Health and Retirement Study Imputation of Cognitive Functioning Measures: 1992-2018 - Ryan J McCammon; Gwenith G Fisher; Hassan, Halimah; Jessica Faul; Rogers, Willard; David R Weir (Survey Research Center, University of Michigan, 2022)
Keywords: Health Conditions and Status; Methodology

Health literacy and self-reported hearing aid use in the Health and Retirement Study. - Niall Andre Muns Klyn; Zain Mohammed Shaikh; Dhar, Sumitrajit (Ear and Hearing, 2020)
OBJECTIVES: Understanding the determinants of hearing aid use is important to improve the provision of hearing healthcare. Prior research has indicated that materials in the clinic and online, as well as audiologists' language during appointments, require a higher literacy level than most patients possess. We hypothesized that low health literacy is a barrier to entry in hearing healthcare, and therefore that health literacy would be positively correlated with the probability of hearing aid use. DESIGN: We performed retrospective analyses of the Health and Retirement Study, a longitudinal survey of American adults of retirement age. Objective health literacy was measured in different but overlapping subsamples using subsets of the Test of Functional Health Literacy in Adults and the Rapid Estimate of Adult Literacy in Medicine (n = 1240, n = 1586, and n = 2412). Subjective health literacy was assessed using a single-question screener in a larger sample (n = 8362). Separate discrete time models including common covariates of hearing aid use were constructed for each subsample. RESULTS: Objective health literacy measures did not correlate significantly with hearing aid use when age, gender, race/ethnicity, self-assessed hearing ability, and net income were included in the models. Subjective health literacy did correlate significantly with hearing aid use in the complete model, with lower subjective health literacy correlated with lower odds of reporting hearing aid use. CONCLUSIONS: Taken at face value, the results provide mixed evidence for a link between health literacy and hearing aid use. The results from the analysis of the largest sample, using the subjective health literacy measure, were consistent with the hypothesis that low health literacy is a barrier to hearing aid use. However, this was not supported by the analysis of the objective health literacy measures in these samples. Further research using full health literacy measurement tools and capturing other relevant variables would offer clarification on this conflict. The literacy level of clinical materials and conversation is a modifiable potential factor in hearing aid uptake, so further clinical and research consideration is warranted.
Keywords: Health Behavior; Health Conditions and Status; Hearing aids; Self-reported health

Patterns of social engagement among older adults with mild cognitive impairment. - Amano, Takashi; Morrow-Howell, Nancy; So Jung Park (The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 2020)
OBJECTIVES: Promoting engagement in social activities may be an intervention that prevents or delays cognitive impairment. Nevertheless, little is known about social engagement among people with mild cognitive impairment. We aim to examine patterns of social engagement among people with mild cognitive impairment and to assess whether factors under four domains of the WHO's ICF model (personal factors, environmental factors, body functions and structure, and health condition) associate with different patterns of social engagement. METHOD: Data were drawn from the 2010 Health and Retirement Study. The final sample comprised 1,227 people with Cognitive Impairment No Dementia (CIND). Latent class analysis and multinomial logistic regression were utilized. RESULTS: Three patterns of social engagement were identified: informal social engagement only, formal and informal social engagement, and low social engagement. Factors in each of the four ICF model domains were associated with the probability of class membership. DISCUSSION: Our findings suggest that social engagement is heterogeneous among people with CIND and that some groups of people with CIND have possibilities of engaging in more social activities, especially in formal social activities. Results also indicate that providing informal social resources may be essential for social programs designed specifically for people with CIND to promote their formal social engagement. Future study is needed to examine possible differences in outcomes across groups with similar patterns of social engagement.
Keywords: CIND; Cognition & Reasoning; Health Conditions and Status; Social Support

Comparing anxiety and depression to obesity and smoking as predictors of major medical illnesses and somatic symptoms. - Andrea N Niles; Aoife O'Donovan (Health Psychology, 2019)
OBJECTIVE: Anxiety and depression predict poor physical health longitudinally, but are neglected in primary care settings compared to other risk factors such as obesity and smoking. Further, anxiety has been less commonly studied than depression, and whether anxiety has unique predictive effects for physical health is unknown. We compared anxiety and depression to obesity and smoking as predictors of physical health indices and examined unique predictive effects of anxiety and depression. METHOD: Using data from the Health and Retirement study, a US population-based cohort study of older adults, we tested longitudinal associations of anxiety and depression symptoms with onset of self-reported physical health indices (N = 15,418; M age = 68). Medical illnesses (heart disease, stroke, arthritis, high blood pressure, diabetes, and cancer) and somatic symptoms (stomach problems, shortness of breath, dizziness, back pain, headache, pain, and eyesight difficulties) were assessed on two occasions over four years. Anxiety and depression were measured at the initial time point and tested as predictors of medical illness and somatic symptom onset. RESULTS: Anxiety and depression symptoms predicted greater incidence of nearly all medical illnesses and somatic symptoms. Effects were as strong as or stronger than those of obesity and smoking, and anxiety and depression independently increased risk for most physical health indices assessed. CONCLUSIONS: Findings suggest that anxiety and depression are as strongly predictive of poor future physical health as obesity and smoking and that anxiety is independently linked to poor physical health. Greater attention should be paid towards these conditions in primary care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Keywords: Depressive symptoms; Health Conditions and Status; Obesity; Smoking

Do Nationally Representative Cutpoints for Clinical Muscle Weakness Predict Mortality? Results from Nine Years of Follow-up in the Health and Retirement Study. - Kate A Duchowny (Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 2019)
Background: Muscle weakness, as measured by handgrip strength, is associated with cardiovascular and all cause-mortality; however, there are wide inconsistences in the magnitude of these effects due to divergent definitions used to define muscle weakness across studies. Therefore, the objective of this study was to examine the relationship between previously defined sex- and race-specific cutpoints of clinical muscle weakness and early mortality. Methods: Data come from the 2006-2014 Health and Retirement Study. Time-varying clinical muscle weakness, as defined by handgrip strength cutpoints, was the primary exposure. Time to death, ascertained from the National Death Index, was the outcome of interest. The association between time-varying clinical muscle weakness and early mortality across a 9-year observation period was determined using Kaplan-Meier methods and extended Cox regression. Results: Out of the 8,326 individuals in the study, 1,799 deaths (21%) occurred during the observation period. Median follow-up time was 8.3 years (SD ±1.9 years). Weak individuals had a steeper decline in their survival trajectory, compared to non-weak individuals (Log-Rank test, p<.001). After adjusting for sociodemographic factors and time-varying smoking history, weak individuals were over 50% more likely to die earlier than non-weak individuals (HR=1.52, 95% CI= 1.15, 1.47). Conclusions: This is the first study to use muscle weakness cut-points derived in a nationally-representative sample to identify those individuals who may be at greatest risk for premature mortality. Results underscore the importance of muscle weakness, as defined by handgrip strength, as a key risk factor for premature mortality in older Americans.
Keywords: Cut points; Health Conditions and Status; Mortality

Essays in health, labor supply, and savings in later life - Siha Lee (Economics, 2019)
Chapter 1 examines married women's time allocation to market hours and spousal care in the event of their husbands' disability and its implications for evaluating the insurance value of the Social Security Disability Insurance (SSDI) program. Using an event study approach, I find that while spousal labor supply responses to husbands' disability are small, wives spend a sizable amount of time in spousal care after their husbands become disabled, and the magnitude of this response is comparable to the increase in wives' labor supply in the event of their husbands' layoff. Motivated by these facts, I develop a dynamic model of married households that incorporates husbands' disability status, wives' time allocation choices, health state dependent utility, and the institutional features of SSDI. Counterfactual experiments indicate that the insurance value of SSDI relative to its costs is considerably higher when I take into account that spousal care significantly reduces the insurance role of wives' labor supply in the event of their husbands' disability. Chapter 2 is joint with Kegon K. T. Tan. We exploit an unanticipated change in Social Security benefits, commonly called the Social Security Notch, to distinguish bequest motives from precautionary savings. Our instrumental variable estimates show that an increase in benefits leads to a sizable increase in bequest amounts. Combining these estimates with a model of late-life savings behavior, we find that roughly two-fifths of accumulated assets and bequests are attributable to bequest motives among retirees. A more progressive Social Security benefits schedule that reduces benefits for the richest retirees has a modest impact on consumption since wealth acts as a cushion against benefit reduction. Chapter 3 studies the reasons behind why self-employment rates increase with age. I compare among three mechanisms that make self-employment more attractive to older workers than younger workers: 1) accumulated work experience that can be tailored into a feasible business idea, 2) greater difficulty in finding a wage-and-salary job once laid off, and 3) flexibility in working hours. I find that flexible working hours is the most important element in understanding transitions to self-employment and longer labor force attachment of self-employed workers.
Keywords: Employment and Labor Force; Health Conditions and Status; Savings

Evaluating eight-year trajectories for sense of purpose in the Health and Retirement Study. - Patrick L Hill; Sara J Weston (Aging & Mental Health, 2019)
OBJECTIVES: Though cross-sectional research has suggested that sense of purpose declines into older adulthood, it remains unclear whether inter-individual variability occurs in these trajectories, and what factors predict these trajectories. The current study provides one of the first longitudinal investigations into how individuals' sense of purpose fluctuates in older adulthood. METHOD: Participants from the Health and Retirement Study (n = 4,234, mean age = 65 years), completed assessments of sense of purpose over three years, along with multiple potential predictors (health, personality, demographics) at the start. RESULTS: Second-order latent growth models demonstrated both mean-level declines on purpose over time, as well as the capacity for inter-individual variability in change patterns for retired adults. Among this cohort, health status, educational attainment, and marital status were significant predictors of purpose trajectories over time, though broad personality trait dimensions failed to uniquely predict change in sense of purpose. However, measurement invariance tests suggest that the scale did not operate similarly across work status groups. CONCLUSION: Findings advance the previous literature by demonstrating inter-individual variability in sense of purpose for those participants who had retired. Future research should consider that purpose inventories may operate differently for those in the workplace versus retired adults.
Keywords: Health Conditions and Status; Purpose in life; Well-being

A friend in need? Exploring the influence of disease and disability onset on the number of close friends among older adults. - Kenzie Latham-Mintus (Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 2019)
OBJECTIVES: This research examines whether onset of life-threatening disease (i.e., cancer, lung disease, heart disease, or stroke) or Activities of Daily Living (ADL) disability influences the reported number of close friends. METHODS: Using data from the Health and Retirement Study (HRS) (2006-2012), this research capitalizes on panel data to assess changes in number of close friends over a four-year period. Lagged dependent variable (LDV) and change score (CS) approaches were employed. RESULTS: Both the LDV and CS models provide evidence that onset of life-threatening disease was associated with reporting more friends four years later. In particular, onset of cancer was associated with reporting more close friends. DISCUSSION: This research provides evidence of the network activation hypothesis following onset of life-threatening disease among older adults.
Keywords: Disabilities; Health Conditions and Status; Social Support

Health and social-physical environment profiles among older adults living alone: Associations with depressive symptoms. - So Jung Park; Jacqui Smith; Ruth E Dunkle; Ingersoll-Dayton, Berit; Toni C Antonucci (Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2019)
Objectives: We examined differences in depressive symptoms among people 65 and older who live alone, exploring whether these differences are associated with both health and environmental contexts. Method: Data are from the 2006 wave of Health Retirement Study (N = 2,956, age range: 65-104). We used a two-step cluster analytical approach to identify subgroups of health-limitation profiles and environmental profiles. Logistic regression models determined associations between subgroups and depressive symptoms. Results: Cluster analysis identified four health-profile subgroups (sensory-cognitively impaired, physically impaired, multiply impaired, and healthy) and three different physical-social environmental-profile subgroups (physically average/socially unsupported, physically unsupported/socially supported, and physically supported/socially above average). Compared to members of healthier groups, members of the multiply impaired group were the oldest and were more likely both to live in senior housing and to have depressive symptoms if they lived in a physically average/socially unsupported environment. Members of the sensory-cognitively impaired group were more likely to have depressive symptoms when they lived in a physically unsupported/socially supported environment. Discussion: Findings regarding the range of both health and social-physical environmental profiles as well as the associations between person-environment profiles combinations (fit) and depressive symptomatology have important policy and intervention implications.
Keywords: Depressive symptoms; Health Conditions and Status; Living arrangements

High-density lipoprotein cholesterol and all-cause and cause-specific mortality among the elderly. - Li, Zhi-Hao; Lv, Yue-Bin; Zhong, Wen-Fang; Gao, Xiang; Virginia Byers Kraus; Zou, Meng-Chen; Zhang, Xi-Ru; Li, Fu-Rong; Yuan, Jin-Qiu; Shi, Xiao-Ming; Wu, Xian-Bo; Mao, Chen (Journal of Clinical Endocrinology and Metabolism, 2019)
CONTEXT: The patterns of the association between high-density lipoprotein cholesterol (HDL-C) concentrations and mortality among the elderly are still unclear. OBJECTIVE: To examine the association of HDL-C concentrations with mortality, and to identify the optimal HDL-C concentration range that predicts the lowest risk of all-cause mortality among the elderly. DESIGN: This was a nationwide, community-based prospective cohort study. METHODS: This study included 7,766 elderly individuals (aged ≥65 years; mean age: 74.4 years) from the Health and Retirement Study. Cox proportional hazards models and Cox models with penalized smoothing splines were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and cause-specific mortality. RESULTS: During a median follow-up of 5.9 years, 1,921 deaths occurred. After fully adjustment for covariates, a nonlinear (P for nonlinearity<0.001) association was found between HDL-C and all-cause mortality (minimum mortality risk at 71 mg/dL [1.84 mM]); the risk for all-cause mortality was significantly higher in the group with HDL-C concentration <61 mg/dL (1.58 mM) (HR: 1.18; 95% CI: 1.05-1.33) and in the group with HDL-C concentration >87 mg/dL (2.25 mM) (HR: 1.56; 95% CI: 1.17-2.07) than in the group with HDL-C concentrations ranging from 61 to 87 mg/dL (1.58-2.25 mM). Nonlinear associations of HDL-C concentrations with both cardiovascular and non-cardiovascular mortality were also observed (both P for nonlinearity<0.001). CONCLUSIONS: Among the elderly, nonlinear associations were found between HDL-C and all-cause and cardiovascular mortality. The single optimal HDL-C concentration and range were 71 mg/dL and 61 to 87 mg/dL, respectively.
Keywords: Cholesterol; Health Conditions and Status; Mortality

The joint effect of health shocks and eligibility for Social Security on labor supply - Candon, David (The European Journal of Health Economics, 2019)
This paper investigates whether or not suffering a health shock, and becoming eligible for social security, have a joint effect on labor supply. Despite millions of people experiencing both of these events each year, no paper has focused exclusively on the joint effect that these events may have on work outcomes. This is surprising given that experiencing a health shock may impact on how a worker responds to becoming eligible for social security. With data from the Health and Retirement Study, I model weekly hours of work as a function of health shocks, social security eligibility, and their interaction. I find that this interaction leads to a 3–4 h reduction in weekly hours of work for men, but has no effect for women. The results are robust to using different work outcomes, age groups, health shock definitions, subgroups, as well as falsification and placebo tests. The results appear to be driven by men who would have had to return to work with impaired health. Policies that promote a more flexible work situation for older men may alleviate these problems in the future.
Keywords: Employment and Labor Force; Gender Differences; Health Conditions and Status; Health Shocks; Social Security

Married people walk faster and have stronger grip, new study says - Emily Dixon (CNN, 2019)
Keywords: Health Conditions and Status; Marriage; News; Physical Health

Positive views of aging reduce risk of developing later-life obesity. - Becca R Levy; Martin D Slade (Preventative Medicine Reports, 2019)
The obesity epidemic among older adults is expected to continue increasing unless public-health efforts address this age group. Yet, little is known about psychosocial determinants of obesity that relate specifically to older persons. In this study, we investigated for the first time whether self-perceptions of aging (SPA), defined as beliefs about oneself as an older person that are assimilated from society, relate to new cases of obesity. This seemed plausible because older persons who report more-positive SPA tend to engage in more health-promoting behaviors. Our sample consisted of 5702 Americans in the nationally representative Health and Retirement Study who were aged 60 years or older and not obese at baseline. The participants were followed from 2008 to 2014. As predicted, older persons with more-positive SPA, compared to those with more-negative SPA, were significantly less likely to become obese over the next 6 years, after adjusting for relevant covariates. For example, according to our model, a participant with the most-positive SPA score was 27% less likely to become obese than a same-aged peer with an average score on the SPA measure. These findings suggest that interventions aimed at reducing the prevalence of obesity in later life could benefit from targeting SPA.
Keywords: Ageism; BMI; Health Conditions and Status

Prevalence and multivariable factors associated with preoperative cognitive impairment in outpatient surgery in the United States. - Timothy G. Gaulton; Roderic G Eckenhoff; Mark D Neuman (Anesthesia and Analgesia, 2019)
Preoperative cognitive impairment increases the risk of adverse events after surgery but its prevalence in outpatient surgery has not been defined. We aimed to determine the prevalence and multivariable factors associated with cognitive impairment in individuals who present for outpatient surgery. We used data from the Health and Retirement Study, a longitudinal panel survey of older Americans. Of 1836 participants who reported having outpatient surgery, we found that 16.1% had evidence of cognitive impairment. Significant multivariable factors associated with preoperative cognitive impairment included non-Hispanic African American race, prior stroke, preoperative functional dependence, and lower socioeconomic status and education level.
Keywords: Cognitive Ability; Health Conditions and Status; Surgery

Retrospective memories of parental care and health from mid- to late life. - William J. Chopik; Robin S. Edelstein (Health Psychology, 2019)
Keywords: Childhood; Cognitive Ability; Health Conditions and Status; Memory

Subjective Age and Cystatin C Among Older Adults. - Yannick Stephan; Angelina R Sutin; Antonio Terracciano; Shevaun Neupert (Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 2019)
Objective: Cystatin C (CysC) is a marker of kidney function that is relevant for the health and cognition of older adults. Little is known about the link between psychological factors and CysC. Therefore, the present study examined whether subjective age is related to CysC level and changes in CysC over time. Method: Participants were 5,066 individuals drawn from the Health and Retirement Study aged from 50 to 107 years (60% women, mean age = 69.36 years, SD = 9.54). They provided data on subjective age, demographic covariates, and CysC at baseline. CysC was assessed again 4 years later. Results: Analysis revealed that an older subjective age was related to higher level of CysC at baseline and to an increase in CysC over 4 years, controlling for demographic factors. An older subjective age was also related to higher risk of exceeding the clinical threshold of CysC at baseline and 4 years later. Additional analysis revealed that disease burden, depressive symptoms, physical inactivity, and BMI partly mediated these associations. Conclusion: The present study provides new evidence on the role of subjective age as a psychological factor associated with individuals' risk of kidney dysfunction, an association beyond chronological age.
Keywords: Cystatin C; Health Conditions and Status; Subjective age

The unobserved pattern of material hardship and health among older Americans. - Li Donni, Paolo (Journal of Health Economics, 2019)
This paper investigates the relationship between self-reported health and material hardship among older Americans. Differently from income-based measures, material hardship provides a more specific description of the concrete adversities faced by the elderly. We have used the last six waves of the Health and Retirement Study to explore the relative contributions of state dependence, unobserved heterogeneity and time-specific shocks on reporting poor health, experiencing food insecurity and medication cutbacks. We have used a Latent Markov model to estimate a multivariate non-linear system of equations for panel data allowing time-varying unobserved heterogeneity. Our results reveal a high state dependence of both health and material hardship conditions. Estimated trajectories reveal that pathways of material hardship are associated differently with health. Material hardship is also spread across its dimensions.
Keywords: Health Conditions and Status; Health Trajectories; Self Report

Activities Matter: Personality and Resource Determinants of Activities and their Effect on Mental and Physical Well-being and Retirement Expectations - Beier, Margaret E.; Torres, W. Jackeline; Gilberto, Jacqueline M. (Work, Aging and Retirement, 2018)
Remaining active throughout the lifespan is central to healthy aging. The current study tests a model derived from investment and resource theories that examines the extent to which activities mediate the relationship between individual differences in personality and resources on mental and physical well-being and retirement expectations. A subsample (N = 400; 58% women) of participants from the nationally representative Health and Retirement Study (HRS) was used. Self-reported activities were grouped into 4 broad categories: productive, physical, social, and leisure. Activity variety, operationalized as the number of different activity categories in which a person reported participating over a specified period of time, was also examined. Correlations and path analysis results suggest small but significant effects between personality traits and activity participation, and more consistent effects of personality for predicting activity variety. Personality was also significantly correlated with well-being and retirement expectations as was activity variety. There was limited evidence, however, that activity variety mediated the relationship between personality and resources and mental and physical well-being and retirement expectations as would be predicted by investment theory.
Keywords: Activities of Daily Living; Health Conditions and Status; Personality; Psychosocial; Retirement Planning and Satisfaction; Well-being

Association Between Social Support and Health of Aging Adults with Dementia - Pakstis, Allyson; Kim, Jinhee; Bhargava, Vibha (Ageing International, 2018)
The purpose of this cross-sectional study was to explore the relationship between social support and the health outcomes of older adults, ages 50 and older, with dementia in the United States, using data from the 2012 wave of the Health and Retirement Study (N = 446). The dependent variables included depressive symptoms (CES-D), self-reported health, number of chronic conditions, and the sum of activities of daily living (ADL) limitations. The key independent variables were measures of social support including marital status, children living within ten miles, relatives near, good friends near or in congregation, how often they attend religious services, relatives in congregation, and number of times they get together with people. Guided by the convoy model, this study focused on the layers of social support that typically surround an aging adult and the types of support within those layers. Findings of the logistic regression suggest that attending religious services was significantly associated with the ADL (p = .004). Having friends near or in a congregation was negatively associated with number of ADL limitations (p < .001), and positively associated with the likelihood of fewer depressive symptoms (p < .001). Results suggest that social support may be playing an important role in the health of aging adults with dementia. It may be important to focus on how to better ensure reliable social networks for aging adults with dementia and how to help secure meaningful social connections. Future research should prioritize assessing the effects of the quality of social supports on different types of health outcomes, within varying social proximities.
Keywords: Cognitive Ability; Dementia; Health Conditions and Status; Social Support

Comfort Eating and All-Cause Mortality in the US Health and Retirement Study. - Jenna R. Cummings; Ashley E Mason; Puterman, Eli; A Janet Tomiyama (International Journal of Behavioral Medicine, 2018)
PURPOSE: Comfort eating is a prevalent behavior. Prior research shows that comfort eating is associated with reduced stress responses and increased metabolic risk across adolescence, young adulthood, and middle adulthood. The purpose of the current research was to test if comfort eating prospectively predicted all-cause mortality in older adulthood. METHOD: The US Health and Retirement Study is an ongoing, nationally representative, longitudinal study of older adults. The final sample for the present study (N = 1445) included participants randomly selected to report how often they comfort ate. Comfort eating data were collected in 2008 and all-cause mortality data were collected in 2014. Participants also reported how often they consumed high-fat/sugar food as well as their height and weight in 2008. RESULTS: For each 1-unit increase in comfort eating, the expected odds of all-cause mortality (n = 255 deceased) decreased by 14%, OR = 0.86, p = 0.048, 95% CI [0.74, 0.99]. This analysis statistically accounted for other predictors of mortality in the sample including age, biological sex, race, highest educational degree attained, moderate and vigorous exercise, smoking, and cumulative illness. High-fat/sugar intake did not mediate (or diminish) the association but body mass index did. CONCLUSION: Comfort eating-irrespective of consuming high-fat/sugar food-may be associated with reduced mortality in older adults because it may promote greater body mass, and greater body mass is associated with lower risk of mortality in nationally representative samples. Interventionists might consider both beneficial and detrimental aspects of comfort eating across the lifespan.
Keywords: BMI; Depressive symptoms; Health Conditions and Status; Mortality

Does Telomere Length Indicate Biological, Physical and Cognitive Health Among Older Adults? Evidence from the Health and Retirement Study. - Lauren L Brown; Yuan S Zhang; Colter Mitchell; Jennifer A Ailshire (Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2018)
Telomere length (TL) has been suggested as a biomarker that can indicate individual variability in the rate of aging. Yet, it remains unclear whether TL is related to recognized indicators of health in an aging, older nationally representative sample. We examine whether TL is associated with 15 biological, physical and cognitive markers of health among older adults ages 54+. TL was assayed from saliva using quantitative PCR (T/S ratio) in the 2008 Health and Retirement Study (n=4,074). We estimated probability of high risk levels across indictors of health by TL and age-singly and jointly. TL was associated with seven indicators of poor functioning: HDL and total cholesterol, cystatin C, pulse pressure, BMI, lung function, and walking speed. However, after adjusting for age, associations were substantially attenuated; only associations with cholesterol and lung function remained significant. Additionally, findings show TL did not add to the predictive power of chronological age in predicting poor functioning. While TL may not be a useful clinical marker of functional aging in an older adult population, it may still play an important role in longitudinal studies in young and middle aged populations that attempt to understand aging.
Keywords: Biomarkers; Cognitive Ability; Health Conditions and Status; Telomeres

Financial and socio-economic factors influencing pre- and post-cancer therapy oral care. - Derek K Smith; Emily H. Castellanos; Barbara A Murphy (Support Care Cancer, 2018)
PURPOSE: The primary objective of this study is to evaluate how attendance at dental visits may change as cancer patients move through pre-diagnosis, diagnosis, and into survivorship. METHODS: The Health and Retirement Study consists of longitudinal survey data collected biannually detailing financial and health information in subjects over 51 years old. We assessed a subset of 4195 patients who received a new cancer diagnosis during the study period. The odds of reporting a dental visit were examined using a mixed effects logistic regression model. A propensity score weighted analysis of the association between dental attendance and survival was also undertaken. RESULTS: The odds of attending a dental visit were substantially lower in the peri-diagnosis period OR = 0.784 (0.700, 0.876) and the post-diagnosis period OR = 0.734 (0.655, 0.823) compared to pre-diagnosis. This effect persisted in patients who survived for at least 2 years indicating that the decline in oral health visits was not due to low expected survival. After propensity score weighting, patients who attended a dental visit in the peri-diagnosis period demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance. CONCLUSIONS: Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy despite guideline recommendations encouraging dental referral and monitoring for many types of cancer therapy. Attendance at dental appointments during cancer therapy is associated with improved survival, which is likely due to a combination of direct and indirect effects.
Keywords: Cancer screenings; Dental Care; Finances; Health Conditions and Status; Socioeconomic factors

Happy Childhood Memories May Boost Physical and Mental Health in Later Life - Aristos Georgiou (Newsweek, 2018)
Keywords: Childhood; Health Conditions and Status; News; Positivity

Healthy Aging Among Older Black and White Men: What Is the Role of Mastery? - Kenzie Latham-Mintus; Ashley Vowels; Huskins, Kyle (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2018)
Objectives: This research explores black-white differences in healthy aging and investigates whether mastery acts as a buffer against poor health for older black and white men. Methods: Using data from the Health and Retirement Study (HRS) (2008-2012), a series of binary logit models were created to assess healthy aging over a 2-year period. Healthy aging was defined as good subjective health and free of disability at both waves. Mastery was lagged, and analyses (n = 4,892) controlled for social and health factors. Results: Black-white disparities in healthy aging were observed, where older black men had lower odds of healthy aging. Mastery was associated with higher odds of healthy aging, and race moderated the relationship between mastery and healthy aging. The predicted probability of healthy aging was relatively flat across all levels of mastery among black men, yet white men saw consistent gains in the probability of healthy aging with higher levels of mastery. In race-stratified models, mastery was not a significant predictor of healthy aging among black men. Discussion: High levels of mastery are linked to positive health-often acting as a buffer against stressful life events. However, among older black men, higher levels of mastery did not necessarily equate to healthy aging.
Keywords: Health Conditions and Status; Men's health; Racial/ethnic differences

How Does Self-Rated Health Differ among Older Vietnamese Men and Women? - Le, Dung Duc; Quashie, Nekehia T.; Prachuabmoh, Vipan (Journal of Population Ageing, 2018)
Due to gender differences in life expectancy, women outlive their male counterparts but experience more years of poor health. Whereas the correlates of gender differences in later life health have been examined in Western countries there is a limited but growing body of research among older adults in developing countries. Utilizing data from the 2011 Vietnam National Aging Study, this study examines gender differentials in self-rated health among Vietnamese aged 60 years and over (N = 2467) within the differential exposure and differential vulnerability frameworks. Logistic regression analyses show women had higher odds of reporting poor health but this differential was significantly reduced after adjusting for socio-demographic factors. Differential exposure to socio-economic resources did not explain the gender gap in perceived health status. After controlling for health behaviors, physical and mental health conditions, the gender differential was reversed with women showing lower odds of reporting poor health than similar men. Gender specific associations were evidenced by social participation, educational attainment, and employment status, which were protective for women’s health but unrelated to men’s. Older Vietnamese men and women show many similarities in the correlates of self-rated health. Comorbidity of chronic conditions, functional limitations, symptoms of psychological distress, and living in the Central region of Viet Nam were positively associated with poor self-rated health for men and women. The findings provide insight for gender sensitive social policies and investments in health systems to address the changing health profile of the Vietnamese population.
Keywords: Aging; Gender Differences; Health Conditions and Status

The Moderating Role of Employment Status and Gender on Relationships Between Psychological Age and Health: A Two-Wave Cross-Lagged Panel Analysis of Data From the Health and Retirement Study - Janet L. Barnes-Farrell; Petery, Gretchen A. (Work, Aging and Retirement, 2018)
In this study we explored the direction of over-time relationships between psychological age (PA) and 4 facets of health for older adults, with social comparison theory (SCT) and stereotype embodiment theory (SET) providing the rationale for competing causal orderings of these relationships. Expanding on recent longitudinal work (Petery, 2015; Spuling, Miche, Wurm, & Wahl, 2013) we investigated whether over-time employment status (employed, transition to retired, retired), gender, and the interaction of employment status and gender moderate the nature of these relationships for older (over 50 years old) adults. We examined data on PA and indicators of general, functional, physical, and mental health from the Health and Retirement Study collected at 2 time points, 4 years apart. Hypothesis testing on the causal ordering of the 2 constructs and the proposed moderations were conducted, with each health facet examined independently using cross-lagged panel path analysis and multigroup analysis of employment by gender subgroups. Effect sizes for relationships between PA and health were small in magnitude for all health facets and all employment status and gender subgroups. The apparent primary causal direction of relationships differed by health facet, with support provided for both Health > PA and PA > Health temporal orderings. Furthermore, with the exception of physical health, which exhibited consistent support for a Health -> PA relationship, the primary causal direction of the relationship between PA and health depended on both employment status and gender, jointly. These provide further evidence of the complexity of the health-PA relationship.
Keywords: Employment and Labor Force; Gender Differences; Health Conditions and Status; Marriage; Subjective age

Older adults in jail: high rates and early onset of geriatric conditions. - Greene, Meredith; Cyrus Ahalt; Stijacic-Cenzer, Irena; Metzger, Lia; Brie A Williams (Health Justice, 2018)
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.
Keywords: Criminal justice; Health Conditions and Status; Public Health

Psychological well-being and risk of dementia. - Angelina R Sutin; Yannick Stephan; Antonio Terracciano (International Journal of Geriatric Psychiatry, 2018)
OBJECTIVE: Well-being is a psychological resource that buffers against age-related disease. We test whether this protective effect extends to dementia and whether it is independent of distress. METHODS: Participants (N = 10,099) were from the Health and Retirement Study. Five aspects of positive psychological functioning (life satisfaction, optimism, mastery, purpose in life, and positive affect) were tested as predictors of incident dementia over 6 to 8 years. RESULTS: Purpose in life was associated with a 30% decreased risk of dementia, independent of psychological distress, other clinical and behavioral risk factors, income/wealth, and genetic risk. After controlling for distress and other risk factors, the other aspects of well-being were not associated with dementia risk. CONCLUSIONS: After considering psychological distress, we found that measures of well-being were generally not protective against risk of dementia. An exception is purpose in life, which suggests that a meaningful and goal-driven life reduces risk of dementia.
Keywords: Alzheimer's disease; Dementia; Depressive symptoms; Health Conditions and Status; Well-being

Public health insurance and household portfolio Choices: Unravelling financial “Side Effects” of Medicare. - Marco Angrisani; Atella, Vincenzo; Brunetti, Marianna (Journal of Banking & Finance, 2018)
Large, unpredictable and not fully insurable health-care costs represent a source of background risk that might deter households’ financial risk taking. Using panel data from the Health and Retirement Study, we test whether universal health insurance, like Medicare for over-65 Americans, shields against this risk promoting stockholding. We adopt a fixed-effects estimation strategy, thereby taking into account household-level heterogeneity in health status and private insurance coverage. We find that, before Medicare eligibility, households in poor health, who face a higher risk of medical expenses, are less likely to hold stocks than their healthier counterparts. Yet, this gap is mostly eliminated by Medicare. Notably, the offsetting is primarily experienced by households in poor health and without private health insurance over the observation period.
Keywords: Finances; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Stocks

The Relation of Volunteering and Subsequent Changes in Physical Disability in Older Adults. - Dawn C Carr; Ben Lennox Kail; John W Rowe (Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 2018)
Objectives: To describe the association between initiating volunteering and changes in physical disability in older adults, and whether intensity and gender modify this relationship. Methods: Employing propensity score weighted regression adjustment, we calculate changes in disability using a sample of U.S. adults (n = 7,135) in the Health and Retirement Study (1996-2012) not volunteering at baseline but later initiating volunteering (1-99 hr/year or 100+ hours per year) or remaining a nonvolunteer. Results: Relative to continuous nonvolunteers, low-intensity volunteering is related to 34% lower disability in the low-intensity group (average treatment effect [ATE] = -0.12) and 63% lower in the higher-intensity group (ATE = -0.23). For men, progression was lower only in the highest intensity group (ATE = +0.02), but women experienced similarly less progression of disability (38%-39%) at either level of new engagement (ATE = -0.17 and -0.18). Discussion: Initiating a new volunteer role in later life is related to decreased progression of disability, at low or high levels for women and only at higher levels for men. This study suggests that volunteer intervention programs may represent a major public health strategy to delay the progression of physical disability for older adults.
Keywords: Disabilities; Health Conditions and Status; Volunteerism

Religion and health in the US context of secularization and aging - Vern L. Bengtson; Idler, Ellen (New Dimensions in Spirituality, Religion, and Aging, 2018)
Trends in US religious observance increasingly show lower levels of religious affiliation and participation among younger Americans. Although older persons may have higher levels of religiosity, they also experience health problems that may limit participation. In this chapter, I analyze data from the Health and Retirement Study, which shows the expected pattern of increasing importance of religion by age group, a dimension of religious participation that would not be affected by poor health. Attendance at services weekly is also lowest for those aged 24-49 and highest for those aged 75-89, while just slightly less for those aged 90+. Further, I find that age is positively associated with both attendance and the importance of religion even when an extensive number of health status measures are controlled. Older persons with poor physical health do not show lower levels of attendance but attendance is strongly associated with poor mental health. The implications of the argument in this chapter are that increasing secularization of younger cohorts of Americans may deprive them of a social resource that is more widely available to current churchgoers.
Keywords: Cognition & Reasoning; Health Conditions and Status; Religion

The role of health in retirement - Alan L Gustman; Thomas L. Steinmeier (Emerald Publishing Limited, 2018)
A dynamic model of the evolution of health for those over the age of 50 is embedded in a structural, econometric model of retirement and saving. Effects of smoking, obesity, alcohol consumption, depression, and other proclivities on medical conditions are analyzed, including hypertension, diabetes, cancer, lung disease, heart problems, stroke, psychiatric problems, and arthritis. Compared to a population in good health, the current health of the population reduces retirement age by about one year. Including detailed health dynamics in a retirement model does not influence estimates of the marginal effects of economic incentives on retirement.
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance; Retirement Planning and Satisfaction

Self-perceptions of aging mediate the longitudinal relationship of hopelessness and depressive symptoms. - Amber M Gum; Liat Ayalon (International Journal of Geriatric Psychiatry, 2018)
OBJECTIVES: The purpose of the current study was to examine the hypothesis that the prospective relationship between hopelessness and depressive symptoms is mediated by self-perceptions of aging. METHODS: Data from 3 waves of the US Health and Retirement Study (2008, 2012, and 2014) were used (N = 4606; age M = 65.3, 55.5% female). In mediation analyses, hopelessness in 2008 was the independent variable, self-perceptions of aging in 2012 were the mediator, and depressive symptoms in 2014 were the outcome variable. RESULTS: After controlling for covariates, hopelessness in 2008 was an independent predictor of self-perceptions of aging in 2012 (β = -.10, P < .001), and self-perceptions of aging in 2012 was an independent predictor of depressive symptoms in 2014 (β = -.41, P < .001). Hopelessness in 2008 showed both direct (β = .09, P < .001) and indirect (β = .03, P < .001) effects on depressive symptoms in 2014, indicating partial mediation by change in self-perceptions of aging. CONCLUSIONS: As hypothesized, change in self-perceptions of aging partially mediated the relationship of hopelessness with depressive symptoms 6 years later. Findings are consistent with a conceptualization of hopelessness as broad negative expectations about the future that may contribute to negative self-perceptions of aging and subsequent changes in depressive symptoms. Reducing hopelessness, increasing hope, and improving self-perceptions of aging have potential to reduce and prevent depressive symptoms for older adults. Future research should examine the mechanisms of these interrelationships and other aging outcomes.
Keywords: Depressive symptoms; Health Conditions and Status; Optimism; Self-reported health

Sense of Control, Job Stressors, and Well-Being: Inter-relations and Reciprocal Effects Among Older U.S. Workers - Liu, Mengqiao; McGonagle, Alyssa K.; Gwenith G Fisher (Work, Aging and Retirement, 2018)
The purpose of this study was to examine dynamic relations among job stressors, sense of control, and well-being among older working adults. Sense of control can be especially important among older adults given their potential vulnerability due to declining resources in health and work ability. Drawing on the conservation of resources (COR) theory, we examined relations between job stressors and sense of control as they relate to older workers' well-being, along with reciprocal relations between sense of control and both job and life satisfaction. Using 3 waves of survey data from 477 older working U.S. adults (age 51+) in the Health and Retirement Study, we examined cross-lagged model results and found reciprocal relations between sense of control and both job and life satisfaction. Results highlight the key role of sense of control in maintaining well-being among older workers. These findings resonate with COR, suggesting that sense of control both affects and is affected by individuals' well-being. Our study sheds light on dynamic processes involving job stressors, sense of control, and well-being and underscores the importance of promoting sense of control for older working adults.
Keywords: Depressive symptoms; Health Conditions and Status; Life Satisfaction; Stress; Well-being

Subjective Social Status Predicts Late-Life Memory Trajectories through Both Mental and Physical Health Pathways - Laura B Zahodne; A Zarina Kraal; Afsara B. Zaheed; Sol, Ketlyne (Gerontology, 2018)
Background: Subjective social status (SSS) is associated with mental and physical health, independent of objective socioeconomic status (SES), but its association with late-life cognitive decline is unknown. Objective: This study characterizes the association between SSS and late-life memory trajectories in a large, nationally representative sample of older adults in the United States. Methods: Using data from 8,530 participants aged 65 years and older in the Health and Retirement Study, structural equation models tested associations between SSS, objective SES (i.e., educational attainment, occupation, income, and wealth), physical and mental health, and 6-year memory trajectories, controlling for sociodemographic characteristics. Results: Independent of objective SES, lower SSS was associated with worse initial memory but not subsequent memory decline. The association between SSS and initial memory was separately mediated by chronic diseases, stroke, and depressive symptoms. Conclusion: Results provide preliminary behavioral evidence for the deleterious effects of social stress on cognitive aging. These results may help inform the development of policies and interventions to reduce cognitive morbidity among older adults who perceive a low position on the social hierarchy.
Keywords: Cognitive Ability; Depressive symptoms; Health Conditions and Status; Late-life Health; Memory

Accelerated increase and relative decrease in subjective age and changes in attitudes toward own aging over a 4-year period: results from the Health and Retirement Study - Ehud Bodner; Liat Ayalon; Sharon Avidor; Yuval Palgi (European Journal of Ageing, 2017)
The passage of time may force people to adjust their subjective age in response to changes in their attitudes toward own aging (ATOA). Although positive associations have been found between well-being and both positive ATOA and younger subjective age, the relationships between changes in these measures have not been examined yet. We expected (1) a decrease in positive ATOA to be associated with an accelerated increase in subjective age and (2) an increase in positive ATOA to be associated with a relative decrease in subjective age. Participants were individuals and their spouses, aged 50 and over, recruited by the Health and Retirement Study, who provided responses to a question concerning one’s subjective age in 2008 and 2012 (n = 4174). A change in subjective age over the two waves was regarded as (1) an accelerated increase if it was greater than 5 years (36.2 % of the sample); (2) a relative decrease (39.1 %), if it was less than the 3 years; (3) no change if it did not comply with criteria 1 or 2 (24.7 %). A decrease in positive ATOA over the two waves resulted in an accelerated increase in subjective age, and an increase resulted in a relative decrease in subjective age. Older age and more physical impairments and depressive symptoms in 2012 compared with 2008 were associated with an accelerated increase in subjective age. Our findings emphasize the consequences ATOA might have on subjective age experiences, and the need to improve them.
Keywords: Aging; Cognitive Ability; Health Conditions and Status; Older Adults; Self-reported health

Baby boomers in the United States: Factors associated with working longer and delaying retirement. - Xiuwen S Dong; Wang, Xuanwen; Ringen, Knut; Sokas, Rosemary (American Journal of Industrial Medicine, 2017)
OBJECTIVES: This study estimated the self-reported probability of working full-time past age 62 (P62) or age 65 (P65) among four cohorts of Americans born between 1931 and 1959. METHODS: Data from the Health and Retirement Study (HRS) were analyzed. Respondents in four age cohorts were selected for comparison. Multivariable linear regression models were used to assess cohort differences in P62 and P65 while adjusting for covariates. RESULTS: P62 and P65 increased among boomers despite worsened self-rated health compared to the two preceding cohorts, with 37% and 80% increases among mid-boomers in construction trades. Cohort differences in P62 and P65 remained after controlling for covariates. Changes in pensions, income inequity, and education were significantly associated with work expectations, but SSA policy was not. CONCLUSIONS: Baby boomers expect to work longer than their predecessors. Efforts to improve work quality and availability for older workers are urgently needed, particularly in physically demanding occupations. Am. J. Ind. Med. 60:315-328, 2017. © 2017 Wiley Periodicals, Inc.
Keywords: Baby Boomers; Delaying retirement; Health Conditions and Status; Older Adults; Retirement Planning and Satisfaction

Dementia rates are declining, and education could have a lot to do with it - Stateside Staff (Stateside, 2017)
Keywords: Dementia; Education; Health Conditions and Status; Interviews; Local news; Older Adults

Depression and Frailty: Concurrent Risks for Adverse Health Outcomes - Matthew C. Lohman; Briana Mezuk; Dumenci, Levent (Aging and Mental Health, 2017)
Objectives: This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury. Methods: Data come from five waves (2004 2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury. Results: Prevalence of frailty increased over the study period (24.1 32.1 ), while the prevalence of depression was relatively constant over time (approximately 13 ). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: ORNursing home = 1.33, 95 CI: 1.09 1.66; ORFall = 1.52, 95 CI: 1.12 2.08; Depression: ORNursing home = 3.63, 95 CI: 1.29 9.97; ORFall = 1.16, 95 CI: 1.01 1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression. Conclusion: Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes to a similar degree as frailty. Focus should be given to distilling elements of the frailty index which confer most risk for poor health outcomes.
Keywords: Health Conditions and Status; Healthcare

Depressive Symptoms Association With Health Outcomes And Treatment In Older Americans With Diabetes - Williams, Lashonda Javon (Health Services and Policy Management, 2017)
Introduction: Diabetes remains the 7th leading cause of death in the United States. Diabetes is a major public health concern of its own, but when you add the comorbidity of depression, diabetes outcomes are amplified. This dissertation examines how depressive symptomatology and treatment for depression are associated with selfreported health (SRH) and diabetes control. Methods: Chi-square and logistic regression were used to analyze data from the Health and Retirement Study (2012). We assessed the associations between SRH and diabetes control with depressive symptomatology data. Results: In our sample (n=4374), 19% of respondents reported high depressive symptomatology and 59% self-reported “good” health compared to 41% self-reported “bad” health. Associated with “bad” SRH were psychiatric medication or psychotherapy treatment (p=.0211), education (p=<.0001), insulin usage (<.0001), diabetes control (p=<.0001), depressive symptomatology (p=<.0001), and clinical diagnosis for depression (p=.0005). For the second outcome, only 9% of the sample reported no diabetes control. Insulin usage (p=<.0001), SRH (p=<.0001), depressive symptoms (p=.0039), sex (p=.0363) and age (p=.0015) were associated with no diabetes control. Conclusion: Depressive symptomatology is associated with SRH and diabetes control. Treatment is moderately significant with SRH, but not significant with diabetes control. A depression diagnosis was not significantly associated with diabetes control.
Keywords: Depressive symptoms; Diabetes; Health Conditions and Status

Durable Disparity: The Emergence and Entrenchment of the Great American Smoking Gap - Lucie Kalousova (Philosophy, 2017)
This dissertation consists of three chapters that investigate how inequalities in health behaviors originate and how they are maintained, using cigarette smoking as a case. In Chapter II, I examine the associations between parental and adult child smoking and consider how they may be modified by the adult child’s socioeconomic attainment and social mobility. Using data collected by the Panel Study of Income Dynamics in 1968, 1986, and 2011, I find that having a smoking parent as a child is associated with a 9 percent to 10 percentage point increase in the probability of smoking as an adult in 1986 and 2011, respectively. However, the parental contribution to an adult child’s smoking likelihood decreased to 7 and 5 percentage point and is no longer statistically significant in 2011 after accounting for the adult child’s own socioeconomic attainment. Children of 1968 parents (themselves interviewed in 1986) are more likely to reproduce their parents’ smoking behavior if they maintain their parents’ economic position or are downwardly mobile than if they are upwardly mobile. For children of 1986 parents (interviewed in 2011), adult children who are downwardly mobile with respect to parental education show a larger effect of parental smoking on their own behavior than those who maintain their parents’ education or are upwardly mobile. x In Chapter III, I evaluate the contribution of smoke-free laws to the socioeconomic inequality in smoking. Using a state-level dataset constructed from multiple sources, I show that states with lower smoking rates are more likely to adopt smoke-free laws. Lower unemployment rates and higher educational attainment in a state are positively associated with smoke-free workplace and bar laws, respectively. I then use a personlevel survey dataset, the Behavioral Risk Factor Surveillance Survey, to estimate the effect of the laws’ implementation on individuals’ probability of smoking. Smoke-free laws are associated with a decline in smoking among women. The decline is concentrated among women who have high school diplomas or are college graduates. Taken together, the results suggest that smoke-free laws may contribute to betweenstate smoking inequalities and that they may contribute to gender disparities. In Chapter IV, I examine the associations between tobacco control policy change and smoking cessation and smoking intensity of older adults, and how they vary by education and race. I use geocoded longitudinal data from the 1992 to 2014 waves of the Health and Retirement Study including smokers 51 and older to assess the relationship between the implementation of 100 percent smoke-free nonhospitality and hospitality workplace laws at local and state levels, average cigarette pack price at the state level, and the likelihood of an individual’s smoking cessation or change in the number of cigarettes smoked daily. The implementation of a non-hospitality workplace law was associated with an increased likelihood of cessation among men, but not among women. Implementation of restaurant and bar smoke-free laws was not associated with increased cessation or lowered intensity. White men, nonwhite women, xi and high school graduates decreased their smoking intensity in response to cigarette price change more than others. These results suggest that the sensitivity of older U.S. adults to changes in smoke-free laws and cigarette prices is limited. I close the dissertation by discussing promising future research direction on health behavior disparities and smoking
Keywords: Family Roles/Relationships; Health Conditions and Status; Smoking

Effect of mortgage indebtedness on health of U.S. homeowners - Leigh Ann Leung; Lau, Catherine (Review of Economics of the Household, 2017)
This paper examines the effect of excessive mortgage indebtedness on health among homeowners using nine waves of the Health and Retirement Study from 1992 to 2008. Health status is measured by subjective well-being, number of depressive symptoms, and incidence of hypertension. Using average annual state-level home prices as an instrument, we attempt to identify the causal effect in an panel IV framework. Results from the panel IV estimations suggest that having a high mortgage loan to home value (LTV), defined as LTV at or above 80 %, leads to more depressive symptoms and a higher incidence of hypertension, but has no effect on subjective well-being. Since the results from panel estimations did not show that debt affects health, whether the panel IV results demonstrate a causal relationship depends critically on the exclusion assumption.
Keywords: Debt; Economics; Health Conditions and Status; Housing; Mortgages; Older Adults

Effects of Pre-Retirement Personality, Health and Job Lock on Post-Retirement Subjective Well-being. - Lindsay H Ryan; Nicky J Newton; Preet K. Chauhan; William J. Chopik (Translational Issues in Psychological Science, 2017)
Retirement can be difficult, and experiences vary greatly. Although health, financial status, and family responsibilities have been associated with retirement adjustment, individual psychosocial characteristics may also play a role. Moreover, relatively little is known about the impact of perceived 'job lock'-the belief that retirement is impossible due to financial or health constraints-and its relationship with later retirement adjustment. The current study addresses these limitations in the literature by examining the retirement transition over four years in a large sample of U.S. adults, with a particular focus on the ways in which personality may affect this transition. Data collected at baseline (2008/2010) and again four years later (2012/2014) included the Big Five personality traits, pre-retirement job lock, self-rated health, and multiple indicators of post-retirement well-being, such as global and experienced well-being (anchored within activities in a single day). Participants were drawn from the Health and Retirement Study (= 716;= 61.9 at baseline). Results indicated that experienced positive affect was the only post-retirement well-being outcome with a significant association with job lock, although only for those with low conscientiousness. Findings also suggest that pre-retirement personality and subjective health play an important role for post-retirement well-being. Thus, the current study highlights the importance for researchers and practitioners to consider both pre-retirement personality and health when evaluating individuals' management of the retirement transition.
Keywords: Health Conditions and Status; Personality; Positive beliefs; Retirement Planning and Satisfaction; Self-reported health; Well-being

Effects of working part-time and full-time on physical and mental health in old age - Tunga Kantarcı (NETSPAR Academic Series, 2017)
An increasing number of studies are analyzing the effect of retirement on health. When analyzing the effect of retirement against work activity, these studies do not distinguish between part-time and full-time work activity. We study how the amount of work hours affects the health conditions in old age. To avoid the potential bias that deteriorating health can cause employees to work fewer hours, retirement eligibility ages are used as instruments for part-time or full-time work decisions. We find that self-perceived health, self-rated memory and body mass index respond to working part-time much more than they respond to working full-time. This suggests that the effect of the number of hours worked on health in old age is not linear.
Keywords: Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction

Health, Health Insurance, and Retirement: A Survey - Eric French; John Bailey Jones (Working Paper Series, 2017)
The degree to which retirement decisions are driven by health is a key concern for both academics and policymakers. In this paper we survey the economic literature on the health-retirement link in developed countries. We describe the mechanisms through which health affects labor supply and discuss how they interact with public pensions and public health insurance. The historical evidence suggests that health is not the primary source of variation in retirement across countries and over time. Furthermore, declining health with age can only explain a small share of the decline in employment near retirement age. Health considerations nonetheless play an important role, especially in explaining cross-sectional variation in employment and other outcomes within countries. We review the mechanisms through which health affects retirement and discuss recent empirical analyses.
Keywords: Disabilities; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Older Adults; Retirement Planning and Satisfaction

Health Status, Health Shocks, and Asset Adequacy Over Retirement Years. - Geoffrey L Wallace; Haveman, Robert; Barbara Wolfe (Research on Aging, 2017)
This article uses data on a sample of retirees drawn from the Health and Retirement Study (HRS) to examine changes in health over the retirement years and to estimate the effects of health changes in retirement on wealth. Using the framework of item response theory, we develop a novel measure of health that makes use of multiple indicators of physical health that are available in the HRS. We find that large negative shocks to the health of male retirees and their spouses are frequent in retirement and that when such shocks do occur, recovery to the preshock level of health is rare. Using a dynamic panel data model, we then estimate short- and long-run effects of changes in health on wealth. While our estimated short-run effects are modest, long-run estimates of the impact of health shocks on wealth are large, ranging from a 12% to 20% reduction in wealth by the 10th year, following a permanent one standard deviation decrease in health.
Keywords: Health Conditions and Status; Health Shocks; Older Adults; Retirement Planning and Satisfaction

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the Health and Retirement Survey (HRS) - Amy M Yorke; Amy B. Curtis; Shoemaker, Michael; Vangsnes, Eric (Archives of Gerontology and Geriatrics, 2017)
Background: Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength. Methods: A cross-sectional analysis was conducted of 5877 respondents (2744 = male, 3103 = female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg). Results: As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b = 3.1, 95% CI = 2.3–3.9, p < 0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength. Conclusion: Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.
Keywords: Comorbidity; Grip strength; Health Conditions and Status

The Impact of Retirement on Health Behaviours - Larlee, Caroline (Department of Economics, 2017)
The objective of the analysis is to identify the causal effects of being retired for at least one year on health behaviours. To estimate the effect of retirement, biannual data from the 2004 to 2014 Health and Retirement Study (HRS) is used. The endogeneity of retirement is acknowledged in our model by using an instrumental variable approach with the social security eligibility ages of 62 and 65 as instruments. Additionally, the longitudinal nature of the data gives us the ability to estimate an individual Fixed Effect (FE) model to control for unobservable time-invariant individual heterogeneity. The retirement parameter estimates of the FE-2SLS model show that being retired for at least one year is associated with a 26 percentage point increase in the likelihood of meeting the physical activity guidelines and a 17 percentage point increase in the likelihood of getting a flu shot, but a 9 percentage point decrease in the likelihood of getting a cholesterol blood test. Thus retirement is associated with some improvement in health behaviours.
Keywords: Health Behavior; Health Conditions and Status; Retirement Planning and Satisfaction

Intraindividual Variability in Late-Life Functional Limitations Among White, Black, and Hispanic Older Adults. - Lin, Jielu; Jessica Kelley-Moore (Res Aging, 2017)
Consistent with the weathering hypothesis, many studies have captured racial/ethnic disparities in average functional health trajectories. The same mechanisms of social inequality that contribute to worse average health among minority adults may also contribute to greater fluctuations in their physical function at upper ages. Using panel data from the Health and Retirement Study, we examine patterns of intraindividual variability over time in trajectories of functional limitations for White, Black, and Hispanic older adults. Intraindividual variability increases with age for both Whites and Blacks and such increase is greater for Blacks. Hispanics have the greatest intraindividual variability but there is no age-based pattern. Socioeconomic status and comorbidity are associated with intraindividual variability for all race/ethnicity yet do not explain the age-based increase in intraindividual variability for Whites or Blacks. The findings suggest further nuances to the weathering hypothesis-social disadvantage can generate instability in physical function as minority adults age.
Keywords: Functional limitations; Health Conditions and Status; Older Adults; Racial/ethnic differences

Later-life employment trajectories and health - McDonough, Peggy; Worts, Diana; Corna, Laurie M.; McMunn, Anne; Sacker, Amanda (Advances in Life Course Research, 2017)
Background: Despite the recent policy push to keep older adults in the labour force, we know almost nothing about the potential health consequences of working longer. Drawing on a life course approach that considers stability and change in employment patterns, this study examines the relationship between long-term labour market involvement in later life and self-rated health. Methods: Our data are from the Health and Retirement Study (1992-2012) for the cohort born 1931-1941 (N = 6522). We used optimal matching analysis to map employment trajectories from ages 52-69, and then logistic regression to examine associations between these trajectories and self-rated health in the early 70s, net of socio-demographics, household resources and prior health. Findings: Women prevail in groups characterized by a weak(er) attachment to the labour market and men, in groups signifying a strong(er) attachment. Men who downshifted from full-time to part-time work around age 65 were the least likely to report poor health in their early 70s.Women had the best health if they remained employed, either full-time or part-time. However, unlike men, they appeared to benefit most in health terms when part-time hours were part of a longer-term pattern. Conclusion: While our study findings show that continuing to work in later life may be positively associated with health, they also suggest the need for flexible employment policies that foster opportunities to work part-time.
Keywords: Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction

The Long Reach of Education: Health, Wealth, and DI Participation - James M. Poterba; Steven F Venti; David A Wise (NBER Working Paper Series, 2017)
Education is strongly related to participation in the Social Security Disability Insurance (DI) program. To explore this relationship, we describe the correlation between education and DI participation, and then explore how four factors related to education - health, wealth, occupation, and employment - feature in this correlation. We label these four factors “pathway” variables. We find that a large component of the relationship between education and DI participation - more than one-third for men, and over two-thirds for women - can be attributed to the correlation of education with health, and of health with DI receipt. We use data from the Health and Retirement Study for the 1992-2012 period to explore the corresponding roles for each of the pathway variables, and also to study how changes over time in these variables, such as the widening gap between the health status of those with high and low educational attainment, have affected DI participation.
Keywords: Education; Health Conditions and Status; Older Adults; Wealth

The long-term effect of health insurance on near-elderly health and mortality - Black, Bernard; José-Antonio Espín-Sánchez; Eric French; Litvak, Kate (American Journal of Health Economics, 2017)
We use the best available longitudinal data set, the Health and Retirement Study, and a battery of causal inference methods to provide both central estimates and bounds for the long-term effect of health insurance on health and mortality among the near-elderly (initial age 50-61) over a 20-year period. Compared with matched insured persons, those uninsured in 1992 consume fewer health-care services, but their health (while alive) does not deteriorate relative to the insured, and, in our central estimates, they do not die significantly faster than the insured. Our upper and lower bounds suggest that prior studies have greatly overestimated the health and mortality benefits of providing health insurance to the uninsured.
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance; Mortality

More Americans say they're in pain. It’s a fascinating and disturbing medical mystery. - Frostenson, Sarah (Vox Media, 2017)
Keywords: Chronic pain; Health Conditions and Status; News; Older Adults

Quantifying the relationship between patient characteristics and involvement in developing and implementing a treatment plan - Roy, Natalie T.; Ulrich, Erin E. (Drug, Healthcare and Patient Safety, 2017)
Objective: Improving the patient-physician relationship through patient involvement in the care may lead to improved patient safety and better health outcomes. There exists a gap in knowledge in identifying factors that affect self-reported patient involvement in individualized treatment plans. The objectives of this study were to 1) describe patients’ perceptions of their involvement in the creation and implementation of their treatment plans and 2) determine if patient involvement varied by medical condition or demographic characteristics. Methods: This study was a cross-sectional analysis of data from the “Quality of Care” module of the 2008 Health and Retirement Study (HRS). The individuals of HRS surveys were older than 50 years. One-way analyses of variance were conducted to determine differences between patient characteristics and involvement in creating a treatment plan. A linear regression was conducted to determine predictors of the summed involvement score. Results: Average summed scores for each domain (shared decision-making, counseling, and follow-up) and overall involvement scores were ~50%. Linear regression showed that being non-White, older age, and diagnosed with a psychiatric condition or diabetes were predictors of increased self-reported involvement in the development and communication of a patient’s treatment plan. Conclusion: Age, race, and having diabetes or a psychiatric condition were the major predictors affecting patient involvement in care, although overall involvement in care was low for all groups. Practice implications: Patient involvement in care was lower than expected and should be further studied to determine the effects of involvement on health outcomes.
Keywords: Health Conditions and Status; Older Adults; Patient-physician Relationship; Quality of care

Racial and ethnic differences in smoking changes after chronic disease diagnosis among middle-aged and older adults in the United States. - Ana R Quiñones; Corey L Nagel; Jason T Newsom; Nathalie Huguet; Sheridan, Paige; Stephen M Thielke (BMC Geriatrics, 2017)
BACKGROUND: Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US. METHODS: We use longitudinal data from the Health and Retirement Study (HRS 1992-2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers. RESULTS: The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14% after diabetes diagnosis to 32% after cancer diagnosis; for black smokers, the percentage ranged from 15% after lung disease diagnosis to 40% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38% quit. In logistic models, black (OR = 0.43, 95% CI: 0.19-0.99) and Latino (OR = 0.26, 95% CI: 0.11-0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95% CI [1.05-6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes. CONCLUSIONS: A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults.
Keywords: Chronic disease; Health Conditions and Status; Older Adults; Racial/ethnic differences; Smoking

Relationships between resilience indicators and engagement in disease prevention behavior among adults in the Health and Retirement Study - Kelsi O. Jackson (Epidemiology, 2017)
BACKGROUND: Seniors are the fastest growing age demographic in the United States; by 2030, 72 million Americans are projected to be over the age of 65. These rapid demographic changes have called for better understanding of healthy, successful aging. Previous work using data on Americans of retirement age showed that resiliency is associated with lower healthcare utilization which tends to be costly to individuals and burdensome to an already strained healthcare system. The primary goal and hypothesis of this study is to test the association between resiliency and participation in disease prevention behaviors. METHODS: The study used a sample of 6,693 respondents from the 2012 wave of the Health and Retirement Study who answered the Psychosocial Leave-Behind questionnaire. Logistic regression was used to evaluate the relationship between indicators of resilience (mastery and social support) with the behavioral outcomes (receiving a flu shot, prostate screening, or mammography). The cancer screening models were restricted by gender. Relationships between the outcomes and workforce participation status, marital status, physical activity, education, history of smoking, comorbidity, body mass index, and cumulative lifetime adversity were also explored. All analyses were conducted using SAS survey procedures to account for complex survey design. RESULTS: The present findings do not provide consistent evidence that higher resilience corresponds to greater utilization of preventative health behavior. Results indicate that high mastery is associated with greater likelihood of receiving a mammogram, but show lower odds of receiving a flu shot. For social support, the results demonstrated that individuals who scored higher on the negative social support scale are more likely to get a mammogram or flu shot. There is little to suggest that resilient individuals engage in healthy disease prevention behaviors more than their less resilient counterparts. Future studies might look at comparing estimates based on different methodologies for measuring resilience in this population or exploring different variables that better characterize the health behaviors of resilient senior citizens.
Keywords: Health Conditions and Status; Preventative Care; Resilience

The Role of Negative Cognitions in Depression, Functional Limitations, and Activity: A National Longitudinal Study of Older Adults - Diane C Wagner (Clinical Psychology, 2017)
This study examines the role of negative cognitions in late life depression, functional limitations, and activity. Participants were 673 adults (36% male) aged 50 to 88 who completed repeated measures in 2004, 2008, and 2012 as part of the Health and Retirement Study, a large nationally representative longitudinal sample. Novel contributions of this study include combining functional limitations and cognitions in a cognitive model of depression to include aspects of depression that are specific to older adults, examining the unique contribution of cognitions in depression, and testing both growth and temporal covariance to capture the interrelatedness of depression and related factors over time. Three bivariate Latent Difference Score models tested time-lagged associations in pairs of variables at three time points. Contrary to expectations, depression levels and negative cognitions were unrelated over time, suggesting that cognitive theories of depression, which place cognitions at the core of depression etiology and maintenance, may not generalize to older adults. Negative cognitions were not related to functional limitations, suggesting that functional limitations do not influence negative cognitions in older adults. Higher levels of negative cognitions were related to increases in activity over time, suggesting that negative cognitions may motivate older adults to increase activity levels.
Keywords: Demographics; Health Conditions and Status; Healthcare

The Role of Primary Care for the Oral Health of Rural and Urban Older Adults. - Julia T. Caldwell; Lee, Haena; Kathleen A. Cagney (The Journal of Rural Health, 2017)
CONTEXT: Rural populations often have restricted access to dental care and poor oral health. These problems may disproportionately affect older blacks in rural areas. Little is known about how access to primary health care may improve the oral health of rural seniors. PURPOSE: This study examines whether the relationship between having a usual source of health care and oral health varies for white and black older adults in rural and urban areas in the United States. METHODS: We draw on cross-sectional data of adults (50 years+) from the nationally representative Health and Retirement Study (n = 15,473). Multivariate logistic regression examined the role of a usual source of health care in conditioning racial differences in complete tooth loss and a dental visit in the past 2 years. A usual source of health care is a place, not including an emergency room, where a person goes when he or she is sick or needs health advice. FINDINGS: In rural areas, blacks had high rates of tooth loss (28%) and low rates of dental visits (34%). Having a usual source of health care was associated with higher odds of a dental visit for all adults. In rural areas, the association between a usual source of health care and tooth loss varied by race (P < .001); blacks had more tooth loss than whites even with a usual source of health care. CONCLUSIONS: Access to primary health care was associated with improved oral health outcomes, but it did not close the gap between whites and blacks in rural areas.
Keywords: Dental Care; Health Conditions and Status; Rural Settings; urban life

The shock of falling among older Americans - Kelly, Inas Rashad (The Journal of the Economics of Ageing, 2017)
Direct medical costs associated with falls have been shown to be $34 billion in 2013, an underestimate since full costs are not factored in. Using the 1998-2012 waves of the Health and Retirement Study and several econometric methods to address the endogeneity of falls, this study seeks to answer the question of how much worse physical and mental health outcomes are for individuals who fall compared to their steadier counterparts. Results across various specifications suggest that falling leads to lower activities of daily living, more depression, and more psychological problems. It leads to greater probabilities of being in poor health, having heart problems, and having a stroke. These results survive several robustness checks.
Keywords: Depressive symptoms; Falls; Health Conditions and Status; Health Shocks

Taking Your Grandparents to Museums Could Improve Their Health - Herzig, Ilana (Artsy, 2017)
Keywords: Editorial; Health Conditions and Status; News

Age differences in conscientiousness facets in the second half of life: Divergent associations with changes in physical health - William J. Chopik (Personality and Individual Differences, 2016)
The development of personality across the lifespan has captivated researchers for several years. However, lower order facets may show different developmental trends and divergent associations with outcomes compared to their higher order traits. In a sample of 12,762 older adults, age differences in conscientiousness and its facets were examined. Further, the degree to which conscientiousness and its facets differentially predicted physical health over a four-year period was also examined. Broader conscientiousness, orderliness, and industriousness were lowest in late life. Traditionalism and virtue were highest in late life. Responsibility was highest around age 70. Self-control did not show any significant age-related differences. Conscientiousness, orderliness, industriousness, and responsibility were most consistently related to physical health over time. The findings are discussed in the context of the mechanisms that give rise to personality development and divergent associations in outcomes among seemingly related facets.
Keywords: Conscientiousness; Health Conditions and Status; Older Adults; Self-control

Alcohol Use Predicts 10-Year Depressive Symptom Trajectories in the Health and Retirement Study - Penny L. Brennan; SooHoo, Sonya; Lemke, Sonne; Kathleen K Schutte (Journal of Aging and Health, 2016)
Objective: To determine effects of late-middle-aged adults baseline drinking behavior on their subsequent 10-year depressive symptom trajectories. Method: Health and Retirement Study participants (N = 7,939) were assessed on baseline demographic, health, and drinking characteristics, and biennially assessed for the next 10 years on their depressive symptoms. Results: Growth mixture modeling generated four classes of depressive symptom trajectories: Consistently low (72 ), consistently elevated (6 ), increasing (12 ), and decreasing (10 ). Baseline abstinence from alcohol, possibly enforced by poorer health and a history of drinking problems, and heavier drinking, binge drinking, and having a history of drinking problems, raised risk of membership in the consistently elevated class. Abstinence by participants without history of drinking problems and light, moderate, and heavier drinking protected against membership in the increasing class. Abstinence by participants without history of drinking problems elevated and moderate drinking reduced likelihood of membership in the decreasing class. Discussion: Late-middle-aged adults alcohol use is associated with the subsequent long-term course of their depressive symptoms.
Keywords: Alcohol Consumption; Depressive symptoms; Health Conditions and Status

Assessing morbidity compression in two cohorts from the Health and Retirement Study - Hiram Beltrán-Sánchez; Marcia P Jimenez; S. V. Subramanian (Journal of Epidemiology and Community Health, 2016)
Background: Increases in life expectancy are hypothesised to be associated with shorter proportional time spent with morbidity (compression of morbidity). We assessed whether this has occurred among older adults in the USA during the 1990s and 2000s. Methods: We used data from the Health and Retirement Study to estimate a morbidity score based on eight chronic conditions and compare it (1) prospectively between two age-matched cohorts in 1992 and 2004 over a 6-year follow-up, and (2) retrospectively in the three waves prior to death among respondents who die in (1998 2004) and (2004 2010). Results: Prospective assessment shows significantly higher prevalence in 6 of eight chronic conditions in the 2000s, with 37 higher diabetes prevalence. A retrospective evaluation shows significantly higher prevalence in 7 of eight chronic conditions in the three waves prior to death for (2004 2010) versus (1998 2004), with 41 higher prevalence of arthritis. Importantly, the farther away from time of death, the higher the average number of chronic conditions in (2004 2010). Conclusions: Using the largest longitudinal ageing study in the USA, we found no clear evidence of compression of morbidity as measured by self-reported chronic disease. Older adults in the USA may be experiencing greater disease burden in recent times.
Keywords: Chronic conditions; Disease; Expectations; Health Conditions and Status; Self-reported health

The Association Between Alcohol Consumption And Cognitive Function In The Middle-Aged And Older Population: A Study Using The Health And Retirement Study (Hrs) Data - Chen, C.; Raisch, D. W. (Value in Health, 2016)
Keywords: Alcohol Consumption; Cognitive Ability; Health Conditions and Status; Older Adults

Baseline Depressive Symptoms Predict Subsequent Heart Disease; A 20-Year Cohort - Maryam Moghani Lankarani; Shervin Assari (International Cardiovascular Research Journal, 2016)
Background: Depression is common among patients with heart disease. Depression is also associated with worse outcomes among patients with heart disease. Fewer studies have shown whether or not baseline depressive symptoms predict subsequent heart disease in general population. Objectives: This study aimed to investigate whether depressive symptoms at baseline predict risk of developing heart disease during the next 20 years in the United States. Patients and Methods: The data were extracted from the Health and Retirement Study (HRS), 1992 - 2012. The study was conducted on 8,375 individuals who were older than 50 years at entry, did not have heart disease at baseline, and had data on heart disease over the next 20 years. High depressive symptoms (modified Center for Epidemiologic Studies Depression Scale CES-D ) were considered as the independent variable. Self-reported data on physician diagnosis of heart disease were measured on a biannual basis. Baseline demographic data (i.e., age and gender), socioeconomic status (i.e., race, marital status, and education level), health behaviors (i.e., drinking, smoking, and exercise), and body mass index were controlled. Cox proportional hazard model was used for data analysis. Results: Cox proportional hazard model revealed a link between high depressive symptoms at baseline and time to developing heart disease (Hazard ratio = 1.439, 95 CI = 1.253 1.652), suggesting that individuals with high depressive symptoms at baseline developed heart disease sooner than others. The association between baseline depressive symptoms and risk of heart disease was significant after controlling for all the covariates. Conclusions: Individuals with depressive symptomatology are at higher risk of development of heart disease over time. Thus, individuals with depressed mood may need more rigorous evaluation for heart disease.
Keywords: Depressive symptoms; Health Conditions and Status; Heart disease; Older Adults

Bridge Employment and Health - Cho, Jihyun (Epidemiological Science, 2016)
Due to the increasing longevity, advancing yet skyrocketing health care costs, and the lack of funds for elderly welfare, post-retirement health among older adults has become a crucial issue both at the individual and societal level. Concurrently, with widespread implementation of pro-work policies and the notion of retirement as a gradual process rather than one-time transition, bridge employment rate in the US has increased continually for last few decades. However, little is known regarding how the two major societal trends are related. Determinants of bridge employment are not fully understood, and how bridge employment affects post-retirement health is largely unknown. In addition, there is little systematic information on gender difference in the precursors and consequences of bridge employment despite distinct occupational experiences and biological differences in men and women. This dissertation focuses on the complex relationship between bridge employment and post-retirement health. Using data from Health and Retirement Study, a nationally representative longitudinal survey of individuals over age 50, major determinants of bridge employment among men and women were identified. Then, the effects of bridge employment on physical and mental health were investigated. Statistical analyses accounted for time-dependent confounders and potential bidirectional association in the relationship between bridge employment and health outcomes. Via separate analyses for men and women, this study shows that men’s bridge employment is often driven especially by his early-life socioeconomic status, rather than his high occupational ability or self-esteem in the work place, while women’s bridge employment is significantly influenced by her marital status, which may partly be due to women’s nonlinear career trajectories. Bridge employment was associated with fewer depressive symptoms, while it was found to have deteriorative effects on physical functioning. Both associations did not differ by potential modifiers such as gender, income, education, and pre-retirement occupation. By investigating the antecedents of bridge employment and examining its physical and mental health effects, this dissertation provides an insight on the mechanism of the non-traditional retirement process. Our findings may be useful for policy implications to improve well-being of a number of prospective retirees who may engage in bridge employment in the next few decades. Advisors/Committee Members: Mendes de Leon, Carlos (committee member), Elliott, Michael R (committee member), Liang, Jersey (committee member), Needham, Belinda L (committee member), Schoeni, Bob (committee member).
Keywords: Bridge employment; Health Conditions and Status; Older Adults

Characteristics of Decedents in Medicare Advantage and Traditional Medicare - Byhoff, Elena; Tamara B Harris; John Z. Ayanian (JAMA Internal Medicine, 2016)
Approximately 25% of all Medicare expenditures are for care received in the last year of life.1 Much research has been done to understand cost and utilization patterns for Medicare beneficiaries at the end of life (EOL).2 However, when assessing EOL costs, most studies focus on decedents with traditional fee-for-service (FFS) Medicare owing to the lack of cost and utilization data for the 30% of Medicare beneficiaries in Medicare Advantage (MA) plans.3 This gap is a cause for concern because utilization and quality of care may differ between MA and FFS beneficiaries.4- 6 We sought to examine differences in characteristics of decedents in MA and FFS Medicare based on detailed survey data. Methods The Health and Retirement Study (HRS) is a biennial longitudinal survey of a nationally representative cohort of US adults 51 years or older that measures a broad range of questions about health and aging. Between interview cycles, the HRS identifies participants who have died using information from family members and the National Death Index. We included decedents 65 years or older who died between the 1998 and 2012 survey waves and who authorized their HRS responses to be linked to Medicare data. We compared demographic, health, and functional and cognitive characteristics of all HRS decedents enrolled in Medicare FFS and MA plans using χ2 and t test. We performed multivariable ordinal regressions to determine if demographic differences between the Medicare groups explained differences in health, functional, and cognitive status. We used multiple imputation for missing data. The study was exempt from institutional review board approval because the data looked only at decedents. There were no significant differences in results of multivariable analyses using imputed or nonimputed variables (Table 1). Results Of the 9385 decedents included in our analysis, 2280 (24.3%) were continuously enrolled in MA plans for the last 6 months of life and 7105 (75.7%) were continuously enrolled in Medicare FFS. The FFS beneficiaries were significantly older than MA beneficiaries at the time of death, and the 2 groups differed with respect to marital status, race, net worth, and educational attainment (Table 1). The MA decedents were less likely to have supplemental insurance compared with FFS decedents, including Medicaid or private insurance. The MA decedents were more likely to be living in urban areas and in the Northeast or West, whereas FFS decedents resided commonly in the Midwest and South. The MA and FFS decedents did not differ in having an advance directive or having discussed their EOL treatment preferences with their health care proxy. At their last survey before death, FFS beneficiaries were more likely than MA beneficiaries to rate their health as “poor,” to have limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), and to have dementia. After adjusting for demographic differences between FFS and MA decedents in our sample, differences between FFS and MA decedents in self-rated health, functional limitations, and cognitive status remained significant (Table 2). Discussion The FFS beneficiaries were sicker than MA beneficiaries during the last year of life, with worse functional status, higher rates of dementia, and poorer self-rated health. These are important considerations because policymakers and researchers consider patient-specific factors related to high EOL costs in the Medicare population. Because MA beneficiaries are, on average, younger and more independent at the EOL, their health care utilization and costs may differ from those enrolled in FFS. Prior research6 shows that MA beneficiaries have lower inpatient and Emergency Department utilization at the EOL, and increased hospice enrollment compared with FFS beneficiaries. This pattern may arise from improved EOL management by MA plans but could also reflect a less chronically impaired population, with fewer acute care needs at the EOL owing to better social support and functional and cognitive status.
Keywords: Health Conditions and Status; Medicare/Medicaid/Health Insurance; Older Adults

Comorbidities Among Persons With Incident Psychiatric Condition - Fluegge, Kyle R. (Gerontology and Geriatric Medicine, 2016)
Objective: I sought to determine how medical comorbidities co-exist with incident psychiatric condition. Method: I used data from all 11 available waves (1992-2012) of the Health and Retirement Study (HRS). I identified 4,358 index participants with self-reported incident psychiatric condition. I collected comorbidity data from participants preceding, including, and succeeding that incident wave. Comorbidities assessed included high blood pressure (HBP), diabetes mellitus, cancer, lung disease, heart disease, stroke, and arthritis. Modified Poisson regression combined with log-linked binomial regression was used to estimate relative risks (RRs) of reporting a comorbidity preceding and following the incident wave. Multiple comparison testing dictated significance of RRs with p .007. Results: For the waves preceding the index wave, the RRs of reporting all comorbidities except HBP and cancer were significantly (p .007) increased. For the waves following incident psychiatric condition, the risks of reporting heart disease, diabetes, and lung disease were significantly (p .007) increased. These results were adjusted for participant age, race, gender, other comorbidities listed, and the wave in which a comorbidity was reported. Conclusion: The bidirectional association between a psychiatric condition and medical illnesses could only be statistically confirmed for lung disease, diabetes, and heart disease. It is of interest to determine how reporting a psychiatric condition may affect the sequelae of health care use and treatment outcomes for patients with either of these comorbidities or a combination of them.
Keywords: Comorbidity; Health Conditions and Status; Older Adults; Psychiatry

Diverging Fortunes: Racial/Ethnic Inequality in Wealth Trajectories in Middle and Late Life - Tyson H Brown (Race and Social Problems, 2016)
The primary aim of this study is to examine whether racial/ethnic inequality in wealth dissipates or increases between middle and late life, and by how much. To address this aim, this study draws on critical race and life course perspectives as well as 10 waves of panel data from the Health and Retirement Study and growth curve models to understand racial/ethnic inequality in wealth trajectories among whites, blacks, and Mexican Americans (N = 8337). Findings show that, by midlife, significant inequalities in net worth emerge between whites and their black and Mexican American counterparts. On average, white households have amassed a net worth of 105k by midlife, compared to less than 5k and 39k among black and Mexican American families, respectively. Moreover, whites experience much more rapid rates of wealth accumulation during their 50s and 60s than their minority counterparts, resulting in increasing wealth disparities with age, consistent with a process of cumulative disadvantage. At the peak of their wealth trajectory (at age 66), whites have approximately 245k more than blacks and 219k more than Mexican Americans. A wide range of socioeconomic, behavioral, and health factors account for a portion, but not all, of racial/ethnic inequality in wealth, suggesting that unobserved factors such as parental wealth, segregation, and discrimination may play a role in the production and maintenance of wealth inequality.
Keywords: Event History/Life Cycle; Health Conditions and Status; Inequality; Net Worth and Assets; Older Adults; Racial/ethnic differences

Does Dementia Caregiving Accelerate Frailty? Findings From the Health and Retirement Study - Kara B. Dassel; Dawn C Carr (The Gerontologist, 2016)
Purpose of the Study: Numerous studies have discovered negative health consequences associated with spousal caregiving at the end of life; however, little is known about how care-recipient cognitive status impacts caregiver health outcomes, specifically in the area of frailty, and whether health consequences remain over time. This study examines differences in frailty between spousal caregivers of persons with and without a dementia diagnosis. Design and Methods: Using 7 biannual waves of the Health and Retirement Study data (1998 2010), we examined odds of becoming frailer among surviving spouses of individuals who died between 2000 and 2010 (N = 1,246) with and without dementia. To assess increased frailty, we used a Frailty Index, which assesses chronic diseases, mobility, functional status, depressive symptoms, and subjective health. Logistic regression was used to examine the relationship between care-recipient cognitive status and whether, compared with the wave prior to death of the care-recipient, spousal caregivers were frailer: (1) in the wave the death was reported and (2) 2 years after the death was reported.Results: Dementia caregivers had 40.5 higher odds of experiencing increased frailty by the time the death was reported and 90 higher odds in the following wave compared with non-dementia caregivers.Implications: Given our findings, we discuss public health implications regarding the health and well-being of caregivers of persons with dementia. Given projected increases in dementia diagnoses as the population ages, we propose a need for interventions that provide enhanced support for dementia caregivers.
Keywords: Adult children; End of life decisions; Health Conditions and Status; Healthcare; Public Policy

Does retirement mean more physical activity? A longitudinal study - Feng, Xiaoqi; Croteau, Karen; Kolt, Gregory S.; Astell-Burt, Thomas (BMC Public Health, 2016)
Background: Evidence on physical activity (PA) and transitions out of full-time employment in middle-to-older age is mainly cross-sectional and focused upon retirement. The purpose was to examine trajectories in PA before and after transitions out of full-time employment. Methods: Data were obtained for 5,754 people in full-time employment aged 50-75 from the US Health and Retirement Survey. Logistic regression was used to examine trajectories in twice-weekly participation in light, moderate and vigorous PA among those transitioning to part-time work, semi-retirement, full retirement, or economic inactivity due to disability, in comparison to those remaining in full-time employment. Results: Twice weekly participation in vigorous and light physical activity changed little for those who remained in full-time employment, while moderate physical activity decreased between baseline and follow-up (OR 0.95, 95 % CI 0.91, 0.99). Differences in physical activity according to transitional categories at follow-up were evident. Baseline differences in physical activity across all intensities were greatest among participants transitioning from full-time to part-time employment compared to those who remained in full-time employment throughout the study period (vigorous OR 1.41 95 % CI 1.23, 1.61; moderate OR 1.28 95 % CI 1.12, 1.46; light OR 1.29 95 % CI 1.12, 1.49). Those transitioning to unemployment were already among the least physically active at baseline, irrespective of intensity (albeit, with 95 % CIs spanning unity). Those transitioning to full-time retirement were also among the least active (e.g. vigorous OR 0.71 95 % CI 0.61, 0.81; moderate OR 0.80 95 % CI 0.71, 0.90). Declines in physical activity were reported for those transitioning to economic inactivity due to a disability (vigorous OR 0.29 95 % CI 0.14, 0.64; moderate OR 0.56 95 % CI 0.33, 0.95; light OR 0.34 95 % CI 0.19, 0.63). Physical activity increased regardless of intensity among participants transitioning to semi-retirement (p > 0.05) and full retirement (e.g. vigorous OR 1.28 95 % CI 1.09, 1. 51; moderate OR 1.24 95 % CI 1.07, 1.43). Light physical activity increased for those transitioning to unemployment (OR 1.40 95 % CI 1.02, 1.93), though less change was evident in moderate or vigorous physical activity. Conclusions: The amount and intensity of PA varies by the type of transition out of full-time employment among people in middle-to-older age.
Keywords: Aging; Health Conditions and Status; Older Adults; Physical activity; Retirement Planning and Satisfaction

Epidemiology of Mixed, Stress, and Urgency Urinary Incontinence in Middle-Aged/Older Women: the Importance of Incontinence History - Yuko M Komesu; Ronald M Schrader; Loren H Ketai; Rebecca G Rogers; Gena C. Dunivan (International Urogynecology Journal, 2016)
Introduction and hypothesis Urinary incontinence (UI) is common and the relationship among its subtypes complex. Our objective was to describe the natural history and predictors of the incontinence subtypes stress, urgency, and mixed, in middle-aged and older US women. We tested our hypothesis that UI subtype history predicted future occurrence, evaluating subtype incidence/remission over multiple time points in a stable cohort of women. Methods We analyzed longitudinal urinary incontinence data in 10,572 community-dwelling women aged 50 in the 2004 2010 Health and Retirement Study. Mixed, stress, and urgency incontinence prevalence (2004, 2006, 2008, 2010) and 2-year cumulative incidence and remissions (2004 2006, 2006 2008, 2008 2010) were estimated. Patient characteristics and incontinence subtype status 2004 2008 were entered into a multivariable, transition model to determine predictors for incontinence subtype occurrence in 2010. Results The prevalence of each subtype in this population (median age 63 66) was 2.6 8.9 . Subtype incidence equaled 2.1 3.5 and remissions for each varied between 22.3 and 48.7 . Incontinence subtype incidence predictors included ethnicity/race, age, body mass index, and functional limitations. Compared with white women, black women had decreased odds of incident stress incontinence and Hispanic women had increased odds of stress incontinence remission. The age range 80 90 and severe obesity predicted incident mixed incontinence. Functional limitations predicted mixed and urgency incontinence. The strongest predictor of incontinence subtype was subtype history. The presence of the respective incontinence subtypes in 2004 and 2006 strongly predicted 2010 recurrence (odds ratio OR stress incontinence = 30.7, urgency OR = 47.4, mixed OR = 42.1). Conclusions Although the number of remissions was high, a previous history of incontinence subtypes predicted recurrence. Incontinence status is dynamic, but tends to recur over the longer term.
Keywords: Health Conditions and Status; Methodology

Essays on aging-related disease in the U.S. population - Ezra I. Fishman (Demography, 2016)
I research three topics in adult morbidity in the United States, focusing on two increasingly prevalent chronic diseases, diabetes and dementia. In the first essay, I investigate changes in age-specific diabetes prevalence across cohorts born in the 20th century and use the cross-cohort comparisons to generate model age patterns of diabetes prevalence and incidence. I show that most of the increase in diabetes prevalence over time is attributable to increases in age-specific prevalence from one cohort to the next. Because the risk of diabetes is embodied in cohorts, diabetes prevalence is likely to increase in the future even if the prevalence of risk factors such as obesity plateau. In the second essay, I use multiple-decrement life tables to estimate age-specific lifetime risks of dementia for a dementia-free person. I estimate that about a quarter of dementia-free 70-year-old males and a third of females will develop dementia in their lifetimes. Although interventions that delay dementia onset could substantially reduce dementia risk, the results indicate a widespread need to prepare for a life stage with dementia. In the third essay, I use recent advances in propensity-score matching techniques to estimate the association between incidence diabetes and subsequent accumulation of mobility limitations. Among observationally similar pairs of individuals, those who developed diabetes reported an average of 25% more mobility limitations at study exit than those who did not develop diabetes. My estimates of this association are smaller than those found in most of the existing literature, but they are likely less biased.
Keywords: Aging; Disease; Health Conditions and Status; Older Adults

Essays on the well-being of an aging population - Alice Zulkarnain (Economics, 2016)
This dissertation consists of three essays that examine health and labor issues among the middle aged and elderly. Chapter 1. A Delayed Retirement Policy and Male Labor Supply: Evidence from the Entire Dutch Population: This chapter examines the labor supply effects of a national delayed retirement policy introduced in the Netherlands in 2009. The policy offers a reduction in taxes on labor income for each year after the age of 62 in which a person worked. I estimate the average effect of the policy on male labor supply as well as its responsiveness to the size of the incentive. Comparing differentially affected birth cohorts suggests that labor force participation increased by about 3.8 to 5.5 percentage points in the three years after introduction for cohorts that were eligible before the normal retirement age. I also find that a higher bonus induces a greater increase in participation and in the number of hours supplied by those working. Chapter 2. Joint Delayed Retirement of Couples: In this chapter, I study the effect of husbands’ labor force participation on the participation decision of their wives. I exploit the fact that the introduction of the delayed retirement policy studied in chapter one provides a natural experiment allowing me to estimate the Local Average Treatment Effect (LATE) of husbands working on the probability that their wives work, for couples in which the husband was induced by the policy to remain in the labor force. I also study both the average effect of the policy on wives who were not eligible themselves, as well as the spillover effect of the policy through their husbands’ response to the policy. My results suggest that wives are 30 percentage points more likely to work if their husbands work among couples that were affected by the policy and I find a treatment effect on the labor force participation of wives associated with the policy of about 1.5-2 percentage points. Chapter 3. The Effect of Divorce on Health in Middle and Older Ages with Sanders D. Korenman: Both the prevalence and incidence of divorce at older ages have doubled since 1990. We use Health and Retirement Study data to describe associations between divorce and health in middle and later life, using models that follow individuals and couples through divorce (i.e., individual and couple fixed effects). Divorce in middle and older ages is associated with adverse physical health changes for women but not men, and greater mental health declines for women than men. Following individuals over time, women who divorce experience deteriorations in self-reported health and mental health, including depression. Following couples over time, divorce is associated with deterioration in self-reported health for wives but not their husbands. After divorce, a woman is more likely than her ex-husband to be diagnosed with mental health conditions. Differences in self-reported health associated with divorce appear linked to changes in mental rather than physical health.
Keywords: Aging; Couples; Depressive symptoms; Divorce; Health Conditions and Status; Marriage; Older Adults

Estimating Telomere Length Heritability in an Unrelated Sample of Adults: Is Heritability of Telomere Length Modified by Life Course Socioeconomic Status? - Jessica Faul; Colter Mitchell; Wei Zhao (Biodemography and Social Biology, 2016)
Telomere length (TL) is a widely used marker of biological aging and is associated with an increased risk of morbidity and mortality. Recently, there has been evidence for an association between TL and socioeconomic status (SES), particularly for measures of education and childhood SES. Individual differences in TL are also influenced by genetic factors, with heritability estimates from twin and sibling studies ranging from 34 to 82 percent. Yet the additive heritability of TL as a result of measured genetic variations and the extent to which heritability is modified by SES is still unknown. Data from the Health and Retirement Study, a nationally representative cohort of older adults (mean age 69years), were used to provide the first estimates of molecular-based heritability of TL using genome-wide complex trait analysis (GCTA). We found that additive genetic variance contributed 28 percent (p=.012) of total phenotypic variance of TL in the European American sample (n=3,290). Estimation using the GCTA and KING Robust relationship inference methods did not differ significantly in this sample. None of the variance from the gene-by-SES interactions examined contributed significantly to the total TL variance. Estimation of heritability and genetic interaction with SES in the African American sample (n=442) was too unstable to provide reliable estimates.
Keywords: Genetics; Health Conditions and Status

Estimating the Co-Development of Cognitive Decline and Physical Mobility Limitations in Older US Adults - Nicholas J Bishop; Eggum-Wilkens, Natalie D.; Steven A Haas; Jennie J. Kronenfeld (Demography, 2016)
This study examines the co-development of cognitive and physical function in older Americans using an age-heterogeneous sample drawn from the Health and Retirement Study (1998-2008). We used multiple-group parallel process latent growth models to estimate the association between trajectories of cognitive function as measured by immediate word recall scores, and limitations in physical function as measured as an index of functional mobility limitations. Nested model fit testing was used to assess model fit for the separate trajectories followed by estimation of an unconditional parallel process model. Controls for demographic characteristics, socioeconomic status, and chronic health conditions were added to the best-fitting parallel process model. Pattern mixture models were used to assess the sensitivity of the parameter estimates to the effect of selective attrition. Results indicated that favorable cognitive health and mobility at initial measurement were associated with faster decline in the alternate functional domain. The cross-process associations remained significant when we adjusted estimates for the influence of covariates and selective attrition. Demographic and socioeconomic characteristics were consistently associated with initial cognitive and physical health but had few relations with change in these measures.
Keywords: Health Conditions and Status

Families and Disability Onset: Are Spousal Resources Less Important for Individuals at High Risk of Dementia? - Pamela M. Rist; Sze Y Liu; M. Maria Glymour (The American Journal of Geriatric Psychiatry, 2016)
Objective To determine whether social contacts and spousal characteristics predict incident instrumental or basic activities of daily living (I/ADL) limitations and whether effects differ for individuals with high risk of dementia. Design Cohort study. Setting Biennial interviews of Health and Retirement Study participants over up to 12 years. Participants 4,125 participants aged 65 years and older without baseline I/ADL limitations. Measurements Participants' family characteristics (living arrangements, proximity to children, contacts with friends, marital status, and spouse's depression, employment, and education) and dementia probability (high versus low risk of dementia based on direct and proxy cognitive assessments) were characterized at baseline. Family characteristics and their interactions with dementia probability were used to predict incident I/ADL limitations in pooled logistic regressions. Results ADL limitation incidence was higher among the unmarried (odds ratio OR versus married: 1.14; 95 CI: 1.01 1.30); those married to a depressed spouse (OR versus nondepressed spouse: 1.56, 95 CI: 1.21 2.00); or whose spouse had less than high school education (OR versus spouse with high school or more: 1.29, 95 CI: 1.06 1.57). Living with someone other than a spouse compared with living with a spouse predicted higher risk of both incident ADL (OR: 1.35; 95 CI: 1.11 1.65), and IADL (OR: 1.30; 95 CI: 1.06 1.61) limitations. Effects were similar for respondents with high and low dementia probability. Conclusions Regardless of dementia risk, older adults may receive important marriage benefits, which help delay disability. The salience of spouse's education and depression status implicate modifiable mechanisms, such as information and instrumental support, which may be amenable to interventions.
Keywords: Demographics; Disabilities; Health Conditions and Status; Healthcare

Feeling older and risk of hospitalization: Evidence from three longitudinal cohorts - Yannick Stephan; Angelina R Sutin; Antonio Terracciano (Health Psychology, 2016)
Objective: Subjective age is a biopsychosocial marker of aging with a range of health-related implications. Using 3 longitudinal samples, this study examined whether subjective age predicts hospitalization among older adults. Method: Participants were adults aged from 24 to 102 years old, drawn from the 1995 1996 and 2004 2005 waves of the Midlife in the United States Survey (MIDUS, N = 3209), the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 3779), and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 3418). In each sample, subjective age and covariates were assessed at baseline and hospitalization was assessed at follow-up. Results: Consistent across the 3 samples, participants who felt subjectively older at baseline had an increased likelihood of hospitalization (combined effect size: 1.17, 95 CI 1.11 1.23), controlling for age, sex, race, and education. Further adjusting for disease burden and depression reduced the magnitude of the association between subjective age and hospitalization in the 3 samples, but it remained significant in the MIDUS and HRS. Conclusion: This study provides consistent evidence that subjective age predicts incident hospitalization. Subjective age assessment can help identify individuals at greater risk of hospitalization, who may benefit from prevention and intervention efforts. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: Health Conditions and Status; Healthcare; Risk Taking

Financial Strain and Mental Health Among Older Adults During the Great Recession - Lindsay R. Wilkinson (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2016)
Objectives: The economic recession has garnered the interest of many scholars, with much attention being drawn to how the recession has affected labor force participation, household wealth, and even retirement decisions. Certainly, the Great Recession has influenced the financial well-being of older adults, but has it had discernible effects on mental health?Method: This study draws on 5,366 respondents from the Health and Retirement Study (2006 2010) to examine objective and subjective measures of financial well-being in the period surrounding the Great Recession. Guided by cumulative inequality theory, this research investigates whether the economic downturn contributed to worsening anxiety and depressive symptoms over a 4-year period.Results: Results from linear fixed effects models reveal that decreases in objective financial resources were associated with increased financial strain during the Great Recession. Unlike the objective indicators, however, financial strain was a strong and robust predictor of worsening mental health between 2006 and 2010.Discussion: Building on prior research, this study elucidates the factors that shape financial strain and provides evidence that the Great Recession not only affected the financial well-being of older adults but also had adverse effects on mental health.
Keywords: Health Conditions and Status; Public Policy

Gender Differences in Trajectories of Physical Activity Among Older Americans With Diabetes - Sara J McLaughlin; Cathleen M. Connell; Mary R Janevic (Journal of Aging and Health, 2016)
Objective: The primary objective of this study was to examine gender differences in engagement in physical activity over time among older U.S. adults with diabetes. Method: Using data from the Health and Retirement Study, we investigated physical activity between 2004 and 2010 among 1,857 adults aged 65 years and above with diabetes. Results: Less than half of adults were physically active at baseline. The probability of physical activity declined over the 6-year period, with no significant gender variation in the effect of time. Because the odds of physical activity were lower for women at baseline and the effect of time did not vary by gender, the trajectory of physical activity was less favorable for women than men. Discussion: The women in this cohort of older Americans started and remained less active than their male counterparts. Investigations covering a larger portion of the life course and those examining the impact of life events and transitions on physical activity among adults with diabetes are needed.
Keywords: Demographics; Health Conditions and Status; Methodology

Genetic Moderators of Cognitive Decline in the Health and Retirement Study - Shannon K Runge (Aging Studies, 2016)
The current dissertation used a gene x environment (G x E) approach to examine the independent and interactive effects of specific genetic variants and participation in physical and cognitive/social activities (PA and CSA) on cognitive performance in 4,764 participants of the Health and Retirement Study. Using three-wave data, three sets of multi-level growth models were conducted to examine baseline, longitudinal, and interactive effects of genotype (i.e., ApoE, COMT, and BDNF) and CSA/PA on performance across five cognitive measures: immediate, delayed and total word recall, and serial 7s and backwards counting. At baseline, the ApoE ϵ4 allele predicted worse performance in all measures except backwards counting, and the BDNF Met allele predicted better recall scores. The effect of COMT genotype was not significant. Higher CSA/PA predicted better performance on almost all measures. One significant G x E interaction was found between COMT x CSA for backwards counting. Longitudinally, participation in CSA moderated the effect of time on word recall in the ApoE and BDNF models. These results support the idea that genetic and environmental factors are mechanisms of cognitive aging, but also exemplify the variability seen in genetic association studies. Further research is needed to translate such findings into clinically relevant criteria that can be used to identify individual susceptibility to cognitive decline.
Keywords: Aging; Cognitive Ability; Genetics; Health Conditions and Status; Older Adults

Health and Mortality Delta: Assessing the Welfare Cost of Household Insurance Choice - Koijen, Ralph S. J.; Van Nieuwerburgh, Stijn; Yogo, Motohiro (Journal of Finance, 2016)
We develop a pair of risk measures, health and mortality delta, for the universe of life and health insurance products. A life-cycle model of insurance choice simplifies to replicating the optimal health and mortality delta through a portfolio of insurance products. We estimate the model to explain the observed variation in health and mortality delta implied by the ownership of life insurance, annuities including private pensions, and long-term care insurance in the Health and Retirement Study. For the median household aged 51 to 57, the lifetime welfare cost of market incompleteness and suboptimal choice is 3.2 of total wealth.
Keywords: Health Conditions and Status; Insurance; Net Worth and Assets; Pensions

Health and wellbeing of older adults in the United States and Japan: A comparative study - Suzuki, Yukari (Public Health, 2016)
The global population is projected to reach 9.1 billion in 2050 due to an increase in the number of older adults. Older adults are living longer; however, life expectancy values vary by country. While a country’s degree of economic development is a contributor to the health of its national population, life expectancy varies among economically developed countries as well. Social engagement has been studied as a factor contributing to longevity and the health of older adults. According to the convoy model of social relations, family members begin to play an increasingly integral role in the lives of older adults as they age. Literature has demonstrated preventive benefits of family engagement for the physical, psychological, and cognitive health of older adults. However, family engagement has also been linked to low health among older adults as a means of accommodating functional decline. Cultural values and attitudes have been shown to influence family engagement behaviors as well in both individualist and collectivist nations. This study examined the association of family engagement and self-rated health status (SHS) of older adults (ages 50 to 75 years) in the United State and Japan through a secondary cross-sectional analysis of the 2008 wave of the Health and Retirement Study and the 2007 Japanese Study of Aging and Retirement. Logistic regression found SHS, frequency of family engagement, and proximity of children’s residence to be significantly associated with the survey country. In the combined sample, family contact of at least once a week (OR: 1.9, 95% CI: 1.0-3.5), residence within 10 miles of their children (OR: 0.8, 95% CI: 0.7-1.0), and residence with children (OR: 0.6, 95% CI: 0.5-0.7) were significantly associated with SHS, even after controlling for age, gender, ethnicity, marital status, income, and comorbidities. Future research may consider a longitudinal analysis to observe whether family engagement demonstrates protective factors for maintaining high SHS over time. While these national surveys had been modeled after each other, increasing alignment of survey instruments for improved equivalence and comparability would strengthen the internal and external validity of findings.
Keywords: Comorbidity; Cross-National; Health Conditions and Status; JSTAR; Older Adults; Racial/ethnic differences

The Health Consequences of Negative Wealth Shock During Late Middle Age - Lindsay R Pool (Epidemiological Science, 2016)
There is robust empirical evidence for a link between lower economic status and adverse health outcomes, but little is known about whether a sudden, unplanned loss of assets – a negative wealth shock – has long-term health consequences. Previous research has shown associations between negative wealth shocks and short-term health declines, primarily from losses of housing and investment wealth, with macroeconomic recession presumed to have triggered these shocks. Even during better economic times, however, negative wealth shocks arise frequently from more individualized circumstances, such as high medical expenses, but causal mechanisms linking subsequent health outcomes to these endogenous shocks can be difficult to establish due to the potential for reverse causality and residual confounding. Using data from the Health and Retirement Study, a nationally representative study of US adults aged 50 and older, this dissertation examined markers of short-term changes in stress and health care consumption after negative wealth shock in late middle age, a time of particular vulnerability. Then, differences by whether an individual experienced negative wealth shock in late middle age were assessed for three long-term aging-related trajectories – cognitive decline, physical function limitation accumulation, and all-cause mortality. Design and analytic methods addressed bidirectional and time-dependent causation in the relationship between negative wealth shock and health outcomes. Over 15 percent of late middle-aged adults with existing assets experienced negative wealth shock. The main findings indicated that experiencing a negative wealth shock during late middle age was associated with a higher risk of elevated depressive symptoms, a marker of increased stress, as well as long-term risk of mortality and cognitive decline. However, there was no significant association between negative wealth shock and risk of cost-related medication non-adherence – a marker of reduced health-related consumption, nor accelerated physical function limitation accumulation. With a substantial proportion of the late middle-aged population experiencing negative wealth shock, targeted interventions to prevent of the occurrence of these shocks and the health consequences thereafter may have a large impact on the health of older Americans
Keywords: Health Conditions and Status; Health Shocks; Income; Medicare/Medicaid/Health Insurance; Older Adults; Wealth Shocks

Health sensitivity: Age differences in the within-person coupling of individuals’ physical health and well-being. - Schöllgen, Ina; Morack, Jennifer; Frank J Infurna; Ram, Nilam; Denis Gerstorf (Developmental Psychology, 2016)
Well-being and physical health are central indicators of quality of life in old age. Research from a between-person difference perspective finds that people in better health than their peers also report higher well-being than their peers. However, we know very little about whether changes in one domain are accompanied by changes in the other domain, particularly at the within-person level. In the present study, we introduce the construct of health sensitivity, that is, how susceptible an individuals’ well-being is to changes in physical health. In doing so, we used 9-wave longitudinal data covering 17 years from the Health and Retirement Study (N = 21,689; 50–109 year olds; 55% women) and applied multilevel modeling to examine the covariation of central indicators of well-being (depressive affect) and health (functional limitations) simultaneously at both the between-person and within-person level. At the within-person level, we found evidence of health sensitivity—on occasions when a typical person experienced more functional limitations than usual, he or she also reported more depressive affect—and that health sensitivity decreased with age. Survival analysis revealed that health sensitivity was related to mortality hazards, controlling for mean levels of health and well-being. We discuss the theoretical importance of examining within-person associations between health and well-being and consider practical implications. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Keywords: Age differences; Health Conditions and Status; Marriage; Mortality; Older Adults

Here's why dementia rates are falling across U.S. - Szabo, Liz (The Los Angeles Times, 2016)
The decline in dementia rates translates to about one million fewer Americans suffering from the condition, said John Haaga, director of behavioral and social research at the National Institute on Aging, part of the National Institutes of Health, which funded the new study.
Keywords: Dementia; Health Conditions and Status; News; Older Adults

History of major depression as a barrier to health behavior changes after a chronic disease diagnosis - Xiang, Xiaoling (Journal of Psychosomatic Research, 2016)
Objective: To examine whether changes in smoking, drinking, and physical activity after a chronic disease diagnosis differ between middle-aged and older adults with and without a history of major depression. Methods: Individual-level data came from 1996 to 2010 waves of the U.S. Health and Retirement Study. Chronic disease diagnosis was ascertained from self-reports of physician diagnosed diseases. Major depression was assessed by the short-form Composite International Diagnostic Interview. Mixed-effects logistic regressions were performed to estimate the potential moderating effect of a history of major depression. Results: Baseline major depression was associated with a more than 3-fold increase (OR = 4.48, 95 CI = 2.27 8.86) in the odds of smoking and 37 decrease (OR = 0.63, 95 CI = 0.52 0.75) in the odds of staying physically active, but not with odds of excessive drinking. After a chronic disease diagnosis, the odds of smoking was reduced by 75 (OR = 0.25, 95 CI = 0.20 0.32), the odds of excessive drinking was reduced by 47 (OR = 0.53, 95 CI = 0.47 0.61), and the odds of staying physically active was reduced by 30 (OR = 0.70, 95 CI = 0.63 0.78). There was a significant interaction effect for smoking such that the decline in the odds of smoking was smaller among adults with a history of major depression. Conclusion: Chronic disease diagnosis may be an important teachable moment for health behavior change, but the behavior changing effect may be smaller for those with a history of major depression especially when it comes to smoking.
Keywords: Demographics; Health Conditions and Status; Other

How Childhood Trauma Can Cause Premature Aging - Jeffrey T Kullgren (TIME, 2016)
Keywords: Aging; Childhood adversity; Health Conditions and Status; Premature Aging; Telomeres

How does dementia onset in parents influence unmarried adult children's wealth - Arora, Kanika (Social Science and Medicine, 2016)
There is a growing concern that long-term care (LTC) needs of older adults lead to negative financial consequences for their family members. This paper examines whether the onset of dementia in parents influences wealth change among unmarried adult children regardless of their status as informal caregivers. Longitudinal data from seven waves (1998-2010) of the Health and Retirement Study (1540 person-wave observations) are used to analyze this question. Unconditional quantile regressions demonstrate that as a result of parental dementia diagnosis, unmarried adult children have lower wealth accumulation above the median of the wealth change distribution. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent period as well. Both losses in labor income and nursing home expenditures may play a role in leading to wealth declines.
Keywords: Adult children; Health Conditions and Status; Healthcare; Net Worth and Assets

How Might Differences in Immigration Experiences for Men and Women Lead to Gender Disparities in Functional Limitations for Older Mexican Immigrants in the U.S.? - Stepler, Renee A. (The George Washington University, 2016)
A number of studies have shown that across all races and ethnicities women tend to have higher levels of functional limitations than men despite lower rates of mortality (Warner and Brown 2011; Solé-Auró et al. 2014). While several studies do incorporate Mexican-Americans and include nativity as a control, it is possible that Mexican-born immigrants' experiences differ from their U.S.-born counterparts in ways that may affect health later in life. Using longitudinal data from the Health and Retirement Study, this study investigates the factors that may account for differences in the strength and mobility limitations between older men and women who are Mexican immigrants living in the United States. These data indicate that socioeconomic status, chronic disease, and depressive symptoms serve as predictors for functional limitations later in life for Mexican-born men and women, and that each of these predictors serves as an explanation for differences in the functional status of these men and women. These findings extend research of gender disparities in morbidity by examining this subpopulation and highlight the importance of focusing on preventing comorbidities and depression, especially for women.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology

The Impact of Retirement on Smoking Behavior - Padmaja Ayyagari (Eastern Economic Journal, 2016)
We use data from the Health and Retirement Study to examine the relationship between retirement and smoking decisions. Retirement might affect smoking behavior through a change in the opportunity cost of time, job-related factors or income. To estimate the causal effect of retirement on smoking habits, we exploit eligibility for Social Security benefits at age 62 to account for the endogeneity of retirement. We find suggestive evidence that retirement increases the probability of smoking among ever smokers, but this effect is sensitive to the econometric specification used. We also find evidence of heterogeneity in the impact of retirement.
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey - Amara E. Ezeamama; Elkins, Jennifer; Simpson, Cherie; Smith, Shaniqua L.; Joseph C. Allegra; Toni Miles (Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2016)
OBJECTIVE: To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50-70years old enrolled in the US 2010 health and retirement survey. METHODS: Multivariable logistic regression models estimated odds ratios (ORs) and 95 confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. Cumulative lifetime adversity was defined as 0, 1-2, 3-4 or 5 events. HCU included hospitalization (any vs. none) and physician visits ( 20 vs. 20) over 2years. FINDINGS: Hospitalization odds declined by 25 (OR 0.75, 95 CI 0.64-0.86), odds of 20 physician visits declined by 47 (OR 0.53, 95 CI 0.45-0.63) and the odds of SRH improvement increased by 49 (OR 1.49, 95 CI 1.17-1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 elevated for participants that reported 1-2, 3-4 and 5 versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician's visits and hospitalizations. CONCLUSION: In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU.
Keywords: Expectations; Health Conditions and Status; Healthcare

Low-Intensity Physical Activity and Cardiometabolic Risk Factors among Older Adults with Multiple Chronic Conditions - Yueyao Li (Epidemiology, 2016)
Introduction Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear. Objectives 1). Examine the association between LIPA and cardiometabolic risk factors. 2). Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. Methods Data from the Health and Retirement Study (HRS) were used for this study. We ascertained 2006 and 2008 HRS data from the Public Use Dataset, the RAND HRS Data File (Version N), and the HRS Biomarker Dataset. There were11890 participants aged 50 or older for cross-sectional analysis. Physical activity was converted to metabolic equivalent of tasks (METS) and outcome variables (systolic and diastolic blood pressure and HbA1c) were measured objectively. Mean levels of blood pressure and HbA1c were compared across physical activity intensity groups. Separate linear regression models were used to examine the association between LIPA and cardiometabolic risks adjusting for potential sociodemographic, behavioral, and clinical confounders. Results In the final study sample, 28.75% were sedentary, 9.46% regularly engaged in LIPA, 34.68% engaged in MIPA, and 27.12% engaged in VIPA. We did not find significant associations between LIPA and systolic blood pressure (B 0.235; 95% confidence interval (CI), -1.127, 1.597), diastolic blood pressure (B = -0.167; 95% CI, -0.954, 0.621), or HbA1c levels (B -0.009; 95% CI, -0.049, 0.066). The average HbA1c was significantly lower only among individuals who engaged in MIPA (B -0.097; 95% CI, -0.174, -0.020) and MIPA ( B -0.140; 95% CI, -0.218, -0.063) in comparison to individuals who were categorized as in sedentary group Conclusion The findings from our study do not suggest that LIPA is independently associated with lower cardiometabolic risk factors among older adults. Associations between physical activity intensity and cardiometabolic risk factors among older adults with multiple chronic conditions need to be verified in studies using more objective measurement of physical activity.
Keywords: Comorbidity; Health Conditions and Status; Heart disease; Older Adults; Physical activity; Risk Factors

Mapping the Two Levels of Digital Divide: Internet Access and Social Network Site Adoption among Older Adults in the USA - Rebecca P. Yu; Nicole B. Ellison; Ryan J McCammon; Kenneth M. Langa (Information, Communication and Society, 2016)
Older adults have increasingly adopted Internet and social network sites (SNSs), but little communication scholarship has explored systematic differences in access within this population. Using a nationally representative sample of Americans over the age of 50 years from the 2012 Health and Retirement Study, we examine Internet access (N?=?18,851) and SNS adoption patterns (N?=?869) among this sample and explore how these patterns vary by age. Regarding Internet access, results suggest that while the gender divide has reversed in favor of women, older adults who are economically, socioculturally, or physically disadvantaged are less likely to have reliable Internet access. In addition, the view that the various divides in Internet access are less of a concern for those who are younger is only partially supported, as some access-related divides do not vary by age or even decrease with age. For SNS adoption, we found that access to technological resources (diversity of online activities) positively predicts SNS use. Moreover, SNS users are more likely to be younger, female, widowed, and homemakers, perhaps because these individuals are more motivated to use SNSs to complement or compensate for their existing social status. These findings reveal unique challenges and motivations in relation to Internet access and SNS adoption patterns across the later life span.
Keywords: Demographics; Health Conditions and Status

Marital Quality and Health in Middle and Later Adulthood: Dyadic Associations - Choi, Heejeong; Yorgason, Jeremy B.; Johnson, David R. (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2016)
Objectives. We investigated associations between positive marital quality and health among married persons aged 50 or older and their spouses. Prior research using data from married individuals has yielded inconsistent findings regarding the association between positive marital quality and global health outcomes. The present study involved married couples to examine how spouses positive marital quality affect their own and each other s health, and whether these effects vary by age.Methods. Using data from 3 waves of the Health and Retirement Study (2006, 2008, 2010), we estimated a series of actor partner interdependence models using mixed linear models.Results. Analyses found that over the 4-year period (2006 2010) increases in positive marital quality of both spouses were independently associated with increases in their self-rated health in midlife and old age as well as with declines in disability in old age. Increases in positive marital quality were also linked with declines in functional limitations for middle-aged and older adults.Discussion. Being perceived as a supportive spouse, as well as perceiving one s partner as such, has significant health implications. Overall, positive marital quality of both spouses contributes to health protection for middle-aged and older spouses.
Keywords: Adult children; Health Conditions and Status; Methodology

Marital Status as a Moderating Factor in the Process of Disablement - Ben Lennox Kail (Journal of Aging and Health, 2016)
Objective: To test current marital status as a moderator on the influence of depressive symptoms and chronic conditions on subsequent functional limitations. Method: Data come from the Health and Retirement Study (HRS; 1998-2010). Hierarchal linear modeling models tested differences in functional limitations among a sample of 20,215 people. Results: At baseline, married people suffered from fewer subsequent functional limitations than the unmarried. Moreover, limited evidence suggests the influence of depressive symptoms was greater for the married than the unmarried; however, the influence of chronic conditions was consistently attenuated for married people. Accounting for differences in prior health, work, socioeconomic status, and health behaviors did not explain the moderating influence of marital status on the associations between symptoms of depression and chronic conditions with functional limitations. Discussion: This research highlights the need to identify potential modifiers that may help disrupt the process of disablement among both the married and the unmarried alike.
Keywords: Adult children; Disabilities; Health Conditions and Status; Other

Measures of aging with disability in U.S. secondary data sets: Results of a scoping review - Putnam, Michelle; Molton, Ivan R.; Truitt, Anjali R.; Smith, Amanda E.; Jensen, Mark P. (Disability and Health Journal, 2016)
AbstractBackground There remain significant knowledge gaps in our understanding of aging with long-term disability. It is possible that important advances in knowledge could be gained using existing secondary data sets. However, little is known regarding which of the data sets available to researchers contain the age-related measures needed for this purpose, specifically age of onset and/or duration of disability measures. Objective To better understand the capacity to investigate aging with long-term disability (e.g. mobility limitation) and aging with long-term chronic conditions (e.g. spinal cord injury, multiple sclerosis) using extant data. Methods Public use national and regional data sets were identified through existing reports, web-based searches, and expert nomination. The age- and disability-related variables, including age of onset and duration of disability, were tabulated for data sets meeting inclusion criteria. Analysis was descriptive. Results A total of N = 44 data sets were reviewed. Of these, 22 contained both age and disability variables. Within these 22 data sets, 9 contained an age of onset or duration of disability variable. Six of the nine data sets contained age of diagnosis for a single or set of health conditions. Onset of functional limitation is in two, and onset of self-reported and/or employment disability is in four, of the nine data sets respectively. Conclusions There is some, but limited opportunity to investigate aging with long-term disability in extant U.S. public use secondary data sets.
Keywords: Disabilities; Health Conditions and Status; Methodology

Mechanisms of the Effect of Involuntary Retirement on Older Adults Self-Rated Health and Mental Health - Min-Kyoung Rhee; Michàlle E. Mor Barak; William T Gallo (Journal of Gerontological Social Work, 2016)
This study examined mechanisms of the effect of involuntary retirement on self-rated health and mental health among adults aged 50 or older. Using two waves of the Health and Retirement Study (2006 and 2010), we selected a sample of 1,195 individuals working for pay at baseline who responded to a lifestyle questionnaire in both waves. Regression-based path analyses were conducted to test the mediating effects of financial control, positive and negative family relationships, and social integration on the relationship between involuntary retirement and self-rated health and mental health. Results of mediation analyses indicated that transition to involuntary retirement was directly negatively associated with subsequent self-rated health and indirectly negatively associated with mental health via perception of less financial control. Voluntary retirement was indirectly positively associated with both self-rated and mental health via perception of more financial control. No significant direct or indirect effects of retirement were found when retirement was measured with an aggregate measure without specifying its voluntariness. Findings emphasize the importance of specifying the voluntariness of retirement and recognizing the heterogeneity in the mechanisms of involuntary and voluntary retirement.
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

The Mental and Physical Health Consequences of Changes in Private Insurance Before and After Early Retirement - Ben Lennox Kail (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2016)
Objectives. This study evaluated the impact of private insurance coverage on the symptoms of depression, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in the years leading up to Medicare eligibility focusing on the transition from full-time work to early full retirement.Method. The Health and Retirement Study was used to (a) estimate 2-stage selection equations of (i) the transition to retirement and (ii) current insurance status, and (b) the impact of insurance coverage on health, net of endogeneity associated retirement and insurance coverage.Results. Employment-based insurance coverage was generally associated with better health. Moreover, being without employment-based insurance was particularly problematic during the transition to retirement. Non-group insurance only moderated the association between losing employment-based insurance and IADLs.Discussion. Results indicated that private insurance coverage is an important contextual factor for the health of early retirees. Those who maintain steady coverage tend to fare the best in retirement. This highlights the dynamic nature of changes in health in later life.
Keywords: Health Conditions and Status; Insurance; Retirement Planning and Satisfaction

Moderate Alcohol Consumption Is Not Associated with Reduced All-cause Mortality - Goulden, Robert (The American Journal of Medicine, 2016)
Background A large body of research suggests that light or moderate alcohol consumption is associated with reduced all-cause mortality. However, concerns remain that the observed relationship is due to selection bias, misclassification of ex-drinkers, or residual confounding. Methods The association between alcohol consumption and all-cause mortality was analyzed using Cox regression. The analysis was performed using data from the Health and Retirement Study, a longitudinal cohort of 24,029 individuals from a nationally representative sample of US adults aged more than 50 years. Drinking level was based on alcohol consumption measured at 3 points over the 4 years before the start of follow-up. Occasional drinkers those who reported drinking on at least 1 occasion, but always less than once per week served as the reference category. There was extensive adjustment for sociodemographic variables, health status, and functional status. Results During 206,966 person-years of follow up, 7902 individuals died. No level of regular alcohol consumption was associated with reduced all-cause mortality. The hazard ratio and 95 confidence interval in fully adjusted analyses was 1.02 (0.94-1.11) for andlt;7 drinks/week, 1.14 (1.02-1.28) for 7 to andlt;14 drinks/week, 1.13 (0.96-1.35) for 14 to andlt;21 drinks/week, and 1.45 (1.16-1.81) for 21 drinks/week. Conclusions Moderate alcohol consumption is not associated with reduced all-cause mortality in older adults. The previously observed association may have been due to residual confounding.
Keywords: Health Conditions and Status; Methodology

Modifiable Risk Factors for New-Onset Slow Gait in Older Adults - Joe Verghese; Wang, Cuiling; Allali, Gilles; Holtzer, Roee; Emmeline Ayers (Journal of the American Medical Directors Association, 2016)
AbstractObjective Despite the growing importance of slow gait as a universal screen of health, systematic investigation of risk factors for incident slow gait is lacking. Our objective was to identify potentially modifiable risk factors for incident slow gait. Design Prospective cohort study. Setting The Health and Retirement Study, a nationally representative US sample. Participants A total of 2306 individuals age 65 and older (56.5 women) from the 2008 wave with timed walks at baseline and 4 years later. Measurements Incident slow gait (walking speed 1 SD below age and sex means) was the outcome. Fifteen potentially modifiable medical and lifestyle risk factors were examined as predictors. Results Incident slow gait developed in 243 participants (11 ) at 4 years. Physical inactivity (adjusted relative risk aRR 1.94), cognitive impairment (aRR 1.77), muscle weakness (aRR 1.48), pain (aRR 1.45), obesity (aRR 1.35), vision (aRR 1.36), and falls (aRR 1.32) predicted increased risk of developing incident slow gait. Together, these risk factors accounted for 77 (95 confidence interval 14 95) of the Population Attributable Risk for incident slow gait. Conclusion A limited set of potentially modifiable risk factors is associated with new-onset slow gait in older adults. These findings provide a foundation for developing clinical guidelines and preventive interventions for slow gait.
Keywords: Health Conditions and Status; Healthcare

Modifiable risk factors for nursing home admission among individuals with high and low dementia risk - Pamela M. Rist; Thu T Nguyen; Rachel A Whitmer; M. Maria Glymour (Archives of Gerontology and Geriatrics, 2016)
AbstractBackground Strategies to prevent or delay nursing home admission in individuals with cognitive impairment are urgently needed. We hypothesized that physical inactivity, not consuming alcohol (as opposed to moderate alcohol use), and having a history of smoking predict nursing home admission among individuals with normal cognitive function, but these behavioral factors would have attenuated associations with nursing home admission among individuals with impaired cognition. Methods We performed a prospective cohort study among 7631 Health and Retirement Study participants aged 65 at baseline. Baseline dementia risk (high versus low, based on brief psychometric assessments and proxy reports) and modifiable risk factors (physical inactivity, ever smoking, and not consuming alcohol) were used to predict nursing home admission in pooled logistic regression models. We evaluated whether estimated effects of modifiable factors varied by dementia risk, comparing both relative and absolute effects using interaction terms between dementia risk and each modifiable risk factor. Results Low dementia probability was associated with lower nursing home admission risk (RR = 0.49; 95 CI: 0.41, 0.59). Physical inactivity (RR = 1.27; 95 CI: 1.15, 1.41), ever smoking (RR = 1.12; 95 CI: 1.01, 1.25), and not consuming alcohol (RR = 1.28; 95 CI: 1.13, 1.45) predicted increased relative risk of nursing home admission regardless of cognitive status. The relative effects of modifiable risk factors were similar for those with low and high dementia risk. Conclusion Although cognitive impairment associated with incipient dementia strongly predicts nursing home admission, this risk can be partially ameliorated with modifiable risk factors such as physical activity.
Keywords: Health Conditions and Status; Healthcare; Risk Taking

Multimorbidity Combinations and Disability in Older Adults - A. R. Quinones; Markwardt, Sheila; Anda Botoseneanu (The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2016)
Background: Multimorbidity (multiple co-occurring chronic diseases) is associated with greater likelihood of disability and mortality, above and beyond the risk attributable to individual diseases. This study identifies prevalent multimorbidity patterns and evaluates their association with disability among U.S. older adults.Methods: Prospective cohort study using longitudinal Health and Retirement Study data (2010 2012). We included 8,782 participants aged 65 years and older and used negative binomial models to examine prospective disability, measured by the combined activities of daily living instrumental activities of daily living index. Multimorbidity was defined as the co-occurring combination of at least two of the following chronic diseases: hypertension, cardiovascular disease, lung disease, diabetes, cancer, arthritis, stroke, cognitive impairment, or high depressive symptoms (CES-D score 4).Results: We found 291 unique disease combinations with 1 to 1,167 older adults per disease combination. The three most prevalent combinations were: (a) hypertension and arthritis (n = 1,167); (b) hypertension, arthritis, and cardiovascular disease (n = 510); and (c) hypertension, arthritis, and diabetes (n = 430). Only one of the prevalent combinations included depressive symptoms (in combination with arthritis, hypertension; n = 129). This group showed the highest level of activities of daily living instrumental activities of daily living disability compared to healthy participants or participants with a single disease (either included in the combination or different from diseases in the combination) even after adjusting for age, gender, education, race/ethnicity, and body mass index.Conclusions: Clinicians stand to gain from a better understanding of which disease combinations are more and less disabling among older adults. Understanding how multimorbidity combinations relate to functional status is an important step towards reducing disability and sustaining independent living among older adults.
Keywords: Disabilities; Health Conditions and Status

Multiple Chronic Conditions, Spouse's Depressive Symptoms, and Gender within Marriage - Thomeer, Mieke Beth (Journal of Health and Social Behavior, 2016)
Multiple chronic conditions (i.e., multimorbidity) increase a person's depressive symptoms more than having one chronic condition. Little is known regarding whether multimorbidity similarly increases the depressive symptoms of one's spouse and whether this depends on type of condition, gender, or both spouses' health status. Analysis of multiple waves of the Health and Retirement Study reveals husband's number of chronic conditions is positively related to wife's depressive symptoms when both spouses are chronically ill. The association between wife's chronic conditions and husband's depressive symptoms is weaker and less robust. Type of chronic condition also matters but which type depends on the gender and health status of both spouses. By highlighting key contexts where chronic conditions are connected to spousal depressive symptoms, this study identifies areas of vulnerability and urges researchers and clinicians to consider multimorbidity when designing and implementing interventions, along with gender, both spouses' chronic conditions, and condition type.
Keywords: Adult children; Health Conditions and Status

Perceived discrimination and personality development in adulthood - Angelina R Sutin; Yannick Stephan; Antonio Terracciano (Developmental Psychology, 2016)
Perceived discrimination is common and a significant source of stress that may have implications for personality development across adulthood. In this study, we examined whether experiences with discrimination were associated with maladaptive changes in the 5 major dimensions of personality using 2 longitudinal samples that differed in age and follow-up interval. In the Health and Retirement Study, participants who perceived discrimination increased in their tendency to experience negative emotions (neuroticism), decreased in their tendency to be trusting (agreeableness), and decreased in their tendency to be organized and disciplined (conscientiousness). These associations replicated using participants from the Midlife in the United States study. The findings indicate that social pathways, in addition to biological and developmental tasks, are important for adult personality development. (PsycINFO Database Record
Keywords: Health Conditions and Status; Methodology

Physical Activity, Central Adiposity, and Functional Limitations in Community-Dwelling Older Adults - Cassandra M Germain; Elizabeth Vasquez; John A. Batsis (Journal of Geriatric Physical Therapy, 2016)
Background and Purpose: Obesity and physical inactivity are independently associated with physical and functional limitations in older adults. The current study examines the impact of physical activity on odds of physical and functional limitations in older adults with central and general obesity. Methods: Data from 6279 community-dwelling adults aged 60 years or more from the Health and Retirement Study 2006 and 2008 waves were used to calculate prevalence and odds of physical and functional limitation among obese older adults with high waist circumference (waist circumference = 88 cm in females and = 102 cm in males) who were physically active versus inactive (engaging in moderate/vigorous activity less than once per week). Logistic regression models were adjusted for age, sex, race/ethnicity, education, smoking status, body mass index, and number of comorbidities. Results: Physical activity was associated with lower odds of physical and functional limitations among older adults with high waist circumference (odds ratio OR , 0.59; confidence interval CI , 0.52-0.68, for physical limitations; OR, 0.52; CI, 0.44-0.62, for activities of daily living; and OR, 0.44; CI, 0.39-0.50, for instrumental activities of daily living). Conclusions: Physical activity is associated with significantly lower odds of physical and functional limitations in obese older adults regardless of how obesity is classified. Additional research is needed to determine whether physical activity moderates long-term physical and functional limitations.
Keywords: Health Conditions and Status

Polygenic Risk of Schizophrenia and Cognition in a Population-Based Survey of Older Adults - Liebers, David T.; Pirooznia, Mehdi; Seiffudin, Fayaz; Musliner, Katherine L.; Zandi, Peter P.; Goes, Fernando S. (Schizophrenia Bulletin, 2016)
Cognitive impairment is a common feature of the major psychotic disorders, with deficits often present in at risk individuals and unaffected first-degree relatives. Previous studies have suggested that polygenic risk scores (PRS) for schizophrenia (SCZ) are associated with cognitive deficits, but there has been little examination of this association in longitudinal datasets, or comparison with other disorders. We used mixed models to study the association between PRS for 4 adult onset psychiatric disorders with cross-sectional cognitive performance and longitudinal cognitive decline in 8616 older adults from the Health and Retirement Study (HRS), followed for an average of 10 years. PRS were computed for SCZ, bipolar disorder (BD), Major Depressive Disorder (MDD), and Alzheimer s disease (ALZ). SCZ PRS associated with decreased cognitive function (z = 3.00, P = .001, R 2 = 0.04 ), which was largely driven by an association with impaired attention and orientation (z = 3.33, P = 4.3 10 4, R 2 = 0.08 ). We found no effect of BD or MDD PRS on cognition, in contrast to a robust effect of the APOE4/TOMM40 locus (z = 5.05, P = 2.2 10 7, R 2 = 0.36 ), which was primarily associated with impaired verbal memory (z = 5.15, P = 1.3 10 7, R 2 = 0.21 ). APOE4/TOMM40 locus and the ALZ PRS, but not the PRS for SCZ, were associated with greater cognitive decline. In summary, using a large, representative sample of older adults, we found evidence for different degrees of association between polygenic risk for SCZ and genetic risk factors for ALZ on cognitive function and decline, highlighting potential differences in the pathophysiology of cognitive deficits seen in SCZ and ALZ.
Keywords: Health Conditions and Status

Positive, Negative, and Ambivalent Interactions With Family and Friends: Associations With Well-being - Lee, Hyo Jung; Maximiliane E Szinovacz (Journal of Marriage and Family, 2016)
Although the relationship between social relationships and mental health is well established, debate continues about the relative importance of specific sources (spouses, children, relatives, friends) as well as of positive and negative interactions. The authors examined the associations of positive, negative, and ambivalent interactions with life satisfaction and depressive symptoms for spouses, children, relatives, and friends, using data from the 2008 Health and Retirement Study (N = 6,418). The findings generally showed positive associations between positive interactions and mental health and negative associations between negative or ambivalent interactions and mental health. These associations were most pronounced for relationships with spouses and children. Gender differences were found in life satisfaction but not in depressive symptoms. These results imply that future research on older adults needs to consider both positive and negative relationship features from diverse sources separately and in combination to disentangle their relative effects and their additive or compensatory potential.
Keywords: Health Conditions and Status

Predictors of Dementia and Memory Decline: Lifecourse Socioeconomic Status and Diabetes - Jessica R Marden (Harvard T.H. Chan School of Public Health, 2016)
This dissertation examines the relationship between both lifecourse socioeconomic status and diabetes and memory decline and dementia using data from the Health and Retirement Study. Chapter 1 examines associations between lifecourse measures of socioeconomic status (SES) and late life memory function and decline. Memory function was modeled longitudinally from 2002-2012 and decline was modeled for the same years via growth curves. SES measures included childhood SES, high school and college education, as well as late life household income. Of our SES measures, education was the strongest predictor of level of memory function, whereas rate of decline was driven by late life income, suggesting that late life interventions focused on SES or its downstream consequences – like health behaviors – may have the potential to slow cognitive decline. Chapter 2 assesses socioeconomic status (SES) at three points in the lifecourse in order to evaluate alternative lifecourse models with respect to the association between SES and risk of dementia. We used generalized estimating equations with a logit link to model dementia probability from 2002-2012. SES measures included childhood SES, high school education, and late life household income. We found that high school completion was the strongest predictor of decreased dementia risk, consistent with either of two lifecourse models: a sensitive period in early adulthood and/or cumulative risk. Chapter 3 explores how type 2 diabetes (T2D) and blood glucose levels relate to cognitive decline, which is important for understanding the mechanisms driving higher dementia rates among individuals with T2D. Memory decline was modeled via generalized estimating equations using linear growth curves with diabetes, HbA1c, and covariates as predictors. Diabetes and higher levels of HbA1c both predicted faster memory decline after controlling for an extensive battery of potential social confounders in a large, U.S. dataset. Our results add support for a causal pathway from diabetes to risk of dementia. Blood glucose concentration may partially explain the association between diabetes and both dementia and cognitive decline, although precise biological mechanisms are still unknown.
Keywords: Demographics; Health Conditions and Status

Predictors of New Onset Sleep Medication and Treatment Utilization Among Older Adults in the United States - Amanda N Leggett; Renee Pepin; Amanda Sonnega; Shervin Assari (The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2016)
Background. Sleep disturbances are common among older adults resulting in frequent sleep medication utilization, though these drugs are associated with a number of risks. We examine rates and predictors of new prescription sleep medications and sleep treatments, as well as sleep treatments without a doctor s recommendation.Methods. Participants were 8,417 adults aged 50 and older from two waves of the nationally representative Health and Retirement Study (HRS) who were not using a sleep medication or treatment at baseline (2006). Logistic regression analyses are run with sociodemographic, health, and mental health factors as predictors of three outcomes: new prescription medication use, sleep treatment use, and sleep treatment out of a doctor s recommendation in 2010.Results. New sleep medication prescriptions were started by 7.68 , 12.62 started using a new sleep treatment, and 31.93 were using the treatment outside of their doctor s recommendation. Common predictors included greater severity of insomnia, worsening insomnia, older age, and use of psychiatric medications. New prescription medication use was also associated with poorer mental and physical health, whereas new sleep treatment was associated with being White, higher educated, and drinking less alcohol.Conclusions. Starting a new prescription sleep medication may reflect poorer health and higher health care utilization, whereas beginning a sleep treatment may reflect an individual s awareness of treatments and determination to treat their problem. Clinicians should be aware of predictors of new sleep medication and treatment users and discuss various forms of treatment or behavioral changes to help patients best manage sleep disturbance.
Keywords: Health Conditions and Status

Psychological and Functional Vulnerability Predicts Fraud Cases in Older Adults: Results of a Longitudinal Study - Peter A Lichtenberg; Sugarman, Michael A.; Daniel Paulson; Ficker, Lisa J.; Rahman-Filipiak, Annalise (CLINICAL GERONTOLOGIST, 2016)
Using cross sectional data Psychological vulnerability was identified as a correlate of older adults being defrauded. We extend that research by examining fraud prevalence using longitudinal data from the Health and Retirement Study, and to identify the best predictors of fraud longitudinally across a 4-year time frame. Whereas reported fraud prevalence was 5.0 in a 5-year look-back period in 2008, it increased to 6.1 in 2012. The rate of new-incident fraud across only a 4-year look-back was 4.3 . Being younger-old, having a higher level of education, and having more depression significantly predicted the new cases of fraud reported in 2012. Psychological vulnerability was a potent longitudinal predictor of fraud, with the most vulnerable individuals being more than twice as likely to be defrauded. Results indicate that fraud victimization among older adults is rising, and that vulnerability variables, along with some demographic variables, predict new cases of fraud.
Keywords: Health Conditions and Status; Net Worth and Assets; Public Policy

Racial/Ethnic Differences in Insomnia Trajectories Among U.S. Older Adults - Christopher N Kaufmann; Ramin Mojtabai; Hock, Rebecca S.; Roland J. Thorpe Jr.; Sarah L. Canham; Chen, Lian-Yu; Alexandra M. V. Wennberg; Lenis P. Chen-Edinboro; Adam P Spira (The American Journal of Geriatric Psychiatry, 2016)
Objectives Insomnia is reported to be more prevalent in minority racial/ethnic groups. Little is known, however, about racial/ethnic differences in changes in insomnia severity over time, particularly among older adults. We examined racial/ethnic differences in trajectories of insomnia severity among middle-aged and older adults. Design Data were drawn from five waves of the Health and Retirement Study (2002 2010), a nationally representative longitudinal biennial survey of adults aged andgt; 50 years. Setting Population-based. Participants 22,252 participants from non-Hispanic white, non-Hispanic black, Hispanic, and other racial/ethnic groups. Measurements Participants reported the severity of four insomnia symptoms; summed scores ranged from 4 (no insomnia) to 12 (severe insomnia). We assessed change in insomnia across the five waves as a function of race/ethnicity. Results Across all participants, insomnia severity scores increased 0.19 points (95 CI: 0.14 0.24; t = 7.52; design df = 56; p andlt; 0.001) over time after adjustment for sex, race/ethnicity, education, and baseline age. After adjusting for the number of accumulated health conditions and body mass index, this trend decreased substantially and even changed direction (B = 0.24; 95 CI: 0.29 to 0.19; t = 9.22; design df = 56; p andlt; 0.001). The increasing trajectory was significantly more pronounced in Hispanics compared with non-Hispanic whites, even after adjustment for number of accumulated health conditions, body mass index, and number of depressive symptoms. Conclusions Although insomnia severity increases with age largely due to the accumulation of health conditions this trend appears more pronounced among Hispanic older adults than in non-Hispanic whites. Further research is needed to determine the reasons for a different insomnia trajectory among Hispanics.
Keywords: Health Conditions and Status; Other

Is regional income inequality associated with the individual health of older adults? Evidence from the Health and Retirement Study - Jin H. Kim (Poverty & Public Policy, 2016)
This research examined the association between regional income inequality and the individual health of older adults. Individuals ages 50 and older were drawn from the 1996 to 2012 waves of the Health and Retirement Study to estimate panel data regression models to assess the respective impacts of household income ratios of the 90th to 10th percentiles as well as the 50th to 10th percentiles on the number of doctor-diagnosed health conditions, controlling for regional fixed effects, time fixed effects, and individual characteristics. The findings revealed that in regions with greater 50/10 income ratios, older adults experience fewer doctor-diagnosed health conditions. Namely, a one-unit increase in the 50/10 income ratio was significantly associated with a 9.1 percent decrease in the number of doctor-diagnosed health conditions. The research also revealed that in regions with greater within-group income inequality, that is, inequality as measured within the same marital status reference group, older adults still experience fewer health conditions. Thus, in light of prior studies on the topic that either support the connection between greater income inequality and worse individual health or oppose this connection altogether, the findings suggest that greater income inequality at the regional level may be linked with better individual health.
Keywords: Finances; Health Conditions and Status; Inequality; Regional associations

The risks of meddling with Obamacare while the nation's health is on the line - Jacqueline L. Angel (Dallas Morning News, 2016)
Keywords: Health Conditions and Status; Low incomes; Medicare/Medicaid/Health Insurance; Older Adults; Risk Factors

Satisfaction with Aging Results in Reduced Risk for Falling - Liat Ayalon (International Psychogeriatrics, 2016)
Background: Falls are highly frequent in older adults and are associated with increased morbidity and mortality. The present study was designed to assess the role of satisfaction with one's aging process as a predictor of the risk for falling over a four-year period and to identify potential mediators of this relationship. Methods: The Health and Retirement Study (HRS) is a US nationally representative sample of individuals over the age of 50 years and their spouse of any age. The present study was based on the 2008 2012 waves of the HRS. Analyses were restricted to 4,121 respondents over the age of 50 years, who had fall data in 2008 and 2012 and were eligible to complete the satisfaction with aging measure as part of the 2008 psychosocial questionnaire. Results: Overall, 38.1 of the sample reported having fallen at least once between 2006 and 2008 and 40.7 reported having fallen at least once between 2010 and 2012. Higher levels of satisfaction with aging in 2008 were found to be protective against falls assessed in 2012 (OR 95 CI = 0.88 0.79 0.98 ) even after adjustment for age, gender, education, ethnicity, medical status, functional status, cognitive functioning, walking speed, balance, vision, depressive symptoms, physical activities, and past falls. Bootstrap procedures have shown that the effect of satisfaction with aging on falls is partially accounted for through its effect on functional decline. Conclusions: The findings point to the important role of satisfaction with aging as a potential protective mechanism against falls. The results call for the development of psychosocial interventions to reduce falls in older adults.
Keywords: Health Conditions and Status; Healthcare

Sex, race and age differences in muscle strength and limitations in community dwelling older adults: Data from the Health and Retirement Survey (HRS) - Cassandra M Germain; Elizabeth Vasquez; John A. Batsis; Douglas R McQuoid (Archives of Gerontology and Geriatrics, 2016)
Background: Aging-related muscle weakness is associated with increased risk of functional limitations and disability. This study examined the association between varying degrees of hand grip strength on functional ability in community-dwelling older adults. Methods: Cross-sectional analysis of 4289 men and 5860 women 60 from 2006 and 2008 waves of the population-based Health and Retirement Study (HRS) were stratified by sex-specific grip strength tertiles (low, mid, high). Prevalence and adjusted odds of physical limitations (PL), and ADL/IADL limitation were calculated by sex, race/ethnicity and age group (60-69, 70-79, 80 ). Models were weighted, adjusted for age, sex, race/ethnicity, education, smoking status, BMI, comorbidities and participation in physical activity. Results: Prevalence of PL, ADL and IADL limitations were significantly lower among adults in the highest grip category as compared to those in the lowest grip category. Adjusted odds for PL OR 0.41 0.33,0.52 ; ADL OR.51 0.39,0.67 , and IADL OR 0.47 0.38-0.59 limitations were significantly lower among adults in the highest grip compared to the lowest grip category. However, notable differences were observed in the strength of these associations by gender, race and age group. Conclusion: Demographic characteristics are important factors to consider for risk stratification and the development of effective grip strength training interventions for older adults.
Keywords: Health Conditions and Status

Social Supports as Enabling Factors in Nursing Home Admissions: Rural, Suburban, and Urban Differences - Cohen, Adrienne; Jennifer R. Bulanda (Journal of Applied Gerontology, 2016)
This study investigates differences in social support and nursing home admission by rurality of residence. We use discrete-time event history models with longitudinal data from seven waves (1998-2010) of the Health and Retirement Study to prospectively examine the risk of spending 30 or more days in a nursing home (n = 5,913). Results show that elders with a health problem who live in rural areas of the South or Midwest have approximately 2 times higher odds of nursing home entry than elders living in urban areas in the Northeast. Rural elders report somewhat higher social support than non-rural elders, and controlling for these forms of social support does not explain the higher risk of a nursing home stay for Southerners and Midwesterners living in rural areas. Results suggest that social support has a similar association with nursing home entry for rural, suburban, and urban elders.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

Socioeconomic Status Across the Life Course and Cognitive Function Among Older Adults: An Examination of the Latency, Pathways, and Accumulation Hypotheses - Jiyoung Lyu; Jeffrey A Burr (Journal of Aging and Health, 2016)
Objective: This study investigated the relationship between life course socioeconomic status (SES) and cognitive function among older adults in the United States over a 12-year observation period. The mediation of adult SES on the association between childhood SES and cognition was examined, along with the relationship between cumulative SES and cognition. Method: Using a nationally representative sample from the Health and Retirement Study, cognitive status and change in cognition from 1998 to 2010 were examined using growth curve models. Results: The results showed that cognitive function varied within-persons and between-persons. SES disadvantage in childhood was associated with lower cognitive function at baseline. Adult SES mediated the relationship between childhood SES and cognitive function. Persons with higher cumulative SES demonstrated an advantage in cognitive function. Discussion: Childhood SES and adult SES both had relationships with cognitive status and, to a lesser degree, change in cognition in later life.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status

A study of telomere length as a prospective biomarker of cancer risk - Zhang, Chenan (Public Health Sciences, 2016)
This dissertation is comprised of two peer-reviewed articles and one manuscript, aiming to identify knowledge gaps in terms of the role of telomere length as a biomarker of cancer. Individuals with relatively short telomeres in peripheral blood cells have been shown in epidemiological studies to be at increased risk for mortality and cancer, leading investigators to hypothesize that telomere length and attrition over the life-course is a critical mechanism underlying cancer and many other age-related health conditions. However, such associations are not consistent across all cancers or even within cancer types, with some studies showing null, or even opposite associations. Furthermore, due to the cross-sectional nature of case-control studies, from which most associations of telomere length and cancer risk are obtained, it is possible that telomere shortening occurs after diagnosis (due to the cancer itself or treatment effects), or is confounded by other common risk factors, and therefore may not be a true biomarker of subsequent cancer risk. I employed three strategies for addressing these potential issues: 1) use genetic polymorphisms that influence telomere length as proxies for telomere length to estimate associations between telomere length and cancer risk; 2) perform careful adjustment of potential confounders of the telomere length-cancer association, including the assessment of time-varying effects on smoking, a potential telomere length correlate; and 3) utilize a prospective study design in which baseline telomere length is measured prior to the development of any adverse health outcomes. In the first study of this dissertation (Chapter 2), I used a Mendelian randomization approach to estimate the associations between nine telomere length-associated SNPs and risk for five common cancer types (breast, lung, colorectal, ovarian and prostate cancer, including subtypes) using data on 51,725 cases and 62,035 controls. The long TL genetic score was significantly associated with increased risk of lung adenocarcinoma (P=6.3E -15), with an estimated odds ratio of 2.78. Under Mendelian randomization assumptions, this estimate was interpreted as the odds ratio for lung adenocarcinoma corresponding to a 1000 base pair increase in telomere length. The SNP score was not associated with other cancer types or subtypes. In the second study of this dissertation (Chapter 3), I estimated the associations between telomere length (measured by quantitative PCR using saliva DNA) and concurrent and past smoking status, reported biennially for up to 16 years prior to telomere length measurement, using data from the Health and Retirement Study (n=5,624). Smoking was associated with shorter telomere length when using prospective data on smoking status among men and women, but the association was strongly attenuated in cross-sectional analyses among men. This attenuation was largely due to a higher rate of smoking cessation during the study period among males with shorter telomere length compared to males with longer telomere length. Short telomere length was also associated with poorer overall health in men, suggesting that male smokers with short telomere length were more likely to quit smoking due to poor health. Analyses of years since cessation, smoking duration, and pack-years all support the hypothesis that increased cigarette use shortens telomere length. In the third study of this dissertation (Chapter 4), I investigated the association between arsenic exposure and telomere length, and the association between telomere length and incident arsenical skin lesion in the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh. In this prospective study, baseline telomere length was assessed in skin lesion-free subjects who were followed for up to 12 years. No association was observed between baseline arsenic exposure and telomere length. However, we observed higher incident skin lesion risk with shorter telomere length (Ptrend =4.6E-5), with odds ratios of 3.05, 1.30, and 1.21 for the first (shortest), second, and third telomere length quartiles compared to the longest. The role of telomere length as a biomarker of cancer appears to be striking yet nuanced. Addressing the existing knowledge gaps is a critical step towards clarifying the causal relationship between telomere length and cancer, and ultimately, improving cancer prediction and prevention.
Keywords: Cancer screenings; Health Conditions and Status; Older Adults; Risk Factors; Telomeres

Subjective Age and Changes in Memory in Older Adults - Yannick Stephan; Angelina R Sutin; Caudroit, Johan; Antonio Terracciano (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2016)
Objective. The subjective experience of aging, indexed by how old or young an individual feels, has been related to well-being and health-related outcomes among older adults. The present study examined whether subjective age is associated with memory level and changes, as indexed by measures of immediate and delayed recall. A complementary purpose was to test the mediating role of depressive symptoms and physical activity in the relation between subjective age and memory changes. Method. Participants were drawn from three waves of the Health and Retirement Study. Subjective age, baseline memory measures, and covariates were assessed during the 2008 wave (N = 5809), depressive symptoms and physical activity were assessed again in the 2010 wave, and the follow-up memory measures were assessed in the 2012 wave. Results. Regression analyses that included demographic, metabolic, and vascular covariates revealed that a younger subjective age at baseline was associated with better concurrent performance and with slower decline in immediate and delayed recall. Bootstrap procedures indicated that fewer depressive symptoms mediated these associations. Additional analyses revealed that memory level and change were unrelated to changes in subjective age. Conclusion. Beyond chronological age, the subjective experience of age is associated with cognitive aging.
Keywords: Expectations; Health Conditions and Status

Subjective cognitive impairment of older adults: a comparison between the US and China - Bei Wu (International Journal of Methods in Psychiatric Research, 2016)
Subjective assessment may be incomparable across countries due to differences in reporting styles. Based on two nationally representative surveys from the US and China, this study used data from three anchoring vignettes to estimate to what extent the US and Chinese older adults aged 50 and above differed in their reporting styles of subjective cognitive impairment. Cross country differences of subjective cognitive impairment were then estimated, both before and after adjusting for reporting heterogeneity. Directly assessed word recall test scores were analyzed to evaluate whether findings based on subjective cognitive impairment was consistent with objective performance. The results revealed a discrepancy between self-reported subjective cognitive impairment and directly assessed memory function among older adults: while Chinese respondents reported lower severity levels of subjective cognitive impairment, the US respondents demonstrated better performance in immediate word recall tests. By accounting for differences in reporting styles using anchoring vignettes data, Chinese older adults showed higher levels of subjective cognitive impairment than the US older adults, which was consistent with results from direct assessment of memory function. Non-negligible differences are present in reporting styles of subjective cognitive impairment. Cross country comparison needs to take into account such reporting heterogeneity.
Keywords: Cross-National; Health Conditions and Status; Methodology

Time discounting and economic decision-making among the elderly - Huffman, David; Maurer, Raimond; Olivia S. Mitchell (NBER Working Paper Series, 2016)
This paper evaluates the extent of heterogeneity in time discounting among elderly Americans, as well as its role in explaining older peoples' key behaviors. We first show how older Americans evaluate simple (hypothetical) intertemporal choices in which payments now are compared with payments in the future. This adds to the literature on time horizon experiments by focusing on a nationally representative sample of persons age 70+. Using the indicators derived from this experiment, we show how differences in discounting patterns are associated with characteristics of particular importance in elderly populations, such as serious health and mental conditions. We then relate our discounting measure to key outcome variables including wealth, the timing of retirement, investments in health, and decisions about end of life care.
Keywords: Decision making; Health Conditions and Status; Older Adults

Time to Burn (Calories)? The Impact of Retirement on Physical Activity among Mature Americans - Fabrice Kämpfen; Jürgen Maurer (Journal of Health Economics, 2016)
Physical activity is crucial for maintaining and improving health, especially at advanced ages. While retirement increases the amount of time available for physical activity, there is only limited evidence regarding the causal effect of retirement on recommended levels of physical activity. Addressing this gap in the literature, we use data from the U.S. Health and Retirement Study to estimate the causal impact of retirement on meeting the federal government's 2008 Physical Activity Guidelines for Americans. Using official early and normal retirement ages as instruments for retirement, our causal IV analyses suggest significant positive effects of retirement on meeting the Guidelines. These effects are robust with regard to the treatment of unobserved individual-specific heterogeneity, the measurement of guideline compliance, the definition of retirement and respondents health insurance status. We also show that the effects of retirement on physical activity are larger for persons with higher levels of education and wealth.
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

Trends in Retirement Satisfaction in the United States: Fewer Having a Great Time - Sudipto Banerjee (EBRI Notes, 2016)
Most of the existing research on overall retirement satisfaction of retirees uses single-year data and focuses on identifying and measuring the factors that may affect retirement satisfaction. However, the analysis presented in this paper uses data from the 1998-2012 rounds of the Health and Retirement Study (HRS) to illustrate longer trends in retirement satisfaction and the relationships with various other factors. The cross-sectional results in this study show that the share of respondents reporting very satisfying retirements dropped from 60.5 percent in 1998 to 48.6 percent in 2012. On the other hand, the share of respondents reporting moderately satisfying and not at all satisfying retirements increased from 31.7 percent to 40.9 percent and from 7.9 percent to 10.5 percent, respectively. The longitudinal results from a fixed sample observed over the 15-year period from 1998 to 2012 show similar declines in the share of respondents reporting very satisfying retirements and similar increases in the share of respondents reporting moderately satisfying retirements. This is in contrast to some of the previous research, which shows that retirement satisfaction increases with age. These trends are not limited to particular economic groups: Both the highest- and lowest-asset quartiles show similar trends. Also, people with and without pension income show similar trends in retirement satisfaction levels. As might be expected, net worth and health status are strongly correlated with retirement satisfaction. Higher net worth is associated with higher levels of satisfaction, and poorer health is associated with lower levels of satisfaction. There is no significant difference in retirement satisfaction levels between men and women. Although this study does not investigate the reasons behind the changes in retirement satisfaction levels, the reported shift in the retirement satisfaction trends raises an important question: Why is the share of very satisfied retirees dropping? Further research to answer this question might provide some important answers.
Keywords: Health Conditions and Status; Net Worth and Assets; Pensions; Retirement Planning and Satisfaction

U.S. Dementia Rates Are Dropping Even as Population Ages - Gina Kolata (The New York Times, 2016)
Keywords: Aging; Dementia; Health Conditions and Status; Older Adults

Volunteering is prospectively associated with health care use among older adults - Eric S Kim; Konrath, Sara H. (Social Science and Medicine, 2016)
lthough observational and experimental studies have shown that volunteering is linked with better mental health, physical health, and health behaviors, no studies have examined whether volunteering is associated with patterns of health care use. Objective The purpose of this study was to prospectively examine whether volunteering was associated with a greater use of preventive health care services, but fewer doctor visits and nights spent in the hospital. Methods Participants (n = 7168) were drawn from the 2006 wave of the Health and Retirement Study, a nationally representative panel study of American adults over the age of 51, and tracked for one wave (2 years). Logistic regression and generalized linear models were used for analyses. Results In analyses that adjusted for sociodemographic factors and baseline health, volunteers were 30 more likely to receive flu shots (OR = 1.30, 95 CI = 1.16 1.47), 47 more likely to receive cholesterol tests (OR = 1.47, 95 CI = 1.24 1.74); female volunteers were 53 more likely to receive mammograms/x-rays (OR = 1.53, 95 CI = 1.28 1.83) and 21 more likely to receive Pap smears (OR = 1.21, 95 CI = 1.03 1.41); male volunteers were 59 more likely to receive prostate exams (OR = 1.59, 95 CI = 1.29 1.95). In a model that adjusted for sociodemographic factors, volunteers spent 38 fewer nights in the hospital (RR = 0.62, 95 CI = 0.52 0.76), however volunteering was not associated with frequency of doctor visits (RR = 0.94, 95 CI = 0.87 1.02). The association between volunteering and number of nights spent in the hospital was minimally affected after adjusting for potential confounding (baseline health) and explanatory variables (health behaviors, social integration, stress, positive psychological factors, personality). Conclusion This is the first known study to examine the association between volunteering and health care use. If future studies replicate these findings, the results may be used to inform the development of new strategies for increasing preventive health screenings, lowering health care use and costs, and enhancing the health of older adults.
Keywords: Adult children; Health Conditions and Status; Healthcare

What about African American Older Women and Depressive Symptoms? - Tamika C. Baldwin; Halaevalu F. Ofaheng Vakalahi; Anderson, Brian (Educational Gerontology, 2016)
Depression is a major problem among African American older women; however, they also tend to be understudied as members of a multiple minority and oppressed group. As matriarchs and grandmothers in their families and communities, depression often emerges and becomes a detrimental problem for these older African American women. This study, a secondary data analysis, utilized the Health and Retirement Study (HRS) 2010 database to examine depression among older African American women. This article discusses the joint impact of age, social support, religion, caregiving, and physical health on depression among older community dwelling African American women. Findings indicate that age, physical health, and marital status as an aspect of social support were significant predictors of whether or not an older African American woman had ever had depression and whether or not she felt depressed in the past year. Receiving help from relatives as an aspect of social support also remained significant for participants who were feeling depressed in the past year. Implications for research, theory, and policy are offered.
Keywords: Adult children; Health Conditions and Status; Women and Minorities

You Can Inherit Loneliness - Melissa Dahl (New York Magazine, 2016)
Keywords: Depressive symptoms; Genetics; Health Conditions and Status; Loneliness; News; Older Adults

Accounting for adaptation in the economics of happiness - Miles S Kimball; Ryan D. Nunn; Daniel S. Silverman (2015)
Reported happiness provides a potentially useful way to evaluate unpriced goods and events; but measures of subjective well-being (SWB) often revert to the mean after responding to events, and this hedonic adaptation creates challenges for interpretation. Previous work tends to estimate time-invariant effects of events on happiness. In the presence of hedonic adaptation, this restriction can lead to biases, especially when comparing events to which people adapt at different rates. Our paper provides a flexible, extensible econometric framework that accommodates adaptation and permits the comparison of happiness-relevant life events with dissimilar hedonic adaptation paths. We present a method that is robust to individual fixed effects, imprecisely-dated data, and permanent consequences. The method is used to analyze a variety of events in the Health and Retirement Study panel. Many of the variables studied have substantial consequences for subjective well-being--consequences that differ greatly in their time profiles.
Keywords: Expectations; Health Conditions and Status; Methodology

Accounting for differences in cognitive health between older adults in New Zealand and the USA - Christine Stephens; Spicer,John; Claire Budge; Brendan Stevenson; Fiona M. Alpass (International Psychogeriatrics, 2015)
Background: National differences in cognitive health of older adults provide an opportunity to shed light on etiological factors. We compared the cognitive health of older adults in New Zealand and the USA, and examined differences in known risk factors. Methods: Two nationally representative samples were derived from the 2010 waves of the New Zealand Longitudinal Study of Ageing (n = 953) and the US Health and Retirement Study (HRS) (n = 3,746). Data from comparable measures of cognitive function, gender, age, income, education, prevalence of cancer, diabetes, heart disease, hypertension and stroke, exercise, alcohol consumption, smoker status, depression, and self-reported health were subjected to hierarchical regression analysis to examine how national differences in cognitive function might be explained by differences in these risk factors. Results: The New Zealand sample scored 4.4 points higher on average than the US sample on the 43 point cognitive scale. Regression analyses of the combined samples showed that poorer cognitive health is more likely in those who are male, older, less educated, have suffered a stroke, consume alcohol less frequently, are more depressed, and report worse overall health. Controlling for age and sex reduced the mean difference to 2.6 and controlling for risk factors further reduced it to 2.3. Conclusions: Older New Zealand adults displayed better cognitive function than those in a US sample. This advantage can be partially explained by age and sex differences and, to some extent, by differences in known risk factors. However, the national advantage remained even when all measured risk factors are statistically controlled.
Keywords: Cross-National; Demographics; Health Conditions and Status; Other

Adoption and maintenance of health behaviors among middle-aged and older adults: the role of chronic disease diagnosis and depression - Xiang, Xiaoling (University of Illinois at Urbana–Champaign, 2015)
This study is a secondary-data analysis of adoption and maintenance of health behavior changes among U.S. middle-aged and older adults. This investigation focused on the impact of a chronic disease diagnosis on the likelihood of a health behavior change and whether the magnitude of change is modified by major or persistent depression prior to the chronic disease diagnosis. Further analyses assessed whether depression and a new chronic disease diagnosis affected long-term maintenance of health behaviors changes, once made. The study sample came from 1996-2010 waves of the Health and Retirement Study and consisted of 11,439 community-dwelling adults aged 50-80 years who were free of diabetes, heart disease, stroke, cancer, and chronic lung disease in 1996. Depression was measured by the 8-item Center for Epidemiologic Studies Depression Scale and the short form of the World Health Organization's Composite International Diagnostic Interview. Chronic disease diagnosis was ascertained from self-reported physician diagnosis of a specific condition. Health behaviors included six dichotomous measures of current smoking status, drinking level (moderate or excessive), vigorous physical activity (≥ 3 times per week), receipt of influenza vaccination, blood test for cholesterol, prostate exam for men, and mammography for women. Matched case-control difference-in-differences estimator was used to estimate the effect of each chronic disease diagnosis on the likelihood of change in each health behavior. Mixed-effects logistic regression was applied to analyze the longitudinal impact of depression on health behaviors and to examine whether depression modified the impact of a chronic disease diagnosis on health behaviors. Kaplan-Meier estimator and the marginal risk set model were performed to assess the impact of a chronic disease diagnosis, depression, and their interaction on the likelihood of relapse after a health behavior change had been initiated. Middle-aged and older adults tended to reduce smoking and drinking, and increase utilization of preventive health services after a diagnosis of chronic disease. However, they reported a consistent decline in vigorous physical activity post diagnosis across disease conditions. Participants with major or persistent depression at baseline were more likely to remain smoking and less likely to engage in vigorous physical activity during the 14 years of follow-up. Depression also appeared to modify behavioral responses to a chronic disease diagnosis. Participants with depression experienced smaller increase in influenza vaccination utilization after a chronic disease diagnosis compared to their initially non-depressed counterparts. Depression did not seem to modify the impact of a new chronic disease on other health behaviors. The majority of middle-aged and older adults who initiated a health behavior change adhered to the change in the long-term. A new diagnosis of chronic disease did not appear to affect the likelihood of behavior maintenance. Chronic disease diagnosis may be an important teachable moment that can motivate individuals to spontaneously adopt risk-reducing health behaviors. More focused and intensive interventions are needed for those with chronic disease and comorbid depression to produce meaningful behavior change outcomes. Future research needs to elucidate the mechanisms through which chronic disease diagnosis affects health behaviors, develop and test the effectiveness of interventions utilizing the teachable moment effect of a chronic disease diagnosis, along with identifying population-based strategies to promote physical activity among adults with chronic disease.
Keywords: Demographics; Health Conditions and Status; Methodology; Other

Adult Child Caregiver Health Trajectories and the Impact of Multiple Roles Over Time - Barnett, Amanda E. (Research on Aging, 2015)
Guided by stress process and life course theory, the purpose of this study was to examine adult child caregivers psychological and physical health trajectories and how their multiple family (caregiving, marital, and parenting) and nonfamily (employment) roles contributed to these health outcomes over time. Seven waves of data from the Health and Retirement Study were analyzed for 1,300 adult child caregivers using latent growth curve models. Adult child caregivers have distinct psychological and physical health trajectories that are related to their roles over time. The importance of any given role varies by the type of health outcome and timing in the life course. Caregiving alone does not contribute to adult child caregivers psychological and physical health; marital and employment roles also contribute significantly to caregivers life courses.
Keywords: Adult children; Employment and Labor Force; Event History/Life Cycle; Health Conditions and Status; Healthcare; Methodology

Age at Migration and Self-Rated Health Trajectories After Age 50: Understanding the Older Immigrant Health Paradox - Gubernskaya, Zoya (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2015)
Objectives. This research contributes to the immigrant health paradox debate by testing the hypothesis that older age at migration is associated with the increased risk of poor health in later life.Method. Using the 1992 2008 Health and Retirement Study, I construct linear random-intercept models to estimate self-rated health (SRH) trajectories after age 50 for the native and foreign born by age at migration.Results. At age 50, both Hispanic and non-Hispanic foreign born report better SRH compared with their native-born counterparts, net of race, gender, and education. Non-Hispanic foreign born who migrated after age 35 and Hispanic foreign born who migrated after age 18, however, experience steeper decline in SRH after age 50, which results in a health disadvantage vis- -vis the native born in old age. Education has a smaller protective effect on SRH for the foreign born, especially those who migrated as adults.Discussion. Age at migration is an important factor for understanding health status of older immigrants. Steeper health decline in later life of the foreign born who migrated in advanced ages may be related to longer exposure to unfavorable conditions in home countries and limited opportunities for incorporation in the United States.
Keywords: Demographics; Health Conditions and Status; Healthcare

Are cancer survivors who are eligible for social security more likely to retire than healthy workers? Evidence from difference-in-differences - Candon, David (Dublin, UCD School of Economics, University College Dublin, 2015)
Despite the fact that there are over a million new cancer cases detected in the U.S. every year, none of retirement-health literature focuses specifically on the effect that cancer has on retirement. Social Security may offer a pathway to retirement for eligible workers but the separate effects of both cancer, and Social Security, on retirement, need to be accounted for. I use the fact that some workers will be eligible for Social Security when they are diagnosed with cancer, while some will not, as a source of exogenous variation to identify the joint effect of cancer diagnosis and Social Security eligibility on retirement. With data from the Health and Retirement Study (HRS), I use a difference-in-differences model to show that being eligible for Social Security, and surviving cancer, increases the probability of retirement by 11.2 for male workers. Given the increase in both cancer survival rates, and the number of older workers in the labour force, it is important to know if cancer is causing permanent exits, in a population who otherwise would continue working.
Keywords: Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction; Social Security

Assessing the burden of worsening self-reported vision in older Americans using the Health and Retirement Study - Shih, Vanessa (Pharmacy, 2015)
Background Visual disorders are estimated to affect about 3.6% of Americans by 2020. Vision impairment has a substantial impact on individuals functionally. Vision impairment is associated with many comorbidities, functional limitations, as well as higher caregiving needs. This study aims to assess the transition to self-reported vision impairment and the effect on an individual's functionality and ability to live independently. Methods The Health and Retirement Study is an ongoing, biennial survey of older Americans that collects an abundance of data on an individual's family, health, and financial circumstances. The explanatory variable of interest was a dichotomous variable of vision impaired or not vision impaired as defined by their self-reported vision status. Outcomes studied were functional limitations defined as difficulty performing activities of daily living (ADLs) and instrumental activities of daily living (IADLs), likelihood of move to nursing home, and both informal and formal caregiving needs. Descriptive univariate and bivariate statistics were performed to describe the demographics of the sample over the ten waves of data used, from 1995-2012. Multivariable logistic regressions controlling for sociodemographic characteristics, were performed to test the association between vision status and outcomes of interest for specific representative waves. Panel data methods of logistic regression were used to measure the association between a transition to impaired vision and the effect on functional limitations and nursing home residence while controlling for potential confounders and within-patient correlation. Specifically, mixed-effects logistic regressions with subject-level random-effects were conducted for the binary outcomes of nursing home residence, difficulty in performing at least one ADL, and difficulty in performing at least one IADL. Results The prevalence of overall vision impairment was, on average, about 6%. On average, about 5% and 7% of respondents had near and distal vision impairment, respectively. The overall prevalence of nursing home residence in our sample was approximately 2%. Prevalence of ADL and IADL limitations was stable across waves but ranged from 1%-20% for each of the six ADL and five IADL limitations. More respondents reported receiving informal caregiving versus formal caregiving; however the hours of caregiving received was similar for both formal and informal caregiving recipients. Multivariable logistic regression for three representative waves found numerically higher odds of a nursing home residence for vision impaired individuals compared to individuals with no vision impairment, though the difference was not significant. The odds ratios for 1998, 2006, and 2012 were 1.08 (95% CI: 0.64, 1.84), 1.09 (95% CI: 0.64, 1.86), and 1.22 (95% CI: 0.76, 1.97), respectively. Significant associations were found between vision impairment and functional limitations. Using a similar approach, the odds ratio for difficulty performing at least one ADL was 2.57 (95% CI: 2.16, 3.05), 2.37 (95% CI: 1.97, 2.84), and 2.31 (95% CI: 1.92, 2.77) in 1998, 2006, and 2012, respectively. The odds ratios for difficulty performing at least one IADL was 3.78 (95% CI: 3.15, 4.53), 3.94 (95% CI: 3.26, 4.76), and 3.49 (95% CI: 2.89, 4.22) in 1998, 2006, and 2012, respectively. In the mixed-effects logistic regression of the total study panel, a transition from no vision impairment to vision impairment was significantly associated with 1.37 times higher odds of a nursing home residence (95% CI: 1.05, 1.78), a 2.96 times higher odds of difficulty performing at least one ADL (95% CI: 2.71, 3.24), and a 4.02 times higher odds of difficulty performing at least one IADL (95% CI: 3.70, 4.37), after controlling for confounders. Discussion We found the estimated prevalence of visual impairment and functional limitations within our sample, and the association between the two, to remain relatively stable over time. Additionally, we found an age-adjusted transition to self-reported vision impairment within n in ividual to have significant detrimental effects on the ability to live independently and perform ADLs and IADLs without difficulty. Thus, prevention of this transition can substantially impact an individual's quality of life, and benefits derived from early detection and improved treatment of medical conditions that contribute to vision loss can have extensive value beyond simply improving vision.
Keywords: Health Conditions and Status; Healthcare; Public Policy; Retirement Planning and Satisfaction

Asset accumulation and labor force participation of disability insurance applicants - Shu, Pian (Journal of Public Economics, 2015)
This paper provides empirical evidence of the existence of forward-looking asset-accumulation behavior among disability-insurance applicants, previously examined only in the theoretical literature. Using panel data from the RAND Health and Retirement Study, I show that rejected applicants for Social Security Disability Insurance (SSDI) possess significantly more assets than accepted applicants immediately prior to application and exhibit lower attachment to the labor force. These empirical results are consistent with the theoretical prediction in Diamond and Mirrlees (1978) and Golosov and Tsyvinski (2006) that certain individuals with high unwillingness to work maximize utility by planning in advance for their future disability insurance application. Because the existing empirical literature on disability insurance does not account for this intertemporal channel, it may underestimate the total work-disincentive effect of SSDI. (C) 2015 Elsevier B.V. All rights reserved.
Keywords: Consumption and Savings; Disabilities; Employment and Labor Force; Health Conditions and Status; Net Worth and Assets; Other; Social Security; Women and Minorities

Associations of childhood adversity and adulthood trauma with C-reactive protein: A cross-sectional population-based study - Joy E. Lin; Thomas C Neylan; Elissa S Epel; Aoife O'Donovan (Brain, behavior, and immunity, 2015)
Mounting evidence highlights specific forms of psychological stress as risk factors for ill health. Particularly strong evidence indicates that childhood adversity and adulthood trauma exposure increase risk for physical and psychiatric disorders, and there is emerging evidence that inflammation may play a key role in these relationships. In a population-based sample from the Health and Retirement Study (n = 11,198, mean age 69. . 10), we examine whether childhood adversity, adulthood trauma, and the interaction between them are associated with elevated levels of the systemic inflammatory marker high sensitivity C-reactive protein (hsCRP). All models were adjusted for age, gender, race, education, and year of data collection, as well as other possible confounds in follow-up sensitivity analyses. In our sample, 67 of individuals had experienced at least one traumatic event during adulthood, and those with childhood adversity were almost three times as likely to have experienced trauma as an adult. Childhood adversities and adulthood traumas were independently associated with elevated levels of hsCRP ( = 0.03, p = 0.01 and = 0.05, p . 0.001, respectively). Those who had experienced both types of stress had higher levels of hsCRP than those with adulthood trauma alone, Estimate = -0.06, 95 CI -0.003, -0.12 , p = 0.04, but not compared to those with childhood adversity alone, Estimate = -0.06, 95 CI 0.03, -0.16 , p = 0.19. There was no interaction between childhood and adulthood trauma exposure. To our knowledge, this is the first study to examine adulthood trauma exposure and inflammation in a large population-based sample, and the first to explore the interaction of childhood adversity and adulthood trauma with inflammation. Our study demonstrates the prevalence of trauma-related inflammation in the general population and suggests that childhood adversity and adulthood trauma are independently associated with elevated inflammation.
Keywords: Health Conditions and Status

Bargaining Power, Parental Caregiving, and Intergenerational Coresidence - Liliana E Pezzin; Robert A. Pollak; Barbara Steinberg Schone (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2015)
Objective. To examine the effect of changes in parent child coresidence on caregiving decisions of non-resident siblings over a 5-year period while controlling for characteristics of the elderly parent and adult children in the family network.Method. We use difference-in-difference models applied to Health and Retirement Study-Assets and Health Dynamics of the Elderly data to test the hypothesis that the formation of a joint household between a parent and one of her children raises the bargaining power of non-resident siblings, who then reduce their care to the parent. Similarly, the dissolution of a parent child household is expected to increase the bargaining power of the child who no longer coresides with the parent relative to her siblings.Results. We find that children whose parent and sibling begin coresiding during the study period are less likely to provide care and provide fewer hours of care than children whose parents never coresided with a child. Adult children whose parent cease coresiding with a sibling, on the other hand, have a higher likelihood of providing care and provide significantly more hours of care relative to children whose parents either coresided with a sibling in both time periods or never coresided with a child.Discussion. Meeting the needs of the growing elderly population while maintaining them in the community is a particular focus of long-term care policy. To the extent that shared living is an important component of such care, the observed sensitivity of non-resident children s caregiving efforts has implications for the well-being of both disabled parents and their coresiding adult children.
Keywords: Adult children; Event History/Life Cycle; Health Conditions and Status; Healthcare; Public Policy

The Big Five Personality Factors as Predictors of Driving Status in Older Adults - Gadbois, Emily A.; Dugan, Elizabeth (Journal of Aging and Health, 2015)
Objective: Although factors including cognitive and health status have been associated with driving cessation in older adults, the role of psychosocial variables is not well studied. Previous research on young adult drivers has suggested that personality may be related to driving behavior, but this study is among the first to explore the relationship between driving status and the Big Five Model of personality for older adults. Method: Data are from the Health and Retirement Study (2008 wave, n = 4,028). Descriptive, bivariate, and multiple logistic regression analyses were conducted. Results: Neuroticism ( = 0.4511, p .001) and agreeableness ( = 0.5058, p .001) were associated with decreased likelihood of driving; extraversion ( = 0.4588, p .001), openness ( = 0.5903, p .001), and conscientiousness ( = 0.4077, p .001) were associated with increased likelihood of driving, although results were partially mediated by including known risk factors. People who limited their driving to nearby locations were the most different from those who no longer drove. Discussion: Personality adds a unique contribution to the prediction of late-life driving status.
Keywords: Health Conditions and Status

Binge drinking and insomnia in middle-aged and older adults: the Health and Retirement Study - Sarah L. Canham; Christopher N Kaufmann; Pia M Mauro; Ramin Mojtabai; Adam P Spira (International Journal of Geriatric Psychiatry, 2015)
Objective Alcohol use in later life has been linked to poor sleep. However, the association between binge drinking, which is common among middle-aged and older adults, and insomnia has not been previously assessed. Methods: We studied participants aged 50 years and older (n = 6027) from the 2004 Health and Retirement Study who reported the number of days they had 4 drinks on one occasion in the prior 3 months. Participants also reported the frequency of four insomnia symptoms. Logistic regression analyses assessed the association between binge drinking frequency and insomnia. Results Overall, 32.5 of participants had 0 to 2 binge drinking days/week; and 3.6 had 2 binge drinking days/week. After adjusting for demographic variables, medical conditions, body mass index, and elevated depressive symptoms, participants who binged 2 days/week had a 64 greater odds of insomnia than non-binge drinkers (adjusted odds ratio aOR = 1.64, 95 confidence interval CI = 1.09 2.47, p = 0.017). Participants reporting 0 to 2 binge days/week also had a 35 greater odds of insomnia than non-binge drinkers (aOR = 1.35, 95 CI = 1.15 1.59, p = 0.001). When smoking was added to the regression model, these associations fell just below the level of significance. Conclusions: Results suggest that binge drinking is associated with a greater risk of insomnia among adults aged 50 years and older, although this relationship may be driven in part by current smoking behavior. The relatively high prevalence of both binge drinking and sleep complaints among middle-aged and older populations warrants further investigation into binge drinking as a potential cause of late-life insomnia.
Keywords: Health Conditions and Status

Body weight status and onset of cognitive impairment among US middle-aged and older adults - Xiang, Xiaoling; An, Ruopeng (Archives of Gerontology and Geriatrics, 2015)
Objective: To examine the relationship between body weight status and onset of cognitive impairment among U.S. middle-aged and older adults. Methods: Study sample came from 1996 to 2010 waves of the Health and Retirement Study, consisting of 6739 community-dwelling adults born between 1931 and 1941 who were free from cognitive impairment in 1996. Body mass index (BMI) was calculated from self-reported height/weight. Cognitive impairment was defined by a composite score of 11 or lower on the immediate and delayed word recall, serial 7's, and backwards counting tests. Kaplan-Meier estimator and Cox proportional hazards model were performed to examine the association between base-year body weight status and future onset of cognitive impairment. Results: Compared with their normal weight counterparts, the unadjusted hazard ratio (HR) for cognitive impairment incidence was 2.03 (95 confidence interval: 1.38-3.00), 1.15 (1.02-1.29), 1.28 (1.14-1.43), and 1.59 (1.33-1.92) among underweight (BMI 18.5), overweight (25 = BMI 30), class I obese (30 = BMI 35), and class II obese or above (BMI = 35) participants, respectively. The unadjusted relationship between obesity and cognitive impairment onset appeared stronger among females than among males. After adjusting for base-year individual sociodemographics, functional limitations and chronic conditions, the estimated associations between body weight status and cognitive impairment were attenuated but remained statistically significant for underweight participants. Conclusion: Underweight is a robust risk factor for onset of cognitive impairment in later life. Weight management programs targeting middle-aged and older adults should focus on achieving and maintaining optimal body weight. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Health Conditions and Status

Body weight status and onset of functional limitations in U.S. middle-aged and older adults - An, Ruopeng; Shi, Yuyan (Disability and Health Journal, 2015)
AbstractBackground The sweeping obesity epidemic could further increase the incidence of functional limitations in the U.S. rapidly aging population. Objective To examine the relationship between body weight status and onset of functional limitations in U.S. middle-aged and older adults. Methods Study sample came from 1992 to 2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling middle-aged and older adults. Body mass index (BMI) was calculated from self-reported height/weight. Functional limitations were classified into physical mobility limitation (PM), large muscle function limitation (LMF), activities of daily living limitation (ADL), gross motor function limitation (GMF), and fine motor function limitation (FMF). Mixed-effect logistic regressions were performed to estimate the relationship between prior-wave body weight status and current-wave onset of functional limitations, adjusted for individual characteristics and survey design. Results Prior-wave body weight status prospectively predicted onset of functional limitation, and the relationship showed a U-shaped pattern. Compared with their normal weight counterparts, the odds ratios (ORs) in underweight (BMI andlt; 18.5) and obese (BMI 30) adults were 1.30 (95 confidence interval, 1.05 1.62) and 2.31 (2.11 2.52) for PM, 1.20 (0.96 1.50) and 1.63 (1.49 1.79) for LMF, 2.02 (1.66 2.46) and 1.40 (1.28 1.54) for ADL, 1.96 (1.60 2.39) and 1.77 (1.62 1.93) for GMF, and 1.66 (1.37 2.02) and 1.34 (1.22 1.46) for FMF, respectively. For PM, LMF and GMF, the impact of obesity appeared more pronounced in women, whereas that of underweight more pronounced in men. Conclusions Proper weight management during aging is crucial in preventing functional limitations in middle-aged and older adults.
Keywords: Demographics; Disabilities; Health Conditions and Status

Changes in Optimism Are Associated with Changes in Health Over Time Among Older Adults. - William J. Chopik; Eric S Kim; Jacqui Smith (Social Psychological and Personality Science, 2015)
Little is known about how optimism differs by age and changes over time, particularly among older adults. Even less is known about how changes in optimism are related to changes in physical health. We examined age differences and longitudinal changes in optimism in 9,790 older adults over a four-year period. We found an inverted U-shaped pattern between optimism and age both cross-sectionally and longitudinally, such that optimism generally increased in older adults before decreasing. Increases in optimism over a four-year period were associated with improvements in self-rated health and fewer chronic illnesses over the same time frame. The findings from the current study are consistent with changes in emotion regulation strategies employed by older adults and age-related changes in well-being.
Keywords: Health Changes; Health Conditions and Status; Older Adults; Optimism

Changes to the Social Patterning of Economic Resources and the Distribution of Mental and Biological Health Markers - Anusha M Vable (Harvard, 2015)
This dissertation examines the relationship between life course social mobility and socio-economic disparities in health using data from the Health and Retirement Study. Chapter 1 explores how eligibility for the Korean War GI Bill, which provided socio-economic benefits to veterans, impacted the mental health of veterans compared to non-veterans. Using coarsened exact matching (CEM) to rigorously control for selection into the military, Korean War era veterans were matched to non-veterans. Regression models were used to predict number of depressive symptoms (NDS) and an indicator for depression. Pooled results were null, however veterans from low socio-economic backgrounds benefited from military service while veterans from high socio-economic backgrounds did not, resulting in a reduction in socio-economic disparities in NDS and depression prevalence. Chapter 2 examines if the benefits from Korean War era military service had a spillover effect to wives of veterans. Using CEM, veteran wives were matched to wives of non-veterans. Pooled results were null, however, among women from high socio-economic backgrounds, veteran wives had fewer NDS than non-veteran wives; there was no effect of husband's military service among wives from low socio-economic backgrounds. Chapter 3 examines the relationship between life course social mobility and markers for stress (C-reactive protein), blood sugar (hemoglobin A1c), cholesterol (high density lipoprotein), and kidney function (Cystatin C). Results from linear regression models indicate that all outcomes followed a social gradient whereby individuals who experienced high SES at both time points had the best biomarker levels, while individuals who experienced low SES at both time points had the worst biomarker levels. Individuals who experienced upward mobility over the life course had statistically equivalent biomarker levels as individuals who experienced high SES at both time points, while individuals who experienced downward mobility had statistically equivalent biomarker levels as individuals who experienced low SES at both time points. These results suggest that the deleterious effects of a low SES childhood may be ameliorated or eliminated by upward social mobility in adulthood for these outcomes.
Keywords: Demographics; Event History/Life Cycle; Health Conditions and Status

The Changing Nature of the Retirement Transition for Dual Earning Couples (University of Maryland, College Park, 2015)
My dissertation examines how dual-earning couples navigate the retirement transition differently now that women's and men's work lives have become more similar. As the retirement transition has become more complex, understanding how and when people retire requires researchers and policymakers to be attuned to the family lives in which individuals are embedded. The decision to retire is an individual choice but one's family circumstances, particularly one's spouse, can influence the process. Couples must often factor in spouses' age, health, pension assets, and health insurance coverage, especially since the work lives of many women have become much more similar to men. Whereas men's retirement decisions were seen to depend on their employment situation and women's' on their husband's, women's rising attachment to the labor force means their work lives should be increasingly important in understanding the retirement transition of couples. This dissertation fills a gap in retirement research by utilizing a life course perspective to systematically study change across cohorts in how marital partners manage the retirement transition amidst rapid structural changes in the economy. Analyses use multiple waves of data from the Health and Retirement Study, applying a variety of modeling techniques to investigate the way that couples move from employment to retirement. Specifically, I focus on retirement expectations and timing, looking at whether dual earning couples influence and synchronize each other's retirement and how this may change across cohorts. Results suggest that coordination between couples may be declining, as both husbands and wives influence their respective partners' retirement expectations less in later cohorts. Analysis of the degree to which dual-earning couples synchronize their retirement expectations show that such couples expect to retire together when they both have the pension resources to do so. Results from event history models further indicate that the retirement trajectories have changed for the leading baby boom cohort, as evidence implies they are delaying retirement longer than previous cohorts. The findings provide mixed support for the notion that wives are influencing their husbands' retirement timing more in later cohorts or that the influence of husbands on wives' retirement timing has declined across cohorts.
Keywords: Adult children; Demographics; Employment and Labor Force; Event History/Life Cycle; Health Conditions and Status; Methodology; Pensions; Policy; Retirement Planning and Satisfaction

Childhood Conditions and Multimorbidity Among Older Adults - Gregory Pavela; Kenzie Latham (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2015)
Objectives. This research tests whether childhood conditions are associated with trajectories of chronic conditions among older adults.Methods. Using data from the Health and Retirement Study (1992 2008), a series of hierarchical linear models are used to estimate number of chronic conditions at survey midpoint and the rate of increase in chronic conditions across 18 years of data.Results. Results suggest that lower childhood socioeconomic status (SES) and poor childhood health are associated with increased number of chronic conditions; however, childhood SES is no longer associated with chronic conditions after adjustment for adult SES and adult health. Poor childhood health continues to be associated with total number of chronic conditions after adjustment for adult SES and health. Rate of change in chronic conditions was not associated with childhood conditions. Results from a multinomial logistic regression model further indicated that the association between childhood conditions and adult multimorbidity increased at higher levels of multimorbidity.Discussion. This research adds to the evidence that early life conditions have a lasting influence on adult health, and that their influence may be independent of adult health and SES.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status

Chronic Disease Diagnosis as a Teachable Moment for Health Behavior Changes Among Middle-Aged and Older Adults - Xiang, Xiaoling (Journal of Aging and Health, 2015)
Objective: To examine the impact of a new chronic disease diagnosis on substance use (i.e., smoking and drinking), utilization of preventive medical procedures, and physical activity among middle-aged and older adults. Method: Individual-level data came from 1996 to 2010 waves of the U.S. Health and Retirement Study. Disease diagnosis was ascertained from self-reports of physician-diagnosed diseases. A case-control difference-in-differences approach estimated in logistic regression was applied to test study hypotheses. Results: After a diagnosis of chronic disease, participants decreased substance use and increased utilization of preventive medical procedures. Physical activity declined after a diagnosis of lung disease, cancer, and stroke. Discussion: Chronic disease diagnosis may be an important teachable moment that can motivate individuals to adopt multiple risk-reducing health behaviors. Future research needs to elucidate the mechanisms through which disease diagnosis affects behaviors and test the modifying effect of time since diagnosis on intervention effectiveness.
Keywords: Health Conditions and Status; Other

Cigarette Taxes and Older Adult Smoking: Evidence from the Health and Retirement Study - Johanna Catherine Maclean; Asia Sikora Kessler; Donald S. Kenkel; Department of Economics (Temple University, 2015)
In this study we use the Health and Retirement Study (HRS) to test whether older adult smokers, defined as those 50 years and older, respond to cigarette tax increases. Our preferred specifications show that older adult smokers respond modestly to tax increases: a 1.00 (131.6 ) tax increase leads to a 3.8 to 5.2 reduction in cigarettes smoked per day (implied tax elasticity = -0.03 to -0.04). We identify heterogeneity in tax-elasticity across demographic groups as defined by sex, race/ethnicity, education, and marital status, and by smoking intensity and level of addictive stock. These findings have implications for public health policy implementation in an aging population.
Keywords: Consumption and Savings; Demographics; Employment and Labor Force; Health Conditions and Status; Public Policy; Women and Minorities

Cognitive Ability and the Stock Reallocations of Retirees during the Great Recession - Chris Browning; Michael S. Finke (Journal of Consumer Affairs, 2015)
Retirees are increasingly responsible for managing their retirement savings. The ability to manage these assets efficiently can have an important impact on retirement well-being. Lower levels of cognitive ability in old age can reduce an investor's ability to control emotional responses to a loss. Greater sensitivity to loss may increase preferences for safety following a market decline, resulting in allocations away from stocks that are associated with long-term underperformance. We investigate whether cognitive ability is related to stock reallocations among retirees during the Great Recession. Using the Health and Retirement Study, we find that cognitive ability is negatively related to allocations away from stock. Compared to those with the lowest levels of cognitive ability, respondents with higher cognitive ability are 40 less likely to reduce their stock allocation by 50 or more. These results suggest that the quality of investment decisions in old age may be compromised by cognitive decline.
Keywords: Health Conditions and Status; Net Worth and Assets; Public Policy; Retirement Planning and Satisfaction

Comorbidities, smoking status, and life expectancy among individuals eligible for lung cancer screening - Howard, David H.; Richards, Thomas B.; Bach, Peter B.; Kegler, Michelle C.; Berg, Carla J. (Cancer, 2015)
In the current study, the authors determine how the screening-eligible US population differs from National Lung Screening Trial participants in terms of characteristics that affect their ability to benefit from screening. The population eligible for lung cancer screening in the United States is older and more likely to have comorbidities and smoke, and has a shorter life expectancy than participants in the National Lung Screening Trial.
Keywords: Expectations; Health Conditions and Status

Computational approaches for intelligent processing of biomedical data - Mirina, Alexandra (Yeshiva University, 2015)
The rapid development of novel experimental techniques has led to the generation of an abundance of biological data, which holds great potential for elucidating many scientific problems. The analysis of such complex heterogeneous information, which we often have to deal with, requires appropriate state-of-the-art analytical methods. Here we demonstrate how an unconventional approach and intelligent data processing can lead to meaningful results. This work includes three major parts. In the first part we describe a correction methodology for genome-wide association studies (GWAS). We demonstrate the existing bias for the selection of larger genes for downstream analyses in GWA studies and propose a method to adjust for this bias. Thus, we effectively show the need for data preprocessing in order to obtain a biologically relevant result. In the second part, building on the results obtained in the first part, we attempt to elucidate the underlying mechanisms of aging and longevity by conducting a longevity GWAS. Here we took an unconventional approach to the GWAS analysis by applying the idea of genetic buffering. Doing this allowed us to identify pairs of genetic markers that play a role in longevity. Furthermore, we were able to confirm some of them by means of a downstream network analysis. In the third and final part, we discuss the characteristics of chronic lymphocytic leukemia (CLL) B-cells and perform clustering analysis based on immunoglobulin (Ig) mutation patterns. By comparing the sequences of Ig of CLL patients and healthy donors, we show that different Ig heavy chain (IGHV) regions in CLL exhibit similarities with different B-cell subtypes of healthy donors, which raised a question about the single origin of CLL cases.
Keywords: Genetics; Health Conditions and Status; Other

Correlates and Moderators of Change in Subjective Memory and Memory Performance: Findings from the Health and Retirement Study - Hueluer, Gizem; Hertzog, Christopher; Ann M. Pearman; Denis Gerstorf (Gerontology, 2015)
Aging researchers have long been interested in understanding individuals' subjective perceptions of their own memory functioning. Previous research has shown that subjective memory ratings are partly based on memory performance but also reflect the influence of other factors, such as depressive symptoms. The aim of the present study was to examine (1) longitudinal associations between trajectories of subjective memory and memory performance, (2) variables that predict levels of and changes in subjective memory and memory performance, and (3) variables that moderate associations between these constructs. We applied a latent growth curve model to four occasions of data from 15,824 participants of the Health and Retirement Study (HRS; mean age at baseline = 64.27 years, SD = 9.90; 58 women). Results revealed that latent changes in subjective memory were correlated with latent changes in memory performance (f = 0.49), indicating that participants who reported steeper declines of subjective memory indeed showed steeper declines of memory performance over time. Three major patterns of associations emerged with respect to predictors of subjective memory and subjective memory change. First, the level of memory performance showed stronger associations with age, gender, and education, whereas subjective memory was more strongly associated with subjective age and personality traits. For example, women performed better than men on the episodic memory test, but there were no gender differences in subjective memory. Also, older age was associated with steeper declines of memory performance but with less decline of subjective memory. Second, personality traits that predicted subjective memory intercepts did not predict subjective memory slopes. Third, the strength of associations between levels and slopes of subjective memory and memory performance varied as a function of gender, education, depressive symptoms, and personality traits. Conscientiousness moderated the relationship of the level of subjective memory to the level of memory performance, consistent with the hypothesis that persons high in conscientiousness more accurately monitor memory successes and failures. The results reinforce the importance of depressive symptoms as a predictor of subjective memory but also indicate that a broader perspective on the reasons why memory complaints have modest correlations with memory itself is needed. (C) 2015 S. Karger AG, Basel
Keywords: Demographics; Expectations; Health Conditions and Status

Covariance pattern mixture models for the analysis of multivariate heterogeneous longitudinal data - Anderlucci, Laura; Cinzia Viroli (Annals of Applied Statistics, 2015)
We propose a novel approach for modeling multivariate longitudinal data in the presence of unobserved heterogeneity for the analysis of the Health and Retirement Study (HRS) data. Our proposal can be cast within the framework of linear mixed models with discrete individual random intercepts; however, differently from the standard formulation, the proposed Covariance Pattern Mixture Model (CPMM) does not require the usual local independence assumption. The model is thus able to simultaneously model the heterogeneity, the association among the responses and the temporal dependence structure. We focus on the investigation of temporal patterns related to the cognitive functioning in retired American respondents. In particular, we aim to understand whether it can be affected by some individual socio-economical characteristics and whether it is possible to identify some homogenous groups of respondents that share a similar cognitive profile. An accurate description of the detected groups allows government policy interventions to be opportunely addressed. Results identify three homogenous clusters of individuals with specific cognitive functioning, consistent with the class conditional distribution of the covariates. The flexibility of CPMM allows for a different contribution of each regressor on the responses according to group membership. In so doing, the identified groups receive a global and accurate phenomenological characterization.
Keywords: Demographics; Health Conditions and Status; Methodology

Cumulative disadvantage: The role of childhood health and marital quality in the relationship between marriage and later life health - Zugarek, Gwendolyn R. E. (Sociology, 2015)
Married older adults tend to fare better in terms of health and mortality than those who are not married, and this association is especially pronounced for those with high marital quality. At the same time, childhood health is related to later life health outcomes. The aim of this study is to determine how much of the relationship between marriage, marital quality, and later life health can be explained by the long arm of childhood health. From the cumulative disadvantage theory, childhood health is linked to marriage and marital quality as well as later life health. Using the 2008-2010 Health and Retirement Study (N=13,620), I examine whether marital status and quality are related to self-rated health and cardiovascular disease net of childhood health. Marital quality is associated with later life health, net of childhood health and other factors. High marital quality is associated with a decrease in risk of poor self-rated health and low-quality marriage is related to an increased risk of cardiovascular conditions compared to the unmarried. Poor childhood health is associated with an increased health risk, but the relationship between marriage and health remains robust after controlling for childhood factors, indicating it is not spurious. Finally, there is no significant difference in how marital status and quality function for men and women.
Keywords: Adult children; Demographics; Health Conditions and Status

Depression and anxiety symptoms in male veterans and non-veterans: The Health and Retirement Study - Christine E Gould; Rideaux, T.; Adam P Spira; Sherry A. Beaudreau (International Journal of Geriatric Psychiatry, 2015)
Objectives: We examined whether veteran status was associated with elevated depression and anxiety symptoms in men aged 50 and older after adjusting for sociodemographic factors. Methods: Participants were 6577 men aged 50years and older who completed the 2006 wave of the Health and Retirement Study (HRS). Forty-nine percent of participants were veterans. A randomly selected subset of participants completed the HRS Psychosocial Questionnaire (N=2957), which contained the anxiety items. Elevated depression and anxiety symptoms were determined based on brief versions of Center for Epidemiologic Studies-Depression Scale (CES-D total score 4) and Beck Anxiety Inventory (BAI total score 12). Results: Elevated depression and anxiety symptoms were found in 11.0 and 9.9 of veterans, respectively, compared with 12.8 and 12.3 of non-veterans. Veteran status was not associated with increased odds of anxiety or depression symptoms in the multivariable-adjusted logistic regression analyses. Additional analyses indicated that Vietnam War veterans were more than twice as likely as World War II or Korean War veterans to have elevated depression symptoms (OR=2.15, 95 CI: 1.54-3.00) or anxiety symptoms (OR=2.12, 95 CI: 1.28-3.51). Conclusions: In a community-based sample of men aged 50 and older, veteran status was not associated with the presence of elevated depression and anxiety symptoms. Rather, these symptoms were associated with age, ethnicity, education, and medical conditions. Among veterans, cohort effects accounted for differences in psychiatric symptoms. Including younger cohorts from the Global War on Terror may yield different results in future studies.
Keywords: Demographics; Health Conditions and Status

Depression and onset of cardiovascular disease in the US middle-aged and older adults - Xiang, Xiaoling; An, Ruopeng (Aging and Mental Health, 2015)
Objectives: To examine the relationship between depression and onset of cardiovascular disease (CVD) among the US middle-aged and older adults. Methods: The study sample came from 1992-2010 waves of the Health and Retirement Study, a nationally representative longitudinal survey, consisting of 8597 community-dwelling adults aged 51-61 years old in 1992 with no CVD history. A score of 3 on the 8-item Center for Epidemiologic Studies Depression Scale was used to define clinically relevant depressive symptoms. Kaplan-Meier estimator and Cox proportional hazards model were performed to examine the association between baseline depressive symptoms and future CVD event. Subgroup analyses were conducted by sex and race/ethnicity. Results: Compared with their counterparts without clinically relevant depressive symptoms, adults with clinically relevant depressive symptoms in 1992 were 27 (hazard ratio HR = 1.27, 95 confidence interval = 1.17-1.39) more likely to report new diagnosis of CVD during the 18 years of follow-up. A significant dose-response relationship was present between severity of depressive symptoms and elevated CVD risk. The adjusted HRs for males and Hispanics appeared moderately larger than for their female and non-Hispanic white or African American counterparts, although the differences were not statistically significant. Conclusion: Holistic promotion of mental health through prevention, education, treatment, and rehabilitation is warranted to reduce CVD risk in the US middle-aged and older population.
Keywords: Health Conditions and Status; Healthcare; Risk Taking

Depressive Symptoms and Disability Risk Among Older White and Latino Adults by Nativity Status - Mary E Bowen; Ruch, Alexandra (Journal of Aging and Health, 2015)
Objective:To examine how the relationship between depressive symptoms and disability may vary by nativity status in later life. Method: This nationally representative prospective study of community-dwelling adults age 51 years and older in the Health and Retirement Study (1998-2010) used hierarchical linear modeling to examine how depressive symptoms (Center for Epidemiological Symptoms of Depression) and disability (instrumental activities of daily living IADL ; activities of daily living ADL ) vary by nativity status (U.S.- vs. foreign-born), accounting for changes in social support, health behaviors, and health conditions. Results: Depressive symptoms were associated with increased IADL and ADL disability among Latinos compared with Whites; foreign-born Latinos had lower than expected depressive symptom related IADL and ADL (0.82; p .001) disability. Discussion: Given that U.S.-born Latinos had similar or poorer depressive symptom related disability outcomes than Whites, interventions focused on early detection and treatment of depressive symptoms for this group are warranted and may improve disablement outcomes.
Keywords: Health Conditions and Status; Public Policy; Women and Minorities

Development and demonstration of a state model for the estimation of incidence of partly undetected chronic diseases - Ralph Brinks; Barbara H. Bardenheier; Annika Hoyer; Ji Lin; Sandra Landwehr; Edward W Gregg (BMC MEDICAL RESEARCH METHODOLOGY, 2015)
Background: Estimation of incidence of the state of undiagnosed chronic disease provides a crucial missing link for the monitoring of chronic disease epidemics and determining the degree to which changes in prevalence are affected or biased by detection. Methods: We developed a four-part compartment model for undiagnosed cases of irreversible chronic diseases with a preclinical state that precedes the diagnosis. Applicability of the model is tested in a simulation study of a hypothetical chronic disease and using diabetes data from the Health and Retirement Study (HRS). Results: A two dimensional system of partial differential equations forms the basis for estimating incidence of the undiagnosed and diagnosed disease states from the prevalence of the associated states. In the simulation study we reach very good agreement between the estimates and the true values. Application to the HRS data demonstrates practical relevance of the methods. Discussion: We have demonstrated the applicability of the modeling framework in a simulation study and in the analysis of the Health and Retirement Study. The model provides insight into the epidemiology of undiagnosed chronic diseases.
Keywords: Health Conditions and Status; Methodology

Diagnosis and control of hypertension in the elderly populations of Japan and the United States - Saito, Yasuhiko; Davarian, Shieva; Takahashi, Atsuhiko; Schneider, Edward; Eileen M. Crimmins (International Journal of Population Studies, 2015)
The Japanese have the highest life expectancy in the world while the United States (U.S.) has relatively low life expectancy. Furthermore, the Americans have relatively poorer health compared to the Japanese. Examination of the treatment of specific conditions such as hypertension in these two countries may provide insights into how the health care system con-tributes to the relative health in these two countries. In this study, we focus on the treatment of hypertension, as this is the most common condition requiring therapeutic interventions in se-niors. This study examines hypertension diagnoses and controls in nationally representative samples of the older populations (68 years old or older) of Japan and the U.S. Data come from two nationally representative samples: the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) (n = 2,309) and the U.S. Health and Retirement (HRS) Study (n = 3,517). The overall prevalence of hypertension is higher in Japan than the U.S. Undiagnosed hyperten-sion is about four times higher in Japan than in the U.S., while the control of blood pressure is more than four times higher in the U.S. than in Japan. Thus, the use of antihypertensive medi-cation is much more frequent and more effective in the U.S. The medical care system seems to be more effective in controlling hypertension in the U.S. than in Japan. This may be due to the more aggressive diagnosis and treatment of hypertension in the U.S.
Keywords: Blood pressure; Cross-National; Health Conditions and Status; Heart disease; Hypertension; Older Adults

Did the Great Recession Influence Retirement Plans? - Maximiliane E Szinovacz; Adam Davey; Lauren Martin (Research on Aging, 2015)
The recent recession constitutes one of the macro forces that may have influenced workers retirement plans. We evaluate a multilevel model that addresses the influence of macro-, meso-, and micro-level factors on retirement plans, changes in these plans, and expected retirement age. Using data from Waves 8 and 9 of the Health and Retirement Study (N = 2,618), we find that individuals with defined benefit plans are more prone to change toward plans to stop work before the stock market declined, whereas the opposite trend holds for those without pensions. Debts, ability to reduce work hours, and firm unionization also influenced retirement plans. Findings suggest retirement planning education may be particularly important for workers without defined pensions, especially in times of economic volatility.
Keywords: Employment and Labor Force; Health Conditions and Status; Pensions; Retirement Planning and Satisfaction

Disability-Free Life-Years Lost Among Adults Aged ≥50 Years, With and Without Diabetes - Barbara H. Bardenheier; Ji Lin; Zhuo, Xiaohui; Mohammed K. Ali; Theodore J Thompson; Yiling J. Cheng; Edward W Gregg (Diabetes Care, 2015)
OBJECTIVE Quantify the impact of diabetes status on healthy and disabled years of life for older adults in the U.S. and provide a baseline from which to evaluate ongoing national public health efforts to prevent and control diabetes and disability.RESEARCH DESIGN AND METHODS Adults (n = 20,008) aged 50 years and older were followed from 1998 to 2012 in the Health and Retirement Study, a prospective biannual survey of a nationally representative sample of adults. Diabetes and disability status (defined by mobility loss, difficulty with instrumental activities of daily living IADL , and/or difficulty with activities of daily living ADL ) were self-reported. We estimated incidence of disability, remission to nondisability, and mortality. We developed a discrete-time Markov simulation model with a 1-year transition cycle to predict and compare lifetime disability-related outcomes between people with and without diabetes. Data represent the U.S. population in 1998.RESULTS From age 50, adults with diabetes died 4.6 years earlier, developed disability 6 7 years earlier, and spent about 1 2 more years in a disabled state than adults without diabetes. With increasing baseline age, diabetes was associated with significant (P 0.05) reductions in the number of total and disability-free life-years, but the absolute difference in years between those with and without diabetes was less than at younger baseline age. Men with diabetes spent about twice as much of their remaining years disabled (20 24 of remaining life across the three disability definitions) as men without diabetes (12 16 of remaining life across the three disability definitions). Similar associations between diabetes status and disability-free and disabled years were observed among women.CONCLUSIONS Diabetes is associated with a substantial reduction in nondisabled years, to a greater extent than the reduction of longevity.
Keywords: Health Conditions and Status; Methodology

Do Physical Activity, Smoking, Drinking, or Depression Modify Transitions from Cognitive Impairment to Functional Disability? - Pamela M. Rist; Jessica R Marden; Benjamin D Capistrant; Bei Wu; M. Maria Glymour (Journal of Alzheimer's Disease, 2015)
Background: Individual-level modifiers can delay onset of limitations in basic activities of daily living (ADLs) among cognitively impaired individuals. We assessed whether these modifiers also delayed onset of limitations in instrumental ADLs (IADLs) among individuals at elevated dementia risk. Objectives: To determine whether modifiable individual-level factors delay incident IADL limitations among adults stratified by dementia risk. Methods: Health and Retirement Study participants aged 65 without activity limitations in 1998 or 2000 (n = 5,219) were interviewed biennially through 2010. Dementia probability, categorized in quartiles, was used to predict incident IADL limitations with Poisson regression. We estimated relative (risk ratio) and absolute (number of limitations) effects from models including dementia, individual-level modifiers (physical inactivity, smoking, no alcohol consumption, and depression) and interaction terms between dementia and individual-level modifiers. Results: Dementia probability quartile predicted incident IADL limitations (relative risk for highest versus lowest quartile = 0.44; 95 CI: 0.28 0.70). Most modifiers did not significantly increase risk of IADL limitations among the cognitively impaired. Physical inactivity (RR = 1.60; 95 CI: 1.16, 2.19) increased the risk of IADL limitations among the cognitively impaired. The interaction between physical inactivity and low dementia probability was statistically significant (p = 0.009) indicating that physical inactivity had significantly larger effects on incident IADLs among cognitively normal than among those with high dementia probability. Conclusion: Physical activity may protect against IADL limitations while smoking, alcohol consumption, and depression do not afford substantial protection among the cognitively impaired. Results highlight the need for extra support for IADLs among individuals with cognitive losses.
Keywords: Disabilities; Health Conditions and Status; Healthcare

Does Age-Related Decline in Ability Correspond with Retirement Age? - Belbase, Anek; Geoffrey T. Sanzenbacher; Gillis, Christopher M. (Center for Retirement Research at Boston College, 2015)
While declines in physical and mental performance are inevitable as workers age, they are not uniform across the various systems of the body – some physical and cognitive abilities decline much earlier than others. This variance implies that workers in occupations that rely on skills that decline early may be unable to work until late ages, even as policy changes like increases in the Full Retirement Age (FRA) encourage them to. Researchers often estimate models of early retirement that include a control for whether a worker is in a blue-collar job – basically assuming that less-physical white-collar work allows longer careers. But this assumption ignores the fact that even workers in white-collar occupations may find themselves relying on skills that have declined. This paper instead reviews the literature on aging and constructs a Susceptibility Index meant to reflect how susceptible an occupation is to declines in ability, regardless of whether the occupation relies on physical abilities (as blue-collar occupations do) or cognitive ones.
Keywords: Bridge employment; Cognitive Ability; Health Conditions and Status; Older Adults; Physical Ability; Retirement Planning and Satisfaction

Does Investors' Personality Influence Their Portfolios? - Alessandro Bucciol; Luca Zarri (Tilburg, Netherlands, Netspar, 2015)
Based on large-scale survey data from the 2006-2012 waves of the US Health and Retirement Study (HRS) we show that individual portfolio decisions are influenced by a variety of traits and facets traditionally investigated in the field of personality psychology. Two personality traits that taken together depict a self-centered personality profile have the most significant impact on financial risk taking: lower Agreeableness and higher Cynical Hostility predict higher willingness to take risks. The effects of Agreeableness seem to pass through the preferences rather than the beliefs channel. Our findings shed new light on the non-cognitive side of individuals risk taking.
Keywords: Health Conditions and Status; Methodology; Net Worth and Assets; Risk Taking

Does Mode of Contact with Different Types of Social Relationships Predict Depression in Older Adults? Evidence from a Nationally Representative Survey - Alan R Teo; Choi, Hwajung; Sarah B. Andrea; Marcia A. Valenstein; Jason T Newsom; Dobscha, Steven K.; Zivin, Kara (Journal of the American Geriatrics Society, 2015)
ObjectivesTo determine associations between use of three different modes of social contact (in person, telephone, written or e-mail), contact with different types of people, and risk of depressive symptoms in a nationally representative, longitudinal sample of older adults. DesignPopulation-based observational cohort. SettingUrban and suburban communities throughout the contiguous United States. ParticipantsIndividuals aged 50 and older who participated in the Health and Retirement Survey between 2004 and 2010 (N = 11,065). MeasurementsFrequency of participant use of the three modes of social contact with children, other family members, and friends at baseline were used to predict depressive symptoms (measured using the eight-item Center for Epidemiologic Studies Depression Scale) 2 years later using multivariable logistic regression models. ResultsProbability of having depressive symptoms steadily increased as frequency of in-personbut not telephone or written or e-mail contactdecreased. After controlling for demographic, clinical, and social variables, individuals with in-person social contact every few months or less with children, other family, and friends had a significantly higher probability of clinically significant depressive symptoms 2 years later (11.5 ) than those having in-person contact once or twice per month (8.1 ; P .001) or once or twice per week (7.3 ; P .001). Older age, interpersonal conflict, and depression at baseline moderated some of the effects of social contact on depressive symptoms. ConclusionFrequency of in-person social contact with friends and family independently predicts risk of subsequent depression in older adults. Clinicians should consider encouraging face-to-face social interactions as a preventive strategy for depression.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Does Neighborhood Disorder Predict Recovery From Mobility Limitation? Findings From the Health and Retirement Study - Kenzie Latham; Monica M Williams (Journal of Aging and Health, 2015)
Objective: This research explores whether perceptions of physical neighborhood disorder predict recovery from mobility limitation over a 2-year period and examines whether psychosocial factors (i.e., depressive symptomology and mastery) and physical activity are salient mediators. Method: Using data from the Health and Retirement Study (HRS): Participant Lifestyle Questionnaire (2008-2010), odds ratio estimates of recovery were ascertained using binary logistic regression, and post hoc Sobel tests were conducted to formally assess mediation. Results: Net of demographic characteristics and socioeconomic status, increased neighborhood disorder was associated with lower odds of recovery. However, both psychosocial indicators and physical activity were significant individual partial mediators, which suggest neighborhood disorder influences recovery from physical impairment via psychosocial processes and barriers to physical activity. Discussion: Reducing neighborhood disorder may enhance older residents' psychosocial well-being and improve participation in physical activity, thus increasing recovery from mobility limitation and preventing subsequent disability.
Keywords: Demographics; Disabilities; Health Conditions and Status; Other; Public Policy

Does prescription drug coverage improve mental health? Evidence from Medicare Part D - Padmaja Ayyagari; Dan M. Shane (Journal of Health Economics, 2015)
The introduction of the Medicare Prescription Drug program (Part D) in 2006 resulted in a significant increase in access to coverage for older adults in the U.S. Several studies have documented the impact of this program on prescription drug utilization, expenditures and medication adherence among older adults. However, few studies have evaluated the extent to which these changes have affected the health of seniors. In this study we use data from the Health and Retirement Study to identify the impact of the Medicare Part D program on mental health. Using a difference-in-difference approach, we find that the program significantly reduced depressive symptoms among older adults. We explore the mechanisms through which this effect operates and evaluate heterogeneity in impact. (C) 2015 Elsevier B.V. All rights reserved.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

Does Retirement Impact Health Care Utilization? - Norma B Coe; Gema Zamarro (Los Angeles, CA, Center for Economic and Social Research, University of Southern California, 2015)
The objective of this paper is to estimate the causal effect of retirement on health care utilization. To do so, we use data from the 1992-2008 waves of the Health and Retirement Study (HRS) and the 2004-2006 waves of the Survey of Health, Aging, and Retirement in Europe (SHARE).In particular, we estimate the causal impact of retirement on health care utilization as measured by: doctor visits, visits to a general practitioner, nights in the hospital, and preventative care use. This paper uses panel data and instrumental variable methods, exploiting variation in statutory retirement ages across countries, to estimate the causal effects. Cross-country comparisons allow us to examine the role of a health care system s use of the general practitioner as a gate keeper to specialists in this relationship. We find that while retirement is associated with increased health care use, our causal estimates show that retirement leads to fewer doctor visits in both the US and continental Europe. Nights in the hospital are unaffected by retirement status. Further we find that health care systems with primary care physicians who act as gatekeepers are particularly effective at decreasing doctor visits at retirement. Therefore, we conclude that increasing the statutory retirement age to help the solvency of the retirement systems will also increase doctor visits as individuals continue to work longer. In the US, the burden of this increased utilization will likely be borne by private insurance companies and public insurance to the extent it covers working individuals in their 60 s. European evidence suggests that this increase in doctor visits due to delayed retirement will be particularly evident in health systems without strong gatekeeper roles for general practitioners.
Keywords: Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

Does Retirement Improve Health and Life Satisfaction? - Gorry, Aspen; Gorry, Devon; Sita Nataraj Slavov (2015)
We utilize panel data from the Health and Retirement Study to investigate the impact of retirement on physical and mental health, life satisfaction, and health care utilization. Because poor health can induce retirement, we instrument for retirement using eligibility for Social Security and employer sponsored pensions and coverage by the Social Security earnings test. We find strong evidence that retirement improves both health and life satisfaction. While the impact on life satisfaction occurs within the first 4 years of retirement, many of the improvements in health show up 4 or more years later, consistent with the view that health is a stock that evolves slowly. We find little evidence that retirement influences health care utilization.
Keywords: Health Conditions and Status; Pensions; Public Policy; Retirement Planning and Satisfaction; Social Security

An Economic Perspective on Personality Traits and Alcohol Misuse: Evidence from the Health and Retirement Study - Asia Sikora Kessler; Johanna Catherine Maclean (Journal of Mental Health Policy and Economics, 2015)
Background: Recent economic work suggests a role for personality traits in determining socioeconomic outcomes. Much of this work has considered labor market outcomes, human capital accumulation, and, to some extent, health outcomes. No economic studies have explored the role of the Big Five taxonomy in alcohol use and misuse. Given defining characteristics of the Big Five, they are plausibly linked with these outcomes. Alcohol misuse is associated with large social costs through healthcare costs, traffic fatalities, violence, and reduced labor market productivity. Thus, understanding risk factors for such use is warranted. Aims of the Study: To investigate the associations between the Big Five, and measures of alcohol use and alcohol misuse. Methods: We obtain data on older adults 50 years and older from the Health and Retirement Study (HRS). Our outcomes include one measure of use (any use) and two measures of misuse (heavy drinking and binge drinking). Comparing across different measures of alcohol consumption can shed light on whether the Big Five are related to moderate alcohol use that need not impose social costs or alcohol misuse that may indeed impose such costs. A randomly selected sub-set of respondents completed a self-administered questionnaire developed for the Midlife Development Inventory in either the 2006 or 2008 round of the HRS. We use information collected in this instrument to generate our independent variables of primary interest: agreeableness, openness, extraversion, neuroticism, and conscientiousness traits. Results: We find that the Big Five personality traits are linked with measures of both alcohol use and alcohol misuse. We observe substantial heterogeneity in the associations by personality traits. Specifically, agreeableness is associated with increased risk for alcohol use/misuse while extraversion and openness are negatively associated with risk for these patterns of alcohol consumption. We find no evidence that neuroticism or contentiousness predict alcohol use and misuse. We identify heterogeneity in the associations across demographic characteristics. Discussion: We find associations between the Big Five and our measures of alcohol use and alcohol misuse. Our findings are subject to several data limitations, however. Although the Big Five personality taxonomy is well utilized, it has known limitations. Even in a survey as rich as the HRS, it is likely that we are unable to control for all important variables leading to omitted variable bias. Because we focus on a sample of older adults, the generalizability of our findings to other demographic groups is not clear. Implications for Healthcare Provision and Use: Agreeableness is significantly associated with alcohol use and misuse, which could lead to greater utilization of healthcare services and thus increased costs to the healthcare system. Implication for Health Policies: Healthcare providers should consider aspects of personality when developing and communicating treatment options. Moreover, psychology and economic work documents that interventions can alter aspects of personality even among older adults. Further research on and implementation of effective interventions may be warranted. Implications for Further Research: Future studies should examine the implications of personality for a broader range of outcomes. Survey administrators could consider including validated measures of personality in surveys to facilitate such research.
Keywords: Employment and Labor Force; Health Conditions and Status; Public Policy

Education, glucose control, and mortality risks among US older adults with diabetes - Matthew E Dupre; Silberberg, Mina; Willis, Janese M.; Feinglos, Mark N. (Diabetes Research and Clinical Practice, 2015)
Aims: Studies have shown that diabetes mellitus disproportionately afflicts persons of low socioeconomic status and that the burden of disease is greatest among the disadvantaged. However, our understanding of educational differences in the control of diabetes and its impact on survival is limited. This study investigated the associations among education, hemoglobin A(1c) (HbA(1c)), and subsequent mortality in adults with diabetes. Methods: Prospective cohort data from the 2006, 2008, and 2010 Health and Retirement Study were linked with biomarker data for U.S. older adults with diabetes (n = 3312). Weighted distributions were estimated for all subjects at baseline and by the American Diabetes Association's general guidelines for HbA(1c) control ( 7.0 53 mmol/mol vs. = 7.0 53 mmol/mol ). Proportional hazard models were used to estimate educational differences in all-cause mortality by HbA(1c) level with sequential adjustments for contributing risk factors. Results: Mortality risks associated with HbA1c = 7.0 53 mmol/mol were significantly greater in lower-educated adults than higher-educated adults (P 0.001). We found that the hazard ratios (HR) associated with HbA(1c) = 7.0 53 mmol/mol were highest among low-educated adults (HR = 2.18, 95 CI: 1.62, 2.94) and that a combination of socioeconomic, psychosocial, and behavioral factors accounted for most, but not all, of the associations. Conclusions: Educational differences in HbA(1c) control have significant implications for mortality and efforts to reduce these disparities should involve more vigilant screening and monitoring of lower-educated adults with diabetes. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Demographics; Health Conditions and Status; Methodology; Risk Taking

The Effect of Health Reform on Retirement - Helen G Levy; Thomas Buchmueller; Sayeh Nikpay (University of Michigan Retirement Research Center (MRRC) Working Paper, 2015)
Many studies have shown that the availability of health insurance is an important determinant of the retirement decision. Beginning in January 2014, the Affordable Care Act (ACA) made affordable alternatives to employer-sponsored health insurance much more widely available than they had been previously through the establishment of health insurance exchanges and, in some states, the expansion of Medicaid eligibility to low-income, childless adults. We analyze whether these new health insurance options led to an increase in retirement or part-time work among individuals ages 55 through 64 during the first 18 months after the policy took effect. Using data from the basic monthly Current Population Survey from January 2005 through June 2015, we find that there was no increase in retirement in 2014 either overall or in Medicare expansion states relative to nonexpansion states. We also find no change in the fraction of older workers who are working part-time.
Keywords: Health Conditions and Status; Health Shocks; Medicare/Medicaid/Health Insurance; Older Adults; Retirement Planning and Satisfaction

The effects of housing wealth on education and other essays in empirical microeconomics - Ruddy, Ryan (University of Houston, 2015)
This dissertation is composed of three essays. The first essay, Family Resources and Secondary Education Investment: Evidence From the Housing Boom uses plausibly exogenous home price increases during the housing boom in the late 1990's and early 2000's to identify the effect of family resources on investment in secondary education. Exploiting the large spatial and timing variation of home price changes during this period, I find the average home price increase lowered the probability of dropping out of high school by age 19 by 1 percentage point, a 10% reduction. Consistent with an increased expectation of ability to pay for college, home price increases also raised the probability of completing a college preparatory curriculum and attending college. Students who reported low grades in eighth grade respond the strongest to home price increases suggesting that merit-based scholarship programs might be less beneficial than scholarship programs which are not contingent on ability. Black students of all ability levels are more likely to remain in high school in response to a home price increase. A mean change in home price decreased the probability of black students dropping out by 20%. The second chapter, The Effect of Housing Wealth on Labor Market Outcomes and Behavior , expands on the findings of Chapter 1 and previous literature that found a link between housing wealth and education by examining the impact of home wealth on adult labor market outcomes and behavior. Using the NLSY97, I measure the effect of a change in home price while in high school on income at age 26, job industry, criminal behavior, and community participation. I find evidence that home wealth shocks increase the probability of holding white collar jobs, increase wages, and positively impact behavior outcomes. These effects are likely manifesting through the increased education found in previous work. The final chapter examines the effect of the introduction of Sildenafil (Viagra) on marriage rates for elderly men in the United States. I exploit the sudden introduction and rise of Viagra use along with the difficulty in obtaining Viagra prescriptions for men with heart problems or history of stroke in a difference in difference framework to find the effect of Viagra on marriage rates. I find that men physically able to take Viagra which married prior to the introduction of Viagra were more likely to remain in their current marriage or enter a new marriage after Viagra's introduction. Furthermore, I find no evidence that the marital behavior of women was altered by health conditions at the time of Viagra's introduction.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Other; Public Policy; Women and Minorities

Effects of social security policies on benefit claiming, retirement and saving - Alan L Gustman; Thomas L. Steinmeier (Journal of Public Economics, 2015)
An enhanced version of a structural model jointly explains benefit claiming, wealth and retirement, including reversals from states of lesser to greater work. The model is estimated with Health and Retirement Study data. Alternative beliefs about the future of Social Security affect claiming behavior. Effects of three potential policies are also examined: increasing the early entitlement age, increasing the full retirement age, and eliminating the payroll tax for seniors. Predicted responses to increasing the full entitlement age are sensitive to beliefs. 2015 Elsevier B.V.
Keywords: Consumption and Savings; Event History/Life Cycle; Health Conditions and Status; Methodology; Pensions; Retirement Planning and Satisfaction; Social Security

Engagement in activities and cognitive functioning among older adults in the health and retirement study - May, Pamela E. (Psychology, 2015)
The goal of this dissertation is to examine the effect of cognitive and social activities on cognitive performance and health conditions in a national sample of older adults from the Health and Retirement Study (HRS). This dissertation first aimed to identify longitudinal relations between activity frequency and cognitive functioning. Two hypotheses were tested, baseline activity frequency predicts change in cognitive functioning over time, and baseline cognitive performance predicts change in activity frequency over time. The dissertation's second aim was to identify links between activity frequency and cognitive trajectories. The third aim was to identify longitudinal relations between activity frequency and overall health. Changes in cognitive functioning and health were also compared simultaneously over three time points, to identify causal relations. The sample included 3,397 respondents aged ? 60 years old from the Health and Retirement Study's 2008, 2010, and 2012 waves. Respondents completed brief cognitive tests and items regarding their health during each wave, as well as items ranking frequency of engagement in cognitive and social activities in 2008 and 2012. A series of structural equation models were implemented to test the aforementioned aims. A paucity of significant findings precluded a comparison between the two hypothesized models on activity frequency and cognitive functioning, as well as between the two contrasting models for activity frequency and overall health. Activity frequency did not significantly predict rate of change in cognitive performance or health conditions over time. Activity frequency also did not significantly change over time. However, frequency of baseline cognitive activity was associated with initial level of episodic memory. Further, a lower frequency of cognitive activities was associated with a higher number of health conditions at baseline, when education was not included in the model. Relations between health and cognition were not consistently indicated over time, suggesting that health conditions may not have strong causal effects on age-related changes in cognitive functioning. Significant associations between baseline activity engagement and initial level of episodic memory and health conditions does not allow one to rule out the protective effect of activity engagement on cognition and overall health.
Keywords: Demographics; Event History/Life Cycle; Health Conditions and Status; Healthcare; Methodology

The English are healthier than the Americans: really? - Cieza, Alarcos; Oberhauser, Cornelia; Bickenbach, Jerome; Richard N Jones; Tevfik Bedirhan Üstün; Kostanjsek, Nenad; John N Morris; Chatterji, Somnath (International Journal of Epidemiology, 2015)
Background: When comparing the health of two populations, it is not enough to compare the prevalence of chronic diseases. The objective of this study is therefore to propose a metric of health based on domains of functioning to determine whether the English are healthier than the Americans.Methods: We analysed representative samples aged 50 to 80 years from the 2008 wave of the Health and Retirement Study (N = 10 349) for the US data, and wave 4 of the English Longitudinal Study of Ageing (N = 9405) for English counterpart data. We first calculated the age-standardized disease prevalence of diabetes, hypertension, all heart diseases, stroke, lung disease, cancer and obesity. Second, we developed a metric of health using Rasch analyses and the questions and measured tests common to both surveys addressing domains of human functioning. Finally, we used a linear additive model to test whether the differences in health were due to being English or American.Results: The English have better health than the Americans when population health is assessed only by prevalence of selected chronic health conditions. The English health advantage disappears almost completely, however, when health is assessed with a metric that integrates information about functioning domains.Conclusions: It is possible to construct a metric of health, based on data directly collected from individuals, in which health is operationalized as domains of functioning. Its application has the potential to tackle one of the most intractable problems in international research on health, namely the comparability of health across countries.
Keywords: Cross-National; Health Conditions and Status; Healthcare; Methodology

Essays on the economics of aging - Zhao, Zhendong (Economics, 2015)
The increase in life expectancy in the US and the changing labor supply of older workers have raised issues about the fiscal solvency of health care and pension systems, as well as labor market stability and employment opportunities for younger workers. In light of these facts, this dissertation consists of three essays that focus on the economic causes and consequences of changes in the labor supply of older workers due to population aging. The first essay examines the effect of longevity on older Americans' labor supply decisions of retirement and un-retirement. Instead of using self-rated survival probabilities as the proxy of longevity expectations, I use data from the Health and Retirement Study to predict longevity from a Gompertz survival model with a rich set of variables including parental mortality information, current health and socio-economic variables. I find that the predicted longevity fits actual longevity better than subjective survival rates. Using predicted longevity as one of the independent variables in a sequential logit model of retiring and un-retiring, I find that individuals retire and re-enter the labor market as if they knew their true potential longevity, i.e., individuals with higher predicted objective longevity retire later, and are more likely to return to the labor market after initial retirement. I further investigate the consequences of extreme mismatch between subjective survival rates and objective longevity implied by the model's prediction, and I find that the misperception leads to retirees' sub-optimal saving behaviors. The second essay makes an effort to explore the theoretical foundation for the mechanism through which the risk of mortality affects individuals' decisions about work. I construct a life-cycle model of labor supply with health investment and heterogeneous risk of mortality. The heterogeneity in mortality risk is modeled as a frailty parameter which shifts the mortality hazard proportionally. Individuals can invest in health in order to recover from an adverse health shock and revert the high propensity of death which they were born with. I estimate and calibrate the model using data from Health and Retirement Survey. I simulate the life cycle path of labor supply for two groups of representative individuals under the same condition except for different survival curves, one in year 2000 and one projected in 2100 where life expectancy is predicted to be increased by 9 years. I find that in a more favorable survival environment, individuals would choose to work more and spend more on health. The third essay examines a natural follow-up question about the consequence of a larger labor supply of older workers: does the higher labor force participation rate of the elderly crowd out employment opportunities of younger workers? I utilize the Social Security "Notch", a reduction in Social Security benefits for cohorts born after 1916 due to the 1977 Amendments, as an exogenous policy change to identify the effect on younger workers' employment. Using data from Current Population Survey from 1972 to 1981, I do not find any significant crowding-out effect of the notch generation on younger workers age 25-39. I further investigate the variations in different occupational categories and find that changes in employment rates of younger workers vary across occupations. Last, I do not find significant suppressing effect of increasing labor supply of older workers on younger workers' wage income.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Estimating the Cognitive Effects of Prevalent Diabetes, Recent Onset Diabetes, and the Duration of Diabetes among Older Adults - Bei Wu; Eric J. Tchetgen Tchetgen; Theresa L Osypuk; Weuve, Jennifer; White, Kellee; Mujahid, Mahasin; M. Maria Glymour (Dementia and Geriatric Cognitive Disorders, 2015)
Background: Little evidence is available on the effects of incident diabetes or diabetes duration on cognitive aging. Methods: We evaluated the effects of prevalent and incident diabetes on deteriorations in cognitive function, based on participants (n = 8,671) aged 65 in the Health and Retirement Study in 2000. Inverse probability weighting was used to account for selective attrition and time-varying confounding of incident diabetes. Results: Prevalent diabetes predicted higher odds of dementia odds ratio 1.27; 95 confidence interval (CI) 1.03-1.58 and worse memory (-0.06 in z-score units; 95 CI -0.10 to -0.02), but incident diabetes or diabetes duration up to 8 years of follow-up was not predictive. Conclusion: Prevalent diabetes predicted lower cognition but not recent onset diabetes. (C) 2015 S. Karger AG, Basel
Keywords: Health Conditions and Status

Evidence of Increasing Differential Mortality: A Comparison of the HRS and SIPP - Barry Bosworth; Zhang, Kan (Boston College, 2015)
This paper uses data from the Survey of Income and Program Participation (SIPP) and the Health and Retirement Study (HRS) to explore the extent of a widening in life expectancies by socioeconomic status (SES) for older persons. We construct four alternative measures of SES, using educational attainment, average (career) earnings in the prime working ages of 41-50, wealth, and occupational classifications. The paper finds that: There is strong statistical evidence in both the SIPP and HRS of a growing inequality of mortality risk by SES across birth cohorts from 1910 to 1961. Growing inequality in mortality risk is evident using all four indicators of SES, but it is strongest for the measures based on career earnings and educational attainment. The secular changes in differential mortality are very large, but their influence on the length of time for which people receive benefits has been dampened by legal restrictions on early retirement for low-SES individuals and by voluntary postponement of retirement at the top of the distribution. Self-reported health status is a highly significant predictor of mortality risk, but its inclusion in the statistical models has only a marginal effect on the evidence of differential mortality operating through the various SES indicators. The combination of survey measures of the various SES indicators and the administrative records covering earnings, death records, and OASDI benefits provides a particularly large and rich data set for the analysis of mortality experience and its implications for the distribution of benefits. The policy implications of the findings are: Indexing the retirement age to increases in average life expectancy to stabilize OASDI finances may have substantial unintended distributional consequences, because most mortality gains have been concentrated among workers with relatively high SES.
Keywords: Demographics; Health Conditions and Status; Public Policy

Familial Caregiving and Timing of Retirement: A Gendered Cohort Analysis - Rachel R Stoiko (West Virginia University, 2015)
Retirement timing has been linked to a host of outcomes for individuals, families, and communities. Well-known predictors of retirement timing include health, wealth, and cognitive capacity; a few studies have also linked gender and family caregiving to retirement timing. In the present study, data from the Health and Retirement Study were used to create profiles of pre-retirement family caregiving (operationalized as time and financial transfers to participants' aging parents and adult children). These profiles, as well as participant gender and cohort, were used to predict later retirement timing. All profiles retired, on average, earlier than their full eligibility for Social Security benefits. The Eldercare profile, which was characterized by high levels of time and financial transfers to aging parents, retired the earliest. On average, women retired earlier than men. Members of the War Babies cohort (b. 1941-1947) retired earlier than members of the HRS cohort (b. 1931-1941). There was not a significant interaction between caregiving profile and gender, revealing that when men enacted female-typical caregiving roles, their retirement timing resembled women's. Implications for individual retirement decision-making and policy are discussed.
Keywords: Adult children; Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Methodology; Other; Retirement Planning and Satisfaction

Feeling younger, walking faster : subjective age and walking speed in older adults - Yannick Stephan; Angelina R Sutin; Antonio Terracciano (Age, 2015)
Walking speed is a key vital sign in older people. Given the implications of slower gait speed, a large literature has identified health-related, behavioral, cognitive, and biological factors that moderate age-related decline in mobility. The present study aims to contribute to existing knowledge by examining whether subjective age, how old or young individuals experience themselves to be relative to their chronological age, contributes to walking speed. Participants were drawn from the 2008 and 2012 waves of the Health and Retirement Study (HRS, N = 2970) and the 2011 and 2013 waves of the National Health and Aging Trends Study (NHATS, N = 5423). In both the HRS and the NHATS, linear regression analysis revealed that a younger subjective age was associated with faster walking speed at baseline and with less decline over time, controlling for age, sex, education, and race. These associations were partly accounted for by depressive symptoms, disease burden, physical activity, cognition, body mass index, and smoking. Additional analysis revealed that feeling younger than one s age was associated with a reduced risk of walking slower than the frailty-related threshold of 0.6 m/s at follow-up in the HRS. The present study provides novel and consistent evidence across two large prospective studies for an association between the subjective experience of age and walking speed of older adults. Subjective age may help identify individuals at risk for mobility limitations in old age and may be a target for interventions designed to mitigate functional decline. 2015, American Aging Association.
Keywords: Demographics; Expectations; Health Conditions and Status

Financial strain and the health of Black, White, and Hispanic older adults: Lingering effects of the Great Recession? - Lindsay R. Wilkinson (Purdue University, 2015)
The Great Recession that began in late 2007 and ended in mid-2009 has influenced the financial well-being of older adults, but has it had discernible effects on health? Prior research has repeatedly shown the deleterious effects of financial strain on mental and physical health and mortality; however, less is known about how this relationship functions during a historical fluctuation in the economy. Guided by cumulative inequality theory, the objective of this dissertation is to examine pre-recession and post-recession financial strain and health and investigate whether financial strain (1) increased for older adults following the Great Recession, and (2) if so, the impact of the recession on health. Drawing on the Health and Retirement Study, this research uses data collected on 5,205 older adults in 2006 and 2010 to examine change in financial strain and three domains of health: mental health, somatic well-being, and sleep disturbances. This dissertation is divided into three main articles, with each article focused on a separate health domain. Findings from this research indicate that while older adults were more likely to experience decreases in financial strain following the Great Recession, both initial financial strain and change in financial strain between 2006 and 2010 explained change in anxiety and depressive symptoms, psychotropic drug use, acute physical symptoms, and sleep disturbances over roughly the same span of time.
Keywords: Health Conditions and Status; Public Policy

Frailty in Older Adults with Heart Failure - Xie, Boqin (Nursing, 2015)
Frailty is prevalent in older adults with heart failure (HF), which increases their risk for basic and instrumental activities of daily living (ADL/IADL) disability and a diminished quality of life (QOL). However, the issue of conceptualizing frailty remains unresolved. To date, the two predominant frailty models are the Fried model, which defines frailty as purely physical, and the Gobben model, which defines frailty as multi-domain with physical, psychological, and social domains. An integrative literature review of frailty components in existing frailty measures was conducted. The most commonly used frailty components were mobility and balance, nutrition, and cognitive function. Next, a cross-sectional, secondary data analysis was conducted using data from the Health and Retirement Study (HRS) to compare the capacity of the Fried model and the Gobbens model to predict ADL/IADL disability and QOL. Compared to the Fried physical frailty model, the inclusion of psychological components from the Gobbens model significantly increased the power to predict ADL/IADL disability, while the psychological and social components from the Gobbens' model significantly increased the ability to predict QOL. These findings support the view that frailty is a multidimensional syndrome with three domains (physical, psychological, and social). The levels of the three frailty domains were then compared, and older adults with HF were found to have higher levels of frailty across all three domains compared to older adults without HF. Lastly, a longitudinal examination of multidimensional frailty in older adults with HF was conducted, using HRS data collected at two time-points (2006/2008 to 2010/2012) from two cohorts. Across the two time-points, older adults with HF had higher levels of frailty across all three domains compared to older adults without HF. All HF and three frailty domains were associated with increased risks of ADL/IADL disability and decreased QOL. Each frailty domain mediated the relationship between HF and outcomes (ADL/IADL disability and QOL). The findings in this dissertation support frailty as a multidimensional syndrome. These findings have implications for the development of tailored, broad-based intervention aimed at preventing frailty or delaying its onset to reduce adverse outcomes of ADL/IADL disability and decreased QOL.
Keywords: Disabilities; Health Conditions and Status

Functional Limitations as Potential Mediators of the Effects of Self-Reported Vision Status on Fall Risk of Older Adults - Bernard A Steinman; Susan M Allen; Chen, Jie; Pynoos, Jon (Journal of Aging and Health, 2015)
Objective: To test whether limitations in mobility and large-muscle functioning mediate self-reported vision status to increase fall risk among respondents age 65 and above. Method: This study used two waves from the Health and Retirement Study. We conducted binary logistic and negative binomial regression analyses to test indirect paths leading from self-reported vision status to falls, via indices of mobility and large-muscle functioning. Results: Limited evidence was found for a mediating effect among women; however, large-muscle groups were implicated as partially mediating risk factors for falls among men with fair self-reported vision status. Discussion: Implications of these findings are discussed including the need for prioritizing improved muscle strength of older men and women with poor vision as a preventive measure against falls.
Keywords: Health Conditions and Status

Future Monetary Costs of Dementia in the United States under Alternative Dementia Prevalence Scenarios. - Michael D Hurd; Martorell, Paco; Kenneth M. Langa (Journal of Population Ageing, 2015)
Population aging will likely lead to increases is health care spending and the ability of governments to support entitlement programs such as Medicare and Medicaid. Dementia is a chronic condition that is especially pertinent because of its strong association with old age and because care for dementia is labor intensive and expensive. Indeed, prior research has found that if current dementia prevalence rates persist population aging will generate very large increases in health care spending for dementia. In this study we considered two alternative assumptions or scenarios about future prevalence. The first adjusts the prevalence projections using recent research that suggests dementia prevalence may be declining. The second uses growth hypertension, obesity and diabetes, and the relationship between dementia and these conditions to adjust future prevalence rates. We find under the first scenario that if the rates of decline in age-specific dementia rates persist, future costs will be much less than previous estimates, about 40% lower. Under the second scenario, the growth in those conditions makes only small differences in costs.
Keywords: Dementia; Forecasting; Health Conditions and Status; Older Adults

Gender Differences in the Association between Childhood Socioeconomic Status and Cognitive Function in Later Life - Jiyoung Lyu (Journal of Geriatrics, 2015)
Objectives. This study was aimed to explore the gender differences in the association between childhood socioeconomic status (SES) and cognitive function in later life. Methods. Using a nationally representative sample from the Health and Retirement Study, 5,544 females and 3,863 males were analyzed separately. Growth curve models were used to examine memory status and change in memory from 1998 to 2010. Results. The results showed that SES disadvantage in childhood was associated with lower memory at baseline controlling for adult SES and other covariates. In addition, cumulated disadvantage in SES was associated with poor memory in both genders. Statistically, the impact of cumulative SES on memory function at baseline was significantly different by gender. Discussion. These findings suggest that childhood SES has long-term effects on cognitive function among both men and women, and cumulative SES from childhood to adulthood may be more important for men than women with respect to their memory performance.
Keywords: Adult children; Demographics; Health Conditions and Status; Methodology

Go Gentle into That Good Night The Past, Present, and Future of End-of-Life Care - Adam E Singer (The Pardee RAND Graduate School, 2015)
End-of-life care has received increasing attention in recent years as the baby boomers age and health care costs continue to rise. This attention has brought with it remarkable growth in the field and improvement in care, but there remains work to be done in order to more consistently deliver high quality, compassionate, and patient- and family-centered end-of-life care. In this dissertation, I examine the past, present, and future of end-of-life care in order to shed light on the most effective ways to organize and deliver it. In the first analysis, I describe changes in symptom prevalence in the last year of life from 1998 to 2010. I find that the many important and troubling end-of-life symptoms, including pain and depression, became more common over that time frame, and that no symptom became less common. These changes occurred at the same time national efforts were underway to improve end-of-life care, which calls into question the nature of these changes and highlights the need to reexamine aspects of the delivery of end-of-life care. In the second analysis, I review the current evidence for palliative health services interventions to identify the populations that are appropriate for palliative care and the interventions that are effective in improving patient and family quality of life and reducing health care use and costs. I find that there are a broad range of currently available interventions that span a variety of goals, settings, and providers; that certain types of interventions are more or less effective for certain quality of life outcomes; and that health care use and cost outcomes are poorly studied overall. Some of these results enhance the existing understanding of what makes for effective end-of-life care. This information can be used in designing end-of-life care programs and in organizing research priorities for the field. In the third analysis, I simulate how cost and quality of life outcomes could fare through 2040 if three of the most effective palliative health services interventions identified in the second analysis were implemented today. I find that all three interventions lower health care costs, reduce mortality, improve quality-adjusted life years, and reduce pain, depression, and activities of daily living dependencies. These results highlight the benefit to individuals and to society of implementing evidence-based approaches to end-of-life care.
Keywords: Gerontology; Health Conditions and Status; Healthcare; Methodology; Policy; Public Policy; Retirement Planning and Satisfaction

Grip Strength Values Stratified by Age, Gender, and Chronic Disease Status in Adults Aged 50 Years and Older - Amy M Yorke; Amy B. Curtis; Shoemaker, Michael; Vangsnes, Eric (Journal of Geriatric Physical Therapy, 2015)
Background and Purpose: Grip strength is a measure of overall muscle strength and has been found to be a predictor of disability and mortality. Almost 3 in 4 adults aged 65 years and older have multiple chronic conditions, known as multimorbidity. Normative data for grip strength have commonly been reported on healthy convenience samples that may not accurately represent the population of interest. Grip strength values of US adults, utilizing a nationally representative data set based on the number of chronic diseases, would be beneficial to health care providers who serve adults with multimorbidity. The purpose of this study was to describe grip strength values of adults in the United States, based on gender, age, and the number of chronic diseases. Methods: A cross-sectional analysis was conducted using data collected from adults aged 50 years or older (n = 5877) from the Health and Retirement Study survey administered in 2008. Grip strength values (in kilograms) were determined and stratified on the basis of the number of self-reported chronic diseases (0, 1, 2, = 3) and stratified by age (decades) and gender. Results: Consistent with previously published values, males demonstrated higher mean hand grip strength than females and grip strength values decreased with age. Adults with multimorbidity demonstrated decreased grip strength as compared with those without chronic conditions (males/females with 0 chronic diseases right grip strength GRAPHICS = 44.2/26.8 kg as compared with males/females with 3 or more chronic disease right grip strength GRAPHICS = 36.1/21.7 kg). Conclusions: The grip strength values presented can serve as a standard of comparison for the large proportion of adults who have multimorbidity. Clinicians should consider grip strength as a component of a comprehensive physical assessment to identify decreased grip strength and recommend increased physical activity as an appropriate intervention.
Keywords: Disabilities; Health Conditions and Status; Healthcare; Other

Health Changes after Diabetes Diagnosed in Middle and Old Age: Physical, Mental and Cognitive Health Trajectories and Social Stratification - Ndao-Brumblay, Sokhna Khady (University of Michigan, 2015)
The current study focuses exclusively on middle-aged and old-aged adults with incident diabetes, and describes the course of diabetes in late adulthood in terms of physical, mental, and cognitive health change. To do this, it utilizes time-varying diabetes duration as the measure of time to define health trajectories after diabetes diagnosis. The study consists of three empirical analyses of the Health and Retirement Study, an ongoing representative biennial panel survey of Americans age 50 and older. Each study covers a different domain of health, and together they provide a comprehensive and dynamic view of people's experiences with diabetes. Hierarchical linear models of health change with longer diabetes duration (used as the measure of time), reveals that the course of diabetes is characterized by a quadratic acceleration in physical disability and a linear decline in mental and cognitive health. People who are older at the time of diagnosis, younger cohorts, women (due to lower socioeconomic status), blacks and Hispanics (partly due to socioeconomic disadvantage and health disparities before diagnosis) are generally at increased risk of a poor course of diabetes, when compared to their counterparts. Cumulative or persistent socioeconomic disadvantages were found for all outcomes, with worse health trajectories among older adults whose socioeconomic status was lower, with the exception of those in the top two income quartiles, who experienced a faster decline in mental health despite better scores at diagnosis. The study results confirm that diabetes cannot be viewed as a time-constant individual characteristic. Rather, the clinical course of diabetes in terms of physical, mental, and cognitive health changes with longer diabetes duration. Social variations in these changes need to be better understood so that effective healthcare and policy interventions can be devised to ensure successful and equitable aging with late-onset diabetes.
Keywords: Health Conditions and Status; Healthcare; Methodology

Home safety, accessibility, and elderly health: Evidence from falls - Michael D. Eriksen; Nadia Greenhalgh-Stanley; Gary V. Engelhardt (Journal of Urban Economics, 2015)
This article presents estimates of the impact of home safety and accessibility features on the prevention of serious, non-fatal falls for elderly widowed individuals. As these features are not randomly assigned across homes, we develop an instrumental variable (IV) strategy that relies on the differential decline in the health and functional status of spouses to identify impacts. Specifically, we use the deceased spouse's functional status when alive, as measured by limits to Activities of Daily Living (ADLs), as an IV for the presence of home safety and accessibility features for the surviving spouse in the years after widowhood, and then estimate the effect of these features on the likelihood of a serious fall for the widow using rich longitudinal data from the Health and Retirement Study. The presence of such features reduces the likelihood of a fall requiring medical treatment by 20 percentage points, a substantial effect. However, falls are not the type of health shock that is a main driver of housing tenure transitions among the elderly. Although somewhat speculative, cost-benefit estimates suggest that investments in home safety for the elderly may generate in the short run as much as a dollar-for-dollar reduction in medical expenditures. 2015 Elsevier Inc.
Keywords: Demographics; Health Conditions and Status; Housing

How Large Is the Gap Between Self-Report and Assessed Mental Health and Does It Impact Older Adult Mental Health Service Utilization? - Lee, Hyo Jung; Dugan, Elizabeth (Journal of Gerontological Social Work, 2015)
We examined the relationship between self-reported and assessed mental health status and service use, using data from the Health and Retirement Study (N=9,547). Twelve percent and thirty percent had inaccurate perceptions of their mood and memory status, respectively. No significant difference was found in the likelihood of service use between older adults who were unaware of current depressive symptoms and those who self-reported problems but had no assessed symptoms. Older adults who scored low in cognitive test were more likely to use services, regardless of self-reported memory status. Discrepancies between self-reported and assessed status may contribute to service utilization.
Keywords: Demographics; Health Conditions and Status

How Much Longer Do People Need to Work? - Alicia H. Munnell; Anthony Webb; Anqi Chen (Boston, Center for Retirement Research at Boston College, 2015)
Working longer is a powerful lever to enhance retirement security. Individuals should be able to extend the number of years they work because, on average, they are healthier, live longer, and face less physically demanding jobs. But averages are misleading when discrepancies in health, job prospects, and life expectancy have widened between individuals with low and high socioeconomic status (SES). To understand the magnitude of the problem, this paper, using data from the Health and Retirement Study (HRS), specifies how much longer households in each SES quartile would need to work to maintain their pre-retirement standard of living and compares those optimal retirement ages with their planned retirement ages to calculate a retirement gap. It then uses regression analysis to explore whether the gaps reflect poor circumstances or poor planning that is, the extent to which the retirement gap results from health, employment, and marital shocks that occur before the HRS interview but too late for the household to adjust saving (between ages 50 and 58), as opposed to a gap resulting from inadequate foresight. The analysis shows that households in lower-SES quartiles have larger retirement gaps, and this pattern remains true even after controlling for late-career shocks. In short, the most vulnerable have the largest retirement gaps, and these gaps arise from poor planning rather than late-career shocks.
Keywords: Consumption and Savings; Demographics; Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction

How socioeconomic status shapes health: Essays on the biological and social determinants of human welfare at older ages - Lauren L Schmitz (The New School, 2015)
Economic and epidemiological research has long established that socioeconomic status (SES) and the core characteristics that define it--education, earnings, and occupation--are strongly associated with health and mortality. However, the actual pathway these interventions and life circumstances take to affect health is not well known, and more research is needed to identify how socioeconomic-related health disparities develop and "get underneath the skin." This dissertation considers the influence of early- and late-life occupational stressors in tandem with genetic inheritances and other elements of SES to better understand how biological and social determinants cumulate over the life span and affect the health of greying populations. The first chapter explores whether characteristics of the physical and psychosocial work environment shape the health gradient in the years leading up to retirement. Dynamic panel and instrumental variable (IV) methods are used in combination with a rich data set that combines demographic information from the Health and Retirement Study (HRS), expert ratings on job characteristics from the Occupational Information Network (O*NET), and W-2 earnings records to draw more robust connections between workplace demands and health at older ages. Results indicate physical demands, environmental hazards, and conditions of the psychosocial work environment are all associated with health outcomes after age 50. In particular, there is a strong relationship between the degree of control and influence exercised on the job and improved self-reported health status, blood pressure, musculoskeletal conditions, cognitive function, and depression. The second two chapters use IV methods that exploit an exogenous shock to occupation at a young age--the Vietnam-era draft lotteries--to investigate genotype-by-environment interactions. Instrumented veteran status is interacted with polygenic scores for smoking initiation and educational attainment to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on health behaviors, educational attainment, earnings, and labor force participation at older ages. Results reveal conscription both amplified polygenic risk for smoking and moderated the socioeconomic attainment of veterans, indicating genetic inheritances further mediate the gestation of health disparities across the life course.
Keywords: Demographics; Employment and Labor Force; Genetics; Health Conditions and Status; Healthcare; Methodology; Public Policy

The Impact of Cognitive Impairment and Comorbid Depression on Disability, Health Care Utilization, and Costs - Xiang, Xiaoling; An, Ruopeng (Psychiatric Services, 2015)
Objectives: This study examined the impact of co-occurring cognitive impairment and depression on functional limitations, hospital and nursing home admissions, and out-of-pocket expenditures (OOPEs) among older adults. Methods: Individual mixed-effects regressions were performed to examine the relationship between cognitive impairment and depression and selected outcomes among 18,315 community-dwelling adults ages 50 and over from the Health and Retirement Study from 1998 to 2010. Results: Cognitive impairment and depression were independently associated with the outcomes of interest, and the estimated effects were largest among individuals with both conditions. Cognitive impairment with comorbid depression predicted limitations in activities of daily living (odds ratio OR =3.02) and instrumental activities of daily living (OR=4.18), hospitalizations (OR=1.53), nursing home admissions (OR=3.34), and an increase of 1,150 in annual OOPEs. Conclusions: Compared with cognitive impairment or depression alone, cognitive impairment plus depression was associated with substantial functional limitations, health services utilization, and costs.
Keywords: Health Conditions and Status; Healthcare

In Sickness and in Health? Physical Illness as a Risk Factor for Marital Dissolution in Later Life - Karraker, Amelia; Kenzie Latham (Journal of Health and Social Behavior, 2015)
The health consequences of marital dissolution are well known, but little work has examined the impact of health on the risk of marital dissolution. In this study we use a sample of 2,701 marriages from the Health and Retirement Study (1992-2010) to examine the role of serious physical illness onset (i.e., cancer, heart problems, lung disease, and/or stroke) in subsequent marital dissolution due to either divorce or widowhood. We use a series of discrete-time event history models with competing risks to estimate the impact of husband's and wife's physical illness onset on risk of divorce and widowhood. We find that only wife's illness onset is associated with elevated risk of divorce, while either husband's or wife's illness onset is associated with elevated risk of widowhood. These findings suggest the importance of health as a determinant of marital dissolution in later life via both biological and gendered social pathways.
Keywords: Adult children; Health Conditions and Status; Net Worth and Assets

Individual and Work Factors Related to Perceived Work Ability and Labor Force Outcomes - McGonagle, Alyssa K.; Gwenith G Fisher; Janet L. Barnes-Farrell; James Grosch (Journal of Applied Psychology, 2015)
Perceived work ability refers to a worker's assessment of his or her ability to continue working in his or her job, given characteristics of the job along with his or her resources. Perceived work ability is a critical variable to study in the United States, given an aging workforce, trends to delay retirement, and U.S. policy considerations to delay the age at which full Social Security retirement benefits may be obtained. Based on the job demands-resources model, cognitive appraisal theory of stress, and push/pull factors related to retirement, we proposed and tested a conceptual model of antecedents and outcomes of perceived work ability using 3 independent samples of U.S. working adults. Data regarding workers' job characteristics were from self-report and Occupational Information Network measures. Results from relative importance analysis indicated that health and sense of control were consistently and most strongly related to work ability perceptions relative to other job demands and job and personal resources when perceived work ability was measured concurrently or 2 weeks later in samples with varying occupations. Job demands (along with health and sense of control) were most strongly related to work ability perceptions when perceived work ability was measured in a manufacturing worker sample 1.6 years later. Perceived work ability also predicted lagged labor force outcomes (absence, retirement, and disability leave) while controlling for other known predictors of each. Consistent indirect effects were observed from health status and sense of control to all 3 of these outcomes via perceived work ability.
Keywords: Employment and Labor Force; Health Conditions and Status

Individual personality differences in adjustment to retirement - Eby, Rachel E. (Psychology, 2015)
Retirement is an important life event to study at present, because more people are entering their retirement years and are spending more time in retirement than ever before in our nation's history. Historically, research has shown mixed results on effects of retirement that are not accurately explained by any one theory. These mixed results suggest the possibility of individual differences in retirement adjustment that may not be accounted for with aggregated data. Wang, Henkens, and Shultz (2011) proposed a comprehensive framework of retirement adjustment: the resource-based dynamic perspective, which reasons that adjustment is influenced by antecedent variables, via level of resources possessed by the individual at a given time. The current study seeks to assess the relation between personality as an antecedent variable and retirement adjustment in a longitudinal analysis of participants from the nationally representative Health and Retirement Study. Resources are also modeled as covariates in the analysis. Results should be interpreted with caution due to limitations in model fit. Results from the Growth Mixture Model (GMM) revealed two classes of retirement trajectories and certain personality traits were significant as predictors for these trajectories. Implications for both research and practice are discussed.
Keywords: Health Conditions and Status; Healthcare; Other; Retirement Planning and Satisfaction

Instrumental variable estimation in a survival context - Eric J. Tchetgen Tchetgen; Stefan Walter; Vansteelandt, Stijn; Martinussen, Torben; M. Maria Glymour (Epidemiology, 2015)
Bias due to unobserved confounding can seldom be ruled out with certainty when estimating the causal effect of a nonrandomized treatment. The instrumental variable (IV) design offers, under certain assumptions, the opportunity to tame confounding bias, without directly observing all confounders. The IV approach is very well developed in the context of linear regression and also for certain generalized linear models with a nonlinear link function. However, IV methods are not as well developed for regression analysis with a censored survival outcome. In this article, we develop the IV approach for regression analysis in a survival context, primarily under an additive hazards model, for which we describe 2 simple methods for estimating causal effects. The first method is a straightforward 2-stage regression approach analogous to 2-stage least squares commonly used for IV analysis in linear regression. In this approach, the fitted value from a first-stage regression of the exposure on the IV is entered in place of the exposure in the second-stage hazard model to recover a valid estimate of the treatment effect of interest. The second method is a so-called control function approach, which entails adding to the additive hazards outcome model, the residual from a first-stage regression of the exposure on the IV. Formal conditions are given justifying each strategy, and the methods are illustrated in a novel application to a Mendelian randomization study to evaluate the effect of diabetes on mortality using data from the Health and Retirement Study. We also establish that analogous strategies can also be used under a proportional hazards model specification, provided the outcome is rare over the entire follow-up.
Keywords: Health Conditions and Status; Methodology

Inter-Cohort Variation in the Consequences of U.S. Military Service for Men's Mid- to Late-Life Body Mass Index Trajectories - Janet M Wilmoth; Andrew S London; Christine L Himes (A Life Course Perspective on Health Trajectories and Transitions, 2015)
Body mass index (BMI) is an important health indicator that changes with age and may be shaped in important ways by prior military service. While a high proportion of older men in the United States served in the military, to date, there has been no longitudinal, population-representative study of veteran status differences in men s mid- to late-life BMI trajectories. In this chapter, we use data from the 1992 2010 Health and Retirement Study (HRS) and growth curve models to examine veteran status differences in mid- to late-life BMI trajectories for cohorts of men born in the United States during the first half of the twentieth century. Without any controls in the models, veterans exhibit lower BMI, on average, than non-veterans. Once we add controls for birth cohort, early-life characteristics that occur prior to military service, potentially mediating mid- to late-life characteristics, and methodological controls for proxy report, attrition, and death during the study period, the effect of veteran status is small, marginally significant, and positive net of other factors, veterans are marginally heavier than their non-veteran counterparts. Taken together, our analyses demonstrate the large effect of the secular trend in increased weight across the population younger cohorts are substantially heavier than older cohorts regardless of their veteran status and a substantively small but consistent, positive intra-cohort effect of veteran status.
Keywords: Demographics; Health Conditions and Status; Methodology

Internet Use and Well-Being in Older Adults - Jinmoo Heo; Sanghee Chun; Lee, Sunwoo; Lee, Kyung Hee; Kim, Junhyoung (Cyberpsychology Behavior and Social Networking, 2015)
The Internet has become an important social context in the lives of older adults. Extant research has focused on the use of the Internet and how it influences well-being. However, conflicting findings exist. The purpose of the study was to develop an integrative research model in order to determine the nature of the relationships among Internet use, loneliness, social support, life satisfaction, and psychological well-being. Specifically, loneliness and social support were tested as potential mediators that may modify the relationship between Internet use and indicators of well-being. Data from the U.S. Health and Retirement Study (HRS) were used, and the association among Internet use, social support, loneliness, life satisfaction, and psychological well-being was explored. The sample consisted of 5,203 older adults (aged 65 years and older). The results indicated that higher levels of Internet use were significant predictors of higher levels of social support, reduced loneliness, and better life satisfaction and psychological well-being among older adults.
Keywords: Adult children; Health Conditions and Status; Other