%0 Journal Article %J Alzheimer's & Dementia: The Journal of the Alzheimer's Association %D Forthcoming %T Alzheimer's disease genetic burden is associated with mid-life depression among persons with normal cognition. %A Wingo, Thomas S %A Gerasimov, Ekaterina S %A Canon, Se Min %A Lah, James J %A Levey, Allan I %A Wingo, Aliza P %K Alzheimer's disease %K mid-life depression %K Polygenic risk score %X

INTRODUCTION: Despite an established link between depression and higher Alzheimer's disease (AD) risk, it is unclear whether the conditions share pathophysiology. Here, we investigated whether depression manifesting after age 50 is associated with a genetic predisposition to AD.

METHODS: From the population-based Health and Retirement Study cohort with biennial assessments of depressive symptoms and cognitive performance, we studied 6656 individuals of European ancestry with whole-genome genotyping. Polygenic risk scores (PRSs) for AD were estimated and examined for an association with depression in cognitively normal participants using regression modeling.

RESULTS: Among cognitively normal participants, those with a higher AD PRS were more likely to experience depression after age 50 after accounting for the effects of genetic predisposition to depression, sex, age, and education.

DISCUSSION: Genetic predisposition to AD may be one of the factors contributing to the pathogenesis of mid-life depression. Whether there is a shared genetic basis between mid-life depression and AD merits further study.

%B Alzheimer's & Dementia: The Journal of the Alzheimer's Association %G eng %R 10.1002/alz.12716 %0 Journal Article %J Archives of Gerontology and Geriatrics %D Forthcoming %T Associations between self-perceptions of aging and social functioning in older adults: An analysis based on health and retirement study data. %A Cai, Yingying %A Ren, Xiaohe %A Wang, Jingyi %A Hou, Yue %A Zhang, Mengyuan %A Chen, Ou %K Attitudes toward own aging %K healthy aging %K Human Activities %X

OBJECTIVES: Self-perception of aging (SPA) and social functioning are two important variables in the process of healthy aging, but the relationship between them is still unclear. This study aimed to explore the association between SPA and social functioning in older adults.

METHODS: We conducted a longitudinal study utilizing data from the Health and Retirement Study. The sample comprised individuals aged 50 and above. Socio-demographic, psychosocial, and lifestyle information of study participants was systematically collected at baseline (2012 and 2014) and during follow-up four years later (2016 and 2018). SPA was measured using a scale assessing individuals' attitudes toward their aging process. Social functioning was evaluated through 22 questions, reflecting individuals' abilities to engage in and perform various roles and tasks in their daily lives. Multilevel modeling was employed to analyze the relationship between SPA and social functioning. Differences in social functioning changes among various SPA groups were assessed through the Generalized Estimating Equations methodology.

RESULTS: The study included 8,454 participants with an average age of 68.3 years (SD = 9.92). The multilevel model revealed a significant correlation between SPA and social functioning (β = 0.131; P < 0.001). This relationship persisted after adjusting the model (β = 0.088; P < 0.001). Generalized Estimating Equations indicated noteworthy differences in social functioning changes among distinct SPA groups (P = 0.034).

DISCUSSION: Positive SPA is associated with the healthy social functioning of older adults. Healthcare providers could target modifiable aspects of SPA to enhance the social function of older adults and promote successful aging.

%B Archives of Gerontology and Geriatrics %V 119 %P 105307 %G eng %R 10.1016/j.archger.2023.105307 %0 Journal Article %J 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 American Journal of Hospice and Palliative Medicine %D Forthcoming %T Comparing Variations in Advance Directives Timing among Older Adults with End-Stage Renal Disease versus Cancer. %A Wang, Yu-Hsuan %A Enguidanos, Susan %K advance directive %K Cancer %K End of life care %K renal disease %X

Having an advance directive (AD) is associated with better care at end of life and better quality of death. However, AD completion rates among End-Stage Renal Disease patients are lower than among cancer patients. ESRD patients commonly experience cognitive impairment, reducing their ability to make their own care choices as their disease progresses. Thus, having an AD earlier in the disease trajectory is important. Little is known about differences in AD completion timing among ESRD and cancer patients. Therefore, the purpose of this study was to (1) investigate difference in AD completion and timing between ESRD and cancer patients; and, (2) identify factors associated with the early and late AD completion. A retrospective cohort study was conducted. Data was drawn from the Health and Retirement Study, a United States representative longitudinal survey of older adults, using exit interviews conducted from 2006 to 2016 among 1886 proxy reporters of deceased participants with ESRD or cancer. ESRD patients had lower rates of AD completion compared to those with cancer. Higher education and being older were negatively associated with late AD completion in the last 3 months of life. Additionally, decedents with a diagnosis of ESRD, older age, and with higher education had higher odds of completing ADs one year or more before death. While ESRD patient were less likely to have ADs, those that had ADS were more likely than cancer patients to develop ADs earlier in the disease trajectory. Further studies are needed to determine effective strategies to increase the AD completion rate among patients with ESRD.

%B American Journal of Hospice and Palliative Medicine %G eng %R 10.1177/10499091221097676 %0 Journal Article %J JAMA Neurology %D Forthcoming %T Declines in Wealth Among US Older Adults at Risk of Dementia. %A Li, Jing %A Skinner, Jonathan S %A Kathleen McGarry %A Nicholas, Lauren Hersch %A Wang, Shao-Pang %A Bollens-Lund, Evan %A Kelley, Amy S %K Dementia %K medical cost %K Wealth %X Dementia is a set of neurocognitive conditions marked by a gradual deterioration of cognitive capacity that interferes with daily life, with Alzheimer disease being the most common.1 This process may adversely affect household wealth, a key social determinant of health, due to negative outcomes of financial decision capacity2 and need for expensive medical and long-term care services.3,4 We compared trajectories in household wealth for older adults (aged ≥65 years) who developed probable dementia with those of a control cohort without dementia. %B JAMA Neurology %G eng %R 10.1001/jamaneurol.2023.3216 %0 Journal Article %J Scandinavian Journal of Work, Environment & Health %D Forthcoming %T Effect of retirement on self-rated oral health and dental services use: longitudinal fixed-effects instrumental variable study in 31 countries. %A Baumeister, Sebastian-Edgar %A Wesselmann, Hanna %A Nascimento, Gustavo G %A Listl, Stefan %K dental services %K health systems %K Oral Health %K Retirement %X

OBJECTIVE: This study examined the effect of retirement on self-rated oral health and dental services use.

METHODS: Covering 31 countries, we used harmonized panel data from the English Longitudinal Study on Aging (ELSA), Health and Retirement Study (HRS), and the Survey of Health, Aging and Retirement in Europe (SHARE). Data comprised 485 085 observations from 112 240 individuals aged ≥50 years. Official and early retirement ages were leveraged as instruments in a fixed-effects instrumental variable approach.

RESULTS: We found that retirement exhibited a negative effect on self-rated oral health (β = -0.37; 95% confidence interval (CI) -0.44- -0.30) and a positive effect on the propensity to seek dental care (β = 0.56; 95% CI 0.53-0.60). Male retirees showed a stronger decrease in self-rated oral health and increase in dental services use than female retirees. Participants who previously worked in a physically demanding job showed a stronger effect on self-rated oral health. Conversely, participants without a physically demanding job in the past exhibited a stronger retirement effect on dental service use. Compared with other health system clusters, retirement effects on dental services use were stronger in three health system clusters: Belgium, Denmark, Finland, France, Ireland, Luxembourg, The Netherlands, and Sweden; Israel; and the United States.

CONCLUSIONS: Using a quasi-experimental design, we found that transition to retirement lowers self-rated oral health and increases the use of dental services. Retirement effects appeared heterogeneous across sexes, type of previous labor, and health systems.

%B Scandinavian Journal of Work, Environment & Health %G eng %R 10.5271/sjweh.4134 %0 Journal Article %J Neuropsychology %D Forthcoming %T Factor structure of the Harmonized Cognitive Assessment Protocol neuropsychological battery in the Health and Retirement Study %A Richard N Jones %A Jennifer J Manly %A Kenneth M. Langa %A Lindsay H Ryan %A Deborah A Levine %A Ryan J McCammon %A David R Weir %K Cognitive Ability %K Confirmatory Factor Analysis %K HCAP %K Older Adults %X Objectives: The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS).Method: The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically-driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data. Results: For the eight domains of cognitive functioning identified theoretically (orientation, memory [immediate, delayed, & recognition], set shifting, attention/speed, language/fluency, andvisuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where good fit is axiomatic. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94). Discussion: The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used as anchors for calibrating cross-national studies of cognitive performance, and to identify persons performing atthe low end as part of an algorithmic classification of probable dementia %B Neuropsychology %G eng %R 10.31234/osf.io/rvmhj %0 Journal Article %J Archives of Gerontology and Geriatrics %D Forthcoming %T Gender-specific association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms. %A Hu, Mengxiao %A Yu, Haiyang %A Zhang, Yike %A Xiang, Bowen %A Wang, Qing %K Depressive symptoms %K Disability in activities of daily living %K Longitudinal mediating effect %K The accumulation of chronic conditions %X

BACKGROUND: In the era of rapid aging with a rising prevalence of multimorbidity, complex interactions between physical and psychological conditions have challenged the health care system. However, little is known about the association of the accumulation of chronic conditions and disability in activities of daily living with depressive symptoms, especially in developed countries.

METHODS: This population-based cohort study used data from the Health and Retirement Study. A total of 22,335 middle-aged and older adults participated in the 2014 (T1), 2016 (T2), and 2018 (T3) waves of the cohort were included. The accumulation of chronic conditions and disability were defined as the number of chronic diseases and the five activities of daily living. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale. A longitudinal mediation model with a cross-lagged panel model was run. As robust check, the models were applied with a longer follow-up period (from 2012 to 2018). Additionally, results were estimated in China.

RESULTS: Bidirectional associations have been found among the accumulation of chronic conditions, disability, and depressive symptoms, especially between disability and depression. Disability (T2) mediated 11.11 % and 16.87 % of the association between the accumulation of chronic conditions (T1) and depression (T3) for men and women in the United States. The results were consistent in robust analysis.

CONCLUSIONS: This study found that men and women routinely experienced disability and depressive symptoms because of the accumulation of chronic conditions. In terms of depressive symptoms, women were more sensitive to the accumulation of chronic conditions through disability.

%B Archives of Gerontology and Geriatrics %V 118 %P 105287 %G eng %R 10.1016/j.archger.2023.105287 %0 Journal Article %J medRxiv %D Forthcoming %T Harmonization of Later-Life Cognitive Function Across National Contexts: Results from the Harmonized Cognitive Assessment Protocols (HCAPs). %A Gross, Alden L %A LI, CHIHUA %A Briceño, Emily M %A Rentería, Miguel Arce %A Richard N Jones %A Kenneth M. Langa %A Jennifer J Manly %A Nichols, Emma L %A David R Weir %A Wong, Rebeca %A Berkman, Lisa %A Lee, Jinkook %A Lindsay C Kobayashi %K Cognition %K Education %K harmonization %K HCAP %X

BACKGROUND: The Harmonized Cognitive Assessment Protocol (HCAP) is an innovative instrument for cross-national comparisons of later-life cognitive function, yet its suitability across diverse populations is unknown. We aimed to harmonize general and domain-specific cognitive scores from HCAPs across six countries, and evaluate precision and criterion validity of the resulting harmonized scores.

METHODS: We statistically harmonized general and domain-specific cognitive function across the six publicly available HCAP partner studies in the United States, England, India, Mexico, China, and South Africa (N=21,141). We used an item banking approach that leveraged common cognitive test items across studies and tests that were unique to studies, as identified by a multidisciplinary expert panel. We generated harmonized factor scores for general and domain- specific cognitive function using serially estimated graded-response item response theory (IRT) models. We evaluated precision of the factor scores using test information plots and criterion validity using age, gender, and educational attainment.

FINDINGS: IRT models of cognitive function in each country fit well. We compared measurement reliability of the harmonized general cognitive function factor across each cohort using test information plots; marginal reliability was high (r> 0·90) for 93% of respondents across six countries. In each country, general cognitive function scores were lower with older ages and higher with greater levels of educational attainment.

INTERPRETATION: We statistically harmonized cognitive function measures across six large, population-based studies of cognitive aging in the US, England, India, Mexico, China, and South Africa. Precision of the estimated scores was excellent. This work provides a foundation for international networks of researchers to make stronger inferences and direct comparisons of cross-national associations of risk factors for cognitive outcomes.

FUNDING: National Institute on Aging (R01 AG070953, R01 AG030153, R01 AG051125, U01 AG058499; U24 AG065182; R01AG051158).

%B medRxiv %G eng %R 10.1101/2023.06.09.23291217 %0 Journal Article %J bioRxiv %D Forthcoming %T Heterogeneity in polygenic scores for common human traits %A Erin B Ware %A Lauren L Schmitz %A Jessica Faul %A Arianna M Gard %A Colter Mitchell %A Wei Zhao %A David R Weir %A Sharon L R Kardia %K Genetics %K Heterogeneity %K PGS %X This study investigates the creation of polygenic scores (PGS)s for human population research. PGSs are a linear, usually weighted, combination of risk alleles that estimate the cumulative genetic risk of an individual for a particular trait. While conceptually simple, there are numerous ways to estimate PGSs, not all achieving the same end goals. In this paper, we systematically investigate the impact of four key decisions in the building of PGSs from published genome-wide association meta-analysis results: 1) whether to use single nucleotide polymorphisms (SNPs) assessed by imputation, 2) criteria for selecting which SNPs to include in the score, 3) whether to account for linkage disequilibrium (LD), and 4) if accounting for LD, which type of method best captures the correlation structure among SNPs (i.e. clumping vs. pruning). Using the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal panel study of Americans over the age of 50, we examine the predictive ability as well as the variability and co-variability in PGSs arising from these different estimation approaches. We examine four traits with large published and replicated genome-wide association studies (height, body mass index, educational attainment, and depression). Our central finding demonstrates PGSs that include all available SNPs either explain the most amount of variation in an outcome or are not significantly different than the PGSs that does. Thus, for reproducibility through rigor and transparency, we recommend that researchers include a PGS with all available SNPs as a reference, and provide substantial justification for using alternative methods. %B bioRxiv %G eng %R 10.1101/106062 %0 Journal Article %J Research Square %D Forthcoming %T The Hidden Role of Racial Wealth Disparities in Older Adults’ Vulnerability to COVID-19 %A Ruth Winecoff %A Padmaja Ayyagari %A Melissa McInerney %A Kosali I. Simon %A M Kate Bundorf %K COVID-19 %K Racial wealth disparities %X Background: To examine racial and ethnic differences in wealth and other economic, exposure and baseline health-related risks of COVID-19 among older adults in the U.S. Methods: Using rich data on wealth and long-term care use among older Americans unique to the 2016 Health and Retirement Study, we quantify differences in COVID-19 vulnerability among non-Hispanic white, non-Hispanic Black and Hispanic respondents aged 50+. We measure wealth, other economic (insurance, income); exposure (long-term care, employment, telework, household size); and health (chronic conditions, smoking) risk stratified by age (50-64, 65+). Results: Blacks and Hispanics face dramatically greater financial risk that potentially increases exposure to COVID-19, relative to whites; Blacks and Hispanics are four to five times more likely to have no financial wealth. Blacks are also more likely than whites to use long-term care. Blacks and Hispanics also are less likely to have health insurance and face greater risk of exposure to COVID-19 because they are less likely to telework, and Hispanic older adults reside in larger households. Black and Hispanic older adults are also more likely to have a chronic condition associated with worse COVID-19 outcomes. Conclusions: Our results suggest that wealth differences may play a substantial role in contributing to the very large racial and ethnic disparities in the health burden of COVID-19. Racial disparities in long-term care, where COVID-19 risks are higher, contribute to make older Black Americans even more vulnerable to COVID-19. %B Research Square %@ 2693-5015 %G eng %R 10.21203/rs.3.rs-271452/v1 %0 Journal Article %J JOURNAL OF MARRIAGE AND FAMILY %D Forthcoming %T Keeping us young? Grandchild caregiving and older adults' cognitive functioning %A Caputo, Jennifer %A Cagney, Kathleen A. %A Waite, Linda %K Caregiving %K Dementia %K grandchildren %K health %K intergenerational relationships %K Longitudinal research %X Objective; This study investigates longitudinal associations between providing care to grandchildren and cognitive functioning. It also examines heterogeneity in these relationships. Background: Grandchild caregiving may support older adults' cognitive functioning by providing social engagement and emotional meaning. However, studies caution that time-intensive or custodial grandchild caregiving can take a toll on grandparents. The cognitive health implications of grandchild caregiving may thus depend on contexts including time spent providing care and living arrangements. They may also vary across sociodemographic groups and have greater effects on older adults who are more vulnerable to cognitive decline. Method: Data came from the 1998-2016 waves of the Health and Retirement Study (HRS) and represented over 11,000 US adults aged 50+. Using linear growth curve and dynamic panel models, the analysis explored relationships between level of grandchild care and cognitive functioning over time and across sociodemographic, family, work, and health characteristics. Results: Those providing 100-199, 200-499, or 500+ h of care to grandchildren had better cognitive functioning than non-caregivers regardless of whether they lived with grandchildren. Positive links between grandchild caregiving and cognition were stronger for lower income, non-working, and unpartnered adults and grew with age and functional limitations. Conclusion: These findings suggest that providing care to minor grandchildren may help support cognitive functioning as adults age. They also support the hypothesis that more vulnerable or isolated groups of older adults may benefit the most from grandchild caregiving. %B JOURNAL OF MARRIAGE AND FAMILY %G eng %R 10.1111/jomf.12945 %0 Journal Article %J 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 Journal of the American Geriatrics Society %D Forthcoming %T Money may matter: Financial hardship and its association with satisfaction of care among people living with dementia. %A Miller, Katherine E M %A White, Lindsay %A Coe, Norma B %A Khandelwal, Nita %K Dementia %K Finances %K Life Satisfaction %X Financial hardship is a multidimensional construct that includes, but is not limited to, out-of-pocket costs. Financial hardship has mostly been studied in patients with cancer and is independently associated with decreased treatment adherence,1 worse quality of life,2 worse psychological and physical symptoms,2, 3 and mortality4 — outcomes of great importance to people living with dementia (PLWD) as well. However, there are limited data specifically examining the prevalence or the impact of financial hardship among PLWD. Our objectives are to estimate the prevalence of financial hardship among PLWD and describe measures of satisfaction with life and with health care among PLWD, compared to a cancer cohort. %B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.18723 %0 Journal Article %J Molecular Psychiatry %D Forthcoming %T A naturally occurring variant of SHLP2 is a protective factor in Parkinson's disease. %A Kim, Su-Jeong %A Miller, Brendan %A Hartel, Nicolas G %A Ramirez, Ricardo %A Braniff, Regina Gonzalez %A Leelaprachakul, Naphada %A Huang, Amy %A Wang, Yuzhu %A Arpawong, Thalida Em %A Crimmins, Eileen M %A Wang, Penglong %A Sun, Xianbang %A Liu, Chunyu %A Levy, Daniel %A Yen, Kelvin %A Petzinger, Giselle M %A Graham, Nicholas A %A Jakowec, Michael W %A Cohen, Pinchas %K DNA %K Parkinson Disease %X

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

%B Molecular Psychiatry %G eng %R 10.1038/s41380-023-02344-0 %0 Journal Article %J 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 JDR Clinical & Translational Research %D Forthcoming %T Prediction Model Development and Validation of 12-Year Incident Edentulism of Older Adults in the United States. %A Preisser, J S %A Moss, K %A Finlayson, T L %A Jones, J A %A Weintraub, J A %K Epidemiology %K Geriatrics %K Incidence %K Oral Health %K Tooth Loss %X

INTRODUCTION: Edentulism affects health and quality of life.

OBJECTIVES: Identify factors that predict older adults becoming edentulous over 12 y in the US Health and Retirement Study (HRS) by developing and validating a prediction model.

METHODS: The HRS includes data on a representative sample of US adults aged >50 y. Selection criteria included participants in 2006 and 2018 who answered, "Have you lost all of your upper and lower natural permanent teeth?" Persons who answered "no" in 2006 and "yes" in 2018 experienced incident edentulism. Excluding 2006 edentulous, the data set ( = 4,288) was split into selection (70%, = 3,002) and test data (30%, = 1,286), and Monte Carlo cross-validation was applied to 500 random partitions of the selection data into training ( = 1,716) and validation ( = 1,286) data sets. Fitted logistic models from the training data sets were applied to the validation data sets to obtain area under the curve (AUC) for 32 candidate models. Six variables were included in all models (age, race/ethnicity, gender, education, smoking, last dental visit) while all combinations of 5 variables (income, alcohol use, self-rated health, loneliness, cognitive status) were considered for inclusion. The best parsimonious model based on highest mean AUC was fitted to the selection data set to obtain a final prediction equation. It was applied to the test data to estimate AUC and 95% confidence interval using 1,000 bootstrap samples.

RESULTS: From 2006 to 2018, 9.7% of older adults became edentulous. The 2006 mean (SD) age was 66.7 (8.7) for newly edentulous and 66.3 (8.4) for dentate ( = 0.31). The baseline 6-variable model mean AUC was 0.740. The 7-variable model with cognition had AUC = 0.749 and test data AUC = 0.748 (95% confidence interval, 0.715-0.781), modestly improving prediction. Negligible improvement was gained from adding more variables.

CONCLUSION: Cognition information improved the 12-y prediction of becoming edentulous beyond the modifiable risk factors of smoking and dental care use, as well as nonmodifiable demographic factors.

KNOWLEDGE TRANSFER STATEMENT: This prediction modeling and validation study identifies cognition as well as modifiable (dental care use, smoking) and nonmodifiable factors (race, ethnicity, gender, age, education) associated with incident complete tooth loss in the United States. This information is useful for the public, dental care providers, and health policy makers in improving approaches to preventive care, oral and general health, and quality of life for older adults.

%B JDR Clinical & Translational Research %G eng %R 10.1177/23800844221112062 %0 Journal Article %J Diabetes research and clinical practice %D Forthcoming %T Prevalence and incidence of mild cognitive impairment in adults with diabetes in the United States. %A Zheng, Yaguang %A Ma, Qianheng %A Qi, Xiang %A Zhu, Zheng %A Wu, Bei %K Clinical %K cognition impairment %K Complications of diabetes %K Epidemiology %K prevalence estimation %K type 2 diabetes mellitus %X

BACKGROUND: Limited evidence exists about the prevalence and incidence of mild cognitive impairment (MCI) in individuals with diabetes in the U.S. We aimed to address such knowledge gaps using a nationally representative study dataset.

METHOD: We conducted a secondary analysis from the Health and Retirement Study (HRS) (1996-2018). The sample for examining the prevalence of MCI was14,988, with 4192 (28.0%) having diabetes, while the sample for the incidence was 21,824, with 1534 (28.0%) having diabetes.

RESULTS: Participants with diabetes had a higher prevalence of MCI than those without diabetes (19.9 % vs. 14.8 %; odds ratio [95 % confidence interval] (OR[95 %CI]): 1.468 [1.337, 1.611], p <.001). The incidence of MCI in participants with/without newly diagnosed diabetes was 42.9 % vs. 31.6 % after a mean 10-year follow-up, with the incidence rate ratio (IRR) [95 %CI] (1.314 [1.213, 1.424], p <.001). Newly diagnosed diabetes was associated with elevated risks of MCI compared with non-diabetes, with the uncontrolled hazard ratio (HR) [95 %CI] (1.498 [1.405, 1.597], p <.001).

CONCLUSIONS: Using a nationally representative study data in the U.S., participants with diabetes had a higher prevalence and incidence of MCI than those without diabetes. Findings show the importance of developing interventions tailored to the needs of individuals with diabetes and cognitive impairment.

%B Diabetes research and clinical practice %V 205 %P 110976 %G eng %R 10.1016/j.diabres.2023.110976 %0 Journal Article %J Alzheimer's & Dementia %D Forthcoming %T Public spending on acute and long-term care for Alzheimer's disease and related dementias. %A Norma B Coe %A White, Lindsay %A Oney, Melissa %A Basu, Anirban %A Larson, Eric B %K longitudinal costs %K Medicaid %K Medicare %K Spending %X

INTRODUCTION: We estimate the spending attributable to Alzheimer's disease and related dementias (ADRD) to the United States government for the first 5 years post-diagnosis.

METHODS: Using data from the Health and Retirement Study matched to Medicare and Medicaid claims, we identify a retrospective cohort of adults with a claims-based ADRD diagnosis along with matched controls.

RESULTS: The costs attributable to ADRD are $15,632 for traditional Medicare and $8833 for Medicaid per dementia case over the first 5 years after diagnosis. Seventy percent of Medicare costs occur in the first 2 years; Medicaid costs are concentrated among the longer-lived beneficiaries who are more likely to need long-term care and become Medicaid eligible.

DISCUSSION: Because the distribution of the incremental costs varies over time and between insurance programs, when interventions occur and the effect on the disease course will have implications for how much and which program reaps the benefits.

%B Alzheimer's & Dementia %G eng %R 10.1002/alz.12657 %0 Journal Article %J Journal of the American Geriatrics Society %D Forthcoming %T Racial inequality in functional trajectories between Black and White U.S. veterans. %A Jacobs, Josephine C %A Bowling, Christopher Barrett %A Brown, Tyson %A Smith, Valerie A %A Decosimo, Kasey %A Wilson, Sarah M %A Hastings, Susan Nicole %A Shepherd-Banigan, Megan %A Allen, Kelli %A Van Houtven, Courtney %K Functional limitations %K psychosocial stressors %K racial inequity %K Veterans %X

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

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

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

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

%B Journal of the American Geriatrics Society %G eng %R 10.1111/jgs.18169 %0 Journal Article %J Journal of Aging and Health %D Forthcoming %T Rural-Urban Health Care Cost Differences Among Latinx Adults With and Without Dementia in the United States. %A Gutiérrez, Ángela %A Lopez-Anuarbe, Monika %A Webster, Noah J %A Mahmoudi, Elham %K Dementia %K Health Services %K Hispanic health %K rural aging %X

OBJECTIVES: To compare rural-urban health care costs among Latinx adults ages 51+ and examine variations by dementia status.

METHODS: Data are from the Health and Retirement Study (2006-2018 waves; = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics.

RESULTS: Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas ( < .001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas ( < .001). Dementia status was not an effect modifier.

DISCUSSION: Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority.

%B Journal of Aging and Health %P 8982643231207517 %G eng %R 10.1177/08982643231207517 %0 Journal Article %J Alzheimer's & Dementia %D Forthcoming %T Using Medicare claims in identifying Alzheimer's disease and related dementias. %A Jain, Siddharth %A Rosenbaum, Paul R %A Reiter, Joseph G %A Geoffrey J Hoffman %A Small, Dylan S %A Ha, Jinkyung %A Hill, Alexander S %A Wolk, David A %A Timothy G. Gaulton %A Mark D Neuman %A Roderic G Eckenhoff %A Fleisher, Lee A %A Jeffrey H Silber %K administrative data %K Alzheimer's disease %K cognitive impairment %K Dementia %K Medicare %X

INTRODUCTION: This study develops a measure of Alzheimer's disease and related dementias (ADRD) using Medicare claims.

METHODS: Validation resembles the approach of the American Psychological Association, including (1) content validity, (2) construct validity, and (3) predictive validity.

RESULTS: We found that four items-a Medicare claim recording ADRD 1 year ago, 2 years ago, 3 years ago, and a total stay of 6 months in a nursing home-exhibit a pattern of association consistent with a single underlying ADRD construct, and presence of any two of these four items predict a direct measure of cognitive function and also future claims for ADRD.

DISCUSSION: Our four items are internally consistent with the measurement of a single quantity. The presence of any two items do a better job than a single claim when predicting both a direct measure of cognitive function and future ADRD claims.

%B Alzheimer's & Dementia %G eng %R 10.1002/alz.12199 %0 Journal Article %J The Journals of Gerontology. Series A %D Forthcoming %T Validation of Self-Reported Cancer Diagnoses by Respondent Cognitive Status in the U.S. Health and Retirement Study. %A Mullins, Megan A %A Kabeto, Mohammed %A Wallner, Lauren P %A Lindsay C Kobayashi %K Cognition %K Dementia %K self-reported diagnoses %K sensitivity %K specificity %K Validation %X

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

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

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

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

%B The Journals of Gerontology. Series A %G eng %R 10.1093/gerona/glac248 %0 Journal Article %J Journal of Aging and Health %D Forthcoming %T The Worst of Times: Depressive Symptoms Among Racialized Groups Living With Dementia and Cognitive Impairment During the COVID-19 Pandemic. %A Brown, Monique J %A Adkins-Jackson, Paris B %A Sayed, Linda %A Wang, Fei %A Leggett, Amanda %A Ryan, Lindsay H %K Cognition %K COVID %K Dementia %K depression %K Older Adults %X

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

%B Journal of Aging and Health %P 8982643231223555 %G eng %R 10.1177/08982643231223555 %0 Journal Article %J 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 American Journal of Human Biology %D 2024 %T Dried blood spot based biomarkers in the Health and Retirement Study: 2006 to 2016. %A Jung K Kim %A Faul, Jessica %A Weir, David R %A Crimmins, Eileen M %K Biomarkers %K C-reactive protein %K Cystatin C %K Dried Blood Spot Testing %K Retirement %X

INTRODUCTION: The Health and Retirement Study (HRS) has collected biomarker data over multiple waves. Such data can help improve our understanding of health changes in individuals and the causal pathways related to health. There are, however, technical challenges to using the HRS dried blood spots (DBS) biomarker data due to changes over time in assay protocols, platforms, and laboratories. We provide technical and summary information on biological indicators collected as part of the HRS from 2006 to 2016 that should be helpful to users of the data.

METHODS: We describe the opportunities and challenges provided by the HRS DBS data as well as insights provided by the data. The HRS collected DBS from its nationally representative sample of respondents 51 years of age or older from 2006 to 2016. DBS-based biomarkers were collected from half the sample in 2006, 2010, and 2014, and from the other half of the sample in 2008, 2012, and 2016. These DBS specimens were used to assay total and HDL cholesterol, glycosylated hemoglobin, C-reactive protein, and cystatin C from 2006 to 2016, and Interleukin 6 was added in 2014/2016. Samples included approximately 6000 individuals at each wave, and completion rates ranged from 81% to 90%. HRS transformed DBS values into venous blood equivalents to make them more comparable to those of the whole blood-based assays collected in most other studies and to facilitate longitudinal analysis.

RESULTS: Distribution of changes over time by age shows that total cholesterol levels decreased for each age, while HbA1c levels increased. Cystatin C shows a clear age gradient, but a number of other markers do not. Non-Hispanic Black persons and Hispanic respondents have a higher incidence of risk levels of each biomarker except for CRP among non-Hispanic Black older persons.

CONCLUSION: These public-use DBS data provide analysis opportunities that can be used to improve our understanding of health change with age in both populations and among individuals.

%B American Journal of Human Biology %V 36 %P e23997 %G eng %N 2 %R 10.1002/ajhb.23997 %0 Journal Article %J The Journal of Nutrition %D 2024 %T Food Insecurity, Race and Ethnicity, and Cognitive Function Among United States Older Adults. %A Wang, Haowei %A El-Abbadi, Naglaa %K Aged %K Cognition %K Cognitive Dysfunction %K ethnicity %K Food insecurity %K Food Supply %K Humans %K Middle Aged %K Minority Groups %K Racial Groups %K United States %X

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

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

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

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

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

%B The Journal of Nutrition %V 154 %P 233-242 %G eng %N 1 %R 10.1016/j.tjnut.2023.11.015 %0 Journal Article %J Social Science & Medicine (1982) %D 2024 %T The impact of informal caregiving on U.S. Veterans Health Administration utilization and expenditures. %A Jacobs, Josephine C %A Lo, Jeanie %A Van Houtven, Courtney H %A Wagner, Todd H %K Adult %K Adult children %K Health Expenditures %K Humans %K Inpatients %K Investments %K Veterans Health %X

Few studies have examined the effect of informal care receipt on health care utilization and expenditures while accounting for the potentially endogenous relationship between informal and formal care, and none have examined these relationships for U.S. Veterans. With rapidly increasing investments in caregiver supports over the past decade, including stipends for caregivers, the U.S. Department of Veterans Affairs (VA) needs to better understand the costs and benefits of informal care provision. Using a unique data linkage between the 1998-2010 Health and Retirement Study and VA administrative data (n = 2083 Veterans with 9511 person-wave observations), we applied instrumental variable techniques to understand the effect of care from an adult child on Veterans' two-year VA utilization and expenditures. We found that informal care decreased overall utilization by 53 percentage points (p < 0.001) and expenditures by $19,977 (p < 0.01). These reductions can be explained by informal care decreasing the probability of inpatient utilization by 17 percentage points (p < 0.001), outpatient utilization by 57 percentage points (p < 0.001), and institutional long-term care by 3 percentage points (p < 0.05). There were no changes in the probability of non-institutional long-term care use, though these expenditures decreased by $882 (p < 0.05). Expenditure decreases were greatest amongst medically complex patients. Our results indicate relative alignment between VA's stipend payments, which are based on replacement cost methods, and the monetary benefits derived through VA cost avoidances due to informal care. For health systems considering similar caregiver stipend payments, our findings suggest that the cost of these programs may be offset by informal care substituting for formal care, particularly for higher need patients.

%B Social Science & Medicine (1982) %V 344 %P 116625 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/38324974?dopt=Abstract %R 10.1016/j.socscimed.2024.116625 %0 Journal Article %J Physiological Reports %D 2024 %T The long and the short of it: Salivary telomere length as a candidate biomarker for hypertension and age-related changes in blood pressure. %A Speer, Hollie %A McKune, Andrew J %A Woodward, Andrew P %K Aged %K Bayes Theorem %K Biomarkers %K Blood pressure %K Female %K Humans %K Hypertension %K Telomere %K Telomere Shortening %X

Hypertension becomes more prevalent with increasing age. Telomere length (TL) has been proposed as a candidate biomarker and can be accessibly extracted from saliva. However, clarity is needed to evaluate the suitability of using TL as a predictor in such instances. This study investigated salivary TL in a cohort of older adults from the 2008 Health and Retirement Study (n = 3329; F: 58%, mean age: 69.4, SD: 10.3 years) to examine any associations with blood pressure (BP). A Bayesian robust regression model was fit using weakly informative priors to predict the effects of TL with age, sex, systolic BP (SBP), diastolic BP (DBP), and treatment status. There were small effects of treatment (β: -0.07, 95% CrI [-0.33, 0.19], pd: 71.91%) and sex (β: -0.10, 95% CrI [-0.27, 0.07], pd: >86.78%). Population effects showed a reduction of 0.01 log units in TL with each year of advancing age (95% CrI [-0.01, -0.00]). Conditional posterior predictions suggest that females, and treated individuals, experience greater change in TL with increasing age. Bayes R was ~2%. TL declines with increasing age, differs between sexes, and appears to be influenced by antihypertensive drugs. Overall, all effects were weak. The data do not currently support the suitability of salivary TL as a biomarker to predict or understand any age-related changes in BP.

%B Physiological Reports %V 12 %P e15910 %G eng %N 1 %R 10.14814/phy2.15910 %0 Journal Article %J Social Science & Medicine %D 2024 %T A national longitudinal dyadic analysis of spousal education and cognitive decline in the United States. %A Liu, Hui %A Chopik, William J %A Shrout, M Rosie %A Wang, Juwen %K Cognitive decline %K dyadic relationships %K Education %K spouse %X

Education plays a significant role in shaping cognitive functioning throughout an individual's life. However, existing research has not adequately explored how the educational attainment of the spouse can impact cognitive functioning over time. This study presents one of the first longitudinal analyses of how spousal education is linked to cognitive trajectories of each member within couples during their later life in the United States. Guided by the linked lives perspective, we analyze data from 8370 couples in the Health and Retirement Study spanning from 2000 to 2018. Results from the Actor-Partner Interdependence Model (APIM) integrated with latent growth curve models reveal that cognitive trajectories exhibit a correlation between spouses over time. Moreover, our analysis uncovers gender-specific effects of spousal education on cognition, shedding light on the underlying mechanisms driving this connection. Notably, the lower educational attainment of husbands is associated with a faster cognitive decline in both themselves and their wives. This association is partially explained by economic resources, but not by health and social behaviors. The lower educational attainment of wives is linked to their own faster cognitive decline as well as lower initial cognitive levels of their husbands, in part via economic resources. However, wives' educational attainment is largely unrelated to their husbands' cognitive decline. Intriguingly, wives' education has a more pronounced impact on the health and social behaviors of their husbands than vice versa, although these health and social behaviors do not appear to influence husbands' cognitive decline. In conclusion, these results underscore the importance of considering spousal education in comprehending the complexities of cognitive decline within dyadic relationships.

%B Social Science & Medicine %V 343 %P 116603 %G eng %R 10.1016/j.socscimed.2024.116603 %0 Journal Article %J Journal of Personality %D 2024 %T Rural-urban differences in personality traits and well-being in adulthood. %A Atherton, Olivia E %A Willroth, Emily C %A Graham, Eileen K %A Luo, Jing %A Mroczek, Daniel K %A Lewis-Thames, Marquita W %K Big Five %K Life Satisfaction %K MIDUS %K psychological well-being %K rurality %X

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

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

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

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

%B Journal of Personality %V 92 %P 73-87 %G eng %N 1 %R 10.1111/jopy.12818 %0 Journal Article %J 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 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 %J Alzheimers Dement %D 2023 %T Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations. %A Llibre-Guerra, Jorge J %A Li, Jing %A Qian, Yuting %A Llibre-Rodriguez, Juan de Jesús %A Jiménez-Velázquez, Ivonne Z %A Acosta, Daisy %A Salas, Aquiles %A Llibre-Guerra, Juan Carlos %A Valvuerdi, Adolfo %A Harrati, Amal %A Weiss, Jordan %A Liu, Mao-Mei %A Dow, William H %K Aged %K Alleles %K Alzheimer disease %K Apolipoprotein E4 %K Apolipoproteins E %K Caribbean Region %K Female %K Genotype %K Hispanic or Latino %K Humans %K Male %X

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

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

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

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

%B Alzheimers Dement %V 19 %P 602-610 %G eng %N 2 %R 10.1002/alz.12699 %0 Journal Article %J Journal of Personality and Social Psychology %D 2023 %T Are some people more consistent? Examining the stability and underlying processes of personality profile consistency. %A Wright, Amanda J %A Jackson, Joshua J %K Big Five %K ipsative consistency %K person-centered %K Personality Development %K profile correlations %X

Personality traits are relatively consistent across time, as indicated by test-retest correlations. However, ipsative consistency approaches suggest there are individual differences in this consistency. Despite this, it is unknown whether these differences are due to person-level characteristics (i.e., some people are just more consistent) or exogenous forces (i.e., lack of consistency is due to environmental changes). Moreover, it is unclear whether the processes promoting long-term consistency are the same across people. We examine these two questions using item-level profile correlations across four to nine waves of data with four data sets ( = 21,616) with multilevel asymptotic growth models. Results indicated that there were, on average, high levels of profile consistency. However, there were notable individual differences in initial profile correlation values as well as in changes in levels of consistency across time, indicating that some people are more consistent than others. Moreover, the directions of people's trajectories across increasing time intervals suggest that the mechanisms responsible for reinforcing personality consistency vary across people. These effects were typically moderated by age at 30 years old, maturity-related traits, and education level. Overall, findings indicate some people are more consistent than others, such that this stable level of (in)consistency is a dispositional factor. Additionally, individual differences in profile consistency are shaped by different levels of three processes. On average, stochastic factors are not impactful for most individuals, and transactional processes have an important role in increasing consistency for a sizable amount of people-nuances not previously revealed when focusing on rank-order stability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

%B Journal of Personality and Social Psychology %V 124 %P 1314-1337 %G eng %N 6 %R 10.1037/pspp0000429 %0 Thesis %B Sociology %D 2023 %T Arthritis Diagnosis, Self-Rated Health, and the Period Pattern in Arthritis Prevalence %A Siqi Wang %K Arthritis %K health %K period pattern %K Self-rated health %X Arthritis is one of the most common chronic conditions with a prevalence that increases with age, particularly among adults with comorbid conditions. Diagnosis as a medical process connects patients with medical care, whereas health insurance status may influence how long a person has illness symptoms before they receive a diagnosis. Progressing arthritis can change one's health status significantly. The distribution of healthcare resources also varies by health insurance status, which may impact individuals’ access arthritis care. Cohort and period effects may affect the prevalence of arthritis over time due to changes in wealth, education attainment, health insurance status and increasing BMI. This study investigates the relationship between health insurance status and the time one reports arthritis diagnosis, the relationship between arthritis diagnosis and self-rated health, and cohort and period effects in arthritis prevalence. I address these research questions using data from Midlife in the United States (MIDUS) and Health and Retirement Study (HRS) where I test hypotheses using a variety of statistical models. In the first empirical chapter, I examine the relationship between health insurance status (coverage and type) and the time at which a person self-reports an arthritis diagnosis using data from three waves of MIDUS and panel-data survival analysis. Results indicate that respondents who reported arthritis symptoms who were covered by public health insurance took longer to report arthritis diagnosis than their privately insured counterparts. In the second chapter, I investigate the relationship between arthritis diagnosis and selfrated health (physical and mental) using data from three waves of MIDUS and growth curve models. Results demonstrate that having baseline private health insurance coverage moderates the relationship between arthritis diagnosis and self-rated physical health. Symptomatic individuals with arthritis diagnosis benefitted from baseline private health insurance coverage vii and reported better self-rated physical health than their counterparts who were not covered by private health insurance. In the final empirical chapter, I use fourteen waves of the Health and Retirement Study (HRS, 1992-2018) along with hierarchical age-period-cohort (HAPC) models to study cohort and period effects on the prevalence of self-reported doctor-diagnosed arthritis over time. Factors that predicted significantly higher risk of arthritis, independent of period, include age and high BMI. Wealth explained away cohort effects for pre-War Baby Cohorts and period effects from survey year 2006 to 2018. Overall, under the guidance of fundamental cause theory and sociology of diagnosis theory, my dissertation provides empirical evidence on the role of health insurance status as a form of flexible resource in predicting the timeliness of an arthritis diagnosis, and as a moderator in the arthritis diagnosis—self-rated health relationship. Private health insurance also lowered one’s likelihood of reporting arthritis over time. My findings contribute to systematic examination of the role of health insurance status in the persistent of health inequality in the field of medical sociology. %B Sociology %I University of Buffalo %C Buffalo, New York %V Doctor of Philosophy %8 6/1/2023 %G eng %U https://www.proquest.com/docview/2829371108?pq-origsite=gscholar&fromopenview=true %9 Dissertation %0 Report %D 2023 %T Assessing the First Economic Impact Payment in the Older Population Using the Health and Retirement Study %A Gábor Kézdi %A David R Weir %K economic impact %K older population %X We use data collected by the Health and Retirement Study in its 2020 wave to study awareness and the impact of the Economic Impact Payment stimulus on different groups of older Americans during the coronavirus pandemic. %I University of Michigan %C Ann Arbor, Michigan %G eng %U https://mrdrc.isr.umich.edu/publications/papers/pdf/wp454.pdf %0 Report %D 2023 %T Assessing the First Economic Impact Payment in the Older Population Using the Health and Retirement Study %A Gábor Kézdi %A David R Weir %K economic impact %K Impact payment %B Michigan Retirement and Disability Research Center, Research Brief %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, Michigan %G eng %U https://mrdrc.isr.umich.edu/pubs/assessing-the-first-economic-impact-payment-in-the-older-population-using-the-health-and-retirement-study-2/ %0 Journal Article %J BMC Geriatrics %D 2023 %T Association between BMI trajectories in late-middle age and subsequent dementia risk in older age: a 26-year population-based cohort study. %A Qin, Zijian %A Liu, Zheran %A Li, Ruidan %A Luo, Yaxin %A Wei, Zhigong %A He, Ling %A Pei, Yiyan %A Su, Yonglin %A Hu, Xiaolin %A Peng, Xingchen %K Aged %K Body Mass Index %K Cognition %K Cohort Studies %K Dementia %K Humans %K Risk Factors %X

BACKGROUND: The association between body mass index (BMI) and dementia risk differs depending on follow-up time and age at BMI measurement. The relationship between BMI trajectories in late-middle age (50-65 years old) and the risk of dementia in older age (> 65 years old) has not been revealed.

METHODS: In the present study, participants from the Health and Retirement Study were included. BMI trajectories were constructed by combining BMI trend and variation information. The association between BMI trajectories at the age of 50-65 years and dementia risk after the age of 65 years was investigated. Participants with European ancestry and information on polygenic scores for cognitive performance were pooled to examine whether genetic predisposition could modify the association.

RESULTS: A total of 10,847 participants were included in the main analyses. A declining BMI trend and high variation in late-middle age were associated with the highest subsequent dementia risk in older age compared with an ascending BMI trend and low variation (RR = 1.76, 95% CI = 1.45-2.13). Specifically, in stratified analyses on BMI trajectories and dementia risk based on each individual's mean BMI, the strongest association between a declining BMI trend with high variation and elevated dementia risk was observed in normal BMI group (RR = 2.66, 95% CI = 1.72-4.1). Similar associations were found when participants were stratified by their genetic performance for cognition function without interaction.

CONCLUSIONS: A declining BMI trend and high variation in late-middle age were associated with a higher risk of dementia. Early monitoring of these individuals is needed to prevent dementia in older individuals.

%B BMC Geriatrics %V 23 %P 773 %G eng %N 1 %R 10.1186/s12877-023-04483-z %0 Journal Article %J Intelligence %D 2023 %T The association between intelligence and financial literacy: A conceptual and meta-analytic review %A Zoe Callis %A Paul Gerrans %A Dana L. Walker %A Gilles E. Gignac %K Cognitive Ability %K Comprehension knowledge %K Financial literacy %K Intelligence %K Numeracy %X Financial literacy is positively associated with intelligence, with typically moderate to large effect sizes across studies. The magnitude of the effect, however, has not yet been estimated meta-analytically. Such results suggest financial literacy may be conceptualised as a possible cognitive ability within the Cattel-Horn-Carroll (CHC) model of cognitive abilities. Consequently, we present a psychometric meta-analysis that estimated the true score correlation between cognitive ability and financial literacy. We identified a large, positive correlation with general intelligence (r’ = .62; k = 64, N = 62,194). We also found that financial literacy shared a substantial amount of variance with quantitative knowledge (Gq; via numeracy; r’ = .69; k = 42, N = 35,611), comprehension knowledge (crystallised intelligence; Gc; r’ = .48; k = 14, N = 10,835), and fluid reasoning (fluid intelligence; Gf; r’ = .48; k =20, N = 15,101). Furthermore, meta-analytic structural equation modelling revealed Gq partially mediated the association between cognitive ability (excluding Gq) and financial literacy. Additionally, both Gc and Gq had significant direct effects on financial literacy, whereas the total effect of Gf on financial literacy was fully mediated by a combination of Gc and Gq. While the meta-analyses provide preliminary support for the potential inclusion of financial literacy as primarily a Gc or Gq ability within the CHC taxonomy (rather than Gf), the review revealed that very few studies employed comprehensive cognitive ability measures and/or psychometrically robust financial literacy tests. Consequently, the review highlighted the need for future factor analytic research to evaluate financial literacy as a candidate for inclusion in the CHC taxonomy. %B Intelligence %V 100 %P 101781 %G eng %U https://www.sciencedirect.com/science/article/pii/S0160289623000624 %R https://doi.org/10.1016/j.intell.2023.101781 %0 Journal Article %J JAMA Surgery %D 2023 %T Association Between Loneliness and Postoperative Mortality Among Medicare Beneficiaries. %A Shen, Mary R %A Suwanabol, Pasithorn A %A Howard, Ryan A %A Hu, Hsou Mei %A Levine, Deborah A %A Kenneth M. Langa %A Waljee, Jennifer F %K Loneliness %K Medicare %B JAMA Surgery %V 158 %P 212-214 %G eng %N 2 %R 10.1001/jamasurg.2022.4784 %0 Journal Article %J Arch Gerontol Geriatr %D 2023 %T Association between perceived risk of Alzheimer's disease and related dementias and cognitive function among U.S. older adults. %A Wang, Nan %A Xu, Hanzhang %A West, Jessica S %A Østbye, Truls %A Wu, Bei %A Xian, Ying %A Dupre, Matthew E %K Alzheimer's disease %K cognitive function %K Dementia %K Older Adults %K United States %X

INTRODUCTION: The aim of the study was to assess factors associated with the perceived risk of developing Alzheimer's disease and related dementias (ADRD) and how the perceived risk of ADRD was related to cognitive function.

METHODS: We conducted a retrospective cohort study using 5 waves of data from the Health and Retirement Study (2012-2022) that included adults aged 65 years or older with no previous diagnosis of ADRD at baseline. Cognitive function was measured at baseline and over time using a summary score that included immediate/delayed word recall, serial 7's test, objective naming test, backwards counting, recall of the current date, and naming the president/vice-president (range = 0-35). Perceived risk of developing ADRD was categorized at baseline as "definitely not" (0% probability), "unlikely" (1-49%), "uncertain" (50%), and "more than likely" (>50-100%). Additional baseline measures included participants' sociodemographic background, psychosocial resources, health behaviors, physiological status, and healthcare utilization.

RESULTS: Of 1457 respondents (median age 74 [IQR = 69-80] and 59.8% women), individuals who perceived that they were "more than likely" to develop ADRD had more depressive symptoms and were more likely to be hospitalized in the past two years than individuals who indicated that it was "unlikely" they would develop ADRD. Alternatively, respondnets who perceived that they would "definitely not" develop ADRD were more likely to be non-Hispanic Black, less educated, and have lower income than individuals who indicated it was "unlikely" they would develop ADRD. Respondents who reported their risks of developing ADRD as "more than likely" (β = -2.10, P < 0.001) and "definitely not" (β = -1.50, P < 0.001) had the lowest levels of cognitive function; and the associations were explained in part by their socioeconomic, psychosocial, and health status.

CONCLUSIONS: Perceived risk of developing ADRD is associated with cognitive function. The (dis)concordance between individuals' perceived risk of ADRD and their cognitive function has important implications for increasing public awareness and developing interventions to prevent ADRD.

%B Arch Gerontol Geriatr %V 115 %P 105126 %G eng %R 10.1016/j.archger.2023.105126 %0 Journal Article %J Neurology %D 2023 %T Association Between Supplemental Nutrition Assistance Program Use and Memory Decline: Findings From the Health and Retirement Study. %A Lu, Peiyi %A Kezios, Katrina %A Lee, Jongseong %A Calonico, Sebastian %A Wimer, Christopher %A Al Hazzouri, Adina Zeki %K cognitive aging %K government food benefits %K health policy %K SNAP %X

BACKGROUND AND OBJECTIVES: Studies on the effect of the Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. We sought to examine the associations between SNAP use and memory decline among SNAP-eligible US older adults.

METHODS: Participants aged 50+ and SNAP-eligible in 1996 from the Health and Retirement Study were included. Participants' SNAP eligibility was constructed using federal criteria. Participants also self-reported whether they used SNAP. Memory function was assessed biennially from 1996 through 2016 using a composite score. To account for pre-existing differences in characteristics between SNAP users and non-users, we modeled the probability of SNAP use using demographic and health covariates. Using linear mixed-effect models, we then modeled trajectories of memory function for SNAP users and non-users using inverse probability (IP) weighting and propensity score (PS) matching techniques. In all models, we accounted for study attrition.

RESULTS: Of the 3,555 SNAP-eligible participants, a total of 15.7% were SNAP users. At baseline, SNAP users had lower socioeconomic status and a greater number of chronic conditions than non-users, and were more likely to be lost to follow-up. Our multivariable IP-weighted models (N=3,555) suggested SNAP users had worse memory scores at baseline but slower rates of memory decline compared with non-users (annual decline rate is -0.038 standardized units [95%CI=-0.044, -0.032] for users and -0.046 [95%CI=-0.049, -0.043] for non-users). Results were slightly stronger from the PS-matched sample (N=1,014) (annual decline rate was -0.046 units [95%CI=-0.050; -0.042] for users and -0.060 units [95%CI=-0.064, -0.056] for non-users). Put in other words, our findings suggested that SNAP users had about 2 fewer years of cognitive aging over a 10-year period compared with non-users.

DISCUSSION: After accounting for pre-existing differences between SNAP users and non-users as well as differential attrition, we find SNAP use to be associated with slower memory function decline.

%B Neurology %G eng %R 10.1212/WNL.0000000000201499 %0 Journal Article %J Gerontology & Geriatric Medicine %D 2023 %T Association Between Types of Family Support and Glycemic Control for Adults With Cognitive Impairment. %A Zheng, Yaguang %A Lawrence, Katharine %A Fletcher, Jason %A Qi, Xiang %A Wu, Bei %K cognitive impairment %K Diabetes %K family support %X

BACKGROUND: Family support is important in assisting with diabetes self-management for individuals with cognitive impairment, but what types of family support are most effective remain unknown.

OBJECTIVES: We aimed to examine the association between the types of family support in diabetes self-management with glycemic control in middle-aged and older adults with cognitive impairment.

METHODS: A total of 267 individuals were included with diabetes and cognitive impairment (27-point Telephone Interview for Cognitive Status score <12), using the data of 2003 Health and Retirement Study (HRS) Diabetes Study and 2004 wave of the HRS.

RESULTS: Most respondents were White (68.9%), followed by Black (25.8%). The mean age was 73.4±8.4 years. Adults with strong family support (as indicated by a "strongly agree" response) in testing sugar and in handling feelings about diabetes had significantly lower A1C compared with those with less family support (mean ± standard deviation: 7.08±1.39 vs. 7.51±1.42, =.03; 6.79±0.87 vs. 7.57±1.53; =.007 respectively).

CONCLUSIONS: Our findings indicate that family members of individuals with cognitive impairment provide critical support to patients with diabetes and cognitive impairment, and may need additional intervention to assist with diabetes self-management tasks that require unique knowledge and skills.

%B Gerontology & Geriatric Medicine %V 9 %P 23337214231218800 %G eng %R 10.1177/23337214231218800 %0 Journal Article %J Am J Geriatr Psychiatry %D 2023 %T Association Between Types of Loneliness and Risks of Functional Disability in Older Men and Women: A Prospective Analysis. %A Qi, Xiang %A Belsky, Daniel W %A Yang, Yang Claire %A Wu, Bei %X

OBJECTIVE: To examine the association between types of loneliness (transient, incident, and chronic) and the risk of functional disability.

METHODS: Data were from the Health and Retirement Study 2006/2008-2016/2018. A total of 7,148 adults aged ≥50 was included. Functional status was measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). Loneliness was assessed using the 3-item UCLA Loneliness Scale. We defined loneliness as no/transient/incident/chronic loneliness based on the pattern and duration of loneliness across 2006/2008 and 2010/2012. We applied multivariate Cox proportional hazard models with the new-onset ADL/IADL disability as outcome.

RESULTS: Overall, 69.3% respondents showed no loneliness; while 10.3%, 8.9%, and 11.5% showed transient, incident, and chronic loneliness, respectively. A total of 1,298 (18.16%) and 1,260 (17.63%) functionally normal respondents developed ADL and IADL disability during 36,294 person-years of follow-up, respectively. After adjusting for socio-demographic, behavioral, and health factors, chronic loneliness was associated with higher risks of ADL (hazard ratio [HR] = 1.37, 95% confidence interval [CI] = 1.16-1.63, p <0.001, χ = 3.60, degree of freedom [df] = 1) and IADL disability (HR = 1.25, 95% CI = 1.09-1.44, p = 0.002, χ = 3.17, df = 1) compared to no loneliness. By contrast, no significant associations between transient loneliness and ADL (HR = 1.17, 95% CI = 0.88-1.57, p = 0.273, χ = 1.10, df = 1) or IADL disability (HR = 1.16, 95% CI = 0.97-1.39, p = 0.112, χ = 1.59, df = 1) were found. Chronic loneliness was not associated with the risk of IADL disability in men (HR = 1.13, 95% CI = 0.91-1.40, p = 0.263, χ = 1.12, df = 1).

CONCLUSION: Chronic loneliness, rather than transient loneliness, is an independent risk factor for functional disability in middle-aged and older adults, especially for women.

%B Am J Geriatr Psychiatry %8 2023 Feb 25 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/36935279?dopt=Abstract %R 10.1016/j.jagp.2023.02.046 %0 Journal Article %J PNAS %D 2023 %T Association of cumulative loneliness with all-cause mortality among middle-aged and older adults in the United States, 1996 to 2019. %A Yu, Xuexin %A Cho, Tsai-Chin %A Westrick, Ashly C %A Chen, Chen %A Kenneth M. Langa %A Lindsay C Kobayashi %K cumulative loneliness %K excess death %K Mortality %X

Loneliness is a growing public health concern worldwide. We characterized the association between cumulative loneliness and subsequent all-cause mortality, using data from 9,032 participants aged 50+ in the population-based US Health and Retirement Study (HRS) from 1996 to 2019. Loneliness status (yes; no) was measured biennially from 1996 to 2004, and we categorized the experience of cumulative loneliness over the 8-y period as never, one time point, two time points, and ≥three time points. A multivariable-adjusted age-stratified Cox proportional hazards regression model was fitted to examine the association between cumulative loneliness from 1996 to 2004 and all-cause mortality from 2004 to 2019. Excess deaths due to each category of cumulative loneliness were calculated. Compared to those who never reported loneliness from 1996 to 2004, participants experiencing loneliness at one time point, two time points, and ≥three time points respectively had 1.05 (95% CI: 0.96 to 1.15), 1.06 (95% CI: 0.95 to 1.19), and 1.16 (95% CI: 1.02 to 1.33) times higher hazards of mortality from 2004 to 2019 ( trend = 0.01). These results correspond to 106 (95% CI: 68 to 144), 202 (95% CI: 146 to 259), and 288 (95% CI: 233 to 343) excess deaths per 10,000 person-years, for those experiencing loneliness at each of one, two, or ≥three time points from 1996 to 2004. Cumulative loneliness in mid-to-later life may thus be a mortality risk factor with a notable impact on excess mortality. Loneliness may be an important target for interventions to improve life expectancy in the United States.

%B PNAS %V 120 %P e2306819120 %G eng %N 51 %R 10.1073/pnas.2306819120 %0 Journal Article %J JAMA Internal Medicine %D 2023 %T Association of Functional Status, Cognition, Social Support, and Geriatric Syndrome With Admission From the Emergency Department %A Smulowitz, Peter B. %A Weinreb, Gabe %A McWilliams, J. Michael %A O’Malley, A. James %A Landon, Bruce E. %X The role of patient-level factors that are unrelated to the specific clinical condition leading to an emergency department (ED) visit, such as functional status, cognitive status, social supports, and geriatric syndromes, in admission decisions is not well understood, partly because these data are not available in administrative databases.To determine the extent to which patient-level factors are associated with rates of hospital admission from the ED.This cohort study analyzed survey data collected from participants (or their proxies, such as family members) enrolled in the Health and Retirement Study (HRS) from January 1, 2000, to December 31, 2018. These HRS data were linked to Medicare fee-for-service claims data from January 1, 1999, to December 31, 2018. Information on functional status, cognitive status, social supports, and geriatric syndromes was obtained from the HRS data, whereas ED visits, subsequent hospital admission or ED discharge, and other claims-derived comorbidities and sociodemographic characteristics were obtained from Medicare data. Data were analyzed from September 2021 to April 2023.The primary outcome measure was hospital admission after an ED visit. A baseline logistic regression model was estimated, with a binary indicator of admission as the dependent variable of interest. For each primary variable of interest derived from the HRS data, the model was reestimated, including the HRS variable of interest as an independent variable. For each of these models, the odds ratio (OR) and average marginal effect (AME) of changing the value of the variable of interest were calculated.A total of 42 392 ED visits by 11 783 unique patients were included. At the time of the ED visit, patients had a mean (SD) age of 77.4 (9.6) years, and visits were predominantly for female (25 719 visits [60.7\%]) and White (32 148 visits [75.8\%]) individuals. The overall percentage of patients admitted was 42.5\%. After controlling for ED diagnosis and demographic characteristics, functional status, cognition status, and social supports all were associated with the likelihood of admission. For instance, difficulty performing 5 activities of daily living was associated with an 8.5–percentage point (OR, 1.47; 95\% CI, 1.29-1.66) AME increase in the likelihood of admission. Having dementia was associated with an AME increase in the likelihood of admission of 4.6 percentage points (OR, 1.23; 95\% CI, 1.14-1.33). Living with a spouse was associated with an AME decrease in the likelihood of admission of 3.9 percentage points (OR, 0.84; 95\% CI, 0.79-0.89), and having children living within 10 miles was associated with an AME decrease in the likelihood of admission of 5.0 percentage points (OR, 0.80; 95\% CI, 0.71-0.89). Other common geriatric syndromes, including trouble falling asleep, waking early, trouble with vision, glaucoma or cataract, use of hearing aids or trouble with hearing, falls in past 2 years, incontinence, depression, and polypharmacy, were not meaningfully associated with the likelihood of admission.Results of this cohort study suggest that the key patient-level characteristics, including social supports, cognitive status, and functional status, were associated with the decision to admit older patients to the hospital from the ED. These factors are critical to consider when devising strategies to reduce low-value admissions among older adult patients from the ED. %B JAMA Internal Medicine %G eng %R 10.1001/jamainternmed.2023.2149 %0 Journal Article %J Preventive Medicine Reports %D 2023 %T The association of health behaviors prior to cancer diagnosis and functional aging trajectories after diagnosis: Longitudinal cohort study of middle-aged and older US cancer survivors. %A Westrick, Ashly C %A Kenneth M. Langa %A Lindsay C Kobayashi %K alcohol use %K Cancer survivorship %K Functional aging %K Health behaviors %K Physical activity %K Smoking %X

We aimed to determine the influence of modifiable health behaviors prior to a cancer diagnosis on functional aging trajectories after diagnosis among middle-aged and older cancer survivors in the United States. Data were from biennial interviews with 2,717 survivors of a first incident cancer diagnosis after age 50 in the population-based US Health and Retirement Study from 1998 to 2016. Smoking status, alcohol use, and vigorous physical activity frequency were assessed at the interview prior to cancer diagnosis. Confounder-adjusted multinomial logistic regression was used to determine the associations between each pre-diagnosis health behavior and post-diagnosis trajectories of memory function and limitations to activities of daily living (ADLs), which were identified using group-based trajectory modeling. Overall, 20.7 % of cancer survivors were current smokers, 30.6 % drank alcohol, and 27.1 % engaged in vigorous physical activity >=once a week prior to their diagnosis. In the years following diagnosis, those who had engaged in vigorous physical activity > once a week were less likely to have a medium-high (OR: 0.5; 95 % CI: 0.2-0.9) or medium-low memory loss trajectories (OR: 0.6; 95 % CI: 0.3-1.0) versus very low memory loss trajectory, and were less likely to have a high, increasing ADL limitation trajectory (OR: 0.3; 95 % CI: 0.2, 0.6) versus no ADL limitation trajectory. Vigorous physical activity, but not smoking or alcohol use, was associated with better post-diagnosis functional aging trajectories after a first incident cancer diagnosis in mid-to-later life in this population-based study. Identification of modifiable risk factors can inform targeted interventions to promote healthy aging among cancer survivors.

%B Preventive Medicine Reports %V 31 %P 102083 %G eng %R 10.1016/j.pmedr.2022.102083 %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 Journal of Pain and Symptom Management %D 2023 %T Associations Between Baseline Pain, Depression, and Caregiving and One-Year Post-Discharge Outcomes Among Seriously Ill Older Adults Admitted for Trauma (Sch411) %A Hiba DhananiScM %A Yihan Wang %A Evan Bollens-Lund %A Amanda Reich %A Amy KelleyMSHS %A Zara Cooper %X {Outcomes 1. Understand how pain, depression, and caregiving in seriously ill trauma patients impacts healthcare utilization costs 1 year after discharge. 2. Conceptualize how palliative care intervention targeting pain, depression, and caregiving in seriously ill trauma patients may improve healthcare outcomes 1-year post discharge. Introduction Many older trauma patients have preexisting serious illness (SI) like dementia, frailty, and organ insufficiency and are candidates for palliative care to improve outcomes and reduce downstream healthcare utilization. However, there are few data about targets for palliative care in these patients. We hypothesized that older SI adults with pain, depression, and caregiving needs before trauma admission have higher 1-year postdischarge healthcare utilization compared to trauma patients without SI. Methods Using data from the Health and Retirement Study (2008-2018) linked to Medicare claims, we identified seriously ill adults over 66 years old and assessed patient characteristics including demographics, comorbidity, baseline pain (none/mild versus moderate/severe), depression (CES-D ≥3) and caregiving needs (≥30 hours/month), as well as hospital characteristics including trauma center designation and palliative care service. Comparisons between pain, depression, caregiving, and SI were reported using chi square tests. Differences in healthcare utilization between groups with palliative care, pain, depression, and caregiving were reported using t-tests. Results The study cohort included 513. Mean age was 82.1 years (SD 8.1), 73.1% were female, and 84.1% were non-Hispanic white. Most (70.5%) were admitted to a trauma center and (88.8%) hospital with a palliative care service. Compared to those without preexisting pain, depression, and caregiving needs, SI older trauma patients with these conditions were less likely to be alive a year after discharge (71.2% vs 81.6% %B Journal of Pain and Symptom Management %V 65 %P e584-e585 %G eng %R https://doi.org/10.1016/j.jpainsymman.2023.02.148 %0 Journal Article %J The Journal of Gerontology, Series A %D 2023 %T Associations between Change in Kidney Functioning, Age, Race/ethnicity and Health Indicators in the Health and Retirement Study. %A Zhao, Erfei %A Jennifer A Ailshire %A Jung K Kim %A Wu, Qiao %A Crimmins, Eileen M %K Cystatin C %K Kidney function %K Metabolism %X

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

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

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

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

%B The Journal of Gerontology, Series A %V 78 %P 2094-2104 %G eng %N 11 %R 10.1093/gerona/glad204 %0 Journal Article %D 2023 %T Associations between diagnosis with stroke, comorbidities, and activity of daily living among older adults in the United State %A Suebsarn Ruksakulpiwat %A Wendie Zhou %A Lalipat Phianhasin %A Chitchanok Benjasirisan %A Saeideh Salehizadeh %A Limin Wang %A Joachim G. Voss %K Older Adults %K Stroke %K United States %X Background Stroke is the leading cause of mortality. This study aimed to investigate the association between stroke, comorbidities, and activity of daily living (ADL) among older adults in the United States. Methods Participants were 1165 older adults aged 60 and older from two waves (2016 and 2018) of the Health and Retirement Study who had a stroke. Descriptive statistics were used to describe demographic information and comorbidities. Logistic regressions and multiple regression analyses were used to determine associations between stroke, comorbidities, and ADL. Results The mean age was 75.32 ± 9.5 years, and 55.6% were female. An adjusted analysis shows that older stroke adults living with diabetes as comorbidity are significantly associated with difficulty in dressing, walking, bedding, and toileting. Moreover, depression was significantly associated with difficulty in dressing, walking, bathing, eating, and bedding. At the same time, heart conditions and hypertension as comorbidity were rarely associated with difficulty in ADL. After adjusting for age and sex, heart condition and depression are significantly associated with seeing a doctor for stroke (odds ratio [OR]: 0.66; 95% confidence interval [CI]: 0.49–0.91; p = 0.01) and stroke therapy (OR: 0.46; 95% CI: 0.25–0.84; p = 0.01). Finally, stroke problem (unstandardized β [B] = 0.58, p = 0.017) and stroke therapy (B = 1.42, p < 0.001) significantly predict a lower level of independence. Conclusion This study could benefit healthcare professionals in developing further interventions to improve older stroke adults' lives, especially those with a high level of dependence. %G eng %R https://doi.org/10.1002/cdt3.60 %0 Journal Article %J Journal of Affective Disorders %D 2023 %T Associations of cumulative depressive symptoms with subsequent cognitive decline and adverse health events: Two prospective cohort studies. %A Zhu, Yidan %A Li, Chenglong %A Wu, Tao %A Wang, Yongqian %A Hua, Rong %A Ma, Yanjun %A Xie, Wuxiang %K Adverse health events %K Cumulative exposure %K Depressive symptoms %K ELSA %X

BACKGROUND: The course of depression is variable; however, few studies examined the relationship between long-term cumulative depressive symptoms and adverse health outcomes in the elderly.

METHODS: In this cohort study, we used data from the Health and Retirement Study (HRS) over 24 years and the English Longitudinal Study of Ageing (ELSA) over 16 years. Cumulative depressive symptoms were estimated by calculating the areas under the curve based on the Center for Epidemiological Research Depression scale assessed at four examinations. Outcomes include cognitive decline, incident dementia, cardiovascular disease (CVD), cancer, and all-cause mortality.

RESULTS: A total of 8284 American (mean age: 60.1 years; male: 35.4 %) and 4314 British (60.1 years; 42.4 %) were included in the analysis. The median follow-up was 16.1 years in the HRS and 9.9 years in the ELSA. Similar results were observed in two cohorts. Comparing with the first tertile of cumulative depressive symptoms, the third tertile experienced faster cognitive decline (p = 0.013 in the ELSA and p < 0.001 in the HRS), increased risk of dementia (both p < 0.001), CVD (both p < 0.001) and all-cause mortality (p = 0.002 in the HRS). Strong dose-response relationships were observed. We did not found clearly association between cumulative depressive symptoms and incident cancer.

CONCLUSIONS: This study suggests that long-term cumulative depressive symptoms were associated with subsequent faster cognitive decline and greater risks for dementia, CVD and all-cause mortality, but not cancer. These findings provide insights on potential effective strategy that may improve health in the elderly, future clinical trials are needed to determine causality.

%B Journal of Affective Disorders %V 320 %P 91-97 %G eng %R 10.1016/j.jad.2022.09.128 %0 Journal Article %J Alzheimer's & dementia %D 2023 %T Associations of self‐rated mental and physical work demands with cognition are dependent in a cross‐sectional sample of the Health and Retirement Study %A Hickman, Ruby %A Bakulski, Kelly M %A Brandt, Daniel %A Jessica Faul %A Ware, Erin B %K Cognition %K mental work demands %K physical work demands %X Background The number of older adults remaining in the workforce is growing, but little is known about how physical and mental work demands jointly affect cognitive health. This study assessed whether self‐rated physical and mental work demands were associated with cognition among older working adults and whether their associations were dependent. Methods Our cross‐sectional sample consisted of 6,376 working older adults in the 2004 wave of the Health and Retirement Study. Self‐rated work demands were summarized from four questions about frequency of mental or physical demands in the respondent’s current job. Cognition was assessed using a subset of the Telephone Interview for Cognitive Status. We used multivariable linear regression to test for associations and additive interaction between physical and mental work demands and cognition, adjusted for age, sex, race, education, and practice effect. Result Independently, higher physical work demands were associated (P<0.001) with poorer cognition and higher mental work demands were associated (P<0.001) with better cognition. In an interaction analysis, the effect of one work demand measure became more negative as level of the other increased (B for interaction = ‐0.22, 95% CI: ‐0.42, ‐0.02). A one‐point increase in mental work demands was associated with 0.69 (95% CI: 0.40, 0.99) points higher cognition score when physical work demands were lowest. At the highest level of physical work demands, mental work demands were not associated with cognition (0.11, 95% CI: ‐0.28, 0.49). A one‐point increase in physical work demands was not associated with cognition (0.09, 95% CI: ‐0.30, 0.48) when mental work demands were lowest. At the highest level of mental work demands, physical work demands were associated with ‐0.53 (95% CI: ‐0.78, ‐0.29) points lower cognition score. The highest predicted cognition score was for the highest mental and lowest physical work demands. Results were robust to additional adjustment for health and behavior covariates. Conclusion The associations of self‐rated mental and physical work demand with cognition were dependent. Beneficial cognitive effects of mental work demands may not apply to workers with physically demanding jobs. Future studies should strongly consider examining interactions to capture the range of work demand effects. %B Alzheimer's & dementia %V 19 %G eng %R 10.1002/alz.066265 %0 Journal Article %J Psychiatry Res %D 2023 %T Associations of social isolation and loneliness with the onset of insomnia symptoms among middle-aged and older adults in the United States: A population-based cohort study. %A Qi, Xiang %A Malone, Susan K %A Pei, Yaolin %A Zhu, Zheng %A Wu, Bei %X

There is an inconsistent conclusion regarding the relationship of social isolation and loneliness with poor sleep. We investigated the associations of social isolation and loneliness with new-onset insomnia symptoms in a nationally-representative sample of 9,430 adults aged ≥50 who were free of any insomnia symptoms/sleep disorders at baseline (wave 12/13) and followed up to 4 years from the Health and Retirement Study. Social isolation was measured by Steptoe's Social Isolation Index. Loneliness was measured by the revised 3-item UCLA-Loneliness Scale. Insomnia symptoms were quantified using the modified Jenkins Sleep Questionnaire. During a mean follow-up of 3.52 years, 1,522 (16.1%) participants developed at least one insomnia symptom. Cox models showed that loneliness was associated with the onset of difficulties initiating or maintaining sleep, early-morning awakening, nonrestorative sleep, and at least one of these symptoms after adjusting for potential covariates; while social isolation was not associated with the onset of difficulties maintaining sleep, early-morning awakening, or at least one insomnia symptom after adjusting for health indicators. These results are consistent in sensitivity analyses and stratified analyses by age, sex, race/ethnicity, and obesity. Public health interventions aimed at fostering close emotional relationships may reduce the burden of poor sleep among middle-aged and older adults.

%B Psychiatry Res %V 325 %P 115266 %G eng %R 10.1016/j.psychres.2023.115266 %0 Journal Article %J Am J Epidemiol %D 2023 %T BMI trajectories in late middle age, genetic risk, and the incident diabetes in older adults: evidence from a 26-year longitudinal study. %A Luo, Yaxin %A Liu, Zheran %A Luo, Jiawei %A Li, Ruidan %A Wei, Zhigong %A Yang, Lianlian %A Li, Juejin %A He, Ling %A Su, Yonglin %A Peng, Xingchen %A Hu, Xiaolin %X

This study investigated the association between BMI trajectories in late middle age and incident diabetes in later years. A total of 11,441 participants aged 50-60 years from the Health and Retirement Study with at least two self-reported BMI records were included. Individual BMI trajectories representing average BMI changes per year were generated using multilevel modeling. Adjusted risk ratios (ARRs) and 95% confidence intervals (95% CIs) were calculated. Associations between BMI trajectories and diabetes risk in participants with different genetic risks were estimated for 5720 participants of European ancestry. BMI trajectories were significantly associated with diabetes risk in older age (slowly increasing vs. stable: ARR 1.31, 95% CI 1.12-1.54; rapidly increasing vs. stable: ARR 1.5, 95% CI 1.25-1.79). This association was strongest for normal-initial-BMI participants (slowly increasing: ARR 1.34, 95% CI 0.96-1.88; rapidly increasing: ARR 2.06, 95% CI 1.37-3.11). Participants with a higher genetic liability to diabetes and a rapidly increasing BMI trajectory had the highest risk for diabetes (ARR 2.15, 95% CI 1.67-2.76). These findings confirmed that BMI is the leading risk factor for diabetes and that although the normal BMI group has the lowest incidence rate for diabetes, people with normal BMI are most sensitive to changes in BMI.

%B Am J Epidemiol %G eng %R 10.1093/aje/kwad080 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T The burden of pre-admission pain, depression, and caregiving on palliative care needs for seriously ill trauma patients. %A Abbas, Muhammad %A Reich, Amanda Jane %A Wang, Yihan %A Hu, Frances Y %A Bollens-Lund, Evan %A Kelley, Amy S %A Cooper, Zara %X

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

%B J Frailty Aging %V 12 %P 103-108 %8 2023 %G eng %N 2 %R 10.14283/jfa.2023.10 %0 Web Page %D 2023 %T Chances Are Your Financial Future Will Be Determined by This Social Security Table %A Williams, Sean %K claiming age %K financial behavior %K Social Security %I The Motley Fool %G eng %U https://www.fool.com/retirement/2023/08/06/financial-future-determined-social-security-table/ %0 Journal Article %J Am J Epidemiol %D 2023 %T Comparison of Imputation Strategies for Incomplete Longitudinal Data in Lifecourse Epidemiology. %A Shaw, Crystal %A Wu, Yingyan %A Zimmerman, Scott C %A Hayes-Larson, Eleanor %A Belin, Thomas R %A Power, Melinda C %A Glymour, M Maria %A Mayeda, Elizabeth Rose %X

Incomplete longitudinal data are common in lifecourse epidemiology and may induce bias leading to incorrect inference. Multiple imputation (MI) is increasingly preferred for handling missing data, but few studies explore MI method performance and feasibility in real data settings. We compared three MI methods using real data under nine missing data scenarios, representing combinations of 10%, 20%, and 30% missingness and missing completely at random, at random, and not at random. Using data from Health and Retirement Study (HRS) participants, we introduced record-level missingness to a sample of participants with complete data on depressive symptoms (1998-2008), mortality (2008-2018), and relevant covariates. We then imputed missing data using three MI methods (normal linear regression, predictive mean matching, variable-tailored specification), and fit Cox proportional hazards models to estimate effects of four operationalizations of longitudinal depressive symptoms on mortality. We compared bias in hazard ratios, root mean square error (RMSE), and computation time for each method. Bias was similar across MI methods and results were consistent across operationalizations of the longitudinal exposure variable. However, our results suggest predictive mean matching may be an appealing strategy for imputing lifecourse exposure data given consistently low RMSE, competitive computation times, and few implementation challenges.

%B Am J Epidemiol %G eng %R 10.1093/aje/kwad139 %0 Journal Article %J JAMA Intern Med %D 2023 %T Comparison of Particulate Air Pollution From Different Emission Sources and Incident Dementia in the US. %A Zhang, Boya %A Weuve, Jennifer %A Kenneth M. Langa %A D'Souza, Jennifer %A Szpiro, Adam %A Jessica Faul %A Mendes de Leon, Carlos %A Gao, Jiaqi %A Kaufman, Joel D %A Sheppard, Lianne %A Lee, Jinkook %A Lindsay C Kobayashi %A Hirth, Richard %A Adar, Sara D %X

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

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

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

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

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

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

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

%B JAMA Intern Med %G eng %R 10.1001/jamainternmed.2023.3300 %0 Journal Article %J The Journal of Gerontology, Series B %D 2023 %T Cross-National and Cross-Generational Evidence That Educational Attainment May Slow the Pace of Aging in European-Descent Individuals. %A Sugden, Karen %A Moffitt, Terrie E %A Arpawong, Thalida Em %A Arseneault, Louise %A Belsky, Daniel W %A Corcoran, David L %A Crimmins, Eileen M %A Hannon, Eilis %A Houts, Renate %A Mill, Jonathan S %A Poulton, Richie %A Ramrakha, Sandhya %A Wertz, Jasmin %A Williams, Benjamin S %A Caspi, Avshalom %K Academic Success %K Educational Status %K Genome-Wide Association Study %X

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

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

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

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

%B The Journal of Gerontology, Series B %V 78 %P 1375-1385 %G eng %N 8 %R 10.1093/geronb/gbad056 %0 Journal Article %J Neuropsychology %D 2023 %T A cultural neuropsychological approach to harmonization of cognitive data across culturally and linguistically diverse older adult populations. %A Briceño, Emily M %A Arce Rentería, Miguel %A Gross, Alden L %A Richard N Jones %A Gonzalez, Christopher %A Wong, Rebeca %A David R Weir %A Kenneth M. Langa %A Jennifer J Manly %K cognitive data %K HCAP %K Mex-Cog %K neuropsychology %X

OBJECTIVE: To describe a cultural neuropsychological approach to prestatistical harmonization of cognitive data across the United States (U.S.) and Mexico with the Harmonized Cognitive Assessment Protocol (HCAP).

METHOD: We performed a comprehensive review of the administration, scoring, and coding procedures for each cognitive test item administered across the English and Spanish versions of the HCAP in the Health and Retirement Study (HRS) in the U.S. and the Ancillary Study on Cognitive Aging in Mexico (Mex-Cog). For items that were potentially equivalent across studies, we compared each cognitive test item for linguistic and cultural equivalence and classified items as confident or tentative linking items, based on the degree of confidence in their comparability across cohorts and language groups. We evaluated these classifications using differential item functioning techniques.

RESULTS: We evaluated 132 test items among 21 cognitive instruments in the HCAP across the HRS and Mex-Cog. We identified 72 confident linking items, 46 tentative linking items, and 14 items that were not comparable across cohorts. Measurement invariance analysis revealed that 64% of the confident linking items and 83% of the tentative linking items showed statistical evidence of measurement differences across cohorts.

CONCLUSIONS: Prestatistical harmonization of cognitive data, performed by a multidisciplinary and multilingual team including cultural neuropsychologists, can identify differences in cognitive construct measurement across languages and cultures that may not be identified by statistical procedures alone. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

%B Neuropsychology %V 37 %P 247-257 %G eng %N 3 %R 10.1037/neu0000816 %0 Journal Article %J Alzheimer's & Dementia %D 2023 %T Cumulative loneliness and subsequent memory function and rate of decline among adults aged ≥50 in the United States, 1996 to 2016: Cumulative loneliness and memory aging in the US: Cumulative loneliness and memory aging in the US. %A Yu, Xuexin %A Westrick, Ashly C %A Lindsay C Kobayashi %K loneliness trajectories %K memory aging %X

INTRODUCTION: The study objective was to investigate the association between loneliness duration and memory function over a 20-year period.

METHODS: Data were from 9032 adults aged ≥50 in the Health and Retirement Study. Loneliness status (yes vs. no) was assessed biennially from 1996 to 2004 and its duration was categorized as never, 1 time point, 2 time points, and ≥3 time points. Episodic memory was assessed from 2004 to 2016 as a composite of immediate and delayed recall trials combined with proxy-reported memory. Mixed-effects linear regression models were fitted.

RESULTS: A longer duration of loneliness was associated with lower memory scores (P < 0.001) and a faster rate of decline (P < 0.001). The association was stronger among adults aged ≥65 than those aged <65 (three-way interaction P = 0.013) and was stronger among women than men (three-way interaction P = 0.002).

DISCUSSION: Cumulative loneliness may be a salient risk factor for accelerated memory aging, especially among women aged ≥65.

HIGHLIGHT: A longer duration of loneliness was associated with accelerated memory aging. The association was stronger among women than men and among older adults than the younger. Reducing loneliness in mid- to late life may help maintain memory function.

%B Alzheimer's & Dementia %G eng %R 10.1002/alz.12734 %0 Journal Article %J Innovation in Aging %D 2023 %T Decision Making for Patients With Severe Dementia Versus Normal Cognition Near the End of Life. %A Nicholas, Lauren Hersch %A Halpern, Scott D %A David R Weir %A Baum, Micah Y %A Nolan, Marie %A Gallo, Joseph %A Kenneth M. Langa %K Advance care planning %K cognitive impairment %K family caregivers %X

BACKGROUND AND OBJECTIVES: The clinical progression of severe dementia frequently leads to situations where surrogate decision makers must quickly make choices about potentially burdensome treatments that offer limited clinical benefit. We examined whether the number of decision makers and their access to advance directives were related to treatment choice for patients with severe dementia in comparison to those with normal cognition.

RESEARCH DESIGN AND METHODS: We retrospectively linked survey responses about end-of-life treatment decisions to Medicare claims for Health and Retirement Study respondents dying between 2002 and 2015 whose next-of-kin reported a need for surrogate decision making. We estimated multivariable logistic regression models to study measures of aggressive care in the last 6 months of life; in-hospital death, burdensome transfers, and burdensome treatments.

RESULTS: Compared to patients who were cognitively normal near the end of life ( = 1 198), patients with severe dementia ( = 722) were less likely to experience burdensome treatments (18% [95% confidence interval {CI} 14-21] vs 32% [95% CI 29-35]), burdensome transfers (20% [95% CI 17-24] vs 30% [95% CI 27-33]), and in-hospital death (24% [95% CI 20-28] vs 30% [95% CI 26-33]) when surrogates were involved. Rates of burdensome treatments, transfers, or in-hospital death for decedents with severe dementia did not vary with single versus multiple decision makers or when decision makers were informed by advance directives. However, among decedents with normal cognition, a single decision maker informed by an advance directive was associated with the lowest rates of burdensome treatments and in-hospital death.

DISCUSSION AND IMPLICATIONS: Surrogate decision makers made similar choices around end-of-life care for patients with severe dementia regardless of the number of decision makers and availability of advance directives. However, both advance directives and single decision makers were associated with less aggressive care for cognitively normal decedents.

%B Innovation in Aging %V 7 %P igad081 %G eng %N 7 %R 10.1093/geroni/igad081 %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 Alzheimers Disease: JAD %D 2023 %T Dementia Attributable Healthcare Utilizations in the Caribbean versus United States. %A Li, Jing %A Weiss, Jordan %A Rajadhyaksha, Ashish %A Acosta, Daisy %A Harrati, Amal %A Jiménez Velázquez, Ivonne Z %A Liu, Mao-Mei %A Guerra, Jorge J Llibre %A Rodriguez, Juan de Jesús Llibre %A Dow, William H %K Aged %K Alzheimer disease %K Delivery of Health Care %K ethnicity %K Humans %K Patient Acceptance of Health Care %K Puerto Rico %K United States %X

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

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

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

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

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

%B Journal of Alzheimers Disease: JAD %V 96 %P 801-811 %G eng %N 2 %R 10.3233/JAD-230505 %0 Journal Article %J Journal of Alzheimers Disease: JAD %D 2023 %T Dementia Attributable Healthcare Utilizations in the Caribbean versus United States. %A Li, Jing %A Weiss, Jordan %A Rajadhyaksha, Ashish %A Acosta, Daisy %K Aged %K Alzheimer disease %K Delivery of Health Care %K ethnicity %K Humans %K Patient Acceptance of Health Care %K Puerto Rico %K United States %X

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

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

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

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

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

%B Journal of Alzheimers Disease: JAD %V 96 %P 801-811 %G eng %N 2 %R 10.3233/JAD-230505 %0 Journal Article %J Gerontology %D 2023 %T Depression trajectories, genetic risk, and cognitive performance in older adults: multilevel model with a 10-year longitudinal cohort. %A Liu, Zheran %A Su, Yonglin %A Huang, Rendong %A Li, Ruidan %A Wei, Zhigong %A He, Ling %A Pei, Yiyan %A Min, Yu %A Hu, Xiaolin %A Peng, Xingchen %K depression %K genetic risk %K Older Adults %X

BACKGROUND: Cognitive performance in older ages is strongly affected by individuals' genetic predispositions. We investigated whether depression trajectories were associated with subsequent cognitive performance independent of participants' genetic predispositions.

METHODS: Participants from the Health and Retirement Study with European ancestry and aged over 50 were included in the analysis. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale, and the 6-year trajectories were fitted using latent class linear mixed models. Linear multilevel regression was applied to model the associations between depression trajectory and subsequent cognitive performance. Stratified analyses were performed to investigate these associations in participants with different genetic predispositions of cognitive performance and APOE ε4 allelic status.

RESULTS: A total of 5942 eligible participants were included in the study. Four depression trajectories were identified. Compared with the non-depression trajectory, all other depression trajectories were associated with worse cognitive performance (β [95% CI]: mild-depression trajectory: -0.20 [-0.56, -0.06], p = 0.007; worsening-depression trajectory: -0.29 [-0.47, -0.12], p = 0.001; persistent-depression trajectory: -0.32 [-0.53, -0.13], p = 0.001). Although these associations were independent of participants' inherent genetic risk, the participants with a low polygenetic score for cognitive performance were more likely to have an enhanced association between depression trajectories and cognitive decline. Similar relationships were also found in APOE ε4 noncarriers.

CONCLUSION: Among older participants with European ancestry, even a mild-depression trajectory was associated with worse cognitive performance. Early intervention in participants with any degree of depression might benefit regarding preventing cognitive performance decline.

%B Gerontology %G eng %R 10.1159/000530200 %0 Journal Article %J Journal of Aging and Health %D 2023 %T Depressive Symptom Trajectories and Cognition Among Older American Couples: A Dyadic Perspective. %A Kong, Dexia %A Lu, Peiyi %A Solomon, Phyllis %A Woo, Jean %A Shelley, Mack %K Couples %K depressive symptom trajectory %K dyadic data %K latent class growth analysis %K Memory %X

OBJECTIVES: This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse's memory.

METHODS: Longitudinal data from the Health and Retirement Study (2004-2016) were used ( = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory.

RESULTS: Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives' depressive symptom trajectories was significantly associated with husbands' memory ( > .05), husbands' decreasing trajectory was linked to wives' better memory (β = 0.498, 95% CI = 0.106, 0.890).

DISCUSSION: Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses' memory.

%B Journal of Aging and Health %G eng %R 10.1177/08982643221125838 %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 Nutrients %D 2023 %T Dietary Intake Levels of Iron, Copper, Zinc, and Manganese in Relation to Cognitive Function: A Cross-Sectional Study. %A Zhao, Dong %A Huang, Yilun %A Wang, Binghan %A Chen, Hui %A Pan, Wenfei %A Yang, Min %A Xia, Zhidan %A Zhang, Ronghua %A Yuan, Changzheng %K Aged %K Cognition %K Copper %K Cross-Sectional Studies %K Eating %K Humans %K Iron %K Manganese %K Trace Elements %K Zinc %X

: Previous studies have related circulating levels of trace metal elements, of which dietary intake is the major source, to cognitive outcomes. However, there are still relatively few studies evaluating the associations of dietary intake levels of iron, copper, zinc, and manganese with cognitive function (CF). : We leveraged the data of 6863 participants (mean [standard deviation] age = 66.7 [10.5] years) in the Health and Retirement Study (2013/2014). Dietary intake levels of iron, copper, zinc, and manganese were calculated from a semi-quantitative food frequency questionnaire. CF was assessed using the 27-point modified Telephone Interview for Cognitive Status (TICS). We used linear regression models to calculate the mean differences in global CF scores by quintiles of dietary intake levels of trace metal elements. : Among the study participants, the mean (SD) values of daily dietary intake were 13.3 (6.3) mg for iron, 1.4 (0.7) mg for copper, 10.7 (4.6) mg for zinc, and 3.3 (1.6) mg for manganese. Compared with the lowest quintile of dietary iron intake (<8.1 mg), the highest quintile (≥17.7 mg) was associated with a lower cognitive score (-0.50, -0.94 to -0.06, P-trend = 0.007). Higher dietary copper was significantly associated with poorer CF (P-trend = 0.002), and the mean difference in cognitive score between extreme quintiles (≥1.8 vs. <0.8 mg) was -0.52 (95% confidence interval: -0.94 to -0.10) points. We did not observe significant associations for dietary intake of zinc (P-trend = 0.785) and manganese (P-trend = 0.368). : In this cross-sectional study, higher dietary intake of iron and copper was related to worse CF, but zinc and manganese intake levels were not significantly associated with CF.

%B Nutrients %V 15 %8 2023 Jan 30 %G eng %N 3 %R 10.3390/nu15030704 %0 Report %D 2023 %T Documentation of lnterleukin-6 (IL-6) Assays from Dried Blood Spots 2014 and 2016 %A Crimmins, Eileen %A Jessica Faul %A Jung K Kim %A David R Weir %K User guide %X This document describes the collection of lnterleukin-6 (IL-6) in 2014 and 2016 Assays from Dried Blood Spots. %I Institute for Social Research, University of Michigan %C Ann Arbor, MI %G eng %0 Journal Article %J Alzheimers Dement %D 2023 %T Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India. %A Westrick, Ashly C %A Avila-Rieger, Justina %A Gross, Alden L %A Hohman, Timothy %A Vonk, Jet M J %A Zahodne, Laura B %A Lindsay C Kobayashi %K Education %K gender disparities %K India %K memory function %K United States %X

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

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

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

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

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

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

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

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

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

%B J Aging Health %P 8982643231184593 %G eng %R 10.1177/08982643231184593 %0 Journal Article %J Aging Ment Health %D 2023 %T Early life adversity, race, and childhood socioeconomic status: intersecting drivers of later life cognition. %A Reynolds, Addam %A Greenfield, Emily A %A Williams-Butler, Abigail %K Adverse childhood experiences; intersectionality; life course perspective; minority diminished returns; racism. %X

OBJECTIVES: Research on associations between early life adversity (ELA) and later life cognition has yielded mixed results and generally have not considered how broader societal systems of stratification potentially influence associations. The current study addresses this gap by exploring if racialized identity and childhood socioeconomic status (cSES) moderate associations between ELA exposure and later life cognition.

METHODS: Using data from the Health and Retirement Study (Waves 2010-2018), we used growth curve modeling to examine if the confluence of ELA, cSES, and racialized identity is associated with cognition.

RESULTS: Among White participants, greater exposure to ELA was associated with poorer baseline cognitive functioning, and higher cSES buffered against this association. Among Black participants, exposure to ELA was not associated with baseline cognitive functioning, regardless of cSES. We did not find evidence of any associations between main predictors nor their interactions with change in cognition over time.

CONCLUSIONS: This study provides evidence that associations between ELA and later life cognition is contingent upon multiple social positions in the United States. These findings support the importance of integrating insights on intersecting social positions within life-course-oriented efforts to reduce racialized cognitive disparities.

%B Aging Ment Health %P 1-9 %G eng %R 10.1080/13607863.2023.2242296 %0 Journal Article %J J Aging Health %D 2023 %T Early Origins of Frailty: Do Later-Life Social Relationships Alter Trajectories of Decline? %A Williams-Farrelly, Monica M %A Ferraro, Kenneth F %K adult relationships %K childhood experiences %K Social Relationships %X

Social relationships are widely regarded as salubrious, but do they mediate the influence of childhood experiences on frailty in later life? Drawing from cumulative inequality theory, we assess the influence of childhood experiences and adult relationships on frailty trajectories. We analyzed data from the Health and Retirement Study to examine the influence of six domains of childhood experiences and social relationships on frailty trajectories over 8 years. Mediation analyses were completed with structural equation models. Risky adolescent behavior, chronic disease, and impairments during childhood are associated directly with higher risk of initial frailty, but not over time. More social roles and higher social support mediate the relationship between childhood experiences and frailty, and the effect of more social roles continues over time. This study provides compelling evidence that supportive social relationships mediate the risk and severity of frailty in later life associated with noxious childhood experiences.

%B J Aging Health %P 8982643231185426 %G eng %R 10.1177/08982643231185426 %0 Journal Article %J J Dent Res %D 2023 %T Edentulism Predicts Cognitive Decline in the US Health and Retirement Cohort Study. %A Jones, J A %A Moss, K %A Finlayson, T L %A Preisser, J S %A Weintraub, J A %X

This longitudinal cohort study examines if 1) cognitive decline varies by birth cohort, adjusting for covariates, and 2) edentulism and nonuse of dental care predict 10-y cognitive decline (2008-2018). The Health and Retirement Study (HRS) features a representative sample of US adults over age 50. Eligibility criteria included having cognitive interview data available and responding to the question, "Have you lost all of your upper and lower natural permanent teeth?" at 2+ time points between 2006 and 2018. Use of dental care in the past 2 y was assessed. Linear mixed models for repeated measures estimated the trajectories of mean cognition over time for the birth cohorts, adjusted for baseline cognition, dentition status, dental care use, and covariates (demographic characteristics, health behaviors, and medical conditions). Cohort-by-time interaction terms were included to assess if cognitive decline varied by birth cohort. Ten-year change in cognition status (measured by HRS Cogtot27)-categorized as dementia (<7); cognitive impairment, not demented (7-11) 7≤Cogtot27<12; and normal (≥12)-was also investigated according to birth cohort, dentition status, and dental care use. Mean (SD) baseline age was 63.4 (10.1) y ( = 22,728). Older birth cohorts had greater cognitive decline than younger cohorts. Linear mixed-model estimates and 95% confidence intervals for protective factors for cognitive decline included higher baseline cognition (HRS Cogtot27) (0.49; 0.48-0.50), use of dental care in the past 2 y (0.17; 0.10-0.23), and covariates such as greater household wealth and being married. Risk increased with being edentulous (-0.42; -0.56 to -0.28), history of stroke or diabetes, less education, Medicaid recipient, current smoker, loneliness, and poor/fair self-rated health. Edentulism and irregular dental care are among important predictors of cognitive decline. Tooth retention and regular dental care throughout life appear to be important for maintaining oral and cognitive health.

%B J Dent Res %P 220345231167805 %G eng %R 10.1177/00220345231167805 %0 Journal Article %J J Geriatr Oncol %D 2023 %T Education, incident cancer, and rate of memory decline in a national sample of US adults in mid-to-later-life. %A Ospina-Romero, Monica %A Brenowitz, Willa D %A Glymour, M Maria %A Westrick, Ashly %A Graff, Rebecca E %A Hayes-Larson, Eleanor %A Mayeda, Elizabeth Rose %A Ackley, Sarah F %A Lindsay C Kobayashi %K Aged %K Aging %K Cancer Survivors %K Educational Status %K Humans %K Longitudinal Studies %K Memory Disorders %K Middle Aged %K Neoplasms %X

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

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

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

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

%B J Geriatr Oncol %V 14 %P 101530 %G eng %N 5 %R 10.1016/j.jgo.2023.101530 %0 Journal Article %J 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 J Gerontol B Psychol Sci Soc Sci %D 2023 %T Everyday Discrimination, Neighborhood Perceptions, and Incidence of Activity Limitations Among Middle-Aged and Older African Americans. %A Qin, Weidi %A Nguyen, Ann W %A Wang, Yi %A Hamler, Tyrone C %A Wang, Fei %K Activities of Daily Living %K Aged %K Black or African American %K Humans %K Incidence %K Middle Aged %K Residence Characteristics %K Retirement %X

OBJECTIVES: This study aims to examine the relationship between everyday discrimination, neighborhood perceptions, and the incidence of daily activity limitations (i.e., activities of daily living [ADL] and instrumental activities of daily living [IADL]) among middle-aged and older African Americans. This study also examines whether neighborhood perceptions moderate the association between discrimination and the incidence of daily activity limitations.

METHODS: Data were from the 2006 to 2016 waves of the Health and Retirement Study. African Americans aged 50 or older free of ADL limitations (N = 1,934) and IADL limitations (N = 2,007) at baseline were selected. Cox proportional hazards regression models were performed to test the study aims. Multiple imputations were applied to handle missing data.

RESULTS: One-unit increase in everyday discrimination was associated with a 25% (p < .05) higher risk of ADL limitation onset. Perceived neighborhood social cohesion and physical disadvantage moderated the association between discrimination and IADL limitation onset.

DISCUSSION: Everyday discrimination represents a significant stressor that negatively affects older African Americans' performance of daily activities. Community-level efforts that improve neighborhood perceptions are needed to alleviate the negative effects of discrimination on the incidence of activity limitations.

%B J Gerontol B Psychol Sci Soc Sci %V 78 %P 866-879 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/36661210?dopt=Abstract %R 10.1093/geronb/gbad001 %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 Alzheimers Res Ther %D 2023 %T Expected and diagnosed rates of mild cognitive impairment and dementia in the U.S. Medicare population: observational analysis. %A Mattke, Soeren %A Jun, Hankyung %A Chen, Emily %A Liu, Ying %A Becker, Andrew %A Wallick, Christopher %K cognitive impairment %K Medicare %K United States %X

BACKGROUND: With the emergence of disease-modifying Alzheimer's treatments, timely detection of early-stage disease is more important than ever, as the treatment will not be indicated for later stages. Contemporary population-level data for detection rates of mild cognitive impairment (MCI), the stage at which treatment would ideally start, are lacking, and detection rates for dementia are only available for subsets of the Medicare population. We sought to compare documented diagnosis rates of MCI and dementia in the full Medicare population with expected rates based on a predictive model.

METHODS: We performed an observational analysis of Medicare beneficiaries aged 65 and older with a near-continuous enrollment over a 3-year observation window or until death using 100% of the Medicare fee-for-service or Medicare Advantage Plans beneficiaries from 2015 to 2019. Actual diagnoses for MCI and dementia were derived from ICD-10 codes documented in those data. We used the 2000-2016 data of the Health and Retirement Study to develop a prediction model for expected diagnoses for the included population. The ratios between actually diagnosed cases of MCI and dementia over number of cases expected, the observed over expected ratio, reflects the detection rate.

RESULTS: Although detection rates for MCI cases increased from 2015 to 2019 (0.062 to 0.079), the results mean that 7.4 of 8 million (92%) expected MCI cases remained undiagnosed. The detection rate for MCI was 0.039 and 0.048 in Black and Hispanic beneficiaries, respectively, compared with 0.098 in non-Hispanic White beneficiaries. Individuals dually eligible for Medicare and Medicaid had lower estimated detection rates than their Medicare-only counterparts for MCI (0.056 vs 0.085). Dementia was diagnosed more frequently than expected (1.086 to 1.104) from 2015 to 2019, mostly in non-Hispanic White beneficiaries (1.367) compared with 0.696 in Black beneficiaries and 0.758 in Hispanic beneficiaries.

CONCLUSIONS: These results highlight the need to increase the overall detection rates of MCI and of dementia particularly in socioeconomically disadvantaged groups.

%B Alzheimers Res Ther %V 15 %P 128 %G eng %N 1 %R 10.1186/s13195-023-01272-z %0 Journal Article %J Neurology %D 2023 %T Expected vs Diagnosed Rates of Mild Cognitive Impairment and Dementia in the US Medicare Population (S15.010) %A Soeren Mattke %A Hankyung Jun %A Emily Chen %A Ying Liu %A Andrew Becker %A Chris Wallick %X Objective: We sought to derive contemporary population-level diagnosis rates of mild cognitive impairment (MCI) and dementia from US Medicare data and compare those rates to expected rates based on a predictive model.Background: Cognitive impairment is common in elderly populations but remains under diagnosed.Design/Methods: We analyzed data from 2017–2019 100% samples for Medicare fee-for-service and Medicare Advantage; diagnoses were identified based on ICD-10 codes. To estimate the expected prevalence of MCI and dementia, we used the Health and Retirement Study, a nationally representative, longitudinal survey of older US adults, which includes formal cognitive assessments. We predicted MCI, dementia, and any cognitive impairment based on age, sex, race/ethnicity, dual eligibility status (ie, individuals covered by both Medicare and Medicaid), and a continuous linear trend to account for the secular decline in dementia incidence with a probit model. The model was calibrated using 2000–2014 data, validated using 2016 data, and applied to 2017–2019 Medicare data to generate expected diagnosis rates.Results: The prediction model performed well, with areas under the curve of 0.7128 (MCI), 0.8156 (dementia), and 0.7449 (any cognitive impairment). Differences between model-predicted rates and observed diagnosis rates were 0.2013 (MCI), 0.015 (dementia), and 0.1487 (MCI or dementia). A total of 7,291,008 MCI cases and 483,649 dementia cases were undiagnosed.Conclusions: Dementia is diagnosed in the US Medicare population at approximately the expected rate; however, MCI remains substantially underdiagnosed. If failure to diagnose is not addressed, it will have negative implications for timely access to a disease-modifying treatment for Alzheimer’s disease.Disclosure: Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Mattke has received personal compensation in the range of $500-$4,999 for serving as a Consultant for C2N. Dr. Mattke has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Senscio Systems. The institution of Dr. Mattke has received research support from various companies, CMS. Dr. Jun has nothing to disclose. Ms. Chen has nothing to disclose. Dr. Liu has nothing to disclose. Mr. Becker has received personal compensation for serving as an employee of University of Southern California. Chris Wallick has nothing to disclose. %B Neurology %V 100 %G eng %R 10.1212/WNL.0000000000201996 %0 Journal Article %J Journal of the Royal Statistical Society Series A: Statistics in Society %D 2023 %T An experimental evaluation of a stopping rule aimed at maximizing cost-quality trade-offs in surveys %A Wagner, James %A Zhang, Xinyu %A Elliott, Michael R %A Brady T. West %A Coffey, Stephanie M %X Surveys face difficult choices in managing cost-error trade-offs. Stopping rules for surveys have been proposed as a method for managing these trade-offs. A stopping rule will limit effort on a select subset of cases to reduce costs with minimal harm to quality. Previously proposed stopping rules have focused on quality with an implicit assumption that all cases have the same cost. This assumption is unlikely to be true, particularly when some cases will require more effort and, therefore, more costs than others. We propose a new rule that looks at both predicted costs and quality. This rule is tested experimentally against another rule that focuses on stopping cases that are expected to be difficult to recruit. The experiment was conducted on the 2020 data collection of the Health and Retirement Study (HRS). We test both Bayesian and non-Bayesian (maximum-likelihood or ML) versions of the rule. The Bayesian version of the prediction models uses historical data to establish prior information. The Bayesian version led to higher-quality data for roughly the same cost, while the ML version led to small reductions in quality with larger reductions in cost compared to the control rule. %B Journal of the Royal Statistical Society Series A: Statistics in Society %G eng %R 10.1093/jrsssa/qnad059 %0 Journal Article %J Cancer Medicine %D 2023 %T Financial burden among cancer patients: A national-level perspective. %A Mudaranthakam, Dinesh Pal %A Wick, Jo %A Calhoun, Elizabeth %A Gurley, Tami %K cancer treatment %K Financial burden %K financial challenges %K treatment burden %X

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

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

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

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

%B Cancer Medicine %G eng %R 10.1002/cam4.5049 %0 Journal Article %J Innovation in Aging %D 2023 %T FINDING THE MINDS OF OUR ELDERS: TESTING THE MINORITY STRESS AND COGNITION MODEL WITH INDIGENOUS OLDER ADULTS %A Whetung, Cliff %K cognitive function %K Indigenous older adults %K Minority Stress and Cognition Model %X This study used data from the Health and Retirement Study (HRS) data to investigate how an understudied group of Indigenous Older Adults (IOAs) in the United States fared over a 14-year period (2006-2020) in the domain of global cognitive function. The number of IOAs, defined here as Native American and Alaska Natives, will more than double in the next 30 years. Concurrently, the number of IOAs living with cognitive impairments will also increase. Guided by the Minority Stress and Cognition Model, we tested the hypothesis that discriminatory stress increases the risk of cognitive impairment in later life. Using a robust set of psychosocial (e.g. educational quality, perceived everyday discrimination experiences), behavioral (e.g. substance use, exercise), and physiological (e.g. diabetes, hypertension, obesity) risk factors, we modeled the cognition trajectories 186 IOAs using mixed growth curves. We found that one third of these IOAs reported experiencing everyday discrimination at least once per month, the highest of any ethnic group. They also reported high rates of other risk factors for cognitive impairment like low education, SES, and physical activity, and high rates of depression and chronic health conditions. Our analysis found that everyday discrimination was negatively associated with total cognition among IOAs but that this relationship was mediated by allostatic loads. On average, the total cognition scores of IOAs declined significantly faster than those of Whites. This study has important implications for the integration of stress as a mechanism for cognitive decline and the health equity of Indigenous older adults. %B Innovation in Aging %V 6 %P 429-430 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1687 %0 Journal Article %J MedComm (2020) %D 2023 %T Frailty trajectory predicts subsequent cognitive decline: A 26-year population-based longitudinal cohort study. %A Li, Ruidan %A Liu, Zheran %A Huang, Rendong %A Chen, Ye %A Wei, Zhigong %A Wang, Jingjing %A He, Ling %A Pei, Yiyan %A Su, Yonglin %A Hu, Xiaolin %A Peng, Xingchen %X

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

%B MedComm (2020) %V 4 %P e296 %G eng %N 3 %R 10.1002/mco2.296 %0 Web Page %D 2023 %T From Breadwinner to Retiree: How to Manage the Transition %A Wood, Erin %K Retirement %I Kiplinger Personal Finance %G eng %U https://www.kiplinger.com/retirement/new-retiree-how-to-manage-the-transition-from-breadwinner %0 Journal Article %J Journal of Cancer Survivorship %D 2023 %T Functional aging trajectories of older cancer survivors: A latent growth analysis of the US Health and Retirement Study. %A Westrick, Ashly C %A Kenneth M. Langa %A Eastman, Marisa %A Ospina-Romero, Monica %A Mullins, Megan A %A Lindsay C Kobayashi %K Activities for daily living %K Aging %K Cancer %K Memory %X

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

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

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

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

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

%B Journal of Cancer Survivorship %V 17 %P 1499-1509 %G eng %N 5 %R 10.1007/s11764-022-01185-0 %0 Journal Article %J Biodemography Soc Biol %D 2023 %T Gender differences in the association of polygenic risk and divergent depression trajectories from mid to late life: a national longitudinal study. %A Chen, Ping %A Li, Yi %A Wu, Fang %K Adult %K Aged %K Aged, 80 and over %K depression %K Depressive Disorder, Major %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Risk Factors %K Sex Factors %X

Our research fills a critical gap in the depression literature by utilizing a life course perspective to examine gender-gene interactions in association with depression trajectories over time. Using data from the Health and Retirement Study, we estimated multi-level negative binomial and logistic mixed models to analyze gender-specific trajectories of depressive symptoms (CESD-8) and potential clinical depression risk from middle to late adulthood in relation to gender-by-polygenic-risk (PRS) interactions. We found increasingly greater female-male gaps in the CESD-8 scale and a higher probability of clinical depression risk with increasing polygenic risk scores. Furthermore, females' higher genetic vulnerabilities to depressive conditions than males vary from ages 51 to 90 years, (e.g. 0.28 higher CESD-8 scale for females at ages 76-85 years than for similar-aged males; higher 3.44% probability of depression risk for females at ages 81-85 compared to similar-aged males) (e.g. about 2.40% higher probability of depression risk for females at ages 61-70 years than for similar-aged males) . This study contributes to new knowledge of how gender-by-polygenic-risk interactions are associated with depression trajectories across the life course.

%B Biodemography Soc Biol %V 68 %P 32-53 %G eng %N 1 %R 10.1080/19485565.2023.2196710 %0 Journal Article %J 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 J Pers Soc Psychol %D 2023 %T Getting under the skin? Influences of work-family experiences on personality trait adaptation and reciprocal relationships. %A Li, Wen-Dong %A Wang, Jiexin %A Allen, Tammy %A Zhang, Xin %A Yu, Kaili %A Zhang, Hong %A Huang, Jason L %A Liu, Mengqiao %A Li, Andrew %X

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

%B J Pers Soc Psychol %G eng %R 10.1037/pspp0000476 %0 Journal Article %J Applied Economics Letters %D 2023 %T Grey Divorce and labour Supply %A Sita Nataraj Slavov %A Chao Wei %K Divorce %K gender %K Labor Supply %X We use data from the Health and Retirement Study (HRS) to examine how labour supply changes around divorces that occur later in life. We find that the probability of work and hours worked increase for women, but decline for men, with evidence of an anticipation effect for men. We find weak evidence of a post-divorce decline in per-capita wealth and stronger evidence of a decline in per-capita non-own-wage income for women, but not for men. While not causal, these findings are consistent with income and possibly wealth effects driving the post-divorce increase in women’s labour supply. %B Applied Economics Letters %V 1 %P 66-79 %G eng %R 10.1080/13504851.2021.1975026 %0 Journal Article %J BMC Geriatr %D 2023 %T Handgrip strength is associated with risks of new-onset stroke and heart disease: results from 3 prospective cohorts. %A Li, Guochen %A Lu, Yanqiang %A Shao, Liping %A Wu, Luying %A Qiao, Yanan %A Ding, Yi %A Ke, Chaofu %K Aged %K Hand Strength %K Heart Diseases %K Humans %K Longitudinal Studies %K Middle Aged %K Prospective Studies %K Stroke %X

BACKGROUND: Stroke and heart disease are two major contributors to the global disease burden. We aimed to evaluate and compare the roles of different handgrip strength (HGS) expressions in predicting stroke and heart disease in three nationally representative cohorts.

METHODS: This longitudinal study used data from the Health and Retirement Study (HRS), the Survey of Health, Ageing, and Retirement in Europe (SHARE), and the China Health and Retirement Longitudinal Study (CHARLS). The Cox proportional hazard model was applied to analyze the relationship between HGS and stroke and heart disease, and Harrell's C index was used to assess the predictive abilities of different HGS expressions.

RESULTS: A total of 4,407 participants suffered from stroke and 9,509 from heart disease during follow-up. Compared with the highest quartile, participants in the lowest quartile of dominant HGS, absolute HGS and relative HGS possessed a significantly higher risk of new-onset stroke in Europe, America, and China (all P < 0.05). After adding HGS to office-based risk factors, there were minimal or no differences in the increases of Harrell's C indexes among three HGS expressions. In contrast, the modest association between HGS and heart disease was only seen in SHARE and HRS, but not in CHARLS.

CONCLUSION: Our findings support that HGS can be used as an independent predictor of stroke in middle-aged and older European, American and Chinese populations, and the predictive ability of HGS may not depend on how it is expressed. The relationship between HGS and heart disease calls for further validation.

%B BMC Geriatr %V 23 %P 268 %G eng %N 1 %R 10.1186/s12877-023-03953-8 %0 Web Page %D 2023 %T Here's the Average Social Security Benefit at Age 62 %A Williams, Sean %K claiming age %K Social Security %I The Motley Fool %G eng %U https://www.fool.com/retirement/2023/09/23/heres-the-average-social-security-benefit-age-62/ %0 Journal Article %J JAMA Network Open %D 2023 %T History of Incarceration and Its Association With Geriatric and Chronic Health Outcomes in Older Adulthood. %A Garcia-Grossman, Ilana R %A Cenzer, Irena %A Steinman, Michael A %A Williams, Brie A %K Activities of Daily Living %K Chronic disease %K Diabetes Mellitus %K Health Care %K Lung Diseases %K Outcome Assessment %X

IMPORTANCE: Although incarcerated older adults experience higher rates of chronic disease and geriatric syndromes, it is unknown whether community-dwelling older adults with a history of incarceration are also at risk for worse health outcomes.

OBJECTIVE: To evaluate the association between a history of incarceration and health outcomes, including chronic health conditions and geriatric syndromes, in older age.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study using population-based data from the nationally representative Health and Retirement Study included US community-dwelling adults aged 50 years or older who completed the 2012 or 2014 survey waves assessing self-reported history of incarceration. Statistical analysis was completed from December 2021 to July 2022.

EXPOSURES: Self-reported history of incarceration.

MAIN OUTCOMES AND MEASURES: Geriatric health outcomes included cognitive impairment, mobility impairment, vision impairment, hearing impairment, urinary incontinence, and impairment of activities of daily living (ADLs). Chronic health outcomes included high blood pressure, diabetes, chronic lung disease, heart disease, stroke, mental health conditions, heavy alcohol use, and self-reported health. Survey weights were applied to adjust for the survey design.

RESULTS: Among 13 462 participants, 946 (7.6%) had experienced incarceration (mean [SD] age, 62.4 [7.8] years); compared with 12 516 people with no prior incarceration (mean [SD] age, 66.7 [10.0] years), previously incarcerated adults were more likely to be male (83.0% vs 42.8%; P < .001) and in the lowest quartile of wealth (44.1% vs 21.4%; overall P < .001). After adjusting for age, sex, race and ethnicity, wealth, educational attainment, and uninsured status, a history of incarceration was associated with a 20% to 80% increased risk of all geriatric syndromes evaluated, including impairment of ADLs (relative risk [RR], 1.62; 95% CI, 1.40-1.88) and hearing impairment (RR, 1.22; 95% CI, 1.04-1.44). Incarceration was also associated with increased risk of some chronic diseases, including chronic lung disease (RR, 1.56; 95% CI, 1.27-1.91), mental health conditions (RR, 1.80; 95% CI, 1.55-2.08), and heavy alcohol use (RR, 2.13; 95% CI, 1.59-2.84). Prior incarceration was not associated with diabetes or cardiovascular conditions.

CONCLUSIONS AND RELEVANCE: In this study, at least 1 in 15 older US adults reported a history of incarceration in their lifetime. Past incarceration was associated with many chronic diseases and geriatric syndromes even after accounting for socioeconomic status. These findings suggest that attention to incarceration history may be an important consideration in understanding and mitigating health risks in older age.

%B JAMA Network Open %V 6 %P e2249785 %G eng %N 1 %R 10.1001/jamanetworkopen.2022.49785 %0 Journal Article %J Nature Medicine %D 2023 %T Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries. %A Mak, Hei Wan %A Noguchi, Taiji %A Bone, Jessica K %A Wels, Jacques %A Gao, Qian %A Kondo, Katsunori %A Saito, Tami %A Fancourt, Daisy %K hobbies %K Life Expectancy %K Mental Health %K Self Report %X

Growing aging populations pose a threat to global health because of the social and psychological challenges they experience. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different national settings. We harmonized measures of hobby engagement and multiple aspects of mental wellbeing across 16 nations represented in five longitudinal studies (N = 93,263). Prevalence of hobby engagement varied substantially across countries, from 51.0% of Spanish respondents to 96.0% of Danish respondents. Fixed effects models and multinational meta-analyses were applied to compare the longitudinal associations between hobbies and mental wellbeing. Independent of confounders, having a hobby was associated with fewer depressive symptoms (pooled coefficient = -0.10; 95% confidence intervals (CI) = -0.13, -0.07), and higher levels of self-reported health (pooled coefficient = 0.06; 95% CI = 0.03, 0.08), happiness (pooled coefficient = 0.09; 95% CI = 0.06, 0.13) and life satisfaction (pooled coefficient = 0.10; 95% CI = 0.08, 0.12). Further analyses suggested a temporal relationship. The strength of these associations, and prevalence of hobby engagement, were correlated with macrolevel factors such as life expectancy and national happiness levels but overall, little variance in findings was explained by country-level factors (<9%). Given the relative universality of findings, ensuring equality in hobby engagement within and between countries should be a priority for promoting healthy aging.

%B Nature Medicine %V 29 %P 2233-2240 %G eng %N 9 %R 10.1038/s41591-023-02506-1 %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 International Studies of Economics %D 2023 %T How do subjective mortality beliefs affect the value of social security and the optimal claiming ages? %A Dai, Tiantian %A Sun, Wei %A Webb, Anthony %K Annuity %K Life Expectancy %K Social Security %K subjective mortality beliefs %K variance of age of death %X Households that postpone claiming Social Security benefits are, in effect, making additional purchases of the Social Security annuity and acquiring valuable longevity insurance. This paper investigates the impact of plausible variations of subjective mortality beliefs on the value of delayed claiming and the optimal claiming ages of retired workers. Using the Health and Retirement Study data, we show that older individuals could, on average, predict their life expectancy correctly; however, the average variance of age of death calculated from subjective mortality tables is 6.2%–14.4% lower than that from cohort life tables. Using numerical optimization techniques, we further show that, theoretically, older households place a lower value on delaying claiming when they have greater confidence in their ability to forecast their age of death. But the magnitude of this effect is not large enough to change their optimal claiming ages, unless they hold extreme subjective mortality beliefs. As a result, we conclude that subjective mortality beliefs alone cannot explain the prevalence of early claiming behaviors. © 2023 The Authors. International Studies of Economics published by John Wiley & Sons Australia, Ltd on behalf of Shanghai University of Finance and Economics. %B International Studies of Economics %G eng %R 10.1002/ise3.69 %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 JAMA Network Open %D 2023 %T Hypertension and Stroke as Mediators of Air Pollution Exposure and Incident Dementia. %A Zhang, Boya %A Kenneth M. Langa %A Weuve, Jennifer %A D'Souza, Jennifer %A Szpiro, Adam %A Jessica Faul %A Mendes de Leon, Carlos %A Kaufman, Joel D %A Lisabeth, Lynda %A Hirth, Richard A %A Adar, Sara D %K Air Pollution %K Dementia %K Hypertension %K Particulate Matter %K Stroke %X

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

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

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

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

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

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

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

%B JAMA Network Open %V 6 %P e2333470 %G eng %N 9 %R 10.1001/jamanetworkopen.2023.33470 %0 Journal Article %J Soc Sci Med %D 2023 %T The impact of hearing loss on trajectories of depressive symptoms in married couples. %A West, Jessica S %A Smith, Sherri L %A Dupre, Matthew E %K Aged %K depression %K Female %K Hearing loss %K Humans %K Male %K Marriage %K Retirement %K Spouses %X

Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual's stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n = 4881 couples), we estimate age-based mixed models to examine how 1) one's own hearing, 2) one's spouse's hearing, or 3) both spouses' hearing influence changes in depressive symptoms. For men, their wives' hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands' hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.

%B Soc Sci Med %V 321 %P 115780 %8 2023 Mar %G eng %R 10.1016/j.socscimed.2023.115780 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Impacts of Caregiving on Health of New Spousal Caregivers to Older Adults in the United States: A Coarsened Exact Matching Analysis. %A Liu, Ruotong %A Chi, Iris %A Wu, Shinyi %X

OBJECTIVES: Spousal caregivers of older adults, especially new spousal caregivers, face increased risks of negative health outcomes due to the demands of caregiving and their own health decline. Estimating the impacts of caregiving on health without controlling for caregivers' own aging-related health decline could exaggerate the negative health consequences of caregiving, while focusing solely on caregivers could result in selection bias where healthier individuals enter and/or remain in caregiving. This study aims to estimate the impacts of caregiving on health of new spousal caregivers while controlling for observable confounders.

METHODS: We utilized coarsened exact matching analysis to compare health outcomes between new spousal caregivers and spousal non-caregivers using pooled panel data from 2006 to 2018 in the Health and Retirement Study. We analyzed 242,123 person-wave observations from 42,180 unique individuals, among whom 3,927 were new spousal caregivers. Variables used for matching were classified into three categories: care needs, willingness to provide care, and ability to provide care. Two-year outcomes assessed are spouse's self-rated health, depressive symptoms, and cognitive functioning.

RESULTS: A total of 3,417 (87.01%) new spousal caregivers were matched with 129,798 observations of spousal non-caregivers. Regression analysis indicated being a new spousal caregiver was associated with a 0.18 (SE=0.05) unit increase in number of depressive symptoms. No statistically significant results were identified for self-rated health and cognitive functioning.

DISCUSSION: Our results highlighted the needs to address mental health among new spousal caregivers and emphasized the importance of addressing mental health in long-term care programs and policies.

%B J Gerontol B Psychol Sci Soc Sci %G eng %R 10.1093/geronb/gbad064 %0 Journal Article %J Am J Geriatr Psychiatry %D 2023 %T Important Correlates of Purpose in Life in a Diverse Population-Based Cohort: A Machine Learning Approach. %A Bhatt, Rishab %A Lori, Adriana %A Liu, Jiaqi %A Mei, Zhen %A Wingo, Thomas S %A Wingo, Aliza P %K diverse %K Purpose in life %X

BACKGROUND: Purpose-in-life (PiL) refers to the tendency to derive meaning and purpose from daily life experiences. Individuals with higher PiL were more likely to have better physical, mental, and cognitive health in prospective studies. Here, we aimed to identify important correlates of PiL among people of diverse backgrounds.

METHODS: Participants were recruited by the population-based Health and Retirement Study and provided information on 34 different sociodemographic and psychosocial factors through psychometrically validated measures. To identify important correlates of PiL, we employed regularized regression implemented by Elastic Net on the entire cohort as well as among self-identified black participants only and white participants only, respectively.

RESULTS: A total of 6,620 participants were included in this study, among whom 913 were black and 5,707 were white. We identified 12 and 23 important sociodemographic and psychosocial correlates of PiL among black and white participants, respectively. Notably, all the 12 correlates in black participants were also correlates among white participants. Interestingly, when we examined both black and white participants together, being black was associated with having higher PiL. The correlates with the largest effect on PiL that were shared among black and white participants were hopelessness, perceived constraint on personal control, and self-mastery.

CONCLUSION: Several sociodemographic and psychosocial factors most strongly associated with PiL were shared among black and white participants. Future studies should investigate whether interventions targeting correlates of PiL can lead to higher sense of life purpose in participants of diverse backgrounds.

%B Am J Geriatr Psychiatry %G eng %R 10.1016/j.jagp.2023.03.003 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia. %A Hsu, Kristie Y %A Cenzer, Irena %A Harrison, Krista L %A Ritchie, Christine S %A Waite, Linda %A Kotwal, Ashwin %K Dementia %K depression %K health %K Loneliness %K Marital quality %K sickness %K Spouses %X

BACKGROUND: Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes.

METHODS: We used a US population-based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3-item scale), depressive symptoms (CESD-8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health-related characteristics. We then tested for interaction terms between marital quality (4-item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms.

RESULTS: The sample was 55% women and on average 67-years-old (range: 50-97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20%, CIND: 23%, PLwD: 29%; p = 0.04), depressed (NCI: 8%, CIND: 15%, PLwD: 14%; p < 0.01), and both (NCI: 4%, CIND: 9%, PLwD: 7%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p-value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37).

CONCLUSIONS: One in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high-quality social connection, clinical teams might improve the lives of older couples facing dementia.

%B J Am Geriatr Soc %G eng %R 10.1111/jgs.18520 %0 Journal Article %J SSM - Population Health %D 2023 %T In the wake of a crisis: Caught between housing and healthcare %A Monica Hernandez %A Rebeca Wong %A Xiaoying Yu %A Neil Mehta %K Foregone medication due to cost %K Great Recession %K Health Disparities %K Housing insecurity %K Medicare Beneficiaries %X Objective To measure the association between housing insecurity and foregone medication due to cost among Medicare beneficiaries aged 65+ during the Recession. Methods Data came from Medicare beneficiaries aged 65+ years from the 2006–2012 waves of the Health and Retirement Study (HRS). Two-wave housing insecurity changes are evaluated as follows: (i) No insecurity, (ii) Persistent insecurity, (iii) Onset insecurity, and (iv) Onset security. We implemented a series of four weighted longitudinal General Estimating Equation (GEE) models, two minimally adjusted and two fully adjusted models, to estimate the probability of foregone medications due to cost between 2008-2012. Results Our study sample was restricted to non-proxy interviews of non-institutionalized Medicare beneficiaries aged 65+ in the 2006 wave (n = 9936) and their follow up visits (n = 8753; in 2008; n = 7464 in 2010; and n = 6594 in 2012). Results from our fully adjusted model indicated that the odds of foregone medication was 64% higher among individuals experiencing Onset insecurity versus No insecurity in 2008, and also generally larger for individuals experiencing Onset Insecurity versus Persistent Insecurity. Odds of foregone medication was also larger among females, minority versus non-Hispanic white adults, those reporting a chronic condition, those with higher medical expenditures, and those living in the South versus Northeast. Conclusion This study drew from nationally representative data to elucidate the disparate health and financial impacts of a crisis on Medicare beneficiaries who, despite health insurance coverage, displayed variability in foregone medication patterns. Our findings suggest that the onset of housing insecurity is most closely linked with unexpected acute economic shocks leading households with little time to adapt and forcing trade-offs in their prescription and other needs purchases. Both housing and healthcare policy implications exist from these findings including expansion of low-income housing units and rent relief post-recession as well as wider prescription drug coverage for Medicare adults. %B SSM - Population Health %P 101453 %G eng %R https://doi.org/10.1016/j.ssmph.2023.101453 %0 Journal Article %J PLoS One %D 2023 %T Inequality in housing transitions during cognitive decline. %A Mawhorter, Sarah L %A Wilkie, Rachel Z %A Jennifer A Ailshire %K Caregivers %K Cognitive Dysfunction %K Dementia %K Housing %K Humans %K Nursing homes %K Quality of Life %K United States %X

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

%B PLoS One %V 18 %P e0282329 %G eng %N 4 %R 10.1371/journal.pone.0282329 %0 Journal Article %J Annals of Surgery %D 2023 %T The Influence of Cognitive Impairment on Post-Operative Outcomes. %A Blair, Emilie M %A Deborah A Levine %A Hu, Hsou Mei %A Kenneth M. Langa %A Mohammed U Kabeto %A Waljee, Jennifer %K cognition impairment %K Postoperative Period %X

OBJECTIVE: To examine differences in rates of elective surgery, postoperative mortality, and readmission by pre-existing cognitive status among Medicare beneficiaries undergoing surgery.

BACKGROUND: Mild cognitive impairment (MCI) is common among older adults, but the impact of MCI on surgical outcomes is understudied.

METHODS: We conducted a retrospective cohort study of individuals ≥65 who underwent surgery between 2001 and 2015 using data from the nationally-representative Health and Retirement Study linked with Medicare claims. Cognitive status was assessed by the modified Telephone Interview for Cognitive Status score and categorized as normal cognition (score: 12-27), MCI (7-11), and dementia (<7). Outcomes were 30- and 90-day postoperative mortality and readmissions. We used Cox proportional hazard models to estimate the risk of each outcome by cognition, adjusting for patient characteristics.

RESULTS: In 6,590 patients, 69.9% had normal cognition, 20.1% had MCI, and 9.9% had dementia. Patients with MCI (79.9%) and dementia (73.6%) were less likely to undergo elective surgery than patients with normal cognition (85.9%). Patients with MCI had similar postoperative mortality and readmissions rates as patients with normal cognition. However, patients with dementia had significantly higher postoperative 90-day mortality (5.2% vs. 8.4%, p=0.002) and readmission rates (13.9% vs. 17.3%, p=0.038).

CONCLUSION: Patients with self-reported MCI are less likely to undergo elective surgery but have similar postoperative outcomes compared with patients with normal cognition. Despite the variability of defining MCI, our findings suggest that MCI may not confer additional risk for older individuals undergoing surgery, and should not be a barrier for surgical care.

%B Annals of Surgery %V 277 %P e212-e217 %G eng %N 1 %R 10.1097/SLA.0000000000004799 %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 Family Issues %D 2023 %T Interpersonal Discrimination and Relationship Quality among Married Mid-Life and Older Black Adults %A Andrea K. Henderson %A Jaclyn S. Wong %A Adrianne Dues %A Katrina M. Walsemann %K Black adults %K Interpersonal discrimination %K Older Adults %K relationship quality %X Theories of minority stress contagion suggest that the consequences of racial discrimination may extend beyond the individual to impact close others. We empirically test direct and spillover associations between racialized stress and marital support and strain among mid-life and older Black spouses. We use actor-partner interdependence models to analyze dyadic data from 280 different-sex, married Black couples from the 2014 and 2016 Health and Retirement Study who completed the psychosocial leave-behind module. We find significant actor effects for husbands’ racial discrimination on their own marital support and strain, while wives’ racial discrimination is positively associated with their own marital strain. We find no evidence of partner effects nor significant gender differences in the association between racial discrimination and marital quality. The findings highlight pathways by which racial discrimination affects the marriage quality of Black men and women in mid- to late-life. %B Journal of Family Issues %P 0192513X221150988 %G eng %R 10.1177/0192513X221150988 %0 Journal Article %J Research on Aging %D 2023 %T Job Quality in the Late Career in Sweden, Japan and the United States. %A Platts, Loretta G %A Sacco, Lawrence B %A Hiyoshi, Ayako %A Westerlund, Hugo %A Cahill, Kevin E %A König, Stefanie %K international comparative study %K post-retirement work %K Working conditions %K working retirees %X

Increasing numbers of older workers continue to work after being eligible to claim a state pension, yet little is known about the quality of these jobs. We examine how psychosocial and physical job quality as well as job satisfaction vary over the late career in three contrasting national settings: Sweden, Japan and the United States. Analyses using random effects modelling drew on data from the Swedish Longitudinal Occupational Survey of Health ( = 13,936-15,520), Japanese Study of Ageing and Retirement ( = 3704) and the Health and Retirement Study ( = 6239 and 8002). Age was modelled with spline functions in which two knots were placed at ages indicating eligibility for pensions claiming or mandatory retirement. In each country, post-pensionable-age jobs were generally less stressful, freer and more satisfying than jobs held by younger workers, results that held irrespective of gender or education level.

%B Research on Aging %G eng %R 10.1177/01640275221075985 %0 Journal Article %J Cell Genomics %D 2023 %T Joint analysis of GWAS and multi-omics QTL summary statistics reveals a large fraction of GWAS signals shared with molecular phenotypes %A Yang Wu %A Ting Qi %A Naomi R. Wray %A Peter M. Visscher %A Jian Zeng %A Jian Yang %K Bayesian analysis %K complex trait %K gene discovery %K genetic regulatory mechanisms %K Genome-Wide Association Study %K joint analysis %K molecular phenotype %K molecular quantitative trait locus %K multi-omics %K summary statistics %X Summary Molecular quantitative trait loci (xQTLs) are often harnessed to prioritize genes or functional elements underpinning variant-trait associations identified from genome-wide association studies (GWASs). Here, we introduce OPERA, a method that jointly analyzes GWAS and multi-omics xQTL summary statistics to enhance the identification of molecular phenotypes associated with complex traits through shared causal variants. Applying OPERA to summary-level GWAS data for 50 complex traits (n = 20,833–766,345) and xQTL data from seven omics layers (n = 100–31,684) reveals that 50% of the GWAS signals are shared with at least one molecular phenotype. GWAS signals shared with multiple molecular phenotypes, such as those at the MSMB locus for prostate cancer, are particularly informative for understanding the genetic regulatory mechanisms underlying complex traits. Future studies with more molecular phenotypes, measured considering spatiotemporal effects in larger samples, are required to obtain a more saturated map linking molecular intermediates to GWAS signals. %B Cell Genomics %P 100344 %G eng %R https://doi.org/10.1016/j.xgen.2023.100344 %0 Journal Article %J JOURNAL OF RISK AND INSURANCE %D 2023 %T Lapses in long-term care insurance %A Friedberg, Leora %A Hou, Wenliang %A Sun, Wei %A Webb, Anthony %K cognitively impaired %K Long-term Care %X About a quarter of long-term care insurance (LTCI) policy holders aged 65 let their policies lapse before death, forfeiting all benefits. We find that lapse rates are substantially higher among the cognitively impaired in the Health and Retirement Study. This generates a pernicious form of dynamic advantageous selection, as the cognitively impaired are more likely to use care. Simulations show that an inappropriately optimistic asset drawdown path further increases the individual welfare cost of unanticipated lapses. Meanwhile, we find evidence of a significant but very small role for either strategic or financial motives for lapsing. %B JOURNAL OF RISK AND INSURANCE %G eng %R 10.1111/jori.12425 %0 Web Page %D 2023 %T Lecanemab Prescriptions Could Increase Medicare Annual Spending by Up to $5 Billion %A Caitlin Heaney West %K Alzheimer %K Health Care Costs %K lecanemab %K Medicare spending %I NeurologyToday %G eng %U https://journals.lww.com/neurotodayonline/blog/breakingnews/pages/post.aspx?PostID=1356 %0 Report %D 2023 %T Living arrangements and food insufficiency among seniors %A Tara Watson %A Lara Shore-Sheppard %A Lucie Schmidt %A Kristin Butcher %X This study investigates recent trends in living arrangements among older Americans and how they relate to nutrition assistance program participation and food insufficiency. We specifically focus on the rising propensity for older adults to live with children under 18 and the decline in living in institutions. We find that both of these living arrangements are associated with SNAP participation and with patterns of food insufficiency. Using an event study design, we find suggestive evidence that living in an institution may alleviate food insufficiency. Seniors living with children under 18 appear to have rising rates of food insufficiency even before the period of co-residence, suggesting that other factors may be driving both food hardship and living arrangements. %B University of Kentucky Center for Poverty Discussion Paper Series %I University of Kentucky Center For Poverty Research %C Lexington, Kentucky %G eng %U https://ukcpr.org/sites/ukcpr/files/research-pdfs/DP2023-09.pdf %0 Web Page %D 2023 %T Loneliness in later life lessens when older adults spend many hours volunteering %A Wadley, Jared %K Loneliness %K Volunteering %I Michigan News, University of Michigan %G eng %U https://news.umich.edu/loneliness-in-later-life-lessens-when-older-adults-spend-many-hours-volunteering/#:~:text=Volunteering%20not%20only%20fulfills%20a,a%20major%20public%20health%20problem. %0 Journal Article %J The Journals of Gerontology, Series B %D 2023 %T The Long Shadow: Early Life Adversity and Later Life Loneliness in the United States. %A Furuya, Shiro %A Wang, Jia %K Childhood adversity %K life course %K Loneliness %X

OBJECTIVES: This study assesses how early life adversity (ELA) is associated with later life loneliness among those aged 55 and over in the U.S. We consider multiple domains of ELA to understand domain-specific associations between ELA and later life loneliness.

METHODS: Using data from the 2008 to 2016 rounds of Health and Retirement Study (n = 29,661 person-waves (weighted)), we evaluate whether and how different domains of ELA are associated with loneliness, and how their relationships are explained through adulthood conditions and are dependent upon educational attainment.

RESULTS: Our analyses demonstrate significant and distinctive relationships between various domains of ELA and later life loneliness. Whereas adulthood conditions largely explain positive associations between loneliness with some domains of ELA (socioeconomic disadvantages and chronic diseases), disruptive home environment, risky adolescent behaviors, and impairment during childhood are still related to a higher level of loneliness after controlling for adulthood conditions. We also find empirical evidence supporting educational differences in relationships between some ELA domains and later life loneliness. Our results also show that the associations between ELA and later life loneliness differ between subdimensions of loneliness (emotional versus social loneliness).

DISCUSSION: This study underscores ELA as an important early life risk factor contributing to later life loneliness. Our findings suggest that policy interventions to reduce adverse childhood experiences may alleviate individuals' exposure to loneliness in later life.

%B The Journals of Gerontology, Series B %V 78 %P 370-382 %G eng %N 2 %R 10.1093/geronb/gbac164 %0 Journal Article %J Obesity (Silver Spring) %D 2023 %T Longitudinal body weight dynamics in relation to cognitive decline over two decades: A prospective cohort study. %A Zhou, Tianjing %A Chen, Hui %A Huang, Yuhui %A Wang, Binghan %A Zheng, Yan %A Wang, Liang %A Rong, Shuang %A Ma, Yuan %A Yuan, Changzheng %K Aged %K Body Weight %K Cognitive Dysfunction %K Humans %K Longitudinal Studies %K Middle Aged %K Prospective Studies %K Weight Gain %K Weight Loss %X

OBJECTIVE: The aim of this study was to investigate the associations of body weight change (BWC) and body weight variability (BWV) with changes in cognitive function.

METHODS: In 10,340 Health and Retirement Study participants (mean age: 68.0 years), body weight was reported biennially from 1993/1994 to 2016, and cognitive function was measured biennially from 1998 to 2016. We calculated BWC and BWV as the slope and root-mean-square error by regressing body weight on time for each individual. BWC was categorized by quintiles (Q): stable weight (Q2 to Q4), weight loss (Q1), and weight gain (Q5). BWV was categorized by tertiles. We used linear mixed regression models to assess associations with cognitive change.

RESULTS: Compared with stable weight (median: 0 kg/y), weight loss (median: -1.3 kg/y) predicted faster cognitive decline as demonstrated by mean difference of -0.023 (95% CI: -0.027 to -0.019) in cognitive change z score per year, whereas weight gain (median: 1 kg/y) was related to slower cognitive decline (β = 0.006; 95% CI: 0.003 to 0.009). Larger BWV was also associated with faster cognitive decline (β comparing the top with bottom tertile = -0.003; 95% CI: -0.006 to -0.0002). Similar associations were observed for episodic and working memory.

CONCLUSIONS: Weight loss and large BWV over a long time independently predicted faster cognitive decline in middle-aged and older adults, underscoring the importance of long-term dynamic body weight monitoring.

%B Obesity (Silver Spring) %V 31 %P 852-860 %8 2023 Mar %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/36782381?dopt=Abstract %R 10.1002/oby.23671 %0 Journal Article %J Alzheimer's research & therapy %D 2023 %T A longitudinal study of polygenic score and cognitive function decline considering baseline cognitive function, lifestyle behaviors, and diabetes among middle-aged and older US adults. %A Liu, Tingting %A Li, Changwei %A Zhang, Ruiyuan %A Millender, Eugenia Flores %A Miao, Hongyu %A Ormsbee, Michael %A Guo, Jinzhen %A Westbrook, Adrianna %A Pan, Yang %A Wang, Jing %A Kelly, Tanika N %K Adult %K Aged %K Apolipoproteins E %K Cognition %K Cognitive Dysfunction %K Diabetes Mellitus %K Humans %K Life Style %K Longitudinal Studies %K Middle Aged %X

BACKGROUND: Genomic study of cognition decline while considering baseline cognition and lifestyle behaviors is scarce. We aimed to evaluate the impact of a polygenic score for general cognition on cognition decline rate, while considering baseline cognition and lifestyle behaviors, among the general population and people with diabetes, a patient group commonly affected by cognition impairment.

METHODS: We tested associations of the polygenic score for general cognition with annual changing rates of cognition measures in 8 years of follow-up among 12,090 White and 3100 Black participants of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 50 years and older in the USA. Cognition measures including word recall, mental status, and total cognitive score were measured biannually. To maximize sample size and length of follow-up, we treated the 2010 wave of survey as baseline, and follow-up data until 2018 were analyzed. Baseline lifestyle behaviors, APOE status, and measured cognition were sequentially adjusted. Given racial differences in polygenic score, all analyses were conducted by race.

RESULTS: The polygenic score was significantly associated with annual changing rates of all cognition measures independent of lifestyle behaviors and APOE status. Together with age and sex, the polygenic score explained 29.9%, 15.9%, and 26.5% variances of annual changing rates of word recall, mental status, and total cognitive scores among Whites and explained 17.2%, 13.9%, and 18.7% variance of the three traits among Blacks. Among both White and Black participants, those in the top quartile of polygenic score had the three cognition measures increased annually, while those in the bottom quartile had the three cognition measures decreased annually. After further adjusting for the average cognition assessed in 3 visits around baseline, the polygenic score was still positively associated with annual changing rates of all cognition measures for White (P ≤ 2.89E - 19) but not for Black (P ≥ 0.07) participants. In addition, among participants with diabetes, physical activity offset the genetic susceptibility to decline of mental status (interaction P ≤ 0.01) and total cognitive scores (interaction P = 0.03).

CONCLUSIONS: Polygenic score predicted cognition changes in addition to measured cognition. Physical activity offset genetic risk for cognition decline among diabetes patients.

%B Alzheimer's research & therapy %V 15 %P 196 %G eng %N 1 %R 10.1186/s13195-023-01343-1 %0 Journal Article %J Aging & Mental Health %D 2023 %T Long-term psychological consequences of parental bereavement prior to midlife: volunteering helps. %A Huo, Meng %A Kim, Kyungmin %A Wang, Dahua %K bereaved parents %K child loss %K depression %K volunteer %X

OBJECTIVES: Losing a child prior to midlife may be a uniquely traumatic event that continues to compromise parents' well-being in later life. This study compared psychological well-being between bereaved and non-bereaved parents, and examined whether volunteering protects bereaved parents. Because most families have more than one child, we further explored whether the number of living children parents had differentiated bereaved parents in their well-being.

METHODS: We analyzed a pooled sample of parents aged 50+ ( = 12,023) from the (2010/2012-2012/2014), including parents who lost a child prior to 50 and those who never lost a child. Two-level linear regression models were estimated to test the associations between child loss, volunteering, and psychological well-being, and examine the moderating effect of number of living children.

RESULTS: Bereaved parents reported more depressive symptoms and lower life satisfaction than their non-bereaved counterparts, which was more evident among parents with fewer children alive. Among bereaved parents, volunteering, particularly volunteering 100+ hours/year, was associated with better psychological well-being at baseline; yet, volunteering 1-99 hours/year led to a larger increase in life satisfaction over time. The benefits of volunteering held true regardless of the number of living children.

CONCLUSION: This study adds to our understanding of the lasting effect of parental bereavement and suggests volunteering as a potential intervention aimed at helping bereaved older parents. Findings identify parents with fewer children as a particularly vulnerable population in the face of child loss and calls for more resources allocated to help them.

%B Aging & Mental Health %G eng %R 10.1080/13607863.2022.2087209 %0 Journal Article %J BMC Med %D 2023 %T Long-term variability in physiological measures in relation to mortality and epigenetic aging: prospective studies in the USA and China. %A Chen, Hui %A Zhou, Tianjing %A Wu, Shaowei %A Cao, Yaying %A Zong, Geng %A Yuan, Changzheng %K Aging %K China %K Epigenesis, Genetic %K Humans %K Longitudinal Studies %K Prospective Studies %X

BACKGROUND: Visit-to-visit body weight variability (BWV), pulse rate variability (PRV), and blood pressure variability (BPV) have been respectively linked to multiple health outcomes. The associations of the combination of long-term variability in physiological measures with mortality and epigenetic age acceleration (EAA) remain largely unknown.

METHODS: We constructed a composite score of physiological variability (0-3) of large variability in BWV, PRV, and BPV (the top tertiles) in 2006/2008-2014/2016 in the Health and Retirement Study (HRS) and 2011-2015 in the China Health and Retirement Longitudinal Study (CHARLS). All-cause mortality was documented through 2018. EAA was calculated using thirteen DNA methylation-based epigenetic clocks among 1047 participants in a substudy of the HRS. We assessed the relation of the composite score to the risk of mortality among 6566 participants in the HRS and 6906 participants in the CHARLS by Cox proportional models and then investigated its association with EAA using linear regression models.

RESULTS: A higher score of variability was associated with higher mortality risk in both cohorts (pooled hazard ratio [HR] per one-point increment, 1.27; 95% confidence interval [CI], 1.18, 1.39; P-heterogeneity = 0.344), after adjustment for multiple confounders and baseline physiological measures. Specifically, each SD increment in BWV, PRV, and BPV was related to 21% (95% CI: 15%, 28%), 6% (0%, 13%), and 12% (4%, 19%) higher hazard of mortality, respectively. The composite score was significantly related to EAA in second-generation clocks trained on health outcomes (e.g., standardized coefficient = 0.126 in the Levine clock, 95% CI: 0.055, 0.196) but not in most first-generation clocks trained on chronological age.

CONCLUSIONS: Larger variability in physiological measures was associated with a higher risk of mortality and faster EAA.

%B BMC Med %V 21 %P 20 %8 2023 Jan 16 %G eng %N 1 %R 10.1186/s12916-022-02674-w %0 Web Page %D 2023 %T Low wages linked with elevated mortality risk for middle-age workers in the US, study finds %A McPhillips, Deidre %A Wallace, Alicia %K low wages %K mortality risk %I CNN %G eng %U https://www.cnn.com/2023/02/21/health/wages-mortality-risk/index.html %0 Journal Article %J Neurology %D 2023 %T Measures of Aging Biology in Saliva and Blood as Novel Biomarkers for Stroke and Heart Disease in Older Adults. %A Waziry, Reem %A Gu, Yian %A Boehme, Amelia K %A Williams, Olajide A %K Aged %K Aging %K Biology %K Biomarkers %K DNA Methylation %K Heart Diseases %K Humans %K Middle Aged %K Saliva %K Stroke %K United States %X

BACKGROUND AND OBJECTIVES: The role of aging biology as a novel risk factor and biomarker for vascular outcomes in different accessible body tissues such as saliva and blood remain unclear. We aimed to (1) assess the role of aging biology as a risk factor of stroke and heart disease among individuals of same chronologic age and sex and (2) compare aging biology biomarkers measured in different accessible body tissues as novel biomarkers for stroke and heart disease in older adults.

METHODS: This study included individuals who consented for blood and saliva draw in the Venous Blood Substudy and Telomere Length Study of the Health and Retirement Study (HRS). The HRS is a population-based, nationally representative longitudinal survey of individuals aged 50 years and older in the United States. Saliva-based measures included telomere length. Blood-based measures included DNA methylation and physiology biomarkers. Propensity scores-matched analyses and Cox regression models were conducted.

RESULTS: This study included individuals aged 50 years and older, who consented for blood (N = 9,934) and saliva (N = 5,808) draw in the HRS. Blood-based biomarkers of aging biology showed strong associations with incident stroke as follows: compared with the lowest tertile of blood-based biomarkers of aging, biologically older individuals had significantly higher risk of stroke based on DNA methylation Grim Age clock (adjusted hazard ratio [aHR] = 2.64, 95% CI 1.90-3.66, < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.75, 95% CI 1.27-2.42, < 0.001). In secondary analysis, biologically older individuals had increased risk of heart disease as follows: DNA methylation Grim Age clock (aHR = 1.77, 95% CI 1.49-2.11, < 0.001) and Physiology-based Phenotypic Age clock (aHR = 1.61, 95% CI 1.36-1.90, < 0.001).

DISCUSSION: Compared with saliva-based telomere length, blood-based aging physiology and some DNA methylation biomarkers are strongly associated with vascular disorders including stroke and are more precise and sensitive biomarkers of aging. Saliva-based telomere length and blood-based DNA methylation and physiology biomarkers likely represent different aspects of biological aging and accordingly vary in their precision as novel biomarkers for optimal vascular health.

%B Neurology %V 101 %P e2355-e2363 %G eng %N 23 %R 10.1212/WNL.0000000000207909 %0 Journal Article %J Alzheimer's & Dementia (Amsterdam, Netherlands) %D 2023 %T Memory and language cognitive data harmonization across the United States and Mexico. %A Arce Rentería, Miguel %A Briceño, Emily M %A Chen, Diefei %A Saenz, Joseph %A Lindsay C Kobayashi %A Gonzalez, Christopher %A Vonk, Jet M J %A Richard N Jones %A Jennifer J Manly %A Wong, Rebeca %A David R Weir %A Kenneth M. Langa %A Gross, Alden L %K Alzheimer's disease %K cognitive aging %K cross‐cultural %K cultural neuropsychology %K harmonization %X

INTRODUCTION: We used cultural neuropsychology-informed procedures to derive and validate harmonized scores representing memory and language across population-based studies in the United States and Mexico.

METHODS: Data were from the Health and Retirement Study Harmonized Cognitive Assessment Protocol (HRS-HCAP) and the Mexican Health and Aging Study (MHAS) Ancillary Study on Cognitive Aging (Mex-Cog). We statistically co-calibrated memory and language domains and performed differential item functioning (DIF) analysis using a cultural neuropsychological approach. We examined relationships among harmonized scores, age, and education.

RESULTS: We included 3170 participants from the HRS-HCAP (age = 76.6 [standard deviation (SD): 7.5], 60% female) and 2042 participants from the Mex-Cog (age = 68.1 [SD: 9.0], 59% female). Five of seven memory items and one of twelve language items demonstrated DIF by study. Harmonized memory and language scores showed expected associations with age and education.

DISCUSSION: A cultural neuropsychological approach to harmonization facilitates the generation of harmonized measures of memory and language function in cross-national studies.

HIGHLIGHTS: We harmonized memory and language scores across studies in the United States and Mexico.A cultural neuropsychological approach to data harmonization was used.Harmonized scores showed minimal measurement differences between cohorts.Future work can use these harmonized scores for cross-national studies of Alzheimer's disease and related dementias.

%B Alzheimer's & Dementia (Amsterdam, Netherlands) %V 15 %P e12478 %G eng %N 3 %R 10.1002/dad2.12478 %0 Journal Article %J Journal of Pension Economics and Finance %D 2023 %T Migration, work, and retirement: the case of Mexican-origin populations %A Emma Aguila %A Lee, Zeewan %A Rebeca Wong %K Hispanics %K Immigrants %K Retirement %K Social Security %X Mexico and the United States both face rapid population aging as well as older populations with high poverty rates. Among the most vulnerable populations of retirement age in either nation are Mexican immigrants to the United States. This work uses data from the U.S. Health and Retirement Study and the Mexican Health and Aging Study to assess retirement decisions among persons born in Mexico and working in either nation as well as such decisions by non-Hispanic Whites in the United States. Social security system incentives matter for the retirement of Mexican immigrants in the U.S. but not for return-migrants in Mexico. %B Journal of Pension Economics and Finance %G eng %R 10.1017/S1474747221000342 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T The mode effect of web-based surveying on the 2018 HRS measure of cognitive functioning. %A Domingue, Benjamin W %A McCammon, Ryan %A Brady T. West %A Kenneth M. Langa %A David R Weir %A Jessica Faul %X

OBJECTIVES: Measuring cognition in an aging population is a public health priority. A move towards survey measurement via the web (as opposed to phone or in-person) is cost effective but challenging as it may induce bias in cognitive measures. We examine this possibility using an experiment embedded in the 2018 wave of data collection for the US Health and Retirement Study (HRS).

METHODS: We utilize techniques from multiple group item response theory to assess the effect of survey mode on performance on the HRS cognitive measure. We also study the problem of attrition by attempting to predict dropout and via approaches meant to minimize bias in subsequent inferences due to attrition.

RESULTS: We find evidence of an increase in scores for HRS respondents who are randomly assigned to the web-based mode of data collection in 2018. Web-based respondents score higher in 2018 than do phone-based respondents, and they show much larger gains relative to 2016 performance and subsequently larger declines in 2020. The bias in favor of web-based responding is observed across all items, but most pronounced for the serial 7 task and numeracy items. Due to the relative ease of the web-based mode, we suggest a cutscore of 12 being used to indicate CIND (cognitively impaired but not demented) status when using the web-based version rather than 11.

DISCUSSION: The difference in mode may be non-ignorable for many uses of the HRS cognitive measure. In particular, it may require reconsideration of some cutscore-based approaches to identify impairment.

%B J Gerontol B Psychol Sci Soc Sci %G eng %R 10.1093/geronb/gbad068 %0 Journal Article %J Chronic Stress (Thousand Oaks, Calif.) %D 2023 %T More Problems, More Pain: The Role of Chronic Life Stressors and Racial/Ethnic Identity on Chronic Pain Among Middle-Aged and Older Adults in the United States. %A Spector, Antoinette L %A Quinn, Katherine G %A Wang, Inga %A Gliedt, Jordan A %A Fillingim, Roger B %A Cruz-Almeida, Yenisel %K Chronic pain %K Chronic stressors %K Health and Retirement Study %K high-impact chronic pain %K middle-aged and older adults %X

There is a high prevalence of chronic pain among middle-aged and older adults in the United States. Chronic life stressors have been shown to have detrimental consequences for myriad health conditions, including chronic pain. However, there is limited evidence on the types of chronic life stressors that affect middle-aged and older adults and how these stressors influence the chronic pain burden in this population. Moreover, the interaction between chronic life stressors and racial/ethnic identity remains poorly understood as it relates to chronic pain. The current analysis used the 2018 Health and Retirement Study to investigate relationships between chronic life stressors and odds to experience any chronic pain and high-impact chronic pain. Chronic life stressors were characterized, overall and by racial/ethnic identity, and the main and interaction effects were calculated to evaluate relationships between chronic life stressors, racial/ethnic identity, and odds of experiencing any chronic pain and high-impact chronic pain. Results indicate that in 2018, the most common chronic life stressor among middle-aged and older adults was dealing with their own health problems (68%), followed by dealing with the physical or emotional issues affecting a spouse or child (46%). Adjusted analyses showed that a higher total of chronic life stressors increased the odds of middle-aged and older adults experiencing any chronic pain and high-impact chronic pain. There were no significant interactions between the overall chronic life stress burden and racial/ethnic identity as a predictor of odds to experience any chronic pain or high-impact chronic pain, but significant interaction effects were found related to specific chronic life stressors. Findings underscore the significant impact of chronic life stressors on the chronic pain burden among middle-aged and older adults in the United States, which cut across racial/ethnic identity.

%B Chronic Stress (Thousand Oaks, Calif.) %V 7 %P 24705470231208281 %G eng %R 10.1177/24705470231208281 %0 Journal Article %J Ann Am Thorac Soc %D 2023 %T National Prevalence of Social Isolation and Loneliness in Adults with Chronic Obstructive Pulmonary Disease. %A Suen, Angela O %A Iyer, Anand S %A Cenzer, Irena %A Farrand, Erica %A White, Douglas B %A Singer, Jonathan %A Sudore, Rebecca %A Kotwal, Ashwin %X

RATIONALE: Social isolation and loneliness are gaining recognition for their role in health outcomes, yet have not been defined in people with COPD.

OBJECTIVE: To determine the national prevalence of and characteristics associated with social isolation and loneliness in people with COPD.

METHODS: This is a cross-sectional study of community-dwelling adults aged ≥50 years in the nationally-representative Health and Retirement Study (HRS) (2016-2018). Participants self-reported COPD and supplemental oxygen use and were categorized into three groups: 1) no COPD; 2) COPD; and 3) COPD on oxygen. Social isolation was defined using a 9-item scale indicating minimal household contacts, social network interaction, and community engagement. Loneliness was measured using the 3-item UCLA Loneliness Scale. Multivariable logistic regression defined prevalence and associated characteristics for both.

RESULTS: Participants (n=10,384) were on average 68 years old (SD±10.5), 54% female, 10% Black, 11% self-reported COPD, and 2% self-reported supplemental oxygen. Overall, 12% were socially isolated, 12% lonely, and 3% both socially isolated and lonely. People with COPD had a higher adjusted prevalence of social isolation (no COPD: 11%, COPD: 16%, COPD on oxygen: 20%, p<0.05) and loneliness (no COPD: 11%, COPD: 18%, COPD on oxygen: 22%, p<0.001). In those with COPD, characteristics associated with social isolation (p<0.05) included gender (men: 22%, women: 13%), non-Hispanic White ethnicity (White: 19%, Black: 7%), low net-worth ($<6000: 32%, $81,001-239,000: 10%), depression (depression: 24%, no depression: 14%), having ≥1 ADL difficulty (≥1 difficulty: 22%, no difficulty: 14%), and current cigarette use (current: 24%, never: 13%). Characteristics associated with loneliness (p<0.05) included younger age (50-64 years: 22%, 75-84 years: 12%), being single (single: 32%, married: 12%), depression (depression: 36%, no depression: 13%), having ≥1 ADL difficulty (≥1 difficulty: 29%, no difficulty: 15%), diabetes (diabetes: 26%, no diabetes: 17%), and heart disease (heart disease 23%, no heart disease: 17%).

CONCLUSIONS: Nearly 1 in 6 adults with COPD experience social isolation, and 1 in 5 experience loneliness, with almost twice the prevalence among those on supplemental oxygen compared to the general population. Demographic and clinical characteristics identify those at highest risk to guide clinical and policy interventions. Primary source of funding: NIH NHLBI T32HL007185-45.

%B Ann Am Thorac Soc %G eng %R 10.1513/AnnalsATS.202304-288OC %0 Journal Article %J JAMA Network Open %D 2023 %T Neighborhood Characteristics and Elevated Blood Pressure in Older Adults. %A Sims, Kendra D %A Willis, Mary D %A Hystad, Perry W %A Batty, G David %A Bibbins-Domingo, Kirsten %A Smit, Ellen %A Odden, Michelle C %K Aged %K Blood pressure %K Cohort Studies %K ethnicity %K Female %K Humans %K Hypertension %K Male %K Neighborhood characteristics %X

IMPORTANCE: The local environment remains an understudied contributor to elevated blood pressure among older adults. Untargeted approaches can identify neighborhood conditions interrelated with racial segregation that drive hypertension disparities.

OBJECTIVE: To evaluate independent associations of sociodemographic, economic, and housing neighborhood factors with elevated blood pressure.

DESIGN, SETTING, AND PARTICIPANTS: In this cohort study, the sample included Health and Retirement Study participants who had between 1 and 3 sets of biennial sphygmomanometer readings from 2006 to 2014 or 2008 to 2016. Statistical analyses were conducted from February 5 to November 30, 2021.

EXPOSURES: Fifty-one standardized American Community Survey census tract variables (2005-2009).

MAIN OUTCOMES AND MEASURES: Elevated sphygmomanometer readings over the study period (6-year period prevalence): a value of at least 140 mm Hg for systolic blood pressure and/or at least 90 mm Hg for diastolic blood pressure. Participants were divided 50:50 into training and test data sets. Generalized estimating equations were used to summarize multivariable associations between each neighborhood variable and the period prevalence of elevated blood pressure, adjusting for individual-level covariates. Any neighborhood factor associated (Simes-adjusted for multiple comparisons P ≤ .05) with elevated blood pressure in the training data set was rerun in the test data set to gauge model performance. Lastly, in the full cohort, race- and ethnicity-stratified associations were evaluated for each identified neighborhood factor on the likelihood of elevated blood pressure.

RESULTS: Of 12 946 participants, 4565 (35%) had elevated sphygmomanometer readings (median [IQR] age, 68 [63-73] years; 2283 [50%] male; 228 [5%] Hispanic or Latino, 502 [11%] non-Hispanic Black, and 3761 [82%] non-Hispanic White). Between 2006 and 2016, a lower likelihood of elevated blood pressure was observed (relative risk for highest vs lowest tertile, 0.91; 95% CI, 0.86-0.96) among participants residing in a neighborhood with recent (post-1999) in-migration of homeowners. This association was precise among participants with non-Hispanic White and other race and ethnicity (relative risk, 0.91; 95% CI, 0.85-0.97) but not non-Hispanic Black participants (relative risk, 0.97; 95% CI, 0.85-1.11; P = .48 for interaction) or Hispanic or Latino participants (relative risk, 0.84; 95% CI, 0.65-1.09; P = .78 for interaction).

CONCLUSIONS AND RELEVANCE: In this cohort study of older adults, recent relocation of homeowners to a neighborhood was robustly associated with reduced likelihood of elevated blood pressure among White participants but not their racially and ethnically marginalized counterparts. Our findings indicate that gentrification may influence later-life blood pressure control.

%B JAMA Network Open %P e2335534 %8 2023 Sep 05 %G eng %N 9 %R 10.1001/jamanetworkopen.2023.35534 %0 Journal Article %J Curr Obes Rep %D 2023 %T Obesity Stigma: Causes, Consequences, and Potential Solutions. %A Westbury, Susannah %A Oyebode, Oyinlola %A van Rens, Thijs %A Barber, Thomas M %K Body Weight %K Humans %K Obesity %K Social Behavior %K Social Stigma %K Stereotyping %X

PURPOSE OF REVIEW: This review aims to examine (i) the aetiology of obesity; (ii) how and why a perception of personal responsibility for obesity so dominantly frames this condition and how this mindset leads to stigma; (iii) the consequences of obesity stigma for people living with obesity, and for the public support for interventions to prevent and manage this condition; and (iv) potential strategies to diminish our focus on personal responsibility for the development of obesity, to enable a reduction of obesity stigma, and to move towards effective interventions to prevent and manage obesity within the population.

RECENT FINDINGS: We summarise literature which shows that obesity stems from a complex interplay of genetic and environment factors most of which are outside an individual's control. Despite this, evidence of obesity stigmatisation remains abundant throughout areas of media, entertainment, social media and the internet, advertising, news outlets, and the political and public health landscape. This has damaging consequences including psychological, physical, and socioeconomic harm. Obesity stigma does not prevent obesity. A combined, concerted, and sustained effort from multiple stakeholders and key decision-makers within society is required to dispel myths around personal responsibility for body weight, and to foster more empathy for people living in larger bodies. This also sets the scene for more effective policies and interventions, targeting the social and environmental drivers of health, to ultimately improve population health.

%B Curr Obes Rep %V 12 %P 10-23 %8 2023 Mar %G eng %N 1 %R 10.1007/s13679-023-00495-3 %0 Magazine Article %D 2023 %T Older adult loneliness on the rise around the world %A Lauren Newmyer %A Ashton M. Verdery %A Haowei Wang %A Rachel Margolis %K Loneliness %K Older Adults %B IUSSP's online news magazine %G eng %U https://www.niussp.org/individual-and-population-ageing/older-adult-loneliness-on-the-rise-around-the-world/#:~:text=Expected%20demographic%20changes%20imply%20massive,to%20333%20million%20in%202050. %0 Journal Article %J Spec Care Dentist %D 2023 %T Oral health issues of early baby boomers. %A Jones, Judith A %A Moss, Kevin %A Weintraub, Jane A %K Dental Caries %K Humans %K Nutrition Surveys %K Oral Health %X

OBJECTIVES: The purpose of this article is to detail the oral health status of early baby boomers and how it is affected by the cultural influences after World War II.

METHODS: National data on clinically and self-assessed oral conditions from the 2021 NIDCR Oral Health in America Report, National Health and Nutrition Examination Survey (2011-2014), Center for Disease Control and Prevention, National Cancer Institute (2018), the Indian Health Service (2022), and the Health and Retirement Study (2018) were tabulated and compared (where available) to similar data for older and younger cohorts.

RESULTS: Data analyses show that there is more tooth retention overall. There are higher levels of tooth loss, unrestored caries, and periodontitis among Black, American Indian, Alaskan Native, and Hispanic baby boomers, and the poor. Smokers had higher rates of periodontitis.

CONCLUSION: A life course approach to oral health care is warranted. Only by regular access and preventive care throughout life can avoidable, unnecessary, overly complex, and invasive procedures be prevented.

%B Spec Care Dentist %V 43 %P 313-319 %G eng %N 3 %R 10.1111/scd.12844 %0 Journal Article %J Arch Phys Med Rehabil %D 2023 %T Positive Self-perceptions of Aging Increase Physical Resilience to Facilitate Social Re-engagement of Older Adults Who Fall: Analysis Based on Health and Retirement Study Data. %A Zhang, Zeyi %A Wang, Jingjing %A Ma, Bin %A Wang, Jingyi %A Jia, Yuanmin %A Chen, Ou %K Aging %K Older Adults %K physical resilience %X

OBJECTIVE: To determine whether self-perceptions of aging (SPAs) predict physical resilience after a fall and whether SPA and physical resilience affect subsequent social engagement in older adults with a fall.

DESIGN: Prospective cohort study.

SETTING: General community.

PARTICIPANTS: Older adults who reported a fall within 2 years after baseline data collection (N=1707, mean age 72.9 years, 60.9% women).

MAIN OUTCOME MEASURE: Physical resilience indicates the ability to resist or recover from functional decline from a stressor. The change in frailty status from directly after the fall to up to 2 years of follow-up was used to generate 4 physical resilience phenotypes. Social engagement was dichotomized based on the presence at 1 of the 5 social activities at least once a month. The 8-item Attitudes Toward Own Aging Scale was used to assess SPA at baseline. Multinomial logistic regression and nonlinear mediation analysis were used.

RESULTS: Positive prefall SPA predicted more resilient phenotypes after a fall. Both positive SPA and physical resilience affected subsequent social engagement. Physical resilience partially mediated the association between SPA and social re-engagement (mediated percentage of 14.5%, P=.004). This mediation effect was fully driven by those with previous falls.

CONCLUSION: Positive SPA promotes physical resilience in older adults with a fall, both of which affect subsequent social engagement. Physical resilience partially mediated the effect of SPA on social engagement but only for previous fallers. Multidimensional recovery incorporating psychological, physiological, and social aspects should be stressed in the rehabilitation of older adults who fall.

%B Arch Phys Med Rehabil %G eng %R 10.1016/j.apmr.2023.02.006 %0 Report %D 2023 %T Predicting individual-level longevity with statistical and machine learning methods %A Luca Badolato %A Ari Decter-Frain %A Nicholas J. Irons %A Maria Miranda %A Erin Walk %A Elnura Zhalieva %A Monica Alexander %A Ugofilippo Basellini %A Emilio Zagheni %K forecasts %K Inequality %K Longevity %K USA %X Individual-level mortality prediction is a fundamental challenge with implications for people and societies. Accurate longevity predictions improve life planning, targeting of high-risk individuals, and organization of social interventions, policies, and public spending. Demographers and actuaries have been primarily concerned with mortality modeling and prediction at a macro level, leveraging strong regularities in mortality rates over age, sex, space, and time. Besides clinical settings, individual-level mortality predictions have been largely overlooked and have remained a challenging task. We model and predict individual-level lifespan using data from the US Health and Retirement Study, a nationally representative longitudinal survey of people over 50 years of age. We estimate 12 statistical and machine learning survival analysis models using over 150 predictors measuring behavioral, biological, demographic, health, and social indicators. Extending previous research on inequalities in mortality and morbidity, we investigate inequalities in individual mortality prediction by gender, race and ethnicity, and education. Machine learning and traditional models report comparable accuracy and relatively high discriminative performance, particularly when including time-varying information (best mean Area Under the Curve = 0.87). However, the models and predictors used fail to account for a majority of lifespan heterogeneity at the individual level. We observe consistent inequalities in mortality predictability and risk discrimination, with lower prediction accuracy for men, non-Hispanic Blacks, and low-educated individuals. In addition, people in these groups show lower accuracy in their subjective predictions of their own lifespan. Finally, we see minimal variation in the top features across groups, with variables related to habits, health history, and finances being relevant predictors. Our results assess how well mortality can be predicted from representative surveys, providing baselines and guidance for future research across countries. %I Max Planck Institute %G eng %R 10.4054/MPIDR-WP-2023-008 %0 Journal Article %J 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 Aging & Mental Health %D 2023 %T Prevalence and health outcomes in community-dwelling older adults with comorbid cancer and dementia: A longitudinal analysis. %A Parajuli, Jyotsana %A Berish, Diane %A Jao, Ying-Ling %A Liao, Yo-Jen %A Johnson, Lee Ann %A Walsh, Amanda %K Cancer %K comorbid cancer-dementia %K Dementia %K health outcomes %X

OBJECTIVES: To examine health outcomes in community-dwelling older adults with: dementia only, cancer only, and comorbid cancer and dementia.

METHODS: Longitudinal analysis was conducted using data from 2010 to 2016 waves of the Health and Retirement Study. Health outcomes included mortality, limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), nursing home utilization, hospital stay, homecare use, self-rated health, and out-of-pocket medical expenditure. Panel regression was used for statistical analysis.

RESULTS: The prevalence of comorbid cancer and dementia ranged from 2.56% to 2.97%. Individuals with comorbid cancer and dementia demonstrated a higher likelihood of nursing home utilization and poorer self-rated health but a lower likelihood of hospital stay, homecare use, and out-of-pocket expenditures, compared to the cancer only or dementia only groups. The differences in mortality and ADL and IADL limitations were not statistically significant.

CONCLUSION: Comorbid cancer and dementia predicted longer nursing home utilization and poorer self-rated health. The results help guide care planning for individuals with comorbid cancer and dementia.

%B Aging & Mental Health %G eng %R 10.1080/13607863.2021.2003298 %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Prevalence of unpaid caregiving, pain, and depression in older seriously ill patients undergoing elective surgery. %A Hu, Frances Y %A Wang, Yihan %A Abbas, Muhammad %A Bollens-Lund, Evan %A Reich, Amanda J %A Lipsitz, Stuart R %A Gray, Tamryn F %A Kim, Dae %A Ritchie, Christine %A Kelley, Amy S %A Cooper, Zara %K depression %K Surgery %K unpaid caregiving %X

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

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

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

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

%B J Am Geriatr Soc %8 2023 Mar 13 %G eng %R 10.1111/jgs.18316 %0 Journal Article %J iScience %D 2023 %T Progression and trajectory network of age-related functional impairments and their combined associations with mortality %A Chen, Hui %A Wang, Binghan %A Lv, Rongxia %A Zhou, Tianjing %A Shen, Jie %A Song, Huan %A Xu, Xiaolin %A Ma, Yuan %A Yuan, Changzheng %K Age %K association analysis %K Bioinformatics %K Health sciences %X Age-related functional impairments (ARFIs) contribute to the loss of independence in older adults, but their progressions, interrelations, and combined relations with mortality are largely unknown. We conducted a prospective study among 17,914 participants in the Health and Retirement Study (2000–2020). The incidence rates of visual impairment, hearing impairment, physical frailty, and cognitive impairment increased exponentially with age, while those of restless sleep and depression increased relatively slowly. These ARFIs were associated with each other in temporal sequence and constituted a hazard network. We observed a dose-response relationship between the number of ARFIs and mortality risk, and the dyads involving physical frailty demonstrated the strongest associations with mortality. Our findings may assist in the identification of individuals at higher mortality risk and highlight the potential for future investigations to explore the impact of multiple ARFIs in aging. %B iScience %V 26 %G eng %R 10.1016/j.isci.2023.108368 %0 Report %D 2023 %T Psychosocial and Lifestyle Questionnaire 2006 - 2022 %A Jacqui Smith %A Lindsay H Ryan %A Larkina, Marina %A Amanda Sonnega %A David R Weir %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %G eng %0 Journal Article %J Population Research and Policy Review %D 2023 %T Race, gender, and cohort differences in the educational experiences of Black and White Americans %A Walsemann, Katrina M. %A Fisk, Calley E. %A Farina, Mateo P. %A Abbruzzi, Emily %A Jennifer A Ailshire %K Educational experiences %K life course %K life history %K Schools %X Federal legislation and judicial intervention led to significant transformation in the U.S. education system during the early to mid-twentieth century. These changes may differentiate older adults in their experiences of aging, particularly at the intersection of race, gender, and cohort, but are not well documented among current cohorts of older adults. Our study addresses this gap by providing rich, descriptive information on the educational experiences of U.S. adults who attended primary or secondary school between 1915 and 1977. We used data from the Health and Retirement Study (HRS), a nationally representative, prospective study of U.S. adults over age 50 years. The HRS collected information on respondents’ schooling history and experiences through a Life History Mail Survey (LHMS). We restricted our sample to age-eligible HRS-LHMS respondents who self-identified as non-Hispanic White or non-Hispanic Black and completed at least 75% of their primary or secondary schooling in the U.S. (n = 10,632). Educational experiences, defined as pre-k to post-secondary education, varied across cohort, regardless of race or gender. Greater course offerings, improvements in learning support, and increasing exposure to integrated schools occurred across successive cohorts. We found the highest rates of enrollment in college preparatory curriculum and foreign-language courses as well as diagnosed learning differences in cohorts born after 1948. Among White adults, many of the gender differences in educational experiences documented in the oldest cohort were still found among the most recent cohort. Few gender differences, however, were found for Black adults regardless of cohort. Conversely, most race inequities in educational experiences persisted. Such inequities may be an important source of continued differences in experiences of aging observed across demographic groups. © 2023, The Author(s), under exclusive licence to Springer Nature B.V. %B Population Research and Policy Review %V 42 %G eng %R 10.1007/s11113-023-09831-w %0 Journal Article %J J Am Geriatr Soc %D 2023 %T Readmissions and postdischarge mortality by race and ethnicity among Medicare beneficiaries with multimorbidity. %A Wei, Melissa Y %A Cho, Jinmyoung %X

BACKGROUND: Disparities in readmission risk and reasons they might exist among diverse complex patients with multimorbidity, disability, and unmet social needs have not been clearly established. These characteristics may be underestimated in claims-based studies where individual-level data are limited. We sought to examine the risk of readmissions and postdischarge mortality by race and ethnicity after rigorous adjustment for multimorbidity, physical functioning, and sociodemographic and lifestyle characteristics.

METHODS: We used Health and Retirement Study (HRS) data linked to Medicare claims. To obtain ICD-9-CM diagnostic codes to compute the ICD-coded multimorbidity-weighted index (MWI-ICD) we used Medicare Parts A and B (inpatient, outpatient, carrier) files between 1991-2015. Participants must have had at least one hospitalization between January 1, 2000 and September 30, 2015 and continuous enrollment in fee-for-service Medicare Part A 1-year prior to hospitalization. We used multivariable logistic regression to assess the association of MWI-ICD with 30-day readmissions and mortality 1-year postdischarge. Using HRS data, we adjusted for age, sex, BMI, smoking, physical activity, education, household net worth, and living arrangement/marital status, and examined for effect modification by race and ethnicity.

RESULTS: The final sample of 10,737 participants had mean ± SD age 75.9 ± 8.7 years. Hispanic adults had the highest mean MWI-ICD (16.4 ± 10.1), followed by similar values for White (mean 14.8 ± 8.9) and Black (14.7 ± 8.9) adults. MWI-ICD was associated with a higher odds of readmission, and there was no significant effect modification by race and ethnicity. For postdischarge mortality, a 1-point increase MWI-ICD was associated with a 3% higher odds of mortality (OR = 1.03, 95% CI: 1.03-1.04), which did not significantly differ by race and ethnicity.

CONCLUSIONS: Multimorbidity was associated with a monotonic increased odds of 30-day readmission and 1-year postdischarge mortality across all race and ethnicity groups. There was no significant difference in readmission or mortality risk by race and ethnicity after robust adjustment.

%B J Am Geriatr Soc %8 2023 Jan 27 %G eng %R 10.1111/jgs.18251 %0 Journal Article %J Soc Sci Med %D 2023 %T Reciprocal associations between social media use and self-perception of aging among older adults: Do men and women differ? %A Wang, Kun %A Gu, Danan %K Adult %K Age Factors %K Aged %K Aging %K Female %K Humans %K Male %K Retirement %K Self Concept %K Social media %X

PURPOSE: Despite the positive impact of social media use in late adulthood, social media use is still low among older adults. Research in technology adoption and utilization indicates the importance of age-specific factors, such as self-perception of aging (SPA). As it is unclear whether SPA facilitates social media use or social media use promotes SPA, reverse causality has emerged as a major point of contention within this literature, with several studies reporting conflicting results. Thus, in this study, we aim to contribute unique insight by examining (1) whether positive and negative SPAs demonstrate unique associations with social media use and (2) whether these reciprocal associations differ by gender.

METHODS: Using two waves (2014 and 2018) from the Health and Retirement Study, 4101 older Americans (age ≥65 years) with normal baseline cognition were included in this study. Autoregressive cross-lagged analyses were conducted to assess reciprocal associations between SPA and social media use among the total sample and by gender subgroups.

RESULTS: Controlling for covariates, we found that more frequent social media use marginally predicted higher positive SPA four years later (B = 0.02, p = .07), and higher negative SPA marginally predicted less frequent social media use four years later (B = -0.07, p = .08). However, the by-gender analysis showed that the positive effect of social media use on positive SPA was only significant among older men (B = 0.04, p < .05), whereas the negative impact of negative SPA on social media use only existed among older women (B = -0.13, p < .01).

CONCLUSIONS: The reciprocal associations between SPA and social media use differ by the valence of SPA (positive/negative) and gender. Future interventions for SPA and digital technology use among older adults should be gender-tailored.

%B Soc Sci Med %V 321 %P 115786 %8 2023 Mar %G eng %R 10.1016/j.socscimed.2023.115786 %0 Journal Article %J American Journal of Hospice and Palliative Medicine %D 2023 %T The Relationship Between Multiple Chronic Conditions and Physician Visits in Advance Care Planning Activities. %A Wang, Yu-Hsuan %A Enguidanos, Susan %K Advance care planning %K Advance directives %K physician visit %B American Journal of Hospice and Palliative Medicine %V 40 %P 965-970 %G eng %N 9 %R 10.1177/10499091221136854 %0 Report %D 2023 %T Representativeness of the oversamples of Blacks and Hispanics in the Health and Retirement Study: A geographic analysis of 2020 %A Schroeder, Heather %A David R Weir %A Brady T. West %K Methodology %K minorities %K oversampling %K survey design %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %G eng %0 Journal Article %J Empirical Economics %D 2023 %T A semiparametric alternative to the Heckman correction: application with left-censored data on parental transfers %A Wang, Lu %A Jiang, Yixiao %A He, Zhaochen %K Earning income tax credit (EITC) %K Heteroskedasticity %K Inter Vivos Transfers %X Using a semiparametric estimator developed by Klein and Vella (J Appl Econom 24(5):735–762, 2009b), we study the motives for parental wealth transfers to living children using left-censored data from the Health and Retirement Study. We confirm the presence of heteroskedastic errors in our data and show that the inverse Mills ratio approach employed by the Heckman correction would be biased in such a setting. Using the more flexible semiparametic approach, we find evidence of a nonlinear relationship between amount of inter vivo transfers and recipient children’s household incomes, suggesting that parents’ motives for transferring wealth may vary depending on their child’s income level. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. %B Empirical Economics %G eng %R 10.1007/s00181-023-02507-6 %0 Journal Article %J Aging Ment Health %D 2023 %T Sensory impairment and depressive symptoms among older adults before and during the COVID-19 pandemic. %A Xu, Shu %A Wang, Haowei %A Song, Qian %A Burr, Jeffrey A %K Emotional well-being; hearing impairment; public health crisis; social networks; visual impairment. %X

OBJECTIVES: This study examined the associations between sensory impairment (SI), lack of social contact during the COVID-19 pandemic, and depressive symptoms among Americans aged 50 and above.

METHODS: We employed data from the 2018 and 2020 Health and Retirement Study ( = 13,460) to examine four SI groups: no SI, visual impairment (VI) only, hearing impairment (HI) only, and dual sensory impairment (DSI). First, multilevel models were employed to estimate the associations between SI and depressive symptoms before and during the pandemic using the full dataset ( = 13,460). Second, linear regression models were employed to estimate the moderation effect of lack of social contact during the pandemic using the 2020 wave data only ( = 4,133).

RESULTS: Among older adults, 15.60% had VI only, 10.16% had HI only, and 9.66% had DSI. All SI groups reported significantly more depressive symptoms than the no SI group. The differences between older adults with VI and DSI and those without SI regarding depressive symptoms narrowed during the pandemic. There was no statistically significant moderation effect of lack of social contact for SI and depressive symptoms.

CONCLUSION: Older adults with SI faced mental health challenges and demonstrated psychological resilience during the pandemic. Future research should examine other risk factors that may modify the relationship between SI and mental health during public health crises.

%B Aging Ment Health %P 1-9 %8 2023 Aug 07 %G eng %R 10.1080/13607863.2023.2242290 %0 Web Page %D 2023 %T Should You Take Social Security at Age 62, 65, or 70? A Comprehensive Analysis Offers a Very Clear Answer %A Williams, Sean %K claiming age %K Retirement %K Social Security %I The Motley Fool %G eng %U https://www.fool.com/retirement/2023/10/07/should-you-take-social-security-at-age-62-65-or-70/ %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2023 %T Social Isolation, Sleep Disturbance, and Cognitive Functioning (HRS): A Longitudinal Mediation Study. %A Qi, Xiang %A Pei, Yaolin %A Malone, Susan K %A Wu, Bei %K cognitive functioning %K Sleep disturbance %K social isolation %X

BACKGROUND: Social isolation is prevalent and associated with dementia, yet the directionality and mechanisms are less understood. This study examined the association between social isolation and cognitive functioning and explored the mediating role of sleep disturbance on the social isolation-cognition relationship.

METHODS: Data from 5,753 dementia-free Americans aged ≥50 of 2006 (T1), 2010 (T2), and 2014 (T3) waves of the Health and Retirement Study. Social isolation was measured by the Steptoe Social Isolation Index. Cognitive functioning was measured by the Telephone Interview of Cognitive Status. Sleep disturbance was measured with the modified Jenkins Sleep Scale. We used cross-lagged panel models to determine the associations between social isolation, sleep disturbance, and cognitive functioning.

RESULTS: Social isolation is significantly associated with subsequent cognitive functioning (T1 to T2: β = -0.055, standard error [SE] = 0.014, p < 0.001; T2 to T3: β = -0.044, SE = 0.016, p < 0.001). Lower cognitive functioning is significantly associated with greater subsequent social isolation (T1 to T2: β = -0.101, SE = 0.020, p < 0.001; T2 to T3: β = -0.058, SE = 0.011, p < 0.001). Sleep disturbance at T2 partially mediated the effect of social isolation (T1) on cognitive functioning (T3), accounting for 6.2% of the total effect (β = -0.003, SE = 0.001, p < 0.01).

CONCLUSIONS: Social isolation may deteriorate cognitive functioning and vice versa. The association between social isolation and cognition is partially explained by sleep disturbance.

%B J Gerontol A Biol Sci Med Sci %G eng %R 10.1093/gerona/glad004 %0 Journal Article %J J Aging Health %D 2023 %T Social Mediators of the Association Between Depression and Falls Among Older Adults. %A Lohman, Matthew C %A Fallahi, Afsaneh %A Mishio Bawa, Eric %A Wei, Jingkai %A Merchant, Anwar T %X

OBJECTIVES: To investigate the role of social factors in the association between depression and falls among older adults.

METHODS: The sample included data from 3443 older adults from three waves of the Health and Retirement Study (2010-2014). A Lifestyle Questionnaire was used to measure social engagement, social network contact, and neighborhood social context. Mediating effects of social factors were estimated through causal mediation analysis. Poorer social engagement and network contact were associated with greater likelihood of falls, while poorer neighborhood context was associated with greater likelihood of fall injuries. Social engagement mediated a significant portion of the effect of depression on falls (OR: 1.03, 95% CI: 1.00, 1.06), and neighborhood context mediated a portion of the effect of depression on fall injuries (OR: 1.03, 95% CI: 1.00, 1.07). The direct and indirect impacts of social factors suggest that considering them may help improve existing fall prevention approaches.

%B J Aging Health %P 8982643231152276 %G eng %R 10.1177/08982643231152276 %0 Journal Article %J Journal of Social and Personal Relationships %D 2023 %T Social support and social strain from children and subsequent health and well-being among older U.S. adults %A Renae Wilkinson %A Julia S. Nakamura %A Eric S. Kim %A Tyler J. VanderWeele %K children %K Social strain %K Social Support %X Social relationships contribute to well-being across the life course and may be especially vital resources for supporting healthy aging among older adults. This research examined associations between perceptions of social support and social strain from children assessed by older adult parents and 35 indicators of physical, behavioral, and psychosocial health and well-being. We utilized three waves of data from the Health and Retirement Study (HRS; N = 11,609), a diverse, national sample of U.S. adults over age 50. We found that increases in social support were associated with better subsequent outcomes on all psychological indicators (higher positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints) and most social factors (lower loneliness, greater likelihood of contact with children and other family) over the four-year follow-up period. Results also showed that increases in social strain were subsequently related to worse functioning across all indicators of psychological well-being and select social factors (i.e., higher loneliness) and psychological distress outcomes (i.e., higher hopelessness, negative affect, and perceived constraints). However, we did not find evidence that changes in social support and social strain were associated with physical health or health behavior outcomes. %B Journal of Social and Personal Relationships %P 02654075231164900 %G eng %R 10.1177/02654075231164900 %0 Journal Article %J Journal of Pain and Symptom Management %D 2023 %T Spousal Loneliness, Depression, and Closeness Among Older Adults Married to Persons with Dementia: A Nationally Representative Study (SA314B) %A Kristie Hsu %A Irena Cenzer %A Krista Harrison %A Christine Ritchie %A Linda Waite %A Linda Waite %K closeness %K depression %K Loneliness %K Older Adults %X Outcomes 1. Analyze the role of marriage in serious illness and dementia 2. Discuss interactive biopsychosocial model underlying marriage and health among older adults with serious illness, and key social measures 3. Describe the prevalence of loneliness, depression, or both among spouses married to persons with dementia 4. Discuss how one's partner's cognitive decline is associated with higher levels of loneliness and depression Background Older adults married to persons with dementia (PWD) may be at risk for loneliness and depression. However, it is unclear how often each occur and the extent to which they are distinct. Research objectives To determine the prevalence of loneliness and depression among older adults married to PWD or mild cognitive impairment (MCI) and the role of marital closeness in mediating these outcomes Methods We used a nationally representative sample of 3,666 married couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PWD (N=201), married to persons with MCI (N=778), or married to persons with normal cognition (N=2,687). We determined the prevalence of loneliness using multivariable logistic regression adjusting for socio-demographic characteristics, then tested for interaction between marital closeness and degree of spousal cognitive impairment. We assessed the prevalence of depression, and both loneliness and depression, using the same method. Results The sample was 54% women and on average 67 years old (Range: 50–97). After adjustment, older adults married to PWD were more likely to be lonely (Normal: 20%, MCI: 21%, PWD: 30%; p=0.02), depressed (Normal: 7%, MCI: 14%, PWD: 16%; p< 0.01), and both (Normal: 4%, MCI: 8%, PWD: 9%; p< 0.01). The association between spousal cognition and loneliness differed by marital closeness (interaction p-value=0.01); among “close” couples, spousal cognitive impairment was associated with higher likelihood of loneliness (p=0.01). In contrast, no association existed between spousal cognitive impairment and loneliness among “not close” couples (p=0.24). Conclusion Nearly 1 in 3 spouses of PWD experienced loneliness and 1 in 6 experienced depression. The association between spousal cognition and loneliness was stronger among those with close marital bonds. Implications Findings highlight substantial opportunity to identify and address loneliness and depression among spouses of PWD with close relational bonds to improve quality of life. %B Journal of Pain and Symptom Management %V 65 %P e304-e305 %G eng %R https://doi.org/10.1016/j.jpainsymman.2022.12.132 %0 Web Page %D 2023 %T Statistically Speaking, This Is the Worst Age to Claim Social Security Benefits %A Williams, Sean %K claiming age %K Social Security Benefits %I The Motley Fool %G eng %U https://www.fool.com/retirement/2023/09/02/this-is-worst-age-to-claim-social-security-benefit/ %0 Journal Article %J International Journal of Stress Management %D 2023 %T Stressor appraisals among adults in late middle age and late adulthood in the United States: Applying the intersectionality framework. %A Wang, Kun %A Marbut, Alexander R %A Zheng, Dianhan %A Peet, J. Zak %K Disability %K gender %K Immigration %K intersectionality framework %K Race/ethnicity %K stressor appraisals %X Although the intersectionality framework suggests that social identities may combine to create unique experiences of hardship, few studies have applied it to older adults’ stress appraisals. Thus, in this study, guided by the intersectionality framework, we examined whether older participants with multiple marginalized identities had more negative global stressor appraisals and whether they had specific patterns concerning individual stressor appraisals than those with singular or no marginalized identities. A sample of 6,015 participants aged 50 and older was drawn from the 2016 Health and Retirement Study. Six social identities relevant to age, gender, race/ethnicity, immigration, (dis)ability, and poverty were included. Latent class analysis was conducted to identify marginalized identity patterns. The three-step approach was applied to compare global stressor appraisals and individual stressor appraisals between the intersectional class and other classes. Three marginalized identity classes were identified: the intersectional class consisting of females and individuals living in poverty, the Black, Indigenous, and Other People of Color class, and the older adult class. Compared to the other two classes, the intersectional class reported more negative global stressor appraisals and was more likely to feel upset or very upset about self-health, family health, family substance use, work, financial, housing, and relationship stressors. Caregiving stressor appraisal was not statistically significantly different between the intersectional class and the other two classes. Overall, the findings in this study supported the intersectionality framework as it applies to stress appraisal among older adults. An intersectionality perspective may be needed in future stress research and interventions among older adults. %B International Journal of Stress Management %V 30 %P 47–56 %G eng %N 1 %R 10.1037/str0000283 %0 Journal Article %D 2023 %T Systemic inflammation is associated with dementia status in the health and retirement study %A Higgins, Cesar %A Ware, Erin B %A Hicken, Margaret %A Zawistowski, Matthew %A Bakulski, Kelly M %X BackgroundThe prevalence of dementia is expected to increase in the coming decades. The highest burden of this chronic condition will likely be borne by racial/ethnic minorities. Systemic inflammation is associated with dementia. This effect may be modified by race/ethnicity, since racial minorities are more likely to have elevated levels of systemic inflammation due to the accumulation of compounded negative experiences (e.g., discrimination, racism, and marginalization). Our goal was to test baseline systemic inflammation in relation to cognitive function in a racially/ethnically representative cohort of US adults.MethodsIn a cross‐sectional analysis of the Health and Retirement Study (2006 and 2008 waves, n=9,983), highly sensitive C‐reactive protein (hsCRP) was measured in dried blood spots. Cognitive status (dementia, cognitive impairment non‐dementia (CIND), and normal cognition) was measured and categorized using the Langa‐Weir classification of a modified telephone interview for cognition scale. We estimated the adjusted associations between hsCRP and cognitive status, using multivariable logistic regression. We stratified models by race/ethnicity to explore race‐dependent associations.ResultsOur study prevalence of dementia and CIND is 3.5% and 15.8%, respectively. Similarly, 26.7% of dementia and 30.1% of CIND cases occurred among participants with circulating hsCRP levels above the 75th quartile. We observed a racial and gender gradient in the levels of hsCRP in our cohort. For example, Black females had the highest average concentration of hsCRP (7.53 mg/L, SD =15.1) and Whites males the lowest (3.95 mg/L, SD = 7.42). Among participants with hsCRP >75th we observed higher odds of CIND (OR = 1.45; 95%CI: 1.22, 1.72) with respect to those in the . Similarly, elevated hsCRP >75th was associated with dementia (OR= 1.21; 95%CI: 0.86, 1.69), in comparison to the reference lower quartile. We did not observe a race‐dependent relationship between hsCRP and cognitive status.ConclusionsSystemic inflammation, as represented by high levels of hsCRP, was associated with concurrent cognitive status. Despite racial minorities exhibiting higher levels of hsCRP; in our study, the association between inflammation on cognition did not differ by race. Further studies should explore whether the established relationship is causal, seek larger sample sizes in diverse populations, and examine longitudinal relationships Peer Reviewed %G eng %R 10.1002/alz.053316 %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 Innov Aging %D 2023 %T Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults With Cognitive Impairment Living Alone, 2000-2018. %A Chen, Shanquan %A Zhang, Huanyu %A Underwood, Benjamin R %A Wang, Dan %A Chen, Xi %A Cardinal, Rudolf N %K gender %K Racial and ethnic disparities. physical disability. social support %X

BACKGROUND AND OBJECTIVES: Informal care is the primary source of support for older adults with cognitive impairment, yet is less available to those who live alone. We examined trends in the prevalence of physical disability and social support among older adults with cognitive impairment living alone in the United States.

RESEARCH DESIGN AND METHODS: We analyzed 10 waves of data from the U.S. Health and Retirement Survey spanning 2000-2018. Eligible people were those aged ≥65, having cognitive impairment, and living alone. Physical disability and social support were measured via basic and instrumental activities of daily living (BADLs, IADLs). We estimated linear temporal trends for binary/integer outcomes via logistic/Poisson regression, respectively.

RESULTS: A total of 20 070 participants were included. Among those reporting BADL/IADL disability, the proportion unsupported for BADLs decreased significantly over time (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), and the proportion unsupported for IADLs increased (OR = 1.02, CI 1.01-1.04). Among those receiving IADL support, the number of unmet IADL support needs increased significantly over time (relative risk [RR] 1.04, CI 1.03-1.05). No gender disparities were found for these trends. Over time, Black respondents had a relatively increasing trend of being BADL-unsupported (OR = 1.03, CI 1.0-1.05) and Hispanic and Black respondents had a relatively increasing trend in the number of unmet BADL needs (RR = 1.02, CI 1.00-1.03; RR = 1.01, CI 1.00-1.02, respectively), compared to the corresponding trends in White respondents.

DISCUSSION AND IMPLICATIONS: Among lone-dwelling U.S. older adults with cognitive impairment, fewer people received IADL support over time, and the extent of unmet IADL support needs increased. Racial/ethnic disparities were seen both in the prevalence of reported BADL/IADL disability and unmet BADL/IADL support needs; some but not all were compatible with a reduction in disparity over time. This evidence could prompt interventions to reduce disparities and unmet support needs.

%B Innov Aging %V 7 %P igad028 %G eng %N 4 %R 10.1093/geroni/igad028 %0 Journal Article %J 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 Epidemiology and Psychiatric Sciences %D 2023 %T United we thrive: friendship and subsequent physical, behavioural and psychosocial health in older adults (an outcome-wide longitudinal approach). %A Kim, E S %A Chopik, W J %A Chen, Y %A Wilkinson, R %A VanderWeele, T J %K Aged %K Aging %K Friends %K Humans %K Interpersonal Relations %K Prospective Studies %X

AIMS: Three factors converge to underscore the heightened importance of evaluating the potential health/well-being effects of friendships in older adulthood. First, policymakers, scientists, and the public alike are recognizing the importance of social relationships for health/well-being and creating national policies to promote social connection. Second, many populations are rapidly aging throughout the world. Third, we currently face what some call a 'friendship recession'. Although, growing research documents associations between friendship with better health and well-being, friendship can also have a 'dark side' and can potentially promote negative outcomes. To better capture friendship's potential heterogeneous effects, we took an outcome-wide analytic approach.

METHODS: We analysed data from 12,998 participants in the Health and Retirement Study (HRS) - a prospective and nationally representative cohort of U.S. adults aged >50, and, evaluated if increases in friendship strength (between ; 2006/2008 and ; 2010/2012) were associated with better health/well-being across 35 outcomes (in ; 2014/2016). To assess friendship strength, we leveraged all available friendship items in HRS and created a composite 'friendship score' that assessed the following three domains: (1) friendship network size, (2) friendship network contact frequency and (3) friendship network quality.

RESULTS: Stronger friendships were associated with better outcomes on some indicators of physical health (e.g. reduced risk of mortality), health behaviours (e.g. increased physical activity) and nearly all psychosocial indicators (e.g. higher positive affect and mastery, as well as lower negative affect and risk of depression). Friendship was also associated with increased likelihood of smoking and heavy drinking (although the latter association with heavy drinking did not reach conventional levels of statistical significance).

CONCLUSIONS: Our findings indicate that stronger friendships can have a dual impact on health and well-being. While stronger friendships appear to mainly promote a range of health and well-being outcomes, stronger friendships might also promote negative outcomes. Additional research is needed, and any future friendship interventions and policies that aim to enhance outcomes should focus on how to amplify positive outcomes while mitigating harmful ones.

%B Epidemiology and Psychiatric Sciences %V 32 %P e65 %G eng %R 10.1017/S204579602300077X %0 Web Page %D 2023 %T Weight Loss, Body Weight Variability Associated With Faster Cognitive Decline %A Wei, Sophie %K Body Weight %K Cognitive decline %K Weight Loss %I Endocrinology Advisor %G eng %U https://www.endocrinologyadvisor.com/home/topics/general-endocrinology/weight-loss-body-weight-variability-associated-with-faster-cognitive-decline/ %0 Journal Article %J The Journals of Gerontology: Series B %D 2023 %T Well-Being as a Protective Factor Against Cognitive Decline and Dementia: A Review of the Literature and Directions for Future Research %A Willroth, Emily C %A Pfund, Gabrielle N %A McGhee, Chloe %A Rule, Payton %K Cognitive decline %K Dementia %X Treatments that target the biological causes of dementia remain limited, making prevention critically important. Well-being—defined broadly as living in accordance with one’s potential and experiencing one’s life as enjoyable and satisfying—is a promising avenue for prevention. It can be targeted by large-scale, noninvasive interventions and has been linked with better cognitive health and lower dementia risk. In the current review, we begin by summarizing empirical evidence linking well-being to cognitive functioning, cognitive decline, dementia diagnosis, and dementia-related neuropathology. Then, we highlight 3 key areas for future research.We searched the literature on wellbeing, cognitive decline, and dementia, focusing on prospective and longitidinal evidence.The research reviewed here provides consistent evidence for associations of well-being with cognitive decline, dementia risk, and cognitive resilience to neuropathology. However, several open questions remain regarding (1) causality and mechanism(s), (2) specificity versus generalizability of associations, and (3) timing.To inform potential intervention efforts, the field must address complex open questions about whether, how, when, and for whom well-being influences dementia risk. The majority of existing research on well-being and cognitive health is correlational, and few studies have tested potential mechanisms that may explain those associations. Further, relatively little is known about the generalizability of associations across different aspects of well-being and for different sociocultural groups. Finally, we do not yet understand when in the life span and on what timescale well-being might influence cognitive health. We discuss challenges and opportunities for addressing each of these open questions, including concrete recommendations for research designs and use of open science practices. %B The Journals of Gerontology: Series B %V 78 %P 765-776 %8 02 %G eng %R 10.1093/geronb/gbad020 %0 Report %D 2023 %T What Matters for Annuity Demand: Objective Life Expectancy or Subjective Survival Pessimism? %A Arapakis, Karolos %A Gal Wettstein %K Annuity %K Life Expectancy %K Survival expectation %X Objective life expectancy and subjective survival pessimism (defined as the difference between objective and subjective life expectancy) may both affect the demand for annuities. The question this project answers is: how do these two explanations contribute to annuitization decisions in practice? To explore this question, the analysis estimates regression models that include objective life expectancy, subjective survival pessimism, and other characteristics that are linked to annuitization decisions. The results show that, as one would expect, individuals with higher objective life expectancy are more likely to buy an annuity. Similarly, less pessimistic individuals are also more likely to buy an annuity. A one-year rise in objective life expectancy increases the probability of buying an annuity product by 0.20 percentage points, which is nearly nine times larger than a one-year decline in pessimism. %B Working Papers %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/what-matters-for-annuity-demand-objective-life-expectancy-or-subjective-survival-pessimism/ %0 Report %D 2023 %T Wills, Wealth, and Race %A Aubry, Jean-Pierre %A Alicia H. Munnell %A Gal Wettstein %K inheritances %K Racial Disparities %K Retirement %X The brief’s key findings are: The analysis explores how receiving an inheritance, having a will, and planning and realizing a bequest are interrelated and vary by race. Black and Hispanic individuals are less likely to get an inheritance, have a will, and plan to leave a bequest. Among those who do plan to leave a bequest, Black and Hispanic individuals are less likely to realize their bequest target. However, having a will increases the chances of achieving one’s bequest target, offering a potential way to improve the situation. %B Issue in Brief %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/wills-wealth-and-race/ %0 Journal Article %J Journal of Affective Disorders %D 2022 %T 6-Year trajectories of depressive symptoms and incident stroke in older adults: Results from the Health and Retirement Study. %A Li, Yanzhi %A Wang, Xiaojie %A Wang, Wanxin %A Li, Xiuwen %A Guo, Lan %A Lu, Ciyong %K Depressive symptoms %K Stroke %K Trajectories %X

BACKGROUND: Depressive symptoms (DS) can increase the risk of stroke, but it is unclear whether long-term DS trajectories are associated with incident stroke. This study aimed to explore the association of long-term DS trajectories with incident stroke.

METHODS: This prospective cohort study included 11,002 adults aged 50 and older from the Health and Retirement Study during 1994-2018. DS was assessed using the 8-item version of the Center for Epidemiologic Studies Depression Scale. Stroke was obtained through self-report of doctors' diagnosis. The group-based trajectory model was used to determine DS trajectories from 1994 to 2000. Cox proportional hazard model was applied to explore the correlation of DS trajectories with incident stroke from 2000 to 2018.

RESULTS: We identified five distinct 6-year DS trajectories. Compared with the persistent no DS trajectory, the full-adjusted HRs (95% CIs) for the persistent mild, improving, worsening, and persistent high DS trajectories were 1.15 (1.01, 1.30), 1.27 (0.88, 1.84), 1.41 (1.17, 1.71), and 1.61 (1.21, 2.16), respectively. In addition, the persistent mild DS trajectories had the largest population attributable risk percent (PAR%).

LIMITATIONS: There was a lack of information on stroke subtypes.

CONCLUSIONS: This study suggests that compared with persistent no DS, persistent mild, worsening, and persistent high DS trajectories increase the risk of stroke in the elderly. Considering that the PAR% of stroke events in the persistent mild DS trajectory is the largest, we should pay attention not only to individuals with DS, but also to those being chronically close to the cut-off value of DS.

%B Journal of Affective Disorders %V 309 %P 229-235 %G eng %R 10.1016/j.jad.2022.04.137 %0 Journal Article %J JAMA Neurology %D 2022 %T Addition of Vision Impairment to a Life-Course Model of Potentially Modifiable Dementia Risk Factors in the US. %A Ehrlich, Joshua R %A Goldstein, Jenna %A Swenor, Bonnie K %A Whitson, Heather %A Kenneth M. Langa %A Veliz, Phillip %K dementia risk %K life-course model %K vision impairment %X

Importance: Dementia prevention is a high priority, given the large impact of dementia on the well-being of individuals and society. The number of older adults with dementia in the US and globally is projected to increase as a result of population aging and growth. Thus, it is vital to identify potentially modifiable dementia risk factors. Vision impairment has been identified as a risk factor for accelerated cognitive decline and incident dementia. An estimated 90% of vision impairment is preventable or has yet to be treated. Nevertheless, vision impairment has not been included in the dominant life-course model of dementia risk factors, developed by the Lancet Commission, used to shape public health policy and research priorities.

Objective: To strengthen an existing model of potentially modifiable dementia risk factors through the inclusion of vision impairment and to estimate the contributions of those risk factors in the US population.

Design, Setting, and Participants: Population-based, cross-sectional study using data from the 2018 round of the Health and Retirement Study. Analyses were conducted from March 11 through September 24, 2021. The study population was a probability sample of US adults aged 50 years and older.

Exposures: Potentially modifiable dementia risk factors, including vision impairment.

Main Outcomes and Measures: 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. The PAF represents the number of cases of dementia that would potentially be prevented if a risk factor were eliminated.

Results: The probability sample from the Health and Retirement Study included 16 690 participants (weighted demographic characteristics: 54.0% female, 52.0% age ≥65, 10.6% Black, 80% White, and 9.2% identified as other [including American Indian or Alaska Native, Asian, and Hawiian Native or Pacific Islander, although specific data were not available]). The 12 dementia risk factors in the PAF model were associated with an estimated 62.4% of dementia cases in the US. The risk factor with the highest weighted PAF for dementia was hypertension (12.4%). The PAF of vision impairment was 1.8%, suggesting that more than 100 000 prevalent dementia cases in the US could potentially have been prevented through healthy vision.

Conclusions and Relevance: Existing life-course models of potentially modifiable dementia risk factors, such as the Lancet Commission's, may consider including vision impairment. Since a large majority of vision impairment can be treated with cost-effective but underused interventions, this may represent a viable target for future interventional research that aims to slow cognitive decline and prevent incident dementia.

%B JAMA Neurology %V 79 %P 623-626 %G eng %N 6 %R 10.1001/jamaneurol.2022.0723 %0 Journal Article %J Personnel Psychology %D 2022 %T Age and sickness absence: Testing physical health issues and work engagement as countervailing mechanisms in a cross-national context %A Shao, Yiduo %A Goštautaitė, Bernadeta %A Wang, Mo %A Ng, Thomas W. H. %K health expenditure per capita %K labor force participation rate %K physical health issues %K sickness absence %K Work Engagement %X Workforces are aging rapidly and older workers are typically assumed to take more sickness absence. However, the relationship between age and sickness absence is not well understood, as research has yielded mixed findings and has neglected broader societal factors that cascade to shape the age-sickness absence relationship. To advance the literature, we adopted a resource-based perspective and investigated the relationship between employee age and sickness absence as mediated by two countervailing mechanisms: physical health issues and work engagement. We also highlighted two country-level boundary conditions (health expenditure per capita and labor force participation rate) for these mechanisms. We tested our hypotheses with two archival datasets. In Study 1, using a sample of 28,553 employees from 35 European countries, we tested a multilevel model and found that age was positively related to the number of physical health issues, which in turn was positively associated with sickness absence. Country-level health expenditure per capita was found to mitigate this relationship. We also found that age was positively related to work engagement, which was negatively related to sickness absence, and country-level labor force participation rate strengthened this relationship. In Study 2, using a multi-wave dataset (N = 304) from the Health and Retirement Study in the United States, we found further support for the two hypothesized mechanisms (physical health issues and work engagement) between age and sickness absence. Our findings have cross-national implications for understanding and managing sickness absence by helping workers stay healthier and be more engaged in the context of population aging. This article is protected by copyright. All rights reserved %B Personnel Psychology %V 75 %P 895-927 %@ 0031-5826 %G eng %N 4 %R https://doi.org/10.1111/peps.12498 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Age Profiles of Cognitive Decline and Dementia in Late Life in the Aging, Demographics and Memory Study (ADAMS). %A Walsh, Christine E %A Yang, Yang C %A Oi, Katsuya %A Allison E Aiello %A Daniel W. Belsky %A Mullan Harris, Kathleen %A Brenda L Plassman %K ADAMS %K Cognition %K joint models %K latent class %K longitudinal trajectories %K Mortality %X

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

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

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

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

%B The Journals of Gerontology, Series B %V 77 %P 1880-1891 %G eng %N 10 %R 10.1093/geronb/gbac038 %0 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 A %D 2022 %T Association Between Baseline Buccal Telomere Length and Progression of Kidney Function: The Health and Retirement Study. %A Westbrook, Adrianna %A Zhang, Ruiyuan %A Shi, Mengyao %A Razavi, Alexander C %A Huang, Zhijie %A Chen, Jing %A He, Jiang %A Tanika N Kelly %A Shen, Ye %A Li, Changwei %K Kidney disease %K Kidney function %K Telomere %X

We aimed to evaluate associations of baseline telomere length with overall and annual change in estimated glomerular filtration rate (eGFR) and trajectory of kidney function during an 8-year follow-up. A total of 3,964 participants of the Health and Retirement Study (HRS) were included. We identified three trajectory groups of kidney function: consistently normal (n=1,163 or 29.3%), normal to impaired (n=2,306 or 58.2%), and consistently impaired groups (n=495 or 12.5%). After controlling for age, sex, race, education, smoking, drinking, diabetes, heart disease, blood pressure, body mass index, total cholesterol, and hemoglobin A1c, participants with longer telomere length were 20% less likely (odds ratio [OR]=0.80, 95% confidence interval [CI]: 0.69-0.93, P=0.003) to have a normal to impaired kidney function trajectory than a consistently normal function trajectory. Telomere length was not associated with changing rate of eGFR over 8 years (P=0.45). Participants with longer telomere length were more likely to have consistently normal kidney function.

%B The Journals of Gerontology, Series A %V 77 %P 471-476 %G eng %N 3 %R 10.1093/gerona/glac004 %0 Journal Article %J Front Endocrinol %D 2022 %T Association Between Long-Term HbA1c Variability and Functional Limitation in Individuals Aged Over 50 Years: A Retrospective Cohort Study. %A Shao, Di %A Wang, Shuang-Shuang %A Sun, Ji-Wei %A Wang, Hai-Peng %A Sun, Qiang %K Activities of Daily Living %K Blood Glucose %K Cohort Studies %K Diabetes Mellitus %K Glycated Hemoglobin A %K Retrospective Studies %K Type 2 %X

Background: As mean HbA1c provides incomplete information regarding glycemic variability, there has been considerable interest in the emerging association between glycemic variability and macrovascular events and with microvascular complications and mortality in adults with and without diabetes. However, the association between long-term glycemic variability, represented by visit-to-visit HbA1c variability, and functional limitations has not been clarified in previous literature. The present study aimed to explore the longitudinal association between long-term glycemic variability, represented by visit-to-visit HbA1c variability and functional limitations.

Methods: This cohort study included adults aged over 50 years who participated in the 2006 to 2016 waves of the Health and Retirement Study. Physical functions, including mobility, large muscle function, activities of daily living (ADLs), and instrumental ADLs (IADLs), were assessed at baseline and every 2 years, and HbA1c levels were assessed at baseline and every 4 years. Visit-to-visit HbA1c variability was calculated using the HbA1c variability score (HVS) during the follow-up period. Generalized estimating equation models were used to evaluate the longitudinal association between HbA1c variability and functional limitations with adjustment for a series of confounders.

Results: A total of 5,544 participants having three HbA1c measurements from 2006 to 2016, having two or more physical function measures (including one at baseline), and age over 50 years were included in this analysis. The mean age at baseline was 66.13 ± 8.39 years. A total of 916 (16.5%) participants had an HVS = 100, and 35.1% had an HVS = 50. The highest HVS category (HVS =100) was associated with increased functional status score (β = 0.093, 95% CI: 0.021-0.165) in comparison with the lowest HVS category (HVS = 0). Sensitivity analyses using the CV and SD of HbA1c as measures of variability showed similar associations between HbA1c variability and functional limitation. An incremental increase in HbA1c-CV (β = 0.630, 95% CI: 0.127-1.132) or HbA1c-SD (β = 0.078, 95% CI: 0.006-0.150) was associated with an increase in functional limitation in the fully adjusted model.

Conclusions: HbA1c variability was associated with heightened difficulty in performing functional activities over time after adjusting for mean HbA1c levels and multiple demographics and comorbidities. This study provides further evidence regarding the detrimental effect of HbA1c variability and highlights the significance of steady glycemic control.

%B Front Endocrinol %V 13 %P 847348 %G eng %R 10.3389/fendo.2022.847348 %0 Journal Article %J Maturitas %D 2022 %T Association between marital relationship and multimorbidity in middle-aged adults: A longitudinal study across the US, UK, Europe, and China %A Danyang Wang %A Duanhui Li %A Shiva Raj Mishra %A Carmen Lim %A Xiaochen Dai %A Shu Chen %A Xiaolin Xu %K Marital Status %K marriage duration %K multimorbidity %K Prevalence %X Background Marital relationship plays an important role in health and wellbeing. However, how marriage is associated with multimorbidity (the co-occurrence of two or more chronic conditions) has not been comprehensively investigated. We aimed to assess the association between marriage and multimorbidity in middle-aged adults. Methods We used nationally representative data on 23641 adults aged 50-60 years who participated in four longitudinal studies in the US, UK, Europe, and China (Health and Retirement Study, English Longitudinal Study on Ageing, Survey of Health, Ageing and Retirement in Europe, and China Health and Retirement Longitudinal Study). Respondents were followed up in 2010-11 (baseline), 2012-13, and 2014-15. We used generalized estimating equations to evaluate the associations between marital status (married/partnered or non-married [separated/devoiced/widowed/never married]), marriage duration and multimorbidity, adjusting for socioeconomic and lifestyle factors. Results Over 4-year follow-up, 24% (n=5699) of respondents experienced separation, divorce, widowhood, or never-married status, and approximately 43% (n=10228) of respondents reported multimorbidity. Those who were not married had a higher odds of multimorbidity (age-, sex- and region-adjusted odds ratio 1.19; 95% confidence interval 1.14 to 1.25). Those who had been married for 21-30 years had a lower odds of experiencing multimorbidity than those married for less than 10 years. The associations remained robust after adjusting for socioeconomic and lifestyle factors. Conclusions Marital relationship (status and length) was associated with multimorbidity in middle-aged adults, highlighting the role of marital relationship in shaping the trajectory of health and wellbeing across the life course. These findings provide insight for the prevention and management of chronic disease and multimorbidity. %B Maturitas %V 155 %P 32-39 %G eng %R https://doi.org/10.1016/j.maturitas.2021.09.011 %0 Journal Article %J JAMA Network Open %D 2022 %T Association Between Racial Wealth Inequities and Racial Disparities in Longevity Among US Adults and Role of Reparations Payments, 1992 to 2018. %A Himmelstein, Kathryn E W %A Lawrence, Jourdyn A %A Jahn, Jaquelyn L %A Ceasar, Joniqua N %A Morse, Michelle %A Bassett, Mary T %A Wispelwey, Bram P %A Darity, William A %A Venkataramani, Atheendar S %K Black People %K ethnicity %K Income %K Socioeconomic factors %X

IMPORTANCE: In the US, Black individuals die younger than White individuals and have less household wealth, a legacy of slavery, ongoing discrimination, and discriminatory public policies. The role of wealth inequality in mediating racial health inequities is unclear.

OBJECTIVE: To assess the contribution of wealth inequities to the longevity gap that exists between Black and White individuals in the US and to model the potential effects of reparations payments on this gap.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study, a nationally representative panel study of community-dwelling noninstitutionalized US adults 50 years or older that assessed data collected from April 1992 to July 2019. Participants included 7339 non-Hispanic Black (hereinafter Black) and 26 162 non-Hispanic White (hereinafter White) respondents. Data were analyzed from January 1 to September 17, 2022.

EXPOSURES: Household wealth, the sum of all assets (including real estate, vehicles, and investments), minus the value of debts.

MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality by the end of survey follow-up in 2018. Using parametric survival models, the associations among household wealth, race, and survival were evaluated, adjusting for age, sex, number of household members, and marital status. Additional models controlled for educational level and income. The survival effects of eliminating the current mean wealth gap with reparations payments ($828 055 per household) were simulated.

RESULTS: Of the 33 501 individuals in the sample, a weighted 50.1% were women, and weighted mean (SD) age at study entry was 59.3 (11.1) years. Black participants' median life expectancy was 77.5 (95% CI, 77.0-78.2) years, 4 years shorter than the median life expectancy for White participants (81.5 [95% CI, 81.2-81.8] years). Adjusting for demographic variables, Black participants had a hazard ratio for death of 1.26 (95% CI, 1.18-1.34) compared with White participants. After adjusting for differences in wealth, survival did not differ significantly by race (hazard ratio, 1.00 [95% CI, 0.92-1.08]). In simulations, reparations to close the mean racial wealth gap were associated with reductions in the longevity gap by 65.0% to 102.5%.

CONCLUSIONS AND RELEVANCE: The findings of this cohort study suggest that differences in wealth are associated with the longevity gap that exists between Black and White individuals in the US. Reparations payments to eliminate the racial wealth gap might substantially narrow racial inequities in mortality.

%B JAMA Network Open %V 5 %P e2240519 %G eng %N 11 %R 10.1001/jamanetworkopen.2022.40519 %0 Journal Article %J Frontiers in Public Health %D 2022 %T Association between the domestic use of solid cooking fuel and increased prevalence of depression and cognitive impairment in a big developing country: A large-scale population-based study. %A Jin, Yuming %A Zhou, Xianghong %A Deng, Linghui %A Xiong, Xingyu %A Li, Yifan %A Wei, Qiang %A Dong, Birong %A Qiu, Shi %K Aging %K Cognitive Dysfunction %K Educational Status %K Prevalence %K Research %X

BACKGROUND: Previous studies have suggested that air pollution affects physiological and psychological health. Using solid fuel at home is a significant source of indoor air pollution. The associations between solid fuel use and depressive symptoms and cognitive health were unclear among older adults from low- and middle-income countries (LMICs).

METHODS: To evaluate the association of solid fuel use with depressive symptoms and cognitive health among older adults, we obtained data from the Longitudinal Aging Study in India (LASI) and excluded subjects younger than 60 years and without critical data (solid fuel use, depressive symptoms, and cognitive health). The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to assess depressive symptoms, with more than ten indicative of depression. Cognitive health was assessed using measures from the Health and Retirement Study (HRS), and subjects with the lowest 10th percentile were considered to have cognitive impairment. The participants' responses defined solid fuel use. Multivariable logistic regression, linear regression, subgroup analysis, and interaction tests were performed to appraise the relationship between solid fuel use and depression and cognitive impairment.

RESULTS: A total of 29,789 participants over 60 years old were involved in this study. Almost half of the participants (47.5%) reported using solid fuel for home cooking. Compared with clean fuel use, solid fuel use was related to an increased prevalence of depression [odds ratio (OR) 1.09, 95% CI 1.03-1.16] and higher CES-D-10 scores (β 0.23, 95% CI 0.12-0.35) after fully adjusted covariables. Using solid fuel was also related to a higher risk of cognitive impairment (OR 1.21, 95% CI 1.11-1.32) and a lower cognitive score (β -0.63, 95% CI -0.79 to -0.47) compared with those who used clean fuel. In the subgroup analysis, the prevalence of depression increased in females and non-smokers. The association of solid fuel use with depression and cognitive impairment exists in subgroups of BMI, economic status, caste, living area, education, and drinking.

CONCLUSIONS: The use of solid fuel at home was associated with an increased prevalence of depression and cognitive impairment among older adults in India.

%B Frontiers in Public Health %V 10 %P 1038573 %G eng %R 10.3389/fpubh.2022.1038573 %0 Journal Article %J Scientific Reports %D 2022 %T Association of plasma cystatin C with all-cause and cause-specific mortality among middle-aged and elderly individuals: a prospective community-based cohort study. %A Wu, Jinhua %A Liang, Yuemei %A Chen, Rong %A Xu, Linli %A Ou, Zejin %A Liang, Haiying %A Zhao, Lina %K Cardiovascular Diseases %K Cause of Death %K Cohort Studies %K Cystatin C %K Mortality %K Neoplasms %K Proportional Hazards Models %K Prospective Studies %K Risk Factors %X

We investigated the associations of plasma cystatin C with all-cause and cause-specific mortality risk and identified potential modifying factors affecting these associations in middle-aged and elderly people (≥ 50 years). This community-based prospective cohort study included 13,913 individuals aged ≥ 50 years from the Health and Retirement Study. Cox proportional hazard models were used to estimate the associations between cystatin C concentrations and the risk of all-cause and cardiovascular and cancer mortality after adjustment for sociodemographic characteristics, lifestyle factors, self-reported medical history, and other potential confounding factors. During a total of 71,988 person-years of follow-up (median: 5.8 years; interquartile range 3.3-7.6 years), 1893 all-cause deaths were documented, including 714 cardiovascular-related and 406 cancer-related deaths. The comparisons of the groups with the highest (quartile 4) and lowest (quartile 1) cystatin C concentrations revealed that the adjusted hazard ratios and 95% confidence intervals were 1.92 (1.62-2.28) for all-cause mortality, 1.98 (1.48-2.65) for cardiovascular mortality, and 1.62 (1.13-2.32) for cancer mortality. The associations of cystatin C concentrations with all-cause, cardiovascular and cancer mortality did not differ substantially when participants were stratified by sex, age, BMI, current smoking status, current alcohol consumption, and regular exercise (all P for interactions > 0.05). Our study indicates that an elevated plasma cystatin C concentration is associated with an increased risk of all-cause, cardiovascular and cancer mortality both men and women among the middle-aged and elderly individuals.

%B Scientific Reports %V 12 %P 22265 %G eng %N 1 %R 10.1038/s41598-022-24722-4 %0 Journal Article %J JAMA Network Open %D 2022 %T Association of 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 JAMA Network Open %D 2022 %T Association of Social Risk Domains With Poor Cardiovascular Risk Factor Control in US Adults With Diabetes, From 2006 to 2016. %A Corwin, Timothy %A Ozieh, Mukoso N %A Garacci, Emma %A Walker, Rebekah J %A Egede, Leonard E %K Cardiovascular Diseases %K Diabetes Mellitus %K Glycated Hemoglobin A %K HDL %K Heart Disease Risk Factors %K Lipoproteins %K Risk Factors %X

Importance: Few studies have examined the association between social risk factors and poor control of cardiovascular disease (CVD) risk factors.

Objective: To examine the sequential association between social risk domains and CVD risk control over time in older adults with diabetes.

Design, Setting, and Participants: This cohort study analyzed core interviews from 4877 US adults with diabetes who were participating in the Health and Retirement Study, a national longitudinal survey of US adults. Participants were older than 50 years, completed the social risk domain questions, and had data on CVD risk factor measures from January 2006 to December 2016. Data were analyzed from June to July 2022.

Exposures: Five social risk domains were created: (1) economic stability, (2) neighborhood or built environment, (3) education access, (4) health care access, and (5) social or community context.

Main Outcomes and Measures: The 4 primary outcomes were (1) poor glycemic control (hemoglobin A1c [HbA1c] level ≥8.0%), (2) poor blood pressure (BP) control (systolic BP≥140 mm Hg and diastolic BP ≥90 mm Hg), (3) poor cholesterol control (total cholesterol/high-density lipoprotein ratio ≥5), and (4) a composite of poor CVD risk control (≥2 poorly controlled glucose level, BP, or cholesterol level).

Results: Among this cohort of 4877 older adults with diabetes (mean [SD] age, 68.6 [9.8] years; 2715 women [55.7%]), 890 participants (18.3%) had an HbA1c level of 8% or higher, 774 (15.9%) had systolic BP of 140 mm Hg or higher and diastolic BP of 90 mm Hg or higher, 962 (19.7%) had total cholesterol/high-density lipoprotein ratio of 5 or higher, and 437 (9.0%) had at least 2 poorly controlled CVD risk factors. Neighborhood or built environment (ie, adverse social support) was independently associated with poor glycemic control (odds ratio [OR], 1.31; 95% CI, 1.06-1.63), whereas economic stability (ie, medication cost-related nonadherence) (OR, 1.40; 95% CI, 1.04-1.87) and health care access (ie, lack of health insurance) (OR, 1.58; 95% CI, 1.20-2.09) were independently associated with poor BP control after full adjustment. Education access (ie, lack of education) (OR, 1.24; 95% CI, 1.01-1.52) and health care access (ie, lack of health insurance) (OR, 1.31; 95% CI, 1.02-1.68) were independently associated with poor cholesterol control. Health care access (ie, lack of health insurance) was the only social risk domain that was independently associated with having at least 2 poorly controlled CVD risk factors (OR, 1.72; 95% CI, 1.26-2.37).

Conclusions and Relevance: Results of this study suggest that certain social risk domains are associated with control of CVD risk factors over time. Interventions targeting domains, such as neighborhood or built environment, economic stability, and education access, may be beneficial to controlling CVD risk factors in older adults with diabetes.

%B JAMA Network Open %V 5 %P e2230853 %G eng %N 9 %R 10.1001/jamanetworkopen.2022.30853 %0 Journal Article %J JAMA Internal Medicine %D 2022 %T Association of Social Support With Functional Outcomes in Older Adults Who Live Alone. %A Sachin J Shah %A Margaret C Fang %A Wannier, S Rae %A Michael A Steinman %A Kenneth E Covinsky %K health outcomes %K Social Support %X

Importance: Older adults who live alone are at risk for poor health outcomes. Whether social support mitigates the risk of living alone, particularly when facing a sudden change in health, has not been adequately reported.

Objective: To assess if identifiable support buffers the vulnerability of a health shock while living alone.

Design, Setting, and Participants: In this longitudinal, prospective, nationally representative cohort study from the Health and Retirement Study (enrollment March 2006 to April 2015), 4772 community-dwelling older adults 65 years or older who lived alone in the community and could complete activities of daily living (ADLs) and instrumental ADLs independently were followed up biennially through April 2018. Statistical analysis was completed from May 2020 to March 2021.

Exposures: Identifiable support (ie, can the participant identify a relative/friend who could help with personal care if needed), health shock (ie, hospitalization, new diagnosis of cancer, stroke, heart attack), and interaction (multiplicative and additive) between the 2 exposures.

Main Outcomes and Measures: The primary outcomes were incident ADL dependency, prolonged nursing home stay (≥30 days), and death.

Results: Of 4772 older adults (median [IQR] age, 73 [68-81] years; 3398 [71%] women) who lived alone, at baseline, 1813 (38%) could not identify support, and 3013 (63%) experienced a health shock during the study. Support was associated with a lower risk of a prolonged nursing home stay at 2 years (predicted probability, 6.7% vs 5.2%; P = .002). Absent a health shock, support was not associated with a prolonged nursing home stay (predicted probability over 2 years, 1.9% vs 1.4%; P = .21). However, in the presence of a health shock, support was associated with a lower risk of a prolonged nursing home stay (predicted probability over 2 years, 14.2% vs 10.9%; P = .002). Support was not associated with incident ADL dependence or death.

Conclusions and Relevance: In this longitudinal cohort study among older adults who live alone, identifiable support was associated with a lower risk of a prolonged nursing home stay in the setting of a health shock.

%B JAMA Internal Medicine %V 182 %P 26-32 %G eng %N 1 %R 10.1001/jamainternmed.2021.6588 %0 Journal Article %J 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 Health & Social Care in the Community %D 2022 %T Associations between volunteering and cognitive impairment: The moderating role of race/ethnicity. %A Wang, Yi %A Wong, Roger %A Amano, Takashi %A Shen, Huei-Wern %K formal volunteering %K informal volunteering %K minority ageing %K objective cognition %K subjective cognition %X

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

%B Health & Social Care in the Community %V 30 %P e4433-e4441 %G eng %N 6 %R 10.1111/hsc.13847 %0 Journal Article %J Journal of the American Geriatrics Society %D 2022 %T Bad company: Loneliness longitudinally predicts the symptom cluster of pain, fatigue, and depression in older adults. %A Powell, Victoria D %A Kumar, Navasuja %A Galecki, Andrzej T %A Kabeto, Mohammed %A Clauw, Daniel J %A Williams, David A %A Hassett, Afton %A Silveira, Maria J %K complex pain %K Psychosocial stress %K Quality of Life %K Social Support %X

BACKGROUND: Pain, fatigue, and depression frequently co-occur as a symptom cluster. While commonly occurring in those with cancer and autoimmune disease, the cluster is also found in the absence of systemic illness or inflammation. Loneliness is a common psychosocial stressor associated with the cluster cross-sectionally. We investigated whether loneliness predicted the development of pain, fatigue, depression, and the symptom cluster over time.

METHODS: Data from the Health and Retirement Study were used. We included self-respondents ≥50 year-old who had at least two measurements of loneliness and the symptom cluster from 2006-2016 (n = 5974). Time-varying loneliness was used to predict pain, fatigue, depression, and the symptom cluster in the subsequent wave(s) using generalized estimating equations (GEE) and adjusting for sociodemographic covariates, living arrangement, and the presence of the symptom(s) at baseline.

RESULTS: Loneliness increased the odds of subsequently reporting pain (aOR 1.22, 95% CI 1.08, 1.37), fatigue (aOR 1.47, 95% CI 1.32, 1.65), depression (aOR 2.33, 95% CI 2.02, 2.68), as well as the symptom cluster (aOR 2.15, 95% CI 1.74, 2.67). The median time between the baseline and final follow-up measurement was 7.6 years (IQR 4.1, 8.2).

CONCLUSIONS: Loneliness strongly predicts the development of pain, fatigue, and depression as well as the cluster of all three symptoms several years later in a large, nonclinical sample of older American adults. Future studies should examine the multiple pathways through which loneliness may produce this cluster, as well as examine whether other psychosocial stressors also increase risk. It is possible that interventions which address loneliness in older adults may prevent or mitigate the cluster of pain, fatigue, and depression.

%B Journal of the American Geriatrics Society %V 70 %P 2225-2234 %G eng %N 8 %R 10.1111/jgs.17796 %0 Journal Article %J SSM - Population Health %D 2022 %T Black-White variation in the relationship between early educational experiences and trajectories of cognitive function among US-born older adults %A Katrina M. Walsemann %A Eleanor M. Kerr %A Jennifer A Ailshire %A Pamela Herd %K cognitive impairment %K Dementia %K Early Life %K Memory %K school segregation %X Black adults face a substantially higher risk for dementia in later life compared to their White peers. Given the critical role of educational attainment and cognitive function in later life dementia risk, this paper aims to determine if early educational experiences and educational attainment are differentially related to trajectories of cognitive status across race and if this further varies by education cohort. We use data from the Life History Mail Survey (LHMS) and prospective data on cognition from the Health and Retirement Study (HRS). We restrict our sample to Black and White US-born adults who provided at least one measure of cognitive status from 1995/6–2016. We find evidence of Black-White differences in the association between educational experiences and level of cognitive function, episodic memory, and working memory, but little evidence of Black-White differences in these associations with decline. Having a learning problem was associated with lower levels of cognitive function, episodic memory, and working memory for White and Black older adults, but was more strongly related to these outcomes among Black older adults. Further, the Black-White difference in this association was generally found in older cohorts that completed schooling after enactment of federal policies that improved educational resources for children with learning disabilities. Attending racially discordant schools was positively associated with level of these cognitive outcomes for Black older adults but not for White older adults. We also find that the educational gradient in level of cognitive function was larger for Black compared to White older adults in older cohorts not benefiting from the Brown v Board of Education decision but was similar for Black and White older adults attending school in the post-Brown era. %B SSM - Population Health %V 19 %P 101184 %G eng %R 10.1016/j.ssmph.2022.101184 %0 Journal Article %J Biological Research for Nursing %D 2022 %T The Brain-Derived Neurotrophic Factor Functional Polymorphism and Hand Grip Strength Impact the Association between Brain-Derived Neurotrophic Factor Levels and Cognition in Older Adults in the United States. %A Liu, Tingting %A Li, Hongjin %A Conley, Yvette P %A Primack, Brian A %A Wang, Jing %A Li, Changwei %K Brain-Derived Neurotrophic Factor %K Cognition %K Exercise %K Gene-Environment Interaction %K Hand Strength %X

INTRODUCTION: Aging is associated with subtle cognitive decline in attention, memory, executive function, processing speed, and reasoning. Although lower brain-derived neurotrophic factor (BDNF) has been linked to cognitive decline among older adults, it is not known if the association differs among individuals with various Val66Met (rs6265) genotypes. In addition, it is not clear whether these associations vary by hand grip strength or physical activity (PA).

METHODS: A total of 2904 older adults were included in this study using data from the Health and Retirement Study. Associations between serum BDNF and measures of cognitive function were evaluated using multivariable linear regression models stratified by Met allele status. PA and hand grip strength were added to the model to evaluate whether including these variables altered associations between serum BDNF and cognition.

RESULTS: Mean age was 71.4 years old, and mean body mass index was 28.3 kg/m. Serum BDNF levels were positively associated with higher total cognitive score (beta = 0.34, = .07), mental status (beta = 0.16, = .07), and word recall (beta = 0.22, =.04) among Met carriers, while serum BDNF levels were negatively associated with mental status (beta = -0.09, = .07) among non-Met carriers. Furthermore, associations changed when hand grip strength was added to the model but not when PA was added to the model.

CONCLUSIONS: The Val66Met variant may moderate the association between serum BDNF levels and cognitive function in older adults. Furthermore, such associations differ according to hand grip strength but not PA.

%B Biological Research for Nursing %V 24 %P 226-234 %G eng %N 2 %R 10.1177/10998004211065151 %0 Journal Article %J The Journal of Gerontology, Series B %D 2022 %T A Brief Report on Older Working Caregivers: Developing a Typology of Work Environments. %A Dawn C Carr %A Kendra Jason %A Taylor, Miles %A Tiffany R Washington %K latent class %K Older workers %K productive engagement %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 PLoS One %D 2022 %T Can adherence to moral standards and ethical behaviors help maintain a sense of purpose in life? Evidence from a longitudinal study of middle-aged and older adults. %A Weziak-Bialowolska, Dorota %A Bialowolski, Piotr %K Health Status %K Morals %K Retirement %X

Personal factors, such as character strengths, have been shown to be favorably associated with concurrent and future well-being. Positive associations have also been reported between purpose in life and concurrent and subsequent health and well-being. Evidence on antecedents of purpose in life is, however, limited. This study examines whether the adherence to moral standards and ethical behaviors (AMSEB) is associated with subsequent purpose in life. Data from the Health and Retirement Study obtained from a sample of 8,788 middle-aged and older adults in the US (mean age = 64.9 years, age range 50-96 years) were used. The prospective associations between AMSEB and purpose in life were examined using generalized linear models. A rich set of covariates and prior outcomes were used as controls to reduce the risk of reverse causation. The robustness analyses included computation of sensitivity measures, E-values, and running a set of secondary analyses conducted on subsamples of respondents and using a limited set of covariates. It was found that middle-aged and older adults who demonstrated higher AMSEB reported a higher sense of purpose in life after the 4-year follow-up period. This association was found to be monotonic, moderately robust to potential unmeasured confounding and independent of demographics, prior socioeconomic status, prior health conditions, and health behaviors as well as prior psychological predispositions such as dispositional optimism and life satisfaction. It was also robust to missing data patterns. Policymakers and health practitioners may consider a predisposition to adherence to moral standards and ethical behaviors as a potential intervention target, as its improvement and/or maintenance has the potential to improve longevity and to help promote healthy and purposeful aging.

%B PLoS One %V 17 %P e0273221 %G eng %N 8 %R 10.1371/journal.pone.0273221 %0 Report %D 2022 %T Can We Predict Boomers’ Drawdown Behavior from Earlier Cohorts? %A Gal Wettstein %A Siliciano, Robert L. %K defined pension plans %K drawdown behavior %K Retirees %X The brief’s key findings are: Studies show that retirees have tended to draw down their financial wealth very slowly. But these retirees generally had defined benefit (DB) pension plans, which pay benefits for life. Hence, this slow drawdown pattern may not hold for new retirees, who rely on 401(k)s. Indeed, the analysis finds that households with a DB plan retain more of their wealth – that is, they draw it down more slowly than those with a 401(k).For example, a household retiring with $200,000 in savings and a DB plan would retain $28,000 more wealth at age 70 than a similar household with no DB plan. The analysis suggests that many new retirees could deplete their 401(k) assets by age 85, meaning that they face a greater risk of outliving their savings. %B Briefs %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U https://crr.bc.edu/briefs/can-we-predict-boomers-drawdown-behavior-from-earlier-cohorts/ %0 Journal Article %J Circulation. Heart Failure %D 2022 %T Challenges for Patients Dying of Heart Failure and Cancer. %A Orlovic, Martina %A Mossialos, Elias %A Orkaby, Ariela R %A Joseph, Jacob %A Gaziano, J Michael %A Skarf, Lara M %A Nohria, Anju %A Warraich, Haider J %K Activities of Daily Living %K Heart Failure %K Hospice Care %K Neoplasms %K Palliative care %K Terminal Care %X

BACKGROUND: Hospice and palliative care were originally implemented for patients dying of cancer, both of which continue to be underused in patients with heart failure (HF). The objective of this study was to understand the unique challenges faced by patients dying of HF compared with cancer.

METHODS: We assessed differences in demographics, health status, and financial burden between patients dying of HF and cancer from the Health and Retirement Study.

RESULTS: The analysis included 3203 individuals who died of cancer and 3555 individuals who died of HF between 1994 and 2014. Compared with patients dying of cancer, patients dying of HF were older (80 years versus 76 years), had poorer self-reported health, and had greater difficulty with all activities of daily living while receiving less informal help. Their death was far more likely to be considered unexpected (39% versus 70%) and they were much more likely to have died without warning or within 1 to 2 hours (20% versus 1%). They were more likely to die in a hospital or nursing home than at home or in hospice. Both groups faced similarly high total healthcare out-of-pockets costs ($9988 versus $9595, =0.6) though patients dying of HF had less wealth ($29 895 versus $39 008), thereby experiencing greater financial burden.

CONCLUSIONS: Compared with patients dying of cancer, those dying from HF are older, have greater difficulty with activities of daily living, are more likely to die suddenly, in a hospital or nursing home rather than home or hospice, and had worse financial burden.

%B Circulation. Heart Failure %V 15 %P e009922 %G eng %N 12 %R 10.1161/CIRCHEARTFAILURE.122.009922 %0 Journal Article %J Frontiers in Psychology %D 2022 %T Childhood adversity and cognitive impairment in later life. %A Xiang, Xiaoling %A Cho, Joonyoung %A Sun, Yihang %A Wang, Xiafei %K ACE %K Adverse childhood events %K Childhood adversity %K cognitive impairment %K Dementia %K life course %X

Objectives: This study examined the association between childhood adversity and cognitive impairment in later life and explored the potential moderation effect of gender and race.

Methods: The study sample included 15,133 participants of the Health and Retirement Study (1998-2016 surveys) who had complete data on key study measures and were more than 50. The outcome variable is a dichotomous indicator of cognitive impairment as assessed by the Telephone Interview for Cognitive Status for self-respondents and the 16-item Informant Questionnaire on Cognitive Decline in the Elderly for proxies. A total of six childhood adversity indicators included grade retention, parental substance abuse, physical abuse, trouble with the police, moving due to financial hardship, and receipt of help due to financial hardship in early life. The estimation of the association between childhood adversity and cognitive impairment involved Cox proportional hazards regression. Results: Grade retention had the largest effect on incident cognitive impairment (HR = 1.3, 95% CI = 1.23-1.38, < 0.001), followed by physical abuse by a parent (HR = 1.10, 95% CI = 1.00-1.20, = 0.001). The impact of grade retention was more detrimental to women than men (interaction term HR = 0.89, 95% CI = 0.80-1.00, = 0.048, female as the reference). Parental substance abuse was associated with a lower risk of incident cognitive impairment for most racial groups (HR = 0.89, 95% CI = 0.83-0.95, = 0.001), but this association was reversed in "non-Hispanic other" race, consisting mainly of Asians (HR = 1.54, 95% CI = 1.05-2.26, = 0.025).

Discussion: Some aspects of childhood adversity continue to harm cognitive functioning in later life, while some events may have the opposite effect, with evidence of heterogeneity across gender and race.

%B Frontiers in Psychology %V 13 %P 935254 %G eng %R 10.3389/fpsyg.2022.935254 %0 Journal Article %J Science Advances %D 2022 %T Childhood lead exposure is associated with lower cognitive functioning at older ages. %A Lee, Haena %A Lee, Mark W %A Warren, John Robert %A Ferrie, Joseph %K childhood lead exposure %K cognitive functioning %X

The Flint, Michigan water crisis renewed concern about lead toxicity in drinking water. While lead in drinking water has been shown to negatively affect cognition among children, much less is known about its long-term consequences for late-life cognition. Using a nationally representative sample of U.S. older adults linked to historical administrative data from 1940, we find that older adults who lived as children in cities with lead pipes and acidic or alkaline water-the conditions required for lead to leach into drinking water-had worse cognitive functioning but not steeper cognitive decline. About a quarter of the association between lead and late-life cognition was accounted for by educational attainment. Within the next 10 years, American children exposed to high levels of lead during the 1970s will enter older ages. Our evidence highlights the need for stronger actions to identify interventions to mitigate long-term damage among people at high risk.

%B Science Advances %V 8 %P eabn5164 %G eng %N 45 %R 10.1126/sciadv.abn5164 %0 Journal Article %J Transportation %D 2022 %T Cohort analysis of driving cessation and limitation among older adults %A Schouten, Andrew %A Wachs, Martin %A Evelyn Blumenberg %A Hannah R. King %K Cohort Effect %K driving cessation %K driving reduction %K gender %X Automobiles are central to participation in economic, social, and cultural activities in the United States. The ability to drive as one ages is fundamental to the quality of life among older adults. Driving rates decline significantly with age. Researchers using cross-sectional data have studied the reasons former drivers have stopped driving, but few have followed individuals over time to examine changes in relationships among driving cessation, socio-demographics, and health conditions. We used longitudinal data from a national sample of 20,000 observations from the University of Michigan Health and Retirement Study (HRS) to examine relationships among demographic variables, health conditions, and driving reduction and driving cessation. Longitudinal data allow analysis of generational differences in behavior, a major advantage over cross-sectional data which only allow comparisons of different people at one point in time. We found, like many other studies, that personal decisions to limit and eventually stop driving vary with sex, age, and health conditions. In addition, unlike most previous studies, we also found that those relationships differ by birth cohort with younger cohorts less likely to stop and limit their driving than their older counterparts. The findings indicate an evolution in the association between driving cessation and its causes. %B Transportation %V 49 %P 841–865 %@ 1572-9435 %G eng %R 10.1007/s11116-021-10196-2 %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 Labour Economics %D 2022 %T Computerization, obsolescence and the length of working life %A Péter Hudomiet %A Robert J. Willis %K Occupation %K Retirement %K skills %K Technology %X This paper analyzes how computerization affected the labor market outcomes of older workers between 1984 and 2017. Using the computerization supplements of the Current Population Survey (CPS) we show that different occupations were computerized at different times, older workers tended to start using computers with a delay compared to younger workers, but computer use within occupations converged to the same levels across age groups eventually. That is, there was a temporary knowledge gap between younger and older workers in most occupations. Using this variation, we estimate how this knowledge gap affected older workers’ labor market outcomes using millions of observations from the CPS, and additional data from the Health and Retirement Study. Our models control for occupation and time fixed effects and in some models, we also control for full occupation-time interactions and use middle aged (age 40-49) workers as the control group. We find strong and robust negative effects of the knowledge gap on wages, and a large, temporary increase in transitions from work to non-participation. These results are consistent with a model of creative destruction in which the computerization of jobs made older workers’ skills obsolete in birth cohorts that experienced computerization relatively late in their careers. We find larger effects on females and on middle-skilled workers. %B Labour Economics %V 77 %P 102005 %G eng %R https://doi.org/10.1016/j.labeco.2021.102005 %0 Journal Article %J Computers in Human Behavior %D 2022 %T Consistent and robust predictors of Internet Use among older adults over time identified by machine learning %A Xiaoqing Wan %A Nichole R. Lighthall %A Rui Xie %K Internet use %K Machine learning %X Older adults tend to under-utilize digital technology and online services that can yield substantial benefits to their health and wellbeing. Addressing this problem requires determining robust and consistent predictors of older adults’ Internet use over time. Informed by current models of technology use in aging, the present study took a data-driven approach to determine the predictors of Internet use among older adults. Machine learning was applied to a large, nationally representative sample of older Americans with data for hundreds of variables – both before and after the advent of smartphones and tablets. Machine learning models achieved classification accuracy slightly higher than a theory-driven benchmark model, with results largely supporting current models of aging and technology use. Specifically, data from 2002 and 2016 indicated that age, socioeconomics, and cognitive functions that decline with age (immediate memory, delayed memory, and visuospatial skills) were the most robust and consistent predictors of Internet use among older adults. Machine learning also discovered additional factors that should be considered in models of technology use in aging, such as alcohol use. Taken with prior literature, these results suggest that automaticity should be a high design priority to reduce the age-related cognitive challenges that impact technology use. %B Computers in Human Behavior %V 137 %P 107413 %G eng %R https://doi.org/10.1016/j.chb.2022.107413 %0 Journal Article %J The Journals of Gerontology: Series B %D 2022 %T The contributions of hypertension diagnosis and blood pressure control to subjective life expectancy in a representative sample of older U.S. adults. %A Zacher, Meghan %A Wang, Jiwen %A Short, Susan E %K Biomarkers %K blood pressure monitoring %K health beliefs %K hypertension awareness %K subjective survival expectations %X

OBJECTIVES: High blood pressure (BP) or hypertension, a major risk factor for death and disease, is pervasive among older adults. While reducing BP to targeted levels can prevent adverse outcomes, rates of successful BP control remain suboptimal, and it is unclear whether older adults recognize its proven benefits. The current study sheds light on older adults' beliefs about the consequences of hypertension and benefits of BP control by examining how their self-reports of hypertension diagnosis and BP control, as well as measured BP, contribute to subjective life expectancy (SLE), their perceived probability of surviving to a target age.

METHODS: In a representative sample of U.S. adults ages 50-89 from the 2006-2014 Health and Retirement Study (n=18,979 respondents), we analyze SLE using generalized linear regression.

RESULTS: Diagnosed hypertension is associated with lower SLE, regardless of measured BP. Among diagnosed hypertensives, those who self-report controlled BP expect to live longer than those who do not. Finally, about one in ten older adults have high measured BP but have never been diagnosed with hypertension, and most diagnosed hypertensives with uncontrolled measured BP self-report their BP as controlled.

DISCUSSION: Older adults appear to recognize the harmful effects of hypertension and the benefits of BP control, but often lack knowledge of their own hypertension and BP control statuses. Health communications should continue to stress the value of BP control, although improvements may require increased hypertension awareness and BP monitoring.

%B The Journals of Gerontology: Series B %V 77 %P 378-388 %G eng %N 2 %R 10.1093/geronb/gbab022 %0 Journal Article %J The Journal of Gerontology, Series A %D 2022 %T COVID-19 pandemic impact on trajectories in cardiometabolic health, physical activity and functioning among adults from the 2006-2020 Health and Retirement Study. %A Beydoun, Hind A %A Beydoun, May A %A Gautam, Rana S %A Alemu, Brook T %A Weiss, Jordan %A Hossain, Sharmin %A Zonderman, Alan B %K Activities of Daily Living %K COVID-19 %K lifestyle %K Obesity %K Statistical models %X

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

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

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

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

%B The Journal of Gerontology, Series A %V 77 %P 1371-1379 %G eng %N 7 %R 10.1093/gerona/glac028 %0 Journal Article %J 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 Web Page %D 2022 %T Dementia Rates Have Decreased by Nearly One-Third, According to a New Report—These Healthy Habits Can Help You Lower Your Risk, Too %A Walsh, Karla %K dementia rates %K healthy habits %I Yahoo! %G eng %U https://www.yahoo.com/lifestyle/dementia-rates-decreased-nearly-one-182329809.html %0 Journal Article %J IJERPH %D 2022 %T Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults ≥50 Years during the Pandemic: 2006–2020 Health and Retirement Study %A Beydoun, Hind A. %A Beydoun, May A. %A Alemu, Brook T. %A Weiss, Jordan %A Hossain, Sharmin %A Gautam, Rana S. %A Zonderman, Alan B. %K cardiometabolic %K COVID-19 %K healthcare services %K lifestyle %K Machine learning %K socio-demographic %X Background: The coronavirus disease 19 (COVID-19) was declared a global pandemic on 11 March 2020. To date, a limited number of studies have examined the impact of this pandemic on healthcare-seeking behaviors of older populations. This longitudinal study examined personal characteristics linked to COVID-19 outcomes as predictors of self-reported delayed healthcare services attributed to this pandemic, among U.S. adults, ≥50 years of age. Methods: Secondary analyses were performed using cross-sectional data (1413 participants) and longitudinal data (2881 participants) from Health and Retirement Study (HRS) (2006–2018) linked to the 2020 HRS COVID-19 Project (57% female, mean age: 68 years). Demographic, socioeconomic, lifestyle and health characteristics were evaluated in relation to delayed overall, surgical and non-surgical healthcare services (“Since March 2020, was there any time when you needed medical or dental care, but delayed getting it, or did not get it at all?” and “What type of care did you delay”) using logistic regression and Ensemble machine learning for cross-sectional data as well as mixed-effects logistic modeling for longitudinal data. Results: Nearly 32.7% delayed healthcare services, 5.8% delayed surgical services and 31.4% delayed non-surgical services. Being female, having a college degree or higher and 1-unit increase in depression score were key predictors of delayed healthcare services. In fully adjusted logistic models, a history of 1 or 2 cardiovascular and/or metabolic conditions (vs. none) was associated with 60–70% greater odds of delays in non-surgical services, with distinct findings for histories of hypertension, cardiovascular disease, diabetes and stroke. Ensemble machine learning predicted surgical better than overall and non-surgical healthcare delays. Conclusion: Among older adults, sex, education and depressive symptoms are key predictors of delayed healthcare services attributed to the COVID-19 pandemic. Delays in surgical and non-surgical healthcare services may have distinct predictors, with non-surgical delays more frequently observed among individuals with a history of 1 or 2 cardiovascular and/or metabolic conditions. %B IJERPH %V 19 %P 1-24 %G eng %U https://EconPapers.repec.org/RePEc:gam:jijerp:v:19:y:2022:i:19:p:12059-:d:923426 %0 Journal Article %J JAMA Internal Medicine %D 2022 %T Development and External Validation of a Mortality Prediction Model for Community-Dwelling Older Adults With Dementia. %A Deardorff, W James %A Barnes, Deborah E %A Jeon, Sun Y %A Boscardin, W John %A Kenneth M. Langa %A Covinsky, Kenneth E %A Mitchell, Susan L %A Whitlock, Elizabeth L %A Smith, Alexander K %A Lee, Sei J %K community dwelling %K Dementia %K mortality risk %X

Importance: Estimating mortality risk in older adults with dementia is important for guiding decisions such as cancer screening, treatment of new and chronic medical conditions, and advance care planning.

Objective: To develop and externally validate a mortality prediction model in community-dwelling older adults with dementia.

Design, Setting, and Participants: This cohort study included community-dwelling participants (aged ≥65 years) in the Health and Retirement Study (HRS) from 1998 to 2016 (derivation cohort) and National Health and Aging Trends Study (NHATS) from 2011 to 2019 (validation cohort).

Exposures: Candidate predictors included demographics, behavioral/health factors, functional measures (eg, activities of daily living [ADL] and instrumental activities of daily living [IADL]), and chronic conditions.

Main Outcomes and Measures: The primary outcome was time to all-cause death. We used Cox proportional hazards regression with backward selection and multiple imputation for model development. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (plots of predicted and observed mortality).

Results: Of 4267 participants with probable dementia in HRS, the mean (SD) age was 82.2 (7.6) years, 2930 (survey-weighted 69.4%) were female, and 785 (survey-weighted 12.1%) identified as Black. Median (IQR) follow-up time was 3.9 (2.0-6.8) years, and 3466 (81.2%) participants died by end of follow-up. The final model included age, sex, body mass index, smoking status, ADL dependency count, IADL difficulty count, difficulty walking several blocks, participation in vigorous physical activity, and chronic conditions (cancer, heart disease, diabetes, lung disease). The optimism-corrected iAUC after bootstrap internal validation was 0.76 (95% CI, 0.75-0.76) with time-specific AUC of 0.73 (95% CI, 0.70-0.75) at 1 year, 0.75 (95% CI, 0.73-0.77) at 5 years, and 0.84 (95% CI, 0.82-0.85) at 10 years. On external validation in NHATS (n = 2404), AUC was 0.73 (95% CI, 0.70-0.76) at 1 year and 0.74 (95% CI, 0.71-0.76) at 5 years. Calibration plots suggested good calibration across the range of predicted risk from 1 to 10 years.

Conclusions and Relevance: We developed and externally validated a mortality prediction model in community-dwelling older adults with dementia that showed good discrimination and calibration. The mortality risk estimates may help guide discussions regarding treatment decisions and advance care planning.

%B JAMA Internal Medicine %V 182 %P 1161-1170 %G eng %N 11 %R 10.1001/jamainternmed.2022.4326 %0 Journal Article %J Innovation in Aging %D 2022 %T DEVELOPMENT OF A FRAILTY INDEX FOR PEOPLE WITH DEMENTIA IN THE HEALTH AND RETIREMENT STUDY %A Wilkie, Rachel %A Jennifer A Ailshire %K Dementia %K frailty index %X Frailty indices (FI) have been found to predict adverse outcomes, such as, mortality, hospitalization, and institutionalization in older adults. However, traditional FIs often exclude people with dementia (PWD), who may not be able to consent to or complete all of the standard frailty items. While frailty is a known risk factor for onset of dementia and PWD have higher rates of frailty, little is known regarding how frailty predicts outcomes among PWD. Our study aims to develop an FI for PWD and to examine how this index relates to mortality, hospitalization, and nursing home stays. We used data from the Health and Retirement Study to create a 52-item FI for community-dwelling adults aged 50 years and over classified as having dementia (n = 1,107) in 2014. The index includes deficits in four domains: chronic health conditions, functional status, sensory problems, and overall health and wellbeing. A standardized FI score between 0 and 1 was calculated for each respondent. We used logistic regression to examine associations with FI and 2-year mortality, hospitalization, and nursing home stay, adjusting for age and gender. We found that a 0.1 unit increase in FI was significantly associated with higher odds of 2-year mortality (OR 1.39, p< 0.001), hospitalization (OR 1.45, p< 0.001), and nursing home stay (OR 1.38, p< 0.001) for people with dementia. This study developed an FI which is predictive for adverse outcomes among PWD. Future work should explore how socioeconomic and neighborhood factors contribute to the relationship between frailty and adverse outcomes among PWD. %B Innovation in Aging %V 6 %P 429 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1685 %0 Journal Article %J Western Journal of Nursing Research %D 2022 %T The Differential Effects of Caregiving Intensity on Overnight Hospitalization. %A Meyer, Kylie %A Zachary Gassoumis %A Kathleen H. Wilber %K Caregiving %K Dementia %K Health Services %K hospitalizations %K Policy %X

This study aims to examine how caregiving for a spouse affects caregivers' likelihood of overnight hospitalization. Using data from the Health and Retirement Study, we examine the odds of spousal caregivers experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and change in caregiving intensity. Caregivers were no more likely to experience an overnight hospitalization than noncaregivers ( = .92; CI [.84, 1.00]). Effects varied by intensity of care. Compared to noncaregivers, caregivers who reported providing no assistance with activities of daily living were less likely to experience overnight hospitalization ( = .77; CI [.66, .89]); however, caregivers who provided care to someone living with dementia for 4 to <6 years had 2.11 times the odds of experiencing an overnight hospitalization (CI [1.16, 3.85]). Although caregivers overall experience overnight hospitalization at a similar rate as noncaregivers, there are differences between caregivers by the intensity of care.

%B Western Journal of Nursing Research %V 44 %P 528-539 %G eng %N 6 %R 10.1177/01939459211002907 %0 Journal Article %J BMC Geriatrics %D 2022 %T Difficulty and help with activities of daily living among older adults living alone during the COVID-19 pandemic: a multi-country population-based study. %A Chen, Shanquan %A Jones, Linda A %A Jiang, Shan %A Jin, Huajie %A Dong, Dong %A Chen, Xi %A Wang, Dan %A Zhang, Yun %A Xiang, Li %A Zhu, Anna %A Cardinal, Rudolf N %K Activities of Daily Living %K COVID-19 %K Domiciliary care %K Living Alone %X

BACKGROUND: Older adults who live alone and have difficulties in activities of daily living (ADLs) may have been more vulnerable during the COVID-19 pandemic. However, little is known about pandemic-related changes in ADL assistance (such as home care, domiciliary care) and its international variation. We examined international patterns and changes in provision of ADL assistance, and related these to country-level measures including national income and health service expenditure.

METHODS: We analysed data covering 29 countries from three longitudinal cohort studies (Health and Retirement Study, English Longitudinal Study of Aging, and Survey of Health, Ageing and Retirement in Europe). Eligible people were aged ≥50 years and living alone. Outcomes included ADL difficulty status (assessed via six basic ADLs and five instrumental ADLs) and receipt of ADL assistance. Wealth-related inequality and need-related inequity in ADL assistance were measured using Erreygers' corrected concentration index (ECI). Correlations were estimated between prevalence/inequality/inequity in ADL assistance and national health-related indicators. We hypothesized these measures would be associated with health system factors such as affordability and availability of ADL assistance, as well as active ageing awareness.

RESULTS: During COVID-19, 18.4% of older adults living alone reported ADL difficulties (ranging from 8.8% in Switzerland to 29.2% in the USA) and 56.8% of those reporting difficulties received ADL assistance (ranging from 38.7% in the UK to 79.8% in Lithuania). Females were more likely to receive ADL assistance than males in 16/29 countries; the sex gap increased further during the pandemic. Wealth-related ECIs indicated socioeconomic equality in ADL assistance within 24/39 countries before the pandemic, and significant favouring of the less wealthy in 18/29 countries during the pandemic. Needs-related ECIs indicated less equity in assistance with ADLs during the pandemic than before. Our hypotheses on the association between ADL provision measures and health system factors were confirmed before COVID-19, but unexpectedly disconfirmed during COVID-19.

CONCLUSION: This study revealed an unequal (and in some countries, partly needs-mismatched) response from countries to older adults living alone during the COVID-19 pandemic. The findings might inform future research about, and policies for, older adults living alone, particularly regarding social protection responses during crises.

%B BMC Geriatrics %V 22 %P 181 %G eng %N 1 %R 10.1186/s12877-022-02799-w %0 Book Section %B New Models for Managing Longevity Risk: Public-Private Partnerships %D 2022 %T Disability-free life trends at older ages: Implications for longevity risk management %A Douglas A. Wolf %A Olivia S. Mitchell %K Activities of Daily Living %K Disability %B New Models for Managing Longevity Risk: Public-Private Partnerships %I Oxford University Press %@ 978–0–19–285980–8 %G eng %& 3 %R 10.1093/oso/9780192859808.001.0001 %0 Journal Article %J Alzheimer Disease & Associated Disorders %D 2022 %T Does a Cancer Diagnosis in Mid-to-Later Life Modify Racial Disparities in Memory Aging? %A Eastman, Marisa R %A Ospina-Romero, Monica %A Westrick, Ashly C %A Jasdeep S Kler %A M. Maria Glymour %A Abdiwahab, Ekland %A Lindsay C Kobayashi %K cancer diagnosis %K Memory %K Racial Disparities %X

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

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

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

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

%B Alzheimer Disease & Associated Disorders %V 36 %P 140-147 %G eng %N 2 %R 10.1097/WAD.0000000000000493 %0 Journal Article %J Innovation in Aging %D 2022 %T DOES NEIGHBORHOOD DISADVANTAGE ALTER MEMORY AFTER A CANCER DIAGNOSIS? A US HEALTH AND RETIREMENT STUDY %A Ashly Westrick %A Monica Ospina-Romero %A Philippa Clarke %A Lindsay C Kobayashi %K Cancer %K Memory %X We aimed to determine the influence of neighborhood socioeconomic status (NSES) on long-term cancer-related memory decline of older adults. Incident cancer diagnosis and memory were assessed in the U.S. Health and Retirement Study (N=15,074, 1998-2016). Proportion of female-headed households with children, households with public assistance income, people with income below poverty, and proportion 16+ years unemployed was categorized into NSES tertiles. Linear mixed-effects models compared the standardized memory trajectories by cancer status and NSES. Cancer-free individuals living in more disadvantaged neighborhoods had worse mean memory function at age 75 and steeper memory declines than participants from less disadvantaged neighborhoods. An incident cancer diagnosis was associated with an acute memory drop at diagnosis for those living in the least disadvantaged neighborhoods. Cancer survivors had better memory prior to but not after diagnosis compared to cancer-free individuals across NSES. These findings could inform future interventions to promote cancer survivor’s long-term aging. %B Innovation in Aging %V 6 %8 12/2022 %G eng %N Supplement_1 %9 Journal Article %& 8 %R 10.1093/geroni/igac059.026 %0 Journal Article %J SSM Population Health %D 2022 %T Education in the Jim Crow South and Black-White inequities in allostatic load among older adults. %A Walsemann, Katrina M %A Pearson, Jay %A Abbruzzi, Emily %K Education %K Measurement %K race disparity %X

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

%B SSM Population Health %V 19 %P 101224 %G eng %R 10.1016/j.ssmph.2022.101224 %0 Journal Article %J Alzheimer's & Dementia: The Journal of the Alzheimer's Association %D 2022 %T Effect of cognitive impairment on risk of death in Hispanic/Latino adults over the age of 50 residing in the United States with and without diabetes: Data from the Health and Retirement Study 1995-2014. %A Martinez, Martin %A Aprill Z Dawson %A Lu, Kevin %A Rebekah J Walker %A Leonard E Egede %K cognitive function %K cognitive impairment %K Hispanics %K Mortality %X

OBJECTIVE: To understand the relationship between mortality and cognitive function among older US Hispanic adults with and without diabetes.

METHODS: Data from the Health and Retirement Study (1995-2014) were analyzed. Cox proportional hazard models were used to estimate the association between mortality and cognitive function. Models were stratified by diabetes.

RESULTS: Four thousand thirteen older US Hispanic adults were included. Fully adjusted models for individuals with diabetes showed those with mild cognitive impairment (MCI; hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.06, 2.45; P = .025) and dementia (HR: 2.14; 95% CI: 1.25, 3.67; P = .006) had increased mortality compared to normal cognition. Fully adjusted models for individuals without diabetes showed those with MCI (HR: 1.87; 95% CI: 1.28, 2.74; P = .001) and dementia (HR: 3.25; 95% CI: 1.91, 5.55; P < .001) had increased mortality compared to normal cognition.

CONCLUSIONS: Cognitive impairment is associated with increased mortality in older US Hispanic adults with and without diabetes. Clinicians should regularly assess cognitive function in this group to quickly identify declines and make appropriate referrals for support to optimize health and reduce mortality.

%B Alzheimer's & Dementia: The Journal of the Alzheimer's Association %V 18 %P 1616-1624 %G eng %N 9 %R 10.1002/alz.12521 %0 Journal Article %J American Journal of Health Behavior %D 2022 %T Effect of Job Stressors on Presenteeism among Aging Workers: A Longitudinal Moderated Mediation Model. %A Deng, Jianwei %A Wu, Zhennan %A Shi, Hubin %A Yang, Tianan %A Duan, Zhezhe %K Aging workers %K Job stressors %X

With the rapid global increase in the age of workforces, companies are increasingly concerned with improving the working conditions of older workers. Anxiety is an important psychological variable in sociological studies but has attracted less attention in studies of occupational health and management. In this study, we explored the mediating effect of anxiety on the relationship between job stressors and presenteeism, and the moderating effect of pessimism. We collected longitudinal data from 892 respondents who participated in the 2008 and 2012 waves of the Health and Retirement Study in the United States. We tested the proposed moderated mediation model using structural equation modeling. Job stressors were positively related to anxiety and presenteeism. Anxiety was positively related to presenteeism and mediated the relationship between job stressors and presenteeism. Pessimism had a statistically significant negative effect on the relationship between anxiety and presenteeism. These results make theoretical and practical contributions to the literature on the influencing mechanisms of presenteeism. The use of longitudinal data ensured that the research conclusions were reliable; we suggest ways to improve the productivity of aging workers.

%B American Journal of Health Behavior %V 46 %P 39-48 %G eng %N 1 %R 10.5993/AJHB.46.1.4 %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 Aging %D 2022 %T Epigenetic clocks and their association with trajectories in perceived discrimination and depressive symptoms among US middle-aged and older adults. %A Beydoun, May A %A Beydoun, Hind A %A Noren Hooten, Nicole %A Maldonado, Ana I %A Weiss, Jordan %A Evans, Michele K %A Zonderman, Alan B %K Biological age %K Depressive symptoms %K DNA Methylation %K epigenetic clocks %K Perceived Discrimination %X

BACKGROUND: Perceived discrimination may be associated with accelerated aging later in life, with depressive symptoms acting as potential mediator.

METHODS: A nationally representative sample of older adults was used [Health and Retirement Study 2010-2016, Age: 50-100 y in 2016, = 2,806, 55.6% female, 82.3% Non-Hispanic White (NHW)] to evaluate associations of perceived discrimination measures [Experience of discrimination or EOD; and Reasons for Perceived discrimination or RPD) and depressive symptoms (DEP)] with 13 DNAm-based measures of epigenetic aging. Group-based trajectory and four-way mediation analyses were used.

RESULTS: Overall, and mostly among female and NHW participants, greater RPD in 2010-2012 had a significant adverse total effect on epigenetic aging [2016: DNAm GrimAge, DunedinPoAm38 (MPOA), Levine (PhenoAge) and Horvath 2], with 20-50% of this effect being explained by a pure indirect effect through DEP in 2014-2016. Among females, sustained elevated DEP (2010-2016) was associated with greater LIN DNAm age (β ± SE: +1.506 ± 0.559, = 0.009, reduced model), patterns observed for elevated DEP (high vs. low) for GrimAge and MPOA DNAm markers. Overall and in White adults, the relationship of the Levine clock with perceived discrimination in general (both EOD and RPD) was mediated through elevated DEP.

CONCLUSIONS: Sustained elevations in DEP and RPD were associated with select biological aging measures, consistently among women and White adults, with DEP acting as mediator in several RPD-EPICLOCK associations.

%B Aging %V 14 %P 5311—5344 %G eng %N 13 %R 10.18632/aging.204150 %0 Journal Article %J Innovation in Aging %D 2022 %T Estimated Pulse Wave Velocity and All-Cause Mortality: Findings from the Health and Retirement Study %A Heffernan, Kevin S %A Wilmoth, Janet M %A London, Andrew S %K Cardiovascular disease %K Estimated pulse wave velocity %K Mortality %K Vascular aging %K Vascular stiffness %X The gold standard method for the assessment of vascular aging is carotid-femoral pulse wave velocity (cfPWV). cfPWV can be estimated from two commonly assessed clinical variables—age and blood pressure. This analysis uses data from the Health and Retirement Study to examine the relationship between estimated pulse wave velocity (ePWV) and mortality among 9,293 middle-age and older adults.Cox proportional hazard models were used to predict mortality occurring over a 10 to12-year period. Controls were included for sociodemographic characteristics (age, gender, race, ethnicity, wealth, income, education), health status (history of cardiovascular disease, diabetes, and stroke and related medication use), health behaviors (smoking, physical activity, body mass index), and cardiovascular disease (CVD)-related biomarkers (systolic and diastolic blood pressure, C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein (HDL) cholesterol).By 2018, 26.19\% of the weighted analytic sample were reported as deceased. In the fully specified models that control for age, age-squared, systolic and diastolic blood pressure, sociodemographic variables, health status and behaviors, and biomarkers, ePWV was associated with a greater likelihood of mortality.An estimate of PWV derived from age and blood pressure is independently associated with increased likelihood of death in a representative sample of middle-age and older adults in the U.S. %B Innovation in Aging %8 08 %G eng %R 10.1093/geroni/igac056 %0 Journal Article %J JAMA Neurology %D 2022 %T Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US: The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project %A Jennifer J Manly %A Richard N Jones %A Kenneth M. Langa %A Ryan, Lindsay H. %A Levine, Deborah A. %A McCammon, Ryan %A Heeringa, Steven G. %A David R Weir %K Dementia %K HCAP %K mild cognitive impairment %X Nationally representative data are critical for understanding the causes, costs, and outcomes associated with dementia and mild cognitive impairment (MCI) in the US and can inform policies aimed at reducing the impact of these conditions on patients, families, and public programs. The nationally representative Health and Retirement Study (HRS) is an essential resource for such data, but the HRS substudy providing dementia diagnostic information was fielded more than 20 years ago and more recent data are needed.The Harmonized Cognitive Assessment Protocol (HCAP) was developed to update national estimates of the prevalence of MCI and dementia in the US and examine differences by age, race, ethnicity, and sex.HRS is an ongoing longitudinal nationally representative study of people 51 years and older with staggered entry dates from 1992 to 2022 and follow-up ranging from 4 to 30 years. HCAP is a cross-sectional random sample of individuals in HRS who were 65 years or older in 2016. Of 9972 age-eligible HRS participants, 4425 were randomly selected for HCAP, and 3496 completed a comprehensive neuropsychological test battery and informant interview, none of whom were excluded. Dementia and MCI were classified using an algorithm based on standard diagnostic criteria and comparing test performance to a robust normative sample.Groups were stratified by age, sex, education, race, and ethnicity.National prevalence estimates using population weights.The mean (SD) age of the study population sample (N = 3496) was 76.4 (7.6) years, and 2095 participants (60\%) were female. There were 551 participants who self-identified as Black and not Hispanic (16\%), 382 who self-identified as Hispanic regardless of race (16\%), 2483 who self-identified as White and not Hispanic (71\%), and 80 who self-identified as another race (2\%), including American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, or another self-described race. A total of 393 individuals (10\%; 95\% CI, 9-11) were classified as having dementia and 804 (22\%; 95\% CI, 20-24) as having MCI. Every 5-year increase in age was associated with higher risk of dementia (weighted odds ratio [OR], 1.95 per 5-year age difference; 95\%, CI, 1.77-2.14) and MCI (OR, 1.17 per 5-year age difference, 95\% CI, 1.09-1.26). Each additional year of education was associated with a decrease in risk of dementia (OR, 0.93 per year of school, 95\% CI, 0.89-0.97) and MCI (OR, 0.94, 95\% CI, 0.91-0.97). Dementia was more common among non-Hispanic Black individuals (OR, 1.81; 95\% CI, 1.20-2.75) and MCI in Hispanic individuals (OR, 1.42; 95\% CI, 1.03-1.96) compared with non-Hispanic White individuals. Other group comparisons by race and ethnicity were not possible owing to small numbers. No differences in prevalence were found between female individuals and male individuals.Using a comprehensive neuropsychological test battery and large sample, the national prevalence of dementia and MCI in 2016 found in this cross-sectional study was similar to that of other US-based studies, indicating a disproportionate burden of dementia and MCI among older Black and Hispanic adults and those with lower education. %B JAMA Neurology %V 79 %P 1242-1249 %G eng %N 12 %R 10.1001/jamaneurol.2022.3543 %0 Journal Article %J Genes %D 2022 %T Exome Array Analysis of 9721 Ischemic Stroke Cases from the SiGN Consortium. %A Xu, Huichun %A Nguyen, Kevin %A Gaynor, Brady J %A Ling, Hua %A Zhao, Wei %A McArdle, Patrick F %A O'Connor, Timothy D %A Stine, O Colin %A Ryan, Kathleen A %A Lynch, Megan %A Smith, Jennifer A %A Jessica Faul %A Hu, Yao %A Haessler, Jeffrey W %A Fornage, Myriam %A Kooperberg, Charles %A Perry, James A %A Hong, Charles C %A Cole, John W %A Pugh, Elizabeth %A Doheny, Kimberly %A Sharon L R Kardia %A David R Weir %A Kittner, Steven J %A Mitchell, Braxton D %K Exome %K Gene Frequency %K Genome-Wide Association Study %K Ischemic stroke %K Stroke %X

Recent genome wide association studies have identified 89 common genetic variants robustly associated with ischemic stroke and primarily located in non-coding regions. To evaluate the contribution of coding variants, which are mostly rare, we performed an exome array analysis on 106,101 SNPs for 9721 ischemic stroke cases from the SiGN Consortium, and 12,345 subjects with no history of stroke from the Health Retirement Study and SiGN consortium. We identified 15 coding variants significantly associated with all ischemic stroke at array-wide threshold (i.e., < 4.7 × 10), including two common SNPs in that have previously been associated with stroke. Twelve of the remaining 13 variants were extremely rare in European Caucasians (MAF < 0.1%) and the associations were driven by African American samples. There was no evidence for replication of these associations in either TOPMed Stroke samples ( = 5613 cases) or UK Biobank ( = 5874 stroke cases), although power to replicate was very low given the low allele frequencies of the associated variants and a shortage of samples from diverse ancestries. Our study highlights the need for acquiring large, well-powered diverse cohorts to study rare variants, and the technical challenges using array-based genotyping technologies for rare variant genotyping.

%B Genes %V 14 %P 61 %G eng %N 1 %R 10.3390/genes14010061 %0 Journal Article %J Epidemiology %D 2022 %T Explaining the variance in cardiovascular disease risk factors: A comparison of demographic, socioeconomic, and genetic predictors. %A Hamad, Rita %A M. Maria Glymour %A Calmasini, Camilla %A Thu T Nguyen %A Stefan Walter %A David Rehkopf %K Cardiovascular disease %K Demographics %K Genetics %K Risk Factors %K socioeconomics %X

BACKGROUND: Efforts to explain the burden of cardiovascular disease (CVD) often focus on genetic factors or social determinants of health. There is little evidence on the comparative predictive value of each, which could guide clinical and public health investments in measuring genetic versus social information. We compared the variance in CVD-related outcomes explained by genetic versus socioeconomic predictors.

METHODS: Data were drawn from the Health and Retirement Study (N=8,720). We examined self-reported diabetes, heart disease, depression, smoking, and body mass index, and objectively measured total and high-density lipoprotein cholesterol. For each outcome, we compared the variance explained by demographic characteristics, socioeconomic position (SEP), and genetic characteristics including a polygenic score for each outcome and principal components (PCs) for genetic ancestry. We used R-squared values derived from race-stratified multivariable linear regressions to evaluate the variance explained.

RESULTS: The variance explained by models including all predictors ranged from 3.7% to 14.3%. Demographic characteristics explained more than half this variance for most outcomes. SEP explained comparable or greater variance relative to the combination of the polygenic score and PCs for most conditions among both white and Black participants. The combination of SEP, polygenic score, and PCs performed substantially better, suggesting that each set of characteristics may independently contribute to prediction of CVD related outcomes.

CONCLUSIONS: Focusing on genetic inputs into personalized medicine predictive models, without considering measures of social context that have clear predictive value, needlessly ignores relevant information that is more feasible and affordable to collect on patients in clinical settings.

%B Epidemiology %V 33 %P 25-33 %G eng %N 1 %R 10.1097/EDE.0000000000001425 %0 Journal Article %J BMC Geriatrics %D 2022 %T Explanatory role of sociodemographic, clinical, behavioral, and social factors on cognitive decline in older adults with diabetes. %A O'Toole, Sean M %A Rebekah J Walker %A Emma Garacci %A Aprill Z Dawson %A Campbell, Jennifer A %A Leonard E Egede %K Cognitive decline %K Diabetes %K Health Disparities %X

BACKGROUND: The aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes.

METHODS: Adults aged 50+ years with diabetes from the Health and Retirement Survey were assessed for cognitive function (normal, mild cognitive impairment [MCI], and dementia). Generalized estimating equation (GEE) logistic regression models were used to account for repeating measures over time. Models were adjusted for sociodemographic (gender, age, education, household income and assets), behavioral (smoking), clinical (ie. comorbidities, body mass index), and social (social support, loneliness, social participation, perceived constraints and perceived mastery on personal control) factors.

RESULTS: Unadjusted models showed non-Hispanic Blacks (NHB) and Hispanics were significantly more likely to progress from normal cognition to dementia (NHB OR: 2.99, 95%CI 2.35-3.81; Hispanic OR: 3.55, 95%CI 2.77-4.56), and normal cognition to MCI (NHB OR = 2.45, 95%CI 2.14-2.82; Hispanic OR = 2.49, 95%CI 2.13-2.90) compared to non-Hispanic Whites (NHW). Unadjusted models for the transition from mild cognitive decline to dementia showed Hispanics were more likely than NHW to progress (OR = 1.43, 95%CI 1.11-1.84). After adjusting for sociodemographic, clinical/behavioral, and social measures, NHB were 3.75 times more likely (95%CI 2.52-5.56) than NHW to reach dementia from normal cognition. NHB were 2.87 times more likely (95%CI 2.37-3.48) than NHW to reach MCI from normal. Hispanics were 1.72 times more likely (95%CI 1.17-2.52) than NHW to reach dementia from MCI.

CONCLUSION: Clinical/behavioral and social factors did not explain racial/ethnic disparities. Racial/ethnic disparities are less evident from MCI to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important.

%B BMC Geriatrics %V 22 %P 39 %G eng %N 1 %R 10.1186/s12877-021-02740-7 %0 Journal Article %J Disability and Health Journal %D 2022 %T Factors influencing participation among adults aging with long-term physical disability. %A Heeb, Rachel %A Putnam, Michelle %A Keglovits, Marian %A Weber, Courtney %A Campbell, Margaret %A Stark, Susan %A Morgan, Kerri %K Aging %K environment %K Participation %K Physical disability %K Qualitative methods %X

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

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

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

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

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

%B Disability and Health Journal %V 15 %P 101169 %G eng %N 1 %R 10.1016/j.dhjo.2021.101169 %0 Journal Article %J Frontiers in Molecular Neuroscience %D 2022 %T Favourable Lifestyle Protects Cognitive Function in Older Adults With High Genetic Risk of Obesity: A Prospective Cohort Study. %A Liu, Huamin %A Wang, Zhenghe %A Zou, Lianwu %A Gu, Shanyuan %A Zhang, Minyi %A Hukportie, Daniel Nyarko %A Zheng, Jiazhen %A Zhou, Rui %A Yuan, Zelin %A Wu, Keyi %A Huang, Zhiwei %A Zhong, Qi %A Huang, Yining %A Wu, Xianbo %K cognitive function %K genetic risk %K lifestyle %K Obesity %X

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

%B Frontiers in Molecular Neuroscience %V 15 %P 808209 %G eng %R 10.3389/fnmol.2022.808209 %0 Journal Article %J PLoS One %D 2022 %T Frailty does not cause all frail symptoms: United States Health and Retirement Study. %A Chao, Yi-Sheng %A Wu, Chao-Jung %A Po, June Y T %A Huang, Shih-Yu %A Wu, Hsing-Chien %A Hsu, Hui-Ting %A Cheng, Yen-Po %A Lai, Yi-Chun %A Chen, Wei-Chih %K Frail Elderly %K Frailty %K Geriatric Assessment %K Retirement %X

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

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

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

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

%B PLoS One %V 17 %P e0272289 %G eng %N 11 %R 10.1371/journal.pone.0272289 %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2022 %T Gender Disparities of Heart Disease and the Association with Smoking and Drinking Behavior among Middle-Aged and Older Adults, a Cross-Sectional Study of Data from the US Health and Retirement Study and the China Health and Retirement Longitudinal Study. %A Li, Yifei %A Lu, Yuanan %A Eric L Hurwitz %A Wu, Yanyan %K Alcohol Drinking %K CHARLS %K gender %K Heart disease %K Smoking %X

Heart disease remains the leading cause of death globally by gender and region. Smoking and alcohol drinking are known modifiable health behaviors of heart disease. Utilizing data from the US Health and Retirement Study and the China Health and Retirement Longitudinal Study, this study examines heart disease disparities and the association with smoking and drinking behavior among men and women in the US and China. Smoking and drinking behavior were combined to neither, smoke-only, drink-only, and both. In the US, the prevalence was higher in men (24.5%, 95% CI: 22.5-26.6%) than in women (20.6%, 95% CI: 19.3-22.1%) and a higher prevalence was found in the smoke-only group for both genders. In contrast, women in China had higher prevalence (22.9%, 95% CI: 21.7-24.1%) than men (16.1%, 95% CI: 15.1-17.2%), and the prevalence for women who smoked or engaged in both behaviors were ~1.5 times (95% CI: 1.3-1.8, < 0.001) those who did not smoke or drink, but no statistical difference were found in men. The findings might be due to differences in smoking and drinking patterns and cultures by gender in the two countries and gender inequality among older adults in China. Culturally tailored health promotion strategies will help reduce the burden of heart disease.

%B International Journal of Environmental Research and Public Health %V 19 %P 2188 %G eng %N 4 %R 10.3390/ijerph19042188 %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2022 %T Gender Disparities of Heart Disease and the Association with Smoking and Alcohol Drinking Behavior Among the Middle-Aged and Older Population in the US and China, a Cross-Sectional Study of CHARLS and HRS Data %A Li, Yifei %A Lu, Yuanan %A Eric L Hurwitz %A Wu, Yanyan %K Alcohol Drinking %K CHARLS %K gender %K health survey %K Heart disease %X Background Heart disease remains the leading cause of death globally with substantial variabilities in mortalities by gender and region. Smoking and alcohol drinking are known modifiable health behaviors associated with heart disease. This study aims to estimate the prevalence of heart disease and to examine the association with smoking and drinking behavior for men and women in the United States (US) and China. Methods This study utilized the Harmonized data from the US Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS), which are sister surveys as part of the Gateway to Global Aging Data (https://g2aging.org/). We performed cross-sectional comparisons using the 2016 wave HRS and 2015 wave CHARLS data. Age was categorized into four groups (50–59, 60–69, 70–79, and 80 years or older) and smoking and drinking behavior were combined to neither, smoking only, drinking only and both behaviors. Weighted analyses were conducted to estimate the prevalence and prevalence ratios (PRs) of heart disease accounting for complex survey design. Results The overall prevalence of heart disease was higher in men (24.5%) than in women (20.6%) in the US. In contrast, women had higher prevalence (22.9%) than men (16.1%) in China. The prevalence of heart disease increased by age with increasing gender gap in the US, while in China, the highest prevalence was observed in the 70–79 age group and gender difference were more apparent before 80 years of age. Adjusting for socio-demographic variables and health conditions, smoking only was associated with a higher prevalence of heart disease in both countries and the associations were stronger among women (US: PR = 1.39, 95%CI: 1.26 to 1.54; China: PR = 1.49, 95%CI: 1.30 to 1.72) than among men (US: PR = 1.20, 95%CI: 1.04 to 1.38; China: PR = 1.37, 95%CI: 0.94 to 1.98). Conclusions Findings from this study will improve present understanding of heart disease etiology and provide essential insights for future prevention, treatment, and control. Better management of smoking behaviors by gender might be beneficial for reducing the burden of heart disease in both countries and worldwide. %B International Journal of Environmental Research and Public Health %V 19 %P 2188 %G eng %N 4 %R 10.21203/rs.3.rs-626338/v1 %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 Drugs & Aging %D 2022 %T Hallucinations, Antipsychotic Use, and Mortality in Older Adults with Dementia: Retrospective Cohort Study of Two Medicare-Linked National Health Surveys. %A Hamedani, Ali G %A Weintraub, Daniel %A Willis, Allison W %K Antipsychotic Agents %K Dementia %K Medicare %K Retrospective Studies %X

BACKGROUND: Hallucinations are associated with earlier death in older adults with dementia, but antipsychotic medications are also associated with mortality, and comparisons of their relative harms are lacking.

OBJECTIVE: To determine the individual and combined association between hallucinations, antipsychotic use, and mortality.

METHODS: We performed a retrospective cohort study using Medicare-linked survey data from two nationally representative studies (the National Health and Aging Trends Study and the Health and Retirement Study) containing validated dementia identification algorithms and a screening question for hallucinations. Using Medicare claims, we identified participants with dementia who had no history of antipsychotic use during the year of or prior to entry. We used extended Cox regression with time-varying covariates to analyze the association between hallucinations, antipsychotic use, and mortality adjusting for confounders.

RESULTS: We identified 1703 eligible subjects who contributed 4,819 person-years of follow-up. 555 (32.6%) had hallucinations at baseline, 705 (41.4%) reported hallucinations at least once during follow-up, and 284 (16.7%) received antipsychotics. Hallucinations were associated with an increased risk of death in unadjusted models (hazard ratio (HR) 1.36; 95% confidence interval (CI): 1.18-1.5), but antipsychotic use was not (HR 1.03; 95% CI 0.85-1.2). After adjusting for age, race, gender, dementia severity, and comorbidities, the HR for hallucinations attenuated and was no longer statistically significant (1.15, 95% CI 0.98-1.34). There was no significant interaction between hallucinations and antipsychotic use.

CONCLUSION: Hallucinations are associated with an increased risk of death that is greater than the risk associated with antipsychotic use, though this is partially confounded by dementia severity and comorbidities.

%B Drugs & Aging %V 39 %P 967-974 %G eng %N 12 %R 10.1007/s40266-022-00991-6 %0 Report %D 2022 %T Health and Retirement Study Imputation of Cognitive Functioning Measures: 1992-2018 %A Ryan J McCammon %A Gwenith G Fisher %A Hassan, Halimah %A Jessica Faul %A Rogers, Willard %A David R Weir %K Health Conditions and Status %K Methodology %I Survey Research Center, University of Michigan %C Ann Arbor, Michigan %G eng %U https://hrsdata.isr.umich.edu/sites/default/files/documentation/data-descriptions/1651088507/COGIMP9218_dd.pdf %4 Cognition/HRS User Guide/methodology %0 Journal Article %J Journal of Immigrant and Minority Health %D 2022 %T Healthy Debate: Major Depression among Older Immigrants and the United States 2016 Election. %A Rachel S. Bergmans %A Kelly, Kristen M %A Riley Wegryn-Jones %K Foreign born %K Gerontology %K Health Disparities %K Psychiatric epidemiology %K Social Environment %X

This study investigated whether anti-immigrant sentiment leading up to the 2016 election increased risk of major depression among older U.S. immigrants. Drawing data from the Health and Retirement Study, we tested whether there was a disproportionate increase in major depression among U.S. immigrants than non-immigrants from 2014 to 2016 using a Difference in Difference approach. Older immigrants had a higher relative change in major depression from 2014 to 2016 than non-immigrants (RRR 1.35; 95% CI 1.06, 1.73). This relationship was driven by associations among those who are White (RRR 2.07; 95% CI 1.26, 3.41) or Hispanic (RRR 1.55; 95% CI 0.99, 2.40). Anti-immigrant sentiment leading up to the 2016 election was associated with an increase in major depression among older U.S. immigrants. Findings may help identify high-risk groups in future election years and inform treatment strategies for major depression that consider the influence of sociopolitical factors.

%B Journal of Immigrant and Minority Health %V 24 %P 360-367 %G eng %N 2 %R 10.1007/s10903-021-01217-4 %0 Journal Article %J Innovation in Aging %D 2022 %T HEARING LOSS AND ITS CONSEQUENCES FOR SPOUSAL MENTAL HEALTH: EVIDENCE FROM THE HEALTH AND RETIREMENT STUDY %A West, Jessica %A Smith, Sherri %A Dupre, Matthew %K Hearing loss %K Mental Health %K Spouses %X Hearing loss (HL) is an increasingly prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course perspective and stress process framework highlight that an individual’s stressors may have a short and/or long-term impact on the health of others. However, little is known about how HL influences the proliferation of stress within married couples. Drawing on nationally-representative data from 11 waves (1998-2018) of the Health and Retirement Study (n=9,000 individuals, 4,500 couples), we use age-based mixed models to examine how one’s own HL, spouse’s HL, or both spouses have HL shape the level and changes in depressive symptoms. For men, we find that their wives’ HL, their own HL, and both spouses having HL are each associated with an increase in depressive symptoms—and that the associations persist as spouses age. For women, we find that their own HL and both spouses having HL is associated with an increase in depressive symptoms. Furthermore, we find that the differences in women’s depressive symptoms between spouses who both have HL and those who do not have HL significantly declines with age. We also find no evidence to suggest that husbands’ HL is associated with wives’ depressive symptoms. Together, these findings suggest that the connections between spouses’ HL and their depressive symptoms are a dynamic process that unfolds differently by gender over time. Interventions that recognize the proliferation of stress associated with HL may help both individuals with HL and their spouses reduce their depressive symptoms. %B Innovation in Aging %V 6 %P 431 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1692 %0 Generic %D 2022 %T HOPELESSNESS AMONG MIDDLE-AGED AND OLDER ADULTS: A COMPARISON OF NATIVE WHITES, NATIVE MINORITIES, AND IMMIGRANTS %A Guo, Man %A Wang, Yi %A Carter, Kara %K hopelessness %K Immigrants %K middle-aged adult %K minorities %K Older adult %K Whites %X Abstract Sense of hopelessness is closely linked to poor physical/mental health and elevated suicidal risk. The aging and immigration processes put middle-aged and older immigrants at a greater risk of feeling hopeless. However, we know little about hopelessness among this population. This study asks two questions: do middle-aged and older immigrants have higher levels of hopelessness compared to native-born Whites and native-born ethnic minorities? If so, what factors contribute to such differences? Data was from the 2018 psychosocial assessment of the Health and Retirement Study (N = 5,534). ANOVA was used to compare levels of hopelessness among three groups of middle-aged/older adults (50 yrs+): native-born Whites (n =3,603), native-born minorities (n = 1,209), and immigrants (n = 722). Linear regressions were used to examine the association between nativity/race and hopelessness, with five sets of explanatory variables (i.e., SES, health, social support, social engagement, and neighborhood characteristics) entered in the models individually and then collectively. The findings showed that middle-aged/older immigrants had the highest levels of hopelessness, followed by native minorities, and then native Whites. Controlling for each set of the explanatory variables respectively reduced the group differences between native Whites and native ethnic minorities, but not between Whites and immigrants. When controlling for all the explanatory variables, the levels of hopelessness no longer differed significantly between immigrants and native Whites. Findings suggest that immigrants’ multiple disadvantages in personal, family, and social lives may contribute to their heightened levels of hopelessness. Interventions are sorely needed to protect against hopelessness for this population. %G eng %R 10.1093/geroni/igac059.047 %0 Report %D 2022 %T How Does Local Cost-of-Living Affect Retirement for Low and Moderate Earners? %A Quinby, Laura D. %A Gal Wettstein %K cost-of-living %K Low income %K moderate income %K Retirement %X This paper uses the Health and Retirement Study to explore how local cost-of-living affects Social Security replacement rates and household behavior. In theory, labor markets with high cost-of-living also offer more compensation. If this compensating differential is paid in wages, rather than benefits, it reduces the share of earnings replaced by Social Security due to the progressive benefit structure. This paper examines how important the cost-of-living penalty is, in practice, and whether it impacts households’ saving or labor supply. %B Working Papers %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/how-does-local-cost-of-living-affect-retirement-for-low-and-moderate-earners/ %0 Journal Article %J Journal of the American Heart Association %D 2022 %T Hypertension and Diabetes Status by Patterns of Stress in Older Adults From the US Health and Retirement Study: A Latent Class Analysis. %A Fernandez, Jessica R %A Montiel Ishino, Francisco A %A Williams, Faustine %A Slopen, Natalie %A Forde, Allana T %K Diabetes Mellitus %K ethnicity %K Hypertension %K Latent Class Analysis %K Retirement %X

Background Hypertension and diabetes disproportionately affect older non-Hispanic Black and Hispanic adults in the United States. Chronic stress may partially explain these disparities. This study identified underlying stress profiles of older US adults, analyzed stress profiles in relation to hypertension and diabetes, examined the distribution of stress profiles by race and ethnicity, and assessed patterns of change in latent classes of stress over time. Methods and Results Latent class analysis was conducted with a nationally representative sample of older US adults who completed 3 waves of the HRS (Health and Retirement Study) (ie, 2010 [n=6863], 2014 [n=4995], and 2018 [n=3089]). Latent classes of stress in 2010 (ie, stress profiles) were identified using 15 indicators of unmet needs within 5 categories (ie, physiological, safety/security, belonging, esteem, and self-fulfillment). Hypertension and diabetes status were examined as outcomes of latent class membership at 3 time points, and race and ethnicity were examined in association with class membership, adjusting for sociodemographic covariates. Finally, a latent transition analysis examined the stability of latent class membership and racial and ethnic differences in the patterns of stress profiles experienced from 2010 to 2018. Five classes were identified: Generally Unmet Needs (13% of sample), Generally Met Needs (42% of sample), Unmet Self-Efficacy/Goal Needs (12% of sample), Unmet Financial Needs (20% of sample), and Unmet Social Belonging Needs (13% of sample). Compared with the Generally Met Needs class, the Generally Unmet Needs class had higher odds of hypertension (odds ratio [OR], 1.80; [95% CI, 1.35-2.39]) and diabetes (OR, 1.94; [95% CI, 1.45-2.59]), and the Unmet Financial Needs class had higher odds of diabetes (OR, 1.50; [95% CI, 1.10-2.05]). Non-Hispanic Black participants compared with non-Hispanic White participants had higher odds of being members of the Generally Unmet Needs, Unmet Self-Efficacy/Goal Needs, and Unmet Financial Needs classes (OR, 2.70; [95% CI, 1.59-4.58]; OR, 1.99; [95% CI, 1.15-3.43]; and OR, 4.74; [95% CI, 3.32-6.76], respectively). Class membership remained relatively stable over time, with 93% of participants remaining in Generally Met Needs and 78% of participants remaining in Generally Unmet Needs across time points. Compared with non-Hispanic White participants, non-Hispanic Black participants had lower odds of Generally Met Needs class membership at any time point (OR, 0.60; [95% CI, 0.42-0.84]) and had lower odds of moving into the Generally Met Needs class and higher odds of moving into the Unmet Financial Needs class from 2010 to 2014 (OR, 0.33; [95% CI, 0.13-0.86]; and OR, 3.02; [95% CI, 1.16-7.87], respectively). Conclusions Underlying classes of stress based on unmet needs were associated with hypertension and diabetes status. Racial and ethnic differences were observed for both latent class membership and transitions between classes over time. Latent classes of stress associated with unmet needs, hypertension, and diabetes and the ability to transition between classes may explain the perpetuation of racial and ethnic disparities in cardiovascular health. Interventions targeting unmet needs may be used to confront these disparities.

%B Journal of the American Heart Association %V 11 %P e024594 %G eng %N 12 %R 10.1161/JAHA.121.024594 %0 Journal Article %J The Journal of Retirement %D 2022 %T The Illusory Benefit of Working Longer on Retirement Financial Preparedness: Rethinking Advice That Working Longer Increases Retirement Income %A Ghilarducci, Teresa %A Papadopoulos, Michael %A Webb, Anthony %K financial preparedness %K Older workers %K Social Security %K Working Longer %X This article demonstrates that although working longer can, in theory, substantially improve financial preparedness for retirement, it yields much smaller improvements in practice. Multivariate analysis using data from the Health and Retirement Study reveals that working longer improves financial preparedness only for workers who also delay claiming Social Security. But most older workers combine work with Social Security benefits, do not increase their financial wealth, and miss out on the delayed retirement credit. For many, early claiming is a rational choice because their low and often part-time earnings fall short of projected post-retirement income. %B The Journal of Retirement %V 9 %G eng %N 3 %R 10.3905/jor.2022.1.104 %0 Journal Article %J Sustainability %D 2022 %T The Impact of COVID-19 on Depressive Symptoms and Loneliness for Middle-Aged and Older Adults %A Curl, Angela L. %A Wolf, Katie E. %K COVID-19 %K Depressive symptoms %K Loneliness %X This study examines the impact of the COVID-19 pandemic on depressive symptoms and loneliness in older adults, using the Protection Motivation Theory Framework. Using data collected between March 2020 and May 2021 as part of the Health and Retirement Study (N = 2145 adults over age 50), the roles of threat and coping appraisals as predictors of protective health behaviors and, ultimately, mental health outcomes, were analyzed using structural equation modeling. Being at high risk for COVID-19 complications and death was associated with more depressive symptoms and loneliness. Higher levels of concern about COVID-19 were associated with more depressive symptoms while knowing someone who had died of the coronavirus was associated with less loneliness. Lower scores for perceived control over one’s health and social life were associated with more depressive symptoms and higher loneliness. These results suggest that moving forward, mental health assessments should consider the impact of the pandemic and include measures specifically asking about COVID-19 concerns and experiences (e.g., death of close friends or family due to COVID-19, protective health measures). Additionally, future responses to this pandemic and other public health emergencies should consider the influence that self-efficacy has on health behaviors and mental health. The pandemic has raised public awareness of the negative consequences of social isolation and acted to destigmatize mental illness, and this greater awareness could encourage middle-aged and older adults to seek various treatments for depression and loneliness. %B Sustainability %V 14 %P 6316 %G eng %R 10.3390/su14106316 %0 Journal Article %J Transport Policy %D 2022 %T Impact of health on driving for America's older adults: A nationwide, longitudinal study %A Xize Wang %K Aging %K Elderly %K Mode choice %K Well Being %X By 2030, one in every five Americans will be 65 or older. To better serve the mobility needs of a rapidly aging population, a better understanding of older adults' driving behavior is needed. This study explores the impact of health on driving reduction for America's older adults, using a nationwide, longitudinal dataset from the Health and Retirement Study (HRS). I propose two outcome variables: having driven in the past month, and having driven beyond nearby places; and measure health using overall self-rated health status and specific sensory, mobility and physical conditions. Controlling for socio-demographics, residential patterns, personal fixed effects, time fixed effects, and regional fixed effects, I find that older adults with lower self-rated health were less likely to drive or drive beyond nearby places. The magnitudes of such effects vary by race but not by gender. I also identify specific health conditions that could predict driving reduction. The findings imply that in the near future, there will be a large number of older adults suffering from unmet travel demands due to declining health conditions. Hence, planners and policy makers should be proactive in seeking for solutions, including using my findings to identify at-risk older drivers and provide various types of mobility assistance. %B Transport Policy %V 120 %P 69-79 %G eng %R 10.1016/j.tranpol.2022.02.005 %0 Journal Article %J Journal of Economics, Race, and Policy %D 2022 %T The Impact of the COVID-19 Pandemic on Business Ownership Across Racial/Ethnic Groups and Gender. %A Choi, Shinae L %A Harrell, Erin R %A Watkins, Kimberly %K COVID-19 %K Entrepreneurship %K gender %K Race/ethnicity %X

This study examined the economic impact of the COVID-19 pandemic on US older entrepreneurs' businesses using the Health and Retirement Study. We estimated logistic regression models to document the odds of experiencing economic impact. The COVID-19 pandemic has affected nearly 76% of US older entrepreneurs but has disproportionately impacted the businesses of Black, Hispanic, Asian/other races, and women entrepreneurs. Older Black entrepreneurs had significantly higher odds of facing business closure (OR = 2.31,  < .01), implementing new procedures (OR = 2.44,  < .01), workers quitting (OR = 2.95,  < .001), and difficulty paying regular bills (OR = 2.88,  < .001) than their White counterparts. Older Hispanic entrepreneurs also had significantly higher odds of instituting new procedures (OR = 2.27,  < .05), workers quitting (OR = 2.26,  < .01), and difficulty paying regular bills (OR = 2.35,  < .01) than their White counterparts. Similarly, older Asian/other races entrepreneurs were significantly more likely to report difficulty paying regular bills since the start of the pandemic than their White counterparts (OR = 3.11,  < .01). Women entrepreneurs were significantly more likely to close their businesses than their male counterparts (OR = 2.11,  < .001). These significant associations persisted after controlling for confounders. Support for underserved racial/ethnic groups and older women entrepreneurs should focus on accessibility to financial services, capital, and support packages as well as legislative support for ensuring business continuity and success.

%B Journal of Economics, Race, and Policy %V 5 %P 307-317 %G eng %N 4 %R 10.1007/s41996-022-00102-y %0 Journal Article %J Health Affairs %D 2022 %T Informal Caregivers Provide Considerable Front-Line Support In Residential Care Facilities And Nursing Homes. %A Norma B Coe %A Werner, Rachel M %K Caregiving %K Informal care %X

Informal care, or care provided by family and friends, is the most common form of care received by community-dwelling older adults with functional limitations. However, less is known about informal care provision within residential care settings including residential care facilities (for example, assisted living) and nursing homes. Using data from the Health and Retirement Study (2016) and the National Health and Aging Trends Study (2015), we found that informal care was common among older adults with functional limitations, whether they lived in the community, a residential care facility, or a nursing home. The hours of informal care provided were also nontrivial across all settings. This evidence suggests that informal caregiving and some of the associated burdens do not end when a person transitions from the community to residential care or a nursing home setting. It also points to the large role that families play in the care and well-being of these residents, which is especially important considering the recent visitor bans during the COVID-19 epidemic. Family members are an invisible workforce in nursing homes and residential care facilities, providing considerable front-line work for their loved ones. Providers and policy makers could improve the lives of both the residents and their caregivers by acknowledging, incorporating, and supporting this workforce.

%B Health Affairs %V 41 %P 105-111 %G eng %N 1 %R 10.1377/hlthaff.2021.01239 %0 Journal Article %J BMC Geriatrics %D 2022 %T Interactions between the apolipoprotein E4 gene and modifiable risk factors for cognitive impairment: a nationally representative panel study. %A Kolli, Ajay %A Zhou, Yunshu %A Chung, Grace %A Ware, Erin B %A Kenneth M. Langa %A Ehrlich, Joshua R %K Apolipoprotein E4 %K Cognitive Dysfunction %K Dementia %K Risk Factors %X

BACKGROUND: Few studies using rigorous clinical diagnosis have considered whether associations with cognitive decline are potentiated by interactions between genetic and modifiable risk factors. Given the increasing burden of cognitive impairment (CI) and dementia, we assessed whether Apolipoprotein E ε4 (APOE4) genotype status modifies the association between incident CI and key modifiable risk factors .

METHODS: Older adults (70+) in the US were included. APOE4 status was genotyped. Risk factors for CI were self-reported. Cognitive status (normal, CI, or dementia) was assigned by clinical consensus panel. In eight separate Cox proportional hazard models, we assessed for interactions between APOE4 status and other CI risk factors.

RESULT: The analytical sample included 181 participants (mean age 77.7 years; 45.9% male). APOE4 was independently associated with a greater hazard of CI in each model (Hazard Ratios [HR] between 1.81-2.66, p < 0.05) except the model evaluating educational attainment (HR 1.65, p = 0.40). The joint effects of APOE4 and high school education or less (HR 2.25, 95% CI: 1.40-3.60, p < 0.001), hypertension (HR 2.46, 95% CI: 1.28-4.73, p = 0.007), elevated depressive symptoms (HR 5.09, 95% CI: 2.59-10.02, p < 0.001), hearing loss (HR 3.44, 95% CI: 1.87-6.33, p < 0.0001), vision impairment (HR 5.14, 95% CI: 2.31-11.43, p < 0.001), smoking (HR 2.35, 95% CI: 1.24-4.47, p = 0.009), or obesity (HR 3.80, 95% CI: 2.11-6.85, p < 0.001) were associated with the hazard of incident CIND (compared to no genetic or modifiable risk factor) in separate models. The joint effect of Apolipoprotein ε4 and type 2 diabetes was not associated with CIND (HR 1.58, 95% CI: 0.67-2.48, p = 0.44).

DISCUSSION: The combination of APOE4 and selected modifiable risk factors conveys a stronger association with incident CI than either type of risk factor alone.

%B BMC Geriatrics %V 22 %P 938 %G eng %N 1 %R 10.1186/s12877-022-03652-w %0 Journal Article %J Genes %D 2022 %T The Interplay of Epigenetic, Genetic, and Traditional Risk Factors on Blood Pressure: Findings from the Health and Retirement Study. %A Zhang, Xinman %A Ammous, Farah %A Lin, Lisha %A Ratliff, Scott M %A Ware, Erin B %A Jessica Faul %A Zhao, Wei %A Sharon L R Kardia %A Smith, Jennifer A %K Blood pressure %K DNA Methylation %K genetic risk score %K Genetics %K interaction %K methylation risk score. %X

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

%B Genes %V 13 %P 1959 %G eng %N 11 %R 10.3390/genes13111959 %0 Journal Article %J Journal of the American Planning Association %D 2022 %T Keys to the Car: Driving Cessation and Residential Location Among Older Adults %A Schouten, Andrew %A Evelyn Blumenberg %A Wachs, Martin %A Hannah R. King %K driving cessation %K residential location %X Abstract: Problem, research strategy, and findings Most Americans live in communities in which automobiles are central to participation in economic, social, and cultural activities. Outside of dense central cities, the ability to continue driving as one ages is fundamental to the quality of life among older adults. Driving rates decline significantly with age. Researchers have studied the myriad reasons former drivers stop driving, but few have examined associations between these transitions and characteristics of the neighborhoods in which older adults live or to which they move. We used longitudinal data from a national sample of 20,000 observations from the University of Michigan Health and Retirement Study (HRS) to examine relationships between residential location, driving reduction, and driving cessation. Longitudinal data allow analysis of changes in behavior, a major advantage over cross-sectional data; however, the timing and sequencing of behavioral changes remain difficult to isolate. Cities provide opportunities for older adults to travel by automobile and other modes that are less available outside cities. Older adults are more likely to reduce or give up driving if they reside in dense, urban, transit-oriented neighborhoods than other neighborhood types. Very few older adults move from suburban to urban neighborhoods; when they do, they are rarely more likely to reduce or stop driving. Takeaway for practice: The findings underscore the importance of planning to accommodate aging in place. To do this in urban neighborhoods, policies must foster high-quality urban neighborhoods that not only attract younger adults (as is currently the trend) but also retain them as they age through the life cycle. %B Journal of the American Planning Association %V 88 %P 3-14 %@ 0194-4363 %G eng %N 1 %R 10.1080/01944363.2021.1907608 %0 Journal Article %J Journal of Health Economics %D 2022 %T Late-career unemployment and cognitive abilities %A Diana Freise %A Hendrik Schmitz %A Matthias Westphal %K Cognitive abilities %K Event studies %K Mental Health %K Plant closures %K Unemployment %X We study the effect of unemployment on cognitive abilities among individuals aged between 50 and 65 in Europe. To this end, we exploit plant closures and use flexible event-study estimations together with an experimentally elicited measure of fluid intelligence, namely word recall. We find that, within a time period of around eight years after the event of unemployment, cognitive abilities only deteriorate marginally – the effects are insignificant both in statistical and economic terms. We do, however, find significant effects of late-career unemployment on the likelihood to leave the labor force, and short-term effects on mental health problems such as depression and sleep problems. %B Journal of Health Economics %G eng %R https://doi.org/10.1016/j.jhealeco.2022.102689 %0 Report %D 2022 %T LHMS User Guide 2015-2017 %A Jacqui Smith %A Ofstedal, Mary Beth %A Larkina, Marina %A Helppie-McFall, Brooke %A Amanda Sonnega %A David R Weir %K life history %K mail survey %K User guide %I Institute for Social Research, University of Michigan %C Ann Arbor, MI %G eng %0 Journal Article %J Demography %D 2022 %T Loneliness at Older Ages in the United States: Lonely Life Expectancy and the Role of Loneliness in Health Disparities. %A Raymo, James M %A Wang, Jia %K health %K Health Disparities %K Life Expectancy %K Loneliness %X

We provide an empirical foundation for research on the demography of loneliness at older ages. First, we use published life tables and data from the U.S.-based Health and Retirement Study for the period 2008-2016 to calculate lonely life expectancy for Americans aged 55 or older. Using Sullivan's method, we demonstrate pronounced differences in lonely life expectancy by sex, race/ethnicity, and educational attainment that correspond to well-established patterns of stratification in other dimensions of well-being. Next, we estimate models that decompose observed sex, racial/ethnic, and educational differences in three key health outcomes into the part explained (in a statistical accounting sense) by loneliness and the part accounted for by other factors. We find little evidence of an important role for loneliness in understanding disparities in mortality and the onset of physical disability and cognitive impairment among Americans aged 55 or older, net of several established correlates of health disparities. These descriptive findings provide an empirical foundation for continued development of a demography of loneliness at older ages in response to the anticipated growth in scientific and policy emphasis on loneliness and the fundamental life changes that have accompanied the COVID-19 pandemic.

%B Demography %V 59 %P 921-947 %G eng %N 3 %R 10.1215/00703370-9937606 %0 Journal Article %J Sleep %D 2022 %T Longitudinal associations between insomnia symptoms and all-cause mortality among middle-aged and older adults: A population-based cohort study. %A Mahmood, Asos %A Ray, Meredith %A Kenneth D. Ward %A Dobalian, Aram %A Ahn, Sang Nam %K all-cause mortality %K insomnia symptoms %K Marginal Structural Modeling %K middle-aged %K risk factor %K Sleep disturbance %X

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

%B Sleep %V 45 %P zsac019 %G eng %N 6 %R 10.1093/sleep/zsac019 %0 Journal Article %J Journal of Aging and Health %D 2022 %T The Long-Term Impact of Childhood Disability on Mental Health Trajectories in Mid- to Late-Life. %A Jessica S West %A Kamis, Christina %K aging with disability %K Disability %K growth curve models %K Mental Health %X

OBJECTIVES: We draw from the life course and stress process frameworks to examine how experiencing disability in early life influences mental health in adulthood.

METHODS: Data come from the Health and Retirement Study Cross-Wave Childhood Health and Family Aggregated Data file (2008-2018, = 15,289). Childhood disability status is a retrospective self-report of whether respondents were disabled for six months or more because of a health problem before the age of 16 ( = 581). We used age-based growth curve models to construct trajectories of depressive symptoms by childhood disability status.

RESULTS: Respondents who experienced childhood disability exhibit more depressive symptoms at age 50 compared to those who did not experience this stressor. However, there is no difference in the growth of depressive symptoms with age between these groups, suggesting maintained inequality over the late adulthood life course.

DISCUSSION: Findings suggest that childhood disability has long-term implications for life course mental health.

%B Journal of Aging and Health %G eng %R 10.1177/08982643211066184 %0 Journal Article %J JAMA Network Open %D 2022 %T Management of Financial Assets by Older Adults With and Without Dementia or Other Cognitive Impairments. %A Li, Jing %A Wang, Shuqi %A Nicholas, Lauren Hersch %K Cognitive Dysfunction %K Dementia %K Financial Statements %X Dementia and other cognitive impairments are prevalent among US older adults.1 Brain changes linked to cognitive impairment can lead to overconfidence, memory problems, and deficits in decision-making.2,3 These changes can have financial consequences, including missed bill payments, risky investment choices, and financial exploitation.3,4 To characterize the population at risk of cognitive impairment–associated asset mismanagement, we assessed the extent to which older US adults with and without cognitive impairment manage their own money, including risky assets (eg, stocks and loans). %B JAMA Network Open %V 5 %P e2231436 %G eng %N 9 %R 10.1001/jamanetworkopen.2022.31436 %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 Sex Roles %D 2022 %T Married Mixed-gender Couples’ Midlife Employment and Later Life Well-being and Housework %A Wikle, Jocelyn S %A Yorgason, Jeremy B. %K Couples %K Division of labor %K Housework %K Sex roles %K Well Being %X This study explored the role of midlife market-work arrangements of married mixed-gender couples on gendered experiences in emotional well-being and housework during the encore years. Working during midlife may shape long-term outcomes after couples leave the workforce and begin retirement. Using three theories of gender as a framework to understand work sharing in couples, the study theoretically connects work arrangements in midlife with long-term predictions of gender differences in couple emotional well-being and housework. Using longitudinal data from the Health and Retirement Study (2000–2015; N = 3,231), the study found that gender differences in housework were similar in male-earner and dual-earner couples during the encore years. However, women in male-earner marriages reported low levels of emotional well-being in the encore years, while men in dual-earner couples in mid-life reported high levels of well-being. The findings suggest more gendered experiences in midlife employment correlated with worse mental health in the encore years for women. Understanding midlife employment as a protective factor against depressive symptoms is useful for families, practitioners, and policymakers to be aware of as they seek to understand and mitigate drivers of poor mental health during the encore years. The study demonstrates a need for further development of dynamic theoretical models to explain gender differences over the life course. %B Sex Roles %V 87 %P 154–166 %G eng %R 10.1007/s11199-022-01306-0 %0 Journal Article %J The American Journal of Geriatric Psychiatry %D 2022 %T Medicare claims data underestimate hallucinations in older adults with dementia %A Ali G Hamedani %A Weintraub, Daniel %A Allison W Willis %K Dementia %K Hallucinations %K Medicare %K sensitivity %K specificity %K validity %X Objective Administrative claims data are used to study the incidence and outcomes of dementia-related hallucinations, but the validity of International Classification of Diseases (ICD) codes for identifying dementia-related hallucinations is unknown. Methods We analyzed Medicare-linked survey data from two nationally representative studies of U.S. older adults (the National Health and Aging Trends Study and the Health and Retirement Study) which contain validated cognitive assessments and a screening question for hallucinations. We identified older adults who had dementia or were permanent nursing home residents, and we combined this with questionnaire responses to define dementia-related hallucinations. Using Medicare claims data, we calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD codes for dementia-related hallucinations overall and within prespecified strata of age, neurologic comorbidity, and health care utilization. Results We included 2,337 older adults with dementia in our cohort. Among 3,789 person-years of data, 1,249 (33.0%) had hallucations, and of these 286 had a qualifying ICD code for dementia-related hallucinations or psychosis (sensitivity 22.9%). Of 2,540 person-years of dementia without hallucinations, 284 had a diagnosis code for hallucinations (specificity 88.8%). PPV was 50.2%, and NPV was 70.1%. Sensitivity was greatest (57.0%) among those seeing a psychiatrist. Otherwise, there were no significant differences in sensitivity, specificity, PPV, or NPV by age, neurologic diagnosis, or neurologist care. Conclusion Dementia-related hallucinations are poorly captured in administrative claims data, and estimates of their prevalence and outcomes using these data are likely to be biased. %B The American Journal of Geriatric Psychiatry %V 30 %P 352-359 %@ 1064-7481 %G eng %N 3 %R 10.1016/j.jagp.2021.07.018 %0 Journal Article %J Innovation in Aging %D 2022 %T MODE EFFECTS ON COGNITIVE FUNCTIONING ASSESSMENTS IN THE HEALTH AND RETIREMENT STUDY %A Jessica Faul %A Domingue, Ben %A Stenhaug, Ben %A Brady T. West %A Kenneth M. Langa %A David R Weir %K Cognition %K cognitive functioning assessments %X As the population of the US ages, there is interest in assessing health conditions associated with age and longevity, such as age-related decline in cognitive functioning. As a result, there is an increased focus on measuring cognitive functioning in surveys of older populations. One challenge relates to conducting comparable measurement across survey modes (e.g., phone vs. web). Compounding this is that mode of survey administration is often not assigned randomly making inter-group comparison more difficult. This paper addresses these issues using a novel experiment embedded within the Health and Retirement Study (HRS). The HRS, a US-based cohort of people over 50, has measured cognition since its inception using both in-person and telephone modes. In 2018, a sample of approximately 3700 respondents was identified as web-eligible based on a prior report of internet access along with other selection criteria. Of these, 60% were randomly selected for the web sample with the remainder serving as controls, assigned to telephone mode for comparison purposes. We deploy techniques from item response theory (IRT) and differential item functioning (DIF) to estimate the difference in cognitive functioning between web and phone respondents in 2018 based on longitudinal cognition data collected prior to 2018. Second, we estimate the overall effect of taking the survey via the web as compared to the phone. Third, we examine item-level variation in the magnitude of the mode effect and suggest possible methods for adjustment to support longitudinal consistency. These results are important in guiding future research that utilizes web-based cognitive measures. %B Innovation in Aging %V 6 %P 163 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.652 %0 Journal Article %J BMC Geriatrics %D 2022 %T Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study. %A Aubert, Carole E %A Kabeto, Mohammed %A Kumar, Navasuja %A Wei, Melissa Y %K Activities of Daily Living %K Hand Strength %K multimorbidity %K Retirement %K walking speed %X

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

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

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

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

%B BMC Geriatrics %V 22 %P 910 %G eng %N 1 %R 10.1186/s12877-022-03548-9 %0 Journal Article %J Journal of Applied Gerontology %D 2022 %T Multimorbidity and Social Participation Is Moderated by Purpose in Life and Life Satisfaction. %A Jamie E Luster %A Ratz, David %A Melissa Y Wei %K Epidemiology %K health-related quality of life %K Leisure %K Successful aging %X

OBJECTIVES: We examined the association between multimorbidity and social participation and whether purpose in life and life satisfaction moderate this relationship.

METHODS: Participants were 12,825 Health and Retirement Study adults. We used multiple linear regression to examine the association between a cumulative-updated multimorbidity-weighted index (MWI) and social participation.

RESULTS: Among adults with average purpose in life or life satisfaction, MWI was associated with lower social participation. For those with above average purpose in life, each 1-point increase in MWI was associated with a 0.11-point (95% confidence interval [CI]: [0.07, 0.14]) better social participation score. Participants with above average life satisfaction experienced a 0.04-point (95% CI: [0.02, 0.07]) better social participation score with each 1-point increase in MWI.

DISCUSSION: Multimorbidity was associated with worse social participation, but this was reversed by above average purpose in life and life satisfaction. Interventions that improve well-being should be assessed to enhance social participation among older adults with any degree of multimorbidity.

%B Journal of Applied Gerontology %V 41 %P 560-570 %G eng %N 2 %R 10.1177/07334648211027691 %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 Journal Article %J International Journal of Aging & Human Development %D 2022 %T Neighborhood Social Cohesion and Mobility Limitations Among Community-dwelling Older Americans: The Mediating Roles of Depressive Symptoms and Mastery. %A Wang, Fei %A Qin, Weidi %A Yu, Jiao %K Depressive symptoms %K Mastery %K Mobility limitations %K neighborhood social cohesion %K Social capital %X

Neighborhood environment plays an important role in late-life health; yet, the social aspect of neighborhood environment and its impact on mobility limitations have rarely been examined. This nonexperimental, cross-sectional study examines the relationship between neighborhood social cohesion and mobility limitations and the potential mediators (i.e., depressive symptoms, mastery) of this relationship. A total of 8,317 Americans aged 65 years and older were selected from the Health and Retirement Study. Using ordinary least squares regressions, this study shows that neighborhood social cohesion was negatively associated with mobility limitations (  =  -0.04,  < .01). A Sobel test of mediation indicated that this relationship was significantly mediated by depressive symptoms (  =  -9.10,  < .001) and mastery (  =  -8.86,  < .001). Findings suggest that neighborhood cohesion can reduce mobility limitations through mitigating depressive symptoms and increasing mastery. Future research should disentangle the temporal ordering of the mediators.

%B International Journal of Aging & Human Development %V 94 %P 290-311 %G eng %N 3 %R 10.1177/00914150211037657 %0 Journal Article %J Journal of General Internal Medicine %D 2022 %T Observational study of patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment without dementia. %A White, Lindsay %A Ingraham, Bailey %A Eric B Larson %A Fishman, Paul %A Park, Sungchul %A Norma B Coe %K cognitive impairment %K Dementia %K Diagnosis %K Disparities %X

BACKGROUND: Timely diagnosis of cognitive impairment is a key goal of the National Plan to Address Alzheimer's Disease, but studies of factors associated with a timely diagnosis are limited.

OBJECTIVE: To identify patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment (MCI).

DESIGN: Retrospective observational study using survey data from the Health and Retirement Study (HRS) from 1995-2016 (interview waves 3-13).

PARTICIPANTS: 4,760 respondents with incident dementia and 1,864 with incident MCI identified using longitudinal measures of cognitive functioning.

MAIN MEASURES: Timely or delayed diagnosis based on the timing of a self or proxy report of a healthcare provider diagnosis in relation to respondents first dementia or MCI-qualifying cognitive score, sociodemographic characteristics, health status, health care utilization, insurance provider, and year of first qualifying score.

KEY RESULTS: Only 26.0% of the 4,760 respondents with incident dementia and 11.4% of the 1,864 respondents with incident MCI received a timely diagnosis. Non-Hispanic Black respondents and respondents with less than a college degree were significantly less likely to receive a timely diagnosis of either dementia or MCI than Non-Hispanic White respondents (dementia odds ratio (OR): 0.61, 95% CI: 0.50, 0.75; MCI OR: 0.40, 95% CI: 0.23, 0.70) and those with a college degree (dementia OR for less than high school degree: 0.30, 95% CI: 0.23, 0.38; MCI OR: 0.36, 95% CI: 0.22, 0.60). Respondents that lived alone were also less likely to receive a timely diagnosis of dementia (OR: 0.69, 95% CI: 0.59, 0.81), though not MCI. Timely diagnosis of both conditions increased over time.

CONCLUSIONS: Targeting resources for timely diagnosis of cognitive impairment to individuals from racial and ethnic minorities, lower educational attainment, and living alone may improve detection and reduce disparities around timely diagnosis of dementia and MCI.

%B Journal of General Internal Medicine %V 37 %P 2957-2965 %G eng %N 12 %R https://doi.org/10.1007/s11606-021-07169-7 %0 Journal Article %J Neurology %D 2022 %T Offspring Sex and Parental Cognition in Mid-life and Older Adulthood (P1-3.004) %A Wolfova, Katrin %A Wu, Di %A Weiss, Jordan %A Cermakova, Pavla %A Kohler, Hans-Peter %A Skirbekk, Vegard Fykse %A Stern, Yaakov %A Gemmill, Alison %A Tom, Sarah %K Cognition %K Cognitive decline %K offspring sex %K Parents %X Objective: We aim to examine the relationship between offspring sex and parental baseline level of cognition and rate of cognitive decline in older adults.Background: Studies suggest a link between offspring sex and maternal long-term health outcomes, including dementia. One of the proposed explanations is male microchimerism of foetal origin. We hypothesize that mothers of at least 1 boy would have better cognition than mothers with no boys, and there would be no differences in fathers.Design/Methods: We analysed a cohort of 13,777 adults age >= 50 years from the US Health and Retirement Study. Offspring sex was classified as no boy vs. at least 1 boy in primary analysis and as number of boys (0 boys, 1 boy, 2 boys, 3 or more boys) and number of girls (0 girls, 1 girl, 2 girls, 3 or more girls) in secondary analysis. Cognition was assessed using a sum of scores from immediate and delayed 10-noun free recall tests, a serial 7s subtraction test, and a backwards counting test. Associations were evaluated using linear mixed-effects models, adjusting for 1) baseline age, sex, ethnicity, parity; 2) socioeconomic factors; and 3) health-related factors and marital status.Results: A total of 17.7% of respondents had no boy and 60.1% of respondents were female. Stratifying on parental sex, mothers and fathers of at least 1 boy had a significantly higher baseline cognition in comparison to those with no boy. Associations were attenuated in adjusted models. In secondary analysis, having 3 or more boys was associated with higher baseline cognition in fathers, there were no differences in mothers. We found a significant association of cognitive decline with number of boys, but not with number of girls.Conclusions: Offspring sex was associated with cognitive aging among both mothers and fathers, suggesting interplay of biological and social influences.Disclosure: Dr. Wolfova has nothing to disclose. Mr. Wu has nothing to disclose. Mr. Kohler has nothing to disclose. Prof. Skirbekk has nothing to disclose. Dr. Stern has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Stern has received intellectual property interests from a discovery or technology relating to health care. Dr. Stern has received publishing royalties from a publication relating to health care. Prof. Gemmill has received research support from National Institutes of Health and the Robert Wood Johnson Foundation. Prof. Gemmill has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with World Health Organization. The institution of Sarah Tom has received research support from National Institutes of Health . Sarah Tom has received personal compensation in the range of $500-$4,999 for serving as a Consultant with Alzheimer’s Association . %B Neurology %V 98 %P 970 %G eng %U https://n.neurology.org/content/98/18_Supplement/970 %N 18 Supplement %0 Report %D 2022 %T Older Immigrants Are More Likely Than Older Nonimmigrants to Experience Loneliness %A Zemba, Stephanie %A Wilmoth, Janet %K Immigrants %K Loneliness %X • Immigrant older adults are at a higher risk for loneliness than nonimmigrants. • Age at immigration matters: risk of loneliness is significantly higher for immigrants who arrived in the United States after age 18. • Factors such as socio-demographic characteristics, health, and engagement in volunteering partially explain immigrant older adults’ higher risk of loneliness. • Programs that promote social connection are necessary to reduce loneliness among older adult immigrants. %I Lerner Center for Public Health Promotion & Population Health, Syracuse University %C Syracuse, NY %G eng %U https://surface.syr.edu/cgi/viewcontent.cgi?article=1193&context=lerner %0 Journal Article %J Economics Letters %D 2022 %T One-sided commitment in life insurance contracts: Evidence from Health and Retirement Study %A Xi Wu %A Li Gan %K Life insurance %K One-sided commitment %X We study the properties of long-term insurance contracts using an individual-level survey data. Results indicate longer-term contracts are involved with lower lapse rates and healthier pool. These are consistent with the implications of Hendel and Lizzeri model with one-sided commitment. %B Economics Letters %V 219 %P 110825 %G eng %R https://doi.org/10.1016/j.econlet.2022.110825 %0 Journal Article %J Journal of the American Geriatrics Society %D 2022 %T Out-of-pocket costs attributable to dementia: A longitudinal analysis. %A Oney, Melissa %A White, Lindsay %A Norma B Coe %K Dementia %K Long-term services and supports %K out-of-pocket costs %X

BACKGROUND: Alzheimer's disease and related dementias (ADRD) affect 5.7 million Americans, and are expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, even though one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare.

METHODS: In this paper, we use survey data for 2002-2016 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after the onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization.

RESULTS: We identified a cohort of 3619 incident dementia cases, 38.9% were male, and 66.9% were non-Hispanic White. Dementia onset was 77.7 years of age, on average. OOP costs attributable to dementia are $8751 over the first 8 years after the onset. These incremental costs are driven by nursing home expenditures, which are largely uninsured in the US. OOP spending is highest for whites and women.

CONCLUSION: The financial burden of ADRD is significant, and largely attributable to the lack of wide-spread long-term care insurance.

%B Journal of the American Geriatrics Society %V 70 %P 1538-1545 %G eng %N 5 %R 10.1111/jgs.17746 %0 Journal Article %J Journal of Pain and Symptom Management %D 2022 %T Pain and the Alzheimer's Disease and Related Dementia Spectrum in Community-Dwelling Older Americans: A Nationally Representative Study. %A Wang, Jinjiao %A Cheng, Zijing %A Kim, Yeunkyung %A Yu, Fang %A Heffner, Kathi L %A Quiñones-Cordero, Maria M %A Li, Yue %K Alzheimer %K Dementia %K pain %K Pain Management %X

CONTEXT: Pain is a significant concern among older adults with Alzheimer's disease and related dementias (ADRD).

OBJECTIVES: Examine the association between cognitive impairment across the ADRD spectrum and pain assessment and treatment in community-dwelling older Americans.

METHODS: This cross-sectional, population-based study included 16,836 community-dwelling participants ≥ 50 years in the 2018 Health and Retirement Study. ADRD, assessed by validated cognitive measures, was categorized into "dementia," "cognitive impairment, no dementia (CIND)" and "intact cognition." Pain assessment included pain presence (often being troubled with pain), pain severity (degree of pain most of the time [mild/moderate/severe]), and pain interference (pain making it difficult to do usual activities). Pain treatment included recent use of over-the-counter pain medications and opioids (past 3 months), and regular intake of prescriptions for pain.

RESULTS: Dementia were associated with lower likelihood of reporting pain presence (Odds Ratio [OR]= 0.61, P = 0.01), pain interference (OR = 0.46, P < 0.001), reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.38, P < 0.001), and lower likelihood of receiving pain treatment, that is, recent use of over-the-counter pain medications (OR = 0.60, P = 0.02) and opioids (OR = 0.33, P < 0.001), and regular intake of prescriptions for pain (OR = 0.461, P = 0.002). CIND was associated with reporting lower pain severity (e.g., moderate vs. no: Relative Risk Ratio = 0.75, P = 0.021), lower likelihood of reporting pain interference (OR = 0.79, P = 0.045) and recent over-the-counter pain medication use (OR = 0.74, P = 0.026).

CONCLUSION: CIND and dementia increased the risk of under-report and under-treatment of pain. Systematic efforts are needed to improve pain recognition and treatment among older adults with cognitive impairment, regardless of dementia diagnosis.

%B Journal of Pain and Symptom Management %V 63 %P 654-664 %G eng %N 5 %R 10.1016/j.jpainsymman.2022.01.012 %0 Journal Article %J Social Science & Medicine %D 2022 %T Patterns in older adults' perceived chronic stressor types and cognitive functioning trajectories: Are perceived chronic stressors always bad? %A Kun Wang %A Alexander R. Marbut %A Zainab Suntai %A Dianhan Zheng %A Xiayu Chen %K Challenge-hindrance perspective %K cognitive functioning %K Egocentric stressor %K Nonegocentric stressor %X Purpose Previous studies have linked levels of perceived chronic stress to older adults' cognitive functioning, but few have focused on the impact of chronic stressor types. Thus, this study aimed to (1) identify patterns of chronic stressor types and (2) examine the effects of these patterns on cognitive functioning trajectories among older adults. Methods Two longitudinal studies were conducted separately to test the study aims and ensure replicability across samples and time points. Both used three timepoints (Study 1: 2006, 2008, and 2010, n = 6974; Study 2: 2012, 2014, and 2016, n = 6604) collected from older Americans in the Health and Retirement Study. Participants did not overlap between the two studies. Latent class analyses were conducted to identify chronic stressor-type patterns. Latent growth curve models were used to test the effects of chronic stressor-type patterns on cognitive functioning trajectories. Results Three latent classes of stressor types were identified in both studies: egocentric (4.56%; 5.85%), nonegocentric (8.58%; 10.03%), and low stressor (86.86%; 84.12%). In both studies, compared to the low stressor class, the egocentric stressor class had significantly lower initial cognitive scores (B = −0.72, ρ < 0.001; B = −0.46, ρ < 0.05), while the nonegocentric stressor class did not have significantly different initial scores, with covariates controlled. Additionally, in Study 1, the nonegocentric stressor class had significantly slower cognitive decline rates than the low stressor class (B = 0.11, ρ < 0.05). Conclusions Findings suggested that nonegocentric stressors are an important stressor source in late adulthood but are less detrimental to cognitive functioning than egocentric stressors. Health management interventions may reduce older adults' cognitive health disparities caused by self-health and financial stressors. More support, including financial subsidies, caregiver stress management training, or support groups, should be provided to older caregivers, especially those with few resources. %B Social Science & Medicine %V 311 %P 115297 %G eng %R https://doi.org/10.1016/j.socscimed.2022.115297 %0 Journal Article %J Journal of Psychiatric Research %D 2022 %T Patterns of depressive symptoms over 16 Years with incident dementia: The Health and Retirement Study. %A Wei, Jingkai %A Yang, Chih-Hsiang %A Lohman, Matthew C %A Brown, Monique J %A Friedman, Daniela B %K Aging %K Dementia %K Depressive symptoms %K Trajectories %X

The associations of patterns of depressive symptoms, including trajectories of depressive symptoms and significant depressive symptoms among older adults over a long period of time with incident dementia are not frequently studied. We aimed to examine the associations of patterns of depressive symptoms among older adults with incident dementia. Participants of the Health and Retirement Study from 1994 to 2018 with information of incident dementia and complete measurements of depressive symptoms were included. Depressive symptoms assessed on 8 waves between 1994 and 2010 using the 8-item Center for Epidemiologic Studies Depression (CES-D) Scale. Significant depressive symptoms were defined as ≥4 points in the CES-D. Trajectories of depressive symptoms and significant depressive symptoms were identified. Cox proportional hazards models were used to examine the associations of patterns of depressive symptoms with incident dementia. A total of 6317 participants were included in the analysis. Over the follow-up period of 8 years, trajectories of "increase from mild" (hazards ratio (HR): 1.84, 95% confidence interval (CI): 1.29, 2.63) and "persistently high" (HR: 1.76, 95% CI: 1.17, 2.65) depressive symptoms were associated with higher risk of incident dementia, after adjustment for covariates. Future studies are needed to examine the interaction of depression in different stages of life on incident dementia. Studies are also expected to estimate the effect of preventing dementia through reducing depressive symptoms.

%B Journal of Psychiatric Research %V 156 %P 485-490 %G eng %R 10.1016/j.jpsychires.2022.10.064 %0 Journal Article %J Frontiers in Psychiatry %D 2022 %T Persistent Depressive Symptoms and the Changes in Serum Cystatin C Levels in the Elderly: A Longitudinal Cohort Study. %A Han, Tiandong %A Zhang, Li %A Jiang, Weixing %A Wang, Lei %K persistent depressive symptoms %K renal function %K serum cystatin C %X

Background: The burden of depression in the elderly is increasing worldwide with global aging. However, there is still a lack of research on the relationship between depressive symptoms and the progression of renal function. Our aim is to evaluate the longitudinal association between baseline depressive symptoms and the changes in serum cystatin C levels over 10 years' follow-up period.

Methods: We used longitudinal data from the Health and Retirement Study (HRS), an existing community based nationally representative aging cohort study which enrolled individuals over age 50 in the USA. Depressive symptoms were determined using an eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD) at wave 7 (2004) and wave 8 (2006). Persistent depressive symptoms were defined as both CESD scores measured at waves 7 and 8 were ≥3; episodic depressive symptoms were defined as CESD scores ≥3 at wave 7 or wave 8. A linear mixed model was used to evaluate the correlation between baseline depressive symptoms and future changes in cystatin C levels.

Results: The mean age of the 7,642 participants was 63.8 ± 10.8 years, and 60.9% were women. Among the participants, 1,240 (16.2%) had episodic depressive symptoms and 778 (10.2%) had persistent depressive symptoms. Compared with participants with no depressive symptoms at both waves, a significant increase in serum cystatin C levels was found among those with persistent depressive symptoms.

Conclusions: Our results showed that baseline persistent depressive symptoms were significantly associated with an increased rate of serum cystatin C levels. The level of serum cystatin C should be monitored in the elderly with persistent depressive symptoms.

%B Frontiers in Psychiatry %V 13 %P 917082 %G eng %R 10.3389/fpsyt.2022.917082 %0 Journal Article %J Scientific Reports %D 2022 %T Predictors of Covid-19 level of concern among older adults from the health and retirement study. %A Beydoun, Hind A %A Beydoun, May A %A Weiss, Jordan %A Gautam, Rana S %A Hossain, Sharmin %A Alemu, Brook T %A Zonderman, Alan B %K COVID-19 %K Female %K Life Style %K Retirement %K Risk Factors %X

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

%B Scientific Reports %V 12 %P 4396 %G eng %N 1 %R 10.1038/s41598-022-08332-8 %0 Thesis %D 2022 %T Predictors of Technology Use among Older Adults: Evidence Ranging from Non-Users to Elite Users %A Xiaoqing Wan %K Cognition %K Machine learning %K socioeconomic %K Technology %X Older adults tend to under-utilize digital technology and online services that can yield substantial benefits to their health and wellbeing. Addressing this problem requires determining robust and consistent predictors of older adults’ technology use. Also, few studies have examined older adults who are elite users of digital technology, who may provide insights into how individuals can prepare to become competent users of future technologies as they age. To address these gaps in the technology and aging literature, this dissertation offers (1) large-scale machine learning analyses, (2) longitudinal perspectives, (3) age group comparisons across the adult life span, (4) the novel recruitment of elite, older users of digital technology, and (5) the development and validation of a technology use scale focused on current innovations. In Study 1, data from the Health and Retirement Study were used. Machine learning classified Internet users versus non-users with an accuracy of ~80%. Across a 14-year span, results largely supported current models of aging and technology use. Age, cognition, and socioeconomics emerged as the most robust and consistent predictors of Internet use from competition with hundreds of variables. In Study 2, the outcome variable was expanded to include nine domains of technology use. Elite, older users exhibited many markers of successful aging, including higher levels of cognition, socioeconomics, and self-efficacy. Across studies, results suggested that skills needed to engage with technology at a basic level differ slightly from those needed to reach higher levels of technology use. Specifically, poor episodic long-term memory may pose a barrier to basic technology use among older adults (e.g., assessing the Internet), while better short-term memory is required to achieve elite-level technology use. These results highlight the potential value of exposure to new technology at a younger age – when there are fewer barriers of entry (e.g., cognitive limitations) and a foundation of technology use principles can be developed and built upon across adulthood. %I University of Central Florida %C Orlando, FL %V Ph.D. %G eng %U https://stars.library.ucf.edu/cgi/viewcontent.cgi?article=2110&context=etd2020 %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 Preventive Medicine %D 2022 %T Purpose in life and 8-year mortality by gender and race/ethnicity among older adults in the U.S. %A Shiba, Koichiro %A Kubzansky, Laura D %A Williams, David R %A VanderWeele, Tyler J %A Kim, Eric S %K Cohort Studies %K ethnicity %K Mortality %K Odds Ratio %K Retirement %X

We examined the associations between a sense of purpose and all-cause mortality by gender and race/ethnicity groups. Data were from the Health and Retirement Study, a nationally representative cohort study of U.S. adults aged >50 (n = 13,159). Sense of purpose was self-reported at baseline (2006/2008), and risk of all-cause mortality was assessed over an 8-year follow-up period. We also formally tested for potential effect modification by gender and race/ethnicity. We observed the associations between higher purpose and lower all-cause mortality risk across all gender and race/ethnicity groups. There was modest evidence that the highest level of purpose (versus lowest quartile) was associated with even lower risk of all-cause mortality among women (risk ratio = 0.66, 95% confidence interval: 0.56, 0.77) compared to men (risk ratio = 0.80, 95% confidence interval: 0.69, 0.93; p-value for multiplicative effect modification =0.07). However, we observed no evidence of effect modification by race/ethnicity. Having a higher sense of purpose appears protective against all-cause mortality regardless of gender and race/ethnicity. Purpose, a potentially modifiable factor, might be a health asset across diverse populations.

%B Preventive Medicine %V 164 %P 107310 %G eng %R 10.1016/j.ypmed.2022.107310 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Race inequity in school attendance across the Jim Crow South and its implications for Black-White disparities in trajectories of cognitive function among older adults. %A Katrina M Walsemann %A Urena, Stephanie %A Mateo P Farina %A Jennifer A Ailshire %K cognitive function %K Education %K historical data %K life course %K Racial Disparities %K school segregation %X

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

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

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

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

%B The Journals of Gerontology, Series B %V 77 %P 1467-1477 %G eng %N 8 %R 10.1093/geronb/gbac026 %0 Journal Article %J Brain Communications %D 2022 %T Race, polygenic risk and their association with incident dementia among older US adults. %A Beydoun, May A %A Weiss, Jordan %A Banerjee, Sri %A Beydoun, Hind A %A Noren Hooten, Nicole %A Evans, Michele K %A Zonderman, Alan B %K Ageing %K Alzheimer’s disease %K Dementia %K national surveys %K polygenic scores %X

Dementia incidence increases steadily with age at rates that may vary across racial groups. This racial disparity may be attributable to polygenic risk, as well as lifestyle and behavioural factors. We examined whether Alzheimer's disease polygenic score and race predict Alzheimer's disease and other related dementia incidence differentially by sex and mediation through polygenic scores for other health and behavioural conditions. We used longitudinal data from the nationally representative Health and Retirement Study. We restricted participants to those with complete data on 31 polygenic scores, including Alzheimer's disease polygenic score (2006-2012). Among participants aged 55 years and older in 2008, we excluded those with any memory problems between 2006 and 2008 and included those with complete follow-up on incident Alzheimer's disease and all-cause dementia, between 2010 and 2018 ( = 9683), based on self- or proxy-diagnosis every 2 years (2010, 2012, 2014, 2016 and 2018). Cox proportional hazards and 4-way decomposition models were conducted. Analyses were also stratified by sex and by race. There were racial differences in all-cause dementia incidence (age and sex-adjusted model, per standard deviation: hazard ratio, HR = 1.34, 95% confidence interval, CI: 1.09-1.65, = 0.007), partially driven by educational attainment and income. We also found independent associations of race (age and sex-adjusted model, African American versus White adults: HR = 2.07, 95% CI: 1.52-2.83, < 0.001) and Alzheimer's disease polygenic score (age and sex-adjusted model, per SD: HR = 1.37, 95% CI: 1.00-1.87, < 0.001) with Alzheimer's disease incidence, including sex differences whereby women had a stronger effect of Alzheimer's disease polygenic score on Alzheimer's disease incidence compared with men ( < 0.05 for sex by Alzheimer's disease polygenic score interaction) adjusting for race and other covariates. The total impact of Alzheimer's disease polygenic scores on Alzheimer's disease incidence was mostly direct, while the effect of race on all-cause dementia incidence was mediated through socio-economic, lifestyle and health-related factors. Finally, among the 30 polygenic scores we examined, the total effects on the pathway Alzheimer's disease polygenic score --> Other polygenic score --> Incident Alzheimer's or all-cause dementia, were statistically significant for all, driven primarily by the controlled direct effect (P< 0. 001). In conclusion, both race and Alzheimer's disease polygenic scores were associated independently with Alzheimer's disease and all-cause dementia incidence. Alzheimer's disease polygenic score was more strongly linked to incident Alzheimer's disease among women, while racial difference in all-cause dementia was explained by other factors including socio-economic status.

%B Brain Communications %V 4 %P fcac317 %G eng %N 6 %R 10.1093/braincomms/fcac317 %0 Journal Article %J SSM - Population Health %D 2022 %T Regional variation in U.S dementia trends from 2000-2012 %A Jennifer A Ailshire %A Katrina M. Walsemann %A Calley E. Fisk %K Dementia %K health trends %K Regional variation %X Although recent studies report a decline in dementia prevalence among U.S. older adults, national trends may mask subnational variation, particularly given large health and social inequalities linked to geography. To address this gap, we determined if there was subnational variation in reported national dementia trends and if region-specific trends were explained by sociodemographic and health characteristics. Data come from the 2000 (n = 10,447) and 2012 (10,426) waves of the Health and Retirement Study. We used validated methods for dementia classification using proxy and self-respondents. Logistic regression models, adjusted for within-person clustering over time, estimated trends in dementia prevalence by region and census division. We found subnational variation in dementia prevalence in both 2000 and 2012, as well as in change in dementia prevalence during this period. In 2000, dementia prevalence was lowest in the West (8.6%), higher in the Midwest (10.0%) and Northeast (11.1%), and highest in the South (14.6%). Dementia prevalence declined over time across all regions of the U.S. from 2000 to 2012 but remained highest in the South (10.7%) compared to the other regions (7.0–7.8%). Despite downward trends in dementia across the U.S., the prevalence of dementia in the South in 2012 approximated levels found in other regions in 2000. There was relatively less change over time in the West compared to other regions, but dementia prevalence was already quite low in the West in 2000. Within region, trends in dementia prevalence between 2000 and 2012 also varied slightly across census divisions. Subnational variation in changes in dementia prevalence were largely explained by education and health status. Variation in baseline prevalence, as well as differential rates of change, highlight the importance of examining subnational variation in dementia trends. %B SSM - Population Health %V 19 %P 101164 %G eng %R https://doi.org/10.1016/j.ssmph.2022.101164 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T The Relationship Between Fertility History and Incident Dementia in the U.S. Health and Retirement Study. %A Gemmill, Alison %A Weiss, Jordan %K Cohort Studies %K Dementia %K Fertility %K Pregnancy %K Prospective Studies %K Retirement %K Risk Factors %X

OBJECTIVES: An emerging literature suggests that fertility history, which includes measures of parity and birth timing, may influence cognitive health in older ages, especially among women given their differential exposure to pregnancy and sex hormones. Yet, few studies have examined associations between measures of fertility history and incident dementia in population-based samples.

METHOD: We examined the associations between parity, younger age at first birth, and older age at last birth with incident dementia over a 16-year period in a prospective sample of 15,361 men and women aged 51-100 years at baseline drawn from the Health and Retirement Study. We used Cox regression and the Fine and Gray model to obtain cause-specific hazard ratios (csHRs) and subdistribution hazard ratios for incident dementia from gender-stratified models, with the latter method accounting for the semicompeting risk of death.

RESULTS: During the follow-up period (median 13.0 years), the crude incidence rate for dementia was 16.6 and 19.9 per 1,000 person-years for men and women, respectively. In crude models estimating csHRs, higher parity (vs parity 2) and younger age at first birth were associated with increased risk of dementia for both genders. These associations did not persist after adjusting for sociodemographic characteristics, smoking status, and health conditions, with much of the attenuation in estimates occurring after adjustment for sociodemographic characteristics.

DISCUSSION: In this population-based, multiethnic cohort, we observed limited evidence for an association between measures of fertility history and incident dementia among men and women after adjusting for potential confounders.

%B The Journals of Gerontology, Series B %V 77 %P 1118-1131 %G eng %N 6 %R 10.1093/geronb/gbab183 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Religious Involvement and Cognitive Functioning at the Intersection of Race/Ethnicity and Gender in Mid-Life and Older Adults. %A Henderson, Andrea K %A Katrina M Walsemann %A Jennifer A Ailshire %K cognitive functioning %K gender %K race %K Religion %X

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

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

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

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

%B The Journals of Gerontology, Series B %V 77 %P 237-248 %G eng %N 1 %R 10.1093/geronb/gbab034 %0 Web Page %D 2022 %T Relocation later in life and contact frequency with friends: Do contact modes matter? %A Wadley, Jared %K relocation %K Social interactions %K Social Support %K Well-being %I Michigan News, University of Michigan %G eng %U https://news.umich.edu/relocation-later-in-life-and-contact-frequency-with-friends-do-contact-modes-matter/ %0 Journal Article %J Research on Aging %D 2022 %T Responding to Disability Onset in the Late Working Years: What do Older Workers do? %A Jody Schimmel Hyde %A Wu, April Yanyuan %A Livermore, Gina %K Disability %K Occupations %K Older workers %K Transitions %K work limitations %X

This study uses occupational data from the Health and Retirement Study to document the link between disability onset and occupational transitions among older adults who are working and do not report a disabling condition at age 55. We find that one-quarter of workers go on to experience new disabilities before full-retirement age. Relative to their peers who do not report disabilities, stopping work and significant occupational changes are more common among workers who experience new disabilities. Our results suggest that policies to support labor force attachment might consider the importance of new disability onset and whether employer accommodations might help workers with new disabling conditions remain in the jobs they held when their health began to limit their work.

%B Research on Aging %V 44 %P 643-657 %G eng %N 9-10 %R 10.1177/01640275221074634 %0 Journal Article %J Journal of Pension Economics and Finance %D 2022 %T Retirement plan wealth inequality: measurement and trends %A Ghilarducci, Teresa %A Radpour, Siavash %A Webb, Anthony %K Inequality %K Retirement wealth %X Using Health and Retirement Study data linked to summary plan descriptions and W-2s, this study reports trends in retirement wealth inequality of older employees 1992–2010. The study identifies and corrects methodological flaws in past research. Retirement wealth is highly unequally distributed; the top lifetime earnings quintile holds half of all retirement wealth, the bottom quintile, only 1%. The top earnings quintile fared better in 2010 than in 1992, whereas bottom-quintile earners fared worse. But retirement wealth inequality mainly reflects inequality within earnings quintiles, resulting from inadequate savings, not outsize accumulations. Systemic flaws reduce median retirement wealth by 84% %B Journal of Pension Economics and Finance %V 21 %P 119–139 %G eng %R 10.1017/S1474747220000074 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T The Role of Incarceration as a Risk Factor for Cognitive Impairment. %A Cox, Robynn J A %A Robert B Wallace %K cognitive impairment %K Cognitive Reserve %K formerly incarcerated %K Health Disparities %K reentry %X

OBJECTIVES: The objective of this study was to understand disparities in cognitive impairment between middle aged formerly incarcerated (FI) and nonincarcerated (NI) individuals.

METHODS: The 1979 National Longitudinal Survey of Youth is a nationally representative longitudinal dataset containing information on incarceration, cognitive functioning, and other health conditions. Using a modified version of the Telephone Interview for Cognitive Status (TICS-m), adapted from the Health and Retirement Study, we analyzed the association between incarceration and cognitive impairment, cognitive impairment-not dementia, and dementia. Multivariable regression models were estimated including prior incarceration status and covariates associated with incarceration and cognitive functioning.

RESULTS: FI individuals had lower unadjusted scores on TICS-m (-2.5, p<.001), and had significantly greater unadjusted odds ratios (OR) for scoring in the cognitive impairment (OR=2.4, p<.001) and dementia (OR=2.7, p<.001) range. Differences were largely explained by a combination of risk factors associated with incarceration and cognition. Education and premorbid cognition (measured by Armed Forces Qualifying Test) separately and completely explained differences in the odds of dementia. Regardless of incarceration status, Blacks and Hispanics had significantly greater odds of cognitive impairment and dementia relative to Whites, holding other factors constant.

DISCUSSION: The association between prior incarceration and cognitive impairment in middle age was largely explained by differences in educational attainment and premorbid cognitive functioning, supporting the cognitive reserve hypothesis. Greater prevalence of cognitive impairment and dementia among the FI could create challenges and should be considered in reentry planning. Structural and institutional factors should be considered when addressing health disparities in ADRD.

%B The Journals of Gerontology, Series B %V 77 %P e247-e262 %G eng %N 12 %R 10.1093/geronb/gbac138 %0 Thesis %D 2022 %T The Role of Physical Activity and Gender as Moderators for the Relationship between Insomnia and Depression %A Wickersham, Claire E. %K depression %K Depressive symptoms %K gender %K insomnia %K Physical activity %K Sleep disturbances %X Objective: The aim of this study was to examine the association between insomnia and depressive symptoms among middle-aged and older adults and to investigate whether gender or physical activity moderates this relationship. Method: This study used nationally representative data from the 2016 and 2018 waves of the Health and Retirement Study (HRS) and binomial logistic regression was used to estimate models. Regression models for risk of depressive symptoms (2018) were based on a longitudinal model with time-lagged indicators of insomnia, levels of physical activity, and covariates (2016). Results: Analyses showed that participants who reported having insomnia in 2016 were more likely to report depressive symptoms in 2018. This study did not find a statistically significant interaction between insomnia and physical activity or insomnia and gender. Discussion: This study showed how insomnia is associated with an increased risk of depression over a two-year period among middle-aged and older adults. Further research is needed to explore differences in gender and physical activity in greater detail. Findings from this study have the potential to inform health professionals and policymakers about the importance of insomnia and depression and develop health promotion programs to reduce the negative and costly health consequences of depression. Moreover, results from the current study can be useful in providing a baseline for pre-and post-pandemic levels of insomnia and depression. %I University of Massachusetts, Boston %C Boston, MA %V Ph.D. %G eng %U www.proquest.com/dissertations-theses/role-physical-activity-gender-as-moderators/docview/2681823300/se-2 %0 Journal Article %D 2022 %T The Role of Physical, Cognitive, and Interpersonal Occupational Requirements and Working Conditions on Disability and Retirement %A Italo Lopez Garcia %A Kathleen J. Mullen %A Jeffrey Wenger %K cognitive %K Disability %K physical %K Retirement %X We examine of the role of physical and mental job requirements, as well as hazardous working conditions, on retirement and disability among older individuals in the United States. By linking occupation-level data on job requirements from the Occupational Requirements Survey (ORS) to individual-level data from the Health and Retirement Study (HRS), we create composite indices for physical activities and the physical work environment, as well as two indices of mental job requirements related to job autonomy and flexibility index, and being supervised and working with the pubic. Using data from the HRS Life History Mail Survey, we merge these indices to the HRS panel using the most important occupation held by the individual in her prime years. We find that a 1 standard deviation (SD) increase in the physical activity and physical work environment indices are associated with a 10 to 13 percentage point (pp) increase in the probability of being retired and a 3 to 5 pp increase in the probability of transitioning into retirement. The associations of these indices with disability outcomes follow the same patterns as retirement, but they are lower in magnitude. A 1 SD increase in job autonomy/flexibility is associated with a 22 pp decrease in the probability of being retired and a 12 pp decrease in retirement transitions, but it does not predict disability outcomes. Finally, the effects of physically demanding and hazardous jobs on labor force exit are concentrated among men and low-educated workers, while delays in retirement predicted by higher job autonomy and flexibility are driven by college-educated workers. %G eng %U https://mrdrc.isr.umich.edu/pubs/the-role-of-physical-cognitive-and-interpersonal-occupational-requirements-and-working-conditions-on-disability-and-retirement/ %0 Journal Article %J The Journals of Gerontology: Series B %D 2022 %T The Roles of General and Domain-Specific Perceived Stress in Healthy Aging. %A Luo, Jing %A Zhang, Bo %A Willroth, Emily C %A Daniel K. Mroczek %A Brent W Roberts %K Aging %K Bifactor model %K health %K Perceived stress %X

OBJECTIVES: Theoretical and empirical evidence suggests the existence of a general perceived stress factor overarching different life domains. The present study investigated the general perceived stress relative to domain-specific perceived stress as predictors of 26 diverse health outcomes, including mental and physical health, health behaviors, cognitive functioning, and physiological indicators of health.

METHOD: A bifactor exploratory structural equational modelling (BiESEM) approach was adopted in two aging samples from the Health and Retirement Study (HRS; N = 8325 in Sample 1, N = 7408 in Sample 2).

RESULTS: Across the two samples, perceived stress was well-represented by a bifactor structure where there was a robust general perceived stress factor representing a general propensity towards stress perception. Meanwhile, after controlling for the general perceived stress factor, specific factors that represent perceived stress in different life domains were still clearly present. Results also suggested age, sex, race, education, personality traits, and past and recent stressor exposure as possible factors underlying individual differences in the general perceived stress factor. The general perceived stress factor was the most robust predictor of the majority of health outcomes, as well as changes in mental health outcomes. The specific factor of perceived neighborhood stress demonstrated incremental predictive effects across different types of health outcomes.

DISCUSSION: The current study provides strong evidence for the existence of a general perceived stress factor that captures variance shared among stress across life domains, and the general perceived stress factor demonstrated substantial prospective predictive effects on diverse health outcomes in older adulthood.

%B The Journals of Gerontology: Series B %V 77 %P 536-549 %G eng %N 3 %R 10.1093/geronb/gbab134 %0 Journal Article %J International Journal of Population Studies %D 2022 %T Self-reported hearing loss, hearing aid use, and cognitive function among U.S. older adults %A West, Jessica %A Smith, Sherri %A Dupre, Matthew %K Cognitive decline %K Dementia %K Hearing loss %K racial/ethnic disparities %X There has been increasing attention to the role of hearing loss as a potentially modifiable risk factor for Alzheimer’s disease and related dementias. However, more nationally-representative studies are needed to understand the co-occurring changes in hearing loss and cognitive function in older adults over time, and how hearing aid use might influence this association. The purpose of this report is to examine how age-related changes in hearing loss and hearing aid use are associated with trajectories of cognitive function in a nationallyrepresentative sample of U.S. older adults. We used 11 waves of longitudinal data from the Health and Retirement Study (HRS) from 1998 to 2018 to examine changes in self-reported hearing loss, hearing aid use, and cognitive function in adults 65 and older by race and ethnicity. Results from mixed models showed that greater levels of hearing loss were associated with lower levels of cognitive function at age 65 in non-Hispanic White, non-Hispanic Black, and Hispanic older adults. We also found that the associations diminished across age in White and Black individuals; but remained persistent in Hispanic individuals. The use of hearing aids was not associated with cognitive function in Black older adults but appeared protective for White and Hispanic older adults. Overall, the findings from this report suggest that the timely identification of hearing loss and subsequent acquisition of hearing aids may be important considerations for reducing declines in cognitive function that manifests differently in U.S. population subgroups. %B International Journal of Population Studies %V 8 %P 17-26 %G eng %N 1 %R 10.18063/ijps.v8i1.1308 %0 Journal Article %J Front Neurosci %D 2022 %T Sensory impairment and cognitive decline among older adults: An analysis of mediation and moderation effects of loneliness. %A Ge, Shaoqing %A Pan, Wei %A Wu, Bei %A Plassman, Brenda L %A Dong, XinQi %A McConnell, Eleanor S %K Cognitive decline %K Loneliness %K Older Adults %X

BACKGROUND: Multiple studies have reported that hearing and vision impairment are linked to cognitive decline. Yet little is known about factors that may influence the association between sensory impairment and cognitive decline. This study examined if loneliness mediates or moderates the impact of sensory impairment on cognitive decline as individuals age.

METHODS: This was a longitudinal study using data from the Health and Retirement Study (HRS) and The Aging, Demographics, and Memory Study (ADAMS) ( = 243). We used one timepoint of hearing and vision (ADAMS 2006-2008), one timepoint of loneliness (HRS 2006-2008), and five waves of cognition (HRS 2006-2014). Hearing impairment was defined by an inability to hear pure-tone stimuli of 25 dB at frequencies between 0.5 and 4.0 kHz in either ear. Visual impairment was defined as having corrected binocular vision worse than 20/40. Longitudinal parallel-process (LPP) analysis was conducted at a significance level of α = 0.05 (one-tailed).

RESULTS: Loneliness moderated but did not mediate the association between visual impairment and the rate of cognitive decline (standardized β =-0.108, < 0.05). No moderation or mediation effect of loneliness was found for the association between hearing impairment and cognitive decline. Both vision and hearing impairment were significantly associated with increased severity of loneliness.

CONCLUSION: Visual impairment combined with an elevated level of loneliness may produce a more synergistic, deleterious impact on older adults' cognitive function than visual impairment alone. This study highlights the importance of promoting a healthy social and psychological status for older adults with sensory impairment.

%B Front Neurosci %V 16 %P 1092297 %8 2022 %G eng %R 10.3389/fnins.2022.1092297 %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 Report %D 2022 %T Societal Impact of Research Funding for Women's Health in Rheumatoid Arthritis %A Baird, Matthew D. %A Melanie A. Zaber %A Annie Chen %A Andrew W. Dick %A Chloe E. Bird %A Molly Waymouth %A Grace Gahlon %A Denise D. Quigley %A Hamad Al-Ibrahim %A Lori Frank %X Women's health has suffered from insufficient research addressing women. The research community has not widely embraced the value of this research, and the impact of limited knowledge about women's health relative to men's is far-reaching. Without information on the potential return on investment for women's health research, research funders, policymakers, and business leaders lack a basis for altering research investments to improve knowledge of women's health. As part of an initiative of the Women's Health Access Matters (WHAM) nonprofit foundation, RAND Corporation researchers examined the impact of increasing funding for women's health research on rheumatoid arthritis (RA). RA was chosen partly because of its higher prevalence in women than men, with some symptom profiles differing by sex. In this report, the authors present the results of microsimulation models used to explore the potential for enhanced investment in women's health research, in terms of the economic well-being of women and for the U.S. population. %B Research Reports %I RAND Corporation %C Santa Monica, CA %G eng %U https://www.rand.org/content/dam/rand/pubs/research_reports/RRA700/RRA708-3/RAND_RRA708-7.appendixes.pdf %0 Journal Article %J American Journal of Infection Control %D 2022 %T Socio-demographic, lifestyle and health characteristics as predictors of self-reported Covid-19 history among older adults: 2006-2020 Health and Retirement Study. %A Beydoun, Hind A %A Beydoun, May A %A Hossain, Sharmin %A Alemu, Brook T %A Gautam, Rana S %A Weiss, Jordan %A Zonderman, Alan B %K Cardiovascular Diseases %K Chronic disease %K COVID-19 %K ethnicity %K Female %K Life Style %K Retirement %K Self Report %X

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

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

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

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

%B American Journal of Infection Control %V 50 %P 482-490 %G eng %N 5 %R 10.1016/j.ajic.2022.02.021 %0 Journal Article %J 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 Computers in Human Behavior %D 2022 %T Subjective markers of successful aging and change in Internet use among older adults: The distinctive role of subjective health %A Xiaoqing Wan %A Nichole R. Lighthall %A Daniel Paulson %K Internet use %K Life Satisfaction %K Self-perceptions %K Subjective age %K Subjective health %X Lower rates of Internet adoption among older adults pose significant challenges in delivering important online services to older adults. Addressing the age-related digital divide requires determining factors that can influence Internet use in aging and may be targeted for intervention. Candidate factors include self-perceptions associated with successful aging, but prior research has not determined whether changes in self-perceptions are related to changes in Internet use within individuals. The present study examined the relationship between self-perception measures (subjective age, subjective health, and life satisfaction) and Internet use among older adults, using longitudinal data from the Health and Retirement Study. Results indicated a selectively robust relationship between Internet use and better subjective health among older Americans. Further, these relationships were not altered by changes in technology adoption over time. Finally, longitudinal data over eight years revealed that change in Internet use was selectively associated with changes in subjective health. Together, these results indicate that among self-perception measures of successful aging, subjective health has a robust relationship with both current Internet use and changes in Internet use over time among older Americans. Such findings suggest that effective interventions to increase digital technology utilization likely require accommodations for older adults with poor subjective health. %B Computers in Human Behavior %V 127 %P 107064 %G eng %R https://doi.org/10.1016/j.chb.2021.107064 %0 Journal Article %J Age and Ageing %D 2022 %T Trajectories of depressive symptoms and subsequent cognitive decline in older adults: a pooled analysis of two longitudinal cohorts. %A Zhu, Yidan %A Li, Chenglong %A Xie, Wuxiang %A Zhong, Baoliang %A Wu, Yangfeng %A Blumenthal, James A %K Cognitive decline %K Depressive symptoms %K trajectory %X

BACKGROUND: the course of depression is variable, but it is unknown how this variability over time affects long-term cognitive decline.

OBJECTIVE: to examine the relationship of different trajectories of depressive symptoms on rates of subsequent cognitive decline in older adults.

DESIGN: population-based cohort study.

SETTING: communities in the USA and England.

SUBJECTS: 17,556 older adults from the Health and Retirement Study and the English Longitudinal Study of Ageing.

METHODS: depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale, and trajectories were calculated using group-based trajectory modelling. Global cognitive function and three cognitive domains of memory, executive function and temporal orientation were assessed for up to 18 years.

RESULTS: five trajectories of depressive symptoms were identified. Compared with the 'non-depressed' trajectory, the 'worsening depressive symptoms' trajectory (pooled β = -0.016 standard deviation (SD)/year, 95% confidence interval (CI): -0.021 to -0.010), 'persistent depressive symptoms' trajectory (pooled β = -0.016 SD/year, 95% CI: -0.024 to -0.008), and 'mild depressive symptoms' trajectory (pooled β = -0.008 SD/year, 95% CI: -0.014 to -0.003) were associated with faster rates of cognitive decline, while no such association was found for the 'improving depressive symptoms' trajectory (pooled β = 0.001 SD/year, 95% CI: -0.010 to 0.012).

CONCLUSIONS: subthreshold depressive symptoms are associated with an increased rate of cognitive decline, while individuals who show improving depressive symptoms do not exhibit accelerated cognitive decline. These findings raise the possibility that maintaining depressive symptoms as low as possible and ignoring the clinical threshold, might mitigate cognitive decline in older adults.

%B Age and Ageing %V 51 %P afab191 %G eng %N 1 %R 10.1093/ageing/afab191 %0 Journal Article %J Journal of Affective Disorders %D 2022 %T The trajectories of depressive symptoms and subsequent incident dementia, coronary heart diseases, stroke and all-cause mortality. %A Wu, Tao %A Li, Chenglong %A Zhu, Yidan %A Ma, Yanjun %A Hua, Rong %A Zhong, Baoliang %A Xie, Wuxiang %K Dementia %K depressive disorders %K Mental Health %K Population Health %X

BACKGROUND: Evidence suggests the occurrence of depressive symptoms in mid- to late-life inflates the risk for ageing-related morbidity compared to people without depressive symptoms. The eventual association between depressive symptoms in mid- to late-life and long-term (over 10-year) risks for incident dementia, coronary heart disease (CHD), stroke, and morbidity is to be established.

METHODS: This longitudinal cohort study utilized Health and Retirement Study (HRS) of U.S residents aged ≥ 50 years who were interviewed every 2-year during follow-up (average follow-up: 11.6 ± 2.85 years). Trajectories of depressive symptoms were assessed by the Center for Epidemiologic Studies Depression (CES-D) scale from 1994 to 2000 at baseline. Incident dementia, CHD, stroke and all-cause mortality were determined from 2000 to 2018.

RESULTS: Among 7810 individuals who were free from dementia, CHD and stroke, five trajectories of depressive symptoms were identified: non-depressed (36.7 %), mild (48.8 %), worsening (7.8 %), improving (4.1 %) and persistent (2.7 %). Compared with those in the non-depressed group, participants with mild, worsening and persistent depressive symptoms had significantly greater hazards of incident dementia (multivariable adjusted hazard ratios and 95 % confidence intervals: 1.32 [1.17-1.48], 1.58 [1.30-1.93], 2.82 [2.17-3.67], respectively), CHD (1.13 [1.03-1.24], 1.47 [1.25-1.73], 1.34 [1.03-1.74], respectively), stroke (1.30 [1.12-1.52], 1.58 [1.23-2.04], 1.71 [1.16-2.53], respectively) and all-cause mortality (1.17 [1.07-1.27], 1.46 [1.27-1.68], 1.66 [1.35-2.06], respectively). The hazards of incident events, except for CHD, were not significantly greater in individuals with improving depressive symptoms.

CONCLUSIONS: The present findings suggest even sub-clinical threshold depressive symptoms were associated with the hazards of ageing related diseases while such associations were not significant with managed depressive symptoms.

%B Journal of Affective Disorders %V 312 %P 9-16 %G eng %R 10.1016/j.jad.2022.06.001 %0 Journal Article %J Innovation In Aging %D 2022 %T Trajectories of Frailty With Aging: Coordinated Analysis of Five Longitudinal Studies. %A Jenkins, Natalie D %A Hoogendijk, Emiel O %A Armstrong, Joshua J %A Lewis, Nathan A %A Ranson, Janice M %A Rijnhart, Judith J M %A Ahmed, Tamer %A Ghachem, Ahmed %A Mullin, Donncha S %A Ntanasi, Eva %A Welstead, Miles %A Auais, Mohammad %A Bennett, David A %A Bandinelli, Stefania %A Cesari, Matteo %A Ferrucci, Luigi %A French, Simon D %A Huisman, Martijn %A Llewellyn, David J %A Scarmeas, Nikolaos %A Piccinin, Andrea M %A Hofer, Scott M %A Muniz-Terrera, Graciela %K Age-related changes %K Frailty %K Latent growth curve %X

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

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

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

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

%B Innovation In Aging %V 6 %P igab059 %G eng %N 2 %R 10.1093/geroni/igab059 %0 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 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 Cancer Epidemiology, Biomarkers & Prevention %D 2022 %T Validation of self-reported cancer diagnoses using Medicare diagnostic claims in the U.S. Health and Retirement Study, 2000-2016. %A Megan Mullins %A Jasdeep S Kler %A Eastman, Marisa R %A Mohammed U Kabeto %A Lauren P Wallner %A Lindsay C Kobayashi %K cancer diagnoses %K medicare diagnostic claims %K Self-reported health %X

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

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

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

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

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

%B Cancer Epidemiology, Biomarkers & Prevention %V 31 %P 287-292 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/34737206?dopt=Abstract %R 10.1158/1055-9965.EPI-21-0835 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T The Validity and Reliability of Retrospective Measures of Childhood Socioeconomic Status in the Health and Retirement Study: Evidence from the 1940 U.S. Census. %A Warren, John Robert %A Lee, Mark %A Theresa L Osypuk %K Data quality %K family income %K Measurement %K Parental education %X

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

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

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

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

%B The Journals of Gerontology, Series B %V 77 %P 1661-1673 %G eng %N 9 %R 10.1093/geronb/gbac045 %0 Journal Article %J Journal of Family and Economic Issues %D 2022 %T Who Decides? Financial Decision-Making Among Older Couples %A Lim, HanNa %A Su Hyun Shin %A Wilmarth, Melissa J. %A Park, Narang %K Bargaining power %K Cognitive Ability %K Constraints on self-control %K Couples %K Financial decisions %K Risk tolerance %X Using a sample of 2621 respondents from the 2014 Health and Retirement Study (HRS), this study identifies factors associated with who makes complex financial decisions among older couples. Our results show that the bargaining power of wives has a positive association with their decision-making about savings, investments, and health insurance, while the power of husbands is negatively associated with wives being more responsible for decisions about health insurance and tax filing. Moreover, while the husband’s sense of control, risk tolerance, and cognitive ability are associated with decisions for all financial decisions, the wife’s sense of control, risk tolerance, and cognitive ability are related to some financial decisions only. Our results show some moderating roles of the perceived spousal social support, household income, and mother’s education on the association between the four explanatory variables (bargaining power, sense of control, risk tolerance, and cognitive ability) and who makes the financial decisions. The findings provide potential benefits for older couples who consult financial professionals about financial management. %B Journal of Family and Economic Issues %V 43 %P 310–337 %@ 1573-3475 %G eng %R 10.1007/s10834-021-09775-3 %0 Web Page %D 2022 %T Why Do Mental Illnesses—From Depression to Schizophrenia—Raise the Risk of Dementia? %A Wallis, Claudia %K Dementia %K depression %K Mental Illness %K Schizophrenia %I Scientific America %G eng %U https://www.scientificamerican.com/article/why-do-mental-illnesses-from-depression-to-schizophrenia-raise-the-risk-of-dementia/ %0 Report %D 2022 %T Will Survivors of the First Year of the COVID-19 Pandemic Have Lower Mortality? %A Gal Wettstein %A Gok, Nilufer %A Anqi Chen %A Alicia H. Munnell %K COVID-19 %K Mortality %X The mortality burden of the COVID-19 pandemic was particularly heavy among older adults, racial and ethnic minorities, and those with underlying health conditions. These groups are known to have higher mortality rates than others even in the absence of COVID. Using data from the 2019 American Community Survey, the 2018 Health and Retirement Study, and the 2020 National Vital Statistics System, this paper estimates how much lower the overall mortality rate will be for those who lived through the acute phase of the early pandemic after accounting for this selection effect of those who died from COVID. Such selection may have implications for life insurance and annuity premiums, as well as assessments of the financial standing of Social Security – if the selection is large enough to substantially alter projected survivor mortality. The paper found that: 10-year mortality rates, absent direct COVID deaths and long COVID, will likely be lower in 2021 than anticipated in 2019.However, these differences are small, ranging from a decline of 0.4 percentage points for people in their 60s to 1 percentage point for those in their 90s.The small difference is in spite of the fact that COVID mortality was, indeed, very selective, with mortality declines exceeding half the maximum possible declines, holding total COVID deaths constant, for every age group. The policy implications of the findings are: That declines in mortality due to COVID selection likely will not impact overall population mortality substantially enough to affect Social Security cost projections.Any impact of selection effects on Social Security costs will likely be swamped by ongoing mortality increases directly attributable to acute and long COVID. %B Working Papers %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/will-survivors-of-the-first-year-of-the-covid-19-pandemic-have-lower-mortality/ %0 Journal Article %J Lancet %D 2021 %T The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. %A Watts, Nick %A Amann, Markus %A Arnell, Nigel %A Ayeb-Karlsson, Sonja %A Beagley, Jessica %A Belesova, Kristine %A Boykoff, Maxwell %A Byass, Peter %A Cai, Wenjia %A Campbell-Lendrum, Diarmid %A Capstick, Stuart %A Chambers, Jonathan %A Coleman, Samantha %A Dalin, Carole %A Daly, Meaghan %A Dasandi, Niheer %A Dasgupta, Shouro %A Davies, Michael %A Di Napoli, Claudia %A Dominguez-Salas, Paula %A Drummond, Paul %A Dubrow, Robert %A Ebi, Kristie L %A Eckelman, Matthew %A Ekins, Paul %A Escobar, Luis E %A Georgeson, Lucien %A Golder, Su %A Grace, Delia %A Graham, Hilary %A Haggar, Paul %A Hamilton, Ian %A Hartinger, Stella %A Hess, Jeremy %A Hsu, Shih-Che %A Hughes, Nick %A Jankin Mikhaylov, Slava %A Marcia P Jimenez %A Kelman, Ilan %A Kennard, Harry %A Kiesewetter, Gregor %A Kinney, Patrick L %A Kjellstrom, Tord %A Kniveton, Dominic %A Lampard, Pete %A Lemke, Bruno %A Liu, Yang %A Liu, Zhao %A Lott, Melissa %A Lowe, Rachel %A Martinez-Urtaza, Jaime %A Maslin, Mark %A McAllister, Lucy %A McGushin, Alice %A McMichael, Celia %A Milner, James %A Moradi-Lakeh, Maziar %A Morrissey, Karyn %A Munzert, Simon %A Murray, Kris A %A Neville, Tara %A Nilsson, Maria %A Sewe, Maquins Odhiambo %A Oreszczyn, Tadj %A Otto, Matthias %A Owfi, Fereidoon %A Pearman, Olivia %A Pencheon, David %A Quinn, Ruth %A Rabbaniha, Mahnaz %A Robinson, Elizabeth %A Rocklöv, Joacim %A Romanello, Marina %A Semenza, Jan C %A Sherman, Jodi %A Shi, Liuhua %A Springmann, Marco %A Tabatabaei, Meisam %A Taylor, Jonathon %A Triñanes, Joaquin %A Shumake-Guillemot, Joy %A Vu, Bryan %A Wilkinson, Paul %A Winning, Matthew %A Gong, Peng %A Montgomery, Hugh %A Costello, Anthony %K Climate Change %K Conservation of Natural Resources %K COVID-19 %K Extreme Weather %K Global Health %K health policy %K Humans %K International Cooperation %K Pandemics %K SARS-CoV-2 %B Lancet %V 397 %P 129-170 %G eng %N 10269 %R 10.1016/S0140-6736(20)32290-X %0 Journal Article %J Journal of Gerontological Social Work %D 2021 %T Acknowledging Systemic Discrimination in the Context of a Pandemic: Advancing an Anti-Racist and Anti-Ageist Movement. %A Gonzales, Ernest %A Gordon, Stacey %A Whetung, Cliff %A Connaught, Gerri %A Collazo, Jasmin %A Hinton, Jill %K COVID-19 %K Health Disparities %K systemic racism %X

This commentary draws together the confluence of current events - COVID-19 pandemic and racial injustice. Vulnerability to COVID-19 cannot be understood by age alone but within the context of inequity. We first review how COVID-19 has disproportionately affected Black and Latinx populations across the life span with the latest data from New York City Department of Health. We then discuss critical race theory and analyze longstanding inequities in health, economic, and social conditions that heighten the risk for vulnerability. We conclude with a discussion for the social work profession on the issues of defunding the police to undoing stereotypes.

%B Journal of Gerontological Social Work %V 64 %P 223-237 %G eng %N 3 %R 10.1080/01634372.2020.1870604 %0 Journal Article %J Journal of Affective Disorders %D 2021 %T Age and sex trends in depressive symptoms across middle and older adulthood: Comparison of the Canadian Longitudinal Study on Aging to American and European cohorts %A John R. Best %A Daniel R.Y. Gan %A Andrew V. Wister %A Theodore D. Cosco %K Cross-cohort comparison %K Gender Differences %K Mental Health %K Population-based trends %K SHARE %X Background : The literature suggests depressive symptoms differ in a non-linear fashion across adulthood and are more commonly reported in women as compared to men. Whether these trends are observed across countries in population-based cohorts is unclear. Methods : Cross-sectional observational study of approximately 138,000 women and men between the ages of 45 and 95 from three population-based cohorts representing Canadian, European, and American populations. Age, gender, educational attainment and annual income were assessed in each cohort. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale in the US and Canadian cohorts, and by the EURO-D in the European cohort. Results : Across all three cohorts, non-linear age trends and gender differences were observed in the report of depressive symptoms, independent from educational attainment and annual income effects. The non-linear age trends reflected a negative association between depressive symptoms and age during midlife and then a positive association in late life. Females reported greater depressive symptoms than males; however, an interaction between gender and age was also observed in the Canadian and European cohorts. Among Canadians, the gender differences were largest after age 70, whereas among Europeans, gender differences where largest among those approximately aged 60. Limitations : Limitations include: 1) the cross-sectional nature of the study, resulting in age differences potentially reflecting cohort effects rather than a developmental process; and 2) the use of different depressive symptoms measures across cohorts. Conclusions : Characterization of depressive symptoms over mid and late adulthood in women and men provides insights into potential focal points for intervention and allocation of resources. %B Journal of Affective Disorders %V 295 %P 1169-1176 %G eng %R 10.1016/j.jad.2021.08.109 %0 Journal Article %J The Annals of Applied Statistics %D 2021 %T Assessing selection bias in regression coefficients estimated from nonprobability samples with applications to genetics and demographic surveys %A Brady T. West %A Roderick J.A. Little %A Rebecca R. Andridge %A Philip S. Boonstra %A Erin B Ware %A Anita Pandit %A Fernanda Alvarado-Leiton %K Linear regression %K nonprobability samples %K polygenic scores %K probit regression %K Selection Bias %X Selection bias is a serious potential problem for inference about relationships of scientific interest based on samples without well-defined probability sampling mechanisms. Motivated by the potential for selection bias in: (a) estimated relationships of polygenic scores (PGSs) with phenotypes in genetic studies of volunteers and (b) estimated differences in subgroup means in surveys of smartphone users, we derive novel measures of selection bias for estimates of the coefficients in linear and probit regression models fitted to nonprobability samples, when aggregate-level auxiliary data are available for the selected sample and the target population. The measures arise from normal pattern-mixture models that allow analysts to examine the sensitivity of their inferences to assumptions about nonignorable selection in these samples. We examine the effectiveness of the proposed measures in a simulation study and then use them to quantify the selection bias in: (a) estimated PGS-phenotype relationships in a large study of volunteers recruited via Facebook and (b) estimated subgroup differences in mean past-year employment duration in a nonprobability sample of low-educated smartphone users. We evaluate the performance of the measures in these applications using benchmark estimates from large probability samples. %B The Annals of Applied Statistics %V 15 %P 1556-1581 %G eng %N 3 %R https://doi.org/10.1214/21-AOAS1453 %0 Conference Paper %B Retirement and Disability Research Consortium 23rd Annual Meeting %D 2021 %T Assessing the Economic Impact Payment in the Older Population %A Kezdi, Gabor %A David R Weir %K COVID-19 %K economic impact %K Stimulus effects %X The COVID-19 pandemic is the greatest threat to the health and well-being of the older population in at least a century. The economic consequences of public health policies to mitigate that threat are also of serious concern. This project proposes to study one part of the policy response. We will use data collected by the Health and Retirement Study in its 2020 wave to study awareness and impact of the Economic Impact Payment (EIP) stimulus on different groups of older Americans during the coronavirus pandemic. The EIP was authorized as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed in late March 2020. It provides for a direct stimulus payment to individuals, similar to stimulus programs in previous economic downturns in 2001 and 2008. The great advantage to studying the impact of the EIP in HRS is the volume of other information that can be used to understand differentials in eligibility, awareness, and disposition. From the 2020 survey we will know about the impact of COVID-19 on work and health, as well as the usual measures of income and wealth. %B Retirement and Disability Research Consortium 23rd Annual Meeting %I Center for Financial Security, University of Wisconsin-Madison %C Virtual Event %8 08/2021 %G eng %U https://cfsrdrc.wisc.edu/files/2021-RDRC-Meeting-Booklet.pdf#page=7 %0 Journal Article %J Financial Planning Review %D 2021 %T Assessing the relationship between health and household portfolio allocation %A Wu, Stephen %K health %K household finance %K Portfolio choice %X This paper surveys the literature on the relationship between health and household portfolio allocation and provides updated empirical analysis based on recent data. Prior research finds robust evidence for cross-sectional correlations between measures of health status and portfolio decisions, but establishing the causal pathways and underlying mechanisms has proven more difficult and complex. Analysis from the most recently available 2016 and 2018 waves of the Health and Retirement Study yields results that are consistent with existing literature. Households with worse self-reported health have a lower probability of holding various types of financial assets and invest a higher share of their portfolios in safe assets, relative to other asset categories. However, there is only weak evidence that new health shocks to a household change portfolio holdings. The paper concludes with a discussion of the implications of this research and directions for future work. %B Financial Planning Review %V 4 %P e1128 %G eng %N 4 %R 10.1002/cfp2.1128 %0 Journal Article %J Alzheimer Disease & Associated Disorders %D 2021 %T The Association Between Cancer and Spousal Rate of Memory Decline: A Negative Control Study to Evaluate (Unmeasured) Social Confounding of the Cancer-memory Relationship. %A Ospina-Romero, Monica %A Willa D Brenowitz %A M. Maria Glymour %A Elizabeth R Mayeda %A Graff, Rebecca E %A Witte, John S %A Ackley, Sarah F %A Lu, Kun Ping %A Lindsay C Kobayashi %K Cancer %K Cognition %K Spouses %X

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

%B Alzheimer Disease & Associated Disorders %V 35 %P 271-274 %G eng %N 3 %R 10.1097/WAD.0000000000000398 %0 Conference Proceedings %B APHA 2021 Annual Meeting and Expo %D 2021 %T Association between insomnia symptoms and incident heart failure among middle-aged and older adults: A population-based cohort study %A Mahmood, Asos %A Ray, Meredith %A Dobalian, Aram %A Kenneth D. Ward %A Ahn, SangNam %K Heart Failure %K insomnia symptoms %X Background. Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue. Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF. Methods. Data were obtained from the Health and Retirement Study in the US for a sample of 12,761 adults (age ≥50 years; mean [SD] age, 66.7 [9.4] years; 57.7% females) who were free from HF at baseline in 2002. Respondents were followed for 16 years for incident HF. We employed marginal structural discretetime survival analyses to adjust for potential time-varying biological, psycho-cognitive, and behavioral factors and to account for bias due to differential loss to follow-up. Results. At baseline, 38.4% of the respondents reported at least one insomnia symptom. During follow-up, 1,730 respondents had incident HF. Respondents experiencing one (hazard ratio [HR]=1.22; 95% CI: 1.08– 1.38), two (HR=1.45; 95% CI: 1.21–1.72), three (HR=1.66; 95% CI: 1.37–2.02), or four (HR=1.80; 95% CI: 1.25–2.59) insomnia symptoms had a higher hazard of incident HF than asymptomatic respondents. Respondents experiencing trouble initiating sleep (HR=1.17; 95%CI: 1.01–1.36), maintaining sleep (HR=1.14; 95% CI: 1.01–1.28), early-morning awakening (HR=1.20; 95% CI: 1.02–1.43), or non-restorative sleep (HR=1.25; 95% CI: 1.06–1.46) had a higher hazard of incident HF than asymptomatic respondents. Conclusions. Insomnia symptoms, both cumulatively and individually, are associated with incident HF. Public health awareness and screening for insomnia symptoms in at-risk populations should be encouraged to reduce HF incidence. %B APHA 2021 Annual Meeting and Expo %G eng %U https://apha.confex.com/apha/2021/meetingapi.cgi/Session/63001?filename=2021_Session63001.pdf&template=Word %0 Journal Article %J JAMA %D 2021 %T Association of Coronary Artery Bypass Grafting vs Percutaneous Coronary Intervention With Memory Decline in Older Adults Undergoing Coronary Revascularization %A Elizabeth L Whitlock %A L Grisell Diaz-Ramirez %A Alexander K Smith %A W John Boscardin %A Kenneth E Covinsky %A Michael S. Avidan %A M. Maria Glymour %K cardiology %K cardiothoracic surgery %K ischemic heart disease %X It is uncertain whether coronary artery bypass grafting (CABG) is associated with cognitive decline in older adults compared with a nonsurgical method of coronary revascularization (percutaneous coronary intervention [PCI]).To compare the change in the rate of memory decline after CABG vs PCI.Retrospective cohort study of community-dwelling participants in the Health and Retirement Study, who underwent CABG or PCI between 1998 and 2015 at age 65 years or older. Data were modeled for up to 5 years preceding and 10 years following revascularization or until death, drop out, or the 2016-2017 interview wave. The date of final follow-up was November 2017.CABG (including on and off pump) or PCI, ascertained from Medicare fee-for-service billing records.The primary outcome was a summary measure of cognitive test scores and proxy cognition reports that were performed biennially in the Health and Retirement Study, referred to as memory score, normalized as a z score (ie, mean of 0, SD of 1 in a reference population of adults aged ≥72 years). Memory score was analyzed using multivariable linear mixed-effects models, with a prespecified subgroup analysis of on-pump and off-pump CABG. The minimum clinically important difference was a change of 1 SD of the population-level rate of memory decline (0.048 memory units/y).Of 1680 participants (mean age at procedure, 75 years; 41% female), 665 underwent CABG (168 off pump) and 1015 underwent PCI. In the PCI group, the mean rate of memory decline was 0.064 memory units/y (95% CI, 0.052 to 0.078) before the procedure and 0.060 memory units/y (95% CI, 0.048 to 0.071) after the procedure (within-group change, 0.004 memory units/y [95% CI, −0.010 to 0.018]). In the CABG group, the mean rate of memory decline was 0.049 memory units/y (95% CI, 0.033 to 0.065) before the procedure and 0.059 memory units/y (95% CI, 0.047 to 0.072) after the procedure (within-group change, −0.011 memory units/y [95% CI, −0.029 to 0.008]). The between-group difference-in-differences estimate for memory decline for PCI vs CABG was 0.015 memory units/y (95% CI, −0.008 to 0.038; P = .21). There was statistically significant increase in the rate of memory decline after off-pump CABG compared with after PCI (difference-in-differences: mean increase in the rate of decline of 0.046 memory units/y [95% CI, 0.008 to 0.084] after off-pump CABG), but not after on-pump CABG compared with PCI (difference-in-differences: mean slowing of decline of 0.003 memory units/y [95% CI, −0.024 to 0.031] after on-pump CABG).Among older adults undergoing coronary revascularization with CABG or PCI, the type of revascularization procedure was not significantly associated with differences in the change of rate of memory decline. %B JAMA %V 325 %P 1955-1964 %@ 0098-7484 %G eng %N 19 %R 10.1001/jama.2021.5150 %0 Journal Article %J Alzheimer's & Dementia %D 2021 %T Associations between education and dementia in the Caribbean and the United States: An international comparison. %A Li, Jing %A Llibre-Guerra, Jorge J %A Harrati, Amal %A Weiss, Jordan %A Jiménez-Velázquez, Ivonne Z %A Acosta, Daisy %A Llibre-Rodriguez, Juan de Jesús %A Liu, Mao-Mei %A William H Dow %K Caribbean %K Dementia %K Education %K Hispanics %K Sister studies %X

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

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

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

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

%B Alzheimer's & Dementia %V 7 %P e12204 %G eng %N 1 %R 10.1002/trc2.12204 %0 Journal Article %J American Journal of Preventive Medicine %D 2021 %T Associations Between Purpose in Life and Mortality by SES. %A Shiba, Koichiro %A Laura D Kubzansky %A Williams, David R %A Tyler J VanderWeele %A Eric S Kim %K life purpose %K Mortality %K socioeconomic status %X

INTRODUCTION: Having a higher purpose in life has been linked to favorable health outcomes. However, little research has examined whether the purpose-health association persists across different levels of SES. This study assesses whether the association between higher purpose in life and lower mortality is similar across the levels of SES.

METHODS: A national sample of 13,159 U.S. adults aged >50 years from the Health and Retirement Study was analyzed. The baseline year was 2006‒2008. Purpose in life was assessed at baseline using Purpose in Life Subscale of the Ryff Psychological Well-being Scales. The risk of death during an 8-year follow-up was assessed. SES was measured using education, income, and wealth. Using multivariable Poisson regression, effect modification by SES was tested on both the additive and multiplicative scales. Analyses were done in 2020.

RESULTS: In analyses stratified by SES, people with the highest level of purpose consistently tended to have lower mortality risk across the levels of SES than those with the lowest level of purpose. However, people with middle-range purpose levels had lower mortality risk only if they also had mid-to-high education, income, and wealth. When formally testing the effect modification by SES, there was modest evidence that the associations between higher purpose and lower mortality were stronger among individuals with high education, income, and wealth.

CONCLUSIONS: The highest level of purpose appeared protective against all-cause mortality regardless of the levels of SES. By contrast, when levels of purpose were more modest, people with lower SES may benefit less health-wise from having a purpose.

%B American Journal of Preventive Medicine %V 61 %P e53-e61 %G eng %N 2 %R 10.1016/j.amepre.2021.02.011 %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 Conference Paper %B ISEE Conference Abstracts %D 2021 %T Associations of Long-term Air Pollution Exposure and Incident Late-Life Disability in Older U.S. Adults: The Health Retirement Study %A Gao, Jiaqi %A Carlos F. Mendes de Leon %A D'Souza, Jennifer %A Zhang, Boya %A Szpiro, Adam %A Young, Michael %A Weuve, Jennifer %A Kenneth M. Langa %A Jessica Faul %A Kaufman, Joel %A Richard A Hirth %A Sara Dubowsky Adar %K Activities of Daily Living %K Air Pollution %K Long-Term Exposure %X Late-life disability is of critical concern to older adults and can reflect the cumulative burden of chronic disease over the lifespan. Although air pollution has been associated with many common chronic conditions, associations with disability are understudied. We aimed to quantify associations between long-term exposures to air pollution and late-life disability. METHODS: We used biennial data between 2000 and 2016 on self-reported Activities of Daily Living (ADL) from participants 65 years from the nationally representative Health and Retirement Study. Using a spatiotemporal prediction model, we estimated 10-year PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences. We then estimated the risk of incident ADL disability as a function of time-varying air pollution, adjusting for individual and area-level confounders and sampling weights in a Cox model. We fitted single- and two-pollutant models. RESULTS:Our study population of 16,927 adults (70+6.4 years) was predominantly non-Hispanic White (76%), Non-Hispanic Black (14%), and Hispanic White (8%) and 32% reported a new disability during follow-up. Overall, we found some evidence that air pollution was associated with an increased risk of ADL disability. After adjustment for place and PM2.5, we found that interquartile increases in PM10-2.5 and NO2 were associated with 8% (HR: 1.08 per 5 µg/m3, 95% CI: 1.01, 1.17) and 9% (HR: 1.09 per 6 ppb, 95% CI: 1.00, 1.19) greater hazards of ADL, respectively, with similar findings in the single pollutant models. PM2.5 and O3 were not associated with higher hazards of ADL in single or multipollutant models after detailed adjustment for place. CONCLUSIONS:This prospective study in a nationally representative sample of older adults found some evidence that higher levels of some but not all long-term air pollutants assessed are associated with increased risk of late-life disability. %B ISEE Conference Abstracts %V 2021 %G eng %U https://ehp.niehs.nih.gov/action/doSearch?AllField=Associations+of+Long-term+Air+Pollution+Exposure+and+Incident+Late-Life+Disability+in+Older+U.S.+Adults%3A+The+Health+Retirement+Study %N 1 %0 Journal Article %J American Journal of Ophthalmology %D 2021 %T Associations of vision impairment and eye diseases with memory decline over four years in China and the United States. %A Shang, Xianwen %A Zhu, Zhuoting %A Wang, Wei %A He, Mingguang %K cataract surgery %K CHARLS %K Distance vision impairment %K Glaucoma %K moderation analysis %K near vision impairment %X

PURPOSE: To examine whether vision impairment and eye diseases are independently associated with memory decline in older adults.

DESIGN: Cohort study.

METHODS: We included 8315 participants aged 50-94 years in China Health and Retirement Longitudinal Study (CHARLS) from China and 8939 participants aged 50-95 years in Health and Retirement Study (HRS) from the United States in our analysis.

RESULTS: During 4.0 years' follow-up, the composite memory decreased by 0.16 points in CHARLS. During 3.9 years' follow-up, the composite memory decreased by 0.51 in HRS. Distance vision impairment was inversely associated with an annual change in composite memory (β (95% CI): -0.07 (-0.12, -0.01)) and immediate memory (-0.04 (-0.07, -0.02)) in CHARLS, and the corresponding values in HRS were -0.19 (-0.34, -0.05) and -0.07 (-0.13, -0.00), respectively. Near vision impairment was inversely associated with an annual change in delayed memory in CHARLS and composite memory, immediate memory, and delayed memory in HRS. In HRS, the association between distance vision impairment and memory decline was observed in individuals aged <65 years (β (95% CI): -0.54 (-0.78, -0.30) but not in those aged ≥65 years (-0.01 (-0.20, 0.18)). Cataract surgery or glaucoma was not significantly associated with memory decline in either CHARLS or HRS.

CONCLUSION: Distance vision impairment was independently associated with an accelerated rate of memory decline in both China and the United States. Near vision impairment was predictive of the decline in delayed memory in China and the decline in composite, immediate, and delayed memory in the United States.

%B American Journal of Ophthalmology %V 228 %P 16-26 %G eng %R 10.1016/j.ajo.2021.03.021 %0 Journal Article %J Social Science & Medicine %D 2021 %T Being good, doing good: The role of honesty and integrity for health %A Dorota Weziak-Bialowolska %A Piotr Bialowolski %A Ryan M. Niemiec %K Character strength %K depression %K Honesty %K integrity %K Lung disease %K Physical Health %X Psychological traits, such as character strengths, have been already established in experimental studies as factors playing a favorable role for well-being and potentially reducing the risk of depression. Positive associations have been also reported between character strengths and physical fitness, self-reported physical and mental health. Yet, evidence with large scale, epidemiological data on the role of character strength of honesty and integrity (CSHI) in shaping subsequent health outcomes and daily functioning remains unexplored. We examined whether the character strength of honesty and integrity was prospectively associated with six physical health outcomes, two depression outcomes, and two daily functioning outcomes. We used data from the Health and Retirement Study obtained from a sample of 9813 older adults. We found that after a 4-year follow-up period, compared with individuals who scored the lowest in CSHI, participants who scored in the third tertile had a 18% lower risk of lung disease (RR = 0.824; 95% CI = 0.732; 0.927), and a 11% lower risk of depression (RR = 0.891; 95% CI = 0.806; 0.986). They also reported lower limitations in mobility (β = −0.048; 95% CI (−0.089; −0.008)] and less difficulty in instrumental activities of daily living [β = −0.088; 95% CI (−0.128; −0.047)]. These associations were independent of demographics, prior socioeconomic status, psychological factors, health conditions, and health behaviors. Policy makers and practitioners may consider the character strength of honesty and integrity as a factor for promoting healthy longevity, limiting risks of becoming physically inactive and reducing risk of physical and mental disease. %B Social Science & Medicine %V 291 %P 114494 %G eng %R https://doi.org/10.1016/j.socscimed.2021.114494 %0 Journal Article %J Geriatric Nursing %D 2021 %T Biopsychosocial characteristics associated with engagement in art making among older adults. %A Kim, Kyung Soo %A Kristine L Kwekkeboom %A Roberts, Tonya %A Ward, Earlise %K Art making %K Holistic practice %K Older Adults %K Patient-centered intervention %X

In order to design patient-centered art making interventions for health and well-being, investigators need to understand the population of interest regarding their relationship to engagement in art making activities. This study, therefore, aimed to examine older adults' characteristics that were associated with engagement in art making activities, and to provide practical examples of how to use the identified characteristics. We conducted correlation analyses to evaluate such associations, using cross-sectional survey data from the 2014 Health and Retirement Study (n=731). Female sex, higher education, personality traits, positive attitude toward the arts, and a larger social network size were positively associated with engagement in art making activities (p<.05). Males and those with lower education could be targeted, while the type of art making activity could be tailored based on personality traits for patient-centered art making interventions. Future studies can use this information to empirically study art making interventions for older adults.

%B Geriatric Nursing %V 42 %P 727-733 %G eng %N 3 %R 10.1016/j.gerinurse.2021.03.011 %0 Report %D 2021 %T Can the Drawdown Patterns of Earlier Cohorts Help Predict Boomers’ Behavior? %A Siliciano, Robert L. %A Gal Wettstein %K defined benefit plan %K defined contribution plan %K Retirement %X Past generations drew down their wealth slowly in retirement, leaving much of their savings untouched. However, this pattern may not hold as the Baby Boomer generation retires, because they are less likely to have a defined benefit (DB) plan and will need to tap the assets in their defined contribution (DC) plans to support their consumption. This paper uses data from the Health and Retirement Study to estimate the relationship between access to DB plans and the speed at which past generations drew down their wealth. %B Working Paper %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/can-the-drawdown-patterns-of-earlier-cohorts-help-predict-boomers-behavior/ %0 Journal Article %J The Journals of Gerontology, Series A %D 2021 %T Cardiometabolic Risk Trajectory among Older Americans: Findings from the Health and Retirement Study. %A Wu, Qiao %A Jennifer A Ailshire %A Jung K Kim %A Eileen M. Crimmins %K cardiovascular %K Change with age %K Medication %K Metabolism %X

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

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

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

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

%B The Journals of Gerontology, Series A %V 76 %P 2265-2274 %G eng %N 12 %R 10.1093/gerona/glab205 %0 Journal Article %J The Journals of Gerontology, Series B %D 2021 %T Change in Mobility: Consistency of Estimates and Predictors Across Studies of Older Adults. %A Jennifer C. Cornman %A Dana A Glei %A Weinstein, Maxine %K Decline %K Measures %K physical functioning %K Recovery %K Risk Factors %X

OBJECTIVES: This study compares estimates and determinants of within-individual changes in mobility across surveys of older U.S. adults.

METHODS: Data come from the Health and Retirement Study (HRS) and the Midlife in the United States (MIDUS) study. Measures of mobility comprise self-reported level of difficulty with walking several blocks, going up several flights of stairs, lifting and carrying 10 pounds, and stooping. Predictors include sociodemographic characteristics and indicators of health and health behaviors. We pool the datasets and estimate weighted lagged dependent variable logistic regression models for each activity, assessing cross-study differences using interaction terms between a survey indicator and relevant variables.

RESULTS: Estimates of declines in mobility differ substantially across surveys for walking, lifting and carrying, and stooping, but there are no between-survey differences in the probability of (not) recovering from a limitation. With the exception of age, determinants of change are similar between studies. For lifting/carrying and stooping, the age-related increase in developing limitations is less steep at younger ages for HRS respondents than MIDUS respondents, but steeper at older ages.

DISCUSSION: To compare estimates of mobility change across surveys, mobility measures would need to be harmonized. Determinants of mobility change, however, are more comparable.

%B The Journals of Gerontology, Series B %V 76 %P 209-218 %G eng %N 1 %R 10.1093/geronb/gbz091 %0 Journal Article %J 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 SSM - Population Health %D 2021 %T Contribution of socioeconomic, lifestyle, and medical risk factors to disparities in dementia and mortality. %A Weiss, Jordan %K Dementia %K Intersectionality %K Mortality %K Multistate %K Population attributable fraction %X

Extensive literature in the United States documents racial/ethnic and gender disparities in the incidence and prevalence of dementia yet few studies have examined how race/ethnicity and gender intersect to shape inequalities in the risk of dementia. Moreover, few studies have examined heterogeneity in the contribution of known risk factors to dementia across these demographic strata while properly accounting for the semi-competing risk of death. I calculated the proportion of dementia cases attributable to socioeconomic, lifestyle, and medical risk factors across demographic subgroups using nationally representative data from the US-based Health and Retirement Study for the years 2000-2016 and a multistate framework that accounts for the semi-competing risk of death. Socioeconomic resources contributed to the largest number of dementia cases but the magnitude of this contribution varied across strata defined by race/ethnicity and gender. The greatest potential for dementia prevention was observed among non-Hispanic black and Hispanic men and women, supporting an intersectionality approach, and underscoring the need for culturally sensitive intervention and public health initiatives to address the growing burden of dementia. Taken together, work demonstrates the potential benefit of taking an intersectional approach to understanding disparities in dementia.

%B SSM - Population Health %V 16 %P 100979 %G eng %R 10.1016/j.ssmph.2021.100979 %0 Journal Article %J Age and Ageing %D 2021 %T Creation and validation of a polysocial score for mortality among community-dwelling older adults in the USA: The Health and Retirement Study. %A Ping, Yongjing %A Michelle C Odden %A Stawski, Robert S %A Abdel Magid, Hoda S %A Wu, Chenkai %K healthy ageing %K polysocial score %K Public Health %K Social determinants of health %X

BACKGROUND: the interrelatedness between social determinants of health impedes researchers to identify important social factors for health investment. A new approach is needed to quantify the aggregate effect of social factors and develop person- centred social interventions.

METHODS: participants ([n = 7,383], 54.5% female) were aged 65 years or above who complete an additional psychosocial questionnaire in the health and retirement study in 2006 or 2008. Social determinants of health encompassed five social domains: economic stability, neighbourhood and physical environment, education, community and social context, and healthcare system. We used the forward stepwise logistic regression to derive a polysocial score model for 5-year mortality. Indices of goodness-of-fit, discrimination and reclassification were used to assess model performance. We used logistic regression to identify the association between polysocial score and mortality. Subgroup analyses were conducted to examine sex- and race-specific association.

RESULTS: polysocial score was created using 14 social determinants of health. In the training cohort, the C-statistic was 0.71 for the reference model (only age, sex and race/ethnicity) and increased to 0.75 for the continuous and categorical polysocial score. Compared with the reference model, the integrated discrimination index for adding the continuous or categorical polysocial score was both 0.03 (P values < 0.001). Participants with an intermediate (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.51-0.82) or high (OR = 0.48; 95% CI, 0.38-0.60) polysocial score had lower odds of death than those in the low category in the fully adjusted model, respectively.

CONCLUSIONS: the polysocial approach may offer possible solutions to monitor social environments and suggestions for older people to improve their social status for specific health outcomes.

%B Age and Ageing %V 50 %P 2214-2221 %G eng %N 6 %R 10.1093/ageing/afab174 %0 Journal Article %J Neurology Genetics %D 2021 %T Cumulative Genetic Risk and APOE ε4 Are Independently Associated With Dementia Status in a Multiethnic, Population-Based Cohort %A Kelly M Bakulski %A Vadari, Harita S %A Jessica Faul %A Steven G Heeringa %A Sharon L R Kardia %A Kenneth M. Langa %A Jennifer A. Smith %A Jennifer J Manly %A Colter Mitchell %A Benke, Kelly S %A Erin B Ware %K Aging %K Alzheimer disease %K Cognition %K genetic risk %X

Objective: Alzheimer disease (AD) is a common and costly neurodegenerative disorder. A large proportion of AD risk is heritable, and many genetic risk factors have been identified. The objective of this study was to test the hypothesis that cumulative genetic risk of known AD markers contributed to odds of dementia in a population-based sample.

Methods: In the US population-based Health and Retirement Study (waves 1995-2014), we evaluated the role of cumulative genetic risk of AD, with and without the alleles, on dementia status (dementia, cognitive impairment without dementia, borderline cognitive impairment without dementia, and cognitively normal). We used logistic regression, accounting for demographic covariates and genetic principal components, and analyses were stratified by European and African genetic ancestry.

Results: In the European ancestry sample (n = 8,399), both AD polygenic score excluding the genetic region (odds ratio [OR] = 1.10; 95% confidence interval [CI]: 1.00-1.20) and the presence of any alleles (OR = 2.42; 95% CI: 1.99-2.95) were associated with the odds of dementia relative to normal cognition in a mutually adjusted model. In the African ancestry sample (n = 1,605), the presence of any alleles was associated with 1.77 (95% CI: 1.20-2.61) times higher odds of dementia, whereas the AD polygenic score excluding the genetic region was not significantly associated with the odds of dementia relative to normal cognition 1.06 (95% CI: 0.97-1.30).

Conclusions: Cumulative genetic risk of AD and are both independent predictors of dementia in European ancestry. This study provides important insight into the polygenic nature of dementia and demonstrates the utility of polygenic scores in dementia research.

%B Neurology Genetics %V 7 %P e576 %G eng %N 2 %R 10.1212/NXG.0000000000000576 %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 The Journals of Gerontology: Series B %D 2021 %T Demographic and Socioeconomic Disparities in Life Expectancy with Hearing Impairment in the U.S. %A Jessica S West %A Scott M Lynch %K Aging %K Bayesian multistate life table methods %K Hearing impairment %K Life Expectancy %X Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired. We investigate the number of years an “average” person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n=20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50. Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy. Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes. %B The Journals of Gerontology: Series B %V 76 %P 944-955 %@ 1079-5014 %G eng %N 5 %R 10.1093/geronb/gbaa166 %0 Journal Article %J Journal of Alzheimer's Disease %D 2021 %T Depression as a Mediator of the Association Between Wealth Status and Risk of Cognitive Impairment and Dementia: A Longitudinal Population-Based Cohort Study. %A Zhou, Rui %A Liu, Hua-Min %A Li, Fu-Rong %A Yang, Hai-Lian %A Zheng, Jia-Zhen %A Zou, Meng-Chen %A Zou, Lian-Wu %A Wu, Xiao-Xiang %A Wu, Xian-Bo %K cognitive impairment %K Dementia %K depression %K mediation analysis %K wealth status %X

BACKGROUND: Wealth and income are potential modifiable risk factors for dementia, but whether wealth status, which is composed of a combination of debt and poverty, and assessed by wealth and income, is associated with cognitive impairment among elderly adults remains unknown.

OBJECTIVE: To examine the associations of different combinations of debt and poverty with the incidence of dementia and cognitive impairment without dementia (CIND) and to evaluate the mediating role of depression in these relationships.

METHODS: We included 15,565 participants aged 51 years or older from the Health and Retirement Study (1992-2012) who were free of CIND and dementia at baseline. Dementia and CIND were assessed using either the modified Telephone Interview for Cognitive Status (mTICS) or a proxy assessment. Cox models with time-dependent covariates and mediation analysis were used.

RESULTS: During a median of 14.4 years of follow-up, 4,484 participants experienced CIND and 1,774 were diagnosed with dementia. Both debt and poverty were independently associated with increased dementia and CIND risks, and the risks were augmented when both debt and poverty were present together (the hazard ratios [95% confidence intervals] were 1.35 [1.08-1.70] and 1.96 [1.48-2.60] for CIND and dementia, respectively). The associations between different wealth statuses and cognition were partially (mediation ratio range: 11.8-29.7%) mediated by depression.

CONCLUSION: Debt and poverty were associated with an increased risk of dementia and CIND, and these associations were partially mediated by depression. Alleviating poverty and debt may be effective for improving mental health and therefore curbing the risk of cognitive impairment and dementia.

%B Journal of Alzheimer's Disease %V 80 %P 1591-1601 %G eng %N 4 %R 10.3233/JAD-201239 %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 Journal of General Internal Medicine %D 2021 %T Development, Validation, and Performance of a New Physical Functioning–Weighted Multimorbidity Index for Use in Administrative Data %A Melissa Y Wei %A Jamie E Luster %A Ratz, David %A Kenneth J Mukamal %A Kenneth M. Langa %K Medicaid %K Medicare %K multimorbidity index %K physical functioning %B Journal of General Internal Medicine %V 36 %P 2427–2433 %G eng %R 10.1007/s11606-020-06486-7 %0 Journal Article %J Journal of General Internal Medicine %D 2021 %T Development, Validation, and Performance of a New Physical Functioning-Weighted Multimorbidity Index for Use in Administrative Data. %A Wei, Melissa Y %A Luster, Jamie E %A Ratz, David %A Mukamal, Kenneth J %A Kenneth M. Langa %K Activities of Daily Living %K multimorbidity %B Journal of General Internal Medicine %V 36 %P 2427-2433 %G eng %N 8 %R 10.1007/s11606-020-06486-7 %0 Journal Article %J Preventive Medicine %D 2021 %T Dietary quality modifies the association between multimorbidity and change in mobility limitations among older Americans. %A Nicholas J Bishop %A Sarah Ullevig %A Wang, Kaipeng %A Krystle E Zuniga %K diet quality %K Health care and nutrition study %K Mobility limitations %K multimorbidity %X

To identify potentially modifiable risk-factors in the age-related disablement process, we examined the association between change in mobility limitations and multimorbidity and how dietary quality moderates this association. Information from 3320 adults aged 65 and older in 2012 was drawn from the Health and Retirement Study and the Health Care and Nutrition Study. Mobility limitations reported in 2012 and change in mobility limitations from 2012 to 2014 were regressed on multimorbidity measured as number of chronic conditions in 2012, dietary quality measured in 2013 using the Alternative Healthy Eating Index-2010 (AHEI-2010), and their interaction term using Poisson regression. Respondents reported an average of 2.9 (SD, 2.9) mobility limitations in 2012 and 3.1 (SD, 3.0) mobility limitations in 2014, an average of 2.64 (SD, 1.4) chronic conditions in 2012, and mean AHEI-2010 score in 2013 of 57.1 (SD, 10.9). Greater AHEI-2010 scores were associated with fewer mobility limitations at baseline (p < .001) and slower progression of mobility limitations over the two-year observational window (p < .001). For those with AHEI-2010 scores ≥48.4, dietary quality appeared to moderate the association between multimorbidity and change in mobility limitations. These results suggest that improving dietary quality may be an effective means of reducing the progression of mobility limitations among older adults and that dietary quality may modify the effect of multimorbidity on progressive disablement. Our work adds to research supporting dietary quality as a potentially intervenable factor in the reduction of disablement in aging populations.

%B Preventive Medicine %V 153 %P 106721 %G eng %R 10.1016/j.ypmed.2021.106721 %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 The Journal of Retirement %D 2021 %T Do Households Increase Their Savings When the Kids Leave Home? %A Irena Dushi %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %A Anthony Webb %A Anqi Chen %K children %K consumption %K Households %K Savings %X Much of the disagreement over whether households are adequately prepared for retirement reflects differences in assumptions regarding the extent to which consumption declines when the kids leave home. If consumption declines substantially when the kids leave home, as some life-cycle models of retirement saving assume, households need to achieve lower replacement rates in retirement and need to accumulate less wealth. Using administrative tax data from the Health and Retirement Study (HRS), as well as the Survey of Income and Program Participation (SIPP), this article investigates whether household consumption declines when kids leave the home and, if so, by how much. Because consumption data are noisy and savings is the flip side of consumption, this article examines whether savings in 401(k) plans increase when the kids leave home. The article also investigates alternative methods of saving, including non-401(k) savings and increased mortgage payments. %B The Journal of Retirement %V 9 %P 21-35 %G eng %N 2 %R https://doi.org/10.3905/jor.2021.1.091 %0 Journal Article %J Stroke %D 2021 %T Dose-Response Relationship Between Long-Term Blood Pressure Variability and Cognitive Decline. %A Li, Chenglong %A Ma, Yanjun %A Hua, Rong %A Yang, Zhenchun %A Zhong, Baoliang %A Wang, Hongyu %A Xie, Wuxiang %K Blood pressure %K Cognitive decline %K ELSA %K Hypertension %K Retirement %X

BACKGROUND AND PURPOSE: We aimed to test whether higher long-term blood pressure variability was associated with accelerated rate of cognitive decline and evaluate potential dose-response relationship.

METHODS: Original survey data from the Health and Retirement Study and the English Longitudinal Study of Ageing were used. Standardized score of cognitive function was the main outcome measure. Visit-to-visit blood pressure SD, coefficient of variation, and variation independent of mean were used. Linear mixed model and restricted spline were applied to assess association and explore dose-response pattern. Segmented regression was used to analyze dose-response relationship and estimate turning point. Meta-analysis using random-effects model was conducted to pool results, with used to test heterogeneity.

RESULTS: A total of 12 298 dementia-free participants were included (mean age: 64.6±8.6 years). Significant association was observed between blood pressure variability and cognitive decline. Each 10% increment in coefficient of variation of systolic and diastolic blood pressure was associated with accelerated global cognitive decline of 0.026 SD/y (95% CI, 0.016-0.036, 0.001) and 0.022 SD/y (95% CI, 0.017-0.027, 0.001), respectively. Nonlinear dose-response relationship was found (0.001 for nonlinearity), with clear turning point observed (0.001 for change in slopes).

CONCLUSIONS: Higher long-term blood pressure variability was associated with accelerated cognitive decline among general adults aged ≥50 years, with nonlinear dose-response relationship. Further randomized controlled trials are warranted to evaluate potential benefits of blood pressure variability-lowering strategies from a cognitive health perspective.

%B Stroke %V 52 %P 3249–3257 %G eng %N 10 %R 10.1161/STROKEAHA.120.033697 %0 Journal Article %J Frontiers in Psychiatry %D 2021 %T Early Life Experiences Moderate the Relationship Between Genetic Risk of Autism and Current and Lifetime Mental Health. %A Su Hyun Shin %A Wright, Cheryl %A Johnston, Susan %K autism genetics %K early life experience %K mother relationship %K police encounters %K psychiatric problem %X

Although individuals with autism are at greater risk of mental health challenges than others, we know little about the relationship between the mental health of older adults (50+) and autism because they are less likely to be diagnosed. Identifying the risk and protective factors that are associated with mental health can increase educational awareness, inform clinical practice, and provide information to help diagnose and treat older adults with autism. This study used longitudinal panel data of the 2008-2016 waves of the Health and Retirement Study. It estimated individual random-effect models by interacting a genetic propensity toward autism and early life experiences to test whether the latter has a moderating effect on the relationships between genetics and the Center for Epidemiologic Studies Depression (CES-D) score, self-reported depression, and history of psychiatric problems. Results suggest that individuals with a higher genetic propensity for autism are less likely to develop psychiatric problems if they report a positive maternal relationship early in life. Further, a combined effect of police encounters early in life and genetic risk for autism is associated with higher CES-D scores, increased odds of self-reported depression, and a history of psychiatric problems. Clinical applications of these findings include the need to establish and support high-quality relationships by addressing both child and caregiver needs. Further, these findings support the need to design and implement proactive interventions to teach police and autistic individuals how to successfully navigate these encounters.

%B Frontiers in Psychiatry %V 12 %P 772841 %G eng %R 10.3389/fpsyt.2021.772841 %0 Journal Article %J Journal of Alzheimer's Disease %D 2021 %T Education Differences in the Adverse Impact of PM2.5 on Incident Cognitive Impairment Among U.S. Older Adults. %A Jennifer A Ailshire %A Katrina M Walsemann %K Aging %K Air Pollution %K Cognition %K Dementia %K Education %K Modifiable risk factors %X

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

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

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

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

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

%B Journal of Alzheimer's Disease %V 79 %P 615-625 %G eng %N 2 %R 10.3233/JAD-200765 %0 Journal Article %J The Gerontologist %D 2021 %T Educational Benefits and Cognitive Health Life Expectancies: Racial/Ethnic, Nativity, and Gender Disparities %A Marc Garcia %A Brian Downer %A Chi-Tsun Chiu %A Joseph L Saenz %A Ortiz, Kasim %A Rebeca Wong %K cognitive impairment %K Dementia %K Life Expectancy %K nativity %K Race/ethnicity %X To examine racial/ethnic, nativity, and gender differences in the benefits of educational attainment on cognitive life expectancies among older adults in the United States.We used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively healthy, cognitively impaired/no dementia (CIND), and dementia life expectancies by gender for older White, Black, U.S.-born and foreign-born Hispanic adults with less than high school, high school, and some college or more.White respondents lived a greater percentage of their remaining lives cognitive healthy than their minority Black or Hispanic counterparts, regardless of level of education. Among respondents with some college or more, versus less than high school, Black and U.S.-born Hispanic women exhibited the greatest increase (both 37 percentage points higher) in the proportion of total life expectancy spent cognitively healthy; whereas White women had the smallest increase (17 percentage points higher). For men, the difference between respondents with some college or more, versus less than high school, was greatest for Black men (35 percentage points higher) and was lowest for U.S.-born Hispanic men (21 percentage points higher).Our results provide evidence that the benefits of education on cognitive life expectancies are largest for Black men and women, and U.S.-born Hispanic women. The combination of extended longevity and rising prevalence of Alzheimer’s disease point to the need for understanding why certain individuals spend an extended period of their lives with poor cognitive health. %B The Gerontologist %V 61 %P 330-340 %@ 0016-9013 %G eng %N 3 %R 10.1093/geront/gnaa112 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T The Effect of Childhood Socioeconomic Position and Social Mobility on Cognitive Function and Change Among Older Adults: A Comparison Between the United States and England. %A Jessica Faul %A Erin B Ware %A Mohammed U Kabeto %A Fisher, Jonah %A Kenneth M. Langa %K Cognition %K Cross-national comparison %K Early origins of health %K Education %K ELSA %K Life course analysis %X

OBJECTIVES: This study aims to examine the relationship between childhood socioeconomic position (SEP) and cognitive function in later life within nationally representative samples of older adults in the United States and England, investigate whether these effects are mediated by later-life SEP, and determine whether social mobility from childhood to adulthood affects cognitive function and decline.

METHOD: Using data from the Health and Retirement Study (HRS) and the English Longitudinal Survey of Ageing (ELSA), we examined the relationships between measures of SEP, cognitive performance and decline using individual growth curve models.

RESULTS: High childhood SEP was associated with higher cognitive performance at baseline in both cohorts and did not affect the rate of decline. This benefit dissipated after adjusting for education and adult wealth in the United States. Respondents with low childhood SEP, above median education, and high adult SEP had better cognitive performance at baseline than respondents with a similar childhood background and less upward mobility in both countries.

DISCUSSION: These findings emphasize the impact of childhood SEP on cognitive trajectories among older adults. Upward mobility may partially compensate for disadvantage early in life but does not protect against cognitive decline.

%B The Journals of Gerontology: Series B %V 76 %P S51-S63 %G eng %N Supplement_1 %R 10.1093/geronb/gbaa138 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T The effect of diabetes on the cognitive trajectory of older adults in Mexico and the U.S %A Jaqueline C Avila %A Mejia Arango, Silvia %A Jupiter, Daniel %A Brian Downer %A Rebeca Wong %K cognitive aging %K Cross-cultural study %K Longitudinal methods %K MHAS %X To study the impact of diabetes on the long-term cognitive trajectories of older adults in two countries with different socioeconomic and health settings, and to determine if this relationship differs by cognitive domains. This study uses Mexico and the United States to confirm if patterns hold in both populations, as these countries have similar diabetes prevalence but different socioeconomic conditions and diabetes-related mortality.Two nationally representative cohorts of adults aged 50 years or older are used: the Mexican Health and Aging Study for Mexico, and the Health and Retirement Study for the U.S., with sample sizes of 18, 810 and 26, 244 individuals, respectively, followed over 14 years. The outcome is cognition measured as a total composite score, and by domain (memory and non-memory). Mixed-effect linear models are used to test the effect of diabetes on cognition at 65 years old and over time in each country.Diabetes is associated with lower cognition and non-memory scores at baseline and over time in both countries. In Mexico, diabetes only predicts lower memory scores over time, while in the U.S. it only predicts lower memory scores at baseline. Women have higher total cognition and memory scores than men in both studies. The magnitude of the effect of diabetes on cognition is similar in both countries.Despite the overall lower cognition in Mexico and different socioeconomic characteristics, the impact of diabetes on cognitive decline and the main risk and protective factors for poor cognition are similar in both countries. %B The Journals of Gerontology: Series B %V 76 %P e153-e164 %@ 1079-5014 %G eng %N 4 %R 10.1093/geronb/gbaa094 %0 Journal Article %J 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 Journal of Pain and Symptom Management %D 2021 %T End-of-Life Planning Depends on Socio-Economic and Racial Background: Evidence from the US Health and Retirement Study (HRS). %A Martina Orlovic %A Warraich, Haider %A Douglas A. Wolf %A Elias Mossialos %K Advance care planning %K end-of-life %K End-of-life planning %K Living will %X

CONTEXT: Americans express a strong preference for participating in decisions regarding their medical care, yet they are often unable to participate in decision-making regarding their end-of-life care.

OBJECTIVE: To examine determinants of end-of-life planning; including, the effect of an individual's ageing and dying process, health status and socio-economic and racial/ethnic background.

METHODS: US observational cohort study, using data from the Health and Retirement Study (1992 - 2014) including 37,494 individuals. Random-effects logistic regression analysis was used to examine the relationship between the presence of a living will and a range of individual time-varying characteristics, including time to death, and several time-invariant characteristics.

RESULTS: End-of-life planning depends on several patient characteristics and circumstances, with socio-economic and racial/ethnic background having the largest effects. The probability of having a living will rises sharply late in life, as we would expect, and is further modified by the patient's proximity to death. The dying process, exerts a stronger influence on end-of-life planning than does the aging.

CONCLUSIONS: Understanding differences that increase end-of-life planning is important to incentivize patients' participation. Advance planning should be encouraged and accessible to people of all ages as it is inevitable for the provision of patient-centered and cost-effective care.

%B Journal of Pain and Symptom Management %V 62 %P 1198-1206 %G eng %N 6 %R 10.1016/j.jpainsymman.2021.05.018 %0 Journal Article %J Journal of the American Geriatrics Society %D 2021 %T The epidemiology of social isolation and loneliness among older adults during the last years of life. %A Ashwin A Kotwal %A Irena Cenzer %A Linda J. Waite %A Kenneth E Covinsky %A Perissinotto, Carla M %A W John Boscardin %A Louise C Hawkley %A Dale, William %A Smith, Alexander K %K Cognition %K end of life %K Loneliness %K Palliative care %K social isolation %X

BACKGROUND: Social isolation and loneliness are critical to the health of older adults, but they have not been well-described at the end of life.

OBJECTIVES: To determine the prevalence and correlates of social isolation and loneliness among older adults in the last years of life.

DESIGN: Nationally representative, cross-sectional survey.

SETTING: Health and Retirement Study, 2006-2016 data.

PARTICIPANTS: Adults age > 50 interviewed once in the last 4 years of life (n = 3613).

MEASUREMENTS: We defined social isolation using a 15-item scale measuring household contacts, social network interaction, and community engagement, and frequent loneliness using the 3-item UCLA Loneliness Scale. We used multivariable logistic regression to determine their adjusted prevalence by time prior-to-death and by subgroups of interest.

RESULTS: Approximately 19% experienced social isolation, 18% loneliness, and 5% both in the last 4 years of life (correlation = 0.11). The adjusted prevalence of social isolation was higher for individuals nearer to death (4 years: 18% vs 0-3 months: 27%, p = 0.05) and there was no significant change in loneliness (4 years: 19% vs 0-3 months: 23%, p = 0.13). Risk factors for both isolation and loneliness included (p < 0.01): low net-worth (Isolation: 34% vs 14%; Loneliness: 29% vs 13%), hearing impairment (Isolation: 26% vs 20%; Loneliness: 26% vs 17%), and difficulty preparing meals (Isolation: 27% vs 19%; Loneliness: 29% vs 15%). Factors associated with loneliness, but not social isolation, included being female, pain, incontinence, and cognitive impairment.

CONCLUSIONS: Social isolation and loneliness are common at the end of life, affecting 1 in 4 older adults, but few experience both. Rates were higher for older adults who were poor and experienced functional or sensory impairments. Results can inform clinical efforts to identify and address end-of-life psychosocial suffering and health policies which prioritize social needs at the end of life.

%B Journal of the American Geriatrics Society %V 69 %P 3081-3091 %G eng %N 11 %R 10.1111/jgs.17366 %0 Thesis %B Economics %D 2021 %T ESSAYS ON MEDICARE PART D MARKET: SOURCES OF WELFARE EFFECTS AND MERGER AND ACQUISITION EFFECTS %A Wang, Yichuan %K health outcomes %K Medicare Part D %K Out-of-pocket medical expenses %K prescription drugs %X This dissertation contains three essays on the Medicare Part D market in the United States. Three chapters account the benefit of Medicare Part D, analyze how merger and acquisition affect insurance plan’s characteristics and how merger and acquisition affect senior’s health outcomes. The first chapter studies the benefits of Medicare Part D. The Medicare prescription drug program (Part D) launched in 2006. Since then, the stand-alone prescription drug plans (PDPs) available to consumers and their plan characteristics have been evolving. This paper examines how those evolutions affect consumer surplus of Medicare beneficiaries. We estimate a structural demand model of stand-alone PDPs for Medicare beneficiaries using plan level data across 34 markets defined by Centers for Medicare and Medicaid Services (CMS) from 2008 to 2017. Encouragingly, consumer surplus increases over time because there are more enhanced plans available in the market over time despite the total number of plans available reduces over time. Nonetheless, such effect of consumer surplus is unevenly distribution across markets because the evolutions of plan availability and characteristics vary across markets. The second chapter examines the effects of mergers and acquisitions (M&A) on Part D prescription drug plans(PDPs). The Medicare prescription drug program (Part D) launched in 2006. Since then, there has been a series of M&A among the parent companies providing the PDPs, which concentrates the Medicare Part D market. This paper applies a differences-in-differences model to a plan-level dataset from 2007 to 2019 to estimate the effects of M&A on plan’s premium, characteristics, and market shares. We find that, on average, those M&A increases premium and deteriorates plan quality but increases market share. Such effects are stronger in the Medicare region that the merging insurers are serving together and in the mergers among publicly traded (potentially larger) insurers but less in insurers are consolidating their plans. The chapter 3 studies the effects of M&A on individual’s health outcomes. Given the previous chapter reports that M&A among the parent companies providing the PDPs increases premium and deteriorates plan quality, especially in the Medicare region that the merging insurers are serving together. This chapter matches the individual-level data from the 2008-2018 waves of RAND Health and Retirement Study (HRS) and the M&A and plan information from CMS Landscape, and examine the effects of those M&As on seniors’ Part D participation, out-of-pocket costs and prescription drug usage. We find that M&As increase the out-of-pocket (OOP) prescription drug costs for enrollees and reduces their drug usage. Our results are consistent with elderly shifts their plans with poorer coverage after the M&As and results in those poorer outcomes. %B Economics %I State University of New York at Albany %C Albany, NY %V Ph.D. %G eng %U https://www.proquest.com/docview/2569681798?pq-origsite=gscholar&fromopenview=true %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 The Journals of Gerontology: Series B %D 2021 %T Family caregiving and place of death: Insights from cross-national analysis of the Harmonized End of Life Data. %A Jennifer A Ailshire %A Osuna, Margarita %A Wilkens, Jenny %A Jinkook Lee %K Activities of Daily Living %K Aging %K Disability %K family caregivers %K Nursing homes %K SHARE %K spouse %K Terminally Ill %X

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

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

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

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

%B The Journals of Gerontology: Series B %V 76 %P S76-S85 %G eng %N Supplement_1 %R 10.1093/geronb/gbaa225 %0 Journal Article %J The Journals of Gerontology, Series A %D 2021 %T Feature selection algorithms enhance the accuracy of frailty indexes as measures of biological age. %A Kim, Sangkyu %A Fuselier, Jessica %A Welsh, David A %A Cherry, Katie E %A Myers, Leann %A Jazwinski, S Michal %K Biological age %K DNA Methylation %K frailty index %K Mortality %X

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

%B The Journals of Gerontology, Series A %V 76 %P 1347-1355 %G eng %N 8 %R 10.1093/gerona/glab018 %0 Report %D 2021 %T Finding Needles in Haystacks: Multiple-Imputation Record Linkage Using Machine Learning %A Abowd, John M. %A Abramowitz, Joelle %A Levenstein, Margaret C. %A McCue, Kristin %A Patiki, Dhiren %A Trivellore E. Raghunathan %A Rodgers, Ann %A Matthew D. Shapiro %A Wasi, Nada %A Zinsser, Dawn %K Machine learning %K record linkage %X This paper considers the problem of record linkage between a household-level survey and an establishment-level frame in the absence of unique identifiers. Linkage between frames in this setting is challenging because the distribution of employment across establishments is highly skewed. To address these difficulties, this paper develops a probabilistic record linkage methodology that combines machine learning (ML) with multiple imputation (MI). This ML-MI methodology is applied to link survey respondents in the Health and Retirement Study to their workplaces in the Census Business Register. The linked data reveal new evidence that non sampling errors in household survey data are correlated with respondents’ workplace characteristics. %B Working Paper %I United State Census Bureau %G eng %U https://www.census.gov/library/working-papers/2021/adrm/CES-WP-21-35.html %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Gateway to Global Aging Data: Resources for Cross-National Comparisons of Family, Social Environment, and Healthy Aging. %A Lee, Jinkook %A Drystan F. Phillips %A Wilkens, Jenny %K Cross-Country %K Gateway to Global Aging %K social network %X

OBJECTIVES: The Gateway to Global Aging Data (Gateway; g2aging.org) is a data and information platform developed to facilitate cross-country analyses on aging, especially those using the international family of Health and Retirement studies. We provide a brief introduction to the Gateway to Global Aging Data, discussing its potential for cross-national comparisons of family, social environment, and healthy aging.

METHODS: We summarize the survey metadata, study characteristics, and harmonized data available from the Gateway, describing the population represented in each study. We portray cohort characteristics and key measures of health and social environment from 37 countries in North America, Europe, and Asia using harmonized data.

RESULTS: Significant cross-country heterogeneity was observed in many measures of family, social environment, and healthy aging indicators. For example, there was a three-fold difference in co-residence with children, ranging from 14% in Sweden to over 46% in Spain and Korea in 2014. From 2002-2014, the difference between informal care receipt in individuals of low and high wealth decreased by 6% in the US and remained unchanged in England. The percentage of individuals aged 50-59 living alone in 2012 varied fifteen-fold, from a low of 2% in China to a high of 30% in Mexico.

DISCUSSION: By partnering with nationally representative studies around the globe, the Gateway to Global Aging Data facilitates comparative research on aging through the provision of easy-to-use harmonized data files and other valuable tools.

%B The Journals of Gerontology: Series B %V 76 %P S5-S16 %G eng %N Supplement_1 %R 10.1093/geronb/gbab050 %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 Book Section %B Handbook of Aging and the Social Sciences (Ninth Edition)Handbooks of Aging %D 2021 %T Genomic data measures and methods: a primer for social scientists %A Erin B Ware %A Jessica Faul %E Kenneth F Ferraro %E Deborah Carr %K epigenetics %K Genetics %K Genomics %K Telomeres %X Recent advances in the field of genetics have produced a multitude of genomic data, which researchers are integrating increasingly into social science research. In this chapter, we discuss types of genomic data arising from the technological advances in the field of genetics including genome-wide variant data, DNA methylation, and telomere length. We outline several statistical genetics methodologies used to assess relationships between genomics and specific outcome such as genome-wide association studies, gene-region based tests, epigenetic aging clocks, and pathway enrichment tests. We highlight important social, epidemiological, and statistical considerations for incorporating genomics in the field of aging. Finally, we discuss what is on the horizon for aging, social science, and genomics. %B Handbook of Aging and the Social Sciences (Ninth Edition)Handbooks of Aging %I Academic Press %P 49-62 %@ 978-0-12-815970-5 %G eng %& 4 %R https://doi.org/10.1016/B978-0-12-815970-5.00004-8 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Hearing Impairment and Mental Health Among Married Couples %A Jessica S West %K Couples %K hearing %K Mental Health %X Disablement is a significant health problem and chronic stressor for older adults and is associated with negative mental health outcomes. Although some research has explored how disability extends beyond individuals to influence the mental health of their support networks, less population-based research has assessed the consequences of hearing impairment, a growing public health concern that affects 72.4\% of people aged 65 and older. Moreover, although much research has examined the negative individual impact of hearing impairment, less population-based research has assessed its consequences on spouses. To fill this gap, the current study builds on gender, marriage, and stress proliferation research to examine 1) the association between own hearing impairment and spouses’ depressive symptoms, and 2) whether this association varies by the gender of the spouse.Fixed-effects regression models were conducted using data from 5,485 couples (10,970 individuals) from 10 waves of the Health and Retirement Study (1998-2016).Wives’ fair or poor hearing is significantly associated with an increase in husbands’ depressive symptoms, net of controls. However, husbands’ fair or poor hearing is not associated with an increase in wives’ depressive symptoms.These findings suggest that hearing impairment can proliferate from one spouse to the other, but that this proliferation depends on gender. Health care providers need to be aware of the implications for husbands when treating women with hearing impairment. %B The Journals of Gerontology: Series B %V 76 %P 933-943 %G eng %N 5 %R 10.1093/geronb/gbaa023 %0 Journal Article %J Review of Economics of the Household %D 2021 %T Hire or care: the effects of aging parents on household labor supply %A Wang, Jue (Jessie) %K Elder care %K Household decisions %K Labor Supply %X This paper analyzes how aging parents’ health conditions affect household labor supply. I propose a time-use model with wage heterogeneity and assume that care responsibilities involve both time and budget constraints. When households can purchase care services, differences in secondary earners’ wages and care requirements lead to heterogeneity in household responses to a parental health shock. Primary earners and high-wage secondary earners work more. I confirm the model’s predictions by using panel data from the Health and Retirement Study to construct an exogenous shock from the change in parents’ health conditions and estimate its impact on labor supply. %B Review of Economics of the Household %@ 1573-7152 %G eng %R 10.1007/s11150-021-09571-w %0 Journal Article %J Journal of Pension Economics and Finance %D 2021 %T How do older workers use nontraditional jobs? %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %A Abigail N. Walters %K Alternative work %K employer benefits %K nontraditional jobs %K Older workers %K retirement security %K Sequence analysis %X Working consistently through one's early 60s is key to retirement security. However, workers without access to retirement plans and health insurance will likely struggle to achieve such security. This paper uses the Health and Retirement Study to identify nontraditional jobs – which lack these benefits – and applies sequence analysis to explore how workers aged 50–62 use them. The results suggest that most nontraditional jobs are used by workers consistently, and that fewer workers use these jobs briefly or as a bridge to retirement. Workers consistently in nontraditional jobs end up with less retirement income and are more likely to be depressed. %B Journal of Pension Economics and Finance %V 20 %P 374–392 %G eng %N 3 %R 10.1017/S1474747220000086 %0 Journal Article %J Ear and Hearing %D 2021 %T Impact of Hearing Aid Use on Falls and Falls-Related Injury: Results From the Health and Retirement Study. %A Riska, Kristal M %A Peskoe, Sarah B %A Kuchibhatla, Maragatha %A Gordee, Alexander %A Pavon, Juliessa M %A Kim, Se Eun %A Jessica S West %A Smith, Sherri L %K Fall injury %K Falls %K Hearing aids %X

OBJECTIVES: Falls are considered a significant public health issue and falls risk increases with age. There are many age-related physiologic changes that occur that increase postural instability and the risk for falls (i.e., age-related sensory declines in vision, vestibular, somatosensation, age-related orthopedic changes, and polypharmacy). Hearing loss has been shown to be an independent risk factor for falls. The primary objective of this study was to determine if hearing aid use modified (reduced) the association between self-reported hearing status and falls or falls-related injury. We hypothesized that hearing aid use would reduce the impact of hearing loss on the odds of falling and falls-related injury. If hearing aid users have reduced odds of falling compared with nonhearing aid users, then that would have an important implications for falls prevention healthcare.

DESIGN: Data were drawn from the 2004-2016 surveys of the Health and Retirement Study (HRS). A generalized estimating equation approach was used to fit logistic regression models to determine whether or not hearing aid use modifies the odds of falling and falls injury associated with self-reported hearing status.

RESULTS: A total of 17,923 individuals were grouped based on a self-reported history of falls. Self-reported hearing status was significantly associated with odds of falling and with falls-related injury when controlling for demographic factors and important health characteristics. Hearing aid use was included as an interaction in the fully-adjusted models and the results showed that there was no difference in the association between hearing aid users and nonusers for either falls or falls-related injury.

CONCLUSIONS: The results of the present study show that when examining self-reported hearing status in a longitudinal sample, hearing aid use does not impact the association between self-reported hearing status and the odds of falls or falls-related injury.

%B Ear and Hearing %V 43 %P 487-494 %G eng %N 2 %R 10.1097/AUD.0000000000001111 %0 Journal Article %J The Journals of Gerontology: Series A %D 2021 %T The Importance of Engaging in Physical Activity in Older Adulthood for Transitions between Cognitive Status Categories and Death: A Coordinated Analysis of Fourteen Longitudinal Studies. %A Yoneda, Tomiko %A Nathan A Lewis %A Knight, Jamie E %A Rush, Jonathan %A Vendittelli, Rebecca %A Kleineidam, Luca %A Hyun, Jinshil %A Andrea M Piccinin %A Scott M Hofer %A Emiel O Hoogendijk %A Derby, Carol A %A Scherer, Martin %A Steffi G Riedel-Heller %A Wagner, Michael %A van den Hout, Ardo %A Wang, Wenyu %A David A Bennett %A Muniz-Terrera, Graciela %K cognitive aging %K Exercise %K Longevity %K Successful aging %X

BACKGROUND: Given increasing incidence of cognitive impairment and dementia, further understanding of modifiable factors contributing to increased healthspan is crucial. Extensive literature provides evidence that physical activity (PA) delays the onset of cognitive impairment; however, it is unclear whether engaging in PA in older adulthood is sufficient to influence progression through cognitive status categories.

METHODS: Applying a coordinated analysis approach, this project independently analyzed fourteen longitudinal studies (NTotal = 52,039; mean baseline age across studies= 69.9-81.73) from North America and Europe using multi-state survival models to estimate the impact of engaging in PA on cognitive status transitions (non-impaired, mildly impaired, severely impaired) and death. Multinomial regression models were fit to estimate life expectancy (LE) based on American PA recommendations. Meta-analyses provided the pooled effect sizes for the role of PA on each transition and estimated LEs.

RESULTS: Controlling for baseline age, sex, education and chronic conditions, analyses revealed that more PA is significantly associated with decreased risk of transitioning from non-impaired to mildly impaired cognitive functioning and death, as well as substantially longer LE. Results also provided evidence for a protective effect of PA after onset of cognitive impairment (e.g., decreased risk of transitioning from mild to severe cognitive impairment; increased likelihood of transitioning backward from severe to mild cognitive impairment), though between-study heterogeneity suggests a less robust association.

CONCLUSIONS: These results yield evidence for the importance of engaging in PA in older adulthood for cognitive health, and a rationale for motivating older adults to engage consistently in PA.

%B The Journals of Gerontology: Series A %V 76 %P 1661-1667 %G eng %N 9 %R 10.1093/gerona/glaa268 %0 Journal Article %J Sleep Medicine %D 2021 %T Insomnia as a predictor of diagnosed memory problems: 2006-2016 Health and Retirement Study %A Beydoun, Hind A. %A Beydoun, May A. %A Weiss, Jordan %A Hossain, Sharmin %A Huang, Shuyan %A Alemu, Brook T. %A Alan B Zonderman %K Aging %K Alzheimer’s disease %K Dementia %K insomnia %K Neurodegenerative %K Sleep %X ObjectiveTo evaluate the longitudinal relationship in insomnia symptoms over time with incident memory problems and dementia diagnoses among U.S. adults aged 65 years and older.MethodsSecondary analyses were performed on 9,518 elderly participants (≥65 years) who completed the 2006 wave of the Health and Retirement Study (HRS) and were followed-up to determine if insomnia symptom scores (2006-2014) were associated with time-to-onset of [1] physician-diagnosed “memory-related disease”, “Alzheimer’s disease” and/or “dementia, senility or any other serious memory impairment” and [2] diagnosis of dementia based on HRS-specific criteria. Cox proportional hazards models were constructed adjusting for socio-demographic, lifestyle, and health characteristics.ResultsIn fully adjusted models, severe insomnia symptoms were associated with increased risk of physician-diagnosed memory problems. Individuals reporting any change (increase or decrease) in insomnia symptoms during the 2006-2010 period were more likely to be diagnosed with dementia based on HRS criteria. Finally, those who experienced an increase in the severity of insomnia symptoms over time exhibited 41-72% increased risks of physician-diagnosed memory problems and 45-58% increased risks of dementia diagnosis based on HRS criteria.ConclusionsWhen severe insomnia symptoms increased over time, physician-diagnosed memory problems and dementia diagnoses also increased among U.S. elderly people over a 10-year follow-up period. More studies are required to confirm these findings using large prospective cohort designs and validated tools. %B Sleep Medicine %V 80 %P 158-166 %@ 1389-9457 %G eng %R 10.1016/j.sleep.2021.01.038 %0 Journal Article %J European Heart Journal %D 2021 %T Insomnia symptoms and incident heart failure: a population-based cohort study. %A Mahmood, Asos %A Ray, Meredith %A Dobalian, Aram %A Kenneth D. Ward %A Ahn, SangNam %K Heart Failure %K insomnia symptoms %K Marginal structural models %K risk factor %K Sleep disturbance %X

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

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

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

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

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

%B Mechanisms of Ageing and Development %V 196 %P 111477 %G eng %R 10.1016/j.mad.2021.111477 %0 Journal Article %J Journal of the American Medical Directors Association %D 2021 %T Longitudinal Assessment of the Relationships Between Geriatric Conditions and Loneliness. %A Yu, Kexin %A Wu, Shinyi %A Yuri Jang %A Chou, Chih-Ping %A Kathleen H. Wilber %A Aranda, María P %A Iris Chi %K fall %K geriatric syndrome %K Longitudinal analysis %K random intercept cross-lagged panel model %K Reciprocal relationships %X

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

DESIGN: Longitudinal panel study.

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

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

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

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

%B Journal of the American Medical Directors Association %V 22 %P 1107-1113.e1 %G eng %N 5 %R 10.1016/j.jamda.2020.09.002 %0 Journal Article %J Journal of the American Geriatrics Society %D 2021 %T Longitudinal Association Between Hearing Loss, Vision Loss, Dual Sensory Loss, and Cognitive Decline. %A Ge, Shaoqing %A McConnell, Eleanor S %A Bei Wu %A Pan, Wei %A Dong, XinQi %A Brenda L Plassman %K ADAMS %K Cognitive decline %K Dementia %K Hearing loss %K longitudinal %K vision loss %X

BACKGROUND/OBJECTIVES: To better understand the role of sensory loss as a potentially modifiable risk factor for cognitive decline, this study examined cognitive decline in relation to single modality hearing or vision loss and dual sensory loss.

DESIGN: Longitudinal secondary data analysis.

SETTING: The Health and Retirement Study (HRS) and its supplement: The Aging, Demographics, and Memory Study (ADAMS).

PARTICIPANTS: Individuals aged 73 and older (N = 295).

MEASUREMENTS: Hearing loss was defined by an inability to hear sounds of 25 dB at frequencies between 0.5 and 4.0 kHz in either ear. Vision loss was defined as having corrected binocular vision worse than 20/40. Dual sensory loss was defined as having both hearing and vision loss. We used one time point of hearing and vision data objectively measured in ADAMS Wave C (June 2006-May 2008) and five waves of cognitive function data measured by the HRS version of the Telephone Interview for Cognitive Status in HRS (2006-2014). Multilevel mixed models were used.

RESULTS: Among the participants, 271 completed a hearing assessment and 120 had hearing loss; 292 completed a vision assessment and 115 had vision loss; 52 had dual sensory loss. Older adults with hearing loss had a significantly faster rate of cognitive decline as they aged compared to those with normal hearing (β = -0.16, P < .05). No significant association was found between vision loss and the rate of cognitive decline (β = -0.06, P = .41). Older adults who had dual sensory loss likewise had a significantly faster rate of cognitive decline as they age (β = -0.23, P < .05) compared to those with no sensory loss.

CONCLUSION: Older adults with hearing loss and dual sensory loss have faster rates of cognitive decline than those with normal sensory function.

%B Journal of the American Geriatrics Society %V 69 %P 644-650 %G eng %N 3 %R 10.1111/jgs.16933 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2021 %T Longitudinal associations between cancer history and cognitive functioning among older adults %A Kun Wang %A Leah P. Cheatham %A Alexander R. Marbut %A Xiayu Chen %K Cancer history %K Chemotherapy %K cognitive functioning %K Middle-old adults %K Mixed-effects modeling %X Objectives This study aimed to examine 1) whether cancer history accelerates older adults’ rates of cognitive decline over time and 2) whether chemotherapy increases older cancer patients’/ survivors’ rates of cognitive decline over time. Methods This longitudinal study drew a subsample of 8,811 adults aged 65 or older from Wave 6 of the Health and Retirement Study in 2002 and followed biannually until Wave 13 in 2016. Linear mixed-effects models were performed to test whether cancer history and chemotherapy were associated with accelerated rates of cognitive decline over time among older adults in different age groups. Results Middle-old adults (aged 75-84) with a cancer history had significantly reduced rates of cognitive decline over time, including the global measure of cognitive functioning (B= .16, p< .01), mental status (B= .08, p< .01), and episodic memory (B= .09, p< .05) compared to their counterparts without a cancer history. This effect was not significant for the youngest-old (aged 65-74) or oldest-old adults (aged 85 or older). Also, chemotherapy was not significantly associated with older cancer patients’/survivors’ cognitive functioning at baseline or over time in different age groups. Conclusions This study finds that cancer history and chemotherapy do not further exacerbate older adults’ cognitive functioning over time. On the contrary, cancer history shows a “protective” effect on middle-old adults’ cognitive functioning. This encouraging finding indicates that older adults can be more actively engaged in the decision-making of treatments and following care plans. Future mediation studies are needed to further investigate underlying mechanisms. %B Archives of Gerontology and Geriatrics %V 97 %P 104521 %G eng %R 10.1016/j.archger.2021.104521 %0 Journal Article %J 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 Quarterly Journal of Economics %D 2021 %T MEDICAID AND MORTALITY: NEW EVIDENCE FROM LINKED SURVEY AND ADMINISTRATIVE DATA %A Miller, Sarah %A Johnson, Norman %A Wherry, Laura R. %K administrative data %K Medicaid %K Mortality %X We use large-scale federal survey data linked to administrative death records to investigate the relationship between Medicaid enrollment and mortality. Our analysis compares changes in mortality for near-elderly adults in states with and without Affordable Care Act Medicaid expansions. We identify adults most likely to benefit using survey information on socioeconomic status, citizenship status, and public program participation. We find that prior to the ACA expansions, mortality rates across expansion and nonexpansion states trended similarly, but beginning in the first year of the policy, there were significant reductions in mortality in states that opted to expand relative to nonexpanders. Individuals in expansion states experienced a 0.132 percentage point decline in annual mortality, a 9.4% reduction over the sample mean, as a result of the Medicaid expansions. The effect is driven by a reduction in disease-related deaths and grows over time. A variety of alternative specifications, methods of inference, placebo tests, and sample definitions confirm our main result. %B Quarterly Journal of Economics %V 136 %P 1783–1829 %G eng %N 3 %R 10.1093/qje/qjab004 %0 Journal Article %J Frontiers in Neurology %D 2021 %T Mendelian Randomization of Dyslipidemia on Cognitive Impairment Among Older Americans %A Fu, Mingzhou %A Kelly M Bakulski %A Higgins, Cesar %A Erin B Ware %K blood cholesterol %K cognitive domain %K Dementia %K Mendelian randomization %K polygenic score %X Background: Altered lipid metabolism may be a risk factor for dementia, and blood cholesterol level has a strong genetic component. We tested the hypothesis that dyslipidemia (either low levels of high-density lipoprotein cholesterol (HDL-C) or high total cholesterol) is associated with cognitive status and domains, and assessed causality using genetic predisposition to dyslipidemia as an instrumental variable. Methods: Using data from European and African genetic ancestry participants in the Health and Retirement Study, we selected observations at the first non-missing biomarker assessment (waves 2006-2012). Cognition domains were assessed using episodic memory, mental status, and vocabulary tests. Overall cognitive status was categorized in three levels (normal, cognitive impairment non-dementia, dementia). Based on 2018 clinical guidelines, we compared low HDL-C or high total cholesterol to normal levels. Polygenic scores for dyslipidemia were used as instrumental variables in a Mendelian randomization framework. Multivariable logistic regressions and Wald-type ratio estimators were used to examine associations. Results: Among European ancestry participants (n = 8,781), at risk HDL-C levels were associated with higher odds of cognitive impairment (OR = 1.20, 95% CI: 1.03, 1.40) and worse episodic memory, specifically. Using cumulative genetic risk for HDL-C levels as a valid instrumental variable, a significant causal estimate was observed between at risk low HDL-C levels and higher odds of dementia (OR = 2.15, 95% CI: 1.16, 3.99). No significant associations were observed between total cholesterol levels and cognitive status. No significant associations were observed in the African ancestry sample (n = 2,101). Conclusion: Our study demonstrates low blood HDL-C is a potential causal risk factor for impaired cognition during aging in non-Hispanic whites of European ancestry. Dyslipidemia can be modified by changing diets, health behaviors, and therapeutic strategies, which can improve cognitive aging. Studies on low density lipoprotein cholesterol, the timing of cholesterol effects on cognition, and larger studies in non-European ancestries are needed. %B Frontiers in Neurology %V 12 %G eng %N 660212 %R 10.3389/fneur.2021.660212 %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 New Issues in Life Course Research: Which Early-Life Factors Matter for Late-Life Outcomes? %A Jacqui Smith %A Katrina M Walsemann %K late-life outcomes %K life course %X The increased availability of retrospective information about the lives of participants in population panel studies has expanded the range of precursors to include in life course research. However, this also challenges researchers to select among many potential precursors to a late-life outcome and to determine the relative role of factors from different periods in the life course. Each paper in this symposium uses life course information from the Health and Retirement Study (HRS) to examine different late-life outcomes. Speakers will discuss what guided the particular selection of factors and outcome to examine in their study. Sonnega, Helppie-McFall, and Lee focus on indicators of childhood financial and social adversity as potential predictors of early retirement due to poor health. Park, Larkina, and Smith ask if decisions taken in early adulthood about how to balance work-and family-life by individuals and their partners are related to the categories of important life accomplishments older adults report in their life review. Two papers examine precursors of late-life health outcomes. Williams-Farrelly and Smith identified different profiles of physical activity in early- and mid-adulthood. They discuss associations between these profiles and cognitive aging. Whereas social losses, relocation, and multimorbidity are well-documented precursors of Major Depression in old age, Bergmans and Smith asked if poor health in childhood played a distal role. The session concludes with an integrative discussion of issues by Walsemann. %B Innovation in Aging %V 5 %P 28 %G eng %N Suppl _1 %R https://doi.org/10.1093/geroni/igab046.101 %0 Journal Article %J Innovation in Aging %D 2021 %T Oral Health, Cognitive Function, and Mortality: Findings From National Surveys %A Bei Wu %A Keepper, Susie %A Saunders, Michele %K cognitive function %K Mortality %K Oral Health %X Poor oral health, diabetes mellitus (DM), and cognitive impairment are common problems in older adults. Using national surveys, this symposium aims to present new findings regarding the impact of the co-occurrence of DM and poor oral health on cognitive function, cognitive decline, and mortality. This symposium will also cover the topic of dental care use among adult populations in the U.S. Using data from the Health and Retirement Study (HRS) (2006- 2018), the first study shows that adults with both DM and edentulism had the worst cognitive function, followed by those with edentulism alone, and those with DM alone. Using the same HRS data, the second study found that co-occurrence of DM and edentulism had a higher risk of more rapid cognitive decline with advancing age than the presence of each condition alone. The third study used data from the 2006-2016 HRS linked with mortality files, and revealed that the risk of diabetes and edentulism on mortality may vary across racial/ethnic groups. Using the Behavioral Risk Factor Surveillance System survey (2002-2018), the fourth study examined disparities of dental service utilization among racial/ethnic groups (Whites, Hispanics, Blacks, Asians, American Indians or Alaska Natives, and Native Hawaiian or other Pacific Islanders). Age differences in dental services were also compared between older adults and other younger and middle-aged populations. This symposium highlights the role of oral health in improving cognitive health. Policies and programs are needed to increase dental care access, a critical way to help maintain good oral health. %B Innovation in Aging %V 5 %P 206 %G eng %N Suppl _1 %R https://doi.org/10.1093/geroni/igab046.790 %0 Journal Article %J Translational Psychiatry %D 2021 %T Phenotypic and genetic markers of psychopathology in a population-based sample of older adults. %A Arianna M Gard %A Erin B Ware %A Hyde, Luke W %A Lauren L Schmitz %A Jessica Faul %A Colter Mitchell %K Genetic Markers %K Phenotypic markers %K psychopathology %X

Although psychiatric phenotypes are hypothesized to organize into a two-factor internalizing-externalizing structure, few studies have evaluated the structure of psychopathology in older adults, nor explored whether genome-wide polygenic scores (PGSs) are associated with psychopathology in a domain-specific manner. We used data from 6003 individuals of European ancestry from the Health and Retirement Study, a large population-based sample of older adults in the United States. Confirmatory factor analyses were applied to validated measures of psychopathology and PGSs were derived from well-powered genome-wide association studies (GWAS). Genomic SEM was implemented to construct latent PGSs for internalizing, externalizing, and general psychopathology. Phenotypically, the data were best characterized by a single general factor of psychopathology, a factor structure that was replicated across genders and age groups. Although externalizing PGSs (cannabis use, antisocial behavior, alcohol dependence, attention deficit hyperactivity disorder) were not associated with any phenotypes, PGSs for major depressive disorder, neuroticism, and anxiety disorders were associated with both internalizing and externalizing phenotypes. Moreover, the variance explained in the general factor of psychopathology increased by twofold (from 1% to 2%) using the latent internalizing or latent one-factor PGSs, derived using weights from Genomic Structural Equation Modeling (SEM), compared with any of the individual PGSs. Collectively, results suggest that genetic risk factors for and phenotypic markers of psychiatric disorders are transdiagnostic in older adults of European ancestry. Alternative explanations are discussed, including methodological limitations of GWAS and phenotypic measurement of psychiatric outcome in large-scale population-based studies.

%B Translational Psychiatry %V 11 %P 239 %G eng %N 1 %R 10.1038/s41398-021-01354-2 %0 Journal Article %J Entrepreneurship Theory and Practice %D 2021 %T The Polygenic Risk Score of Subjective Well-Being, Self-Employment, and Earnings Among Older Individuals %A Pankaj C Patel %A Cornelius A Rietveld %A Wolfe, Marcus T. %A Wiklund, Johan %K Earnings %K Occupational choice %K Polygenic risk score %K Self-employment %K Subjective well-being %X We investigate whether the polygenic risk score (PRS) of subjective well-being (SWB), a weighted combination of multiple genetic variants which captures an individual?s time-invariant genetic predisposition to SWB, influences the choice of self-employment and whether it explains differences in earnings between older self-employed and employed workers. In a sample of 4,571 individuals (50 to 65 years old) representing 14,937 individual-year observations from the Health and Retirement Study, we find that the PRS of SWB is positively associated with self-employment and earnings. However, contrary to our expectations, the positive association with earnings is not significantly different between self-employed and employed individuals. %B Entrepreneurship Theory and Practice %V 45 %P 440-466 %@ 1042-2587 %G eng %N 2 %R https://doi.org/10.1177/1042258720936984 %0 Journal Article %J Preventative Medicine %D 2021 %T The positive influence of sense of control on physical, behavioral, and psychosocial health in older adults: An outcome-wide approach. %A Hong, Joanna H %A Margie E Lachman %A Susan T Charles %A Chen, Ying %A Wilson, Caitlyn L %A Tyler J VanderWeele %A Julia S Nakamura %A Eric S Kim %K physical well-being %K psychosocial health %X

Accumulating research indicates robust associations between sense of control and salutary health and well-being outcomes. However, whether change in sense of control is associated with subsequent outcomes has been under-evaluated. Participants (N = 12,998) were from the Health and Retirement Study-a diverse, nationally representative, and longitudinal sample of U.S. adults aged >50 years. We examined how increase in sense of control (from t:2006/2008 to t: 2010/2012) was associated with better outcomes on 35 indicators of: physical-, behavioral-, and psychosocial-health (t:2014/2016). We used multiple logistic-, linear-, and generalized-linear regression models and controlled for sociodemographic characteristics, personality traits, sense of control, and all outcomes in the pre-baseline wave (t:2006/2008). During the 4-year follow-up, people in the highest (vs. lowest) quartile of sense of control, conditional on prior sense of control, had reduced risk of mortality and improved physical-health outcomes (lower risk of: stroke, lung disease, physical limitations, cognitive impairment, chronic pain and higher self-rated health). Sense of control was related to better health-behaviors (increased physical activity, reduced sleep problems), higher psychological well-being (positive affect, life satisfaction, optimism, purpose, personal-, health-, financial-mastery), lower psychological distress (depression, hopelessness, negative affect, perceived constraints), decreased loneliness, and increased contact with friends. Sense of control was unrelated to other physical health indicators (diabetes, hypertension, heart disease, cancer, arthritis, overweight/obesity), health behaviors (binge drinking, smoking), and social factors (living with spouse/partner, frequency of contact with children and other family). These findings underscore the importance of sense of control as a potential intervention target for fostering physical-, behavioral-, and psychosocial-health.

%B Preventative Medicine %V 149 %P 106612 %G eng %R 10.1016/j.ypmed.2021.106612 %0 Journal Article %J 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 Diabetes Research and Clinical Practice %D 2021 %T Progression to diabetes by baseline glycemic status among middle-aged and older adults in the United States, 2006-2014. %A Barbara H. Bardenheier %A Wu, Wen-Chih %A Zullo, Andrew R %A Gravenstein, Stefan %A Edward W Gregg %K Diabetes %K Glycemic Index %X

AIMS: Primary prevention studies have indicated that structured lifestyle change programs in adults with an annual diabetes risk of 4.7% are cost-effective. However, few population-based studies have quantified the risk of diabetes among adults with prediabetes.

METHODS: We used the nationally representative U.S. Health and Retirement Study to identify adults aged ≥ 52 years with prediabetes (A1c: 5.7% - 6.4%) in 2006 and followed them to 2014 to assess diabetes status defined by A1c ≥ 6.5% in 2010 or 2014 or by self-report of a diabetes diagnosis by various risk factors.

RESULTS: Among the 1,406 adults with prediabetes (average 4.7 years of follow-up), risk factors significantly associated with subsequent incident diabetes with adjusted annual risk of diabetes ≥ 4.7% were: male gender (4.8%); aged 52-64 years (5.0%); Black race (5.5%); obesity (body mass index (kg/m) ≥ 30.0, 6.8%); large waist circumference (women: > 35 inches; men: > 40 inches, 4.9%); C-reactive protein levels ≥3 ug/L (5.5%); treated for high cholesterol (4.7%); treated for hypertension (5.3%); and moderate mobility loss (4.8%).

CONCLUSIONS: Primary prevention interventions among adults with prediabetes who also have moderate mobility loss or well-known risk factors for diabetes are likely to be cost-effective.

%B Diabetes Research and Clinical Practice %V 174 %P 108726 %G eng %R 10.1016/j.diabres.2021.108726 %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 Race, Gender, and Socioeconomic Variations in C-Reactive Protein Using the Health and Retirement Study %A Heather R. Farmer %A Linda A. Wray %A Steven A Haas %K Health Disparities %K race %K socioeconomic status %X To clarify the relationships among race, gender, and socioeconomic status (SES) with C-reactive protein (CRP).The present study analyzed data from 6,521 Black and White respondents aged 51 and older in the Health and Retirement Study, a nationally representative sample of midlife and older adults, to address two aims. We sought to (i) assess the independent associations between race, gender, and SES with CRP concentrations and (ii) test whether race, gender, and SES interacted to produce unequal CRP concentrations cross-sectionally and over a 4-year follow-up.The results demonstrated that race, gender, and SES were each independently associated with baseline CRP, but only SES was associated with CRP at follow-up. Furthermore, race, gender, and education interacted to produce differential CRP levels at baseline. There were incremental benefits for each additional level of education for White men and women, but the relationship between education and CRP was more complicated for Black men and women. Compared with other race/gender groups with less than high school, Black women had the highest and Black men had the lowest levels of CRP. There were no apparent benefits to CRP for Black women with college compared with Black women with high school, while Black men with less than high school and college had similar concentrations of CRP.In clarifying the complexity inherent in CRP disparities, this work contributes to a greater understanding of the biological mechanisms underlying racial disparities in leading causes of morbidity and mortality in the United States. %B The Journals of Gerontology: Series B %V 76 %P 583–595 %G eng %N 3 %R 10.1093/geronb/gbaa027 %0 Journal Article %J Journal of Applied Gerontology %D 2021 %T Relationship Between Multiple Measures of Financial Hardship and Glycemic Control in Older Adults With Diabetes %A Walker, R.J. %A Emma Garacci %A Campbell, J.A. %A Harris, M. %A Mosley-Johnson, E. %A Leonard E Egede %K Chronic illness %K Diabetes %K socioeconomic status %X Aim: To examine the relationship between multiple measures of financial hardship and glycemic control in older adults with diabetes. Methods: Using data from Health and Retirement Study (HRS), we investigated four measures of financial hardship: difficulty paying bills, ongoing financial strain, decreasing food intake due to money, and taking less medication due to cost. Using linear regression models, we investigated the relationship between each measure, and a cumulative score of hardships per person, on glycemic control (HbA1c). Results: After adjustment, a significant relationship existed with each increasing number of hardships associated with increasing HbA1c (0.09, [95%CI 0.04, 0.14]). Difficulty paying bills (0.25, [95%CI 0.14, 0.35]) and decreased medication usage due to cost (0.17, [95%CI 0.03, 0.31]) remained significantly associated with HbA1c. Conclusion: In older adults, difficulty paying bills and cost-related medication nonadherence is associated with glycemic control, and every additional financial hardship was associated with an increased HbA1c by nearly 0.1%. © The Author(s) 2020. %B Journal of Applied Gerontology %V 40 %P 162-169 %G eng %N 2 %9 Journal %R 10.1177/0733464820911545 %0 Journal Article %J Aging & Mental Health %D 2021 %T The relationship between perceived support and depression in spousal care partners: a dyadic approach. %A Meyer, Kylie %A Patel, Neela %A White, Carole %K Caregiving %K depression %K Social Support %X

OBJECTIVES: Caregiving within a spousal partnership marks a novel relationship stage for couples. Caregiving introduces new stressors and affects couples' ability to cope, and potentially alters perceptions of emotional support. Prior research on older married couples illustrates how perceived support not only affects an individual's mental health, but also that of their partner. To date, the dyadic relationship between emotional support and mental health is largely unexamined among caregiving partners, where support expectations may differ.

METHOD: Actor partner interdependence models using linear mixed modeling were applied to data from spouses where one partner received caregiving within the 2014 and 2016 waves of the Health and Retirement Study. We examined the cross-sectional and lagged associations between perceived emotional support and strain from a spouse on actor and partner depression scores, as well as whether one was the caregiver or the care recipient moderated associations.

RESULTS: More positive perceptions of support were associated with lower depression scores for oneself (= -0.55,  < 0.001) and one's partner (= -0.24,  < 0.001). Actor effects-how one's own perceptions of support associate with one's own depressive symptomology-were stronger for care recipients than for caregivers (= -0.83,  < 0.001 v. = -0.26,  < 0.05). Higher perceptions of strain were also associated with higher depression scores for oneself ( = 0.57,  < 0.001) and one's partner ( = 0.39,  < 0.001), associations that remained even in lagged models.

CONCLUSIONS: The observation of both actor and partner effects in this study suggests opportunities to improve care recipient outcomes through intervention with caregivers or both members of the care dyad.

%B Aging & Mental Health %V 25 %P 1830-1838 %G eng %N 10 %R 10.1080/13607863.2020.1836474 %0 Journal Article %J Journal of the Society for Social Work & Research %D 2021 %T Reversing the Gains of the Civil Rights and Women’s Movements: How Housing Strain and Market Exclusion Led to Wealth Depletion During the Great Recession %A West, Stacia %A Amy Castro Baker %A Ma, Chenyi %A Elliot, Stacy %K Black women %K gender %K Intersectionality %K race %K Recession %K Retirement %K Wealth %X Objective: We use feminist standpoint theory to investigate how the intersection of identity influenced wealth loss following the Great Recession among older single adults who benefitted from the social movements and legislative gains of the 1960s and 1970s. Looking back on more than a decade of recession and recovery, this study explores how intersections of race, class, and gender produced different wealth outcomes for the early baby boomer EBB cohort. Method: A sample of older baby boomers from the University of Michigan Health and Retirement Study were selected at two waves, 2004 and 2016. We used a generalized estimation equation with interaction effects to test changes in wealth over time for different race and gender groups. Results: Controlling for income and health, we found that both single Black and white women lost wealth at significantly higher rates than single white men. Poor health was associated with wealth shocks, or substantial wealth loss, for single white women, whereas the intersection of race and gender was associated with wealth loss for single Black women. Black women in this cohort ended the Great Recession with $85,000 less than their peers based on the overlapping identities of race and gender independent of health trouble. Conclusions: The policy history of women’s credit and lending access, as well as predatory targeting during the subprime lending crisis, contextualizes our findings. We discuss policy approaches to prevent future wealth erosion in households headed by Black women. %B Journal of the Society for Social Work & Research %V 12 %G eng %N 2 %R 10.1086/714544 %0 Journal Article %J Gerontologist %D 2021 %T The Role of Polygenic Score and Cognitive Activity in Cognitive Functioning among Older Adults %A Su Hyun Shin %A Park, Soohyun %A Wright, Cheryl %A D’astous, Valerie Anne %A Kim, Giyeon %K Alzheimer’s disease %K Cognition %K Cognitively Stimulating Activity %K Genetics %X This study explored whether the intensity of cognitive activities could moderate the relationship between a genetic predisposition for developing Alzheimer’s disease (AD) and cognitive functioning among older adults in the U.S. Further, we examined whether the same moderating effects were dependent on different measures of cognition.We used a dataset from the 2000-2014 waves of the Health and Retirement Study and the Consumption and Activities Mail Survey. Our sample included 3,793 individuals aged 50 or older. We used the polygenic score (PGS) for AD as a genetic trait for cognitive functioning. Reading, listening to music, using a computer, playing cards/games/solving puzzles, singing/playing musical instruments, and creating art and crafts were included as cognitive activities, and TV viewing as passive activities. We used total cognition, fluid intelligence, and crystallized intelligence as proxies for cognitive functioning. Growth-curve models were conducted.After controlling for covariates, we found that reading books, using a computer, and playing cards/games/solving puzzles had a positive effect on cognitive functioning. An additional hour spent reading books moderated the negative effect of AD PGS on cognition. The measure of fluid, when compared with crystallized intelligence, appeared to drive these results.Reading could be a protective factor against cognitive decline among older adults who are genetically predisposed to developing AD. Implications for individuals, caregivers, clinicians, and policymakers are suggested. Furthermore, the onset of AD in those at a greater genetic risk may be delayed with this intervention. %B Gerontologist %V 61 %P 319-329 %@ 0016-9013 %G eng %N 3 %R 10.1093/geront/gnaa073 %0 Journal Article %D 2021 %T Roles of interacting stress-related genes in lifespan regulation: Insights for translating experimental findings to humans %A Anatoliy Yashin %A Wu, Deqing %A Konstantin G Arbeev %A Arseniy P Yashkin %A Akushevich, Igor %A Bagley, Olivia %A Duan, Matt %A Svetlana Ukraintseva %K amino acids starvation %K GCN2/EIF2AK4 and CHOP/DDI3T genes %K GxG interactions %K Integrated stress response %K Lifespan %X Aim: Experimental studies provided numerous evidence that caloric/dietary restriction may improve health and increase the lifespan of laboratory animals, and that the interplay among molecules that sense cellular stress signals and those regulating cell survival can play a crucial role in cell response to nutritional stressors. However, it is unclear whether the interplay among corresponding genes also plays a role in human health and lifespan. Methods: Literature about roles of cellular stressors have been reviewed, such as amino acid deprivation, and the integrated stress response (ISR) pathway in health and aging. Single nucleotide polymorphisms (SNPs) in two candidate genes (GCN2/EIF2AK4 and CHOP/DDI3T) that are closely involved in the cellular stress response to amino acid starvation, have been selected using information from experimental studies. Associations of these SNPs and their interactions with human survival in the Health and Retirement Study data have been estimated. The impact of collective associations of multiple interacting SNP pairs on survival has been evaluated, using a recently developed composite index: the SNP-specific Interaction Polygenic Risk Score (SIPRS). Results: Significant interactions have been found between SNPs from GCN2/EIF2AK4 and CHOP/DDI3T genes that were associated with survival 85+ compared to survival between ages 75 and 85 in the total sample (males and females combined) and in females only. This may reflect sex differences in genetic regulation of the human lifespan. Highly statistically significant associations of SIPRS [constructed for the rs16970024 (GCN2/EIF2AK4) and rs697221 (CHOP/DDIT3)] with survival in both sexes also been found in this study. Conclusion: Identifying associations of the genetic interactions with human survival is an important step in translating the knowledge from experimental to human aging research. Significant associations of multiple SNPxSNP interactions in ISR genes with survival to the oldest old age that have been found in this study, can help uncover mechanisms of multifactorial regulation of human lifespan and its heterogeneity. %V 5 %P 357-379 %G eng %R 10.20517/jtgg.2021.26 %0 Journal Article %J CMAJ %D 2021 %T Sex differences in mortality: results from a population-based study of 12 longitudinal cohorts %A Wu, Yu-Tzu %A Niubo, Albert Sanchez %A Daskalopoulou, Christina %A Moreno-Agostino, Dario %A Stefler, Denes %A Bobak, Martin %A Oram, Sian %A Prince, Martin %A Matthew Prina %K CHARLS %K ELSA %K JSTAR %K KLoSA %K Men %K Mortality %K SHARE %K women %X BACKGROUND: Women generally have longer life expectancy than men but have higher levels of disability and morbidity. Few studies have identified factors that explain higher mortality in men. The aim of this study was to identify potential factors contributing to sex differences in mortality at older age and to investigate variation across countries.METHODS: This study included participants age >= 50 yr from 28 countries in 12 cohort studies of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. Using a 2-step individual participant data meta-analysis framework, we applied Cox proportional hazards modelling to investigate the association between sex and mortality across different countries. We included socioeconomic (education, wealth), lifestyle (smoking, alcohol consumption), social (marital status, living alone) and health factors (cardiovascular disease, diabetes, mental disorders) as covariates or interaction terms with sex to test whether these factors contributed to the mortality gap between men and women.RESULTS: The study included 179 044 individuals. Men had 60% higher mortality risk than women after adjustment for age (pooled hazard ratio [HR] 1.6; 95% confidence interval 1.5–1.7), yet the effect sizes varied across countries (I2 = 71.5%, HR range 1.1–2.4). Only smoking and cardiovascular diseases substantially attenuated the effect size (by about 22%).INTERPRETATION: Lifestyle and health factors may partially account for excess mortality in men compared with women, but residual variation remains unaccounted for. Variation in the effect sizes across countries may indicate contextual factors contributing to gender inequality in specific settings. %B CMAJ %V 193 %P E361–E370 %G eng %N 11 %R 10.1503/cmaj.200484 %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Social Engagement and Cognitive Function of Older Adults in Mexico and the United States: How Universal Is the Interdependence in Couples? %A Bret Howrey %A Jaqueline C Avila %A Brian Downer %A Rebeca Wong %K Cohort Analysis %K Cross-country study %K Marriage %K MHAS %X

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

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

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

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

%B The Journals of Gerontology: Series B %V 76 %P S41-S50 %G eng %N Supplement_1 %R 10.1093/geronb/gbaa025 %0 Report %D 2021 %T Societal Impact of Research Funding for Women's Health in Alzheimer's Disease and Alzheimer's Disease - Related Dementias %A Baird, Matthew D. %A Melanie A. Zaber %A Andrew W. Dick %A Chloe E. Bird %A Annie Chen %A Molly Waymouth %A Grace Gahlon %A Denise D. Quigley %A Hamad Al Ibrahim %A Lori Frank %K Alzheimer's disease %K Dementia %K health %K women %X Women's health has suffered from insufficient research addressing women. The research community has not widely embraced the value of this research, and the impact of limited knowledge about women's health relative to men's is far-reaching. Without information on the potential return on investment for women's health research, research funders, policymakers, and business leaders lack a basis for altering research investments to improve knowledge of women's health. As part of an initiative of the Women's Health Access Matters (WHAM) nonprofit foundation, RAND Corporation researchers examined the impact of increasing funding for women's health, beginning with a focus on Alzheimer's disease and Alzheimer's disease–related dementias (AD/ADRD), which result in substantial illness burden, health care costs, caregiving burden, and mortality. In this report, the authors present the results of microsimulation models used to explore the potential for enhanced investment in women's health research, in terms of the economic well-being of women and for the U.S. population. %B Research Report %I RAND Corporation %C Santa Monica, CA %G eng %R 10.7249/RR-A708-1 %0 Thesis %B Sociology %D 2021 %T Stress Proliferation and Disability over the Life Course %A Jessica S West %K hearing impaired %K life course %K stress process %X For decades, life course and stress process scholars have documented that negative, stressful experiences have consequences for health across the life course. However, less attention has been paid to hearing impairment, a highly prevalent functional limitation that has significant implications for the quality of life of older adults. Hearing impairment is common at older ages (reported by 27.3% of those aged 65-74 and 45.1% of those aged 75 and older) and has negative consequences for the quality of life not only of the focal individual but also for those close to them (CDC 2017, Ciorba et al. 2012, Dalton et al. 2003, Wallhagen et al. 2004). The aim of this dissertation is to apply a life course and stress process framework to the experience of hearing impairment via two studies that each use nationally representative, longitudinal data from the Health and Retirement Study (HRS). My findings contribute to our understanding of marriage, family, gender, and health by moving beyond the traditional approach that focuses on individuals with disabilities to explore the impacts of disability on spouses. In Chapter 2, I build on the stress process framework by conceptualizing hearing impairment as a chronic stressor that impacts mental health and examining the role of social support in this relationship. Using fixed-effects regression models applied to three waves of HRS data (2006, 2010, 2014), I found that worse self-rated hearing is associated with a significant increase in depressive symptoms, and that social support interacted with hearing impairment: low levels of social support were associated with more depressive symptoms but only among people with poor self-rated hearing. Moreover high levels of social support reduced depressive symptoms for those with poor hearing. These findings suggest that hearing impairment is a chronic stressor in individuals' lives, and that responses to this stressor vary by the availability of social resources. Chapter 3 examines stress proliferation among married couples. While decades of research show the health benefits of marriage, stress proliferation suggests that chronic stressors such as disability may undermine social relations, thus limiting their role as a coping resource. For this study, I matched couples by household identification number over ten waves of the HRS (1998-2016). Fixed-effects regression models revealed that wives’ hearing impairment is associated with an increase in husbands’ depressive symptoms, but that husbands’ hearing impairment is not associated with wives’ depressive symptoms. This could be because women in heterosexual marriages have traditionally been expected to monitor their husbands’ health, but not vice versa. Since men are less used to serving as caregivers, they may find their wives’ hearing impairment distressing. Also, wives usually find social support outside of the marriage, while husbands traditionally rely on their wives for companionship. This would provide wives, but not husbands, with external resources to cope with their spouses’ hearing impairment. These findings reveal that the stress of hearing impairment does spill over from one spouse to another, depending on gender. Overall, this dissertation demonstrates that hearing impairment is a chronic stressor that has major implications for individuals’ mental health. Moreover, the mental health consequences of hearing impairment are not only limited to individuals but can also spill over to impact spouses. Further research is needed to extend our understanding of how disability, in general, and hearing impairment, specifically, shapes health across the life course for individuals and those close to them. %B Sociology %I Duke University %C Durham, NC %V Ph.D. %G eng %U https://dukespace.lib.duke.edu/dspace/bitstream/handle/10161/23020/West_duke_0066D_16082.pdf?sequence=1 %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 Journal Article %J Stroke %D 2021 %T Temporal Trends in Stroke-Related Memory Change: Results From a US National Cohort 1998-2016. %A Chloe W Eng %A Elizabeth R Mayeda %A Paola Gilsanz %A Rachel A Whitmer %A Kim, Anthony S %A M. Maria Glymour %K Dementia %K Incidence %K Memory %K Survivors %X

BACKGROUND AND PURPOSE: Findings from the Framingham Heart Study suggest that declines in dementia incidence rates over recent decades are partially due to decreases in stroke incidence and mortality; however, whether trends of declining dementia rates extend to survivors of incident stroke remains unclear. We investigated evidence for temporal trends in memory change related to incident stroke in a nationally representative cohort.

METHODS: Adults age 50+ in the HRS (Health and Retirement Study) were followed across three successive 6-year epochs (epoch 1: 1998-2004, n=16 781; epoch 2: 2004-2010, n=15 345; and epoch 3: 2010-2016; n=15 949). Participants were included in an epoch if they were stroke-free at the start of that epoch. Annual rates of change in a composite z-standardized memory score were compared using demographic-adjusted linear regression models for stroke-free participants, those who survived after stroke, and those who died after stroke, considering memory change before stroke, at the time of stroke, and for years following stroke.

RESULTS: Crude stroke incidence rates decreased from 8.5 per 1000 person-years in epoch 1 to 6.8 per 1000 person-years in epoch 3. Rates of memory change before and following stroke onset were similar across epochs. Memory decrement immediately after stroke onset attenuated from -0.37 points (95% CI, -0.44 to -0.29) in epoch 1 to -0.26 (95% CI, -0.33 to -0.18) points in epoch 2 and -0.25 (95% CI, -0.33 to -0.17) points in epoch 3 ( value for linear trend=0.02).

CONCLUSIONS: Decreases in stroke-related dementia in recent years may be partially attributable to smaller memory decrements immediately after stroke onset. Findings suggest reductions in stroke incidence and improvements in stroke care may also reduce population burden of dementia. Further investigations into whether temporal trends are attributable to improvements in stroke care are needed.

%B Stroke %V 52 %P 1702-1711 %G eng %N 5 %R 10.1161/STROKEAHA.120.031063 %0 Journal Article %J Journal of Survey Statistics and Methodology %D 2021 %T Tools for Selecting Working Correlation Structures When Using Weighted GEE to Model Longitudinal Survey Data %A Westgate, Philip M %A Brady T. West %K GEEs %K Methodology %X Weighted generalized estimating equations (GEEs) are popular for the marginal analysis of longitudinal survey data. This popularity is due to the ability of these estimating equations to provide consistent regression parameter estimates and corresponding standard error estimates as long as the population mean and survey weights are correctly specified. Although the data analyst must incorporate a working correlation structure within the weighted GEEs, this structure need not be correctly specified. However, accurate modeling of this structure has the potential to improve regression parameter estimation (i.e., reduce standard errors) and therefore, the selection of a working correlation structure for use within GEEs has received considerable attention in standard longitudinal data analysis settings. In this article, we describe how correlation selection criteria can be extended for use with weighted GEE in the context of analyzing longitudinal survey data. Importantly, we provide and demonstrate an R function that we have created for such analyses. Furthermore, we discuss correlation selection in the context of using existing software that does not have this explicit capability. The methods are demonstrated via the use of data from a real survey in which we are interested in the mean number of falls that elderly individuals in a specific subpopulation experience over time. %B Journal of Survey Statistics and Methodology %V 9 %P 141-158 %G eng %N 1 %R 10.1093/jssam/smz048 %0 Report %D 2021 %T Transportation, Quality of Life, and Older Adults %A Wachs, Martin %A Evelyn Blumenberg %A Schouten, Andrew %A Hannah R. King %K California %K transportation planning %K travel behavior %X Driving rates decline with age as vision, health, and cognitive ability cause some older adults to give up driving. Many older adults first gradually limit their driving as they age and later cease driving. Using data from the Health and Retirement Study (HRS), which surveys 22,000 older Americans every two years, we modeled the extent to which older drivers limit and stop driving. The data are longitudinal, allowing analysis of changes in driving and residential location as well as cohort effects that could not be studied using standard, cross-sectional survey data that only allow comparisons of different people at one point in time. The analysis shows that decisions to limit and eventually stop driving vary in statistically significant ways with sex, age, and health conditions. These relationships also differ by birth cohort. More recent cohorts are less likely to stop and limit driving than older ones. To analyze the relationship between residential location and driving behavior, we linked the HRS data to census-tract level data from the US Census and a categorization of community types. We found that residential density and other urban built environment features are associated with changes in driving and vehicle ownership. HRS survey participants showed a greater propensity to reduce or give up driving if they resided in denser, more diverse, transit-oriented neighborhoods. People who prefer non-automotive modes of transportation may have been more likely than others to self-select into walkable and transit-rich areas. The findings should inform California’s strategic planning for aging and its community development policies. In addition to informing planning for the next generation of older Californians, this study demonstrated the utility of longitudinal information and models for the understanding of older populations and their travel. %B UC Office of the President: ITS Reports %I Institute of Transportation Studies, University of California, Los Angeles %C Los Angeles, CA %G eng %R 10.17610/T6T30J %0 Journal Article %J Frontiers in Genetics %D 2021 %T Type 2 Diabetes and Cognitive Status in the Health and Retirement Study: A Mendelian Randomization Approach. %A Erin B Ware %A Morataya, Cristina %A Fu, Mingzhou %A Kelly M Bakulski %K Dementia %K Mendelian randomization %K polygenic score %K type 2 diabetes mellitus %X

Background: Type 2 diabetes mellitus (T2DM) and dementia are leading causes of mortality and disability in the US. T2DM has been associated with dementia; however, causality has not been clearly established. This study tested inferred causality between T2DM and dementia status using a Mendelian randomization approach.

Methods: Participants (50+ years) from the 2010 wave of the Health and Retirement Study of European or African genetic ancestry were included ( = 10,322). History of T2DM was self-reported. Cognitive status (dementia, cognitive impairment non-dementia, or normal cognition) was defined from clinically validated cognitive assessments. Cumulative genetic risk for T2DM was determined using a polygenic score calculated from a European ancestry T2DM genome-wide association study by Xue et al. (2018). All models were adjusted for age, sex, education, -ε4 carrier status, and genetic principal components. Multivariable logistic regression was used to test the association between cumulative genetic risk for T2DM and cognitive status. To test inferred causality using Mendelian randomization, we used the inverse variance method.

Results: Among included participants, 20.9% had T2DM and 20.7% had dementia or cognitive impairment. Among European ancestry participants, T2DM was associated with 1.66 times odds of cognitive impairment non-dementia (95% confidence interval: 1.55-1.77) relative to normal cognition. A one standard deviation increase in cumulative genetic risk for T2DM was associated with 1.30 times higher odds of T2DM (95% confidence interval: 1.10-1.52). Cumulative genetic risk for T2DM was not associated with dementia status or cognitive-impaired non-dementia in either ancestry ( > 0.05); lack of association here is an important assumption of Mendelian randomization. Using Mendelian randomization, we did not observe evidence for an inferred causal association between T2DM and cognitive impairment (odds ratio: 1.04; 95% confidence interval: 0.90-1.21).

Discussion: Consistent with prior research, T2DM was associated with cognitive status. Prevention of T2DM and cognitive decline are both critical for public health, however, this study does not provide evidence that T2DM is causally related to impaired cognition. Additional studies in other ancestries, larger sample sizes, and longitudinal studies are needed to confirm these results.

%B Frontiers in Genetics %V 12 %P 634767 %G eng %R 10.3389/fgene.2021.634767 %0 Journal Article %J Journal of Clinical Oncology %D 2021 %T Validation of self-reported incident cancer diagnoses in the U.S. Health and Retirement Study: A tool for population-based cancer and aging research. %A Megan Mullins %A Jasdeep S Kler %A Eastman, Marissa %A Mohammed U Kabeto %A Lauren P Wallner %A Lindsay C Kobayashi %K biomarker data %K cancer diagnoses %K Medicare %K self-report %X Background: Population aging and improving cancer survival rates are resulting in a growing population of older cancer survivors in the United States (US). As a result, there is an increasing need for longitudinal, population-representative data for interdisciplinary cancer research among older adults. The US Health Retirement Study (HRS) is an ongoing population-representative cohort of US adults over age 50 that contains rich interview and biomarker data on health during aging. Interviews have collected self-reported cancer diagnoses since 1998, but these self-reports have not been validated. We compared first incident cancer diagnoses self-reported in HRS interviews against diagnostic claims from linked Medicare records. Methods: We examined the validity of first incident cancer diagnoses self-reported in biennial HRS interviews from 2000 through 2016 against ICD-9 and ICD-10 diagnostic claim records among 8,242 HRS participants aged ≥65 with 90% continuous enrollment in fee-for-service Medicare, using the claim records as the gold standard. We calculated the sensitivity, specificity, and k for first incident cancer diagnoses (all cancers combined, excluding non-melanoma skin cancer, and each of bladder, breast, colorectal/anal, uterine, kidney/renal, lung/bronchus, and prostate cancers) cumulatively over the follow-up, and at each biennial study interview. Results: Self-reports of first incident cancer diagnosis (agnostic of site) between 2000 and 2016 had 73.2% sensitivity and 96.2% specificity against Medicare claims (k = 0.73). For site-specific self-reports, sensitivities ranged from 44.7% (kidney) to 75.0% (breast), and specificities ranged from 99.2% (prostate) to 99.9% (bladder, uterine, and kidney). Results were similar in sensitivity analyses restricting to individuals with 100% continuous fee-for-service Medicare enrollment and when restricting to individuals with at least 24 months of Medicare enrollment. Conclusions: Self-reported cancer diagnoses in the HRS have reasonable validity for population-based research on cancer and aging across cancer types. Apart from breast cancer, cancer site specific analyses will greatly benefit from the improved validity of self-report with Medicare claim linkage. %B Journal of Clinical Oncology %V 39 %P 312 %G eng %N 28_suppl %R 10.1200/JCO.2020.39.28_suppl.312 %0 Journal Article %J Research in Nursing & Health %D 2021 %T Within-couple dissimilarities in functional impairment as determinants of spousal care arrangement among older married couples. %A Liu, Huiying %A Li, Yuekang %A Wang, Yi %A Morrow-Howell, Nancy %A Vivian W Q Lou %A Shen, Huei-Wern %K Caregiving %K family sociology %K Functional health status %K Marriage %K within-couple perspective %X

Existing research on spousal care focuses on one spouse receiving care from the other, which fails to address the complexity that is created when both spouses experience some impairments. Our study included situations in which one or both spouses have functional impairments when examining the extent to which spouses from the same couple hold a (dis)similar level of functional impairment and whether such within-couple (dis)similarity has an impact on the spousal care arrangement. A subsample of 1170 older married couples was selected from the 2014 Health and Retirement Study. Descriptive statistics were used for describing the level of each spouse's functional impairment regarding the number of limitations in activities (activities of daily living [ADL]) or instrumental ADL (IADL). Logistic regressions were used to examine whether spousal dissimilarity in functional impairment (dissimilar, similarly low, similarly high) was associated with spousal care arrangement. Within couples with one functionally impaired spouse, the impaired spouse was more likely to receive spousal care when reporting a higher level of ADL/IADL impairment. Within couples with two functionally impaired spouses, the more impaired person was more likely to receive spousal care (without giving back) when spouses reported dissimilar level of IADL impairment; spouses were more likely to report mutual care when they had similarly high levels of IADL impairment. By documenting the role of spousal dissimilarities in functioning for determining spousal care arrangement, our study can inform couple-based interventions that capitalize on each spouse's capabilities and resources.

%B Research in Nursing & Health %V 44 %P 365-375 %G eng %N 2 %R 10.1002/nur.22113 %0 Journal Article %J Diabetes %D 2020 %T 1407-P: Predictors of Glycemic Control among Older Adults with Type 2 Diabetes Stratified by Living Environment %A Aprill Z Dawson %A Lu,Kaiwei %A Rebekah J Walker %A Leonard E Egede %K Caregivers %K Cognitive Ability %K Diabetes %K Diabetes mellitus (non-insulin dependent) %K Hispanics %K Medical Sciences–Endocrinology %K Nursing %K Nursing homes %K Older people %K Physical activity %K Socio-economic aspects %X About 50% of adults with diabetes are ages 50 and older. As individuals age, their living situation changes which may impact self-care and glycemic control (GC). We examined predictors of GC among older adults with diabetes stratified by living environment; defined as living independently, living at home with a caregiver, or living in a nursing home. Data on 2370 adults ages 50 and older with diabetes from the Health and Retirement Study (2006 - 2014) was analyzed. Generalized estimating equations were used to assess the association between HbA1c and living environment. GC was the outcome and living environment was the primary independent variable. Covariates were socioeconomic factors, cognitive impairment, functional limitations, health status, lifestyle, and comorbidities. We also identified predictors of GC stratified by living environment. Unadjusted models showed no difference in HbA1c for individuals living with a caregiver compared to those living independently. Living in a nursing home was associated with lower HbA1c (β -0.33; p=0.011), however after adjusting for covariates the relationship was not significant. Predictors of GC among older adults living independently were: age (β -0.018; p<0.001), being female (β -0.20; p=0.007), non-Hispanic Black (β 0.53; p<0.001), Hispanic/Other (β 0.47; p<0.001), no physical activity (β -0.20; p=0.032). Predictors of GC among older adults living at home with a caregiver were: having a GED/high school diploma (β -0.49; p=0.029), not being physically active (β -0.45; p=0.013), and ADLs (β 0.12; p=0.03). Predictors of GC among older adults living in a nursing home were being Hispanic/Other (β 0.94; p=0.048). In this nationally representative sample, type of living environment does not have an effect on GC, however predictors of GC varied across living environment. Interventions need to be tailored to living environment of seniors. %B Diabetes %V 69 %@ 00121797 %G eng %R 10.2337/db20-1407-P %0 Journal Article %J Diabetes %D 2020 %T 1493-P: The Impact of Adverse Social Determinants on Health Care Utilization and Expenditures among U.S. Adults with DKD %A Mukoso N. Ozieh %A Emma Garacci %A Rebekah J Walker %A Leonard E Egede %K Diabetes Mellitus %K Expenditures %K Food security %K Health Services Utilization %K Kidney diseases %K Medical Sciences–Endocrinology %K Neighborhoods %K Regression Analysis %K Social interactions %K United States–US %X Introduction: This study examined whether adverse social determinants of health (SDOH) are associated with higher health care utilization and out of pocket (OOP) expenditures in U.S. adults with diabetic kidney disease (DKD). Methods: Data from 458 adults with self-reported DKD age ≥50 from the Health and Retirement Study 2008-2012 was analyzed. Primary outcomes were number of hospital overnight stays (HOS), number of physician visits (PV) and OOP expenditures. Primary independent variables were nine adverse SDOH factors clustered around three SDOH domains: psychosocial (depression, perceived social support and discrimination); financial hardship (difficulty paying bills, food insecurity, medication cost non-adherence); neighborhood (neighborhood social cohesion, social participation and physical disorder). Two variables were created, a continuous 0-9 and a categorical variable of 0, 1-2, 3+. We used negative binomial regression and marginalized two-part models to determine the impact of adverse SDOH on outcomes. Results: In the unadjusted model, compared to adults with no adverse SDOH, adults with 3+ adverse SDOH had 3% lower likelihood of PV (95%CI 0.72-1.29), 75% (95%CI 1.10-2.79) and 87% (95%CI 1.31-2.65) higher likelihood of HOS and OOP expenditures respectively. In the adjusted model, having 3+ adverse SDOH was not significantly associated with PV (Ratio 0.94 95%CI 0.69-1.29) or HOS (Ratio 1.53 95%CI 0.93-2.49) but was associated with a 2-fold higher likelihood of OOP expenditures (95% CI 1.60-3.31). Adverse neighborhood factors were associated with 63% higher likelihood of HOS (adjusted 95% CI 1.19-2.24) and financial hardship factors were associated with 85% higher likelihood of OOP expenditures (adjusted 95% CI 1.42-2.41). Conclusions: Our findings suggest having 3+ adverse SDOH especially financial hardship impacts OOP expenditures in adults with DKD. Interventions targeting adults with 3+ adverse SDOH may significantly decrease OOP expenditures in DKD. %B Diabetes %V 69 %@ 00121797 %G eng %R 10.2337/db20-1493-P %0 Journal Article %J Inquiry : a journal of medical care organization, provision and financing %D 2020 %T ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study %A Melissa McInerney %A Ruth Winecoff %A Padmaja Ayyagari %A Kosali I. Simon %A M Kate Bundorf %K crowd-out %K difference-in-differences %K Health Status %K Insurance Coverage %K Medicaid %K near-elderly adults %K Patient Protection and Affordable Care Act %X The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12% reduction in metabolic syndrome; a 32% reduction in complications from metabolic syndrome; an 18% reduction in the likelihood of gross motor skills difficulties; and a 34% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults. %B Inquiry : a journal of medical care organization, provision and financing %V 57 %@ 1945-72430046-9580 %G eng %R 10.1177/0046958020935229 %0 Report %D 2020 %T Age-specific Retirement Effects of The ACA Exchanges %A Woodruff, Corey %K Affordable Care Act %K Older workers %K Retirement %X In the U.S., as workers near traditional retirement age, health insurance becomes a major consideration in retirement decisions, especially for those who are too young to qualify for Medicare. In this paper, I examine the extent to which the opening of the Affordable Care Act (ACA) exchanges affected the retirement expectations and decisions of older workers. I estimate a difference-in-differences model that exploits variation in workers’ access to employer-based retiree health insurance (RHI) prior to the passage of the Affordable Care Act. Retirement expectations and behavior are compared before and after the 2014 opening of the ACA health insurance exchanges. I find significant effects on both expectations and behavior for those nearing the minimum Social Security Eligibility age of 62, but not for earlier or later ages. The expected probability of working full-time at age 62 declines 5.4 percentages points for those without RHI relative to those with RHI. Treated individuals were 49 percentage points more likely to be retired by age 61 or 62 following the opening of the exchanges, relative to those in the comparison group. %I University of Colorado, Boulder %C Boulder, CO %G eng %U https://www.colorado.edu/economics/sites/default/files/attached-files/jmp_woodruff_1026.pdf %0 Journal Article %J The Gerontologist %D 2020 %T Alternative retirement paths and cognitive performance: Exploring the role of preretirement job complexity. %A Dawn C Carr %A Robert J. Willis %A Ben Lennox Kail %A Carstensen, Lisbeth %K Cognitive Ability %K Employment and Labor Force %K Trajectories %X

BACKGROUND AND OBJECTIVES: Recent research suggests that working longer may be protective of cognitive functioning in later life, especially for workers in low complexity jobs. As postretirement work becomes increasingly popular, it is important to understand how various retirement pathways influence cognitive function. The present study examines cognitive changes as a function of job complexity in the context of different types of retirement transitions.

RESEARCH DESIGN AND METHODS: We use data from the Health and Retirement Study (HRS) to examine change in cognitive function for workers who have held low, moderate, and high complexity jobs and move through distinct retirement pathways-retiring and returning to work, partial retirement-compared with those who fully retire or remain full-time workers. Inverse probability weighted regression adjustment (a propensity score method) is used to adjust for selection effects.

RESULTS: There are systematic variations in the relationships between work and cognitive performance as a function of job complexity and retirement pathways. All retirement pathways were associated with accelerated cognitive decline for workers in low complexity jobs. In contrast, for high complexity workers retirement was not associated with accelerated cognitive decline and retiring and returning to work was associated with modest improvement in cognitive functioning.

DISCUSSION AND IMPLICATIONS: Both policy makers and individuals are beginning to embrace longer working lives which offer variety of potential benefits. Our findings suggest that continued full-time work also may be protective for cognitive health in workers who hold low complexity jobs.

%B The Gerontologist %V 60 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/31289823?dopt=Abstract %N 3 %9 Journal %& 460-471 %R 10.1093/geront/gnz079 %0 Report %D 2020 %T Are Homeownership Patterns Stable Enough to Tap Home Equity? %A Alicia H. Munnell %A Abigail N. Walters %A Belbase, Anek %A Wenliang Hou %K Home ownership %X As retirees live longer, spend more on medical care, and get less income replaced by Social Security, many may need to tap their home equity to be comfortable in retirement. The most direct way to access home equity is downsizing, but few choose this option because they generally prefer to stay in their house. The alternative is withdrawing equity through a reverse mortgage or a property tax deferral, but few households use these options either. A potential reason that homeowners are reluctant to borrow against their house is that, if they do decide to move, they have to pay back the loan with interest, which could leave them with inadequate resources at a vulnerable time in their life. This paper assesses how likely households are to move as they age to see if borrowing against one’s home is a viable financial strategy. The analysis uses the Health and Retirement Study (HRS) to analyze three cohorts: the HRS cohort (ages 50-54 in 1992), the AHEAD cohort (ages 70-74 in 1993), and a synthetic cohort covering the whole lifespan from age 50 to death. The analysis identifies typical housing trajectories in retirement and explores how often, and for whom, tapping home equity would be a viable strategy. %B Working papers %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/are-homeownership-patterns-stable-enough-to-tap-home-equity/ %0 Journal Article %J The Journal of Economics of Ageing %D 2020 %T Are homeownership patterns stable enough to tap home equity? %A Alicia H. Munnell %A Abigail N. Walters %A Belbase, Anek %A Wenliang Hou %K Home equity %K Housing trajectories %K Property tax deferrals %K retirement security %K Reverse mortgage %K Sequence analysis %X As retirees live longer, spend more on medical care, and get less income replaced by Social Security, many may need to consider tapping their home equity to be comfortable in retirement. The most direct way to access home equity is downsizing, but few choose this option because they generally prefer to stay in their house. The alternative is withdrawing equity through a reverse mortgage or a property tax deferral, but few households use these options either. While this low take-up has been well documented, a more fundamental question is the extent to which homeowners exhibit sufficient stability in their housing patterns to make them well-suited to tap their equity. For example, if homeowners do tap their equity and then end up moving, they have to pay back the loan with interest, which could leave them with inadequate resources at a vulnerable time in their life. This paper assesses how likely households are to move as they age to see if borrowing against one’s home is a reasonable financial strategy. The analysis uses the Health and Retirement Study (HRS) to analyze three cohorts: the HRS cohort (ages 50–54 in 1992), the AHEAD cohort (ages 70–74 in 1993), and a synthetic cohort covering the whole lifespan from age 50 to death. The analysis identifies typical housing trajectories in retirement and explores how often, and for whom, tapping home equity would be a viable strategy. The paper found that:•Seventy percent of households have very stable homeownership patterns, even over several decades. They either stay in the home they own in their 50 s (53 percent) or purchase a new home around retirement and stay for the rest of their life (17 percent).•The 30 percent of households that do move consist of two distinct subgroups. Frequent movers (14 percent) appear to face labor market challenges. Late movers (16 percent) look like a slightly more affluent version of the households that never move, but then face a health shock that forces them out of the home that they owned into a rental unit or a long-term services and supports facility.•Overall, the findings largely support the narrative from prior research that most people want to age in place and move only in response to a shock. The policy implications of the findings are:•Most homeowners experience enough residential stability to tap home equity through reverse mortgages or property tax deferrals.•Retirees might be more likely to tap their home equity if they felt that they had adequate public or private insurance protection against the risk of needing long-term services and supports. %B The Journal of Economics of Ageing %V 17 %@ 2212-828X %G eng %R https://doi.org/10.1016/j.jeoa.2020.100277 %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 Journal of Aging and Health %D 2020 %T Association of parenthood with incident heart disease in United States' older men and women: A longitudinal analysis of health and retirement study data. %A Sarah L Hipp %A Wu, Yan Yan %A Nicole T A Rosendaal %A Catherine M. Pirkle %K Gender Differences %K Heart disease %K Parents %K Risk Factors %K Socioeconomic factors %X

OBJECTIVE: To examine the association of number of children birthed/fathered with incident heart disease, accounting for socioeconomic and lifestyle characteristics.

METHODS: We analyzed data from 24,923 adults 50 and older (55% women) in the Health and Retirement Study. Participants self-reported number of children and doctor-diagnosed incident heart disease. Cox proportional hazards models estimated heart disease risk.

RESULTS: Compared to women with one to two children, those with five or more had increased risk of heart disease (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = [1.03, 1.25]). Compared to men with one to two children, those with five or more had a marginally increased risk of heart disease (HR = 1.11, 95% CI = [0.99, 1.25]), but this association attenuated in models adjusting for socioeconomic and lifestyle variables. Compared to men with no children, those with five or more retained a borderline significant association in the fully adjusted model (HR = 1.15, 95% CI = [0.99, 1.35]).

DISCUSSION: Social and lifestyle pathways appear to link parenthood to cardiovascular health.

%B Journal of Aging and Health %V 32 %P 517-529 %G eng %N 7-8 %9 Journal %R 10.1177/0898264319831512 %0 Journal Article %J Neurology %D 2020 %T Association of work-family experience with mid- and late-life memory decline in US women. %A Elizabeth R Mayeda %A Mobley, Taylor M %A Weiss, Robert E %A Audrey R Murchland %A Lisa F Berkman %A Erika L. Sabbath %K Cognition %K women %K work-family interference %X

OBJECTIVE: To test the hypothesis that lifecourse patterns of employment, marriage, and childrearing influence later-life rate of memory decline among women, we examined the relationship of work-family experiences between ages 16 and 50 years and memory decline after age 55 years among U.S. women.

METHODS: Participants were women ages ≥55 years in the Health and Retirement Study. Participants reported employment, marital, and parenthood statuses between ages 16 and 50 years. Sequence analysis was used to group women with similar work-family life histories; we identified 5 profiles characterized by similar timing and transitions of combined work, marital, and parenthood statuses. Memory performance was assessed biennially 1995-2016. We estimated associations between work-family profiles and later-life memory decline with linear mixed-effects models adjusted for practice effects, baseline age, race/ethnicity, birth region, childhood socioeconomic status, and educational attainment.

RESULTS: There were 6,189 study participants (n = 488 working non-mothers, n = 4,326 working married mothers, n = 530 working single mothers, n = 319 non-working single mothers, n = 526 non-working married mothers). Mean baseline age was 57.2 years; average follow-up was 12.3 years. Between ages 55 and 60, memory scores were similar across work-family profiles. After age 60, average rate of memory decline was 50% greater among women whose work-family profiles did not include working for pay post-childbearing, compared with those who were working mothers.

CONCLUSIONS: Women who worked for pay in early adulthood and midlife experienced slower rates of later-life memory decline, regardless of marital and parenthood status, suggesting participation in the paid labor force may protect against later-life memory decline.

%B Neurology %V 95 %P e3072-e3080 %G eng %N 23 %R 10.1212/WNL.0000000000010989 %0 Journal Article %J Gerontologist %D 2020 %T The Benefit of Moderate Alcohol Use on Mood and Functional Ability in Later Life: Due to Beers or Frequent Cheers? %A Rosanna G Scott %A Wiener, Chelsea H %A Daniel Paulson %K Alcohol Consumption %X

BACKGROUND AND OBJECTIVES: Evidence relates moderate alcohol consumption in later life to fewer depressive symptoms and greater functional ability. This study evaluated social interaction as a mediator of these outcomes.

RESEARCH DESIGN AND METHODS: Data included older adults in the Health and Retirement Study. In Study 1, cross-sectional mediation analyses evaluated social interaction as a mechanism through which moderate alcohol use was related to decreased depressive symptomatology (Model 1; N = 2,294) and less functional limitation (Model 2; N = 2,357). In Study 2, longitudinal cross-lagged path analyses further evaluated the impact of moderate alcohol use and social interaction on future depressive symptoms and functional limitation.

RESULTS: In Study 1, results from Model 1 indicated that moderate alcohol use was associated with decreased depressive symptomatology indirectly via greater social interaction. In Model 2, moderate alcohol use was associated with less functional limitation indirectly via greater social interaction. In Study 2, significant indirect effects corroborated findings from Study 1. In Model 3, moderate alcohol use in 2012 inversely predicted depressive symptomatology in 2014 via greater levels of social interaction in 2012. In Model 4, moderate alcohol use in 2012 predicted less functional limitation in 2014 via greater social interaction in 2012.

DISCUSSION AND IMPLICATIONS: Social interaction is essential to the seemingly beneficial effect of moderate alcohol use on depressive symptomatology and functional ability. Clinically, this suggests caution in attributing health benefits to consumption of alcohol itself and identifies social interaction as a treatment target for improved health outcomes in later life.

%B Gerontologist %V 60 %P 80-88 %8 2020 01 24 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30358833?dopt=Abstract %R 10.1093/geront/gny129 %0 Journal Article %J Work, Aging and Retirement %D 2020 %T Boundaries of the Construct of Unemployment in the Preretirement Years: Exploring an Expanded Measurement of Lost-Work Opportunity %A Voss, M.W. %A Al Snih, S. %A Li, Wei %A Hung, M. %A Richards, L.G. %A Wang, M. %K Retirement %K Retirement Planning %K Work %X There is uncertainty related to whether retirement negatively affects health - possibly due to complexity around retirement decisions. Lost-work opportunity through unemployment or forced retirement has been shown to negatively affect health. Lost-work opportunity can be captured in two measurement fields, either a reported experience of being forced into retirement or reported unemployment. However, 17% of individuals retiring due to the loss of work opportunity identified in qualitative interviewing (i.e., unemployment, temporary lay-offs, company buy-outs, forced relocations, etc.) do not report this unemployment or involuntary retirement in quantitative survey responses. We propose broadening the conceptualization of late-career unemployment to incorporate other lost work opportunity scenarios. Using the Health and Retirement Study (HRS), a lost-work opportunity score (LOS) was computed from items indicating unemployment and forced or unplanned retirement. Correlations were computed between this LOS and all continuous variables in the RAND longitudinal compilation of the HRS to determine its convergent and discriminant validity. The LOS demonstrated a Chronbach's alpha of α =. 82 and had convergent validity with constructs of employment (9 variables), finances (36 variables), and health (14 variables), as predicted by the literature on retirement timing. No other continuous variables in the HRS were identified with a moderate or strong correlation to LOS, demonstrating discriminant validity. Further research should explore whether a combination of variables in the HRS can improve the accuracy of measuring lost-work opportunity. Improved precision in measurement, through an expanded conceptualization of lost-work opportunity, may help explicate the retirement-related factors that affect health, to inform policy and support healthy aging decisions at a societal level. %B Work, Aging and Retirement %V 6 %P 59-63 %G eng %N 1 %R 10.1093/workar/waz006 %0 Journal Article %J The Journal of Positive Psychology %D 2020 %T Building sense of purpose in older adulthood: Examining the role of supportive relationships. %A Sara J Weston %A Nathan A Lewis %A Patrick L Hill %K No terms assigned %K older adulthood %K Sense of purpose %K Social Support %K Well-being %X Having supportive others appears valuable for developing a purpose, at least during adolescence and young adulthood. However, work has yet to consider whether sense of purpose and social support change in tandem or predict one another during older adulthood. Using a subsample (N = 7,452) of older adults from the Health and Retirement Study, we estimate the associations of purpose in life to social support and social strain in four domains (spouses/partners, children, family, friends) using bivariate growth models. Participants provided responses at three assessment occasions, 4 years apart. Analyses controlled for social contact frequency to focus on the unique role of supportive relationships. Initial levels of support correlated positively with levels for sense of purpose, while strain was negatively associated with purpose. Moreover, with the exception of family support, changes in sense of purpose were correlated with changes in support and strain in the same direction across doma %B The Journal of Positive Psychology %G eng %U http://dx.doi.org/10.1080/17439760.2020.1725607 %0 Journal Article %J Innovation in Aging %D 2020 %T Cardiometabolic Risk and Biomarker Trajectories Among Older Adults: Findings From the Health and Retirement Study %A Wu, Qiao %A Eileen M. Crimmins %A Jennifer A Ailshire %A Jung K Kim %A Zhao, Erfei %K biomarker trajectories %K cardiometabolic risk %X The deterioration of the cardiovascular system is a process associated with aging. Most of the prior works have examined changes in cardiometabolic risk (CMR) while aging at the population level using cross-sectional data, but we study within-person changes for total CMR and separate risk factors, including pulse pressure, resting heart rate, C-reactive protein, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, total cholesterol, waist circumference, and obesity. We examine 8-year changes (from 2006 to 2014) among respondents from the Health and Retirement Study biomarker sample (n=19,776). We use growth curve models to identify differences at baseline and the changes while aging, by age, gender, race/ethnicity, and education. Blacks, the old-old, the less educated, and current smokers have higher baseline CMR. The total CMR increases while people age over 8 years. HbA1c, waist circumference, and pulse pressure increase significantly with age. A reduction in total cholesterol can be observed and is likely due to medication. The CMR increase is no longer significant after accounting for socioeconomic status. The next step of this study is to focus on the disparity of risk distribution, in order to identify the individuals that are most in need of specific care and support. %B Innovation in Aging %V 4 %P 429 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.1386 %0 Journal Article %J Chest %D 2020 %T Changes in Self-Rated Health After Sepsis in Older Adults: A Retrospective Cohort Study. %A Carey, Matthew R %A Hallie C Prescott %A Theodore J Iwashyna %A Wilson, Michael E %A Angela Fagerlin %A Valley, Thomas S %K Aging %K health-related quality of life %K Quality of Life %K Sepsis %X

BACKGROUND: As more individuals survive sepsis, there is an urgent need to understand its effects on patient-reported outcomes.

RESEARCH QUESTION: What is the effect of sepsis on self-rated health, and what role, if any, does functional disability play in mediating this effect?

STUDY DESIGN AND METHODS: We conducted a survey- and administrative claims-based retrospective cohort study using the US Health and Retirement Study, a nationally representative cohort-based survey of older adults in the United States, from 2000 through 2016. We matched Medicare beneficiaries hospitalized with sepsis in 2000 to 2008 to nonhospitalized individuals. Self-rated health and functional disability were tracked biannually for 8 years. Differences in self-rated health between the cohorts were measured using mixed models with and without controlling for changes in functional disability.

RESULTS: Seven hundred fifty-eight individuals with sepsis were matched 1:1 to 758 nonhospitalized individuals, all aged 65 years and older. Among survivors, sepsis was associated with worse self-rated health in years 2 and 4 (adjusted absolute difference in self-rated health on a 5-point scale in year 2: -0.24 [95% CI, -0.38 to -0.10] and year 4: -0.17 [95% CI, -0.33 to -0.02]) but not in years 6 or 8. After accounting for changes in functional status, the association between sepsis and self-rated health was still present but reduced in year 2 (adjusted absolute difference in self-rated health, -0.18 [95% CI, -0.31 to -0.05]) and was not present in years 4, 6, or 8.

INTERPRETATION: Self-rated health worsened initially after sepsis but returned to the level of that of nonhospitalized control subjects by year 6. Mitigating sepsis-related functional disability may play a key role in improving self-rated health after sepsis.

%B Chest %V S0012-3692 %P 31732-3 %8 2020 Nov %G eng %N 20 %R 10.1016/j.chest.2020.05.606 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2020 %T Childhood adversity and major depression in later life: A competing-risks regression analysis %A Xiang, Xiaoling %A Wang, Xiafei %K adverse childhood experience %K Competing risks analysis %K geriatric depression %X Objectives This study examined the relationship between childhood adversities and major depression in older adults over eight years. Methods The study sample consisted of 16?946 participants aged 51?years and older from the U.S. Health and Retirement Study. Major depression was assessed using the Composite International Diagnostic Interview (CIDI-SF). Competing-risks regression analysis was conducted to examine the impact of each childhood adversity on late-life major depression and the potential moderation effects of sex, race/ethnicity, and adulthood trauma. Results After controlling for covariates, childhood adversities including physical abuse by a parent (SHR = 1.67, 95% CI = 1.49-1.89, P?OBJECTIVES: To investigate how cardiometabolic-inflammatory risk factors are related to cognition among older adults in India and the United States.

DESIGN: The Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) and the Harmonized Cognitive Assessment Protocol of the Health and Retirement Study (HRS-HCAP) in the United States conducted an in-depth assessment of cognition, using protocols designed for international comparison.

SETTING: Cognitive tests were conducted in hospital or household settings in India and in household settings in the United States.

PARTICIPANTS: Respondents aged 60 years and older from LASI-DAD (N = 1,865) and respondents aged 65 years and older from HRS-HCAP (N = 2,111) who provided venous blood specimen.

MEASUREMENTS: We used total composite scores from the common cognitive tests administered. Cardiovascular risk was indicated by systolic and diastolic blood pressure, pulse rate, pro-B-type natriuretic peptide (proBNP), and homocysteine. Metabolic risk was measured by body mass index, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, and lipoprotein (a) (only in India). Inflammatory risk was indicted by white blood cell count, C-reactive protein, albumin, and uric acid (only in India).

RESULTS: The distribution of both total cognition scores and of cardiometabolic risk factors differed significantly between India and the United States. In both countries, lower cognition was associated with older age, lower education, elevated homocysteine, elevated proBNP, and lower albumin levels. The associations between HbA1c levels and cognitive measures were statistically significant in both countries, but in the opposite direction, with a coefficient of 1.5 (P < .001) in India and -2.4 (P < .001) in the United States for one percentage increase in absolute HbA1c value.

CONCLUSION: Cardiometabolic-inflammatory biomarkers are associated with cognitive functional levels in each country, but the relationships may vary across countries. J Am Geriatr Soc 68:S36-S44, 2020.

%B Journal of the American Geriatrics Society %V 68 %P S36-S44 %G eng %N Suppl 3 %R 10.1111/jgs.16734 %0 Journal Article %J Scientific Reports %D 2020 %T Composite diagnostic criteria are problematic for linking potentially distinct populations: the case of frailty %A Yi-Sheng Chao %A Chao-Jung Wu %A Hsing-Chien Wu %A Hui-Ting Hsu %A Tsao, L.-C. %A Cheng, Y.-P. %A Lai, Y.-C. %A Wei-Chih Chen %K Frail Elderly %K Frailty Phenotype %K Residence Characteristics %X {Composite diagnostic criteria are common in frailty research. We worry distinct populations may be linked to each other due to complicated criteria. We aim to investigate whether distinct populations might be considered similar based on frailty diagnostic criteria. The Functional Domains Model for frailty diagnosis included four domains: physical, nutritive, cognitive and sensory functioning. Health and Retirement Study participants with two or more deficiencies in the domains were diagnosed frail. The survival distributions were analyzed using discrete-time survival analysis. The distributions of the demographic characteristics and survival across the groups diagnosed with frailty were significantly different (p < 0.05). A deficiency in cognitive functioning was associated with the worst survival pattern compared with a deficiency in the other domains (adjusted p < 0.05). The associations of the domains with mortality were cumulative without interactions. Cognitive functioning had the largest effect size for mortality prediction (Odds ratios %B Scientific Reports %V 10 %G eng %U https://www.scopus.com/inward/record.uri?eid=2-s2.0-85079339704&doi=10.1038%2fs41598-020-58782-1&partnerID=40&md5=ba7c890ffb416ce5b17f819b2c21936a %N 1 %9 Article %R 10.1038/s41598-020-58782-1 %0 Journal Article %J BMC Health Services Research %D 2020 %T Comprehensive review of ICD-9 code accuracies to measure multimorbidity in administrative data %A Melissa Y Wei %A Jamie E Luster %A Chan, Chiao-Li %A Lillian C. Min %K ICD-9 %K Literature Review %K multimorbidity %K Validation %X Background Quantifying the burden of multimorbidity for healthcare research using administrative data has been constrained. Existing measures incompletely capture chronic conditions of relevance and are narrowly focused on risk-adjustment for mortality, healthcare cost or utilization. Moreover, the measures have not undergone a rigorous review for how accurately the components, specifically the International Classification of Diseases, Ninth Revision (ICD-9) codes, represent the chronic conditions that comprise the measures. We performed a comprehensive, structured literature review of research studies on the accuracy of ICD-9 codes validated using external sources across an inventory of 81 chronic conditions. The conditions as a weighted measure set have previously been demonstrated to impact not only mortality but also physical and mental health-related quality of life. Methods For each of 81 conditions we performed a structured literature search with the goal to identify 1) studies that externally validate ICD-9 codes mapped to each chronic condition against an external source of data, and 2) the accuracy of ICD-9 codes reported in the identified validation studies. The primary measure of accuracy was the positive predictive value (PPV). We also reported negative predictive value (NPV), sensitivity, specificity, and kappa statistics when available. We searched PubMed and Google Scholar for studies published before June 2019. Results We identified studies with validation statistics of ICD-9 codes for 51 (64%) of 81 conditions. Most of the studies (47/51 or 92%) used medical chart review as the external reference standard. Of the validated using medical chart review, the median (range) of mean PPVs was 85% (39–100%) and NPVs was 91% (41–100%). Most conditions had at least one validation study reporting PPV ≥70%. Conclusions To help facilitate the use of patient-centered measures of multimorbidity in administrative data, this review provides the accuracy of ICD-9 codes for chronic conditions that impact a universally valued patient-centered outcome: health-related quality of life. These findings will assist health services studies that measure chronic disease burden and risk-adjust for comorbidity and multimorbidity using patient-centered outcomes in administrative data. %B BMC Health Services Research %V 20 %@ 1472-6963 %G eng %! BMC Health Services Research %& 489 %R 10.1186/s12913-020-05207-4 %0 Journal Article %J BMC Medical Genomics %D 2020 %T Considering the APOE locus in Alzheimer's disease polygenic scores in the Health and Retirement Study: a longitudinal panel study. %A Erin B Ware %A Jessica Faul %A Colter Mitchell %A Kelly M Bakulski %K Alzheimer’s disease %K Apolipoprotein E %K Dementia %K P-value %K polygenic score %K Thresholding %X

BACKGROUND: Polygenic scores are a strategy to aggregate the small, additive effects of single nucleotide polymorphisms across the genome. With phenotypes like Alzheimer's disease, which have a strong and well-established genomic locus (APOE), the cumulative effect of genetic variants outside of this area has not been well established in a population-representative sample.

METHODS: Here we examine the association between polygenic scores for Alzheimer's disease both with and without the APOE region (chr19: 45,384,477 to 45,432,606, build 37/hg 19) at different P value thresholds and dementia. We also investigate the addition of APOE-ε4 carrier status and its effect on the polygenic score-dementia association in the Health and Retirement Study using generalized linear models accounting for repeated measures by individual and use a binomial distribution, logit link, and unstructured correlation structure.

RESULTS: In a large sample of European ancestry participants of the Health and Retirement Study (n = 9872) with an average of 5.2 (standard deviation 1.8) visit spaced two years apart, we found that including the APOE region through weighted variants in a polygenic score was insufficient to capture the large amount of risk attributed to this region. We also found that a polygenic score with a P value threshold of 0.01 had the strongest association with the odds of dementia in this sample (odds ratio = 1.10 95%CI 1.0 to 1.2).

CONCLUSION: We recommend removing the APOE region from polygenic score calculation and treating the APOE locus as an independent covariate when modeling dementia. We also recommend using a moderately conservative P value threshold (e.g. 0.01) when creating polygenic scores for Alzheimer's disease on dementia. These recommendations may help elucidate relationships between polygenic scores and regions of strong significance for phenotypes similar to Alzheimer's disease.

%B BMC Medical Genomics %V 13 %P 164 %G eng %N 1 %R 10.1186/s12920-020-00815-9 %0 Journal Article %J International Journal of Population Studies %D 2020 %T Correlates of internet use among African American older adults: Gender and age differences %A Wang, Kun %A Kubanga, Kefentse %K African Americans %K gender %K Internet use %X This study aimed to compare internet use among African American older adults by gender and age group and investigate correlates of internet use by gender and age group. A total of 1117 African American older adults aged over 50 from the 2016 Wave of the Health Retirement Study were included in the study. Sequential ordinal logistic regressions were conducted to investigate correlates of internet use among older African Americans by gender and age group. Significant gender and age differences were identified in internet use frequency. Gender differences on correlates were revealed: being old-old and limitations on activities of daily living were only associated with decreased odds of more frequent internet use among women. In addition, higher depression was only associated with reduced odds of more frequent internet use among men. Age differences on correlates indicated that education and cognition were the only two significant factors pertinent to internet use among the old-old. By contrast, for young-old adults, retirement, poverty, education, cognition, and depression were also predictive. Practitioners should consider these gender and age differences when promoting internet use among older African Americans. The results presented in this study might also inform the design of future gender- and age-tailored interventions. %B International Journal of Population Studies %V 6 %P 26-38 %G eng %N 2 %R 10.18063/ijps.v6i2.1226 %0 Journal Article %J PLoS One %D 2020 %T A data-driven prospective study of dementia among older adults in the United States. %A Weiss, Jordan %A Puterman, Eli %A Aric A Prather %A Erin B Ware %A David Rehkopf %X

BACKGROUND: Studies examining risk factors for dementia have typically focused on testing a priori hypotheses within specific risk factor domains, leaving unanswered the question of what risk factors across broad and diverse research fields may be most important to predicting dementia. We examined the relative importance of 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors across the life course in predicting incident dementia and how these rankings may vary across racial/ethnic (non-Hispanic white and black) and gender (men and women) groups.

METHODS AND FINDINGS: We conducted a prospective analysis of dementia and its association with 65 risk factors in a sample of 7,908 adults aged 51 years and older from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine and Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the semi-competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups such that at most four risk factors were consistently observed in the top ten predictors across the four demographic strata (non-Hispanic white men, non-Hispanic white women, non-Hispanic black men, non-Hispanic black women).

CONCLUSIONS: We identified leading risk factors across racial/ethnic and gender groups that predict incident dementia over a 14-year period among a nationally representative sample of US aged 51 years and older. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein.

%B PLoS One %V 15 %8 2020 %G eng %N 10 %R 10.1371/journal.pone.0239994 %0 Report %D 2020 %T A data-driven prospective study of incident dementia among older adults in the United States %A Weiss, Jordan %A Puterman, Eli %A Aric A Prather %A Erin B Ware %A David Rehkopf %K data-driven %K Dementia %K Fine-Gray models %K risk of death %X We conducted a prospective analysis of incident dementia and its association with 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors in a sample of 7,908 adults over the age of 50 from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine-Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein. %I Cornell University %C Ithaca, NY %G eng %U https://arxiv.org/abs/2006.13275 %0 Journal Article %J Gerontology and Geriatric Medicine %D 2020 %T Dementia Is Associated With Earlier Mortality for Men and Women in the United States. %A White, Lindsay %A Fishman, Paul %A Basu, Anirban %A Paul K Crane %A Eric B Larson %A Norma B Coe %K Dementia %K gender %K Medicare %K Medicare administrative data %X

Sociodemographic trends in the United States may influence future dementia-associated mortality, yet there is little evidence about their potential impact. Our study objective was to estimate the effect of dementia on survival in adults stratified by sex, education, and marital status. Using survey data from the Health and Retirement Study (HRS) linked to Medicare claims from 1991 to 2012, we identified a retrospective cohort of adults with at least one International Classification of Diseases-ninth revision-Clinical Modification (ICD-9-CM) dementia diagnosis code ( = 3,714). For each case, we randomly selected up to five comparators, matching on sex, birth year, education, and HRS entry year ( = 9,531), and assigned comparators the diagnosis date of their matched case. Participants were followed for up to 60 months following diagnosis. We estimated a survival function for the entire study population and then within successive strata defined by sex, education, and marital status. On average, dementia cases were 80.5 years old at diagnosis. Most were female, had less than college-level education, and approximately 40% were married at diagnosis. In multivariate analyses, dementia diagnosis was associated with earlier mortality for women (predicted median survival of 54.5 months vs. 62.5 months; dementia coefficient = -0.13; 95% confidence interval [CI] = [-0.22, -0.04]; = .003), but even more so among men (predicted median survival of 35.5 months vs. 54.5 months; dementia coefficient = -0.42; 95% CI = [-0.52, -0.31]; < .001). We found substantial heterogeneity in the relationship between dementia and survival, associated with both education and marital status. Both sex and level of education moderate the relationship between dementia diagnosis and length of survival.

%B Gerontology and Geriatric Medicine %V 6 %P 2333721420945922 %G eng %R 10.1177/2333721420945922 %0 Journal Article %J Journal of General Internal Medicine %D 2020 %T Difficulty with Taking Medications Is Associated with Future Diagnosis of Alzheimer's Disease and Related Dementias. %A Douglas Barthold %A Marcum, Zachary A %A Chen, Shuxian %A White, Lindsay %A Ailabouni, Nagham %A Basu, Anirban %A Norma B Coe %A Gray, Shelly L %K Alzheimer’s disease and related dementias %K cognitive screening %K medication management %X

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

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

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

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

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

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

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

%B Journal of General Internal Medicine %G eng %R 10.1007/s11606-020-06279-y %0 Journal Article %J Innovation in Aging %D 2020 %T Do Social Support and Strain Mediate the Relationship Between Childhood Exposures and Frailty in Later Life? %A Monica Williams-Farrelly %A Kenneth F Ferraro %K Childhood exposures %K Frailty %K Social strain %K Social Support %X Previous studies have identified the early origins of physical frailty, notably poor childhood health and socioeconomic status, but relatively few studies examine whether social support in later life mitigates the influence of early noxious exposures on frailty. Given the established relationship between health and social relationships in older adults, this research uses data from the Health and Retirement study (2004-2016) to examine whether social support and strain mediate the effect of childhood exposures on frailty in later life. A series of linear regression and pathway models were estimated to test whether childhood exposures, including socioeconomic status, infectious and chronic diseases, impairments, and risky adolescent parental behaviors, were associated with phenotypic frailty (Fried et al. 2001). After adjusting for demographic and adult factors, accumulated childhood misfortune was directly (b=0.015, p<.01) and indirectly (b=0.007, p<.001) associated with more frailty. Average social support, but not strain, from oneā€™s spouse, children, family and friends significantly mediated the relationship between accumulated misfortune and frailty (b= -.002, p<.01). Path analysis revealed that social support reduces later life frailty directly (b=-0.106 ,p<.001) and indirectly through a reduction in adult morbidity (b=-0.031, p<.001). However, counterintuitively we found that accumulated misfortune was associated with more social support. Supplemental analyses reveal that one or more infectious diseases in childhood were responsible for the positive relationship (b= 0.393, p<.001). These results have implications for how we may reduce the burden of frailty on those who have experienced misfortune early in life. %B Innovation in Aging %V 4 %P 497 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1606 %0 Report %D 2020 %T Does Late-Career Nontraditional Work Improve Retirement Security? %A Matthew S. Rutledge %A Gal Wettstein %K nontraditional jobs %K retirement security %X Policymakers and the media have expressed concern that nontraditional jobs lack stability and financial security. Indeed, having a nontraditional job – defined here as a job without employer health and retirement benefits – during the prime saving years of ages 50-61 is associated with less retirement security.1 But nontraditional jobs need not be “bad jobs” for all workers. Compared to traditional work, they may be a better fit for those in their 60s looking to prolong their careers by offering less stress and more flexibility.2 This brief, based on a recent study, examines how workers use nontraditional jobs after age 62, relying on data from the Health and Retirement Study linked to administrative earnings.3 It explores two questions. First, are workers in their early 60s who are underprepared for retirement more likely to use nontraditional jobs? Second, are such jobs a useful alternative to traditional work for those seeking to enhance their retirement security? The discussion proceeds as follows. The first section introduces the data and the sample. The second section describes the analytic approach, which follows three groups of workers with different employment patterns in their 60s. The third section compares the retirement security of these three groups at ages 61-62 and examines the changes they experience in retirement security by ages 67-68. The final section concludes that the workers who start out less prepared for retirement are not more likely to switch to nontraditional work in their mid-60s. But underprepared workers who do switch improve their retirement security as much as those who stay in traditional work. These results suggest that extended careers are financially beneficial, even in jobs without health and retirement benefits.4 %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/briefs/does-late-career-nontraditional-work-improve-retirement-security/ %0 Journal Article %J Innovation in Aging %D 2020 %T Does the Sharing of Resources Impact Health Among Married Couples? New Findings From Dyadic Models %A Wang, Shuangshuang %A Kim, Kyungmin %A Lyons, Karen %K dyadic models %K health %K Married Individuals %X As married couples aging together, their health behaviors and outcomes could be shaped by both one’s own and the spouse’s characteristics. Using dyadic datasets, speakers in this symposium explored the interdependence nature of marital relations by identifying the mechanisms of how shared resources or strains affect spouses’ physical and mental health outcomes among married couples. Wang, Kim, and Burr identified distinct types of personality configurations among older couples using the Health and Retirement Study, and examined how personality compatibilities could buffer negative effects of adverse life events on older couples’ mental health. Using data from the National Social Life, Health, and Aging Project, Proulx, Skoblow, and Han further investigated the associations between marital quality and mental health among caregiving dyads, with a special focus on a comparison of different caregiving groups (spouse, child, others). From a physical health perspective, Wilson and Novak presented the dynamic behind relationship quality, joint health behaviors, health problems, health satisfaction, and health similarity between spouses. Finally, Kim, Jang, Park, and Chiriboga focused on couple contexts for acculturation among older Korean immigrants in the U.S., and examined how each spousal acculturation level affects healthcare utilization and difficulties in health service use. Focusing on married couples, this symposium showcases the interplay of family experiences, health behaviors, and relational dynamics of both spouses in shaping their health, and highlights the benefits of dyadic approaches. Speakers and our discussant, Dr. Karen Lyons, will discuss implications for social program design and future research. %B Innovation in Aging %V 4 %P 582 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1941 %0 Journal Article %J Innovation in Aging %D 2020 %T The Dyadic Effects of Perceived Support on Depression in Spousal Care Partners %A Meyer, Kylie %A Patel, Neela %A White, Carole %K depression %K dyadic effects %K perceived support %K Spouses %X Relationship quality is an important factor affecting care partners’ health and wellbeing. Supportive marital relationships are associated with better physical and subjective health, whereas strain is associated with poorer health. Recent studies now indicate a dyadic effect of relationship quality on health outcomes, such that an individual’s perceptions of their relationship also affects their partner’s outcomes. Few studies have examined the dyadic effects of relationship quality on mental health among older cognitively intact caregiving couples. To address the lack of dyadic research about how perceived support from one’s spouse related to experiences of depression for individuals and their care partners, we apply cross-sectional actor partner interdependence models (APIMs) to data from the Health and Retirement Study (HRS) (N=490 dyads). APIM regression models controlled for participant demographic characteristics, relationship length, and care recipient functional ability. Findings showed that positive perceived support from a spouse had a stronger negative association with one’s own depression for care recipients than for caregivers. Similarly, greater negative perceived support from a partner was associated with higher levels of depression; whether the partner was the caregiver or care recipient did not make a difference in this model. Although there are hundreds of caregiver interventions to address caregivers’ mental health, few have demonstrated improvement in care recipient outcomes. Observation of both actor and partner effects in this study suggests there may be opportunities to improve care recipient and caregiver mental health by targeting interventions to promote high quality relationships with caregivers or both members of the care dyad. %B Innovation in Aging %V 4 %P 354 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1139 %0 Journal Article %J Journal of Social and Personal Relationships %D 2020 %T Dyadic profiles of personality among older couples: Associations with marital quality %A Wang, S. %A Kyungmin Kim %A Jeffrey E Stokes %K Dyadic data analysis %K Gender Differences %K Marriage %K Personality %X Understanding dyadic personality configurations and their associations with marital quality helps identify couples who are at high risk of marital strain. However, current research on personality similarity among spouses usually confounds couples with similarly positive and similarly negative personalities. This study aimed to (1) provide a clearer classification of dyadic personality profiles among older couples, (2) examine the associations between these profiles and both partners’ marital quality, and (3) explore gender differences in these associations. Data came from 3,178 older couples drawn from the 2010/2012 waves of the Health and Retirement Study. Latent profile analysis was used to identify dyadic personality profiles based on spouses’ standardized Big Five personality scores. Multilevel models examined associations between dyadic personality profiles and each partner’s marital quality, testing for gender differences as well. Six dyadic personality profiles were identified, including two opposite profiles (52%; positive wife–negative husband and positive husband–negative wife), two similar profiles (40%; similarly positive and similarly negative), and two extreme profiles (8%; extremely negative husband and extremely negative wife). Couples in the similarly positive profile reported the best marital quality, whereas couples in the similarly negative profile and the two extreme profiles reported the worst marital quality. The associations between profiles characterized by negative traits and marital quality were more pronounced among wives than husbands. This study advances the understanding of personality similarity and its consequences, suggesting heterogeneous subgroups of dyadic personalities among older couples and providing evidence of gender differences in the implications of personality similarity for relationship quality. %B Journal of Social and Personal Relationships %V 37 %G eng %N 6 %R 10.1177/0265407520916246 %0 Journal Article %J American Journal of Epidemiology %D 2020 %T Early Educational Experiences and Trajectories of Cognitive Functioning Among Mid-Life and Older U.S. Adults %A Katrina M Walsemann %A Jennifer A Ailshire %X Educational attainment is often considered the most important protective factor against cognitive impairment and dementia, yet significant variation in early educational experiences exists among mid-life and older U.S. adults. We use prospective data from the Health and Retirement Study (HRS) along with information on respondents’ early educational experiences collected in the 2015 and 2017 HRS Life History Mail Survey (HRS-LHMS) to examine if school context, educational content, and academic ability are associated with trajectories of cognitive functioning and whether educational attainment explains this relationship. We restrict our sample to age-eligible HRS-LHMS respondents who provided data on cognitive functioning at least once from 1998 to 2014, and attended primary school or higher (n=9,565 respondents providing 62,037 person-period observations). Estimates from linear mixed models revealed that school context, educational content, and academic ability were significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Educational attainment explained from 9\% to 55\% of the association between these early educational experiences and level of cognitive functioning; however, all relationships remained statistically significant. Our results suggest that educational experiences that span childhood and adolescence are independently related to level of cognitive functioning decades later. %B American Journal of Epidemiology %8 01 %G eng %U https://doi.org/10.1093/aje/kwz276 %R 10.1093/aje/kwz276 %0 Journal Article %J Innovation in Aging %D 2020 %T Early Life Conditions, Adulthood Experiences, and Edentulism at Older Ages %A Lee, Haena %A Linda J. Waite %K adulthood experiences %K early life conditions %K edentulism %K Oral Health %X The role of childhood in shaping overall adult health has been well documented, especially for physical and mental health, but much less is known about the impact of early disadvantage on oral health in later life. Using data from the 2006 and 2012 Health and Retirement Study, we investigate the link between childhood financial and psychosocial adversity and edentulism over a six-year period among U.S. adults aged 51 and older. We find that those growing up with parents with fewer resources face higher risks of having lost all their tooth at baseline and during the follow-up. Adulthood socioeconomic status and health behaviors are strongly associated with the risk of edentulism, net of childhood conditions. However, the effect of low parental resources on the onset of edentulism persists when accounting for these life course factors. Part of a symposium sponsored by the Oral Health Interest Group. %B Innovation in Aging %V 4 %P 800 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.2900 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Edentulism and trajectories of cognitive functioning among older adults: The role of dental care service utilization. %A Sae Hwang Han %A Bei Wu %A Jeffrey A Burr %K Cognitive Ability %K Dental Care %K Health Services Utilization %X

OBJECTIVE: This study examined the associations between edentulism, dental care service utilization, and cognitive functioning trajectories among older adults.

METHOD: Longitudinal data from the Health and Retirement Study (2006-2014) were employed to examine individuals aged 51 and older who were identified as having normal cognition at baseline ( N = 12,405). Cognitive functioning was measured with a modified version of the Telephone Interview for Cognition Status. Edentulism was self-reported as total tooth loss at baseline. Dental care service utilization was measured by self-report of having visited a dentist at least once during the previous 2 years.

RESULTS: The results indicated that edentulism and dental care service utilization were independently associated with cognitive decline during the observation period. Findings also showed that dental care service utilization moderated the association between edentulism and cognitive decline.

DISCUSSION: The findings suggested that providing access to dental services may promote cognitive health and potentially reduce health care expenditures.

%B Journal of Aging and Health %V 32 %P 744-752 %G eng %N 7-8 %R 10.1177/0898264319851654 %0 Journal Article %J Sustainability %D 2020 %T Effect of Work Environment on Presenteeism among Aging American Workers: The Moderated Mediating Effect of Cynical Hostility %A Deng, Jianwei %A Wu, Zhennan %A Tianan Yang %A Cao, Yunfei %A Chen, Zhenjiao %K chronic work discrimination %K cynical hostility %K Presenteeism %K work environment %X Cynical hostility in the workplace has been studied. However, there is still no complete study examining how cynical hostility affects work performance. We examined how work environment impacts presenteeism through the mediation of cynical hostility and how chronic work discrimination moderates the relationship between work environment and cynical hostility among ageing workforces. The psychosocial vulnerability model supplies theoretical support for our model. We analyzed data from a sample of 2926 aging workforces from the Health and Retirement Study. Structural equation modeling (SEM) was used to examine the relationships with a moderated mediation model. In the final SEM model, our results showed that work environment was directly negatively associated with presenteeism. Moreover, cynical hostility was significantly inversely correlated with work environment and positively correlated with presenteeism. We found that the significant indirect effect between work environment and presenteeism can be significantly mediated by cynical hostility. In addition, cynical hostility is more likely to be affected by work environment among ageing workforces with lower levels of chronic work discrimination than those with higher levels. Enterprise, government, and employees themselves should be aware of the impact of presenteeism on ageing workforces with high levels of cynical hostility. %B Sustainability %V 12 %G eng %N 13 %R https://doi.org/10.3390/su12135314 %0 Journal Article %J JAMA Neurology %D 2020 %T Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records %A Andrew C. Stokes %A Weiss, Jordan %A Lundberg, Dielle J. %A Xie, Wubin %A Jung K Kim %A Samuel H. Preston %A Eileen M. Crimmins %K Dementia %K Mortality %X Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed.To estimate the percentage of deaths attributable to dementia in the US.A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults.Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff.Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates.Of the 7342 total sample, 4348 participants (60.3%) were women. At baseline, 4533 individuals (64.0%) were between ages 70 and 79 years, 2393 individuals (31.0%) were between 80 and 89 years, and 416 individuals (5.0%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6% (95% CI, 12.2%-15.0%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7%; 95% CI, 17.3-31.4) than non-Hispanic White participants (12.2%; 95% CI, 10.7-13.6) and among adults with less than a high school education (16.2%; 95% CI, 13.2%-19.0%) compared with those with a college education (9.8%; 95% CI, 7.0%-12.5%). Underlying cause of death recorded on death certificates (5.0%; 95% CI, 4.3%-5.8%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation.The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia. %B JAMA Neurology %V 77 %P 1543-1550 %@ 2168-6149 %G eng %N 12 %R 10.1001/jamaneurol.2020.2831 %0 Journal Article %J Social Science & Medicine %D 2020 %T Examining associations of food insecurity with major depression among older adults in the wake of the Great Recession %A Rachel S. Bergmans %A Riley Wegryn-Jones %K depression %K Food insecurity %K Life transitions %K Older Adults %K Recession %K relative disadvantage %K social comparison %K stress process %X Abstract: As a psychosocial stressor, the degree to which food insecurity impacts depression may be dependent on macro-level context, which can be examined in the wake of the Great Recession. The objective of this study was to determine (1) whether food insecurity transition status (i.e. initially food insecure, becoming food insecure, and remaining food insecure vs. not food insecure) was associated with major depression in older adults, and; (2) whether this association was moderated by macrolevel context. Data came from the United States Health and Retirement Study, 2008-2016. Multivariable logistic regression across all years revealed that major depression was associated with any exposure to food insecurity, however; this association was moderated by time period. Remaining food insecure was associated with major depression during all time periods. In contrast, becoming food insecure was associated with major depression in the years during and immediately following the Recession, but not in later time periods. Findings suggest that associations of food insecurity with major depression among older adults are moderated by macro-level context, consistent with theories of social comparison and relative disadvantage. Food insecurity may represent an important risk factor for major depression and mental health disparities across socioeconomic strata among older adults. Thus, policies that increase access to food assistance programs or improve the quality of local food environments may buffer against the impact of food insecurity on depression and associated complications in old age. %B Social Science & Medicine %V 258 %G eng %R 10.1016/j.socscimed.2020.113033 %0 Journal Article %J Current Developments in Nutrition %D 2020 %T Food Insecurity and Dietary Quality in Older Adults: Do Nutrition Assistance Programs Play a Protective Role? %A Nicholas J Bishop %A Sarah Ullevig %A Krystle E Zuniga %A Wang, Kaipeng %K acute hemorrhagic edema of childhood %K Aging %K diet %X Objectives The emergence of food insecurity as a primary nutrition-related health issue among older adults suggests a need to examine how nutritional assistance programs are related to food insecurity and dietary quality in aging populations. This project examines food insecurity and dietary quality in US adults age 65 and older and the impact of nutrition assistance programs. Methods The sample was drawn from the 2012 Health and Retirement Study and 2013 Health Care and Nutrition Study and included 3779 respondents representing a population of 37,217,566 adults aged 65 and older. Food insecurity was a binary measure based on the USDA six-item US Adult Food Security Survey Module. Two forms of nutritional assistance included receipt of supplemental food from sources such as food banks and Meals-on-Wheels (1 = yes, 0 = no) and reported receipt of SNAP benefits (1 = yes, 0 = no). Dietary quality was measured using the Alternative Healthy Eating Index-2010 based on a food frequency questionnaire. General linear modeling adjusting for covariates and complex sampling design was used to test if nutritional assistance moderated the association between food insecurity and AHEI-2010. Results Around 10% of the sample was food insecure, 14% reported receipt of supplemental food, and 6.4% were SNAP benefit recipients. In covariate-adjusted models, food insecurity and receipt of SNAP benefits were not associated with AHEI-2010, but receipt of supplemental food was (b = −1.39, SE = 0.67, P = 0.038). Receipt of supplemental food moderated the association between AHEI-2010 and food insecurity (P = 0.001). Simple effect estimates suggested that among those not receiving supplemental food, the food insecure had lower AHEI-2010 scores than the food secure (b = −2.15, SE = 0.88, P = 0.014). Among those receiving supplemental food, the food insecure had greater AHEI-2010 scores than the food secure (b = 2.62, SE = 1.25, P = 0.035) and similar AHEI-2010 scores as the food secure not receiving supplemental food. Conclusions Preliminary analysis suggests that receipt of supplemental food appears to be associated with better dietary quality among food-insecure older adults and confirms the importance of food assistance programs in combating the negative effect of food insecurity on dietary quality. %B Current Developments in Nutrition %V 4 %P 1379 %G eng %N 2 %R 10.1093/cdn/nzaa061_007 %0 Newspaper Article %B Michigan News %D 2020 %T For elderly couples, negative thoughts about aging can be detrimental to their spouses %A Wadley, Jared %K elderly couples %K health %K Self-perception %X Elderly husbands and wives can expect their health to decline—as well as that of their spouse—when their self-perceptions about aging become negative, a new study suggests. Led by researchers at the University of Michigan and Zhejiang University, the study found that health effects differ by gender among elderly couples. The husband’s self-perceptions about aging are associated with his wife’s depressive symptoms, whereas the wife’s views correlate with her husband’s physical disability, functional limitations and chronic diseases, the findings indicated. %B Michigan News %C Ann Arbor, MI %G eng %U https://news.umich.edu/for-elderly-couples-negative-thoughts-about-aging-can-be-detrimental-to-their-spouses/ %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 Neuroepidemiology %D 2020 %T The Health and Retirement Study Harmonized Cognitive Assessment Protocol Project: Study Design and Methods %A Kenneth M. Langa %A Lindsay H Ryan %A Ryan J McCammon %A Richard N Jones %A Jennifer J Manly %A Deborah A Levine %A Amanda Sonnega %A Farron, M. %A David R Weir %K Cognition %K cognitive assessment %K study design %X Introduction: The Harmonized Cognitive Assessment Protocol (HCAP) Project is a substudy within the Health and Retirement Study (HRS), an ongoing nationally representative panel study of about 20,000 adults aged 51 or older in the United States. The HCAP is part of an international research collaboration funded by the National Institute on Aging to better measure and identify cognitive impairment and dementia in representative population-based samples of older adults, in the context of ongoing longitudinal studies of aging in high-, middle-, and low-income countries around the world. Methods: The HCAP cognitive test battery was designed to measure a range of key cognitive domains affected by cognitive aging (including attention, memory, executive function, language, and visuospatial function) and to allow harmonization and comparisons to other studies in the United States and around the world. The HCAP included a pair of in-person interviews, one with the target HRS respondent (a randomly selected HRS sample member, aged 65+) that lasted approximately 1 h and one with an informant nominated by the respondent that lasted approximately 20 min. The final HRS HCAP sample included 3,496 study subjects, representing a 79% response rate among those invited to participate. Conclusion: Linking detailed HCAP cognitive assessments to the wealth of available longitudinal HRS data on cognition, health, biomarkers, genetics, health care utilization, informal care, and economic resources and behavior will provide unique and expanded opportunities to study cognitive impairment and dementia in a nationally representative US population-based sample. The fielding of similar HCAP projects in multiple countries around the world will provide additional opportunities to study international differences in the prevalence, incidence, and outcomes of dementia globally with comparable data. Like all HRS data, HCAP data are publicly available at no cost to researchers. %B Neuroepidemiology %8 2019 %@ 0251-5350 %G eng %R 10.1159/000503004 %0 Journal Article %J Journal of Aging and Health %D 2020 %T Health effects of late-career unemployment %A Maren W Voss %A Lori Wadsworth %A Wendy Church Birmingham %A Merryman, M. Beth %A Crabtree, Lisa %A Subasic, Kathy %A Hung, Man %K Job loss %K Retirement Planning and Satisfaction %K Unemployment %X Objective: Job loss has a demonstrated negative impact on physical and mental health. Involuntary retirement has also been linked to poorer physical and mental health outcomes. This study examined whether late-career unemployment is related to involuntary retirement and health declines postretirement. Method: Analysis was conducted using the 2000-2012 U.S. Health and Retirement Study (HRS) survey data with unemployment months regressed with demographic and baseline health measures on physical and mental health. Results: Individuals with late-career unemployment reported more involuntary retirement timing (47.0%) compared with those reporting no unemployment (27.9%). Late-career unemployment had no significant effect on self-reported physical health (β =.003, p =.84), but was significantly associated with lower levels of mental health (β =.039; p <.01). Conclusion: Self-reports of late-career unemployment are not associated with physical health in retirement, but unemployment is associated with involuntary retirement timing and mental health declines in retirement. Unemployment late in the working career should be addressed as a public mental health concern. %B Journal of Aging and Health %V 32 %P 106-116 %G eng %U https://journals.sagepub.com/doi/10.1177/0898264318806792 %N 1 %9 Journal %! J Aging Health %R 10.1177/0898264318806792 %0 Journal Article %J 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 Report %D 2020 %T The Illusory Benefit of Working Longer on Financial Preparedness for Retirement %A Teresa Ghilarducci %A Papadopoulos, Michael %A Anthony Webb %K older worker labor supply %K Retirement income %K Social Security claiming %X Older workers with insufficient savings are advised to delay retirement. Using Health and Retirement Study data, we compare outcomes of those who delay retirement, a possibly select group, with the predictions of a typical spreadsheet model. Work to age 70 is associated with an 18 percentage-point increase in the share financially prepared for retirement, compared with a predicted 46 percentage points because most older workers claim Social Security and retirement wealth barely increases. Drawing down retirement wealth while working makes sense for most, because earnings are lower than post-retirement income, in part because many older workers voluntarily work part time. %B Schwartz Center for Economic Policy Analysis Working Paper %I The New School for Social Research %C New York City %G eng %U https://www.economicpolicyresearch.org/images/docs/research/retirement_security/The_Illusory_Benefits_of_Working_Longer_Working_Paper_2020.pdf %0 Journal Article %J Journal of General internal Medicine %D 2020 %T Impact of Instrumental Activities of Daily Living Limitations on Hospital Readmission: an Observational Study Using Machine Learning %A Nicholas K Schiltz %A Dolansky, Mary A. %A David F Warner %A Kurt C Stange %A Gravenstein, Stefan %A Siran M Koroukian %K Activities of Daily Living %K Health Services Research %K multimorbidity %K Patient Readmission %K supervised machine learning %X Background Limitations in instrumental activities of daily living (IADL) hinder a person’s ability to live independently in the community and self-manage their conditions, but its impact on hospital readmission has not been firmly established. Objective To test the importance of IADL dependency as a predictor of 30-day readmissions and quantify its impact relative to other morbidities. Design A retrospective cohort study of the population-based Health and Retirement Study linked to Medicare claims data. Random forest was used to rank each predictor variable in terms of its ability to predict readmission. Classification and regression tree (CART) was used to identify complex multimorbidity combinations associated with high or low risk of readmission. Generalized linear regression was used to estimate the adjusted relative risk of readmission for IADL limitations. Subjects Hospitalizations of adults age 65 and older (n = 20,007), from 6617 unique subjects. Main Measures The main outcome was 30-day all-cause unplanned readmission. The main predictor of interest was self-reported IADL limitation. Other key predictors were self-reported complex multimorbidity including chronic diseases, geriatric syndromes, and activities of daily living (ADL) limitations, along with demographic, socioeconomic, and behavioral factors. Key Results The overall 30-day readmission rate in the study was 16.4%. Random forest analysis ranked ADLs and IADL limitations as the two most important predictors of 30-day readmission. CART identified hospitalizations of patients with IADL limitations and diabetes as a subgroup at the highest risk of readmission (26% readmitted). Multivariable regression analyses showed that ADL limitations were associated with 1.17 (1.06–1.29) times higher risk of readmission even after adjusting for other patient covariates. Risk prediction was modest though for even the best model (AUC = 0.612). Conclusions IADL limitations are key predictors of 30-day readmission as demonstrated using several machine learning methods. Routine assessment of functional abilities in hospital settings could help identify those most at risk. %B Journal of General internal Medicine %@ 1525-1497 %G eng %R https://doi.org/10.1007/s11606-020-05982-0 %0 Journal Article %J Research in Human Development %D 2020 %T The Impact of Region and Urbanicity on the Discrimination-Cognitive Health Link Among Older Blacks %A Kimson E Johnson %A Sol, Ketlyne %A Sprague, Briana N. %A Tamara J. Cadet %A Muñoz, Elizabeth %A Noah J Webster %K Cognitive health %K Discrimination %K non-urban versus urban areas %X Little research has examined how the link between discrimination and cognitive health varies by where people live. This study investigates how living in non-urban versus urban areas in different regions in the United States moderates the discrimination-cognitive health link among older non-Hispanic Blacks. Data are from the 2012 and 2014 waves of the Health and Retirement Study (HRS; N = 2,347). Regression analyses indicate that experiencing more everyday discrimination is significantly associated with lower episodic memory when living in urban areas. Among non-Hispanic Blacks, the discrimination-episodic memory link does not significantly vary across U.S. regional contexts. Findings highlight variation in the association between everyday discrimination and cognitive health by where older non-Hispanic Blacks live. Results suggest the importance of socio-environmental factors in shaping how stressful experiences such as discrimination are linked to cognitive health in later life. %B Research in Human Development %V 17 %P 4 - 19 %@ 1542-7609 %G eng %N 1 %R 10.1080/15427609.2020.1746614 %0 Journal Article %J Journal of Family Issues %D 2020 %T The Implications of Providing Grandchild Care for Grandparents’ Marital Quality %A Wang, Shuangshuang %A Jan E Mutchler %K Child Care %K dyadic relationship/quality/satisfaction %K gender and family %K intergenerational %K quantitative %X This study distinguished among types of grandchild care (i.e., co-residence, high and low levels of babysitting, and no care), and examined their associations with grandparents? marital quality. The sample consisted of 7,267 married grandparents aged 40 years and over from the 2008, 2010, and 2012 waves of the Health and Retirement Study. Providing grandchild care generally undermined grandparents? marital quality; however, different types of grandchild care affected different aspects of marital quality. The negative effects of providing grandchild care were more pronounced among grandmothers than grandfathers. Grandmothers providing high-level babysitting care were at especially higher risk of experiencing marital strain among the caregiver groups. Findings suggest that providing grandchild care appears to be more of a stressor than a source of reward with respect to shaping grandparents? marital quality. Sensitivity to such impact on marital quality may be usefully incorporated into developing supports and services meant for grandparent caregivers. %B Journal of Family Issues %@ 0192-513X %G eng %R 10.1177/0192513X20934845 %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 Thesis %B Gerontology %D 2020 %T Intergenerational Relationships and Sleep in Aging Families %A Wang, Haowei %K insomnia %K Parent-Child Relations %K Sleep %X Sleep is a fundamental health behavior that has implications for physical and psychological well-being across the life course. As people age, they have increased concerns about sleep. This dissertation comprises three studies that provide complementary perspectives on how intergenerational relationships are associated with sleep for older adults. Using 2006, 2010, and 2014 waves data of the Health and Retirement Study, Study 1 examined the bidirectional link between parent-child relationship quality and insomnia among U.S. older adults (N = 3,567). Results from autoregressive cross-lagged panel models showed that negative parent-child relationship quality at earlier waves was indirectly associated with older parents’ insomnia in later waves through depressive symptoms. Older parents’ insomnia at earlier waves was related to more depressive symptoms in later waves, which further led to more strained parent-child relationship quality. Study 2 investigated the psychological mechanisms linking parent-child relationships and sleep among U.S. older adults. This study used self-reported sleep quality and actigraph-measured sleep characteristics from the second wave of the National Social Life, Health, and Project (N = 548). Results from structural equation modeling showed that parents’ closeness with their children was associated with better objective sleep characteristics, and more frequent contact with their children was related to fewer insomnia symptoms. Moreover, less closeness with children was related to more insomnia via depressive symptoms among older adults. Study 3 drew data from the 2014 China Longitudinal Ageing Social Survey and analyzed older parents’ (N = 8,450) reports on their sleep quality and relationships with each of their children. Results from logistic regression models showed that living alone, greater variation in children’s financial transfers and emotional closeness, and more instrumental support from children were associated with higher risk of sleep difficulty for Chinese older parents with multiple children. Greater instrumental support from offspring was associated with a higher risk of sleep difficulty for parents from one-child families. Focusing on an increasingly important public health issue, this research adds to the scientific knowledge of how intergenerational relationships are associated with sleep in later life. Findings from three studies highlights the importance of parent-child relationships for sleep health in multigenerational families. %B Gerontology %I University of Massachusetts, Boston %C Boston %V Doctor of Philosophy %G eng %U https://scholarworks.umb.edu/doctoral_dissertations/557/ %0 Journal Article %J Journal of Aging and Health %D 2020 %T Isolation, not loneliness or cynical hostility, predicts cognitive decline in older Americans. %A Sarah C. Griffin %A Briana Mezuk %A Williams, Allison Baylor %A Paul B. Perrin %A Bruce D. Rybarczyk %K Cognition & Reasoning %K Depressive symptoms %K Loneliness %K Risk Factors %X

OBJECTIVE: To jointly examine isolation, loneliness, and cynical hostility as risk factors for cognitive decline in older adults.

METHOD: Data came from the 2006 to 2012 waves of the Health and Retirement Study (HRS), a longitudinal study of U.S. older adults (age ⩾ 65 years, n = 6,654). Measures included frequency of contact with social network (objective isolation), the Hughes Loneliness Scale (loneliness), a modified version of the Cook-Medley Hostility Inventory (cynical hostility), and a modified version of the Telephone Interview for Cognitive Status (cognitive function). Multilevel modeling (random slope + intercept) was used to examine the association between these factors and trajectories of cognitive function.

RESULTS AND DISCUSSION: After controlling for demographic characteristics, self-reported health, and functional limitations, loneliness (β = -.34, 95% confidence interval [CI] = [-0.56, -0.11), and cynical hostility (β = -.14, 95% CI = [-0.24, -0.04) correlated with lower cognitive function, but none predicted change in cognitive function. Objective social isolation was associated with lower cognitive function (β = -.27, 95% CI = [-0.41, -0.12]) and steeper decline in cognitive function (β = -.09, 95% CI = [-0.16, -0.01]).

%B Journal of Aging and Health %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30289338?dopt=Abstract %R 10.1177/0898264318800587 %0 Report %D 2020 %T Job Characteristics and Transitions Among Older Self-Employed Individuals with Work-Limiting Health Conditions %A Gurley-Calvez, Tami %A Williams, Jessica %A Kandice Kapinos %K health %K Labor %K Self-employment %X Older workers are an economically important group as they represent a large and growing portion of the United States workforce. These workers are more likely to experience health conditions that limit their options in terms of the type and amount of work they pursue. Self employed workers who report a new work-limiting health condition are more likely to remain in the workforce than wage and salary workers who also report a work-limiting health condition. Previous research suggests that self-employment provides more opportunities to accommodate work-limiting health conditions; this report explores whether self-employed workers with work limiting health conditions report less physically demanding jobs or different hours and weeks worked than wage and salary workers who also report work-limiting health conditions. %I U.S. Small Business Administration %G eng %U https://advocacy.sba.gov/2020/01/15/new-research-from-advocacy-job-characteristics-and-transitions-among-older-self-employed-individuals-with-work-limiting-health-conditions/ %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2020 %T Lifetime History of Traumatic Brain Injury is Associated with Increased Loneliness in Adults: A U.S. Nationally Representative Study %A Raj G. Kumar %A Katherine A Ornstein %A Bollens-Lund, Evan %A Watson, Eric M. %A Claire K. Ankuda %A Amy Kelley %A Dams-O'Connor, Kristen %K Loneliness %K Older Adults %K Traumatic Brain Injury %X Background/Objectives: An estimated 55 million individuals worldwide live with chronic disability associated with Traumatic Brain Injury (TBI) which may include cognitive, behavioral and social impairments. Reduced participation in social activities is common after TBI, however few studies have evaluated loneliness among survivors of TBI. The current study aimed to evaluate the association between history of TBI and loneliness, and to identify mediators of this association. Methods/Design: Retrospective cohort study. Nationally representative sample of N=724 adults over age 50 (Health and Retirement Study). Loneliness was evaluated using the 11-item Revised UCLA (R-UCLA) Loneliness Scale (range 11-33). Lifetime history of TBI evaluated retrospectively using the Ohio State University TBI Identification Method. We included the following covariates: age, sex, race, education; and mediators: depressive symptoms, number of comorbidities, chronic pain, difficulty with activities of daily living, and social network index. Results: History of TBI was associated with a 1.28 point (95% CI: 0.46, 2.11, p<0.05; Cohen's D=0.284) increase in R-UCLA loneliness scale scores, after covariate adjustment. Individuals with more recent injuries (within 10 years) and multiple lifetime TBIs reported the highest loneliness scores. In the structural equation model, depressive symptoms and comorbidity burden partially mediated the relationship between TBI and loneliness. All models were adjusted for United States (U.S.) population sampling weights. Conclusions: History of TBI was associated with greater loneliness compared to individuals without TBI in a representative sample of U.S. adults. Managing depressive symptoms and medical consequences of TBI may be a target to ameliorate reporting of loneliness in this population. This article is protected by copyright. All rights reserved. %B International Journal of Geriatric Psychiatry %V 35 %P 553-563 %G eng %N 5 %R 10.1002/gps.5271 %0 Report %D 2020 %T Linking 1940 U.S. Census Data to the Health and Retirement Survey: Technical Documentation %A Warren, John Robert %A Pfeffer, Fabian %A Helgertz, Jonas %A Xu, Dafeng %K census %K documentation %K linkage %X In this document we describe a project to link records from the 1940 U.S. Census to records for respondents to the Health and Retirement Survey (HRS). The project is part of a larger effort to conduct parallel linkages to the 1940 Census for respondents to the HRS, the Panel Study of Income Dynamics (PSID), the Wisconsin Longitudinal Study (WLS), the National Social Life, Health, and Aging Project (NSHAP), and the National Health and Aging Trends Study (NHATS). In each cohort study, many sample members were alive at the time of the 1940 federal census and were thus enumerated (along with their families and household members). These five ongoing longitudinal studies are central components of America’s data infrastructure for interdisciplinary research on aging and the life course; physical and mental health, disability, and well-being; later-life work, economic well-being, and retirement; end-of-life issues, and many other topics. Adding information about sample members from the 1940 Census will expand the utility of all five projects and will enable important research on the effects of early life social, economic, environmental, contextual, and other factors on subsequent life outcomes. Broadly, the project described in this document involved (1) preparing and formatting data files containing respondents’ identifying information; (2) deploying machine learning algorithms to mechanically link project records to the 1940 U.S. Census; (3) hand linking records that could not be machine linked and hand-verifying a portion of those that could; and (4) documenting the new measures and making them available as part of the HRS’s restricted access dissemination systems in a manner consistent with HRS respondents’ privacy rights. In this document we describe the linking procedures, explain the structure of the resulting linked files and how they can be accessed, and provide information about linkage rates and the reliability and validity of the links. %B HRS Documentation Report %I Institute for Social Research, The University of Michigan %C Ann Arbor, MI %G eng %U https://hrs.isr.umich.edu/sites/default/files/restricted_data_docs/HRS-1940-Census-Data-Documentation-Report.pdf %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 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 Diabetes Care %D 2020 %T The Longitudinal Influence of Social Determinants of Health on Glycemic Control in Elderly Adults With Diabetes %A Rebekah J Walker %A Emma Garacci %A Palatnik, Anna %A Mukoso N. Ozieh %A Leonard E Egede %K Diabetes %X OBJECTIVE This study aimed to understand the longitudinal relationship between financial, psychosocial, and neighborhood social determinants and glycemic control (HbA1c) in older adults with diabetes.RESEARCH DESIGN AND METHODS Data from 2,662 individuals with self-reported diabetes who participated in the Health and Retirement Study (HRS) were used. Participants were followed from 2006 through 2014. Financial hardship, psychosocial, and neighborhood-level social determinant factors were based on validated surveys from the biennial core interview and RAND data sets. All social determinant factors and measurements of HbA1c from the time period were used and treated as time varying in analyses. SAS Proc Glimmix was used to fit a series of hierarchical linear mixed models. Models controlled for nonindependence among the repeated observations using a random intercept and treating each individual participant as a random factor. Survey methods were used to apply HRS weighting.RESULTS Before adjustment for demographics, difficulty paying bills (0.18 [95% CI 0.02, 0.24]) and medication cost nonadherence (0.15 [0.01, 0.29]) were independently associated with increasing HbA1c over time, and social cohesion (-0.05 [-0.10, -0.001]) was independently associated with decreasing HbA1c over time. After adjusting for both demographics and comorbidity count, difficulty paying bills (0.13 [0.03, 0.24]) and religiosity (0.04 [0.001, 0.08]) were independently associated with increasing HbA1c over time.CONCLUSIONS Using a longitudinal cohort of older adults with diabetes, this study found that financial hardship factors, such as difficulty paying bills, were more consistently associated with worsening glycemic control over time than psychosocial and neighborhood factors. %B Diabetes Care %G eng %U https://care.diabetesjournals.org/content/early/2020/02/06/dc19-1586 %R 10.2337/dc19-1586 %0 Journal Article %J Alzheimer's & Dementia: The Journal of the Alzheimer's Association %D 2020 %T Mendelian randomization of smoking behavior on cognitive status among older Americans %A Kelly M Bakulski %A Fu, Mingzhou %A Jessica Faul %A Jin, Yuan %A Erin B Ware %K Dementia %K Mendelian randomization %K Smoking %X Background Smoking is associated with dementia status, and smoking behavior has a genetic component. In this study, we jointly test the associations between cumulative genetic risk for smoking, smoking behavior, and cognitive status. Method We conducted a cross-sectional study using the 2010 wave of the Health and Retirement Study. First, we used logistic regression to test the relationship between cumulative genetic risk for smoking and current smoking behavior. Second, we tested the association between smoking behavior and cognitive status. Third, we checked the assumption that cumulative genetic risk for smoking was not associated with cognitive status. All analyses were adjusted for age, sex, years of education, rural/urban residence and five ancestry-specific genetic principal components. Analyses were stratified by ancestry. Finally, a Mendelian randomization framework was used to test inferred causal relationships between smoking behavior and cognitive status via genetic instruments. Result Among European ancestry participants (n = 8,735), one standard deviation increase in smoking polygenic score was associated with 1.28 times odds of current smoking behavior (95% confidence interval: 1.18, 1.38) relative to never smoking. Current smoking was associated with 1.62 times odds of cognitive impairment (95% confidence interval: 1.29, 2.01) relative to never smokers and those with normal cognition. No association was observed between smoking polygenic score and cognitive status, an important assumption of the Mendelian randomization framework. Using the smoking genetic instrument, a significant inferred causal relationship was observed between current smoking and cognitive impairment (P=0.02, 1.53 odds ratio, 95% confidence interval: 1.07, 2.18). Conclusion These findings demonstrate current smoking is likely causally related to cognitive impairment. Promotion of smoking cessation is important for public health and brain health specifically. Studies on dose and duration of smoking on cognition are critically needed, as well as in research non-European ancestries. %B Alzheimer's & Dementia: The Journal of the Alzheimer's Association %V 16 %P e041221 %G eng %N S10 %R 10.1002/alz.041221 %0 Journal Article %J Molecular Psychiatry %D 2020 %T Meta-analysis of up to 622,409 individuals identifies 40 novel smoking behaviour associated genetic loci. %A Erzurumluoglu, A Mesut %A Liu, Mengzhen %A Jackson, Victoria E %A Barnes, Daniel R %A Datta, Gargi %A Melbourne, Carl A %A Young, Robin %A Batini, Chiara %A Surendran, Praveen %A Jiang, Tao %A Adnan, Sheikh Daud %A Afaq, Saima %A Agrawal, Arpana %A Altmaier, Elisabeth %A Antoniou, Antonis C %A Asselbergs, Folkert W %A Baumbach, Clemens %A Laura Bierut %A Bertelsen, Sarah %A Boehnke, Michael %A Bots, Michiel L %A Brazel, David M %A Chambers, John C %A Chang-Claude, Jenny %A Chen, Chu %A Corley, Janie %A Chou, Yi-Ling %A David, Sean P %A de Boer, Rudolf A %A Christiaan de Leeuw %A Joe G Dennis %A Dominiczak, Anna F %A Dunning, Alison M %A Easton, Douglas F %A Charles B Eaton %A Elliott, Paul %A Evangelou, Evangelos %A Jessica Faul %A Tatiana Foroud %A Goate, Alison %A Gong, Jian %A Hans-Jörgen Grabe %A Jeffrey Haessler %A Christopher A Haiman %A Hallmans, Göran %A Anke R Hammerschlag %A Sarah E Harris %A Andrew T Hattersley %A Andrew C Heath %A Hsu, Chris %A Iacono, William G %A Kanoni, Stavroula %A Kapoor, Manav %A Kaprio, Jaakko %A Sharon L R Kardia %A Karpe, Fredrik %A Kontto, Jukka %A Kooner, Jaspal S %A Charles Kooperberg %A Kuulasmaa, Kari %A Laakso, Markku %A Lai, Dongbing %A Langenberg, Claudia %A Le, Nhung %A Lettre, Guillaume %A Loukola, Anu %A Luan, Jian'an %A Pamela A F Madden %A Mangino, Massimo %A Riccardo E Marioni %A Marouli, Eirini %A Marten, Jonathan %A Nicholas G Martin %A McGue, Matt %A Michailidou, Kyriaki %A Mihailov, Evelin %A Moayyeri, Alireza %A Moitry, Marie %A Müller-Nurasyid, Martina %A Naheed, Aliya %A Nauck, Matthias %A Neville, Matthew J %A Sune Fallgaard Nielsen %A Kari E North %A Markus Perola %A Pharoah, Paul D P %A Pistis, Giorgio %A Tinca J Polderman %A Posthuma, Danielle %A Neil Poulter %A Qaiser, Beenish %A Rasheed, Asif %A Reiner, Alex %A Renstrom, Frida %A Rice, John %A Rohde, Rebecca %A Rolandsson, Olov %A Nilesh J Samani %A Samuel, Maria %A Schlessinger, David %A H Steven Scholte %A Scott, Robert A %A Peter Sever %A Shao, Yaming %A Shrine, Nick %A Smith, Jennifer A %A John M Starr %A Kathleen E Stirrups %A Stram, Danielle %A Heather M Stringham %A Tachmazidou, Ioanna %A Tardif, Jean-Claude %A Thompson, Deborah J %A Hilary A Tindle %A Tragante, Vinicius %A Trompet, Stella %A Turcot, Valérie %A Tyrrell, Jessica %A Vaartjes, Ilonca %A Van Der Leij, Andries R %A van der Meer, Peter %A Varga, Tibor V %A Verweij, Niek %A Völzke, Henry %A Wareham, Nicholas J %A Warren, Helen R %A David R Weir %A Weiss, Stefan %A Wetherill, Leah %A Yaghootkar, Hanieh %A Yavas, Ersin %A Jiang, Yu %A Chen, Fang %A Zhan, Xiaowei %A Zhang, Weihua %A Zhao, Wei %A Zhao, Wei %A Zhou, Kaixin %A Amouyel, Philippe %A Blankenberg, Stefan %A Caulfield, Mark J %A Chowdhury, Rajiv %A Francesco Cucca %A Ian J Deary %A Deloukas, Panos %A Di Angelantonio, Emanuele %A Marco M Ferrario %A Ferrières, Jean %A Franks, Paul W %A Timothy M Frayling %A Frossard, Philippe %A Hall, Ian P %A Caroline Hayward %A Jansson, Jan-Håkan %A Jukema, J Wouter %A Kee, Frank %A Männistö, Satu %A Andres Metspalu %A Munroe, Patricia B %A Børge G Nordestgaard %A Palmer, Colin N A %A Veikko Salomaa %A Sattar, Naveed %A Timothy Spector %A David P Strachan %A van der Harst, Pim %A Zeggini, Eleftheria %A Saleheen, Danish %A Adam S Butterworth %A Wain, Louise V %A Gonçalo R Abecasis %A Danesh, John %A Tobin, Martin D %A Scott Vrieze %A Liu, Dajiang J %A Howson, Joanna M M %K Biological Specimen Banks %K Databases, Factual %K Europe %K Exome %K Female %K Genetic Loci %K Humans %K Male %K Polymorphism, Single Nucleotide %K Smoking %K United Kingdom %X

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

%B Molecular Psychiatry %V 25 %P 2392-2409 %G eng %N 10 %R 10.1038/s41380-018-0313-0 %0 Journal Article %J Journals of Gerontology. Series A, Biological Sciences & Medical Sciences %D 2020 %T Multimorbidity and cognitive decline over 14 years in older Americans. %A Melissa Y Wei %A Deborah A Levine %A Laura B Zahodne %A Mohammed U Kabeto %A Kenneth M. Langa %K Cognitive Ability %K Comorbidity %K Longitudinal data %X

BACKGROUND: Multimorbidity is associated with greater disability and accelerated declines in physical functioning over time in older adults. However, less is known about its effect on cognitive decline.

METHODS: Participants without dementia from the Health and Retirement Study were interviewed about physician-diagnosed conditions, from which their multimorbidity-weighted index (MWI) that weights diseases to physical functioning was computed. We used linear mixed-effects models to examine the predictor MWI with the modified Telephone Interview for Cognitive Status (TICSm, global cognition), 10-word immediate recall and delayed recall, and serial 7s outcomes biennially after adjusting for baseline cognition and covariates.

RESULTS: 14,265 participants, 60% female, contributed 73,700 observations. Participants had a meanSD age 679.3 years and MWI 4.43.9 at baseline. Each point increase in MWI was associated with declines in global cognition (0.04, 95%CI: 0.03-0.04 TICSm), immediate recall (0.01, 95%CI: 0.01-0.02 words), delayed recall (0.01, 95%CI: 0.01-0.02 words), and working memory (0.01, 95%CI: 0.01-0.02 serial 7s) (all P<0.001). Multimorbidity was associated with faster declines in global cognition (0.003 points/year faster, 95%CI: 0.002-0.004), immediate recall (0.001 words/year faster, 95%CI: 0.001-0.002), and working memory (0.006 incorrect serial 7s/year faster, 95%CI: 0.004-0.009) (all P<0.001), but not delayed recall compared with premorbid slopes.

CONCLUSIONS: Multimorbidity using a validated index weighted to physical functioning was associated with acute decline in cognition and accelerated and persistent cognitive decline over 14 years. This study supports an ongoing geriatric syndrome of coexisting physical and cognitive impairment in adults with multimorbidity. Clinicians should monitor and address both domains in older multimorbid adults.

%B Journals of Gerontology. Series A, Biological Sciences & Medical Sciences %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31173065?dopt=Abstract %R 10.1093/gerona/glz147 %0 Journal Article %J Journal of the American Geriatrics Society %D 2020 %T Multimorbidity in Medicare Beneficiaries: Performance of an ICD-Coded Multimorbidity-Weighted Index %A Melissa Y Wei %A Ratz, David %A Kenneth J Mukamal %K administrative claims data %K Comorbidity %K Medicare %K multimorbidity %K physical functioning %X OBJECTIVES Most older adults have multimorbidity that impairs physical functioning, but it is difficult to quantify using claims data. We previously developed and validated a multimorbidity-weighted index (MWI) that embeds physical functioning through disease weightings. We mapped these conditions to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and compared them with existing indices. DESIGN Population-based prospective cohort. SETTING Respondents to the 2006-2016 waves of the Health and Retirement Study (HRS) with linked Medicare claims data and continuous enrollment in 2006. PARTICIPANTS Community-dwelling Medicare-eligible HRS participants (N = 9923; mean age = 75.5 ± 8.5 y). MEASUREMENTS Individuals were followed for future physical functioning (2006-2014) and mortality (2007-2016). MWI conditions were mapped to ICD-9-CM codes to produce an ICD-coded MWI (MWI-ICD). We compared MWI-ICD, simple disease count, Charlson, Elixhauser, and the health-related quality of life comorbidity index (HRQOL-CI) through distributions, hazard ratios for mortality, and relationships with future physical functioning. RESULTS MWI-ICD exhibited the broadest distribution and most unique values (5891). Left censoring was most pronounced for Charlson (34.3% score = 0) and Elixhauser (13.1% score = 0) vs MWI (5.0% score = 0). Hazard ratios and concordance (C)-statistics for mortality across extreme quartiles were similar for MWI-ICD, Elixhauser, and Charlson but lower for disease count and the HRQOL-CI. For physical functioning, MWI-ICD yielded the greatest contrast across extreme quartiles and overall coefficient of determination (R2). CONCLUSION MWI-ICD was significantly associated with mortality and future physical functioning and comparable with established metrics for mortality prediction although not weighted to mortality. MWI-ICD successfully captures diseases accumulation and functioning in claims data. %B Journal of the American Geriatrics Society %V n/a %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16310 %R 10.1111/jgs.16310 %0 Thesis %B Philosophy %D 2020 %T Non-observation of Recurrent Biomeasures Collected in Longitudinal Panel Surveys %A Brian M. Wells %K biomeasure %K human behavior %X Biomeasure collection in surveys has increased substantially in the last two decades, but little focus has been given to the recurrent nature of this collection in longitudinal panel surveys. The purpose of this dissertation is to explore various sources of biomeasure non-observation in a population-based longitudinal survey, identify predictors of missingness, ascertain if bias results from these different sources, and address approaches to imputation for this kind of data. These studies utilize interview, biomeasure, and interviewer data from the Health and Retirement Study (HRS) encompassing the 2006 through 2014 cycles. %B Philosophy %I University of Michigan %C Ann Arbor %V Doctorate %G eng %U https://deepblue.lib.umich.edu/bitstream/handle/2027.42/155284/bmwells_1.pdf?sequence=1 %0 Report %D 2020 %T Is nontraditional work at older ages associated with better retirement security? %A Matthew S. Rutledge %A Gal Wettstein %K nontraditional jobs %K Older workers %K retirement security %X Holding nontraditional jobs – those that provide neither health insurance nor retirement benefits – at younger ages likely hurts retirement security relative to traditional jobs. But nontraditional work might be helpful to those looking to extend their careers for financial reasons. This study uses the Health and Retirement Study to determine the extent to which workers in traditional jobs with less retirement security when they reach the cusp of retirement are more likely to move to nontraditional jobs in their mid- to late-60s than those who are more secure, all else equal. It then examines whether working in nontraditional jobs at older ages helps to improve their retirement security by ages 67-68. The results indicate that workers in traditional jobs who reach age 62 with less projected retirement income, relative to their preretirement standard of living, are no more likely to engage in nontraditional work after age 62 than those who are better prepared. In fact, some evidence suggests that those who transition to nontraditional work have greater retirement wealth, especially business income, than those who stay in traditional work or who opt not to keep working. Among those workers who are at risk of not maintaining their pre-retirement income level in retirement, however, nontraditional work appears to move them closer to retirement security. These results suggest that nontraditional work may help underprepared workers in good health lengthen their careers and improve their retirement security. %B Center for Retirement Research at Boston College Working Paper %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/wp-content/uploads/2020/07/wp_2020-13_.pdf %0 Report %D 2020 %T Nursing Home Use Expectations and Wealth Accumulation Among Older Adults %A Padmaja Ayyagari %A Wang, Yang %K Disparities %K Nursing home use %K Subjective Expectations %K wealth accumulation %X Long-term care represents a significant cost to older adults in the US, and nursing home use is an important part of long-term care. It is therefore important to understand how older adults make nursing home-related decisions. This study analyzes the determinants of older adults’ nursing home use expectations, their relationship with actual nursing home use in the future, and the association between nursing home use expectations and older adults’ decisions regarding wealth accumulation. The findings indicate that older adults update their nursing home use expectations rationally and their nursing home use expectations have strong predictive power for actual nursing home use in the future, but these expectations are not statistically significantly associated with wealth accumulation. %B Retirement & Disability Research Center working paper %I Center for Financial Security, University of Wisconsin-Madison %C Madison, WI %G eng %U https://cfsrdrc.wisc.edu/publications/working-paper/wi20-01 %0 Journal Article %J Innovation in Aging %D 2020 %T Older Couples Coping With Adverse Life Events: The Importance of Dyadic Personality Profiles %A Wang, Shuangshuang %A Kim, Kyungmin %A Jeffrey A Burr %K dyadic personality profiles %K Older couples %X Personality can be an important resource as older couples cope with adverse life events. Analyzing 4,893 older couples from the Health and Retirement Study, this study examined how one’s own and spouse’s adverse life events (health decline, job exit, loss of wealth, family member’s death) occurring in the past two years are associated with changes in depressive symptoms. We further examined the moderating effects for this association of six dyadic personality profiles (combinations of spouses’ positive and negative personality characteristics). We found significant actor and partner effects of health decline for increases in both spouses’ depressive symptoms, and significant actor effects of a family death for husbands’ increased depressive symptoms. For wives, having positive personality profiles buffered negative effects of one’s own health decline and spouses’ family death, whereas having negative profiles intensified negative effects of husbands’ job exit and loss of wealth on the depressive symptoms for both spouses. %B Innovation in Aging %V 4 %P 582-583 %@ 2399-5300 %G eng %N Suppl 1 %R https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7741535/ %0 Journal Article %J Innovation in Aging %D 2020 %T Out-of-Pocket Costs Attributable to Dementia: A Longitudinal Analysis %A Oney, Melissa %A White, Lindsay %A Norma B Coe %K Alzheimer disease %K Dementia %K Out-of-pocket medical expenses %X Alzheimer’s disease and related dementias (ADRD) affects 5.5 million Americans, and is expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, despite the fact that one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare. In this paper, we use survey data for 2002-2014 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization. We consider total out-of-pocket expenditures, as well as out-of-pocket expenditures by category (i.e. hospital, nursing home, doctor, prescription drug, and other). Our results suggest that the out-of-pocket costs of ADRD are quite substantial over the first 8 years after onset. We also find that out-of-pocket spending is decreasing over the first 8 years, similar to the trend seen in Medicare expenditures. The results of this study highlight the financial burden of ADRD, particularly for the population paying out-of-pocket for care. %B Innovation in Aging %V 4 %P 475-476 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1539 %0 Journal Article %J Innovation in Aging %D 2020 %T Perceived Discrimination Trajectories and Depressive Symptoms Among Middle-Aged And Older Black Adults %A White, Kellee %A Bell, Bethany A %A Huang, Shuo J %A Williams, David R %K Cumulative Inequality %K Life-course perspective %K Mental Health %K Minority aging %K Race/ethnicity %K Racial Discrimination %X Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults.Data were analyzed from a subsample of black Health and Retirement Study respondents (2006 – 2018, N = 2,926, 50+). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiologic Studies – Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested.Individuals in the persistently high (IRR: 1.70; 95% CI: 1.49, 1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06, 1.33), were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged 65+. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29, 1.73) had higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point.Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination. %B Innovation in Aging %V 4 %P igaa041 %@ 2399-5300 %G eng %N 5 %R 10.1093/geroni/igaa041 %0 Journal Article %J Social Security Bulletin %D 2020 %T Perspectives: The Benefit Receipt Patterns and Labor Market Experiences of Older Workers Who Were Denied Social Security Disability Insurance Benefits on the Basis of Work Capacity %A Jody Schimmel Hyde %A April Yanyuan Wu %A Gill, Lakhpreet %K disability insurance %K Social Security %X This article examines the experiences of Social Security Disability Insurance (DI) applicants aged 51 or older who were initially denied benefits because the disability examiner determined that they could perform either their past work or other work. We use Health and Retirement Study survey data linked to administrative data on benefit application and receipt and earnings from the Social Security Administration. We find that few older DI applicants who were denied benefits on this basis resumed work at a substantial level following denial. More commonly, applicants denied at this stage continued to pursue benefits, often successfully. Nearly two-thirds of initial work capacity-related denials were ultimately allowed DI benefits after appealing the initial decision or reapplying, and our estimates suggest that many of the rest claimed Old-Age and Survivors Insurance benefits before they reached full retirement age. %B Social Security Bulletin %V 80 %G eng %U https://www.ssa.gov/policy/docs/ssb/v80n2/v80n2p25.html %N 2 %0 Journal Article %J Proceedings of the National Academy of Sciences %D 2020 %T Predicting mortality from 57 economic, behavioral, social, and psychological factors %A Puterman, Eli %A Weiss, Jordan %A Hives, Benjamin A. %A Gemmill, Alison %A Karasek, Deborah %A Mendes, Wendy Berry %A David Rehkopf %K Behavioral Symptoms %K Mortality %K social %K transdisciplinary %X In our prospective study using nationally representative data from 13,611 adults in the US Health and Retirement Study, we used traditional and machine-learning statistical approaches to reveal the most important factors across the behavioral and social sciences that predict mortality in older adults. In the study, we found that top predictors of mortality spanned all investigated domains, opening up opportunities for future hypothesis generation in observational and clinical studies and the identification of potential new targets for screening and policy.Behavioral and social scientists have identified many nonbiological predictors of mortality. An important limitation of much of this research, however, is that risk factors are not studied in comparison with one another or from across different fields of research. It therefore remains unclear which factors should be prioritized for interventions and policy to reduce mortality risk. In the current investigation, we compare 57 factors within a multidisciplinary framework. These include (i) adverse socioeconomic and psychosocial experiences during childhood and (ii) socioeconomic conditions, (iii) health behaviors, (iv) social connections, (v) psychological characteristics, and (vi) adverse experiences during adulthood. The current prospective cohort investigation with 13,611 adults from 52 to 104 y of age (mean age 69.3 y) from the nationally representative Health and Retirement Study used weighted traditional (i.e., multivariate Cox regressions) and machine-learning (i.e., lasso, random forest analysis) statistical approaches to identify the leading predictors of mortality over 6 y of follow-up time. We demonstrate that, in addition to the well-established behavioral risk factors of smoking, alcohol abuse, and lack of physical activity, economic (e.g., recent financial difficulties, unemployment history), social (e.g., childhood adversity, divorce history), and psychological (e.g., negative affectivity) factors were also among the strongest predictors of mortality among older American adults. The strength of these predictors should be used to guide future transdisciplinary investigations and intervention studies across the fields of epidemiology, psychology, sociology, economics, and medicine to understand how changes in these factors alter individual mortality risk. %B Proceedings of the National Academy of Sciences %G eng %R 10.1073/pnas.1918455117 %0 Journal Article %J Journals of Gerontology Series B: Psychological Sciences & Social Sciences %D 2020 %T Purpose in Life Among Centenarian Offspring. %A Marone, Sarah %A Bloore, Katherine %A Sebastiani, Paola %A Flynn, Christopher %A Leonard, Brittany %A Whitaker, Kelsey %A Mostowy, Marilyn %A Thomas T Perls %A Andersen, Stacy L %K Adult children %K Logistic Regression %K Mortality %K Multigenerational %K Parents %K Purpose in life %X

Objectives: Purpose in life (PIL), a feeling of meaning and direction in life, is associated with favorable health outcomes including lower mortality and reduced risk of disease, disability, and cognitive impairment. Since centenarian offspring have been shown to have long health spans we sought to examine whether they have higher PIL than individuals without familial longevity.

Method: We compared PIL scores from the Ryff Scales of Psychological Well-Being in centenarian offspring from the New England Centenarian Study (N=361, mean age=82.0 years) with three referent groups: spouses, birth cohort-matched referents, and Health and Retirement Study (HRS) participants.

Results: Logistic regression analyses adjusted for age, sex, education, and marital status indicated greater odds of high PIL among centenarian offspring compared with spouse (adjusted odds ratio [aOR] 1.92, 95% CI 1.002-3.68, p=.049) and birth cohort referents (aOR 2.64, 95% CI 1.36-5.14, p=.004). Offspring had an almost three times greater odds of having high PIL than HRS participants (OR 2.93, 95% CI 2.17-3.96, p<0.0001).

Discussion: Higher PIL is associated with being an offspring of a long-lived parent and may play a role in the ability to delay age-associated illnesses and functional decline. Increasing purposefulness may be a target for interventions to promote healthy aging.

%B Journals of Gerontology Series B: Psychological Sciences & Social Sciences %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29522128?dopt=Abstract %R 10.1093/geronb/gby023 %0 Journal Article %J Journal of Economics and Social Measurement %D 2020 %T Recent trends in wealth inequality among older Americans in two surveys %A Kezdi, Gabor %A Margaret Lay %A David R Weir %K Education %K net wealth %K race disparity %K social security wealth %K Wealth Inequality %X We document changes in wealth inequality across American households with a member aged 55 or older, comparing data in the Health and Retirement Study (HRS) with that in the Survey of Consumer Finances (SCF) between 1998 and 2016. We examine net wealth including housing, financial and nonfinancial assets and debt, without the cash value of insurances, DB pensions or Social Security wealth. We find very similar distributions of net wealth in the two surveys between the 25th and 90th percentiles, but substantially higher wealth in the SCF at the top of the distribution. Both surveys show an increase in wealth inequality between 1998 and 2016, first mostly due to increased wealth at the top, and, after 2012, due to an increase in the share of households with very little wealth as well. Both surveys agree that wealth inequality by education and race, already substantial in 1998, increased further by 2016. %B Journal of Economics and Social Measurement %V 45 %P 215-236 %G eng %N 3-4 %R 10.3233/jem-210477 %0 Journal Article %J Journal of Epidemiology & Community Health %D 2020 %T Regional differences in the impact of diabetes on population health in the USA %A Zang, Emma %A Scott M Lynch %A Jessica S West %K Diabetes %K epidemiology of chronic diseases %K Geography %K Health expectancy %K Quality of Life %X Background To evaluate regional disparities in the influence of diabetes on population health, we examine life expectancies at age 50 between population with diabetes and healthy population and life quality among the population with diabetes among native-born Americans by birth region and current residence.Methods Using data on a cohort of 17 686 native-born individuals from the Health and Retirement Survey (1998–2014), we applied a Bayesian multistate life table method to estimate life expectancies at age 50 between population with diabetes and healthy population by each birth/current region combination. We further estimate the proportion of life remaining without either chronic conditions or disabilities as a quality of life measure and the probabilities that one region is worse than the other in terms of different health outcomes.Results At age 50, persons with diabetes (PWD) were expected to live on average 5.8–10.8 years less than their healthy equivalents across regions. Diabetes had the greatest influence on life expectancy (LE) for older adults who lived in the South at the time of interviews. PWD born in the South were more likely to have developed chronic conditions or disabilities and spent greater proportions of life with these two issues compared to other regions.Conclusion Diabetes is a significant threat to LE and healthy LE in the USA, particularly for people born or living in the South. %B Journal of Epidemiology & Community Health %G eng %R 10.1136/jech-2020-214267 %0 Report %D 2020 %T The Relationship Between Fertility History and Incident Dementia in the US Health and Retirement Study %A Gemmill, Alison %A Weiss, Jordan %K Cognitive health %K Dementia %K fertility history %K gender %K Parity %K post-reproductive health %X Objectives An emerging literature suggests that fertility history, which includes measures of parity and birth timing, may influence cognitive health in older ages, especially among women given their differential exposure to pregnancy and sex hormones. Yet, few studies have examined associations between measures of fertility history and incident dementia in a population-based sample. Methods We examined the associations between parity, younger age at first birth, and older age at last birth with incident dementia over a 16-year period in a prospective sample of 15,361 men and women aged 51-100 years at baseline in 2000 drawn from the Health and Retirement Study. We used Cox regression and the Fine and Gray model from which we obtained cause-specific (csHRs) and subdistribution hazard ratios (sdHRs) for incident dementia from gender-stratified models in which we accounted for the semi-competing risk of death. Results During the follow-up period (median 13.0 years), the crude incidence rate for dementia was 16.6 and 19.9 per 1,000 person-years for men and women, respectively. In crude models estimating csHRs, higher parity (vs. parity 2) and younger age at first birth were associated with increased risk of dementia for both genders. These associations did not persist after full covariate adjustment. Across all models in which we estimated sdHRs, we observed a positive relationship between older age at last birth and incident dementia for women only. Discussion In this population-based, multi-ethnic cohort, we observed limited evidence for an association between measures of fertility history and incident dementia among men and women after adjusting for potential confounders. %B SocArXiv Papers %G eng %R 10.31235/osf.io/3fje9 %0 Journal Article %J Epidemiology and Health %D 2020 %T Relationship between smoking status and muscle strength in the United States older adults. %A Wiener, R Constance %A Findley, Patricia A %A Shen, Chan %A Dwibedi, Nilanjana %A Sambamoorthi, Usha %K Aged %K Aged, 80 and over %K Female %K Hand Strength %K Humans %K Male %K Middle Aged %K Muscle Strength %K Smoking %K United States %X

OBJECTIVES: Muscle strength in older adults is associated with greater physical ability. Identifying interventions to maintain muscle strength can therefore improve quality of life. The purpose of this study was to evaluate whether current or former smoking status is associated with a decrease in muscle strength in older adults.

METHODS: Data from the Health and Retirement Study from 2012-2014 were analyzed with regard to maximum dominant hand grip strength, maximum overall hand grip strength, and smoking status (current, former, or never). Unadjusted linear regression was conducted. Other factors known to be related to strength were included in the adjusted linear regression analyses.

RESULTS: For maximum grip strength, the regression coefficient was 4.91 for current smoking (standard error [SE], 0.58; p<0.001), 3.58 for former smoking (SE, 0.43; p<0.001), and 28.12 for never smoking (SE, 0.34). Fully adjusted linear regression on the relationship between dominant hand grip strength and smoking did not yield a significant result. The factors significantly associated with dominant hand grip strength were male sex, younger age, a race/ethnicity of non-Hispanic White or non-Hispanic Black, higher income, morbidity of ≤1 condition, no pain, and moderate or vigorous exercise more than once a week.

CONCLUSIONS: Muscle strength in older adults was not associated with smoking status in the adjusted analysis.

%B Epidemiology and Health %V 42 %P e2020055 %G eng %R 10.4178/epih.e2020055 %0 Journal Article %J Journal of the American Geriatrics Society %D 2020 %T The Relationship of Loneliness to End-of-Life Experience in Older Americans: A Cohort Study %A Nauzley C Abedini %A Choi, Hwajung %A Melissa Y Wei %A Kenneth M. Langa %A Vineet Chopra %K Advance care planning %K aggressive care %K end of life %K Loneliness %K symptoms %X OBJECTIVES Little is known about the relationship between loneliness and end-of-life (EOL) experience including symptom burden, intensity of care, and advance care planning among older adults. DESIGN Secondary analysis of the Health and Retirement Study (HRS). SETTING Population based. PARTICIPANTS Decedents older than 50 years who died between 2004 and 2014 (n = 8700). Exclusions included those who were ineligible for surveys assessing loneliness (n = 2932) or had missing or incomplete loneliness or symptom data (n = 2872). MEASUREMENTS Individuals were characterized as lonely based on responses to the three-item Revised University of California, Los Angeles Loneliness Scale in the most recent HRS survey before death. Outcomes were proxy reports of total EOL symptom burden, intensity of EOL care (eg, late hospice enrollment, place of death, hospitalizations, use of life support), and advance care planning. Results were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS One-third of 2896 decedents (n = 942) were lonely. After adjusting for demographics, socioeconomic status, multimorbidity, depressive symptoms, family and friends, and social support, loneliness was independently associated with increased total symptom burden at EOL (ß = .13; P = .004). Compared with nonlonely individuals, lonely decedents were more likely to use life support in the last 2 years of life (35.5% vs 29.4%; aOR = 1.36; 95% CI = 1.08-1.71) and more likely to die in a nursing home (18.4% vs 14.2%; aOR = 1.78; 95% CI = 1.30-2.42). No significant differences in other measures of intense care (late hospice enrollment, number of hospitalizations, or dialysis use) or likelihood of advance care planning were observed. CONCLUSION Lonely older people may be burdened by more symptoms and may be exposed to more intense EOL care compared with nonlonely people. Interventions aiming to screen for, prevent, and mitigate loneliness during the vulnerable EOL period are necessary. J Am Geriatr Soc 68:1064–1071, 2020 %B Journal of the American Geriatrics Society %V 68 %P 1064-1071 %G eng %U https://pubmed.ncbi.nlm.nih.gov/32128789/ %N 5 %R 10.1111/jgs.16354 %0 Journal Article %J Journal of the American Geriatrics SocietyJournal of the American Geriatrics SocietyJ Am Geriatr Soc %D 2020 %T The Relationship of Loneliness to End-of-Life Experience in Older Americans: A Cohort Study %A Nauzley C Abedini %A Choi, Hwajung %A Melissa Y Wei %A Kenneth M. Langa %A Vineet Chopra %K Advance care planning %K aggressive care %K end of life %K Loneliness %K symptoms %X OBJECTIVES Little is known about the relationship between loneliness and end-of-life (EOL) experience including symptom burden, intensity of care, and advance care planning among older adults. DESIGN Secondary analysis of the Health and Retirement Study (HRS). SETTING Population based. PARTICIPANTS Decedents older than 50?years who died between 2004 and 2014 (n = 8700). Exclusions included those who were ineligible for surveys assessing loneliness (n = 2932) or had missing or incomplete loneliness or symptom data (n = 2872). MEASUREMENTS Individuals were characterized as lonely based on responses to the three-item Revised University of California, Los Angeles Loneliness Scale in the most recent HRS survey before death. Outcomes were proxy reports of total EOL symptom burden, intensity of EOL care (eg, late hospice enrollment, place of death, hospitalizations, use of life support), and advance care planning. Results were expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS One-third of 2896 decedents (n = 942) were lonely. After adjusting for demographics, socioeconomic status, multimorbidity, depressive symptoms, family and friends, and social support, loneliness was independently associated with increased total symptom burden at EOL (ß = .13; P =?.004). Compared with nonlonely individuals, lonely decedents were more likely to use life support in the last 2?years of life (35.5% vs 29.4%; aOR = 1.36; 95% CI = 1.08-1.71) and more likely to die in a nursing home (18.4% vs 14.2%; aOR = 1.78; 95% CI = 1.30-2.42). No significant differences in other measures of intense care (late hospice enrollment, number of hospitalizations, or dialysis use) or likelihood of advance care planning were observed. CONCLUSION Lonely older people may be burdened by more symptoms and may be exposed to more intense EOL care compared with nonlonely people. Interventions aiming to screen for, prevent, and mitigate loneliness during the vulnerable EOL period are necessary. %B Journal of the American Geriatrics SocietyJournal of the American Geriatrics SocietyJ Am Geriatr Soc %@ 0002-8614 %G eng %U https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16354 %9 Journal %! Journal of the American Geriatrics Society %R 10.1111/jgs.16354 %0 Journal Article %J Journals of Gerontology, Series B. Psychological Sciences and Social Sciences %D 2020 %T Relationship quality among older cohabitors: A comparison to remarrieds. %A Matthew R Wright %K Cohabitation %K Divorce %K Marriage %K Relationships %K Social Support %X

OBJECTIVES: Later life marital patterns have undergone shifts over the past few decades, including a rapid growth of cohabiting unions. Despite the increase in older adult cohabitation, research on this population has been slow to keep up. Intimate relationships are linked to well-being and relationship quality is especially important because high quality relationships offer a number of benefits for well-being, whereas poor quality relationships often are detrimental. This study compares cohabiting and remarried individuals on two measures of relationship quality.

METHOD: Using data from the 2010 and 2012 Health and Retirement Study, I investigate the positive and negative relationship quality of cohabitors relative to their remarried counterparts and whether the association of union type and relationship quality varies by race.

RESULTS: Across both positive and negative relationship quality, I found few differences between cohabiting and remarried individuals. Black cohabitors report higher positive relationship quality than remarrieds, whereas White cohabitors and remarrieds do not differ.

DISCUSSION: These findings suggest that cohabiting unions and remarriages are comparable among White older adults, but that Black cohabitors may gain more in terms of positive relationship quality than their remarried counterparts.

%B Journals of Gerontology, Series B. Psychological Sciences and Social Sciences %V 75 %P 1808-1017 %G eng %N 8 %9 Journal %R 10.1093/geronb/gbz069 %0 Journal Article %J CLINICAL SOCIAL WORK JOURNAL %D 2020 %T Resource and Network Predictors of Multiple Volunteering Cessations: Implications for Social Policy and Practice %A Shen, Huei-Wern %A Wang, Yi %A Wong, Roger %A Amano, Takashi %K civic engagement %K productive aging %K Volunteer activity %K Volunteer cessation %X The benefits of volunteering are well-documented, however, studies specifically investigating the cessation of volunteering in old age are relatively limited, especially on multiple stops of volunteering. The present study explores the number of times older people stop volunteering over 14 years, and examines its association with financial resources, health, family demands, social networks, neighborhood environment as well as the sociodemographic characteristics. Using eight-wave data from the Health and Retirement Study, the sample included 3914 volunteers who were 50 + in 1998 and were alive throughout 2012. Among the sample, 32.75% never stopped volunteering, 41.47% stopped once, 20.77% stopped twice, and 5.01% stopped three times. Findings from Poisson regression models indicated that respondents who were older, less educated, less religious, had lower income at baseline, later developed cognitive problems, became caregivers, and had no friends living nearby were more likely to stop volunteering multiple times. Findings from the present study suggest retaining volunteers by adjusting volunteering responsibilities for older volunteers who are more vulnerable to volunteering cessation and encouraging continued commitment by maximizing their friendship and religious networks. %B CLINICAL SOCIAL WORK JOURNAL %G eng %U https://link.springer.com/article/10.1007%2Fs10615-020-00748-x %9 Article; Early Access %R 10.1007/s10615-020-00748-x %0 Journal Article %J Global Epidemiology %D 2020 %T The role of Hope in subsequent health and well-being for older adults: An outcome-wide longitudinal approach %A Long, Katelyn N.G. %A Eric S Kim %A Chen, Ying %A Wilson, Matthew F. %A Worthington Jr., Everett L. %A Tyler J VanderWeele %K Hope %K hopelessness %K Older Adults %K outcome-wide analysis %K Physical Health %K Well-being %X Hope is a topic widely discussed in the humanities and researched in the field of psychology. To explore the potential public health implications of hope for subsequent health and well-being outcomes, we prospectively examined the relation between baseline hope and a wide range of outcomes that included indicators of: physical health, health behaviors, and psychosocial well-being in older adults using an outcome-wide approach. Data from the Health and Retirement Study (N = 12,998, mean age = 66 years) were analyzed. Bonferroni correction was used to account for multiple testing. All models controlled for a wide array of factors including: sociodemographic characteristics, personality factors, and prior values of the exposure (hope) and all outcomes. A greater sense of hope was associated with: better physical health and health behavior outcomes on some indicators (e.g., reduced risk of all cause-mortality, fewer number of chronic conditions, lower risk of cancer, and fewer sleep problems), higher psychological well-being (e.g., increased positive affect, life satisfaction, and purpose in life), lower psychological distress, and better social well-being. A secondary analysis explored antecedents of hope. We identified several potentially modifiable factors that may lead to increased hope. These results may have important population-level implications for increasing hope and improving the physical, psychological, and social well-being of our growing older adult population. %B Global Epidemiology %V 2 %P 100018 %G eng %R https://doi.org/10.1016/j.gloepi.2020.100018 %0 Journal Article %J The Journal of Gerontology, Series B %D 2020 %T The Roles of Marital Dissolution and Subsequent Repartnering on Loneliness in Later Life. %A Matthew R Wright %A Anna M Hammersmith %A Susan L. Brown %A Lin, I-Fen %K Cohabitation %K Divorce %K Remarriage %K Well-being %K Widowhood %X

OBJECTIVES: Loneliness in later life is associated with poorer health and higher risk of mortality. Our study assesses whether gray divorced adults report higher levels of loneliness than the widowed and whether social support or repartnership offset loneliness.

METHOD: Using data from the 2010 and 2012 Health and Retirement Study, we estimated ordinary least squares regression models for women (n = 2,362) and men (n = 1,127) to examine differences in loneliness by dissolution pathway (i.e., divorce versus widowhood), accounting for social support and repartnership.

RESULTS: Divorced men were lonelier than their widowed counterparts. Although social support reduced loneliness among men, the difference between the divorced and widowed persisted. Repartnership assuaged men's loneliness and reduced the variation between divorced and widowed men. Among women, the results did not reveal differences in loneliness for the divorced and widowed although social support and repartnership linked to less loneliness.

DISCUSSION: Later-life marital dissolutions increasingly occur through divorce rather than spousal death. Some older adults go on to form new partnerships. Our findings demonstrate the importance of gerontological research widening the lens beyond widowhood to consider the ramifications of later-life divorce and repartnership for well-being.

%B The Journal of Gerontology, Series B %V 75 %P 1796-1807 %G eng %N 8 %R 10.1093/geronb/gbz121 %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 BMJ Open %D 2020 %T Sleep disturbance as a moderator of the association between physical activity and later pain onset among American adults aged 50 and over: evidence from the Health and Retirement Study %A Whibley, Daniel %A Heidi M Guyer %A Swanson, Leslie M %A Braley, Tiffany J %A Kratz, Anna L %A Galit L Dunietz %K pain %K Physical activity %K sleep disorders %X Objective To examine whether sleep disturbance modifies the association between physical activity and incident pain.Design Prospective population-based study.Setting Health and Retirement Study.Participants American adults aged >=50 years who reported no troublesome pain in 2014 were re-assessed for pain in 2016. Of 9828 eligible baseline respondents, 8036 (82%) had complete follow-up data for adjusted analyses (weighted analysis population N=42 407 222).Exposures Physical activity was assessed via interview with questions about time spent in moderate and vigorous physical activity. Sleep disturbance, assessed using a modified form of the Jenkins Sleep Scale, was examined as a potential moderator.Main outcome measure Troublesome pain.Results In weighted analyses, 37.9% of the 2014 baseline pain-free sample participated in moderate or vigorous physical activity once a week or less, with an overall mean Physical Activity Index Score of 9.0 (SE=0.12). 18.6% went on to report troublesome pain in 2016. Each one-point higher on the Physical Activity Index Score was associated with a reduced odds ratio (OR) of incident pain for those who endorsed sleep disturbance never/rarely (OR=0.97, 95% CI 0.94 to 0.99), but not for those who endorsed sleep disturbance sometimes (OR=0.99, 95% CI 0.97 to 1.01) or most of the time (OR=1.01, 95% CI 0.99 to 1.03). The analysis of possible interaction demonstrated that frequency of sleep disturbance moderated the physical activity and incident pain association (Wald test: p=0.02).Conclusions The beneficial association of physical activity on reduced likelihood of later pain was only observed in persons who endorsed low levels of sleep disturbance. %B BMJ Open %V 10 %P e036219 %G eng %N 6 %R 10.1136/bmjopen-2019-036219 %0 Journal Article %J International Journal of Behavioral Medicine %D 2020 %T Sleep Disturbance Mediates the Association Between Loneliness and Health in Older Americans %A Sarah C. Griffin %A Samantha N Mladen %A Williams, Allison Baylor %A Dautovich, Natalie D. %A Lageman, Sarah K. %A Joseph M. Dzierzewski %A Paul B. Perrin %A Bruce D. Rybarczyk %K Aging %K health %K Loneliness %K Older Adults %K Sleep %X Background As the research documenting loneliness as a risk factor for morbidity and mortality continues to grow, it becomes increasingly critical to understand the mechanics of this relationship. This study assessed whether sleep disturbance mediates the relationship between loneliness and health. Method Data came from the 2006, 2010, and 2014 waves of the Health and Retirement Study, a longitudinal study of older Americans; participants ≥ 65 who completed the Psychosocial and Lifestyle Questionnaire in 2006 were included (n = 5067). Measures include the Hughes loneliness scales, a modified version of the Jenkins sleep scale, and self-reported health. Cross-lagged mediation models (i.e., path analysis) were used to model the relationships between loneliness, sleep disturbance, and self-reported health over the 8-year span. Results Loneliness predicted subsequent sleep disturbance, which in turn predicted subsequent self-reported health. Moreover, there was evidence of both direct and indirect effects (via sleep disturbance) of loneliness on self-reported health. These effects remained after controlling for demographics, isolation, and depression. Conclusion Sleep disturbance partially mediates the relationship between loneliness and self-reported health over 8 years. These findings are not attributable to isolation or depression. Further research is necessary to develop and assess a more comprehensive model of how loneliness shapes health. This study indicates that targeting sleep disturbance may mitigate the health risks of loneliness in older Americans. %B International Journal of Behavioral Medicine %@ 1532-7558 %G eng %! International Journal of Behavioral Medicine %R 10.1007/s12529-020-09897-2 %0 Journal Article %J Innovation in Aging %D 2020 %T Social Engagement and Cognitive Function of Older Adults in Mexico and the United States %A Bret Howrey %A Jaqueline C Avila %A Brian Downer %A Rebeca Wong %K Cognition %K Mexico %K MHAS %K social engagement %X Social engagement is linked to better cognition, but it is unclear if the social engagement of husbands and wives influences their own cognition as well as each other’s cognition in two very different country contexts. Data on married couples come from the 2001 Mexican Health and Aging Study (MHAS) and the 2000 Health and Retirement Study (HRS), with follow-up cognition measured in 2012. Structural equation models (SEM) were used to test the actor-partner interdependence model on the association of social engagement with cognition. In Mexico wives’ social engagement benefited their own cognition as well as their husbands’, but husband’s social engagement was unrelated to cognition. In the U.S. both wives’ and husbands’ social engagement benefited their own cognition, but not each other’s. Results suggest asymmetric patterns of actor-partner interdependence in Mexico, possibly reflecting more traditional social roles of women and co-dependence within couples, but more independence within U.S. couples. %B Innovation in Aging %V 4 %P 560 - 561 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.1846 %0 Journal Article %J Innovation in Aging %D 2020 %T Social Support, Everyday Discrimination, and Depressive Symptoms Among Older African Americans: A Longitudinal Study %A Qin, Weidi %A Ann W Nguyen %A Mouzon, Dawne M %A Tyrone C Hamler %A Wang, Fei %K Black older adults %K family social support networks %K friendship social support networks %K Mental Health %K unfair treatment %X The purpose of the study is to explore the long-term effects of everyday discrimination on depressive symptoms among older African Americans, as well as the moderating role of social support in this association.Mixed-effects negative binomial regression analyses were performed on data selected from six waves of the Health and Retirement Study (2006-2016; baseline N=1144). The number of depressive symptoms was calculated based on an 8-item CES-D measure. Everyday discrimination was measured by using a 6-item scale. Contact with and perceived support from extended family and friends were assessed.Older African Americans who experienced more frequent perceived discrimination had more depressive symptoms over time. Significant interactions between discrimination and perceived support from extended family and friends were found, indicating that among older African Americans who reported higher support from extended family and friends, perceived discrimination was positively associated with depressive symptoms over time. However, perceived discrimination and depressive symptoms were not longitudinally related among those who reported lower levels of perceived support.This is one of the few studies to examine the effects of discrimination on depressive symptoms over time and the first longitudinal study to test the role of social support in coping with discrimination in older African Americans. This study extends cross-sectional works on discrimination and mental health, indicating that experiences of discrimination can result in worse mental health over time. The significant interactions are consistent with the resource mobilization framework, which suggests that individuals who are more negatively affected by discrimination (more depressive symptoms) are more likely to reach out to friends and family to cope with discrimination.Older African Americans who experience more discrimination and depressive symptoms are more likely to seek support from extended family and friends for coping with discrimination over time. The study findings suggest that older African Americans may benefit from interventions based on stress coping resources via support from extended family and friends in coping with discrimination. %B Innovation in Aging %V 4 %P igaa032 %@ 2399-5300 %G eng %N 5 %R 10.1093/geroni/igaa032 %0 Journal Article %J The Journals of Gerontology: Series A %D 2020 %T Socioeconomic Inequalities in Disability-free Life Expectancy in Older People from England and the United States: A Cross-national Population-Based Study %A Zaninotto, Paola %A G David Batty %A Stenholm, Sari %A Ichiro Kawachi %A Hyde, Martin %A Goldberg, Marcel %A Westerlund, Hugo %A Vahtera, Jussi %A Head, Jenny %K Cross-National %K Disability %K Healthy life expectancy %K socioeconomic status %X We examined socioeconomic inequalities in disability-free life expectancy in older men and women from England and the United States and explored whether people in England can expect to live longer and healthier lives than those in the United States.We used harmonized data from the Gateway to Global Aging Data on 14,803 individuals aged 50+ from the U.S. Health and Retirement Study (HRS) and 10,754 from the English Longitudinal Study of Ageing (ELSA). Disability was measured in terms of impaired activities and instrumental activities of daily living. We used discrete-time multistate life table models to estimate total life expectancy and life expectancy free of disability.Socioeconomic inequalities in disability-free life expectancy were of a similar magnitude (in absolute terms) in England and the United States. The socioeconomic disadvantage in disability-free life expectancy was largest for wealth, in both countries: people in the poorest group could expect to live seven to nine fewer years without disability than those in the richest group at the age of 50.Inequalities in healthy life expectancy exist in both countries and are of similar magnitude. In both countries, efforts in reducing health inequalities should target people from disadvantaged socioeconomic groups. %B The Journals of Gerontology: Series A %V 75 %P 906-913 %8 01 %G eng %N 5 %R 10.1093/gerona/glz266 %0 Report %D 2020 %T Still shortchanged: An update on women's retirement preparedness %A Bond, Tyler %A Saad-Lessler, Joelle %A Christian Weller %K Caregiving %K Divorce %K Retirement Planning %K women %X Most Americans struggle to adequately save for retirement, but women face unique challenges in saving, largely stemming from a gender pay gap that persists into a retirement wealth gap. This update of previous research from the National Institute on Retirement Security (NIRS) takes a fresh look at the data on women’s retirement preparedness. Relying on data from the 2014 Survey of Income and Program Participation (SIPP), this research finds that older women receive approximately 80 percent of the retirement income that older men receive - nearly identical to the gender pay gap for American women. The data also reveals that different groups of women have very different retirement experiences, with older women in a first marriage faring better than the rest, and widows, especially those age 80 and older, seeing a marked decline in income. The report’s key findings are as follows: • In 2016, women age 65 and older had a median household retirement income of $47,244 or 83 percent of median household income for men ($57,144). • Women earn less than men over the course of their career. Men with savings in a defined contribution (DC) plan far surpass the earnings trajectory of women with savings in a DC plan, and earn significantly more than women without DC savings. • Women experience a steep decline in income past age 80. Women age 80 and older are much more likely to be widows and widowhood presents challenges on both the income and cost side of retirement. • There are stark differences in the sources of income for women in the top and bottom income quintiles. Women with less than $20,000 of income in retirement are much more dependent on Social Security income, whereas women with income above $80,000 receive much more from earnings and property income. • Divorce presents a complex set of issues relating to retirement preparedness. The timing of divorce seems to matter, as does the division of assets following a divorce. • Caregiving, especially spousal caregiving, has a strong effect on retirement preparedness, and this particularly impacts women as they remain much more likely to provide caregiving than men. %B National Institute on Retirement Security %I National Institute on Retirement Security %C Washington, D.C. %G eng %U https://www.nirsonline.org/wp-content/uploads/2020/04/Still-Shortchanged-Final.pdf %0 Journal Article %J Economics Letters %D 2020 %T Is there adverse selection in the U.S. social security system? %A Andrew Beauchamp %A Mathis Wagner %K Adverse selection %K Optimal policy %K Social Security %X Despite facing some of the same challenges as private insurance markets, little is known about the role of adverse selection in Old-Age Social Security. Using data from the Health and Retirement Study, we perform the unused observables version of the positive correlation test, and find robust evidence that people who expect to live shorter lives both choose smaller annuities - by claiming benefits early - and are less costly to insure, implying adverse selection in the system. Results are consistent when using either subjective expectations or observed longevity. Decomposing the sources of adverse selection we find that health, demographics, occupation and financial information together account for much of the positive correlation between mortality and claiming. IV estimates help to rule out moral hazard. %B Economics Letters %P 108995 %G eng %U http://www.sciencedirect.com/science/article/pii/S0165176520300318 %R https://doi.org/10.1016/j.econlet.2020.108995 %0 Journal Article %J JAMA Network Open %D 2020 %T Use of Health Savings Accounts Among US Adults Enrolled in High-Deductible Health Plans. %A Jeffrey T Kullgren %A Cliff, Elizabeth Q %A Krenz, Christopher %A Brady T. West %A Helen G Levy %A A. Mark Fendrick %A Angela Fagerlin %K Costs and Cost Analysis %K Deductibles and Coinsurance %K Female %K health %K Insurance %K Male %K Medical Savings Accounts %X

Importance: Health savings accounts (HSAs) can be used by enrollees in high-deductible health plans (HDHPs) to save for health care expenses before taxes. Expansion of and encouraging contributions to HSAs have been centerpieces of recent federal legislation. Little is known about how US residents who may be eligible for HSAs are using them to save for health care.

Objective: To determine which patients who may be eligible for an HSA do not have one and what decisions patients with HSAs make about contributing to them.

Design, Setting, and Participants: This cross-sectional national survey assessed an online survey panel representative of the US adult population. Adults aged 18 to 64 years and enrolled in an HDHP for at least 12 months were eligible to participate. Data were collected from August 26 to September 19, 2016, and analyzed from November 1, 2019, to April 30, 2020.

Main Outcomes and Measures: Prevalence of not having an HSA or not making HSA contributions in the last 12 months and reasons for not making the HSA contributions.

Results: Based on data from 1637 individuals (American Association of Public Opinion Research response rate 4, 54.8%), half (50.6% [95% CI, 47.7%-53.6%]) of US adults in HDHPs were female, and most were aged 36 to 51 (35.7% [95% CI, 32.8%-38.6%]) or 52 to 64 (36.8% [95% CI, 34.1%-39.5%]) years. Approximately 1 in 3 (32.5% [95% CI, 29.8%-35.3%]) did not have an HSA. Those who obtained their health insurance through an exchange were more likely to lack an HSA (70.3% [95% CI, 61.9%-78.6%]) than those who worked for an employer that offered only 1 health insurance plan (36.5% [95% CI, 30.9%-42.1%]; P < .001). More than half of individuals with an HSA (55.0% [95% CI, 51.1%-58.8%]) had not contributed money into it in the last 12 months. Among HDHP enrollees with an HSA, those with at least a master's degree (46.1% [95% CI, 38.3%-53.9%]; P = .02) or a high level of health insurance literacy (47.3% [95% CI, 40.7%-54.0%]; P = .03) were less likely to have made no HAS contributions. Common reasons for not contributing to an HSA included not considering it (36.8% [95% CI, 30.8%-42.8%]) and being unable to afford saving for health care (31.9% [95% CI, 26.2%-37.6%]).

Conclusions and Relevance: These findings suggest that many US adults enrolled in an HDHP lack an HSA, and few with an HSA saved for health care in the last year. Targeted interventions should be explored by employers, health plans, and health systems to encourage HSA uptake and contributions among individuals who could benefit from their use.

%B JAMA Network Open %V 3 %P e2011014 %G eng %N 7 %R 10.1001/jamanetworkopen.2020.11014 %0 Journal Article %J Scientific Reports %D 2020 %T Using syndrome mining with the Health and Retirement Study to identify the deadliest and least deadly frailty syndromes %A Yi-Sheng Chao %A Chao-Jung Wu %A Hsing-Chien Wu %A Hui-Ting Hsu %A Tsao, Lien-Cheng %A Cheng, Yen-Po %A Lai, Yi-Chun %A Wei-Chih Chen %K Epidemiology %K Geriatrics %X Syndromes are defined with signs or symptoms that occur together and represent conditions. We use a data-driven approach to identify the deadliest and most death-averse frailty syndromes based on frailty symptoms. A list of 72 frailty symptoms was retrieved based on three frailty indices. We used data from the Health and Retirement Study (HRS), a longitudinal study following Americans aged 50 years and over. Principal component (PC)-based syndromes were derived based on a principal component analysis of the symptoms. Equal-weight 4-item syndromes were the sum of any four symptoms. Discrete-time survival analysis was conducted to compare the predictive power of derived syndromes on mortality. Deadly syndromes were those that significantly predicted mortality with positive regression coefficients and death-averse ones with negative coefficients. There were 2,797 of 5,041 PC-based and 964,774 of 971,635 equal-weight 4-item syndromes significantly associated with mortality. The input symptoms with the largest regression coefficients could be summed with three other input variables with small regression coefficients to constitute the leading deadliest and the most death-averse 4-item equal-weight syndromes. In addition to chance alone, input symptoms’ variances and the regression coefficients or p values regarding mortality prediction are associated with the identification of significant syndromes. %B Scientific Reports %V 10 %@ 2045-2322 %G eng %9 Journal %! Scientific Reports %R 10.1038/s41598-020-60869-8 %0 Report %D 2020 %T VC-BART: Bayesian trees for varying coefficients %A Deshpande, Sameer K. %A Bai, Ray %A Balocchi, Cecilia %A Starling, Jennifer E. %A Weiss, Jordan %K Cognition %K Methodology %K socioeconomics %X Many studies have reported associations between later-life cognition and socioeconomic position in childhood, young adulthood, and mid-life. However, the vast majority of these studies are unable to quantify how these associations vary over time and with respect to several demographic factors. Varying coefficient (VC) models, which treat the covariate effects in a linear model as nonparametric functions of additional effect modifiers, offer an appealing way to overcome these limitations. Unfortunately, state-of-the-art VC modeling methods require computationally prohibitive parameter tuning or make restrictive assumptions about the functional form of the covariate effects. In response, we propose VCBART, which estimates the covariate effects in a VC model using Bayesian Additive Regression Trees. With simple default hyperparameter settings, VCBART outperforms existing methods in terms of covariate effect estimation and prediction. Using VCBART, we predict the cognitive trajectories of 4,167 subjects from the Health and Retirement Study using multiple measures of socioeconomic position and physical health. We find that socioeconomic position in childhood and young adulthood have small effects that do not vary with age. In contrast, the effects of measures of mid-life physical health tend to vary with respect to age, race, and marital status. %I Cornell University %C Ithaca, NY %G eng %U https://arxiv.org/abs/2003.06416 %0 Journal Article %J American Journal of Preventive Medicine %D 2020 %T Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach %A Eric S Kim %A Whillans, Ashley V. %A Lee, Matt %A Ying Chen %A Tyler J VanderWeele %K Prosocial Behavior %K Volunteering %K Well-being %X Growing evidence documents strong associations between volunteering and favorable health and well-being outcomes. However, epidemiological studies have not evaluated whether changes in volunteering are associated with subsequent health and well-being outcomes. %B American Journal of Preventive Medicine %V 59 %P 176-186 %G eng %U https://www.hbs.edu/faculty/Pages/item.aspx?num=57873 %N 2 %0 Journal Article %J Biodemography and Social Biology %D 2020 %T What your genes can (and can't) tell you about BMI and diabetes. %A Carmen D Ng %A Weiss, Jordan %K BMI polygenic scores %K Genetics %X

Body mass index (BMI) is commonly used as a proxy for adiposity in epidemiological and public health studies. However, BMI may suffer from issues of misreporting and, because it fluctuates over the life course, its association with morbidities such as diabetes is difficult to measure. We examined the associations between actual BMI, genetic propensity for high BMI, and diabetes to better understand whether a BMI polygenic score (PGS) explained more variation in diabetes than self-reported BMI. We used a sample of non-Hispanic white adults from the longitudinal Health and Retirement Study (1992-2016). Structural equation models were used to determine how much variation in BMI could be explained by a BMI PGS. Then, we used logistic regression models (n = 12,086) to study prevalent diabetes at baseline and Cox regression models (n = 11,129) to examine incident diabetes with up to 24 years of follow-up. We observed that while both actual BMI and the BMI PGS were significantly associated with diabetes, actual BMI had a stronger association than its genetic counterpart and resulted in better model performance. Moreover, actual BMI explained more variation in baseline and incident diabetes than its genetic counterpart which may suggest that actual BMI captures more than just adiposity as intended.

%B Biodemography and Social Biology %V 66 %P 40-49 %G eng %N 1 %R 10.1080/19485565.2020.1806032 %0 Magazine Article %D 2020 %T Women Have Less Secure Retirement, Following Lives Filled With Discrimination And Risks %A Christian Weller %K Caregiving %K Retirement %K women %X Women face a vastly more insecure retirement than men, a new report co-authored by Joelle Saad-Lessler, Tyler Bond and myself shows. They have fewer opportunities to save for retirement during their careers. They earn lower wages in part because of discrimination, structural barriers and more economic risks, especially from divorce and caregiving, during their working lives. They then enter retirement with fewer savings, while still facing added economic risks such as longer life expectancies. %B Forbes %G eng %U https://www.forbes.com/sites/christianweller/2020/05/20/women-have-less-secure-retirement-following-lives-filled-with-discrimination-and-risks/#5ac9312160c5 %0 Journal Article %J Psychology and Aging %D 2019 %T Are US older adults getting lonelier? Age, period, and cohort differences. %A Louise C Hawkley %A Wroblewski, Kristen %A Kaiser, Till %A Luhmann, Maike %A Schumm, L. Philip %K Age differences %K age–period–cohort effects %K Aging %K Baby Boom cohorts %K civic engagement %K Cohort Analysis %K Community Involvement %K Epidemics %K Generational Differences %K Living Alone %K Loneliness %K religious affiliation %K Test Construction %X Media portrayals of a loneliness 'epidemic' are premised on an increase in the proportion of people living alone and decreases in rates of civic engagement and religious affiliation over recent decades. However, loneliness is a subjective perception that does not correspond perfectly with objective social circumstances. In this study, we examined whether perceived loneliness is greater among the Baby Boomers—individuals born 1948–1965—relative to those born 1920–1947 and whether older adults have become lonelier over the past decade (2005–2016). We used data from the National Social Life, Health and Aging Project and from the Health and Retirement Study collected during 2005–2016 to estimate differences in loneliness associated with age, birth year, and survey time point. Overall, loneliness decreased with age through the early 70s, after which it increased. We found no evidence that loneliness is substantially higher among the Baby Boomers or that it has increased over the past decad %B Psychology and Aging %V 34 %P 1144 - 1157 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31804118 %R 10.1037/pag0000365 %0 Journal Article %J Gerontologist %D 2019 %T Asset Depletion, Chronic Financial Stress, and Mortgage Trouble Among Older Female Homeowners. %A Amy Castro Baker %A West, Stacia %A Wood, Anna %K Chronic stress %K Financial Health %K Mortgages %K Retirement Planning and Satisfaction %K Wealth Inequality %K Women and Minorities %X

Background and Objectives: The Great Recession disproportionately impacted older adults and women of color, suggesting that women may be entering retirement without adequate assets. However, the current literature lacks a detailed account of women's experiences of mortgage trouble and foreclosure, as well as a longitudinal view of how these experiences impacted their overall financial assets.

Research Design and Methods: Grounded in cumulative inequality theory, this mixed methods study employed a QUAL→quan approach to gather qualitative data from a sample of 21 older adult women regarding their experiences of mortgage trouble. Quantitative longitudinal data was gathered for a subsample of the Early Baby Boomer Cohort using the Health and Retirement Study.

Results: Qualitative findings indicated women approaching retirement experienced chronic underemployment, wage stagnation, and financial volatility as contributors to asset depletion and eventual mortgage default or foreclosure. Quantitative results indicated asset depletion both during and post-Recession was considerably more pronounced among older adult women of color compared to older adult White men.

Discussion and Implications: These findings suggest that a lifetime of financial disadvantage coupled with macroeconomic instability situates older adult women, particularly women of color, in a financially vulnerable position for retirement. The ways in which 2017 attacks on the Consumer Financial Protection Bureau, Dodd-Frank, and the Fiduciary rule carry potential to further destabilize this population are also discussed.

%B Gerontologist %V 59 %P 230-241 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28958066?dopt=Abstract %R 10.1093/geront/gnx137 %0 Journal Article %J JAMA Network Open %D 2019 %T Association between life purpose and mortality among US adults older than 50 years %A Alimujiang, Aliya %A Wiensch, Ashley %A Boss, Jonathan %A Fleischer, Nancy L. %A Mondul, Alison M. %A McLean, Karen %A Mukherjee, Bhramar %A Pearce, Celeste Leigh %K Longevity %K Mortality %K Purpose in life %X **Importance** A growing body of literature suggests that having a strong sense of purpose in life leads to improvements in both physical and mental health and enhances overall quality of life. There are interventions available to influence life purpose; thus, understanding the association of life purpose with mortality is critical. **Objective** To evaluate whether an association exists between life purpose and all-cause or cause-specific mortality among older adults in the United States. **Design, Setting, and Participants** The Health and Retirement Study (HRS) is a national cohort study of US adults older than 50 years. Adults between the ages of 51 to 61 were enrolled in the HRS, and their spouses or partners were enrolled regardless of age. Initially, individuals born between 1931 and 1941 were enrolled starting in 1992, but subsequent cohort enrichment was carried out. The present prospective cohort study sample was drawn from 8419 HRS participants who were older than 50 years and who had filled out a psychological questionnaire during the HRS 2006 interview period. Of these, 1142 nonresponders with incomplete life purpose data, 163 respondents with missing sample weights, 81 participants lost to follow-up, 1 participant with an incorrect survival time, and 47 participants with missing information on covariates were excluded. The final sample for analysis was 6985 individuals. Data analyses were conducted between June 5, 2018, and April 22, 2019. **Exposures** Purpose in life was assessed for the 2006 interview period with a 7-item questionnaire from the modified Ryff and Keyes Scales of Psychological Well-being evaluation using a Likert scale ranging from 1 to 6, with higher scores indicating greater purpose in life; for all-cause and cause-specific mortality analyses, 5 categories of life purpose scores were used (1.00-2.99, 3.00-3.99, 4.00-4.99, 5.00-5.99, and 6.00). **Main Outcomes and Measures** All-cause and cause-specific mortality were assessed between 2006 and 2010. Weighted Cox proportional hazards models were used to evaluate life purpose and mortality. **Results** Of 6985 individuals included in the analysis, 4016 (57.5%) were women, the mean (SD) age of all participants was 68.6 (9.8) years, and the mean (SD) survival time for decedents was 31.21 (15.42) months (range, 1.00-71.00 months). Life purpose was significantly associated with all-cause mortality in the HRS (hazard ratio, 2.43; 95% CI, 1.57-3.75, comparing those in the lowest life purpose category with those in the highest life purpose category). Some significant cause-specific mortality associations with life purpose were also observed (heart, circulatory, and blood conditions: hazard ratio, 2.66; 95% CI, 1.62-4.38). Conclusions and Relevance This study’s results indicated that stronger purpose in life was associated with decreased mortality. Purposeful living may have health benefits. Future research should focus on evaluating the association of life purpose interventions with health outcomes, including mortality. In addition, understanding potential biological mechanisms through which life purpose may influence health outcomes would be valuable. %B JAMA Network Open %V 2 %P e194270 %G eng %N 5 %R 10.1001/jamanetworkopen.2019.4270 %0 Journal Article %J JAMA Internal Medicine %D 2019 %T Association of functional impairment in middle age with hospitalization, nursing home admission, and death %A Rebecca T Brown %A L Grisell Diaz-Ramirez %A W John Boscardin %A Sei J. Lee %A Brie A Williams %A Michael A Steinman %K Functional limitations %K Hospitalization %K Mortality %K Nursing homes %X Importance Difficulty performing daily activities such as bathing and dressing (“functional impairment”) affects nearly 15% of middle-aged adults. Older adults who develop such difficulties, often because of frailty and other age-related conditions, are at increased risk of acute care use, nursing home admission, and death. However, it is unknown if functional impairments that develop among middle-aged people, which may have different antecedents, have similar prognostic significance. Objective To determine whether middle-aged individuals who develop functional impairment are at increased risk for hospitalization, nursing home admission, and death. Design, Setting, and Participants This matched cohort study analyzed longitudinal data from the Health and Retirement Study, a nationally representative prospective cohort study of US adults. The study population included 5540 adults aged 50 to 56 years who did not have functional impairment at study entry in 1992, 1998, or 2004. Participants were followed biennially through 2014. Individuals who developed functional impairment between 50 and 64 years were matched by age, sex, and survey wave with individuals without impairment as of that age and survey wave. Statistical analysis was conducted from March 15, 2017, to December 11, 2018. Exposures Impairment in activities of daily living (ADLs), defined as self-reported difficulty performing 1 or more ADLs, and impairment in instrumental ADLs (IADLs), defined similarly. Main Outcomes and Measures The 3 primary outcomes were time from the first episode of functional impairment (or matched survey wave, in controls) to hospitalization, nursing home admission, and death. Follow-up assessments occurred every 2 years until 2014. Competing risks survival analysis was used to assess the association of functional impairment with hospitalization and nursing home admission and Cox proportional hazards regression analysis was used to assess the association with death. Results Of the 5540 study participants (2739 women and 2801 men; median age, 53.7 years [interquartile range, 52.3-55.2 years]), 1097 (19.8%) developed ADL impairment between 50 and 64 years, and 857 (15.5%) developed IADL impairment. Individuals with ADL impairment had an increased risk of each adverse outcome compared with those without impairment, including hospitalization (subhazard ratio, 1.97; 95% CI, 1.77-2.19), nursing home admission (subhazard ratio, 2.62; 95% CI, 1.99-3.45), and death (hazard ratio, 2.06; 95% CI, 1.74-2.45). After multivariable adjustment, the risks of hospitalization (subhazard ratio, 1.54; 95% CI, 1.36-1.75) and nursing home admission (subhazard ratio, 1.73; 95% CI, 1.24-2.43) remained significantly higher among individuals with ADL impairment, but the risk of death was not statistically significant (hazard ratio, 1.06; 95% CI, 0.85-1.32). Individuals with IADL impairment had an increased risk of all 3 outcomes in adjusted and unadjusted analyses. Conclusions and Relevance Similar to older adults, middle-aged adults who develop functional impairment appear to be at increased risk for adverse outcomes. Even among relatively young people, functional impairment has important clinical implications. %B JAMA Internal Medicine %8 Aug-04-2019 %G eng %U http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2019.0008http:///jamainternalmedicine/article-pdf/doi/10.1001/jamainternmed.2019.0008/17440339/jamainternal_brown_2019_oi_190001.pdf %! JAMA Intern Med %R 10.1001/jamainternmed.2019.0008 %0 Journal Article %J BMC Public Health %D 2019 %T Association of genetic and behavioral characteristics with the onset of diabetes %A Carmen D Ng %A Weiss, Jordan %K Behavior %K Diabetes %K Genetics %X Background Prior work has established sociodemographic, lifestyle, and behavioral risk factors for diabetes but the contribution of these factors to the onset of diabetes remains unclear when accounting for genetic propensity for diabetes. We examined the contribution of a diabetes polygenic score (PGS) to the onset of diabetes in the context of modifiable known risk factors for diabetes. Methods Our sample consisted of 15,190 respondents in the United States-based Health and Retirement Study, a longitudinal study with up to 22 years of follow-up. We performed multivariate Cox regression models stratified by race (non-Hispanic white and non-Hispanic black) with time-varying covariates. Results We observed 4217 (27.76%) cases of incident diabetes over the survey period. The diabetes PGS was statistically significantly associated with diabetes onset for both non-Hispanic whites (hazard ratio [HR] = 1.38, 95% confidence interval [CI] = 1.30, 1.46) and non-Hispanic blacks (HR = 1.22, 95% CI = 1.06, 1.40) after adjusting for a range of known risk factors for diabetes, highlighting the critical role genetic endowment might play. Nevertheless, genetics do not downplay the role that modifiable characteristics could still play in diabetes management; even with the inclusion of the diabetes PGS, several behavioral and lifestyle characteristics remained significant for both race groups. Conclusions The effects of genetic and lifestyle characteristics should be taken into consideration for both future studies and diabetes management. %B BMC Public Health %V 19 %P 1297 %8 2019/10/15 %@ 1471-2458 %G eng %U https://doi.org/10.1186/s12889-019-7618-z %N 1 %! BMC Public Health %0 Journal Article %J Nature Genetics %D 2019 %T Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use. %A Liu, Mengzhen %A Jiang, Yu %A Wedow, Robbee %A Li, Yue %A Brazel, David M %A Chen, Fang %A Datta, Gargi %A Davila-Velderrain, Jose %A McGuire, Daniel %A Tian, Chao %A Zhan, Xiaowei %A Choquet, Hélène %A Docherty, Anna R %A Jessica Faul %A Foerster, Johanna R %A Fritsche, Lars G %A Gabrielsen, Maiken Elvestad %A Gordon, Scott D %A Jeffrey Haessler %A Jouke-Jan Hottenga %A Huang, Hongyan %A Jang, Seon-Kyeong %A Philip R Jansen %A Ling, Yueh %A Mägi, Reedik %A Matoba, Nana %A McMahon, George %A Mulas, Antonella %A Orrù, Valeria %A Palviainen, Teemu %A Anita Pandit %A Reginsson, Gunnar W %A Skogholt, Anne Heidi %A Smith, Jennifer A %A Taylor, Amy E %A Turman, Constance %A Gonneke Willemsen %A Young, Hannah %A Young, Kendra A %A Zajac, Gregory J M %A Zhao, Wei %A Zhou, Wei %A Bjornsdottir, Gyda %A Boardman, Jason D %A Boehnke, Michael %A Dorret I Boomsma %A Chen, Chu %A Francesco Cucca %A Davies, Gareth E %A Charles B Eaton %A Ehringer, Marissa A %A Tõnu Esko %A Fiorillo, Edoardo %A Gillespie, Nathan A %A Gudbjartsson, Daniel F %A Haller, Toomas %A Kathleen Mullan Harris %A Andrew C Heath %A Hewitt, John K %A Hickie, Ian B %A Hokanson, John E %A Hopfer, Christian J %A Hunter, David J %A Iacono, William G %A Johnson, Eric O %A Kamatani, Yoichiro %A Sharon L R Kardia %A Matthew C Keller %A Kellis, Manolis %A Charles Kooperberg %A Kraft, Peter %A Krauter, Kenneth S %A Laakso, Markku %A Penelope A Lind %A Loukola, Anu %A Lutz, Sharon M %A Pamela A F Madden %A Nicholas G Martin %A McGue, Matt %A Matthew B McQueen %A Sarah E Medland %A Andres Metspalu %A Mohlke, Karen L %A Nielsen, Jonas B %A Okada, Yukinori %A Peters, Ulrike %A Tinca J Polderman %A Posthuma, Danielle %A Reiner, Alexander P %A Rice, John P %A Rimm, Eric %A Rose, Richard J %A Runarsdottir, Valgerdur %A Stallings, Michael C %A Stančáková, Alena %A Stefansson, Hreinn %A Thai, Khanh K %A Hilary A Tindle %A Tyrfingsson, Thorarinn %A Wall, Tamara L %A David R Weir %A Weisner, Constance %A Whitfield, John B %A Winsvold, Bendik Slagsvold %A Yin, Jie %A Zuccolo, Luisa %A Laura Bierut %A Hveem, Kristian %A Lee, James J %A Munafò, Marcus R %A Saccone, Nancy L %A Willer, Cristen J %A Marilyn C Cornelis %A David, Sean P %A Hinds, David A %A Jorgenson, Eric %A Kaprio, Jaakko %A Stitzel, Jerry A %A Stefansson, Kari %A Thorgeirsson, Thorgeir E %A Gonçalo R Abecasis %A Liu, Dajiang J %A Scott Vrieze %K Alcohol Drinking %K Female %K Genetic Variation %K Genome-Wide Association Study %K Humans %K Male %K Middle Aged %K Phenotype %K Risk %K Smoking %K Tobacco %K Tobacco Use Disorder %X

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

%B Nature Genetics %V 51 %P 237-244 %G eng %N 2 %R 10.1038/s41588-018-0307-5 %0 Journal Article %J Immunity & Ageing %D 2019 %T Associations of plasma high-sensitivity C-reactive protein concentrations with all-cause and cause-specific mortality among middle-aged and elderly individuals %A Li, Zhi-Hao %A Zhong, Wen-Fang %A Lv, Yue-Bin %A Virginia Byers Kraus %A Gao, Xiang %A Chen, Pei-Liang %A Huang, Qing-Mei %A Ni, Jin-Dong %A Shi, Xiao-Ming %A Mao, Chen %A Wu, Xian-Bo %K C-reactive protein %K Genetics %K Mortality %X Background The association of high-sensitivity C-reactive protein (hsCRP) with mortality is controversial. We aimed to investigate the associations of hsCRP concentrations with the risks of all-cause and cause-specific mortality and identify potential modifying factors affecting these associations among middle-aged and elderly individuals. Methods This community-based prospective cohort study included 14,220 participants aged 50+ years (mean age: 64.9 years) from the Health and Retirement Study. Cox proportional hazard models were employed to estimate the associations between the hsCRP concentrations and the risk of all-cause and cause-specific mortality with adjustment for sociodemographic and lifestyle factors, self-reported medical history, and other potential confounders. Results In total, 1730 all-cause deaths were recorded, including 725 cardiovascular- and 417 cancer-related deaths, after an 80,572 person-year follow-up (median: 6.4 years; range: 3.6–8.1 years). The comparisons of the groups with the highest (quartile 4) and lowest (quartile 1) hsCRP concentrations revealed that the adjusted hazard ratios and 95% confidence intervals were 1.50 (1.31–1.72) for all-cause mortality, 1.44 (1.13–1.82) for cardiovascular mortality, and 1.67 (1.23–2.26) for cancer mortality. The associations between high hsCRP concentrations and the risks of all-cause, cardiovascular, and cancer mortality were similar in the men and women (P for interaction > 0.05). Conclusions Among middle-aged and older individuals, elevated hsCRP concentration could increase the risk of all-cause, cardiovascular, and cancer mortality in men and women. %B Immunity & Ageing %V 16 %P 28 %8 Nov 2019 %G eng %U https://doi.org/10.1186/s12979-019-0168-5 %R 10.1186/s12979-019-0168-5 %0 Journal Article %J Journals of Gerontology, Series B. Psychological Sciences & Social Sciences %D 2019 %T Avoiding the major causes of death: Does childhood misfortune reduce the likelihood of being disease free in later life? %A Monica M Williams %A Blakelee R Kemp %A Kenneth F Ferraro %A Sarah A Mustillo %K Childhood adversity %K Mortality %K Risk Factors %X

Objectives: Although previous research reveals the detrimental effects of early misfortune on the development of chronic diseases in later life, few studies have investigated its effects on remaining disease free. This study draws on cumulative inequality theory to investigate whether experiencing childhood misfortune reduces the likelihood of remaining disease free over time.

Method: This study utilizes five waves of data from the Health and Retirement Study to test whether five domains of childhood misfortune predict being disease free at baseline (2004) and developing disease over time (2004-2012).

Results: Respondents reporting risky parental behaviors during childhood were less likely to be disease free at baseline and had an increased risk of disease onset over time, the latter driven by having a guardian who smoked in combination with more pack-years smoked in adulthood. Furthermore, we find that adult resources, that is wealth, help to mitigate the noxious effects of other misfortunes, notably poor socioeconomic conditions.

Discussion: Consistent with cumulative inequality theory, these findings reveal that experiencing multiple types of misfortune during childhood decreases the likelihood of remaining disease free in later life, but engaging in health behaviors, such as physical activity, can help to ameliorate some of the noxious effects of early misfortune.

%B Journals of Gerontology, Series B. Psychological Sciences & Social Sciences %V 74 %P 170-180 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29617874?dopt=Abstract %R 10.1093/geronb/gby039 %0 Thesis %B Social Work %D 2019 %T Beyond Wealth and Health: Psycho-Social Factors and Retirement Planning and Expectations in the U.S. %A Wang, Yihan %K family and work %K personal mastery %K retirement expectation %K Retirement Planning %K retirement satisfaction %K Social work %X Retirement is a significant transition in an individual’s life course. More and more people are working past traditional retirement ages. Planning before retirement has been shown to relate to a number of positive outcomes and lead to a smoother transition to a retired life, such as more retirement savings, better retirement satisfaction, better social life, health, and mental health. However, most of the studies about retirement to date have focused on the impact of health and wealth in preparing for a successful retirement. This dissertation examines three issues related to retirement planning and expectations: (1) How do work and family relationships relate to having a plan to reduce or stop work and expected retirement timing in late life, and are there gender and occupational differences in these relationships? (2) How do workplace experiences relate to expectations to retire earlier or later than what is normative in different occupations? (3) Does sense of control explain the relationship between involuntary retirement and retirement satisfaction? To answer the three questions, the author adopts the role theory, the age norm theory, and the theory of self-efficacy to explain the background and findings. The data for this dissertation comes from the Health and Retirement Study (HRS), a nationally representative dataset that captures the information about the health and retirement issues among adults over age 50 in the U.S. This proposed study uses pooled cross-sectional data from waves 2012 and 2014. Ordinary least squares (OLS) regression and logistic regression were used to examine the effect of work and family relationships and the plans/retirement timing of pre-retirees. Multinomial logistic regression was used to examine workplace factors that contribute to the non-normative retirement age expectations. Mediation analysis was used to study how personal mastery, perceived constraints, and domain-specific control mediates the relationship between involuntary retirement and retirement satisfaction. %B Social Work %I Boston College University %C Newton, MA %V Ph.D. %P 179 %8 2019 %G eng %U https://dlib.bc.edu/islandora/object/bc-ir:108593 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2019 %T Changes in cognitive function among older adults: A latent profile transition analysis %A Huang, Feifei %A Zhang, Minqiang %A Wang, Shaojie %K Cognitive Ability %K Gender Differences %K Latent Variable Modeling %X Cognitive decline in late life is a crucial health problem. It is important to understand the consistency and change of older adults’ cognitive function in late life. Data for older adults (78 years and above) from the Health and Retirement Study (N = 1680) were used to explore meaningful subtypes of cognitive function and transitions patterns between those profiles across times. Age, gender, levels of education and nursing home were incorporated as covariates to explore the association between these variables and cognitive function transition pattern. Three cognitive function subgroups (Normal Cognitive Function, Fluid Intelligence Impairment and Cognitive Impairment) were identified. Individuals in Normal Cognitive Function status had a high probability to convert to the Fluid Intelligence Impairment status whereas the Cognitive Impairment status appeared a predominant tendency for stability. Increasing age played a significant role in fluid intelligence impairment and cognitive impairment process. Female and individuals with nursing home might be at higher risk of subsequent fluid intelligence impairment, while higher education did not protect against fluid intelligence impairment. These findings highlighted the usefulness to adopt a person-centered approach rather than a variable-centered approach, suggesting directions for future research and tailored interventions approaches to older adults with particular characteristics. %B Archives of Gerontology and Geriatrics %V 80 %P 12-19 %G eng %U https://linkinghub.elsevier.com/retrieve/pii/S0167494318301821https://api.elsevier.com/content/article/PII:S0167494318301821?httpAccept=text/xmlhttps://api.elsevier.com/content/article/PII:S0167494318301821?httpAccept=text/plain %! Archives of Gerontology and Geriatrics %R 10.1016/j.archger.2018.09.006 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2019 %T Chronic Stress and Negative Marital Quality Among Older Couples: Associations With Waist Circumference. %A Kira S. Birditt %A Nicky J Newton %A James A. Cranford %A Noah J Webster %K Family Conflict %K Female %K Humans %K Interviews as Topic %K Longitudinal Studies %K Male %K Marriage %K Middle Aged %K Obesity %K Stress, Psychological %K Surveys and Questionnaires %K Waist Circumference %X

Objective: More than a third of the U.S. population of older adults is obese. The present study tests the Dyadic Biopsychosocial Model of Marriage and Health, which hypothesizes that, among married couples, individual and partner chronic stress predicts increased waist circumference and these links are exacerbated in negative quality marriages.

Method: Participants were from the nationally representative longitudinal Health and Retirement Study (HRS). A total of 2,042 married individuals (in 1,098 married couples) completed psychosocial and waist circumference assessments in 2006 and 2010. Analyses examined whether negative marital quality and chronic stress in Wave 1 (2006) were associated with changes in waist circumference over time.

Results: Actor-partner interdependence models revealed that greater partner stress, rather than individuals' own reports of stress, was associated with increased waist circumference over time. Higher perceived negative marital quality among husbands and lower negative marital quality among wives exacerbated the positive link between partner stress and waist circumference.

Discussion: Consistent with the Dyadic Biopsychosocial Model of Marriage and Health, partner stress has direct associations with waist circumference among couples and this link is moderated by negative marital quality. Thus, dyadic perceptions of stress and negative marital quality are important to consider for understanding marriage and obesity.

%B J Gerontol B Psychol Sci Soc Sci %V 74 %P 318-328 %8 2019 01 10 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/27664418?dopt=Abstract %R 10.1093/geronb/gbw112 %0 Journal Article %J The Annals of Thoracic Surgergy %D 2019 %T Cognitive Change After Cardiac Surgery Versus Cardiac Catheterization: A Population-Based Study. %A Elizabeth L Whitlock %A L Grisell Diaz-Ramirez %A Alexander K Smith %A W John Boscardin %A Michael S. Avidan %A M. Maria Glymour %K Cardiac surgery %K Cardiovascular disease %K Cognition & Reasoning %K Memory %X

BACKGROUND: Despite concern that cardiac surgery may adversely affect cognition, little evidence is available from population-based studies using presurgery data. With the use of the Health and Retirement Study, we compared memory change after participant-reported cardiac catheterization or cardiac surgery.

METHODS: Participants were community-dwelling adults aged 65 years and older who self-reported cardiac catheterization or "heart surgery" at any biennial Health and Retirement Study interview between 2000 and 2014. Participants may have undergone the index procedure any time in the preceding 2 years. We modeled preprocedure to postprocedure change in composite memory score, derived from objective memory testing, using linear mixed effects models. We modeled postprocedure subjective memory decline with logistic regression. To quantify clinical relevance, we used the predicted memory change to estimate impact on ability to manage medications and finances independently.

RESULTS: Of 3,105 participants, 1,921 (62%) underwent catheterization and 1,184 (38%) underwent operation. In adjusted analyses, surgery participants had little difference in preprocedure to postprocedure memory change compared with participants undergoing cardiac catheterization (-0.021 memory units; 95% confidence interval: -0.046 to 0.005 memory units, p = 0.12). If the relationship were causal, the point estimate for memory decline would confer an absolute 0.26% or 0.19% decrease in ability to manage finances or medications, respectively, corresponding to 4.6 additional months of cognitive aging. Cardiac surgery was not associated with subjective memory decline (adjusted odds ratio 0.93, 95% confidence interval: 0.74 to 1.18).

CONCLUSIONS: In this large, population-based cohort, memory declines after heart surgery and cardiac catheterization were similar. These findings suggest intermediate-term population-level adverse cognitive effects of cardiac surgery, if any, are likely subtle.

%B The Annals of Thoracic Surgergy %V 107 %P 1119-1125 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/30578068?dopt=Abstract %R 10.1016/j.athoracsur.2018.10.021 %0 Journal Article %J European Journal of Human Genetics %D 2019 %T Combined linkage and association analysis identifies rare and low frequency variants for blood pressure at 1q31. %A Wang, Heming %A Nandakumar, Priyanka %A Tekola-Ayele, Fasil %A Bamidele O Tayo %A Erin B Ware %A Gu, C Charles %A Lu, Yingchang %A Yao, Jie %A Zhao, Wei %A Smith, Jennifer A %A Hellwege, Jacklyn N %A Guo, Xiuqing %A Edwards, Todd L %A Ruth J F Loos %A Donna K Arnett %A Myriam Fornage %A Charles N Rotimi %A Sharon L R Kardia %A Cooper, Richard S %A Rao, D C %A Georg B Ehret %A Chakravarti, Aravinda %A Zhu, Xiaofeng %K African Americans %K Chromosomes, Human, Pair 1 %K Gene Frequency %K Genome-Wide Association Study %K Humans %K Hypertension %K Linkage Disequilibrium %K Polymorphism, Single Nucleotide %X

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

%B European Journal of Human Genetics %V 27 %P 269-277 %G eng %N 2 %R 10.1038/s41431-018-0277-1 %0 Journal Article %J Cells %D 2019 %T Comparing the utility of mitochondrial and nuclear DNA to adjust for genetic ancestry in association studies. %A Miller, Brendan %A Thalida E. Arpawong %A Jiao, Henry %A Kim, Su-Jeong %A Yen, Kelvin %A Hemal H Mehta %A Wan, Junxiang %A John Carpten %A Cohen, Pinchas %K Genetics %K GWAS %K Survey Methodology %X Mitochondrial genome-wide association studies identify mitochondrial single nucleotide polymorphisms (mtSNPs) that associate with disease or disease-related phenotypes. Most mitochondrial and nuclear genome-wide association studies adjust for genetic ancestry by including principal components derived from nuclear DNA, but not from mitochondrial DNA, as covariates in statistical regression analyses. Furthermore, there is no standard when controlling for genetic ancestry during mitochondrial and nuclear genetic interaction association scans, especially across ethnicities with substantial mitochondrial genetic heterogeneity. The purpose of this study is to (1) compare the degree of ethnic variation captured by principal components calculated from microarray-defined nuclear and mitochondrial DNA and (2) assess the utility of mitochondrial principal components for association studies. Analytic techniques used in this study include a principal component analysis for genetic ancestry, decision-tree classification for self-reported ethnicity, and linear regression for association tests. Data from the Health and Retirement Study, which includes self-reported White, Black, and Hispanic Americans, was used for all analyses. We report that (1) mitochondrial principal component analysis (PCA) captures ethnic variation to a similar or slightly greater degree than nuclear PCA in Blacks and Hispanics, (2) nuclear and mitochondrial DNA classify self-reported ethnicity to a high degree but with a similar level of error, and 3) mitochondrial principal components can be used as covariates to adjust for population stratification in association studies with complex traits, as demonstrated by our analysis of height-a phenotype with a high heritability. Overall, genetic association studies might reveal true and robust mtSNP associations when including mitochondrial principal components as regression covariates. %B Cells %V 8 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/30987182?dopt=Abstract %R 10.3390/cells8040306 %0 Journal Article %J Epidemiology %D 2019 %T Comparison of methods for algorithmic classification of dementia status in the Health and Retirement Study. %A Kan Z Gianattasio %A Bei Wu %A M. Maria Glymour %A Melinda C Power %K Cognition & Reasoning %K Dementia %K Meta-analyses %K Survey Methodology %X

BACKGROUND: Dementia ascertainment is time-consuming and costly. Several algorithms use existing data from the U.S.-representative Health and Retirement Study (HRS) to algorithmically identify dementia. However, relative performance of these algorithms remains unknown.

METHODS: We compared performance across five algorithms (Herzog-Wallace, Langa-Kabeto-Weir, Crimmins, Hurd, Wu) overall and within sociodemographic subgroups in participants in HRS and Wave A of the Aging, Demographics, and Memory Study (ADAMS, 2000-2002), an HRS sub-study including in-person dementia ascertainment. We then compared algorithmic performance in an internal (time-split) validation dataset including participants of HRS and ADAMS Waves B, C, and/or D (2002-2009).

RESULTS: In the unweighted training data, sensitivity ranged from 53% to 90%, specificity ranged from 79% to 97%, and overall accuracy ranged from 81% to 87%. Though sensitivity was lower in the unweighted validation data (range: 18% to 62%), overall accuracy was similar (range: 79% to 88%) due to higher specificities (range: 82% to 98%). In analyses weighted to represent the age-eligible US population, accuracy ranged from 91% to 94% in the training data and 87% to 94% in the validation data. Using a 0.5 probability cutoff, Crimmins maximized sensitivity, Herzog-Wallace maximized specificity, and Wu and Hurd maximized accuracy. Accuracy was higher among younger, highly-educated, and non-Hispanic white participants versus their complements in both weighted and unweighted analyses.

CONCLUSIONS: Algorithmic diagnoses provide a cost-effective way to conduct dementia research. However, naïve use of existing algorithms in disparities or risk-factor research may induce non-conservative bias. Algorithms with more comparable performance across relevant subgroups are needed.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

%B Epidemiology %V 30 %P 291-302 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/30461528?dopt=Abstract %R 10.1097/EDE.0000000000000945 %0 Journal Article %J Journal of Aging and Health %D 2019 %T Comparisons of the Association of Family and Social Factors With Functional Limitations Across the United States, Mexico, and South Korea: Findings From the HRS Family of Surveys %A Ickpyo Hong %A Pryor, Loree %A Rebeca Wong %A Ottenbacher, Kenneth J. %A Timothy A Reistetter %K Cross-Cultural Comparison %K cross-national study %K Family %K KLoSA %K MHAS %K multiple studies %K socialization %X Objective: The association of family and social factors with the level of functional limitations was examined across the United States, Mexico, and Korea. Method: Participants included adults from the 2012 Health and Retirement Study (n = 10,017), Mexican Health and Aging Study (n = 6,367), and Korean Longitudinal Study of Aging (n = 4,134). A common functional limitation scale was created based on Rasch analysis with a higher score indicating better physical function. Results: The American older adults (3.65 logits) had better physical function compared with Mexican (2.81 logits) and Korean older adults (1.92 logits). There were different associations of family and social factors with functional limitations across the three countries. Discussion: The American older adults demonstrated less functional limitation compared with Mexican and Korean older adults at the population level. The findings indicate the need to interpret carefully the individual family and social factors associated with functional limitations within the unique context of each country. %B Journal of Aging and Health %8 2019/10/04 %@ 0898-2643 %G eng %! J Aging Health %R https://doi.org/10.1177/0898264319878549 %0 Journal Article %J The Gerontologist %D 2019 %T Complex multimorbidity and breast cancer screening among midlife and older women: The role of perceived need %A David F Warner %A Siran M Koroukian %A Nicholas K Schiltz %A Kathleen A Smyth %A Cooper, Gregory S %A Owusu, Cynthia %A Kurt C Stange %A Nathan A. Berger %K Cancer screenings %K Comorbidity %K Decision making %K Women and Minorities %X Background and Objectives There is minimal survival benefit to cancer screening for those with poor clinical presentation (complex multimorbidity) or at advanced ages. The current screening mammography guidelines consider these objective indicators. There has been less attention, however, to women’s subjective assessment of screening need. This study examines the interplay between complex multimorbidity, age, and subjective assessments of health and longevity for screening mammography receipt. Research Design and Method This cross-sectional study uses self-reported data from 8,938 women over the age of 52 in the 2012 Health and Retirement Study. Logistic regression models estimated the association between women’s complex multimorbidity (co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes), subjective health and longevity assessments, age, and screening mammography in the 2 years before the interview. These associations were evaluated adjusting for sociodemographic and behavioral factors. Results Both age and complex multimorbidity were negatively associated with screening mammography. However, women’s perceived need for screening moderated these effects. Most significantly, women optimistic about their chances of living another 10–15 years were more likely to have had screening mammography regardless of their health conditions or advanced age. Discussion and Implications Women with more favorable self-assessed health and perceived life expectancy were more likely to receive screening mammography even if they have poor clinical presentation or advanced age. This is contrary to current cancer screening guidelines and suggests an opportunity to engage women’s subjective health and longevity assessments for cancer screening decision making in both for screening policy and in individual clinician recommendations. %B The Gerontologist %V 59 %P S77 - S87 %G eng %U https://academic.oup.com/gerontologist/article/59/Supplement_1/S77/5491135http://academic.oup.com/gerontologist/article-pdf/59/Supplement_1/S77/28667857/gny180.pdf %N Supplement_1 %R 10.1093/geront/gny180 %0 Journal Article %J BMJ Open %D 2019 %T A cross-sectional study of self-rated health among older adults: a comparison of China and the United States. %A Xu, Dongjuan %A Arling, Greg %A Wang, Kefang %K CHARLS %K Cross-National %K Self-reported health %K Sister studies %X

OBJECTIVES: We used nationally representative samples of China and the US older population to investigate (1) whether factors influencing self-rated health among older Chinese were similar to those among older Americans; and (2) whether there was a significant cross-national difference in self-rated health between China and the USA after controlling those available influencing factors.

DESIGN: A cross-sectional study. Data came from the 2014 Health and Retirement Study and China Health and Retirement Longitudinal Study conducted from 2014 to 2015.

PARTICIPANTS: Our final sample size totaled 8905 older adults in the USA and 4442 older adults in China.

OUTCOME: The response variable was self-rated health. Ordered logistic regression models were conducted to investigate factors influencing self-rated health among older adults.

RESULTS: More than three-fourths (78%) of older adults in China reported fair or poor health status, while almost 74% of older adults in the USA reported excellent, very good or good health status. In the overall ordered logistic regression model, when controlling statistically for sociodemographics, family structure, functional limitations, cognition, chronic conditions, mental health and health-related behaviours, the Chinese survey respondents were much more likely to rate their health as being poorer than the US respondents. The odds of having better versus poorer health was almost five times greater in American older adults than those in China (OR=4.88, 95% CI 4.06 to 5.86). Older adults in China living alone rated their health better than those living with spouse/partner; however, no significant difference was found between these two living arrangements in older Americans. In contrast, older adults in the USA living with others rated their health worse compared with those living with spouse/partner. In addition, older adults who had more activities of daily living limitations, poorer self-reported memory, worse mental health and chronic health conditions had lower self-rated health in both countries.

CONCLUSIONS: We found a striking difference in self-rated health between China and the USA even after controlling for measures of disease, functional status and other influencing factors. Relative to their American counterparts, Chinese elders were much more likely to report worse health.

%B BMJ Open %V 9 %P e027895 %8 2019 Jul 31 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/31371288?dopt=Abstract %R 10.1136/bmjopen-2018-027895 %0 Journal Article %J Journal of Health and Social Behavior %D 2019 %T Depressive symptoms following later-life marital dissolution and subsequent repartnering. %A Lin, I-Fen %A Susan L. Brown %A Matthew R Wright %A Anna M Hammersmith %K Depressive symptoms %K Divorce %K Family Roles/Relationships %K Marriage %K Widowhood %X The doubling of the divorce rate among individuals over age 50 during the past 20 years underscores the urgency of studying the consequences of gray divorce and subsequent repartnering for adult well-being. We filled this gap by using the 1998-to-2014 Health and Retirement Study to evaluate how the levels of depressive symptoms changed following gray divorce versus widowhood. Individuals who divorced or became widowed already had experienced higher levels of depressive symptoms before dissolution relative to those who remained married. Compared with those who became widowed, those who transitioned to divorce experienced a lower elevation and a shorter time to recovery in depressive symptoms. When repartnering, both groups experienced similar magnitudes of initial reduction and subsequent rates of increase. Both the negative consequences of marital dissolution and the beneficial effects of repartnership for mental health persisted for several years, although ultimately they reverted to their predissolution levels of depressive symptoms. %B Journal of Health and Social Behavior %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30957562?dopt=Abstract %R 10.1177/0022146519839683 %0 Journal Article %J The Gerontologist %D 2019 %T Determinants of Hearing Aid Use Among Older Americans With Hearing Loss %A Michael M McKee %A Choi, Hwajung %A Wilson, Shelby %A Melissa J DeJonckheere %A Zazove, Philip %A Helen G Levy %K Hearing aids %K Hearing loss %K Social Support %K Stigma %X Background and Objectives Hearing loss (HL) is common among older adults and is associated with significant psychosocial, cognitive, and physical sequelae. Hearing aids (HA) can help, but not all individuals with HL use them. This study examines how social determinants may impact HA use. Research Design and Methods We conducted an explanatory sequential mixed methods study involving a secondary analysis of a nationally representative data set, the Health and Retirement Study (HRS; n = 35,572). This was followed up with 1:1 qualitative interviews (n = 21) with community participants to clarify our findings. Both samples included individuals aged 55 and older with a self-reported HL, with or without HA. The main outcome measure was the proportion of participants with a self-reported HL who use HA. Results and Discussion Analysis of HRS data indicated that younger, nonwhite, non-Hispanic, lower income, and less-educated individuals were significantly less likely to use HA than their referent groups (all p values < .001). Area of residence (e.g., urban) were not significantly associated with HA use. Qualitative findings revealed barriers to HA included cost, stigma, vanity, and a general low priority placed on addressing HL by health care providers. Facilitators to obtaining and using HA included family/friend support, knowledge, and adequate insurance coverage for HA. Implications Many socioeconomic factors hinder individuals’ ability to obtain and use HA, but these obstacles appeared to be mitigated in part when insurance plans provided adequate HA coverage, or when their family/friends provided encouragement to use HA. %B The Gerontologist %G eng %U https://academic.oup.com/gerontologist/advance-article/doi/10.1093/geront/gny051/5000029http://academic.oup.com/gerontologist/advance-article-pdf/doi/10.1093/geront/gny051/24836322/gny051.pdf %R 10.1093/geront/gny051 %0 Journal Article %J 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 Thesis %B Health and Rehabilitation Sciences %D 2019 %T Emergence of Disability in Late Life %A Chao-Yi Wu %K 0212:Therapy %K 0498:Occupational Therapy %K Cognition %K depression %K Intervention %K Occupational therapy %K Prevention %K Therapy %X In 2050, the life expectancy is anticipated to be 82 years in the United States. This increased in life expectancy has raised questions as to whether a longer period of old age guarantees a longer period of good health. As of now, the potential for a healthy late life is tempered by disability – the loss of independence with activities of daily living (ADL). Disability looms as a personal, family, and public health crisis. Older adults with disability have low autonomy, require assistance from loved ones, and often require costly health care services. Effective interventions to prevent disability are critical to support wellness in late life. We identified gaps in existing non-pharmacological interventions for the prevention of disability, suggesting that 1) these interventions are associated with modest to moderate effect sizes and 2) the most robust interventions are complex and include multiple “active ingredients.” However, the best combination of “active ingredients” remains unclear, and the combinations may vary based on clinical indicators. To better understand these variations, we examined selected indicators of change in brain health (depressive symptoms, cognitive complaints) and their associations with patterns of everyday activities in at-risk older adults (i.e., with a recent diagnosis of a chronic condition). We learned that changes in these indicators of brain health accelerated disablement in older adults with a newly-diagnosed Diabetes Mellitus. We also learned that indicators of brain health influenced patterns of everyday activities in older adults at-risk for disability (i.e., self-reported changes in daily routines); depressive symptoms were associated with engagement in fewer instrumental ADL, and cognitive complaints were associated with engagement in fewer leisure activities. This information gives insight to the risk architecture contributing to the onset of disability, as well as potential clinical indicators that could be explored in future clinical trials. Age-related disability is “a situation without precedent.” The information gleaned from this dissertation may inform 1) studies to examine the health consequences of everyday activities patterns; 2) the identification of factors that may elucidate the complex disablement; and 3) the structure, timing, and dosage of future interventions that aim to prevent disability in late life. %B Health and Rehabilitation Sciences %I University of Pittsburgh %V PhD %P 156 %@ 9781085724814 %G eng %U http://d-scholarship.pitt.edu/36126/ %9 phd %0 Journal Article %J Aging & Mental Health %D 2019 %T Evaluating eight-year trajectories for sense of purpose in the Health and Retirement Study. %A Patrick L Hill %A Sara J Weston %K Health Conditions and Status %K Purpose in life %K Well-being %X

OBJECTIVES: Though cross-sectional research has suggested that sense of purpose declines into older adulthood, it remains unclear whether inter-individual variability occurs in these trajectories, and what factors predict these trajectories. The current study provides one of the first longitudinal investigations into how individuals' sense of purpose fluctuates in older adulthood.

METHOD: Participants from the Health and Retirement Study (n = 4,234, mean age = 65 years), completed assessments of sense of purpose over three years, along with multiple potential predictors (health, personality, demographics) at the start.

RESULTS: Second-order latent growth models demonstrated both mean-level declines on purpose over time, as well as the capacity for inter-individual variability in change patterns for retired adults. Among this cohort, health status, educational attainment, and marital status were significant predictors of purpose trajectories over time, though broad personality trait dimensions failed to uniquely predict change in sense of purpose. However, measurement invariance tests suggest that the scale did not operate similarly across work status groups.

CONCLUSION: Findings advance the previous literature by demonstrating inter-individual variability in sense of purpose for those participants who had retired. Future research should consider that purpose inventories may operate differently for those in the workplace versus retired adults.

%B Aging & Mental Health %V 23 %P 233-237 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/29212348?dopt=Abstract %R 10.1080/13607863.2017.1399344 %0 Journal Article %J American Journal of Medical Genetics Part B: Neuropsychiatric Genetics %D 2019 %T Examining sex differences in pleiotropic effects for depression and smoking using polygenic and gene-region aggregation techniques %A Lauren L Schmitz %A Arianna M Gard %A Erin B Ware %K Depressive symptoms %K Genetics %K PGS %K Sex differences %K Smoking %X Sex differences in rates of depression are thought to contribute to sex differences in smoking initiation (SI) and number of cigarettes smoked per day (CPD). One hypothesis is that women smoke as a strategy to cope with anxiety and depression, and have difficulty quitting because of concomitant changes in hypothalamic–pituitary–adrenocortical (HPA) axis function during nicotine withdrawal states. Despite evidence of biological ties, research has not examined whether genetic factors that contribute to depression‐smoking comorbidity differ by sex. We utilized two statistical aggregation techniques—polygenic scores (PGSs) and sequence kernel association testing—to assess the degree of pleiotropy between these behaviors and moderation by sex in the Health and Retirement Study (N = 8,086). At the genome‐wide level, we observed associations between PGSs for depressive symptoms and SI, and measured SI and depressive symptoms (all p < .01). At the gene level, we found evidence of pleiotropy in FKBP5 for SI (p = .028), and sex‐specific pleiotropy in females in NR3C2 (p = .030) and CHRNA5 (p = .025) for SI and CPD, respectively. Results suggest bidirectional associations between depression and smoking may be partially accounted for by shared genetic factors, and genetic variation in genes related to HPA‐axis functioning and nicotine dependence may contribute to sex differences in SI and CPD. %B American Journal of Medical Genetics Part B: Neuropsychiatric Genetics %V 180 %P 448 - 468 %8 Jan-09-2019 %G eng %U http://doi.wiley.com/10.1002/ajmg.v180.6http://doi.wiley.com/10.1002/ajmg.b.32748http://onlinelibrary.wiley.com/wol1/doi/10.1002/ajmg.b.32748/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fajmg.b.32748 %N 6 %! Am J Med Genet %R 10.1002/ajmg.v180.610.1002/ajmg.b.32748 %0 Journal Article %J American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics %D 2019 %T Examining sex differences in pleiotropic effects for depression and smoking using polygenic and gene-region aggregation techniques. %A Lauren L Schmitz %A Arianna M Gard %A Erin B Ware %K Depressive symptoms %K Genetics %K PGS %K Sex differences %K Smoking %X Sex differences in rates of depression are thought to contribute to sex differences in smoking initiation (SI) and number of cigarettes smoked per day (CPD). One hypothesis is that women smoke as a strategy to cope with anxiety and depression, and have difficulty quitting because of concomitant changes in hypothalamic-pituitary-adrenocortical (HPA) axis function during nicotine withdrawal states. Despite evidence of biological ties, research has not examined whether genetic factors that contribute to depression-smoking comorbidity differ by sex. We utilized two statistical aggregation techniques-polygenic scores (PGSs) and sequence kernel association testing-to assess the degree of pleiotropy between these behaviors and moderation by sex in the Health and Retirement Study (N = 8,086). At the genome-wide level, we observed associations between PGSs for depressive symptoms and SI, and measured SI and depressive symptoms (all p < .01). At the gene level, we found evidence of pleiotropy in FKBP5 for SI (p = .028), and sex-specific pleiotropy in females in NR3C2 (p = .030) and CHRNA5 (p = .025) for SI and CPD, respectively. Results suggest bidirectional associations between depression and smoking may be partially accounted for by shared genetic factors, and genetic variation in genes related to HPA-axis functioning and nicotine dependence may contribute to sex differences in SI and CPD. %B American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31219244?dopt=Abstract %R 10.1002/ajmg.b.32748 %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 Journal Article %J Journal of the American Geriatrics Society %D 2019 %T Factors associated with becoming edentulous in the US Health and Retirement Study. %A Jane A Weintraub %A Orleans, Brian %A Mark Alan Fontana %A Phillips, Ceib %A Judith A Jones %K Dental Care %K Risk Factors %K Smoking %X

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

DESIGN: Longitudinal study over a 6-year period.

SETTING: United States, 2006, 2012.

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

INTERVENTION: None.

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

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

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

%B Journal of the American Geriatrics Society %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31335967?dopt=Abstract %R 10.1111/jgs.16079 %0 Journal Article %J Health Affairs %D 2019 %T The financial burden of paid home care on older adults: Oldest and sickest are least likely to have enough income %A Richard W. Johnson %A Wang, Claire Xiaozhi %K Community-dwelling %K Financial burden %K Long-term Care %X Paid home care can significantly improve the lives of older adults with disabilities and their families, but recipients often incur substantial out-of-pocket spending. We simulated the financial burden of paid home care for a nationally representative sample of non-Medicaid community-dwelling adults ages sixty-five and older. We found that 74 percent could fund at least two years of a moderate amount of paid home care if they liquidated all of their assets, and 58 percent could fund at least two years of an extensive amount of paid home care. Among older adults with significant disabilities, however, only 57 percent could fund at least two years of moderate paid home care by liquidating all of their assets, and 40 percent could fund at least two years of extensive paid home care. Paid home care could become less affordable if growing labor shortages raise future costs. %B Health Affairs %V 38 %P 994-1002 %G eng %U http://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00025 %N 6 %! Health Affairs %R 10.1377/hlthaff.2019.00025 %0 Journal Article %J Journal of Gerontological Social Work %D 2019 %T Gender differences in the effect of social resources and social status on the retirement satisfaction and health of retirees. %A Wang, Yihan %A Matz-Costa, Christina %K Gender Differences %K Retirement Planning and Satisfaction %K Social Support %X This study explores the effect of positive and negative social support, social reciprocity, and subjective social status on the retirement satisfaction and health of retirees and gender differences therein. Using cross-sectional data from the 2010 and 2012 waves of the Health and Retirement Study (HRS), we found that social support seems to matter more for the retirement satisfaction and health of women, while social reciprocity matters more for the health of men and subjective social status for the retirement satisfaction of men. Implications for the development of social programs and policies over the life course are discussed.< %B Journal of Gerontological Social Work %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29768108?dopt=Abstract %R 10.1080/01634372.2018.1474156 %0 Journal Article %J AMERICAN SOCIOLOGICAL REVIEW %D 2019 %T Genes, Gender Inequality, and Educational Attainment %A Herd, Pamela %A Freese, Jeremy %A Sicinski, Kamil %A Benjamin W Domingue %A Kathleen Mullan Harris %A Wei, Caiping %A Hauser, Robert M. %K biodemography %K Education %K gender %K Genetics %X Women's opportunities have been profoundly altered over the past century by reductions in the social and structural constraints that limit women's educational attainment. Do social constraints manifest as a suppressing influence on genetic indicators of potential, and if so, did equalizing opportunity mean equalizing the role of genetics? We address this with three cohort studies: the Wisconsin Longitudinal Study (WLS; birth years 1939 to 1940), the Health and Retirement Study, and the National Longitudinal Study of Adolescent Health (Add Health; birth years 1975 to 1982). These studies include a ``polygenic score'' for educational attainment, providing a novel opportunity to explore this question. We find that within the WLS cohort, the relationship between genetics and educational outcomes is weaker for women than for men. However, as opportunities changed in the 1970s and 1980s, and many middle-aged women went back to school, the relationship between genetic factors and education strengthened for women as they aged. Furthermore, utilizing the HRS and Add Health, we find that as constraints limiting women's educational attainment declined, gender differences in the relationship between genetics and educational outcomes weakened. We demonstrate that genetic influence must be understood through the lens of historical change, the life course, and social structures like gender. %B AMERICAN SOCIOLOGICAL REVIEW %V 84 %P 1069-1098 %8 DEC %G eng %9 Article %R 10.1177/0003122419886550 %0 Journal Article %J Neurology %D 2019 %T Genetic basis of motoric cognitive risk syndrome in the Health and Retirement Study. %A Sathyan, Sanish %A Wang, Tao %A Emmeline Ayers %A Joe Verghese %K BMI %K Cognition & Reasoning %K Genetics %K Risk Factors %X

OBJECTIVE: To examine polygenic inheritance of motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by the presence of subjective cognitive complaints and slow gait.

METHODS: We analyzed 4,915 individuals, age 65 years and above, with European ancestry (mean age 75.0 ± 6.8 years, 56.6% women) in the Health and Retirement Study. Polygenic scores (PGS) were calculated as weighted sums of the effect of single nucleotide polymorphisms, with effect sizes derived from genome-wide association studies. The association between PGSs of 9 phenotypes (general cognition, body mass index [BMI], mean arterial pressure, education, Alzheimer disease [AD], neuroticism, well-being, waist circumference, and depressive symptoms) and MCR as well as its key components (cognitive complaints and slow gait) were examined by logistic regression, adjusting for age, sex, education, and genetic ancestry, and reported as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: There were 260 prevalent MCR cases, 529 with slow gait, and 1,928 with subjective cognitive complaints. Higher PGSs for BMI (OR 1.22, 95% CI 1.07-1.39) and waist circumference (OR 1.23, 95% CI 1.07-1.40) were associated with MCR, and PGS of AD showed a suggestive association (OR 1.16, 95% CI 1.02-1.32). Higher PGS for neuroticism (OR 1.10, 95% CI 1.03-1.18) was associated with cognitive complaints, whereas higher well-being PGS (OR 0.92, 95% CI 0.87-0.98) was protective. PGS for BMI (OR 1.16, 95% CI 1.06-1.28), waist circumference (OR 1.19, 95% CI 1.08-1.31), and AD (OR 1.13, 95% CI 1.03-1.24) was associated with slow gait.

CONCLUSION: Obesity-related genetic traits increase risk of MCR syndrome; further investigation is required to identify potential therapeutic targets.

%B Neurology %V 92 %P e1427-e1434 %8 2019 Mar 26 %G eng %N 13 %1 http://www.ncbi.nlm.nih.gov/pubmed/30737336?dopt=Abstract %R 10.1212/WNL.0000000000007141 %0 Journal Article %J 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 Journal of Clinical Endocrinology and Metabolism %D 2019 %T Glycated hemoglobin and all-cause and cause-specific mortality among adults with and without diabetes. %A Li, Fu-Rong %A Zhang, Xi-Ru %A Zhong, Wen-Fang %A Li, Zhi-Hao %A Gao, Xiang %A Virginia Byers Kraus %A Lv, Yue-Bin %A Zou, Meng-Chen %A Chen, Guo-Chong %A Chen, Pei-Liang %A Zhang, Min-Yi %A Kur, Akech Kuol Akech %A Shi, Xiao-Ming %A Wu, Xian-Bo %A Mao, Chen %K Biomarkers %K Diabetes %K Mortality %X

CONTEXT: The patterns of associations between glycated hemoglobin (HbA1c) and mortality are still unclear.

OBJECTIVE: To explore the extent to which ranges of HbA1c levels are associated with the risk of mortality among participants with and without diabetes.

DESIGN: Setting and patients: This was a nationwide, community-based prospective cohort study. Included were 15,869 participants (median age 64 years) of the Health and Retirement Study, with available HbA1c data and without a history of cancer. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (95% CIs) for mortality.

RESULTS: A total of 2,133 participants died during a median follow-up of 5.8 years. In participants with diabetes, those with an HbA1c level of 6.5% were at the lowest risk of all-cause mortality. When HbA1c level was lower than 5.6% or higher than 7.4%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 6.5%. As for participants without diabetes, those with an HbA1c level of 5.4% were at the lowest risk of all-cause mortality. When HbA1c level was lower than 5.0%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 5.4%. However, we did not observe a statistically significant elevated risk of all-cause mortality above an HbA1c level of 5.4%.

CONCLUSIONS: A U-shaped and a reverse J-shaped association for all-cause mortality were found among participants with and without diabetes. The corresponding Optimal ranges for overall survival are predicted to be 5.6-7.4% and 5.0-6.5%, respectively.

%B Journal of Clinical Endocrinology and Metabolism %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30896760?dopt=Abstract %R 10.1210/jc.2018-02536 %0 Journal Article %J Journal of Clinical Endocrinology and Metabolism %D 2019 %T High-density lipoprotein cholesterol and all-cause and cause-specific mortality among the elderly. %A Li, Zhi-Hao %A Lv, Yue-Bin %A Zhong, Wen-Fang %A Gao, Xiang %A Virginia Byers Kraus %A Zou, Meng-Chen %A Zhang, Xi-Ru %A Li, Fu-Rong %A Yuan, Jin-Qiu %A Shi, Xiao-Ming %A Wu, Xian-Bo %A Mao, Chen %K Cholesterol %K Health Conditions and Status %K Mortality %X

CONTEXT: The patterns of the association between high-density lipoprotein cholesterol (HDL-C) concentrations and mortality among the elderly are still unclear.

OBJECTIVE: To examine the association of HDL-C concentrations with mortality, and to identify the optimal HDL-C concentration range that predicts the lowest risk of all-cause mortality among the elderly.

DESIGN: This was a nationwide, community-based prospective cohort study.

METHODS: This study included 7,766 elderly individuals (aged ≥65 years; mean age: 74.4 years) from the Health and Retirement Study. Cox proportional hazards models and Cox models with penalized smoothing splines were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and cause-specific mortality.

RESULTS: During a median follow-up of 5.9 years, 1,921 deaths occurred. After fully adjustment for covariates, a nonlinear (P for nonlinearity<0.001) association was found between HDL-C and all-cause mortality (minimum mortality risk at 71 mg/dL [1.84 mM]); the risk for all-cause mortality was significantly higher in the group with HDL-C concentration <61 mg/dL (1.58 mM) (HR: 1.18; 95% CI: 1.05-1.33) and in the group with HDL-C concentration >87 mg/dL (2.25 mM) (HR: 1.56; 95% CI: 1.17-2.07) than in the group with HDL-C concentrations ranging from 61 to 87 mg/dL (1.58-2.25 mM). Nonlinear associations of HDL-C concentrations with both cardiovascular and non-cardiovascular mortality were also observed (both P for nonlinearity<0.001).

CONCLUSIONS: Among the elderly, nonlinear associations were found between HDL-C and all-cause and cardiovascular mortality. The single optimal HDL-C concentration and range were 71 mg/dL and 61 to 87 mg/dL, respectively.

%B Journal of Clinical Endocrinology and Metabolism %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30869791?dopt=Abstract %R 10.1210/jc.2018-02511 %0 Report %D 2019 %T How Best to Annuitize Defined Contribution Assets? %A Alicia H. Munnell %A Gal Wettstein %A Wenliang Hou %K Annuitization %K contribution %X Unlike defined benefit pensions that provide participants with steady benefits for as long as they live, 401(k) plans and Individual Retirement Accounts (IRAs) provide little guidance on how to turn accumulated assets into income. As a result, retirees have to decide how much to withdraw each year and face the risk of either spending too quickly and outliving their resources or spending too conservatively and consuming too little. Surveys of individuals’ plans and several recent studies suggest that people will not draw down their accumulations for fear that they will exhaust their money and be unable to cover end-of-life health care costs. They also must consider how to invest their savings after retirement. These are difficult decisions. Better strategies are possible that will ensure a higher level of lifetime income, reduce the likelihood that people will outlive their resources, and alleviate some of the anxiety associated with post-retirement investing. Workers could use a portion of their 401(k) and IRA assets to purchase an immediate annuity that pays a fixed amount throughout their lives, typically starting at age 65. Or they could purchase an advanced life deferred annuity (ALDA) that requires a smaller share of accumulated assets and begins payments at a later age like 85. Alternatively, they could use their assets to delay claiming Social Security – essentially purchasing an inflation-indexed annuity. Right now, none of these three options is commonly used. Very few workers choose to purchase immediate or deferred annuities (the first two options). And few retirees appear to be deferring claiming in order to receive the maximum annuity income from Social Security – most people simply retire earlier and claim immediately. Increasing annuitization in a meaningful way would require embedding annuities in 401(k) plans, with annuitization as the default. Recent proposed federal legislation, such as the SECURE Act (Setting Every Community Up for Retirement Enhancement), encourages plan sponsors to offer annuities in their plans by establishing a fiduciary safe harbor when specific statutory conditions are followed in selecting an insurance company. This legislation does not address, however, the question of defaults or the possibility of using 401(k) assets to purchase additional Social Security benefits. Moving forward on these fronts would require some consensus about the appropriate share of 401(k) assets to be annuitized and the best method for annuitizing them. To address these issues, this paper compares the level of lifetime utility generated by alternative annuitization approaches – immediate annuities, deferred annuities, and additional Social Security through delayed claiming. The analysis also tests different assumptions for the share of initial wealth that participants use to purchase these products. %B Center for Retirement Research at Boston College Working Paper %I Center for Retirement Research at Boston College %C Newton, MA %G eng %U https://crr.bc.edu/working-papers/how-best-to-annuitize-defined-contribution-assets/ %9 Report %0 Report %D 2019 %T How Do Older Workers Use Nontraditional Jobs? %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %A Abigail N. Walters %K nontraditional jobs %X Working consistently through one’s fifties and early sixties is key to attaining retirement security. However, workers also need access to retirement plans – so they can continue to accumulate resources – and health insurance – so they can avoid withdrawing assets in the event of a health shock. Workers without access to these benefits will likely struggle as they approach retirement, both financially and perhaps emotionally, as they deal with the stress of being unprepared. Yet, despite the fact that a large literature focuses on nontraditional jobs that often lack these benefits, it is unclear how older workers use these jobs and what the consequences are. If some older workers use nontraditional work for much of their late careers, then they likely will end up worse off. If, instead, older workers use nontraditional jobs only temporarily, then it is unlikely that their situation will substantially change. This paper uses the Health and Retirement Study to identify nontraditional jobs and relies on sequence analysis to explore how workers ages 50-62 use them. The results suggest that the majority of nontraditional jobs are used by workers consistently, and that fewer workers use these jobs briefly or as a bridge to retirement. In the end, workers consistently in nontraditional jobs end up with less retirement income than other workers and are more likely to be depressed, even controlling for their financial situation and depression prior to age 50. Given this situation, policymakers may want to consider ways to expand benefits to workers in these jobs to improve their well-being in retirement. %B Center for Retirement Research at Boston College %I Boston College %8 10/2019 %G eng %U https://crr.bc.edu/working-papers/how-do-older-workers-use-nontraditional-jobs/ %0 Journal Article %J J Aging Health %D 2019 %T Impact of Diabetes and Disease Duration on Work Status Among U.S. Older Adults. %A Mutambudzi, Miriam %A César González-González %A Rebeca Wong %K Aging Workforce %K Diabetes %K Disability %K Retirement %X

OBJECTIVES: To examine the effects of diabetes and disease duration on work status over a 9-year period.

METHOD: Multinomial logistic regression models examined the probability of retirement and disability impeding work, using data from the Health and Retirement Study ( n = 5,576).

RESULTS: Among participants who had retired in 2012, almost 14% had incident diabetes (4.91 mean years with diabetes, 95% confidence interval [CI] = [4.67, 5.15]). Approximately 22% of participants who reported a disability impeded labor force participation had prevalent diabetes (17.1 mean years with diabetes, 95%CI = [16.41, 17.71]). Only prevalent diabetes that indicated longer disease duration was associated with disability (relative risk ratio [RRR] = 1.83, 95% CI = [1.30, 2.57]). There was evidence of effect modification among Hispanics only ( p = .02).

DISCUSSION: Diabetes increased risk of exiting the workforce due to disability, and mean disease duration was associated with changes. Disease management and workplace interventions may enable older adults to continue being productive should they choose to remain in the workforce.

%B J Aging Health %V 32 %G eng %U https://pubmed.ncbi.nlm.nih.gov/30767603/ %N 5-6 %1 http://www.ncbi.nlm.nih.gov/pubmed/30767603?dopt=Abstract %& 432-440 %R 10.1177/0898264318822897 %0 Journal Article %J Journal of Aging & Health %D 2019 %T The Influence of Multimorbidity on Leading Causes of Death in Older Adults With Cognitive Impairment. %A Nicholas K Schiltz %A David F Warner %A Kathleen A Smyth %A Gravenstein, Stefan %A Kurt C Stange %A Siran M Koroukian %K Cognitive Ability %K Comorbidity %K Mortality %K NDI %X

OBJECTIVE: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity.

METHOD: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index ( n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest identified which combinations of multimorbidity associated with causes of death.

RESULTS: Multimorbidity is common in the study population. Heart disease is the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different "paths" down the regression trees show that the distribution of causes of death changes with different combinations of multimorbidity.

DISCUSSION: Understanding the considerable heterogeneity in chronic conditions, functional limitations, geriatric syndromes, and causes of death among people with cognitive impairment can target care management and resource allocation.

%B Journal of Aging & Health %V 31 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/29347865?dopt=Abstract %R 10.1177/0898264317751946 %0 Journal Article %J Research on Aging %D 2019 %T Intersections of Home, Health, and Social Engagement in Old Age: Formal Volunteering as a Protective Factor to Health After Relocation. %A Guillermo Ernest Gonzales %A Shen, Huei-Wern %A Tam E Perry %A Wang, Yi %K Moves %K Protective factors %K Social Support %K Volunteerism %X This study aims to further our understanding of formal volunteering as a protective mechanism for health in the context of housing relocation and to explore race, gender, and education as moderators. A quasi-experimental design evaluated the effects of volunteering on older adults' health (self-report health, number of instrumental activities of daily living [IADLs], and depressive symptoms) among individuals who relocated but did not volunteer at Time 1 ( N = 682) in the Health and Retirement Study (2008-2010). Propensity score weighting examined health differences at Time 2 between 166 volunteers (treated) and 516 nonvolunteers (controlled). Interaction terms tested moderation. Individuals who moved and engaged in volunteering reported higher levels of self-rated health and fewer IADL difficulties compared to the control group. Race moderated the relationship between volunteering and depressive symptoms, while gender moderated the relationship between volunteering and self-assessed health. Formal volunteering protects different dimensions of health after relocation. Volunteering was particularly beneficial for females and older Whites. %B Research on Aging %V 41 %P 31-53 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29742961?dopt=Abstract %R 10.1177/0164027518773125 %0 Journal Article %J Innovation in Aging %D 2019 %T LIFE COURSE ORIGINS OF FRAILTY IN LATER LIFE %A Monica Williams-Farrelly %A Kenneth F Ferraro %K Frailty %X Frailty, generally characterized as a clinical state of increased vulnerability resulting from age-related decline in reserve and function across multiple physiologic systems, has been gaining attention in recent years due to its high correlates with a number of poor health outcomes including falls, hospitalization, and mortality. Similar to other adult health outcomes, research on the etiology of frailty has begun to move from proximal risk factors only to those more distal in time. This research uses data from the Health and Retirement study (2004-2016) to examine whether childhood exposures predict developing frailty in later life. A series of ordinal logistic regression models were estimated to test whether six domains of childhood exposures (socioeconomic status, infectious disease, chronic disease, impairments, risky adolescent behavior, and risky parental behavior) were associated with frailty, composed of five components: unintentional weight loss, weakness, slowness, exhaustion, and low energy expenditure (Fried et al., 2001). After adjusting for demographic factors, experiencing multiple SES misfortunes or risky adolescent behaviors in childhood are associated with higher odds of frailty in later life (OR= 1.24 and 2.37, respectively), while experiencing any infectious diseases is associated with lower odds of frailty (OR= 0.67 and 0.72). After further adjusting for adult characteristics, experiencing 2 or more chronic diseases in childhood is associated with a 1.35 higher odds of incident frailty over an 8-year period. These results reveal some of the early exposures that may raise frailty risk in later life but also the mid-life factors that mediate those risks. %B Innovation in Aging %V 3 %P S59 - S59 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841584/ %N Suppl 1 %! Innov Aging %0 Web Page %D 2019 %T The life-changing magic of working a bit longer %A Weston, Liz %K Financial security %K News %K Retirement Planning & Satisfaction %K Social Security %B NerdWallet %I NerdWallet %C San Francisco %V 2019 %G eng %U https://www.nerdwallet.com/article/investing/the-life-changing-magic-of-working-a-bit-longer %0 Journal Article %J American Journal of Health Promotion %D 2019 %T Light-Intensity Physical Activity and Cardiometabolic Risk Among Older Adults With Multiple Chronic Conditions. %A Yueyao Li %A White, Kellee %A Katherine R O'Shields %A Alexander C McLain %A Anwar T Merchant %K Community-dwelling %K Comorbidity %K Physical activity %X

PURPOSE: To assess the relationship between light-intensity physical activity (LIPA) and cardiometabolic risk factors among middle-aged and older adults with multiple chronic conditions.

DESIGN: Cross-sectional design utilizing data from the Health and Retirement Study (2010, 2012).

SETTING: Laboratory- and survey-based testing of a nationally representative sample of community-dwelling middle aged and older adults.

PARTICIPANTS: Adults aged 50 years and older (N = 14 996).

MEASURES: Weighted metabolic equivalent of tasks was calculated using self-reported frequency of light, moderate, and vigorous physical activity. Cardiometabolic risk factors (systolic and diastolic blood pressure, glycosylated hemoglobin [HbA], high-density lipoprotein cholesterol [HDL-C], total cholesterol, and non-HDL-C) were objectively measured. A multiple chronic condition index was based on 8 self-reported chronic conditions.

ANALYSIS: Weighted multivariate linear regression models.

RESULTS: Light-intensity physical activity was independently associated with favorable HDL-C (β = 1.25; 95% confidence interval [CI]: 0.46-2.05) and total cholesterol (β = 2.72; 95% CI: 0.53-4.90) after adjusting for relevant confounders. The HDL-C health benefit was apparent when stratified by number of chronic conditions, for individuals with 2 to 3 conditions (β = 1.73; 95% CI: 0.58-2.89). No significant associations were observed between LIPA and blood pressure, HbA, or non-HDL-C.

CONCLUSIONS: Engaging in LIPA may be an important health promotion activity to manage HDL-C and total cholesterol. Additional longitudinal research is needed to determine the causal association between LIPA and cardiometabolic risk which can potentially inform physical activity guidelines targeting older adults with multiple chronic conditions.

%B American Journal of Health Promotion %V 33 %P 507-515 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/30157668?dopt=Abstract %R 10.1177/0890117118796459 %0 Journal Article %J PLoS One %D 2019 %T Marriage and physical capability at mid to later life in England and the USA. %A Wood, Natasha %A McMunn, Anne %A Webb, Elizabeth %A Stafford, Mai %K Disabilities %K Gait speed %K Grip strength %K Marriage %X Background Married people have lower rates of mortality and report better physical and mental health at older ages, compared to their unmarried counterparts. However, there is limited evidence on the association between marriage and physical capability, the ability to carry out the tasks of daily living, which is predictive of future mortality and social care use. We investigate the association between marital status and physical capability at mid to later life in England and the United States. Methods We examine the association between marriage and physical capability at mid to later life in England and the USA using two performance-based measures of physical capability: grip strength and walking speed. Multiple linear regression was carried out on Wave 4 (2008) of the English Longitudinal Study of Ageing (ELSA) and Waves 8 and 9 (2006 and 2008) of the US Health and Retirement Study (HRS). Results In age adjusted models married men and women had better physical capability than their unmarried counterparts. Much of the marriage advantage was explained by the greater wealth of married people. However, remarried men were found to have stronger grip strength and widowed and never married men had a slower walking speed than men in their first marriage, which was not explained by wealth, demographic and socioeconomic characteristics, health behaviours, chronic disease or depressive symptoms. There were no differences in the association between England and the USA. Conclusions Marriage may be an important factor in maintaining physical capability in both England and the USA, particularly because of the greater wealth which married people have accrued by the time they reach older ages. The grip strength advantage for remarried men may be due to unobserved selective factors into remarriage. %B PLoS One %V 14 %P e0209388 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/30673714?dopt=Abstract %R 10.1371/journal.pone.0209388 %0 Journal Article %J Health Services Research %D 2019 %T Medicare expenditures attributable to dementia. %A Lindsay L Waite %A Fishman, Paul %A Basu, Anirban %A Paul K Crane %A Eric B Larson %A Norma B Coe %K Cognition & Reasoning %K Dementia %K Medicare linkage %K Medicare/Medicaid/Health Insurance %X

OBJECTIVE: To estimate dementia's incremental cost to the traditional Medicare program.

DATA SOURCES: Health and Retirement Study (HRS) survey-linked Medicare part A and B claims from 1991 to 2012.

STUDY DESIGN: We compared Medicare expenditures for 60 months following a claims-based dementia diagnosis to those for a randomly selected, matched comparison group.

DATA COLLECTION/EXTRACTION METHODS: We used a cost estimator that accounts for differential survival between individuals with and without dementia and decomposes incremental costs into survival and cost intensity components.

PRINCIPAL FINDINGS: Dementia's five-year incremental cost to the traditional Medicare program is approximately $15 700 per patient, nearly half of which is incurred in the first year after diagnosis. Shorter survival with dementia mitigates the incremental cost by about $2650. Increased costs for individuals with dementia were driven by more intensive use of Medicare part A covered services. The incremental cost of dementia was about $7850 higher for females than for males because of sex-specific differential mortality associated with dementia.

CONCLUSIONS: Dementia's cost to the traditional Medicare program is significant. Interventions that target early identification of dementia and preventable inpatient and post-acute care services could produce substantial savings.

%B Health Services Research %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30868557?dopt=Abstract %R 10.1111/1475-6773.13134 %0 Journal Article %J Nature Communications %D 2019 %T A meta-analysis of genome-wide association studies identifies multiple longevity genes. %A Deelen, Joris %A Daniel S Evans %A Dan E Arking %A Tesi, Niccolò %A Nygaard, Marianne %A Liu, Xiaomin %A Wojczynski, Mary K %A Biggs, Mary L %A van der Spek, Ashley %A Atzmon, Gil %A Erin B Ware %A Sarnowski, Chloé %A Albert Vernon Smith %A Seppälä, Ilkka %A Cordell, Heather J %A Dose, Janina %A Amin, Najaf %A Alice M. Arnold %A Kristin L. Ayers %A Barzilai, Nir %A Becker, Elizabeth J %A Beekman, Marian %A Blanché, Hélène %A Christensen, Kaare %A Christiansen, Lene %A Collerton, Joanna C %A Cubaynes, Sarah %A Steven R Cummings %A Davies, Karen %A Debrabant, Birgit %A Deleuze, Jean-François %A Duncan, Rachel %A Jessica Faul %A Franceschi, Claudio %A Galan, Pilar %A Gudnason, Vilmundur %A Tamara B Harris %A Huisman, Martijn %A Hurme, Mikko A %A Jagger, Carol %A Jansen, Iris %A Jylhä, Marja %A Kähönen, Mika %A Karasik, David %A Sharon L R Kardia %A Kingston, Andrew %A Kirkwood, Thomas B L %A Lenore J Launer %A Lehtimäki, Terho %A Lieb, Wolfgang %A Lyytikäinen, Leo-Pekka %A Martin-Ruiz, Carmen %A Min, Junxia %A Nebel, Almut %A Anne B Newman %A Nie, Chao %A Nohr, Ellen A %A Orwoll, Eric S %A Thomas T Perls %A Province, Michael A %A Psaty, Bruce M %A Olli T Raitakari %A Reinders, Marcel J T %A Robine, Jean-Marie %A Rotter, Jerome I %A Sebastiani, Paola %A Jennifer A Smith %A Sørensen, Thorkild I A %A Kent D Taylor %A André G Uitterlinden %A van der Flier, Wiesje %A Sven J van der Lee %A Cornelia M van Duijn %A van Heemst, Diana %A James W Vaupel %A David R Weir %A Ye, Kenny %A Zeng, Yi %A Zheng, Wanlin %A Holstege, Henne %A Douglas P Kiel %A Kathryn L Lunetta %A Eline P Slagboom %A Joanne M Murabito %K genes %K Genome-Wide Association Study %K GWA %K longevity genes %K meta-analysis %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 Innovation in Aging %D 2019 %T MOBILITY TRAJECTORIES, HEALTHCARE SATISFACTION, AND PERCEIVED DISABILITY DISCRIMINATION AMONG OLDER ADULTS %A Mueller, Collin %A Jessica S West %K Disabilities %K disability discrimination %K Discrimination %K Healthcare %K healthcare satisfaction %K Mobility Limitation %X Although functional mobility limitations are associated with increased healthcare needs in later life, little research explores how older adults with varying functional mobility trajectories experience healthcare quality. To this end, we explore the effects of functional mobility trajectories on differences in healthcare treatment satisfaction, perceived disability discrimination in healthcare settings, and perceived everyday disability discrimination. We analyzed 9 waves of the Health and Retirement Study (n=29,284, 1998-2014, ages 50-84). First, we estimate age-specific group-based trajectories of functional mobility across age using finite mixture models. Second, we use multinomial logistic regression to identify sociodemographic factors that place individuals at elevated risk of membership in each group. Third, we explore how membership in one disability trajectory group over another affects healthcare satisfaction, perceptions of everyday discrimination in the context of healthcare treatment settings, and perceived discrimination in everyday life. Regression models include clustered standard errors to account for heteroscedasticity across repeated observations of individuals over time. We identify six group-based trajectories of functional mobility limitation among aging Americans. Black, female, and less-educated Americans are at higher risk of membership in disadvantaged trajectories, characterized by more rapidly increasing counts of functional mobility limitations, than their counterparts. Disadvantaged functional limitation trajectories are associated with lower levels of healthcare satisfaction, higher levels of perceived physical disability discrimination in healthcare treatment settings, and higher levels of perceived physical discrimination in other contexts of everyday life. The present study advances our knowledge of how older adults experience healthcare settings and discrimination across functional mobility status trajectories. %B Innovation in Aging %V 3 %P S523-S524 %8 11 %G eng %U https://doi.org/10.1093/geroni/igz038.1928 %R 10.1093/geroni/igz038.1928 %0 Journal Article %J Journal of Family and Economic Issues %D 2019 %T The Moderating Role of Depressive Symptoms Between Financial Assets and Bequests Expectation %A Shinae L Choi %A Wilmarth, Melissa J. %K Decision making %K Depressive symptoms %K Financial Health %X This study investigated the association between financial assets and bequests expectation, specifically whether having depression moderated the association. Our sample included 10,340 middle-aged and older Americans from the 2014 Health and Retirement Study. Results from ordinary least squares regression models showed a positive association between financial assets and bequests expectation, whereas a negative association between depression and bequests expectation. Furthermore, a moderating role of depression was revealed. Specifically, the relationship between financial assets and bequests expectation was stronger for individuals with depression than for individuals without depression. Future research and practice should incorporate perspectives of both financial assets and depressive symptoms to more effectively help individuals and families deal their current financial situation as well as identify their estate planning needs. We also discuss public policy implications of the findings. %B Journal of Family and Economic Issues %V 40 %P 498–510 %G eng %N 3 %! J Fam Econ Iss %R 10.1007/s10834-019-09621-7 %0 Journal Article %J Nature Communications %D 2019 %T Multi-ancestry study of blood lipid levels identifies four loci interacting with physical activity. %A Kilpeläinen, Tuomas O %A Bentley, Amy R %A Noordam, Raymond %A Yun Ju Sung %A Schwander, Karen %A Thomas W Winkler %A Jakupović, Hermina %A Daniel I Chasman %A Alisa Manning %A Ntalla, Ioanna %A Aschard, Hugues %A Brown, Michael R %A de Las Fuentes, Lisa %A Franceschini, Nora %A Guo, Xiuqing %A Vojinovic, Dina %A Aslibekyan, Stella %A Feitosa, Mary F %A Kho, Minjung %A Musani, Solomon K %A Melissa Richard %A Wang, Heming %A Wang, Zhe %A Traci M Bartz %A Bielak, Lawrence F %A Campbell, Archie %A Dorajoo, Rajkumar %A Fisher, Virginia %A Hartwig, Fernando P %A Horimoto, Andrea R V R %A Li, Changwei %A Kurt Lohman %A Marten, Jonathan %A Sim, Xueling %A Smith, Albert V %A Tajuddin, Salman M %A Alver, Maris %A Amini, Marzyeh %A Boissel, Mathilde %A Jin-Fang Chai %A Chen, Xu %A Divers, Jasmin %A Evangelou, Evangelos %A Gao, Chuan %A Graff, Mariaelisa %A Sarah E Harris %A He, Meian %A Hsu, Fang-Chi %A Jackson, Anne U %A Jing Hua Zhao %A Kraja, Aldi T %A Kühnel, Brigitte %A Laguzzi, Federica %A Lyytikäinen, Leo-Pekka %A Ilja M Nolte %A Rauramaa, Rainer %A Riaz, Muhammad %A Robino, Antonietta %A Rueedi, Rico %A Heather M Stringham %A Takeuchi, Fumihiko %A van der Most, Peter J %A Varga, Tibor V %A Verweij, Niek %A Erin B Ware %A Wen, Wanqing %A Li, Xiaoyin %A Yanek, Lisa R %A Amin, Najaf %A Donna K Arnett %A Boerwinkle, Eric %A Brumat, Marco %A Brian E Cade %A Canouil, Mickaël %A Chen, Yii-Der Ida %A Concas, Maria Pina %A Connell, John %A de Mutsert, Renée %A de Silva, H Janaka %A de Vries, Paul S %A Demirkan, Ayse %A Ding, Jingzhong %A Charles B Eaton %A Jessica Faul %A Friedlander, Yechiel %A Gabriel, Kelley P %A Ghanbari, Mohsen %A Giulianini, Franco %A Gu, Chi Charles %A Gu, Dongfeng %A Tamara B Harris %A He, Jiang %A Heikkinen, Sami %A Heng, Chew-Kiat %A Hunt, Steven C %A Ikram, M Arfan %A Jost Bruno Jonas %A Koh, Woon-Puay %A Komulainen, Pirjo %A Krieger, Jose E %A Stephen B Kritchevsky %A Kutalik, Zoltán %A Kuusisto, Johanna %A Langefeld, Carl D %A Langenberg, Claudia %A Lenore J Launer %A Leander, Karin %A Lemaitre, Rozenn N %A Lewis, Cora E %A Liang, Jingjing %A Liu, Jianjun %A Mägi, Reedik %A Manichaikul, Ani %A Meitinger, Thomas %A Andres Metspalu %A Milaneschi, Yuri %A Mohlke, Karen L %A Thomas H Mosley %A Murray, Alison D %A Michael A Nalls %A Nang, Ei-Ei Khaing %A Nelson, Christopher P %A Nona, Sotoodehnia %A Norris, Jill M %A Nwuba, Chiamaka Vivian %A Jeff O'Connell %A Palmer, Nicholette D %A Papanicolau, George J %A Pazoki, Raha %A Nancy L Pedersen %A Peters, Annette %A Peyser, Patricia A %A Polasek, Ozren %A David J Porteous %A Poveda, Alaitz %A Olli T Raitakari %A Rich, Stephen S %A Neil Risch %A Robinson, Jennifer G %A Rose, Lynda M %A Rudan, Igor %A Schreiner, Pamela J %A Scott, Robert A %A Stephen Sidney %A Sims, Mario %A Smith, Jennifer A %A Snieder, Harold %A Sofer, Tamar %A John M Starr %A Sternfeld, Barbara %A Strauch, Konstantin %A Tang, Hua %A Kent D Taylor %A Tsai, Michael Y %A Tuomilehto, Jaakko %A André G Uitterlinden %A van der Ende, M Yldau %A van Heemst, Diana %A Voortman, Trudy %A Waldenberger, Melanie %A Wennberg, Patrik %A Wilson, Gregory %A Xiang, Yong-Bing %A Yao, Jie %A Yu, Caizheng %A Yuan, Jian-Min %A Zhao, Wei %A Alan B Zonderman %A Becker, Diane M %A Boehnke, Michael %A Bowden, Donald W %A de Faire, Ulf %A Ian J Deary %A Elliott, Paul %A Tõnu Esko %A Freedman, Barry I %A Froguel, Philippe %A Paolo P. Gasparini %A Gieger, Christian %A Kato, Norihiro %A Laakso, Markku %A Lakka, Timo A %A Lehtimäki, Terho %A Patrik K E Magnusson %A Oldehinkel, Albertine J %A Brenda W J H Penninx %A Nilesh J Samani %A Shu, Xiao-Ou %A van der Harst, Pim %A Jana V. van Vliet-Ostaptchouk %A Vollenweider, Peter %A Wagenknecht, Lynne E %A Wang, Ya X %A Wareham, Nicholas J %A David R Weir %A Wu, Tangchun %A Zheng, Wei %A Zhu, Xiaofeng %A Michele K Evans %A Franks, Paul W %A Gudnason, Vilmundur %A Caroline Hayward %A Horta, Bernardo L %A Tanika N Kelly %A Liu, Yongmei %A Kari E North %A Pereira, Alexandre C %A Ridker, Paul M %A Tai, E Shyong %A van Dam, Rob M %A Fox, Ervin R %A Sharon L R Kardia %A Liu, Ching-Ti %A Dennis O Mook-Kanamori %A Province, Michael A %A Redline, Susan %A Cornelia M van Duijn %A Rotter, Jerome I %A Charles Kooperberg %A Gauderman, W James %A Psaty, Bruce M %A Kenneth Rice %A Munroe, Patricia B %A Myriam Fornage %A Cupples, L Adrienne %A Charles N Rotimi %A Alanna C Morrison %A Rao, Dabeeru C %A Ruth J F Loos %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Asians %K Blacks %K Brazil %K Calcium-Binding Proteins %K Cholesterol %K Cholesterol, HDL %K Cholesterol, LDL %K Exercise %K Female %K Genetic Loci %K Genome-Wide Association Study %K Genotype %K Hispanic or Latino %K Humans %K LIM-Homeodomain Proteins %K Lipid Metabolism %K Lipids %K Male %K Membrane Proteins %K Microtubule-Associated Proteins %K Middle Aged %K Muscle Proteins %K Nerve Tissue Proteins %K Transcription Factors %K Triglycerides %K Whites %K Young Adult %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 Thesis %B Social Work %D 2019 %T Neighborhood Environment, Social Participation, and Well-Being among Older Adults in the U.S %A Y Wang %K 0452:Social work %K 0470:Environmental Health %K 0493:Aging %K Aging %K Environmental Health %K Health and environmental sciences %K Neighborhood environment %K Older adults in the U.S %K Social participation %K Social Sciences %K Social work %K Well-being %X Due to their diminished functional capacity, older adults are most sensitive and susceptible to the influences of immediate environmental situations. For older adults to enjoy healthy, safe, and active lives in the community, their neighborhood environment must have good person-environment fit. This study extends the current knowledge base of environment and healthy aging by using structural equation modeling with nationally representative panel data, the 2012–2014 Health and Retirement Study, (1) to discern the direct impact of neighborhood features on well-being (i.e., physical health, mental health, and life satisfaction) in later life, (2) to investigate the intermediate outcome (i.e. social participation) of environmental antecedents and its pathway pointing to the ultimate health outcomes, and 3) to determine the relative importance of physical versus social aspects of neighborhood environment to participation and well-being in later life. A significant pathway was found between neighborhood environment and individual health outcomes (i.e., life satisfaction, depressive symptoms) and that pathway partially went through participation of the following social activities: interpersonal exchange/helping others and community leisure. Neighborhood physical environment (measured by neighborhood physical disorder scale) was found significantly associated with physical health, whereas neighborhood social environment (measured by neighborhood social cohesion scale) mattered to mental health (i.e., depressive symptoms) and psychological well-being (i.e., life satisfaction). Understanding the associations among environment, participation, and well-being confirms the hypothesis that environment influences people’s well-being both directly and indirectly by changing human behaviors (i.e., social participation). The findings bring greater attention to the environmental and social factors of health in later life and set the stage for the development and implementation of interventions/ programs fundamentally informed by the person-environment perspective so as to improve human lives. %B Social Work %I Washington University in St. Louis %V PhD %P 123 %@ 9781392074145 %G eng %U https://openscholarship.wustl.edu/art_sci_etds/1829/ %9 phd %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 Report %D 2019 %T New Work-Limiting Health Events and Occupational Transitions Among Older Workers %A Jody Schimmel Hyde %A April Yanyuan Wu %K Disability %K Occupations %K Transitions %K work limitations %X In this study, we use the Health and Retirement Study linked to detailed occupational data to descriptively examine whether the occupational path of older workers who report a new work-limiting health condition in the years before retirement differs from that of workers who remain limitation-free. %I Mathematica Policy Research %G eng %U https://ideas.repec.org/p/mpr/mprres/0d12254d6aa542e09156584e8db851ba.html %0 Journal Article %J JAMA Intern Med %D 2019 %T One-Year Mortality After Dialysis Initiation Among Older Adults. %A Melissa W Wachterman %A O'Hare, Ann M %A Rahman, Omari-Khalid %A Karl A Lorenz %A Edward R Marcantonio %A Alicante, Gabrielle K %A Amy Kelley %K Aged %K Aged, 80 and over %K Female %K Humans %K Male %K Renal Dialysis %K United States %X This cohort study examines the incidence of mortality 1 year after the start of hemodialysis in patients 65 years and older. %B JAMA Intern Med %V 179 %P 987-990 %8 2019 07 01 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/31009039?dopt=Abstract %R 10.1001/jamainternmed.2019.0125 %0 Newspaper Article %B NerdWallet %D 2019 %T Peak performance: Use early career wage gains to supercharge retirement savings %A Weston, Liz %K Financial Health %K News %K Retirement Planning and Satisfaction %B NerdWallet %C San Francisco %G eng %U https://www.chicagotribune.com/business/dollarsense/ct-biz-retirement-savings-procrastinate-dollarsense-20190429-story.html %) Chicago Tribune %0 Journal Article %J Journal of the American Geriatrics Society %D 2019 %T Perceived Stress, Social Support, and Dry Mouth Among US Older Chinese Adults %A Mao, Weiyu %A Chen, Yiwei %A Bei Wu %A Ge, Shaoqing %A Yang, Wei %A Iris Chi %A Dong, XinQi %K Dry Mouth %K Stress %K US Chinese Adults %X OBJECTIVESDry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We conducted a study to examine the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the potential moderating role of social support and social strain from different sources in the relationship.DESIGNCross‐sectional analysis.SETTINGBaseline of the Population Study of Chinese Elderly in Chicago, a community‐engaged, population‐based longitudinal study of health and well‐being among community‐dwelling US older Chinese adults.PARTICIPANTSIndividuals 60 years or older (N = 3157).MEASUREMENTSPerceived stress was measured by the 10‐item Chinese Perceived Stress Scale to evaluate the degree to which life situations were perceived as stressful during the preceding month on a 5‐point scale, ranging from 0 (“never”) to 4 (“very often”). Dry mouth was a binary self‐reported outcome variable (1 = “dry mouth”). Social support was measured by the Health and Retirement Study's social support and strain scale from sources including spouse, other family members, and friends with a 3‐point response set, ranging from 0 (“hardly ever”) to 2 (“often”). Sociodemographics and disease processes were assessed as covariates. We conducted stepwise logistic regressions with interaction terms.RESULTSHaving higher levels of perceived stress was significantly associated with a higher likelihood of reporting dry mouth (odds ratio = 1.03; 95% confidence interval = 1.02‐1.04). The effect of perceived stress on dry mouth may vary by levels of family and friend support.CONCLUSIONPerceived stress may influence dry mouth either directly or indirectly. To prevent or reduce dry mouth, in addition to disease processes, interventions need to consider psychosocial factors in dry mouth, especially perceived stress and social support, in this growing population. J Am Geriatr Soc 67:S551–S556, 2019.OBJECTIVESDry mouth is a common condition among older adults that negatively influences oral health, general health, and quality of life. The role of psychosocial factors in oral health conditions and diseases remains largely unknown. We conducted a study to examine the relationship between perceived stress and dry mouth among US older Chinese adults and further investigated the potential moderating role of social support and social strain from different sources in the relationship.DESIGNCross‐sectional analysis.SETTINGBaseline of the Population Study of Chinese Elderly in Chicago, a community‐engaged, population‐based longitudinal study of health and well‐being among community‐dwelling US older Chinese adults.PARTICIPANTSIndividuals 60 years or older (N = 3157).MEASUREMENTSPerceived stress was measured by the 10‐item Chinese Perceived Stress Scale to evaluate the degree to which life situations were perceived as stressful during the preceding month on a 5‐point scale, ranging from 0 (“never”) to 4 (“very often”). Dry mouth was a binary self‐reported outcome variable (1 = “dry mouth”). Social support was measured by the Health and Retirement Study's social support and strain scale from sources including spouse, other family members, and friends with a 3‐point response set, ranging from 0 (“hardly ever”) to 2 (“often”). Sociodemographics and disease processes were assessed as covariates. We conducted stepwise logistic regressions with interaction terms.RESULTSHaving higher levels of perceived stress was significantly associated with a higher likelihood of reporting dry mouth (odds ratio = 1.03; 95% confidence interval = 1.02‐1.04). The effect of perceived stress on dry mouth may vary by levels of family and friend support.CONCLUSIONPerceived stress may influence dry mouth either directly or indirectly. To prevent or reduce dry mouth, in addition to disease processes, interventions need to consider psychosocial factors in dry mouth, especially perceived stress and social support, in this growing population. J Am Geriatr Soc 67:S551–S556, 2019. %B Journal of the American Geriatrics Society %V 67 %P S551-S556 %8 2019 %@ 0002-8614 %G eng %U https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15890 %! Journal of the American Geriatrics Society %R https://doi.org/10.1111/jgs.15890 %0 Journal Article %J Journal of Consumer Affairs %D 2019 %T Personality and Saving Behavior Among Older Adults %A Asebedo, Sarah D. %A Wilmarth, Melissa J. %A Martin C. Seay %A Archuleta, Kristy %A Brase, Gary L. %A Maurice MacDonald %K Finances %K Personality %K Retirement Planning and Satisfaction %K Saving %X This study investigates how psychological characteristics influence saving behavior within a sample of 1,380 U.S. preretirees aged 50–70 from the Health and Retirement Study (HRS). Using the 3M Model of Motivation and Personality as a theoretical basis, structural equation model results revealed that financial self‐efficacy (FSE) directly explains saving behavior and is central to understanding the link between other psychological characteristics and the saving behavior of older adults. Through higher FSE, increased positive affect and reduced negative affect indirectly supported saving behavior. Moreover, the results revealed personality traits indirectly explained saving behavior. Conscientiousness and extroversion indirectly supported saving behavior; whereas openness to experience and neuroticism indirectly undermined saving behavior. This study connects broad personality traits with saving behavior, which provides information about how older adults' psychological composition is related to their saving practices. %B Journal of Consumer Affairs %V 53 %P 488-519 %8 09/2019 %G eng %U http://doi.wiley.com/10.1111/joca.12199http://onlinelibrary.wiley.com/wol1/doi/10.1111/joca.12199/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjoca.12199 %N 2 %! J Consum Aff %R 10.1111/joca.12199 %0 Journal Article %J Journals of Gerontology Series A: Biological Sciences & Medical Sciences %D 2019 %T Physical Functioning Decline and Mortality in Older Adults with Multimorbidity: Joint Modeling of Longitudinal and Survival Data. %A Melissa Y Wei %A Mohammed U Kabeto %A Andrzej T Galecki %A Kenneth M. Langa %K Comorbidity %K Mortality %K Physical Ability %X

Background: Multimorbidity is common among older adults and strongly associated with physical functioning decline and increased mortality. However, the full spectrum of direct and indirect effects of multimorbidity on physical functioning and survival has not been quantified. We aimed to determine the longitudinal relationship of multimorbidity on physical functioning and quantify the impact of multimorbidity and multimorbidity-attributed changes in physical functioning on mortality risk.

Methods: The Health and Retirement Study is a nationally-representative population-based prospective cohort of adults aged 51 or older. In 2000, participants were interviewed about physician-diagnosed chronic conditions, from which their multimorbidity-weighted index (MWI) was computed. Between 2000-2011, participants reported their current physical functioning using a modified Short Form-36. With MWI as a time-varying exposure, we jointly modeled its associations with physical functioning and survival.

Results: The final sample included 74,037 observations from 18,174 participants. At baseline, participants had a weighted mean MWI of 4.64.2 (range 0-36.8). During follow-up, physical functioning declined -1.72 (95% CI: -1.77, -1.67, p<0.001) HRS physical functioning units per point MWI in adjusted models. Over follow-up, 6,362 (34%) participants died. Mortality risk increased 8% (HR 1.08, 95% CI 1.07-1.08, p<0.001) per point MWI in adjusted models. Across all population subgroups, MWI was associated with greater physical functioning decline and mortality risk.

Conclusions: Multimorbidity and its associated decline in physical functioning were significantly associated with increased mortality. These associations can be predicted with an easily interpreted and applied multimorbidity index that can better identify and target adults at increased risk for disability and death.

%B Journals of Gerontology Series A: Biological Sciences & Medical Sciences %V 74 %P 226-232 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/29529179?dopt=Abstract %R 10.1093/gerona/gly038 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2019 %T Predicting current and future anxiety symptoms in cognitively intact older adults with memory complaints. %A Nikki L Hill %A Mogle, Jacqueline %A Tyler Reed Bell %A Bhargava, Sakshi %A Wion, Rachel K. %A Bhang, Iris %K Anxiety %K coordinated analysis %K longitudinal %K memory complaints %K No terms assigned %X Objectives Memory complaints are a common concern for older adults and may co‐occur with anxiety symptoms. Although both memory complaints and anxiety are associated with heightened cognitive decline risk, little is known about how these symptoms develop over time. The purpose of this study was to examine the differential concurrent and longitudinal relationships among anxiety symptoms and two types of memory complaints in cognitively intact older adults. Methods/Design The current study sample was drawn from two longitudinal, nationally representative datasets, the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Cognitively intact older adults aged 65 and over were included, representing six (n = 5069; NHATS) and two (n = 5284; HRS) waves of data, respectively. Using multilevel linear modeling, we tested bidirectional relationships between anxiety and two types of memory complaints: current rating of memory performance and perceived memory de %B International Journal of Geriatric Psychiatry %V 34 %P 1874-1882 %G eng %N 12 %R 10.1002/gps.5204 %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 THE AMERICAN GERIATRICS SOCIETY %D 2019 %T Racial Differences in Elevated C-Reactive Protein Among US Older Adults %A Heather R. Farmer %A Linda A. Wray %A Xian, Ying %A Xu, Hanzhang %A Pagidipati, Neha %A Eric D Peterson %A Matthew E Dupre %K C-reactive protein %K Health and Retirement Study %K race %X OBJECTIVES To investigate racial differences in elevated C-reactive protein (CRP) and the potential factors contributing to these differences in US older men and women. DESIGN Nationally representative cohort study. SETTING Health and Retirement Study, 2006 to 2014. PARTICIPANTS Noninstitutionalized non-Hispanic black and white older adults living in the United States (n = 13 517). MEASUREMENTS CRP was categorized as elevated (>3.0 mg/L) and nonelevated (<= 3.0 mg/L) as the primary outcome. Measures for demographic background, socioeconomic status, psychosocial factors, health behaviors, and physiological health were examined as potential factors contributing to race differences in elevated CRP. RESULTS Median CRP levels (interquartile range) were 1.67 (3.03) mg/L in whites and 2.62 (4.95) mg/L in blacks. Results from random effects logistic regression models showed that blacks had significantly greater odds of elevated CRP than whites (odds ratio = 2.58; 95% confidence interval [CI] = 2.20-3.02). Results also showed that racial difference in elevated CRP varied significantly by sex (predicted probability [PP] [white men] = 0.28 [95% CI = 0.27-0.30]; PP [black men] = 0.38 [95% CI = 0.35-0.41]; PP [white women] = 0.35 [95% CI = 0.34-0.36]; PP [black women] = 0.49 [95% CI = 0.47-0.52]) and remained significant after risk adjustment. In men, the racial differences in elevated CRP were attributable to a combination of socioeconomic (12.3%) and behavioral (16.5%) factors. In women, the racial differences in elevated CRP were primarily attributable to physiological factors (40.0%). CONCLUSION In the US older adult population, blacks were significantly more likely to have elevated CRP than whites; and the factors contributing to these differences varied in men and women. %B JOURNAL OF THE AMERICAN GERIATRICS SOCIETY %V 68 %P 362-369 %G eng %N 2 %R 10.1111/jgs.16187 %0 Journal Article %J Research on Aging %D 2019 %T Racial/ethnic disparities in dental service utilization for foreign-born and U.S.-born middle-aged and older adults. %A Wei Zhang %A Wu, Yan Yan %A Bei Wu %K Dental Care %K Health Services Utilization %K Racial/ethnic differences %X This study examines racial/ethnic disparities of dental service utilization for foreign-born and U.S.-born dentate residents aged 50 years and older. Generalized linear mixed-effects models (GLMM) were used to perform longitudinal analyses of five-wave data of dental service utilization from the Health and Retirement Study (HRS). We used stratified analyses for the foreign-born and U.S.-born and assessed the nonlinear trend in rates of dental service utilization for different racial/ethnic groups. Findings indicate that Whites had higher rates of service utilization than Blacks and Hispanics regardless of birthplace. For all groups, the rates of service utilization decreased around age 80, and the rates of decline for Whites were slower than others. The U.S.-born showed the trend of higher rates of service utilization than the foreign-born for all racial/ethnic groups. These findings suggest the importance of developing culturally competent programs to meet the dental needs of the increasingly diverse populations in the United States. %B Research on Aging %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/31272288?dopt=Abstract %R 10.1177/0164027519860268 %0 Journal Article %J Journal of Aging and Health %D 2019 %T Reciprocal Effects Between Loneliness and Sleep Disturbance in Older Americans. %A Sarah C. Griffin %A Williams, Allison Baylor %A Samantha N Mladen %A Paul B. Perrin %A Joseph M. Dzierzewski %A Bruce D. Rybarczyk %K health %K insomnia %K Loneliness %K Older Adults %K Sleep %X

To model the relationship between loneliness and sleep disturbance over time. : Data came from the Health and Retirement Study (2006, 2010, 2014 waves; age ≥ 65 years; = 5,067). Loneliness was measured via the Hughes Loneliness Scale and sleep disturbance via a four-item scale assessing sleep and restedness. Cross-lagged panel modeling (path analysis) was used to jointly examine reciprocal effects between loneliness and sleep disturbance. : Higher loneliness correlated with higher sleep disturbance at baseline. There was evidence of reciprocal effects between loneliness and sleep across timepoints. These associations overall remained when accounting for demographics, objective isolation, and depression. : Although causality cannot be established, the findings indicate that the relationship between loneliness and sleep disturbance is bidirectional. This requires revision to the current theory on sleep disturbance as a mechanism for the relationship between loneliness and health and indicates that effective treatment of sleep disturbance may reduce loneliness.

%B Journal of Aging and Health %G eng %R 10.1177/0898264319894486 %0 Journal Article %J Innovation in Aging %D 2019 %T REDUCING THE IMPACT OF CHILDHOOD MISFORTUNE: THE ROLE OF ADULT PHYSICAL ACTIVITY ON LATER OBESITY %A Kenneth F Ferraro %A Sauerteig, Madison R %A Monica Williams-Farrelly %K Childhood %K Childhood adversity %K Obesity %X This study investigates the effects of childhood misfortune and adult physical activity on later-life body mass index (BMI) and waist circumference. We use ordinary least squares regression to examine the impact of childhood misfortune (30 indicators), and adult physical activity (frequency and intensity) on waist circumference and BMI (kg/m²) using data from the Health and Retirement Study (N=5,732). Results emphasize that experiencing childhood misfortune is associated with a larger waist circumference and BMI in later life, while adjusting for social status and lifestyle variables. Adjusting for adult physical activity decreases the effect of childhood misfortune on waist circumference, suggesting mediation. The analysis reveals that the effects of childhood misfortune on BMI and abdominal adiposity are remediable. Although childhood misfortune is associated with larger waist circumference and BMI in later life, regular physical activity reduces the risk on both indicators of obesity. %B Innovation in Aging %V 3 %P S57 - S57 %8 2019/11/08 %@ 2399-5300 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841294/ %N Suppl 1 %! Innov Aging %0 Newspaper Article %B Michigan News %D 2019 %T Religious involvement may improve cognitive health %A Wadley, Jared %K Cognition %K Cognitive health %K Religion %X People over 50 who attend religious services and pray privately may notice better memory performance, a new study from the University of Michigan found. According to the study’s findings, frequent religious service attendance and private prayer was linked to stronger cognitive health among blacks, Hispanics and whites. Previous research has shown religious involvement benefits physical and mental health of older minority adults. %B Michigan News %C Ann Arbor %G eng %U https://news.umich.edu/religious-involvement-may-improve-cognitive-health/ %0 Report %D 2019 %T The retirement solution hiding in plain sight %A Fellows, Matt %A Fichtner, Jason %A Plews, Lincoln %A Whitman, Kevin %K Decision making %K Retirement %K Social Security %X Social Security now accounts for about one-third of all income annually received by U.S. retirees, amounting to $1 trillion in annual benefits. While impactful, research consistently finds that the financial effect of Social Security could be even greater if more people waited to enroll, since monthly benefits can increase in value if retirees delay claiming. But, we don’t know how much is annually lost from households making the sub-optimal decision about when to claim Social Security, how many are making mistakes, or who is making those wrong decisions. To explore these questions, we utilize new technology invented by United Income and data sponsored by the Social Security Administration, finding: Retirees will collectively lose $3.4 trillion in potential income that they could spend during their retirement because they claimed Social Security at a financially sub-optimal time, or an average of $111,000 per household. The average Social Security recipient would receive 9 percent more income in retirement if they made the financially optimal decision about when to claim this retirement benefit. Current retirees will collectively lose an estimated $2.1 trillion in wealth because they made the sub-optimal decision about when to claim Social Security, or an average of $68,000 per household. Most retirees will lose wealth in their 60s and early 70s if they choose to optimize Social Security, but will be wealthier in their late 70s through the rest of their lives. Only 4 percent of retirees make the financially optimal decision about when to claim Social Security. About 57 percent of retirees would build more wealth through their life if they waited to claim until they were 70 years old (when only 4 percent of retirees currently claim), while only 6.5 percent of retirees would have more wealth if they claimed prior to turning 64 (when over 70 percent of retirees currently claim benefits). About 21 percent of those at risk of not affording retirement (or having enough income to cover their expected cost of living) would see an improvement in their chances if they claimed Social Security at the optimal time. Among those retirees at risk that start with a greater than 10 percent chance of affording retirement, 95 percent see their chances of affording retirement improve by an average of 28 percent. Elderly poverty could be cut by nearly 50 percent if all retirees claimed Social Security at the financially optimal time. In particular, about 13 percent of people over the age of 70 are expected to live in poverty at some point, which is estimated to fall to 7 percent if retirees had claimed Social Security at the optimal time –a rate that could potentially fall even further if they earned additional income while they waited to claim Social Security. This report finds that nearly no retirees are making the financially optimal decision about Social Security, and that the costs of those mistakes are high for retiring households, particularly those at risk of not being able to afford retirement. In addition, since making the optimal decision means sacrificing wealth in the near-term, we think it is unlikely more people will make the right decision without a policy intervention. There are numerous difficulties associated with solving this problem, though, which will require a thorough and diverse process for addressing. Among the topics for consideration should be the eligibility age range rules, which were last materially modified in 1983. Since 92 percent of retirees are expected to be better off waiting to claim until at least their 65th birthday, claiming before should ideally be an exception for those who demonstrably need to claim benefits before the full retirement age. Means-testing rules may be one way to address this, though an easier place to start would be to change how the Social Security Administration frames claiming age options to the public. Instead of portraying age 62 as the “early eligibility age,” for instance, claiming at age 62 could instead be labeled as the “minimum benefit age” while age 70 could be labeled as the “maximum benefit age.” The Social Security Administration could also be provided with resources to improve utilization of the policy it administers, perhaps in partnership with third-party fiduciaries. With the potential to put $2.1 trillion wealth and $3.4 trillion in income in the pockets of retirees, policymakers should be focused on improving this program. %B United Income White Papers %I Capital One %C Washington, D.C. %G eng %U https://unitedincome.capitalone.com/library/the-retirement-solution-hiding-in-plain-sight %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 Food Security %D 2019 %T Social support and monetary resources as protective factors against food insecurity among older Americans: findings from a health and retirement study %A Nicholas J Bishop %A Wang, Kaipeng %K Assets %K Emotional support %K Food insecurity %K Income %K Social strain %X We examined the association between social support, monetary resources, and food insecurity among a nationally representative sample of older Americans. Analyses included 1164 Americans aged 65 and above from the 2012 Health and Retirement Study and the 2013 Health Care and Nutrition Study. Logistic regression analyses were used to estimate the likelihood of food insecurity as a function of social support (including social contact, emotional support, and social strain), monetary resources (including household income and household assets), and covariates. We found older adults with greater social strain and lower emotional support were at increased risk of food insecurity. Greater monetary resources were associated with lower risk of food insecurity. Select indicators of social support appeared to moderate the effect of monetary resources on food insecurity, with increasing social strain reducing the protective benefits of greater household assets, and low emotional support reducing the protective effect of increased household income to non-significance. Emotional support and social strain are aspects of social relationships that may play important roles in the relationship between monetary resources and food insecurity. Interventions seeking to reduce the burden of food insecurity should consider the quality and quantity of social relationships as potential risk factors. %B Food Security %V 11 %P 929–939 %8 08/2019 %G eng %U https://link.springer.com/article/10.1007/s12571-019-00945-8 %N 4 %0 Journal Article %J Health Affairs %D 2019 %T Spousal caregivers are caregiving alone in the last years of life %A Katherine A Ornstein %A Jennifer L. Wolff %A Bollens-Lund, Evan %A Rahman, Omari-Khalid %A Amy Kelley %K Activities of Daily Living %K Caregiving %K Community-dwelling %K Couples %X Caregiving in the last years of life is associated with increased depression and negative health outcomes for surviving spouses, many of whom are themselves in poor health. Yet it is unclear how often spouses are caregiving alone, how they differ from supported spouses, and whether lack of support affects postbereavement outcomes. We hypothesized that spouses who were solo caregivers—that is, the only caregivers (paid or unpaid) who provided assistance with a spouse’s self-care or household activities—would experience more depression after bereavement than supported spouses would. Using information from the Health and Retirement Study, we found that 55 percent of the spouses of community-dwelling married people with disability were solo caregivers. Solo caregiving was even common among people who cared for spouses with dementia and those with adult children living close by. Bereavement outcomes did not differ between solo and supported caregiving spouses. Caregiving spouses are often isolated and may benefit from greater support, particularly during the final years before bereavement. While some state and federal policy proposals aim to systematically recognize and assess caregivers, further innovations in care delivery and reimbursement are needed to adequately support seriously ill older adults and their caregivers. Ultimately, the focus of serious illness care must be expanded from the patient to the family unit. %B Health Affairs %V 38 %P 964-972 %G eng %U http://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00087 %N 6 %! Health Affairs %R 10.1377/hlthaff.2019.00087 %0 Journal Article %J Advances in Life Course Research %D 2019 %T Stress and salivary telomere length in the second half of life: A comparison of life-course models %A Willis, Margaret %A Ursula M. Staudinger %A Factor-Litvak, Pam %A Calvo, Esteban %K Biomarkers %K Depressive symptoms %K Telomeres %B Advances in Life Course Research %V 39 %P 34-41 %G eng %! Advances in Life Course Research %R 10.1016/j.alcr.2019.02.001 %0 Journal Article %J Journal of Small Business Management %D 2019 %T To Your Health: Health Insurance, Self-Employment Exit, and Older Entrepreneurs %A Wolfe, Marcus T. %A Pankaj C Patel %K Entrepeneurship %K Medicare/Medicaid/Health Insurance %K Self-employment %X Drawing on a sample of 5,238 individuals in the Health and Retirement Study, we examined the relationship between having one's own health insurance and exit from self-employment to employment. Our results indicate that individuals who have health insurance are less likely to exit self-employment. When self-employed individuals have their own health insurance, males, relative to females, are more likely to exit self-employment. Additionally, when self-employed individuals have their own health insurance, those who do not have health problems that limit work are more likely to exit. We discuss the implications that these findings have on the literature and policymakers. %B Journal of Small Business Management %V 57 %P 593-615 %G eng %U http://doi.wiley.com/10.1111/jsbm.12412http://onlinelibrary.wiley.com/wol1/doi/10.1111/jsbm.12412/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjsbm.12412 %N 2 %! Journal of Small Business Management %R 10.1111/jsbm.12412 %0 Journal Article %J Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %D 2019 %T Trajectories of Perceived Workplace Age Discrimination and Long-Term Associations With Mental, Self-Rated, and Occupational Health. %A Lisa A Marchiondo %A Guillermo Ernest Gonzales %A Larry J Williams %K Discrimination %K Employment and Labor Force %K Older Adults %K Self-reported health %X

Objective: This study addresses older employees' trajectories of perceived workplace age discrimination, and the long-term associations among perceived age discrimination and older workers' mental and self-rated health, job satisfaction, and likelihood of working past retirement age. We evaluate the strength and vulnerability integration (SAVI) model.

Method: Three waves of data from employed participants were drawn from the Health and Retirement Study (N = 3,957). Latent growth modeling was used to assess relationships between the slopes and the intercepts of the variables, thereby assessing longitudinal and cross-sectional associations.

Results: Perceived workplace age discrimination tends to increase with age, although notable variance exists. The initial status of perceived age discrimination relates to the baseline statuses of depression, self-rated health, job satisfaction, and likelihood of working past retirement age in the expected directions. Over time, perceived age discrimination predicts lower job satisfaction and self-rated health, as well as elevated depressive symptoms, but not likelihood of working past retirement age.

Discussion: This study provides empirical support for the SAVI model and uncovers the "wear and tear" effects of perceived workplace age discrimination on older workers' mental and overall health. We deliberate on social policies that may reduce age discrimination, thereby promoting older employees' health and ability to work longer.

%B Journals of Gerontology, Series B: Psychological Sciences & Social Sciences %V 74 %P 655-663 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28977664?dopt=Abstract %R 10.1093/geronb/gbx095 %0 Journal Article %J The Journals of Gerontology: Series B %D 2019 %T Widowhood and Depression in a Cross-National Perspective: Evidence from the United States, Europe, Korea, and China. %A Jadhav, Apoorva %A David R Weir %K Bereavement %K CHARLS %K Cross-National %K Depressive symptoms %K ELSA %K KLoSA %K SHARE %X

Objectives: We explore marital and depression trajectories over time for men and women, and distinguish between mood and somatic depression across contexts.

Method: We use longitudinal data from 2002 to 2013 from the United States, England, Europe, Korea, and China to explore depression among individuals married at baseline and follow their trajectories into widowhood with married as the reference group. We use random effects models to estimate these trajectories using the Center for Epidemiologic Studies Depression Scale (CES-D) or EURO-D scales for men and women.

Results: Depression peaks within the first year of widowhood for men and women, but women recover to levels comparable to married counterparts in all countries. Men sustain high levels of depression even 6-10 years post-widowhood everywhere except Europe. Widowed women have higher somatic depression compared to men, who have higher mood depression. Family plays differential roles in mediating depression across countries.

Discussion: Our research shows the complex global relationship between widowhood and depression. Studies that do not compare depression trajectories over time may make incorrect inferences about the persistence of depression by gender and country. Interventions should target different components of depression: mood-related symptoms for men and somatic-related symptoms for women for most effective recovery.

%B The Journals of Gerontology: Series B %V 73 %P e143-e153 %G eng %N 8 %R 10.1093/geronb/gbx021 %0 Report %D 2019 %T Will Fewer Children Boost Demand for Formal Caregiving? %A Gal Wettstein %A Alice Zulkarnain %K Caregiving %K children %X Today, 25 percent of all caregivers of elderly are adult children. However, while the parents of the Baby Boom generation had three children per household on average, the Boomers themselves only have two. This project uses the Health and Retirement Study to assess how the number of children a person has affects the demand for formal long-term care, i.e. long-term services and supports (LTSS), using ordinary linear regression, a Cox proportional hazard model, and an instrumental variable approach. Results suggest that the lower fertility of the Baby Boom generation is likely to lead to greater demand for LTSS in the coming decades. For example, the instrumental variable estimates indicate that having one fewer child increases the probability of having spent a night in a nursing home in the last two years from 10.7 percent to 12.4 percent among those with two or more Activities of Daily Living limitations. %I Center for Retirement Research at Boston College %8 03/2019 %G eng %U https://crr.bc.edu/working-papers/will-fewer-children-boost-demand-for-formal-caregiving/ %0 Web Page %D 2018 %T 4 Big Benefits of a Roth IRA %A Rita Williams %K News %K Retirement Planning and Satisfaction %K Roth IRA %I The Motley Fool %C Alexandria, VA %G eng %U https://www.fool.com/retirement/2018/10/16/4-big-benefits-of-a-roth-ira.aspx %0 Journal Article %J Journal of Official Statistics %D 2018 %T An Analysis of Interviewer Travel and Field Outcomes in Two Field Surveys %A James Wagner %A Olson, Kristen %K Interviews %K Nonresponse %K Survey Methodology %X In this article, we investigate the relationship between interviewer travel behavior and field outcomes, such as contact rates, response rates, and contact attempts in two studies, the National Survey of Family Growth and the Health and Retirement Study. Using call record paradata that have been aggregated to interviewer-day levels, we examine two important cost drivers as measures of interviewer travel behavior: the distance that interviewers travel to segments and the number of segments visited on an interviewer-day. We explore several predictors of these measures of travel - the geographic size of the sampled areas, measures of urbanicity, and other sample and interviewer characteristics. We also explore the relationship between travel and field outcomes, such as the number of contact attempts made and response rates.We find that the number of segments that are visited on each interviewer-day has a strong association with field outcomes, but the number of miles travelled does not. These findings suggest that survey organizations should routinely monitor the number of segments that interviewers visit, and that more direct measurement of interviewer travel behavior is needed. %B Journal of Official Statistics %V 34 %P 211-237 %G eng %N 1 %R 10.1515/jos-2018-0010 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Antecedents of Gray Divorce: A Life Course Perspective. %A Lin, I-Fen %A Susan L. Brown %A Matthew R Wright %A Anna M Hammersmith %K Age Factors %K Divorce %K Female %K Humans %K Interviews as Topic %K Male %K Marriage %K Middle Aged %K Prospective Studies %K Retirement %K Risk Factors %K Socioeconomic factors %K Spouses %K United States %X

Objectives: Increasingly, older adults are experiencing divorce, yet little is known about the risk factors associated with divorce after age 50 (termed "gray divorce"). Guided by a life course perspective, our study examined whether key later life turning points are related to gray divorce.

Method: We used data from the 1998-2012 Health and Retirement Study to conduct a prospective, couple-level discrete-time event history analysis of the antecedents of gray divorce. Our models incorporated key turning points (empty nest, retirement, and poor health) as well as demographic characteristics and economic resources.

Results: Contrary to our expectations, the onset of an empty nest, the wife's or husband's retirement, and the wife's or husband's chronic conditions were unrelated to the likelihood of gray divorce. Rather, factors traditionally associated with divorce among younger adults were also salient for older adults. Marital duration, marital quality, home ownership, and wealth were negatively related to the risk of gray divorce.

Discussion: Gray divorce is especially likely to occur among couples who are socially and economically disadvantaged, raising new questions about the consequences of gray divorce for individual health and well-being.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 1022-1031 %8 2018 08 14 %G eng %U http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbw164 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27986850?dopt=Abstract %! GERONB %R 10.1093/geronb/gbw164 %0 Journal Article %J American Journal of Industrial Medicine %D 2018 %T Are there health benefits of being unionized in late career? A longitudinal approach using HRS. %A Wels, Jacques %K Employment and Labor Force %K Self-reported health %K Unions %X

OBJECTIVE: To assess whether unionization prevents deterioration in self-reported health and depressive symptoms in late career transitions.

METHODS: Data come from the Health and Retirement Study (N = 6475). The change in self-perceived health (SPH) and depressive symptoms (CESD) between wave 11 and wave 12 is explained using an interaction effect between change in professional status from wave 10 to wave 11 and unionization in wave 10.

RESULTS: The odds of being affected by a negative change in CESD when unionized are lower for unionized workers remaining in full-time job (OR:0.73, CI95%:0.58;0.89), unionized full-time workers moving to part-time work (OR:0.66, CI95%:0.46;0.93) and unionized full-time workers moving to part-retirement (OR:0.40, CI95%:0.34;0.47) compared to non-unionized workers. The same conclusion is made for the change in SPH but with odds ratios closer to 1.

CONCLUSION: The reasons for the associations found in this paper need to be explored in further research.

%B American Journal of Industrial Medicine %V 61 %P 751-761 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/29956360?dopt=Abstract %R 10.1002/ajim.22877 %0 Journal Article %J Annals of Behavioral Medicine %D 2018 %T Association Between Purpose in Life and Glucose Control Among Older Adults. %A Hafez, Dina %A Michele M Heisler %A Choi, Hwajung %A Claire K. Ankuda %A Winkelman, Tyler %A Jeffrey T Kullgren %K Biomarkers %K Diabetes %K Glutamic Acid %K Purpose in life %X

Background: Greater purpose in life is associated with lower rates of certain chronic diseases. Whether purpose in life can protect against development of prediabetes or type 2 diabetes is unknown.

Purpose: To examine the association between purpose in life and blood glucose control among adults ≥50 years.

Methods: We conducted a longitudinal cohort study of 3,907 participants of the Health and Retirement Study who at baseline did not have type 2 diabetes or prediabetes. Baseline purpose in life was measured using the Ryff and Keyes' Scales of Psychological Well-Being and grouped into tertiles (high, medium, and low). We used multivariable linear regression to examine the association between baseline purpose in life and HbA1c over 4 years. Multivariable logistic regression was used to examine the association between baseline purpose and incident prediabetes or type 2 diabetes over the same period.

Results: After adjusting for sociodemographic factors, body mass index, physical activity, and physical and mental health factors, HbA1c was 0.07 percentage points lower among participants with high purpose than those with low purpose (95% confidence interval [CI] -0.12 to -0.02; p = .011). Participants with high purpose had lower odds of developing prediabetes or type 2 diabetes than those with low purpose (adjusted odds ratio 0.78; 95% CI 0.62 to 0.98; p = .037).

Conclusions: Among older adults, greater purpose in life is associated with a lower incidence of prediabetes or type 2 diabetes. Strategies to promote greater purpose in life should be tested as a part of type 2 diabetes prevention efforts.

%B Annals of Behavioral Medicine %V 52 %P 309-318 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/30084896?dopt=Abstract %R 10.1093/abm/kax012 %0 Book Section %B The Palgrave Handbook of Survey Research %D 2018 %T Biomarkers in Representative Population Surveys. %A David R Weir %K Biomarkers %X Objective measures of health indicators have historically been very challenging to collect with large-scale representative population surveys. Cost, interviewer training, and the invasiveness of collection techniques were some of the primary barriers. However new methods in biological specimen or biomarker collection and analysis mean that a number of these barriers have been reduced or removed. This chapter discusses some of the existing studies that collect biomarkers in the United States as example cases for how new developments have changed the viability of collecting these measures at scale. In particular, dried blood spot (DBS) and DNA sampling and analysis are discussed as groundbreaking advancements in this area of data collection. %B The Palgrave Handbook of Survey Research %I Palgrave Macmillan, Cham %P 227-233 %@ 978-3-319-54395-6 %G eng %U https://link.springer.com/chapter/10.1007%2F978-3-319-54395-6_29 %R https://doi.org/10.1007/978-3-319-54395-6 %0 Journal Article %J Medical Care %D 2018 %T Changes in Case-Mix and Health Outcomes of Medicare Fee-for-Service Beneficiaries and Managed Care Enrollees During the Years 1992-2011. %A Siran M Koroukian %A Basu, Jayasree %A Nicholas K Schiltz %A Navale, Suparna %A Paul M Bakaki %A David F Warner %A Avi Dor %A Charles W Given %A Kurt C Stange %K Medicare linkage %K Medicare/Medicaid/Health Insurance %K Mortality %X

BACKGROUND: Recent studies suggest that managed care enrollees (MCEs) and fee-for-service beneficiaries (FFSBs) have become similar in case-mix over time; but comparisons of health outcomes have yielded mixed results.

OBJECTIVE: To examine changes in differentials between MCEs and FFSBs both in case-mix and health outcomes over time.

DESIGN: Temporal study of the linked Health and Retirement Study (HRS) and Medicare data, comparing case-mix and health outcomes between MCEs and FFSBs across 3 time periods: 1992-1998, 1999-2004, and 2005-2011. We used multivariable analysis, stratified by, and pooled across the study periods. The unit of analysis was the person-wave (n=167,204).

SUBJECTS: HRS participants who were also enrolled in Medicare.

MEASURES: Outcome measures included self-reported fair/poor health, 2-year self-rated worse health, and 2-year mortality. Our main covariate was a composite measure of multimorbidity (MM), MM0-MM3, defined as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes.

RESULTS: The case-mix differential between MCEs and FFSBs persisted over time. Results from multivariable models on the pooled data and incorporating interaction terms between managed care status and study period indicated that MCEs and FFSBs were as likely to die within 2 years from the HRS interview (P=0.073). This likelihood remained unchanged across the study periods. However, MCEs were more likely than FFSBs to report fair/poor health in the third study period (change in probability for the interaction term: 0.024, P=0.008), but less likely to rate their health worse in the last 2 years, albeit at borderline significance (change in probability: -0.021, P=0.059).

CONCLUSIONS: Despite the persistence of selection bias, the differential in self-reported fair/poor status between MCEs and FFSBs seems to be closing over time.

%B Medical Care %V 56 %P 39-46 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29176368?dopt=Abstract %R 10.1097/MLR.0000000000000847 %0 Journal Article %J International Journal of Behavioral Development %D 2018 %T The co-development of perceived support and the Big Five in middle and older adulthood %A Patrick L Hill %A Sara J Weston %K Personality %K Retirement Planning and Satisfaction %K Self-reported health %K Social Support %X The current study examined whether relationships also influence personality trait development during middle and older adulthood, focusing on the individual's perception of support from the relationship partner. Using data from the Health and Retirement Study (n = 20,422; mean age = 65.9 years), we examined the longitudinal relationships between Big Five personality trait levels and perceived support from children, family, friends, and spouses. Results found that participants who reported more positive social support and lower negative support also tended to score higher on conscientiousness, extraversion, agreeableness, and openness to experience, but lower on neuroticism. Moreover, changes in positive support across relationship partners coincided with trait changes over time, in the form of more positive support was associated with seemingly adaptive changes on the Big Five. Findings are discussed with respect to identifying social influences on personality development in adulthood. %B International Journal of Behavioral Development %V 42 %P 26-33 %G eng %N 1 %! International Journal of Behavioral Development %R 10.1177/0165025417690262 %0 Book Section %B Contextualizing Health and Aging in the Americas %D 2018 %T Cognitive Functioning of U.S. Adults by Race and Hispanic Origin %A Díaz-Venegas, Carlos %A Brian Downer %A Kenneth M. Langa %A Rebeca Wong %E William A. Vega %E Jacqueline L. Angel %E Gutiérrez Robledo, Luis Miguel F. %E Kyriakos S Markides %K Alzheimer's disease %K Cognitive Ability %K Hispanics %K Racial/ethnic differences %X The U.S. older adult population is becoming increasingly diverse. The evidence from research using data from diverse older adult populations indicates that Hispanics have poorer performance on cognitive tests than older non-Hispanic whites (NHW). However, the evidence that older Hispanics are at an increased risk for Alzheimer’s disease or related dementia (ADRD) than NHW is less clear. Interpreting the evidence from existing research on disparities between NHWs and Hispanics is complicated by the fact that few studies have differentiated between Hispanic subgroups by country of origin. In this chapter, we use the ethnic descriptor of Hispanic as interchangeable with Latino. We summarize the current evidence on disparities between Hispanics and NHW in cognitive functioning and ADRD, and factors that may contribute to these disparities. This summary focuses on the rationale for considering specific Hispanic populations when studying differences in cognitive functioning between Hispanics and NHWs. Finally, we present and discuss the findings from an analysis of data from the 2010 wave of the Health and Retirement Study (n = 18,982) in which we examine differences in three cognitive domains by race/ethnicity, including four Hispanic subgroups. In this analysis, all Hispanic subgroups, except Cubans, had significantly lower scores for all cognitive domains compared to NHWs, with Puerto Ricans showing the lowest scores among Hispanics. %B Contextualizing Health and Aging in the Americas %I Springer International Publishing %C Cham %P 85 - 107 %@ 978-3-030-00583-2 %G eng %U https://link.springer.com/chapter/10.1007/978-3-030-00584-9_5 %R 10.1007/978-3-030-00584-910.1007/978-3-030-00584-9_5 %0 Journal Article %J Work, Aging and Retirement %D 2018 %T A comparison of subjective and objective job demands and fit with personal resources as predictors of retirement timing in a national U.S. Sample %A Amanda Sonnega %A Helppie-McFall, Brooke %A Péter Hudomiet %A Robert J. Willis %A Gwenith G Fisher %K Comparisons %K Job stressors %K Retirement Planning and Satisfaction %X Population aging and attendant pressures on public budgets have spurred considerable interest in understanding factors that influence retirement timing. A range of sociodemographic and economic characteristics predict both earlier and later retirement. Less is known about the role of job characteristics on the work choices of older workers. Researchers are increasingly using the subjective ratings of job characteristics available in the Health and Retirement Study in conjunction with more objective measures of job characteristics from the Occupational Information Network (O*NET) database. Employing a theoretically-informed model of job demands-personal resources fit, we constructed mismatch measures between resources and job demands (both subjectively and objectively assessed) in physical, emotional, and cognitive domains. When we matched comparable measures across the 2 data sources in the domains of physical, emotional, and cognitive job demands, we found that both sources of information held predictive power in relation to retirement timing. Physical and emotional but not cognitive mismatch were associated with earlier retirement. We discuss theoretical and practical implications of these findings and directions for future research. %B Work, Aging and Retirement %V 4 %G eng %U https://academic.oup.com/workar/article-lookup/doi/10.1093/workar/wax016 %N 1 %& 37–51 %R 10.1093/workar/wax016 %0 Journal Article %J Innovation in Aging %D 2018 %T CORRELATES AND HEALTH OUTCOMES OF LONG-TERM VOLUNTEERING: EVIDENCE FROM 16 YEARS OF THE HEALTH AND RETIREMENT STUDY %A Y Wang %A Shen, H %A Wong, R %A Amano, T %K health %K long-term volunteering %K Volunteering %K volunteering and health %X The importance and benefits of volunteering in later life has long been an interest for gerontological professionals. Most existing literature have studied volunteering using cross-sectional data or within a short period of time. While some people never stop volunteering and some never start, little is known about the profiles of these individuals. This study contributes to the literature by investigating correlates and health outcomes of long-term volunteers and non-volunteers using nationally-representative data from the 1998 to 2014 Health and Retirement Study. The present study includes individuals who were 50+ in 1998 and were alive through 2014. We further selected people who either never-stopped (25.88\%) or never-started (74.12\%) volunteering in the study period, yielding a final sample of 3,408. Logistic regression results showed that compared to non-volunteers, long-term volunteers tend to be younger, white, married, and have higher levels of education, economic status, and health status. Other significant correlates included religiosity (p\<.000), having friends living nearby (p\<.000), and living in non-urban areas (p=0.016). For health outcomes, OLS and ordered logit regression results showed that long-term volunteers had fewer number of depressive symptoms (b= -0.41, p\<.000) and better self-rated health status (OR=1.83, p\<.000), respectively. Given the significant health benefits of long-term volunteering, practitioners and policymakers are encouraged to make volunteering opportunities more accessible for people who were less likely to involve in long-term volunteering, so that they could also benefit from engaging in volunteering. Future research is encouraged to examine the mechanism among correlates, health outcomes and continuous/no engagement in volunteering. %B Innovation in Aging %V 2 %P 331-331 %8 11 %G eng %U https://doi.org/10.1093/geroni/igy023.1211 %R 10.1093/geroni/igy023.1211 %0 Journal Article %J The Journals of Gerontology: Series A %D 2018 %T Cross-Country Comparisons of Disability and Morbidity: Evidence from the Gateway to Global Aging Data %A Jinkook Lee %A Drystan F. Phillips %A Wilkens, Jenny %A Chien, Sandy %A Lin, Yu-Chen %A Marco Angrisani %A Eileen M. Crimmins %K Cross-National %K Disabilities %K Disease %K Gateway to Global Aging %X Background International comparisons of disease prevalence have been useful in understanding what proportion of disease might be preventable and in informing potential policy interventions in different cultural and economic contexts. Using newly available, harmonized data from 20 countries, we compare disability and morbidity of older adults between the ages of 55 and 74. Methods The Gateway to Global Aging Data, a data and information portal, provides access to easy-to-use individual-level longitudinal data from 10 surveys covering over 30 countries. Exploiting harmonized measures available from the Gateway, we descriptively examine how disability and morbidity differ across countries. Results Significant cross-country differences are observed for several health indicators. Comparing countries with the highest and lowest prevalence rates, we observe that hypertension rates vary twofold and stroke rates vary threefold, while disability and arthritis rates vary more than fivefold. Among women, higher gross domestic product and life expectancy are related to lower diabetes, heart disease, and better functioning. Among men, national indicators of economic conditions are not significantly associated with reported disease prevalence. Conclusions We document substantial heterogeneity in disability and morbidity across countries, separately for men and women and after controlling for population age composition and education. Rich data from various surveys across the world offers remarkable opportunities for cross-country analyses, calling for further investigation of what drives observed differences. The Gateway to Global Aging Data provides easy-to-use harmonized data files and tools to facilitate this type of research. %B The Journals of Gerontology: Series A %V 73 %P 1519-1524 %G eng %U http://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/glx224/4683782http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/glx224/22474170/glx224.pdf %N 11 %R 10.1093/gerona/glx224 %0 Journal Article %J Quality of Life Research %D 2018 %T Cross-national health comparisons using the Rasch model: findings from the 2012 US Health and Retirement Study and the 2012 Mexican Health and Aging Study %A Ickpyo Hong %A Timothy A Reistetter %A Díaz-Venegas, Carlos %A Alejandra Michaels-Obregon %A Rebeca Wong %K Arthritis %K Chronic conditions %K Comparisons %K Disabilities %K MHAS %X Purpose Cross-national comparisons of patterns of population aging have emerged as comparable national micro-data have become available. This study creates a metric using Rasch analysis and determines the health of American and Mexican older adult populations. Methods Secondary data analysis using representative samples aged 50 and older from 2012 U.S. Health and Retirement Study (n = 20,554); 2012 Mexican Health and Aging Study (n = 14,448). We developed a function measurement scale using Rasch analysis of 22 daily tasks and physical function questions. We tested psychometrics of the scale including factor analysis, fit statistics, internal consistency, and item difficulty. We investigated differences in function using multiple linear regression controlling for demographics. Lastly, we conducted subgroup analyses for chronic conditions. Results The created common metric demonstrated a unidimensional structure with good item fit, an acceptable precision (person reliability = 0.78), and an item difficulty hierarchy. The American adults appeared less functional than adults in Mexico (β = − 0.26, p < 0.0001) and across two chronic conditions (arthritis, β = − 0.36; lung problems, β = − 0.62; all p < 0.05). However, American adults with stroke were more functional than Mexican adults (β = 0.46, p = 0.047). Conclusions The Rasch model indicates that Mexican adults were more functional than Americans at the population level and across two chronic conditions (arthritis and lung problems). Future studies would need to elucidate other factors affecting the function differences between the two countries. %B Quality of Life Research %V 27 %P 2431-2441 %8 09/2018 %G eng %U https://link-springer-com.proxy.lib.umich.edu/article/10.1007%2Fs11136-018-1878-4 %N 9 %0 Journal Article %J Postepy Psychiatrii i Neurologii %D 2018 %T Depression and depressive symptoms as risk factors of labour deactivation and early or disability retirement in economically active adults in different age groups %A Konopko, M. %A Antosik-Wojcinska, A. %A Swiecicki, L. %A Wojnar, M. %A Bienkowski, P. %A Sienkiewicz-Jarosz, H. %K Depressive symptoms %K Disabilities %K Retirement %K SHARE %X Purpose: Over the recent years, the number of people over 54 years of age, who decide to make use of early retirement, has systematically increased. Economic inactivation is also an emerging problem in the group of younger adults. Depression or depressive symptoms should be taken into consideration in analysing variables that may play a role in the decisional process regarding occupational activities. The aim of the present work is to summarise the role of depression or depressive symptoms in the process of decision-making to continue occupational activities or to quit them. Review: The authors listed and discussed the most recent and representative surveys and studies regarding causes of retirement, concentrating especially on depression and depressive symptoms. The studies summarised here include the Health and Retirement Study, English Longitudinal Study of Ageing, Survey of Health, Ageing and Retirement in Europe and WHO's Study on Global Ageing and Adult Health. It has been shown, that prevalence of depressive symptoms of different severity in professionally active people may range from 6% to 32%. Depressive symptoms significantly increase the chance for retirement. Conclusions: Depressive disorders can affect people in all age categories and are one of the main cause of early disability retirement or early retirement tendencies. It is important to consider depressive disorders in policies supporting labour force participation. © 2018 Institute of Psychiatry and Neurology. Production and hosting by Termedia sp. z o.o. %B Postepy Psychiatrii i Neurologii %V 27 %G eng %N 1 %& 59-63 %0 Journal Article %J American Journal of Epidemiology %D 2018 %T Development, Construct Validity, and Predictive Validity of a Continuous Frailty Scale: Results from Two Large U.S. Cohorts. %A Wu, Chenkai %A G John Geldhof %A Xue, Qian-Li %A Dae H Kim %A Anne B Newman %A Michelle C Odden %K Comparisons %K Frailty %K Survey Methodology %X Frailty is an age-related clinical syndrome of decreased resilience to stressors. Among numerous assessments of frailty, the frailty phenotype (FP) scale, proposed by Fried and colleagues has been the most widely used one. We aimed to develop a continuous frailty scale that may overcome limitations facing the categorical FP scale and to evaluate its construct validity, predictive validity, and measurement properties. Data were from the Cardiovascular Health Study (N = 4243) and Health and Retirement Study (N = 7600). Frailty was conceptualized as a continuous construct, measured by five measures used in FP scale: gait speed, grip strength, exhaustion, physical activity, and weight loss. We used confirmatory factor analysis to investigate the relationship between five indicators and the latent frailty construct. We examined the association of the continuous frailty scale with mortality and disability. The unidimensional model fit the data satisfactorily; similar factor structure was observed across two cohorts. Gait speed and weight loss were the strongest and weakest indicators, respectively; grip strength, exhaustion, and physical activity had similar strength in measuring frailty. In each cohort, the continuous frailty scale was strongly associated with mortality and disability and persisted to be associated with outcomes among robust and prefrail persons classified by the FP scale. %B American Journal of Epidemiology %V 187 %P 1752-1762 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/29688247?dopt=Abstract %R 10.1093/aje/kwy041 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Differences in the Progression of Disability: A U.S.-Mexico Comparison. %A Díaz-Venegas, Carlos %A Timothy A Reistetter %A Rebeca Wong %K Activities of Daily Living %K Age Factors %K Aged %K Disabled Persons %K disease progression %K Female %K Humans %K Male %K Mexico %K MHAS %X

Objectives: This article seeks to document the progression of disability in a developing country by implementing a model to examine how this process compares to a developed country.

Methods: Data come from the Mexican Health and Aging Study (MHAS), including a baseline survey in 2001 and a follow-up in 2003, and from the U.S. Health and Retirement Study (HRS), using the 2000 and 2002 waves. An ordinal logistic regression approach is used to examine a progression of disability that considers (a) no disability, (b) mobility problems, (c) mobility plus limitations with instrumental activities of daily living, (d) mobility plus limitations with activities of daily living (ADLs), (e) limitations in all three areas and (f) death.

Results: In both data sets, approximately 44% of the sample remained in the same level of disability at the 2-year follow-up. However, the progression of limitations with two disabilities differs by gender in the MHAS but is consistent for both men and women in the HRS.

Discussion: Our model reflects the importance of ADLs in the disablement process in Mexico. We speculate that the difference in lifetime risk profiles and cultural context might be responsible for the divergence in the progression of disability by gender.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 913-922 %8 2018 06 14 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27436102 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27436102?dopt=Abstract %R 10.1093/geronb/gbw082 %0 Journal Article %J Work, Aging and Retirement %D 2018 %T The Distribution of Time in Retirement: Evidence From the Health and Retirement Survey %A Teresa Ghilarducci %A Anthony Webb %K Retirement Planning and Satisfaction %K Time Use %X This is the first study to investigate the distribution of retirement time. We apply hot-deck imputation to Health and Retirement Study data to construct a synthetic sample of people who lived natural human life spans to measure their duration of time between withdrawing from the labor force and death. Men are more likely than women to die without retiring and Blacks and women with low educational attainment have shorter retirements and spend larger shares of their retirement time needing assistance with one or more activities of daily living (ADLs). We also find defined benefit pensions offset the negative impact of male low socioeconomic status how much time is spent in retirement needing assistance with ADLs impaired. Some groups with shorter than average life spans cannot entirely compensate by retiring early. In the United States, access to retirement time is unequally distributed and may become more unequal as pension wealth and longevity inequalities increase. %B Work, Aging and Retirement %V 4 %P 251-261 %G eng %U https://academic.oup.com/workar/advance-article/doi/10.1093/workar/way001/4865893http://academic.oup.com/workar/advance-article-pdf/doi/10.1093/workar/way001/23978292/way001.pdf %N 3 %R 10.1093/workar/way001 %0 Journal Article %J Medical Care Research & Review %D 2018 %T Do Medicare Advantage Rebates Reduce Enrollees' Out-of-Pocket Spending? %A Lauren Hersch Nicholas %A Wu, Shannon %K Medicare linkage %K Medicare/Medicaid/Health Insurance %X The majority of Medicare Advantage (MA) plans receive payments that exceed their costs of providing basic Medicare benefits. There is controversy about whether these payments are passed on to the enrollees as supplemental benefits or are retained by plans. We used survey data on MA beneficiaries' actual out-of-pocket (OOP) spending linked to MA payment information to test whether higher plan payments and rebates lowered enrollee OOP spending. We used instrumental variables regression models to address concerns that plan payments and rebates may reflect anticipation of enrollees with particular health-spending profiles. We found that beneficiaries recovered only $0.65 of every $1.00 in payments exceeding fee-for-service spending through lower OOP spending but more than fully recovered the value of the rebates supporting supplemental benefits. %B Medical Care Research & Review %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30382801?dopt=Abstract %R 10.1177/1077558718807847 %0 Report %D 2018 %T Do Older SSDI Applicants Denied Benefits on the Basis of their Work Capacity Return to Work After Denial? %A Jody Schimmel Hyde %A April Yanyuan Wu %K Disabilities %K Insurance %K Social Security %K Work %X Key Findings: * Very few older denied SSDI applicants returned to work in the years following denial. * Among those who worked in the years before or after application, average earnings were lower after initial denial relative to before applying for SSDI. * The majority of older SSDI applicants denied on the basis of residual work capacity ultimately receive SSDI before full retirement age (FRA), either after appeal or reapplication. In this issue brief, we document the post-denial employment and benefit experiences of older applicants who are initially denied Social Security Disability Insurance (SSDI) for “work capacity” reasons. Specifically, a disability examiner determined that these applicants had a severe impairment, but denied benefits because the applicants’ residual functional capacity allowed them to perform past work or other work. For simplicity, we use “work capacity” denials for these cases, though that is not SSA’s official nomenclature. We follow the experience of older SSDI applicants from the time they receive an initial denial for SSDI benefits through full retirement age (FRA; age 65 or 66, depending on their birth year). The information in this brief highlights findings from a longer manuscript (Schimmel Hyde et al. 2018). Our findings shed light on the types of policies that might be most beneficial to older workers who experience disability onset to remain working and therefore delay claiming Social Security benefits. %B Mathematica Policy Research Published Reports %I Princeton %C Princeton, NJ %8 09/2018 %G eng %U https://search.proquest.com/docview/2083857692/abstract/40375250D95640A2PQ/1?accountid=14667 %0 Journal Article %J Scandinavian Journal of Work, Environment and Health %D 2018 %T Do resources buffer the prospective association of psychosocial work stress with depression? Longitudinal evidence from ageing workers. %A Lunau, Thorsten %A Morten Wahrendorf %A Müller, Andreas %A Wright, Bradley %A Dragano, Nico %K Depressive symptoms %K Psychosocial %K Well-being %X Objectives There is now convincing evidence that psychosocial work stressors are linked to depression. Few studies, however, have tested if individual resources can buffer the longitudinal effects of psychosocial work stressors on depressive symptoms. This study investigates how two types of resources (internal and external resources) affect the association between psychosocial work stressors and depressive symptoms. Methods Data were obtained from the US Health and Retirement Study, with baseline information on psychosocial work stressors [job strain and effort-reward imbalance (ERI)] and on internal ("high mastery" and "low constraints") and external resources ("private social support") among initially healthy workers. This information was linked to elevated depressive symptoms two years later. The sample includes 5473 observations and we report relative risks (RR) and effect modification on the additive and multiplicative scale. Results Psychosocial stressors and low resources (internal and external) were both independently related to depressive symptoms. Individuals with both, psychosocial stressors and low resources, had the highest risk of developing elevated depressive symptoms (eg, RR ERI-LowMastery3.32, 95% CI 2.49-4.42; RR JobStrain-LowMastery2.89, 95% CI 2.18-3.84). Yet, based on interaction analyses, only social support from friends buffered the association between work stressors and depressive symptoms. Conclusions Our findings have demonstrated that psychosocial stressors at work are related to mental health, and that in most cases this relationship holds true both for people with high and with low resources. Therefore, there is no clear indication that internal or external resources buffer the association between psychosocial work stressors and depressive symptoms. %B Scandinavian Journal of Work, Environment and Health %V 44 %P 183-191 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/29185626?dopt=Abstract %R 10.5271/sjweh.3694 %0 Journal Article %J Journal of Aging and Health %D 2018 %T Does oral health predict functional status in late life? Findings from a national sample. %A Wei Zhang %A Wu, Yan Yan %A Bei Wu %K Dental Care %K Functional limitations %X

OBJECTIVE: This study aims to examine the association between oral health and the decline in functional status among middle-aged and older adults in the United States.

METHOD: Generalized estimation equation (GEE) Poisson regression models with robust standard errors were used to analyze the longitudinal panel data (2008-2014) from the Health and Retirement Study ( N = 1,243). Oral health was evaluated using self-rated oral health, poor mouth condition, and tooth loss. Decline in functional status was assessed by disabilities in activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

RESULTS: Respondents with poor oral health were more likely to experience decline in ADLs/IADLs. Adjusting for sociodemographics and comorbidities attenuated the effects of oral health.

DISCUSSION: Findings suggest that oral health might be one of the important predictors of functioning decline in late life, after adjusting sociodemographics and comorbidities.

%B Journal of Aging and Health %V 30 %P 924-944 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28553812?dopt=Abstract %R 10.1177/0898264317698552 %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 Journal Article %J Research on Aging %D 2018 %T Estimating the Prevalence of Serious Mental Illness and Dementia Diagnoses Among Medicare Beneficiaries in the Health and Retirement Study %A Maria T. Brown %A Douglas A. Wolf %K Cognitive Ability %K Dementia %K Depressive symptoms %K Medicare linkage %K Mental Health %X Methods: This study utilizes HRS-linked Medicare claims data sets and inverse probability weighting to estimate overall and age-specific cumulative prevalence rates of dementia and serious mental illnesses among 18,740 Medicare beneficiaries. Two-way tabulations determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, and binary logistic regressions determine conditional probabilities of dementia diagnoses among beneficiaries diagnosed with specific mental illnesses, controlling for covariates. Results: Weighted prevalence estimates for dementia, schizophrenia (SZP), bipolar disorder (BPD), and major depressive disorder (MDD) are similar to previous studies. Odds of dementia diagnosis are significantly greater for beneficiaries diagnosed with SZP, BPD, or MDD. Conclusions: Co-occurring mental disabilities require further investigation, as in the near future increasing numbers of mentally ill older adults will need appropriate and affordable community-based services and supports. %B Research on Aging %V 40 %P 668-686 %G eng %U http://journals.sagepub.com/doi/10.1177/0164027517728554 %N 7 %! Res Aging %R 10.1177/0164027517728554 %0 Journal Article %J Preventative Med %D 2018 %T Food insecurity, comorbidity, and mobility limitations among older U.S. adults: Findings from the Health and Retirement Study and Health Care and Nutrition Study. %A Nicholas J Bishop %A Wang, Kaipeng %K Comorbidity %K Disabilities %K Food insecurity %X Both food insecurity and comorbidity have been identified as precursors to functional limitation in older adults, yet whether food insecurity modifies the progression from chronic disease to disability has not been assessed. We examined 5986 respondents age 50 and older drawn from the 2012-2014 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Mobility limitations reported in 2014 and change in mobility limitations from 2012 to 2014 were regressed on measures of food insecurity, number of chronic conditions, and their interaction terms using Poisson regression. Around 17.3% of the sample was identified as food insecure. In 2012, respondents reported an average of 1.9 (SD = 1.5) chronic conditions and 2.4 mobility limitations (SD = 3.0). In 2014, individuals reported an average of 2.5 (SD = 3.1) mobility limitations. Food insecurity was associated with a greater number of mobility limitations (IRR = 1.20, 95% CI: 1.11-1.29, p < .001) and more rapid increase in mobility limitations over the two-year observational period (IRR = 1.06, 95% CI: 1.00-1.11, p = .047). Food security status also modified the association between comorbidity and both mobility limitation outcomes, with the food secure exhibiting a stronger positive association between chronic conditions and mobility limitations than the food insecure. The food insecure tended to have more mobility limitations than the food secure when few chronic conditions were reported. Our results suggest that food insecurity is associated with prevalence and change in mobility limitations among older adults. %B Preventative Med %V 114 %P 180-187 %8 09/2018 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/30003897?dopt=Abstract %R 10.1016/j.ypmed.2018.07.001 %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 Genetic risks for chronic conditions: Implications for long-term wellbeing. %A George L Wehby %A Benjamin W Domingue %A Frederic D Wolinsky %K Chronic conditions %K Genetics %K Well-being %X

Background: Relationships between genetic risks for chronic diseases and long-run wellbeing are largely unexplored. We examined the associations between genetic predispositions to several chronic conditions and long-term functional health and socioeconomic status (SES).

Methods: We used data on a nationally representative sample of 9,317 adults aged 65 years or older from the 1992 to 2012 Health and Retirement Survey (HRS) in the US. Survey data were linked to genetic data on nearly 2 million single-nucleotide polymorphisms (SNPs). We measured individual-level genetic predispositions for coronary-artery disease, type 2 diabetes (T2D), obesity, rheumatoid arthritis (RA), Alzheimer's disease, and major depressive disorder (MDD) by polygenic risk scores (PRS) derived from genome-wide association studies (GWAS). The outcomes were self-rated health, depressive symptoms, cognitive ability, activities of everyday life, educational attainment, and wealth. We employed regression analyses for the outcomes including all polygenic scores and adjusting for gender, birth period, and genetic ancestry.

Results: The polygenic scores had important associations with functional health and SES. An increase in genetic risk for all conditions except T2D was significantly (p < .01) associated with reduced functional health and socioeconomic outcomes. The magnitudes of functional health declines were meaningful and in many cases equivalent in magnitude to several years of aging. These associations were robust to several sensitivity checks for ancestry and adjustment for parental educational attainment and age at death or the last interview if alive.

Conclusion: Stronger genetic predispositions for leading chronic conditions are related to worse long-run health and SES outcomes, likely reflecting the adverse effects of the onset of these conditions on one's wellbeing.

%B Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %V 73 %P 477-483 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/28958056?dopt=Abstract %R 10.1093/gerona/glx154 %0 Journal Article %J Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %D 2018 %T Genetics of human longevity from incomplete data: New findings from the long life family study. %A Anatoliy Yashin %A Konstantin G Arbeev %A Wu, Deqing %A Liubov S Arbeeva %A Bagley, Olivia %A Stallard, Eric %A Alexander M Kulminski %A Akushevich, Igor %A Fang, Fang %A Wojczynski, Mary K %A Christensen, Kaare %A Anne B Newman %A Boudreau, Robert M %A Province, Michael A %A Stephen M Thielke %A Thomas T Perls %A An, Ping %A Irma Elo %A Svetlana Ukraintseva %K Genetics %K Longevity %X The special design of the Long Life Family Study provides a unique opportunity to investigate the genetics of human longevity by analyzing data on exceptional lifespans in families. In this article, we performed two series of genome wide association studies of human longevity which differed with respect to whether missing lifespan data were predicted or not predicted. We showed that the use of predicted lifespan is most beneficial when the follow-up period is relatively short. In addition to detection of strong associations of SNPs in APOE, TOMM40, NECTIN2, and APOC1 genes with longevity, we also detected a strong new association with longevity of rs1927465, located between the CYP26A1 and MYOF genes on chromosome 10. The association was confirmed using data from the Health and Retirement Study. We discuss the biological relevance of the detected SNPs to human longevity. %B Journals of Gerontology, Series A: Biological Sciences & Medical Sciences %V 73 %P 1472-1481 %8 10/2018 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/30299504?dopt=Abstract %R 10.1093/gerona/gly057 %0 Journal Article %J Nature Genetics %D 2018 %T Genome-wide association meta-analysis in 269,867 individuals identifies new genetic and functional links to intelligence %A Savage, Jeanne E. %A Philip R Jansen %A Stringer, Sven %A Watanabe, Kyoko %A Bryois, Julien %A Christiaan de Leeuw %A Nagel, Mats %A Awasthi, Swapnil %A Barr, Peter B. %A Coleman, Jonathan R. I. %A Grasby, Katrina L. %A Anke R Hammerschlag %A Kaminski, Jakob A. %A Karlsson, Robert %A Krapohl, Eva %A Lam, Max %A Nygaard, Marianne %A Chandra A Reynolds %A Joey W Trampush %A Young, Hannah %A Zabaneh, Delilah %A Hägg, Sara %A Narelle K Hansell %A Ida Karlsson %A Linnarsson, Sten %A Grant W Montgomery %A Muñoz-Manchado, Ana B. %A Quinlan, Erin B. %A Schumann, Gunter %A Skene, Nathan G. %A Webb, Bradley T. %A White, Tonya %A Dan E Arking %A Avramopoulos, Dimitrios %A Robert M Bilder %A Bitsios, Panos %A Katherine E Burdick %A Tyrone D. Cannon %A Chiba-Falek, Ornit %A Christoforou, Andrea %A Elizabeth T. Cirulli %A Congdon, Eliza %A Corvin, Aiden %A Gail Davies %A Ian J Deary %A DeRosse, Pamela %A Dickinson, Dwight %A Djurovic, Srdjan %A Donohoe, Gary %A Conley, Emily Drabant %A Johan G Eriksson %A Espeseth, Thomas %A Nelson A. Freimer %A Giakoumaki, Stella %A Giegling, Ina %A Gill, Michael %A David C. Glahn %A Ahmad R Hariri %A Hatzimanolis, Alex %A Matthew C Keller %A Knowles, Emma %A Koltai, Deborah %A Konte, Bettina %A Lahti, Jari %A Stephanie Le Hellard %A Lencz, Todd %A David C Liewald %A London, Edythe %A Astri J Lundervold %A Anil K. Malhotra %A Melle, Ingrid %A Morris, Derek %A Anna C Need %A William E R Ollier %A Aarno Palotie %A Payton, Antony %A Pendleton, Neil %A Russell A Poldrack %A Katri Räikkönen %A Reinvang, Ivar %A Roussos, Panos %A Rujescu, Dan %A Fred W Sabb %A Matthew A Scult %A Smeland, Olav B. %A Smyrnis, Nikolaos %A John M Starr %A Vidar M Steen %A Nikos C Stefanis %A Richard E Straub %A Sundet, Kjetil %A Henning Tiemeier %A Aristotle N Voineskos %A Daniel R Weinberger %A Elisabeth Widen %A Yu, Jin %A Gonçalo R Abecasis %A Andreassen, Ole A. %A Breen, Gerome %A Christiansen, Lene %A Debrabant, Birgit %A Danielle M. Dick %A Heinz, Andreas %A Hjerling-Leffler, Jens %A Mohammed Arfan Ikram %A Kendler, Kenneth S. %A Nicholas G Martin %A Sarah E Medland %A Nancy L Pedersen %A Plomin, Robert %A Tinca J Polderman %A Ripke, Stephan %A van der Sluis, Sophie %A Patrick F. Sullivan %A Scott Vrieze %A Margaret J Wright %A Posthuma, Danielle %K Genome-Wide Association Study %K Intelligence %K Meta-analyses %X Intelligence is highly heritable1 and a major determinant of human health and well-being2. Recent genome-wide meta-analyses have identified 24 genomic loci linked to variation in intelligence3-7, but much about its genetic underpinnings remains to be discovered. Here, we present a large-scale genetic association study of intelligence (n = 269,867), identifying 205 associated genomic loci (190 new) and 1,016 genes (939 new) via positional mapping, expression quantitative trait locus (eQTL) mapping, chromatin interaction mapping, and gene-based association analysis. We find enrichment of genetic effects in conserved and coding regions and associations with 146 nonsynonymous exonic variants. Associated genes are strongly expressed in the brain, specifically in striatal medium spiny neurons and hippocampal pyramidal neurons. Gene set analyses implicate pathways related to nervous system development and synaptic structure. We confirm previous strong genetic correlations with multiple health-related outcomes, and Mendelian randomization analysis results suggest protective effects of intelligence for Alzheimer's disease and ADHD and bidirectional causation with pleiotropic effects for schizophrenia. These results are a major step forward in understanding the neurobiology of cognitive function as well as genetically related neurological and psychiatric disorders. %B Nature Genetics %V 50 %P 912 - 919 %8 Jan-07-2018 %G eng %U http://www.nature.com/articles/s41588-018-0152-6http://www.nature.com/articles/s41588-018-0152-6.pdfhttp://www.nature.com/articles/s41588-018-0152-6http://www.nature.com/articles/s41588-018-0152-6.pdf %N 7 %! Nat Genet %R 10.1038/s41588-018-0152-6 %0 Journal Article %J Molecular Psychiatry %D 2018 %T A genome-wide association study for extremely high intelligence %A Zabaneh, D %A Krapohl, E %A Gaspar, H A %A Curtis, C %A Lee, S H %A Patel, H %A Newhouse, S %A Wu, H M %A Simpson, M A %A Putallaz, M %A Lubinski, D %A Plomin, R %A Breen, G %K Cognitive Ability %K Education %K Genome %K Hereditary %K Humans %X We used a case-control genome-wide association (GWA) design with cases consisting of 1238 individuals from the top 0.0003 (~170 mean IQ) of the population distribution of intelligence and 8172 unselected population-based controls. The single-nucleotide polymorphism heritability for the extreme IQ trait was 0.33 (0.02), which is the highest so far for a cognitive phenotype, and significant genome-wide genetic correlations of 0.78 were observed with educational attainment and 0.86 with population IQ. Three variants in locus ADAM12 achieved genome-wide significance, although they did not replicate with published GWA analyses of normal-range IQ or educational attainment. A genome-wide polygenic score constructed from the GWA results accounted for 1.6% of the variance of intelligence in the normal range in an unselected sample of 3414 individuals, which is comparable to the variance explained by GWA studies of intelligence with substantially larger sample sizes. The gene family plexins, members of which are mutated in several monogenic neurodevelopmental disorders, was significantly enriched for associations with high IQ. This study shows the utility of extreme trait selection for genetic study of intelligence and suggests that extremely high intelligence is continuous genetically with normal-range intelligence in the population. %B Molecular Psychiatry %V 23 %P 1226 - 1232 %8 Apr-05-2018 %G eng %U http://www.nature.com/doifinder/10.1038/mp.2017.121http://www.nature.com/doifinder/10.1038/mp.2017.121 %N 5 %! Mol Psychiatry %R 10.1038/mp.2017.121 %0 Thesis %B Philosophy %D 2018 %T Grandchild Care and Marital Quality in Later Life %A Wang, Shuangshuang %K Caregiving %K Family Roles/Relationships %K Grandparents %K Marriage %X Grandparents providing any type of care to their grandchildren are typically married. Having a good marital quality has great implications to older adults’ health and longevity; however, our knowledge regarding how marital quality could be shaped by providing grandchild care is limited. Guided by the Stress Process Model and Role Theory (i.e. role strain perspective, role enhancement perspective and gender roles), this dissertation examined the associations between grandparents’ marital quality and three aspects of grandchild care: types of care, transitions in care, and division of care between spouses. Each aspect was examined in one of the three studies that composed this dissertation. In addition, gender differences in the impacts of providing grandchild care on grandparents’ marital quality was investigated in each study. Using data of 7,275 married grandparents aged 40 and over from the 2008, 2010 and 2012 waves of the Health and Retirement Study, multiple-imputation estimate logistic and linear regression models were conducted to predict marital quality (i.e., perceived closeness with spouse, perceived spousal support, perceived spousal strain). Providing high-intensity grandchild care (i.e. primary, co-parenting and high levels of babysitting) was associated with grandparents’ lower marital quality. The negative consequences of high-intensity care were established both for grandparents who transitioned into high levels of care, and those who provided care on an ongoing basis. The negative effect of providing high-intensity care on marital quality was more pronounced among women than among men. In contrast, the positive effect of discontinuing high-intensity care on marital quality is more pronounced among men than among women. Regarding division of care, equal sharing between spouses was associated with grandparents’ higher marital quality than having a spouse who provided less care, and the effect was same among men and women. Findings of this dissertation aligned with the Stress Process Model and the role strain perspective. Support groups may help raise awareness among grandparents that providing grandchild care may affect their marital quality, and create marital relationship-specific activities. Health professionals and counselors should be aware that grandparents who provide intensive care to their grandchildren or care that is uneven between spouses could be at higher risk for marital distress. %B Philosophy %I University of Massachusetts %C Boston %V PhD %P 185 %G eng %U https://search.proquest.com/docview/2051417236/abstract/8520E329230146CBPQ/1?accountid=14667 %9 Dissertation %0 Journal Article %J Experimental Gerontology %D 2018 %T Hidden heterogeneity in Alzheimer's disease: Insights from genetic association studies and other analyses %A Anatoliy Yashin %A Fang, Fang %A Kovtun, Mikhail %A Wu, Deqing %A Duan, Matt %A Konstantin G Arbeev %A Akushevich, Igor %A Alexander M Kulminski %A Culminskaya, Irina %A Zhbannikov, Ilya %A Arseniy P Yashkin %A Stallard, Eric %A Svetlana Ukraintseva %K Alzheimer's disease %K Cancer screenings %K Genetics %K GWAS %X Despite evident success in clarifying many important features of Alzheimer's disease (AD) the efficient methods of its prevention and treatment are not yet available. The reasons are likely to be the fact that AD is a multifactorial and heterogeneous health disorder with multiple alternative pathways of disease development and progression. The availability of genetic data on individuals participated in longitudinal studies of aging health and longevity, as well as on participants of cross-sectional case-control studies allow for investigating genetic and non-genetic connections with AD and to link the results of these analyses with research findings obtained in clinical, experimental, and molecular biological studies of this health disorder. The objective of this paper is to perform GWAS of AD in several study populations and investigate possible roles of detected genetic factors in developing AD hallmarks and in other health disorders. The data collected in the Framingham Heart Study (FHS), Cardiovascular Health Study (CHS), Health and Retirement Study (HRS) and Late Onset Alzheimer's Disease Family Study (LOADFS) were used in these analyses. The logistic regression and Cox's regression were used as statistical models in GWAS. The results of analyses confirmed strong associations of genetic variants from well-known genes APOE, TOMM40, PVRL2 (NECTIN2), and APOC1 with AD. Possible roles of these genes in pathological mechanisms resulting in development of hallmarks of AD are described. Many genes whose connection with AD was detected in other studies showed nominally significant associations with this health disorder in our study. The evidence on genetic connections between AD and vulnerability to infection, as well as between AD and other health disorders, such as cancer and type 2 diabetes, were investigated. The progress in uncovering hidden heterogeneity in AD would be substantially facilitated if common mechanisms involved in development of AD, its hallmarks, and AD related chronic conditions were investigated in their mutual connection. %B Experimental Gerontology %V 107 %P 148-160 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0531556517304242 %! Experimental Gerontology %R 10.1016/j.exger.2017.10.020 %0 Report %D 2018 %T Household Time Use Among Older Couples: Evidence and Implications for Labor Supply Parameters %A Rogerson, Richard %A Wallenius, Johanna %K Couples %K Employment and Labor Force %K Retirement Planning and Satisfaction %K Transitions %X Using the Consumption Activities Mail Survey (CAMS) module in the HRS we document how time allocations change for individuals within a household when one or more members transitions from full time work to not working. Our basic finding is that the ratio of home production to leisure time is approximately constant for both family members. We then build a model of household labor supply to understand the implications of this finding for preferences and the home production function. We conclude that this fact suggests a relatively large elasticity of substitution between the leisure of the two members. For commonly used preference specifications, this also implies a large (i.e., greater than one) intertemporal elasticity of substitution for leisure. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 01/2018 %G eng %U http://www.nber.org/papers/w24263.pdf %R 10.3386/w24263 %0 Journal Article %J PLoS One %D 2018 %T Index or illusion: The case of frailty indices in the Health and Retirement Study. %A Yi-Sheng Chao %A Hsing-Chien Wu %A Chao-Jung Wu %A Wei-Chih Chen %K Frailty %X

INTRODUCTION: Frailty is a geriatric syndrome that has been defined differently with various indices. Without a uniform definition, it remains unclear how to interpret and compare different frailty indices (FIs). With the advances in index mining, we find it necessary to review the implicit assumptions about the creation of FIs. We are concerned the processing of frailty data may introduce measurement error and bias. We aim to review the assumptions, interpretability and predictive power of FIs regarding mortality.

METHODS: Three FIs, the Functional Domains Model proposed by Strawbridge et al. (1998), the Burden Model by Rockwood et al. (2007) and the Biologic Syndrome Model by Fried et al. (2004), were directly compared using the data from the Health and Retirement Study (HRS), a longitudinal study since 1996 mainly following up Americans aged 50 years and over. The FIs were reproduced according to Cigolle et al. (2009) and interpreted with their input variables through forward-stepwise regression. Biases were the residuals of the FIs that could not be explained by own input variables. Any four of the input variables were used to create alternative indices. Discrete-time survival analysis was conducted to compare the predictive power of FIs, input variables and alternative indices on mortality.

RESULTS: We found frailty a syndrome not unique to the elderly. The FIs were produced with different degrees of bias. The FIs could not be fully interpreted with the theory-based input variables. The bias induced by the Biological Syndrome Model better predicted mortality than frailty status. A complicated FI, the Burden Model, could be simplified. The input variables better predicted mortality than the FIs. The continuous FIs predicted mortality better than the frailty statuses. At least 6865 alternative indices better predicted mortality than the FIs.

CONCLUSION: FIs have been used as outcome in clinical trials and need to be reviewed for adequacy based on our findings. The three FIs are not closely linked to the theories because of bias introduced by data manipulation and excessive numbers of input variables. We are developing new algorithms to develop and validate innovative indices.

%B PLoS One %V 13 %P e0197859 %8 07/2018 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/30020923?dopt=Abstract %R 10.1371/journal.pone.0197859 %0 Journal Article %J Nature Communications %D 2018 %T Integrative analysis of omics summary data reveals putative mechanisms underlying complex traits %A Wu, Yang %A Zeng, Jian %A Zhang, Futao %A Zhihong Zhu %A Qi, Ting %A Zheng, Zhili %A Lloyd-Jones, Luke R. %A Riccardo E Marioni %A Nicholas G Martin %A Grant W Montgomery %A Ian J Deary %A Naomi R. Wray %A Peter M Visscher %A McRae, Allan F. %A Yang, Jian %K Complex Traits %K Genetics %K GWAS %X The identification of genes and regulatory elements underlying the associations discovered by GWAS is essential to understanding the aetiology of complex traits (including diseases). Here, we demonstrate an analytical paradigm of prioritizing genes and regulatory elements at GWAS loci for follow-up functional studies. We perform an integrative analysis that uses summary-level SNP data from multi-omics studies to detect DNA methylation (DNAm) sites associated with gene expression and phenotype through shared genetic effects (i.e., pleiotropy). We identify pleiotropic associations between 7858 DNAm sites and 2733 genes. These DNAm sites are enriched in enhancers and promoters, and >40% of them are mapped to distal genes. Further pleiotropic association analyses, which link both the methylome and transcriptome to 12 complex traits, identify 149 DNAm sites and 66 genes, indicating a plausible mechanism whereby the effect of a genetic variant on phenotype is mediated by genetic regulation of transcription through DNAm. %B Nature Communications %V 9 %G eng %U http://www.nature.com/articles/s41467-018-03371-0http://www.nature.com/articles/s41467-018-03371-0.pdfhttp://www.nature.com/articles/s41467-018-03371-0.pdfhttp://www.nature.com/articles/s41467-018-03371-0 %N 1 %! Nat Commun %R 10.1038/s41467-018-03371-0 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Later Life Marital Dissolution and Repartnership Status: A National Portrait. %A Susan L. Brown %A Lin, I-Fen %A Anna M Hammersmith %A Matthew R Wright %K Age Factors %K Aged %K Aged, 80 and over %K Divorce %K Female %K Humans %K Longitudinal Studies %K Male %K Marriage %K Middle Aged %K Socioeconomic factors %K Spouses %K United States %K Widowhood %X

OBJECTIVES: Our study compares two types of later life marital dissolution that occur after age 50-divorce and widowhood-and their associations with repartnership status (i.e., remarried, cohabiting, or unpartnered).

METHOD: We used data from the Health and Retirement Study to provide a portrait of later life divorce and widowhood for women and men. Next, we tested whether marital dissolution type is related to women's and men's repartnered status, distinguishing among remarrieds, cohabitors, and unpartnereds, net of key sociodemographic indicators.

RESULTS: Divorcees are more often repartnered through either remarriage or cohabitation than are widoweds. This gap persists among women net of an array of sociodemographic factors. For men, the differential is reduced to nonsignificance with the inclusion of these factors.

DISCUSSION: Later life marital dissolution increasingly occurs through divorce rather than widowhood, and divorce is more often followed by repartnership. The results from this study suggest that gerontological research should not solely focus on widowhood but also should pay attention to divorce and repartnering during later life.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 1032-1042 %8 2018 Aug 14 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/04/29/geronb.gbw051.abstract %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27131167?dopt=Abstract %4 Cohabitation/Divorce/Marriage/Remarriage/Widowhood %$ 999999 %R 10.1093/geronb/gbw051 %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 ∼250000 European participants have led to the discovery of ∼700 and ∼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 ∼450000 UK Biobank participants of European ancestry. Overall, our combined GWAS meta-analysis reaches N ∼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 × 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 ∼24.6% of the variance of height and ∼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 ∼0.44 and ∼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 %1 http://www.ncbi.nlm.nih.gov/pubmed/30124842?dopt=Abstract %R 10.1093/hmg/ddy271 %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 Journal Article %J Journals of Gerontology Series A: Biological Sciences & Medical Sciences %D 2018 %T Multimorbidity and physical and cognitive function: performance of a new multimorbidity-weighted index. %A Melissa Y Wei %A Mohammed U Kabeto %A Kenneth M. Langa %A Kenneth J Mukamal %K Cognition & Reasoning %K Comorbidity %X

Background: Multimorbidity is an important health outcome but is difficult to quantify. We recently developed a multimorbidity-weighted index (MWI) and herein assess its performance in an independent nationally-representative cohort.

Methods: Health and Retirement Study (HRS) participants completed an interview on physician-diagnosed chronic conditions and physical functioning. We determined the relationship of chronic conditions on physical functioning and validated these weights with the original, independently-derived MWI. We then determined the association between MWI with physical functioning, grip strength, gait speed, basic and instrumental activities of daily living (ADL/IADL) limitations, and the modified Telephone Interview for Cognitive Status (TICS-m) in adjusted models.

Results: Among 20,509 adults, associations between chronic conditions and physical functioning varied several-fold. MWI values based on weightings in the HRS and original cohorts correlated strongly (Pearson's r=0.92) and had high classification agreement (Kappa statistic=0.80, p<0.0001). Participants in the highest vs. lowest MWI quartiles had weaker grip strength (-2.91 kg, 95%CI: -3.51, -2.30), slower gait speed (-0.29 m/s, 95%CI: -0.35, -0.23), more ADL (0.79, 95%CI: 0.71, 0.87) and IADL (0.49, 95%CI: 0.44, 0.55) limitations, and lower TICS-m (-0.59, 95%CI: -0.77, -0.41) (all P<0.001). We observed monotonic graded relationships for all outcomes with increasing MWI quartiles.

Conclusion: A multimorbidity index weighted to physical functioning performed nearly identically in a nationally-representative cohort as it did in its development cohorts, confirming broad generalizability. MWI was strongly associated with subjective and objective physical and cognitive performance. Thus, MWI serves as a valid patient-centered measure of multimorbidity, an important construct in research and clinical practice.

%B Journals of Gerontology Series A: Biological Sciences & Medical Sciences %V 73 %P 225 %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28605457?dopt=Abstract %R 10.1093/gerona/glx114 %0 Book Section %B Future Directions for the Demography of Aging: Proceedings of a Workshop %D 2018 %T New Measures and New Designs in Demography of Aging Research %A David R Weir %A Linda J. Waite %A Wong, R. %A Vicki A Freedman %X A volume devoted to the demography of aging does well to recognize the importance of innovative data collection and data sharing. The field has been a leader in developing new designs and measurement approaches, and these studies in turn have shaped and pushed the research frontier for the study of aging. The strong commitment to data sharing with open access to the data for the scientific community—and the resulting high volume of research—has begun to influence other related fields. The National Institute on Aging (NIA), and in particular its branch of Behavioral and Social Research, has been the primary force behind this empirical infrastructure, providing funding, scientific leadership, and encouraging collaboration across the studies it supports and beyond. %B Future Directions for the Demography of Aging: Proceedings of a Workshop %I The National Academies Press %C Washington, DC %P 371-396 %@ 978-0-309-47413-9 %G eng %U https://www.nap.edu/read/25064/chapter/21 %& 13 %R https://doi.org/10.17226/25064 %0 Conference Paper %B 6th Annual Meeting of the Disability Research Consortium %D 2018 %T Occupational Changes Following Disability Onset in the Late Working Years %A April Yanyuan Wu %A Jody Schimmel Hyde %K Disabilities %K Disability %K Disability onset %K Occupation %K Occupational choice %X The onset of a work-limiting health condition in the years approaching retirement significantly reduces earnings and income, and leads to a sustained increase in the risk for poverty in both the late working years and into retirement. Schimmel and Stapleton (2012) found that earnings among older workers two years after the onset of a work-limiting health condition were 50 percent lower on average, and poverty rates were nearly double the rates for individuals who did not report a work-limiting health condition. Wu and Schimmel Hyde (forthcoming) reported that the likelihood of poverty in retirement was significantly higher for Social Security Disability Insurance (SSDI) beneficiaries and denied applicants—both groups who had substantial medical conditions—relative to older adults who had never sought SSDI before retirement—and who were presumably healthier than the two SSDI groups. %B 6th Annual Meeting of the Disability Research Consortium %I Mathematica Policy Research %G eng %U https://www.mathematica.org/-/media/internet/conferences/2018/drc-annual-meeting/summaries/occupational-changes-following-disability-onset-in-the-late-working-years-summary.pdf %0 Report %D 2018 %T Occupational Retirement and Social Security Reform: the Roles of Physical and Cognitive Health %A Jiayi Wen %K Cognition %K Retirement %K Social Security %X Under skill-biased technical change, jobs are becoming less physically demanding whereas require increasing cognitive abilities. However, existing research does not pay sufficient attention on the role of cognitive health in older people's labor supply, nor to the occupation-dependent labor supply effects of physical and cognitive health. This paper reveals several facts about the heterogeneity of physical and cognitive health, as well as their relationship with older people's labor supply across occupations. Based on these facts, this paper proposes and estimates a dynamic programming structural model of individual retirement and saving decisions. The model allows labor supply effects of physical and cognitive health to differ across occupations via four channels respectively: disutility of working, wage, medical expenditure and life expectancy . I estimate the model with the U.S. Health and Retirement Study data by Indirect Inference. The counterfactual experiments suggest cognitive health has little retirement effect for manual workers. However, for clerical workers, the effect is almost as large as the one of physical health. The counterfactual experiment also reveals the mechanisms through which physical and cognitive health affects labor supply respectively. Finally, this paper quantifies the distributional effects of proposed Social Security changes on retirement, benefits and welfare across occupations. %G eng %U https://ideas.repec.org/p/wyi/wpaper/002390.html %0 Journal Article %J Health Justice %D 2018 %T Older adults in jail: high rates and early onset of geriatric conditions. %A Greene, Meredith %A Cyrus Ahalt %A Stijacic-Cenzer, Irena %A Metzger, Lia %A Brie A Williams %K Criminal justice %K Health Conditions and Status %K Public Health %X

BACKGROUND: The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ("accelerated aging"), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults.

METHODS: This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth.

RESULTS: All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older.

CONCLUSIONS: Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.

%B Health Justice %V 6 %P 3 %8 02/2018 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29455436?dopt=Abstract %R 10.1186/s40352-018-0062-9 %0 Journal Article %J Journal of Arthroplasty %D 2018 %T Older Adults Undergoing Total Hip or Knee Arthroplasty: Chronicling Changes in Their Multimorbidity Profile in the Last Two Decades. %A Siran M Koroukian %A Nicholas K Schiltz %A David F Warner %A Alison K Klika %A Carlos A. Higuera-Rueda %A Wael K. Barsoum %K Chronic conditions %K Comorbidity %K Functional limitations %K Joint replacement %X

BACKGROUND: Despite the ubiquitous use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in older adults, little is known about the multimorbidity (MM) profile of this patient population. This study evaluates the temporal trends of MM, hypothesizing that patients with MM have had an increasingly greater representation in THA and TKA patients over time.

METHODS: Data on a US representative sample of older adults from the linked Health and Retirement Study and Medicare data from 1993 to 2012 were used. The Health and Retirement Study is a biennial survey that collects data on a broad array of measures, including self-reported chronic conditions and geriatric syndromes, which were used to account for MM. Medicare data were used to identify fee-for-service Medicare beneficiaries who underwent THA (n = 479) or TKA (n = 998) during the study years, which were grouped into 3 periods: 1993-1999, 2000-2006, and 2007-2012. Multivariable logistic regression analysis was conducted to obtain age-, gender-, and race-adjusted time trends for MM.

RESULTS: Compared to the earliest study period, and for both THA and TKA patients, there were significantly fewer patients with stroke and/or poor cognitive performance in the most recent study period. In addition, more TKA than THA patients presented with 2+ chronic conditions. Nearly 70% presented with co-occurring chronic conditions and geriatric syndromes, and this percentage did not change significantly over time.

CONCLUSION: The high representation of THA and TKA patients presenting with co-occurring chronic conditions and geriatric syndromes in this patient population warrants detailed exploration of the effects of geriatric syndromes on postoperative outcomes.

%B Journal of Arthroplasty %V 33 %P 976-982 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/29223403?dopt=Abstract %R 10.1016/j.arth.2017.11.014 %0 Web Page %D 2018 %T People with Weak Muscles Are More Likely to Die Early, Says Study %A Williams, Brett %K Grip strength %K Mortality %K News %I Men's Health/Hearst %C New York City %G eng %U https://www.menshealth.com/health/a22851634/university-of-michigan-strength-mortality-study/ %0 Journal Article %J Personal Relationships %D 2018 %T Personality similarity and marital quality among couples in later life %A Wang, Shuangshuang %A Kyungmin Kim %A Boerner, Kathrin %K Gender Differences %K Marriage %K Personality %X Using a modified actor-partner interdependence model, associations of individuals' personality traits (i.e., actor and partner effects) and personality similarity (i.e., trait-level and profile-level similarity between spouses) with marital quality were examined among 2,228 older couples from the Health and Retirement Study (2010/2012). Actor and partner effects of personality traits were stronger than similarities in explaining older couples' marital quality. Trait-level and profile-level similarities also contributed to marital quality. The effects of personality traits and personality similarity were similar for husbands and wives, although some gender differences in the partner effects were detected. Findings suggest that the effects of personality on marital quality persist into old age, indicating that being similar on personalities may be a benefit to older couples' marriages. %B Personal Relationships %V 25 %P 565-580 %G eng %U http://doi.wiley.com/10.1111/pere.2018.25.issue-4http://doi.wiley.com/10.1111/pere.12260http://onlinelibrary.wiley.com/wol1/doi/10.1111/pere.12260/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fpere.12260 %N 4 %! Pers Relationship %R 10.1111/pere.2018.25.issue-410.1111/pere.12260 %0 Journal Article %J Journal of Disability Policy Studies %D 2018 %T The Postretirement Well-Being of Workers With Disabilities %A April Yanyuan Wu %A Jody Schimmel Hyde %K Disabilities %K Disability %K Retirement %K Well-being %X Older workers who develop significant limitations in health or functioning face declines in income and consumption and an increased likelihood of poverty in the years prior to retirement. We assess the extent to which those differences persist after reaching retirement age. We use the Health and Retirement Study (HRS) linked to Social Security Administration (SSA) records to compare the postretirement financial well-being of workers who experienced disability onset during their working years with those who did not, based on their claiming behavior for Social Security disability and retirement benefits. We find that even after full retirement age, gaps that emerged prior to retirement persist; those who experienced disability prior to retirement had lower incomes, were more likely to be in poverty, and had significantly lower wealth. Workers with disabilities who claimed Social Security Disability Insurance (DI) fared better than those who were rejected for such benefits, yet both groups were worse off than those who delayed claiming benefits until they were eligible for Social Security Old Age and Survivors Insurance (OASI) benefits. Our findings indicate that any changes to the Social Security benefit structure must be mindful of the short- and longer term implications for already-vulnerable groups of workers. %B Journal of Disability Policy Studies %V 30 %P 46 - 55 %8 2019/06/01 %@ 1044-2073 %G eng %U https://doi.org/10.1177/1044207318793161 %N 1 %! Journal of Disability Policy Studies %0 Government Document %D 2018 %T Poverty among the aged population: The role of out-of-pocket medical expenditures and annuitized assets in supplemental poverty measure estimates %A William J. Chopik %A Wimer, Christopher %A Betson, David M. %A Manfield, Lucas %K Annuitization %K Medical Expenses %K Out-of-pocket payments %K Poverty %X We examine the extent to which the Supplemental Poverty Measure (SPM) overestimates the poverty rate of the aged population because it does not account for asset holdings. Following a conservative annuity approach, we use 2010 Health and Retirement Study data to estimate high and low bounds of potential annuitized asset withdrawals and then recalculate 2009 SPM poverty rates. Including annuitized asset principal in family resources reduces the estimated SPM poverty rate for the aged, especially among those who are in poverty because of medical out-of-pocket expenditures. For example, between 30.8 percent and 45.2 percent of the latter group would be reclassified as not SPM poor if they were to annuitize their financial assets. To better represent available family resources, poverty measurements for the aged should incorporate (at minimum) the conservative estimates of available assets produced by the bounded-annuity approach. %I Social Security Bulletin %P 47-75 %G eng %0 Journal Article %J 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 Gerontologist %D 2018 %T Racial/Ethnic and Nativity Differences in Cognitive Life Expectancies Among Older Adults in the United States. %A Marc Garcia %A Brian Downer %A Chi-Tsun Chiu %A Joseph L Saenz %A Rote, Sunshine %A Rebeca Wong %K Cognitive Ability %K Dementia %K Mortality %K Racial/ethnic differences %X

Background and Objectives: To document racial/ethnic and nativity differences by gender in cognitive life expectancies among older adults in the United States.

Research Design and Methods: Sullivan-based life tables were used to estimate cognitively normal, cognitively impaired/no dementia (CIND), and dementia life expectancies by gender for White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults 50 years and older in the Health and Retirement Study.

Results: Among women, the number of years spent living with dementia for Whites, Blacks, U.S.-born Hispanics, and foreign-born Hispanics was 1.6, 3.9, 4.7, and 6.0 years, respectively. For men, Whites lived 1.1 years with dementia compared to 3.1 years for Blacks, 3.0 years for U.S.-born Hispanics and 3.2 years for foreign-born Hispanics. Similar patterns were observed for race/ethnic and nativity differences in CIND life expectancies. Blacks and Hispanics spend a larger fraction of their remaining years with CIND and dementia relative to Whites, regardless of gender. Foreign-born Hispanic men and women and Black men are particularly disadvantaged in the proportion of years spent after age 50 with CIND and/or dementia.

Discussion and Implications: Disparities in cognitive life expectancies indicate that intervention strategies should target the specific needs of minority and immigrant older adults with dementia. Given that education is a strong predictor of cognitive health, improving access to the social and economic resources that delay dementia onset is key to improving the well-being of diverse older adults.

%B Gerontologist %V 38 %P 155-168 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28958071?dopt=Abstract %R 10.1093/geront/gnx142 %0 Journal Article %J American Journal of Hospital Palliative Care %D 2018 %T Relationship Between Expectation of Death and Location of Death Varies by Race/Ethnicity. %A Rafael D Romo %A Irena Cenzer %A Brie A Williams %A Alexander K Smith %K End of life decisions %K Mortality %K Racial/ethnic differences %K Subjective Expectations %X

BACKGROUND: Older black and Latino Americans are more likely than white Americans to die in the hospital. Whether ethnic differences in expectation of death account for this disparity is unknown.

OBJECTIVES: To determine whether surviving family members' expectation of death has a differential association with site of death according to race or ethnicity.

METHODS: We conducted an analysis of decedents from the Health and Retirement Study, a nationally representative study of US older adults. Telephone surveys were conducted with family members for 5979 decedents (decedents were 55% were women, 85% white, 9% black, and 6% Latino). The outcome of interest was death in the hospital; the predictor variable was race/ethnicity, and the intervening variable was expectation of death. Covariates included sociodemographics (gender, age, household net worth, educational attainment level, religion) and health factors (chronic conditions, symptoms, health-care utilization).

RESULTS: Decedents' race/ethnicity was statistically related to the expectation of death and death in the hospital. When death was not expected, whites and Latinos were more likely to die in the hospital than when death was expected (49% vs 29% for whites and 55% vs 37% for Latinos; P < .001). There was no difference in site of death according to family's expectation of death among blacks.

CONCLUSION: Expectation of death did not fully account for site of death and played a greater role among whites and Latinos than among black Americans. Discussing prognosis by itself is unlikely to address ethnic disparities. Other factors appear to play an important role as well.

%B American Journal of Hospital Palliative Care %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/29724110?dopt=Abstract %R 10.1177/1049909118773989 %0 Journal Article %J Translational Psychiatry %D 2018 %T A role for genes in the ‘caregiver stress process’? %A Douglas A. Wolf %A Middleton, Frank A. %K Caregiving %K Genetics %K Psychiatry %K Translational research %X The stress that accompanies caring for one’s parent, and the contribution of that stress to adverse physical and mental-health outcomes, is extensively studied and widely acknowledged. Yet there has been almost no attempt to incorporate the well-documented role of genetic variation in psychological distress into research on caregiving. We use phenotypic data from a large, population-based sample linked to extensive genotype data to develop a polygenic risk score (PRS) for depression, and test for both direct and interactive effects of the PRS in a multilevel repeat-measures model of caregiver-related stress. We distinguish three groups: potential caregivers (those with a living parent who does not need care), noncaregivers (those who do not provide care to their parent that needs care), and caregivers. We also obtain separate estimates according to the gender of both the parent and child. We found that a parent’s need for care, and the child’s provision of care, are associated with depression in some but not all cases; in contrast the PRS was significantly associated with the risk for increased depressive symptoms (with P ≤ 0.01) in all cases. These findings support an additive genetic contribution to the diathesis-stress model of depression in the context of caregiving. %B Translational Psychiatry %V 8 %G eng %U http://www.nature.com/articles/s41398-018-0275-7http://www.nature.com/articles/s41398-018-0275-7.pdfhttp://www.nature.com/articles/s41398-018-0275-7.pdfhttp://www.nature.com/articles/s41398-018-0275-7 %N 1 %! Transl Psychiatry %R 10.1038/s41398-018-0275-7 %0 Journal Article %J Demographic Research %D 2018 %T The role of education in the association between race/ethnicity/nativity, cognitive impairment, and dementia among older adults in the United States %A Marc Garcia %A Joseph L Saenz %A Brian Downer %A Rebeca Wong %K Cognitive Ability %K Dementia %K Education %K Racial/ethnic differences %X Older Black and Hispanic adults are more likely to be cognitively impaired than older White adults. Disadvantages in educational achievement for minority and immigrant populations may contribute to disparities in cognitive impairment. Examine the role of education in racial/ethnic and nativity differences in cognitive impairment/no dementia (CIND) and dementia among older US adults. Data comes from the 2012 Health and Retirement Study. A total of 19,099 participants aged >50 were included in the analysis. Participants were categorized as having normal cognition, CIND, or dementia based on the Telephone Interview for Cognitive Status (TICS) or questions from a proxy interview. We document age and educational differences in cognitive status among White, Black, US-born Hispanic, and foreign-born Hispanic adults by sex. Logistic regression is used to quantify the association between race/ethnicity/nativity, education, and cognitive status by sex. Among women, foreign-born Hispanics have higher odds of CIND and dementia than Whites. For men, Blacks have higher odds for CIND and dementia compared to Whites. The higher odds for CIND and dementia across race/ethnic and nativity groups was reduced after controlling for years of education but remained statistically significant for older Black and US-born Hispanic adults. Controlling for education reduces the odds for CIND (women and men) and dementia (men) among foreign-born Hispanics to nonsignificance. These results highlight the importance of education in CIND and dementia, particularly among foreign-born Hispanics. Addressing inequalities in education can contribute to reducing racial/ethnic/nativity disparities in CIND and dementia for older adults. %B Demographic Research %V 38 %P 155-168 %G eng %U https://www.demographic-research.org/volumes/vol38/6/ %! DemRes %R 10.4054/DemRes.2018.38.6 %0 Journal Article %J American Journal of Preventive Medicine %D 2018 %T Secular Trends in Dementia and Cognitive Impairment of U.S. Rural and Urban Older Adults %A Margaret M Weden %A Regina A Shih %A Mohammed U Kabeto %A Kenneth M. Langa %K Cognitive Ability %K Dementia %K Religion %K Rural Settings %K urban life %X Introduction This is a nationally representative study of rural−urban disparities in the prevalence of probable dementia and cognitive impairment without dementia (CIND). Methods Data on non-institutionalized U.S. adults from the 2000 (n=16,386) and 2010 (n=16,311) cross-sections of the Health and Retirement Study were linked to respective Census assessments of the urban composition of residential census tracts. Relative risk ratios (RRR) for rural−urban differentials in dementia and CIND respective to normal cognitive status were assessed using multinomial logistic regression. Analyses were conducted in 2016. Results Unadjusted prevalence of dementia and CIND in rural and urban tracts converged so that rural disadvantages in the relative risk of dementia (RRR=1.42, 95% CI=1.10, 1.83) and CIND (RRR=1.35, 95% CI=1.13, 1.61) in 2000 no longer reached statistical significance in 2010. Adjustment for the strong protective role of educational attainment reduced rural disadvantages in 2000 to statistical nonsignificance, whereas adjustment for race/ethnicity resulted in a statistically significant increase in RRRs in 2010. Full adjustment for sociodemographic and health factors revealed persisting rural disadvantages for dementia and CIND in both periods with RRR in 2010 for dementia of 1.79 (95% CI=1.31, 2.43) and for CIND of 1.38 (95% CI=1.14, 1.68). Conclusions Larger gains in rural adults’ cognitive functioning between 2000 and 2010 that are linked with increased educational attainment demonstrate long-term public health benefits of investment in secondary education. Persistent disadvantages in cognitive functioning among rural adults compared with sociodemographically similar urban peers highlight the importance of public health planning for more rapidly aging rural communities. %B American Journal of Preventive Medicine %V 54 %P 164-172 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S074937971730644Xhttp://api.elsevier.com/content/article/PII:S074937971730644X?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S074937971730644X?httpAccept=text/plain %N 2 %! American Journal of Preventive Medicine %R 10.1016/j.amepre.2017.10.021 %0 Journal Article %J Biometrics %D 2018 %T Semi-parametric methods of handling missing data in mortal cohorts under non-ignorable missingness. %A Wen, Lan %A Shaun R Seaman %K Data collection %K Datasets %K Survey Methodology %X We propose semi-parametric methods to model cohort data where repeated outcomes may be missing due to death and non-ignorable dropout. Our focus is to obtain inference about the cohort composed of those who are still alive at any time point (partly conditional inference). We propose: i) an inverse probability weighted method that upweights observed subjects to represent subjects who are still alive but are not observed; ii) an outcome regression method that replaces missing outcomes of subjects who are alive with their conditional mean outcomes given past observed data; and iii) an augmented inverse probability method that combines the previous two methods and is double robust against model misspecification. These methods are described for both monotone and non-monotone missing data patterns, and are applied to a cohort of elderly adults from the Health and Retirement Study. Sensitivity analysis to departures from the assumption that missingness at some visit t is independent of the outcome at visit t given past observed data and time of death is used in the data application. %B Biometrics %V 74 %P 1427-1437 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/29772074?dopt=Abstract %R 10.1111/biom.12891 %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 Report %D 2018 %T A Test of Supply-side Explanations of Geographic Variation in Health Care Use %A Callison, Kevin %A Kaestner, Robert %A Ward, Jason %K Geography %K Health care utilization %K Medicare/Medicaid/Health Insurance %X Evidence of regional variation in health care utilization has been well-documented over the past 40 years. Yet uncertainty persists about whether this variation is primarily the result of supply-side or demand-side forces, and the difference matters for both theory and policy. In this article, we provide new evidence as to the cause of geographic variation in health care utilization. We do so by examining changes in health care use by the near-elderly as they transition from being uninsured into Medicare. Results provide support for a causal supply-side explanation of regional variation. Estimates indicate that gaining Medicare coverage in above-median spending regions increases the probability of at least one hospital visit by 36% and the probability of having more than five doctor visits by 25% relative to similar individuals in below-median spending regions. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 09/2018 %G eng %U http://www.nber.org/papers/w25037.pdf %R 10.3386/w25037 %0 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 Thesis %B Social Work %D 2018 %T Who's In, Who's Out: A Descriptive Analysis of Demographic and Contextual Factors Related to Labor Force Participation among Older Adults %A White-Chapman,Nyshetia %K 0351:Gerontology %K 0452:Social work %K Gerontology %K Older workers %K Reemployment %K Social Sciences %K Social work %K Unemployment %K Worker displacement %K Working Longer %X As the proportion of older adults in the United States grows, there are significant concerns surrounding economic well-being in retirement. The two major components of the U.S retirement income system, Social Security and employer-sponsored retirement plans, have undergone significant changes that erode financial security in retirement. Working longer has been proposed to help older adults overcome deficits in retirement income. However, even when motivated to work, many older adults face significant challenges in the labor market, particularly those who are unemployed or displaced. In the current study, secondary data from the Health and Retirement Study (HRS) is used to identify demographic and contextual factors associated with unemployment, displacement, and reemployment (among those who are displaced at Time 2) among older adults. Logistic regression is used to examine the influence of race/ethnicity, gender, education, relationship status, health status, income status, geographical location, eligibility for retirement/age, and sector of employment on unemployment, displacement, and reemployment. Results suggest being of an “other” race, being married, being in fair to poor health, and having household income below the poverty threshold increased the odds of employed while being previously employed in the service sector reduced the odds of unemployment. All else equal, being African American and living in the West increases the likelihood of displacement among older adults while being female, living in poverty, and being eligible for retirement (aged 62 and older) reduces an older adult’s chances of being displaced. Finally, all else equal, being African American, living in the Northeast, and being eligible for retirement (aged 62 and older) reduced the likelihood reemployment at Time 2. The major implications of these findings for research, policy, and practice are discussed. %B Social Work %I University of Alabama %V PhD %P 98 %@ 9780438040755 %G eng %U https://books.google.com/books/about/Who_s_In_Who_s_Out.html?id=ouXsvQEACAAJ %9 phd %0 Journal Article %J Work, Aging and Retirement %D 2018 %T Work-Hour Trajectories and Depressive Symptoms Among Midlife and Older Married Couples %A Wylie H Wan %A Toni C Antonucci %A Kira S. Birditt %A Jacqui Smith %A Gwenith G Fisher %K Couples %K Depressive symptoms %K Employment and Labor Force %X Life course theories highlight the importance of understanding psychological health of aging individuals in context. Work and marriage are influential contexts in later life that are increasingly relevant because both spouses of many households work and individuals are delaying retirement. Although there is extensive literature on predictors of depressive symptoms, incorporating life course histories of work and social contexts has been a critical omission in the aging and health field. This study identifies couples’ work trajectories as a function of husband’s and wife’s weekly work hours and examines the link between couple work-hour trajectory membership and individual depressive symptoms. Data are from 1,641 married couples who participated in the 1998–2012 waves (ages 51–89) of the Health and Retirement Study (HRS). Findings revealed 6 distinct subgroups of work-hour trajectories among couples and that membership in these subgroups was associated with depressive symptoms. Retiring husbands with wives who continued to work and wives who worked minimally throughout the years (regardless of whether their husbands worked or retired) reported more depressive symptoms than other subgroups. These results suggest that work trajectories themselves, beyond current health status, may carry differential psychological health risk. Moreover, several sociodemographic and life course factors in 1998 were significant predictors of trajectory membership. These findings provide insight into midlife factors that may influence work trajectories (and the potential health risk) through to older adulthood. They suggest that a life course examination of work and social contexts is needed for a greater understanding of individual and couple health development. %B Work, Aging and Retirement %V 4 %P 108-122 %G eng %U http://academic.oup.com/workar/article/4/1/108/4762667http://academic.oup.com/workar/article-pdf/4/1/108/23002634/wax028.pdf %N 1 %R 10.1093/workar/wax028 %0 Book Section %B Oxford Textbook of Geriatric Medicine %D 2017 %T Ageing in North America: Canada and the United States %A Eileen M. Crimmins %A Hiram Beltrán-Sánchez %A Lauren L Brown %A Yon, Yongjie %A Michel, Jean-Pierre %A Beattie, B. Lynn %A Martin, Finbarr C. %A Jeremy D Walston %K Aging %K Cross-National %B Oxford Textbook of Geriatric Medicine %7 3rd %I Oxford University Press %C Cary, NC %P 19-26 %@ 978-0198701590 %G eng %& 3 %0 Journal Article %J Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %D 2017 %T Alzheimer's disease genetic risk variants beyond APOE ε4 predict mortality %A Mez, Jesse %A Jessica R Marden %A Mukherjee, Shubhabrata %A Stefan Walter %A Laura E Gibbons %A Alden L Gross %A Laura B Zahodne %A Paola Gilsanz %A Brewster, Paul %A Nho, Kwangsik %A Paul K Crane %A Eric B Larson %A M. Maria Glymour %K Alzheimer's disease %K APoE4 %K Cognitive Ability %K Genetics %K Mortality %K Risk Factors %X We hypothesized that, like apolipoprotein E (APOE), other late-onset Alzheimer's disease (LOAD) genetic susceptibility loci predict mortality. Methods We used a weighted genetic risk score (GRS) from 21 non-APOE LOAD risk variants to predict survival in the Adult Changes in Thought and the Health and Retirement Studies. We meta-analyzed hazard ratios and examined models adjusted for cognitive performance or limited to participants with dementia. For replication, we assessed the GRS-longevity association in the Cohorts for Heart and Aging Research in Genomic Epidemiology, comparing cases surviving to age ≥90 years with controls who died between ages 55 and 80 years. Results Higher GRS predicted mortality (hazard ratio = 1.05; 95% confidence interval: 1.00–1.10, P =.04). After adjusting for cognitive performance or restricting to participants with dementia, the relationship was attenuated and no longer significant. In case-control analysis, the GRS was associated with reduced longevity (odds ratio = 0.64; 95% confidence interval: 0.41–1.00, P =.05). Discussion Non-APOE LOAD susceptibility loci confer risk for mortality, likely through effects on dementia incidence. %B Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %V 8 %P 188-195 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S2352872917300416http://api.elsevier.com/content/article/PII:S2352872917300416?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2352872917300416?httpAccept=text/plain %! Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring %R 10.1016/j.dadm.2017.07.002 %0 Journal Article %J Biological Psychiatry %D 2017 %T An Analysis of Two Genome-wide Association Meta-analyses Identifies a New Locus for Broad Depression Phenotype. %A Nese Direk %A Williams, Stephanie %A Smith, Jennifer A %A Ripke, Stephan %A Air, Tracy %A Amare, Azmeraw T %A Amin, Najaf %A Baune, Bernhard T %A David A Bennett %A Blackwood, Douglas H R %A Dorret I Boomsma %A Breen, Gerome %A Buttenschøn, Henriette N %A Byrne, Enda M %A Børglum, Anders D %A Castelao, Enrique %A Cichon, Sven %A Clarke, Toni-Kim %A Marilyn C Cornelis %A Dannlowski, Udo %A Philip L de Jager %A Demirkan, Ayse %A Domenici, Enrico %A Cornelia M van Duijn %A Dunn, Erin C %A Johan G Eriksson %A Tõnu Esko %A Jessica Faul %A Luigi Ferrucci %A Myriam Fornage %A Eco J. C. de Geus %A Gill, Michael %A Gordon, Scott D %A Hans-Jörgen Grabe %A van Grootheest, Gerard %A Hamilton, Steven P %A Catharina A Hartman %A Andrew C Heath %A Karin Hek %A Hofman, Albert %A Homuth, Georg %A Horn, Carsten %A Jouke-Jan Hottenga %A Sharon L R Kardia %A Kloiber, Stefan %A Karestan C Koenen %A Kutalik, Zoltán %A Ladwig, Karl-Heinz %A Lahti, Jari %A Douglas F Levinson %A Lewis, Cathryn M %A Lewis, Glyn %A Li, Qingqin S %A David J Llewellyn %A Lucae, Susanne %A Kathryn L Lunetta %A MacIntyre, Donald J %A Pamela A F Madden %A Nicholas G Martin %A McIntosh, Andrew M %A Andres Metspalu %A Milaneschi, Yuri %A Grant W Montgomery %A Mors, Ole %A Thomas H Mosley %A Joanne M Murabito %A Müller-Myhsok, Bertram %A Markus M Nöthen %A Nyholt, Dale R %A O'Donovan, Michael C %A Brenda W J H Penninx %A Pergadia, Michele L %A Perlis, Roy %A Potash, James B %A Preisig, Martin %A Shaun M Purcell %A Quiroz, Jorge A %A Katri Räikkönen %A Rice, John P %A Rietschel, Marcella %A Rivera, Margarita %A Schulze, Thomas G %A Shi, Jianxin %A Shyn, Stanley %A Sinnamon, Grant C %A Johannes H Smit %A Smoller, Jordan W %A Snieder, Harold %A Toshiko Tanaka %A Tansey, Katherine E %A Teumer, Alexander %A Uher, Rudolf %A Umbricht, Daniel %A Van der Auwera, Sandra %A Erin B Ware %A David R Weir %A Weissman, Myrna M %A Gonneke Willemsen %A Yang, Jingyun %A Zhao, Wei %A Henning Tiemeier %A Patrick F. Sullivan %K Acid Anhydride Hydrolases %K depression %K Depressive Disorder %K Genetic Loci %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Humans %K Neoplasm Proteins %K Phenotype %K Whites %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 JAMA Internal Medicine %D 2017 %T Association between persistent pain and memory decline and dementia in a longitudinal cohort of elders %A Elizabeth L Whitlock %A L Grisell Diaz-Ramirez %A M. Maria Glymour %A W John Boscardin %A Kenneth E Covinsky %K Chronic pain %K Cognitive Ability %K Memory %X Importance: Chronic pain is common among the elderly and is associated with cognitive deficits in cross-sectional studies; the population-level association between chronic pain and longitudinal cognition is unknown. Objective: To determine the population-level association between persistent pain, which may reflect chronic pain, and subsequent cognitive decline. Design, Setting, and Participants: Cohort study with biennial interviews of 10 065 community-dwelling older adults in the nationally representative Health and Retirement Study who were 62 years or older in 2000 and answered pain and cognition questions in both 1998 and 2000. Data analysis was conducted between June 24 and October 31, 2016. Exposures: “Persistent pain,” defined as a participant reporting that he or she was often troubled with moderate or severe pain in both the 1998 and 2000 interviews. Main Outcomes and Measures: Coprimary outcomes were composite memory score and dementia probability, estimated by combining neuropsychological test results and informant and proxy interviews, which were tracked from 2000 through 2012. Linear mixed-effects models, with random slope and intercept for each participant, were used to estimate the association of persistent pain with slope of the subsequent cognitive trajectory, adjusting for demographic characteristics and comorbidities measures in 2000 and applying sampling weights to represent the 2000 US population. We hypothesized that persistent pain would predict accelerated memory decline and increased probability of dementia. To quantify the impact of persistent pain on functional independence, we combined our primary results with information on the association between memory and ability to manage medications and finances independently. Results: Of the 10,065 eligible HRS sample members, 60% were female, and median baseline age was 73 years (interquartile range, 67-78 years). At baseline, persistent pain affected 10.9% of participants and was associated with worse depressive symptoms and more limitations in activities of daily living. After covariate adjustment, persistent pain was associated with 9.2% (95% CI, 2.8%-15.0%) more rapid memory decline compared with those without persistent pain. After 10 years, this accelerated memory decline implied a 15.9% higher relative risk of inability to manage medications and an 11.8% higher relative risk of inability to manage finances independently. Adjusted dementia probability increased 7.7% faster (95% CI, 0.55%-14.2%); after 10 years, this translates to an absolute 2.2% increase in dementia probability for those with persistent pain. Conclusions and Relevance: Persistent pain was associated with accelerated memory decline and increased probability of dementia. %B JAMA Internal Medicine %V 177 %G eng %U https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2629448 %N 8 %& 1146-1153 %R 10.1001/jamainternmed.2017.1622 %0 Journal Article %J Soc Sci Med %D 2017 %T Associations between community-level disaster exposure and individual-level changes in disability and risk of death for older Americans. %A Samuel L. Brilleman %A Wolfe, Rory %A Moreno-Betancur, Margarita %A Anne E Sales %A Kenneth M. Langa %A Yun Li %A Elizabeth L. Daugher Biddison %A Rubinson, Lewis %A Theodore J Iwashyna %K Aged %K Aged, 80 and over %K Cohort Studies %K Community Participation %K Continental Population Groups %K Disabled Persons %K Disaster Planning %K Disasters %K Female %K Humans %K Income %K Longitudinal Studies %K Male %K Middle Aged %K Mortality %K United States %X

Disasters occur frequently in the United States (US) and their impact on acute morbidity, mortality and short-term increased health needs has been well described. However, barring mental health, little is known about the medium or longer-term health impacts of disasters. This study sought to determine if there is an association between community-level disaster exposure and individual-level changes in disability and/or the risk of death for older Americans. Using the US Federal Emergency Management Agency's database of disaster declarations, 602 disasters occurred between August 1998 and December 2010 and were characterized by their presence, intensity, duration and type. Repeated measurements of a disability score (based on activities of daily living) and dates of death were observed between January 2000 and November 2010 for 18,102 American individuals aged 50-89 years, who were participating in the national longitudinal Health and Retirement Study. Longitudinal (disability) and time-to-event (death) data were modelled simultaneously using a 'joint modelling' approach. There was no evidence of an association between community-level disaster exposure and individual-level changes in disability or the risk of death. Our results suggest that future research should focus on individual-level disaster exposures, moderate to severe disaster events, or higher-risk groups of individuals.

%B Soc Sci Med %V 173 %P 118-125 %8 2017 01 %G eng %U https://www.sciencedirect.com/science/article/abs/pii/S0277953616306785?via%3Dihub %1 http://www.ncbi.nlm.nih.gov/pubmed/27960126?dopt=Abstract %! Social Science & Medicine %R 10.1016/j.socscimed.2016.12.007 %0 Journal Article %J American Journal of Industrial Medicine %D 2017 %T Baby boomers in the United States: Factors associated with working longer and delaying retirement. %A Xiuwen S Dong %A Wang, Xuanwen %A Ringen, Knut %A Sokas, Rosemary %K Baby Boomers %K Delaying retirement %K Health Conditions and Status %K Older Adults %K Retirement Planning and Satisfaction %X

OBJECTIVES: This study estimated the self-reported probability of working full-time past age 62 (P62) or age 65 (P65) among four cohorts of Americans born between 1931 and 1959.

METHODS: Data from the Health and Retirement Study (HRS) were analyzed. Respondents in four age cohorts were selected for comparison. Multivariable linear regression models were used to assess cohort differences in P62 and P65 while adjusting for covariates.

RESULTS: P62 and P65 increased among boomers despite worsened self-rated health compared to the two preceding cohorts, with 37% and 80% increases among mid-boomers in construction trades. Cohort differences in P62 and P65 remained after controlling for covariates. Changes in pensions, income inequity, and education were significantly associated with work expectations, but SSA policy was not.

CONCLUSIONS: Baby boomers expect to work longer than their predecessors. Efforts to improve work quality and availability for older workers are urgently needed, particularly in physically demanding occupations. Am. J. Ind. Med. 60:315-328, 2017. © 2017 Wiley Periodicals, Inc.

%B American Journal of Industrial Medicine %V 60 %P 315-328 %8 2017 Apr %G eng %N 4 %R 10.1002/ajim.22694 %0 Government Document %D 2017 %T Changes in the life cycle of women's employment %A Richard Works %K Employment and Labor Force %K Women and Minorities %X According to "The new lifecycle of women's employment: disappearing humps, sagging middles, expanding tops" (National Bureau of Economic Research working paper no. 22913, December 2016) by Claudia Goldin and Joshua Mitchell, the increased employment of older women is related to a higher frequency of continuous work experience during their career. %I Monthly Labor Review %P 1-2 %G eng %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1879041784?accountid=14667 %N March 2017 %0 Journal Article %J Gerontology & Geriatric Medicine %D 2017 %T Is childhood socioeconomic status related to coronary heart disease? Evidence from the Health and Retirement Study (1992-2012). %A Lee, Minjee %A M. Mahmud Khan %A Wright, Brad %K Childhood adversity %K Heart disease %K Socioeconomic factors %X Objective: We investigated the association between childhood socioeconomic status (SES) and coronary heart disease (CHD) in older Americans. Method: We used Health and Retirement Study data from 1992 to 2012 to examine a nationally representative sample of Americans aged ≥50 years (N = 30,623). We modeled CHD as a function of childhood and adult SES using maternal and paternal educational level as a proxy for childhood SES. Results: Respondents reporting low childhood SES were significantly more likely to have CHD than respondents reporting high childhood SES. Respondents reporting both low childhood and adult SES were 2.34 times more likely to have CHD than respondents reporting both high childhood and adult SES. People with low childhood SES and high adult SES were 1.60 times more likely than people with high childhood SES and high adult SES to report CHD in the fully adjusted model. High childhood SES and low adult SES increased the likelihood of CHD by 13%, compared with high SES both as a child and adult. Conclusion: Childhood SES is significantly associated with increased risk of CHD in later life among older adult Americans. %B Gerontology & Geriatric Medicine %V 3 %P 2333721417696673 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28540340?dopt=Abstract %R 10.1177/2333721417696673 %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 Thesis %B Sociology %D 2017 %T Cohabitation among Older Adults: Well-Being, Relationships with Adult Children, and Perceptions of Care Availability %A Matthew R Wright %K Caregiving %K Relationships %K Well-being %X Cohabitation has been increasing among older adults over the past decade. Despite the growth in cohabitation, research on this population remains limited. It is well established that the married enjoy better health than the unmarried, and while previous research has considered the psychological well-being of older cohabitors, it is less clear whether cohabitation provides physical health benefits. It is also unclear how cohabitors compare with the married and unpartnered on parent-child relationships. These omissions are notable because families play a key role in the lives of older adults. Using 2008 and 2010 Health and Retirement Study data, I assess psychological well-being and physical health differences between continuously married, remarried, cohabiting, divorced, widowed, and never married older adults. Second, I examine how cohabitors compare to the continuously married, remarried, divorced, and widowed on relationships with adult children. Finally, I explore marital status differences in parent’s beliefs that their children would help in the future with basic personal care. Throughout the project, gender differences are considered. I find that older cohabitors have poorer self-rated health than the continuously married and remarried, but the disadvantaged profile of cohabitors explains the differences. Cohabitors and unpartnereds have similar physical health. Cohabitors do not differ from the continuously married and remarried on psychological well-being, but enjoy better well-being than unpartnereds. There is little variation by gender. On parent-child relationships, cohabitors have less frequent contact and lower positive relationship quality than the continuously married and widowed, but are similar to the remarried and divorced. Mothers reported more frequent contact and higher positive and negative relationship quality with children than fathers. Moreover, positive quality differs by marital status for fathers but not mothers, whereas negative quality differs for mothers but not fathers. Finally, cohabitors are the least likely to list a child as someone they believe is willing to provide future help with basic personal care. Parent-child relationship characteristics explained the differences in care perceptions. Overall, my study extends prior research on the well-being of older cohabitors, and sheds new light on how cohabitation is linked to parent-child relationships and perceptions of future care receipt from adult children. %B Sociology %I Bowling Green State University %C Bowling Green, OH %V Doctor of Philosophy %P 116 %G eng %U http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1497986334237288 %9 Dissertation %0 Journal Article %J JAMA Intern Med %D 2017 %T A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. %A Kenneth M. Langa %A Eric B Larson %A Eileen M. Crimmins %A Jessica Faul %A Deborah A Levine %A Mohammed U Kabeto %A David R Weir %K Aged %K Dementia %K Female %K Humans %K Male %K Prevalence %K Risk Factors %K United States %X

Importance: The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Objective: To compare the prevalence of dementia in the United States in 2000 and 2012.

Design, Setting, and Participants: We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.

Main Outcomes and Measures: Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

Results: The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.

Conclusions and Relevance: The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

%B JAMA Intern Med %V 177 %P 51-58 %8 2017 01 01 %G eng %U http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.6807http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2587084 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27893041?dopt=Abstract %! JAMA Intern Med %R 10.1001/jamainternmed.2016.6807 %0 Journal Article %J Aging (Albany NY) %D 2017 %T The complex genetics of gait speed: genome-wide meta-analysis approach. %A Ben-Avraham, Dan %A Karasik, David %A Joe Verghese %A Kathryn L Lunetta %A John D Eicher %A Vered, Rotem %A Deelen, Joris %A Alice M. Arnold %A Aron S Buchman %A Toshiko Tanaka %A Jessica Faul %A Nethander, Maria %A Myriam Fornage %A Hieab H Adams %A Amy M Matteini %A Michele L Callisaya %A Albert Vernon Smith %A Lei Yu %A Philip L de Jager %A Denis A Evans %A Gudnason, Vilmundur %A Hofman, Albert %A Pattie, Alison %A Corley, Janie %A Lenore J Launer %A David S Knopman %A Parimi, Neeta %A Stephen T Turner %A Bandinelli, Stefania %A Beekman, Marian %A Gutman, Danielle %A Sharvit, Lital %A Simon P Mooijaart %A David C Liewald %A Jeanine J Houwing-Duistermaat %A Ohlsson, Claes %A Moed, Matthijs %A Vincent J Verlinden %A Mellström, Dan %A Jos N van der Geest %A Karlsson, Magnus %A Dena G Hernandez %A McWhirter, Rebekah %A Yongmei Liu %A Thomson, Russell %A Tranah, Gregory J %A André G Uitterlinden %A David R Weir %A Wei Zhao %A John M Starr %A Mohammed Arfan Ikram %A David A Bennett %A Steven R Cummings %A Ian J Deary %A Tamara B Harris %A Sharon L R Kardia %A Thomas H Mosley %A Velandai K Srikanth %A Beverly G Windham %A Anne B Newman %A Jeremy D Walston %A Gail Davies %A Daniel S Evans %A Eline P Slagboom %A Luigi Ferrucci %A Douglas P Kiel %A Joanne M Murabito %A Atzmon, Gil %K Genetics %K GWAS %X Emerging evidence suggests that the basis for variation in late-life mobility is attributable, in part, to genetic factors, which may become increasingly important with age. Our objective was to systematically assess the contribution of genetic variation to gait speed in older individuals. We conducted a meta-analysis of gait speed GWASs in 31,478 older adults from 17 cohorts of the CHARGE consortium, and validated our results in 2,588 older adults from 4 independent studies. We followed our initial discoveries with network and eQTL analysis of candidate signals in tissues. The meta-analysis resulted in a list of 536 suggestive genome wide significant SNPs in or near 69 genes. Further interrogation with Pathway Analysis placed gait speed as a polygenic complex trait in five major networks. Subsequent eQTL analysis revealed several SNPs significantly associated with the expression of PRSS16, WDSUB1 and PTPRT, which in addition to the meta-analysis and pathway suggested that genetic effects on gait speed may occur through synaptic function and neuronal development pathways. No genome-wide significant signals for gait speed were identified from this moderately large sample of older adults, suggesting that more refined physical function phenotypes will be needed to identify the genetic basis of gait speed in aging. %B Aging (Albany NY) %V 9 %P 209-246 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28077804?dopt=Abstract %R 10.18632/aging.101151 %0 Journal Article %J Family Medicine and Community Health %D 2017 %T Complex multimorbidity and health outcomes in older adult cancer survivors %A David F Warner %A Nicholas K Schiltz %A Kurt C Stange %A Charles W Given %A Owusu, Cynthia %A Nathan A. Berger %A Siran M Koroukian %K Cancer screenings %K Comorbidity %K Health Care Outcomes %X Objective: To characterize complex multimorbidity among cancer survivors and evaluate the association between cancer survivorship, time since cancer diagnosis, and self-reported fair/poor health, self-rated worse health in 2 years, and 2-year mortality. Methods: We used the 2010-2012 Health and Retirement Study. Cancer survivors were individuals who reported a (nonskin) cancer diagnosis 2 years or more before the interview. We defined complex multimorbidity as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. In addition to descriptive analyses, we used logistic regression to evaluate the independent association between cancer survivor status and health outcomes. We also examined whether cancer survivorship differed by the number of years since diagnosis. Results: Among 15,808 older adults (age ≥50 years), 11.8% were cancer survivors. Compared with cancer-free individuals, a greater percentage of cancer survivors had complex multimorbidity: co-occurring chronic conditions, functional limitations, and geriatric syndromes. Cancer survivorship was significantly associated with self-reported fair/poor health, self-rated worse health in 2 years, and 2-year mortality. These effects declined with the number of years since diagnosis for fair/ poor health and mortality but not for self-rated worse health. Conclusion: Cancer survivor status is independently associated with more complex multimorbidity, and with worse health outcomes. These effects attenuate with time, except for patient perception of being in worse health. %B Family Medicine and Community Health %V 5 %P 129-138 %G eng %U http://www.ingentaconnect.com/content/10.15212/FMCH.2017.0127http://www.ingentaconnect.com/content/cscript/fmch/2017/00000005/00000002/art00005http://www.ingentaconnect.com/content/cscript/fmch/2017/00000005/00000002/art00005 %N 2 %! family med commun hlth %R 10.15212/FMCH.2017.0127 %0 Journal Article %J American Journal of Epidemiology %D 2017 %T Contemporaneous Social Environment and the Architecture of Late-Life Gene Expression Profiles. %A Morgan E. Levine %A Eileen M. Crimmins %A David R Weir %A Steven W. Cole %K Genetics %K Socioeconomic factors %X Environmental or social challenges can stimulate a cascade of coordinated physiological changes in stress response systems. Unfortunately, chronic activation of these adaptations under conditions such as low socioeconomic status (SES) can have negative consequences for long-term health. While there is substantial evidence tying low SES to increased disease risk and reduced life expectancy, the underlying biology remains poorly understood. Using pilot data on 120 older adults from the Health and Retirement Study (United States, 2002-2010), we examined the associations between SES and gene expression levels in adulthood, with particular focus on a gene expression program known as the conserved transcriptional response to adversity. We also used a bioinformatics-based approach to assess the activity of specific gene regulation pathways involved in inflammation, antiviral responses, and stress-related neuroendocrine signaling. We found that low SES was related to increased expression of conserved transcriptional response to adversity genes and distinct patterns of proinflammatory, antiviral, and stress signaling (e.g., sympathetic nervous system and hypothalamic-pituitary-adrenal axis) transcription factor activation. %B American Journal of Epidemiology %V 186 %P 503-509 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/28911009?dopt=Abstract %R 10.1093/aje/kwx147 %0 Journal Article %J Research in Human Development %D 2017 %T Contextualization of Survey Data: What Do We Gain and Does It Matter? %A Lindsay R. Wilkinson %A Kenneth F Ferraro %A Blakelee R Kemp %K Survey Methodology %X Survey research designs that integrate contextual data have become more prevalent in recent decades, presumably to enable a more refined focus on the person as the unit of analysis and a greater emphasis on interindividual differences due to social forces and contextual conditions. This article reviews varied approaches to contextualizing survey data and examines the value of linking two data sources to respondent information: interviewer ratings and neighborhood information (measured via census tracts). The utility of an integrative approach is illustrated with data from the Health and Retirement Study. The results reveal modest gains by using a contextualized approach but also demonstrate that neglecting contextual factors may lead to misdirected substantive conclusions, especially for older racial and ethnic minorities. To enhance the ecological validity of survey data, investigators should select theoretically-meaningful contextual data for specific research questions and consider cross-level interactions. %B Research in Human Development %V 14 %P 234-252 %G eng %N 3 %R 10.1080/15427609.2017.1340049 %0 Journal Article %J Health Serv Res %D 2017 %T The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs. %A Geoffrey J Hoffman %A Hays, Ron D %A Martin F Shapiro %A Steven P Wallace %A Susan L Ettner %K Accidental Falls %K Age Factors %K Aged %K Aged, 80 and over %K Female %K Financing, Personal %K Health Expenditures %K Health Services %K Humans %K Male %K Medicare %K Models, Econometric %K Sex Factors %K Socioeconomic factors %K United States %K Wounds and Injuries %X

OBJECTIVE: To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries.

DATA SOURCES: The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries.

STUDY DESIGN: FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated.

PRINCIPAL FINDINGS: Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion).

CONCLUSIONS: FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.

%B Health Serv Res %V 52 %P 1794-1816 %8 2017 10 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27581952?dopt=Abstract %R 10.1111/1475-6773.12554 %0 Thesis %D 2017 %T Dementia Risk in Elders with Anxiety and Insomnia %A Wallis, Richard David %K ADAMS %K Dementia %K Medication %X Current evidence suggests that there is an association between benzodiazepinereceptor-agonist medications (BZRA) and subsequent dementia. Expert opinions differ regarding whether the association indicates a causal relationship. There is sufficient evidence that neuropsychiatric symptoms, such as anxiety and insomnia, are indicators of prodromal dementia which may lead to treatment with benzodiazepine-receptor agonist medications. Therefore, the association between BZRAs and subsequent dementia may be a spurious correlation for which the prodromal onset is responsible. This study proposed to test the postulate that the anxiety and insomnia symptom cluster (A/I) is a predictor of dementia. A retrospective data analysis was conducted on the Aging, Demographics, and Memory Study (ADAMS) dataset in order to determine whether A/I symptoms or treatment were associated with subsequent dementia or cognitive impairment (DOCI). The study controlled for gender and comorbid depression. The study excluded BZRA usage and medical comorbidities that were either confounding variables in assessment or alternative explanations of cognitive decline. The study used chi-square analysis, comparison of incidence rates, odds ratios, relative risk, and logistic regression to investigate the idea that the A/I symptom cluster indicates developing prodromal dementia. The study failed to find an association between A/I symptoms and subsequent DOCI in the total sample. However, there was a significant relationship between A/I symptoms and subsequent DOCI in the male gender that was not found in females. No association was found for the A/I medications in any of the analyses. Further investigation of the ADAMS dataset without removing the exclusion variables also showed that BZRA usage was not associated with subsequent DOCI. The gender differences identified suggest prodromal dementia phenotypes that are differentially expressed in males and females. The lack of association between A/I medications and subsequent DOCI in this study is validated by the lack of association between BZRA medications and subsequent DOCI in the larger ADAMS dataset. While it is unlikely that a single reliable predictor of subsequent dementia exists, by triangulating the approaches between multiple disciplines—such as biomarkers and neurological studies—with neuropsychiatric manifestations of prodromal dementia, it is possible that reliable early prediction may be accomplished. Earlier identification would then lead to effective treatments and ultimately prevention. %I The University of Texas, Medical Branch at Galveston %C Galveston, TX %V Doctor of Philosophy %G eng %U https://www.researchgate.net/profile/Richard_Wallis/publication/344360789_Dementia_Risk_in_Elders_with_Anxiety_and_Insomnia/links/5f6c36f8a6fdcc00863859c6/Dementia-Risk-in-Elders-with-Anxiety-and-Insomnia.pdf %0 Journal Article %J Social Science & Medicine %D 2017 %T Depressive symptomatology and fall risk among community-dwelling older adults. %A Geoffrey J Hoffman %A Hays, Ron D %A Steven P Wallace %A Martin F Shapiro %A Susan L Ettner %K Community-dwelling %K Depressive symptoms %K Falls %K Health Shocks %K Older Adults %K Restricted data %X

RATIONALE: Falls are common among older adults and may be related to depressive symptoms (DS). With advancing age, there is an onset of chronic conditions, sensory impairments, and activity limitations that are associated with falls and with depressive disorders. Prior cross-sectional studies have observed significant associations between DS and subsequent falls as well as between fractures and subsequent clinical depression and DS.

OBJECTIVE: The directionality of these observed relationship between falls and DS is in need of elaboration given that cross-sectional study designs can yield biased estimates of the DS-falls relationship.

METHODS: Using 2006-2010 Health and Retirement Study data, cross-lagged panel structural equation models were used to evaluate associations between falls and DS among 7233 community-dwelling adults ages ≥65. Structural coefficients between falls and DS (in 2006→2008, 2008→2010) were estimated.

RESULTS: A good-fitting model was found: Controlling for baseline (2006) physical functioning, vision, chronic conditions, and social support and neighborhood social cohesion, falls were not associated with subsequent DS, but a 0.5 standard deviation increase in 2006 DS was associated with a 30% increase in fall risk two years later. This DS-falls relationship was no longer significant when use of psychiatric medications, which was positively associated with falls, was included in the model.

CONCLUSION: Using sophisticated methods and a large U.S. sample, we found larger magnitudes of effect in the DS-falls relationship than in prior studies-highlighting the risk of falls for older adults with DS. Medical providers might assess older individuals for DS as well as use of psychotropic medications as part of a broadened falls prevention approach. National guidelines for fall risk assessments as well as quality indicators for fall prevention should include assessment for clinical depression.

%B Social Science & Medicine %V 178 %P 206-213 %8 04/2017 %G eng %R 10.1016/j.socscimed.2017.02.020 %0 Journal Article %J Psychosom Med %D 2017 %T Depressive Symptoms and Salivary Telomere Length in a Probability Sample of Middle-Aged and Older Adults. %A Mark A Whisman %A Emily D Richardson %K Aged %K Anxiety Disorders %K Body Mass Index %K Chronic disease %K depression %K Female %K Humans %K Life Style %K Male %K Middle Aged %K Neuroticism %K Psychological Trauma %K Saliva %K Sex Factors %K Smoking %K Telomere Shortening %X

OBJECTIVE: To examine the association between depressive symptoms and salivary telomere length in a probability sample of middle-aged and older adults, and to evaluate age and sex as potential moderators of this association and test whether this association was incremental to potential confounds.

METHODS: Participants were 3,609 individuals from the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction on DNA extracted from saliva samples. Depressive symptoms were assessed via interview, and health and lifestyle factors, traumatic life events, and neuroticism were assessed via self-report. Regression analyses were conducted to examine the associations between predictor variables and salivary telomere length.

RESULTS: After adjusting for demographics, depressive symptoms were negatively associated with salivary telomere length (b = -.003; p = .014). Furthermore, this association was moderated by sex (b = .005; p = .011), such that depressive symptoms were significantly and negatively associated with salivary telomere length for men (b = - .006; p < .001) but not for women (b = - .001; p = .644). The negative association between depressive symptoms and salivary telomere length in men remained statistically significant after additionally adjusting for cigarette smoking, body mass index, chronic health conditions, childhood and lifetime exposure to traumatic life events, and neuroticism.

CONCLUSIONS: Higher levels of depressive symptoms were associated with shorter salivary telomeres in men, and this association was incremental to several potential confounds. Shortened telomeres may help account for the association between depression and poor physical health and mortality.

%B Psychosom Med %V 79 %P 234-242 %8 2017 Feb/Mar %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00006842-900000000-98910 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28029664?dopt=Abstract %! Psychosomatic Medicine %R 10.1097/PSY.0000000000000383 %0 Thesis %B Health Services and Policy Management %D 2017 %T Depressive Symptoms Association With Health Outcomes And Treatment In Older Americans With Diabetes %A Williams, Lashonda Javon %K Depressive symptoms %K Diabetes %K Health Conditions and Status %X Introduction: Diabetes remains the 7th leading cause of death in the United States. Diabetes is a major public health concern of its own, but when you add the comorbidity of depression, diabetes outcomes are amplified. This dissertation examines how depressive symptomatology and treatment for depression are associated with selfreported health (SRH) and diabetes control. Methods: Chi-square and logistic regression were used to analyze data from the Health and Retirement Study (2012). We assessed the associations between SRH and diabetes control with depressive symptomatology data. Results: In our sample (n=4374), 19% of respondents reported high depressive symptomatology and 59% self-reported “good” health compared to 41% self-reported “bad” health. Associated with “bad” SRH were psychiatric medication or psychotherapy treatment (p=.0211), education (p=<.0001), insulin usage (<.0001), diabetes control (p=<.0001), depressive symptomatology (p=<.0001), and clinical diagnosis for depression (p=.0005). For the second outcome, only 9% of the sample reported no diabetes control. Insulin usage (p=<.0001), SRH (p=<.0001), depressive symptoms (p=.0039), sex (p=.0363) and age (p=.0015) were associated with no diabetes control. Conclusion: Depressive symptomatology is associated with SRH and diabetes control. Treatment is moderately significant with SRH, but not significant with diabetes control. A depression diagnosis was not significantly associated with diabetes control. %B Health Services and Policy Management %I University of South Carolina %C Columbia, SC %V Public Health Doctorate %G eng %U http://scholarcommons.sc.edu/etd/4019/ %9 Dissertation %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2017 %T Development and Validation of a 10-Year Mortality Prediction Model: Meta-Analysis of Individual Participant Data From Five Cohorts of Older Adults in Developed and Developing Countries. %A Suemoto, Claudia Kimie %A Ueda, Hiroshi %A Hiram Beltrán-Sánchez %A Lebrão, Maria Lucia %A Duarte, Yeda Aparecida %A Rebeca Wong %A Danaei, Goodarz %K Aged %K Aged, 80 and over %K Developed Countries %K Developing Countries %K Female %K Humans %K Male %K Meta-Analysis as Topic %K Middle Aged %K Models, Statistical %K Mortality %K Prognosis %K Time Factors %X

Background: Existing mortality prediction models for older adults have been each developed using a single study from the United States or Western Europe. We aimed to develop and validate a 10-year mortality prediction model for older adults using data from developed and developing countries.

Methods: We used data from five cohorts, including data from 16 developed and developing countries: ELSA (English Longitudinal Study of Aging), HRS (Health and Retirement Study), MHAS (Mexican Health and Aging Study), SABE-Sao Paulo (The Health, Well-being and Aging), and SHARE (Survey on Health, Ageing and Retirement in Europe). 35,367 older adults were split into training (two thirds) and test (one third) data sets. Baseline predictors included age, sex, comorbidities, and functional and cognitive measures. We performed an individual participant data meta-analysis using a sex-stratified Cox proportional hazards model, with time to death as the time scale. We validated the model using Harrell's C statistic (discrimination) and the estimated slope between observed and predicted 10-year mortality risk across deciles of risk (calibration).

Results: During a median of 8.6 years, 8,325 participants died. The final model included age, sex, diabetes, heart disease, lung disease, cancer, smoking, alcohol use, body mass index, physical activity, self-reported health, difficulty with bathing, walking several blocks, and reporting date correctly. The model showed good discrimination (Harrell's C = 0.76) and calibration (slope = 1.005). Models for developed versus developing country cohorts performed equally well when applied to data from developing countries.

Conclusion: A parsimonious mortality prediction model using data from multiple cohorts in developed and developing countries can be used to predict mortality in older adults in both settings.

%B J Gerontol A Biol Sci Med Sci %V 72 %P 410-416 %8 2017 03 01 %G eng %U http://biomedgerontology.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=27522061 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/27522061?dopt=Abstract %R 10.1093/gerona/glw166 %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 Thesis %B Nursing %D 2017 %T Disparities Between Patients' End-of-Life Care Preferences and Actual End-of-Life Care Received %A Wishner, Denise %K End-of-life care %K Nursing homes %K Patient-physician Relationship %X Background: Data suggest that patients’ end-of-life (EOL) care preferences are not consistently followed. Based on these data, in 2015, the IOM called for research to identify the prevalence of the problem of EOL care preferences not honored. The current study used an ethical framework to study this problem. Objective: The purpose was to identify the prevalence of patient’s not having their EOL care preferences followed using data from an existing nationally representative study. Methods: A secondary analysis of data from seven biennial waves (2002-2014) of the Health and Retirement Study (HRS) was performed. A cross-sectional analysis was accomplished using primarily the HRS exit interview. All respondents indicating that a written EOL preference had been documented were included. Deceased patients’ proxies provided the information about the patient’s preferred EOL care and the actual care received. Because proxies could select more than one EOL care option, both a sample and a subsample of proxies who only selected one option were evaluated. Associations between mismatched EOL preferred vs. EOL received care options and respondent characteristics were also evaluated. Results: 3,754 respondents died during the study period, of who 3,660 met the inclusion criteria of having written EOL care instructions. The subsample included 212 respondents. Analysis of the sample found that the most preferred type of EOL care was comfort care, followed by limit care. The frequencies of both samples revealed that in the four EOL care types for which HRS collects data (all care possible, limit care, withhold treatment, comfort care), patient preferences were not followed 53-72% of the time. A question about providers verbally offering EOL care treatments to the patient’s proxy were asked and nearly 17% of the time those instructions were not followed. Discussion: Using data from a nationally representative study, this study confirms that regardless of the type of EOL care patients’ prefer, and the presence of written instructions, patients do not receive that care greater than 50% of the time, and a significant number are receiving unwanted EOL care. Further data are needed to ascertain why patients’ autonomous preferences are not followed at the EOL. %B Nursing %I University of California, San Francisco %C San Francisco, CA %V Ph.D. %8 2017 %G eng %U https://search.proquest.com/docview/1984355653/abstract/850FAF56564645A4PQ/1?accountid=14667 %9 Dissertation %0 Journal Article %J International Dental Journal %D 2017 %T Disparity in dental out-of-pocket payments among older adult populations: a comparative analysis across selected European countries and the USA. %A Richard J. Manski %A John F Moeller %A Haiyan Chen %A Widstrom, Eeva %A Listl, Stefan %K Cross-National %K Dental Care %K Older Adults %K Out-of-pocket payments %K SHARE %X

BACKGROUND: The current study addresses the extent to which diversity exists in dental out-of-pocket (OOP) payments across population subgroups within and between the USA and selected European countries. This represents the final paper in a series in which the previous two papers addressed diversity in dental coverage and dental utilisation, respectively, using similar data and methods.

METHOD: We used data from the 2006/2007 Health and Retirement Study (HRS) and from the 2004-2006 Survey of Health, Ageing and Retirement in Europe (SHARE) for respondents ≥51 years of age. We estimated the impacts of dental-care coverage and of demographic, socio-economic and health status on the likelihood and amount of dental OOP payments.

RESULTS: In the USA, older persons with the least education, lowest income and worst health are most likely to pay nothing OOP for their dental care and, for persons with an OOP payment, the amount of this payment increases with income and education and is higher for persons who are uninsured and in fair or poor health. However, these results were not consistently found in the 10 European countries we studied.

CONCLUSIONS: European countries classified according to social welfare state or the presence of social health insurance (SHI) showed no effect on the likelihood of making payments OOP for dental care nor, when OOP payments were made, on the amounts paid. Variation in generosity of coverage and procedures reimbursed by insurance, even within countries with SHI, as well as differing needs, tastes and access to care across countries, contribute to this finding.

%B International Dental Journal %V 67 %P 157-171 %G eng %N 3 %R 10.1111/idj.12284 %0 Report %D 2017 %T Documentation of Blood-Based Biomarkers in the 2014 Health and Retirement Study %A Eileen M. Crimmins %A Jessica Faul %A Jung K Kim %A David R Weir %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %8 12/2017 %G eng %0 Journal Article %J Social Work Research %D 2017 %T Does a Sense of Benevolence Influence Volunteering and Caregiving among Older People? %A Shen, Huei-Wern %A Delston, J. B. %A Wang, Yi %K Activity engagement %K Caregiving %K Volunteerism %X Volunteering and caregiving are both helping behaviors, but they take place in different social contexts. Although personal resources and networks are important factors in understanding whether older people volunteer and provide family care, studies of the psychological factors influencing these behaviors are rare. Using theoretical guidance of the resource and strategic mobilization model, this study aims to construct a psychological factor-sense of benevolence (SBEN)-and elucidate the effects of SBEN on volunteering and caregiving among older adults when personal resources and networks are controlled. Authors, using data from the 2000 Health and Retirement Study, included 939 community-dwelling older adults age 55 years and older in the study. Using principal component analysis, authors retained 10 items to construct the SBEN scale (Cronbach's alpha =.86). Two separate logistic regression models were used to assess the relationships between SBEN and volunteering and SBEN and caregiving. Findings show that higher SBEN increased the likelihood for older people to give care but was not related to volunteering. SBEN may be used as a construct to help understand the psychological factors behind older individuals' helping behaviors to family. Further research identifying mechanisms of engaging older volunteers-that is, psychological and institutional motivating factors-is needed. %B Social Work Research %V 41 %P 155-166 %G eng %U http://academic.oup.com/swr/article/41/3/155/4080844/Does-a-Sense-of-Benevolence-Influence-Volunteeringhttp://academic.oup.com/swr/article-pdf/41/3/155/19658245/svx012.pdf %N 3 %R 10.1093/swr/svx012 %0 Journal Article %J Journal of Financial Therapy %D 2017 %T Does How We Feel About Financial Strain Matter for Mental Health? %A Asebedo, Sarah D. %A Wilmarth, Melissa J. %K Depressive symptoms %K Financial burden %K Mental Health %K Stress %X This study investigated how stress responses to financial strain are related to mental health (i.e., depression) to answer the question: Does how we feel about financial strain matter? Informed by the ABC-X model of family stress and analyzed with data from the Health and Retirement Study (HRS), results reveal that financial strain is significantly related to increased depression; however, financial stress was found to moderate this relationship. Financially strained respondents without a stress response did not have significantly different depression scores than those who were not experiencing financial strain; however, depression scores increased as the stress response to financial strain increased. Consistent with the ABC-X model, results suggest that financial strain is a neutral event until it is processed and interpreted by an individual, with subjective perceptions a more powerful predictor of mental health than objective financial circumstances. These results emphasize an area of synergy for financial and mental health researchers and professionals. %B Journal of Financial Therapy %V 8 %P 63-78 %G eng %U http://newprairiepress.org/jft/vol8/iss1/5 %N 1 %! Journal of Financial Therapy %R 10.4148/1944-9771.1130 %0 Journal Article %J American Journal of Preventive Medicine %D 2017 %T Economic Burden of Informal Caregiving Associated With History of Stroke and Falls Among Older Adults in the U.S. %A Heesoo Joo %A Wang, Guijing %A Yee, Sue Lin %A Zhang, Ping %A Sleet, David %K Caregiving %K Economics %K Falls %K Health Shocks %K Stroke %X Introduction Older adults are at high risk for stroke and falls, both of which require a large amount of informal caregiving. However, the economic burden of informal caregiving associated with stroke and fall history is not well known. Methods Using the 2010 Health and Retirement Study, data on non-institutionalized adults aged ≥65 years (N=10,129) in 2015–2017 were analyzed. Two-part models were used to estimate informal caregiving hours. Based on estimates from the models using a replacement cost approach, the authors derived informal caregiving hours and costs associated with falls in the past 2 years for stroke and non-stroke persons. Results Both the prevalence of falls overall and of falls with injuries were higher among people with stroke than those without (49.5% vs 35.1% for falls and 16.0% vs 10.3% for injurious falls, p<0.01). Stroke survivors needed more informal caregiving hours than their non-stroke counterparts, and the number of informal caregiving hours was positively associated with non-injurious falls and even more so with injurious falls. The national burden of informal caregiving (2015 U.S. dollars) associated with injurious falls amounted to $2.9 billion (95% CI=$1.1 billion, $4.7 billion) for stroke survivors (about 0.5 million people), and $6.5 billion (95% CI=$4.3 billion, $8.7 billion) for those who never had a stroke (about 3.6 million people). Conclusions In U.S. older adults, informal caregiving hours and costs associated with falls are substantial, especially for stroke survivors. Preventing falls and fall-related injuries, especially among stroke survivors, therefore has potential for reducing the burden of informal caregiving. %B American Journal of Preventive Medicine %V 53 %P S197-S204 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0749379717304270http://api.elsevier.com/content/article/PII:S0749379717304270?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0749379717304270?httpAccept=text/plain %N 6 %! American Journal of Preventive Medicine %R 10.1016/j.amepre.2017.07.020 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2017 %T The educational, racial and gender crossovers in life satisfaction: Findings from the longitudinal Health and Retirement Study. %A Wei Zhang %A Kathryn L. Braun %A Wu, Yan Yan %K Education %K Gender Differences %K Life Satisfaction %K Racial/ethnic differences %X

OBJECTIVE: To examine variations in life satisfaction by education, gender, and race/ethnicity over a period of eight years among middle-aged and older Americans.

METHODS: Mixed-effects models were used to analyze five waves (2006, 2008, 2010, 2012 and 2014) of longitudinal data from 16,163 participants born 1890-1953 in the U.S. Health and Retirement Study.

RESULTS: Life satisfaction was higher in older adults, and the Great Recession had great impact on life satisfaction. Crossover interactions were found by gender, education, and race/ethnicity. Higher education was associated with higher life satisfaction for both genders, with stronger effects for females. Hispanics had the higher level of life satisfaction than non-Hispanic Whites and African Americans.

DISCUSSION: Longitudinal evidence revealed disparities in life satisfaction. The racial/ethnic differences in the impact of education suggest that the economic and health returns of education vary by social group. Researchers should continue to examine reasons for these disparities.

%B Archives of Gerontology and Geriatrics %V 73 %P 60-68 %8 11/2017 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28779590?dopt=Abstract %R 10.1016/j.archger.2017.07.014 %0 Report %D 2017 %T The Effect of Physical and Cognitive Decline at Older Ages on Work and Retirement: Evidence from Occupational Job Demands and Job Mismatch %A Michael D Hurd %A Susann Rohwedder %A Robert J. Willis %A Péter Hudomiet %K Cognitive Ability %K Motor processes %K Physical Ability %K Work %X As workers age, their physical and cognitive abilities tend to decline. This could lead to a mismatch between workers’ resources and the demands of their jobs, restricting future work. We use longitudinal data from the Health and Retirement Study (HRS) linked to detailed occupational characteristics from the O*NET project to investigate how mismatches between job demands and workers’ resources in two physical and two cognitive domains affect retirement outcomes. We estimate how changes in physical and cognitive resources as well as their interactions with occupational job-demands affect changes in 1) subjective reports of work-limiting health problems; 2) mental health; and 3) subjective probabilities of working past age 65. We also estimate hazard models for transitions from full-time work to retirement. We found that declines in physical and cognitive resources are strong predictors of all outcomes: Fewer resources lead to greater reporting of work-limiting health problems; decline in mental health; smaller subjective probabilities of working full-time past age 65; and more transitions from work to retirement. The interaction of resources with job demands, however, is only statistically significant for workers with large-muscle limitations who are more likely to report changes in outcomes when they work in occupations that rely heavily on physical strength. In contrast, the effects of declines in fine motor skills and cognition do not show statistically significant differences by occupational job demands. It appears cognitive and fine motor skills, at least as measured in the HRS, are universally important determinants of working, not specific to certain occupations. %B Working Papers %I Michigan Retirement Research Center %C Ann Arbor, MI %P 1-84 %G eng %U http://mrrc.isr.umich.edu/wp372/ %0 Journal Article %J Journal of Pain and Symptom Management %D 2017 %T End-of-Life Experience of Older Adults Dying of End-Stage Renal Disease: a Comparison with Cancer. %A Melissa W Wachterman %A Stuart R Lipsitz %A Karl A Lorenz %A Edward R Marcantonio %A Li, Zhonghe %A Nancy L. Keating %K Cancer screenings %K End of life decisions %K Kidney disease %K Mortality %X

CONTEXT: Older adults with end-stage renal disease (ESRD) are a rapidly growing group of seriously-ill patients. Yet, despite a mortality rate almost twice that of cancer, less is known about ESRD's impact on patients' end-of-life experience.

OBJECTIVE: To compare the end-of-life experience of older adults who died of ESRD versus cancer.

METHODS: We used data from the Health and Retirement Study (HRS), a nationally-representative survey of older adults. Our sample included 1883 HRS participants who died of cancer or ESRD between 2000 and 2010 and their family respondents. We compared advance care planning, treatment intensity, and symptoms between the two groups, and used propensity score weighting to adjust for differences by diagnosis.

RESULTS: Among propensity-weighted cohorts, older adults with ESRD, compared with similar patients with cancer, were less likely to have end-of-life instructions (adjusted proportions 38.5% vs. 49.7%, P=.005) and were more likely to die in the hospital (53.5% vs. 29.0%, P<.001) and to use the ICU in the last two years of life (57.1% vs. 37.0%, P<.001). Decedents with ESRD and cancer had similarly high rates of moderate or severe pain (53.7% vs. 57.8%, P=.34) and all other symptoms.

CONCLUSION: Older adults dying of ESRD had lower rates of advance care planning and higher treatment intensity near the end of life than similar patients dying of cancer; both groups had similarly high rates of symptoms. Efforts are needed to make treatment more supportive and alleviate suffering for older adults with ESRD and their families near the end of life.

%B Journal of Pain and Symptom Management %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28843455?dopt=Abstract %R 10.1016/j.jpainsymman.2017.08.013 %0 Journal Article %J Work, Aging and Retirement %D 2017 %T Examining bridge employment from a self-employment perspective—evidence from the Health and Retirement Study %A von Bonsdorff, Monika E. %A Zhan, Yujie %A Song, Yifan %A Wang, Mo %K Bridge employment %K Retirement Planning and Satisfaction %K Self-employment %X This study examines bridge employment decision-making from a self-employment perspective using 3 prominent retirement theories, the life course perspective, continuity theory and role theory. Focusing on self-employment extends the current theoretical understanding of bridge employment and offers interesting implications for retirement policy-making. Specifically, using longitudinal data from the Health and Retirement Study (n = 2,080), we conducted multinomial regression analysis to examine who were more/less likely to fully retire, enter bridge employment in the wage-and-salary form, or enter bridge employment in the self-employment form. Furthermore, we examined the role of pre-retirement self-employment status, to provide us with more information on the very much understudied retirement process of entrepreneurs and self-employed workforce. Our findings indicated that self-employment can be considered as an independent form of bridge employment, apart from bridge employment in wage-and-salary jobs. Furthermore, the decision to enter different forms of bridge employment, including self-employment, may stem from a variety of antecedents. Practical implications of this study are also discussed. %B Work, Aging and Retirement %V 3 %P 298-312 %G eng %U https://academic.oup.com/workar/article-lookup/doi/10.1093/workar/wax012 %N 3 %R 10.1093/workar/wax012 %0 Report %D 2017 %T The Financial Vulnerability of Former Disability Beneficiaries in Retirement %A Jody Schimmel Hyde %A April Yanyuan Wu %K Disabilities %K Disability %K disability discrimination %K disability finance %K Finance %K Retirement %X By their early 60s, one in four workers has experienced the onset of a work-limiting health condition (Johnson et al. 2007), and nearly four in five adults in this age group have experienced the onset of a chronic health condition (Smith 2003). Older workers who develop significant medical conditions or impairments face declines in earnings, income, and consumption and an increase in poverty (Schimmel and Stapleton 2012; Meyer and Mok 2014). In addition to these effects, leaving the labor force during peak earning years may have a lasting impact on financial security after retirement. In this brief, we consider the post-retirement financial well-being of workers based on whether they received Social Security Disability Insurance (DI). We compare their experiences to other workers who did not receive DI but claimed Old Age and Survivors’ Insurance (OASI) program. %I Mathematica Policy Research %G eng %U https://mathematica.org/publications/the-financial-vulnerability-of-former-disability-beneficiaries-in-retirement %0 Journal Article %J Journal of the American Geriatrics Society %D 2017 %T Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study %A Wu, Chenkai %A Smit, Ellen %A Peralta, Carmen A %A Sarathy, Harini %A Michelle C Odden %K Blood pressure %K Grip strength %K Mortality %K Older Adults %X Objective To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality. Design Nationally representative cohort study. Setting Health and Retirement Study. Participants 7,492 U.S. adults aged ≥65 years. Measurements Grip strength was measured by a hand dynamometer and classified as normal (≥16 kg for female; ≥26 kg for male) and weak. Gait speed was assessed over a 98.5-inch walk and classified as non-slow (≥0.60 m/s for female; ≥0.52 m/s for male) and slow. Results Over an average follow-up time of 6.0 years, 1,870 (25.0%) participants died. After adjustment for socio-demographic, behavioral, and clinical measures, elevated SBP (≥150 mmHg) and DBP (≥90 mmHg) was associated with a 24% (95% CI, 7–43%) and 25% (95% CI, 5–49%) higher mortality among participants with normal grip strength. In contrast, elevated SBP and DBP was associated with a 6% (95% CI, 31 to −27%) and a 16% (95% CI, 46 to −26%) lower mortality among those with weak grip strength (P-values of interactions: both=.07). The inverse relations between BP with death were most pronounced among slow walkers with weak grip strength. The HRs of elevated SBP and DBP for death was 0.85 (95% CI, 0.56–1.29) and 0.53 (95% CI, 0.30–0.96), respectively, and was substantially different from non-slow walkers with normal grip strength (HR = 1.24 and 1.15, respectively; P-values of interactions: both <.001). Therefore, associations of BP with death varied modestly by gait speed. Conclusion Grip strength modified the association of BP with death. Combination of grip strength and gait speed has incremental value for modifying the association of BP with death. %B Journal of the American Geriatrics Society %V 65 %P 1482-1489 %G eng %U http://doi.wiley.com/10.1111/jgs.14816http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.14816/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fjgs.14816 %N 7 %! J Am Geriatr Soc %R 10.1111/jgs.14816 %0 Journal Article %J Int J Environ Res Public Health %D 2017 %T Gene-by-Psychosocial Factor Interactions Influence Diastolic Blood Pressure in European and African Ancestry Populations: Meta-Analysis of Four Cohort Studies. %A Wei Zhao %A Yasutake, Kalyn %A August, Carmella %A Scott M Ratliff %A Jessica Faul %A Boerwinkle, Eric %A Chakravarti, Aravinda %A Ana V. Diez-Roux %A Gao, Yan %A Michael E Griswold %A Gerardo Heiss %A Sharon L R Kardia %A Alanna C Morrison %A Musani, Solomon K %A Mwasongwe, Stanford %A Kari E North %A Rose, Kathryn M %A Sims, Mario %A Yan V Sun %A David R Weir %A Belinda L Needham %K Blood pressure %K Genetics %K GWAS %K Meta-analyses %K Psychosocial %K Socioeconomic factors %X Inter-individual variability in blood pressure (BP) is influenced by both genetic and non-genetic factors including socioeconomic and psychosocial stressors. A deeper understanding of the gene-by-socioeconomic/psychosocial factor interactions on BP may help to identify individuals that are genetically susceptible to high BP in specific social contexts. In this study, we used a genomic region-based method for longitudinal analysis, Longitudinal Gene-Environment-Wide Interaction Studies (LGEWIS), to evaluate the effects of interactions between known socioeconomic/psychosocial and genetic risk factors on systolic and diastolic BP in four large epidemiologic cohorts of European and/or African ancestry. After correction for multiple testing, two interactions were significantly associated with diastolic BP. In European ancestry participants, outward/trait anger score had a significant interaction with the C10orf107 genomic region (p = 0.0019). In African ancestry participants, depressive symptom score had a significant interaction with the HFE genomic region (p = 0.0048). This study provides a foundation for using genomic region-based longitudinal analysis to identify subgroups of the population that may be at greater risk of elevated BP due to the combined influence of genetic and socioeconomic/psychosocial risk factors. %B Int J Environ Res Public Health %V 14 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/29258278?dopt=Abstract %R 10.3390/ijerph14121596 %0 Journal Article %J The Journals of Gerontology: Series A %D 2017 %T Genetic Predisposition to Obesity and Medicare Expenditures %A George L Wehby %A Benjamin W Domingue %A Fred A Ullrich %A Frederic D Wolinsky %K genetic predisposition %K Genetics %K Medicare %K Obesity %X The relationship between obesity and health expenditures is not well understood. We examined the relationship between genetic predisposition to obesity measured by a polygenic risk score for body mass index (BMI) and Medicare expenditures.Biennial interview data from the Health and Retirement Survey for a nationally representative sample of older adults enrolled in fee-for-service Medicare were obtained from 1991 through 2010 and linked to Medicare claims for the same period and to Genome-Wide Association Study (GWAS) data. The study included 6,628 Medicare beneficiaries who provided 68,627 complete person-year observations during the study period. Outcomes were total and service-specific Medicare expenditures and indicators for expenditures exceeding the 75th and 90th percentiles. The BMI polygenic risk score was derived from GWAS data. Regression models were used to examine how the BMI polygenic risk score was related to health expenditures adjusting for demographic factors and GWAS-derived ancestry.Greater genetic predisposition to obesity was associated with higher Medicare expenditures. Specifically, a 1 SD increase in the BMI polygenic risk score was associated with a \\$805 (p \< .001) increase in annual Medicare expenditures per person in 2010 dollars ( 15\% increase), a \\$370 (p \< .001) increase in inpatient expenses, and a \\$246 (p \< .001) increase in outpatient services. A 1 SD increase in the polygenic risk score was also related to increased likelihood of expenditures exceeding the 75th percentile by 18\% (95\% CI: 10\%–28\%) and the 90th percentile by 27\% (95\% CI: 15\%–40\%).Greater genetic predisposition to obesity is associated with higher Medicare expenditures. %B The Journals of Gerontology: Series A %V 73 %P 66-72 %8 05 %G eng %U https://doi.org/10.1093/gerona/glx062 %R 10.1093/gerona/glx062 %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 Research on Aging %D 2017 %T Health Status, Health Shocks, and Asset Adequacy Over Retirement Years. %A Geoffrey L Wallace %A Haveman, Robert %A Barbara Wolfe %K Health Conditions and Status %K Health Shocks %K Older Adults %K Retirement Planning and Satisfaction %X

This article uses data on a sample of retirees drawn from the Health and Retirement Study (HRS) to examine changes in health over the retirement years and to estimate the effects of health changes in retirement on wealth. Using the framework of item response theory, we develop a novel measure of health that makes use of multiple indicators of physical health that are available in the HRS. We find that large negative shocks to the health of male retirees and their spouses are frequent in retirement and that when such shocks do occur, recovery to the preshock level of health is rare. Using a dynamic panel data model, we then estimate short- and long-run effects of changes in health on wealth. While our estimated short-run effects are modest, long-run estimates of the impact of health shocks on wealth are large, ranging from a 12% to 20% reduction in wealth by the 10th year, following a permanent one standard deviation decrease in health.

%B Research on Aging %V 39 %P 222-248 %8 2017 Jan %G eng %N 1 %R 10.1177/0164027516669567 %0 Journal Article %J Demography %D 2017 %T Healthy Grandparenthood: How Long Is It, and How Has It Changed? %A Rachel Margolis %A Wright, Laura %K Adult children %K Cross-National %K Grandparents %K Mortality %X Healthy grandparenthood represents the period of overlap during which grandparents and grandchildren can build relationships, and grandparents can make intergenerational transfers to younger kin. The health of grandparents has important implications for upward and downward intergenerational transfers within kinship networks in aging societies. Although the length of grandparenthood is determined by fertility and mortality patterns, the amount of time spent as a healthy grandparent is also affected by morbidity. In this study, we estimate the length of healthy grandparenthood for the first time. Using U.S. and Canadian data, we examine changes in the length of healthy grandparenthood during years when grandparenthood was postponed, health improved, and mortality declined. We also examine variation in healthy grandparenthood by education and race/ethnicity within the United States. Our findings show that the period of healthy grandparenthood is becoming longer because of improvements in health and mortality, which more than offset delays in grandparenthood. Important variation exists within the United States by race/ethnicity and education, which has important implications for family relationships and transfers. %B Demography %V 54 %P 2073-2099 %G eng %U http://link.springer.com/10.1007/s13524-017-0620-0http://link.springer.com/content/pdf/10.1007/s13524-017-0620-0.pdfhttp://link.springer.com/article/10.1007/s13524-017-0620-0/fulltext.htmlhttp://link.springer.com/content/pdf/10.1007/s13524-017-0620-0.pdf %N 6 %! Demography %R 10.1007/s13524-017-0620-0 %0 Journal Article %J Social Science & Medicine %D 2017 %T Hearing impairment, social support, and depressive symptoms among U.S. adults: A test of the stress process paradigm. %A Jessica S West %K Depressive symptoms %K Disabilities %K Hearing loss %K Social Support %X Hearing impairment is a growing physical disability affecting older adults and is an important physical health stressor, but few studies have examined it in relation to mental health outcomes and even fewer have considered the role of social support in buffering this relationship. The current study builds on the stress process framework and uses longitudinal data from three waves of the Health and Retirement Study (2006, 2010, 2014) to examine the relationship between hearing impairment and depressive symptoms among U.S. adults aged 50 and older (n = 6075). The analysis uses fixed-effects models to assess this relationship and examine the extent to which social support mediates (buffers) or moderates (interaction) the association. The results found that worse self-rated hearing was associated with a significant increase in depressive symptoms, even after controlling for sociodemographic factors. Social support did not buffer this relationship. Instead, social support interacted with hearing impairment: low levels of social support were associated with more depressive symptoms but only among people with poor self-rated hearing. Among those with excellent self-rated hearing, low levels of social support did not increase depressive symptoms. Moreover, high levels of social support reduced depressive symptoms for those with poor hearing. These findings suggest that hearing impairment is a chronic stressor in individuals' lives, and that responses to this stressor vary by the availability of social resources. %B Social Science & Medicine %V 192 %P 94-101 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28963989?dopt=Abstract %R 10.1016/j.socscimed.2017.09.031 %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 Journal of the American Geriatrics Society %D 2017 %T The Hispanic paradox: Race/ethnicity and nativity, immigrant enclave residence and cognitive impairment among older US adults. %A Margaret M Weden %A Jeremy Miles %A Esther M Friedman %A José J Escarce %A Peterson, Christine %A Kenneth M. Langa %A Regina A Shih %K Cognitive Ability %K Racial/ethnic differences %K Socioeconomic factors %K Women and Minorities %X Hispanics, and particularly foreign-born Mexican Americans, have been shown to fare better across a range of health outcomes than might be expected given the generally higher levels of socioeconomic disadvantage in this population, a phenomena termed the "Hispanic Paradox". Previous research on social disparities in cognitive aging, however, has been unable to address both race/ethnicity and nativity (REN) in a nationally-representative sample of US adults leaving unanswered questions about potentially "paradoxical" advantages of Mexican ethnic-origins and the role of nativity, socioeconomic status (SES), and enclave residence. We employ biennial assessments of cognitive functioning to study prevalent and incident cognitive impairment (CI) within the three largest US REN groups: US-born non-Hispanic whites (US-NHW), US-born non-Hispanic blacks (US-NHB), US-born Mexican Americans (US-MA), and foreign-born Mexican Americans (FB-MA). Data come from a nationally-representative sample of community-dwelling older adults in the Health and Retirement Study linked with the 2000 Census and followed over 10 years (N = 8,433). Large disadvantages in prevalent and incident CI were observed for all REN minorities respective to US-born non-Hispanic whites. Individual and neighborhood SES accounted substantially for these disadvantages and revealed an immigrant advantage: FB-MA odds of prevalent CI were about half those of US-NHW and hazards of incident CI were about half those of US-MA. Residence in an immigrant enclave was protective of prevalent CI among FB-MA. The findings illuminate important directions for research into the sources of cognitive risk and resilience and provide guidance about CI screening within the increasingly diverse aging US population. %B Journal of the American Geriatrics Society %V 65 %P 1085-1091 %G eng %N 5 %R 10.1111/jgs.14806 %0 Journal Article %J Journal of Aging and Health %D 2017 %T Hispanics' retirement transitions and differences by nativity. %A Mudrazija, Stipica %A Richard W. Johnson %A Wang, Claire Xiaozhi %K Hispanics %K Racial/ethnic differences %K Retirement Planning and Satisfaction %X

OBJECTIVE: This study examines differences in retirement decisions between older Hispanics and non-Hispanics, with a special focus on the role of nativity.

METHODS: We use 1998-2012 waves of the Health and Retirement Study. We estimate survival models of retirement and compare retirement transitions for U.S.-born Hispanics, foreign-born Hispanics, non-Hispanic Whites, and non-Hispanic Blacks.

RESULTS: Foreign-born Hispanics retire significantly later than other racial and ethnic groups. Controlling for personal characteristics, their risk of retirement is 39% lower compared with non-Hispanic Whites. Retirement transitions do not differ significantly between U.S.-born Hispanics and non-Hispanic Whites.

DISCUSSION: Difference in retirement timing between U.S.- and foreign-born Hispanics may partly be due to lower incomes and wealth accumulation of foreign-born Hispanics. Workforce development initiatives, policy initiatives promoting retirement savings, and Social Security reforms could improve future retirement security for older Hispanics, and make retirement a viable option for more foreign-born Hispanics.

%B Journal of Aging and Health %V 29 %P 1096-1115 %8 09/2017 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28569096?dopt=Abstract %R 10.1177/0898264317711608 %0 Journal Article %J J Occup Environ Med %D 2017 %T Honest Labor Bears a Lovely Face: Will Late-Life Unemployment Impact Health and Satisfaction in Retirement? %A Maren W Voss %A Wendy Church Birmingham %A Lori Wadsworth %A Wei Chen %A Bounsanga, Jerry %A Gu, Yushan %A Hung, Man %K Age Factors %K Aged %K Chronic disease %K depression %K Female %K Health Status %K Health Surveys %K Humans %K Male %K Mental Health %K Middle Aged %K Personal Satisfaction %K Retirement %K Unemployment %K United States %K Work %X

OBJECTIVE: Unemployment among older adults during recessionary cycles has been tied to early retirement decisions and negative health outcomes. This study explored episodes of unemployment experienced between age 50 and retirement as predictors of retirement age and health outcomes.

METHODS: A total of 1540 participants from the U.S. Health and Retirement Study aged 50 years and older who transitioned from workforce to retirement were analyzed with descriptive statistics and multiple regression controlling for unemployment, demographics, and health status.

RESULTS: Late-life unemployment significantly related to earlier retirement age and lowered life satisfaction, independent of income effects. We found no main effect for late-life unemployment on physical health status.

CONCLUSIONS: Potential improvements in future life satisfaction might be gained if job search obstacles are removed for older unemployed adults, reducing reliance on involuntary early retirement as an income source.

%B J Occup Environ Med %V 59 %P 184-190 %8 2017 02 %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00043764-900000000-98945 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28002355?dopt=Abstract %! Journal of Occupational and Environmental Medicine %R 10.1097/JOM.0000000000000933 %0 Journal Article %J 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 Report %D 2017 %T HRS Institutional Review Board Information %A David R Weir %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %8 10/2017 %G eng %0 Report %D 2017 %T HRS Polygenic Scores: 2006-2010 Genetic Data %A Erin B Ware %A Lauren L Schmitz %A Jessica Faul %K PGS %B HRS Documentation Report %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %8 07/2017 %G eng %0 Report %D 2017 %T HRS Psychosocial and Lifestyle Questionnaire 2006-2016 %A Jacqui Smith %A Lindsay H Ryan %A Gwenith G Fisher %A Amanda Sonnega %A David R Weir %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %1 Please note that this replaces an earlier version of this report. %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 Med Care %D 2017 %T Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach. %A Nicholas K Schiltz %A David F Warner %A Jiayang Sun %A Paul M Bakaki %A Avi Dor %A Charles W Given %A Kurt C Stange %A Siran M Koroukian %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Comorbidity %K Female %K Health Behavior %K Health Expenditures %K Health Status %K Humans %K Machine learning %K Male %K Medicare %K Retrospective Studies %K Self Report %K Socioeconomic factors %K United States %X

BACKGROUND: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood.

OBJECTIVE: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization.

DESIGN: Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims. Analysis used machine-learning techniques: classification and regression trees and random forest.

SUBJECTS: A population-based sample of 5771 Medicare-enrolled adults aged 65 and older in the United States.

MEASURES: Main covariates: self-reported chronic conditions (measured as none, mild, or severe), geriatric syndromes, and functional limitations. Secondary covariates: demographic, social, economic, behavioral, and health status measures.

OUTCOMES: Medicare expenditures in the top quartile and inpatient utilization.

RESULTS: Median annual expenditures were $4354, and 41% were hospitalized within 2 years. The tree model shows some notable combinations: 64% of those with self-rated poor health plus activities of daily living and instrumental activities of daily living disabilities had expenditures in the top quartile. Inpatient utilization was highest (70%) in those aged 77-83 with mild to severe heart disease plus mild to severe diabetes. Functional limitations were more important than many chronic diseases in explaining resource use.

CONCLUSIONS: The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Modeling the conjoint effects of chronic conditions, functional limitations, and geriatric syndromes can advance understanding of groups at greatest risk and inform targeted tailored interventions aimed at cost containment.

%B Med Care %V 55 %P 276-284 %8 2017 03 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/27753745?dopt=Abstract %R 10.1097/MLR.0000000000000660 %0 Journal Article %J Health Economics %D 2017 %T The Impact of Medicare Part D on Emergency Department Visits. %A Padmaja Ayyagari %A Dan M. Shane %A George L Wehby %K Aged %K Delivery of Health Care %K Emergency Service, Hospital %K Female %K Humans %K Insurance Coverage %K Insurance, Health %K Male %K Medicare Part D %K Middle Aged %K prescription drugs %K Surveys and Questionnaires %K United States %X

The Medicare Part D program introduced prescription drug coverage for seniors in 2006. We examine the impact of this program on the use of emergency department (ED) care. Using a difference-in-differences model, we find declines in the number of ED visits for non-emergency care but not for emergency care, suggesting that Part D may have led to better management of health and reduced unnecessary use of EDs. Copyright © 2016 John Wiley & Sons, Ltd.

%B Health Economics %V 26 %P 536-544 %8 2017 04 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/26865471?dopt=Abstract %R 10.1002/hec.3326 %0 Journal Article %J The Journal of Retirement %D 2017 %T Improving the system of financing long-term services and supports for older Americans %A Mark J. Warshawsky %A Marchand, Ross A. %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X Medicaid currently pays for most of the long-term services and supports (LTSS) provided older Americans. With an aging population, these costs will increase rapidly. Contrary to a widely held view, current Medicaid eligibility rules allow covered households to own significant housing and retirement assets. The authors present new information about the weak efforts of states in asset recovery and discuss the extensive asset holdings, especially in housing and retirement assets, of retired households. Given that Medicaid crowds out the purchase of private long-term care insurance, liberal eligibility rules and uneven enforcement must increase the costs of governments and discourage better-off households from covering LTSS exposure through private insurance and assets. They conclude with targeted recommendations to reform Medicaid and improve the LTSS financing system, following up on proposals made by certain members of the 2013 federal Commission on Long-Term Care. %B The Journal of Retirement %V 5 %P 48-68 %G eng %U http://www.iijournals.com/doi/10.3905/jor.2017.5.1.048 %N 1 %! Retirement %R 10.3905/jor.2017.5.1.048 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2017 %T Incorporating Persistent Pain in Phenotypic Frailty Measurement and Prediction of Adverse Health Outcomes. %A Matthew C. Lohman %A Karen L Whiteman %A Rebecca L. Greenberg %A Martha L. Bruce %K Aged %K Chronic pain %K Female %K Frail Elderly %K Geriatric Assessment %K Humans %K Male %K Phenotype %K Prognosis %X

BACKGROUND: Frailty, a syndrome of physiological deficits, is prevalent among older adults and predicts elevated risk of adverse health outcomes. Although persistent pain predicts similar risk, it is seldom considered in frailty measurement. This article evaluated the construct and predictive validity of including persistent pain in phenotypic frailty measurement.

METHODS: Frailty and persistent pain were operationalized using data from the Health and Retirement Study (2006-2012 waves). Among a subset of adults aged 65 and older (n = 3,652), we used latent class analysis to categorize frailty status and to evaluate construct validity. Using Cox proportional hazards models, we compared time to incident adverse outcomes (death, fall, hospitalization, institutionalization, and functional disability) between frailty classes determined by either including or excluding persistent pain as a frailty component.

RESULTS: In latent class models, persistent pain occurred with other frailty components in patterns consistent with a medical syndrome. Frail and intermediately frail classes determined by including persistent pain were more strongly associated with all adverse outcomes compared with frail and intermediately frail classes determined excluding persistent pain. Frail respondents had significantly greater risk of death compared with nonfrail respondents when frailty models included rather than excluded persistent pain (respectively, hazard ratio [HR] = 3.87, 95% confidence interval [CI] = 2.99-5.00 (including pain); HR = 2.10, 95% CI = 1.71-2.59 (excluding pain).

CONCLUSIONS: Findings support consideration of persistent pain as a component of the frailty phenotype. Persistent pain assessment may provide an expedient method to enhance frailty measurement and improve prediction of adverse outcomes.

%B J Gerontol A Biol Sci Med Sci %V 72 %P 216-222 %8 2017 02 %G eng %U http://biomedgerontology.oxfordjournals.org/lookup/doi/10.1093/gerona/glw212 %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28087677?dopt=Abstract %! GERONA %R 10.1093/gerona/glw212 %0 Journal Article %J American Journal of Alzheimer's Disease and Other Dementias %D 2017 %T Increasing Burden of Complex Multimorbidity Across Gradients of Cognitive Impairment. %A Siran M Koroukian %A Nicholas K Schiltz %A David F Warner %A Kurt C Stange %A Kathleen A Smyth %K Cognitive Ability %K Comorbidity %K Functional limitations %X

INTRODUCTION: This study evaluates the burden of multimorbidity (MM) across gradients of cognitive impairment (CI).

METHODS: Using data from the 2010 Health and Retirement Study, we identified individuals with no CI, mild CI, and moderate/severe CI. In addition, we adopted an expansive definition of complex MM by accounting for the occurrence and co-occurrence of chronic conditions, functional limitations, and geriatric syndromes.

RESULTS: In a sample of 18 913 participants (weighted n = 87.5 million), 1.93% and 1.84% presented with mild and moderate/severe CI, respectively. The prevalence of most conditions constituting complex MM increased markedly across the spectrum of CI. Further, the percentage of individuals presenting with 10 or more conditions was 19.9%, 39.3%, and 71.3% among those with no CI, mild CI, and moderate/severe CI, respectively.

DISCUSSION: Greater CI is strongly associated with increased burden of complex MM. Detailed characterization of MM across CI gradients will help identify opportunities for health care improvement.

%B American Journal of Alzheimer's Disease and Other Dementias %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/28871795?dopt=Abstract %R 10.1177/1533317517726388 %0 Journal Article %J International Journal of Environmental Research and Public Health %D 2017 %T Interaction between Social/Psychosocial Factors and Genetic Variants on Body Mass Index: A Gene-Environment Interaction Analysis in a Longitudinal Setting %A Wei Zhao %A Erin B Ware %A He, Zihuai %A Sharon L R Kardia %A Jessica Faul %K BMI %K Genetics %K Obesity %X Obesity, which develops over time, is one of the leading causes of chronic diseases such as cardiovascular disease. However, hundreds of BMI (body mass index)-associated genetic loci identified through large-scale genome-wide association studies (GWAS) only explain about 2.7% of BMI variation. Most common human traits are believed to be influenced by both genetic and environmental factors. Past studies suggest a variety of environmental features that are associated with obesity, including socioeconomic status and psychosocial factors. This study combines both gene/regions and environmental factors to explore whether social/psychosocial factors (childhood and adult socioeconomic status, social support, anger, chronic burden, stressful life events, and depressive symptoms) modify the effect of sets of genetic variants on BMI in European American and African American participants in the Health and Retirement Study (HRS). In order to incorporate longitudinal phenotype data collected in the HRS and investigate entire sets of single nucleotide polymorphisms (SNPs) within gene/region simultaneously, we applied a novel set-based test for gene-environment interaction in longitudinal studies (LGEWIS). Childhood socioeconomic status (parental education) was found to modify the genetic effect in the gene/region around SNP rs9540493 on BMI in European Americans in the HRS. The most significant SNP (rs9540488) by childhood socioeconomic status interaction within the rs9540493 gene/region was suggestively replicated in the Multi-Ethnic Study of Atherosclerosis (MESA) (p = 0.07). %B International Journal of Environmental Research and Public Health %V 14 %P 1153 %8 09/2017 %G eng %U http://www.mdpi.com/1660-4601/14/10/1153http://www.mdpi.com/1660-4601/14/10/1153/pdf %N 10 %! IJERPH %R 10.3390/ijerph14101153 %0 Journal Article %J Advances in Life Course Research %D 2017 %T Later-life employment trajectories and health %A McDonough, Peggy %A Worts, Diana %A Corna, Laurie M. %A McMunn, Anne %A Sacker, Amanda %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Background: Despite the recent policy push to keep older adults in the labour force, we know almost nothing about the potential health consequences of working longer. Drawing on a life course approach that considers stability and change in employment patterns, this study examines the relationship between long-term labour market involvement in later life and self-rated health. Methods: Our data are from the Health and Retirement Study (1992-2012) for the cohort born 1931-1941 (N = 6522). We used optimal matching analysis to map employment trajectories from ages 52-69, and then logistic regression to examine associations between these trajectories and self-rated health in the early 70s, net of socio-demographics, household resources and prior health. Findings: Women prevail in groups characterized by a weak(er) attachment to the labour market and men, in groups signifying a strong(er) attachment. Men who downshifted from full-time to part-time work around age 65 were the least likely to report poor health in their early 70s.Women had the best health if they remained employed, either full-time or part-time. However, unlike men, they appeared to benefit most in health terms when part-time hours were part of a longer-term pattern. Conclusion: While our study findings show that continuing to work in later life may be positively associated with health, they also suggest the need for flexible employment policies that foster opportunities to work part-time. %B Advances in Life Course Research %V 34 %P 22-33 %G eng %! Advances in Life Course Research %R 10.1016/j.alcr.2017.09.002 %0 Book %D 2017 %T Later-Life Social Support and Service Provision in Diverse and Vulnerable Populations: Understanding Networks of Care %A Janet M Wilmoth %A Merril Silverstein %K Racial/ethnic differences %K Social Support %X Later-Life Social Support and Service Provision in Diverse and Vulnerable Populations offers current, multidisciplinary perspectives on social support and service provision to older Americans. The chapters trace how our understanding of social support among older adults has developed over the past 40 years and explore current gerontological research in the area. They consider how informal care arrangements articulate with formal long-term care policies and programs to provide support to the diverse population of older Americans. They also emphasize heterogeneity in the composition of support networks, particularly in relation to gender, sexual orientation, race/ethnicity, and immigrant status. Collectively, the chapters provide insight into the complexity of older adult’s social support networks that can be used to improve the services provided to caregivers and care recipients as well as the policies that promote high-quality support to people of all ages who are in need of assistance. %I Routledge %C Abingdon, UK %P 234 %@ 9780415788304 %G eng %0 Journal Article %J Int J Geriatr Psychiatry %D 2017 %T Loneliness, depression and cognitive function in older U.S. adults. %A Nancy J. Donovan %A Bei Wu %A Dorene M. Rentz %A Reisa A. Sperling %A Gad A. Marshall %A M. Maria Glymour %K Aged %K Aged, 80 and over %K Cognitive Dysfunction %K Demography %K Depressive Disorder %K Female %K Humans %K Loneliness %K Longitudinal Studies %K Male %K Middle Aged %K Risk Factors %X

OBJECTIVE: To examine reciprocal relations of loneliness and cognitive function in older adults.

METHODS: Data were analyzed from 8382 men and women, age 65 and older, participating in the US Health and Retirement Study from 1998 to 2010. Participants underwent biennial assessments of loneliness and depression (classified as no, low or high depression) determined by the Center for Epidemiologic Studies Depression scale (8-item version), cognition (a derived memory score based on a word list memory task and proxy-rated memory and global cognitive function), health status and social and demographic characteristics from 1998 to 2010. We used repeated measures analysis to examine the reciprocal relations of loneliness and cognitive function in separate models controlling sequentially and cumulatively for socio-demographic factors, social network, health conditions and depression.

RESULTS: Loneliness at baseline predicted accelerated cognitive decline over 12 years independent of baseline socio-demographic factors, social network, health conditions and depression (β = -0.2, p = 0.002). After adjustment for depression interacting with time, both low and high depression categories were related to faster cognitive decline and the estimated effect of loneliness became marginally significant. Reciprocally, poorer cognition at baseline was associated with greater odds of loneliness over time in adjusted analyses (OR 1.3, 95% CI (1.1-1.5) p = 0.005), but not when controlling for baseline depression. Furthermore, cognition did not predict change in loneliness over time.

CONCLUSION: Examining longitudinal data across a broad range of cognitive abilities, loneliness and depressive symptoms appear to be related risk factors for worsening cognition but low cognitive function does not lead to worsening loneliness over time. Copyright © 2016 John Wiley & Sons, Ltd.

%B Int J Geriatr Psychiatry %V 32 %P 564-573 %8 2017 May %G eng %U http://dx.doi.org/10.1002/gps.4495 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27162047?dopt=Abstract %4 loneliness/depression/memory/cognitive function/aging/longitudinal %$ 999999 %R 10.1002/gps.4495 %0 Report %D 2017 %T The Long Reach of Education: Health, Wealth, and DI Participation %A James M. Poterba %A Steven F Venti %A David A Wise %K Education %K Health Conditions and Status %K Older Adults %K Wealth %X Education is strongly related to participation in the Social Security Disability Insurance (DI) program. To explore this relationship, we describe the correlation between education and DI participation, and then explore how four factors related to education - health, wealth, occupation, and employment - feature in this correlation. We label these four factors “pathway” variables. We find that a large component of the relationship between education and DI participation - more than one-third for men, and over two-thirds for women - can be attributed to the correlation of education with health, and of health with DI receipt. We use data from the Health and Retirement Study for the 1992-2012 period to explore the corresponding roles for each of the pathway variables, and also to study how changes over time in these variables, such as the widening gap between the health status of those with high and low educational attainment, have affected DI participation. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 04/2017 %G eng %U http://www.nber.org/papers/w23307.pdf %R 10.3386/w23307 %0 Report %D 2017 %T Longitudinal Determinants of End-of-Life Wealth Inequality %A James M. Poterba %A Steven F Venti %A David A Wise %K Income inequality %K Inequality %K Retirement Planning and Satisfaction %X This paper examines inequality in end-of-life wealth and the factors that contribute to individuals reaching this life stage with few financial resources. It analyzes repeated cross-sections of the Health and Retirement Study, as well as a small longitudinal sample of individuals observed both at age 65 and shortly before death. Most of those who die with little wealth had little wealth at retirement. There is strong persistence over time in the bottom tail of the wealth distribution, but the probability of having low wealth increases slowly with age after age 65. Those with low lifetime earnings are much more likely to report low wealth at retirement, and to die with little wealth, than their higher-earning contemporaries. The onset of a major medical condition and the loss of a spouse increase in the probability of falling into the low wealth category at advanced ages, although these factors appear to contribute to wealth decline for only a small fraction of those who had modest wealth at age 65 but low wealth at the time of death. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %G eng %U http://www.nber.org/papers/w23839.pdf %R 10.3386/w23839 %0 Report %D 2017 %T Long-Term Effects of Leaving Military Service in a Weak Economy %A Italo Gutierrez %A Jennie W. Wenger %K Labor force participation %K Recession %K Unemployment %K Veterans %X Previous research finds negative effects in the short and medium term for those who initially entered the labor force during weak labor markets. Discerning the effects of initial market conditions is difficult as young workers may attempt to time their entry by, for example, spending additional time in school during weak markets. In this paper, we take advantage of a novel form of exogenous variation that affected a large group of older workers to study longer-term effects of entering labor markets during bad economic times. Using the Health and Retirement Study, we focus on veterans from the draft era and examine the effects of leaving military service during periods of high unemployment on earnings, wealth, and retirement. These men had little choice about the timing of entry into the labor force; they generally were drafted or volunteered based on world events, and they left the military at the end of fixed contracts after short terms of service. Our results indicate that draft-era veterans who entered the labor force during a weaker economy had lower levels of earnings, and the effects lasted for more than a decade. We also find that while veterans who enter weak labor markets eventually catch up with other veterans in terms of earnings, the accumulated negative effects on wealth and financial preparedness for retirement are large; we find some evidence that veterans compensate by extending their working lives. %B Working Papers %I Michigan Retirement Research Center %C Ann Arbor, MI %P 1-48 %G eng %U http://mrrc.isr.umich.edu/wp369/ %0 Journal Article %J Inquiry %D 2017 %T Medicare Expenditures Associated With Hospital and Emergency Department Use Among Beneficiaries With Dementia. %A Daras, Laura Coots %A Feng, Zhanlian %A Joshua M Wiener %A Kaganova, Yevgeniya %K Dementia %K Emergency services %K Medicare linkage %K Older Adults %X Understanding expenditure patterns for hospital and emergency department (ED) use among individuals with dementia is crucial to controlling Medicare spending. We analyzed Health and Retirement Study data and Medicare claims, stratified by beneficiaries' residence and proximity to death, to estimate Medicare expenditures for all-cause and potentially avoidable hospitalizations and ED visits. Analysis was limited to the Medicare fee-for-service population age 65 and older. Compared with people without dementia, community residents with dementia had higher average expenditures for hospital and ED services; nursing home residents with dementia had lower average expenditures for all-cause hospitalizations. Decedents with dementia had lower expenditures than those without dementia in the last year of life. Medicare expenditures for individuals with and without dementia vary by residential setting and proximity to death. Results highlight the importance of addressing the needs specific to the population with dementia. There are many initiatives to reduce hospital admissions, but few focus on people with dementia. %B Inquiry %V 54 %P 46958017696757 %8 2017 Jan %G eng %R 10.1177/0046958017696757 %0 Journal Article %J International Journal of Epidemiolpgy %D 2017 %T Mortality selection in a genetic sample and implications for association studies. %A Benjamin W Domingue %A Daniel W. Belsky %A Harrati, Amal %A Dalton C Conley %A David R Weir %A Jason D Boardman %K Genetics %K GWAS %K Mortality %X

Background: Mortality selection occurs when a non-random subset of a population of interest has died before data collection and is unobserved in the data. Mortality selection is of general concern in the social and health sciences, but has received little attention in genetic epidemiology. We tested the hypothesis that mortality selection may bias genetic association estimates, using data from the US-based Health and Retirement Study (HRS).

Methods: We tested mortality selection into the HRS genetic database by comparing HRS respondents who survive until genetic data collection in 2006 with those who do not. We next modelled mortality selection on demographic, health and social characteristics to calculate mortality selection probability weights. We analysed polygenic score associations with several traits before and after applying inverse-probability weighting to account for mortality selection. We tested simple associations and time-varying genetic associations (i.e. gene-by-cohort interactions).

Results: We observed mortality selection into the HRS genetic database on demographic, health and social characteristics. Correction for mortality selection using inverse probability weighting methods did not change simple association estimates. However, using these methods did change estimates of gene-by-cohort interaction effects. Correction for mortality selection changed gene-by-cohort interaction estimates in the opposite direction from increased mortality selection based on analysis of HRS respondents surviving through 2012.

Conclusions: Mortality selection may bias estimates of gene-by-cohort interaction effects. Analyses of HRS data can adjust for mortality selection associated with observables by including probability weights. Mortality selection is a potential confounder of genetic association studies, but the magnitude of confounding varies by trait.

%B International Journal of Epidemiolpgy %V 46 %8 08/2017 %G eng %N 4 %R 10.1093/ije/dyx041 %0 Journal Article %J J Comorbidity %D 2017 %T Multimorbidity: constellations of conditions across subgroups of midlife and older individuals, and related Medicare expenditures. %A Siran M Koroukian %A Nicholas K Schiltz %A David F Warner %A Jiayang Sun %A Kurt C Stange %A Charles W Given %A Avi Dor %K Death %K Medicare %K Medicare claims data %K multimorbidity %X

INTRODUCTION: The Department of Health and Human Services' 2010 Strategic Framework on Multiple Chronic Conditions called for the identification of common constellations of conditions in older adults.

OBJECTIVES: To analyze patterns of conditions constituting multimorbidity (CCMM) and expenditures in a US representative sample of midlife and older adults (50-64 and ≥65 years of age, respectively).

DESIGN: A cross-sectional study of the 2010 Health and Retirement Study (HRS; =17,912). The following measures were used: (1) count and combinations of CCMM, including (i) chronic conditions (hypertension, arthritis, heart disease, lung disease, stroke, diabetes, cancer, and psychiatric conditions), (ii) functional limitations (upper body limitations, lower body limitations, strength limitations, limitations in activities of daily living, and limitations in instrumental activities of daily living), and (iii) geriatric syndromes (cognitive impairment, depressive symptoms, incontinence, visual impairment, hearing impairment, severe pain, and dizziness); and (2) annualized 2011 Medicare expenditures for HRS participants who were Medicare fee-for-service beneficiaries (=5,677). Medicaid beneficiaries were also identified based on their self-reported insurance status.

RESULTS: No large representations of participants within specific CCMM categories were observed; however, functional limitations and geriatric syndromes were prominently present with higher CCMM counts. Among fee-for-service Medicare beneficiaries aged 50-64 years, 26.7% of the participants presented with ≥10 CCMM, but incurred 48% of the expenditure. In those aged ≥65 years, these percentages were 16.9% and 34.4%, respectively.

CONCLUSION: Functional limitations and geriatric syndromes considerably add to the MM burden in midlife and older adults. This burden is much higher than previously reported.

%B J Comorbidity %V 7 %P 33-43 %8 2017 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/29090187?dopt=Abstract %R 10.15256/joc.2017.7.91 %0 Journal Article %J The Gerontologist %D 2017 %T Multiple Chronic Conditions, Resilience, and Workforce Transitions in Later Life: A Socio-Ecological Model. %A Kendra Jason %A Dawn C Carr %A Tiffany R Washington %A Tandrea S Hilliard %A Chivon A Mingo %K Comorbidity %K Resilience %K Retirement Planning and Satisfaction %X

Purpose of the Study: Despite the growing prevalence of multiple chronic conditions (MCC), a problem that disproportionally affects older adults, few studies have examined the impact of MCC status on changes in workforce participation in later life. Recent research suggests that resilience, the ability to recover from adversity, may buffer the negative impact of chronic disease. Guided by an adapted socio-ecological risk and resilience conceptual model, this study examined the buffering effect of resilience on the relationship between individual and contextual risks, including MCC, and workforce transitions (i.e., leaving the workforce, working fewer hours, working the same hours, or working more hours).

Design and Methods: Using the Health and Retirement Study, this study pooled a sample of 4,861 older workers aged 51 and older with 2 consecutive biannual waves of data. Nonnested multinomial logistic regression analysis was applied.

Results: MCC are related to higher risk of transitioning out of the workforce. Resilience buffered the negative effects of MCC on workforce engagement and remained independently associated with increased probability of working the same or more hours compared with leaving work.

Implications: MCC are associated with movement out of the paid workforce in later life. Despite the challenges MCC impose on older workers, having higher levels of resilience may provide the psychological resources needed to sustain work engagement in the face of new deficits. These findings suggest that identifying ways to bolster resilience may enhance the longevity of productive workforce engagement.

%B The Gerontologist %V 57 %P 269-281 %8 2017 Apr 01 %G eng %N 2 %R 10.1093/geront/gnv101 %0 Journal Article %J Soc Sci Med %D 2017 %T Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S. %A Esther M Friedman %A Regina A Shih %A Mary E Slaughter %A Margaret M Weden %A Kathleen A. Cagney %K Aged %K Aged, 80 and over %K Aging %K Cognition %K Female %K Health Status %K Humans %K Interpersonal Relations %K Male %K Residence Characteristics %K Social Support %K Socioeconomic factors %K United States %X

Recent evidence suggests that living in a neighborhood with a greater percentage of older adults is associated with better individual health, including lower depression, better self-rated health, and a decreased risk of overall mortality. However, much of the work to date suffers from four limitations. First, none of the U.S.-based studies examine the association at the national level. Second, no studies have examined three important hypothesized mechanisms - neighborhood socioeconomic status and neighborhood social and physical characteristics - which are significantly correlated with both neighborhood age structure and health. Third, no U.S. study has longitudinally examined cognitive health trajectories. We build on this literature by examining nine years of nationally-representative data from the Health and Retirement Study (2002-2010) on men and women aged 51 and over linked with Census data to examine the relationship between the percentage of adults 65 and older in a neighborhood and individual cognitive health trajectories. Our results indicate that living in a neighborhood with a greater percentage of older adults is related to better individual cognition at baseline but we did not find any significant association with cognitive decline. We also explored potential mediators including neighborhood socioeconomic status, perceived neighborhood cohesion and perceived neighborhood physical disorder. We did not find evidence that neighborhood socioeconomic status explains this relationship; however, there is suggestive evidence that perceived cohesion and disorder may explain some of the association between age structure and cognition. Although more work is needed to identify the precise mechanisms, this work may suggest a potential contextual target for public health interventions to prevent cognitive impairment.

%B Soc Sci Med %V 174 %P 149-158 %8 2017 02 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0277953616306669http://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S0277953616306669?httpAccept=text/xml %1 http://www.ncbi.nlm.nih.gov/pubmed/28033564?dopt=Abstract %! Social Science & Medicine %R 10.1016/j.socscimed.2016.12.005 %0 Journal Article %J 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 PLoS One %D 2017 %T The obesity paradox and incident cardiovascular disease: A population-based study. %A Virginia W Chang %A Kenneth M. Langa %A David R Weir %A Theodore J Iwashyna %K BMI %K Cardiovascular disease %K Obesity %X

BACKGROUND: Prior work suggests that obesity may confer a survival advantage among persons with cardiovascular disease (CVD). This obesity "paradox" is frequently studied in the context of prevalent disease, a stage in the disease process when confounding from illness-related weight loss and selective survival are especially problematic. Our objective was to examine the association of obesity with mortality among persons with incident CVD, where biases are potentially reduced, and to compare these findings with those based on prevalent disease.

METHODS: We used data from the Health and Retirement Study, an ongoing, nationally representative longitudinal survey of U.S. adults age 50 years and older initiated in 1992 and linked to Medicare claims. Cox proportional hazard models were used to estimate the association between weight status and mortality among persons with specific CVD diagnoses. CVD diagnoses were established by self-reported survey data as well as Medicare claims. Prevalent disease models used concurrent weight status, and incident disease models used pre-diagnosis weight status.

RESULTS: We examined myocardial infarction, congestive heart failure, stroke, and ischemic heart disease. A strong and significant obesity paradox was consistently observed in prevalent disease models (hazard of death 18-36% lower for obese class I relative to normal weight), replicating prior findings. However, in incident disease models of the same conditions in the same dataset, there was no evidence of this survival benefit. Findings from models using survey- vs. claims-based diagnoses were largely consistent.

CONCLUSION: We observed an obesity paradox in prevalent CVD, replicating prior findings in a population-based sample with longer-term follow-up. In incident CVD, however, we did not find evidence of a survival advantage for obesity. Our findings do not offer support for reevaluating clinical and public health guidelines in pursuit of a potential obesity paradox.

%B PLoS One %V 12 %P e0188636 %8 2017 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/29216243?dopt=Abstract %R 10.1371/journal.pone.0188636 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2017 %T Older Adults With Three Generations of Kin: Prevalence, Correlates, and Transfers. %A Rachel Margolis %A Wright, Laura %K Aged %K Black or African American %K Family %K Family Characteristics %K Female %K Hispanic or Latino %K Humans %K Intergenerational Relations %K Male %K Middle Aged %K Resource Allocation %K Social Support %K Surveys and Questionnaires %K United States %K White People %X

OBJECTIVES: We document the prevalence and sociodemographic correlates of older adults with three generations of living kin and examine the patterns of transfers among this group compared with those with fewer generations of kin available.

METHOD: We use the Health and Retirement Study (1998-2010) to estimate kin availability and intergenerational transfers among respondents in their 50s, 60s, and 70s.

RESULTS: It is far more common for older adults to have aging parents, children, and grandchildren than to have just two generations of kin (parents and children). Forty percent of adults in their 50s, 30% of those in their 60s, and 7.5% of those in their 70s have three generations of kin available. Hispanics and the least educated are more likely to have this generational configuration. The vast majority provides financial or in-kind transfers to at least one generation, and a large minority provides support to both older and younger generations.

DISCUSSION: Although there has been much concern about the strains among those sandwiched between parents and children, it is far more common among older adults to also have grandchildren, and many of these adults are transferring resources both upward and downward to multiple generations.

%B J Gerontol B Psychol Sci Soc Sci %V 72 %P 1067-1072 %8 2017 Oct 01 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/01/26/geronb.gbv158.abstract %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26817631?dopt=Abstract %4 Intergenerational exchange/Intergenerational support/Population aging/Sandwich generation %$ 999999 %R 10.1093/geronb/gbv158 %0 Journal Article %J Work, Aging and Retirement %D 2017 %T Overview of the Health and Retirement Study and Introduction to the Special Issue %A Gwenith G Fisher %A Lindsay H Ryan %E Wang, Mo %K Meta-analyses %X Twenty-five years ago, the largest academic behavioral and social science project ever undertaken in the United States began: the Health and Retirement Study (HRS). The HRS is an invaluable publicly available dataset for investigating work, aging, and retirement and informing public policy on these issues. This biennial longitudinal study began in 1992 and has studied more than 43,000 individuals and produced almost 4,000 journal articles, dissertations, books, book chapters, and reports to date. The purpose of this special issue of Work, Aging and Retirement is to describe the HRS and highlight relevant research that utilizes this rich and complex dataset. First, we briefly describe the background that led to the development of the HRS. Then we summarize key aspects of the study, including its development, sampling, and methodology. Our review of the content of the survey focuses on the aspects of the study most relevant to research on worker aging and retirement. Next, we identify key strengths and important limitations of the study and provide advice to current and future HRS data users. Finally, we summarize the articles in this Special Issue (all of which use data from the HRS) and how they advance our knowledge and understanding of worker aging and retirement. %B Work, Aging and Retirement %V 4 %P 1-9 %G eng %U http://academic.oup.com/workar/article/4/1/1/4762672http://academic.oup.com/workar/article-pdf/4/1/1/23297023/wax032.pdf %N 1 %R 10.1093/workar/wax032 %0 Journal Article %J Nature %D 2017 %T Rare and low-frequency coding variants alter human adult height. %A Marouli, Eirini %A Graff, Mariaelisa %A Medina-Gomez, Carolina %A Ken Sin Lo %A Andrew R Wood %A Kjaer, Troels R %A Fine, Rebecca S %A Lu, Yingchang %A Schurmann, Claudia %A Highland, Heather M %A Rüeger, Sina %A Thorleifsson, Gudmar %A Justice, Anne E %A Lamparter, David %A Kathleen E Stirrups %A Turcot, Valérie %A Young, Kristin L %A Thomas W Winkler %A Tõnu Esko %A Karaderi, Tugce %A Locke, Adam E %A Masca, Nicholas G D %A Ng, Maggie C Y %A Mudgal, Poorva %A Rivas, Manuel A %A Vedantam, Sailaja %A Mahajan, Anubha %A Guo, Xiuqing %A Gonçalo R Abecasis %A Aben, Katja K %A Adair, Linda S %A Alam, Dewan S %A Albrecht, Eva %A Allin, Kristine H %A Matthew A. Allison %A Amouyel, Philippe %A Appel, Emil V %A Arveiler, Dominique %A Asselbergs, Folkert W %A Auer, Paul L %A Balkau, Beverley %A Banas, Bernhard %A Bang, Lia E %A Benn, Marianne %A Bergmann, Sven %A Bielak, Lawrence F %A Blüher, Matthias %A Boeing, Heiner %A Boerwinkle, Eric %A Böger, Carsten A %A Bonnycastle, Lori L %A Bork-Jensen, Jette %A Bots, Michiel L %A Erwin P Bottinger %A Bowden, Donald W %A Brandslund, Ivan %A Breen, Gerome %A Brilliant, Murray H %A Broer, Linda %A Burt, Amber A %A Adam S Butterworth %A Carey, David J %A Caulfield, Mark J %A Chambers, John C %A Daniel I Chasman %A Yii-Der I Chen %A Chowdhury, Rajiv %A Cramer Christensen %A Chu, Audrey Y %A Cocca, Massimiliano %A Collins, Francis S %A Cook, James P %A Corley, Janie %A Jordi Corominas Galbany %A Cox, Amanda J %A Cuellar-Partida, Gabriel %A Danesh, John %A Gail Davies %A de Bakker, Paul I W %A de Borst, Gert J %A de Denus, Simon %A de Groot, Mark C H %A de Mutsert, Renée %A Ian J Deary %A George Dedoussis %A Ellen W Demerath %A Anneke I den Hollander %A Joe G Dennis %A Di Angelantonio, Emanuele %A Drenos, Fotios %A Du, Mengmeng %A Dunning, Alison M %A Easton, Douglas F %A Ebeling, Tapani %A Edwards, Todd L %A Ellinor, Patrick T %A Elliott, Paul %A Evangelou, Evangelos %A Farmaki, Aliki-Eleni %A Jessica Faul %A Feitosa, Mary F %A Feng, Shuang %A Ferrannini, Ele %A Marco M Ferrario %A Ferrières, Jean %A Florez, Jose C %A Ford, Ian %A Myriam Fornage %A Franks, Paul W %A Frikke-Schmidt, Ruth %A Galesloot, Tessel E %A Gan, Wei %A Gandin, Ilaria %A Paolo P. Gasparini %A Giedraitis, Vilmantas %A Giri, Ayush %A Giorgia G Girotto %A Gordon, Scott D %A Gordon-Larsen, Penny %A Gorski, Mathias %A Grarup, Niels %A Grove, Megan L %A Gudnason, Vilmundur %A Gustafsson, Stefan %A Hansen, Torben %A Kathleen Mullan Harris %A Tamara B Harris %A Andrew T Hattersley %A Caroline Hayward %A He, Liang %A Iris M Heid %A Heikkilä, Kauko %A Helgeland, Øyvind %A Hernesniemi, Jussi %A Hewitt, Alex W %A Lynne J Hocking %A Hollensted, Mette %A Oddgeir L Holmen %A Hovingh, G Kees %A Howson, Joanna M M %A Hoyng, Carel B %A Huang, Paul L %A Hveem, Kristian %A Mohammed Arfan Ikram %A Ingelsson, Erik %A Jackson, Anne U %A Jansson, Jan-Håkan %A Jarvik, Gail P %A Jensen, Gorm B %A Jhun, Min A %A Jia, Yucheng %A Jiang, Xuejuan %A Johansson, Stefan %A Jørgensen, Marit E %A Jørgensen, Torben %A Jousilahti, Pekka %A Jukema, J Wouter %A Kahali, Bratati %A Kahn, René S %A Kähönen, Mika %A Kamstrup, Pia R %A Kanoni, Stavroula %A Kaprio, Jaakko %A Karaleftheri, Maria %A Sharon L R Kardia %A Karpe, Fredrik %A Kee, Frank %A Keeman, Renske %A Lambertus A Kiemeney %A Kitajima, Hidetoshi %A Kluivers, Kirsten B %A Kocher, Thomas %A Komulainen, Pirjo %A Kontto, Jukka %A Kooner, Jaspal S %A Charles Kooperberg %A Kovacs, Peter %A Kriebel, Jennifer %A Kuivaniemi, Helena %A Küry, Sébastien %A Kuusisto, Johanna %A La Bianca, Martina %A Laakso, Markku %A Lakka, Timo A %A Lange, Ethan M %A Leslie A Lange %A Langefeld, Carl D %A Langenberg, Claudia %A Eric B Larson %A Lee, I-Te %A Lehtimäki, Terho %A Lewis, Cora E %A Li, Huaixing %A Li, Jin %A Li-Gao, Ruifang %A Lin, Honghuang %A Lin, Li-An %A Lin, Xu %A Lars Lind %A Lindström, Jaana %A Linneberg, Allan %A Liu, Yeheng %A Yongmei Liu %A Lophatananon, Artitaya %A Luan, Jian'an %A Lubitz, Steven A %A Lyytikäinen, Leo-Pekka %A Mackey, David A %A Pamela A F Madden %A Alisa Manning %A Männistö, Satu %A Marenne, Gaëlle %A Marten, Jonathan %A Nicholas G Martin %A Mazul, Angela L %A Meidtner, Karina %A Andres Metspalu %A Mitchell, Paul %A Mohlke, Karen L %A Dennis O Mook-Kanamori %A Morgan, Anna %A Morris, Andrew D %A Morris, Andrew P %A Müller-Nurasyid, Martina %A Munroe, Patricia B %A Michael A Nalls %A Nauck, Matthias %A Nelson, Christopher P %A Neville, Matt %A Sune Fallgaard Nielsen %A Nikus, Kjell %A Njølstad, Pål R %A Børge G Nordestgaard %A Ntalla, Ioanna %A Jeff O'Connell %A Oksa, Heikki %A Loes M Olde Loohuis %A Ophoff, Roel A %A Owen, Katharine R %A Packard, Chris J %A Padmanabhan, Sandosh %A Palmer, Colin N A %A Pasterkamp, Gerard %A Patel, Aniruddh P %A Pattie, Alison %A Pedersen, Oluf %A Peissig, Peggy L %A Peloso, Gina M %A Pennell, Craig E %A Markus Perola %A Perry, James A %A Perry, John R B %A Person, Thomas N %A Pirie, Ailith %A Polasek, Ozren %A Posthuma, Danielle %A Olli T Raitakari %A Rasheed, Asif %A Rauramaa, Rainer %A Reilly, Dermot F %A Reiner, Alex P %A Renstrom, Frida %A Ridker, Paul M %A Rioux, John D %A Neil R Robertson %A Robino, Antonietta %A Rolandsson, Olov %A Rudan, Igor %A Ruth, Katherine S %A Saleheen, Danish %A Veikko Salomaa %A Nilesh J Samani %A Sandow, Kevin %A Sapkota, Yadav %A Sattar, Naveed %A Schmidt, Marjanka K %A Schreiner, Pamela J %A Schulze, Matthias B %A Scott, Robert A %A Segura-Lepe, Marcelo P %A Svati H Shah %A Sim, Xueling %A Sivapalaratnam, Suthesh %A Small, Kerrin S %A Albert Vernon Smith %A Jennifer A Smith %A Southam, Lorraine %A Timothy Spector %A Elizabeth K Speliotes %A John M Starr %A Steinthorsdottir, Valgerdur %A Heather M Stringham %A Stumvoll, Michael %A Surendran, Praveen %A 't Hart, Leen M %A Tansey, Katherine E %A Tardif, Jean-Claude %A Kent D Taylor %A Teumer, Alexander %A Thompson, Deborah J %A Thorsteinsdottir, Unnur %A Thuesen, Betina H %A Tönjes, Anke %A Tromp, Gerard %A Trompet, Stella %A Tsafantakis, Emmanouil %A Tuomilehto, Jaakko %A Tybjaerg-Hansen, Anne %A Tyrer, Jonathan P %A Uher, Rudolf %A André G Uitterlinden %A Ulivi, Sheila %A van der Laan, Sander W %A Van Der Leij, Andries R %A Cornelia M van Duijn %A van Schoor, Natasja M %A van Setten, Jessica %A Varbo, Anette %A Varga, Tibor V %A Varma, Rohit %A Digna R Velez Edwards %A Vermeulen, Sita H %A Vestergaard, Henrik %A Vitart, Veronique %A Vogt, Thomas F %A Vozzi, Diego %A Walker, Mark %A Wang, Feijie %A Wang, Carol A %A Wang, Shuai %A Wang, Yiqin %A Wareham, Nicholas J %A Warren, Helen R %A Wessel, Jennifer %A Willems, Sara M %A Wilson, James G %A Daniel Witte %A Woods, Michael O %A Wu, Ying %A Yaghootkar, Hanieh %A Yao, Jie %A Yao, Pang %A Laura M Yerges-Armstrong %A Young, Robin %A Zeggini, Eleftheria %A Zhan, Xiaowei %A Zhang, Weihua %A Jing Hua Zhao %A Wei Zhao %A Wei Zhao %A Zheng, He %A Zhou, Wei %A Rotter, Jerome I %A Boehnke, Michael %A Kathiresan, Sekar %A McCarthy, Mark I %A Willer, Cristen J %A Stefansson, Kari %A Ingrid B Borecki %A Liu, Dajiang J %A Kari E North %A Heard-Costa, Nancy L %A Pers, Tune H %A Lindgren, Cecilia M %A Oxvig, Claus %A Kutalik, Zoltán %A Fernando Rivadeneira %A Ruth J F Loos %A Timothy M Frayling %A Joel N Hirschhron %A Deloukas, Panos %A Lettre, Guillaume %X

Height is a highly heritable, classic polygenic trait with approximately 700 common associated variants identified through genome-wide association studies so far. Here, we report 83 height-associated coding variants with lower minor-allele frequencies (in the range of 0.1-4.8%) and effects of up to 2 centimetres per allele (such as those in IHH, STC2, AR and CRISPLD2), greater than ten times the average effect of common variants. In functional follow-up studies, rare height-increasing alleles of STC2 (giving an increase of 1-2 centimetres per allele) compromised proteolytic inhibition of PAPP-A and increased cleavage of IGFBP-4 in vitro, resulting in higher bioavailability of insulin-like growth factors. These 83 height-associated variants overlap genes that are mutated in monogenic growth disorders and highlight new biological candidates (such as ADAMTS3, IL11RA and NOX4) and pathways (such as proteoglycan and glycosaminoglycan synthesis) involved in growth. Our results demonstrate that sufficiently large sample sizes can uncover rare and low-frequency variants of moderate-to-large effect associated with polygenic human phenotypes, and that these variants implicate relevant genes and pathways.

%B Nature %V 542 %P 186-190 %8 2017 Feb 09 %G eng %N 7640 %1 http://www.ncbi.nlm.nih.gov/pubmed/28146470?dopt=Abstract %R 10.1038/nature21039 %0 Journal Article %J PLoS Genetics %D 2017 %T Rare variants in fox-1 homolog A (RBFOX1) are associated with lower blood pressure. %A He, Karen Y %A Wang, Heming %A Brian E Cade %A Nandakumar, Priyanka %A Giri, Ayush %A Erin B Ware %A Jeffrey Haessler %A Liang, Jingjing %A Smith, Jennifer A %A Franceschini, Nora %A Le, Thu H %A Charles Kooperberg %A Edwards, Todd L %A Sharon L R Kardia %A Lin, Xihong %A Chakravarti, Aravinda %A Redline, Susan %A Zhu, Xiaofeng %K Adult %K Blood pressure %K Body Mass Index %K Chromosomes, Human, Pair 16 %K Family Health %K Female %K Gene Expression %K Gene Frequency %K Genetic Linkage %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Genotype %K Humans %K Male %K Middle Aged %K Pedigree %K Polymorphism, Single Nucleotide %K RNA Splicing Factors %K Whites %X

Many large genome-wide association studies (GWAS) have identified common blood pressure (BP) variants. However, most of the identified BP variants do not overlap with the linkage evidence observed from family studies. We thus hypothesize that multiple rare variants contribute to the observed linkage evidence. We performed linkage analysis using 517 individuals in 130 European families from the Cleveland Family Study (CFS) who have been genotyped on the Illumina OmniExpress Exome array. The largest linkage peak was observed on chromosome 16p13 (MLOD = 2.81) for systolic blood pressure (SBP). Follow-up conditional linkage and association analyses in the linkage region identified multiple rare, coding variants in RBFOX1 associated with reduced SBP. In a 17-member CFS family, carriers of the missense variant rs149974858 are normotensive despite being obese (average BMI = 60 kg/m2). Gene-based association test of rare variants using SKAT-O showed significant association with SBP (p-value = 0.00403) and DBP (p-value = 0.0258) in the CFS participants and the association was replicated in large independent replication studies (N = 57,234, p-value = 0.013 for SBP, 0.0023 for PP). RBFOX1 is expressed in brain tissues, the atrial appendage and left ventricle in the heart, and in skeletal muscle tissues, organs/tissues which are potentially related to blood pressure. Our study showed that associations of rare variants could be efficiently detected using family information.

%B PLoS Genetics %V 13 %P e1006678 %G eng %N 3 %R 10.1371/journal.pgen.1006678 %0 Journal Article %J J Gen Intern Med %D 2017 %T Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. %A Victoria L. Tang %A Rebecca L. Sudore %A Irena Cenzer %A W John Boscardin %A Alexander K Smith %A Christine S Ritchie %A Margaret Wallhagen %A Finlayson, Emily %A Petrillo, Laura %A Kenneth E Covinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Comorbidity %K Dementia %K Female %K Geriatric Assessment %K Hip Fractures %K Humans %K Longitudinal Studies %K Male %K Mobility Limitation %K Recovery of Function %K Walking %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 Med Care %D 2017 %T Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults. %A Geoffrey J Hoffman %A Hays, Ron D %A Steven P Wallace %A Martin F Shapiro %A Yakusheva, Olga %A Susan L Ettner %K Accidental Falls %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Female %K Geriatric Assessment %K Humans %K Independent Living %K Longitudinal Studies %K Male %K Middle Aged %K Risk Assessment %K Risk Factors %K United States %X

BACKGROUND: Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk.

DESIGN: Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship.

RESULTS: Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired.

CONCLUSIONS: Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.

%B Med Care %V 55 %P 371-378 %8 2017 04 %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005650-900000000-98801 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27875481?dopt=Abstract %! Medical Care %R 10.1097/MLR.0000000000000677 %0 Journal Article %J Annals of Internal Medicine %D 2017 %T The relationship of health insurance and mortality: Is lack of insurance deadly? %A Woolhandler, Steffie %A Himmelstein, David U. %K Medicare/Medicaid/Health Insurance %K Mortality %X About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97. %B Annals of Internal Medicine %8 Mar-06-2019 %G eng %U http://annals.org/article.aspx?doi=10.7326/M17-1403 %! Ann Intern Med %R 10.7326/M17-1403 %0 Journal Article %J Annals of Internal Medicine %D 2017 %T The Relationship of Obesity to Hospice Use and Expenditures: A Cohort Study. %A Tamara B Harris %A Byhoff, Elena %A Chithra R Perumalswami %A Kenneth M. Langa %A Alexi A Wright %A Jennifer J Griggs %K Hospice %K Medicare/Medicaid/Health Insurance %K Obesity %K Older Adults %X

Background: Obesity complicates medical, nursing, and informal care in severe illness, but its effect on hospice use and Medicare expenditures is unknown.

Objective: To describe the associations between body mass index (BMI) and hospice use and Medicare expenditures in the last 6 months of life.

Design: Retrospective cohort.

Setting: The HRS (Health and Retirement Study).

Participants: 5677 community-dwelling Medicare fee-for-service beneficiaries who died between 1998 and 2012.

Measurements: Hospice enrollment, days enrolled in hospice, in-home death, and total Medicare expenditures in the 6 months before death. BMI was modeled as a continuous variable with a quadratic functional form.

Results: For decedents with BMI of 20 kg/m2, the predicted probability of hospice enrollment was 38.3% (95% CI, 36.5% to 40.2%), hospice duration was 42.8 days (CI, 42.3 to 43.2 days), probability of in-home death was 61.3% (CI, 59.4% to 63.2%), and total Medicare expenditures were $42 803 (CI, $41 085 to $44 521). When BMI increased to 30 kg/m2, the predicted probability of hospice enrollment decreased by 6.7 percentage points (CI, -9.3 to -4.0 percentage points), hospice duration decreased by 3.8 days (CI, -4.4 to -3.1 days), probability of in-home death decreased by 3.2 percentage points (CI, -6.0 to -0.4 percentage points), and total Medicare expenditures increased by $3471 (CI, $955 to $5988). For morbidly obese decedents (BMI ≥40 kg/m2), the predicted probability of hospice enrollment decreased by 15.2 percentage points (CI, -19.6 to -10.9 percentage points), hospice duration decreased by 4.3 days (CI, -5.7 to -2.9 days), and in-home death decreased by 6.3 percentage points (CI, -11.2 to -1.5 percentage points) versus decedents with BMI of 20 kg/m2.

Limitation: Baseline data were self-reported, and the interval between reported BMI and time of death varied.

Conclusion: Among community-dwelling decedents in the HRS, increasing obesity was associated with reduced hospice use and in-home death and higher Medicare expenditures in the last 6 months of life.

Primary Funding Source: Robert Wood Johnson Foundation Clinical Scholars Program.

%B Annals of Internal Medicine %8 2017 Feb 07 %G eng %R 10.7326/M16-0749 %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 Thesis %B Clinical Psychology %D 2017 %T The Role of Negative Cognitions in Depression, Functional Limitations, and Activity: A National Longitudinal Study of Older Adults %A Diane C Wagner %Y Jerome L Short %K Demographics %K Health Conditions and Status %K Healthcare %X This study examines the role of negative cognitions in late life depression, functional limitations, and activity. Participants were 673 adults (36% male) aged 50 to 88 who completed repeated measures in 2004, 2008, and 2012 as part of the Health and Retirement Study, a large nationally representative longitudinal sample. Novel contributions of this study include combining functional limitations and cognitions in a cognitive model of depression to include aspects of depression that are specific to older adults, examining the unique contribution of cognitions in depression, and testing both growth and temporal covariance to capture the interrelatedness of depression and related factors over time. Three bivariate Latent Difference Score models tested time-lagged associations in pairs of variables at three time points. Contrary to expectations, depression levels and negative cognitions were unrelated over time, suggesting that cognitive theories of depression, which place cognitions at the core of depression etiology and maintenance, may not generalize to older adults. Negative cognitions were not related to functional limitations, suggesting that functional limitations do not influence negative cognitions in older adults. Higher levels of negative cognitions were related to increases in activity over time, suggesting that negative cognitions may motivate older adults to increase activity levels. %B Clinical Psychology %I George Mason University %C Fairfax, VA %V Ph.D. %P 101 %@ 9781339532547 %G English %U http://mars.gmu.edu/handle/1920/10134 %9 Dissertation %M 1773972497 %4 0622:Clinical psychology %! The Role of Negative Cognitions in Depression, Functional Limitations, and Activity: A National Longitudinal Study of Older Adults %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 Geriatr Oncol %D 2017 %T Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer. %A Siran M Koroukian %A Nicholas K Schiltz %A David F Warner %A Charles W Given %A Mark Schluchter %A Owusu, Cynthia %A Nathan A. Berger %K Age Factors %K Aged %K Aged, 80 and over %K Emergency Service, Hospital %K Female %K Health Surveys %K Hospices %K Hospital Mortality %K Humans %K Logistic Models %K Male %K multimorbidity %K Neoplasms %K Population Surveillance %K Quality of Health Care %K Risk Factors %K Socioeconomic factors %K Terminal Care %X

OBJECTIVE: Most prior studies on aggressive end-of-life care in older patients with cancer have accounted for social determinants of health (e.g., race, income, and education), but rarely for multimoribidity (MM). In this study, we examine the association between end-of-life care and each of the social determinants of health and MM, hypothesizing that higher MM is associated with less aggressive care.

METHODS: From the linked 1991-2008 Health and Retirement Study, Medicare data, and the National Death Index, we identified fee-for-service patients age ≥66years who died from cancer (n=835). MM was defined as the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. Aggressive care was based on claims-derived measures of receipt of cancer-directed treatment in the last two weeks of life; admission to the hospital and/or emergency department (ED) within the last month; and in-hospital death. We also identified patients enrolled in hospice. In multivariable logistic regression models, we analyzed the associations of interest, adjusting for potential confounders.

RESULTS: While 61.2% of the patients enrolled in hospice, 24.6% underwent cancer-directed treatment; 55.1% were admitted to the hospital and/or ED; and 21.7% died in the hospital. We observed a U-shaped distribution between income and in-hospital death. Chronic conditions and geriatric syndromes were associated with some outcomes, but not with others.

CONCLUSIONS: To improve quality end-of-life care and curtail costs incurred by dying patients, relevant interventions need to account for social determinants of health and MM in a nuanced fashion.

%B J Geriatr Oncol %V 8 %P 117-124 %8 2017 03 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S1879406816301229http://api.elsevier.com/content/article/PII:S1879406816301229?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1879406816301229?httpAccept=text/plain %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/28029586?dopt=Abstract %! Journal of Geriatric Oncology %R 10.1016/j.jgo.2016.10.001 %0 Journal Article %J Journals of Gerontology Series A: Biological Sciences and Medical Sciences %D 2017 %T Social support, social strain, and cognitive function among community-dwelling U.S. Chinese older adults. %A Ge, Shaoqing %A Bei Wu %A Donald E. Bailey Jr. %A Dong, XinQi %K Adult children %K Cognitive Ability %K Community-dwelling %X

Background: Limited research is available on the relationship between social support, social strain, and cognitive function among community-dwelling U.S. Chinese older adults. This study aims to examine the associations between social support/strain and cognitive outcomes.

Methods: Data were drawn from the Population-Based Study of Chinese Elderly (N = 3,159). Cognitive function was measured by a battery of tests including the East Boston Memory Test, the Digit Span Backwards assessment, and the Symbol Digit Modalities Test. Social support and strain were measured by the scales drawn from the Health and Retirement study. Multiple regression analyses were conducted.

Results: Social support was significantly associated with global cognitive function (β = .11, SE = .02, p < .001), episodic memory (β = .11, SE = .03, p < .001), working memory (β = .18, SE = .08, p < .05), and executive function (β = 1.44, SE = .37, p < .001). Social strain was significantly associated with global cognitive function (β = .23, SE = .05, p < .001), episodic memory (β = .27, SE = .07, p < .001), working memory (β = .34, SE = .17, p < .05), and executive function (β = 2.75, SE = .85, p < .01). In terms of sources of social support/strain, higher support from friends was significantly associated with higher global cognitive function (β = .04, SE = .02, p < .05), higher episodic memory (β = .05, SE = .02, p < .05), and higher executive function (β = .71, SE = .29, p < .05). Higher strain from spouse was significantly associated with higher global cognitive function (β = .10, SE = .03, p < .01), higher episodic memory (β = .11, SE = .04, p < .01), and higher executive function (β = 1.28, SE = .49, p < .01). Higher strain from friends was significantly associated with higher executive function (β = 3.59, SE = 1.17, p < .01).

Conclusions: Social support and strain were associated with cognitive outcomes. Future longitudinal studies should be conducted.

%B Journals of Gerontology Series A: Biological Sciences and Medical Sciences %V 72 %P S16-S21 %8 2017 Jul 01 %G eng %N suppl_1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28575260?dopt=Abstract %R 10.1093/gerona/glw221 %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 Report %D 2017 %T Spending in retirement…or not? %A Wolfe, Bruce %A Brazier, Robert %K Financial Health %K Retirement Planning and Satisfaction %K Spending %X Something unexpected has been the shared experience for our most recent generation of retirees. The vast majority haven't been spending their retirement savings—leaving nest eggs mostly untouched and living on ready sources of income instead. However, future retirees may be less fortunate. %B Savings & Investing %I BlackRock %C New York City, NY %8 11/2017 %G eng %U https://www.blackrock.com/investing/retirement/blackrock-retirement-institute/savings-and-investing/spending-in-retirement %0 Web Page %D 2017 %T Study Shows One Way to Extend Working Years %A Lisa Ward %K Employment and Labor Force %K News %K Older Adults %B Journal Reports: Wealth Management %I The Wall Street Journal %C New York City, NY %G eng %U https://www.wsj.com/articles/study-shows-one-way-to-extend-working-years-1490582352 %0 Web Page %D 2017 %T This Is How Much Your Kids Are Worth %A Woolley, Suzanne %K Consumption and Savings %K Medical Expenses %K News %K Nursing homes %B Bloomberg %I Bloomberg %C New York City, NY %G eng %U https://www.bloomberg.com/news/articles/2017-08-28/this-is-the-best-long-term-care-insurance %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 Report %D 2016 %T 2016 Harmonized Cognitive Assessment Protocol (HCAP) Study Protocol Summary %A David R Weir %A Kenneth M. Langa %A Lindsay H Ryan %I Health and Retirement Study, Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, MI %P 1-15 %8 03/2018 %G eng %0 Journal Article %J Biodemography Soc Biol %D 2016 %T African Ancestry, Social Factors, and Hypertension Among Non-Hispanic Blacks in the Health and Retirement Study. %A Jessica R Marden %A Stefan Walter %A Jay S Kaufman %A M. Maria Glymour %K African Americans %K Aged %K Female %K Health Status Disparities %K Humans %K Hypertension %K Life Style %K Male %K Middle Aged %K Prevalence %K Risk Factors %K Socioeconomic factors %K United States %X

The biomedical literature contains much speculation about possible genetic explanations for the large and persistent black-white disparities in hypertension, but profound social inequalities are also hypothesized to contribute to this outcome. Our goal is to evaluate whether socioeconomic status (SES) differences provide a plausible mechanism for associations between African ancestry and hypertension in a U.S. cohort of older non-Hispanic blacks. We included only non-Hispanic black participants (N = 998) from the Health and Retirement Study who provided genetic data. We estimated percent African ancestry based on 84,075 independent single nucleotide polymorphisms using ADMIXTURE V1.23, imposing K = 4 ancestral populations, and categorized into quartiles. Hypertension status was self-reported in the year 2000. We used linear probability models (adjusted for age, sex, and southern birth) to predict prevalent hypertension with African ancestry quartile, before and after accounting for a small set of SES measures. Respondents with the highest quartile of African ancestry had 8 percentage points' (RD = 0.081; 95% CI: -0.001, 0.164) higher prevalence of hypertension compared to the lowest quartile. Adjustment for childhood disadvantage, education, income, and wealth explained over one-third (RD = 0.050; 95% CI: -0.034, 0.135) of the disparity. Explanations for the residual disparity remain unspecified and may include other indicators of SES or diet, lifestyle, and psychosocial mechanisms.

%B Biodemography Soc Biol %I 62 %V 62 %P 19-35 %8 2016 %G eng %U http://www.tandfonline.com/doi/full/10.1080/19485565.2015.1108836 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27050031?dopt=Abstract %R 10.1080/19485565.2015.1108836 %0 Report %D 2016 %T Are Early Claimers Making a Mistake? %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %A Anthony Webb %A Gillis, Christopher M. %X Using Health and Retirement Study (HRS) data and Latent Class Analysis for three cohorts (those born in 1931-1936, 1937-1941, and 1942-1947), this paper explores: 1) who claims Social Security benefits at age 62; 2) what percentage of households claiming at 62 are unprepared for retirement; and 3) whether the unprepared early claimers were pushed into claiming through job shocks and/or poor health or simply decided to take benefits early. Looking across three cohorts makes it possible to see whether these patterns have changed as the average claim age has increased and pension coverage has shifted away from defined benefit (DB) plans. That is, have those who have moved out of age-62 claiming been educated, financially prepared households or unprepared households that have recognized the need to delay claiming? %B Center for Retirement Research at Boston College Working Paper Series %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U http://crr.bc.edu/working-papers/are-early-claimers-making-a-mistake/ %0 Book Section %B Reimagining Pensions: The Next 40 Years %D 2016 %T Are Retirees Falling Short? Reconciling the Conflicting Evidence %A Alicia H. Munnell %A Matthew S. Rutledge %A Anthony Webb %E Olivia S. Mitchell %E Shea, Richard C. %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper examines conflicting assessments of whether people will have adequate retirement income to maintain their pre-retirement standard of living. The studies that it examines use data from the Survey of Consumer Finances (SCF), the Health and Retirement Study (HRS), and the HRS supplement Consumption and Activities Mail Survey (CAMS). Critical components of the analysis are behavioral assumptions about household consumption patterns when children leave home and when households retire. A key limitation is that the behavioral assumptions in the different studies are based on incomplete knowledge of actual household behavior. %B Reimagining Pensions: The Next 40 Years %I Oxford University Press %C Oxford, United Kingdom %P 11-36 %G eng %4 household consumption/retirement preparedness/pre-retirement standard of living %! Are Retirees Falling Short? Reconciling the Conflicting Evidence %0 Generic %D 2016 %T Assessing the impact of military service in the Health and Retirement Study: Current status and suggestions for the future %A Avron Spiro III %A Janet M Wilmoth %A Andrew S London %K Military service %K Veterans %I National Institute on Aging %C Bethesda, MD %0 Journal Article %J JAMA %D 2016 %T Association of a Genetic Risk Score With Body Mass Index Across Different Birth Cohorts. %A Stefan Walter %A Mejía-Guevara, Iván %A Estrada, Karol %A Sze Y Liu %A M. Maria Glymour %K African Continental Ancestry Group %K Age Factors %K Aged %K Aged, 80 and over %K Alleles %K Body Mass Index %K Cohort Studies %K European Continental Ancestry Group %K Female %K Genetic Predisposition to Disease %K Genetic Variation %K Genome-Wide Association Study %K Humans %K Male %K Middle Aged %K Multilocus Sequence Typing %K Obesity %K Polymorphism, Single Nucleotide %K Risk Factors %K United States %X

IMPORTANCE: Many genetic variants are associated with body mass index (BMI). Associations may have changed with the 20th century obesity epidemic and may differ for black vs white individuals.

OBJECTIVE: Using birth cohort as an indicator for exposure to obesogenic environment, to evaluate whether genetic predisposition to higher BMI has a larger magnitude of association among adults from more recent birth cohorts, who were exposed to the obesity epidemic at younger ages.

DESIGN, SETTING, AND PARTICIPANTS: Observational study of 8788 adults in the US national Health and Retirement Study who were aged 50 years and older, born between 1900 and 1958, with as many as 12 BMI assessments from 1992 to 2014.

EXPOSURES: A multilocus genetic risk score for BMI (GRS-BMI), calculated as the weighted sum of alleles of 29 single nucleotide polymorphisms associated with BMI, with weights equal to the published per-allele effects. The GRS-BMI represents how much each person's BMI is expected to differ, based on genetic background (with respect to these 29 loci), from the BMI of a sample member with median genetic risk. The median-centered GRS-BMI ranged from -1.68 to 2.01.

MAIN OUTCOMES AND MEASURES: BMI based on self-reported height and weight.

RESULTS: GRS-BMI was significantly associated with BMI among white participants (n = 7482; mean age at first assessment, 59 years; 3373 [45%] were men; P <.001) and among black participants (n = 1306; mean age at first assessment, 57 years; 505 [39%] were men; P <.001) but accounted for 0.99% of variation in BMI among white participants and 1.37% among black participants. In multilevel models accounting for age, the magnitude of associations of GRS-BMI with BMI were larger for more recent birth cohorts. For example, among white participants, each unit higher GRS-BMI was associated with a difference in BMI of 1.37 (95% CI, 0.93 to 1.80) if born after 1943, and 0.17 (95% CI, -0.55 to 0.89) if born before 1924 (P = .006). For black participants, each unit higher GRS-BMI was associated with a difference in BMI of 3.70 (95% CI, 2.42 to 4.97) if born after 1943, and 1.44 (95% CI, -1.40 to 4.29) if born before 1924.

CONCLUSIONS AND RELEVANCE: For participants born between 1900 and 1958, the magnitude of association between BMI and a genetic risk score for BMI was larger among persons born in later cohorts. This suggests that associations of known genetic variants with BMI may be modified by obesogenic environments.

%B JAMA %V 316 %P 63-9 %8 2016 Jul 05 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27380344 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27380344?dopt=Abstract %& 63 %R 10.1001/jama.2016.8729 %0 Journal Article %J J Epidemiol Community Health %D 2016 %T Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA. %A Wu, Chenkai %A Michelle C Odden %A Gwenith G Fisher %A Stawski, Robert S %K Adult %K Aged %K Female %K Health Status %K Humans %K Life Expectancy %K Life Style %K Longitudinal Studies %K Male %K Middle Aged %K Mortality, Premature %K Retirement %K Risk Factors %K United States %X

BACKGROUND: Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association.

METHODS: On the basis of the Health and Retirement Study, 2956 participants who were working at baseline (1992) and completely retired during the follow-up period from 1992 to 2010 were included. Healthy retirees (n=1934) were defined as individuals who self-reported health was not an important reason to retire. The association of retirement age with all-cause mortality was analysed using the Cox model. Sociodemographic effect modifiers of the relation were examined.

RESULTS: Over the study period, 234 healthy and 262 unhealthy retirees died. Among healthy retirees, a 1-year older age at retirement was associated with an 11% lower risk of all-cause mortality (95% CI 8% to 15%), independent of a wide range of sociodemographic, lifestyle and health confounders. Similarly, unhealthy retirees (n=1022) had a lower all-cause mortality risk when retiring later (HR 0.91, 95% CI 0.88 to 0.94). None of the sociodemographic factors were found to modify the association of retirement age with all-cause mortality.

CONCLUSIONS: Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.

%B J Epidemiol Community Health %V 70 %P 917-23 %8 2016 Sep %G eng %U http://jech.bmj.com/content/early/2016/03/21/jech-2015-207097.abstract %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/27001669?dopt=Abstract %$ 999999 %R 10.1136/jech-2015-207097 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2016 %T Better Off Alone Than With a Smoker: The Influence of Partner's Smoking Behavior in Later Life. %A Rachel Margolis %A Wright, Laura %K Aged %K Female %K Health Behavior %K Humans %K Logistic Models %K Male %K Marital Status %K Middle Aged %K Motivation %K Single Person %K Smoking %K Smoking cessation %K Spouses %X

OBJECTIVES: We examine how the likelihood of smoking cessation among smokers and patterns of adherence to smoking cessation differ by partnership status, partnership changes, and partners' smoking behavior. The data are a nationally representative sample of smokers in middle and older age from the Health and Retirement Study (1992-2010).

METHOD: We use multivariate logistic regression models to analyze the likelihood of smoking cessation among smokers and then estimate adherence to smoking cessation using discrete-time event history models.

RESULTS: Those partnered with smokers and those whose partners relapse into smoking are much less likely than the unpartnered to quit smoking and adhere to smoking cessation. Respondents partnered with non-smokers and those whose partners quit smoking are more likely to quit smoking than the unpartnered. Those recently widowed, divorced, and repartnered have similar smoking changes to the consistently unpartnered.

DISCUSSION: Being partnered does not always mean healthier behavior changes. Rather, the association between partnership status and smoking changes depends greatly on the health behavior changes of the partner. The partnership context at the time of smoking cessation sets the stage for longer term patterns of adherence, shaping health in older age.

%B J Gerontol B Psychol Sci Soc Sci %V 71 %P 687-97 %8 2016 Jul %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/02/17/geronb.gbu220.abstract %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25693998?dopt=Abstract %R 10.1093/geronb/gbu220 %0 Journal Article %J Med Care %D 2016 %T Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults. %A Geoffrey J Hoffman %A Hays, Ron D %A Martin F Shapiro %A Steven P Wallace %A Susan L Ettner %K Accidental Falls %K Aged %K Aged, 80 and over %K Cross-Over Studies %K Female %K Humans %K Insurance Claim Review %K Male %K Medicare %K United States %K Wounds and Injuries %X

OBJECTIVES: Compare expenditures of fall-related injuries (FRIs) using several methods to identify FRIs in administrative claims data.

RESEARCH DESIGN: Using 2007-2009 Medicare claims and 2008 Health and Retirement Survey data, FRIs were identified using external-cause-of-injury (e-codes 880/881/882/884/885/888) only, e-codes plus a broad set of primary diagnosis codes, and a newer approach using e-codes and diagnostic and procedural codes. Linear regression models adjusted for sociodemographic, health, and geographic characteristics were used to estimate per-FRI, service component, patient cost share, expenditures by type of initial FRI treatment (inpatient, emergency department only, outpatient), and total annual FRI-related Medicare expenditures.

SUBJECTS: The analysis included 5497 community-dwelling adults ≥65 (228 FRI, 5269 non-FRI individuals) with continuous Medicare coverage and alive during the 24-month study.

RESULTS: The 3 FRI identification methods produced differing distributions of index FRI type and varying estimated expenditures: $12,171 [95% confidence interval (CI), $4662-$19,680], $5648 (95% CI, $3819-$7476), and $9388 (95% CI, $5969-$12,808). In all models, most spending occurred in hospital, outpatient, and skilled nursing facility (SNF) settings, but greater proportions of SNF and outpatient spending were observed with commonly used FRI identification methods. Patient cost-sharing was estimated at $691-$1900 across the 3 methods. Inpatient-treated index FRIs were more expensive than emergency department and outpatient-treated FRIs across all methods, but were substantially higher when identifying FRI using only e-codes. Estimated total FRI-related Medicare expenditures were highly variable across methods.

CONCLUSIONS: FRIs are costly, with implications for Medicare and its beneficiaries. However, expenditure estimates vary considerably based on the method used to identify FRIs.

%B Med Care %V 54 %P 664-71 %8 2016 07 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27057747 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27057747?dopt=Abstract %R 10.1097/MLR.0000000000000531 %0 Report %D 2016 %T Cohort Changes in Social Security Benefits and Pension Wealth %A Fang, Chichun %A Charles Brown %A David R Weir %B University of Michigan Retirement Research Center (MRRC) Working Paper %I University of Michigan %C Ann Arbor, MI %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp350.pdf %0 Journal Article %J J Gen Intern Med %D 2016 %T Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes. %A Siran M Koroukian %A Nicholas K Schiltz %A David F Warner %A Jiayang Sun %A Paul M Bakaki %A Kathleen A Smyth %A Kurt C Stange %A Charles W Given %K Activities of Daily Living %K Age Distribution %K Aged %K Aged, 80 and over %K Chronic disease %K Comorbidity %K Female %K Geriatric Assessment %K Health Status %K Health Status Indicators %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Prognosis %K Risk Factors %K Self Report %K Sex Distribution %K Socioeconomic factors %K Syndrome %K United States %X

BACKGROUND: The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health.

OBJECTIVE: We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50 years of age or older (n = 16,640).

MAIN MEASURES: Outcomes were: Self-reported fair/poor health, self-rated worse health at 2 years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes.

KEY RESULTS: Twenty-nine percent and 23 % of respondents reported fair/poor health and self-rated worse health at 2 years, respectively, and 5 % died in 2 years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80 %); b) for self-rated worse health at 2 years: 68.5 years of age or older, difficulty walking several blocks and being in fair/poor health (60 %); and c) for 2-year mortality: 80.5 years of age or older, and presenting with limitations in both ADLs and IADLs (> 40 %).

CONCLUSIONS: Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

%B J Gen Intern Med %V 31 %P 630-7 %8 2016 Jun %G eng %U http://dx.doi.org/10.1007/s11606-016-3590-9 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26902246?dopt=Abstract %& 630 %R 10.1007/s11606-016-3590-9 %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 Alzheimer Dis Assoc Disord %D 2016 %T Diabetic Phenotypes and Late-Life Dementia Risk: A Mechanism-specific Mendelian Randomization Study. %A Stefan Walter %A Jessica R Marden %A Laura D Kubzansky %A Elizabeth R Mayeda %A Paul K Crane %A Chang, Shun-Chiao %A Marilyn C Cornelis %A David Rehkopf %A Mukherjee, Shubhabrata %A M. Maria Glymour %K Alzheimer disease %K Diabetes Mellitus, Type 2 %K Genetic Predisposition to Disease %K Humans %K Insulin %K Mendelian Randomization Analysis %K Phenotype %K Polymorphism, Single Nucleotide %K Risk Factors %X

BACKGROUND: Mendelian Randomization (MR) studies have reported that type 2 diabetes (T2D) was not associated with Alzheimer disease (AD). We adopted a modified, mechanism-specific MR design to explore this surprising result.

METHODS: Using inverse-variance weighted MR analysis, we evaluated the association between T2D and AD using data from 39 single nucleotide polymorphisms (SNPs) significantly associated with T2D in DIAbetes Genetics Replication And Meta-analysis (DIAGRAM) and the corresponding associations of each SNP with AD risk obtained from the International Genomics of Alzheimer's Project (IGAP, n=17,008 AD cases and n=37,154 controls). We evaluated mechanism-specific genetic subscores, including β-cell function, insulin sensitivity, and adiposity, and repeated analyses in 8501 Health and Retirement Study participants for replication and model validation.

RESULTS: In IGAP, the overall T2D polygenic score did not predict AD [odds ratio (OR) for the T2D polygenic score=1.01; 95% confidence interval (CI), 0.96, 1.06] but the insulin sensitivity polygenic score predicted higher AD risk (OR=1.17; 95% CI, 1.02, 1.34). In the Health and Retirement Study, polygenic scores were associated with T2D risk; the associations between insulin sensitivity genetic polygenic score and cognitive phenotypes were not statistically significant.

CONCLUSIONS: Evidence from polygenic scores suggests that insulin sensitivity specifically may affect AD risk, more than T2D overall.

%B Alzheimer Dis Assoc Disord %I 30 %V 30 %P 15-20 %8 2016 Jan-Mar %G eng %U http://europepmc.org/abstract/MED/26650880 %N 1 %M 00002093-201601000-00003 %1 http://www.ncbi.nlm.nih.gov/pubmed/26650880?dopt=Abstract %R 10.1097/WAD.0000000000000128 %0 Book Section %B Social Security Programs and Retirement Around the World: Disability INsurance Programs and Retirement %D 2016 %T Disability Insurance Incentives and the Retirement Decision: Evidence from the United States %A Courtney Coile %E David A Wise %K Employment and Labor Force %K Insurance %K Older Adults %K Public Policy %K Retirement Planning and Satisfaction %X Public programs that benefit older individuals, such as Social Security and Medicare, may be changed in the future in ways that reflect an expectation of longer work lives. But do older Americans have the health capacity to work longer? This paper explores this question by asking how much older individuals could work if they worked as much as those with the same mortality rate in the past or as much as their younger counterparts in similar health. Using both methods, we estimate that there is significant additional capacity to work at older ages. We also explore whether there are differences in health capacity across education groups and whether health has improved more over time for the highly educated, using education quartiles to surmount the challenge of changing levels of education over time. %B Social Security Programs and Retirement Around the World: Disability INsurance Programs and Retirement %I Chicago University Press %C Chicago %P 45-80 %G eng %! Disability Insurance Incentives and the Retirement Decision: Evidence from the United States %0 Generic %D 2016 %T Disability Measurement in the Health and Retirement Study %A Emily M. Agree %A Douglas A. Wolf %K Disability %I National Institute on Aging %C Bethesda, MD %0 Journal Article %J Int Dent J %D 2016 %T Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA. %A Richard J. Manski %A John F Moeller %A Haiyan Chen %A Widstrom, Eeva %A Listl, Stefan %K Aged %K Aged, 80 and over %K Demography %K Dental Care %K Europe %K Female %K Humans %K Insurance Coverage %K Interviews as Topic %K Male %K Middle Aged %K Oral Health %K Patient Acceptance of Health Care %K United States %X

BACKGROUND: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries.

METHOD: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents≥51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use.

RESULTS: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance.

CONCLUSIONS: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.

%B Int Dent J %I 66 %V 66 %P 36-48 %8 2016 Feb %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/idj.12190/epdf %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26465093?dopt=Abstract %2 PMC4728006 %R 10.1111/idj.12190 %0 Report %D 2016 %T Do Households Save More When the Kids Leave Home? %A Alicia H. Munnell %A Irena Dushi %A Geoffrey T. Sanzenbacher %A Anthony Webb %A Anqi Chen %K 401(k) %K Family %K Family Characteristics %X Kids are expensive. As a result, when children become financially independent, parents often have a substantial amount of extra money on hand. In this case, they have two basic choices: spend more on themselves or increase their saving for retirement. What they actually do is an open question. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/briefs/do-households-save-more-when-the-kids-leave-home/ %0 Report %D 2016 %T Does Socioeconomic Status Lead People to Retire Too Soon? %A Alicia H. Munnell %A Anthony Webb %A Anqi Chen %K Retirement %K socioeconomic status %X Working longer is a powerful lever to enhance retirement security. Individuals, on average, are healthier, live longer, and face less physically demanding jobs, so they should be able to extend the number of years worked. But averages are misleading when differences in health, job prospects, and life expectancy have widened between individuals with low and high socioeconomic status (SES). Thus, a single prescription for all no longer seems appropriate. Rather, it is important to know: 1) how long individuals in different SES groups have to work to maintain their preretirement standard of living; 2) how long they plan to work; and 3) what explains any gap between the two. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/briefs/does-socioeconomic-status-lead-people-to-retire-too-soon/ %0 Journal Article %J Health Serv Res %D 2016 %T Does the Relationship of the Proxy to the Target Person Affect the Concordance between Survey Reports and Medicare Claims Measures of Health Services Use? %A George L Wehby %A Michael P Jones %A Fred A Ullrich %A Yiyue Lou %A Frederic D Wolinsky %K Ambulatory Surgical Procedures %K Female %K Hospitalization %K Humans %K Insurance Claim Review %K Male %K Medicare %K Patient Acceptance of Health Care %K Proxy %K Self Report %K Socioeconomic factors %K Spouses %K United States %X

OBJECTIVES: To compare concordance of survey reports of health service use versus claims data between self respondents and spousal and nonspousal relative proxies.

DATA SOURCES: 1995-2010 data from the Survey on Assets and Health Dynamics among the Oldest Old and 1993-2010 Medicare claims for 3,229 individuals (13,488 person-years).

STUDY DESIGN: Regression models with individual fixed effects were estimated for discordance of any hospitalizations and outpatient surgery and for the numbers of under- and over-reported physician visits.

PRINCIPAL FINDINGS: Spousal proxies were similar to self respondents on discordance. Nonspousal proxies, particularly daughters/daughters-in-law and sons/sons-in-law, had less discordance, mainly due to reduced under-reporting.

CONCLUSIONS: Survey reports of health services use from nonspousal relatives are more consistent with Medicare claims than spousal proxies and self respondents.

%B Health Serv Res %V 51 %P 314-27 %8 2016 Feb %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/26059195 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26059195?dopt=Abstract %R 10.1111/1475-6773.12321 %0 Report %D 2016 %T Evaluating Strategies for Reducing Field Costs in a Longitudinal Study %A David R Weir %A Mary Beth Ofstedal %I Institute for Social Research, University of Michigan %C Ann Arbor, MI %P 1-8 %8 06/2017 %G eng %0 Journal Article %J Ageing Soc %D 2016 %T Female disability disadvantage: a global perspective on sex differences in physical function and disability. %A Felicia V Wheaton %A Eileen M. Crimmins %X

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

%B Ageing Soc %V 36 %P 1136-1156 %8 2016 Jul %G eng %U http://www.journals.cambridge.org/abstract_S0144686X15000227 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/27453613?dopt=Abstract %! Ageing and Society %R 10.1017/S0144686X15000227 %0 Journal Article %J The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2016 %T Financial Strain and Mental Health Among Older Adults During the Great Recession %A Lindsay R. Wilkinson %K Health Conditions and Status %K Public Policy %X Objectives: The economic recession has garnered the interest of many scholars, with much attention being drawn to how the recession has affected labor force participation, household wealth, and even retirement decisions. Certainly, the Great Recession has influenced the financial well-being of older adults, but has it had discernible effects on mental health?Method: This study draws on 5,366 respondents from the Health and Retirement Study (2006 2010) to examine objective and subjective measures of financial well-being in the period surrounding the Great Recession. Guided by cumulative inequality theory, this research investigates whether the economic downturn contributed to worsening anxiety and depressive symptoms over a 4-year period.Results: Results from linear fixed effects models reveal that decreases in objective financial resources were associated with increased financial strain during the Great Recession. Unlike the objective indicators, however, financial strain was a strong and robust predictor of worsening mental health between 2006 and 2010.Discussion: Building on prior research, this study elucidates the factors that shape financial strain and provides evidence that the Great Recession not only affected the financial well-being of older adults but also had adverse effects on mental health. %B The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %V 71 %P 745-754 %8 02/2016 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/02/17/geronb.gbw001.abstract %N 4 %4 Financial strain/Great Recession/Mental health %$ 999999 %& 745 %R 10.1093/geronb/gbw001 %0 Journal Article %J Am J Obstet Gynecol %D 2016 %T Functional status in older women diagnosed with pelvic organ prolapse. %A Tatiana V D Sanses %A Nicholas K Schiltz %A Bruna M. Couri %A Sangeeta T Mahajan %A Holly E Richter %A David F Warner %A Jack M. Guralnik %A Siran M Koroukian %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Cross-Sectional Studies %K Female %K Health Status %K Health Surveys %K Humans %K Medicare %K Middle Aged %K Mobility Limitation %K Muscle Strength %K Pelvic Organ Prolapse %K United States %K Upper Extremity %X

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

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

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

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

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

%B Am J Obstet Gynecol %I 214 %V 214 %P 613.e1-7 %8 2016 May %G eng %U http://www.sciencedirect.com/science/article/pii/S0002937815024783 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26704893?dopt=Abstract %2 PMC4851569 %4 activities of daily living/functional status/limitations/mobility/pelvic organ prolapse/strength %$ 999999 %R 10.1016/j.ajog.2015.11.038 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2016 %T Functioning, Forgetting, or Failing Health: Which Factors Are Associated With a Community-Based Move Among Older Adults? %A Esther M Friedman %A Margaret M Weden %A Regina A Shih %A Stephanie Kovalchik %A Singh, Reema %A José J Escarce %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Cognitive Dysfunction %K Female %K Health Status %K Health Surveys %K Humans %K Male %K Middle Aged %K Population Dynamics %K Residence Characteristics %K United States %X

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

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

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

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

%B J Gerontol B Psychol Sci Soc Sci %V 71 %P 1120-1130 %8 2016 Nov %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/10/07/geronb.gbv075.abstract %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26450960?dopt=Abstract %4 Activities of daily living/Aging/Cognition/Health/HEALTH STATUS/health condition/Migration %$ 999999 %R 10.1093/geronb/gbv075 %0 Journal Article %J The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %D 2016 %T Gender, Illness-Related Diabetes Social Support, and Glycemic Control Among Middle-Aged and Older Adults %A Mondesir, Favel L. %A White, Kellee %A Liese, Angela D. %A Alexander C McLain %K Diabetes %K Gender Differences %K Older Adults %K Social Support %K Women and Minorities %X This study examined whether the association between illness-related diabetes social support (IRDSS) and glycemic control among middle-aged and older adults is different for men and women. This cross-sectional analysis included 914 adults with diabetes who completed the Health and Retirement Study's 2003 Mail Survey on Diabetes. IRDSS is a composite score of 8 diabetes self-care measures. Hemoglobin A1c levels were obtained to measure good glycemic control (< 8.0%). Gender-stratified multivariate log-binomial regression models were used to estimate prevalence ratios and examine the association between IRDSS and glycemic control after controlling for sociodemographic, lifestyle, and clinical characteristics. The prevalence of good glycemic control was 48.9% among women and 51.1% among men. Mean composite IRDSS scores did not differ by gender. Among women, composite IRDSS was associated with adequate glycemic control (prevalence ratio: 1.06; 95% confidence interval: 1.02, 1.08), and all individual components of IRDSS, with the exception of keeping appointments, were positively associated with adequate glycemic control. No significant associations were observed in men for composite or individual components of IRDSS. Determining the gender-specific impact derived from IRDSS is a worthwhile approach to highlighting factors that differentially predict optimal glycemic control among middle-aged and older adults. %B The Journals of Gerontology Series B: Psychological Sciences and Social Sciences %V 71 %P 1081 - 1088 %8 May-11-2017 %G eng %U http://psychsocgerontology.oxfordjournals.org/lookup/doi/10.1093/geronb/gbv061https://academic.oup.com/psychsocgerontology/article/71/6/1081/2194711/Gender-IllnessRelated-Diabetes-Social-Support-and %N 6 %! GERONB %R 10.1093/geronb/gbv061 %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 Economics and Human Biology %D 2016 %T On the genetic bias of the quarter of birth instrument %A Cornelius A Rietveld %A Webbink, Dinand %K Genetics %K Methodology %X Many studies in economics use quarter of birth as an instrument for identifying the causal effect of schooling on outcomes such as earnings and health. The key assumption in these studies is that people born in different quarters of the year do not differ systematically in their unobserved abilities. This study uses genetic data from the US Health and Retirement Study to analyze the validity of the quarter of birth instrument. We find some evidence that genetic factors influencing education are not randomly distributed over the year. However, these factors only slightly change the effect of quarter of birth on schooling. %B Economics and Human Biology %I 21 %V 21 %P 137-146 %G eng %U http://www.sciencedirect.com/science/article/pii/S1570677X16000034 %4 Quarter of birth/Instrumental variable/Genetic variation/Genetic analysis %$ 999999 %R 10.1016/j.ehb.2016.01.002 %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 Book %B Handbooks in Economics %D 2016 %T Handbook of the Economics of Population Aging %A Piggott, John %A Woodland, Alan %K Aging %K Economics %X Ten papers provide perspectives from economists concerning population aging, explore the economic causes and consequences of demographic change, and analyze policy responses that have emerged. Papers discuss retirement incentives and labor supply; investing and portfolio allocation for retirement; conflict and cooperation within the family, and between the state and the family, in the provision of old-age security; complex decision making—the roles of cognitive limitations, cognitive decline, and aging; taxation, pensions, and demographic change; social security and public insurance; workplace-linked pensions for an aging demographic; poverty and aging; health and long-term care; and the Health and Retirement Study around the world surveys. Papers in volume 1A also provide perspectives from economists concerning population aging, explore the economic causes and consequences of demographic change, and analyze policy responses that have emerged. Piggott is with the ARC Centre of Excellence in Population Ageing Research at the University of New South Wales. Woodland is with the School of Economics and the ARC Centre of Excellence in Population Ageing Research at the University of New South Wales. Index. %B Handbooks in Economics %I Elsevier, North-Holland %C Boston and Amsterdam %V 1B %@ 978–0–444–53840–6 %G eng %0 Journal Article %J American Journal of Preventive Medicine %D 2016 %T Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study. %A Cleopatra M Abdou %A Adam W. Fingerhut %A James S Jackson %A Felicia V Wheaton %K Age Factors %K Aged %K Ageism %K Attitude of Health Personnel %K depression %K Female %K Health Status %K Humans %K Hypertension %K Male %K Mental Health %K Middle Aged %K Overweight %K Physician-Patient Relations %K Physicians %K Prejudice %K Racism %K Sex Factors %K Socioeconomic factors %K Stereotyping %X

INTRODUCTION: Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care.

METHODS: Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use.

RESULTS: Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine.

CONCLUSIONS: The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups.

%B American Journal of Preventive Medicine %I 50 %V 50 %P 191-198 %G eng %N 2 %2 PMC4755717 %4 HEALTH CARE/Stereotypes/PHYSICIAN TRUST/Social identity/Social identity %$ 999999 %R 10.1016/j.amepre.2015.07.034 %0 Journal Article %J J Pain Symptom Manage %D 2016 %T High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture. %A Christine S Ritchie %A Amy Kelley %A Irena Cenzer %A Margaret Wallhagen %A Kenneth E Covinsky %K Activities of Daily Living %K Aged, 80 and over %K Dementia %K depression %K Female %K Hip Fractures %K Humans %K Interviews as Topic %K Male %K multimorbidity %K pain %K Palliative care %K Patient Acceptance of Health Care %K Prodromal Symptoms %K Vulnerable Populations %X

CONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care.

OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture.

METHODS: Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression.

RESULTS: Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls.

CONCLUSIONS: A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.

%B J Pain Symptom Manage %V 52 %P 533-538 %8 2016 10 %G eng %U http://www.sciencedirect.com/science/article/pii/S0885392416302214 %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27521282?dopt=Abstract %R 10.1016/j.jpainsymman.2016.07.003 %0 Report %D 2016 %T How Has Pension Income Changed Between 1992 and 2010? %A Alicia H. Munnell %A Wenliang Hou %A Anthony Webb %A Yinji Li %X Using data from the 1992, 1998, 2004, and 2010 waves of the Health and Retirement Study (HRS), this paper compares pension participation, pension wealth, projected retirement income, and replacement rates attributable to past service, by pension type for households ages 51-56. The analysis includes workers’ pension coverage during both current and past jobs. Defined contribution (DC) wealth is simply the current account balance. DC income is calculated by projecting current plan balances to retirement, assuming no further contributions, and assuming that households then annuitize. Defined benefit (DB) wealth and income are calculated by apportioning projected benefits to past and future service. %B Center for Retirement Research at Boston College Working Paper Series %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %G eng %U http://crr.bc.edu/wp-content/uploads/2016/07/wp_2016-3.pdf %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 Conference Paper %B Gerontological Society of America %D 2016 %T Internet Usage Among Older Adults: Findings from the Health and Retirement Study 2002-2014 %A Gwenith G Fisher %A Wallace, L. E. %A Lindsay H Ryan %A Ryan J McCammon %A John J McArdle %K Internet usage %K Older Adults %K Societal changes %B Gerontological Society of America %I Oxford %8 NOV %G eng %M WOS:000388585000170 %0 Journal Article %J Proc Natl Acad Sci U S A %D 2016 %T Lifespan adversity and later adulthood telomere length in the nationally representative US Health and Retirement Study. %A Puterman, Eli %A Gemmill, Alison %A Karasek, Deborah %A David R Weir %A Nancy E Adler %A Aric A Prather %A Elissa S Epel %K Aged %K Aged, 80 and over %K Cellular Senescence %K Female %K Humans %K Longevity %K Male %K Middle Aged %K Multivariate Analysis %K Odds Ratio %K Public Health Surveillance %K Risk Factors %K Stress, Psychological %K Telomere %K Telomere Shortening %K United States %X

Stress over the lifespan is thought to promote accelerated aging and early disease. Telomere length is a marker of cell aging that appears to be one mediator of this relationship. Telomere length is associated with early adversity and with chronic stressors in adulthood in many studies. Although cumulative lifespan adversity should have bigger impacts than single events, it is also possible that adversity in childhood has larger effects on later life health than adult stressors, as suggested by models of biological embedding in early life. No studies have examined the individual vs. cumulative effects of childhood and adulthood adversities on adult telomere length. Here, we examined the relationship between cumulative childhood and adulthood adversity, adding up a range of severe financial, traumatic, and social exposures, as well as comparing them to each other, in relation to salivary telomere length. We examined 4,598 men and women from the US Health and Retirement Study. Single adversities tended to have nonsignificant relations with telomere length. In adjusted models, lifetime cumulative adversity predicted 6% greater odds of shorter telomere length. This result was mainly due to childhood adversity. In adjusted models for cumulative childhood adversity, the occurrence of each additional childhood event predicted 11% increased odds of having short telomeres. This result appeared mainly because of social/traumatic exposures rather than financial exposures. This study suggests that the shadow of childhood adversity may reach far into later adulthood in part through cellular aging.

%B Proc Natl Acad Sci U S A %V 113 %P E6335-E6342 %8 2016 10 18 %G eng %U http://www.pnas.org/content/113/42/E6335.long %N 42 %1 http://www.ncbi.nlm.nih.gov/pubmed/27698131?dopt=Abstract %R 10.1073/pnas.1525602113 %0 Journal Article %J Social Science and Medicine %D 2016 %T Marital disruption is associated with shorter salivary telomere length in a probability sample of older adults %A Mark A Whisman %A Robustelli, Briana L. %A Sbarra, David A. %K Adult children %K Demographics %X Rationale: Marital disruption (i.e., marital separation, divorce) is associated with a wide range of poor mental and physical health outcomes, including increased risk for all-cause mortality. One biological intermediary that may help explain the association between marital disruption and poor health is accelerated cellular aging. Objective: This study examines the association between marital disruption and salivary telomere length in a United States probability sample of adults 50 years of age. Method: Participants were 3526 individuals who participated in the 2008 wave of the Health and Retirement Study. Telomere length assays were performed using quantitative real-time polymerase chain reaction (qPCR) on DNA extracted from saliva samples. Health and lifestyle factors, traumatic and stressful life events, and neuroticism were assessed via self-report. Linear regression analyses were conducted to examine the associations between predictor variables and salivary telomere length. Results: Based on their marital status data in the 2006 wave, people who were separated or divorced had shorter salivary telomeres than people who were continuously married or had never been married, and the association between marital disruption and salivary telomere length was not moderated by gender or neuroticism. Furthermore, the association between marital disruption and salivary telomere length remained statistically significant after adjusting for demographic and socioeconomic variables, neuroticism, cigarette use, body mass, traumatic life events, and other stressful life events. Additionally, results revealed that currently married adults with a history of divorce evidenced shorter salivary telomeres than people who were continuously married or never married. Conclusion: Accelerated cellular aging, as indexed by telomere shortening, may be one pathway through which marital disruption is associated with morbidity and mortality. %B Social Science and Medicine %I 157 %V 157 %P 60-67 %G eng %U http://www.sciencedirect.com/science/article/pii/S0277953616301290 %4 United States/Telomere/Cellular aging/Marital disruption/Divorce/Marital separation %$ 999999 %R 10.1016/j.socscimed.2016.03.029 %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 Book Section %B Handbook of the Life Course %D 2016 %T Military Service in Lives: Where Do We Go From Here? %A Andrew S London %A Janet M Wilmoth %K Military service %K Older Adults %K Veterans %X Although the military has enduring effects on the lives of service members and their families, it is often overlooked as an institutional force that shapes the life course. This chapter aims to bring military service to the attention of life-course scholars by: providing a conceptual model for understanding the impact of military service on lives that builds on the core principles of the life-course perspective; reviewing empirical evidence regarding how military service is related to childhood and adolescence, influences the transition to adulthood, and has long-term consequences for various outcomes in mid-to-late life; and identifying methodological challenges and relatively unexplored questions that should be the focus of future inquiry. In doing so, this chapter facilitates an understanding of military service in lives while also underscoring the role of social institutions in shaping the life course. %B Handbook of the Life Course %I Springer %P 277-300 %G eng %0 Journal Article %J Journal of the American Medical Directors Association %D 2016 %T Modifiable Risk Factors for New-Onset Slow Gait in Older Adults %A Joe Verghese %A Wang, Cuiling %A Allali, Gilles %A Holtzer, Roee %A Emmeline Ayers %K Health Conditions and Status %K Healthcare %X AbstractObjective Despite the growing importance of slow gait as a universal screen of health, systematic investigation of risk factors for incident slow gait is lacking. Our objective was to identify potentially modifiable risk factors for incident slow gait. Design Prospective cohort study. Setting The Health and Retirement Study, a nationally representative US sample. Participants A total of 2306 individuals age 65 and older (56.5 women) from the 2008 wave with timed walks at baseline and 4 years later. Measurements Incident slow gait (walking speed 1 SD below age and sex means) was the outcome. Fifteen potentially modifiable medical and lifestyle risk factors were examined as predictors. Results Incident slow gait developed in 243 participants (11 ) at 4 years. Physical inactivity (adjusted relative risk aRR 1.94), cognitive impairment (aRR 1.77), muscle weakness (aRR 1.48), pain (aRR 1.45), obesity (aRR 1.35), vision (aRR 1.36), and falls (aRR 1.32) predicted increased risk of developing incident slow gait. Together, these risk factors accounted for 77 (95 confidence interval 14 95) of the Population Attributable Risk for incident slow gait. Conclusion A limited set of potentially modifiable risk factors is associated with new-onset slow gait in older adults. These findings provide a foundation for developing clinical guidelines and preventive interventions for slow gait. %B Journal of the American Medical Directors Association %I 17 %V 17 %P 421-425 %G eng %U http://www.sciencedirect.com/science/article/pii/S1525861016000554 %N 5 %4 epidemiology/incidence %$ 999999 %R 10.1016/j.jamda.2016.01.017 %0 Journal Article %J Archives of Gerontology and Geriatrics %D 2016 %T Modifiable risk factors for nursing home admission among individuals with high and low dementia risk %A Pamela M. Rist %A Thu T Nguyen %A Rachel A Whitmer %A M. Maria Glymour %K Health Conditions and Status %K Healthcare %K Risk Taking %X AbstractBackground Strategies to prevent or delay nursing home admission in individuals with cognitive impairment are urgently needed. We hypothesized that physical inactivity, not consuming alcohol (as opposed to moderate alcohol use), and having a history of smoking predict nursing home admission among individuals with normal cognitive function, but these behavioral factors would have attenuated associations with nursing home admission among individuals with impaired cognition. Methods We performed a prospective cohort study among 7631 Health and Retirement Study participants aged 65 at baseline. Baseline dementia risk (high versus low, based on brief psychometric assessments and proxy reports) and modifiable risk factors (physical inactivity, ever smoking, and not consuming alcohol) were used to predict nursing home admission in pooled logistic regression models. We evaluated whether estimated effects of modifiable factors varied by dementia risk, comparing both relative and absolute effects using interaction terms between dementia risk and each modifiable risk factor. Results Low dementia probability was associated with lower nursing home admission risk (RR = 0.49; 95 CI: 0.41, 0.59). Physical inactivity (RR = 1.27; 95 CI: 1.15, 1.41), ever smoking (RR = 1.12; 95 CI: 1.01, 1.25), and not consuming alcohol (RR = 1.28; 95 CI: 1.13, 1.45) predicted increased relative risk of nursing home admission regardless of cognitive status. The relative effects of modifiable risk factors were similar for those with low and high dementia risk. Conclusion Although cognitive impairment associated with incipient dementia strongly predicts nursing home admission, this risk can be partially ameliorated with modifiable risk factors such as physical activity. %B Archives of Gerontology and Geriatrics %I 65 %V 65 %P 140-145 %G eng %U http://www.sciencedirect.com/science/article/pii/S0167494316300565 %4 Nursing home/Risk factors/Cognitive function/Epidemiology %$ 999999 %R 10.1016/j.archger.2016.03.016 %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 Occupational Transitions at Older Ages: What Moves are People Making? %A Amanda Sonnega %A McFall, Brooke Helppie %A Robert J. Willis %K Employment and Labor Force %K Older Adults %K Transitions %X Given the clear benefit for both public and private finances of extending work lives, many policymakers are interested in finding and promoting ways to accomplish this objective while balancing concerns for work ability at older ages. At the same time, retirement itself is transforming from a simple transition from full-time work to full and permanent retirement to more of a process, potentially occurring in several stages over a number of years. We consider a set of work transitions at ages when the largest numbers of people are retiring and potentially pursuing different paths to full and permanent retirement. Among workers who transition between occupations, the most common transitions are between those that are closely related. However, even within closely related occupations, there are no large pipelines between any two. By age 62, 57 percent of workers are no longer in the labor force, 26 percent are still in their “career” occupation, and 17 percent have changed from their career occupation to another occupation. Beginning at age 66, however, the percentages in different occupations, which may be bridge employment or unretirement, are very similar to the percentages remaining in career occupations. Occupational changes later in life tend to be accompanied by decreases in hourly earnings, suggesting that if workers are seeking flexible or part-time bridge employment, it may come at a cost. %B Working Paper Series %I Michigan Retirement Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %8 09/2016 %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp352.pdf %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 Report %D 2016 %T Pension Participation, Wealth, and Income: 1992-2010 %A Alicia H. Munnell %A Wenliang Hou %A Anthony Webb %A Yinji Li %X Using data from the 1992, 1998, 2004, and 2010 waves of the Health and Retirement Study (HRS), this paper compares pension participation, pension wealth, projected retirement income, and replacement rates attributable to past service, by pension type for households ages 51-56. The analysis includes workers’ pension coverage during both current and past jobs. Defined contribution (DC) wealth is simply the current account balance. DC income is calculated by projecting current plan balances to retirement, assuming no further contributions, and assuming that households then annuitize. Defined benefit (DB) wealth and income are calculated by apportioning projected benefits to past and future service. %B CRR Working Paper Series %I Center for Retirement Research at Boston College %G eng %U http://crr.bc.edu/working-papers/pension-participation-wealth-and-income-1992-2010/ %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 J Pers Soc Psychol %D 2016 %T Personality trait development at the end of life: Antecedents and correlates of mean-level trajectories. %A Wagner, Jenny %A Ram, Nilam %A Jacqui Smith %A Denis Gerstorf %K Aged %K Aged, 80 and over %K Aging %K Anxiety Disorders %K Berlin %K Extraversion, Psychological %K Female %K Health Status %K Human Development %K Humans %K Internal-External Control %K Longitudinal Studies %K Male %K Neuroticism %K Personality %K Social Support %X

Empirical evidence over the past 20 years has documented that key aspects of personality traits change during adulthood. However, it is essentially an open question whether and how traits change at the very end of life and what role health, cognitive performance, perceived control, and social factors play in those changes. To examine these questions, we applied growth models to 13-year longitudinal data obtained from now-deceased participants in the Berlin Aging Study (N = 463; age at baseline M = 85.9 years, SD = 8.4; 51% men). Results revealed that neuroticism, on average, increases (about 0.3 SD in the last 10 years) and that this increase becomes even steeper at the end of life. In contrast, extraversion and openness decline rather steadily at the end of life (about -0.5 SD in the last 10 years). Additionally, poor health manifested as a risk factor for declines in extraversion and openness late in life but not neuroticism. Similar to earlier phases of life, better cognitive performance related to more openness. More loneliness was associated with higher neuroticism, whereas more social activity was associated with higher levels of extraversion and openness. Intriguing additional insights indicated that more personal control was associated with higher levels of extraversion and openness, whereas the feeling that one's life is controlled by others was associated with higher neuroticism but also with higher openness closer to death. We discuss potential pathways by which health, cognitive performance, control, and social inclusion resources and risk factors affect personality development late in life. (PsycINFO Database Record

%B J Pers Soc Psychol %V 111 %P 411-29 %8 2016 09 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/26479363?dopt=Abstract %R 10.1037/pspp0000071 %0 Journal Article %J J Urban Health %D 2016 %T Physical and/or Cognitive Impairment, Out-of-Pocket Spending, and Medicaid Entry among Older Adults. %A Willink, Amber %A Davis, Karen %A Schoen, Cathy %A Jennifer L. Wolff %K Aged %K Cognitive Dysfunction %K Delivery of Health Care %K Disabled Persons %K Eligibility Determination %K Female %K Financing, Personal %K Humans %K Insurance Coverage %K Insurance, Health %K Male %K Medicaid %K Middle Aged %K United States %X

While Medicare provides health insurance coverage for those over 65 years of age, many still are underinsured, experiencing substantial out-of-pocket costs for covered and non-covered services as a proportion of their income. Using the Health and Retirement Study (HRS), this study found that being underinsured is a significant predictor of entering into Medicaid coverage over a 16-year period. The rate of entering Medicaid was almost twice as high for those who were underinsured and with physical and/or cognitive impairment than those who were not, while supplemental health insurance reduced the rate of entering Medicaid by 30 %. Providing more comprehensive coverage through the traditional Medicare program, including a ceiling on out-of-pocket expenditures or targeted support for those with physical or cognitive impairment, could postpone becoming covered by Medicaid and yield savings in Medicaid.

%B J Urban Health %V 93 %P 840-850 %8 2016 10 %G eng %U https://link.springer.com/article/10.1007%2Fs11524-016-0078-1 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27653385?dopt=Abstract %R 10.1007/s11524-016-0078-1 %0 Journal Article %J BMC Health Serv Res %D 2016 %T A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf. %A Frederic D Wolinsky %A Ayres, Lioness %A Michael P Jones %A Yiyue Lou %A George L Wehby %A Fred A Ullrich %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Epidemiologic Methods %K Female %K Health Status %K Hospitalization %K Humans %K Iowa %K Male %K Medicare %K Middle Aged %K Patient Acceptance of Health Care %K Physicians %K Proxy %K Spouses %K United States %X

BACKGROUND: Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.

METHODS: We used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.

RESULTS: PABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = -0.21 to 0.60) for health ratings, and physician and dental visits.

CONCLUSIONS: These results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses' Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.

%B BMC Health Serv Res %V 16 %P 485 %8 2016 09 09 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27612571?dopt=Abstract %R 10.1186/s12913-016-1734-6 %0 Journal Article %J PLoS Genet %D 2016 %T Pleiotropic Associations of Allelic Variants in a 2q22 Region with Risks of Major Human Diseases and Mortality. %A Alexander M Kulminski %A He, Liang %A Culminskaya, Irina %A Loika, Yury %A Kernogitski, Yelena %A Konstantin G Arbeev %A Loiko, Elena %A Liubov S Arbeeva %A Bagley, Olivia %A Duan, Matt %A Arseniy P Yashkin %A Fang, Fang %A Kovtun, Mikhail %A Svetlana Ukraintseva %A Wu, Deqing %A Anatoliy Yashin %E Barsh, Gregory S. %K Activin Receptors, Type II %K Atherosclerosis %K Chromosomes, Human, Pair 2 %K Coronary Disease %K Diabetes Mellitus %K Female %K Genetic Association Studies %K Genetic Diseases, Inborn %K Genetic Pleiotropy %K Genetic Predisposition to Disease %K Genome-Wide Association Study %K Heart Failure %K Homeodomain Proteins %K Humans %K Male %K Repressor Proteins %K Risk Factors %K Stroke %K Zinc Finger E-box Binding Homeobox 2 %X

Gaining insights into genetic predisposition to age-related diseases and lifespan is a challenging task complicated by the elusive role of evolution in these phenotypes. To gain more insights, we combined methods of genome-wide and candidate-gene studies. Genome-wide scan in the Atherosclerosis Risk in Communities (ARIC) Study (N = 9,573) was used to pre-select promising loci. Candidate-gene methods were used to comprehensively analyze associations of novel uncommon variants in Caucasians (minor allele frequency~2.5%) located in band 2q22.3 with risks of coronary heart disease (CHD), heart failure (HF), stroke, diabetes, cancer, neurodegenerative diseases (ND), and mortality in the ARIC study, the Framingham Heart Study (N = 4,434), and the Health and Retirement Study (N = 9,676). We leveraged the analyses of pleiotropy, age-related heterogeneity, and causal inferences. Meta-analysis of the results from these comprehensive analyses shows that the minor allele increases risks of death by about 50% (p = 4.6×10-9), CHD by 35% (p = 8.9×10-6), HF by 55% (p = 9.7×10-5), stroke by 25% (p = 4.0×10-2), and ND by 100% (p = 1.3×10-3). This allele also significantly influences each of two diseases, diabetes and cancer, in antagonistic fashion in different populations. Combined significance of the pleiotropic effects was p = 6.6×10-21. Causal mediation analyses show that endophenotypes explained only small fractions of these effects. This locus harbors an evolutionary conserved gene-desert region with non-coding intergenic sequences likely involved in regulation of protein-coding flanking genes ZEB2 and ACVR2A. This region is intensively studied for mutations causing severe developmental/genetic disorders. Our analyses indicate a promising target region for interventions aimed to reduce risks of many major human diseases and mortality.

%B PLoS Genet %V 12 %P e1006314 %8 2016 Nov %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/27832070/ %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/27832070?dopt=Abstract %! PLoS Genet %R 10.1371/journal.pgen.1006314 %0 Journal Article %J Osteoporos Int %D 2016 %T Predictors of bone mineral density testing among older women on Medicare. %A Yiyue Lou %A Edmonds, S. W. %A Michael P Jones %A Fred A Ullrich %A George L Wehby %A Cram, P. %A Frederic D Wolinsky %K Absorptiometry, Photon %K Aged %K Bone density %K Delivery of Health Care %K Female %K Humans %K Medicare %K Osteoporosis %K Prospective Studies %K United States %X

Although dual-energy X-ray absorptiometry (DXA) is recommended for all women ≥65 and is covered by Medicare, 40 % of women on Medicare report never having had a DXA. In a longitudinal cohort of 3492 women followed for two decades, we identified several risk factors that should be targeted to improve DXA testing rates.

INTRODUCTION: DXA is used to measure bone mineral density, screen for osteoporosis, and assess fracture risk. DXA is recommended for all women ≥65 years old. Although Medicare covers DXA every 24 months for women, about 40 % report never having had a DXA test, and little is known from prospective cohort studies about which subgroups of women have low use rates and should be targeted for interventions. Our objective was to identify predictors of DXA use in a nationally representative cohort of women on Medicare.

METHODS: We used baseline and biennial follow-up survey data (1993-2012) for 3492 women ≥70 years old from the nationally representative closed cohort known as the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The survey data for these women were then linked to their Medicare claims (1991-2012), yielding 17,345 person years of observation. DXA tests were identified from the Medicare claims, and Cox proportional hazard regression models were used with both fixed and time-dependent predictors from the survey interviews including demographic characteristics, socioeconomic factors, health status, health habits, and the living environment.

RESULTS: DXA use was positively associated with being Hispanic American, better cognition, higher income, having arthritis, using other preventative services, and living in Florida or other southern states. DXA use was negatively associated with age, being African-American, being overweight or obese, having mobility limitations, and smoking.

CONCLUSIONS: Interventions to increase DXA use should target the characteristics that were observed here to be negatively associated with such screening.

%B Osteoporos Int %V 27 %P 3577-3586 %8 2016 12 %G eng %U http://link.springer.com/10.1007/s00198-016-3688-2 %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/27358177?dopt=Abstract %! Osteoporos Int %R 10.1007/s00198-016-3688-2 %0 Journal Article %J Gerontologist %D 2016 %T Promoting and Protecting Against Stigma in Assisted Living and Nursing Homes. %A Zimmerman, Sheryl %A Dobbs, Debra %A Roth, Erin G %A Goldman, Susan %A Peeples, Amanda D %A Wallace, Brandy %K Aged %K Aged, 80 and over %K Aging %K Anthropology, Cultural %K Assisted Living Facilities %K Attitude of Health Personnel %K Female %K Humans %K Male %K Nursing homes %K Prejudice %K Social Stigma %X

PURPOSE OF THE STUDY: To determine the extent to which structures and processes of care in multilevel settings (independent living, assisted living, and nursing homes) result in stigma in assisted living and nursing homes.

DESIGN AND METHODS: Ethnographic in-depth interviews were conducted in 5 multilevel settings with 256 residents, families, and staff members. Qualitative analyses identified the themes that resulted when examining text describing either structures of care or processes of care in relation to 7 codes associated with stigma.

RESULTS: Four themes related to structures of care and stigma were identified, including the physical environment, case mix, staff training, and multilevel settings; five themes related to processes of care and stigma, including dining, independence, respect, privacy, and care provision. For each theme, examples were identified illustrating how structures and processes of care can potentially promote or protect against stigma.

IMPLICATIONS: In no instance were examples or themes identified that suggested the staff intentionally promoted stigma; on the other hand, there was indication that some structures and processes were intentionally in place to protect against stigma. Perhaps the most important theme is the stigma related to multilevel settings, as it has the potential to reduce individuals' likelihood to seek and accept necessary care. Results suggest specific recommendations to modify care and reduce stigma.

%B Gerontologist %V 56 %P 535-47 %8 2016 06 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/24928555 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24928555?dopt=Abstract %4 Assisted living, stigma, older adults, independence %R 10.1093/geront/gnu058 %0 Journal Article %J International Journal of Geriatric Psychiatry %D 2016 %T Racial and ethnic differences in cognitive function among older adults in the USA. %A Díaz-Venegas, Carlos %A Brian Downer %A Kenneth M. Langa %A Rebeca Wong %K African Americans %K Aged %K Aged, 80 and over %K Cognition %K Ethnic Groups %K European Continental Ancestry Group %K Female %K Hispanic Americans %K Humans %K Male %K Middle Aged %K United States %X

OBJECTIVE: Examine differences in cognition between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) older adults in the United States.

DATA/METHODS: The final sample includes 18 982 participants aged 51 or older who received a modified version of the Telephone Interview for Cognitive Status during the 2010 Health and Retirement Study follow-up. Ordinary least squares will be used to examine differences in overall cognition according to race/ethnicity.

RESULTS: Hispanics and NHB had lower cognition than NHW for all age groups (51-59, 60-69, 70-79, 80+). Hispanics had higher cognition than NHB for all age groups but these differences were all within one point. The lower cognition among NHB compared to NHW remained significant after controlling for age, gender, and education, whereas the differences in cognition between Hispanics and NHW were no longer significant after controlling for these covariates. Cognitive scores increased with greater educational attainment for all race/ethnic groups, but Hispanics exhibited the least benefit.

DISCUSSION: Our results highlight the role of education in race/ethnic differences in cognitive function during old age. Education seems beneficial for cognition in old age for all race/ethnic groups, but Hispanics appear to receive a lower benefit compared to other race/ethnic groups. Further research is needed on the racial and ethnic differences in the pathways of the benefits of educational attainment for late-life cognitive function. Copyright © 2016 John Wiley & Sons, Ltd.

%B International Journal of Geriatric Psychiatry %V 31 %P 1004-1012 %G eng %N 9 %4 Racial differences Whites Hispanics Non-Hispanic Whites Non-Hispanic Blacks Older Adults Cognitive function %R 10.1002/gps.4410 %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 Occup Med Health Aff %D 2016 %T Respiratory Cancer and Non-Malignant Respiratory Disease-Related Mortality among Older Construction Workers-Findings from the Health and Retirement Study. %A Wang, Xuanwen %A Xiuwen S Dong %A Welch, Laura %A Largay, Julie %X

OBJECTIVE: This study explored the risk of respiratory cancer and non-malignant respiratory disease (NMRD)-related mortality among older construction workers.

METHODS: Analyzed data from the 1992-2010 RAND Health and Retirement Study (HRS) and the HRS National Death Index - Cause of Death file. About 25,183 workers aged 50 years and older were examined, including 5,447 decedents and 19,736 survivors, of which 1,460 reported their longest job was in construction. Multinomial logistic regression assessed the differences in mortality between workers' longest occupations, controlling for confounders.

RESULTS: After adjusting for smoking and demographics, construction workers were almost twice as likely to die from respiratory cancer (OR = 1.65; CI: 1.10-2.47) or NMRD (OR = 1.73; CI: 1.16-2.58) compared to white-collar workers.

CONCLUSIONS: This study adds to the growing evidence that respiratory cancer and NMRD are frequently associated with construction exposure.

%B Occup Med Health Aff %V 4 %P 235 %8 2016 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975376/ %1 http://www.ncbi.nlm.nih.gov/pubmed/27500180?dopt=Abstract %R 10.4172/2329-6879.1000235 %0 Journal Article %J Issue Brief (Commonwealth Fund) %D 2016 %T Risks for nursing home placement and Medicaid entry among older Medicare beneficiaries with physical or cognitive impairment. %A Willink, Amber %A Davis, Karen %A Schoen, Cathy %K Cognitive Ability %K Disabilities %K Medicare/Medicaid/Health Insurance %K Nursing homes %X Issue: More than half of individuals who age into Medicare will experience physical and/or cognitive impairment (PCI) at some point that hinders independent living and requires long-term services and supports. As a result of Medicare’s limits on covered services, Medicare beneficiaries with PCI experience financial burdens and reduced ability to live independently. Goal: Describe the characteristics and health spending of Medicare beneficiaries with PCI and estimate the likelihood of Medicaid entry and long-term nursing home placement. Methods: The Health and Retirement Study 1998–2012 is used to estimate long-term nursing home placement, as well as Medicaid entry. The Medicare Current Beneficiary Survey 2012 provides information on health care spending and utilization. Key findings and conclusions: Almost two-thirds of community-dwelling Medicare beneficiaries with PCI have three or more chronic conditions. More than one-third of those with PCI have incomes less than 200 percent of the federal poverty level but are not covered by Medicaid; almost half spend 10 percent or more of their incomes out-of-pocket on health care. Nineteen percent of individuals with PCI and high out-of-pocket costs entered Medicaid over 14 years, compared to 10 percent without PCI and low out-of-pocket costs. %B Issue Brief (Commonwealth Fund) %V 37 %P 1-14 %8 2016 Oct %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/27827434?dopt=Abstract %0 Journal Article %J J Am Geriatr Soc %D 2016 %T Self-Reported Hearing in the Last 2 Years of Life in Older Adults. %A Christine S Ritchie %A Yinghui Miao %A W John Boscardin %A Margaret Wallhagen %K Activities of Daily Living %K Aged %K Aged, 80 and over %K California %K Demography %K Female %K Hearing aids %K Hearing loss %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prevalence %K Quality of Life %K Risk Factors %K Self Report %K Vulnerable Populations %X

OBJECTIVES: To assess the prevalence and correlates of self-reported hearing loss during the last 2 years of life.

DESIGN: Observational cohort study.

SETTING: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of adults aged 50 and older (2000-13).

PARTICIPANTS: Older adults (N = 5,895, mean age at death 78, 53% female, 20% nonwhite).

MEASUREMENTS: The HRS interview closest to death was used (mean 12.2 months before death). Participants rated their hearing (excellent, very good, good, fair, poor) and indicated whether they used hearing aids. The prevalence and correlates of fair and poor ratings are described, adjusted for age and sex.

RESULTS: Thirty-two percent (95% confidence interval (CI) = 31-34%) of all participants and 60% (95% CI = 57-64%) of the 7% of participants who used hearing aids rated their hearing as fair or poor. The prevalence of fair or poor hearing was highest in participants interviewed closest to death (29% 19-24 months before death, 36% 1-6 months before death, P for trend = .01). Correlates of fair or poor hearing during the last 2 years of life included age at death (50-59, 22%; 60-69, 21%; 70-79, 26%; 80-89, 38%; ≥90, 50%), sex (men 35%, women 30%), race and ethnicity (Hispanic 42%, white 33%), wealth (lowest quartile 38%, highest quartile 27%), history of heart disease (yes 38%, no 27%), activity of daily living dependence (yes 42%, no 26%), difficulty taking medications (yes 46%, no 29%), and probable dementia (yes 44%, no 24%).

CONCLUSION: Self-reported hearing loss increases during the last 2 years of life and is associated with physical and social vulnerability.

%B J Am Geriatr Soc %V 64 %P 1486-91 %8 2016 07 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27341383 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27341383?dopt=Abstract %R 10.1111/jgs.14145 %0 Report %D 2016 %T Social Security and Retirement Programs Around the World: The Capacity to Work at Older Ages - Introduction and Summary %A Courtney Coile %A Kevin Milligan %A David A Wise %K Disabilities %K Employment and Labor Force %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X This is the introduction and summary to the seventh phase of an ongoing project on Social Security Programs and Retirement Around the World. The project compares the experiences of a dozen developed countries and uses differences in their retirement program provisions to explore the effect of SS on retirement and related questions. The first three phases of this project document that: 1) incentives for retirement from SS are strongly correlated with labor force participation rates across countries; 2) within countries, workers with stronger incentives to delay retirement are more likely to do so; and 3) changes to SS could have substantial effects on labor force participation and government finances. The fourth volume explores whether higher employment among older persons might increase youth unemployment and finds no link between the two. The fifth and sixth volumes focus on the disability insurance (DI) program, finding that changes in DI participation are more closely linked to DI reforms than to changes in health and that reducing access to DI would raise labor supply. This seventh phase of the project explores whether older people are healthy enough to work longer. We use two main methods to estimate the health capacity to work, asking how much older individuals today could work if they worked as much as those with the same mortality rate in the past or as younger individuals in similar health. Both methods suggest there is significant additional health capacity to work at older ages. %I Cambridge, MA: National Bureau of Economic Research %G eng %U https://www.nber.org/papers/w21939 %4 Social Security/labor Force Participation/retirement planning/Public Policy/disability insurance %$ 999999 %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 International Journal of Methods in Psychiatric Research %D 2016 %T Subjective cognitive impairment of older adults: a comparison between the US and China %A Bei Wu %K Cross-National %K Health Conditions and Status %K Methodology %X Subjective assessment may be incomparable across countries due to differences in reporting styles. Based on two nationally representative surveys from the US and China, this study used data from three anchoring vignettes to estimate to what extent the US and Chinese older adults aged 50 and above differed in their reporting styles of subjective cognitive impairment. Cross country differences of subjective cognitive impairment were then estimated, both before and after adjusting for reporting heterogeneity. Directly assessed word recall test scores were analyzed to evaluate whether findings based on subjective cognitive impairment was consistent with objective performance. The results revealed a discrepancy between self-reported subjective cognitive impairment and directly assessed memory function among older adults: while Chinese respondents reported lower severity levels of subjective cognitive impairment, the US respondents demonstrated better performance in immediate word recall tests. By accounting for differences in reporting styles using anchoring vignettes data, Chinese older adults showed higher levels of subjective cognitive impairment than the US older adults, which was consistent with results from direct assessment of memory function. Non-negligible differences are present in reporting styles of subjective cognitive impairment. Cross country comparison needs to take into account such reporting heterogeneity. %B International Journal of Methods in Psychiatric Research %I 25 %V 25 %P 68-75 %G eng %N 1 %4 cross-national comparison/cross Cultural Comparison/CHARLS/Chinese older adults/Cognition/cognitive Impairment/memory functioning %$ 999999 %R 10.1002/mpr.1499 %0 Journal Article %J Exp Gerontol %D 2016 %T Telomere length and health outcomes: A two-sample genetic instrumental variables analysis. %A Hamad, Rita %A Stefan Walter %A David Rehkopf %K Aged %K Aging %K Coronary Artery Disease %K Databases, Factual %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Molecular Epidemiology %K Polymorphism, Single Nucleotide %K Self Report %K Telomere %K Telomere Homeostasis %K United States %X

OBJECTIVE: Previous studies linking telomere length (TL) and health have been largely associational. We apply genetic instrumental variables (IV) analysis, also known as Mendelian randomization, to test the hypothesis that shorter TL leads to poorer health. This method reduces bias from reverse causation or confounding.

METHODS: We used two approaches in this study that rely on two separate data sources: (1) individual-level data from the Health and Retirement Study (HRS) (N=3734), and (2) coefficients from genome-wide association studies (GWAS). We employed two-sample genetic IV analyses, constructing a polygenic risk score (PRS) of TL-associated single nucleotide polymorphisms. The first approach examined the association of the PRS with nine individual health outcomes in HRS. The second approach took advantage of estimates available in GWAS databases to estimate the impact of TL on five health outcomes using an inverse variance-weighted meta-analytic technique.

RESULTS: Using individual-level data, shorter TL was marginally statistically significantly associated with decreased risk of stroke and increased risk of heart disease. Using the meta-analytic approach, shorter TL was associated with increased risk of coronary artery disease (OR 1.02 per 100 base pairs, 95%CI: 1.00, 1.03).

DISCUSSION: With the exception of a small contribution to heart disease, our findings suggest that TL may be a marker of disease rather than a cause. They also demonstrate the utility of the inverse variance-weighted meta-analytic approach when examining small effect sizes.

%B Exp Gerontol %V 82 %P 88-94 %8 2016 09 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27321645 %1 http://www.ncbi.nlm.nih.gov/pubmed/27321645?dopt=Abstract %R 10.1016/j.exger.2016.06.005 %0 Journal Article %J Int J Geriatr Psychiatry %D 2016 %T Trajectories of depressive symptoms and oral health outcomes in a community sample of older adults. %A Celia F. Hybel %A Joan M. Bennett %A Lawrence R Landerman %A Jersey Liang %A Brenda L Plassman %A Bei Wu %K Aged %K Aged, 80 and over %K Chronic disease %K Depressive Disorder %K Female %K Humans %K Longitudinal Studies %K Male %K Oral Health %K Regression Analysis %X

OBJECTIVE: Adverse outcomes associated with chronic depressive symptoms are of clinical importance. The objective was to identify subgroups of older adults based on their trajectories of depressive symptoms over a 10-year period and determine if these subgroups predicted oral health outcomes.

METHODS: The sample was 944 adults aged 65+ who participated in the oral health module of the the Health and Retirement Survey in 2008. Depressive symptoms were measured with a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. Latent class trajectory analysis was used to identify distinct subgroups of elders based on their CES-D scores from 1998-2008. Group membership was used to predict self-rated oral health, overall mouth condition (problems with bleeding gums, gum sensitivity, and food avoidance), and edentulism in 2008.

RESULTS: Three distinct subgroups were identified using zero-inflated Poisson regression models: (i) minimal depressive symptoms over the study period (43%), (ii) low but generally stable level of depressive symptoms (41%), and (iii) moderate symptoms and higher CES-D scores than the other groups over the 10 years (16%). Controlling for demographic and health variables and edentulism status, having a trajectory of moderate symptoms was associated with poorer mouth condition (p < 0.0001) and poorer self-rated oral health (p = 0.0003) compared with those with minimal symptoms. Having low levels of depressive symptoms was not significantly associated with these two outcomes. Group membership was not significantly associated with the probability of edentulism.

CONCLUSIONS: Chronic moderate depressive symptoms are associated with poorer oral health in older adults.

%B Int J Geriatr Psychiatry %I 31 %V 31 %P 83-91 %8 2016 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25962827?dopt=Abstract %2 PMC4641817 %4 Depressive symptoms/Edentulism/Latent class trajectory analysis/Oral health %$ 999999 %R 10.1002/gps.4292 %0 Journal Article %J American Journal of Hospice and Palliative Medicine %D 2016 %T Trends in Engagement in Advance Care Planning Behaviors and the Role of Socioeconomic Status %A Khosla, Nidhi %A Angela L Curl %A Washington, Karla T. %K Demographics %K End of life decisions %K Methodology %K Retirement Planning and Satisfaction %X We investigated the trends in advance care planning (ACP) between 2002 and 2010 and whether socioeconomic status explained such trends. We conducted a pooled regression analysis of Health and Retirement Study data from 6052 proxies of deceased individuals. We studied 3 ACP behaviors, discussing end-of-life (EOL) care preferences, providing written EOL care instructions, and appointing a durable power of attorney for health care (DPAHC). ACP increased by 12 to 23 every 2 years from 2002 to 2010. Higher household income increased the odds of having a DPAHC. Education was not associated with ACP. Socioeconomic status alone appears to play a very limited role in predicting ACP. Engagement in ACP likely depends on a constellation of many social and contextual factors. %B American Journal of Hospice and Palliative Medicine %V 33 %P 651-657 %G eng %U http://ajh.sagepub.com/content/early/2015/04/20/1049909115581818.abstract %N 7 %4 advance care planning/advance directives/socioeconomic status/health and retirement study/older adults/end-of-life care %$ 999999 %& 651 %R 10.1177/1049909115581818 %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 Report %D 2016 %T Validating Mortality Ascertainment in the Health and Retirement Study %A David R Weir %X Accurate tracking of mortality is of central importance in longitudinal studies of older populations, both as an important health outcome and as a necessary part of accounting for the representativeness of the panel over time. For nationally representative studies where good population life tables exist the quality of mortality ascertainment can be validated by comparison with life tables. This is demonstrated here for the Health and Retirement Study (HRS), using both period and cohort comparisons from 1992-2011. Mortality ascertainment in the HRS is effectively complete. %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %8 11/2016 %G eng %0 Journal Article %J Mol Psychiatry %D 2015 %T The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects. %A Wouter J Peyrot %A Lee, S H %A Milaneschi, Y %A Abdel Abdellaoui %A Byrne, E M %A Tõnu Esko %A Eco J. C. de Geus %A Hemani, G %A Jouke-Jan Hottenga %A Kloiber, S %A Douglas F Levinson %A Lucae, S %A Nicholas G Martin %A Sarah E Medland %A Andres Metspalu %A Lili Milani %A Markus M Nöthen %A Potash, J B %A Rietschel, M %A Cornelius A Rietveld %A Ripke, S %A Jianxin Shi %A Gonneke Willemsen %A Zhihong Zhu %A Dorret I Boomsma %A Naomi R. Wray %A Brenda W J H Penninx %K Adult %K Aged %K Cohort Studies %K Depressive Disorder, Major %K Educational Status %K Estonia %K Female %K Gene-Environment Interaction %K Genetic Association Studies %K Genotype %K Humans %K Likelihood Functions %K Male %K Middle Aged %K Netherlands %K Odds Ratio %K Polymorphism, Single Nucleotide %K Psychiatric Status Rating Scales %K Regression Analysis %X

An association between lower educational attainment (EA) and an increased risk for depression has been confirmed in various western countries. This study examines whether pleiotropic genetic effects contribute to this association. Therefore, data were analyzed from a total of 9662 major depressive disorder (MDD) cases and 14,949 controls (with no lifetime MDD diagnosis) from the Psychiatric Genomics Consortium with additional Dutch and Estonian data. The association of EA and MDD was assessed with logistic regression in 15,138 individuals indicating a significantly negative association in our sample with an odds ratio for MDD 0.78 (0.75-0.82) per standard deviation increase in EA. With data of 884,105 autosomal common single-nucleotide polymorphisms (SNPs), three methods were applied to test for pleiotropy between MDD and EA: (i) genetic profile risk scores (GPRS) derived from training data for EA (independent meta-analysis on ~120,000 subjects) and MDD (using a 10-fold leave-one-out procedure in the current sample), (ii) bivariate genomic-relationship-matrix restricted maximum likelihood (GREML) and (iii) SNP effect concordance analysis (SECA). With these methods, we found (i) that the EA-GPRS did not predict MDD status, and MDD-GPRS did not predict EA, (ii) a weak negative genetic correlation with bivariate GREML analyses, but this correlation was not consistently significant, (iii) no evidence for concordance of MDD and EA SNP effects with SECA analysis. To conclude, our study confirms an association of lower EA and MDD risk, but this association was not because of measurable pleiotropic genetic effects, which suggests that environmental factors could be involved, for example, socioeconomic status.

%B Mol Psychiatry %V 20 %P 735-43 %8 2015 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/25917368?dopt=Abstract %R 10.1038/mp.2015.50 %0 Journal Article %J 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 Journal Article %J Soc Sci Med %D 2015 %T Childhood and later life stressors and increased inflammatory gene expression at older ages. %A Morgan E. Levine %A Steven W. Cole %A David R Weir %A Eileen M. Crimmins %K Adolescent %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Continental Population Groups %K Cyclooxygenase 2 %K Female %K Health Status %K Health Surveys %K Humans %K Interleukin-1beta %K Interleukin-8 %K Life Change Events %K Male %K Middle Aged %K Obesity %K RNA %K Sex Factors %K Smoking %K Socioeconomic factors %K Stress, Psychological %X

Adverse experiences in early life have the ability to "get under the skin" and affect future health. This study examined the relative influence of adversities during childhood and adulthood in accounting for individual differences in pro-inflammatory gene expression in late life. Using a pilot-sample from the Health and Retirement Study (N = 114) aged from 51 to 95, OLS regression models were run to determine the association between a composite score from three proinflammatory gene expression levels (PTGS2, ILIB, and IL8) and 1) childhood trauma, 2) childhood SES, 3) childhood health, 4) adult traumas, and 5) low SES in adulthood. Our results showed that only childhood trauma was found to be associated with increased inflammatory transcription in late life. Furthermore, examination of interaction effects showed that childhood trauma exacerbated the influence of low SES in adulthood on elevated levels of inflammatory gene expression-signifying that having low SES in adulthood was most damaging for persons who had experienced traumatic events during their childhood. Overall our study suggests that traumas experienced during childhood may alter the stress response, leading to more sensitive reactivity throughout the lifespan. As a result, individuals who experienced greater adversity in early life may be at higher risk of late life health outcomes, particularly if adulthood adversity related to SES persists.

%B Soc Sci Med %I 130 %V 130 %P 16-22 %8 2015 Apr %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25658624?dopt=Abstract %2 PMC4394113 %4 childhood health/adverse events/adverse events/trauma %$ 999999 %R 10.1016/j.socscimed.2015.01.030 %0 Journal Article %J Med Care %D 2015 %T Cognitive function and the concordance between survey reports and Medicare claims in a nationally representative cohort of older adults. %A Frederic D Wolinsky %A Michael P Jones %A Fred A Ullrich %A Yiyue Lou %A George L Wehby %K Aged %K Aging %K Cognition Disorders %K Data collection %K Female %K Humans %K Insurance Claim Review %K Male %K Medicare %K Mental Health %K Psychiatric Status Rating Scales %K Self Report %K United States %X

BACKGROUND: While age-related cognitive decline may affect all stages in the response process--comprehension, retrieval, judgment, response selection, and response reporting--the associations between objective cognitive tests and the agreement between self-reports and Medicare claims has not been assessed. We evaluate those associations using the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD).

METHODS: Eight waves of reinterviews (1995-2010) were linked to Medicare claims for 3661 self-respondents yielding 12,313 person-period observations. Cognitive function was measured by 2 episodic memory tests (immediate and delayed recall of 10 words) and 1 mental status test (backward counting, dates, and names). Survey reports on 12 diseases and 4 health services were mapped to Medicare claims to derive counts of concordant reports, underreports, and overreports, as were the numbers of hospital episodes and physician visits. GEE negative binomial and logistic regression models were used.

RESULTS: Better mental status was associated with more concordant reporting and less underreporting on disease history and the number of hospital episodes. Better mental status and delayed word recall were associated with more concordant reporting and less underreporting on health services use. Better delayed recall was significantly associated with less underreporting on the number of physician visits. These associations were not appreciably altered by adjustment for demographic characteristics, socioeconomic status, self-rated health, or secular trends.

CONCLUSION: We recommend that future surveys of older adults include an objective measure of mental status (rather than memory), especially when those survey reports cannot be verified by access to Medicare claims or chart review.

%B Med Care %V 53 %P 455-62 %8 2015 May %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/25793268 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25793268?dopt=Abstract %R 10.1097/MLR.0000000000000338 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2015 %T Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study. %A Stenholm, Sari %A Westerlund, Hugo %A Head, Jenny %A Hyde, Martin %A Ichiro Kawachi %A Pentti, Jaana %A Mika Kivimäki %A Vahtera, Jussi %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Chronic disease %K Comorbidity %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K Socioeconomic factors %K United States %X

BACKGROUND: The number of diseases and physical functioning difficulties tend to increase with age. The aim of this study was to examine the trajectories of physical functioning across age groups and whether the trajectories differ according to disease status in different population subgroups.

METHODS: Repeat data from a nationally representative population sample, the Health and Retirement Study, was used. Participants were 10,709 men and 13,477 women aged 60-107 years at baseline with biennial surveys from 1992 to 2010. Average length of follow-up was 10.3 years ranging from 0 to 18 years. Disease status and physical functioning was asked about at all study phases and 10 items were summed to obtain a physical functioning score (0-10).

RESULTS: Age modified the relationship between number of chronic diseases and physical functioning with older participants having more physical functioning difficulties with increasing number of diseases. An average 70-year-old participant with no diseases had 0.89 (95% CI: 0.85-0.93) physical functioning difficulties, with one disease 1.72 (95% CI: 1.69-1.76) difficulties, with two diseases 2.57 (95% CI: 2.52-2.62) difficulties, and with three or more diseases 3.82 (95% CI: 3.76-3.88) difficulties. Of the individual diseases memory-related diseases, stroke, pulmonary diseases, and arthritis were associated with significantly higher physical functioning difficulties compared with other diseases.

CONCLUSIONS: Comorbidity is associated with greater burden of physical functioning difficulties. Of the studied diseases, memory-related diseases, stroke, pulmonary diseases, and arthritis alone or in combination limit most physical functioning.

%B J Gerontol A Biol Sci Med Sci %I 70 %V 70 %P 332-8 %8 2015 Mar %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2014/07/23/gerona.glu113.abstract %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/25060316?dopt=Abstract %2 PMC4336333 %4 Aging/Comorbidity/Physical functioning/Disability/Disability %$ 999999 %R 10.1093/gerona/glu113 %0 Journal Article %J BMC Genet %D 2015 %T Comparative genome-wide association studies of a depressive symptom phenotype in a repeated measures setting by race/ethnicity in the Multi-Ethnic Study of Atherosclerosis. %A Erin B Ware %A Mukherjee, Bhramar %A Yan V Sun %A Ana V. Diez-Roux %A Sharon L R Kardia %K Atherosclerosis %K Black or African American %K depression %K ethnicity %K Female %K Genome-Wide Association Study %K Humans %K Male %K Meta-Analysis as Topic %K Middle Aged %K Phenotype %K Racial Groups %K Statistics, Nonparametric %K White People %X

BACKGROUND: Time-varying phenotypes have been studied less frequently in the context of genome-wide analyses across ethnicities, particularly for mood disorders. This study uses genome-wide association studies of depressive symptoms in a longitudinal framework and across multiple ethnicities to find common variants for depressive symptoms. Ethnicity-specific GWAS for depressive symptoms were conducted using three approaches: a baseline measure, longitudinal measures averaged over time, and a repeated measures analysis. We then used meta-analysis to jointly analyze the results across ethnicities within the Multi-ethnic Study of Atherosclerosis (MESA, n = 6,335), and then within ethnicity, across MESA and a sample from the Health and Retirement Study African- and European-Americans (HRS, n = 10,163).

METHODS: This study uses genome-wide association studies of depressive symptoms in a longitudinal framework and across multiple ethnicities to find common variants for depressive symptoms. Ethnicity-specific GWAS for depressive symptoms were conducted using three approaches: a baseline measure, longitudinal measures averaged over time, and a repeated measures analysis. We then used meta-analysis to jointly analyze the results across ethnicities within the Multi-ethnic Study of Atherosclerosis (MESA, n = 6,335), and then within ethnicity, across MESA and a sample from the Health and Retirement Study African- and European-Americans (HRS, n = 10,163).

RESULTS: Several novel variants were identified at the genome-wide suggestive level (5×10(-8) < p-value ≤ 5×10(-6)) in each ethnicity for each approach to analyzing depressive symptoms. The repeated measures analyses resulted in typically smaller p-values and an increase in the number of single-nucleotide polymorphisms (SNP) reaching genome-wide suggestive level.

CONCLUSIONS: For phenotypes that vary over time, the detection of genetic predictors may be enhanced by repeated measures analyses.

%B BMC Genet %I 16 %V 16 %P 118 %8 2015 Oct 12 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/26459564?dopt=Abstract %2 PMC4603946 %4 ethnic differences/depressive Symptoms/Sociocultural Factors/African American %$ 999999 %R 10.1186/s12863-015-0274-0 %0 Journal Article %J Human Molecular Genetics %D 2015 %T Contribution of common non-synonymous variants in PCSK1 to body mass index variation and risk of obesity: a systematic review and meta-analysis with evidence from up to 331 175 individuals. %A Nead, Kevin T %A Li, Aihua %A Wehner, Mackenzie R %A Neupane, Binod %A Gustafsson, Stefan %A Adam S Butterworth %A Engert, James C %A Davis, A Darlene %A Hegele, Robert A %A Miller, Ruby %A den Hoed, Marcel %A Khaw, Kay-Tee %A Kilpeläinen, Tuomas O %A Wareham, Nick %A Edwards, Todd L %A Hallmans, Göran %A Varga, Tibor V %A Sharon L R Kardia %A Smith, Jennifer A %A Zhao, Wei %A Jessica Faul %A David R Weir %A Mi, Jie %A Xi, Bo %A Quinteros, Samuel Canizales %A Cooper, Cyrus %A Sayer, Avan Aihie %A Jameson, Karen %A Grøntved, Anders %A Myriam Fornage %A Stephen Sidney %A Hanis, Craig L %A Highland, Heather M %A Häring, Hans-Ulrich %A Heni, Martin %A Lasky-Su, Jessica %A Weiss, Scott T %A Gerhard, Glenn S %A Still, Christopher %A Melka, Melkaey M %A Pausova, Zdenka %A Paus, Tomáš %A Grant, Struan F A %A Hakonarson, Hakon %A Price, R Arlen %A Wang, Kai %A Scherag, Andre %A Hebebrand, Johannes %A Hinney, Anke %A Franks, Paul W %A Timothy M Frayling %A McCarthy, Mark I %A Hirschhorn, Joel N %A Ruth J F Loos %A Ingelsson, Erik %A Gerstein, Hertzel C %A Yusuf, Salim %A Beyene, Joseph %A Anand, Sonia S %A Meyre, David %K Alleles %K Body Mass Index %K Genetic Predisposition to Disease %K Genetic Variation %K Humans %K Obesity %K Odds Ratio %K Polymorphism, Single Nucleotide %K Proprotein Convertase 1 %X

Polymorphisms rs6232 and rs6234/rs6235 in PCSK1 have been associated with extreme obesity [e.g. body mass index (BMI) ≥ 40 kg/m(2)], but their contribution to common obesity (BMI ≥ 30 kg/m(2)) and BMI variation in a multi-ethnic context is unclear. To fill this gap, we collected phenotypic and genetic data in up to 331 175 individuals from diverse ethnic groups. This process involved a systematic review of the literature in PubMed, Web of Science, Embase and the NIH GWAS catalog complemented by data extraction from pre-existing GWAS or custom-arrays in consortia and single studies. We employed recently developed global meta-analytic random-effects methods to calculate summary odds ratios (OR) and 95% confidence intervals (CIs) or beta estimates and standard errors (SE) for the obesity status and BMI analyses, respectively. Significant associations were found with binary obesity status for rs6232 (OR = 1.15, 95% CI 1.06-1.24, P = 6.08 × 10(-6)) and rs6234/rs6235 (OR = 1.07, 95% CI 1.04-1.10, P = 3.00 × 10(-7)). Similarly, significant associations were found with continuous BMI for rs6232 (β = 0.03, 95% CI 0.00-0.07; P = 0.047) and rs6234/rs6235 (β = 0.02, 95% CI 0.00-0.03; P = 5.57 × 10(-4)). Ethnicity, age and study ascertainment significantly modulated the association of PCSK1 polymorphisms with obesity. In summary, we demonstrate evidence that common gene variation in PCSK1 contributes to BMI variation and susceptibility to common obesity in the largest known meta-analysis published to date in genetic epidemiology.

%B Human Molecular Genetics %V 24 %P 3582-3594 %G eng %N 12 %R 10.1093/hmg/ddv097 %0 Journal Article %J Am Heart J %D 2015 %T Cost of informal caregiving for patients with heart failure. %A Heesoo Joo %A Fang, Jing %A Jan L Losby %A Wang, Guijing %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Heart Failure %K Humans %K Linear Models %K Male %K Middle Aged %K Models, Econometric %X

BACKGROUND: Heart failure is a serious health condition that requires a significant amount of informal care. However, informal caregiving costs associated with heart failure are largely unknown.

METHODS: We used a study sample of noninstitutionalized US respondents aged ≥50 years from the 2010 HRS (n = 19,762). Heart failure cases were defined by using self-reported information. The weekly informal caregiving hours were derived by a sequence of survey questions assessing (1) whether respondents had any difficulties in activities of daily living or instrumental activities of daily living, (2) whether they had caregivers because of reported difficulties, (3) the relationship between the patient and the caregiver, (4) whether caregivers were paid, and (5) how many hours per week each informal caregiver provided help. We used a 2-part econometric model to estimate the informal caregiving hours associated with heart failure. The first part was a logit model to estimate the likelihood of using informal caregiving, and the second was a generalized linear model to estimate the amount of informal caregiving hours used among those who used informal caregiving. Replacement approach was used to estimate informal caregiving cost.

RESULTS: The 943 (3.9%) respondents who self-reported as ever being diagnosed with heart failure used about 1.6 more hours of informal caregiving per week than those who did not have heart failure (P < .001). Informal caregiving hours associated with heart failure were higher among non-Hispanic blacks (3.9 hours/week) than non-Hispanic whites (1.4 hours/week). The estimated annual informal caregiving cost attributable to heart failure was $3 billion in 2010.

CONCLUSION: The cost of informal caregiving was substantial and should be included in estimating the economic burden of heart failure. The results should help public health decision makers in understanding the economic burden of heart failure and in setting public health priorities.

%B Am Heart J %I 169 %V 169 %P 142-48.e2 %8 2015 Jan %G eng %U http://search.proquest.com/docview/1634498117/abstract/1B5FA0446C27487FPQ/46http://ac.els-cdn.com/S0002870314006176/1-s2.0-S0002870314006176-main.pdf?_tid=0594e8aa-b649-11e5-862d-00000aab0f6bandacdnat=1452286224_94f2bbbda86fc78991ea145942769029http://medi %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25497259?dopt=Abstract %2 PMC4392718 %4 Caregivers/Chronic illnesses/Costs/Cardiovascular Diseases/Mortality/Older people/Informal caregiver/Health Care Costs %$ 999999 %R 10.1016/j.ahj.2014.10.010 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2015 %T Cross-National Differences in Disability Among Elders: Transitions in Disability in Mexico and the United States. %A Kerstin Gerst %A Rebeca Wong %A Alejandra Michaels-Obregon %A Alberto Palloni %K Aged %K Aged, 80 and over %K Aging %K Cross-Cultural Comparison %K Disabled Persons %K Female %K Humans %K Male %K Mexico %K Middle Aged %K Mortality %K Prevalence %K United States %X

OBJECTIVES: Little is known about how exposure to a combination of infectious and chronic conditions throughout the lifecourse could impact disability in old age. This paper compares 2 cohorts of adults who have aged under very different country contexts by contrasting disability transitions among elders in Mexico with elders in the United States.

METHODS: Data comes from the Mexican Health and Aging Study (MHAS) and the U.S. Health and Retirement Study (HRS). Estimated probabilities of 2-year transitions among disability states and mortality are presented for adults aged 50 and older.

RESULTS: The levels of disability prevalence and 2 year transitions are consistent with a higher rate of disability for the United States compared to Mexico. In 2-year transitions, the U.S. sample was more likely to transition to a disabled state or increase the number of disabilities than the Mexican counterparts, while Mexicans are more likely to move out of disability or reduce the number of disabilities reported.

DISCUSSION: The findings suggest that the current rate of disability in old age is lower for a less developed country compared with a developed society. We discuss implications, possible explanations, and likely future scenarios.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 759-68 %8 2015 Sep %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/01/28/geronb.gbu185.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25633135?dopt=Abstract %2 PMC4635645 %4 Disability/Disability/Elders/Mexico/MHAS_/cross-national comparison/cross Cultural Comparison %$ 999999 %R 10.1093/geronb/gbu185 %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 J Gerontol B Psychol Sci Soc Sci %D 2015 %T Disability Trajectories at the End of Life: A "Countdown" Model. %A Douglas A. Wolf %A Vicki A Freedman %A Jan I Ondrich %A Christopher L Seplaki %A Brenda C Spillman %K Aged %K Aged, 80 and over %K Aging %K Death %K Disabled Persons %K Female %K Humans %K Male %K Time Factors %K United States %X

OBJECTIVES: Studies of late-life disablement typically address the role of advancing age as a factor in developing disability, and in some cases have pointed out the importance of time to death (TTD) in understanding changes in functioning. However, few studies have addressed both factors simultaneously, and none have dealt satisfactorily with the problem of missing data on TTD in panel studies.

METHODS: We fit latent-class trajectory models of disablement using data from the Health and Retirement Study. Among survivors (~20% of the sample), TTD is unknown, producing a missing-data problem. We use an auxiliary regression equation to impute TTD and employ multiple imputation techniques to obtain final parameter estimates and standard errors.

RESULTS: Our best-fitting model has 3 latent classes. In all 3 classes, the probability of having a disability increases with nearness to death; however, in only 2 of the 3 classes is age associated with disability. We find gender, race, and educational differences in class-membership probabilities.

DISCUSSION: The model reveals a complex pattern of age- and time-dependent heterogeneity in late-life disablement. The techniques developed here could be applied to other phenomena known to depend on TTD, such as cognitive change, weight loss, and health care spending.

%B J Gerontol B Psychol Sci Soc Sci %I 70 %V 70 %P 745-52 %8 2015 Sep %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2015/04/23/geronb.gbu182.abstract %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25740918?dopt=Abstract %2 PMC4635644 %4 Disability/Disability/Latent classes/Time to death/Trajectories %$ 999999 %R 10.1093/geronb/gbu182 %0 Journal Article %J International Dental Journal %D 2015 %T Disparity in dental coverage among older adult populations: a comparative analysis across selected European countries and the USA %A Richard J. Manski %A John F Moeller %A Haiyan Chen %A Widstrom, Eeva %A Jinkook Lee %A Listl, Stefan %K Cross-National %K Healthcare %K Insurance %K Public Policy %X Background Insurance against the cost of preventing and treating oral diseases can reduce inequities in dental-care use and oral health. The purpose of this study was to examine the extent of variation in dental insurance coverage for older adult populations within and between the USA and various European countries. Method The analyses relied on 2006 2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and on 2004 2006 data from the Health and Retirement Study (HRS) in the USA for respondents 51 years of age and older. A series of logistic regression models was estimated to identify disparities in dental coverage. Results The highest extent of significant insurance differences between various population subgroups was found for the USA. In comparison with southern and eastern European countries, a lower number of significant differences in coverage was found for Scandinavian countries. Countries categorised as having comprehensive public insurance coverage showed a tendency towards less insurance variation within their populations than did countries categorised as not having comprehensive public coverage. The exceptions were Poland and Switzerland. Conclusions The findings of the present study suggest that significant variations in dental coverage exist within all elderly populations examined and that the extent of inequalities also differs between countries. By and large, the observed variations corroborate the perception that population dental coverage is more equally distributed under public subsidy. This could be relevant information for decision makers who seek to improve policies in order to provide more equitable dental coverage. %B International Dental Journal %V 65 %P 77-88 %8 04/2015 %G eng %U http://dx.doi.org/10.1111/idj.12139 %N 2 %4 SHARE/cross-national comparison/Dental insurance coverage/dental Care/Public Policy/Oral health %$ 999999 %& 77 %R 10.1111/idj.12139 %0 Report %D 2015 %T Do Households Increase Their Savings When the Kids Leave Home? %A Irena Dushi %A Alicia H. Munnell %A Geoffrey T. Sanzenbacher %A Anthony Webb %K Consumption and Savings %K Event History/Life Cycle %K Net Worth and Assets %K Pensions %K Retirement Planning and Satisfaction %X Much of the disagreement over whether households are adequately prepared for retirement reflects differences in assumptions regarding the extent to which consumption declines when the kids leave home. If consumption declines substantially when the kids leave home, as some life-cycle models of retirement saving assume, households need to achieve lower replacement rates in retirement and need to accumulate less wealth. Using administrative tax data from the Health and Retirement Study (HRS), as well as the Survey of Income and Program Participation (SIPP), this paper investigates whether household consumption declines when kids leave the home and, if so, by how much. Because consumption data are noisy and savings is the flip side of consumption, this paper examines whether savings in 401(k) plans increase when the kids leave home. The paper also investigates alternative methods of saving, including non-401(k) savings and increased mortgage payments. %I Boston College %G eng %4 retirement planning/survey of Income and Program Participation/household consumption/savings/401(k) participation and balances/life cycle models %$ 999999 %0 Journal Article %J Journal of Alzheimer's Disease %D 2015 %T Do Physical Activity, Smoking, Drinking, or Depression Modify Transitions from Cognitive Impairment to Functional Disability? %A Pamela M. Rist %A Jessica R Marden %A Benjamin D Capistrant %A Bei Wu %A M. Maria Glymour %K Disabilities %K Health Conditions and Status %K Healthcare %X Background: Individual-level modifiers can delay onset of limitations in basic activities of daily living (ADLs) among cognitively impaired individuals. We assessed whether these modifiers also delayed onset of limitations in instrumental ADLs (IADLs) among individuals at elevated dementia risk. Objectives: To determine whether modifiable individual-level factors delay incident IADL limitations among adults stratified by dementia risk. Methods: Health and Retirement Study participants aged 65 without activity limitations in 1998 or 2000 (n = 5,219) were interviewed biennially through 2010. Dementia probability, categorized in quartiles, was used to predict incident IADL limitations with Poisson regression. We estimated relative (risk ratio) and absolute (number of limitations) effects from models including dementia, individual-level modifiers (physical inactivity, smoking, no alcohol consumption, and depression) and interaction terms between dementia and individual-level modifiers. Results: Dementia probability quartile predicted incident IADL limitations (relative risk for highest versus lowest quartile = 0.44; 95 CI: 0.28 0.70). Most modifiers did not significantly increase risk of IADL limitations among the cognitively impaired. Physical inactivity (RR = 1.60; 95 CI: 1.16, 2.19) increased the risk of IADL limitations among the cognitively impaired. The interaction between physical inactivity and low dementia probability was statistically significant (p = 0.009) indicating that physical inactivity had significantly larger effects on incident IADLs among cognitively normal than among those with high dementia probability. Conclusion: Physical activity may protect against IADL limitations while smoking, alcohol consumption, and depression do not afford substantial protection among the cognitively impaired. Results highlight the need for extra support for IADLs among individuals with cognitive losses. %B Journal of Alzheimer's Disease %V 44 %P 1171-1180 %G eng %U http://dx.doi.org/10.3233/JAD-141866 %N 4 %4 Cognition/disability/disability/epidemiology/dementia/IADLs/Smoking/alcohol use/physical Activity %$ 999999 %& 1171 %R 10.3233/JAD-141866 %0 Report %D 2015 %T Documentation of Biomarkers in the 2010 and 2012 Health and Retirement Study %A Eileen M. Crimmins %A Jessica Faul %A Jung K Kim %A David R Weir %K Biomarkers %K Meta-analyses %K Survey Methodology %I Survey Research Center, University of Michigan %C Ann Arbor, Michigan %P 15 %8 04/2015 %G eng %0 Journal Article %J Journal of Aging and Health %D 2015 %T Does Neighborhood Disorder Predict Recovery From Mobility Limitation? Findings From the Health and Retirement Study %A Kenzie Latham %A Monica M Williams %K Demographics %K Disabilities %K Health Conditions and Status %K Other %K Public Policy %X Objective: This research explores whether perceptions of physical neighborhood disorder predict recovery from mobility limitation over a 2-year period and examines whether psychosocial factors (i.e., depressive symptomology and mastery) and physical activity are salient mediators. Method: Using data from the Health and Retirement Study (HRS): Participant Lifestyle Questionnaire (2008-2010), odds ratio estimates of recovery were ascertained using binary logistic regression, and post hoc Sobel tests were conducted to formally assess mediation. Results: Net of demographic characteristics and socioeconomic status, increased neighborhood disorder was associated with lower odds of recovery. However, both psychosocial indicators and physical activity were significant individual partial mediators, which suggest neighborhood disorder influences recovery from physical impairment via psychosocial processes and barriers to physical activity. Discussion: Reducing neighborhood disorder may enhance older residents' psychosocial well-being and improve participation in physical activity, thus increasing recovery from mobility limitation and preventing subsequent disability. %B Journal of Aging and Health %I 27 %V 27 %P 1415 %G eng %N 8 %4 disability/disability/neighborhood disorder/mobility limitation/recovery/Public Policy/mental Health/DEPRESSION/BUILT ENVIRONMENT/CRIME/PHYSICAL ACTIVITY/PREVENTION/SOCIOECONOMIC STATUS/Neighborhoods/Quality of life %$ 999999 %R 10.1177/0898264315584328 %0 Report %D 2015 %T Does Social Security Continue to Favor Couples? %A Nadia S. Karamcheva %A April Yanyuan Wu %A Alicia H. Munnell %K Divorce %K Marriage %K Older Adults %K Retirement Planning and Satisfaction %K Social Security %K Women and Minorities %X While dramatic increases in women’s labor supply and earnings have led to a substantial decline in the fraction of women eligible for spouse benefits at retirement, most wives still receive a survivor benefit, as wives still typically have lower earnings than their husbands and live longer. Using the MINT microsimulation model and the HRS data linked with Social Security administrative earnings records, this paper examines the extent to which Social Security continues to favor couples and will do so in the future. The paper finds that while the OASI program still distributes lifetime income from singles to couples, the transfers appear to be shrinking over time. Nevertheless, couples are still projected to have a higher benefit/tax ratio, a lower median net tax rate, and a higher share of them will be receiving positive net transfers from the system as compared to those who are never married or divorced. The increased labor force participation and earnings of women have contributed significantly to the decline in redistribution from men to women, and from singles to couples, while the effect of declining marriage rates has only a modest effect. %I Center for Retirement Research at Boston College %C Chestnut Hills, MA %P 1-44 %8 06/2015 %G eng %U http://crr.bc.edu/wp-content/uploads/2015/06/wp_2015-111.pdf %0 Thesis %D 2015 %T Dynamic models of health and labor supply in later life %A Lindsay Jacobs %Y Walker, James R. %K Disabilities %K Employment and Labor Force %K Methodology %K Retirement Planning and Satisfaction %X In these essays, I develop and estimate life-cycle models aimed at explaining various patterns in labor supply behavior at older ages. The first study measures the extent to which later-life differences in health and disability risks across occupations affect retirement behavior and how these risks influence initial career choice. In the second essay, I look at the degree to which the changing composition of occupations over time--from more to less physically demanding--has contributed to the increase in labor force participation at older ages. The final study examines the effects of wage and health transition processes as well as the role of accrued work-related strain on the labor force participation decisions of older males, aimed particularly at accounting for the high rates of "reverse retirement" seen in the data. %I The University of Wisconsin - Madison %C Madison, WI %V 3708322 %P 193 %8 2015 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1697922475?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/Dissertations+%26+Theses+%40+CIC+Institutions&rft_val_fmt=info:of %9 Ph.D. %M 1697922475 %4 0501:Economics %! Dynamic models of health and labor supply in later life %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 Diabetes Research and Clinical Practice %D 2015 %T Education, glucose control, and mortality risks among US older adults with diabetes %A Matthew E Dupre %A Silberberg, Mina %A Willis, Janese M. %A Feinglos, Mark N. %K Demographics %K Health Conditions and Status %K Methodology %K Risk Taking %X Aims: Studies have shown that diabetes mellitus disproportionately afflicts persons of low socioeconomic status and that the burden of disease is greatest among the disadvantaged. However, our understanding of educational differences in the control of diabetes and its impact on survival is limited. This study investigated the associations among education, hemoglobin A(1c) (HbA(1c)), and subsequent mortality in adults with diabetes. Methods: Prospective cohort data from the 2006, 2008, and 2010 Health and Retirement Study were linked with biomarker data for U.S. older adults with diabetes (n = 3312). Weighted distributions were estimated for all subjects at baseline and by the American Diabetes Association's general guidelines for HbA(1c) control ( 7.0 53 mmol/mol vs. = 7.0 53 mmol/mol ). Proportional hazard models were used to estimate educational differences in all-cause mortality by HbA(1c) level with sequential adjustments for contributing risk factors. Results: Mortality risks associated with HbA1c = 7.0 53 mmol/mol were significantly greater in lower-educated adults than higher-educated adults (P 0.001). We found that the hazard ratios (HR) associated with HbA(1c) = 7.0 53 mmol/mol were highest among low-educated adults (HR = 2.18, 95 CI: 1.62, 2.94) and that a combination of socioeconomic, psychosocial, and behavioral factors accounted for most, but not all, of the associations. Conclusions: Educational differences in HbA(1c) control have significant implications for mortality and efforts to reduce these disparities should involve more vigilant screening and monitoring of lower-educated adults with diabetes. (C) 2015 Elsevier Ireland Ltd. All rights reserved. %B Diabetes Research and Clinical Practice %I 107 %V 107 %P 392-399 %G eng %N 3 %4 diabetes mellitus/Proportional Hazards Models/risk factors/mortality/education %$ 999999 %R 10.1016/j.diabres.2014.12.013 %0 Report %D 2015 %T Elderly Poverty in the United States in the 21st Century: Exploring the Role of Assets in the Supplemental Poverty Measure %A Wimer, Christopher %A Manfield, Lucas %K Income %K Net Worth and Assets %X Official estimates of elderly poverty do not take into account either the medical needs of the elderly, which can be quite extensive, or the assets at their disposal, which may also be extensive. The new Supplemental Poverty Measure (SPM) explicitly takes into account medical needs but has been criticized for not concomitantly taking into account asset portfolios. In this paper we consider both jointly, using an approach adapted from a recent National Academy of Sciences report recommending methods for measuring poverty and medical risk while taking account of assets. We use longitudinal data from the Health and Retirement Study (HRS). %I Boston College %G eng %U http://crr.bc.edu/working-papers/elderly-poverty-in-the-united-states-in-the-21st-century-exploring-the-role-of-assets-in-the-supplemental-poverty-measure/ %4 Poverty/medical needs/assets/medical risk %$ 999999 %0 Thesis %B Psychology %D 2015 %T Engagement in activities and cognitive functioning among older adults in the health and retirement study %A May, Pamela E. %Y Woodard, John L. %K Demographics %K Event History/Life Cycle %K Health Conditions and Status %K Healthcare %K Methodology %X The goal of this dissertation is to examine the effect of cognitive and social activities on cognitive performance and health conditions in a national sample of older adults from the Health and Retirement Study (HRS). This dissertation first aimed to identify longitudinal relations between activity frequency and cognitive functioning. Two hypotheses were tested, baseline activity frequency predicts change in cognitive functioning over time, and baseline cognitive performance predicts change in activity frequency over time. The dissertation's second aim was to identify links between activity frequency and cognitive trajectories. The third aim was to identify longitudinal relations between activity frequency and overall health. Changes in cognitive functioning and health were also compared simultaneously over three time points, to identify causal relations. The sample included 3,397 respondents aged ? 60 years old from the Health and Retirement Study's 2008, 2010, and 2012 waves. Respondents completed brief cognitive tests and items regarding their health during each wave, as well as items ranking frequency of engagement in cognitive and social activities in 2008 and 2012. A series of structural equation models were implemented to test the aforementioned aims. A paucity of significant findings precluded a comparison between the two hypothesized models on activity frequency and cognitive functioning, as well as between the two contrasting models for activity frequency and overall health. Activity frequency did not significantly predict rate of change in cognitive performance or health conditions over time. Activity frequency also did not significantly change over time. However, frequency of baseline cognitive activity was associated with initial level of episodic memory. Further, a lower frequency of cognitive activities was associated with a higher number of health conditions at baseline, when education was not included in the model. Relations between health and cognition were not consistently indicated over time, suggesting that health conditions may not have strong causal effects on age-related changes in cognitive functioning. Significant associations between baseline activity engagement and initial level of episodic memory and health conditions does not allow one to rule out the protective effect of activity engagement on cognition and overall health. %B Psychology %I Wayne State University %V Ph.D. %P 159 %8 2015 %G eng %9 Dissertation %4 Social sciences %! Engagement in activities and cognitive functioning among older adults in the health and retirement study %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 Neurology %D 2015 %T Factors associated with cognitive evaluations in the United States. %A Vikas Kotagal %A Kenneth M. Langa %A Brenda L Plassman %A Gwenith G Fisher %A Bruno J Giordani %A Robert B Wallace %A James F. Burke %A David C Steffens %A Mohammed U Kabeto %A Roger L. Albin %A Norman L Foster %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cohort Studies %K Dementia %K Female %K Humans %K Logistic Models %K Male %K Marital Status %K Multivariate Analysis %K Neuropsychological tests %K Severity of Illness Index %K United States %X

OBJECTIVE: We aimed to explore factors associated with clinical evaluations for cognitive impairment among older residents of the United States.

METHODS: Two hundred ninety-seven of 845 subjects in the Aging, Demographics, and Memory Study (ADAMS), a nationally representative community-based cohort study, met criteria for dementia after a detailed in-person study examination. Informants for these subjects reported whether or not they had ever received a clinical cognitive evaluation outside of the context of ADAMS. Among subjects with dementia, we evaluated demographic, socioeconomic, and clinical factors associated with an informant-reported clinical cognitive evaluation using bivariate analyses and multivariable logistic regression.

RESULTS: Of the 297 participants with dementia in ADAMS, 55.2% (representing about 1.8 million elderly Americans in 2002) reported no history of a clinical cognitive evaluation by a physician. In a multivariable logistic regression model (n = 297) controlling for demographics, physical function measures, and dementia severity, marital status (odds ratio for currently married: 2.63 [95% confidence interval: 1.10-6.35]) was the only significant independent predictor of receiving a clinical cognitive evaluation among subjects with study-confirmed dementia.

CONCLUSIONS: Many elderly individuals with dementia do not receive clinical cognitive evaluations. The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia associates with certain patient-specific factors, particularly severity of cognitive impairment and current marital status.

%B Neurology %V 84 %P 64-71 %8 2015 Jan 06 %G eng %U http://www.neurology.org/cgi/doi/10.1212/WNL.0000000000001096 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25428689?dopt=Abstract %! Neurology %R 10.1212/WNL.0000000000001096 %0 Journal Article %J Mol Psychiatry %D 2015 %T FASTKD2 is associated with memory and hippocampal structure in older adults. %A Vijay K Ramanan %A Nho, Kwangsik %A Shen, Li %A Shannon L Risacher %A Brenna C McDonald %A Martin R Farlow %A Tatiana Foroud %A Gao, Sujuan %A Soininen, Hilkka %A Kloszewska, Iwona %A Mecocci, Patrizia %A Tsolaki, Magda %A Vellas, Bruno %A Lovestone, Simon %A Aisen, Paul S. %A Ronald C Petersen %A Jack, Clifford R. %A Shaw, Leslie M. %A Trojanowski, John Q. %A Weiner, Michael W. %A Green, Robert C. %A Arthur W. Toga %A Philip L de Jager %A Lei Yu %A David A Bennett %A Andrew J Saykin %K Age Factors %K Aged %K Aged, 80 and over %K Alzheimer disease %K Female %K Genetic Association Studies %K Genome-Wide Association Study %K Hippocampus %K Humans %K Longitudinal Studies %K Male %K Memory %K Memory Disorders %K Polymorphism, Single Nucleotide %K Protein-Serine-Threonine Kinases %K Structure-Activity Relationship %X

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

%B Mol Psychiatry %I 20 %V 20 %P 1197-204 %8 2015 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/25385369?dopt=Abstract %2 PMC4427556 %4 Genetic analysis/Alzheimer disease/Memory impairment/predictors/FASTKD2 %$ 999999 %R 10.1038/mp.2014.142 %0 Thesis %D 2015 %T Financial strain and the health of Black, White, and Hispanic older adults: Lingering effects of the Great Recession? %A Lindsay R. Wilkinson %K Health Conditions and Status %K Public Policy %X The Great Recession that began in late 2007 and ended in mid-2009 has influenced the financial well-being of older adults, but has it had discernible effects on health? Prior research has repeatedly shown the deleterious effects of financial strain on mental and physical health and mortality; however, less is known about how this relationship functions during a historical fluctuation in the economy. Guided by cumulative inequality theory, the objective of this dissertation is to examine pre-recession and post-recession financial strain and health and investigate whether financial strain (1) increased for older adults following the Great Recession, and (2) if so, the impact of the recession on health. Drawing on the Health and Retirement Study, this research uses data collected on 5,205 older adults in 2006 and 2010 to examine change in financial strain and three domains of health: mental health, somatic well-being, and sleep disturbances. This dissertation is divided into three main articles, with each article focused on a separate health domain. Findings from this research indicate that while older adults were more likely to experience decreases in financial strain following the Great Recession, both initial financial strain and change in financial strain between 2006 and 2010 explained change in anxiety and depressive symptoms, psychotropic drug use, acute physical symptoms, and sleep disturbances over roughly the same span of time. %I Purdue University %C West Lafayette, IN %G eng %4 morbidity %! Financial strain and the health of Black, White, and Hispanic older adults: Lingering effects of the Great Recession? %0 Journal Article %J Nature %D 2015 %T Genetic studies of body mass index yield new insights for obesity biology. %A Locke, Adam E %A Kahali, Bratati %A Berndt, Sonja I %A Justice, Anne E %A Pers, Tune H %A Day, Felix R %A Powell, Corey %A Vedantam, Sailaja %A Buchkovich, Martin L %A Yang, Jian %A Croteau-Chonka, Damien C %A Tõnu Esko %A Fall, Tove %A Ferreira, Teresa %A Gustafsson, Stefan %A Kutalik, Zoltán %A Luan, Jian'an %A Mägi, Reedik %A Randall, Joshua C %A Thomas W Winkler %A Andrew R Wood %A Workalemahu, Tsegaselassie %A Jessica Faul %A Jennifer A Smith %A Jing Hua Zhao %A Wei Zhao %A Chen, Jin %A Rudolf Ferhmann %A Hedman, Åsa K %A Karjalainen, Juha %A Schmidt, Ellen M %A Absher, Devin %A Amin, Najaf %A Anderson, Denise %A Beekman, Marian %A Bolton, Jennifer L %A Bragg-Gresham, Jennifer L %A Buyske, Steven %A Demirkan, Ayse %A Deng, Guohong %A Georg B Ehret %A Feenstra, Bjarke %A Feitosa, Mary F %A Fischer, Krista %A Goel, Anuj %A Gong, Jian %A Jackson, Anne U %A Kanoni, Stavroula %A Kleber, Marcus E %A Kristiansson, Kati %A Lim, Unhee %A Lotay, Vaneet %A Mangino, Massimo %A Irene Mateo Leach %A Medina-Gomez, Carolina %A Sarah E Medland %A Michael A Nalls %A Palmer, Cameron D %A Pasko, Dorota %A Pechlivanis, Sonali %A Peters, Marjolein J %A Prokopenko, Inga %A Shungin, Dmitry %A Stančáková, Alena %A Strawbridge, Rona J %A Yun Ju Sung %A Toshiko Tanaka %A Teumer, Alexander %A Trompet, Stella %A van der Laan, Sander W %A van Setten, Jessica %A Jana V. van Vliet-Ostaptchouk %A Wang, Zhaoming %A Yengo, Loic %A Zhang, Weihua %A Isaacs, Aaron %A Albrecht, Eva %A Ärnlöv, Johan %A Arscott, Gillian M %A Attwood, Antony P %A Bandinelli, Stefania %A Barrett, Amy %A Bas, Isabelita N %A Bellis, Claire %A Bennett, Amanda J %A Berne, Christian %A Blagieva, Roza %A Blüher, Matthias %A Böhringer, Stefan %A Bonnycastle, Lori L %A Böttcher, Yvonne %A Boyd, Heather A %A Bruinenberg, Marcel %A Caspersen, Ida H %A Yii-Der I Chen %A Robert Clark %A Daw, E Warwick %A de Craen, Anton J M %A Delgado, Graciela %A Dimitriou, Maria %A Doney, Alex S F %A Eklund, Niina %A Estrada, Karol %A Eury, Elodie %A Folkersen, Lasse %A Fraser, Ross M %A Melissa E Garcia %A Geller, Frank %A Giedraitis, Vilmantas %A Gigante, Bruna %A Alan S Go %A Golay, Alain %A Goodall, Alison H %A Gordon, Scott D %A Gorski, Mathias %A Hans-Jörgen Grabe %A Grallert, Harald %A Grammer, Tanja B %A Gräßler, Jürgen %A Grönberg, Henrik %A Groves, Christopher J %A Gusto, Gaëlle %A Jeffrey Haessler %A Hall, Per %A Haller, Toomas %A Hallmans, Göran %A Catharina A Hartman %A Hassinen, Maija %A Caroline Hayward %A Heard-Costa, Nancy L %A Helmer, Quinta %A Hengstenberg, Christian %A Oddgeir L Holmen %A Jouke-Jan Hottenga %A James, Alan L %A Janina Jeff %A Johansson, Åsa %A Jolley, Jennifer %A Juliusdottir, Thorhildur %A Kinnunen, Leena %A Koenig, Wolfgang %A Koskenvuo, Markku %A Kratzer, Wolfgang %A Laitinen, Jaana %A Lamina, Claudia %A Leander, Karin %A Lee, Nanette R %A Lichtner, Peter %A Lars Lind %A Lindström, Jaana %A Ken Sin Lo %A Lobbens, Stéphane %A Lorbeer, Roberto %A Lu, Yingchang %A Mach, François %A Patrik K E Magnusson %A Mahajan, Anubha %A McArdle, Wendy L %A McLachlan, Stela %A Menni, Cristina %A Merger, Sigrun %A Mihailov, Evelin %A Lili Milani %A Moayyeri, Alireza %A Monda, Keri L %A Morken, Mario A %A Mulas, Antonella %A Müller, Gabriele %A Müller-Nurasyid, Martina %A Musk, Arthur W %A Nagaraja, Ramaiah %A Markus M Nöthen %A Ilja M Nolte %A Pilz, Stefan %A Nigel W Rayner %A Renstrom, Frida %A Rettig, Rainer %A Ried, Janina S %A Ripke, Stephan %A Neil R Robertson %A Rose, Lynda M %A Sanna, Serena %A Scharnagl, Hubert %A Scholtens, Salome %A Schumacher, Fredrick R %A Scott, William R %A Seufferlein, Thomas %A Jianxin Shi %A Albert Vernon Smith %A Smolonska, Joanna %A Stanton, Alice V %A Steinthorsdottir, Valgerdur %A Kathleen E Stirrups %A Heather M Stringham %A Sundström, Johan %A Swertz, Morris A %A Swift, Amy J %A Syvänen, Ann-Christine %A Tan, Sian-Tsung %A Bamidele O Tayo %A Thorand, Barbara %A Thorleifsson, Gudmar %A Tyrer, Jonathan P %A Uh, Hae-Won %A Vandenput, Liesbeth %A Verhulst, Frank C %A Vermeulen, Sita H %A Verweij, Niek %A Vonk, Judith M %A Lindsay L Waite %A Warren, Helen R %A Dawn M Waterworth %A Michael N Weedon %A Wilkens, Lynne R %A Willenborg, Christina %A Wilsgaard, Tom %A Wojczynski, Mary K %A Wong, Andrew %A Alan F Wright %A Zhang, Qunyuan %A Brennan, Eoin P %A Murim Choi %A Dastani, Zari %A Alexander W Drong %A Eriksson, Per %A Franco-Cereceda, Anders %A Gådin, Jesper R %A Gharavi, Ali G %A Goddard, Michael E %A Handsaker, Robert E %A Huang, Jinyan %A Karpe, Fredrik %A Kathiresan, Sekar %A Keildson, Sarah %A Kiryluk, Krzysztof %A Kubo, Michiaki %A Lee, Jong-Young %A Liang, Liming %A Lifton, Richard P %A Ma, Baoshan %A McCarroll, Steven A %A McKnight, Amy J %A Min, Josine L %A Moffatt, Miriam F %A Grant W Montgomery %A Joanne M Murabito %A Nicholson, George %A Nyholt, Dale R %A Okada, Yukinori %A Perry, John R B %A Dorajoo, Rajkumar %A Reinmaa, Eva %A Salem, Rany M %A Sandholm, Niina %A Scott, Robert A %A Stolk, Lisette %A Takahashi, Atsushi %A Tanaka, Toshihiro %A Ferdinand M van 't Hooft %A Anna A E Vinkhuyzen %A Westra, Harm-Jan %A Wei Zhang %A Krina T Zondervan %A Andrew C Heath %A Arveiler, Dominique %A Bakker, Stephan J L %A Beilby, John %A Bergman, Richard N %A Blangero, John %A Bovet, Pascal %A Campbell, Harry %A Caulfield, Mark J %A Cesana, Giancarlo %A Chakravarti, Aravinda %A Daniel I Chasman %A Chines, Peter S %A Collins, Francis S %A Crawford, Dana C %A Cupples, L Adrienne %A Cusi, Daniele %A Danesh, John %A de Faire, Ulf %A Hester M den Ruijter %A Dominiczak, Anna F %A Erbel, Raimund %A Erdmann, Jeanette %A Johan G Eriksson %A Farrall, Martin %A Felix, Stephan B %A Ferrannini, Ele %A Ferrières, Jean %A Ford, Ian %A Forouhi, Nita G %A Forrester, Terrence %A Franco, Oscar H %A Gansevoort, Ron T %A Gejman, Pablo V %A Gieger, Christian %A Gottesman, Omri %A Gudnason, Vilmundur %A Gyllensten, Ulf %A Hall, Alistair S %A Tamara B Harris %A Andrew T Hattersley %A Hicks, Andrew A %A Hindorff, Lucia A %A Aroon Hingorani %A Hofman, Albert %A Homuth, Georg %A Hovingh, G Kees %A Humphries, Steve E %A Hunt, Steven C %A Hyppönen, Elina %A Illig, Thomas %A Jacobs, Kevin B %A Järvelin, Marjo-Riitta %A Jöckel, Karl-Heinz %A Johansen, Berit %A Jousilahti, Pekka %A Jukema, J Wouter %A Jula, Antti M %A Kaprio, Jaakko %A Kastelein, John J P %A Keinanen-Kiukaanniemi, Sirkka M %A Lambertus A Kiemeney %A Knekt, Paul %A Kooner, Jaspal S %A Charles Kooperberg %A Kovacs, Peter %A Kraja, Aldi T %A Kumari, Meena %A Kuusisto, Johanna %A Lakka, Timo A %A Langenberg, Claudia %A Loic Le Marchand %A Lehtimäki, Terho %A Lyssenko, Valeriya %A Männistö, Satu %A Marette, André %A Matise, Tara C %A McKenzie, Colin A %A McKnight, Barbara %A Moll, Frans L %A Morris, Andrew D %A Morris, Andrew P %A Murray, Jeffrey C %A Nelis, Mari %A Ohlsson, Claes %A Oldehinkel, Albertine J %A Ong, Ken K %A Pamela A F Madden %A Pasterkamp, Gerard %A Peden, John F %A Peters, Annette %A Postma, Dirkje S %A Pramstaller, Peter P %A Price, Jackie F %A Qi, Lu %A Olli T Raitakari %A Rankinen, Tuomo %A Rao, D C %A Rice, Treva K %A Ridker, Paul M %A Rioux, John D %A Ritchie, Marylyn D %A Rudan, Igor %A Veikko Salomaa %A Nilesh J Samani %A Saramies, Jouko %A Sarzynski, Mark A %A Schunkert, Heribert %A Schwarz, Peter E H %A Peter Sever %A Alan R Shuldiner %A Sinisalo, Juha %A Stolk, Ronald P %A Strauch, Konstantin %A Tönjes, Anke %A Trégouët, David-Alexandre %A Tremblay, Angelo %A Tremoli, Elena %A Virtamo, Jarmo %A Vohl, Marie-Claude %A Völker, Uwe %A Waeber, Gérard %A Gonneke Willemsen %A Witteman, Jacqueline C %A Zillikens, M Carola %A Adair, Linda S %A Amouyel, Philippe %A Asselbergs, Folkert W %A Assimes, Themistocles L %A Bochud, Murielle %A Boehm, Bernhard O %A Boerwinkle, Eric %A Bornstein, Stefan R %A Erwin P Bottinger %A Bouchard, Claude %A Cauchi, Stéphane %A Chambers, John C %A Chanock, Stephen J %A Cooper, Richard S %A de Bakker, Paul I W %A George Dedoussis %A Luigi Ferrucci %A Franks, Paul W %A Froguel, Philippe %A Leif C Groop %A Christopher A Haiman %A Hamsten, Anders %A Hui, Jennie %A Hunter, David J %A Hveem, Kristian %A Kaplan, Robert C %A Mika Kivimäki %A Kuh, Diana %A Laakso, Markku %A Yongmei Liu %A Nicholas G Martin %A März, Winfried %A Melbye, Mads %A Andres Metspalu %A Moebus, Susanne %A Munroe, Patricia B %A Njølstad, Inger %A Ben A Oostra %A Palmer, Colin N A %A Nancy L Pedersen %A Markus Perola %A Pérusse, Louis %A Peters, Ulrike %A Power, Chris %A Quertermous, Thomas %A Rauramaa, Rainer %A Fernando Rivadeneira %A Saaristo, Timo E %A Saleheen, Danish %A Sattar, Naveed %A Eric E Schadt %A Schlessinger, David %A Eline P Slagboom %A Snieder, Harold %A Timothy Spector %A Thorsteinsdottir, Unnur %A Stumvoll, Michael %A Tuomilehto, Jaakko %A André G Uitterlinden %A Uusitupa, Matti %A van der Harst, Pim %A Walker, Mark %A Wallaschofski, Henri %A Wareham, Nicholas J %A Watkins, Hugh %A David R Weir %A Wichmann, H-Erich %A James F Wilson %A Zanen, Pieter %A Ingrid B Borecki %A Deloukas, Panos %A Caroline S Fox %A Iris M Heid %A Jeff O'Connell %A David P Strachan %A Stefansson, Kari %A Cornelia M van Duijn %A Gonçalo R Abecasis %A Lude L Franke %A Timothy M Frayling %A McCarthy, Mark I %A Peter M Visscher %A Scherag, Andre %A Willer, Cristen J %A Boehnke, Michael %A Mohlke, Karen L %A Lindgren, Cecilia M %A Beckmann, Jacques S %A Barroso, Inês %A Kari E North %A Ingelsson, Erik %A Joel N Hirschhron %A Ruth J F Loos %A Elizabeth K Speliotes %K Age Factors %K BMI %K Continental Population Groups %K Energy Metabolism %K Europe %K Female %K Genome-Wide Association Study %K Glutamic Acid %K Humans %K Insulin %K Male %K Obesity %K Polymorphism, Single Nucleotide %K Quantitative Trait Loci %K Synapses %X

Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.

%B Nature %V 518 %P 197-206 %8 2015 Feb 12 %G eng %N 7538 %1 http://www.ncbi.nlm.nih.gov/pubmed/25673413?dopt=Abstract %R 10.1038/nature14177 %0 Journal Article %J Soc Sci Med %D 2015 %T Genetic vulnerability to diabetes and obesity: does education offset the risk? %A Sze Y Liu %A Stefan Walter %A Jessica R Marden %A David Rehkopf %A Laura D Kubzansky %A Thu T Nguyen %A M. Maria Glymour %K Aged %K Body Mass Index %K Diabetes Mellitus, Type 2 %K Educational Status %K European Continental Ancestry Group %K Female %K Genetic Predisposition to Disease %K Genotype %K Glycated Hemoglobin A %K Health Status Disparities %K Humans %K Male %K Middle Aged %K Obesity %K Risk Factors %K Social determinants of health %X

The prevalence of type 2 diabetes (T2D) and obesity has recently increased dramatically. These common diseases are likely to arise from the interaction of multiple genetic, socio-demographic and environmental risk factors. While previous research has found genetic risk and education to be strong predictors of these diseases, few studies to date have examined their joint effects. This study investigates whether education modifies the association between genetic background and risk for type 2 diabetes (T2D) and obesity. Using data from non-Hispanic Whites in the Health and Retirement Study (HRS, n = 8398), we tested whether education modifies genetic risk for obesity and T2D, offsetting genetic effects; whether this effect is larger for individuals who have high risk for other (unobserved) reasons, i.e., at higher quantiles of HbA1c and BMI; and whether effects differ by gender. We measured T2D risk using Hemoglobin A1c (HbA1c) level, and obesity risk using body-mass index (BMI). We constructed separate genetic risk scores (GRS) for obesity and diabetes respectively based on the most current available information on the single nucleotide polymorphism (SNPs) confirmed as genome-wide significant predictors for BMI (29 SNPs) and diabetes risk (39 SNPs). Linear regression models with years of schooling indicate that the effect of genetic risk on HbA1c is smaller among people with more years of schooling and larger among those with less than a high school (HS) degree compared to HS degree-holders. Quantile regression models show that the GRS × education effect systematically increased along the HbA1c outcome distribution; for example the GRS × years of education interaction coefficient was -0.01 (95% CI = -0.03, 0.00) at the 10th percentile compared to -0.03 (95% CI = -0.07, 0.00) at the 90th percentile. These results suggest that education may be an important socioeconomic source of heterogeneity in responses to genetic vulnerability to T2D.

%B Soc Sci Med %V 127 %P 150-8 %8 2015 Feb %G eng %U http://www.sciencedirect.com/science/article/pii/S0277953614005760 %1 http://www.ncbi.nlm.nih.gov/pubmed/25245452?dopt=Abstract %R 10.1016/j.socscimed.2014.09.009 %0 Journal Article %J Alzheimers Dement %D 2015 %T Genetically predicted body mass index and Alzheimer's disease-related phenotypes in three large samples: Mendelian randomization analyses. %A Mukherjee, Shubhabrata %A Stefan Walter %A Kauwe, John S K %A Andrew J Saykin %A David A Bennett %A Eric B Larson %A Paul K Crane %A M. Maria Glymour %K Aged %K Aged, 80 and over %K Alzheimer disease %K Body Mass Index %K Female %K Genotype %K Humans %K Linear Models %K Male %K Mendelian Randomization Analysis %K Obesity %K Phenotype %K Polymorphism, Single Nucleotide %K Risk Factors %X

Observational research shows that higher body mass index (BMI) increases Alzheimer's disease (AD) risk, but it is unclear whether this association is causal. We applied genetic variants that predict BMI in Mendelian randomization analyses, an approach that is not biased by reverse causation or confounding, to evaluate whether higher BMI increases AD risk. We evaluated individual-level data from the AD Genetics Consortium (ADGC: 10,079 AD cases and 9613 controls), the Health and Retirement Study (HRS: 8403 participants with algorithm-predicted dementia status), and published associations from the Genetic and Environmental Risk for AD consortium (GERAD1: 3177 AD cases and 7277 controls). No evidence from individual single-nucleotide polymorphisms or polygenic scores indicated BMI increased AD risk. Mendelian randomization effect estimates per BMI point (95% confidence intervals) were as follows: ADGC, odds ratio (OR) = 0.95 (0.90-1.01); HRS, OR = 1.00 (0.75-1.32); GERAD1, OR = 0.96 (0.87-1.07). One subscore (cellular processes not otherwise specified) unexpectedly predicted lower AD risk.

%B Alzheimers Dement %V 11 %P 1439-1451 %8 2015 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/26079416?dopt=Abstract %R 10.1016/j.jalz.2015.05.015 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2015 %T GWAS of longevity in CHARGE consortium confirms APOE and FOXO3 candidacy. %A Broer, Linda %A Aron S Buchman %A Deelen, Joris %A Daniel S Evans %A Jessica Faul %A Kathryn L Lunetta %A Sebastiani, Paola %A Jennifer A Smith %A Albert Vernon Smith %A Toshiko Tanaka %A Lei Yu %A Alice M. Arnold %A Aspelund, Thor %A Emelia J Benjamin %A Philip L de Jager %A Guðny Eiríksdóttir %A Melissa E Garcia %A Hofman, Albert %A Kaplan, Robert C %A Sharon L R Kardia %A Douglas P Kiel %A Ben A Oostra %A Orwoll, Eric S %A Parimi, Neeta %A Psaty, Bruce M %A Fernando Rivadeneira %A Rotter, Jerome I %A Seshadri, Sudha %A Andrew B Singleton %A Henning Tiemeier %A André G Uitterlinden %A Wei Zhao %A Bandinelli, Stefania %A David A Bennett %A Luigi Ferrucci %A Gudnason, Vilmundur %A Tamara B Harris %A Karasik, David %A Lenore J Launer %A Thomas T Perls %A Eline P Slagboom %A Tranah, Gregory J %A David R Weir %A Anne B Newman %A Cornelia M van Duijn %A Joanne M Murabito %K Aged %K Aged, 80 and over %K Apolipoproteins E %K Cell Adhesion Molecules %K Cohort Studies %K Female %K Forkhead Box Protein O3 %K Forkhead Transcription Factors %K Genome-Wide Association Study %K Humans %K Longevity %K Male %K Middle Aged %K Polymorphism, Single Nucleotide %K Receptors, Kainic Acid %X

BACKGROUND: The genetic contribution to longevity in humans has been estimated to range from 15% to 25%. Only two genes, APOE and FOXO3, have shown association with longevity in multiple independent studies.

METHODS: We conducted a meta-analysis of genome-wide association studies including 6,036 longevity cases, age ≥90 years, and 3,757 controls that died between ages 55 and 80 years. We additionally attempted to replicate earlier identified single nucleotide polymorphism (SNP) associations with longevity.

RESULTS: In our meta-analysis, we found suggestive evidence for the association of SNPs near CADM2 (odds ratio [OR] = 0.81; p value = 9.66 × 10(-7)) and GRIK2 (odds ratio = 1.24; p value = 5.09 × 10(-8)) with longevity. When attempting to replicate findings earlier identified in genome-wide association studies, only the APOE locus consistently replicated. In an additional look-up of the candidate gene FOXO3, we found that an earlier identified variant shows a highly significant association with longevity when including published data with our meta-analysis (odds ratio = 1.17; p value = 1.85×10(-10)).

CONCLUSIONS: We did not identify new genome-wide significant associations with longevity and did not replicate earlier findings except for APOE and FOXO3. Our inability to find new associations with survival to ages ≥90 years because longevity represents multiple complex traits with heterogeneous genetic underpinnings, or alternatively, that longevity may be regulated by rare variants that are not captured by standard genome-wide genotyping and imputation of common variants.

%B J Gerontol A Biol Sci Med Sci %V 70 %P 110-8 %8 2015 Jan %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296168/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/25199915?dopt=Abstract %R 10.1093/gerona/glu166 %0 Report %D 2015 %T How Much Longer Do People Need to Work? %A Alicia H. Munnell %A Anthony Webb %A Anqi Chen %K Consumption and Savings %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Working longer is a powerful lever to enhance retirement security. Individuals should be able to extend the number of years they work because, on average, they are healthier, live longer, and face less physically demanding jobs. But averages are misleading when discrepancies in health, job prospects, and life expectancy have widened between individuals with low and high socioeconomic status (SES). To understand the magnitude of the problem, this paper, using data from the Health and Retirement Study (HRS), specifies how much longer households in each SES quartile would need to work to maintain their pre-retirement standard of living and compares those optimal retirement ages with their planned retirement ages to calculate a retirement gap. It then uses regression analysis to explore whether the gaps reflect poor circumstances or poor planning that is, the extent to which the retirement gap results from health, employment, and marital shocks that occur before the HRS interview but too late for the household to adjust saving (between ages 50 and 58), as opposed to a gap resulting from inadequate foresight. The analysis shows that households in lower-SES quartiles have larger retirement gaps, and this pattern remains true even after controlling for late-career shocks. In short, the most vulnerable have the largest retirement gaps, and these gaps arise from poor planning rather than late-career shocks. %I Boston, Center for Retirement Research at Boston College %G eng %4 retirement planning/labor Force Participation/retirement security/retirement security/socioeconomic Status/Standard of living/Standard of living/health shocks %$ 999999 %0 Report %D 2015 %T The Impact of Temporary Assistance Programs on the Social Security Claiming Age %A Geoffrey T. Sanzenbacher %A April Yanyuan Wu %A Matthew S. Rutledge %K Older Adults %K Public Health %K Public Policy %K Social Security %K Welfare %X Delaying claiming past the early eligibility age of 62 has taken on increased importance. Individuals turning 62 with no job and limited income may be able to use temporary assistance programs such as Unemployment Insurance (UI), Medicaid, and the Supplemental Nutrition Assistance Program (SNAP) as sources of support prior to collecting Social Security benefits. To what extent do these programs allow recipients to delay Social Security claiming? The challenge in answering this question stems from the fact that program users’ dire economic straits may make them more likely to claim benefits from both Social Security and these programs, generating a misleading correlation between Social Security claiming and temporary assistance benefits. This paper constructs instruments for program generosity that vary with an individual’s state of residence but should not reflect the characteristics or circumstances of the individual. %I Center for Retirement Research at Boston College %C Chestnut Hill, MA %P 1-331 %G eng %U http://crr.bc.edu/wp-content/uploads/2015/10/wp_2015-27.pdf %0 Journal Article %J J Am Geriatr Soc %D 2015 %T Increase in Disability Prevalence Before Hip Fracture. %A Irena Cenzer %A W John Boscardin %A Christine S Ritchie %A Margaret Wallhagen %A Kenneth E Covinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Dementia %K Disability Evaluation %K Disabled Persons %K Educational Status %K Female %K Health Surveys %K Hip Fractures %K Humans %K Income %K Male %K Mobility Limitation %K Prevalence %K United States %X

OBJECTIVES: To establish the prevalence and correlates of disability during the 2 years before hip fracture.

DESIGN: Data from participants who experienced hip fracture in the Health and Retirement Study (HRS) with hip fracture identified using linked Medicare claims. Each participant was interviewed at varying time points in the 2 years before hip fracture. Disability was defined as self-report of the need for assistance in any activity of daily living (walking across the room, eating, bathing, dressing, using the toilet, transferring). Based on the timing between interview and hip fracture, prevalence of disability was calculated in the cohort as a whole over the 2 years before hip fracture and in subgroups defined according to demographic and clinical characteristics.

SETTING: The HRS is a nationally representative longitudinal study (1992-2010).

PARTICIPANTS: HRS participants aged ≥65 with hip fracture (mean age at fracture 84, 77% female).

RESULTS: The adjusted prevalence of disability was 20% (95% confidence interval (CI) = 14-25%) 2 years before hip fracture, with little change until approximately 10 months before fracture, when it started to rise, reaching 44% (95% CI = 33-55%) in the month before hip fracture. The prevalence of disability was highest in the last month before fracture for persons aged 85 and older (53%) and for those with dementia (60%).

CONCLUSION: Care models for hip fracture need to consider not only the acute medical and surgical needs, but also the high level of need for supportive care and caregiver assistance that chronically disabled individuals require.

%B J Am Geriatr Soc %I 63 %V 63 %P 2029-35 %8 2015 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/26480970?dopt=Abstract %2 PMC4699653 %4 medicare/ADMINISTRATIVE DATA/Disabilities/Hip Fractures/ADL/IADL %$ 999999 %R 10.1111/jgs.13658 %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 Book Section %B A Life Course Perspective on Health Trajectories and Transitions %D 2015 %T Inter-Cohort Variation in the Consequences of U.S. Military Service for Men's Mid- to Late-Life Body Mass Index Trajectories %A Janet M Wilmoth %A Andrew S London %A Christine L Himes %E Burton-Jeangros, Claudine %E Cullati, Stéphane %E Sacker, Amanda %E Blane, David %K Demographics %K Health Conditions and Status %K Methodology %X Body mass index (BMI) is an important health indicator that changes with age and may be shaped in important ways by prior military service. While a high proportion of older men in the United States served in the military, to date, there has been no longitudinal, population-representative study of veteran status differences in men s mid- to late-life BMI trajectories. In this chapter, we use data from the 1992 2010 Health and Retirement Study (HRS) and growth curve models to examine veteran status differences in mid- to late-life BMI trajectories for cohorts of men born in the United States during the first half of the twentieth century. Without any controls in the models, veterans exhibit lower BMI, on average, than non-veterans. Once we add controls for birth cohort, early-life characteristics that occur prior to military service, potentially mediating mid- to late-life characteristics, and methodological controls for proxy report, attrition, and death during the study period, the effect of veteran status is small, marginally significant, and positive net of other factors, veterans are marginally heavier than their non-veteran counterparts. Taken together, our analyses demonstrate the large effect of the secular trend in increased weight across the population younger cohorts are substantially heavier than older cohorts regardless of their veteran status and a substantively small but consistent, positive intra-cohort effect of veteran status. %B A Life Course Perspective on Health Trajectories and Transitions %I Springer %C New York %P 133-154 %G eng %4 body mass index/military service/veterans/cohort effects %$ 999999 %! Inter-Cohort Variation in the Consequences of U.S. Military Service for Men's Mid- to Late-Life Body Mass Index Trajectories %0 Journal Article %J Nat Genet %D 2015 %T Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair. %A Day, Felix R %A Ruth, Katherine S %A Thompson, Deborah J %A Kathryn L Lunetta %A Pervjakova, Natalia %A Daniel I Chasman %A Stolk, Lisette %A Finucane, Hilary K %A Sulem, Patrick %A Bulik-Sullivan, Brendan %A Tõnu Esko %A Andrew D Johnson %A Elks, Cathy E %A Franceschini, Nora %A He, Chunyan %A Altmaier, Elisabeth %A Brody, Jennifer A %A Lude L Franke %A Huffman, Jennifer E %A Keller, Margaux F %A McArdle, Patrick F %A Nutile, Teresa %A Porcu, Eleonora %A Robino, Antonietta %A Rose, Lynda M %A Schick, Ursula M %A Jennifer A Smith %A Teumer, Alexander %A Traglia, Michela %A Vuckovic, Dragana %A Yao, Jie %A Wei Zhao %A Albrecht, Eva %A Amin, Najaf %A Corre, Tanguy %A Jouke-Jan Hottenga %A Mangino, Massimo %A Albert Vernon Smith %A Toshiko Tanaka %A Gonçalo R Abecasis %A Andrulis, Irene L %A Anton-Culver, Hoda %A Antoniou, Antonis C %A Arndt, Volker %A Alice M. Arnold %A Barbieri, Caterina %A Beckmann, Matthias W %A Beeghly-Fadiel, Alicia %A Benitez, Javier %A Bernstein, Leslie %A Bielinski, Suzette J %A Blomqvist, Carl %A Boerwinkle, Eric %A Bogdanova, Natalia V %A Bojesen, Stig E %A Manjeet K. Bolla %A Borresen-Dale, Anne-Lise %A Boutin, Thibaud S %A Brauch, Hiltrud %A Brenner, Hermann %A Brüning, Thomas %A Burwinkel, Barbara %A Campbell, Archie %A Campbell, Harry %A Chanock, Stephen J %A Chapman, J Ross %A Yii-Der I Chen %A Chenevix-Trench, Georgia %A Couch, Fergus J %A Coviello, Andrea D %A Cox, Angela %A Czene, Kamila %A Darabi, Hatef %A De Vivo, Immaculata %A Ellen W Demerath %A Joe G Dennis %A Devilee, Peter %A Dörk, Thilo %A Dos-Santos-Silva, Isabel %A Dunning, Alison M %A John D Eicher %A Fasching, Peter A %A Jessica Faul %A Figueroa, Jonine %A Flesch-Janys, Dieter %A Gandin, Ilaria %A Melissa E Garcia %A García-Closas, Montserrat %A Giles, Graham G %A Giorgia G Girotto %A Goldberg, Mark S %A González-Neira, Anna %A Goodarzi, Mark O %A Grove, Megan L %A Gudbjartsson, Daniel F %A Guénel, Pascal %A Guo, Xiuqing %A Christopher A Haiman %A Hall, Per %A Hamann, Ute %A Henderson, Brian E %A Lynne J Hocking %A Hofman, Albert %A Homuth, Georg %A Hooning, Maartje J %A John L Hopper %A Hu, Frank B %A Huang, Jinyan %A Humphreys, Keith %A Hunter, David J %A Jakubowska, Anna %A Jones, Samuel E %A Kabisch, Maria %A Karasik, David %A Knight, Julia A %A Kolcic, Ivana %A Charles Kooperberg %A Kosma, Veli-Matti %A Kriebel, Jennifer %A Kristensen, Vessela %A Lambrechts, Diether %A Langenberg, Claudia %A Li, Jingmei %A Li, Xin %A Lindström, Sara %A Yongmei Liu %A Luan, Jian'an %A Lubinski, Jan %A Mägi, Reedik %A Mannermaa, Arto %A Manz, Judith %A Margolin, Sara %A Marten, Jonathan %A Nicholas G Martin %A Masciullo, Corrado %A Meindl, Alfons %A Michailidou, Kyriaki %A Mihailov, Evelin %A Lili Milani %A Milne, Roger L %A Müller-Nurasyid, Martina %A Michael A Nalls %A Neale, Benjamin M %A Nevanlinna, Heli %A Neven, Patrick %A Anne B Newman %A Børge G Nordestgaard %A Olson, Janet E %A Padmanabhan, Sandosh %A Peterlongo, Paolo %A Peters, Ulrike %A Petersmann, Astrid %A Peto, Julian %A Pharoah, Paul D P %A Nicola Pirastu %A Pirie, Ailith %A Pistis, Giorgio %A Polasek, Ozren %A David J Porteous %A Psaty, Bruce M %A Pylkäs, Katri %A Radice, Paolo %A Raffel, Leslie J %A Fernando Rivadeneira %A Rudan, Igor %A Rudolph, Anja %A Ruggiero, Daniela %A Cinzia Felicita Sala %A Sanna, Serena %A Sawyer, Elinor J %A Schlessinger, David %A Schmidt, Marjanka K %A Schmidt, Frank %A Schmutzler, Rita K %A Schoemaker, Minouk J %A Scott, Robert A %A Seynaeve, Caroline M %A Simard, Jacques %A Sorice, Rossella %A Southey, Melissa C %A Stöckl, Doris %A Strauch, Konstantin %A Swerdlow, Anthony %A Kent D Taylor %A Thorsteinsdottir, Unnur %A Toland, Amanda E %A Tomlinson, Ian %A Truong, Thérèse %A Tryggvadottir, Laufey %A Stephen T Turner %A Vozzi, Diego %A Wang, Qin %A Wellons, Melissa %A Gonneke Willemsen %A James F Wilson %A Winqvist, Robert %A Wolffenbuttel, Bruce B H R %A Alan F Wright %A Yannoukakos, Drakoulis %A Zemunik, Tatijana %A Wei Zhang %A Zygmunt, Marek %A Bergmann, Sven %A Dorret I Boomsma %A Buring, Julie E %A Luigi Ferrucci %A Grant W Montgomery %A Gudnason, Vilmundur %A Timothy Spector %A Cornelia M van Duijn %A Alizadeh, Behrooz Z %A Ciullo, Marina %A Crisponi, Laura %A Easton, Douglas F %A Paolo P. Gasparini %A Gieger, Christian %A Tamara B Harris %A Caroline Hayward %A Sharon L R Kardia %A Kraft, Peter %A McKnight, Barbara %A Andres Metspalu %A Alanna C Morrison %A Reiner, Alex P %A Ridker, Paul M %A Rotter, Jerome I %A Toniolo, Daniela %A André G Uitterlinden %A Ulivi, Sheila %A Völzke, Henry %A Wareham, Nicholas J %A David R Weir %A Laura M Yerges-Armstrong %A Price, Alkes L %A Stefansson, Kari %A Visser, Jenny A %A Ong, Ken K %A Chang-Claude, Jenny %A Joanne M Murabito %A Perry, John R B %A Murray, Anna %K Age Factors %K Aging %K BRCA1 Protein %K Breast Neoplasms %K DNA Repair %K Female %K Genome %K Genome-Wide Association Study %K Genotype %K Humans %K Hypothalamus %K Menopause %K Middle Aged %K Models, Genetic %K Older Adults %K Phenotype %K Reproduction %K Signal Transduction %X

Menopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in ∼70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (∼6% increase in risk per year; P = 3 × 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms.

%B Nat Genet %V 47 %P 1294-303 %8 2015 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/26414677?dopt=Abstract %R 10.1038/ng.3412 %0 Journal Article %J Psychoneuroendocrinology %D 2015 %T Loneliness, eudaimonia, and the human conserved transcriptional response to adversity. %A Steven W. Cole %A Morgan E. Levine %A Jesusa M. G. Arevalo %A Ma, Jeffrey %A David R Weir %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Down-Regulation %K Female %K Humans %K Inflammation %K Loneliness %K Longitudinal Studies %K Male %K Mental Health %K Middle Aged %K social isolation %K Social Support %K Stress, Psychological %K Transcriptome %X

BACKGROUND: Chronic social adversity activates a conserved transcriptional response to adversity (CTRA) marked by increased expression of pro-inflammatory genes and decreased expression of antiviral- and antibody-related genes. Recent findings suggest that some psychological resilience factors may help buffer CTRA activation, but the relative impact of resilience and adversity factors remains poorly understood. Here we examined the relative strength of CTRA association for the two best-established psychological correlates of CTRA gene expression-the risk factor of perceived social isolation (loneliness) and the resilience factor of eudaimonic well-being (purpose and meaning in life).

METHODS: Peripheral blood samples and validated measures of loneliness and eudaimonic well-being were analyzed in 108 community-dwelling older adults participating in the longitudinal US Health and Retirement Study (56% female, mean age 73). Mixed effect linear model analyses quantified the strength of association between CTRA gene expression and measures of loneliness and eudaimonic well-being in separate and joint analyses.

RESULTS: As in previous studies, separate analyses found CTRA gene expression to be up-regulated in association with loneliness and down-regulated in association with eudaimonic well-being. In joint analyses, effects of loneliness were completely abrogated whereas eudaimonic well-being continued to associate with CTRA down-regulation. Similar eudaimonia-dominant effects were observed for positive and negative affect, optimism and pessimism, and anxiety symptoms. All results were independent of demographic and behavioral health risk factors.

CONCLUSIONS: Eudaimonic well-being may have the potential to compensate for the adverse impact of loneliness on CTRA gene expression. Findings suggest a novel approach to targeting the health risks associated with social isolation by promoting purpose and meaning in life.

%B Psychoneuroendocrinology %I 62 %V 62 %P 11-7 %8 2015 Dec %G eng %U http://www.sciencedirect.com/science/article/pii/S0306453015002358 %1 http://www.ncbi.nlm.nih.gov/pubmed/26246388?dopt=Abstract %2 PMC4637182 %4 Social genomics/Psychoneuroimmunology/Gene expression/Transcriptome/Microarray/Stress/Social support/Psychological well-being/Eudaimonia/Positive psychology %$ 999999 %R 10.1016/j.psyneuen.2015.07.001 %0 Journal Article %J The Journal of the Economics of Ageing %D 2015 %T The long reach of education: Early retirement %A Steven F Venti %A David A Wise %K disability insurance %K Education %K Retirement %K Social Security %X The goal of this paper is to draw attention to the long lasting effect of education on economic outcomes. We use the relationship between education and two routes to early retirement – the receipt of Social Security Disability Insurance (DI) and the early claiming of Social Security retirement benefits – to illustrate the long-lasting influence of education. We find that for both men and women with less than a high school degree the median DI participation rate is 6.6 times the participation rate for those with a college degree or more. Similarly, men and women with less than a high school education are over 25 percentage points more likely to claim Social Security benefits early than those with a college degree or more. We focus on four critical “pathways” through which education may indirectly influence early retirement – health, employment, earnings, and the accumulation of assets. We find that for women health is the dominant pathway through which education influences DI participation. For men, the health, earnings, and wealth pathways are of roughly equal magnitude. For both men and women the principal channel through which education influences early Social Security claiming decisions is the earnings pathway. We also consider the direct effect of education that does not operate through these pathways. The direct effect of education is much greater for early claiming of Social Security benefits than for DI participation, accounting for 72% of the effect of education for men and 67% for women. For women the direct effect of education on DI participation is not statistically significant, suggesting that the total effect may be through the four pathways. %B The Journal of the Economics of Ageing %V 6 %P 133 - 148 %G eng %U http://www.sciencedirect.com/science/article/pii/S2212828X15000201 %R https://doi.org/10.1016/j.jeoa.2015.08.001 %0 Journal Article %J Review of Economics of the Household %D 2015 %T Marital bargaining in the demand for life insurance: evidence from the Health and Retirement Study %A Edwin S. Wong %K End of life decisions %K Insurance %K Net Worth and Assets %K Other %X A vast literature explores life insurance from the perspective of a single individual. This paper considers an alternative approach by developing and testing a theoretical model for term life insurance demand by married households over age 50. Allowing for joint, cooperative decision making between spouses, empirical findings show that increasing the relative bargaining power of husbands results in reductions in the size of the insurance policies covering the lives of husbands in a manner consistent with theory. The intuition is that households reallocate resources to states of nature that husbands place greater weight by reducing the amount spent on purchasing insurance covering the lives of husbands. In contrast, marital bargaining power generally has a substantially smaller effect in the demand for life insurance covering the lives of wives. However, when bargaining power is shifted towards husbands, life insurance coverage increases among the subsample of wives who provide a large proportion of total household income and are more likely to require protection against lost future income in the event of death. %B Review of Economics of the Household %I 13 %V 13 %P 243-268 %G eng %N 2 %4 life Insurance/household income/decision Making/Bargaining %$ 999999 %0 Journal Article %J BMC Genomics %D 2015 %T Mixture SNPs effect on phenotype in genome-wide association studies. %A Wang, Ling %A Shen, Haipeng %A Hexuan Liu %A Guo, Guang %K Algorithms %K Alleles %K Alpha-Ketoglutarate-Dependent Dioxygenase FTO %K Bayes Theorem %K Body Mass Index %K Chromosomes, Human, Pair 16 %K Genome-Wide Association Study %K Humans %K Linkage Disequilibrium %K Phenotype %K Polymorphism, Single Nucleotide %K Principal Component Analysis %K Proteins %X

BACKGROUND: Recently mixed linear models are used to address the issue of "missing" heritability in traditional Genome-wide association studies (GWAS). The models assume that all single-nucleotide polymorphisms (SNPs) are associated with the phenotypes of interest. However, it is more common that only a small proportion of SNPs have significant effects on the phenotypes, while most SNPs have no or very small effects. To incorporate this feature, we propose an efficient Hierarchical Bayesian Model (HBM) that extends the existing mixed models to enforce automatic selection of significant SNPs. The HBM models the SNP effects using a mixture distribution of a point mass at zero and a normal distribution, where the point mass corresponds to those non-associative SNPs.

RESULTS: We estimate the HBM using Gibbs sampling. The estimation performance of our method is first demonstrated through two simulation studies. We make the simulation setups realistic by using parameters fitted on the Framingham Heart Study (FHS) data. The simulation studies show that our method can accurately estimate the proportion of SNPs associated with the simulated phenotype and identify these SNPs, as well as adapt to certain model mis-specification than the standard mixed models. In addition, we analyze data from the FHS and the Health and Retirement Study (HRS) to study the association between Body Mass Index (BMI) and SNPs on Chromosome 16, and replicate the identified genetic associations. The analysis of the FHS data identifies 0.3% SNPs on Chromosome 16 that affect BMI, including rs9939609 and rs9939973 on the FTO gene. These two SNPs are in strong linkage disequilibrium with rs1558902 (Rsq =0.901 for rs9939609 and Rsq =0.905 for rs9939973), which has been reported to be linked with obesity in previous GWAS. We then replicate the findings using the HRS data: the analysis finds 0.4% of SNPs associated with BMI on Chromosome 16. Furthermore, around 25% of the genes that are identified to be associated with BMI are common between the two studies.

CONCLUSIONS: The results demonstrate that the HBM and the associated estimation algorithm offer a powerful tool for identifying significant genetic associations with phenotypes of interest, among a large number of SNPs that are common in modern genetics studies.

%B BMC Genomics %I 16 %V 16 %P 3 %8 2015 Feb 03 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25649116?dopt=Abstract %2 PMC4417323 %4 genetics/genetics/Phenotypes/Phenotypes/Hierarchical Bayesian Model/Statistical analysis/Framingham Heart Study/Body Mass Index %$ 999999 %R 10.1186/1471-2164-16-3 %0 Journal Article %J Prev Chronic Dis %D 2015 %T Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions. %A Siran M Koroukian %A David F Warner %A Owusu, Cynthia %A Charles W Given %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Body Mass Index %K Chronic disease %K Cognition Disorders %K Comorbidity %K Cross-Sectional Studies %K Data Interpretation, Statistical %K ethnicity %K Female %K Health Status Indicators %K Humans %K Interviews as Topic %K Male %K Middle Aged %K Mobility Limitation %K Outcome Assessment, Health Care %K Prospective Studies %K Recurrence %K Retirement %K Self Report %K Smoking %K Social Class %K Syndrome %K United States %K Vulnerable Populations %X

INTRODUCTION: Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature.

METHODS: We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality.

RESULTS: All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95% confidence intervals were as follows: 2.61 (1.79-3.78) and 2.20 (1.42-3.41) for MM1; 7.49 (5.20-10.77) and 3.70 (2.40-5.71) for MM2; and 22.66 (15.64-32.83) and 4.72 (3.03-7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72-24.62]) as likely as an adult classified as MM0 to die within 2 years.

CONCLUSION: Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used - both in clinical practice and in research - to identify older adults with heightened vulnerability for adverse outcomes.

%B Prev Chronic Dis %I 12 %V 12 %P E55 %8 2015 Apr 23 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25906436?dopt=Abstract %2 PMC4415428 %4 MORBIDITY/health status/health decline/mortality/baseline multimorbidity/health status %$ 999999 %R 10.5888/pcd12.140478 %0 Journal Article %J International Psychogeriatrics %D 2015 %T Neighborhood physical disorder, social cohesion, and insomnia: results from participants over age 50 in the Health and Retirement Study %A Lenis P. Chen-Edinboro %A Christopher N Kaufmann %A Augustinavicius, J. L. %A Ramin Mojtabai %A Parisi, J. M. %A Alexandra M. V. Wennberg %A Smith, M. T. %A Adam P Spira %K Consumption and Savings %K Demographics %K Health Conditions and Status %X Background:: We determined the association between neighborhood socio-environmental factors and insomnia symptoms in a nationally representative sample of US adults aged 50 years. Methods:: Data were analyzed from two waves (2006 and 2010) of the Health and Retirement Study using 7,231 community-dwelling participants (3,054 men and 4,177 women) in the United States. Primary predictors were neighborhood physical disorder (e.g. vandalism/graffiti, feeling safe alone after dark, and cleanliness) and social cohesion (e.g. friendliness of people, availability of help when needed, etc.); outcomes were insomnia symptoms (trouble falling asleep, night awakenings, waking too early, and feeling unrested). Results:: After adjustment for age, income, race, education, sex, chronic diseases, body mass index, depressive symptoms, smoking, and alcohol consumption, each one-unit increase in neighborhood physical disorder was associated with a greater odds of trouble falling asleep (odds ratio (OR) = 1.09, 95 confidence interval (CI): 1.04 1.14), waking too early (OR = 1.05, 95 CI: 1.00 1.10), and, in adults aged 69 years (adjusting for all variables above except age), feeling unrested in the morning (OR = 1.11, 95 CI: 1.02 1.22 in 2006). Each one-unit increase in lower social cohesion was associated with a greater odds of trouble falling asleep (OR = 1.06, 95 CI: 1.01 1.11) and feeling unrested (OR = 1.09, 95 CI: 1.04 1.15). Conclusions:: Neighborhood-level factors of physical disorder and social cohesion are associated with insomnia symptoms in middle-aged and older adults. Neighborhood-level factors may affect sleep, and consequently health, in our aging population. %B International Psychogeriatrics %V 27 %P 289-296 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84911902104andpartnerID=40andmd5=b1c8afcbfd51895bd32bf5836deba987 %N 2 %4 aging/sociodemographic characteristics/sociodemographic characteristics/insomnia/neighborhood Characteristics/physical disorder/sleep/social cohesion %$ 999999 %& 289 %0 Report %D 2015 %T Occupations and Work Characteristics: Effects on Retirement Expectations and Timing %A McFall, Brooke Helppie %A Amanda Sonnega %A Robert J. Willis %A Péter Hudomiet %K Employment and Labor Force %K Retirement Planning and Satisfaction %X Population aging and attendant pressures on public budgets have spurred considerable interest in understanding factors that influence retirement timing. A range of sociodemographic and economic characteristics have been shown to predict both earlier and later retirement. Less is known about the role of occupations and their characteristics on the work choices of older workers. Knowing more about the occupations that workers seem to stay in longer or leave earlier may point the way to policy interventions that are beneficial to both individuals and system finances. This project uses detailed occupational categories and work characteristics in the Health and Retirement Study (HRS) linked to information in the Occupational Information Network (O NET) to examine compositional changes in occupations held by older workers over time; to provide some basic and interesting information about relationships between occupations and their characteristics and retirement expectations and outcomes; and to shed some light on which occupations and associated characteristics might encourage or discourage longer working lives. There are large percentage changes (increases in decreases) in the percentage of older workers in occupations over time. Considering detailed as opposed to aggregated occupational categories yields interesting additional information. Jobs that HRS respondents say entail less physical effort, less stress, and jobs that have not increased in difficulty in recent decades, and those in which people can reduce hours if desired, are associated with longer work. While the traditional blue collar-retire earlier and white collar-work longer associations emerge, we find interesting exceptions that suggest fruitful directions for future research. %I Ann Arbor, MI, Michigan Retirement Research Center %G eng %4 O NET/Retirement %$ 999999 %0 Report %D 2015 %T An Ounce of Prevention at Half Price: Evaluating a Subsidy on Health Investments %A Matthew N. White %K Consumption and Savings %K Event History/Life Cycle %K Health Conditions and Status %X This paper examines how investments in health, through spending on preventive care, affect subsequent spending on medical care among the retired population.Augmenting a traditional dynamic consumption-savings model with two medical care goods, I estimate a structural life cycle model using data on single retired Americans from the Health and Retirement Study; I then conduct policy counterfactuals to ascertain the effect of a subsidy on preventive care on health and fiscal outcomes. A narrowly targeted subsidy improves longevity by 0.76 months at a public cost of 760 per capita, but does not reduce lifetime demand for medical care. %I Newark, DE, University of Delaware, Alfred Lerner College of Business and Economics %G eng %4 prevention/consumption/savings/life Cycle %$ 999999 %0 Journal Article %J Epidemiology %D 2015 %T Patterns of Weight Gain in Middle-Aged and Older US Adults, 1992-2010 %A Stenholm, Sari %A Vahtera, Jussi %A Ichiro Kawachi %A Pentti, Jaana %A Halonen, Jaana I. %A Westerlund, Hugo %A Razak, Fahad %A S. V. Subramanian %A Mika Kivimäki %K Health Conditions and Status %X Background: Cross-sectional analyses of national data have found that persons with high baseline body mass index (BMI) gain weight faster than persons at the median and that those whose weight was below the median gain very little weight. However, it is not clear whether these population-level changes reflect patterns at the individual level. Methods: We examined longitudinal changes in BMI in initially underweight, normal-weight, overweight, and obese US men and women using individual-level repeat data from the Health and Retirement Study (n = 15,895; age range, 40-69 years at baseline). Linear mixed-effect regression was used to model 6-year change in self-reported BMI during 4 study periods (1992/1994-1998/2000, 1996/1998-2002/2004, 2000/2002-2006/2008, and 2004-2010). Results: In the first 6-year period, the mean increase in BMI was greatest among persons who were initially normal weight (0.3 kg/m(2) 95 confidence interval = 0.2 to 0.4 ) and overweight (0.2 kg/m(2) 0.1 to 0.3 ). Weight gain accelerated in these groups with each subsequent period. Weight gain was less for initially class-I obese participants, and a net decrease in BMI was observed for class-II obese participants. Conclusion: These analyses suggest that the change in mean BMI among middle-aged and older US adults between 1992 and 2010 resulted mainly from accelerated weight gain among persons who were initially normal weight and overweight. %B Epidemiology %I 26 %V 26 %P 165-168 %G eng %N 2 %4 Body Mass Index/weight gain/Obesity %$ 999999 %R 10.1097/ede.0000000000000228 %0 Journal Article %J Annals of Epidemiology %D 2015 %T Predictors of functional limitation trajectories after injury in a nationally representative U.S. older adult population %A Teresa M. Bell %A Wang, Junling %A Nolly, Robert %A Ozdenerol, Esra %A Relyea, George %A Ben L. Zarzaur %K Demographics %K Disabilities %K Event History/Life Cycle %K Health Conditions and Status %K Healthcare %X Studies examining postinjury functional status have demonstrated that individuals with severe injuries often do not return to baseline levels of physical functioning. We sought to investigate the impact injuries have on changes in physical functioning across the life course of older adults. The study's objectives were to (1) identify trajectories of long-term functional limitations after injury in the older adult population to better characterize the recovery process and (2) predict which individuals are most at risk for poor functional trajectories after injury. A retrospective cohort study was conducted using six waves of data from the Health and Retirement Study, which surveys Americans older than 50 years every two years. A group-based trajectory model was used to identify trajectories of functional limitations in injured participants. Using multivariate regression, we identified significant predictors of each trajectory. Five distinct trajectories were identified: Trajectory 1-consistently low functional limitations scores (18.9 ), Trajectory 2-increase in functional limitations after injury followed by a gradual, incomplete recovery (46.3 ), Trajectory 3-increase in functional limitations followed by further decline in functioning (10.5 ), Trajectory 4-increase in functional limitations after injury followed by a gradual, complete recovery (13.4 ), and Trajectory 5-consistently high functional limitations scores (10.8 ). Gender, multiple health conditions, and insurance status predicted trajectory membership. Functional limitations after injury follow distinct trajectories that can be predicted by baseline individual characteristics. %B Annals of Epidemiology %I 25 %V 25 %P 894 %G eng %N 12 %4 Disability/Disability/Life course epidemiology/Quality of Life/Aging/Trauma/Functional Assessment/Functional limitations/Trajectories %$ 999999 %0 Journal Article %J American Journal of Public Health %D 2015 %T Preparaci n de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional %A Tala M. Al-rousan %A Linda M. Rubenstein %A Robert B Wallace %K Demographics %K Health Conditions and Status %K Public Policy %X We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3 reported participating in an educational program or reading materials about disaster preparation. Nearly 15 reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society. %B American Journal of Public Health %I 105 %V 105 %P S614 %G eng %N S4 %R 10.2105/AJPH.2013.301559s %0 Report %D 2015 %T Racial Difference in the Use of VA Health Services %A Fang, Chichun %A Kenneth M. Langa %A Helen G Levy %A David R Weir %X We study the factors that affect the utilization of health care services administered by the Department of Veterans Affairs (VA) and its racial differences. Due to data limitation, previous research in this regard mostly only focuses on veterans who are VA users or at least eligible for VA services. We fill in the gap in literature with a random sample of veterans 51 and older from the Health and Retirement Study. We find that, among all veterans, those who are black and less healthy are more likely to use VA health services. These factors, nevertheless, are no longer statistically significant after the sample is restricted to veterans who are eligible for VA services. We also find that VA health services and services provided through other channels are at least partial substitutes: VA usage drops when a veteran becomes age eligible for Medicare or when a veteran has health insurance coverage through employment. This drop in usage holds not only among all veterans, but also among veterans eligible for VA services. Finally, perception about the quality of services delivered in VA versus non-VA facilities strongly predicts VA services usage. Those who have favorable views toward VA use VA services more, and the results from variance decomposition suggests a majority part of the racial difference in VA usage can be attributed to the racial difference in such perception. %I Ann Arbor, MI, Michigan Reirement Research Center, University of Michigan %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/pdf/wp334.pdf %4 Demographics %$ 999999 %0 Journal Article %J American Journal of Men's Health %D 2015 %T Racial Disparities in Mortality Among Middle-Aged and Older Men: Does Marriage Matter? %A Su, Dejun %A Stimpson, Jim P. %A Wilson, Fernando A. %K Adult children %K Demographics %K Health Conditions and Status %K Women and Minorities %X Based on longitudinal data from the Health and Retirement Study, this study assesses the importance of marital status in explaining racial disparities in all-cause mortality during an 18-year follow-up among White and African American men aged 51 to 61 years in 1992. Being married was associated with significant advantages in household income, health behaviors, and self-rated health. These advantages associated with marriage at baseline also got translated into better survival chance for married men during the 1992-2010 follow-up. Both marital selection and marital protection were relevant in explaining the mortality advantages associated with marriage. After adjusting for the effect of selected variables on premarital socioeconomic status and health, about 28 of the mortality gap between White and African American men in the Health and Retirement Study can be explained by the relatively low rates of marriage among African American men. Addressing the historically low rates of marriage among African Americans and their contributing factors becomes important for reducing racial disparities in men s mortality. %B American Journal of Men's Health %I 9 %V 9 %P 289-300 %G eng %U http://jmh.sagepub.com/content/early/2014/06/24/1557988314540199.abstract %N 4 %4 racial disparities/mortality/marriage/health Behavior/Self assessed health/African American %$ 999999 %R 10.1177/1557988314540199 %0 Generic %D 2015 %T Reciprocal relations of loneliness and cognitive function in older U.S. adults %A Nancy J. Donovan %A Bei Wu %A Dorene M. Rentz %A Reisa A. Sperling %A Gad A. Marshall %A M. Maria Glymour %K Cognitive Ability %K Lone %K Relationships %X In older adults, loneliness has been associated with functional decline and increased progression to dementia. The objective of this study was to examine the reciprocal relations of loneliness and cognitive function in older adults, adjusting for sociodemographic and health-related factors, social network and depression. %G eng %U http://www.alzheimersanddementia.com/article/S1552-5260(15)02344-4/fulltext %R 10.1016/j.jalz.2015.07.194 %0 Thesis %B School of Public Service Leadership %D 2015 %T Relationship of financial literacy to retirement preparedness among female baby-boomer cohorts %A Womack, Barbara Klein %Y Keefer, Autumn %K End of life decisions %K Health Conditions and Status %K Methodology %K Net Worth and Assets %K Public Policy %K Retirement Planning and Satisfaction %K Women and Minorities %X Studies have not examined the impact of components of financial literacy on retirement preparedness nor the relationship between financial literacy and decision-making among female baby-boomers. This study examined data from the 2010 wave of the Health and Retirement Study for females born between 1946 and 1959. This study defined financial literacy as including knowledge of investment strategies, the bond market, risk, and diversity. It defined retirement preparedness as the possession of specific financial assets. Financial decision-making was defined as the potential for mortgage default and carrying balances on credit cards. The study used a synthesis of rational choice and planned behavior theories. Correlation was used to describe the relationships between variables, and Fisher's transformation was used to determine significant differences between cohorts. Multiple linear regression was used to create predictive models for retirement planning, with the resultant finding that age was significant in predicting retirement preparedness ( p < .01). Older cohorts were more prepared, particularly in terms of owning IRA/Keogh plans. Understanding the effects of holding a variety of stocks and foreign stocks were most strongly related to retirement preparedness. There was a significant relationship between financial literacy and the potential for mortgage default ( p < .05) but not for carrying credit card balances. The regression produced a significant ( p < .05) predictive model for retirement preparedness, thought the relationship with financial literacy was slight. The research has implications in terms of housing, health, and municipal sustainability. Further research is necessary to define financial literacy, retirement preparedness, and their relationship. %B School of Public Service Leadership %I Capella University %V Ph.D. %P 115 %8 2015 %G eng %4 Social research %! Relationship of financial literacy to retirement preparedness among female baby-boomer cohorts %0 Journal Article %J Journal of Geriatric Psychiatry and Neurology %D 2015 %T Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study %A Pertl, Maria M. %A Lawlor, Brian A. %A Robertson, Ian H. %A Walsh, Cathal %A Brennan, Sabina %K Health Conditions and Status %K Healthcare %X Caring for a spouse with dementia is a chronic stressor that may compromise caregivers own cognitive functioning and capacity to provide adequate care. We examined whether having (i) a spouse with dementia and (ii) a spouse who requires assistance with activities of daily living predicted cognitive and functional impairments in respondents to the Health and Retirement Study (n = 7965). Respondents who had a spouse who requires care had poorer cognitive functioning, whereby this relationship was significantly stronger for male respondents. Having a spouse with dementia moderated the relationship between income and cognition and predicted caregiver functional impairment, though not when depression was controlled. Although we found no significant differences on any individual cognitive domains between 179 dementia caregivers and sociodemographically matched noncaregivers, our findings suggest that caregivers, especially men, and low-income individuals who have a spouse with dementia are more vulnerable to adverse cognitive outcomes. Targeting depression in spouses of people with dementia may help to prevent functional impairments. %B Journal of Geriatric Psychiatry and Neurology %I 28 %V 28 %P 260-271 %G eng %U http://jgp.sagepub.com/content/early/2015/06/10/0891988715588834.abstract %N 4 %4 caregiver burden/dementia/cognitive impairment/stress/activities of daily living/depression %$ 999999 %R 10.1177/0891988715588834 %0 Journal Article %J Journal of the International Neuropsychological Society %D 2015 %T Role of Place in Explaining Racial Heterogeneity in Cognitive Outcomes among Older Adults %A Sze Y Liu %A M. Maria Glymour %A Laura B Zahodne %A Weiss, Christopher %A Jennifer J Manly %K Health Conditions and Status %K Healthcare %K Women and Minorities %X Racially patterned disadvantage in Southern states, especially during the formative years of primary school, may contribute to enduring disparities in adult cognitive outcomes. Drawing on a lifecourse perspective, we examine whether state of school attendance affects cognitive outcomes in older adults and partially contributes to persistent racial disparities. Using data from older African American and white participants in the national Health and Retirement Study (HRS) and the New York based Washington Heights Inwood Cognitive Aging Project (WHICAP), we estimated age-and gender-adjusted multilevel models with random effects for states predicting years of education and cognitive outcomes (e.g., memory and vocabulary). We summarized the proportion of variation in outcomes attributable to state of school attendance and compared the magnitude of racial disparities across states. Among WHICAP African Americans, state of school attendance accounted for 9 of the variance in years of schooling, 6 of memory, and 12 of language. Among HRS African Americans, state of school attendance accounted for 13 of the variance in years of schooling and also contributed to variance in cognitive function (7 ), memory (2 ), and vocabulary (12 ). Random slope models indicated state-level African American and white disparities in every Census region, with the largest racial differences in the South. State of school attendance may contribute to racial disparities in cognitive outcomes among older Americans. Despite tremendous within-state heterogeneity, state of school attendance also accounted for some variability in cognitive outcomes. Racial disparities in older Americans may reflect historical patterns of segregation and differential access to resources such as education. %B Journal of the International Neuropsychological Society %I 21 %V 21 %P 677-687 %G eng %N 9 %4 Cognitive functioning/Geographical variation/Memory/AFRICAN-AMERICANS/DEMENTIA/CLINICAL NEUROLOGY/PSYCHIATRY/NEUROSCIENCES/MORTALITY/Sociocultural Factors %$ 999999 %R 10.1017/s1355617715000806 %0 Report %D 2015 %T Slowed or Sidelined? The Effect of Normal Cognitive Decline on Job Performance Among the Elderly %A Belbase, Anek %A Khan, Mashfiqur R. %A Alicia H. Munnell %A Anthony Webb %K Employment and Labor Force %K Health Conditions and Status %X This paper examines the relationship between age-related cognitive decline and three potential workplace outcomes: 1) coping with increased job difficulty; 2) shifting to a less cognitively demanding job; and 3) retiring early. It uses data from the Health and Retirement Study (HRS) and the O NET database. Critical components of the analysis are the metric used to measure cognitive decline, inclusion of cognitive reserve as an independent variable, and the use of overlapping 10-year observation windows. A key limitation is that the study cannot conclusively discern a causal relationship between cognitive decline and workforce exit. %I Boston, MA, Center for Retirement Research at Boston College %G eng %4 O NET/workplace/Cognitive reserve/labor Force Participation/Cognitive decline %$ 999999 %0 Thesis %D 2015 %T Three Essays on the Supply of Long-Term Care Services to the Elderly in the U.S %A Arora, Kanika %Y Douglas A. Wolf %K Adult children %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Methodology %K Net Worth and Assets %K Public Policy %X Situated in the context of a rapidly aging population, this dissertation examines the implications of supplying long-term care (LTC) services to the elderly in the United States. The first two essays investigate private costs of LTC assistance borne by adult children of elderly parents. In contrast, the third essay focuses on the cost of publicly-provided, formal LTC services. The first essay analyzes whether adult children devote less time to exercise as time allocation in parental caregiving increases. The empirical model is a system of four correlated equations, where the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. I use pooled cross-sectional data from the Health and Retirement Study (HRS) for this analysis. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, nor in hours of work, among either men or women. The second essay goes beyond time resources and examines whether dementia onset in parents leads to a reduction in adult children's household wealth. Towards this, I construct a longitudinal dataset from seven waves of HRS. Estimates from unconditional quantile regressions indicate that parental dementia substantially reduces household wealth of an unmarried adult child in the upper quantiles of the wealth change distribution in the first two years after parental diagnosis. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent time period as well. An examination of mechanisms suggests that both, losses in labor income and nursing home expenditures, may play a role in leading to wealth declines. This paper makes two contributions: first, it focuses on a broader outcome of private cost, and second, unlike previous studies, it does not limit the analysis to adult children who are informal caregivers. The final essay examines the cost implications of publicly provided formal care services. Medicaid's Personal Care Services (PCS) State Plan benefit is a key mechanism through which states provide personal assistance services to eligible beneficiaries. But, it is widely claimed that states are reluctant to adopt the program over fears of runaway spending. Surprisingly, there has been very little empirical work on examining the effect of the PCS State Plan benefit on Medicaid expenditures. Using aggregate state-level data from 1975 through 2009, this study finds that PCS State Plan adoption had no overall effect on Medicaid expenditures, except briefly during the early-growth years in 1980s. Further, findings suggest that states make decisions to adopt the program based on financial experiences of other adopting states. This study provides evidence consistent with the interpretation that when faced with the dilemma of balancing increased access and uncontrolled expenditures, state officials adapt the design of an entitlement benefit in an effort to make it less expensive. In its entirety, the dissertation provides new thinking on two dominant themes in conventional long-term care research: "caregiver burden" and "woodwork effect". In particular, the results of the first and third essay question the presence of "caregiver burden" and "woodwork effect" respectively, while the third essay challenges the pervasiveness of "caregiver burden" among unmarried adult children. These findings, which in some aspect are unexpected in the context of existing literature, have important implications for policy intervention and the direction of future research efforts in this area. %I Syracuse University %C Syracuse, NY %V 3713670 %P 105 %8 2015 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1708672813?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ %9 Ph.D. %M 1708672813 %4 0630:Public policy %! Three Essays on the Supply of Long-Term Care Services to the Elderly in the U.S %0 Report %D 2015 %T To What Extent Does SES Status Lead People to Retire Too Soon? %A Alicia H. Munnell %A Anqi Chen %A Anthony Webb %K Retirement %K socioeconomic status %X Working longer is a powerful lever to enhance retirement security. Individuals should be able to extend the number of years they work because, on average, they are healthier, live longer, and face less physically demanding jobs. But averages are misleading when discrepancies in health, job prospects, and life expectancy have widened between individuals with low and high socioeconomic status (SES). To understand the extent of disparities across SES groups, this paper uses data from the Health and Retirement Study (HRS) to identify the retirement gap – the difference between how much longer each household would need to work to maintain their pre-retirement standard of living and their planned retirement age. The analysis shows that households in lower-SES quartiles have larger retirement gaps than their higher-SES counterparts, even after controlling for household characteristics and late-career shocks. This same group has seen little improvement in health and life expectancy and faces poor job prospects. In short, retirement shortfalls for the most vulnerable may not be able to be bridged by working longer, and other solutions will be needed. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/how-much-longer-do-people-need-to-work/ %0 Report %D 2015 %T The Transition from Defined Benefit to Defined Contribution Pensions: Does It Influence Elderly Poverty? %A Orlova, Natalia S. %A Matthew S. Rutledge %A April Yanyuan Wu %K Net Worth and Assets %K Pensions %K Retirement Planning and Satisfaction %X The transition from defined benefit (DB) to defined contribution (DC) pension plans has left workers forced to make choices that may decrease their financial resources in retirement: taking lump-sum distributions before retirement that divert funds that could support consumption in retirement, not annuitizing DC benefits, or choosing a single-life annuity over a joint-and-survivor option so that their surviving spouses are left susceptible to income loss. This study examines pension coverage, lump-sum distributions, annuitization, and annuity life options among Health and Retirement Study households observed at ages 65-69 and 75-79 and relates these pension provisions to poverty incidence and the risk of falling into poverty at older ages. The results indicate that households with pensions that are annuitized with the joint-and-survivor life option and that do not take lump-sum distributions before age 55 are best able to avoid income and asset poverty. The results emphasize the importance of making DC plans operate more like DB plans, because the opportunities for these poor financial choices are likely only to grow given the reliance on DC plans as the sole source of employer pension income for future cohorts of retirees. %I Boston College %G eng %4 Retirement planning/pension plans/Defined benefit plans/defined contribution pension plans/annuitization %$ 999999 %0 Journal Article %J JAMA Oncol %D 2015 %T Trends in Advance Care Planning in Patients With Cancer: Results From a National Longitudinal Survey. %A Amol K Narang %A Alexi A Wright %A Lauren Hersch Nicholas %K Female %K Health Maintenance Organizations %K Health Resources %K Humans %K Male %K Neoplasms %K Terminal Care %X

IMPORTANCE: Advance care planning (ACP) may prevent end-of-life (EOL) care that is nonbeneficial and discordant with patient wishes. Despite long-standing recognition of the merits of ACP in oncology, it is unclear whether participation in ACP by patients with cancer has increased over time.

OBJECTIVES: To characterize trends in durable power of attorney (DPOA) assignment, living will creation, and participation in discussions of EOL care preferences and to explore associations between ACP subtypes and EOL treatment intensity as reflected in EOL care decisions and terminal hospitalizations.

DESIGN, SETTING, AND PARTICIPANTS: We analyzed prospectively collected survey data from 1985 next-of-kin surrogates of Health and Retirement Study (HRS) participants with cancer who died between 2000 and 2012, including data from in-depth "exit" interviews conducted with the surrogates after the participant's death. The HRS is a nationally representative, biennial, longitudinal panel study of US residents older than 50 years. Trends in ACP subtypes were tested, and multivariable logistic regression models examined for associations between ACP subtypes and measures of treatment intensity.

MAIN OUTCOMES AND MEASURES: Trends in the surrogate-reported frequency of DPOA assignment, living will creation, and participation in discussions of EOL care preferences; associations between ACP subtypes and both surrogate-reported EOL care decisions and terminal hospitalizations.

RESULTS: From 2000 to 2012, there was an increase in DPOA assignment (52% to 74%, P = .03), without significant change in use of living wills (49% to 40%, P = .63) or EOL discussions (68% to 60%, P = .62). Surrogate reports that patients received "all care possible" at EOL increased during the period (7% to 58%, P = .004), and rates of terminal hospitalizations were unchanged (29% to 27%, P = .70). Limiting or withholding treatment was associated with living wills (adjusted odds ratio [AOR], 2.51; 95% CI, 1.53-4.11; P < .001) and EOL discussions (AOR, 1.93; 95% CI, 1.53-3.14; P = .002) but not with DPOA assignment.

CONCLUSIONS AND RELEVANCE: Use of DPOA increased significantly between 2000 and 2012 but was not associated with EOL care decisions. Importantly, there was no growth in key ACP domains such as discussions of care preferences. Efforts that bolster communication of EOL care preferences and also incorporate surrogate decision makers are critically needed to ensure receipt of goal-concordant care.

%B JAMA Oncol %I 1 %V 1 %P 601-8 %8 2015 Aug %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/26181909?dopt=Abstract %2 PMC4537325 %4 advance care planning/Durable power of attorney/end of life/living will %$ 999999 %R 10.1001/jamaoncol.2015.1976 %0 Thesis %D 2015 %T Using mixed methods to identify the characteristics of older fraud victims %A DeLiema, Marguerite %Y Kathleen H. Wilber %K Consumption and Savings %K Employment and Labor Force %K Gerontology %K Health Conditions and Status %K Healthcare %K Methodology %K Public Policy %X In 2011, 7.3% of U.S. adults ages 65-74 and 6.5% of adults ages 75 and older were victims of financial fraud (Anderson, 2013). In addition to the billions of dollars lost annually to scams, indirect societal costs include paying for the care and support of elders who lost their life savings, and the expense of investigating cases and prosecuting offenders. One of the first steps in stopping fraud is determining who is most vulnerable, yet the research literature on risk factors presents a conflicting narrative. Some research studies and consumer protection agencies report that older adults are the most vulnerable age group due to greater social isolation and impairments in financial decision-making however, national prevalence studies have found that elders are the least likely to experience fraud. According to the Financial Fraud Research Center (2012), research identifying the specific risk factors that make elders susceptible to fraud is important to inform policies and where to target resources. After describing the prevalence, cost, and mechanisms of fraud, this dissertation discusses multiple theoretical explanations for why older adults are vulnerable. Chapter I presents a temporospatial framework for fraud based on the routine activity theory (Cohen & Felson, 1979) and an ecological theory of elder financial exploitation (Rabiner, O'Keefe, & Brown, 2004). The adapted model proposes that targets and scam artists are nested within the broader social and political macrostructure comprised of public policy and legislation on consumer protection, prevention/education efforts to reduce fraud, fraud reporting mechanisms, and society's values, beliefs and attitudes about older adults. In the following three empirical chapters, a mixed methods approach is used to identify the demographic, socioeconomic, psychological and cognitive characteristics of older fraud victims using the nationally-representative Health and Retirement Study (HRS) and a sample of victims in Los Angeles County. Researchers have observed that different types of fraud target different socio-demographic groups (Pak & Shadel, 2011). To identify heterogeneity among the respondents who reported fraud in the HRS, Chapter III employs latent class analysis (LCA) to test the hypothesis that older victims of fraud vary in terms of their socioeconomic and demographic characteristics. Two distinct victim classes (i.e., typologies, profiles) emerged from the analysis. Based on the distribution of socioeconomic and demographic characteristics within each group, Class 1 was descriptively labeled " high-SES middle-age married adults, " and Class 2 was labeled " low-SES older widowed females ." The high-SES middle-aged married adult group was larger than the low-SES older widowed female group, suggesting that the former group of victims is more prominent in the U.S. population over age 50. High-SES middle-aged married adults had higher average levels of cognitive functioning and also experienced a higher average number of stressful life events in the past five years compared to low-SES older widowed females . Using a national sample, this analysis provides comparable results to earlier studies that identified two victim typologies using a smaller sample of older victims identified by law enforcement: "bogus prize promotion" and "investment fraud" victim (Pak & Shadel, 2011; Financial Industry Regulatory Authority; 2006). The main finding of Chapter IV is that although fraud and financial abuse victims share many of the same physiological, environmental, demographic, and psychosocial characteristics, they differ in that fraud victims have significantly higher Mini Mental State Exam scores, better mobility, and are more likely to be childless. A proposed explanation for the similarities is that exploitation has less to do with the characteristics and risk factors associated with the victim, and more to do with the people surrounding the victim (or lack thereof). In othe words, the structure of the victim's social network determines whether he or she is more likely t be a victim of fraud by strangers or financial abuse by family and friends. This analysis illuminates areas where intervention and prevention strategies may differ between each type of exploitation. This dissertation contributes to the literature in several important ways. First, it helps clarify the relationship between fraud susceptibility, age, and socioeconomic status among adults ages 50 and older in the U.S. Second, it uses prospective (pre-fraud) data on individuals to determine whether the purported risk factors for fraud--loneliness, poor cognitive functioning, stressful life events--actually do increase like likelihood of victimization later on. Third, findings from the latent class analysis support previous research using victim complaint data to categorize victims based on their SES and demographic characteristics. And fourth, the qualitative findings in this study reveal the tremendous financial cost of fraud, and also the importance of friends and family members in protecting older adults from predatory strangers. (Abstract shortened by UMI.) %I University of Southern California %C Los Angeles, CA %V 3704229 %P 132 %8 2015 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1705799725?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+Full+Text&rft_val_fmt=info:ofi/ %9 Ph.D. %M 1705799725 %4 0493:Aging %! Using mixed methods to identify the characteristics of older fraud victims %0 Report %D 2015 %T What Determines End-of-Life Assets? A Retrospective View %A James M. Poterba %A Steven F Venti %A David A Wise %K Consumption and Savings %K Employment and Labor Force %K Net Worth and Assets %K Women and Minorities %X We consider assets when individuals were last observed prior to death in the Health and Retirement Study (HRS) and trace assets backwards to the age when these individuals were first observed. For most individuals, assets in the last year observed (LYO) were very similar to assets in the first year observed (FYO). In particular, most of those who were last observed with very low asset levels also had low assets when first observed. We also estimate the relationship between an individual's asset change between the first and last date of observation, that individual's education and health status when first observed, and that individual's within-sample changes in health and family composition. We obtain estimates for HRS respondents who were 51 to 61 in 1992 and for AHEAD respondents who were age 70 and over in 1993. %G eng %4 Consumption/Saving/Wealth/Economics of the Elderly/Economics of the Handicapped/Non-labor Market Discrimination %$ 999999 %0 Journal Article %J Communities and Banking %D 2015 %T Why Don't Lower-Income Individuals Have Retirement Saving Plans? %A April Yanyuan Wu %A Matthew S. Rutledge %A Penglase, Jacob %K Income %K Pensions %X Lower-income individuals lower employment rate and the smaller probability of their working for an employer that offers pensions underlie the pension gap between higher- and lower-income groups. %B Communities and Banking %I 16 %V 16 %P 16-19 %G eng %N 1 %4 pensions/income %$ 999999 %0 Report %D 2015 %T Will the Average Retirement Age Continue to Increase? %A Matthew S. Rutledge %A Gillis, Christopher M. %A Anthony Webb %K Employment and Labor Force %K Pensions %K Retirement Planning and Satisfaction %K Social Security %X Using Health and Retirement Study (HRS) data, this paper examines how changes in individual workers past and present pension coverage, retirement incentives in Social Security, and retiree health insurance have contributed to retirement decisions for the 1931-1953 birth cohorts. It then uses these findings to project retirement behavior for the 1955-1987 cohorts in the Survey of Income and Program Participation (SIPP). A key assumption is that younger cohorts will have no defined benefit (DB) pensions or retiree health coverage in their future jobs. A key limitation is the assumption of a stable relationship in each successive cohort between each factor and labor market decisions. %I Boston, MA, Center for Retirement Research at Boston College %G eng %4 retirement planning/labor market decisions/retiree health insurance/social Security/pensions %$ 999999 %0 Thesis %D 2015 %T Work Hour Trajectories, Marital Quality, and Health of Couples Across the Life Course %A Wylie H Wan %K Adult children %K Demographics %K Employment and Labor Force %K Event History/Life Cycle %X There has been a growing interest in understanding work and family roles over the last several decades. Much of the literature has examined the work-family context as static and homogenous, but work and family lives change and develop over a lifetime. This dissertation conceptualizes work-family context as complex, dynamic, and heterogeneous for individuals and couples. Adopting a lifespan/life course framework, I use longitudinal data to examine work hour trajectories of both husband and wife among a sample of young newlyweds and a sample of older couples. I further investigate the associations among couples' work hour trajectories, marital quality, and health over time. The first study examined work hour trajectories among newlywed couples over the first 16 years of marriage. Data were from the Early Years of Marriage Project, which included 352 Black and White American newlyweds in their first year of marriage in 1986 (Year 1), and in Years 3, 7, and 16 of their marriage. Four qualitatively distinct trajectories of work hours were identified. Notably, husbands worked full time in Year 1 of marriage with no change over 16 years across all four trajectories, whereas wives varied in the number of work hours in Year 1 and in how they changed over time. Results showed that these trajectories were associated with changes in marital happiness and depression predominantly among husbands even though it was the wives' work hours that varied. The second study examined work hour trajectories among midlife and older couples over 14 years of marriage. Analyzing a nationally representative sample of 1641 midlife and older couples from the Health and Retirement Study, six distinct work hour trajectories were identified. Work hours significantly decreased for all trajectories and the slopes of decline varied. Results showed that work hour trajectories were associated with changes in self-rated health and depression among husbands and wives. Taken together, these studies illustrate the heterogeneity of couples' work trajectories over the life course and the importance of studying linked lives over time. The findings also suggest that family roles and other work-related factors may moderate the effects of work on marital and health outcomes. %I University of Michigan %C Ann Arbor, MI %G eng %4 Marital History %! Work Hour Trajectories, Marital Quality, and Health of Couples Across the Life Course %0 Journal Article %J Journal of the American Geriatrics Society %D 2014 %T Advance directive completion by elderly americans: A decade of change %A Maria J Silveira %A Wiitala, W. %A John D Piette %K End of life decisions %K Retirement Planning and Satisfaction %X Objectives: To describe trends in advance directive (AD) completion from 2000 to 2010 and to explore the relationship between AD and hospitalization and hospital death at the end of life. Design: Retrospective cohort study. Setting: Health and Retirement Study (HRS). Participants: HRS participants who died between 2000 and 2010 and were aged 60 and older at death (N = 6,122). Measurements: Trends over time in rates of AD completion, hospitalization before death, and death in hospital are described. The association between trends in AD completion and hospital death was then assessed by comparing nested, multivariable logistic regression models predicting the odds of hospital death over time with and without adjusting for AD status and sociodemographic characteristics. The complex sampling design was accounted for in all analyses. Results: The proportion of decedents with an AD increased from 47 in 2000 to 72 in 2010. At the same time, the proportion of decedents with at least one hospitalization in the last 2 years of life increased from 52 to 71 , and the proportion dying in the hospital decreased from 45 to 35 . After adjusting for confounding by sociodemographic characteristics, the trend in declining hospital death over the decade was negligibly associated with the greater use of ADs. Conclusion: There has been a significant increase in rates of AD completion over the last decade, but this trend has had little effect upon hospitalization and hospital death, suggesting that AD completion is unlikely to stem hospitalization before death. 2014, The American Geriatrics Society. %B Journal of the American Geriatrics Society %V 62 %P 706-710 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84897346861andpartnerID=40andmd5=6c3047d8b5bb80860463fea1777abea9 %N 4 %4 Advance care planning/Advance directives/End of life %$ 999999 %0 Journal Article %J Health Affairs %D 2014 %T Advance directives and nursing home stays associated with less aggressive end-of-life care for patients with severe dementia. %A Lauren Hersch Nicholas %A Julie P W Bynum %A Theodore J Iwashyna %A David R Weir %A Kenneth M. Langa %K Advance directives %K Dementia %K Disabilities %K End-of-life care %K Nursing homes %K Older Adults %X

The number of older adults with cognitive impairment is increasing, and such adults often require a surrogate to make decisions about health care. However, little is known about the aggressiveness of end-of-life care for these people, especially those who reside in the community. We found that cognitive impairment is common among older adults approaching the end of life, whether they live in the community or in a nursing home, and that nearly 30 percent of patients with severe dementia remained in the community until death. Among those patients, having an advance directive in the form of a living will was associated with significantly less aggressive care at the end of life, compared to similar patients without an advance directive-as measured by Medicare spending ($11,461 less per patient), likelihood of in-hospital death (17.9 percentage points lower), and use of the intensive care unit (9.4 percentage points lower). In contrast, advance directives were not associated with differences in care for people with normal cognition or mild dementia, whether they resided in the community or in a nursing home. Timely advance care planning after a diagnosis of cognitive impairment may be particularly important for older adults who reside in the community.

%B Health Affairs %V 33 %P 667-74 %8 2014 Apr %G eng %N 4 %R 10.1377/hlthaff.2013.1258 %0 Journal Article %J Journal of Epidemiology and Community Health %D 2014 %T Age-related trajectories of physical functioning in work and retirement: The role of sociodemographic factors, lifestyle and disease %A Stenholm, Sari %A Westerlund, Hugo %A Salo, P. %A Hyde, Martin %A Pentti, Jaana %A Head, Jenny %A Mika Kivimäki %A Vahtera, Jussi %K Demographics %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Background: Loss of physical functioning is an early marker of declining health in older people. The objective of this study was to examine the age-related trajectories of physical functioning among those in full-time work and retirement. Methods: Based on the Health and Retirement Study, participants who were working full-time or were in full-time retirement and 65-85 years of age during the follow-up period from 1992 to 2010 were included (n=17 844, n of observations from repeated measures in full-time work 5891 and in retirement 57 117). Details of physical functioning were asked about at all study phases and 10 items related to mobility and activities of daily living were summed to obtain a physical functioning score (0-10). Results: The number of physical functioning difficulties increased every 10 years by 0.17 (95 CI 0.04 to 0.29) when in full-time work and by 0.46 (95 CI 0.41 to 0.50) in retirement after adjusting for age, sex, race, education, total wealth, Body Mass Index, smoking, physical activity and number of diseases. Factors that were associated with a significantly greater increase in number of physical functioning difficulties in full-time work and retirement include lifestyle-related risks and chronic conditions. Conclusions: Physical functioning declines faster in retirement than in full-time work in employees aged 65 years or older and the difference is not explained by absence of chronic diseases and lifestyle-related risks. 2014 by the BMJ Publishing Group Ltd. %B Journal of Epidemiology and Community Health %I 68 %V 68 %P 503-509 %G eng %N 6 %4 Physical Activity/ADL/IADL/trajectories/Physical function/retirement %$ 999999 %R 10.1136/jech-2013-203555 %0 Journal Article %J Alzheimer's and Dementia %D 2014 %T Aging children of long-lived parents experience slower cognitive decline %A Ambarish Dutta %A Henley, William %A Robine, Jean-Marie %A David J Llewellyn %A Kenneth M. Langa %A Robert B Wallace %A David Melzer %K Adult children %K Expectations %K Genetics %K Health Conditions and Status %B Alzheimer's and Dementia %I 10 %V 10 %P S315-S322 %G eng %U http://www.sciencedirect.com/science/article/pii/S1552526013024965 %N 5 %4 Dementia/Memory disorder/Aging/Parental longevity/Extreme survival/Cognitive impairment/Heritability %$ 999999 %R 10.1016/j.jalz.2013.07.002 %0 Journal Article %J Cerebrovascular Diseases %D 2014 %T Changes in Memory before and after Stroke Differ by Age and Sex, but Not by Race %A Qianyi Wang %A Mejía-Guevara, Iván %A Pamela M. Rist %A Stefan Walter %A Benjamin D Capistrant %A M. Maria Glymour %K Health Conditions and Status %K Methodology %X Background: Post-stroke memory impairment is more common among older adults, women and blacks. It is unclear whether post-stroke differences reflect differential effects of stroke per se or differences in prestroke functioning. We compare memory trajectories before and after stroke by age, sex and race. Methods: Health and Retirement Study participants aged 50 years (n = 17,341), with no stroke history at baseline, were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n = 1,574). Segmented linear regression models were used to compare annual rates of memory change before and after stroke among 1,169 stroke survivors, 405 stroke decedents and 15,767 stroke-free participants. Effect modification was evaluated with analyses stratified by baseline age ( 70 vs. 70), sex and race (white vs. nonwhite), and using interaction terms between age/sex/race indicators and annual memory change. Results: Older ( 70 years) adults experienced a faster memory decline before stroke (-0.19 vs. -0.10 points/year for survivors, -0.24 vs. -0.13 points/year for decedents, p 0.001 for both interactions), and among stroke survivors, larger memory decrements (-0.64 vs. -0.26 points, p 0.001) at stroke and faster memory decline (-0.15 vs. -0.07 points/year, p = 0.003) after stroke onset, compared to younger adults. Female stroke survivors experienced a faster prestroke memory decline than male stroke survivors (-0.14 vs. -0.10 points/year, p 0.001). However, no sex differences were seen for other contrasts. Although whites had higher post-stroke memory scores than nonwhites, race was not associated with rate of memory decline during any period of time; i.e. race did not significantly modify the rate of decline before or after stroke or the immediate effect of stroke on memory. Conclusions: Older age predicted worse memory change before, at and after stroke onset. Sex and race differences in post-stroke memory outcomes might be attributable to prestroke disparities, which may be unrelated to cerebrovascular disease. 2014 S. Karger AG, Basel. %B Cerebrovascular Diseases %I 37 %V 37 %P 235-243 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84897121425andpartnerID=40andmd5=22785f81bf8b09c85697670c6a2e2382 %N 4 %4 Memory change/Stroke/Effect modifier %$ 999999 %0 Journal Article %J J Manipulative Physiol Ther %D 2014 %T Chiropractic use in the Medicare population: prevalence, patterns, and associations with 1-year changes in health and satisfaction with care. %A Paula A Weigel %A Jason Hockenberry %A Frederic D Wolinsky %K Aged %K Aged, 80 and over %K Female %K Humans %K Male %K Manipulation, Chiropractic %K Medicare %K Patient Satisfaction %K Time Factors %K Treatment Outcome %K United States %X

OBJECTIVE: The purpose of this study was to examine how chiropractic care compares to medical treatments on 1-year changes in self-reported function, health, and satisfaction with care measures in a representative sample of Medicare beneficiaries.

METHODS: Logistic regression using generalized estimating equations is used to model the effect of chiropractic relative to medical care on decline in 5 functional measures and 2 measures of self-rated health among 12170 person-year observations. The same method is used to estimate the comparative effect of chiropractic on 6 satisfaction with care measures. Two analytic approaches are used, the first assuming no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: The unadjusted models show that chiropractic is significantly protective against 1-year decline in activities of daily living, lifting, stooping, walking, self-rated health, and worsening health after 1 year. Persons using chiropractic are more satisfied with their follow-up care and with the information provided to them. In addition to the protective effects of chiropractic in the unadjusted model, the propensity score results indicate a significant protective effect of chiropractic against decline in reaching.

CONCLUSION: This study provides evidence of a protective effect of chiropractic care against 1-year declines in functional and self-rated health among Medicare beneficiaries with spine conditions, and indications that chiropractic users have higher satisfaction with follow-up care and information provided about what is wrong with them.

%B J Manipulative Physiol Ther %V 37 %P 542-51 %8 2014 Oct %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/25233887 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/25233887?dopt=Abstract %R 10.1016/j.jmpt.2014.08.003 %0 Report %D 2014 %T Cognitive Test Selection for the Harmonized Cognitive Assessment Protocol (HCAP) %A David R Weir %A Ryan J McCammon %A Lindsay H Ryan %A Kenneth M. Langa %K Cognitive Ability %K HCAP %K Meta-analyses %K Survey Methodology %X The goal of this effort, set by the National Institute on Aging (NIA), is to devise a cognitive assessment that meets the following criteria: 1) Can be administered in the home by a survey interviewer in about one hour, 2) Has sufficient overlap with the 2002/03 HRS-ADAMS study that it can be used to establish trends in prevalence of dementia and cognitive impairment without dementia, and 3) Can be administered comparably and lead to comparably valid diagnoses in other developed and developing countries where HRS-type surveys are conducted. This goal is achievable because of substantial investment by the NIA in data collection in population studies focused on dementia. There is thus now an empirical basis for making test selection. Informant reports are a key element of most population-based approaches to assessment to establish the presence or absence of change in cognitive ability and of limitation in activity resulting from change. We intend to include informant reports in our data collection protocol and in the diagnostic algorithm. This document is focused on cognitive testing of the subject. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %8 10/2014 %G eng %0 Journal Article %J Int J Epidemiol %D 2014 %T Cohort Profile: the Health and Retirement Study (HRS). %A Amanda Sonnega %A Jessica Faul %A Mary Beth Ofstedal %A Kenneth M. Langa %A John W R Phillips %A David R Weir %K Aged %K Female %K Genetic Predisposition to Disease %K Health Status %K Humans %K Longitudinal Studies %K Male %K Mental Health %K Middle Aged %K Physical Fitness %K Retirement %K United States %X

The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37 000 individuals over age 50 in 23 000 households in the USA. The survey, which has been fielded every 2 years since 1992, was established to provide a national resource for data on the changing health and economic circumstances associated with ageing at both individual and population levels. Its multidisciplinary approach is focused on four broad topics-income and wealth; health, cognition and use of healthcare services; work and retirement; and family connections. HRS data are also linked at the individual level to administrative records from Social Security and Medicare, Veteran's Administration, the National Death Index and employer-provided pension plan information. Since 2006, data collection has expanded to include biomarkers and genetics as well as much greater depth in psychology and social context. This blend of economic, health and psychosocial information provides unprecedented potential to study increasingly complex questions about ageing and retirement. The HRS has been a leading force for rapid release of data while simultaneously protecting the confidentiality of respondents. Three categories of data-public, sensitive and restricted-can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu).

%B Int J Epidemiol %I 43 %V 43 %P 576-85 %8 2014 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/24671021?dopt=Abstract %4 administrative data/Restricted data %$ 999999 %R 10.1093/ije/dyu067 %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 Manipulative Physiol Ther %D 2014 %T The comparative effect of episodes of chiropractic and medical treatment on the health of older adults. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Frederic D Wolinsky %K Activities of Daily Living %K Aged, 80 and over %K Back Pain %K Episode of Care %K Female %K Humans %K Male %K Manipulation, Chiropractic %K Treatment Outcome %X

OBJECTIVES: The comparative effect of chiropractic vs medical care on health, as used in everyday practice settings by older adults, is not well understood. The purpose of this study is to examine how chiropractic compares to medical treatment in episodes of care for uncomplicated back conditions. Episodes of care patterns between treatment groups are described, and effects on health outcomes among an older group of Medicare beneficiaries over a 2-year period are estimated.

METHODS: Survey data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old were linked to participants' Medicare Part B claims under a restricted Data Use Agreement with the Centers for Medicare and Medicaid Services. Logistic regression was used to model the effect of chiropractic use in an episode of care relative to medical treatment on declines in function and well-being among a clinically homogenous older adult population. Two analytic approaches were used, the first assumed no selection bias and the second using propensity score analyses to adjust for selection effects in the outcome models.

RESULTS: Episodes of care between treatment groups varied in duration and provider visit pattern. Among the unadjusted models, there was no significant difference between chiropractic and medical episodes of care. The propensity score results indicate a significant protective effect of chiropractic against declines in activities of daily living (ADLs), instrumental ADLs, and self-rated health (adjusted odds ratio [AOR], 0.49; AOR, 0.62; and AOR, 0.59, respectively). There was no difference between treatment types on declines in lower body function or depressive symptoms.

CONCLUSION: The findings from this study suggest that chiropractic use in episodes of care for uncomplicated back conditions has protective effects against declines in ADLs, instrumental ADLs, and self-rated health for older Medicare beneficiaries over a 2-year period.

%B J Manipulative Physiol Ther %V 37 %P 143-54 %8 2014 Mar-Apr %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/24636108 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24636108?dopt=Abstract %R 10.1016/j.jmpt.2013.12.009 %0 Journal Article %J Medical Care %D 2014 %T The Concordance of Survey Reports and Medicare Claims in a Nationally Representative Longitudinal Cohort of Older Adults %A Frederic D Wolinsky %A Michael P Jones %A Fred A Ullrich %A Yiyue Lou %A George L Wehby %K Medicare linkage %K Medicare/Medicaid/Health Insurance %K Meta-analyses %K Survey Methodology %X Background: Concordance between survey reports and claims data is not well established. We compared them for disease histories, preventative, and other health services use in a large, nationally representative sample of older Medicare beneficiaries with special attention given to evaluating age, aging, memory, and respondent status effects. Methods: Baseline (1993) and biennial follow-up data (through 2010) from the Survey on Assets and Health Dynamics among the Oldest-Old were linked to Medicare claims from 1991 to 2010, for 4910 participants yielding 19,556 person-periods. Concordance was measured by simple, weighted, and prevalence and bias-adjusted κ, and Lin’s concordance statistics. Generalized estimating equation negative binomial models were used to predict the summary counts of concordant reports, survey underreports, and survey overreports. Results: Concordance was highly variable overall, unacceptably low for arthritis and physician visits, and less than substantial for angina, heart disease, hypertension, and outpatient surgery. Generalized estimating equation negative binomial models revealed reductions in reporting accuracy (more underreporting and overreporting) associated with both age (interindividual) and aging (intraindividual) effects, countervailing memory effects on concordance due to less underreporting but more overreporting, and countervailing proxy-respondent effects on concordance due to less underreporting but more overreporting. Conclusions: Further research should explore whether these findings are time or cohort bound, address the potential heterogeneity of the proxy-respondent effects based on the reason for and relationship of the proxy to the target person, and evaluate the effects of a broader spectrum of performance-based cognitive abilities. In the interim, the significant predictors identified here should be included in future studies. %B Medical Care %V 52 %P 462-468 %G eng %U http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005650-201405000-00014 %N 5 %! Medical Care %R 10.1097/MLR.0000000000000120 %0 Journal Article %J Psychology and Health %D 2014 %T Connecting Social Environment Variables to the Onset of Major Specific Health Outcomes %A Patrick L Hill %A Sara J Weston %A Joshua J Jackson %K Adult children %K Demographics %K Health Conditions and Status %X Abstract Objective: The present research examined the effects of the social environment on the onset of specific health ailments. Design: Using data from the Health and Retirement Study, we examined participants? responses to social environment questions in 2006 as predictors of onset of different health conditions over the next four years. Main Outcome Measures: Healthy participants (n = 7514) reported on their number of social partners, interaction frequency, positive social support, and negative social support with respect to both their family and friends. These variables were used to predict onset of seven conditions in 2010: high blood pressure, heart condition, lung disease, cancer, stroke, diabetes, and arthritis. Results: Logistic regressions indicated that the social environment provided some predictive value for onset of most health outcomes, with more positive and less negative social support appearing to buffer against onset. Social environmental variables related to friendships appeared to play a greater role than the family indicators. However, no variable proved universally adaptive, and social indicators had little value in predicting onset of chronic conditions. Conclusion: The current findings point to the potential for the social environment to influence later health, while demonstrating the nuanced role that our social lives play with respect to health. Objective: The present research examined the effects of the social environment on the onset of specific health ailments. Design: Using data from the Health and Retirement Study, we examined participants? responses to social environment questions in 2006 as predictors of onset of different health conditions over the next four years. Main Outcome Measures: Healthy participants (n = 7514) reported on their number of social partners, interaction frequency, positive social support, and negative social support with respect to both their family and friends. These variables were used to predict onset of seven conditions in 2010: high blood pressure, heart condition, lung disease, cancer, stroke, diabetes, and arthritis. Results: Logistic regressions indicated that the social environment provided some predictive value for onset of most health outcomes, with more positive and less negative social support appearing to buffer against onset. Social environmental variables related to friendships appeared to play a greater role than the family indicators. However, no variable proved universally adaptive, and social indicators had little value in predicting onset of chronic conditions. Conclusion: The current findings point to the potential for the social environment to influence later health, while demonstrating the nuanced role that our social lives play with respect to health. %B Psychology and Health %I 29 %V 29 %P 753-767 %G eng %U http://dx.doi.org/10.1080/08870446.2014.884221 %N 7 %4 Social Environment/Ailment Onset/Social Support/Social Network Size %$ 999999 %R 10.1080/08870446.2014.884221 %0 Journal Article %J Neurology %D 2014 %T Cost of informal caregiving associated with stroke among the elderly in the United States %A Heesoo Joo %A Dunet, Diane O. %A Fang, Jing %A Wang, Guijing %K Adult children %K Health Conditions and Status %K Healthcare %K Public Policy %X Objectives: We estimated the informal caregiving hours and costs associated with stroke. Methods: We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. We compared informal caregiving hours between case and control groups in 2006 (prestroke period for case group) and in 2008 (poststroke period for case group) and estimated incremental informal caregiving hours attributable to stroke by applying a difference-in-differences technique to propensity score-matched populations. We used a replacement approach to estimate the economic value of informal caregiving. Results: The weekly incremental informal caregiving hours attributable to stroke were 8.5 hours per patient. The economic value of informal caregiving per stroke survivor was 8,211 per year, of which 4,356 (53 ) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at 14.2 billion in 2008. Conclusions: Recent changes in public health and social support policies recognize the economic burden of informal caregiving. Our estimates reinforce the high economic burden of stroke in the United States and provide up-to-date information for policy development and decision-making. %B Neurology %I 83 %V 83 %P 1831-1837 %G eng %N 20 %4 informal caregiving/informal caregiving/Stroke/public policy/social Support/economic burden %$ 999999 %0 Journal Article %J Neurology %D 2014 %T Dementia and dependence: Do Modifiable Risk Factors Delay Disability? %A Pamela M. Rist %A Benjamin D Capistrant %A Bei Wu %A Jessica R Marden %A M. Maria Glymour %K Health Conditions and Status %K Income %X Objective: To identify modifying factors that preserve functional independence among individuals at high dementia risk. Methods: Health and Retirement Study participants aged 65 years or older without baseline activities of daily living (ADL) limitations (n = 4,922) were interviewed biennially for up to 12 years. Dementia probability, estimated from direct and proxy cognitive assessments, was categorized as low (i.e., normal cognitive function), mild, moderate, or high risk (i.e., very impaired) and used to predict incident ADL limitations (censoring after limitation onset). We assessed multiplicative and additive interactions of dementia category with modifiers (previously self-reported physical activity, smoking, alcohol consumption, depression, and income) in predicting incident limitations. Results: Smoking, not drinking, and income predicted incident ADL limitations and had larger absolute effects on ADL onset among individuals with high dementia probability than among cognitively normal individuals. Smoking increased the 2-year risk of ADL limitations onset from 9.9 to 14.9 among the lowest dementia probability category and from 32.6 to 42.7 among the highest dementia probability category. Not drinking increased the 2-year risk of ADL limitations onset by 2.1 percentage points among the lowest dementia probability category and 13.2 percentage points among the highest dementia probability category. Low income increased the 2-year risk of ADL limitations onset by 0.4 among the lowest dementia probability category and 12.9 among the highest dementia probability category. Conclusions: Smoking, not drinking, and low income predict incident dependence even in the context of cognitive impairment. Regardless of cognitive status, reducing these risk factors may improve functional outcomes and delay institutionalization. %B Neurology %V 82 %P 1543-1550 %8 04/2014 %G eng %N 17 %4 dementia probability/smoking/alcohol/income/depression %$ 999999 %& 1543 %R 10.1212/WNL.0000000000000357 %0 Thesis %D 2014 %T Determinants of spouse/partner informal caregiving and its impacts on informal caregivers' physical, psychological health and economic well-being: evidence from the health and retirement study %A Wang, Ming Sheng %K Healthcare %K Methodology %K Public Policy %X State policies have recently trended towards encouraging home and community-based services (HCBS) over institutionalized care because of the relative higher costs and lower quality in institutions. Studies suggest, however, that this cost-saving strategy has hidden individual and societal costs that may only surface when the informal caregivers grow older themselves. For example, intense caregiving can negatively impact the caregivers' long-term physical, mental/psychological, and economic well-being. However, the determinants of caregiving duration and their impacts on caregivers' later physical health and psychological health and economic well-being have never been examined holistically. Prior studies touching on these issues have narrowly emphasized the influence of either the elderly recipients' or caregivers' characteristics on informal caregiving and caregivers' outcomes. To address these limitations, this study examined the following questions: Q1) What are the determinants of informal caregivers' time spent on caregiving? Q2) How do caregiving hours impact informal caregivers' later physical health, psychological health, and economic well-being? Furthermore, this study examined the associations between predisposing, enabling, and need factors from the viewpoints of both care recipients and caregivers. It also examines differing lengths of caregiver commitments and how they impact the caregivers' outcomes (physical health, psychological health, and economic well-being) in the future across various caregiver characteristics. Using longitudinal, nationally representative data of the Health and Retirement Study from two waves (2008 and 2010), I looked at 496 dyad units (including care recipients and couples/partners as caregivers) of community-dwelling elderly to evaluate the impact of relative factors on the length of informal caregiving hours and whether providing more caregiving hours cause greater negative impacts on caregivers' later physical health, psychological health, and economic well-being. To answer Q1, I used a hierarchical ordinal logistic regression model to identify predisposing, enabling, and need factors from both care recipients and care recipients' and their impacts on caregiving hours. For Q2, multivariate ordinal logistic regression or ordinal least square (OLS) regression models were separately used to examine the impact of three durations of caregiving hours (providing fewer, medium, and longer caregiving hours) at Time 1 on caregivers' physical, psychological, and economic well-being at Time 2. Findings indicate that recipients with higher functional impairment (activities of daily living (ADL) and instrument activities of daily living (IADL)) and usage of home care service by caregivers have a significant, negative impact on caregivers' length of caregiving hours. In addition, caregivers who are older and employed are more likely to provide a greater number of hours. Furthermore, caregivers who provide more hours are more likely to have a higher level of chronic illness (objective physical health). On the other hand, I found no significant associations between caregiving intensity and self-rated health (subjective physical health), psychological health, or household wealth (including assets and income). The analysis considering predisposing, enabling, and need factors from both care recipients and caregivers to unravel the complicated caregiving phenomena are presented. Implications for research, practice, and policy are drawn based on the results. %I University of Illinois at Urbana-Champaign %C Champaign, IL %G eng %4 methodology %$ 999999 %! Determinants of spouse/partner informal caregiving and its impacts on informal caregivers' physical, psychological health and economic well-being: evidence from the health and retirement study %0 Journal Article %J Alzheimers Dement %D 2014 %T Development and validation of a brief dementia screening indicator for primary care. %A Deborah E Barnes %A Alexa S. Beiser %A Anne Lee %A Kenneth M. Langa %A Alain Koyama %A Sarah R Preis %A John Neuhaus %A Ryan J McCammon %A Kristine Yaffe %A Seshadri, Sudha %A Mary Haan %A David R Weir %K Aged %K Cohort Studies %K Dementia %K Female %K Humans %K Male %K Mass Screening %K Predictive Value of Tests %K Primary Health Care %K Proportional Hazards Models %K Risk Assessment %X

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m(2) (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

%B Alzheimers Dement %I 10 %V 10 %P 656-665.e1 %8 2014 Nov %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84893186546andpartnerID=40andmd5=3b617dce24578e022db389d90ad9ddd1 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/24491321?dopt=Abstract %2 PMC4119094 %4 Dementia/Primary care/Risk prediction modeling/Screening/Cognitive Impairment %$ 999999 %R 10.1016/j.jalz.2013.11.006 %0 Journal Article %J Ethnicity and Disease %D 2014 %T Diabetes risk, diagnosis, and control: Do psychosocial factors predict hemoglobin A1C defined outcomes or accuracy of self-reports? %A White, Kellee %A Mondesir, Favel L. %A Lisa M. Bates %A M. Maria Glymour %K Demographics %K Health Conditions and Status %K Other %X Objective: To evaluate the accuracy of self-reported diabetes among multi-ethnic older adults by psychosocial factors and assess predictors of diabetes risk, diagnosis, and control. Design and Methods: The 2006 Health and Retirement Study (N=5,594) was used to determine agreement between self-reported diabetes and measured diabetes (HbA1c = 6.5 ) by age, sex, race/ethnicity, nativity, education, health insurance coverage, body mass index, depressive symptoms, and prior report of racial discrimination. We also examined associations between these factors and pre-diabetes (HbA1c = 6.0- 6.5 ) among individuals without diabetes, and those with undiagnosed and poorly controlled (HbA1c = 8.0 ) diabetes. Results: Accuracy of self-reported diabetes was good (ie, sensitivity = 80 and specificity = 95 ) among all demographic subgroups and across most social strata. Among those who reported racial discrimination, sensitivity of self-reported diabetes was lower among Blacks who reported racial discrimination in comparison to Blacks who did not report racial discrimination (82.7 vs 89.0 ) an association that was marginally statistically significant (P=.05). Blacks and Hispanics had higher odds of pre-diabetes, undiagnosed diabetes, and poor glycemic control. Conclusions: Self-reported diabetes corresponded well with HbA1c assessed disease for all social strata examined in this sample of multi-ethnic older adults. Blacks with a history of racial discrimination may be less likely to know diabetes status. %B Ethnicity and Disease %I 24 %V 24 %P 19-27 %G eng %N 1 %4 Diabetes/Self-report/Accuracy/Race/ethnicity/Racial Discrimination %$ 999999 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2014 %T The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort. %A Benjamin D Capistrant %A Nicte I Mejia %A Sze Y Liu %A Qianyi Wang %A M. Maria Glymour %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Black or African American %K Cohort Studies %K Disabled Persons %K Female %K Humans %K Male %K Prospective Studies %K Stroke %K United States %K White People %X

BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace.

METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace.

RESULTS: Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke.

CONCLUSION: Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.

%B J Gerontol A Biol Sci Med Sci %I 69 %V 69 %P 860-70 %8 2014 Jul %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/24444610?dopt=Abstract %2 PMC4067116 %4 Minority aging/Disablement process/Stroke/Cardiovascular/Epidemiology. %$ 999999 %R 10.1093/gerona/glt191 %0 Journal Article %J Field methods %D 2014 %T Does Sequence Matter in Multi-Mode Surveys: Results from an Experiment. %A James Wagner %A Arrieta, Jennifer %A Heidi M Guyer %A Mary Beth Ofstedal %X

Interest in a multi-mode approach to surveys has grown substantially in recent years, in part due to increased costs of face-to-face interviewing and the emergence of the internet as a survey mode. Yet, there is little systematic evidence of the impact of a multimode approach on survey costs and errors. This paper reports the results of an experiment designed to evaluate whether a mixed-mode approach to a large screening survey would produce comparable response rates at a lower cost than a face-to-face screening effort. The experiment was carried out in the Health and Retirement Study (HRS), an ongoing panel study of Americans over age 50. In 2010, HRS conducted a household screening survey to recruit new sample members to supplement the existing sample. The experiment varied the sequence of modes with which the screening interview was delivered. One treatment offered mail first, followed by face-to-face interviewing; the other started with face-to-face and then mail. A control group was offered only face-to-face interviewing. Results suggest that the mixed mode options reduced costs without reducing response rates to the screening interview. There is some evidence, however, that the sequence of modes offered may impact the response rate for a follow-up in-depth interview.

%B Field methods %I 26 %V 26 %P 141-155 %8 2014 May 01 %G eng %U http://fmx.sagepub.com/content/early/2013/07/24/1525822X13491863.abstract %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/24764767?dopt=Abstract %4 Mixed Mode/Nonresponse/Survey research/multimode/Response Rate %$ 999999 %R 10.1177/1525822X13491863 %0 Journal Article %J Population Research and Policy Review %D 2014 %T Does the Hispanic Paradox in U.S. Adult Mortality Extend to Disability? %A Mark D Hayward %A Robert A Hummer %A Chi-Tsun Chiu %A César González-González %A Rebeca Wong %K Demographics %K Disabilities %K Health Conditions and Status %K Women and Minorities %X Studies consistently document a Hispanic paradox in U.S. adult mortality, whereby Hispanics have similar or lower mortality rates than non-Hispanic whites despite lower socioeconomic status. This study extends this line of inquiry to disability, especially among foreign-born Hispanics, since their advantaged mortality seemingly should be paired with health advantages more generally. We also assess whether the paradox extends to U.S.-born Hispanics to evaluate the effect of nativity. We calculate multistate life tables of life expectancy with disability to assess whether racial/ethnic and nativity differences in the length of disability-free life parallel differences in overall life expectancy. Our results document a Hispanic paradox in mortality for foreign-born and U.S.-born Hispanics. However, Hispanics low mortality rates are not matched by low disability rates. Their disability rates are substantially higher than those of non-Hispanic whites and generally similar to those of non-Hispanic blacks. The result is a protracted period of disabled life expectancy for Hispanics, both foreign- and U.S.-born. %B Population Research and Policy Review %I 33 %V 33 %P 81-96 %G eng %U http://dx.doi.org/10.1007/s11113-013-9312-7 %N 1 %4 Hispanic paradox/Disability/Disability/Mortality/Disabled life expectancy/Nativity %$ 999999 %R 10.1007/s11113-013-9312-7 %0 Journal Article %J American Economic Journal: Applied Economics %D 2014 %T Dynamic Implications of Subjective Expectations: Evidence from Adult Smokers %A Wang, Yang %K Consumption and Savings %K Expectations %K Health Conditions and Status %K Methodology %K Other %X We set up a dynamic discrete choice model with subjective expectations data to explain adult smokers' find important differences between subjective survival probabilities and those estimated using observed mortality data. Subjectively, individuals attach less weight to their health conditions and smoking choices and more weight to such factors as age, race, and parents' longevity. Moreover, adult smokers are found to care more about their health and to be more forward-looking than predicted by a rational expectations framework. We further show the importance of unobserved heterogeneity in agents' subjective survival probabilities, and discuss policy implications of subjective expectations. %B American Economic Journal: Applied Economics %I 6 %V 6 %P 1-37 %G eng %U http://www.aeaweb.org/articles.php?doi=10.1257/app.6.1.1 %N 1 %4 Consumer Economics/Empirical Analysis/Expectations/Speculations/Health Production %$ 999999 %R 10.1257/app.6.1.1 %0 Journal Article %J Journal of Economics of Ageing %D 2014 %T Economic development and gender inequality in cognition: a comparison of China and India, and of SAGE and the HRS sister studies. %A David R Weir %A Margaret Lay %A Kenneth M. Langa %K CHARLS %K Economics %K Gender Differences %K LASI %K Older Adults %K SAGE %K Sister studies %X

This paper examines cognition measures by age and gender from two types of studies in China and India. It finds that despite some notable differences in samples and measures, a general strong association of cognition in older ages with education emerges as a potential explanation for gender gaps and cohort differences. Female disadvantage in cognition is greater in India, both before and after controlling for education. The process of rural-urban migration draws more cognitively able women to cities in China but not in India. The advent of modern longitudinal studies of aging in these developing countries holds great promise for future work.

%B Journal of Economics of Ageing %V 4 %P 114-125 %8 2014 Dec 01 %G eng %R 10.1016/j.jeoa.2014.08.002 %0 Thesis %D 2014 %T The economic security of an aging minority population: A profile of Latino baby boomers to inform future retirees %A Zachary Gassoumis %Y Kathleen H. Wilber %K Demographics %K Income %K Methodology %K Net Worth and Assets %K Women and Minorities %X The United States is facing dramatic demographic changes due to the aging of the Baby Boom Generation and increasing diversity, including rapid growth of the Latino population. Questions have been raised regarding the economic security of the aging baby boomers' generational cohort once they retire, which are of particular relevance to minority and Latino members of the cohort. Latinos tend to have lower levels of financial security than their white, non-Latino counterparts, but there is little research that examines individuals who fall into the intersection of these two groups: the Latino baby boomers. Because Latino boomers are a largely hidden population, their economic status and prospects are difficult to estimate. The first empirical chapter (Chapter 2) looks at the characteristics of the Baby Boomer population living in the 50 U.S. states and the District of Columbia, broken down by Latino ethnicity and citizenship status. Drawing from several U.S. Census Bureau data sources, it revealed three key findings: 1) there were 80 million baby boomers in the U.S. in 2000--more than previously reported--of which 8.0 million (10%) were Latinos; 2) U.S.-born Latino boomers were more similar to non-Latino boomers in terms of demographic characteristics, whereas foreign-born citizens and non-citizens scored less well on key demographic indicators; and 3) compared to non-Latino baby boomers, U.S.-born Latino baby boomers had somewhat less favorable economic characteristics. The second empirical chapter identifies the magnitude of racial/ethnic structural disadvantage for income and wealth in the years preceding retirement for the Baby Boom Generation, then compares their structural disadvantage with that of members of the Silent Generation cohort when they were the same age. After adjusting for sociodemographic variables (age, gender, citizenship status, education, marital status, and labor force participation), the structural effects of race/ethnicity on income--using the American Community Survey--and wealth--using the Health and Retirement Study--were considerably reduced, confirming two of the chapter's four hypotheses; however, the expected reduction in structural effects from the Silent Generation to the Baby Boom Generation was seen for wealth but not for income, confirming only one of the remaining two hypotheses. This reduction of structural disparities in wealth from the Silent Generation to the Baby Boom Generation follows the expectation that these disparities would be reduced over time, which signals good news for the younger members of the Baby Boom Generation, Generation X, and future generational cohorts. But large gaps still exist between racial/ethnic groups, even after sociodemographic adjustment; future reduction in those structural inequalities can help decrease those gaps, an especially important consideration for low-income racial/ethnic minority groups. The third empirical chapter takes an initial step toward disaggregating by age the effect of naturalization on income growth. Using linear growth curve modeling on data from the Survey of Income and Program Participation's 2004 panel, it attempts to replicate past findings across the entire lifespan, but fails to detect an effect of naturalization on income growth; only non-citizens had a significantly higher level of income growth during the study period than U.S.-born citizens. In subsetting the analysis for older and younger working-age groups, an effect of naturalization was not detected for either group, and the positive effect for non-citizens was seen only for the younger age group. The predictor variables on the whole had minimal relationships with slope in the model, with less than 1% of variance explained in each model. Although a stronger effect of the predictor variables, including an effect of naturalization, may have appeared were more years of data available, it was not detected over the 4-year study period. Two unexpected findings were: 1) individuals in the younger sample who had naturalized before the study had higher intercepts than U.S.-born citizens but no such difference emerged in the older sample; and 2) in a bivariate context, those who naturalized during the study represented a socioeconomic midpoint of sorts--on racial/ethnic composition, education, and income--naturalized prior to the study. In sum, these chapters shed light on the Baby Boom cohort's characteristics and dynamics in the period leading up to their retirement age. This dissertation provides insights into the characteristics, demographic history, and socioeconomic patterns of the upcoming cohort of retirees. Implications of these findings have the potential to inform and to modify practice and policy for the next cohort: Generation X. The findings underscore the importance of reducing disparities in education and, to a degree, citizenship as a mechanism for countering the persistent effects of structural inequality on income. These insights have implications for both theory and policy and lay a foundation for a wide range of future research, which is discussed in the final chapter. %I University of Southern California %C Los Angeles %V 3628171 %P 124 %8 2014 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1560683648?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 1560683648 %4 ethnicity %$ 999999 %! The economic security of an aging minority population: A profile of Latino baby boomers to inform future retirees %0 Book %D 2014 %T Economics of the Family %A Browning, Martin %A Chiappori, Pierre-Andr %A Weiss, Yoram %K Adult children %K Demographics %K Net Worth and Assets %X The family is a complex decision unit in which partners with potentially different objectives make consumption, work, and fertility decisions. Couples marry and divorce partly based on their ability to coordinate these activities, which in turn depends on how well they are matched. This book provides a comprehensive, modern, and self-contained account of the research in the growing area of family economics. The first half of the book develops several alternative models of family decision making. Particular attention is paid to the collective model and its testable implications. The second half discusses household formation and dissolution and who marries whom. Matching models with and without frictions are analyzed and the important role of within-family transfers is explained. The implications for marriage, divorce, and fertility are discussed. The book is intended for graduate students in economics and for researchers in other fields interested in the economic approach to the family. %I Cambridge University Press %C New York %G eng %U http://www.amazon.com/Economics-Cambridge-Surveys-Economic-Literature/dp/0521795397 %4 families/Family economics/household finance/marriage/divorce/Fertility %$ 999999 %0 Journal Article %J The European Journal of Public Health %D 2014 %T The effect of retirement on alcohol consumption: results from the US Health and Retirement Study %A Wang, Xu %A Steier, Jessica B. %A William T Gallo %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Background: Prior research examining the association between retirement and alcohol consumption is inconsistent with respect to salience, direction and magnitude. Reasonable conceptual arguments for both positive (e.g. coping, introduction of leisure time) and negative (e.g. severance of work-related social relationships) changes further complicate investigations of this critical association, as do differences in study design, national setting and measurement of alcohol use. Methods: This prospective longitudinal study analyses 2-year wave-pairs drawn from seven waves (14 years) of data from the US Health and Retirement Study to assess the effect of complete retirement on weekly alcohol consumption (n = 9979 observations; 4674 unique participants). We use multiple regression analysis in a two-period follow-up design and account for potential selection bias and reverse causality not addressed in prior research on this topic. Results: We find that retirement is positively associated with subsequent weekly alcohol consumption for men who reported drinking at both follow-up and the prior study wave ( = 1.9, 95 confidence interval = 0.43 3.36). No association was observed among women. Conclusion: Our results suggest that health care professionals should monitor the drinking habits of retired men, as older individuals are particularly susceptible to the adverse effects of heavy alcohol use. %B The European Journal of Public Health %I 24 %V 24 %P 485-489 %G eng %U http://eurpub.oxfordjournals.org/content/early/2014/03/17/eurpub.cku027.abstract %N 3 %4 alcohol consumption/retirement/alcohol Abuse %$ 999999 %R 10.1093/eurpub/cku027 %0 Book %D 2014 %T Essential Demographic Methods %A Kenneth W. Wachter %K Methodology %I Harvard University Press %C Cambridge, MA %G eng %4 demographic analysis/methodology/statistical analysis %$ 999999 %0 Book Section %B DISCOVERIES IN THE ECONOMICS OF AGING %D 2014 %T Expectations, Aging and Cognitive Decline %A Kezdi, Gabor %A Robert J. Willis %A David A Wise %K Aging %K Cognitive decline %X We use longitudinal data from the HRS to document general patterns in expectations with respect to aging in various domains and investigate the potential role of cognitive decline in those patterns. We focus on two aspects of expectations: optimism and uncertainty. We estimate the effect of age controlling for cohort, selection and calendar time effects. With the notable exception of survival expectations, we find that optimism decreases with age in most domains. Uncertainty appears to increase with age in most cases except for survival expectations, but these findings are less robust. Using methods that minimize the likelihood of spurious associations due to survey noise, we show that cognitive decline plays a modest but statistically significant role in explaining the decline of optimism with age, again, with the exception of survival expectations. We do not find a role for cognitive decline in accounting for the increase in uncertainty. %B DISCOVERIES IN THE ECONOMICS OF AGING %I University of Chicago Press %C Chicago, IL %@ 0-226-14609-X %G eng %U https://www.nber.org/books-and-chapters/discoveries-economics-aging/expectations-aging-and-cognitive-decline %0 Journal Article %J Social Science Research %D 2014 %T Fundamental resource dis/advantages, youth health and adult educational outcomes %A Elman, Cheryl %A Linda A. Wray %A Xi, Juan %K Adult children %K Demographics %K Event History/Life Cycle %K Health Conditions and Status %K Healthcare %K Methodology %X Recent studies find lasting effects of poor youth health on educational attainment but use young samples and narrow life course windows of observation to explore outcomes. We apply a life course framework to three sets of Health and Retirement Study birth cohorts to examine early health status effects on education and skills attainment measured late in life. The older cohorts that we study were the earliest recipients of U.S. policies promoting continuing education through the GI Bill, community college expansions and new credentials such as the GED. We examine a wide range of outcomes but focus on GEDs, postsecondary school entry and adult human capital as job-related training. We find that older U.S. cohorts had considerable exposure to these forms of attainment and that the effects of youth health on them vary by outcome: health selection and ascription group effects are weak or fade, respectively, in outcomes associated with delayed or adult attainment. However, poorer health and social disadvantage in youth and barriers associated with ascription carry forward to limit attainment of key credentials such as diplomas and college degrees. We find that the human capital - health gradient is dynamic and that narrow windows of observation in existing studies miss much of it. National context also matters for studying health-education linkages over the life course. %B Social Science Research %I 43 %V 43 %P 108-126 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/24267756 %4 Life Course/Health Disparities/Adult Education/Low-Birth-Weight/Childhood Health/Cumulative Disadvantage/Socioeconomic-Status/Gender-Gap %$ 69354 %R 10.1016/j.ssresearch.2013.09.001 %0 Thesis %D 2014 %T Gender, race, and ethnic differences in the effects of education on depression in later life: The mediating roles of mastery and stress %A Wong, Cathy M. %Y Jeffrey A Burr %K Demographics %K Health Conditions and Status %X The central objective of this study was to examine gender, race, and ethnic differences in the effects of education on late-life depression. This study differentiated education from other measures of SES due to the psychosocial resources developed through schooling. Education provides intrinsic resources, such as perceived mastery, that are beyond monetary value. Higher levels of education is hypothesized to increase perceived mastery throughout the life course and result in lower levels of stress, influencing psychological well-being in later life. The Stress Process Paradigm was the conceptual framework used for this study. The Stress Process Paradigm includes elements of Ross and Mirowsky's (2006) Resource Substitution and Resource Multiplication hypotheses. Ross and Mirowsky's hypotheses were used to examine whether education improves psychological well-being more for disadvantaged or advantaged groups. The Health and Retirement Study (HRS) was the data source used for this study. The analyses included an evaluation of both the prevalence of depression (cross-sectional models with the 2006 wave of the HRS) and the incidence of depression onset and recovery (longitudinal models with the 2006 and 2008 waves of the HRS). The analyses included examining the moderating effects of gender, race, and ethnic group status on the relationship between SES and late-life depression. Also, this study examined the mediating effects of perceived mastery and stress in the SES-depression relationship. The results suggested the benefits of education may have a more significant effect on psychological well-being than other indicators of SES. There was no evidence of gender moderating the relationship between education and depression. The results showed there appears to be a protective effect of education on depression for Whites. The results did not show mediating effects of perceived mastery and stress in the relationship between education and depression. Rather, the results implied a suppressor effect. Last, this study examined depression among specific gender-race-ethnic groups. It was found that White men have significantly lower odds of having depression than all other groups. This study concludes that it is important to understand that socioeconomic inequalities throughout the life course have an effect on mental health disparities in later life. %I University of Massachusetts Boston %C Boston %V 3622216 %P 267 %8 2014 %G English %U http://search.proquest.com.proxy.lib.umich.edu/docview/1547725299?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:kev:mtx:dissertat %9 Ph.D. %M 1547725299 %4 mental Health %$ 999999 %! Gender, race, and ethnic differences in the effects of education on depression in later life: The mediating roles of mastery and stress %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 Journal Article %J PLoS One %D 2014 %T Genomic assortative mating in marriages in the United States. %A Guo, Guang %A Wang, Lin %A Hexuan Liu %A Randall, Thomas %K Data collection %K Female %K Genome, Human %K Genomics %K Genotype %K Humans %K Male %K Marriage %K Middle Aged %K Phenotype %K Polymorphism, Single Nucleotide %K Reproduction %K United States %X

Assortative mating in phenotype in human marriages has been widely observed. Using genome-wide genotype data from the Framingham Heart study (FHS; number of married couples = 989) and Health Retirement Survey (HRS; number of married couples = 3,474), this study investigates genomic assortative mating in human marriages. Two types of genomic marital correlations are calculated. The first is a correlation specific to a single married couple "averaged" over all available autosomal single-nucleotide polymorphism (SNPs). In FHS, the average married-couple correlation is 0.0018 with p = 3 × 10(-5); in HRS, it is 0.0017 with p = 7.13 × 10(-13). The marital correlation among the positively assorting SNPs is 0.001 (p = .0043) in FHS and 0.015 (p = 1.66 × 10(-24)) in HRS. The sizes of these estimates in FHS and HRS are consistent with what are suggested by the distribution of the allelic combination. The study also estimated SNP-specific correlation "averaged" over all married couples. Suggestive evidence is reported. Future studies need to consider a more general form of genomic assortment, in which different allelic forms in homologous genes and non-homologous genes result in the same phenotype.

%B PLoS One %V 9 %P e112322 %8 2014 %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/25384046?dopt=Abstract %R 10.1371/journal.pone.0112322 %0 Journal Article %J Open Health Data %D 2014 %T The Health and Retirement Study: A Public Data Resource for Research on Aging %A Amanda Sonnega %A David R Weir %K Data methods %K Survey Methodology %X The Health and Retirement Study (HRS) is a nationally representative longitudinal survey of more than 37,000 individuals in 23,000 households over age 50 in the United States. Fielded biennially since 1992, it was established to provide a national resource for data on the changing health and economic circumstances associated with aging. HRS covers four broad topic areas—income and wealth; health, cognition, and use of health care services; work and retirement; and family connections. HRS data are also linked at the individual level to administrative records from Social Security and Medicare, Veteran’s Administration, the National Death Index, and employer-provided pension plan information. In 2006, data collection expanded to include biomarkers and genetics and greater depth in psychosocial well-being and social context. This blend of economic, health, and psychosocial information provides unprecedented potential to study increasingly complex questions about aging and retirement. HRS prioritizes rapid release of data while simultaneously protecting the confidentiality of respondents. Three categories of data—public, sensitive, and restricted—can be accessed through procedures described on the HRS website (hrsonline.isr.umich.edu). %B Open Health Data %V 2 %8 Apr-10-2015 %G eng %U http://openhealthdata.metajnl.com/articles/10.5334/ohd.am/ %N 1 %R 10.5334/ohd.am %0 Journal Article %J PLoS One %D 2014 %T The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease? %A Stefan Walter %A M. Maria Glymour %A Mauricio Avendano %K Aged %K Cardiovascular Diseases %K Female %K Geography %K Humans %K Incidence %K Insurance Benefits %K Insurance, Health %K Longitudinal Studies %K Male %K Middle Aged %K Risk Factors %K Unemployment %K United States %X

OBJECTIVE: Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk.

METHODS: Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50-65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk.

RESULTS: States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71-0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79-1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models.

CONCLUSION: Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.

%B PLoS One %I 9 %V 9 %P e101193 %8 2014 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25025281?dopt=Abstract %2 PMC4098914 %4 Unemployment insurance/Cardiovascular disease/unemployment insurance %$ 999999 %R 10.1371/journal.pone.0101193 %0 Journal Article %J Med Decis Making %D 2014 %T Health numeracy: the importance of domain in assessing numeracy. %A Helen G Levy %A Peter A. Ubel %A Amanda J. Dillard %A David R Weir %A Angela Fagerlin %K Aged %K Humans %K Mathematics %K Middle Aged %K Self Efficacy %K Surveys and Questionnaires %K Task Performance and Analysis %X

BACKGROUND AND OBJECTIVE: Existing research concludes that measures of general numeracy can be used to predict individuals' ability to assess health risks. We posit that the domain in which questions are posed affects the ability to perform mathematical tasks, raising the possibility of a separate construct of "health numeracy" that is distinct from general numeracy. The objective was to determine whether older adults' ability to perform simple math depends on domain.

METHODS: Community-based participants completed 4 math questions posed in 3 different domains: a health domain, a financial domain, and a pure math domain. Participants were 962 individuals aged 55 and older, representative of the community-dwelling US population over age 54.

RESULTS: We found that respondents performed significantly worse when questions were posed in the health domain (54% correct) than in either the pure math domain (66% correct) or the financial domain (63% correct). Our experimental measure of numeracy consisted of only 4 questions, and it is possible that the apparent effect of domain is specific to the mathematical tasks that these questions require.

CONCLUSIONS: These results suggest that health numeracy is strongly related to general numeracy but that the 2 constructs may not be the same. Further research is needed into how different aspects of general numeracy and health numeracy translate into actual medical decisions.

%B Med Decis Making %I 34 %V 34 %P 107-15 %8 2014 Jan %G eng %U http://mdm.sagepub.com/content/34/1/107.abstract %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23824401?dopt=Abstract %4 Health Numeracy/Health Literacy/Health Literacy/Cognition %$ 999999 %R 10.1177/0272989X13493144 %0 Book Section %B Essential Demographic Methods %D 2014 %T Heterogeneous Risks %A Kenneth W. Wachter %K Demographics %K Methodology %K Public Policy %X ...uses themes from the individual lifecourse, history, and global change to convey the meaning of concepts such as exponential growth, cohorts and periods, lifetables, population projection, proportional hazards, parity, marity, migration flows, and stable populations. %B Essential Demographic Methods %I Harvard University Press %C Cambridge, MA %P 174-200 %@ 9780674045576 %G eng %4 demography/Demographic aspects/Public Health/social sciences %$ 999999 %! Heterogeneous Risks %& 8 %0 Journal Article %J Am J Geriatr Psychiatry %D 2014 %T History of alcohol use disorders and risk of severe cognitive impairment: a 19-year prospective cohort study. %A Kuźma, Elżbieta %A David J Llewellyn %A Kenneth M. Langa %A Robert B Wallace %A Iain A Lang %K Alcohol-Related Disorders %K Cognition Disorders %K Diagnosis, Dual (Psychiatry) %K Female %K Humans %K Incidence %K Male %K Memory Disorders %K Middle Aged %K Prospective Studies %K Risk Factors %K United States %X

OBJECTIVE: To assess the effects of a history of alcohol use disorders (AUDs) on risk of severe cognitive and memory impairment in later life.

METHODS: We studied the association between history of AUDs and the onset of severe cognitive and memory impairment in 6,542 middle-aged adults born 1931 through 1941 who participated in the Health and Retirement Study, a prospective nationally representative U.S. cohort. Participants were assessed at 1992 baseline and follow-up cognitive assessments were conducted biannually from 1996 through 2010. History of AUDs was identified using the three-item modified CAGE questionnaire. Cognitive outcomes were assessed using the 35-item modified Telephone Interview for Cognitive Status at last follow-up with incident severe cognitive impairment defined as a score ≤ 8, and incident severe memory impairment defined as a score ≤ 1 on a 20-item memory subscale.

RESULTS: During up to 19 years of follow-up (mean: 16.7 years, standard deviation: 3.0, range: 3.5-19.1 years), 90 participants experienced severe cognitive impairment and 74 participants experienced severe memory impairment. History of AUDs more than doubled the odds of severe memory impairment (odds ratio [OR] = 2.21, 95% confidence interval [CI] = 1.27-3.85, t = 2.88, df = 52, p = 0.01). The association with severe cognitive impairment was statistically non-significant but in the same direction (OR = 1.80, 95% CI = 0.97-3.33, t = 1.92, df = 52, p = 0.06).

CONCLUSION: Middle-aged adults with a history of AUDs have increased odds of developing severe memory impairment later in life. These results reinforce the need to consider the relationship between alcohol consumption and cognition from a multifactorial lifespan perspective.

%B Am J Geriatr Psychiatry %I 22 %V 22 %P 1047-54 %8 2014 Oct %G eng %U http://www.sciencedirect.com/science/article/pii/S1064748114001675 %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/25091517?dopt=Abstract %2 PMC4165640 %4 Alcohol use disorders/memory impairment/cognitive impairment/cognitive ability/alcohol consumption %$ 999999 %R 10.1016/j.jagp.2014.06.001 %0 Journal Article %J Health Affairs %D 2014 %T Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death %A Feng, Zhanlian %A Coots, Laura A. %A Kaganova, Yevgeniya %A Joshua M Wiener %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %X Hospitalizations and emergency department (ED) visits for people with Alzheimer s disease and related disorders are of particular concern because many of these patients are physically and mentally frail, and the care delivered in these settings is costly. Using data from the Health and Retirement Study linked with Medicare claims from the period 2000 08, we found that among community-dwelling elderly fee-for-service Medicare beneficiaries, those who had dementia were significantly more likely than those who did not to have a hospitalization (26.7 percent versus 18.7 percent) and an ED visit (34.5 percent versus 25.4 percent) in each year. Comparing nursing home residents who had dementia with those who did not, we found only small differences in hospitalizations (45.8 percent versus 41.9 percent, respectively) and ED use (55.3 percent versus 52.7 percent). As death neared, however, utilization rose sharply across settings and by whether or not beneficiaries had dementia: Nearly 80 percent of community-dwelling decedents were hospitalized, and an equal proportion had at least one ED visit during the last year of life, regardless of dementia. Our research suggests that substantial portions of hospitalizations and ED visits both before and during the last year of life were potentially avoidable. %B Health Affairs %I 33 %V 33 %P 683-690 %G eng %U http://content.healthaffairs.org/content/33/4/683.abstract %N 4 %4 Hospitalization/Emergency department/Alzheimers dementia/Long-Term Care/Medicare/Medicaid/Chronic Care %$ 999999 %R 10.1377/hlthaff.2013.1179 %0 Report %D 2014 %T How Does Increased Longevity for Men Affect Well-Being for Their Wives in Old Age? %A Matthew S. Rutledge %A April Yanyuan Wu %A Orlova, Natalia S. %K gender %K Longevity %K Marital Relations %X The marked increase in male longevity and the shrinking gap in male-female life expectancy in recent decades should improve the financial outcomes of older women, but this improvement may be dampened if the growth in medical spending and the incidence of disability translates to living husbands burdening the family’s budget. Using the Health and Retirement Study and an endogenous switching model to account for non-random selection into widowhood, we find that widows are worse off than non-widows, and that women whose husbands die young have worse financial outcomes. But his survival, if accompanied by ill health, hurts women’s financial well-being substantially: women married to men in poor health or with limitations in their daily activities have lower income and are more likely to fall below the poverty line, especially while the husband is still alive. We also find that high end-of-life health care costs deplete the wealth that the husband leaves his widow. Finally, we find that being poor in the past is more closely correlated with financial outcomes for married women than it is for widows, suggesting that widowhood may actually break the poverty cycle for some women. The results emphasize the importance of policies like Social Security survivor benefits and Medicaid but also suggest that older couples may need further help to better manage an aging husband’s care needs. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/how-does-increased-longevity-for-men-affect-well-being-for-their-wives-in-old-age/ %0 Journal Article %J BMC Health Serv Res %D 2014 %T Identifying diabetics in Medicare claims and survey data: implications for health services research. %A Joseph W Sakshaug %A David R Weir %A Lauren Hersch Nicholas %K Aged %K Aged, 80 and over %K Algorithms %K Diabetes Mellitus %K Female %K Glycated Hemoglobin %K Health Services Research %K Humans %K Insurance Claim Review %K Male %K Medicare %K Prevalence %K United States %X

BACKGROUND: Diabetes health services research often utilizes secondary data sources, including survey self-report and Medicare claims, to identify and study the diabetic population, but disagreement exists between these two data sources. We assessed agreement between the Chronic Condition Warehouse diabetes algorithm for Medicare claims and self-report measures of diabetes. Differences in healthcare utilization outcomes under each diabetes definition were also explored.

METHODS: Claims data from the Medicare Beneficiary Annual Summary File were linked to survey and blood data collected from the 2006 Health and Retirement Study. A Hemoglobin A1c reading, collected on 2,028 respondents, was used to reconcile discrepancies between the self-report and Medicare claims measures of diabetes. T-tests were used to assess differences in healthcare utilization outcomes for each diabetes measure.

RESULTS: The Chronic Condition Warehouse (CCW) algorithm yielded a higher rate of diabetes than respondent self-reports (27.3 vs. 21.2, p < 0.05). A1c levels of discordant claims-based diabetics suggest that these patients are not diabetic, however, they have high rates of healthcare spending and utilization similar to diabetics.

CONCLUSIONS: Concordance between A1c and self-reports was higher than for A1c and the CCW algorithm. Accuracy of self-reports was superior to the CCW algorithm. False positives in the claims data have similar utilization profiles to diabetics, suggesting minimal bias in some types of claims-based analyses, though researchers should consider sensitivity analysis across definitions for health services research.

%B BMC Health Serv Res %I 14 %V 14 %P 150 %8 2014 Apr 03 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/24693862?dopt=Abstract %2 PMC3975984 %4 Diabetes/Survey data/Medicare claims/Chronic condition warehouse %$ 999999 %R 10.1186/1472-6963-14-150 %0 Journal Article %J Bmc Cancer %D 2014 %T The impact of a cancer diagnosis on weight change: findings from prospective, population-based cohorts in the UK and the US %A Sarah E Jackson %A Williams, Kate %A Andrew Steptoe %A Wardle, Jane %K Health Conditions and Status %X Background: Obesity is a risk factor for cancer incidence and survival, but data on patterns of weight change in cancer survivors are scarce and few stratify by pre-diagnosis weight status. In two population-based cohorts of older adults, we examined weight change in cancer survivors and cancer-free controls in relation to baseline weight status. Methods: In the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), we identified participants diagnosed with cancer who had pre- and post-diagnosis BMI data (ELSA n = 264; HRS n = 2553), and cancer-free controls (ELSA n = 1538; HRS n = 4946). Repeated-measures ANOVAs tested three-way interactions by group (cancer/control), time (pre-/post-diagnosis), and pre-diagnosis weight status (normal-weight/overweight/obese). Results: Mean BMI change was -0.07 (SD = 2.22) in cancer survivors vs. 0.14 (SD = 1.11) in cancer-free controls in ELSA, and -0.20 (SD = 2.84) vs. 0.11 (SD = 0.93) respectively in HRS. Three-way interactions were significant in both cohorts (ELSA p = .015; HRS p .001). In ELSA, mean BMI change in normal-weight cancer survivors was 0.19 (SD = 1.53) compared with -0.33 (SD = 3.04) in obese survivors. In ELSA controls, the respective figures were 0.09 (SD = 0.81) and 0.16 (SD = 1.50). In HRS, mean change in normal-weight cancer survivors was 0.07 (SD = 2.30) compared with -0.72 (SD = 3.53) in obese survivors. In HRS controls, the respective figures were 0.003 (SD = 0.66) and 0.27 (SD = 1.27). Conclusion: Over a four-year period, in two cohorts of older adults, cancer survivors lost weight relative to cancer-free controls. However, cancer survivors who were obese pre-diagnosis were more likely to lose weight than healthy-weight survivors or obese adults without a cancer diagnosis. Whether this was due to differences in clinical status or deliberate lifestyle change triggered by the cancer diagnosis is not known. Further research is needed to establish why weight loss occurs more frequently in cancer survivors who were obese at diagnosis, and whether this has favourable effects on mortality. %B Bmc Cancer %I 14 %V 14 %P 926-926 %G eng %4 Weight loss/Body weight changes/Cancer diagnosis/Overweight/Obese/Cancer survivors %$ 999999 %0 Thesis %D 2014 %T International sex and age differences in physical function and disability %A Felicia V Wheaton %Y Eileen M. Crimmins %K CHARLS %K Cross-National %K Demographics %K Disabilities %K Health Conditions and Status %K IFLS %K KLoSA %K Methodology %K MHAS %X Worldwide population aging will undoubtedly be accompanied by an increase in the number of disabled older adults. Female gender and increased age are two of the most widely identified risk factors for poor physical functioning and disability. Yet the contexts in which people are aging vary markedly across countries. Countries differ greatly in their level of economic development, both past and present. Economic development is in turn related to improvements in infrastructure, health care, public health, education, etc. that are hypothesized to be related to improved physical function and less disability. Therefore, this dissertation examined whether sex and age differences/changes in both objectively-measured physical performance and reported difficulties with functional tasks and activities of daily living (ADLs) were similar or varied across seven countries whose per capita GNP ranged from $200 to $40,100 (United Sates, Taiwan, Korea, Mexico, China, Indonesia, and the Tsimane of Bolivia). It also sought to determine if sex differences and age differences varied systematically in terms of macro-level indicators including GDP, life expectancy, and measures of gender equality. Overall, sex differences were remarkably consistent across countries with very different contexts. Sex differences in physical performance and functional limitations were more pronounced than sex differences in difficulty with basic self-care tasks, but the magnitude of differences did not vary systematically in relation to country-level measures of development or gender equality. This may be because gender equality can be either protective or detrimental, depending on the domain. In terms of age differences, it was necessary to consider both the level of performance/prevalence of difficulty at younger ages as well as age differences, since poor performance/high levels of difficulty among the young-old indicate that "aging" has already occurred. Some populations did appear to be "aging" more rapidly, particularly those at the lowest end of the development spectrum, however, there was no clear evidence for a linear correlation between macro-level indicators of development and age differences. Interestingly, findings showed that functioning in some domains could be fairly well maintained despite declines in other domains, and these varied across countries. For example, Indonesians appeared to be "aging" more rapidly in terms of upper body strength, but showed relatively high levels of lower body function and less age-related decline. This may be due to differences across populations in patterns of work, physical activity, the built environment, etc. %I University of Southern California %C Los Angeles %V 3644708 %P 144 %8 2014 %G English %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1625050780?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 1625050780 %4 ADL/IADL %$ 999999 %! International sex and age differences in physical function and disability %0 Book Section %B Discoveries in the Economics of Aging %D 2014 %T The Lifetime Risk of Nursing Home Use %A Michael D Hurd %A Pierre-Carl Michaud %A Susann Rohwedder %E David A Wise %K Health Conditions and Status %K Healthcare %X This paper estimates the lifetime risk and distribution of stays in nursing homes using 10 waves of data from the Health and Retirement Study covering the population over the age of 50. Using both non-parametric and parametric approaches which account for censoring, we estimate that a 50 year old has a 53 to 59 chance of ever entering a nursing home before he dies and that, conditional on any stay, the average duration is just over a year. We show that stays at the end of life which are typically not captured in core interviews are very important for assessing lifetime exposure. The HRS performs exit interviews with proxies for those who died. Excluding exit interviews yields lifetime risk under 40 . Being female, white and a non-smoker are associated with higher lifetime risk due to lower (competing) mortality risk and higher nursing home risk at older ages. %B Discoveries in the Economics of Aging %I University of Chicago Press %C Chicago %P 81-109 %G eng %4 nursing home rist/nursing homes/mortality %$ 999999 %! The Lifetime Risk of Nursing Home Use %0 Journal Article %J Prev Chronic Dis %D 2014 %T Longitudinal predictors of self-rated health and mortality in older adults. %A Diane C Wagner %A Jerome L Short %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Chronic disease %K depression %K Educational Status %K Female %K Health Behavior %K Health Status Indicators %K Humans %K Longitudinal Studies %K Male %K Mental Recall %K Middle Aged %K Proportional Hazards Models %K Psychometrics %K Retirement %K Self Report %K Survival Analysis %K United States %X

INTRODUCTION: Few studies have compared the effects of demographic, cognitive, and behavioral factors of health and mortality longitudinally. We examined predictors of self-rated health and mortality at 3 points, each 2 years apart, over 4 years.

METHODS: We used data from the 2006 wave of the Health and Retirement Study and health and mortality indicators from 2006, 2008, and 2010. We analyzed data from 17,930 adults (aged 50-104 y) to examine predictors of self-rated health and data from a subgroup of 1,171 adults who died from 2006 through 2010 to examine predictors of mortality.

RESULTS: Time 1 depression was the strongest predictor of self-rated health at all points, independent of age and education. Education, mild activities, body mass index, delayed word recall, and smoking were all associated with self-rated health at each point and predicted mortality. Delayed word recall mediated the relationships of mild activity with health and mortality. Bidirectional mediation was found for the effects of mild activity and depression on health.

CONCLUSION: Medical professionals should consider screening for depression and memory difficulties in addition to conducting medical assessments. These assessments could lead to more effective biopsychosocial interventions to help older adults manage risks for mortality.

%B Prev Chronic Dis %I 11 %V 11 %P E93 %8 2014 Jun 05 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/24901793?dopt=Abstract %2 PMC4049199 %4 Self assessed health/depression/mortality/memory decline/psychosocial influences/psychosocial influences %$ 999999 %R 10.5888/pcd11.130241 %0 Report %D 2014 %T Lower-Income Individuals Without Pensions: Who Misses Out and Why? %A April Yanyuan Wu %A Matthew S. Rutledge %X In 2010, only 19 percent of individuals ages 50-58 whose household incomes were less than 300 percent of the poverty line participated in a pension of any kind at their current jobs, compared to 56 percent of those above 300 percent of poverty. This paper investigates this pension gap. In particular, we decompose the pension participation rate into its four elements in order to compare coverage between higher- and lower-income individuals: 1) the fraction of people who are currently working (the employment rate); 2) the fraction of workers who are in firms that offer pension benefits to at least some workers (the offer rate); 3) the fraction of workers who are eligible for pension benefits, conditional on being in a firm where it is offered (the eligibility rate); and 4) the fraction of workers who enroll in a pension plan when they are eligible (the take-up rate). We find that the substantial pension gap between higher- and lower-income individuals is driven primarily by the lower-income group’s lower employment rate and the smaller probability of working for an employer that offers pensions; when lower-income workers do have a pension plan at work, their eligibility and take-up rates are nearly equivalent to higher-income workers. We also find that the factors associated with a higher value for each element of pension participation are very consistent: higher education and income, previous pension history, and job characteristics including firm size, occupation, job tenure, and union status. Together, these findings suggest that policies such as automatic enrollment that focus on pension eligibility or take-up are unlikely to close the pension coverage gap between older, lower-income individuals and their higher-income contemporaries; instead, greater pension participation requires more jobs and, in particular, more “good jobs.” %B Center for Retirement Research at Boston College Working Paper Series %I Center for Retirement Research at Boston College %C Boston, MA %G eng %U http://crr.bc.edu/working-papers/lower-income-individuals-without-pensions-who-misses-out-and-why/ %0 Journal Article %J Health Psychology %D 2014 %T Marital quality and diabetes: Results from the Health and Retirement Study %A Mark A Whisman %A Li, Angela %A Sbarra, David A. %A Raison, Charles L. %K Adult children %K Demographics %K Health Conditions and Status %X Objective: Poor marital quality is associated with many different indicators of poor health, including immunologic and metabolic responses that have relevance for distal disease outcomes such as diabetes. We conducted this study to evaluate whether poor marital quality was associated with the prevalence of diabetes in a population-based sample of Americans over the age of 50. Method: Participants were married adults from the 2006 (N = 3,898) and 2008 (N = 3,452) waves of the Health and Retirement Study. Participants completed an interview and a self-report questionnaire, and current use of diabetes medication and glycosylated hemoglobin obtained from blood spot samples were used to index diabetes status. Marital quality was assessed with items regarding perceived frequency of positive and negative exchanges with partner. Results: Decreasing frequency of positive exchanges and increasing frequency of negative exchanges with one s spouse were associated with higher prevalence of diabetes among men, but not women at both waves; gender significantly moderated the associations between partner exchanges and diabetes status for the 2006 data. The association between frequency of partner exchanges and diabetes status generally remained significant in men after accounting for demographic characteristics and other risk factors (obesity, hypertension, low physical activity). Conclusion: Poor marital quality as operationalized by rates of positive and negative partner exchanges was associated with increased prevalence of diabetes in men. These results are consistent with prior work on marriage and health, and suggest that poor marital quality may be a unique risk factor for diabetes. %B Health Psychology %I 33 %V 33 %P 832-840 %G eng %N 8 %4 marital quality/diabetes/gender difference %$ 999999 %R 10.1037/hea0000064 %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 Journal of Clinical Oncology %D 2014 %T Multimorbidity and racial disparities in use of hospice by older patients dying from cancer. %A Siran M Koroukian %A Nicholas K Schiltz %A Warner, David %A Charles W Given %A Owusu, Cynthia %A Mark Schluchter %A Nathan A. Berger %K Cancer %K Death %K multimorbidity %K National Death Index %K race %K race difference %K race-ethnicity %X 9542 Background: While previous studies have documented lower use of hospice by Non-Hispanic Blacks (NHBs) than by Non-Hispanic Whites (NHWs), racial variations have not been examined in the context of multimorbidity (MM), which affects minority patients disproportionately. We sought to determine the impact of MM severity on NHBs’ use of hospice in a U.S. representative sample of older adults. Methods: We used data from the linked 1991-2008 Health and Retirement Study (HRS), Medicare data, and the National Death Index (NDI). From the NDI, we identified fee-for-service patients ≥65 years of age who died from cancer (n=812), and retrieved their demographic data, presence of comorbidities (COM), functional limitations (FL), and geriatric syndromes (GS) from their last HRS interview. We characterized severity of MM by 3 levels: none or only one of COM, FL, or GS (MM0/1); presence of two of COM, FL, or GS (MM2); or presence of all three of COM, FL, and GS (MM3). Hospice use was identified from Medicare claims data. We developed multivariable logistic regression models to analyze the association between race and hospice use, adjusting for MM and other patient covariates. Results: Nearly 12% of the study population was NHB; 61.3% of NHBs and 53.0% of NHWs were identified in MM3 (p=0.057). Overall, 61% of the patients received hospice care (63.7% in NHWs, and 43.0% in NHBs, p < 0.001). The distribution NHBs and NHWs by MM was similar across hospice users and non-users. Adjusting for MM and other confounders, NHBs were significantly less likely than NHWs to utilize hospice (Adjusted odds ratio: 0.42, 95% Confidence Interval: 0.27-0.66, p < 0.001). Conclusions: Despite the greater representation of NHBs in the highest severity of MM category, NHBs remain significantly less likely than NHWs to use hospice, even after adjusting for MM. The findings carry important implications with regard to disparities in providing optimal, and cost effective quality of end-of-life care. %B Journal of Clinical Oncology %V 32 %P 9542-9542 %G eng %N 15_Suppl %R 10.1200/jco.2014.32.15_suppl.9542 %0 Report %D 2014 %T New Evidence on the Risk of Requiring Long-Term Care %A Wenliang Hou %A Friedberg, Leora %A Wei Sun %A Anthony Webb %A Zhenyu Li %K Long-term Care %X The expectation of needing long-term care is an essential input into optimal saving and long-term care insurance decisions. Previous optimization models have used the Robinson (2002) transition probabilities, which have not been systematically updated and which underpredict the use of care while overpredicting the average stay of people who enter care. We develop a new statistical model and use current data to estimate health impairment and care transition probabilities. We show that impairment and care use have declined and that, after incorporating the new transition probabilities, optimal long-term care insurance holdings are much lower and are close to actual holdings. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/new-evidence-on-the-risk-of-requiring-long-term-care/ %0 Book Section %B Discoveries in the Economics of Aging %D 2014 %T The Nexus of Social Security Benefits, Health, and Wealth at Death %A James M. Poterba %A Steven F Venti %A David A Wise %K health %K Social Security Benefits %K Wealth %X Social Security (SS) benefits are the most important component of the income of a large fraction of older Americans. A significant fraction approach later life relying heavily on SS benefits. Persons in poor health in old age have a higher-than-average probability of having experienced low earnings while in the labor force, increasing the risk of having low SS benefits in retirement. While the progressivity of the SS benefit formula provides a safety net to support low-wage workers in retirement, a noticeable fraction still have income below the poverty level in their last years. In general, low assets and low income in old age are strongly related to poor health. We explore this nexus and describe the relationship between SS benefits and the exhaustion of non-annuity assets near the end of life. We examine the relationship between the drawdown of assets between the first year an individual is observed in the AHEAD data (1995) and the last year that individual is observed before death, and that individual's health, SS benefits, and other annuity benefits. SS and defined benefit pension benefits are strongly "protective" of non-annuity assets, with a negative relationship between these income flows and the likelihood of exhausting non-annuity assets. %B Discoveries in the Economics of Aging %I University of Chicago Press %P 159-182 %G eng %U http://www.nber.org/chapters/c12964 %0 Book Section %B The interdisciplinary science of consumption %D 2014 %T Older Adults as Consumers: An Examination of Differences by Birth Cohort %A Fin, Debra N. %A Yoon, Carolyn %A Hartsell, Debra L. %A Toni C Antonucci %A Noah J Webster %A McCullough, Wayne R. %K Demographics %K Methodology %X The U.S. and much of the developed world are currently undergoing a demographic transition marked by fundamental changes in the age structure of the population. These changes pose a number of challenges for society such as understanding the consumption patterns of middle aged and older people. In this chapter, the authors use data from the Health and Retirement Study to explore consumption patterns among five cohorts of adults age 50 and older. They found that older, compared to younger, birth cohorts of older adults reported less spending on food, transportation, trips and vacations, and durable goods; they spent more on donations and gifts; all cohorts reported similar levels of spending on health-related expenses. Results also identified a critical middle age group (i.e. ages 70 to 80), in which the greatest differences in consumption patterns were evident. Such findings may be useful for industry and organizations allowing them to be responsive and competitive by helping them target goods and products that meet the changing needs of an aging society %B The interdisciplinary science of consumption %I The MIT Press %P 292-298 %@ 9780262325387 %G eng %4 Health and Retirement Study/Consumer behavior/Older adults/neuropsychology %$ 999999 %! Older Adults as Consumers: An Examination of Differences by Birth Cohort %R 10.7551/mitpress/9780262027670.003.0015 %0 Journal Article %J 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 Social Psychological and Personality Science %D 2014 %T Personality Traits Predict the Onset of Disease %A Sara J Weston %A Patrick L Hill %A Joshua J Jackson %K Health Conditions and Status %K Healthcare %X While personality traits have been linked concurrently to health status and prospectively to outcomes such as mortality, it is currently unknown whether traits predict the diagnosis of a number of specific diseases (e.g., lung disease, heart disease, and stroke) that may account for their mortality effects more generally. A sample (N = 6,904) of participants from the Health and Retirement Study, a longitudinal study of older adults, completed personality measures and reported on current health conditions. Four years later, participants were followed up to see if they developed a new disease. Initial cross-sectional analyses replicated past findings that personality traits differ across disease groups. Longitudinal logistic regression analyses predicting new disease diagnosis suggest that traits are associated with the risk of developing disease most notably the traits of conscientiousness, neuroticism, and openness. Findings are discussed as a means to identify pathways between personality and health. %B Social Psychological and Personality Science %V 6 %P 309-317 %G eng %U http://spp.sagepub.com/content/early/2014/10/13/1948550614553248.abstract %N 3 %4 personality/personality/health outcomes/disease groups/conscientiousness/conscientiousness/openness/neuroticism/personality traits %$ 999999 %& 309 %R 10.1177/1948550614553248 %0 Journal Article %J Journal of Physical Activity and Health %D 2014 %T Physical Activity and Mortality Among Middle-Aged and Older Adults in the United States %A Wen, Ming %A Li, Lifeng %A Su, Dejun %K Demographics %K Health Conditions and Status %K Retirement Planning and Satisfaction %K Women and Minorities %X Background: Physical activity (PA) has been routinely linked to lower all-cause mortality, yet extant research in the United States is primarily based on nonrepresentative samples. Evidence is scant on the relative and independent merits of leisure-time (LTPA) versus non-leisure-time (NLTPA) activities and how the PA-mortality link may vary across racial-ethnic-gender groups. Methods: Data were from Health and Retirement Study which began in 1992 collecting data on individuals aged 51-61 years who were subsequently surveyed once every 2 years. The current study assessed group-specific effects of LTPA and NLTPA measured in 1992 on mortality that occurred during the 1992-2008 follow-up period. Cox proportional hazard analyses were performed to examine the PA-mortality link. Results: Net of a wide range of controls, both LTPA and NLTPA showed a gradient negative relation with mortality. No gender-PA interaction effects were evident. Some interaction effects of PA with race-ethnicity were found but they were weak and inconsistent. The mortality reduction effects of PA seemed robust across racial-ethnic-gender groups. Conclusions: Regardless of personal background, PA is a major health promoting factor and should be encouraged in aging populations. More research is needed to assess relative merits of different types and domains of PA. %B Journal of Physical Activity and Health %I 11 %V 11 %P 303-312 %G eng %N 2 %4 aging/ethnicity/ALL-CAUSE MORTALITY/BODY-MASS INDEX/LEISURE-TIME/CARDIOVASCULAR-DISEASE/ETHNIC-DIFFERENCES/EXERCISE CAPACITY/WOMEN/HEALTH/CENTENARIANS %$ 999999 %0 Journal Article %J Psychology and Aging %D 2014 %T Positive and Negative Social Exchanges and Cognitive Aging in Young-Old Adults: Differential Associations Across Family, Friend, and Spouse Domains %A Tim D Windsor %A Denis Gerstorf %A Pearson, Elissa %A Lindsay H Ryan %A Kaarin J. Anstey %K End of life decisions %K Event History/Life Cycle %K Health Conditions and Status %K Methodology %K Other %K Retirement Planning and Satisfaction %X We examined how positive and negative social exchanges with friends, family, and spouses were related to cognitive aging in episodic and working memory, and perceptual speed. To do so, we used a large sample of cognitively intact young-old participants from the PATH Through Life Study ( PATH; aged 60 to 64 years at baseline, n = 1,618) who were assessed on 3 occasions over 8 years. Additional replication analyses were conducted using the Health and Retirement Study (HRS), which provided data on episodic memory. The main analysis of PATH Through Life showed that positive exchanges with friends and family were associated with less decline in perceptual speed, with these associations attenuated by adjustment for physical functioning and depressive symptoms. Negative exchanges with spouses were associated with poorer working memory performance. Positive exchanges with friends were associated with better initial episodic memory in both PATH and HRS. More frequent negative exchanges with friends and family were associated with better episodic memory in the PATH sample. However, these findings were not replicated in HRS. Our findings provide indirect support for the role of social exchange quality in contributing to cognitive enrichment. However, the inconsistent pattern of results across cognitive and social exchange domains points to possibilities of reverse causality, and may also indicate that social exchange quality plays a less important role for cognitive enrichment than other psychosocial characteristics. %B Psychology and Aging %I 29 %V 29 %P 28-43 %G eng %N 1 %4 cognition/cognitive aging/social exchanges/social relations/PSYCHOLOGICAL DISTRESS/PERCEPTUAL SPEED/LONGITUDINAL EVIDENCE/MENTAL-HEALTH/LIFE PROJECT/FOLLOW-UP/SUPPORT/DECLINE/RETIREMENT %$ 999999 %0 Journal Article %J Educational Gerontology %D 2014 %T Predicting SNAP Participation in Older Adults: Do Age Categorizations Matter? %A Geiger, Jennifer R. %A Wilks, Scott E. %A Livermore, Michelle M. %K Demographics %K Health Conditions and Status %K Income %K Public Policy %X Prior, Supplemental Nutrition Assistance Program (SNAP) research reveals limited age cohort analyses that may not accurately reflect nuanced age differences in SNAP participation. The purpose of this study was to add depth to older age analysis and SNAP participation via four models of age categorizations. This secondary data analysis used a sample of 10,116 older adults from the 2010 Health and Retirement Study. Controlling for demographic, socioeconomic, and physical factors, logistic regression tested four age categorization models: Third-Age and Fourth-Age groupings; young-old, middle-old, and oldest old groupings; generic decade cohorts; and continuous age. Hypotheses for each model predicted older age as negative to SNAP participation. Significant predictors of SNAP participation included female gender, nonwhite non-Hispanic and Hispanic ethnicities, lower household income, inadequate food budget, and difficulty in self-dressing. Odds ratios confirmed age as a negative factor to SNAP participation. Addition of age categorizations into each model yielded nominal, effect size change. Yet, addition of age into the models changed the relationship between control variables and SNAP receipt, namely gender and Hispanic ethnicity. While age categorizations offered marginal effect predicting SNAP participation, difficulty dressing most strongly predicted increased participation across all models. This finding is relevant, as standard SNAP participation models for younger individuals rely heavily on socioeconomic indicators. Results suggest future research modeling SNAP participation in older individuals that emphasizes physical/medical issues. %B Educational Gerontology %I 40 %V 40 %P 932-946 %G eng %U http://dx.doi.org/10.1080/03601277.2014.912837 %N 12 %4 Aging/elderly/food stamps/older adults/poverty/welfare %$ 999999 %R 10.1080/03601277.2014.912837 %0 Journal Article %J Obesity Facts %D 2014 %T Predictors of Weight Loss in Obese Older Adults: Findings from the USA and the UK %A Sarah E Jackson %A Rebecca J. Beeken %A Wardle, Jane %K Adult children %K Health Conditions and Status %K Women and Minorities %X Objective: To examine the prevalence and demographic predictors of clinically meaningful weight loss in community samples of obese older adults in the USA and the UK. Methods: Data were from obese older adults (BMI 30 kg/m2; age 52 years), free of a cancer diagnosis, from the Health and Retirement Study (HRS; n = 3398) and the English Longitudinal Study of Ageing (ELSA; n = 998). Weight change was assessed from 2004 to 2008. Multivariable logistic regression tested whether age, sex, ethnicity, marital status, education, or BMI predicted 5 weight loss. Results: Over a quarter (28.7 ) of obese participants from HRS and 16.6 from ELSA lost 5 weight. Being female (odds ratio (OR) = 1.31, 95 confidence interval (CI) = 1.11-1.54) and heavier (BMI 35 kg/m2) (OR = 1.60, 95 CI = 1.37-1.87) predicted weight loss in HRS. Trends were similar in ELSA (female: OR = 1.18, 95 CI = 0.83-1.69; BMI 35 kg/m2: OR = 1.24, 95 CI = 0.85-1.82). ORs were increased in 65-year-olds in HRS (OR = 1.55, 95 CI = 1.33-1.81), and reduced in married people in ELSA (OR = 0.69, 95 CI = 0.48-1.00). Neither education nor ethnicity predicted weight loss in either cohort. Conclusion: A high proportion of obese older adults experience clinically meaningful weight loss, but few demographic variables consistently predict weight loss in this population. 2014 S. Karger GmbH, Freiburg. %B Obesity Facts %I 7 %V 7 %P 102-110 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84897119471andpartnerID=40andmd5=f9f70f628dc5b0a20a721ff7288b13f4 %N 2 %4 Weight loss/Obesity/WOMEN/Married couples %$ 999999 %0 Journal Article %J Am J Public Health %D 2014 %T Preparedness for natural disasters among older US adults: a nationwide survey. %A Tala M. Al-rousan %A Linda M. Rubenstein %A Robert B Wallace %K Aged %K Aged, 80 and over %K Disaster Planning %K Female %K Humans %K Male %K Middle Aged %K Surveys and Questionnaires %K United States %X

OBJECTIVES: We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents.

METHODS: We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness.

RESULTS: Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness.

CONCLUSIONS: Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.

%B Am J Public Health %V 104 %P 506-11 %8 2014 Mar %G eng %U http://dx.doi.org/10.2105/AJPH.2013.301559 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24432877?dopt=Abstract %4 disaster preparedness/public policy/emergency management %$ 999999 %& 506 %R 10.2105/AJPH.2013.301559 %0 Journal Article %J Journal of the American Geriatrics Society %D 2014 %T Racial and Ethnic Differences in Obesity and Overweight as Predictors of the Onset of Functional Impairment %A Wei, Liang %A Bei Wu %K Demographics %K Health Conditions and Status %X Objectives To examine racial and ethnic differences in the effects of body mass index (BMI) on the onset of functional impairment over 10 years of follow-up. Design Longitudinal analyses of a cohort from a nationally representative survey of community-dwelling American adults. Setting Six waves (1996 2006) of the Health and Retirement Study (HRS). Participants Two groups of HRS participants aged 50 and older without functional impairment at baseline (1996): 5,884 with no mobility difficulty and 8,484 with no activity of daily living (ADL) difficulty. Measurements Mobility difficulty was a composite measure of difficulty walking several blocks, walking one block, climbing several flights of stairs, and climbing one flight of stairs. ADL difficulty was measured as difficulty in dressing, bathing or showering, eating, and getting in and out of bed without help. The association between baseline BMI and risk of developing functional impairment was estimated using generalized estimating equation models. Results Overweight and obesity were significant predictors of functional impairment. Overweight and obese Hispanics were 41 and 91 more likely, respectively, to develop ADL disability than whites in the same BMI categories. Overweight and severely obese blacks were also more likely than their white counterparts to develop ADL disability. Risk of developing ADL difficulty was higher for Hispanics than for blacks in the obese category. No significant differences in onset of mobility difficulty were found between racial or ethnic groups within any BMI category. Conclusion Blacks and Hispanics were at higher risk than whites of ADL but not mobility impairment. In addition to weight control, prevention efforts should promote exercise to reduce functional impairment, especially for blacks and Hispanics, who are at higher risk. %B Journal of the American Geriatrics Society %I 62 %V 62 %P 61-70 %G eng %U http://dx.doi.org/10.1111/jgs.12605 %N 1 %4 obesity/overweight/mobility difficulty/ADL difficulty/racial and ethnic difference %$ 999999 %R 10.1111/jgs.12605 %0 Journal Article %J PLoS One %D 2014 %T Self-rated health in the last 12 years of life compared to matched surviving controls: the Health and Retirement Study. %A Stenholm, Sari %A Pentti, Jaana %A Ichiro Kawachi %A Westerlund, Hugo %A Mika Kivimäki %A Vahtera, Jussi %K Adult %K Aged %K Aged, 80 and over %K Diagnostic Self Evaluation %K Female %K health %K Health Status %K Humans %K Life Style %K Male %K Middle Aged %K Mortality %K Retirement %K Retrospective Studies %X

Self-rated health (SRH) is a valid measure of health status and associated with mortality. Based on individual-level biannual repeat data on SRH we sought to characterize the natural history of poor SRH during the 12 years prior to death in men and women in different age groups. We conducted a retrospective analysis of the Health and Retirement Study participants who died between 1998 and 2010 and had at least two SRH measurements in the 12 years prior to death. We used a nested case-control design to compare SRH trajectories of deceased men and women aged 30-64, 65-79 and 80 years versus surviving participants. The cases comprised 3,350 deceased participants who were matched to surviving controls (n = 8,127). SRH was dichotomized into good vs. poor health. Men and women dying at age 65-79 and ≥ 80 years had 1.5 to 3 times higher prevalence of poor SRH already 11-12 years prior to death compared to surviving controls. The risk estimates remained statistically significant even after adjusting for life-style related risk factors and diagnosed diseases. Prevalence of poor SRH before death was lowest among those aged ≥ 80 years and highest in 30-64 year-olds. In conclusion, men and women who subsequently die perceive their health worse already 11-12 years prior to death compared to their surviving controls.

%B PLoS One %I 9 %V 9 %P e107879 %8 2014 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/25237814?dopt=Abstract %2 PMC4169624 %4 Self assessed health/Mortality/health Status/retrospective analysis/health trajectories/health trajectories %$ 999999 %R 10.1371/journal.pone.0107879 %0 Journal Article %J Health Psychol %D 2014 %T Social relationships, leisure activity, and health in older adults. %A Chang, Po-Ju %A Linda A. Wray %A Lin, Yeqiang %K Aged %K Aged, 80 and over %K Female %K Health Status %K Humans %K Interpersonal Relations %K Leisure activities %K Longitudinal Studies %K Male %K Middle Aged %K United States %X

OBJECTIVE: Although the link between enhanced social relationships and better health has generally been well established, few studies have examined the role of leisure activity in this link. This study examined how leisure influences the link between social relationships and health in older age.

METHOD: Using data from the 2006 and 2010 waves of the nationally representative U.S. Health and Retirement Study and structural equation modeling analyses, we examined data on 2,965 older participants to determine if leisure activities mediated the link between social relationships and health in 2010, controlling for race, education level, and health in 2006.

RESULTS: The results demonstrated that leisure activities mediate the link between social relationships and health in these age groups. Perceptions of positive social relationships were associated with greater involvement in leisure activities, and greater involvement in leisure activities was associated with better health in older age.

CONCLUSION: The contribution of leisure to health in these age groups is receiving increasing attention, and the results of this study add to the literature on this topic, by identifying the mediating effect of leisure activity on the link between social relationships and health. Future studies aimed at increasing leisure activity may contribute to improved health outcomes in older adults.

%B Health Psychol %I 33 %V 33 %P 516-23 %8 2014 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/24884905?dopt=Abstract %2 PMC4467537 %4 Social relationships/leisure activity/health outcomes %$ 999999 %R 10.1037/hea0000051 %0 Report %D 2014 %T Social Security Programs and Retirement Around the World: Disability Insurance Programs and Retirement - Introduction and Summary %A Courtney Coile %A Kevin Milligan %A David A Wise %K Social Security %X This is the introduction and summary to the sixth phase of an ongoing project on Social Security Programs and Retirement Around the World. The first phase described the retirement incentives inherent in plan provisions and documented the strong relationship across countries between social security incentives to retire and the proportion of older persons out of the labor force. The second phase documented the large effects that changing plan provisions would have on the labor force participation of older workers. The third phase demonstrated the consequent fiscal implications that extending labor force participation would have on net program costs–reducing government social security benefit payments and increasing government tax revenues. The fourth phase presented analyses of the relationship between the labor force participation of older persons and the labor force participation of younger persons in twelve countries. We found no evidence that increasing the employment of older persons will reduce the employment opportunities of youth and no evidence that increasing the employment of older persons will increase the unemployment of youth. The fifth phase on "Historical Trends in Mortality and Health, Employment, and Disability Insurance Participation and Reforms" was intended to set the stage for this current phase. This sixth phase of the ongoing ISS project is particularly related to the fifth phase (Wise, 2012) and the second phase (Gruber and Wise, 2004) of the project. This volume continues the focus of the previous volume on DI programs while extending the methodology to study retirement behavior used in the second phase to focus in particular on the effects of the DI programs. The key question this volume seeks to address is: given health status, to what extent are differences in labor force participation across countries determined by the provisions of disability insurance programs? %I NBER %G eng %U http://www.nber.org/papers/w20120 %R 10.3386/w20120 %0 Journal Article %J Journal of Behavioral Medicine %D 2014 %T Spousal social support and strain: impacts on health in older couples. %A Lindsay H Ryan %A Wylie H Wan %A Jacqui Smith %K Health Conditions and Status %K Marriage %K Older Adults %K Social Support %K Stress %X

Using a nationally representative sample of couples aged 51+ in the United States (N = 1,923 couples), the current study investigated whether both partners' perceptions of relationship support and strain are associated with an individual's self-rated health and functional limitations. The sample had an average age of 67.17 years (SD = 9.0; range 50-97). Actor-Partner Interdependence Models adjusting for couple interdependencies were applied using multilevel models. After accounting for age, education, gender, race, and couple differences in length of marriage, results indicate that individual perceptions of support were significantly associated with higher self-rated health and fewer functional limitations. These individual-level benefits increased if the spouse also perceived positive support and low strain. Finally, the negative association of an individual's perceived support on functional limitations was greater in those with a spouse reporting low levels of perceived strain. Findings are discussed relative to theory on behavioral and psychological pathways between partners' perceptions of support and health.

%B Journal of Behavioral Medicine %V 37 %P 1108-17 %8 2014 Dec %G eng %N 6 %R 10.1007/s10865-014-9561-x %0 Journal Article %J Demography %D 2014 %T Is There a Trade-off Between Parent Care and Self-care? %A Arora, Kanika %A Douglas A. Wolf %K Adult children %K Healthcare %X Caregiving for family members is often described as a 36-hour day. Previous literature has suggested that family caregivers have little time to attend to their own health needs, such as participating in leisure-time physical activity. Using data from the Health and Retirement Study, we analyze whether time-allocation decisions reflect a conflict between time devoted to informal care and time devoted to self-health promotion through physical activity. The empirical model is a system of four correlated equations, wherein the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, or in hours of work, among either men or women. %B Demography %I 51 %V 51 %P 1251-70 %G eng %N 4 %4 caregiving/family caregivers/parental care %$ 999999 %R 10.1007/s13524-014-0309-6 %0 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 Journal Article %J Biodemography Soc Biol %D 2014 %T Validation of blood-based assays using dried blood spots for use in large population studies. %A Eileen M. Crimmins %A Jung K Kim %A Heather McCreath %A Jessica Faul %A David R Weir %A Teresa Seeman %K Biomarkers %K C-reactive protein %K Cholesterol %K Cholesterol, HDL %K Cystatin C %K Dried Blood Spot Testing %K Glycated Hemoglobin A %K Humans %K Middle Aged %K Reference Values %K Reproducibility of Results %X

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

%B Biodemography Soc Biol %V 60 %P 38-48 %8 2014 %G eng %U http://www.tandfonline.com/doi/abs/10.1080/19485565.2014.901885 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/24784986?dopt=Abstract %! Biodemography and Social Biology %R 10.1080/19485565.2014.901885 %0 Journal Article %J Journal of Aging and Health %D 2014 %T Veteran Status and Men s Later-Life Cognitive Trajectories: Evidence from the Health and Retirement Study %A Maria T. Brown %A Janet M Wilmoth %A Andrew S London %K Demographics %K Event History/Life Cycle %K Health Conditions and Status %X Objective: The aim of this study is to determine the extent to which men s later-life cognitive trajectories vary by veteran status. Method: We use Health and Retirement Study (HRS) data to estimate growth curve models examining men s later-life cognitive trajectories by veteran status, war service status, and period of service. Analyses control for early-life characteristics that influence selection into military service and later-life cognition, and mid- to late-life characteristics that potentially mediate the relationship between military service and later-life cognition. Results: Veterans have higher cognition scores relative to nonveterans around retirement age, but their cognition scores decline more rapidly with increasing age, such that cognition scores are similar in both groups among the oldest old. Veterans who served during the Korean War have lower cognition scores around retirement age, but less steep age-related declines, than veterans who served during World War II. Discussion: Findings are discussed in relation to the extant literature, future research, potential service needs, and study limitations. %B Journal of Aging and Health %G eng %U http://jah.sagepub.com/content/early/2014/05/23/0898264314534893.abstract %4 cognitive trajectories/veterans/life course/Military service %$ 999999 %R 10.1177/0898264314534893 %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 J Gen Intern Med %D 2013 %T BMI change patterns and disability development of middle-aged adults with diabetes: a dual trajectory modeling approach. %A Chiu, Ching-Ju %A Linda A. Wray %A Lu, Feng-hwa %A Elizabeth A Beverly %K Activities of Daily Living %K Body Mass Index %K Diabetes Mellitus, Type 2 %K Disability Evaluation %K Disabled Persons %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Models, Statistical %K Obesity %K Obesity, Morbid %K Overweight %K Retrospective Studies %K United States %K Weight Gain %K Weight Loss %X

BACKGROUND: Few longitudinal studies have examined associations between body mass index (BMI) changes in adults with diabetes and the development of disability.

OBJECTIVE: To investigate association patterns between BMI and disability in middle-aged adults with diabetes.

DESIGN AND SETTING: Retrospective cohort design with data from the 1992-2006 Health and Retirement Study (HRS). A group-based joint trajectory method identified distinct BMI change trajectories and their link to subsequent disability trajectories.

PARTICIPANTS: U.S. nationally representative adults aged 51-61 who reported a diagnosis of diabetes in the 1992 HRS (N = 1,064).

MEASUREMENTS: BMI and self-reported disability score were the main variables. Sociodemographic, clinical, behavioral, and diabetes-related factors were also examined.

RESULTS: Four distinct weight trajectories (stable normal weight, 28.7 %; stable overweight, 46.2 %; loss and regain obese, 18.0 %; weight cumulating morbidly obese, 7.1 %) and three disability trajectories (little or low increase, 34.4 %; moderate increase, 45.4 %; chronic high increase, 20.2 %) best characterized the long-term patterns of BMI and disability change in middle-aged adults with diabetes. Adults in stable normal weight had the highest probability of being in the little/low increase disability group; however, one in five adults in that group progressed into chronic high disability, a higher proportion compared to the stable overweight group.

CONCLUSIONS: Although there were various ways in which the two trajectories were linked, the beneficial impacts of optimizing weight in adults with diabetes were supported. In addition, the complexity of diabetes control in those with relatively normal weight was highlighted from this study.

%B J Gen Intern Med %I 28 %V 28 %P 1150-6 %8 2013 Sep %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/23463456?dopt=Abstract %2 PMC3744313 %4 Medical Sciences/Body fat/Disability/Disability/Middle age/Diabetes/Models %$ 69104 %R 10.1007/s11606-013-2399-z %0 Journal Article %J Health Economics %D 2013 %T Borrowing to cope with adverse health events: liquidity constraints, insurance coverage, and unsecured debt %A Patryk D. Babiarz %A Widdows, Richard %A Tansel Yilmazer %K Medicare/Medicaid/Health Insurance %K Net Worth and Assets %K Public Policy %X This article uses data from the Health and Retirement Study for 1998-2010 to investigate whether households respond to the financial stress caused by health problems by increasing their unsecured debt. Results show both the probability of having unsecured debt and the amount of debt increase after an adverse health event among households with low financial assets, who are uninsured, or who have less generous health insurance. The effect of health problems on borrowing is caused by both medical expenditures and disruptions to the income stream. Unsecured debt seems to remain on some households' balance sheets for an extended period. %B Health Economics %I 22 %V 22 %P 1177-98 %G eng %N 10 %4 financial security/health Insurance/Financial risk taking/unsecured debt %$ 69120 %R 10.1002/hec.2877 %0 Journal Article %J J Manipulative Physiol Ther %D 2013 %T Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Frederic D Wolinsky %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Cohort Studies %K Databases, Factual %K Disability Evaluation %K Female %K Geriatric Assessment %K Humans %K Low Back Pain %K Male %K Manipulation, Chiropractic %K Medicare %K Mobility Limitation %K Musculoskeletal Diseases %K Patient Satisfaction %K Quality of Life %K Risk Assessment %K Sex Factors %K Treatment Outcome %K United States %X

OBJECTIVE: The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

METHODS: Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

RESULTS: Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

CONCLUSION: The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.

%B J Manipulative Physiol Ther %V 36 %P 572-84 %8 2013 Nov-Dec %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/24636108 %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/24144425?dopt=Abstract %R 10.1016/j.jmpt.2013.08.008 %0 Report %D 2013 %T The Cognitive Demands of Work and the Length of Working Life: The Case of Computerization %A Robert J. Willis %K Cognition %K Cognitive Demand %K Computerization %K Work %X This paper focuses on impact of computerization on the work and retirement decisions of the cohort of 51-61 year old individuals who entered the Health and Retirement Study in 1992 and have been followed for next 18 years through 2010. I use data on cognition and detailed occupations in the HRS linked to a measure of occupational computerization from the O*NET data assembled by the Bureau of Labor Statistics. Beginning with Autor et al. (2003), the labor economics literature suggests that advances in computers substitute for the tasks done by many middle-skilled workers and complement those done by high-skilled individuals. Advances in computer technology tend, therefore, to lower the productivity of the middle-skilled and raise the productivity of the high skilled. Older workers face a decision of whether to invest in keeping up with new technology, shifting to another occupation or exiting from full time work into partial or full retirement. I find strong evidence that women and many men retired earlier if they are in computer-intensive occupations while, for other men it appears that computerization does not have a significant effect on retirement. Higher cognition and being in a high wage occupation appears to partially offset retirement incentives of computerization. %I Stanford Institute of Economic Policy Research %G eng %U https://siepr.stanford.edu/research/publications/cognitive-demands-work-and-length-working-life-case-computerization %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 Journal of Human Capital %D 2013 %T Dementia Risk and Financial Decision Making by Older Households: The Impact of Information. %A Joanne W. Hsu %A Robert J. Willis %K Decision making %K Dementia %K Finances %K Older Adults %X

The knowledge and reasoning ability needed to manage one's finances is a form of human capital. Alzheimer's disease and other dementias cause progressive declines in cognition that lead to a complete loss of functional capacities. In this paper we analyze the impact of information about cognitive decline on the choice of household financial decision-maker. Using longitudinal data on older married couples in a novel application of survival analysis, we find that as the financial decision maker's cognition declines, the management of finances is eventually turned over to his cognitively intact spouse, often well after difficulties handling money have already emerged. However, a memory disease diagnosis increases the hazard of switching the financial respondent by over 200 percent for couples who control their retirement accounts, like 401(k) accounts, relative to those who passively receive retirement income. This finding is consistent with a model of the value of information: households with the most to gain financially from preparation are most responsive to information about cognitive decline.

%B Journal of Human Capital %P 45 %8 2013 Apr 01 %G eng %R 10.2139/ssrn.2339225 %0 Journal Article %J JAMA Intern Med %D 2013 %T Disability during the last two years of life. %A Alexander K Smith %A Louise C Walter %A Yinghui Miao %A W John Boscardin %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disability Evaluation %K Disabled Persons %K Educational Status %K Female %K Frail Elderly %K Humans %K Income %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Prospective Studies %K Sex Distribution %K Socioeconomic factors %K United States %X

IMPORTANCE: Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life.

OBJECTIVE: To determine national estimates of disability during the last 2 years of life.

DESIGN: Prospective cohort study.

SETTING: A nationally representative study of older adults in the United States.

PARTICIPANTS: Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex.

MAIN OUTCOMES AND MEASURES: Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet.

RESULTS: There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52% women). The prevalence of disability increased from 28% (95% CI, 24%-31%) 2 years before death to 56% (95% CI, 52%-60%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14%; 70-79 years, 21%; 80-89 years, 32%; 90 years or more, 50%; P for trend, <.001). Disability was more common in women 2 years before death (32% [95% CI, 28%-36%]) than men (21% [95% CI, 18%-25%]; P < .001), even after adjustment for older age at death.

CONCLUSIONS AND RELEVANCE: Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.

%B JAMA Intern Med %I 173 %V 173 %P 1506-13 %8 2013 Sep 09 %G eng %N 16 %1 http://www.ncbi.nlm.nih.gov/pubmed/23836120?dopt=Abstract %2 PMC3773297 %4 Medical Sciences/Older people/Disability/Disability/Palliative care/Aging/United States--US %$ 69096 %R 10.1001/jamainternmed.2013.8738 %0 Report %D 2013 %T Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study %A Eileen M. Crimmins %A Jessica Faul %A Jung K Kim %A Heidi M Guyer %A Kenneth M. Langa %A Mary Beth Ofstedal %A Amanda Sonnega %A Robert B Wallace %A David R Weir %K Health Conditions and Status %K Healthcare %K Methodology %X Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 Biomarker data/survey Methods/health measures %$ 62720 %0 Thesis %D 2013 %T Essays on formal and informal long-term health insurance markets %A Woldemichael, Andinet D. %Y Gurmu, Shiferaw %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %K Methodology %K Other %X This dissertation consists of two essays examining formal and informal long term health insurance markets. The first essay analyzes heterogeneity of Long-Term Care Insurance policyholders in their lapse decision, and how their ex-ante and ex-post subjective beliefs about the probability of needing Long-Term Care affect their lapse decisions. In this essay, I develop a model of lapse decision in a two-period insurance framework with a Bayesian learning process and implement several empirical specifications of the model using longitudinal data from the Health and Retirement Study. The results show that policyholders' ex-ante point predictions of their probabilities and their uncertainties about them have a persistent but declining impact on lapse decisions. Those who believe that their risk is higher are indeed more likely to remain insured. However, as their uncertainties surrounding their ex-ante point predictions increase, their chances of lapsing increase regardless of their initial perception biases. These results are heterogeneous across cohorts and policyholders and, in particular, show that those in the older group near the average age of Nursing Home entry have a precise prediction of their risk levels compared to the younger cohort. Policy simulations show that a more informed initial purchase decision reduces the chance of lapsing down the road. The second essay examines the extent to which informal risk sharing arrangement provides insurance against health shocks. I develop a comprehensive model of informal risk sharing contract with two-sided limited commitment which extends the standard model to a regime with the following features. Information regarding the nature of realized health shocks is imperfect and individuals' health capital stock serves as a storage technology and is a factor of production. The theoretical results show that, in such a regime, Pareto optimal allocations are history dependent even if participation constraints do not bind. I perform numerical analysis to show that risk sharing against health shock is less likely to be sustainable among non-altruistic individuals with different levels of biological survival rates and health capital productivity. The results also show that optimal allocations vary depending on the set of information available to individuals. Using panel data of households from villages in rural Ethiopia, I test the main predictions of the theoretical model. While there is negative history dependence in transfers among non-altruistic partners, history dependence is positive when risk sharing is along bloodline and kinship. However, neither short-term nor long-term health shocks are insured through informal risk sharing arrangements among non-altruistic individuals. %I Georgia State University %C Atlanta, GA %V 3613385 %P 128 %8 2013 %G English %U https://scholarworks.gsu.edu/econ_diss/91/ %9 Ph.D. %M 1511453814 %4 0501:Economics %$ 999999 %! Essays on formal and informal long-term health insurance markets %0 Report %D 2013 %T Estimates of the Potential Insurance Value of Disability Insurance for Individuals with Mental Health Impairments %A John Bound %A Caswell, Kyle J. %A Timothy A Waidmann %K Health Conditions and Status %K Public Policy %K Social Security %X Since the mid-1980s there has been dramatic growth in the number and fraction of DI and SSI beneficiaries with mental illness. With longer life expectancies and younger ages of disability onset than beneficiaries with physical impairments, their growth exerts added fiscal pressure on the programs. While not specifically focused on mental illness, fears of an increase in the duration (and thus prevalence) of disability claims that may result from this demographic shift have generated calls to tighten eligibility rules again. Using data from the Health and Retirement Study linked to SSA administrative records, we created statistically matched control groups of non-beneficiaries with severe mental illness. We then estimated the earnings, income, and health insurance coverage among rejected DI/SSI applicants with mental illness who have characteristics comparable to persons awarded benefits on the basis of mental impairments. We found that even after controlling for health and demographic characteristics, DI beneficiaries were substantially worse off than rejected applicants in terms of wealth and income. While these rejected applicants with mental illness were worse off than those with physical impairments, our findings suggests that the programs successfully select applicants with the greatest income needs,and that retrenchment could result in significant hardship. %I Ann Arbor, MI, University of Michigan Retirement Research Center %G eng %4 Social Security Disability Insurance/Supplemental Security Income/Mental illness/Public Policy/Disabilities %$ 69286 %0 Journal Article %J Decis Anal %D 2013 %T Estimating Second Order Probability Beliefs from Subjective Survival Data. %A Péter Hudomiet %A Robert J. Willis %X

Based on subjective survival probability questions in the Health and Retirement Study (HRS), we use an econometric model to estimate the determinants of individual-level uncertainty about personal longevity. This model is built around the modal response hypothesis (MRH), a mathematical expression of the idea that survey responses of 0%, 50%, or 100% to probability questions indicate a high level of uncertainty about the relevant probability. We show that subjective survival expectations in 2002 line up very well with realized mortality of the HRS respondents between 2002 and 2010. We show that the MRH model performs better than typically used models in the literature of subjective probabilities. Our model gives more accurate estimates of low probability events and it is able to predict the unusually high fraction of focal 0%, 50%, and 100% answers observed in many data sets on subjective probabilities. We show that subjects place too much weight on parents' age at death when forming expectations about their own longevity, whereas other covariates such as demographics, cognition, personality, subjective health, and health behavior are under weighted. We also find that less educated people, smokers, and women have less certain beliefs, and recent health shocks increase uncertainty about survival, too.

%B Decis Anal %I 10 %V 10 %8 2013 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/24403866?dopt=Abstract %2 PMC3882032 %4 Subjective expectations/Survival/Epistemic probability beliefs/Ambiguity/control beliefs %$ 999999 %R 10.1287/deca.2013.0266 %0 Journal Article %J International Review of Applied Economics %D 2013 %T Gender preference and transfers from parents to children: an inter-regional comparison %A Edwin S. Wong %K Adult children %K Cross-National %K Demographics %K Methodology %K Net Worth and Assets %X This paper examines whether parents exhibit gender preference in the allocation of family resources to their adult children. Gender preference is defined in the context of an altruistic model for inter-vivos transfer from parents to children extended to include educational investment. Data from the Health and Retirement Study (United States) and the Korean Longitudinal Study of Ageing are used to show that the degree of gender preference differs across these culturally distinct regions. Among Korean families, empirical results point to male preference as sons receive larger inter-vivos transfers and attain higher levels of education compared with daughters. In contrast, the evidence pertaining to gender preference among American families points to daughter preference as inter-vivos transfers and educational investment is generally higher among female adult children. PUBLICATION ABSTRACT %B International Review of Applied Economics %I 27 %V 27 %P 61 %G eng %N 1 %4 gender preference/gender/cross-national comparison/Cross Cultural Comparison/inter Vivos Transfers/Families/Sex preselection/Resource allocation/Living trusts/parent Child Relations %$ 69740 %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 Book Section %B Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health %D 2013 %T Health and Wealth in Early Retirement %A Geoffrey L Wallace %A Haveman, Robert %A Karen C. Holden %A Barbara Wolfe %E Kenneth A. Couch %E Mary C. Daly %E Julie M Zissimopoulos %K Health Conditions and Status %K Income %K Retirement Planning and Satisfaction %X Retirement years are a precarious time for many older Americans. Even if successful in accumulating resources expected to be sufficient to maintain their pre-retirement standard of living, many retirees face unexpected adverse health shocks after retirement. Because of the uncertainty of shocks to physical and cognitive health, there exists the potential for significant deterioration in resource adequacy both at the time of retirement and into the retirement years due to their occurrence. In this study, we select a sample of new retirees constructed from the Health and Retirement Study (HRS) data and follow them during the first decade of their retirement. Using these data, we identify the nature of shocks to physical and cognitive health for which individuals are at risk during their retirement years, and estimate both the absolute and relative risk of these shocks. We then estimate the impact of the occurrence of these shocks on wealth-based measures of retirement adequacy. %B Lifecycle Events and Their Consequences: Job Loss, Family Change, and Declines in Health %I Stanford University %C Stanford, CA %P 261-279 %G eng %4 health shocks/retirement planning/retirement adequacy/physical health/cognitive health %$ 999999 %! Health and Wealth in Early Retirement %0 Report %D 2013 %T Health, Education, and the Post-Retirement Evolution of Household Assets %A James M. Poterba %A Steven F Venti %A David A Wise %K Demographics %K Health Conditions and Status %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper explores the relationship between education and the evolution of wealth after retirement. Asset growth following retirement depends in part on health capital and financial capital accumulated prior to retirement, which in turn are strongly related to educational attainment. These initial conditions for retirement can have a lingering effect on subsequent asset evolution. Our aim is to disentangle the effects of education on post-retirement asset evolution that operate through health and financial capital accumulated prior to retirement from the effects of education that impinge directly on asset evolution after retirement. We consider the indirect effect of education through financial resources in particular Social Security benefits and defined benefit pension benefits and through health capital that was accumulated before retirement. We also consider the direct effect of education on asset growth following retirement, emphasizing the correlation between education and the returns households earn on their post-retirement investments. Households with different levels of education invest, on average, in different assets, and they may consequently earn different rates of return. Finally, we consider the additional effects of education that are not captured through these pathways. Our empirical findings suggest a substantial association between education and the evolution of assets. For example, for two person households the growth of assets between 1998 and 2008 is on average much greater for college graduates than for those with less than a high school degree. This difference ranges from about 82,000 in the lowest asset quintile to over 600,000 in the highest. %I Cambridge, MA, National Bureau of Economic Research %G eng %4 education/wealth/asset accumulation/household finances/retirement planning/health capital/health capital %$ 69270 %0 Journal Article %J Journal of Global Health Care Systems %D 2013 %T Health spending during Medicare coverage and associated health change %A Yi-Sheng Chao %A Chao-Jung Wu %K Health Conditions and Status %K Healthcare %K Medicare/Medicaid/Health Insurance %X Introduction: Medicare spending growth is creating financial and fiscal issues in the US, but health returns from the spending under Medicare were not clear. This study aims to quantify the returns to mortality, self-rated health status and mental health, from the spending on health care in the first four years of Medicare coverage. Method: Eligible Medicare enrollees in the Health and Retirement Study (HRS) from 1992 to 2008 were chosen to understand the returns to health after four years of Medicare coverage, while controlling for individual characteristics before Medicare coverage (pre-Medicare characteristics). Ordered logit models were used for 4,099 eligible Medicare enrollees. Results: Health spending was associated with a higher likelihood of mortality in total spending model (n=1752, odds ratio OR =1.0044 per 1,000, p 0.01); out-of-pocket spending was not significant (n=4032, OR=1.0027 per 1,000, p=0.12). For health status, total and out-of-pocket spending were associated with worsening (n=1731, OR=1.0056, p=0.001; n=4029, OR=1.0154, p 0.01), while this association was confirmed for mental health only in total spending model (n=1658, OR=1.0018, p 0.001 and n=3922, OR=1.0029, p=0.06). Conclusion: there is an association between health spending and worsening of three health dimensions after first four years of Medicare coverage, as pre-Medicare characteristics also play a role in these health outcomes. Medicare could be more efficient in improving health outcomes if there are incentives to adopt effective care and a focus on the temporal externality from pre-Medicare health coverage and pre-Medicare characteristics. %B Journal of Global Health Care Systems %I 13 %V 13 %G eng %N 2 %4 Medicare/Health returns/Mortality/Health status/Mental health/health expenditures/CESD scale %$ 69278 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2013 %T Heterogeneity in multidimensional health trajectories of late old years and socioeconomic stratification: a latent trajectory class analysis. %A Kandauda Wickrama %A Jay A. Mancini %A Kwag, Kyunghwa %A Kwon, Josephine %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K depression %K Female %K Health Status %K Health Transition %K Humans %K Longitudinal Studies %K Male %K Marriage %K Memory Disorders %K Middle Aged %K Socioeconomic factors %X

OBJECTIVES: This study examines (a) the heterogeneity in individual multidimensional health trajectories and (b) the socioeconomic stratification of individual multidimensional health trajectories during the late older years.

METHOD: This study used prospective data from 1,945 adults, 75 to 85 years old, collected over an 8-year period from the Health and Retirement Study. To examine inconsistent findings in the research literature, a latent trajectory class analysis was performed.

RESULTS: Multidimensional overall health trajectories showed three heterogeneous latent classes (maintaining, persistently high, and deteriorating), and profiles of ascribed and achieved socioeconomic characteristics of multidimensional health trajectory classes showed a significant social and racial/ethnic stratification in late older years.

DISCUSSION: Past adverse socioeconomic circumstances, including childhood and adulthood adversity, are potential sources of unobserved heterogeneity of multidimensional health trajectories even in late older years. The identification of members of latent trajectory health classes and the associated antecedents linked to health class membership are consistent with a life-course conceptual framework. Thus, multidimensional health capturing the full range of health problems needs to be investigated for proper examination of socioeconomic correlates of health. This facilitates the understanding of the associations between life-course experiences and health in late old age that ultimately have implications for prevention and intervention.

%B J Gerontol B Psychol Sci Soc Sci %I 68 %V 68 %P 290-7 %8 2013 Mar %G eng %U http://psychsocgerontology.oxfordjournals.org/content/68/2/290.full.pdf html %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23197341?dopt=Abstract %3 23197341 %4 health trajectories/health trajectories/Socioeconomic Differences/life Course/life Events/prevention/Public Policy/social Welfare %$ 69816 %R 10.1093/geronb/gbs111 %0 Report %D 2013 %T How Do the Changing Labor Supply Behavior and Marriage Patterns of Women Affect Social Security Replacement Rates? %A April Yanyuan Wu %A Nadia S. Karamcheva %A Alicia H. Munnell %A Patrick J. Purcell %K Adult children %K Employment and Labor Force %K Social Security %K Women and Minorities %X This paper seeks to determine the impact of the changing lives of women increased labor force participation/earnings and reduced marriage rates on Social Security replacement rates. First, our estimates, based on the Health and Retirement Study and Modeling Income in the Near Term, show that Social Security replacement rates have dropped sharply at both the household- and individual-level, and the decline will continue for future retirees. Our second finding is that this aggregate change masks a complex relationship between replacement rates and the marital status and income levels of individuals. The decline in replacement rates over time is largest for married couples with husbands whose earnings are in the top tercile. Decomposing the reasons for the overall decline shows that increases in the labor supply and earnings of women explain more than one-third of the change. In contrast, the impact of changing marital patterns is relatively small. Much of the remaining explanation rests with the increased Full Retirement Age and changing claiming behaviors. %I Chestnut Hill, MA, Center for Retirement Research at Boston College %G eng %4 women/labor force participation/marriage/social security/claiming behavior/claiming behavior %$ 999999 %0 Journal Article %J Social Security Bulletin %D 2013 %T How do trends in women's labor force activity and marriage patterns affect social security replacement rates? %A April Yanyuan Wu %A Nadia S. Karamcheva %A Alicia H. Munnell %A Patrick J. Purcell %K Adult children %K Employment and Labor Force %K Methodology %K Women and Minorities %X This article examines how women's increased labor force participation, increased earnings, and reduced marriage rates affect Social Security replacement rates over time. Based on data from the Health and Retirement Study and Modeling Income in the Near Term, our estimates show that Social Security replacement rates have dropped sharply at both the household and individual levels, and the declines will continue for future retirees. We also find that this aggregate change masks a complex relationship between replacement rates and the marital status and income levels of individuals. The decline in replacement rates over time is largest for married couples with husbands having higher earnings. Increases in the labor force activity and earnings of women explain more than one-third of the change. By contrast, the impact of changing marital patterns is relatively small. Changes to the full retirement age and the timing of benefit claiming explain much of the remaining decline. %B Social Security Bulletin %I 73 %V 73 %P 1-24 %G eng %N 4 %4 women/labor Force Participation/marriage/replacement rate %$ 999999 %0 Thesis %D 2013 %T Illness-related diabetes social support and glycemic control among middle aged and older adults %A Mondesir, Favel L. %Y White, Kellee %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Public Policy %K Women and Minorities %X Objective: The objective of this study is to investigate the association between illness-related diabetes social support (IRDSS) and glycemic control (GC) among a racially diverse sample of middle aged and older adults. In gender-stratified models we examine whether the relationship between IRDSS and GC is modified by race/ethnicity. Additionally, we explore the association between eight individual types of IRDSS and GC. Methods: We used the Health and Retirement Study (HRS) 2002 and the 2003 Diabetes Survey. The final analytic sample consisted of 914 study respondents. Gender-stratified multivariable logistic regression models were used to calculate odd ratios (ORs) and 95% confidence intervals (CIs) for the association between IRDSS and GC, test an interaction between race/ethnicity and IRDSS, and investigate the association between individual IRDSS variables and GC. Final models were adjusted for socio-demographic characteristics, lifestyle factors and clinical characteristics. Results: 79.5% and 76.7% of males and females respectively are classified as having adequate glycemic control. Among females, there was a significant association between IRDSS and GC (OR: 2.39; 95% CI: 1.44, 4.00), but no significant association was observed among males. There was a significant interaction between race/ethnicity and IRDSS (p-value < 0.10). Among Hispanic females, there was a higher odds (OR: 5.75; 95% CI: 1.01, 32.63) of adequate glycemic control in those who had high levels of IRDSS. The strongest association was found between high levels of emotional oriented social support and GC among females (OR=2.05; 95% CI: 1.18, 3.54). Conclusion: Our findings suggest that the relationship between IRDSS and GC varied by gender, where we only observed an association among females. Although we found a significant interaction between Hispanic race/ethnicity and IRDSS among females, our results should be interpreted with caution due to small sample sizes for the groups. We found that type of social support for self-care activities may play a role in achieving GC, where emotional support was most important. Further studies should aim at identifying factors which may determine gender differences in the association between IRDSS and GC. Race/ethnicity as an effect modifier of this association also needs further exploration in studies with larger sample sizes. %I University of South Carolina %C Columbia, SC %V 1544617 %P 84 %8 2013 %G English %U http://search.proquest.com.proxy.lib.umich.edu/docview/1438176454?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:kev:mtx:dissertat %9 M.S.P.H. %M 1438176454 %4 0766:Epidemiology %$ 999999 %! Illness-related diabetes social support and glycemic control among middle aged and older adults %0 Journal Article %J Nicotine Tob Res %D 2013 %T Impact of cigarette smoking on utilization of nursing home services. %A Kenneth E. Warner %A Ryan J McCammon %A Brant E Fries %A Kenneth M. Langa %K Age Factors %K Aged %K Aged, 80 and over %K Black or African American %K Cross-Sectional Studies %K Female %K Hispanic or Latino %K Humans %K Length of Stay %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Nursing homes %K Risk %K Self Report %K Smoking %K Socioeconomic factors %K United States %K White People %X

INTRODUCTION: Few studies have examined the effects of smoking on nursing home utilization, generally using poor data on smoking status. No previous study has distinguished utilization for recent from long-term quitters.

METHODS: Using the Health and Retirement Study, we assessed nursing home utilization by never-smokers, long-term quitters (quit >3 years), recent quitters (quit ≤3 years), and current smokers. We used logistic regression to evaluate the likelihood of a nursing home admission. For those with an admission, we used negative binomial regression on the number of nursing home nights. Finally, we employed zero-inflated negative binomial regression to estimate nights for the full sample.

RESULTS: Controlling for other variables, compared with never-smokers, long-term quitters have an odds ratio (OR) for nursing home admission of 1.18 (95% CI: 1.07-1.2), current smokers 1.39 (1.23-1.57), and recent quitters 1.55 (1.29-1.87). The probability of admission rises rapidly with age and is lower for African Americans and Hispanics, more affluent respondents, respondents with a spouse present in the home, and respondents with a living child. Given admission, smoking status is not associated with length of stay (LOS). LOS is longer for older respondents and women and shorter for more affluent respondents and those with spouses present.

CONCLUSIONS: Compared with otherwise identical never-smokers, former and current smokers have a significantly increased risk of nursing home admission. That recent quitters are at greatest risk of admission is consistent with evidence that many stop smoking because they are sick, often due to smoking.

%B Nicotine Tob Res %V 15 %P 1902-9 %8 2013 Nov %G eng %U http://ntr.oxfordjournals.org/content/early/2013/06/18/ntr.ntt079.abstract %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/23803394?dopt=Abstract %R 10.1093/ntr/ntt079 %0 Journal Article %J Annals of Economics and Finance %D 2013 %T The impact of house price movements on non-durable goods consumption of older households %A Shenyi Jiang %A Wei Sun %A Anthony Webb %K Net Worth and Assets %X Using Health and Retirement Study (HRS) data, we create a new, up-to-date panel dataset to investigate the impact of house price movements on the non-durable goods consumption of older households. We find that older homeowners respond asymmetrically when experiencing house price gains and house price losses. More specifically, they increase total non-durable goods expenditure when house prices appreciate, but fail to reduce consumption when house prices fall. %B Annals of Economics and Finance %I 14 %V 14 %P 491-510 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84874026500andpartnerID=40andmd5=9b24de128cf6ceeaf4346ecc7151389a %N 2 %4 House price fluctuations/Household consumption/Asset accumulation %$ 69150 %0 Journal Article %J Advances in Life Course Research %D 2013 %T The influence of working later in life on memory functioning %A Kandauda Wickrama %A Catherine W. O'Neal %K Employment and Labor Force %K Health Conditions and Status %X This article examines the influence of work status on subsequent memory trajectories in later years. Using a subsample of 8165 older adults who participated in the Health and Retirement Study and were 65 years or older in 2002, we examined work status and memory functioning after controlling for age and demographic characteristics. In growth curve analyses, work status predicted the rate of immediate memory decline from 2002 to 2006 with full-time employed individuals showing less immediate memory decline after controlling for age. However, work status categories were not associated with subsequent age-adjusted delayed memory trajectories. The findings from these growth curve analyses support the hypothesis that working late in life helps to impede immediate memory declines that often occur in later years. %B Advances in Life Course Research %I 18 %V 18 %P 288-295 %G eng %N 4 %4 Employment/Memory/Impairment/Impairment/memory trajectories/labor Force Participation %$ 69362 %R 10.1016/j.alcr.2013.09.001 %0 Journal Article %J Population Research and Policy Review %D 2013 %T Leaving Retirement: Age-Graded Relative Risks of Transitioning Back to Work or Dying %A Ben Lennox Kail %A David F Warner %K Employment and Labor Force %K Health Conditions and Status %K Methodology %K Public Policy %K Retirement Planning and Satisfaction %K Risk Taking %X Demographic research has documented the age-graded risk of returning to work after a period of retirement; few studies, however, have disaggregated this risk into the different forms work takes in later life. Moreover, prior research has not explored the age-graded risk of re-retiring after reentry. This study uses the 1992-2008 Health and Retirement Study to first examine the age-graded and duration dependent risks of transitioning to full-time work, part-time work, and mortality from full retirement. Second, this study documents the age-graded duration of reemployment, and the age-graded risk of re-retiring. Results from multi-decrement life tables indicate reemployment both occurs more frequently and lasts longer than previously estimated. The gender differences in risk of reemployment are modest, although women are at greater risk of returning to part-time work, whereas men are at greater risk of returning to full-time work. Additionally, retirees from services-producing industries are at lower risk of transitioning to work, but greater risks of mortality, suggesting retirement is a less permanent feature in the life course of retirees from goods-producing industries. Finally, the results suggest Social Security benefit eligibility plays a part in reducing reentry at later ages. %B Population Research and Policy Review %I 32 %V 32 %P 159-182 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1317152105?accountid=14667 %N 2 %4 Mortality/Labor Force Participation/Social policy/Employment/Retirement planning/Risk tolerance/Retirees/Economic conditions/forecasts/Older workers %$ 68994 %R http://dx.doi.org/10.1007/s11113-012-9256-3 %0 Report %D 2013 %T Level-of-Effort Paradata and Nonresponse Adjustment Models for a National Face-to-Face Survey %A James Wagner %A Valliant, Richard %A Hubbard, Frost %A Jiang, Charley %K Bias %K Data collection %K Meta-analyses %K Sample weight %K Survey Methodology %X Survey samples are designed to produce unbiased estimates. Unfortunately, nonresponse may lead to bias if the responders and nonresponders are different with respect to the survey variables. One common approach to addressing nonresponse after data collection has been completed is to differentially weight responding cases such that the respondents match the full sample on the selected characteristics. The selection of the characteristics is a modeling step that assumes that conditional upon the selected characteristics, responders and nonresponders are equivalent. This method is known as nonresponse weighting. The method relies upon having data available for the entire sample that predicts both response and the survey variables themselves. These data can come from either the sampling frame or from paradata (Couper, 1998; Couper and Lyberg, 2005), that is, from process data created during data collection. If the available data are only useful for predicting response and not for predicting the survey variables, then adjustments based upon these data can only add noise to estimates. This is true even when the true probability of responding is known. In practice, the true probability is never known and estimates of it have associated sampling error and, possibly, misspecification error which may also add noise to estimates. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %8 08/2013 %G eng %0 Journal Article %J Journal of Risk and Insurance %D 2013 %T The Life Care Annuity: A New Empirical Examination of an Insurance Innovation That Addresses Problems in the Markets for Life Annuities and Long-Term Care Insurance %A Brown, Jason %A Mark J. Warshawsky %K Disabilities %K Health Conditions and Status %K Insurance %K Medicare/Medicaid/Health Insurance %K Net Worth and Assets %X The integration of the life annuity with long-term care insurance coverage is intended to deal with major problems in the currently separate markets for life annuities and long-term care insurance. The integration would allow the inclusion of most of the population currently rejected by underwriting those in poor health or lifestyles but who would not go immediately into long-term care claim who also have lower life expectancies. We make use of the Health and Retirement Study, on individuals in retirement and their disability incidence, exploiting the panel nature of the survey to estimate transition probabilities in and out of disability states according to numerous demographic and health characteristics. This allows for analysis of disability and mortality risk across a number of dimensions. We find that different risk groups at age 65 have similar projected long-term care expenses, but that the level-periodic-premium structure of most long-term care insurance policies creates incentives for individuals to separate into different risk pools according to observable characteristics, justifying the underwriting observed on the market. Yet we also find that gender-rated life care annuities could succeed in pooling risks currently segmented in the market for long-term care insurance, thus qualifying individuals at or near retirement for permanent long-term care insurance coverage who do not currently qualify, and allowing for life annuities to be purchased more cheaply than in the stand-alone annuity market now subject to adverse selection. %B Journal of Risk and Insurance %I 80 %V 80 %P 677-704 %G eng %N 3 %4 long term care insurance/Annuities/mortality risk/mortality risk/disability/disability/Insurance %$ 69124 %R 10.1111/j.1539-6975.2013.12013.x %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2013 %T Longer lived parents: protective associations with cancer incidence and overall mortality. %A Ambarish Dutta %A Henley, William %A Robine, Jean-Marie %A Kenneth M. Langa %A Robert B Wallace %A David Melzer %K Aged %K Aged, 80 and over %K Female %K Humans %K Incidence %K Longevity %K Male %K Middle Aged %K Mortality %K Neoplasms %K Parents %X

BACKGROUND: Children of centenarians have lower cardiovascular disease prevalence and live longer. We aimed to estimate associations between the full range of parental attained ages and health status in a middle-aged U.S. representative sample.

METHODS: Using Health and Retirement Study data, models estimated disease incidence and mortality hazards for respondents aged 51-61 years at baseline, followed up for 18 years. Full adjustment included sex, race, smoking, wealth, education, body mass index, and childhood socioeconomic status. Mother's and father's attained age distributions were used to define short-, intermediate-, and long-lived groups, yielding a ranked parental longevity score (n = 6,055, excluding short-long discordance). Linear models (n = 8,340) tested mother's or father's attained ages, adjusted for each other.

RESULTS: With increasing mother's or father's survival (>65 years), all-cause mortality declined 19% (hazard ratio [HR] = 0.81, 95% CI: 0.76-0.86, p < .001) and 14% per decade (HR = 0.87, 95% CI: 0.81-0.92, p < .001). Estimates changed only modestly when fully adjusted. Parent-in-law survival was not associated with mortality (n = 1,809, HR = 1.00, 95% CI: 0.90-1.12, p = .98). Offspring with one or two long-lived parents had lower cancer incidence (938 cases, HR per parental longevity score = 0.76, 95% CI: 0.61-0.94, p = .01) versus two intermediate parents. Similar HRs for diabetes (HR = 0.89, 95% CI: 0.84-0.96, p = .001), heart disease (HR = 0.88, 95% CI: 0.82-0.93, p < .001), and stroke (HR = 0.86, 95% CI: 0.78-0.95, p = .002) were significant, but there was no trend for arthritis.

CONCLUSIONS: The results provide the first robust evidence that increasing parental attained age is associated with lower cancer incidence in offspring. Health advantages of having centenarian parents extend to a wider range of parental longevity and may provide a quantitative trait of slower aging.

%B J Gerontol A Biol Sci Med Sci %I 68 %V 68 %P 1409-18 %8 2013 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/23685624?dopt=Abstract %4 Family History/Parental Longevity/Cancer/Cardiovascular Disease/Centenarian/Lower Risk/Biomarkers %$ 999999 %R 10.1093/gerona/glt061 %0 Report %D 2013 %T Medicaid Spend Down: Implications for Long-Term Services and Supports and Aging Policy %A Joshua M Wiener %A Anderson, Wayne L. %A Khatutsky, Galina %A Kaganova, Yevgeniya %A Janet O'Keeffe %K Healthcare %K Medicare/Medicaid/Health Insurance %K Other %K Public Policy %X Medicaid provides an important safety net for people who are poor or become poor, either because of the high costs of health and long-term services and supports, or for other reasons. The transition from non-Medicaid to Medicaid status can be difficult, especially since it is often associated with illness, disability, and declining income and assets. The high cost of long-term services and supports results in catastrophic out-of-pocket costs for many people needing services, some of whom spend down to Medicaid. For people who have been independent all of their lives, transitioning to Medicaid means depending on a means-tested welfare program for their health and long-term services and supports. Moreover, spending for people transitioning to Medicaid is a substantial portion of state Medicaid expenditures. This study examines transitions to Medicaid eligibility or Medicaid spend down by people age 50 and older over a 12-year period. Data for this study come from the 1996 to 2008 waves of the Health and Retirement Study, which has been merged with Medicare data to help establish Medicaid eligibility. %I Long Beach, CA, The SCAN Foundation %G eng %4 Medicaid/Long Term Care/eligibility/spend down/Medicare/out of pocket costs/Public Policy %$ 69308 %0 Journal Article %J Journal of Global Health Care Systems %D 2013 %T Medicare HMO coverage selection and its impact on the accumulated health spending over the first four years of Medicare coverage in the US %A Yi-Sheng Chao %A Chao-Jung Wu %K Healthcare %K Medicare/Medicaid/Health Insurance %K Methodology %X Introduction: this study aims 1) to determine the association between individual characteristics before Medicare coverage (pre-Medicare) and the selection into Medicare HMOs (health maintenance organizations) and 2) to quantify the financial impact of Medicare HMO coverage on total and out-of-pocket (OOP) health spending in the first four years of Medicare coverage. Methods: individuals eligible for Medicare because of age in the Health and Retirement Study from 1992 to 2008 were chosen. Individuals interviewed from age 65 to 68 years were included. Pre-Medicare characteristics were used to predict the propensity of selecting into Medicare HMOs and adjust its effect on health spending as well as to quantify the financial impact of Medicare HMO coverage in the first four years, compared to traditional Medicare from 1992 to 2008. There were 1,841 and 4,126 eligible Medicare enrollees included in total and OOP spending models. Results: The pre-Medicare characteristics that were significantly associated with selection into Medicare HMOs included blacks, Hispanic origin, regions of residence and pre-Medicare health plans. The results showed that the average HMO effect on total spending was insignificant, 2,651.0 less than the traditional Medicare plans (SE = 3,761.2, p = 0.46). The saving on OOP spending was significantly 1,411.5 (SE = 620.8, p = 0.03). Conclusion: the HMOs provide better financial protection in OOP health spending for Medicare enrollees in the first four years of Medicare coverage. However, this effect is not significant for total spending. %B Journal of Global Health Care Systems %I 3 %V 3 %P 2 %G eng %4 Medicare/Biased selection/HMO (health maintenance organization)/Propensity score matching/Out of pocket costs/health maintenance organization (hmo) %$ 69274 %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 Thesis %D 2013 %T Multivariate fractional response models in a panel setting with an application to portfolio allocation %A Carlton, Michael Anthony %Y Wooldridge, Jeffrey M. %K Methodology %K Net Worth and Assets %X Several papers use subjective survival probabilities as a measure of mortality risk in studying economic behavior. The first chapter "Wealth Holdings, Asset Allocation and Mortality: A Test of the Information Content of Subjective Survival Probabilities" studies whether subjective survival probability measures contain any additional information that can explain differential wealth holdings and asset allocation among households. We find some evidence that survival probabilities can explain differences in household wealth holding and allocation once we control for other factors that affect decision-making. We also find that the estimated impact of subjective survival is sensitive to the inclusion of reported survival probabilities of one. Some fractional response variables, like the proportion of financial wealth allocated across multiple assets, must satisfy an adding up restriction. In the second chapter "A Model for Multivariate Fractional Responses with an Application to Asset Allocation", we develop a twostep procedure where we estimate a model with multiple fractional response variables exploiting the fact that these variables sum to one in each period and are correlated over time. The first step entails estimation of the multivariate fractional responses using the multinomial quasi-likelihood function which explicitly imposes the adding-up restriction and the second step uses the Classical Minimum Distance estimator to account for serial correlation. Many panel data estimators implicitly assume that we have a balanced panel at our disposal. Unfortunately this is rarely the case and dropping observations is an unsatisfactory solution to the problem. Estimation of fractional responses in a panel requires assumptions about the distribution of the unobserved effect and its relationship with observables, which requires special treatment in an unbalanced panel. In the third chapter, "Estimation of a Multivariate Fractional Response Model with Unbalanced Panel Data", we extend the approach in Wooldridge (2010) to the case of multiple fractional responses and apply this to unbalanced panel data on the allocation of financial wealth across several assets. %I Michigan State University %V 3558362 %P 131 %8 2013 %G English %9 Ph.D. %M 1348915867 %4 Economics %$ 69226 %! Multivariate fractional response models in a panel setting with an application to portfolio allocation %0 Journal Article %J Health and place %D 2013 %T Neighborhood racial residential segregation and changes in health or death among older adults %A Joseph J Sudano %A Perzynski, Adam %A Wong, David W. %A Colabianchi, Natalie %A Litaker, David %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Public Policy %K Women and Minorities %X We assessed relationships between neighborhood racial residential segregation (RRS), individual-level health declines and mortality using Health and Retirement Study data. We calculated the census-tract level Location Quotient for Racial Residential Segregation (LQRRS), and estimated adjusted relative risks (ARR) of LQRRS for declines in self-reported health or death 1992-2000, controlling for individual-level characteristics. Of 6653 adults, 3333 lived in minimal, 2242 in low, 562 in moderate, and 516 in high LQRRS tracts in 1992. Major decline/death rates were: 18.6 , 25.2 , 33.8 and 30.4 in minimal, low, moderate and high tracts, respectively. Adjusting for demographic characteristics, residence in low, moderate and high LQRRS census tracts was associated with greater likelihood of major decline/death compared to minimal LQRRS. Controlling for all variables, only moderate LQRRS predicted major decline/death, ARR=1.31 (95 CI 1.07, 1.59; p .05). %B Health and place %I 19 %V 19 %P 80 %G eng %4 Segregation/Residential Segregation/Location Quotient for Racial Residential Segregation/Contextual effects/Health status/Census tracts/Health disparities/Mortality/public Policy/Public health %$ 69754 %0 Report %D 2013 %T New Measures of Fluid Intelligence in the HRS %A Gwenith G Fisher %A John J McArdle %A Ryan J McCammon %A Amanda Sonnega %A David R Weir %K Health Conditions and Status %K Methodology %X This user guide describes how measures designed to test quantitative reasoning, verbal reasoning and verbal fluency were implemented in the 2010 and 2012 waves of the Health and Retirement Study. The Number Series test and Retrieval Fluency test were administered in the 2010 and 2012 waves of HRS to the full sample. The Verbal Analogies test was administered to a 10 percent random sample of the full HRS sample in 2012. Number Series measures quantitative reasoning, a specific type of fluid cognitive ability or fluid intelligence. Quantitative reasoning ability involves reasoning with concepts that depend upon mathematical relationships. The number series task requires the respondent to look at a series of numbers with a number missing from the series. The respondent must determine the numerical pattern and then provide the missing number in the series. Retrieval Fluency measures an aspect of long-term retrieval : fluency of retrieval from stored knowledge. It was first incorporated in the HRS in the 2010 wave . This test is a typical neuropsychology test and was adapted by McArdle and Woodcock from the WJ-III Tests of Achievement: Retrieval Fluency ( Riverside Publishing). The measure consisted of a single item in which respondents were asked to name as many animals as they could within a 60-second time limit. This measure is consistent with animal fluency measures commonly administered in other neuropsychological exams (e.g., the CERAD animal fluency measure; Morris et al., 1989) . Administration protocols, test scoring, and data quality review procedures are discussed for each measure. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 Quantitative Reasoning/Verbal Reasoning/Verbal Fluency/Cognition/Cognitive ability/survey Methods %$ 69092 %0 Journal Article %J Developmental Psychology %D 2013 %T Parental educational attainment and sense of control in mid- and late-adulthood %A Ward, Michael M. %K Adult children %K Demographics %K Event History/Life Cycle %K Healthcare %X Sense of control is greater among children who grow up in households of higher socioeconomic status. It is unclear if this childhood advantage persists throughout life or if schooling and adulthood experiences override any early childhood advantage. Using data from 2 nationally representative samples of primarily middle-aged (National Survey of Midlife Development in the United States, or MIDUS), and older adults (Health and Retirement Study, or HRS), I tested if personal mastery and perceived constraints in adulthood were associated with the educational attainment of the participant's father or mother, adjusting for participant's education level, income, and other demographic characteristics. In both samples, personal mastery was not associated with either parent's education level, but perceived constraints had a graded inverse association with mother's education level. These results indicate that childhood experiences continue to be associated with perceived constraints, even in later life, and may not be completely overridden by adult experiences. PUBLICATION ABSTRACT %B Developmental Psychology %I 49 %V 49 %P 1407-1412 %G eng %N 7 %4 Psychology/Educational attainment/Parent educational background/Parent socioeconomic status/Demographics/Child development %$ 69060 %R 10.1037/a0029557 %0 Journal Article %J JAMA %D 2013 %T Predicting 10-year mortality for older adults. %A Cruz, Marisa %A Kenneth E Covinsky %A Eric W Widera %A Stijacic-Cenzer, Irena %A Sei J. Lee %K Aged %K Aged, 80 and over %K Cohort Studies %K Female %K Forecasting %K Humans %K Kaplan-Meier Estimate %K Life Expectancy %K Male %K Middle Aged %K Mortality %K Risk Assessment %K United States %B JAMA %I 309 %V 309 %P 874-6 %8 2013 Mar 06 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/23462780?dopt=Abstract %2 PMC3760279 %4 mortality/cancer screening/Diabetes/glycemic control/glycemic control/preventive interventions %$ 69310 %R 10.1001/jama.2013.1184 %0 Report %D 2013 %T Psychosocial and Lifestyle Questionnaire 2006 - 2010: Documentation Report %A Jacqui Smith %A Gwenith G Fisher %A Lindsay H Ryan %A Philippa J Clarke %A House, Jim %A David R Weir %K Data collection %K Meta-analyses %K Psychosocial %K Question Characteristics %X In 2004, HRS piloted a new feature for data collection in the form of self-administered questionnaires that were left with respondents upon the completion of an in-person Core Interview. Since 2006, this mode of data collection has been utilized to obtain information about participants' evaluations of their life circumstances, subjective wellbeing, and lifestyle. This psychosocial information is obtained in each biennial wave from a rotating (random) 50% of the core panel participants who complete the enhanced face-to-face interview (EFTF). Longitudinal data will be available at four-year intervals: the 2010 wave provides the first longitudinal psychosocial data from the 2006 participants. Some longitudinal data is also available for the 2004 participants in subsequent waves. Electronic versions of the HRS Participant (Psychosocial) Lifestyle Questionnaires used in the 2004 pilot, and the 2006, 2008, and 2010 waves are available on the HRS website (Documentation/Questionnaires - scroll down to the end of the Biennial Content to Psychosocial - Section LB). Because the questionnaire was left with respondents at the end of the EFTF interview for them to complete and mail back to study offices, the questionnaire came to be known and is referred to on the HRS website as the LeaveBehind (LB). We use the terms Participant Lifestyle Questionnaire and Leave-Behind (or LB) in this report to refer to the self-administered psychosocial data collection. %I Survey Research Center, Institute for Social Research, University of Michigan %C Ann Arbor %P 62 %8 02/2013 %G eng %1 This has been replaced by a newer version of this report: https://hrs.isr.umich.edu/publications/biblio/9066 %0 Journal Article %J PloS one %D 2013 %T Relationships of Disability with Age Among Adults Aged 50 to 85: Evidence from the United States, England and Continental Europe %A Morten Wahrendorf %A Reinhardt, Jan D. %A Johannes Siegrist %K Cross-National %K Disabilities %K ELSA %K Net Worth and Assets %K SHARE %X Objectives: To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions. Methods: We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity). Results: Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA. Conclusions: This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability. %B PloS one %I 8 %V 8 %G eng %N 8 %4 ELSA_/SHARE/cross-national comparison/disability/disability/wealth %$ 69196 %R 10.1371/journal.pone.0071893 %0 Journal Article %J Public Finance Review %D 2013 %T Retiree Health Benefits as Deferred Compensation: Evidence from the Health and Retirement Study %A J. Marton %A Stephen A. Woodbury %K Income %K Medicare/Medicaid/Health Insurance %K Pensions %K Public Policy %K Retirement Planning and Satisfaction %X Are early retiree health benefits (RHBs) a form of deferred compensation binding workers to an employer? Most employers who offer RHBs offer them only to workers who have ten or more years of tenure and have reached age fifty-five. Accordingly, workers in firms offering RHBs have an incentive to stay with a firm in the years before they attain eligibility for RHBs, and a greater incentive than otherwise to retire thereafter. The authors test for such a pattern of incentives by examining the age-specific relationship between workers' eligibility for RHBs and retirement. The findings suggest that workers in RHB-offering firms are less likely to retire at ages fifty and fifty-one than similar RHB-ineligible workers. Also, RHB-eligible workers aged sixty and sixty-one are more likely to retire than similar RHB-ineligible workers. These results are consistent with RHBs acting as part of a delayed payment contract of the kind described by Lazear. The Author(s) 2012. %B Public Finance Review %I 41 %V 41 %P 64-91 %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84870787886andpartnerID=40andmd5=c08987ab242cd92a5c017e380d8602dc %N 1 %4 compensation methods/deferred compensation/employee benefits/health insurance/retirement planning/early Retirement/tax subsidies %$ 69170 %R 10.1177/1091142112449375 %0 Thesis %D 2013 %T Rural African American grandmothers raising grandchildren: The impact of chronic illness %A Woods, Tamara M. %Y Daines, Andrea %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %K Women and Minorities %X The purpose of this qualitative phenomenological study was to explore the experiences of eight African American grandmothers residing in rural North Carolina caring for their grandchildren, while suffering from chronic health issues. The research questions for this study are as follows: (1. What is the perceived impact of chronic health issues on African American grandmothers raising their grandchildren in rural North Carolina? (2. How do grandmothers who reside in rural communities describe how their health issues have impacted their ability to care for their grandchild? (3. Do perceptions of social support and life transitions impact grandmother's health? The research examined the health, physical functioning, well-being, social support, and resources of these grandmothers. Family development theory and Wellness theory formed the theoretical frameworks for understanding the impact of the health issues on these grandmothers. The grandmothers reported challenges and needs which included their own health issues, financial difficulties, limited support, transportation difficulties, and childcare concerns. A major finding was that the grandmother's health did not negatively impact their ability to care for their grandchildren. Developing health education programs and other formal supports which focus on the health of the grandmothers, their financial difficulties, transportation needs, respite, and childcare may help address grandmother's perceptions of their changing health and level of community and social support. %I Capella University %C Minneapolis, MN %V 3605171 %P 138 %8 2013 %G English %U http://search.proquest.com.proxy.lib.umich.edu/docview/1477862228?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:kev:mtx:dissertat %9 Ph.D. %M 1477862228 %4 0493:Aging %$ 999999 %! Rural African American grandmothers raising grandchildren: The impact of chronic illness %0 Journal Article %J The Journals of Gerontology %D 2013 %T Is Self-Rated Health Comparable Between Non-Hispanic Whites and Hispanics? Evidence From the Health and Retirement Study %A Su, Dejun %A Wen, Ming %A Kyriakos S Markides %K Demographics %K Health Conditions and Status %K Methodology %K Retirement Planning and Satisfaction %K Women and Minorities %X Using subsequent all-cause mortality as a yardstick for retrospective health, this study assessed the comparability of self-rated health (SRH) between non-Hispanic whites and Hispanics. Based on longitudinal data from 6,870 white and 886 Hispanic respondents aged between 51 and 61 in the 1992 Health and Retirement Study, we related SRH in 1992 to risk of mortality in the 1992-2008 period. Logit models were used to predict white-Hispanic differences in reporting fair or poor SRH. Survival curves and cox proportional hazard models were estimated to assess whether and the extent to which the SRH-mortality association differs between non-Hispanic whites and Hispanics. Hispanic respondents reported worse SRH than whites at the baseline, yet they had similar risk of mortality as whites in the 1992-2008 period. Overall, Hispanics rated their health more pessimistically than whites. This was especially the case for Hispanics who rated their health fair or poor at the baseline, whereas their presumed health conditions, as reflected by subsequent risk of mortality, should be considerably better than their white counterparts. Health disparities between whites and Hispanics aged between 51 and 61 will be overestimated if the assessment has been solely based on differences in SRH between the two groups. Findings from this study call for caution in relying on SRH to quantify and explain health disparities between non-Hispanic whites and Hispanics in the United States. %B The Journals of Gerontology %I 68 %V 68 %P 622 %G eng %N 4 %4 survival curves/Personal health/Whites/Hispanics/Mortality/Retirement/Self assessed health %$ 69064 %0 Journal Article %J International Journal of Behavioral Medicine %D 2013 %T Sense of Control and Self-Reported Health in a Population-Based Sample of Older Americans: Assessment of Potential Confounding by Affect, Personality, and Social Support %A Ward, Michael M. %K Adult children %K Health Conditions and Status %K Healthcare %K Methodology %K Other %X Sense of control has been linked to improved health outcomes, but it is unclear if this association is independent of other psychosocial factors. The aim of this study is to test the strength of association between sense of control and self-reported health after adjustment for positive and negative affect, Big 5 personality factors, and social support. Data on sense of control (measured by personal mastery, perceived constraints, and a health-specific rating of control), affect, personality, social support, and two measures of self-reported health (global rating of fair or poor health and presence of functional limitations) were obtained on 6,891 participants in the Health and Retirement Study, a population-based survey of older Americans. The cross-sectional association between sense of control measures and each measure of self-reported health was tested in hierarchical logistic regression models, before and after adjustment for affect, personality, and social support. Participants with higher personal mastery were less likely to report fair/poor health (odds ratio 0.76 per 1-point increase) while those with higher perceived constraints were more likely to report fair/poor health (odds ratio 1.37 per 1-point increase). Associations remained after adjustment for affect, but adjustment for affect attenuated the association of personal mastery by 37 and of perceived constraints by 67 . Further adjustment for personality and social support did not alter the strength of association. Findings were similar for the health-specific rating of control, and for associations with functional limitations. Sense of control is associated with self-reported health in older Americans, but this association is partly confounded by affect. %B International Journal of Behavioral Medicine %I 20 %V 20 %P 140-7 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1288990847?accountid=14667 %N 1 %4 Social support/Personality traits/Psychology/Self assessed health/methodology/psychosocial/Sense of control %$ 68998 %R 10.1111/ j.2044-8287.2011.02055.x. 10.1093/geronb/gbr072. http://dx.doi.org/10.1007/s12529-011-9218-x %0 Journal Article %J J Am Geriatr Soc %D 2013 %T Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset. %A Benjamin D Capistrant %A Qianyi Wang %A Sze Y Liu %A M. Maria Glymour %K Activities of Daily Living %K Age of Onset %K Aged %K Aged, 80 and over %K Bayes Theorem %K Disability Evaluation %K Disabled Persons %K Female %K Follow-Up Studies %K Geriatric Assessment %K Humans %K Male %K Middle Aged %K Morbidity %K Prospective Studies %K Risk Assessment %K Risk Factors %K Socioeconomic factors %K Stroke %K Stroke Rehabilitation %K Survival Rate %K Survivors %K Time Factors %K United States %X

OBJECTIVES: To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke.

DESIGN: Prospective, observational study.

SETTING: Community-dwelling Health and Retirement Study (HRS) cohort.

PARTICIPANTS: HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441).

MEASUREMENTS: Strokes were assessed using self- or proxy-report of a doctor's diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates.

RESULTS: Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards.

CONCLUSION: In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.

%B J Am Geriatr Soc %I 61 %V 61 %P 931-938 %8 2013 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/23668393?dopt=Abstract %4 Gerontology And Geriatrics/ADL and IADL Impairments/Stroke/Self assessed health/risk Factors %$ 69008 %R 10.1111/jgs.12270 %0 Journal Article %J Demography %D 2013 %T Trends in late-life activity limitations in the United States: an update from five national surveys. %A Vicki A Freedman %A Brenda C Spillman %A Patricia Andreski %A Jennifer C. Cornman %A Eileen M. Crimmins %A Kramarow, Ellen %A Lubitz, James %A Linda G Martin %A Sharon S. Merkin %A Robert F. Schoeni %A Teresa Seeman %A Timothy A Waidmann %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disabled Persons %K Female %K Health Surveys %K Humans %K Male %K Mobility Limitation %K Models, Statistical %K United States %X

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

%B Demography %I 50 %V 50 %P 661-71 %8 2013 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23104207?dopt=Abstract %2 PMC3586750 %4 methodology/Meta-analysis/ADL and IADL Impairments/Public Policy/health Care Costs/PREVALENCE %$ 68982 %R 10.1007/s13524-012-0167-z %0 Journal Article %J J Epidemiol Community Health %D 2013 %T Urban neighbourhood unemployment history and depressive symptoms over time among late middle age and older adults. %A Richard G Wight %A Carol S Aneshensel %A Barrett, Christopher %A Michelle J Ko %A Joshua Chodosh %A Arun S Karlamangla %K Age Factors %K depression %K Female %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Multilevel Analysis %K Residence Characteristics %K Retirement %K Risk Factors %K Socioeconomic factors %K Stress, Psychological %K Surveys and Questionnaires %K Time Factors %K Unemployment %K United States %K Urban Population %X

BACKGROUND: Little is known about how a neighbourhood's unemployment history may set the stage for depressive symptomatology. This study examines the effects of urban neighbourhood unemployment history on current depressive symptoms and subsequent symptom trajectories among residentially stable late middle age and older adults. Contingent effects between neighbourhood unemployment and individual-level employment status (ie, cross-level interactions) are also assessed.

METHODS: Individual-level survey data are from four waves (2000, 2002, 2004 and 2006) of the original cohort of the nationally representative US Health and Retirement Study. Neighbourhoods are operationalised with US Census tracts for which historical average proportion unemployed between 1990 and 2000 and change in proportion unemployed between 1990 and 2000 are used to characterise the neighbourhood's unemployment history. Hierarchical linear regressions estimate three-level (time, individual and neighbourhood) growth models.

RESULTS: Symptoms in 2000 are highest among those residing in neighbourhoods characterised by high historical average unemployment beginning in 1990 and increasing unemployment between 1990 and 2000, net of a wide range of socio-demographic controls including individual-level employment status. These neighbourhood unemployment effects are not contingent upon individual-level employment status in 2000. 6-year trajectories of depressive symptoms decrease over time on average but are not significantly influenced by the neighbourhood's unemployment history.

CONCLUSIONS: Given the current US recession, future studies that do not consider historical employment conditions may underestimate the mental health impact of urban neighbourhood context. The findings suggest that exposure to neighbourhood unemployment earlier in life may be consequential to mental health later in life.

%B J Epidemiol Community Health %I 67 %V 67 %P 153-8 %8 2013 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22918896?dopt=Abstract %2 PMC3681821 %4 Depressive Symptoms/depression/neighborhood Characteristics/employment status/mental Health/labor Force Participation/Socioeconomic Factors/Great Recession %$ 69198 %R 10.1136/jech-2012-201537 %0 Journal Article %J Ageing and Society %D 2013 %T Why are the oldest old less generous? Explanations for the unexpected age-related drop in charitable giving %A Wiepking, Pamala %A Russell N. James III %K Adult children %K Demographics %K Health Conditions and Status %X Previous research has demonstrated that the generally positive relationship between age and the presence of charitable giving becomes negative at the oldest ages. We investigate potential causes of this drop in charitable giving among the oldest old including changes in health, cognition, egocentric networks, religious attendance, and substitution of charitable bequest planning. A longitudinal analysis of data from the United States Health and Retirement Survey indicates that the drop in charitable giving is mediated largely by changes in the frequency of church attendance, with only modest influences from changes in health and cognition. %B Ageing and Society %I 33 %V 33 %P 486-510 %G eng %N 3 %4 Oldest old people/Altruism/charitable giving/Donations/church Membership %$ 68980 %R 10.1017/S0144686X12000062 %0 Journal Article %J BMC Public Health %D 2013 %T Work stress and depressive symptoms in older employees: impact of national labour and social policies. %A Lunau, T. %A Morten Wahrendorf %A Dragano, N. %A Johannes Siegrist %K depression %K Employment %K Europe %K Female %K Humans %K Male %K Middle Aged %K Psychiatric Status Rating Scales %K Public Policy %K Risk Factors %K Stress, Psychological %K Surveys and Questionnaires %X

BACKGROUND: Maintaining health and work ability among older employees is a primary target of national labour and social policies (NLSP) in Europe. Depression makes a significant contribution to early retirement, and chronic work-related stress is associated with elevated risks of depression. We test this latter association among older employees and explore to what extent indicators of distinct NLSP modify the association between work stress and depressive symptoms. We choose six indicators, classified in three categories: (1) investment in active labour market policies, (2) employment protection, (3) level of distributive justice.

METHODS: We use data from three longitudinal ageing studies (SHARE, HRS, ELSA) including 5650 men and women in 13 countries. Information on work stress (effort-reward imbalance, low work control) and depressive symptoms (CES-D, EURO-D) was obtained. Six NLSP indicators were selected from OECD databases. Associations of work stress (2004) with depressive symptoms (2006) and their modification by policy indicators were analysed using logistic multilevel models.

RESULTS: Risk of depressive symptoms at follow-up is higher among those experiencing effort-reward imbalance (OR: 1.55 95% CI 1.27-1.89) and low control (OR: 1.46 95% CI 1.19-1.79) at work. Interaction terms indicate a modifying effect of a majority of protective NLSP indicators on the strength of associations of effort - reward imbalance with depressive symptoms.

CONCLUSIONS: Work stress is associated with elevated risk of prospective depressive symptoms among older employees from 13 European countries. Protective labour and social policies modify the strength of these associations. If further supported findings may have important policy implications.

%B BMC Public Health %I 13 %V 13 %P 1086 %8 2013 Nov 21 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/24256638?dopt=Abstract %4 Cross-national study/Demand-control/Depressive symptoms/Effort-reward imbalance/Labour and social policies/Work stress %$ 999999 %R 10.1186/1471-2458-13-1086 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2013 %T Is working later in life good or bad for health? An investigation of multiple health outcomes. %A Kandauda Wickrama %A Catherine W. O'Neal %A Kyung H. Kwag %A Lee, Tae K. %K Activities of Daily Living %K Age Factors %K Aged %K depression %K Educational Status %K Employment %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Memory, Short-Term %K Middle Aged %K Neuropsychological tests %K Psychiatric Status Rating Scales %K Sex Factors %X

OBJECTIVES: To examine the mutual influences between changes in work status and multiple dimensions of health outcomes (immediate memory, physical disability, and depressive symptoms) over later years.

METHODS: We used a subsample of 8,524 older adults who participated in the Health and Retirement Study from 1998 to 2008 and were 62 years or older in 1998 to examine work status and health outcomes after controlling for age and background characteristics.

RESULTS: We present results of cross-lagged auto-regressive models. Work status (level of work) predicted subsequent residual changes in immediate memory over time, whereas immediate memory predicted subsequent residual changes in work status over time, even after controlling for physical disability and depressive symptoms. Similar results were indicated for the associations between work status and physical disability and depressive symptoms over time.

DISCUSSION: Consistent with social causation and social selection traditions, the findings support bi-directional associations among changes in work status (the level of work), immediate memory, physical disability, and depressive symptoms in later years. Practical implications are discussed.

%B J Gerontol B Psychol Sci Soc Sci %I 68 %V 68 %P 807-15 %8 2013 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/23887930?dopt=Abstract %4 Medical Sciences--Psychiatry And Neurology/Employment/Older people/Personal health/Mental depression/Gerontology/Disability/Disability/Memory %$ 69094 %R 10.1093/geronb/gbt069 %0 Journal Article %J Journal of Manipulative & Physiological Therapeutics %D 2012 %T Chiropractic episodes and the co-occurrence of chiropractic and health services use among older Medicare beneficiaries. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Kaskie, Brian %A Frederic D Wolinsky %K Age Factors %K Aged %K Aged, 80 and over %K Chiropractic %K Combined Modality Therapy %K Episode of Care %K Female %K Geriatric Assessment %K Health Care Surveys %K Health Services %K Humans %K Incidence %K Insurance Claim Reporting %K Low Back Pain %K Medicare Part B %K Musculoskeletal Diseases %K Primary Health Care %K Retrospective Studies %K Sex Factors %K Treatment Outcome %K United States %X

OBJECTIVE: The purpose of this study was to define and characterize episodes of chiropractic care among older Medicare beneficiaries and to evaluate the extent to which chiropractic services were used in tandem with conventional medicine.

METHODS: Medicare Part B claims histories for 1991 to 2007 were linked to the nationally representative survey on Assets and Health Dynamics among the Oldest Old baseline interviews (1993-1994) to define episodes of chiropractic sensitive care using 4 approaches. Chiropractic and nonchiropractic patterns of service use were examined within these episodes of care. Of the 7447 Assets and Health Dynamics among the Oldest Old participants, 971 used chiropractic services and constituted the analytic sample.

RESULTS: There were substantial variations in the number and duration of episodes and the type and volume of services used across the 4 definitions. Depending on how the episode was constructed, the mean number of episodes per chiropractic user ranged from 3.74 to 23.12, the mean episode duration ranged from 4.7 to 28.8 days, the mean number of chiropractic visits per episode ranged from 0.88 to 2.8, and the percentage of episodes with co-occurrent use of chiropractic and nonchiropractic providers ranged from 4.9% to 10.9% over the 17-year period.

CONCLUSION: Treatment for back-related musculoskeletal conditions was sought from a variety of providers, but there was little co-occurrent service use or coordinated care across provider types within care episodes. Chiropractic treatment dosing patterns in everyday practice were much lower than that used in clinical trial protocols designed to establish chiropractic efficacy for back-related conditions.

%B Journal of Manipulative & Physiological Therapeutics %V 35 %P 168-175 %G eng %N 3 %R 10.1016/j.jmpt.2012.01.011 %0 Journal Article %J Int J Occup Environ Health %D 2012 %T Chronic back pain among older construction workers in the United States: a longitudinal study. %A Xiuwen S Dong %A Wang, Xuanwen %A Fujimoto, Alissa %A Dobbin, Ronald %K Back Pain %K Employment %K Humans %K Longitudinal Studies %K Occupational Diseases %K Occupations %K United States %X

This study assessed chronic back pain among older construction workers in the United States by analyzing data from the 1992-2008 Health and Retirement Study (HRS), a large-scale longitudinal survey. Fixed-effects methods were applied in the multiple logistic regression model to explore the association between back pain and time-varying factors (e.g., employment, job characteristics, general health status) while controlling for stable variables (e.g., gender, race, ethnicity). Results showed that about 40% of older construction workers over the age of 50 suffered from persistent back pain or problems. Jobs involving a great deal of stress or physical effort significantly increased the risk of back disorders and longest-held jobs in construction increased the odds of back disorders by 32% (95% CI: 1·04-1·67). Furthermore, poor physical and mental health were strongly correlated with back problems. Enhanced interventions for construction workers are urgently needed given the aging workforce and high prevalence of back disorders in this industry.

%B Int J Occup Environ Health %I 18 %V 18 %P 99-109 %8 2012 Apr-Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/22762489?dopt=Abstract %3 22762489 %4 labor force participation/Chronic illness/back pain/construction workers %$ 69578 %R 10.1179/1077352512Z.0000000004 %0 Book Section %B Work, Health and Well-Being: The Challenges of Managing Health at Work %D 2012 %T Comparing Health and Employment in England and the United States %A Lain, David %E Vickerstaff, Sarah %E Phillipson, Chris %E Wilkie, Ross %K Cross-National %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %K Income %X This chapter explores how health influences employment past age 65 in the United States and England. This is of policy interest, because England followed the United States by extending age-discrimination legislation above 65 in 2011. Drawing conclusions about the health-related capacity of this age group to work is, however, a challenge. Common health measures are often problematic for use with older workers, particularly when they are used to make comparisons between countries. Nevertheless, the most appropriate health measures are identified from the English Longitudinal Study of Ageing and the US Health and Retirement Study. The survey analysis presented shows that, in both countries, health limitations had the strongest negative impact on employment for the poorest over-65s. This suggests that the financial benefits of working are likely to be limited for the over-65s most in need of additional income. %B Work, Health and Well-Being: The Challenges of Managing Health at Work %I Policy Press %C Bristol, UK %P 57-78 %G eng %U http://policypress.universitypressscholarship.com/view/10.1332/policypress/9781847428080.001.0001/upso-9781847428080-chapter-4 %4 Working past 65/Post-retirement work/Health measures/Additional income/cross-national comparison/ELSA_/health status/labor Force Participation %$ 69290 %! Comparing Health and Employment in England and the United States %R 10.1332/policypress/9781847428080.003.0004 %0 Journal Article %J Global Health %D 2012 %T Depressive symptoms and psychosocial stress at work among older employees in three continents. %A Johannes Siegrist %A Lunau, T. %A Morten Wahrendorf %A Dragano, N. %K Asia %K Cross-Sectional Studies %K Data collection %K depression %K Europe %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K North America %K Prevalence %K Regression Analysis %K Risk Factors %K Stress, Psychological %K Work %X

BACKGROUND: To assess whether an association of psychosocial stress at work with depressive symptoms among older employees is evident in a set of comparable empirical studies from Europe, North America and Asia.

METHODS: Cross-sectional and longitudinal multivariate regression analyses of data from 4 cohort studies with elder workers (2004 and 2006) testing associations of psychosocial stress at work ('effort-reward imbalance'; 'low control') with depressive symptoms.

RESULTS: Cross-sectional analyses from 17 countries with 14.236 participants reveal elevated odds ratios of depressive symptoms among people experiencing high work stress compared to those with low or no work stress. Adjusted odds ratios vary from 1.64 (95% CI 1.02-2.63) in Japan to 1.97 (95% CI 1.75-2.23) in Europe and 2.28 (95% CI 1.59-3.28) in the USA. Odds ratios from additional longitudinal analyses (in 13 countries) controlling for baseline depression are smaller, but remain in part significant.

CONCLUSION: Findings indicate that psychosocial stress at work might be a relevant risk factor for depressive symptoms among older employees across countries and continents. This observation may call for global policy efforts to improve quality of work in view of a rapidly aging workforce, in particular in times of economic globalization.

%B Global Health %I 8 %V 8 %P 27 %8 2012 Jul 20 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/22818354?dopt=Abstract %4 psychosocial/Depression/cross-national/labor Force Participation/Older Workers/Stress/workplace %$ 69706 %R 10.1186/1744-8603-8-27 %0 Journal Article %J COPD %D 2012 %T The Disability burden of COPD. %A Thornton Snider, Julia %A J. A. Romley %A Ken S Wong %A Zhang, Jie %A Eber, Michael %A Dana P Goldman %K Aged %K Cost of Illness %K Disabled Persons %K Employment %K Female %K Humans %K Income %K Insurance, Disability %K Likelihood Functions %K Logistic Models %K Male %K Middle Aged %K Pulmonary Disease, Chronic Obstructive %K Social Security %K United States %X

Affecting an estimated 12.6 million people and causing over 100,000 deaths per year, chronic obstructive pulmonary disease (COPD) exacts a heavy burden on American society. Despite knowledge of the impact of COPD on morbidity, mortality, and health care costs, little is known about the association of the disease with economic outcomes such as employment and the collection of disability. We quantify the impact of COPD on Americans aged 51 and older-in particular, their employment prospects and their likelihood of collecting federal disability benefits-by conducting longitudinal regression analysis using the Health and Retirement Study. Controlling for initial health status and a variety of sociodemographic factors, we find that COPD is associated with a decrease in the likelihood of employment of 8.6 percentage points (OR = 0.58, 95% CI 0.50-0.67), from 44% to 35%. This association rivals that of stroke and is larger than those of heart disease, cancer, hypertension, and diabetes. Furthermore, COPD is associated with a 3.9 percentage point (OR 2.52, 95% CI 2.00-3.17) increase in the likelihood of collecting Social Security Disability Insurance (SSDI), from 3.2% to 7.1%, as well as a 1.7 percentage point (OR 2.87, 95% CI 2.02-4.08) increase in the likelihood of collecting Supplemental Security Income (SSI), from 1.0% to 2.7%. The associations of COPD with SSDI and SSI are the largest of any of the conditions studied. Our results are consistent with the hypothesis that COPD imposes a substantial burden on American society by inhibiting employment and creating disability.

%B COPD %V 9 %P 513-21 %8 2012 Aug %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/22721264?dopt=Abstract %2 PMID: 22721264 (PMC in pr %4 chronic obstructive pulmonary disease/employment/disability/disability/Morbidity/Mortality/health care costs/social security/Social Security Disability Insurance/Supplemental Security Income %$ 69586 %R 10.3109/15412555.2012.696159 %0 Thesis %D 2012 %T Disability Insurance in General Equilibrium %A Wang, Ruwei %Y Young, Eric %K Disabilities %K Event History/Life Cycle %K Methodology %K Other %K Public Policy %K Social Security %X The Social Security Disability Insurance (DI) Program, which provides income protection to qualified workers who suffer from disabilities, is now facing rapid growth in the number of recipients. The DI program also discourages exit by workers whose health improves by penalizing work heavily. In the first chapter, I build a dynamic general equilibrium model to provide a quantitative analysis of the welfare effects of the DI program and the impact of DI policy reforms on the program's financial health and on worker behavior and welfare. A recently proposed policy to provide two extra years of partial benefits for DI beneficiaries returning to work would reduce the size of the DI beneficiary population, lowering total DI payments and the tax rate and raising welfare of a healthy newborn by 0.33%. Increasing the Social Security Normal Retirement Age from 65 to 67 raises the number of DI recipients by 8.9%. Policy changes strengthening the strictness of disability criteria increase social welfare mainly due to the reduction in the tax rate. Lastly, simulation results for the case of eliminating the DI program shows a large welfare gain in the new steady state, implying that the distortionary effects of taxation outweigh the gains from providing insurance. The second chapter takes into consideration that people can also obtain financial protection from public and private health insurance programs to have medical costs covered when they suffer health problems. I build a dynamic general equilibrium model to quantitatively analyze the impact of policy reforms on the DI program and on workers' behavior and welfare when Medicare, Medicaid, and employer-sponsored health insurance programs interact with the DI program. A policy change strengthening the strictness of the DI admission process increases social welfare mainly due to the reduction in the tax rate and the increase in the wage level. Expanding Medicaid eligibility, which is a provision in the Affordable Care Act, reduces the number of DI recipients by 4.0% and increases general equilibrium welfare by 0.1%. However, the welfare effects differ by education. %I University of Virginia %C Charlottesville, VA %V Ph.D. %G English %M 1151450347 %4 Economics %$ 69238 %0 Thesis %B Economics %D 2012 %T Essays on impact of risk preference on health and occupational choice %A Beri, Meenakshi %Y Jennifer L. Ward-Batts %K Health Conditions and Status %K Methodology %K Public Policy %X This dissertation re-examines Health and Retirement Study (HRS) data in order to ascertain whether there exists behavioral heterogeneity among people regarding health risk as compared to that of financial risk as well as whether there exists racial-ethnic and gender heterogeneity in the health state dependence of marginal utility. Given heterogeneous risk and time preferences of individuals, this study investigates the impact of those preferences on sorting into occupations and industries using various measures of job risk. I construct three measures of risk across jobs, cross-categorized by occupation and industry: a fatal injury rate, non-fatal injury and illness rate, and a measure of inter-person income variability. Using these measures, I analyze how risk and time preference of an individual affects his occupational choice. This study finds that there are different domains of risk and that individuals do not think of these in the same way. Using Health and Retirement Study data, I find that there exists a behavioral inconsistency in health risks versus income risk. This dissertation advises against the use of health risk proxy for making inferences about financial risk. This dissertation then examines the heterogeneity in health dependence of utility and contingent upon the findings of heterogeneity, it examines the factors contributing to utility heterogeneity. To examine this empirically, I begin with theoretical and empirical models used by Finkelstein, et al. (2011) relaxing the assumptions of those models to allow for differential effects by race, gender and ethnicity. Using happiness as a utility proxy and objective health measures in our baseline model, I find strong evidence of heterogeneity in health state dependence of utility among males and females, hispanic and non-hispanic and white, and black; not only in seven objective health conditions but also functionality limitations; not only by using happiness as a utility proxy but also with CES-D score. Since, there is slight evidence of heterogeneity in the health state dependence of utility among different health states, the policies like Medicare, and Medicaid would have varying impact on people depending upon race, ethnicity and gender. The non-linear B-O decomposition of utility unfolds that the significant contributors towards the explained gender, racial and ethnic gap in utility proxy (happiness and CES-D Score) are: marital status, number of diseases, log adjusted income, risk attitudes and ethnicity. Approximately 80 percent of the gender utility gap and 100 percent race utility gap is explained by the endowment effect. Thus, this dissertation reaffirms the findings of Halliday (2008) that there may be larger potential gains to identifying as well as targeting factors that influence individual heterogeneity since the health state dependence of utility is mostly driven by individual characteristics, as has been found to be the case in B-O decomposition of utility in the current study. %B Economics %I Wayne State University %C Detroit, MI %V Ph.D. %G English %U https://digitalcommons.wayne.edu/oa_dissertations/530/ %N Ph.D. %4 CES Depression Scale %$ 69672 %0 Report %D 2012 %T Estimating Second Order Probability Beliefs from Subjective Survival Data %A Péter Hudomiet %A Robert J. Willis %K Methodology %X Based on subjective survival probability questions in the Health and Retirement Study, we use an econometric model to estimate the determinants of individual-level uncertainty about personal longevity. This model is built around the Modal Response Hypothesis (MRH), a mathematical expression of the idea that survey responses of 0, 50 or 100 percent to probability questions indicate a high level of uncertainty about the relevant probability. We show that subjective survival expectations in 2002 line up very well with realized mortality of the HRS respondents between 2002 and 2010. We show that the MRH model performs better than typically used models in the literature of subjective probabilities. Our model gives more accurate estimates of low probability events and it is able to predict the unusually high fraction of focal 0, 50 and 100 answers observed in many datasets on subjective probabilities. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 Demographic Economics./Bayesian Analysis/survival probabilities/survey response/Modal response hypothesis %$ 69050 %R 10.3386/w18258 %0 Journal Article %J The Journal of Consumer Affairs %D 2012 %T Family Decision Making and Resource Protection Adequacy %A Patryk D. Babiarz %A Robb, Cliff A. %A Woodyard, A. %K Consumption and Savings %K End of life decisions %K Income %K Methodology %K Other %X This study examines the correlation between resource protection and the intrahousehold distribution of bargaining power. Using data from the Health and Retirement Study, the analysis quantifies potential changes in the surviving individual's living standard to evaluate the adequacy of resource protection. Individuals who generate a larger share of family income, are more financially knowledgeable, or have the final say in family decisions leverage their bargaining power to secure higher protection of their hypothetical widowhood living standard. Consequently, spouses with more bargaining power are less likely to experience declines of their living standard in the event of their spouse passing away and are more likely to be overprotected. %B The Journal of Consumer Affairs %I 46 %V 46 %P 1 %G eng %U www.jstor.org/stable/23860114 %N 1 %4 Correlation analysis/Studies/Standard of living/Standard of living/Decision making/Family income/Family income/Market research/Market research %$ 62856 %0 Journal Article %J Soc Sci Res %D 2012 %T Family structure and the reproduction of inequality: Parents' contribution to children's college costs. %A John C Henretta %A Douglas A. Wolf %A Matthew F. Van Voorhis %A Beth J Soldo %X

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

%B Soc Sci Res %I 41 %V 41 %P 876-87 %8 2012 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/23017857?dopt=Abstract %4 Parent educational background/Higher education/Higher education/Families and family life/Children and youth/Education finance/Education finance/Transfers %$ 69432 %R 10.1016/j.ssresearch.2012.02.008 %0 Journal Article %J Journal of Family Issues %D 2012 %T Grandparents Providing Care to Grandchildren: A Population-Based Study of Continuity and Change %A Ye Luo %A Tracey A. LaPierre %A Mary Elizabeth Hughes %A Linda J. Waite %K Caregiving %K grandchildren %K Grandparents %K intergenerational relationship %K Living arrangements %X This study examines transitions in grandchild care and the characteristics of grandparents making these transitions, using longitudinal data from a nationally representative sample of 13,626 grandparents in the 1998-2008 Health and Retirement Study. More than 60 of grandparents provided grandchild care over the 10-year period; more than 70 of those did it for 2 years or more. Grandparents with fewer functional limitations and more economic resources were more likely to start or continue nonresidential care, whereas relatively disadvantaged grandparents were more likely to start and continue coresidential care. Grandparents who were African American, younger, married, living with fewer minor children of their own, or had more grandchildren were more likely to start care, particularly nonresidential care. African Americans and Hispanics were more likely than Whites to start and continue coresidential care. These findings demonstrate the heterogeneity of caregiving and point to the lack of resources among those who provide coresidential care. PUBLICATION ABSTRACT %B Journal of Family Issues %I 33 %V 33 %P 1143-1167 %G eng %N 9 %4 family Structure/intergenerational transfers/Children/grandparents %$ 69604 %R 10.1177/0192513X12438685 %0 Journal Article %J Health Aff (Millwood) %D 2012 %T Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. %A Alexander K Smith %A Ellen P McCarthy %A Ellen Weber %A Irena Cenzer %A W John Boscardin %A Jonathan Fisher %A Kenneth E Covinsky %K Aged %K Aged, 80 and over %K Emergency Service, Hospital %K Female %K Hospital Mortality %K Hospitalization %K Humans %K Insurance Claim Review %K Male %K Terminal Care %K Terminally Ill %K United States %X

Emergency department use contributes to high end-of-life costs and is potentially burdensome for patients and family members. We examined emergency department use in the last months of life for patients age sixty-five or older who died while enrolled in a longitudinal study of older adults in the period 1992-2006. We found that 51 percent of the 4,158 [corrected] decedents visited the emergency department in the last month of life, and 75 percent in the last six months of life. Repeat visits were common. A total of 77 percent of the patients seen in the emergency department in the last month of life were admitted to the hospital, and 68 percent of those who were admitted died there. In contrast, patients who enrolled in hospice at least one month before death rarely visited the emergency department in the last month of life. Policies that encourage the preparation of patients and families for death and early enrollment in hospice may prevent emergency department visits at the end of life.

%B Health Aff (Millwood) %I 31 %V 31 %P 1277-85 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22665840?dopt=Abstract %2 PMC3736978 %4 elderly/Medicare/Primary Care/public policy/Health care policy/emergency department service use/emergency department service use %$ 69508 %R 10.1377/hlthaff.2011.0922 %0 Journal Article %J J Gen Intern Med %D 2012 %T How safe is your neighborhood? Perceived neighborhood safety and functional decline in older adults. %A Vivien K Sun %A Irena Cenzer %A Helen Kao %A Cyrus Ahalt %A Brie A Williams %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Perception %K Residence Characteristics %K Safety %K Surveys and Questionnaires %X

BACKGROUND: Neighborhood characteristics are associated with health and the perception of safety is particularly important to exercise and health among older adults. Little is known about the relationship between perception of neighborhood safety and functional decline in older adults.

OBJECTIVE: To determine the relationship between perceived neighborhood safety and functional decline in older adults.

DESIGN/SETTING: Longitudinal, community-based.

PARTICIPANTS: 18,043 persons, 50 years or older, who participated in the 1998 and 2008 Health and Retirement Study.

MAIN MEASURES: The primary outcome was 10-year functional decline (new difficulty or dependence in any Activity of Daily Living, new mobility difficulty, and/or death). The primary predictor was perceived neighborhood safety categorized into three groups: "very safe", "moderately safe", and "unsafe." We evaluated the association between perceived neighborhood safety and 10-year functional decline using a modified Poisson regression to generate unadjusted and adjusted relative risks (ARR).

KEY RESULTS: At baseline 11,742 (68.0%) participants perceived their neighborhood to be very safe, 4,477 (23.3%) moderately safe, and 1,824 (8.7%) unsafe. Over 10 years, 10,338 (53.9%) participants experienced functional decline, including 6,266 (50.2%) who had perceived their neighborhood to be very safe, 2,839 (61.2%) moderately safe, and 1,233 (63.6%) unsafe, P < 0.001. For the 11,496 (63.3%) of participants who were functionally independent at baseline, perceived neighborhood safety was associated with 10-year functional decline (moderately safe ARR 1.15 95% CI 1.09-1.20; unsafe ARR 1.21 95% CI: 1.03-1.31 compared to very safe group). The relationship between perceived neighborhood safety and 10-year functional decline was not statistically significant for participants who had baseline functional impairment.

CONCLUSION: Asking older adults about their perceived neighborhood safety may provide important information about their risk of future functional decline. These findings also suggest that future studies might focus on assessing whether interventions that promote physical activity while addressing safety concerns help reduce functional decline in older adults.

%B J Gen Intern Med %V 27 %P 541-7 %8 2012 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/22160889?dopt=Abstract %2 PMC3326109 %4 neighborhood Characteristics/Safety/Functional decline/Functional decline/Activities Of Daily Living/Mobility/HEALTH %$ 62672 %R 10.1007/s11606-011-1943-y %0 Journal Article %J Industrial and Labor Relations Review %D 2012 %T The Importance of Anti-Discrimination and Workers' Compensation Laws on the Provision of Workplace Accommodations Following the Onset of a Disability %A R.V. Burkhauser %A Maximilian D. Schmeiser %A Robert R. Weathers II %K Employment and Labor Force %K Health Conditions and Status %K Other %X The Americans with Disabilities Act of 1990 (ADA) was the first federal disability-based anti-discrimination law that applied to a broad range of workers. Whereas some studies have focused on its impact on workplace accommodation, this is the first to do so while accounting for previous state anti-discrimination and Workers' Compensation laws. Using data from the Health and Retirement Study, the authors find that prior to the implementation of the ADA, employers were more likely to accommodate workers if their disability onset was work-related and hence likely to be covered by Workers' Compensation laws. State anti-discrimination laws significantly increased accommodations to workers whose disabilities were not work-related, effectively bringing their accommodation rates in line with workers whose disabilities were. Though implementation of the ADA increased accommodation for all workers, the authors point out that failure to account for pre-existing state anti-discrimination and Workers' Compensation laws will underestimate its effect. PUBLICATION ABSTRACT %B Industrial and Labor Relations Review %I 65 %V 65 %P 161 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2588500331andFmt=7andclientId=17822andRQT=309andVName=PQD %N 1 %4 Studies/Americans with Disabilities Act 1990-US/Americans with Disabilities Act 1990-US/Employment discrimination/Employment discrimination/Workers compensation/Workers compensation %$ 62822 %0 Journal Article %J Sociological Methods & Research %D 2012 %T Linking Survey and Administrative Records: Mechanisms of Consent %A Joseph W Sakshaug %A Mick P. Couper %A Mary Beth Ofstedal %A David R Weir %K Consent %K Meta-analyses %K Survey Methodology %X

Survey records are increasingly being linked to administrative databases to enhance the survey data and increase research opportunities for data users. A necessary prerequisite to linking survey and administrative records is obtaining informed consent from respondents. Obtaining consent from all respondents is a difficult challenge and one that faces significant resistance. Consequently, data linkage consent rates vary widely from study-to-study. Several studies have found significant differences between consenters and non-consenters on socio-demographic variables, but no study has investigated the underlying mechanisms of consent from a theory-driven perspective. In this study, we describe and test several hypotheses related to respondents' willingness to consent to an earnings and benefit data linkage request based on mechanisms related to financial uncertainty, privacy concerns, resistance towards the survey interview, level of attentiveness during the interview, the respondents' preexisting relationship with the administrative data agency, and matching respondents and interviewers on observable characteristics. The results point to several implications for survey practice and suggestions for future research.

%B Sociological Methods & Research %V 41 %P 535-569 %8 2012 Nov %G eng %N 4 %R 10.1177/0049124112460381 %0 Journal Article %J Soc Sci Med %D 2012 %T Loneliness, health, and mortality in old age: a national longitudinal study. %A Ye Luo %A Louise C Hawkley %A Linda J. Waite %A John T. Cacioppo %K Aged %K Aged, 80 and over %K Aging %K Cohort Studies %K depression %K Female %K Health Behavior %K Health Status %K Humans %K Interpersonal Relations %K Loneliness %K Longitudinal Studies %K Male %K Middle Aged %K Mortality %K Social Support %K Socioeconomic factors %K United States %X

This study examined the relationship between loneliness, health, and mortality using a U.S. nationally representative sample of 2101 adults aged 50 years and over from the 2002 to 2008 waves of the Health and Retirement Study. We estimated the effect of loneliness at one point on mortality over the subsequent six years, and investigated social relationships, health behaviors, and health outcomes as potential mechanisms through which loneliness affects mortality risk among older Americans. We operationalized health outcomes as depressive symptoms, self-rated health, and functional limitations, and we conceptualized the relationships between loneliness and each health outcome as reciprocal and dynamic. We found that feelings of loneliness were associated with increased mortality risk over a 6-year period, and that this effect was not explained by social relationships or health behaviors but was modestly explained by health outcomes. In cross-lagged panel models that tested the reciprocal prospective effects of loneliness and health, loneliness both affected and was affected by depressive symptoms and functional limitations over time, and had marginal effects on later self-rated health. These population-based data contribute to a growing literature indicating that loneliness is a risk factor for morbidity and mortality and point to potential mechanisms through which this process works.

%B Soc Sci Med %I 74 %V 74 %P 907-14 %8 2012 Mar %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2601961601andFmt=7andclientId=17822andRQT=309andVName=PQD %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22326307?dopt=Abstract %2 PMC3303190 %4 Emotions/Emotions/Mortality/Clinical outcomes/Health behavior/Risk factors/Personal health/Older people %$ 62840 %R 10.1016/j.socscimed.2011.11.028 %0 Journal Article %J Research on Aging %D 2012 %T A Longitudinal Study of Social Status, Perceived Discrimination, and Physical and Emotional Health Among Older Adults %A Ye Luo %A Jun Xu %A Granberg, E. %A Wentworth, W. %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Women and Minorities %X This study examines the relationships between social status, perceived discrimination, and physical and emotional health using a nationally representative sample of 6,377 older adults from the 2006 and 2008 waves of the Health and Retirement Study. About 63 of older adults reported at least one type of everyday discrimination and 31 reported at least one major discriminatory event during lifetime. Blacks, those separated, divorced, or widowed, and those with lower household assets have higher levels of perceived discrimination than Whites, the married or partnered, and those with more assets. Perceived discrimination is negatively associated with changes in health over 2 years, and everyday discrimination has stronger effects than major discriminatory events, especially on emotional health. The effects of perceived everyday discrimination on changes in depressive symptoms and self-rated health are independent of general stress. Efforts to reduce discrimination, including perceptions of discrimination, can be beneficial for health in old age. PUBLICATION ABSTRACT %B Research on Aging %I 34 %V 34 %P 275 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2621993131andFmt=7andclientId=17822andRQT=309andVName=PQD %N 3 %4 Perceptions/Perceptions/Status/Status/Older people/Age discrimination/Blacks/Whites %$ 62853 %0 Journal Article %J Stroke %D 2012 %T Long-term rate of change in memory functioning before and after stroke onset. %A Qianyi Wang %A Benjamin D Capistrant %A Amy Ehntholt %A M. Maria Glymour %K Aged %K Aged, 80 and over %K Cohort Studies %K disease progression %K Female %K Follow-Up Studies %K Humans %K Linear Models %K Longitudinal Studies %K Male %K Memory %K Memory Disorders %K Middle Aged %K Stroke %K Survivors %K Time Factors %X

BACKGROUND AND PURPOSE: Memory impairment is a predictor and a consequence of stroke, but memory decline is common even in healthy elderly individuals. We compared the long-term trajectory of memory functioning before and after stroke with memory change in stroke-free elderly individuals.

METHODS: Health and Retirement Study participants aged 50 years and older (n=17 340) with no stroke history at baseline were interviewed biennially up to 10 years for first self-reported or proxy-reported stroke (n=1574). Age-, sex-, and race-adjusted segmented linear regression models were used to compare annual rates of change in a composite memory score before and after stroke among 3 groups: 1189 stroke survivors; 385 stroke decedents; and 15 766 cohort members who remained stroke-free.

RESULTS: Before stroke onset, individuals who later survived stroke had significantly (P<0.001) faster average annual rates of memory decline (-0.143 points per year) than those who remained stroke-free throughout follow-up (-0.101 points per year). Stroke decedents had even faster prestroke memory decline (-0.212 points per year). At stroke onset, memory declined an average of -0.369 points among stroke survivors, comparable with 3.7 years of age-related decline in stroke-free cohort members. After stroke, memory in stroke survivors continued to decline at -0.142 points per year, similar to their prestroke rates (P=0.93). Approximately 50% of the memory difference between stroke survivors soon after stroke and age-matched stroke-free individuals was attributable to prestroke memory.

CONCLUSIONS: Although stroke onset induced large decrements in memory, memory differences were apparent years before stroke. Memory declines before stroke, especially among those who did not survive the stroke, were faster than declines among stroke-free adults.

%B Stroke %V 43 %P 2561-6 %8 2012 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/22935399?dopt=Abstract %2 PMC3675175 %4 Cognition/Cognitive impairment/memory impairment/cognitive decline/stroke %$ 69656 %R 10.1161/STROKEAHA.112.661587 %0 Journal Article %J Econ Hum Biol %D 2012 %T Marriage, gender and obesity in later life. %A Sven E. Wilson %K Age Factors %K Aged %K Body Mass Index %K Female %K Humans %K Male %K Marital Status %K Middle Aged %K Models, Statistical %K Obesity %K Sex Factors %K United States %K Weight Gain %K Weight Loss %X

A large body of literature argues that marriage promotes health and increases longevity. But do these benefits extend to maintaining a healthy body weight, as the economic theory of health investment suggests they should? They do not. Using the Health and Retirement Study (HRS), I find that entry into marriage among both men and women aged 51-70 is associated with weight gain and exit from marriage with weight loss. I evaluate three additional theories with respect to the cross-sectional and longitudinal variation in the data. First, it may be that a broader set of shared risk factors (such as social obligations regarding meals) raises body mass for married couples. However, the shared risk factor model predicts that the intra-couple correlation should increase with respect to marital duration. Instead, it declines. Second, scholars have recently promoted a "crisis" model of marriage in which marital transitions, not marital status, determine differences in body mass. The crisis model is consistent with short-term effects seen for divorce, but not for the persistent weight gains associated with marriage or the persistent weight loss following widowhood. And transition models, in general, cannot explain significant cross-sectional differences across marital states in a population that is no longer experiencing many transitions, nor can it account for the prominent gender differences (in late middle-age, the heaviest group is unmarried women and the lightest are unmarried men). Third, I argue that pressures of the marriage market, in combination with gendered preferences regarding partner BMI, can account for all the longitudinal and cross-sectional patterns found in the data.

%B Econ Hum Biol %V 10 %P 431-53 %8 2012 Dec %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22795874?dopt=Abstract %2 PMC in process %4 marriage/Risk factors/body mass/shared risk factor %$ 69570 %R 10.1016/j.ehb.2012.04.012 %0 Report %D 2012 %T The national retirement risk index: An update. %A Alicia H. Munnell %A Anthony Webb %A Golub-Sass, Francesca N. %K Restricted data %K Retirement Planning and Satisfaction %X The release of the Federal Reserve’s 2010 Survey of Consumer Finances is a great opportunity to reassess Americans’ retirement preparedness as measured by the National Retirement Risk Index (NRRI). The NRRI shows the share of working households who are “at risk” of being unable to maintain their pre-retirement standard of living in retirement. The Index compares projected replacement rates – retirement income as a percentage of pre-retirement income – for today’s working households with target rates that would allow them to maintain their living standard and calculates the percentage at risk of falling short. The NRRI was originally constructed using the Federal Reserve’s 2004 Survey of Consumer Finances (SCF). The SCF is a triennial survey of a nationally representative sample of U.S. households, which collects detailed information on households’ assets, liabilities, and demographic characteristics. The 2007 SCF did not allow for a meaningful update, because stock market and housing prices plummeted right after the survey interviews were completed. Thus, the 2010 survey is the first opportunity to see how the financial crisis and ensuing recession have affected Americans’ readiness for retirement. The discussion proceeds as follows. The first section describes the nuts and bolts of constructing the NRRI and how the new SCF data were incorporated. The second section updates the NRRI using the 2010 SCF, showing that the percentage of households at risk increased by nine percentage points between the 2007 and 2010 surveys – 44 percent to 53 percent. The third section identifies the impact of various factors on the change. The final section concludes that the NRRI confirms what we already know: today’s workers face a major retirement income challenge. Even if households work to age 65 and annuitize all their financial assets, including the receipts from reverse mortgages on their homes, more than half are at risk of being unable to maintain their standard of living in retirement. %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston, MA %G eng %U https://crr.bc.edu/briefs/the-national-retirement-risk-index-an-update/ %0 Report %D 2012 %T Personality Traits and Economic Preparation for Retirement %A Michael D Hurd %A Angela Lee Duckworth %A Susann Rohwedder %A David R Weir %K Consumption and Savings %K Health Conditions and Status %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper assesses the effects of personality traits on economic preparation for retirement, wealth accumulation, and consumption, among persons 66 to 69 years of age. Among the five chief personality traits of neuroticism, extroversion, agreeableness, conscientiousness, and openness, we focus most on conscientiousness. We find levels of adequate economic preparation for retirement ranging from 29 percent to 90 percent and that conscientiousness positively affects the proportion of persons adequately prepared for retirement, while neuroticism negatively affects it. Both consumption and wealth increase with conscientiousness but wealth increases faster, indicating that more conscientious persons save more out of retirement resources. %B MRDRC Working Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://ideas.repec.org/p/mrr/papers/wp279.html %4 personality traits/Conscientiousness/Conscientiousness/retirement planning/wealth Accumulation/consumption/wealth %$ 69838 %0 Thesis %D 2012 %T Religion, spirituality and aging: A longitudinal study of mental and physical coping %A Nathenson, Sophia Lyn %Y Wen, Ming %K Adult children %K Demographics %K Health Conditions and Status %X A connection to the divine, God, or nature can be a source of comfort, guidance and insight, particularly during times of hardship or illness. This study draws together sociological theories on religion, aging and health to explore the ways in which religious and spiritual practices may impact the mental and physical aspects of old age. Analyzing data from the Health and Retirement Study (HRS) from 2000 to 2010, the effects of religious salience, prayer and meditation are investigated in terms of their impact on mental health and physical functioning. Additionally the study examines a sample of cancer survivors to determine if the effects of religion differ for this unique population. Results demonstrated a salutary effect of religious salience on mental health and coping with cancer, but a negative association with disability. Similarly, moderate prayer improved outcomes of depression and disability while daily prayer and meditation was associated with poorer outcomes. Theoretical explanations for these results are discussed with respect to policy implications and future research directions. %I The University of Utah %C Salt Lake City, UT %V Ph.D. %G English %U https://www.semanticscholar.org/paper/Religion%2C-spirituality-and-aging%3A-A-longitudinal-of-Nathenson/c507119e202b319bd6bc9054d9ef9245cdb85a5f %M 1267740404 %4 Physical function %$ 69796 %0 Journal Article %J BMC Geriatr %D 2012 %T Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study. %A Dominic J Cirillo %A Robert B Wallace %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cross-Sectional Studies %K Disabled Persons %K Female %K Humans %K Male %K Middle Aged %K Prevalence %K Restless Legs Syndrome %K Risk Factors %K United States %X

BACKGROUND: Restless legs syndrome (RLS) is a common condition associated with decreased quality of life in older adults. This study estimates the prevalence, risk factors, and functional correlates of among U.S. elders.

METHODS: Subjects (n = 1,008) were sub-sampled from the 2002 cross-sectional interview survey of the Health and Retirement Study (HRS), a nationally representative study of U.S. elders. Symptoms and sleep disturbances consistent with RLS were identified. Activities of daily living (ADL), instrumental activities of daily living (IADL), and limitations for mobility, large muscle groups, gross and fine motor function were measured using standardized questions. Incident functional limitations were detected over six years of observation.

RESULTS: The prevalence of RLS among U.S. elders born before 1947 was 10.6%. Factors associated with increased prevalence RLS at baseline included: overweight body mass index (multivariate adjusted prevalence ratio = 1.77; 95% confidence interval (CI) 1.05-2.99); mild-to-moderate pain (2.67, 1.47-4.84) or pain inferring with activity (3.44, 2.00-5.93); three or more chronic medications (2.54, 1.26-5.12), highest quartile of out-of-pocket medical expenses (2.12, 1.17-3.86), frequent falls (2.63, 1.49-4.66), health limiting ability to work (2.91, 1.75-4.85), or problems with early waking or frequent wakening (1.69, 1.09-2.62 and 1.55, 1.00-2.41, respectively). Current alcohol consumption (0.59, 0.37-0.92) and frequent healthcare provider visits (0.49, 0.27-0.90) were associated with decreased RLS prevalence. RLS did not predict incident disability for aggregate measures but was associated with increased risk for specific limitations, including: difficulty climbing several stair flights (multivariate-adjusted hazard ratio = 2.38, 95% CI 1.39-4.06), prolonged sitting (2.17, 1.25-3.75), rising from a chair (2.54, 1.62-3.99), stooping (2.66, 1.71-4.15), moving heavy objects (1.79, 1.08-2.99), carrying ten pounds (1.61, 1.05-2.97), raising arms (1.76, 1.05-2.97), or picking up a dime (1.97, 1.12-3.46).

CONCLUSIONS: RLS sufferers are more likely to have functional disability, even after adjusting for health status and pain syndrome correlates.

%B BMC Geriatr %I 12 %V 12 %P 39 %8 2012 Jul 26 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/22834914?dopt=Abstract %2 PMC3433378 %4 Restless legs syndrome/activities of daily living/ADL/IADL/mobility/Functional Assessment/Quality of Life %$ 69636 %R 10.1186/1471-2318-12-39 %0 Report %D 2012 %T Retiree Health Benefits as Deferred Compensation: Evidence from the Health and Retirement Study %A J. Marton %A Stephen A. Woodbury %K Income %K Medicare/Medicaid/Health Insurance %K Other %K Pensions %K Public Policy %K Retirement Planning and Satisfaction %X Are early retiree health benefits (RHBs) a form of deferred compensation binding workers to an employer? Most employers who offer RHBs offer them only to workers who have ten or more years of tenure and have reached age fifty-five. Accordingly, workers in firms offering RHBs have an incentive to stay with a firm in the years before they attain eligibility for RHBs, and a greater incentive than otherwise to retire thereafter. The authors test for such a pattern of incentives by examining the age-specific relationship between workers eligibility for RHBs and retirement. The findings suggest that workers in RHB-offering firms are less likely to retire at ages fifty and fifty-one than similar RHB-ineligible workers. Also, RHB-eligible workers aged sixty and sixty-one are more likely to retire than similar RHB-ineligible workers. These results are consistent with RHBs acting as part of a delayed payment contract of the kind described by Lazear. %B Upjohn Institute Working Papers %I W.E. Upjohn Institute for Employment Research %C Kalamazoo, MI %G eng %4 Deferred compensation/retirement/health insurance/tax subsidies/compensation methods/Public Policy/Incentives/employee benefits/Eligibility %$ 69716 %R 10.17848/wp12-182 %0 Journal Article %J J Immigr Minor Health %D 2012 %T Self-reported and measured hypertension among older US- and foreign-born adults. %A White, Kellee %A Mauricio Avendano %A Benjamin D Capistrant %A J Robin Moon %A Sze Y Liu %A M. Maria Glymour %K Aged %K Black or African American %K Blood Pressure Determination %K Emigrants and Immigrants %K Female %K Hispanic or Latino %K Humans %K Hypertension %K Male %K Middle Aged %K Nutrition Surveys %K Reproducibility of Results %K Self Report %K United States %K White People %X

Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n = 13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9%), whites (82.8%), and Hispanics (84.0%), and both foreign-born (83.2%) and US-born (84.0%). Specificity was above 90% for both US-born and foreign-born, but higher for whites (92.8%) than blacks (86.0%). Despite the potential vulnerability of older foreign-born Americans, self-reported hypertension may be considered a reasonable estimate of hypertension status. Future research should confirm these findings in samples with a larger and more ethnically diverse foreign-born population.

%B J Immigr Minor Health %I 14 %V 14 %P 721-6 %8 2012 Aug %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1022672464?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22109587?dopt=Abstract %3 22109587 %4 Social policy/self assessed health/Hypertension/African-americans/Hispanics/Ethnic Interests %$ 69514 %R 10.1007/s10903-011-9549-3 %0 Journal Article %J Quality of Life Research %D 2012 %T Sense of control and sociodemographic differences in self-reported health in older adults %A Ward, Michael M. %K Demographics %K Health Conditions and Status %K Healthcare %K Other %X Stronger sense of control has been associated with improved health outcomes. This study tested whether the association between sense of control and self-reported health varied among demographic groups and whether sense of control attenuated sociodemographic differences in self-reported health. Data from 6,815 participants in the Health and Retirement Study were used to examine moderation between demographic characteristics and sense of control (measured by the personal mastery and perceived constraints scales of the Midlife Developmental Inventory) in their associations with three self-reported health measures (global rating of fair/poor health, functional limitations, and number of comorbid conditions). Higher personal mastery and lower perceived constraints were associated with better self-reported health. There were no significant interactions between the sense of control measures and age, gender, education level, income, or marital status in their associations with either global self-rated health or functional limitations. Higher levels of mastery were associated with lower likelihood of functional limitations among blacks and whites, but not among those of other races. Perceived constraints were slightly more strongly associated with number of comorbid conditions among older than younger individuals. Sense of control measures were generally similarly associated with self-reported health across demographic groups and did not attenuate demographic differences in health. PUBLICATION ABSTRACT %B Quality of Life Research %I 21 %V 21 %P 1509-18 %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1112162539?accountid=14667 %N 9 %4 Medical Sciences/health outcomes/Sense of control/Self assessed health/sociodemographic differences/sociodemographic differences/demographic groups/demographic groups/COMORBIDITY/Functional limitation %$ 69786 %R http://dx.doi.org/10.1007/s11136-011-0068-4 %0 Journal Article %J J Gen Intern Med %D 2012 %T Subjective social status and functional decline in older adults. %A Bonnie Chen %A Kenneth E Covinsky %A Irena Cenzer %A Nancy E Adler %A Brie A Williams %K Activities of Daily Living %K Aged %K Aging %K Female %K Health Status Disparities %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mobility Limitation %K Risk Factors %K Self Report %K Social Class %X

BACKGROUND: It is unknown whether subjective assessment of social status predicts health outcomes in older adults.

OBJECTIVE: To describe the relationship between subjective social status and functional decline in older adults.

DESIGN: Longitudinal cohort study.

SETTING: The Health and Retirement Study, a nationally representative survey of community-dwelling older adults (2004-2008).

PARTICIPANTS: Two thousand five hundred and twenty-three community-dwelling older adults.

MAIN MEASURES: Self-report of social status (SSS), categorized into three groups, reported by participants who marked a 10-rung ladder to represent where they stand in society. Four-year functional decline (new difficulty in any of five activities of daily living, mobility decline and/or death)

KEY RESULTS: Mean age was 64; 46% were male, 85% were white. At baseline, lower SSS was associated with being younger, unmarried, of nonwhite race/ethnicity, higher rates of chronic medical conditions and ADL impairment (P < 0.01). Over 4 years, 50% in the lowest SSS group declined in function, compared to the middle and highest groups (28% and 26%), P-trend <0.001. Those in the lowest rungs of SSS were at increased risk of 4-year functional decline (unadjusted RR = 1.91, CI 1.-9-2.46). The relationship between a subjective belief that one is worse off than others and functional decline persisted after serial adjustment for demographics, objective SES measures, and baseline health and functional status (RR 1.36, CI 1.08-1.73).

CONCLUSIONS: In older adults, the belief that one is in the lowest rungs of social status is a measure of socioeconomic distress and of significant risk for functional decline. These findings suggest that self-report of low subjective social status may give clinicians additional information about which older adults are at high risk for future functional decline.

%B J Gen Intern Med %V 27 %P 693-9 %8 2012 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/22215272?dopt=Abstract %2 PMC3358399 %4 health outcomes/socioeconomic Differences/social status/social status/functional decline/functional decline/ADL and IADL Impairments %$ 62662 %R 10.1007/s11606-011-1963-7 %0 Thesis %D 2012 %T Three essays in health economics %A Wang, Xu %Y Michael Grossman %K Event History/Life Cycle %K Health Conditions and Status %K Healthcare %K Public Policy %K Retirement Planning and Satisfaction %X This dissertation consists of three essays. In my first essay, I examine the relationship of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) to breastfeeding. Although WIC promotes breastfeeding among its participants through education, counseling, and the provision of enhanced food packages to breastfeeding women, the program has been criticized for discouraging breastfeeding by providing free infant formula. In order to estimate the extent to which participation in WIC discourages breastfeeding, I employ a methodology that disentangles selection bias associated with WIC participation from the incentives associated with the provision of free infant formula. Findings suggest that postpartum entrants are less likely to breastfed for at least 6 months and have shorter breastfeeding durations than non-participants, and the effects are significantly larger among twin mothers than among singleton mothers. In my second essay, I investigate the association between WIC participation and infant health. How effective WIC is at improving birth outcomes is under debate. Identifying treatment effect is challenged by selection bias and gestational age bias. We use twins to minimize selection bias associated with WIC participation because twin pregnancy increases the probability of adverse birth outcomes significantly but is unlikely related to other risky behaviors. Our focus is on measures of fetal growth as outcomes amenable to nutritional supplementation. Our findings from two national datasets, PNSS and ECLS-B, suggest that prenatal WIC participation has very limited effect on fetal growth. We do not find evidence of causal effect between WIC and better birth outcomes, especially among twin births. In my third essay, I turn my interest to a different research question, the association between retirement and alcohol consumption. Retirement is life transition whose significance may provoke lifestyle and health behavioral alterations such as alcohol consumption. We examine the effect of retirement on subsequent period alcohol consumption within a two period follow up. We use seven waves of the data from Health and Retirement Study (HRS) and found retirement lead to consume 1.3 more alcoholic drinks per day within men. No effect has been found within retired women. %I City University of New York %C United States -- New York %V Ph.D. %P 118 %G English %U http://search.proquest.com.proxy.lib.umich.edu/docview/1115316395?accountid=14667 %9 3541918 %M 1115316395 %4 life-cycle %$ 69812 %! Three essays in health economics %0 Journal Article %J European Journal of Ageing %D 2012 %T Unexpected retirement from full time work after age 62: consequences for life satisfaction in older Americans %A Philippa J Clarke %A Marshall, Victor W. %A David R Weir %K Demographics %K Employment and Labor Force %K Event History/Life Cycle %K Expectations %X Recent policy shifts in the United States have resulted in an increase in the number of older workers remaining in the labor force. Increases in the retirement age for receiving full Social Security benefits coupled with declining pension funds and the erosion of employer retiree health benefits, mean that current cohorts of older workers may fully expect to work longer than previous generations. Yet, working longer may not always be possible due to health problems, outdated skills, economic insecurity, and competing obligations. We examine the consequences of unmet expectations for full time work after age 62 for life satisfaction in a nationally representative sample of older Americans. With longitudinal data from the Health and Retirement Study (1998-2008), this paper uses repeated measures of expectations for later life work among a cohort of Americans (N = 1684) gathered prospectively over an 8-year period, and examines the effects of unfulfilled expectations on subsequent life satisfaction. Using generalized growth mixture modeling three latent classes of individuals were identified with distinct trajectories of later life work expectations (low expectations, high expectations, and neutral expectations for full time work after age 62). A majority of men had generally high expectations to work full time past age 62, whereas the majority of women reported a low probability of working full time after age 62. When comparing expectations to actual full time work past age 62, we found no effects of unmet expectations for women. However, men with less job stability (reflected by shorter job tenure and lower incomes) generally had high expectations to work longer, and their life satisfaction scores were significantly lower when these expectations were not realized. The hazards of missed expectations for later life work have consequences for subjective well-being in older adults. %B European Journal of Ageing %I 9 %V 9 %P 207-219 %G eng %N 3 %4 labor Force Participation/Older Workers/life Course/gender Differences/expectations %$ 69692 %R 10.1007/s10433-012-0229-5 %0 Journal Article %J Proc Natl Acad Sci U S A %D 2012 %T Variation in cognitive functioning as a refined approach to comparing aging across countries. %A Skirbekk, V. %A Loichinger, E. %A Daniela Weber %K Age Distribution %K Aged %K Aged, 80 and over %K Aging %K Cognition %K Data collection %K Databases as Topic %K Humans %K Internationality %K Male %K Middle Aged %X

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

%B Proc Natl Acad Sci U S A %I 109 %V 109 %P 770-4 %8 2012 Jan 17 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22184241?dopt=Abstract %2 PMC3271876 %4 Age Distribution/Aged, 80 and over/Aging/ physiology/Aging/ physiology/Cognition/ physiology/Cognition/ physiology/Data Collection/Middle Aged/Cross Cultural Comparison %$ 69466 %R 10.1073/pnas.1112173109 %0 Report %D 2012 %T Were They Prepared for Retirement? Financial Status at Advanced Ages in the HRS and AHEAD Cohorts %A James M. Poterba %A Steven F Venti %A David A Wise %K Consumption and Savings %K Employment and Labor Force %K Event History/Life Cycle %K Net Worth and Assets %K Women and Minorities %X Many analysts have considered whether households approaching retirement age have accumulated enough assets to be well prepared for retirement. In this paper, we shift from studying household finances at the start of the retirement period, an ex ante measure of retirement preparation, to studying the asset holdings of households in their last years of life. The analysis is based on Health and Retirement Study with special attention to Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort that was first surveyed in 1993. We consider the level of assets that households hold in the last survey wave preceding their death. We study how assets at the end of life depend on three family status pathways prior to death--(1) original one-person households in 1993, (2) persons in two-person household in 1993 with a deceased spouse in the last year observed, and (3) persons in two-person households in 1993 with the spouse alive when last observed. We find that a substantial fraction of persons die with virtually no financial assets--46.1 percent with less than 10,000--and many of these households also have no housing wealth and rely almost entirely on Social Security benefits for support. In addition this group is disproportionately in poor health. Based on a replacement rate comparison, many of these households may be deemed to have been well-prepared for retirement, in the sense that their income in their final years was not substantially lower than their income in their late 50s or early 60s. Yet with such low asset levels, they would have little capacity to pay for unanticipated needs such as health expenses or other financial shocks or to pay for entertainment, travel, or other activities. This raises a question of whether the replacement ratio is a sufficient statistic for the adequacy of retirement preparation. %I National Bureau of Economic Research %G eng %U URL:http://www.nber.org/papers/w17824.pdf URL %4 Asset accumulation/Personal Finance/Intertemporal Consumer Choice/Life Cycle Models and Saving/Economics of the Elderly/Economics of the Handicapped/Non-labor Market Discrimination %$ 62866 %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 J Gerontol B Psychol Sci Soc Sci %D 2011 %T Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study. %A Eileen M. Crimmins %A Jung K Kim %A Kenneth M. Langa %A David R Weir %K Age Factors %K Aged %K Aged, 80 and over %K Cognition %K Cognition Disorders %K Dementia %K Educational Status %K Female %K Humans %K Interviews as Topic %K Logistic Models %K Longitudinal Studies %K Male %K Multivariate Analysis %K Neuropsychological tests %K Odds Ratio %K Prevalence %K Sex Factors %K United States %X

OBJECTIVES: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]).

METHODS: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS.

RESULTS: The cognitive tests in HRS predict the ADAMS diagnosis in 74% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84% and 93%, respectively.

DISCUSSION: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.

%B J Gerontol B Psychol Sci Soc Sci %I 66 Suppl 1 %V 66 Suppl 1 %P i162-71 %8 2011 Jul %G eng %N Suppl 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21743047?dopt=Abstract %2 PMC3165454 %4 Age Factors/Aged, 80 and over/Cognition/Cognition Disorders/ diagnosis/epidemiology/psychology/Cognition Disorders/ diagnosis/epidemiology/psychology/Dementia/ diagnosis/epidemiology/psychology/Dementia/ diagnosis/epidemiology/psychology/Educational Status/Female/Logistic Models/Longitudinal Studies/Multivariate Analysis/Neuropsychological Tests/Odds Ratio/Prevalence/Sex Factors/United States/epidemiology/United States/epidemiology %$ 62734 %R 10.1093/geronb/gbr048 %0 Journal Article %J Res Aging %D 2011 %T BMI Trajectories During the Transition to Older Adulthood: Persistent, Widening, or Diminishing Disparities by Ethnicity and Education? %A Katrina M Walsemann %A Jennifer A Ailshire %X

Previous research has produced inconsistent results on whether education and ethnic disparities in body mass index (BMI) persist, widen, or diminish over time. The authors investigate how education and ethnicity, independently and conditionally, influence BMI trajectories during the transition to older adulthood. Employing random coefficient modeling, the authors analyzed eight biennial waves of data (1992-2006) from the Health and Retirement Study, a nationally representative longitudinal study of individuals born between 1931 and 1941. After adjusting for health behaviors and health status, education and ethnic disparities in BMI persisted for most groups, but narrowed between high-educated White men and both low-educated Hispanic men and high-educated Black men. As such, the findings generally support the persistent inequality interpretation. Therefore, even though interventions targeted at earlier points in the life course may be effective in reducing BMI disparities in later life, social and health policies directed at reducing obesity among older adults is also warranted.

%B Res Aging %I 33 %V 33 %P 286-311 %8 2011 May %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/30089935?dopt=Abstract %4 Body mass index/Older people/Ethnicity/Education/Health behavior/Obesity/Aging %$ 62500 %R 10.1177/0164027511399104 %0 Journal Article %J J Occup Environ Med %D 2011 %T Chronic diseases and functional limitations among older construction workers in the United States: a 10-year follow-up study. %A Xiuwen S Dong %A Wang, Xuanwen %A Daw, Christina %A Ringen, Knut %K Aged %K Aging %K Arthritis %K Chronic disease %K Disabled Persons %K Facility Design and Construction %K Follow-Up Studies %K Humans %K Lung Diseases %K Male %K Middle Aged %K Occupational Diseases %K Occupations %K United States %X

OBJECTIVES: To examine the health status of older construction workers in the United States, and how occupation and the aging process affect health in workers' later years.

METHODS: We analyzed six waves (1998 to 2008) of the Health and Retirement Study, a longitudinal survey of US residents age 50+. The study sample totaled 7200 male workers (510 in construction trades) in the baseline. Multiple logistic regression and paired t tests were conducted to compare health outcomes across occupations and within individuals over time.

RESULTS: Compared with white-collar workers, construction workers had increased odds of arthritis, back problems, chronic lung disease, functional limitations, work disability, and work-related injuries after controlling for possible confounders.

CONCLUSIONS: Safety and health interventions, as well as retirement and pension policy, should meet the needs of older construction workers, who face increasingly chronic health conditions over time.

%B J Occup Environ Med %I 53 %V 53 %P 372-80 %8 2011 Apr %G eng %N 4 %L newpubs20110418_Dong.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21407096?dopt=Abstract %3 21407096 %4 Occupation/Aging/DISABILITY/DISABILITY/construction workers/chronic Disease %$ 24730 %R 10.1097/JOM.0b013e3182122286 %0 Book Section %B Explorations in the Economics of Aging %D 2011 %T Cognition and Economic Outcomes %A John J McArdle %A James P Smith %A Robert J. Willis %E David A Wise %K Health Conditions and Status %B Explorations in the Economics of Aging %I University of Chicago Press %C Chicago %G eng %4 cognition %$ 23450 %! Cognition and Economic Outcomes %0 Report %D 2011 %T Cognitive Aging and Human Capital %A John J McArdle %A Robert J. Willis %K Health Conditions and Status %K Net Worth and Assets %I University of Michigan %G eng %4 human Capital/Cognitive ability/Aging %$ 62830 %0 Report %D 2011 %T The Composition and Draw-down of Wealth in Retirement %A James M. Poterba %A Steven F Venti %A David A Wise %K Consumption and Savings %K Employment and Labor Force %K Event History/Life Cycle %K Women and Minorities %X This paper presents evidence on the resources available to households as they enter retirement. It draws heavily on data collected by the Health and Retirement Study and calculates the potential additional annuity income that households could purchase, given their holdings of non-annuitized financial assets at the start of retirement. Even if households used all of their financial assets inside and outside personal retirement accounts to purchase a life annuity, only 47 percent of households between the ages of 65 and 69 in 2008 could increase their life-contingent income by more than 5,000 per year. At the upper end of the wealth distribution, however, a substantial number of households could make large annuity purchases. The paper also considers the role of housing equity in the portfolios of retirement-age households, and explores the extent to which households draw down housing equity and financial assets as they age. Many households appear to treat housing equity and non-annuitized financial assets as precautionary savings, tending to draw them down only when they experience a shock such as the death of a spouse or a period of substantial medical outlays. Because home equity is often conserved until very late in life, for many households it may provide some insurance against the risk of living longer than expected. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 Personal Finance/Intertemporal Consumer Choice/Life Cycle Models and Saving/Economics of the Elderly/Economics of the Handicapped/Non-labor Market Discrimination %$ 62801 %R 10.3386/w17536 %0 Journal Article %J Journal of General Internal Medicine %D 2011 %T Conducting High-Value Secondary Dataset Analysis: An Introductory Guide and Resources %A John Z. Ayanian %A Kenneth E Covinsky %A Landon, Bruce E. %A Ellen P McCarthy %A Wee, Christina C. %A Michael A Steinman %K Datasets %K Meta-analyses %K Survey Methodology %X Secondary analyses of large datasets provide a mechanism for researchers to address high impact questions that would otherwise be prohibitively expensive and time-consuming to study. This paper presents a guide to assist investigators interested in conducting secondary data analysis, including advice on the process of successful secondary data analysis as well as a brief summary of high-value datasets and online resources for researchers, including the SGIM dataset compendium (www.sgim.org/go/datasets). The same basic research principles that apply to primary data analysis apply to secondary data analysis, including the development of a clear and clinically relevant research question, study sample, appropriate measures, and a thoughtful analytic approach. A real-world case description illustrates key steps: (1) define your research topic and question; (2) select a dataset; (3) get to know your dataset; and (4) structure your analysis and presentation of findings in a way that is clinically meaningful. Secondary dataset analysis is a well-established methodology. Secondary analysis is particularly valuable for junior investigators, who have limited time and resources to demonstrate expertise and productivity. %B Journal of General Internal Medicine %V 26 %P 920-929 %G eng %N 8 %R 10.1007/s11606-010-1621-5 %0 Journal Article %J J Am Geriatr Soc %D 2011 %T Determinants of death in the hospital among older adults. %A Amy Kelley %A Susan L Ettner %A Neil S. Wenger %A Catherine A Sarkisian %K Aged %K Aged, 80 and over %K Female %K Hospital Mortality %K Humans %K Male %K Multivariate Analysis %K Risk Factors %K Socioeconomic factors %X

OBJECTIVES: To investigate patient-level determinants of in-hospital death, adjusting for patient and regional characteristics.

DESIGN: Using multivariable regression, the relationship between in-hospital death and participants' social, functional, and health characteristics was investigated, controlling for regional Hospital Care Intensity Index (HCI) from the Dartmouth Atlas of Health Care.

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

PARTICIPANTS: People aged 67 and older who died between 2,000 and 2,006 (N = 3,539) were sampled.

MEASUREMENTS: In-hospital death.

RESULTS: Thirty-nine percent (n = 1,380) of participants died in the hospital (range 34% in Midwest to 45% in Northeast). Nursing home residence, functional dependence, and cancer or dementia diagnosis, among other characteristics, were associated with lower adjusted odds of in-hospital death. Being black or Hispanic, living alone, and having more medical comorbidities were associated with greater adjusted odds, as was higher HCI. Sex, education, net worth, and completion of an advance directive did not correlate with in-hospital death.

CONCLUSION: Black race, Hispanic ethnicity, and other functional and social characteristics are correlates of in-hospital death, even after controlling for the role of HCI. Further work must be done to determine whether preferences, provider characteristics and practice patterns, or differential access to medical and community services drive this difference.

%B J Am Geriatr Soc %I 59 %V 59 %P 2321-5 %8 2011 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/22092014?dopt=Abstract %3 22092014 %4 in-hospital death/in-hospital death/COMORBIDITY/African American/hispanic/Hospital Mortality/Hospital Mortality/Hospital Care Intensity Index/Hospital Care Intensity Index %$ 62684 %R 10.1111/j.1532-5415.2011.03718.x %0 Journal Article %J Annals of Internal Medicine %D 2011 %T Determinants of medical expenditures in the last 6 months of life. %A Amy Kelley %A Susan L Ettner %A R Sean Morrison %A Qingling Du %A Neil S. Wenger %A Catherine A Sarkisian %K Aged %K Aged, 80 and over %K Chronic disease %K Ethnic Groups %K Female %K Health Expenditures %K Humans %K Income %K Independent Living %K Male %K Medicare %K Regression Analysis %K Social Support %K Socioeconomic factors %K Terminal Care %K United States %X

BACKGROUND: End-of-life medical expenditures exceed costs of care during other years, vary across regions, and are likely to be unsustainable. Identifying determinants of expenditure variation may reveal opportunities for reducing costs.

OBJECTIVE: To identify patient-level determinants of Medicare expenditures at the end of life and to determine the contributions of these factors to expenditure variation while accounting for regional characteristics. It was hypothesized that race or ethnicity, social support, and functional status are independently associated with treatment intensity and controlling for regional characteristics, and that individual characteristics account for a substantial proportion of expenditure variation.

DESIGN: Using data from the Health and Retirement Study, Medicare claims, and The Dartmouth Atlas of Health Care, relationships were modeled between expenditures and patient and regional characteristics.

SETTING: United States, 2000 to 2006.

PARTICIPANTS: 2394 Health and Retirement Study decedents aged 65.5 years or older.

MEASUREMENTS: Medicare expenditures in the last 6 months of life were estimated in a series of 2-level multivariable regression models that included patient, regional, and patient and regional characteristics.

RESULTS: Decline in function (rate ratio [RR], 1.64 [95% CI, 1.46 to 1.83]); Hispanic ethnicity (RR, 1.50 [CI, 1.22 to 1.85]); black race (RR, 1.43 [CI, 1.25 to 1.64]); and certain chronic diseases, including diabetes (RR, 1.16 [CI, 1.06 to 1.27]), were associated with higher expenditures. Nearby family (RR, 0.90 [CI, 0.82 to 0.98]) and dementia (RR, 0.78 CI, 0.71 to 0.87]) were associated with lower expenditures, and advance care planning had no association. Regional characteristics, including end-of-life practice patterns (RR, 1.09 [CI, 1.06 to 1.14]) and hospital beds per capita (RR, 1.01 [CI, 1.00 to 1.02]), were associated with higher expenditures. Patient characteristics explained 10% of overall variance and retained statistically significant relationships with expenditures after regional characteristics were controlled for.

LIMITATION: The study limitations include the decedent sample, proxy informants, and a large proportion of unexplained variation.

CONCLUSION: Patient characteristics, such as functional decline, race or ethnicity, chronic disease, and nearby family, are important determinants of expenditures at the end of life, independent of regional characteristics.

PRIMARY FUNDING SOURCE: The Brookdale Foundation.

%B Annals of Internal Medicine %V 154 %P 235-242 %G eng %N 4 %R 10.7326/0003-4819-154-4-201102150-00004 %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 informal care attenuate the cycle of ADL/IADL disability and depressive symptoms in late life? %A Lin, I-Fen %A Wu, Hsueh-Sheng %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Cohort Studies %K Cost of Illness %K depression %K Disability Evaluation %K Female %K Humans %K Longitudinal Studies %K Male %K Models, Psychological %K United States %X

OBJECTIVE: Prior studies have extensively examined the reciprocal relation between disability and depressive symptoms in late life, but little is known about whether informal care attenuates the reciprocal relation over time. This study examined whether disability and depressive symptoms mobilize informal care and whether informal care, once mobilized, protects older adults against the progression of disability and depressive symptoms.

METHODS: The analysis was based on 6,454 community-dwelling older adults who were interviewed in one or more waves of the Health and Retirement Study between 1998 and 2006. Extending an autoregressive cross-lagged model, we constructed 3 cycles of the relations among disability, depressive symptoms, and informal care. Comparing the relations across 3 cycles informs us about the attenuating effect of informal care on the relation between disability and depressive symptoms over time.

RESULTS: Although older adults' disability and depressive symptoms mobilized informal care initially, worsening disability and depressive symptoms often exhausted support. Receipt of care generally increased, rather than decreased, disability and depressive symptoms, and the detrimental effects remained the same over time.

DISCUSSION: We need to better understand the linkage between disability and depressive symptoms and seek effective interventions to reduce caregiver strain and enhance care receivers' well-being.

%B J Gerontol B Psychol Sci Soc Sci %I 66B %V 66 %P 585-94 %8 2011 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21746870?dopt=Abstract %2 PMC3155031 %4 Disability/Disability/Mental depression/Older people/Caregivers/Gerontology/Mobility %$ 62618 %R 10.1093/geronb/gbr060 %0 Thesis %D 2011 %T The Dynamics of Living Arrangements Among the Elderly %A Witvorapong, Nopphol %K Healthcare %K Methodology %K Public Policy %X Combining care arrangements and whom the elderly live with, I study the mechanisms behind changes in living arrangements. I estimate a dynamic model of living arrangements, savings, intergenerational transfers and health outcomes. I use the nonlinear discrete factor random effects estimation method to control for unobserved heterogeneity. I use the rich data available in the 1995 - 2006 waves of the Health and Retirement Study (HRS) and supplement them with data on Medicaid and costs of care, resulting in a unique data set. I find that living arrangements are strongly influenced by health and savings. In particular, functional health is the strongest predictor of living arrangements. Inter vivos transfers and bequest intent affect living arrangements only to the extent that they impact the distribution of unobserved heterogeneity, indicating the absence of the exchange hypothesis as far as living arrangements are concerned. Public policies have a small but significant effect in the determination of living arrangements. For example, a twofold increase in the probability of receiving nursing home benefits among Medicaid eligibles increases the use of nursing home only by a 0.1 percentage point. The effects of public policies are more pronounced among elderly individuals with poor initial health and low initial wealth. %I The University of North Carolina at Chapel Hill %C Chapel Hill, NC %V Ph.D. %P 175 %G eng %4 Public health %$ 62658 %R https://doi.org/10.17615/g4eg-0w45 %0 Journal Article %J Nicotine Tob Res %D 2011 %T Effects of smoking cessation on pain in older adults. %A Yu Shi %A Hooten, W Michael %A David O. Warner %K Aged %K Body Mass Index %K depression %K Female %K Follow-Up Studies %K Humans %K Interviews as Topic %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Odds Ratio %K pain %K Pain Perception %K Smoking %K Smoking cessation %K Smoking Prevention %X

INTRODUCTION: Smokers are at increased risk of developing chronic pain and suffering higher pain intensity. However, nicotine has analgesic properties, and smokers may view smoking as a means to cope with pain. Smoking cessation is clearly beneficial to the long-term health of smokers. However, it is not known how abstinence from smoking affects pain. The aim of this study was to determine the association between smoking cessation and changes in pain symptoms by secondary analysis of a large longitudinal dataset of older adults.

METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992 through 2006) from the nationally representative Health and Retirement Study of United States adults older than 50 years. Multivariate logistic regressions were utilized to determine the relationship between the changes in smoking status and changes in pain symptoms, controlling for demographics, depression, self-rated health, history of arthritis, and body mass index.

RESULTS: In multivariate analyses, among the 4,695 smokers who reported no pain or mild pain at enrollment, smoking status was not independently associated with exacerbation of pain (odds ratio [OR]: 0.95, 95% CI: 0.84, 1.08). Among the 1,118 smokers who reported moderate to severe pain at enrollment, smoking status was not independently associated with improvement of pain (OR: 0.87, 95% CI: 0.70, 1.08).

CONCLUSIONS: Smoking cessation was not independently associated with changes in pain symptoms in older adults. These results suggest that concerns regarding the effects of abstinence from smoking on pain should not pose a barrier to offering tobacco use interventions to smokers with chronic pain.

%B Nicotine Tob Res %I 13 %V 13 %P 919-25 %8 2011 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/21571690?dopt=Abstract %2 PMC3179669 %4 Smoking/chronic Disease/smoking Cessation/Socioeconomic Differences %$ 62756 %R 10.1093/ntr/ntr097 %0 Journal Article %J JAMA %D 2011 %T The evolution of advance directives. %A Douglas B. White %A Robert M. Arnold %K Advance directives %K Cost Savings %K Decision making %K Health Expenditures %K Humans %K Medicare %K Palliative care %K Terminal Care %K United States %B JAMA %I 306 %V 306 %P 1485-6 %8 2011 Oct 05 %G eng %N 13 %1 http://www.ncbi.nlm.nih.gov/pubmed/21972313?dopt=Abstract %3 21972313 %4 Medicare/Advance directives/Medical technology/Health care expenditures %$ 62612 %R 10.1001/jama.2011.1430 %0 Report %D 2011 %T Expectations versus Realizations of Familial Insurance: Evidence from the Great Recession of 2008 %A Cox, Donald %A Way, Megan McDonald %K Expectations %I Boston College %G eng %4 expectations %$ 25320 %0 Journal Article %J Ann Behav Med %D 2011 %T Gender differences in functional limitations in adults living with type 2 diabetes: biobehavioral and psychosocial mediators. %A Chiu, Ching-Ju %A Linda A. Wray %K Adult %K Aged %K Aged, 80 and over %K Biomarkers %K Blood Glucose Self-Monitoring %K Body Mass Index %K Diabetes Mellitus, Type 2 %K Exercise %K Female %K Health Behavior %K Humans %K Male %K Middle Aged %K Models, Psychological %K Prospective Studies %K Risk Factors %K Self Report %K Sex Characteristics %K Socioeconomic factors %K United States %X

BACKGROUND: Differences in functional limitations between adults with and without diabetes are more evident in women than they are in men.

PURPOSE: This study aims to investigate if there are gender differences in biological, behavioral, and psychosocial variables, and how these gender-related variables explain the gender-functional limitations relationship in adults with type 2 diabetes.

METHODS: We drew data on 1,619 adults with type 2 diabetes from the Health and Retirement Study and its diabetes-specific mail survey. The fit of a series of mediation models to the data was assessed by structural equation modeling.

RESULTS: Although women had better diet and blood glucose self-monitoring behaviors than did men, they reported less favorable body mass index, glycosylated hemoglobin (HbA1c) value, blood pressure, early complications, exercise behaviors, perceived control, self-efficacy, coping, depressive symptoms, and family support than did men. Psychosocial factors made an indirect contribution in the gender-functional limitations relationship by way of their strong association with biological and behavioral factors, two factors that directly and completely mediated the gender-functional limitations relationship.

CONCLUSIONS: Interventions promoting psychosocial well-being and empowering perceived diabetes control, coping, and self-efficacy in women with type 2 diabetes may help improve biological and behavioral determinants, and further, their long-term functional health.

%B Ann Behav Med %I 41 %V 41 %P 71-82 %8 2011 Feb %G eng %N 1 %L newpubs20110418_Chiu.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20827519?dopt=Abstract %4 Gender differences/Psychosocial well-being/Mediator/Structural equation modeling/Functional limitations %$ 24790 %R 10.1007/s12160-010-9226-0 %0 Book Section %B Investigations in the Economics of Aging %D 2011 %T "Healthy, Wealthy and Wise?" Revisited: An Analysis of the Causal Pathways from Socioeconomic Status to Health %A Till Stowasser %A Florian Heiss %A Daniel McFadden %A Joachim Winter %K health %K socioeconomic status %X In health economics, there is little dispute that the socioeconomic status (SES) of individuals is positively correlated with their health status. The size of the body of literature documenting that wealthy and well- educated people generally enjoy better health and longer life is impressive.1 The robustness of this association is underscored by the fact that the so- called health- wealth gradient has been detected in different times, countries, populations, age structures, and for both men and women. Moreover, the results are largely insensitive to the choice of SES measures (such as wealth, income, education, occupation, or social class) and health outcomes. %B Investigations in the Economics of Aging %I University of Chicago Press %P 267-317 %G eng %U http://www.nber.org/chapters/c12443 %0 Journal Article %J Eur J Epidemiol %D 2011 %T Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study. %A Mieke Reuser %A Frans J Willekens %A Luc G Bonneux %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cognition Disorders %K Educational Status %K Female %K Health Surveys %K Humans %K Incidence %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Prevalence %K Proportional Hazards Models %K Retirement %K Sex Factors %K Smoking %K Time Factors %K United States %X

Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.

%B Eur J Epidemiol %I 26 %V 26 %P 395-403 %8 2011 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21337033?dopt=Abstract %2 PMC3109265 %4 Cognitive ability/Life tables/Body mass index/Smoking/Educational attainment/Minority groups/ethnic Groups %$ 69390 %R 10.1007/s10654-011-9553-x %0 Report %D 2011 %T Household Stock Market Beliefs and Learning %A Kezdi, Gabor %A Robert J. Willis %K Consumption and Savings %K Expectations %K Methodology %K Net Worth and Assets %X This paper characterizes heterogeneity of the beliefs of American households about future stock market returns, provides an explanation for that heterogeneity and establishes its relationship to stock holding behavior. We find substantial belief heterogeneity that is puzzling since households can observe the same publicly available information about the stock market. We propose a simple learning model where agents can invest in the acquisition of financial knowledge. Differential incentives to learn about the returns process can explain heterogeneity in beliefs. We check this explanation by using data on beliefs elicited as subjective probabilities and a rich set of other variables from the Health and Retirement Study. Both descriptive statistics and estimated relevant heterogeneity of the structural parameters provide support for our explanation. People with higher lifetime earnings, higher education, higher cognitive abilities, defined contribution as opposed to defined benefit pension plans, for example, possess beliefs that are considerably closer to what historical time series would imply. Our results also suggest that a substantial part of the reduced form relationship between stock holding and household characteristics is due to differences in beliefs. Our methodological contribution is estimating relevant heterogeneity of structural belief parameters from noisy survey answers to probability questions. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 Multiple or Simultaneous Equation Models/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Information, Knowledge, and Uncertainty: General/Information, Knowledge, and Uncertainty: General/Subjective Probabilities/Stock Market %$ 62802 %R 10.3386/w17614 %0 Report %D 2011 %T How Do Subjective Mortality Beliefs Affect the Value of Social Security and the Optimal Claiming Age %A Wei Sun %A Anthony Webb %K Expectations %K Health Conditions and Status %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X Households that delay claiming Social Security are, in effect, making additional purchases of the Social Security annuity. Theoretical calculations show the delayed claiming is optimal, even for high mortality households. Yet most claim well before the theoretically optimal age. This paper investigates whether subjective mortality beliefs contribute to the prevalence of early claiming. The value of delay depends not only on life expectancy, but also on the degree of uncertainty surrounding the age of death. Using data from the Health and Retirement Study, we show that women approaching retirement understate their probabilities of surviving to age 75 by an average of 10 percentage points, whereas men's forecasts are, on average, correct. But both men and women exhibit greater confidence in their ability to forecast their age of death, relative to the predictions of life tables. But these subjective mortality beliefs have little effect on the value of Social Security or the optimal claim age, and cannot explain the prevalence of early claiming. We also find that self-assessed survival probabilities do not predict survival after controlling for health and socio-economic status, indicating a potential for medical underwriting to reduce adverse selection in the annuity market. %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/how-do-subjective-mortality-beliefs-affect-the-value-of-social-security-and-the-optimal-claiming-age/ %4 Mortality/social security/public policy/subjective mortality beliefs/early claiming %$ 69552 %0 Journal Article %J J Aging Res %D 2011 %T The Impact of Physical Activity on Disability Incidence among Older Adults in Mexico and the United States. %A Kerstin Gerst %A Alejandra Michaels-Obregon %A Rebeca Wong %X

Evidence suggests that transitions among older adults towards healthy habits, such as physical activity, appear underway in developed countries such as the USA but not in developing countries such as Mexico. However, little is known about the potential benefit of physical activity in preventing disability among elders in countries at different stages of epidemiological transition. We explore the impact of physical activity on the disablement process among elders in Mexico compared to the USA. Data are from two waves of the Mexican Health and Aging Study and the Health and Retirement Study. We examine the impact of exercise on the transition from no disability to ADL limitations two years later. Findings indicate that exercise is more common in the U.S. than in Mexico. There is a positive effect of exercise on negative outcomes in both countries. However, the protective effect of exercise is stronger in the U.S. than in Mexico.

%B J Aging Res %I 2011 %V 2011 %P 420714 %8 2011 Apr 10 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21584238?dopt=Abstract %2 PMC3092574 %4 MHAS_/physical Activity/DISABILITY/DISABILITY/developing countries/developing countries/exercise %$ 62754 %R 10.4061/2011/420714 %0 Thesis %B Department of Economics %D 2011 %T The implications of Alzheimer's Risk for Household Financial Decision Making: Essays on the acquisition of human capital %A John Hsu %Y Robert J. Willis %K Health Conditions and Status %K Retirement Planning and Satisfaction %B Department of Economics %I University of Michigan %G eng %U https://irs.princeton.edu/sites/g/files/toruqf276/files/uploads/documents/ReivsedRobertWillis.pdf %9 Dissertation Chapter %4 household decision-making %$ 25260 %! The implications of Alzheimer's Risk for Household Financial Decision Making: Essays on the acquisition of human capital %0 Journal Article %J Ann Neurol %D 2011 %T Incidence of dementia and cognitive impairment, not dementia in the United States. %A Brenda L Plassman %A Kenneth M. Langa %A Ryan J McCammon %A Gwenith G Fisher %A Guy G Potter %A James R Burke %A David C Steffens %A Norman L Foster %A Bruno J Giordani %A Frederick W Unverzagt %A Kathleen A Welsh-Bohmer %A Steven G Heeringa %A David R Weir %A Robert B Wallace %K Aged %K Aged, 80 and over %K Alzheimer disease %K Cognition Disorders %K Cohort Studies %K Dementia %K Diagnostic and Statistical Manual of Mental Disorders %K disease progression %K Female %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Models, Statistical %K United States %X

OBJECTIVE: Estimates of incident dementia, and cognitive impairment, not dementia (CIND) (or the related mild cognitive impairment) are important for public health and clinical care policy. In this paper, we report US national incidence rates for dementia and CIND.

METHODS: Participants in the Aging, Demographic, and Memory Study (ADAMS) were evaluated for cognitive impairment using a comprehensive in-home assessment. A total of 456 individuals aged 72 years and older, who were not demented at baseline, were followed longitudinally from August 2001 to December 2009. An expert consensus panel assigned a diagnosis of normal cognition, CIND, or dementia and its subtypes. Using a population-weighted sample, we estimated the incidence of dementia, Alzheimer disease (AD), vascular dementia (VaD), and CIND by age. We also estimated the incidence of progression from CIND to dementia.

RESULTS: The incidence of dementia was 33.3 (standard error [SE], 4.2) per 1,000 person-years and 22.9 (SE, 2.9) per 1,000 person-years for AD. The incidence of CIND was 60.4 (SE, 7.2) cases per 1,000 person-years. An estimated 120.3 (SE, 16.9) individuals per 1,000 person-years progressed from CIND to dementia. Over a 5.9-year period, about 3.4 million individuals aged 72 and older in the United States developed incident dementia, of whom approximately 2.3 million developed AD, and about 637,000 developed VaD. Over this same period, almost 4.8 million individuals developed incident CIND.

INTERPRETATION: The incidence of CIND is greater than the incidence of dementia, and those with CIND are at high risk of progressing to dementia, making CIND a potentially valuable target for treatments aimed at slowing cognitive decline.

%B Ann Neurol %V 70 %P 418-26 %8 2011 Sep %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/21425187?dopt=Abstract %2 PMC3139807 %4 Dementia/Cognitive Impairment/Alzheimer disease/vascular dementia/incident dementia %$ 25310 %R 10.1002/ana.22362 %0 Journal Article %J BMC Geriatr %D 2011 %T Long-term declines in ADLs, IADLs, and mobility among older Medicare beneficiaries. %A Frederic D Wolinsky %A Suzanne E Bentler %A Jason Hockenberry %A Michael P Jones %A Maksym Obrizan %A Paula A Weigel %A Kaskie, Brian %A Robert B Wallace %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cohort Studies %K Disabled Persons %K Female %K Follow-Up Studies %K Geriatric Assessment %K Health Surveys %K Humans %K Insurance Benefits %K Longitudinal Studies %K Male %K Medicare %K Mobility Limitation %K Prospective Studies %K Time Factors %K United States %X

BACKGROUND: Most prior studies have focused on short-term (≤ 2 years) functional declines. But those studies cannot address aging effects inasmuch as all participants have aged the same amount. Therefore, the authors studied the extent of long-term functional decline in older Medicare beneficiaries who were followed for varying time lengths, and the authors also identified the risk factors associated with those declines.

METHODS: The analytic sample included 5,871 self- or proxy-respondents who had complete baseline and follow-up survey data that could be linked to their Medicare claims for 1993-2007. Functional status was assessed using activities of daily living (ADLs), instrumental ADLs (IADLs), and mobility limitations, with declines defined as the development of two of more new difficulties. Multiple logistic regression analysis was used to focus on the associations involving respondent status, health lifestyle, continuity of care, managed care status, health shocks, and terminal drop.

RESULTS: The average amount of time between the first and final interviews was 8.0 years. Declines were observed for 36.6% on ADL abilities, 32.3% on IADL abilities, and 30.9% on mobility abilities. Functional decline was more likely to occur when proxy-reports were used, and the effects of baseline function on decline were reduced when proxy-reports were used. Engaging in vigorous physical activity consistently and substantially protected against functional decline, whereas obesity, cigarette smoking, and alcohol consumption were only associated with mobility declines. Post-baseline hospitalizations were the most robust predictors of functional decline, exhibiting a dose-response effect such that the greater the average annual number of hospital episodes, the greater the likelihood of functional status decline. Participants whose final interview preceded their death by one year or less had substantially greater odds of functional status decline.

CONCLUSIONS: Both the additive and interactive (with functional status) effects of respondent status should be taken into consideration whenever proxy-reports are used. Encouraging exercise could broadly reduce the risk of functional decline across all three outcomes, although interventions encouraging weight reduction and smoking cessation would only affect mobility declines. Reducing hospitalization and re-hospitalization rates could also broadly reduce the risk of functional decline across all three outcomes.

%B BMC Geriatr %I 11 %V 11 %P 43 %8 2011 Aug 16 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21846400?dopt=Abstract %2 PMC3167753 %4 SELF-RATED HEALTH/Medicare/Functional decline/Functional decline/ADL/IADL/risk Factors %$ 25090 %R 10.1186/1471-2318-11-43 %0 Journal Article %J BMC Geriatrrics %D 2011 %T Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns. %A Kaskie, Brian %A Maksym Obrizan %A Michael P Jones %A Suzanne E Bentler %A Paula A Weigel %A Jason Hockenberry %A Robert B Wallace %A Robert L. Ohsfeldt %A Gary E Rosenthal %A Frederic D Wolinsky %K Emergency services %K Health Shocks %K Medicare/Medicaid/Health Insurance %K Older Adults %X

BACKGROUND: It is well known that older adults figure prominently in the use of emergency departments (ED) across the United States. Previous research has differentiated ED visits by levels of clinical severity and found health status and other individual characteristics distinguished severe from non-severe visits. In this research, we classified older adults into population groups that persistently present with severe, non-severe, or indeterminate patterns of ED episodes. We then contrasted the three groups using a comprehensive set of covariates.

METHODS: Using a unique dataset linking individual characteristics with Medicare claims for calendar years 1991-2007, we identified patterns of ED use among the large, nationally representative AHEAD sample consisting of 5,510 older adults. We then classified one group of older adults who persistently presented to the ED with clinically severe episodes and another group who persistently presented to the ED with non-severe episodes. These two groups were contrasted using logistic regression, and then contrasted against a third group with a persistent pattern of ED episodes with indeterminate levels of severity using multinomial logistic regression. Variable selection was based on Andersen's behavioral model of health services use and featured clinical status, demographic and socioeconomic characteristics, health behaviors, health service use patterns, local health care supply, and other contextual effects.

RESULTS: We identified 948 individuals (17.2% of the entire sample) who presented a pattern in which their ED episodes were typically defined as severe and 1,076 individuals (19.5%) who typically presented with non-severe episodes. Individuals who persistently presented to the ED with severe episodes were more likely to be older (AOR 1.52), men (AOR 1.28), current smokers (AOR 1.60), experience diabetes (AOR (AOR 1.80), heart disease (AOR 1.70), hypertension (AOR 1.32) and have a greater amount of morbidity (AOR 1.48) than those who persistently presented to the ED with non-severe episodes. When contrasted with 1,177 individuals with a persistent pattern of indeterminate severity ED use, persons with severe patterns were older (AOR 1.36), more likely to be obese (AOR 1.36), and experience heart disease (AOR 1.49) and hypertension (AOR 1.36) while persons with non-severe patterns were less likely to smoke (AOR 0.63) and have diabetes (AOR 0.67) or lung disease (AOR 0.58).

CONCLUSIONS: We distinguished three large, readily identifiable groups of older adults which figure prominently in the use of EDs across the United States. Our results suggest that one group affects the general capacity of the ED to provide care as they persistently present with severe episodes requiring urgent staff attention and greater resource allocation. Another group persistently presents with non-severe episodes and creates a considerable share of the excess demand for ED care. Future research should determine how chronic disease management programs and varied co-payment obligations might impact the use of the ED by these two large and distinct groups of older adults with consistent ED use patterns.

%B BMC Geriatrrics %V 11 %P 65 %G eng %R 10.1186/1471-2318-11-65 %0 Journal Article %J Alzheimers Dement %D 2011 %T Operationalizing diagnostic criteria for Alzheimer's disease and other age-related cognitive impairment-Part 2. %A Seshadri, Sudha %A Alexa S. Beiser %A Au, Rhoda %A Philip A Wolf %A Robert S Wilson %A Ronald C Petersen %A David S Knopman %A Walter A Rocca %A Claudia H Kawas %A Maria M Corrada %A Brenda L Plassman %A Kenneth M. Langa %A Helena C Chui %K Age Factors %K Aging %K Alzheimer disease %K Cognition Disorders %K Community Health Planning %K Humans %K Incidence %K Longitudinal Studies %K Neuropsychological tests %K Prevalence %K United States %X

This article focuses on the effects of operational differences in case ascertainment on estimates of prevalence and incidence of cognitive impairment and/or dementia of the Alzheimer type. Experience and insights are discussed by investigators from the Framingham Heart Study, the East Boston Senior Health Project, the Chicago Health and Aging Project, the Mayo Clinic Study of Aging, the Baltimore Longitudinal Study of Aging, and the Aging, Demographics, and Memory Study. There is a general consensus that the single most important factor determining prevalence estimates of Alzheimer's disease (AD) is the severity of cognitive impairment used as a threshold to define cases. Studies that require a level of cognitive impairment in which persons are unable to provide self-care will have much lower estimates than the studies aimed at identifying persons in the earliest stages of AD. There are limited autopsy data from the aforementioned epidemiological studies to address accuracy in the diagnosis of etiological subtype, namely the specification of AD alone or in combination with other types of pathology. However, other community-based cohort studies show that many persons with mild cognitive impairment and also some persons without dementia or mild cognitive impairment meet pathological criteria for AD, thereby suggesting that the number of persons who would benefit from an effective secondary prevention intervention is probably higher than the published prevalence estimates. Improved accuracy in the clinical diagnosis of AD is anticipated with the addition of molecular and structural biomarkers in the next generation of epidemiological studies.

%B Alzheimers Dement %I 7 %V 7 %P 35-52 %8 2011 Jan %G eng %N 1 %L newpubs20110328_Seshadri.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21255742?dopt=Abstract %2 PMC3039838 %4 Alzheimer disease/cognitive Impairment/PREVALENCE/Incidence/Dementia %$ 24570 %R 10.1016/j.jalz.2010.12.002 %0 Report %D 2011 %T Personality and Response to the Financial Crisis %A Angela Lee Duckworth %A David R Weir %K Health Conditions and Status %K Net Worth and Assets %K Public Policy %X In a previous study, we found the family of personality traits known as conscientiousness to be associated in cross-sectional analyses with both lifetime earnings and wealth. In this study, we used data from an Internet survey of HRS respondents in the second quarter of 2009 to test whether conscientiousness and other Big Five factors prospectively predicted responses to the financial crisis of 2008/09. In addition, to improve the targeting and design of behavioral interventions for at-risk individuals, we examined two specific facets of conscientiousness (i.e., self-control and perseverance) that may be more highly related to these economic outcomes than other facets. Finally, we used data from the Consumption and Activities Mail Survey (CAMS) to examine whether personality is related to the proportion of income saved vs. spent. Missing data precluded sufficiently powerful prospective analyses of personality and responses to the financial crisis. Likewise, data on self-control and perseverance from the 2010 experimental module were not sufficient at the time of final reporting to come to definitive conclusions about how these facets relate to economic outcomes. We did find that conscientious adults save more and spend less of their incomes, whereas adults who are higher in openness to experience (e.g., adventurous, sophisticated) save less and spend more of their income. The robust associations between conscientiousness and economic outcomes suggests further investigation of interventions that improve conscientiousness as well as policies that specifically target less conscientious individuals (e.g., default choices for retirement savings). %B Michigan Retirement and Disability Research Center Working Paper %I The University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/projects/personality-and-response-to-the-financial-crisis/ %4 wealth/lifetime earnings/lifetime earnings/conscientiousness/conscientiousness/great Recession %$ 62852 %0 Journal Article %J Gerontologist %D 2011 %T Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education. %A Chiu, Ching-Ju %A Linda A. Wray %K Activities of Daily Living %K Age Distribution %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Diabetes Mellitus %K Disabled Persons %K Educational Status %K ethnicity %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Models, Theoretical %K Racial Groups %K Sex Distribution %K Time Factors %K United States %X

PURPOSE: This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education.

DESIGN AND METHODS: Data were examined on 20,433 adults aged 51 and older from the 1998 to 2006 Health and Retirement Study. Multilevel models and a cohort-sequential design were applied to quantitatively depict the age norm of physical disability after age 50.

RESULTS: Adults with diabetes not only experience greater levels of physical disability but also faster rates of deterioration over time. This pattern is net of attrition, time-invariant sociodemographic factors, and time-varying chronic disease conditions. Differences in physical disability between adults with and without diabetes were more pronounced in women, non-White, and those of lower education. The moderating effects of gender and education remained robust even after controlling for selected covariates in the model.

IMPLICATIONS: This study highlighted the consistently greater development of disability over time in adults with diabetes and particularly in those who are women, non-White, or adults of lower education. Future studies are recommended to examine the mechanisms underlying the differential effects of diabetes on physical disability by gender and education.

%B Gerontologist %I 51 %V 51 %P 51-63 %8 2011 Feb %G eng %N 1 %L newpubs20110418_Chiu2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20713455?dopt=Abstract %2 PMC3018868 %4 Gerontology/Older people/Diabetes/Gender/Ethnicity/Disability/Disability %$ 24840 %R 10.1093/geront/gnq069 %0 Journal Article %J BMC Public Health %D 2011 %T A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries. %A Frederic D Wolinsky %A Suzanne E Bentler %A Jason Hockenberry %A Michael P Jones %A Paula A Weigel %A Kaskie, Brian %A Robert B Wallace %K Aged %K Aged, 80 and over %K Aging %K Cognition %K Cognition Disorders %K Cohort Studies %K Female %K Humans %K Interviews as Topic %K Male %K Medicare %K Mental Health %K Outcome Assessment, Health Care %K Prospective Studies %K Regression Analysis %K Risk Factors %K United States %X

BACKGROUND: Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function.

METHODS: We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests.

RESULTS: Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status.

CONCLUSIONS: In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.

%B BMC Public Health %I 11 %V 11 %P 710 %8 2011 Sep 20 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21933430?dopt=Abstract %2 PMC3190354 %4 Cognition/Cognitive decline/public policy/Medicare/cognitive Function/TICS Scale %$ 25100 %R 10.1186/1471-2458-11-710 %0 Journal Article %J Longit Life Course Stud %D 2011 %T Proxy interviews and bias in the distribution of cognitive abilities due to non-response in longitudinal studies: a comparison of HRS and ELSA. %A David R Weir %A Jessica Faul %A Kenneth M. Langa %B Longit Life Course Stud %I 2 %V 2 %P 170-184 %8 2011 May %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/25360159?dopt=Abstract %4 Cognitive ability/Methodology/longitudinal Studies/proxy interviews/proxy interviews/ELSA_/cross-national %$ 62761 %R 10.14301/llcs.v2i2.116 %0 Journal Article %J Gerontologist %D 2011 %T Recruitment and retention of minority participants in the health and retirement study. %A Mary Beth Ofstedal %A David R Weir %K Aged %K Biomarkers %K Black or African American %K Female %K Health Promotion %K Health Surveys %K Hispanic or Latino %K Humans %K Male %K Middle Aged %K Minority Groups %K Minority health %K National Health Programs %K Patient Dropouts %K Patient Selection %K Retirement %K Sampling Studies %K Surveys and Questionnaires %K United States %X

PURPOSE: Minority oversamples of African Americans and Hispanics have been a key feature of the Health and Retirement Study (HRS) design from its origins in 1992. The objective of this article was to assess the quality of the HRS with respect to the recruitment and retention of minority respondents.

DESIGN AND METHODS: To evaluate minority recruitment efforts, we examine baseline response rates for the early baby boom cohort that was added in the 2004 wave and the representativeness of this cohort with regard to demographic, socioeconomic, and health characteristics. To evaluate retention, we focus on minority differentials in 2008 interview, nonresponse and mortality outcomes for the full HRS sample. We also examine minority differentials in participation in supplemental components of the HRS.

RESULTS: Minority response rates at baseline and in longitudinal follow-ups for the main HRS interview have been equal to or better than that of majority Whites. Conversely, response rates to some specific supplemental components have been lower for minority sample members.

IMPLICATIONS: The oversample strategies that the HRS has employed have been successful at identifying and recruiting minority participants at response rates very comparable with that of Whites and others. Minority differentials in participation in supplemental components have been overcome to some extent through interviewer training and targeted follow-up strategies. The HRS experience suggests that well-trained interviewers can overcome most if not all of whatever race and ethnic differentials exist in willingness to participate in surveys, including those involving biological data collection.

%B Gerontologist %I 51 Suppl 1 %V 51 Suppl 1 %P S8-20 %8 2011 Jun %G eng %N Suppl 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21565822?dopt=Abstract %2 PMC3106365 %R 10.1093/geront/gnq100 %0 Journal Article %J Alzheimers Dement %D 2011 %T Reducing case ascertainment costs in U.S. population studies of Alzheimer's disease, dementia, and cognitive impairment-Part 1. %A David R Weir %A Robert B Wallace %A Kenneth M. Langa %A Brenda L Plassman %A Robert S Wilson %A David A Bennett %A Duara, Ranjan %A Loewenstein, David %A Ganguli, Mary %A Sano, Mary %K Aging %K Algorithms %K Alzheimer disease %K Cognition Disorders %K Community Health Planning %K Cost-Benefit Analysis %K Dementia %K Health Surveys %K Humans %K Internet %K Reproducibility of Results %K United States %X

Establishing methods for ascertainment of dementia and cognitive impairment that are accurate and also cost-effective is a challenging enterprise. Large population-based studies often using administrative data sets offer relatively inexpensive and reliable estimates of severe conditions including moderate to advanced dementia that are useful for public health planning, but they can miss less severe cognitive impairment which may be the most effective point for intervention. Clinical and epidemiological cohorts, intensively assessed, provide more sensitive detection of less severe cognitive impairment but are often costly. In this article, several approaches to ascertainment are evaluated for validity, reliability, and cost. In particular, the methods of ascertainment from the Health and Retirement Study are described briefly, along with those of the Aging, Demographics, and Memory Study (ADAMS). ADAMS, a resource-intense sub-study of the Health and Retirement Study, was designed to provide diagnostic accuracy among persons with more advanced dementia. A proposal to streamline future ADAMS assessments is offered. Also considered are algorithmic and Web-based approaches to diagnosis that can reduce the expense of clinical expertise and, in some contexts, can reduce the extent of data collection. These approaches are intended for intensively assessed epidemiological cohorts where goal is valid and reliable case detection with efficient and cost-effective tools.

%B Alzheimers Dement %I 7 %V 7 %P 94-109 %8 2011 Jan %G eng %U http://mgetit.lib.umich.edu/sfx_local?ctx_enc=info 3Aofi 2Fenc 3AUTF-8;ctx_id=10_1;ctx_tim=2011-03-28T16 3A26 3A0EDT;ctx_ver=Z39.88-2004;rfr_id=info 3Asid 2Fsfxit.com 3Acitation;rft.genre=article;rft_id=info 3Apmid 2F21255747;rft_val_fmt=info 3Aofi 2Ffmt %N 1 %L newpubs20110328_Weir.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21255747?dopt=Abstract %2 PMC3044596 %4 Alzheimers disease/Dementia/Mild cognitive impairment/Cognitive impairment not dementia/Diagnostic algorithms/Cognition/Epidemiology/Screening/Technology/Education/Ethnicity %$ 24600 %R 10.1016/j.jalz.2010.11.004 %0 Journal Article %J JAMA %D 2011 %T Regional variation in the association between advance directives and end-of-life Medicare expenditures. %A Lauren Hersch Nicholas %A Kenneth M. Langa %A Theodore J Iwashyna %A David R Weir %K Advance directives %K Aged %K Aged, 80 and over %K Data collection %K Female %K Health Expenditures %K Hospice Care %K Hospital Mortality %K Hospitals %K Humans %K Kidney Failure, Chronic %K Male %K Medicare %K Palliative care %K Prospective Studies %K Regression Analysis %K Terminal Care %K United States %X

CONTEXT: It is unclear if advance directives (living wills) are associated with end-of-life expenditures and treatments.

OBJECTIVE: To examine regional variation in the associations between treatment-limiting advance directive use, end-of-life Medicare expenditures, and use of palliative and intensive treatments.

DESIGN, SETTING, AND PATIENTS: Prospectively collected survey data from the Health and Retirement Study for 3302 Medicare beneficiaries who died between 1998 and 2007 linked to Medicare claims and the National Death Index. Multivariable regression models examined associations between advance directives, end-of-life Medicare expenditures, and treatments by level of Medicare spending in the decedent's hospital referral region.

MAIN OUTCOME MEASURES: Medicare expenditures, life-sustaining treatments, hospice care, and in-hospital death over the last 6 months of life.

RESULTS: Advance directives specifying limits in care were associated with lower spending in hospital referral regions with high average levels of end-of-life expenditures (-$5585 per decedent; 95% CI, -$10,903 to -$267), but there was no difference in spending in hospital referral regions with low or medium levels of end-of-life expenditures. Directives were associated with lower adjusted probabilities of in-hospital death in high- and medium-spending regions (-9.8%; 95% CI, -16% to -3% in high-spending regions; -5.3%; 95% CI, -10% to -0.4% in medium-spending regions). Advance directives were associated with higher adjusted probabilities of hospice use in high- and medium-spending regions (17%; 95% CI, 11% to 23% in high-spending regions, 11%; 95% CI, 6% to 16% in medium-spending regions), but not in low-spending regions.

CONCLUSION: Advance directives specifying limitations in end-of-life care were associated with significantly lower levels of Medicare spending, lower likelihood of in-hospital death, and higher use of hospice care in regions characterized by higher levels of end-of-life spending.

%B JAMA %I 112 %V 306 %P 1447-53 %8 2011 Oct 05 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2590187421andFmt=7andclientId=17822andRQT=309andVName=PQD %N 13 %1 http://www.ncbi.nlm.nih.gov/pubmed/21972306?dopt=Abstract %2 PMC3332047 %4 Advance directives/Palliative care/Health care expenditures/Medicare %$ 62821 %R 10.1001/jama.2011.1410 %0 Journal Article %J Alzheimers Dement %D 2011 %T Sources of variability in estimates of the prevalence of Alzheimer's disease in the United States. %A Robert S Wilson %A David R Weir %A Sue E Leurgans %A Denis A Evans %A Liesi Hebert %A Kenneth M. Langa %A Brenda L Plassman %A Brent J. Small %A David A Bennett %K Aged %K Aged, 80 and over %K Alzheimer disease %K Community Health Planning %K Comorbidity %K Dementia %K Diagnosis, Differential %K Female %K Humans %K Incidence %K Male %K Prevalence %K United States %X

BACKGROUND: The prevalence of Alzheimer's disease (AD) in the United States was estimated at 2.3 million in 2002 by the Aging, Demographics, and Memory Study (ADAMS), which is almost 50% less than the estimate of 4.5 million in 2000 derived from the Chicago Health and Aging Project.

METHODS: We considered how differences in diagnostic criteria may have contributed to these differences in AD prevalence.

RESULTS: We identified several important differences in diagnostic criteria that may have contributed to the differing estimates of AD prevalence. Two factors were especially noteworthy. First, the Diagnostic and Statistical Manual of Mental Disorders III-R and IV criteria of functional limitation documented by an informant used in ADAMS effectively concentrated the diagnosis of dementia toward a relatively higher level of cognitive impairment. ADAMS separately identified a category of cognitive impairment not dementia and within that group there were a substantial number of cases with "prodromal" AD (a maximum of 1.95 million with upweighting). Second, a substantial proportion of dementia in ADAMS was attributed to either vascular disease (representing a maximum of 0.59 million with upweighting) or undetermined etiology (a maximum of 0.34 million), whereas most dementia, including mixed dementia, was attributed to AD in the Chicago Health and Aging Project.

CONCLUSION: The diagnosis of AD in population studies is a complex process. When a diagnosis of AD excludes persons meeting criteria for vascular dementia, when not all persons with dementia are assigned an etiology, and when a diagnosis of dementia requires an informant report of functional limitations, the prevalence is substantially lower and the diagnosed cases most likely have a relatively higher level of impairment.

%B Alzheimers Dement %I 7 %V 7 %P 74-9 %8 2011 Jan %G eng %N 1 %L newpubs20110328_Wilson.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21255745?dopt=Abstract %2 PMC3145367 %4 Epidemiology/Dementia/Alzheimers disease/Vascular dementia/Mild cognitive impairment/Cognitive impairment no dementia %$ 24590 %R 10.1016/j.jalz.2010.11.006 %0 Journal Article %J J Appl Econ %D 2011 %T STOCK MARKET CRASH AND EXPECTATIONS OF AMERICAN HOUSEHOLDS. %A Péter Hudomiet %A Kezdi, Gabor %A Robert J. Willis %X

This paper utilizes data on subjective probabilities to study the impact of the stock market crash of 2008 on households' expectations about the returns on the stock market index. We use data from the Health and Retirement Study that was fielded in February 2008 through February 2009. The effect of the crash is identified from the date of the interview, which is shown to be exogenous to previous stock market expectations. We estimate the effect of the crash on the population average of expected returns, the population average of the uncertainty about returns (subjective standard deviation), and the cross-sectional heterogeneity in expected returns (disagreement). We show estimates from simple reduced-form regressions on probability answers as well as from a more structural model that focuses on the parameters of interest and separates survey noise from relevant heterogeneity. We find a temporary increase in the population average of expectations and uncertainty right after the crash. The effect on cross-sectional heterogeneity is more significant and longer lasting, which implies substantial long-term increase in disagreement. The increase in disagreement is larger among the stockholders, the more informed, and those with higher cognitive capacity, and disagreement co-moves with trading volume and volatility in the market.

%B J Appl Econ %I 26 %V 26 %P 393-415 %8 2011 %G eng %N 3 %L newpubs20100921_Hudomiet.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21547244?dopt=Abstract %2 PMC3086799 %4 Stock Market/expectations/Asset accumulation %$ 23460 %R 10.1002/jae.1226 %0 Journal Article %J Alzheimers Dement %D 2011 %T Trends in the incidence and prevalence of Alzheimer's disease, dementia, and cognitive impairment in the United States. %A Walter A Rocca %A Ronald C Petersen %A David S Knopman %A Liesi Hebert %A Denis A Evans %A Kathleen S Hall %A Gao, Sujuan %A Frederick W Unverzagt %A Kenneth M. Langa %A Eric B Larson %A Lon R White %K Age Factors %K Alzheimer disease %K Cognition Disorders %K Cohort Studies %K Community Health Planning %K Dementia %K Humans %K Incidence %K Prevalence %K Residence Characteristics %K Retrospective Studies %K Time Factors %K United States %X

Declines in heart disease and stroke mortality rates are conventionally attributed to reductions in cigarette smoking, recognition and treatment of hypertension and diabetes, effective medications to improve serum lipid levels and to reduce clot formation, and general lifestyle improvements. Recent evidence implicates these and other cerebrovascular factors in the development of a substantial proportion of dementia cases. Analyses were undertaken to determine whether corresponding declines in age-specific prevalence and incidence rates for dementia and cognitive impairment have occurred in recent years. Data spanning 1 or 2 decades were examined from community-based epidemiological studies in Minnesota, Illinois, and Indiana, and from the Health and Retirement Study, which is a national survey. Although some decline was observed in the Minnesota cohort, no statistically significant trends were apparent in the community studies. A significant reduction in cognitive impairment measured by neuropsychological testing was identified in the national survey. Cautious optimism appears justified.

%B Alzheimers Dement %I 7 %V 7 %P 80-93 %8 2011 Jan %G eng %N 1 %L newpubs20110328_Rocca.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21255746?dopt=Abstract %2 PMC3026476 %4 Alzheimers disease/Dementia/Cognitive impairment/Prevalence/Incidence/Time trends %$ 24610 %R 10.1016/j.jalz.2010.11.002 %0 Journal Article %J Soc Sci Med %D 2011 %T Understanding how race/ethnicity and gender define age-trajectories of disability: an intersectionality approach. %A David F Warner %A Tyson H Brown %K Age Factors %K Black or African American %K Disability Evaluation %K Disabled Persons %K Female %K Health Status Disparities %K Health Surveys %K Hispanic or Latino %K Humans %K Male %K Middle Aged %K Models, Statistical %K Models, Theoretical %K Sex Factors %K Social Class %K United States %K White People %X

A number of studies have demonstrated wide disparities in health among racial/ethnic groups and by gender, yet few have examined how race/ethnicity and gender intersect or combine to affect the health of older adults. The tendency of prior research to treat race/ethnicity and gender separately has potentially obscured important differences in how health is produced and maintained, undermining efforts to eliminate health disparities. The current study extends previous research by taking an intersectionality approach (Mullings & Schulz, 2006), grounded in life course theory, conceptualizing and modeling trajectories of functional limitations as dynamic life course processes that are jointly and simultaneously defined by race/ethnicity and gender. Data from the nationally representative 1994-2006 US Health and Retirement Study and growth curve models are utilized to examine racial/ethnic/gender differences in intra-individual change in functional limitations among White, Black and Mexican American Men and Women, and the extent to which differences in life course capital account for group disparities in initial health status and rates of change with age. Results support an intersectionality approach, with all demographic groups exhibiting worse functional limitation trajectories than White Men. Whereas White Men had the lowest disability levels at baseline, White Women and racial/ethnic minority Men had intermediate disability levels and Black and Hispanic Women had the highest disability levels. These health disparities remained stable with age-except among Black Women who experience a trajectory of accelerated disablement. Dissimilar early life social origins, adult socioeconomic status, marital status, and health behaviors explain the racial/ethnic disparities in functional limitations among Men but only partially explain the disparities among Women. Net of controls for life course capital, Women of all racial/ethnic groups have higher levels of functional limitations relative to White Men and Men of the same race/ethnicity. Findings highlight the utility of an intersectionality approach to understanding health disparities.

%B Soc Sci Med %I 72 %V 72 %P 1236-48 %8 2011 Apr %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/21470737?dopt=Abstract %4 Ethnicity/Older people/Gender differences/Socioeconomic factors/Racial differences/Disability/Disability %$ 62540 %R 10.1016/j.socscimed.2011.02.034 %0 Report %D 2011 %T Updates to HRS Sample Weights %A Mary Beth Ofstedal %A David R Weir %A Chen, K.T. %A James Wagner %K Methodology %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 Survey Methods/Sample Design %$ 62850 %0 Journal Article %J J Health Soc Behav %D 2011 %T The urban neighborhood and cognitive functioning in late middle age. %A Carol S Aneshensel %A Michelle J Ko %A Joshua Chodosh %A Richard G Wight %K Activities of Daily Living %K Age Factors %K Aged %K Aging %K Chi-Square Distribution %K Cognition %K Cognition Disorders %K ethnicity %K Female %K Health Status Disparities %K Humans %K Male %K Middle Aged %K Psychometrics %K Residence Characteristics %K Risk Factors %K Socioeconomic factors %K United States %K Urban Population %X

This study examines the association of cognitive functioning with urban neighborhood socioeconomic disadvantage and racial/ethnic segregation for a U.S. national sample of persons in late middle age, a time in the life course when cognitive deficits begin to emerge. The key hypothesis is that effects of neighborhood on cognitive functioning are not uniform but are most pronounced among subgroups of the population defined by socioeconomic status and race/ethnicity. Data are from the third wave of the Health and Retirement Survey for the birth cohort of 1931 to 1941, which was 55 to 65 years of age in 1996 (analytic N = 4,525), and the 1990 U.S. Census. Neighborhood socioeconomic disadvantage has an especially large negative impact on cognitive functioning among persons who are themselves poor, an instance of compound disadvantage. These findings have policy implications supporting "upstream" interventions to enhance cognitive functioning, especially among those most adversely affected by neighborhood socioeconomic disadvantage.

%B J Health Soc Behav %I 52 %V 52 %P 163-79 %8 2011 Jun %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21673145?dopt=Abstract %2 PMC3152319 %4 Segregation/Cognitive ability/Cognition/reasoning %$ 62634 %R 10.1177/0022146510393974 %0 Journal Article %J Res Aging %D 2011 %T Urban Neighborhoods and Depressive Symptoms in Late Middle Age. %A Richard G Wight %A Michelle J Ko %A Carol S Aneshensel %X

This study examines associations between multiple urban neighborhood characteristics (socioeconomic disadvantage, affluence, and racial/ethnic composition) and depressive symptoms among late middle aged persons and compares findings to those previously obtained for persons age 70 years and older. Survey data are from the Health and Retirement Study (HRS), a U.S. national probability sample of noninstitutionalized persons aged 51 to 61 years in 1992. Neighborhoods are 1990 U.S. census tracts. Hierarchical linear regression is used to estimate multilevel models. Depressive symptoms vary significantly across urban neighborhoods among late middle age persons. Neighborhood socioeconomic disadvantage is significantly associated with depressive symptoms, net of both individual-level sociodemographic and health variables. However, this association is contingent upon individual-level wealth in that persons with low wealth in the most disadvantaged neighborhoods report the most depressive symptoms. Unlike findings for older adults for whom neighborhood effects appear to be entirely compositional in nature, neighborhood context matters to subgroups of late middle age adults.

%B Res Aging %I 33 %V 33 %P 28-50 %8 2011 Jan 01 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21572903?dopt=Abstract %2 PMC3092717 %4 Neighborhoods/Middle age/Urban Population/Urban areas/Mental depression/Socioeconomic factors/Polls and surveys %$ 24530 %R 10.1177/0164027510383048 %0 Report %D 2010 %T The Asset Cost of Poor Health %A James M. Poterba %A Steven F Venti %A David A Wise %K Health Conditions and Status %K Net Worth and Assets %X This paper examines the correlation between poor health and asset accumulation for households in the first nine waves of the Health and Retirement Survey. Rather than enumerating the specific costs of poor health, such as out of pocket medical expenses or lost earnings, we estimate how the evolution of household assets is related to poor health. We construct a simple measure of health status based on the first principal component of HRS survey responses on self-reported health status, diagnoses, ADLs, IADL, and other indicators of underlying health. Our estimates suggest large and substantively important correlations between poor health and asset accumulation. We compare persons in each 1992 asset quintile who were in the top third of the 1992 distribution of latent health with those in the same 1992 asset quintile who were in the bottom third of the latent health distribution. By 2008, those in the top third of the health distribution had accumulated, on average, more than 50 percent more assets than those in the bottom third of the health distribution. This asset cost of poor health appears to be larger for persons with substantial 1992 asset balances than for those with lower balances. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 health Status/Asset accumulation %$ 26100 %R 10.3386/w16389 %0 Report %D 2010 %T Children and Household Utility: Evidence from Kids Flying the Coop %A Norma B Coe %A Anthony Webb %K children %X Using consumption and wealth data from the Health and Retirement Study (HRS), this paper explores the impact of children leaving home on household consumption. We find that households maintain their household-level consumption, despite the fact that the number of individuals in the household has decreased, increasing per-capita consumption. Further, we find no evidence of increases in total net wealth, or any of its components, after children leave the household. These findings suggest that households do not dramatically change their savings or consumption patterns when their children fly the coop. Those households who are already behind in their retirement preparations will remain at risk of entering retirement with insufficient wealth to maintain their pre-retirement standard of living. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/children-and-household-utility-evidence-from-kids-flying-the-coop-ii/ %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 J Gerontol A Biol Sci Med Sci %D 2010 %T Continuity of care with a primary care physician and mortality in older adults. %A Frederic D Wolinsky %A Suzanne E Bentler %A Li Liu %A John F Geweke %A Elizabeth A Cook %A Maksym Obrizan %A Elizabeth A Chrischilles %A Kara B Wright %A Michael P Jones %A Gary E Rosenthal %A Robert L. Ohsfeldt %A Robert B Wallace %K Aged %K Continuity of Patient Care %K Female %K Health Services for the Aged %K Humans %K Male %K Mortality %K Physicians, Family %X

BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

RESULTS: Two thousand nine hundred and fifty-four (54%) participants died during the follow-up period. Using the cumulative exposure measure, 27% never had continuity of care, whereas 31%, 20%, 14%, and 8%, respectively, had continuity for 1%-33%, 34%-67%, 68%-99%, and 100% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1%-33%, 34%-67%, 68%-99%, and 100% categories of the cumulative exposure measure).

CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

%B J Gerontol A Biol Sci Med Sci %I 65A %V 65 %P 421-8 %8 2010 Apr %G eng %N 4 %L newpubs20100519_Wolinsky.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19995831?dopt=Abstract %2 PMC2844057 %4 continuity of care/medicare/primary care physician/MORTALITY %$ 21950 %R 10.1093/gerona/glp188 %0 Journal Article %J BMC Health Serv Res %D 2010 %T Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries. %A Kaskie, Brian %A Maksym Obrizan %A Elizabeth A Cook %A Michael P Jones %A Li Liu %A Suzanne E Bentler %A Robert B Wallace %A John F Geweke %A Kara B Wright %A Elizabeth A Chrischilles %A Claire E Pavlik %A Robert L. Ohsfeldt %A Gary E Rosenthal %A Frederic D Wolinsky %K Aged %K Aged, 80 and over %K Cohort Studies %K Emergency Service, Hospital %K Humans %K Insurance Claim Review %K Medicare %K Prospective Studies %K Severity of Illness Index %K United States %X

BACKGROUND: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.

METHODS: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity.

RESULTS: Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001).

CONCLUSIONS: We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.

%B BMC Health Serv Res %I 8 %V 10 %P 173 %8 2010 Jun 21 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/20565949?dopt=Abstract %2 PMC2903585 %4 HOSPITALIZATION/emergency department service use/emergency department service use/medicare/predictive validity/predictive validity %$ 25020 %R 10.1186/1472-6963-10-173 %0 Book Section %B Demography and the Economy %D 2010 %T Demographic Trends, Housing Equity, and the Financial Security of Future Retirees %A James M. Poterba %A Steven F Venti %A David A Wise %K Demography %K Financial security %K Housing %X About 80 percent of households with heads at retirement age own a home. Aside from Social Security and dedicated retirement saving, home equity is the primary asset of a large fraction of these homeowners. Thus, the fi nancial security of many older households depends importantly on the value of their homes. Venti and Wise (1990, 2001, 2004); Megbolugbe, Sa- Aadu, and Shilling (1997); and Banks et al. (2010) show that housing equity tends to be withdrawn when households experience shocks to family status like entry to a nursing home or death of a spouse. If, as these analyses suggest, housing equity is conserved for a “rainy day,” then the value of housing can have important implications for the reserve of wealth in the event of such shocks %B Demography and the Economy %I University of Chicago Press %P 227-287 %@ 0-226-75472-3 %G eng %U http://www.nber.org/chapters/c8416 %0 Thesis %D 2010 %T Determinants and Implications of Mortality Risk at the End of the Life Cycle %A Edwin S. Wong %K Consumption and Savings %K Employment and Labor Force %K End of life decisions %K Health Conditions and Status %K Time Use %K Women and Minorities %X The primary goal of this dissertation is to investigate the impacts of survival uncertainty on outcomes relevant to older Americans. While objective measures of life expectancy are useful in explaining economic outcomes, this dissertation also highlights the importance of subjective measures. In particular, results suggest survival beliefs provide otherwise unobservable information that better predict outcomes. Chapter one employs a Life Cycle model, showing that households smooth consumption and labor supply. Specifically, a longer expected lifetime is associated with the delay of consumption into the future and substitution of hours worked to the present. The second chapter develops a model for purchases of life insurance by older households and tests for the presence of marital bargaining power. Results indicate that increasing the relative bargaining power of the husband reduces the size of the insurance policy taken against the husband's life, and increases insurance taken on his wife's life. In other words, the household reallocates resources to states of nature that the husband places greater weight, and purchases insurance to guarantee adequate resources for funding optimal consumption in the event of the wife's death. Furthermore, results show systematic differences in the effect of survival uncertainty on life insurance purchases. In particular, life insurance purchases are decreasing with objective survival probabilities, but are increasing with subjective measures, suggesting the presence of asymmetric information. The secondary goal of this dissertation is to extend the literature examining the determinants of adult mortality. The third chapter examines the impacts of family characteristics such as parental and sibling on adult mortality at the objective level using survey data from the Health and Retirement Study. Using a competing risk model that controls for correlation between individual death and survey non-response, I find evidence that individuals with longer lived parents exhibit lower mortality risk. Increases in parental age not only affect mortality through increasing the predisposition to survive, but also through positive information from knowledge of extended parental survival and positive social relationships formed. Also, I find individuals with higher vitality and a higher opportunity cost to completing the survey are less likely to respond in future survey waves. %I University of Washington %V Ph.D. %8 2010 %G English %M 1143077 %4 Mortality %$ 24480 %! Determinants and Implications of Mortality Risk at the End of the Life Cycle %0 Book Section %B Research Findings in the Economics of Aging %D 2010 %T Education and the Prevalence of Pain %A Atlas, Steven J. %A Jonathan S Skinner %E David A Wise %K Demographics %K Disabilities %K Healthcare %X Many Americans report chronic and disabling pain, even in the absence of identifiable clinical disorders. We first examine the prevalence of pain in the older U.S. population using the Health and Retirement Study (HRS). Among 50-59 year females, for example, pain rates ranged from 26 percent for college graduates to 55 percent for those without a high school degree. Occupation, industry, and marital status attenuated but did not erase these educational gradients. Second, we used a study of patients with lower back pain and sciatica arising from intervertebral disk herniation (IDH). Initially, nearly all patients reported considerable pain and discomfort, with a sizeable fraction undergoing surgery for their IDH. However, baseline severity measures and surgical or medical treatment explained little of the variation in 10-year outcomes. By contrast, education exerted a strong impact on changes over time in pain: just 9 percent of college graduates report leg or back pain always or almost always after 10 years, compared to 34 percent for people without a high school degree. This close association of education with pain is consistent with recent research emphasizing the importance of neurological -- and perhaps economic -- factors in the perception of pain. %B Research Findings in the Economics of Aging %S National Bureau of Economic Research conference report %I University of Chicago Press %C Chicago %P 145-166 %G eng %4 EDUCATION/DISABILITY/DISABILITY/lower back pain/socioeconomic Status %$ 24140 %! Education and the Prevalence of Pain %& 6 %R 10.3386/w14964 %0 Journal Article %J Review of Economics and Statistics %D 2010 %T The Effect of Inheritance Receipt on Retirement %A Brown, Jeffrey R. %A Courtney Coile %A Weisbenner, Scott J %K Adult children %K Employment and Labor Force %K Net Worth and Assets %K Other %K Retirement Planning and Satisfaction %X This paper provides new evidence on how wealth shocks influence retirement behavior. Economic theory generally posits that leisure is a normal good, yet it is difficult to obtain reliable empirical estimates of the wealth effect because wealth is correlated with numerous unobservable characteristics that affect labor supply. We use inheritance receipt as a wealth shock and find that it is associated with a significant increase in the probability of retirement, especially when the inheritance is unexpected. This evidence has important implications for how public policies, such as pension or tax reform, may influence retirement behavior through the wealth effect. %B Review of Economics and Statistics %I 92 %V 92 %P 425-434 %G eng %N 2 %4 Wealth/Impact analysis/Retirement planning/Inheritances/Studies/Labor supply %$ 25260 %R 10.1162/rest.2010.11182 %0 Journal Article %J Journal of Applied Gerontology %D 2010 %T Effects of Immigration and Age on Health of Older People in the United States %A Chizuko Wakabayashi %K Demographics %K Health Conditions and Status %K Healthcare %K Methodology %X Following cumulative advantage/disadvantage theory and drawing longitudinal data from the 1996, 1998, 2000, 2002, 2004, and 2006 Health and Retirement Studies, this article examined the relationship between immigration experience and health transitions in late life among non-Hispanic White, non-Hispanic Black, and Mexicans in the United States. The results revealed that the timing of migration in the life course helped determine the ways in which individual health transitions would be associated with their aging process, and the pathways would be complex and vary based on the health outcomes and gender of the immigrants. For example, among women, the later-life immigrants would face most disadvantageous health trajectories as they aged with respect to activities of daily living limitations. The results suggested that the timing of U.S. immigration would affect the degree to which immigrants could take advantage of economic opportunities to accumulate financial resources that would benefit health later in life. %B Journal of Applied Gerontology %I 29 %V 29 %P 697-719 %G eng %N 6 %L newpubs20110418_Wakabayashi.pdf %4 Health decline/aging/immigrant/socioeconomic status/cumulative disadvantage %$ 24980 %R 10.1177/0733464809353602 %0 Journal Article %J Ann Intern Med %D 2010 %T The epidemiology of pain during the last 2 years of life. %A Alexander K Smith %A Irena Cenzer %A Sara J Knight %A Kathleen A Puntillo %A Eric W Widera %A Brie A Williams %A W John Boscardin %A Kenneth E Covinsky %K Aged %K Aged, 80 and over %K Arthritis %K Chronic disease %K Cross-Sectional Studies %K Death %K Female %K Humans %K Male %K pain %K Palliative care %K Prevalence %K Quality of Life %K Socioeconomic factors %K Terminally Ill %K Time Factors %X

BACKGROUND: The epidemiology of pain during the last years of life has not been well described.

OBJECTIVE: To describe the prevalence and correlates of pain during the last 2 years of life.

DESIGN: Observational study. Data from participants who died while enrolled in the Health and Retirement Study were analyzed. The survey interview closest to death was used. Each participant or proxy was interviewed once in the last 24 months of life and was classified into 1 of 24 cohorts on the basis of the number of months between the interview and death. The relationship between time before death and pain was modeled and was adjusted for age, sex, race or ethnicity, education level, net worth, income, terminal diagnosis category, presence of arthritis, and proxy status.

SETTING: The Health and Retirement Study, a nationally representative survey of community-living older adults (1994 to 2006).

PARTICIPANTS: Older adult decedents.

MEASUREMENTS: Clinically significant pain, as indicated by a report that the participant was "often troubled" by pain of at least moderate severity.

RESULTS: The sample included 4703 decedents. Mean age (SD) of participants was 75.7 years (SD, 10.8); 83.1% were white, 10.7% were black, 4.7% were Hispanic; and 52.3% were men. The adjusted prevalence of pain 24 months before death was 26% (95% CI, 23% to 30%). The prevalence remained flat until 4 months before death (28% [CI, 25% to 32%]), then it increased, reaching 46% (CI, 38% to 55%) in the last month of life. The prevalence of pain in the last month of life was 60% among patients with arthritis versus 26% among patients without arthritis (P < 0.001) and did not differ by terminal diagnosis category (cancer [45%], heart disease [48%], frailty [50%], sudden death [42%], or other causes [47%]; P = 0.195).

LIMITATION: Data are cross-sectional; 19% of responses were from proxies; and information about cause, location, and treatment of pain was not available.

CONCLUSION: Although the prevalence of pain increases in the last 4 months of life, pain is present in more than one quarter of elderly persons during the last 2 years of life. Arthritis is strongly associated with pain at the end of life.

PRIMARY FUNDING SOURCE: National Institute on Aging, National Center for Research Resources, National Institute on Musculoskeletal and Skin Diseases, and National Palliative Care Research Center.

%B Ann Intern Med %I 153 %V 153 %P 563-9 %8 2010 Nov 02 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/21041575?dopt=Abstract %2 PMC3150170 %$ 23690 %R 10.7326/0003-4819-153-9-201011020-00005 %0 Thesis %B Economics %D 2010 %T Essays in contemporary tax law changes %A Biswas, Arpita %Y Wilson, Paul W. %K Net Worth and Assets %K Other %K Public Policy %X In the first essay, I provide estimates of price and income elasticities of charitable contributions which reveal substantial differences in giving patterns across different income groups. The paper develops an intertemporal model of giving which predicts that lowering current income taxes induces substitution away from current giving towards giving in future periods. Cragg's Generalized Tobit model applied to Consumer Expenditure data from 1997-2006 provides estimates of income and price elasticities conditioned upon contribution, which range between 0.17 to 0.81 and -0.50 to -1.16 respectively. Empirical analysis shows substantial evidence of intertemporal substitution, implying that if the difference between future and current prices increase by 1 percent, current period giving increases by 0.8 percent. The second essay is an extension of the first, wherein I provide estimates of how reduction in income tax rates brought about by EGTRRA, 2001 and alternative tax rate regimes affect charitable contributions. Results from difference-in-difference analysis suggests that after Economic Growth Tax Relief Reconciliation Act (EGTRRA), itemizers reduced their contributions by 24% and the likelihood of contributions fell by 10%. While limiting the tax deductibility to 28% reduces price elasticity by 0.02 percentage points, a flat tax rate regime makes contributions 11 percentage points more price elastic compared to the progressive tax rate system. The third essay focuses on another contemporary tax law change, reduction in capital gains and dividend tax rates brought about by Jobs and Growth Tax Relief and Reconciliation Act, 2003. I study two main impacts of the law change, the effect on portfolio allocation between retirement and non-retirement accounts and the effect on labor supply decisions. Difference-in-difference analysis using Health and Retirement Study finds that for the age group above 55, annual investments in IRA fall by $175 and the likelihood of holding IRAs fall by 11%. With respect to labor market behavior, annual labor supply for individuals who diversify their assets fall by 41 hours and about 9 individuals drop out of the labor force. Results using planned retirement age as a dependent variable shows increase in expected retirement age, indicating intertemporal substitution of labor supply. %B Economics %I Clemson University %V Ph.D. %P 115 %G eng %U https://tigerprints.clemson.edu/all_dissertations/589/ %4 Tax law %$ 24030 %! Essays in contemporary tax law changes %0 Report %D 2010 %T Estimating Dynamic Discrete Choice Models with Hyperbolic Discounting, with an Application to Mammography Decisions %A Fang, Hanming %A Wang, Yang %K Health Conditions and Status %K Methodology %X We extend the semi-parametric estimation method for dynamic discrete choice models using Hotz and Miller's (1993) conditional choice probability (CCP) approach to the setting where individuals may have hyperbolic discounting time preferences and may be naive about their time inconsistency. We illustrate the proposed estimation method with an empirical application of adult women's decisions to undertake mammography to evaluate the importance of present bias and naivety in the under-utilization of this preventive health care. Our results show evidence for both present bias and naivety. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %4 methodology/semi-parametric estimation/conditional choice probablilty/Mammography %$ 25670 %R 10.3386/w16438 %0 Journal Article %J Prev Chronic Dis %D 2010 %T Factors predicting glycemic control in middle-aged and older adults with type 2 diabetes. %A Chiu, Ching-Ju %A Linda A. Wray %K Age Factors %K Aged %K Blood Glucose %K Diabetes Mellitus, Type 2 %K Female %K Glycated Hemoglobin %K Humans %K Hypoglycemic Agents %K Male %K Middle Aged %K Retrospective Studies %K Socioeconomic factors %X

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

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

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

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

%B Prev Chronic Dis %I 7 %V 7 %P A08 %8 2010 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/20040223?dopt=Abstract %2 PMC2811503 %4 diabetes/demographics/treatment modality/lifestyle/hemoglobin A1c (HbA1c) levels %$ 22210 %0 Report %D 2010 %T Family Status Transitions, Latent Health, and the Post-Retirement Evolution of Assets %A James M. Poterba %A Steven F Venti %A David A Wise %K Adult children %K Housing %K Net Worth and Assets %K Pensions %X We consider the evolution of assets after retirement. We ask whether total assets--including housing equity, personal retirement accounts, and other financial assets--tend to be husbanded for a rainy day and drawn down primarily at the time of precipitating shocks, or whether they are drawn down throughout the retirement period. We focus on the relationships between family status transitions, latent health status, and the evolution of assets. Our analysis is based primarily on longitudinal data from the HRS and AHEAD cohorts of the Health and Retirement Study. We find that the evolution of assets is strongly related to family status transitions. For both single individuals and married couples who do not experience a death or divorce, total assets increase well into old age. In contrast, individuals in married couples that experience a family status transition, either a death or a divorce, exhibit much slower asset growth and often experience a large decline in asset values at the time of the transition. In addition, the level and evolution of assets is very strongly related to health, measured by a latent health index. For example, for continuing two-person HRS households between the ages of 56 and 61 in 1992 the ratio of assets of households in the top health quintile to the assets of those in the bottom quintile was 1.7 in 1992. It had increased to 2.2 by the end of 2006. %B NBER Working Paper %I National Bureau of Economic Research %C Cambridge, MA %G eng %L newpubs20100407_Poterba.pdf %4 Asset allocation/housing Equity/personal retirement accounts/family transfers, structure %$ 21830 %R 10.3386/w15789 %0 Journal Article %J Econ J (London) %D 2010 %T Financial Decision Making and Cognition in a Family Context. %A James P Smith %A John J McArdle %A Robert J. Willis %X

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

%B Econ J (London) %I 120 %V 120 %P F363-F380 %8 2010 Nov 01 %G eng %N 549 %L newpubs20110418_Smith.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21116477?dopt=Abstract %2 PMC2992344 %4 cognition/numeracy/financial decision-making/financial decision-making/Families %$ 25510 %R 10.1111/j.1468-0297.2010.02394.x %0 Book Section %B Social Security Programs and Retirement around the World %D 2010 %T Fiscal Effects of Social Security Reform in the United States %A Courtney Coile %A Gruber, Jonathan %E Gruber, Jonathan %E David A Wise %K Other %K Public Policy %K Social Security %B Social Security Programs and Retirement around the World %S A National Bureau of Economic Research conference report %I University of Chicago Press %C Chicago %P 503-531 %G eng %4 social security/OASDI/earnings and Benefits File/actuarial reform/common reform/social security wealth %$ 24200 %! Fiscal Effects of Social Security Reform in the United States %& 12 %0 Journal Article %J J Econom %D 2010 %T Health, Economic Resources and the Work Decisions of Older Men. %A John Bound %A Todd R. Stinebrickner %A Timothy A Waidmann %X

We specify a dynamic programming model that addresses the interplay among health, financial resources, and the labor market behavior of men late in their working lives. We model health as a latent variable, for which self reported disability status is an indicator, and allow self-reported disability to be endogenous to labor market behavior. We use panel data from the Health and Retirement Study. While we find large impacts of health on behavior, they are substantially smaller than in models that treat self-reports as exogenous. We also simulate the impacts of several potential reforms to the Social Security program.

%B J Econom %I 156 %V 156 %P 106-129 %8 2010 May %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27158180?dopt=Abstract %4 Economic models/Labor economics/Health/Older workers/Dynamic programming/Studies %$ 22310 %R 10.1016/j.jeconom.2009.09.010 %0 Journal Article %J J Aging Health %D 2010 %T Health trajectories among older movers. %A Janet M Wilmoth %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Multivariate Analysis %K Regression Analysis %K Social Class %K Transients and Migrants %X

OBJECTIVE: To examine health trajectories among older migrants by reason for move.

METHOD: Data from the 1992 to 2006 Health and Retirement Study (HRS) are used to model trajectories of self-rated health and activity of daily living (ADL) limitations that occurred prior seven types of moves.

RESULTS: There are substantial differences across the reason-for-move groups in initial levels of self-rated health. Declines in self-rated health among nursing home movers are more than two times steeper than the other reason-for-move groups. Employment, comfort, economic security, life crisis, and affiliation movers have low initial levels of ADL limitations and slow increases in ADL limitations. Health and nursing home movers have higher initial ADL limitations and increases in ADL limitations that are three and seven times higher respectively than the other groups.

DISCUSSION: The results are consistent with the predictions of Litwak and Longino's (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.

%B J Aging Health %I 22 %V 22 %P 862-81 %8 2010 Oct %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/20710006?dopt=Abstract %3 20710006 %4 Activities of Daily Living/Health/Migration/Health Care/Nursing Homes/Mobility/Employment %$ 24090 %R 10.1177/0898264310375985 %0 Book Section %B Research Findings in the Economics of Aging %D 2010 %T Housing Price Volatility and Downsizing in Later Life %A James Banks %A Richard Blundell %A Oldfield, Zoë %A James P Smith %E David A Wise %K Consumption and Savings %K Cross-National %K Demographics %K Housing %K Retirement Planning and Satisfaction %X In this paper, we modeled several types of housing transitions of the elderly in two countries -- Britain and the United States. One important form of these transitions involves downsizing of housing consumption, the importance of which among older households is still debated. This downsizing takes multiple forms, including reductions in the number of rooms per dwelling and the value of the home. There is also evidence that this downsizing is greater when house price volatility is greater and that American households try to escape housing price volatility by moving to places that are experience significantly less housing price volatility. Our comparative evidence in suggests that there is less evidence of downsizing in Britain. Our results indicate that housing consumption appears to decline with age in the US, even after controlling for the other demographic and work transitions associated with age that would normally produce such a decline. No such fall in housing consumption is found in Britain, largely because British households are much more likely to stay in their original residence. %B Research Findings in the Economics of Aging %I University of Chicago Press %C Chicago %P 337-379 %G eng %4 Housing/consumption/cross-national comparison/downsizing/Mobility %$ 24150 %! Housing Price Volatility and Downsizing in Later Life %& 12 %0 Report %D 2010 %T How Much Is Enough? The Distribution of Lifetime Health Care Costs %A Anthony Webb %A Natalia A. Zhivan %K Healthcare %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X Estimates of the expected present value of lifetime out-of-pocket medical costs from age 65 onward are of limited value to households managing wealth decumulation in retirement. Their risk characteristics may differ from the average. They will also care about the whole probability distribution of health cost outcomes, and will want to update that probability distribution during the course of retirement. Using Health and Retirement Study data, we simulate health, mortality, and health cost histories of retired households. We show that the life expectancy and average health costs of our simulated households closely match published life tables and the findings of previous research. Using our simulated data, assuming a 3-percent real interest rate and including Medicare and private insurance premiums, we estimate that a typical household age 65 has a 5-percent risk of the present value of its lifetime health care costs exceeding 311,000, or 570,000 including the cost of long-term care. We find that relatively little resolution of uncertainty occurs with age, even for those who remain free of chronic disease. %G eng %U http://crr.bc.edu/images/stories/Working_Papers/wp_2010-1.pdf %L newpubs20100407_Webb.pdf %4 health insurance/health care costs/Medicare/retirement planning %$ 21840 %0 Journal Article %J Am J Public Health %D 2010 %T Impact of cognitive impairment on screening mammography use in older US women. %A Kala M. Mehta %A Kathy Z Fung %A Christine E Kistler %A Chang, Anna %A Louise C Walter %K Aged %K Aged, 80 and over %K Cognition Disorders %K Female %K Humans %K Incidence %K Longitudinal Studies %K Mammography %K Medicare %K Patient Acceptance of Health Care %K Social Class %K United States %X

OBJECTIVES: We evaluated mammography rates for cognitively impaired women in the context of their life expectancies, given that guidelines do not recommend screening mammography in women with limited life expectancies because harms outweigh benefits.

METHODS: We evaluated Medicare claims for women aged 70 years or older from the 2002 wave of the Health and Retirement Study to determine which women had screening mammography. We calculated population-based estimates of 2-year screening mammography prevalence and 4-year survival by cognitive status and age.

RESULTS: Women with severe cognitive impairment had lower rates of mammography (18%) compared with women with normal cognition (45%). Nationally, an estimated 120,000 screening mammograms were performed among women with severe cognitive impairment despite this group's median survival of 3.3 years (95% confidence interval = 2.8, 3.7). Cognitively impaired women who had high net worth and were married had screening rates approaching 50%.

CONCLUSIONS: Although severe cognitive impairment is associated with lower screening mammography rates, certain subgroups with cognitive impairment are often screened despite lack of probable benefit. Given the limited life expectancy of women with severe cognitive impairment, guidelines should explicitly recommend against screening these women.

%B Am J Public Health %I 100 %V 100 %P 1917-23 %8 2010 Oct %G eng %N 10 %L newpubs20101012_Mehta.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20075325?dopt=Abstract %2 PMC2936976 %4 Cognition Disorders/Mammography/Medicare %$ 23540 %R 10.2105/AJPH.2008.158485 %0 Report %D 2010 %T The Influence of Retiree Health Benefits on Retirement Patterns %A James Marton %A Stephen A. Woodbury %K Consumption and Savings %K Insurance %K Public Policy %K Retirement Planning and Satisfaction %X We estimate the effect of employer offers of retiree health benefits (RHBs) on the timing of retirement using a sample of Health and Retirement Study (HRS) men observed over a period of up to 12 years. We hypothesize that the effect of RHBs differs for workers of different ages--a hypothesis we can test now that the main HRS cohort has aged sufficiently. We apply three wellknown panel data estimators and find that, for men in their 50s, RHBs have little or no effect on retirement decisions; however, a substantial effect emerges for men in their early 60s. We use simulations to illustrate how RHBs alter retirement patterns. %B Upjohn Institute Working Papers %I W. E. Upjohn Institute for Employment Research %C Kalamazoo, MI %G eng %U https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.665.2810&rep=rep1&type=pdf %L newpubs20100407_Marton.pdf %4 Retirement, Retirement Policies/Public Health/Personal Finance/Retirement, Health Insurance, Employee Benefits, Panel Data %$ 21800 %0 Journal Article %J Chiropr Osteopat %D 2010 %T A longitudinal study of chiropractic use among older adults in the United States. %A Paula A Weigel %A Jason Hockenberry %A Suzanne E Bentler %A Maksym Obrizan %A Kaskie, Brian %A Michael P Jones %A Robert L. Ohsfeldt %A Gary E Rosenthal %A Robert B Wallace %A Frederic D Wolinsky %X

BACKGROUND: Longitudinal patterns of chiropractic use in the United States, particularly among Medicare beneficiaries, are not well documented. Using a nationally representative sample of older Medicare beneficiaries we describe the use of chiropractic over fifteen years, and classify chiropractic users by annual visit volume. We assess the characteristics that are associated with chiropractic use versus nonuse, as well as between different levels of use.

METHODS: We analyzed data from two linked sources: the baseline (1993-1994) interview responses of 5,510 self-respondents in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD), and their Medicare claims from 1993 to 2007. Binomial logistic regression was used to identify factors associated with chiropractic use versus nonuse, and conditional upon use, to identify factors associated with high volume relative to lower volume use.

RESULTS: There were 806 users of chiropractic in the AHEAD sample yielding a full period prevalence for 1993-2007 of 14.6%. Average annual prevalence between 1993 and 2007 was 4.8% with a range from 4.1% to 5.4%. Approximately 42% of the users consumed chiropractic services only in a single calendar year while 38% used chiropractic in three or more calendar years. Chiropractic users were more likely to be women, white, overweight, have pain, have multiple comorbid conditions, better self-rated health, access to transportation, higher physician utilization levels, live in the Midwest, and live in an area with fewer physicians per capita. Among chiropractic users, 16% had at least one year in which they exceeded Medicare's "soft cap" of 12 visits per calendar year. These over-the-cap users were more likely to have arthritis and mobility limitations, but were less likely to have a high school education. Additionally, these over-the-cap individuals accounted for 58% of total chiropractic claim volume. High volume users saw chiropractors the most among all types of providers, even more than family practice and internal medicine combined.

CONCLUSION: There is substantial heterogeneity in the patterns of use of chiropractic services among older adults. In spite of the variability of use patterns, however, there are not many characteristics that distinguish high volume users from lower volume users. While high volume users accounted for a significant portion of claims, the enforcement of a hard cap on annual visits by Medicare would not significantly decrease overall claim volume. Further research to understand the factors causing high volume chiropractic utilization among older Americans is warranted to discern between patterns of "need" and patterns of "health maintenance".

%B Chiropr Osteopat %I 18 %V 18 %P 34 %8 2010 Dec 21 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21176137?dopt=Abstract %2 PMC3019203 %4 Chiropractic/Medicare/health Services/Arthritis/Mobility %$ 25030 %R 10.1186/1746-1340-18-34 %0 Journal Article %J J Econ Perspect %D 2010 %T Mental Retirement. %A Susann Rohwedder %A Robert J. Willis %X

Some studies suggest that people can maintain their cognitive abilities through "mental exercise." This has not been unequivocally proven. Retirement is associated with a large change in a person's daily routine and environment. In this paper, we propose two mechanisms how retirement may lead to cognitive decline. For many people retirement leads to a less stimulating daily environment. In addition, the prospect of retirement reduces the incentive to engage in mentally stimulating activities on the job. We investigate the effect of retirement on cognition empirically using cross-nationally comparable surveys of older persons in the United States, England, and 11 European countries in 2004. We find that early retirement has a significant negative impact on the cognitive ability of people in their early 60s that is both quantitatively important and causal. Identification is achieved using national pension policies as instruments for endogenous retirement.

%B J Econ Perspect %I 24 %V 24 %P 119-138 %8 2010 Winter %G eng %N 1 %L newpubs20100921_Rohwedder.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20975927?dopt=Abstract %2 PMC2958696 %4 early Retirement/Cognition/retirement Planning/Public Policy/labor Force Participation/cross-national comparison/Social Security and Public Pensions/Economics of the Elderly/Economics of the Handicapped/Non-labor Market Discrimination/Retirement/Retirement Policies/ELSA_/SHARE %$ 23440 %R 10.1257/jep.24.1.119 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2010 %T Military service and men's health trajectories in later life. %A Janet M Wilmoth %A Andrew S London %A Wendy M Parker %K Activities of Daily Living %K Aged %K Aging %K Health Status %K Humans %K Korean War %K Male %K Middle Aged %K Military Personnel %K Multivariate Analysis %K Racial Groups %K Self-Assessment %K Veterans %K Vietnam Conflict %K World War II %X

OBJECTIVES: This study examines differences in the relationship between veteran status and men's trajectories of health conditions, activities of daily living limitations, and self-rated health.

METHODS: We use data on 12,631 men drawn from the 1992-2006 waves of the Health and Retirement Study to estimate growth curve models that examine differences in health trajectories between nonveterans and veterans, veterans with and without wartime service, and war service veterans who served during World War II, Korea, Vietnam, and multiple wars.

RESULTS: The results indicate that veterans have better health at the mean age of 66.2 years, but experience greater age-related changes in health than nonveterans. Similarly, men who served during wartime have better health at the mean age, but more age-related changes in health than men who did not serve during wartime. Among war veterans, Vietnam veterans are in poorer health at the mean age, but they experience less substantial age-related health changes than men who served during previous wars.

DISCUSSION: Although veterans experience better health relative to nonveterans around retirement age, they have poorer health than nonveterans among the oldest old. These findings inform our understanding of the veteran-nonveteran health-mortality paradox found in previous research and suggest a health crossover among veterans and nonveterans in later life.

%B J Gerontol B Psychol Sci Soc Sci %I 65B %V 65 %P 744-55 %8 2010 Nov %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/20864570?dopt=Abstract %2 PMC2954333 %4 Veterans: statistics/numerical/Models/Mens health/Age differences/MORTALITY %$ 24240 %R 10.1093/geronb/gbq072 %0 Book Section %B Research Findings in the Economics of Aging %D 2010 %T Mind the Gap! Consumer Perceptions and Choices of Medicare Part D Prescription Drug Plans %A Florian Heiss %A Daniel McFadden %A Joachim Winter %E David A Wise %K End of life decisions %K Healthcare %K Medicare/Medicaid/Health Insurance %X Medicare Part D provides prescription drug coverage through Medicare approved plans offered by private insurance companies and HMOs. In this paper, we study the role of current prescription drug use and health risks, related expectations, and subjective factors in the demand for prescription drug insurance. To characterize rational behavior in the complex Part D environment, we develop an intertemporal optimization model of enrollment decisions. We generally find that seniors' choices respond to the incentives provided by their own health status and the market environment as predicted by the optimization model. The proportion of individuals who do not attain the optimal choice is small, but the margin for error is also small since enrollment is transparently optimal for most eligible seniors. Further, there is also evidence that seniors over-react to some salient features of the choice situation, do not take full account of the future benefit and cost consequences of their decisions, or the expected net benefits and risk properties of alternative plans. %B Research Findings in the Economics of Aging %S The Economics of Aging %I University of Chicago Press %C Chicago %P 413-481 %@ 0-226-90306-0 %G eng %U https://www.nber.org/books-and-chapters/research-findings-economics-aging/mind-gap-consumer-perceptions-and-choices-medicare-part-d-prescription-drug-plans %4 Medicare Part D/prescription drug coverage/health insurance/decision Making %$ 24160 %& 14 %0 Journal Article %J Pain %D 2010 %T Modifiable risk factors for incidence of pain in older adults. %A Yu Shi %A Hooten, W Michael %A Rosebud O. Roberts %A David O. Warner %K Age Factors %K Aged %K Aged, 80 and over %K Cross-Sectional Studies %K Demography %K depression %K Female %K Humans %K Incidence %K Longitudinal Studies %K Male %K Middle Aged %K Overweight %K pain %K Prevalence %K Retrospective Studies %K Risk Assessment %K Risk Factors %K Smoking %K United States %X

Pain symptoms in aging populations have significant public health impact. The aim of this study was to determine risk factors for the incidence of pain in older adults, focusing on those factors that can be modified. Secondary analyses were performed of survey data from the nationally representative Health and Retirement Study of US adults older than 50 years. Generalized estimating equations logistic regressions were used to evaluate the effect of selected variables on the incidence of pain using biennial (1992 through 2006) data, determining the relationship between the incidence of pain and the potential risk factors. Of the 18,439 survey respondents in 2006, 34.1% (95% CI: 33.2%, 35.0%) reported that they were often troubled by pain; 24.3% reported having moderate to severe pain; and 22.3% reported that their daily life was affected by pain. Between 1992 and 2006, 7967 individuals reported new onset of pain in 169,762 person-years of follow-up, an incidence of 4.69 (4.59, 4.80) per 100 person-years. Depression and being overweight were independent predictors associated with an increased likelihood of incident pain. Current smoking increased the likelihood of incident pain only in those subjects who also reported depression. In conclusion, pain is a common symptom in older adults. Depression, smoking, and overweight are potentially modifiable risk factors and could be considered in the prevention and management of pain in older adults.

%B Pain %I 151 %V 151 %P 366-371 %8 2010 Nov %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20696524?dopt=Abstract %3 20696524 %4 Age Factors/Demography/Depression/Depressive Symptoms/Incidence/Obesity/Prevalence/Risk Assessment/Risk Factors/Smoking/Public Policy %$ 69476 %R 10.1016/j.pain.2010.07.021 %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 Report %D 2010 %T Occupational Learning, Financial Knowledge, and the Accumulation of Retirement Wealth %A Brooke Helppie %A Kandice Kapinos %A Robert J. Willis %A Michigan Retirement Research Center %K Health Conditions and Status %K Net Worth and Assets %X This study explores the relationship between general human capital investment, financial knowledge, occupational spillovers, and the accumulation of wealth in a primarily descriptive manner. Drawing upon human capital theory and following previous related work by Delavande, Rohwedder and Willis (2008), we hypothesized that individuals with daily exposure to financial knowledge through their occupation would benefit by having greater financial knowledge that would translate into greater wealth accumulation than individuals who do not enjoy such spillovers from their occupation. Using data from the Cognitive Economics Study and the Health and Retirement Study, we find strong evidence that individuals in financial occupations tend to have greater financial knowledge and moderate evidence that they also have greater wealth accumulation. %B Working Paper %I Michigan Retirement Research Center, University of Michigan %C Ann Arbor, MI %G eng %U http://hdl.handle.net/2027.42/78354 %4 human capital/financial knowledge/Cognitive Economics Study/wealth Accumulation %$ 24320 %0 Journal Article %J Med Care %D 2010 %T Out-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy. %A Becky A. Briesacher %A Ross-Degnan, Dennis %A Anita K Wagner %A Hassan Fouayzi %A Fang Zhang %A Jerry Gurwitz %A Soumerai, Stephen B %K Adult %K Aged %K Confidence Intervals %K Cost of Illness %K Deductibles and Coinsurance %K Drug Prescriptions %K Female %K Financing, Personal %K Health Expenditures %K Humans %K Income %K Male %K Medicare Part D %K Middle Aged %K Odds Ratio %K Poverty %K Socioeconomic factors %K United States %X

BACKGROUND: Evaluating the adequacy of Medicare prescription drug program (Part D) and its low-income subsidy (LIS) requires a comprehensive understanding of drug spending in relation to household resources.

OBJECTIVE: : To estimate out-of-pocket health care costs in the year before Part D, in context of total household spending, health status, and LIS eligibility.

RESEARCH DESIGN: Nationally representative cross-sectional study.

SUBJECTS: Two thousand two hundred thirty-one Medicare families in the 2005/2006 Health and Retirement Study.

METHODS: We assessed health care costs as a share of household resources remaining after spending on essential housing, food, personal care, and transportation. Burdensome health care costs were defined as exceeding 40% of nonessential resources. We used logistic regressions to assess the probability of incurring burdensome health expenditures, controlling for LIS eligibility.

RESULTS: In the year before Part D, more than half of Medicare families [56.0%; 95% confidence interval (CI): 55.3-59.9] experienced burdensome health care costs. Families in poor health allocated a median of 68.1% [interquartile range (IQR): 35.1-82.9] of nonessential resources to health care (compared with 34.0% median; IQR 11.9-52.2 among families in excellent health, P < 0.011). Most (64%) out-of-pocket health care spending was allocated to health insurance premiums and medications. As many as 26% of Medicare families had burdensome health care costs but were not eligible for LIS assistance.

CONCLUSIONS: Before Part D, burdensome health care expenditures were common in Medicare families. Our estimates of Part D and LIS benefits indicate a limited scope of relief.

%B Med Care %I 48 %V 48 %P 503-9 %8 2010 Jun %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/20473197?dopt=Abstract %2 PMC3084515 %4 Low income groups/Medicare/Medicare Part D/Health care expenditures/Prescription drug plans/Families and family life/Insurance premiums/Health insurance/Health care access %$ 22480 %R 10.1097/MLR.0b013e3181dbd8d3 %0 Report %D 2010 %T Personality, Lifetime Earnings, and Retirement Wealth %A Angela Lee Duckworth %A David R Weir %A Michigan Retirement Research Center %K Health Conditions and Status %K Healthcare %K Public Policy %K Social Security %X Studies of adolescents and young adults have shown that schooling impacts economic outcomes beyond its impact on cognitive ability. Research has also shown that the personality trait of conscientiousness predicts health outcomes, academic outcomes, and divorce. Using the Big Five taxonomy of personality traits, this study examines whether non-cognitive traits are related to economic success over the life course. Examining Health and Retirement Study survey data linked to Social Security records on over 10,000 adults age 50 and over, we investigate the relationship of personality traits to economic outcomes. Controlling for cognitive ability and background variables, do more conscientious and emotionally stable adults have higher lifetime earnings, and is this due to higher annual earnings, longer work lives, or both? Do more conscientious adults save a higher proportion of their earnings for retirement, and does conscientiousness of each partner in a married couple matter? Do conscientiousness and emotional stability interact such that the effects of conscientiousness are greater among less emotionally stable adults? %I Michigan Retirement Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://ideas.repec.org/p/mrr/papers/wp235.html %4 health outcomes/cognitive ability/economic outcomes/earnings and Benefits File %$ 24340 %0 Journal Article %J Int J Aging Hum Dev %D 2010 %T Predicting positive well-being in older men and women. %A Erin L. Waddell %A Joy M Jacobs-Lawson %K Aged %K Aged, 80 and over %K Aging %K depression %K Female %K Health Status %K Humans %K Male %K Marriage %K Middle Aged %K Personal Satisfaction %K Predictive Value of Tests %K Quality of Life %K Regression Analysis %K Religion and Psychology %K Self Concept %K Sex Distribution %K Social Behavior %K Surveys and Questionnaires %K Volunteers %X

The purpose of this study was to examine the effects of background, psychological, and social variables on older adults' well-being, and how this may differ for men and women. Participants included 800 adults from the 2002 Health and Retirement Study (HRS), aged 60 to 101 years old (M = 71.22, SD = 8.46), who completed the optional positive well-being module. Gender-based regression models revealed that for men, marital status, self-rated health, and depression were significant predictors and accounted for 32% of the variability in positive well-being. Similar to men, self-rated health and depression were significant predictors of well-being for women. Additional significant predictors for women included age, the importance of religion, and volunteer work. Combined, these variables explained 35% of the variance in women's positive well-being. These results can help us understand which variables are important to target when developing interventions to improve the well-being of older men and women.

%B Int J Aging Hum Dev %I 70 %V 70 %P 181-97 %8 2010 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/20503804?dopt=Abstract %3 20503804 %4 Well Being/Elderly/Women/Health/Depression/Marital Status/Psycho-social %$ 23350 %R 10.2190/AG.70.3.a %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2010 %T Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries. %A Frederic D Wolinsky %A Suzanne E Bentler %A Li Liu %A Michael P Jones %A Kaskie, Brian %A Jason Hockenberry %A Elizabeth A Chrischilles %A Kara B Wright %A John F Geweke %A Maksym Obrizan %A Robert L. Ohsfeldt %A Gary E Rosenthal %A Robert B Wallace %K Aged %K Educational Status %K Female %K Hospitalization %K Humans %K Male %K Marital Status %K Medicare %K Myocardial Infarction %K Patient Discharge %K Proportional Hazards Models %K Prospective Studies %K Risk Factors %K Sex Factors %K United States %X

BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8%) suffered postbaseline heart attacks, with 423 participants (7.7%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.

%B J Gerontol A Biol Sci Med Sci %I 65 %V 65 %P 769-77 %8 2010 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/20106961?dopt=Abstract %2 PMC2904597 %4 HOSPITALIZATION/heart disease/risk Factors/Medicare/Public Policy %$ 23090 %R 10.1093/gerona/glq003 %0 Thesis %D 2010 %T Psychiatric history and cognition trajectories in later life: Variation by sex, race and ethnicity, and childhood disadvantage %A Maria T. Brown %Y Janet M Wilmoth %K Adult children %K Demographics %K Health Conditions and Status %X Advocates of the life course perspective suggest that cumulative inequality affects later-life cognitive function, and that a history of psychiatric problems may be detrimental to cognition among individuals at risk of experiencing cumulative disadvantage. Psychiatric conditions are more prevalent among disadvantaged groups, who may also be at risk of experiencing cognitive decline in later life. Therefore, it is important to explore the relationships between sex, race/ethnicity, childhood disadvantage, psychiatric history, and cognitive function. This study addresses the following research questions: (1) Do individuals with a history of psychiatric problems have lower initial cognitive functioning and/or a unique trajectory of cognitive function with age? (2) Does the relationship between psychiatric history and cognitive function in later life change when controlling for ascribed, early-life, and later-life characteristics? (3) Do ascribed characteristics interact with psychiatric history to affect cognitive function in later life? This study applies growth curve models to analyze six waves of Health and Retirement Study data, examining influences on total cognitive function and three components of cognitive function, while controlling for demographic and health variables. The psychiatric history variable includes psychiatric, emotional, and nervous problems. Findings indicate that psychiatric history is related to lower cognition and steeper rates of decline, and that race/ethnicity and childhood disadvantage are also related to cognition. These findings also demonstrate that cumulative disadvantage and psychiatric history shape later-life cognition and decline and can enhance our understanding of trajectories of cognitive decline experienced by disadvantaged groups. %I Syracuse University %C Syracuse, NY %V Ph.D. %P 241 %8 2010 %G eng %9 Dissertation %L AAT 3429051 %4 socioeconomic Factors %$ 24260 %! Psychiatric history and cognition trajectories in later life: Variation by sex, race and ethnicity, and childhood disadvantage %0 Journal Article %J Demography %D 2010 %T Recent developments in longitudinal studies of aging in the United States. %A Hauser, Robert M. %A David R Weir %K Aging %K Data collection %K Demography %K Genome-Wide Association Study %K Health Status Indicators %K Health Surveys %K Humans %K Longitudinal Studies %K Research Design %K Socioeconomic factors %K United States %X

We review recent developments in longitudinal studies of aging, focusing on the Wisconsin Longitudinal Study (WLS) and the Health and Retirement Study (HRS). Both studies are part of a trend toward biosocial surveys in which biological measurement is joined with traditional survey techniques, and a related trend toward greater harmonization across studies. Both studies have collected DNA samples and are working toward genotyping that would allow broadly based association studies. Increased attention to psychological measurement of personality and of cognitive ability using adaptive testing structures has also been shared across the studies. The HRS has expanded its economic measurement to longitudinal studies of consumption and to broader-based measurement of pension and Social Security wealth. It has added biomarkers of cardiovascular risk. The WLS has developed an integrated approach to the study of death and bereavement and an innovative use of high school yearbook photographs to capture information about health in early life of its participants.

%B Demography %I 47 Suppl %V 47 Suppl %P S111-30 %8 2010 %G eng %N Suppl 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21302430?dopt=Abstract %4 Aging/Data Collection/methods/Data Collection/methods/Demography/methods/ trends/Demography/methods/ trends/Genome-Wide Association Study/Genome-Wide Association Study/Health Status Indicators/Health Status Indicators/Health Surveys/methods/ trends/Health Surveys/methods/ trends/Humans/Longitudinal Studies/methods/ trends/Longitudinal Studies/methods/ trends/Research Design/Socioeconomic Factors/United States %$ 62778 %R 10.1353/dem.2010.0012 %0 Report %D 2010 %T Is the Reduction in Older Workers’ Job Tenure a Cause for Concern? %A Anthony Webb %A Sass, Steven A. %K Labor Dynamics %K Labor economics %K Tenure %X Using data from the Health and Retirement Study (HRS), we analyze trends in voluntary, pressured, and forced quits and risk factors associated with each type of quit. We show that leaving one's age-50 job between ages 50 and 56 in any of the above circumstances more than doubles the likelihood that an individual will be working part-time at age 60, relative to a base case of working full-time. Pressured and forced quits also substantially increase the likelihood that the individual will not be working for pay at that age. Statistical tests confirm that pressured quits represent a separate and distinct category with its own risk factors and that they cannot be regarded as a subset of either voluntary or forced quits. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/is-the-reduction-in-older-workers-job-tenure-a-cause-for-concern/ %0 Journal Article %J Inquiry %D 2010 %T Reforming beneficiary cost sharing to improve Medicare performance. %A Zuckerman, Stephen %A Shang, Baoping %A Timothy A Waidmann %K Aged %K Aged, 80 and over %K Cost Sharing %K Health Expenditures %K Humans %K Medicare %K Middle Aged %K Models, Economic %K United States %X

This paper explores options for reforming Medicare cost sharing in an effort to provide better financial protection for those beneficiaries with the greatest health care needs. Using data from the Health and Retirement Study (HRS) and the Medicare Current Beneficiary Survey (MCBS), we consider how unified annual deductibles, alternative coinsurance rates, and a limit on out-of-pocket spending would alter program spending, beneficiary cost sharing, and premiums for supplemental coverage. We show that adding an out-of-pocket limit and raising deductibles and coinsurance slightly would provide better safeguards to beneficiaries with high costs than the current Medicare benefit structure. Our estimates also suggest that policies protecting these beneficiaries could be structured in a way that would add little to overall program costs.

%B Inquiry %I 47 %V 47 %P 215-25 %8 2010 Fall %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/21155416?dopt=Abstract %4 Medicare/out of pocket costs/Beneficiaries %$ 25260 %R 10.5034/inquiryjrnl_47.03.215 %0 Book %B The Economics of Aging %D 2010 %T Research findings in the economics of aging %A David A Wise %K Demographics %K Disabilities %K Medicare/Medicaid/Health Insurance %K Net Worth and Assets %K Pensions %X The baby boom generation’s entry into old age has led to an unprecedented increase in the elderly population. The social and economic effects of this shift are significant, and in Research Findings in the Economics of Aging, a group of leading researchers takes an eclectic view of the subject. Among the broad topics discussed are work and retirement behavior, disability, and their relationship to the structure of retirement and disability policies. While choices about when to retire are made by individuals, these decisions are influenced by a set of incentives, including retirement benefits and health care, and this volume includes cross-national analyses of the effects of such programs on these decisions. Furthermore, the volume also offers in-depth analysis of the effects of retirement plans, employer contributions, and housing prices on retirement. It explores well-established relationships among economic circumstances, health, and mortality, as well as the effects of poverty and lower levels of economic development on health and life satisfaction. By combining micro and macro evidence, this volume continues a tradition of expanding the research agenda on the economics of aging. %B The Economics of Aging %I University of Chicago Press %C Chicago %@ 0-226-90306-0 %G eng %U https://www.nber.org/books-and-chapters/research-findings-economics-aging %4 Aging / Economic aspects / Congresses./Older people / Economic conditions / Congresses./Old age pensions / Congresses./Disability retirement / Congresses./Medicare / Congresses. %$ 26200 %0 Journal Article %J Popul Res Policy Rev %D 2010 %T The Retirement Life Course in America at the Dawn of the Twenty-First Century. %A David F Warner %A Mark D Hayward %A Melissa A. Hardy %X

As the baby boom cohorts expand the number of U.S. retirees, population estimates of the employment, withdrawal and reentry behaviors of older Americans' remain scarce. How long do people work? How frequently is retirement reversed? How many years are people retired? What is the modal age of retirement? And, how do the patterns for women compare to those for men? Using the 1992-2004 Health and Retirement Study, we estimate multistate working life tables to update information on the age-graded regularities of the retirement life course of men and women in the United States. We find that at age 50 men can expect to spend half of their remaining lives working for pay, while women can expect to spend just one-third. Half of all men and women have left the labor force by ages 63 and 61, respectively. Although the majority of retirement exits are final, variation in the nature and duration of the retirement process is substantial, as about a third of men's and women's exits are reversed. By quantifying these patterns for men and women, we provide a sound empirical basis for evaluating policy designed to address the financial pressures population aging places on public and private pension systems.

%B Popul Res Policy Rev %I 29 %V 29 %P 893-919 %8 2010 Jan 12 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/21170285?dopt=Abstract %2 PMC3002227 %4 Retirement/Working Women/women/labor Force Participation/Twenty First Century/Males/Aging %$ 24430 %R 10.1007/s11113-009-9173-2 %0 Journal Article %J Soc Psychiatry Psychiatr Epidemiol %D 2010 %T The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: a structural equation modeling approach. %A Chiu, Ching-Ju %A Linda A. Wray %A Elizabeth A Beverly %A Oralia G Dominic %K Adult %K Aged %K Blood Glucose %K Body Weight %K Comorbidity %K depression %K Diabetes Mellitus, Type 2 %K Female %K Follow-Up Studies %K Glycated Hemoglobin %K Glycemic Index %K Health Behavior %K Health Surveys %K Humans %K Life Style %K Longitudinal Studies %K Male %K Middle Aged %K Models, Statistical %K Self Care %K Smoking %K United States %X

OBJECTIVES: We investigated the longitudinal association between depressive symptoms and glycemic control (HbA1c) in adults with type 2 diabetes, and the extent to which that association was explained by health behaviors.

METHODS: This study assessed data on 998 adults (aged 51 and above) with type 2 diabetes in the US nationally representative Health and Retirement Study and its diabetes-specific mail survey. Participants' depressive symptoms and baseline health behaviors (exercise, body weight control, and smoking status) were collected in 1998. Follow-up health behaviors and the glycemic control outcome were measured at a 2- and 5-year intervals, respectively.

RESULTS: Nearly one in four of participants (23%) reported moderate or high levels of depressive symptoms at baseline (CES-D score >or=3). Adults with higher levels of depressive symptoms at baseline showed lower scores on baseline and follow-up health behaviors as well as higher HbA1c levels at a 5-year follow-up. Structural equation models (SEM) reveal that health behaviors accounted for 13% of the link between depressive symptoms and glycemic control.

CONCLUSIONS: The long-term relationship between depressive symptoms and glycemic control was supported in the present study. Health behaviors, including exercise, body weight control, and smoking status, explained a sizable amount of the association between depressive symptoms and glycemic control. More comprehensive diabetes self-care behaviors should be examined with available data. Other competing explicators for the link, such as endocrinological process and antidepressant effects, also warrant further examination.

%B Soc Psychiatry Psychiatr Epidemiol %I 45 %V 45 %P 67-76 %8 2010 Jan %G eng %N 1 %L newepubs20100129_Chiu-Wray.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19343264?dopt=Abstract %2 PMC2804782 %4 diabetes/Depressive Symptoms/Health care management %$ 21750 %R 10.1007/s00127-009-0043-3 %0 Report %D 2010 %T The Social Security Early Retirement Benefit as Safety Net %A John Bound %A Timothy A Waidmann %A Michigan Retirement Research Center %K Demographics %K Disabilities %K Retirement Planning and Satisfaction %K Social Security %X In this paper we used the Health and Retirement Study to examine the health and economic status of those who collect Social Security retirement benefits prior to the full retirement age. We used a propensity score reweighting method to estimate the fraction of early retirees who uses early retirement benefits as a safety net against deteriorating health and who might be induced to apply for disability benefits (SSDI) or retire without income replacement if the generosity or availability of early retirement benefits were reduced. We find that while the majority of early retirees would likely not qualify for disability benefits, approximately one in five have health characteristics similar to SSDI beneficiaries, and thus might not be able to replace losses in benefit income with labor income. %I The University of Michigan, Michigan Retirement Research Center %G eng %4 socioeconomic Status/retirement benefits/disability benefits/early Retirement/earnings and Benefits File %$ 24300 %0 Report %D 2010 %T Socio-economic Status and Mortality: Perceptions and Outcomes %A David R Weir %K Demographics %K Health Conditions and Status %X This paper draws on over 300,000 person-years of mortality observation on over 30,000 participants in the Health and Retirement Study (HRS) to study the relationship of education, income, and wealth to mortality expectations and mortality outcomes in older Americans. Using quintiles to facilitate comparison across variables, we find that all three SES measures significantly predict mortality, but that in joint models education is dominated by the other two which are realized later in life, and particularly by wealth. As others have found, SES differentials in mortality decline with age, though wealth remains a powerful determinant even at advanced ages. When strictly interpreted as expressions of relative risk, the subjective probabilities of survival offered by HRS respondents substantially understate the true differentials by SES, as they do for other factors like smoking and very low or very high body weight. In particular, the large mortality disadvantage of low wealth is not recognized. SES accounts for most of black-white differentials in mortality, whereas it unveils an Hispanic advantage relative to other whites that was masked by lower SES. %G eng %U https://paa2010.princeton.edu/papers/101560 %4 Mortality/socioeconomic Differences/racial Differences/ethnic differences %$ 26180 %0 Journal Article %J Anesthesiology %D 2010 %T Surgery as a teachable moment for smoking cessation. %A Yu Shi %A David O. Warner %K Aged %K Aged, 80 and over %K Ambulatory Surgical Procedures %K Analysis of Variance %K Cohort Studies %K Female %K Follow-Up Studies %K General Surgery %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Patient Education as Topic %K Regression Analysis %K Smoking cessation %K Treatment Outcome %K United States %X

BACKGROUND: A "teachable moment" is an event that motivates spontaneous behavior change. Some evidence suggests that major surgery for a smoking-related illness can serve as a teachable moment for smoking cessation. This study tested the hypotheses that surgery increases the likelihood of smoking cessation and that cessation is more likely after major surgical procedures compared with outpatient surgery.

METHODS: Secondary analyses were performed of longitudinal biennial survey data (1992-2004) from the nationally representative Health and Retirement Study of U.S. adults older than 50 yr, determining the relationship between the incidence of smoking cessation and the occurrence of surgery.

RESULTS: Five thousand four hundred ninety-eight individuals reported current smoking at enrollment, and 2,444 of them (44.5%) quit smoking during the period of examination. The incidence of quitting in smokers undergoing major surgery was 20.6/100 person-years of follow-up and 10.2/100 person-years in those undergoing outpatient surgery. In a multivariate negative binomial regression model, the incidence rate ratio of quitting associated with major surgery was 2.02 (95% CI: 1.67-2.44) and that of those associated with outpatient surgery was 1.28 (95% CI: 1.09-1.50). Estimates derived from national surgical utilization data show that approximately 8% of all quit events in the United States annually can be attributed to the surgical procedures analyzed.

CONCLUSIONS: Undergoing surgery is associated with an increased likelihood of smoking cessation in the older U.S. population. Cessation is more likely in association with major procedures compared with outpatient surgery. These data support the concept that surgery is a teachable moment for smoking cessation.

%B Anesthesiology %I 112 %V 112 %P 102-7 %8 2010 Jan %G eng %N 1 %L newpubs20100129_Shi-Warner.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19996946?dopt=Abstract %3 19996946 %4 Smoking/Smoking Cessation %$ 21700 %R 10.1097/ALN.0b013e3181c61cf9 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2010 %T Take-up of Medicare Part D: results from the Health and Retirement Study. %A Helen G Levy %A David R Weir %K Aged %K ethnicity %K Humans %K Longitudinal Studies %K Medically Uninsured %K Medicare Part D %K Multivariate Analysis %K Poverty %K prescription drugs %K Prescription Fees %K United States %X

OBJECTIVES: To estimate the impact of Medicare Part D on prescription drug coverage among elderly Medicare beneficiaries and to analyze the predictors of program enrollment ("take-up") among those with no prior drug coverage.

METHODS: Multivariate analyses of data from the 2002, 2004, and 2006 waves of the Health and Retirement Study.

RESULTS: Take-up of Part D among those without drug coverage in 2004 was high; about 50%-60% of this group had Part D coverage in 2006. Only 7% of senior citizens lacked drug coverage in 2006 compared with 24% in 2004. Demand for prescription drugs was the most important determinant of the decision to enroll in Part D among those with no prior coverage. Many of those who remained without coverage in 2006 reported that they do not use prescribed medicines, and the majority had relatively low out-of-pocket spending.

CONCLUSION: For the most part, Medicare beneficiaries seem to have been able to make economically rational decisions about Part D enrollment despite the complexity of the program.

%B J Gerontol B Psychol Sci Soc Sci %I 65 %V 65 %P 492-501 %8 2010 Jul %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20034992?dopt=Abstract %4 medicare/older people/prescription drugs/Multivariate Analysis/Medicare Part D %$ 23390 %R 10.1093/geronb/gbp107 %0 Report %D 2010 %T Trigger Events and Financial Outcomes Among Older Households %A Geoffrey L Wallace %A Haveman, Robert %A Karen C. Holden %A Barbara Wolfe %K Adult children %K Health Conditions and Status %K Healthcare %K Net Worth and Assets %K Social Security %X Follow a sample of social security beneficiaries drawn from the Health and Retirement Study from their first year of retirement up to 15 years into retirement, we estimate rates at which retirees are subject to family structure change, cognitive decline, health decline, and other events. Then we assess the vulnerability of wealth and wealth-based adequacy measures to adverse events, drawing conclusions about the effect of events on a wealth-based measure and a wealth-based inadequacy measure. Our findings highlight the importance of cognitive and health decline as events with the potential to shape the evolution of wealth post-retirement. %B Center for Financial Security Working Paper %I Center for Financial Security, University of Wisconsin-Madison %C Madison, WI %G eng %U https://cfs.wisc.edu/2010/09/10/trigger-events-and-financial-outcomes-among-older-households/ %4 social Security/wealth/adverse events/adverse events/Cognitive decline/health decline/Families %$ 26170 %0 Journal Article %J J Aging Health %D 2010 %T Urban neighborhood context and mortality in late life. %A Richard G Wight %A Janet R. Cummings %A Arun S Karlamangla %A Carol S Aneshensel %K Age Factors %K Aged %K Aging %K Cognition %K Confidence Intervals %K depression %K Female %K Health Status %K Humans %K Los Angeles %K Male %K Middle Aged %K Mortality %K Odds Ratio %K Poverty %K Psychometrics %K Residence Characteristics %K Self Report %K Socioeconomic factors %K Statistics as Topic %K Urban Population %X

OBJECTIVE: To examine the contextual effects of urban neighborhood characteristics on mortality among older adults.

METHOD: Data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD). Death is assessed between the baseline assessment (1993) and the first follow-up interview (1995). Neighborhood data are from the 1990 Census.

RESULTS: The log odds of dying between the two time points are higher in high proportion Hispanic neighborhoods, net of individual-level sociodemographic variables, but this effect is partly mediated by individual-level health. The log odds of dying are significantly (p < .05) lower in affluent neighborhoods, controlling for all individual-level variables and neighborhood proportion Hispanic.

DISCUSSION: There are survival-related benefits of living in an affluent urban neighborhood, which we posit may be manifested through the diffusion of innovations in health care and health-promotion activities.

%B J Aging Health %I 22 %V 22 %P 197-218 %8 2010 Mar %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20056813?dopt=Abstract %2 PMC3155256 %4 Neighborhoods/Mortality Rates/Hispanic Americans/Dying/Elderly/Health/mortality/affluence/social work theory %$ 21980 %R 10.1177/0898264309355980 %0 Report %D 2010 %T Validating Diabetes Disease Status in Claims and Survey Data. Proceedings of the 2010 International Methodology Symposium: The Interplay among Censuses, Surveys and Administrative Data %A Joseph W Sakshaug %A David R Weir %A Lauren Hersch Nicholas %K Health Conditions and Status %K Methodology %I Ottawa %G eng %4 Diabetes/methodology/ADMINISTRATIVE DATA %$ 24550 %0 Report %D 2010 %T What Is The Impact Of Foreclosures On Retirement Security? %A Irena Dushi %A Friedberg, Leora %A Anthony Webb %K Net Worth and Assets %X Using data from several sources, we show that households nearing retirement have lower rates of housing distress than younger households, as measured by arrears and foreclosure rates. However, almost all of the housing wealth gains observed for cohorts aged 51-56 between 1992 and 2004 were erased by 2010, while their mortgages have grown throughout. As a consequence, their loan-to-value ratios are considerably higher, though the percentage paying more than 30 percent of their household income towards their mortgage remains flat. Worrisomely, their financial wealth also declined between 2004 and 2010. Declines in house prices will adversely affect households that need to liquidate housing wealth, and rising mortgage obligations will increase pressure on retirement resources. We develop an econometric model to show factors associated with housing distress and then use the results to forecast housing distress among older households through 2012. We project that the risk of arrears will increase to 3.4 percent in 2010 and 4.4 percent by 2012. We also find that 6.7 percent of HRS households have children or other relatives who are facing housing distress, potentially putting further pressure on their retirement preparedness. %I Center for Retirement Research at Boston College %G eng %U http://www.policyarchive.org/handle/10207/bitstreams/95949.pdf %4 housing wealth/mortgage obligation/foreclosure rates %$ 25620 %0 Book Section %B Research Findings in the Economics of Aging %D 2010 %T Work Disability: The Effects of Demography, Health, and Disability Insurance %A Axel Borsch-Supan %E David A Wise %K Cross-National %K Disabilities %K Employment and Labor Force %K Social Security %B Research Findings in the Economics of Aging %S National Bureau of Economic Research conference report %I University of Chicago Press %C Chicago %P 37-58 %G eng %4 disability insurance/workforce/social Security/cross-national comparison %$ 24130 %! Work Disability: The Effects of Demography, Health, and Disability Insurance %& 2 %0 Journal Article %J BMC Geriatr %D 2009 %T A 12-year prospective study of stroke risk in older Medicare beneficiaries. %A Frederic D Wolinsky %A Suzanne E Bentler %A Elizabeth A Cook %A Elizabeth A Chrischilles %A Li Liu %A Kara B Wright %A John F Geweke %A Maksym Obrizan %A Claire E Pavlik %A Robert L. Ohsfeldt %A Michael P Jones %A Robert B Wallace %A Gary E Rosenthal %K Aged %K Aged, 80 and over %K Female %K Humans %K Insurance Benefits %K Male %K Medicare %K Prospective Studies %K Risk Factors %K Socioeconomic factors %K Stroke %K United States %X

BACKGROUND: 5.8 M living Americans have experienced a stroke at some time in their lives, 780K had either their first or a recurrent stroke this year, and 150K died from strokes this year. Stroke costs about $66B annually in the US, and also results in serious, long-term disability. Therefore, it is prudent to identify all possible risk factors and their effects so that appropriate intervention points may be targeted.

METHODS: Baseline (1993-1994) interview data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to 1993-2005 Medicare claims. Participants were 5,511 self-respondents >or= 70 years old. Two ICD9-CM case-identification approaches were used. Two approaches to stroke case-identification based on ICD9-CM codes were used, one emphasized sensitivity and the other emphasized specificity. Participants were censored at death or enrollment into managed Medicare. Baseline risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting post-baseline non-stroke hospitalizations was included to reflect health shocks, and sensitivity analyses were conducted to identify its peak effect. Competing risk, proportional hazards regression was used.

RESULTS: Post-baseline strokes occurred for 545 (9.9%; high sensitivity approach) and 374 (6.8%; high specificity approach) participants. The greatest static risks involved increased age, being widowed or never married, living in multi-story buildings, reporting a baseline history of diabetes, hypertension, or stroke, and reporting difficulty picking up a dime, refusing to answer the delayed word recall test, or having poor cognition. Risks were similar for both case-identification approaches and for recurrent and first-ever vs. only first-ever strokes. The time-dependent health shock (recent hospitalization) marker did not alter the static model effect estimates, but increased stroke risk by 200% or more.

CONCLUSION: The effect of our health shock marker (a time-dependent recent hospitalization indicator) was large and did not mediate the effects of the traditional risk factors. This suggests an especially vulnerable post-hospital transition period from adverse effects associated with both their underlying health shock (the reasons for the recent hospital admission) and the consequences of their treatments.

%B BMC Geriatr %I 9 %V 9 %P 17 %8 2009 May 09 %G eng %L newpubs20090908_WolinskyBMC.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19426528?dopt=Abstract %2 PMC2683849 %4 Stroke/risk factors/DISABILITY/DISABILITY/Health Shocks %$ 20520 %R 10.1186/1471-2318-9-17 %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 Report %D 2009 %T Actual and Anticipated Inheritance Receipts %A Norma B Coe %A Anthony Webb %K Adult children %K Consumption and Savings %K Net Worth and Assets %X Using data from the Health and Retirement Study, we compare actual inheritances received during the period 1994 to 2004 with the amounts that, in 1994, households anticipated receiving within 10 years. We find little evidence of systematic forecasting errors. The factors affecting inheritance receipt also affect expectation formation. Although the distribution is highly skewed, inheritances are generally modest in amount and uncorrelated with lifetime income, and therefore have almost no effect on various measures of inequality. We find no evidence that households anticipating receipt of an inheritance save less than that of similar households, although this could reflect unobserved heterogeneity in tastes for saving. %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/actual-and-anticipated-inheritance-receipts/ %4 household income/savings/wills/inheritance %$ 22090 %0 Journal Article %J Am J Epidemiol %D 2009 %T The aftermath of hip fracture: discharge placement, functional status change, and mortality. %A Suzanne E Bentler %A Li Liu %A Maksym Obrizan %A Elizabeth A Cook %A Kara B Wright %A John F Geweke %A Elizabeth A Chrischilles %A Claire E Pavlik %A Robert B Wallace %A Robert L. Ohsfeldt %A Michael P Jones %A Gary E Rosenthal %A Frederic D Wolinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K depression %K Female %K Health Status %K Health Status Indicators %K Hip Fractures %K Humans %K Interviews as Topic %K Iowa %K Length of Stay %K Logistic Models %K Medicare %K Patient Discharge %K Prospective Studies %K Psychometrics %K Socioeconomic factors %K Time Factors %K Treatment Outcome %K United States %X

The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993-2005. There were 495 postbaseline hip fractures among 5,511 respondents aged >or=69 years. Mean age at hip fracture was 85 years; 73% of fracture patients were white women, 45% had pertrochanteric fractures, and 55% underwent surgical pinning. Most patients (58%) were discharged to a nursing facility, with 14% being discharged to their homes. In-hospital, 6-month, and 1-year mortality were 2.7%, 19%, and 26%, respectively. Declines in functional-status-scale scores ranged from 29% on the fine motor skills scale to 56% on the mobility index. Mean scale score declines were 1.9 for activities of daily living, 1.7 for instrumental activities of daily living, and 2.2 for depressive symptoms; scores on mobility, large muscle, gross motor, and cognitive status scales worsened by 2.3, 1.6, 2.2, and 2.5 points, respectively. Hip fracture characteristics, socioeconomic status, and year of fracture were significantly associated with discharge placement. Sex, age, dementia, and frailty were significantly associated with mortality. This is one of the few studies to prospectively capture these declines in functional status after hip fracture.

%B Am J Epidemiol %I 170 %V 170 %P 1290-9 %8 2009 Nov 15 %G eng %N 10 %L newpubs20091202_HipFracture.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19808632?dopt=Abstract %2 PMC2781759 %4 Functional Status/Mortality/Nursing Homes %$ 21300 %R 10.1093/aje/kwp266 %0 Report %D 2009 %T Aging, Demographics and Memory Study (ADAMS): Sample Design, Weighting and Analysis for ADAMS %A Steven G Heeringa %A Gwenith G Fisher %A Michael D Hurd %A Kenneth M. Langa %A Mary Beth Ofstedal %A Brenda L Plassman %A Rogers, Willard %A David R Weir %K Health Conditions and Status %K Methodology %X This technical report describes the sample design, design-based weighting and analysis procedures for the Aging, Demographics and Memory Study (ADAMS), a national study that recruited Health and Retirement Study (HRS) panel members to undergo a psychometric evaluation and clinical assessment visit. Langa et al. (2005) describe the general design and methods for the ADAMS including relevant background on the HRS longitudinal sample. This document provides additional detail on the sample design for the ADAMS including a description of survey sample selection, sample attrition and nonresponse, population weights, design-based variance estimation and related topics of importance to analysts of the ADAMS data. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 survey Methods/Sample Design/Cognition %$ 24910 %0 Journal Article %J J Health Econ %D 2009 %T Are mature smokers misinformed? %A Ahmed Khwaja %A Daniel S. Silverman %A Frank A Sloan %A Wang, Yang %K Aged %K Deception %K Female %K Health Knowledge, Attitudes, Practice %K Health Surveys %K Humans %K Male %K Middle Aged %K Risk Assessment %K Smoking %K United States %X

While there are many reasons to continue to smoke in spite of its consequences for health, the concern that many smoke because they misperceive the risks of smoking remains a focus of public discussion and motivates tobacco control policies and litigation. In this paper we investigate the relative accuracy of mature smokers' risk perceptions about future survival, and a range of morbidities and disabilities. Using data from the survey on smoking (SOS) conducted for this research, we compare subjective beliefs elicited from the SOS with corresponding individual-specific objective probabilities estimated from the health and retirement study. Overall, consumers in the age group studied, 50-70, are not overly optimistic in their perceptions of health risk. If anything, smokers tend to be relatively pessimistic about these risks. The finding that smokers are either well informed or pessimistic regarding a broad range of health risks suggests that these beliefs are not pivotal in the decision to continue smoking. Although statements by the tobacco companies may have been misleading and thus encouraged some to start smoking, we find no evidence that systematic misinformation about the health consequences of smoking inhibits quitting.

%B J Health Econ %I 28 %V 28 %P 385-97 %8 2009 Mar %G eng %N 2 %L newpubs20090908/Khwajaetal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19178971?dopt=Abstract %3 19178971 %4 Subjective Probabilities/Mortality/Health/Smoking %$ 20360 %R 10.1016/j.jhealeco.2008.12.004 %0 Journal Article %J Alzheimers Dement %D 2009 %T "Below average" self-assessed school performance and Alzheimer's disease in the Aging, Demographics, and Memory Study. %A Kala M. Mehta %A Anita L Stewart %A Kenneth M. Langa %A Kristine Yaffe %A Sandra Y. Moody-Ayers %A Brie A Williams %A Kenneth E Covinsky %K Aged %K Aged, 80 and over %K Aging %K Alzheimer disease %K Apolipoprotein E4 %K Cognition Disorders %K Educational Status %K Female %K Geriatric Assessment %K Humans %K Male %K Memory %K Neuropsychological tests %K Risk Factors %X

BACKGROUND: A low level of formal education is becoming accepted as a risk factor for Alzheimer's disease (AD). Although increasing attention has been paid to differences in educational quality, no previous studies addressed participants' own characterizations of their overall performance in school. We examined whether self-assessed school performance is associated with AD beyond the effects of educational level alone.

METHODS: Participants were drawn from the population-representative Aging, Demographics, and Memory Study (ADAMS, 2000-2002). The ADAMS participants were asked about their performance in school. Possible response options included "above average," "average," or "below average." The ADAMS participants also underwent a full neuropsychological battery, and received a research diagnosis of possible or probable AD.

RESULTS: The 725 participants (mean age, 81.8 years; 59% female; 16% African-American) varied in self-assessed educational performance: 29% reported "above average," 64% reported "average," and 7% reported "below average" school performance. Participants with a lower self-assessed school performance had higher proportions of AD: 11% of participants with "above average" self-assessed performance had AD, as opposed to 12% of participants with "average" performance and 26% of participants with "below average" performance (P < 0.001). After controlling for subjects' years in school, a literacy test score (Wide-Range Achievement Test), age, sex, race/ethnicity, apolipoprotein E-epsilon4 status, socioeconomic status, and self-reported comorbidities, respondents with "below average" self-assessed school performance were four times more likely to have AD compared with those of "average" performance (odds ratio, 4.0; 95% confidence interval, 1.2-14). "Above average" and "average" self-assessed school performance did not increase or decrease the odds of having AD (odds ratio, 0.9; 95% confidence interval, 0.5-1.7).

CONCLUSIONS: We suggest an association between "below average" self-assessed school performance and AD beyond the known association with formal education. Efforts to increase cognitive reserve through better school performance, in addition to increasing the number of years of formal education in early life, may be important in reducing vulnerability throughout the life course.

%B Alzheimers Dement %I 5 %V 5 %P 380-7 %8 2009 Sep %G eng %U http://www.sciencedirect.com/science?_ob=ArticleURLand_udi=B7W6D-4X6VH7W-7and_user=99318and_coverDate=09 2F30 2F2009and_rdoc=1and_fmt=highand_orig=searchand_origin=searchand_sort=dand_docanchor=andview=cand_acct=C000007678and_version=1and_urlVersion=0and_ %N 5 %L newpubs20101112_Mehta.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19751917?dopt=Abstract %2 PMC2787515 %4 alzheimer disease/cognition Disorders/educational Status/Geriatric Assessment/neuropsychological Tests/risk Factors %$ 23670 %R 10.1016/j.jalz.2009.07.039 %0 Journal Article %J J Occup Health Psychol %D 2009 %T Bridge employment and retirees' health: a longitudinal investigation. %A Zhan, Yujie %A Wang, Mo %A Liu, Songqi %A Kenneth S. Shultz %K Employment %K Female %K Health Status %K Humans %K Interviews as Topic %K Longitudinal Studies %K Male %K Middle Aged %K Retirement %K United States %X

The present study examined the relationship between bridge employment and retirees' health outcomes (i.e., major diseases, functional limitations, and mental health). We used a nationally representative sample of 12,189 retirees from the first 4 waves of the Health and Retirement Study. Hierarchical regression analyses showed that compared with full retirement, engaging in bridge employment either in a career field or in a different field was associated with fewer major diseases and functional limitations, whereas engaging in career bridge employment was associated with better mental health. The findings highlight the health benefits of engaging in bridge employment for retirees. The practical implications of this study are discussed at both the individual and policy levels. Limitations of the current findings are also noted in conjunction with future research directions.

%B J Occup Health Psychol %I 14 %V 14 %P 374-89 %8 2009 Oct %G eng %N 4 %L newpubs20091202_Zhan_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19839658?dopt=Abstract %3 19839658 %4 Bridge Jobs/health outcomes/RETIREMENT %$ 21240 %R 10.1037/a0015285 %0 Journal Article %J Am J Respir Crit Care Med %D 2009 %T Cognitive decline among patients with chronic obstructive pulmonary disease. %A William W. Hung %A Juan P. Wisnivesky %A Albert L Siu %A Joseph S. Ross %K Aged %K Case-Control Studies %K Cognition Disorders %K Female %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Pulmonary Disease, Chronic Obstructive %K Pulmonary Ventilation %K Risk Factors %K Severity of Illness Index %K Socioeconomic factors %K United States %X

RATIONALE: Prior research has suggested an association between chronic obstructive pulmonary disease (COPD) and the development of cognitive decline; however, these studies have been cross-sectional or small case series.

OBJECTIVES: To determine whether COPD increases the risk of cognitive decline among older adults surveyed in a large, population-based longitudinal cohort.

METHODS: We included data from the 1996 to 2002 waves of the Health and Retirement Study, a biennial nationally representative survey. We studied respondents who completed cognitive testing in 1996 and at least one subsequent survey, and excluded those with unknown history of COPD. Clinical history of COPD was based on self-report; severity was categorized based on use of oxygen or disease-related activity limitations. Our primary outcome was cognitive performance, measured using a validated 35-point scale. We examined the effect of COPD on cognition using multivariable mixed linear models accounting for repeated measurements, adjusted for sociodemographic and clinical characteristics.

MEASUREMENTS AND MAIN RESULTS: A total of 4,150 adults were included in our study. Among them, 12% reported a history of COPD (29% severe, 71% nonsevere disease). On repeated measurement, mean cognition scores of older adults with both severe and nonsevere COPD were significantly lower when compared with adults without COPD (2.6 points [P < 0.001] and 0.9 points [P < 0.001], respectively). After multivariable adjustment, mean scores of adults with severe COPD remained lower (0.9 point [P < 0.001]), whereas mean score of adults with nonsevere COPD was no longer different (P = 0.39) when compared with adults without COPD.

CONCLUSIONS: Severe COPD was associated with lower cognitive performance on standardized measurement over time.

%B Am J Respir Crit Care Med %I 180 %V 180 %P 134-7 %8 2009 Jul 15 %G eng %N 2 %L newpubs20090908_Hung_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19423714?dopt=Abstract %3 19423714 %4 Cognitive Functioning %$ 20660 %R 10.1164/rccm.200902-0276OC %0 Journal Article %J BMC Geriatr %D 2009 %T Cognitive health among older adults in the United States and in England. %A Kenneth M. Langa %A David J Llewellyn %A Iain A Lang %A David R Weir %A Robert B Wallace %A Mohammed U Kabeto %A Felicia A Huppert %K Aged %K Aged, 80 and over %K Aging %K Cognition %K Cognition Disorders %K Cohort Studies %K Cross-Sectional Studies %K England %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Neuropsychological tests %K United States %X

BACKGROUND: Cognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries.

METHODS: Data were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87% for the HRS vs. 67% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale).

RESULTS: US adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P < .001; age- and sex-adjusted: 13.2 vs. 11.7, P < .001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P = .014 for treatment x country interaction).

CONCLUSION: Despite methodological differences in the administration of the surveys in the two countries, US adults aged >/= 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.

%B BMC Geriatr %I 9 %V 9 %P 23 %8 2009 Jun 25 %G eng %L newpubs20090908_LangaBMC.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19555494?dopt=Abstract %2 PMC2709651 %4 Cross Cultural Comparison/Cognitive Function/Hypertension/Medicine/ELSA_/cross-national comparison %$ 20770 %R 10.1186/1471-2318-9-23 %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 Report %D 2009 %T Cross-Wave Prospective Social Security Wealth Measures of Pre-Retirees, Public Release: Data Description and Usage %A Kandice Kapinos %A Charles Brown %A Michael A. Nolte %A Helena Stolyarova %A David R Weir %K Net Worth and Assets %K Social Security %X The Prospective Social Security Wealth Measures of Pre-Retirees data set consists of respondent-level, cross-sectional files constructed from the employment sections of the HRS 1992 (wave 1), HRS 1998 (wave 4), HRS 2004 (wave 7) and the restricted SSA summary and detailed earnings and benefits files. In this public use file, we calculate wealth only for individuals who have not yet retired (as evidenced by claiming SS benefits) (see Section III.C). Each individual is uniquely identified by the concatenation of the household ID and the person number, HHID and PN. We organize the data to match the organization of the RAND HRS data files. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 social Security/wealth %$ 62780 %0 Journal Article %J J Genet Psychol %D 2009 %T Doing well: a SEM analysis of the relationships between various activities of daily living and geriatric well-being. %A James A Katt %A Speranza, Linda %A Shore, Wendy %A Karen H. Saenz %A E. Lea Witta %K Activities of Daily Living %K Adaptation, Psychological %K Aged %K Cognition %K depression %K Humans %K Models, Psychological %K Socioeconomic factors %K United States %X

An existing large data set, the Health and Retirement Study (HRS) with the subsequent addition of the Consumption and Activities Mail Survey (CAMS) data, provides a rich data set for the examination of the activities of older adults. In this study HRS and CAMS data are used to examine relationships between various activities of daily living (ADLs) and well-being in older adults. Using structural equation modeling, influences of direct and indirect factors that affect older individuals' cognitive and emotional well-being are analyzed. The data suggest ability to perform ADLs has little to do with cognitive well-being, but is an influential factor in determining emotional well-being.

%B J Genet Psychol %I 170 %V 170 %P 213-26 %8 2009 Sep %G eng %N 3 %L newpubs20100129_Katt_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19928315?dopt=Abstract %3 19928315 %4 ADL and IADL Impairments/Cognitive Function/Well Being %$ 21490 %R 10.1080/00221320903218190 %0 Book Section %B Developments in the economics of aging %D 2009 %T The Effect of Large Capital Gains or Losses on Retirement %A Michael D Hurd %A Reti, Monika %A Susann Rohwedder %E David A Wise %K Net Worth and Assets %K Retirement Planning and Satisfaction %B Developments in the economics of aging %I University of Chicago Press %C Chicago %P 127-172 %@ 0-226-90335-4 %G eng %U https://www.nber.org/books-and-chapters/developments-economics-aging/effect-large-capital-gains-or-losses-retirement %4 Early Retirement/Wealth Accumulation/Stock Market %$ 24170 %& 4 %0 Thesis %B Economics %D 2009 %T Essays in Intergenerational Transfers %A Way, Megan McDonald %K Adult children %K Expectations %X Chapter 1. Intergenerational Transfer Inflows to Adult Children of Divorce. Do adult children of divorce receive less money from their parents than children of intact unions? Are they less likely to receive parental help for buying a house, starting a business or weathering a financial crisis? Though there is evidence that an individual divorced parent gives less to his child than he would give if he were married to his child's other parent, no study has examined the transfers given by both divorced parents. I approach the question of transfers to adult children of divorce from a fresh angle by asking not, "How much did the parent give?" but instead, "How much did the child get?" I also examine the correlation between parents' remarriage and transfers received. Using data from the 1988 wave of the PSID, I find that parental divorce and remarriage are uncorrelated with the incidence of a transfer. Within the select group of children who receive a transfer, however, divorce is correlated with an increased transfer amount, while a father's remarriage is correlated with a decreased amount. Chapter 2. The Correlation Between Subjective Parental Longevity and Intergenerational Transfers. Are parental financial transfers to adult children correlated with subjective parental longevity? Despite rapid and continuing increases in life expectancy, no previous study has looked at transfers in relation to parents' opinions of how long they will live. This paper uses the subjective survival probability data included in the Health and Retirement Study to examine this potential correlation for a select group of unmarried older parents. For mothers only, I consistently find modest positive correlations between subjective longevity and anticipated future inter vivos transfers and bequests. For fathers, I find a nonlinear relationship between subjective longevity and anticipated future inter vivos transfers. I discuss the potential reasons for these descriptive results and some further questions that arise from them. %B Economics %I Boston College %C Boston %V Doctor of Philosophy %G eng %U http://hdl.handle.net/2345/749 %4 Subjective Probabilities of Survival %$ 20900 %0 Thesis %D 2009 %T Factors Associated with Sleep Disruption among Community-Dwelling Older Adults in the Health and Retirement Study %A Williams, Laura L. %K Health Conditions and Status %X The purpose of this study was to examine behavioral outcomes and sleep disruption in aging adults using data from the 2004 wave of the longitudinal Health and Retirement Study (HRS). It was hypothesized that sleep disruption is associated with behavioral outcomes and sociodemographic variables in a population-based sample. Methods. The 2004 HRS data (N=20,129) represents a cross-sectional analysis of community dwelling aging adults born in the US at or before 1923 through 1953. Data are stratified by date of birth to provide five cohorts of aging elderly. The HRS Psychosocial Leave-Behind Participant Lifestyle Questionnaire (PLBQ) was given to a random sample of participants (N=1,439; 52.5% male; 47.5% female; 91.5% White; 5.2% Black; Response Rate 76.8%) who completed the 2004 HRS wave. Portions of the HRS including age, gender, race, marital status, education, income, comorbidities, and sleep measures were matched to the subjects who completed the PLBQ. An index of sleep disruption items was computed and sleep sensitive behaviors (cynical hostility, optimism, pessimism and social participation) were computed according to instrument directions. Results. After controlling for sociodemographic variables, sleep disruption independently predicted social integration ( t =2.135, p <.0001), pessimism ( t =3.995, p <.0001), cynical hostility ( t =3.854, p <.0001), and negatively predicted optimism ( t =-4.876, p <.0001). Oldest-old adults had no greater sleep disruption than younger aging adults (? 2 =1.234, p =.872), although 59% of the oldest-old subset reported frequent waking during the night. Women reported more sleep disruption than men ( t =3.270, p <.001), but all subjects reported frequent waking during the night (Men=58%; Women=68%). Married participants reported more sleep disruption than divorced or widowed participants ( t =2.161, p =.03). Blacks had no greater sleep disruption than Whites ( t =.812, p =.417). Higher education was the most influential SES predictor for sleep disruption ( F =15.309, p <.0001), and income did not independently predict sleep disruption ( t =1.297, p =.195). Conclusion. Sleep disruption predicts negative behavioral outcomes, when controlling for sociodemographic variables. Sleep disruption was greater among women and married participants, but there were no racial differences. Education was also a strong influence on sleep disruption. Further research should examine the role of sleep disruption in other behavioral and attitudinal traits. %I The University of Alabama %C Birmingham, Alabama %G eng %U https://www.semanticscholar.org/paper/Factors-associated-with-sleep-disruption-among-in-Williams/ea13b2694467094535428eccd393cc95e22cdb40 %4 Personality Assessment %$ 21020 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers. %A Sei J. Lee %A Rebecca L. Sudore %A Brie A Williams %A Lindquist, Karla %A Helen L. Chen %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Alcohol Drinking %K Comorbidity %K Education %K Female %K Humans %K Income %K Male %K Obesity %K Risk Factors %K Sex Factors %K Smoking %K Socioeconomic factors %X

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

DESIGN: Prospective cohort.

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

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

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

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

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

%B J Am Geriatr Soc %I 57 %V 57 %P 955-62 %8 2009 Jun %G eng %N 6 %L newpubs20090908_Lee_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19473456?dopt=Abstract %2 PMC2847409 %4 Alcohol Drinking/socioeconomic status/ADL and IADL Impairments/Mobility/Survival Analysis %$ 20510 %R 10.1111/j.1532-5415.2009.02184.x %0 Book Section %B Developments in the economics of aging %D 2009 %T How Do The Better Educated Do It? Socioeconomic Status And The Ability To Cope With Underlying Impairment %A David M Cutler %A Landrum, Mary Beth %A Stewart, Kate A. %E David A Wise %K Demographics %K Disabilities %K Healthcare %X Our analysis considers two primary issues. First, we ask how much of this gradient in health is a result of underlying differences in functioning versus the ability to cope with impairments. We show that while the bulk of the difference is a result of underlying functioning—the better off have much less difficulty with these measures even in the absence of help—coping is important as well. The better educated are less likely to have functional disabilities in the first place, and cope with them better when they occur. %B Developments in the economics of aging %S A National Bureau of Economic Research conference report %I University of Chicago Press %C Chicago %P 203-254 %@ 0-226-90335-4 %G eng %U https://www.nber.org/books-and-chapters/developments-economics-aging/how-do-better-educated-do-it-socioeconomic-status-and-ability-cope-underlying-impairment %4 socioeconomic Status/DISABILITY/DISABILITY/health outcomes/health gradient %$ 24180 %& 6 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2009 %T The impact of occupation on self-rated health: cross-sectional and longitudinal evidence from the health and retirement survey. %A Ralitza Gueorguieva %A Jody L Sindelar %A Tracy Falba %A Jason M. Fletcher %A Patricia S Keenan %A Wu, Ran %A William T Gallo %K Aged %K Attitude to Health %K Cohort Studies %K Cross-Sectional Studies %K Educational Status %K Female %K Health Status Indicators %K Health Surveys %K Humans %K Linear Models %K Longitudinal Studies %K Male %K Middle Aged %K Mortality %K Occupations %K Odds Ratio %K Retirement %K Social Class %K Socioeconomic factors %K United States %X

BACKGROUND: The objective of this study is to estimate occupational differences in self-rated health, both in cross-section and over time, among older individuals.

METHODS: We use hierarchical linear models to estimate self-reported health as a function of 8 occupational categories and key covariates. We examine self-reported health status over 7 waves (12 years) of the Health and Retirement Study. Our study sample includes 9,586 individuals with 55,389 observations. Longest occupation is used to measure the cumulative impact of occupation, address the potential for reverse causality, and allow the inclusion of all older individuals, including those no longer working.

RESULTS: Significant baseline differences in self-reported health by occupation are found even after accounting for demographics, health habits, economic attributes, and employment characteristics. But contrary to our hypothesis, there is no support for significant differences in slopes of health trajectories even after accounting for dropout.

CONCLUSIONS: Our findings suggest that occupation-related differences found at baseline are durable and persist as individuals age.

%B J Gerontol B Psychol Sci Soc Sci %I 64 %V 64 %P 118-24 %8 2009 Jan %G eng %N 1 %L newpubs20090302_RalitzaJog.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19196689?dopt=Abstract %2 PMC2654983 %4 SELF-RATED HEALTH/Occupations %$ 19760 %R 10.1093/geronb/gbn006 %0 Journal Article %J Journal of Disability Policy Studies %D 2009 %T Income Security for Workers %A David Stapleton %A R.V. Burkhauser %A Peiyun She %A Robert R. Weathers II %A Livermore, Gina A. %K Employment and Labor Force %K Insurance %K Other %K Social Security %X The current mix of public and private programs to support workers after they experience disability onset provides benefits to millions of workers and former workers. Yet, despite the large and growing costs of these programs, the inflation-adjusted household incomes of workers with disabilities have been falling for more than two decades, both absolutely and, especially, relative to the incomes of those without disabilities. The aging of the baby boom generation is likely to make matters worse, and the government's fiscal circumstance will make it increasingly difficult to sustain existing public programs. Current public policy initiatives might eventually improve the disability support system, but they are not likely to ward off the adverse consequences of the pending crisis. Policy changes that leverage existing private sector practices and capabilities might achieve greater success but have received little attention and are far from proven. %B Journal of Disability Policy Studies %I 19 %V 19 %P 204-220 %G eng %N 4 %4 insurance/security/Social Security/employment %$ 25380 %R 10.1177/1044207308314949 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2009 %T Individual well-being in middle and older adulthood: do spousal beliefs matter? %A Tim D Windsor %A Lindsay H Ryan %A Jacqui Smith %K Adult %K Affect %K Aged %K Aged, 80 and over %K Aging %K Attitude to Health %K Culture %K Female %K Humans %K Individuality %K Internal-External Control %K Male %K Marriage %K Middle Aged %K Quality of Life %K Spouses %X

Associations between health, control beliefs, and well-being in later life are frequently conceptualized in terms of the characteristics of individuals. However, spousal interdependencies in psychosocial characteristics are also likely to be relevant for well-being. The present study investigated associations of self-rated health, control, and relationship closeness with life satisfaction and positive and negative affect in a sample of 2,235 spousal dyads. A significant proportion of variance in health, control, closeness, and well-being occurred between dyads. Individuals' self-rated health, control, and relationship closeness were associated with higher well-being. Spouses' self-rated health and control beliefs were consistently and positively associated with individuals' well-being; however, effect sizes were small. Some evidence for individual's control beliefs buffering the association between health and well-being emerged, whereas spouses' perceived control was not a significant moderator of the health-well-being association. Results highlight the importance of couple interdependencies for contextualizing health and well-being in older adulthood.

%B J Gerontol B Psychol Sci Soc Sci %I 64B %V 64 %P 586-96 %8 2009 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/19608855?dopt=Abstract %3 19608855 %4 psycho-social/spousal care/SELF-RATED HEALTH/Couples %$ 62841 %R 10.1093/geronb/gbp058 %0 Journal Article %J J Health Soc Behav %D 2009 %T Marital biography and health at mid-life. %A Mary Elizabeth Hughes %A Linda J. Waite %K Female %K Health Status %K Humans %K Interviews as Topic %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K United States %X

This article develops a series of hypotheses about the long-term effects of one's history of marriage, divorce, and widowhood on health, and it tests those hypotheses using data from the Health and Retirement Study. We examine four dimensions of health at mid-life: chronic conditions, mobility limitations, self-rated health, and depressive symptoms. We find that the experience of marital disruption damages health, with the effects still evident years later; among the currently married, those who have ever been divorced show worse health on all dimensions. Both the divorced and widowed who do not remarry show worse health than the currently married on all dimensions. Dimensions of health that seem to develop slowly, such as chronic conditions and mobility limitations, show strong effects of past marital disruption, whereas others, such as depressive symptoms, seem more sensitive to current marital status. Those who spent more years divorced or widowed show more chronic conditions and mobility limitations.

%B J Health Soc Behav %I 50 %V 50 %P 344-58 %8 2009 Sep %G eng %N 3 %L newpubs20090908_Hughes-Waite.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19711810?dopt=Abstract %2 PMC3148098 %4 Marital Status/Widowhood/Health/Marital Dissolution %$ 20880 %R 10.1177/002214650905000307 %0 Journal Article %J Inquiry %D 2009 %T Medicare savings programs: analyzing options for expanding eligibility. %A Zuckerman, Stephen %A Shang, Baoping %A Timothy A Waidmann %K Aged %K Demography %K Disabled Persons %K Eligibility Determination %K Female %K Health Status %K Humans %K Income %K Male %K Medical Assistance %K Medicare %K Medicare Part D %K Public Policy %K United States %X

The Medicare Savings Programs (MSPs) are designed to provide financial assistance to Medicare beneficiaries who do not qualify for full Medicaid coverage. This paper considers changes in eligibility that would better align MSP program rules with those related to receiving low-income subsidies for the Medicare Part D drug benefit. These changes would make more people eligible for the MSPs and could encourage greater participation; similar changes were incorporated in recently passed legislation. Our analysis, based on 2006 data from the Health and Retirement Study, shows there is a trade-off between making larger numbers of beneficiaries eligible by eliminating resource requirements and better targeting of individuals with greater health care needs by expanding income standards.

%B Inquiry %I 46 %V 46 %P 391-404 %8 2009-2010 Winter %G eng %U URL:http://www.inquiryjournal.org Publisher's URL %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20184166?dopt=Abstract %3 20184166 %4 Analysis of Health Care Markets/Health: Government Policy,/Public Health/Medicare Savings Programs/Health Care/Medicare/Medicare Part D %$ 22150 %R 10.5034/inquiryjrnl_46.4.391 %0 Journal Article %J Soc Work Public Health %D 2009 %T A new measure of medication affordability. %A Becky A. Briesacher %A Ross-Degnan, Dennis %A Adams, Alyce %A Anita K Wagner %A Jerry Gurwitz %A Soumerai, Stephan %K Aged %K Data collection %K Female %K Financing, Personal %K Humans %K Male %K Medicaid %K Middle Aged %K Poverty %K Prescription Fees %K United States %X

This study developed a new measure of medication affordability that examines out-of-pocket drug expenses relative to available household resources. The authors assessed the spending patterns of approximately 2.1 million poor households (< or =100% federal poverty level) of adults aged 51 and older by Medicaid status. The data were drawn from the 2000-2001 Health and Retirement Study. Household spending was categorized into three broad types: basic living, health care, and discretionary. Older (aged 51 or older) poor households without Medicaid allocated about 72% of their total resources ($17,421, SE $783) to basic living needs. In comparison, those with Medicaid had scarcer total resources ($12,498, SE $423) and allocated 85% to basic living needs. Medication costs consumed the largest proportion of health care expenses for both types of poor households (Medicaid: $463, SE $67; non-Medicaid: $970, SE $102). After paying for basic living needs and health care costs, these families had, on average, only $16 left each week. Poor families have very few resources available for anything beyond basic living needs, even when they have Medicaid coverage. There is no great reservoir of discretionary funds to pay for increases in cost-sharing under Medicaid and Medicare Part D.

%B Soc Work Public Health %I 24 %V 24 %P 600-12 %8 2009 Nov-Dec %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/19821195?dopt=Abstract %2 PMC2893303 %4 Medical Expenditures/Prescription Fees/Medicare %$ 21210 %R 10.1080/19371910802672346 %0 Journal Article %J Health Econ %D 2009 %T Proximity to death and participation in the long-term care market. %A Weaver, France %A Sally C. Stearns %A Edward C Norton %A Spector, William %K Aged %K Aged, 80 and over %K Caregivers %K Female %K Health Services Needs and Demand %K Home Care Services %K Humans %K Interviews as Topic %K Longevity %K Male %K Models, Statistical %K Nursing homes %K Terminal Care %K United States %X

The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care--i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+ from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care.

%B Health Econ %I 18 %V 18 %P 867-83 %8 2009 Aug %G eng %N 8 %L newpubs20090908_Weaver_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18770873?dopt=Abstract %2 PMC3786420 %4 Long-Term Care/Longevity/Nursing Homes/Home Nursing %$ 20760 %R 10.1002/hec.1409 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2009 %T Recent hospitalization and the risk of hip fracture among older Americans. %A Frederic D Wolinsky %A Suzanne E Bentler %A Li Liu %A Maksym Obrizan %A Elizabeth A Cook %A Kara B Wright %A John F Geweke %A Elizabeth A Chrischilles %A Claire E Pavlik %A Robert L. Ohsfeldt %A Michael P Jones %A Kelly K Richardson %A Gary E Rosenthal %A Robert B Wallace %K Accidental Falls %K Age Distribution %K Aged %K Aged, 80 and over %K Aging %K Cohort Studies %K Female %K Follow-Up Studies %K Geriatric Assessment %K Hip Fractures %K Hospitalization %K Humans %K Logistic Models %K Male %K Multivariate Analysis %K Probability %K Proportional Hazards Models %K Prospective Studies %K Risk Factors %K Sex Distribution %K Survival Analysis %K United States %X

BACKGROUND: We identified hip fracture risks in a prospective national study.

METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.

RESULTS: A total of 495 (8.9%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).

CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.

%B J Gerontol A Biol Sci Med Sci %I 64 %V 64 %P 249-55 %8 2009 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/19196641?dopt=Abstract %2 PMC2655029 %4 Accidental Falls/Aged, 80 and over/Geriatric Assessment/Hip Fractures/Hospitalization/Prospective Studies/Risk Factors/Sex Distribution/Survival Analysis %$ 23100 %R 10.1093/gerona/gln027 %0 Book Section %B Social Security Policy in a Changing Environment %D 2009 %T Reducing Social Security PRA Risk at the Individual Level: Life-Cycle Funds and No-Loss Strategies %A James M. Poterba %A Joshua Rauh %A Steven F Venti %A David A Wise %K Social Security %X Retirement savers in a Social Security system with a personal retirement account (PRA) component would face the challenge of deciding how to allocate their PRA portfolios across a broad range of asset classes and across many different financial products. Asset allocation decisions have important consequences for retirement wealth accumulation because they affect the expenses of investing as well as the risk of low returns. The goal of this chapter is to assess the relative risk associated with alternative asset allocation strategies in PRAs. It also offers insight on the consequences of different asset allocation rules in current private-sector defined contribution (DC) plans, such as 401(k) plans. Quantifying the risk associated with %B Social Security Policy in a Changing Environment %I University of Chicago Press %P 255-292 %G eng %U http://www.nber.org/chapters/c4543 %0 Thesis %D 2009 %T The Relationship between Fall Severity, Residential Adjustment, Functional Status, and Future Falls among Community Living Older Adults %A Wiatrowski, Natalie Leland %K Disabilities %K Health Conditions and Status %K Housing %X Accidental falls are common, yet costly events among older adults which have been associated with an increased risk of disability, institutionalization, and death. As the population continues to age, the number of older adults at risk of falling is predicted to increase unless strategies are implemented to limit the risk of falling. While previous studies have explored the relationship between fall history, future fall risk, and disability there have been limited studies that have incorporated the number of falls experienced along with the occurrence of an injury and compared the outcome of these fall groups to older adults with no fall history. The objective of this quantitative study was to expand the current research and explore the longitudinal relationship between fall severity, future fall risk, and future disability among community-living older adults using the Health and Retirement Study. Additionally, this study also explored the longitudinal relationship between fall history and the decision to make residential adjustments. The study concluded that over a two year period, fall history was significant in predicting future fall risk and disability status. As baseline fall status increases in severity, the predicted probability of no future fall decreases and the predicted probability of multiple falls and/or an injurious fall increases. Experiencing multiple non-injurious falls over a two year period at baseline was associated with a subsequent ADL or IADL disability, while an injurious fall was associated with a subsequent functional limitation and ADL or IADL disability. Similarly, fall history was significant in predicting the decisions to make residential adjustments. The decision to make any residential adjustment is significant among those reporting one or more falls and at least one injurious fall, compared to non-fallers. Experiencing at least one injurious fall was the only fall history variable associated with the type of adjustment made. More specifically, persons who experienced at least one injurious fall were more likely to increase their subsequent use of personal care or adaptive equipment. The results of this study support early detection and prevention of fall risk as a strategy to decrease risk of future falls, disability, and support older adults living in the community. %I University of Massachusetts %C Boston, Massachusetts %8 2009 %G eng %4 Housing %$ 21040 %! The Relationship between Fall Severity, Residential Adjustment, Functional Status, and Future Falls among Community Living Older Adults %0 Report %D 2009 %T Retiree Health Benefits and the Decision to Retire %A James Marton %A Stephen A. Woodbury %K Employment and Labor Force %K Medicare/Medicaid/Health Insurance %K Retirement Planning and Satisfaction %X We estimate the effect of employer offers of retiree health benefits (RHBs) on the timing of retirement using a sample of men observed over a period of up to 12 years in the Health and Retirement Study (HRS). Our main concern is that such estimates may be contaminated by unobserved heterogeneity - workers with a taste for early retirement sort into jobs offering RHBs. We attempt to address this concern by using a fixed-effects estimator, which yields substantially smaller estimates of the effect of RHB offers than estimators that do not attempt to control for unobservables. The findings suggest that an RHB offer increased the probability of retirement by 14 percent on average for men born between 1931 and 1941. %B Staff Working Papers %I W.E. Upjohn Institute for Employment Research %C Kalamazoo, MI %G eng %L newpubs20090908_09-149.pdf %4 Health Insurance Coverage/Employer contributions/Retirement Behavior %$ 20540 %0 Book Section %B Developments in the economics of aging %D 2009 %T The SES Health Gradient On Both Sides Of The Atlantic %A James Banks %A Michael Marmot %A Oldfield, Zoë %A James P Smith %E David A Wise %K Cross-National %K Healthcare %K Risk Taking %X Looking across many diseases, average health among mature men is much worse in America compared to England. Second, there exists a steep negative health gradient for men in both countries where men at the bottom of the economic hierarchy are in much worse health than those at the top. This health gradient exists whether education, income, or financial wealth is used as the marker of one's SES status. These conclusions are maintained even after controlling for a standard set of behavioral risk factors such as smoking, drinking, and obesity and are equally true using either biological measures of disease or individual self-reports. In contrast to these disease based measures, health of American men appears to be superior to the health of English men when self-reported general health status is used. The contradiction most likely stems instead from different thresholds used by Americans and English when evaluating health status on subjective scales. For the same objective health status, Americans are much more likely to say that their health is good than are the English. Finally, feedbacks from new health events to household income are one of the reasons that underlie the strength of the income gradient with health in England. %B Developments in the economics of aging %S A National Bureau of Economic Research conference report %I University of Chicago Press %C Chicago %P 359-406 %G eng %U https://ssrn.com/abstract=942969 %4 health outcomes/cross-national comparison/risk Factors/ELSA_ %$ 24190 %! The SES Health Gradient On Both Sides Of The Atlantic %& 10 %0 Journal Article %J Obesity (Silver Spring) %D 2009 %T Smoking kills, obesity disables: a multistate approach of the US Health and Retirement Survey. %A Mieke Reuser %A Luc G Bonneux %A Frans J Willekens %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Body Mass Index %K Disability Evaluation %K Educational Status %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Obesity %K Proportional Hazards Models %K Prospective Studies %K Smoking %K United States %K White People %X

Increasing BMI causes concerns about the consequences for health care. Decreasing cardiovascular mortality has lowered obesity-related mortality, extending duration of disability. We hypothesized increased duration of disability among overweight and obese individuals. We estimated age-, risk-, and state-dependent probabilities of activities of daily living (ADL) disability and death and calculated multistate life tables, resulting in the comprehensive measure of life years with and without ADL disability. We used prospective data of 16,176 white adults of the Health and Retirement Survey (HRS). Exposures were self-reported BMI and for comparison smoking status and levels of education. Outcomes were years to live with and without ADL disability at age 55. The reference categories were high normal weight (BMI: 23-24.9), nonsmoking and high education. Mild obesity (BMI: 30-34.9) did not change total life expectancy (LE) but exchanged disabled for disability-free years. Mild obesity decreased disability-free LE with 2.7 (95% confidence limits 1.2; 3.2) year but increased LE with disability with 2.0 (0.6; 3.4) years among men. Among women, BMI of 30 to 34.9 decreased disability-free LE with 3.6 (2.1; 5.1) year but increased LE with disability with 3.2 (1.6;4.8) years. Overweight (BMI: 25-29.9) increases LE with disability for women only, by 2.1 (0.8; 3.3) years). Smoking compressed disability by high mortality. Smoking decreased LE with 7.2 years, and LE with disability with 1.3 (0.5; 2.5) years (men) and 1.4 (0.3; 2.6) years (women). A lower education decreased disability-free life, but not duration of ADL disability. In the aging baby boom, higher BMI will further increase care dependence.

%B Obesity (Silver Spring) %I 17 %V 17 %P 783-9 %8 2009 Apr %G eng %N 4 %L newpubs20100129 %1 http://www.ncbi.nlm.nih.gov/pubmed/19165165?dopt=Abstract %3 19165165 %4 Obesity/Smoking/Body Mass Index/DISABILITY/DISABILITY/Mortality %$ 21690 %R 10.1038/oby.2008.640 %0 Report %D 2009 %T Stock Market Expectations and Portfolio Choice of American Households %A Kezdi, Gabor %A Robert J. Willis %K Expectations %K Methodology %K Net Worth and Assets %K Risk Taking %X This paper measures heterogeneity in the stock market expectations of households using survey answers to probability questions. We address survey measurement error in an explicit way and develop a joint model of the effect of expectations on portfolio choice on the one hand and survey answers on the other hand. The model is consistent with documented features of measurement error. We show substantial heterogeneity and that heterogeneity in expectations predicts heterogeneity in stockholding. We show that a general tendency to be optimistic is related to optimism about stock returns and in turn increases stockholding, while a general tendency to be uncertain is strongly related to uncertainty about stock market returns and in turn decreases stockholding. We estimate the level of risk tolerance that links subjective beliefs to stockholding to be moderate. We also show that a significant part of stockholding differences among demographic groups is explained by differences in their expectations. %I University of Michigan %G eng %U http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.506.1967&rep=rep1&type=pdf %4 subjective expectations/survey measurement/household finances/Stock Market/expectations/risk tolerance %$ 23500 %0 Thesis %D 2009 %T Subjective Expectations: Test for Bias and Implications for Choices %A Wang, Yang %K Expectations %K Risk Taking %X In expected utility models, individuals' choices critically depend on their subjective expectations of future events (Manski 2004). A common approach in the literature is to evoke the rational expectations assumption and substitute objectively estimated state transitions in the data for the subjective probabilities that individuals assign to future events. This methodology takes a strong stand that individuals' subjective expectations should coincide with objective estimates in the data, which rules out the possibility of biased expectations. This restriction might not be warranted in empirical work, and may lead to misspecification of the model and misleading conclusions regarding individuals' behaviors and the effectiveness of different public policies. In this paper, I relax the rational expectations assumption by directly using subjective expectations elicited from individuals. I theoretically show that the data on subjective expectations can identify the distribution of individuals' expectation bias. Combined with individuals' choices, the subjective expectations data can further be used to identify the structural parameters of binary choice models. In the empirical part of the paper, I focus on individuals' subjective survival probabilities available from the survey data, show how the mortality expectations affect individuals' smoking decisions and discuss policy implications. The theoretical methods developed in this paper provide the tools to quantitatively understand individuals' subjective expectations and their relation to the objective counterparts in the data. In particular, non-parametric identification of individuals' expectation bias can be used to test the rational expectations assumption, assess the extent of individuals' unobserved heterogeneity, and identify the difference in relative importance of factors for subjective versus objective probabilities in the data. In empirical analysis, I propose a new dynamic approach to the formation of subjective expectations, which allows me to back out, in a forward-looking fashion, the one-period ahead subjective expectations of the agents from their expectations of multi-step ahead events elicited in the survey. Applying this method to the subjective longevity expectations from the Health and Retirement Study, I find that while the factors that individuals take into consideration are similar to those identified in the objective mortality data, the relative weights placed on factors can be quite different in the two approaches. For instance, high income and good health tend to increase expected longevity, both objectively and subjectively, However, I find that individuals subjectively put a disproportionately large weight on genetic information and small weight on their health-related choices, relative to the objective estimation. Subjective expectations are further used in a structural dynamic model of smoking choice. I find that individuals subjectively care more about their health and are more forward-looking than estimated based purely on objective data. Hence, the reason that people smoke is not that they do not care about their health or that they are myopic, but that they put much more weight on their genetic makeup and too little weight on their health-related behaviors. The direct implication of these results for public policy is to design information campaigns in a more personalized way to decrease this bias in individuals' subjective expectations. %I Duke University %C United States, North Carolina %8 2009 %G eng %4 Risk Behavior %$ 21590 %! Subjective Expectations: Test for Bias and Implications for Choices %0 Report %D 2009 %T Take-Up of Medicare Part D and the SSA Subsidy: Early Results from the Health and Retirement Study %A Helen G Levy %A David R Weir %K Healthcare %K Medicare/Medicaid/Health Insurance %X We analyze newly available data from the Health and Retirement Study on senior citizens take-up of Medicare Part D and the associated SSA Low-Income Subsidy. We find that economic factors specifically, demand for prescription drugs - drove the decision to enroll in Part D. For the most part, individuals with employer-sponsored coverage in 2004 kept that coverage, as they should have. Individuals with no prescription drug coverage in 2004 mostly enrolled in Part D or obtained other coverage; many of those who remained without coverage reported that they do not use prescribed medicines. Take-up of the SSA Extra Help subsidy seems to have been more problematic, with many Part D beneficiaries unaware of the subsidy program or unsure about their eligibility. There is apparent under-reporting in the HRS of participation in the subsidy program, suggesting that some who profess to be unaware of the program may actually be participating in it. In terms of respondents subjective experiences of decision-making, the majority report having had little or no difficulty with the Part D enrollment decision and being confident that they made the right decision. Thus, for the most part, despite the complexity of the program, Medicare beneficiaries seem to have been able to make economically rational decisions in which they had confidence, although additional intervention for low-income beneficiaries may be desirable. %I Cambridge, MA, National Bureau of Economic Research, Working Paper 14692 %G eng %U http://www.nber.org/papers/w14692 %L newpubs20080229_wp163.pdf %4 Medicare/Prescription Fees %$ 18420 %0 Journal Article %J Am J Epidemiol %D 2009 %T Trajectories of cognitive function in late life in the United States: demographic and socioeconomic predictors. %A Arun S Karlamangla %A Miller-Martinez, Dana %A Carol S Aneshensel %A Teresa Seeman %A Richard G Wight %A Joshua Chodosh %K Aged %K Aged, 80 and over %K Aging %K Black or African American %K Cognition %K Confidence Intervals %K Education %K Female %K Geriatric Assessment %K Hispanic or Latino %K Humans %K Income %K Male %K Marital Status %K Mexican Americans %K Poverty %K Sampling Studies %K Socioeconomic factors %K Surveys and Questionnaires %K United States %K White People %X

This study used mixed-effects modeling of data from a national sample of 6,476 US adults born before 1924, who were tested 5 times between 1993 and 2002 on word recall, serial 7's, and other mental status items to determine demographic and socioeconomic predictors of trajectories of cognitive function in older Americans. Mean decline with aging in total cognition score (range, 0-35; standard deviation, 6.00) was 4.1 (0.68 standard deviations) per decade (95% confidence interval: 3.8, 4.4) and in recall score (range, 0-20; standard deviation, 3.84) was 2.3 (0.60 standard deviations) per decade (95% confidence interval: 2.1, 2.5). Older cohorts (compared with younger cohorts), women (compared with men), widows/widowers, and those never married (both compared with married individuals) declined faster, and non-Hispanic blacks (compared with non-Hispanic whites) and those in the bottom income quintile (compared with the top quintile) declined slower. Race and income differences in rates of decline were not sufficient to offset larger differences in baseline cognition scores. Educational level was not associated with rate of decline in cognition scores. The authors concluded that ethnic and socioeconomic disparities in cognitive function in older Americans arise primarily from differences in peak cognitive performance achieved earlier in the life course and less from declines in later life.

%B Am J Epidemiol %I 170 %V 170 %P 331-42 %8 2009 Aug 01 %G eng %N 3 %L newpubs20090908_Karlamangla.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19605514?dopt=Abstract %2 PMC2727175 %4 Cognition/health outcomes/Socioeconomic Factors %$ 20810 %R 10.1093/aje/kwp154 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2009 %T Urban neighborhood context and change in depressive symptoms in late life. %A Richard G Wight %A Janet R. Cummings %A Arun S Karlamangla %A Carol S Aneshensel %K Aged %K Aged, 80 and over %K Aging %K Cultural Diversity %K depression %K Disability Evaluation %K Educational Status %K Female %K Humans %K Longitudinal Studies %K Los Angeles %K Male %K Personality Inventory %K Poverty %K Psychosocial Deprivation %K Residence Characteristics %K Risk Factors %K Urban Population %X

OBJECTIVES: This study examines associations between urban neighborhood sociodemographic characteristics and change over time in late-life depressive symptoms.

METHODS: Survey data are from three waves (1993, 1995, and 1998) of the Study of Assets and Health Dynamics Among the Oldest Old, a U.S. national probability sample of noninstitutionalized persons aged 70 years or older in 1993. Neighborhoods are 1990 U.S. Census tracts. Hierarchical linear regression is used to estimate multilevel models.

RESULTS: The average change over time in depressive symptoms varies significantly across urban neighborhoods. Change in depressive symptoms is significantly associated with neighborhood-level socioeconomic disadvantage and ethnic composition in unadjusted models but not in models that control for individual-level characteristics.

CONCLUSIONS: Findings indicate that apparent neighborhood-level effects on change in depressive symptoms over time among urban-dwelling older adults reflect, for the most part, differences in characteristics of the neighborhood residents.

%B J Gerontol B Psychol Sci Soc Sci %I 64B %V 64 %P 247-51 %8 2009 Mar %G eng %N 2 %L newpubs20090908/Wightetal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19181693?dopt=Abstract %2 PMC2655167 %4 Depressive Symptoms/Neighborhood Characteristics %$ 20350 %R 10.1093/geronb/gbn016 %0 Book Section %B Social Protection in and Ageing World (International Series on Social Security) %D 2008 %T Ageing in the U.S.: The Health and Retirement Study %A Robert J. Willis %E Kemp, Peter A. %E Van den Bosch, Karel %E Smith, Lindsey %K Methodology %X In this paper, I attempt to describe from both historical and analytical standpoints how and why the HRS began and how and why it has evolved into an interdisciplinary and international scientific project of major significance both for basic science and for public policy.The spread ofthe HRSmodel internationally has not been the result of top-down agreements among governments. Rather, in analogy with open source software such as Linux, the HRS design and content provides researchers with a platform that can be used as a template to develop surveys in their own countries to address scientific and policy questions of both local and general significance. Each of the international studies has found it in its self-interest to be as comparable as possible to the HRS and to one another because, by being comparable, each country can use data from other countries as natural experiments to explore the implications of alternative policies. American researchers, for example, are interested in the implications of alternative forms of financing and delivering health care that have been developed in England and continental Europe. Were data available, American health insurance researchers would be especially interested in Canada. %B Social Protection in and Ageing World (International Series on Social Security) %I Intersentia %C Portland, OR %V 13 %P 47-61 %G eng %L newpubs20081205_Willis_Ageing.pdf %4 HRS content and design %$ 19480 %! Ageing in the U.S.: The Health and Retirement Study %0 Journal Article %J J Appl Psychol %D 2008 %T Antecedents of bridge employment: a longitudinal investigation. %A Wang, Mo %A Zhan, Yujie %A Liu, Songqi %A Kenneth S. Shultz %K Aged %K Career Mobility %K Employment %K Female %K Follow-Up Studies %K Humans %K Job Satisfaction %K Male %K Middle Aged %K Psychological Theory %K Retirement %K Surveys and Questionnaires %X

Bridge employment is the labor force participation pattern increasingly observed in older workers between their career jobs and their complete labor force withdrawal. It serves as a transition process from career employment to full retirement. Typical bridge employment decisions include full retirement, career bridge employment, and bridge employment in a different field. In the current study, 3 dominant theories (i.e., role theory, continuity theory, and life course perspective) on retirement processes were reviewed. On the basis of these theories, the authors proposed 4 categories of antecedents (i.e., individual attributes, job-related psychological variables, family-related variables, and a retirement-planning-related variable) of different types of bridge employment decisions. The authors used longitudinal data of a large, nationally representative sample from the Health and Retirement Study (F. Juster & R. Suzman, 1995) to test the current hypotheses. These data were analyzed with multinomial logistic regression, and most of the hypotheses were supported by the results. The implications of this study are discussed at both theoretical and practical levels.

%B J Appl Psychol %I 98 %V 93 %P 818-30 %8 2008 Jul %G eng %N 4 %L newpubs20080822_AppPsych %1 http://www.ncbi.nlm.nih.gov/pubmed/18642986?dopt=Abstract %3 18642986 %4 Labor Force Participation/Bridge Jobs/Older workers/RETIREMENT %$ 19230 %R 10.1037/0021-9010.93.4.818 %0 Journal Article %J Eur J Epidemiol %D 2008 %T The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey. %A Mieke Reuser %A Luc G Bonneux %A Frans J Willekens %K Aged %K Aged, 80 and over %K Body Mass Index %K Educational Status %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Multivariate Analysis %K Obesity %K Proportional Hazards Models %K Smoking %K United States %K Weight Gain %K Weight Loss %X

The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.

%B Eur J Epidemiol %I 23 %V 23 %P 601-7 %8 2008 %G eng %N 9 %L newpubs20081014_Reuser_EJEP_2008.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18584293?dopt=Abstract %3 18584293 %4 Mortality/Obesity/Education/Smoking/Life Expectancy %$ 19400 %R 10.1007/s10654-008-9269-8 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2008 %T Divergent pathways? Racial/ethnic differences in older women's labor force withdrawal. %A Tyson H Brown %A David F Warner %K Aged %K Black People %K Demography %K Disability Evaluation %K Disabled Persons %K Employment %K ethnicity %K Hispanic or Latino %K Humans %K Middle Aged %K Retirement %K United States %X

OBJECTIVES: The purpose of this study was to investigate how women's labor force withdrawal behavior varies across race/ethnicity and to identify life course factors that generate these differences.

METHODS: Using a sample of 7,235 women from the 1992-2004 Health and Retirement Study, we estimated cross-sectional multinomial logit models to explore racial/ethnic differences in labor force status at first interview. We then examined the prospective risk of exiting the labor force via retirement, work disability, or death using discrete-time hazard models.

RESULTS: Black and Hispanic women had twice the odds of Whites of being work-disabled at first interview. Whereas younger minorities had lower odds of being retired at first interview, older minorities had higher odds. The prospective results showed that both Blacks and Hispanics had higher risks of work disability but not of retirement or of dying in the labor force. Overall, racial/ethnic differences in mid- and later life work behavior stemmed primarily from disparities in life course capital.

DISCUSSION: This study shows that substantial racial/ethnic disparities in labor force exit behavior have already emerged by midlife. It is important to note that distinguishing between alternative pathways out of the labor force demonstrates that work disability is a more common experience for Black and Hispanic women than for Whites.

%B J Gerontol B Psychol Sci Soc Sci %I 63B %V 63 %P S122-34 %8 2008 May %G eng %N 3 %L newpubs20080822_Brown_Warner %1 http://www.ncbi.nlm.nih.gov/pubmed/18559687?dopt=Abstract %3 18559687 %4 Women/Labor Force Participation/Racial Differences/Ethnic Groups %$ 19190 %R 10.1093/geronb/63.3.s122 %0 Report %D 2008 %T Documentation of Health Behaviors and Risk Factors Measured in the Health and Retirement Study (HRS/AHEAD) %A Kristi Rahrig Jenkins %A Mary Beth Ofstedal %A David R Weir %K Health Conditions and Status %K Methodology %X The two most important negative behaviors for population health are smoking, which is declining over time, and obesity, which is on the rise. Recognizing the important role of health behaviors and risk factors with respect to issues of key importance to the HRS (health, employment, wealth, timing of retirement), the original designers of the HRS incorporated a set of core measures of health behaviors at the outset. These measures have been expanded over time. The health behaviors and risk factors that are covered in the HRS include: Cigarette smoking (current and past behavior); Alcohol consumption (current behavior and past drinking problems); Body mass index (derived from self-reports of height and weight); Exercise (current level); Preventive health screenings. This report is organized as follows. Section II provides an inventory of the measures of health behaviors and risk factors that are covered in HRS, noting additions and changes that have occurred across waves. Special methodological issues that must be considered when using these data are covered in Section III. Section IV (and corresponding Tables 2-28) presents prevalence estimates and frequency counts for each of the health behavior and risk factor measures over time. Lastly, Section V addresses data quality by comparing HRS prevalence estimates with those from other surveys, reviewing results from some of the studies that have used HRS data to study health behaviors and risk factors, and investigating the level of missing data for these measures. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 survey measurement/methodology/health Behavior/alcohol consumption/Body Mass Index %$ 62880 %0 Report %D 2008 %T Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study %A Eileen M. Crimmins %A Heidi M Guyer %A Kenneth M. Langa %A Mary Beth Ofstedal %A Robert B Wallace %A David R Weir %K Health Conditions and Status %K Healthcare %K Methodology %X The assessment of physical performance is an important component of the evaluation of functioning of older persons. The HRS has employed a set of standardized assessments of lung function, grip strength, balance, and walking speed. In addition, HRS collected measures of blood pressure, height, weight, and waist circumference. In 2006, HRS included the following measurements, administered in this order: Blood pressure; Lung function; Hand grip strength; Balance tests; Timed walk; Height; Weight; Waist circumference. This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 health measures/survey Methods/Physical Activity %$ 62710 %0 Journal Article %J Aging Ment Health %D 2008 %T Early motherhood and mental health in midlife: a study of British and American cohorts. %A John C Henretta %A Emily M D Grundy %A Lucy C Okell %A Michael E J Wadsworth %K Adolescent %K Birth Order %K Cohort Studies %K England %K Female %K Humans %K Interviews as Topic %K Maternal Age %K Mental Health %K Middle Aged %K Mothers %K Pregnancy %K Pregnancy in Adolescence %K United States %X

OBJECTIVES: Examine the relationship between early age at first birth and mental health among women in their fifties.

METHODS: Analysis of data on women from a British 1946 birth cohort study and the U.S. Health and Retirement Study birth cohort of 1931-1941.

RESULTS: In both samples a first birth before 21 years, compared to a later first birth, is associated with poorer mental health. The association between early first birth and poorer mental health persists in the British study even after controlling for early socioeconomic status, midlife socioeconomic status and midlife health. In the U.S. sample, the association becomes non-significant after controlling for educational attainment.

CONCLUSIONS: Early age at first birth is associated with poorer mental health among women in their fifties in both studies, though the pattern of associations differs.

%B Aging Ment Health %I 12 %V 12 %P 605-14 %8 2008 Sep %G eng %N 5 %L newpubs20090126_Henretta_etal %1 http://www.ncbi.nlm.nih.gov/pubmed/18855176?dopt=Abstract %2 PMC3191851 %4 Women/Mental health/CHILDREN %$ 19690 %R 10.1080/13607860802343084 %0 Journal Article %J Addiction %D 2008 %T Economic theory and evidence on smoking behavior of adults. %A Frank A Sloan %A Wang, Yang %K Adult %K Aged %K Aged, 80 and over %K Choice Behavior %K Costs and Cost Analysis %K health policy %K Humans %K Impulsive Behavior %K Middle Aged %K Risk Factors %K Smoking %K Smoking cessation %K Time Factors %X

AIMS: To describe: (i) three alternative conceptual frameworks used by economists to study addictive behaviors: rational, imperfectly rational and irrational addiction; (ii) empirical economic evidence on each framework and specific channels to explain adult smoking matched to the frameworks; and (iii) policy implications for each framework.

METHODS: A systematic review and appraisal of important theoretical and empirical economic studies on smoking.

RESULTS: There is some empirical support for each framework. For rational and imperfectly rational addiction there is some evidence that anticipated future cigarette prices influence current cigarette consumption, and quitting costs are high for smokers. Smokers are more risk-tolerant in the financial domain than are others and tend to attach a lower value to being in good health. Findings on differences in rates of time preference by smoking status are mixed; however, short-term rates are higher than long-term rates for both smokers and non-smokers, a stylized fact consistent with hyperbolic discounting. The economic literature lends no empirical support to the view that mature adults smoke because they underestimate the probability of harm to health from smoking. In support of the irrationality framework, smokers tend to be more impulsive than others in domains not related directly to smoking, implying that they may be sensitive to cues that trigger smoking.

CONCLUSIONS: Much promising economic research uses the imperfectly rational addiction framework, but empirical research based on this framework is still in its infancy.

%B Addiction %I 103 %V 103 %P 1777-85 %8 2008 Nov %G eng %U http://dx.doi.org/10.1111/j.1360-0443.2008.02329.x %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/18778387?dopt=Abstract %3 18778387 %4 Addiction/cigarette prices/hyperbolic discounting/impulsivity/rationality/risk preference/time preferences/smoking %$ 25410 %R 10.1111/j.1360-0443.2008.02329.x %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2008 %T Emergency department utilization patterns among older adults. %A Frederic D Wolinsky %A Li Liu %A Thomas R Miller %A An, Hyonggin %A John F Geweke %A Kaskie, Brian %A Kara B Wright %A Elizabeth A Chrischilles %A Claire E Pavlik %A Elizabeth A Cook %A Robert L. Ohsfeldt %A Kelly K Richardson %A Gary E Rosenthal %A Robert B Wallace %K Aged %K Emergency Service, Hospital %K Factor Analysis, Statistical %K Female %K Humans %K Logistic Models %K Male %K Medicare %K Risk Factors %K United States %X

BACKGROUND: We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them.

METHODS: A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used.

RESULTS: The majority (56.6%) of participants had no ED visits during the 4-year period. Just 5.7% had only low-intensity ED use patterns, whereas 28.9% used the ED only for high-intensity visits, and 8.7% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns.

CONCLUSIONS: Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.

%B J Gerontol A Biol Sci Med Sci %I 63A %V 63 %P 204-9 %8 2008 Feb %G eng %N 2 %L newpubs20080528_JoGserA %1 http://www.ncbi.nlm.nih.gov/pubmed/18314459?dopt=Abstract %2 PMC2923576 %4 Medicare/Health Care Utilization/Elderly %$ 19050 %R 10.1093/gerona/63.2.204 %0 Report %D 2008 %T Examining the Relationships between Excess Body Weight, Health and Disability %A Timothy A Waidmann %A Vicki A Freedman %A Christine L Himes %A Ahmad, Saad %K Health Conditions and Status %X The recent rise in the prevalence of obesity and overweight in the overall United States population has raised many concerns about the future. In addition to concerns about the medical costs of treating obesity-related illness, an apparent correlation between obesity and disability has led to concern that the recent declines in rates of disability among the elderly may cease or reverse. In this report, we explore the relationship between excess weight and obesity in a series of cross-sectional and longitudinal analyses in an attempt to evaluate these concerns. Using data from the 1998-2004 waves of the Health and Retirement Study (HRS), we find evidence that the risks of developing difficulties with activities of daily living (ADLs) does increase with the prevalence of obesity, but the effects appear to be less dramatic than the effects on the limitations in physical functioning, which can be precursors of ADL disability. Further, we find only a weak relationship between excess weight and the onset of difficulties with instrumental activities of daily living (IADLs). %B U.S. Department of Health and Human Services %I Office of the Assistant Secretary for Planning and Evaluation %C Washington, D.C. %G eng %U https://aspe.hhs.gov/basic-report/examining-relationships-between-excess-body-weight-health-and-disability %L newpubs20090908/weight.pdf %4 Obesity/Weight/ADL and IADL Impairments %$ 20190 %0 Book Section %B The Assisted Living Residence: A Vision for the Future %D 2008 %T Family Care and Assisted Living: An Uncertain Future? %A Douglas A. Wolf %A Jenkins, Carol %E Golant, Steven M. %E Hyde, Joan %K Healthcare %K Retirement Planning and Satisfaction %B The Assisted Living Residence: A Vision for the Future %I Johns Hopkins University Press %C Baltimore %P 198-222 %G eng %4 Assisted Living/Caregiving %$ 19160 %! Family Care and Assisted Living: An Uncertain Future? %0 Report %D 2008 %T Guide to Content of the HRS Psychosocial Leave-Behind Participant Lifestyle Questionnaires: 2004 and 2006 %A Philippa J Clarke %A Gwenith G Fisher %A House, Jim %A Jacqui Smith %A David R Weir %K Disabilities %K Health Conditions and Status %X In 2004, HRS added a new feature for data collection in the form of self-administered questionnaires that were left with respondents upon the completion of an in-person Core Interview. These are referred to as Leave-Behind Questionnaires and electronic versions of the questionnaires are included in the 2004 Final release and 2006 Early Release. The purpose of the Leave-Behind Questionnaire is to collect additional information from respondents without adding to the interview length. Two separate questionnaires on different topics were included in HRS 2004: a) Participant Lifestyle Questionnaire, which measures psychosocial issues that are described in much more detail later in this report, and b) Participant questionnaire on Work and Health, which included a series of disability vignettes in which people with various levels of physical and mental health impairment were described and respondents were asked to indicate the extent to which they think the person described is limited in the kind or amount of work they can do. At the beginning of the vignettes, respondents were asked to rate their own degree of limitation in the kind or amount of work they can do. %I Ann Arbor, The University of Michigan %G eng %U http://hrsonline.isr.umich.edu/sitedocs/userg/HRS2006LBQscale.pdf %4 psycho-social/disability vignettes/physical health/mental Health %$ 24890 %0 Report %D 2008 %T How Much Do Older Workers Value Employee Health Insurance? %A Friedberg, Leora %A Wei Sun %A Anthony Webb %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %X This brief seeks to answer the question in the title by analyzing data from the Health and Retirement Study (HRS), a nationally representative survey of older Americans. New questions in the HRS enable researchers to compare the value that workers place on health insurance with their perceptions about the cost of coverage. %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %L newpubs20081014_ib_8-9.pdf %4 Health Insurance/Health Expenditures %$ 19460 %0 Journal Article %J J Aging Health %D 2008 %T Impact of functional limitations and medical comorbidity on subsequent weight changes and increased depressive symptoms in older adults. %A Valerie L Forman-Hoffman %A Kelly K Richardson %A Jon W. Yankey %A Stephen L Hillis %A Robert B Wallace %A Frederic D Wolinsky %K Activities of Daily Living %K Age Factors %K Arthritis %K Comorbidity %K depression %K Depressive Disorder %K Diabetes Complications %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Surveys %K Heart Diseases %K Humans %K Hypertension %K Lung Diseases %K Male %K Mental Disorders %K Middle Aged %K Neoplasms %K Obesity %K Risk Factors %K Sex Factors %K Stroke %K United States %K Weight Gain %X

OBJECTIVE: The primary goal of this study was to determine the effect of the onset of major medical comorbidity and functional decline on subsequent weight change and increased depressive symptoms.

METHODS: The sample included a prospective cohort of 53 to 63 year olds (n = 10,150) enrolled in the Health and Retirement Study. Separate lagged covariate models for men and women were used to study the impact of functional decline and medical comorbidity on subsequent increases in depressive symptoms and weight change 2 years later.

RESULTS: Functional decline and medical comorbidity were individual predictors of subsequent weight changes but not increased depressive symptoms. Most specific incident medical comorbidities or subtypes of functional decline predicted weight changes in both directions.

DISCUSSION: The elevated risk of weight gain subsequent to functional decline or onset of medical comorbidities may require the receipt of preventive measures to reduce further weight-related complications.

%B J Aging Health %I 20 %V 20 %P 367-84 %8 2008 Jun %G eng %N 4 %L newpubs20080528_JnlAgingHlth.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18390865?dopt=Abstract %3 18390865 %4 Weight/Depressive Symptoms/COMORBIDITY/Health Physical %$ 18870 %R 10.1177/0898264308315851 %0 Journal Article %J Journal of Risk and Insurance %D 2008 %T Mortality, Heterogeneity and the Distributional Consequences of Mandatory Annuitization %A Gong, Guan %A Anthony Webb %K Demographics %K Expectations %K Health Conditions and Status %K Net Worth and Assets %X This article investigates the distributional consequences of mandatory annuitization. Using data from the Health and Retirement Study (HRS), we calculate the relationship between socio-economic status and a utility based measure of annuity value. We find considerable variation between groups once we take account of not only socio-economic differences in mortality, but also pre-annuitized wealth and longevity risk pooling in marriage. Using HRS data on subjective survival probabilities, we then construct a subjective life table for each individual in the HRS. We show that these tables vary appropriately between groups and aggregate closely to group level averages. We calculate the value each household would place on annuitization, based on the husband and wife's subjective life tables, and the household's degree of risk-aversion and proportion of pre-annuitized wealth. A significant minority would perceive themselves as suffering a net loss from mandatory annuitization. %B Journal of Risk and Insurance %I 75 %V 75 %P 1055-79 %G eng %N 4 %L wp_2006/CRRwp2006-11.pdf %4 Annuities/socioeconomic status/mortality/Subjective Probabilities of Survival %$ 16640 %R https://doi.org/10.1111/j.1539-6975.2008.00297.x %0 Journal Article %J Soc Sci Med %D 2008 %T A multilevel analysis of urban neighborhood socioeconomic disadvantage and health in late life. %A Richard G Wight %A Janet R. Cummings %A Miller-Martinez, Dana %A Arun S Karlamangla %A Teresa Seeman %A Carol S Aneshensel %K Aged %K Female %K Health Behavior %K Health Status Disparities %K Humans %K Male %K Poverty %K Small-Area Analysis %K Socioeconomic factors %K United States %K Urban Population %X

The associations between neighborhood context and various indicators of health are receiving growing empirical attention, but much of this research is regionally circumscribed or assumes similar effects across the life course. This study utilizes a U.S. national sample to investigate the association between urban neighborhood socioeconomic disadvantage and health specifically among older adults. Data are from 3442 participants aged 70 years and older in the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) Study, and the 1990 U.S. Census. Our approach underscores the importance of multiple dimensions of health (self-reported physician-diagnosed cardiovascular disease [CVD], functional status, and self-rated health) as well as multiple dimensions of neighborhood disadvantage, which are conceptualized as environmental hazards that may lead to a physiologically consequential stress response. We find that individual-level factors attenuate the association between neighborhood disadvantage and both CVD and functional status, but not self-rated health. Net of covariates, high neighborhood socioeconomic disadvantage is significantly associated with reporting poor health. In late life, neighborhood socioeconomic disadvantage is more consequential to subjective appraisals of health than diagnosed CVD or functional limitations.

%B Soc Sci Med %I 66 %V 66 %P 862-72 %8 2008 Feb %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/18160194?dopt=Abstract %2 PMC3681874 %4 Urban Population/socioeconomic status/HEALTH %$ 18470 %R 10.1016/j.socscimed.2007.11.002 %0 Journal Article %J J Aging Health %D 2008 %T Parent caregiving choices of middle-generation Blacks and Whites in the United States. %A Shelley I. White-Means %A Rose M. Rubin %K Activities of Daily Living %K Black People %K Caregivers %K Employment %K Family Characteristics %K Financial Support %K Humans %K Intergenerational Relations %K Logistic Models %K Parent-Child Relations %K Parents %K Siblings %K Socioeconomic factors %K United States %K White People %X

OBJECTIVE: This study compares how middle-generation caregivers and non-caregivers differ by race and explores racial differences in activities of daily living (ADL), instrumental activities of daily living (IADL), and financial assistance that middle-generation caregivers provide for their parents.

METHOD: Using 2000 Health and Retirement Study data, racially stratified descriptive analyses and logistic regression models for ADL, IADL, and financial assistance are presented.

RESULTS: Parental need and race influence support, with similar patterns of Black and White ADL support, but racial differences in IADL and financial support. Having more children motivates Whites to increase IADL support and reduce financial support; more children decreases Blacks' IADL support. Sibling caregiver networks influence IADL and financial support in ways that vary by race. The number employed is a key determinant for Blacks for all support, but only influences White ADL support.

DISCUSSION: The findings of this article indicate the importance of sample stratification by race and that employment or other subsidies may aid the expansion of caregiving by middle-generation adults.

%B J Aging Health %I 20 %V 20 %P 560-82 %8 2008 Aug %G eng %N 5 %L newpubs20080822_JnlAgingHlth %1 http://www.ncbi.nlm.nih.gov/pubmed/18448685?dopt=Abstract %3 18448685 %4 Caregivers/sociodemographic differences/sociodemographic differences/Racial Differences/ADL and IADL Impairments/Financial Support %$ 19170 %R 10.1177/0898264308317576 %0 Book Section %B Health at Older Ages: The Causes and Consequences of Declining Disability %D 2008 %T Pathways to Disability: Predicting Health Trajectories %A Florian Heiss %A Axel Borsch-Supan %A Michael D Hurd %A David A Wise %E David M Cutler %E David A Wise %K Disabilities %K Healthcare %B Health at Older Ages: The Causes and Consequences of Declining Disability %P 105-150 %@ 0-226-13231-5 %G eng %U https://www.nber.org/books-and-chapters/health-older-ages-causes-and-consequences-declining-disability-among-elderly/pathways-disability-predicting-health-trajectories %4 DISABILITY/DISABILITY/health trajectories/health trajectories %$ 25920 %& 4 %0 Report %D 2008 %T Pension Wealth and Income: 1992, 1998, and 2004 %A Sorokina, Olga %A Anthony Webb %A Muldoon, Dan %K Net Worth and Assets %K Pensions %X What is the impact of the shift from defined benefit to defined contribution plans on the pension wealth of households approaching retirement? Using data from the Health and Retirement Study, this brief documents this shift and compares employer-sponsored pension wealth across households with heads age 51-56 in 1992, 1998, and 2004. The results show that, for the average household, both pension wealth and replacement rates the ratio of annual benefits to pre-retirement earnings fell between 1992 and 2004. %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/briefs/pension-wealth-and-income-1992-1998-and-2004/ %L newpubs20080411_CRRJan08.pdf %4 Pension Wealth/defined benefits/defined contribution pension plans/Retirement Wealth %$ 18750 %0 Report %D 2008 %T Preparation for Retirement, Financial Literacy and Cognitive Resources %A Delavande, Adeline %A Susann Rohwedder %A Robert J. Willis %K Methodology %K Net Worth and Assets %X Traditional economic models assume that individuals have full information and act perfectly rationally. However, we show that there is considerable variation in financial literacy in the population and propose modeling the acquisition of financial knowledge in a human capital production framework. The model makes several predictions, notably with respect to portfolio choice. For example, it helps explain household non-participation in the stock market for some fraction of the population, and it provides guidance about the share of risky assets to hold for other types of households. Estimation of the human capital production function for financial knowledge on data from the Cognitive Economics Survey yields results that are consistent with important features of the model %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/wp190.html %4 stock Market/Probabilistic expectations/Financial literacy %$ 23510 %0 Journal Article %J Ann Intern Med %D 2008 %T Prevalence of cognitive impairment without dementia in the United States. %A Brenda L Plassman %A Kenneth M. Langa %A Gwenith G Fisher %A Steven G Heeringa %A David R Weir %A Mary Beth Ofstedal %A James R Burke %A Michael D Hurd %A Guy G Potter %A Willard L Rodgers %A David C Steffens %A John J McArdle %A Robert J. Willis %A Robert B Wallace %K Aged %K Aged, 80 and over %K Cognition Disorders %K Dementia %K disease progression %K Humans %K Longitudinal Studies %K Prevalence %K United States %X

BACKGROUND: Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States.

OBJECTIVE: To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes.

DESIGN: Longitudinal study from July 2001 to March 2005.

SETTING: In-home assessment for cognitive impairment.

PARTICIPANTS: Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment.

MEASUREMENTS: Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample.

RESULTS: In 2002, an estimated 5.4 million people (22.2%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2%) and cerebrovascular disease (5.7%). Among participants who completed follow-up assessments, 11.7% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17% to 20%. The annual death rate was 8% among those with cognitive impairment without dementia and almost 15% among those with cognitive impairment due to medical conditions.

LIMITATIONS: Only 56% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to nonresponse and attrition.

CONCLUSION: Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes.

%B Ann Intern Med %I 148 %V 148 %P 427-34 %8 2008 Mar 18 %G eng %N 6 %L newpubs20080528_AnnIntMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18347351?dopt=Abstract %2 PMC2670458 %4 Cognitive Functioning/Dementia/Health Risk/PREVALENCE %$ 18530 %R 10.7326/0003-4819-148-6-200803180-00005 %0 Journal Article %J The Gerontologist %D 2008 %T Racial and Ethnic Differences in Undiagnosed and Poorly Managed Diabetes and Hypertension: Combining Population Surveys with Biomarker Data (HRS2006). %A David R Weir %A Eileen M. Crimmins %K Demographics %K Health Conditions and Status %X CA Diabetes and hypertension are common conditions of aging that increase risk for cardiovascular events if not properly treated.Concerns about undiagnosed, and inadequately treated disease, are particularly strong for minority populations.Diabetes diagnosis rates vary from 16 among whites to 29 for blacks and 27 for Hispanics. %B The Gerontologist %I 48 %V 48 %P 1 %G eng %N SPECIAL ISSUE III %4 Diabetes/ethnic differences/sociodemographic differences/sociodemographic differences %$ 62861 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2008 %T Racial disparities in receipt of hip and knee joint replacements are not explained by need: the Health and Retirement Study 1998-2004. %A Steel, Nicholas %A Clark, Allan %A Iain A Lang %A Robert B Wallace %A David Melzer %K Aged %K Arthroplasty, Replacement, Hip %K Arthroplasty, Replacement, Knee %K Black or African American %K Educational Status %K Female %K Health Services Needs and Demand %K Humans %K Male %K Middle Aged %K United States %X

BACKGROUND: Hip and knee joint replacement rates vary by demographic group. This article describes the epidemiology of need for joint replacement, and of subsequent receipt of a joint replacement by those in need.

METHODS: Data from the Health and Retirement Study were used to assess need for hip or knee joint replacement in a total of 14,807 adults aged 60 years or older in 1998, 2000, and 2002 and receipt of needed surgery 2 years later. "Need" classification was based on difficulty walking, joint pain, stiffness, or swelling and receipt of treatment for arthritis, without contraindications to surgery.

RESULTS: Need in 2002 was greater in participants who were older than 74 years (vs 60-64: adjusted odds ratio 2.06; 95% confidence interval, 1.68-2.53), women (vs men: 1.81; 1.53-2.14), less educated (vs college educated: 1.27; 1.06-1.52), in the poorest third (vs richest: 2.20; 1.78-2.72), or obese (vs nonobese: 2.39; 2.02-2.81). One hundred sixty-eight participants in need received a joint replacement, with lower receipt in black or African American participants (vs white: 0.47; 0.26-0.83) or less educated (vs college educated: 0.65; 0.44-0.96). These differences were not explained by current employment, access to medical care, family responsibilities, disability, living alone, comorbidity, or exclusion of those younger than Medicare eligibility age.

CONCLUSIONS: After taking variations in need into consideration, being black or African American or lacking a college education appears to be a barrier to receiving surgery, whereas age, sex, relative poverty, and obesity do not. These disparities maintain disproportionately high levels of pain and disability in disadvantaged groups.

%B J Gerontol A Biol Sci Med Sci %I 63A %V 63 %P 629-34 %8 2008 Jun %G eng %N 6 %L newpubs20080822_Steeletal %1 http://www.ncbi.nlm.nih.gov/pubmed/18559639?dopt=Abstract %3 18559639 %4 DISABILITY/DISABILITY/Joint Replacement %$ 19240 %R 10.1093/gerona/63.6.629 %0 Journal Article %J ANNALS OF BEHAVIORAL MEDICINE %D 2008 %T The relationship of diabetes and working memory: Results from the health and retirement study, 1998-2006 %A Linda A. Wray %K Health Conditions and Status %B ANNALS OF BEHAVIORAL MEDICINE %I 35 %V 35 %P S66-S66 %G eng %4 diabetes/health Status %$ 22410 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2008 %T Retirement and weight changes among men and women in the health and retirement study. %A Valerie L Forman-Hoffman %A Kelly K Richardson %A Jon W. Yankey %A Stephen L Hillis %A Robert B Wallace %A Frederic D Wolinsky %K Aged %K Aging %K Body Mass Index %K Body Weight %K Demography %K depression %K Female %K Health Behavior %K Health Status %K Humans %K Interviews as Topic %K Male %K Middle Aged %K Obesity %K Retirement %X

OBJECTIVES: Older adults may experience weight changes upon retirement for a number of reasons, such as being less physically active; having less structured meal times; and consuming food in response to losing personal identity, the potential for social interactions, or the sense of accomplishment derived from working. The purpose of this study was to determine whether retirement was associated with either weight gain or weight loss.

METHODS: We used the 1994-2002 Health and Retirement Study to determine whether retirement between biennial interviews was associated with weight change, separately for men (n = 1,966) and women (n = 1,759). We defined weight change as a 5% increase or decrease in body mass index between interviews.

RESULT: . We did not find a significant association between retirement and weight change among men. Women who retired were more likely to gain weight than women who continued to work at least 20 hr per week (odds ratio [OR] = 1.24, 95% confidence interval [CI] = 1.04-1.48). We found a significant relationship between retirement and weight gain only for women who were normal weight upon retiring (OR = 1.30, 95% CI = 1.01-1.69) and who retired from blue-collar jobs (OR = 1.58, 95% CI = 1.13-2.21).

DISCUSSION: Public health interventions may be indicated for women, particularly those working in blue-collar occupations, in order to prevent weight gain upon retirement.

%B J Gerontol B Psychol Sci Soc Sci %I 63B %V 63 %P S146-53 %8 2008 May %G eng %N 3 %L newpubs20080822_JoG63B146 %1 http://www.ncbi.nlm.nih.gov/pubmed/18559689?dopt=Abstract %3 18559689 %4 RETIREMENT/Weight/Women %$ 19200 %R 10.1093/geronb/63.3.s146 %0 Journal Article %J Arch Intern Med %D 2008 %T Screening mammography in older women. Effect of wealth and prognosis. %A Brie A Williams %A Lindquist, Karla %A Rebecca L. Sudore %A Kenneth E Covinsky %A Louise C Walter %K Aged %K Breast Neoplasms %K Chi-Square Distribution %K Female %K Humans %K Longitudinal Studies %K Mammography %K Mass Screening %K Prognosis %K Risk Factors %K Social Class %X

BACKGROUND: Wealthy women have higher rates of screening mammography than poor women do. Screening mammography is beneficial for women with substantial life expectancies, but women with limited life expectancies are unlikely to benefit. It is unknown whether higher screening rates in wealthy women are due to increased screening in women with substantial life expectancies, limited life expectancies, or both. This study examines the relationship between wealth and screening mammography use in older women according to life expectancy.

METHODS: A cohort study was performed of 4222 women 65 years or older with Medicare participating in the 2002 and 2004 Health and Retirement Survey. Women were categorized according to wealth and life expectancy (based on 5-year prognosis from a validated prognostic index). The outcome was self-reported receipt of screening mammography within 2 years.

RESULTS: Overall, within 2 years, 68% of women (2871 of 4222) received a screening mammogram. Screening was associated with wealth (net worth, > $100 000) and good prognosis (< or = 10% probability of dying in 5 years). Screening mammography was more common among wealthy women than among poor women (net worth, < $10 000) both for women with good prognosis (82% vs 68%; P < .001) and for women with limited prognoses (> or = 50% probability of dying in 5 years) (48% vs 32%; P = .02). These associations remained after multivariate analysis accounting for age, race, education, proxy report, and rural residence.

CONCLUSIONS: Poorer older women with favorable prognoses are at risk of not receiving screening mammography when they are likely to benefit. Wealthier older women with limited prognoses are often screened when they are unlikely to benefit.

%B Arch Intern Med %I 168 %V 168 %P 514-20 %8 2008 Mar 10 %G eng %N 5 %L newpubs20101112_Williams.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18332298?dopt=Abstract %3 18332298 %4 Mammography/WOMEN/life Expectancy/Wealth/methodology/risk factors %$ 23610 %R 10.1001/archinternmed.2007.103 %0 Journal Article %J J Econom %D 2008 %T Social Security and the Retirement and Savings Behavior of Low Income Households. %A van der Klaauw, Wilbert %A Wolpin, Kenneth I. %X

In this paper, we develop and estimate a model of retirement and savings incorporating limited borrowing, stochastic wage offers, health status and survival, social security benefits, Medicare and employer provided health insurance coverage, and intentional bequests. The model is estimated on sample of relatively poor households from the first three waves of the Health and Retirement Study (HRS), for whom we would expect social security income to be of particular importance. The estimated model is used to simulate the responses to changes in social security rules, including changes in benefit levels, in the payroll tax, in the social security earnings tax and in early and normal retirement ages. Welfare and budget consequences are estimated.

%B J Econom %I 145 %V 145 %P 21-42 %8 2008 Jul %G eng %N 1-2 %L newpubs20081014_econometrics.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21566719?dopt=Abstract %4 Retirement Saving/Social Security/Medicare/Survival/health status %$ 19380 %R 10.1016/j.jeconom.2008.05.004 %0 Journal Article %J Journal of Economics %D 2008 %T Social security and the retirement and savings behavior of low-income households %A van der Klaauw, Wilbert %A Wolpin, Kenneth I. %K Retirement %K Social Security %K structural estimation %X In this paper, we develop and estimate a model of retirement and savings incorporating limited borrowing, stochastic wage offers, health status and survival, social security benefits, Medicare and employer-provided health insurance coverage, and intentional bequests. The model is estimated on a sample of relatively poor households from the first three waves of the Health and Retirement Study (HRS), for whom we would expect social security income to be of particular importance. The estimated model is used to simulate the responses to changes in social security rules, including changes in benefit levels, in the payroll tax, in the social security earnings tax and in early and normal retirement ages. Welfare and budget consequences are estimated. %B Journal of Economics %V 145 %G eng %N 1-2 %& 21-42 %R 10.1016/j.jeconom.2008.05.004 %0 Report %D 2008 %T Tapping Assets in Retirement: Which Assets, How, and When? %A James M. Poterba %A David A Wise %A Steven F Venti %K Assets %X Just two or three decades ago retirement saving in the United States was based heavily on employer-provided defined benefit plans. Benefits after retirement were typically received in the form of lifetime annuities. Now personal retirement accounts—401(k), IRA, Keogh, and others plans—have become the primary form of saving for retirement. In 2007, private sector defined contribution assets totaled $9.2 trillion and assets in traditional defined benefit programs were $2.4 trillion (ICI 2008). At the time of retirement, the participant has sole control of the accumulated assets in these plans and must determine when to withdraw assets from the plans. To date, assets held in personal retirement accounts have rarely been annuitized. This has raised concern that some participants will draw down assets precipitously and run the danger of outliving their assets. In this paper, we consider the drawdown of assets after retirement, in particular the drawdown of 401(k)-like assets. %I NBER %G eng %U https://www.researchgate.net/publication/241384656_Tapping_Assets_in_Retirement_Which_Assets_How_and_When %0 Journal Article %J Eur J Ageing %D 2008 %T Unhealthy lifestyles among older adults: exploring transitions in Mexico and the US. %A Rebeca Wong %A Mary Beth Ofstedal %A Yount, Kathryn %A Emily M. Agree %X

Lifestyle risk factors are important precursors of old age disease and disability, and the population level impact of these factors likely differs across countries that vary in their economic growth and the attributes of the populations that adopt and abandon unhealthy lifestyles. This paper describes the stage of "lifestyle transition" among older adults in two countries with vastly different trajectories of socio-economic development. A series of hypotheses are proposed on the socioeconomic patterns of health risk factors that would be expected in the two countries, given their economic circumstances and the historical timing of policy interventions that were initiated to mitigate lifestyle risks in these populations. The paper compares the prevalence of smoking tobacco, drinking alcohol, obesity, and lack of physical exercise, as well as the socioeconomic and demographic covariates of these risk factors, among adults aged 55 and older in Mexico and the United States. The findings indicate that smoking- and physical-activity-related transitions toward healthier lifestyles are well under way among older adults in the United States but not in Mexico, whereas a trend toward reduced levels of obesity has just begun in the United States but not in Mexico. There is no evidence of a transition in heavy alcohol drinking in either country among older adults.

%B Eur J Ageing %I 5 %V 5 %P 311-326 %8 2008 Dec %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/25419206?dopt=Abstract %4 MHAS_/Cross Cultural Comparison/cross-national comparison/Lifestyle/Obesity/Smoking/Alcohol/Exercise/Mexico/United States %$ 62602 %R 10.1007/s10433-008-0098-0 %0 Report %D 2008 %T What Effect Do Time Constraints Have on the Age of Retirement? %A Friedberg, Leora %A Wei Sun %A Anthony Webb %K Employment and Labor Force %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Work affects both the time available for non-market activities and the times at which those activities are performed and therefore work-induced constraints on time use may influence retirement decisions. We analyze these effects by combining new data from the American Time Use Survey with information on retirement in the Health and Retirement Study. We find that the propensity to engage in three types of non-work activities household production, leisure, and tertiary activities (eating, sleeping, grooming) are substantially altered by work. Moreover, the ways in which the timing of these activities are distorted differ across ten different job types (industry-occupation combinations) that we examine in the ATUS. We use the resulting measures of time distortions as control variables in multinomial logit retirement models that we estimate in the HRS. Older workers in jobs with greater distortions to the quantity and timing of leisure activities have an increased propensity to leave those jobs, either for new jobs or for retirement. On the other hand, workers in jobs with greater distortions to household production have a reduced propensity to leave their jobs, and distortions to tertiary activities raise the propensity to take new jobs but reduce the propensity to retire. %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/what-effect-do-time-constraints-have-on-the-age-of-retirement/ %L newpubs20090908_CRR2008-17.pdf %4 Household Production/Leisure/Working Hours/Retirement planning %$ 20580 %0 Report %D 2008 %T When Should Married Men Claim Social Security Benefits? %A Sass, Steven A. %A Wei Sun %A Anthony Webb %K Adult children %K Public Policy %K Retirement Planning and Satisfaction %K Social Security %X Most married men claim Social Security benefits at age 62 or 63, well short of the age that maximizes the expected present value of the average household s benefits. That many married men leave money on the table is surprising. It is also problematic. It results in much lower benefits for surviving spouses and the low incomes of elderly widows are a major social problem. If married men delayed claiming Social Security benefits, retirement income security would significantly improve. This brief focuses on the potential gains from delayed claiming and the factors that may influence claiming behavior. It then considers possible policy responses. %B Center for Retirement Research at Boston College Briefs %I Center for Retirement Research at Boston College %C Boston %G eng %U https://crr.bc.edu/briefs/when-should-married-men-claim-social-security-benefits/ %L newpubs20081014_ib_8-4.pdf %4 Social Security benefit claiming/Claiming behavior/Claiming behavior/Marital Status/retirement planning/public Policy/retirement income / United States. %$ 19470 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T All in the family: the impact of caring for grandchildren on grandparents' health. %A Mary Elizabeth Hughes %A Linda J. Waite %A Tracey A. LaPierre %A Ye Luo %K Adaptation, Psychological %K Aged %K Aged, 80 and over %K Aging %K Caregivers %K Child Care %K Child, Preschool %K Family Relations %K Female %K Health Status %K Humans %K Intergenerational Relations %K Male %K Middle Aged %K Parenting %K Risk Assessment %K Stress, Psychological %X

OBJECTIVES: The purpose of this study was to examine the effects of caring for grandchildren on health behaviors and mental and physical health among older adults.

METHODS: Using a sample of 12,872 grandparents aged 50 through 80 from the Health and Retirement Study, we examined the relationship between stability and change in various types of grandchild care and subsequent health, controlling for covariates and earlier health.

RESULTS: We found no evidence to suggest that caring for grandchildren has dramatic and widespread negative effects on grandparents' health and health behavior. We found limited evidence that grandmothers caring for grandchildren in skipped-generation households are more likely to experience negative changes in health behavior, depression, and self-rated health. We also found some evidence of benefits to grandmothers who babysit.

DISCUSSION: Our findings suggest that the health disadvantages found previously among grandparent caregivers arise from grandparents' prior characteristics, not as a consequence of providing care. Health declines as a consequence of grandchild care appear to be the exception rather than the rule. These findings are important given continuing reliance on grandparents for day care and increasing reliance on grandparents for custodial care. However, the findings should be tempered by the recognition that for a minority of grandparents, coresidential grandchild care may compromise health.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S108-19 %8 2007 Mar %G eng %N 2 %L newpubs20070501_JoGS108.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17379680?dopt=Abstract %2 PMC2562755 %4 Caregiving/Child Care/Health Physical %$ 17410 %R 10.1093/geronb/62.2.s108 %0 Book Section %B Redefining Retirement: How Will Boomers Fare? %D 2007 %T Are Baby Boomers Living Well Longer? %A David R Weir %K Expectations %K Health Conditions and Status %K Other %X This chapter uses the Health and Retirement Study to describe the relationship between work and health for older persons by age. We examine not only the patterns within a given cross-section, but also we study trends in health at ages 51-56 between 1992 and 2004. Most retirement occurs well before the onset of work-limiting disability, leaving a large reserve of potential for longer worklives. Baby Boomers will likely have to draw on this reserve, yet its health is not demonstrably better than that of persons born a dozen years earlier. Nevertheless, advances in medical care for health conditions that most 51-56 year olds have not yet encountered may still yield better health at older ages for the Boomer cohort. %B Redefining Retirement: How Will Boomers Fare? %I Oxford University Press %C New York, NY %G eng %U https://repository.upenn.edu/prc_papers/364/ %4 Longevity/Retirement Expectations/health status/COHORT %$ 18130 %! Are Baby Boomers Living Well Longer? %0 Journal Article %J J Gen Intern Med %D 2007 %T Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients' treatment priorities and self-management? %A Eve A Kerr %A Michele M Heisler %A Sarah L. Krein %A Mohammed U Kabeto %A Kenneth M. Langa %A David R Weir %A John D Piette %K Aged %K Attitude to Health %K Cohort Studies %K Comorbidity %K Cross-Sectional Studies %K Diabetes Mellitus %K Female %K Health Priorities %K Heart Failure %K Humans %K Male %K Middle Aged %K Self Care %K Severity of Illness Index %K United States %X

BACKGROUND: The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40% have at least three.

OBJECTIVE: We sought to understand how the number, type, and severity of comorbidities influence diabetes patients' self-management and treatment priorities.

DESIGN: Cross-sectional observation study.

PATIENTS: A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey.

MEASUREMENTS: We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF).

RESULTS: 40% of respondents had at least 1 microvascular comorbidity, 79% at least 1 macrovascular comorbidity, and 61% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores.

CONCLUSIONS: The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients' self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.

%B J Gen Intern Med %I 22 %V 22 %P 1635-40 %8 2007 Dec %G eng %N 12 %L newpubs20090302_Kerr_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17647065?dopt=Abstract %2 PMC2219819 %4 diabetes/COMORBIDITY/Chronic Illness %$ 18460 %R 10.1007/s11606-007-0313-2 %0 Conference Paper %B Increasing the Effectiveness of Financial Education and Saving Programs %D 2007 %T The Changing Landscape of Pensions in the United States %A James M. Poterba %A Steven F Venti %A David A Wise %K Pensions %X The pension landscape in the U.S. has changed dramatically over the past 25 years. Saving through personal retirement accounts has become the principal form of retirement saving. We document the transition from a defined benefit system to a personal account system and show the effect it has had on wealth at retirement. We summarize results from other research we have done to project the growth of retirement assets over the next three decades. Our projections suggest that the advent of personal account saving will increase wealth at retirement for future retirees across the lifetime earnings spectrum. %B Increasing the Effectiveness of Financial Education and Saving Programs %I NBER %G eng %R 10.3386/w13381 %0 Journal Article %J J Public Econ %D 2007 %T DEFINED CONTRIBUTION PLANS, DEFINED BENEFIT PLANS, AND THE ACCUMULATION OF RETIREMENT WEALTH. %A James M. Poterba %A Joshua Rauh %A Steven F Venti %A David A Wise %X

The private pension structure in the United States, once dominated by defined benefit (DB) plans, is currently divided between defined contribution (DC) and DB plans. Wealth accumulation in DC plans depends on the participant's contribution behavior and on financial market returns, while accumulation in DB plans is sensitive to a participant's labor market experience and to plan parameters. This paper simulates the distribution of retirement wealth under representative DB and DC plans. It uses data from the Health and Retirement Study (HRS) to explore how asset returns, earnings histories, and retirement plan characteristics contribute to the variation in retirement wealth outcomes. We simulate DC plan accumulation by randomly assigning individuals a share of wages that they and their employer contribute to the plan. We consider several possible asset allocation strategies, with asset returns drawn from the historical return distribution. Our DB plan simulations draw earnings histories from the HRS, and randomly assign each individual a pension plan drawn from a sample of large private and public defined benefit plans. The simulations yield distributions of both DC and DB wealth at retirement. Average retirement wealth accruals under current DC plans exceed average accruals under private sector DB plans, although DC plans are also more likely to generate very low retirement wealth outcomes. The comparison of current DC plans with more generous public sector DB plans is less definitive, because public sector DB plans are more generous on average than their private sector counterparts.

%B J Public Econ %I 91 %V 91 %P 2062-2086 %8 2007 Nov 01 %G eng %N 10 %L newpubs20080229_Poterba_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21057597?dopt=Abstract %4 Pensions/Retirement Wealth/defined benefits/defined contribution pension plans %$ 18440 %R 10.1016/j.jpubeco.2007.08.004 %0 Journal Article %J Social Science and Medicine %D 2007 %T Disease prevalence and survey design effects: A response to Weir and Smith %A Sven E. Wilson %A Benjamin L. Howell %K Health Conditions and Status %K Methodology %X Evidence provided by Weir and Smith, particularly the findings from the National Health and Nutrition Examination Survey (NHANES), leads us to conclude that an increase in arthritis prevalence during the 1990s in the United States is probable, but the trend is likely overstated in the Health and Retirement Study (HRS). We show that a mistake in our earlier method does not change substantively our previous conclusion that survey duration effects are occurring in the HRS, a finding that is also supported by a variety of regression models (including that of Weir and Smith). Furthermore, very little evidence exists for an upward trend among self-reporters in the National Health Interview Survey (NHIS), and less than 25 of the increase in the HRS over the 1990s can be attributed to increases in obesity. %B Social Science and Medicine %I 65 %V 65 %P 1078 %G eng %N 6 %4 Methodology/arthritis/Obesity %$ 23020 %R https://doi.org/10.1016/j.socscimed.2007.04.039 %0 Journal Article %J Soc Sci Med %D 2007 %T Do panel surveys really make people sick? A commentary on Wilson and Howell (60:11, 2005, 2623-2627). %A David R Weir %A James P Smith %K Arthritis %K Female %K Health Surveys %K Humans %K Male %K Middle Aged %K Prevalence %K United States %X

In a recent article in this journal, Wilson and Howell [2005. Do panel surveys make people sick? US arthritis trends in the Health and Retirement Survey. Social Science & Medicine, 60(11), 2623-2627.] argue that the sharp trend of rising age-specific arthritis prevalence from 1992 to 2000 in the USA among those in their 50s based on the original Health and Retirement Study (HRS) cohort of respondents is "almost surely spurious." Their reasons are that no such trend is found in the National Health Interview Study (NHIS) over this same time period, and that an introduction of a new birth cohort into HRS in 1998 also indicates no trend. They also claim that there may be an inherent bias in panel surveys leading respondents to report greater levels of disease as the duration of their participation in the panel increases. This bias, which they call "panel conditioning," suggests a tendency for participants in a longitudinal survey to seek out medical care and diagnosis of symptoms asked about in previous waves. In this paper, we show that the evidence presented and the conclusions reached by Wilson and Howell are incorrect. Properly analyzed, three national health surveys--the NHIS, National Health and Nutrition Examination Survey (NHANES), and HRS--all show increases in age-specific arthritis prevalence during the 1990s. Since the new HRS sample cohort introduced in 1998 represents only a part of that birth cohort, we also demonstrate that Wilson and Howell's evidence in favor of panel conditioning was flawed. We find little indication of panel conditioning among existing participants in a panel survey.

%B Soc Sci Med %I 65 %V 65 %P 1071-7; discussion 1078-81 %8 2007 Sep %G eng %N 6 %L newpubs20071002_Commentary.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17574714?dopt=Abstract %4 Research Design/Survey Methods/arthritis %$ 17920 %R 10.1016/j.socscimed.2007.04.019 %0 Journal Article %J Applied Economics %D 2007 %T Do the Sick Retire Early? Chronic illness, asset accumulation and early retirement %A Miah, M. Solaiman %A Wilcox-Gök, Virginia %K Health Conditions and Status %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Our objective is to determine how chronic illness affects asset accumulation and retirement. Previous studies have found that poor health leads to early retirement, but those studies failed to look at the indirect impact of chronic illness on retirement. Using data from the Health and Retirement Study, we define an illness as chronic if the individual reports having asthma, cancer, heart disease, stroke or diabetes for four or more years. We first estimate how a chronic illness influences asset accumulation. We then estimate how asset accumulation and current poor health influence retirement. We observe that the vast majority of the chronically ill population do not report their general health to be poor nor do they report functional limitations in activities of daily living. Nevertheless, our results indicate that chronic illness leads these people to accumulate fewer assets during their working years and consequently retire later. Neither researchers nor policymakers discussing the many critical issues surrounding illness and retirement have addressed this issue. %B Applied Economics %I 39 %V 39 %P 1921 %G eng %U https://commons.lib.niu.edu/handle/10843/13288 %N 15 %L newpubs20071002_AppliedEcon.pdf %4 Chronic Illness/Assets/Early Retirement %$ 18020 %0 Journal Article %J J Aging Health %D 2007 %T Does more health care improve health among older adults? A longitudinal analysis. %A Ezra Golberstein %A Jersey Liang %A A. R. Quinones %A Frederic D Wolinsky %K Activities of Daily Living %K Aged %K Health Services %K Health Services for the Aged %K Health Status %K Humans %K Longitudinal Studies %K United States %X

OBJECTIVE: This research assesses the association of health services use with subsequent physical health among older Americans, adjusting for the confounding between health care use and prior health.

METHOD: Longitudinal data are from the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Linear and logistic regressions are used to model the linkages between medical care use and health outcomes, including self-rated health, functional limitations, and mortality.

RESULTS: There is limited evidence that increased health care use is correlated with improved subsequent health. Increased use of medical care is largely associated with poorer health outcomes. Moreover, there are no significant interaction effects of health care use and baseline health on Activities of Daily Living and Instrumental Activities of Daily Living, despite the existence of a significant but very small interaction effect on self-rated health.

CONCLUSIONS: The findings have implications for the quality of care delivered by the American health care system.

%B J Aging Health %I 19 %V 19 %P 888-906 %8 2007 Dec %G eng %N 6 %L newpubs20080229_888.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18165287?dopt=Abstract %4 Health Services Research/Health Care Utilization/health status/ADL and IADL Impairments %$ 18660 %R 10.1177/0898264307308338 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2007 %T Does physician communication influence older patients' diabetes self-management and glycemic control? Results from the Health and Retirement Study (HRS). %A Michele M Heisler %A Cole, Ian %A David R Weir %A Eve A Kerr %A Rodney A. Hayward %K Aged %K Blood Glucose %K Communication %K Cross-Sectional Studies %K Diabetes Mellitus %K Female %K Glycated Hemoglobin %K Humans %K Male %K Multivariate Analysis %K Physician-Patient Relations %K Self Care %X

BACKGROUND: Effective chronic disease self-management among older adults is crucial for improved clinical outcomes. We assessed the relative importance of two dimensions of physician communication-provision of information (PCOM) and participatory decision-making (PDM)-for older patients' diabetes self-management and glycemic control.

METHODS: We conducted a national cross-sectional survey among 1588 older community-dwelling adults with diabetes (response rate: 81%). Independent associations were examined between patients' ratings of their physician's PCOM and PDM with patients' reported diabetes self-management (medication adherence, diet, exercise, blood glucose monitoring, and foot care), adjusting for patient sociodemographics, illness severity, and comorbidities. Among respondents for whom hemoglobin A1c (HbA1c) values were available (n=1233), the relationship was assessed between patient self-management and HbA1c values.

RESULTS: In separate multivariate regressions, PCOM and PDM were each associated with overall diabetes self-management (p<.001) and with all self-management domains (p<.001 in all models), with the exception of PDM not being associated with medication adherence. In models with both PCOM and PDM, PCOM alone predicted medication adherence (p=.001) and foot care (p=.002). PDM alone was associated with exercise and blood glucose monitoring (both p<.001) and was a stronger independent predictor than PCOM of diet. Better patient ratings of their diabetes self-management were associated with lower HbA1c values (B= -.10, p=.005).

CONCLUSION: Among these older adults, both their diabetes providers' provision of information and efforts to actively involve them in treatment decision-making were associated with better overall diabetes self-management. Involving older patients in setting chronic disease goals and decision-making, however, appears to be especially important for self-care areas that demand more behaviorally complex lifestyle adjustments such as exercise, diet, and blood glucose monitoring.

%B J Gerontol A Biol Sci Med Sci %I 62A %V 62 %P 1435-42 %8 2007 Dec %G eng %N 12 %L newpubs2008_Heisler_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18166697?dopt=Abstract %4 aging/Chronic Illness/diabetes %$ 18740 %R 10.1093/gerona/62.12.1435 %0 Book Section %B Bio-Social Surveys: Current insight and future promise %D 2007 %T Elastic Powers: The Integration of Biomarkers into the Health and Retirement Study %A David R Weir %E Weinstein, Maxine %E James W Vaupel %E Kenneth W. Wachter %K Methodology %B Bio-Social Surveys: Current insight and future promise %I The National Academies Press %C Washington, DC %P 78-95 %G eng %U https://www.ncbi.nlm.nih.gov/books/NBK62437/ %4 Methodology %$ 18850 %! Elastic Powers: The Integration of Biomarkers into the Health and Retirement Study %0 Journal Article %J BMC Health Serv Res %D 2007 %T Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services. %A Frederic D Wolinsky %A An, Hyonggin %A Li Liu %A Thomas R Miller %A Gary E Rosenthal %K Aged %K Aged, 80 and over %K Ambulatory Care %K Cluster Analysis %K Continuity of Patient Care %K Emergency Service, Hospital %K Episode of Care %K Hospital Mortality %K Hospitals, Veterans %K Humans %K Male %K Medicare %K Proportional Hazards Models %K United States %K Veterans %X

BACKGROUND: Older veterans may use both the Veterans Health Administration (VHA) and Medicare, but the association of dual use with health outcomes is unclear. We examined the association of indirect measures of dual use with mortality.

METHODS: Our secondary analysis used survey, claims, and National Death Index data from the Survey on Assets and Health Dynamics among the Oldest Old. The analytic sample included 1,521 men who were Medicare beneficiaries. Veterans were classified as dual users when their self-reported number of hospital episodes or physician visits exceeded that in their Medicare claims. Veterans reporting inpatient or outpatient visits but having no Medicare claims were classified as VHA-only users. Proportional hazards regression was used.

RESULTS: 897 (59%) of the men were veterans, of whom 134 (15%) were dual users. Among dual users, 60 (45%) met the criterion based on inpatient services, 54 (40%) based on outpatient services, and 20 (15%) based on both. 766 men (50%) died. Adjusting for covariates, the independent effect of any dual use was a 38% increased mortality risk (AHR = 1.38; p = .02). Dual use based on outpatient services marginally increased mortality risk by 45% (AHR = 1.45; p = .06), and dual use based on both inpatient and outpatient services increased the risk by 98% (AHR = 1.98; p = .02).

CONCLUSION: Indirect measures of dual use were associated with increased mortality risk. New strategies to better coordinate care, such as shared medical records, should be considered.

%B BMC Health Serv Res %I 7 %V 7 %P 70 %8 2007 May 09 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/17490488?dopt=Abstract %2 PMC1884152 %4 Veterans: statistics/numerical/medicare/mortality/Physician visits/Physician visits/HOSPITALIZATION %$ 25010 %R 10.1186/1472-6963-7-70 %0 Journal Article %J Med Care %D 2007 %T Hospital episodes and physician visits: the concordance between self-reports and medicare claims. %A Frederic D Wolinsky %A Thomas R Miller %A An, Hyonggin %A John F Geweke %A Robert B Wallace %A Kara B Wright %A Elizabeth A Chrischilles %A Li Liu %A Claire E Pavlik %A Elizabeth A Cook %A Robert L. Ohsfeldt %A Kelly K Richardson %A Gary E Rosenthal %K Aged %K Centers for Medicare and Medicaid Services, U.S. %K Episode of Care %K Female %K Hospitalization %K Humans %K Insurance Claim Review %K Interviews as Topic %K Male %K Physicians %K Quality Assurance, Health Care %K Self Disclosure %K United States %X

BACKGROUND: Health services use typically is examined using either self-reports or administrative data, but the concordance between the 2 is not well established.

OBJECTIVE: We evaluated the concordance of hospital and physician utilization data from self-reports and claims data, and identified factors associated with disagreement.

METHODS: We performed a secondary analysis on linked observational and administrative data. A national sample of 4310 respondents who were 70 years old or older at their baseline interviews was used. Self-reported and Medicare claims-based hospital episodes and physician visits for 12 months before baseline were examined. Kappa statistics were used to evaluate concordance, and multivariable multinomial logistic regression was used to identify factors associated with overreporting (self-reports > claims), underreporting (self-reports < claims), and concordant-reporting (self-reports approximately claims).

RESULTS: The concordance of hospital episodes was high (kappa = 0.767 for the 2 x 2 comparison of none vs. some and kappa = 0.671 for the 6 x 6 comparison of none, 1, ..., 4, or 5 or more), but concordance for physician visits was low (kappa = 0.255 for the 2 x 2 comparison of none versus some and kappa = 0.351 for the 14 x 14 comparison of none, 1, ..., 12, and 13 or more). Multivariable multinomial logistic regression indicated that over-, under-, and concordant-reporting of hospital episodes was significantly associated with gender, alcohol consumption, arthritis, cancer, heart disease, psychologic problems, lower body functional limitations, self-rated health, and depressive symptoms. Over-, under-, and concordant-reporting of physician visits were significantly associated with age, gender, race, living alone, veteran status, private health insurance, arthritis, cancer, diabetes, hypertension, heart disease, lower body functional limitations, and poor memory.

CONCLUSIONS: Concordance between self-reported and claims-based hospital episodes was high, but concordance for physician visits was low. Factors significantly associated with bidirectional (over- and underreporting) and unidirectional (over- or underreporting) error patterns were detected. Therefore, caution is advised when drawing conclusions based on just one physician visit data source.

%B Med Care %I 45 %V 45 %P 300-7 %8 2007 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/17496713?dopt=Abstract %2 PMC1904836 %4 health Services/ADMINISTRATIVE DATA/Self-reported health/Medicare/HOSPITALIZATION %$ 25000 %R 10.1097/01.mlr.0000254576.26353.09 %0 Thesis %D 2007 %T Immigrant Status, Health, and Mortality in Later Life %A Woo, Hae-bong %K Demographics %K Health Conditions and Status %X Given the growing importance of the immigrant population in the United States, identifying the determinants of immigrant health following migration is critical to understanding the impact of international migration on the health of the nation. Using the Health and Retirement Study (HRS), this study examined nativity differences in mortality and physical functioning in later life, with special attention to (1) the determinants of nativity differences in mortality and physical functioning and (2) the association between mortality and disability in terms of the compression of morbidity paradigm. This study found that immigrant men had lower mortality compared to their U.S.-born counterparts of similar racial/ethnic backgrounds. However, immigrant women were indistinguishable from U.S.-born women of similar racial/ethnic backgrounds. With respect to physical functioning, immigrants showed lower levels of functional limitations but were indistinguishable from U.S.-born residents of similar racial/ethnic backgrounds in terms of disability. The data also showed that the effect of immigrant status somewhat differs across mortality and physical functioning. While all foreign-born racial/ethnic minorities showed lower or comparable mortality risks compared to native-born whites, foreign-born Hispanics showed poorer functional health than native-born whites. This study also found that socioeconomic status, social integration, and health behaviors play important roles in explaining the observed nativity differences in mortality and physical functioning. In particular, compared to prior research, the results indicate that socioeconomic factors better explain the observed nativity differences in mortality and physical functioning compared to social integration and health behaviors. This study also illustrated that integrating mortality and disability is a valuable way to investigate immigrant health. Compared to U.S.-born residents, the analysis of active life expectancy revealed that mortality is loosely coupled with disability for immigrants and that, except for foreign-born whites, immigrants' lengthy lives are expected to be a prolonged period of disability. Overall, the results indicate that immigrant's socioeconomic adaptation into U.S. society has a great impact on immigrant health in later life. This study also suggests that social policies aimed at promoting immigrant health need to be accompanied by a more general effort to integrate immigrants into U.S. society. %I The University of Texas at Austin %8 2007 %G eng %U https://repositories.lib.utexas.edu/bitstream/handle/2152/13280/wooh05958.pdf%3Bjsessionid%3DE37C5FAE0EEFA3E406945DDA79982CAD?sequence%3D2 %4 Mortality %$ 18250 %! Immigrant Status, Health, and Mortality in Later Life %0 Book Section %B Redefining Retirement: How Will Boomers Fare? %D 2007 %T The Impact of Pensions on Nonpension Investment Choices %A Friedberg, Leora %A Anthony Webb %K Consumption and Savings %K Net Worth and Assets %K Pensions %X This chapter documents the investment choices of workers outside their company pensions. The Health and Retirement Study is used to evaluate how investment patterns outside pension holdings have been influenced by the shift from defined benefit to defined contribution pensions. Since workers with defined benefit plans can expect steady income in retirement, they might be thought to invest less conservatively outside their pensions. Nevertheless, the data show otherwise. Defined contribution participants also hold stock investments outside their pension portfolios. These findings suggest that increased stock holding as defined benefit plans decline in importance. %B Redefining Retirement: How Will Boomers Fare? %I Oxford University Press %C New York, NY %P 179-210 %@ 9780199230778 %G eng %4 Investments/Pensions/Retirement Saving %$ 18160 %R DOI:10.1093/acprof:oso/9780199230778.003.0009 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T An interpersonal continuity of care measure for Medicare Part B claims analyses. %A Frederic D Wolinsky %A Thomas R Miller %A John F Geweke %A Elizabeth A Chrischilles %A An, Hyonggin %A Robert B Wallace %A Claire E Pavlik %A Kara B Wright %A Robert L. Ohsfeldt %A Gary E Rosenthal %K Aged %K Aged, 80 and over %K Continuity of Patient Care %K Disability Evaluation %K Female %K Health Services Accessibility %K Health Surveys %K Humans %K Insurance Claim Review %K Male %K Medicare Part B %K Mobility Limitation %K Physician-Patient Relations %K Primary Health Care %K United States %X

OBJECTIVES: This article presents an interpersonal continuity of care measure.

METHODS: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals. We linked Medicare Part A and B claims to baseline survey data for 4,596 respondents to the Survey on Asset and Health Dynamics Among the Oldest Old. We addressed the potential for selection bias by using propensity score methods, and we explored construct validity.

RESULTS: Interpersonal continuity with a primary care physician was 17.3%, and interpersonal continuity of care with any physician was 26.1%. Older participants; men; individuals who lived alone; people who had difficulty walking; and respondents with medical histories of arthritis, cancer, diabetes, heart conditions, hypertension, and stroke were most likely to have continuity. Individuals who had never married, were widowed, were working, or had low subjective life expectancy were least likely to have continuity.

DISCUSSION: Researchers can measure interpersonal continuity of care using Medicare Part B claims. Replication of these findings and further construct validation, however, are needed prior to widespread adoption of this method.

%B J Gerontol B Psychol Sci Soc Sci %I 62B %V 62 %P S160-8 %8 2007 May %G eng %N 3 %L newpubs20071002_JoGS160.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17507591?dopt=Abstract %2 PMC2914469 %4 Medicare/Health Care Utilization %$ 18060 %R 10.1093/geronb/62.3.s160 %0 Report %D 2007 %T Managing the Risk of Life %A Delavande, Adeline %A Robert J. Willis %K Expectations %K Social Security %X This study analyzes the role of individual s and spouse s survival expectations and knowledge about Social Security rules on the expected Social Security claiming age, taking into account the various incentives single and married individuals face. There is substantial heterogeneity in the level of knowledge about SS rules according to demographic characteristics. We find that single men and women who expect to be longlived plan on delaying Social Security claiming. When we allow for differential effects of survival on knowledge about Social Security rules, subjective survivals matter only for single women who are knowledgeable. For single men, knowledge is not so important in their decisions. The claiming decision of married individuals is more complicated, because they are entitled to spouse s and survivor s benefits. Consistent with the incentives provided by Social Security rules, we find that married men base their expected claiming age on their spouse s survival expectations but not on their own survival. For married women, both own and spouse s subjective survivals positively influence the timing of claiming. Knowledge about Social Security rules affects the expected claiming age of both married men and women. %B Michigan Retirement and Disability Research Center Research Paper %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1082051 %L newpubs20080229_wp167.pdf %4 Subjective Probabilities of Survival/Social Security/Social Security benefit claiming %$ 18390 %0 Journal Article %J Arch Intern Med %D 2007 %T Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. %A Michele M Heisler %A Jessica Faul %A Rodney A. Hayward %A Kenneth M. Langa %A Caroline S Blaum %A David R Weir %K Aged %K Aged, 80 and over %K Black People %K Diabetes Mellitus %K Female %K Glycated Hemoglobin %K Health Services Accessibility %K Hispanic or Latino %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Patient Compliance %K Socioeconomic factors %K Treatment Refusal %K United States %K White People %X

BACKGROUND: Mechanisms for racial/ethnic disparities in glycemic control are poorly understood.

METHODS: A nationally representative sample of 1901 respondents 55 years or older with diabetes mellitus completed a mailed survey in 2003; 1233 respondents completed valid at-home hemoglobin A(1c) (HbA(1c)) kits. We constructed multivariate regression models with survey weights to examine racial/ethnic differences in HbA(1c) control and to explore the association of HbA(1c) level with sociodemographic and clinical factors, access to and quality of diabetes health care, and self-management behaviors and attitudes.

RESULTS: There were no significant racial/ethnic differences in HbA(1c) levels in respondents not taking antihyperglycemic medications. In 1034 respondents taking medications, the mean HbA(1c) value (expressed as percentage of total hemoglobin) was 8.07% in black respondents and 8.14% in Latino respondents compared with 7.22% in white respondents (P < .001). Black respondents had worse medication adherence than white respondents, and Latino respondents had more diabetes-specific emotional distress (P < .001). Adjusting for hypothesized mechanisms accounted for 14.0% of the higher HbA(1c) levels in black respondents and 19.0% in Latinos, with the full model explaining 22.0% of the variance. Besides black and Latino ethnicity, only insulin use (P < .001), age younger than 65 years (P = .007), longer diabetes duration (P = .004), and lower self-reported medication adherence (P = .04) were independently associated with higher HbA(1c) levels.

CONCLUSIONS: Latino and African American respondents had worse glycemic control than white respondents. Socioeconomic, clinical, health care, and self-management measures explained approximately a fifth of the HbA(1c) differences. One potentially modifiable factor for which there were racial disparities--medication adherence--was among the most significant independent predictors of glycemic control.

%B Arch Intern Med %I 167 %V 167 %P 1853-60 %8 2007 Sep 24 %G eng %N 17 %L newpubs20071203_HeislerFaul.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17893306?dopt=Abstract %4 Racial Differences/Diabetes Mellitus %$ 18300 %R 10.1001/archinte.167.17.1853 %0 Report %D 2007 %T New Estimates of the Future Path of 401(k) Assets %A James M. Poterba %A Steven F Venti %A David A Wise %K Wealth %X Over the past two and a half decades there has been a fundamental change in saving for retirement in the United States, with a rapid shift from employer-managed defined benefit pensions to defined contribution saving plans that are largely controlled by employees. To understand how this change will affect the well-being of future retirees, we project the future growth of assets in self-directed personal retirement plans. We project the 401(k) assets at age 65 for cohorts attaining age 65 between 2000 and 2040. We also project the total value of assets in 401(k) accounts in each year through 2040 and we project the value of 401(k) assets as a percent of GDP over this period. We conclude that cohorts that attain age 65 in future decades will have accumulated much greater retirement saving (in real dollars) than the retirement saving of current retirees. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w13083 %0 Journal Article %J Med Care %D 2007 %T New evidence of racial differences in access and their effects on the use of nursing homes among older adults. %A Adaeze B Akamigbo %A Frederic D Wolinsky %K Aged %K Assisted Living Facilities %K Attitude to Health %K Black or African American %K Female %K Health Services Accessibility %K Health Status %K Homes for the Aged %K Humans %K Male %K Nursing homes %K Socioeconomic factors %K Time Factors %K White People %X

BACKGROUND: Historical disparities in rates of nursing home placement between blacks and whites have been well documented, and are thought to result from more extensive and supportive social networks, cultural aversion, and poorer geographic access among African Americans. A few recent studies, however, suggest that these racial disparities may no longer exist. We used comprehensive data to assess whether racial differences in nursing home placement remain, and if so, to identify the reasons for them.

METHODS: Data on 6242 black and white self-respondents to the Survey of Assets and Health Dynamics Among the Oldest Old cohort who were 70 years old or older at baseline (1993) were used. Placement status was ascertained at each biennial follow-up through 2004, and discrete-time hazards models were estimated.

RESULTS: After adjusting for baseline covariates, it was found that blacks were 26% (lambda = 0.74, P < 0.001) less likely to use a nursing home over an 11-year period than whites. Moreover, the supply of skilled nursing beds was more salient for nursing home placement for blacks than whites, as was the increasing supply of assisted living beds.

CONCLUSIONS: The racial gap in nursing home placement remains, despite the increased supply of nursing home beds and the emergence of assisted living facilities as the preferred alternative. As the supply of skilled nursing beds increases, in part due to whites choosing assisted living facilities, the racial gap in the risks of nursing home placement may be lessening. Blacks, however, remain less likely to be placed in a nursing home than whites.

%B Med Care %I 45 %V 45 %P 672-9 %8 2007 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/17571016?dopt=Abstract %R 10.1097/MLR.0b013e3180455677 %0 Journal Article %J Social Science Research %D 2007 %T Noncoverage and Nonresponse in an Internet Survey %A Mick P. Couper %A Arie Kapteyn %A Matthias Schonlau %A Joachim Winter %K Methodology %X We explore the correlates of noncoverage and nonresponse in an Internet survey conducted as part of the Health and Retirement Study (HRS), a panel study of persons 50 years old and older in the US. About 30 of HRS respondents indicated they used the Internet. Of these, 73 expressed willingness to do a Web survey. A subset of this group was subsequently sent a mailed invitation to participate in a Web survey and 78 completed the survey. Using multivariate models, we Wnd signiWcant demographic, Wnancial, and health-related diVerences in access, consistent with other research. There are fewer diVerences in willingness (given access) and response (given willingness). However, disparities in health and socio-economic status persist after controlling for demographic diVerences in coverage and response. Weighting on demographics alone is thus unlikely to yield a representative sample in such surveys. Noncoverage (lack of access to the Internet) appears to be of greater concern than nonresponse (unwillingness to participate given access) for representation in Internet surveys of this age group. %B Social Science Research %I 36 %V 36 %P 131 %G eng %N 1 %L newpubs20070125_Couper_etal_SSR %4 Methodology/Non-Response %$ 15710 %R https://doi.org/10.1016/j.ssresearch.2005.10.002 %0 Journal Article %J Neuroepidemiology %D 2007 %T Prevalence of dementia in the United States: the aging, demographics, and memory study. %A Brenda L Plassman %A Kenneth M. Langa %A Gwenith G Fisher %A Steven G Heeringa %A David R Weir %A Mary Beth Ofstedal %A James R Burke %A Michael D Hurd %A Guy G Potter %A Willard L Rodgers %A David C Steffens %A Robert J. Willis %A Robert B Wallace %K Age Distribution %K Aged %K Aged, 80 and over %K Cohort Studies %K Dementia %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Logistic Models %K Male %K Prevalence %K Sex Distribution %K United States %X

AIM: To estimate the prevalence of Alzheimer's disease (AD) and other dementias in the USA using a nationally representative sample.

METHODS: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender.

RESULTS: The prevalence of dementia among individuals aged 71 and older was 13.9%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0% of those aged 71-79 years to 37.4% of those aged 90 and older.

CONCLUSIONS: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as our population ages.

%B Neuroepidemiology %I 29 %V 29 %P 125-32 %8 2007 %G eng %N 1-2 %L newpubs20071203_ADAMSprevalence.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17975326?dopt=Abstract %4 aging/Dementia/Epidemiology %$ 18200 %R 10.1159/000109998 %0 Journal Article %J Journal of Applied Psychology %D 2007 %T Profiling retirees in the retirement transition and adjustment process: examining the longitudinal change patterns of retirees' psychological well-being. %A Wang, Mo %K Aged %K Female %K Follow-Up Studies %K Humans %K Male %K Middle Aged %K Quality of Life %K Retirement %K Social Adjustment %X

The author used role theory, continuity theory, and the life course perspective to form hypotheses regarding the different retirement transition and adjustment patterns and how different individual and contextual variables related to those patterns. The longitudinal data of 2 samples (n(1) = 994; n(2) = 1,066) from the Health and Retirement Survey were used. Three latent growth curve patterns of retirees' psychological well-being were identified as coexisting in the retiree samples through growth mixture modeling (GMM) analysis. On the basis of the latent class membership derived from GMM, retiree subgroups directly linked to different growth curve patterns were profiled with individual (e.g., bridge job status) and contextual variables (e.g., spouse working status). By recognizing the existence of multiple retiree subgroups corresponding to different psychological well-being change patterns, this study suggests that retirees do not follow a uniform adjustment pattern during the retirement process, which reconciles inconsistent previous findings. A resource perspective is further introduced to provide a more integrated theory for the current findings. The practical implications of this study are also discussed at both individual level and policy level.

%B Journal of Applied Psychology %V 92 %P 455-74 %8 2007 Mar %G eng %N 2 %R 10.1037/0021-9010.92.2.455 %0 Journal Article %J J Am Geriatr Soc %D 2007 %T The relationship between self-rated health and mortality in older black and white Americans. %A Sei J. Lee %A Sandra Y. Moody-Ayers %A C. Seth Landefeld %A Louise C Walter %A Lindquist, Karla %A Mark Segal %A Kenneth E Covinsky %K Age Distribution %K Aged %K Aged, 80 and over %K Black People %K Educational Status %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Mortality %K Population Surveillance %K Prognosis %K Self Disclosure %K Sex Distribution %K United States %K White People %X

OBJECTIVES: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship.

DESIGN: Prospective cohort.

SETTING: Communities in the United States.

PARTICIPANTS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older.

MEASUREMENTS: Subjects were asked to self-identify their race and their overall health by answering the question, "Would you say your health is excellent, very good, good, fair, or poor?" Death was determined according to the National Death Index.

RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95% confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95% CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH.

CONCLUSION: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.

%B J Am Geriatr Soc %I 55 %V 55 %P 1624-9 %8 2007 Oct %G eng %N 10 %L newpubs20101112_Lee.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17697102?dopt=Abstract %4 Minorities/African Americans/SELF-RATED HEALTH/EDUCATION/MORTALITY %$ 23650 %R 10.1111/j.1532-5415.2007.01360.x %0 Journal Article %J Journal of the American Geriatrics Society %D 2007 %T The Relationship Between Self-Rated Health and Mortality in Older Black and White Americans %A Sei J. Lee %A Sandra Y. Moody-Ayers %A C. Seth Landefeld %A Louise C Walter %A Lindquist, Karla %A Mark Segal %A Kenneth E Covinsky %K Demographics %K Health Conditions and Status %K Women and Minorities %X PURPOSE: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship. METHODS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older. Subjects were asked to self-identify their race and their overall health by answering the question, Would you say your health is excellent, very good, good, fair, or poor? Death was determined according to the National Death Index. RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c -statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95 confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95 CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH. CONCLUSIONS: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects. %B Journal of the American Geriatrics Society %I 55 %V 55 %P 1624 %G eng %N 10 %L newpubs20071203_Lee_etal_JAGS.pdf %4 SELF-RATED HEALTH/Mortality/Education/African-Americans %$ 18290 %R 10.1111/j.1532-5415.2007.01360.x %0 Report %D 2007 %T The Responsiveness of Private Savings to Medicaid Long Term Care Policies %A Purvi Sevak %A Walker, Lina %K Consumption and Savings %K Insurance %K Medicare/Medicaid/Health Insurance %X This paper examines the extent to which private savings responds to the availability of a social insurance program. We focus on the Medicaid nursing home assistance program and uses variation in state Medicaid policies in the 1960s and 1990s to identify whether household wealth correlates negatively with access to public insurance coverage. We use data from the 1962 and 1970 Survey of Consumer Finances and the 1992 through 2002 Health and Retirement Study. We find that household savings in 1970 was substantially lower in states with easier access to Medicaid assistance and that household savings in the 1990s was lower when access to the Medicaid program was lower. %B Michigan Retirement and Disability Research Center Publication %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/the-responsiveness-of-private-savings-to-medicaid-long-term-care-policies/ %L newpubs20070125_Sevak-Walker_wp150 %4 Medicaid/insurance/Savings %$ 17020 %0 Book Section %B Redefining Retirement: How Will Boomers Fare? %D 2007 %T Retiring on the House? Cross-Cohort Differences in Housing Wealth %A Coronado, Julia L. %A Maki, Dean %A Weitzer, Ben %K Housing %K Other %B Redefining Retirement: How Will Boomers Fare? %I Oxford University Press %C New York, NY %G eng %U https://repository.upenn.edu/prc_papers/373/ %4 Housing/COHORT %$ 18190 %! Retiring on the House? Cross-Cohort Differences in Housing Wealth %0 Report %D 2007 %T Rise of 401(k) Plans, Lifetime Earnings, and Wealth at Retirement %A James M. Poterba %A Steven F Venti %A David A Wise %K 401(k) %K Wealth %X Saving through private pensions has been an important complement to Social Security in providing for the financial needs of older Americans. In the past twenty five years, however, there has been a dramatic change in private retirement saving. Personal retirement accounts have replaced defined benefit pension plans as the primary means of retirement saving. It is important to understand how this change will affect the wealth of future retirees. The personal retirement account system is not yet mature. A person who retired in 2000, for example, could have contributed to a 401(k) for at most 18 years and the typical 401(k) participant had only contributed for a little over seven years. Nonetheless, current 401(k) assets are quite large. We consider in this paper the implications of rising 401(k) saving through the year 2040. In particular, we emphasize the growth of the sum of Social Security wealth and 401(k) assets for families in each decile of the Social Security wealth distribution. Our projections show a substantial increase between 2000 and 2040 in the sum of these retirement assets in each wealth decile. We also consider the accumulation of 401(k) assets by families in different deciles of the distribution of lifetime earnings. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %R 10.3386/w13091 %0 Journal Article %J American Family Physician %D 2007 %T Safe Alcohol Limits Similar for Younger and Older Adults %A Wellbery, Caroline %K Cross-National %K Health Conditions and Status %X The study used data from the U.S. Health and Retirement Study (HRS) and the English Longitudinal Study of Aging (ELSA). For those drinking more than one to two drinks per day, the odds ratios (ORs) in the pooled analysis were 0.96 for reported difficulty with ADLs, 0.75 for reported difficulty with IADLs, and 0.82 for poor cognitive function. %B American Family Physician %I 76 %V 76 %P 868-9 %G eng %U https://www.aafp.org/afp/2007/0915/p868.html %N 6 %L newpubs20071002_Wellbery.pdf %4 Alcohol Drinking/Activities of Daily Living/ELSA_/cross-national comparison %$ 17890 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Self-rated health trajectories and mortality among older adults. %A Thomas R Miller %A Frederic D Wolinsky %K Age Factors %K Aged %K Aged, 80 and over %K Attitude to Health %K Cardiovascular Diseases %K Cause of Death %K Female %K Follow-Up Studies %K Health Status %K Health Status Indicators %K Humans %K Logistic Models %K Longitudinal Studies %K Lung Diseases %K Male %K Mortality %K Multivariate Analysis %K Risk Factors %K Sex Factors %K Smoking %K Socioeconomic factors %K Survival Analysis %K United States %X

OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates.

METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources.

RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked.

DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S22-7 %8 2007 Jan %G eng %N 1 %L newpubs20070403_Miller-Wolinsky %1 http://www.ncbi.nlm.nih.gov/pubmed/17284562?dopt=Abstract %4 SELF-RATED HEALTH/mortality %$ 17270 %R 10.1093/geronb/62.1.s22 %0 Journal Article %J Am J Prev Med %D 2007 %T Should health studies measure wealth? A systematic review. %A Craig E Pollack %A Chideya, Sekai %A Cubbin, Catherine %A Brie A Williams %A Dekker, Mercedes %A Paula Braveman %K Bias %K Biomedical Research %K Female %K Financing, Personal %K Health Services Research %K Health Status Indicators %K Humans %K Male %K Research Design %K Socioeconomic factors %X

BACKGROUND: Health researchers rarely measure accumulated wealth to reflect socioeconomic status/position (SES). In order to determine whether health research should more frequently include measures of wealth, this study assessed the relationship between wealth and health.

METHODS: Studies published between 1990 to 2006 were systematically reviewed. Included studies used wealth and at least one other SES measure as independent variables, and a health-related dependent variable.

RESULTS: Twenty-nine studies met inclusion criteria. Measures of wealth varied greatly. In most studies, greater wealth was associated with better health, even after adjusting for other SES measures. The findings appeared most consistent when using detailed wealth measures on specific assets and debts, rather than a single question. Adjusting for wealth generally decreased observed racial/ethnic disparities in health.

CONCLUSIONS: Health studies should include wealth as an important SES indicator. Failure to measure wealth may result in under-estimating the contribution of SES to health, such as when studying the etiology of racial/ethnic disparities. Validation is needed for simpler approaches to measuring wealth that would be feasible in health studies.

%B Am J Prev Med %I 33 %V 33 %P 250-64 %8 2007 Sep %G eng %N 3 %L newpubs20071002_sdarticle.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17826585?dopt=Abstract %4 Health Care Surveys/HEALTH/Wealth/socioeconomic status %$ 17960 %R 10.1016/j.amepre.2007.04.033 %0 Book Section %B Redefining Retirement: How Will Boomers Fare? %D 2007 %T The Sufficiency of Retirement Savings: Comparing Cohorts at the Time of Retirement %A Haveman, Robert %A Karen C. Holden %A Barbara Wolfe %A Romanov, Andrei %K Consumption and Savings %K Income %K Other %X Assessing savings sufficiency requires detailed information on both potential retirement benefits and the characteristics of a national sample of older citizens. This chapter uses the Health and Retirement Survey and the New Beneficiary Survey linked to administrative records to assess and compare the saving adequacy of two different cohorts. Specifically we compare the two groups in terms of their annuitized net wealth (ANW) and ANW relative to the poverty line, as well as the near-poverty line. We find that the mean wealth levels of both new retiree cohorts rose over time (by about two-thirds for wealth and by half for ANW), but the chance of meeting social adequacy targets has also risen. This shortfall we believe is concentrated increasingly among nonmarried persons, and those with low human capital and labor force attachment. In other words, vulnerability during the working life appears to persist into retirement. %B Redefining Retirement: How Will Boomers Fare? %I Oxford University Press %C New York, NY %G eng %U https://repository.upenn.edu/cgi/viewcontent.cgi?article=1363&context=prc_papers %4 Retirement Saving/retirement adequacy/COHORT %$ 18120 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Urban neighborhoods and depressive symptoms among older adults. %A Carol S Aneshensel %A Richard G Wight %A Miller-Martinez, Dana %A Amanda L. Botticello %A Arun S Karlamangla %A Teresa Seeman %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Comorbidity %K Cross-Sectional Studies %K Depressive Disorder %K Female %K Health Status Indicators %K Health Surveys %K Humans %K Incidence %K Male %K Minority Groups %K Peer Group %K Population Dynamics %K Risk Factors %K Social Environment %K United States %K Urban Population %X

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older.

METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models.

RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population.

DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S52-9 %8 2007 Jan %G eng %N 1 %L newpubs20070403_Aneshensel_etal %1 http://www.ncbi.nlm.nih.gov/pubmed/17284567?dopt=Abstract %4 Depressive Symptoms/Socioeconomic Factors/Urban Population %$ 17280 %R 10.1093/geronb/62.1.s52 %0 Journal Article %J Chiropr Osteopat %D 2007 %T The use of chiropractors by older adults in the United States. %A Frederic D Wolinsky %A Li Liu %A Thomas R Miller %A John F Geweke %A Elizabeth A Cook %A Barry R. Greene %A Kara B Wright %A Elizabeth A Chrischilles %A Claire E Pavlik %A An, Hyonggin %A Robert L. Ohsfeldt %A Kelly K Richardson %A Gary E Rosenthal %A Robert B Wallace %X

BACKGROUND: In a nationally representative sample of United States Medicare beneficiaries, we examined the extent of chiropractic use, factors associated with seeing a chiropractor, and predictors of the volume of chiropractic use among those having seen one.

METHODS: We performed secondary analyses of baseline interview data on 4,310 self-respondents who were 70 years old or older when they first participated in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). The interview data were then linked to their Medicare claims. Multiple logistic and negative binomial regressions were used.

RESULTS: The average annual rate of chiropractic use was 4.6%. During the four-year period (two years before and two years after each respondent's baseline interview), 10.3% had one or more visits to a chiropractor. African Americans and Hispanics, as well as those with multiple depressive symptoms and those who lived in counties with lower than average supplies of chiropractors were much less likely to use them. The use of chiropractors was much more likely among those who drank alcohol, had arthritis, reported pain, and were able to drive. Chiropractic services did not substitute for physician visits. Among those who had seen a chiropractor, the volume of chiropractic visits was lower for those who lived alone, had lower incomes, and poorer cognitive abilities, while it was greater for the overweight and those with lower body limitations.

CONCLUSION: Chiropractic use among older adults is less prevalent than has been consistently reported for the United States as a whole, and is most common among Whites, those reporting pain, and those with geographic, financial, and transportation access.

%B Chiropr Osteopat %I 15 %V 15 %P 12 %8 2007 Sep 06 %G eng %L newpubs20090908/Wolinskyetal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17822549?dopt=Abstract %2 PMC2034378 %4 Chiropractic/Health Care Utilization/Medicare %$ 20280 %R 10.1186/1746-1340-15-12 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Weight and depressive symptoms in older adults: direction of influence? %A Valerie L Forman-Hoffman %A Jon W. Yankey %A Stephen L Hillis %A Robert B Wallace %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cohort Studies %K Comorbidity %K Depressive Disorder %K Female %K Health Status Indicators %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Models, Statistical %K Odds Ratio %K Prospective Studies %K Sex Factors %K Statistics as Topic %K United States %K Weight Gain %K Weight Loss %X

OBJECTIVE: . The purpose of this study was to clarify the direction of the relationship between changes in depressive symptoms and changes in weight in older adults. Methods. The sample included a prospective cohort of individuals aged 53-63 (n = 9,130) enrolled in the Health and Retirement Study. We used separate cross-lagged models for men and women in order to study the impact of weight change on subsequent increases in depressive symptoms 2 years later and vice versa.

RESULT: . Weight gain did not lead to increased depressive symptoms, and weight loss preceded increased depressive symptoms only in unadjusted models among men (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.04-1.53). Increased depressive symptoms were not predictive of subsequent weight loss, but they were predictive of subsequent weight gain in unadjusted models only (men: OR = 1.24, 95% CI = 1.00-1.54; women: OR = 1.12, 95% CI = 1.00-1.26). In adjusted models, baseline depressive symptoms predicted both weight loss and weight gain among both men and women. Increase in functional limitations and medical conditions were significant predictors of both weight loss and weight gain. Baseline functional limitations also predicted increased depressive symptoms. Discussion. Based on our findings, it is apparent that researchers need to examine the pathways between changes in weight and increases in depressive symptoms in the context of functional limitations and medical comorbidity.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S43-51 %8 2007 Jan %G eng %N 1 %L newpubs20070403_Forman-Hoffman_etal %1 http://www.ncbi.nlm.nih.gov/pubmed/17284566?dopt=Abstract %4 Weight/Depressive Symptoms %$ 17260 %R 10.1093/geronb/62.1.s43 %0 Journal Article %J Demography %D 2007 %T What a drop can do: dried blood spots as a minimally invasive method for integrating biomarkers into population-based research. %A Thomas W McDade %A Sharon Williams %A J Josh Snodgrass %K Biomarkers %K Blood Specimen Collection %K Humans %K Phlebotomy %K Preservation, Biological %X

Logistical constraints associated with the collection and analysis of biological samples in community-based settings have been a significant impediment to integrative, multilevel bio-demographic and biobehavioral research. However recent methodological developments have overcome many of these constraints and have also expanded the options for incorporating biomarkers into population-based health research in international as well as domestic contexts. In particular using dried blood spot (DBS) samples-drops of whole blood collected on filter paper from a simple finger prick-provides a minimally invasive method for collecting blood samples in nonclinical settings. After a brief discussion of biomarkers more generally, we review procedures for collecting, handling, and analyzing DBS samples. Advantages of using DBS samples-compared with venipuncture include the relative ease and low cost of sample collection, transport, and storage. Disadvantages include requirements for assay development and validation as well as the relatively small volumes of sample. We present the results of a comprehensive literature review of published protocols for analysis of DBS samples, and we provide more detailed analysis of protocols for 45 analytes likely to be of particular relevance to population-level health research. Our objective is to provide investigators with the information they need to make informed decisions regarding the appropriateness of blood spot methods for their research interests.

%B Demography %I 44 %V 44 %P 899-925 %8 2007 Nov %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/18232218?dopt=Abstract %3 18232218 %4 Diabetes/Dried blood spot/Dried blood spot/biomarkers/Methodology %$ 69618 %R 10.1353/dem.2007.0038 %0 Journal Article %J Journal of the American Geriatrics Society %D 2007 %T What Level of Alcohol Consumption Is Hazardous for Older People? Functioning and Mortality in U.S. and English National Cohorts %A Iain A Lang %A Jack M. Guralnik %A Robert B Wallace %A David Meltzer %K Cross-National %K Health Conditions and Status %K Methodology %X OBJECTIVES: To estimate disability plus mortality risks in older people according to level of alcohol intake. DESIGN: Two population-based cohort studies. SETTING: The Health and Retirement Study (United States) and the English Longitudinal Study of Aging (England). PARTICIPANTS: Thirteen thousand three hundred thirtythree individuals aged 65 and older followed for 4 to 5 years. MEASUREMENTS: Difficulties with activities of daily living (ADLs), instrumental activities of daily living (IADLs), poor cognitive function, and mortality. RESULTS: One-tenth (10.8 ) of U.S. men, 28.6 of English men, 2.9 of U.S. women, and 10.3 of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older. Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 (95 confidence interval (CI)50.8 1.2) for ADL problems, 0.7 (95 CI50.6 1.0) for IADL problems, and 0.8 (95 CI5 0.6 1.1) for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women. CONCLUSION: Functioning and mortality outcomes in older people with alcohol intakes above U.S. recommended levels for the old but within recommendations for younger adults are not poor. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day. %B Journal of the American Geriatrics Society %I 55 %V 55 %P 49- %G eng %N 1 %L newpubs20070125Lang_etal_JAGS %4 ADL and IADL Impairments/Alcohol Drinking/Cross Cultural Comparison/aging/ELSA_/cross-national comparison %$ 16930 %R 10.1111/j.1532-5415.2006.01007.x %0 Report %D 2007 %T Why Do Married Men Claim Social Security Benefits So Early? Ignorance or Caddishness? %A Anthony Webb %A Wei Sun %A Sass, Steven A. %K Social Security %K Social Security Benefits %X Most married men claim Social Security benefits at age 62 or 63, well short of both Social Security’s Full Retirement Age and the age that maximizes the household’s expected present value of benefits (EPVB). This results in a loss of less than 4 percent in household EPBV. But essentially the entire loss is borne by the survivor benefit, falls nearly 20 percent. As many elderly widows have very low incomes, early claiming by married men is a major social problem. Regression results found no association between early claiming and caddishness or the ability of husbands to make claiming decisions independently. The one statistically significant finding is the association of college education and later claiming, which cautiously take to indicate greater financial awareness. This suggests that an effective educational campaign might be able to raise the claiming ages of married men and improve widows’ retirement income security. But financial education has not been especially effective in changing behavior. Policymakers should thus consider other initiatives to assure a survivor benefit greater than that produced by an age 62 or 63 husbands’ claiming age. Such initiatives include raising the Earliest Eligibility Age, requiring spousal consent for claiming prior to the Full Retirement Age, and preserving the survivor benefit at its Full Retirement Age value and allowing the higher-earning spouse to access only a portion of his (or her) Primary Insured Amount prior to the Full Retirement Age. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/why-do-married-men-claim-social-security-benefits-so-early-ignorance-or-caddishness/ %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 Report %D 2006 %T Determinants and Consequences of Bargaining Power in Households %A Friedberg, Leora %A Anthony Webb %K Adult children %K End of life decisions %X A growing literature offers indirect evidence that the distribution of bargaining power within a household influences decisions made by the household. These results undermine the notion that a household can be treated as a unitary decision maker. The indirect evidence links household outcomes to variables that are assumed to influence the distribution of bargaining power within the household. In this paper, we have data on whether a husband or wife in the Health and Retirement Study has the final say when making major decisions in a household. We use this variable to analyze determinants and some consequences of bargaining power. Our analysis overcomes endogeneity problems arising in many earlier studies and constitutes the missing link confirming the importance of household bargaining models. %I Boston College, Center for Retirement Research at Boston College %G eng %U http://www.bc.edu//centers/crr %L wp_2006/CRRwp2006-13.pdf %4 household behavior/Decision Making %$ 16660 %0 Journal Article %J Journal of Health and Social Behavior %D 2006 %T Does Caregiving Increase Poverty among Women in Later Life? Evidence from the Health and Retirement Survey %A Chizuko Wakabayashi %A Donato, Katharine M. %K Healthcare %K Income %K Women and Minorities %X Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women's subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women's risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women's poverty risks in later life by intensifying the negative effects of stopping work and declining health on women's economic well-being. %B Journal of Health and Social Behavior %I 47 %V 47 %P 258-74 %G eng %N 3 %L pubs_2006_Wakabayashi.pdf %4 Caregiving/WOMEN/Poverty %$ 16920 %0 Journal Article %J BMC Health Serv Res %D 2006 %T Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes? %A Frederic D Wolinsky %A Thomas R Miller %A An, Hyonggin %A Paul R Brezinski %A Thomas E Vaughn %A Gary E Rosenthal %K Aged %K Aged, 80 and over %K Deductibles and Coinsurance %K Episode of Care %K Health Services Research %K Hospitals, Veterans %K Humans %K Male %K Medicare %K Mortality %K Outcome Assessment, Health Care %K Proportional Hazards Models %K Quality Indicators, Health Care %K Risk Assessment %K Selection Bias %K Surveys and Questionnaires %K United States %K United States Department of Veterans Affairs %K Veterans %X

BACKGROUND: Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.

METHODS: Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.

RESULTS: 96 (11%) of the veterans were classified as dual users. 766 men (50.3%) had died by December 31, 2002, including 64.9% of the dual users and 49.3% of all others, for an attributable mortality risk of 15.6% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1% increased relative risk of mortality (AHR = 1.561; p = .009).

CONCLUSION: An indirect measure of veterans' dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.

%B BMC Health Serv Res %I 6 %V 6 %P 131 %8 2006 Oct 09 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/17029643?dopt=Abstract %2 PMC1617101 %4 Veterans: statistics/numerical/Medicare/public Policy/Mortality %$ 24990 %R 10.1186/1472-6963-6-131 %0 Journal Article %J J Am Geriatr Soc %D 2006 %T Functional impairment, race, and family expectations of death. %A Brie A Williams %A Lindquist, Karla %A Sandra Y. Moody-Ayers %A Louise C Walter %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Attitude to Death %K Black or African American %K Cross-Sectional Studies %K Disabled Persons %K Family %K Female %K Hispanic or Latino %K Humans %K Male %K White People %X

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

DESIGN: Cross-sectional.

SETTING: Community based.

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

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

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

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

%B J Am Geriatr Soc %I 54 %V 54 %P 1682-7 %8 2006 Nov %G eng %N 11 %L newpubs20101112_Willams2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17087694?dopt=Abstract %4 Activities of Daily Living/Minorities/Hispanic/African Americans/functional impairment/expectations/death %$ 23640 %R 10.1111/j.1532-5415.2006.00941.x %0 Journal Article %J Health Services Research %D 2006 %T Health Insurance and Health at Age 65: Implications for medical care spending on new Medicare beneficiaries %A Hadley, J. %A Timothy A Waidmann %K End of life decisions %K Healthcare %K Insurance %K Medicare/Medicaid/Health Insurance %K Other %X Objectives. To investigate the consequences of endogeneity bias on the estimated effect of having health insurance on health at age 63 or 64, just before most people qualify for Medicare, and to simulate the implications for total and public insurance (Medicare and Medicaid) spending on newly enrolled beneficiaries in their first years of Medicare coverage. . Data. The longitudinal Health and Retirement Survey of people who were 55-61 years old in 1992, followed through biannual surveys to age 63-64 or until 2000 (whichever came first), and those who were 66-70 years olds from the Medicare Current Beneficiary Surveys, 1992-1998. . Study Design. Instrumental variable (IV) estimation of a simultaneous equation model of insurance choice and health at age 63-64 as a function of baseline health and sociodemographic characteristics in 1992 and endogenous insurance coverage over the observation period. . Findings. Continuous insurance coverage is associated with significantly fewer deaths prior to age 65 and, among those who survive, a significant upward shift in the distribution of health states from fair and poor health with disabilities to good to excellent health. Treating insurance coverage as endogenous increases the magnitude of the estimated effect of having insurance on improved health prior to age 65. The medical spending simulations suggest that if the near-elderly had continuous insurance coverage, average annual medical spending per capita for new Medicare beneficiaries in their first few years of coverage would be slightly lower because of the improvement in health status. In addition, total Medicare and Medicaid spending for new beneficiaries over their first few years of coverage would be about the same or slightly lower, even though more people survive to age 65. Conclusions. Extending insurance coverage to all Americans between the ages of 55 and 64 would improve health (increase survival and shift people from good-fair-poor health to excellent-very good health) at age 65, and possibly reduce total short-term spending by Medicare and Medicaid for newly eligible Medicare beneficiaries, even though more people would enter the program because of increased survival. %B Health Services Research %I 41 %V 41 %P 429 -451 %G eng %N 2 %L pubs_2006_Hadley.pdf %4 insurance/health outcomes/Medicare and Medicaid spending/IV analysis/INSTRUMENTS/SERVICES/COVERAGE/DECLINE %$ 15870 %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 Report %D 2006 %T Lifecycle Asset Allocation Strategies and the Distribution of 401(k) Retirement Wealth %A James M. Poterba %A Joshua Rauh %A Steven F Venti %A David A Wise %K Wealth %X This paper examines how different asset allocation strategies over the course of a worker's career affect the distribution of retirement wealth and the expected utility of wealth at retirement. It considers both rules that allocate a constant portfolio fraction to various assets at all ages, as well as "lifecycle" rules that vary the mix of portfolio assets as the worker ages. The analysis simulates retirement wealth using asset returns that are drawn from the historical return distribution. The results suggest that the distribution of retirement wealth associated with typical lifecycle investment strategies is similar to that from age-invariant asset allocation strategies that set the equity share of the portfolio equal to the average equity share in the lifecycle strategies. There is substantial variation across workers with different characteristics in the expected utility from following different asset allocation strategies. The expected utility associated with different 401(k) asset allocation strategies, and the ranking of these strategies, is very sensitive to three parameters: the expected return on corporate stock, the worker's relative risk aversion, and the amount of non-401(k) wealth that the worker will have available at retirement. At modest levels of risk aversion, or in the presence of substantial non-401(k) wealth at retirement, the historical pattern of stock and bond returns implies that the expected utility of an all-stock investment allocation rule is greater than that from any of the more conservative strategies. Higher risk aversion or lower expected returns on stocks raise the expected utility of following lifecycle strategies or other strategies that reduce equity exposure throughout the lifetime. %B NBER Working Paper %I The National Bureau of Economic Research %C Washington, D.C. %G eng %R 10.3386/w11974 %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 Research on Aging %D 2006 %T Military Service and (Dis)Continuity in the Life Course: Evidence on Disadvantage and Mortality from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest Old %A Andrew S London %A Janet M Wilmoth %K Demographics %K Event History/Life Cycle %K Health Conditions and Status %X This study uses a life-course framework and data from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest-Old to examine three hypotheses related to (dis)continuity in the effects of early-life disadvantage (African American race and low paternal education) and military service on later-life mortality. Specifically, the authors consider whether military service (and age at enlistment) mediates or moderates the effects of early-life disadvantage on later-life mortality and whether mid- to late-life marital status, socioeconomic status, health status, and health behaviors mediate the effects of military service on mortality. The authors find very little evidence to support the notion that any mortality benefits accrue to men as a consequence of military service overall or enlistment at any particular age. Most of the evidence is consistent with life-course disruption and continuity of disadvantage interpretations. %B Research on Aging %I 28 %V 28 %P 135 %G eng %N 1 %L pubs_2006_MilServ_RA.pdf %4 Life Events/mortality/socioeconomic status %$ 15990 %0 Report %D 2006 %T A New National Retirement Risk Index %A Alicia H. Munnell %A Anthony Webb %A Delorme, Luke %K Methodology %K Public Policy %K Retirement Planning and Satisfaction %X Americans weaned on post-war affluence have come to expect an extended period of leisure at the end of their work life. And, indeed, the majority of today s retirees are able to afford a decent retirement. However, this group is living in a golden age that will fade as Baby Boomers and Generation Xers reach traditional retirement ages in the coming decades. This gloomy prediction reflects the trend towards longer retirements and likely declines in retirement incomes relative to pre-retirement earnings known as replacement rates. Because many Americans appear unaware of these disquieting trends, the Center for Retirement Research at Boston College has developed the National Retirement Risk Index. The Index measures the share of working-age households who are at risk of being unable to maintain their pre-retirement standard of living in retirement. %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/briefs/a-new-national-retirement-risk-index/ %4 retirement planning/Public Policy/National Retirement Risk Index/National Retirement Risk Index %$ 62680 %0 Journal Article %J The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 2006 %T Parent Care and the Stress Process: Findings from panel data %A Amirkhanyan, Anna A. %A Douglas A. Wolf %K Health Conditions and Status %K Healthcare %X OBJECTIVE: The purpose of this study was to test with panel data an extended model of the stress process recognizing the separate effects of a parent's need for care and an adult child's caring activities. Methods. Using data from the 1996, 1998, and 2000 waves of the Health and Retirement Study, we estimated nonlinear mixed models of mental health outcomes. We assessed mental health for separate samples of 3,350 men and 3,659 women by using an 8-item scale of depressive symptoms. We also explored the sensitivity of results to alternative measures and model specifications. RESULT: . We found that female, but not male, caregivers whose parents needed care exhibited adverse mental health consequences. However, we found that, generally, both male and female noncaregivers whose parents needed care were more likely to report symptoms of depression than were noncaregivers without disabled parents. Additional findings suggest that the stress process is still more complex among married couples. Discussion. This study distinguishes the outcomes of parental care needs from those attributable to caregiving activities. Adverse psychological outcomes appear to be dispersed throughout the family. To focus narrowly on active caregivers is to underestimate the social burdens of disability at older ages. %B The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %I 61 %V 61 %P S248-55 %G eng %U http://psychsoc.gerontologyjournals.org/contents-by-date.2006.shtml %N 5 %L pubs_2006_JoG_S248.pdf %4 Caregivers/Stress Psychology %$ 13902 %0 Report %D 2006 %T Probabilistic Thinking and Early Social Security Claiming %A Delavande, Adeline %A Michael M. Perry %A Robert J. Willis %K Methodology %K Retirement Planning and Satisfaction %K Social Security %X This study analyzes the extent to which an individual.s survival expectations influence his or her decision to claim social security benefits at an early age. We find that subjective survival probabilities capture meaningful behavioral responses to incentives for early Social Security claiming when they are purged of measurement error using risk factors as instruments. Among people who are still working at age 62, those who expect to live longer are likely to delay claiming of Social Security benefits to a degree that is both statistically and economically significant. %I The University of Michigan, Michigan Retirement Research Center %G eng %U http://www.mrrc.isr.umich.edu/publications/papers/ %L newpubs20070125_Delavande_etal_2006 %4 Probability/Social Security benefit claiming/Early Retirement %$ 17000 %0 Report %D 2006 %T A Profile of Frail Older Americans and their Caregivers %A Joshua M Wiener %A Richard W. Johnson %K Health Conditions and Status %K Healthcare %I Washington, DC, The Urban Institute %G eng %U http://www.urban.org/UploadedPDF/311284_older_americans.pdf %L wp_2006/UrbanInst_Profile.pdf %4 Frail Elderly/Caregivers %$ 15780 %0 Journal Article %J Gerontologist %D 2006 %T Reported expectations for nursing home placement among older adults and their role as risk factors for nursing home admissions. %A Adaeze B Akamigbo %A Frederic D Wolinsky %K Age Factors %K Aged %K Female %K Health Status %K Homes for the Aged %K Humans %K Male %K Nursing homes %K Patient Admission %K Risk Factors %K Sex Factors %K Social Support %K Socioeconomic factors %X

PURPOSE: Individual expectations among community-dwelling older adults and their subsequent effect on placement status have recently been considered. Previous studies, however, have been limited by eligibility and exclusion criteria, treating expectations as a continuous measure, omitting potential confounders, and ignoring Race x Gender interactions.

DESIGN AND METHODS: We used data on 6,242 Black or White self-respondents who were 70 years old or older when they were enrolled in the survey of Assets and Health Dynamics Among the Oldest Old. We modeled expectations for nursing home placement over the next 5 years, as well as actual placement status, by using multivariable multinomial and binomial logistic regression models.

RESULTS: Expectations are not normally distributed: 14% of the participants refused to answer, 51% estimated no chance, 10% indicated a 1% to 50% chance, 21% indicated an 11% to 50% chance and 4% indicated a 51% to 100% chance. Age, gender, education, social supports, and health status were associated with expectations, as well as an interaction effect for Black men. Age, social supports, health status, prior hospital or nursing home use, and expectations were associated with subsequent placement.

IMPLICATIONS: Black and White older adults' expectations for nursing home placement rationally reflect their individual risk profiles and are associated with subsequent placement status. The expectations question may facilitate the early identification of high-risk individuals for further evaluation.

%B Gerontologist %I 46 %V 46 %P 464-73 %8 2006 Aug %G eng %N 4 %L newpubs20071203_Akamigbo.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16921000?dopt=Abstract %R 10.1093/geront/46.4.464 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2006 %T Social status, risky health behaviors, and diabetes in middle-aged and older adults. %A Linda A. Wray %A Duane F. Alwin %A Ryan J McCammon %A Manning, Timothy %A Best, Latrica E. %K Aged %K Body Mass Index %K Diabetes Mellitus %K Female %K Follow-Up Studies %K Health Behavior %K Humans %K Incidence %K Male %K Middle Aged %K Prevalence %K Risk-Taking %K Social Behavior %K Social Class %K Surveys and Questionnaires %X

OBJECTIVE: This article investigates: (a) how social status influences diabetes prevalence and incidence; (b) how risky health behaviors contribute to the prediction of incident diabetes; (c) if the effects of health behaviors mediate the effects of social status on incident diabetes; and (d) if these effects differ in midlife and older age.

METHODS: We examined nationally representative data from the 1992/1993-1998 panels of the Health and Retirement Study for middle-aged and older adults using logistic regression analyses.

RESULT: The odds of prevalent diabetes were higher for people of older age, men, Black adults, and Latino adults. Higher early-life social status (e.g., parental schooling) and achieved social status (e.g., respondent schooling, economic resources) reduced the odds in both age groups. We observed similar patterns for incident diabetes in midlife but not in older age. Risky health behaviors--particularly obesity--increased the odds of incident diabetes in both age groups independent of social status. The increased odds of incident diabetes in midlife persisted for Black and Latino adults net of other social status factors.

DISCUSSION: Risky health behaviors are key predictors of incident diabetes in both age groups. Economic resources also play an important protective role in incident diabetes in midlife but not in older age.

%B J Gerontol B Psychol Sci Soc Sci %I 61B %V 61 %P S290-8 %8 2006 Nov %G eng %N 6 %L newpubs20070125_Wray_etal_JOG %1 http://www.ncbi.nlm.nih.gov/pubmed/17114308?dopt=Abstract %4 Health Insurance/mortality/health behaviors/diabetes %$ 16970 %R 10.1093/geronb/61.6.s290 %0 Thesis %D 2006 %T Three Essays in Public Economics %A Wu, Binzhen %K Consumption and Savings %K Medicare/Medicaid/Health Insurance %K Methodology %K Net Worth and Assets %X The first essay uses the policy changes surrounding the 1992 Amendments to the Higher Education Act (HEA92) to examine the effects that the implicit financial-aid tax has on household saving behavior, particularly on portfolio choices. The empirical results show that the financial-aid tax does not significantly affect the total level of wealth. However, families significantly adjust their portfolio composition to avoid the tax. In addition, families seem to lack knowledge about financial-aid rules if they have not experienced with the financial-aid applications. Even if families know the rules, they do not change assets in response to the financial-aid tax if they face no imminent taxation. This second essay uses the policy changes surrounding the 1992 Amendments to the Higher Education Act (HEA92) to examine the reasons for which families have borrowed much more after the HEA92 increased the loan limits on subsidized and unsubsidized student loans. I find that the loan-limit changes do not significantly affect education investments. However, families significantly reduce some other financial instruments used to finance students' higher education, including loans from parents, parents' direct contributions, working while in school, and work-study aid. The third essay uses the Health and Retirement Study to study the effects of group health insurance on women's retirement decisions. I find the availability of alternative group health insurance, including retiree health insurance and spousal health insurance, significantly increases the retirement hazard and decreases retirement age for women. Married women are much more sensitive to the availability of spousal health insurance than to retiree health insurance. Medicare also has significant effect on women' retirement behavior. %I The University of Wisconsin - Madison %C United States -- Wisconsin %8 2006 %G eng %4 Economics %$ 17530 %0 Thesis %D 2006 %T Three Essays on Elderly Migration and Local Fiscal Policy %A Woo, Seokjin %K Demographics %K Public Policy %K Retirement Planning and Satisfaction %X The first essay develops a retirement migration model using a nested logit (NL) specification. The dichotomous nest structure is constructed based on States' average temperature; Sunbelt nest and Non-sunbelt nest. The estimation results from the census 2000 reveal two interesting facts. First, the Multinomial-logit model and the NL retirement migration model agree on which state tax policy is an important determinant of interstate migration of retirees in terms of the magnitude and statistical significance of the coefficient. Second, the migration patterns predicted by the MNL-based model tend to be under-estimated, compared to the NL retirement migration model. Second essay develops a retirement migration model based on the random coefficient specification to investigate the effect of individual heterogeneity on migration decisions of retirees. The estimation results from the census 2000 reveal three interesting facts regarding the effect of individual heterogeneity on migration decisions. First, income and housing value of retirees interact negatively with income tax and property tax, respectively. Second, warm winter interacts positively with health condition and education level, and negatively with home ownership. Third, retirees are heterogeneous regarding the degree to which they appreciate warm winter. Third essay develops a stochastic dynamic programming discrete choice model which explains the sequence of migration and retirement decisions of older workers in the United States. The structural parameters of the model are estimated using the panel data from the Health and Retirement Study for the households whose heads worked in 1992. This paper contributes to the elderly migration literature in the following three aspects. First, it examines the migration decisions of older workers approaching retirement, an age group whose migration behavior has rarely been investigated. Second, including retirement decision in the model allows me to investigate the interaction between retirement and migration decisions. Third, this is the first study which estimates a stochastic dynamic programming discrete choice model for elderly migration. I find that the differentials in local fiscal policy across U.S. states affect the decision of where-to-move conditioning on moving, but does not affect the decision of whether-to-move to any significant extent. %I The University of Wisconsin - Madison %8 2006 %G eng %4 Fiscal policy %$ 17740 %! Three Essays on Elderly Migration and Local Fiscal Policy %0 Journal Article %J J Aging Health %D 2006 %T The tide to come: elderly health in Latin America and the Caribbean. %A Alberto Palloni %A Mary McEniry %A Rebeca Wong %A Pelaez, M. %K Aged %K Aged, 80 and over %K Caribbean Region %K Child %K Diabetes Mellitus %K Forecasting %K Health Status %K Heart Diseases %K Humans %K Latin America %K Malnutrition %K Middle Aged %K Mortality %K Nutritional Status %K United States %X

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status' connection to early conditions has some merit.

%B J Aging Health %I 18 %V 18 %P 180-206 %8 2006 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/16614340?dopt=Abstract %4 childhood conditions/diabetes/heart disease/Latin America/health/health outcomes/nutritional status/mortality/STATURE PREDICTION EQUATIONS/ADULT HEALTH/CHILDHOOD/MORTALITY/GROWTH/MORBIDITY/DYNAMICS/FRAILTY/IMPACT %$ 15970 %R 10.1177/0898264305285664 %0 Journal Article %J Am J Epidemiol %D 2006 %T Urban neighborhood context, educational attainment, and cognitive function among older adults. %A Richard G Wight %A Carol S Aneshensel %A Miller-Martinez, Dana %A Amanda L. Botticello %A Janet R. Cummings %A Arun S Karlamangla %A Teresa Seeman %K Aged %K Aged, 80 and over %K Chi-Square Distribution %K Cognition Disorders %K Educational Status %K Female %K Humans %K Linear Models %K Male %K Residence Characteristics %K Risk Factors %K Socioeconomic factors %K United States %K Urban Population %X

Existing research has not addressed the potential impact of neighborhood context--educational attainment of neighbors in particular--on individual-level cognition among older adults. Using hierarchical linear modeling, the authors analyzed data from the 1993 Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a large, nationally representative sample of US adults born before 1924. Data from participants residing in urban neighborhoods (n = 3,442) were linked with 1990 US Census tract data. Findings indicate that 1) average cognitive function varies significantly across US Census tracts; 2) older adults living in low-education areas fare less well cognitively than those living in high-education areas, net of individual characteristics, including their own education; 3) this association is sustained when controlling for contextual-level median household income; and 4) the effect of individual-level educational attainment differs across neighborhoods of varying educational profiles. Promoting educational attainment among the general population living in disadvantaged neighborhoods may prove cognitively beneficial to its aging residents because it may lead to meliorations in stressful life conditions and coping deficiencies.

%B Am J Epidemiol %I 163 %V 163 %P 1071-8 %8 2006 Jun 15 %G eng %N 12 %L pubs_2006_WightAJE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16707655?dopt=Abstract %4 Cognition/EDUCATION/Socioeconomic Factors %$ 16570 %R 10.1093/aje/kwj176 %0 Journal Article %J J Soc Work End Life Palliat Care %D 2006 %T The validation of the Texas revised inventory of grief on an older Latino sample. %A Wilson, Steve %K Aged %K Aged, 80 and over %K Bereavement %K Culture %K Factor Analysis, Statistical %K Female %K Grief %K Hispanic or Latino %K Humans %K Male %K Middle Aged %K Psychometrics %K Reproducibility of Results %K Socioeconomic factors %K Surveys and Questionnaires %K Texas %X

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

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

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

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

%B J Soc Work End Life Palliat Care %V 2 %P 33-60 %8 2006 %G eng %N 4 %R 10.1300/j457v02n04_03 %0 Journal Article %J Neuroepidemiology %D 2005 %T The Aging, Demographics and Memory Study: Study Design and Methods %A Kenneth M. Langa %A Brenda L Plassman %A Robert B Wallace %A A. Regula Herzog %A Steven G Heeringa %A Mary Beth Ofstedal %A James F. Burke %A Gwenith G Fisher %A Fultz, Nancy H. %A Michael D Hurd %A Guy G Potter %A Willard L Rodgers %A David C Steffens %A David R Weir %K Health Conditions and Status %K Healthcare %X Objective: We describe the design and methods of the Aging, Demographics, and Memory Study (ADAMS), a new national study that will provide data on the antecedents, prevalence, outcomes, and costs of dementia and cognitive impairment, not demented (CIND) using a unique study design based on the nationally representative Health and Retirement Study (HRS). We also illustrate potential uses of the ADAMS data and provide information to interested researchers on obtaining ADAMS and HRS data. Methods: The ADAMS is the first population-based study of dementia in the United States to include subjects from all regions of the country, while at the same time using a single standardized diagnostic protocol in a community-based sample. A sample of 856 individuals aged 70 or older who were participants in the on-going HRS received an extensive in-home clinical and neuropsychological assessment to determine a diagnosis of normal, CIND, or dementia. Within the CIND and dementia categories, subcategories (e.g., Alzheimer disease, vascular dementia) were assigned to denote the etiology of cognitive impairment. Conclusion: Linking the ADAMS dementia clinical assessment data to the wealth of available longitudinal HRS data on health, health care utilization, informal care, and economic resources and behavior, will provide a unique opportunity to study the onset of CIND and dementia in a nationally-representative population-based sample, as well as the risk factors, prevalence, outcomes, and costs of CIND and dementia. %B Neuroepidemiology %I 25 %V 25 %P 181-191 %G eng %L pubs_2005_Neuroepidemiology.pdf %4 Aging/Dementia/Epidemiology %$ 13302 %0 Book Section %B Analyses in the Economics of Aging %D 2005 %T Comment: Broken Down by Work and Sex: How Our Health Declines %A Daniel McFadden %E David A Wise %K Health Conditions and Status %K Other %X Commentary on the Case and Deaton chapter, Broken Down by Work and Sex: How Our Health Declines, Using AHEAD data for comparison. %B Analyses in the Economics of Aging %I University of Chicago Press 2005 %C Chicago %G eng %4 Health Status/Subjective %$ 15580 %! Comment: Broken Down by Work and Sex: How Our Health Declines %0 Book Section %B Analyses in the Economics of Aging %D 2005 %T Consequences and Predictors of New Health Events %A James P Smith %E David A Wise %K Demographics %K Health Conditions and Status %X The emphasis in health research has been on understanding and disentangling the multiple ways in which socio-economic status may influence a variety of health outcomes. Consequently, much less is currently known about the impact health may have on SES. But at least for working-aged individuals, health feedbacks to labor supply, household income, and wealth may be quantitatively quite important. Therefore, one aim of this paper will be to estimate the effect of new health events on a series of subsequent outcomes that are both directly and indirectly related to SES. These outcomes will include out-of-pocket medical expenses, the intensive and extensive margins of labor supply, health insurance, and household income. %B Analyses in the Economics of Aging %I University of Chicago Press %C Chicago %G eng %U http://www.ifs.org.uk/publications.php %L wp_2003/smith_wp0322.pdf %4 Health/Socioeconomic Status %$ 14282 %! Consequences and Predictors of New Health Events %0 Journal Article %J Journal of the American Geriatrics Society %D 2005 %T Differences in Amount of Informal Care Received by Non-Hispanic Whites and Latinos in a Nationally Representative Sample of Older Americans %A Weiss, Carlos O. %A Hector M González %A Mohammed U Kabeto %A Kenneth M. Langa %K Healthcare %K Women and Minorities %X The objective of this study was to evaluate informal (unpaid) care and its broad determinants for Latinos in a nationally representative sample. A cross-sectional analysis of the 1993 Asset and Health Dynamics Study, a national probability sample of 7,443 older adults aged 70 and older, was performed to determine the independent effect of Latino ethnicity on the receipt of informal care by disabled older individuals. Self-reported race/ethnicity was used to predict the mean daily hours of informal care received for activity of daily living (ADL) or instrumental activity of daily living (IADL) assistance after adjustment for predisposing, need, and enabling variables. There was a significant association between informal home care and ethnic group, with 44.3 of Latinos receiving informal care, compared with 33.9 of African Americans and 24.6 of non-Hispanic whites (Po.001). After adjustment, Latinos received 11.0 weekly hours of informal care, compared with 7.5 hours for non-Hispanic whites and 6.3 hours for African Americans (Po.001). The results from this nationally representative sample indicate that Latinos receive significantly more hours of informal care on average than African Americans or non-Hispanic whites for ADL and IADL disability. Clinicians should be alert to the significant amount of informal care and possible associated strain in caregivers of older Latinos. %B Journal of the American Geriatrics Society %I 53 %V 53 %P 146-151 %G eng %N 1 %L pubs_2005_Weiss_etal.pdf %4 Hispanic Americans/Caregiving %$ 16030 %0 Book Section %B Analyses in the Economics of Aging %D 2005 %T Discussion of James Poterba, Joshua Rauh, Steven Venti and David Wise, Utility Evaluation of Risk in Retirement Savings Accounts %A Robert J. Willis %E David A Wise %K Net Worth and Assets %K Public Policy %K Retirement Planning and Satisfaction %K Risk Taking %B Analyses in the Economics of Aging %I University of Chicago Press %C Chicago %P 53 %G eng %4 retirement Planning/pension Wealth/risk Aversion/Stock Market/Public Policy %$ 23490 %! Discussion of James Poterba, Joshua Rauh, Steven Venti and David Wise, Utility Evaluation of Risk in Retirement Savings Accounts %0 Book Section %B Analyses in the Economics of Aging %D 2005 %T Discussion of Li Gan, Michael Hurd and Daniel McFadden, Individual Subjective Survival Curves %A Robert J. Willis %E David A Wise %K Expectations %K Methodology %B Analyses in the Economics of Aging %S NBER conference report %I University of Chicago Press %C Chicago %G eng %4 methodology/data Quality/survey response/subjective Probabilities %$ 23480 %! Discussion of Li Gan, Michael Hurd and Daniel McFadden, Individual Subjective Survival Curves %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2005 %T Disparities among older adults in measures of cognitive function by race or ethnicity. %A Frank A Sloan %A Wang, Jingshu %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Black or African American %K Case-Control Studies %K Cognition %K Cognition Disorders %K Cross-Sectional Studies %K Female %K Hispanic or Latino %K Humans %K Linear Models %K Longitudinal Studies %K Male %K Racial Groups %K United States %X

This study examined racial or ethnic differences in cognitive function, cross-sectionally and longitudinally, using survey data from the Asset and Health Dynamics Among the Oldest Old. A version of the Telephone Interview for Cognitive Status (TICS), proxy assessments of cognition, and difficulties in performing daily tasks were assessed. Blacks performed below Whites on the TICS at baseline and on proxy assessments of cognition. TICS score declined with age for Whites and Blacks, with some relative gains for Blacks. At baseline, Blacks more often had difficulties in performing daily tasks, with some increase in difficulties relative to Whites with age. Differences between other groups and Whites were smaller than those between Blacks and Whites.

%B J Gerontol B Psychol Sci Soc Sci %I 60B %V 60 %P P242-50 %8 2005 Sep %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/16131618?dopt=Abstract %4 Racial disparities/Cognitive Function/Elderly %$ 13852 %R 10.1093/geronb/60.5.p242 %0 Journal Article %J Social Science and Medicine %D 2005 %T Do Panel Surveys Make People Sick? U.S. Arthritis Trends in the Health and Retirement Study %A Sven E. Wilson %A Benjamin L. Howell %K Health Conditions and Status %K Methodology %X Researchers have long viewed large, longitudinal studies as essential for understanding chronic illness and generally superior to cross-sectional studies. In this study, we show that (1) age-specific arthritis prevalence in the longitudinal Health and Retirement Study (HRS) from the United States has risen sharply since its inception in 1992, and (2) this rise is almost surely spurious. In periods for which the data sets are comparable, we find no such increase in the crosssectional National Health Interview Survey (NHIS), the primary source for prevalence data of chronic conditions in the US. More important, the upward trend in the HRS is not internally consistent: even though prevalence in the HRS rises sharply between 1992 and 1996 for 55 56 year-olds, the prevalence for that age group plummets to its 1992 level among the new cohort added in 1998 and then rises rapidly again between 1998 and 2002. We discuss possible reasons for these discrepancies and demonstrate that they are not due to sample attrition in the HRS. %B Social Science and Medicine %I 60 %V 60 %P 2623-7 %G eng %N 11 %L pubs_2005_Wilson-Howell.pdf %4 Arthritis/Survey Methods %$ 13882 %0 Report %D 2005 %T Documentation of Chronic Disease Measures in the Health and Retirement Study %A Gwenith G Fisher %A Jessica Faul %A David R Weir %A Robert B Wallace %K Health Conditions and Status %K Healthcare %K Methodology %X The focus of this report is on (1) self-rated overall health status and recent changes in overall health, (2) the presence of common chronic medical conditions and follow-up questions concerning treatments in all waves of the core HRS/AHEAD through 2002. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 health Status/chronic Disease/health measures/Survey Methods %$ 14022 %0 Journal Article %J The Journals of Gerontology, Series A: Medical Sciences %D 2005 %T The Effect of Diabetes on Diability in Middle-Aged and Older Adults %A Linda A. Wray %A Mary Beth Ofstedal %A Kenneth M. Langa %A Caroline S Blaum %K Demographics %K Disabilities %K Health Conditions and Status %X Background. Physical disability is increasingly recognized as an adverse health consequence of type 2 diabetes in older adults. We studied the effect of diabetes on disability in middle-aged and older adults to: 1) characterize the association of diabetes with physical disability in middle-aged adults, and 2) determine the extent to which the effect of diabetes is explained by related covariates in either or both age groups. Methods. We used data from two parallel national panel studies of middle-aged and older adults to study the effect of self-reported diabetes at baseline on disability 2 years later, adjusting for baseline covariates. Results. Diabetes was strongly associated with subsequent physical disability (measured by a composite variable combining activities of daily living, mobility, and strength tasks) in middle-aged and older adults. Controlling for socioeconomic characteristics and common diabetes-related and unrelated comorbidities and conditions reduced the diabetes effect substantially, but it remained a significant predictor of disability in both groups. Conclusions. Our analyses demonstrated that disability is an important diabetes-related health outcome in middle-aged and older adults that should be prevented or mitigated through appropriate diabetes management. %B The Journals of Gerontology, Series A: Medical Sciences %I 60A %V 60A %P 1206-1211 %G eng %U http://biomedgerontology.oxfordjournals.org/content/60/9/1206.long %N 9 %L pubs_2005_Wray_etal.pdf %4 Diabetes/Disability/Disability/Middle Aged Adults %$ 13482 %R 10.1093/gerona/60.9.1206 %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 Journal Article %J The Gerontologist %D 2005 %T Epidemiologic studies on disability prevention - Perspectives from the English longitudinal study of ageing (ELSA) and the US health and retirement study %A David Melzer %A Jack M. Guralnik %A Robert B Wallace %K Demographics %K Healthcare %X An abstract of a study by Benjamin and Matthias examining client outcomes in several areas: service experience, safety, empowerment, unmet needs, service satisfaction, and quality of life is presented. Interpretation of the findings is complex; variations may be due to differences in quality of care or differences in perceptions shaped by cultural lenses. %B The Gerontologist %I 45 %V 45 %P 153 -154 %G eng %4 clinical outcomes/Home health care/Older people/Racial Differences %$ 15950 %0 Thesis %D 2005 %T Essays on Intergenerational Transfers %A Wang, Jingshu %K Adult children %K Healthcare %X Intergenerational transfers are an important economic phenomenon, with many aspects still unknown. Using national longitudinal data from the Health Retirement Study, this dissertation expands the issue of transfers into three other economic areas and offers new research angles and techniques. The first study investigates how recent welfare reforms affect childcare provision by grandparents. In general, parents of single mothers are found to spend more time with their grandchildren. Welfare reforms affect grandparents differently: for families who had been depending on grandparents for childcare, welfare reforms increase their reliance on this safety net. However, for families who did not have such a relationship with grandparents, there is no increase in the likelihood that they will start to use grandparents caring for their grandchildren after welfare reforms. As grandparents are usually the primary childcare providers next to center care, the finding that some families did not use grandparents for childcare raise the concern that these school-age children may not be receiving enough adult supervision. The second study estimates the price of time, i.e. the unit value people put on time doing certain activities. It finds that time spent on caregiving did not affect the value of time on leisure, indicating that caregiving was not treated in the same way as labor market work. It thus offers an explanation why previous studies find different relationship between these two decisions. Furthermore, the study provides a framework to simulate policies that compensate caregivers for their care provision. The simulation results show that such policies can increase the amount of caregivers and caregiving, with a low corresponding reduction in labor supply. The third study proposes new tests and evidence of the transfer motive, an important yet inconclusive question in the literature. It examines the key relationship on which the "exchange motive" model is built: whether a donor's behavior is affected by his own expectation of receiving an inheritance or intervivos transfers. The study finds that children's time transfers were positively associated with their expectation of intervivos transfers. They were found not to be affected by the expectation of receiving bequests. %I Duke University %8 2005 %G eng %4 Bequests %$ 15540 %! Essays on Intergenerational Transfers %0 Book Section %B Analyses in the Economics of Aging %D 2005 %T Healthy, Wealthy, and Knowing Where to Live: Trajectories of Health, Wealth, and Living Arrangements among the Oldest Old %A Florian Heiss %A Michael D Hurd %A Axel Borsch-Supan %E David A Wise %K Consumption and Savings %K Health Conditions and Status %K Net Worth and Assets %X There are many mechanisms that suggest that living arrangements and well-being derived from health and economic status are closely related. This paper investigates the joint evolution of the three conditions, using a microeconometric approach similar to what is known as vector autoregressions (VAR) in the macroeconomics literature. %B Analyses in the Economics of Aging %I University of Chicago Press %C Chicago %P 241-275 %G eng %L wp_2003/Heiss-Hurd-Supan_NBER9897.pdf %4 Health Status/Wealth/Living Standards %$ 11622 %+ NBER Working Paper 9897. Copies available from: National Bureau of Economic Research, 1050 Massachusetts Avenue,Cambridge, MA 02138. %! Healthy, Wealthy, and Knowing Where to Live: Trajectories of Health, Wealth, and Living Arrangements among the Oldest Old %R 10.3386/w9897 %0 Report %D 2005 %T HRS 2001 HUMS College Tuition Imputations %A Cao, Honggao %A John C Henretta %A Norgard, T.M. %A Beth J Soldo %A David R Weir %K Consumption and Savings %K Methodology %K Net Worth and Assets %X HRS 2001 Off-Year Mail Survey on Human Capital Investment (HRS 2001 HUMS) collected important information on the education of HRS respondents children. Among other things, the survey asked a selected set of HRS respondents to provide information about whether a child attended a two- or four-year undergraduate college, the total number of years in college(s), his or her age when he or she last attended college, and the name of the college that he or she last attended. One way to use the information is to produce college tuition data associated with each child, which can then be linked in an integrated analysis of family transfer with other family transfer information collected in the HRS core survey. In this document we describe what we have done in imputing HRS 2001 HUMS college tuitions. The general idea is to link the children college attendance information in HRS 2001 HUMS with a college tuition database (CASPAR) created and administered by the National Science Foundation. For 2000 and 2001, college cost data are also taken from the NCES IPEDS online database. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 imputations/methodology/human Capital/college tuition %$ 62890 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2005 %T The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life. %A Ye Luo %A Linda J. Waite %K Aged %K Aging %K Black People %K Child %K Cognition %K Cohort Studies %K Data collection %K Education %K ethnicity %K Female %K Health Status %K Hispanic or Latino %K Humans %K Income %K Male %K Mental Health %K Middle Aged %K Quality of Life %K Retirement %K Sex Factors %K Social Class %K White People %X

OBJECTIVES: To examine the relationships between socioeconomic status (SES) and health across the life course and their variations by gender and race/ethnicity.

METHODS: The sample included 19,949 respondents aged 50 or over from the 1998 Health and Retirement Study.

RESULTS: Lower childhood SES was associated with worse health outcomes in later life. Part of the effect of childhood SES on adult health occurred through childhood health. The impact of childhood SES on education and income in adulthood explained an even larger share of this effect. We also found a stronger effect of adult SES for those with lower childhood SES than for those with more advantaged childhoods. Moreover, childhood SES had a similar impact on health in later life for women and men and for Whites and non-Whites. However, college education seemed more important for women's later health, whereas income seemed more important for men's health. Education appeared to have a weaker effect on adult health for Blacks and Hispanics than for Whites.

DISCUSSION: Both childhood and adult SES are important for health. The negative impact of low childhood SES can be partially ameliorated if people from a low SES position during childhood mobilize to higher status in adulthood.

%B J Gerontol B Psychol Sci Soc Sci %I 60B %V 60 %P S93-S101 %8 2005 Mar %G eng %N 2 %L pubs_2005_luo_waite.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15746030?dopt=Abstract %2 PMC2505177 %4 Childhood/Socioeconomic Status/Well Being %$ 14232 %R 10.1093/geronb/60.2.s93 %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 Book Section %B Analyses in the Economics of Aging %D 2005 %T Individual Subjective Survival Curves %A Gan, Li %A Michael D Hurd %A Daniel McFadden %E David A Wise %K Expectations %X Testing life-cycle models and other economic models of saving and consumption at micro level requires knowledge of individuals' subjective believes of their mortality risk. Previous studies have shown that individual responses on subjective survival probabilities are generally consistent with life tables. However, survey responses suffer serious problems caused by focal responses of zero and one. This paper suggests using a Bayesian update model that accounts for the problems encountered in focal responses. We also propose models that help us to identify how much each individual deviates from life table in her subjective belief. The resulting individual subjective survival curves have considerable variations and are readily applicable in testing economic models that require individual subjective life expectancies. %B Analyses in the Economics of Aging %I University of Chicago Press %C Chicago %P 337-412 %G eng %U https://www.nber.org/chapters/c10367 %L wp_2003/Gan-Hurd-McFadden_NBER.pdf %4 Subjective Probabilities of Survival %$ 10032 %+ NBER Working Paper 6478. Copies available from: National Bureau of Economic Research, 1050Mass achusetts Avenue, Cambridge, MA 02138. Website: www.nber.org %& 12 %0 Book Section %B Analyses in the Economics of Aging %D 2005 %T Institutions and Saving for Retirement: Comparing the United States, Italy, and the Netherlands %A Arie Kapteyn %A Panis, Constantijn %E David A Wise %K Consumption and Savings %K Methodology %X This paper analyzes retirement saving and portfolio choice in the United States, Italy, and the Netherlands. In addition to relying on public retirement provisions, households prepare for retirement through tax-sheltered and after-tax savings. They may invest these funds in a wide variety of assets, including housing, stocks, bonds, savings accounts, and so on. These asset types differ in their risk, return, and liquidity characteristics as well as in their fiscal treatment. Economic theory postulates that housholds allocate their portfolios according to their risk aversion, time horizon, uncertain out-of-pocket medical expenditures, income risk, informal (family) risk-sharing arrangements, and more. While the literature has tested various parts of the theory, both testing and quantification of the theory are hampered by the fact that some of the major variables do not exhibit sufficient variation within a country to establish their relative importance for portfolio choice, or, more generally, for retirement saving and investment. This paper partially fills that gap by exploring three countries with widely varying institutional arrangements for retirement income. %B Analyses in the Economics of Aging %I University of Chicago Press %C Chicago %P 281-316 %G eng %U https://www.nber.org/chapters/c10364 %4 Cross Cultural Comparison/Retirement Saving %$ 13202 %& 9 %0 Book Section %B Aging, Health, and Public Policy: Demographic and Economic Perspectives %D 2005 %T Integrating Biology into the Study of Health Disparities %A Eileen M. Crimmins %A Teresa Seeman %E Linda J. Waite %K Methodology %B Aging, Health, and Public Policy: Demographic and Economic Perspectives %S Population and Development Review %I Population Council %C New York %V 30 %P 89-107 %G eng %4 Health Care Surveys %$ 14102 %6 (Suppl) %! Integrating Biology into the Study of Health Disparities %0 Journal Article %J Journal of Human Resources %D 2005 %T Retirement and the Evolution of Pension Structure %A Friedberg, Leora %A Anthony Webb %K Pensions %K Retirement Planning and Satisfaction %X Defined benefit pension plans have become considerably less common since the early 1980s, while defined contribution plans have spread. Previous research showed that defined benefit plans, with sharp incentives encouraging retirement after a certain point, contributed to the striking decline in American retirement ages. In this paper we find that the absence of age-related incentives in defined contribution plans leads workers to retire almost two years later on average, compared to workers with defined benefit plans. Thus, the evolution of pension structure can help explain recent increases in the typical retirement age, after decades of decline. %B Journal of Human Resources %I 40 %V 40 %P 281-308 %G eng %N 2 %4 Retirement Behavior/Pension Plans %$ 13172 %R 10.3368/jhr.XL.2.281 %0 Thesis %D 2005 %T A Slippery Slope: Essays on Income, Wealth, and the Health Gradient %A Wenzlow, Audra T. %K Health Conditions and Status %K Income %K Net Worth and Assets %X The relationship between health and socioeconomic status (SES), often called the health gradient, is a complex and perplexing research puzzle. Individuals with higher incomes tend to be healthier (although at a declining rate with higher income), yet it is unclear why this is so. Here, I argue that wealth and savings, largely neglected in past empirical work, provide important insights into the health-SES relationship. An empirical model in which income and wealth are transformed using the inverse hyperbolic sine is shown to capture important variations in health throughout the income and wealth distributions for U.S. working-age adults. The three-dimensional gradient in income, wealth, and health illustrates two patterns that are investigated in the following chapters: the predominance of poor health among those with little savings, and variations in health disparities by wealth over the life cycle. Panel data from the Health and Retirement Study are used to investigate a likely mode through which wealth may have a causal effect on health among the poor: through financial constraints that limit access to health care at the time of illness. I capitalize on recent research suggesting that income and wealth do not cause the onset of certain acute illnesses, conditional on past health. Viewing unexpected costs associated with such illnesses as financial shocks, I find that approximately one quarter of the population that experiences a stroke, cancer, heart problem, or high blood pressure has insufficient liquid assets to cover typical costs of unexpected medical care. Furthermore, this study suggests that a causal relationship between lack of savings and health recovery is plausible, possibly contributing to the steep slope of the gradient about zero. In the final chapter, I test a number of hypotheses that could account for the observed life cycle pattern of declining socioeconomic disparities in health in old age. I find that poor measurement of financial resources and possible cohort, Medicare, or retirement effects, but not attrition, are likely contributors to this phenomenon. Taking into account life-cycle patterns of income receipt and wealth decumulation, I find a large health gradient in wealth among the oldest old. %I The University of Wisconsin - Madison %8 2005 %G eng %4 Health Shocks %$ 15730 %! A Slippery Slope: Essays on Income, Wealth, and the Health Gradient %0 Report %D 2005 %T Social Security and the Retirement and Savings Behavior of Low Income Households %A van der Klaauw, Wilbert %A Wolpin, Kenneth I. %K Consumption and Savings %K Social Security %X In this paper, we develop and estimate a model of retirement and savings incorporating limited borrowing, stochastic wage offers, health status and survival, social security benefits, Medicare and employer provided health insurance coverage, and intentional bequests. The model is estimated on sample of relatively poor households from the first three waves of the Health and Retirement Study (HRS), for whom we would expect social security income to be of particular importance. The estimated model is used to simulate the responses to several counterfactual experiments corresponding to changes in social security rules. These include changes in benefit levels, in the payroll tax, in the social security earnings tax and in early and normal retirement ages. %I Penn Institute for Economic Research, University of Pennsylvania %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=719982 %L wp_2005_05-020.pdf %4 Retirement Saving/Social Security %$ 15070 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2005 %T Social status and risky health behaviors: results from the health and retirement study. %A Linda A. Wray %A Duane F. Alwin %A Ryan J McCammon %K Aged %K Aging %K Alcohol Drinking %K Body Weight %K Exercise %K Female %K Health Behavior %K Humans %K Life Style %K Likelihood Functions %K Logistic Models %K Longitudinal Studies %K Male %K Middle Aged %K Smoking %K Social Class %K United States %X

OBJECTIVES: We focus on a hypothesized mechanism that may underlie the well-documented link between social status and health-behavioral health risks.

METHODS: We use longitudinal data from representative samples of 6,106 middle-aged and 3,636 older adults from the Health and Retirement Study to examine the relationships between social status-including early life social status (e.g., parental schooling), ascribed social status (e.g., sex, race-ethnicity), and achieved social status (e.g., schooling, economic resources)-and behavioral health risks (e.g., weight, smoking, drinking, physical activity) to (1) assess how early life and ascribed social statuses are linked to behavioral health risks, (2) investigate the role of achieved factors in behavioral health risks, (3) test whether achieved status explains the contributions of early life and ascribed status, and (4) examine whether the social status and health risk relationships differ at midlife and older age.

RESULTS: We find that early life, achieved, and ascribed social statuses strongly predict behavioral health risks, although the effects are stronger in midlife than they are in older age.

DISCUSSION: Ascribed social statuses (and interactions of sex and race-ethnicity), which are important predictors of behavioral health risks even net of early life and achieved social status, should be explored in future research.

%B J Gerontol B Psychol Sci Soc Sci %I 60B %V 60 Spec No 2 %P 85-92 %8 2005 Oct %G eng %L pubs_2005_WrayAlwin.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16251597?dopt=Abstract %4 Social Stratification/Health Behaviors %$ 15420 %R 10.1093/geronb/60.special_issue_2.s85 %0 Book Section %B Aging, Health and Public Policy: Demographic and Economic Perspectives %D 2005 %T Survey Design and Methodology in the Health and Retirement Study and the Wisconsin Longitudinal Study %A Hauser, Robert M. %A Robert J. Willis %E Linda J. Waite %K Methodology %X Large-scale data collection has become the kernel of the growth of knowledge in the social sciences. Nowhere is this more evident than in research in the demography of aging and the life course, where scientific progress has been stimulated and sustained by complementary longitudinal studies of aging populations. In this chapter, we review the history, organization, and design of two of these public resources, the Wisconsin Longitudinal Study (WLS) and the Health and Retirement Study (HRS). Recent innovations in each of these studies hold promise for major advances in knowledge about the demography, economics, sociology, and epidemiology of aging. The stories of the WLS and HRS highlight important clues about the creation of systems of continuing surveys to inform science and public policy. %B Aging, Health and Public Policy: Demographic and Economic Perspectives %S Population and Development Review %I Population Council %C New York %V 30 %P 209-235 %G eng %L pubs_2005_PDR30supp.pdf %4 Survey Methods %$ 14012 %6 (Suppl) %! Survey Design and Methodology in the Health and Retirement Study and the Wisconsin Longitudinal Study %R 10.7826/isr-um.06.585031.001.05.0012.2005 %0 Thesis %D 2005 %T Three Essays on Retirement Wealth %A Walker, Lina %K Adult children %K Healthcare %K Housing %K Net Worth and Assets %X One of the central questions in economics is what motivates savings. This question is important for a number of reasons, one of which is it provide a benchmark for evaluating whether households are financially prepared for retirement. This is particularly relevant given the aging of the baby boom cohort, where the anticipated surge in the number of elderly persons could exert considerable pressure on the budgets of existing government programs. My dissertation includes three essays that focus on some of the current themes in the ongoing debate over the motivation for savings. The first essay focuses on the tendency among the elderly to hold onto their homes and examines whether this behavior is consistent with the notion that housing wealth is insurance against out-of-pocket medical expenses in retirement. I find that housing sales for single households is mostly driven by worsening health and it suggests that homeowners are selling because of a change in demand for housing services. Among married households, there are indications that some households are selling in order to access housing equity; however, the magnitude of the effect is very small. Taken together, the evidence does not lend much validity to the insurance story. The second essay examines the effect of uncertain nursing home expenses in retirement on savings behavior. Using differences in differences, I find that households with lower exposure to nursing home expenses accumulate lower retirement wealth. The results suggest that households are responsive to the incentives embedded in the Medicaid program and they are forward-looking in their savings decisions. The third essay focuses on the tendency among parents to leave equal inheritances to all their children. The paper examines the pattern of bequest giving and attempts to draw a picture of what motivates bequests. I find that the larger the differences among children, the more likely the decedent deviates from equal giving. These differences include differences in children's resources and differences in time assistance to parents. Among decedents that choose unequal division, bequests appear to be motivated by exchange. Among decedents that choose equal division, bequests are consistent with altruist preferences. %I University of Michigan %C Ann Arbor, MI %8 2005 %G eng %U https://www.proquest.com/docview/305459722 %4 Bequests %$ 19340 %! Three Essays on Retirement Wealth %0 Book Section %B Aging, Health and Public Policy: Demographic and Economic Perspectives %D 2005 %T Unraveling the SES-Health Connection %A James P Smith %E Linda J. Waite %K Demographics %K Health Conditions and Status %B Aging, Health and Public Policy: Demographic and Economic Perspectives %S Population and Development Review %I Population Council %C New York %V 30 %P 108-132 %G eng %L pubs_2005_SMITH.PGS108-132.pdf %4 Health/Socioeconomic Status %$ 14002 %6 (Suppl) %! Unraveling the SES-Health Connection %0 Journal Article %J Gerontologist %D 2005 %T Use of complementary medicine in older Americans: results from the Health and Retirement Study. %A Ness, Jose %A Dominic J Cirillo %A David R Weir %A Nisly, Nicole L. %A Robert B Wallace %K Activities of Daily Living %K Aged %K Chi-Square Distribution %K Complementary Therapies %K Female %K Humans %K Male %K Middle Aged %K Regression Analysis %K Surveys and Questionnaires %K United States %X

PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy.

DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices).

RESULTS: Of respondents over 65 years of age, 88% used CAM, with dietary supplements and chiropractic most commonly reported (65% and 46%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases.

IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.

%B Gerontologist %I 45 %V 45 %P 516-24 %8 2005 Aug %G eng %N 4 %L pubs_2005_cam.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16051914?dopt=Abstract %4 Medicine/Chiropractic/Dietary Supplements %$ 15180 %R 10.1093/geront/45.4.516 %0 Report %D 2005 %T Using a Structural Retirement Model to Simulate the Effect of Changes to the OASDI and Medicare Programs %A John Bound %A Todd R. Stinebrickner %A Timothy A Waidmann %K Employment and Labor Force %K Health Conditions and Status %K Methodology %X In this paper, we specify a dynamic programming model that addresses the interplay among health, financial resources, and the labor market behavior of men in the later part of their working lives. Unlike previous work which has typically used self reported health of disability status as a proxy for health status, we model health as a latent variable, using self reported disability status as an indicator of this latent construct. Our model is explicitly designed to account for the possibility that the reporting of disability may be endogenous to the labor market behavior we are studying. The model is estimated using data from the Health and Retirement Study. We compare results based on our model to results based on models that treat in the typical way, and find large differences in the estimated effect of health on behavior. While estimates based on our model suggest that health has a large impact on behavior, the estimates suggest a substantially smaller role for health than we find when using standard techniques. We use our model to simulate the impact on behavior of raising the normal retirement age, eliminating early retirement altogether, eliminating the Social Security Disability Insurance program and introducing universal health insurance. %B Michigan Retirement Research Center Publication %I University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/using-a-structural-retirement-model-to-simulate-the-effects-of-changes-to-the-oasdi-and-medicare-programs/ %L wp_2005/ERIU_Bound.pdf %4 labor market behavior/Health/Models, Economic %$ 15190 %0 Book Section %B Analyses in the Economics of Aging %D 2005 %T Utility Evaluation of Risk in Retirement Saving Accounts %A James M. Poterba %A Joshua Rauh %A Steven F Venti %A David A Wise %E David A Wise %K Net Worth and Assets %K Retirement Planning and Satisfaction %X The shift from defined benefit to defined contribution plans in the United States has drawn new attention to the effect of participants' asset allocation decisions on their financial resources for retirement. This paper develops a stochastic simulation algorithm to evaluate the effect of holding a broadly diversified portfolio of common stocks, or a portfolio of index bonds, on the distribution of 401(k) account balances at retirement. We compare the alternative distributions of retirement wealth both by showing the empirical distribution of potential wealth values, and by computing the expected utility of these outcomes under standard assumptions about the structure of household preferences. Our analysis highlights the critical role of other sources of wealth, such as Social Security, defined benefit pension annuities, and saving outside retirement plans in determining the expected utility cost of holding equities in the retirement account. Our findings also demonstrate the importance of the equity premium in affecting investors' utility from different retirement asset allocations. Viewed from the beginning of a working career, and given the historical pattern of returns on stocks and bonds, a household that does not have extremely high risk aversion would achieve a higher expected utility by holding a portfolio of stocks rather than bonds. %B Analyses in the Economics of Aging %I University of Chicago Press %C Chicago %G eng %L wp_2003/Poterba-etal_NBER9892.pdf %4 Assets/Retirement Planning/Retirement Wealth %$ 11572 %+ NBER Working Paper 9892. Copies available from: National Bureau of Economic Research, 1050 Massachusetts Avenue,Cambridge, MA 02138. %! Utility Evaluation of Risk in Retirement Saving Accounts %R 10.3386/w9892 %0 Journal Article %J Am J Epidemiol %D 2005 %T When is baseline adjustment useful in analyses of change? An example with education and cognitive change. %A M. Maria Glymour %A Weuve, Jennifer %A Lisa F Berkman %A Ichiro Kawachi %A Robins, James M. %K Age Factors %K Aged %K Bias %K Cognition Disorders %K Educational Status %K Epidemiologic Methods %K Female %K Health Status %K Humans %K Longitudinal Studies %K Male %K Models, Statistical %K Neuropsychological tests %K Regression Analysis %K United States %X

In research on the determinants of change in health status, a crucial analytic decision is whether to adjust for baseline health status. In this paper, the authors examine the consequences of baseline adjustment, using for illustration the question of the effect of educational attainment on change in cognitive function in old age. With data from the US-based Assets and Health Dynamics Among the Oldest Old survey (n = 5,726; born before 1924), they show that adjustment for baseline cognitive test score substantially inflates regression coefficient estimates for the effect of schooling on change in cognitive test scores compared with models without baseline adjustment. To explain this finding, they consider various plausible assumptions about relations among variables. Each set of assumptions is represented by a causal diagram. The authors apply simple rules for assessing causal diagrams to demonstrate that, in many plausible situations, baseline adjustment induces a spurious statistical association between education and change in cognitive score. More generally, when exposures are associated with baseline health status, this bias can arise if change in health status preceded baseline assessment or if the dependent variable measurement is unreliable or unstable. In some cases, change-score analyses without baseline adjustment provide unbiased causal effect estimates when baseline-adjusted estimates are biased.

%B Am J Epidemiol %I 162 %V 162 %P 267-78 %8 2005 Aug 01 %G eng %N 3 %L pubs_2005_Glymour_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15987729?dopt=Abstract %4 Methodology/EDUCATION/Health-cognitive ability %$ 16180 %R 10.1093/aje/kwi187 %0 Journal Article %J Proceedings of the American Statistical Association %D 2004 %T Adjust for Selection Bias in Web Surveys with Propensity Scores: The case of the Health and Retirement Study %A Matthias Schonlau %A Arthur H.O. vanSoest %A Mick P. Couper %A Arie Kapteyn %A Joachim Winter %K Methodology %X Many web surveys allow respondents to self select into the survey. Making inference about the population from a self-selected survey is very difficult. We analyzed data from the Health and Retirement Study (HRS) respondents of the 2002 wave as well as supplementary information about which subset of HRS respondents also responded to an additional web survey (web responders). The HRS is a longitudinal study of health, retirement and aging. The target population of the HRS includes all adults in the contiguous United States, aged 51 and over, who reside in households. We investigated whether it is possible to adjust for selection bias using propensity scores. We found that it is possible to make inferences for financial assets based on data from web responders only. However, making inferences about home values was not possible based on data from the web responders only. %B Proceedings of the American Statistical Association %G eng %U https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.538.1141&rep=rep1&type=pdf %4 Methodology %$ 15700 %0 Book Section %B Perspectives on the Economics of Aging %D 2004 %T Aging and Housing Equity: Another Look %A Steven F Venti %A David A Wise %E David A Wise %K Adult children %K Housing %K Net Worth and Assets %X Prior research has shown that except for Social Security and employer-provided pension assets, housing equity is the most important asset of a large fraction of older Americans. These assets are the primary source of retirement consumption. This paper looks at the change in the home equity of older families as they age. The two ways for households to change home equity are by discontinuing home ownership- an action that seems to be fairly unlikely- or by selling and moving to another home. Findings suggest that housing equity increases with age until about age 75 and then declines slightly as households grow older. In general, home equity should not be counted on to support general non-housing consumption needs as households grow older. %B Perspectives on the Economics of Aging %I University of Chicago Press %C Chicago %G eng %U http://www.nber.org/papers/w8608 %L wp_2001/venti-wise_NBER8608.pdf %4 Home Ownership/Family Structure/Housing Equity/Economic Status %$ 6627 %+ Revision of NBER Working Paper No. 8608 %! Aging and Housing Equity: Another Look %0 Report %D 2004 %T All in the Family: Providing support to grandchildren and health in midlife %A Mary Elizabeth Hughes %A Tracey A. LaPierre %A Linda J. Waite %A Ye Luo %K Adult children %K Demographics %K Health Conditions and Status %X The purpose of this study was to examine the effects of caring for grandchildren on health behaviors and mental and physical health among older adults. METHODS: Using a sample of 12,872 grandparents aged 50 through 80 from the Health and Retirement Study, we examined the relationship between stability and change in various types of grandchild care and subsequent health, controlling for covariates and earlier health. RESULTS: We found no evidence to suggest that caring for grandchildren has dramatic and widespread negative effects on grandparents' health and health behavior. We found limited evidence that grandmothers caring for grandchildren in skipped-generation households are more likely to experience negative changes in health behavior, depression, and self-rated health. We also found some evidence of benefits to grandmothers who babysit. DISCUSSION: Our findings suggest that the health disadvantages found previously among grandparent caregivers arise from grandparents' prior characteristics, not as a consequence of providing care. Health declines as a consequence of grandchild care appear to be the exception rather than the rule. These findings are important given continuing reliance on grandparents for day care and increasing reliance on grandparents for custodial care. However, the findings should be tempered by the recognition that for a minority of grandparents, coresidential grandchild care may compromise health. %I Duke University %G eng %L wp_2004/Hughes_04.pdf %4 Child Care/Health/Middle Aged Adults %$ 13932 %0 Book Section %B Families in Ageing Societies: A multi-disciplinary approach %D 2004 %T The American Family as a Context for Healthy Aging %A Mary Elizabeth Hughes %A Linda J. Waite %E Harper, Sarah %K Adult children %B Families in Ageing Societies: A multi-disciplinary approach %I Oxford University Press %C Oxford %G eng %4 Family Structure %$ 8684 %! The American Family as a Context for Healthy Aging %0 Journal Article %J Journal of General Internal Medicine %D 2004 %T Development and Validation of a Functional Morbidity Index to Predict Mortality in Community-Dwelling Elders %A Carey, Elise C. %A Louise C Walter %A Lindquist, Karla %A Kenneth E Covinsky %K Health Conditions and Status %K Methodology %X OBJECTIVE: Functional measures have a great appeal for prognostic instruments because they are associated with mortality, they represent the end-impact of disease on the patient, and information about them can be obtained directly from the patient. However, there are no prognostic indices that have been developed for community-dwelling elders based primarily on functional measures. Our objective in this study was to develop and validate a prognostic index for 2-year mortality in community-dwelling elders, based on self-reported functional status, age, and gender. DESIGN: Population-based cohort study from 1993 to 1995. SETTING: Community-dwelling elders within the United States. PARTICIPANTS: Subjects, age 70 and over (N= 7,393), from the Asset and Health Dynamics Among the Oldest Old study. We developed the index in 4,516 participants (mean age 78, 84 white, 61 female), and validated it in 2,877 different participants (mean age 78, 73 white, 61 female). MAIN OUTCOME MEASURES: Prediction of 2-year mortality using risk factors such as activities of daily living, instrumental activities of daily living, additional measures of physical function, age, and gender. RESULTS: Overall mortality was 10 in the development cohort and 12 in the validation cohort. In the development cohort, 6 independent predictors of mortality were identified and weighted, using logistic regression models, to create a point scale: male gender, 2 points; age (76 to 80, 1 point; 80, 2 points); dependence in bathing, 1 point; dependence in shopping, 2 points; difficulty walking several blocks, 2 points; and difficulty pulling or pushing heavy objects, 1 point. We calculated risk scores for each patient by adding the points of each independent risk factor present. In the development cohort, 2-year mortality was 3 in the lowest risk group (0 to 2 points), 11 in the middle risk group (3 to 6 points), and 34 in the highest risk group ( 7 points). In the validation cohort, 2-year mortality was 5 in the lowest risk group, 12 in the middle risk group, and 36 in the highest risk group. The c-statistics for the point system were 0.76 and 0.74 in the development and validation cohorts, respectively. CONCLUSIONS: This prognostic index, which relies solely on self-reported functional status, age, and gender, provides a simple and accurate method of stratifying communitydwelling elders into groups at varying risk of mortality. %B Journal of General Internal Medicine %I 19 %V 19 %P 1027-1033 %G eng %N 10 %L pubs_2004_carey_etal.pdf %4 Activities of Daily Living/Survival/Mortality %$ 13732 %0 Journal Article %J Research on Aging %D 2004 %T Diabetes Diagnosis and Weight Loss in Middle-Aged Adults %A Linda A. Wray %A Caroline S Blaum %A Mary Beth Ofstedal %A A. Regula Herzog %K Demographics %K Health Conditions and Status %K Healthcare %X Using three waves of Health and Retirement Study data, this study investigated whether (a) self-reported physician-diagnosed diabetes prior to 1994 predicted weight loss between 1994 and 1996 in adults who were aged 51 to 61 and relatively healthy but overweight in 1992 (n = 2,642) and (b) socioeconomic status influenced that relationship. The authors found that these overweight middle-aged adults were at least 50 more likely to report that they lost at least 10 pounds of excess body weight if they had been diagnosed with diabetes than if they had not. Furthermore, the authors found that neither education nor net worth predicted weight loss in these adults. Identifying the social, psychological, and physiological mechanisms linking chronic conditions and health behaviors can inform policy makers and health care providers and enhance the development of effective interventions to prevent or reduce health risks in middle-aged and older adults. %B Research on Aging %I 26 %V 26 %P 62-81 %G eng %U http://roa.sagepub.com/content/26/1/62.abstract %N 1 %L pubs_2004_Wray_etal.pdf %4 Diabetes/Diagnosis/Middle Aged Adults %$ 12792 %R 10.1177/0164027503258741 %0 Journal Article %J The Journals of Gerontology: Social Sciences %D 2004 %T Disability and Home Care Dynamics Among Unmarried Older Americans %A Vicki A Freedman %A Aykan, Hakan %A John E. Marcotte %A Douglas A. Wolf %K Disabilities %K Healthcare %X Objectives. We describe how paid and unpaid home care hours received by older unmarried Americans change in response to disability dynamics. We test whether responses to disability declines and improvements are symmetric; that is, we test whether reductions in care hours that are due to disability improvements are of similar magnitude to increases in care hours that are due to disability declines. Methods. Using a national sample of older unmarried Americans, we examine changes in total hours, paid hours, and unpaid hours of care in response to declines and improvements in personal care (activities of daily living, or ADLs) and routine care (instrumental ADLs, or IADLs) disability. We model changes in the total hours of care received in the past month and jointly model changes in unpaid and paid hours, using Tobit models. Results. Changes in the total hours of care received respond to both increases and decreases in the count of ADL limitations and appear close to symmetric. In contrast, responses to IADL disability dynamics appear to be far less symmetric: Although increases in the count of IADL limitations are met with substantial increases in the total hours of care, decreases are not met with correspondingly large declines in care. The same general pattern is found for unpaid and paid care, and for Medicaid-funded home care. Discussion. Disability and care are not static constructs in old age. Older unmarried persons experience worsening, stabilizing, and recovery of function, and their care hours change accordingly. Evaluations of home care programs must be cognizant of such dynamic realities. %B The Journals of Gerontology: Social Sciences %I 59B %V 59B %P S25-S33 %G eng %U http://psychsoc.gerontologyjournals.org/ %N 1 %L pubs_2004_Freedman_etal.pdf %4 Disability/Disability/Caregiving %$ 12992 %0 Journal Article %J Social Security Bulletin %D 2004 %T The Economic Consequences of a Husband's Death: Evidence from the HRS and AHEAD %A Purvi Sevak %A David R Weir %A Robert J. Willis %K Net Worth and Assets %X This article examines the economic status of older widowed women in the 1990s using the Health and Retirement Study. Widowhood remains an important risk factor for transition into poverty, although somewhat less so than 20 years ago. Despite increased labor force participation rates among women and Employee Retirement Income Security Act (ERISA) reforms, widows live with lower household earnings, pension income, and wealth than do married women. Women widowed at younger ages are at greatest risk for economic hardship after widowhood and their situation declines with the duration of widowhood. We also find that women in households that are least prepared financially for widowhood are at greatest risk of husband's death, because of the strong relationship between mortality and wealth. %B Social Security Bulletin %I 65 %V 65 %P 31-44 %G eng %U https://www.ssa.gov/policy/docs/ssb/v65n3/v65n3p31.html %N 3 %L pubs_2004_Sevak_SSB.pdf %4 Widowhood/Economic Status %$ 13462 %0 Book Section %B Social Security Programs and Retirement Around the World %D 2004 %T The Effect of Social Security on Retirement in the United States %A Courtney Coile %A Gruber, Jonathan %E Gruber, Jonathan %E David A Wise %K Methodology %K Retirement Planning and Satisfaction %B Social Security Programs and Retirement Around the World %I University of Chicago Press %C Chicago, IL %G eng %4 Retirement Policies/Social Security Research %$ 13272 %! The Effect of Social Security on Retirement in the United States %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 Journal Article %J Journal of Pension Economics and Finance %D 2004 %T Household Annuitization Decisions: Simulations and empirical analyses %A Irena Dushi %A Anthony Webb %K Net Worth and Assets %X Annuities provide insurance against outliving one s wealth. Previous studies have indicated that, for many households, the value of the longevity insurance should outweigh the actuarial unfairness of prices in the voluntary annuity market. Nonetheless, voluntary annuitization rates are extremely low. Previous research on the value of annuitization has compared an optimal decumulation of unannuitized wealth with the alternative of annuitizing all unannuitized wealth at age 65. We relax these assumptions, allowing households to annuitize any part of their unannuitized wealth at any age and to return to the annuity market as many times as they wish. Using numerical optimization techniques, assuming the levels of actuarial unfairness of annuities calculated in previous research, and retaining the assumption made in previous research that one half of household wealth is pre-annuitized, we conclude that it is optimal for couples to delay annuitization until they are aged 73 82, and in some cases never to annuitize. It is usually optimal for single men and women to annuitize at substantially younger ages, between 65 and 70. Households that annuitize will generally wish to annuitize only part of their unannuitized wealth. Using data from the Asset and Health Dynamics Among the Oldest Old and Health and Retirement Study panels, we show that much of the failure of the average currently retired household to annuitize can be attributed to the exceptionally high proportions of the wealth of these cohorts that is pre-annuitized. We expect younger cohorts to have smaller proportions of pre-annuitized wealth and we project increasing demand for annuitization as successive cohorts age. %B Journal of Pension Economics and Finance %I 3 %V 3 %P 109-143 %G eng %N 2 %4 Annuities/Retirement Wealth %$ 13192 %R https://doi.org/10.1017/S1474747204001696 %0 Report %D 2004 %T The Impact of New Health Problems on Self-Reported Health Over Time %A Jun Xu %A Werner, R. %A Daniel Polsky %K Healthcare %X Background: Many cross-sectional studies have found that self-reported health is highly correlated with physical and functional indicators of health. However, the extent to which self-reported health changes with new health problems and over time has not been well documented. Objectives: To investigate how self-reported health changes over time following a new acute or chronic health problem. Research Design: Using 6 years of longitudinal data for 7388 subjects from the Health and Retirement Study of the US, we assessed self-reported health after a new health problem over 2, 4, and 6 year intervals. Seven health problems (cancer, heart disease, lung disease, diabetes, high blood pressure, psychiatric disorders, and arthritis) were included in logistic regression models to predict the impact of new health problems on self-reported health over time. The probability of recovery of self-reported health was predicted using an interaction between length of time since the new health problem occurred and the new health problem. Results: All seven new health problems examined were associated with a significant decline in self-reported health. People who reported new cancer, heart disease, and lung disease experienced the greatest decline in health status. For most health problems, self-reported health improved over time. Relative to people with no new health problems, people with new cancer and heart disease had the most significant recovery in self-reported health over time. Conclusions: Self-reported health typically gets worse after a new health problem and gradually improves over time. This pattern is particularly true for cancer and heart problems. %I University of Michigan Population Studies Center, PSC Publications %G eng %4 Health Problems %$ 13592 %0 Thesis %D 2004 %T A Longitudinal Look at the Predictors of Four Types of Retirement %A Weymouth, Penny L. %K Health Conditions and Status %K Healthcare %K Methodology %K Retirement Planning and Satisfaction %X The general purpose of the study was to further the understanding of the retirement process. More specifically, the study investigated several personal and work-related predictors of individual retirement status that have received relatively little past examination. By gaining a better understanding of the retirement process, policy makers and organizational leaders can use this knowledge to make informed decisions affecting older workers, their organizations, and society in general. Public release data of the Health and Retirement Study (HRS)--a recent, large, representative, national panel study that focuses on the health, retirement, and aging of persons born between the years of 1931 and 1941--were analyzed. In-home, face-to-face interviews were conducted in 1992, with follow-up interviews conducted every two years by phone. From survey years 1992 through 2000, samples of working individuals over the age of 50 were used to examine nine hypotheses and four different operationalizations of retirement. The hypotheses involved the following predictor variables: gender, partner status, characteristics of one's partner (i.e., retirement status and health), number of dependents, obsolescence of job skills, "demanding" job characteristics, perceived age-related discrimination, work and retirement attitudes, and flexibility of organizational policies regarding older workers. Event history analysis using logistic regression was used to predict the dichotomous criterion variables, while linear mixed model analysis for repeated measures was used to predict the continuous dependent variable. After statistically controlling variables such as age, health, and finances, results indicated that gender, partner's retirement status, work and retirement attitudes, and organizational flexibility were each predictors of at least one type of retirement. In addition, the statistical interaction of gender with partner status predicted retirement defined in several ways. The study expanded what is known about retirement predictors by examining actual versus intended retirement behavior and increased the generalizability of past research by utilizing national panel data. The study also highlighted the importance of clearly defining retirement measures and explored the complete versus partial retirement typology. It was suggested that flexible work options may improve work and retirement attitudes by making the transition into retirement a gradual process, and may keep older employees in the work force longer. %I Central Michigan University %C United States -- Michigan %8 2004 %G eng %4 Gerontology %$ 17590 %! A Longitudinal Look at the Predictors of Four Types of Retirement %0 Thesis %D 2004 %T Marital Status Differences in Working Life after Age 50: A sex-stratified analysis %A David F Warner %K Adult children %K Demographics %K Employment and Labor Force %K Healthcare %X Although retirement is a prominent feature of the modern life course, prior research has largely focused on the experiences of men or married couples. However, rising female labor force participation and decreasing marital stability means that many women are entering later-life with substantial work histories, but also without the economic protections of marriage. Men too are increasingly entering later-life nonmarried. Given the rapidly aging population, it is imperative to understand the implications of these demographic shifts for the organization of working life in the later-years for men and women. Drawing on data from the 1992-2000 waves of the Health and Retirement Study (HRS), this research expands on prior studies by examining marital status differences in working life and retirement for both men and women. The HRS is a nationally representative sample of noninstitutionalized adults over the age of 50. Population-based working life tables are estimated using discrete-time hazard models. Results indicate that older men are more likely to be in the labor force than are women, due to both lower exit risks and higher reentry risks. Among men, the married have longer working lives and lower retirement risks than divorced, widowed and never married men. Never married men have the shortest working life. The opposite is true for women; married women have shorter working lives and higher risks of retirement than divorced widowed and never married women. Divorced and never married women spend the most remaining years in the labor force. Both nonmarried men and women spend more years disabled than the married. Differences in socioeconomic resources, primarily, mediate some, but not all, of the effect of divorced and widowhood on the risk of retirement for women. Differences in socioeconomic resources, health and current family context do not account for the higher risk of retirement for divorced, widowed and never married men relative to the married. In fact, if nonmarried men had the characteristics of married men, they would be even more likely to retire. %I The Pennsylvania State University %C United States -- Pennsylvania %8 2004 %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=845711461&Fmt=7&clientId=17822&RQT=309&VName=PQD %4 Gerontology %$ 17650 %! Marital Status Differences in Working Life after Age 50: A sex-stratified analysis %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 Journal Article %J Alzheimer Dis Assoc Disord %D 2004 %T Out-of-pocket health care expenditures among older Americans with dementia. %A Kenneth M. Langa %A Eric B Larson %A Robert B Wallace %A A. Mark Fendrick %A Norman L Foster %A Mohammed U Kabeto %A David R Weir %A Robert J. Willis %A A. Regula Herzog %K Aged %K Aged, 80 and over %K Alzheimer disease %K Costs and Cost Analysis %K Data Interpretation, Statistical %K Female %K Financing, Personal %K Health Care Costs %K Health Expenditures %K Health Surveys %K Humans %K Insurance Coverage %K Longitudinal Studies %K Male %X

The number of older individuals with dementia will likely increase significantly in the next decades, but there is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by cognitively impaired individuals and their families. We used data from the 1993 and 1995 Asset and Health Dynamics Study, a nationally representative longitudinal survey of older Americans, to determine the OOPE for individuals with and without dementia. Dementia was identified in 1993 using a modified version of the Telephone Interview for Cognitive Status for self-respondents, and proxy assessment of memory and judgment for proxy respondents. In 1995, respondents reported OOPE over the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. The adjusted mean annual OOPE was 1,350 US dollars for those without dementia, 2,150 US dollars for those with mild/moderate dementia, and 3,010 US dollars for those with severe dementia (p < 0.01). Expenditures for hospital/nursing home care (1,770 per year US dollars) and prescription medications (800 per year US dollars) were the largest OOPE components for those with severe dementia. We conclude that dementia is independently associated with significantly higher OOPE for medical care compared with those with normal cognitive function. Severe dementia is associated with a doubling of OOPE, mainly due to higher payments for long-term care. Given that the number of older Americans with dementia will likely increase significantly in the coming decades, changes in public funding aimed at reducing OOPE for both long-term care and prescription medications would have considerable impact on individuals with dementia and their families.

%B Alzheimer Dis Assoc Disord %I 18 %V 18 %P 90-8 %8 2004 Apr-Jun %G eng %N 2 %L pubs_2004_Langa_etal_dementia_ADAD.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15249853?dopt=Abstract %4 Dementia/Health Expenditures %$ 12282 %R 10.1097/01.wad.0000126620.73791.3e %0 Journal Article %J J Gen Intern Med %D 2004 %T Quality of preventive clinical services among caregivers in the health and retirement study. %A Kim, Catherine %A Mohammed U Kabeto %A Robert B Wallace %A Kenneth M. Langa %K Aged %K Caregivers %K Cohort Studies %K Cross-Sectional Studies %K Female %K Health Care Surveys %K Humans %K Male %K Middle Aged %K Patient Acceptance of Health Care %K Preventive Health Services %K Quality of Health Care %K Time Factors %K United States %X

We examined the association between caregiving for a spouse and preventive clinical services (self-reported influenza vaccination, cholesterol screening, mammography, Pap smear, and prostate cancer screening over 2 years and monthly self-breast exam) for the caregiver in a cross-sectional analysis of the Health and Retirement Study, a nationally representative sample of U.S. adults aged > or = 50 years (N = 11,394). Spouses engaged in 0, 1-14, or > or = 14 hours per week of caregiving. Each service was examined in logistic regression models adjusting for caregiver characteristics. After adjustment for covariates, there were no significant associations between spousal caregiving and likelihood of caregiver receipt of preventive services.

%B J Gen Intern Med %I 19 %V 19 %P 875-8 %8 2004 Aug %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/15242474?dopt=Abstract %4 Caregiving/Spouses/Health Care Utilization/Caregivers/Health Services %$ 12292 %R 10.1111/j.1525-1497.2004.30411.x %0 Journal Article %J Int J Aging Hum Dev %D 2004 %T Race, gender, and the retirement decisions of people ages 60 to 80: prospects for age integration in employment. %A Tay K. McNamara %A Williamson, John B. %K Age Distribution %K Aged %K Aged, 80 and over %K Black People %K Educational Status %K Employment %K Female %K Health Status %K Humans %K Income %K Logistic Models %K Male %K Middle Aged %K Retirement %K Sex Distribution %K White People %X

UNLABELLED: Demographic projections have prompted concerns about the potential economic burden of an aging population. This article, drawing on the 1998 Health and Retirement Study, explores ways in which race, gender, and age moderate the effects of various factors on labor force participation among people ages 60 to 80. Key findings center on health, education, and non-wage income. First, the effect of low non-wage income is weaker at older ages due to higher levels of functional disability. Second, the effect of low education is stronger for women, who perceive their chances of finding employment as low. Third, the effect of health is weaker for blacks, as they are less likely to find steady employment regardless of health.

POLICY IMPLICATIONS: Employer flexibility in number of hours worked might make sense for workers close to retirement age, while job search and training programs might be preferable for workers past the typical retirement age.

%B Int J Aging Hum Dev %I 59 %V 59 %P 255-86 %8 2004 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/15566013?dopt=Abstract %4 Racial disparities/Labor Force Participation %$ 13692 %R 10.2190/GE24-03MX-U34P-AMNH %0 Journal Article %J Research on Aging %D 2004 %T Relationship of Body Mass and Net Worth for Retirement-Aged Men and Women %A Stephanie J. Fonda %A Fultz, Nancy H. %A Kristi Rahrig Jenkins %A Wheeler, Laura M. %A Linda A. Wray %K Health Conditions and Status %K Net Worth and Assets %X This article examines linkages between body weight and socioeconomic status (SES) among Americans at or near retirement age. The authors hypothesize that (a) body weight relates negatively to SES, (b) this relationship is greater for women than men, and (c) the relationship attenuates when health, employment, and marital status are controlled.We use the 1992 Health and Retirement Study for this examination. SES is measured as net worth. Body weight is measured as body mass index and categorized as normal weight, overweight, and obese. Results indicate that, for women, overweight and obesity relate to lower logged networth. This relationship attenuates once covariates are considered. For men, overweight and obesity relate to higher logged net worth, even when covariates are considered. The findings suggest that greater weight has different meanings for men and women in this cohort; it might be related to success for men but a sociocultural detriment for women. %B Research on Aging %I 26 %V 26 %P 153-176 %G eng %N 1 %L pubs_2004_Fonda_etal.pdf %4 Body Mass Index/Net Worth %$ 11522 %R https://doi.org/10.1177/0164027503258739 %0 Journal Article %J Demography %D 2004 %T Resolving inconsistencies in trends in old-age disability: report from a technical working group. %A Vicki A Freedman %A Eileen M. Crimmins %A Robert F. Schoeni %A Brenda C Spillman %A Aykan, Hakan %A Kramarow, Ellen %A Land, Kenneth %A Lubitz, James %A Kenneth G. Manton %A Linda G Martin %A Shinberg, Diane %A Timothy A Waidmann %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Chronic disease %K Disabled Persons %K Female %K Health Surveys %K Homemaker Services %K Humans %K Male %K Models, Statistical %K Self-Help Devices %K United States %X

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

%B Demography %I 41 %V 41 %P 417-41 %8 2004 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/15461008?dopt=Abstract %4 Disability/Disability/ADL and IADL Impairments/Elderly/Caregiving %$ 12982 %R 10.1353/dem.2004.0022 %0 Thesis %B Economics %D 2004 %T Savings and Retirement in the New Millennium %A Anthony Webb %K Pensions %K Retirement Planning and Satisfaction %X The typical pension plan has changed dramatically in the past twenty-five years. There has been a large increase in the coverage of defined contribution (DC) plans, in which the pension is generally paid in unannuitized form, and where the amount of the pension depends on investment returns and the amount contributed. There has been a corresponding decline in the coverage of defined benefit (DB) plans in which the pension is some function of salary and years of service. DC plans place greater responsibility on the individual to make adequate provision for his retirement. They also lack many of the age related incentives of DB plans that have been shown to influence retirement. The first chapter, "The Effect of 401(k) Eligibility on Household Asset Holdings: New Evidence from the Health and Retirement Study", examines the question of whether contributions to 401(k) plans, the most common type of DC plan, have merely displaced other non pension savings, or whether they represent additional saving that would not otherwise have been made. A comparison of the savings of participants with those of non-participants would likely produce biased estimates, as participants probably have a stronger unobserved taste for savings than non-participants. I therefore follow previous practice in comparing eligible with ineligible households. Eligibility is, however correlated with DB plan membership, which may also affect savings behavior. I therefore restrict my analysis to households that are also members of DB plans, a relatively homogenous group. Previous researchers use asset balances imputed from donor households of a different pension type, leading to further potential bias. I therefore re-impute missing data, including eligibility among my covariates. Using the Health and Retirement Study, a panel dataset, I find no evidence of any displacement of other savings in either financial assets or home equity by 401(k) contributions. If anything, eligible households save more in other financial assets, a finding that I attribute to the financial education often associated with the introduction of DC plans. In my second chapter, co-authored with Professor Friedberg, I use data from the same dataset to show that retirement patterns have changed as DC plans have spread. We estimate that the financial incentives in DB plans lead people to retire almost two years earlier on average, and that the decline in DB plan coverage over the period 1983 to 1995 has increased average retirement age by two to four months. In my third chapter, I examine whether the observed failure of the elderly to dissave is a result of concerns about end-of-life expenditure. Using data from the Asset and Health Dynamics among the Oldest Old (AHEAD) dataset, I show that married couples save more if they expect to enter long-term care, but that single women do not. I attribute the difference in behavior between the two groups to a desire on the part of couples to make adequate provision for the surviving spouse. %B Economics %I University of California, San Diego %C San Diego, CA %V Doctor of Philosophy %8 2004 %G eng %U https://search.proquest.com/openview/c743ebe775959ac60d71942c8ddc9b1f/1?pq-origsite=gscholar&cbl=18750&diss=y %4 Retirement Incentives %$ 12672 %0 Journal Article %J Res Aging %D 2004 %T A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies. %A Mary Elizabeth Hughes %A Linda J. Waite %A Louise C Hawkley %A John T. Cacioppo %X

Most studies of social relationships in later life focus on the amount of social contact, not on individuals' perceptions of social isolation. However, loneliness is likely to be an important aspect of aging. A major limiting factor in studying loneliness has been the lack of a measure suitable for large-scale social surveys. This article describes a short loneliness scale developed specifically for use on a telephone survey. The scale has three items and a simplified set of response categories but appears to measure overall loneliness quite well. The authors also document the relationship between loneliness and several commonly used measures of objective social isolation. As expected, they find that objective and subjective isolation are related. However, the relationship is relatively modest, indicating that the quantitative and qualitative aspects of social relationships are distinct. This result suggests the importance of studying both dimensions of social relationships in the aging process.

%B Res Aging %I 26 %V 26 %P 655-672 %8 2004 %G eng %N 6 %L pubs_2004_Hughes_etal_RA.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18504506?dopt=Abstract %4 Loneliness/Social Support %$ 14092 %R 10.1177/0164027504268574 %0 Report %D 2004 %T Social Integration of Older Immigrants in 21st Century America %A Janet M Wilmoth %K Demographics %X There are various reasons for the burgeoning interest in detailed research into the determinants of social well-being among older immigrants in this country. As a result of shifting federal government policies, the total volume of immigrants has increased significantly, the countries from which they migrate have changed, and more immigrant families have brought their parents into the United States than ever before. Consequently, the older adult population is becoming more diverse due in part to the aging-in-place of younger immigrants and an increasing number of immigrants who are older upon arrival in the United States. These trends create challenges for social service providers, who are encountering language and cultural differences among their clients for which they are unprepared. This report provides an overview of research about older adult immigrants in the United States that my colleagues and I have conducted over the past few years. Various demographic and cultural aspects of today’s immigrants that differ from the past are described. The importance of social integration to older immigrants’ well-being is considered. Then some intriguing research about the “new immigrants” is summarized and additional areas for future research are suggested %B The Policy Brief %I Syracuse University %C Syracuse, NY %G eng %U https://surface.syr.edu/cgi/viewcontent.cgi?article=1013&context=cpr %L pubs_2004_wilmoth_pb29.pdf %4 Immigrants/Social Environment %$ 13562 %0 Book Section %B Perspectives on the Economics of Aging %D 2004 %T The Transition to Personal Retirement Accounts and Increasing Retirement Wealth %A James M. Poterba %A Steven F Venti %A David A Wise %E David A Wise %K Net Worth and Assets %K Pensions %X Retirement saving has changed dramatically over the last two decades. There has been a shift from employer-managed defined benefit pensions to defined contribution retirement saving plans that are largely controlled by employees. In 1980, 92 percent of private retirement saving contributions were to employer-based plans and 64 percent of these contributions were to defined benefit plans. Today, about 85 percent of private contributions are to plans in which individuals decide how much to contribute to the plan, how to invest plan assets and how and when to withdraw money from the plan. In this paper we use both macro and micro data to describe the change in retirement assets and in retirement saving. We give particular attention to the possible substitution of pension assets in one plan for assets in another plan such as the substitution of 401(k) assets for defined benefit plan assets. Aggregate data show that between 1975 and 1999 assets to support retirement increased about five-fold relative to wage and salary income. This increase suggests large increases in the wealth of future retirees. The enormous increase in defined contribution plan assets dwarfed any potential displacement of defined benefit plan assets. In addition, in recent years the annual 'retirement plan contribution rate,' defined as retirement plan contributions as a percentage of NIPA personal income, has been over 5 percent. This is much higher than the NIPA total personal saving rate, which has been close to zero. Retirement saving as a share of personal income today would likely be at least one percentage point greater had it not been for legislation in the 1980s that limited employer contributions to defined benefit pension plans, and the reduction in defined benefit plan contributions associated with the rising stock market of the 1990s. It is also likely that the 'retirement plan contribution rate' would be much higher today if it were not for the 1986 retrenchment of the IRA program. Rising retirement plan contributions, as well as favorable rates of return on retirement plan assets in the 1990s, explain the large increase in these assets relative to income. Employee retirement saving under a defined contribution plan is easily measured and quite %B Perspectives on the Economics of Aging %I University of Chicago Press %C Chicago, IL %G eng %4 Retirement Wealth/defined contribution pension plans %$ 13362 %R 10.3386/w8610 %0 Journal Article %J J Aging Health %D 2003 %T Additive and interactive effects of comorbid physical and mental conditions on functional health. %A Fultz, Nancy H. %A Mary Beth Ofstedal %A A. Regula Herzog %A Robert B Wallace %K Activities of Daily Living %K Aged %K Aging %K Black or African American %K Cognition Disorders %K depression %K Diabetes Complications %K Educational Status %K Health Surveys %K Hispanic or Latino %K Humans %K Stroke %K United States %K White People %X

OBJECTIVE: To understand the role of cognitive impairment and depressive symptoms on functional outcomes of stroke and diabetes. Evaluation approaches to functional outcomes have rarely focused on the presence of specific comorbidities, particularly those involving mental health disorders.

METHODS: Data are from the AHEAD cohort of the Health and Retirement Study (HRS), a nationally representative panel of persons 70+ years of age in 1993. Analyses are limited to 5,646 self-respondents for whom functional outcome data are available in 1995. Additive and interactive multiple regression models are compared for each outcome and focal condition combination.

RESULTS: The additive model is sufficient for the majority of outcome and focal condition combinations. The interaction term is significant in 4 of 12 comparisons.

DISCUSSION: Stroke, diabetes, cognitive impairment, and depressive symptoms exhibit strong independent effects on physical functioning. Support for the hypothesis that cognitive impairment and depression exacerbate the impact of stroke and diabetes is more limited.

%B J Aging Health %I 15 %V 15 %P 465-81 %8 2003 Aug %G eng %N 3 %L pubs_2003_Fultz_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12914014?dopt=Abstract %4 Activities of Daily Living/Chronic Disease/Epidemiology/Health Surveys %$ 11682 %R 10.1177/0898264303253502 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2003 %T Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults. %A Kala M. Mehta %A Kristine Yaffe %A Kenneth M. Langa %A Laura Sands %A Whooley, Mary %A Kenneth E Covinsky %K Aged %K Cognition %K depression %K Female %K Humans %K Male %K Mortality %K Proportional Hazards Models %K Risk Factors %X

BACKGROUND: Poor cognitive function and depressive symptoms are common in the elderly, frequently coexist, and are interrelated. Both risk factors are independently associated with mortality. Few studies have comprehensively described how the combination of poor cognitive function and depressive symptoms affect the risk for mortality. Our aim was to examine whether the combination of varying levels of cognitive function and depressive symptoms affect the risk of mortality in community-living elderly adults.

METHODS: We studied 6301 elderly adults (mean age, 77 years; 62% women; 81% white) enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study, a prospective study of community-living participants conducted from 1993 to 1995. Cognitive function and depressive symptoms were measured using two validated measures developed for the AHEAD study. On each measure, participants were divided into tertiles representing the best, middle, and worst scores, and then placed into one of nine mutually exclusive groups ranging from best functioning on both measures to worst functioning on both measures. Mortality rates were assessed in each of the nine groups. Cox proportional hazards models were used to control for potentially confounding characteristics such as demographics, education, income, smoking, alcohol consumption, comorbidity, and baseline functional impairment.

RESULTS: During 2 years of follow-up, 9% (548) of the participants died. Together, cognitive function and depressive symptoms differentiated between elderly adults at markedly different risk for mortality, ranging from 3% in those with the best function on both measures to 16% in those with the worst function on both measures (p <.001). Furthermore, for each level of cognitive function, more depressive symptoms were associated with higher mortality rates, and for each level of depressive symptoms, worse cognitive function was associated with higher mortality rates. In participants with the best cognitive function, mortality rates were 3%, 5%, and 9% in participants with low, middle, and high depressive symptoms, respectively (p <.001 for trend). The corresponding rates were 6%, 7%, and 12% in participants with the middle level of cognitive function (p <.001 for trend), and 10%, 13%, and 16% in participants with the worst level of cognitive function (p <.001 for trend). After adjustment for confounders, participants with the worst function on both measures remained at considerably higher risk for death than participants with the best function on both measures (adjusted hazard ratio, 3.1; 95% confidence interval, 2.0-4.7).

CONCLUSIONS: Cognitive function and depressive symptoms can be used together to stratify elderly adults into groups that have significantly different rates of death. These two risk factors are associated with an increased risk in mortality in a progressive, additive manner.

%B J Gerontol A Biol Sci Med Sci %I 58A %V 58 %P M461-7 %8 2003 May %G eng %N 5 %L pubs_2003_Mehta_KJoG.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12730257?dopt=Abstract %4 Cognitive Function/Depressive Symptoms/Mortality %$ 8680 %R 10.1093/gerona/58.5.m461 %0 Report %D 2003 %T Bad Luck and Consumption Behavior %A Owen,Ann L. %A Stephen Wu %K Consumption and Savings %K Net Worth and Assets %I Hamilton College %C Clinton, NY %G eng %4 Consumption/Financial Management %$ 12132 %0 Journal Article %J Gerontologist %D 2003 %T Caregiver stress and noncaregiver stress: exploring the pathways of psychiatric morbidity. %A Amirkhanyan, Anna A. %A Douglas A. Wolf %K Caregivers %K depression %K Female %K Humans %K Male %K Middle Aged %K Regression Analysis %K Risk Factors %K Stress, Psychological %X

PURPOSE: This study examines depressive symptoms among adult children of elderly parents; it views the parents' care needs and child's care activities as two separate stressors, different combinations of which may affect both caregiving and noncaregiving family members.

DESIGN AND METHODS: A sample of 4,380 women and 3,965 men from the first wave of the Health and Retirement Study was analyzed by use of four alternative forms of multiple regression analysis. Using the Center for Epidemiological Studies Depression scale, respondents reported on their depressive symptoms, as well as on parental disability and care provided by themselves, their spouses, and siblings.

RESULTS: Noncaregivers reporting severe parental disability were significantly more likely to experience depression symptoms. Evidence of increased manifestations of depression was not found among those caring for severely disabled relatives; nor was it found among those providing care in the absence of severe parental care needs. Having a caregiving sibling was associated with increased CES-D scores among noncaregivers.

IMPLICATIONS: In the current literature, personal care needs of a close relative are named among significant disturbances in the lives of caregivers. By extending this approach to members of a family network regardless of caregiver status, this study allows us to distinguish the magnitude of negative outcomes of serious parental care needs while clarifying the impact uniquely attributable to caregiving activities.

%B Gerontologist %I 43 %V 43 %P 817-27 %8 2003 Dec %G eng %N 6 %L pubs_2003_Amirkhanyan-Wolf_TG2003.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/14704381?dopt=Abstract %4 Caregiving/Stress/Stress Psychology %$ 12302 %R 10.1093/geront/43.6.817 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2003 %T Cognitive function and acute care utilization. %A Walsh, Edith G. %A Bei Wu %A Mitchell, Janet B. %A Lisa F Berkman %K Aged %K Cognition Disorders %K Female %K Geriatric Assessment %K Health Behavior %K Health Status %K Hospitalization %K Hospitals %K Humans %K Length of Stay %K Male %K Neuropsychological tests %K Outpatient Clinics, Hospital %K Severity of Illness Index %K United States %X

OBJECTIVES: Little is known about variation in cognitive function across the aged population, or how use and costs of health care vary with cognitive impairment. This study was designed to create a typology of cognitive function in a nationally representative sample, and evaluate acute care use in relation to cognitive function, holding constant confounding factors. By including proxy assessments of cognitive function, this is the first study to include individuals unable to respond themselves.

METHODS: We analyzed the baseline year of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, sponsored by the National Institute on Aging, to create three levels of cognitive function, using direct measures for self-respondents (n = 6,651) and proxy evaluations for the others (n = 792). We used a two-part model to predict the likelihood of using various health services and to evaluate intensity of care among users.

RESULTS: Sixteen percent, 64%, and 20% of the sample fell into the low, moderate, and high cognitive function groups, respectively, that differed significantly on almost all demographic and health status measures, and some utilization measures. Controlling for other health and functional status measures, lower cognitive function had a significant and negative effect on outpatient services, but did not affect hospital use directly.

DISCUSSION: Lower cognitive function may be a barrier to outpatient care, but these analyses should be repeated using administrative use and cost data.

%B J Gerontol B Psychol Sci Soc Sci %I 58B %V 58 %P S38-49 %8 2003 Jan %G eng %N 1 %L pubs_2003_Walsh_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12496307?dopt=Abstract %4 Cognitive Function/Health Care Utilization %$ 13572 %R 10.1093/geronb/58.1.s38 %0 Journal Article %J The Journal of Human Resources %D 2003 %T The Effects of Health Events on the Economic Status of Married Couples %A Stephen Wu %K Adult children %K Employment and Labor Force %K Health Conditions and Status %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper uses measures of exogenous health shocks to identify the different channels through which changes in health conditions affect income, wealth, and consumption behavior. The results indicate that serious health conditions have strong effects on household wealth, but that the effects for women are larger and more significant than the effects for men. The source of the asymmetry arises from the fact that general living expenses increase when wives become seriously ill, while for husbands, health shocks do not affect these expenditures. %B The Journal of Human Resources %I 38 %V 38 %P 219-230 %G eng %N 1 %4 Health/Retirement/Labor Force/Marriage/Economic Status %$ 6580 %0 Journal Article %J Journal of the American Geriatrics Society %D 2003 %T Functional Status and Health Outcomes in Older Americans with Diabetes: Should diabetes management be targeted to health status? %A Caroline S Blaum %A Mary Beth Ofstedal %A Kenneth M. Langa %A Linda A. Wray %K Diabetes Mellitus %K Functional status %K Older Adults %X OBJECTIVES: To determine how baseline functional status affects health outcomes in older adults with diabetes mellitus (DM). DESIGN: Nationally representative cross‐sectional and longitudinal health interview survey. SETTING: Waves I (1993) and II (1995) of the Assets and Health Dynamics of the Oldest Old Survey (AHEAD) in the United States. PARTICIPANTS: AHEAD respondents aged 70 and older (n = 7,447, including 995 with DM). MEASUREMENTS: At baseline, the entire sample was divided into three groups: high‐functioning group, defined as having no physical limitations or instrumental activities of daily living/activities of daily living (IADL/ADL) disabilities (39%); low‐functioning group, having three or more limitations or IADL/ADL disabilities (24%); and intermediate‐functioning group, those in the middle (36%). Older adults with and without DM, within each of the functioning groups, were compared at 2‐year follow‐up with respect to demographic characteristics, weight/body mass index, baseline and incident chronic diseases and conditions, and follow‐up functioning. RESULTS: Of people aged 70 and older, 28% with DM and 41% without were high functioning; 38% with DM and 22% without were low functioning (both P < .001). High‐functioning people with DM remained high functioning at 2 years but had a significantly higher incidence of heart disease and mortality than high‐functioning people without DM. Low‐functioning people with DM were significantly more likely to have vascular comorbidities at baseline than low‐functioning people without DM, but their 2‐year outcomes were similar. The intermediate‐functioning group showed the most differences between those with and without DM; those with DM were significantly (P < .01) more likely to have baseline vascular disease, low cognitive performance, increased incident vascular disease, and significantly worse 2‐year functioning and to have experienced falls (P < .001). CONCLUSION: Differences in baseline functional status in older adults with DM were associated with outcome differences. High‐functioning older people with DM tended to remain high functioning but demonstrated significantly higher incidence of heart disease and mortality than those without DM, whereas low‐functioning people with and without DM had similar outcomes. However, intermediate‐functioning older diabetics had worse health and functioning outcomes than a similarly impaired group without DM. DM management adjusted to functional status can potentially address the most‐relevant outcomes in the heterogeneous older population with DM. %B Journal of the American Geriatrics Society %I 51 %V 51 %P 745-53 %G eng %N 6 %4 Diabetes/Health Status %$ 12802 %R 10.1046/j.1365-2389.2003.51256.x %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2003 %T Immigrant status, living arrangements, and depressive symptoms among middle-aged and older adults. %A Janet M Wilmoth %A Pei-Chun Chen %K Acculturation %K Aged %K Cross-Sectional Studies %K depression %K Emigration and Immigration %K Female %K Follow-Up Studies %K Humans %K Male %K Middle Aged %K Quality of Life %K Residence Characteristics %X

OBJECTIVES: This research draws from social integration theory to explain the relationship between living arrangements and depressive symptoms among middle-aged and older adults. Particular attention is given to identifying differences between nonimmigrants and immigrants.

METHODS: The data come from the baseline and first 2-year follow-up of the Health and Retirement Study, which were collected in 1992 and 1994. The analysis is based on 6,391 primary respondents who were aged 51 to 61 at the baseline. Descriptive statistics, cross-sectional ordinary least squares regression models, and longitudinal residualized regression models are estimated for the entire sample and by immigrant status.

RESULTS: Living arrangements and immigrant status interact to influence depressive symptoms. The results confirm that depressive symptoms are higher among those who live alone, particularly among immigrants. Living with family or others is related to higher cross-sectional levels of depressive symptoms, especially for immigrants, and greater longitudinal increases in depressive symptoms among nonimmigrants.

DISCUSSION: The results highlight the important influence of social integration on mental health while demonstrating that context shapes the effect of social integration. They suggest that interventions should promote social integration, particularly among older adults living alone or with family or others. However, those programs should be sensitive to the unique needs of native-born and immigrant populations.

%B J Gerontol B Psychol Sci Soc Sci %I 58B %V 58 %P S305-13 %8 2003 Sep %G eng %N 5 %L pubs_2003_Wilmoth-Chen.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/14507941?dopt=Abstract %4 Immigrants/Living Conditions/Depression %$ 13552 %R 10.1093/geronb/58.5.s305 %0 Report %D 2003 %T The Impact of Poor Health Behaviors on Workforce Disability %A Richardson, Caroline R. %A Jennifer T. Hanlon %A Hillary J. Mull %A Sandeep Vijan %A Rodney A. Hayward %A Linda A. Wray %A Kenneth M. Langa %K Disabilities %K Health Behavior %K Labor force participation %K Older Adults %X The effects of poor health habits on mortality have been studied extensively. However, few studies have examined the impact of these health behaviors on workforce disability. In the Health and Retirement Study, a nationally representative cohort of 6044 Americans who were between the ages of 51 and 61 and who were working in 1992, we found that both baseline smoking status and a sedentary lifestyle predict workforce disability six years later. If this relationship is causal, cost-benefit analyses of health behavior intervention that neglect workforce disability may substantially underestimate the benefits of such interventions. %I University of Michigan Retirement Research Center %C Ann Arbor %P 1-22 %8 06/2003 %G eng %U https://core.ac.uk/download/pdf/7189096.pdf %0 Journal Article %J Milbank Q %D 2003 %T The labor market consequences of race differences in health. %A John Bound %A Timothy A Waidmann %A Michael Schoenbaum %A Bingenheimer,Jeffrey B. %K Adult %K Age Distribution %K Age Factors %K Attitude to Health %K Black or African American %K Cross-Cultural Comparison %K Data Interpretation, Statistical %K Employment %K Female %K Health Services Needs and Demand %K Health Status Indicators %K Humans %K Indians, North American %K Male %K Middle Aged %K Sex Distribution %K Sex Factors %K Socioeconomic factors %K United States %K White People %B Milbank Q %I 81 %V 81 %P 441-73 %8 2003 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/12941003?dopt=Abstract %4 Racial Differences/Health Status/labor market behavior %$ 12222 %R 10.1111/1468-0009.t01-1-00063 %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 Journal Article %J Social and Preventative Medicine %D 2003 %T Patterns of Body Weight in Middle-Aged and Older Americans by Gender and Race, 1993-2000 %A Kristi Rahrig Jenkins %A Fultz, Nancy H. %A Stephanie J. Fonda %A Linda A. Wray %K Demographics %K Health Conditions and Status %X Objectives: Despite evidence of poor health outcomes associated with excessive weight gain or loss, longitudinal patterns of body weight over the adult life course have not been fully described. This article seeks to address this by examining body weight patterns for middle-aged and older adults.Methods: Panel data from the Health and Retirement Study (HRS) original cohort and the original cohort of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study are used to compare, by social group, characteristics of respondents and non-respondents, baseline weight (1993 and 1994) to year 2000 weight, and explore various weight change trajectories over time.Results: Overall, a greater proportion of middle-aged adults are heavier over time than at baseline and a greater proportion of older adults lose weight over time compared to baseline. Examining the transitions across weight trajectories for all of the social groups suggests considerable variability.Con clusions: These findings suggest that differing physiologic and social or environmental experiences may have implications for body weight patterns. Understanding these patterns by race/ethnicity and gender could provide insight into health disparities among different social groups. %B Social and Preventative Medicine %I 48 %V 48 %P 257-268 %G eng %N 4 %4 United States/Obesity/Body Mass Index/Adults %$ 11922 %R https://doi.org/10.1007/s00038-003-2053-3 %0 Report %D 2003 %T Portfolio Choice and Health Status %A Rosen, Harvey S. %A Stephen Wu %K Health Conditions and Status %K Net Worth and Assets %X This paper analyzes the role that health status plays in household portfolio decisions using data from the Health and Retirement Study. The results indicate that health is a significant predictor of both the probability of owning different types of financial assets and the share of financial wealth held in each asset category. Households in poor health are less likely to hold risky financial assets, other things (including the level of total wealth) being the same. Poor health is associated with a smaller share of financial wealth held in risky assets and a larger share in safe assets. We find no evidence that the relationship between health status and portfolio allocation is driven by 'third variables' that simultaneously affect health and financial decisions. Further, the relationship between health status and portfolio choice does not appear to operate through the effect of poor health on individuals' attitudes toward risk, their planning horizons, or their health insurance status. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %U http://papers.ssrn.com/paper.taf?abstract_id=375305 %L wp_2003/Rosen-Wu.pdf %4 Health Status/Stock Market/Assets/Wealth %$ 10102 %0 Report %D 2003 %T The Role of Marital History, Early Retirement Benefits, and the Economic Status of Women %A Tay K. McNamara %A Regina O'Grady-LeShane %A Williamson, John B. %K Adult children %K Net Worth and Assets %K Women and Minorities %X This article compares the relative economic status of women who take and postpone taking early Social Security benefits, with particular attention to the role of marital history. Marital history categories discussed include: lifelong marriages, marriages in which the woman had been previously divorced or widowed, divorced, widowed, and never married. The results presented here should be useful in evaluating the potential consequences of increasing the Earliest Entitlement Age (EEA). While increasing the EEA would not cause economic hardship for many, it may have adverse effects on divorced and widowed women who generally are at greater risk of poverty than married women. The economic effects of prior divorce or widowhood are reflected in the lower financial resources of women who remarry. ( 2003, by Tay K. McNamara, Regina O Grady-LeShane, and John B. Williamson.) %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/the-role-of-marital-history-early-retirement-benefits-and-the-economic-status-of-women/ %L wp_2003/CRRwp_2003-01.pdf %4 Economic Status/Women/Marital History %$ 10062 %0 Journal Article %J J Health Econ %D 2003 %T Sickness and preventive medical behavior. %A Stephen Wu %K Aged %K Anxiety %K Breast Self-Examination %K Cholesterol %K Female %K Health Behavior %K Health Expenditures %K Health Status %K Humans %K Influenza Vaccines %K Male %K Mammography %K Mass Screening %K Middle Aged %K Papanicolaou Test %K Patient Acceptance of Health Care %K Preventive Health Services %K Primary Prevention %K Prostatic Neoplasms %K Retirement %K Risk Factors %K Vaginal Smears %X

Using data from two sources, the Health and Retirement Study (HRS) and the Medical Expenditure Panel Survey (MEPS), I analyze the relationship between health status and the likelihood of engaging in medical screening and other preventive behavior. The results show that individuals who are in poorer health are more likely to get flu shots and cholesterol checks, but less likely to have mammograms, pap smears, breast examinations and prostate checks. There is some evidence that suggests that psychological factors such as fear and anxiety may be important reasons why sicker people are less likely to get cancer screens.

%B J Health Econ %I 22 %V 22 %P 675-89 %8 2003 Jul %G eng %N 4 %L pubs_2003_Wu_SHealthEcon.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12842321?dopt=Abstract %4 Health Status--physical, mental, and emotional/screening/prevention/anxiety %$ 11032 %R 10.1016/S0167-6296(03)00042-0 %0 Journal Article %J Journal of Human Resources %D 2003 %T Special Issue on Cross-National Comparative Research Using Panel Surveys (Introduction) %A James P Smith %A Stafford, Frank %A Walker, James R. %K Households %K retirement savings %K Wealth %K Workforce %X Until recently, international comparative research had a poor reputation, especially in economics. Panel surveys comparable to those in the United States either did not exist or were viewed as being of low quality. However, the number and quantity of international panels surveys are improving rapidly and in many dimensions will soon exceed those of their U.S. counterparts, particularly as foreign-born academics trained in the United States use data from their home countries in their research. This article introduces a series of papers presented at a conference on comparative international research using panel surveys, which took place in Ann Arbor, Michigan in October 2000. Its goal was to encourage researchers in the social sciences to use panel surveys to address critical scientific and policy issues that would be better informed by international comparisons and the variation in policy environments across countries. Five of the seven papers explicitly or implicitly examine international differences in savings behavior and wealth accumulation; the two remaining papers use international comparisons to assess the status of young children. %B Journal of Human Resources %I 38 %V 38 %P 231-240 %G eng %N 2 %4 Longitudinal Studies/Panel Data/Cross Cultural Comparison %$ 11512 %R 10.2307/1558744 %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 Book Section %B Public Policies and Private Pensions %D 2003 %T What People Don't Know About Their Pensions and Social Security: An Analysis Using Linked Data from the Health and Retirement Study %A Alan L Gustman %A Thomas L. Steinmeier %E William G. Gale %E John B. Shoven %E Mark J. Warshawsky %K Consumption and Savings %K Employment and Labor Force %K Income %K Pensions %K Retirement Planning and Satisfaction %K Social Security %X Pension plan descriptions from respondents to the 1992 Health and Retirement Study are compared with descriptions obtained from their employers. Earnings histories reported by respondents are compared with earnings histories from the Social Security Administration. The probability of linking employer pension data, which is two thirds for current jobs, and of obtaining permission to link an earnings history, which is over 70 percent, are not well explained by respondent characteristics. Half of respondents with linked pension data correctly identify plan type, and fewer than half identify, within one year, dates of eligibility for early and normal retirement benefits. Benefit reduction rates are essentially not reported. Respondents do better in reporting pension values, but the unexplained variation is still considerable. In contrast, respondent reported values together with other observables, account for 80 percent of the variation in pension values and 75 percent of the variation in covered earnings measured from linked records. Thus prospects are good for imputing plan values, but not for imputing the location or size of early retirement incentives. Our findings raise questions about how well respondents understand complex pension and Social Security rules. %B Public Policies and Private Pensions %I Brookings Institution %C Washington, DC %P 57-125 %G eng %U https://www.nber.org/papers/w7368 %4 Personal Income and Wealth Distribution/Social Security and Public Pensions/Economics of the Elderly/Retirement/Retirement Policies/Nonwage Labor Costs and Benefits/Private Pensions/Pension/Social Security/Retirement/Income Distribution/Nonwage Benefits %$ 1116 %+ National Bureau of Economic Research Working Paper 7368. Copies available from: National Bureau of Economic Research, 1050 Massachusetts Avenue, Cambridge, MA 02138. Website: www.nber.org %0 Report %D 2003 %T Widowhood, Divorce and Loss of Health Insurance Among Near-Elderly Women: Evidence from the Health and Retirement Study %A David R Weir %A Robert J. Willis %K Adult children %K Demographics %K Medicare/Medicaid/Health Insurance %K Net Worth and Assets %K Women and Minorities %X We have found modest effects of widowhood events on loss of health insurance. There are also modest effects of widowhood on labor supply, which we have not as yet attempted to attribute to insurance demand. Even new widowhood events, however, are not random with respect to initial conditions. Both initial health insurance status and risk of future widowhood are related to basic characteristics observed when married at baseline. When these confounding variables are controlled for in models of the effect of widowhood events on uninsurance, there is no longer statistical evidence of an independent effect of husband's death on risk of losing insurance. Part of the reason why the measured independent effect of widowhood appears small is that there are events within marriage that can also affect insurance coverage, such as retirement or health events. Even though the number of uninsured women whose lack of coverage can be attributed to widowhood is therefore small, and not a distinct major policy motive for changes in age of eligibility for Medicare, uninsurance rates overall among the near elderly, and the potential public burden of cost-shifting from years just before 65 to years just after gaining Medicare coverage, suggest that Medicare eligibility policies should be a focus of continued research. %B Michigan Retirement Research Center Research Paper %I Michigan Retirement Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=1090894 %4 Widowhood/Divorce/Health Insurance Coverage/Middle Aged Adults/Women %$ 6657 %0 Report %D 2003 %T Work Disability Among Non-Elderly Adult Males: The United States, 1893-2001 %A Sven E. Wilson %A Burton, Joseph %A Benjamin L. Howell %K Disabilities %I Brigham Young University %G eng %4 Disability/Disability %$ 12172 %0 Book Section %B Innovations in Retirement Financing %D 2002 %T Aging and Housing Equity %A Steven F Venti %A David A Wise %E Zvi Bodie %E P. Brett Hammond %E Olivia S. Mitchell %E Stephen P. Zeldes %K Housing %B Innovations in Retirement Financing %I University of Pennsylvania Press/Pension Research Council %C Philadephia, PA %G eng %U http://www.nber.org/papers/w7882 %L wp_2000/Venti-Wise_NBER_W7882.pdf %4 Housing Equity %$ 12352 %+ Revision of NBER Working Paper 7882 %! Aging and Housing Equity %0 Journal Article %J Journal of Marriage and Family %D 2002 %T Does Marital History Matter? Marital Status and Wealth Outcomes Among Preretirement Adults %A Janet M Wilmoth %A Koso, G. %K Adult children %K Demographics %K Event History/Life Cycle %K Net Worth and Assets %B Journal of Marriage and Family %I 64 %V 64 %P 254-268 %G eng %N 1 %L pubs_2002_Wilmonth_JJMandF.pdf %4 Marital Status/Wealth/Sex Differences/Life Cycle/Life Events/Adults/Marriage/the family and socialization/sociology of the family, marriage and divorce %$ 8536 %R https://doi.org/10.1111/j.1741-3737.2002.00254.x %0 Report %D 2002 %T The Effect of Unplanned Changes in Marital and Disability Status: Interrupted Trajectories and Labor %A Williamson, John B. %A Tay K. McNamara %K Adult children %K Disabilities %K Employment and Labor Force %X This study explored the effect of unplanned changes in disability and marital status on labor force participation for a sample of just under six thousand men and women born between 1931 and 1941. It was based on wave 1 (1992) through wave 4 (1998) of the Health and Retirement Study (HRS) data. Binomial hierarchical linear models were used to evaluate the change in the probability of working. Unplanned changes in disability and marital status had effects on labor force participation over and above the effects of the statuses themselves. These findings highlight the need for employer and government policies that minimize the stress that exists with unplanned events. Such policies might encourage higher labor force participation among workers who experience unplanned events that prompt them to exit the labor force earlier than they otherwise would have, with potentially adverse consequences for their subsequent socioeconomic status. %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/the-effect-of-unplanned-changes-in-marital-and-disability-status-interrupted-trajectories-and-labor/ %L wp_200/CRRwp_2002-05.pdf %4 Disability/Disability/Marital Status/Labor Force Participation %$ 15140 %0 Journal Article %J Population Research and Policy Review %D 2002 %T Good Marriages Gone Bad: Health mismatches as a cause of later-life marital dissolution %A Sven E. Wilson %A Waddoups, S.L. %K Adult children %K Health Conditions and Status %X This study explores the impact of health status on marital dissolution for couples in late mid-life. A key feature of the empirical framework is that it incorporates the interaction of health between the spouses. This specification allows not only a general test of whether health matters but also a specific test of an important implication of cost-benefit models of marriage dissolution. In particular, cost-benefit models imply that marriages exhibiting a health mismatch (where one partner has substantially better health than the other one) are more likely to get divorced than couples who have similar health (whether good or bad). Using a Cox proportional hazards model, we test this hypothesis by estimating the impact of different spousal health combinations on the probability of marital dissolution (as indicated by separation). Data are taken from four waves of the Health and Retirement Study (19921998) and consist of 4, 241 couples where at leas t one spouse is between the ages of 51 and 61 in 1992. We do find evidence for the health mismatch hypothesis, but only among couples in which both couples report their marriages to be very satisfying. Among other couples, no effect is found. This suggests that health is of minor consequence for already unhappy couples, but health mismatches pose a significant risk of dissolution to happy couples within this age cohort, possibly because of the unexpected nature of poor health at a relatively young age. %B Population Research and Policy Review %I 21 %V 21 %P 505-533 %G eng %N 6 %4 Divorce/Aging/Health Status %$ 11882 %R https://doi.org/10.1023/A:1022990517611 %0 Journal Article %J Soc Sci Med %D 2002 %T The health capital of families: an investigation of the inter-spousal correlation in health status. %A Sven E. Wilson %K Activities of Daily Living %K Chronic disease %K Decision making %K Female %K Health Behavior %K Health Status Indicators %K Humans %K Interviews as Topic %K Life Style %K Male %K Marital Status %K Middle Aged %K Regression Analysis %K Risk Factors %K Risk-Taking %K Self Efficacy %K Sociology, Medical %K Spouses %K United States %X

This study documents and analyzes the inter-spousal correlation in health status (ISCIHS) among married couples in later life. A simple economic theory is developed that integrates standard theories of marriage markets and health capital formation. This theory implies that several causal factors will lead to a positive correlation in the health status of spouses. These include assortative matching in the marriage market along dimensions related to health (such as education); a tendency to share common life-style behaviors such as diet, smoking and exercise; shared environmental risk factors for disease; and a potential for direct effects of the health of one spouse on the health of the other. Empirical estimates using the 1992 Health and Retirement study in the USA demonstrate that ISCIHS is large in magnitude, highly statistically significant, and robust to alternative measures of health status. ISCIHS exists even after controlling for age, education, income, and other socioeconomic and demographic determinants of health status, including behavioral risk factors. These covariates reduce the overall correlation coefficient by 33% to 57%, depending on the health measure, which suggests both that marriage formation and decision making processes systematically affect health in later life and that heretofore unidentified risk factors for disease and disability exist at the household level.

%B Soc Sci Med %I 55 %V 55 %P 1157-72 %8 2002 Oct %G eng %N 7 %L pubs_2002_Wilson_SSocSciMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12365528?dopt=Abstract %4 Health production/Economics of the family/Marriage markets/Shared risks %$ 11782 %R 10.1016/s0277-9536(01)00253-2 %0 Journal Article %J J Health Soc Behav %D 2002 %T Health in household context: living arrangements and health in late middle age. %A Mary Elizabeth Hughes %A Linda J. Waite %K Activities of Daily Living %K Depressive Disorder %K Family Characteristics %K Family Health %K Female %K Health Status Indicators %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Middle Aged %K Self Efficacy %K United States %X

People living in some arrangements show better health than persons in other living arrangements. Recent prospective studies document higher mortality among persons living in particular types of households. We extend this research by examining the influence of household structure on health using longitudinal data. We theorize that individuals experience role-based household relations as sets of resources and demands. In certain household structures, individuals are more likely to perceive that the demands made on them outweigh the resources available to them. This perceived imbalance poses a risk to individual health. We test our expectations by analyzing the relationship between living arrangements and health using data from waves 1 and 2 of the Health and Retirement Study. We focus on persons ages 51-61 and explore gender differences. We find prospective links between household structure and self-rated health, mobility limitation, and depressive symptoms. Married couples living alone or with children only are the most advantaged; single women living with children appear disadvantaged on all health outcomes. Men and women in other household types are disadvantaged on some health outcomes. Our results suggest that the social context formed by the household may be important to the social etiology of health. In addition, they qualify the well-known link between marital status and health: The effect of marital status on health depends on household context.

%B J Health Soc Behav %I 43 %V 43 %P 1-21 %8 2002 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/11949193?dopt=Abstract %4 Family Structure/Health/Living Conditions/Middle Aged Adults/Sex Differences/Households %$ 1234 %R 10.2307/3090242 %0 Journal Article %J Social Security Bulletin %D 2002 %T How Policy Variables Influence the Timing of Social Security Disability Insurance Applications %A R.V. Burkhauser %A Butler, J.S. %A Robert R. Weathers II %K Disabilities %K Social Security %X This article analyzes the impact of policy variables—employer accommodations, state Social Security Disability Insurance (DI) allowance rates, and DI benefits— on the timing of an application for DI benefits by workers with a work-limiting health condition starting when their health condition first begins to bother them. The analysis uses a rich mixture of personal and employer characteristics from the Health and Retirement Study linked to Social Security administrative records. %B Social Security Bulletin %I 64 %V 64 %P 52-83 %G eng %U https://www.ssa.gov/policy/docs/ssb/v64n1/v64n1p52.pdf %N 1 %4 Social Security/Disability/Disability %$ 10232 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2002 %T Informal caregiving for diabetes and diabetic complications among elderly americans. %A Kenneth M. Langa %A Sandeep Vijan %A Rodney A. Hayward %A M.E. Chernew %A Caroline S Blaum %A Mohammed U Kabeto %A David R Weir %A Steven J. Katz %A Robert J. Willis %A A. Mark Fendrick %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Costs and Cost Analysis %K Diabetes Complications %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Surveys %K Humans %K Hypoglycemic Agents %K Insulin %K Male %K Time Factors %X

OBJECTIVES: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care.

METHODS: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM.

RESULTS: Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p <.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM.

DISCUSSION: Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease.

%B J Gerontol B Psychol Sci Soc Sci %I 57B %V 57 %P S177-86 %8 2002 May %G eng %N 3 %L pubs_2002_Langa_KJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11983744?dopt=Abstract %4 Aged, 80 and Over/Caregivers/Cost of Illness/Costs and Cost Analysis/Diabetes Mellitus/Complications/Therapy/Disabled Persons/Female/Health Surveys/Hypoglycemic Agents/Insulin/Support, Non U.S. Government/Support, U.S. Government--non PHS/Support, U.S. Government--PHS/Time Factors %$ 4080 %R 10.1093/geronb/57.3.s177 %0 Journal Article %J J Aging Health %D 2002 %T It takes two: marriage and smoking cessation in the middle years. %A Melissa M Franks %A Pienta, Amy M. %A Linda A. Wray %K Female %K Health Behavior %K Humans %K Male %K Marital Status %K Marriage %K Middle Aged %K Smoking cessation %K Social Support %K Spouses %X

OBJECTIVES: In this prospective study of smoking cessation among married individuals in midlife we examine correspondence in the change of each partner's smoking status with that of the other, independent of established psychosocial correlates of smoking cessation.

METHODS: Using longitudinal data from the first two waves of the Health and Retirement Study, 1992-1994, hierarchical logistic regression models were estimated for married male and female smokers separately.

RESULTS: Findings support our hypothesis of correspondence in the smoking cessation of married male and female smokers net of other sociodemographic, health, and health behavior characteristics.

DISCUSSION: These findings suggest that initiation and maintenance of this positive lifestyle change may be more easily achieved when both marital partners are given information and support to quit smoking at the same time.

%B J Aging Health %I 14 %V 14 %P 336-54 %8 2002 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/12146510?dopt=Abstract %4 Smoking Cessation %$ 11832 %R 10.1177/08964302014003002 %0 Journal Article %J Parkinsonism Relat Disord %D 2002 %T Linking clinical variables to health-related quality of life in Parkinson's disease. %A Elizabeth A Chrischilles %A Linda M. Rubenstein %A Voelker, Margaret D. %A Robert B Wallace %A Rodnitzky, Robert L. %K Aged %K Cross-Sectional Studies %K Female %K Health Status %K Humans %K Male %K Mental Health %K Middle Aged %K Parkinson Disease %K Quality of Life %X

OBJECTIVE: Identify the point-in-time relationship between Parkinson's disease (PD) signs and symptoms and measures of health-related quality of life (HRQL).

BACKGROUND: Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms.

DESIGN/METHODS: A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews.

RESULTS: The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures.

CONCLUSION: PD patients' well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment.

%B Parkinsonism Relat Disord %I 8 %V 8 %P 199-209 %8 2002 Jan %G eng %N 3 %L pubs_2002_Chrischilles_EParkandRelDis.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12039432?dopt=Abstract %4 Health Status/Mental Health/Quality of Life/Parkinson disease %$ 11742 %R 10.1016/s1353-8020(01)00044-x %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 Report %D 2002 %T Social Security, Pensions and the Savings and Retirement Behavior of Households %A van der Klaauw, Wilbert %A Wolpin, Kenneth I. %K Consumption and Savings %K Employment and Labor Force %K Methodology %X In this paper we formulate and estimate an explicit sequential decision model of savings and work behavior of elderly individuals and couples. More specifcally, we develop a stochastic dynamic model of retirement behavior in which forward-looking individuals are making employment and savings decisions in a setting that accounts for uncertainty about future labor market opportunities, health insurance coverage, health status, survival, and the future generosity of the social security system. The choice environment is characterized by an incomplete health insurance market, the presence and characteristics of employer provided health insurance and private pension plans, the Social Security and Medicare insurance system, and a capital market which applies borrowing limits. The model is estimated using longitudinal data from the Health and Retirement Study. The estimates are used to evaluate the importance of potential earnings, health, social security benefits and employer provided health insurance coverage and pensions in explaining observed retirement behavior, and to simulate the impact of potential social security reforms on life cycle employment and savings behavior and on welfare. %I University of North Carolina at Chapel Hill %G eng %L wp_2002/vanderKlaauw.pdf %4 Savings/Work Behavior/Models, Statistical %$ 10492 %0 Journal Article %J Southern Economic Journal %D 2002 %T Upstream Intergenerational Transfers %A Frank A Sloan %A Zhang, Harold H. %A Wang, Jingshu %K Altruism %K Error rates %K Expected values %K Nursing homes %K Older Adults %K Parents %K Siblings %K Standard of living %K Wage rate %X This study analyzes upstream intergenerational transfers from middle-aged children to their elderly parents. We formulate a model in which the middle-aged child transfers both money and time to an elderly parent based on an altruistic motive. We examine substitution between financial transfers and time transfers using data from the Health and Retirement Study (HRS). Empirical results support the assumption that upstream transfers are motivated by altruism, particularly financial transfers. Parents financially worse off than their middle-aged children receive more money. They are more likely to live nearby if not coresident. Overall, the results for time transfers provide weaker support for our model than financial transfers. A child with a high wage tends to transfer money rather than time, suggesting that the two types of transfers are partial substitutes. Reprinted by permission of the publisher. %B Southern Economic Journal %I 69 %V 69 %P 363-80 %G eng %N 2 %L pubs_2002_Sloan_FSouthEconJourn.pdf %4 Intergenerational Transfers %$ 10282 %R 10.2307/1061677 %0 Report %D 2002 %T Who Becomes a Stockholder? Expectations, Subjective Uncertainty, and Asset Allocation %A Kezdi, Gabor %A Robert J. Willis %K Net Worth and Assets %B MRDRC Publications %I Michigan Retirement and Disability Research Center, University of Michigan %C Ann Arbor, MI %G eng %U https://mrdrc.isr.umich.edu/pubs/who-becomes-a-stockholder-expectations-subjective-uncertainty-and-asset-allocation/ %L wp_2002/Kezdi-Willis_NBER.pdf %4 Assets/Stock Market %$ 6656 %0 Book Section %B Assets for the Poor: The Benefits of Spreading Asset Ownership %D 2001 %T Access to wealth among older workers in the 1990s and how it is distributed: Data from the Health and Retirement Study %A R.V. Burkhauser %A Robert R. Weathers II %E Shapiro, Thomas M. %E Wolfe, Edward N. %K Demographics %K Income %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Older American laborers' access to financial assets is investigated. Data from the Health and Retirement Study are analyzed to determine whether older workers had access to wealth and how financial assets were distributed among older working Americans. Three categories of wealth for older working Americans are identified: home equity, social security compensation, and employer pensions. Several findings regarding (1) the connection between wealth distribution, poverty, and income; (2) the occupational and racial characteristics of wealth deciles; (3) discrepancies in the asset holdings across wealth deciles; (4) changes in the wealth accumulation of older working Americans between 1992 and 1996; and (5) changes in income mobility over the same period. Several methodological recommendations for future research on wealth distribution are offered, eg, taking the size of one's household into consideration since the head of household may not have access to all of the household's wealth. 17 Tables, 1 Figure, 1 Appendix. J. W. Parker %B Assets for the Poor: The Benefits of Spreading Asset Ownership %I Russell Sage Press %C New York %P 74-131 %G eng %4 Income Inequality/Income Distribution/Elderly/Poverty/United States/Wealth/Retirement/Wealth %$ 1244 %! Access to Wealth among Older Workers in the 1990s and How It Is Distributed: Data from the Health and Retirement Study %0 Journal Article %J Journal of Health Economics %D 2001 %T Adapting to Heart Conditions: A Test of the Hedonic Treadmill %A Stephen Wu %K Consumption and Savings %K Disabilities %K Health Conditions and Status %X This paper tests the hypothesis of hedonic adaptation by analyzing the role that a history of heart problems has on the ability to deal with future heart conditions. The results show that those who have had a heart condition in the past are less likely to report worse self-assessed health and emotional health due to the onset of a new condition than those who have not previously had exposure to heart trouble. The results are fairly supportive of the notion of a hedonic treadmill. %B Journal of Health Economics %I 20 %V 20 %P 495-508 %G eng %U http://www.elsevier.com/inca/publications/store/5/0/5/5/6/0/index.htt %N 4 %L pubs_2001_Wu_SJHE.pdf %4 Health Status/Health Behavior/Disability/Disability/Economic Behavior/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Health %$ 1066 %0 Book Section %B Themes in the Economics of Aging %D 2001 %T Anticipated and Actual Bequests %A Michael D Hurd %A James P Smith %E David A Wise %K Adult children %K Consumption and Savings %K Demographics %K Event History/Life Cycle %K Health Conditions and Status %X This paper uses data on anticipated bequests from two waves of the Health and Retirement Study and the Asset and Health Dynamics of the Oldest Old (AHEAD), and on actual bequests from AHEAD. Actual bequests were measured in exit interviews given by proxy respondents for 774 AHEAD respondents who died between waves 1 and 2. Because the exit interview is representative of the elderly population, the distribution of estate values is quite different from that obtained from estate records, which represent just a wealthy subset of the population. Anticipated bequests were measured by the subjective probability of leaving bequests. Between waves 1 and 2, increases in bequest probabilities were associated with increases in the subjective probability of surviving, increments in household wealth, and widowing while out-of-pocket medical expenses reduced the likelihood of a bequest. By comparing bequest probabilities with baseline wealth we were able to test a main prediction of the life-cycle model, that individuals will dissave at advanced old-age. The AHEAD respondents anticipate substantial dissaving before they die. %B Themes in the Economics of Aging %I University of Chicago Press %C Chicago, IL %G eng %U http://www.nber.org %4 Altruism/Intertemporal Consumer Choice/Life Cycle Models and Saving/Health Production--Nutrition, Mortality, Morbidity, Disability, and Economic Behavior/Economics of the Elderly/Bequests/Elderly/Life Cycle Models/Dissaving/Estate Values/Health %$ 1118 %+ NBER Working Paper 7380. Copies available from: National Bureau of Economic Research, 1050 Massachusetts Avenue, Cambridge, MA 02138. %! Anticipated and Actual Bequests %0 Book Section %B Themes in the Economics of Aging %D 2001 %T Are the Elderly Really Over-Annuitized? New Evidence on Life Insurance and Bequests %A Brown, Jeffrey R. %E David A Wise %K Adult children %K Demographics %K Insurance %K Net Worth and Assets %X This paper assesses the validity of the claim that elderly individuals with strong bequest motives purchase term life insurance to offset mandatory annuitization by the Social Security System. The annuity offset model is re-examined using better, more recent data. Results demonstrate that the elderly do not hold life insurance to offset mandated annuitization. All four of the major implications of the annuity offset model fail empirical testing. The model does not explain life insurance behavior of elderly households and the fact that many elderly households own term life insurance is not a sufficient reason to argue against mandatory annuitization of retirement resources. Further research is being conducted using the AHEAD data in order to find other explanations for why the elderly hold life insurance. %B Themes in the Economics of Aging %I University of Chicago Press %C Chicago %G eng %U http://www.nber.org/papers/w7193 %4 Life Insurance Coverage/Economic Status/Bequest Motives/Basic Demographics %$ 8430 %+ AHEAD 1993 %! Are the Elderly Really Over-Annuitized? New Evidence on Life Insurance and Bequests %0 Journal Article %J Journal of Business and Psychology %D 2001 %T Balancing Elder Care Responsibilities and Work: The Impact on Emotional Health %A Lee, Jo Ann %A Walker, Matthew %A Shoup, Richard %K Adult children %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %X As the elderly population over 85 and the amount of women in the workforce both rise there is an increasing number of persons that must divide their time between working and caring for an elderly relative. These researchers hypothesize that (1a) the relationship between caregiver status and emotional health will be resultant on whether or not the respondent is employed; (1b) those people that are caregivers and employed are expected to have more problems with emotional stability; (2) these problems will grow as the caregiver becomes more involved with the elderly person; and (3) male caregivers are expected to fair better, emotionally, than female caregivers. They found mixed support for hypothesis 1a and no support for hypothesis 1b. However, hypothesis 2 was supported as more emotional difficulties evolved when a caregiver became more involved with the elderly person. Hypothesis 3, found support in that depression was more prevalent in the women caregivers than the men, but other emotional factors did not show significant relationships. %B Journal of Business and Psychology %I 16 %V 16 %P 277-289 %G eng %N 2 %L pubs_2001_Lee_JJBP.pdf %4 Labor Force Participation/Health Status/Caregiver Status/Family/Transfers %$ 8564 %R 10.1023/A:1011165318139 %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 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2001 %T Changes in driving patterns and worsening depressive symptoms among older adults. %A Stephanie J. Fonda %A Robert B Wallace %A A. Regula Herzog %K Activities of Daily Living %K Adaptation, Psychological %K Aged %K Aged, 80 and over %K Automobile Driving %K depression %K Female %K Humans %K Male %K Quality of Life %K Risk Factors %K Social Environment %X

OBJECTIVES: This study examined whether changes in driving patterns-driving cessation and reduction-have negative consequences for the depressive symptoms of older Americans and whether these consequences are mitigated for people with a spouse who drives.

METHODS: The project used data from 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. Depressive symptoms were assessed with an abbreviated Center for Epidemiologic Studies-Depression scale. Using 2 models, the project examined how driving cessation and reduction that occurred between Waves 1 and 2 contributed to increases in depressive symptoms between Waves 2 and 3. The first model included the entire sample (N = 5,239), and the second model focused on drivers only (n = 3,543). A third model added interaction terms to the analysis to consider whether respondents who stopped driving but had a spouse who drove were less at risk of worsening depressive symptoms.

RESULTS: Respondents who stopped driving had greater risk of worsening depressive symptoms. Drivers who restricted their driving distances before the study began also had greater risk of worsening depressive symptoms, but seemingly less so than the respondents who stopped driving altogether. For respondents who stopped driving, having a spouse available to drive them did not mitigate the risk of worsening symptoms.

DISCUSSION: Changes in driving patterns can be deleterious for older people's depressive symptoms. Initiatives for assisting older people should focus on strategies that help them retain driving skills, that prepare them for the possible transition from driver to ex-driver, and that ensure that they have access to mental health therapies if driving changes are imminent.

%B J Gerontol B Psychol Sci Soc Sci %I 56B %V 56 %P S343-51 %8 2001 Nov %G eng %N 6 %L pubs_2001_Fonda_SJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11682595?dopt=Abstract %4 Health Status/Depressive Symptoms/Driving Patterns/Basic Demographics %$ 8496 %R 10.1093/geronb/56.6.s343 %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 Report %D 2001 %T Cognition and Wealth: The Importance of Probabilistic Thinking %A Lee A. Lillard %A Robert J. Willis %K Health Conditions and Status %K Net Worth and Assets %X Proposed reforms of Social Security that expand household choice and private sector trends away from defined benefit pension plans toward defined contribution plans offer new financial planning options. Although these options have many potential benefits for households, critics argue that many people will fail to make choices that exploit them, and, consequently, that expanded choice will increase the risks of poverty for some populations. Subjective probabilities are key in models of optimal financial planning, yet little is known about the capacity of individuals to use probabalistic thinking in this area. In the research reported here, we used a battery of subjective probability questions administered to more than 20,000 people in the Health and Retirement Study to investigate how probabalistic thinking affects portfolio choices and net worth. Our objectives are to develop a measure of competence in probabilistic thinking and to link this measure to risk aversion and financial outcomes. %I Michigan Retirement Research Center at the University of Michigan %C Ann Arbor, MI %G eng %U https://www.ssc.wisc.edu/~jkennan/teaching/Lillard-Willis_RAND1.pdf %L wp_2001/Lillard-Willis_RAND.pdf %4 Cognition/Wealth %$ 6640 %0 Journal Article %J The Gerontologist %D 2001 %T Explaining the Role of Sex on Disability: A population-based study %A Linda A. Wray %A Caroline S Blaum %K Demographics %K Disabilities %K Health Conditions and Status %K Methodology %X PURPOSE: There is no clear consensus about how sex influences prevalent disability and through what mechanisms. We investigated whether sex had a direct independent effect on disability or whether sex had an interactive effect on the relationship between chronic diseases/conditions and disability, and whether these effects differed in middle-aged versus older adults. DESIGN AND METHODS: We used baseline data from two nationally representative health interview surveys, the Health and Retirement Study (HRS) and the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD), and disability and covariate measures that were nearly identical in both surveys. Logistic regression models tested the contributions of diseases, impairments, and demographic and social characteristics on difficulties with prevalent activities of daily living (ADLs), mobility, and strength. RESULTS: Models demonstrated no direct sex effect for ADL disability in either age group after adjusting for key covariates. However, sex did exert an indirect effect on ADL disability in older adults via musculoskeletal conditions and depressive symptoms. In contrast, female sex remained strongly associated with mobility and strength disability in both age groups, net of covariates. Major interactions were also significant, including a female sex/body mass index (BMI) interaction for mobility difficulty and several sex-disease interactions for strength disability in the middle-aged group. IMPLICATIONS: The effect of sex on ADL difficulty is largely explained by social and health-related covariates in middle-aged and older adults. In contrast, the independent association of female sex with decreased strength and mobility in both groups cannot be explained by our models' social or health-related variables. In addition, the positive association of BMI with mobility difficulty is significantly worse for women than for men. %B The Gerontologist %I 41 %V 41 %P 499-510 %G eng %N 4 %L pubs_2001_Wray_LGer.pdf %4 Activities of Daily Living/Aged, 80 and Over/Body Mass Index/Chronic Disease/Disability Evaluation/Disabled Persons/Gender/Health Surveys/Middle Age/Sex Factors/Support, U.S. Government--PHS %$ 4360 %R 10.1093/geront/41.4.499 %0 Journal Article %J Journal of Consumer Affairs %D 2001 %T Giving Incentives of Adult Children Who Care for Disabled Parents %A Shelley I. White-Means %A Gong-Soog Hong %K Adult children %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Net Worth and Assets %X What motivates adult children in the United States to care for their disabled parents? This paper examines whether altruism and bequest motives influence adult childrens decisions about giving time to care for a disabled parent, giving financial resources, and giving future financial resources. Further, the paper examines the ways these different forms of giving affect caregivers' overall well-being, financial, family life, and life satisfaction. Using data from the 1992 Health and Retirement Study, we find that bequest incentives, noneconomicllly motivated altruism, the type of disability faced by the parent, and considerations of opportunity cost are key factors. They influence adult childrens decisions about employment, giving time, and giving money to support disabled parents. General well-being, financial and family life satisfaction are lower when adult children risk long term income resources by decreasing labor market participation. Giving money increases family life satisfaction for adult children who care for parents who have cognitive limitations. While giving time to care for disabled parents increases financial satisfaction among adult children, it decreases their family life satisfaction. %B Journal of Consumer Affairs %I 35 %V 35 %P 364-389 %G eng %N 2 %L pubs_2001_White-Means_SJConsAff.pdf %4 Altruism/Bequests/Family transfers, structure/Economic Status/Labor/Basic Demographics/Health Status %$ 8562 %R 10.1111/j.1745-6606.2001.tb00119.x %0 Report %D 2001 %T Health, Wealth, and Gender: Do Health Shocks of Husbands and Wives Have Different Impacts on Household Wealth? %A Jennifer L. Ward-Batts %K Adult children %K Health Conditions and Status %X The extent to which men s versus women s health affects household wealth and the mechanisms through which these effects occur have important implications for the welfare of older individuals living with a spouse, and in particular for women who are likely to outlive their husbands by several years. Intermediate mechanisms through which individual health shocks may affect household wealth are discussed. Four waves of HRS data on married couples are used to estimate the direct effect of onset of various health conditions on household wealth, with these effects allowed to differ for husbands and wives. Estimates using only wave 2 health shocks (controlling for baseline health) indicate that the impact of a health shock to the wife has a larger negative impact than a health shock to the husband, which is consistent with prior work. Estimates in which health shocks from waves 2-4 are allowed for produce conflicting results. Further research is required to ascertain the reason for this apparent conflict. %I The University of Michigan, Michigan Retirement Research Center %G eng %U http://www.mrrc.isr.umich.edu/ %L wp_2001/Ward-Battswp016.pdf %4 Health Shocks/Households/Spouse %$ 11162 %0 Report %D 2001 %T The Impact of the Cost of Long-Term Care on the Saving of the Elderly %A Anthony Webb %K Consumption and Savings %K Healthcare %X One of the predictions of the life-cycle model of savings behavior is that the elderly should dissave at a rate that increases with age. But there is little evidence that significant dissaving takes place at any age. One explanation is that the elderly wish to retain assets to cover the cost of long-term care. I propose a model in which the elderly are informed about both their life expectancy and their likelihood of entering long-term care, and in which the utility of consumption in long-term care differs from that of consumption at home. I consider how the Medicaid rules relating to long-term care might influence the behavior of married couples and single persons whose wealth is above or below Medicaid eligibility limits. I test the predictions on data from the 1993 and 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) dataset, which has information on expectations. I make use of interstate differences in Medicaid financial eligibility rules to investigate the effects of Medicaid on household saving. In accordance with the predictions of my model, I find no evidence that people who are eligible for Medicaid dissave more rapidly if they expect to enter long-term care. On the contrary, married couples save more if they believe it is likely that they will enter long-term care. However, even those households that do not expect to enter long-term care fail to dissave. I find that an increase in the generosity of spousal protection rules leads to a decrease in household saving. %I University of California, San Diego %G eng %U http://www.nber.org/ confer/2001/si2001/webb.pdf %L wp_2001/webb.pdf %4 Long-Term Care/Saving %$ 15040 %0 Report %D 2001 %T Longevity-Insured Retirement Distributions from Pension Plans: Market and Regulatory Issues %A Brown, Jeffrey R. %A Mark J. Warshawsky %K Demographics %K Health Conditions and Status %K Insurance %X Increasing average longevity and the trend toward early retirement make the risk of outliving one's resources more widespread among the elderly population. Annuities insure individuals against financial risks associated with longevity uncertainty. This paper explores the extent to which retirees can and do insure themselves against longevity risk in private pension plans. The shift from defined benefit (DB) plans to defined contribution (DC) plans means a reduction in the opportunities available to retirees to annuitize retirement assets because only a small number of DC plans include life annuity as a payout option. The paper discusses some of the options available to policy makers interested in increasing the annuitization rates. %B NBER Working Paper %I The National Bureau of Economic Research %C Cambridge, MA %G eng %U http://www.nber.org/papers/w8064 %4 Insurance Coverage/Basic Demographics/Longevity %$ 6593 %0 Journal Article %J J Gen Intern Med %D 2001 %T National estimates of the quantity and cost of informal caregiving for the elderly with dementia. %A Kenneth M. Langa %A M.E. Chernew %A Mohammed U Kabeto %A A. Regula Herzog %A Mary Beth Ofstedal %A Robert J. Willis %A Robert B Wallace %A Mucha, L.M. %A Walter L. Straus %A A. Mark Fendrick %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Dementia %K Female %K Health Care Costs %K Humans %K Male %K Multivariate Analysis %K Regression Analysis %K Severity of Illness Index %K Time Factors %K United States %X

OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.

DESIGN: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).

SETTING: National population-based sample of the community-dwelling elderly.

MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.

RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.

CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

%B J Gen Intern Med %I 16 %V 16 %P 770-8 %8 2001 Nov %G eng %N 11 %L pubs_2001_Langa_KJGIM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11722692?dopt=Abstract %4 Aged, 80 and Over/Caregivers/Economics/Cost of Illness/Dementia/Economics/Therapy/Female/Health Care Costs/Multivariate Analysis/Regression Analysis/Severity of Illness Index/Support, Non U.S. Government/Support, U.S. Government--PHS/Time Factors/United States %$ 4090 %R 10.1111/j.1525-1497.2001.10123.x %0 Journal Article %J Am J Ind Med %D 2001 %T New methods and data sources for measuring economic consequences of workplace injuries. %A Reville, Robert T. %A Bhattacharya, Jay %A Sager Weinstein, L.R. %K Accidents, Occupational %K Cost of Illness %K Data collection %K Database Management Systems %K Employer Health Costs %K Evaluation Studies as Topic %K Forecasting %K Humans %K Income %K Insurance Claim Reporting %K Registries %K Research Design %K Workplace %X

BACKGROUND: Evaluation of programs and policies to reduce the incidence of workplace injuries require that the consequences of injury are estimated correctly. Because workplace injuries are complex events, the availability of data that reflects this complexity is the largest obstacle to this estimation.

METHODS: We review the literature on the consequences of workplace injuries for both workers and employers, focusing on data sources, particularly linked administrative data from different public agencies. We also review other approaches to obtaining data to examine workplace injuries, including public-use longitudinal survey data, primary data collection, and linked employee-employer databases. We make suggestions for future research.

RESULTS: Recent advances in the literature on the economic consequences of workplace injuries for workers have been driven to a great extent by the availability of new data sources. Much remains unexplored. We find longitudinal survey databases including the National Longitudinal Survey of Youth, and the Health and Retirement Survey, to be very promising though largely untapped sources of data on workplace injuries. We also find that linked employee-employer databases are well suited for the study of consequences for employers.

CONCLUSIONS: We expect that new data sources should lead to rapid advances in our understanding of the economic consequences of workplace injuries for both workers and employers.

%B Am J Ind Med %I 40 %V 40 %P 452-63 %8 2001 Oct %G eng %N 4 %L pubs_2001_Reville_RAJIndMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11598994?dopt=Abstract %4 Accidents, Occupational/Cost of Illness/Data Collection/Economics/Methods/Database Management Systems/Employer Health Costs/Evaluation Studies/Forecasting/Income/Insurance Claim Reporting/Research Design/Support, Non U.S. Government/Workplace %$ 4140 %R 10.1002/ajim.1115 %0 Book Section %B Themes in the Economics of Aging %D 2001 %T Predictors of Mortality among the Elderly %A Michael D Hurd %A Daniel McFadden %A Merrill, Angela %E David A Wise %K Demographics %K Expectations %K Health Conditions and Status %K Net Worth and Assets %X This paper examines the quantitative importance of some predictors of mortality among the population aged 70 and over. As expected, this research confirms that socioeconomic status is related to mortality. This relationship is strong at younger ages and appears to weaken as the cohort gets older. The 13 health indicators are also strong predictors of mortality. Results also show that subjective probabilities of survival predict mortality and remain strong predictors even after controlling for socioeconomic indicators and health conditions. %B Themes in the Economics of Aging %I Univ. of Chicago Press %C Chicago %G eng %U https://www.nber.org/papers/w7440 %4 Basic Demographics/Economic Status/Health Status/Subjective Probabilities of Survival/Mortality Rates between waves 1 and 2 of the AHEAD %$ 8432 %+ AHEAD 1993 and 1995 %! Predictors of Mortality among the Elderly %0 Book Section %B Themes in the Economics of Aging %D 2001 %T Preretirement Cashouts and Foregone Retirement Saving: Implications for 401(k) Asset Accumulation %A James M. Poterba %A Steven F Venti %A David A Wise %E David A Wise %K Consumption and Savings %K Net Worth and Assets %K Pensions %B Themes in the Economics of Aging %I University of Chicago Press %C Chicago, IL %P 23-58 %G eng %U https://www.nber.org/chapters/c10320 %4 401(k) participation and balances/Retirement Saving/Distribution %$ 8650 %! Preretirement Cashouts and Foregone Retirement Saving: Implications for 401(k) Asset Accumulation %0 Newspaper Article %B Washington Post %D 2001 %T Products Of Clean Living %A Williams, Marjorie %K Health Conditions and Status %K Retirement Planning and Satisfaction %B Washington Post %I Washington Post %C Washington D.C. %P A25 %8 March 14, 2001 %G eng %4 Retirement/Health Status %$ 9844 %! Products Of Clean Living %& Editorial %0 Journal Article %J Journal of Human Resources %D 2001 %T Reducing Panel Attrition: A Search for Effective Policy Instruments %A Daniel H. Hill %A Robert J. Willis %K Methodology %X In this paper we develop a theory of the survey response decision process and apply it to the analysis of field office policy measures in an attempt to see which of these are effective in reducing panel attrition. We use data from the Health and Retirement Study (HRS) to assess the effectiveness of 1) reducing the length of the interview and 2) assigning the same initial interviewer wave after wave. There is virtually no evidence in the data that interview length affects subsequent wave response. Assigning the same interviewer wave after wave, however, has a strong positive effect on response rates. %B Journal of Human Resources %I 36 %V 36 %P 416-38 %G eng %N 3 %L pubs_2001_Hill-Willis.pdf %4 Survey Methods/Microeconomic Data Management/Data Collection and Data Estimation Methodology %$ 1144 %R 10.2307/3069625 %0 Thesis %D 2001 %T The Retirement Decision of Working Married Couples: A test of some competing hypotheses %A Wang, Jianxin %K Adult children %K Employment and Labor Force %K Other %K Retirement Planning and Satisfaction %X This dissertation investigates the retirement decision of married couples. Using the longitudinal Health and Retirement Study (hrs), i test how well the stackelberg model of joint decision-making fit the data. I test several hypotheses regarding leadership role in the household. I also use sub-samples defined by cluster analysis to allow for heterogeneity in decision-making. %I State University of New York at Stony Brook %8 2001 %G eng %4 Economics, General (0501) %$ 5029 %+ ISBN 0-493-65428-3 %0 Newspaper Article %B New York Times on the Web %D 2001 %T Reversing Decades-Long Trend, Americans Retiring Later in Life %A Walsh, Mary Williams %K Retirement Planning and Satisfaction %B New York Times on the Web %I The New York Times Co. %C New York, NY %8 February 26, 2001 %G eng %4 Retirement Planning %$ 9826 %! Reversing Decades-Long Trend, Americans Retiring Later in Life %& Business %0 Book Section %B Themes in the Economics of Aging %D 2001 %T Social Security Incentives for Retirement %A Courtney Coile %A Gruber, Jonathan %E David A Wise %K Demographics %K Employment and Labor Force %K Net Worth and Assets %K Retirement Planning and Satisfaction %X The 'tax effect' is one of the effects used to explain the rapid decline in the labor force participation of older men over age 62. This paper provides a thorough investigation of this 'tax effect' by studying it along four different dimensions. Using HRS data, the impact of SS retirement incentives are considered and the distribution of the incentives across the population is assessed. The paper then examines the role of private pensions and the importance of considering retirement incentives in the next year vs. considering incentives for all possible years. %B Themes in the Economics of Aging %I Univ. of Chicago Press %C Chicago %G eng %U https://www.nber.org/papers/w7651 %4 Economic Status/Labor Force Participation/Basic Demographics/Retirement Incentives %$ 8428 %+ HRS 1992 and 1994 %& 10 %0 Journal Article %J Am J Public Health %D 2001 %T Socioeconomic status and the prevalence of health problems among married couples in late midlife. %A Sven E. Wilson %K Activities of Daily Living %K Cohort Studies %K Female %K Health Status %K Humans %K Male %K Marital Status %K Middle Aged %K Odds Ratio %K Risk Factors %K Socioeconomic factors %K Spouses %K United States %X

OBJECTIVES: This study analyzed the association between socioeconomic status (SES) and the prevalence of mutually occurring health problems among married couples in late midlife.

METHODS: Data consisted of 4746 married couples aged 51 to 61 years from the 1992 US Health and Retirement Study. Two health measures were used: (1) self-assessed health status and (2) an index of functional limitations and activity restrictions. SES indicators were household income, education, and insurance coverage.

RESULTS: In general, after adjustment for age cohort, a strong association was found between the health of a married individual and the health of his or her spouse. SES was highly associated with the joint occurrence of health problems among marriage partners.

CONCLUSIONS: Public health policy should pay particular attention to the interaction between health, SES, and interpersonal relationships.

%B Am J Public Health %I 91 %V 91 %P 131-5 %8 2001 Jan %G eng %N 1 %L pubs_2001_Wilson_SAJPH.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11189807?dopt=Abstract %4 Cohort Studies/Gender/Health Status/Marital Status/Middle Age/Odds Ratio/Risk Factors/Socioeconomic Status/Spouses/Support, Non U.S. Government/Support, U.S. Government--PHS %$ 4345 %R 10.2105/ajph.91.1.131 %0 Book Section %B Cells and Surveys: Should Biological Measures Be Included in Social Research? %D 2001 %T Stretching Social Surveys to Include Bioindicators: Possibilities for the Health and Retirement Study, Experience from The Taiwan Study of the Elderly %A Weinstein, Maxine %A Robert J. Willis %E Caleb E Finch %E James W Vaupel %E Kevin Kinsella %K Methodology %K Mortality %B Cells and Surveys: Should Biological Measures Be Included in Social Research? %I National Academy Press %G eng %U https://www.ncbi.nlm.nih.gov/books/NBK110037/ %4 Survey Methods %$ 13472 %& 11 %0 Journal Article %J J Aging Health %D 2001 %T Valuation of life: a concept and a scale. %A Lawton, M. Powell %A Moss, Miriam %A Hoffman, Christine %A Kleban, Morton H. %A Ruckdeschel, Katy %A Winter, Laraine %K Factor Analysis, Statistical %K Humans %K Psychometrics %K Quality of Life %K United States %X

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

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

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

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

%B J Aging Health %I 13 %V 13 %P 3-31 %8 2001 Feb %G eng %N 1 %L pubs_2001_Lawton_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11503845?dopt=Abstract %4 Longevity/quality of life %$ 16260 %R 10.1177/089826430101300101 %0 Report %D 2001 %T Why Some Workers Remain in the Labor Force Beyond the Typical Age of Retirement %A Williamson, John B. %A Tay K. McNamara %K Employment and Labor Force %K Retirement Planning and Satisfaction %X This study explored the ways in which race, gender, and age moderated the effects of several determinants of labor force participation among people ages 60 to 80. The role of race, gender, and age in moderating the effect of various factors on labor force participation was examined using the 1998 Health and Retirement Study (HRS) data. Binomial logistic regression models were used to evaluate the interaction between race, gender, age and other determinants of labor force participation. The effects of various factors on labor force participation differed by gender, race, and age. The negative effects of low education and poor health, respectively, were stronger for women and blacks. Also, the positive effect of low nonwage income was weaker for older workers, probably due partly to poorer health. Our findings suggest that different types of policies would help to encourage labor force participation among different groups. Because lack of access to employment may deter continued work among subgroups such as blacks and women with low education, job training or job search programs might provide incentives for employment in these groups. Additionally, employer flexibility regarding part-time work and work demands might make continued work attractive for more older workers. %B Boston College CRR Working Paper %I Boston College Center for Retirement Research %C Boston %G eng %U https://papers.ssrn.com/sol3/papers.cfm?abstract_id=290095 %L wp_2001/williamson-mcnamara.pdf %4 Retirement/Labor Force %$ 6635 %0 Report %D 2000 %T Black and White Differences in Health and Functional Status Dimensions: How Many and What Type Among Older Americans %A Alvin E. Headen Jr. %A Kenneth G. Manton %A Woodbury, Max A. %K Health Conditions and Status %I North Carolina State University %G eng %4 Health Status %$ 6577 %0 Book %D 2000 %T The Case for Marriage: Why Married People are Happier, Healthier, and Better Off Financially %A Linda J. Waite %A Gallagher, Maggie %K Adult children %K Health Conditions and Status %K Net Worth and Assets %X The Case for Marriage is a critically important intervention in the national debate about the future of family. Based on the authoritative research of family sociologist Linda J. Waite, journalist Maggie Gallagher, and a number of other scholars, this book’s findings dramatically contradict the anti-marriage myths that have become the common sense of most Americans. Today a broad consensus holds that marriage is a bad deal for women, that divorce is better for children when parents are unhappy, and that marriage is essentially a private choice, not a public institution. Waite and Gallagher flatly contradict these assumptions, arguing instead that by a broad range of indices, marriage is actually better for you than being single or divorced– physically, materially, and spiritually. They contend that married people live longer, have better health, earn more money, accumulate more wealth, feel more fulfillment in their lives, enjoy more satisfying sexual relationships, and have happier and more successful children than those who remain single, cohabit, or get divorced. %I Doubleday %C New York %G eng %4 Marriage/Health Status/Economic Status %$ 8686 %0 Report %D 2000 %T Does Mental Health Affect Transitions out of the Labor Force in Older Workers? %A Linda A. Wray %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %K Retirement Planning and Satisfaction %X This paper extends earlier studies on health and work by examining how mental health affects transitions out of paid work in the years prior to the traditional Social Security retirement ages. Specifically, I investigate how mental health is linked to transitions to early retirement or other unemployed state in 1996 for middle-age adults who were currently working in 1992 and, in particular, whether deficits in mental health affect those transitions. To answer those questions, I use data from the first three waves of the Health and Retirement Study, a panel study of a nationally representative sample of Americans age 51-61 in 1992. Results of logistic regression analyses indicated that mental health had a strong and significant influence on the move from paid work to unemployment in three ways, net of other documented health, job, and socioeconomic correlates of work status: (1) Above-average self-assessed mental health predicted the transition from current worker to retiree. (2) Above -average mental health played a protective role in keeping workers in the work force rather than being laid off, on sick leave, or otherwise unemployed. (3) Increased CES-D depressive symptoms between 1992 and 1994 predicted exits from paid employment and into other unemployment by 1996. The results also indicate that mental health was an even more important predictor of transitions out of paid work among middle-age workers than were physical health and functioning. %I American Sociological Association %G eng %4 Labor Force Participation/Mental Health/Life Stage Transitions/Retirement/Unemployment/Middle Aged Adults/Workers/role exit/sociology of health and medicine/social psychiatry (mental health) %$ 1266 %0 Report %D 2000 %T Drug Use Among the Elderly: An Assessment of California's Need for Prevention and Treatment Services %A Wong, Mamie M. %A Anglin, M. Douglas %K Health Conditions and Status %K Healthcare %I State of California, Dept. of Alcohol and Drug Programs %G eng %4 Health Status/Drug Use/Health Care %$ 8476 %0 Report %D 2000 %T Employment Income Inequality among Older U.S. Workers: Gender, Race, and Class Comparisons %A Behringer, Autumn %A Janet M Wilmoth %A Hogan, Richard %A Perrucci, Carolyn C. %K Demographics %K Employment and Labor Force %K Income %K Other %X As the elderly segment of the US population continues to grow in size and voice, the economic status of older workers and retirees, particularly women and racial minorities, is of growing social and political interest and concern. While sociologists have analyzed occupational and industrial segmentation and racial and gender inequality in retirement, most studies have narrowly focused on either race or gender and on either pension or Social Security earnings. This research examines effects of gender, race, class, occupation, work, and marital status characteristics on older workers' preretirement income. This research is based on the preretired respondents who are currently working for pay (N = 4,959) in the 1992 Health and Retirement Study, a nationally representative survey of individuals ages 51-61 and their spouses. Ordinary least squares regressions were used to estimate the effects of ascribed characteristics (race and gender) as well as work and family history on employment income prior to retirement. Race and gender were found to interact to produce preretirement employment income advantages/disadvantages. Similarly, occupation, class, and the interaction of these variables created considerable differences in income, especially along race and gender lines. The findings suggest status inequality is produced and sustained throughout the life course. %G eng %4 Elderly/Income Inequality/Labor Supply/Sexual Inequality/Racial Differences/Class Differences/United States/Workers %$ 1270 %0 Report %D 2000 %T The Impact of 401(k) Plans on Retirement %A Friedberg, Leora %A Anthony Webb %K Employment and Labor Force %K Pensions %K Retirement Planning and Satisfaction %X In 1993 38.9 million people were covered by a 401(k) plan, up from 7.1 million in 1983. The rapid growth of 401(k) and other defined contribution pension plans may alter retirement patterns of older workers. Previous research showed that the spread of defined benefit plans, with sharp age-related incentives first discouraging and later encouraging retirement, contributed to the early retirement trend of past decades. Defined contribution plans differ along several dimensions, especially in their smooth rate of pension wealth accrual. We use data from the Health and Retirement Study to show that retirement patterns have begun to change as defined contribution plans have spread. Our estimates indicate that the financial incentives in defined benefit pensions lead people to retire almost two years earlier on average, compared to people with defined contribution plans. %I University of California, San Diego %G eng %U https://ideas.repec.org/p/cdl/ucsdec/qt2jr5w8b9.html %L wp_2000/Friedberg-Webb11-00.pdf %4 Household effects on labor supply/Retirement/Retirement Policies/Nonwage Labor Costs and/Private Pensions/Occupational and Intergenerational Mobility/Promotion/401(k) participation and balances/Pension/Retirement %$ 1128 %0 Thesis %D 2000 %T Intergenerational Intervivos Transfers: What is the pattern and level of financial support parents provide their adult children? %A Wilkinson, Jody Ann %K Adult children %K Healthcare %X Why do parents give their adult children money? What child and parental characteristics influence monetary transfers? Does the effect of these characteristics differ across low, medium, and high transfer dollar amounts? What is the parent's motive behind providing their adult child with a financial transfer? Is it based on the child's income or a life event experienced by the child (i.e., Altruism or contingent exchange)? This research examines the relationship between financial transfers and characteristics of the adult child. The data used are the 1992-1994 Health and Retirement Study (HRS), which contains a nationally representative sample of adults born between 1931 and 1941. At baseline, financial transfers to 18,463 adult children living independently from their parent's household (n = 6,001) are examined. Cross-sectional and longitudinal models are specified to determine the relationship between the financial transfer and characteristics of the adult child, controlling characteristics of the parental household across transfer levels. The motive behind the financial transfer behavior is tested using two competing theories, altruism and contingent exchange. Lastly, the relationship between race and the financial transfer as a percent of total household income is examined. Two variables consistently have the greatest effect on the amount of the financial transfer the adult child %I Purdue University %8 2000 %G eng %U https://docs.lib.purdue.edu/dissertations/AAI3018290/ %4 Sociology, Individual and Family Studies (0628) %$ 5032 %+ Available from UMI, Ann Arbor, MI. Order No. DA3018290. %0 Journal Article %J J Aging Health %D 2000 %T Job characteristics and leisure physical activity. %A Bei Wu %A Frank Porell %K Demography %K Exercise %K Female %K Humans %K Job Description %K Job Satisfaction %K Leisure activities %K Male %K Middle Aged %K Stress, Psychological %K United States %X

OBJECTIVES: This study employs a sample population of older workers to estimate an empirical model of leisure exercise activity. Alternative theories relating work and leisure attitudes relevant for understanding the exercise behavior of older workers are tested empirically.

METHODS: Responses of 6,433 full-time older workers (51 to 61 years old) from the 1992 Health and Retirement Study (HRS) are grouped into two white-collar and blue-collar worker categories and are analyzed to test whether self-reported levels of regular physical activity are associated with the physical demands and stress associated with one's job.

RESULTS: Although the white-collar workers, whose jobs involve more physical efforts, are more likely to do light physical activity, the blue-collar workers, whose jobs are more physically demanding, tend to engage in more vigorous exercise.

DISCUSSION: The empirical results are most supportive of the generalization theory, and they also illustrate the complexity of relationships between work and leisure physical activity.

%B J Aging Health %I 12 %V 12 %P 538-59 %8 2000 Nov %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/11503731?dopt=Abstract %4 Job Characteristics/Physical Fitness/Occupational Stress/Workers/Health Behavior/Work to Leisure Relationship/Work Attitudes %$ 1250 %R 10.1177/089826430001200405 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2000 %T Measuring morbidity: disease counts, binary variables, and statistical power. %A Kenneth F Ferraro %A Janet M Wilmoth %K Adult %K Aged %K Chronic disease %K Cross-Sectional Studies %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Models, Statistical %K United States %X

OBJECTIVES: This study compares the use of the binary disease variables with counts of the same conditions in models of self-rated health to better understand the advantages and disadvantages of each approach. In particular, the analysis seeks to determine if statistical power is adequate for the binary variable approach.

METHODS: Morbidity measures from adults in 2 large national surveys were used in both cross-sectional and longitudinal analyses.

RESULTS: Although differences across the approaches are modest, the binary variable approach offers greater explanatory power and slightly higher R2 values. Despite these advantages, statistical power is insufficient in some cases, especially for conditions that are relatively rare and/or that manifest modest differences on the outcome variable.

DISCUSSION: Statistical power estimates are advisable when using the binary variable approach, especially if the list of diseases and health conditions is extensive. Although a simple count of diseases may be useful in some research applications, separate counts for serious and nonserious conditions should be more useful in many research projects while avoiding the risk of inadequate statistical power.

%B J Gerontol B Psychol Sci Soc Sci %I 55B %V 55 %P S173-89 %8 2000 May %G eng %N 3 %L pubs_2000_ferraro_morbidity.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11833985?dopt=Abstract %4 Disease/Morbidity/Subjective Probabilities %$ 15030 %R 10.1093/geronb/55.3.s173 %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 Report %D 2000 %T Modeling the Effect of Health on Retirement %A John Bound %A Michael Schoenbaum %A Todd R. Stinebrickner %A Timothy A Waidmann %K Health Conditions and Status %K Retirement Planning and Satisfaction %I National Bureau of Economic Research %G eng %4 Health/Retirement %$ 10052 %0 Report %D 2000 %T Patterns of Dissaving in Retirement %A Steven Haider %A Michael D Hurd %A Reardon, Elaine %A Williamson, Stephanie %K Consumption and Savings %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Abstract: Examined patterns of dissaving among households with at least one older adult. Data were obtained from the Social Security Administration's New Beneficiary Data System (NBDS) on older adults (mainly those aged 62-65) who received Social Security benefits for the first time in 1980-1981 and who were interviewed in 1982 and 1991. Data were also obtained from the 1993 and 1995 waves of the National Institute on Aging's Asset and Health Dynamics Among the Oldest Old (AHEAD) survey of adults aged 70 and older. Multivariate analyses indicated that changes in wealth were fairly flat in the 1980s (based on NBDS data), with mean wealth growing just under one percent per year for the 9 years of the sample period, while median wealth declined by about one-quarter of a percentage point per year. The AHEAD data from the 1990s suggest that most adults aged 70 and older enjoyed wealth increases, which in large part were due to the dramatic rise in stock prices over the 2 years of the survey period. Overall, there was increasing wealth inequality, with less well off households dissaving more rapidly than better off households. Households in which health declined between the waves studied were more likely to dissave. Savings patterns of households with and without children were fairly similar. Two appendixes provide information on the study methodology and additional data tables %I AARP Public Policy Institute %C Washington, D.C. %G eng %U https://assets.aarp.org/rgcenter/econ/2000_10_dissaving.pdf %L wp_2000/dissaving.pdf %4 Assets/Wealth/RETIREMENT/Dissaving %$ 16140 %0 Book Section %B Forecasting retirement needs and retirement wealth. %D 2000 %T Prospects for Widow Poverty %A David R Weir %A Robert J. Willis %E Olivia S. Mitchell %E P. Brett Hammond %E Anna M. Rappaport %K Consumption and Savings %K Methodology %K Net Worth and Assets %K Retirement Planning and Satisfaction %B Forecasting retirement needs and retirement wealth. %S Pension Research Council Publications.: %I University of Pennsylvania Press %C Philadelphia %P 208 -34 %G eng %4 Widowhood/Economics of the Elderly/Economics of Gender/Measurement and Analysis of Poverty/Retirement/Retirement Policies %$ 1062 %! Prospects for Widow Poverty %0 Newspaper Article %B The Economist %D 2000 %T The Road Ahead %A Wheelan, Charles J. %K Methodology %X This article provides a brief overview of the HRS. It mentions the study's history and funding, and then goes on to discuss its accomplishments and major findings. %B The Economist %P 31-32 %8 March 18, 2000 %G eng %4 HRS Sponsorship, Sample, Study Design/HRS content and design %$ 8370 %+ HRS %! The Road Ahead %& Ageing America %0 Journal Article %J American Economic Review %D 2000 %T Saver Behavior and 401(k) Retirement Wealth %A James M. Poterba %A Steven F Venti %A David A Wise %K Consumption and Savings %K Net Worth and Assets %K Pensions %K Retirement Planning and Satisfaction %K Social Security %X Contributions to 401(k) plans are now the most important form of retirement saving. Since 401(k) plans were introduced in the early 1980's, they have expanded rapidly and continuously. By 1998, roughly half of all households were eligible to participate in 401(k) plans, and more than 36 million workers made contributions to these employer-provided saving plans. In 1995, the last year for which the U.S. Department of Labor has released definitive data, 401(k) contribu- tions amounted to $87.4 billion, or 55 percent of all contributions to employer-sponsored pension plans. The level of contributions, and their share of all pension contributions, is probably signifi- cantly higher today. The spread of 401(k) plans is the most important indicator of the move to personal retirement saving. In 1980, almost 92 percent of pension-plan contributions were to tradi- tional employer-provided plans, and about 64 percent of these contributions were to conventional defined-benefit plans. Today, almost 60 percent of contributions are to personal retirement accounts, including 401(k), IRA, and Keogh plans. Including employer- provided, non-40 1 (k) defined-contribution plans, over 76 percent of contributions are to plans that are controlled in large measure by individuals. These individuals make partici- pation, contribution, asset-allocation, and withdrawal decisions. In this paper, we describe the likely impor- tance of 401(k) assets for future older Ameri- cans and the effect of investment decisions on asset accumulation. We also examine the extent to which retirement assets may be affected by several decisions: preretirement withdrawals, management fees and expenses, contribution rates, and early retirement. Our analysis focuses on 401(k) saving, but applies more broadly to other forms of individual retirement saving. %B American Economic Review %I 90 %V 90 %P 297-302 %G eng %U https://www.jstor.org/stable/117239?seq=1 %N 2 %4 401(k) participation and balances/Retirement Wealth/Consumer Economics/Retirement Policies/Social Security and Public Pensions %$ 8652 %0 Report %D 2000 %T Saving for Retirement: Household Bargaining and Household Net Worth %A Lundberg, Shelly J. %A Jennifer L. Ward-Batts %K Consumption and Savings %K Net Worth and Assets %X Traditional economic models treat the household as a single individual, and do not allow for separate preferences of and possible conflicts of interest between husbands and wives. Since wives are typically younger than their husbands and life expectancy for women exceeds that for men, wives may prefer to save more for retirement than do their husbands. This suggests that households in which wives have greater relative bargaining power may accumulate greater net worth as they approach retirement. Most empirical models of net worth in the literature do not include characteristics of both spouses. We present a more complete unitary model of household net worth and find, among couples in the first wave of the Health and Retirement Survey, that the characteristics of both husband and wife are determinants of net worth. We explore the importance of bargaining in marriages of older couples by examining the empirical relationship between their net worth and factors such as relative control over current income sources, relative age, and relative education. We find some evidence that low relative education of wives is associated with low net worth. %I University of Michigan, Michigan Retirement Research Center %G eng %U https://mrdrc.isr.umich.edu/publications/Papers/pdf/wp004.pdf %L wp_2000/lundberg-batts_mrrc.pdf %4 Saving/Net Worth %$ 6572 %0 Newspaper Article %B USA Today Electronic News %D 2000 %T Widow's poverty tied to length of time since husband's death %A Wheeler, Larry %K Net Worth and Assets %B USA Today Electronic News %I USA Today %8 May 22, 2000 %G eng %4 Widowhood %$ 9820 %! Widow's poverty tied to length of time since husband's death %0 Book Section %B Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster %D 1999 %T The Association of Influenza Vaccine Receipt with Health and Economic Expectations among Elders: The AHEAD Study %A Robert B Wallace %A Nichols, Sara %A Michael D Hurd %E James P Smith %E Robert J. Willis %K Consumption and Savings %K Expectations %K Health Conditions and Status %K Methodology %B Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster %I University of Michigan Press %C Ann Arbor, MI %P 326-34. %G eng %4 Health Production/Health Behavior/Economic Behavior/Expectations of Future Events/Economics of the Elderly/Microeconomic Data Management/Health %$ 1058 %! The Association of Influenza Vaccine Receipt with Health and Economic Expectations among Elders: The AHEAD Study %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 1999 %T At risk on the cusp of old age: living arrangements and functional status among black, white and Hispanic adults. %A Linda J. Waite %A Mary Elizabeth Hughes %K Activities of Daily Living %K Aging %K Black or African American %K Cultural Characteristics %K Family Relations %K Female %K Hispanic or Latino %K Housing %K Humans %K Male %K Middle Aged %K Quality of Life %K Retirement %K Risk Factors %K White People %X

OBJECTIVES: We examine the relationship between living arrangements and multiple measures of physical, cognitive, and emotional functioning in late midlife.

METHODS: Using cross-sectional data from the Health and Retirement Study, we first assess the bivariate relationship between living arrangements and functioning; we then take into account demographic characteristics and measures of household resources and demands.

RESULTS: We find evidence of differential functioning among individuals in various living arrangements. Married couples living alone or with children show the highest levels of functioning, whereas single adults living in complex households show the lowest levels. Functional deficits for those in complex households are reduced but not eliminated when we take demographic characteristics and household resources and demands into account. We find few differences by gender and race/ethnicity in the relationship between living arrangements and functioning.

DISCUSSION: We show a pattern of poorer functioning among those in arguably the most demanding and least supportive household environments. This points to a vulnerable and risk-filled transition from middle to old age for these persons. Because Blacks and Hispanics show lower levels of functioning than Whites and are more likely to live in complex households, they may be particularly disadvantaged.

%B J Gerontol B Psychol Sci Soc Sci %I 54B %V 54 %P S136-44 %8 1999 May %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/10363044?dopt=Abstract %N 3 %L pubs_1999_Waite_LJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10363044?dopt=Abstract %4 Aging/Ethnicity/Gender/Cultural Characteristics/Family Relations/Housing/Middle Age/Quality of Life/Retirement/Risk Factors/Support, Non U.S. Government/Support, U.S. Government--PHS %$ 4200 %R 10.1093/geronb/54b.3.s136 %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 Journal of Consumer Affairs %D 1999 %T Consumer Preferences for Health Care Reform Options %A Gong-Soog Hong %A Shelley I. White-Means %K Consumption and Savings %K Health Conditions and Status %K Healthcare %K Net Worth and Assets %K Public Policy %X This study uses the 1992 Health and Retirement Study to examine consumer preferences for four health care reform options: tax-financed national health insurance, personally subsidized Medicare extensions, publicly subsidized nursing home insurance, and tax credits for health insurance purchases. Males, non-Caucasians, the self-employed, those in excellent health, and those who reside in the Northeast favor national health insurance, while those with high levels of liquid and non-liquid assets tend to disfavor it. Males and those with higher expectations of living in nursing homes tend to favor personally subsidized Medicare extensions to cover nursing homes and home health care. Those with higher expectations of living in nursing homes also favor publicly subsidized nursing home insurance. Relatively little support for subsidized nursing home insurance is found among males and those with high levels of liquid and non-liquid assets. The self-employed tend to support tax credits for health insurance premiums. %B Journal of Consumer Affairs %I 33 %V 33 %P 237-53 %G eng %U https://www.jstor.org/stable/23859957?seq=1#page_scan_tab_contents %N 2 %L pubs_1999_Hong_GJConsAff.pdf %4 Health Policy/Nursing Homes/Tax Policy/Health Production--Nutrition, Mortality, Morbidity, Disability, and Economic Behavior/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Net Worth %$ 1002 %0 Journal Article %J Labour Economics %D 1999 %T The Dynamic Effects of Health on the Labor Force Transitions of Older Workers %A John Bound %A Michael Schoenbaum %A Todd R. Stinebrickner %A Timothy A Waidmann %K Demographics %K Employment and Labor Force %K Health Conditions and Status %X This article analyzes the relationship between health and alternative labor force transitions, including labor force exit, job change, and application for disability insurance. Health is a very significant determinant of labor force patterns. Controlling for lagged values of health, poor contemporaneous health is strongly related to older men and women's exit from the labor force and their decisions to apply for disability insurance. Controlling for poor contemporaneous health, poor lagged health is associated with continued participation in the work force. The earlier a health shock occurs, the less likely it is to lead to labor force exit. People who experience health setbacks earlier in life tend to switch jobs instead of stopping to work. Results suggest that both poor health and declines in health are significant variables that help to explain retirement behavior. %B Labour Economics %I 6 %V 6 %P 179-202 %G eng %N 2 %L pubs_1999_Bound_JLabEcon.pdf %4 Labor Force Participation/Health Status/Basic Demographics %$ 8306 %R 10.1016/S0927-5371(99)00015-9 %0 Thesis %D 1999 %T Essays in Applied Microeconometrics %A Robert R. Weathers II %K Demographics %K Disabilities %K Employment and Labor Force %K Methodology %K Social Security %X This dissertation consists of three essays in applied microeconometrics. In the first essay, I use retrospective data from the Health and Retirement Study (HRS) together with matching state level data on SSDI allowance rates and individual level Social Security administrative record data on the generosity of SSDI benefits to examine how the Social Security Disability Insurance program affects a person's work behavior following the onset of a disability. A hazard model that allows for both measured and unmeasured heterogeneity is used to estimate the relative importance of policy variables--employer accommodation as well as the relative value and likelihood of acceptance onto the SSDI program--on the timing of SSDI application following the onset of a disability. The results show that employer accommodation significantly slows a worker's application for SSDI benefits while easier access to SSDI benefits and more generous SSDI benefits increase the speed of application following the onset of a health condition. In the second essay, I develop three approaches that may be used to obtain consistent estimates of the structural parameters in the fixed effects ordered logit model. The first approach uses the adjacent categories form of the ordered logit along with the conditional logit and minimum distance estimator to obtain estimates of the structural parameters. In a second step, the Generalized Method of Moments (GMM) is used to estimate the sum of the limit parameters and the fixed effects, and finally the limits are estimated based on the means of the sums. The other approaches interpret fixed effects as random effects. The second approach specifies the fixed effects as omitted variables that raise the variance of the disturbance and bias the logit estimates. A generated regressor is created to allow the bias to be corrected. The third approach generalizes a new method of estimation for the fixed effects logit model to the ordered logit. Specification tests are extended to these estimators and a Monte Carlo experiment is constructed to test the small sample properties of the estimator. The third essay uses data from the Panel Study of Income Dynamics (PSID) to examine how experience with entrepreneurship--defined as persons who are self-employed--has affected an individual's place in the earnings distribution. The strategy is to follow individuals' positions in the income distribution over time, and to see how their mobility was affected by involvement with entrepreneurship. The results show that for low-income individuals there is some merit to the notion that the self-employed moved ahead in the earnings distribution relative to those who remained wage earners. On the other hand, for those at the upper end of the earnings distribution, those who became self-employed often advanced less in the earnings distribution than their wage and salary counterparts. %I Syracuse University %8 1999 %G eng %4 Methodology Data Analysis (D516763) %$ 5031 %+ ISBN 0-599-68954-4 %! Essays in Applied Microeconometrics %0 Journal Article %J Research on Aging %D 1999 %T Ethnic Differences in Time Transfers from Adult Children to Elderly Parents: Unobserved Heterogeneity across Families? %A Rebeca Wong %A Kitayama, Kathy E. %A Beth J Soldo %K Adult children %K Demographics %K Time Use %X Examines differences across racial-ethnic groups in patterns of time transfers from middle-age adult children to their elderly parents and the degree to which heterogeneity in unobserved family-level factors may explain observed differences. Analysis of data from the 1992 Health and Retirement Study for 12,253 adult respondents and their siblings supports the hypothesis that the determinants of time assistance vary across racial-ethnic groups: controlling for socioeconomic attributes of potential donors and the recipient, there is evidence of unobserved family-level heterogeneity for whites and blacks, but not for Hispanics. 7 Tables, 40 References. Adapted from the source document %B Research on Aging %I 21 %V 21 %P 144-175 %G eng %N 2 %L pubs_1999_Wong_RRoA.pdf %4 Racial Differences/Ethnicity/Time Utilization/Adult Children/Parent Child Relations/Elderly/Middle Aged Adults/Transfers %$ 1272 %R 10.1177/0164027599212002 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 1999 %T Financial assistance from middle-aged couples to parents and children: racial-ethnic differences. %A Rebeca Wong %A Capoferro, C. %A Beth J Soldo %K Aged %K Child %K ethnicity %K Family Relations %K Female %K Financing, Personal %K Humans %K Intergenerational Relations %K Male %K Middle Aged %K Parent-Child Relations %K Racial Groups %X

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

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

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

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

%B J Gerontol B Psychol Sci Soc Sci %I 54B %V 54 %P S145-53 %8 1999 May %G eng %N 3 %L pubs_1999_Wong_RJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10363045?dopt=Abstract %4 Child/Ethnicity/Gender/Family Relations/Financing, Personal/Intergenerational Transfers/Intergenerational Relations/Middle Age/Parent Child Relations/Support, U.S. Government--PHS %$ 4355 %R 10.1093/geronb/54b.3.s145 %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 Journal Article %J The Journal of Human Resources %D 1999 %T The Importance of Accommodation on the Timing of Disability Insurance Applications: Results from the Survey of Disability and Work and the Health and Retirement Study %A R.V. Burkhauser %A Butler, J. S. %A Kim, Yang-Woo %A Weathers, Robert R. %K Disabilities %K Disability %K disability insurance %K Work %K work conditions %K work environment %X [Using data from the 1978 Survey of Disability and Work and the 1992 Health and Retirement Study, we test the importance of accommodation and other policy variables on the timing of application for Social Security Disability Insurance benefits following the onset of a work-limiting condition. We correct for choice-based sampling in the Survey of Disability and Work by extending the Manski and Lerman (1977) correction to the likelihood function of our continuous time hazard model, we find that this correction significantly affects the results. Similar findings emerge from these two data sets. Accommodation significantly reduces the speed of application and more generous benefits increase the speed of applying for SSDI.] %B The Journal of Human Resources %V 34 %P - 611589 %8 1999 %@ 0022166X %G eng %U http://www.jstor.org/stable/146381 %N 3 %0 Journal Article %J Journal of Human Resources %D 1999 %T The Importance of Accommodation on the Timing of Male Disability Insurance Application %A R.V. Burkhauser %A Butler, J.S. %A Kim, Yang-Woo %A Robert R. Weathers II %K Disabilities %K Employment and Labor Force %K Health Conditions and Status %K Retirement Planning and Satisfaction %X Using data from the 1978 Survey of Disability and Work and the 1992 Health and Retirement Study, we test the importance of accommodation and other policy variables on the timing of application for Social Security Disability Insurance benefits following the onset of a work-limiting condition. We correct for choice-based sampling in the Survey of Disability and Work by extending the Manski and Lerman (1977) correction to the likelihood function of our continuous time hazard model, we find that this correction significantly affects the results. Similar findings emerge from these two data sets. Accommodation significantly reduces the speed of application and more generous benefits increase the speed of applying for SSDI. %B Journal of Human Resources %I 34 %V 34 %P 589-611 %G eng %N 3 %L pubs_1996_Burkhauser_RGer.pdf %4 Safety/Accidents/Industrial Health/Job Satisfaction/Workmens Compensation/Retirement/Retirement Policies/Disability/Disability/Retirement %$ 8336 %R 10.2307/146381 %0 Journal Article %J Journal of Occupational and Organizational Psychology %D 1999 %T Influences on the Bridge Employment Decision Among Older USA Workers %A Weckerle, Joelle R. %A Kenneth S. Shultz %K Employment and Labor Force %K Retirement Planning and Satisfaction %X This study examines four organizational and personal variables (voluntariness of retirement, organizational flexibility, pre-retirement planning, and anticipated financial rewards) to determine their influence on the retirement decisions of older workers. The retirement decisions being studied are: considering early retirement, continuing to work, or obtaining bridge employment either in the same job or a different job. Results indicate that anticipated financial reward, job flexibility, and voluntariness of retirement are all significant predictors that distinguish older workers in the four retirement decision groups. The implications of these findings for both workers and employers are discussed as well as some of the benefits of utilizing bridge employment as an option when considering early retirement decisions. %B Journal of Occupational and Organizational Psychology %I 72 %V 72 %P 317-329 %G eng %N 3 %L pubs_1999_Weckerle_JJOccandOrgPsy.pdf %4 Labor--retirement decisions/Retirement Planning/Job Characteristics/Retirement Behavior %$ 8338 %R 10.1348/096317999166707 %0 Book Section %B Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster %D 1999 %T Inheritances and Bequests %A James P Smith %E James P Smith %E Robert J. Willis %K Adult children %K Consumption and Savings %K Methodology %B Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster %I University of Michigan Press %C Ann Arbor, MI %P 121-49 %G eng %4 Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Altruism/Microeconomic Data Management/Bequests/Inheritance/Wills/Transfers %$ 1102 %! Inheritances and Bequests %0 Book Section %B Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster. %D 1999 %T Intergenerational Transfers: Blood, Marriage, and Gender Effects on Household Decisions %A Beth J Soldo %A Douglas A. Wolf %A John C Henretta %E James P Smith %E Robert J. Willis %K Adult children %K Consumption and Savings %K Demographics %K Event History/Life Cycle %K Methodology %B Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster. %I University of Michigan Press %C Ann Arbor, MI %P 335-55 %G eng %4 Economics of Gender/Marriage/Marital Dissolution/Family Structure/Intertemporal Consumer Choice/Life Cycle Models and Saving/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Microeconomic Data Management/Gender %$ 1048 %! Intergenerational Transfers: Blood, Marriage, and Gender Effects on Household Decisions %0 Book Section %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %D 1999 %T Labor Market Transitions in the HRS: Effects of the Subjective Probability of Retirement and of Pension Eligibility %A Michael D Hurd %E James P Smith %E Robert J. Willis %K Employment and Labor Force %K Expectations %K Pensions %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %I University of Michigan Press %C Ann Arbor, MI %P 267-90 %G eng %4 Labor/Pensions/Subjective Probabilities %$ 8206 %! Labor Market Transitions in the HRS: Effects of the Subjective Probability of Retirement and of Pension Eligibility %0 Book Section %B Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster %D 1999 %T Lifetime Earnings, Saving Choices, and Wealth at Retirement %A Steven F Venti %A David A Wise %E James P Smith %E Robert J. Willis %K Consumption and Savings %K Event History/Life Cycle %K Methodology %K Net Worth and Assets %K Retirement Planning and Satisfaction %B Wealth, work, and health: Innovations in measurement in the social sciences: Essays in honor of F. Thomas Juster %I University of Michigan Press %C Ann Arbor, MI %P 87-120. %G eng %4 Retirement Planning/Retirement Behavior/Savings/Wealth/Microeconomic Data Management/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Intertemporal Consumer/Life Cycle Models and Saving/Retirement/Retirement Policies %$ 1052 %! Lifetime Earnings, Saving Choices, and Wealth at Retirement %0 Journal Article %J The American Economic Review %D 1999 %T New Evidence on the Money's Worth of Individual Annuities %A Olivia S. Mitchell %A James M. Poterba %A Mark J. Warshawsky %A Brown, Jeffrey R. %K Age %K Annuity payments %K Income taxes %K Insurance premiums %K Life annuities %K Life insurance %K Life Tables %K Men %K Mortality rates %B The American Economic Review %V 89 %P 1299-1318 %@ 00028282 %G eng %U https://www.jstor.org/stable/117059?seq=1 %N 5 %9 Journal %0 Report %D 1999 %T Older Adults and Their Health Insurance %A Gail A Jensen %A Weycker, Derek A. %A Gabel, John R. %K Medicare/Medicaid/Health Insurance %I AARP Public Policy Institute 9903 %G eng %4 Health Insurance Coverage %$ 11062 %0 Book Section %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %D 1999 %T Pension and Social Security Wealth in the Health and Retirement Study %A Alan L Gustman %A Olivia S. Mitchell %A Andrew A. Samwick %A Thomas L. Steinmeier %E James P Smith %E Robert J. Willis %K Net Worth and Assets %K Pensions %K Social Security %X This study attempts to understand the impact of pension and social security wealth on decisions made by people of retirement age. Their in-depth analysis of the Health and Retirement Study gives many interesting findings. Of those people participating in the Health and Retirement Study, more then half of the wealth is in the form of social security, pensions, and health insurance. Various topics are explored in this paper. %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %I University of Michigan Press %C Ann Arbor, MI %P 150-208 %G eng %4 Pensions/Social Security/Wealth %$ 8198 %+ HRS: 1992 %! Pension and Social Security Wealth in the Health and Retirement Study %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 1999 %T Prevalence and severity of urinary incontinence in older African American and Caucasian women. %A Fultz, Nancy H. %A A. Regula Herzog %A Trivellore E. Raghunathan %A Robert B Wallace %A Diokno, A.C. %K Aged %K Aged, 80 and over %K Black or African American %K Female %K Humans %K Prevalence %K Risk Factors %K United States %K Urinary incontinence %K White People %X

BACKGROUND: Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of urinary incontinence and be used in planning screening programs and treatment services.

METHODS: Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nationally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups.

RESULTS: A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02% of the Caucasian women reported incontinence, compared with 16.17% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women.

CONCLUSION: This study identifies or confirms important risk factors for self-reported urinary incontinence in a national context, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.

%B J Gerontol A Biol Sci Med Sci %I 54A %V 54 %P M299-303 %8 1999 Jun %G eng %N 6 %L pubs_1997_Fultz_NJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10411017?dopt=Abstract %4 Aged, 80 and Over/Blacks/Statistics and Numerical Data/Female/Human/Prevalence/Risk Factors/Support, U.S. Government--PHS/United States/Epidemiology/Urinary Incontinence/Ethnology/Whites %$ 4495 %R 10.1093/gerona/54.6.m299 %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 Book Section %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %D 1999 %T The Several Cultures of Research on Subjective Expectations %A Dominitz, Jeff %A Charles F Manski %E James P Smith %E Robert J. Willis %K Expectations %K Methodology %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %I University of Michigan Press %C Ann Arbor, MI %P 15-33 %@ 0472110268 %G eng %U https://books.google.com/books?id=lKvp4D1HuH8C&pg=PA209&lpg=PA209&dq=The+Size+Distribution+of+Wealth+in+the+United+States:+A+Comparison+Among+Recent+Household+Surveys&source=bl&ots=hFIAdSeWob&sig=ACfU3U2nIQ6QSOJ4wEBUDcbZOo-x7n8b7g&hl=en&sa=X&ved=2ahUKEwjQ %4 Methodology/Subjective Expectations %$ 8188 %! The Several Cultures of Research on Subjective Expectations %0 Book Section %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %D 1999 %T The Size Distribution of Wealth in the United States: A Comparison Among Recent Household Surveys %A Wolff, Edward %E James P Smith %E Robert J. Willis %K Income %K Methodology %B Wealth, Work and Health: Innovations in Measurement in the Social Sciences %I University of Michigan Press %C Ann Arbor, MI %P 209-32 %G eng %U https://books.google.com/books?id=lKvp4D1HuH8C&pg=PA209&lpg=PA209&dq=The+Size+Distribution+of+Wealth+in+the+United+States:+A+Comparison+Among+Recent+Household+Surveys&source=bl&ots=hFIAdSeWob&sig=ACfU3U2nIQ6QSOJ4wEBUDcbZOo-x7n8b7g&hl=en&sa=X&ved=2ahUKEwjQ %4 Personal Income and Wealth Distribution/Microeconomic Data Management %$ 8200 %! The Size Distribution of Wealth in the United States: A Comparison Among Recent Household Surveys %0 Newspaper Article %B Detroit News %D 1999 %T Study: Depression as deadly as smoking %A Webster, Sarah A. %K Health Conditions and Status %B Detroit News %I Detroit News %C Detroit, MI %8 November 23, 1999 %G eng %4 Depression/Smoking %$ 9816 %! Study: Depression as deadly as smoking %0 Journal Article %J Labour Economics %D 1999 %T Theory Confronts Data: How the HRS is Shaped by the Economics of Aging and How the Economics of Aging Will be Shaped by the HRS %A Robert J. Willis %K Health Conditions and Status %K Methodology %K Net Worth and Assets %X This paper describes the evolution of the HRS from its origins in 1992 to its current design as a longitudinal 'steady state' sample of older Americans which is representative of the U.S. population over age 50. It discusses the conceptual framework of the survey as well as the broad theoretical concepts that lead to its content and design. The paper concludes with a description of some recent findings that use the HRS data; in particular the positive correlation between health and wealth. %B Labour Economics %I 6 %V 6 %P 119-145 %G eng %N 2 %L pubs_1999_Willis_RLabEcon.pdf %4 HRS content and design/Longitudinal Studies/Economic Status/Health Status %$ 8302 %R 10.1016/S0927-5371(99)00011-1 %0 Book Section %B Wealth, Work, and Health: Innovations in Measurement in the Social Sciences: Essays in honor of F. Thomas Juster. %D 1999 %T Unfolding Bracket Method in the Measurement of Expenditures and Wealth %A Daniel H. Hill %E James P Smith %E Robert J. Willis %K Consumption and Savings %K Methodology %K Net Worth and Assets %B Wealth, Work, and Health: Innovations in Measurement in the Social Sciences: Essays in honor of F. Thomas Juster. %I University of Michigan Press %C Ann Arbor, MI %P 64-86 %G eng %U https://books.google.com/books?id=lKvp4D1HuH8C&pg=PA64&lpg=PA64&dq=Unfolding+Bracket+Method+in+the+Measurement+of+Expenditures+and+Wealth&source=bl&ots=hFIAdSfSt6&sig=ACfU3U2f2HvZoq6nQLadPt_pPaidMEBcyQ&hl=en&sa=X&ved=2ahUKEwjAruG52p3qAhWIZM0KHTMiBpAQ6AEwA %4 Microeconomic Data Management/Consumer Economics: Empirical Analysis/Consumer Economics: Empirical Analysis/Expenditure/Wealth/Data Collection and Data Estimation Methodology %$ 1000 %! Unfolding Bracket Method in the Measurement of Expenditures and Wealth %0 Book %D 1999 %T Wealth, Work, and Health: Innovations in Measurement in the Social Sciences: Essays in honor of F. Thomas Juster %A James P Smith %A Robert J. Willis %K Consumption and Savings %K Health Conditions and Status %K Income %K Methodology %K Retirement Planning and Satisfaction %X Twelve papers, presented at a December 1996 conference at the Institute for Social Research (ISR), celebrating the career of F. Thomas Juster and his retirement from the University of Michigan and the ISR, focus on survey measurement and analysis of survey data in the social sciences. Papers discuss the several cultures of research on subjective expectations; measuring investment in young children with time diaries; the unfolding bracket method in the measurement of expenditures and wealth; lifetime earnings, saving choices, and wealth at retirement; inheritances and bequests; pension and social security wealth in the Health and Retirement Study; the size distribution of wealth in the United States as measured by recent household surveys; a cross -national comparison of health, work, and economic well-being of older workers aged fifty-one to sixty-one using the U.S. and Dutch data sets; labor market transitions and whether subjective probabilities of working have predictive power for actual retirement; the impact of education and heart attack on smoking cessation among middle-aged adults; the association of influenza vaccine receipt with health and economic expectations among elders; and co -residence between married adult children and their elderly unmarried mothers. Contributors include economists. Smith is at the RAND Corporation. Willis is at the University of Michigan and the Institute for Social Research. No index. %I University of Michigan Press %C Ann Arbor, MI %G eng %U https://www.semanticscholar.org/paper/Wealth%2C-work%2C-and-health-%3A-innovations-in-in-the-%3A-Juster-Smith/38354f435b24934cee24184e55e2a75214e2462b %4 Personal Income and Wealth Distribution/Retirement/Retirement Policies/Health Production/Nutrition/Mortality/Morbidity,/Economic Behavior/Cross Cultural Comparison %$ 1044 %0 Journal Article %J American Economic Review %D 1998 %T 401(k) Plans and future patterns of retirement saving %A James M. Poterba %A Steven F Venti %A David A Wise %K Employment and Labor Force %K Net Worth and Assets %K Pensions %K Retirement Planning and Satisfaction %X This paper summarizes current participation and contribution patterns in 401(k) plans and projects 401(k) balances at retirement age for workers currently between the ages of 30 and 40. The various factors that will influence future 401(k) balances are discussed. The projections based on HRS data suggest that 401(k) plans are likely to play a significant role in providing for the retirement income of future retirees. %B American Economic Review %I 88 %V 88 %P 179-184 %G eng %U https://www.jstor.org/stable/116915?seq=1 %N 2 %L pubs_1998_Poterba_JAER.pdf %4 Economic Status--net worth, earnings history/Labor/401(k) participation and balances/Retirement Planning %$ 8274 %0 Book Section %B Inquiries in the economics of aging %D 1998 %T Caring for the Elderly: The Role of Adult Children %A Kathleen McGarry %E David A Wise %K Adult children %K Consumption and Savings %K Demographics %K Healthcare %K Methodology %B Inquiries in the economics of aging %S NBER Project Report series %I University of Chicago Press %C Chicago and London %P 133-63 %G eng %U https://www.nber.org/chapters/c7084.pdf %4 Caregiver Status/Adult Children/Economics of the Elderly/Analysis of Health Care Markets/Marriage/Marital Dissolution/Family Structure/Elderly %$ 1088 %! Caring for the Elderly: The Role of Adult Children %0 Journal Article %J American Economic Review %D 1998 %T The Cause of Wealth Dispersion at Retirement: Choice or Chance? %A Steven F Venti %A David A Wise %K Income %K Net Worth and Assets %K Retirement Planning and Satisfaction %B American Economic Review %I 88 %V 88 %P 185-91 %G eng %U https://www.jstor.org/stable/116916?seq=1 %N 2 %L pubs_1998_Venti_SAER.pdf %4 Personal Income and Wealth Distribution/Retirement/Retirement Policies/Retirement/Wealth %$ 1054 %0 Book Section %B Frontiers in the Economics of Aging %D 1998 %T Consumption and Saving Balances of the Elderly: Experimental Evidence on Survey Response Bias %A Michael D Hurd %A Daniel McFadden %A Chand, Harish %A Gan, Li %A Merrill, Angela %A Michael Ewing Roberts %E David A Wise %K Consumption and Savings %K Methodology %X A prerequisite for understanding the economic behavior of the elderly, and the impacts of public policy on their health and well-being, is accurate data on key economic variables such as income, consumption, and assets, as well as on expectations regarding future economic and demographic events such as major health costs, disabilities, and death. Standard practice is to elicit such information in economic surveys, relying on respondents’ statements regarding the variables in question. Economists are generally aware that stated responses are noisy. Item nonresponse is a common problem, and carefully done surveys are designed to minimize it. Well-designed analyses of economic survey data are careful about detecting implausible outliers, imputing missing values, and correcting for selection caused by dropping missing observations. Circumstances are recognized that tend to produce systematic biases in response, such as telescoping in recall of past events that arises from the psychophysical perception of time intervals, or overstatement of charitable contributions that arises from the incentive to project a positive self-image. Nevertheless, economic studies are often too sanguine about the reliability of subjects’ statements regarding objective economic data. %B Frontiers in the Economics of Aging %I Univ. of Chicago Press %C Chicago %P 353-387 %G eng %U https://www.nber.org/chapters/c7306 %4 Consumption/Savings/Survey Methods %$ 8284 %! Consumption and Saving Balances of the Elderly: Experimental Evidence on Survey Response Bias %0 Book Section %B Frontiers in the Economics of Aging %D 1998 %T Health Events, Health Insurance and Labor Supply: Evidence from the Health and Retirement Survey %A Mark McClellan %E David A Wise %K Employment and Labor Force %K Health Conditions and Status %K Medicare/Medicaid/Health Insurance %X The economic consequences of health problems are reported to be enormous. For example, many investigators have concluded that the cost to society of common health problems such as heart disease, diabetes, and cancer is many billions of dollars per year in terms of lost work productivity, intensive medical treatments, and additional supportive care. However, these estimates have several important limitations. Few data sets have incorporated detailed information on health problems and economic circumstances such as retirement, medical and personal care expenditures, income, and wealth. Consequently, most existing studies have had to combine data from different sources, possibly missing important correlations between variables such as insurance availability and the occurrence of health problems. Many of these studies have been based on cross-sectional, descriptive comparisons of individuals with and without health problems. As a result, it is difficult to account for other differences besides health problems that might also have affected these outcomes. For example, individuals with health problems may have had chronically worse health status, or have lower-income backgrounds, or have other differences in preferences that might have led to differences in economic outcomes anyway. %B Frontiers in the Economics of Aging %I Univ. of Chicago Press %C Chicago, IL %G eng %U https://www.nber.org/chapters/c7304 %4 Health Status/Labor Supply/Health Insurance %$ 8174 %! Health Events, Health Insurance and Labor Supply: Evidence from the Health and Retirement Survey %0 Magazine Article %D 1998 %T His Paycheck is His Pep Pill %A Whitford, David %K Demographics %K Employment and Labor Force %B Fortune Magazine %V 138 %P 138-142 %8 Aug 17, 1998 %G eng %N 4 %4 Labor/Basic Demographics %$ 8596 %! His Paycheck is His Pep Pill %0 Book Section %B Inquiries in the economics of aging %D 1998 %T Household Wealth of the Elderly under Alternative Imputation Procedures %A Hoynes, Hilary %A Michael D Hurd %A Chand, Harish %E David A Wise %K Consumption and Savings %K Demographics %K Income %K Net Worth and Assets %K Retirement Planning and Satisfaction %X Although many reach retirement with few resources except housing equity and a claim to social security and Medicare, financial wealth, nonetheless, makes an important contribution to the economic status of many of the elderly. Most of our up-to-date information about the wealth of the elderly is based on the Survey of Income and Program Participation (SIPP), which sometimes adds an asset module to its core survey. As in many surveys of assets, the rate of missing data on individual asset items is high, about 30 to 40 percent among those with the asset. This raises the issue of the reliability of SIPP wealth measures because respondents who refuse or are unable to give a value to an asset item may not be representative of the population. Indeed, in the Health and Retirement Survey (HRS) it is clear that asset data are not missing at random. Through the use of bracketing methods, which we will discuss below, the HRS was able to reduce the rate of missing asset data substantially, and the data that were added in this way increased mean wealth in the HRS by about 40 percent (Smith 1995). Furthermore, because the additional data increased the mean so much, they undoubtedly increased measures of wealth inequality. %B Inquiries in the economics of aging %I University of Chicago Press %C Chicago and London %P 229 -54 %G eng %U https://www.nber.org/chapters/c7088 %N NBER Project Report series %4 Economics of the Elderly/Retirement/Retirement Policies/Personal Income and Wealth Distribution/Elderly/Wealth %$ 1008 %! Household Wealth of the Elderly under Alternative Imputation Procedures %0 Journal Article %J Journal of Health and Social Behavior %D 1998 %T The Impact of Education and Heart Attack on Smoking Cessation Among Middle-aged Adults %A Linda A. Wray %A A. Regula Herzog %A Robert J. Willis %A Robert B Wallace %K Demographics %K Health Conditions and Status %K Methodology %X Considerable evidence supports the premise that higher levels of education lead to enhanced health, including protective health behaviors. This paper focuses on how education affects one health behavior known to lead to enhanced health: the cessation of smoking. In particular, the authors examine the extent to which education influences the decision by middle-aged adults to quit smoking following a heart attack, a potentially life-threatening health event. We first hypothesize that middle-aged adults with more formal education will stop smoking more readily than people with less formal education following the experience of a heart attack. Second, we ask what other factors might underlie and explain that hypothesized effect. Using longitudinal data, the authors track changes in individual smoking behaviors after a heart attack among preretirement-age Americans. We control for documented correlates of smoking and heart attack plus other factors associated with education, heart attack, and smoking that may also influence whether a person quits smoking. In addition to confirming evidence on the education-health association as well as the documented connection between heart attack and smoking cessation, this study provides a surprising twist on those links: Our results show that the move to quit smoking following the experience of a heart attack among middle-aged adults is significantly and dramatically moderated by their level of educational attainment. %B Journal of Health and Social Behavior %I 39 %V 39 %P 271-94 %G eng %N 4 %4 Education/Gender/Health Behavior/Logistic Models/Longitudinal Studies/Middle Age/Multivariate Analysis/Myocardial Infarction/Odds Ratio/Smoking Cessation/Support, U.S. Government--PHS %$ 4365 %0 Book Section %B Frontiers in the Economics of Aging %D 1998 %T Implications of Rising Personal Retirement Saving %A James M. Poterba %A Steven F Venti %A David A Wise %E David A Wise %K Employment and Labor Force %K Income %K Pensions %X This paper simulates the 401(k) assets of future generations of retirees and compares these assets with the social security and other assets of the households who are approaching retirement now. The accumulation of 401(k) assets at retirement for the cohort that was 25 years old in 1984 and the cohort that was 15 years old in 1984 was projected. Findings based on these projections suggest that 401(k) assets will definitely be a significant component of the retirement wealth of future retirees and could be the dominant component for a large fraction of them. %B Frontiers in the Economics of Aging %I University of Chicago Press %C Chicago, IL %P 125-167 %G eng %4 Economic Status--earnings histories, wealth/401(k) participation and balances/Labor %$ 8276 %+ HRS 1992 %! Implications of Rising Personal Retirement Saving %0 Journal Article %J Journal of Vocational Behavior %D 1998 %T The Influence of Push and Pull Factors on Voluntary and Involuntary Early Retirees' Retirement Decision and Adjustment %A Kenneth S. Shultz %A Morton, Kelly R. %A Weckerle, Joelle R. %K Adult children %K Health Conditions and Status %K Net Worth and Assets %K Retirement Planning and Satisfaction %X This paper examines early retirees' decisions to retire, as well as their postretirement adjustment, in terms of both push (negative considerations: e.g., poor health) and pull (positive considerations: e.g., leisure interests) factors. Results confirm the hypothesis that both negative push and positive pull factors differentially influenced those retirees who voluntarily retired and those forced to retire. After retirement, the negative push factors became the more salient differentiators; those forced to retire appeared to have generally lower self ratings of physical and emotional health and lower satisfaction rates. In addition, the findings suggest that the way an individual views their retirement decision is related to their postretirement experience: those who viewed their retirement decision as voluntary reported higher satisfaction and health levels during retirement than those who viewed their retirement as involuntary. %B Journal of Vocational Behavior %I 53 %V 53 %P 45-57 %G eng %N 1 %4 Retirement Planning/Health Status/Desire for Leisure/Family Time/Economic Status/Retirement Behavior/Satisfaction %$ 8224 %0 Report %D 1998 %T The Microeconomics of the Retirement Decision in the United States %A Joseph F. Quinn %A R.V. Burkhauser %A Kevin E. Cahill %A Robert R. Weathers II %K Methodology %K Retirement Planning and Satisfaction %G eng %U https://www.researchgate.net/publication/4922743_The_Microeconomics_of_the_Retirement_Decision_in_the_United_States %4 Retirement Planning/Microeconomic Data Management %$ 6528 %0 Journal Article %J Am J Public Health %D 1998 %T Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994. %A Zwerling, Craig %A Nancy L. Sprince %A Charles S. Davis %A Paul S. Whitten %A Robert B Wallace %A Steven G Heeringa %K Accidents, Occupational %K Age Distribution %K Aged %K Aged, 80 and over %K Analysis of Variance %K Cross-Sectional Studies %K Disabled Persons %K Female %K Health Surveys %K Humans %K Logistic Models %K Male %K Middle Aged %K Odds Ratio %K Prospective Studies %K Retirement %K Risk Factors %K United States %X

OBJECTIVES: We tested the hypothesis that among older workers, disabilities in general, and hearing and visual impairments in particular, are risk factors for occupational injuries.

METHODS: Using the first 2 interviews of the Health and Retirement Study, a nationally representative survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers.

RESULTS: Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: service personnel, odds ratio = 1.71 (95% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios.

CONCLUSIONS: Poor sight and poor hearing, as well as work disabilities in general, are associated with occupational injuries among older workers.

%B Am J Public Health %I 88 %V 88 %P 1691-5 %8 1998 Nov %G eng %U https://pubmed.ncbi.nlm.nih.gov/9807538/ %N 11 %L pubs_1998_Zwerling_CAJPH.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/9807538?dopt=Abstract %4 Labor/Occupational Injury/Health Status/Basic Demographics/Health Behaviors/Risk Factors/Disability/Disability %$ 8152 %R 10.2105/ajph.88.11.1691 %0 Journal Article %J J Occup Environ Med %D 1998 %T Occupational injuries among older workers with visual, auditory, and other impairments. A validation study. %A Zwerling, Craig %A Paul S. Whitten %A Charles S. Davis %A Nancy L. Sprince %K Accidents, Occupational %K Aged %K Cohort Studies %K Disabled Persons %K Female %K Health Surveys %K Humans %K Logistic Models %K Male %K Middle Aged %K Persons With Hearing Impairments %K Risk Factors %K Visually Impaired Persons %X

This study aims to validate a previously defined model of the risk of occupational injuries among older workers with visual, auditory, or other impairments. That model was based upon the Health and Retirement Study (HRS). The previous logistic regression model was recalculated using data from the 1994 National Health Interview Survey (NHIS). The parameter estimates for impaired hearing (.181 in NHIS, 1.55 in HRS), impaired vision (2.42 in NHIS, 1.48 in HRS), and self-employment (0.22 in NHIS, 0.49 in HRS) were in same direction and of roughly the same magnitude. The previously defined model was confirmed using NHIS data. The data suggest that as the workforce ages, more attention must be paid to the accommodation of disabilities in the workplace, especially sensory impairments-poor vision and hearing.

%B J Occup Environ Med %I 40 %V 40 %P 720-3 %8 1998 Aug %G eng %U https://pubmed.ncbi.nlm.nih.gov/9729756/ %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/9729756?dopt=Abstract %4 Accidents, Occupational/Cohort Studies/Disabled Persons/Gender/Hearing Impaired Persons/Logistic Models/Middle Age/Risk Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Visually Impaired Persons %$ 8344 %R 10.1097/00043764-199808000-00010 %0 Book Section %B Frontiers in the Economics of Aging %D 1998 %T Pensions and the Distribution of Wealth %A Kathleen McGarry %A Davenport, Andrew %E David A Wise %K Net Worth and Assets %B Frontiers in the Economics of Aging %I University of Chicago Press %C Chicago, IL %G eng %4 Pension Wealth %$ 8246 %! Pensions and the Distribution of Wealth %0 Journal Article %J Journal of Aging and Health %D 1998 %T Predictors of Mobility and Basic ADL Difficulty Among Adults Aged 70 Years and Older %A Daniel O. Clark %A Timothy E. Stump %A Hui, S.L. %A Frederic D Wolinsky %K Health Conditions and Status %X We use data from the 1993-1995 Assets and Health Dynamics of the Oldest-Old survey to estimate predictors of onset of mobility difficulty, onset of basic activity of daily living (ADL) difficulty, and improvement to no mobility difficulty. Onset of mobility difficulty occurred among 20 of those with no difficulty at baseline (n = 2,857) and was most likely among those 85 years of age or over, women, those with a body-mass index of 30 or over, and those who reported lung disease, arthritis, frequent pain, and poor memory. For those with mobility difficulty at baseline (n = 1,871), improvement occurred among 24 and onset of basic ADL difficulty occurred among 25 . Improvement was more likely among those with difficulty in just one mobility item at baseline, and onset of ADL difficulty was most common among those with difficulty in three or more mobility items at baseline. %B Journal of Aging and Health %I 10 %V 10 %P 422-40 %G eng %N 4 %4 ADL and IADL Impairments/Old Age/Mobility Difficulty %$ 12962 %0 Journal Article %J American Journal of Epidemiology %D 1998 %T Predictors of Onset Of and Recovery From Mobility Difficulty Among Adults Aged 51-61 Years %A Daniel O. Clark %A Timothy E. Stump %A Frederic D Wolinsky %K Demographics %K Disabilities %K Health Conditions and Status %K Methodology %K Other %K Risk Taking %X Relative to information on activities of daily living, information regarding the onset of and recovery from mobility difficulty has been limited. Drawing upon data gathered from 6,376 self-respondents aged 51-61 years at baseline (1992) who were successfully reinterviewed in 1994 as part of the Health and Retirement Survey, the authors were able to build upon and add to knowledge gained from previous studies of the onset of and recovery from mobility difficulty. Hierarchical logistic regression was used to separate the direct and indirect effects of predictors of mobility difficulty onset and recovery at 2-year follow-up. To separate direct and indirect effects, the authors categorized various predictors as being related to sociodemographic factors, economic factors, health behavior, chronic disease, or physical impairment, and the categories were sequentially incorporated into a series of equations. The order in which the predictors were incorporated into the equations followed from a theoretical model of the disability process. In this study of mobility difficulty, the strongest direct predictors of recovery were having little baseline difficulty and the absence of diabetes mellitus, lung disease, and frequent pain. The strongest direct predictors of onset were female sex, less education, low net worth, lack of private health insurance, obesity, and frequent pain. Few indirect predictors for either onset or recovery were identified. Predictors of recovery were few and differed from predictors of onset. Further efforts are needed to identify modifiable predictors among females, persons with few economic resources, and those with frequent pain. %B American Journal of Epidemiology %I 148 %V 148 %P 63-71 %G eng %N 1 %4 Activities of Daily Living/Age of Onset/Chronic Disease/Disabled Persons/Statistics and Numerical Data/Female/Health Behavior/Human/Logistic Models/Middle Age/Movement/Odds Ratio/Risk Factors/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS %$ 4045 %0 Book Section %B Inquiries in the Economics of Aging %D 1998 %T Subjective Survival Curves and Life Cycle Behavior %A Michael D Hurd %A Daniel McFadden %A Gan, Li %E David A Wise %K Consumption and Savings %K Event History/Life Cycle %K Health Conditions and Status %B Inquiries in the Economics of Aging %S NBER Project Reports %I University of Chicago Press %C Chicago and London %P 259 -305 %G eng %4 Intertemporal Consumer Choice/Life Cycle Models and Saving/Economics of the Elderly/Health Production--Nutrition, Mortality, Morbidity, Disability, and Economic Behavior/Life Cycle %$ 1012 %! Subjective Survival Curves and Life Cycle Behavior %0 Journal Article %J The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 1997 %T Asset and Health Dynamics Among the Oldest Old: An overview of the AHEAD Study %A Beth J Soldo %A Michael D Hurd %A Willard L Rodgers %A Robert B Wallace %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Income %K Methodology %K Net Worth and Assets %X This article contains background information on the study of Asset and Health Dynamics Among the Oldest Old (AHEAD), a prospective panel survey of persons born in 1923 or earlier who were residing in the community at the time of the 1993 baseline. Interviews were sought with both spouses in married households, and an overall total of 8,222 were completed. We review the interdisciplinary scientific issues that motivated the study, describe the fundamental design decisions that structured AHEAD, and summarize the content in the core and experimental modules. The study provides unusually detailed data on cognition, family structure and transfers, and assets. Data are presented on sample selections, response rates, and oversamples of minority groups. Basic descriptive data on the demographic, health, and socioeconomic attributes of respondents also are presented. Plans for future waves of AHEAD are described, including a next-of-kin interview for decreased respondents. %B The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %I 52B %V 52B %P 1-20 %G eng %N Spec %L pubs_1997_Soldo_BJGSeriesB.pdf %4 HRS content and design/Aged, 80 and Over/Family/Female/Financing, Personal/Health Services/Utilization/Health Status/Income/Longitudinal Studies/Support, U.S. Government--PHS/United States %$ 4205 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 1997 %T The division of family labor: care for elderly parents. %A Douglas A. Wolf %A Vicki A Freedman %A Beth J Soldo %K Aged %K Caregivers %K Family %K Frail Elderly %K Humans %K Models, Theoretical %K Time Factors %X

We consider the division of caregiving efforts among the children of older, functionally limited parents. Our model of parental care assumes that care decisions are made in the context of an extended family, with each child taking into account not only the parent's needs and the child's own circumstances, but also the characteristics and actual care behavior of siblings. We propose a simultaneous-Tobit statistical framework that embodies these assumptions. The model is estimated using data from the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) study. The findings indicate that a child's hours of parent care are reduced, but on much less than a one-for-one basis, as the parent-care hours of siblings increase. We also find that a child's supply of parent-care hours is reduced by having sisters, holding constant the care efforts of siblings.

%B J Gerontol B Psychol Sci Soc Sci %I 52B %V 52 Spec No %P 102-9 %8 1997 May %G eng %L pubs_1997_Wolf_DJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/9215362?dopt=Abstract %4 Caregivers/Family/Frail Elderly/Human/Models, Theoretical/Time Factors/Transfers %$ 4350 %R 10.1093/geronb/52b.special_issue.102 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 1997 %T Measures of cognitive functioning in the AHEAD Study. %A A. Regula Herzog %A Robert B Wallace %K Aged %K Aged, 80 and over %K Cognition %K Geriatric Assessment %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Memory %K Mental Status Schedule %K Psychological Tests %K Socioeconomic factors %K United States %X

Decline in cognitive functioning and onset of cognitive impairment are potentially important predictors of elderly persons needing informal assistance and formal health care. This article describes the measures of cognitive functioning that were developed for the Asset and Health Dynamics Among the Oldest Old (AHEAD) study of some 6,500 Americans aged 70 years and older. The study was designed to investigate the impact of health on disbursement of family and economic resources. Evaluation of the cognitive measures in terms of psychometric properties and missing data, telephone administration, and formation of an aggregate index is encouraging. Their construct validity is evidenced by their correlations with sociodemographic characteristics and health indicators that replicate existing findings as well as by their prediction of IADL and ADL functioning that are consistent with theory.

%B J Gerontol B Psychol Sci Soc Sci %I 52B %V 52 Spec No %P 37-48 %8 1997 May %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/9215356 %L pubs_1997_Herzog_ARJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/9215356?dopt=Abstract %4 Psychological Tests/Survey Methods/Cognitive Functioning %$ 8074 %R 10.1093/geronb/52b.special_issue.37 %0 Report %D 1997 %T New Evidence on the Money's Worth of Individual Annuities %A Olivia S. Mitchell %A James M. Poterba %A Mark J. Warshawsky %K Annuitization %K Economics %K Retirement Planning and Satisfaction %X This paper presents new information on the expected present discounted value of payouts on individual life annuities. The annuity we examine is the single premium immediate life annuity, an insurance product that pays out a nominal level sum as long as the covered person lives, in exchange for an initial lump-sum premium. This annuity offers protection against the risk of someone outliving his saving, given uncertainty about longevity. For reasonable estimates of behavioral parameters, we calculate that individual annuities are currently priced so that retirees without bequest motives should find these policies of substantial value in configuring their portfolios to smooth retirement consumption. We also find that the expected present discounted value of payouts, relative to the initial cost of the annuity, has increased over the last decade. These findings bear on the policy debate regarding the role of individual choice and self-reliance in retirement planning. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %P 1-47 %8 04/1997 %G eng %U http://www.nber.org/papers/w6002.pdf %R 10.3386/w6002 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 1997 %T Prevalence and impact of risk factors for lower body difficulty among Mexican Americans, African Americans, and whites. %A Daniel O. Clark %A Mungai, S.M. %A Timothy E. Stump %A Frederic D Wolinsky %K Aged %K Aged, 80 and over %K Black or African American %K Chronic disease %K Cohort Studies %K Disabled Persons %K Disease %K Female %K Health Behavior %K Humans %K Male %K Memory Disorders %K Mexican Americans %K Middle Aged %K Prevalence %K Risk Factors %K Socioeconomic factors %K White People %X

BACKGROUND: The purpose of the study was to estimate the prevalence of sociodemographic, health behavior, chronic disease, and impairment factors and their impact on difficulty in lower body function among two age-cohorts (51-61 and 71-81 years) of Mexican Americans, African Americans, and Whites.

METHODS: Reports from 8,727 and 4,510 self-respondents of the 1992 baseline Health and Retirement Survey and the 1993 baseline Assets and Health Dynamics Study, respectively, were used to estimate prevalence. Multiple linear regression of the 4-item lower body difficulty scale (alpha = .80) was used to estimate the direct effects of the risk factors within the age-cohort and ethnicity groups.

RESULTS: Overall, the risk factors are more prevalent among both minority groups and the older age-cohort. Lower body deficits are particularly high among Mexican Americans and the younger age-cohort of African Americans. The impact of risk factors does not vary much by ethnicity or age-cohort. Female gender, pain, arthritis, and heart and lung disease are the major risk factors, and they account for about one-third of the variance in lower body difficulty for each group.

CONCLUSIONS: Efforts to prevent or reduce lower body difficulty should pay particular attention to pain, arthritis, and heart and lung disease. The central role of sociodemographic and behavioral factors in chronic disease argues for their continued inclusion in disability modeling and prevention.

%B J Gerontol A Biol Sci Med Sci %I 52A %V 52 %P M97-105 %8 1997 Mar %G eng %U http://biomed.gerontologyjournals.org/contents-by-date.0.shtml %N 2 %L pubs_1997_Clark_DJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/9060977?dopt=Abstract %4 Aged, 80 and Over/Blacks/Chronic Disease/Cohort Studies/Disabled Persons/Disease/Female/Health Behavior/Human/Memory Disorders/Mexican Americans/Middle Age/Prevalence/Risk Factors/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Whites %$ 4055 %R 10.1093/gerona/52a.2.m97 %0 Journal Article %J Aging and Mental Health %D 1997 %T Protecting Persons With Severe Cognitive and Mental Disorders: An Analysis of Public Conservatorship in Los Angeles County, California %A Sandra L Reynolds %A Kathleen H. Wilber %K Health Conditions and Status %K Net Worth and Assets %K Public Policy %X This article begins to identify the factors that place older adults at risk for conservatorship. Comaprisons are drawn between the characteristics of adult public conservatees in the civil commitment and Probate programs in Los Angeles, between young and old conservatees, and then between old conservatees and adults nationwide who are part of the AHEAD sample. Findings show obvious differences between the two types of conservatees. Individuals in the Probate program have the characteristics of young conservatees while adults in the civil commitment program have the characteristics of older conservatees and have less available family memebers, implying social isolation as a risk factor for older adults for public conservatorship. Compared to older adults nationwide, older public conservatees (70 and older) are much older, more likely to suffer from dementia, to be physically impaired, and are far less affluent. This comparison suggests that older adults in public conservatorship in Los Angeles appear to reflect the correct target population for such a service, socially isolated and highly impaired adults. %B Aging and Mental Health %I Vol. 1 %V Vol. 1 %P 87-97 %G eng %4 Health Status/Economic Status/Cognition/Public Policy %$ 8250 %R https://doi.org/10.1080/13607869757425 %0 Journal Article %J The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 1997 %T Race, Socioeconomic Status, and Health: Accounting for race differences in health %A Michael Schoenbaum %A Timothy A Waidmann %K Demographics %K Health Conditions and Status %K Public Policy %X This article uses the Asset and Health Dynamics Among the Oldest Old (AHEAD) study to examine the extent to which observed differences in the prevalence of chronic conditions and functional limitations between Black and White adults (aged 70 ) in the United States can be attributed to differences in various aspects of socioeconomic status (SES) between these groups. We use linear and logistic regression techniques to model the relationships between health outcomes and SES. Our findings indicate that race differences in measurable socioeconomic characteristics indeed explain a substantial fraction, but in general not all, of Black/White differences in health status. While our findings do not suggest that low SES directly causes poor health, any more than being Black does so, they do suggest that research and policy intended to address the deficit in health status among Blacks (when compared to Whites) in the U.S. would be well-served to begin with the deficit in wealth, education, and other SES measures. %B The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %I 52B %V 52B %P 61-73 %G eng %N Spec %L pubs_1997_Schoenbaum_MJGSeriesB.pdf %4 Health Status/Socioeconomic Status/Chronic Disease/Aged, 80 and Over/Public Policy %$ 4155 %0 Journal Article %J The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 1997 %T Selection of Children to Provide Care: The effect of earlier parental transfers %A John C Henretta %A Martha S. Hill %A Li, Wei %A Beth J Soldo %A Douglas A. Wolf %K Adult children %K Demographics %K Health Conditions and Status %K Healthcare %K Income %K Methodology %K Other %X We use the first wave of data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study to examine the effects of past parent-to-child financial transfers on selection of a child to provide assistance with basic personal care for unmarried parents. We estimate a fixed-effects conditional logit model and find a positive and significant association between past financial transfers and a child's current helping behavior. The coefficient of past financial transfers is in the direction hypothesized, and its magnitude is 80 as large as that of gender, a well-documented powerful predictor of parental caregiving. There appears to be substantial evidence that earlier parent-to-child financial gifts play a role in determining which child in the family will provide assistance. %B The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %I 52B %V 52B %G eng %N Spec %L pubs_1997_Henretta_JJGSeriesB.pdf %4 Caregivers/Family/Female/Frail Elderly/Human/Income/Models, Theoretical/Parent Child Relations/Support, U.S. Government--PHS %$ 4295 %0 Journal Article %J The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %D 1997 %T The Structure of Health Status among Hispanic, African American, and White Older Adults %A Timothy E. Stump %A Daniel O. Clark %A Johnson, R.J. %A Frederic D Wolinsky %K Demographics %K Disabilities %K Health Conditions and Status %K Methodology %K Women and Minorities %X Activities of daily living (ADLs), instrumental ADLs, and disability markers have traditionally been the most common indicators of functional status. The study on Asset and Health Dynamics Among the Oldest Old (AHEAD) is used to replicate a five-dimensional measurement model composed of these observable indicators among the older adult self-respondents. The items available to measure upper body disability were found wanting, but the lower body disability, and the basic, household, and advanced ADL constructs were confirmed. Analyses of the measurement model separately among subgroups of women, men, Hispanics, Mexican Americans, African Americans, and Whites found no meaningful differences. Two structural models linking the lower body disability, and the basic, household, and advanced ADL constructs to perceived health and depression were also replicated among the older adult self-respondents, as well as separately among African Americans and among Whites. These models reaffirmed the dominant role of lower body disability on the everyday activities of older adults, and on their perceived health and depression. %B The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences %I 52B %V 52B %P 49-60 %G eng %N Spec %L pubs_1997_Stump_TJGSeriesB.pdf %4 Disability/Disability/Activities of Daily Living/Aged, 80 and Over/Blacks/Whites/Female/Geriatric Assessment/Health Status/Hispanic Americans/Models, Theoretical/Socioeconomic Factors/Support, Non U.S. Government/Support, U.S. Government--PHS %$ 4305 %0 Journal Article %J Accident Analysis and Prevention %D 1996 %T Alcohol and Occupational Injuries among Older Workers %A Zwerling, Craig %A Nancy L. Sprince %A Robert B Wallace %A Charles S. Davis %A Paul S. Whitten %A Steven G Heeringa %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Methodology %K Risk Taking %B Accident Analysis and Prevention %I 28 %V 28 %P 371-6. %G eng %N 3 %L pubs_1996_Zwerling_CAAPrev.pdf %4 Accidents, Occupational/Alcohol Drinking/Gender/Middle Age/Risk Factors/Sex Distribution/Support, U.S. Government--PHS/Wounds and Injuries %$ 4420 %0 Book Section %B Health Survey Research Methods %D 1996 %T Comparisons of Two Sampling Frames for Surveys of the Oldest Old %A Willard L Rodgers %E Warnecke, R.B. %K Methodology %B Health Survey Research Methods %I National Center for Health Statistics, Centers for Disease Control and Prevention, Public Health Service, US Dept. of Health and Human Services %C Washington, DC %V DHHS Publication No. (PHS)96-1013 %P 117-122 %G eng %4 HRS Sponsorship, Sample, Study Design %$ 8066 %! Comparisons of Two Sampling Frames for Surveys of the Oldest Old %0 Book Section %B Advances in the Economics of Aging %D 1996 %T Living Arrangements: Health and Wealth Effects %A Daniel McFadden %A Axel Borsch-Supan %A Schnabel, R. %E David A Wise %K Health Conditions and Status %K Housing %K Net Worth and Assets %B Advances in the Economics of Aging %I University of Chicago Press %C Chicago, IL %P 193-216 %G eng %4 Housing/Wealth/Health Status %$ 8262 %! Living Arrangements: Health and Wealth Effects %0 Journal Article %J Journal of the American Geriatrics Society %D 1996 %T Pain in Ethnic Minorities: A Report from the Health and Retirement Study %A Kramer, B.J. %A Linda A. Wray %A Ferrell, B.A. %K Women and Minorities %B Journal of the American Geriatrics Society %I 44 %V 44 %P P263-263 %G eng %N 9 %4 Minorities %$ 8350 %0 Journal Article %J Gerontologist %D 1996 %T Physical function among retirement-aged African American men and women. %A Daniel O. Clark %A Christopher M. Callahan %A Mungai, S.M. %A Frederic D Wolinsky %K Black or African American %K Female %K Health Behavior %K Health Status %K Humans %K Male %K Middle Aged %K Models, Theoretical %K Odds Ratio %K Retirement %K United States %X

Prior attempts to identify factors associated with physical function (here, major lower body movements) among African Americans have been constrained by a narrow range of measures, small sample sizes, or both. The 1992 Health and Retirement Study (HRS) contains a substantial over-sample of African Americans (649 men and 957 women self-respondents aged 51 to 61 years), and detailed measures of high-risk behaviors, disease prevalence and severity, impairment, and physical function. We extend the natural history of disease to the natural history of functional status and model sociodemographic characteristics, high-risk behaviors, disease prevalence and severity, and impairments as direct and indirect influences on physical function in this African American sample. This natural history of functional status model fits the data well for both men (ROC = .88) and women (ROC = .83), although there are gender differences. Slightly over one-half of the women report some difficulty in physical function, compared with one-third of the men. Women also have a higher mean body-mass and report a greater prevalence and severity in 6 of 9 chronic diseases and more pain, but are less likely to smoke or abuse alcohol than men. Importantly, many of the factors with the largest direct and indirect associations with difficulty in physical function among these African American men (alcohol abuse, smoking, body mass, diabetes, heart disease, cerebrovascular disease, arthritis, and pain) and women (alcohol abuse, body mass, arthritis, and respiratory illness) are all potentially preventable or manageable.

%B Gerontologist %I 36 %V 36 %P 322-31 %8 1996 Jun %G eng %N 3 %L pubs_1996_Clark_DGer.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/8682330?dopt=Abstract %4 Blacks/Female/Health Behavior/Health Status/Human/Middle Age/Models, Theoretical/Odds Ratio/Retirement %$ 4040 %R 10.1093/geront/36.3.322 %0 Book Section %B Implementing the Americans with Disabilities Act %D 1996 %T The Potential Impact on the Employment of People with Disabilities %A R.V. Burkhauser %A Mary C. Daly %E West, Jane %K Disabilities %K Employment and Labor Force %B Implementing the Americans with Disabilities Act %I Blackwell Publishers %C Cambridge, MA %P 153-192 %G eng %4 Labor Force/Disability/Disability %$ 8068 %! The Potential Impact on the Employment of People with Disabilities %0 Journal Article %J The Gerontologist %D 1996 %T Race Differences in Labor Force Attachment and Disability Status %A John Bound %A Michael Schoenbaum %A Timothy A Waidmann %K Demographics %K Disabilities %K Employment and Labor Force %K Health Conditions and Status %K Methodology %K Other %K Women and Minorities %X We used the first wave of the Health and Retirement Survey to study the effect of health on the labor force activity of black and white men and women in their 50s. The evidence we present confirms the notion that health is an extremely important determinant of early labor force exit. Our estimates suggest that health differences between blacks and whites can account for most of the racial gap in labor force attachment for men. For women, when participation rates are comparable, our estimates imply that black women would be substantially more likely to work than white women were it not for the marked health differences. We also found for both men and women that poor health has a substantially larger effect on labor force behavior for blacks. The evidence suggests that these differences result from black/white differences in access to the resources necessary to retire. %B The Gerontologist %I 36 %V 36 %P 311-21. %G eng %U https://academic.oup.com/gerontologist/article/36/3/311/705045 %N 3 %L pubs_1996_Bound_JGer.pdf %4 Blacks/Comparative Study/Disabled Persons/Employment/Female/Health Status/Human/Middle Age/Models, Theoretical/Odds Ratio/Support, Non U.S. Government/Support, U.S. Government--PHS/Whites %$ 4025 %R https://doi.org/10.1093/geront/36.3.311 %0 Journal Article %J Am J Public Health %D 1996 %T Risk factors for occupational injuries among older workers: an analysis of the health and retirement study. %A Zwerling, Craig %A Nancy L. Sprince %A Robert B Wallace %A Charles S. Davis %A Paul S. Whitten %A Steven G Heeringa %K Accidents, Occupational %K Cross-Sectional Studies %K Educational Status %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Occupational Diseases %K Regression Analysis %K Retirement %K Risk Factors %K Sex Factors %K United States %K Wounds and Injuries %X

OBJECTIVES: This study examined risk factors for occupational injury among older workers.

METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old.

RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers' impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47).

CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.

%B Am J Public Health %I 86 %V 86 %P 1306-9 %8 1996 Sep %G eng %N 9 %L pubs_1996_Zwerling_CAJPH.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/8806386?dopt=Abstract %4 Accidents, Occupational/Educational Status/Health Status/Gender/Middle Age/Occupational Diseases/Regression Analysis/Retirement/Risk Factors/Sex Factors/Support, Non U.S. Government/Support, U.S. Government--PHS/Wounds and Injuries %$ 4415 %R 10.2105/ajph.86.9.1306 %0 Journal Article %J Gerontologist %D 1996 %T The role of ethnicity in the disability and work experience of preretirement-age Americans. %A Linda A. Wray %K Activities of Daily Living %K Analysis of Variance %K Disabled Persons %K Employment %K ethnicity %K Female %K Humans %K Male %K Middle Aged %K Odds Ratio %K Regression Analysis %K Risk Factors %K United States %X

Using the 1992 HRS, this study examines the effects of social and demographic risk factors, including ethnicity, as well as health and job characteristics on disability and work status among 8,701 preretirement-age Americans with work history. Analytic results indicated that non-Anglo ethnicity was not a significant predictor of disability status but that being African American was a strong significant predictor of being a past versus current worker. The primary predictors of disability and work status were health behaviors, effects of health conditions, job characteristics, and workplace adaptations, factors that lend themselves to policy manipulation.

%B Gerontologist %I 36 %V 36 %P 287-98 %8 1996 Jun %G eng %N 3 %L pubs_1996_Wray_LGer.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/8682327?dopt=Abstract %4 Disabled Persons/Employment/Ethnic Groups/Gender/Middle Age/Odds Ratio/Risk Factors/Support, U.S. Government--PHS/Methodology %$ 4370 %R 10.1093/geront/36.3.287 %0 Journal Article %J Am J Ind Med %D 1995 %T Effect of recall period on the reporting of occupational injuries among older workers in the Health and Retirement Study. %A Zwerling, Craig %A Nancy L. Sprince %A Robert B Wallace %A Charles S. Davis %A Paul S. Whitten %A Steven G Heeringa %K Accidents, Occupational %K Adult %K Aged %K Bias %K Cross-Sectional Studies %K Data collection %K Female %K Humans %K Incidence %K Linear Models %K Male %K Mental Recall %K Middle Aged %K Models, Statistical %K Reproducibility of Results %K Retirement %K Risk Factors %K Time Factors %K United States %X

Studies of injury morbidity often rely on self-reported survey data. In designing these surveys, researchers must chose between a shorter recall period to minimize recall bias and a longer period to maximize the precision of rate estimates. Using data from the Health and Retirement Study, which employed a recall period of 1 year, we examined the effect of the recall period on rates of occupational injuries among older workers as well as upon rate ratios of these injuries for nine risk factors. We fit a stochastic model to the occupational injury rates as a function of time before the interview and used this model to estimate what the injury rates would have been had we used a 4-week recall period. The adjusted occupational injury rate of 5.9 injuries per 100 workers per year was 36% higher than the rate based on a 1-year recall period. Adjustment for recall period had much less effect on rate ratios, which typically varied by < 10%. Our work suggests that self-reported surveys with longer recall periods may be used to estimate occupational injury rates and also may be useful in studying the associations between occupational injuries and a variety of risk factors.

%B Am J Ind Med %I 28 %V 28 %P 583-90 %8 1995 Nov %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/8561168?dopt=Abstract %4 Accidents, Occupational/Adult/Bias (Epidemiology)/Morbidity/Gender/Incidence/Middle Age/Models, Statistical/Recall/Reproducibility of Results/Retirement/Risk Factors/Support, U.S. Government--PHS/Time Factors %$ 4425 %R 10.1002/ajim.4700280503 %0 Report %D 1995 %T Lump-Sum Distributions from Retirement Saving Plans: Receipt and Utility %A James M. Poterba %A Steven F Venti %A David A Wise %K Income %K Net Worth and Assets %X One of the central issues in evaluating the ongoing shift from defined benefit (DB) to defined contribution (DC) pension plans is the degree to which assets in DC plans will be withdrawn before plan participants reach retirement age. The annual flow of withdrawals from such plans, which are known as lump sum distributions and which are frequently but not always associated with employment changes, has exceeded 100 billion in recent years. This flow is substantially greater than the flow of new contributions to IRAs and other targeted retirement saving programs. This paper draws on data from the 1993 Current Population Survey and the Health and Retirement Survey to summarize the incidence and disposition of lump sum distributions. We find that while less than half of all lump sum distributions are rolled over into IRAs or other retirement saving plans, large distributions are substantially more likely to be saved than smaller ones are. Consequently, more than half of the dollars paid out as lump sum distributions are reinvested. We also explore the correlation between various individual characteristics and the probability of rolling over a lump sum distribution. This is a first step toward developing a model that can be used to evaluate the long- term effects of lump sum distributions, or policies that might affect them, on the financial status of elderly households. %I NBER %G eng %U https://www.researchgate.net/publication/5193273_Lump-Sum_Distributions_from_Retirement_Saving_Plans_Receipt_and_Utilization %L wp_1995/poterba-wise_NBER5298.pdf %4 Retirement Incomes/Distribution %$ 6655 %0 Journal Article %J Journal of Agricultural Safety and Health %D 1995 %T Occupational Injuries Among Agricultural Workers 51 to 61 Years Old: A National Study %A Zwerling, Craig %A Nancy L. Sprince %A Robert B Wallace %A Charles S. Davis %A Paul S. Whitten %A Steven G Heeringa %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Net Worth and Assets %X This paper examines risk factors for occupational injuries among agricultural workers and compares them with the risk factors for injury among other older workers. The findings suggest that the risks for occupational injuries among agricultural workers differ from those that affect workers in all other occupations. While heavy lifting and poor eye sight were risk factors for both agricultural and other workers, self-employment- - which acted as a protective factor for other workers- - proved to be a risk factor for agricultural workers. Other variables - depressive symptoms and dissatisfaction with marriage, job, family life, the way problems are handled, and life overall - tended to be more strongly associated with occupational injuries in agricultural workers than among other workers. %B Journal of Agricultural Safety and Health %I 1 %V 1 %P 273-281 %G eng %U https://elibrary.asabe.org/abstract.asp?search=1&JID=3&AID=19469&CID=j1995&v=1&i=4&T=1&urlRedirect=[anywhere=&keyword=&abstract=&title=on&author=&references=&docnumber=&journals=All&searchstring=Occupational%20Injuries%20among%20Agricultural%20Workers&pg= %N 4 %4 Self-Employment/Labor/Occupational Injury/Basic Demographics/Health Status/Health Behaviors/Economic Status %$ 8048 %R 10.13031/2013.19469 %0 Journal Article %J The Journal of Human Resources %D 1995 %T Overview of the Health Measures in the Health and Retirement Survey %A Robert B Wallace %A A. Regula Herzog %K Consumption and Savings %K Health Conditions and Status %K Healthcare %K Methodology %X This report discusses the conceptual and logistical issues that lead to the items and instruments used to measure health and function status in Wave 1 of the Health and Retirement Study (HRS). Health status was conceptualized as multidimensional, and included selected major symptoms, diseases and conditions, global self-assessment of health, physical and cognitive functional status, the utilization of health services and selected elements of emotional health. In addition, two physiologic measures were obtained on a sample basis: grip strength and pulmonary maximum expiratory flow rate. Prevalence rates for major conditions and functional states are presented. Correlational analyses generally demonstrated a high rate of convergent, discriminant and construct validity. These findings should assist those intending to analyze HRS data in terms of the focus and utility of the measures employed. %B The Journal of Human Resources %I 30 %V 30 %P S84-S107 %G eng %N Supplement 1995 %L pubs_1994_Wallace_RJHR.pdf %4 Health Status--physical, mental, and emotional/Health Production/Economic Behavior/Health Services/Microeconomic Data Management %$ 8004 %0 Report %D 1995 %T Prevalence and Incidence of Health Problems in the First Two Waves of the Health and Retirement Study %A Eileen M. Crimmins %A Mark D Hayward %A Linda A. Wray %A Lu, Ranyan %K Health Conditions and Status %G eng %4 Health status %$ 6521 %0 Journal Article %J The Journal of Human Resources %D 1995 %T Race and Education Differences in Disability Status and Labor Force Attachment in the Health and Retirement Study %A John Bound %A Michael Schoenbaum %A Timothy A Waidmann %K Demographics %K Employment and Labor Force %K Health Conditions and Status %X This article examines the various effects of health problems, functional limitations, socioeconomic characteristics, and job characteristics on the disability and labor market status of black and white men. Results show that measures of current health status are significant predictors of both labor force participation and self-reported disability status of men aged 50-61. Differences in health status and functional ability between this cohort of black and white men does account for some of the differences in labor force attachment. Health differences between men with different education levels seem to account for all of the gap in labor force attachment between the two groups. Results also suggest that job characteristics affect the manner in which adults adapt to the onset of health limitations and their ability to continue working. %B The Journal of Human Resources %I 30 %V 30 %P S227-S267 %G eng %N Supplement 1995 %L pubs_1995_Bound_JJHR.pdf %4 Health Status/Labor Force/Basic Demographics %$ 8014 %0 Book Section %B Studies in the economics of aging %D 1994 %T Demographics, the Housing Market, and the Welfare of the Elderly %A Daniel McFadden %E David A Wise %K Consumption and Savings %K Demographics %K Housing %B Studies in the economics of aging %S National Bureau of Economic Research Project Report series %I University of Chicago Press %C Chicago and London %P 225-85 %G eng %4 Economics of the Elderly/Demographic Trends and Forecasts/Housing Supply and Markets/Demographics/Elderly/Housing %$ 1070 %! Demographics, the Housing Market, and the Welfare of the Elderly %0 Book Section %B Aging in the United States and Japan %D 1994 %T Problems of Housing the Elderly in the United States and Japan %A Daniel McFadden %A David A Wise %E Yukio Noguchi %K Housing %K Methodology %B Aging in the United States and Japan %I University of Chicago Press %C Chicago, IL %P 109-137 %G eng %U https://www.nber.org/chapters/c8044 %4 Cross Cultural Comparison/Housing %$ 8258 %! Problems of Housing the Elderly in the United States and Japan %0 Report %D 1993 %T The 20-item word list as a measure of cognitive functioning in the HRS: Norms and validity for white, African-American, and Hispanic respondents %A Fillenbaum, Gerda G. %A Burchett, Bruce M. %A Welsh, Kathleen A. %K Health Conditions and Status %X The Health and Retirement Survey includes among its measures of cognitive functioning a 20-item Word List Learning task from which measures of immediate recall, delayed recall and savings (delayed recall/immediate recall) can be derived. Those with preferred demographic condition (white, increased education, younger) and better physical and mental health have better recall scores, so suggesting that this task is a valid measure of cognitive functioning. Norms have been developed for subcategories of race, gender, education and age. Recall performance may help to identify those experiencing difficulty the job, those may be prone to retire, those less likely to obtain or retain new employment, and those with incipient dementia. %I University of Michigan %G eng %U http://www.psc.isr.umich.edu/pubs/series.html %4 Psychological Tests/Cognition %$ 6502 %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