1111/jgs.14088 %0 Conference Paper %D 2016 %T The Unintended Consequences of Informal Childcare Subsidies for Older Women ’ s Retirement Security %A Yulya Truskinovsky %K Childcare %K gender %K Gender Differences %K Retirement %K subsidies %X Grandmothers provide a significant amount of childcare in the US, but little is known about how this informal, and often uncompensated, time transfer impacts their economic and health outcomes. This project addresses the impact of federally funded, state-level means-tested programs that compensate grandparent-provided childcare on the retirement security of older women, an economically vulnerable group of considerable policy interest. Childcare assistance can be used to compensate grandparent-provided childcare and/or to substitute market care for grandparent care. I use the variation in the availability and generosity of childcare subsidies to model the effect of government payments for grandchild care on grandmothers’ time use, income, earnings, interfamily transfers, and health outcomes. After establishing that more generous government payments induce grandmothers to provide more hours of childcare, I find that grandmothers adjust their behavior by reducing their formal labor supply and earnings. Grandmothers make up for lost earnings by claiming Social Security earlier, increasing their reliance on Supplemental Security Income (SSI) and reducing financial transfers to their children. While the policy does not appear to negatively impact grandmothers’ immediate economic well-being, there are significant costs to the state, in terms of both up-front costs for care payments and long-term costs as a result of grandmothers’ increased reliance on social insurance. %G eng %U https://www.semanticscholar.org/paper/The-Unintended-Consequences-of-Informal-Childcare-%E2%80%99-Truskinovsky/41d55b106e1418a87eb13633d4acbeb3b5b0e62a %0 Journal Article %J Alzheimer Dis Assoc Disord %D 2016 %T Using an Alzheimer Disease Polygenic Risk Score to Predict Memory Decline in Black and White Americans Over 14 Years of Follow-up. %A Jessica R Marden %A Elizabeth R Mayeda %A Stefan Walter %A Vivot, Alexandre %A Tchetgen Tchetgen, Eric J %A Ichiro Kawachi %A M. Maria Glymour %K Alzheimer disease %K Black or African American %K ethnicity %K Female %K Follow-Up Studies %K Genome-Wide Association Study %K Humans %K Male %K Memory Disorders %K Middle Aged %K Risk Factors %K United States %K White People %X

Evidence on whether genetic predictors of Alzheimer disease (AD) also predict memory decline is inconsistent, and limited data are available for African ancestry populations. For 8253 non-Hispanic white (NHW) and non-Hispanic black (NHB) Health and Retirement Study participants with memory scores measured 1 to 8 times between 1998 and 2012 (average baseline age=62), we calculated weighted polygenic risk scores [AD Genetic Risk Score (AD-GRS)] using the top 22 AD-associated loci, and an alternative score excluding apolipoprotein E (APOE) (AD-GRSexAPOE). We used generalized linear models with AD-GRS-by-age and AD-GRS-by-age interactions (age centered at 70) to predict memory decline. Average NHB decline was 26% faster than NHW decline (P<0.001). Among NHW, 10% higher AD-GRS predicted faster memory decline (linear β=-0.058 unit decrease over 10 y; 95% confidence interval,-0.074 to -0.043). AD-GRSexAPOE also predicted faster decline for NHW, although less strongly. Among NHB, AD-GRS predicted faster memory decline (linear β=-0.050; 95% confidence interval, -0.106 to 0.006), but AD-GRSexAPOE did not. Our nonsignificant estimate among NHB may reflect insufficient statistical power or a misspecified AD-GRS among NHB as an overwhelming majority of genome-wide association studies are conducted in NHW. A polygenic score based on previously identified AD loci predicts memory loss in US blacks and whites.

%B Alzheimer Dis Assoc Disord %V 30 %P 195-202 %8 2016 Jul-Sep %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/26756387?dopt=Abstract %4 Gene Ontology/Diseases/Genes/Proteins %$ 999999 %R 10.1097/WAD.0000000000000137 %0 Journal Article %J J Health Soc Behav %D 2016 %T Using Multiple-hierarchy Stratification and Life Course Approaches to Understand Health Inequalities: The Intersecting Consequences of Race, Gender, SES, and Age. %A Tyson H Brown %A Liana J Richardson %A Taylor W. Hargrove %A Courtney S Thomas %K Age Factors %K Aged %K Aging %K Continental Population Groups %K Female %K Health Status Disparities %K Health Surveys %K Humans %K Male %K Middle Aged %K Sex Factors %K Social Class %K Socioeconomic factors %X

This study examines how the intersecting consequences of race-ethnicity, gender, socioeconomics status (SES), and age influence health inequality. We draw on multiple-hierarchy stratification and life course perspectives to address two main research questions. First, does racial-ethnic stratification of health vary by gender and/or SES? More specifically, are the joint health consequences of racial-ethnic, gender, and socioeconomic stratification additive or multiplicative? Second, does this combined inequality in health decrease, remain stable, or increase between middle and late life? We use panel data from the Health and Retirement Study (N = 12,976) to investigate between- and within-group differences in in self-rated health among whites, blacks, and Mexican Americans. Findings indicate that the effects of racial-ethnic, gender, and SES stratification are interactive, resulting in the greatest racial-ethnic inequalities in health among women and those with higher levels of SES. Furthermore, racial-ethnic/gender/SES inequalities in health tend to decline with age. These results are broadly consistent with intersectionality and aging-as-leveler hypotheses.

%B J Health Soc Behav %V 57 %P 200-22 %8 2016 06 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905600/ %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27284076?dopt=Abstract %R 10.1177/0022146516645165 %0 Journal Article %J The Lancet %D 2016 %T The World report on ageing and health: a policy framework for healthy ageing %A Beard, John R %A Officer, Alana %A de Carvalho, Islene Araujo %A Sadana, Ritu %A Pot, Anne Margriet %A Michel, Jean-Pierre %A Lloyd-Sherlock, Peter %A Epping-Jordan, JoAnne E %A G. M. E. E. Peeters %A Mahanani, Wahyu Retno %A Thiyagarajan, Jotheeswaran Amuthavalli %A Chatterji, Somnath %K Aging %K Life Expectancy %K Mortality %K Older Adults %X Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report. %B The Lancet %V 387 %P 2145 - 2154 %8 Jan-05-2016 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0140673615005164http://api.elsevier.com/content/article/PII:S0140673615005164?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0140673615005164?httpAccept=text/plain %N 10033 %! The Lancet %R 10.1016/S0140-6736(15)00516-4 %0 Journal Article %J J Am Heart Assoc %D 2015 %T Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults. %A Stefan Walter %A Eric J. Tchetgen Tchetgen %A Kristen K Patton %A J Robin Moon %A Benjamin D Capistrant %A Jessica R Marden %A Laura D Kubzansky %A Paola Gilsanz %A Ichiro Kawachi %A M. Maria Glymour %K Adult %K Aged %K Aged, 80 and over %K Aging %K depression %K Female %K Humans %K Incidence %K Longitudinal Studies %K Male %K Middle Aged %K Proportional Hazards Models %K Risk Factors %K Sex Factors %K Stroke %K Time Factors %X

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.

%B J Am Heart Assoc %I 4 %V 4 %8 2015 May 13 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25971438?dopt=Abstract %2 PMC4599421 %4 depressive Symptoms/stroke risk/CES Depression Scale/CES Depression Scale/depression/stroke %$ 999999 %R 10.1161/JAHA.115.001923 %0 Report %D 2015 %T Comparing Retirement Wealth Trajectories on Both Sides of the Pond %A Richard Blundell %A Crawford, Rowena %A Eric French %A Tetlow, Gemma %K Cross-National %K Income %K Older Adults %K Retirement Planning and Satisfaction %B Promoting research on retirement and Social Security policy %I Institute for Social Research %C Ann Arbor %G eng %U http://www.mrrc.isr.umich.edu/publications/briefs/pdf/rb333.pdf %9 Brief %0 Journal Article %J Journal of Pension Economics and Finance %D 2015 %T Debt literacy, financial experiences, and overindebtedness %A Annamaria Lusardi %A Peter Tufano %K Healthcare %K Methodology %K Net Worth and Assets %K Other %X We analyze a national sample of Americans with respect to their debt literacy, financial experiences, and their judgments about the extent of their indebtedness. Debt literacy is a component of broader financial understanding that measures knowledge about debt and self-assessed financial knowledge. Financial experiences are the participants' reported experiences with traditional borrowing, alternative borrowing, and investing. Overindebtedness is a self-reported measure. Debt literacy is low, with only about one-third of the population grasping the basics of interest compounding. Even after controlling for demographics, we find a relationship between debt literacy and both financial experiences and debt loads. Individuals with lower levels of debt literacy tend to transact in high-cost manners, incurring higher fees and using high-cost borrowing. We provide a rough estimate of the national implications of debt ignorance on credit card costs by consumers. Less knowledgeable individuals also report that their debt loads are excessive or that they are unable to judge their debt position. %B Journal of Pension Economics and Finance %I 14 %V 14 %P 332 %G eng %N 4 %4 debt loads/credit card borrowing/BEHAVIOR/numeracy/BUSINESS, FINANCE/DEFAULT/ECONOMICS/HOUSEHOLD FINANCE/Financial knowledge %$ 999999 %0 Report %D 2015 %T Declining Wealth and Work Among Male Veterans in the Health and Retirement Study %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Demographics %K Net Worth and Assets %X The composition, wealth and employment of male veterans and nonveterans are analyzed for four cohorts from the Health and Retirement Study, ages 51 to 56 in 1992, 1998, 2004 and 2010. Half of the men in the two oldest cohorts served in the military. Only 16 percent of the men in the youngest cohort, the only cohort subject to the All-Volunteer Military, served. One fifth to one third of the members of each cohort who served saw combat, mainly in Viet Nam and in the First Gulf War. Among those 51 to 56 in 1992, veterans were better educated, healthier, wealthier, and more likely to be working than nonveterans. By the 2010 cohort, 51 to 56 year old veterans had lost their educational advantage over nonveterans, were less healthy, less wealthy and less likely to be working. After standardizing in multiple regressions for the influence of major observable characteristics, for the original 1992 HRS cohort the wealth of veterans is no longer higher than the wealth of nonveterans. In contrast, the wealth of veterans from the youngest cohort, those 51 to 56 in 2010, remains about 10 to 13 percent below the wealth of nonveterans from that cohort. There also is a decline from older to younger cohorts of veterans compared to nonveterans in the probability of being not retired, of working more than 35 hours per week, and in the likelihood of holding a job for more than 10 years. Comparisons are made within the group of veterans by years of service, officer rank and other covariates. %I Cambridge, MA, National Bureau of Economic Research %G eng %4 veterans/Vietnam War/Gulf War/WEALTH %$ 999999 %0 Journal Article %J International Journal of Population Studies %D 2015 %T Diagnosis and control of hypertension in the elderly populations of Japan and the United States %A Saito, Yasuhiko %A Davarian, Shieva %A Takahashi, Atsuhiko %A Schneider, Edward %A Eileen M. Crimmins %K Blood pressure %K Cross-National %K Health Conditions and Status %K Heart disease %K Hypertension %K Older Adults %X The Japanese have the highest life expectancy in the world while the United States (U.S.) has relatively low life expectancy. Furthermore, the Americans have relatively poorer health compared to the Japanese. Examination of the treatment of specific conditions such as hypertension in these two countries may provide insights into how the health care system con-tributes to the relative health in these two countries. In this study, we focus on the treatment of hypertension, as this is the most common condition requiring therapeutic interventions in se-niors. This study examines hypertension diagnoses and controls in nationally representative samples of the older populations (68 years old or older) of Japan and the U.S. Data come from two nationally representative samples: the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) (n = 2,309) and the U.S. Health and Retirement (HRS) Study (n = 3,517). The overall prevalence of hypertension is higher in Japan than the U.S. Undiagnosed hyperten-sion is about four times higher in Japan than in the U.S., while the control of blood pressure is more than four times higher in the U.S. than in Japan. Thus, the use of antihypertensive medi-cation is much more frequent and more effective in the U.S. The medical care system seems to be more effective in controlling hypertension in the U.S. than in Japan. This may be due to the more aggressive diagnosis and treatment of hypertension in the U.S. %B International Journal of Population Studies %V 1 %P 19-28 %8 Jul-01-2016 %G eng %U http://ijps.whioce.com/index.php/ijps/article/view/01008 %R 10.18063/IJPS.2015.01.008 %0 Journal Article %J Soc Indic Res %D 2015 %T Dimensions of Subjective Well-Being. %A Arie Kapteyn %A Jinkook Lee %A Caroline Tassot %A Hana Vonkova %A Gema Zamarro %X

We use two waves of a population based survey (the RAND American Life Panel) to investigate the relations between various evaluative and experienced well-being measures based on the English Longitudinal Study of Aging, the Gallup Wellbeing Index, and a 12-item hedonic well-being module of the Health and Retirement Study. In a randomized set-up we administered several versions of the survey with different response scales. Using factor analysis, we find that all evaluative measures load on the same factor, but the positive and negative experienced affect measures load on different factors. We find evidence of an effect of response scales on both the estimated number of underlying factors and their relations with demographics. We conclude that finer response scales allowing more nuanced answers offer more reliability. The relation of evaluative and experienced measures with demographics are very different; perhaps the most striking aspect is the lack of a consistent relation of experienced well-being measures with income, while evaluative well-being is strongly positively related with income.

%B Soc Indic Res %I 123 %V 123 %P 625-660 %8 2015 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/26316674?dopt=Abstract %2 PMC4543406 %4 Life satisfaction/Life satisfaction/Response scales/Subjective well-being/ELSA_/cross-national comparison/hedonic well-being/Factor analysis/Income %$ 999999 %R 10.1007/s11205-014-0753-0 %0 Journal Article %J Nature %D 2015 %T Directional dominance on stature and cognition in diverse human populations. %A Joshi, Peter K %A Tõnu Esko %A Mattsson, Hannele %A Eklund, Niina %A Gandin, Ilaria %A Nutile, Teresa %A Jackson, Anne U %A Schurmann, Claudia %A Albert Vernon Smith %A Zhang, Weihua %A Okada, Yukinori %A Stančáková, Alena %A Jessica Faul %A Wei Zhao %A Traci M Bartz %A Maria Pina Concas %A Franceschini, Nora %A Enroth, Stefan %A Vitart, Veronique %A Trompet, Stella %A Guo, Xiuqing %A Daniel I Chasman %A Jeff O'Connell %A Corre, Tanguy %A Nongmaithem, Suraj S %A Chen, Yuning %A Mangino, Massimo %A Ruggiero, Daniela %A Traglia, Michela %A Farmaki, Aliki-Eleni %A Kacprowski, Tim %A Bjonnes, Andrew %A van der Spek, Ashley %A Wu, Ying %A Giri, Anil K %A Yanek, Lisa R %A Wang, Lihua %A Edith Hofer %A Cornelius A Rietveld %A McLeod, Olga %A Marilyn C Cornelis %A Pattaro, Cristian %A Verweij, Niek %A Baumbach, Clemens %A Abdel Abdellaoui %A Warren, Helen R %A Vuckovic, Dragana %A Mei, Hao %A Bouchard, Claude %A Perry, John R B %A Cappellani, Stefania %A Saira S Mirza %A Benton, Miles C %A Broeckel, Ulrich %A Sarah E Medland %A Penelope A Lind %A Malerba, Giovanni %A Alexander W Drong %A Yengo, Loic %A Bielak, Lawrence F %A Zhi, Degui %A van der Most, Peter J %A Daniel Shriner %A Mägi, Reedik %A Hemani, Gibran %A Karaderi, Tugce %A Wang, Zhaoming %A Tian Liu %A Demuth, Ilja %A Jing Hua Zhao %A Meng, Weihua %A Lataniotis, Lazaros %A van der Laan, Sander W %A Bradfield, Jonathan P %A Andrew R Wood %A Bonnefond, Amelie %A Ahluwalia, Tarunveer S %A Hall, Leanne M %A Salvi, Erika %A Yazar, Seyhan %A Carstensen, Lisbeth %A de Haan, Hugoline G %A Abney, Mark %A Afzal, Uzma %A Matthew A. Allison %A Amin, Najaf %A Asselbergs, Folkert W %A Bakker, Stephan J L %A Barr, R Graham %A Baumeister, Sebastian E %A Daniel J. Benjamin %A Bergmann, Sven %A Boerwinkle, Eric %A Erwin P Bottinger %A Campbell, Archie %A Chakravarti, Aravinda %A Chan, Yingleong %A Chanock, Stephen J %A Chen, Constance %A Yii-Der I Chen %A Collins, Francis S %A Connell, John %A Correa, Adolfo %A Cupples, L Adrienne %A Gail Davies %A Dörr, Marcus %A Georg B Ehret %A Ellis, Stephen B %A Feenstra, Bjarke %A Feitosa, Mary F %A Ford, Ian %A Caroline S Fox %A Timothy M Frayling %A Friedrich, Nele %A Geller, Frank %A Scotland, Generation %A Gillham-Nasenya, Irina %A Gottesman, Omri %A Graff, Misa %A Grodstein, Francine %A Gu, Charles %A Haley, Chris %A Hammond, Christopher J %A Sarah E Harris %A Tamara B Harris %A Nicholas D Hastie %A Heard-Costa, Nancy L %A Heikkilä, Kauko %A Lynne J Hocking %A Homuth, Georg %A Jouke-Jan Hottenga %A Huang, Jinyan %A Huffman, Jennifer E %A Hysi, Pirro G %A Mohammed Arfan Ikram %A Ingelsson, Erik %A Joensuu, Anni %A Johansson, Åsa %A Jousilahti, Pekka %A Jukema, J Wouter %A Kähönen, Mika %A Kamatani, Yoichiro %A Kanoni, Stavroula %A Kerr, Shona M %A Khan, Nazir M %A Philipp D Koellinger %A Koistinen, Heikki A %A Kooner, Manraj K %A Kubo, Michiaki %A Kuusisto, Johanna %A Lahti, Jari %A Lenore J Launer %A Lea, Rodney A %A Lehne, Benjamin %A Lehtimäki, Terho %A David C Liewald %A Lars Lind %A Loh, Marie %A Lokki, Marja-Liisa %A London, Stephanie J %A Loomis, Stephanie J %A Loukola, Anu %A Lu, Yingchang %A Lumley, Thomas %A Lundqvist, Annamari %A Männistö, Satu %A Marques-Vidal, Pedro %A Masciullo, Corrado %A Matchan, Angela %A Mathias, Rasika A %A Matsuda, Koichi %A Meigs, James B %A Meisinger, Christa %A Meitinger, Thomas %A Menni, Cristina %A Mentch, Frank D %A Mihailov, Evelin %A Lili Milani %A Montasser, May E %A Grant W Montgomery %A Alanna C Morrison %A Myers, Richard H %A Nadukuru, Rajiv %A Navarro, Pau %A Nelis, Mari %A Nieminen, Markku S %A Ilja M Nolte %A O'Connor, George T %A Ogunniyi, Adesola %A Padmanabhan, Sandosh %A Walter R Palmas %A Pankow, James S %A Patarcic, Inga %A Pavani, Francesca %A Peyser, Patricia A %A Pietilainen, Kirsi %A Neil Poulter %A Prokopenko, Inga %A Ralhan, Sarju %A Redmond, Paul %A Rich, Stephen S %A Rissanen, Harri %A Robino, Antonietta %A Rose, Lynda M %A Rose, Richard %A Cinzia Felicita Sala %A Babatunde Salako %A Veikko Salomaa %A Sarin, Antti-Pekka %A Saxena, Richa %A Schmidt, Helena %A Scott, Laura J %A Scott, William R %A Sennblad, Bengt %A Seshadri, Sudha %A Peter Sever %A Shrestha, Smeeta %A Smith, Blair H %A Jennifer A Smith %A Soranzo, Nicole %A Sotoodehnia, Nona %A Southam, Lorraine %A Stanton, Alice V %A Stathopoulou, Maria G %A Strauch, Konstantin %A Strawbridge, Rona J %A Suderman, Matthew J %A Tandon, Nikhil %A Tang, Sian-Tsun %A Kent D Taylor %A Bamidele O Tayo %A Töglhofer, Anna Maria %A Tomaszewski, Maciej %A Tšernikova, Natalia %A Tuomilehto, Jaakko %A André G Uitterlinden %A Vaidya, Dhananjay %A van Hylckama Vlieg, Astrid %A van Setten, Jessica %A Vasankari, Tuula %A Vedantam, Sailaja %A Vlachopoulou, Efthymia %A Vozzi, Diego %A Vuoksimaa, Eero %A Waldenberger, Melanie %A Erin B Ware %A Wentworth-Shields, William %A Whitfield, John B %A Sarah Wild %A Gonneke Willemsen %A Yajnik, Chittaranjan S %A Yao, Jie %A Zaza, Gianluigi %A Zhu, Xiaofeng %A Salem, Rany M %A Melbye, Mads %A Bisgaard, Hans %A Nilesh J Samani %A Cusi, Daniele %A Mackey, David A %A Cooper, Richard S %A Froguel, Philippe %A Pasterkamp, Gerard %A Grant, Struan F A %A Hakonarson, Hakon %A Luigi Ferrucci %A Scott, Robert A %A Morris, Andrew D %A Palmer, Colin N A %A George Dedoussis %A Deloukas, Panos %A Bertram, Lars %A Lindenberger, Ulman %A Berndt, Sonja I %A Lindgren, Cecilia M %A Nicholas J Timpson %A Tönjes, Anke %A Munroe, Patricia B %A Thorkild I. A. Sørensen %A Charles N Rotimi %A Donna K Arnett %A Oldehinkel, Albertine J %A Sharon L R Kardia %A Balkau, Beverley %A Gambaro, Giovanni %A Morris, Andrew P %A Johan G Eriksson %A Margaret J Wright %A Nicholas G Martin %A Hunt, Steven C %A John M Starr %A Ian J Deary %A Griffiths, Lyn R %A Henning Tiemeier %A Nicola Pirastu %A Kaprio, Jaakko %A Wareham, Nicholas J %A Pérusse, Louis %A Wilson, James G %A Giorgia G Girotto %A Caulfield, Mark J %A Olli T Raitakari %A Dorret I Boomsma %A Gieger, Christian %A van der Harst, Pim %A Hicks, Andrew A %A Kraft, Peter %A Sinisalo, Juha %A Knekt, Paul %A Johannesson, Magnus %A Patrik K E Magnusson %A Hamsten, Anders %A Schmidt, Reinhold %A Ingrid B Borecki %A Vartiainen, Erkki %A Becker, Diane M %A Bharadwaj, Dwaipayan %A Mohlke, Karen L %A Boehnke, Michael %A Cornelia M van Duijn %A Sanghera, Dharambir K %A Teumer, Alexander %A Zeggini, Eleftheria %A Andres Metspalu %A Paolo P. Gasparini %A Ulivi, Sheila %A Ober, Carole %A Toniolo, Daniela %A Rudan, Igor %A David J Porteous %A Ciullo, Marina %A Timothy Spector %A Caroline Hayward %A Dupuis, Josée %A Ruth J F Loos %A Alan F Wright %A Chandak, Giriraj R %A Vollenweider, Peter %A Alan R Shuldiner %A Ridker, Paul M %A Rotter, Jerome I %A Sattar, Naveed %A Gyllensten, Ulf %A Kari E North %A Pirastu, Mario %A Psaty, Bruce M %A David R Weir %A Laakso, Markku %A Gudnason, Vilmundur %A Takahashi, Atsushi %A Chambers, John C %A Kooner, Jaspal S %A David P Strachan %A Campbell, Harry %A Joel N Hirschhron %A Markus Perola %A Polasek, Ozren %A James F Wilson %K Biological Evolution %K Blood pressure %K Body Height %K Cholesterol %K Cognitive Ability %K Cohort Studies %K Education %K Female %K Forced Expiratory Volume %K Genome %K Homozygote %K Humans %K Lung Volume Measurements %K Male %K Phenotype %X

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

%B Nature %V 523 %P 459-62 %8 2015 Jul 23 %G eng %N 7561 %1 http://www.ncbi.nlm.nih.gov/pubmed/26131930?dopt=Abstract %R 10.1038/nature14618 %0 Journal Article %J Diabetes Care %D 2015 %T Disability-Free Life-Years Lost Among Adults Aged ≥50 Years, With and Without Diabetes %A Barbara H. Bardenheier %A Ji Lin %A Zhuo, Xiaohui %A Mohammed K. Ali %A Theodore J Thompson %A Yiling J. Cheng %A Edward W Gregg %K Health Conditions and Status %K Methodology %X OBJECTIVE Quantify the impact of diabetes status on healthy and disabled years of life for older adults in the U.S. and provide a baseline from which to evaluate ongoing national public health efforts to prevent and control diabetes and disability.RESEARCH DESIGN AND METHODS Adults (n = 20,008) aged 50 years and older were followed from 1998 to 2012 in the Health and Retirement Study, a prospective biannual survey of a nationally representative sample of adults. Diabetes and disability status (defined by mobility loss, difficulty with instrumental activities of daily living IADL , and/or difficulty with activities of daily living ADL ) were self-reported. We estimated incidence of disability, remission to nondisability, and mortality. We developed a discrete-time Markov simulation model with a 1-year transition cycle to predict and compare lifetime disability-related outcomes between people with and without diabetes. Data represent the U.S. population in 1998.RESULTS From age 50, adults with diabetes died 4.6 years earlier, developed disability 6 7 years earlier, and spent about 1 2 more years in a disabled state than adults without diabetes. With increasing baseline age, diabetes was associated with significant (P 0.05) reductions in the number of total and disability-free life-years, but the absolute difference in years between those with and without diabetes was less than at younger baseline age. Men with diabetes spent about twice as much of their remaining years disabled (20 24 of remaining life across the three disability definitions) as men without diabetes (12 16 of remaining life across the three disability definitions). Similar associations between diabetes status and disability-free and disabled years were observed among women.CONCLUSIONS Diabetes is associated with a substantial reduction in nondisabled years, to a greater extent than the reduction of longevity. %B Diabetes Care %G eng %U http://care.diabetesjournals.org/content/early/2015/12/17/dc15-1095.abstract %4 Diabetes/methodology/Disabilities/Longevity %$ 999999 %R 10.2337/dc15-1095 %0 Journal Article %J J Gen Intern Med %D 2015 %T Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012. %A Stephanie E Rogers %A Angela D Thrasher %A Yinghui Miao %A W John Boscardin %K Activities of Daily Living %K Aged %K Ageism %K Aging %K Disabled Persons %K Female %K Follow-Up Studies %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Surveys and Questionnaires %X

BACKGROUND: As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.

OBJECTIVE: We aimed to examine the relationship between healthcare discrimination and new or worsened disability.

DESIGN: This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.

PARTICIPANTS: Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study.

MAIN MEASURES: Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.

KEY RESULTS: In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 % CI 1.16-2.27).

CONCLUSIONS: One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.

%B J Gen Intern Med %I 30 %V 30 %P 1413-20 %8 2015 Oct %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84924662760andpartnerID=40andmd5=4aaf0227e962a58fb0e6670d3d3c6bff %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/25773918?dopt=Abstract %2 PMC4579241 %4 health Care Use/discrimination/health outcomes/health care discrimination/Cox proportional hazards model %$ 999999 %R 10.1007/s11606-015-3233-6 %0 Journal Article %J Journal of the American Geriatrics Society %D 2015 %T Does Mode of Contact with Different Types of Social Relationships Predict Depression in Older Adults? Evidence from a Nationally Representative Survey %A Alan R Teo %A Choi, Hwajung %A Sarah B. Andrea %A Marcia A. Valenstein %A Jason T Newsom %A Dobscha, Steven K. %A Zivin, Kara %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %X ObjectivesTo determine associations between use of three different modes of social contact (in person, telephone, written or e-mail), contact with different types of people, and risk of depressive symptoms in a nationally representative, longitudinal sample of older adults. DesignPopulation-based observational cohort. SettingUrban and suburban communities throughout the contiguous United States. ParticipantsIndividuals aged 50 and older who participated in the Health and Retirement Survey between 2004 and 2010 (N = 11,065). MeasurementsFrequency of participant use of the three modes of social contact with children, other family members, and friends at baseline were used to predict depressive symptoms (measured using the eight-item Center for Epidemiologic Studies Depression Scale) 2 years later using multivariable logistic regression models. ResultsProbability of having depressive symptoms steadily increased as frequency of in-personbut not telephone or written or e-mail contactdecreased. After controlling for demographic, clinical, and social variables, individuals with in-person social contact every few months or less with children, other family, and friends had a significantly higher probability of clinically significant depressive symptoms 2 years later (11.5 ) than those having in-person contact once or twice per month (8.1 ; P .001) or once or twice per week (7.3 ; P .001). Older age, interpersonal conflict, and depression at baseline moderated some of the effects of social contact on depressive symptoms. ConclusionFrequency of in-person social contact with friends and family independently predicts risk of subsequent depression in older adults. Clinicians should consider encouraging face-to-face social interactions as a preventive strategy for depression. %B Journal of the American Geriatrics Society %I 63 %V 63 %P 2014 %G eng %N 10 %4 social isolation/in-person/telephone/face-to-face/e-mail/written/in person/face to face/e mail/GERIATRICS/GERONTOLOGY/TRIAL/RETIREMENT/THERAPY/HEALTH/LONELINESS/NETWORKS/OUTCOMES/GERONTOLOGY/Surveys/Social aspects/Depression, Mental/Older people/Social interaction/Geriatric psychology/Mental depression %$ 999999 %0 Book Section %B Challenges of Latino Aging in the Americas %D 2015 %T The Economic Security of Latino Baby Boomers: Implications for Future Retirees and for Healthcare Funding in the U.S. %A Zachary Gassoumis %A Kathleen H. Wilber %A Torres-Gil, Fernando M. %E William A. Vega %E Kyriakos S Markides %E Jacqueline L. Angel %E Torres-Gil, Fernando M. %K Consumption and Savings %K Healthcare %K Net Worth and Assets %K Public Policy %K Women and Minorities %B Challenges of Latino Aging in the Americas %I Springer %C New York %P 355-378 %G eng %4 health Care Costs/Latinos/economic security/Public Policy/economic disparity %$ 999999 %! The Economic Security of Latino Baby Boomers: Implications for Future Retirees and for Healthcare Funding in the U.S. %& 21 %0 Journal Article %J Alzheimers Dement (Amst) %D 2015 %T Educational inequalities in aging-related declines in fluid cognition and the onset of cognitive pathology. %A Sean A. P. Clouston %A M. Maria Glymour %A Graciela Muñiz Terrera %X

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.

%B Alzheimers Dement (Amst) %I 1 %V 1 %P 303-310 %8 2015 Sep 01 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84939130794andpartnerID=40andmd5=218306a4a3716a17f4bc7aca7963272c %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/26309906?dopt=Abstract %2 PMC4542007 %4 Aging/Cognitive reserve/Dementia/Educational status/Neurology/Social medicine %$ 999999 %R 10.1016/j.dadm.2015.06.001 %0 Journal Article %J Dementia and Geriatric Cognitive Disorders %D 2015 %T Estimating the Cognitive Effects of Prevalent Diabetes, Recent Onset Diabetes, and the Duration of Diabetes among Older Adults %A Bei Wu %A Eric J. Tchetgen Tchetgen %A Theresa L Osypuk %A Weuve, Jennifer %A White, Kellee %A Mujahid, Mahasin %A M. Maria Glymour %K Health Conditions and Status %X Background: Little evidence is available on the effects of incident diabetes or diabetes duration on cognitive aging. Methods: We evaluated the effects of prevalent and incident diabetes on deteriorations in cognitive function, based on participants (n = 8,671) aged 65 in the Health and Retirement Study in 2000. Inverse probability weighting was used to account for selective attrition and time-varying confounding of incident diabetes. Results: Prevalent diabetes predicted higher odds of dementia odds ratio 1.27; 95 confidence interval (CI) 1.03-1.58 and worse memory (-0.06 in z-score units; 95 CI -0.10 to -0.02), but incident diabetes or diabetes duration up to 8 years of follow-up was not predictive. Conclusion: Prevalent diabetes predicted lower cognition but not recent onset diabetes. (C) 2015 S. Karger AG, Basel %B Dementia and Geriatric Cognitive Disorders %I 39 %V 39 %P 239-249 %G eng %N 3-4 %4 Diabetes/Cognitive Function/Dementia %$ 999999 %R 10.1159/000368654 %0 Journal Article %J Mol Psychiatry %D 2015 %T FASTKD2 is associated with memory and hippocampal structure in older adults. %A Vijay K Ramanan %A Nho, Kwangsik %A Shen, Li %A Shannon L Risacher %A Brenna C McDonald %A Martin R Farlow %A Tatiana Foroud %A Gao, Sujuan %A Soininen, Hilkka %A Kloszewska, Iwona %A Mecocci, Patrizia %A Tsolaki, Magda %A Vellas, Bruno %A Lovestone, Simon %A Aisen, Paul S. %A Ronald C Petersen %A Jack, Clifford R. %A Shaw, Leslie M. %A Trojanowski, John Q. %A Weiner, Michael W. %A Green, Robert C. %A Arthur W. Toga %A Philip L de Jager %A Lei Yu %A David A Bennett %A Andrew J Saykin %K Age Factors %K Aged %K Aged, 80 and over %K Alzheimer disease %K Female %K Genetic Association Studies %K Genome-Wide Association Study %K Hippocampus %K Humans %K Longitudinal Studies %K Male %K Memory %K Memory Disorders %K Polymorphism, Single Nucleotide %K Protein-Serine-Threonine Kinases %K Structure-Activity Relationship %X

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

%B Mol Psychiatry %I 20 %V 20 %P 1197-204 %8 2015 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/25385369?dopt=Abstract %2 PMC4427556 %4 Genetic analysis/Alzheimer disease/Memory impairment/predictors/FASTKD2 %$ 999999 %R 10.1038/mp.2014.142 %0 Journal Article %J Age %D 2015 %T Feeling younger, walking faster : subjective age and walking speed in older adults %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Demographics %K Expectations %K Health Conditions and Status %X Walking speed is a key vital sign in older people. Given the implications of slower gait speed, a large literature has identified health-related, behavioral, cognitive, and biological factors that moderate age-related decline in mobility. The present study aims to contribute to existing knowledge by examining whether subjective age, how old or young individuals experience themselves to be relative to their chronological age, contributes to walking speed. Participants were drawn from the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 2970) and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 5423). In both the HRS and the NHATS, linear regression analysis revealed that a younger subjective age was associated with faster walking speed at baseline and with less decline over time, controlling for age, sex, education, and race. These associations were partly accounted for by depressive symptoms, disease burden, physical activity, cognition, body mass index, and smoking. Additional analysis revealed that feeling younger than one s age was associated with a reduced risk of walking slower than the frailty-related threshold of 0.6 m/s at follow-up in the HRS. The present study provides novel and consistent evidence across two large prospective studies for an association between the subjective experience of age and walking speed of older adults. Subjective age may help identify individuals at risk for mobility limitations in old age and may be a target for interventions designed to mitigate functional decline. 2015, American Aging Association. %B Age %I 37 %V 37 %P 9830-9830 %G eng %N 5 %4 Mobility/Subjective age/Walking speed %$ 999999 %R 10.1007/s11357-015-9830-9 %0 Journal Article %J Womens Health Issues %D 2015 %T Gender Differences in Institutional Long-Term Care Transitions. %A Mudrazija, Stipica %A Thomeer, Mieke Beth %A Jacqueline L. Angel %K Aged %K Aged, 80 and over %K Continuity of Patient Care %K Family Characteristics %K Female %K Geriatric Assessment %K Home Care Services %K Humans %K Length of Stay %K Logistic Models %K Long-term Care %K Male %K Marital Status %K Middle Aged %K Nursing homes %K Patient Discharge %K Residence Characteristics %K Sex Characteristics %K United States %X

INTRODUCTION: This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics.

METHODS: We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n = 3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models.

RESULTS: Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements.

CONCLUSION: Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs.

%B Womens Health Issues %I 25 %V 25 %P 441-9 %8 2015 Sep-Oct %G eng %U http://www.sciencedirect.com/science/article/pii/S1049386715000638 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26123639?dopt=Abstract %2 PMC4569522 %4 Long Term Care/discharge likelihood/discharge planning/sociodemographic differences/sociodemographic differences/LTC discharge %$ 999999 %R 10.1016/j.whi.2015.04.010 %0 Journal Article %J Nature %D 2015 %T Genetic studies of body mass index yield new insights for obesity biology. %A Locke, Adam E %A Kahali, Bratati %A Berndt, Sonja I %A Justice, Anne E %A Pers, Tune H %A Day, Felix R %A Powell, Corey %A Vedantam, Sailaja %A Buchkovich, Martin L %A Yang, Jian %A Croteau-Chonka, Damien C %A Tõnu Esko %A Fall, Tove %A Ferreira, Teresa %A Gustafsson, Stefan %A Kutalik, Zoltán %A Luan, Jian'an %A Mägi, Reedik %A Randall, Joshua C %A Thomas W Winkler %A Andrew R Wood %A Workalemahu, Tsegaselassie %A Jessica Faul %A Jennifer A Smith %A Jing Hua Zhao %A Wei Zhao %A Chen, Jin %A Rudolf Ferhmann %A Hedman, Åsa K %A Karjalainen, Juha %A Schmidt, Ellen M %A Absher, Devin %A Amin, Najaf %A Anderson, Denise %A Beekman, Marian %A Bolton, Jennifer L %A Bragg-Gresham, Jennifer L %A Buyske, Steven %A Demirkan, Ayse %A Deng, Guohong %A Georg B Ehret %A Feenstra, Bjarke %A Feitosa, Mary F %A Fischer, Krista %A Goel, Anuj %A Gong, Jian %A Jackson, Anne U %A Kanoni, Stavroula %A Kleber, Marcus E %A Kristiansson, Kati %A Lim, Unhee %A Lotay, Vaneet %A Mangino, Massimo %A Irene Mateo Leach %A Medina-Gomez, Carolina %A Sarah E Medland %A Michael A Nalls %A Palmer, Cameron D %A Pasko, Dorota %A Pechlivanis, Sonali %A Peters, Marjolein J %A Prokopenko, Inga %A Shungin, Dmitry %A Stančáková, Alena %A Strawbridge, Rona J %A Yun Ju Sung %A Toshiko Tanaka %A Teumer, Alexander %A Trompet, Stella %A van der Laan, Sander W %A van Setten, Jessica %A Jana V. van Vliet-Ostaptchouk %A Wang, Zhaoming %A Yengo, Loic %A Zhang, Weihua %A Isaacs, Aaron %A Albrecht, Eva %A Ärnlöv, Johan %A Arscott, Gillian M %A Attwood, Antony P %A Bandinelli, Stefania %A Barrett, Amy %A Bas, Isabelita N %A Bellis, Claire %A Bennett, Amanda J %A Berne, Christian %A Blagieva, Roza %A Blüher, Matthias %A Böhringer, Stefan %A Bonnycastle, Lori L %A Böttcher, Yvonne %A Boyd, Heather A %A Bruinenberg, Marcel %A Caspersen, Ida H %A Yii-Der I Chen %A Robert Clark %A Daw, E Warwick %A de Craen, Anton J M %A Delgado, Graciela %A Dimitriou, Maria %A Doney, Alex S F %A Eklund, Niina %A Estrada, Karol %A Eury, Elodie %A Folkersen, Lasse %A Fraser, Ross M %A Melissa E Garcia %A Geller, Frank %A Giedraitis, Vilmantas %A Gigante, Bruna %A Alan S Go %A Golay, Alain %A Goodall, Alison H %A Gordon, Scott D %A Gorski, Mathias %A Hans-Jörgen Grabe %A Grallert, Harald %A Grammer, Tanja B %A Gräßler, Jürgen %A Grönberg, Henrik %A Groves, Christopher J %A Gusto, Gaëlle %A Jeffrey Haessler %A Hall, Per %A Haller, Toomas %A Hallmans, Göran %A Catharina A Hartman %A Hassinen, Maija %A Caroline Hayward %A Heard-Costa, Nancy L %A Helmer, Quinta %A Hengstenberg, Christian %A Oddgeir L Holmen %A Jouke-Jan Hottenga %A James, Alan L %A Janina Jeff %A Johansson, Åsa %A Jolley, Jennifer %A Juliusdottir, Thorhildur %A Kinnunen, Leena %A Koenig, Wolfgang %A Koskenvuo, Markku %A Kratzer, Wolfgang %A Laitinen, Jaana %A Lamina, Claudia %A Leander, Karin %A Lee, Nanette R %A Lichtner, Peter %A Lars Lind %A Lindström, Jaana %A Ken Sin Lo %A Lobbens, Stéphane %A Lorbeer, Roberto %A Lu, Yingchang %A Mach, François %A Patrik K E Magnusson %A Mahajan, Anubha %A McArdle, Wendy L %A McLachlan, Stela %A Menni, Cristina %A Merger, Sigrun %A Mihailov, Evelin %A Lili Milani %A Moayyeri, Alireza %A Monda, Keri L %A Morken, Mario A %A Mulas, Antonella %A Müller, Gabriele %A Müller-Nurasyid, Martina %A Musk, Arthur W %A Nagaraja, Ramaiah %A Markus M Nöthen %A Ilja M Nolte %A Pilz, Stefan %A Nigel W Rayner %A Renstrom, Frida %A Rettig, Rainer %A Ried, Janina S %A Ripke, Stephan %A Neil R Robertson %A Rose, Lynda M %A Sanna, Serena %A Scharnagl, Hubert %A Scholtens, Salome %A Schumacher, Fredrick R %A Scott, William R %A Seufferlein, Thomas %A Jianxin Shi %A Albert Vernon Smith %A Smolonska, Joanna %A Stanton, Alice V %A Steinthorsdottir, Valgerdur %A Kathleen E Stirrups %A Heather M Stringham %A Sundström, Johan %A Swertz, Morris A %A Swift, Amy J %A Syvänen, Ann-Christine %A Tan, Sian-Tsung %A Bamidele O Tayo %A Thorand, Barbara %A Thorleifsson, Gudmar %A Tyrer, Jonathan P %A Uh, Hae-Won %A Vandenput, Liesbeth %A Verhulst, Frank C %A Vermeulen, Sita H %A Verweij, Niek %A Vonk, Judith M %A Lindsay L Waite %A Warren, Helen R %A Dawn M Waterworth %A Michael N Weedon %A Wilkens, Lynne R %A Willenborg, Christina %A Wilsgaard, Tom %A Wojczynski, Mary K %A Wong, Andrew %A Alan F Wright %A Zhang, Qunyuan %A Brennan, Eoin P %A Murim Choi %A Dastani, Zari %A Alexander W Drong %A Eriksson, Per %A Franco-Cereceda, Anders %A Gådin, Jesper R %A Gharavi, Ali G %A Goddard, Michael E %A Handsaker, Robert E %A Huang, Jinyan %A Karpe, Fredrik %A Kathiresan, Sekar %A Keildson, Sarah %A Kiryluk, Krzysztof %A Kubo, Michiaki %A Lee, Jong-Young %A Liang, Liming %A Lifton, Richard P %A Ma, Baoshan %A McCarroll, Steven A %A McKnight, Amy J %A Min, Josine L %A Moffatt, Miriam F %A Grant W Montgomery %A Joanne M Murabito %A Nicholson, George %A Nyholt, Dale R %A Okada, Yukinori %A Perry, John R B %A Dorajoo, Rajkumar %A Reinmaa, Eva %A Salem, Rany M %A Sandholm, Niina %A Scott, Robert A %A Stolk, Lisette %A Takahashi, Atsushi %A Tanaka, Toshihiro %A Ferdinand M van 't Hooft %A Anna A E Vinkhuyzen %A Westra, Harm-Jan %A Wei Zhang %A Krina T Zondervan %A Andrew C Heath %A Arveiler, Dominique %A Bakker, Stephan J L %A Beilby, John %A Bergman, Richard N %A Blangero, John %A Bovet, Pascal %A Campbell, Harry %A Caulfield, Mark J %A Cesana, Giancarlo %A Chakravarti, Aravinda %A Daniel I Chasman %A Chines, Peter S %A Collins, Francis S %A Crawford, Dana C %A Cupples, L Adrienne %A Cusi, Daniele %A Danesh, John %A de Faire, Ulf %A Hester M den Ruijter %A Dominiczak, Anna F %A Erbel, Raimund %A Erdmann, Jeanette %A Johan G Eriksson %A Farrall, Martin %A Felix, Stephan B %A Ferrannini, Ele %A Ferrières, Jean %A Ford, Ian %A Forouhi, Nita G %A Forrester, Terrence %A Franco, Oscar H %A Gansevoort, Ron T %A Gejman, Pablo V %A Gieger, Christian %A Gottesman, Omri %A Gudnason, Vilmundur %A Gyllensten, Ulf %A Hall, Alistair S %A Tamara B Harris %A Andrew T Hattersley %A Hicks, Andrew A %A Hindorff, Lucia A %A Aroon Hingorani %A Hofman, Albert %A Homuth, Georg %A Hovingh, G Kees %A Humphries, Steve E %A Hunt, Steven C %A Hyppönen, Elina %A Illig, Thomas %A Jacobs, Kevin B %A Järvelin, Marjo-Riitta %A Jöckel, Karl-Heinz %A Johansen, Berit %A Jousilahti, Pekka %A Jukema, J Wouter %A Jula, Antti M %A Kaprio, Jaakko %A Kastelein, John J P %A Keinanen-Kiukaanniemi, Sirkka M %A Lambertus A Kiemeney %A Knekt, Paul %A Kooner, Jaspal S %A Charles Kooperberg %A Kovacs, Peter %A Kraja, Aldi T %A Kumari, Meena %A Kuusisto, Johanna %A Lakka, Timo A %A Langenberg, Claudia %A Loic Le Marchand %A Lehtimäki, Terho %A Lyssenko, Valeriya %A Männistö, Satu %A Marette, André %A Matise, Tara C %A McKenzie, Colin A %A McKnight, Barbara %A Moll, Frans L %A Morris, Andrew D %A Morris, Andrew P %A Murray, Jeffrey C %A Nelis, Mari %A Ohlsson, Claes %A Oldehinkel, Albertine J %A Ong, Ken K %A Pamela A F Madden %A Pasterkamp, Gerard %A Peden, John F %A Peters, Annette %A Postma, Dirkje S %A Pramstaller, Peter P %A Price, Jackie F %A Qi, Lu %A Olli T Raitakari %A Rankinen, Tuomo %A Rao, D C %A Rice, Treva K %A Ridker, Paul M %A Rioux, John D %A Ritchie, Marylyn D %A Rudan, Igor %A Veikko Salomaa %A Nilesh J Samani %A Saramies, Jouko %A Sarzynski, Mark A %A Schunkert, Heribert %A Schwarz, Peter E H %A Peter Sever %A Alan R Shuldiner %A Sinisalo, Juha %A Stolk, Ronald P %A Strauch, Konstantin %A Tönjes, Anke %A Trégouët, David-Alexandre %A Tremblay, Angelo %A Tremoli, Elena %A Virtamo, Jarmo %A Vohl, Marie-Claude %A Völker, Uwe %A Waeber, Gérard %A Gonneke Willemsen %A Witteman, Jacqueline C %A Zillikens, M Carola %A Adair, Linda S %A Amouyel, Philippe %A Asselbergs, Folkert W %A Assimes, Themistocles L %A Bochud, Murielle %A Boehm, Bernhard O %A Boerwinkle, Eric %A Bornstein, Stefan R %A Erwin P Bottinger %A Bouchard, Claude %A Cauchi, Stéphane %A Chambers, John C %A Chanock, Stephen J %A Cooper, Richard S %A de Bakker, Paul I W %A George Dedoussis %A Luigi Ferrucci %A Franks, Paul W %A Froguel, Philippe %A Leif C Groop %A Christopher A Haiman %A Hamsten, Anders %A Hui, Jennie %A Hunter, David J %A Hveem, Kristian %A Kaplan, Robert C %A Mika Kivimäki %A Kuh, Diana %A Laakso, Markku %A Yongmei Liu %A Nicholas G Martin %A März, Winfried %A Melbye, Mads %A Andres Metspalu %A Moebus, Susanne %A Munroe, Patricia B %A Njølstad, Inger %A Ben A Oostra %A Palmer, Colin N A %A Nancy L Pedersen %A Markus Perola %A Pérusse, Louis %A Peters, Ulrike %A Power, Chris %A Quertermous, Thomas %A Rauramaa, Rainer %A Fernando Rivadeneira %A Saaristo, Timo E %A Saleheen, Danish %A Sattar, Naveed %A Eric E Schadt %A Schlessinger, David %A Eline P Slagboom %A Snieder, Harold %A Timothy Spector %A Thorsteinsdottir, Unnur %A Stumvoll, Michael %A Tuomilehto, Jaakko %A André G Uitterlinden %A Uusitupa, Matti %A van der Harst, Pim %A Walker, Mark %A Wallaschofski, Henri %A Wareham, Nicholas J %A Watkins, Hugh %A David R Weir %A Wichmann, H-Erich %A James F Wilson %A Zanen, Pieter %A Ingrid B Borecki %A Deloukas, Panos %A Caroline S Fox %A Iris M Heid %A Jeff O'Connell %A David P Strachan %A Stefansson, Kari %A Cornelia M van Duijn %A Gonçalo R Abecasis %A Lude L Franke %A Timothy M Frayling %A McCarthy, Mark I %A Peter M Visscher %A Scherag, Andre %A Willer, Cristen J %A Boehnke, Michael %A Mohlke, Karen L %A Lindgren, Cecilia M %A Beckmann, Jacques S %A Barroso, Inês %A Kari E North %A Ingelsson, Erik %A Joel N Hirschhron %A Ruth J F Loos %A Elizabeth K Speliotes %K Age Factors %K BMI %K Continental Population Groups %K Energy Metabolism %K Europe %K Female %K Genome-Wide Association Study %K Glutamic Acid %K Humans %K Insulin %K Male %K Obesity %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %K Synapses %X

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

%B Nature %V 518 %P 197-206 %8 2015 Feb 12 %G eng %N 7538 %1 http://www.ncbi.nlm.nih.gov/pubmed/25673413?dopt=Abstract %R 10.1038/nature14177 %0 Report %D 2015 %T The Great Recession, Retirement and Related Outcomes %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Employment and Labor Force %K Expectations %K Public Policy %X This paper uses data from the Health and Retirement Study to examine retirement and related labor market outcomes for the Early Boomer cohort, those in their mid-fifties at the onset of the Great Recession. Outcomes are then compared with older cohorts at the same age. The Great Recession increased their probability of being laid off and the length of time it took to find other full-time employment. Differences in layoffs between those affected by the recession and members of older cohorts in turn accounted for almost the entire difference between cohorts in employment change with age. The Great Recession does not appear, however, to have depressed the wages in subsequent jobs for those who experienced a layoff. In 2010, 17 percent of the Early Boomers were Not Working and Not Retired or Partially Retired, and 6 percent were unemployed, leaving at least 9 percent who were not working and not unemployed but not retired or only partially retired. At the recession s peak, half of those who experienced a layoff ended up in the Not Retired or Partially Retired, Not Working category. But only a quarter of those who declared themselves to be Not Retired or Partially Retired, and were Not Working, had experienced a layoff. Most of the jump in Not Retired or Partially Retired, Not Working appears to reflect a change in expectations about the potential or need for future work, a change that is not the result of an actual job loss. %I Cambridge, MA, National Bureau of Economic Research %G eng %4 great Recession/labor Force Participation/Unemployment/expectations %$ 999999 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2015 %T GWAS of longevity in CHARGE consortium confirms APOE and FOXO3 candidacy. %A Broer, Linda %A Aron S Buchman %A Deelen, Joris %A Daniel S Evans %A Jessica Faul %A Kathryn L Lunetta %A Sebastiani, Paola %A Jennifer A Smith %A Albert Vernon Smith %A Toshiko Tanaka %A Lei Yu %A Alice M. Arnold %A Aspelund, Thor %A Emelia J Benjamin %A Philip L de Jager %A Guðny Eiríksdóttir %A Melissa E Garcia %A Hofman, Albert %A Kaplan, Robert C %A Sharon L R Kardia %A Douglas P Kiel %A Ben A Oostra %A Orwoll, Eric S %A Parimi, Neeta %A Psaty, Bruce M %A Fernando Rivadeneira %A Rotter, Jerome I %A Seshadri, Sudha %A Andrew B Singleton %A Henning Tiemeier %A André G Uitterlinden %A Wei Zhao %A Bandinelli, Stefania %A David A Bennett %A Luigi Ferrucci %A Gudnason, Vilmundur %A Tamara B Harris %A Karasik, David %A Lenore J Launer %A Thomas T Perls %A Eline P Slagboom %A Tranah, Gregory J %A David R Weir %A Anne B Newman %A Cornelia M van Duijn %A Joanne M Murabito %K Aged %K Aged, 80 and over %K Apolipoproteins E %K Cell Adhesion Molecules %K Cohort Studies %K Female %K Forkhead Box Protein O3 %K Forkhead Transcription Factors %K Genome-Wide Association Study %K Humans %K Longevity %K Male %K Middle Aged %K Polymorphism, Single Nucleotide %K Receptors, Kainic Acid %X

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

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

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

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

%B J Gerontol A Biol Sci Med Sci %V 70 %P 110-8 %8 2015 Jan %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296168/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25199915?dopt=Abstract %R 10.1093/gerona/glu166 %0 Journal Article %J The Gerontologist %D 2015 %T HEALTHY AGING IN OLDER ADULTS: THE ROLE OF CHILDHOOD CIRCUMSTANCES AND LIFECYCLE FACTORS %A Nasim B Ferdows %A Gail A Jensen %A Wassim Tarraf %K childhood effects %K healthy aging %K lifecycle factors %X Objectives. We examine the direct and indirect effects of childhood and later-life circumstances on “healthy aging” among U.S adults ages 65-years and older. Methods. Using 2010 Health and Retirement Study data, we estimate “healthy aging” as the output of a health production function, produced by childhood health and socioeconomic status, adult socioeconomic achievements, health habits and pertinent demographics. In addition to the direct effects of these factors on healthy aging, we examine the indirect effects of childhood factors that operate through adult achievements. Results. The proportion of respondents satisfying our criteria for “healthy aging” was 0.12. Good childhood health status (vs. average) had both a positive direct effect (0.0461; p\<0.01) and indirect effect (0.0026; p\<0.05) on healthy aging, for a total effect of 0.0487. The direct effect of father’s education (0.0166; p=0.161) and mother’s education (0.0177; p=0.128) were not significant. However, having a father with a high-school or above education (0.0047; p\<0.05), having a mother with a high-school or above education (0.0054; p\<0.05) had clear indirect positive effects on healthy aging. Finally, respondent’s own education, personal finances, and all current period health habits were also strongly associated with healthy aging. Conclusion. Our findings complement available research on the health of US older adults by showing that healthy aging is a function of both childhood and adult factors and later life habits. The pathways from childhood factors to healthy aging, however, could be more complex than previously reported. %B The Gerontologist %V 55 %P 576-577 %8 10 %G eng %U https://doi.org/10.1093/geront/gnv287.05 %R 10.1093/geront/gnv287.05 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2015 %T How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study. %A Thomeer, Mieke Beth %A Mudrazija, Stipica %A Jacqueline L. Angel %K Activities of Daily Living %K African Continental Ancestry Group %K Disability Evaluation %K European Continental Ancestry Group %K Hispanic Americans %K Homes for the Aged %K Humans %K Nursing homes %K Proportional Hazards Models %K Socioeconomic factors %K United States %X

OBJECTIVES: This study investigates how health- and disability-based need factors and enabling factors (e.g., socioeconomic and family-based resources) relate to nursing home admission among 3 different racial and ethnic groups.

METHOD: We use Cox proportional hazard models to estimate differences in nursing home admission for non-Hispanic whites, non-Hispanic blacks, and Hispanics from 1998 to 2010 in the Health and Retirement Study (N = 18,952).

RESULTS: Racial-ethnic differences in nursing home admission are magnified after controlling for health- and disability-based need factors and enabling factors. Additionally, the degree to which specific factors contribute to risk of nursing home admission varies significantly across racial-ethnic groups.

DISCUSSION: Our findings indicate that substantial racial and ethnic variations in nursing home admission continue to exist and that Hispanic use is particularly low. We argue that these differences may demonstrate a significant underuse of nursing homes for racial and ethnic minorities. Alternatively, they could signify different preferences for nursing home care, perhaps due to unmeasured cultural factors or structural obstacles.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 628-38 %8 2015 Jul %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/09/08/geronb.gbu114.abstract %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25204311?dopt=Abstract %2 PMC4462672 %4 Hispanic ethnicity/Long-term care/Nursing homes/ethnicity/race/ethnic differences %$ 999999 %R 10.1093/geronb/gbu114 %0 Journal Article %J PLoS One %D 2015 %T How old do you feel? The role of age discrimination and biological aging in subjective age. %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Aerobiosis %K Aged %K Aged, 80 and over %K Aging %K Cardiovascular Physiological Phenomena %K Cellular Senescence %K Discrimination, Psychological %K Emotions %K Female %K Humans %K Male %K Middle Aged %K Muscle Strength %K Perception %X

Subjective age, or how young or old individuals experience themselves to be relative to their chronological age, is a crucial construct in gerontology. Subjective age is a significant predictor of important health outcomes, but little is known about the criteria by which individuals' subjectively evaluate their age. To identify psychosocial and biomedical factors linked to the subjective evaluation of age, this study examined whether perceived age discrimination and markers of biological aging are associated with subjective age. Participants were 4776 adults (Mage = 68) from the 2008 and 2010 waves of the Health and Retirement Study (HRS) who completed measures of subjective age, age discrimination, demographic variables, self-rated health and depression, and had physical health measures, including peak expiratory flow, grip strength, waist circumference, systolic and diastolic blood pressure. Telomere length was available for a subset of participants in the 2008 wave (n = 2214). Regression analysis indicated that perceived age discrimination, lower peak expiratory flow, lower grip strength, and higher waist circumference were associated with an older subjective age, controlling for sociodemographic factors, self-rated health, and depression. In contrast, blood pressure and telomere length were not related to subjective age. These findings are consistent with the hypothesis that how old a person feels depends in part on psychosocial and biomedical factors, including the experiences of ageism and perceptible indices of fitness and biological age.

%B PLoS One %I 10 %V 10 %P e0119293 %8 2015 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25738579?dopt=Abstract %2 PMC4349738 %4 subjective age/health outcomes/psychosocial factors/psychosocial factors/biomedical factors/Biological aging %$ 999999 %R 10.1371/journal.pone.0119293 %0 Journal Article %J J Appl Gerontol %D 2015 %T Improving the validity of activity of daily living dependency risk assessment. %A Daniel O. Clark %A Timothy E. Stump %A Tu, Wanzhu %A Douglas K Miller %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cognition %K Cognition Disorders %K Female %K Gait %K Geriatric Assessment %K Humans %K Independent Living %K Interviews as Topic %K Male %K Quality Improvement %K Reproducibility of Results %K Risk Assessment %X

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.

%B J Appl Gerontol %I 34 %V 34 %P 329-42 %8 2015 Apr %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24652867?dopt=Abstract %2 PMC4597469 %4 ADL/IADL/Cognitive measures/Cognitive measures/ADL dependency %$ 999999 %R 10.1177/0733464812471894 %0 Journal Article %J Epidemiology %D 2015 %T Instrumental variable estimation in a survival context %A Eric J. Tchetgen Tchetgen %A Stefan Walter %A Vansteelandt, Stijn %A Martinussen, Torben %A M. Maria Glymour %K Health Conditions and Status %K Methodology %X Bias due to unobserved confounding can seldom be ruled out with certainty when estimating the causal effect of a nonrandomized treatment. The instrumental variable (IV) design offers, under certain assumptions, the opportunity to tame confounding bias, without directly observing all confounders. The IV approach is very well developed in the context of linear regression and also for certain generalized linear models with a nonlinear link function. However, IV methods are not as well developed for regression analysis with a censored survival outcome. In this article, we develop the IV approach for regression analysis in a survival context, primarily under an additive hazards model, for which we describe 2 simple methods for estimating causal effects. The first method is a straightforward 2-stage regression approach analogous to 2-stage least squares commonly used for IV analysis in linear regression. In this approach, the fitted value from a first-stage regression of the exposure on the IV is entered in place of the exposure in the second-stage hazard model to recover a valid estimate of the treatment effect of interest. The second method is a so-called control function approach, which entails adding to the additive hazards outcome model, the residual from a first-stage regression of the exposure on the IV. Formal conditions are given justifying each strategy, and the methods are illustrated in a novel application to a Mendelian randomization study to evaluate the effect of diabetes on mortality using data from the Health and Retirement Study. We also establish that analogous strategies can also be used under a proportional hazards model specification, provided the outcome is rare over the entire follow-up. %B Epidemiology %I 26 %V 26 %P 402-410 %G eng %N 3 %4 Methodology/instrumental variable/statistical analysis/Diabetes/Mortality/Proportional Hazards Models %$ 999999 %R 10.1097/ede.0000000000000262 %0 Journal Article %J Nat Genet %D 2015 %T Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair. %A Day, Felix R %A Ruth, Katherine S %A Thompson, Deborah J %A Kathryn L Lunetta %A Pervjakova, Natalia %A Daniel I Chasman %A Stolk, Lisette %A Finucane, Hilary K %A Sulem, Patrick %A Bulik-Sullivan, Brendan %A Tõnu Esko %A Andrew D Johnson %A Elks, Cathy E %A Franceschini, Nora %A He, Chunyan %A Altmaier, Elisabeth %A Brody, Jennifer A %A Lude L Franke %A Huffman, Jennifer E %A Keller, Margaux F %A McArdle, Patrick F %A Nutile, Teresa %A Porcu, Eleonora %A Robino, Antonietta %A Rose, Lynda M %A Schick, Ursula M %A Jennifer A Smith %A Teumer, Alexander %A Traglia, Michela %A Vuckovic, Dragana %A Yao, Jie %A Wei Zhao %A Albrecht, Eva %A Amin, Najaf %A Corre, Tanguy %A Jouke-Jan Hottenga %A Mangino, Massimo %A Albert Vernon Smith %A Toshiko Tanaka %A Gonçalo R Abecasis %A Andrulis, Irene L %A Anton-Culver, Hoda %A Antoniou, Antonis C %A Arndt, Volker %A Alice M. Arnold %A Barbieri, Caterina %A Beckmann, Matthias W %A Beeghly-Fadiel, Alicia %A Benitez, Javier %A Bernstein, Leslie %A Bielinski, Suzette J %A Blomqvist, Carl %A Boerwinkle, Eric %A Bogdanova, Natalia V %A Bojesen, Stig E %A Manjeet K. Bolla %A Borresen-Dale, Anne-Lise %A Boutin, Thibaud S %A Brauch, Hiltrud %A Brenner, Hermann %A Brüning, Thomas %A Burwinkel, Barbara %A Campbell, Archie %A Campbell, Harry %A Chanock, Stephen J %A Chapman, J Ross %A Yii-Der I Chen %A Chenevix-Trench, Georgia %A Couch, Fergus J %A Coviello, Andrea D %A Cox, Angela %A Czene, Kamila %A Darabi, Hatef %A De Vivo, Immaculata %A Ellen W Demerath %A Joe G Dennis %A Devilee, Peter %A Dörk, Thilo %A Dos-Santos-Silva, Isabel %A Dunning, Alison M %A John D Eicher %A Fasching, Peter A %A Jessica Faul %A Figueroa, Jonine %A Flesch-Janys, Dieter %A Gandin, Ilaria %A Melissa E Garcia %A García-Closas, Montserrat %A Giles, Graham G %A Giorgia G Girotto %A Goldberg, Mark S %A González-Neira, Anna %A Goodarzi, Mark O %A Grove, Megan L %A Gudbjartsson, Daniel F %A Guénel, Pascal %A Guo, Xiuqing %A Christopher A Haiman %A Hall, Per %A Hamann, Ute %A Henderson, Brian E %A Lynne J Hocking %A Hofman, Albert %A Homuth, Georg %A Hooning, Maartje J %A John L Hopper %A Hu, Frank B %A Huang, Jinyan %A Humphreys, Keith %A Hunter, David J %A Jakubowska, Anna %A Jones, Samuel E %A Kabisch, Maria %A Karasik, David %A Knight, Julia A %A Kolcic, Ivana %A Charles Kooperberg %A Kosma, Veli-Matti %A Kriebel, Jennifer %A Kristensen, Vessela %A Lambrechts, Diether %A Langenberg, Claudia %A Li, Jingmei %A Li, Xin %A Lindström, Sara %A Yongmei Liu %A Luan, Jian'an %A Lubinski, Jan %A Mägi, Reedik %A Mannermaa, Arto %A Manz, Judith %A Margolin, Sara %A Marten, Jonathan %A Nicholas G Martin %A Masciullo, Corrado %A Meindl, Alfons %A Michailidou, Kyriaki %A Mihailov, Evelin %A Lili Milani %A Milne, Roger L %A Müller-Nurasyid, Martina %A Michael A Nalls %A Neale, Benjamin M %A Nevanlinna, Heli %A Neven, Patrick %A Anne B Newman %A Børge G Nordestgaard %A Olson, Janet E %A Padmanabhan, Sandosh %A Peterlongo, Paolo %A Peters, Ulrike %A Petersmann, Astrid %A Peto, Julian %A Pharoah, Paul D P %A Nicola Pirastu %A Pirie, Ailith %A Pistis, Giorgio %A Polasek, Ozren %A David J Porteous %A Psaty, Bruce M %A Pylkäs, Katri %A Radice, Paolo %A Raffel, Leslie J %A Fernando Rivadeneira %A Rudan, Igor %A Rudolph, Anja %A Ruggiero, Daniela %A Cinzia Felicita Sala %A Sanna, Serena %A Sawyer, Elinor J %A Schlessinger, David %A Schmidt, Marjanka K %A Schmidt, Frank %A Schmutzler, Rita K %A Schoemaker, Minouk J %A Scott, Robert A %A Seynaeve, Caroline M %A Simard, Jacques %A Sorice, Rossella %A Southey, Melissa C %A Stöckl, Doris %A Strauch, Konstantin %A Swerdlow, Anthony %A Kent D Taylor %A Thorsteinsdottir, Unnur %A Toland, Amanda E %A Tomlinson, Ian %A Truong, Thérèse %A Tryggvadottir, Laufey %A Stephen T Turner %A Vozzi, Diego %A Wang, Qin %A Wellons, Melissa %A Gonneke Willemsen %A James F Wilson %A Winqvist, Robert %A Wolffenbuttel, Bruce B H R %A Alan F Wright %A Yannoukakos, Drakoulis %A Zemunik, Tatijana %A Wei Zhang %A Zygmunt, Marek %A Bergmann, Sven %A Dorret I Boomsma %A Buring, Julie E %A Luigi Ferrucci %A Grant W Montgomery %A Gudnason, Vilmundur %A Timothy Spector %A Cornelia M van Duijn %A Alizadeh, Behrooz Z %A Ciullo, Marina %A Crisponi, Laura %A Easton, Douglas F %A Paolo P. Gasparini %A Gieger, Christian %A Tamara B Harris %A Caroline Hayward %A Sharon L R Kardia %A Kraft, Peter %A McKnight, Barbara %A Andres Metspalu %A Alanna C Morrison %A Reiner, Alex P %A Ridker, Paul M %A Rotter, Jerome I %A Toniolo, Daniela %A André G Uitterlinden %A Ulivi, Sheila %A Völzke, Henry %A Wareham, Nicholas J %A David R Weir %A Laura M Yerges-Armstrong %A Price, Alkes L %A Stefansson, Kari %A Visser, Jenny A %A Ong, Ken K %A Chang-Claude, Jenny %A Joanne M Murabito %A Perry, John R B %A Murray, Anna %K Age Factors %K Aging %K BRCA1 Protein %K Breast Neoplasms %K DNA Repair %K Female %K Genome %K Genome-Wide Association Study %K Genotype %K Humans %K Hypothalamus %K Menopause %K Middle Aged %K Models, Genetic %K Older Adults %K Phenotype %K Reproduction %K Signal Transduction %X

Menopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in ∼70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (∼6% increase in risk per year; P = 3 × 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms.

%B Nat Genet %V 47 %P 1294-303 %8 2015 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/26414677?dopt=Abstract %R 10.1038/ng.3412 %0 Journal Article %J Journal of Applied Gerontology %D 2015 %T More Caregiving, Less Working: Caregiving Roles and Gender Difference %A Lee, Yeonjung %A Tang, Fengyan %K Adult children %K Demographics %K Employment and Labor Force %K Healthcare %X This study examined the relationship of caregiving roles to labor force participation using the nationally representative data from the Health and Retirement Study. The sample was composed of men and women aged 50 to 61 years (N = 5,119). Caregiving roles included caregiving for spouse, parents, and grandchildren; a summary of three caregiving roles was used to indicate multiple caregiving roles. Bivariate analysis using chi-square and t tests and binary logistic regression models were applied. Results show that women caregivers for parents and/or grandchildren were less likely to be in the labor force than non-caregivers and that caregiving responsibility was not related to labor force participation for the sample of men. Findings have implication for supporting family caregivers, especially women, to balance work and caregiving commitments. %B Journal of Applied Gerontology %I 34 %V 34 %P 465-483 %G eng %U http://jag.sagepub.com/content/early/2013/10/29/0733464813508649.abstract %N 4 %4 Caregiving Role/Labor Force Participation/Spouse Caregiving/Parent Caregiving/Grandchild Caregiving/Gender Difference %$ 999999 %R 10.1177/0733464813508649 %0 Journal Article %J Am J Geriatr Psychiatry %D 2015 %T Perceived discrimination and physical, cognitive, and emotional health in older adulthood. %A Angelina R Sutin %A Yannick Stephan %A Carretta, H. %A Antonio Terracciano %K Aged %K Cognition %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Mental Health %K Prejudice %K Social Perception %X

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).

%B Am J Geriatr Psychiatry %I 23 %V 23 %P 171-9 %8 2015 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/24745563?dopt=Abstract %2 PMC4170050 %4 Discrimination/disease burden/loneliness/stress/well-being/Self assessed health/Physical health/emotional health %$ 999999 %R 10.1016/j.jagp.2014.03.007 %0 Book Section %B Challenges of Latino Aging in the Americas %D 2015 %T Racial and Ethnic Disparities in Willingness to Pay for Improved Health: Evidence from the Aging and Population %A Odufuwa, Olufolake O. %A Berrens, Robert P. %A Valdez, R. Burciaga %E William A. Vega %E Kyriakos S Markides %E Jacqueline L. Angel %E Torres-Gil, Fernando M. %K Health Conditions and Status %K Net Worth and Assets %K Women and Minorities %B Challenges of Latino Aging in the Americas %I Springer %C New York %P 333-354 %G eng %4 mortality risk reduction/mortality/health status/morbidity/Latinos/statistical life value %$ 999999 %! Racial and Ethnic Disparities in Willingness to Pay for Improved Health: Evidence from the Aging and Population %& 20 %0 Journal Article %J Journal of Retirement %D 2015 %T Retirement and the Great Recession %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Employment and Labor Force %K Public Policy %K Retirement Planning and Satisfaction %X This article uses data from the Health and Retirement Study to examine retirement and related labor market outcomes for the Early Boomer cohort, those in their mid-fifties at the onset of the Great Recession. Outcomes are then compared with older cohorts at the same age. The Great Recession increased their probability of being laid off and the length of time needed to find other full-time employment. Differences in layoffs between those affected by the recession and members of older cohorts in turn accounted for almost the entire difference between cohorts in employment change with age. However, The Great Recession does not appear to have depressed wages in subsequent jobs for those who experienced a layoff. In 2010, 17 of the Early Boomers were Not Working and Not Retired or Partially Retired, and 6 were unemployed, leaving at least 11 percent who were not unemployed but not retired or only partially retired. At the recession s peak, half of those who experienced a layoff ended up in the Not Retired or Partially Retired, Not Working category. But only a quarter of those who declared themselves to be Not Retired or Partially Retired, and were Not Working, had experienced a layoff. Most of the jump in Not Retired or Partially Retired, Not Working appears to reflect a change in expectations about the potential or need for future work, a change that is not the result of an actual job loss. %B Journal of Retirement %I 3 %V 3 %P 87-106 %G eng %N 1 %4 Great Recession/labor market outcomes/retirement/Layoffs %$ 999999 %R 10.3905/jor.2015.3.1.087 %0 Journal Article %J Ageing and Society %D 2015 %T Revisiting the pathways to retirement: a latent structure model of the dynamics of transition from work to retirement %A Tang, Fengyan %A Jeffrey A Burr %K Employment and Labor Force %K Methodology %K Retirement Planning and Satisfaction %X A dynamic latent structure model of the work-retirement transition process was identified, focusing on transitions of work and retirement status for men and women aged 51-74 years. Using the Health and Retirement Study data (1998-2004), latent transition analysis was used to identify a best fitting model capturing work-retirement statuses in four samples defined by age and sex. The prevalence of each status was described and the dynamic transition probabilities within the latent structure were examined. Using multinomial logistic regression, socio-demographic, health, family and occupational factors were assessed to determine how each was related to the likelihood of occupying a specific latent status at baseline. Results showed that study respondents were classified into distinct groups: full retiree, partial retiree or part-time worker, full-time worker, work-disabled or home-maker. The prevalence of full retiree status increased, while the prevalence for full-time worker status decreased over time for both men and women. Membership rates in the work-disabled and partial retiree status were generally consistent, with decreased probabilities of the work-disabled status in the older age groups and increased probabilities of partial retirees among younger men. Our findings indicated that many older Americans experience multiple transitions on the pathway to retirement. Future research on late-life labour-force transitions should evaluate the impact of the recent Great Recession and examine the role of larger socio-economic contexts. %B Ageing and Society %I 35 %V 35 %P 1739-1770 %G eng %N 8 %4 Health and Retirement Study/labour-force behaviour/latent transition analysis/retirement transition %$ 999999 %R 10.1017/S0144686X14000634 %0 Journal Article %J Health Economics (United Kingdom) %D 2015 %T Self-employment and health: Barriers or benefits? %A Cornelius A Rietveld %A van Kippersluis, Hans %A A. Roy Thurik %K Employment and Labor Force %K Health Conditions and Status %X The self-employed are often reported to be healthier than wageworkers; however, the cause of this health difference is largely unknown. The longitudinal nature of the US Health and Retirement Study allows us to gauge the plausibility of two competing explanations for this difference: a contextual effect of self-employment on health (benefit effect), or a health-related selection of individuals into self-employment (barrier effect). Our main finding is that the selection of comparatively healthier individuals into self-employment accounts for the positive cross-sectional difference. The results rule out a positive contextual effect of self-employment on health, and we present tentative evidence that, if anything, engaging in self-employment is bad for one's health. Given the importance of the self-employed in the economy, these findings contribute to our understanding of the vitality of the labor force. %B Health Economics (United Kingdom) %I 24 %V 24 %P 1302-1313 %G eng %N 10 %4 Health Status/labor Force Participation/Self-employment %$ 999999 %R 10.1002/hec.3087 %0 Journal Article %J Annals of Internal Medicine %D 2015 %T Symptom Trends in the Last Year of Life From 1998 to 2010 A Cohort Study %A Adam E Singer %A Meeker, Daniella %A Joan M Teno %A Lynn, Joanne %A June R Lunney %A Karl A Lorenz %K Health Conditions and Status %K Methodology %K Retirement Planning and Satisfaction %X Background: Calls for improvement in end-of-life care have focused attention on the management of pain and other troubling symptoms at the end of life. Objective: To describe changes in pain intensity and symptom prevalence during the last year of life from 1998 to 2010. Design: Observational study. Setting: The HRS (Health and Retirement Study), a nationally representative longitudinal survey of community-dwelling U. S. residents aged 51 years or older. Participants: 7204 HRS participants who died while enrolled in the study and their family respondents. Measurements: Proxy-reported pain during the last year of life and other symptoms for at least 1 month during the last year of life. Trends in pain intensity and symptom prevalence were analyzed for all decedents and within the categories of sudden death, cancer, congestive heart failure or chronic lung disease, and frailty. Results: Between 1998 and 2010, proxy reports of the prevalence of any pain increased for all decedents from 54.3 (95 CI, 51.6 to 57.1 ) to 60.8 (CI, 58.2 to 63.4 ), an increase of 11.9 (CI, 3.1 to 21.4 ). Reported prevalences of depression and periodic confusion also increased for all decedents by 26.6 (CI, 14.5 to 40.1 ) and 31.3 (CI, 18.6 to 45.1 ), respectively. Individual symptoms increased in prevalence among specific decedent categories, except in cancer, which showed no significant changes. The prevalence of moderate or severe pain did not change among all decedents or in any specific decedent category. Limitation: Use of proxy reports and limited information about some patient and surrogate variables. Conclusion: Despite national efforts to improve end-of-life care, proxy reports of pain and other alarming symptoms in the last year of life increased from 1998 to 2010. %B Annals of Internal Medicine %I 162 %V 162 %P 175-U58 %G eng %N 3 %4 end-of-life care/pain management/symptom prevalence/depression/confusion/Proxy informants %$ 999999 %R 10.7326/m13-1609 %0 Journal Article %J Journal of the American Geriatrics Society %D 2015 %T Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia %A Christopher M. Callahan %A Tu, Wanzhu %A Kathleen T. Unroe %A LaMantia, Michael A. %A Timothy E. Stump %A Daniel O. Clark %K Health Conditions and Status %K Healthcare %X Objectives: To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment. Design: Longitudinal cohort study. Setting: Health and Retirement Study (HRS). Participants: HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N=16,186). Measurements: Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. Results: The 3,447 (21.3 ) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2 returned home without home care services, and 33.8 transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2 transitioned to the hospital, and 25.3 returned home without services. There were 2,139 transitions to death, and 58.7 of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. Conclusion: In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition. %B Journal of the American Geriatrics Society %I 63 %V 63 %P 1495-1502 %G eng %N 8 %4 care transitions/cognitive Impairment/functional impairment/dementia/health services/cognitive function/Activities Of Daily Living %$ 999999 %0 Report %D 2015 %T Unequal Bequests %A Francesconi, Marco %A Robert A. Pollak %A Tabasso, Domenico %K Adult children %K Healthcare %K Other %X Using data from the Health and Retirement Study (HRS), we make two contributions to the literature on end-of-life transfers. First, we show that unequal bequests are much more common than generally recognized, with one-third of parents with wills planning to divide their estates unequally among their children. These plans for unequal division are particularly concentrated in complex families, which are of two types: families with stepchildren and families with genetic children with whom the parent has had no contact, e.g., children from previous marriages. We find that in complex families past and current contact between parents and children reduces or eliminates unequal bequests. Second, although the literature focuses on the bequest intentions of parents who have made wills, we find that many older Americans have not made wills. Although the probability of having a will increases with age, 30 percent of HRS respondents aged 70 and over have no wills. Of HRS respondents who died between 1995 and 2010, 38 percent died without wills. Thus, focusing exclusively on the bequest intentions of parents who have made wills may provide an incomplete and misleading picture of end-of-life transfers. %I Cambridge, United States, National Bureau of Economic Research, Inc. %G eng %U http://search.proquest.com/docview/1728706877/1B5FA0446C27487FPQ/27 %4 altruism/bequests/evolutionary motives/exchange/family structure/intergenerational transfers %$ 999999 %0 Journal Article %J BMC Public Health %D 2015 %T Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort %A Hui Zheng %A Dmitry Tumin %K Adult children %K Demographics %K Event History/Life Cycle %K Health Conditions and Status %X Background: Studies have identified prenatal and early childhood conditions as important contributors to weight status in later life. To date, however, few studies have considered how weight status in adulthood is shaped by regional variation in early-life conditions, rather than the characteristics of the individual or their family. Furthermore, gender and life course differences in the salience of early life conditions to weight status remain unclear. This study investigates whether the effect of family background and birth region on adult obesity status varies by gender and over the life course. Methods: We used data from a population-based cohort of 6,453 adults from the Health and Retirement Study, 1992-2008. Early life conditions were measured retrospectively at and after the baseline. Obesity was calculated from self-reported height and weight. Logistic models were used to estimate the net effects of family background and birth region on adulthood obesity risk after adjusting for socioeconomic factors and health behaviors measured in adulthood. Four economic and demographic data sets were used to further test the birthplace effect. Results: At ages 50-61, mother's education and birth region were associated with women's obesity risk, but not men's. Each year's increase in mother's education significantly reduces the odds of being obese by 6 (OR = 0.94; 95 CI: 0.92, 0.97) among women, and this pattern persisted at ages 66-77. Women born in the Mountain region were least likely to be obese in late-middle age and late-life. Measures of per capita income and infant mortality rate in the birth region were also associated with the odds of obesity among women. Conclusions: Women's obesity status in adulthood is influenced by early childhood conditions, including regional conditions, while adulthood health risk factors may be more important for men's obesity risk. Biological and social mechanisms may account for the gender difference. %B BMC Public Health %I 15 %V 15 %P 535 %G eng %N 1 %4 Life course/Obesity/health status/Socioeconomic Status/body Mass Index/Early-life conditions/Gender/Mothers education/Birth place %$ 999999 %0 Journal Article %J BMC Public Health %D 2015 %T Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort. %A Hui Zheng %A Dmitry Tumin %K Aged %K Aged, 80 and over %K Body Weight %K Cohort Studies %K ethnicity %K Family Characteristics %K Female %K Health Behavior %K Humans %K Interviews as Topic %K Logistic Models %K Male %K Middle Aged %K Obesity %K Prospective Studies %K Qualitative Research %K Retirement %K Risk Factors %K Socioeconomic factors %K United States %X

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

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

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

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

%B BMC Public Health %I 15 %V 15 %P 535 %8 2015 Jun 05 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84934903370andpartnerID=40andmd5=b19c15d412d4437881f0111906f49570 %1 http://www.ncbi.nlm.nih.gov/pubmed/26088317?dopt=Abstract %2 PMC4474348 %4 Birth place/Early-life conditions/Gender/Life course/Mothers education/Obesity %$ 999999 %R 10.1186/s12889-015-1870-7 %0 Journal Article %J Journals of Gerontology Series B-Psychological Sciences and Social Sciences %D 2015 %T The Vicious Cycle of Parental Caregiving and Financial Well-being: A Longitudinal Study of Women %A Lee, Yeonjung %A Tang, Fengyan %A Kim, Kevin H. %A Steven M. Albert %K Adult children %K Healthcare %K Net Worth and Assets %K Women and Minorities %X Objectives. This study examines the relationship between caring for older parents and the financial well-being of caregivers by investigating whether a reciprocal association, or vicious cycle, exists between female caregiver's lower household incomes and caring for elderly parents. Method. Data for women aged 51 or older with at least 1 living parent or parent-in-law were drawn from the Health and Retirement Survey 2006, 2008, and 2010 (N = 2,093). A cross-lagged panel design was applied with structural equation modeling. Results. We found support for the reciprocal relationship between parental caregiving and lower household income. Female caregivers were more likely than noncaregivers to be in lower household income at later observation points. Also, women with lower household income were more likely than women with higher household income to assume caregiving at later observation points. Discussion. This study suggests that there exists a vicious cycle of parental care and lower household income among women. A key concern for policy is female caregivers' financial status when care of older parents is assumed and care burden when women's financial status declines. %B Journals of Gerontology Series B-Psychological Sciences and Social Sciences %I 70 %V 70 %P 425-431 %G eng %N 3 %4 older parents/caregiver burden/household income/women/parental care/financial status %$ 999999 %R 10.1093/geronb/gbu001 %0 Report %D 2015 %T The Wealth of Wealthholders %A Ameriks, John %A Caplin, Andrew %A Lee, Minjoon %A Matthew D. Shapiro %A Tonetti, Christopher %K Adult children %K Consumption and Savings %K Employment and Labor Force %K Event History/Life Cycle %K Net Worth and Assets %K Public Policy %K Women and Minorities %X This paper introduces the Vanguard Research Initiative (VRI), a new panel survey of wealthholders designed to yield high-quality measurements of a large sample of older Americans who arrive at retirement with significant financial assets. The VRI links survey data with a variety of administrative data from Vanguard. The survey features an account-by-account approach to asset measurement and a real-time feedback and correction mechanism that are shown to be highly successful in eliciting accurate measures of wealth. Specifically, the VRI data reflect unbiased and precise estimates of wealth when compared to administrative account data. The VRI sample has characteristics similar to populations meeting analogous wealth and Internet access eligibility conditions in the Health and Retirement Study (HRS) and Survey of Consumer Finances (SCF). To illustrate the value of the VRI, the paper shows that the relationship between wealth and expected retirement date is very different in the VRI than in the HRS and SCF--mainly because those surveys have so few observations where wealth levels are high enough to finance substantial consumption during retirement. %I Cambridge, United States, NBER Working Paper No. 20972 %G eng %U http://search.proquest.com/docview/1687935318/1B5FA0446C27487FPQ/32 %4 Consumption/Saving/Wealth/Fiscal Policy/Fiscal Policy/Public Policy/transfers/Household economics/Intertemporal Household Choice/Life Cycle Models/Economics of the Elderly/Economics of the Handicapped/Non-labor Market Discrimination %$ 999999 %0 Journal Article %J Psychol Sci %D 2015 %T Weight Discrimination and Risk of Mortality. %A Angelina R Sutin %A Yannick Stephan %A Antonio Terracciano %K Adult %K Aged %K Female %K Humans %K Male %K Mental Health %K Middle Aged %K Mortality %K Overweight %K Prejudice %K Proportional Hazards Models %K Social Discrimination %K Stress, Psychological %K Surveys and Questionnaires %K United States %X

Discrimination based on weight is a stressful social experience linked to declines in physical and mental health. We examined whether this harmful association extends to risk of mortality. Participants in the Health and Retirement Study (HRS; N = 13,692) and the Midlife in the United States Study (MIDUS; N = 5,079) reported on perceived discriminatory experiences and attributed those experiences to a number of personal characteristics, including weight. Weight discrimination was associated with an increase in mortality risk of nearly 60% in both HRS participants (hazard ratio = 1.57, 95% confidence interval = [1.34, 1.84]) and MIDUS participants (hazard ratio = 1.59, 95% confidence interval = [1.09, 2.31]). This increased risk was not accounted for by common physical and psychological risk factors. The association between mortality and weight discrimination was generally stronger than that between mortality and other attributions for discrimination. In addition to its association with poor health outcomes, weight discrimination may shorten life expectancy.

%B Psychol Sci %I 26 %V 26 %P 1803-11 %8 2015 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/26420442?dopt=Abstract %2 PMC4636946 %4 psychological stress/open data/open materials/health Status/body Mass Index/PERCEIVED DISCRIMINATION/OBESITY/Discrimination/Mortality/Risk factors %$ 999999 %R 10.1177/0956797615601103 %0 Thesis %D 2015 %T Weight Stigma and Its Associations with Health Behaviors Among Older Adults %A Sandi Phibbs %Y Thorburn, Sheryl %K Demographics %K Health Conditions and Status %X Having excess weight carries a negative social stigma in the U.S. Previous research has shown that experiencing stigma has negative physical and mental health consequences. Few studies have examined how experiencing weight stigma might act as a barrier to engaging in healthy behaviors among older adults. The purpose of this study was to examine weight discrimination and weight-based stereotype threat as mechanisms of weight stigma among older adults. Using data from the 2010 and 2012 waves of the Health and Retirement Study, this study investigated weight discrimination and weight-based stereotype threat and their possible associations with specific health behaviors, namely the use of clinical preventive services and level of physical activity. This study also examined factors associated with experiencing weight-based stereotype threat in a medical setting among older adults. Results indicated that experiences of weight discrimination were negatively associated with reporting vigorous and moderate physical activity, positively associated with receiving an influenza vaccination, and t associated with receiving breast or cervical cancer screenings. Results also indicated that weight discrimination mediated 13% of the relationship between body mass index and vigorous physical activity. In addition, 9% of the effect of BMI on moderate physical activity was mediated by weight discrimination. Having a higher BMI and previous experiences of weight discrimination were significantly associated with reporting weight-based stereotype threat in the medical setting. Weight-based stereotype threat was t associated with the use of clinical preventive services and level of physical activity, although the sample size lacked sufficient power to detect a small effect size in these analyses. This study provides evidence that older adults experience weight discrimination and weight-based stereotype threat. Efforts to increase physical activity among older adults should address weight discrimination as a possible barrier. Further research on the mechanisms of weight stigma among older adults and their effects is warranted. %I Oregon State University %V Doctor of Philosophy (Ph. D.) in Public Health %G eng %9 Thesis/Dissertation %4 aging %! Weight Stigma and Its Associations with Health Behaviors Among Older Adults %0 Thesis %D 2015 %T A woman's work is never done? Earlier life child, marital, and work history and older women's relationship to the paid labor force %A Shattuck, Anne M. %Y Turner, Heather A. %K Employment and Labor Force %K Methodology %K Policy %X In the past 40 years, women in the U.S. have experienced higher rates of labor force participation and higher rates of divorce and single motherhood. How these changes will affect women when they reach old age is not yet understood. Using a pooled sample from the Health and Retirement Study of 4,350 women born between 1931 and 1943, this dissertation assesses patterns of women's work/retirement circumstances at age 66–68 and evaluates the relationship between those patterns and women's earlier life marital, work, and childrearing history. Latent class analysis revealed four distinct classes of older women: the "retired well" (57.6% of the sample) were not working for pay but were in good or excellent health and had household wealth in the top 75%. "Retired unwell" women (14% of the sample) were also not working but were in fair/poor physical health and had very low household wealth. The "working advantaged" (17.1% of the sample) were healthy women still working, primarily in professional/managerial occupations, earning above median wages, and having the highest median levels of household wealth of the four groups. The "working average" class (11.7% of the sample) were women still in the labor force, overwhelmingly in sales/labor/service jobs and making below median wages. This group had a 1 in 5 chance of being in fair/poor health and a 1 in 3 chance of being in the bottom wealth quartile. Multivariate latent class analysis including covariates revealed several significant relationships between women's earlier life history and latent class at age 66–68. Women who had spent any time as a single mother or who had ever been divorced had higher odds of being retired unwell or working advantaged than retired well. Women with strong attachment to the labor force across their lives were less likely to be retired unwell and more likely to be either working advantaged or working average at age 66–68. Although single motherhood, work history, and marital history had independent effects on women's late life status, race/ethnicity, education, and current marital status had stronger effects. Implications for future cohorts of older women are discussed. %I University of New Hampshire %C Durham, NH %V 10000385 %P 138 %8 2015 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1760991377?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt: %9 Ph.D. %M 1760991377 %4 0626:Sociology %! A woman's work is never done? Earlier life child, marital, and work history and older women's relationship to the paid labor force %0 Journal Article %J Brain, behavior, and immunity %D 2015 %T Younger subjective age is associated with lower C-reactive protein among older adults %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Expectations %K Health Conditions and Status %K Healthcare %X Subjective age, or how young or old individuals experience themselves to be, is related to a range of health-related outcomes in old age, including mortality risk. Little is known, however, about its association with markers of systemic inflammation. Using data from the Health and Retirement Study (HRS), the present study examined the relation between subjective age and C-reactive protein (CRP). Participants were 4120 older adults from the 2008 wave of the HRS who provided measures of subjective age, CRP, demographic variables, Body Mass Index (BMI), depression, smoking, physical activity and disease burden. Regression analyses revealed that a younger subjective age was related to lower CRP, controlling for demographic factors. This association was reduced by half but remained significant when health and behavioral covariates were adjusted for, suggesting that BMI, physical activity and disease burden may partially account for lower inflammation in individuals with a younger subjective age. Furthermore, a logistic regression revealed that feeling younger than one's age was associated with reduced risk of exceeding the clinical threshold of CRP, controlling for covariates. The present study provides the first evidence of an association between subjective age and systemic inflammation among older adults. It suggests that individuals' ratings of their subjective age may help identify individuals at greater risk for immune dysfunction related to morbidity and mortality. %B Brain, behavior, and immunity %I 43 %V 43 %P 33-6 %G eng %4 Aging/C-reactive protein/Inflammation/Subjective age/systemic inflammation %$ 999999 %R 10.1016/j.bbi.2014.07.019 %0 Journal Article %J Proc Natl Acad Sci U S A %D 2014 %T Common genetic variants associated with cognitive performance identified using the proxy-phenotype method. %A Cornelius A Rietveld %A Tõnu Esko %A Gail Davies %A Pers, Tune H %A Turley, Patrick %A Benyamin, Beben %A Chabris, Christopher F %A Emilsson, Valur %A Andrew D Johnson %A Lee, James J %A Christiaan de Leeuw %A Riccardo E Marioni %A Sarah E Medland %A Michael B Miller %A Rostapshova, Olga %A Sven J van der Lee %A Anna A E Vinkhuyzen %A Amin, Najaf %A Dalton C Conley %A Derringer, Jaime %A Cornelia M van Duijn %A Fehrmann, Rudolf %A Lude L Franke %A Edward L Glaeser %A Narelle K Hansell %A Caroline Hayward %A Iacono, William G %A Carla A Ibrahim-Verbaas %A Vincent Jaddoe %A Karjalainen, Juha %A David I Laibson %A Paul Lichtenstein %A David C Liewald %A Patrik K E Magnusson %A Nicholas G Martin %A McGue, Matt %A McMahon, George %A Nancy L Pedersen %A Pinker, Steven %A David J Porteous %A Posthuma, Danielle %A Fernando Rivadeneira %A Smith, Blair H %A John M Starr %A Henning Tiemeier %A Nicholas J Timpson %A Trzaskowski, Maciej %A André G Uitterlinden %A Verhulst, Frank C %A Mary E Ward %A Margaret J Wright %A George Davey Smith %A Ian J Deary %A Johannesson, Magnus %A Plomin, Robert %A Peter M Visscher %A Daniel J. Benjamin %A Cesarini, David %A Philipp D Koellinger %K Cell Adhesion Molecules, Neuronal %K Cognition %K Female %K Humans %K Learning %K Male %K Memory %K Multifactorial Inheritance %K Nerve Tissue Proteins %K Neuronal Plasticity %K Octamer Transcription Factors %K Polymorphism, Single Nucleotide %K Synaptic Transmission %X

We identify common genetic variants associated with cognitive performance using a two-stage approach, which we call the proxy-phenotype method. First, we conduct a genome-wide association study of educational attainment in a large sample (n = 106,736), which produces a set of 69 education-associated SNPs. Second, using independent samples (n = 24,189), we measure the association of these education-associated SNPs with cognitive performance. Three SNPs (rs1487441, rs7923609, and rs2721173) are significantly associated with cognitive performance after correction for multiple hypothesis testing. In an independent sample of older Americans (n = 8,652), we also show that a polygenic score derived from the education-associated SNPs is associated with memory and absence of dementia. Convergent evidence from a set of bioinformatics analyses implicates four specific genes (KNCMA1, NRXN1, POU2F3, and SCRT). All of these genes are associated with a particular neurotransmitter pathway involved in synaptic plasticity, the main cellular mechanism for learning and memory.

%B Proc Natl Acad Sci U S A %V 111 %P 13790-4 %8 2014 Sep 23 %G eng %N 38 %1 http://www.ncbi.nlm.nih.gov/pubmed/25201988?dopt=Abstract %R 10.1073/pnas.1404623111 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2014 %T Cumulative inequality and racial disparities in health: private insurance coverage and black/white differences in functional limitations. %A Ben Lennox Kail %A Miles G Taylor %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Black or African American %K Cross-Sectional Studies %K Female %K Health Status Disparities %K Hispanic or Latino %K Humans %K Insurance Coverage %K Insurance, Health %K Longitudinal Studies %K Male %K Medicare %K Socioeconomic factors %K United States %X

OBJECTIVES: To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans.

METHOD: Data come from 7 waves of the Health and Retirement Study (1996-2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations.

RESULTS: In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations.

DISCUSSION: Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans.

%B J Gerontol B Psychol Sci Soc Sci %I 69 %V 69 %P 798-808 %8 2014 Sep %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/24/geronb.gbu005.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/24569001?dopt=Abstract %2 PMC4189650 %4 Cumulative inequality/Insurance/Functional limitations/Private insurance %$ 999999 %R 10.1093/geronb/gbu005 %0 Journal Article %J Preventive Medicine %D 2014 %T Diabetes diagnosis and exercise initiation among older Americans %A Leigh Ann Leung %A Shailender Swaminathan %A Amal Trivedi %K Demographics %K Health Conditions and Status %K Healthcare %X Objective: To determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. Methods: We used data from the 2004-2010 Health and Retirement Study in a pre-post study design. Individuals newly-diagnosed with diabetes (N. = 635) were propensity score matched to a comparison group with no diabetes. Results: In the year following a reported diagnosis, 35.7 (95 confidence interval 32.0 to 39.5) of those newly diagnosed with diabetes initiated exercise as compared with 31.4 (95 confidence interval 27.9 to 35.1) for the matched cohort with no diabetes, with a between-group difference of 4.3 percentage points (95 confidence interval -0.9 to 9.4). Among individuals with fewer health risk factors at baseline, the between-group difference was 15.6 percentage points (95 confidence interval 1.58 to 29.5). Conclusion: Over 35 of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis. Among individuals with fewer health risk factors at baseline, those newly-diagnosed with diabetes were more likely to begin exercise than those without diabetes. 2014 Elsevier Inc. %B Preventive Medicine %I 65 %V 65 %P 128-132 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84901829825andpartnerID=40andmd5=4961de60a077ce36676e9d5c53632ed9 %4 Diagnosis/Exercise/Health behavior/Physician counseling/Tertiary prevention/Type 2 diabetes/diabetes mellitus/low risk population %$ 999999 %R 10.1016/j.ypmed.2014.05.001 %0 Thesis %D 2014 %T Dyadic analyses of chronic conditions and distress within marriage : a gendered perspective %A Thomeer, Mieke Beth %K Demographics %K Health Conditions and Status %K Healthcare %X Chronic conditions negatively impact well-being, and the negative impact of a chronic condition can extend beyond the diagnosed person to his or her spouse. This association may be further influenced by gender, as gender can shape how individuals experience their own chronic conditions-- including what conditions they develop-- and how they react to the conditions and distress of their spouses. In my dissertation, I examine how one spouse's chronic conditions are related to the other spouse's psychological distress over time. I address this using quantitative analysis of the Health and Retirement Study and qualitative analysis of in-depth interviews. In my quantitative analysis, I find that the association between one spouse's chronic conditions and the other spouse's distress differs by gender, number of conditions, whether one or both spouses have chronic conditions, and type of condition. Regarding number of conditions, a husband's number of chronic conditions increases his wife's distress more so than a wife's number of chronic conditions increases her husband's. These associations are mitigated by the chronically ill spouse's own distress and functional limitations. Additionally, this gender difference is more pronounced if both spouses have chronic conditions compared to if only one has chronic conditions. Regarding type of condition, lung disease and stroke are the most negatively impactful for spouses' distress, whereas high blood pressure, cancer, and arthritis are not related to spouses' distress. All conditions, except for stroke, relate to husbands' and wives' distress similarly, but a husband's stroke increases a wife's distress initially whereas the wife's stroke increases the husband's distress over time. In my qualitative analysis, I find that when women are chronically ill, they continue to emotionally care for their husbands, which likely protects their husbands from psychological distress but exacerbates women's own distress. My results point to the importance of promoting the psychological well-being of both spouses during periods of chronic conditions. This is especially critical for spouses of people with more than one condition, chronically ill women whose husbands are also chronically ill, and spouses of people experiencing stroke and lung disease. %I University of Texas, Austin %C Austin, TX %G eng %4 psychological well-being %$ 999999 %! Dyadic analyses of chronic conditions and distress within marriage : a gendered perspective %0 Journal Article %J J Am Geriatr Soc %D 2014 %T Factors influencing the use of intensive procedures at the end of life. %A Evan C Tschirhart %A Qingling Du %A Amy Kelley %K Advance directives %K Aged %K Aged, 80 and over %K Alzheimer disease %K Cause of Death %K Chronic disease %K Critical Care %K Female %K Homes for the Aged %K Humans %K Life Support Care %K Logistic Models %K Male %K Multivariate Analysis %K Neoplasms %K Nursing homes %K Odds Ratio %K Terminal Care %K United States %K Utilization Review %X

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

DESIGN: Retrospective cohort study.

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

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

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

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

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

%B J Am Geriatr Soc %I 62 %V 62 %P 2088-94 %8 2014 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/25376084?dopt=Abstract %2 PMC4241150 %4 end-of-life decisions/terminal care/intensive care/Medicare/Advance Directives/regional variations/MEDICARE EXPENDITURES/SUSTAINING TREATMENTS/PATIENT PREFERENCES %$ 999999 %R 10.1111/jgs.13104 %0 Journal Article %J Psychoneuroendocrinology %D 2014 %T Five-factor model personality traits and inflammatory markers: new data and a meta-analysis. %A Martina Luchetti %A James M Barkley %A Yannick Stephan %A Antonio Terracciano %A Angelina R Sutin %K Adult %K Aged %K Aged, 80 and over %K Biomarkers %K C-reactive protein %K Female %K Humans %K Inflammation %K Male %K Middle Aged %K Personality %X

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

%B Psychoneuroendocrinology %I 50 %V 50 %P 181-93 %8 2014 Dec %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25233337?dopt=Abstract %2 PMC4544833 %4 Personality/Personality/Conscientiousness/Conscientiousness/C-reactive protein/Interleukin-6/Meta-analysis %$ 999999 %R 10.1016/j.psyneuen.2014.08.014 %0 Journal Article %J BMC Genet %D 2014 %T Genetic diversity is a predictor of mortality in humans. %A Bihlmeyer, Nathan A %A Brody, Jennifer A %A Albert Vernon Smith %A Kathryn L Lunetta %A Michael A Nalls %A Jennifer A Smith %A Toshiko Tanaka %A Gail Davies %A Lei Yu %A Saira S Mirza %A Teumer, Alexander %A Coresh, Josef %A Pankow, James S %A Franceschini, Nora %A Scaria, Anish %A Oshima, Junko %A Psaty, Bruce M %A Gudnason, Vilmundur %A Guðny Eiríksdóttir %A Tamara B Harris %A Li, Hanyue %A Karasik, David %A Douglas P Kiel %A Melissa E Garcia %A Yongmei Liu %A Jessica Faul %A Sharon L R Kardia %A Wei Zhao %A Luigi Ferrucci %A Allerhand, Michael %A David C Liewald %A Redmond, Paul %A John M Starr %A Philip L de Jager %A Nese Direk %A Mohammed Arfan Ikram %A André G Uitterlinden %A Homuth, Georg %A Lorbeer, Roberto %A Hans-Jörgen Grabe %A Lenore J Launer %A Joanne M Murabito %A Andrew B Singleton %A David R Weir %A Bandinelli, Stefania %A Ian J Deary %A David A Bennett %A Henning Tiemeier %A Kocher, Thomas %A Lumley, Thomas %A Dan E Arking %K Genome-Wide Association Study %K Heterozygote %K Humans %K Mortality %K Polymorphism, Single Nucleotide %K Proportional Hazards Models %X

BACKGROUND: It has been well-established, both by population genetics theory and direct observation in many organisms, that increased genetic diversity provides a survival advantage. However, given the limitations of both sample size and genome-wide metrics, this hypothesis has not been comprehensively tested in human populations. Moreover, the presence of numerous segregating small effect alleles that influence traits that directly impact health directly raises the question as to whether global measures of genomic variation are themselves associated with human health and disease.

RESULTS: We performed a meta-analysis of 17 cohorts followed prospectively, with a combined sample size of 46,716 individuals, including a total of 15,234 deaths. We find a significant association between increased heterozygosity and survival (P = 0.03). We estimate that within a single population, every standard deviation of heterozygosity an individual has over the mean decreases that person's risk of death by 1.57%.

CONCLUSIONS: This effect was consistent between European and African ancestry cohorts, men and women, and major causes of death (cancer and cardiovascular disease), demonstrating the broad positive impact of genomic diversity on human survival.

%B BMC Genet %V 15 %P 159 %8 2014 Dec 29 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301661/ %1 http://www.ncbi.nlm.nih.gov/pubmed/25543667?dopt=Abstract %R 10.1186/s12863-014-0159-7 %0 Journal Article %J PLoS One %D 2014 %T Genetic variation associated with differential educational attainment in adults has anticipated associations with school performance in children. %A Mary E Ward %A McMahon, George %A St Pourcain, Beate %A Cornelius A Rietveld %A Daniel J. Benjamin %A Philipp D Koellinger %A Cesarini, David %A Nicholas J Timpson %E Yun Li %K Adolescent %K Adult %K Child %K Child, Preschool %K Educational Status %K Female %K Genetic Association Studies %K Genome-Wide Association Study %K Humans %K Intelligence %K Intelligence Tests %K Learning %K Longitudinal Studies %K Male %K Mathematics %K Polymorphism, Single Nucleotide %X

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.

%B PLoS One %V 9 %P e100248 %8 2014 %G eng %U http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100248 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25032841?dopt=Abstract %! PLoS ONE %R 10.1371/journal.pone.0100248 %0 Report %D 2014 %T The Great Recession, Decline and Rebound in Household Wealth for the Near Retirement Population %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Health Conditions and Status %K Net Worth and Assets %K Public Policy %X This paper uses data from the Health and Retirement Study to examine the effects of the Great Recession on the wealth held by the near retirement age population from 2006 to 2012. For the Early Boomer cohort (ages 51 to 56 in 2004), real wealth in 2012 remained 3.6 percent below its 2006 value. This is a modest decline considering the fall in asset values during the Great Recession. Much of the decline in wealth over the 2006 to 2010 period was cushioned by wealth originating from Social Security and defined benefit pensions. For the most part, these are stable sums that ensured a major fraction of total wealth did not decline as a result of the recession. The rebound in asset values observed between 2010 and 2012 mitigated, but did not erase, the asset losses experienced in the first years of the Great Recession. Effects of the Great Recession varied with the household's initial wealth. Those who were in the highest wealth deciles typically had a larger share of their assets subject to the influence of declining markets, and were hurt most severely. Unlike those falling in lower wealth deciles, they have yet to regain all the wealth they lost during the recession. Recovering losses in assets is only part of the story. The assets held by members of the cohort nearing retirement at the onset of the recession would normally have grown over ensuing years. Members of older HRS cohorts accumulated assets rapidly in the years just before retirement. Those on the cusp of retiring at the onset of the recession would be much better off had they had enjoyed similar growth in assets as experienced by members of older cohorts. The bottom line is that the losses in assets imposed by the Great Recession were relatively modest. The recovery has helped. But much of the remaining penalty due to the Great Recession is in the failure of assets to grow beyond their initial levels. %I Cambridge, MA, National Bureau of Economic Research %G eng %4 great Recession/Asset accumulation/household wealth/asset values/loss recovery %$ 999999 %0 Journal Article %J J Occup Health Psychol %D 2014 %T Mental work demands, retirement, and longitudinal trajectories of cognitive functioning. %A Gwenith G Fisher %A Stachowski, Alicia %A Frank J Infurna %A Jessica Faul %A James Grosch %A Lois E Tetrick %K Cognition %K Employment %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Stress, Psychological %X

Age-related changes in cognitive abilities are well-documented, and a very important indicator of health, functioning, and decline in later life. However, less is known about the course of cognitive functioning before and after retirement and specifically whether job characteristics during one's time of employment (i.e., higher vs. lower levels of mental work demands) moderate how cognition changes both before and after the transition to retirement. We used data from n = 4,182 (50% women) individuals in the Health and Retirement Study, a nationally representative panel study in the United States, across an 18 year time span (1992-2010). Data were linked to the O*NET occupation codes to gather information about mental job demands to examine whether job characteristics during one's time of employment moderates level and rate of change in cognitive functioning (episodic memory and mental status) both before and after retirement. Results indicated that working in an occupation characterized by higher levels of mental demands was associated with higher levels of cognitive functioning before retirement, and a slower rate of cognitive decline after retirement. We controlled for a number of important covariates, including socioeconomic (education and income), demographic, and health variables. Our discussion focuses on pathways through which job characteristics may be associated with the course of cognitive functioning in relation to the important transition of retirement. Implications for job design as well as retirement are offered.

%B J Occup Health Psychol %I 19 %V 19 %P 231-42 %8 2014 Apr %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84896104239andpartnerID=40andmd5=8a0c0422ba5b68927fdc926a3e8a25b4 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/24635733?dopt=Abstract %2 PMC4663987 %4 Aging/Cognitive Ability/Job Characteristics/Retirement %$ 999999 %R 10.1037/a0035724 %0 Journal Article %J Journal of Pension Economics and Finance %D 2014 %T Mismeasurement of pensions before and after retirement: the mystery of the disappearing pensions with implications for the importance of Social Security as a source of retirement support %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Net Worth and Assets %K Pensions %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X A review of the literature suggests that when pension values are measured by the wealth equivalent of promised defined benefit pension benefits and defined contribution balances for those approaching retirement, pensions account for more support in retirement than is suggested when their contribution is measured by incomes received directly from pension plans by those who have already retired. Estimates from the Health and Retirement Study for respondents in their early fifties suggest that pension wealth is about 82 as valuable as Social Security wealth. In data from the Current Population Survey (CPS), for members of the same cohort, measured when they are 65-69, pension incomes are about 58 as valuable as incomes from Social Security. Our empirical analysis uses data from the HRS to examine the reasons for these differences in the contributions of pensions as measured in income and wealth data. Key factors accounting for these differences include: a difference in methodology between surveys affecting what is included in pension income; some pension wealth 'disappears' at retirement because respondents change their pension into other forms that are not counted as pension income; and the form of annuitization may influence the measure of pension income. A series of caveats notwithstanding, the bottom line is that CPS data on pension incomes received in retirement understates the full contribution pensions make to supporting retirees. PUBLICATION ABSTRACT %B Journal of Pension Economics and Finance %I 13 %V 13 %P 1-26 %G eng %N 1 %4 pensions/retirement planning/Public Policy/social security wealth/wealth/Defined benefit plans/Defined contribution pension plans/pension income %$ 69340 %0 Journal Article %J Am J Transplant %D 2014 %T Mortality and cardiovascular disease among older live kidney donors. %A P. P. Reese %A R. D. Bloom %A H. I. Feldman %A Rosenbaum, P %A Wang, W %A P. Saynisch %A Tarsi, N M %A Mukherjee, N %A Garg, A X %A A. Mussell %A J. Shults %A Even-Shoshan, O %A R. R. Townsend %A J. H. Silber %K Age Factors %K Aged %K Cardiovascular Diseases %K Female %K Follow-Up Studies %K Humans %K Kidney Transplantation %K Living Donors %K Longitudinal Studies %K Male %K Medicare %K Middle Aged %K Nephrectomy %K Quality of Life %K Renal Insufficiency %K Time Factors %K Treatment Outcome %K United States %X

Over the past two decades, live kidney donation by older individuals (≥55 years) has become more common. Given the strong associations of older age with cardiovascular disease (CVD), nephrectomy could make older donors vulnerable to death and cardiovascular events. We performed a cohort study among older live kidney donors who were matched to healthy older individuals in the Health and Retirement Study. The primary outcome was mortality ascertained through national death registries. Secondary outcomes ascertained among pairs with Medicare coverage included death or CVD ascertained through Medicare claims data. During the period from 1996 to 2006, there were 5717 older donors in the United States. We matched 3368 donors 1:1 to older healthy nondonors. Among donors and matched pairs, the mean age was 59 years; 41% were male and 7% were black race. In median follow-up of 7.8 years, mortality was not different between donors and matched pairs (p = 0.21). Among donors with Medicare, the combined outcome of death/CVD (p = 0.70) was also not different between donors and nondonors. In summary, carefully selected older kidney donors do not face a higher risk of death or CVD. These findings should be provided to older individuals considering live kidney donation.

%B Am J Transplant %I 14 %V 14 %P 1853-61 %8 2014 Aug %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/25039276?dopt=Abstract %2 PMC4105987 %4 public policy/health services and outcomes research/kidney transplantation/nephrology/living donor/organ procurement/cardiovascular disease %$ 999999 %R 10.1111/ajt.12822 %0 Journal Article %J Research on Aging %D 2014 %T A Multilevel Dyadic Study of the Impact of Retirement on Self-Rated Health: Does Retirement Predict Worse Health in Married Couples? %A Angela L Curl %A Aloen L. Townsend %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %X Objectives: This study examined the effects of retirement on self-rated health for married couples, using interdependence and social stratification theoretical frameworks. Method: Dyadic multilevel modeling of data (N = 2,213 non- Hispanic couples) from 1992 to 2010 of the Health and Retirement Survey. Results: Retirement was associated with worse self-ratings of health (SRH) short term (ST) for both husbands and wives during the first couple of years of retirement. In addition, the longer the husbands (but not wives) were retired, the worse was their SRH. Cross-spouse effects varied by gender: When wives retired, their husbands SRH improved ST, but when husbands retired their wives SRH improved long term. Spouse education moderated the relationship between years since spouses retirement and SRH for wives. Discussion: Practitioners can use this information to help married couples through retirement planning and transitions. Results suggest that models of retirement in couples should pay greater attention to gender and other social stratification factors, spousal interdependence, and length of time since retirement. %B Research on Aging %I 36 %V 36 %P 297-321 %G eng %N 3 %4 Gerontology/GERIATRICS/retirement planning/married couples/socioeconomic status/self-rated health/longitudinal analysis %$ 999999 %R 10.1177/0164027513486900 %0 Journal Article %J Obesity %D 2014 %T Perceived weight discrimination and C-reactive protein %A Angelina R Sutin %A Yannick Stephan %A Martina Luchetti %A Antonio Terracciano %K Health Conditions and Status %K Methodology %X Objective: Perceived weight discrimination has been linked to health outcomes, including risk of obesity. Less is known about how discrimination is associated with intermediate physiological markers of health, such as systemic inflammation. This research examined the association between weight discrimination and C-reactive protein (CRP) and whether it varied by participants' body mass index (BMI). Methods: Cross-sectional design using data from the Health and Retirement Study. Among participants who were overweight or obese (N=7,394), regression analysis was used to test for an association between weight discrimination and CRP and whether this association was moderated by BMI. Similar associations among seven other attributions for discrimination were tested. Results: The association between weight discrimination and CRP varied as a function of BMI: At BMI between the thresholds for overweight and obesity (BMI 25-30), weight discrimination was associated with higher circulating levels of CRP; there was no association between weight discrimination and CRP as BMI approached Class 3 obesity (BMI 40). A similar pattern emerged for discrimination based on a physical disability, but not for the other attributions for discrimination (e.g., race, age). Conclusions: Weight discrimination is associated with higher circulating CRP, an association that is moderated by BMI. . %B Obesity %I 22 %V 22 %P 1959-1961 %G eng %N 9 %4 weight discrimination/Obesity/physiological markers/weight/height/biomarkers %$ 999999 %R 10.1002/oby.20789 %0 Journal Article %J The journals of gerontology. Series B, Psychological sciences and social sciences %D 2014 %T Personality measures in the national social life, health, and aging project %A Iveniuk, James %A Laumann, Edward O. %A Linda J. Waite %A McClintock, Martha K. %A Andrew D. Tiedt %K Health Conditions and Status %K Methodology %X OBJECTIVES: Provide recommendations for researchers on the use of the Big Five personality battery in the National Social Life, Health, and Aging Project (NSHAP), and ensure that the battery does proxy the Big Five. Also, describe the levels of Big Five traits across gender and age. METHOD: We used an Exploratory Structural Equation Model (ESEM) to analyze NHSAP's personality battery, comparing NSHAP with the National Longitudinal Study of Midlife in the United States (MIDUS) and the Health and Retirement Study (HRS). RESULTS: ESEM revealed a 5-factor structure in the NSHAP battery, but with considerable cross-loadings. When these cross-loadings were not included in the model, model fit notably worsened. Reliabilities of Big Five scales were comparable to the HRS and MIDUS, even though NSHAP's battery is shorter. Women were considerably more Agreeable than men, although this gender gap closed among the oldest in the sample (80 years or older). DISCUSSION: Researchers will be able to make use of NSHAP's personality battery to examine a range of social, biological, and psychological factors at older ages, in light of individuals' general traits. We recommend models which allow for cross-loadings. %B The journals of gerontology. Series B, Psychological sciences and social sciences %I 69 %V 69 %P S117-24 %G eng %N Suppl 2 %4 Big Five/Factor analysis/NSHAP/Personality traits %$ 999999 %R 10.1093/geronb/gbu073 %0 Journal Article %J Journal of Research in Personality %D 2014 %T Physical activity and personality development across adulthood and old age: Evidence from two longitudinal studies %A Yannick Stephan %A Angelina R Sutin %A Antonio Terracciano %K Event History/Life Cycle %K Health Conditions and Status %K Methodology %X Personality traits are associated with a number of health-related factors; less is known about how such factors contribute to adult personality development. Based on evidence for the protective role of physical activity for individual functioning, the present study tests whether physical activity contributes to personality stability and change. Using longitudinal data from the Midlife in the United States study (N= 3758) and the Health and Retirement Study (N= 3774), we found that more physically active individuals declined less on conscientiousness, extraversion, openness and agreeableness, and had higher rank-order stability and profile consistency over time. These findings suggest that physical activity may help preserve personality stability and prevent maladaptive personality changes across adulthood and old age. 2013 Elsevier Inc. %B Journal of Research in Personality %I 49 %V 49 %P 1-7 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84891893126andpartnerID=40andmd5=e8bbe16791d8966632edd46360a3f5e6 %N 1 %4 Normative development/Personality change/Physical activity/Stability %$ 999999 %0 Journal Article %J J Aging Health %D 2014 %T Racial/Ethnic predictors of falls among older adults: the health and retirement study. %A Emily J Nicklett %A Taylor, Robert Joseph %K Accidental Falls %K Aged %K Black or African American %K Female %K Health Surveys %K Hispanic or Latino %K Humans %K Logistic Models %K Male %K Poisson Distribution %K Risk Factors %K White People %X

OBJECTIVE: The objective of this study was to examine racial/ethnic differences in the probability and frequency of falls among adults aged 65 and older.

METHOD: Using data from the Health and Retirement Study (HRS) from 2000 to 2010, the authors conducted random-intercept logistic and Poisson regression analyses to examine whether race/ethnicity predicted the likelihood of a fall event and the frequency of falls.

RESULTS: The analytic sample included 10,484 older adults. Baseline analyses showed no significant racial/ethnic differences in the probability or number of falls. However, in the longitudinal random-intercept models, African Americans had significantly lower odds (0.65) of experiencing at least one fall compared with non-Hispanic Whites. Among fallers, African Americans had significantly fewer falls (24%) than non-Hispanic Whites, controlling for health and sociodemographic covariates (all ps < .05). Latinos did not differ from non-Hispanic Whites in the likelihood or number of falls.

DISCUSSION: African Americans are less likely to experience initial or recurrent falls than non-Hispanic Whites.

%B J Aging Health %I 26 %V 26 %P 1060-75 %8 2014 Sep %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/25005171?dopt=Abstract %2 PMC4227632 %4 falls/fall rates/fall risk/ethnicity/older adults/risk factors/ethnic differences/African Americans/hispanics %$ 999999 %R 10.1177/0898264314541698 %0 Journal Article %J Social Security Bulletin %D 2014 %T The Social Security Windfall Elimination and Government Pension Offset Provisions for Public Employees in the Health and Retirement Study %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Employment and Labor Force %K Income %K Pensions %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X This article uses Health and Retirement Study data to investigate the effects of Social Security's Windfall Elimination Provision (WEP) and Government Pension Offset (GPO) on Social Security benefits received by households. The provisions reduce benefits for individuals or the dependents of individuals whose work histories include jobs for which they were entitled to a pension and were not subject to Social Security payroll taxes ( noncovered employment). We find that about 3.5 percent of households are subject to either the WEP or the GPO, and that the provisions reduce the present value of their Social Security benefits by roughly one-fifth. Households affected by both provisions experience benefit reductions of about one-third. Under the WEP, the Social Security benefit reduction is capped at one-half of the amount of the pension from noncovered employment, which substantially reduces the WEP penalty and prevents the WEP adjustment from falling disproportionately on households in the lowest earnings category. %B Social Security Bulletin %I 74 %V 74 %P 55-69 %G eng %N 3 %4 Retirement Policies/Wage Level and Structure/Wage Differentials/Public Sector Labor Markets/labor Force Participation/Earnings/Pensions/Public Employee/Social Security/Windfall Elimination Provision/Government Pension Offset %$ 999999 %0 Journal Article %J International Journal of Social Science Studies %D 2014 %T Successful Aging: Multiple Trajectories and Population Heterogeneity %A Tang, Fengyan %K Demographics %K Other %X Following Rowe and Kahn s successful aging model, this study identified successful aging as a distinctive aging trajectory and examined gender differences in the aging process. Using the Health and Retirement Study data (2000-2008), this study applied group-based trajectory analysis to identify multiple aging trajectories in a sample of older Americans aged 65 and over (N=9,226). Six dimensions were analyzed in the multi-trajectory model: chronic disease, physical functional limitation, disability, depressive symptom, cognitive functioning, and active engagement with life. Three aging trajectory groups were identified: successful aging, usual aging, and pathological aging in both samples of men and women. About one third of women and 40 percent of men fell into the successful aging trajectory. Women were more likely than men to experience functional limitations and disability over time, thus less likely to age successfully. Younger age and higher levels of education and income were related to the likelihood of successful aging. Findings provide support for a multidimensional model of successful aging that emphasizes the heterogeneity in physical, cognitive, and social functioning among the older population. Future research need incorporate subjective assessments of successful aging, examine the potential transitions among different aging trajectories, and assess the impacts of health behavior and resource variables on the aging outcomes. %B International Journal of Social Science Studies %I 2 %V 2 %P 12-22 %G eng %N 3 %4 successful aging/aging trajectory/gender difference %$ 999999 %R 10.11114/ijsss.v2i2.372 %0 Journal Article %J Obstetrics and Gynecology %D 2014 %T Urinary Incontinence, Depression, and Economic Outcomes in a Cohort of Women Between the Ages of 54 and 65 Years %A Hung, Kristin J. %A Awtrey, Christopher S. %A Tsai, Alexander C. %K Employment and Labor Force %K Health Conditions and Status %X OBJECTIVE: To estimate the association between urinary incontinence (UI) and probable depression, work disability, and workforce exit. METHODS: The analytic sample consisted of 4,511 women enrolled in the population-based Health and Retirement Study cohort. The analysis baseline was 1996, the year that questions about UI were added to the survey instrument, and at which time study participants were 54 65 years of age. Women were followed-up with biennial interviews until 2010 2011. Outcomes of interest were onset of probable depression, work disability, and workforce exit. Urinary incontinence was specified in different ways based on questions about experience and frequency of urine loss. We fit Cox proportional hazards regression models to the data, adjusting the estimates for baseline sociodemographic and health status variables previously found to confound the association between UI and the outcomes of interest. RESULTS: At baseline, 727 participants (survey-weighted prevalence, 16.6 ; 95 confidence interval CI 15.4 18.0) reported any UI, of which 212 (survey-weighted prevalence, 29.2 ; 95 CI 25.4 33.3) reported urine loss on more than 15 days in the past month; and 1,052 participants were categorized as having probable depression (survey-weighted prevalence, 21.6 ; 95 CI 19.8 23.6). Urinary incontinence was associated with increased risks for probable depression (adjusted hazard ratio, 1.43; 95 CI 1.27 1.62) and work disability (adjusted hazard ratio, 1.21; 95 CI 1.01 1.45), but not workforce exit (adjusted hazard ratio, 1.06; 95 CI 0.93 1.21). CONCLUSION: In a population-based cohort of women between ages 54 and 65 years, UI was associated with increased risks for probable depression and work disability. Improved diagnosis and management of UI may yield significant economic and psychosocial benefits. LEVEL OF EVIDENCE: II %B Obstetrics and Gynecology %I 123 %V 123 %P 822-827 %G eng %U http://journals.lww.com/greenjournal/Fulltext/2014/04000/Urinary_Incontinence,_Depression,_and_Economic.15.aspx %N 4 %4 Depression/Work limitation/Workforce issues/Urinary incontinence %$ 999999 %R 10.1097/AOG.0000000000000186 %0 Journal Article %J Brain Behav %D 2014 %T Validation of a polygenic risk score for dementia in black and white individuals. %A Jessica R Marden %A Stefan Walter %A Eric J. Tchetgen Tchetgen %A Ichiro Kawachi %A M. Maria Glymour %K African Americans %K Aged %K Aged, 80 and over %K Dementia %K European Continental Ancestry Group %K Female %K Humans %K Male %K Middle Aged %K Multifactorial Inheritance %K Polymorphism, Genetic %K Reproducibility of Results %K Risk Assessment %K Risk Factors %K Surveys and Questionnaires %K United States %X

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

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

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

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

%B Brain Behav %V 4 %P 687-97 %8 2014 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25328845?dopt=Abstract %R 10.1002/brb3.248 %0 Book Section %B Safety Nets and Benefit Dependence %D 2014 %T What Impact Does Old-Age Pension Receipt Have on the Use of Public Assistance Programs Among the Elderly? %A Norma B Coe %A April Yanyuan Wu %E Carcillo, Stéphane %E Immervoll, Herwig %E Stephen P. Jenkins %E Königs, Sebastian %E Tatsiramos, Konstantinos %K Health Conditions and Status %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %B Safety Nets and Benefit Dependence %I Emerald Group Publishing %C Bingley, UK %P 259-290 %G eng %4 social Security/old age pensions/retirement planning/Public assistance %$ 999999 %! What Impact Does Old-Age Pension Receipt Have on the Use of Public Assistance Programs Among the Elderly? %0 Journal Article %J Neuropsychology %D 2013 %T The apolipoprotein E genotype predicts longitudinal transitions to mild cognitive impairment but not to Alzheimer's dementia: findings from a nationally representative study. %A Brainerd, C. J. %A V. F. Reyna %A Ronald C Petersen %A Glenn E Smith %A Kenney, A. E. %A C. J. Gross %A Taub, E. S. %A Brenda L Plassman %A Gwenith G Fisher %K Aged %K Aged, 80 and over %K Alzheimer disease %K Apolipoproteins E %K Cognitive Dysfunction %K disease progression %K Female %K Genetic Predisposition to Disease %K Genetic Testing %K Genotype %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K National Institutes of Health (U.S.) %K Neuropsychological tests %K Risk Factors %K United States %X

OBJECTIVE: The ε4 allele of the apolipoprotein E (APOE) genotype is the most widely accepted genetic risk factor for Alzheimer's dementia (AD), but findings on whether it is a risk factor for the AD prodrome, mild cognitive impairment (MCI), have been inconsistent. In a prospective longitudinal design, we investigated (a) whether transitions to MCI and other forms of neurocognitive impairment without dementia (CIND) are more frequent among normal ε4 carriers than among noncarriers and (b) whether subsequent transitions to AD from MCI and from other forms of CIND are more frequent among ε4 carriers than among noncarriers.

METHOD: The frequency of the ε4 allele was studied in older adults (mean age > 70), who had participated in two or more waves of neuropsychological testing and diagnosis in the Aging, Demographics, and Memory Study (ADAMS) of the United States Department of Health and Human Services, National Institutes of Health, National Institute on Aging's Health and Retirement Study, conducted by the University of Michigan. The association between ε4 and longitudinal transitions to specific types of CIND and dementia can be determined with this data set.

RESULTS: Epsilon 4 increased the rate of progression from normal functioning to MCI (58% of new diagnoses were carriers) but not to other forms of CIND. The rate of progression to AD from MCI or from other forms of CIND was not increased by ε4.

CONCLUSIONS: The results support the hypothesis that ε4 is a risk factor for transitions from normal functioning to MCI but not for subsequent transitions to AD. In the ADAMS sample, the reason ε4 is elevated in AD individuals is because it is already elevated in MCI individuals, who are the primary source of new AD diagnoses.

%B Neuropsychology %V 27 %P 86-94 %8 2013 Jan %G eng %U http://psycnet.apa.org/journals/neu/27/1/86/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23356599?dopt=Abstract %R 10.1037/a0030855 %0 Journal Article %J The journals of gerontology. Series B, Psychological sciences and social sciences %D 2013 %T Causal effects of retirement timing on subjective physical and emotional health %A Calvo, Esteban %A Sarkisian, Natalia %A Tamborini, Christopher R. %K Health Conditions and Status %K Retirement Planning and Satisfaction %X This article explores the effects of the timing of retirement on subjective physical and emotional health. Using panel data from the Health and Retirement Study (HRS), we test 4 theory-based hypotheses about these effects-that retirements maximize health when they happen earlier, later, anytime, or on time. We employ fixed and random effects regression models with instrumental variables to estimate the short- and long-term causal effects of retirement timing on self-reported health and depressive symptoms. Early retirements--those occurring prior to traditional and legal retirement age--dampen health. Workers who begin their retirement transition before cultural and institutional timetables experience the worst health outcomes; this finding offers partial support to the psychosocial-materialist approach that emphasizes the benefits of retiring later. Continued employment after traditionally expected retirement age, however, offers no health benefits. In combination, these findings offer some support for the cultural-institutional approach but suggest that we need to modify our understanding of how cultural-institutional forces operate. Retiring too early can be problematic but no disadvantages are associated with late retirements. Raising the retirement age, therefore, could potentially reduce subjective health of retirees by expanding the group of those whose retirements would be considered early. %B The journals of gerontology. Series B, Psychological sciences and social sciences %I 68 %V 68 %P 73 %G eng %N 1 %4 Mental health/Early retirement/retirement planning/physical health/emotional health/health Status %$ 69748 %0 Journal Article %J Alzheimer Dis Assoc Disord %D 2013 %T Combining direct and proxy assessments to reduce attrition bias in a longitudinal study. %A Bei Wu %A Tchetgen Tchetgen, Eric J %A Theresa L Osypuk %A White, Kellee %A Mujahid, Mahasin %A M. Maria Glymour %K Aged %K Bias %K Caregivers %K Dementia %K Female %K Humans %K Longitudinal Studies %K Male %K Neuropsychological tests %K Prevalence %K Proxy %X

Retaining severely impaired individuals poses a major challenge in longitudinal studies of determinants of dementia or memory decline. In the Health and Retirement Study (HRS), participants complete direct memory assessments biennially until they are too impaired to complete the interview. Thereafter, proxy informants, typically spouses, assess the subject's memory and cognitive function using standardized instruments. Because there is no common scale for direct memory assessments and proxy assessments, proxy reports are often excluded from longitudinal analyses. The Aging, Demographics, and Memory Study (ADAMS) implemented full neuropsychological examinations on a subsample (n=856) of HRS participants, including respondents with direct or proxy cognitive assessments in the prior HRS core interview. Using data from the ADAMS, we developed an approach to estimating a dementia probability and a composite memory score on the basis of either proxy or direct assessments in HRS core interviews. The prediction model achieved a c-statistic of 94.3% for DSM diagnosed dementia in the ADAMS sample. We applied these scoring rules to HRS core sample respondents born 1923 or earlier (n=5483) for biennial assessments from 1995 to 2008. Compared with estimates excluding proxy respondents in the full cohort, incorporating information from proxy respondents increased estimated prevalence of dementia by 12 percentage points in 2008 (average age=89) and suggested accelerated rates of memory decline over time.

%B Alzheimer Dis Assoc Disord %I 27 %V 27 %P 207-12 %8 2013 Jul-Sep %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22992720?dopt=Abstract %2 PMC3731387 %4 Dementia/Memory decline/dementia probability/composite memory score/Cognitive assessments/Proxy informants %$ 69200 %R 10.1097/WAD.0b013e31826cfe90 %0 Journal Article %J The Journals of Gerontology %D 2013 %T Cross-National Comparisons of Gender Differences in Late-Life Depressive Symptoms in Japan and the United States %A Andrew D. Tiedt %K Adult children %K Cross-National %K Demographics %K Health Conditions and Status %X This study compared changes in self-reported depressive symptoms in the United States and Japan across 2 points in time. The investigation focused on the gendered processes of intergenerational coresidence and support as the primary distinctions between nations. Fixed-effects models were fit to examine the covariates of depressive symptoms in the Health and Retirement Study (HRS) and the Nihon University Japanese Longitudinal Study of Aging. Gender differences in depressive symptoms persisted across survey waves in both nations, with Japanese men reporting sharper increases by Time 2 than Japanese women. Getting older was associated with more depressive symptoms among Japanese men, whereas income provided a slight buffering effect. Coresiding with daughters also appeared to protect Japanese men and women with functional limitations from depressive symptoms. HRS data demonstrated that changes in marital status and physical health were correlated with increased depressive symptoms for men and women in the United States. The analyses revealed more variety in Center for Epidemiologic Studies Depression scale reports by gender in Japan than in the United States. Future research should consider the diversity of contemporary Japanese households, reflecting new interpretations of traditional family support relationships. %B The Journals of Gerontology %I 68 %V 68 %P 443 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1329184720?accountid=14667 %N 3 %4 Cross-national comparison/Japanese Longitudinal Study of Aging/Social support/Gender differences/Japan/Mental depression/Functional limitation %$ 68976 %0 Thesis %D 2013 %T Essays on Labor Economics %A Tanaka, Atsuko %Y John Kennan %K Cross-National %K Employment and Labor Force %K Health Conditions and Status %K Methodology %K Net Worth and Assets %K Other %X This dissertation investigates determinants of labor supply decision and worker productivity. In the first two chapters, I investigate inefficiency due to statistical discrimination, in which employers---who do not observe the individual worker's labor force intention---offer a female worker fewer human capital investment opportunities than a male worker because of women's weaker labor force attachment. Owing to imperfect information, productivity inefficiency arises when women receive the same amount of investment despite the fact that women with shorter job tenure are potentially less productive than other workers. To study such a situation, I develop a model of statistical discrimination with a screening mechanism. In the third chapter, a joint project with Laurel Beck, I shift focus from statistical discrimination to worker's mental health as determinants of worker productivity. The first chapter applies the above model empirically to Japanese data, whose features exhibit evidence for statistical discrimination. The Japanese female labor market is found to be in a pooling equilibrium, thereby allowing statistical discrimination. I then estimate the effects of child-care subsides on the degree of statistical discrimination. The counterfactual analysis shows that child-care subsides could bring a drastic change in efficiency to Japan by altering the equilibrium of the worker-firm game from pooling to separating. The second chapter theoretically examines the factors that further complicate the screening process. I argue that long-term wage contracts implicitly distribute compensation from the employed to the unemployed and thus provide workers collective bargaining over wages. This finding allows us a new way to understand long-term contracts. The third chapter examines the effect of depression on various labor force outcomes. We use panel data from the Japanese Panel Survey of Consumers (JPSC) and the Health and Retirement Study (HRS) to follow respondents over several years, using questions about both mental health and labor force outcomes. In order to understand the causal effect of depression on work participation and compensation, we use deaths of the parents or children of respondents as an exogenous shock to mental health, and assess the impact of that event over time. %I The University of Wisconsin - Madison %V 3589854 %P 167 %8 May 2013 %G English %9 Ph.D. %M 1430930606 %4 mental Health %$ 69202 %! Essays on Labor Economics %0 Journal Article %J American journal of public health %D 2013 %T Gender-stratified models to examine the relationship between financial hardship and self-reported oral health for older US men and women %A Chi, Donald L. %A Reginald D. Tucker-Seeley %K Demographics %K Health Conditions and Status %K Healthcare %K Net Worth and Assets %X OBJECTIVES: We evaluated the relationship between financial hardship and self-reported oral health for older men and women. METHODS: We focused on adults in the 2008 Health and Retirement Study (n=1,359). The predictor variables were 4 financial hardship indicators. We used Poisson regression models to estimate the prevalence ratio of poor self-reported oral health. RESULTS: In the non-gender-stratified model, number of financial hardships was not significantly associated with self-reported oral health. Food insecurity was associated with a 12 greater prevalence of poor self-reported oral health (95 confidence interval CI =1.04, 1.21). In the gender-stratified models, women with 3 or more financial hardships had a 24 greater prevalence of poor self-reported oral health than women with zero (95 CI=1.09, 1.40). Number of hardships was not associated with self-reported oral health for men. For men, skipping medications was associated with 50 lower prevalence of poor self-reported oral health (95 CI=0.32, 0.76). CONCLUSIONS: Number of financial hardships was differentially associated with self-reported oral health for older men and women. Most financial hardship indicators affected both genders similarly. Future interventions to improve vulnerable older adults' oral health should account for gender-based heterogeneity in financial hardship experiences. %B American journal of public health %I 103 %V 103 %P 1507-15 %G eng %N 8 %4 Gender/ORAL-HEALTH/SELF-RATED HEALTH/financial hardships %$ 69130 %R 10.2105/ajph.2012.301145 %0 Journal Article %J Am J Epidemiol %D 2013 %T A Genetic IV Analysis to Assess the Effect of Body Mass Index on Depression in the Health And Retirement Study %A Stefan Walter %A Mejía-Guevara, Iván %A Eric J. Tchetgen Tchetgen %A Karestan C Koenen %A Ichiro Kawachi %A Laura D Kubzansky %A M. Maria Glymour %K Genetics %K Health Conditions and Status %K Public Policy %X Background: The relationship between adiposity and mental health remains controversial despite extensive prior observational research. We use a genetic risk score (GRS) as an instrumental variable (IV) to estimate effects of increases in body mass index (BMI) on depressive symptoms. Methods: Data are from 11842 (whites = 10322, blacks = 1520) individuals from the nationally representative Health and Retirement Study with data on a 10-item Center for Epidemiologic Studies Depression (CESD) scale and genetics collected in 2006 or 2008. Based on 32 Single Nucleotide Polymorphisms (SNPs) known to predict BMI, we calculated a GRS as the sum of the number of risk alleles multiplied by the per allele effect size on BMI (based on prior publica- tions). We conducted over-identification tests with 4 IVs using subsets of the SNPs organized based on biological pathways (adiposity, appetite, and cardio-pulmonary factors) by which the genes might influence adiposity. Self-reported BMI prior to the assessment of CESD was used for validation of the external instrument. The CESD score was regressed on each genetic IV plus population stratification eigenvectors to derive the IV effect estimate. We compared these to conventional effect estimates derived from regressing CESD on self-reported BMI. Results: The GRS significantly predicted BMI in blacks (r2=0.016, p 0.001) and whites (r2=0.010, p 0.001). Self-reported BMI significantly predicted CESD, more strongly in whites (0.043, 95 -CI: 0.036, 0.05) than blacks (0.021, CI: 0.004, 0.038). IV effect estimates were large and statistically significant for whites (0.0 96, CI: 0.026, 0.167) but had very wide CIs for blacks (0.016, CI: -0.224, 0.256) . Over-identification tests showed no evidence of possible pleiotropy in the genetic risk score. Conclusions: Our IV analysis reveals that genotypes associated with BMI are also associated with depressive symptoms in whites, supporting a causal effect of BMI on depression. %B Am J Epidemiol %I 177 %V 177 %P S12 %G eng %4 public Health/occupational health/Body Mass Index/Genetic Markers/risk alleles/genetic risk score/Depression/biological pathways/mental Health/genetics/genetics %$ 69334 %0 Journal Article %J Am J Hum Genet %D 2013 %T Genome-wide association analysis of blood-pressure traits in African-ancestry individuals reveals common associated genes in African and non-African populations. %A Franceschini, Nora %A Fox, Ervin %A Zhang, Zhaogong %A Edwards, Todd L %A Michael A Nalls %A Yun Ju Sung %A Bamidele O Tayo %A Yan V Sun %A Gottesman, Omri %A Adebawole Adeyemo %A Andrew D Johnson %A Young, J Hunter %A Kenneth Rice %A Duan, Qing %A Chen, Fang %A Yun Li %A Tang, Hua %A Myriam Fornage %A Keene, Keith L %A Andrews, Jeanette S %A Jennifer A Smith %A Jessica Faul %A Guangfa, Zhang %A Guo, Wei %A Liu, Yu %A Murray, Sarah S %A Musani, Solomon K %A Srinivasan, Sathanur %A Digna R Velez Edwards %A Wang, Heming %A Becker, Lewis C %A Bovet, Pascal %A Bochud, Murielle %A Broeckel, Ulrich %A Burnier, Michel %A Carty, Cara %A Daniel I Chasman %A Georg B Ehret %A Chen, Wei-Min %A Chen, Guanjie %A Wei Chen %A Ding, Jingzhong %A Dreisbach, Albert W %A Michele K Evans %A Guo, Xiuqing %A Melissa E Garcia %A Jensen, Rich %A Keller, Margaux F %A Lettre, Guillaume %A Lotay, Vaneet %A Martin, Lisa W %A Moore, Jason H %A Alanna C Morrison %A Thomas H Mosley %A Ogunniyi, Adesola %A Walter R Palmas %A George J Papanicolaou %A Alan Penman %A Polak, Joseph F %A Ridker, Paul M %A Babatunde Salako %A Andrew B Singleton %A Daniel Shriner %A Kent D Taylor %A Ramachandran S Vasan %A Kerri Wiggins %A Williams, Scott M %A Yanek, Lisa R %A Wei Zhao %A Alan B Zonderman %A Becker, Diane M %A Berenson, Gerald %A Boerwinkle, Eric %A Erwin P Bottinger %A Cushman, Mary %A Charles B Eaton %A Nyberg, Fredrik %A Gerardo Heiss %A Joel N Hirschhron %A Howard, Virginia J %A Karczewsk, Konrad J %A Lanktree, Matthew B %A Liu, Kiang %A Yongmei Liu %A Ruth J F Loos %A Margolis, Karen %A Snyder, Michael %A Psaty, Bruce M %A Schork, Nicholas J %A David R Weir %A Charles N Rotimi %A Sale, Michele M %A Tamara B Harris %A Sharon L R Kardia %A Hunt, Steven C %A Donna K Arnett %A Redline, Susan %A Cooper, Richard S %A Neil Risch %A Rao, D C %A Rotter, Jerome I %A Chakravarti, Aravinda %A Reiner, Alex P %A Levy, Daniel %A Keating, Brendan J %A Zhu, Xiaofeng %K Africa %K African Continental Ancestry Group %K Blood pressure %K Cohort Studies %K Databases, Genetic %K Genetic Loci %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Polymorphism, Single Nucleotide %K Quantitative Trait, Heritable %K Reproducibility of Results %X

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

%B Am J Hum Genet %V 93 %P 545-54 %8 2013 Sep 05 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/23972371?dopt=Abstract %R 10.1016/j.ajhg.2013.07.010 %0 Journal Article %J Science %D 2013 %T GWAS of 126,559 individuals identifies genetic variants associated with educational attainment. %A Cornelius A Rietveld %A Sarah E Medland %A Derringer, Jaime %A Yang, Jian %A Tõnu Esko %A Martin, Nicolas W %A Westra, Harm-Jan %A Shakhbazov, Konstantin %A Abdel Abdellaoui %A Agrawal, Arpana %A Albrecht, Eva %A Alizadeh, Behrooz Z %A Amin, Najaf %A Barnard, John %A Baumeister, Sebastian E %A Benke, Kelly S %A Bielak, Lawrence F %A Boatman, Jeffrey A %A Patricia A. Boyle %A Gail Davies %A Christiaan de Leeuw %A Eklund, Niina %A Daniel S Evans %A Rudolf Ferhmann %A Fischer, Krista %A Gieger, Christian %A Gjessing, Håkon K %A Hägg, Sara %A Harris, Jennifer R %A Caroline Hayward %A Holzapfel, Christina %A Carla A Ibrahim-Verbaas %A Ingelsson, Erik %A Jacobsson, Bo %A Joshi, Peter K %A Jugessur, Astanand %A Marika A Kaakinen %A Kanoni, Stavroula %A Karjalainen, Juha %A Kolcic, Ivana %A Kristiansson, Kati %A Kutalik, Zoltán %A J. Lahti %A Lee, Sang H %A Lin, Peng %A Penelope A Lind %A Yongmei Liu %A Kurt Lohman %A Loitfelder, Marisa %A McMahon, George %A Vidal, Pedro Marques %A Osorio Meirelles %A Lili Milani %A Myhre, Ronny %A Nuotio, Marja-Liisa %A Christopher J Oldmeadow %A Katja E Petrovic %A Wouter J Peyrot %A Polasek, Ozren %A Quaye, Lydia %A Reinmaa, Eva %A Rice, John P %A Rizzi, Thais S %A Schmidt, Helena %A Schmidt, Reinhold %A Albert Vernon Smith %A Jennifer A Smith %A Toshiko Tanaka %A Antonio Terracciano %A van der Loos, Matthijs J H M %A Vitart, Veronique %A Völzke, Henry %A Jürgen Wellmann %A Lei Yu %A Wei Zhao %A Allik, Jüri %A John R. Attia %A Bandinelli, Stefania %A Bastardot, François %A Jonathan P. Beauchamp %A David A Bennett %A Klaus Berger %A Laura Bierut %A Dorret I Boomsma %A Bültmann, Ute %A Campbell, Harry %A Chabris, Christopher F %A Cherkas, Lynn %A Chung, Mina K %A Francesco Cucca %A de Andrade, Mariza %A Philip L de Jager %A De Neve, Jan-Emmanuel %A Ian J Deary %A George Dedoussis %A Deloukas, Panos %A Dimitriou, Maria %A Guðny Eiríksdóttir %A Elderson, Martin F %A Johan G Eriksson %A Jessica Faul %A Luigi Ferrucci %A Melissa E Garcia %A Grönberg, Henrik %A Guðnason, Vilmundur %A Hall, Per %A Harris, Juliette M %A Tamara B Harris %A Nicholas D Hastie %A Andrew C Heath %A Dena G Hernandez %A Hoffmann, Wolfgang %A Hofman, Adriaan %A Holle, Rolf %A Holliday, Elizabeth G %A Jouke-Jan Hottenga %A Iacono, William G %A Illig, Thomas %A Järvelin, Marjo-Riitta %A Kähönen, Mika %A Kaprio, Jaakko %A Kirkpatrick, Robert M %A Kowgier, Matthew %A Latvala, Antti %A Lenore J Launer %A Lawlor, Debbie A %A Lehtimäki, Terho %A Li, Jingmei %A Paul Lichtenstein %A Lichtner, Peter %A David C Liewald %A Pamela A F Madden %A Patrik K E Magnusson %A Mäkinen, Tomi E %A Masala, Marco %A McGue, Matt %A Andres Metspalu %A Mielck, Andreas %A Michael B Miller %A Grant W Montgomery %A Mukherjee, Sutapa %A Nyholt, Dale R %A Ben A Oostra %A Palmer, Lyle J %A Aarno Palotie %A Brenda W J H Penninx %A Markus Perola %A Peyser, Patricia A %A Preisig, Martin %A Katri Räikkönen %A Olli T Raitakari %A Realo, Anu %A Ring, Susan M %A Ripatti, Samuli %A Fernando Rivadeneira %A Rudan, Igor %A Rustichini, Aldo %A Veikko Salomaa %A Sarin, Antti-Pekka %A Schlessinger, David %A Rodney J Scott %A Snieder, Harold %A St Pourcain, Beate %A John M Starr %A Sul, Jae Hoon %A Surakka, Ida %A Svento, Rauli %A Teumer, Alexander %A Henning Tiemeier %A van Rooij, Frank J A %A Van Wagoner, David R %A Vartiainen, Erkki %A Viikari, Jorma %A Vollenweider, Peter %A Vonk, Judith M %A Waeber, Gérard %A David R Weir %A Wichmann, H-Erich %A Elisabeth Widen %A Gonneke Willemsen %A James F Wilson %A Alan F Wright %A Dalton C Conley %A Davey-Smith, George %A Lude L Franke %A Groenen, Patrick J F %A Hofman, Albert %A Johannesson, Magnus %A Sharon L R Kardia %A Krueger, Robert F %A David I Laibson %A Nicholas G Martin %A Meyer, Michelle N %A Posthuma, Danielle %A A. Roy Thurik %A Nicholas J Timpson %A André G Uitterlinden %A Cornelia M van Duijn %A Peter M Visscher %A Daniel J. Benjamin %A Cesarini, David %A Philipp D Koellinger %K Cognition %K Educational Status %K Endophenotypes %K Female %K Genetic Loci %K Genome-Wide Association Study %K Humans %K Male %K Multifactorial Inheritance %K Polymorphism, Single Nucleotide %X

A genome-wide association study (GWAS) of educational attainment was conducted in a discovery sample of 101,069 individuals and a replication sample of 25,490. Three independent single-nucleotide polymorphisms (SNPs) are genome-wide significant (rs9320913, rs11584700, rs4851266), and all three replicate. Estimated effects sizes are small (coefficient of determination R(2) ≈ 0.02%), approximately 1 month of schooling per allele. A linear polygenic score from all measured SNPs accounts for ≈2% of the variance in both educational attainment and cognitive function. Genes in the region of the loci have previously been associated with health, cognitive, and central nervous system phenotypes, and bioinformatics analyses suggest the involvement of the anterior caudate nucleus. These findings provide promising candidate SNPs for follow-up work, and our effect size estimates can anchor power analyses in social-science genetics.

%B Science %V 340 %P 1467-71 %8 2013 Jun 21 %G eng %N 6139 %1 http://www.ncbi.nlm.nih.gov/pubmed/23722424?dopt=Abstract %R 10.1126/science.1235488 %0 Journal Article %J Alzheimer Dis Assoc Disord %D 2013 %T Hospital and nursing home use from 2002 to 2008 among U.S. older adults with cognitive impairment, not dementia in 2002. %A Daniel O. Clark %A Timothy E. Stump %A Tu, Wanzhu %A Douglas K Miller %A Kenneth M. Langa %A Frederick W Unverzagt %A Christopher M. Callahan %K Aged %K Aged, 80 and over %K Aging %K Cognition Disorders %K Dementia %K Female %K Homes for the Aged %K Hospitalization %K Humans %K Male %K Nursing homes %K United States %X

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.

%B Alzheimer Dis Assoc Disord %V 27 %P 372-8 %8 2013 Oct-Dec %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00002093-201310000-00012 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/23151595?dopt=Abstract %! Alzheimer Disease & Associated Disorders %R 10.1097/WAD.0b013e318276994e %0 Journal Article %J Society and Mental Health %D 2013 %T Marital Processes around Depression: A Gendered and Relational Perspective %A Thomeer, Mieke Beth %A Debra Umberson %A Tetyana Pudrovska %K Adult children %K Demographics %K Health Conditions and Status %X Despite extensive evidence of the importance of marriage and marital processes for mental health, little is known about the interpersonal processes around depression within marriage and the extent to which these processes are gendered. We use a mixed-methods approach to explore the importance of gender in shaping processes around depression within marriage. We approach this in two ways: First, using quantitative longitudinal analysis of 2,601 couples from the Health and Retirement Study (HRS), we address whether depressive symptoms in one spouse shape the other spouse s depressive symptoms and whether men or women are more influential in this process. We find that a wife s depressive symptoms influence her husband s future depressive symptoms, but a husband s depressive symptoms do not influence his wife s future symptoms. Second, we conduct a qualitative analysis of in-depth interviews with 29 couples wherein one or both spouses experienced depression to provide additional insight into how gender impacts depression and reactions to depression within marriage. Our study points to the importance of cultural scripts of masculinity and femininity in shaping depression and emotional processes within marriage and highlights the importance of applying a gendered couple-level approach to better understand the mental health effects of marital processes. %B Society and Mental Health %I 3 %V 3 %P 151-169 %G eng %U http://smh.sagepub.com/content/3/3/151.abstract %N 3 %4 gender/families/depression %$ 999999 %R 10.1177/2156869313487224 %0 Journal Article %J Journal of Aging and Health %D 2013 %T Mental and physical health consequences of spousal health shocks among older adults %A Valle, Giuseppina %A Weeks, Janet A. %A Miles G Taylor %A Eberstein, Isaac W. %K Demographics %K Health Conditions and Status %X OBJECTIVE: To examine how the experience of a negative health event (i.e., onset of heart disease, diabetes, lung disease, cancer, or stroke) of one spouse affects the mental and physical well-being of the other partner as measured by depressive symptoms and self-reported health. METHODS: We employ latent growth curve analysis and examine adults 50 using six waves of data (1998-2008) from the Health and Retirement Study. RESULTS: One spouse's health shock affects the health of the other partner. Results indicate that a spouse's onset of a severe health condition worsens the mental health of women and the self-reported health of men. DISCUSSION: These findings illustrate that the family context of spouses is important to consider when examining health. %B Journal of Aging and Health %I 25 %V 25 %P 1121-42 %G eng %N 7 %4 Depression/Gender differences/Health shocks/Self-reported health %$ 69192 %R 10.1177/0898264313494800 %0 Journal Article %J American Journal of Epidemiology %D 2013 %T Obesity and Mortality Risk: New Findings From Body Mass Index Trajectories %A Hui Zheng %A Dmitry Tumin %A Qian, Zhenchao %K Demographics %K Health Conditions and Status %X Little research has addressed the heterogeneity and mortality risk in body mass index (BMI) trajectories among older populations. Applying latent class trajectory models to 9,538 adults aged 51 to 77 years from the US Health and Retirement Study (1992 2008), we defined 6 latent BMI trajectories: normal weight downward, normal weight upward, overweight stable, overweight obesity, class I obese upward, and class II/III obese upward. Using survival analysis, we found that people in the overweight stable trajectory had the highest survival rate, followed by those in the overweight obesity, normal weight upward, class I obese upward, normal weight downward, and class II/III obese upward trajectories. The results were robust after controlling for baseline demographic and socioeconomic characteristics, smoking status, limitations in activities of daily living, a wide range of chronic illnesses, and self-rated health. Further analysis suggested that BMI trajectories were more predictive of mortality risk than was static BMI status. Using attributable risk analysis, we found that approximately 7.2 of deaths after 51 years of age among the 1931 1941 birth cohort were due to class I and class II/III obese upward trajectories. This suggests that trajectories of increasing obesity past 51 years of age pose a substantive threat to future gains in life expectancy. %B American Journal of Epidemiology %I 178 %V 178 %P 1591-1599 %G eng %U http://aje.oxfordjournals.org/content/178/11/1591.abstract %N 11 %4 body Mass Index/obesity/self assessed health/Chronic illness/sociodemographic characteristics/sociodemographic characteristics/mortality risk/mortality risk %$ 69346 %R 10.1093/aje/kwt179 %0 Journal Article %J PLoS One %D 2013 %T Perceived Weight Discrimination and Obesity %A Angelina R Sutin %A Antonio Terracciano %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Methodology %K Other %K Retirement Planning and Satisfaction %X Weight discrimination is prevalent in American society. Although associated consistently with psychological and economic outcomes, less is known about whether weight discrimination is associated with longitudinal changes in obesity. The objectives of this research are (1) to test whether weight discrimination is associated with risk of becoming obese (Body Mass Index 30; BMI) by follow-up among those not obese at baseline, and (2) to test whether weight discrimination is associated with risk of remaining obese at follow-up among those already obese at baseline. Participants were drawn from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US residents. A total of 6,157 participants (58.6 female) completed the discrimination measure and had weight and height available from the 2006 and 2010 assessments. Participants who experienced weight discrimination were approximately 2.5 times more likely to become obese by follow-up (OR = 2.54, 95 CI = 1.58-4.08) and participants who were obese at baseline were three times more likely to remain obese at follow up (OR = 3.20, 95 CI = 2.06-4.97) than those who had not experienced such discrimination. These effects held when controlling for demographic factors (age, sex, ethnicity, education) and when baseline BMI was included as a covariate. These effects were also specific to weight discrimination; other forms of discrimination (e.g., sex, race) were unrelated to risk of obesity at follow-up. The present research demonstrates that, in addition to poorer mental health outcomes, weight discrimination has implications for obesity. Rather than motivating individuals to lose weight, weight discrimination increases risk for obesity. %B PLoS One %I 8 %V 8 %G eng %N 7 %4 SCIENCES: COMPREHENSIVE WORKS/Obesity/Studies/Discrimination/Retirement/Biomedical research/Secondary school students/Confidence intervals/United States--US %$ 69112 %R 10.1371/journal.pone.0070048 10.2105/ajph.2009.159491 10.1038/oby.2008.35 10.1177/002214650504600303 10.1111/j.1746-1561.2011.00646.x 10.1002/eat.20933 10.1016/j.eatbeh.2010.03.002 10.1038/oby.2010.234 10.1016/j.bodyim.2003.12.001 10.1016/j.jvb.2007.04.00 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2013 %T Race differences in the relationship between formal volunteering and hypertension. %A Jane Tavares %A Jeffrey A Burr %A Jan E Mutchler %K Black or African American %K Blood pressure %K Female %K Humans %K Hypertension %K Logistic Models %K Male %K Middle Aged %K Prevalence %K Risk Factors %K United States %K Volunteers %K White People %X

OBJECTIVES: This study investigated race differences in the relationship between formal volunteering and hypertension prevalence among middle-aged and older adults.

METHOD: Using data from the 2004 and 2006 Health and Retirement Study (N = 5,666; 677 African Americans and 4,989 whites), we examined regression models stratified by race to estimate relationships among hypertension prevalence, systolic and diastolic blood pressure, and volunteer status and hours spent volunteering among persons aged 51 years old and older.

RESULTS: White volunteers had a lower risk of hypertension than white nonvolunteers. A threshold effect was also present; compared with nonvolunteers, volunteering a moderate number of hours was associated with lowest risk of hypertension for whites. Results for hypertension were consistent with results from alternative models of systolic and diastolic blood pressure. We found no statistically significant relationship between volunteering activity and hypertension/blood pressure for African Americans.

DISCUSSION: There may be unmeasured cultural differences related to the meaning of volunteering and contextual differences in volunteering that account for the race differences we observed. Research is needed to determine the pathways through which volunteering is related to hypertension risk and that may help explain race differences identified here.

%B J Gerontol B Psychol Sci Soc Sci %I 68 %V 68 %P 310-9 %8 2013 Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23292324?dopt=Abstract %3 23292324 %4 racial Differences/Volunteering/Hypertension %$ 68950 %R 10.1093/geronb/gbs162 %0 Journal Article %J Journal of Aging and Health %D 2013 %T Reciprocity Between Depressive Symptoms and Physical Limitations Pre- and Postretirement: Exploring Racial Differences %A Gayman, Mathew D. %A Pai, Manacy %A Ben Lennox Kail %A Miles G Taylor %K Demographics %K Health Conditions and Status %K Healthcare %K Retirement Planning and Satisfaction %X This study assesses (a) the reciprocity between mental and physical health pre- and postretirement, and (b) the extent to which these associations vary by race. Data are from the 1994 to 2008 waves of the Health and Retirement Study. Analyses based on structural equation modeling reveal that depression and physical health exert reciprocal effects for Whites pre- and postretirement. For Blacks preretirement, physical limitations predict changes in depression but there is no evidence of the reverse association. Further, the association between physical limitations and changes in depressive symptoms among Blacks is no longer significant after retirement. The transition into retirement alleviates the translation of physical limitations into depressive symptoms for Blacks only. The findings underscore the relevance of retirement for reciprocity between mental and physical health and suggest that the health implications associated with this life course transition vary by race. %B Journal of Aging and Health %I 25 %V 25 %P 555 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1368997953?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Apqrlandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articleandr %N 4 %4 Gerontology And Geriatrics/Retirement/Racial differences/Mental depression/Personal health %$ 69012 %0 Journal Article %J Journal of Pension Economics and Finance %D 2013 %T Redistribution under the Social Security benefit formula at the individual and household levels, 1992 and 2004 %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Adult children %K Income %K Pensions %K Social Security %K Women and Minorities %X Studies using data from the early 1990s suggested that while the progressive Social Security benefit formula succeeded in redistributing benefits from individuals with high earnings to individuals with low earnings, it was much less successful in redistributing benefits from households with high earnings to households with low earnings. Wives often earned much less than their husbands. As a result, much of the redistribution at the individual level was effectively from high earning husbands to their own lower earning wives. In addition, spouse and survivor benefits accrue disproportionately to women from high income households. Both factors mitigate redistribution at the household level. It has been argued that with the increase in the labor force participation and earnings of women, Social Security now should do a better job of redistributing benefits at the household level. To be sure, when we compare outcomes for a cohort with a household member age 51 to 56 in 1992 with those from a cohort born twelve years later, redistribution at the household level has increased over time. Nevertheless, as of 2004 there still is substantially less redistribution of benefits from high to low earning households than from high to low earning individuals. %B Journal of Pension Economics and Finance %I 12 %V 12 %P 1-27 %G eng %N 1 %4 Social Security/Redistribution/Benefits/Spouse benefits/Survivor benefits/Benefit formula/Womens earnings/Family %$ 69144 %R 10.1017/s1474747212000108 %0 Report %D 2013 %T Savings and Wealth of the Lifetime Rich: Evidence from the UK and US %A Bozio, Antoine %A Carl Emmerson %A Cormac O'Dea %A Tetlow, Gemma %K ELSA %K Net Worth and Assets %X Whether higher lifetime income household do save a larger share of their income is one of the longstanding empirical questions in economics that has been surprisingly difficult to answer. We use both consumption data and a new dataset containing both individual survey data on wealth holdings and administrative data on earnings histories from the UK to examine this question. We find evidence of a positive relationship between savig rates (and wealth accumulation) and levels of permanent income. Our findings are consistent with earlier results from Dynan, Skinner and Zeldes (2004) using consumption data from the US, but somewhat at odds with evidence from the US which has examined retirement wealth and lifetime earnings in the Health and Reirement Study, HRS (Gustman andSteinmeier 1999, Venti and Wise 1998). We present new evidence using more recent HRS data, applying exactly the same methodology as we have used on the UK data, and find broadly the same results as these earlier papers. This suggests that the differences are not solely driven by differences in methodology or time period considered. %I London, Institute for Fiscal Studies %G eng %4 Lifetime Earnings, Savings, Wealth %$ 999999 %0 Report %D 2013 %T Self-employment and Health: Barriers or Benefits? %A Cornelius A Rietveld %A van Kippersluis, Hans %A A. Roy Thurik %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %X The self-employed are often reported to be healthier than wage workers; however, the cause of this health difference is largely unknown. The longitudinal nature of the US Health and Retirement Study allows us to gauge the plausibility of two competing explanations for this difference: a contextual, causal effect of self-employment on health (benefit effect), or a health-related selection of individuals into self-employment (barrier effect). Our main finding is that the selection of comparatively healthier individuals into self-employment accounts for the positive cross-sectional difference. The results rule out a positive contextual effect of self-employment on health, and we present tentative evidence that, if anything, engaging in self-employment is bad for one's health. Given the importance of the self-employed in the economy, these findings contribute to our understanding of the vitality of the labor force. %I Rotterdam, Erasmus School of Economics (ESE), Tinbergen Institute %G eng %4 Health Status/labor Force Participation/health-related selection/Self-employment %$ 69284 %0 Report %D 2013 %T The Social Security Windfall Elimination and Government Pension Offset Provisions for Public Employees in the Health and Retirement Study %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X This paper uses data from the Health and Retirement Study to investigate the effects of Social Security s Windfall Elimination Provision (WEP) and Government Pension Offset (GPO) provision on Social Security benefits received by individuals and households. WEP reduces the benefits of individuals who worked in jobs covered by Social Security and also worked in uncovered jobs where a pension was earned. WEP also reduces spouse benefits. GPO reduces spouse and survivor benefits for persons who worked in uncovered government employment where they also earned a pension. Unlike previous studies, we take explicit account of pensions earned on jobs not covered by Social Security, a key determinant of the size of WEP and GPO adjustments. Also unlike previous studies, we focus on the household. This allows us to incorporate the full effects of WEP and GPO on spouse and survivor benefits, and to evaluate the effects of WEP and GPO on the assets accumulated by affected families. Among our specific findings: About 3.5 percent of households are subject to either WEP or to GPO. The present value of their Social Security benefits is reduced by roughly one fifth. This amounts to five to six percent of the total wealth they accumulate before retirement. Households affected by both WEP and GPO lose about one third of their benefit. Limiting the Social Security benefit to half the size of the pension from uncovered employment reduces the penalty from WEP for members of the original HRS cohort by about 60 percent. %I Ann Arbor, The University of Michigan %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp288.pdf %4 public Pensions/retirement planning/social Security/Public Policy/government pension offset/windfall elimination provision %$ 69116 %0 Journal Article %J Revista Debate Econ mico %D 2013 %T A taxa de atividade economica e saude mental: a relacao entre aposentadoria e depressao %A Terra, Luisa Pimenta %A Queiroz, Bernardo Lanza %K Demographics %K Health Conditions and Status %K Retirement Planning and Satisfaction %X As ltimas d cadas observaram um crescimento acelerado de transtornos mentais na sociedade, com cerca de 450 milh es de pessoas com esse diagn stico no mundo. O alto custo para o sistema de sa de e para a qualidade de vida das pessoas refor a a discuss o do tema como uma quest o de sa de p blica. H uma ampla discuss o sobre o efeito da depress o na decis o de sa da do mercado de trabalho das pessoas mais idosas. Entretanto, h resultados recentes que apontam o aumento do n mero de aposentadorias precoces em diversos pa ses. O objetivo deste trabalho investigar qual a rela o entre a rec m-aposentadoria e a depress o em mulheres norte-americanas. Dados longitudinais do Health and Retirement Study entre 1992 e 2004 s o utilizados. A hip tese central que ser rec m-aposentada tem rela o negativa com o quadro de depress o, e baseada na ideia da intera o social como um agente protetor da depress o. Os resultados mostram que aposentar tem forte rela o com depress o. Mulheres rec m-aposentadas apresentam pior quadro de depress o do que as mulheres n o aposentadas e do que as que j est o aposentadas h mais de um ano. The last decades have observed a rapid increase of mental disorders in society, with about 450 million people with this diagnosis in the world. The high cost to the health system and the quality of life reinforces the discussion of the issue as a public health issue. There is an extensive discussion on the effect of depression in the decision to leave the labor market for older people. However, recent results indicate that the increase in the number of early retirement in many countries. The objective of this study is to investigate the relation between the newly-retirement and depression in U.S. women. Longitudinal data from the Health and Retirement Study between 1992 and 2004 are used. The central hypothesis is that being newly retired is negatively related to depressive states, and is based on the idea of social interaction as a protective agent of depression. The results show that retirement is strongly related to depression. Newly retired women have a worse picture of depression than women not retired and those who are already retired for over a year. %B Revista Debate Econ mico %I 1 %V 1 %P 86-100 %G eng %U https://publicacoes.unifal-mg.edu.br/revistas/index.php/revistadebateeconomico/article/view/120 %N 2 %4 mental health/retirement/depression/elderly %$ 999999 %0 Journal Article %J Neuroepidemiology %D 2013 %T What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline. %A Hector M González %A Wassim Tarraf %A Mary E Bowen %A Michelle D Johnson-Jennings %A Gwenith G Fisher %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cognitive Reserve %K Cohort Studies %K Female %K Humans %K Longevity %K Longitudinal Studies %K Male %K Parents %K Prospective Studies %K Socioeconomic factors %K United States %X

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

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

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

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

%B Neuroepidemiology %I 41 %V 41 %P 101-9 %8 2013 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23860477?dopt=Abstract %2 PMC3811933 %4 Cognitive reserve/Older adults/Life course/Development/CHILDHOOD/Socioeconomic Status %$ 69140 %R 10.1159/000350723 %0 Journal Article %J Medical Care %D 2012 %T A comparison and cross-validation of models to predict basic activity of daily living dependency in older adults. %A Daniel O. Clark %A Timothy E. Stump %A Tu, Wanzhu %A Douglas K Miller %K Accidental Falls %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Body Mass Index %K Chronic disease %K Female %K Humans %K Male %K Mobility Limitation %K Models, Statistical %K Risk Assessment %K Sex Factors %X

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.

%B Medical Care %V 50 %P 534-9 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22581013?dopt=Abstract %R 10.1097/MLR.0b013e318245a50c %0 Thesis %D 2012 %T Essays in Residential Choice and Non-Market Valuation %A Kuzmenko, Tatyana %Y Timmins, Christopher D. %K Health Conditions and Status %K Other %K Public Policy %X This dissertation focuses on non-market valuation of environmental goods, using housing values and residential location decisions to infer the value of local environmental quality. It makes two contributions to the literature: First, it explores the role of expected longevity in environmental risks valuation in a framework where individuals face multiple mortality and morbidity risks. The presence of background mortality risk from the causes unrelated to pollution reduces the willingness to pay for environmental risks reduction, because the competing risk lowers the chance that the consumer will be alive to benefit from environmental quality improvements. Using data from the Health and Retirement Study, we find that individuals with shorter expected lifespan are more likely to reside near toxins-emitting facilities. The effect of the longevity expectations is significant as compared to other determinants of environmental risk exposure identified in the previous literature, such as level of education, race, and wealth. These findings imply that the expected longevity can be an important source of heterogeneity in environmental risks valuation. Second, we find evidence that owner-assessed home values "lag behind" market prices, and that this lag has the potential to substantially alter values ascribed to local amenities using property-value hedonic techniques. We hypothesize that long-standing homeowners lack an incentive to gather recent information on housing markets, and that their ignorance is reflected in the bias in their self-reported housing values. We first demonstrate that bias in self-reported home values is significantly correlated with tenure. We then examine how tenure length affects homeowners' valuation of changes in a particular local amenity--exposure to sites on the EPA's National Priorities List (i.e., the Superfund program). We find that recent movers report a value of a site's deletion from that list (signaling the end of the Superfund remediation process) that is 30-50% greater than that expressed by long-standing owners. This difference is significant and can have important implications for the results of cost-benefit analysis. %I Duke University %C Durham, NC %V Ph.D. %G eng %U https://dukespace.lib.duke.edu/dspace/bitstream/handle/10161/5581/Kuzmenko_duke_0066D_11397.pdf?sequence=1 %4 Longevity %$ 62878 %0 Thesis %D 2012 %T Essays on Bayesian inference of time-series and ordered panel data models %A Park, Jeehyun %Y Tsurumi, Hiroki %K Health Conditions and Status %K Methodology %K Public Policy %X At the heart of my dissertation is the study of Markov chain Monte Carlo algorithms and their applications. My dissertation consists of three essays as follow. The first chapter is on MCMC algorithms for the dynamic ordered probit model with random effects. I have tried to estimate the model with four representative MCMC algorithms: two algorithms by Albert and Chib (1993) and Albert and Chib (2001), Liu and Sabatti (2000), and Chen and Dey (2000). I have found that the autocorrelations still remain high in the cutoffs compared to other parameters even though the levels of autocorrelation are reduced in the algorithms by Liu and Sabatti (2000), and Chen and Dey (2000). In the second chapter, I have developed the dynamic ordered probit model studied in the first chapter. It is natural for panel data to have missing data problem because there is no guarantee that subjects will stay over the study periods. This chapter provides Bayesian statistical methods that permit non-ignorable missing data in panel datasets. In order to incorporate non-random missing data in the model, I jointly model observed and non-ignorable missing ordinal data with selection model approach. In the empirical section, I have used the model to examine determinants of self-rated health of old people in the Health and Retirement Study. I have concluded that in this elderly American population, the longest occupation that respondents have held over their careers is strongly associated with self-rated health. In the third chapter of my dissertation, I analyze financial time-series data before and after the Wall Street meltdown in 2008. In this chapter, I develop MCMC algorithms for the CKLS model and examine (1) time-series characteristics of the credit default swap index, stock index and federal funds rate from January 2007 to September 2009, the highly volatile period. (2) The lead-lag relationship between the credit default swap and stock markets are examined using the CKLS model employing multivariate analysis. %I Rutgers The State University of New Jersey %C New Brunswick, NJ %V Ph.D. %G English %M prod.academic_MSTAR_1284154159 %4 methodological Problems (D516750) %$ 69034 %R 10.7282/T3W094QN %0 Journal Article %J The American Economic Review %D 2012 %T Financial Knowledge and Financial Literacy at the Household Level %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Net Worth and Assets %K Other %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X There is evidence of a relation between numeracy and wealth held outside of pensions and Social Security. With pensions and Social Security accounting for half of wealth at retirement, and evidence that those with pensions save more in other forms, one would expect to find knowledge of pensions and Social Security influencing retirement saving. Yet we find no evidence that knowledge of pensions and Social Security is related to nonpension, non-Social Security wealth, to numeracy, or that it plays an intermediate role in the numeracy-wealth relation. Our findings raise questions about policies that would enhance numeracy to increase retirement saving. PUBLICATION ABSTRACT %B The American Economic Review %I 102 %V 102 %P 309-313 %G eng %N 3 %4 numeracy/retirement planning/social security/Wealth/public policy %$ 69526 %R 10.1257/aer.102.3.309 %0 Journal Article %J Soc Secur Bull %D 2012 %T The growth in Social Security benefits among the retirement-age population from increases in the cap on covered earnings. %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Aged %K Cohort Studies %K Female %K Humans %K Insurance Benefits %K Male %K Middle Aged %K Models, Econometric %K Public Policy %K Salaries and Fringe Benefits %K Social Security %K Taxes %K United States %X

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

%B Soc Secur Bull %I 72 %V 72 %P 49-61 %8 2012 %G eng %U https://www.ssa.gov/policy/docs/ssb/v72n2/v72n2p49.html %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22799138?dopt=Abstract %4 Social security/payroll tax/Public policy/retirement planning/taxation %$ 69572 %0 Journal Article %J PLoS One %D 2012 %T Higher rates of Clostridium difficile infection among smokers. %A Mary A M Rogers %A M. Todd Greene %A Sanjay Saint %A Carol E Chenoweth %A Preeti N Malani %A Itishree Trivedi %A David M. Aronoff %K Clostridioides difficile %K Enterocolitis, Pseudomembranous %K Female %K Humans %K Male %K Middle Aged %K Smoking %K United States %X

OBJECTIVES: Cigarette smoking has been shown to be related to inflammatory bowel disease. We investigated whether smoking affected the probability of developing Clostridium difficile infection (CDI).

METHODS: We conducted a longitudinal study of 16,781 older individuals from the nationally representative Health and Retirement Study. Data were linked to files from the Centers for Medicare and Medicaid Services.

RESULTS: Overall, the rate of CDI in older individuals was 220.6 per 100,000 person-years (95% CI 193.3, 248.0). Rates of CDI were 281.6/100,000 person-years in current smokers, 229.0/100,000 in former smokers and 189.1/100,000 person-years in never smokers. The odds of CDI were 33% greater in former smokers (95% CI: 8%, 65%) and 80% greater in current smokers (95% CI: 33%, 145%) when compared to never smokers. When the number of CDI-related visits was evaluated, current smokers had a 75% increased rate of CDI compared to never smokers (95% CI: 15%, 167%).

CONCLUSIONS: Smoking is associated with developing a Clostridium difficile infection. Current smokers have the highest risk, followed by former smokers, when compared to rates of infection in never smokers.

%B PLoS One %I 7 %V 7 %P e42091 %8 2012 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/22848714?dopt=Abstract %2 PMC3407081 %4 cigarette smoking/inflammatory bowel disease/clostridium difficile infection/medicare %$ 69668 %R 10.1371/journal.pone.0042091 %0 Report %D 2012 %T Mismeasurement of Pensions Before and After Retirement: The Mystery of the Disappearing Pensions with Implications for the Importance of Social Security as a Source of Retirement Support %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Methodology %K Net Worth and Assets %K Pensions %K Retirement Planning and Satisfaction %X A review of the literature suggests that when pension values are measured by the wealth equivalent of promised DB pension benefits and DC balances for those approaching retirement, pensions account for more support in retirement than is suggested when their contribution is measured by incomes received directly from pension plans by those who have already retired. Estimates from the Health and Retirement Study (HRS) for respondents in their early fifties suggest that pension wealth is about 86 percent as valuable as Social Security wealth. In data from the Current Population Survey (CPS), for members of the same cohort, measured when they are 65 to 69, pension incomes are about 56 percent as valuable as incomes from Social Security. Our empirical analysis uses data from the Health and Retirement Study to examine the reasons for these differences in the contributions of pensions as measured in income and wealth data. A number of factors cause the contribution of pensions to be understated in retirement income data, especially data from the CPS. One factor is a difference in methodology between surveys affecting what is included in pension income, especially in the CPS, which ignores irregular payments from pensions. In CPS data on incomes of those ages 64 to 69 in 2006, pension values are 59 percent of the value of Social Security. For the same cohort, in HRS data, the pension value is 67 percent of the value of Social Security benefits. Some pension wealth disappears at retirement because respondents change their pension into other forms that are not counted as pension income in surveys of income. Altogether, 16 percent of pension wealth is transformed into some other form at the time of disposition. For those who had a defined benefit pension just before termination, the dominant plan type for current retirees, at termination 12 percent of the benefit was transformed into a state that would not count as pension income after retirement. For those who receive benefits soon after termination, there is a 3.5 percent reduction in DB pension value at termination compared to the year before termination. One reason may be the form of annuitization that is chosen. A series of caveats notwithstanding, the bottom line is that CPS data on pension incomes received in retirement understates the full contribution pensions make to supporting retirees. %B MRDRC Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/mismeasurement-of-pensions-before-and-after-retirement-the-mystery-of-the-disappearing-pensions-with-implications-for-the-importance-of-social-security-as-a-source-of-retirement-support-2/ %4 pension Plans/retirement planning/pension Wealth/Defined benefit plans/Current Population Survey/pension income %$ 69822 %0 Journal Article %J Clin Nurs Res %D 2012 %T Self-care and health outcomes of diabetes mellitus. %A MinKyoung Song %A Sarah J Ratcliffe %A Nancy C Tkacs %A Barbara Riegel %K Adult %K Aged %K Aged, 80 and over %K Clinical Nursing Research %K Diabetes Mellitus %K Female %K Follow-Up Studies %K Hospitalization %K Humans %K Length of Stay %K Male %K Middle Aged %K Self Care %K Treatment Outcome %X

Studies show that self-care improves diabetes mellitus (DM) outcomes; however, previous studies have focused on self-care maintenance, and little is known about self-care management. The objective of this study is to examine the influence of DM self-care maintenance and management on number of hospitalizations and hospitalization days. A cohort design with secondary analysis of data from the Health and Retirement Study 2002-2004 was used. Data from 726 adults with DM were analyzed with logistic regression and negative binomial regression adjusting for covariates. Self-care maintenance and management were significant determinants of hospitalization outcomes. Establishing a goal for HbA1c (self-care management) and eating ≥2 snacks or desserts per day (self-care maintenance) were associated with a decrease in hospitalizations (IRR = 0.860, p = .001; IRR = 0.914, p = .043, respectively). DM self-care maintenance and management influence health outcomes but in different ways. These data provide evidence that both elements are needed in the education of patients about DM.

%B Clin Nurs Res %V 21 %P 309-26 %8 2012 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/21926278?dopt=Abstract %3 21926278 %4 Diabetes/self Care/methods/self Care/methods/HOSPITALIZATION %$ 62701 %R 10.1177/1054773811422604 %0 Thesis %D 2012 %T Unemployment Insurance Offsets and the Labor Force Attachment of Older Workers %A Toohey, Desmond %K Insurance %K Labor %K labor force %K Unemployment insurance %X Recent years have seen a dramatic increase in the number of workers over the age of 62. Although many of these workers are eligible for unemployment insurance (UI) if they lose their jobs, the effects of UI on late-career behavior receive little attention in the literature. I propose a study of the elimination of Social Security “offsets” for unemployment insurance. A decade ago, many states reduced (offset) unemployment compensation for workers receiving Social Security retirement benefits. In the intervening years, almost all offsetting states dropped their policies, allowing unemployed Social Security recipients to collect full benefits. These changes are interesting in their own right, but also provide plausibly exogenous variation in the level of unemployment benefits available to workers over 62. The proposed research will examine the effects of offset eliminations and, more generally, the role of late-career UI benefits. While the effects of UI are extensively studied, older workers face unique barriers to reemployment and particularly salient labor force participation decisions. Using the Health and Retirement Study (HRS), I will exploit cross-time and cross-state variation to analyze different offset regimes. The primary analysis will use event study methods to estimate the effects of different UI policies on reemployment, search, and labor force exit following a job loss. I consider several extension to this analysis, which include proportional hazard and competing risks models of unemployment exit. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/about-us/grants/unemployment-insurance-offsets-and-the-labor-force-attachment-of-older-workers/ %0 Journal Article %J Frontiers in Psychology %D 2012 %T Who does well in life? Conscientious adults excel in both objective and subjective success. %A Angela Lee Duckworth %A David R Weir %A Tsukayama, Eli %A Kwok, David %K Conscientiousness %K Success %X This article investigates how personality and cognitive ability relate to measures of objective success (income and wealth) and subjective success (life satisfaction, positive affect, and lack of negative affect) in a representative sample of 9,646 American adults. In cross-sectional analyses controlling for demographic covariates, cognitive ability, and other Big Five traits, conscientiousness demonstrated beneficial associations of small-to-medium magnitude with all success outcomes. In contrast, other traits demonstrated stronger, but less consistently beneficial, relations with outcomes in the same models. For instance, emotional stability demonstrated medium-to-large associations with life satisfaction and affect but a weak association with income and no association with wealth. Likewise, extraversion demonstrated medium-to-large associations with positive affect and life satisfaction but small-to-medium associations with wealth and (lack of) negative affect and no association with income. Cognitive ability showed small-to-medium associations with income and wealth but no association with any aspect of subjective success. More agreeable adults were worse off in terms of objective success and life satisfaction, demonstrating small-to-medium inverse associations with those outcomes, but they did not differ from less agreeable adults in positive or negative affect. Likewise, openness to experience demonstrated small-to-medium inverse associations with every success outcome except positive affect, in which more open adults were slightly higher. Notably, in each of the five models predicting objective and subjective success outcomes, individual differences other than conscientiousness explained more variance than did conscientiousness. Thus, the benefits of conscientiousness may be remarkable more for their ubiquity than for their magnitude. %B Frontiers in Psychology %V 3 %P 356 %8 2012 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/23162483?dopt=Abstract %R 10.3389/fpsyg.2012.00356 %0 Journal Article %J Neuropsychology %D 2011 %T Is the apolipoprotein e genotype a biomarker for mild cognitive impairment? Findings from a nationally representative study. %A Brainerd, Charles J %A V. F. Reyna %A Ronald C Petersen %A Glenn E Smith %A Taub, Emily S %K Aged %K Aged, 80 and over %K Aging %K Analysis of Variance %K Apolipoprotein E4 %K Cognitive Dysfunction %K Dementia %K Female %K Gene Frequency %K Genetic Markers %K Genetic Testing %K Genotype %K Humans %K Male %K National Institute on Aging (U.S.) %K Neuropsychological tests %K Reference Values %K Reproducibility of Results %K Risk Factors %K United States %X

OBJECTIVE: Although the ε4 allele of the apolipoprotein E (APOE) genotype is a known risk factor for Alzheimer's dementia (AD), prior findings on whether it is also a risk factor for mild cognitive impairment (MCI) have been inconsistent. We tested two contrasting explanations: (a) an ε4-AD specificity hypothesis, and (b) a measurement insensitivity hypothesis.

METHOD: The frequency of the ε4 allele was investigated in older adults (mean age > 70) with various types of cognitive impairment (including MCI) and various types of dementia (including AD) with the aging, demographics, and memory study (ADAMS) of the National Institute on Aging's Health and Retirement Study (HRS). The ADAMS controls sources of Type I and Type II error that are posited in the ε4-AD specificity hypothesis and the measurement insensitivity hypothesis, and it is the only nationally representative data set on aging and cognitive impairment.

RESULTS: ε4 was a reliable predictor of MCI, with a frequency of 32% in MCI subjects versus 20% in healthy control subjects. This link was specific to MCI because ε4 was not a risk factor for other forms of cognitive impairment without dementia.

CONCLUSIONS: The results support the measurement insensitivity hypothesis rather than the ε4-AD specificity hypothesis and are consistent with recent research showing modest reductions in cognitive performance among normal functioning ε4 carriers.

%B Neuropsychology %I 25 %V 25 %P 679-89 %8 2011 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/21728427?dopt=Abstract %3 21728427 %4 Aging/Analysis of Variance/Apolipoprotein E4/genetics/genetics/Dementia/Gene Frequency/Genetic Markers/Genetic Testing/Genotype/Mild Cognitive Impairment/Neuropsychological Tests/Reference Values/Reproducibility of Results/Risk Factors/Alzheimer disease/epsilon4 allele %$ 69468 %R 10.1037/a0024483 %0 Journal Article %J Health Psychol %D 2011 %T Conscientiousness and longevity: an examination of possible mediators. %A Patrick L Hill %A Nicholas A. Turiano %A Michael D Hurd %A Daniel K. Mroczek %A Brent W Roberts %K Adult %K Aged %K Chronic disease %K Cognition %K Educational Status %K Female %K Health Behavior %K Health Status %K Humans %K Longevity %K Longitudinal Studies %K Male %K Middle Aged %K Personality %K Proportional Hazards Models %K Psychological Tests %X

OBJECTIVE: Conscientious individuals tend to experience a number of health benefits, not the least of which being greater longevity. However, it remains an open question as to why this link with longevity occurs. The current study tested two possible mediators (physical health and cognitive functioning) of the link between conscientiousness and longevity.

METHOD: We tested these mediators using a 10-year longitudinal sample (N = 512), a subset of the long-running Health and Retirement Study of aging adults. Measures included an adjective-rating measure of conscientiousness, self-reported health conditions, and three measures of cognitive functioning (word recall, delayed recall, and vocabulary) included in the 1996 wave of the HRS study.

RESULTS: Our results found that conscientiousness significantly predicted greater longevity, even in a model including the two proposed mediator variables, gender, age, and years of education. Moreover, cognitive functioning appears to partially mediate this relationship.

CONCLUSIONS: This study replicates previous research showing that conscientious individuals tend to lead longer lives, and provides further insight into why this effect occurs. In addition, it underscores the importance of measurement considerations.

%B Health Psychol %I 30 %V 30 %P 536-41 %8 2011 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21604882?dopt=Abstract %2 PMC3587967 %4 Adult/Chronic Disease/mortality/psychology/Chronic Disease/mortality/psychology/Cognition/Educational Status/Female/Health Behavior/Health Status/Humans/Longevity/Longitudinal Studies/Middle Aged/Personality/Personality/Proportional Hazards Models/Psychological Tests %$ 62746 %R 10.1037/a0023859 %0 Journal Article %J J Econ Perspect %D 2011 %T Consumer Financial Protection. %A Campbell, John Y. %A Howell E. Jackson %A Brigitte C. Madrian %A Peter Tufano %B J Econ Perspect %I 25 %V 25 %P 91-114 %8 2011 Winter %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/24991083?dopt=Abstract %4 Economic crisis/Securities markets/Securities markets %$ 62642 %R 10.1257/jep.25.1.91 %0 Journal Article %J Arch Intern Med %D 2011 %T Development and validation of a brief cognitive assessment tool: the sweet 16. %A Tamara G Fong %A Richard N Jones %A James L Rudolph %A Frances Margaret Yang %A Tommet, Douglas %A Habtemariam, Daniel %A Edward R Marcantonio %A Kenneth M. Langa %A Sharon K Inouye %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cohort Studies %K Dementia %K Female %K Humans %K Male %K Neuropsychological tests %K Surveys and Questionnaires %X

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

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

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

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

%B Arch Intern Med %I 171 %V 171 %P 432-7 %8 2011 Mar 14 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21059967?dopt=Abstract %3 21059967 %4 Older people/Cognition/reasoning/Correlation analysis/Medical diagnosis/Dementia/Hospitalization %$ 25220 %R 10.1001/archinternmed.2010.423 %0 Journal Article %J Soc Sci Med %D 2011 %T Do biological measures mediate the relationship between education and health: A comparative study. %A Goldman, Noreen %A Cassio M. Turra %A Rosero-Bixby, Luis %A David R Weir %A Eileen M. Crimmins %K Biomarkers %K Blood pressure %K Body Mass Index %K Cholesterol %K Costa Rica %K Educational Status %K Female %K Health Status Disparities %K Health Status Indicators %K Health Surveys %K Humans %K Male %K Middle Aged %K Qualitative Research %K Taiwan %K United States %X

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.

%B Soc Sci Med %I 72 %V 72 %P 307-15 %8 2011 Jan %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21159415?dopt=Abstract %2 PMC3039215 %4 Costa Rica/Taiwan/Biomarkers/Biosocial survey/Socioeconomic disparities/Health outcomes/Longitudinal/Biological measurement/EDUCATION %$ 23750 %R 10.1016/j.socscimed.2010.11.004 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2011 %T Does self-reported health bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the Health and Retirement Study. %A Jennifer B Dowd %A Todd, Megan %K Adult %K Aged %K Aged, 80 and over %K Attitude to Health %K Bias %K Black People %K Disability Evaluation %K Educational Status %K Female %K Geriatric Assessment %K Health Status Indicators %K Health Surveys %K Hispanic or Latino %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Socioeconomic factors %K United States %K White People %X

OBJECTIVES: Measurement of health inequalities based on self-reports may be biased if individuals use response scales in systematically different ways. We use anchoring vignettes to test and adjust for reporting differences by education, race/ethnicity, and gender in self-reported health in 6 domains (pain, sleep, mobility, memory, shortness of breath, and depression).

METHOD: Using data from the 2006 U.S. Health and Retirement Study (HRS) and the 2007 Disability Vignette Survey, we estimated generalized ordered probit models of the respondent's rating of each vignette character's health problem, allowing cut-points to vary by age, gender, education, and race/ethnicity. We then used one-step hierarchical ordered probit (HOPIT) models to jointly estimate the respondent's cut-points from the vignettes and the severity of the respondent's own health problems based on these vignette cut-points.

RESULTS: We found strong evidence of reporting differences by age, gender, education, and race/ethnicity, with the magnitude depending on the specific health domain. Overall, traditional models not accounting for reporting differences underestimated the magnitude of health inequalities by education and race/ethnicity.

DISCUSSION: These results suggest caution in relying on self-reported health measures to quantify and explain health disparities by socioeconomic status and race/ethnicity/ethnicity in the United States. The findings support expansion of the use of anchoring vignettes to properly account for reporting differences in self-reports of health.

%B J Gerontol B Psychol Sci Soc Sci %I 66B %V 66 %P 478-89 %8 2011 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/21666144?dopt=Abstract %3 21666144 %4 Health behavior/Medical research/Gerontology/Adults %$ 62580 %R 10.1093/geronb/gbr050 %0 Report %D 2011 %T The Effects of Changes in Women s Labor Market Attachment on Redistribution Under the Social Security Benefit Formula %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Employment and Labor Force %K Income %K Pensions %K Social Security %K Women and Minorities %X Studies using data from the early 1990s suggested that while the progressive Social Security benefit formula succeeded in redistributing benefits from individuals with high earnings to individuals with low earnings, it was much less successful in redistributing benefits from households with high earnings to households with low earnings. Wives often earned much less than their husbands. As a result, much of the redistribution at the individual level was effectively from high earning husbands to their own lower earning wives. In addition, spouse and survivor benefits accrue disproportionately to women from high income households. Both factors mitigate redistribution at the household level. This paper compares outcomes for the earlier cohort with those of a cohort born twelve years later. With greater growth in women's earnings, the aim of the study is to see whether, after the recent growth in two earner households, and the growth in women's labor market activity and earnings, the Social Security system now fosters somewhat more redistribution from high to low earning households. We use data from the Health and Retirement Study to study a population consisting of members of households with at least one person age 51 to 56 in either 1992 or in 2004. We use four different measures of redistribution: the ratio of the present value of benefits to taxes for households arrayed by decile of covered earnings; the fraction of total Social Security benefits redistributed from households with high earnings to those with low earnings; the share of total benefits paid to members of each cohort redistributed from households falling in the highest deciles of earners to those with lower covered earnings; and the rate of return to Social Security taxes for members with different amounts of covered earnings. Considering differences in earnings between cohorts, women enjoyed a more rapid growth of labor force participation, hours of work and covered earnings than men. This increased the redistribution of Social Security benefits among households. Nevertheless, a considerable gap remains between the labor market activities and earnings of women versus men. As a result, the Social Security system remains much less successful in redistributing benefits from households with high covered earnings to those with lower covered earnings than in redistributing benefits from individuals with high covered earnings to those with lower covered earnings. %B Michigan Retirement and Disability Research Center Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://deepblue.lib.umich.edu/bitstream/handle/2027.42/86250/wp248.pdf?sequence=1 %4 social Security/benefit Formulas/Redistribution/labor Force Participation/women %$ 62644 %0 Thesis %D 2011 %T The gender gap in depressive symptoms among elders in the United States and Japan: Social support, coresidence and somatic health as mediating factors %A Andrew D. Tiedt %K Cross-National %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %X Cross-national research on gender and aging has discussed a persistent gender gap in depressive symptoms among elders, indicating that women report more frequent symptoms than men. In light of recent attention given to both depression and elder care issues in a global context, this dissertation examined the prevalence of depressive symptoms among elder men and women in the United States and Japan. Both nations are facing complications related to aging populations and have similar economic foundations, educational systems and representative governments. Yet the cultural underpinnings of household arrangements and family support obligations are distinct. The analyses used two waves of the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) and the Health and Retirement Study (HRS) to analyze the conditions resulting in the expression of depressive symptoms. One prominent cultural difference between nations is the persistence of intergenerational coresidence among elders and younger generations in Japan, despite more recent shifts in preference towards independent living. This dissertation posited that changing attitudes concerning filial obligations would result in more frequent depressive symptoms among Japanese women due to increased instances of conflict between coresiding elder women and daughters-in-law. Next, the dissertation posited reductions in the gender gap in depressive symptoms over time due to elder men transitioning to retirement, widowhood and disability. The analyses revealed that household relationships were more prominent as predictors of depressive symptoms in Japan than the United States. This was attributed to the persistence of filial piety. There was also evidence of the increased importance of gender in terms of late life transitions such as marital dissolution in Japan, while there was less variation in the correlates of depressive symptoms by gender in the United States. Coresidence proved to be both a buffer and aggravator of depressive symptoms among Japanese women, while coresidence was likely to buffer male mental health in either nation. However, there was evidence that living with children and receiving instrumental support exacerbated depressive symptoms among American men. These findings suggest the importance of within-gender as well as between-gender analytical approaches in order to interpret the role of culture in influencing contemporary family support relationships. %I Fordham University %C New York, NY %V Ph.D. %P 192 %G eng %U https://research.library.fordham.edu/dissertations/AAI3474150/ %9 3474150 %4 NUJLSOA %$ 62626 %! The gender gap in depressive symptoms among elders in the United States and Japan: Social support, coresidence and somatic health as mediating factors %0 Journal Article %J J Gen Intern Med %D 2011 %T Geriatric conditions develop in middle-aged adults with diabetes. %A Christine T Cigolle %A Pearl G. Lee %A Kenneth M. Langa %A Lee, Yuo-Yu %A Zhiyi Tian %A Caroline S Blaum %K Accidental Falls %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Diabetes Mellitus %K Dizziness %K Female %K Geriatric Assessment %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K pain %K Urinary incontinence %X

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.

%B J Gen Intern Med %I 26 %V 26 %P 272-9 %8 2011 Mar %G eng %N 3 %L newpubs20110418_Cigolle.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20878496?dopt=Abstract %2 PMC3043187 %4 geriatric conditions/diabetes/cognitive Impairment/falls/Incontinence/Vision Disorders/Hearing Disorders %$ 24780 %R 10.1007/s11606-010-1510-y %0 Report %D 2011 %T How Did the Recession of 2007-2009 Affect the Wealth and Retirement of the Near Retirement Age Population in the Health and Retirement Study? %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Demographics %K Employment and Labor Force %K Net Worth and Assets %K Public Policy %K Retirement Planning and Satisfaction %X This paper uses asset and labor market data from the Health and Retirement Study (HRS) to investigate how the recent Great Recession has affected the wealth and retirement of those in the population who were just approaching retirement age at the beginning of the recession, a potentially vulnerable segment of the working age population. The retirement wealth held by those ages 53 to 58 before the onset of the recession in 2006 declined by a relatively modest 2.8 percentage points by 2010. In more normal times, their wealth would have increased over these four years. Members of older cohorts accumulated an additional 5 percent of wealth over the same age span. To be sure, a part of that accumulation was the result of the upside of the housing bubble. The wealth holdings of poorer households were least affected by the recession. Relative losses are greatest for those who initially had the highest wealth when the recession began.The adverse labor market effects of the Great Recession are more modest. Although there is an increase in unemployment, that increase is not mirrored in the rate of flow out of full-time work or partial retirement. All told, the retirement behavior of the Early Boomer cohort looks similar, at least so far, to the behavior observed for members of older cohorts at comparable ages. Very few in the population nearing retirement age have experienced multiple adverse events. Although most of the loss in wealth is due to a fall in the net value of housing, because very few in this cohort have found their housing wealth under water, and housing is the one asset this cohort is not likely to cash in for another decade or two, there is time for their losses in housing wealth to recover. %B Michigan Retirement and Disability Research Center Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/how-did-the-recession-of-2007-2009-affect-the-wealth-and-retirement-of-the-near-retirement-age-population-in-the-health-and-retirement-study-2/ %4 asset accumulation/labor Force Participation/wealth Accumulation/housing wealth/retirement planning/Great Recession/early boomers %$ 62646 %0 Journal Article %J BMC Public Health %D 2011 %T Lifecourse socioeconomic circumstances and multimorbidity among older adults. %A Reginald D. Tucker-Seeley %A Li, Yi %A Sorensen, Glorian %A Subramanian, S V %K Aged %K Chronic disease %K Comorbidity %K Cross-Sectional Studies %K Female %K Humans %K Male %K Middle Aged %K Social Class %K United States %X

BACKGROUND: Many older adults manage multiple chronic conditions (i.e. multimorbidity); and many of these chronic conditions share common risk factors such as low socioeconomic status (SES) in adulthood and low SES across the lifecourse. To better capture socioeconomic condition in childhood, recent research in lifecourse epidemiology has broadened the notion of SES to include the experience of specific hardships. In this study we investigate the association among childhood financial hardship, lifetime earnings, and multimorbidity.

METHODS: Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions.

RESULTS: Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.

CONCLUSIONS: This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.

%B BMC Public Health %I 11 %V 11 %P 313 %8 2011 May 14 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21569558?dopt=Abstract %2 PMC3118239 %4 Chronic Disease/epidemiology/Chronic Disease/epidemiology/Comorbidity/ trends/Comorbidity/ trends/Cross-Sectional Studies/Female/Humans/Middle Aged/Social Class/United States/epidemiology/United States/epidemiology %$ 62758 %R 10.1186/1471-2458-11-313 %0 Journal Article %J Industrial and Labor Relations Review %D 2011 %T Pensions in the Health and Retirement Study %A John A. Turner %K Demographics %K Other %K Pensions %K Public Policy %K Retirement Planning and Satisfaction %X Pensions in the Health and Retirement Study, by Alan L. Gustman, Thomas L. Steinmeier, and Nahid Tabatabai, is reviewed. %B Industrial and Labor Relations Review %I 64 %V 64 %P 620 %G eng %N 3 %4 Pension plans/Public Policy/Retirement/Older people/Book reviews/Book reviews %$ 62641 %0 Journal Article %J J Aging Health %D 2011 %T Volunteering and hypertension risk in later life. %A Jeffrey A Burr %A Jane Tavares %A Jan E Mutchler %K Aged %K Aged, 80 and over %K Body Mass Index %K Confidence Intervals %K Female %K Health Behavior %K health policy %K Health Status %K Humans %K Hypertension %K Male %K Middle Aged %K Multivariate Analysis %K Odds Ratio %K Psychometrics %K Regression Analysis %K Risk Factors %K Social Support %K Surveys and Questionnaires %K Volunteers %X

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

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

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

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

%B J Aging Health %I 23 %V 23 %P 24-51 %8 2011 Feb %G eng %N 1 %L newpubs20110418_Burr.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20971920?dopt=Abstract %3 20971920 %4 Volunteers/Hypertension/Risk factors/Cardiovascular disease/Aging/Geriatrics/Older people %$ 24820 %R 10.1177/0898264310388272 %0 Journal Article %J J Am Geriatr Soc %D 2011 %T Volunteering, driving status, and mortality in U.S. retirees. %A Sei J. Lee %A Michael A Steinman %A Erwin J Tan %K Activities of Daily Living %K Aged %K Automobile Driving %K Female %K Health Status %K Humans %K Male %K Prospective Studies %K Retirement %K Risk Factors %K Social Behavior %K Survival Rate %K United States %K Volunteers %X

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

DESIGN: Observational prospective cohort.

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

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

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

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

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

%B J Am Geriatr Soc %I 59 %V 59 %P 274-80 %8 2011 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21314648?dopt=Abstract %2 PMC3089440 %4 Activities of Daily Living/Automobile Driving/driving Patterns/Health Status/Prospective Studies/Retirement planning/Risk Factors/Social Behavior/Social Behavior/Survival/volunteering %$ 62776 %R 10.1111/j.1532-5415.2010.03265.x %0 Report %D 2010 %T Adjusting Social Security for Increasing Life Expectancy: Effects on Progressivity %A Natalia A. Zhivan %A Courtney Monk %A John A. Turner %K Life Expectancy %K Social Security %K Social Security Eligibility %X Achieving long-run Social Security solvency requires addressing rising life expectancy. Increasing the Full Retirement Age (FRA), while holding the Early Entitlement Age (EEA) fixed, could be effective but eventually will result in replacement rates that are viewed by many as too low. A possible policy to prop up replacement rates is to raise the EEA, which has been age 62 for more than 40 years. However, an increase in the EEA introduces unfairness because the variation in life expectancy across socioeconomic groups is positively correlated with lifetime income. Using data from the Health and Retirement Study to investigate how earnings relate to mortality risk and health limitations, this project explores the possibility of constructing a flexible FRA that could preserve or even enhance the progressivity of Social Security benefits. If life expectancy were correlated with lifetime income, Social Security policy could use the AIME (Average Indexed Monthly Earnings) to target policies that are more equitable for people with both lower lifetime income and lower life expectancy. %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/adjusting-social-security-for-increasing-life-expectancy-effects-on-progressivity/ %0 Journal Article %J Acta Med Port %D 2010 %T [The association between self-rated health and health care utilization in retired]. %A F Aloísio Pimenta %A Santos Amaral, Carlos %A Da Gama Torres, Henrique %A Rezende, Nilton %K Delivery of Health Care %K Health Status %K Humans %K Self Concept %X

OBJECTIVE: This article attests the association between self-rated health and health care utilization in a retired population by a narrative review.

METHOD: A systematic review was carried out from 1967 to 2007 to identify studies on self-rated health, in the databases MEDLINE, LILACS e SCIELO. The OVID software was used to Medline research. Contacts with experts were used. The key words retirement, self-rated health, health care utilization and narrative review were used in Portuguese, Spanish and English versions. Al the abstracts were analyzed, but only trials that associated self-rated health in retirement and health care utilization were fully analyzed.

RESULTS: Thirty one out of 443 abstracts were selected to be fully analyzed. Current data indicates that health deterioration, poor self-rated health and increased health care utilization are associated with early retirement, due to disability, but not with individuals who worked until retirement by age.

CONCLUSION: Retirement is probably associated with increased public expenses and increased health care utilization in retired with a poor self-rated health.

%B Acta Med Port %I 23 %V 23 %P 101-6 %8 2010 Jan-Feb %G por %U https://pubmed.ncbi.nlm.nih.gov/20353712/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/20353712?dopt=Abstract %3 20353712 %4 health Care Utilization/SELF-RATED HEALTH/DISABILITY/DISABILITY/retirement/meta-analysis %$ 22420 %0 Journal Article %J Med Care %D 2010 %T Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. %A Caroline S Blaum %A Christine T Cigolle %A Cynthia Boyd %A Jennifer L. Wolff %A Zhiyi Tian %A Kenneth M. Langa %A David R Weir %K Aged %K Cross-Sectional Studies %K Diabetes Complications %K Diabetes Mellitus, Type 2 %K Female %K Glycemic Index %K Health Status %K Health Surveys %K Humans %K Male %K Middle Aged %K Quality of Health Care %K Self Care %K Severity of Illness Index %K Treatment Failure %K United States %X

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.

%B Med Care %I 48 %V 48 %P 327-34 %8 2010 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20355264?dopt=Abstract %2 PMC3153504 %4 Data analysis/Patients/Diabetes/Glycemic index/Older people/Middle age %$ 22430 %R 10.1097/mlr.0b013e3181ca4035 %0 Journal Article %J Soc Sci Med %D 2010 %T Direct and indirect effects of obesity on U.S. labor market outcomes of older working age adults. %A F. Renna %A Thakur, Nidhi %K Chronic disease %K Disabled Persons %K Employment %K Female %K Humans %K Male %K Middle Aged %K Obesity %K Retirement %K Risk Factors %K Sex Factors %K United States %X

In this paper, we study the impact of obesity on labor market decisions of older working age adults in USA. Labor market outcomes are defined as any one of three: working; not working due to a disability; or not working due to an early retirement. Based on existing medical literature, we deduce that obesity can largely impact labor market decisions directly through impairment of bodily functions and indirectly by being a risk factor for various diseases like hypertension, arthritis, etc. We use data from the US Health and Retirement Study on older adults who were no more than 64 years of age in 2002. In our modeling effort, we employ two estimation strategies. We first estimate a model in which employment outcome in 2002 is a function of weight status in 1992. In the second strategy, controlling for time-invariant individual heterogeneity, we first consider the impact of obesity on bodily impairments and chronic illnesses; then, we consider the impact of such impairments and illnesses on labor market outcomes. Our results indicate that, for men, obesity class 2 and 3 increases both the probability of taking an early retirement and the incidence of disability by 1.5 percentage points. For women, we find that obesity class 2 and 3 increases the probability of taking an early retirement by 2.5 percentage points and the incidence of disability by 1.7 percentage points.

%B Soc Sci Med %I 71 %V 71 %P 405-413 %8 2010 Jul %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20488600?dopt=Abstract %3 20488600 %4 Obesity/Retirement/chronic illness/labor Force Participation/Physical handicaps %$ 23330 %R 10.1016/j.socscimed.2010.03.038 %0 Report %D 2010 %T Financial Knowledge and Financial Literacy at the Household Level %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Health Conditions and Status %K Net Worth and Assets %K Other %K Pensions %X This paper uses data from the Health and Retirement Study to explore the mechanism that underlies the robust relation found in the literature between cognitive ability, and in particular numeracy, and wealth, income constant. We have a number of findings. First, the more valuable the pension, the more knowledgeable are covered workers about their pensions. We suggest that causality is more likely to run from pension wealth to pension knowledge, rather than the other way around. Second, most measures of cognitive ability, including numeracy, are not significant determinants of pension and Social Security knowledge. Third, standardizing for incomes and other factors, a pension of higher value does not substitute for other forms of wealth. Rather, counting pensions in total wealth, those with more valuable pensions save more for retirement, other things the same. Fourth, there is no evidence that wealth held outside of pensions is influenced by knowledge of pensions. In sum, numeracy does not influence wealth in whole or in part by affecting financial knowledge of one's pension plan, where financial knowledge of the pension then influences other decisions about retirement saving. These findings raise questions about the mechanism that underlies the relation between cognition, especially numeracy, and wealth. From a policy perspective, they suggest that the numeracy-wealth relation should not be taken as evidence that increasing financial literacy will increase the wealth of households as they enter into retirement. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 cognitive ability/numeracy/wealth/pensions %$ 24390 %R 10.3386/w16500 %0 Report %D 2010 %T Financial Literacy, Schooling, and Wealth Accumulation %A Behrman, Jere R. %A Olivia S. Mitchell %A Soo, Cindy %A Bravo, David %A The Wharton School %K Educational attainment %K Financial literacy %K household wealth %X Financial literacy and schooling attainment have been linked to household wealth accumulation. Yet prior findings may be biased due to noisy measures of financial literacy and schooling, as well as unobserved factors such as ability, intelligence, and motivation that could enhance financial literacy and schooling but also directly affect wealth accumulation. Here we use a new household dataset and an instrumental variables approach to isolate the causal effects of financial literacy and schooling on wealth accumulation. While financial literacy and schooling attainment are both strongly positively associated with wealth outcomes in linear regression models, our approach reveals even stronger and larger effects of financial literacy on wealth. It also indicates no significant positive effects of schooling attainment conditional on financial literacy in a linear specification, but positive effects when interacted with financial literacy. Estimated impacts are substantial enough to suggest that investments in financial literacy could have large positive payoffs. %B PARC Working Paper Series %I Pension Research Council, University of Pennsylvania %C Philadelphia, PA %G eng %U https://repository.upenn.edu/cgi/viewcontent.cgi?article=1031&context=parc_working_papers %L newpubs20101012_Behrman.pdf %4 Financial literacy/education/wealth Accumulation %$ 23520 %0 Report %D 2010 %T The Growth in Social Security Benefits Among the Retirement Age Population from Increases in the Cap on Covered Earnings %A Alan L Gustman %A Thomas L. Steinmeier %A Tabatabai, Nahid %K Demographics %K Public Policy %K Social Security %X This paper investigates how increases in the level of maximum earnings subject to the Social Security payroll tax have affected Social Security benefits and taxes. The analysis uses data from the Health and Retirement Study to ask how different the present value of own benefits and taxes would be for the cohort born from 1948 to 1953 (ages 51 to 56 in 2004) if they faced the lower cap on the payroll tax that faced those born 12 and 24 years earlier, but otherwise had the same earnings stream and faced the same benefit formula. We find that for those in the Early Boomer cohort of the Health and Retirement Study, ages 51 to 56 in 2004, that after adjusting for nominal wage growth, benefits were increased by 1.5 percent by the increase in the payroll tax ceiling compared to the cohort 12 years older, and by 3.7 percent over the benefits under the payroll tax ceiling for the cohort 24 years older. Tax receipts were increased by 5.3 and 10.6 percent over tax receipts that would have been collected under the tax ceilings that applied to the cohorts 12 and 24 years older respectively. About 22 percent of the additional tax revenues created by the increase in the payroll tax cap between the Early Boomer cohort and those 12 years older led to increased benefits. Similarly, about 27 percent of the additional tax revenues created by the increase in the payroll tax cap between the Early Boomer cohort and those 24 years older led to increase benefits. Results are also presented separately for men and women, for those in the top quartile of earners, and for those at the tax ceiling throughout their work lives. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 social Security/early boomers/earnings and Benefits File/Public Policy/payroll tax/tax revenues %$ 24370 %R 10.3386/w16501 %0 Book Section %B Evaluating the Financial Performance of Pension Funds %D 2010 %T Human Capital Risk and Pension Outcomes %A Olivia S. Mitchell %A John A. Turner %K Older Adults %K Pensions %K Retirement Planning and Satisfaction %K Risk Factors %B Evaluating the Financial Performance of Pension Funds %I World Bank %C Washington, DC %P 119-151 %G eng %0 Thesis %B Economics %D 2010 %T The impact of health insurance on cancer prevention: Ex ante and ex post moral hazards %A Tang, Li %Y Jin, Zhe %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Other %X The classic model of moral hazard suggests that health insurance may reduce preventive care because the insurer will pay for part of the treatment in case of disease. However, if health insurance covers preventive care as well, the reduced cost of preventive care will encourage the insured to consume more preventive care. These two countervailing effects are referred to as ex ante and ex post moral hazards (Zweifel & Manning 2000). Most studies do not distinguish the two effects, leading to a potentially wrong characterization of moral hazard. Using Medicare coverage as an example, this thesis identifies ex ante and ex post moral hazard effects of health insurance on cancer prevention. As we know, Medicare eligibility rules increase health insurance coverage at age 65. However, some preventive screenings were not covered in Medicare until recently. The different timing of Medicare eligibility and Medicare expansion of preventive care allows me to use a difference-in-differences framework to separate ex ante and ex post moral hazards. I focus on female uptake of breast cancer screening and male uptake of prostate cancer screening, using the Medical Expenditure Panel Survey (MEPS) and the National Health Interview Survey (NHIS). In both datasets, I find evidence in support of ex ante and ex post moral hazards. No evidence shows that people try to delay screening until it has been covered by Medicare. Moreover, the level of prevention and responsiveness to insurance changes vary with demographics, with larger effects among whites and the better-educated. Then I take a second look at the moral hazard problem in the health insurance market using the Health and Retirement Study (HRS). Compared with MEPS or NHIS, the panel nature of HRS allows me to control for individual fixed effects and therefore provides a more stringent test. The major findings on female uptake of breast cancer screening are consistent. I find strong ex ante and ex post moral hazard effects in female uptake of breast cancer screening, and individual reactions to Medicare enrollment and Medicare's preventive care coverage vary by factors such as race and income. However, moral hazards on male uptake of prostate cancer screening is not found, mainly due to poor quality of data. %B Economics %I University of Maryland, College Park %V Ph.D. %P 118 %8 2010 %G eng %9 Dissertation %L AAT 3426305 %4 prostate cancer %$ 24270 %! The impact of health insurance on cancer prevention: Ex ante and ex post moral hazards %0 Report %D 2010 %T Inference of Signs of Interaction Effects in Simultaneous Games with Incomplete Information, Second Version %A Áureo de Paula %A Tang, Xun %K Methodology %K Other %K Retirement Planning and Satisfaction %X This paper studies the inference of interaction effects, i.e., the impacts of players' actions on each other's payoffs, in discrete simultaneous games with incomplete information. We propose an easily implementable test for the signs of state-dependent interaction effects that does not require parametric specifications of players' payoffs, the distributions of their private signals or the equilibrium selection mechanism. The test relies on the commonly invoked assumption that players' private signals are independent conditional on observed states. The procedure is valid in the presence of multiple equilibria, and, as a by-product of our approach, we propose a formal test for multiple equilibria in the data-generating process. We provide Monte Carlo evidence of the test's good performance infinite samples. We also implement the test to infer the direction of interaction effects in couples' joint retirement decisions using data from the Health and Retirement Study. %B Penn Institute for Economic Research Working Paper %I University of Pennsylvania %C Philadelphia, PA %G eng %U https://economics.sas.upenn.edu/pier/working-paper/2010/inference-signs-interaction-effects-simultaneous-games-incomplete %4 Econometrics/Noncooperative Games/identification,/inference, multiple equilibria, incomplete information games/methodology/retirement Planning %$ 23180 %0 Journal Article %J Ann Epidemiol %D 2010 %T Neighborhood disadvantage and self-assessed health, disability, and depressive symptoms: longitudinal results from the health and retirement study. %A M. Maria Glymour %A Mujahid, Mahasin %A Wu, Qiong %A White, Kellee %A Tchetgen Tchetgen, Eric J %K Activities of Daily Living %K Age Factors %K Aged %K Confidence Intervals %K depression %K Disabled Persons %K Female %K Health Status Disparities %K Humans %K Incidence %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Odds Ratio %K Poverty %K Residence Characteristics %K Risk %K Self-Assessment %K Socioeconomic factors %K Time Factors %X

PURPOSE: By using a longitudinal cohort, we assessed the association between neighborhood disadvantage and incidence of poor health and function in three domains.

METHODS: More than 4,000 enrollees aged 55 to 65 years in the national Health and Retirement Study were assessed biennially from 1998 through 2006 for incidence of fair/poor self-rated health, elevated depressive symptoms, and limitations in six basic activities of daily living (disability). Each analysis was restricted to subjects without that condition in 1994 or 1996. Neighborhoods (census tracts, time-updated for moves), were considered disadvantaged if they fell below the 25th percentile in an index comprising six socioeconomic status indicators. Repeated measures logistic regressions, inverse probability weighted to account for individual confounders, selective survival, and loss to follow-up were used to estimate odds ratios (ORs) for incidence of each outcome in the wave after exposure to disadvantaged neighborhood.

RESULTS: After covariate adjustment, neighborhood disadvantage predicted onset of fair/poor SRH (OR, 1.36; 95% confidence interval, 1.15-1.59) but not disability (OR, 0.97; 0.81-1.16) or elevated depressive symptoms (OR, 0.97; 0.81-1.16).

CONCLUSIONS: Results confirmed previous findings that neighborhood disadvantage predicts self-rated health in a longitudinal context but did not support an association between neighborhood disadvantage and onset of disability or elevated depressive symptoms.

%B Ann Epidemiol %V 20 %P 856-61 %8 2010 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/20933193?dopt=Abstract %R 10.1016/j.annepidem.2010.08.003 %0 Book %D 2010 %T Pensions in the Health and Retirement Study %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Employment and Labor Force %K Net Worth and Assets %K Pensions %K Retirement Planning and Satisfaction %X Draws evidence from the National Institute on Aging's Health and Retirement Study to examine the pensions held by those approaching retirement age in the United States. Discusses theories explaining pensions; employment and retirement in the Health and Retirement Study; pension data in the Health and Retirement Study; pension plan participation in the Health and Retirement Study; pension plan type; imperfect knowledge of pension plan type; pension retirement ages; pension values; retirement incentives from defined benefit pensions; disposition of pensions upon leaving a job and pension incomes in retirement; and the changing role of pensions in total wealth. %I Harvard University Press %C Cambridge and London %G eng %U https://www.hup.harvard.edu/catalog.php?isbn=9780674048669&content=toc %4 pension Plans/Wealth/retirement Planning/employment/pension income %$ 23150 %0 Journal Article %J Res Gerontol Nurs %D 2010 %T Sociodemographic and health-related risks for loneliness and outcome differences by loneliness status in a sample of U.S. older adults. %A Laurie A. Theeke %K Aged %K Aged, 80 and over %K Female %K Health Status %K Humans %K Logistic Models %K Loneliness %K Male %K Middle Aged %K Multivariate Analysis %K Risk Factors %K Socioeconomic factors %K United States %X

This study assesses sociodemographic and health-related factors associated with loneliness and outcome differences between loneliness groups using a sample of 13,812 older adults from the U.S Health and Retirement Study. Descriptive and bivariate analyses were followed by logistic regression to evaluate risks and analysis of covariance testing to determine outcome differences. Overall, prevalence of loneliness was 16.9%. Nonmarried status, poorer self-report of health, lower educational level, functional impairment, increasing number of chronic illnesses, younger age, lower income, and less people living in the household were all associated with loneliness. The chronically lonely group reported less exercise, more tobacco use, less alcohol use, a greater number of chronic illnesses, higher depression scores, and greater average number of nursing home stays. Future research evaluating the effectiveness of both prevention and treatment interventions for loneliness in older adults would provide empirical data to further guide gerontological nursing practice.

%B Res Gerontol Nurs %I 3 %V 3 %P 113-25 %8 2010 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20415360?dopt=Abstract %3 20415360 %4 Aged, 80 and over/Female/Health Status/Humans/Logistic Models/Loneliness/Middle Aged/Multivariate Analysis/Risk Factors/Socioeconomic Factors/United States %$ 22520 %R 10.3928/19404921-20091103-99 %0 Journal Article %J Journal of Economic Perspectives %D 2010 %T What the Stock Market Decline Means for the Financial Security and Retirement Choices of the Near-Retirement Population %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Consumption and Savings %K Employment and Labor Force %K Event History/Life Cycle %K Net Worth and Assets %K Other %K Retirement Planning and Satisfaction %X This paper investigates the effect of the current recession on the retirement age population. Data from the Health and Retirement Study suggest that those approaching retirement age (early boomers ages 53 to 58 in 2006) have only 15.2 percent of their wealth in stocks, held directly or in defined contribution plans or IRAs. Their vulnerability to a stock market decline is limited by the high value of their Social Security wealth, which represents over a quarter of the total household wealth of the early boomers. In addition, their defined contribution plans remain immature, so their defined benefit plans represent sixty five percent of their pension wealth. Simulations with a structural retirement model suggest the stock market decline will lead the early boomers to postpone their retirement by only 1.5 months on average. Health and Retirement Study data also show that those approaching retirement are not likely to be greatly or immediately affected by the decline in housing prices. We end with a discussion of important difficulties facing those who would use labor market policies to increase the employment of older workers. %B Journal of Economic Perspectives %I 24 %V 24 %P 161-82 %G eng %U URL:http://www.aeaweb.org/jep/ Publisher's URL %N 1 %4 Personal Finance/Information and Market Efficiency/Event Studies/Retirement Policies/Older Workers/Retirement/Stock Market %$ 22160 %R 10.1257/jep.24.1.161 %0 Journal Article %J J Alzheimers Dis %D 2009 %T The accuracy of Medicare claims as an epidemiological tool: the case of dementia revisited. %A Donald H. Taylor Jr. %A Østbye, Truls %A Kenneth M. Langa %A David R Weir %A Brenda L Plassman %K Aged %K Aged, 80 and over %K Alzheimer disease %K Cohort Studies %K Dementia %K Female %K Health Care Costs %K Humans %K Insurance Claim Reporting %K Male %K Medicare %K Prevalence %K Sensitivity and Specificity %K United States %X

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

%B J Alzheimers Dis %I 17 %V 17 %P 807-15 %8 2009 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/19542620?dopt=Abstract %2 PMC3697480 %4 Medicare/dementia/Cost of Illness %$ 22950 %R 10.3233/JAD-2009-1099 %0 Journal Article %J Inquiry %D 2009 %T Cancer survivorship, health insurance, and employment transitions among older workers. %A Tunceli, Kaan %A Pamela F. Short %A John R. Moran %A Tunceli, Ozgur %K Career Mobility %K Cohort Studies %K Female %K Health Benefit Plans, Employee %K Health Insurance Portability and Accountability Act %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Models, Statistical %K Neoplasms %K Retirement %K Survivors %K United States %X

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

%B Inquiry %I 46 %V 46 %P 17-32 %8 2009 Spring %G eng %N 1 %L newpubs20090908_Tunceli.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19489481?dopt=Abstract %3 19489481 %4 Health Insurance/Employment/CANCER/labor market behavior %$ 20460 %R 10.5034/inquiryjrnl_46.01.17 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Comparing models of frailty: the Health and Retirement Study. %A Christine T Cigolle %A Mary Beth Ofstedal %A Zhiyi Tian %A Caroline S Blaum %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Cross-Sectional Studies %K Demography %K Disability Evaluation %K Frail Elderly %K Geriatric Assessment %K Health Surveys %K Humans %K Interviews as Topic %K Logistic Models %K Models, Theoretical %K United States %X

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.

%B J Am Geriatr Soc %I 57 %V 57 %P 830-9 %8 2009 May %G eng %N 5 %L newpubs20090908_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19453306?dopt=Abstract %3 19453306 %4 FRAILTY/Models, Theoretical %$ 20440 %R 10.1111/j.1532-5415.2009.02225.x %0 Book Section %B The Sage Handbook of Measurement %D 2009 %T Contemporary Challenges of Longitudinal Measurement Using HRS Data %A John J McArdle %E Geoffrey Walford %E Eric Tucker %E Madhu Viswanathan %K Methodology %B The Sage Handbook of Measurement %I Sage Publications %C London %G eng %4 Methodology %$ 25270 %& 26 %R https://dx.doi.org/10.4135/9781446268230.n26 %0 Journal Article %J Journal of Socio-Economics %D 2009 %T Controlling for Endogeneity in the Health-Socioeconomic Status Relationship of the Near Retired %A Bender, Keith A. %A Theodossiou, Ioannis %K Demographics %K Employment and Labor Force %K Health Conditions and Status %X Although there is a strong correlation between health and socioeconomic status (SES), the direction of causation is not empirically clear. This study a uses a two stage methodology to control for endogeneity. Using data from the U.S. Health and Retirement Study, the results show that after controlling for endogeneity, labor force status turns out to be an even more important factor in determining health than in the case where endogeneity is not controlled for. In particular, unemployment generates much higher odds for worse health as measured by both subjective and objective health measures. %B Journal of Socio-Economics %I 38 %V 38 %P 977-987 %G eng %N 6 %L newpubs20100129_bender.pdf %4 socioeconomic status/health status/Labor Force Participation %$ 21580 %R https://doi.org/10.1016/j.socec.2009.07.009 %0 Journal Article %J Res Aging %D 2009 %T Differential Impact of Involuntary Job Loss on Physical Disability Among Older Workers Does Predisposition Matter? %A William T Gallo %A Jennie E Brand %A Teng, Hsun-Mei %A Leo-Summers, Linda %A Amy L. Byers %X

Older workers' share of involuntary job losses in the United States has grown fairly consistently in recent decades, prompting greater interest in the health consequences of involuntary unemployment among individuals nearing retirement. In this study, the authors applied the multifactorial model of geriatric health to investigate whether late-career involuntary job loss was associated with subsequent physical disability and whether the effect of involuntary job loss on physical disability varied by predisposition. Using data from the first four waves (1992 to 1998) of the Health and Retirement Survey, the authors measured predisposition with individual risk factors for functional disability and indices of aggregate risk. The results of gender-specific models fit with generalized estimating equations revealed that unmarried women and those with low predisplacement incomes had heightened risk for subsequent functional disability. No differential effects of job loss were found for men.

%B Res Aging %I 31 %V 31 %P 345-360 %8 2009 May 01 %G eng %N 3 %L newpubs20101112_Gallo.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19924265?dopt=Abstract %2 PMC2778317 %4 labor Force Participation/Unemployment/DISABILITY/DISABILITY/involuntary unemployment/older Workers %$ 23840 %R 10.1177/0164027508330722 %0 Thesis %B Public Policy %D 2009 %T The effect of obesity or disability on the wages on employees in employer-sponsored health insurance plans %A Thomas, Megan %K Employment and Labor Force %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %X As labor can be compensated through either wages or non-wage (fringe) benefits, employers have incentives to reduce wages of employees in response to the costs of non-wage benefits (Woodbury, 1983). Health insurance is different than most fringe benefits as costs associated with it vary substantially across different individuals in an often uniform and observable way (Levy and Feldman, 2001). Evidence of whether wage penalties are made in response to the provision of employer-sponsored health insurance (ESI) is mixed, and evidence of whether potential penalties are levied more heavily on those with expected or actual high health care costs, like those who are obese or have physical disabilities, has not been well documented. This research explores this relationship using the University of Michigan Health and Retirement Study from 2006. This research tests the hypotheses that wages are lower for full-time workers with ESI obtained through their employer than those without; lower for obese full-time workers with ESI than obese full-time without; and lower for physically disabled full-time workers with ESI than physically disabled full-time workers without. It also tests whether wages are similar between the obese and disabled, and if there are race or gender effects. The findings of this research do not support any of these hypotheses. Employer-sponsored insurance has no significant effect on wages, whether obese, disabled, or not. %B Public Policy %I Georgetown University %C Washington, DC %G eng %U http://hdl.handle.net/10822/553937 %4 Obesity %$ 20480 %0 Journal Article %J Ann Epidemiol %D 2009 %T Financial hardship and mortality among older adults using the 1996-2004 Health and Retirement Study. %A Reginald D. Tucker-Seeley %A Li, Yi %A Subramanian, S V %A Sorensen, Glorian %K Aged %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Male %K Medicaid %K Middle Aged %K Mortality %K Poverty %K Proportional Hazards Models %K Prospective Studies %K Retirement %K Risk %K Sex Factors %K United States %X

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

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

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

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

%B Ann Epidemiol %I 19 %V 19 %P 850-7 %8 2009 Dec %G eng %N 12 %L newpubs20100129_Tucker-Seeley.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19944348?dopt=Abstract %2 PMC2835519 %4 financial resources/socioeconomic status/Mortality/GENDER-DIFFERENCES %$ 21510 %R 10.1016/j.annepidem.2009.08.003 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Health and well-being in older married female cancer survivors. %A Aloen L. Townsend %A Karen J Ishler %A Karen F Bowman %A Rose, Julia Hannum %A Peak, Nicole Juszczak %K Age Factors %K Case-Control Studies %K Depressive Disorder %K Female %K Health Status %K Health Status Indicators %K Health Surveys %K Humans %K Marriage %K Middle Aged %K Neoplasms %K Predictive Value of Tests %K Risk Factors %K Survivors %K United States %X

OBJECTIVES: To investigate differences between older married female cancer survivors and a matched comparison sample on physical health and on effects of health on depressive symptomatology.

DESIGN AND SETTING: National survey data from the 1992 Health and Retirement Study.

PARTICIPANTS: Married women who reported having been diagnosed with cancer (N=245) and married women who did not report a cancer diagnosis but who matched the survivors on age, race, and ethnicity (N=245).

MEASUREMENTS: Outcome measure was depressive symptomatology (modified CES-D). Predictors were multiple indicators of health and demographic characteristics.

RESULTS: Cancer survivors reported significantly worse health on all indicators but not higher depressive symptomatology after health and demographics were controlled. Predictors of higher depression were fatigue, pain, and lower education. These effects did not differ between groups.

CONCLUSION: Health impairment in cancer survivors highlights the need for ongoing follow-up care. Survivorship was associated indirectly with higher depressive symptomatology through its relationship with health impairment.

%B J Am Geriatr Soc %I 57 %V 57 Suppl 2 %P S286-8 %8 2009 Nov %G eng %N Suppl 2 %L newpubs20100129_Townsend.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20122019?dopt=Abstract %2 PMC3372320 %4 CANCER/Women/Depressive Symptoms/Marriage %$ 21570 %R 10.1111/j.1532-5415.2009.02514.x %0 Journal Article %J BMC Public Health %D 2009 %T The health impact of remarriage behavior on chronic obstructive pulmonary disease: findings from the US longitudinal survey. %A Noda, Tatsuya %A Ojima, Toshiyuki %A Hayasaka, Shinya %A Hagihara, Okihito %A Takayanagi, Ryoichi %A Nobutomo, Koichi %K Aged %K Bereavement %K Educational Status %K Female %K Follow-Up Studies %K Health Status %K Health Surveys %K Humans %K Lung Diseases, Obstructive %K Male %K Marriage %K Middle Aged %K Outcome Assessment, Health Care %K Proportional Hazards Models %K Smoking %K United States %X

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major disease among adults, and its deterioration was reported to be associated with psychological imbalance. Meanwhile, bereavement and divorce have proven harmful to the health status of a surviving spouse. But few studies have been conducted to evaluate the remedial effect on survivors' health outcome by remarriage after bereavement. The present study thus examined the associations between remarriage and the onset of COPD.

METHODS: Our cohort was drawn from Health and Retirement Study participants in the United States, and consisted of 2676 subjects who were divorced or bereaved from 1992 to 2002. We then followed them for up to 11 years and assessed the incidence rate of COPD using a Cox proportional hazard model after adjusting for marital status, age, gender, education and the number of cigarettes smoked.

RESULTS: Among all subjects, 224 who remarried after bereavement or divorce tended to be younger and more male dominated. Remarriage after bereavement/divorce was associated with significantly decreased risk of COPD onset for overall subjects [hazard ratio (HR): 0.51, 95% confidence interval (95% CI): 0.28-0.94], female subjects [HR: 0.36, 95% CI: 0.13-0.98], and for those under 70 years old [HR: 0.36, 95% CI: 0.17-0.79].

CONCLUSION: This study investigates the impact of remarriage on health outcome based on a large-scale population survey and indicates that remarriage significantly correlates with reduced risk of COPD incidence, even after adjusting smoking habit.

%B BMC Public Health %I 9 %V 9 %P 412 %8 2009 Nov 14 %G eng %L newpubs20091202_Remarriage.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19912659?dopt=Abstract %2 PMC2781819 %4 Marital Status/risk factors %$ 21390 %R 10.1186/1471-2458-9-412 %0 Report %D 2009 %T The Health-Socioeconomic Status Relationship and the Role of Public Policies in the US and UK %A Bender, Keith A. %A Theodossiou, Ioannis %K Cross-National %K Public Policy %I 5th International Vilnius Conference %G eng %U https://www.researchgate.net/publication/266370077_The_Health_-Socioeconomic_Status_Relationship_and_the_Role_of_Public_Policies_in_the_US_and_UK %4 public policy/ELSA_ %$ 25550 %0 Thesis %D 2009 %T Metabolic Syndrome and Psychosocial Factors %A Tweedy, Maureen P. %K Health Conditions and Status %X Metabolic syndrome is a constellation of risk factors, including abdominal obesity, hypertriglyceridemia, low HDL cholesterol, high blood pressure, and high fasting glucose, that commonly cluster together and can result in cardiovascular disease. The prevalence of metabolic syndrome and the components that comprise the syndrome vary by age and by racial/ethnic group. In addition, previous research has indicated that the risk factors contributing to metabolic syndrome may be exacerbated by exposure to perceived stress. This study utilized data from the 2002, 2004, and 2006 Health and Retirement Study (HRS) and National Health and Nutrition Examination Survey (NHANES) data sets. It was hypothesized that depression and anxiety (conceptualized as stress in this study) increase the risk of presenting with metabolic syndrome while social support decreases the risk of metabolic syndrome. While results of cross-sectional analysis do not indicate a significant relationship between depression and metabolic syndrome ( t = -.84, ns), longitudinal analysis does indicate a significant relationship between depression and metabolic syndrome over time ( t = -5.20, p <.001). However, anxiety is not significantly related to metabolic syndrome when the relationship is examined through cross-sectional analysis ( t = -1.51, ns) and longitudinal analysis (? 2 = 13.83, ns). Similarly, social support is not significantly related to metabolic syndrome when examined in cross-sectional (? 2 = .63, ns) and longitudinal ( t = 1.53, ns) analysis. Although level of stress is not significantly related to metabolic syndrome as a whole, there is a significant relationship between stress and both triglyceride level ( t = -2.94, p = .003) and blood glucose level ( t = -3.26, p = .001). %I University of North Texas %C United States %8 2009 %G eng %4 Depression %$ 21650 %! Metabolic Syndrome and Psychosocial Factors %0 Journal Article %J Am J Prev Med %D 2009 %T Neighborhood safety, socioeconomic status, and physical activity in older adults. %A Reginald D. Tucker-Seeley %A Subramanian, S V %A Li, Yi %A Sorensen, Glorian %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Female %K Florida %K Health Status %K Humans %K Leisure activities %K Male %K Middle Aged %K Motor Activity %K Recreation %K Residence Characteristics %K Safety %K Sex Distribution %K Social Support %K Socioeconomic factors %K Surveys and Questionnaires %X

BACKGROUND: Neighborhood environment can have a substantial influence on the level of physical activity among older adults. Yet, the moderating influence of various measures of SES on the association between perceived neighborhood safety and leisure-time physical activity (LTPA) among older adults remains unknown.

PURPOSE: The study was designed to investigate the association between perceived neighborhood safety and LTPA in a nationally representative sample of older adults, and to evaluate SES characteristics as potential effect modifiers in the association between perceived neighborhood safety and LTPA.

METHODS: Cross-sectional data from the 2004 Health and Retirement Study of older adults aged >or=50 years were used to examine the association between perceived neighborhood safety and LTPA. Differences in LTPA were evaluated across three measures of SES: education, household income, and household wealth. SES was also evaluated as a potential effect modifier in the association between perceived neighborhood safety and LTPA. The analysis was conducted in 2008.

RESULTS: An SES gradient in LTPA was noted across measures of SES used in this study. After controlling for SES and demographic characteristics and functional limitations, older adults who perceived their neighborhood as safe had an 8% higher mean rate of LTPA compared to older adults who perceived their neighborhood as unsafe. The association was no longer significant when self-rated health was added. Additionally, SES was not a significant effect modifier in the association between perceived neighborhood safety and LTPA.

CONCLUSIONS: SES, demographic characteristics, and functional limitations substantially attenuated the positive association between perceived neighborhood safety and LTPA; however, with the inclusion of self-rated health, the association was no longer present. This finding suggests that self-rated health may mediate this association. The lack of significance in the interaction between perceived neighborhood safety and SES suggests that prevention efforts to increase physical activity among older adults should consider perceptions of neighborhood safety as a potential barrier regardless of SES.

%B Am J Prev Med %I 37 %V 37 %P 207-13 %8 2009 Sep %G eng %N 3 %L newpubs20090908_Tucker-SeeleyAJPM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19595554?dopt=Abstract %2 PMC3685411 %4 Neighborhood Characteristics/Leisure/Physical Activity/socioeconomic status %$ 20820 %R 10.1016/j.amepre.2009.06.005 %0 Journal Article %J Arch Psychiatr Nurs %D 2009 %T Predictors of loneliness in U.S. adults over age sixty-five. %A Laurie A. Theeke %K Aged %K Aged, 80 and over %K Female %K Health Status %K Humans %K Likelihood Functions %K Logistic Models %K Loneliness %K Male %K Prevalence %K Risk Factors %K Single Person %K Socioeconomic factors %K United States %X

The purpose of this study was to examine sociodemographic and health-related risks for loneliness among older adults using Health and Retirement Study Data. Overall prevalence of loneliness was 19.3%. Marital status, self-report of health, number of chronic illnesses, gross motor impairment, fine motor impairment, and living alone were predictors of loneliness. Age, female gender, use of home care, and frequency of healthcare visits were not predictive. Loneliness is a prevalent problem for older adults in the United States with its own health-related risks. Future research of interventions targeting identified risks would enhance the evidence base for nursing and the problem of loneliness.

%B Arch Psychiatr Nurs %I 23 %V 23 %P 387-96 %8 2009 Oct %G eng %N 5 %L newpubs20090908_Theeke_2009.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19766930?dopt=Abstract %3 19766930 %4 Loneliness/Marital Status/risk factors %$ 21070 %R 10.1016/j.apnu.2008.11.002 %0 Report %D 2009 %T What the Stock Market Decline Means for the Financial Security and Retirement Choices of the Near-Retirement Population %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Consumption and Savings %K Net Worth and Assets %K Social Security %X This paper investigates the effect of the current recession on the near-retirement age population. Data from the Health and Retirement Study suggest that those approaching retirement age (early boomers ages 53 to 58 in 2006) have only 15.2 percent of their wealth in stocks, held directly or in defined contribution plans or IRAs. Their vulnerability to a stock market decline is limited by the high value of their Social Security wealth, which represents over a quarter of the total household wealth of the early boomers. In addition, their defined contribution plans remain immature, so their defined benefit plans represent sixty five percent of their pension wealth. Simulations with a structural retirement model suggest the stock market decline will lead the early boomers to postpone their retirement by only 1.5 months on average. Health and Retirement Study data also show that those approaching retirement are not likely to be greatly or immediately affected by the decline in housing prices. We end with a discussion of important difficulties facing those who would use labor market policies to increase the employment of older workers. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %L newpubs20091202_w15435.pdf %4 Wealth/Stock Market/Retirement Saving/Retirement Wealth/Social Security expectations %$ 21420 %R 10.3386/w15435 %0 Journal Article %J British Medical Journal (International Edition) %D 2008 %T Downward Trend in Dementia Linked to Better Education and Personal Wealth %A Hopkins Tanne, Janice %K Demographics %K Health Conditions and Status %K Net Worth and Assets %X Cognitive decline is declining among Americans older than 70, a study of 11,000 elderly US residents carried out at the University of Michigan Medical School has found. The study showed that higher education and higher net financial worth protected against cognitive impairment. The authors used data from the Health and Retirement Study, a nationally representative, population based longitudinal study of US adults. %B British Medical Journal (International Edition) %I 336 %V 336 %P 466-7 %G eng %L newpubs20080528_BritMedJnl %4 Cognitive Functioning/Education/Wealth %$ 18980 %0 Journal Article %J Aging & Mental Health %D 2008 %T The effect of spousal caregiving and bereavement on depressive symptoms %A Donald H. Taylor Jr. %A Kuchibhatla, Maragatha %A Truls Ostbye %A Brenda L Plassman %A Elizabeth C. Clipp %K Bereavement %K Caregiving %K Depressive symptoms %K Marriage %K Mortality %K Older Adults %X The objective of the study was to determine whether spousal caregiving and bereavement increases caregiver depressive symptoms. We followed 1,967 community-dwelling elderly couples from the 1993 Health and Retirement Study (HRS) until 2002 (five bi-annual surveys) or death. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CESD) scale. Adjusted depressive symptoms were higher for females for three of the four caregiving arrangements tested (as were unadjusted baseline levels). Depressive symptoms were lowest when neither spouse received caregiving (adjusted CESD of 2.97 for males; 3.44 for females, p < 0.001). They were highest when females provided care to their husband with assistance from another caregiver, (4.01) compared to (3.37; p < 0.001) when males so cared for their wife. A gender by caregiving arrangements interaction was not significant (p = 0.13), showing no differential effect of caregiving on CESD by gender. Depressive symptoms peaked for bereaved spouses within three months of spousal death (4.67; p < 0.001) but declined steadily to 2.75 (p < 0.001) more than 15 months after death. Depressive symptoms initially increased for the community spouse after institutionalization of the care recipient, but later declined. We conclude that caregiving increases depressive symptoms in the caregiver, but does not have a differential effect by gender. Increases in depressive symptoms following bereavement are short-term. %B Aging & Mental Health %V 12 %P 100 - 107 %8 Jan-01-2008 %G eng %U http://www.tandfonline.com/doi/abs/10.1080/13607860801936631 %N 1 %! Aging & Mental Health %R 10.1080/13607860801936631 %0 Report %D 2008 %T How Much Do State Economics and Other Characteristics Affect Retirement Behavior? %A Alicia H. Munnell %A Soto, Mauricio %A Triest, Robert K. %A Natalia A. Zhivan %K Employment and Labor Force %K Retirement Planning and Satisfaction %X The labor force participation of men age 55-64 varies significantly among the various states of the Union. Little is known, however, about the reasons such variations exist. Using the Current Population Survey for the period 1977-2007, this paper demonstrates that the differences in the labor force participation of men age 55-64 are related to the labor market conditions, the nature of employment, and the employee characteristics in each state as well as a state pseudo replacement rate. These variables explain more than one-third of the total variation in labor force participation across states. Even controlling for state specific characteristics only cuts the explanatory power by half. To assess whether these relationships reflect different populations or unique aspects of the state economies, we turn to the Health and Retirement Study (HRS). We estimate equations for the probability of working and for the expected retirement for men in their late fifties and early sixties. We first estimate an equation predicting labor force participation using just the state-level variables taken from the CPS, then estimate an equation using both the CPS state-level variables and demographic and economic information for each individual taken from the HRS. The results show that while the state-level variables explain very little variation in an individual s probability of working or expected retirement age, most state-level variables have a statistically significant effect on such behavior both before and after the inclusion of the HRS information. %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-do-state-economics-and-other-characteristics-affect-retirement-behavior/ %L newpubs20090908_CRR2008-12.pdf %4 Labor Force Participation/Retirement Behavior %$ 20570 %0 Journal Article %J Health Serv Res %D 2008 %T Identification of dementia: agreement among national survey data, medicare claims, and death certificates. %A Truls Ostbye %A Donald H. Taylor Jr. %A Elizabeth C. Clipp %A Lynn Van Scoyoc %A Brenda L Plassman %K Aged %K Consensus %K Data Interpretation, Statistical %K Death Certificates %K Dementia %K Female %K Health Surveys %K Humans %K Incidence %K Insurance Claim Review %K Male %K Mass Screening %K Medicare %K Research Design %K United States %X

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.

%B Health Serv Res %I 43 %V 43 %P 313-26 %8 2008 Feb %G eng %N 1 Pt 1 %L newpubs20080229_Ostbye_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18211532?dopt=Abstract %2 PMC2323140 %4 Dementia/Incidence/Cognitive Function/Survey questions/Medicare/Death Certificates %$ 18650 %R 10.1111/j.1475-6773.2007.00748.x %0 Journal Article %J Alzheimer's and dementia : the journal of the Alzheimer's Association %D 2008 %T Race/ethnic differences in cognitive decline: Results from the health and retirement study %A Kala M. Mehta %A Lisa L. Barnes %A Roland J. Thorpe Jr. %A Eliseo J Perez-Stable %A Kenneth E Covinsky %A Kristine Yaffe %K Health Conditions and Status %X Background: As the minority population and dementia prevalence are rapidly growing, understanding cognitive decline in racially diverse elders is an increasingly important public health issue. Our goal was to evaluate whether cognitive decline occur at an accelerated rate for persons of non-White race/ethnicity (African American, Latino) compared to White older adults. Methods: Participants were from the US-representative Health and Retirement Study (HRS) 1998-2004. Cognitive assessment consisted of immediate and delayed free recall as well as serial 7s test, orientation, and naming for a total score of 35 points. Our primary outcomes were biennial cognitive change from 1998 to 2004 and cognitive decline defined as 5 point decline from 1998 to 2004. We calculated change in cognition, odds of cognitive decline, and evaluated mediators by race/ethnic group using mixed effects regression and logistic regression models. Results: The 5,552 HRS participants (mean age 72 6 years, 60 Female, 10 African Amercan, 6 Latino) had an average cognitive decline of 2.1 4.3 points over the 6 year study period. Overall, 33 of African Americans declined, 28 of Latinos declined and 26 of Whites declined. After controlling for age, gender, educational level in years, socioeconomic factors (total net worth and current income), self-reported medical comorbidity (self reported medical history of hypertension, heart disease, diabetes and stroke), and baseline cognition, African Americans were more likely to decline compared to Whites (OR 2.2; 95 CI 1.7-2.7). Latino older adults were similar to Whites in odds of cognitive decline (OR Latino 1.3; 95 CI 0.9-1.7). Conclusions: African American adults aged 65 and above were more likely to experience cognitive decline compared to White older adults after accounting for demographics, socioeconomics, comorbidity, and their baseline cognitive function. There was no difference between Latino older adults and Whites in rates of cognitive decline. Future research to identify ways to reduce cognitive decline, particularly for racially-diverse groups, are needed. %B Alzheimer's and dementia : the journal of the Alzheimer's Association %I 4 %V 4 %P T194-T195 %G eng %N 4 %4 Dementia/Cognitive decline/COMORBIDITY %$ 25310 %R https://doi.org/10.1016/j.jalz.2008.05.540 %0 Journal Article %J Arch Phys Med Rehabil %D 2008 %T Racial and ethnic differences in activities of daily living disability among the elderly: the case of Spanish speakers. %A Manasi A. Tirodkar %A Song, Jing %A Rowland W Chang %A Dorothy D Dunlop %A Huan J. Chang %K Acculturation %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disability Evaluation %K Disabled Persons %K Female %K Geriatric Assessment %K Health Status Indicators %K Hispanic or Latino %K Humans %K Male %K Middle Aged %X

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.

%B Arch Phys Med Rehabil %I 89 %V 89 %P 1262-6 %8 2008 Jul %G eng %N 7 %L newpubs20090908_Tirodkar.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18534555?dopt=Abstract %2 PMC2740915 %4 ADL and IADL Impairments/hispanics/DISABILITY/DISABILITY %$ 21080 %R 10.1016/j.apmr.2007.11.042 %0 Journal Article %J Journal of Workplace Behavioral Health %D 2008 %T Retirement Transitions Among Married Couples %A Angela L Curl %A Aloen L. Townsend %K Adult children %K Retirement Planning and Satisfaction %X Retirement is often viewed as an event when someone completely withdraws from paid employment. The purpose of the present study was to examine the patterns of retirement transitions evidenced in married couples in the Health and Retirement Study over an 8-year period (1992 to 2000). The sample consisted of White and Black married couples (N = 1,118) where both spouses were working and at least one spouse was aged 51 to 61 at baseline. A variety of complex retirement patterns were found. Husbands were more likely than wives to show a linear pattern (i.e., a transition directly from work to complete retirement). Transitions were related within couples. Policy and practice implications are discussed. %B Journal of Workplace Behavioral Health %I 23 %V 23 %P 89-107 %G eng %N 1-2 %L newpubs20090908/CurlTownsend.pdf %4 Retirement Behavior/Labor--retirement decisions/Couples %$ 20240 %R https://doi.org/10.1080/15555240802189125 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Baseline health, socioeconomic status, and 10-year mortality among older middle-aged Americans: findings from the Health and Retirement Study, 1992 2002. %A Joseph Feinglass %A Lin, Suru %A Jason A. Thompson %A Joseph J Sudano %A Dorothy D Dunlop %A Song, Jing %A David W. Baker %K Adult %K Aged %K Aged, 80 and over %K Economics %K Education %K Follow-Up Studies %K Health Status %K Humans %K Income %K Middle Aged %K Mortality %K Motor Activity %K Pilot Projects %K Proportional Hazards Models %K Retirement %K Risk Factors %K Risk-Taking %K Smoking %K Social Class %K Thinness %K United States %X

OBJECTIVE: This study analyzed whether socioeconomic status in older middle age continues to be associated with 10-year survival after data are controlled for baseline health status.

METHODS: We confirmed deaths through 2002 for 9,759 participants in the Health and Retirement Study, aged 51 to 61 in 1992. We used discrete time survival models to examine hazard ratios over 10 years of follow-up. We examined associations of demographic characteristics and socioeconomic status measures before and after adjustment by health status and behavioral risk factors.

RESULT: The 10-year mortality rate was 10.9%, ranging from 4.7% for respondents reporting excellent health to 35.8% for those reporting poor health at baseline. Lower levels of education, income, and wealth were strongly associated with higher mortality risk after we controlled for just demographic characteristics. After further adjustment for health status and behavioral risk factors, only household income remained significant.

DISCUSSION: Baseline health by age 50 is an important pathway in the association between midlife socioeconomic status and mortality risk to age 70. The continuing effect of low household income on mortality risk was concentrated among respondents reporting excellent to good health at baseline. Socioeconomic disparities in middle-age health continue to limit disability-free life expectancy at older ages.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S209-17 %8 2007 Jul %G eng %N 4 %L newpubs20071002_JoGS209.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17673534?dopt=Abstract %4 socioeconomic status/health status/Mortality %$ 17980 %R 10.1093/geronb/62.4.s209 %0 Journal Article %J Omega (Westport) %D 2007 %T Change in depression of spousal caregivers of dementia patients following patient's death. %A Tweedy, Maureen P. %A Charles A Guarnaccia %K Adaptation, Psychological %K Aged %K Aged, 80 and over %K Bereavement %K Caregivers %K Dementia %K depression %K Female %K Humans %K Life Change Events %K Long-term Care %K Longitudinal Studies %K Male %K Sex Factors %K Spouses %K Surveys and Questionnaires %K United States %X

Caring for an elderly spouse with dementia places a heavy burden on spousal caregivers and often results in chronic depression. Little has been written about change in depression caregivers experience from before to after the death of the spouse with dementia. This longitudinal study examines change in depression of spousal caregivers that occurs following death of the dementia patient. Two theoretical models, the Relief and Stress Models, are discussed in terms of caregiver depression after the death of the dementia-patient care-recipient spouse. These two theoretical models were tested using longitudinal data from the National Institute on Aging sponsored Health and Retirement Study. Both male and female spousal caregivers report an increase in depression after the death of the dementia-patient care-recipient spouse. As time passed following the spouse's death, the conjugally bereaved husbands showed a decrease in depression while the conjugally bereaved wives continued to report increased depression.

%B Omega (Westport) %I 56 %V 56 %P 217-28 %8 2007-2008 %G eng %N 3 %L newpubs20080229_Tweedy.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18300648?dopt=Abstract %4 Caregiving/Spouses/Dementia/Depression %$ 18640 %R 10.2190/om.56.3.a %0 Book Section %B Redefining Retirement: How Will Boomers Fare? %D 2007 %T Cross-Cohort Differences in Health on the Verge of Retirement %A Beth J Soldo %A Olivia S. Mitchell %A Tfaily, Rania %A John McCabe %K Health Conditions and Status %K Other %K Retirement Planning and Satisfaction %X Baby Boomers have left a unique imprint on US culture and society in the last 60 years, and it might be anticipated that they will also put their own stamp on retirement, the last phase of the life cycle. Yet because Boomers have not all fully retired, we cannot yet judge how they will fare as retirees. Instead, we focus on how this group compares with prior groups on the verge of retirement, that is, at ages 51-56. Accordingly, this chapter evaluates the stock of health which Early Boomers bring to retirement and compare these to the circumstances of two prior cohorts at the same point in their life cycles. Using three sets of responses from the Health and Retirement Study, we find some interesting patterns. Overall, the raw evidence indicates that Boomers on the verge of retirement are in poorer health their counterparts 12 years ago. Using a summary health index designed for this study, we find that those born 1948 to 1953 share health risks with the War Baby cohort. This suggests that most of the health decline instead began before the late 1940's. A more complex set of health conclusions emerges from the specific self-reported health measures. Boomers indicate they have relatively more difficulty with a range of everyday physical tasks, but they also report having more pain, more chronic conditions, more drinking and psychiatric problems, than their HRS earlier counterparts. This trend portends poorly for the future health of Boomers as they age and incur increasing costs associated with health care and medications. Using our health index, only those at the 75th percentile or higher are likely to be characterized as having good or better health. %B Redefining Retirement: How Will Boomers Fare? %I Oxford University Press %C New York, NY %G eng %4 COHORT/health status/RETIREMENT %$ 18140 %! Cross-Cohort Differences in Health on the Verge of Retirement %R 10.3386/w12762 %0 Journal Article %J Ann Intern Med %D 2007 %T Geriatric conditions and disability: the Health and Retirement Study. %A Christine T Cigolle %A Kenneth M. Langa %A Mohammed U Kabeto %A Zhiyi Tian %A Caroline S Blaum %K Accidental Falls %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Chronic disease %K Cognition Disorders %K Comorbidity %K Cross-Sectional Studies %K Disability Evaluation %K Dizziness %K Female %K Geriatric Assessment %K Geriatrics %K Hearing Disorders %K Humans %K Male %K Prevalence %K Retirement %K Urinary incontinence %K Vision Disorders %X

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.

%B Ann Intern Med %I 147 %V 147 %P 156-64 %8 2007 Aug 07 %G eng %N 3 %L newpubs20071002_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17679703?dopt=Abstract %4 ADL and IADL Impairments/Geriatrics/Chronic Disease/Health care %$ 18010 %R 10.7326/0003-4819-147-3-200708070-00004 %0 Report %D 2007 %T Imperfect Knowledge of Pension Plan Type %A Alan L Gustman %A Thomas L. Steinmeier %A N. Tabatabai %K Methodology %K Pensions %X This paper investigates the reasons for discrepancies between the pension plan type reported by respondents to the Health and Retirement Study (HRS) and pension plan type obtained from documents produced by their employers, called Summary Plan Descriptions (SPDs). The analysis suggests the discrepancies are sizable and are mainly due to misreports by respondents. Discrepancies between respondent and firm reports of plan type are first documented for different years and from different data sources. Changes over time in respondent and firm reports are analyzed for those who say their plans did not change. Plan type from payroll data produced by Watson Wyatt, a pension consulting company, is examined and compared to respondent reports for employees covered by Watson Wyatt plans. The Watson Wyatt payroll data report plan type without error, and yet we find the patterns of discrepancies between respondent and firm provided data are the same as for the HRS employer and respondent data. We also explore other evidence gathered by the HRS in the course of interviews and various experiments. Our findings that errors are mainly the result of misreporting by respondents, together with findings from experiments, suggest a number of changes in survey design that can help to reduce reporting error. They also suggest that models of retirement and saving behavior should allow for imperfect knowledge by decision makers. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %L newpubs20090126_NBER13379 %4 Pension Plans/Pension Provider Survey %$ 19570 %R DOI 10.3386/w13379 %0 Report %D 2007 %T A New Approach to Raising Social Security's Earliest Eligibility Age. %A Triest, Robert K. %A Haverstick, Kelly %A Margarita Sapozhnikov %A Natalia A. Zhivan %K Social Security %K Social Security Eligibility %X While Social Security’s Normal Retirement Age (NRA) is increasing to 67, the Earliest Eligibility Age (EEA) remains at 62. Similar plans to increase the EEA raise concerns that they would create excessive hardship on workers that are worn-out or in bad health. One simple rule to increase the EEA is to tie an increase to the number of quarters of covered earnings. Such a provision would allow those with long worklives — presumably the less educated and lower paid — to quit earlier. We provide evidence that this simple rule would not satisfy the goal of preventing undue hardship on certain workers. Thus, this paper considers an alternative policy that ties an increase in the EEA to individuals’ Average Indexed Monthly Earnings (AIME). We show that allowing workers with low AIME to continue to be eligible to receive benefits at age 62 has promise as a policy to protect workers who have low earnings and are in poor health from hardship associated with an increase in the EEA. %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/a-new-approach-to-raising-social-securitys-earliest-eligibility-age/ %0 Journal Article %J J Pain %D 2007 %T Pain in aging community-dwelling adults in the United States: non-Hispanic whites, non-Hispanic blacks, and Hispanics. %A Reyes-Gibby, Cielito C. %A Aday, Lu Ann %A Todd, Knox H. %A Cleeland, Charles S. %A Anderson, Karen O. %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Black People %K Chronic disease %K Data collection %K ethnicity %K Female %K Hispanic or Latino %K Humans %K Insurance, Health %K Logistic Models %K Male %K Middle Aged %K pain %K Pain Measurement %K Population %K Socioeconomic factors %K United States %K White People %X

UNLABELLED: Racial and ethnic disparities in healthcare persist in the U.S. Although pain is one of the most prevalent and disabling symptoms of disease, only a few studies have assessed disparities in pain in large racially and ethnically diverse, middle- to late aged community samples, thus limiting the generalizability of study findings in broader populations. With data from the 2000 Health and Retirement Study, we assessed the prevalence and impact of pain in a community sample of aging (> or =51 years old) non-Hispanic whites (n = 11,021), non-Hispanic blacks (n = 1,804), and Hispanics (n = 952) in the U.S. Pain, pain severity, activity limitation as a result of pain, comorbid conditions, and sociodemographic variables were assessed. Results showed that pain prevalence was 28%, and 17% of the sample reported activity limitation as a result of pain. Non-Hispanic blacks (odds ratio [OR], 1.78; 99% confidence interval [CI], 1.33-2.37) and Hispanics (OR, 1.80; 99% CI, 1.26-2.56) had higher risk for severe pain compared with non-Hispanic whites. Analyses of respondents with pain (n = 3,811) showed that having chronic diseases (2 comorbid conditions, OR, 1.5; 99% CI, 1.09-2.17), psychological distress (OR, 1.99; 99% CI, 1.54-2.43), being a Medicaid recipient (OR, 1.63; 99% CI, 1.17-2.25), and lower educational level (OR, 1.45; 99% CI, 1.14-1.85) were significant predictors for severe pain and helped to explain racial/ethnic differences in pain severity.

PERSPECTIVE: This study, which used a large racially and ethnically diverse community sample, provided empirical evidence that racial/ethnic difference in pain severity in aging community adults in the U.S. can be accounted for by differential vulnerability in terms of chronic disease, socioeconomic conditions, and access to care.

%B J Pain %I 8 %V 8 %P 75-84 %8 2007 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/16949874?dopt=Abstract %4 Health Care/Racial Differences/Ethnicity %$ 17190 %R 10.1016/j.jpain.2006.06.002 %0 Thesis %B Nursing %D 2007 %T Sociodemographic and Health-Related Risks for Loneliness and Outcome Differences %A Laurie A. Theeke %K Demographics %K Health Conditions and Status %X Background. Loneliness is a prevalent problem for older adults and has been shown to be associated with negative physical, psychological, and social variables. There has been limited research focusing on the relationship of loneliness to health. There is a gap in the literature when it comes to understanding how the problem of loneliness relates to the health of older adults in the United States. Purpose. The purpose of this study was to address this gap in the literature through the testing of two models, the first model represented the postulated risks for loneliness and the second model represented the postulated outcomes for those who experience loneliness. Variables were chosen for inclusion in the models based on a review of pertinent quantitative and qualitative literature. Methods. The models were tested using a representative sample of U.S. older adults. Data analysis was performed using data from the 2002 and 2004 waves of the Health and Retirement Study. The sample was limited to respondents aged 50 and older who participated in wave 6 (2002) and wave 7 (2004) without proxy, answered the lonely question at both waves, were community-dwelling in 2002 and who had complete data on selected variables in the model. Univariate and bivariate analyses were followed by logistic regression analysis to identify risks. One-way ANOVAs, comparative means testing and independent analysis of covariance tests were used to evaluate the difference in outcomes for those who were never lonely, briefly lonely, or chronically lonely. Results. Non-married status was consistently the primary predictor of self-report of loneliness, followed by poorer self-report of health status, lower educational level, functional impairment, increasing number of chronic illnesses, younger age, lower income, and less people living in the household. Gender and use of home care were not significant predictors of loneliness. Those who were chronically lonely reported less exercise, more tobacco use, less alcohol use, a greater increase in number of chronic illnesses, higher depression scores, more physician contacts and greater average number of nights in a nursing home than those who were never lonely or briefly lonely. After controlling for significant covariates of loneliness, those who were chronically lonely did not have significantly more physician contacts. Discussion. Loneliness is a prevalent problem for older adults in the United States with its own unique health-related risks and outcomes. Given the prevalence, it should be considered a healthcare priority in the United States. Based on the results of this study, inclusion of loneliness and loneliness risk screening as part of routine health histories for those aged 50 and over should be considered. Future research needs to focus on evaluating the effectiveness of both prevention and treatment interventions for loneliness to provide empirical data to guide evidenced based practice. %B Nursing %I West Virginia University %C Morgantown, WV %V Doctor of Philosophy %8 2007 %G eng %4 Demographics %$ 19080 %R https://doi.org/10.33915/etd.2597 %0 Journal Article %J Prev Med %D 2007 %T Use of preventive care by the working poor in the United States. %A Joseph S. Ross %A Bernheim, Susannah M. %A Elizabeth H Bradley %A Teng, Hsun-Mei %A William T Gallo %K Cost of Illness %K Cross-Sectional Studies %K Employment %K Female %K Health Promotion %K Health Services Accessibility %K Health Services Needs and Demand %K Humans %K Male %K Mass Screening %K Middle Aged %K Patient Acceptance of Health Care %K Poverty %K Preventive Health Services %K Risk Assessment %K Socioeconomic factors %K United States %K Vulnerable Populations %X

OBJECTIVE: Examine the association between poverty and preventive care use among older working adults.

METHOD: Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200% of the federal poverty level were defined as poor.

RESULTS: Among 10,088 older working adults, overall preventive care use ranged from 38% (influenza vaccination) to 76% (breast cancer screening). In unadjusted analyses, the working poor were significantly less likely to receive preventive care. After adjustment for insurance coverage, education, and other socio-demographic characteristics, the working poor remained significantly less likely to receive breast cancer (RR 0.92, 95% CI, 0.86-0.96), prostate cancer (RR 0.89, 95% CI, 0.81-0.97), and cholesterol screening (RR 0.91, 95% CI, 0.86-0.96) than the working non-poor, but were not significantly less likely to receive cervical cancer screening (RR 0.96, 95% CI, 0.90-1.01) or influenza vaccination (RR 0.92, 95% CI, 0.84-1.01).

CONCLUSION: The older working poor are at modestly increased risk for not receiving preventive care.

%B Prev Med %I 44 %V 44 %P 254-9 %8 2007 Mar %G eng %N 3 %L newpubs20070403_Ross_etal %1 http://www.ncbi.nlm.nih.gov/pubmed/17196642?dopt=Abstract %4 Poverty/Health Care Utilization/screening %$ 17240 %R 10.1016/j.ypmed.2006.11.006 %0 Thesis %D 2006 %T Caring for Depression and Comorbid Pain: Evidence from HRS and HCC %A Tian, Haijun %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %K Public Policy %X Depression is a common and serious illness, which often occurs together with painful physical symptoms. Though depression and its social and economical impacts have been well documented in the past decades, the role of pain comorbidity is far less understood. Based on two recent national survey datasets, Health and Retirement Study, and Healthcare for Communities, this dissertation investigates the interaction of depression and pain and its impact on labor market, financial, insurance, disability, medication decision, and medication costs outcomes. Chapter 2 examined the relationship between depression and pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65, using wave 3 of Health and Retirement Survey. It found that depression and comorbid pain was associated with worse labor market, financial, insurance and disability outcomes compared to depression alone, and showed the adverse effects were attributed disproportionally to individuals with depression and comorbid pain versus "pure" depression. Chapter 3 examined the relationship between depression and pain, and medication behavior and medication costs outcomes in a nationally representative cross-section of Americans, using first wave of Healthcare for Communities survey. It found that depressed individuals with pain comorbidity were substantially less likely to take antidepressant medications compared to those with depression only, and pain comorbidity was associated with a heavier burden on total medication costs and prescription drug costs. Chapter 4 used Health and Retirement Survey to analyze the effect of depression and comorbid pain on the transition from employment to full retirement for male and female workers. It found that depression and comorbid pain predicted early retirement for female workers, but depression alone did not predict fully retirement for either female workers or male workers. This dissertation not only makes an important contribution to our understanding of depression and pain comorbidity in terms of its prevalence in the general population, and its effect on treatment and access to care, it will also inform health policy makers who want to reduce the burden of depression and pain, and has implications for health care providers and practitioners to improve the quality of care for depression and pain comorbidity. %I The Pardee RAND Graduate School %C United States -- California %8 2006 %G eng %U https://search.proquest.com/openview/9dc142c80dfc678ee1e5b7b1e0cc9647/1?pq-origsite=gscholar&cbl=18750&diss=y %4 Health care %$ 17470 %! Caring for Depression and Comorbid Pain: Evidence from HRS and HCC %0 Thesis %D 2006 %T Change in Depression of Spousal Caregivers of Dementia Patients %A Tweedy, Maureen P. %K Health Conditions and Status %K Healthcare %X Caring for a family member or loved one with dementia places a heavy burden on those providing the care. Caregivers often develop chronic depression because of having to deal with this burden. A great deal of literature has been published discussing coping effectiveness, effects of social support, and other internal and external means of support for the caregiver. However, little has been written about the changes, if any, in depression that the caregiver experiences after the termination of care, either through institutionalization or death of the person with dementia. This study examined whether there is a change in depression of spousal caregivers after institutionalization of the dementia care recipient as well as any changes in depression that may have occurred as a result of the death of the dementia care recipient. Two theoretical models, the wear and tear model and the adaptation model were discussed in terms of caregiver depression after institutionalization of the dementia care recipient. Two other theoretical models, the relief model and the stress model, were discussed in terms of caregiver depression after the death of the dementia care recipient. Datasets from the National Institute on Aging sponsored Health and Retirement Study were analyzed. Results indicate that both male and female spousal caregivers report an increase in depression after the institutionalization or death of the dementia care recipient, but that as time passes, males report a decrease in depression while females continue to report an increase in depression. %I University of North Texas %C United States -- Texas %8 2006 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=1196414461&Fmt=7&clientId=17822&RQT=309&VName=PQD %9 Masters %4 Caregivers %$ 17480 %! Change in Depression of Spousal Caregivers of Dementia Patients %0 Journal Article %J J Gen Intern Med %D 2006 %T Changes in health for the uninsured after reaching age-eligibility for Medicare. %A David W. Baker %A Joseph Feinglass %A Durazo-Arvizu, Ramon %A Whitney P. Witt %A Joseph J Sudano %A Jason A. Thompson %K Age Factors %K Aged %K Cohort Studies %K Eligibility Determination %K Female %K Health Status %K Humans %K Male %K Medically Uninsured %K Medicare %K Middle Aged %K Prospective Studies %K United States %X

BACKGROUND: Uninsured adults in late middle age are more likely to have a health decline than individuals with private insurance.

OBJECTIVE: To determine how health and the risk of future adverse health outcomes changes after the uninsured gain Medicare.

DESIGN: Prospective cohort study.

PARTICIPANTS: Participants (N=3,419) in the Health and Retirement Study who transitioned from private insurance or being uninsured to having Medicare coverage at the 1996, 1998, 2000, or 2002 interview.

MEASUREMENTS: We analyzed risk-adjusted changes in self-reported overall health and physical functioning during the transition period to Medicare (t(-2) to t(0)) and the following 2 years (t(0) to t(2)).

RESULTS: Between the interview before age 65 (t(-2)) and the first interview after reaching age 65 (t(0)), previously uninsured individuals were more likely than those who had private insurance to have a major decline in overall health (adjusted relative risk [ARR] 1.46; 95% confidence interval [CI] 1.03 to 2.04) and to develop a new physical difficulty affecting mobility (ARR 1.24; 95% CI 0.96 to 1.56) or agility (ARR 1.33; 95% CI 1.12 to 1.54). Rates of improvement were similar between the 2 groups. During the next 2 years (t(0) to t(2)), adjusted rates of declines in overall health and physical functioning were similar for individuals who were uninsured and those who had private insurance before gaining Medicare.

CONCLUSIONS: Gaining Medicare does not lead to immediate health benefits for individuals who were uninsured before age 65. However, after 2 or more years of continuous coverage, the uninsured no longer have a higher risk of adverse health outcomes.

%B J Gen Intern Med %I 21 %V 21 %P 1144-9 %8 2006 Nov %G eng %N 11 %L newpubs20070125_Baker_etal_JGIM %1 http://www.ncbi.nlm.nih.gov/pubmed/16879704?dopt=Abstract %R 10.1111/j.1525-1497.2006.00576.x %0 Book Section %B Allocating Public and Private Resources across Generations %D 2006 %T Consequences of Educational Change for the Burden of Chronic Health Problems in the Population %A Mark D Hayward %A Eileen M. Crimmins %A Zhang, Zhenmei %E Gauthier, Anne H. %E Chu, Cyrus %E Tuljapurkar, Shripad %K Educational attainment %K Educational Change %K Functional Limitation %K Functional Problem %K Life Table %X Changes in the public and individual burden of chronic health problems have significant implications for the allocation of public and private resources across generations. Preston (1984) noted almost two decades ago that population ageing in the United States was accompanied by the rapid expansion of public programs benefiting the health of elderswhile public programs benefiting children’s education contracted. Health care is the principal public service provided to the elderly while education is the counterpart for children. Within a historical time period, political choices about the funding of age-targeted service programs have an urgency that oftentimes sweeps aside the fact that investments in children’s well-being pay substantial dividends decades later when children become the elders of a population. In large part, this reflects a lack of attention both by policy makers and by demographers of these long-run associations. Here, we provide new insights into the longrun consequences of investments in children for the burden of chronic health problems by conducting a thought experiment in which we simulate how sweeping historical changes in a population’s educational achievement potentially alters active life expectancy and the prevalence of functioning problems in the population. %B Allocating Public and Private Resources across Generations %I Oxford University Press %C Oxford, UK %P 227-242 %@ 978-1-4020-4480-9 %G eng %L pubs_2005_Hayward_etal.pdf %4 Education/Health Status/Life Expectancy %$ 10502 %+ National Institute on Aging and the National Institute on Child Health and Human Development; Revision of Penn State Population Research Insitute Working Paper 02-02 %R https://doi.org/10.1007/978-1-4020-4481-6_9 %0 Journal Article %J Int Arch Occup Environ Health %D 2006 %T The effect of recurrent involuntary job loss on the depressive symptoms of older US workers. %A William T Gallo %A Elizabeth H Bradley %A Teng, Hsun-Mei %A Stanislav V Kasl %K Adaptation, Physiological %K depression %K Employment %K Female %K Humans %K Life Change Events %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Stress, Psychological %K United States %X

OBJECTIVES: The objective of this study was to assess whether recurrent involuntary job loss among US workers nearing retirement resulted in increasingly less severe changes in depressive symptoms with successive job losses.

METHODS: With data drawn from the US Health and Retirement Survey (HRS), we used repeated measures longitudinal analysis to investigate the effect of recurrent job loss on follow-up depressive symptoms, measured up to 2 years following job loss. Study participants include 617 individuals, aged 51-61 years at the 1992 study baseline, who had at least one job loss between 1990 and 2000. Our primary outcome variable was a continuous measure of depressive symptoms, constructed from the 8-item Center for Epidemiologic Studies-Depression (CES-D) battery administered at every HRS wave. A second, dichotomous outcome, derived from the continuous measure, measured clinically relevant depressive symptoms. The exposure (recurrent job loss) was defined by binary dummy variables representing two and three/four job losses. All job losses were the result of either plant closing or layoff.

RESULTS: Our main finding indicates that, after relevant covariates are controlled, compared to one job loss, two job losses result in a modest increase in the level depressive symptoms (not significant) at two-year follow-up. Three or more job losses result, on average, in a decline in depressive symptoms to a level near pre-displacement assessment (not significant). Somewhat in contrast, two job losses were found to be associated with increased risk of clinically relevant depressive symptoms.

CONCLUSIONS: The principal finding confirms our hypothesis that, among US workers nearing retirement, repeated exposure to job separation results in diminished effects on mental health. Adaptation to the job loss stressor may underlie the observed response, although other explanations, including macroeconomic developments, are possible.

%B Int Arch Occup Environ Health %I 80 %V 80 %P 109-16 %8 2006 Nov %G eng %N 2 %L newpubs20101112_Gallo2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16710713?dopt=Abstract %2 PMC1904500 %4 depression/employment/life Course/Job Loss/RETIREMENT/Stress %$ 23850 %R 10.1007/s00420-006-0108-5 %0 Journal Article %J Medical Care %D 2006 %T Health Insurance Coverage and the Risk of Decline in Overall Health and Death Among the Near Elderly, 1992-2002 %A David W. Baker %A Joseph J Sudano %A Durazo-Arvizu, Ramon %A Joseph Feinglass %A Whitney P. Witt %A Jason A. Thompson %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Methodology %K Other %X Background: Although individuals' health insurance coverage changes frequently, previous analyses have not accounted for changes in insurance coverage over time. . Objective: We sought to determine the independent association between lack of insurance and the risk of a decline in self-reported overall health and death from 1992 to 2002, accounting for changes in self-reported overall health and insurance coverage. .Methods: We analyzed data from the Health and Retirement study, a prospective cohort study of a national sample of community-dwelling adults age 51-61 years old at baseline. Major decline in self-reported overall health and mortality was determined at 2-year intervals. . Results: People who were uninsured at baseline had a 35 (95 confidence interval CI 12-62 ) higher risk-adjusted mortality from 1992 to 2002 compared with those with private insurance. However, when we analyzed outcomes over 2-year intervals, individuals who were uninsured at the start of each interval were more likely to have a major decline in their overall health (pooled adjusted relative risk 1.43, 95 CI 1.28-1.63), but they were equally likely to die (pooled adjusted relative risk 0.96, 95 CI 0.73-1.27). Of the 1512 people who were uninsured at baseline, 220 (14.6 ) died; of those who died, only 70 (31.8 ) were still uninsured at the HRS inter-view prior to death. Conclusions: Death does not appear to be a short-term consequence of being uninsured. Instead, higher long-term mortality among the uninsured results from erosion in this population's health status over time and the attendant higher mortality associated with this. Most deaths among the uninsured occur after individuals have gained either public or private health insurance. %B Medical Care %I 44 %V 44 %P 277 -282 %G eng %N 3 %4 health insurance/mortality/health status/outcome studies/SELF-RATED HEALTH/MYOCARDIAL-INFARCTION/REGRESSION-ANALYSIS/LONGITUDINAL DATA/MORTALITY/OUTCOMES/TERMINATION/CANCER/COHORT/SPELLS %$ 15790 %0 Journal Article %J Occupational and Environmental Medicine %D 2006 %T The impact of late career job loss on myocardial infarction and stroke: a 10 year follow up using the health and retirement survey %A William T Gallo %A Teng, H.M. %A Tracy Falba %A Stanislav V Kasl %A Krumholz, H.V. %A Elizabeth H Bradley %K Economics %K Job loss %K Myocardial Infarction %K Stroke %K Unemployment %X Background: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are at elevated risk. Objective: To assess the 10 year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. Methods: Analysing data from the nationally representative US Health and Retirement Survey (HRS), Cox proportional hazards analysis was used to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. The sample included 4301 individuals who were employed at the 1992 study baseline. Results: Over the 10 year study frame, 582 individuals (13.5% of the sample) experienced involuntary job loss. After controlling for established predictors of the outcomes, displaced workers had a more than twofold increase in the risk of subsequent MI (hazard ratio (HR) = 2.48; 95% confidence interval (CI) = 1.49 to 4.14) and stroke (HR = 2.43; 95% CI = 1.18 to 4.98) relative to working persons. Conclusion: Results suggest that the true costs of late career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and programme planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness. %B Occupational and Environmental Medicine %V 63 %P 683 - 687 %8 Jun-06-2006 %G eng %U http://oem.bmj.com/cgi/doi/10.1136/oem.2006.026823https://syndication.highwire.org/content/doi/10.1136/oem.2006.026823 %N 10 %! Occupational and Environmental Medicine %R 10.1136/oem.2006.026823 %0 Journal Article %J Occupational and Environmental Medicine %D 2006 %T The Impact of Late-Career Job Loss on Myocardial Infarction and Stroke: A 10-year follow-up using the Health and Retirement Survey %A William T Gallo %A Teng, H.M. %A Tracy Falba %A Stanislav V Kasl %A Krumholz, H.V. %A Elizabeth H Bradley %K Employment and Labor Force %K Health Conditions and Status %X OBJECTIVE: Involuntary job loss is a major life event associated with social, economic, behavioural, and health outcomes, for which older workers are elevated risk. Our aim in this study was to assess the 10-year risk of myocardial infarction (MI) and stroke associated with involuntary job loss among workers over 50 years of age. METHODS: Analyzing data from the nationally representative U.S. Health and Retirement Survey (HRS), we used Cox proportional hazards analysis to estimate whether workers who suffered involuntary job loss were at higher risk for subsequent MI and stroke than individuals who continued to work. Our sample included 4,301 individuals who were employed at the 1992 study baseline. RESULTS: Over the 10-year study frame, 582 individuals (13.5 of the sample) experienced involuntary job loss. After controlling for established predictors of our outcomes, we found that displaced workers had a more than two-fold increase in the risk of subsequent MI (Hazard ratio HR = 2.48; 95 Confidence Interval CI = 1.49, 4.14) and stroke (HR = 2.43; CI = 1.18, 4.98) relative to working persons. CONCLUSION: Our results suggest that the true costs of late-career unemployment exceed financial deprivation, and include substantial health consequences. Physicians who treat individuals who lose jobs as they near retirement should consider the loss of employment a potential risk factor for adverse vascular health changes. Policy makers and program planners should also be aware of the risks of job loss, so that programmatic interventions can be designed and implemented to ease the multiple burdens of joblessness. %B Occupational and Environmental Medicine %I 63 %V 63 %P 683-7 %G eng %L pubs_2006_Gallo_etal.pdf %4 Job Loss/Health Risk/MYOCARDIAL-INFARCTION/Stroke %$ 16860 %0 Journal Article %J Psychol Aging %D 2006 %T Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. %A John T. Cacioppo %A Mary Elizabeth Hughes %A Linda J. Waite %A Louise C Hawkley %A Ronald A. Thisted %K Aged %K Cross-Sectional Studies %K depression %K Female %K Follow-Up Studies %K Health Status %K Hostility %K Humans %K Loneliness %K Male %K Middle Aged %K Risk Factors %K Severity of Illness Index %K Social Support %K Stress, Psychological %K Surveys and Questionnaires %X

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.

%B Psychol Aging %I 21 %V 21 %P 140-51 %8 2006 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/16594799?dopt=Abstract %4 Loneliness/Depression/Social Support/Stress %$ 25220 %R 10.1037/0882-7974.21.1.140 %0 Journal Article %J The Gerontologist %D 2006 %T Medicaid and Family Wealth Transfer %A Jinkook Lee %A Hyungsoo Kim %A Tanenbaum, Sandra %K Adult children %K Medicare/Medicaid/Health Insurance %X Purpose: This study examines whether the relationship between making familial wealth transfers and becoming a Medicaid recipient sheds light on the current debate about Medicaid estate planning, whereby some elders transfer their assets to their families to qualify for Medicaid. Design and Methods: Using the Health and Retirement Study, we tracked a national sample of community-based elders who did not receive Medicaid at the 1993 baseline interview but became Medicaid recipients during a 10-year time period and examined wealth transfers for these new Medicaid beneficiaries. Results: Among elders aged 70 or older who did not receive Medicaid in 1993, 16.4 became Medicaid recipients over 10 years. Among these new Medicaid recipients, 17.9 transferred their wealth to family members before receiving Medicaid benefits, with an average transfer amount of 8,507 during the 2 years prior to receiving Medicaid benefits. In addition, 15.2 of community-residing elders entered a nursing home during the 10-year period, and 26.3 of these were covered by Medicaid. Of these new Medicaid recipients living in nursing homes, 12.6 transferred wealth to their families in the mean amount of 4,112. Implications: Familial wealth transfers do occur before changes in Medicaid eligibility in a small, but nontrivial, number of cases, but the amount transferred is modest, especially among nursing home residents. This finding implies that policies to reduce Medicaid long-term-care expenditures by limiting such transfers may not be very effective. %B The Gerontologist %I 46 %V 46 %P 6-13 %G eng %U http://gerontologist.gerontologyjournals.org/ %N 1 %L pubs_2006_Lee_etal.pdf %4 Medicaid/Estate Values/Family transfers, structure %$ 15610 %0 Journal Article %J Journals of Gerontology, Series B: Psychological and Social Sciences %D 2006 %T The Persistence of Depressive Symptoms in Older Workers Who Experience Involuntary Job Loss: Results from the Health and Retirement Study %A William T Gallo %A Elizabeth H Bradley %A J. A. Dubin %A Richard N Jones %A Tracy Falba %A Teng, H.M. %A Stanislav V Kasl %K Employment and Labor Force %K Health Conditions and Status %K Net Worth and Assets %X Objectives. The purpose of this study was to investigate the association between involuntary job loss among workers nearing retirement and long-term changes in depressive symptoms. Methods. Analyzing data from the first four waves (1992 1998) of the Health and Retirement Survey, we used longitudinal multiple regression in order to assess whether involuntary job loss between Wave 1 and Wave 2 was associated with depressive symptoms at Wave 3 and Wave 4. The study sample included 231 workers who had experienced job loss in the Wave 1 Wave 2 interval and a comparison group of 3,324 nondisplaced individuals. We analyzed the effect of job loss on depressive symptoms both in the full study sample and in subsamples determined by wealth. Results. Among individuals with below median net worth, Wave 1 Wave 2 involuntary job loss was associated with increased depressive symptoms at Wave 3 and Wave 4. We found no effect of involuntary job loss for high net worth individuals at the later survey waves. Discussion. Our findings identify older workers with limited wealth as an important group for which the potential effect of involuntary job separation in the years preceding retirement is ongoing (enduring) adverse mental health. %B Journals of Gerontology, Series B: Psychological and Social Sciences %I 61 %V 61 %P S221-8 %G eng %N 4 %L pubs_2006_GalloJoG.pdf %4 Job Loss/Depressive Symptoms/Wealth %$ 16800 %0 Journal Article %J American Journal of Public Health %D 2005 %T Associations Between Obesity and Receipt of Screening Mammography, Papanicolaou Tests, and Influenza Vaccination: Results from the Health and Retirement Study (HRS) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study %A Truls Ostbye %A Donald H. Taylor Jr. %A Yancy, William S. %A Katrina M. Krause %K Health Conditions and Status %X Obese Americans, who receive more care for chronic diseases, may receive fewer preventive services. We evaluated the association between body mass index (BMI) and receipt of screening mammography and Papanicolaou tests among middle-aged women and the association between BMI and receipt of influenza vaccination among the elderly. We analyzed 2 datasets: the Health and Retirement Study (4439 women aged 50-61 years) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) Study (4045 women and 2154 men aged 70 years or more). When BMI was greater than 18.5 kg/m(2), we found an inverse dose-response relationship between BMI and receipt of screening mammography and Pap tests among White, but not Black, middle-aged women. We found a similar association between BMI and influenza vaccination among the elderly. Higher BMI was associated with less frequent receipt of preventive services among middle-aged White women and elderly White women and men. The Healthy People 2010 clinical preventive service goals remain elusive, especially for overweight and obese White persons. %B American Journal of Public Health %I 95 %V 95 %P 1623-30 %G eng %N 9 %L pubs_2005_Mammogram.pdf %4 Obesity %$ 15210 %0 Journal Article %J Journal of Women and Aging %D 2005 %T Depressive Symptoms of Caregiving Women in Midlife: The role of physical health. %A Timothy S Killian %A M Jean Turner %A Rebekah Cain %K Health Conditions and Status %K Healthcare %K Women and Minorities %X This research examined the relationships between providing assistance to aging family members, caregivers' age, caregivers' perceptions of their physical health, and caregivers' depressive symptoms. Several alternative hypotheses were examined. Longitudinal data from 1,898 women from the 1992 and 2000 waves of the Health and Retirement Study (HRS) were used. Results indicate a reciprocal relationship between depression and physical health. These processes were examined using a path analysis. Although the evidence only supported one of the hypotheses, this study clearly demonstrated the importance of physical health for the psychological well-being of women in midlife. %B Journal of Women and Aging %I 17 %V 17 %P 115-27 %G eng %N 1/2 %4 Caregivers/Depression/Health Physical/Women %$ 14328 %0 Journal Article %J Health Services Research %D 2005 %T Do Seniors Understand Their Risk of Moving to a Nursing Home? %A Donald H. Taylor Jr. %A Ostermann, Jan %A Acuff, S. Will %A Truls Ostbye %K Health Conditions and Status %K Healthcare %X Objective: To determine whether seniors understand their risk of moving to a nursing home. Data Sources: We used longitudinal data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) database. AHEAD is a nationally representative survey (n=8,203) of community dwellers aged 70 years and their spouses. Study Design: We followed respondents for 5 years from the date of the first interview fielded in 1993. Our primary dependent variable was whether respondents moved to a nursing home within 5 years of baseline; self-assessed probability of moving to a nursing home within 5 years, also assessed at baseline, was the primary explanatory variable. Principal Findings: We found that seniors who believed they were more likely to move to a nursing home within 5 years were indeed more likely to do so, and that most elders overestimated their likelihood of moving to a nursing home. Conclusions: Low rates of private long-term care insurance are not plausibly a result of seniors underestimating their personal risk of moving to a nursing home; such an assumption is inherent in many strategies to plan for the future long-term care needs of the baby boom generation. %B Health Services Research %I 40 %V 40 %P 811 %G eng %N 3 %L pubs_2005_Taylor_etal.pdf %4 Long-Term Care/Nursing Homes/Aging %$ 15250 %0 Journal Article %J Addiction %D 2005 %T The Effect of Involuntary Job Loss on Smoking Intensity and Relapse %A Tracy Falba %A Teng, Hsun-Mei %A Jody L Sindelar %A William T Gallo %K Employment and Labor Force %K Health Conditions and Status %X Aims: To assess the impact of involuntary job loss due to plant closure or layoff on relapse to smoking and smoking intensity among older workers. Design, participants, sample: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years beginning in 1992. The 3052 participants who were working at the initial wave and had any history of smoking comprise the main sample. Methods: Primary outcomes are smoking relapse at wave 2 (1994) among baseline former smokers, and smoking quantity at wave 2 among baseline current smokers. As reported at the wave 2 follow-up, 6.8 of the sample experienced an involuntary job loss between waves 1 and 2. Findings: Older workers have over two times greater odds of relapse subsequent to involuntary job loss than those who did not. Further, those who were current smokers prior to displacement that did not obtain new employment were found to be smoking more cigarettes, on average, post-job loss. Conclusions: The stress of job loss, along with other significant changes associated with leaving one's job, which would tend to increase cigarette consumption, must outweigh the financial hardship which would tend to reduce consumption. This highlights job loss as an important health risk factor for older smokers. %B Addiction %I 100 %V 100 %P 1330-9 %G eng %N 9 %L pubs_2005_Addiction.pdf %4 Employment/Job Loss/Older Workers/Smoking %$ 15220 %0 Journal Article %J Arthritis Care and Research %D 2005 %T Effect of Physical Activity on Functional Status among Older Middle-Age Adults with Arthritis %A Joseph Feinglass %A Jason A. Thompson %A Xiaoxing He %A Whitney P. Witt %A Rowland W Chang %A David W. Baker %K Health Conditions and Status %X Objective. To determine the effect of leisure time and work-related physical activity on changes in physical functioning among 3,554 nationally representative survey respondents, ages 53 63 years in 1994, with arthritis and joint symptoms, interviewed in the Health and Retirement Study (HRS). Methods. In 1992 1994, light and vigorous exercise items were empirically categorized into recommended, insufficient, and inactive leisure time physical activity levels using data from the HRS. Leisure and work-related physical activity levels in 1994 were used to predict 1996 functional decline or improvement, controlling for baseline functional difficulties, health status, sociodemographic characteristics, and behavioral risk factors. Results. Whereas 29.7 of respondents reported functional declines in 1996, 38.6 of those with baseline difficulties in 1994 reported improvement. Compared with inactive respondents, recommended and insufficient leisure time physical activity were equally protective against functional decline (odds ratio OR 0.59 and 0.62, respectively; P 0.0001). Higher levels of physical activity were also modestly associated with functional improvement among respondents with baseline functional difficulties (OR 1.47, P 0.05 and OR 1.45, P 0.01, respectively). Work-related physical activity was not a significant predictor of decline or improvement. Conclusion. Given the high prevalence of arthritis, even modest increases in rates of lifestyle physical activity among older adults could make a substantial contribution to disability-free life expectancy. %B Arthritis Care and Research %I 53 %V 53 %P 879-85 %G eng %U http://www.rheumatology.org/publications/acr/index.asp %N 6 %L pubs_2005_Feinglass_etal.pdf %4 Arthritis/Exercise %$ 15360 %0 Report %D 2005 %T Health Status, Insurance, and Expenditures in the Transition from Work to Retirement %A Hugo Benítez-Silva %A Boz, Emine %A Buchinsky, Moshe %A Nichols, Joseph B. %A Roy, Sharbani %A Rust, John %A Tristao, Ignez %K Health Conditions and Status %K Insurance %X This paper analyzes the dynamics of health insurance coverage, health expenditures, and health status in the decade expanding from 1992 to 2002, for a cohort of older Americans. We follow 13,594 individuals interviewed in Waves 1 to 6 of the Health and Retirement Study, most of whom were born between 1930 and 1940, as they transition from work into retirement. Although this depression cohort is by and large fairly well prepared for retirement in terms of pension coverage and savings, we identify significant gaps in their health insurance coverage, especially among the most disadvantaged members of this cohort. We find that government health insurance programs particularly Medicare and Medicaid significantly reduce the number of individuals who are uninsured and the risks of large out of pocket health care costs. However, prior to retirement large numbers of these respondents were uninsured, nearly 18 at the first survey in 1992. Moreover, a much larger share, about 55 of this cohort, are transitorily uninsured, that is, they experience one or more spells, lasting from several months to several years, without health insurance coverage. We also identify a much smaller group of persistently uninsured individuals, and show that this group has significantly less wealth, and higher rates of poverty, unemployment, and health problems, disability, and higher mortality rates than the rest of the members of the cohort under study. We provide evidence that lack of health insurance coverage is correlated with reduced utilization of health care services; for example, respondents with no health insurance visit the doctor one fourth as often as those with private insurance and are also more likely to report declines in health status. We also analyze the components of out of pocket health care costs, and show that prescription drug costs constituted a rapidly rising share of the overall cost of health care during the period of analysis. %B ERIU Working Paper %I Economic Research Initiative on the Uninsured, University of Michigan %C Ann Arbor, MI %G eng %U http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.478.8454&rep=rep1&type=pdf %L wp_2005/ERIU_Benitez-Silva.pdf %4 Health Status/Insurance/Health Expenditures %$ 15120 %0 Journal Article %J Soc Sci Med %D 2005 %T Heavy alcohol use and marital dissolution in the USA. %A Ostermann, Jan %A Frank A Sloan %A Donald H. Taylor Jr. %K Alcohol Drinking %K Alcohol-Related Disorders %K Divorce %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Social Class %K United States %X

Using the first five waves of the US Health and Retirement Study, a nationally representative survey of middle-aged persons in the USA conducted between 1992 and 2000, we assessed the association between alcohol consumption and separation and divorce (combined as divorced in the analysis) for 4589 married couples during up to four repeated 2-yr follow-up periods. We found that drinking status was positively correlated between spouses. The correlations did not increase over the follow-up period. Discrepancies in alcohol consumption between spouses were more closely related to the probability of subsequent divorce than consumption levels per se. Couples with two abstainers and couples with two heavy drinkers had the lowest rates of divorce. Couples with one heavy drinker were most likely to divorce. Controlling for current consumption levels, a history of problem drinking by either spouse was not significantly associated with an increased probability of divorce. Our findings on alcohol use and marital dissolution were highly robust in alternative specifications.

%B Soc Sci Med %I 61 %V 61 %P 2304-16 %8 2005 Dec %G eng %N 11 %L pubs_2005_Ostermann.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16139939?dopt=Abstract %4 Alcohol Abuse/Marital Dissolution/Marriage/Divorce/Drinking Behavior %$ 15660 %R 10.1016/j.socscimed.2005.07.021 %0 Journal Article %J Diabetes Care %D 2005 %T The impact of diabetes on employment and work productivity. %A Tunceli, Kaan %A Cathy J. Bradley %A Nerenz, David %A L Keoki Williams %A Pladevall, Manel %A Elston, Lafata J. %K Diabetes Mellitus %K Efficiency %K Employment %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Multivariate Analysis %K Odds Ratio %K United States %K Work %X

OBJECTIVE: The purpose of this study was to longitudinally examine the effect of diabetes on labor market outcomes.

RESEARCH DESIGN AND METHODS: Using secondary data from the first two waves (1992 and 1994) of the Health and Retirement Study, we identified 7,055 employed respondents (51-61 years of age), 490 of whom reported having diabetes in wave 1. We estimated the effect of diabetes in wave 1 on the probability of working in wave 2 using probit regression. For those working in wave 2, we modeled the relationships between diabetic status in wave 1 and the change in hours worked and work-loss days using ordinary least-squares regressions and modeled the presence of health-related work limitations using probit regression. All models control for health status and job characteristics and are estimated separately by sex.

RESULTS: Among individuals with diabetes, the absolute probability of working was 4.4 percentage points less for women and 7.1 percentage points less for men relative to that of their counterparts without diabetes. Change in weekly hours worked was not statistically significantly associated with diabetes. Women with diabetes had 2 more work-loss days per year compared with women without diabetes. Compared with individuals without diabetes, men and women with diabetes were 5.4 and 6 percentage points (absolute increase), respectively, more likely to have work limitations.

CONCLUSIONS: This article provides evidence that diabetes affects patients, employers, and society not only by reducing employment but also by contributing to work loss and health-related work limitations for those who remain employed.

%B Diabetes Care %I 28 %V 28 %P 2662-7 %8 2005 Nov %G eng %N 11 %L pubs_2005_Tunceli_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16249536?dopt=Abstract %4 Diabetes/Labor Force Participation %$ 15400 %R 10.2337/diacare.28.11.2662 %0 Journal Article %J Soc Sci Med %D 2005 %T The impact of own and spouse's urinary incontinence on depressive symptoms. %A Fultz, Nancy H. %A Kristi Rahrig Jenkins %A Truls Ostbye %A Donald H. Taylor Jr. %A Mohammed U Kabeto %A Kenneth M. Langa %K Aged %K Caregivers %K Cohort Studies %K depression %K Female %K Humans %K Male %K Middle Aged %K United States %K Urinary incontinence %X

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

%B Soc Sci Med %I 60 %V 60 %P 2537-48 %8 2005 Jun %G eng %N 11 %L pubs_2005_UIarticle.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15814179?dopt=Abstract %4 Depression Symptoms/Incontinence/Health Services/Mental Health %$ 14350 %R 10.1016/j.socscimed.2004.11.019 %0 Journal Article %J J Ment Health Policy Econ %D 2005 %T Labor market, financial, insurance and disability outcomes among near elderly Americans with depression and pain. %A Tian, Haijun %A Robinson, Rebecca L. %A Sturm, Roland %K Aged %K Cost of Illness %K Cross-Sectional Studies %K depression %K Employment %K Female %K Humans %K Male %K Middle Aged %K pain %K United States %X

BACKGROUND: The economic burden of depression has been documented, but the role of comorbid conditions is unclear. Depression and comorbid pain are particularly common, are associated with worse clinical outcomes and require different care than "pure'' depression. Does this comorbidity account for a large share of the adverse social outcomes attributed to depression?

AIMS OF STUDY: We analyzed the relationship between depression and comorbid pain, and labor market, financial, insurance and disability outcomes among Americans aged 55-65.

METHODS: Cross-sectional data were used from Wave 3 of the Health and Retirement Survey, a nationally representative sample of individuals aged 55-65 surveyed in 1996. Multivariate regression analyses, controlling for socio-demographics and chronic health conditions, estimated the associations between depression and pain, and economic outcomes. Outcomes included: employment and retirement status, household income, total medical expenditures, government health insurance, social security, limitations in activities of daily living (ADLs), and health limitations affecting work. Primary explanatory variables included the presence of severe pain, mild/moderate pain, or absence of pain, with or without depression.

RESULTS: Compared to depression alone, depression and comorbid pain was associated with worse labor market (non-employment, retirement), financial (total medical expenditures), insurance (government insurance, social security) and disability outcomes (limitations in ADLs, health limitations affecting work), after covariate adjustment (p

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The depressed with comorbid pain appear to experience greater burden through increased costs and worse functioning and may require different management than those with depression alone. The depressed with comorbid pain may benefit from treatment practices and guidelines that address the duality of these conditions throughout the process of care. IMPLICATION FOR HEALTH POLICIES: The depressed with comorbid pain were more likely to receive government support than depression alone. Given the central role of employer-sponsored health insurance in the U.S., they may have worse access to health care because they leave employment or retire earlier. With the evolving state of Medicare, broad formulary access to mental health treatments might be considered.

IMPLICATIONS FOR FURTHER RESEARCH: Further research should focus on causality of depression and comorbid pain on economic outcomes. Depression research should consider the heterogeneity of this disorder in outcomes assessment.

%B J Ment Health Policy Econ %I 8 %V 8 %P 219-28 %8 2005 Dec %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/16385147?dopt=Abstract %4 Chronic Disease/Comorbidity/Depression %$ 15340 %0 Journal Article %J Arch Intern Med %D 2005 %T Long-term risk for depressive symptoms after a medical diagnosis. %A Daniel Polsky %A Jalpa A Doshi %A Marcus, Steven %A Oslin, David %A Rothbard, Aileen %A Thomas, Niku %A Thompson, Christy L. %K Chronic disease %K Comorbidity %K Depressive Disorder %K Female %K Humans %K Male %K Middle Aged %K Prospective Studies %K Risk %K Time Factors %X

BACKGROUND: This study examines the risk of development of significant depressive symptoms after a new diagnosis of cancer, diabetes, hypertension, heart disease, arthritis, chronic lung disease, or stroke.

METHODS: The study used 5 biennial waves (1992-2000) of the Health and Retirement Study to follow a sample of 8387 adults (aged 51 to 61 years and without significant depressive symptoms in 1992) from 1994 to 2000. Time-dependent Cox regression models estimated adjusted hazard ratios (HRs) for an episode of significant depressive symptoms after a new diagnosis for each of the 7 medical conditions.

RESULTS: Within 2 years of initial diagnosis, subjects with cancer had the highest hazard of depressive symptoms (HR, 3.55; 95% confidence interval [CI], 2.79-4.52), followed by subjects with chronic lung disease (HR, 2.21; 95% CI, 1.64-2.79) and heart disease (HR, 1.45; 95% CI, 1.09-1.93). The hazard for depressive symptoms for most of these diseases decreased over time; however, subjects with heart disease continued to have a higher risk for depressive symptoms even 2 to 4 years and 4 to 8 years after diagnosis, and a significantly higher hazard for depressive symptoms developed for persons with arthritis 2 to 4 years after diagnosis (HR, 1.46; 95% CI, 1.11-1.92).

CONCLUSION: The findings identify several high-risk patient groups who might benefit from depression screening and monitoring to improve health outcomes in this vulnerable population facing new medical illnesses.

%B Arch Intern Med %I 165 %V 165 %P 1260-6 %8 2005 Jun 13 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/15956005?dopt=Abstract %4 Depressive Symptoms/Disease/Diagnosis %$ 15050 %R 10.1001/archinte.165.11.1260 %0 Journal Article %J Int J Aging Hum Dev %D 2005 %T Supplemental private health insurance and depressive symptoms in older married couples. %A Min, Meeyoung O. %A Aloen L. Townsend %A Baila Miller %A Rovine, Michael J. %K Aged %K Aged, 80 and over %K Analysis of Variance %K Black People %K Chi-Square Distribution %K depression %K Female %K Humans %K Insurance Coverage %K Insurance, Health %K Linear Models %K Male %K Risk Factors %K Spouses %K United States %K White People %X

Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.

%B Int J Aging Hum Dev %I 61 %V 61 %P 293-312 %8 2005 %G eng %N 4 %L pubs_2005_Min_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16320444?dopt=Abstract %4 Economic Status/ADULTS/Medicare %$ 16090 %R 10.2190/21LA-XQCE-BKJF-MC17 %0 Journal Article %J The Review of Economics and Statistics %D 2004 %T Do the Near Elderly Value Mortality Risks Differently from Younger Persons? %A Mary F. Evans %A Kim, Hyun %A Donald H. Taylor Jr. %K Demographics %K Expectations %K Health Conditions and Status %X Wage hedonic models are estimated with the Health and Retirement Study to measure the risk / wage tradeoffs (value of statistical lives) for older workers. The analysis explicitly accounts for multiple employment states including retirement using a multinomial selection model. The results suggest that the oldest and most risk averse workers require significantly higher, not lower, compensation to accept increases in job related fatality risks. %B The Review of Economics and Statistics %I 86 %V 86 %P 423-29 %G eng %N 1 %4 Mortality/Elderly/Subjective expectations %$ 13872 %0 Journal Article %J J Am Geriatr Soc %D 2004 %T The effect of equipment usage and residual task difficulty on use of personal assistance, days in bed, and nursing home placement. %A Donald H. Taylor Jr. %A Hoenig, H. %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Bed Rest %K Cross-Sectional Studies %K Disability Evaluation %K Female %K Homemaker Services %K Humans %K Least-Squares Analysis %K Logistic Models %K Longitudinal Studies %K Male %K Nursing homes %K Risk Factors %K Self-Help Devices %X

OBJECTIVES: To determine whether residual difficulty in functioning in spite of equipment use is linked with increased use of personal assistance.

DESIGN: Longitudinal. Two waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) database were used to test the effect of residual difficulty on hours of personal assistance and bed days at Wave 1 on hours of personal assistance, bed days, and nursing home placement at Waves 1 and 2.

SETTING: A nationally representative setting of community-dwelling persons aged 70 and older and their spouses, regardless of age at Wave 1 AHEAD. There was movement of some respondents into nursing homes by the Wave 2 interview.

PARTICIPANTS: Respondents to the AHEAD survey, N=8,222 at Wave 1.

MEASUREMENTS: The dependent variables were hours of personal assistance in the month before the AHEAD survey (Waves 1 and 2), number of days in month before the survey in which the person did not get out of bed (Waves 1 and 2), and residence in a nursing home at Wave 2. The key explanatory variable was a mutually exclusive (four category) variable that specified whether there was residual difficulty (yes/no) in indoor mobility in spite of using equipment to aid specifically with indoor mobility. The four-category variable was defined by the four categories created by a cross-tabulation of equipment use (yes/no) and difficulty with indoor mobility (yes/no). A similar four-category variable was also defined for transferring in the home.

RESULTS: In cross section, equipment users with residual difficulty reported more hours of personal assistance in the case of indoor mobility impairment and were more likely to have some hours of personal assistance than those without residual difficulty with indoor mobility and transferring. Longitudinally, those with residual difficulty at Wave 1 were more likely to need some personal assistance hours at Wave 2 (odds ratio=1.67, 95% confidence interval= 1.23-2.26 for indoor mobility). For transferring, those with residual difficulty had 43 more hours of personal assistance per month (P=.001) than those for whom equipment resolved their disability. Residual disability was linked to more bed days for users of indoor mobility and transferring equipment, but it was not predictive of nursing home placement by Wave 2.

CONCLUSION: Equipment for indoor mobility or transfers apparently resolves difficulty for some users of the equipment but not for others. Residual task difficulty in spite of equipment for indoor mobility and transferring is linked with worse outcomes, including increased dependency on personal assistance and more days in bed. This shows that more attention is needed to determine whether equipment prescribed is appropriate for a patient's difficulty and that follow-up assessment is crucial after equipment is prescribed.

%B J Am Geriatr Soc %I 52 %V 52 %P 72-9 %8 2004 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/14687318?dopt=Abstract %4 Mobility Difficulty %$ 12852 %R 10.1111/j.1532-5415.2004.52013.x %0 Journal Article %J Health Serv Res %D 2004 %T The effect of smoking on years of healthy life (YHL) lost among middle-aged and older Americans. %A Truls Ostbye %A Donald H. Taylor Jr. %K Age Distribution %K Aged %K Aged, 80 and over %K Female %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Quality of Life %K Quality-Adjusted Life Years %K Regression Analysis %K Sex Distribution %K Smoking %K Smoking cessation %K United States %X

OBJECTIVE: To estimate the effects of smoking on quality of life over time, using the Years of Healthy Life (YHL) construct.

DATA SOURCES/STUDY SETTING: The Health and Retirement Study (HRS) survey (N=12,652) of persons 50 to 60 years old and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (N=8,124) of persons > or =70 years old, plus spouses regardless of age, followed from 1992/1993 to 2000.

STUDY DESIGN: Years of healthy life from baseline to death were estimated. Regression models were developed with smoking as the main explanatory variable and with both YHL and years of life remaining as the outcome variables.

PRINCIPAL FINDINGS: Smoking was strongly and consistently related to YHL lost. In HRS, individuals who had quit smoking at least 15 years prior to baseline had a similar number of YHL left as never smokers.

CONCLUSIONS: Efforts to encourage smoking cessation should emphasize the impact of these factors on quality of life.

%B Health Serv Res %I 39 %V 39 %P 531-52 %8 2004 Jun %G eng %N 3 %L pubs_2004_Ostbye_HSR.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15149477?dopt=Abstract %4 Life Expectancy/Quality of Life/Smoking %$ 12492 %R 10.1111/j.1475-6773.2004.00243.x %0 Journal Article %J Health Econ %D 2004 %T The effect of the tobacco settlement and smoking bans on alcohol consumption. %A Gabriel A. Picone %A Frank A Sloan %A Justin G Trogdon %K Aged %K Alcohol Drinking %K Behavior, Addictive %K Data collection %K Female %K Humans %K Male %K Middle Aged %K Models, Econometric %K Smoking %K United States %X

In the last few years, the price of cigarettes has increased considerably in the USA. In addition, a number of states have also imposed smoking bans. These increases in the cost and barriers to smoking have created a natural experiment to study relationships between smoking and drinking behaviors. In this study, we employ data from the first six waves of the Health and Retirement Survey (HRS) to analyze the effects of smoking bans and cigarette prices on alcohol consumption. We also test if past cigarette and alcohol consumption affect current alcohol consumption as predicted by co-addiction models. We estimate dynamic panel models using GMM estimators. Our approach allows us to obtain consistent estimates irrespective of the number of time periods. The three main findings of this study are: (1) there is positive reinforcement effect of past cigarette consumption on current alcohol consumption, (2) smoking bans reduce alcohol consumption and (3) there is a positive effect of cigarette prices on alcohol consumption.

%B Health Econ %I 13 %V 13 %P 1063-80 %8 2004 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/15386690?dopt=Abstract %4 Smoking/Alcohol Drinking %$ 13702 %R 10.1002/hec.930 %0 Journal Article %J Journal of Risk and Uncertainty %D 2004 %T Effects of Risk and Time Preference and Expected Longevity on Demand for Medical Tests %A Gabriel A. Picone %A Frank A Sloan %A Donald H. Taylor Jr. %K Expectations %K Health Conditions and Status %K Healthcare %X Despite their conceptual importance, the effects of time preference, expected longevity, uncertainty, and risk aversion on behavior have not been analyzed empirically. We use data from the Health and Retirement Study (HRS) to assess the role of risk and time preference, expected longevity, and education on demand for three measures used for early detection of breast and cervical cancer—regular breast self-exams, mammograms, and Pap smears. We find that individuals with a higher life expectancy and lower time preference are more likely to undergo cancer screening. Less risk averse individuals tend to be more likely to undergo testing. %B Journal of Risk and Uncertainty %I 28 %V 28 %P 39-53 %G eng %4 Subjective expectations/Longevity/Health Care Utilization %$ 13802 %R https://doi.org/10.1023/B:RISK.0000009435.11390.23 %0 Journal Article %J Gerontologist %D 2004 %T Elders who delay medication because of cost: health insurance, demographic, health, and financial correlates. %A Klein, Dawn %A Carolyn L. Turvey %A Robert B Wallace %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Drug Therapy %K Fees, Pharmaceutical %K Female %K Health Status %K Humans %K Insurance, Pharmaceutical Services %K Logistic Models %K Male %K Medicare %K Multivariate Analysis %K Patient Compliance %K Self Administration %K Socioeconomic factors %K United States %X

PURPOSE: Prescription medication use is essential to the health and well-being of many elderly persons. However, the cost of medications may be prohibitive and contribute to noncompliance with medical recommendations. This study identifies community-dwelling elders who reported a delay in medication use because of prescription medication cost.

DESIGN AND METHODS: This was a cross-sectional study of a nationwide sample of 6,535 elders participating in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Participants reported if they had taken less medication than prescribed or if they had not filled prescriptions because of cost in the past 2 years. This response was then compared with the self-report of multiple variables, including demographic, health status, health insurance coverage, and financial variables.

RESULTS: Elders who were most vulnerable to medication delay as a result of cost included those with Medicare coverage only, low income, high out-of-pocket prescription costs, and poor health as well as African American elders and those aged 65-80 years.

IMPLICATIONS: This study provides important information about community-dwelling elders that reported a delay in medication use because of cost. As a Medicare prescription benefit has been passed, it will be important to monitor how these changes affect the elders identified at risk for medication delay.

%B Gerontologist %I 44 %V 44 %P 779-87 %8 2004 Dec %G eng %N 6 %L pubs_2004_Klein_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15611214?dopt=Abstract %4 Prescription Fees/Elderly/Medicine/COSTS %$ 16040 %R 10.1093/geront/44.6.779 %0 Report %D 2004 %T How Do Pensions Affect Expected and Actual Retirement Ages %A Alicia H. Munnell %A Triest, Robert K. %A Natalia A. Jivan %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper uses the first six waves of the Health and Retirement Study to investigate the impact of pensions on expected retirement age, on the probability of being retired in each wave given employment in the previous wave, and on the probability of retiring earlier than planned. Pension coverage per se and the type of pension are important in each case. Pension wealth reduces the expected retirement age by 0.6 year, and the incentives in defined benefit plans lower the expected age by another 1.1 years. Pension wealth increases the probability of retiring in a given wave, and pension accruals reduce the probability. Other characteristics of defined benefit plans, as measured by the pension dummy, further raise the probability of being retired. Finally, with regard to the probability of retiring earlier than planned, a change in defined contribution wealth increases the probability, but pension coverage per se reduces it. That is, those with pensions tend to be more accurate planners than those without. %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/wp-content/uploads/2004/11/wp_2004-271.pdf %L wp_2004/munnellCRR2004-27 %4 Pension Wealth/Retirement Planning %$ 13752 %0 Report %D 2004 %T The Impact of Health Status and Out-of-Pocket Medical Expenditures on Annuity Valuation %A Cassio M. Turra %A Olivia S. Mitchell %K Annuitization %K Health Insurance %K Medicare/Medicaid/Health Insurance %K Older Adults %X This paper describes how differences in health status at retirement can influence the decision to purchase a life annuity. We extend previous research on annuitization decisions by incorporating the effect of health differentials via differences in survival throughout the latter portion of life. Next, we consider how precautionary savings motivated by uncertain out-of-pocket medical expenses influence annuitization decisions. Our results show that annuities become less attractive to people facing uncertain medical expenses. While full annuitization would still be optimal if annuity markets were truly complete and both life- and health-contingent, lacking this, annuity equivalent wealth values are much lower for those in poor health, as compared to persons in good health. %B Michigan Retirement Research Center Research Working Paper %I Michigan Retirement Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://ideas.repec.org/p/mrr/papers/wp086.html %0 Journal Article %J Int J Aging Hum Dev %D 2004 %T Life course transitions and depressive symptoms among women in midlife. %A M Jean Turner %A Timothy S Killian %A Rebekah Cain %K Caregivers %K depression %K Female %K Health Status %K Humans %K Interviews as Topic %K Life Change Events %K Longitudinal Studies %K Marital Status %K Middle Aged %K Quality of Life %X

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.

%B Int J Aging Hum Dev %I 58 %V 58 %P 241-65 %8 2004 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/15357328?dopt=Abstract %4 Caregivers/Depressive Symptoms/Womens Health %$ 14122 %R 10.2190/4CUU-KDKC-2XAD-HY0W %0 Journal Article %J J Womens Health (Larchmt) %D 2004 %T Number of children associated with obesity in middle-aged women and men: results from the health and retirement study. %A Weng, Haoling H. %A Bastian, Lori A. %A Donald H. Taylor Jr. %A Truls Ostbye %K Adult %K Aged %K Body Mass Index %K Family Characteristics %K Female %K Health Behavior %K Health Surveys %K Humans %K Male %K Middle Aged %K Obesity %K Parity %K Risk Assessment %K United States %X

OBJECTIVE: To study associations between number of children and obesity in middle-aged women and men.

METHODS: In the Health and Retirement Study, a national survey of households, we tested the association between increasing number of children and obesity (body mass index [BMI] >or= 30) in 9046 middle-aged women and men (4523 couples).

RESULTS: Women (n = 4523) who were obese were more frequently nonwhite, reported lower household income, were more frequently employed outside the home, were less frequently covered by health insurance, and were more frequently less educated compared with nonobese women. Men (n = 4523) who were obese were younger, were more frequently African American, and were more frequently less educated and poorer compared with nonobese men. Among women, a 7% increase in risk of obesity was noted for each additional child, adjusting for age, race, household income, work status, physical activity, tobacco use, and alcohol use. Among men, a 4% increase in risk of obesity was noted for each additional child, adjusting for the same covariates. These sex differences were not significantly different.

CONCLUSIONS: Previous research has demonstrated an association between number of children and obesity among women. These results suggest a similar association among men. Public health interventions focused on obesity prevention should target both parents, especially those parents with several children.

%B J Womens Health (Larchmt) %I 12 %V 13 %P 85-91 %8 2004 Jan-Feb %G eng %N 1 %L pubs_2004_Weng_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15006281?dopt=Abstract %4 Obesity %$ 13712 %R 10.1089/154099904322836492 %0 Book %D 2004 %T The Price of Smoking %A Frank A Sloan %A Ostermann, Jan %A Gabriel A. Picone %A Conover, Christopher %A Donald H. Taylor Jr. %K Consumption and Savings %K Health Conditions and Status %I MIT Press %C Cambridge, MA %G eng %4 Smoking/Costs %$ 13842 %0 Book Section %B Death and Dollars: The Role of Gifts and Estates in America %D 2003 %T The Impact of the Growth of Defined Contribution Plans on Bequests %A Alicia H. Munnell %A Sundén, Annika %A Soto, Mauricio %A Taylor, Catherine %E Alicia H. Munnell %E Sundén, Annika %K Adult children %K Consumption and Savings %K Pensions %X This paper explores the shift from defined benefit to defined contribution plans and considers how it might affect bequests and thereby consumption and saving. Our hypothesis is that both intended bequests and unintended bequests will increase as retirees receive more of their pension benefits as lump sums rather than as annuity payments. We also contend that workers recognize that they may not consume their lump-sum payments and react differently to accumulations in defined benefit and defined contribution plans during their lifetime. %B Death and Dollars: The Role of Gifts and Estates in America %I The Brookings Institution Press %C Washington, DC %G eng %L pubs_2003_munnell-sunden.pdf %4 defined contribution pension plans/defined benefits/Bequests/Savings/Consumption %$ 11022 %! The Impact of the Growth of Defined Contribution Plans on Bequests %0 Report %D 2003 %T Impact of the Social Security Retirement Earnings Test on 62-64 Year-olds %A Ratcliffe, Caroline %A Berk, Jillian %A Perese, Kevin %A Toder, Eric %K Social Security %B Public Policy Institute %I The Urban Institute %C Washington, D.C. %G eng %4 Social Security/Earnings and Benefits File %$ 14222 %R http://dx.doi.org/10.2139/ssrn.2206445 %0 Book %D 2003 %T Labor markets and firm benefit policies in Japan and the United States %A Seiritsu Ogura %A Toshiaki Tachibanaki %A David A Wise %K Employment and Labor Force %K Medicare/Medicaid/Health Insurance %K Public Policy %K Time Use %X Thirteen papers, presented at a joint conference of the Japan Center for Economic Research and the National Bureau of Economic Research held in Hawaii in January 2000, study employment policies in Japan and the United States and relate recent economic and demographic changes in each country to employment practices and labor market trends. Papers discuss the rise of the United States to peak capitalist economy; the recent transformation of participatory employment practices in Japan; determinants of the shadow value of simultaneous information sharing in the Japanese machine tool manufacturing industry; youth employment in an aging Japanese society; total labor costs and the employment adjustment behavior of large Japanese firms; individual expenditures and medical saving accounts; three types of private coverage supplementing public insurance and their implications for medical care systems; option value estimation with Health and Retirement Study data; why the Japanese spend so much on drugs; the demand for health checkups under uncertainty; the role of firms in welfare provision; fringe benefit provision for female part time workers in Japan; and unions, the costs of job loss, and vacation. Ogura is at the Japan Center for Economic Research. Tachibanaki is at the Institute for Economic Research at Kyoto University. Wise is with the John F. Kennedy School of Government at Harvard University. Author and subject indexes. %I University of Chicago Press %C Chicago %@ 0-226-62094-8 %G eng %U https://www.nber.org/books/ogura03-1 %4 Wages/Labor Force/Time Allocation/Work Behavior/Union Status/Employment/Health Insurance/Public Policy %$ 15020 %0 Book Section %B Labor Markets and Firm Benefit Policies in Japan and the United States %D 2003 %T Option Value Estimation with HRS Data %A Andrew A. Samwick %A David A Wise %E Seiritsu Ogura %E Toshiaki Tachibanaki %E David A Wise %K Public Policy %K Retirement Planning and Satisfaction %X We estimate the effect of financial incentives to delay retirement on the probability of retirement in the Health and Retirement Study. We find statistically significant effects of both pension wealth and pension incentives on the probability of retirement. The effects are more robust when retirement is defined only as a job separation rather than a complete transition out of the labor force. We also investigate possible interactions between the effects of health, wealth, and health insurance on retirement. %B Labor Markets and Firm Benefit Policies in Japan and the United States %I University of Chicago Press %C Chicago %P 205-228 %@ 0-226-62094-8 %G eng %U https://www.nber.org/chapters/c10308 %4 financial incentives/retirement behavior/Partial Retirement/retirement planning %$ 10252 %0 Book %D 2003 %T Parsing the Smoking Puzzle: Information, Risk Perception, and Choice %A Frank A Sloan %A Donald H. Taylor Jr. %A V. Kerry Smith %K Consumption and Savings %K Health Conditions and Status %K Healthcare %K Methodology %K Public Policy %K Risk Taking %X Examines how perceptions of the risks of smoking are updated as older individuals receive new personalized information and how risk perceptions affect smoking behavior. Highlights the potential for reducing cigarette consumption using a message about a smoker's quality of life at the end of life. Based on data collected in the Health and Retirement Study (HRS), a national panel survey conducted by the University of Michigan's Institute for Social Research on adults aged fifty one to sixty one in the baseline year of the survey (1992), and on information from focus group meetings and interviews with current or former smokers. Surveys government policy and industry advertising with regard to smoking over the past fifty to one hundred years and their effectiveness in influencing cigarette demand. Summarizes existing knowledge and HRS findings on the effects of smoking on mortality and morbidity. Focuses on the survey respondent's assessment of the probability that they will live to age seventy five; examines how well individuals predict their own survival; and explores how people use new information about their own health to update their longevity expectations. Presents new information on smoking cessation and relapse patterns in older adults, paying special attention to the impact of health shocks. Considers whether it is possible to design information messages that mimic the information conveyed to middle aged smokers by personal health shocks and investigates the factors that may make a message especially salient for smokers. Incorporates new findings into an economic analysis of the demand for cigarettes and evaluates the potential impact of a new information policy on daily cigarette consumption of smokers in the sixth and seventh decade of life. Presents policy implications. Sloan is at Duke University. Smith is at North Carolina State University. Taylor is at the Stanford Institute of Public Policy, Duke University. Index. %I Harvard University Press %C Cambridge, MA %G eng %U https://www.hup.harvard.edu/catalog.php?isbn=9780674010390 %4 Smoking/Risk Behavior/Health Education/General Welfare/Basic Needs/Living Standards/Quality of Life/Health Production/Health/Econometric and Statistical Methods %$ 8614 %0 Journal Article %J BMC Public Health %D 2003 %T Racial Differences in Influenza Vaccination Among Older Americans, 1996-2000: Longitudinal analysis of the Health and Retirement Study (HRS) and the Asset and Health Dynamics among the Oldest Old (AHEAD) survey %A Truls Ostbye %A Donald H. Taylor Jr. %A Lee, Ann Marie M. %A Gary N. Greenberg %A Lynn Van Scoyoc %K Demographics %K Health Conditions and Status %X Background: Influenza is a common and serious public health problem among the elderly. The influenza vaccine is safe and effective. Methods: The purpose of the study was to determine whether frequencies of receipt vary by race, age group, gender, and time (progress from 1995/1996 to 2000), and whether any racial differences remain in age groups covered by Medicare. Subjects were selected from the Health and Retirement Study (HRS) (12,652 Americans 50 61 years of age (1992 2000)) and the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (8,124 community-dwelling seniors aged 70 years (1993 2000)). Using multivariate logistic regression, adjusting for potential confounders, we estimated the relationship between race, age group, gender, time and the main outcome measure, receipt of influenza vaccination in the last 2 years. Results: There has been a clear increase in the unadjusted rates of receipt of influenza vaccination for all groups from 1995/1996 to 2000. However, the proportions immunized are 10 20 higher among White than among Black elderly, with no obvious narrowing of the racial gap from 1995/1996 to 2000. There is an increase in rates from age 50 to age 65. After age 70, the rate appears to plateau. In multivariate analyses, the racial difference remains after adjusting for a series of socioeconomic, health, and health care related variables. (HRS: OR = 0.63 (0.55 0.72), AHEAD: OR = 0.55 (0.44 0.66)) Conclusions: There is much work left if the Healthy People 2010 goal of 90 of the elderly immunized against influenza annually is to be achieved. Close coordination between public health programs and clinical prevention efforts in primary care is necessary, but to be truly effective, these services must be culturally appropriate. %B BMC Public Health %I 3 %V 3 %G eng %N 41 %L pubs_2003_Ostbye_etal_BMC.pdf %4 Influenza/Vaccination/Racial Differences %$ 12092 %R https://doi.org/10.1186/1471-2458-3-41 %0 Journal Article %J Ann Fam Med %D 2003 %T Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD). %A Truls Ostbye %A Gary N. Greenberg %A Donald H. Taylor Jr. %A Lee, Ann Marie M. %K Age Factors %K Aged %K Aged, 80 and over %K Breast Neoplasms %K Cost-Benefit Analysis %K Female %K Health Services for the Aged %K Humans %K Longitudinal Studies %K Mammography %K Middle Aged %K Multivariate Analysis %K Papanicolaou Test %K Patient Acceptance of Health Care %K Risk %K United States %K Uterine Cervical Neoplasms %K Vaginal Smears %X

BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys.

METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998.

RESULTS: Receipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.

CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.

%B Ann Fam Med %I 1 %V 1 %P 209-17 %8 2003 Nov-Dec %G eng %N 4 %L pubs_2003_Ostbye_etal_AFM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15055410?dopt=Abstract %4 Womens Health/Mammography/Pap Test %$ 12102 %R 10.1370/afm.54 %0 Thesis %D 2003 %T A Structural Model of the Effect of Retiree Health Insurance on Early Retirement %A Tunceli, Kaan %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X This study contributes to the existing literature by pursuing two complementary goals: (1) To estimate the effect of planning to retire early on access to employer provided retiree health insurance (ERHI); and (2) to produce a consistent estimate of the effect of ERHI on the probability of early retirement, allowing for the possibility that access to retiree health insurance is an endogenous variable. The empirical analysis uses the data from the first five Waves of the Health and Retirement Study (HRS), which were conducted every other year from 1.992 to 2000. The analysis focuses on men who were less than 65 in 2000, full-time workers, and had insurance as active workers in 1996. The retirement model is specified with three sequential equations: Planning to retire early in 1992, access to retiree health insurance in 1996, and retirement between 1996 and 2000. Not only demographic and socioeconomic characteristics of men, but also those of spouses to estimate the structural retirement model are included in all three equations. Alternative estimation techniques are used including univariate probit, bivariate probit, and trivariate probit models. The results vary significantly across estimation techniques. Planning to retire early encourages access to ERHI in the bivariate and trivariate models, while it does not in the univariate model. The effect of access to ERHI on early retirement is positive and significant in all three models. However, the effect is larger for bivariate and trivariate models compared to the univariate model. The trivariate model provides evidence that correlations between error terms across the structural equations are significant. The correlation between errors in the access equation and the retirement equation is negative. Therefore, it is likely that previous literature underestimated the effect of access to retiree health insurance on early retirement. One important implication for public policy is that policy initiatives such as a Medicare buy-in or health insurance tax credits that increase access to retiree health insurance are likely to have large effects on retirement decisions. In other words, the unintended effects on labor force participation of policies that increase access to retiree health insurance might be greater than previous research has suggested. %I The Pennsylvania State University %8 2003 %G eng %4 Early Retirement %$ 12312 %! A Structural Model of the Effect of Retiree Health Insurance on Early Retirement %0 Journal Article %J Obstet Gynecol %D 2003 %T Urinary incontinence and depression in middle-aged United States women. %A Ingrid E Nygaard %A Carolyn L. Turvey %A Burns, Trudy L. %A Elizabeth A Chrischilles %A Robert B Wallace %K Activities of Daily Living %K Aged %K Comorbidity %K Cross-Sectional Studies %K depression %K Female %K Humans %K Logistic Models %K Middle Aged %K United States %K Urinary incontinence %X

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.

%B Obstet Gynecol %I 101 %V 101 %P 149-56 %8 2003 Jan %G eng %N 1 %L newpubs20091202_Incontinence.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12517660?dopt=Abstract %4 Depression/Women/Incontinence %$ 21260 %R 10.1016/s0029-7844(02)02519-x %0 Journal Article %J Health Services Research %D 2002 %T Health Insurance and Mammography: Would a Medicare buy-in take us to universal screening? %A Donald H. Taylor Jr. %A Lynn Van Scoyoc %A Hawley, Sarah T. %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %K Women and Minorities %X Objective. To determine whether health insurance expansioins via a Medicare buy-in might Plausibly increase mammography screening rates among women aged 50-64.Data Sources. Two waves of the Health and Retirement Study (HRS) (1994, 1996).Study Design. A longitudinal study with most explanatory variables measured at the second wave of HRS (1994); receipt of mammography, number of physician visits, and breast self exam (BSE) were measured at the third wave (1996).Data Extraction. Our sample included women aged 50-62 in 1994 who answered the second and third HRS interview (n=4,583).Principal Findings. From 1994 to 199,6, 72.7 percent of women received a mammogram. Being insured increased mammography in both unadjusted and adjusted analyses. A simulation of universal insurance coverage in,this age group increased mammography rates only to 75-79 percent from the observed 72.7 percent. When we accounted for potential endogeneity of physician visits and BSE to mammo graphy, physician visits remained a strong predictor of mammography but BSE did not.Conclusion. Even in the presence of universal coverage and very optimistic scenarios regarding the effect of insurance on mammography for, newly insured women, mammography rates would only increase a small amount and gaps in screening would remain. Thus, a Medicare buy-in could be expected to have a small impact on mammography screening rates. %B Health Services Research %I 37 %V 37 %P 1469-1486 %G eng %N 6 %4 Health Insurance/Mammography/Medicare/Women %$ 11902 %0 Journal Article %J Econometrica %D 2002 %T Inference on Regressions with Interval Data on a Regressor or Outcome %A Charles F Manski %A Tamer, Elie %K Identification %K interval data %K Regression Analysis %X This paper examines inference on regressions when interval data are available on one variable, the other variables being measured precisely. Let a population be characterized by a distribution P(y, x, v, v0, v1), where y ε R1, x ε Rk, and the real variables (v, v0, v1) satisfy v0 ≤ v ≤ v1. Let a random sample be drawn from P and the realizations of (y, x, v0, v1) be observed, but not those of v. The problem of interest may be to infer E(y|x, v) or E(v|x). This analysis maintains Interval (I), Monotonicity (M), and Mean Independence (MI) assumptions: (I) P(v0 ≤ v ≤ v1) = 1; (M)E(y|x, v) is monotone in v; (MI) E(y|x, v, v0, v1) = E(y|x, v). No restrictions are imposed on the distribution of the unobserved values of v within the observed intervals [v0, v1]. It is found that the IMMI Assumptions alone imply simple nonparametric bounds on E(y|x, v) and E(v|x). These assumptions invoked when y is binary and combined with a semiparametric binary regression model yield an identification region for the parameters that may be estimated consistently by a modified maximum score (MMS) method. The IMMI assumptions combined with a parametric model for E(y|x, v) or E(v|x) yield an identification region that may be estimated consistently by a modified minimum-distance (MMD) method. Monte Carlo methods are used to characterize the finite-sample performance of these estimators. Empirical case studies are performed using interval wealth data in the Health and Retirement Study and interval income data in the Current Population Survey. %B Econometrica %I 70 %V 70 %P 519-46 %G eng %N 2 %L pubs_2002_Manski_CEcmetrica.pdf %4 Econometric Methods: Single Equation Models: General/Regression %$ 1068 %R https://doi.org/10.1111/1468-0262.00294 %0 Journal Article %J Prev Med %D 2002 %T A longitudinal study of the effects of tobacco smoking and other modifiable risk factors on ill health in middle-aged and old Americans: results from the Health and Retirement Study and Asset and Health Dynamics among the Oldest Old survey. %A Truls Ostbye %A Donald H. Taylor Jr. %A Sang-Hyuk Jung %K Age Distribution %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Attitude to Health %K Chi-Square Distribution %K Exercise %K Female %K Health Behavior %K Health Status %K Health Surveys %K Humans %K Life Style %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Risk Assessment %K Risk Factors %K Sex Distribution %K Smoking %K Socioeconomic factors %K Survival Rate %K United States %X

BACKGROUND: While the effects of smoking and other modifiable risk factors on mortality and specific diseases are well established, their effects on ill health more generally are less known. Using two national, longitudinal surveys, the objective of this study was to analyze the effect of smoking and other modifiable risk factors on ill health, defined in a multidimensional fashion (i.e., disability, impaired mobility, health care utilization, and self-reported health).

METHODS: The analyses were based on the Health and Retirement Study (HRS) (12,652 persons 50-60 years old surveyed in 1992, 1994, 1996, and 1998) and the Asset and Health Dynamics among the Oldest Old survey (8,124 persons 60-70 years old surveyed in 1993, 1996, and 1998).

RESULTS: Smoking was strongly related to mortality and to ill health, with similar relative effects in the middle-aged and the elderly. There were consistent adverse dose-response relationships between smoking and ill health in the HRS. Persons who had quit smoking at least 15 years prior to the survey were no more likely than never smokers to experience ill health. A dose-response relationship was found between exercise and ill health. For body mass index and alcohol, there were U-shaped relationships with ill health.

CONCLUSIONS: Public health efforts designed to encourage smoking cessation should emphasize improvements in ill health in addition to decreased mortality.

%B Prev Med %I 34 %V 34 %P 334-45 %8 2002 Mar %G eng %N 3 %L pubs_2002_Ostbye_TPrevMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11902850?dopt=Abstract %4 Smoking/Health Status/Health Behavior/Longitudinal Studies %$ 8602 %R 10.1006/pmed.2001.0991 %0 Generic %D 2002 %T Minorities and the Health and Retirement Survey: Future Analytic Opportunities and Data Requirements %A Tienda, Marta %K administrative data %K health %K minorities %I National Institute on Aging %C Bethesda, MD %0 Report %D 2002 %T Modeling Income in the Near Term: Revised Projections of Retirement Income Through 2020 for the 1931-1960 Birth Cohorts %A Toder, Eric %A Thompson, Lawrence H. %A Melissa Favreault %A Richard W. Johnson %A Perese, Kevin %A Ratcliffe, Caroline %A Karen E. Smith %A Cori E. Uccello %A Timothy A Waidmann %A Berk, Jillian %A Woldemariam, Romina %A Gary T. Burtless %A Claudia R Sahm %A Douglas A. Wolf %K Disabilities %K Net Worth and Assets %K Pensions %K Social Security %X The Division of Policy Evaluation (DPE) of the Social Security Administration (SSA) has entered into two contracts with the Urban Institute to help it develop a new tool for analyzing the distributional consequences of Social Security reform proposals. The first, awarded in 1998, led to the development of Modeling Income in the Near Term (MINT), a tool for simulating the retirement incomes of members of the Baby Boom and neighboring cohorts. The second, awarded in 2000, was to expand and improve on the first version of MINT. In all phases of the project, members of the research staff at SSA/DPE collaborated closely with the contractors. The Brookings Institution served as a subcontractor to the Urban Institute under both contracts and the RAND Corporation participated in the development of the initial version of MINT under a separate contract. This report describes the work of the researchers at Urban and Brookings under the second contract. %B Urban Institute Research Report %I The Urban Institute %C Washington, D.C. %G eng %U http://www.urban.org/UploadedPDF/410609_ModelingIncome.pdf %L wp_2002/Toder_etal_ModelingIncome.pdf %4 Earnings and Benefits File/Disability/Disability/Pensions/Wealth %$ 14212 %0 Journal Article %J J Am Geriatr Soc %D 2002 %T Prevalence and correlates of depressive symptoms in a community sample of people suffering from heart failure. %A Carolyn L. Turvey %A Schultz, K. %A Arndt, Stephan %A Robert B Wallace %A A. Regula Herzog %K Aged %K depression %K Female %K Heart Failure %K Humans %K Longitudinal Studies %K Male %K Prevalence %K United States %X

OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older.

DESIGN: Cross-sectional.

SETTING: Community-based epidemiological study of older people from the continental United States.

PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier.

MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies-Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070).

RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8% of people with other heart conditions and 3.2% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses.

CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.

%B J Am Geriatr Soc %I 50 %V 50 %P 2003-8 %8 2002 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/12473012?dopt=Abstract %4 Heart Diseases/Depression %$ 12932 %R 10.1046/j.1532-5415.2002.50612.x %0 Journal Article %J J Am Geriatr Soc %D 2002 %T The role of smoking and other modifiable lifestyle risk factors in maintaining and restoring lower body mobility in middle-aged and older Americans: results from the HRS and AHEAD. Health and Retirement Study. Asset and Health Dynamics Among the Oldest Ol %A Truls Ostbye %A Donald H. Taylor Jr. %A Katrina M. Krause %A Scoyoc, L.V. %K Age Distribution %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Body Mass Index %K Exercise %K Female %K Humans %K Leg %K Logistic Models %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Risk Factors %K Sex Distribution %K Smoking %K Smoking cessation %K United States %K Walking %X

OBJECTIVES: To analyze the effect of smoking, smoking cessation, and other modifiable risk factors on mobility in middle-aged and older Americans.

DESIGN: Panel study; secondary data analysis.

SETTING: United States (national sample).

PARTICIPANTS: The Health and Retirement Study (HRS) includes data on 12,652 Americans aged 50 to 61 in four waves (1992-1998). The Asset and Health Dynamics Among the Oldest Old (AHEAD) survey followed 8,124 community-dwelling people aged 70 years and older in three waves (1993-1998).

MEASUREMENTS: The relationships between the primary outcome measure, lower body mobility (ability to walk several blocks and walk up one flight of stairs without difficulty), and smoking, exercise (HRS only), body mass index (BMI), and alcohol use were estimated in bivariate and multivariate analyses.

RESULTS: Not smoking was strongly positively related to mobility, and the relative effects were similar in both panels. Among those with impaired mobility at baseline, not smoking was also strongly related to recovery. In the middle aged, there were consistent dose-response relationships between amount smoked and impaired mobility. Fifteen years after quitting, the risk of impaired mobility returned to that of never smokers. There was also a strong dose-response relationship between level of exercise and mobility. Inverted U-shaped relationships with mobility were observed for BMI and alcohol consumption.

CONCLUSIONS: The relationships between not smoking and lower body mobility in middle-aged and older Americans are strong and consistent. Interventions aimed at reducing smoking have the potential to preserve mobility and thereby prolong health and independence in later life.

%B J Am Geriatr Soc %I 50 %V 50 %P 691-9 %8 2002 Apr %G eng %N 4 %L pubs_2002_ostbye_jags.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11982670?dopt=Abstract %4 Middle Aged Adults/Smoking/Mobility Difficulty/Exercise %$ 8610 %R 10.1046/j.1532-5415.2002.50164.x %0 Book Section %B The Economic Analysis of Substance Use and Abuse: The Experience of Developed Countries and Lessons for Developing Countries %D 2001 %T Are Smokers Too Optimistic? %A Frank A Sloan %A Donald H. Taylor Jr. %E Michael Grossman %E Chee-Ruey Hsieh %K Consumption and Savings %K Health Conditions and Status %B The Economic Analysis of Substance Use and Abuse: The Experience of Developed Countries and Lessons for Developing Countries %I Edward Elgar Publishing Limited %C Cheltenham, UK %P 103-33 %G eng %U https://www.e-elgar.com/shop/usd/the-economic-analysis-of-substance-use-and-abuse-9781840646252.html %4 Smoking/Costs and Cost Analysis %$ 13862 %0 Journal Article %J Int Psychogeriatr %D 2001 %T Caregiver report of hallucinations and paranoid delusions in elders aged 70 or older. %A Carolyn L. Turvey %A Schultz, Susan K. %A Arndt, Stephan %A Ellingrod, Vicki %A Robert B Wallace %A A. Regula Herzog %K Aged %K Aged, 80 and over %K Aging %K Caregivers %K Cognition Disorders %K Cohort Studies %K Delusions %K depression %K Female %K Follow-Up Studies %K Hallucinations %K Humans %K Male %K Marital Status %K Paranoid Disorders %K Risk Factors %K Stroke %K Surveys and Questionnaires %K United States %K Vision Disorders %X

This study examined the demographic, medical, and psychiatric correlates of hallucinations and paranoid delusions reported by proxy informants for 822 elders aged 70 or older. This sample comprised people who were deemed unable to complete a direct interview in a large nationwide study of aging. Marital status, trouble with vision, and cognitive impairment were associated with report of both paranoid delusions and hallucinations. Depressive symptoms and stroke were associated with hallucinations only. These results suggest that inadequate external stimulation in the elderly leads to psychotic experiences.

%B Int Psychogeriatr %I 13 %V 13 %P 241-9 %8 2001 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/11495398?dopt=Abstract %4 Caregivers/Dementia/Elderly %$ 16250 %R 10.1017/s1041610201007621 %0 Book Section %B Aging Issues in the United States and Japan %D 2001 %T Choice, Chance, and Wealth Dispersion at Retirement %A Steven F Venti %A David A Wise %E Seiritsu Ogura %E Toshiaki Tachibanaki %E David A Wise %K Net Worth and Assets %K Retirement Planning and Satisfaction %B Aging Issues in the United States and Japan %I University of Chicago Press %C Chicago %P 25-64 %G eng %4 Retirement Planning/Retirement Behavior/Wealth %$ 8676 %R 10.3386/w7521 %0 Journal Article %J The Journals of Gerontology: Social Sciences %D 2001 %T Depressive Symptomatology in Middle-aged and Older Married Couples: A dyadic analysis %A Aloen L. Townsend %A Baila Miller %A Guo, S. %K Adult children %K Demographics %K Health Conditions and Status %K Methodology %X OBJECTIVES: Depressive symptomatology has been frequently conceptualized as an individual matter, but social contextual models argue that symptom levels are likely to covary in close relationships. The present study investigated correlation between spouses' depressive symptomatology in middle-aged and older married couples, the influence of gender and race/ethnicity in predicting variability in symptom level, and the importance of individual-level covariates (education, health, and age) and couple-level covariates (household income and net worth). METHODS: Results were based on secondary analysis of Wave 1 interviews with White, Black, and Mexican American married couples (N = 5,423) from the Health and Retirement Study (HRS) and the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD). Dyadic data from husbands and wives were analyzed with multilevel modeling. RESULTS: Husbands' and wives' depressive symptoms were moderately correlated, gender and race/ethnicity (and their interaction) predicted depressive symptoms, and both individual-level and couple-level characteristics were significant covariates. Similarities as well as differences are noted between the HRS and AHEAD results. DISCUSSION: Results highlight the importance of dyadic data and multilevel models for understanding depressive symptomatology in married couples. The influence of race/ethnicity merits greater attention in future research. Differences in findings between HRS and AHEAD suggest life-course, cohort, or methodological influences. %B The Journals of Gerontology: Social Sciences %I 56B %V 56B %P S352-64 %G eng %N 6 %L pubs_2001_Townsend_AJGSeriesB.pdf %4 Aged, 80 and Over/Cross Cultural Comparison/Depression/Ethnicity/Gender/Gender Identity/Marriage/Middle Age/Personality Assessment/Spouses/Support, U.S. Government--PHS %$ 4325 %R 10.1093/geronb/56.6.S352 %0 Journal Article %J The Review of Economics and Statistics %D 2001 %T Do Smokers Respond to Health Shocks? %A V. Kerry Smith %A Donald H. Taylor Jr. %A Frank A Sloan %A Desvousges, William H. %A F. Reed Johnson %K Health Conditions and Status %X This paper reports the first effort to use data to evaluate how new information, acquired through exogenous health shocks, affects people's longevity expectations. We find that smokers react differently to health shocks than do those who quit smoking or never smoked. These differences, together with insights from qualitative research conducted along with the statistical analysis, suggest specific changes in the health warnings used to reduce smoking. Our specific focus is on how current smokers responded to health information in comparison to former smokers and nonsmokers. The three groups use significantly different updating rules to revise their assessments about longevity. The most significant finding of our study documents that smokers differ from persons who do not smoke in how information influences their personal longevity expectations. When smokers experience smoking-related health shocks, they interpret this information as reducing their chances of living to age 75 or more. Our estimated models imply smokers update their longevity expectations more dramatically than either former smokers or those who never smoked. Smokers are thus assigning a larger risk equivalent to these shocks. They do not react comparably to general health shocks, implying that specific information about smoking-related health events is most likely to cause them to update beliefs. It remains to be evaluated whether messages can be designed that focus on the link between smoking and health outcomes in ways that will have comparable effects on smokers' risk perceptions. %B The Review of Economics and Statistics %I 83 %V 83 %P 675-687 %G eng %N 4 %L pubs_2001_Smith_KRevEconStatStud.pdf %4 Smoking/Health Shocks/Longevity %$ 10192 %R 10.1162/003465301753237759 %0 Report %D 2001 %T The Impact of the Shift to Defined Contribution Plans on Bequests and Living Standards in Retirement %A Alicia H. Munnell %A Soto, Mauricio %A Sundén, Annika %A Taylor, Catherine %K Adult children %K Consumption and Savings %K Pensions %I Boston College %G eng %4 Bequests/Pensions/Living Standards %$ 6618 %0 Journal Article %J The American Economic Review %D 2001 %T Longevity Expectations and Death: Can People Predict Their Own Demise? %A V. Kerry Smith %A Frank A Sloan %A Donald H. Taylor Jr. %K Expectations %K Health Conditions and Status %B The American Economic Review %I 91 %V 91 %P 1126-1134 %G eng %U https://www.jstor.org/stable/2677832 %N 4 %4 Expectations of Future Events/Mortality/Morbidity %$ 8640 %0 Journal Article %J Journal of Aging and Health %D 2000 %T A Health and Demographic Profile of Noninstitutionalized Older Americans Residing in Environments with Home Modifications. %A Tabbarah, M. %A Merril Silverstein %A Teresa Seeman %K Demographics %K Disabilities %K Health Conditions and Status %K Healthcare %K Housing %K Methodology %X OBJECTIVES. In this analysis the authors investigate the demographic characteristics, the health conditions/events, and the disabilities of community-dwelling Americans 70 years of age and older that are associated with residing in environments with specific home modifications. METHODS. Data from a large population-based study of the elderly are used to estimate logistic regression equations that reveal profiles of older individuals who are likely to have distinct home modifications. RESULTS. Having diseases such as diabetes and stroke, having experienced a hip fracture, a fall or a joint replacement, and having greater limitations with activities of daily living raise the likelihood of having home modifications. Low income, Hispanic, and African American elderly appear underrepresented among those with modifications. DISCUSSION. The authors conclude that specialized housing alternatives will be an increasingly important issue in the future as individuals aim to achieve and maintain the delicate balance between their functional ability and their living environment. %B Journal of Aging and Health %I 12 %V 12 %P 204-28 %G eng %N 2 %4 Home Modifications/Health Status/Disability/Disability/Architectural Accessibility/Disabled Persons/Ethnicity/Interior Design and Furnishings/Self Help Devices/Socioeconomic Factors/Support, U.S. Government--PHS %$ 4315 %0 Journal Article %J J Am Geriatr Soc %D 2000 %T Memory complaint in a community sample aged 70 and older. %A Carolyn L. Turvey %A Schultz, Susan K. %A Arndt, Stephan %A Robert B Wallace %A A. Regula Herzog %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cognition %K Depressive Disorder %K Educational Status %K Female %K Geriatric Assessment %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Memory %K Self-Assessment %X

OBJECTIVES: The ability of older people to estimate their own memory, often referred to as "metamemory," has been evaluated in previous studies with conflicting reports regarding accuracy. Some studies have suggested that an older person's metamemory is mostly accurate, whereas others have demonstrated little relationship between memory complaint and actual impairment. This study examines memory complaint in a large national sample of older people aged > or = 70.

DESIGN: A longitudinal cohort study with two waves of data collection spaced 2 years apart.

SETTING: A nationwide random sample of community-dwelling older persons.

PARTICIPANTS: A total of 5,444 community-dwelling persons aged > or = 70 and their spouses.

MEASUREMENTS: Participants were asked if they believed their memory was excellent, very good, good, fair, or poor. They were then administered a cognitive assessment derived from the Mini-Mental Status Exam.

RESULTS: In general, people's assessment of their memory corresponded with their actual performance on cognitive measures. However, large portions of the sample inaccurately assessed their memory skills. People who reported depressive symptoms and had impairment in activities of daily living were more likely to state that their memory was impaired, although they performed very well on cognitive measures.

CONCLUSIONS: The conditions that skew people's self-assessment are the ones most likely to bring them into contact with healthcare professionals. This may give clinicians the general impression that older people cannot assess their own cognitive skills. However, poor metamemory appears to be a characteristic of a specific subgroup of older persons, not necessarily characteristic of the general population.

%B J Am Geriatr Soc %I 48 %V 48 %P 1435-41 %8 2000 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/11083320?dopt=Abstract %4 Aged, 80 and Over/Cognition/Depressive Disorder/Educational Status/Gender/Geriatric Assessment/Longitudinal Studies/Marital Status/Memory/Self Assessment (Psychology)/Support, U.S. Government--PHS %$ 4335 %R 10.1111/j.1532-5415.2000.tb02634.x %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2000 %T Pathways to retirement: patterns of labor force participation and labor market exit among the pre-retirement population by race, Hispanic origin, and sex. %A Chenoa Flippen %A Tienda, Marta %K Aged %K Black or African American %K Cross-Cultural Comparison %K Employment %K Female %K Hispanic or Latino %K Humans %K Logistic Models %K Male %K Middle Aged %K Personnel Downsizing %K Regression Analysis %K Retirement %K Sex Factors %K Socioeconomic factors %K United States %K White People %X

OBJECTIVES: This study examines the pre-retirement labor force participation behavior of Black, White, and Hispanic men and women to determine how patterns of labor market exit differ among groups.

METHODS: We combine data from the first and second waves of the Health and Retirement Study and apply multinomial logit regression techniques to model labor force status in the first wave of the HRS and change over time.

RESULTS: Black, Hispanic, and female elderly persons experience more involuntary job separation in the years immediately prior to retirement, and the resulting periods of joblessness often eventuate in "retirement" or labor force withdrawal. Minority disadvantage in human capital, health, and employment characteristics accounts for a large part of racial and ethnic differences in labor force withdrawal. Nevertheless, Black men and Hispanic women experience more involuntary labor market exits than Whites with similar socioeconomic and demographic characteristics.

DISCUSSION: Workers most vulnerable to labor market difficulties during their youth confront formidable obstacles maintaining their desired level of labor force attachment as they approach their golden years. This has significant policy implications for the contours of gender and race/ethnic inequality among elderly persons, particularly as life expectancy and the size of the minority elderly population continue to increase.

%B J Gerontol B Psychol Sci Soc Sci %I 55B %V 55 %P S14-27 %8 2000 Jan %G eng %N 1 %L pubs_2000_Flippen_CJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10728126?dopt=Abstract %4 Labor Force Participation/Health Status/Economic Status/Retirement Planning/Basic Demographics %$ 8376 %R 10.1093/geronb/55.1.s14 %0 Journal Article %J Arthritis Care Res %D 2000 %T The prevalence and impact of accommodations on the employment of persons 51-61 years of age with musculoskeletal conditions. %A Yelin, Edward %A Sonneborn, Dean %A Laura S. Trupin %K Disabled Persons %K Employment, Supported %K Female %K Health Status %K Health Surveys %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Morbidity %K Musculoskeletal Diseases %K Personnel Turnover %K Program Evaluation %K Surveys and Questionnaires %K United States %K Workload %K Workplace %X

OBJECTIVE: To provide estimates of the frequency with which persons 51 to 61 years of age with musculoskeletal conditions receive workplace accommodations from their employers and to determine if the receipt of such accommodations is associated with higher rates of employment two years later.

METHODS: The estimates derive from the Health and Retirement Survey, a national probability sample of 8,781 respondents who were interviewed both in 1992 and 1994 and who were between the ages of 51 and 61 years, of whom 5,495 reported one or more musculoskeletal conditions. We tabulated the frequency of accommodations provided in 1992 and then estimated the impact of accommodations and demographic and medical characteristics on 1994 employment status, using logistic regression.

RESULTS: In 1992, about 14.40 million persons aged 51-61 years reported a musculoskeletal condition. Of these, 1.32 million (9.2%) reported a disability and were employed, the target population for accommodations. Overall, fewer than 1 in 5 persons with musculoskeletal conditions who had a disability and were employed indicated that they had received any form of accommodation on their current jobs. Although no form of accommodation was reported with great frequency, the most commonly used ones included getting someone to help do one's job (12.1%), scheduling more breaks during the work day (9.5%), changing the time that the work day started and stopped (6.3%), having a shorter work day (5.6%), getting special equipment (5.3%), and changing the work tasks (5.3%). Persons with one or more accommodations in 1992, however, were no more likely to be working in 1994 than those with none. Only one specific accommodation--getting someone to help do one's job--was associated with a higher rate of employment in 1994.

CONCLUSIONS: Receipt of employment accommodations occurred infrequently, and was not generally associated with an improvement in the employment rate of persons with musculoskeletal conditions and disabilities.

%B Arthritis Care Res %I 13 %V 13 %P 168-76 %8 2000 Jun %G eng %N 3 %L pubs_2000_Yelin_EArthRes.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/14635290?dopt=Abstract %4 Employer Accommodation/Musculoskeletal Diseases/Labor Force Attachment %$ 8622 %R 10.1002/1529-0131(200006)13:3<168::aid-anr6>3.0.co;2-r %0 Journal Article %J Am J Psychiatry %D 1999 %T Conjugal loss and syndromal depression in a sample of elders aged 70 years or older. %A Carolyn L. Turvey %A Carney, C. %A Arndt, Stephan %A Robert B Wallace %A A. Regula Herzog %K Age Factors %K Aged %K Aged, 80 and over %K Bereavement %K Cohort Studies %K depression %K Depressive Disorder %K Female %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Marital Status %K Odds Ratio %K Psychiatric Status Rating Scales %K Risk Factors %K Sex Factors %K Widowhood %X

OBJECTIVE: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.

METHOD: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.

RESULTS: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.

CONCLUSIONS: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse's death predicted bereavement-related depression.

%B Am J Psychiatry %I 156 %V 156 %P 1596-601 %8 1999 Oct %G eng %N 10 %L pubs_1999_Turvey_CAJPsy.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10518172?dopt=Abstract %4 Age Factors/Aged, 80 and Over/Bereavement/Cohort Studies/Depression/Depressive Disorders/Logistic Models/Longitudinal Studies/Marital Status/Odds Ratio/Psychiatric Status Rating Scales/Risk Factors/Sex Factors/Support, U.S. Government--PHS/Widowhood %$ 4330 %R 10.1176/ajp.156.10.1596 %0 Journal Article %J The Journals of Gerontology: Social Sciences %D 1999 %T Formation of Trusts and Spend Down to Medicaid %A Donald H. Taylor Jr. %A Frank A Sloan %A Edward C Norton %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Methodology %K Net Worth and Assets %X OBJECTIVE: To identify the proportion of community-dwelling elderly persons (70 ) who could affect their eligibility for Medicaid financing of a nursing home stay through the use of a trust and to quantify the prevalence and predictors of trusts. METHODS: State-specific Medicaid eligibility regulations were used to determine eligibility and to identify those who could affect the same through the use of trusts. Multivariate logistic regression was used to identify correlates of having a trust. Wave 1 of the Assets and Health Dynamics of the Oldest Old (AHEAD) data base was used. RESULTS: Four in 10 elderly community dwellers could potentially qualify for Medicaid by using a trust; however, less than 10 had a trust. On average, wealthier persons had trusts. Avoidance of probate and controlling assets after death appear to be stronger motivations for trust creation among the elderly than achieving Medicaid spend down. DISCUSSION: The use of trusts was not common, and motives other than spend down were more important for those with trusts. Our results suggest little need for policy efforts to limit the use of trusts to achieve spend down. %B The Journals of Gerontology: Social Sciences %I 54B %V 54B %P S194-201. %G eng %U https://watermark.silverchair.com/54B-4-S194.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAArkwggK1BgkqhkiG9w0BBwagggKmMIICogIBADCCApsGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMp0UUg1PuPyPtW2TQAgEQgIICbKvSCKf7gEQSGvy-WxqpuojGLR3OKgcObNMZ3E6gB4hR %N 4 %L pubs_1999_Taylor_FJGSeriesB.pdf %4 Aged, 80 and Over/Assets/Eligibility Determination/Financing, Personal/Homes for the Aged/Intergenerational Transfers/Medicaid/Nursing Homes/Support, U.S. Government--PHS/United States %$ 4320 %0 Book Section %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %D 1999 %T Health, Work, and Economic Well-Being of Older Workers, Aged 51-61: A Cross-National Comparison Using the United States HRS and the Netherlands CERRA Data Sets %A R.V. Burkhauser %A Debra S. Dwyer %A Maarten Lindeboom %A Theeuwes, Jules %A Wottiez, Isolde %E James P Smith %E Robert J. Willis %K Employment and Labor Force %K Health Conditions and Status %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %I University of Michigan Press %C Ann Arbor, MI %P 233-66 %G eng %4 Older Workers/Employment/Health Status %$ 8202 %! Health, Work, and Economic Well-Being of Older Workers, Aged 51-61: A Cross-National Comparison Using the United States HRS and the Netherlands CERRA Data Sets %0 Report %D 1999 %T Racial and Ethnic Differences in Wealth Among the Elderly %A Chenoa Flippen %A Tienda, Marta %K Demographics %K Net Worth and Assets %I University of Chicago Population Research Center %G eng %4 Wealth/Racial Differences/Ethnic Groups %$ 6557 %0 Journal Article %J Int Psychogeriatr %D 1999 %T A revised CES-D measure of depressive symptoms and a DSM-based measure of major depressive episodes in the elderly. %A Carolyn L. Turvey %A Robert B Wallace %A A. Regula Herzog %K Aged %K Antidepressive Agents %K depression %K Depressive Disorder, Major %K Diagnosis, Differential %K Female %K Humans %K Male %K Prospective Studies %K Psychiatric Status Rating Scales %K Psychometrics %K Severity of Illness Index %K Surveys and Questionnaires %X

This study examines the psychometric properties of two new abbreviated versions of standard measures of depression, a revised eight-item Center for Epidemiological Studies-Depression Scale (CES-D) and a short-form Composite International Diagnostic Interview (short-form CIDI). A sample of 6,133 elders, age 70 years or older, completed both measures as part of the Asset and Health Dynamics Study of the Oldest Old. The revised CES-D had an internal consistency and factor structure comparable to that of prior versions of the CES-D. The sources of discordance between the two measures were examined and the two measures were compared on self-report of four clinical variables: medical illness, physician diagnosis, psychiatric treatment, and antidepressant or tranquilizer use. Both measures were associated with self-report of physician diagnosis and psychiatric treatment. Respondents positive for depression on the CES-D reported higher rates of antidepressant use. Respondents positive on the short-form CIDI only did not report more antidepressant use than nondepressed respondents.

%B Int Psychogeriatr %I 11 %V 11 %P 139-48 %8 1999 Jun %G eng %U https://pubmed.ncbi.nlm.nih.gov/11475428/ %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/11475428?dopt=Abstract %4 Antidepressive Agents/Therapeutic Use/Depression/Depression, Involutional/Gender/Prospective Studies/Psychiatric Status Rating Scales/Psychometrics/Severity of Illness Index/Support, Non U.S. Government/Support, U.S. Government--PHS %$ 4340 %R 10.1017/s1041610299005694 %0 Journal Article %J Arthritis Rheum %D 1999 %T Transitions in employment, morbidity, and disability among persons ages 51-61 with musculoskeletal and non-musculoskeletal conditions in the US, 1992-1994. %A Yelin, Edward %A Laura S. Trupin %A Sebesta, D.S. %K Chronic disease %K Disability Evaluation %K Disabled Persons %K Employment %K Female %K Humans %K Incidence %K Male %K Middle Aged %K Morbidity %K Musculoskeletal Diseases %K Prevalence %K Retirement %K United States %X

OBJECTIVE: To provide estimates of the prevalence of musculoskeletal conditions in a sample of persons ages 51-61 living in the community in the US in 1992, to indicate the incidence of such conditions between 1992 and 1994, and to describe the proportion of individuals with these conditions who developed or recovered from disability and who left and entered employment during this time.

METHODS: The estimates were derived from the Health and Retirement Survey, consisting of data on a national probability sample of 8,739 persons, ages 51-61, who were interviewed in the community in 1992 and reinterviewed in 1994.

RESULTS: In 1992, 62.4% of persons (14.4 million) between the ages of 51 and 61 years reported at least 1 musculoskeletal condition; the rate increased to 70.5% by 1994. More than 40% of persons with musculoskeletal conditions reported disability, which was almost 90% of all persons with disability in this age group. Persons with musculoskeletal conditions had lower employment rates, were less likely to enter employment, and were more likely to leave employment compared with persons without these conditions. High rates of disability account for much of these differences.

CONCLUSION: Musculoskeletal conditions affected more than two-thirds of persons ages 51-61 and accounted for all but 10% of those with disabilities. The prevention of disability among such persons should improve their employment prospects.

%B Arthritis Rheum %I 42 %V 42 %P 769-79 %8 1999 Apr %G eng %N 4 %L pubs_1999_Yelin_EArth.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10211893?dopt=Abstract %4 Chronic Disease/Disability Evaluation/Disabled Persons/Employment/Retirement/Musculoskeletal Diseases %$ 8644 %R 10.1002/1529-0131(199904)42:4<769::AID-ANR22>3.0.CO;2-M %0 Report %D 1998 %T Family Structure and Economic Well-Being of Black, Hispanic, and White Pre-Retirement Adults %A Chenoa Flippen %A Tienda, Marta %K Adult children %K Net Worth and Assets %K Women and Minorities %X This paper examines how family structure is related to racial and ethnic inequality among older populations. We show that intergenerational living serves the economic needs of minority and unmarried female elders more than non-minority and married elders. The greater economic motivation for co-residence among minority and female elders was suggested both by their higher reliance on the income of co-resident kin and by their subjective evaluations of who benefited most from co-residence. However, when the contributions of co-resident kin are weighed against the additional costs they bring to the household, the inequality-reducing effect of extension falls considerably. The contributions per co-resident kin are smaller in minority households, and thus the economic well-being of elders living in extended households is often no better, and occasionally worse, than had they lived alone. Only unmarried women receive a substantial net boost from co-residence, primarily because adult offspring who co-reside with unmarried women contribute more than their counterparts in unmarried male or couple households. %B Office of Population Research working paper %I Princeton University %C Princeton %G eng %U https://ideas.repec.org/p/pri/opopre/opr9802.pdf.html %4 Family Structure/Economic Status/Black Americans/Hispanic Americans %$ 6652 %0 Journal Article %J New England Journal of Medicine %D 1997 %T Alcohol Consumption and Mortality among Middle-Aged and Elderly U.S. Adults %A Michael J Thun %A Peto, Richard %A Lopez, Alan D. %A Monaco, Jane H. %A Henley, S. Jane %A Heath, Clark W. %A Doll, Richard %K Alcohol Consumption %K Health Conditions and Status %K Mortality %K Older Adults %K Smoking %X BACKGROUND Alcohol consumption has both adverse and beneficial effects on survival. We examined the balance of these in a large prospective study of mortality among U.S. adults. METHODS Of 490,000 men and women (mean age, 56 years; range, 30 to 104) who reported their alcohol and tobacco use in 1982, 46,000 died during nine years of follow-up. We compared cause-specific death rates and rates of death from all causes across categories of base-line alcohol consumption, adjusting for other risk factors, and related drinking and smoking habits to the cumulative probability of dying between the ages of 35 and 69 years. RESULTS Causes of death associated with drinking were cirrhosis and alcoholism; cancers of the mouth, esophagus, pharynx, larynx, and liver combined; breast cancer in women; and injuries and other external causes in men. The mortality from breast cancer was 30 percent higher among women reporting at least one drink daily than among nondrinkers (relative risk, 1.3; 95 percent confidence interval, 1.1 to 1.6). The rates of death from all cardiovascular diseases were 30 to 40 percent lower among men (relative risk, 0.7; 95 percent confidence interval, 0.7 to 0.8) and women (relative risk, 0.6; 95 percent confidence interval, 0.6 to 0.7) reporting at least one drink daily than among nondrinkers, with little relation to the level of consumption. The overall death rates were lowest among men and women reporting about one drink daily. Mortality from all causes increased with heavier drinking, particularly among adults under age 60 with lower risk of cardiovascular disease. Alcohol consumption was associated with a small reduction in the overall risk of death in middle age (ages 35 to 69), whereas smoking approximately doubled this risk. CONCLUSIONS In this middle-aged and elderly population, moderate alcohol consumption slightly reduced overall mortality. The benefit depended in part on age and background cardiovascular risk and was far smaller than the large increase in risk produced by tobacco. %B New England Journal of Medicine %V 337 %P 1705 - 1714 %8 Nov-12-1997 %G eng %N 24 %! N Engl J Med %R 10.1056/NEJM199712113372401 %0 Report %D 1996 %T Labor Force Behavior of Hispanic Elderly: Insights from the HRS %A Chenoa Flippen %A Tienda, Marta %K Employment and Labor Force %K Women and Minorities %X This paper seeks to augment the relatively scarce information available about the labor market and economic characteristics of Hispanic elderly. Specifically, we examine the factors associated with the late-aged labor force participation decisions of elderly Hispanic men and women, and how they are related to aggregate economic well-being. Our results indicate a high degree of labor force instability and involuntary joblessness among older Hispanics. For many Hispanic elders, retirement is not the voluntary termination of a career job, but instead results from prolonged or frequent periods of joblessness that eventuate in retirement. This process of labor force withdrawal was markedly different for men and women, and was influenced by age, education, job characteristics (e.g., firm size and industrial sector), and employment experience (e.g., experience of being laid off and pension coverage). Low rates of pension coverage and low savings for retirement among the Hispanic elderly imply a high degree of economic vulnerability, especially for the unmarried elderly and for those who do not receive assistance from other family members. %G eng %L wp_1996/Flippen_96-032.pdf %4 Labor Force/Hispanic %$ 6509 %0 Journal Article %J Infect Immun %D 1990 %T Identification of a pathogenic isolate-specific 30,000-Mr antigen of Entamoeba histolytica by using a monoclonal antibody. %A Tachibana, H %A Satoru Kobayashi %A Kato, Y %A Nagakura, K %A Kaneda, Y %A Takeuchi, T %K Animals %K Antibodies, Monoclonal %K Antigens, Protozoan %K Entamoeba histolytica %K Female %K Fluorescent Antibody Technique %K Mice %K Mice, Inbred BALB C %K Molecular Weight %X

A monoclonal antibody (MAb) produced against trophozoites of Entamoeba histolytica strain HM-1:IMSS, reacted with all of 42 isolates and 4 clones showing pathogenic zymodeme (Z) patterns, i.e., Z-II, Z-II alpha-, Z-II (glucose phosphate isomerase: gamma +), Z-VII, Z-VII (glucose phosphate isomerase: alpha lack, gamma +), Z-XI, Z-XIV, and Z-XIX, regardless of culture conditions, geographical origins, or host symptoms in an indirect fluorescence antibody test. In contrast, the MAb failed to react with 14 isolates possessing nonpathogenic zymodemes Z-I and Z-VIII and did not react with other enteric protozoan parasites, such as E. histolytica-like Laredo, Entamoeba hartmanni, Entamoeba coli, Endolimax nana, Dientamoeba fragilis, Trichomonas hominis, and Giardia lamblia. Western immunoblotting analysis showed that the molecular weight of the antigenic component recognized by the MAb was exclusively 30,000 in pathogenic isolates of different zymodemes. These results suggest that the 30,000-molecular-weight antigen is a marker of pathogenic isolates and that the indirect fluorescent-antibody test with the MAb is useful for the accurate discrimination of pathogenic amebae.

%B Infect Immun %I 23 %V 58 %P 955-60 %8 1990 Apr %G eng %U https://iai.asm.org/content/58/4/955.long %N 4 %L newpubs20101112_Schane.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/2180826?dopt=Abstract %2 PMC258567 %4 depression/Chronic Disease/Screening/health care outcomes %$ 23660 %R 10.1128/iai.58.4.955-960.1990 %0 Journal Article %J Social Science & Medicine (1983) %D 0 %T State-level desegregation in the U.S. South and mid-life cognitive function among Black and White adults. %A Walsemann, Katrina M %A Hair, Nicole L %A Farina, Mateo P %A Tyagi, Pallavi %A Jackson, Heide %A Jennifer A Ailshire %K Education %K historical data %K life course %K school segregation %X

RATIONALE: Black adults experience worse cognitive function than their White peers. Although educational attainment is an important predictor of cognitive function, other aspects of education, including school desegregation, may also shape this relationship. For Black adults who grew up in the U.S. South in the 1950s-1970s, exposure to school desegregation may have altered life course pathways critical for later cognitive function.

OBJECTIVE: We determined if state variation in exposure to school desegregation in the U.S. South was associated with cognitive function at mid-life, if the association varied by race, and if the association remained after adjustment for state-level education quality and respondents' educational attainment.

METHODS: We linked historical data on state-level school desegregation to the Health and Retirement Study, a nationally representative sample of U.S. adults aged 50 and older. We restricted our sample to Black (n = 1443) and White (n = 1507) adults born between 1948 and 1963 who resided in the U.S. South during primary school. We assessed three cognition outcomes: total cognitive function, episodic memory, and mental status. We estimated race-stratified linear regression models with cluster adjustment and a final model using state fixed effects.

RESULTS: Greater exposure to desegregated primary schooling was associated with higher cognitive function and episodic memory among Black but not White adults. Among Black adults, the association between school desegregation and cognitive function and episodic memory remained after adjustment for state-level education quality and educational attainment.

CONCLUSIONS: Our findings suggest that state-level school desegregation efforts played a consequential role in shaping the cognitive function of Black adults who grew up in the U.S. South.

%B Social Science & Medicine (1983) %V 338 %P 116319 %G eng %R 10.1016/j.socscimed.2023.116319