%0 Journal Article %J Alzheimers Dement %D 2011 %T National estimates of the prevalence of Alzheimer's disease in the United States. %A Brookmeyer, Ron %A Denis A Evans %A Liesi Hebert %A Kenneth M. Langa %A Steven G Heeringa %A Brenda L Plassman %A Walter Kukull %K Age Factors %K Alzheimer disease %K Community Health Planning %K Data collection %K Humans %K Incidence %K Models, Statistical %K Prevalence %K Sampling Studies %K United States %X

Several methods of estimating prevalence of dementia are presented in this article. For both Brookmeyer and the Chicago Health and Aging project (CHAP), the estimates of prevalence are derived statistically, forward calculating from incidence and survival figures. The choice of incidence rates on which to build the estimates may be critical. Brookmeyer used incidence rates from several published studies, whereas the CHAP investigators applied the incidence rates observed in their own cohort. The Aging, Demographics, and Memory Study (ADAMS) and the East Boston Senior Health Project (EBSHP) were sample surveys designed to ascertain the prevalence of Alzheimer's disease and dementia. ADAMS obtained direct estimates by relying on probability sampling nationwide. EBSHP relied on projection of localized prevalence estimates to the national population. The sampling techniques of ADAMS and EBSHP were rather similar, whereas their disease definitions were not. By contrast, EBSPH and CHAP have similar disease definitions internally, but use different calculation techniques, and yet arrive at similar prevalence estimates, which are considerably greater than those obtained by either Brookmeyer or ADAMS. Choice of disease definition may play the larger role in explaining differences in observed prevalence between these studies.

%B Alzheimers Dement %I 7 %V 7 %P 61-73 %8 2011 Jan %G eng %N 1 %L newpubs20110328_Brookmeyer.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/21255744?dopt=Abstract %2 PMC3052294 %4 Alzheimer disease/Dementia/Cognitive impairment/Prevalence/Population-based/Projection/Probability/sampling %$ 24580 %R 10.1016/j.jalz.2010.11.007 %0 Journal Article %J J Gen Intern Med %D 2009 %T Financial status, employment, and insurance among older cancer survivors. %A Norredam, Marie %A Meara, Ellen %A Landrum, Mary Beth %A Haiden A. Huskamp %A Nancy L. Keating %K Aged %K Aged, 80 and over %K Cohort Studies %K Data collection %K Employment %K Female %K Financing, Personal %K Humans %K Income %K Insurance Coverage %K Insurance, Health %K Longitudinal Studies %K Male %K Middle Aged %K Neoplasms %K Socioeconomic factors %K Survivors %X

BACKGROUND: Few data are available about the socioeconomic impact of cancer for long-term cancer survivors.

OBJECTIVES: To investigate socioeconomic outcomes among older cancer survivors compared to non-cancer patients.

DATA SOURCE: 2002 Health and Retirement Study.

STUDY DESIGN: We studied 964 cancer survivors of > 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans ages >or= 55 years responding to the 2002 Health and Retirement Study.

MEASURES: We compared household income, housing assets, net worth, insurance, employment, and future work expectations.

ANALYSES: Propensity score methods were used to control for baseline differences between cancer survivors and controls.

RESULTS: Female cancer survivors did not differ from non-cancer patients in terms of income, housing assets, net worth, or likelihood of current employment (all P > 0.20); but more were self-employed (25.0% vs. 17.7%; P = 0.03), and fewer were confident that if they lost their job they would find an equally good job in the next few months (38.4% vs. 45.9%; P = 0.03). Among men, cancer survivors and noncancer patients had similar income and housing assets (both P >or= 0.10) but differed somewhat in net worth (P = 0.04). Male cancer survivors were less likely than other men to be currently employed (25.2% vs. 29.7%) and more likely to be retired (66.9% vs. 62.2%), although the P value did not reach statistical significance (P = 0.06). Men were also less optimistic about finding an equally good job in the next few months if they lost their current job (33.5% vs. 46.9%), although this result was not significant (P = 0.11).

CONCLUSIONS: Despite generally similar socioeconomic outcomes for cancer survivors and noncancer patients ages >or=55 years, a better understanding of employment experience and pessimism regarding work prospects may help to shape policies to benefit cancer survivors.

%B J Gen Intern Med %I 24 %V 24 Suppl 2 %P S438-45 %8 2009 Nov %G eng %N Suppl 2 %L newpubs20091202_Norredam.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19838847?dopt=Abstract %2 PMC2763157 %4 CANCER/financial resources/insurance/socioeconomic status %$ 21310 %R 10.1007/s11606-009-1034-5 %0 Journal Article %J Neurology %D 2009 %T Surrogate consent for dementia research: a national survey of older Americans. %A Scott Y H Kim %A H.M. Kim %A Kenneth M. Langa %A Jason H. Karlawish %A David S Knopman %A Appelbaum, P S %K Advance directives %K Age Factors %K Aged %K Aged, 80 and over %K Alzheimer disease %K Biomedical Research %K Caregivers %K Clinical Trials as Topic %K Data collection %K ethnicity %K Female %K Humans %K Informed Consent %K Legal Guardians %K Male %K Mental Competency %K Middle Aged %K Patient Participation %K Proxy %K Research Subjects %K Surveys and Questionnaires %K Therapeutic Human Experimentation %K Third-Party Consent %X

BACKGROUND: Research in novel therapies for Alzheimer disease (AD) relies on persons with AD as research subjects. Because AD impairs decisional capacity, informed consent often must come from surrogates, usually close family members. But policies for surrogate consent for research remain unsettled after decades of debate.

METHODS: We designed a survey module for a random subsample (n = 1,515) of the 2006 wave of the Health and Retirement Study, a biennial survey of a nationally representative sample of Americans aged 51 and older. The participants answered questions regarding one of four randomly assigned surrogate-based research (SBR) scenarios: lumbar puncture study, drug randomized control study, vaccine study, and gene transfer study. Each participant answered three questions: whether our society should allow family surrogate consent, whether one would want to participate in the research, and whether one would allow one's surrogate some or complete leeway to override stated personal preferences.

RESULTS: Most respondents stated that our society should allow family surrogate consent for SBR (67.5% to 82.5%, depending on the scenario) and would themselves want to participate in SBR (57.4% to 79.7%). Most would also grant some or complete leeway to their surrogates (54.8% to 66.8%), but this was true mainly of those willing to participate. There was a trend toward lower willingness to participate in SBR among those from ethnic or racial minority groups.

CONCLUSIONS: Family surrogate consent-based dementia research is broadly supported by older Americans. Willingness to allow leeway to future surrogates needs to be studied further for its ethical significance for surrogate-based research policy.

%B Neurology %I 72 %V 72 %P 149-55 %8 2009 Jan 13 %G eng %N 2 %L newpubs20090302_KimKim_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19139366?dopt=Abstract %2 PMC2663398 %4 Dementia/Surrogate-based research/Surrogate-based research %$ 19740 %R 10.1212/01.wnl.0000339039.18931.a2 %0 Journal Article %J J Palliat Med %D 2005 %T Net worth predicts symptom burden at the end of life. %A Maria J Silveira %A Mohammed U Kabeto %A Kenneth M. Langa %K Aged %K Aged, 80 and over %K Data collection %K Female %K Humans %K Logistic Models %K Male %K Severity of Illness Index %K Social Class %K Terminally Ill %K United States %X

OBJECTIVES: To explore the predictors of symptom burden at the end of life.

DESIGN: Observational, secondary analysis of Health and Retirement Study (HRS) data.

SETTING: USA.

PARTICIPANTS: Two thousand six hundred four deceased, older adults.

METHODS: Multivariate Poisson and logistic regression to explore the relationship between sociodemographic and clinical factors with symptoms.

RESULTS: Fatigue, pain, dyspnea, depression, and anorexia were common and severe; 58% of participants experienced more than 3 of these during their last year of life. Sociodemographic and clinical factors were associated with the number of symptoms as well as the presence of pain, depression, and dyspnea alone. Decedents in the highest quartile of net worth had fewer symptoms (incident rate ratio [IRR] 0.90, confidence interval [CI] 0.85-0.96) and less pain (odds ratio [OR] 0.66, CI 0.51-0.85) than comparisons did. Patients with cancer experienced more pain (OR 2.02, CI 1.62-2.53) and depression (OR 1.31, CI 1.07-1.61). Patients experienced more depression (OR 2.37, CI 1.85-3.03) and dyspnea (OR 1.40, CI 1.09-1.78).

LIMITATION: Use of proxy reports for primary data.

CONCLUSION: Older Americans experience a large symptom burden in the last year of life, largely with treatable symptoms such as pain, dyspnea, and depression. The adequacy of symptom control relates to clinical factors as well as net worth. This association between symptoms and wealth suggests that access to health care and other social services beyond those covered by Medicare may be important in decreasing symptom burden at the end of life.

%B J Palliat Med %I 8 %V 8 %P 827-37 %8 2005 Aug %G eng %N 4 %L pubs_2005_Silviera.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16128657?dopt=Abstract %4 Quality of Life/Net Worth %$ 13892 %R 10.1089/jpm.2005.8.827 %0 Journal Article %J J Health Econ %D 2000 %T Health insurance and retirement behavior: evidence from the health and retirement survey. %A Jeannette Rogowski %A Lynn A Karoly %K Aged %K Career Mobility %K Data collection %K Decision making %K Employment %K Health Services Accessibility %K Humans %K Insurance, Health %K Male %K Retirement %K Social Class %K United States %X

This paper studies the role of health insurance in the retirement decisions of older workers. As policymakers consider mechanisms for how to increase access to affordable health insurance for the near elderly, considerations of the potential labor force implications of such policies will be important to consider--potentially inducing retirements just at a time when the labor force is shrinking. Using data from the 1992 and 1996 waves of the Health and Retirement Survey, this study demonstrates that access to post-retirement health insurance has a large effect on retirement. Among older male workers, those with retiree health benefit offers are 68% more likely to retire (and those with non-employment based insurance are 44% more likely to retire) than their counterparts who would lose employment-based health insurance upon retirement. In addition, the study demonstrated that in retirement models, when retiree health benefits are controlled for, the effects of pension coverage are reduced, suggesting that these effects may have been overestimated in the prior literature.

%B J Health Econ %I 19 %V 19 %P 529-39 %8 2000 Jul %G eng %N 4 %L pubs_2000_Rogowski_JJHE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11010239?dopt=Abstract %4 Retirement/Retirement Policies/Analysis of Health Care Markets/Insurance/Insurance Companies/Elderly/Health Insurance/Health/Insurance/Older Workers/Retirement %$ 1022 %R 10.1016/s0167-6296(00)00038-2