%0 Journal Article %J Psychology of Medicine %D Forthcoming %T The silent epidemic of loneliness: identifying the antecedents of loneliness using a lagged exposure-wide approach. %A Hong, Joanna H %A Nakamura, Julia S %A Sahakari, Sakshi S %A Chopik, William J %A Shiba, Koichiro %A VanderWeele, Tyler J %A Kim, Eric S %K Health behaviors %K Loneliness %K Older Adults %K Physical Health %K predictors %K Psychosocial factors %K Public Health %X

BACKGROUND: A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.

METHODS: We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from ;2006/2008 to ;2010/2012) were associated with subsequent loneliness 4 years later (;2014/2016).

RESULTS: Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.

CONCLUSIONS: Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.

%B Psychology of Medicine %P 1-14 %G eng %R 10.1017/S0033291723002581 %0 Journal Article %J Social Science & Medicine %D 2023 %T Attribution for everyday discrimination typologies and mortality risk among older black adults %A Ryon J. Cobb %A Violeta J. Rodriguez %A Tyson H. Brown %A Patricia Louie %A Heather R. Farmer %A Connor M. Sheehan %A Dawne M. Mouzon %A Roland J. Thorpe %K Psychosocial factors %K Public Health %K race %K Racism %X The present study assessed how attributions of everyday discrimination typologies relate to all-cause mortality risk among older Black adults. Methods This study utilized data from a subsample of older Black adults from the 2006/2008 Health and Retirement Study (HRS). Attributions for everyday discrimination (i.e., ancestry, age, gender, race, physical appearance, physical disability, sexual orientation, weight, and other factors) were based on self-reports, while their vital statuses were obtained from the National Death Index and reports from key informants (spanning 2006–2019). We applied latent class analysis (LCA) to identify subgroups of older Black adults based on their attributions to everyday discrimination. Cox proportional hazards models were used to analyze time to death as a function of LCA group membership and other covariates. Results Based on fit statistics, we selected a four-class model that places respondents into one of the following classes: Class One (7%) attributed everyday discrimination to age, race, and physical disability; Class Two (72%) attributed everyday discrimination to few/no sources, Class Three (19%) attributed everyday discrimination to race and national origin; and Class Four (2%) attributed everyday discrimination to almost every reason. After adjusting for sociodemographic, behavioral, cardiometabolic, and socioeconomic characteristics, we found that the relative risk of death remained higher for the respondents in Class One (Hazard Ratio [H.R.]: 1.80, 95% Confidence Interval [C.I.]: (1.09–2.98) and Class Four (H.R.: 3.92, 95% C.I.: 1.62–9.49) compared to respondents in Class Two. Conclusions Our findings illustrate the utility of using attribution for everyday discrimination typologies in research on the psychosocial dimensions of mortality risk among older Black adults. Future research should assess the mechanisms that undergird the link between everyday discrimination classes and all-cause mortality risk among older Black adults. %B Social Science & Medicine %V 316 %P 115166 %G eng %R https://doi.org/10.1016/j.socscimed.2022.115166 %0 Journal Article %J Social Science and Medicine %D 2023 %T Attribution for everyday discrimination typologies and mortality risk among older black adults: Evidence from the health and retirement study? %A Cobb, Ryon J %A Rodriguez, Violeta J %A Brown, Tyson H %A Louie, Patricia %A Farmer, Heather R %A Sheehan, Connor M %A Mouzon, Dawne M %A Thorpe, Roland J %K Black People %K Disabled Persons %K Minority health %K Perceived Discrimination %K Psychosocial factors %K Public Health %K Retirement %K Social Perception %X

BACKGROUND: The present study assessed how attributions of everyday discrimination typologies relate to all-cause mortality risk among older Black adults.

METHODS: This study utilized data from a subsample of older Black adults from the 2006/2008 Health and Retirement Study (HRS). Attributions for everyday discrimination (i.e., ancestry, age, gender, race, physical appearance, physical disability, sexual orientation, weight, and other factors) were based on self-reports, while their vital statuses were obtained from the National Death Index and reports from key informants (spanning 2006-2019). We applied latent class analysis (LCA) to identify subgroups of older Black adults based on their attributions to everyday discrimination. Cox proportional hazards models were used to analyze time to death as a function of LCA group membership and other covariates.

RESULTS: Based on fit statistics, we selected a four-class model that places respondents into one of the following classes: Class One (7%) attributed everyday discrimination to age, race, and physical disability; Class Two (72%) attributed everyday discrimination to few/no sources, Class Three (19%) attributed everyday discrimination to race and national origin; and Class Four (2%) attributed everyday discrimination to almost every reason. After adjusting for sociodemographic, behavioral, multisystem physiological dysregulation, and socioeconomic characteristics, we found that the relative risk of death remained higher for the respondents in Class One (Hazard Ratio [H.R.]: 1.80, 95% Confidence Interval [C.I.]: (1.09-2.98) and Class Four (H.R.: 3.92, 95% C.I.: 1.62-9.49) compared to respondents in Class Two.

CONCLUSIONS: Our findings illustrate the utility of using attribution for everyday discrimination typologies in research on the psychosocial dimensions of mortality risk among older Black adults. Future research should assess the mechanisms that undergird the link between everyday discrimination classes and all-cause mortality risk among older Black adults.

%B Social Science and Medicine %V 316 %P 115166 %G eng %R 10.1016/j.socscimed.2022.115166 %0 Thesis %B ProQuest Dissertations and Theses %D 2023 %T Cognitively Stimulating Leisure Activities, Emotional Health, and Cognitive Functions Among Older Adults with Mild Cognitive Impairment: A Longitudinal Analysis %A Lee,Jungjoo %K 0347:Mental health %K 0351:Gerontology %K 0573:Public health %K cognitive functions %K cognitive impairment %K Emotional Health %K Gerontology %K Leisure activities %K Mental Health %K Older Adults %K Public Health %X Objectives: The purpose of this study was to investigate the longitudinal relationship between different levels of Cognitively Stimulating Leisure Activity (CSLA) participation and emotional health and cognitive function among older adults with Mild Cognitive Impairment (MCI). Methods: The current study employed the Health and Retirement Study (HRS) data from 2012 to 2020 (n = 5,932). Three cognitive function tests based on Montreal Cognitive Assessment (MoCA) were used to assess three domains of cognition (i.e., memory, working memory, attention and processing speed) and screen whether the respondents have MCI. Using a Repeated-Measured Multivariate Analysis of Covariance (RM-MANCOVA), this study investigated (a) group mean differences in the positive and negative affect and (b) group mean differences in three cognitive functions in three CSLA groups (low, mid, and high participation).Results: (a) The high CSLA group showed higher positive affect and lower negative affect than the mid and low groups. Also, the mid-CSLA group presented higher positive affect and lower negative affect than the low CSLA group. (b) Both positive and negative affect showed significant differences between years and indicated a continuously declining slope year by year without exceptions. (c) The high CSLA group not only presented higher positive affect and lower negative affect during the period but also solely showed a rebounding feature in the declining slope on both emotions. (d) The high CSLA group indicated higher memory, working memory, and attention and processing speed than the mid and low groups. The mid-CSLA group showed higher working memory and attention and processing speed than the low CSLA group but not in working memory. (e) All three cognitive functions displayed significant differences between years and display a declining slope but the differences between the year 2014 and other years are not significant. (f) The high CSLA group always exhibited higher cognitive functions during the period and maintained a similar level of cognitive functions compared to the other groups. Discussion: The findings of this study provide valuable support for the design and implementation of CSLA participation programs and clinical guidelines for older adults with MCI. The results highlight the importance of determining the optimal level of CSLA engagement that is required to promote emotional health and cognitive function in this population. By incorporating the findings of this study into clinical guidelines, healthcare providers are able to offer an optimal level of CSLA programs offered at least four to three times a week. Further, efforts should be made to create strategies to overcome the barriers to CSLA participation, such as caregiver support and financial constraints, by establishing public care services, subsidies, and community support networks. These implications will contribute to the promotion of cognitive function and the potential prevention of dementia in older adults with MCI, and enhance their overall well-being and quality of life. %B ProQuest Dissertations and Theses %P 89 %@ 9798380122030 %G eng %U https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/cognitively-stimulating-leisure-activities/docview/2852386350/se-2 %9 phd %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 Journal of General Internal Medicine %D 2023 %T The Epidemiology of Smoking in Older Adults: A National Cohort Study. %A Hunt, Lauren J %A Covinsky, Kenneth E %A Cenzer, Irena %A Espejo, Edie %A Boscardin, W John %A Leutwyler, Heather %A Lee, Alexandra K %A Cataldo, Janine %K Epidemiology %K Geriatrics %K Public Health %K Smoking %X

BACKGROUND: Older smokers account for the greatest tobacco-related morbidity and mortality in the USA, while quitting smoking remains the single most effective preventive health intervention for reducing the risk of smoking-related illness. Yet, knowledge about patterns of smoking and smoking cessation in older adults is lacking.

OBJECTIVE: Assess trends in prevalence of cigarette smoking between 1998 and 2018 and identify patterns and predictors of smoking cessation in US older adults.

DESIGN: Retrospective cohort study PARTICIPANTS: Individuals aged 55+ enrolled in the nationally representative Health and Retirement Study, 1998-2018 MAIN MEASURES: Current smoking was assessed with the question: "Do you smoke cigarettes now?" Quitting smoking was defined as having at least two consecutive waves (between 2 and 4 years) in which participants who were current smokers in 1998 reported they were not currently smoking in subsequent waves.

KEY RESULTS: Age-adjusted smoking prevalence decreased from 15.9% in 1998 (95% confidence interval (CI) 15.2, 16.7) to 11.2% in 2018 (95% CI 10.4, 12.1). Among 2187 current smokers in 1998 (mean age 64, 56% female), 56% of those living to age 90 had a sustained period of smoking cessation. Smoking less than 10 cigarettes/day was strongly associated with an increased likelihood of quitting smoking (subdistribution hazard ratio 2.3; 95% CI 1.9, 2.8), compared to those who smoked more than 20 cigarettes/day.

CONCLUSIONS: Smoking prevalence among older persons has declined and substantial numbers of older smokers succeed in quitting smoking for a sustained period. These findings highlight the need for continued aggressive efforts at tobacco cessation among older persons.

%B Journal of General Internal Medicine %V 38 %P 1697-1704 %G eng %N 7 %R 10.1007/s11606-022-07980-w %0 Thesis %B ProQuest Dissertations and Theses %D 2023 %T Medicaid and the Life Course: An Intersectional Mixed-Methods Approach %A Petry,Sarah %K 0573:Public health %K 0626:Sociology %K 0630:Public policy %K Gender marginalization %K Health Insurance %K Medicaid policy %K Medicare %K Public Health %K Public Policy %K socioeconomic status %K Sociology %X Health insurance coverage is associated with better access to health care and better health outcomes at every age. The United States does not provide universal health insurance, and most people pay for private insurance that is linked to their job. Individuals whose jobs do not provide insurance have three choices: to remain uninsured, to buy their own insurance, or, in some cases, apply for public health insurance. Select populations in the US may be eligible for public health insurance coverage through Medicare and Medicaid. Medicare provides essentially universal insurance coverage for adults over 65, and, although enrollment is required, there is no application to determine eligibility. Alternately, Medicaid is a means-tested program with a stringent application process and recertification requirements, and take-up rates vary greatly across the US. In some states, individuals who do not have insurance through their employer can apply for and enroll in Medicaid. Individuals with Medicare coverage can also apply for Medicaid. Individuals who are “dually eligible” for Medicare and Medicaid, represent a uniquely vulnerable population due to their age, income, health, and life course exposures to marginalization, poverty, and other risk factors.Medicaid provides an essential health safety net for people in the United States living in poverty, particularly for individuals with high health care needs and costs. Many adults over 65 will need Medicaid to cover health and long-term care costs, yet the process by which older adults gain access to Medicaid is complex and burdensome. Chapter 1 includes the results of a qualitative study of Medicaid enrollment among residents of a skilled nursing facility (SNF). In interviews with caregivers and staff at the Department of Social Services (DSS) in a large, urban county in North Carolina, I find that family members are often applying their aging relatives, and that these applicants have difficulty navigating the Medicaid application process. In addition, I find that prior exposure to institutional care settings facilitates knowledge about Medicaid eligibility and enrollment criteria. Finally, all respondents commented on the costs associated with SNF care. In particular, respondents with higher incomes noted the long process of becoming eligible, while lower income respondents noted the inevitability of running out of funds. This qualitative study illustrates the distinct ways that older adults, marginalized due to their health and socioeconomic status, engage with social welfare programs in the US.Building on the results from Chapter 1, in Chapter 2 I employ an intersectional, life course approach to assess predictors of Medicaid enrollment in later life. In Chapter 1 I hypothesize that, for institutionalized individuals, having living kin facilitates Medicaid enrollment. In addition, I hypothesize that individuals who have experienced health events requiring a skilled nursing facility (SNF) or other institutional care stay, as well as individuals who have low incomes are more likely to enroll in Medicaid as older adults. Using data from 10 waves of the Health and Retirement Survey I test each hypothesis, accounting for other dimensions of social and health disparities. Alternate to my expectations, individuals without living kin are more likely to enroll in Medicaid than those with living family members. Results from discrete-time logit models confirm the second hypothesis, that individuals who have had a short-term SNF stay are more likely to enroll in Medicaid over a two-year period. In addition, as expected from both interviews and Medicaid policy, income is the single greatest predictor of enrollment in late life. Enrollment odds, though, are distinctly racialized and gendered: Black and Hispanic individuals are more likely to enroll than whites, women are at a greater risk than men, and women of color are at the highest risk. In addition, having a higher income is less protective for marginalized racial and ethnic groups than for white populations.In the third chapter, I examine late life health as an outcome of structural, state-level variations in Medicaid policy. Although every US state is required to provide some form of Medicaid coverage to “Aged, Blind, and Disabled” adults, each state establishes distinct requirements and benefits. In this study I use 10 waves of restricted data from the Health and Retirement Survey (HRS) to examine late life consequences of state-level Medicaid generosity. Using multistate life tables, this study demonstrates that Medicaid generosity is associated with more years dually covered by Medicare and Medicaid. In addition, I demonstrate that racial and gender marginalization, low income, and specific late life health risks contribute to inequitable health and mortality outcomes in late life. %B ProQuest Dissertations and Theses %P 135 %@ 9798379569433 %G eng %U https://proxy.lib.umich.edu/login?url=https://www.proquest.com/dissertations-theses/medicaid-life-course-intersectional-mixed-methods/docview/2820001588/se-2 %9 phd %0 Journal Article %J International Journal of Exercise Science %D 2022 %T The Association Between Handgrip Strength Asymmetry Severity and Future Morbidity Accumulation: Results from the Health and Retirement Study %A Klawitter, Lukus %A Collins, Kyle S. %A Ringhofer, Dawson %A Christensen, Bryan K. %A McGrath, Ryan %K environment %K Health Status %K multimorbidity %K muscular atrophy %K Public Health %X Analyzing the severity of handgrip strength (HGS) asymmetry in aging populations may help to screen for morbidities and add utility to handgrip dynamometer testing. Our study sought to determine the relationships between HGS asymmetry severity and future accumulating morbidities in older Americans. Secondary analyses from the 2006-2016 waves of the Health and Retirement Study included 18,506 adults ≥ 50 years old. The highest recorded HGS values from each hand were used to calculate HGS asymmetry ratio (non-dominant HGS/dominant HGS). If the HGS asymmetry ratio < 1.0, it was inversed to make all asymmetry ratios ≥ 1.0. Participants were categorized into groups based on the severity of their HGS asymmetry ratio: 1) 0.0% - 10.0%, 2) 10.1% - 20.0%, 3) 20.1% - 30.0%, and 4) > 30.0%. Healthcare provider-diagnosed morbidities (hypertension, diabetes, cancer, chronic lung disease, cardiovascular disease, stroke, arthritis, and psychiatric problems) were self-reported. Covariate-adjusted ordinal generalized estimating equations evaluated the relationships between HGS asymmetry severity on future accumulating morbidities. Results showed 8,936 (48.3%) participants had HGS asymmetry 0.0%-10.0%, 6,105 (33.0%) participants had HGS asymmetry 10.1%-20.0%, 2,411 (13.0%) participants had HGS asymmetry 20.1%-30.0%, and 1,054 (5.7%) participants had HGS asymmetry > 30.0%. Overall, every 10% increase in HGS asymmetry was associated with a 1.17 (CI: 1.05, 1.32) greater odds of future morbidity accumulation. Additionally, asymmetry between 10.1% - 20.0%, 20.1% - 30.0%, and > 30.0% was associated with a 1.10 (CI: 1.05, 1.15), 1.11 (CI: 1.04, 1.18), and 1.20 (CI: 1.09, 1.33) greater odds for morbidity accumulation during aging. These findings suggest that severe functional asymmetries may elevate the odds for accumulating morbidities. %B International Journal of Exercise Science %V 15 %P 1133-1141 %G eng %U https://digitalcommons.wku.edu/cgi/viewcontent.cgi?article=3327&context=ijes %N 3 %0 Journal Article %J SSM - Population Health %D 2022 %T What makes life purposeful? Identifying the antecedents of a sense of purpose in life using a lagged exposure-wide approach %A Julia S. Nakamura %A Ying Chen %A Tyler J. VanderWeele %A Eric S. Kim %K Health behaviors %K Physical Health %K Psychosocial factors %K Public Health %K Purpose in life %X Prior research documents strong associations between an increased sense of purpose in life and improved health and well-being outcomes. However, less is known about candidate antecedents that lead to more purpose among older adults. Methods We used data from 13,771 participants in the Health and Retirement Study (HRS) — a diverse, national panel study of adults aged >50 in the United States, to evaluate a large number of candidate predictors of purpose. Specifically, using linear regression with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (between t0;2006/2008 and t1;2010/2012) were associated with purpose four years later (t2;2014/2016) after adjustment for a rich set of baseline covariates. Results Some health behaviors (e.g., physical activity ≥1x/week [β = 0.14, 95% CI: 0.09, 0.19]), physical health conditions (e.g., stroke [β = −0.25, 95% CI: −0.40, −0.10]), and psychosocial factors (e.g., depression [β = −0.21, 95% CI: −0.27, −0.15]) were associated with subsequent purpose four years later. However, there was little evidence that other health behaviors, physical health conditions, and psychosocial factors such as smoking, drinking, or financial strain, were associated with subsequent purpose. Conclusions Several of our candidate predictors such as volunteering, time with friends, and physical activity may be important targets for interventions and policies aiming to increase purpose among older adults. However, some effect sizes were modest and contrast with prior work on younger populations, suggesting purpose may be more easily formed earlier in life. %B SSM - Population Health %V 19 %P 101235 %G eng %R https://doi.org/10.1016/j.ssmph.2022.101235 %0 Journal Article %J Quality of Life Research %D 2021 %T Are all domains of life satisfaction equal? Differential associations with health and well-being in older adults %A Julia S Nakamura %A Scott W Delaney %A Diener, Ed %A Tyler J VanderWeele %A Eric S Kim %K Domains of life satisfaction %K Outcome-wide epidemiology %K Public Health %X Growing evidence documents strong associations between overall life satisfaction and favorable health and well-being outcomes. However, because most previous studies have assessed satisfaction with one’s life as a whole, we know little about whether specific domains of life satisfaction (e.g., satisfaction with family life, income) might be responsible for longitudinally driving better health and well-being. %B Quality of Life Research %@ 1573-2649 %G eng %R 10.1007/s11136-021-02977-0 %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 BMJ Open %D 2021 %T Dementia and disadvantage in the USA and England: population-based comparative study. %A Arapakis, Karolos %A Brunner, Eric %A Eric French %A McCauley, Jeremy %K Dementia %K Health Economics %K Public Health %X

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

DESIGN: Population-based comparative study.

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

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

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

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

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

%B BMJ Open %V 11 %P e045186 %G eng %N 10 %R 10.1136/bmjopen-2020-045186 %0 Journal Article %J The Journals of Gerontology: Series A %D 2021 %T Frailty Changes Predict Mortality in 4 Longitudinal Studies of Aging %A Stolz, Erwin %A Emiel O Hoogendijk %A Mayerl, Hannes %A Wolfgang Freidl %K ELSA %K Epidemiology %K Frailty %K Mortality %K Public Health %K SHARE %X Baseline frailty index (FI) values have been shown to predict mortality among older adults, but little is known about the effects of changes in FI on mortality.In a coordinated approach, we analyzed data from 4 population-based cohorts: the Health and Retirement Study (HRS), the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Survey of Ageing (ELSA), and the Longitudinal Aging Study Amsterdam (LASA), comprising a total of 24 961 respondents (65+), 95 897 observations, up to 9 repeated FI assessments, and up to 23 years of mortality follow-up. The effect of time-varying FI on mortality was modeled with joint regression models for longitudinal and time-to-event data.Differences (of 0.01) in current FI levels (hazard ratio [HR] = 1.04, 95% credible interval [CI] = 1.03–1.05) and baseline FI levels (HR = 1.03, 95% CI = 1.03–1.05) were consistently associated with mortality across studies. Importantly, individuals with steeper FI growth also had a higher mortality risk: An increase in annual FI growth by 0.01 was associated with an increased mortality risk of HR = 1.56 (95% CI = 1.49–1.63) in HRS, HR = 1.24 (95% CI = 1.13–1.35) in SHARE, HR = 1.40 (95% CI = 1.25–1.52) in ELSA, and HR = 1.71 (95% CI = 1.46–2.01) in LASA.FI changes predicted mortality independently of baseline FI differences. Repeated assessment of frailty and individual’s frailty trajectory could provide a means to anticipate further health deterioration and mortality and could thus support clinical decision making. %B The Journals of Gerontology: Series A %V 76 %P 1619-1626 %@ 1079-5006 %G eng %N 9 %R 10.1093/gerona/glaa266 %0 Journal Article %J The Milbank Quarterly %D 2021 %T Life Satisfaction and Subsequent Physical, Behavioral, and Psychosocial Health in Older Adults. %A Eric S Kim %A Scott W Delaney %A Tay, Louis %A Chen, Ying %A Diener, E D %A Tyler J VanderWeele %K Life Satisfaction %K Outcome-wide epidemiology %K psychological well-being %K Public Health %X

Policy Points Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction. The results of this study suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes.

CONTEXT: Several intergovernmental organizations (Organisation for Economic Co-operation and Development, World Health Organization, United Nations) are urging countries to use well-being indicators (e.g., life satisfaction) in addition to traditional economic indicators when making important policy decisions. As the number of governments implementing this new approach grows, so does the need to continue evaluating the health and well-being outcomes we might observe from policies aimed at improving life satisfaction.

METHODS: We evaluated whether positive change in life satisfaction (between t ;2006/2008 and t ;2010/2012) was associated with better outcomes on 35 indicators of physical, behavioral, and psychosocial health and well-being (in t ;2014/2016). Data were from 12,998 participants in the University of Michigan's Health and Retirement Study-a prospective and nationally representative cohort of US adults over age 50.

FINDINGS: Participants with the highest (versus lowest) life satisfaction had better subsequent outcomes on some physical health indicators (lower risk of pain, physical functioning limitations, and mortality; lower number of chronic conditions; and higher self-rated health) and health behaviors (lower risk of sleep problems and more frequent physical activity), and nearly all psychosocial indicators (higher positive affect, optimism, purpose in life, mastery, health mastery, financial mastery, and likelihood of living with spouse/partner; and lower depression, depressive symptoms, hopelessness, negative affect, perceived constraints, and loneliness) over the 4-year follow-up period. However, life satisfaction was not subsequently associated with many specific health conditions (i.e., diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, or cognitive impairment), other health behaviors (i.e., binge drinking or smoking), or frequency of contact with children, family, or friends.

CONCLUSIONS: These results suggest that life satisfaction is a valuable target for policies aiming to enhance several indicators of psychosocial well-being, health behaviors, and physical health outcomes.

%B The Milbank Quarterly %V 99 %P 209-239 %G eng %N 1 %R 10.1111/1468-0009.12497 %0 Journal Article %J Public Health in Practice %D 2020 %T The Association Between Oral Health and Food Avoidance Among Older Adults in the United States %A Yeonjung Jane Lee %A Hyun-Kee [Harry] Lee %K Gerontology %K Oral Health %K Public Health %X Objectives This study examines the association between oral health and food avoidance among older adults in the United States. Study Design A population-based sample of 1,278 adults aged 51+ from the Health and Retirement Study was used. A logistic regression model was performed to evaluate various oral health conditions and food avoidance behavior among older adults. Results were quantified as odds ratios (OR). Results This study found a significant association between oral health and food avoidance in older adults. Individuals with teeth loss, poor self-rated oral health, and teeth or gum sensitivity experienced more food avoidance. Conclusions Geriatric health care professionals assessing older adults' well-being can be informed by this study outcome to consider oral health as a potential risk factor for food avoidance. This study can inform policymakers to develop oral health promotion programs and goals for older adults, and also consider nutritional support for older adults with negative oral health conditions. %B Public Health in Practice %V 1 %G eng %R 10.1016/j.puhip.2020.100011 %0 Journal Article %J BMC Geriatrics %D 2020 %T Family caregiving in the community up to 8-years after onset of dementia %A Jutkowitz, Eric %A Joseph E Gaugler %A Amal Trivedi %A Lauren L Mitchell %A Gozalo, Pedro %K Alzheimer’s disease and related dementias %K Community based long-term care %K Health Services %K Public Health %X Background Persons with Alzheimer’s disease and related dementias (ADRD) receive care from family/friends, but how care changes from the onset of dementia remains less understood. Methods We used the Health and Retirement Study (2002–2012) to identify community-dwelling individuals predicted to have incident ADRD. We investigated the amount of caregiving received for activities of daily living in the 8-years after disease onset. Results At incidence (n = 1158), persons with ADRD received 151 h (SD = 231) of caregiving a month, 25 (SD = 26) caregiving days a month and had 1.3 (SD = 1.4) caregivers a month. By 8-years post incidence, 187 (16%) individuals transitioned to a nursing home and 662 (57%) died in the community. Community-dwelling persons with ADRD at 8-years post incidence (n = 30) received 283 h (SD = 257) of caregiving, 38 (SD = 24) caregiving days, and had 2.2 (SD = 1.3) caregivers. Conclusions Community-dwelling persons with ADRD receive a substantial amount of caregiving over the first 8-years after disease onset. %B BMC Geriatrics %V 20 %@ 1471-2318 %G eng %N 1 %R 10.1186/s12877-020-01613-9 %0 Journal Article %J 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 Web Page %D 2020 %T Middle-aged Americans report more pain than the elderly %A Huber, B. Rose %K Aging %K Body Weight %K Death & Dying %K Gerontology %K Longevity %K pain %K Public Health %X As people age, they tend to report more acute or chronic pain -- a common sign of getting older. Yet, in the United States, middle-aged adults are now reporting more pain than the elderly, according to a paper published in the Proceedings of the National Academy of Sciences (PNAS). %B Research News %I EurekAlert/AAAS %C Washington, D.C. %G eng %U https://www.eurekalert.org/pub_releases/2020-09/puww-mar091720.php %0 Journal Article %J Health & Place %D 2020 %T Perceived neighborhood social cohesion and subsequent health and well-being in older adults: An outcome-wide longitudinal approach %A Eric S Kim %A Ying Chen %A Ichiro Kawachi %A Tyler J VanderWeele %K Health and well-being %K Older Adults %K Outcome-wide epidemiology %K Perceived neighborhood social cohesion %K Public Health %K social cohesion %X Background Growing research documents associations between neighborhood social cohesion with better health and well-being. However, other work has identified social cohesion's “dark side” and its ability to promote negative outcomes. It remains unclear if such diverging findings are attributable to differences in study design, or other reasons. To better capture its potential heterogeneous effects, we took an outcome-wide analytic approach to examine perceived neighborhood social cohesion in relation to a range of health and well-being outcomes. Methods Data were from 12,998 participants in the Health and Retirement Study—a large, diverse, prospective, and nationally representative cohort of U.S. adults age >50. Multiple regression models evaluated if social cohesion was associated with physical health, health behavior, psychological well-being, psychological distress, and social well-being outcomes. All models adjusted for sociodemographics, personality, and numerous baseline health and well-being characteristics. To evaluate the effects of change in cohesion, we adjusted for prior social cohesion. Bonferroni correction was used to account for multiple testing. Results Perceived neighborhood social cohesion was not associated with most physical health outcomes (except for reduced risk of physical functioning limitations and better self-rated health) nor health behavior outcomes (except for more binge drinking). However, it was associated with numerous subsequent psychosocial well-being (i.e., higher: positive affect, life satisfaction, optimism, purpose in life, mastery, health mastery, financial mastery; reduced likelihood of infrequent contact with friends) and psychological distress outcomes (i.e., lower depression, hopelessness, negative affect, loneliness) over the 4-year follow-up period.ConclusionsWith further research, these results suggest that perceived neighborhood social cohesion might be a valuable target for innovative policies aimed at improving well-being. %B Health & Place %V 66 %P 102420 %8 2020/11/01/ %@ 1353-8292 %G eng %R https://doi.org/10.1016/j.healthplace.2020.102420 %0 Thesis %B Comparative Human Development %D 2019 %T Exploring Disability Outcomes among Aging Latinos in the United States: A Mixed Methods Approach %A Howard,Alexis L. %K 0351:Gerontology %K 0573:Public health %K 0626:Sociology %K 0737:Hispanic American studies %K ADL disability %K Aging %K ethnicity %K Gerontology %K Hispanic American studies %K Public Health %K Social context %K Social determinants of health %K Sociology %X The population of older adults in the United States is currently growing at unprecedented rates, as is the proportion of those older adults who are of Latino descent. Despite a diversifying population of older adults, much of the research exploring the social context of health and aging does not consider the ways in which the sociocultural environment may differ by ethnicity. The objective of this dissertation is to explore and document the ways in which the social environment and cultural context are related to health and disability outcomes among aging Latinos. This examination explores how the social world of disabled Latinos differs from their non-Latino counterparts, how those differences may drive differential experiences of care receipt upon the onset of disability, and how older Latinos themselves articulate their desires for “aging well” and care receipt in old age. Ultimately, I argue that the relationship between social context and physical and psychological health outcomes varies according to the cultural values and preferences of the community in which an individual is embedded. For Latinos in particular, the cultural values of familismo and respeto can produce social relationships that are protective against adverse health outcomes in old age, but these values can also paradoxically produce their own anxieties and present unique challenges to “aging well” among Latinos. %B Comparative Human Development %I The University of Chicago %V PhD %P 153 %@ 9781085558570 %G eng %U https://knowledge.uchicago.edu/record/1831?ln=en %9 phd %0 Thesis %B Sociology %D 2019 %T Exploring Ethnoracial Disparities in Planning for End-of-Life Care %A Tompkins,Joanne %K 0351:Gerontology %K 0573:Public health %K 0626:Sociology %K Advance care planning %K Advance directives %K Aging %K End of life care %K Ethnoracial difference %K Gerontology %K health %K Health and environmental sciences %K Public Health %K Social Sciences %K Sociology %X Over the last 35 years, high profile court cases have drawn attention to planning for end-of-life care. Despite strong opinions about life-sustaining medical treatment, expressed through public protests and political debates, the majority of Americans do not have advance directives, which state preferences for end-of-life care. Rates are significantly lower for blacks and Hispanics than for non-Hispanic whites; however, the reasons for these disparities remain unclear. Using data from the 2012 and 2014 waves of the Health and Retirement Study (HRS), I examine ethnoracial differences in completing three types of advance care planning: (1) having discussions about life-sustaining treatment preferences; (2) designating a proxy—legally called a durable power of attorney for health care (DPAHC)—to make end-of-life care decisions on one’s behalf; and (3) writing a living will that states treatment preferences. Specifically, I conduct an exploratory descriptive analysis, estimate logistic regression models, and apply Fairlie’s decomposition technique—an extension of the Blinder-Oaxaca decomposition method for nonlinear models—to investigate the likelihood of planning for end-of-life care and to quantify the reasons for ethnoracial differences in advance care planning among non-Hispanic black, non-Hispanic white, and Hispanic adults age 65 and older. Findings suggest that education, wealth, income, and having a last will and testament predict the likelihood of and account for most of the explained ethnoracial gap in advance care planning. This study helps to improve our understanding of population characteristics that influence advance care planning. Additionally, while research generally presumes that advance care planning is beneficial, this study also discusses the potential flaws with this view. %B Sociology %I University at Buffalo %C Buffalo, NY %V PhD %P 113 %@ 9780438944572 %G eng %U https://ubir.buffalo.edu/xmlui/handle/10477/79346 %9 phd %0 Thesis %B Health Services and Policy Management %D 2019 %T Factors Associated with Advance Care Plans and End-of-life Care Choices Among Elderly Americans: An Analysis of Health and Retirement Study Data %A Ajmal,Agha %K 0493:Aging %K 0573:Public health %K 0630:Public policy %K Advance care planning %K Advance directives %K Aging %K Durable Power of Attorney for Health Care %K Elderly Americans %K End-of-life care %K Living will %K Public Health %K Public Policy %X Introduction: Advance care plans (ACPs) allow people to plan for their end-of-life care before they become incompetent to make their treatment decisions. The umbrella term Advance Care Plans (ACP) includes the three most commonly used end-of-life care plans: Advance Care Planning Discussions (ACP discussions) and two advanced directives: living will and Durable Power of Attorney for Health Care (DPAHC). The ACP discussions are the verbal discussions about end-of-life plans, whereas the advance directives are written documents.ACPs are distinct nuances of end-of-life care planning. ACP discussions address a wide array of end-of-life care issues, including terminal care, funeral, burial and the place of death, etc. A living will outlines specific end-of-life care choices and elicits yes or no responses. The choices pertain to use of artificial respiration; artificial feeding and hydration; dialysis; or antibiotics; etc. A DPAHC, appoints a proxy to make treatment decisions on behalf of the incompetent patient at a terminal stage of life.While previous studies have used ACPs as distinct outcomes, in real life the ACPs exist in combinations. People who undertake ACP discussions are more likely to complete advance directives. More than 25 states have combined directives forms. Therefore, it is imperative to evaluate the factors associated with the combinations of ACPs: No ACP; ACP discussions only; a directive (a living will or DPAHC); a directive and ACP discussions; both directives (a living will and DPAHC); and all ACPs (a living will, DPAHC and ACP discussions).Among the factors associated with ACPs, health status has shown an inconsistent association. Some studies have shown that poor health is associated with higher ACP uptake rates, whereas others have noted no association. The possible reasons for inconsistent association include 1) examining the association without controlling for the change in health status and other health factors — prior research shows health status and change in health are closely related in influencing the uptake of ACPs and the end-of-life care choices 2) use of each ACP as a separate outcome instead of using them in combinations. Therefore, our first study attempted to clarify the association between health status, change in health status and interaction between the two measures with the combinations of ACPs.Our second study determined the factors associated with end-of-life care choices. Prior concerning the association between health status and end-of-life care choices have used prospect theory. However, previous research has used convenience samples and end-of-life care scenarios. We tested the prospect theory using a representative population-based sample and using the choices that people make considering their own health status and possible end-of-life circumstances.Methods: We used the Health and Retirement Study (HRS) panel data from 1992-2014 and the HRS exit interview data from 2002-2014. The HRS captures health and retirement characteristics of a representative sample of Americans over 50 years using biennial panel surveys since 1992. It also conducts one-time post-death interviews with the next-of-kin of HRS decedents in the survey waves following their death. The post-death surveys collect information about medical care expenditures and use; advance care planning and end-of-life care choices and distribution of assets towards end-of-life.We used the SAS version 9.4 to examine the association between health status and ACPs, we used a multinomial regression model. The combinations of ACPs were used as the study outcome. To study the association between health status and choices, a separate logistic regression model was used for each choice — limit care in certain situations, comfort care and all care possible.Results: In study 1, self-reported health was not associated with any category of ACP combinations. However, change in health status was associated with ACPs — “worse or somewhat worse” change in health status since the last survey wave was associated with a higher uptake of “two directives” and “all ACPs”, compared with “much or somewhat better or the same”. The number of health conditions and a history of cancer were also associated with “all ACPs”.In study 2, we did not find association between self-reports of health and its change with the two care-limiting choices, including “limit care in certain situations” and “comfort care”. However, change in health status was associated with the “all care possible” option — a decline in health status since the last wave was associated with a higher likelihood of “all care possible” choice than improvement or no change in health status since the last wave. Among other health factors, a psychiatric illness was associated a higher uptake of “all care possible” and a lower uptake of “comfort care”. The decedents with a history of stroke chose less “limit care in certain situations” option.Recommendations: We recommend further research on the factors associated with the combinations of ACPs. Future research should also use the combinations to determine the effects of ACPs on the cost and quality of end-of-life care. %B Health Services and Policy Management %I University of South Carolina %V PhD %P 236 %8 2019 %@ 9781085585590 %G eng %U https://scholarcommons.sc.edu/etd/5126/ %9 phd %0 Thesis %B Psychology %D 2019 %T Resilience to Stressful Life Events in Middle Aged and Older African Americans %A Brown,Shari A. %K 0296:African American Studies %K 0349:Psychobiology %K 0384:Behavioral psychology %K 0493:Aging %K 0573:Public health %K 0622:Clinical psychology %K 0625:Personality psychology %K 0989:Physiological psychology %K African American studies %K Aging %K Behavioral psychology %K Clinical Psychology %K Discrimination %K Personality psychology %K Physiological psychology %K Psychobiology %K Public Health %K Resilience %K Stressful Life Events %X African Americans in later-life have had a life time of exposure to both typical stressful life experiences and racial discrimination and are at risk for exposure to stressors related to old age. Religiosity and eudiamonic well-being are potentially two useful protective resources for this community. This study analyzed data from the Health and Retirement Study to test a main effects model and a double moderation model of the relationship between stress, discrimination, protective factors, and later-life well-being, using a series of four-step linear regression analyses. In line with the hypotheses, both stressful life events and discrimination showed negative main effects on later-life well-being. There also was support for a two-staged moderation effect in which high levels of discrimination exacerbated the negative effects of stressful life events on depression, but people with moderate and high levels of religiosity demonstrated resilience to these effects. Eudamonic well-being was associated with positive well-being but was not supported as a moderator. Limitations and directions for future research are discussed. %B Psychology %I University of Hawai'i at Manoa %V Master of Arts %P 52 %@ 9781085623544 %G eng %U https://search.proquest.com/docview/2290955449?pq-origsite=gscholar %9 phd %0 Journal Article %J Journal of Pension Economics and Finance %D 2019 %T Retirement choices by state and local public sector employees: The role of eligibility and financial incentives %A Papke, Leslie E. %K Finances %K Public Health %K Retirement Planning and Satisfaction %X I analyze the effects of state public pension parameters on the retirement of public employees. Using a panel data set of public sector workers from 12 waves of the Health and Retirement Study, I model the probability of retirement as a function of pension wealth at early and normal retirement eligibility and Social Security coverage in the public sector job. I find that becoming eligible for early retirement, or receiving an early-out offer, significantly increases the probability of retiring. I do not find any effect of retirement wealth levels. These findings suggest that state legislative action to affect retirement decisions and reduce future pension costs would be most effective operating through plan eligibility rules and early-out incentives. © Cambridge University Press 2019. %B Journal of Pension Economics and Finance %G eng %U https://www.nber.org/papers/w25436 %! Journal of Pension Economics and Finance %R 10.1017/S1474747218000446 %0 Thesis %B Public Health %D 2019 %T The Role of Cumulative Advantage/Disadvantage in Disparities in Alzheimer's Disease Risk %A Peterson,Rachel L. %K 0573:Public health %K 0626:Sociology %K 0766:Epidemiology %K African American %K cognitive aging %K Epidemiology %K Health and environmental sciences %K Health Disparities %K Inequality %K Public Health %K race %K Social Sciences %K Social status %K Sociology %X BACKGROUND: Substantial disparities have been observed in Alzheimer’s disease (AD) by race and social class. The persistence of health disparities over time and for diseases with distinct etiological processes suggests that the fundamental cause may reside within processes of advantage and disadvantage that accumulate across the life course. Although education is a well established risk factor for AD, it is unclear if the mechanistic role of education in AD disparities is through direct cognitive stimulation—the most commonly accepted hypothesis in AD research—or if it operates indirectly as a marker of social status and discrimination. OBJECTIVES: This dissertation aims to answer the question of how social processes at different points in the life course produce socioeconomic and racial inequalities in Alzheimer’s disease risk. This question is broken into a series of three studies that examine the existing evidence for the role of modifiable risk factors in AD, and test for the role of cumulative advantage/disadvantage in the context of socioeconomic, and racial disparities. METHODS: Study one is a structured narrative review of studies that tested for differences by race of the effect of any of six modifiable risk factors (education, obesity, smoking, physical activity, social isolation, and psychosocial stress) for AD risk. Study two used a Generalized Estimating Equation to examine the effect of individual SES and state-level income inequality on Subjective Cognitive Decline, as reported in the Cognitive Decline module of the Behavioral Risk Factor Surveillance System. Study three used structural equation modeling to conduct mediation and conditional process analysis (moderated mediation) to examine the role of markers of socioeconomic status and stress in racial disparities in AD risk among participants of the National Social Life Health and Aging Project. RESULTS: Of 3,464 identified studies in study one, 45 tested for differences in the modifiable risk factors by race. Education was the most widely examined risk factor, and the only factor in the review with strong evidence for a role in racial disparities. In study two, a dose-response effect was observed for income while those with high school education reported better cognition than those with some college. State-level income inequality was not associated with cognitive decline. In study three, education consistently mediated the race-cognition pathway, and perceived stress and assets mediated the education-cognition pathway. In all models, the direct effect of race on cognition remained large. CONCLUSIONS: Combined, these studies confirmed the importance of education for socioeconomic and racial disparities in AD risk, but suggested that education operates as an indicator of social status and discrimination, as well as through its role via cognitive stimulation. These findings point to the importance of considering social factors from across the life course in public health research and interventions aiming to understand and reduce disparities in AD risk. %B Public Health %I University of Arizona %V PhD %P 207 %@ 9781392188200 %G eng %U https://repository.arizona.edu/handle/10150/633085 %9 phd %0 Thesis %B Economics %D 2019 %T Three Healthcare Topics: Adult Children's Informal Care to Aging Parents, Working Age Population's Marijuana Use, and Indigenous Adolescents' Suicidal Behaviors %A Qiao,Nan %K 0501:Economics %K 0510:Labor economics %K 0573:Public health %K 0769:Health care management %K Aging %K Economics %K Employment %K Health and environmental sciences %K Health care management %K Indigenous adolescent %K Informal care %K Labor economics %K Marijuana %K Public Health %K Social Sciences %K Suicidal behavior %X This dissertation examines three vulnerable groups’ health and healthcare access. The first research uses the 2002–2011 Health and Retirement Study data to estimate the effects of adult children’s employment on their caregiving to aging parents. State monthly unemployment rates are used as an instrument for employment. Results show that being employed affects neither male nor female adult children’s caregiving to aging parents significantly. The findings imply that the total amount of informal care provided by adult children might not be affected by changes in labor market participation trends of the two genders. The second research studies the labor impact of Colorado and Washington’s passage of recreational marijuana laws in December 2012. The difference-in-differences method is applied on the 2010–2013 National Survey on Drug Use and Health state estimates and the 2008–2013 Survey of Income and Program Participation data to estimate legalization’s effects on employment. The results show that legalizing recreational marijuana increases marijuana use and reduces the number of weeks employed in a given month by 0.090 among those aged 21 to 25. The laws’ labor effects are not significant on those aged 26 and above. To reduce legalization’s negative effects on employment, states may consider raising the minimum legal age for recreational marijuana use. The third research examines disparities in suicidal behaviors between indigenous and non-indigenous adolescents. The study analyzes the 2001–2013 Youth Risk Behavior Survey data. Oaxaca decomposition is applied to detect sources of disparities in suicide consideration, planning, and attempts. The study finds that the disparities in suicidal behaviors can be explained by differences in suicidal factors’ prevalence and effect sizes between the two groups. Suicidal behavior disparities might be reduced by protecting male indigenous adolescents from sexual abuse and depression, reducing female indigenous adolescents’ substance use, as well as involving male indigenous adolescents in sports teams. %B Economics %I Indiana University %V PhD %P 122 %@ 9780438889187 %G eng %U https://scholarworks.iupui.edu/handle/1805/18483 %9 phd %0 Thesis %B Public Affairs %D 2019 %T Topics on Retirement Saving, Retirement and Health in the Era of Population Aging %A Ngoc Dao %K 0573:Public health %K 0630:Public policy %K Long-term Care %K Public Health %K Public Policy %K Retirement %K Retirement saving %X Aging population is a worldwide phenomenon. In the United States, as in 2015 about 48 million Americans are over 65 or older, which accounts for 14.9 percent of the total population. And by 2030, one of every five Americans will be over the age of 65. The ramifications of an aging population are serious and potentially large because it challenges the fiscal and macroeconomic stability tasks through increase in government spending on pension, health care and social benefits programs for the elderly such as Social Security and Medicare programs. This dissertation composes of three essays that aim at examining the relationship between government policies and the preparedness for retirement and healthcare aspects of the aging population. In Chapter 1, I examined the effect of federal tax policy in encouraging working classes to save more for their retirement, especially among those who are approaching to be retired. One of the big questions that center the empirical research on retirement and saving is whether the American save enough for their consumption in the post-retirement period. Although the answer is still unsolved due to disagreement over what constitutes adequate saving for retirement. It is of great importance to see how government policies help promote saving for retirement. The second and third Chapters examined the effects of the federal minimum wage expansion to home care workers on employment, and on the utilization and the cost of home care services that become increasingly important for senior and disabled people in the country. In sum, the dissertation provides important evidence on how public policies influenced economic behaviors among the older workers and families, and have critical policy implications in bolstering the financial and healthy well-being of the older Americans. %B Public Affairs %I Indiana University %V PhD %P 194 %@ 9781687905055 %G eng %9 phd %0 Thesis %B Public Policy %D 2018 %T Aging in America: Exploring the Long-Term Care Puzzle and Barriers to Private Insurance Coverage %A O'Loughlin,Johanna C. %K 0351:Gerontology %K 0573:Public health %K 0630:Public policy %K Ageing %K Aging %K Elderly %K Gerontology %K Health and environmental sciences %K Long-term Care %K Long-term services and supports %K Public Health %K Public Policy %K Social Sciences %X The role of the long-term care insurance intermediary is a crucial but little-examined factor in the decision to purchase insurance coverage. In this mixed methods study, geographic analysis of trained intermediaries is associated with greater take-up of private ownership of long-term care insurance. Quantitative results suggest that access to a trained insurance intermediary increases the odds of obtaining coverage by four percent. Qualitative results highlight the classical market inefficiencies associated with low long-term care insurance take-up stemming from information asymmetry and the crucial demand-side factor of trust. Distrust of the delivery layer, underwriters, and government lies at the heart of the non-purchase decision. Policy implications include the improvement of LTCI ownership rates through greater access to trained agents to facilitate trust and understanding among long-term care insurance consumers. %B Public Policy %I George Mason University %V PhD %P 219 %@ 9780438115132 %G eng %U https://search.proquest.com/docview/2070392044?pq-origsite=gscholar %9 phd %0 Newspaper Article %B The Los Angeles Times %D 2018 %T British government targets a modern public health scourge: Loneliness %A Healy, Melissa %K Cross-National %K Depressive symptoms %K Loneliness %K Policy %K Public Health %B The Los Angeles Times %C Los Angeles %G eng %U http://www.latimes.com/science/sciencenow/la-sci-sn-minister-of-loneliness-20180118-story.html %0 Thesis %B Gerontology %D 2018 %T Individual Characteristics Associated with Dementia Risk in Minority Populations %A Sarah B Hubner %K ADAMS %K Dementia %K Ethnic studies %K ethnicity %K Gerontology %K Health and environmental sciences %K HRS %K Minority %K Public Health %K Social Sciences %X U.S. minority populations are continuously growing. Concurrent with this growth is an increase in persons with cognitive impairment and dementia, especially in vulnerable populations. Despite this increase, there has been a comparative lack of minority focused research, especially in regards to comprehensive models which examine demographics, education, and health. This study utilized the ADAMS dataset (Health and Retirement Study) to investigate the predictive variables of age, sex, marital status, employment, education, and health within the context of ethnicity. Results showed that age, minority status, disability, lower education, cardiovascular disease, and increased number of comorbidities positively predicted development of both cognitive impairment not dementia and dementia. This evidence, in the context of ethnicity, and the burden of health, education, and demographics on minority persons, gives cause for increased support and development of culturally sensitive and focused programming to better serve minority populations. %B Gerontology %I University of Nebraska at Omaha %V Master of Arts in Social Gerontology %P 86 %@ 9780438864016 %G eng %9 phd %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 Thesis %B Epidemiology %D 2018 %T Selected Health Implications of Low Body Mass: Determinants and Health Outcomes %A Holcombe,Andrea L. %K 0573:Public health %K BMI %K Health and environmental sciences %K HRS %K Life-course %K Public Health %K Underweight %X While the role of obesity in health outcomes has been well described, the role of low body mass index (BMI), body weight relative to height, has largely been ignored. Those with low BMI are commonly excluded completely or combined with the normal BMI category in BMI studies. However, there have been some studies indicating poorer health outcomes among those with lower BMI, particularly that of increased risk of mortality. The purpose of this study is to explore the role of low BMI throughout the lifespan. Data from the Health and Retirement Study was used to evaluate 1) the association between childhood health and socioeconomic status (SES) exposures and low BMI in midlife adulthood, 2) the association between low BMI and health related outcomes in midlife adulthood (ages 50 to 65), and 3) the association between low BMI in midlife and health related outcomes, including mortality, over a longer follow-up (maximum of 20 years). To increase sample size, two low BMI definitions were used: the traditional <18.5 definition and a definition of ≤20 based on the J-shaped curves found in BMI mortality studies. Few significant results were found. Low BMI status was consistently associated with older age and female gender as well as current smoking status. Childhood exposure of respiratory disease and greater SES disadvantages was more common among those with low BMI in adulthood. In midlife adulthood, low BMI status was associated with increased difficulties with activities of daily living with either definition of low BMI. Increased risk of fracture was associated with a low BMI definition of <18.5. Increased risk of lung disease and decreased risk of high blood pressure was associated with a low BMI definition of ≤20. An analysis of those 30 years old or older found low BMI to be associated with increased risk of mortality and decreased risk of diabetes regardless of low BMI definition. When low BMI was defined as <18.5, those with low BMI were also more likely to experience difficulty with one or more activities of daily living. When low BMI was defined as ≤20, low BMI status was associated with greater risk of lung disease and decreased risk of high blood pressure. Further research is needed to fully characterize the role of low BMI on health outcomes as well as the role of SES on low BMI. Additionally, there is a need for greater understanding of the potential biological mechanisms of low BMI for health outcomes. Currently, there are few studies evaluating health outcomes and SES of low BMI. Limiting studies to the extreme upper end of the BMI spectrum limits the overall understanding of the role of BMI in health and may overlook unique characteristics and challenges those with low BMI may face. %B Epidemiology %I University of Iowa %V PhD %P 105 %@ 9780438870680 %G eng %U https://ir.uiowa.edu/etd/6592/ %9 phd %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 Am J Public Health %D 2013 %T Genetics in population health science: strategies and opportunities. %A Daniel W. Belsky %A Terrie E Moffitt %A Caspi, Avshalom %K Gene-Environment Interaction %K Genetic Engineering %K Genetic Research %K Humans %K Obesity %K Public Health %K Risk Assessment %K Smoking %K Translational Medical Research %X

Translational research is needed to leverage discoveries from the frontiers of genome science to improve public health. So far, public health researchers have largely ignored genetic discoveries, and geneticists have ignored important aspects of population health science. This mutual neglect should end. In this article, we discuss 3 areas where public health researchers can help to advance translation: (1) risk assessment: investigate genetic profiles as components in composite risk assessments; (2) targeted intervention: conduct life-course longitudinal studies to understand when genetic risks manifest in development and whether intervention during sensitive periods can have lasting effects; and (3) improved understanding of environmental causation: collaborate with geneticists on gene-environment interaction research. We illustrate with examples from our own research on obesity and smoking.

%B Am J Public Health %V 103 Suppl 1 %P S73-83 %8 2013 Oct %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3786748/ %1 http://www.ncbi.nlm.nih.gov/pubmed/23927511?dopt=Abstract %R 10.2105/AJPH.2012.301139 %0 Journal Article %J Soc Sci Med %D 2011 %T Differences in health between Americans and Western Europeans: Effects on longevity and public finance. %A Pierre-Carl Michaud %A Dana P Goldman %A Darius Lakdawalla %A Adam Gailey %A Yuhui Zheng %K Activities of Daily Living %K Adult %K Aged %K Body Mass Index %K Cross-Cultural Comparison %K Disabled Persons %K Europe %K Female %K Health Expenditures %K health policy %K Health Status Disparities %K Health Surveys %K Humans %K Internationality %K Life Expectancy %K Male %K Middle Aged %K Models, Economic %K Models, Statistical %K Mortality %K Public Health %K United States %X

In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.

%B Soc Sci Med %I 73 %V 73 %P 254-63 %8 2011 Jul %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21719178?dopt=Abstract %2 PMC3383030 %4 disability/disability/mortality/international comparisons/Cross-national/microsimulation/Europe/SHARE/ELSA_/longevity %$ 69616 %R 10.1016/j.socscimed.2011.05.027 %0 Report %D 2010 %T Choosing the Nation's Fiscal Future %K Financial Health %K Public Health %K Public Policy %X A mismatch between the federal government's revenues and spending, now and in the foreseeable future, requires heavy borrowing, leading to a large and increasing federal debt. That increasing debt raises a serious challenge to all of the goals that various people expect their government to pursue. It also raises questions about the nation's future wealth and whether too much debt could lead to higher interest rates and even to loss of confidence in the nation's long-term ability and commitment to honor its obligations. Many analysts have concluded that the trajectory of the federal budget set by current policies cannot be sustained. In light of these projections, Choosing the Nation's Fiscal Future assesses the options and possibilities for a sustainable federal budget. This comprehensive book considers a range of policy changes that could help put the budget on a sustainable path: reforms to reduce the rate of growth in spending for Medicare and Medicaid; options to reduce the growth rate of Social Security benefits or raise payroll taxes; and changes in many other government spending programs and tax policies. The book also examines how the federal budget process could be revised to be more far sighted and to hold leaders accountable for responsible stewardship of the nation's fiscal future. Choosing the Nation's Fiscal Future will provide readers with a practical framework to assess budget proposals for their consistency with long-term fiscal stability. It will help them assess what policy changes they want, consistent with their own values and their views of the proper role of the government and within the constraints of a responsible national budget. It will show how the perhaps difficult but possible policy changes could be combined to produce a wide range of budget scenarios to bring revenues and spending into alignment for the long term. This book will be uniquely valuable to everyone concerned about the current and projected fiscal health of the nation. %B Committee on the Fiscal Future of the United States %I The National Academies Press %C Washington, DC %P 1-360 %@ 978-0-309-14723-1 %G eng %R https://doi.org/10.17226/12808