Job strain and trajectories of change in episodic memory before and after retirement: results from the Health and Retirement Study - Andel, Ross; Frank J Infurna; Elizabeth A. Hahn Rickenbach; Crowe, Michael; Lisa A Marchiondo; Gwenith G Fisher (Journal of Epidemiology and Community Health, 2015)
Background: We examined indicators of job strain in relation to level and change in episodic memory in the years leading up to as well as following retirement. Methods: Our analyses centre on 3779 individuals from the nationally representative Health and Retirement Study (baseline age 57.3 years) who reported gainful employment in an occupation for 10 years prior to retirement, and who were assessed for episodic memory performance over up to 20 years (median 8 waves over 16 years). We used ratings from the Occupational Information Network (O Net) to score occupations for job control and job demands, and to measure job strain (job demands/job control). Results: Controlling for sociodemographic characteristics, depressive symptoms, and cardiovascular disease, less job control and greater job strain were not significantly associated with change in episodic memory in the period leading up to retirement, but were associated with significantly poorer episodic memory at retirement and an accelerated rate of decline in episodic memory following retirement. The results did not vary for men and women or by self-employment status. Conclusions: Job strain expressed mainly as low job control is linked to poorer episodic memory at retirement and more decline after retirement. Job characteristics appear to have implications for cognitive ageing independent of relevant confounds.
Keywords: Employment and Labor Force; Health Conditions and Status

Lasting Impacts of Childhood Health and Socioeconomic Circumstances on Adult Health Problems: Analysis of a Longitudinal Count Regression Model - Rashmita Basu (International Journal of Applied Economics, 2015)
Objectives. This study examines the lasting impacts of childhood health and circumstances, in addition to adult socioeconomic status on trajectories of chronic health problems in later life and how these associations vary across race/ethnicity as well as gender. Methods. Employing a longitudinal data set from the Health and Retirement Study (HRS), this study utilizes a random intercept count regression model to examine how circumstances associated with early life may influence chronic health trajectories in later life. Results. The results demonstrate that poor childhood health and disadvantaged socioeconomic status (SES) are associated with the higher incidence rates of chronic health problems over time. The associations are net of adult socioeconomic status and baseline health status. The adverse effects of poor childhood health and disadvantaged socioeconomic conditions are higher for women than men. While both childhood health and SES have significant impacts on chronic health trajectories for both African-American and White, no such effects have been observed among Hispanic. Discussion. Trajectories of chronic health problems in late life continue to be shaped by childhood health and socioeconomic circumstances. The patterns of associations vary across race/ethnicity as well as gender.
Keywords: Adult children; Demographics; Employment and Labor Force; Health Conditions and Status; Women and Minorities

Lifetime Socioeconomic Status, Historical Context, and Genetic Inheritance in Shaping Body Mass in Middle and Late Adulthood - Hexuan Liu; Guo, Guang (American Sociological Review, 2015)
This study demonstrates that body mass in middle and late adulthood is a consequence of the complex interplay among individuals' genes, lifetime socioeconomic experiences, and the historical context in which they live. Drawing on approximately 9,000 genetic samples from the Health and Retirement Study, we first investigate how socioeconomic status (SES) over the life course moderates the impact of 32 established obesity-related genetic variants on body mass index (BMI) in middle and late adulthood. We then consider differences across birth cohorts in the genetic influence on BMI, and cohort variations in the moderating effects of life-course SES on the genetic influence. Our analyses suggest that persistently low SES over the life course or downward mobility (e.g., high SES in childhood but low SES in adulthood) amplify the genetic influence on BMI, and persistently high SES or upward mobility (e.g., low SES in childhood but high SES in adulthood) compensate for such influence. For more recent birth cohorts, the genetic influence on BMI becomes stronger, but the moderating effects of lifetime SES on the genetic influence are weaker compared to earlier cohorts. We discuss these findings in light of social changes during the obesity epidemic in the United States.
Keywords: Demographics; Event History/Life Cycle; Genetics; Health Conditions and Status

Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults - Kerstin Gerst; Jayawardhana, Jayani (American journal of public health, 2015)
OBJECTIVES: We aimed to determine whether loneliness is associated with higher health care utilization among older adults in the United States. METHODS: We used panel data from the Health and Retirement Study (2008 and 2012) to examine the long-term impact of loneliness on health care use. The sample was limited to community-dwelling persons in the United States aged 60 years and older. We used negative binomial regression models to determine the impact of loneliness on physician visits and hospitalizations. RESULTS: Under 2 definitions of loneliness, we found that a sizable proportion of those aged 60 years and older in the United States reported loneliness. Regression results showed that chronic loneliness (those lonely both in 2008 and 4 years later) was significantly and positively associated with physician visits (beta=0.075, SE=0.034). Loneliness was not significantly associated with hospitalizations. CONCLUSIONS: Loneliness is a significant public health concern among elders. In addition to easing a potential source of suffering, the identification and targeting of interventions for lonely elders may significantly decrease physician visits and health care costs.
Keywords: Health Conditions and Status; Healthcare

Longitudinal analyses of obesity determinants and associated health outcomes in the U.S. middle-aged and older adults - Chen, Cheng-Chia (Indiana University, 2015)
This dissertation consists of two sub-studies. Sub-study 1 attempted to examine the longitudinal effects of individual demographics, state-level socioeconomic status (SES), density of fast food restaurants, and proportion of people who walk to work on body mass index (BMI) among adults aged 50 years and older from 2000 to 2010. Data were drawn from the 2000-2010 Health and Retirement Study (HRS) and the 2010 U.S. Census. Respondents who lived at the same census tract during 2000-2010 (N=6,156) were included. A three-level growth model was fit to model BMI trajectories. BMI significantly increased over time showing both a linear and quadratic decelerating trajectory (p<.001). Women living in states with a lower state-level SES had higher BMI level while men living in states with higher state-level SES had a higher BMI (b=-0.242, p=.013). For people living in states with a higher proportion of people who walk to work, Hispanics had higher BMI level at the baseline and lower BMI growth rate, compared with non-Hispanic whites (b=-0.033, p<.001). Evidence suggests that we should provide sex responsive interventions and better walking environments to tackle obesity epidemic. Sub-study 2 investigated the effects of Part D implementation on health outcomes among the U.S. older adults. Data from the 2004-2008 HRS respondents who further participated in the HRS 2005-2007 Prescription Drug Study and consented to share their Medicare claims were analyzed (N=746). A panel ordered logistic regression with a difference-in-differences approach was used to examine the Part D effect on patients' health outcomes before and after Part D implementation. People with continuous Part D enrollment from 2006-2008 were less likely to have a worse self-rated health than those who were not enrolled in Part D (OR=0.48; p <.05). A higher Charlson Comorbidity Index score was associated with a higher likelihood of having worse self-rated overall health, worse mental health, and worse activity daily living impairment (ORs=1.12, 1.17, and 1.36, respectively; all ps <.001). The Part D implementation appeared to have a positive effect on older adults' overall health status. Reducing healthcare cost would likely encourage older adults to utilize more needed medications and help maintain better health.
Keywords: Demographics; Health Conditions and Status; Healthcare; Other; Public Policy

Longitudinal Analysis of Mortality Risk Factors for Actuarial Valuation - Kariyawasam, Ushani (University of Connecticut - Storrs, 2015)
Today, people are living longer and the world population is getting older. Recent statistics indicate that a 65-year-old female in the United States is estimated to live to 88.8 years old, while a 65-year-old male to 86.6 years old. This translates to about a two-year increase in life expectancy from birth compared to that more than a decade ago. Understanding these trends and their potential impact are ever more relevant to the insurance industry. In this thesis, we emphasize the longitudinal modeling framework of pension and long term care insurance using some advanced techniques to analyze patterns and trends in longevity and to investigate potential covariates to further characterize the nature of the risk. Using data from the Health and Retirement Study (HRS), our work finds that factors that incorporate demographic, health, lifestyle, and financial information help improve model projections of mortality. We used multiple state framework to develop models for understanding the utilization of long term care. Some key findings indicate that female tends to be more vulnerable to exposure for long term care needs, and so with low educated people. Finally, motivated by the data obtained from an insurer, this thesis also examined the effect of policy termination on the survival of policyholders with life insurance contracts. We modeled the time until a policy lapses and its subsequent mortality pattern and found some evidence of mortality selection. We subsequently examined the financial cost of policy termination. The lack of available data precluded us from extending this analysis to pension plans and long term care insurance products; such can be done as further studies
Keywords: Expectations; Health Conditions and Status; Medicare/Medicaid/Health Insurance; Pensions; Public Policy

A Longitudinal Analysis of the Influence of Race on Cognitive Performance - Castora-Binkley, Melissa; Peronto, Carol L.; Edwards, Jerri D.; Brent J. Small (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2015)
Objectives. Whether there are racial and ethnic disparities in the rate of cognitive decline among older adults is not clear. The purpose of this study was to determine if there are differences in cognitive decline among racial and ethnic older adults.Method. Data were from the Health and Retirement Study, waves 1998 2010. Participants were community dwelling at baseline (n = 9,492), mostly female participants (58.8 ), ranged in age from 65 to 105 years (M = 74.41, SD = 6.97), and had education levels that averaged less than high school (M = 11.7, SD = 3.4). Cognition was examined using a combined score from word recall, Serial 7 s, backward counting, and naming tasks. To determine changes in cognition across 12 years, we utilized mixed effects models.Results. Results indicated that after adjusting for covariates, race or ethnicity was unrelated to changes in cognitive performance, but there were significant differences in baseline cognition and these differences were more pronounced after adjusting for age, gender, education, poverty, heart disease, diabetes, high blood pressure.Discussion. It is evident that there are significant differences in baseline cognition, although the rate of cognitive decline across 12 years did not vary significantly by race. These findings support previous assertions that the rate of cognitive decline is not associated with race and suggest that it is likely that baseline cognitive performance is a better indicator of performance over time.
Keywords: Demographics; Health Conditions and Status; Methodology

Long-term and short-term predictors of worries about getting Alzheimer's disease - S. J. Cutler; Bragaru, C. (European Journal of Ageing, 2015)
Cumulative stresses associated with concerns about cognitive functioning and worries about developing Alzheimer's disease (AD) have been shown to be related to poorer health and lower psychological well-being. Among older persons, AD also generates higher levels of fear than any other disease. But much remains to be learned about predictors of worries and fears, especially from a temporal perspective. Thus, the principal objective of the current research is to examine long-term effects of self-perceptions of cognitive functioning on worries about developing AD. Data for the study are drawn from the University of Michigan's Health and Retirement Study. We use up to ten measurements of self-perceived cognitive functioning collected from 1992 to 2010 for respondents 50 years of age and older at the time of their entrance into the study. Demographics (marital status, age, education, and gender); beliefs about the role of genetics, personal knowledge of someone with AD, and their interaction; and depression and health are other variables included in the model. The data are analyzed using the full information maximum likelihood procedure and latent growth curve modeling to account for the long-term effects. The analysis shows evidence of both short-term effects of depression, age, beliefs, and the interaction of beliefs and personal familiarity and long-term effects of cognitive self-assessment on worries about getting AD. Further analyses of these relationships and inclusion of these items in other studies are recommended.
Keywords: Health Conditions and Status; Methodology

Long-Term BMI Trajectories and Health in Older Adults: Hierarchical Clustering of Functional Curves - Zajacova, Anna; Huzurbazar, Snehalata; Greenwood, Mark; Nguyen, Huong (Journal of Aging and Health, 2015)
Objective: This project contributes to the emerging research that aims to identify distinct body mass index (BMI) trajectory types in the population. We identify clusters of long-term BMI curves among older adults and determine how the clusters differ with respect to initial health. Method: Health and Retirement Study cohort (N = 9,893) with BMI information collected in up to 10 waves (1992-2010) is analyzed using a powerful cutting-edge approach: hierarchical clustering of BMI functions estimated via the Principal Analysis by Conditional Expectations (PACE) algorithm. Results: Three BMI trajectory clusters emerged for each gender: stable, gaining, and losing. The initial health of the gaining and stable groups in both genders was comparable; the losing cluster experienced significantly poorer health at baseline. Discussion: BMI trajectories among older adults cluster into distinct types in both genders, and the clusters vary substantially in initial health. Weight loss but not gain is associated with poor initial health in this age group.
Keywords: Demographics; Health Conditions and Status; Methodology

The Long-Term Consequences of Vietnam-Era Conscription and Genotype on Smoking Behavior and Health - Lauren L Schmitz; Dalton C Conley (2015)
Research is needed to understand the extent to which environmental factors mediate links between genetic risk and the development of smoking behaviors. The Vietnam-era draft lottery offers a unique opportunity to investigate whether genetic susceptibility to smoking is influenced by risky environments in young adulthood. Access to free or reduced-price cigarettes coupled with the stress of military life meant conscripts were exposed to a large, exogenous shock to smoking behavior at a young age. Using data from the Health and Retirement Study (HRS), we interact a genetic risk score for smoking initiation with instrumented veteran status in an instrumental variables (IV) framework to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on smoking behavior and smoking-related morbidities. We find evidence that veterans with a high genetic predisposition for smoking were more likely to become regular smokers, smoke heavily, and are at a higher risk of being diagnosed with cancer or hypertension at older ages. Smoking behavior was significantly attenuated for high-risk veterans who attended college after the war, indicating post-service schooling gains from veterans' use of the GI Bill may have reduced tobacco consumption in adulthood.
Keywords: Demographics; Health Conditions and Status

Long-term effects of economic fluctuations on health and cognition in Europe and the United States - Hessel, Philipp (Social Policy, 2015)
Several studies suggest that population health improves during recessions and deteriorates during economic expansions. However, the majority of these studies only focus on the short-term or contemporaneous effects of economic fluctuations on health. As a result, very little evidence exists on potential long-term health effects of exposure to booms or recessions. This can be regarded as a major gap in knowledge, given the fact that most diseases are the results of exposure or behaviours during a longer period of time. Furthermore, a large body of research also suggests that many risks associated with recessions may accumulate over the course of life and lead to a gradual deterioration in health. By focusing only on the short-term effects, most studies thus ignore potential longrun health effects of economic fluctuations. This thesis aims to bridge the gap between studies on the population level assessing the short-term effects of economic fluctuations on health, and studies on the individual level, which have analysed the health-effects of risks associated with a declining economy including unemployment, job loss and job insecurity. In order to assess potential longterm effects of business cycles on health, I linked historical information on macroeconomic fluctuations during the 20th century to individual-level data from the Survey of Health, Ageing and Retirement in Europe (SHARE) as well as the U.S. Health and Retirement Study (HRS). This approach makes it possible to identify the state of the economy during different life-course periods for every respondent and relate it to health outcomes measured in later life. Regarding the macroeconomic conditions at any given age as largely exogenous, the four empirical papers included in this thesis thereby assess the relationship between business cycles and health during three different life-course periods: the time around graduation from full-time education, middle and late adulthood as well as the years nearing retirement. Overall, the results suggest that individuals who experienced less favourable economic conditions during these life-course periods have a higher risk of having additional limitations in physical functioning, lower levels of cognitive functioning, as well as higher risks of cardiovascular disease in later life. In contrast to studies showing that population health improves during recessions, these findings suggest that potential short-term improvements in health may be outweighed by deteriorations in health in the long run. They also raise important questions about the role of potential mechanisms linking differential exposure to the business cycle to health in later life.
Keywords: Cross-National; Event History/Life Cycle; Health Conditions and Status; Methodology; Public Policy; SHARE

The long-term mortality impact of combined job strain and family circumstances: A life course analysis of working American mothers - Erika L. Sabbath; Mejía-Guevara, Iván; Noelke, Clemens; Lisa F Berkman (Social Science and Medicine, 2015)
Background: Work stress and family composition have been separately linked with later-life mortality among working women, but it is not known how combinations of these exposures impact mortality, particularly when exposure is assessed cumulatively over the life course. We tested whether, among US women, lifelong work stress and lifelong family circumstances would jointly predict mortality risk. Procedures: We studied formerly working mothers in the US Health and Retirement Study (HRS) born 1924-1957 (n = 7352). We used sequence analysis to determine five prototypical trajectories of marriage and parenthood in our sample. Using detailed information on occupation and industry of each woman's longest-held job, we assigned each respondent a score for job control and job demands. We calculated age-standardized mortality rates by combined job demands, job control, and family status, then modeled hazard ratios for death based on family constellation, job control tertiles, and their combination. Results: Married women who had children later in life had the lowest mortality risks (93/1000). The highest-risk family clusters were characterized by spells of single motherhood (132/1000). Generally, we observed linear relationships between job control and mortality hazard within each family trajectory. But while mortality risk was high for all long-term single mothers, we did not observe a job control-mortality gradient in this group. The highest-mortality subgroup was previously married women who became single mothers later in life and had low job control (HR 1.91, 95 CI 1.38,2.63). Practical implications: Studies of associations between psychosocial work characteristics and health might consider heterogeneity of effects by family circumstances. Worksite interventions simultaneously considering both work and family characteristics may be most effective in reducing health risks. (C) 2015 Elsevier Ltd. All rights reserved.
Keywords: Adult children; Employment and Labor Force; Health Conditions and Status; Healthcare; Public Policy; Risk Taking

The Mechanism of Ageism: The Relationship Between Perceived Ageism and Depressive Symptoms in Later Life - Kim, Hyejin (The Florida State University, 2015)
Extending the human life span has long been a desire of human beings. It seems the wish has been actualized. However, simply living a long life does not always seem to be a blessing. Older adults report a lower level of psychological well-being and quality of life and even have a higher rate of suicide, compared to the general population. Furthermore, as older adults are likely to experience the death of a loved one, deteriorating health, retirement, and changing relationships with others, older adults have a high risk of depression. Social work has a long history of providing social services to older adults. In particular, social work has provided older adults with a variety of services to enhance their quality of life and mental health status. Because ageism is one form of discrimination that social work has long been concerned with, this study focuses on the relationship between perceived ageism and depressive symptoms among older adults. Therefore, the purpose of this study is to examine the relationship between perceived ageism and depressive symptoms among older adults and to investigate the mechanism linking perceived ageism to late-life depression. Three primary effects were examined: the direct effect of perceived ageism on depressive symptoms in later life, the mediating effects of self-perception of aging and purpose in life on the relationship between perceived ageism and late-life depression, and the moderating effect of perceived ageism on the association between religiosity and depression among older adults. The stress process model was used to provide an overall idea to explain the three types of the effects related to the mechanism of ageism. Cooley's looking-glass self, Beck's cognitive theory of depression, and Levy's stress embodiment theory were used to explain the mediating effect of self-perception of aging, and Beck's cognitive theory of depression was applied again to clarify the mediating effect of purpose in life. The stress buffer theory and the life-span theory of control indicated the moderating effect of perceived ageism on the relationship between religiosity and depression. Secondary analysis of existing data was conducted using the Health and Retirement Study (HRS) datasets, a longitudinal panel study of the U.S. population ages 50 and over. The sample of this study was 3,991 participants, who were older adults ages 65 and over and whose answers were available for the study analyses. Descriptive and preliminary analyses were performed to roughly examine the relationships between variables. With regard to the direct effect of perceived ageism on depressive symptoms, multiple regression analyses were performed controlling for significant variables. With regard to the mediating effects of self-perception of aging and purpose in life, structural equation modeling (SEM) analyses using structural regression models were conducted. In respect to the moderating effect of perceived ageism on the relationship between religiosity and depression, SEM analyses with multiple groups were performed. Based on the results of the several different analyses, a direct relationship between perceived ageism and late-life depression was found. That is, older adults who perceive ageism are likely to have a higher level of depressive symptoms than their counterparts. This direct relationship between perceived ageism and late depressive symptoms among older adults, however, was not detected after controlling for self-perception of aging and purpose in life, indicating the full mediation effects of self-perception of aging and purpose in life. That is, older adults who perceive ageism are likely to have negative self-perception of aging, and this negative view of their own aging is likely to increase depressive symptoms. Additionally, older adults who have a negative view of their aging are likely to have a negative view of their future, and this lower purpose in life also increases depressive symptoms. The strength of the effect of religiosity on depression did not differ between the perceived age sm and the not perceived ageism groups, indicating no moderating effect of perceived ageism on the relationship between religiosity and depression. This study contributes to the existing body of knowledge by providing the information about the relationship between perceived ageism and depression and the mechanism of this relationship. Also, this study re-examined and supported established theories in the context of perceived ageism. Additionally, the current study suggests the necessity of anti-ageism policies and social work services and describes possible ways of providing such social policies and social work services at the micro, mezzo, and macro levels. The results of this study imply that more efforts and resources are necessary to reduce ageism and its negative effect on depression among older adults, and these efforts will eventually contribute to making a more just, better society.
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

Mothering alone: cross-national comparisons of later-life disability and health among women who were single mothers - Lisa F Berkman; Yuhui Zheng; M. Maria Glymour; Mauricio Avendano; Axel Borsch-Supan; Erika L. Sabbath (Journal of Epidemiology and Community Health, 2015)
Background Single motherhood is associated with poorer health, but whether this association varies between countries is not known. We examine associations between single motherhood and poor later-life health in the USA, England and 13 European countries.Methods Data came from 25 125 women aged 50 who participated in the US Health and Retirement Study, the English Longitudinal Study of Ageing and Survey of Health, Ageing and Retirement in Europe. We tested whether single motherhood at ages 16 49 was associated with increased risk of limitations with activities of daily living (ADL), instrumental ADL and fair/poor self-rated health in later life.Results 33 of American mothers had experienced single motherhood before age 50, versus 22 in England, 38 in Scandinavia, 22 in Western Europe and 10 in Southern Europe. Single mothers had higher risk of poorer health and disability in later life than married mothers, but associations varied between countries. For example, risk ratios for ADL limitations were 1.51 (95 CI 1.29 to 1.98) in England, 1.50 (1.10 to 2.05) in Scandinavia and 1.27 (1.17 to 1.40) in the USA, versus 1.09 (0.80 to 1.47) in Western Europe, 1.13 (0.80 to 1.60) in Southern Europe and 0.93 (0.66 to 1.31) in Eastern Europe. Women who were single mothers before age 20, for 8 years, or resulting from divorce or non-marital childbearing, were at particular risk.Conclusions Single motherhood during early-adulthood or mid-adulthood is associated with poorer health in later life. Risks were greatest in England, the USA and Scandinavia. Selection and causation mechanisms might both explain between-country variation.
Keywords: Adult children; Cross-National; Disabilities; Health Conditions and Status; Methodology

Neighborhood physical disorder, social cohesion, and insomnia: results from participants over age 50 in the Health and Retirement Study - Lenis P. Chen-Edinboro; Christopher N Kaufmann; Augustinavicius, J. L.; Ramin Mojtabai; Parisi, J. M.; Alexandra M. V. Wennberg; Smith, M. T.; Adam P Spira (International Psychogeriatrics, 2015)
Background:: We determined the association between neighborhood socio-environmental factors and insomnia symptoms in a nationally representative sample of US adults aged 50 years. Methods:: Data were analyzed from two waves (2006 and 2010) of the Health and Retirement Study using 7,231 community-dwelling participants (3,054 men and 4,177 women) in the United States. Primary predictors were neighborhood physical disorder (e.g. vandalism/graffiti, feeling safe alone after dark, and cleanliness) and social cohesion (e.g. friendliness of people, availability of help when needed, etc.); outcomes were insomnia symptoms (trouble falling asleep, night awakenings, waking too early, and feeling unrested). Results:: After adjustment for age, income, race, education, sex, chronic diseases, body mass index, depressive symptoms, smoking, and alcohol consumption, each one-unit increase in neighborhood physical disorder was associated with a greater odds of trouble falling asleep (odds ratio (OR) = 1.09, 95 confidence interval (CI): 1.04 1.14), waking too early (OR = 1.05, 95 CI: 1.00 1.10), and, in adults aged 69 years (adjusting for all variables above except age), feeling unrested in the morning (OR = 1.11, 95 CI: 1.02 1.22 in 2006). Each one-unit increase in lower social cohesion was associated with a greater odds of trouble falling asleep (OR = 1.06, 95 CI: 1.01 1.11) and feeling unrested (OR = 1.09, 95 CI: 1.04 1.15). Conclusions:: Neighborhood-level factors of physical disorder and social cohesion are associated with insomnia symptoms in middle-aged and older adults. Neighborhood-level factors may affect sleep, and consequently health, in our aging population.
Keywords: Consumption and Savings; Demographics; Health Conditions and Status

Neighbourhood racial/ethnic composition and segregation and trajectories of cognitive decline among US older adults - Stephanie Kovalchik; Mary E Slaughter; Jeremy Miles; Esther M Friedman; Regina A Shih (Journal of Epidemiology and Community Health, 2015)
Background The influence of the sociodemographic context of one's environment on cognitive ageing is not well understood.Methods We examined differences in cognitive trajectories according to the racial/ethnic characteristics of the residential environment. On the basis of 63 996 person-years of data from a nationally representative cohort of 6150 adults over the age of 50 years from the Health and Retirement Study, we used multivariate linear mixed models to determine the effect of neighbourhood racial/ethnic composition and county-level segregation on cognitive function and cognitive decline over a 10-year period.Results In models adjusting for individual demographic and health characteristics, Hispanic composition had a significant positive association with cognitive function (standardised =0.136, p 0.05) and moderate evidence of an association with greater cognitive decline (standardised = 0.014, p=0.09). Greater Hispanic-white segregation was associated with statistically significant higher cognitive function at baseline (standardised =0.099, p 0.001) and greater cognitive decline (standardised = 0.011, p 0.01). For a 20 percentage-point increase in Hispanic composition and segregation, the observed associations implied 1 and 1.25 additional years of cognitive ageing over 10 years, respectively. These effects did not differ by individual race/ethnicity and were not explained by neighbourhood socioeconomic status or neighbourhood selection. Black composition and black-white segregation did not have a significant influence on cognitive ageing.Discussion This study demonstrates disparities in the progression of cognitive ageing according to racial/ethnic characteristics of the neighbourhood environment.
Keywords: Demographics; Health Conditions and Status

No Place Like Home? Disability and Living Arrangements in Later Life - Carrie Elizabeth Henning-Smith (Health Services Research, Policy and Administration, 2015)
Current literature on the relationships between disability and both the physical and social environments of one's living arrangement is scarce. The relationship between disability and living arrangements in later life is inherently complex, yet it has the potential to impact older adults' lives in significant ways. With this dissertation, I sought to address this gap in the literature and add to our understanding of how older adults' environments and functional statuses interact. My specific aims were to: 1.) Describe the living arrangements of older adults with disabilities; 2.) Estimate the risk of developing disability by type of living arrangement (both housing type and household composition) for older adults; and, 3.) Estimate the risk of having a change in living arrangement by disability status for older adults. For all three aims, I also examined how the relationships between living arrangements and disability differed by age and socio-economic status. Data came from the American Community Survey (2012; n=504,371 adults age 65 and older) and the Health and Retirement Study (1998-2012; n=43,182 observations.) In Aim 1, I found that disability was most prevalent for older adults living in situations other than with a spouse only and that the odds of disability was highest for older adults living with children (without a spouse.) Compared with living in a single-family home, the odds of disability were higher for older adults living in mobile homes and large apartment buildings. In Aim 2, I found that living in a nursing home or with others was associated with an increased risk of disability, but that living alone was associated with a decreased risk of disabilities related to Instrumental Activities of Daily Living (IADLs.) This latter finding only held true for more affluent older adults, however; the poorest older adults faced an increased risk of disability if they lived alone. Finally, in Aim 3, I found that having IADL and ADL (Activities of Daily Living) disabilities together was predictive of moving, long nursing home stays, and death. ADL and IADL disabilities separately were predictive of long nursing home stays and death, while prior living arrangements were more predictive of moving than individual ADL or IADL disability status. For all of my findings, disability rates were highest among the poorest and oldest older adults. Older adults with the lowest socioeconomic status were also more likely to live alone, with non-spousal others, in rented homes, and in mobile homes or apartment buildings. This population may need additional resources to foster supportive living arrangements and to mitigate disability risk. These findings can be used to identify where older adults with disabilities live and where to target interventions to prevent worsening disability.
Keywords: Demographics; Health Conditions and Status; Healthcare; Methodology; Public Policy; Retirement Planning and Satisfaction

Nonmonetary Job Characteristics and Employment Transitions at Older Ages - Marco Angrisani; Arie Kapteyn; Erik Meijer (Ann Arbor, MI, University of Michigan, 2015)
This paper studies to what extent job characteristics such as physical and cognitive demands, use of technologies, responsibility, difficulty, stress, peer pressure, and relations with co-workers are related to full or partial retirement. We study employment transitions and retirement expectations of older workers by exploiting the wealth of information about individuals older than age 50 in the Health and Retirement Study (HRS), and characteristics of different occupations provided by the Occupation Information Network (O NET) database. Controlling for basic demographics, wages, benefits, health, cognitive ability, personality, and other personal characteristics, we find strong and statistically significant relationships between labor force transitions and job characteristics. These relationships are typically more pronounced and more precisely estimated when we use objective job attributes taken from the O NET than when we use self-reported job characteristics taken from the HRS, but self-reported characteristics are more strongly related to moves from full-time to part-time employment. Using expected retirement age or subjective probabilities of working full-time at older ages gives similar results to using actual labor force transitions as the dependent variable. The estimated effects of job characteristics are again stronger and more robust to alternative specifications when measures of job attributes are taken from the O NET than from the HRS. Our findings suggest that nonmonetary job characteristics are important determinants of labor supply decisions at older ages, but our analysis is still preliminary in its attempt to uncover causal relationships: Unobservable individual characteristics responsible for sorting into specific occupations may also shape retirement decisions.
Keywords: Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction

Obesity and onset of depression among U.S. middle-aged and older adults - Xiang, Xiaoling; An, Ruopeng (Journal of psychosomatic research, 2015)
Objectives: This paper aims to examine the relationship between obesity and onset of depression among U.S. middle-aged and older adults. Methods: Data came from 1994 to 2010 waves of the Health and Retirement Study. Study sample consisted of 6514 community-dwelling adults born between 1931 and 1941 who were free of clinically relevant depressive symptoms in 1994. Body mass index (BMI) was calculated from self-reported height/weight. Body weight status was classified into normal weight (18.5 kg/m2 BMI andlt; 25 kg/m2), overweight (25 kg/m2 BMI andlt; 30 kg/m2), and obesity (BMI 30 kg/m2). 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 time-dependent Cox proportional hazards model were performed to examine the association between body weight status and onset of clinically relevant depressive symptoms. Results: Unhealthy body weight was associated future onset of depression. Compared with their normal weight counterparts, overweight and obese participants were 13 (hazard ratio HR = 1.13, 95 confidence interval CI = 1.04 1.23) and 9 (HR = 1.09, 95 CI = 1.01 1.18) more likely to have onset of clinically relevant depressive symptoms during the 16 years of follow-up, respectively. The relationship between obesity and depression onset appeared stronger among females and non-Hispanic whites than their male and racial/ethnic minority counterparts. Conclusions: Health care providers should be aware of the potential risk for depression among obese older adults.
Keywords: Demographics; Health Conditions and Status; Methodology

Obesity Over the Life Course: A Study of How Obesity Produces Health Disadvantage and Excess Mortality in the United States - Heide Jackson (The University of Wisconsin - Madison, 2015)
This dissertation explores the influence of obesity on U.S. population morbidity and mortality. Across three essays, I examine the relation of obesity to work disability, activity impairment, and mortality. Chapter 1 looks at how obesity in early adulthood affects work disability at young and middle ages. Using data from the National Longitudinal Study of Youth 1979, I employ logistic regression to assess whether an early onset of obesity affects the likelihood of developing a work disabling condition and use event history analysis to predict the time at which that work disability occurs. Results indicate that early obesity increases the likelihood that a person will develop a work disability and uniformly increases the relative hazard of the disability occurring. The association of obesity and work disability remains robust to the inclusion of covariates and modeling the process that selects a person to become obese. Chapter 2 shifts to looking at how mid-life obesity may alter the effect of occupational exposures on later life limitations in activities of daily living. Using data from the Health and Retirement Study and latent growth curve models, I find that the effects of past occupational exposures differ by whether or not a respondent is obese around retirement. For non-obese respondents, physically demanding occupations are associated with a lower risk of developing health impairments, but no such association is found for obese persons. Instead, although not statistically significant, physically demanding occupations are associated with a greater rate of accumulation in health limitations for obese persons. Chapter 3 moves to examine why it is that older obese adults appear more likely to get sick but less likely to die. Using data from the Health and Retirement Survey and a multi-state modelling framework, I find that the obesity-mortality paradox may be explained by obese adults having a higher risk of becoming ill, losing weight, and subsequently dying having a history of obesity. Together, these three chapters suggest important influences of obesity on the health and well-being of adults throughout the life course and highlight the importance of studying the obesity-health relationship in a longitudinal framework.
Keywords: Demographics; Disabilities; Health Conditions and Status; Healthcare; Methodology; Public Policy

Older Adults Reporting More Diabetes Mellitus Care Have Greater 9 Year Survival - Benjamin H Han; Caroline S Blaum; Rosie Ferris; Lillian C. Min; Pearl G. Lee (Journal of the American Geriatrics Society, 2015)
To determine whether receiving more recommended diabetes mellitus (DM) care processes (tests and screenings) would translate into better 9-year survival for middle-aged and older adults. Longitudinal mortality analysis using the Health and Retirement Study Diabetes Mailout Survey. Health and Retirement Study (HRS). Individuals aged 51 and older (n = 1,879; mean age 68.8 or - 8.7, 26.5 aged a yen 75) with self-reported DM who completed the Diabetes Mailout Survey and the core 2002 HRS survey. A composite measure of five self-reported diabetes mellitus care process measures were dichotomized as greater (3-5 processes) versus fewer (0-2 processes) care processes provided. Cox proportional hazards models were used to test relationships between reported measures and mortality, controlling for sociodemographic characteristics, function, comorbidities, geriatric conditions, and insulin use. Prevalence of self-reported care processes was 80.1 for glycosylated hemoglobin test, 75.9 for urine test, 67.5 for eye examination, 67.7 for aspirin counseling, and 48.2 for diabetes education. In 9 years, 32.1 respondents died. Greater care correlated with 24 lower risk of dying (adjusted hazard ratio = 0.76, 95 confidence interval = 0.64-0.91) at 9-year follow up. When respondents were age-stratified (a yen 75 vs 75) longer survival was statistically significant only in the older age group. Although it is not possible to account for differences in adherence to care that may also affect survival, this study demonstrates that monitoring of and counseling about types of DM care processes are associated with long-term survival benefit even in individuals aged 75 and older with DM.
Keywords: Health Conditions and Status; Healthcare

Older Americans, Depression, and Labor Market Outcomes - Koford, Brandon C; Cseh, Attila (Eastern Economic Journal, 2015)
We examine the effect of depressive symptoms on the labor market outcomes of older Americans using the Health and Retirement Study (HRS). We take advantage of the longitudinal nature of the HRS from 1994 to 2008 and employ panel data methods to control for time-invariant, individual unobserved heterogeneity. Models that do not take into account individual heterogeneity show that depressive symptoms significantly reduce wages for males and females. In contrast, models that explicitly take into account individual heterogeneity through fixed effect estimation show no economic or statistically significant reduction in wages for those with depressive symptoms.
Keywords: Employment and Labor Force; Health Conditions and Status

An Ounce of Prevention at Half Price: Evaluating a Subsidy on Health Investments - Matthew N. White (Newark, DE, University of Delaware, Alfred Lerner College of Business and Economics, 2015)
This paper examines how investments in health, through spending on preventive care, affect subsequent spending on medical care among the retired population.Augmenting a traditional dynamic consumption-savings model with two medical care goods, I estimate a structural life cycle model using data on single retired Americans from the Health and Retirement Study; I then conduct policy counterfactuals to ascertain the effect of a subsidy on preventive care on health and fiscal outcomes. A narrowly targeted subsidy improves longevity by 0.76 months at a public cost of 760 per capita, but does not reduce lifetime demand for medical care.
Keywords: Consumption and Savings; Event History/Life Cycle; Health Conditions and Status

Patterns of Weight Gain in Middle-Aged and Older US Adults, 1992-2010 - Stenholm, Sari; Vahtera, Jussi; Ichiro Kawachi; Pentti, Jaana; Halonen, Jaana I.; Westerlund, Hugo; Razak, Fahad; S. V. Subramanian; Mika Kivimäki (Epidemiology, 2015)
Background: Cross-sectional analyses of national data have found that persons with high baseline body mass index (BMI) gain weight faster than persons at the median and that those whose weight was below the median gain very little weight. However, it is not clear whether these population-level changes reflect patterns at the individual level. Methods: We examined longitudinal changes in BMI in initially underweight, normal-weight, overweight, and obese US men and women using individual-level repeat data from the Health and Retirement Study (n = 15,895; age range, 40-69 years at baseline). Linear mixed-effect regression was used to model 6-year change in self-reported BMI during 4 study periods (1992/1994-1998/2000, 1996/1998-2002/2004, 2000/2002-2006/2008, and 2004-2010). Results: In the first 6-year period, the mean increase in BMI was greatest among persons who were initially normal weight (0.3 kg/m(2) 95 confidence interval = 0.2 to 0.4 ) and overweight (0.2 kg/m(2) 0.1 to 0.3 ). Weight gain accelerated in these groups with each subsequent period. Weight gain was less for initially class-I obese participants, and a net decrease in BMI was observed for class-II obese participants. Conclusion: These analyses suggest that the change in mean BMI among middle-aged and older US adults between 1992 and 2010 resulted mainly from accelerated weight gain among persons who were initially normal weight and overweight.
Keywords: Health Conditions and Status

Perceived Control, Chronic Stress, and Geriatric Frailty: Explicating Frailty's Psychosocial Etiology - Christopher J Mooney (University of Rochester, 2015)
Frailty in older adults is a highly prevalent syndrome that is characterized by increased vulnerability to stressors and is more generally thought to result from dysregulation across multiple physiologic systems. Although research has long recognized that psychosocial factors including chronic stress and perceived control influence geriatric health outcomes, relatively little research has explored their etiologic role in the development of frailty. Thus, the primary purpose of this study was to close key knowledge and methodological gaps that exist within the extant literature and to develop empirically based insights into the psychosocial etiology of geriatric or phenotypic frailty, using the allostatic load model of stress and a model of perceived control as guiding theoretical frameworks. Using a population-based sample of older adults from the Health and Retirement Study, the present study found a frailty prevalence of 7-8% in study subsamples. In structural equations modeling, the present study found that perceived control fully mediated the chronic stress and baseline phenotypic frailty and change in phenotypic frailty relationship, as well partially mediated the relationship linking socioeconomic status and baseline phenotypic frailty and change in phenotypic frailty. Multiple group analyses supported hypotheses that the mediating role of control was equivalent across gender and racial subgroups. Contrary to hypotheses, the present study found no evidence to support a stress-buffering or moderating effect of perceived control on baseline or change in phenotypic frailty status. Findings from the study advance the understanding of frailty's psychosocial etiology and underscore the importance of psychosocial factors in senescence and older adult health more generally.
Keywords: Demographics; Gerontology; Health Conditions and Status; Healthcare; Methodology; Public Policy

Predictors of functional limitation trajectories after injury in a nationally representative U.S. older adult population - Teresa M. Bell; Wang, Junling; Nolly, Robert; Ozdenerol, Esra; Relyea, George; Ben L. Zarzaur (Annals of Epidemiology, 2015)
Studies examining postinjury functional status have demonstrated that individuals with severe injuries often do not return to baseline levels of physical functioning. We sought to investigate the impact injuries have on changes in physical functioning across the life course of older adults. The study's objectives were to (1) identify trajectories of long-term functional limitations after injury in the older adult population to better characterize the recovery process and (2) predict which individuals are most at risk for poor functional trajectories after injury. A retrospective cohort study was conducted using six waves of data from the Health and Retirement Study, which surveys Americans older than 50 years every two years. A group-based trajectory model was used to identify trajectories of functional limitations in injured participants. Using multivariate regression, we identified significant predictors of each trajectory. Five distinct trajectories were identified: Trajectory 1-consistently low functional limitations scores (18.9 ), Trajectory 2-increase in functional limitations after injury followed by a gradual, incomplete recovery (46.3 ), Trajectory 3-increase in functional limitations followed by further decline in functioning (10.5 ), Trajectory 4-increase in functional limitations after injury followed by a gradual, complete recovery (13.4 ), and Trajectory 5-consistently high functional limitations scores (10.8 ). Gender, multiple health conditions, and insurance status predicted trajectory membership. Functional limitations after injury follow distinct trajectories that can be predicted by baseline individual characteristics.
Keywords: Demographics; Disabilities; Event History/Life Cycle; Health Conditions and Status; Healthcare

Preparaci n de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional - Tala M. Al-rousan; Linda M. Rubenstein; Robert B Wallace (American Journal of Public Health, 2015)
We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3 reported participating in an educational program or reading materials about disaster preparation. Nearly 15 reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.
Keywords: Demographics; Health Conditions and Status; Public Policy

Productive and Social Engagement Following Driving Cessation: A Couple-Based Analysis - Angela L Curl; Proulx, Christine M.; Stowe, James D.; Teresa M Cooney (Research on Aging, 2015)
Drawing on interdependence theory, this study examined the cross-spouse impact of driving cessation on productive (work, formal volunteering, and informal volunteering) and social engagement of older couples aged 65 using longitudinal data from the Health and Retirement Study (1998 2010; N = 1,457 couples). Multilevel modeling results indicate that driving cessation reduced husbands productive and social engagement, and wives productive engagement. Spousal driving cessation reduced husbands likelihood of working or formal volunteering, and wives likelihood of working or informal volunteering. The more time since spousal driving cessation, the less likely husbands were to work and the less likely wives were to formally volunteer. Results suggest the need for greater recognition of the impact of driving cessation on couples, rather than just individuals, as well as the need for enhanced services or rehabilitation efforts to maintain driving even among couples with one remaining driver.
Keywords: Adult children; Employment and Labor Force; Health Conditions and Status; Methodology; Other

Promises and Pitfalls of Anchoring Vignettes in Health Survey Research - Grol-Prokopczyk, Hanna; Emese Verdes-Tennant; Mary McEniry; Márton Ispány (Demography, 2015)
Data harmonization is a topic of growing importance to demographers, who increasingly conduct domestic or international comparative research. Many self-reported survey items cannot be directly compared across demographic groups or countries because these groups differ in how they use subjective response categories. Anchoring vignettes, already appearing in numerous surveys worldwide, promise to overcome this problem. However, many anchoring vignettes have not been formally evaluated for adherence to the key measurement assumptions of vignette equivalence and response consistency. This article tests these assumptions in some of the most widely fielded anchoring vignettes in the world: the health vignettes in the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) and World Health Survey (WHS) (representing 10 countries; n = 52,388), as well as similar vignettes in the Health and Retirement Study (HRS) (n = 4,528). Findings are encouraging regarding adherence to response consistency, but reveal substantial violations of vignette equivalence both cross-nationally and across socioeconomic groups. That is, members of different sociocultural groups appear to interpret vignettes as depicting fundamentally different levels of health. The evaluated anchoring vignettes do not fulfill their promise of providing interpersonally comparable measures of health. Recommendations for improving future implementations of vignettes are discussed. 2015 Population Association of America
Keywords: Health Conditions and Status; Methodology; SAGE

Purpose in Life and Cardiovascular Health - Eric S Kim (University of Michigan, 2015)
A growing body of research suggests that purpose in life may provide a point of intervention to improve the health behaviors and health of the large segment of adults throughout the world who are progressing into old age. Researchers have recently documented robust associations between purpose and enhanced health behaviors and outcomes. Preliminary studies also indicate that purpose can be systematically enhanced. Further research examining the connection between purpose, health behaviors, and outcomes is needed to guide the design of novel and low-cost prevention and intervention programs. To date, little research has investigated purpose in life's association with cardiovascular health or the possible mechanisms behind this link. In four distinct but linked papers, I use data from the Health and Retirement Study, a nationally representative sample of U.S. adults over the age of 51 to examine this research gap. The first and second studies examined the connection between purpose and cardiovascular health. Each unit increase in purpose (on a 6-point scale) was longitudinally associated with a decreased risk of stroke (OR = 0.78, 95% CI = 0.67-0.91) and myocardial infarction (OR = 0.73, 95% CI = 0.57-0.93), even after adjusting for an array of covariates. The third study examined a potential mechanism behind the purpose and health connection and tested whether higher baseline purpose predicted increased use of six preventive health care services over time. Results showed that higher purpose predicted higher use of cholesterol tests, mammograms, pap smears, prostate exams, and colonoscopies, but not flu shots. The fourth study used structural equation modeling to longitudinally examine if four health behaviors mediated the association between purpose and myocardial infarction. Results showed that only physical activity (β = -.026; 95% CI = -.042, -.009) and smoking (β = -.016; 95% CI = -.035, .004) mediated the association between purpose and myocardial infarction, while sleep quality and cholesterol tests did not. Taken together, these studies expand the literature by enhancing our knowledge about the association between purpose and cardiovascular health. These results are also the first to illuminate how health behaviors mediate the association between purpose and cardiovascular disease.
Keywords: Health Conditions and Status; Healthcare; Other

Purpose in life and incidence of sleep disturbances - Eric S Kim; Hershner, Shelley D.; Victor J Strecher (Journal of Behavioral Medicine, 2015)
Purpose in life has been linked with better mental health, physical health, and health behaviors, but the association between purpose and sleep is understudied. Sleep disturbances increase with age and as the number of older adults rapidly increases, it is ever more important to identify modifiable factors that are associated with reduced incidence of sleep disturbances. We used multiple logistic regression models and data from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, to examine whether higher purpose was linked with a reduced incidence of sleep disturbances. Among 4144 respondents reporting minimal or no sleep disturbances at baseline, higher purpose was associated with a lower incidence of sleep disturbances over the 4-year follow-up. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a 16 reduced odds of developing sleep disturbances (OR 0.84, 95 CI 0.77-0.92). The association between purpose and sleep disturbances remained after adjusting for sociodemographic, behavioral, psychological, and health covariates. Should future research replicate our findings, this area of research may lead to innovative efforts that improve the quality of sleep in older adults.
Keywords: Health Conditions and Status

Racial and Ethnic Disparities in Willingness to Pay for Improved Health: Evidence from the Aging and Population - Odufuwa, Olufolake O.; Berrens, Robert P.; Valdez, R. Burciaga (Challenges of Latino Aging in the Americas, 2015)
Keywords: Health Conditions and Status; Net Worth and Assets; Women and Minorities

Racial Disparities in Mortality Among Middle-Aged and Older Men: Does Marriage Matter? - Su, Dejun; Stimpson, Jim P.; Wilson, Fernando A. (American Journal of Men's Health, 2015)
Based on longitudinal data from the Health and Retirement Study, this study assesses the importance of marital status in explaining racial disparities in all-cause mortality during an 18-year follow-up among White and African American men aged 51 to 61 years in 1992. Being married was associated with significant advantages in household income, health behaviors, and self-rated health. These advantages associated with marriage at baseline also got translated into better survival chance for married men during the 1992-2010 follow-up. Both marital selection and marital protection were relevant in explaining the mortality advantages associated with marriage. After adjusting for the effect of selected variables on premarital socioeconomic status and health, about 28 of the mortality gap between White and African American men in the Health and Retirement Study can be explained by the relatively low rates of marriage among African American men. Addressing the historically low rates of marriage among African Americans and their contributing factors becomes important for reducing racial disparities in men s mortality.
Keywords: Adult children; Demographics; Health Conditions and Status; Women and Minorities

Racial/Ethnic Disparities in Men's Health: Examining Psychosocial Mechanisms - Tyson H Brown; Taylor W. Hargrove; Griffith, Derek M. (Family and community health, 2015)
This study uses data from the Health and Retirement Study and an approach informed by the Biopsychosocial Model of Racism as a Stressor to examine the extent to which socioeconomic status, stressors, discrimination, and neighborhood conditions are mechanisms underlying racial/ethnic disparities in functional limitations among men. Results reveal that racial/ethnic differences in socioeconomic status, stressors, discrimination, and neighborhood conditions-individually and collectively-account for a substantial proportion of racial/ethnic disparities in functional limitations. Findings suggest that the social determinants of health for men of color need to be more seriously considered in investigations of and efforts to address health disparities.
Keywords: Demographics; Health Conditions and Status; Women and Minorities

The Relationship between Psychosocial Factors and Breast Cancer Screening Behaviors of Older Hispanic Women - Tamara J. Cadet (Social Work in Public Health, 2015)
Guided by the theory of planned behavior, this study utilized data from the 2008 wave of the Health and Retirement Study to investigate psychosocial factors associated with older Hispanic women's participation in breast cancer screening services. Hierarchical logistic regression models were used to assess the odds of breast cancer screening participation. Findings indicate that satisfaction with aging and constraints were associated with a reduced likelihood of participating in breast cancer screening. These findings suggest the continued importance to assess older women's attitudes when discussing preventive services.
Keywords: Health Conditions and Status; Healthcare; Women and Minorities

Relationship of financial literacy to retirement preparedness among female baby-boomer cohorts - Womack, Barbara Klein (School of Public Service Leadership, 2015)
Studies have not examined the impact of components of financial literacy on retirement preparedness nor the relationship between financial literacy and decision-making among female baby-boomers. This study examined data from the 2010 wave of the Health and Retirement Study for females born between 1946 and 1959. This study defined financial literacy as including knowledge of investment strategies, the bond market, risk, and diversity. It defined retirement preparedness as the possession of specific financial assets. Financial decision-making was defined as the potential for mortgage default and carrying balances on credit cards. The study used a synthesis of rational choice and planned behavior theories. Correlation was used to describe the relationships between variables, and Fisher's transformation was used to determine significant differences between cohorts. Multiple linear regression was used to create predictive models for retirement planning, with the resultant finding that age was significant in predicting retirement preparedness ( p < .01). Older cohorts were more prepared, particularly in terms of owning IRA/Keogh plans. Understanding the effects of holding a variety of stocks and foreign stocks were most strongly related to retirement preparedness. There was a significant relationship between financial literacy and the potential for mortgage default ( p < .05) but not for carrying credit card balances. The regression produced a significant ( p < .05) predictive model for retirement preparedness, thought the relationship with financial literacy was slight. The research has implications in terms of housing, health, and municipal sustainability. Further research is necessary to define financial literacy, retirement preparedness, and their relationship.
Keywords: End of life decisions; Health Conditions and Status; Methodology; Net Worth and Assets; Public Policy; Retirement Planning and Satisfaction; Women and Minorities

The relationships among perceived discrimination, self-perceptions of aging, and depressive symptoms: a longitudinal examination of age discrimination - Jina Han; Virginia E. Richardson (Aging and Mental Health, 2015)
Objectives: This study examined the relationship between changes in perceived discrimination and changes in depressive symptoms among older people. The association between perceived age discrimination and depressive symptoms was also analyzed longitudinally along with tests to determine whether self-perception of aging mediates this association. Method: Data from two waves (2008 and 2012) of the Health and Retirement Study were used. Longitudinal models were tested using a nationally representative sample of 3921 participants who responded to psychosocial questionnaires in both waves and answered questions about perceived everyday discrimination and attributions of discrimination in 2008. Results: Changes in perceived discrimination was significantly associated with changes in depressive symptoms over time. Perceived age discrimination was significantly related to a change in depressive symptoms over four years and self-perceptions of aging mediated the relationship between perceived age discrimination and depressive symptoms. Conclusion: Findings demonstrate the importance of recognizing perceived discrimination and negative self-perceptions of aging as well as how the negative effects of age discrimination on self-perceptions of aging can be risk factors for the development of depressive symptoms in late life.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status

The relationships that matter: social network site use and social wellbeing among older adults in the United States of America - R. P. Yu; Ryan J McCammon; Nicole B. Ellison; Kenneth M. Langa (Ageing and Society, 2015)
An increasing number of middle-aged and older Americans are using social network sites (SNSs), but little research has addressed how SNS use is associated with social wellbeing outcomes in this population. Using a nationally representative sample of 1,620 Americans older than 50 from the 2012 Health and Retirement Study (HRS), we examine the relationship between older adults SNS use and social wellbeing associated with non-kin and kin relations and explore how these associations vary by age. Results of ordinary least-squares regression analyses suggest that SNS use is positively associated with non-kin-related social wellbeing outcomes, including perceived support from friends ( = 0.13; p 0.001; N = 460) and feelings of connectedness ( = 0.10; p 0.001; N = 463). Regression models employing interaction terms of age and SNS use further reveal that SNS use contributes to feelings of connectedness to a greater extent as people age ( = 0.10; p 0.001; N = 463). Of all kin-related social wellbeing outcomes, SNS use only predicts increased perceived support from children ( = 0.08; p 0.05; N = 410), and age negatively shapes this relationship ( = 0.14; p 0.001; N = 410). As older people engage with an increasingly smaller and narrower network with a greater proportion of kin contacts, our results suggest that SNS use may help older adults access differential social benefits throughout later life. Copyright Cambridge University Press 2015 This is a work of the U.S. Government and is not subject to copyright protection in the United States.
Keywords: Adult children; Health Conditions and Status

Risk, functional outcomes, and the utilization of rehabilitation services among survivors of cerebrovascular accident: A pooled, cross-sectional population-based study - Keptner, Karen M (Case Western Reserve University, 2015)
Many studies conducted on risk factors for cerebrovascular accident (CVA) rely on homogeneous populations from small geographic areas and lack information about relevant personal and clinical features. Very few studies have looked at long-term functional ability following CVA. CVA clinical guidelines for recommend on-going use of rehabilitation by CVA survivors, but little is known about the extent to which this occurs. The Health and Retirement Study, a nationally, representative sample from the US, and linked Medicare claims data were used to study incidence and effects of first CVA, functional ability of CVA survivors, and the utilization of rehabilitation by survivors. The data were pooled cross-sectionally and Generalized Estimating Equations were utilized as the primary analysis method. Results confirm previous findings that age, gender, and smoking status increase CVA risk. The study also found that: 1) Individuals who were disabled had increased risk for CVA. 2) Age, education, and overweight BMI had a significant effect on the odds of dying in those sustaining a CVA. 3) Of those who survived CVA more than 2 years, age and type of CVA were predictive of worse functional ability. 4) Age, race, co-morbidity, current use of rehabilitation, and depressive symptoms were all associated with worse post-CVA functional ability. 5) Employment status and physical activity behaviors at baseline, better cognition, social support, and mild initial severity of CVA were all predictive of better post-CVA functional ability. 6) Age, type of CVA, and recurrent CVA were the primary predictors of rehabilitation use. 7) Those who were employed at baseline used less rehabilitation services overall. Study findings suggest that 1) the role of employment and BMI in CVA risk and severity should be further studied; 2).attention by healthcare providers to post-CVA depression, cognition, and social support might improve CVA survivors' functional ability; and 3) health system factors, such as medical provider knowledge and attitudes about rehabilitation services, may need to be studied to understand variation in CVA clinical guideline implementation. Overall, this study demonstrates the value of using large databases to study utilization of rehabilitation services.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Risk Taking

Risk of Cognitive and Functional Impairment in Spouses of People With Dementia: Evidence From the Health and Retirement Study - Pertl, Maria M.; Lawlor, Brian A.; Robertson, Ian H.; Walsh, Cathal; Brennan, Sabina (Journal of Geriatric Psychiatry and Neurology, 2015)
Caring for a spouse with dementia is a chronic stressor that may compromise caregivers own cognitive functioning and capacity to provide adequate care. We examined whether having (i) a spouse with dementia and (ii) a spouse who requires assistance with activities of daily living predicted cognitive and functional impairments in respondents to the Health and Retirement Study (n = 7965). Respondents who had a spouse who requires care had poorer cognitive functioning, whereby this relationship was significantly stronger for male respondents. Having a spouse with dementia moderated the relationship between income and cognition and predicted caregiver functional impairment, though not when depression was controlled. Although we found no significant differences on any individual cognitive domains between 179 dementia caregivers and sociodemographically matched noncaregivers, our findings suggest that caregivers, especially men, and low-income individuals who have a spouse with dementia are more vulnerable to adverse cognitive outcomes. Targeting depression in spouses of people with dementia may help to prevent functional impairments.
Keywords: Health Conditions and Status; Healthcare

Risk Predictors, Outcomes, and Costs of Falls among Older Adults Living in the Community - Geoffrey J Hoffman (University of California, Los Angeles, 2015)
Background: Non-injurious falls (NIFs) and fall-related injuries (FRI) among older adults are common and impose substantial health burdens. Risks include health and health behavior factors, medications, and environmental hazards. Non-injurious falls (NIFs) and fall-related injuries (FRIs) may particularly compromise older adults' ability to engage in social and recreational activities and activities of daily living and can generate chronic stress, resulting in depressive symptoms. Previous studies have used depression to predict falls, but are potentially subject to endogeneity bias by not controlling for other temporal associations between falls and depression. With 2.5 million and .75 million FRIs treated in emergency departments and hospitals, respectively, FRIs also have important Medicare cost implications. However, existing FRI cost estimates are inconsistent, ranging from $2,000 to $26,000, and traditional FRI identification methods likely undercount FRIs. Three studies were conducted to assess relationships between (1) falls and caregiving, (2) falls and depressive symptoms, and (3) FRIs and Medicare costs. Methods: First, 10 survey waves of pooled data from the 2000-2010 Health and Retirement Study (HRS) were used to compare risks of NIFs and FRIs among respondents receiving and not receiving formal and/or informal caregiving assistance in the past two years. Stratified models were used to assess whether cognitive impairment modified the relationship between caregiving receipt and fall risk. Next, using 2006-10 HRS data, "cross-lagged panel" analyses using structural equation modeling were conducted to evaluate temporal associations between falls and depressive symptoms. Structural coefficients of pathways between falls and depressive symptoms (in 2006[arrow right]2008 and 2008[arrow right]2010) were estimated, controlling for baseline (2006) latent factors: poor physical health status (indicated by vision, hearing, cognitive status, activities of daily living, chronic disease, and functional limitations), perceived social support, and social cohesion. Finally, 2007-9 Inpatient, Outpatient, Carrier, Skilled Nursing Facility, Home Health, Durable Medical Equipment, and Hospice Medicare claims and linked 2008 HRS survey data were used to estimate the difference in predicted medical cost change scores (12-month post-index minus 12-month pre-index costs) for an FRI compared to a non-FRI cohort. For this analysis, linear regression models adjusted for sociodemographic characteristics, indicators of health status (sensory impairments, cognitive status, and indices for functional limitations and chronic health conditions), and geographic factors were used. Four different methods--using (1) external cause-of-injury codes (e-codes) and a select set of inpatient ICD-9 diagnostic codes, (2) e-codes, inpatient diagnostic and outpatient diagnostic and procedure codes, (3) e-codes and a broad set of diagnostic codes, and (4) e-codes only--were used to identify FRIs in the claims data. Population: Community-dwelling older adults (ages 65 and older). For the first study, 17,420 unique individuals (172 with cognitive impairment), with a total of 63,542 pooled person-wave observations; for the second study, 13,439 individuals; and for the third study, 5,548 individuals (103 FRI and 5,445 non-FRI) with continuous Medicare Parts A/B coverage and alive during the 24-month study period. Results: For the first study, adjusting for sociodemographic and health characteristics, relative to no care received, older adults receiving low levels of informal care had a 3 percentage-point increase in NIF risk and 2 percentage-point increase in FRI risk while those receiving high levels of informal care had a 4 percentage-point increase in FRI risk. However, those receiving both formal and informal care had a 4 percentage-point (or 20%) decrease in NIF risk. Wald tests showed that those receiving formal care only or formal care and informal care had lower NIF and FRI risks than those receivin informal care only. Among those with cognitive impairment, older adults receiving informal and formal care generally had reduced NIF and FRI risks compared to those receiving no care. For the second study, both the NIF (χ 2 (dfs = 266) = 2,646.39, p <0.001, Comparative Fit Index (CFI) = 0.944, Root Mean Square Error of Approximation (RMSEA) = 0.026) and FRI (χ2 (dfs = 267) = 2,511.52, p <0.001, CFI = 0.945, RMSEA = 0.025) models had acceptable fit. Depressive symptoms predicted future NIFs (unstandardized structural probit coefficients = 0.85 for 2006[arrow right]2008 and 0.83 for 2008[arrow right]2010, p <0.001), a relationship potentially mediated by psychotropic drug use; however, NIFs did not predict future depressive symptoms. Depressive symptoms predicted future FRIs (unstandardized structural probit coefficients = 1.00, p <0.001 for 2006[arrow right]2008 and 0.95, p <0.001 for 2008[arrow right]2010). For the third study, average, unadjusted medical costs during the 12-month follow-up period were $23,429 and $9,818 for FRI and non-FRI cohort individuals, respectively. The estimated change score difference between the FRI and non-FRI cohort was $14,879 (p<0.001) using the first FRI identification method using e-codes and a select set of inpatient ICD-9 diagnostic codes. Change score differences were $6,587 for inpatient, $2,476 for outpatient, $4,595 for SNF, and $1,141 for HH. Overall change score differences were $11,678 (p<0.001), $8,963 (p<0.001), and $12,757 (p<0.001) using the second, third, and fourth FRI identification methods (using varying sets of e-codes and inpatient and outpatient diagnostic and procedural codes), respectively. An FRI increased the risk of persistently high costs using all identification methods. Findings were robust to the inclusion of pre-index costs as a predictor and respondents who died during the study. Conclusion: For the first study, caregiving receipt significantly predicted falls, but was not uniformly negatively associated with NIF and FRI risk. The 20% risk reduction among those receiving formal and informal care was comparable to common falls prevention interventions. While informal care may encourage more activity and risk-taking, formal caregivers may prevent risky behaviors associated with falls and cognitively impaired individuals may particularly benefit from caregiving in preventing falls. For the second study, compared to latent indicators of poor physical health status and social factors, depressive symptoms are strong predictors of older adult NIFs and FRIs. Controlling for these confounders, a one standard deviation increase in depressive symptom levels was associated with a 22% and 28% increase in the risk of future NIFs and FRIs, respectively. However, NIFs and FRIs were not associated with greater odds of future increased depressive symptoms. For the third study, FRIs were associated with substantial and sustained increases in Medicare spending. Substantial increases in medical costs associated with FRIs were driven by inpatient (44%), SNF (31%), outpatient/carrier (17%), and home health (8%) costs and FRIs increased the probability of having high cost in the four quarters following an index FRI from 11.6% to 19.5%, reflecting a 67% increase. The findings suggest a wide range of per-FRI as well as total FRI-related Medicare costs, depending upon the method used to identify FRIs in the claims data; per-FRI costs ranged from approximately $9,000 to $15,000 while total FRI-related Medicare costs ranged from $5 to $49 billion due to differing proportions of beneficiaries experiencing FRIs depending on the FRI identification method used. Implications: These findings suggest a potential opportunity for population health management of falls. To scale up falls prevention for falls costing Medicare billions of dollars per year, policymakers and providers should consider offering assistance to informal caregivers through educational outreach. Falls assessments should also include caregiving as an essential component. Prevention effo ts should include depressive symptomatology as a main falls risk factor and geriatric evaluations should emphasize the depressive symptoms--falls relationship. Current approaches to claims-based FRI identification and current FRI surveillance techniques may be inadequate. Given substantial, sustained costs of FRIs and known effectiveness of falls prevention efforts, Medicare should consider reimbursement for geriatric FRI risk prevention.
Keywords: Consumption and Savings; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Public Policy; Risk Taking

Risk-Sharing within Families: Evidence from the Health and Retirement Study - Akin, S. Nuray; Leukhina, Oksana (Journal of Economic Dynamics and Control, 2015)
We report strong empirical support for the presence of self-interest-based risk sharing within extended families in the U.S. A standard model of self-interest-based risk sharing predicts that the share of current family income consumed by a child positively depends on that child's permanent income. It follows that parental transfers to children that are expected to earn more over the period of risk-sharing arrangements should exhibit less sensitivity to the recipient's income fluctuations. We test this distinguishing prediction of self-interest-based risk sharing by exploiting the variation of transfer receipts among siblings, observed over 17 years of longitudinal data spanned by the Health and Retirement Study.
Keywords: Adult children; Health Conditions and Status; Income; Retirement Planning and Satisfaction; Risk Factors

The Role of Occupations in Differentiating Health Trajectories in Later Life - Michal Engelman; Heide Jackson (Boston College, 2015)
This study characterizes heterogeneous trajectories of health among older Americans and investigates how employment histories differentiate them. Using the 1998-2010 waves of the Health and Retirement Study, we examine the impact of longest-held occupations on patterns of limitations in activities of daily living. We use latent class growth analysis to identify distinct health trajectory classes and linear growth curve analysis to model the pattern of limitation accumulation for individuals. All analyses are stratified by sex and race, to account for differential labor markets and health experiences of these demographic groups. A limitation of this analysis is its reliance on broad occupational categories rather than specific measures of working conditions. In future work, we plan to incorporate data on specific occupations and merge them with detailed information on occupational characteristics available in the O NET database (an online repository that has updated the Dictionary of Occupational Titles used in previous research on aging and retirement and occupational epidemiology: http://www.onetonline.org/). The paper found that: White respondents (both male and female) are substantially more likely to be in the healthiest class compared to black respondents. Certain occupations are protective against membership in poor health classes, but the list of protective occupational categories differs substantially by sex and race. The impact of occupations on health trajectories was diminished when we controlled for educational attainment and smoking, suggesting the important role of education in sorting individuals into occupations that differ in physical and cognitive demands that likely influence health. The policy implications of the findings are: Life expectancy alone does not capture all the health information that would be relevant for assessing the capacity of American workers to stay on the job beyond traditional retirement ages. Legislators should consider differences in health and in the trajectories of functional decline across demographic groups defined by sex, race, and occupational exposures when debating further increases in the Social Security retirement age.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare

Role of Place in Explaining Racial Heterogeneity in Cognitive Outcomes among Older Adults - Sze Y Liu; M. Maria Glymour; Laura B Zahodne; Weiss, Christopher; Jennifer J Manly (Journal of the International Neuropsychological Society, 2015)
Racially patterned disadvantage in Southern states, especially during the formative years of primary school, may contribute to enduring disparities in adult cognitive outcomes. Drawing on a lifecourse perspective, we examine whether state of school attendance affects cognitive outcomes in older adults and partially contributes to persistent racial disparities. Using data from older African American and white participants in the national Health and Retirement Study (HRS) and the New York based Washington Heights Inwood Cognitive Aging Project (WHICAP), we estimated age-and gender-adjusted multilevel models with random effects for states predicting years of education and cognitive outcomes (e.g., memory and vocabulary). We summarized the proportion of variation in outcomes attributable to state of school attendance and compared the magnitude of racial disparities across states. Among WHICAP African Americans, state of school attendance accounted for 9 of the variance in years of schooling, 6 of memory, and 12 of language. Among HRS African Americans, state of school attendance accounted for 13 of the variance in years of schooling and also contributed to variance in cognitive function (7 ), memory (2 ), and vocabulary (12 ). Random slope models indicated state-level African American and white disparities in every Census region, with the largest racial differences in the South. State of school attendance may contribute to racial disparities in cognitive outcomes among older Americans. Despite tremendous within-state heterogeneity, state of school attendance also accounted for some variability in cognitive outcomes. Racial disparities in older Americans may reflect historical patterns of segregation and differential access to resources such as education.
Keywords: Health Conditions and Status; Healthcare; Women and Minorities

Self-employment and health: Barriers or benefits? - Cornelius A Rietveld; van Kippersluis, Hans; A. Roy Thurik (Health Economics (United Kingdom), 2015)
The self-employed are often reported to be healthier than wageworkers; however, the cause of this health difference is largely unknown. The longitudinal nature of the US Health and Retirement Study allows us to gauge the plausibility of two competing explanations for this difference: a contextual effect of self-employment on health (benefit effect), or a health-related selection of individuals into self-employment (barrier effect). Our main finding is that the selection of comparatively healthier individuals into self-employment accounts for the positive cross-sectional difference. The results rule out a positive contextual effect of self-employment on health, and we present tentative evidence that, if anything, engaging in self-employment is bad for one's health. Given the importance of the self-employed in the economy, these findings contribute to our understanding of the vitality of the labor force.
Keywords: Employment and Labor Force; Health Conditions and Status

Self-Rated Health, Social Engagement, and "Older Places" - Eric M Vogelsang (Sociology - LS, 2015)
This dissertation consists of three essays that are motivated by an aging world. Its primary goals are to (a) identify how older adult health and its correlates--with a particular focus on social engagement--systematically differ by residential context; and (b) consider the implications of subjective health changes across older ages. The first chapter explores how the type and intensity of older-adult social participation varies by county-level population density. Using the 2003 and 2011 waves of the Wisconsin Longitudinal Study (n=3,006), I find that older adults living in rural counties with relatively low population densities are less socially active than their counterparts in higher-density counties. I also find that just five (of twelve) social activities are related to better health; while only three are associated with health change. Chapter two examines relationships between older adult health and living in relatively older and younger municipalities. Using a national sample of almost 5,000 Japanese older adults over two decades, I employ growth curve models to estimate how self-rated health and self-rated health trajectories differs by local area age structure. I find older adults living in the "oldest places" of Japan are more likely to report less than good health, when compared to those living in younger areas. In addition, relatively high levels of social engagement among older adults living in oldest areas help mitigate even greater odds of reporting worse health in these places. Chapter three explores how two measures of self-rated health (SRH) change are related to mortality. Data come from the Asset and Health Dynamics survey--the "oldest-old" portion of the Health and Retirement Study--and follow 6,233 individuals over thirteen years. After controlling for morbidity, individual characteristics, and SRH, those who changed SRH categories between survey waves and those who retrospectively reported an improvement in health continue to have a greater risk of death; when compared to those with no change. These findings suggest that the well-established associations between SRH status and mortality may understate the risk of death for oldest-old individuals with recent subjective health improvements.
Keywords: Health Conditions and Status; Healthcare; Methodology

The shadow of the past: Financial risk taking and negative life events - Alessandro Bucciol; Luca Zarri (Journal of Economic Psychology, 2015)
Based on data from the four 2004-2010 waves of the US Health and Retirement Study (HRS), we show that financial risk taking is significantly related to life-history negative events out of an individual's control. Using observed portfolio decisions to proxy for risk taking, we find correlation with two of such individual-specific events: having been victim of a physical attack and (especially) the loss of a child are associated with lower and less frequent investments in risky assets, with an intensity similar to that of the beginning, in 2008, of a collectively experienced event such as the recent financial crisis. We also find evidence that the correlation of risk taking with a child loss is long-lasting, as opposed to the correlation with a physical attack that disappears after few years. Our analysis is more in favor of a preference-based - rather than a belief-based - explanation of the observed change in risk taking. Overall our findings indicate that the past, especially through the loss of a child, casts a long shadow that extends over individuals' current decisions also within unrelated domains. 2015 Elsevier B.V.
Keywords: Health Conditions and Status; Methodology; Net Worth and Assets; Risk Taking

Slowed or Sidelined? The Effect of Normal Cognitive Decline on Job Performance Among the Elderly - Belbase, Anek; Khan, Mashfiqur R.; Alicia H. Munnell; Anthony Webb (Boston, MA, Center for Retirement Research at Boston College, 2015)
This paper examines the relationship between age-related cognitive decline and three potential workplace outcomes: 1) coping with increased job difficulty; 2) shifting to a less cognitively demanding job; and 3) retiring early. It uses data from the Health and Retirement Study (HRS) and the O NET database. Critical components of the analysis are the metric used to measure cognitive decline, inclusion of cognitive reserve as an independent variable, and the use of overlapping 10-year observation windows. A key limitation is that the study cannot conclusively discern a causal relationship between cognitive decline and workforce exit.
Keywords: Employment and Labor Force; Health Conditions and Status

Smoking and cognitive functioning at older ages: Evidence from the Health and Retirement Study - Padmaja Ayyagari; Asia Sikora Kessler (Journal of the Economics of Ageing, 2015)
It has long been established that smoking has detrimental health effects on the human body and leads to early mortality. However, the evidence regarding the link between smoking behavior and cognitive function in old age is mixed. While nicotine has been shown to improve cognitive functioning in some medical studies, current smokers typically perform worse than non-smokers on cognitive tests in population based studies. We use the Health and Retirement Study to evaluate the role of unobserved factors in explaining these conflicting findings. Results from individual fixed effects models show that much of the lower cognitive function of current and former smokers relative to never smokers can be attributed to unobserved differences between these groups.
Keywords: Demographics; Health Conditions and Status; Methodology

Smoking, Heavy Drinking, and Depression among U.S. Middle-Aged and Older Adults - An, Ruopeng; Xiang, Xiaoling (Preventive Medicine, 2015)
Objective To examine the relationship between smoking, heavy drinking and depression among U.S. middle-aged and older adults. Method Individual-level data came from 1992 2012 waves of the Health and Retirement Study. Smoking was ascertained from self-reported cigarette smoking status at the time of interview. Heavy drinking was defined as one or more drinks per day on average or four or more drinks on any occasion in the past three months for women, and two or more drinks per day on average or four or more drinks on any occasion in the past three months for men. Depression was defined as scoring three and above on the eight-item Center for Epidemiologic Studies Depression Scale. Cox proportional hazards regressions were performed to examine the relationship between smoking, heavy drinking and depression. Results Compared to non-smokers, smokers free from depression and heavy drinking at baseline were 20 (95 confidence interval: 12 28 ) and 34 (20 50 ) more likely to develop depression and engage in heavy drinking during follow-up period, respectively. Compared to non-depressed participants, participants with depression who were nonsmokers and non-heavy drinkers at baseline were 41 (14 74 ) and 18 (6 31 ) more likely to smoke and engage in heavy drinking during follow-up, respectively. Compared to non-heavy drinkers, heavy drinkers who were nonsmokers at baseline were 60 (26 104 ) more likely to smoke during follow-up. Conclusion Health promotion programs in midlife and older age should be mindful of the associations between smoking, heavy drinking and depression in order to improve intervention effectiveness.
Keywords: Demographics; Health Conditions and Status; Methodology; Other

Social relationships, positivity, and personality in older adulthood - Iveniuk, James (The University of Chicago, 2015)
In this dissertation, I examine the implications of personality traits for social relationships in older adulthood. My work brings together insights from mid-20th century sociological theory, recent work by social network scholars, and personality psychologists. I build upon these insights in order to examine not only if personality traits are important for social relationships, but also under what social and relational circumstances. The personality characteristic that I focus on in this dissertation is Positivity, which I conceptualize as a person's overall positive (i.e. upbeat and socially desirable) characteristic patterns of thought and behavior. I measure Positivity using structural equation modeling techniques, applied to a Big Five personality battery in the National Social Life, Health, and Aging Project (NSHAP), a nationally representative, longitudinal survey of older adults. I then employ Positivity scores in three empirical studies. In the first study, I examine older adults' social networks, and I find that Positivity is associated with feeling closer to one's confidants, and being more likely to open up to them about one's health. I also find that Neuroticism (emotional instability) is associated with being more likely to talk to one's friends about one's health. In the second study I use dyadic data from NSHAP to examine the implications of traits for marital conflict, with a focus on gender. I find that the Positivity of a husband is associated with reduced marital conflict according to the reports of his wife, but that a wife's Positivity is not associated with conflict according to her husband. In the final study I examine the implications of Positivity for the diagnosis of chronic conditions, using a combination of biomeasures and self-reports. I find that individuals who are more positive are more likely to be undiagnosed for their hyperglycemia, but not hypertension. I relate this finding to theories of doctor-patient interaction, as well as differences in medical procedures for diagnosing these two chronic conditions. I conclude by offering possibilities for sociological research on personality, arguing that issues related to personality cut across existing subfields of the discipline, and that these issues relate to key questions in sociological theory.
Keywords: Adult children; Health Conditions and Status; Healthcare; Methodology

Social Resource Factors that Influence Cognitive Functioning of Aging Black Adults - Swett, Laura (The Catholic University of America, 2015)
Social workers have found that aging adults are often challenged by reduced cognitive functioning, which impacts their health and mental health. Recent advances in knowledge indicate that social resources such as quality of emotional support and social integration can slow cognitive decline. Aging Black persons are twice more likely to have cognitive impairment than aging White persons. However, the majority of studies investigating associations or predictors of cognitive health are comprised of primarily White samples, and little is known regarding the effect of social resource factors on cognition in aging Black adults. Data for the study came from the 2010 wave of the Health and Retirement Study (HRS), an ongoing, longitudinal, population-based cohort study of adults ages 50 to 98. The analyzed sample was comprised of 338 men and 699 women who self-identified as African American/Black. Controlling for factors known to influence cognitive functioning, a multiple regression analysis of four categories of social resources was conducted, by gender, to determine their effect on global cognitive functioning: quality of social supports, social networks, social integration, and social influence. For Black men, emotional support from family and frequency of contact with their children were predictive of global cognition. For Black women, emotional support from friends was positively predictive of global cognition. Further, locus of control perceived constraints was inversely related with global cognition in men, while education was positively predictive of global cognition across gender. The findings demonstrate that the evaluative aspects of social relationships (perceptions of support) are important in predicting cognitive functioning for both genders, and the structural components (types of relationships or frequency of contacts) are important in predicting cognitive functioning for men. Additionally, this study validated the role of gender as a moderator between quality of social supports and global cognition, and as a moderator between social networks and global cognition in aging Black persons. Research grounded in intersectionality theory yielded unique information for Black men and women that is applicable for evidence-based practice interventions. Practices targeting the reduction of constraints and strengthening family, friend, and children networks in men, and practices assisting women in strengthening their friendship networks, may mitigate their cognitive decline and increase their global cognition as they age.
Keywords: Demographics; Event History/Life Cycle; Gerontology; Health Conditions and Status; Healthcare; Methodology; Other; Women and Minorities

Social Status and Personality Traits - Alessandro Bucciol; Cavasso, Barbara; Luca Zarri (Journal of Economic Psychology, 2015)
We provide direct evidence on the relationship between social status and personality traits. Using survey data from the 2006-2012 waves of the US Health and Retirement Study, we show that self-perceived social status is associated with all the Big Five personality traits, after controlling for observable characteristics that arguably reflect one's actual status. We also construct an objective status measure that in turn is associated with personality traits. Objectively measured status is positively but not highly correlated with its subjective counterpart. When incorporated in a regression specification, it still leaves room for significant correlations between personality traits and status perception: traits such as openness, conscientiousness and extraversion predict a higher self-positioning on the social ladder, while agreeableness and neuroticism predict a lower one. (C) 2015 Elsevier B.V. All rights reserved.
Keywords: Demographics; Expectations; Health Conditions and Status; Income

Sources of Increasing Differential Mortality Among the Aged by Socioeconomic Status - Barry Bosworth; Gary T. Burtless; Zhang, Kan (Boston College, 2015)
This paper uses data from the Health and Retirement Study (HRS) to explore the extent and causes of widening differences in life expectancy by socioeconomic status (SES) for older persons. We construct alternative measures of SES using educational attainment and average (career) earnings in the prime working ages of 41-50. We also use information on causes of death, health status and various behavioral indicators (smoking, drinking, and obesity) that are believed to be predictors of premature death in an effort to explain the causes of the growing disparities in life expectancy between people of high and low SES. The paper finds that: There is strong statistical evidence in the HRS of a growing inequality of mortality risk by SES among more recent birth cohorts compared with cohorts born before 1930. Both educational attainment and career earnings as constructed from Social Security records are equally useful indicators of SES, although the distinction in mortality risk by education is greatest for those with and without a college degree. There has been a significant decline in the risk of dying from cancer or heart conditions for older Americans in the top half of the income distribution, but we find no such reduction of mortality risk in the bottom half of the distribution. The inclusion of the behavioral variables and health status result in substantial improvement in the predictions of mortality, but they do not identify the sources of the increase in differential mortality. The policy implications of the findings are: Indexing the retirement age to increases in average life expectancy to stabilize OASDI finances may have unintended distributional consequences, because most mortality gains have been concentrated among workers in the top half of the earnings distribution. The fact that we cannot identify the sources of the increase in differential mortality contributes to uncertainty about the distributional effects of increases in the retirement age in future years.
Keywords: Demographics; Expectations; Health Conditions and Status; Methodology

Spousal Effects in Smoking Cessation: Matching, Learning, or Bargaining? - McGeary, Kerry Anne (Eastern Economic Journal, 2015)
Previous research studying the correlation in smoking behavior between spouses has discounted the role of bargaining or learning. Using the Health and Retirement Study, which contains information on smoking cessation and spouse s preferences, this paper presents an essential investigation of the impact of spousal bargaining or learning on the decision to cease smoking. We find that, regardless of gender, when one member of a couple ceases smoking this induces the other member to cease smoking through bargaining. Further, we find that women demonstrate either altruistic behavior toward a spouse who has suffered a health shock, or learning from their spouse s health shock.
Keywords: Health Conditions and Status; Methodology; Net Worth and Assets

Subjective health expectations - Kim P. Huynh; Jung, Juergen (Journal of Policy Modeling, 2015)
Subjective health expectations are derived using data from the U.S. Health and Retirement Study (HRS). We first use a Bayesian updating mechanism to correct for focal point responses and reporting errors of the original health expectations variable. We then test the quality of the health expectations measure and describe its correlation with various health indicators and other individual characteristics. Our results indicate that subjective health expectations do contain additional information that is not incorporated in subjective mortality expectations and that the rational expectations assumption cannot be rejected for subjective health expectations. Finally, the data suggest that individuals younger than 70 years of age seem to be more pessimistic about their health than individuals in their 70s. 2015 Society for Policy Modeling.
Keywords: Employment and Labor Force; Expectations; Health Conditions and Status; Healthcare; Methodology; Other

Subjective, Objective, and Observed Long-term Survival - Rafael D Romo; Sei J. Lee; Yinghui Miao; W John Boscardin (JAMA Internal Medicine, 2015)
Many professional guidelines recommend using life expectancy when considering diagnostic or treatment interventions in which the time to benefit may exceed patients’ survival.1 When subjected to such tests and treatments, these patients are put at risk for up-front harms with little chance of reaping benefits.2 Patients’ perceptions of prognosis are important. Clinicians who follow recommended guidelines may urge patients to change health routines to which they have become accustomed. Patients who underestimate their survival may choose to forego interventions that are likely to help them, while those who overestimate may choose to undergo interventions that are more likely to cause harm. However, little is known about how well older adults estimate their survival, the aim of this analysis. Methods We drew a sample of 64-, 69-, 74-, 79-, 84-, and 89-year-old participants in the 2000 wave of the Health and Retirement Study (HRS), a nationally representative, longitudinal, prospective cohort study of adults in the United States.3 Institutional review board approval for HRS was received from the University of California, San Francisco, Committee on Human Research. Informed consent was obtained by HRS at the time of the interview. Our variable of interest was participants’ subjective estimate of long-term survival, assessed by the question, “What is the percent chance you will live to be x or more?” where x was 75, 80, 85, 90, 95, or 100 years old. Our sampling strategy ensured that all participants predicted survival across the same period. We calculated an objective estimate of life expectancy using the Lee life expectancy calculator.4 Observed survival was determined using mortality through 2010 (confirmed using the National Death Index). We compared participants’ subjective estimates to observed survival (using the C statistic) and the objective estimates (using a best-fit analysis). Participants were classified as underestimating or overestimating their survival if their estimate was more than 25 percentage points less or greater than the calculated prediction, respectively. Results A total of 2018 respondents of the specified ages were interviewed directly in the 2000 wave of the HRS, and our final sample included 1722 participants who had complete responses necessary for the calculator (56% female, 88% white). We combined the 84- and 89-year-olds because of the small number of respondents in each group. Overall, discrimination was moderate for participants’ subjective estimates of survival compared with observed survival (C statistic = 0.62; P < .001). The 64- and 69-year-olds were moderately able to estimate their survival (C statistic = 0.62 and 0.58, respectively; P < .001 for both), but older participants fared no better than chance (Table). Substantial dissimilarity was seen between participants’ subjective and the objective estimates of survival (Figure). Overall, 54.7% of participants had estimates similar to the objective calculation; however, 32.7% underestimated and 11.5% overestimated. Underestimation was relatively similar across age groups, but overestimation increased significantly with age (Table) (P < .001). Discussion Our findings have important implications for clinicians. First, approximately half the time, participants accurately estimated survival compared with an objective clinical estimate, and when in error, they were more likely to underestimate than overestimate. Consequently, disclosing prognosis is not necessarily bad news. Second, because of the substantial dissimilarity between the subjective and objective estimates, patients may be hesitant to follow guideline recommendations to change long-standing regimens. Third, our findings make a case for using prognostic calculators, which were more accurate than participants’ subjective estimates and have been shown to be superior to clinician estimates.5 Fourth, participants in the HRS were willing to make an estimate of their survival and report it. Previous research suggests that older adults are generally willing to discuss long-term prognosis.6 Clinicians should solicit patients’ individual perception of prognosis and use this information as a starting point for further discussion, particularly among older patients who may be more prone to errors. Then, in conjunction with prognostic tools, they can begin to bridge the gap between subjective and objective estimates of survival.
Keywords: Health Conditions and Status; Mortality; Older Adults; Self-reported health

Symptom Trends in the Last Year of Life From 1998 to 2010 A Cohort Study - Adam E Singer; Meeker, Daniella; Joan M Teno; Lynn, Joanne; June R Lunney; Karl A Lorenz (Annals of Internal Medicine, 2015)
Background: Calls for improvement in end-of-life care have focused attention on the management of pain and other troubling symptoms at the end of life. Objective: To describe changes in pain intensity and symptom prevalence during the last year of life from 1998 to 2010. Design: Observational study. Setting: The HRS (Health and Retirement Study), a nationally representative longitudinal survey of community-dwelling U. S. residents aged 51 years or older. Participants: 7204 HRS participants who died while enrolled in the study and their family respondents. Measurements: Proxy-reported pain during the last year of life and other symptoms for at least 1 month during the last year of life. Trends in pain intensity and symptom prevalence were analyzed for all decedents and within the categories of sudden death, cancer, congestive heart failure or chronic lung disease, and frailty. Results: Between 1998 and 2010, proxy reports of the prevalence of any pain increased for all decedents from 54.3 (95 CI, 51.6 to 57.1 ) to 60.8 (CI, 58.2 to 63.4 ), an increase of 11.9 (CI, 3.1 to 21.4 ). Reported prevalences of depression and periodic confusion also increased for all decedents by 26.6 (CI, 14.5 to 40.1 ) and 31.3 (CI, 18.6 to 45.1 ), respectively. Individual symptoms increased in prevalence among specific decedent categories, except in cancer, which showed no significant changes. The prevalence of moderate or severe pain did not change among all decedents or in any specific decedent category. Limitation: Use of proxy reports and limited information about some patient and surrogate variables. Conclusion: Despite national efforts to improve end-of-life care, proxy reports of pain and other alarming symptoms in the last year of life increased from 1998 to 2010.
Keywords: Health Conditions and Status; Methodology; Retirement Planning and Satisfaction

Testing for time-invariant unobserved heterogeneity in generalized linear models for panel data - Francesco Bartolucci; Belotti, F.; Peracchi, F. (Journal of Econometrics, 2015)
Recent literature on panel data emphasizes the importance of accounting for time-varying unobservable individual effects, which may stem from either omitted individual characteristics or macro-level shocks that affect each individual unit differently. In this paper, we propose a simple specification test of the null hypothesis that the individual effects are time-invariant against the alternative that they are time-varying. Our test is an application of Hausman (1978) testing procedure and can be used for any generalized linear model for panel data that admits a sufficient statistic for the individual effect. This is a wide class of models which includes the Gaussian linear model and a variety of nonlinear models typically employed for discrete or categorical outcomes. The basic idea of the test is to compare two alternative estimators of the model parameters based on two different formulations of the conditional maximum likelihood method. Our approach does not require assumptions on the distribution of unobserved heterogeneity, nor it requires the latter to be independent of the regressors in the model. We investigate the finite sample properties of the test through a set of Monte Carlo experiments. Our results show that the test performs well, with small size distortions and good power properties. We use a health economics example based on data from the Health and Retirement Study to illustrate the proposed test.
Keywords: Health Conditions and Status; Methodology

Three Essays in Health Economics - Jamal, Taha (McMaster University, 2015)
This thesis comprises three essays that empirically explore two important areas in health economics and policy: the valuation of medical innovations, and access to healthcare. The first essay explores the role of new medical technologies in improving labor market outcomes by conducting a case study of a class of drugs used in the treatment of arthritis called Cox-2 inhibitors. Cox-2 drugs make an excellent case study for investigating the labor supply effects of medical innovation because the potential labor supply effects are large, and the market introduction of these drugs generates plausibly exogenous variation in their use. Using data from the Health and Retirement Study (HRS) and applying a difference-in-differences approach that compares individuals with arthritis to individuals without arthritis, I find that the introduction of Cox-2 drugs had a positive and significant impact on the probability of working among individuals with long-term arthritis. The effects are stronger among older individuals, the less-educated, and those working in physical occupations. These results highlight the importance of evaluating economic outcomes such as labor supply as part of an assessment of the overall benefits of medical technology. The second essay builds on work by Allin et al. (2010) and Hurley et al. (2011) that systematically analyzes the relationship between subjective unmet need and healthcare utilization. However, unlike previous work that uses cross-sectional data, I use panel data from the National Population Health Survey (NPHS) to control for fixed unobserved individual heterogeneity. In addition, healthcare utilization is modeled using latent class models for panel data, which outperform traditional hurdle models. The results of this study confirm previous findings of different patterns of healthcare utilization among individuals with system-related unmet needs, personal-related unmet needs, and no unmet needs. Individuals with personal-related unmet needs tended to use the same amount of services as expected based on their needs. On the other hand, individuals with system-related unmet needs were found to not only be high users of GP and specialist visits, they were also higher-than-expected users. The third essay examines long-term changes in socioeconomic inequality and inequity in influenza immunization in Canada. The concentration index framework is applied using data from the following two Statistics Canada surveys: the cross-sectional component of the 1996/97 National Population Health Survey (NPHS), and the 2007/08 Canadian Community Health Survey (CCHS). The results show large variations in both coverage and inequity across provinces. In addition, increases in coverage levels across many provinces seem to have drawn disproportionately from those of higher socioeconomic status, contributing to a growing pro-rich inequity in utilization. These results highlight the need for more targeted efforts to help reduce inequities in vaccination.
Keywords: Cross-National; Employment and Labor Force; Health Conditions and Status; Healthcare

Three essays on public economics and policy - Li, Xiaoxue (Syracuse University, 2015)
This dissertation studies the effects of public programs that target at disadvantaged population. In particular, I examine the effects of these programs on individual well-being and whether these programs lead to behavior distortions. The dissertation consists of three essays that focus on different policy contexts and different populations. In the first essay, I examine the effects of an active labor market program on the labor market outcomes of veterans. In the 1990s, the US Department of Defense implemented the Transition Assistance Program (TAP) to help military personnel transition to the civilian labor market. The program provides career counseling, employment workshops, and information briefing on educational and medical benefits through the Department of Veterans Affairs. The goal of this study is to measure the long-run effects of TAP on the labor market outcomes of veterans. To identify these effects, I exploit variation in program accessibility generated by its initial rollout process. Using data from the veterans supplement to the Current Population Survey, survey years 2001, 2003 and 2005, I find that TAP improves the labor market outcomes of veterans, measured approximately ten years after their separation from the military. The effects of TAP on labor market outcomes vary across veterans with different lengths of military experience, and these effects attenuate over time. One possible mechanism is that TAP encourages use of the GI Bill, a program that provides tuition reimbursement and a monthly allowance to attend institutions of higher education. Moreover, the effect of TAP is concentrated among participants who, based on self-reports, find TAP most helpful in career related services. In the second essay, I examine linkages between Medicaid availability, insurance coverage for pregnant women, use of prenatal care and the health outcomes of newborns. Medicaid coverage for pregnant women would potentially improve health outcomes of newborns by providing medical services at no cost. At the same time, Medicaid provides an incentive for eligible individuals to drop private insurance coverage. I exploit variation from two federal Medicaid expansions in mid-1980s, which eliminated the eligibility discontinuity across age groups. The main data come from the National Hospital Discharge Survey and the Vital Statistics Birth Records. I employ a difference-in-differences method. Findings suggest that the expansions led to a relative increase in Medicaid coverage for women from the immediately affected age group by a significant 6.5 percentage points. However, up to 60% of new beneficiaries would have been covered by private insurance, absent of the expansions. Findings do not reveal significant improvement in birth outcomes, or increase in prenatal care utilization. In the third essay, I examine the effect of Medicaid on the asset holding behavior of the elderly. Medicaid provides coverage for nursing home care to elderly with limited resources. The eligibility rule potentially creates an incentive for the elderly to reduce their asset by making transfers to children. This study provides empirical evidence for the effect of Medicaid nursing home care policy on elderly's asset allocation. I exploit a policy change in 2006, the Deficit Reduction Act 2005, which imposed stricter penalty to asset transfer behavior when determining Medicaid eligibility. Using data from the Health and Retirement Survey, I employ a difference-in-differences method. I find that the elderly who anticipated nursing home entry significantly reduced asset transfer behavior by 3.2 to 4 percentage points, in response to the policy change. The result is robust across demographic groups and more pronounced for the elderly with the highest nursing home entry risk. The findings provide evidence of moral hazard in the public insurance market: the elderly would game with the system in anticipation of nursing home needs.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Methodology; Public Policy

Three Essays on the Supply of Long-Term Care Services to the Elderly in the U.S - Arora, Kanika (Syracuse University, 2015)
Situated in the context of a rapidly aging population, this dissertation examines the implications of supplying long-term care (LTC) services to the elderly in the United States. The first two essays investigate private costs of LTC assistance borne by adult children of elderly parents. In contrast, the third essay focuses on the cost of publicly-provided, formal LTC services. The first essay analyzes whether adult children devote less time to exercise as time allocation in parental caregiving increases. The empirical model is a system of four correlated equations, where the dependent variables are hours spent caregiving, frequency of moderate and vigorous physical activity, and hours spent in paid work. I use pooled cross-sectional data from the Health and Retirement Study (HRS) for this analysis. Results from joint estimation of the four equations indicate limited evidence of a competition between time spent in caregiving and frequency of physical activity. Parental factors that increase allocation of care time to parents do not comprehensively induce reductions in the frequency of any type of physical activity, nor in hours of work, among either men or women. The second essay goes beyond time resources and examines whether dementia onset in parents leads to a reduction in adult children's household wealth. Towards this, I construct a longitudinal dataset from seven waves of HRS. Estimates from unconditional quantile regressions indicate that parental dementia substantially reduces household wealth of an unmarried adult child in the upper quantiles of the wealth change distribution in the first two years after parental diagnosis. These effects are more pronounced for unmarried adult children without siblings. Further, this response is observed to persist in the subsequent time period as well. An examination of mechanisms suggests that both, losses in labor income and nursing home expenditures, may play a role in leading to wealth declines. This paper makes two contributions: first, it focuses on a broader outcome of private cost, and second, unlike previous studies, it does not limit the analysis to adult children who are informal caregivers. The final essay examines the cost implications of publicly provided formal care services. Medicaid's Personal Care Services (PCS) State Plan benefit is a key mechanism through which states provide personal assistance services to eligible beneficiaries. But, it is widely claimed that states are reluctant to adopt the program over fears of runaway spending. Surprisingly, there has been very little empirical work on examining the effect of the PCS State Plan benefit on Medicaid expenditures. Using aggregate state-level data from 1975 through 2009, this study finds that PCS State Plan adoption had no overall effect on Medicaid expenditures, except briefly during the early-growth years in 1980s. Further, findings suggest that states make decisions to adopt the program based on financial experiences of other adopting states. This study provides evidence consistent with the interpretation that when faced with the dilemma of balancing increased access and uncontrolled expenditures, state officials adapt the design of an entitlement benefit in an effort to make it less expensive. In its entirety, the dissertation provides new thinking on two dominant themes in conventional long-term care research: "caregiver burden" and "woodwork effect". In particular, the results of the first and third essay question the presence of "caregiver burden" and "woodwork effect" respectively, while the third essay challenges the pervasiveness of "caregiver burden" among unmarried adult children. These findings, which in some aspect are unexpected in the context of existing literature, have important implications for policy intervention and the direction of future research efforts in this area.
Keywords: Adult children; Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Methodology; Net Worth and Assets; Public Policy

Time-to-Death Patterns in Markers of Age and Dependency - Riffe, Tim; Chung, Pil H.; Spinjker, Jeroen; MacInnes, John (Rostock, Germany, Max Planck Institute for Demographic Research, 2015)
We aim to determine the extent to which variables commonly used to describe health, wellbeing, and disability in old-age vary primarily as a function of years lived (chronological age), years left (thanatological age), or as a function of both. We analyze data from the US Health and Retirement Study to estimate chronological age and time-to-death patterns in 78 such variables. We describe results from the birth cohort born 1915-1919 in the final 12 years of life. Our results show that most markers used to study well-being in old-age vary along both the age and time-to-death dimensions, but some markers are exclusively a function of either time to death or chronological age, and others display different patterns between the sexes.
Keywords: Disabilities; Health Conditions and Status

Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia - Christopher M. Callahan; Tu, Wanzhu; Kathleen T. Unroe; LaMantia, Michael A.; Timothy E. Stump; Daniel O. Clark (Journal of the American Geriatrics Society, 2015)
Objectives: To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment. Design: Longitudinal cohort study. Setting: Health and Retirement Study (HRS). Participants: HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N=16,186). Measurements: Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. Results: The 3,447 (21.3 ) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2 returned home without home care services, and 33.8 transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2 transitioned to the hospital, and 25.3 returned home without services. There were 2,139 transitions to death, and 58.7 of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. Conclusion: In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition.
Keywords: Health Conditions and Status; Healthcare

Treatment Type and Demographic Characteristics as Predictors for Cancer Adjustment: Prospective Trajectories of Depressive Symptoms in a Population Sample - Burton, C. L.; Isaac R Galatzer-Levy; George A. Bonanno (Health Psychology, 2015)
Objective: Prospectively identifying individuals at heightened risk for depression can alleviate the disease burden of distal physical and mental health consequences after cancer onset. Our objective was to identify heterogeneous trajectories of adjustment in cancer patients, using treatment-type as a predictor. Methods: Participants were followed for 6 years within the Health and Retirement Study (HRS), a prospective population-based cohort study. The sample consisted of 1,294 middle-aged participants who were assessed once before and 3 time points after their report of an initial cancer diagnosis. In addition to self-reported depressive symptoms, subjects indicated receipt of surgical, radiological, or chemical interventions as part of their usual oncological care. Results: Four symptom trajectories were identified with Latent Growth Mixture Modeling: an increasing depression (10.5 ), chronic depression (8.0 ), depressed-improved (7.8 ), and stable-low depression (73.7 ). A conditional model using participants with available predictor data (n = 545) showed individuals in the emerging depression class were significantly more likely to have received chemo/medication therapy when compared with the remitting depression, stable-low, and chronic depression classes. Participants in the chronic and depressed-improved classes generally had worse baseline health, and the depressed-improved were also younger in age. Conclusion: Patients who exhibited increasing depressive symptoms had a greater probability of receiving chemo/medication therapy than any other adjustment trajectory group, although the majority of chemotherapy patients did not exhibit depressive symptom changes. These data underscore the diversity of ways that patients adjust to cancer, and suggest cancer treatment, baseline health, and age may influence long-term patterns of psychological adjustment.
Keywords: Health Conditions and Status; Healthcare; Methodology; Other

Use of life course work-family profiles to predict mortality risk among US women - Erika L. Sabbath; Guevara, Ivan Mejia; M. Maria Glymour; Lisa F Berkman (American journal of public health, 2015)
OBJECTIVES: We examined relationships between US women's exposure to midlife work-family demands and subsequent mortality risk. METHODS: We used data from women born 1935 to 1956 in the Health and Retirement Study to calculate employment, marital, and parenthood statuses for each age between 16 and 50 years. We used sequence analysis to identify 7 prototypical work-family trajectories. We calculated age-standardized mortality rates and hazard ratios (HRs) for mortality associated with work-family sequences, with adjustment for covariates and potentially explanatory later-life factors. RESULTS: Married women staying home with children briefly before reentering the workforce had the lowest mortality rates. In comparison, after adjustment for age, race/ethnicity, and education, HRs for mortality were 2.14 (95 confidence interval CI =1.58, 2.90) among single nonworking mothers, 1.48 (95 CI=1.06, 1.98) among single working mothers, and 1.36 (95 CI=1.02, 1.80) among married nonworking mothers. Adjustment for later-life behavioral and economic factors partially attenuated risks. CONCLUSIONS: Sequence analysis is a promising exposure assessment tool for life course research. This method permitted identification of certain lifetime work-family profiles associated with mortality risk before age 75 years.
Keywords: Adult children; Event History/Life Cycle; Health Conditions and Status; Other; Women and Minorities

Using mixed methods to identify the characteristics of older fraud victims - DeLiema, Marguerite (University of Southern California, 2015)
In 2011, 7.3% of U.S. adults ages 65-74 and 6.5% of adults ages 75 and older were victims of financial fraud (Anderson, 2013). In addition to the billions of dollars lost annually to scams, indirect societal costs include paying for the care and support of elders who lost their life savings, and the expense of investigating cases and prosecuting offenders. One of the first steps in stopping fraud is determining who is most vulnerable, yet the research literature on risk factors presents a conflicting narrative. Some research studies and consumer protection agencies report that older adults are the most vulnerable age group due to greater social isolation and impairments in financial decision-making however, national prevalence studies have found that elders are the least likely to experience fraud. According to the Financial Fraud Research Center (2012), research identifying the specific risk factors that make elders susceptible to fraud is important to inform policies and where to target resources. After describing the prevalence, cost, and mechanisms of fraud, this dissertation discusses multiple theoretical explanations for why older adults are vulnerable. Chapter I presents a temporospatial framework for fraud based on the routine activity theory (Cohen & Felson, 1979) and an ecological theory of elder financial exploitation (Rabiner, O'Keefe, & Brown, 2004). The adapted model proposes that targets and scam artists are nested within the broader social and political macrostructure comprised of public policy and legislation on consumer protection, prevention/education efforts to reduce fraud, fraud reporting mechanisms, and society's values, beliefs and attitudes about older adults. In the following three empirical chapters, a mixed methods approach is used to identify the demographic, socioeconomic, psychological and cognitive characteristics of older fraud victims using the nationally-representative Health and Retirement Study (HRS) and a sample of victims in Los Angeles County. Researchers have observed that different types of fraud target different socio-demographic groups (Pak & Shadel, 2011). To identify heterogeneity among the respondents who reported fraud in the HRS, Chapter III employs latent class analysis (LCA) to test the hypothesis that older victims of fraud vary in terms of their socioeconomic and demographic characteristics. Two distinct victim classes (i.e., typologies, profiles) emerged from the analysis. Based on the distribution of socioeconomic and demographic characteristics within each group, Class 1 was descriptively labeled " high-SES middle-age married adults, " and Class 2 was labeled " low-SES older widowed females ." The high-SES middle-aged married adult group was larger than the low-SES older widowed female group, suggesting that the former group of victims is more prominent in the U.S. population over age 50. High-SES middle-aged married adults had higher average levels of cognitive functioning and also experienced a higher average number of stressful life events in the past five years compared to low-SES older widowed females . Using a national sample, this analysis provides comparable results to earlier studies that identified two victim typologies using a smaller sample of older victims identified by law enforcement: "bogus prize promotion" and "investment fraud" victim (Pak & Shadel, 2011; Financial Industry Regulatory Authority; 2006). The main finding of Chapter IV is that although fraud and financial abuse victims share many of the same physiological, environmental, demographic, and psychosocial characteristics, they differ in that fraud victims have significantly higher Mini Mental State Exam scores, better mobility, and are more likely to be childless. A proposed explanation for the similarities is that exploitation has less to do with the characteristics and risk factors associated with the victim, and more to do with the people surrounding the victim (or lack thereof). In othe words, the structure of the victim's social network determines whether he or she is more likely t be a victim of fraud by strangers or financial abuse by family and friends. This analysis illuminates areas where intervention and prevention strategies may differ between each type of exploitation. This dissertation contributes to the literature in several important ways. First, it helps clarify the relationship between fraud susceptibility, age, and socioeconomic status among adults ages 50 and older in the U.S. Second, it uses prospective (pre-fraud) data on individuals to determine whether the purported risk factors for fraud--loneliness, poor cognitive functioning, stressful life events--actually do increase like likelihood of victimization later on. Third, findings from the latent class analysis support previous research using victim complaint data to categorize victims based on their SES and demographic characteristics. And fourth, the qualitative findings in this study reveal the tremendous financial cost of fraud, and also the importance of friends and family members in protecting older adults from predatory strangers. (Abstract shortened by UMI.)
Keywords: Consumption and Savings; Employment and Labor Force; Gerontology; Health Conditions and Status; Healthcare; Methodology; Public Policy

Variation in the effects of family background and birth region on adult obesity: results of a prospective cohort study of a Great Depression-era American cohort - Hui Zheng; Dmitry Tumin (BMC Public Health, 2015)
Background: Studies have identified prenatal and early childhood conditions as important contributors to weight status in later life. To date, however, few studies have considered how weight status in adulthood is shaped by regional variation in early-life conditions, rather than the characteristics of the individual or their family. Furthermore, gender and life course differences in the salience of early life conditions to weight status remain unclear. This study investigates whether the effect of family background and birth region on adult obesity status varies by gender and over the life course. Methods: We used data from a population-based cohort of 6,453 adults from the Health and Retirement Study, 1992-2008. Early life conditions were measured retrospectively at and after the baseline. Obesity was calculated from self-reported height and weight. Logistic models were used to estimate the net effects of family background and birth region on adulthood obesity risk after adjusting for socioeconomic factors and health behaviors measured in adulthood. Four economic and demographic data sets were used to further test the birthplace effect. Results: At ages 50-61, mother's education and birth region were associated with women's obesity risk, but not men's. Each year's increase in mother's education significantly reduces the odds of being obese by 6 (OR = 0.94; 95 CI: 0.92, 0.97) among women, and this pattern persisted at ages 66-77. Women born in the Mountain region were least likely to be obese in late-middle age and late-life. Measures of per capita income and infant mortality rate in the birth region were also associated with the odds of obesity among women. Conclusions: Women's obesity status in adulthood is influenced by early childhood conditions, including regional conditions, while adulthood health risk factors may be more important for men's obesity risk. Biological and social mechanisms may account for the gender difference.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status

Weight Stigma and Its Associations with Health Behaviors Among Older Adults - Sandi Phibbs (Oregon State University, 2015)
Having excess weight carries a negative social stigma in the U.S. Previous research has shown that experiencing stigma has negative physical and mental health consequences. Few studies have examined how experiencing weight stigma might act as a barrier to engaging in healthy behaviors among older adults. The purpose of this study was to examine weight discrimination and weight-based stereotype threat as mechanisms of weight stigma among older adults. Using data from the 2010 and 2012 waves of the Health and Retirement Study, this study investigated weight discrimination and weight-based stereotype threat and their possible associations with specific health behaviors, namely the use of clinical preventive services and level of physical activity. This study also examined factors associated with experiencing weight-based stereotype threat in a medical setting among older adults. Results indicated that experiences of weight discrimination were negatively associated with reporting vigorous and moderate physical activity, positively associated with receiving an influenza vaccination, and t associated with receiving breast or cervical cancer screenings. Results also indicated that weight discrimination mediated 13% of the relationship between body mass index and vigorous physical activity. In addition, 9% of the effect of BMI on moderate physical activity was mediated by weight discrimination. Having a higher BMI and previous experiences of weight discrimination were significantly associated with reporting weight-based stereotype threat in the medical setting. Weight-based stereotype threat was t associated with the use of clinical preventive services and level of physical activity, although the sample size lacked sufficient power to detect a small effect size in these analyses. This study provides evidence that older adults experience weight discrimination and weight-based stereotype threat. Efforts to increase physical activity among older adults should address weight discrimination as a possible barrier. Further research on the mechanisms of weight stigma among older adults and their effects is warranted.
Keywords: Demographics; Health Conditions and Status

What Causes Workers to Retire Before They Plan? - Alicia H. Munnell; Geoffrey T. Sanzenbacher; Matthew S. Rutledge (Boston, Boston College, 2015)
This paper explores the extent to which health, employment, family, or finances are associated with earlier-than-planned retirement using the Health and Retirement Study (HRS). The importance of any shock that drives early retirement depends both on its effect on those experiencing it and its prevalence in the population; therefore, the analysis proceeds in two steps. First, a probit regression is used to determine the strength of the relationship between the shocks and earlier-than-planned retirement, controlling for individual characteristics. Second, to incorporate the prevalence of the shock, counterfactual experiments are run to determine how much early retirement would be reduced in the population if these shocks did not occur.
Keywords: Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

What impacts life satisfaction of aging adults following stressful life events?: An examination of the buffering effect of personal resources - Barragan, Cassandra (Wayne State University, 2015)
Purpose: Existing research has shown that elders experience changes in their life satisfaction following stressful life events. There is an abundance of literature supporting the predictive nature of not only stressful life events on life satisfaction, but social support, autonomy, and financial security. What the literature is lacking, is examination of the buffering effect of social support, autonomy, and financial security on the relationship between stressful life events and life satisfaction. This study hypothesizes that increases in social support, autonomy, and financial security will buffer the impact of SLEs for elders and thus, they will experience increases in their life satisfaction over time. It is also expected that social support and financial security will buffer differently among Black and White elders. Methods: The public use files of the Health and Retirement Study (HRS) between the years 2006 and 2012 are used to explore the interaction between social support, autonomy, and financial security with stressful life events and the impact on life satisfaction. Linear regression are conducted to explore each buffering impact on life satisfaction over time. Results: The research findings in this dissertation demonstrate that the changes in personal resources; social support, autonomy, and financial security; play an important role in changes in life satisfaction. Additionally, Black and White elders are impacted differently by changes in financial security. In general, the results from this study demonstrate that individuals who have declines in their personal resources following stressful life events also experience declines in their life satisfaction.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Methodology; Net Worth and Assets; Other; Retirement Planning and Satisfaction; Women and Minorities

Who Can Predict Their Own Demise? Accuracy of Longevity Expectations by Education and Cognition - Teresa Bago d'Uva; Esen Erdogan-Ciftci; Owen O'Donnell; Eddy Van Doorslaer (Amsterdam, Netherlands, Tinbergen Institute, 2015)
Biased longevity expectations will lead to suboptimal decisions regarding saving, retirement, annuitization and health, with consequences for wellbeing in old age. Systematic differences in the accuracy of longevity expectations may partly explain heterogeneity in economic behaviour by education and cognitive functioning. Analysis of eight waves of the US Health and Retirement Study reveals that individuals with lower levels of education and cognitive functioning report survival probabilities that are less accurate in predicting their in-sample mortality. There is little evidence that the gradients in the veracity of expectations are due to the less educated and cognitively able responding less to changes in objective mortality risks. However, high school dropouts and the least cognitively able report survival probabilities that are less stable and display greater un explained variability. These disadvantaged groups appear to be less confident in their longevity beliefs, which is justified given that their expectations are less accurate.
Keywords: Demographics; Expectations; Health Conditions and Status

Who Suffers During Recessions? Economic Downturns, Job Loss, and Cardiovascular Disease in Older Americans - Noelke, Clemens; Mauricio Avendano (American Journal of Epidemiology, 2015)
Job loss in the years before retirement has been found to increase risk of cardiovascular disease (CVD), but some studies suggest that CVD mortality among older workers declines during recessions. We hypothesized that recessionary labor market conditions were associated with reduced CVD risk among persons who did not experience job loss and increased CVD risk among persons who lost their jobs. In our analyses, we used longitudinal, nationally representative data from Americans 50 years of age or older who were enrolled in the Health and Retirement Study and surveyed every 2 years from 1992 to 2010 about their employment status and whether they had experienced a stroke or myocardial infarction. To measure local labor market conditions, Health and Retirement Study data were linked to county unemployment rates. Among workers who experienced job loss, recessionary labor market conditions at the time of job loss were associated with a significantly higher CVD risk (hazard ratio = 2.54, 95 confidence interval: 1.39, 4.65). In contrast, among workers who did not experience job loss, recessionary labor market conditions were associated with a lower CVD risk (hazard ratio = 0.50, 95 confidence interval: 0.31, 0.78). These results suggest that recessions might be protective in the absence of job loss but hazardous in the presence of job loss.
Keywords: Employment and Labor Force; Health Conditions and Status; Public Policy; Risk Taking

Worries About Getting Alzheimer's: Who's Concerned? - S. J. Cutler (American Journal of Alzheimers Disease and Other Dementias, 2015)
The prevalence of Alzheimer's disease (AD) is projected to grow dramatically, but efforts to treat its progression have been unsuccessful. Fear of AD among older persons is greater than fear of cancer, and lingering worries about developing AD can be detrimental to well-being. Yet, much remains to be known about such worries and their precursors. This study, based on data from the Health and Retirement Survey, examines correlates of worry. Results of multivariate analyses show the following to be independent and significant correlates: present memory ratings, perceived changes in memory, personal familiarity with AD, belief that being a first-degree relative of someone with AD heightens the chance of developing AD, and age. Interaction analyses show that memory ratings and perceived changes in memory functioning are associated with worry regardless of personal familiarity. These findings will enable practitioners to identify patients and clients at risk of being worried about getting AD.
Keywords: Health Conditions and Status

Younger subjective age is associated with lower C-reactive protein among older adults - Yannick Stephan; Angelina R Sutin; Antonio Terracciano (Brain, behavior, and immunity, 2015)
Subjective age, or how young or old individuals experience themselves to be, is related to a range of health-related outcomes in old age, including mortality risk. Little is known, however, about its association with markers of systemic inflammation. Using data from the Health and Retirement Study (HRS), the present study examined the relation between subjective age and C-reactive protein (CRP). Participants were 4120 older adults from the 2008 wave of the HRS who provided measures of subjective age, CRP, demographic variables, Body Mass Index (BMI), depression, smoking, physical activity and disease burden. Regression analyses revealed that a younger subjective age was related to lower CRP, controlling for demographic factors. This association was reduced by half but remained significant when health and behavioral covariates were adjusted for, suggesting that BMI, physical activity and disease burden may partially account for lower inflammation in individuals with a younger subjective age. Furthermore, a logistic regression revealed that feeling younger than one's age was associated with reduced risk of exceeding the clinical threshold of CRP, controlling for covariates. The present study provides the first evidence of an association between subjective age and systemic inflammation among older adults. It suggests that individuals' ratings of their subjective age may help identify individuals at greater risk for immune dysfunction related to morbidity and mortality.
Keywords: Expectations; Health Conditions and Status; Healthcare

Age-related trajectories of physical functioning in work and retirement: The role of sociodemographic factors, lifestyle and disease - Stenholm, Sari; Westerlund, Hugo; Salo, P.; Hyde, Martin; Pentti, Jaana; Head, Jenny; Mika Kivimäki; Vahtera, Jussi (Journal of Epidemiology and Community Health, 2014)
Background: Loss of physical functioning is an early marker of declining health in older people. The objective of this study was to examine the age-related trajectories of physical functioning among those in full-time work and retirement. Methods: Based on the Health and Retirement Study, participants who were working full-time or were in full-time retirement and 65-85 years of age during the follow-up period from 1992 to 2010 were included (n=17 844, n of observations from repeated measures in full-time work 5891 and in retirement 57 117). Details of physical functioning were asked about at all study phases and 10 items related to mobility and activities of daily living were summed to obtain a physical functioning score (0-10). Results: The number of physical functioning difficulties increased every 10 years by 0.17 (95 CI 0.04 to 0.29) when in full-time work and by 0.46 (95 CI 0.41 to 0.50) in retirement after adjusting for age, sex, race, education, total wealth, Body Mass Index, smoking, physical activity and number of diseases. Factors that were associated with a significantly greater increase in number of physical functioning difficulties in full-time work and retirement include lifestyle-related risks and chronic conditions. Conclusions: Physical functioning declines faster in retirement than in full-time work in employees aged 65 years or older and the difference is not explained by absence of chronic diseases and lifestyle-related risks. 2014 by the BMJ Publishing Group Ltd.
Keywords: Demographics; Health Conditions and Status; Retirement Planning and Satisfaction

Aging children of long-lived parents experience slower cognitive decline - Ambarish Dutta; Henley, William; Robine, Jean-Marie; David J Llewellyn; Kenneth M. Langa; Robert B Wallace; David Melzer (Alzheimer's and Dementia, 2014)
Keywords: Adult children; Expectations; Genetics; Health Conditions and Status

Around a quarter of all older people have disability during the last 2 years of life, with prevalence higher among women and those aged over 80 years - Hirsch, Calvin H (Evidence Based Nursing, 2014)
Context The rapidly growing number of disabled elderly is expected to tax health delivery systems, whose focus has been the management of disease rather than the prevention and management of disability. The burden of caring for the disabled rests largely with family caregivers, who commonly experience physical and emotional strain. The network of community services designed to assist caregivers is fragmented, variable and costly. The activity of daily living (ADL) disability may be especially high among individuals near the end of life. Methods To determine the prevalence of disability in the 2 years preceding death, the authors used data from the Health and Retirement Study (HRS), a longitudinal study of health and wealth in a nationally representative sample of US adults aged 50 and over. The HRS surveyed participants every 2 years and determined the date of death in 99 of those involved. From a sample of 8232 decedents between 1995 and 2010, the authors estimated the national prevalence of disability in the last 24 months of life using restricted cubic spline models. The final spline model was entered into a multivariate regression to estimate the probability of disability in various subgroups. Findings At 24 months before death, the predicted prevalence of disability ranged from 15 for those aged 50 69 to 50 among those aged 90. Regardless of the starting prevalence of disability, the four age groups (50 69, 70 79, 80 89 and 90 ) showed similar linear rates of increase from 24 months to around 9 months before death, after which the prevalence of disability rose sharply. At all points in time women were more disabled than men.
Keywords: Demographics; Disabilities; Health Conditions and Status; Healthcare

Association Among Socioeconomic Status, Health Behaviors, and All-Cause Mortality in the United States - Nandi, Arijit; M. Maria Glymour; S. V. Subramanian (Epidemiology, 2014)
BACKGROUND:Health behaviors may contribute to socioeconomic inequalities in mortality, although the extent of such contribution remains unclear. We assessed the extent to which smoking, alcohol consumption, and physical inactivity have mediated the association between socioeconomic status (SES) and all-cause mortality in a representative sample of US adults. METHODS:Initiated in 1992, the Health and Retirement Study is a longitudinal, biennial survey of a national sample of US adults born between 1931 and 1941. Our analyses are based on a sample of 8037 participants enrolled in 1992 and followed for all-cause mortality from 1998 through 2008. We used exploratory and confirmatory factor analysis to derive a measure of adult SES based on respondents education, occupation, labor force status, household income, and household wealth. Potential mediators (smoking, alcohol consumption, and physical inactivity) were assessed biennially. We used inverse probability weighted mediation models to account for time-varying covariates. RESULTS:During the 10-year mortality follow-up, 859 (10 ) participants died. After accounting for age, sex, and baseline confounders, being in the most-disadvantaged quartile of SES compared with the least disadvantaged was associated with a mortality risk ratio of 2.84 (95 confidence interval = 2.25 3.60). Together, smoking, alcohol consumption, and physical inactivity explained 68 (35 104 ) of this association, leaving a risk ratio of 1.59 (1.03 2.45) for low SES. CONCLUSIONS:The distribution of health-damaging behaviors may explain a substantial proportion of excess mortality associated with low SES in the United States, suggesting the importance of social inequalities in unhealthy behaviors.
Keywords: Demographics; Health Conditions and Status; Public Policy

The Association Between Socioeconomic Status and Cardiovascular Risk Factors Among Middle-Aged and Older Men and Women - Kristi Rahrig Jenkins; Mary Beth Ofstedal (Women and Health, 2014)
Studies of gender differences in the association between socioeconomic status (SES) and cardiovascular risk factors have produced mixed findings. The purpose of this research was to examine whether the association between SES and cardiovascular risk factors differed between older men and women. Using data on physical measures and biomarkers from the 2006 Health and Retirement Study (N = 2,502 men; N = 3,474 women), linear regression models were used to estimate the association between SES and seven cardiovascular risk factors. Interactions between gender and SES were tested. For all seven risks assessed, we observed significant associations of selected SES factors to cardiovascular risk for men and/or women. In all of these cases, lower SES was associated with higher cardiovascular risk. However, for six of the factors, we also observed gender differences in the association between SES and cardiovascular risk, such that lower SES was associated with higher cardiovascular risk for women but not for men. These findings suggest that the association between SES and cardiovascular risk is more pronounced for women than for men. Implementing interventions to reduce cardiovascular risk factors, particularly among older women with lower SES, might, over time, reduce cardiovascular disease in women and improve quality of life.
Keywords: Demographics; Health Conditions and Status; Women and Minorities

Association of functional decline with subsequent diabetes incidence in u.s. Adults aged 51 years and older: the health and retirement study 1998-2010 - Barbara H. Bardenheier; Edward W Gregg; Zhuo, Xiaohui; Yiling J. Cheng; Geiss, Linda S. (Diabetes Care, 2014)
OBJECTIVE We assessed whether functional decline and physical disability increase the subsequent risk of diabetes. RESEARCH DESIGN AND METHODS We used a subsample of adults aged 51 years and older with no diabetes at baseline who were followed up to 12 years (1998-2010) in the Health and Retirement Study, an observational study of a nationally representative survey. We assessed baseline disability status and incident disability with subsequent risk of diabetes, accounting for death as a competing risk and controlling for BMI, age, sex, race/ethnicity, net wealth, mother's level of education, respondents' level of education, and time of follow-up. Disability was defined as none, mild, moderate, and severe, based on a validated scale of mobility measures. Diabetes was identified by self-report of a diagnosis from a doctor. Population attributable fraction (PAF) was calculated to assess the percentage of diabetes cases that were attributable to mobility disability. RESULTS The sample included 22,878 adults with an average of 8.7 years of follow-up; 9,649 (41.2 ) reported some level of disability at baseline, and 8,175 (35.7 ) additional participants developed disability during follow-up; 3,546 (15.5 ) participants developed diabetes; and 5,869 (25.6 ) died. Regression analyses found a statistically significant dose-response relationship of increased risk of diabetes (28-95 ) among those with any level of functional decline, prevalent or incident. Among the subanalytic sample, including incident disability only, the PAF was 6.9 (CI 4.2-9.5). CONCLUSIONS Our findings suggest those who become disabled, even mildly, are at increased risk of developing diabetes. This finding raises the possibility that approaches to prevent disability in older adults could also reduce diabetes incidence.
Keywords: Demographics; Disabilities; Health Conditions and Status; Risk Taking

Body Mass Trajectories and Mortality Among Older Adults: A Joint Growth MixtureDiscrete-Time Survival Analysis - Zajacova, Anna; Jennifer A Ailshire (Gerontologist, 2014)
Purpose of the Study: The aim of this study was to investigate heterogeneity in body weight trajectories among older adults and their association with mortality risks. Design and Methods: Information on body mass index (BMI) and survival come from nine waves of the Health and Retirement Study, a 16-year survey of adults aged 5161 at baseline (N 9,703). We used a sex-stratified joint growth mixture-discrete time survival model to characterize BMI trajectory groups and their associated mortality. Results: Three distinct classes of BMI trajectories were identified: stable overweight, obese gaining, and obese losing. Relative to the stable overweight class, which comprised about 90 of the sample, the obese gaining class had approximately 50 higher mortality risk; the highest mortality was found in the obese losing category (OR 2.7, p .001). The results were similar for men and women. Implications: The findings highlight substantial heterogeneity in weight trajectories of older Americans, as well as large survival differentials across the classes. The direction of weight changes appears inextricably linked to the overall BMI level in terms of predicting older adults longevity. Weight loss is associated with particularly high mortality risk even when the typical BMI change is from obesity to overweight.
Keywords: Health Conditions and Status

Burden and self-efficacy in Alzheimer's disease caregivers - Jackson, Maybelle F. (Southern University and Agricultural and Mechanical College, 2014)
Alzheimer's disease (AD), the most common type of dementia occurring in older adults, has reached epidemic proportions. An estimated 5.2 million Americans are living with this chronic, irreversible brain disease (Alzheimer's Association, 2014). Research has shown that providing care for persons with dementia is associated with higher levels of stress than providing care for other chronic medical conditions, often resulting in negative outcomes for the caregiver. Although self-efficacy has been identified as a potential factor in predicting an individual's ability to cope with stress, limited research has examined this concept within the context of AD caregiving and its impact on caregiving outcomes. Based on this significant gap in the caregiving literature, the purpose of this study was to examine the relationship between caregiver self-efficacy and caregiver burden in family caregivers of persons with AD. Utilizing a predictive cross-sectional research design, the predictive potential of the independent variables on the outcome variable, caregiver burden, was also examined. Theoretical underpinnings that formed the overall conceptual framework for this study were drawn from Lazarus and Folkman's (1984) stress and coping framework. This study's sample of caregivers' racial composition was 74.7 percent African American and 25.3 percent Caucasian. Major findings revealed that the caregiver's self-reported health status, duration in years of caregiving, and self-efficacy for controlling upsetting thoughts explained 42 percent of the variation in caregiver burden scores. Overall findings from this investigation support the significance of caregiving self-efficacy and other independent variables impact on caregiving outcomes, namely, caregiver burden. The identification of factors that mediate the negative outcomes of caregiving is critical to the development of targeted strategies aimed at reducing caregiver burden and improving health outcomes of caregivers of persons with AD.
Keywords: Demographics; Health Conditions and Status; Healthcare

Changes in Memory before and after Stroke Differ by Age and Sex, but Not by Race - Qianyi Wang; Mejía-Guevara, Iván; Pamela M. Rist; Stefan Walter; Benjamin D Capistrant; M. Maria Glymour (Cerebrovascular Diseases, 2014)
Background: Post-stroke memory impairment is more common among older adults, women and blacks. It is unclear whether post-stroke differences reflect differential effects of stroke per se or differences in prestroke functioning. We compare memory trajectories before and after stroke by age, sex and race. Methods: Health and Retirement Study participants aged 50 years (n = 17,341), with no stroke history at baseline, were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n = 1,574). Segmented linear regression models were used to compare annual rates of memory change before and after stroke among 1,169 stroke survivors, 405 stroke decedents and 15,767 stroke-free participants. Effect modification was evaluated with analyses stratified by baseline age ( 70 vs. 70), sex and race (white vs. nonwhite), and using interaction terms between age/sex/race indicators and annual memory change. Results: Older ( 70 years) adults experienced a faster memory decline before stroke (-0.19 vs. -0.10 points/year for survivors, -0.24 vs. -0.13 points/year for decedents, p 0.001 for both interactions), and among stroke survivors, larger memory decrements (-0.64 vs. -0.26 points, p 0.001) at stroke and faster memory decline (-0.15 vs. -0.07 points/year, p = 0.003) after stroke onset, compared to younger adults. Female stroke survivors experienced a faster prestroke memory decline than male stroke survivors (-0.14 vs. -0.10 points/year, p 0.001). However, no sex differences were seen for other contrasts. Although whites had higher post-stroke memory scores than nonwhites, race was not associated with rate of memory decline during any period of time; i.e. race did not significantly modify the rate of decline before or after stroke or the immediate effect of stroke on memory. Conclusions: Older age predicted worse memory change before, at and after stroke onset. Sex and race differences in post-stroke memory outcomes might be attributable to prestroke disparities, which may be unrelated to cerebrovascular disease. 2014 S. Karger AG, Basel.
Keywords: Health Conditions and Status; Methodology

Childhood Experience of Father's Job Loss and Stock Market Participation - Lehtoranta, Antti (Helsinki, Bank of Finland, 2014)
Using data from the Panel Study of Income Dynamics (PSID), I document that childhood experience of father's job loss decreases the propensity to own stocks as an adult. If this experience takes place at the age of 5 10 years, the probability of owning stocks decreases by 2.9 percentage points in a sample with mean stock market participation rate of 17 . This finding is robust to alternative definitions of age ranges and controlling for random unobserved effects. I also find an effect of similar magnitude in the Health and Retirement Study (HRS) data.
Keywords: Employment and Labor Force; Health Conditions and Status; Net Worth and Assets

Chronic obstructive pulmonary disease, cognitive impairment, and development of disability: the health and retirement study - Martinez, Carlos H.; Richardson, Caroline R.; Han, MeiLan K.; Christine T Cigolle (Annals of the American Thoracic Society, 2014)
RATIONALE: The relationship between chronic obstructive pulmonary disease (COPD) and cognitive impairment in leading to disability has not been characterized. OBJECTIVES: We aimed to investigate the prevalence and cumulative incidence of disability among adults with and without COPD and the association of COPD and cognitive impairment with disability. METHODS: We analyzed 2006-2008 waves of the Health and Retirement Study, a nationally representative longitudinal health survey. COPD was self-reported. Prevalent disability was defined as baseline dependency in one or more activities of daily living (ADLs) and incident disability as one or more additional ADL dependencies. We used a validated performance-based measure of cognition to identify dementia and mild cognitive impairment. Covariates included seven chronic diseases, four geriatric syndromes, and sociodemographics. We used logistic regression to test associations between COPD, cognitive status, and prevalent/incident disability. MEASUREMENTS AND MAIN RESULTS: Of 17,535 participants at least 53 years of age in wave 2006 (representing 77.7 million Americans), 9.5 reported COPD and 13.5 mild cognitive impairment; 17.5 of those with COPD had mild cognitive impairment. Prevalent disability for COPD was 12.8 (5.2 for no-COPD, P 0.001). An additional 9.2 with COPD developed incident disability at 2 years (4.0 for no-COPD, P 0.001). In adjusted models, COPD was associated with baseline (odds ratio, 2.0) and incident disability (odds ratio, 2.1; adjusted for baseline disability). Cognitive impairment had an additive effect to COPD. The COPD-disability association, prevalent/incident, was of similar or greater magnitude than that of other chronic diseases (e.g., stroke, diabetes). The associations were maintained in sensitivity analyses using alternative definitions of disability (dependency in two or more ADLs, dependency in instrumental ADLs), and in analysis excluding respondents with dementia. CONCLUSIONS: Both COPD and mild cognitive impairment increase the risk of disability. The risk conferred by COPD is significant and similar or higher than other chronic diseases.
Keywords: Disabilities; Health Conditions and Status; Healthcare

Connecting Social Environment Variables to the Onset of Major Specific Health Outcomes - Patrick L Hill; Sara J Weston; Joshua J Jackson (Psychology and Health, 2014)
Abstract Objective: The present research examined the effects of the social environment on the onset of specific health ailments. Design: Using data from the Health and Retirement Study, we examined participants? responses to social environment questions in 2006 as predictors of onset of different health conditions over the next four years. Main Outcome Measures: Healthy participants (n = 7514) reported on their number of social partners, interaction frequency, positive social support, and negative social support with respect to both their family and friends. These variables were used to predict onset of seven conditions in 2010: high blood pressure, heart condition, lung disease, cancer, stroke, diabetes, and arthritis. Results: Logistic regressions indicated that the social environment provided some predictive value for onset of most health outcomes, with more positive and less negative social support appearing to buffer against onset. Social environmental variables related to friendships appeared to play a greater role than the family indicators. However, no variable proved universally adaptive, and social indicators had little value in predicting onset of chronic conditions. Conclusion: The current findings point to the potential for the social environment to influence later health, while demonstrating the nuanced role that our social lives play with respect to health. Objective: The present research examined the effects of the social environment on the onset of specific health ailments. Design: Using data from the Health and Retirement Study, we examined participants? responses to social environment questions in 2006 as predictors of onset of different health conditions over the next four years. Main Outcome Measures: Healthy participants (n = 7514) reported on their number of social partners, interaction frequency, positive social support, and negative social support with respect to both their family and friends. These variables were used to predict onset of seven conditions in 2010: high blood pressure, heart condition, lung disease, cancer, stroke, diabetes, and arthritis. Results: Logistic regressions indicated that the social environment provided some predictive value for onset of most health outcomes, with more positive and less negative social support appearing to buffer against onset. Social environmental variables related to friendships appeared to play a greater role than the family indicators. However, no variable proved universally adaptive, and social indicators had little value in predicting onset of chronic conditions. Conclusion: The current findings point to the potential for the social environment to influence later health, while demonstrating the nuanced role that our social lives play with respect to health.
Keywords: Adult children; Demographics; Health Conditions and Status

Consumption Behavior, Annuity Income and Mortality Risk of the Elderly - Kutlu-Koc, Vesile; Alessie, Rob J.M.; Kalwij, Adriaan (Tilburg, The Netherlands, Netspar, 2014)
Previous studies find that individuals do not draw down their assets after retirement which is at odds with the predictions of a simple life cycle model without uncertainty. Hurd (1989, 1999) explains saving behavior of elderly singles and couples by adding lifetime uncertainty and bequest motives to the simple life cycle model. In this paper we aim to test whether predictions of the models proposed by Hurd (1989, 1999) hold for a sample of elderly Americans. We also extend the theoretical model of Hurd (1999) for couples. We use data taken from the Health and Retirement Study (HRS) supplemented with the Consumption and Activities Mail Survey (CAMS). In line with theory we find that, on average, individuals total consumption is greater than their annuity income after retirement and the difference between total consumption and annuity income increases with the wealth level. Our results also suggest that consumption growth decreases with higher mortality rates for elderly singles. On the other hand, for elderly couples, consumption growth does not respond to changes in the mortality risk of the couple.
Keywords: Event History/Life Cycle; Health Conditions and Status

Contribution of Leisure-Time Physical Activity on Psychological Benefits Among Elderly Immigrants - Kim, Junhyoung; Sanghee Chun; Jinmoo Heo; Lee, Sunwoo; Areum Han (Applied Research in Quality of Life, 2014)
Research provides evidence that leisure-time physical activity engagement promotes health and well-being among older adults. In this study, using data released from the Health and Retirement Study (HRS) in 2008, we focused on the exploration of the relationship between leisure-time physical activity and psychological benefits such as positive affect, optimism, psychological well-being, and life satisfaction among elderly immigrants. The results of this study demonstrated that leisure-time physical activities play an important role in gaining psychological benefits. This finding provided further evidence that leisure-time physical activities provides rich opportunities for elderly immigrants to experience psychological benefits, which may contribute to quality of life and successful aging.
Keywords: Demographics; Health Conditions and Status; Retirement Planning and Satisfaction

Cost of informal caregiving associated with stroke among the elderly in the United States - Heesoo Joo; Dunet, Diane O.; Fang, Jing; Wang, Guijing (Neurology, 2014)
Objectives: We estimated the informal caregiving hours and costs associated with stroke. Methods: We selected persons aged 65 years and older in 2006 and who were also included in the 2008 follow-up survey from the Health and Retirement Study. We adapted the case-control study design by using self-reported occurrence of an initial stroke event during 2006 and 2008 to classify persons into the stroke (case) and the nonstroke (control) groups. We compared informal caregiving hours between case and control groups in 2006 (prestroke period for case group) and in 2008 (poststroke period for case group) and estimated incremental informal caregiving hours attributable to stroke by applying a difference-in-differences technique to propensity score-matched populations. We used a replacement approach to estimate the economic value of informal caregiving. Results: The weekly incremental informal caregiving hours attributable to stroke were 8.5 hours per patient. The economic value of informal caregiving per stroke survivor was 8,211 per year, of which 4,356 (53 ) was attributable to stroke. At the national level, the annual economic burden of informal caregiving associated with stroke among elderly was estimated at 14.2 billion in 2008. Conclusions: Recent changes in public health and social support policies recognize the economic burden of informal caregiving. Our estimates reinforce the high economic burden of stroke in the United States and provide up-to-date information for policy development and decision-making.
Keywords: Adult children; Health Conditions and Status; Healthcare; Public Policy

Cumulative Childhood Adversity, Educational Attainment, and Active Life Expectancy Among U.S. Adults - Jennifer Karas Montez; Mark D Hayward (Demography, 2014)
Studies of the early-life origins of adult physical functioning and mortality have found that childhood health and socioeconomic context are important predictors, often irrespective of adult experiences. However, these studies have generally assessed functioning and mortality as distinct processes and used cross-sectional prevalence estimates that neglect the interplay of disability incidence, recovery, and mortality. Here, we examine whether early-life disadvantages both shorten lives and increase the number and fraction of years lived with functional impairment. We also examine the degree to which educational attainment mediates and moderates the health consequences of early-life disadvantages. Using the 1998 2008 Health and Retirement Study, we examine these questions for non-Hispanic whites and blacks aged 50 100 years using multistate life tables. Within levels of educational attainment, adults from disadvantaged childhoods lived fewer total and active years, and spent a greater portion of life impaired compared with adults from advantaged childhoods. Higher levels of education did not ameliorate the health consequences of disadvantaged childhoods. However, because education had a larger impact on health than did childhood socioeconomic context, adults from disadvantaged childhoods who achieved high education levels often had total and active life expectancies that were similar to or better than those of adults from advantaged childhoods who achieved low education levels.
Keywords: Adult children; Demographics; Health Conditions and Status; Methodology

Dementia and dependence: Do Modifiable Risk Factors Delay Disability? - Pamela M. Rist; Benjamin D Capistrant; Bei Wu; Jessica R Marden; M. Maria Glymour (Neurology, 2014)
Objective: To identify modifying factors that preserve functional independence among individuals at high dementia risk. Methods: Health and Retirement Study participants aged 65 years or older without baseline activities of daily living (ADL) limitations (n = 4,922) were interviewed biennially for up to 12 years. Dementia probability, estimated from direct and proxy cognitive assessments, was categorized as low (i.e., normal cognitive function), mild, moderate, or high risk (i.e., very impaired) and used to predict incident ADL limitations (censoring after limitation onset). We assessed multiplicative and additive interactions of dementia category with modifiers (previously self-reported physical activity, smoking, alcohol consumption, depression, and income) in predicting incident limitations. Results: Smoking, not drinking, and income predicted incident ADL limitations and had larger absolute effects on ADL onset among individuals with high dementia probability than among cognitively normal individuals. Smoking increased the 2-year risk of ADL limitations onset from 9.9 to 14.9 among the lowest dementia probability category and from 32.6 to 42.7 among the highest dementia probability category. Not drinking increased the 2-year risk of ADL limitations onset by 2.1 percentage points among the lowest dementia probability category and 13.2 percentage points among the highest dementia probability category. Low income increased the 2-year risk of ADL limitations onset by 0.4 among the lowest dementia probability category and 12.9 among the highest dementia probability category. Conclusions: Smoking, not drinking, and low income predict incident dependence even in the context of cognitive impairment. Regardless of cognitive status, reducing these risk factors may improve functional outcomes and delay institutionalization.
Keywords: Health Conditions and Status; Income

Depression and older, community-dwelling, African American women - Tamika C. Baldwin (Morgan State University, 2014)
Using data from the Health and Retirement Study (HRS) 2010 wave, this research examined depression among community-dwelling, African American women, age 50 and over. Depression among this population was examined in relation to age, social support, religion, caregiving, and physical health. Intersectionality and social construction were used as theoretical frameworks for the study. Drawn from an original sample of 22,034 individuals, the sample for this research consisted of 2,249 respondents. Multiple logistic regression was used to predict depression among community-dwelling African American women. Findings indicated significant relationships between depression and age, social support, and physical health. However, religion and caregiving were not found to be significant predictors of depression among this population. Implications for future research, practice and policy are also discussed.
Keywords: Adult children; Health Conditions and Status; Healthcare; Methodology; Women and Minorities

Determinants of socioeconomic inequalities in subjective well-being in later life: a cross-country comparison in England and the USA - Jivraj, S.; James Nazroo (Quality of Life Research, 2014)
Purpose To explore country-specific influences on the determinants of two forms of subjective well-being (life satisfaction and quality of life) among older adults in England and the USA. Methods Harmonised data from two nationally representative panel studies of individuals aged 50 and over, the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), are used. Linear regression models are fitted separately for life satisfaction and quality of life scales using cross-sectional samples in 2004. The ELSA sample was 6,733, and the HRS sample was 2,300. Standardised coefficients are reported to determine the country-specific importance of explanatory variables, and predicted values are shown to highlight the relative importance of statistically significant country-level interaction effects. Results Having a disability, been diagnosed with a chronic conditions or having low household wealth are strongly associated with poorer life satisfaction and quality of life. These statistical effects are consistent in England and the USA. The association of years spent in education, however, varied between the two countries: educational inequalities have a greater adverse effect on subjective well-being in the USA compared with England. Conclusion Interventions are required to counterbalance health and socioeconomic inequalities that restrict sections of the population from enjoying satisfying and meaningful lives in older age. The differential association between education and well-being in England and the USA suggests that the provision of welfare benefits and state-funded public services in England may go some way to protect against the subsequent adverse effect of lower socioeconomic status on subjective well-being.
Keywords: Cross-National; Expectations; Health Conditions and Status; Net Worth and Assets; Public Policy; Retirement Planning and Satisfaction

Diabetes diagnosis and exercise initiation among older Americans - Leigh Ann Leung; Shailender Swaminathan; Amal Trivedi (Preventive Medicine, 2014)
Objective: To determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. Methods: We used data from the 2004-2010 Health and Retirement Study in a pre-post study design. Individuals newly-diagnosed with diabetes (N. = 635) were propensity score matched to a comparison group with no diabetes. Results: In the year following a reported diagnosis, 35.7 (95 confidence interval 32.0 to 39.5) of those newly diagnosed with diabetes initiated exercise as compared with 31.4 (95 confidence interval 27.9 to 35.1) for the matched cohort with no diabetes, with a between-group difference of 4.3 percentage points (95 confidence interval -0.9 to 9.4). Among individuals with fewer health risk factors at baseline, the between-group difference was 15.6 percentage points (95 confidence interval 1.58 to 29.5). Conclusion: Over 35 of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis. Among individuals with fewer health risk factors at baseline, those newly-diagnosed with diabetes were more likely to begin exercise than those without diabetes. 2014 Elsevier Inc.
Keywords: Demographics; Health Conditions and Status; Healthcare

Diabetes risk, diagnosis, and control: Do psychosocial factors predict hemoglobin A1C defined outcomes or accuracy of self-reports? - White, Kellee; Mondesir, Favel L.; Lisa M. Bates; M. Maria Glymour (Ethnicity and Disease, 2014)
Objective: To evaluate the accuracy of self-reported diabetes among multi-ethnic older adults by psychosocial factors and assess predictors of diabetes risk, diagnosis, and control. Design and Methods: The 2006 Health and Retirement Study (N=5,594) was used to determine agreement between self-reported diabetes and measured diabetes (HbA1c = 6.5 ) by age, sex, race/ethnicity, nativity, education, health insurance coverage, body mass index, depressive symptoms, and prior report of racial discrimination. We also examined associations between these factors and pre-diabetes (HbA1c = 6.0- 6.5 ) among individuals without diabetes, and those with undiagnosed and poorly controlled (HbA1c = 8.0 ) diabetes. Results: Accuracy of self-reported diabetes was good (ie, sensitivity = 80 and specificity = 95 ) among all demographic subgroups and across most social strata. Among those who reported racial discrimination, sensitivity of self-reported diabetes was lower among Blacks who reported racial discrimination in comparison to Blacks who did not report racial discrimination (82.7 vs 89.0 ) an association that was marginally statistically significant (P=.05). Blacks and Hispanics had higher odds of pre-diabetes, undiagnosed diabetes, and poor glycemic control. Conclusions: Self-reported diabetes corresponded well with HbA1c assessed disease for all social strata examined in this sample of multi-ethnic older adults. Blacks with a history of racial discrimination may be less likely to know diabetes status.
Keywords: Demographics; Health Conditions and Status; Other

Differential Aging-In-Place - So Jung Park (University of Michigan, 2014)
This three-essay dissertation explores components of aging–in-place among adults living alone aged 65 and older using nationally representative data from the Health and Retirement Study (HRS). Drawing on the Person-Environment Fit and Person-Centered perspectives, the overall goal is to examine the extent to which three dimensions of aging-in-place, namely the environment, the older individual, and individual agency (efficacy), are inter-related in order to enable independent living among this subgroup of older persons. Together, these three components help to characterize the heterogeneity of the life contexts and personal resources of older adults who live alone and are aging-in-place. The first paper explored to what degree the environment and health subgroups are associated with subjective well-being among older adults living alone. Through clustering analysis, the four health subgroups of sensory-cognitive impaired, physically impaired, frail, and healthy were identified. The intersection of these health subgroups with three environmental contexts that reflect different levels of physical and social support were examined. The frail group was more likely to show depressive symptoms if they lived in a physically average and socially unsupported environment. The sensory-cognitive impaired group was more likely to report depressive symptoms when they lived in a physically-unsupported but socially-supported environment. The second paper asked if changes in depressive symptomatology over time are mediated by changes in perceived control. The findings confirm a stronger negative influence of membership in a vulnerable health subgroup on perceived control, which in turn affects depressive symptoms over time. Among the environmental contexts, only greater social support was associated with a decrease in depressive symptoms over time via perceived control. The third paper extended the empirical examination of proposals drawn from the Person-Environment Fit perspective. I asked how much environments moderate the effects of health profiles and low socioeconomic status on mortality risk. The results show that for individuals in the sensory-cognitive impaired and physically impaired groups, broader social network was associated with an increased risk of death. In addition, the study revealed that older adults living alone with low socioeconomic status who live in a senior housing environment had a reduced risk of death.
Keywords: Demographics; Health Conditions and Status; Retirement Planning and Satisfaction

Does Becoming an ADL Spousal Caregiver Increase the Caregiver's Depressive Symptoms? - Ruth E Dunkle; Sheila Feld; Amanda J Lehning; Kim, Hyunjee; Shen, Huei-Wern; Kim, Min Hee (Research on Aging, 2014)
This study investigated whether transitioning into the role of activities of daily living (ADL) spousal caregiver is associated with increased depressive symptoms for older husbands and wives among a sample of coresiding community-dwelling older couples. Using data from the Health and Retirement Study, we estimated a two-level linear model to examine the association between change in caregiver status and respondents depressive symptoms at follow-up, controlling for other factors identified in Pearlin s stress process model (PSPM). Results indicate that both husbands and wives who become ADL caregivers have more follow-up depressive symptoms than noncaregivers. Furthermore, wives continuing as caregivers have more follow-up depressive symptoms than wives who do not provide care. Finally, the physical health of the spousal caregiver is related to depressive symptoms at follow-up. We conclude with policy and practice implications of these three main findings.
Keywords: Adult children; Health Conditions and Status; Healthcare; Public Policy

Does brain reserve protect older women from vascular depression? - Daniel Paulson; Mary E Bowen; Peter A Lichtenberg (The journals of gerontology. Series B, Psychological sciences and social sciences, 2014)
OBJECTIVES: Brain reserve theory, typically discussed in relation to dementia, was examined with regard to late-life depression symptomatology and cerebrovascular burden (CVB) in older-old women. METHOD: It was predicted that in a 6-year longitudinal sample (Health and Retirement Study) of 1,355 stroke-free women aged 80 years and older, higher levels of depressive symptomatology (8-item Center for Epidemiologic Studies-Depression score) would be predicted by high CVB, less educational attainment, and the education CVB interaction after controlling for age and cognitive functioning (Telephone Interview for Cognitive Status). A latent growth curve model was used to identify differences in depression symptomatology at baseline and over time. Logistic regression analyses were used to predict clinically significant depressive symptomatology at each wave based on CVB, education, and the education CVB interaction. RESULTS: Results indicate that among older women, greater educational attainment predicted fewer depression symptoms at baseline, but this advantage was partially eroded over time. The education CVB interaction predicted clinically significant depressive symptoms at baseline when the benefits of education were most robust. DISCUSSION: Brain reserve, characterized by educational attainment, may counterbalance the effect of high CVB with respect to depressive symptoms, thereby preserving mood in late life. These findings support the application of brain reserve theory to late-life depression.
Keywords: Demographics; Health Conditions and Status

Does the Hispanic Paradox in U.S. Adult Mortality Extend to Disability? - Mark D Hayward; Robert A Hummer; Chi-Tsun Chiu; César González-González; Rebeca Wong (Population Research and Policy Review, 2014)
Studies consistently document a Hispanic paradox in U.S. adult mortality, whereby Hispanics have similar or lower mortality rates than non-Hispanic whites despite lower socioeconomic status. This study extends this line of inquiry to disability, especially among foreign-born Hispanics, since their advantaged mortality seemingly should be paired with health advantages more generally. We also assess whether the paradox extends to U.S.-born Hispanics to evaluate the effect of nativity. We calculate multistate life tables of life expectancy with disability to assess whether racial/ethnic and nativity differences in the length of disability-free life parallel differences in overall life expectancy. Our results document a Hispanic paradox in mortality for foreign-born and U.S.-born Hispanics. However, Hispanics low mortality rates are not matched by low disability rates. Their disability rates are substantially higher than those of non-Hispanic whites and generally similar to those of non-Hispanic blacks. The result is a protracted period of disabled life expectancy for Hispanics, both foreign- and U.S.-born.
Keywords: Demographics; Disabilities; Health Conditions and Status; Women and Minorities

Does the Widowhood Effect Precede Spousal Bereavement? Results from a Nationally Representative Sample of Older Adults - Anusha M Vable; S. V. Subramanian; Pamela M. Rist; M. Maria Glymour (American Journal of Geriatric Psychiatry, 2014)
Objective: Increased mortality risk following spousal bereavement (often called the widowhood effect ) is well documented, but little prior research has evaluated health deteriorations preceding spousal loss. Design: Data are from the Health and Retirement Study, a nationally representative sample of Americans over 50 years old. Method: Individuals who were married in 2004 were considered for inclusion. Outcome data from 2006 on mobility (walking, climbing stairs), number of depressive symptoms, and instrumental activities of daily living (IADLs) were used. Exposure was characterized based on marital status at the time of outcome measurement: recent widows (N = 396) were bereaved between 2004 and 2006, before outcomes were assessed; near widows (N = 380) were bereaved between 2006 and 2008, after outcomes were assessed; married individuals (N = 7,330) remained married from 2004 to 2010, the follow-up period for this analysis. Linear regression models predicting standardized mobility, depressive symptoms, and IADLs, were adjusted for age, race, gender, birthplace, socio-economic status, and health at baseline. Results: Compared to married individuals, recent widows had worse depressive symptoms ( = 0.71, 95 confidence interval (CI): 0.57, 0.85 ). Near widows had worse depressive symptoms ( = 0.21, 95 CI: 0.08, 0.34 ), mobility ( = 0.14, 95 CI: 0.01, 0.26 ), and word recall ( = -0.13, 95 CI: -0.23, -0.02 ) compared to married individuals. Conclusions: Health declines before spousal death suggests some portion of the widowhood effect may be attributable to experiences that precede widowhood and interventions prior to bereavement might help preserve the health of the surviving spouse. 2014 American Association for Geriatric Psychiatry.
Keywords: Adult children; Health Conditions and Status; Net Worth and Assets

Does Working for Oneself, not Others, Improve Older Adults Health? An Investigation on Health Impact of SelfEmployment - Zhang, Ting (American Journal of Entrepreneurship, 2014)
This paper examines the health impact of being self-employed versus working for others among older adults (aged 50 ) and its implications. Facing an aging workforce, self-employment at older ages may provide an economic benefit via an alternative to retirement. However, little research has examined the health effects of self-employment in later life. Relying on the latest 7 waves of data from the Health and Retirement Study, this study comprehensively examines health using a 29-item index to measure the impact of self-employment status on changes in older adults overall health. We conduct a 2-stage generalized panel data instrument variables regression model, with lagged values to control potential endogeneity and simultaneity issues. We find self-employment compared to wage-and-salary jobs result in better health, controlling for job stress and work intensity, cognitive performance, prior health conditions, socioeconomic and demographic factors. This positive self-employment impact stands our in knowledge-based industry sectors. In labor intensive industry sectors such as Durable Goods Manufacturing, self-employed older adults' more gradual retirement seems to result in a health advantage over wage-and-salary employees. Limitations of the study and future research directions are discussed.
Keywords: Employment and Labor Force; Health Conditions and Status; Other; Retirement Planning and Satisfaction

Dyadic analyses of chronic conditions and distress within marriage : a gendered perspective - Thomeer, Mieke Beth (University of Texas, Austin, 2014)
Chronic conditions negatively impact well-being, and the negative impact of a chronic condition can extend beyond the diagnosed person to his or her spouse. This association may be further influenced by gender, as gender can shape how individuals experience their own chronic conditions-- including what conditions they develop-- and how they react to the conditions and distress of their spouses. In my dissertation, I examine how one spouse's chronic conditions are related to the other spouse's psychological distress over time. I address this using quantitative analysis of the Health and Retirement Study and qualitative analysis of in-depth interviews. In my quantitative analysis, I find that the association between one spouse's chronic conditions and the other spouse's distress differs by gender, number of conditions, whether one or both spouses have chronic conditions, and type of condition. Regarding number of conditions, a husband's number of chronic conditions increases his wife's distress more so than a wife's number of chronic conditions increases her husband's. These associations are mitigated by the chronically ill spouse's own distress and functional limitations. Additionally, this gender difference is more pronounced if both spouses have chronic conditions compared to if only one has chronic conditions. Regarding type of condition, lung disease and stroke are the most negatively impactful for spouses' distress, whereas high blood pressure, cancer, and arthritis are not related to spouses' distress. All conditions, except for stroke, relate to husbands' and wives' distress similarly, but a husband's stroke increases a wife's distress initially whereas the wife's stroke increases the husband's distress over time. In my qualitative analysis, I find that when women are chronically ill, they continue to emotionally care for their husbands, which likely protects their husbands from psychological distress but exacerbates women's own distress. My results point to the importance of promoting the psychological well-being of both spouses during periods of chronic conditions. This is especially critical for spouses of people with more than one condition, chronically ill women whose husbands are also chronically ill, and spouses of people experiencing stroke and lung disease.
Keywords: Demographics; Health Conditions and Status; Healthcare

Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life (National Academies Press, 2014)
Keywords: End of life decisions; Health Conditions and Status; Healthcare; Public Policy; Retirement Planning and Satisfaction

Dynamic Implications of Subjective Expectations: Evidence from Adult Smokers - Wang, Yang (American Economic Journal: Applied Economics, 2014)
We set up a dynamic discrete choice model with subjective expectations data to explain adult smokers' find important differences between subjective survival probabilities and those estimated using observed mortality data. Subjectively, individuals attach less weight to their health conditions and smoking choices and more weight to such factors as age, race, and parents' longevity. Moreover, adult smokers are found to care more about their health and to be more forward-looking than predicted by a rational expectations framework. We further show the importance of unobserved heterogeneity in agents' subjective survival probabilities, and discuss policy implications of subjective expectations.
Keywords: Consumption and Savings; Expectations; Health Conditions and Status; Methodology; Other

Economic analysis of preventive care utilization among older adults - Ng, Boon Peng (Wayne State University, 2014)
This dissertation seeks to examine the economic determinants of the use of preventive services among older adults. It contains two studies that focus on the effects of public health policy and health shocks on the initiation of use of preventive services among older adults. In January 2005, Medicare began covering a one-time initial preventive physical examination (IPPE), also called a "Welcome to Medicare" visit, for new beneficiaries. This benefit was only available during a beneficiary's first six months after enrolling in Part B. The first study examines the effects of covering an IPPE on the use of mammograms, breast self-exams, Pap smears, prostate cancer screenings, cholesterol screenings, and flu vaccines among beneficiaries new to Medicare Part B. Using data from the 1996-2008 Health and Retirement Study (HRS) and the RAND HRS, I estimate multivariate logit models to quantify the effects of Medicare coverage of an IPPE on the utilization of each of these preventive care services. The findings indicate that, among both men and women, the introduction of Medicare IPPE coverage during a beneficiary's first six months under Part B did not increase the utilization of any of the preventive services examined. Although about 70% of older adults will have one chronic condition and 50% will have more than one chronic illness such as heart disease, cancer, stroke etc. (CDC 2009), only 25% of adults ages 50-64, and fewer than 40% of adults ages 65 and older are up-to-date on recommended preventive healthcare services. The second study evaluates whether new information, acquired through the occurrence of unexpected adverse health events, leads an individual to begin using preventive care services. Using data from the longitudinal Health and Retirement Study (HRS) and the RAND HRS, multivariate logit models are estimated to model the dynamic effects of exogenous health shocks on the initiation of use of mammograms, breast self-exams, Pap smears, prostate cancer screening, cholesterol tests, and flu vaccinations. Findings reveal that among adults with a history of not using preventive care, an unexpected adverse health event often spurs them to begin using such services. Among women ages 40 and older, those who experience an adverse health shock are 1.87 times more likely to begin getting mammograms, 1.48 times more likely to begin getting Pap smears, 1.79 times more likely to begin getting cholesterol tests, and 1.46 times more likely to begin getting flu vaccinations. Among men ages 40 and older, those who experience an adverse health shock are 2.24 times more likely to begin getting prostate cancer screenings, 2.75 times more likely to begin getting cholesterol checks, and 1.64 times more likely to begin getting flu vaccinations. These findings provide strong evidence that people change their health behaviors in positive ways following the occurrence of a negative health experience.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Public Policy

The Effect of Community-Based Services on Functional Limitations of American Older Adults in Retirement Community - So Jung Park; Kim, Min Hee (Korea Social Welfare Research, 2014)
Being discussed among the various environmental factors for the year, with an independent discourse on successful aging, we examine the relationship between health and community services for the elderly using American study. The review is limited in most cases to be vulnerable older people to explore the relationship between the two previous studies, which focused on the effectiveness of many individual services. The present study was derived using the Health and Retirement Study (1998 2008) panel data, and the use of the service pattern of the individual review of the relevant health service use patterns and trends. In addition, the effect of the use of service resources and informal health services were analyzed with the factors that affect the relationship between health map. Was limited to senior living senior housing community with information about the service analysis, we used the daily living skills scores about healthy level and trend are (instrumental). Configured to use the pattern for the official services (housework, care, care, transportation, meals) in the community through the cluster analysis results did not use all the services a large number of elderly (group 1), in addition to using all of the services that the elderly could be classified as elderly (groups 3 and 4), although the nature (group 2), most of the details to use the service. Analysis of the relation of the health services through a growth curve model (Growth Curve Model) results, in the group compared to the group with all of the services that are not used at all, the service tends to be deteriorated health. But if you take advantage of the informal resources around them showed that mitigation is steep trend deteriorating health. The significance of that is then used to present the major reasons for this study is that no magazine to help in maintaining the health community service use, its extent. Suggests that informal, to study the effect of an integrated formal resources and medical necessity of the service area to review the impact of community service than what it.
Keywords: Health Conditions and Status; Healthcare; Methodology; Public Policy

The Effect of Job Loss on Health: Evidence from Biomarkers - Pierre-Carl Michaud; Eileen M. Crimmins; Michael D Hurd (Bonn, Germany, Institute for the Study of Labor, 2014)
The effect of job loss on health may play an important role in the development of the SES-health gradient. In this paper, we estimate the effect of job loss on objective measures of physiological dysregulation using longitudinal data from the Health and Retirement Study and biomarker measures collected in 2006 and 2008. We use a variety of econometric methods to account for selection and reverse causality.Distinguishing between layoffs and business closures, we find no evidence that business closures lead to worse health outcomes. We also find no evidence that biomarker health measures predict subsequent job loss because of business closures. We do find evidence that layoffs lead to diminished health. Although this finding appears to be robust to confounders, we find that reverse causality tends to bias downward our estimates. Matching estimates, which account for self-reported health conditions prior to the layoff and subjective job loss expectations, suggest even stronger estimates of the effect of layoffs on health as measured from biomarkers, in particular for glycosylated hemoglobin (HbA1c) and C-reactive protein (CRP). Overall, we estimate that a layoff could increase annual mortality rates by 9.4 , which is consistent with other evidence of the effect of mass layoffs on mortality.
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Methodology

The effect of retirement on alcohol consumption: results from the US Health and Retirement Study - Wang, Xu; Steier, Jessica B.; William T Gallo (The European Journal of Public Health, 2014)
Background: Prior research examining the association between retirement and alcohol consumption is inconsistent with respect to salience, direction and magnitude. Reasonable conceptual arguments for both positive (e.g. coping, introduction of leisure time) and negative (e.g. severance of work-related social relationships) changes further complicate investigations of this critical association, as do differences in study design, national setting and measurement of alcohol use. Methods: This prospective longitudinal study analyses 2-year wave-pairs drawn from seven waves (14 years) of data from the US Health and Retirement Study to assess the effect of complete retirement on weekly alcohol consumption (n = 9979 observations; 4674 unique participants). We use multiple regression analysis in a two-period follow-up design and account for potential selection bias and reverse causality not addressed in prior research on this topic. Results: We find that retirement is positively associated with subsequent weekly alcohol consumption for men who reported drinking at both follow-up and the prior study wave ( = 1.9, 95 confidence interval = 0.43 3.36). No association was observed among women. Conclusion: Our results suggest that health care professionals should monitor the drinking habits of retired men, as older individuals are particularly susceptible to the adverse effects of heavy alcohol use.
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction

The Effect of Sleep Medication Use and Poor Sleep Quality on Risk of Falls in Community-Dwelling Older Adults - Min, Yaena (Virginia Commonwealth University, 2014)
The work presented in this dissertation focuses on the association between sleep medication use, poor sleep, and falls in community-dwelling adults 65 years or older. Sleep complaints and the consumption of medications to aid sleep are common in older adults. Psychotropic medications, such as sedative hypnotics, are associated with risk of falls in older adults. However, very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls in community-dwelling older adults. In the first project, a cross-sectional analysis of the Health and Retirement Study (HRS) 2010 data was conducted to determine the prevalence of sleep problems, sleep medication use and falls; and to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. A multiple logistic model adjusted for covariates was used. In the sample of community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the older adults. Older adults who had sleep problems and took sleep medications had a significantly higher risk of falls compared with older adults who did not have sleep problems and did not take sleep medications. The other two groups, older adults who had sleep problems and did not take sleep medications, and those who did not have sleep problems and took sleep medications also had a significantly greater risk for falls. The second project was a prospective cohort study of independently-living older adults from senior congregate housing. The effect of combined poor sleep quality and sleep medication use on risk of falls was assessed using logistic regression modeling. In this study of 113 community-dwelling older adults, 46.9% had at least one fall, and 62.8% had poor sleep quality. Sleep medication use was reported by 44.2% of the older adults. Older adults with poor sleep quality and sleep medication use had a significantly increased risk of falls compared with older adults with good sleep quality and no sleep medication use. Older adults with good sleep quality and sleep medication use, and those with poor sleep quality and no sleep medication use did not have a significantly greater risk for falls. In conclusion, poor sleep added to sleep medication use significantly increased the risk of falls in community-dwelling older adults. The research undertaken in this dissertation was the first to evaluate the associations between poor sleep, use of sleep medications, and falls in community-dwelling older adults.
Keywords: Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

Effects of cost-related medication nonadherence on financial health and retirement decisions among adults in late midlife - Gail A Jensen; Yong Li (Journal of Pharmaceutical Health Services Research, 2014)
Objectives Suboptimal adherence to prescribed medications due to cost is known to adversely affect physical health. In this study, we examine whether cost-related nonadherence (CRN) also affects financial health , e.g. an individual's personal finances or the timing of their retirement. Methods We examine this issue for 2927 adults in late midlife with chronic medical conditions who participated in the Health and Retirement Study and who reported regularly taking medication(s) for their condition over the period 1994 to 2004. We hypothesize CRN may indirectly influence financial health by contributing to the occurrence of negative health shocks. We estimate two sets of models, one to quantify the effects of CRN on the occurrence of adverse health events, and another to quantify the effects of adverse health events on personal finances in 2004 and the timing of retirement. We then derive estimates of the indirect effects of CRN on financial health and on retirement decisions. Key findings Among adults in late midlife, CRN contributes significantly to reduced earnings and premature retirements. These effects happen because CRN raises the risk that serious health shocks occur over time, and such adverse events subsequently limit an individual's ability to continue working and accumulating wealth. Conclusions CRN can threaten more than just personal health. In late midlife, CRN can threaten an individual's ability to continue working and saving towards retirement.
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare; Methodology; Net Worth and Assets; Other; Retirement Planning and Satisfaction

The effects of loneliness and social isolation on hypertension in later life: Including risk, diagnosis and management of the chronic condition - Caitlin E. Coyle (University of Massachusetts Boston, 2014)
Social relationships play a vital role in maintaining health and functioning in later life; however, much less is known about the consequences of lacking those social relationships. This research examines the independent effects of social isolation and loneliness on the risk of hypertension as well as on the diagnosis and management of this chronic condition, with particular attention paid to gender differences. Using the Health and Retirement Study (HRS), a series of binary logistic regression analyses are used to estimate the direct effect of isolation and loneliness on hypertension in Wave 9 (2008) and over a two year-period ending in Wave 10 (2010). In addition, the interactive effects of health behavior and depression are explored. A series of multinomial logistic regression analyses are used to estimate the effects of social isolation and loneliness on the likelihood of having undiagnosed or uncontrolled hypertension. Results indicate that even controlling for loneliness, social isolation increases the odds of having hypertension among both men and women. These results also support the idea that social isolation is associated with increased odds of having undiagnosed or uncontrolled hypertension, specifically among women. Results from this study provide no consistent support for the notion that loneliness negatively effects hypertension. In terms of social determinants of health, these results highlight the need for existing chronic disease management to be targeted to include socially isolated older adults. Health professionals may need to focus their efforts on detecting social isolation among their patients, and adjusting treatment plans to be most effective for this vulnerable population of older adults.
Keywords: Health Conditions and Status; Healthcare; Public Policy

The Effects of Total Knee Arthroplasty on Physical Functioning and Health among the Under Age 65 Population - Linda K George; Hu, L.; Frank A Sloan (Value in Health, 2014)
Objectives: This study examined the effects of total knee arthroplasty on six measures of physical functioning, self-rated health, pain, earnings, and employment status among US adults aged 51 to 63 years at baseline. Methods: Data came from the Health and Retirement Study, a nationally representative longitudinal study conducted biannually. The analysis sample consisted of individuals aged 51 to 63 years at baseline with arthritis who were resurveyed at 2-year intervals from 1996 to 2010. Propensity score matching was used to compare outcomes of persons receiving total knee arthroplasty (TKA) with those of matched controls. Six measures of physical functioning were examined: lower-body mobility problems, instrumental activities of daily living limitations, activities of daily living limitations, and large muscle, fine motor, and gross motor limitations. Self-rated health and pain were also examined. The two employment-related outcomes were earnings and employment status. Results: Receipt of TKA was associated with better outcomes for several measures of physical functioning, especially mobility limitations, pain, and self-rated health. Receipt of TKA was not associated with increased earnings or employment. Conclusions: Receipt of TKA yields important improvements in physical function among persons with an arthritis diagnosis who received the procedure before reaching the age of 65 years. This study contributes to knowledge about the benefits of TKA in a community setting among nonelderly recipients of TKA. 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Keywords: Employment and Labor Force; Health Conditions and Status; Healthcare

Essays in applied economics - Sacks, Daniel W. (University of Pennsylvania, 2014)
Essay 1 studies physician agency problems, which arise whenever physicians fail to maximize their patients' preferences, given available information. These agency problems are well documented, but the magnitude of their welfare consequences for patients---the losses from suboptimal treatment choice induced by agency---are unclear. I infer patient drug preference from their compliance decisions. I begin by showing that initial prescriptions respond to physician financial incentives to control costs and to pharmaceutical detailing, but compliance does not, pointing to agency problems. I then develop and estimate a model of physician-patient interactions where physician write initial prescriptions, but patients choose whether to comply. Fully eliminating agency problems increases compliance by 6.5 percentage points, and raises patient welfare by 22% of drug spending. Contracts that better align doctor and patient preferences can improve patient welfare, but attain only half the gains from eliminating agency completely. Although physician agency problems reduce patient welfare, eliminating them is thus likely difficult. Essay 2, co-authored with Alexander M. Gelber and Damon Jones, studies frictions in adjusting earnings to changes in the Social Security Annual Earnings Test (AET) using a panel of Social Security Administration microdata on one percent of the U.S. population from 1961 to 2006. Individuals continue to "bunch" at the convex kink the AET creates even when they are no longer subject to the AET, consistent with the existence of earnings adjustment frictions in the U.S. We develop a novel estimation framework and estimate in a baseline case that the earnings elasticity with respect to the implicit net-of-tax share is 0.23, and the fixed cost of adjustment is $152.08. Essay 3 studies the impact of health expenditure risk on annuitization. Theoretical research suggests that such risk can have an ambiguous influence on the annuitization decisions of the elderly. I provide empirical evidence on this linkage, by estimating the impact of supplemental Medicare insurance (Medigap) coverage on the annuity demand of older Americans. Medigap coverage has a strong impact on annuitization: the extensive margin elasticity is 0.39, the overall elasticity of private annuity income with respect to Medigap coverage is 0.56. These results are robust to controls for health, wealth, and preferences, as well as other robustness tests. They suggest that medical expenditure risk has a large impact on underannuitization.
Keywords: Health Conditions and Status; Healthcare; Income; Net Worth and Assets; Public Policy; Social Security

Essays on health and retirement - Basu Roy, Subhasree (Georgia State University, 2014)
The essays in this dissertation explore issues related to health and retirement of older Americans, using longitudinal data on older Americans from ten waves of the Health and Retirement Study (1992-2010). The first essay explores the effect of both subjective and relatively more objective physical and mental health conditions on the probability of exit from full-time employment. Eight health indices (factors) are created from a wide range of health measures by principal component analysis. The effect of these health factors on the time until exit from full-time employment is empirically examined in a proportional hazard model. Single and competing risk specifications are estimated that allow for multiple spells of full-time employment and control for unobserved heterogeneity. The main results suggest that increase in functional limitation factor makes an individual more likely to exit via any route in general and the complete retirement route in particular. For mental health problems, increase in the depression factor increases the likelihood of exit from full-time employment via the complete retirement, part-time work and unemployment routes. While increase in cognitive disorders factor has no significant effect on the likelihood of exit via complete retirement, but increases the likelihood of exit via the disability route. These results have implications for public policies targeted towards retaining older workers within the labor market. The second essay examines the effect of retirement on post retirement physical and mental health and the extent to which the effects differ across these different health outcomes. The inherent issue of reverse causality between health and retirement that leads to endogeneity is addressed by using multiple sample stratification and instrumental variable estimation strategies. The stratified samples include individuals who are physically and mentally healthy prior to their retirement so that pure effect of retirement on post retirement health may be found. Five different instruments for complete retirement are also used to deal with endogeneity. The sample stratification results unanimously indicate that complete retirement has adverse effect on post retirement physical and mental health. While the instrumental variables approach results are mixed and are based on the choice of instrument for complete retirement.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology; Public Policy; Retirement Planning and Satisfaction; Risk Taking

Exploring differences in prevalence of diagnosed, measured and undiagnosed hypertension: the case of Ireland and the United States of America - Mosca, I.; Kenny, R. A. (International Journal of Public Health, 2014)
OBJECTIVES: To: (1) compare prevalence of diagnosed, measured, total and undiagnosed hypertension among late middle-aged adults in the United States of America and Ireland; (2) identify the most important predictors of hypertension and compare them across the two countries; (3) investigate whether cross-national differences in prevalence rates are explained by country differences in behavioural risk factors. METHODS: We use data from the 2008 and 2010 waves of the Health and Retirement Study (n = 1,938) and the first wave (2009/2011) of The Irish Longitudinal Study on Ageing (n = 1,455). We employ probit models to determine whether individual attributes, socioeconomic characteristics and behavioural health factors, including smoking, alcohol consumption and obesity, are associated with hypertension. We do not consider whether respondents are on antihypertensive medication. RESULTS: Prevalence of diagnosed hypertension is higher in the United States of America (48.6 versus 32.4 ). Prevalence of undiagnosed hypertension is higher in Ireland (41.2 versus 19.7 ). Little of the difference in prevalence rates is explained by country differences in behavioural risk factors. CONCLUSIONS: A greater focus on prevention of high blood pressure is necessary in Ireland.
Keywords: Cross-National; Demographics; Health Conditions and Status; Healthcare; TILDA

Fact Sheet: Cohort Differences in Parental Survival - Maximiliane E Szinovacz (Boston, ScholarWorks, University of Massachusetts Boston, 2014)
Increases in longevity and especially increased survival into very old age have implications not only for individuals own life course but also for that of their families. For example, if parents survive into very old age they will have more opportunities not only to become grandparents but also great-grandparents and to experience these family roles for a longer time period (the so-called beanpole family ). From their adult children s perspective, longer survival of parents also can mean that needs for companionship arising from one parent s widow(er)hood will be postponed into their adult children s later years, possibly after the child s retirement. Similarly, because spouses typically function as primary caregivers for their partners, primary caregiving roles on the part of adult children may be postponed into children s later years if both parents survive into very old age. Despite considerable evidence documenting increases in longevity, little research has been devoted to parental survival among adult children from the World War II babies and baby boom cohorts. We present data comparing parental survival across four cohorts of adult children using data from Health and Retirement Study (HRS).
Keywords: Adult children; Health Conditions and Status; Healthcare

Fact Sheet: Cohort Differences in Parents Illness and Nursing Home Use - Maximiliane E Szinovacz (Boston, ScholarWorks, University of Massachusetts Boston, 2014)
Surviving parents of the war baby and baby boom cohorts are now reaching very old age. Given their increased longevity and postponement of morbidity into very old age (see Fact Sheets on parental mortality and care needs), it is essential to estimate whether and to what extent these parents will require informal or formal care. Such care is typically most burdensome and costly if it involves long-lasting illness prior to death. Furthermore, Medicare and especially Medicaid expenditures will depend on whether or not these parents require nursing home care. To obtain some estimates of the prevalence of long-lasting illness and nursing home care among these groups of parents, we investigated reports of parental illness preceding death and nursing home placement from four cohorts of adult children, using data from the Health and Retirement Study.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

A factor mixture model for analyzing heterogeneity and cognitive structure of dementia - Cagnone, Silvia; Cinzia Viroli (AStA Advances in Statistical Analysis, 2014)
The Health and Retirement Study (HRS) is funded by the National Institute on Aging of US with the aim of investigating the health, social and economic implications of the aging of the American population. The participants of the study receive a thorough in-home clinical and neuropsychological assessment leading to a diagnosis of normal, cognitive impairment but not demented, or dementia. Due to the heterogeneity of the participants into three classes, we analyze some overall cognitive functioning responses through a factor mixture analysis model. The model extends recent proposals developed for binary and continuous data to general mixed data and to the situation of observed heterogeneity, typical of the HRS study.
Keywords: Health Conditions and Status; Methodology; Other

Frailty and Depression: A Latent Trait Analysis - Matthew C. Lohman (Virginia Commonwealth University, 2014)
Background: Frailty, a state indicating vulnerability to poor health outcomes, is a common condition in later life. However, research and intervention progress is hindered by the current lack of a consensus frailty definition and poor understanding of relationships between frailty and depression. Objectives: The goal of this research is to understand the interrelationships between frailty and depression among older adults. Specifically, this project aims 1) to examine the construct overlap between depression and three definitions of frailty (biological syndrome, medical burdens, and functional domains), 2) to determine the degree to which this overlap varies by age, gender, race/ethnicity and other individual characteristics, 3) to evaluate how the association between frailty and depression influences prediction of adverse health outcomes. Methods: This project uses data from the 2004-2012 Health and Retirement Study (HRS), an ongoing, nationally-representative cohort study of adults over the age of 55. Frailty was indexed by three alternative conceptual models: 1) biological syndrome, 2) cumulative medical burdens, and 3) functional domains. Depressive symptoms were indexed by the 8-item Center for Epidemiologic Studies Depression (CESD) scale. Latent class analysis and confirmatory factor analysis were used to assess the construct overlap between depressive symptoms and frailty. Latent growth curve modeling were used to evaluate associations between frailty and depression, and to estimate their joint influence on two adverse health outcomes: nursing home admission and falls. Results: The measurement overlap of frailty and depression was high using a categorical latent variable approach. Approximately 73% of individuals with severe depressive symptoms, and 85% of individuals with primarily somatic depressive symptoms, were categorized as concurrently frail. When modeled as continuous latent factors, each of the three frailty latent factors was significantly correlated with depression: biological syndrome (ρ = .67, p <.01); functional domains (ρ = .70, p <.01); and medical burdens (ρ = .62, p <.01). Higher latent frailty trajectories were associated with higher likelihood of experiencing nursing home admission and serious falls. This association with adverse health outcomes was attenuated after adjustment for depression as a time-varying covariate. Conclusions: Findings suggest that frailty and frailty trajectories are potentially important indicators of vulnerability to adverse health outcomes. Future investigations of frailty syndrome, however it is operationalized, should account for its substantial association with depression in order to develop more accurate measurement and effective treatment.
Keywords: Health Conditions and Status; Methodology; Public Policy

Fundamental resource dis/advantages, youth health and adult educational outcomes - Elman, Cheryl; Linda A. Wray; Xi, Juan (Social Science Research, 2014)
Recent studies find lasting effects of poor youth health on educational attainment but use young samples and narrow life course windows of observation to explore outcomes. We apply a life course framework to three sets of Health and Retirement Study birth cohorts to examine early health status effects on education and skills attainment measured late in life. The older cohorts that we study were the earliest recipients of U.S. policies promoting continuing education through the GI Bill, community college expansions and new credentials such as the GED. We examine a wide range of outcomes but focus on GEDs, postsecondary school entry and adult human capital as job-related training. We find that older U.S. cohorts had considerable exposure to these forms of attainment and that the effects of youth health on them vary by outcome: health selection and ascription group effects are weak or fade, respectively, in outcomes associated with delayed or adult attainment. However, poorer health and social disadvantage in youth and barriers associated with ascription carry forward to limit attainment of key credentials such as diplomas and college degrees. We find that the human capital - health gradient is dynamic and that narrow windows of observation in existing studies miss much of it. National context also matters for studying health-education linkages over the life course.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status; Healthcare; Methodology

Gaps in Receipt of Regular Eye Examinations among Medicare Beneficiaries Diagnosed with Diabetes or Chronic Eye Diseases - Frank A Sloan; Arseniy P Yashkin; Chen, Yiqun (Ophthalmology, 2014)
Objective: To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM). Design: Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS). Participants: The sample consisted of 2151 Medicare beneficiaries who responded to the HRS. Methods: Medicare beneficiaries with = 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual's financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination. Main Outcome Measures: The primary outcome measure was the number of 15-month periods with an eye examination. Results: One third of beneficiaries with the study's chronic diseases saw an eye care provider in all 4 followup periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations. Conclusions: Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use.
Keywords: Health Conditions and Status; Healthcare; Insurance; Medicare/Medicaid/Health Insurance

Gender Differences in Functional Health: Latent Curve Analysis Assessing Differential Exposure - Leah Rohlfsen; Jennie J. Kronenfeld (Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 2014)
Objectives. To examine gender difference in trajectories of functional limitations among middle-aged and older adults using a comprehensive set of predictors and method not previously used to examine this topic. Method. Two-part latent curve models were used to analyze data from the Health and Retirement Study. These models differentiate the occurrence of limitations from the number of limitations at both baseline and over time. Results. Females had 3.70 times greater odds of having any limitations and had 28 more limitations at baseline compared with males, but there was no gender difference in the onset of limitations over time or in the number of limitations over time. Differences in employment status, income, wealth, depressive symptoms, arthritis, cancer, and eyesight partially explained the gender gap. Discussion. Females are disadvantaged in terms of occurrence and number of limitations at baseline but the gender gap remains stable over time, suggesting differences occur before late-middle and old age. Females' lack of full-time employment, and lower levels of income and wealth translate into worse functional health. It is important to improve the socioeconomic status of females while also addressing the health conditions that contribute to functional limitations for males and females.
Keywords: Demographics; Health Conditions and Status; Methodology

Gender Differences in Trajectories of Self-Rated Health in Middle and Old Age: An Examination of Differential Exposure and Differential Vulnerability - Leah Rohlfsen; Jennie J. Kronenfeld (Journal of Aging and Health, 2014)
Objective: This research examined gender differences in self-rated health (SRH) using the differential exposure and differential vulnerability explanations of gender differences in health. Method: Trajectories of SRH were estimated using data that spanned 12 years (1992-2004) from the Health and Retirement Study. Results: There was no gender difference in SRH at baseline, but SRH declined faster for males over time. Factors that mediated the gender difference included changes in employment status, smoking behavior, and the onset of health conditions. Moreover, were it not for gender differences in various structural and health status factors, females would have better SRH at baseline and over time. Discussion: Our results differ from previous research, which often shows a female disadvantage that is reduced or disappears at older ages. Furthermore, gender differences in the predictors of SRH (exposure) contribute more to understanding gender differences in SRH than different responses to the predictors (vulnerability).
Keywords: Demographics; Health Conditions and Status; Methodology

Gender, race, and ethnic differences in the effects of education on depression in later life: The mediating roles of mastery and stress - Wong, Cathy M. (University of Massachusetts Boston, 2014)
The central objective of this study was to examine gender, race, and ethnic differences in the effects of education on late-life depression. This study differentiated education from other measures of SES due to the psychosocial resources developed through schooling. Education provides intrinsic resources, such as perceived mastery, that are beyond monetary value. Higher levels of education is hypothesized to increase perceived mastery throughout the life course and result in lower levels of stress, influencing psychological well-being in later life. The Stress Process Paradigm was the conceptual framework used for this study. The Stress Process Paradigm includes elements of Ross and Mirowsky's (2006) Resource Substitution and Resource Multiplication hypotheses. Ross and Mirowsky's hypotheses were used to examine whether education improves psychological well-being more for disadvantaged or advantaged groups. The Health and Retirement Study (HRS) was the data source used for this study. The analyses included an evaluation of both the prevalence of depression (cross-sectional models with the 2006 wave of the HRS) and the incidence of depression onset and recovery (longitudinal models with the 2006 and 2008 waves of the HRS). The analyses included examining the moderating effects of gender, race, and ethnic group status on the relationship between SES and late-life depression. Also, this study examined the mediating effects of perceived mastery and stress in the SES-depression relationship. The results suggested the benefits of education may have a more significant effect on psychological well-being than other indicators of SES. There was no evidence of gender moderating the relationship between education and depression. The results showed there appears to be a protective effect of education on depression for Whites. The results did not show mediating effects of perceived mastery and stress in the relationship between education and depression. Rather, the results implied a suppressor effect. Last, this study examined depression among specific gender-race-ethnic groups. It was found that White men have significantly lower odds of having depression than all other groups. This study concludes that it is important to understand that socioeconomic inequalities throughout the life course have an effect on mental health disparities in later life.
Keywords: Demographics; Health Conditions and Status

Giving Up the Keys: How Driving Cessation Affects Engagement in Later Life - Angela L Curl; Stowe, James D.; Teresa M Cooney; Proulx, Christine M. (Gerontologist, 2014)
Purpose: Many older adults consider driving vital to maintaining their preferred lifestyle and engagement with society, yet it is normative for individuals to eventually stop driving. This study examined the impact of driving cessation on older adults' productive and social engagement and whether their mental and physical health mediated this relationship. Design and Methods: Multilevel modeling was used to analyze longitudinal data (N = 4,788 adults age 65 and over) from the Health and Retirement Study (1998-2010). Results: Productive engagement (paid work, formal volunteering, and informal volunteering) was negatively affected when older adults stopped driving, but social engagement was not immediately compromised by their transition to nondriver status. The role of physical health and mental health as mediators in explaining this relationship was negligible. Implications: The results suggest that interventions aimed at maintaining nondrivers' participation in productive roles should focus on factors other than enhancement of health and well-being to spur greater engagement (e.g., availability of and barriers to use of public transportation). Also important in the intervention process is planning for mobility transitions. Future research should test for geographic (e.g., urban vs. rural) differences in the impact of driving cessation on productive and social engagement.
Keywords: Adult children; Employment and Labor Force; Health Conditions and Status; Other

The Great Recession, Decline and Rebound in Household Wealth for the Near Retirement Population - Alan L Gustman; Thomas L. Steinmeier; N. Tabatabai (Cambridge, MA, National Bureau of Economic Research, 2014)
This paper uses data from the Health and Retirement Study to examine the effects of the Great Recession on the wealth held by the near retirement age population from 2006 to 2012. For the Early Boomer cohort (ages 51 to 56 in 2004), real wealth in 2012 remained 3.6 percent below its 2006 value. This is a modest decline considering the fall in asset values during the Great Recession. Much of the decline in wealth over the 2006 to 2010 period was cushioned by wealth originating from Social Security and defined benefit pensions. For the most part, these are stable sums that ensured a major fraction of total wealth did not decline as a result of the recession. The rebound in asset values observed between 2010 and 2012 mitigated, but did not erase, the asset losses experienced in the first years of the Great Recession. Effects of the Great Recession varied with the household's initial wealth. Those who were in the highest wealth deciles typically had a larger share of their assets subject to the influence of declining markets, and were hurt most severely. Unlike those falling in lower wealth deciles, they have yet to regain all the wealth they lost during the recession. Recovering losses in assets is only part of the story. The assets held by members of the cohort nearing retirement at the onset of the recession would normally have grown over ensuing years. Members of older HRS cohorts accumulated assets rapidly in the years just before retirement. Those on the cusp of retiring at the onset of the recession would be much better off had they had enjoyed similar growth in assets as experienced by members of older cohorts. The bottom line is that the losses in assets imposed by the Great Recession were relatively modest. The recovery has helped. But much of the remaining penalty due to the Great Recession is in the failure of assets to grow beyond their initial levels.
Keywords: Health Conditions and Status; Net Worth and Assets; Public Policy

Health and Living Arrangements among Older Adults in Diverse Social and Cultural Contexts - BoRin Kim (University of Michigan, 2014)
This dissertation consists of three empirical papers on health and living arrangements among older adults. It aims to investigate the dynamic associations between living arrangements and the physical/mental health among older adults, and to examine how these associations are influenced by various cultural factors, such as age cohort, race/ethnicity, and nationality. To accomplish these specific aims, two nationally representative panel data for older populations are examined: the 2006-2008 Korean Longitudinal Study of Ageing and the 1998-2010 Health and Retirement Study. The first study explores the effects of physical/mental health on transitions in living arrangements among older Koreans. The effects of health on living arrangements vary by marital status; while unmarried elders with health problems are more likely to live with their children, married elders tend to live near their children. The second study investigates how different types of living arrangements influence physical function and psychological well-being in old age, and how these effects differ between the old-old and the young-old. The results show that co-residence does not always positively influence health and well-being, particularly among the young-old. Finally, the third study analyzes the trajectories of living arrangements among older Americans over a twelve-year period. This study examines to what extent physical/mental health influence the trajectories of living arrangements, and if there are racial/ethnic variations. Older Americans are more likely to move closer in proximity to one of their children, but they do not usually move into the same household. The onsets and aggravations of health problems affect changes in living arrangements, and these linkages are stronger among Whites than African Americans and Hispanics. The findings highlight the importance of social and cultural contexts in understanding the linkages between health and living arrangements in old age. Given the increase of rapidly aging societies, understanding the dynamic linkages between health and living arrangements is important for social, health, and long-term care policies. My dissertation can contribute to a clearer identification of the groups of elderly who are at high risk for health problems and social isolation as well as to the design and implementation of service programs for these high-risk groups.
Keywords: Adult children; Cross-National; Demographics; Health Conditions and Status; Public Policy; Retirement Planning and Satisfaction

Health Literacy and Related Psychosocial Factors and Measurement Issues: A Qualitative Study and a Secondary Analysis of the Health and Retirement Study - Dena M. Fernandez (University of Michigan, 2014)
Purpose: Despite the well-known positive relationship between inadequate health literacy and adverse health outcomes, little is known about the impact of health literacy and health literacy testing on patient psychosocial factors. Meanwhile, experts have advised against routine health literacy screening due to potential for shame-related harm, and providers remain largely unaware of their patients' health literacy and health literacy-related challenges. The purpose of this dissertation was to (1) examine relationships between health literacy and psychosocial factors in a Health and Retirement Study sample of adults, (2) learn about the health literacy-related healthcare experience from the perspectives of African American adults with hypertension, and (3) learn about the health literacy testing experience through cognitive interviewing with African American adults with hypertension. Methods: In a secondary analysis of Health and Retirement Study data, logistic regression was conducted to examine relationships between health literacy and psychosocial and health behavioral variables in a subsample who partook in health literacy testing (n=373). In an original study, qualitative data was collected from a sample of African American adults with hypertension (n=15). Narrative interviews were conducted to explore the health literacy-related healthcare experience, and cognitive interviews were conducted to learn about the cognitive and experiential dimensions of health literacy testing. Results: Quantitative results provided evidence that health literacy is related to breast screening practices, tobacco and exercise behaviors, and perceptions of control over health and social standing in the HRS sample. Qualitative analysis of narrative interviews indicated that health literacy-related experiences in the healthcare setting involve practical challenges (primarily related to medication), negative emotions (feeling of anxiety and stigmatization), and both adaptive and maladaptive coping techniques. Findings from cognitive interviews revealed that participants at times felt discomfort, embarrassment, and stress with each of the instruments used in this study; additionally, findings suggest there may be a potential bias in some of the content of the tests.
Keywords: Health Conditions and Status; Methodology

A holistic approach to understanding retirement preparedness - Yook, Miyoung (Kansas State University, 2014)
There has been increased interest in understanding the significant disparity in U.S. households' retirement preparedness due to concern about the stability of Social Security benefits, the shift from defined benefit plans to defined contribution plans, and the decreased rate of saving. This dissertation explores a model that can be utilized to understand and enhance retirement preparedness by individuals, educators, practitioners, and policy makers. Retirement preparedness was measured in two different ways--using the income replacement rate and the capital accumulation ratio--for two separate empirical models. The general conceptualization of the framework is based on the retirement planning work of Hershey (2004). This study utilized the 2008 Rand version (Version L) of the Health and Retirement Study (HRS) and 2006, 2008, and 2010 psychosocial and lifestyle questionnaire. The Rand HRS data file is a user-friendly version of the HRS data and contains cleaned data. The two hierarchical regressions were used to analyze the association between retirement preparedness and the theoretical concepts of cultural influence, environmental influence, task components, and psychological influence. Entering the conceptual components as four separate blocks allows for observation of changes in R 2 based on the addition of the conceptual components. This research investigates the following research questions: (a) How strongly are cultural influences associated with retirement preparedness?, (b) How strongly are environmental influences associated with retirement preparedness?, (c) How strongly are task components associated with retirement preparedness?, and (d) How strongly are psychological influences associated with retirement preparedness? Current retirement planning practices are often based on structural profiles such as financial resources, financial needs, and goals. The holistic approach used for this dissertation is based on the awareness of the influence of psychological and personal factors on financial decision making. The results showed that the variables positively associated with the retirement income replacement rate were self-perception of aging, homeownership, stock ownership, household pension ownership, IRA/Keogh ownership, and business ownership. Pre-retirement income log had a highly negative association with the retirement income replacement ratio. Big Five personality and perceived mastery were not significant. However, when asset ownership (excluding homeownership) was not controlled, conscientiousness and low emotional stability became significant and showed a positive association for conscientiousness and a negative association for low emotional stability. Self-perception of aging was a significant psychological variable in both models. The significant variables from the second model measured by the capital accumulation ratio were asset ownerships including homeownership, stock ownership, IRA ownership, real estate ownership, and business ownership. None of the psychological variables were significant, except for agreeableness, which was related negatively to the capital accumulation ratio when the asset ownerships (excluding home ownership) were not controlled. Other significant variables, when asset ownership was not controlled, were home ownership, pre-retirement income log, being non-White.
Keywords: Adult children; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction; Social Security

Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death - Feng, Zhanlian; Coots, Laura A.; Kaganova, Yevgeniya; Joshua M Wiener (Health Affairs, 2014)
Hospitalizations and emergency department (ED) visits for people with Alzheimer s disease and related disorders are of particular concern because many of these patients are physically and mentally frail, and the care delivered in these settings is costly. Using data from the Health and Retirement Study linked with Medicare claims from the period 2000 08, we found that among community-dwelling elderly fee-for-service Medicare beneficiaries, those who had dementia were significantly more likely than those who did not to have a hospitalization (26.7 percent versus 18.7 percent) and an ED visit (34.5 percent versus 25.4 percent) in each year. Comparing nursing home residents who had dementia with those who did not, we found only small differences in hospitalizations (45.8 percent versus 41.9 percent, respectively) and ED use (55.3 percent versus 52.7 percent). As death neared, however, utilization rose sharply across settings and by whether or not beneficiaries had dementia: Nearly 80 percent of community-dwelling decedents were hospitalized, and an equal proportion had at least one ED visit during the last year of life, regardless of dementia. Our research suggests that substantial portions of hospitalizations and ED visits both before and during the last year of life were potentially avoidable.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

Housing wealth, psychological well-being, and cognitive functioning of older Americans - Hamoudi, Amar; Jennifer B Dowd (The journals of gerontology. Series B, Psychological sciences and social sciences, 2014)
OBJECTIVES: Economic security around retirement age may be an important determinant of psychological and cognitive well-being of older adults. This study examines the impact of the dramatic increase in housing prices from the mid-1990s to the mid-2000s on psychological and cognitive outcomes among Americans born between 1924 and 1960. METHOD: Our quasi-experimental empirical strategy exploits geographic differences in housing market price trends during the housing boom (from the mid-1990s until 2006). We use individual-level data from the Health and Retirement Study (HRS) and estimates of housing values from DataQuick, a California-based real estate consultancy firm, to estimate the association of housing price increases with psychological and cognitive outcomes at follow-up. RESULTS: Greater housing appreciation over the follow-up period was associated with a significantly lower risk of anxiety (for women) and an improved performance on some but not all cognitive tasks. Effects for depressive symptoms, positive and negative affect, and life satisfaction were all in the beneficial direction but not statistically significant. The effects of price run-ups were concentrated on homeowners, as opposed to renters, suggestive of wealth-driven effects. DISCUSSION: Housing market volatility may influence the psychological and cognitive health of older adults, highlighting potential health consequences of pro-home ownership policies, which may be especially important in light of recent dramatic housing price declines.
Keywords: Demographics; Health Conditions and Status; Housing; Other

How Does Household Expenditure Change With Age for Older Americans? - Sudipto Banerjee (EBRI Notes, 2014)
Retirement saving involves a lot of unknowns, the most important being not knowing how much money will be needed in retirement. Although it is impossible to predict the retirement expenses of any particular household, the average amounts spent by current retirees can serve as important benchmarks for individual savers as well as for industry experts and policymakers. This paper examines the expenditure pattern of the older segment of the U.S. population. The majority of the households studied here have either reached retirement age or are on the cusp of retirement. The data come from the Health and Retirement Study (HRS) and the Consumption and Activities Mail Survey (CAMS), which is a supplement of the HRS. CAMS contains detailed spending information on 26 nondurable and six durable categories, and it follows the same group of people over time. Using this information coupled with the income information available in the HRS, this study summarizes the consumption behavior of the American elderly. The primary goal is to examine how overall spending and spending in different categories change with age. Home and home-related expenses is the largest spending category for every age group. Health expenses increase steadily with age. In 2011, households with at least one member between ages 50 and 64 spent 8 percent of their total budget on health items, compared with 19 percent for those age 85 or over. Health-related expenses occupy the second-largest share of total expenditure for those ages 75 or older. The two components of household expenditures that show a declining pattern across age groups are transportation expenses and entertainment expenses. Food and clothing expenses (as a share of total expenditure) remain more or less flat across the different age groups. There is a large increase in spending at the 95th percentile for those ages 90 or older, which can be attributed to very high health care expenses.
Keywords: Consumption and Savings; Health Conditions and Status; Healthcare; Net Worth and Assets; Retirement Planning and Satisfaction

How does personality contribute to retirement savings? - Chan, Wai (Purdue University, 2014)
The aim of this dissertation was to explore how personality factors explain retirement savings over time. Past studies did not systematically examine individual characteristics on financial preparation for retirement or did not adopt a monetary outcome to exemplify retirement investments. Thus, this dissertation modeled two outcomes for retirement savings, i.e., Individual Retirement Accounts (IRAs) ownership and IRA balances. Guided by the Investor Behavior Model and the Behavioral Economics Perspective, conscientiousness and personal mastery were hypothesized to bolster IRA investments, while agreeableness and perceived constraints were hypothesized to undermine IRA investments. Multilevel model techniques were applied to depict the trajectory of IRA investments with longitudinal data from the Health and Retirement Study (HRS 2006, 2008, 2010). Findings were partly consistent with hypotheses. The Individual Sample ( N = 4,117) documented that higher levels of conscientiousness and personal mastery predicted greater odds of IRA ownership. Perceived constraints were associated with lower odds of IRA ownership, while agreeableness was linked to lower IRA balances. Saving horizons and financial controls were found to partially mediate the relationship between personality factors and IRA investments. Based on the findings from the Individual Sample, a Spousal Sample ( N = 4,257) was developed to examine whether perceived spousal relationship qualities accounted for IRA investments above and beyond personality factors. In addition, perceived spousal relationship qualities were explored to mitigate or accentuate the effects of personality factors. Relationship strain was found to undermine IRA ownership while spousal support was associated with higher IRA balances. Interaction effects of spousal relationships were detected only for exploratory personality traits (i.e., openness and extraversion) for IRA ownership. Overall, findings provided empirical support for theoretical perspectives that include personality factors as impacting retirement preparations. Likewise, personality factors demonstrated differential effects on IRA outcomes. With regard to practical implications, this dissertation provides educators and policymakers with insights to improve the existing financial education and social welfare systems.
Keywords: Adult children; Health Conditions and Status; Methodology; Pensions; Public Policy; Retirement Planning and Satisfaction

How is economic hardship avoided by those retiring before the Social Security entitlement age? - Kevin Milligan (Journal of Pension Economics and Finance, 2014)
Governments around the world are reacting to extended lifespans and troubled pension finances by increasing the age of retirement benefit entitlement. This paper studies those who retire before the age of full pension entitlement in the USA using data drawn from the Health and Retirement Study. The major finding is that four out of five people who have zero earnings at pre-entitlement ages are able to find a way to lift their incomes over the poverty line. For men, pension and annuity income are important while for women, spousal income helps most to get them over the line.
Keywords: Health Conditions and Status; Income; Net Worth and Assets; Pensions; Retirement Planning and Satisfaction; Social Security

The Identification of Regions of Significance in the Effect of Multimorbidity on Depressive Symptoms Using Longitudinal Data: An Application of the Johnson-Neyman Technique - Rast, P.; Rush, J.; Andrea M Piccinin; Scott M Hofer (Gerontology, 2014)
Background: The investigation of multimorbidity and aging is complex and highly intertwined with aging-related changes in physical and cognitive capabilities, and mental health and is known to affect psychological distress and quality of life. Under these circumstances it is important to understand how the effects of chronic conditions evolve over time relative to aging-related and end-of-life changes. The identification of periods in time where multimorbidity impacts particular outcomes such as depressive symptoms, versus periods of time where this is not the case, reduces the complexity of the phenomenon. Objective: We present the Johnson-Neyman (J-N) technique in the context of a curvilinear longitudinal model with higher-order terms to probe moderators and to identify regions of statistical significance. In essence, the J-N technique allows one to identify conditions under which moderators impact an outcome from conditions where these effects are not significant. Methods: To illustrate the use of the J-N technique in a longitudinal sample, we used data from the Health and Retirement Study. Analyses were based on time-to-death models including participants who died within the study duration of 12 years. Results: Multimorbidity differentially affects rates of change in depression. For some periods in time the effects are statistically significant while in other periods the same effects are not statistically different from zero. Conclusion: The J-N technique is useful to continuously probe moderating effects and to identify particular interactions with the model for time when certain effects are or are not statistically significant. In the context of multimorbidity this method is particularly useful for interpreting the complex interactions with differential change over time. 2014 S. Karger AG, Basel.
Keywords: Health Conditions and Status; Methodology

The impact of a cancer diagnosis on weight change: findings from prospective, population-based cohorts in the UK and the US - Sarah E Jackson; Williams, Kate; Andrew Steptoe; Wardle, Jane (Bmc Cancer, 2014)
Background: Obesity is a risk factor for cancer incidence and survival, but data on patterns of weight change in cancer survivors are scarce and few stratify by pre-diagnosis weight status. In two population-based cohorts of older adults, we examined weight change in cancer survivors and cancer-free controls in relation to baseline weight status. Methods: In the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS), we identified participants diagnosed with cancer who had pre- and post-diagnosis BMI data (ELSA n = 264; HRS n = 2553), and cancer-free controls (ELSA n = 1538; HRS n = 4946). Repeated-measures ANOVAs tested three-way interactions by group (cancer/control), time (pre-/post-diagnosis), and pre-diagnosis weight status (normal-weight/overweight/obese). Results: Mean BMI change was -0.07 (SD = 2.22) in cancer survivors vs. 0.14 (SD = 1.11) in cancer-free controls in ELSA, and -0.20 (SD = 2.84) vs. 0.11 (SD = 0.93) respectively in HRS. Three-way interactions were significant in both cohorts (ELSA p = .015; HRS p .001). In ELSA, mean BMI change in normal-weight cancer survivors was 0.19 (SD = 1.53) compared with -0.33 (SD = 3.04) in obese survivors. In ELSA controls, the respective figures were 0.09 (SD = 0.81) and 0.16 (SD = 1.50). In HRS, mean change in normal-weight cancer survivors was 0.07 (SD = 2.30) compared with -0.72 (SD = 3.53) in obese survivors. In HRS controls, the respective figures were 0.003 (SD = 0.66) and 0.27 (SD = 1.27). Conclusion: Over a four-year period, in two cohorts of older adults, cancer survivors lost weight relative to cancer-free controls. However, cancer survivors who were obese pre-diagnosis were more likely to lose weight than healthy-weight survivors or obese adults without a cancer diagnosis. Whether this was due to differences in clinical status or deliberate lifestyle change triggered by the cancer diagnosis is not known. Further research is needed to establish why weight loss occurs more frequently in cancer survivors who were obese at diagnosis, and whether this has favourable effects on mortality.
Keywords: Health Conditions and Status

The impact of childhood SES on decline in cognition among older adults - Jiyoung Lyu (University of Massachusetts Boston, 2014)
Previous studies have demonstrated that late-life cognitive change is associated with socioeconomic status (SES) developed from childhood to adulthood. Although the association between childhood SES and late-life cognitive functioning has been demonstrated empirically, few studies examined the relationships between childhood SES and cognitive performance longitudinally. Therefore, the purpose of this study was to investigate the impact of childhood and adult SES on different cognitive domain (global cognition, memory, and mental status) changes. Using a nationally representative sample from the Health and Retirement Study (HRS), cognition change from 1998 to 2010 was examined using growth curve models. The results showed that childhood SES indicators were related to all cognitive functions, adult SES indicators were mediating the effects of childhood SES on cognitive functions, and cumulative SES indicator was related to cognitive functions. In terms of the rate of decline in cognitive functions, indicators of childhood SES were significantly related. In addition, both childhood and adult SES indicators were significantly related to between and within-person variation in cognitive functions. Gender and race differences in the relationship between childhood SES and cognitive functions were also affirmed. These findings suggest that childhood SES has long-term effects on cognitive status as well as for cognitive change in later life although some of the childhood effects are mediated by adult SES factors.
Keywords: Adult children; Demographics; Event History/Life Cycle; Health Conditions and Status

The Impact of Mid- and Late-Life Loss on Insomnia Findings From the Health and Retirement Study, 2010 Cohort - Simpson, Cherie; Joseph C. Allegra; Amara E. Ezeamama; Elkins, Jennifer; Toni Miles (Family and Community Health, 2014)
Bereavement and insomnia are both well-documented risk factors for illness. We use cohort data to estimate risk of insomnia after death of a family member among adults aged 50 to 70 years. Each day, 6700 persons die in the United States. During the next 20 years, this number will increase. In this cohort, any loss increases the likelihood of insomnia. The highest rates of insomnia occur among women aged 50 to 59 years; men aged 65 to 70 years, and persons reporting death of a spouse/partner or child. Physical activity reduces this risk by one-third. Bereavement is a public health issue requiring a targeted response.
Keywords: Adult children; Health Conditions and Status

Improving retirement security in the United States - Burns, Michael J. (Northeastern University, 2014)
The public media, surveys of workers and the general public have indicated increasing concern with retirement security in the face of lengthening life expectancies, the costs of retirement living, and anxieties over the reported insufficiency of retirement savings balances to fund a decent retirement. The major questions of this dissertation are, first, whether the major parts of the United States retirement income security system, namely Social Security and the private pension system, are currently providing sufficient retirement security for all retirees? And second, how could this national system be reformed, if necessary, to provide greater retirement income security? Because the problem of elderly security is an international one, the United States retirement income security system is compared to those of some of the other economically advanced countries of the OECD (Organization for Economic Cooperation and Development), and more particularly, France, Sweden and Japan. An assessment of the contrasting design elements and retirement income security outcomes is made. Recommendations for reform of the United States system are offered which are based on an appraisal of the peculiar strengths and weaknesses of the United States system as well as on any promising design elements of the other examined national systems that might be adaptable to the United States.
Keywords: Cross-National; Health Conditions and Status; Pensions; Public Policy; Retirement Planning and Satisfaction; Social Security

International sex and age differences in physical function and disability - Felicia V Wheaton (University of Southern California, 2014)
Worldwide population aging will undoubtedly be accompanied by an increase in the number of disabled older adults. Female gender and increased age are two of the most widely identified risk factors for poor physical functioning and disability. Yet the contexts in which people are aging vary markedly across countries. Countries differ greatly in their level of economic development, both past and present. Economic development is in turn related to improvements in infrastructure, health care, public health, education, etc. that are hypothesized to be related to improved physical function and less disability. Therefore, this dissertation examined whether sex and age differences/changes in both objectively-measured physical performance and reported difficulties with functional tasks and activities of daily living (ADLs) were similar or varied across seven countries whose per capita GNP ranged from $200 to $40,100 (United Sates, Taiwan, Korea, Mexico, China, Indonesia, and the Tsimane of Bolivia). It also sought to determine if sex differences and age differences varied systematically in terms of macro-level indicators including GDP, life expectancy, and measures of gender equality. Overall, sex differences were remarkably consistent across countries with very different contexts. Sex differences in physical performance and functional limitations were more pronounced than sex differences in difficulty with basic self-care tasks, but the magnitude of differences did not vary systematically in relation to country-level measures of development or gender equality. This may be because gender equality can be either protective or detrimental, depending on the domain. In terms of age differences, it was necessary to consider both the level of performance/prevalence of difficulty at younger ages as well as age differences, since poor performance/high levels of difficulty among the young-old indicate that "aging" has already occurred. Some populations did appear to be "aging" more rapidly, particularly those at the lowest end of the development spectrum, however, there was no clear evidence for a linear correlation between macro-level indicators of development and age differences. Interestingly, findings showed that functioning in some domains could be fairly well maintained despite declines in other domains, and these varied across countries. For example, Indonesians appeared to be "aging" more rapidly in terms of upper body strength, but showed relatively high levels of lower body function and less age-related decline. This may be due to differences across populations in patterns of work, physical activity, the built environment, etc.
Keywords: CHARLS; Cross-National; Demographics; Disabilities; Health Conditions and Status; IFLS; KLoSA; Methodology; MHAS

Internet use and mental health/well-being in old age: Exploring the roles of social integration and social support - Berkowsky, Ronald W. (The University of Alabama at Birmingham, 2014)
The escalating pressures put on the US healthcare system, due in part to the growing needs of the expanding older adult population, has motivated research dedicated to more fully understanding the mental health and mental well-being needs of this population and ways to address these needs and alleviate the pressure on the healthcare system. An increasing area of interest is in examining the role information and communication technologies (ICTs), such as Internet-connected computers and smartphones, in the health of older adults. Research has shown that ICTs can successfully be used to help treat, manage, and cope with mental health/well-being issues, but previous literature also finds that ICTs can contribute to mental health/well-being outcomes more directly. While studies have shown that ICTs may benefit older adults with regards to mental health/well-being, less is known through what mechanisms this relationship is enacted. This study uses data from the Health and Retirement Study to compare Internet-using older adults (aged 65+) with non-users on depression, life satisfaction, loneliness, personal growth, and purpose in life. Specific attention is given to examining the potential mediating roles of social integration (i.e., quantity of social ties) and social support (i.e., quality of social ties), as a Durkheimian perspective of Internet use argues that Internet use can be both beneficial and detrimental to an individual's social life, and changes in social life through Internet use can in turn affect mental health/well-being. Results of cross-sectional and longitudinal analyses finds Internet users, compared to non-users, typically enjoy more favorable mental health/well-being outcomes. Measures of social integration and social support are found to mediate the relationship between Internet use and mental health/well-being, but only partially. Additional analyses find that demographic characteristics, such as income and functional limitations, moderate the relationship between Internet use and mental health/well-being in older adults. The findings suggest that ICT interventions that incorporate elements that help older adults maintain social contacts and develop new ones may lessen mental health/well-being issues and the burdens associated with them.
Keywords: Adult children; Health Conditions and Status; Other; Retirement Planning and Satisfaction

Involuntary Retirement, U.S. Social Security Program Participation and the Great Recession - Seligman, Jason S. (Public Finance and Management, 2014)
Involuntary retirement covers economic and health related dislocations. Over 1992-2011, three-in-ten retirees in the Health and Retirement Study (HRS) report an involuntary retirement. Roughly half of these involuntary retirements are health-related. Following the Great Recession, involuntary retirement in the U.S. grew much faster than voluntary retirement. I find that while the population receiving Social Security retirement benefits grew 6 slower than average, the population receiving no public retirement or disability benefits grew 79 faster than average and the population reporting health-related involuntary retirement grew 270 faster than average. While incomes are found to have fallen for all retiree groups, those reporting health-related involuntary retirements are found to have retirement income declines of 38 and the lowest pre-retirement incomes of any measured group. These findings suggest patterns of vulnerability that have important implications for proposals seeking to reform the U.S. Social Security Program.
Keywords: Disabilities; Employment and Labor Force; Health Conditions and Status; Public Policy; Retirement Planning and Satisfaction; Social Security; Women and Minorities

Item response theory for measurement validity - Frances Margaret Yang; Solon T. Kao (Shanghai Archives of Psychiatry, 2014)
Summary: Item response theory (IRT) is an important method of assessing the validity of measurement scales that is underutilized in the field of psychiatry. IRT describes the relationship between a latent trait (e.g., the construct that the scale proposes to assess), the properties of the items in the scale, and respondents' answers to the individual items. This paper introduces the basic premise, assumptions, and methods of IRT. To help explain these concepts we generate a hypothetical scale using three items from a modified, binary (yes/no) response version of the Center for Epidemiological Studies-Depression scale that was administered to 19, 399 respondents. We first conducted a factor analysis to confirm the unidimensionality of the three items and then proceeded with Mplus software to construct the 2-Parameter Logic (2-PL) IRT model of the data, a method which allows for estimates of both item discrimination and item difficulty. The utility of this information both for clinical purposes and for scale construction purposes is discussed. Copyright 2014 by Editorial Department of the Shanghai Archives of Psychiatry.
Keywords: Health Conditions and Status; Methodology

Lee and Schwarz Respond to Kawada, Question Context, Ethnic Difference, and Self-Rated Health - Lee, Sunghee; Schwarz, Norbert (American Journal of Public Health, 2014)
We agree with Kawada that the ideal data set for our study would include a confounder-free experiment that asks the self-rated health (SRH) question in different contexts (or order) and follows study subjects over time to assess subsequent morbidity and mortality. This data set does not exist. As an approximation with minimal methodological non-comparability, we used the National Health Interview Survey linked with the National Death Index and the Health and Retirement Study (HRS) to examine SRH context effects on health outcome predictions.
Keywords: Health Conditions and Status; Healthcare

Lifetime Job Demands, Work Capacity at Older Ages, and Social Security Benefit Claiming Decisions - Lauren Hersch Nicholas (Boston, Center for Retirement Research at Boston College, 2014)
We use Health and Retirement Study data linked to the Department of Labor s O Net classification system to examine the relationship between lifetime exposure to occupational demands and retirement behavior. We consistently found that both non-routine cognitive analytic and non-routine physical demands were associated with worse health, earlier labor force exit, and increased use of Social Security Disability Insurance. The growing share of workers in jobs with high levels of cognitive demand may contribute to growth in DI use.
Keywords: Employment and Labor Force; Health Conditions and Status; Retirement Planning and Satisfaction; Social Security

The Lifetime Risk of Nursing Home Use - Michael D Hurd; Pierre-Carl Michaud; Susann Rohwedder (Discoveries in the Economics of Aging, 2014)
This paper estimates the lifetime risk and distribution of stays in nursing homes using 10 waves of data from the Health and Retirement Study covering the population over the age of 50. Using both non-parametric and parametric approaches which account for censoring, we estimate that a 50 year old has a 53 to 59 chance of ever entering a nursing home before he dies and that, conditional on any stay, the average duration is just over a year. We show that stays at the end of life which are typically not captured in core interviews are very important for assessing lifetime exposure. The HRS performs exit interviews with proxies for those who died. Excluding exit interviews yields lifetime risk under 40 . Being female, white and a non-smoker are associated with higher lifetime risk due to lower (competing) mortality risk and higher nursing home risk at older ages.
Keywords: Health Conditions and Status; Healthcare

A longitudinal analysis of body mass and morbidity: evidence from the health and retirement study - Boydstun, Jamie (Mississippi State University, 2014)
This dissertation aimed to investigate the direct and indirect pathways between body mass and three indicators of morbidity - health conditions, disability, and self-rated health status - and how these associations differed across birth cohorts. Using data from the Health and Retirement Study, a nationally representative longitudinal sample of adults age 51 or older, I used latent growth curve modeling to investigate the association of body mass on morbidity for five cohorts. Latent growth curve models allow for changes in body mass, health conditions, disability, and self-rated health over several waves of data to be assessed. To determine if the influence of education on health has declined, I also stratified each cohort by educational attainment groups. The results show that starting body mass is positively associated with starting health conditions; no other pathway examined was significant for all cohorts. In the three youngest cohorts, higher starting body mass was associated with worse self-rated health. Changes in body mass over time were not significantly associated with changes in self-rated health over time for the two youngest cohorts, perhaps indicating that adults at older ages do not perceive higher body mass as detrimental to overall well-being. Education was a significant predictor of body mass and self-rated health for all cohorts. When cohorts were stratified based on educational attainment, adults with at least some college had fewer health conditions than their less educated peers in all cohorts except the youngest cohort. The relationship between the rate of change in body mass and the rate of change in health conditions was not significant for the most educated group in the youngest cohort. However, higher starting body mass resulted in worse self-rated health regardless of cohort or education. Despite inconsistent findings, the results potentially support an expansion of morbidity because the onset of illness does seem to be occurring at younger ages. The effect of education on body mass and health was mostly consistent across cohorts. Stratifying the data by educational attainment suggests that the youngest and best educated cohort has not benefited from the increased level of education relative to the older cohorts in the study.
Keywords: Disabilities; Health Conditions and Status; Methodology; Public Policy

Longitudinal Associations of Subjective Memory With Memory Performance and Depressive Symptoms: Between-Person and Within-Person Perspectives - Hueluer, Gizem; Hertzog, Christopher; Ann M. Pearman; Ram, Nilam; Denis Gerstorf (Psychology and Aging, 2014)
Clinical diagnostic criteria for memory loss in adults typically assume that subjective memory ratings accurately reflect compromised memory functioning. Research has documented small positive between-person associations between subjective memory and memory performance in older adults. Less is known, however, about whether within-person fluctuations in subjective memory covary with within-person variance in memory performance and depressive symptoms. The present study applied multilevel models of change to 9 waves of data from 27,395 participants of the Health and Retirement Study (HRS; mean age at baseline = 63.78; SD = 10.30; 58 women) to examine whether subjective memory is associated with both between-person differences and within-person variability in memory performance and depressive symptoms and explored the moderating role of known correlates (age, gender, education, and functional limitations). Results revealed that across persons, level of subjective memory indeed covaried with level of memory performance and depressive symptoms, with small-to-moderate between-person standardized effect sizes (0.19 for memory performance and -0.21 for depressive symptoms). Within individuals, occasions when participants scored higher than usual on a test of episodic memory or reported fewer-than-average depressive symptoms generated above-average subjective memory. At the within-person level, subjective memory ratings became more sensitive to within-person alterations in memory performance over time and those suffering from functional limitations were more sensitive to within-person alterations in memory performance and depressive symptoms. We take our results to suggest that within-person changes in subjective memory in part reflect monitoring flux in one's own memory functioning, but are also influenced by flux in depressive symptoms.
Keywords: Expectations; Health Conditions and Status; Methodology

The Long-Term Effect of Health Insurance on Near-Elderly Health and Mortality - Black, Bernard; José-Antonio Espín-Sánchez; Eric French; Litvak, Kate (Evanston, IL, Northwestern University Law Schoo, 2014)
We use the best available longitudinal dataset, the Health and Retirement Survey, and a battery of causal inference methods to provide both central estimates and bounds on the effect of health insurance on health and mortality among the near elderly (initial age 50-61) over an 18-year period. Those uninsured in 1992 consume fewer healthcare services, but are not less healthy and, in our central estimates, do not die sooner than their insured counterparts. We discuss why a zero average effect of uninsurance on mortality and health is plausible, some selection effects that might explain our full results, and methodological concerns with prior studies.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance; Methodology

Long-term exposure to income inequality: implications for physical functioning at older ages - de Vries, Robert; Blane, David; Netuveli, Gopalakrishnan (European Journal of Ageing, 2014)
The 'inequality hypothesis' proposes that higher levels of societal income inequality have a direct negative causal effect on health. Support for this hypothesis has been mixed; particularly among older people. However, most previous studies have not accounted for people's exposure to inequality over the long-term. We aimed to address this problem by examining the implications of long-term inequality exposure for older people's physical health. Data on individual health and covariates were drawn from three large, comparable surveys of older people, covering 16 countries: the English Longitudinal Study of Ageing, the Survey of Health and Retirement in Europe and the U.S. Health and Retirement Study. Historical inequality information was derived from the Standardised World Income Inequality Database. We used multilevel regression methods to model the association between long-term average inequality and three measures of physical functioning: grip strength, lung function and self-reported activity limitation. Exposure to higher average long-term levels of inequality was significantly negatively related to objectively measured grip strength and lung function, but unrelated to self-reported limitations (although increasing inequality over time was positively related to self-reported limitations). The grip strength and lung function associations were partially explained by between-country differences in height, and in the latter case this factor may fully account for the apparent effect of inequality. We discuss implications of these results for the inequality hypothesis.
Keywords: Health Conditions and Status; Income; Methodology; Other

Marital quality and diabetes: Results from the Health and Retirement Study - Mark A Whisman; Li, Angela; Sbarra, David A.; Raison, Charles L. (Health Psychology, 2014)
Objective: Poor marital quality is associated with many different indicators of poor health, including immunologic and metabolic responses that have relevance for distal disease outcomes such as diabetes. We conducted this study to evaluate whether poor marital quality was associated with the prevalence of diabetes in a population-based sample of Americans over the age of 50. Method: Participants were married adults from the 2006 (N = 3,898) and 2008 (N = 3,452) waves of the Health and Retirement Study. Participants completed an interview and a self-report questionnaire, and current use of diabetes medication and glycosylated hemoglobin obtained from blood spot samples were used to index diabetes status. Marital quality was assessed with items regarding perceived frequency of positive and negative exchanges with partner. Results: Decreasing frequency of positive exchanges and increasing frequency of negative exchanges with one s spouse were associated with higher prevalence of diabetes among men, but not women at both waves; gender significantly moderated the associations between partner exchanges and diabetes status for the 2006 data. The association between frequency of partner exchanges and diabetes status generally remained significant in men after accounting for demographic characteristics and other risk factors (obesity, hypertension, low physical activity). Conclusion: Poor marital quality as operationalized by rates of positive and negative partner exchanges was associated with increased prevalence of diabetes in men. These results are consistent with prior work on marriage and health, and suggest that poor marital quality may be a unique risk factor for diabetes.
Keywords: Adult children; Demographics; Health Conditions and Status

The Material Convoy After Age 50 - David J Ekerdt; Lindsey A Baker (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2014)
Objectives. Possessions constitute a dynamic material convoy that accumulates across adulthood to furnish role enactments and the development of the self. Following a familiar life course arc, older people should hypothetically release the possessions that equipped the daily lives that they no longer have.Method. We use new survey data on possession divestment from the 2010 Health and Retirement Study to assess activity on behalf of the material convoy after age 50.Results. After age 50, people are progressively less likely to divest themselves of belongings. After age 70, about 30 of persons say that they have done nothing in the past year to clean out, give away, or donate things, and over 80 have sold nothing. We tested whether divestments diminish with age because they do not seem necessary or because of health limitations, but the age pattern is robust, suggesting retention of the material convoy in later life.Discussion. Further research on this age pattern might consider housing, the construction of the self, and social networks as explanations for retention. Inertia toward the material convoy maintains the availability and comfort of things, but it may also lead to a predicament wherein the collection becomes a worry for self and others.
Keywords: Consumption and Savings; Event History/Life Cycle; Health Conditions and Status; Housing; Other

Mechanisms of Health Disparities in Inflammation: A Test of the Differential Stress Exposure and Differential Stress Vulnerability Hypotheses - Uchechi A Mitchell (University of California, Los Angeles, 2014)
The current study sheds light on the mechanisms through which group differences in exposure to and the impact of discrimination generate disparities in cardiovascular diseases. The study specifically looks at its effects on C-reactive protein (i.e., CRP), a protein produced in response to exposure to stressors. It is a marker of systemic inflammation that is positively associated with cardiovascular diseases such as stroke, atherosclerosis, and myocardial infarction. The current study goes beyond a basic description of the population-level distribution of CRP by focusing on psychosocial factors that mediate and/or moderate these relationships. The specific aims of the dissertation are to investigate: (1) racial/ethnic and gender differences in CRP levels; (2) differential exposure to discrimination as an explanation for the social patterning of CRP; (3) differential vulnerability to discrimination; and (4) the extent to which coping resources dampens these effects. The dissertation uses data from the Health and Retirement Study (HRS), a multi-cohort longitudinal survey of a large and nationally representative sample of adults age 51 years and older. The HRS aims to identify and better understand the social, economic, psychosocial, and physical factors that influence and result from retirement. Since its inception in 1992, data have been collected every two years on the original HRS cohort and on subsequent cohorts added to the study. The "core" HRS interview is conducted face-to-face at baseline and collects data on demographic characteristics; housing and family structure; employment, income, assets, and insurance; health care, health status, cognition, and disability; and life expectations. Beginning in 2004, HRS respondents were asked to complete a psychosocial questionnaire that included measures of everyday and lifetime discrimination, among other factors, and in 2006 biomarkers--including CRP--were collected from one half of the study sample; biomarkers were collected from the other half in 2008. To maintain sufficient statistical power to detect differences in CRP, multivariate analyses are conducted with data from a hybrid 2006/2008 sample. The analysis involves statistical methods needed to appropriately adjust for the complex sampling design of HRS and to test the intricate causal pathways leading to race differences in CRP. In line with our hypotheses, African Americans have higher levels of CRP than non-Hispanic whites and reported greater exposure to everyday and lifetime discrimination. Hispanics do not significantly differ from non-Hispanic whites in CRP levels or in their reports or everyday and lifetime discrimination. In unadjusted models, everyday and major lifetime discrimination are positively associated with CRP. This association remains for lifetime discrimination in fully adjusted models but not for everyday discrimination. Both everyday and lifetime discrimination mediate racial/ethnic and gender differences in inflammation. Lifetime discrimination mediates these differences in and of itself, and in conjunction with other factors, particularly waist circumference. Everyday discrimination also mediates group differences in inflammation in conjunction with waist circumference. Vulnerability to discrimination does not differ by race/ethnicity or by gender, and the coping resources evaluated in this study do not buffer the effects of discrimination on inflammation. This study supports the presence of racial differences in CRP--an indicator of systemic inflammation and a clinical risk factor for cardiovascular diseases--on a population-level. The findings also suggest that exposure to discrimination, a chronic stressor that disproportionately affects racial minorities, is associated with higher levels of CRP and partially explains racial and gender differences in inflammation. In all, these findings provides further support for the significant contributions of the social environment on health and health disparities. (Abstract shortened by UMI.)
Keywords: Demographics; Employment and Labor Force; Health Conditions and Status; Healthcare; Public Policy

Medicare spending, managed care and pre-Medicare insurance coverage and associated risks of mortality, deterioration of self-rated health and mental health after four years of Medicare coverage - Yi-Sheng Chao (Journal of Hospital Administration, 2014)
National spending on Medicare keeps growing and managed care is reimbursed differently in the United States. Health returns from Medicare spending are not certain. This study aims to quantify the effects of Medicare spending in the first two years of Medicare coverage, managed care and insurance coverage before Medicare (pre-Medicare) on mortality, mental health and self-rated health status after first four years of Medicare coverage. Individuals, who were interviewed from age 65 to 68 years, without Medicare coverage before age 65 years, were included. Health spending (out-of-pocket, OOP) in the first two years of Medicare coverage, their pre-Medicare characteristics and Medicare managed care were used to predict associated risks of mortality, self-rated health status and mental health (Center for Epidemiologic Studies-Depression, CESD scale). Eligible Medicare enrollees (N = 3,503) in the Health and Retirement Study from 1992 to 2011 were chosen. Total health spending was associated with higher likelihood of worse mental health and self-rated health, but OOP spending was associated with risks of health deterioration (p .05 for all). More OOP health spending in the first two years of Medicare coverage was associated with slightly higher chance of more mental problems, but the magnitude of this association became smaller over time. Medicare managed care did not seem to be beneficial for mortality, mental health or self-rated health status. Expanding pre-Medicare health coverage (through the Affordable Care Act) may not influence health status after first four years of Medicare coverage. Preventing pre-Medicare health conditions may be the priority.
Keywords: Health Conditions and Status; Healthcare; Medicare/Medicaid/Health Insurance

Midlife trends in activities and disability - Verbrugge, Lois M.; Xian Li (Journal of Aging and Health, 2014)
Objectives: This is the first analysis that demonstrates empirically the likely tie between activities (time spent) and disability (health-related difficulty in activities). We compare trends in activities and disability for Americans ages 55 to 69 in recent years, and assess cross-sectional linkages of activities and disability. Methods: Data are from the Health and Retirement Study, a longitudinal survey of community-dwelling U.S. adults. Trends are estimated by mixed-effects regression models (MRMs) with time, age, and time-age interaction predictors. Links of activities and disability also use MRM. Results: For midlife adults, hobbies/leisure and sports/exercise increased, repairs/yard decreased, and several activities had convex patterns; by contrast, disability prevalence was stable. Personal care hours rise with disability, but most activities decline. Discussion: Activities are more dynamic than disability, and time use is associated with disability. Taken together, the results encourage broader activities in disability measures to capture better disability's scope and dynamics.
Keywords: Demographics; Disabilities; Event History/Life Cycle; Health Conditions and Status; Methodology; Other

A Multilevel Dyadic Study of the Impact of Retirement on Self-Rated Health: Does Retirement Predict Worse Health in Married Couples? - Angela L Curl; Aloen L. Townsend (Research on Aging, 2014)
Objectives: This study examined the effects of retirement on self-rated health for married couples, using interdependence and social stratification theoretical frameworks. Method: Dyadic multilevel modeling of data (N = 2,213 non- Hispanic couples) from 1992 to 2010 of the Health and Retirement Survey. Results: Retirement was associated with worse self-ratings of health (SRH) short term (ST) for both husbands and wives during the first couple of years of retirement. In addition, the longer the husbands (but not wives) were retired, the worse was their SRH. Cross-spouse effects varied by gender: When wives retired, their husbands SRH improved ST, but when husbands retired their wives SRH improved long term. Spouse education moderated the relationship between years since spouses retirement and SRH for wives. Discussion: Practitioners can use this information to help married couples through retirement planning and transitions. Results suggest that models of retirement in couples should pay greater attention to gender and other social stratification factors, spousal interdependence, and length of time since retirement.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare; Methodology; Retirement Planning and Satisfaction

Negative Social Interactions and Incident Hypertension Among Older Adults - Rodlescia S. Sneed; Cohen, Sheldon (Health Psychology, 2014)
Objective: To determine if negative social interactions are prospectively associated with hypertension among older adults. Method: This is a secondary analysis of data from the 2006 and 2010 waves of the Health and Retirement Study, a survey of community-dwelling older adults (age 50 years). Total average negative social interactions were assessed at baseline by averaging the frequency of negative interactions across 4 domains (partner, children, other family, friends). Blood pressure was measured at both waves. Individuals were considered to have hypertension if they reported use of antihypertensive medications, had measured average resting systolic blood pressure of 140 mmHg or higher, or measured average resting diastolic blood pressure of 90 mmHg or higher. Analyses excluded those who were hypertensive at baseline and controlled for demographics, personality, positive social interactions, and baseline health. Results: Twenty-nine percent of participants developed hypertension over the 4-year follow-up. Each 1-unit increase in the total average negative social interaction score was associated with a 38 increased odds of developing hypertension. Sex moderated the association between total average negative social interactions and hypertension, with effects observed among women but not men. The association of total average negative interactions and hypertension in women was attributable primarily to interactions with friends, but also to negative interactions with family and partners. Age also moderated the association between total average negative social interactions and hypertension, with effects observed among those ages 51-64 years, but not those ages 65 or older. Conclusion: In this sample of older adults, negative social interactions were associated with increased hypertension risk in women and the youngest older adults.
Keywords: Demographics; Health Conditions and Status

Older Adults Receipt of Financial Help: Does Personality Matter? - Gillen, Martie; Hyungsoo Kim (Journal of Family and Economic Issues, 2014)
This study examined the role of personality traits in the receipt of financial help at older ages using the 2006 and 2008 waves of Health and Retirement Study data. An investigation of (1) how the five domains of personality traits (openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism) are associated with the receipt of financial help among older adults and (2) the relationship between personality traits and the source of financial help received was examined. Three sets of probit analyses were conducted. The results indicated that personality can predict financial help and the source of financial help. Specifically, older adults who exhibited relatively higher levels of neuroticism and agreeableness were more likely to receive financial help, whereas those who exhibited relatively higher levels of conscientiousness were less likely to receive financial help regardless of the source. Furthermore, older adults who had relatively higher levels of neuroticism were more likely to help themselves with individual sources such as credit cards whereas agreeable older adults were more likely to receive financial help from family members. These findings have implications for financial counseling, planning and education professionals, public assistance program directors, and policy makers. Understanding the effect of personality on financial decision-making can help with financial planning throughout life and inform outreach efforts for those in need of financial help.
Keywords: Health Conditions and Status; Net Worth and Assets

Patterns of Widowhood Mortality - Allison R Sullivan; Andrew Fenelon (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2014)
Objectives. Becoming widowed is a known risk factor for mortality. This article examines the magnitude of, explanations for, and variation in the association between widowhood and mortality. Previous research on widowhood mortality has revealed variation by socioeconomic status (SES), in that SES is not protective in widowhood, and by gender, such that men s mortality increases more than women s mortality after the death of spouse.Method. Using data from the Health and Retirement Study, we estimated Cox proportional hazard models to estimate the association between widowhood and mortality.Results. Becoming widowed is associated with a 48 increase in risk of mortality. Approximately one third of the increase can be attributed to selection, in that those who become widows are socioeconomically disadvantaged. In contrast to previous studies, SES is protective for widows. Widowhood mortality risk increases for men if their wives deaths were unexpected rather than expected; for women, the extent to which their husbands death was expected matters less.Discussion. Widowhood s harmful association with mortality show how strongly social support and individual s health and mortality are related. These findings support the larger literature on the importance of social support for health and longevity.
Keywords: Adult children; Health Conditions and Status; Methodology; Net Worth and Assets

Perceived control relates to better functional health and lower cardio-metabolic risk: The mediating role of physical activity - Frank J Infurna; Denis Gerstorf (Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 2014)
Objective: The objective of the current study was to examine empirically associations between perceived control and indicators of functional health (grip strength) and cardio-metabolic risk (hemoglobin A1C, High Density Lipoprotein Cholesterol HDL-C , Systolic Blood Pressure SBP , Pulse Rate PR , and Waist Circumference WC ) and to explore the mediating role of physical activity. Method: Using cross-sectional data from the nation-wide Health and Retirement Study (N = 4,292; Mean age = 68, range 50-97; 59 women), we examined whether perceived control was predictive of the various health indicators over and above sociodemographic characteristics. We also used mediation models to test whether those direct associations were mediated by physical activity. Results: Findings indicated that perceiving more control related to better grip strength and lower cardio-metabolic risk. To illustrate, a 1 SD increase in control is associated with 2.5 fewer years of aging on grip strength, 10 fewer years of aging for hemoglobin A1C, 14.5 fewer years of aging for HDL-C, 3.7 fewer years of aging for pulse rate, and 5.75 fewer years of aging for waist circumference. We also found that physical activity mediated five of the six control-health associations. Conclusions: Our findings demonstrate the importance of perceived control as predictor of functional and physiological health and the role of physical exercise as a behavioral mediator of these associations. Our results suggest that control may serve as a facilitator of positive health outcomes, including functional health, cardio-metabolic risk, and physical activity. Findings provide impetus for future research to elucidate mechanisms underlying the health implications of perceived control. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Keywords: Health Conditions and Status; Retirement Planning and Satisfaction; Risk Taking

Perceived Sex Discrimination Amplifies the Effect of Antagonism on Cigarette Smoking - Angelina R Sutin; English, Devin; Michele K Evans; Alan B Zonderman (Nicotine and Tobacco Research, 2014)
Introduction: Compared to men, the decline in smoking over the past few decades has been slower for women and smoking-related morbidity and mortality has increased substantially. Identifying sex-specific risk factors will inform more targeted intervention/prevention efforts. The purpose of this research is to examine the interactive effect of psychological (trait antagonism) and social (perceived sex discrimination) factors on current cigarette smoking and whether these effects differ by sex. Methods: Participants in the Healthy Aging in Neighborhoods of Diversity across the Life Span study (HANDLS; N = 454) and participants in the Health and Retirement Study (HRS; N = 8,155) completed measures of antagonism, perceived sex discrimination, and reported whether they smoked currently. Logistic regressions were used to predict smoking from antagonism, discrimination, and their interaction. Results: Antagonism was associated with an increased risk of smoking. For women, there was an interaction between antagonism and discrimination: among women who perceived sex discrimination, every standard deviation increase in antagonism was associated with a 2.5 increased risk of current smoking in HANDLS (odds ratio OR = 2.54, 95 CI = 1.46 4.39) and an almost 1.5 increased risk in HRS (OR = 1.43, 95 CI = 1.18 1.73). This interaction was not significant for men in either sample. Conclusion: In 2 independent samples, perceived sex discrimination amplified the effect of antagonism on cigarette smoking for women, but not men. A hostile disposition and a perceived hostile social environment have a synergistic effect on current cigarette smoking for women.
Keywords: Health Conditions and Status; Risk Taking; Women and Minorities

Perceived weight discrimination and C-reactive protein - Angelina R Sutin; Yannick Stephan; Martina Luchetti; Antonio Terracciano (Obesity, 2014)
Objective: Perceived weight discrimination has been linked to health outcomes, including risk of obesity. Less is known about how discrimination is associated with intermediate physiological markers of health, such as systemic inflammation. This research examined the association between weight discrimination and C-reactive protein (CRP) and whether it varied by participants' body mass index (BMI). Methods: Cross-sectional design using data from the Health and Retirement Study. Among participants who were overweight or obese (N=7,394), regression analysis was used to test for an association between weight discrimination and CRP and whether this association was moderated by BMI. Similar associations among seven other attributions for discrimination were tested. Results: The association between weight discrimination and CRP varied as a function of BMI: At BMI between the thresholds for overweight and obesity (BMI 25-30), weight discrimination was associated with higher circulating levels of CRP; there was no association between weight discrimination and CRP as BMI approached Class 3 obesity (BMI 40). A similar pattern emerged for discrimination based on a physical disability, but not for the other attributions for discrimination (e.g., race, age). Conclusions: Weight discrimination is associated with higher circulating CRP, an association that is moderated by BMI. .
Keywords: Health Conditions and Status; Methodology

Personality and long-term reproductive success measured by the number of grandchildren - Berg, Venla; Lummaa, Virpi; Lahdenper , Mirkka; Rotkirch, Anna; Markus Jokela (Evolution and Human Behavior, 2014)
Personality, that is, individual behavioral tendencies that are relatively stable across situations and time, has been associated with number of offspring in many animals, including humans, suggesting that some personality traits may be under natural selection. However, there are no data on whether these associations between personality and reproductive success extend over more than one generation to numbers of grandchildren. Using a large representative sample of contemporary Americans from the Health and Retirement Study (n = 10,688; mean age 67.7 years), we studied whether personality traits of the Five Factor Model were similarly associated with number of children and grandchildren, or whether antagonistic effects of personality on offspring number and quality lead to specific personality traits differently maximizing short and long-term fitness measures. Higher extraversion, lower conscientiousness, and lower openness to experience were similarly associated with both higher number of children and grandchildren in both sexes. In addition, higher agreeableness was associated with higher number of grand-offspring only. Our results did not indicate any quality-quantity trade-offs in the associations between personality and reproductive success. These findings represent the first robust evidence for any species that personality may affect reproductive success over several generations.
Keywords: Adult children; Health Conditions and Status; Other

Is personality associated with cancer incidence and mortality? An individual-participant meta-analysis of 2156 incident cancer cases among 42843 men and women - Markus Jokela; G David Batty; Hintsa, T.; Marko Elovainio; Hakulinen, C.; Mika Kivimäki (British journal of cancer, 2014)
Background:The putative role of personality in cancer risk has been controversial, and the evidence remains inconclusive.Methods:We pooled data from six prospective cohort studies (British Household Panel Survey; Health and Retirement Study; Household, Income, and Labour Dynamics in Australia; Midlife in the United Survey; Wisconsin Longitudinal Study Graduate; and Sibling samples) for an individual-participant meta-analysis to examine whether personality traits of the Five Factor Model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) were associated with the incidence of cancer and cancer mortality in 42843 cancer-free men and women at baseline (mean age 52.2 years, 55.6 women).Results:During an average follow-up of 5.4 years, there were 2156 incident cancer cases. In random-effects meta-analysis adjusted for age, sex, and race/ethnicity, none of the personality traits were associated with the incidence of all cancers or any of the six site-specific cancers included in the analysis (lung, colon, breast, prostate, skin, and leukaemia/lymphoma). In the three cohorts with cause-specific mortality data (421 cancer deaths among 21835 participants), none of the personality traits were associated with cancer mortality.Conclusions:These data suggest that personality is not associated with increased risk of incident cancer or cancer-related mortality.
Keywords: Health Conditions and Status

Personality change associated with chronic diseases: pooled analysis of four prospective cohort studies - Markus Jokela; Hakulinen, C.; Archana Singh-Manoux; Mika Kivimäki (Psychological Medicine, 2014)
Background: Common chronic conditions, such as heart disease and cancer, are associated with increased psychological distress, functional limitations and shortened life expectancy, but whether these diseases alter aspects of personality remains unclear. Method: To examine whether the onset of heart disease, stroke, diabetes, cancer, hypertension, arthritis and respiratory disease is associated with subsequent changes in personality traits of the five-factor model, we pooled data from the Health and Retirement Study, the Midlife in the United States Survey, and the graduate and sibling samples of the Wisconsin Longitudinal Study for an individual-participant meta-analysis (total n = 17 493; mean age at baseline 55.8 years). Results: After adjustment for age, we observed consistent decreases in extraversion -0.25 T-scores per one disease; 95 confidence interval (CI) -0.40 to -0.10 , emotional stability (-0.40, 95 CI -0.61 to -0.19), conscientiousness (-0.44, 95 CI -0.57 to -0.30) and openness to experience (-0.25, 95 CI -0.37 to -0.13) but not in agreeableness (-0.05, 95 CI -0.19 to 0.08) after the onset of chronic diseases. The onset of each additional chronic disease accelerated the average age-related personality change by 2.5 years in decreasing extraversion, 5.5 years in decreasing conscientiousness, and 1.6 years in decreasing openness to experience, and attenuated the increasing levels of emotional stability by 1.9 years. Co-morbid conditions were associated with larger changes than single diseases, suggesting a dose-response association between morbidity and personality change. Conclusions: These results support the hypothesis that chronic diseases influence personality development in adulthood. Copyright Cambridge University Press 2014.
Keywords: Health Conditions and Status; Methodology

Personality measures in the national social life, health, and aging project - Iveniuk, James; Laumann, Edward O.; Linda J. Waite; McClintock, Martha K.; Andrew D. Tiedt (The journals of gerontology. Series B, Psychological sciences and social sciences, 2014)
OBJECTIVES: Provide recommendations for researchers on the use of the Big Five personality battery in the National Social Life, Health, and Aging Project (NSHAP), and ensure that the battery does proxy the Big Five. Also, describe the levels of Big Five traits across gender and age. METHOD: We used an Exploratory Structural Equation Model (ESEM) to analyze NHSAP's personality battery, comparing NSHAP with the National Longitudinal Study of Midlife in the United States (MIDUS) and the Health and Retirement Study (HRS). RESULTS: ESEM revealed a 5-factor structure in the NSHAP battery, but with considerable cross-loadings. When these cross-loadings were not included in the model, model fit notably worsened. Reliabilities of Big Five scales were comparable to the HRS and MIDUS, even though NSHAP's battery is shorter. Women were considerably more Agreeable than men, although this gender gap closed among the oldest in the sample (80 years or older). DISCUSSION: Researchers will be able to make use of NSHAP's personality battery to examine a range of social, biological, and psychological factors at older ages, in light of individuals' general traits. We recommend models which allow for cross-loadings.
Keywords: Health Conditions and Status; Methodology

Personality traits as risk factors for stroke and coronary heart disease mortality: pooled analysis of three cohort studies - Markus Jokela; Pulkki-Raback, Laura; Marko Elovainio; Mika Kivimäki (Journal of Behavioral Medicine, 2014)
We examined whether personality traits are differently associated with coronary heart disease and stroke mortality. Participants were pooled from three prospective cohort studies (Health and Retirement Study, Wisconsin Longitudinal Study graduate and sibling samples; n = 24,543 men and women, mean age 61.4 years, mortality follow-up between 3 and 15 years). There were 423 coronary heart disease deaths and 88 stroke deaths during 212,542 person-years at risk. Higher extraversion was associated with an increased risk of stroke (hazard ratio per each standard deviation increase in personality trait HR = 1.41, 95 CI 1.10 1.80) but not with coronary heart disease mortality (HR = 0.93, 0.83 1.05). High neuroticism, in turn, was more strongly related to the risk of coronary heart disease (HR = 1.16, 1.04 1.29) than stroke deaths (HR = 0.95, 0.78 1.17). High conscientiousness was associated with lower mortality risk from both coronary heart disease (HR = 0.74, 0.67 0.81) and stroke (HR = 0.78, 0.63 0.97). Cardiovascular risk associated with personality traits appears to vary between main cardiac and cerebral disease endpoints.
Keywords: Health Conditions and Status; Methodology

Personality Traits Predict the Onset of Disease - Sara J Weston; Patrick L Hill; Joshua J Jackson (Social Psychological and Personality Science, 2014)
While personality traits have been linked concurrently to health status and prospectively to outcomes such as mortality, it is currently unknown whether traits predict the diagnosis of a number of specific diseases (e.g., lung disease, heart disease, and stroke) that may account for their mortality effects more generally. A sample (N = 6,904) of participants from the Health and Retirement Study, a longitudinal study of older adults, completed personality measures and reported on current health conditions. Four years later, participants were followed up to see if they developed a new disease. Initial cross-sectional analyses replicated past findings that personality traits differ across disease groups. Longitudinal logistic regression analyses predicting new disease diagnosis suggest that traits are associated with the risk of developing disease most notably the traits of conscientiousness, neuroticism, and openness. Findings are discussed as a means to identify pathways between personality and health.
Keywords: Health Conditions and Status; Healthcare

Physical Activity and Mortality Among Middle-Aged and Older Adults in the United States - Wen, Ming; Li, Lifeng; Su, Dejun (Journal of Physical Activity and Health, 2014)
Background: Physical activity (PA) has been routinely linked to lower all-cause mortality, yet extant research in the United States is primarily based on nonrepresentative samples. Evidence is scant on the relative and independent merits of leisure-time (LTPA) versus non-leisure-time (NLTPA) activities and how the PA-mortality link may vary across racial-ethnic-gender groups. Methods: Data were from Health and Retirement Study which began in 1992 collecting data on individuals aged 51-61 years who were subsequently surveyed once every 2 years. The current study assessed group-specific effects of LTPA and NLTPA measured in 1992 on mortality that occurred during the 1992-2008 follow-up period. Cox proportional hazard analyses were performed to examine the PA-mortality link. Results: Net of a wide range of controls, both LTPA and NLTPA showed a gradient negative relation with mortality. No gender-PA interaction effects were evident. Some interaction effects of PA with race-ethnicity were found but they were weak and inconsistent. The mortality reduction effects of PA seemed robust across racial-ethnic-gender groups. Conclusions: Regardless of personal background, PA is a major health promoting factor and should be encouraged in aging populations. More research is needed to assess relative merits of different types and domains of PA.
Keywords: Demographics; Health Conditions and Status; Retirement Planning and Satisfaction; Women and Minorities

Physical activity and personality development across adulthood and old age: Evidence from two longitudinal studies - Yannick Stephan; Angelina R Sutin; Antonio Terracciano (Journal of Research in Personality, 2014)
Personality traits are associated with a number of health-related factors; less is known about how such factors contribute to adult personality development. Based on evidence for the protective role of physical activity for individual functioning, the present study tests whether physical activity contributes to personality stability and change. Using longitudinal data from the Midlife in the United States study (N= 3758) and the Health and Retirement Study (N= 3774), we found that more physically active individuals declined less on conscientiousness, extraversion, openness and agreeableness, and had higher rank-order stability and profile consistency over time. These findings suggest that physical activity may help preserve personality stability and prevent maladaptive personality changes across adulthood and old age. 2013 Elsevier Inc.
Keywords: Event History/Life Cycle; Health Conditions and Status; Methodology

Positive and Negative Social Exchanges and Cognitive Aging in Young-Old Adults: Differential Associations Across Family, Friend, and Spouse Domains - Tim D Windsor; Denis Gerstorf; Pearson, Elissa; Lindsay H Ryan; Kaarin J. Anstey (Psychology and Aging, 2014)
We examined how positive and negative social exchanges with friends, family, and spouses were related to cognitive aging in episodic and working memory, and perceptual speed. To do so, we used a large sample of cognitively intact young-old participants from the PATH Through Life Study ( PATH; aged 60 to 64 years at baseline, n = 1,618) who were assessed on 3 occasions over 8 years. Additional replication analyses were conducted using the Health and Retirement Study (HRS), which provided data on episodic memory. The main analysis of PATH Through Life showed that positive exchanges with friends and family were associated with less decline in perceptual speed, with these associations attenuated by adjustment for physical functioning and depressive symptoms. Negative exchanges with spouses were associated with poorer working memory performance. Positive exchanges with friends were associated with better initial episodic memory in both PATH and HRS. More frequent negative exchanges with friends and family were associated with better episodic memory in the PATH sample. However, these findings were not replicated in HRS. Our findings provide indirect support for the role of social exchange quality in contributing to cognitive enrichment. However, the inconsistent pattern of results across cognitive and social exchange domains points to possibilities of reverse causality, and may also indicate that social exchange quality plays a less important role for cognitive enrichment than other psychosocial characteristics.
Keywords: End of life decisions; Event History/Life Cycle; Health Conditions and Status; Methodology; Other; Retirement Planning and Satisfaction

Positive Psychological Attributes and Retirement Satisfaction - Asebedo, Sarah D.; Martin C. Seay (Journal of Financial Counseling and Planning, 2014)
This study investigated the association between positive psychological attributes and retirement satisfaction using a sample of 5,146 retired individuals from the 2006 and 2008 waves of the Health and Retirement Study (HRS). Utilizing Seligman s (2012) well-being theory, positive psychological attributes, as represented by the acronym PERMA, were measured by dispositional optimism (Positive emotion), reading the newspaper daily and having a hobby (Engagement), family support (Positive relationships), purpose in life and religiosity (Meaning), and perceived mastery (Accomplishment). Significant evidence was found supporting the association between positive psychological attributes and retirement satisfaction. Specifically, results of the ordinal logistic model revealed that, holding all else constant, dispositional optimism, family support, purpose in life, and perceived mastery were each positively associated with retirement satisfaction. Relevant implications for financial planners, counselors and educators include learning and developing optimism, cultivating family relationships, fostering purpose in life, discovering accomplishment during retirement, and structuring a phased transition to retirement.
Keywords: Demographics; Expectations; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

Potentially traumatic events and serious life stressors are prospectively associated with frequency of doctor visits and overnight hospital visits - Katerina A B Gawronski; Eric S Kim; Laura E. Miller (Journal of Psychosomatic Research, 2014)
Objective: Cumulative lifetime exposure to potentially traumatic events and serious life stressors has been linked with both mental and physical health problems; however, less is known about the association between exposure to potentially traumatic events and serious life stressors with health care use. We investigated whether a higher number of potentially traumatic events and serious life stressors were prospectively associated with an increased number of doctor visits and nights spent in the hospital. Methods: Participants were drawn from the Health and Retirement Study, a prospective and nationally representative study of adults aged 50. in the United States (n = 7168). We analyzed the data using a generalized linear model with a gamma distribution and log link. Results: A higher number of potentially traumatic events and serious life stressors were associated with an increased number of doctor visits and nights spent in the hospital. On a 10-point scale, each additional potentially traumatic event or serious life stressor was associated with an 8 increase in doctor visits after controlling for sociodemographic factors (RR = 1.08, 95 CI = 1.06-1.11; p . .001). Each additional potentially traumatic event or serious life stressor was also associated with an 18 increase in the number of nights spent in the hospital after controlling for sociodemographic factors (RR = 1.18, 95 CI = 1.10-1.27; p . .001). Conclusion: Exposure to potentially traumatic events and serious life stressors is associated with increased doctor visits and nights spent in the hospital, which may have important implications for the current standard of care. 2014 Elsevier Inc.
Keywords: Event History/Life Cycle; Health Conditions and Status; Healthcare

Predicting SNAP Participation in Older Adults: Do Age Categorizations Matter? - Geiger, Jennifer R.; Wilks, Scott E.; Livermore, Michelle M. (Educational Gerontology, 2014)
Prior, Supplemental Nutrition Assistance Program (SNAP) research reveals limited age cohort analyses that may not accurately reflect nuanced age differences in SNAP participation. The purpose of this study was to add depth to older age analysis and SNAP participation via four models of age categorizations. This secondary data analysis used a sample of 10,116 older adults from the 2010 Health and Retirement Study. Controlling for demographic, socioeconomic, and physical factors, logistic regression tested four age categorization models: Third-Age and Fourth-Age groupings; young-old, middle-old, and oldest old groupings; generic decade cohorts; and continuous age. Hypotheses for each model predicted older age as negative to SNAP participation. Significant predictors of SNAP participation included female gender, nonwhite non-Hispanic and Hispanic ethnicities, lower household income, inadequate food budget, and difficulty in self-dressing. Odds ratios confirmed age as a negative factor to SNAP participation. Addition of age categorizations into each model yielded nominal, effect size change. Yet, addition of age into the models changed the relationship between control variables and SNAP receipt, namely gender and Hispanic ethnicity. While age categorizations offered marginal effect predicting SNAP participation, difficulty dressing most strongly predicted increased participation across all models. This finding is relevant, as standard SNAP participation models for younger individuals rely heavily on socioeconomic indicators. Results suggest future research modeling SNAP participation in older individuals that emphasizes physical/medical issues.
Keywords: Demographics; Health Conditions and Status; Income; Public Policy

Predictors and Mediators of Long-term Functional Limitations after Injury in the Older Adult Population - Teresa M. Bell (The University of Tennessee Health Science Center, 2014)
With nearly 40 million Americans being treated for nonfatal injuries in emergency departments annually, the burden of nonfatal injury in the United States is extensive. The long-term functional consequences of these injuries can be enduring and far-reaching, especially for older adults. Although studies have reported that persistent functional deficits exist after injury, less information is known about long-term recovery patterns and the factors that influence functional outcomes. The primary aims of this study are to (1) classify differences in long-term, longitudinal changes in functional limitations within the injured population, (2) identify individual characteristics that predict recovery after injury and (3) assess whether medical care use mediates the relationship between long-term changes in functional limitations and significant predictors of outcomes after injury, specifically insurance status. Longitudinal survey data from the Health and Retirement Study (HRS) was analyzed using group-based trajectory modeling and mediation analysis. The trajectory analysis identified five distinct functional trajectories with the following characteristics: Trajectory 1- consistently low functional limitations scores (18.9%), Trajectory 2- increase in functional limitations after injury followed by a gradual, but not complete recovery (46.3%), Trajectory 3- increase in functional limitations followed by further decline in functioning over time (10.5%), Trajectory 4- increase in functional limitations after injury followed by a gradual, complete recovery (13.4%), and Trajectory 5- consistently high functional limitations scores (10.8%). Regression analyses showed that women, individuals with multiple health conditions, and individuals with no insurance and public insurance were more likely to belong to trajectories with poorer functional outcomes. The mediation analysis found that public insurance was associated with increased functional limitations relative to private insurance. The total effect of public insurance on functional limitations was partially mediated by medical care use. Doctor visits was the only significant medical care use mediator for individuals with public insurance. The relative total and direct effects of being uninsured on functional limitations were not significant. However, the indirect effect of being uninsured on functional limitations was significant, indicating that medical care use may suppress the effect of being uninsured on functional outcomes. Prescription drug use was the only significant mediator of the effect of not having insurance on functional status. These results illustrate that distinct courses of recovery after injury in the older adult population exist. Furthermore, personal characteristics of individuals can be used to predict functional trajectories. This study also demonstrated that insurance status is a significant predictor of both functional outcomes and medical care use after injury. Insurance status was found to exert its effect on health outcomes both directly and indirectly through medical care. Ultimately, the findings from this study can be used to improve the understanding of how individuals' functional outcomes differ after injury and the causal processes that determine these outcomes. This knowledge may lead to tailored policies and treatments that improve quality of life after injury.
Keywords: Health Conditions and Status; Healthcare; Other; Public Policy

Predictors of falls among community-dwelling older adults with cancer: results from the health and retirement study - Tuo-Yu Chen; Megan C Janke (Supportive Care in Cancer, 2014)
Cancer symptoms and the side effects of its treatment can increase the risk of falling among older adults with cancer. This study aimed to identify predictors of falling and recurrent falls among community-dwelling older adults with cancer over a 2-year period. Data from the Health and Retirement Study were used (N = 1,630) in this study. The sample had a mean age of 75 years and was mostly female (53 ) and white (89 ). Descriptive analyses, correlation analyses, and logistic regressions were used to analyze the data. The results showed that functional limitations (OR = 1.13, 95 CI = 1.03-1.24), the full-tandem stance (OR = 1.48, 95 CI = 1.01-2.16), and self-reported difficulties with balance (OR = 1.50, 95 CI = 1.23-1.83) at time 1 were significant predictors of falling at time 2. Only difficulties with self-reported balance (OR = 1.84, 95 CI = 1.44-2.36) at time 1 were found to be a predictor of recurrent falls at time 2. The consequences of falling can complicate the course of cancer treatment. Measures of functional limitations and balance have the potential to be quick and useful clinical tools to detect falling among seniors with cancer living in communities.
Keywords: Health Conditions and Status; Risk Taking

Predictors of Long-Term Nursing Home Placement Under Competing Risk: Evidence from the Health and Retirement Study - Castora-Binkley, Melissa; Meng, Hongdao; Hyer, Kathryn (Journal of the American Geriatrics Society, 2014)
Objectives:To examine predictors of long-term nursing home placement (LTNHP) while controlling for mortality as a competing risk event. Design: Longitudinal. Setting: Health and Retirement Study, 1998-2010. Participants: Nationally representative sample of community-living older adults (N=10,385). Measurements: Longitudinal data were used with a maximum follow-up of 12years. First, a traditional Cox proportional hazards model was estimated treating death as an uninformative censoring event. A joint cause-specific hazards model that accounts for the competing risk of mortality in estimating the risk of LTNHP was then estimated. Results: The effect of adjusting for competing risk of mortality is evident for nearly all predictors of LTNHP. Predictors were over- or underestimated in the traditional Cox model, and several predictors changed in the direction of the association, whereas others changed in magnitude. For example, after controlling for mortality, women aged 85 and older had more than twice the risk (hazard ratio=7.23, 95 confidence interval=5.18-10.10) of LTNHP than evidenced in the traditional Cox model. Conclusion: Whenever possible, the competing risk of mortality should be recognized and adjusted in developing screening tools and predictive risk models for LTNHP.
Keywords: Health Conditions and Status; Healthcare; Methodology; Risk Taking

Predictors of Weight Loss in Obese Older Adults: Findings from the USA and the UK - Sarah E Jackson; Rebecca J. Beeken; Wardle, Jane (Obesity Facts, 2014)
Objective: To examine the prevalence and demographic predictors of clinically meaningful weight loss in community samples of obese older adults in the USA and the UK. Methods: Data were from obese older adults (BMI 30 kg/m2; age 52 years), free of a cancer diagnosis, from the Health and Retirement Study (HRS; n = 3398) and the English Longitudinal Study of Ageing (ELSA; n = 998). Weight change was assessed from 2004 to 2008. Multivariable logistic regression tested whether age, sex, ethnicity, marital status, education, or BMI predicted 5 weight loss. Results: Over a quarter (28.7 ) of obese participants from HRS and 16.6 from ELSA lost 5 weight. Being female (odds ratio (OR) = 1.31, 95 confidence interval (CI) = 1.11-1.54) and heavier (BMI 35 kg/m2) (OR = 1.60, 95 CI = 1.37-1.87) predicted weight loss in HRS. Trends were similar in ELSA (female: OR = 1.18, 95 CI = 0.83-1.69; BMI 35 kg/m2: OR = 1.24, 95 CI = 0.85-1.82). ORs were increased in 65-year-olds in HRS (OR = 1.55, 95 CI = 1.33-1.81), and reduced in married people in ELSA (OR = 0.69, 95 CI = 0.48-1.00). Neither education nor ethnicity predicted weight loss in either cohort. Conclusion: A high proportion of obese older adults experience clinically meaningful weight loss, but few demographic variables consistently predict weight loss in this population. 2014 S. Karger GmbH, Freiburg.
Keywords: Adult children; Health Conditions and Status; Women and Minorities

Productivity improvements in hip and knee surgery - Frank A Sloan; Linda K George; Hu, Linyan (Arthritis, 2014)
Productivity improvements that occur as technologies become widely used are not well documented. This study measured secular trends over 1998-2010 in productivity of hip and knee procedures gauged in terms of changes in physical function and pain after versus before surgery. We used data from the Health and Retirement Study. Health outcomes from surgery were measured by 6 physical functioning scales and 2 pain indicators. We used propensity score matching to obtain nonsurgery control groups. Not only were there substantial improvements in physical functioning and pain reduction after receipt of these procedures in all years, but also we documented improvements in health outcomes over time. Largest improvements were for reductions in numbers of Activity and Instrumental Activity of Daily Living limitations for knee procedures.
Keywords: Health Conditions and Status; Healthcare; Other

Racial and Educational Disparities in Mobility Limitation Among Older Women: What Is the Role of Modifiable Risk Factors? - Kenzie Latham (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2014)
Objectives. This research explores whether modifiable risk factors (MRFs) are potential mediators and/or moderators of racial/ethnic and educational mobility limitation disparities among older women.Method. Utilizing Waves 2 9 (1994 2008) of the Health and Retirement Study (HRS), discrete-time event history models with multiple competing events were estimated using multinomial logistic regression.Results. Black women were more likely to develop mobility limitation relative to White women. This disparity was partially mediated by body mass index. Educational disparities were also observed, yet MRFs did not appreciably influence this disparity. The effect of vigorous physical activity on mobility limitation onset varied by race; physical activity was not as protective for Black women compared with White women. Being overweight appeared to weaken the benefit of additional years of education.Discussion. These results reiterate the importance of health promotion via MRFs; however, they also illustrate that the effect of MRFs on mobility limitation varies by race and education among older women, which has implications for health professionals interested in functional health interventions. Future recommendations include the development of interventions and health promotion aimed at increasing participation in positive health behaviors that address salient social factors among at-risk older women.
Keywords: Demographics; Health Conditions and Status; Methodology; Risk Taking

Racial and Ethnic Differences in Obesity and Overweight as Predictors of the Onset of Functional Impairment - Wei, Liang; Bei Wu (Journal of the American Geriatrics Society, 2014)
Objectives To examine racial and ethnic differences in the effects of body mass index (BMI) on the onset of functional impairment over 10 years of follow-up. Design Longitudinal analyses of a cohort from a nationally representative survey of community-dwelling American adults. Setting Six waves (1996 2006) of the Health and Retirement Study (HRS). Participants Two groups of HRS participants aged 50 and older without functional impairment at baseline (1996): 5,884 with no mobility difficulty and 8,484 with no activity of daily living (ADL) difficulty. Measurements Mobility difficulty was a composite measure of difficulty walking several blocks, walking one block, climbing several flights of stairs, and climbing one flight of stairs. ADL difficulty was measured as difficulty in dressing, bathing or showering, eating, and getting in and out of bed without help. The association between baseline BMI and risk of developing functional impairment was estimated using generalized estimating equation models. Results Overweight and obesity were significant predictors of functional impairment. Overweight and obese Hispanics were 41 and 91 more likely, respectively, to develop ADL disability than whites in the same BMI categories. Overweight and severely obese blacks were also more likely than their white counterparts to develop ADL disability. Risk of developing ADL difficulty was higher for Hispanics than for blacks in the obese category. No significant differences in onset of mobility difficulty were found between racial or ethnic groups within any BMI category. Conclusion Blacks and Hispanics were at higher risk than whites of ADL but not mobility impairment. In addition to weight control, prevention efforts should promote exercise to reduce functional impairment, especially for blacks and Hispanics, who are at higher risk.
Keywords: Demographics; Health Conditions and Status

Racial Variations of Parity Status as a Predictor of Disability Onset Among Old-Old Women - Kenzie Latham; Holcomb, Jeanne (Journal of Family Issues, 2014)
This research investigates whether the capacity of parity status to predict disability onset varies by race among older women. Data from the Health and Retirement Study (1998-2008) were used, and a series of discrete-time event-history models were estimated using multinomial logistic regression. Disability onset was constructed from five common activities of daily living measures (i.e., difficulty dressing, bathing, eating, getting in/out of bed, and walking). The initial risk group was old-old women (i.e., born before 1925) without disability in 1998 (N = 2,229). Nulliparous and high-parity Black women born before 1925 were more likely to develop disability onset compared with White women with the same parity status. The results suggest that parity status among Black older women may be a salient risk factor for disability onset.
Keywords: Adult children; Event History/Life Cycle; Health Conditions and Status; Healthcare; Women and Minorities

Racial/ethnic variations in the relation between body mass index and cognitive function among older adults - Bryant, Ami N.; Ford, Katy-Lauren; Kim, Giyeon (The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2014)
OBJECTIVES: The present study examines racial/ethnic variations in the relation between body mass index (BMI) and cognitive function among older adults. DESIGN: Cross-sectional study of secondary data. SETTING: Data were obtained from the 2010 Health and Retirement Study. PARTICIPANTS: Racial/ethnic groups analyzed were black (n = 546), Hispanic (n = 110), and non-Hispanic white (n = 4,104). MEASUREMENTS: BMI was calculated based on self-reported height and weight. Cognitive function was measured based on Telephone Interview for Cognitive Status-Health and Retirement Study version scores. RESULTS: Significant main effects were found for both BMI and race/ethnicity, indicating that cognitive function varies significantly by both. The BMI race/ethnicity interaction was also found to be significant. The interaction revealed that among the white sample cognitive function scores tended to increase as BMI increased whereas the opposite relation was observed in the Hispanic sample. The black sample displayed a similar pattern as the white sample, although a decrease was observed in cognitive function scores once BMI reached obesity. CONCLUSION: The results suggest that the relation between BMI and cognitive function does vary by race ethnicity. Therefore, it can be concluded that high or low BMI may vary as a risk or protective factor for cognitive dysfunction among older adults by race/ethnicity. Implications for research and clinical work are discussed.
Keywords: Demographics; Health Conditions and Status; Women and Minorities

Receipt of Care and Depressive Symptoms in Later Life: The Importance of Self-Perceptions of Aging - Kwak, Minyoung; Ingersoll-Dayton, Berit; Sarah A. Burgard (The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2014)
Objectives. This study examines the extent to which self-perceptions of aging and perceived loss of control explain the relationship between the receipt of care and depressive symptoms among older adults. Methods. The sample consists of individuals aged 51 and older from the 2006, 2008, and 2010 waves of the Health and Retirement Study (n = 5,938). Structural equation modeling was used to test an analytic model that focused on the mediating effects of self-perceptions of aging and perceived loss of control. The respondents demographic and health characteristics and depressive symptoms at baseline were included as control variables. Results. The results indicated that self-perceptions of aging mediated the relationship between receipt of care and depressive symptoms. That is, older adults who received a greater amount of care perceive their aging more negatively, which, in turn, increased depressive symptoms 2 years later. However, perceived loss of control did not significantly mediate the relationship between the receipt of care and depressive symptoms. Discussion. These findings suggest that the receipt of care may make frail older adults more vulnerable to negative self-perceptions of aging.
Keywords: Health Conditions and Status; Healthcare; Other

Recessions, job loss, and mortality among older US adults - Noelke, Clemens; Beckfield, Jason (American journal of public health, 2014)
OBJECTIVES: We analyzed how recessions and job loss jointly shape mortality risks among older US adults. METHODS: We used data for 50 states from the Health and Retirement Study and selected individuals who were employed at ages 45 to 66 years during 1992 to 2011. We assessed whether job loss affects mortality risks, whether recessions moderate the effect of job loss on mortality, and whether individuals who do and do not experience job loss are differentially affected by recessions. RESULTS: Compared with individuals not experiencing job loss, mortality risks among individuals losing their job in a recession were strongly elevated (hazard ratio = 1.6; 95 confidence interval = 1.1, 2.3). Job loss during normal times or booms is not associated with mortality. For employed workers, we found a reduction in mortality risks if local labor market conditions were depressed, but this result was not consistent across different model specifications. CONCLUSIONS: Recessions increase mortality risks among older US adults who experience job loss. Health professionals and policymakers should target resources to this group during recessions. Future research should clarify which health conditions are affected by job loss during recessions and whether access to health care following job loss moderates this relation.
Keywords: Employment and Labor Force; Health Conditions and Status; Public Policy

Reducing the Economic Burden of Work-Related Injuries - McLaren, Christopher F. (The Pardee RAND Graduate School, 2014)
This study examines the effectiveness of employer return to work programs in reducing the average duration of absences from work-related injuries. It finds that workers injured with an employer return to work program in place return to sustained employment approximately 1.38 times sooner after an injury. The biggest reductions in work-injury absence are experienced by men and by workers with a permanent disability. Modifying work equipment is associated with the greatest reductions in injury durations relative to other program components. Back-of-the-envelope calculations indicate that these programs are cost effective for large, self-insured employers. Keywords: workers' compensation, injuries and employee return to work, workplace injuries and employer self-insurance
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology; Public Policy

Relationship between pain and chronic illness among seriously ill older adults: expanding role for palliative social work - Morrissey, Mary Beth; Viola, Deborah; Shi, Qiuhu (Journal of social work in end-of-life and palliative care, 2014)
Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011 ). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed.
Keywords: Health Conditions and Status; Healthcare; Public Policy

A Research Note on the Relationship Between Long Working Hours and Weight Gain for Older Workers in the United States - Murat Anil Mercan (Research on Aging, 2014)
Working long hours may be related to obesity in older adults. No studies have focused on older workers and long work hours, although the risk of obesity is high among this population group. This study is the first attempt to investigate the relationship between obesity and the older workforce. Panel data from the Health and Retirement Study are examined using Cox regression techniques. We found that older workers who work more than 59 hr a week are more likely to gain weight than older workers who work less than 59 hr per week.
Keywords: Employment and Labor Force; Health Conditions and Status; Methodology

Residential Satisfaction, Psychological Well-Being, and Personality Traits: Effects on Relocation among Older Adults - Smith, Erin Kate (University of Kansas, 2014)
The focus of this study is the moves made voluntarily in later life. Older adults who engage in voluntary late life relocation are more likely to be white, have better health, have higher socioeconomic status, and have retired from full-time employment. The amenity move, a type of voluntary late life move, is often made by older adults with the above characteristics to a place specifically for community features such as weather, activities, or housing characteristics. The environmental gerontology literature offers some theoretical insight into understanding how an older adult evaluates their environment and suggests that relocation is one possible outcome when an older adult is not satisfied with the environment. This research highlights a new theoretical model, which proposes how personal characteristics and preferences and environmental characteristics influence an individual's evaluation of the environment. The model postulates that a negative evaluation of the environment can lead to relocation. The current study attempts to understand part of the model by examining how personal characteristics such as demographic information, socioeconomic measures, measures of health, retirement status, and personality impact relocation and more specifically amenity relocation directly and indirectly through the appraisal of the environment (residential satisfaction and psychological well-being). The study utilizes the Health and Retirement Study datasets from 2006-2008 and 2008-2010 to test the model because of its psycho-social measures and questions related to relocation. The results indicate that personality and neighborhood social cohesion directly and indirectly influence the decision to engage in relocation and amenity relocation. Specifically, higher levels of openness to experience are directly predictive of relocation in general and amenity relocation. Conscientiousness, extraversion, agreeableness, and neuroticism also influence the decision to relocate through a mediated relationship with neighborhood social cohesion. The results show that when older adults consider relocation, the social aspects of the environment can be just as important as the environment's physical aspects. Governments and senior housing developers can utilize information from this study to improve communities and develop a better understanding of the relocating older adult.
Keywords: Consumption and Savings; Demographics; Health Conditions and Status; Public Policy; Retirement Planning and Satisfaction

The Role of Spousal Characteristics on the Use of Formal Long-Term Care of Elderly Couples in the United States - Eom, Jinyoung (State University of New York at Stony Brook, 2014)
In the United States, the last decades have witnessed a steady increase in the percent of formal long-term care (nursing home care and paid home health care) uses. Specifically, it is shown that the percent of elderly couples, who use formal long-term care is much lower than that of single-living elderly to use formal long-term care. However, it has not been fully understood what factors determine the use of formal long-term care for elderly couples. Different from the previous studies, I scrutinize not only own individual factors but also spousal characteristics in terms of spouses health conditions, which may determine the use of formal long-term care of elderly couples. Detailed health conditions of spouse are considered; spouse's health dynamics and diagnosed illness by doctors. In addition, I carefully consider two different cases, according to the identity of the principal decision-maker regarding uses of formal long-term care: (i) An individual who needs long-term care decides formal long-term care uses himself/herself, and (ii) the spouse of the individual decides the individual's formal long-term care utilization. Models are estimated using multinomial logit specification using data from the Health and Retirement Study. Results suggest that the age, education level, the individual's health conditions and Activities of Daily Living ("ADL") changes are key factors that strongly affect the decision for utilization of formal long-term care for the elderly couples. When the individual has more disabilities in daily living, or has illnesses such as cancer, diabetes, stroke, psychological problem, or memory problem, he/she is more likely to use formal long-term care. I have also found that the spouse's health conditions, such as Instrumental Activities of Daily Living ("IADL"), ADL, diabetes, cancer or psychological problems affect the formal long-term care of the individual. This study shows that the spouse has an important effect on the individual's decision-making, regardless of who is ultimately in charge of that decision. However, when the group is classified according to `decision maker', the role of the spouse in the decisions regarding the individual's utilization of formal long-term care is more clearly understood.
Keywords: Adult children; Health Conditions and Status; Healthcare; Retirement Planning and Satisfaction

The schooling of offspring and the survival of parents - Esther M Friedman; Robert D. Mare (Demography, 2014)
Contemporary stratification research on developed societies usually views the intergenerational transmission of educational advantage as a one-way effect from parent to child. However, parents' investment in their offspring's schooling may yield significant returns for parents themselves in later life. For instance, well-educated offspring have greater knowledge of health and technology to share with their parents and more financial means to provide for them than do their less-educated counterparts. We use data from the 1992-2006 Health and Retirement Study (HRS) to examine whether adult offspring's educational attainments are associated with parents' survival in the United States. We show that adult offspring's educational attainments have independent effects on their parents' mortality, even after controlling for parents' own socioeconomic resources. This relationship is more pronounced for deaths that are linked to behavioral factors: most notably, chronic lower respiratory disease and lung cancer. Furthermore, at least part of the association between offspring's schooling and parents' survival may be explained by parents' health behaviors, including smoking and physical activity. These findings suggest that one way to influence the health of the elderly is through their offspring. To harness the full value of schooling for health, then, a family and multigenerational perspective is needed.
Keywords: Adult children; Demographics; Health Conditions and Status; Healthcare

Sex differences in the construct overlap of frailty and depression: evidence from the health and retirement study - Matthew C. Lohman; Dumenci, Levent; Briana Mezuk (Journal of the American Geriatrics Society, 2014)
OBJECTIVES: To determine the degree of diagnostic overlap between frailty and depression and to investigate whether sex differences in symptom endorsement influence this overlap. DESIGN: Cross-sectional latent class analysis. SETTING: Data were from the 2008 wave of the Health and Retirement Study, a nationally representative longitudinal survey of health characteristics of older adults. PARTICIPANTS: Community-dwelling adults aged 65 and older completing a general health questionnaire and consenting to physical measurements (N=3,665). MEASUREMENTS: Frailty was measured using criteria developed in the Cardiovascular Health Study, and depressive symptoms were measured using the eight-item Center for Epidemiologic Studies Depression scale. RESULTS: Frailty and depression were best modeled as two distinct but highly correlated constructs with three and four classes of symptom response, respectively. Measurement overlap was high in men and women. Approximately 73 of individuals with severe depressive symptoms and 86 with primarily somatic depressive symptoms were categorized as concurrently frail. The degree of construct overlap between depression and frailty did not significantly vary according to sex, but women were significantly more likely to endorse all frailty and depressive symptoms. CONCLUSION: Measures of depression and frailty identify substantially overlapping populations of older men and women. More-frequent endorsement of depressive symptoms, but not differential endorsement of somatic symptoms, may contribute to the higher prevalence of frailty in women. The symptom of exhaustion is particularly important to the correlation between these two conditions. Findings will inform clinician and researcher efforts to refine the definition of geriatric syndromes such as frailty and to develop effective interventions.
Keywords: Health Conditions and Status; Methodology

Snapshots of Mixtures of Affective Experiences in a Day: Findings from the Health and Retirement Study - Jacqui Smith; Lindsay H Ryan; Tara L Queen; Sandra E Becker; Gonzalez, Richard (Journal of Population Ageing, 2014)
In 2009, a representative subsample of participants in the Health and Retirement Study (HRS: N = 5333; Age 50 101) responded to a short day reconstruction self-administered questionnaire that asked about their time and experiences on seven activities the previous day. We evaluate the quality and reliability of responses to this 10-min measure of experienced well-being and compare the properties and correlates of three intensity-based composites reflecting mixtures of activity-linked affective experiences (Activity-Positive Affect, Activity-Negative Affect, and Net Affect), and a frequency-based index, Activity Affective Complexity, that summarizes the proportion of activities that include a mixture of positive and negative affective experiences regardless of intensity. On average, older adults reported that 36 of the activities in their day provided some mixture of feelings (e.g., interested and frustrated). Regression models revealed differential associations for the four constructs of affective well-being with socio-demographic factors, physical and mental health, and proximal indicators of the day s context. We conclude that the HRS short day reconstruction measure is reliable and discuss the conceptual issues in assessing, summarizing, and interpreting the complexity of emotional experience in older adults.
Keywords: Demographics; Expectations; Health Conditions and Status; Methodology

The social environment, APOE-e4, and dementia: The social environment as a moderating factor among individuals genetically predisposed to develop dementia - Judith L Poey (University of Massachusetts Boston, 2014)
Many studies have shown a relationship between the APOE-e4 allele and dementia, as well as a relationship between the social environment and dementia. However, relatively little investigation into the potential moderating effect of the social environment on the relationship between the APOE-e4 allele and cognitive well-being has been reported. Further, studies that did examine these relationships typically have employed clinical populations, along with regional and non-U.S. samples. This study contributed to the research literature, in part, by using the first U.S. nationally representative sample of older adults that included clinical diagnosis of cognition and dementia (Aging, Demographics, and Memory Study from the Health and Retirement Study). A combination of descriptive analyses and multinomial logistic regression models were used to investigate these relationships. Overall, the prevalence of unique APOE genotypic combinations was similar in the ADAMS sample as compared to samples taken from other developed nations. Descriptive results also showed that respondents with and without the APOE-e4 allele were only found to differ on race and ethnic status. Regression results indicated that the APOE-e4 allele was associated with a higher risk of cognitive difficulty, and that being more socially engaged and more socially connected to others was associated with a lower risk of cognitive difficulty and dementia. All aspects of the social environment, except social engagement, were found to moderate the relationship of the APOE-e4 allele to cognitive diagnosis. The relationship of the social environment to dementia, as well as its moderating influence, indicated a need for further investigation into the unique contributions of the social environment for cognitive well-being in later life.
Keywords: Demographics; Genetics; Health Conditions and Status; Methodology

Social regulatory processes in adulthood : responding to change and variability in proximal and distal social forces - Shannon T. Mejia (Oregon State University, 2014)
Adult development and social experiences are intertwined, which has implications for social policy, health, and well-being across the lifespan. This dissertation explores the benefit and risk that close social partners bring to adults' lives, and the efficacy and consequences of engaging social resources to maintain well-being in the face of variability and change in their proximal and distal social environments. The first study, using a life course perspective and a macro analytic lens, traced experiences of financial loss in middle adulthood during the 2008 recession. Using the 2006 and 2010 waves of the Health and Retirement Study (n = 1,881; age range = 51 - 60 years), this study used conditional change models and path analysis to examine the extent to which increasing household complexity, giving help, receiving help, and relationship quality promoted or hindered the capacity to maintain a sense of control in the face of financial loss. Experiencing financial loss was directly associated with decreased control and giving help, and increased household complexity and receiving help. Experiences of financial loss indirectly decreased control through increased household complexity and decreased giving help. Although the experience of financial loss was distributed across differences in income and education, social resources patterned the engagement of interpersonal resources, which translated to engagement patterns that could compromise the sense of control. However, change in relationship quality, which did not systematically differ across experiences of financial loss, created pathways to support or hinder maintaining a sense of control while engaging interpersonal resources. The second study, informed by lifespan developmental theory and developmental systems theory, applied a micro analytic lens to closely examine the within-person processes that connect daily interactions within the social convoy to emotional well-being in older adulthood. Using data from the Personal Understanding of Life and Social Experiences Project, this study linked older adults' (N = 99; age mean = 63.29, SD = 7.93) satisfaction with their five closest social partners to daily experiences of positive and negative affect across 100 days. Multivariate multilevel models suggest that older adults' daily affect is more sensitive to the quality of daily interactions with closest compared to other social partners. The relative strength of positive and negative affect sensitivity also varied within levels of closeness. Negative affect was relatively more sensitive to interactions with the closest social partner, and positive affect was relatively more sensitive to interactions with other close social partners. This study also found emotional sensitivity to vary within individuals. Satisfying contact with other social partners dampened emotional sensitivity to the closest social partner on that day. These patterns differed across overall levels of contact satisfaction. Those with lower overall satisfaction had higher emotional sensitivity, and were less able to regulate the sensitivity of positive affect. Together, the findings from these studies suggest that: (a) how individuals engage their interpersonal resources in response to loss can facilitate or hinder the maintenance of control and well-being; (b) the strategies that individuals engage vary by the presence or absence of socioeconomic and socioemotional resources; and (c) social partners contribute to both emotional reaction and recovery, but this sensitivity can be up and down regulated by reaching out to other close social partners. Relationships with others therefore contribute to well-being by supporting (or hindering) the regulation of self, actions, and emotions. Regulation through close interpersonal ties illustrates a process that links developmental and life course trajectories.
Keywords: Health Conditions and Status; Net Worth and Assets; Public Policy

Social support, social strain, loneliness, and well-being among older adults: An analysis of the Health and Retirement Study - Chen, Yixin; Feeley, Thomas Hugh (Journal of Social and Personal Relationships, 2014)
This study proposed that, among older adults, higher support and lower strain received from each of the four relational sources (spouse/partner, children, family, and friends) were associated with reduced loneliness and improved well-being and that loneliness might mediate the relationship between support/strain and well-being. Structural equation modeling was conducted using a national sample of adults aged 50 years and older (N=7,367) from the Health and Retirement Study. Findings indicated that support from spouse/partner and friends alleviated loneliness, while strain from all the four sources intensified loneliness; higher support and lower strain from various sources directly and indirectly improved well-being, with indirect effects mediated through reduced loneliness. It was concluded that, in later life, various sources of support/strain engender distinct effects on loneliness and well-being, and loneliness serves as one of the psychological pathways linking support/strain to well-being.
Keywords: Adult children; Health Conditions and Status; Other

Socioeconomic inequalities in health after age 50: Are health risk behaviors to blame? - Benjamin A Shaw; McGeever, Kelly; Elizabeth Vasquez; Agahi, Neda; Fors, Stefan (Social Science and Medicine, 2014)
Recent studies indicate that socioeconomic inequalities in health extend into the elderly population, even within the most highly developed welfare states. One potential explanation for socioeconomic inequalities in health focuses on the role of health behaviors, but little is known about the degree to which health behaviors account for health inequalities among older adults, in particular. Using data from the Health and Retirement Study (N = 19,245), this study examined the degree to which four behavioral risk factors smoking, obesity, physical inactivity, and heavy drinking are associated with socioeconomic position among adults aged 51 and older, and whether these behaviors mediate socioeconomic differences in mortality, and the onset of disability among those who were disability-free at baseline, over a 10-year period from 1998 to 2008. Results indicate that the odds of both smoking and physical inactivity are higher among persons with lower wealth, with similar stratification in obesity, but primarily among women. The odds of heavy drinking decrease at lower levels of wealth. Significant socioeconomic inequalities in mortality and disability onset are apparent among older men and women; however, the role that health behaviors play in accounting for these inequalities differs by age and gender. For example, these health behaviors account for between 23 and 45 of the mortality disparities among men and middle aged women, but only about 5 of the disparities found among women over 65 years. Meanwhile, these health behaviors appear to account for about 33 of the disparities in disability onset found among women survivors, and about 9-14 among men survivors. These findings suggest that within the U.S. elderly population, behavioral risks such as smoking and physical inactivity contribute moderately to maintaining socioeconomic inequalities in health. As such, promoting healthier lifestyles among the socioeconomically disadvantaged older adults should help to reduce later life health inequalities. (C) 2013 Elsevier Ltd. All rights reserved.
Keywords: Demographics; Disabilities; Health Conditions and Status; Other

Spousal social support and strain: impacts on health in older couples. - Lindsay H Ryan; Wylie H Wan; Jacqui Smith (Journal of Behavioral Medicine, 2014)
Using a nationally representative sample of couples aged 51+ in the United States (N = 1,923 couples), the current study investigated whether both partners' perceptions of relationship support and strain are associated with an individual's self-rated health and functional limitations. The sample had an average age of 67.17 years (SD = 9.0; range 50-97). Actor-Partner Interdependence Models adjusting for couple interdependencies were applied using multilevel models. After accounting for age, education, gender, race, and couple differences in length of marriage, results indicate that individual perceptions of support were significantly associated with higher self-rated health and fewer functional limitations. These individual-level benefits increased if the spouse also perceived positive support and low strain. Finally, the negative association of an individual's perceived support on functional limitations was greater in those with a spouse reporting low levels of perceived strain. Findings are discussed relative to theory on behavioral and psychological pathways between partners' perceptions of support and health.
Keywords: Health Conditions and Status; Marriage; Older Adults; Social Support; Stress

Subjective Socioeconomic Status in Daily Cognitive Functioning and Cognitive Aging - Zavala, Catalina (University of California, Riverside, 2014)
The primary purpose of this dissertation is to investigate to what extent objective and subjective socioeconomic status (SES) provide unique information regarding the impact of SES on cognitive aging trajectories, as well as daily individual variability and plasticity in cognitive functioning. For Study 1, two large samples were drawn from publically available data in the Health and Retirement Study (HRS) to examine cross-sectional performance on episodic memory and fluid reasoning tasks, and longitudinal change in general cognitive functioning across 6 years. Analyses of the cross-sectional sample indicated that subjective SES positively predicted performance on episodic memory and fluid reasoning tasks above and beyond the effect of objective SES. For both cognitive tasks, objective SES remained a significant predictor of cognitive performance after controlling for physical and mental health, but subjective SES was no longer a significant predictor. In the longitudinal sample, growth curve analyses suggested a small positive effect of increasing subjective SES to level of overall cognitive functioning beginning at around age 68, though this boost waned by age 90. This effect was maintained even while controlling for objective SES, BMI, self-rated health, and depressive symptoms. For Study 2, cognitive functioning across episodic memory and fluid reasoning domains were examined in a sample of 45 older adults who completed an initial baseline questionnaire including assessment of objective and subjective SES, and a 7-day `burst' repeated-measures design including cognitive tasks self-administered once a day. Overall, findings suggested that intraindividual variance in cognitive functioning across seven days was inversely related to overall mean performance for both episodic memory and fluid reasoning, such that individuals who showed more variability in performance tended to perform lower on cognitive tasks. Additionally, findings suggested that intraindividual variance in cognitive functioning is likely associated with both objective and subjective SES, though a number of the observed associations did not reach statistical significance. Collectively, these results suggest that an individual's perceptions of their SES may have fundamental impacts on later cognitive outcomes or, alternatively, that individuals may be able to provide a unique insight regarding their SES as not fully assessed by commonly used SES indicators.
Keywords: Demographics; Employment and Labor Force; Expectations; Health Conditions and Status; Healthcare